NUR 445 Exam 2 UPDATED Questions and CORRECT
Answers
- Measures: volume of blood returning to the right ventricle at the end of diastole
Central Venous Pressure (CVP): what is it (filling); measures preload
measuring? normal range? how to treat - Range: 2-6
high or low CVP? - Low: give fluids and/or vasopressor (levophed, dobutamine)
- High: diuretics (furosemide)
- When it is symptomatic (chest pain, dizziness, syncope)
When is bradycardia treated? How is it
- Start with atropine, treat cause if possible (hypoxia or hypothermia), then
treated?
norepinephrine, then pacemaker
* Not primary treatment for anything!!!*
What are some uses of digoxin? MOA? - Uses: sinus tachycardia, atrial fibrillation, atrial flutter, heart failure
- MOA: inotropic action increases contractility to improve cardiac output
- s/s: visual disturbances (yellow halos), anorexia, low HR/BP
What are the s/s of digoxin toxicity?
- cause: hypokalemia
electrolyte cause? treatment?
- Tx: Digoxin immune fab
What are administration considerations for check apical pulse and K+ prior to administration
Digoxin?
What type of cholesterol increases the risk High LDL cholesterol can cause atherosclerosis and increase risk for blood clots
for heart disease? ** fiber can help reduce LDL cholesterol by binding to in the intestines
What are the s/s of right sided heart dependent edema (lower extremities), ascites, weight gain, Jugular vein distention
failure?
paroxysmal nocturnal dyspnea, elevated pulmonary capillary wedge pressure,
orthopnea, exertional dyspnea, persistent cough, blood tinged sputum,
What are the s/s of left sided heart failure?
crackles/rales, tachypnea, sudden weight gain, confusion due to decreased
perfusion, tachycardia, cyanosis.
How does nicotine affect the blood causes vasoconstriction which increases afterload, decreasing cardiac output, and
vessels? increasing workload on the heart
, What is the difference between stable and stable angina is relieved by nitro tablet administration and rest
unstable angina? unstable angina is not relieved by nitro and rest
- flat bed rest for 2-6 hours
- watch insertion site for hematoma or bleeding
- monitor vitals and continuous cardiac monitoring
What are nursing considerations after
- monitor for chest pain, stroke (confusion, weakness, slurred speech), 5 Ps of
cardiac catheterization?
peripheral extremities, urine output, fluid intake
- monitor renal blood work, H&H, and coagulation studies
- anti-platelet meds may be given to prevent adverse event of thrombotic events
- s/s: Chest pain not relieved by rest, shoulder and arm pain (more often on the left
What are some traditional s/s of MI? who but can be either side), jaw pain, shoulder blade pain, SOB, n/v, diaphoresis
may not have these s/s? - older women: abnormal pain, shoulder blade, jaw pain, abd pain
- diabetic patients: main symptom is SOB
Continuous blood pressure monitoring
What can be assessed from an arterial line?
ABG samples
- arterial lines should be placed farthest down the
limb as possible in case it needs to be replaced,
then the same artery can be used in a higher
location
- the pulse ox can be placed on the same side as
What are nursing considerations for an
the ART line
arterial line?
- allen test prior to art line placement to test if
ulnar artery provides sufficient blood supply if
radial artery is occluded
- after placement need to zero and calibrate line
- check for good waveform on BP monitor
remove dressings
remove catheter and hold pressure on site for 3-5 minutes
How should a nurse remove an art line? if pt on anticoagulants, hold pressure for 10 minutes
apply pressure dressing
monitor site
- Troponin: elevates within 4 hrs of injury, stays elevated for 10 days, best blood test
to diagnostic for acute MI
- EKG: Gold standard MI diagnostic (ST elevation and presence of Q waves)
- Creatine kinase MB (CK-MB): marker specific to myocardial tissue damage, elevates
at 3 hours and stays high for 36 hours
What tests are done if a patient comes into
- BNP: protein released by overstretched ventricular tissue, used to diagnose HF and
the ED with chest pain? important info
cardiomyopathy
about each?
- Echocardiogram: can visualize ejection, ventricular function, cardiac muscle
movement/contractility, and wall movement
- Stress test: exercise or meds (atropine) used to stress the heart while monitoring
with EKG and Echo, nuclear stress test (using contrast) is best for visualizing blood
flow to the heart muscles (myocardial ischemia); only 1x/day
What is the complication of MI? cardiogenic shock
Answers
- Measures: volume of blood returning to the right ventricle at the end of diastole
Central Venous Pressure (CVP): what is it (filling); measures preload
measuring? normal range? how to treat - Range: 2-6
high or low CVP? - Low: give fluids and/or vasopressor (levophed, dobutamine)
- High: diuretics (furosemide)
- When it is symptomatic (chest pain, dizziness, syncope)
When is bradycardia treated? How is it
- Start with atropine, treat cause if possible (hypoxia or hypothermia), then
treated?
norepinephrine, then pacemaker
* Not primary treatment for anything!!!*
What are some uses of digoxin? MOA? - Uses: sinus tachycardia, atrial fibrillation, atrial flutter, heart failure
- MOA: inotropic action increases contractility to improve cardiac output
- s/s: visual disturbances (yellow halos), anorexia, low HR/BP
What are the s/s of digoxin toxicity?
- cause: hypokalemia
electrolyte cause? treatment?
- Tx: Digoxin immune fab
What are administration considerations for check apical pulse and K+ prior to administration
Digoxin?
What type of cholesterol increases the risk High LDL cholesterol can cause atherosclerosis and increase risk for blood clots
for heart disease? ** fiber can help reduce LDL cholesterol by binding to in the intestines
What are the s/s of right sided heart dependent edema (lower extremities), ascites, weight gain, Jugular vein distention
failure?
paroxysmal nocturnal dyspnea, elevated pulmonary capillary wedge pressure,
orthopnea, exertional dyspnea, persistent cough, blood tinged sputum,
What are the s/s of left sided heart failure?
crackles/rales, tachypnea, sudden weight gain, confusion due to decreased
perfusion, tachycardia, cyanosis.
How does nicotine affect the blood causes vasoconstriction which increases afterload, decreasing cardiac output, and
vessels? increasing workload on the heart
, What is the difference between stable and stable angina is relieved by nitro tablet administration and rest
unstable angina? unstable angina is not relieved by nitro and rest
- flat bed rest for 2-6 hours
- watch insertion site for hematoma or bleeding
- monitor vitals and continuous cardiac monitoring
What are nursing considerations after
- monitor for chest pain, stroke (confusion, weakness, slurred speech), 5 Ps of
cardiac catheterization?
peripheral extremities, urine output, fluid intake
- monitor renal blood work, H&H, and coagulation studies
- anti-platelet meds may be given to prevent adverse event of thrombotic events
- s/s: Chest pain not relieved by rest, shoulder and arm pain (more often on the left
What are some traditional s/s of MI? who but can be either side), jaw pain, shoulder blade pain, SOB, n/v, diaphoresis
may not have these s/s? - older women: abnormal pain, shoulder blade, jaw pain, abd pain
- diabetic patients: main symptom is SOB
Continuous blood pressure monitoring
What can be assessed from an arterial line?
ABG samples
- arterial lines should be placed farthest down the
limb as possible in case it needs to be replaced,
then the same artery can be used in a higher
location
- the pulse ox can be placed on the same side as
What are nursing considerations for an
the ART line
arterial line?
- allen test prior to art line placement to test if
ulnar artery provides sufficient blood supply if
radial artery is occluded
- after placement need to zero and calibrate line
- check for good waveform on BP monitor
remove dressings
remove catheter and hold pressure on site for 3-5 minutes
How should a nurse remove an art line? if pt on anticoagulants, hold pressure for 10 minutes
apply pressure dressing
monitor site
- Troponin: elevates within 4 hrs of injury, stays elevated for 10 days, best blood test
to diagnostic for acute MI
- EKG: Gold standard MI diagnostic (ST elevation and presence of Q waves)
- Creatine kinase MB (CK-MB): marker specific to myocardial tissue damage, elevates
at 3 hours and stays high for 36 hours
What tests are done if a patient comes into
- BNP: protein released by overstretched ventricular tissue, used to diagnose HF and
the ED with chest pain? important info
cardiomyopathy
about each?
- Echocardiogram: can visualize ejection, ventricular function, cardiac muscle
movement/contractility, and wall movement
- Stress test: exercise or meds (atropine) used to stress the heart while monitoring
with EKG and Echo, nuclear stress test (using contrast) is best for visualizing blood
flow to the heart muscles (myocardial ischemia); only 1x/day
What is the complication of MI? cardiogenic shock
