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CCRN > CV review > Flashcards

CV review Flashcards

1
Q

Which IV fluid should be avoided in patients with cerebral edema? and why ?

A

Hypotonic solution, it can reduce serum osmolality and create a fluid shift that increase cerebral edema

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2
Q

Proper timing of the IABP requires identification of the _______, correlating with the closure of the ____ ____and the beginning of the ______. In order to visualize the dicrotic notch; the IAP setting my be ____ : ____.

A

Dicrotic notch; aortic valve; diastole; 1;2

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3
Q

Proper inflation timing of the IABP is confirmed when the ______augmentation occurs at the _____ ___ or the beginning of the _______ The entire cycle of inflation and deflation occurs during the ________ and _______

A

Diastolic; dicrotic notch; diastole; beginning of diastole; end diastole

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4
Q

A serious known complication with the IABP is ____________

A

Limb ischemia.

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5
Q

Potential complications associated with removal of Swan-Ganz catheter?

A

Pulmonic valve rupture Air embolism Ventricular arrhythmia

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6
Q

The Swan-Ganz catheter is placed in the__________ artery through the ______(left or right) heart

A

pulmonary ; right

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7
Q

In order to delay the progression of ______ventricular failure for patients with pulmonary artery hypertension, effective treatments is aimed at reducing the _______ which will (increase/decrease) _____afterload for the right ventricle

A

right; PVR; decrease

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8
Q

NYHA Class I

A

No limitation of physical activity

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9
Q

NYHA Class 2

A

Slight limitation of physical activity, comfortable at rest. ordinary physical activity results in fatigue, palpitations, dyspnea.

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10
Q

NYHA Class 3

A

Marked limitation of physical activity less ordinary physical activity results in fatigue, palpitations, dyspnea.

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11
Q

NYHA Class 4

A

Unable to carry any physical activity without discomfort

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12
Q

Inadequate cardiac pumping causes ______ _____ to back up into the _____ and ______ leading to _______ CVP

A

excessive volume; lungs; right ventricle; Elevated

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13
Q

Common precipitator of cardiogenic shock is

A

MI

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14
Q

Beta blocker (increase/decrease)_____ cardiac contractility therefore (increase/ decrease) cardiac index

A

Decrease

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15
Q

Which class of antiarrhythmic medications has been shown to reduce cardiac mortality most significantly in patients with heart failure and reduced EF? _____which are_____

A

Class II; beta blockers

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16
Q

Class I of antiarrhythmic medications include:

A

Sodium channel blockers

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17
Q

Class II of antiarrhythmic medications include:

A

Beta blockers

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18
Q

Class III of antiarrhythmic medications include

A

Potassium channel blockers

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19
Q

Class IV of antiarrhythmic medications include

A

Calcium channel blockers

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20
Q

__________improve mortality related to Stroke

A

Calcium channel blockers

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21
Q

Which of the following malignancies is the most common cause of cardiac tamponade?

A

Lung Carcinoma

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22
Q

Unexplained new R-waves and anterior ST depression indicate __________

A

posterior MI

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23
Q

Dronedarone is contraindicated in which kind of HF patients NYHA _____(class)

A

NYHA Class III and class IV

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24
Q

True or False: beta blockers do not have to be stopped in patients who was taking BBlockers prior to HF diagnosis

A

True. Starting will make worse, continuing existing beta blocker doesn’t affect

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25
Q

Cardiogenic shock is associated with _______pulmonary capillary wedge pressure, ________, ________cardiac output, ________SVR

A

Elevated; low; increased

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26
Q

Septic shock is associated with _______pulmonary capillary wedge pressure, ________, ________cardiac output, ________SVR

A

low; initial high; low

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27
Q

Hypovolemic shock is associated with _______pulmonary capillary wedge pressure, ________, ________cardiac output, ________SVR

A

low; low; high

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28
Q

Autoimmune reaction from sensitization to myocardial cells at time of myocardial infarction is called _______syndrome

A

Dressler

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29
Q

Action of digoxin in heart failure is to the _________ of ______pump resulting in an increased in _____________ and promoting _________through the __________pump which increases________

A

inhibition; Na-K-ATPase ; intracellular sodium; calcium influx; sodium-calcium; contractility

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30
Q

Secondary cause of sudden hypertension in young adults is ________ and is usually the result of _______. Pt will have (hyper or hypokalemia) and may have ______ on exam

A

Renal artery stenosis; Fibro muscular dysplasia; hypokalemia; renal bruit

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31
Q

Hypocalcemia would show __________on an EKG tracings; an appro

A

Prolonged QT;

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32
Q

______ HF is best characterized y a stiff ventricle which requires an adequate ____ ____ to generate adequate ____ ____

A

Diastolic; filling pressure; stroke volume

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33
Q

Which condition predisposes a patient to have esophageal varices bleeding? why?

A

End stage liver disease; because ESLD can lead to prolonged PT and aPTT> that can lead to portal HTN

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34
Q

For treatment of DKA, ____ activates ____ _____ _____ in many cells, causing _______ to enter cells and _________serum ______Levels

A

Insulin; Sodium-Potassium ATPases; potassium decreasing; potassium

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35
Q

A pacemaker spike that is not followed by a complex indicates a

A

FAILURE TO CAPTURE

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36
Q

When the pacemaker fails to sense the heart’s intrinsic activity it is ___________; In that case, _______ _____ can be indicated

A

failure to sense; increase sensitivity

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37
Q

When the pacemaker is over-sensing, as evidenced by the ______ ____ _______ ____, ______ should be decreased

A

absence of pacemaker spikes; Sensitivity

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38
Q

Optimal CPP is considered to be ___ to ____ mmHg

A

50-70

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39
Q

CPP is

A

MAP-ICP

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40
Q

Recommended ventilator setting include minimizing _____ to maintain a _______ above _____ and decreasing _______ ____ to a ______ ____ goal of ________cm H2O

A

FiO2; PaO2, 55; Tidal volume; Plateau pressure; <30cmH20

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41
Q

Cushing’s triad includes: _____, ______ and ______ ____ _and is associated with ________ ICP due to several factors including ____ _____, _____ and _____

A

Hypertension, bradycardia, irregular respiration. elevated, cerebral edema, bleeding and tumor

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42
Q

Excessive vomiting or gastric suctioning can result in loss of ________ _______ which can lead to which ABG abnormlity?

A

Hydrochloric acid; metabolic alkalosis.

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43
Q

The clinical presentation of hypovolemic shock is related to

A

the inadequate volume of circulating blood

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44
Q

Kussmaul respirations occur in _____ and Is to correct _____ ______

A

DKA; Metabolic acidosis .

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45
Q

FLuroquinolones Levofloxaxin or ciprofloxacin can lead to _________

A

Rupture tendinitis

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46
Q

Why are corticosteroids dangerous in patients with post MI pericarditis? It inteferes with __________of MI to _________resulting in _______and increased risk for _______________ wall rupture.

A

conversion; scar tissue resulting in wall thinning and increased risk of post-MI wall rupture.

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47
Q

Short acting ACEI

A

Captopril , start if unsure of reaction to ACE

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48
Q

best point of auscultation for S2

A

Erb’s point

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49
Q

The aortic valve area is located under the ______right ______space at the _____sternal border.

A

second; intercostal; right

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50
Q

The tricuspid valve area is located at the ______, ______space at the _____sternal border.

A

fourth, left; intercostal; left

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51
Q

The mitral valve area is located at the ______, ______space at the________ ______.

A

Left fifth intercostal; mid-clavicular line.

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52
Q

The pulmonic valve area is located at the ______, ______space at the________ ______.

A

second left intercostal; left sternal border

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53
Q

The key to accurate ICP measurement is to use the ______________ which is the _________ or the __________. The landmark is to approximate the __________ of _______

A

same landmark each time ; tragus of the ear; outer canthus of the eye ; foramen of monro

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54
Q

Metabolic acidosis should not be corrected with bicarbonate until pH is _______ and bicarbonate is ___________

A

<7.1 ; 6

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55
Q

CVP reading is reassessed by re-performing _______, ______ and a ______ ____ ____ test

A

zeroing, leveling; square wave form

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56
Q

Additional oxygen should not be withheld due to fear of __________. Goal of patient with resp distress is to maintain sufficient oxygen to achieve SaO2 > ________ and PaO2______

A

losing hypoxic drive; 88%; 55mmhg

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57
Q

Rapid Shallow Breathing Index less than _______ breaths/min/L may predict _____success. and the formula is _____/ (TV/1000)

A

105; vent weaning; RR

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58
Q

Patient with rapid afib lose adequate (atrial or ventricular filling)_________ in addition to loss of _______ _____. as a result , SV is ______resulting in (hypo/hypertension) _____

A

ventricular filling; atrial kick; decreased; hypotension

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59
Q

Defibrillation may cause _________ _____if the electrical current lands on the second half of the ______ , which is the ______ _______ _______. May consider _______for immediate intervention with cardioversion

A

ventricular defibrillation; T wave, absolute refractory period; Amiodarone

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60
Q

The main difference between cardioversion and defibrillation is ___________ based on the

A

the timing of the shock ; cardiac cycles

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61
Q

Synchronized cardioversion senses the _______ _______and delivers a shock during the __________stage of the cardiac cycle, avoiding delivery of shock on the________which may lead to _______ _______

A

QRS complex; repolarization stage; T wave; ventricular fibrillation

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62
Q

ARDS patients have the best outcomes when tidal volumes are ______. Tidal volume of ____ml/kg

A

low; 6

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63
Q

In patients with cholestasis, the__________ is typically elevated to at least four times the upper limit of normal.

A

alkaline phosphatase

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64
Q

Increasing ______in ARDS may improve ________and in combination with low _______ventilation, improve ________

A

PEEP; oxygenation; tidal volume; mortality

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65
Q

Status epilepticus is continuous seizure lasting more than _______minutes or _____or more seizures without full ________of ________. Accumulation of metabolic waste products (lactic acid) and inefficient _______and _____exchange. leading to _____and _______, and ______

A

30; two; recovery of consciousness; oxygen; CO2; hypercapnia; hypoxia, ACIDOSIS (low pH)

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66
Q

According to the ARDS net protocol, VT should be adjusted to maintain Plateau pressure ________ to prevent _______

A

less than 30mmHg; barotrauma

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67
Q

Low tidal volume ventilation begin at ______and volume can be adjusted downwards to _____

A

8ml/kg to 6ml/kg

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68
Q

How often do we check plateau pressure

A

4 hour after change in PEEP or Vt

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69
Q

Central Neurogenic Diabetes insipidus is characterized by (increased/decreased urinary specific gravity_________, increased/or decreased urine osmolality ________ (value ) serum osmolality is (increased or decreased) ________and urine output is (increased or decreased).

A

decreased; decreased; increased serum; increased urine output

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70
Q

SIADH is characterized by (high /low Na+) ; urine output (H/L)_____specific gravity (H/L)

A

low; low; high

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71
Q

Goal in CN Diabetes insipidus is to correct the_________and restore fluid balance by promoting _________and ________retention

A

ADH deficiency; sodium; water

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72
Q

In the acute phase of CNDI, _________ ____is provided in the form of either _______, ________, _______

A

desmopressin, vasopressin or lypressin

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73
Q

CNDI occurs in 3 phases; First phase consists of ___________due to inhibition of ________. Second phase is ____ t_____urine output because the release of ___________. The third phase is _______or ____excessive _________due to depletion of stored _____ or loss of functioning ____that produce ______

A

polyuria; ADH; near-normal; stored ADH. transient or permanent urine output ; ADH; Cells; ADH

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74
Q

Cicatracurium infusion is a ________and require the use of ___________such as __________

A

paralytics; sedation; propofol

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75
Q

When caring for an External Ventricular Drain, the ECV can be _______during transport to prevent excessive _______with a change in body position

A

closed; draining

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76
Q

When caring for an External Ventricular Drain, the ECV can be temporary closed for ______,______, _____,________ to prevent excessive draining

A

crying; sneezing, vomiting; coughing.

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77
Q

ARDS is an _________lung condition that leads to _____of ______and _____of blood and plasma into air space, resulting in low ______levels in blood

A

inflammatory; injury ; lung tissue; leakage; oxygen

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78
Q

ST elevation in II, III, aVF is __________occlusion and indicate _______wall MI

A

Right coronary artery; inferior.

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79
Q

ST elevation in I, V5, V6 is __________occlusion and indicate _______wall MI

A

Circumflex artery; lateral

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80
Q

ST elevation in V1-V4 is __________occlusion and indicate _______wall MI

A

Left anterior descending (LAD) ; anterior (REMEMBER (LAD-ANT)

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81
Q

What is the greatest determinant of oxygen delivery?

A

Cardiac output

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82
Q

3 things about Spontaneous Breathing Trial (SBT ) : - should shorten ____________ - Should follow the _______ _______after_______ - Require active collaboration between _______ and _________

A

time to extubation; Awakening trial; sedation; respiratory therapist ; critical care nurse.

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83
Q

Central cord syndrome results from trauma and is associated with damage to the __________ ______ that carry information directly from the _____ _____ to the ____ _____

A

large nerve fibers; cerebral cortex; spinal cord.

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84
Q

Complications most frequent during acute hospitalization for SCI include ____, _____, _____

A

resp failure, pulmonary edema, PNA, and PE

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85
Q

Which medication should the CC nurse anticipate for a patient with suspected malignant hyperthermia?_________________

A

DANDROLENE

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86
Q

Dandrolene interferes with __________ _______by inhibiting ______ion release from the _______ _________. The initial dose is _______mg/kg , should be repeated every ________ until reversal of the reaction occurs or a total dose of _____ is reached. If there is an insufficient response, another ________ should be considered

A

muscle contraction; calcium; sarcoplasmic reticulum. 2.5; 5 minutes; 10mg/kg

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87
Q

In malignant hyperthermia, there is a massive increase in ______, one of the early signs is a high ____________, despite an increased in minute ventilation setting on the ventilator.

A

CO2, END tidal CO2

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88
Q

A low ScVO2 is a reflection of decreased ________ or increased ___________. In malignant hyperthermia, ScVO2 is __________ due to significantly increased ______ ________

A

oxygen delivery; O2 consumption; decreased; oxygen consumption

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89
Q

Hypotonic solutions such as ______ and ______ may worsen intracranial hypertension and are contraindicated

A

D5W and NS

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90
Q

Hypotonic solutions such as ______ and ______ may worsen intracranial hypertension and are contraindicated. _________, helps reduce the risk of seizures; ________osmotic effects can help decrease elevated intracranial pressure. _________ increased metabolic rate and ________ _______, so prompt _______ is indicated for patients with intracranial hypertensive.

A

D5W and NS; Antiepileptics; Mannitol; Fever; promotes vadodilation. fever treatment.

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91
Q

It was initially believed that hyperventilating resultant _________ would decrease the blood flow and thus decrease _______. Studies shown that ____________ leads to _____ _____and worsened outcomes..

A

vasoconstriction;’ ICP; hyperventilation; cerebral ischemia.

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92
Q

______and _________Reduce patient ventilator dyssynchrony

A

Sedation and paralysis

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93
Q

ECMO allows external _____ of _______ and addition of _______ to blood , a process inhibited in ________

A

removal ; CO2; O2 ; ARDS

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94
Q

the risk of high dose PTU is

A

Sudden and sever liver failure

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95
Q

One of the criteria for diagnosis ARDS is respiratory failure not fully explained by _______ or _______

A

cardiac failure or fluid overload

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96
Q

ARDS is due to _______ ______ producing diffuse ______ _______; lung compliance is __________ and there is impaired ______ ______ due to _______-______mistmatching

A

Alveolar injury; alveolar damage; gas exchange; ventilation-perfusion

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97
Q

Common associated with patients receiving continuous infusion of dexmdetomidine?

A

hypotension , bradycardia

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98
Q

Management of TBI include adequate _____ _____ to avoid _____ _____. CPP should be maintained at least ______mmHg, ICP should be < ___ -__mmHg. If needed, ________ should be given.

A

Blood pressure; cerebral ischemial 60; 15-20; diuretics

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99
Q

In patient that is status epilepticus, the priority is to stop ________ and first line treatment is __________ and one medication is -_________ and should be given as soon as possible

A

seizing; benzodiazepines; lorazepam

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100
Q

CPP is an indicator of the pressure driving ________ ____

A

cerebral blood flow

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101
Q

CPP can be increased by raising ________ using _______ or by lowering ________ using ________,_______ or _______

A

Blood pressure; vasopressors; ICP; ventriculostomy drainage; sedation, or mannitol.

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102
Q

CPAP and BIPAP machine decreases the _________ and decreases _______ ____, opens ______ ____ and increases the _______ _______ of oxygen.

A

work of breathing, intrapulmonary shunt; collapsed alveoli; driving pressure

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103
Q

After a Transsphenoidal hypophysectomy, there is an increased risk of insufficient_______ _____ resulting in _______ ______.

A

ADH release; Diabetes Insipidus.

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104
Q

____________can be used to reduce patient-ventilator dyssynchrony

A

Neuromuscular blockade

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105
Q

It is imperative for sedation to be given with ________ medications

A

paralytics

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106
Q

Synergy Model, clinical inquiry is the ongoing process of ______ and ______ practice and creating -_______ changes through research ________ and ______ learning

A

questioning; evaluating; practice; utilization; experiential

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107
Q

The ability to facilitate learning for patients/families, nursing staff, other members of the healthcare team, and community. Includes both formal and informal facilitation of learning

A

facilitation of learnig.

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108
Q

Abdominal perfusion pressure is ______________ minus ____________

A

MAP- intra-abdominal pressure; normal pressure range from ___ to ____ mmHg

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109
Q

Intraabdominal pressure above ______ is intra abdominal ___________

A

12 mmHg: Hypertension

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110
Q

In critical care, BS is best maintained below _________

A

180

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111
Q

Mainstay of diagnosis of SAH is ____________ with or without _____ _____. if both negative, it effectively __________ the diagnosis of SAH. if still in doubt _____ _______ should be considered

A

Non-contrast head CT; lumbar puncture; Cerebral angiography

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112
Q

Characteristic of SAH initial symptom is _________ described as the ____ ____ ____ . In addition _________ are common. Patient mental status may vary from _____ to _____ ______

A

sudden headaches; most painful ever; mental status changes; awake; deeply comatose.

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113
Q

Hydrocephalus after SAH is caused by obstruction of _______ flow by blood products , it is considered (acute vs chronic)_________or adhesions OR by a reduction of _______ _______ at the _____ _______. It occurs after _____ weeks, more likely to be associated with _____ ______

A

CSF; acute; CSF Absorption; arachnoid granulations; 2 weeks; shunt dependence

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114
Q

Systolic BP is kept between_____________ mmHg before aneurysm securement

A

90-140

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115
Q

Best practices management for ARDS include ________tidal volume and ______PEEP

A

low; High

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116
Q

It is recommended that ARDS patient maintain a CVP of less than ______and a PaOP less than ______in order to ______ ______ _______

A

4; 8; pulmonary microvascular pressure

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117
Q

Low pulmonary microvascular pressure can prevent further ________ _______and potentially allow reabsorption of existing _______ _______

A

pulmonary edema; pulmonary edema

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118
Q

First line of treatment and the mainstay of seizure management is __________

A

benzodiazepines

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119
Q

lorazepam can be given 2mg IV every _____minutes x _____doses

A

2; 5

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120
Q

The goal of treatment of status epilepticus is to ____________ before _______injury occurs

A

stop the seizure activity; neuronal

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121
Q

The second line of treatment in status epilepticus is ____________; A bolus of dose of _____mg/kg and another ____ mg/kg dose can be considered.

A

Dilantin; 20; 10

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122
Q

________lobe masses can manifest in sensory deficits, visual neglect, difficulty with right/left discrimination.

A

Parietal

123
Q

___________lobe masses can include any of the following symptoms: Hemiparesis, visual fields deficits, memory deficits, speech and language deficits.

A

Temporal

124
Q

___________lobe masses can present with hemiparesis, difficulties with high-level functions, personality changes, behavior and mood changes and fluent speech deficits.

A

Frontal

125
Q

CPOT are use for ________ICU patient

A

non-communicating

126
Q

__________ to 30 degree minimizes _____ and optimizes _____

A

HOB elevation ; ICP; CPP

127
Q

__________ can be given to a patient who is shivering. but if ineffective, a _______ agent is highly effective agent when another sedative is not able to control the shivering . _______, _______, ______ are all other agents that can be used for shivering

A

Demerol; Paralytic agent; magnesium sulfate, precede, and propofol

128
Q

Sildenafil is a _________________found in high consentration in the _________prevents the breakdown of ____________ __________ ________ which promotes vascular ____ ____ _____ and decreased ______ _______. For patients with pulmonary HTN, ___________ can improve _______ tolerance, functional class and _____________ hemodynamics.

A

Phosphodiesterase type 5 ; cyclic guanosine monophosphate. smooth muscle relaxation; pulmonary HTN; sildenafil; exercise; cardiopulmonary.

129
Q

Isolated right ventricular dysfunction will lead to ________congestion not,, _____________congestion

A

Vascular; pulmonary

130
Q

SIADH symptoms are (weight gain/loss)_________ (high or low Na+) ______ and high or low urine spec gravity__________

A

Weight gain; low sodium, Anuria, high spec gravity

131
Q

DIC, platelet count is _______because platelets are used up during excessive ______

A

low; clotting

132
Q

Bleeding Esophageal varices treatment (VOB)

A

Vasopression, Octreotide gtt Balloon tamponade.

133
Q

Preferred method of Feeding in ICU, except in _______

A

Enteral ; new onset GIB

134
Q

Is organ failure a contraindication for Enteral feeding?

A

NO

135
Q

Intra-abdominal HTN first step in management

A

Diuretics

136
Q

_______agents are also use in Intraabdominal HTN

A

paralytics

137
Q

______ _____should be monitored in intraabdominal HTN. Normal is ________

A

Bladder pressure, normal is <12mmHG

138
Q

As far as electrolyte imbalances go, Hypocalcemia and _______commonly occur together

A

Hypomagnesemia

139
Q

positive _______sign reflects a twitching of the facial nerve, occur in _____________(what thyroid condition)

A

Chovtestk ; parathyroidism

140
Q

About ________of calcium in plasma that is biologically active is in ionized form

A

1/2

141
Q

_________of _________ provides 3x more calcium compared to ______ ______

A

1 g of calcium chloride; Calcium gluconate

142
Q

Low ionized calcium in renal failure is related to __________ ______

A

Phosphate retention

143
Q

Diagnostic criteria for AKI

A

increase in Cr 1.5X baseline increase in Serum Cr > or equal 0.3 in 48 h

144
Q

Arrhythmia associated with both low K and low mag

A

Torsade de pointes

145
Q

2 drugs to watch for prolonged QT

A

Sotalol and Haloperidol

146
Q

Fluids Contraindicate in SIADH is________ ______, it worsens ___________

A

hypotonic solution; hyponatremia

147
Q

Medication that does not decrease K+ __________________ because it is a

A

spironolactone; potassium-sparing diuretics

148
Q

In a patient with DKA, do not initiate insulin Gtt until serum K is ________

A

at least 3.3

149
Q

ACid base imbalance in DKA is and also is _________respitations

A

Metabolic acidosis; Kussmal’ respirations

150
Q

Spleen’s role in lymphocyte production and ______- ___ stimulation it is intergral part of the ________system. Monitor splenectomy patient for _______

A

B cell; immunological . infection

151
Q

In Hyperkalemia, ________ activates ____ ____ in many cells, causing _____ to enter cells and _____serum _____

A

Insulin; Na+K+-ATPase , K+; decreasing ; potassium

152
Q

Symptoms of DI are : _________, (H/L) Spec gravity , (H/L) Na+ , and presence of _____ ______

A

polyuria, low; high; Pituitary tumor

153
Q

Treatment of SIADH (HDV)

A

Hypertonic saline Dietary fluid restriction Vasopressin-receptor antagonists (TOLVAPTAN)

154
Q

In DKA, ______shift from intracellular to extracellular in response to _____ _____(acid base imbalance)

A

K+; metabolic acidosis

155
Q

Which dose is not given to ET tube in case IO access cannot be obtained?

A

AMIODARONE

156
Q

Calculate MAP formula is

A

Systolic BP + 2 (DBP) / 3

157
Q

Asian males and from Thailand at risk for

A

BRUGADA SYNDROME

158
Q

LBBB will show slurring in R wave in which leads

A

I and V6

159
Q

CO =

A

HR x SV = Cardiac output in ml then convert to Liters

160
Q

MRSA

A

gram positive coverage with Vancomycin

161
Q

Anaerobes Cover with

A

metronidazole

162
Q

Diflucan will be used for

A

Fungal

163
Q

post op fever differentials: Inflammatory response/ cascade, SIRS

A

PE (DVT) ; incisional abscess, lines, tubes, NG tube (sinusitis)

164
Q

Normal SVR

A

800-1200 dynes

165
Q

Normal PVR

A

<250 dynes

166
Q

Normal CVP

A

2-6 mmHg

167
Q

An _______ heart sound is caused by volume overload of the ventricle and is associated with heart failure

A

S3

168
Q

A pericardial friction rub is heard in what condition______usually as a results of ________

A

Pericarditis; MI

169
Q

An _________ heart is heard when ventricle is stiff, such is found in _________

A

S4; hypertension

170
Q

A systolic ejection fraction is caused by ________ or ________of a valve

A

Stenosis, regurgitation

171
Q

What is the major side effect of Nesiritide? If it occurs the nurse should _____________or_______. She should ________ her patient to encourage improvement in BP . When BP is adequate, restart infusion at ______________than the original infusion

A

Hypotension; decrease infusion by 30%; shut it off; reposition; 30% less

172
Q

Because all four chambers of the heart are enlarged, _________cardiomyopathy patients are at risk for _________ they should be _________With _______

A

Dilated; MI, PE, DVT; anticoagulated with Warfarin.

173
Q

As a compensatory mechanism in cardiogenic shock the _______nervous system and _______system will be initiated, there will vasoconstriction and retention of sodium and water. Preload is _______ in cardiogenic shock

A

Decreased

174
Q

In chest tube, the water seal chamber as as a _________ between the patient’s _______ and the _______,thereby preventing the ______and fluid to re-enter the ______ cavity.

A

barrier; lungs; environment; air ;pleural

175
Q

Temporal Lobe is known as the _________ area which affects _____________. Damage of Wenicke’s area leads to the inability to _______ ______and ______ _______. This is identify as __________ _______

A

Wenicke’s , verbal reception; interpret speech; comprehension of words; Wecnike’s aphasia.

176
Q

Damage to left frontal lobe or right frontal lobe can cause

A

Expressive aphasia

177
Q

Patient with bleeding esophageal varices, should protect _________and vasoconstrictors such as _________ -and high dose of _________ would be first to stop bleeding and increase BP

A

Airway; octreotide, Vasopression

178
Q

Chronic __________ result in the release of digestive enzymes in the body including _________A2. It breaks down the cellular structure of the __________ beds and endothelium and leading to tissue damage throughout the body _________

A

Pancreatitis: Phospholipase A2; capillary; MODS

179
Q

CO

A

4-8

180
Q

Dizziness and palpitations during drain phase in peritoneal exchange is because

A

too-rapid fluid shift leading to a vagal response.

181
Q

What is the best method of monitoring dialysis effectiveness during dialysis?

A

Rate of urea clearance.

182
Q

In treating DKA, once the glucose level is less than _________, Fluid ______should be started to slow the drop in glucose and slowly correct the ________ to less than ____ .

A

300; D5NS; Anion Gap; 20.

183
Q

The patient failed to respond to the initial insulin infusion dose, because it should drop serum glucose by ________ if not -____________the infusion rate

A

50mg/Dl; double

184
Q

Definite treatment of DIC

A

Treatment of underlying or potential causes

185
Q

Complication of blood transfusion is __________. When the cell lysis, _________ is released. Monitor electrolytes after _______ PRBCS

A

Cell lysis; intracelluar potassium; 2 units

186
Q

When after liver involvment, be careful when starting

A

Statins

187
Q

Normal Urine output

A

0.5ml/kg/hr

188
Q

What is normal SVO2

A

60-80%

189
Q

The _________phase is the phase in which urine output is the lowest . Administering fluids at this time will not result in increased _______ but in a greater ______ ________

A

OLIGURIC ; Urine output; fluid retention

190
Q

The _________the kidney are putting out large amounts of fluid; but not filtering;Fluid intake is required to preven t________

A

non-oliguric phase; hypovolemia

191
Q

The tidal volume settings for a patient with ARDS

A

5-8ml/kg

192
Q

The tidal volume settings for a patient with ARDS_______

A

5-8ml/kg

193
Q

Excessive tidal volume and high PEEP increase the risk for _________ and ___________

A

Volutrauma and bauratrauma

194
Q

What is the preferred vent mode for a patient receiving neuromuscular blockade?

A

Assist control

195
Q

ITP (idiopathic thrombycytopenia purpura) is a result of

A

Low platelet count; autoimmune

196
Q

Severe complication when an ileostomy is placed

A

DEHYDRATION

197
Q

Normal Doll’s eyes_____________ reflex; the eyes appear to move to the _______direction of head turn. it represents _______and ______damage and may be part of the clinical exam to help determine _____ _____

A

oculocephalic ; opposite; pontine; midbrain; brain death.

198
Q

Requires the patient to be hemodynamically stable ______

A

hemodialysis

199
Q

ASH

A

Syncome, heart failure, Angina (Significant mortality fro it )

200
Q

GB is a ________ weakness; impaired _______function; ______ pain. Death is usually from ________if the _______muscles leading to _____ ______ ______

A

Motor; respiratory ; acute; weakening; respiratory; acute respiratory distress.

201
Q

DI usually present with H/L BP with H/L HR and Hypovolemia due to

A

Low; High ; increased urinary output

202
Q

Low _________will result in numbness and tingling to extremities

A

Magnesium

203
Q

Elevated ICP would result in

A

Widened pulse pressure, pupillary changes and posturing

204
Q

Aggressive correction of hyponatremia result in ___________which results in ______and _______of brain cells. If not corrected lead to _____ _____ ____

A

Osmotic demyelinization; shrinking; lysing ; quadriparesis; flaccidity and neurological deficits.

205
Q

Blunt/penetrating trauma to the right rib 7-9th ribs and complaining of RUQ tenderness, monitor for signs of

A

LIVER LACERATION

206
Q

wait for cocaine to be removed from system before beta blocker is ____________Coronary artery spasms.

A

constriction occurs with both ; Beta blockers will constrict, cocaine

207
Q

Cocaine is a sympatomimetic ; ALPHA STIMULANT;

A

Jittery, high BP,

208
Q

Blunt/penetrating trauma to the left rib 9-10th ribs and complaining of LUQ tenderness, SHOULDER PAIN monitor for signs

A

SPLEEN INJURY

209
Q

Blunt/penetrating trauma to the left rib 9-10th ribs and complaining of LUQ tenderness, SHOULDER PAIN monitor for signs . Peritoneal signs are delayed until

A

SPLEEN INJURY : adequate blood accumulates to peritoneum

210
Q

List the 3 major components of tissue perfusion or oxygen delivery:

A

Cardiac output, PaO2 and Hemoglobin

211
Q

Cardiogenic shock is associated with HR that is ______BP that is ______Cardiac output that is _______, PaOP that is _______and SVR that is _________. Same hemodynamics value in hypovolemic shock except that PaOP is _____

A

HIGH; LOW; LOW; HIGH;HIGH

212
Q

In cases with suspected hypovolemic shock, watch for _____

A

Vomiting, diarrhea, poor po intake

213
Q

Benzodiazepines overdose is usually link with which acid base imbalance and why ?

A

RESPIRATORY ACIDOSIS; because benzo overdose lead s to increase serum carbonic acid

214
Q

_______can treat sepsis with persistent hemodynamic instability

A

Steroids (hydrocortisone)

215
Q

List SIRS criteria and parameters to measure:

A
  1. RR > 20 breaths/min 2. HR > 90bpm 3. Hypothermia <36C (96.8) or hyperthermia >38 , 100.4 F 4. WBC >12000 or less than 4000, >10% immature bands. 5. PaCO2 <32 mmHg
216
Q

Pulmonary artery pressure measures (R or L)

A

Left pressure

217
Q

Normal wedge pressure

A

< 15 mmHg

218
Q

In cardiac tamponade

A

Normalized high PA, wedge pressure and eventually equalized.

219
Q

SVR calculating formula

A

MAP-CVP/ CO x80

220
Q

Dobutamine + Dry patient

A

Arrhythmias

221
Q

Only give Bicarb when pH is less than ____and bicarb less than _____

A

7.2; 12

222
Q

Elevated liver functions

A

FFPs indicated unless contraindicated.

223
Q

Platelets non functionants

A

ESRD Leukemia

224
Q

Octreotide is given because

A

Reduce splanchnic blood flow, inhibit gastric acid secretion, and may have gastric cytoprotective effect

225
Q

GIB interentions: Patient must be ______for blakemore tube,

A

Octreotide, Blakemore tube ,

226
Q

HGB increase___ after 1 unit; HCT ____

A

1-2 per unit for Hgb 2-3 per unit for hct

227
Q

pre-albumin

A

not affected by volume status or calcium

228
Q

pre-albumin Why more accurate ?

A

not affected by volume status or calcium

229
Q

Chronic liver patients with low sodium because

A

Liver disease patient because of third spacing

230
Q

CaO2 is _________ oxygen content, calculated with formula

A

arterial ; CaO2 = 1.34 x hemoglobin concentration xbSaO2 + (0.0031 x PaO2)

231
Q

Causes of pericardial effusion

A
  1. uremia 2. cytology/malignancy 3. Anticoagulation 4. Trauma
232
Q

To decrease VAP

A

Oral care with chlorhexidine and moisturizer lip balm Daily wean trials Cuff pressure 20-25 cmH20 Changing ventilator circuits only when soiled HOB 35-45

233
Q

Sensory and motor impairment occurs in injury below nipple like

A

T3 and T4

234
Q

Decreased FEV1/FVC ratio in obstructive lung disease such as__________reduced vital capacity seen in

A

Asthma and chronic bronchitis restrictive lung disease

235
Q

_________followed by loss of consciousness followed by period of brief lucidity followed by decompensation . and most common involved artery is the

A

epidural hematoma; Middle meningeal artery.

236
Q

________________have gradually worsening confusion and pain; source of bleeding is _______veins

A

Subdural hematoma; bridging

237
Q

hypoventilation and hypercapnia can ________(Increase or decrease)

A

ICP

238
Q

Explain Cheyne Stoke respirations. Causes are

A

progressively increase rate and depth of respirations f/b gradually decreasing rate and depth of ventilation and apnea ; Increased ICP, hepatic and HF, meningitis and drug overdose.

239
Q

Peripheral nerve stimulator also known as ___________is administered to assess________when _______blocking agents are given to _________

A

Train of four monitor ; neuromuscular transmission when neuromuscular blocking agents ; block musculoskeletal activity.

240
Q

Describe train of four

A

When 4 twitches are seen, 0-75% of the receptors are blocked. • When 3 twitches are seen, at least 75% of the receptors are blocked. • When 2 twitches are seen, 80% of the receptors are blocked. • When 1 twitch is seen, 90% of the receptors are blocked. • When no twitches are seen, 100% of receptors are blocked.

241
Q

______allows for removal of CO2 and allow O2 entrance

A

ECMO

242
Q

Inhaled , not IV nitric oxide serve as ________vasodilator, and use to decrease shunting and promote oxygenation

A

pulmonary

243
Q

hARD ASS MRS MSD Heart murmur

A

Aortic Regurg =Diastolic Aortic Stenosis: Systolic Mitral regurgitation: Systolic Mitral Stenosis: Diastolic

244
Q

Aortic stenosis characteristics is SAD

A

Syncope Angina Dyspnea

245
Q

In Pulmonary embolism, when the _________vasculature is occluded, Pulmonary artery pressure is elevated, as a result _________is elevated in ______ventricle

A

Pulmonary; afterload; right ventricle

246
Q

Potent vasodilators should be avoided in _______ ______because their vasodilatory effects will cause increased in ______

A

cerebral edema; ICP

247
Q

Reduced FEV1/FVC is seen in

A

COPD

248
Q

Which medication is prescribed after a myocardial infraction to aid in prevention of remodeling________and its action is to block RAAS stimulated by _________

A

ACEI; renal hypoperfusion

249
Q

The normal diastolic pressure in the pulmonary artery is approximately ______mmHg

A

10

250
Q

The diastolic pressure in the right ventricle is close to ______

A

0

251
Q

Findings that suggest proximal migration of the catheter tip back into the right ventricle

A

sudden decrease in the PA diastolic pressure loss of dicrotic notch Ventricular ectopy

252
Q

True or false: Patient with cardiomyopathy have frequent ventricular dysrhythmias.

A

True

253
Q

Useful in systolic dysfunction but detrimental in diastolic dysfunction_________

A

Vasodilators.

254
Q

Acceleration - deceleration injury will most likely cause

A

Shearing of aorta

255
Q

Which lead is the most specific for the patient with occlusion of the RCA, for ST segment monitoring

A

III

256
Q

Classic signs of Hypertrophic cardiomyopathy: syncope, chest pain, _______and _________ like murmur that ________with squatting

A
  • sudden cardiac death, and AORTIC stenosis like murmur that DECREASES with squatting.
257
Q

A serious complication of anteroseptal MI, seen in lead _____ to _____ is

A

V1-V4 ; Ventricular septal rupture

258
Q

A serious complication of Inferior wall MI seen in lead ____ ____ ____ is ______–and the murmur is loudest at the _____ and the clinical presentation resembles_____

A

`II, III, avF ; Papillary muscle rupture; apex; Acute pulmonary edema

259
Q

Describe the voltage criteria for left ventricular hypertrophy?

A

Depth of S wave in V1 or V2 + Height of R wave V5 and V6 is 35mm or greater

260
Q

Nestiride is contraindicated in ______shock because of its _______and that shock is associated with low

A

cardiogenic; vasodilatory; heart rate.

261
Q

The first stage of compensation in HF is stimulation of ________nervous system which causes _______ and ______ These effects increase myocardial _______consumption and diminish time for ______filling.

A

sympathetic; vasoconstriction ; tachycardia; oxygen, diastolic.

262
Q

The 2:1 block can be type I or type II because with 2;1 block there is not __________

A

progressive lengthening of the PR interval.;

263
Q

Type I block is a block at the _____node

A

AV

264
Q

Type I block is a block at the _____node; And because the ___usually is supplied by the ______ ____-artery Type I is seen is ____MI

A

AV; AV node; Right coronary; inferior

265
Q

Type II block is a block at the ___________And because the ___usually is supplied by the ______ ____-artery Type II is seen is ____MI

A

Bundle of His; bundle of His; Left anterior descending ; anterior

266
Q

2:1 AV block is more likely to be type ____ if the _____is wider than ______

A

II; 0.11 seconds

267
Q

The SA noted is supplied by _____ or ______ _____ _______ artery

A

right or left.

268
Q

Type I block is also called

A

Wenckebach

269
Q

Fever and new murmur indicates______

A

Bacterial Pericarditis

270
Q

Chest pain and pericardial friction rub are seen in ______

A

Pericarditis

271
Q

Chest pain and syncope seen in ________ ________and_____ ____ _____

A

Hypertrophic cardiomyopathy ; severe aortic stenosis

272
Q

Sotalol (beta pace ) has both Class _____ and class ___properties

A

II (beta blockers) III (potassium blockade)

273
Q

The difference between the PAd (Pulmonary artery diameter) and the Pulmonary Artery Occlusive Pressure (PAOP) also called____________ should be _______ or _____if more than ______mmHg, _______is present

A

right to left gradient ; 5mmHg or less; 5, pulmonary HTN

274
Q

IABP is used to ______ ________and increase _______________ ____ _____, when discontinued, watch for signs of

A

decrease afterload; myocardial oxygen supply ; increase afterload; and decrease myocardial oxygen supply

275
Q

Deflation of the IABP should occur at what point in the cardiac cycle _______ because to have the balloon inflated at all during _______ would cause an increase in ______

A

Immediately before SYSTOLE ; systole; AFTERLOAD

276
Q

Drugs contraindicated in hypertrophic cardiomyopathy are ____ ____ and ______ ____

A

Nitrates; Diuretics; positive inotropes, they decrease venous return needed for adequate cardiac filling.

277
Q

The most likely cause of cardiac arrest is ___________ so ______is the top priority

A

Vfib; defibrillation

278
Q

Which muscle maintain normal ______ _____ function therefore ______ valve function? if damaged, what happens? ______ ______ regurgitation

A

left ventricle; mitral ; Papillary muscles. Acute mitral

279
Q

Wolff Parkinson-White syndrome patients should not have which class of medications?

A

Verapamil.

280
Q

Drugs not indicated for severe diastolic dysfunction are______

A

INOTROPES.

281
Q

Wellen’s syndrome is characterized by ____ __ ___ ______in lead ___ and ___ and it is associated with proximal ____ ____ _____ artery disease and a high risk of _____ ____ ____

A

deep T wave inversion ; V2; V3;left anterior descending; sudden cardiac death.

282
Q

Contraindicated in dissecting thoracic Aortic dissection

A

Fibrinolytics

283
Q

Ventricular noncompliance is associated with S—

A

4

284
Q

What is the most common cause of Atrial tachycardias?______ and ______

A

re-entry and accessory pathways

285
Q

What is the most common cause of ectopic beats? __________usually seen with use of ________

A

ENHANCED AUTOMATICITY ; catecholamines

286
Q

most common cause of torsade de pointes

A

Triggered activity related to repolarization problems.

287
Q

___________toxicity in patients receiving nitroprusside longer than _____ hours. That medication may also cause ________ by causing _______ or _________shunt

A

Thiocyanate; 72; methemoglobinemia ; intrapulmonary

288
Q

Nitric oxide, nitroprusside, nitroglycerin, local anesthetics; and hurricane spray and sulfa drugs can all lead to ________________

A

Methemoglobinemia

289
Q

In Methemoglobinemia, _______________is converted to methemoglobin, a non-oxygen carrying form of ________resulting in decrease _______ ________

A

Hemoglobin; hemoglobin; oxygen saturation

290
Q

Treatment of Methemoglobinemia is to first _______ the medication and administer __________the antidote

A

stop; methylene blue

291
Q

The nitroprusside-induced intrapulmonary shunt results in _______ and ________ related to ______ _______ mismatch and admixture of ______________ and _________

A

hypoxia; hypoxemia; ventilation-perfusion; nonoxygenated blood to oxygenated blood.

292
Q

If the ventricles are depolarized before the atria in a junctional rhythm, the p- wave will be __________ the QRS complex

A

after

293
Q

The most common cause of death after vascular surgery

A

MI

294
Q

Mnemonic for location of infarcts

A

LII-LI- ASS (backwards) ALL

295
Q

Mnemonic for location of stenosis

A

(h) ARD- ASS- MRS- MSD

296
Q

Mnemonic for sensory, motor or both CN

A

Some Say Marry Money But My Brother Says Bad Business Marry Money

297
Q

Mnemonic for location for listening to heart sounds

A

All People Enjoy Time Magazine.

298
Q

ABI is to measure

A

Peripheral artery occlusive disease

299
Q

Any ABI less than 0.9 is _________

A

Peripheral arterial disease (PAD)

300
Q

Causes of pericardial effusion

A
  1. uremia 2. cytology/malignancy 3. Anticoagulation
301
Q

Causes of high AG Metabolic Acidosis CAT MUDPILES

A

Congenital heart disease/ Carbon monoxide Aminoglycosides

Theophylline

Methanol

Uremia

DKA,

Paraldehyde Ion, isoniazid,

Inborn errors of metabolism

Lactic acidosis

Ethanol ( due to lactic acidosis)

Salicyclates/ASA

302
Q

The most common conditions that results in effusion are:

A

Cardiac Failure Pneumonia Malignant Neoplasms

303
Q

Symptoms include dyspnea, cough, and occasionally sharp, nonradiating, pleuritic chest pain.

A

Pleural effusions.

304
Q

_______capnia, (acidosis/alkalosi)_________, (increased or decreased) ________blood levels of 2, 3-BPG, and (increased or decreased) _________body temperature all shift the oxyhemoglobin dissociation curve to the right and should therefore increase the _______

A

Hypercapnia; acidosis; increased; increased; P50

CCRN (10 decks)

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