Exam 4

Question 1

Cardiogenic Shock

Answer 1

This will inadequately perfuse primary organs: decreased urine output, confusion, chest pain, dyspnea; NO FLUIDS

Question 2

Beta blockers

Answer 2

Decrease chronotropy; decrease HR, BP, and contractility

Metoprolol (Lopressor) Carvedilol (Coreg)

Question 3

Diuretics

Answer 3

Decrease preload and decrease sodium and water retention

Question 4

Nitrates

Answer 4

decreases SVR afterload, decreases myocardial oxygen demands

Question 5

Natriuretic factors

Answer 5

decreases filling pressure (wedge, CVP), reduces vascular resistance, increaed urine output; Nesiritide, Natrecor
causes smooth muscle dilation and decreases workload of the heart by decreaing preload and afterload, decreasing BP by dilating arteries and veins

Question 6

Inotropes

Answer 6

augment cardiac output by increasing contractility and enhancing contractility and enhancing tissue perfusion; digoxin- cardiac glycoside; sympathomimetics- epiniphrine

Question 7

NATRECOR

Answer 7

Non inotropic drug used in CHF; a recombinant form of human B-type natriuretic peptide (h BNP) a naturally occurring hormone secreted by the ventricles; causes smooth muscle dilation

Question 8

The nurse is conducting a staff in-service on congenital heart defects. Which structural defect constitutes tetralogy of Fallot?

Answer 8

Pulmonic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy

Question 9

A nurse is teaching nursing students the physiology of congenital heart defects. Which defect results in decreased pulmonary blood flow?

Answer 9

Tetralogy of Fallot

Question 10

Nitro

Answer 10

sensitive to light, do not keep for longer than a year; IV- glass bottles with special tubing

Question 11

TPA

Answer 11

within 4 hours of the MI; can make a patient go into arrhythmias which is ok, need to shock; contraindications- recent surgery, anything in spine (epidural), active bleeding

Question 12

If MI is in left main artery (widow maker)

Answer 12

Coronary artery bypass graft (CABG)

Question 13

Unstable angina

Answer 13

“strangling of the chest”; limited ischemia that doesn’t result in permanent damage to myocardium; proressively worse, preinfarction, unpredictable; if you are questioning it, don’t do a stress test! Chest pain occurs with rest or minimal exertion; poorly relieved by nitro; treatment of pain and increased perfusion is priority

Question 14

Peripheral vascular disease

Answer 14

disorders with altered flow of blood through the arteries and/or veins of the peripheral circulation; causes- HTN, DB, aging; intermittent claudication

Question 15

Arterial PAD

Answer 15

Acute
cold, pale limb; decrease or loss of sensory/motor function; absent pulses; veins collapsed; no edema
Chronic
intermittent claudication, delayed healing, atrophy of skin with loss of hair

Question 16

Venous PVD

Answer 16

Acute
elephant legs; elevate legs;moderate steady pain; skin warm
Chronic
aching, heavy sensation, ankle ulcers, increased pigmentation and edema of lower leg, scaling and thickening of skin

Question 17

What to do during an acute anginal attack?

Answer 17

Oxygen, vitals, 12 lead EKG, pain relief (nitrate then narcotic), physical assessment of the chest, position comfortably

Question 18

Complications of coronary artery disease

Answer 18

Hypoxic cells get irritable and “fire off”, left ventricle needs more O2, hurts worse without O2; get arrhythmias, PVC’s because of ischemia and irritability; 80% are silent MIs

Question 19

Hypertensive Crisis

Answer 19

If it’s greater than 180/120 (either number); classified by organ damage; BP is unresponsive to oral antihypertensive medications; can occur from drug abuse, peeclampsia, head injury, IICP, undermedicating

Question 20

Aortic

Answer 20

Severe “tearing” or “ripping” pain; may feel heart beat in the belly or have a pulsing mass, “blue toe” syndrome

Question 21

Thoracic Aortic

Answer 21

Most common site for dissecting aneurysm; sudden, tearing chest pain radiating to shoulders, neck and back; cough hoarseness, resulting from pressure against recurrent laryngeal nerve; pt is bleeding if heart sounds are muffled

Question 22

Abdominal aortic aneurysm (AAA)

Answer 22

most common; pulsation in abdomen, dull abdomen or low back pain (impending rupture), N/V (pressure against duodenum), severe, sharp, sudden pain (rupture), syncope

Question 23

Aortic dissection

Answer 23

Acute severe and instantaneous chest pain, radiating to back, neck or jaw; “Ripping,” “tearing” sensation
Differentiated from AMI by its instantaneous, severe onset and absence of central pulses
Neurologic symptoms (15%) – syncope, presyncope, paralysis, numbness, aphasia

Question 24

Cholesterol levels

Answer 24

Normal: 100-240, want under 200; Triglycerides: 50-160; LDL: 50-160; HDL: 35-45

Question 25

MUGA Multigated

Answer 25

Blood pool imaging, ejection fraction study; normal EF: 55%-65%; crippling: under 35%; to evaluate cardiac function after an MI; used to diagnose cardiac abnormalities involving left ventricle and myocardial wall abnormalities by imaging the blood within the cardiac chamber rather than myocardium

Question 26

Cardiac Catheterization

Answer 26

procedure can dislodge the plaque; assess for s/s of clots, pneomothorax (breath sounds, know baseline O2), aspiration (pts arent always honest about eating), hemorrhage (look behind them), sedation (put them on their sides so tongues don’t fall back)

Question 27

Rheumatic fever

Answer 27

inflammatory disease that is usually self-limiting; usually preceded by group A beta- strep infection; inflammatory hemorrhagic lesions, called Ashoff bodies -> alteration of connective tissue in heart, joints, skin, CNS

Question 28

Treatment of Rheumatic Fever

Answer 28

Monthly administration of penicillin over extended period of time; Penicillin: 1.2 mega units IM; salicylates to control inflammatory process (aspirin 75-100 mg/kg for 6-8 weeks); prophylactic treatment

Question 29

Kawasaki Disease

Answer 29

high fever, conjunctiva, red cracked lips and strawberry tongue, rash, cervical lymphadenopathy

Question 30

Tetrology of fallot

Answer 30

knee to chest position, give morphine, give oxygen, beta blocker and general anesthesia

Question 31

Patent Ductus Arteriosus

Answer 31

connection between aorta and pulmonary artery
usually closees in the first 2 weeks of life
symptoms: if large, can cause CHF 6-8 weeks
signs: systolic murmur in a newborn and a continous “train in a tunnel”
large PDA causes left atrium and ventricle enlargement

Question 32

Coarctition of the Aorta (CoA)

Answer 32

gets narrow and squeezes off aorta; severe -> shock moderate -> CHF mild -> heacaches, leg claudication
Treatment: for an infant in shock PGE1 (prostaglandin E1) immediately or surgical vx. transcatheter repair
BP lower in lower limbs
Diagnostic: echo

Question 33

Which is the most common causative agent of bacterial endocarditis?

Answer 33

Streptococcus viridans

Question 34

Which painful, tender, pea-sized nodules may appear on the pads of the fingers or toes in bacterial endocarditis?

Answer 34

Osler nodes

Question 35

The primary nursing intervention to prevent bacterial endocarditis is to:

Answer 35

counsel parents of high-risk children about prophylactic antibiotics.

Question 36

Asthma

Answer 36

Peak flow meter- green, do nothing; yellow-

Question 37

Cystic fibrosis

Answer 37

earliest sign is they don’t pass meconium in 24 hours; excretion of undigested food in stool; sweat chloride test: normal less than 40 mEq/L (40-60 mEq/L indicates CF)
Pilocarpine
high protein and high calories

Question 38

Acute laryngotracheobronchitis (LTB)

Answer 38

most common croup syndrome; generally affects children younger than 5; inspiratory stridor, barking cough, can progress to respiratory acidosis, respiratory failure, and death

Question 39

Otitis media

Answer 39

malfunction of eustachian tube; an inflammation of the middle ear without pathogenesis

Question 40

bronchitis

Answer 40

persistent dry hacking cough, worse at night

Question 41

Acute otitis media

Answer 41

An inflammation of the middle ear space with a rapid onset of the signs and symptoms of acute infection—namely, fever and otalgia (ear pain)

Question 42

Otitis media with effusion (OME)

Answer 42

Fluid in the middle ear space without symptoms of acute infection

Question 43

Which is an important nursing consideration when chest tubes will be removed from a child?

Answer 43

administer analgesics before procedure

Question 44

A nurse is caring for a school-age child with left unilateral pneumonia and pleural effusion. A chest tube has been inserted to promote continuous closed chest drainage. Which interventions should the nurse implement when caring for this child? (Select all that apply.)

Answer 44

assessing chest tube and drainage device for correct settings
administering prescribed doses of analgesia
monitoring for need of supplemental oxygen

Question 45

Which defect results in increased pulmonary blood flow?

Answer 45

atrial septal defect

Question 46

A nurse is teaching nursing students the physiology of congenital heart defects. Which defect results in decreased pulmonary blood flow?

Answer 46

Tetralogy of Fallot

Question 47

Tracheostomy

Answer 47

give them a way to communicate

Question 48

An infant has developed staphylococcal pneumonia. Nursing care of the child with pneumonia includes which interventions? (Select all that apply.)

Answer 48

Cluster care to conserve energy

Administration of antibiotics

Question 49

A nurse is caring for a school-age child with left unilateral pneumonia and pleural effusion. A chest tube has been inserted to promote continuous closed chest drainage. Which interventions should the nurse implement when caring for this child? (Select all that apply.)

Answer 49

Administering prescribed doses of analgesia
Assessing the chest tube and drainage device for correct settings
Monitoring for need of supplemental oxygen