Adult Care 2: Exam 2

Question 1

When should t-PA be given for a patient with a hemorrhagic stroke?

Answer 1

Never. t-PA should not be given to patients with hemorrhagic strokes

Question 2

A patient reports stroke like symptoms that only lasted about a day, what diagnosis should you expect?

Answer 2

TIA

Question 3

A patient presents to the unit with increasing fatigue, shortness of breath, cough, and orthopnea. They have CHF, what side do you suspect is affected?

Answer 3

Left side. These are all common symptoms r/t left sided heart failure.

Question 4

A patient presents to the unit with known A-fib and reports a “funny feeling” in their chest, and fluttering/palpitations, would you classify this as stable or unstable?

Answer 4

Stable. These findings are consistent with stable A-fib.

Question 5

A patient presents to the unit with know A-fib. The patient has a hx of heart failure and is hypotensive during assessment. The pt reports chest pain, and states that they have episodes of passing out. If cardioversion is needed, which type would be appropriate for this patient?

Answer 5

Electrical cardioversion would be appropriate for this patient because they have unstable A-fib.

Question 6

If a patient has stable A-fib and cardioversion is required, what is the appropriate action?

Answer 6

Chemical cardioversion. Administer adenosine as ordered.

Question 7

A patient has A-fib and is getting an EKG, what would you expect to see?

Answer 7

True P- wave is not identifiable.

Question 8

What are some possible causes of CHF exacerbation?

Answer 8

FVO r/t overhydration, poor diet (too much Na), and non-adherence to medication regimen

Question 9

A patient has CHF and says they have been weighing themself every Monday after breakfast, what should you teach them?

Answer 9

Patients with CHF should weigh themselves daily, in the morning, after first void/BM, before drinking/eating anything.

Question 10

What diet recommendations should be made to a patient w/ CHF to prevent exacerbation?

Answer 10

Low sodium diet (<2g/day) and <2 quarts of water/day.

Question 11

What are common s/s associated w/ right sided heart failure?

Answer 11

Ascites, reduced appetite, fatigue, JVD, and any/all L-sided symptoms bc L-sided HF usually causes R-sided HF.

Question 12

If a pt has stroke symptoms w/rapid onset and they are hypertensive on assessment, which type of stroke do you suspect?

Answer 12

Hemorrhagic stroke.

Question 13

What is unilateral neglect?

Answer 13

This can occur after having a stroke. The person ignores the affected side of their body/ does not recognize affected body parts as being their own.

Question 14

What is important education to provide to someone with hemianopsia?

Answer 14

It is important to turn your head 180 degrees to make up for loss of FOV.

Question 15

If a pt has hx of atherosclerosis and is now reporting stroke symptoms, what type of stroke might you suspect?

Answer 15

Ischemic stroke.

Question 16

Why is dry weight important?

Answer 16

The patient should know their baseline dry weight and weigh themselves daily to look for deviations from their dry/discharge weight.

Question 17

What interventions should take place if a pt has a confirmed DVT?

Answer 17

Have pt wear compression stockings, and encourage elevation of affected limb for 20 min 4-5x/day.

Question 18

A patient on the unit suddenly reports unilateral leg pain. On assessment you find that the affected leg is edematous and warm. What do you suspect and what order would you expect next?

Answer 18

DVT. Would expect a D-dimer test.

Question 19

A patient presents to the unit with leg pain. On assessment, the leg is cool, pale, and the skin is shiny. Pedal pulses are absent. What do you suspect?

Answer 19

Arterial disease

Question 20

A patient with arterial disease states that they have been elevating their extremity since it is swollen, what should you do next?

Answer 20

Educate them by telling them that elevating an extremity with arterial disease decreases blood flow. They should dangle their extremity to increase blood flow.

Question 21

The nurse should be able to identify that a patient with intermittent claudication has which form of PVD?

Answer 21

Arterial.

Question 22

What does ankle brachial index (ABI), help diagnose? And what result indicates a positive diagnosis?

Answer 22

ABI is used to diagnose intermittent claudication. A result < 0.9 indicates arterial disease.

Question 23

What medications are used for management of arterial insufficiency?

Answer 23

Oral vasodilators or topical nitroglycerin

Question 24

If a patient is prescribed anticoags and clopidogrel, what type of PVD do you suspect they have?

Answer 24

Venous

Question 25

What are the different types of antihypertensives?

Answer 25

• ACE inhibitors (-prils)
• ARBs (-sartan)
• Beta blockers (-lol)

Question 26

Types of diuretics?

Answer 26

• Aldosterone antagonists (spirolactone)
• Loop diuretics (furosemide)

Question 27

Types of anticoags?

Answer 27

• Platelet Aggregation Inhibitors (clopidogrel)
• NSAIDs (aspirin)
• Low Molecular Weight Heparin (Enoxaparin)
• Activated factor Xa inhibitor (Fondaparinux/ Rivaroxaban)
• Vitamin K inhibitors (Warfarin)

Question 28

Types of antiarrythmics?

Answer 28

• Calcium channel blockers (diltiazem/ verapamil)
• Cardiac glycoside (Digoxin)

Question 29

What are statins?

Answer 29

Meds that decrease cholesterol. (Atorvastatin)

Question 30

What are common s/s of intermittent claudication?

Answer 30

Resting limb pain, paresthesia, ulcer formation, hair loss on LE, dry, scaly skin, thickened toenails, color changes of affected extremity.

Question 31

What should be evaluated after ablation?

Answer 31

Assess VS for decomposition, monitor for thrombotic events, and monitor labs.