MSN 5410 ADVANCED MEDICAL SURGICAL NURSING

MSN 5410 ADVANCED MEDICAL SURGICAL NURSING LATEST
EXAM 58 REAL EXAM QUESTIONS AND ANSWERS PLUS
MARKING SCHEME
What does the P wave represent? - ANSWER: - atrial contraction (depolarization)

What does the QRS complex represent? - ANSWER: - ventricular contraction
(depolarization)

What does it mean when a P wave changes shape? - ANSWER: - abnormal atria
- pericarditis
- Premature Atrial Contractions (ectopic beat)

What does the PR interval represent? - ANSWER: - The time required for the impulse
to travel from the atria through the AV node (AV conduction time)

What does the ST segment represent? - ANSWER: - interval between ventricular
depolarization and ventricular repolarization.

Normal QRS complex duration - ANSWER: - 0.04-0.10 seconds

Normal PR interval time - ANSWER: - 0.12-0.20 seconds

Atrial Fibrillation (A-Fib) - ANSWER: - an irregular and often very fast heart rate
originating from abnormal conduction in the atria
- no P wave
- no atrial kick
- no PR interval

How does the loss of the atrial kick affect your patient? - ANSWER: - cardiac output is
decreased up to 30%
- increases risk for blood clots and stroke

What medications are prescribed for A-Fib? - ANSWER: - calcium channel blocker
- digoxin
- beta blockers
- blood thinners

Patient teaching following the insertion of a permanent pacemaker - ANSWER: - do
not raise arm above the level of the heart
- avoid contact sports & heavy lifting for 2mo
- resume sexual activity as desired avoiding positions that put stress on the incision
site
- wear medical alert band
- follow medication & dietary guidelines

, - check your pulse daily @ same time notify provider if <PM rate
- never place items that generate a magnetic field over PM generator
- inform providers & dentist about PM

What is ejection fraction? - ANSWER: - compares the amount of blood in the heart to
the amount of blood pumped out
- amount of blood pumped out/amount of blood in chamber
- normal 50-70%

What physiologic change happens when there is a decrease in Ejection fraction? -
ANSWER: - heart failure, cardiomyopathy
- heart valve disease
- decreased blood flow to extremities
- decreased renal blood flow
- increased aldosterone, sodium reabsorption and h2o reabsorption

Signs and Symptoms of right sided heart failure - ANSWER: - Peripheral pitting
edema
- fatigue
- weight gain/anorexia
- JVD
- hepatomegaly/splenomegaly
- ascites
- nocturia

Signs and symptoms of left sided heart failure - ANSWER: -
confusion/agitation/restlessness/dizziness
- tachycardia/SOB
- orthopnea/exertional dyspnea
- crackles, wheezes & frothy pink sputum
- cough
- cyanosis
- oliguria

Why are most patients who've had an MI at risk for developing heart failure? -
ANSWER: - the damage that happens to the heart muscle (myocardium) & the
contractility of the heart is not the same after MI
- ejection fraction, cardiac output & BP are also affected

How do you assess progression of heart failure? - ANSWER: - measure BNP levels
- ejection fraction changes
- assess chest x-ray/CT scan for changes

What labs diagnose heart failure? - ANSWER: - BNP (brain natriuretic peptide)
normal <100pg/mL

Side Effects of nitroglycerin - ANSWER: - headache