NUR 445 FINAL EXAM COMPREHENSIVE REVIEW GUIDE WITH
COMPLETE 120 PRACTICE QUESTIONS AND DETAILED ANSWERS
What medication is used to decrease ICP?
Mannitol
-osmotic diuretic
-reduces ICP by inducing diuresis (creates an osmotic gradient across the blood-brain
barrier [BBB] and increased serum osmolality -> pulls fluid out of brain cells and shifts it
into the intravascular compartment)
What medication would you plan on administering to a patient who is
experiencing bradycardia or heart block?
Atropine
-administer over 1 minute
-therapeutic effect desired = increased HR
-rapid administration may be used during cardiac resuscitation (follow with 20 mL saline
flush)
A patient suffering from a hypertensive crisis enters the ED. What medication is
used to treat this emergent situation?
Nitroprusside
-arteriole vasodilator
-rapidly lowers BP
-decreases preload and afterload
What is clonidine used for?
lowering of BP
Nitroprusside is the preferred agent if BP needs to be lowered quickly
What are the s/sx of 1st degree heart block?
dyspnea, malaise, lightheadedness, chest pain, syncope
usually NSR, P waves are normal and precede each QRS, prolonged PRI (>0.20 sec)
What is the treatment for 1st degree heart block?
generally, none
monitor
What are the s/sx of 2nd degree heart block Mobitz I (Wenckebach)?
most don't experience symptoms
if they do, usually is lightheadedness and dizziness
irregular heart rhythm, rate may vary, normal P waves, progressive lengthening of PRI,
some P waves not followed by QRS, usually normal QRS
What is the treatment for 2nd degree heart block Mobitz I?
Generally, no treatment necessary
Treat underlying cause, monitor, possibly pace
What are the s/sx of 2nd degree heart block Mobitz II?
, Fatigue, dyspnea, chest pain, presyncope, syncope, sudden cardiac arrest
irregular rhythm, varying rate, normal size and shape of P waves, some P waves not
followed by QRS, normal or prolonged PRI BUT always constant for conducted beats,
usually normal QRS but absent at times, atria/junction is still telling ventricle what to do
What is the treatment for 2nd degree Mobitz II?
O2 if needed, may need pacing, correct underlying cause
What are the s/sx of 3rd degree heart block (complete)?
light-headedness, dizziness, fainting, fatigue, chest pain, bradycardia
ventricles fire own impulse (wide and wacky), atrial and ventricular rates are
independently regular, atrial rate = 60-100, ventricular rate = 20-40, p waves are normal
but not related to QRS, no PRI due to dissociation, QRS depends on level of escape
rhythm
What is the treatment for 3rd degree heart block?
Call for help
CPR/ACLS as needed
O2
Pacing
What is cardiac tamponade?
accumulation of blood/fluid around pericardial space
What is a characteristic sign of cardiac tamponade?
Pulsus paradoxus
-Patient takes a deep breath in and SBP drops > 10 mmHg
Beck's Triad
-Muffled heart sounds
-JVD
-Hypotension
How do we diagnose cardiogenic shock?
SBP of <90 for 30 min
Wedge >15 mmHg
CI < 2.2L/minute/m^2
What are s/sx of HF/cardiogenic shock?
crackles in lungs, generalized edema, JVD, increased wedge pressure
How do we treat cardiogenic shock?
vasopressors, vasodilators, inotropes (goal is to increase BP and CO)
Preload
The pressure or stretch exerted on the walls of the ventricle by the VOLUME of blood
filling the ventricle at the end of diastole
What pressures are associated with preload?
RAP or CVP
PAWP
COMPLETE 120 PRACTICE QUESTIONS AND DETAILED ANSWERS
What medication is used to decrease ICP?
Mannitol
-osmotic diuretic
-reduces ICP by inducing diuresis (creates an osmotic gradient across the blood-brain
barrier [BBB] and increased serum osmolality -> pulls fluid out of brain cells and shifts it
into the intravascular compartment)
What medication would you plan on administering to a patient who is
experiencing bradycardia or heart block?
Atropine
-administer over 1 minute
-therapeutic effect desired = increased HR
-rapid administration may be used during cardiac resuscitation (follow with 20 mL saline
flush)
A patient suffering from a hypertensive crisis enters the ED. What medication is
used to treat this emergent situation?
Nitroprusside
-arteriole vasodilator
-rapidly lowers BP
-decreases preload and afterload
What is clonidine used for?
lowering of BP
Nitroprusside is the preferred agent if BP needs to be lowered quickly
What are the s/sx of 1st degree heart block?
dyspnea, malaise, lightheadedness, chest pain, syncope
usually NSR, P waves are normal and precede each QRS, prolonged PRI (>0.20 sec)
What is the treatment for 1st degree heart block?
generally, none
monitor
What are the s/sx of 2nd degree heart block Mobitz I (Wenckebach)?
most don't experience symptoms
if they do, usually is lightheadedness and dizziness
irregular heart rhythm, rate may vary, normal P waves, progressive lengthening of PRI,
some P waves not followed by QRS, usually normal QRS
What is the treatment for 2nd degree heart block Mobitz I?
Generally, no treatment necessary
Treat underlying cause, monitor, possibly pace
What are the s/sx of 2nd degree heart block Mobitz II?
, Fatigue, dyspnea, chest pain, presyncope, syncope, sudden cardiac arrest
irregular rhythm, varying rate, normal size and shape of P waves, some P waves not
followed by QRS, normal or prolonged PRI BUT always constant for conducted beats,
usually normal QRS but absent at times, atria/junction is still telling ventricle what to do
What is the treatment for 2nd degree Mobitz II?
O2 if needed, may need pacing, correct underlying cause
What are the s/sx of 3rd degree heart block (complete)?
light-headedness, dizziness, fainting, fatigue, chest pain, bradycardia
ventricles fire own impulse (wide and wacky), atrial and ventricular rates are
independently regular, atrial rate = 60-100, ventricular rate = 20-40, p waves are normal
but not related to QRS, no PRI due to dissociation, QRS depends on level of escape
rhythm
What is the treatment for 3rd degree heart block?
Call for help
CPR/ACLS as needed
O2
Pacing
What is cardiac tamponade?
accumulation of blood/fluid around pericardial space
What is a characteristic sign of cardiac tamponade?
Pulsus paradoxus
-Patient takes a deep breath in and SBP drops > 10 mmHg
Beck's Triad
-Muffled heart sounds
-JVD
-Hypotension
How do we diagnose cardiogenic shock?
SBP of <90 for 30 min
Wedge >15 mmHg
CI < 2.2L/minute/m^2
What are s/sx of HF/cardiogenic shock?
crackles in lungs, generalized edema, JVD, increased wedge pressure
How do we treat cardiogenic shock?
vasopressors, vasodilators, inotropes (goal is to increase BP and CO)
Preload
The pressure or stretch exerted on the walls of the ventricle by the VOLUME of blood
filling the ventricle at the end of diastole
What pressures are associated with preload?
RAP or CVP
PAWP
