NRSG 421- FINAL EXAM || QUESTIONS WITH A+
GRADED SOLUTIONS!!
Define angina? correct answers § Stable, predictable exertional pain.
§ Doesn't increase in frequency or severity over time.
§ Generally caused by fixed obstructive atheromatous lesion.
§ Resolves with rest and treatment
§ May be preventable with pretreatment
Define unstable angina correct answers § Thrombus partially or intermittently occludes the
coronary artery.
§ S/S:
· Pain with or without radiation to arm, neck, back or epigastric region.
· SOB
· Diaphoresis, N, lightheadedness
· Tachycardia, tachypnea, hypotension or hypertension.
· Decreased SaO2 and rhythm abnormalities
§ Because it is caused by a more significant narrowing of the coronary artery vessel, the
symptoms are generally more pronounced and:
· Increasing with frequency
· Occurs with less provocation
· Are less likely to be resolved with treatment
· May occur at rest-HALLMARK SIGN
· Requires prompt evaluation/treatment
S/S for unstable angina? correct answers · Pain with or without radiation to arm, neck, back
or epigastric region.
· SOB
· Diaphoresis, N, lightheadedness
· Tachycardia, tachypnea, hypotension or hypertension.
· Decreased SaO2 and rhythm abnormalities
§ Because it is caused by a more significant narrowing of the coronary artery vessel, the
symptoms are generally more pronounced and:
· Increasing with frequency
· Occurs with less provocation
· Are less likely to be resolved with treatment
· May occur at rest-HALLMARK SIGN
· Requires prompt evaluation/treatment
Define an NSTEMI correct answers § Cause:
· Thrombus partially or intermittently occludes the coronary artery.
§ S/S:
· Very similar to unstable angina, pain may be more substantial, more difficult to resolve.
§ Major difference:
· Cardiac markers (enzymes) elevate to indicate muscle damage.
· No ST segment elevation
· ST depression, T wave inversion
define a STEMI correct answers § Cause:
,· Thrombus fully occludes the coronary artery, ST elevation
§ S/S:
· Again very similar to angina, unstable angina, but generally more severe and generally
unrelieved with basic treatment (O2, nitro, rest)
What are treatment priorities for the patient that presents with ACS? correct answers § Pain
control
§ Pain assessment- OLC CARTS
§ Nitro- check bp first before administering
§ ASA- platelet aggregation
§ O2 supplementation
§ Morphine (second potential for pain, continuing pain after nitro
§ Ultimate goal is zero pain.
§ Lead a 12 lead EKG, cardiac enzymes (troponin),
§ thrombolytics or Cath lab, get those vessels open!
Describe administration of nitro SL for acute chest pain, what is its action? correct answers o
Causes vasodilation of coronary vessels
o Can drop BP precipitously, so taking BP before each dose is essential
o One nitro SL q 5 min x 3 if pain continues. If remains after 3 doses, MUST call 911.
o May start on Nitro infusion to more gently control pain and sustain BP.
What are three complications post PCI and their emergent treatments? correct answers o
Hematoma at the site- direct pressure, should be some firmness
o Bleeding-direct pressure
o Pseudoaneurysm (femoral)- may heart a bruey and may here a thrill
o Retroperitoneal bleed (flank pain) if you miss flank pain you will see hypotension,
tachycardia, possible bleeding
o Stroke
What is the main action of a thrombolytic in a STEMI correct answers o Dissolve clot in the
coronary vessels
o To limit the size of the MI and get more blood flow
What is 1st degree burn? correct answers § Usually skin is in tact
§ The nonvascular outer layer of the skin and is a thick as a sheet of paper.
§ The epidermis is a protective barrier for the skin, holding in fluids and electrolytes and
aiding in body temperature regulation.
What is 2nd degree burn? correct answers § Caused by chemicals, flame, or hot liquids
damage the epidermis and part of the dermis.
§ A lot more pain you have reached nerves
§ These second-degree burns appear as fluid-filled vesicles that are red and shiny (and wet if
the vesicles have ruptured).
§ Healing typically takes 10-21 days for superficial partial thickness burns, which involve
part of the dermis, and 2-6 weeks for deep partial-thickness burns, which involve more of the
dermis.
§ Symptoms include:
· Include edema, Hyperesthesia, pain cause by nerve injury, and sensitivity to cold air.
, What is 3rd degree burn? correct answers § May extend to the subcutaneous tissue, meaning
the skin can't heal on its own.
§ Caused by prolonged exposure to chemicals, electrical current, flame, hot liquids, or tar.
§ Skin appears dry, waxy, white, leathery, or hard.
§ Thrombosed vessels will be visible, and muscles, tendons, and bones may be involved.
§ S/S:
· Lack of pain
· Possible hematoma
· Possible entrance and exit wounds
· Shock
· Skin grafting is often required.
What is the mechanism in burns by which the burn patient has a significant fluid volume
deficit? correct answers § Increased capillary permeability
§ Inflammatory response, histamine release
§ Loss of heat:
What type of fluid is used in resuscitation for burns and why? correct answers o Lactated
Ringers bc its closer to plasma and helps buffer acidosis
What are symptoms might a patient to lead to suspicion of an inhalation injury? correct
answers o Facial injury
o Facial edema
o Loss of facial hair
o Soot from ashes
o Look for Carbon Monoxide poisoning
o Singed hair
o Hoarse voice
o Wheezes
What are initial nursing priorities in caring for a patient with significant burns? correct
answers o Airway
o Breathing
o circulation
o Pain control
o Temperature control
o Continuously assess
o IV access ASAP
Identify the common ventilator settings? correct answers § FiO2: % of oxygen (above 21-
100)
§ Rate: how many breaths per minute delivered by vent.
§ Tidal Volume: how many mLs per breath.
§ Mode: pattern of ventilation delivery by the vent
§ PEEP: positive end expiratory pressure. Additional pressure to keep alveoli and airway
open.
§ Pressure Support: additional pressure behind each breath to negate the dead space in the
vent tubing
§ Peak inspiratory Pressure: measured by the ventilator, pressure within airways during
ventilation.
GRADED SOLUTIONS!!
Define angina? correct answers § Stable, predictable exertional pain.
§ Doesn't increase in frequency or severity over time.
§ Generally caused by fixed obstructive atheromatous lesion.
§ Resolves with rest and treatment
§ May be preventable with pretreatment
Define unstable angina correct answers § Thrombus partially or intermittently occludes the
coronary artery.
§ S/S:
· Pain with or without radiation to arm, neck, back or epigastric region.
· SOB
· Diaphoresis, N, lightheadedness
· Tachycardia, tachypnea, hypotension or hypertension.
· Decreased SaO2 and rhythm abnormalities
§ Because it is caused by a more significant narrowing of the coronary artery vessel, the
symptoms are generally more pronounced and:
· Increasing with frequency
· Occurs with less provocation
· Are less likely to be resolved with treatment
· May occur at rest-HALLMARK SIGN
· Requires prompt evaluation/treatment
S/S for unstable angina? correct answers · Pain with or without radiation to arm, neck, back
or epigastric region.
· SOB
· Diaphoresis, N, lightheadedness
· Tachycardia, tachypnea, hypotension or hypertension.
· Decreased SaO2 and rhythm abnormalities
§ Because it is caused by a more significant narrowing of the coronary artery vessel, the
symptoms are generally more pronounced and:
· Increasing with frequency
· Occurs with less provocation
· Are less likely to be resolved with treatment
· May occur at rest-HALLMARK SIGN
· Requires prompt evaluation/treatment
Define an NSTEMI correct answers § Cause:
· Thrombus partially or intermittently occludes the coronary artery.
§ S/S:
· Very similar to unstable angina, pain may be more substantial, more difficult to resolve.
§ Major difference:
· Cardiac markers (enzymes) elevate to indicate muscle damage.
· No ST segment elevation
· ST depression, T wave inversion
define a STEMI correct answers § Cause:
,· Thrombus fully occludes the coronary artery, ST elevation
§ S/S:
· Again very similar to angina, unstable angina, but generally more severe and generally
unrelieved with basic treatment (O2, nitro, rest)
What are treatment priorities for the patient that presents with ACS? correct answers § Pain
control
§ Pain assessment- OLC CARTS
§ Nitro- check bp first before administering
§ ASA- platelet aggregation
§ O2 supplementation
§ Morphine (second potential for pain, continuing pain after nitro
§ Ultimate goal is zero pain.
§ Lead a 12 lead EKG, cardiac enzymes (troponin),
§ thrombolytics or Cath lab, get those vessels open!
Describe administration of nitro SL for acute chest pain, what is its action? correct answers o
Causes vasodilation of coronary vessels
o Can drop BP precipitously, so taking BP before each dose is essential
o One nitro SL q 5 min x 3 if pain continues. If remains after 3 doses, MUST call 911.
o May start on Nitro infusion to more gently control pain and sustain BP.
What are three complications post PCI and their emergent treatments? correct answers o
Hematoma at the site- direct pressure, should be some firmness
o Bleeding-direct pressure
o Pseudoaneurysm (femoral)- may heart a bruey and may here a thrill
o Retroperitoneal bleed (flank pain) if you miss flank pain you will see hypotension,
tachycardia, possible bleeding
o Stroke
What is the main action of a thrombolytic in a STEMI correct answers o Dissolve clot in the
coronary vessels
o To limit the size of the MI and get more blood flow
What is 1st degree burn? correct answers § Usually skin is in tact
§ The nonvascular outer layer of the skin and is a thick as a sheet of paper.
§ The epidermis is a protective barrier for the skin, holding in fluids and electrolytes and
aiding in body temperature regulation.
What is 2nd degree burn? correct answers § Caused by chemicals, flame, or hot liquids
damage the epidermis and part of the dermis.
§ A lot more pain you have reached nerves
§ These second-degree burns appear as fluid-filled vesicles that are red and shiny (and wet if
the vesicles have ruptured).
§ Healing typically takes 10-21 days for superficial partial thickness burns, which involve
part of the dermis, and 2-6 weeks for deep partial-thickness burns, which involve more of the
dermis.
§ Symptoms include:
· Include edema, Hyperesthesia, pain cause by nerve injury, and sensitivity to cold air.
, What is 3rd degree burn? correct answers § May extend to the subcutaneous tissue, meaning
the skin can't heal on its own.
§ Caused by prolonged exposure to chemicals, electrical current, flame, hot liquids, or tar.
§ Skin appears dry, waxy, white, leathery, or hard.
§ Thrombosed vessels will be visible, and muscles, tendons, and bones may be involved.
§ S/S:
· Lack of pain
· Possible hematoma
· Possible entrance and exit wounds
· Shock
· Skin grafting is often required.
What is the mechanism in burns by which the burn patient has a significant fluid volume
deficit? correct answers § Increased capillary permeability
§ Inflammatory response, histamine release
§ Loss of heat:
What type of fluid is used in resuscitation for burns and why? correct answers o Lactated
Ringers bc its closer to plasma and helps buffer acidosis
What are symptoms might a patient to lead to suspicion of an inhalation injury? correct
answers o Facial injury
o Facial edema
o Loss of facial hair
o Soot from ashes
o Look for Carbon Monoxide poisoning
o Singed hair
o Hoarse voice
o Wheezes
What are initial nursing priorities in caring for a patient with significant burns? correct
answers o Airway
o Breathing
o circulation
o Pain control
o Temperature control
o Continuously assess
o IV access ASAP
Identify the common ventilator settings? correct answers § FiO2: % of oxygen (above 21-
100)
§ Rate: how many breaths per minute delivered by vent.
§ Tidal Volume: how many mLs per breath.
§ Mode: pattern of ventilation delivery by the vent
§ PEEP: positive end expiratory pressure. Additional pressure to keep alveoli and airway
open.
§ Pressure Support: additional pressure behind each breath to negate the dead space in the
vent tubing
§ Peak inspiratory Pressure: measured by the ventilator, pressure within airways during
ventilation.
