BCC – Comprehensive Study Guide with Key Concepts and
Practice Questions
pain scales for pts who cannot self-report? - ANS✔✔ CPOT: critical care pain observation tool
(pain >2)
BPS: behavioral pain scale (pain >5)
when should a pt be reassessed? - ANS✔✔ Before/after procedures
Shift change
Pt condition changes/declines
what is the phlebostatic axis and where is it located? - ANS✔✔ an external anatomical point on
the chest at the level of atria
4th intercostal space at midaxillary
used for direct bp or cvp monitoring
reversal agents for opioids and benzos? - ANS✔✔ opioids - narcan/naloxone
benzos - flumazenil/romazicon
what dx can cause chest pain? - ANS✔✔ Aortic dissection
Pericarditis
GERD
Carotid dissection
Esophageal spasm
ACS (unstable angina, stemi, nstemi)
,describe diastolic vs systolic heart murmurs? - ANS✔✔ Systolic: if heard when pulse if felt
Diastolic: if heard when pulse is NOT felt
acute coronary syndrome (ACS) includes which conditions? - ANS✔✔ umbrella term describing
the blockage of blood flow to the heart muscle
STEMI
NSTEMI
Unstable angina
atypical symptoms of ACS (females, DM, elderly)? - ANS✔✔ Fatigue
SOB
Activity intolerance
Orthopnea
Wt gain from fluid retention
Peripheral edema
Epigastric discomfort
associated leads and vessels affected in an MI - ANS✔✔ septal: v1 & v2 (septal branch, LAD)
anterior: v3 & v4 (diagonal branch, LAD)
lateral: v5, v6, aVL, I (L circumflex artery)
inferior: II, III, aVF (r coronary artery)
what does st elevation vs st depression indicate? - ANS✔✔ st elevation: injury (infarction)
st depression: ischemia
how does nitroglycerin effect preload and afterload? - ANS✔✔ smooth muscle vasodilation
resulting in coronary artery dilation
, low dose causes venous dilation (dec preload)
high dose causes arterial dilation (dec afterload)
when is nitroglycerin contraindicated? - ANS✔✔ inferior wall MI or RT ventricular infarction
hypotension, brady or tachycardia
recent phosphodiesterase use (Viagra)
Why is morphine useful in acute coronary syndrome? - ANS✔✔ decreases preload via
vasodilation
reduces HR and BP
reduces contractility and lowers myocardial O2 consumption
reduces anxiety and fear
relieves pain
what is the dx criteria for hypertensive crisis? - ANS✔✔ increased BP in addition to dysfunction
in other symptoms (CV, renal, neuro)
*not based on BP # but other systems*
complications of hypertensive crisis? - ANS✔✔ cerebral dysfunction, intracerebral hemorrhage,
increased ICP, LV failure, aortic dissection
at what bp is the pt at risk for encephalopathy? - ANS✔✔ 250/150
describe the process of lowering a bp in hypertensive crisis? - ANS✔✔ dec SBP by max 25%
within 1st hour
dec 160/110-100 over 2-6 hours
normal over 24-48 hours
Practice Questions
pain scales for pts who cannot self-report? - ANS✔✔ CPOT: critical care pain observation tool
(pain >2)
BPS: behavioral pain scale (pain >5)
when should a pt be reassessed? - ANS✔✔ Before/after procedures
Shift change
Pt condition changes/declines
what is the phlebostatic axis and where is it located? - ANS✔✔ an external anatomical point on
the chest at the level of atria
4th intercostal space at midaxillary
used for direct bp or cvp monitoring
reversal agents for opioids and benzos? - ANS✔✔ opioids - narcan/naloxone
benzos - flumazenil/romazicon
what dx can cause chest pain? - ANS✔✔ Aortic dissection
Pericarditis
GERD
Carotid dissection
Esophageal spasm
ACS (unstable angina, stemi, nstemi)
,describe diastolic vs systolic heart murmurs? - ANS✔✔ Systolic: if heard when pulse if felt
Diastolic: if heard when pulse is NOT felt
acute coronary syndrome (ACS) includes which conditions? - ANS✔✔ umbrella term describing
the blockage of blood flow to the heart muscle
STEMI
NSTEMI
Unstable angina
atypical symptoms of ACS (females, DM, elderly)? - ANS✔✔ Fatigue
SOB
Activity intolerance
Orthopnea
Wt gain from fluid retention
Peripheral edema
Epigastric discomfort
associated leads and vessels affected in an MI - ANS✔✔ septal: v1 & v2 (septal branch, LAD)
anterior: v3 & v4 (diagonal branch, LAD)
lateral: v5, v6, aVL, I (L circumflex artery)
inferior: II, III, aVF (r coronary artery)
what does st elevation vs st depression indicate? - ANS✔✔ st elevation: injury (infarction)
st depression: ischemia
how does nitroglycerin effect preload and afterload? - ANS✔✔ smooth muscle vasodilation
resulting in coronary artery dilation
, low dose causes venous dilation (dec preload)
high dose causes arterial dilation (dec afterload)
when is nitroglycerin contraindicated? - ANS✔✔ inferior wall MI or RT ventricular infarction
hypotension, brady or tachycardia
recent phosphodiesterase use (Viagra)
Why is morphine useful in acute coronary syndrome? - ANS✔✔ decreases preload via
vasodilation
reduces HR and BP
reduces contractility and lowers myocardial O2 consumption
reduces anxiety and fear
relieves pain
what is the dx criteria for hypertensive crisis? - ANS✔✔ increased BP in addition to dysfunction
in other symptoms (CV, renal, neuro)
*not based on BP # but other systems*
complications of hypertensive crisis? - ANS✔✔ cerebral dysfunction, intracerebral hemorrhage,
increased ICP, LV failure, aortic dissection
at what bp is the pt at risk for encephalopathy? - ANS✔✔ 250/150
describe the process of lowering a bp in hypertensive crisis? - ANS✔✔ dec SBP by max 25%
within 1st hour
dec 160/110-100 over 2-6 hours
normal over 24-48 hours
