NURS 366 Exam #2 Questions With Complete Solutions
3 phases of peri-operative nursing Correct Answers
Preoperative, intraoperative, postoperative
Acute coronary syndrome Correct Answers = (unstable angina)
any condition causing sudden lack of BF to the coronary
arteries, leads to MI (NSTEMI or STEMI)
> Treatment: 12-lead EKG, IV access/lab draw, troponin levels?
MONA (morphine (pain/vasodilate), oxygen, nitroglycerin,
aspirin (chew)), beta blockers, ACE or ARB inhibitor, statin
Bacterial (ineffective) endocarditis Correct Answers =
infection of the inner lining of the heart generally involving the
valves
> Predisposing factors: structural issues of heart or blood vessels
(mainly valves), bacteremia due to localized infection (usually
strep or staph)
- First degree: routine exposure from normal day
- Second degree: dental procedures, diseased teeth/gums, drug
abuse, indwelling caths, cardiac/GI surgery
Bacterial (ineffective) endocarditis CM & Tx Correct Answers
> Manifestations: insidious onset (malaise, anorexia, weight
loss), rando low fever, new murmur, +BC labs, anemia,
increased ESR, splinter hemorrhages under nails, petechiae on
oral mucous membranes, red/painful raised nodes on pads of
phalanges, Janeway lesions (flat/painless/red/blue spots on
palms/soles)
> Treatment: initial empiric therapy ASAP (high dose IV
antibiotics, 4-6 weeks Tx), pre-procedural antibiotic prophylaxis
in high risks
,Be able to discuss and apply evidence-based practice that
applies to peri-operative nursing Correct Answers > National
patient safety goals & SCIP are EBP guidelines to follow
> Others: antimicrobial prophylaxis, CHG (chlorohexidine)
baths, glycemic control, normothermia, patient education
(post/pre), postoperative oxygenation
Blood flow through the body Correct Answers Systemic
circulation (deoxygenated blood) > inferior/superior vena cava >
Right atrium> tricuspid valve > right ventricle > pulmonary
valve/arteries > lungs > left/right pulmonary veins (oxygenated
blood) > left atrium > bicuspid valve > left ventricle > aortic
valve/aorta > body (start over)
Calculating drops per minute (for gravity flow devices) Correct
Answers > Gtt/min = amount of fluid x drop factor / hours to
infuse x 60 mins
> Remember to convert hours to minutes
> Multiply first, then divide
> Example: Calculate the gtts/min for 200 mL of 0.9% NaCl to
infuse over 2 hours. Drop factor is 20 gtts/min.
- (200 mL/hr X 20 gtts/min) / (2 hrs X 60 mins) = 33 gtts/min
Central catheter heparin flush scenarios Correct Answers >
General saline notes: 5-10 ml NS before continuous infusion,
before/after intermittent IV medications, to cap when ending
continuous infusion, twice daily to maintain patency
> General heparin: 3 ml administered to CVCs, 5 ml to
implanted ports (larger reservoirs and need more flush volume)
> SASH: saline, administer, saline, heparin
,Central catheter line administering a med to a line already HL
and clamped and don't plan to use it continuously. Heparin?
Correct Answers = flush with saline before giving med, flush
with saline after med then heparin
Central catheter line is HL and clamped. Heparin? Correct
Answers = routinely flush with saline followed by heparin
(frequency determined by hospital policy)
Central catheter line running continuous fluid or medication.
Heparin? Correct Answers = no need for heparin unless you
discontinue your continuous med/fluid, once completed flush
with saline followed by heparin
Central venous lines (PICC) - assessing site and dressing
changes Correct Answers > Assessing site: look for infection
(local and systemic), CLABSI (central line bloodstream
infection), air embolism, thrombosis, fibrin sheath
> Need for dressing change: sterile dressing changes, with mask,
sterile gloves, and equipment, change every 5-7 days depending
on hospital policy/type of dressing/dressing integrity
Central venous lines (PICC) drawing blood and flushing catheter
Correct Answers > Drawing blood: flush catheter and aspirate 6
ml of blood, repeat aspiration and reinfuse x3, remove and
discard used syringe, attach a new syringe, and draw up blood
> Flushing catheter: flush with & before each use and routinely
when not in use
- Before use: saline only
- After use: normally saline and heparin
- Routine flush w/o use: saline followed by heparin
, Coarctation of the aorta Correct Answers = localized narrowing
of the aorta near the ductus arteriosus (heart itself is OK),
prevents proper BF pressure from the ventricles & easy for clots
to occur, left sided obstruction
> Manifestations - bounding pulse in UE & cool skin/low B/P in
LE, mechanical ventilation/inotropic support often needed
before surgery. Dizziness, headaches, fainting, epistaxis from
hypertension in older kids
> Management - Surgery for those < 6 months, balloon
angioplasty in older infants/children preferred
Coarctation of the aorta hemodynamics Correct Answers =
Causes increased pressure proximal to the defect (upper
extremities) and decreased pressure distally (lower extremities),
hemodynamic condition can deteriorate quickly with severe
acidosis and hypotension
Common diagnostic studies and their physiologic basis for
patients with cardiac disease Correct Answers > CXR - chest
x-ray to see size/shape of heart (cardiomegaly?)
> ECG - rhythm, width of QRS, voltage
> Echo - ejection fraction, wall motion strength, do we give
something to increase contractility?
> R or L heart cath - determine pulmonary/filling pressures,
determine EF
> Labs (expected findings) - decreased Na/Cl, increased BUN
(kidney issue), decreased RBC (decreased kidney activity),
PaO2/CO2 decreased, BNP (specific to HF) heart stretching
causes release/diuretic/>100 indicates HF/also checked on
admission
3 phases of peri-operative nursing Correct Answers
Preoperative, intraoperative, postoperative
Acute coronary syndrome Correct Answers = (unstable angina)
any condition causing sudden lack of BF to the coronary
arteries, leads to MI (NSTEMI or STEMI)
> Treatment: 12-lead EKG, IV access/lab draw, troponin levels?
MONA (morphine (pain/vasodilate), oxygen, nitroglycerin,
aspirin (chew)), beta blockers, ACE or ARB inhibitor, statin
Bacterial (ineffective) endocarditis Correct Answers =
infection of the inner lining of the heart generally involving the
valves
> Predisposing factors: structural issues of heart or blood vessels
(mainly valves), bacteremia due to localized infection (usually
strep or staph)
- First degree: routine exposure from normal day
- Second degree: dental procedures, diseased teeth/gums, drug
abuse, indwelling caths, cardiac/GI surgery
Bacterial (ineffective) endocarditis CM & Tx Correct Answers
> Manifestations: insidious onset (malaise, anorexia, weight
loss), rando low fever, new murmur, +BC labs, anemia,
increased ESR, splinter hemorrhages under nails, petechiae on
oral mucous membranes, red/painful raised nodes on pads of
phalanges, Janeway lesions (flat/painless/red/blue spots on
palms/soles)
> Treatment: initial empiric therapy ASAP (high dose IV
antibiotics, 4-6 weeks Tx), pre-procedural antibiotic prophylaxis
in high risks
,Be able to discuss and apply evidence-based practice that
applies to peri-operative nursing Correct Answers > National
patient safety goals & SCIP are EBP guidelines to follow
> Others: antimicrobial prophylaxis, CHG (chlorohexidine)
baths, glycemic control, normothermia, patient education
(post/pre), postoperative oxygenation
Blood flow through the body Correct Answers Systemic
circulation (deoxygenated blood) > inferior/superior vena cava >
Right atrium> tricuspid valve > right ventricle > pulmonary
valve/arteries > lungs > left/right pulmonary veins (oxygenated
blood) > left atrium > bicuspid valve > left ventricle > aortic
valve/aorta > body (start over)
Calculating drops per minute (for gravity flow devices) Correct
Answers > Gtt/min = amount of fluid x drop factor / hours to
infuse x 60 mins
> Remember to convert hours to minutes
> Multiply first, then divide
> Example: Calculate the gtts/min for 200 mL of 0.9% NaCl to
infuse over 2 hours. Drop factor is 20 gtts/min.
- (200 mL/hr X 20 gtts/min) / (2 hrs X 60 mins) = 33 gtts/min
Central catheter heparin flush scenarios Correct Answers >
General saline notes: 5-10 ml NS before continuous infusion,
before/after intermittent IV medications, to cap when ending
continuous infusion, twice daily to maintain patency
> General heparin: 3 ml administered to CVCs, 5 ml to
implanted ports (larger reservoirs and need more flush volume)
> SASH: saline, administer, saline, heparin
,Central catheter line administering a med to a line already HL
and clamped and don't plan to use it continuously. Heparin?
Correct Answers = flush with saline before giving med, flush
with saline after med then heparin
Central catheter line is HL and clamped. Heparin? Correct
Answers = routinely flush with saline followed by heparin
(frequency determined by hospital policy)
Central catheter line running continuous fluid or medication.
Heparin? Correct Answers = no need for heparin unless you
discontinue your continuous med/fluid, once completed flush
with saline followed by heparin
Central venous lines (PICC) - assessing site and dressing
changes Correct Answers > Assessing site: look for infection
(local and systemic), CLABSI (central line bloodstream
infection), air embolism, thrombosis, fibrin sheath
> Need for dressing change: sterile dressing changes, with mask,
sterile gloves, and equipment, change every 5-7 days depending
on hospital policy/type of dressing/dressing integrity
Central venous lines (PICC) drawing blood and flushing catheter
Correct Answers > Drawing blood: flush catheter and aspirate 6
ml of blood, repeat aspiration and reinfuse x3, remove and
discard used syringe, attach a new syringe, and draw up blood
> Flushing catheter: flush with & before each use and routinely
when not in use
- Before use: saline only
- After use: normally saline and heparin
- Routine flush w/o use: saline followed by heparin
, Coarctation of the aorta Correct Answers = localized narrowing
of the aorta near the ductus arteriosus (heart itself is OK),
prevents proper BF pressure from the ventricles & easy for clots
to occur, left sided obstruction
> Manifestations - bounding pulse in UE & cool skin/low B/P in
LE, mechanical ventilation/inotropic support often needed
before surgery. Dizziness, headaches, fainting, epistaxis from
hypertension in older kids
> Management - Surgery for those < 6 months, balloon
angioplasty in older infants/children preferred
Coarctation of the aorta hemodynamics Correct Answers =
Causes increased pressure proximal to the defect (upper
extremities) and decreased pressure distally (lower extremities),
hemodynamic condition can deteriorate quickly with severe
acidosis and hypotension
Common diagnostic studies and their physiologic basis for
patients with cardiac disease Correct Answers > CXR - chest
x-ray to see size/shape of heart (cardiomegaly?)
> ECG - rhythm, width of QRS, voltage
> Echo - ejection fraction, wall motion strength, do we give
something to increase contractility?
> R or L heart cath - determine pulmonary/filling pressures,
determine EF
> Labs (expected findings) - decreased Na/Cl, increased BUN
(kidney issue), decreased RBC (decreased kidney activity),
PaO2/CO2 decreased, BNP (specific to HF) heart stretching
causes release/diuretic/>100 indicates HF/also checked on
admission
