Exam One Key Points

Question 1

What leads look at the heart from the Right inferior portion?

Answer 1

Lead I, III, aVF
I- look form the right shoulder to the left shoulder
II- connects the lead on the right to the chest
III- connect the lead on the left shoulder to chest looking at the right ventricle
avf( unipolar)

Question 2

These leads look primarily at the left ventricle/Anterior portion of the heart

Answer 2

V2, V3, V4

Question 3

What are the 4 key factors for transmission of electrical impulses

Answer 3

Automaticity, Excitability, Conductivity, and Contractility

Question 4

can you have an electrical conduction without mechanical ventilation?
Can you have mechanical contraction without electrical conduction?

Answer 4

Yes.
NO.
Electrical activity always precedes mechanical contraction

Question 5

What is the Gold Standard for ECG recording?

Answer 5

5 lead ECG

Question 6

How do we calculate the rate on a ECG strip ? PR interval? QRS complex? QT interval

Answer 6

P waves x 10 or
R wave x 10
PR interval= tiny square x 0.04 (0.06-0.10s)
QRS = small square from beginning to end of QRS x 0.04
QT = beginning of QRS complex to end of T wave x 0.04

Question 7

What is occurring if a pt has 3 pvc in a row

Answer 7

Ventricular Tachycardia

Question 8

Interpret the pacing code: AVI

Answer 8

The pace is located in the atrial, sensing in the ventricle, and Inhibits (does nothing as long as the HR falls within a set number

Question 9

what is describes the HR falling below the set number and the pacemaker not responding

Answer 9

Failure to pace. The nurse must report!

Question 10

This occurs if a pacing spike is not followed by a mechanical contraction

Answer 10

Failure to capture

Pacing spike should always be followed by a complex . Can be caused by electrolyte imbalance and hypoxia

Question 11

A new nurse is caring for a patient with a new intra-arterial blood pressure monitor upon admission to the cardiac unit what with the first action the nurse must take? Can the new nurse inflate or remove the catheter, can she administer meds through the catheter?

Answer 11

The nurse needs to assess the insertion site FIRST. No gauze at the insertion site to visualize and palpate to ensure no hematoma (firm and palpable), assess distal extremities of the catheter. The nurse can remove the catheter if ordered NOT inflate. The nurse will NEVER administer meds into the arterial line!

Question 12

What are the normal values for hemo dynamic monitoring?

CVP, CO, PAP, MAP, PAOP

Answer 12

CVP= 2-6 
CO= 4-8 
PAP= 15-30/10-15
MAP=90-100
PAOP= 4-12

Question 13

What 4 things are cardiac output influenced by?

Answer 13

HR (speed), Preload (volume), Afterload (resistance), and contractility

Question 14

What is important nursing consideration after placement of CVP monitor . What will the nurse do if a pt is experiencing an air embolus following CVP monitor placement

Answer 14

Chest x-ray must be performed. The nurse will place the patient in Left lateral trendelenburg in an attempt to trap the air.

Question 15

The nurse is caring for a patient with an intra-aortic ballon pump and notices blood in the tubing. what is the priority action for the nurse.

Answer 15

The nurse needs to STOP the pumping and Call the MD. The patient needs to be places in a left lateral trendelenburg position. The bleeding in the tubing indicates balloon perforation

Question 16

While caring for a patient on acardiac floor the nurse notices the pateint HR is 54 and has a bp of 96/64, cool clammy skin, and changes in their mental status. What atrial dysrhythmia is the patient experiencing and what will the nurse need to administer

Answer 16

The patient is experiencing bradycardia. Since the patient is symptomatic the nurse will administer ATROPINE 0.5mg IV to increase the HR other interventions include oxygen, transcutaneous pacing, dopamine and epinepherine. If the patient was asymptomatic the nurse would leave the patient alone!!

Question 17

What are the top 2 priorities for a patient in a-fib

Answer 17

1.) control the rate
-Amioderone, bb, ccb, tikosyn
2.) prevent embolus
-eliquis, preadaxa, etc
Synchronized cardioversion will NOT be performed if clots are present

Question 18

The nurse notices this rhythm on the monitior

^^^^^^^^^^^^^^^ (shark tooth). what is the rhythm and what will the nurse do?

Answer 18

The patient is in V-tach (ventricular tachycardia). The nurse will check the carotid pulse, if no pulse is present the nurse will START CPR then defibrillate to save the life. If the patient has a pulse the nurse will administer the antidysrhythmic amioderone and perform a synchronized cardioversion

Question 19

The nurse finds the patient with this rhythm on the monitor ____________ (flat line) the patient has no pulse or perfusion. what is priority

Answer 19

The nurse can only perform CPR administer EPI and antidysrhythmics
NOT SHOCKING WITH ASYSTOLE

Question 20

A patient that has chest pain with moderate to prolonged exertion relieved with rest and/or nitroglycerine most likely has what condition?

Answer 20

This patient likely has chronic stable angina

Question 21

This patient has chest pain that occurs at exertion and rest with severe activity limitation. What does the patient have and can this patient with this condition control it with nitro

Answer 21

This patient has unstable angina pectoris which is NOT relieved by Nitro.

Question 22

This patient has ST elevation in two leads on ECG and cardiac enzymes present, what is the patient experiencing.

Answer 22

STEMI- ST elevation myocardial infarction. A rupture of plaque with thrombus formation at site of rupture causing 100% occlusion of coronary artery

Question 23

For a patient admitted with complaints of chest discomfort what should be obtained within 10 min of patient presentation?

Answer 23

A 12 LEAD ECG should be obtained within 10min

Question 24

After obtaining a 12 lead ECG the patient has changes in leads V1 and V2 what location is the complication? What are the other areas assess for complication

Answer 24

This patient has changes in the septal location= leads v1,v2, s/s of left sided Hf 
Other areas include: 
Anterior: V3,V4 = left Hf 
Lateral: V5,6,avL,1 = Left HF 
Inferior: II, III, avf = right HF

Question 25

A patient with chest pain and a suspected clot must be receive PCI intervention within what time frame? What is priority following PCI, what are signs of reocclusion?

Answer 25

90 MIN !! Door to balloon time = 90 min!!
The first priority is to monitor the insertion site for ANY bleeding. Signs of reocclusion include chest pain and ST elevation

Question 26

While caring for a patient following a CABG with a chest tube drain you noitce drainage of 180mL in the first hr. What will the nurse need to do?

Answer 26

The nurse will need to notify the physician! Report if drainage >150ml in 1 hr. The nurse may need to autotransfuse blood back or give blood production.

Question 27

What is Beck’s Triad? What could these signs indicate

Answer 27

Distant heart tones, decreased arterial blood pressure, and distended jugular veins. This could indicate cardiac tamponade

Question 28

What are interventions for acute decompensated HF?

Answer 28

Unload Fast:
Upright position (high fowlers-legs down)
Nitrates (reduce preload)
Lasix (reduce preload)
Oxygen
ACE inhibitors (reduce afterload)
Digoxin (increase contractility)
Fluids 
Afterload (decrease) 
Sodium Restriction
Tests

Question 29

What is the first symptom of mitral valve stenosis?

Answer 29

Pulmonary congestion and right sided HF. With the valve complication think back flow. With mitral valve complication it goes to the lungs. With aortic valve complication is affects the LV

Question 30

A patient enters with ER with a pulsating abdominal mass then has sudden severe pain in the back of lower abdomen. What is the patient experiencing and what will the nurse need to do?

Answer 30

The patient has an abdominal aortic aneurysm rupture and will need emergency surgery. Following surgery the nurse will need to monitor for s/s of bleeding, covert signs of bleeding include complaints about back pain, the pt will also need to keep the legs straight and assess for changes in the pulses, cool extremities, sever pain.

Question 31

What patient are at risk of infective endocarditis? What is a key manifestation?

Answer 31

Patient with recent dental procedures, patient with skin rashes, lesions, abscesses, surgery or invasive procedures, IV drug uses, valve replacement, systemic infections or structural cardiac defects. A key manifestation is petechiae on the mucous membranes, palate, conjunctive, and skin above the clavicles.

Question 32

A patient with positive blood culture, new regurgitant murmur, and evidence of endocardial involvement on echocardiogram has what?

Answer 32

Infective endocarditis! 
Please No Endocarditis
Positive BC 
New murmur 
Endocardial involvement on echo

Question 33

How much protein can a patient with chronic kidney disease have? acute kidney injury?

Answer 33

The patient can have up to 60g/day if the patient is receiving dialysis. A patient with acute kidney injury can have 40g/day, carbohydrates are encouraged

Question 34

This type on acute kidney injury is caused by an insult before the blood reaches the kidney, is this reversible? What are the other 2 types?

Answer 34

This is prerenal and is cause by hypoperfusion, sever blood loss, renal artery stenosis or thromboemboli and is reversible.
The other 2 types include
intrarenal- cause by toxic insults at the site of the nephrons which injure the glomeruli and tubules.
Postrenal-occurs below the kidney dies to a disruption of flow or obstruction and include things such as kidney stones, prostatic disease, and neurogenic (paralysis).