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ATI Cards > ATI Cardio > Flashcards

ATI Cardio Flashcards

1
Q

Discharge teaching to HF pt, what s/s to report immediately to pcp:

A

Weight gain 1 kg (2.2 lbs) in 24 hours. (This shows fluid retention-worsening heart failure)

(Increase in SBP 10 mmhg, dyspnea with exertion, and dizziness when rising are normal for HF)

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2
Q

Teaching before coronary artery bypass graft?

A

Dont take anticoagulants such as Coumadin or Aspirin for a week prior to surgery.
Withhold digoxin 12 hrs before surgery.
Meds for high BP may be given if indicated by PCP.

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3
Q

Complication after permanent pacemaker insertion?

A

Hiccups may indicate the pacemaker is stimulating the chest wall or diaphragm, this can be a complication such as lead wire perforation.

(Dizziness is expected during adjustment to pacemaker, pain or stinging at incision site is expected, headache shouldn’t be a complication of the insertion procedure but can be from other diseases)

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4
Q

Risk factor for developing peripheral arterial disease?

A

Diabetes mellitus places pt at risk for peripheral neuropathy and progressive PAD.

(25%fat intake is normal, two bottles of beer/d is moderate intake- these aren’t RF)

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5
Q

Prior to stress test:

A

Do not smoke-may change test outcome and place client at additional risk.
Don’t need to be NPO.
Don’t take cardiac meds before test.
Episodes of chest pain are not contraindicated.

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6
Q

How to distinguish between arterial or Venus stasis ulcer?

A

Pts with arterial ulcers experience claudication, those with Venus ulcers do not.

(Family hx won’t help distinguish, both cause pain and can become infected)

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7
Q

Tx for SVT?

Pt is conscious, hr 210, faint radial pulse

A

Vagal stimulation may help the pts heart return to normal sinus rhythm.

(Precordial thump, atropine, and defibrillation won’t help)

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8
Q

Care after abdominal aortic aneurism resection, priority assessment?

A

Urine output- greatest risk is occlusion or dissection.

Neck vein distention, bowel sounds, and peripheral edema are important but not priority

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9
Q

8 hours post CABG surgery, nurse should report what finding?

A

BP 160/80 mmhg- elevated BP is bad because increased vascular pressure may cause bleeding at incision site.

(Mediastinal drainage of 100 is ok (over 150 too much), temp 98.8 is normal, potassium 3.8 is normal)

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10
Q

Complication of endocarditis?

A

Valvular disease or damage often occurs as a result of inflammation or infection of the endocardium.

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11
Q

HTN lifestyle modifications?

A

Limit alcohol, regular exercise, moderate sodium, smoking cessation

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12
Q

Pt in ER for anterior MI, also one week postoperative surgery, what is contraindicated?

A

Thrombolytic therapy- CI with surgery in the past 10 days

IV morphine, oxygen 2L nc, and assisting to bedside commode are all appropriate

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13
Q

CM of left sided heart failure?

A

Weak peripheral pulses because of decreased cardiac output from LHF.

(Increased abdominal girth, JVD, and dependent edema are from systemic congestion-RHF)

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14
Q

Cholesterol levels?

A

Cholesterol should be less than 200.
HDL should be greater than 40.
LDL should be less than 130.

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15
Q

Heart transplant postoperative teaching?

A

“You may no longer be able to feel chest pain”- due to denervation of the heart.
Activity intolerance should improve.
Will need to permanently restrict sodium and fat in diet.
Will remain on immunosuppressants for the remainder of their life.

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16
Q

Pt being treated for LHF with IV loop diuretics and digitalis. Pt is experiencing weakness and irregular HR, what should nurse do?

A

Review serum electrolyte levels-may indicate imbalance

Obtaining current wt, determine time of last dig dose, and checking UO are important but not the first action

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17
Q

Pt has pulmonary edema r/t HF. What indicates effective tx of condition?

A

Absence of adventitious breath sounds- pulmonary edema is resolving, less fluid in lungs.

(Non productive cough, decrease in RR at rest, and sao2 86% on room air are not signs of effective treatment)

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18
Q

Pt with HF has afib. Monitor for:

A

Slurred speech-sign of stroke- inadequate circulation to brain b/c embolus

(Irregular pulse, is common in afib, dependent edema and extreme fatigue are normal in HF)

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19
Q

Monitor for what with ACE inhibitor?

A

Persistent cough- adverse effect.

(Frequent urination is an expected outcome of this med. Constipation is a SE of calcium channel blockers. Bruising is not a SE)

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20
Q

1 hour post aortic aneurism repair, what may indicate shock and should’ve reported to PCP?

A

Urine output 20ml/hr- less than 30 means decreased blood flow to kidneys-shock

(Serosanguinous drainage on drsg is normal in postoperative hours, coughing will be painful, and change in body temp is not associated with shock)

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21
Q

Report what prior to coronary angiography?

A

Previous allergic reaction to shellfish-contrast is iodine based

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22
Q

Increase in what lab is diagnostic of MI?

A

CKMB- enzyme specific to the myocardium, elevates when muscle is injured

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23
Q

Pt with HF taking digoxin and lasix, monitor for which adverse reaction?

A

Light headedness- furosemide can cause a substantial drop in BP

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24
Q

What indicates effectiveness of warfarin therapy?

A

INR 2.5 (needs to be 2-3 to be therapeutic)

(Decreased circumference of the effected limb, minimal or no bruising(desired), and hgb 14(normal) are not the best evidence of effectiveness)

25
Q

Hypertensive crisis first priority?

A

Initiate an IV-will need IV antihypertensive meds to lower BP safely and quickly.

(Monitoring BP, checking vision, and obtaining lab values are important but not the priority)

26
Q

Transdermal nitro patch teaching?

A

Rotate patch sites to prevent local irritation.
Patch may be applied to any hairless area of skin.
Remove old patch and wash with soap and water because all traces of nitro should be removed and remain off for 10-12 hours/d.
Date and initial patch.

27
Q

Pt admitted with diagnosis of bradydysrhythmia, what finding requires immediate intervention?

A

Weakness and fatigue- Brady can lead to inadequate circulation causing weakness and fatigue- this requires immediate intervention.

(Weight gain 0.5 lbs, and pedal pulses 1+ don’t require immediate intervention. Last bowel movement days ago may cause strain/vagal but isn’t most important)

28
Q

Post CABG surgery sign of cardiac tamponade?

A

BP 140/82 on inspiration and 154/90 on expiration- pulsus paradoxus- BP 10 mmhg higher on expiration than inspiration

29
Q

Pt with dilated cardiomyopathy, having difficulty completing daily 1 mile walk, this is a finding of what?

A

Left ventricular failure- activity intolerance

30
Q

Pt receiving heparin for DVT tx, aPTT is 96 seconds, what should nurse do?

A

Stop the heparin infusion immediately- the aPTT is above the therapeutic range of 2 x the control value. Stop heparin to prevent harm to pt.

31
Q

Fresh frozen plasma transfusion affects?

A

Prothrombin time- FFP is rich in clotting factors, given to treat acute clotting disorders, desired effect is to reduce PT.

32
Q

Suspected dissecting aortic aneurism, monitor for what?

A

Back pain- cardinal sign.

Also hypotension and tachycardia.

33
Q

Clinical manifestations of fluid volume excess?

A

Jugular venous distention, decreased hematocrit (hemodilution), hypertension, tachycardia, bounding pulses

34
Q

Pt with angina scheduled for percutaneous transluminal coronary angioplasty (PCTA), what does it do?

A

Dilates an obstructed coronary artery. Catheter with balloon inserted into obstructed artery, balloon is inflated and compresses plaque against wall, dilating artery.

35
Q

Pt with pernicious anemia requires?

A

Monthly injections of vitamin B12. They lack the intrinsic factor to absorb vitamin B12 from the GI tract.

(Iron deficiency anemia(decrease in RBC caused by inadequate intake of dietary iron) need ferrous sulfate supplementation.
Megoblastic anemia- decrease in RBC caused by folate deficiency. Aplastic anemia- may need blood transfusion.)

36
Q

CHF r/t mitral stenosis. Dyspnea because?

A

Fluid accumulation in lungs- defect in mitral valve will cause backup of blood in the pulmonary vein.

37
Q

CM of right sided CHF?

A

Peripheral edema- blood back up into body.

38
Q

Pt receiving blood gets itching and hives, what to do?

A

Stop the infusion of blood. Allergic reaction.

39
Q

Pt hx arteriosclerosis obliterans. Expect what CM in lower extremities and ankles?

A

Thin shiny skin with minimal body hair (disease causes narrowing of blood vessels in arteries of legs and feet, decreased blood flow to distal extremities, tissue damage, common s/s- intermittent claudication, cold or numb feet, loss of hair, weak pulses.)

(Venous- areas of reddish brown pigment

40
Q

Pericarditis CM?

A

Dyspnea with rapid respiratory rate. Also tachypnea, chest pain increases with deep inspiration due to increased pressure on the inflamed pericardial sac. Pt is reluctant to take a deep breath- dyspnea and tachypnea.

(Chest pain decreases when sitting upright, widespread ST segment elevation b/c ischemic changes caused by inflammation around the heart)

41
Q

What solution to administer in hypovolemic shock?

A

0.9% NaCl- used for acute volume expansion. Also LR. Replaces lost volume.

42
Q

Flattened Twave or development of U wave is caused by?

A

Low potassium level 2.8

43
Q

Digoxin

A

Therapeutic range 0.8-2.

Bradycardia, ventricular bigeminy, or ventricular tachycardia occur with toxic levels.

44
Q

Lifestyle changes after MI

A

Limit food high in saturated fat
Count radial pulse before taking meds
Exercise 3x/wk for minimum of 20 min
After eating rest

45
Q

MI 24 hours ago. Assess for?

A

Ventricular dysrhythmias-electrical conduction system of the heart can be irritable and prone to arrhythmia. Ischemic tissue can interfere with normal conduction patterns of the hearts electrical system.

46
Q

Abdominal aortic aneurism is extending. CM?

A

Back and abdominal pain- aneurism is extending downward and pressing on lumbar spinal nerve roots causing pain.

(Also deceased BP will occur)

47
Q

Acute angina attack, monitor for?

A

Transient abnormal PMI (point of maximal impulse)- because of change in compliance of left ventricle

(Also tachycardia)

48
Q

Cardiac confusion. Blunt chest trauma usually results in damage to what?

A

Right ventricle- directly behind the sternum. Impact of the RV against the sternum causes great damage.

49
Q

Recent MI. Sudden sob, air hungry, frothy pink sputum. What breath sounds?

A

Crackles- recent MI at risk for CHF. Fluid in lungs.

50
Q

Post vein ligation and stripping for varicose veins, positioning?

A

Spine with legs elevated 15 degree angle. Promote venous return by gravity

51
Q

Health benefit of flaxseed oil?

A

Omega 3 fatty acids- lower risk of cv disease

52
Q

Epoetin Alfa (epogen)

A

Takes 2-4 weeks to work.

Treats anemia, increases and maintains RBC level.

53
Q

Sickle cell disease

A

Risk for iron toxicity becAuse many transfusions, excessive storage of iron in body- hemosiderosis.

54
Q

Late indication of FLuid volume overload

A

3+ pitting edema

Early signs- decr urine output, high BP, weight gain 1 kg

55
Q

Aplastic anemia CM

A

Pancytopenia, fatigue, pale mucous membranes, dyspnea on exertion. (RBC, WBC, and platelets are reduced or absent)

56
Q

Polycythemia Vera CM

A

headaches, paresthesias, dizziness

57
Q

Pernicious anemia CM

A

low levels b12, macrocytosis, SOB

58
Q

Sickle cell anemia CM

A

vascular occlusions, fatigue, joint pain

59
Q

ARF pt has drop in blood pressure and urine output. What med to give?

A

Dopamine- low dose 1-3 mg, in pts with oliguric renal failure will enhance blood flow to kidneys and increase blood pressure

ATI Cards (10 decks)

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