LS 15 Phelan Final Exam Questions with 100% Correct Answers Verified Updated 2024

What is normal range for cholesterol, HDL, LDL CORRECT ANSWER Less than 200, above 40, less than 130 What is the desired INR range for people taking warfarin CORRECT ANSWER 2.0-3.0 What is an indicator of cardiac tamponade CORRECT ANSWER Blood pressure is 10 MM HG or higher on expiration then on inspiration Patients scheduled for a coronary artery bypass graft should not take anticoagulants for at least blank prior to the surgery to prevent excessive bleeding CORRECT ANSWER A week A patient is admitted with a diagnosis of Bradydysrhythmia. What assessment finding requires immediate intervention? CORRECT ANSWER The patient reports weakness and fatigue Following insertion of a permanent pacemaker, a patient states they cannot get rid of these hiccups. Why is this potentially a problem? CORRECT ANSWER Hiccups may indicate that the pacemaker is stimulating the chest wall or diaphragm. This could indicate a complication such as lead wire perforation Chapter 27 - CORRECT ANSWER What is the normal range for creatine kinase? When are elevated levels first detectable after myocardial injury and what is expected duration of the elevated levels? CORRECT ANSWER 30 to 170 units/L, 4 to 6 hours, 3 days What is the normal range for troponin T? When are elevated levels first detectable after myocardial injury and what is expected duration of the elevated levels? CORRECT ANSWER Less than 0.2 ng/L, 3 to 5 hours, 14 to 21 days What is normal range for troponin I? When are elevated levels first detectable after myocardial injury and what is expected duration of the elevated levels? - CORRECT ANSWER Less than 0.03, three hours, 7 to 10 days What is normal range for myoglobin? When are elevated levels first detectable after myocardial injury and what is expected duration of the elevated levels? - CORRECT ANSWER Less than 90 mcg/L, two hours, 24 hours While an echocardiogram is being performed what side should the patient lie on? - CORRECT ANSWER Left side and remain still What are indications for an echocardiogram - CORRECT ANSWER Cardiomyopathy Heart failure Angina Myocardial infarction What are indications for stress test - CORRECT ANSWER Dysrhythmias HF Angina MI What are two medications that are prescribed for pharmacological stress test - CORRECT ANSWER Dobutamine Adenosine What do you instruct the patient to do 2 to 4 hours before a stress test - CORRECT ANSWER Avoid tobacco, alcohol and caffeine Hemodynamic monitoring involves special indwelling catheters that provide information about blood volume and perfusion, fluid status and how well the heart is pumping. Arterial lines are placed in the radial (most common), brachial or femoral artery. What should you Monitor for? - CORRECT ANSWER Monitor circulation in the limb with the arterial line. Such as capillary refill, temperature, color. Arterial lines are not used for IV fluid administration The pulmonary artery (PA) catheter is inserted into a large vein (internal jugular, femoral, subclavian, brachial) and threaded through the right atria and ventricles into a branch of the pulmonary artery. PA catheters have multiple lumens, ports and components that allow for various hemodynamic measurements, blood sampling and - CORRECT ANSWER Infusion of IV fluids What are the different lumens used for? - CORRECT ANSWER What is the expected reference range for CVP (Central venous pressure) - CORRECT ANSWER 1 to 8 MM HG What is the expected reference range for pulmonary artery systolic (PAS) - CORRECT ANSWER 15 to 26 What is the expected range for pulmonary artery diastolic (PAD) - CORRECT ANSWER 5 to 15 What is expected range for pulmonary artery wedge pressure (PAWP)? - CORRECT ANSWER 4 to 12 What is the expected range for cardiac output - CORRECT ANSWER 4 to 7 L/minute What is expected range for mixed venous oxygen saturation - CORRECT ANSWER 60% to 80% When should a nurse anticipate lower hemodynamic values? - CORRECT ANSWER In older patients especially if dehydration is a complication What position should the patient be in with hemodynamic monitoring - CORRECT ANSWER Supine or Trendelenburg What are post procedure nursing interventions for hemodynamic monitoring - CORRECT ANSWER 1. Obtain chest x-ray to confirm catheter placement Continually monitor vitals Compare NIBP to arterial blood pressure Observe and document waveforms. Report changes in waveforms to the provider Document catheter placement each shift and as needed Place the patient in supine position prior to recording hemodynamic values ( HOB can be elevated 15° to 30°) What are complications of hemodynamic monitoring - CORRECT ANSWER What are nursing actions preprocedure before an angiography - CORRECT ANSWER 1. Patient is NPO for at least eight hours before Assess for iodine/shellfish allergy Assess renal function Teach the client that the affected leg must remain straight after the procedure The other normal stuff like ensure informed consent blah blah What are post procedure nursing interventions for an angiography - CORRECT ANSWER 1. Assess vitals every 15 minutes for One hour, every 30 minutes for one hour, every hour for four hours and then every four hours Assess the site for bleeding and hematoma with every vital sign check Maintain bed rest for 4 to 6 hours after the procedure Monitor urine output and administer IV fluids for hydration (contrast media acts as an osmotic diuretic) How long do patients receive anticoagulation therapy that have stent placement - CORRECT ANSWER 6 to 8 weeks What is cardiac tamponade - CORRECT ANSWER Fluid accumulation in the pericardial sac What are manifestations of cardiac tamponade - CORRECT ANSWER hypotension JVD Muffled heart sounds Paradoxical pulse What are nursing actions for cardiac tamponade - CORRECT ANSWER 1. Notify the provider immediately Administer IV fluids to combat hypotension as prescribed Obtain a chest x-ray or echocardiogram to confirm diagnosis Prepare the client for pericardiocentesis What is retroperitoneal bleeding - CORRECT ANSWER Bleeding into the abdominal cavity behind the peritoneum can occur due to femoral artery puncture (after an angiography) What are nursing actions for retroperitoneal bleeding - CORRECT ANSWER 1. Assess for flank pain and hypotension Notify the provider immediately Administer IV fluids and blood products as prescribed What are central catheter's appropriate for - CORRECT ANSWER Any fluids due to rapid hemodilution in the superior vena cava What is post procedure care for a PICC - CORRECT ANSWER What should you do if there's an occlusion in the access device that impedes flow - CORRECT ANSWER 1. Flush the line at least every 12 hours to maintain patency (3 mL for peripheral & 10 mL for central lines) Administer urokinase to lyse obstructions per facility protocol Flush implanted port after every use and at least once a month while implanted What are nursing actions for a catheter thrombosis/emboli - CORRECT ANSWER 1. Flush the line per facility protocol Do not force fluid if resistance is encountered Use a 10 mL or larger syringe to avoid excessive pressure What is treatment for infiltration and extravasation - CORRECT ANSWER 1. Remove using direct pressure with gauze sponge until bleeding stops Apply cool compress Elevation is optional Avoid starting a new IV site in the same extremity What are nursing interventions to prevent an air embolism in a vascular access device - CORRECT ANSWER 1. Leave central lines clamped when not in use Have the patient hold breath while the tubing is changed If the patient has sudden SOB, place in Trendelenburg on left side, give oxygen and notify the provider What are nursing interventions to prevent accidental dislodgment of a catheter - CORRECT ANSWER 1. Cover the extremity site with stretch netting Wrap a washcloth folded into thirds around the arm before applying a needed restraint When removing the dressing, pull from distal to proximal Hemodynamic pressure lines should be calibrated to read atmospheric pressure as blank. - CORRECT ANSWER Zero. Zero transducer to room air What kind of medication would you use for vasodilation secondary to sepsis - CORRECT ANSWER Dopamine (vasopressors) Chapter 28 - CORRECT ANSWER What are medications/electrical management for bradycardia - CORRECT ANSWER 1. Atropine and isoproterenol (antiarrhythmic and bronchodilator) 2. Pacemaker What are medications/electrical management for a fib, SVT or VT with pulse - CORRECT ANSWER 1. Amiodarone, adenosine, verapamil (CCB) 2. Synchronized cardioversion What are medications/electrical management for VT without a pulse or ventricular fibrillation - CORRECT ANSWER 1. Amiodarone, lidocaine and epinephrine 2. Defibrillation What is cardioversion - CORRECT ANSWER Delivery of a direct countershock to the heart synchronized to the QRS complex What is defibrillation - CORRECT ANSWER Delivery of an unsynchronized, direct countershock to the heart. Stops all electrical activity of the heart, allowing the SA node to take over and reestablish a perfusing rhythm What is held 48 hours prior to elective cardioversion - CORRECT ANSWER Digoxin What is indicative of an MI - CORRECT ANSWER Chest pain and ST segment depression or elevation Chapter 30 - CORRECT ANSWER What is an arthrectomy - CORRECT ANSWER Used to break up and remove plaques within cardiac vessels What is a stent - CORRECT ANSWER Placement of a mesh wire device to hold an artery open and prevent restenosis What is a percutaneous transluminal coronary angioplasty - CORRECT ANSWER Involves inflating a balloon to dilate the arterial lumen and the adhering plaque, therefore widening the arterial lumen What are indications for a PCI (angioplasty) - CORRECT ANSWER What are preprocedure nursing actions for a PCI (besides allergies, informed consent, blah blah) - CORRECT ANSWER 1. NPO at least eight hours if possible Assess renal function prior to introduction of contrast dye Administer antiplatelet medications as prescribed What are two medications that are administered during the intraprocedure for PCI - CORRECT ANSWER Midazolam (Versed) and fentanyl What is post procedure nursing actions after a PCI - CORRECT ANSWER 1. Assess vitals every 15 minutes for one hour, every 30 minutes for one hour, every hour for four hours and then every four hours. Assess the groin site at the same intervals for bleeding and hematoma formation Assess for signs of thrombosis Maintain bed rest in a supine position with the leg straight for 4 to 6 hours ( or prescribed time) Monitor urine output How long does a client with a stent replacement receive anticoagulation therapy - CORRECT ANSWER 6 to 8 weeks after Perforation of an artery by the catheter may cause blank - CORRECT ANSWER Cardiac tamponade What are clinical manifestations of anaphylaxis - CORRECT ANSWER chills Fever Rash Wheezing Tachycardia Bradycardia What are two medications that might be prescribed in the event of anaphylaxis - CORRECT ANSWER Diphenhydramine or epinephrine A coronary artery bypass graft is most effective when a patient has sufficient ventricular function such as an EF greater then - CORRECT ANSWER 40% to 50% What are preprocedure medications for a CABG - CORRECT ANSWER 1. Anxiolytics: lorazepam and diazepam Prophylactic antibiotics Anticholinergic such as scopolamine What are some important preprocedure teachings for a patient that is going to undergo a CABG CORRECT ANSWER 1. Endotracheal tube and mechanical ventilator for airway management for several hours following the surgery Inability to talk while endotracheal tube is in place Sternal incision and possible leg incision 1 to 2 mediastinal chest tubes Indwelling urinary catheter Pacemaker wires Hemodynamic monitoring devices What are two medications that are discontinued before a CABG - CORRECT ANSWER 1. Diuretics 2 to 3 days before surgery 2. Aspirin and other anticoagulants one week before surgery What are medications that are often continued for CABG - CORRECT ANSWER Potassium supplements Antidysrhythmic's Antihypertensives Insulin Post procedure: what should you do with the patient within two hours following extubation - CORRECT ANSWER Dangle and turn the client from side to side as tolerated What should you do within 24 hours after CABG - CORRECT ANSWER Assist the patient to a chair. Ambulate the patient 25 to 100 feet by first postoperative day How often should you assess neurological status after CABG - CORRECT ANSWER Every 30 to 60 minutes until the client awakens from anesthesia, then every 2 to 4 hours or per facility policy Monitor chest tube patency and drainage. Measure drainage at least once an hour. Volume exceeding blank could be a sign of possible hemorrhage and should be reported to the surgeon CORRECT ANSWER 150 mL/hour What kind of manifestations of pain might an older female patient show instead of chest pain - CORRECT ANSWER Dyspnea, indigestion What is a heart healthy diet - CORRECT ANSWER Low-fat, low cholesterol, high-fiber, low-salt What should the patient's activity level be after a CABG - CORRECT ANSWER What can hypothermia cause - CORRECT ANSWER Vasoconstriction, metabolic acidosis and hypertension What are indications of cardiac tamponade after a CABG - CORRECT ANSWER 1. Sudden decrease of chest tube drainage following heavy drainage JVD with clear lung sounds Equal PAWP & CVP values Treatment of cardiac tamponade after a CABG involves - CORRECT ANSWER 1. Volume expansion 2. Emergency sternotomy (Pericardiocentesis is avoided because blood may have clotted) What is maximum potassium administration rate IV - CORRECT ANSWER 10 to 20 mEq/hour How long should a patient remain NPO before a peripheral bypass graft - CORRECT ANSWER Eight hours What are two client education points for a peripheral bypass graft - CORRECT ANSWER 1. Advise the patient not to cross legs 2. Explain that pedal pulses will be checked frequently What are post procedure nursing interventions for a peripheral bypass graft - CORRECT ANSWER 1. Assess vitals every 15 minutes for one hour and then every hour after the first hour Administer anticoagulant therapy/antiplatelet therapy Maintain bed rest for 18 to 24 hours. The leg should be kept straight during this time What are teaching points for foot inspection and care - CORRECT ANSWER The graft may occlude due to reduced blood flow and clot formation. This occurs primarily in the first - CORRECT ANSWER 24 hours post operative What kind of procedure is used for graft occlusion - CORRECT ANSWER Thrombectomy or thrombolytic therapy What procedure is used for compartment syndrome - CORRECT ANSWER Fasciotomy Chapter 35 - CORRECT ANSWER What are physical assessment findings for peripheral artery disease - CORRECT ANSWER 1. Bruit over femoral and aortic artery's Decreased capillary refill of toes Decreased or non-palpable pulses Loss hair on lower calf, ankle and foot Dry, scaly, mottled skin Thick toenails Cold/cyanotic extremity Pallor of extremity with elevation Dependent Rubor Muscle atrophy Ulcers and possible gangrene What are nursing actions for arteriography - CORRECT ANSWER 1. Observe for bleeding and hemorrhage 2. Palpate pedal pulses to identify possible occlusions How does a plethysmography diagnose PAD - CORRECT ANSWER A decrease in pulse pressure of the lower extremity indicates a possible blockage in the leg A Doppler probe is used to take various blood pressure measurements for comparison. In the absence of peripheral arterial disease, pressures in the lower extremities are - CORRECT ANSWER Higher than those in the upper extremities What is nursing care for a patient with PAD - CORRECT ANSWER 1. Encourage collateral circulation Avoid crossing legs Avoid restrictive garments Elevate the leg to reduce swelling, but not to elevate them about the level of the heart Provide a warm environment Avoid exposure to cold Avoid stress, caffeine and nicotine and anything that causes vasoconstriction What are medications for PAD - CORRECT ANSWER 1. Antiplatelet medications - aspirin, Plavix, trental 2. Statins - can relieve manifestations associated with PAD such as intermittent claudication What are two surgical procedures for PAD - CORRECT ANSWER 1. Percutaneous transluminal angioplasty 2. Laser assisted angioplasty What are nursing interventions for these two procedures - CORRECT ANSWER 1. Observe for bleeding/vitals Keep client on bed rest with limb straight for 6 to 8 hours before ambulation Antiplatelet therapy for 1 to 3 months What is arterial revascularization surgery used for - CORRECT ANSWER Patients who have severe claudication and/or limb pain at rest, or patients who are at risk for losing a limb due to poor arterial circulation What are nursing actions for arterial revascularization surgery - CORRECT ANSWER 1. Maintain adequate circulation in the repaired artery. The location of the pedal or dorsalis pulse should be marked and its strength compared with the contralateral leg on a scheduled basis using a Doppler Assess color, temperature, sensation and capillary refill compared with the contralateral extremity on a scheduled basis Monitor BP!!!! No bending of the hip and knee One complication of graft is compartment syndrome what are manifestations of it - CORRECT ANSWER Tingling Numbness Worsening pain Edema Pain on passive movement Unequal pulses (prepare patient for Fasciotomy) What are risk factors for peripheral venous disease - CORRECT ANSWER 1. Venus thromboembolism associated with Virchow triad Hip surgery, total knee replacement, open prostate surgery Heart failure Immobility Pregnancy Oral contraceptives Family history