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AACN CMC Questions Flashcards

1
Q

CVP readings should be performed at *** to eliminate changes in intrathoracic pressure.

A

End-expiration

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2
Q

What are three potential etiologies of a low SvO2?

A

Low Hgb, low CO, low SaO2

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3
Q

Early ARDS manifests as ***?

A

Respiratory Alkalosis

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4
Q

What type of ECG pattern is indicative of LAD disease? What is the course of action?

A

Terminal T wave inversion or symmetrical T wave inversion in leads V1-V3 in a patient with CP or CP at rest (unstable angina).

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5
Q

What is Wellen’s Syndrome?

A

ECG pattern of terminal T wave inversion or symmetrical T wave inversion in leads V1-V3. Associated with significant proximal LAD stenosis.

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6
Q

What are absolute indications to terminate exercise stress testing?

A
  1. ST elevation >1 mm in leads without diagnostic Q waves
  2. Sustained VT
  3. Subjects desire to stop
  4. Moderate to severe angina and signs of poor perfusion
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7
Q

What is a synthetic form of BNP?

A

Nesiritide - promotes vasodilation, natriuresis and diuresis to correct HF.

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8
Q

What are the characteristics of hemothorax?

A

Tachypnea
Hypotension
Absence of breath sounds on the affected side
CXR - complete opacification on the affected side

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9
Q

What medication causes false-positive finding on the stress test?

A

Digitalis. There is an association between development of ST segment depression and stress testing. Digitalis should be withheld on the day of the test because of its negative chronotropic effects.

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10
Q

What are heart changes seen in patients with dilated cardiomyopathy?

A

Decrease in contractility which results in an INCREASE in end-systolic volume / DECREASED ejection fraction.

DECREASE in ventricular wall thickness

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11
Q

What is associated with cardiac tamponade?

A

Hypotension
Tachycardia / Tachypnea
Decrease CO / SV

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12
Q

Indications of an aortic dissection?

A

Severe chest pain with a BP difference >20% between right and left arms, along with pulse deficit.

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13
Q

How to differentiate between NSTEMI from unstable angina while waiting for lab data results?

A

Continuous chest pain for longer than 20 minutes indicate myocardial damage.

Unstable angina occurs at rest and last more than 5 minutes.

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14
Q

What value should be expected in a patient with restrictive cardiomyopathy?

A

Hallmark: elevated R atrial pressure

Left ventricular diastolic dysfunction occurs in restrictive cardiomyopathy. This is often associated with very high end-diastolic pressures and moderate to marked biatrial enlargement secondary to elevated atrial pressures.

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15
Q

What heart condition can be followed by viral illnesses such as influenza, coxsackievirus or adenovirus? What are the delayed presentations?

A

Myocarditis
Fatigue, dyspnea, chest palpitations with nonspecific ECG changes.

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16
Q

A narrowing pulse pressure can indicate?

A

Worsening cardiac tamponade. Pulse pressure is proportional to stroke volume, which is decreased in cardiac tamponade.

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17
Q

Peripheral edema, dyspnea on exertion, JVD, and lightheadedness are all symptoms of which valve stenosis?

A

Pulmonic valves stenosis may have symptoms of R heart failure causing all symptoms that were noted

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18
Q

Amitriptyline overdose causes?

A

QT prolongation leading to Torsades de Pointes. Magnesium 2 gm over 10 minutes is the first and fastest treatment.

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19
Q

Harsh systolic murmur loudest at the lower left sternal border is seen in a patient with what history?

A

Hx Endocarditis, alcoholism and IV drug use

Findings are consistent with tricuspid regurgitation. Hx are risk factors for tricuspid regurgitation (infective endocarditis).

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20
Q

When do you hear a holosystolic murmur?

A

During papillary muscle or ventricular septal rupture

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21
Q

When do you hear S3 or S4 heart sound?

A

After MI and likely to be associated with new-onset heart failure

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22
Q

Why would you hear scratching sound during systole and diastole?

A

A scratching sound is friction rub caused by inflammation of the pericardium that is common after MI and is typically self-limiting.

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23
Q

Indications for:
1. Reteplase
2. Enoxaprin
3. Streptokinase
4. Alteplase

A

Reteplase - AMI when fibrinolytics are iindicated
Enoxaprin - alternative to heparin in patiens with unstable angina, NSTEMI, or deep vein thrombosis
Steptokinase - acute arterial thrombosis or embolism, or occluded arteriovenous cannulas
Alteplase - acute ischemic stroke or acute massive PE

24
Q

Hx of severe aortic stenosis can lead to which life threatening complication?

A

Patients with severe aortic stenosis are susceptible to changes in afterload, especially when afterload increases rapidly This sudden increase in afterload shunts cardiac output through the stenotic valve, which causes blood and fluid to back up in the lungs, leading to flash pulmonary edema.

25
Initial treatment for syncope related to postural hypotension?
Increase salt and water intake.
26
ST segment elevation in all areas of the heart, pain when lying supine, unremarkable biomarkers, and L sided chest pain not associated with SOB or diaphoresis is indicative of?
Pericarditis. First line treatment: NSAIDS
27
What patient history can increase risk for acute decompensation of heart failure?
Alcoholism can worsen LEFT ventricular function and trigger acute decompensation of heart failure
28
What can be seen in a patient with unstable angina?
Continued chest pain for 1 week. Normal 12-lead ECG, CK, CKMB, and troponin.
29
Symptoms of cardiac tamponade?
Sinus tachycardia, precordial ST segment ELEVATION and LOW voltage QRS complexes in limb leads
30
A patient is admitted with ventricular tachycardia storm and started on amiodarone (Cordarone). A 12-lead ECG, troponin and electrolytes are all normal. Pt is hemodynamically stable. Which intervention should the nurse anticipate next?
Propanolol reduces sympathetic stimulation the heart. Beta blockers and amiodarone together are optimal therapy to prevent further episodes of VT. Procainamide is less effective than amiodarone and is not a first-line antiarrhythmic drug. Catheter ablation is for electrical storm that cannot be adequately controlled with medication and would not be performed first.
31
3 of 5 risk factors leads to metabolic syndrome
1. Abdominal obesity, waist circumference >40 inches for men and > 35 for women 2. High BP, >130/80 3. High Blood sugar, fasting glucose > 100 4. High triglycerides >150 5. Low HDL cholesterol
32
Why does taking NSAIDs provide the greatest risk for development of AKI?
NSAIDs inhibit prostaglandin-mediated afferent arteriolar vasodilation, which places the patient at risk for developing AKI
33
How does low serum magnesium levels can ECG?
Prolonged QT interval Flat T waves Prolong PR P waves not affected
34
Which findings should the nugrse anticipate for a patient taking ibuprofen for OA and has undergone prolonged PCI requiring large doses of contrast dye?
Cloudy urine, oliguria. Contrast dye is nephrotoxic and common cause of intrarenal AKI. This patient will have proteinuria forming urinary casts that obstruct the renal tubules
35
ECG changes with hypermagnesemia?
Bradycardia Heart Block Widened QRS complexes Prolong QT interval *** which is also seen in hypomagnesemia
36
Symptoms of hyperphosphatemia (>4.5)?
Muscle spasms Joint pain Prolonged QTc
37
Which electrolyte imbalance causes muscle weakness?
HyperCALCEMIA HyperMAGNESEMIA HypoNATREMIA
38
Symptoms of pancreatitis?
Knife-like twisting pain radiating to the back N/V & adb pain RELIEF - leaning forward Tachycardia, diaphoresis, weakness
39
Which additional lab value will be low when a patient has hypoalbuminemia?
Calcium Half of calcium exists in a free (ionized form while the other half is bound to protein, mostly albumin.
40
What medication is indicated for a patient experiencing thyrotoxicosis?
Propranolol: a beta receptor agonist that treats tachycardia, anxiety and tremors in thyroid storm. Thyrotoxicosis s/s: tachycardia, palpitation, diaphoresis, anxiety and tremors. High levels of T3 T4 and undectable TSH.
41
Hypophosphatemia symptoms?
Encephalopathy Dilated cardiomyopathy Generalized muscle weakness Rhabdomyolysis Hemolysis
42
Hypovolemic shock results in which type of ABG?
Mild metabolic acidosis
43
A patient presents with new-onset rapid atrial fibrillation. The patient is tachycardic, febrile, and agitated. Which lab test is most important to check?
TSH Thyroid storm increases metabolic activity and stimulates beta-adrenergic receptors causing an increased sympathetic nervous system response]e. Hyperactivity of cardiac and nervous tissues causes hyperthermia. Afib is common in patients with hyperthyroidism. Clinical presentation of thyroid storm include various organ systems - thermoregulation, heart, CNS and gastrointestinal
44
For which patient does initiation of slow continuous ultrafiltration have the GREATEST benefit?
HF / CR 1.8 mg/dL (elevated) not responding to diuretic therapy. Slow continuous ultrafiltration (SCUF) slowly removes fluid with minimal effect on solute removal. The primary indication for SCUF is volume removal.
45
*** is an alternative to unfractionated heparin in patients with HIT.
Bivalirudin - a direct thrombin inhibitor
46
A patient who underwent a poplitela angiogram several days ago is now experiencing pain at the access site. A pulsatile mass is palpable on assessment. The nurse should suspect a/an?
Pseudoaneurysm - a common complication of percutaneous access caused by damage to the artery. The pulsatile mass is a hematoma between the outer layers of the blood vessel wall that may resolve spontaneously or increase in size and require further intervention.
47
IABP patient suddenly goes to V-fib. In addition to resuscitative measures, the nurse should?
Change the trigger to internal or pressure to support resuscitative measures.
48
After initiating continuous renal replacement therapy, the patient reports SOB and not feeling well. BP 62/34 HR 122 CVP 3 CO 7.9 SVR 338 What intervention should the nurse anticipate?
IM epinephrine and discontinue lisinopril Blood contact with certain membranes or CRRT filters can precipitate anaphylatic reactions and severe hypotension when taking angiotensin-converting enzymes (ACE) inhibitors. This is due to increased levels of BRADYKININ. ACE inhibitors are recommended to be withheld for 48-72 hours before initiation of CRRT, if possible.
49
In the absence of arrhythmias and an AICD fires, what should the nurse suspect?
A damaged lead. High probability of R wave oversensing due to a dislodged or damaged lead, a loose connection at the header or an oversensitive parameter setting.
49
A patient is being aggressively diuresed with furosemide. The patient is immobile and incontinent of urine, so the nurse has been unable to accurately measure urine output. Which adverse event is this patient most likely to experience?
Asystolic arrest Diuresis without strict monitoring of output may result in unrecognized loss of K+. Severe hypokalemia inhibits cardiac contractility and conduction, leading to bradycardia and eventually asystole if not corrected.
50
Which response by a patient indicates understanding of medication education after placement of a bare metal stent?
My doctor wants me to take clopidogrel (Plavix) for at least one month with aspirin. Bare metal stents have a 15-20% restenosis rate at 6 months. Duration of dual antiplatelet therapy should be prescribed for a minimum of 1 month for non ACS patients and for at least 12 months for stents implanted due to ACS.
51
Which medication is associated with pulmonary toxicity?
Amiodarone Pulmonary toxicity is characterized by dyspnea, fever, hypoxemia, cough, pleuritic chest pain and pleural effusions.
52
When should a provider be notified when a patient has an implantable cardioverter defibrillator?
When the device fires more than one shock or after several successions.
53
CTA of the chest showed PE. The nurse should anticipate administration of?
Catheter-directed alteplase (t-PA) - lowers the rate of major bleeding complications.
54
Two complications from milrinone?
Hypotension Atrial / ventricular dysrhythmias
55
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CMC (3 decks)

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