MED/SURG EXAM #2

Question 1

What is the purpose of cardiac rehabilitation?

Answer 1

safe activity/restore, but will not undo damage

Question 2

Patient has a new onset of chest pain, what is the first priority nursing action?

Answer 2

EKG

Question 3

What type of order will you question if patient has heart failure?

Answer 3

Prescription for fluids in general

Question 4

Patient has PVCs + you auscultate HR for 1 full minute. What are you listening for?

Answer 4

Listening for irregular heartbeat

Question 5

Patient has VFIB + pulseless + apneic. What do you do?

Answer 5

Defibrillate/CPR
NOTE: “if VFIB, DEFIB”

Question 6

Interventions used for heart palpitations + VTACH

Answer 6

Cardioversion

Question 7

S/Effects of diuretics with heart issues + K

Answer 7

with K –> watch for fatigue, cramps, weak/achy muscles

Question 8

AFIB manifestations

Answer 8

– Heart is not regular
– No E
– Dizziness

Question 9

Distinguish between ventricular depolarization + ventricular repolarization

Answer 9

– Ventricular depolarization + activation is represented by the QRS complex
– Ventricular repolarization is expressed as the interval from the beginning of the QRS complex to the end of the T wave (QT interval)

Question 10

Component of the electrical sequence component
______________
P-wave
PR Interval
QRS Complex
ST Segment
T-wave

Answer 10

P-wave: Firing of the SA node + depolarization of the atria
_____________
PR Interval: delay of the electrical impulse @ the AV node + depolarization of the atrium
_________________

QRS Complex: ventricular depolarization
– Q-wave: 1st negative deflection
– R-wave: 1st positive deflection
– S-wave: 2nd negative (-) deflection
_____________________
ST Segment: the beginning of ventricular repolarization. Should be isoelectric (flat @ baseline)
____________________
T-wave: ventricular repolarization

Question 11

HYPOkalemia on an EKG vs. HYPERKalemia on EKG

Answer 11

HYPOK+
– Tall p-waves
– Flattened t-wave
– Widened QRS complex
– Prominent j-waves
– ST-segment depression
– a prolonged QT interval
– Premature ventricular contraction
– Ventricular tachycardia
– Torsade de Pointes
_____________
HYPERK+
– Peaked t-waves

Question 12

A K+ level of 8.0 would commonly be associated with which ECG finding?
T-wave merging w/ QRS
U-wave
Delta wave
Flattening T-wave

Answer 12

T-wave merging w/ QRS
U-wave
Delta wave
Flattening T-wave

Question 13

ECG Readings for:
HYPOK+
HYPERK+
HYPOCa2+
HYPERCa2+

Answer 13

HYPOK+ –> long QU interval; prominent U-wave
HYPERK+ –> peaked t-waves
HYPOCa2+ –> QT prolongation
HYPERCa2+ –> shortening of the ST segment

Question 14

HYPOkalemia on EKG/ECG

Answer 14

– Increase of P wave size and duration.
– PR interval prolongation.
– QRS complex widening.
– QT interval prolongation.
– T wave amplitude decrease or inversion (“flattening”).

Causes U waves!

Question 15

HYPERkalemia on EKG/ECG

Answer 15

– Normal P wave
– PR interval prolongation.
– QRS duration increases with shortened QT intervals.
– Peaked T waves with a narrow base (best seen in precordial leads).

Question 16

HYPERcalcemia on EKG/ECG

Answer 16

– QRS complex widening.
– QT interval shortens.

Question 17

HYPOcalcemia on EKG/ECG

Answer 17

– QRS complex narrows.
– QT interval lengthens

Question 18

HYPERmagnesemia on EKG/ECG

Answer 18

– PR interval prolongation.
– QRS widening.
– Q-T interval increase.

Question 19

HYPOmagnesemia on EKG/ECG

Answer 19

Moderate depletion:
– QRS widening.
– Peaked T waves.

Severe depletion:
– PR interval prolongation.
– T wave decrease in amplitude.
– Atrial arrhythmia.
– Ventricular arrhythmia.

Question 20

How should patient be lying 4hrs after cardiac catheterization?

Answer 20

Still, lying flat (up to 6hrs), DO NOT bed surgical leg

Question 21

Dietary restrictions for heart failure + cardiac patients

Answer 21

– < 1,500mg of Na+
– Less red meat, more fish, fruits, and veggies
– Shredded wheat has less Na+ than yogurt
– Plain rice, pasta, oatmeal

Question 22

Foods with fat animal vs. non-animal

Answer 22

Animal-based: milk, egg, liver (high in cholesterol)
Non-animal (good fats): avocado, soy, lentils

Question 23

Herbals that interact with cardiac drugs

Answer 23

Dabigatran = injectable anticoagulant; Tx DVTs + PEs; like Xeralto

Question 24

How to monitor Dabigatran

Answer 24

anticoagulant + inhibits factors IIa

Thrombin time to test for residual drug. Dilute thrombin time to assess extent of anticoagulation or test for residual drug

Question 25

Common herbals that interfere w/ blood clotting

Answer 25

– Aloe
– Cranberry
– Garlic: lower BP, prevent age-related CVDs, reduce lipids & body weight control
– Ginkgo
– Meadowsweet
– Turmeric
– Feverfew: used to tx migraine H/A, arthritis, GI d/o, allergies, fever|

can potentiate to cause bleeding

Question 26

Lab values for Warfarin vs. Coumadin

Answer 26

Warfarin (Coumadin)
– pT =
– INR = 2.0-3.0
Heparin
– PTT
– anti-factor Xa
LMW Heparin
– Anti-factor Xa (if needed)

Question 27

Symptomatic bradycardia treatment

Answer 27

Atropine sulfate
1st dose: 1mg IV bolus Repeat q3-5 minutes. Max total dosage: 3mg

Question 28

S/Sx thrombus

Answer 28

Warm, painful, swollen

Question 29

Cardiac catheterization post-op what to monitor

Answer 29

– Lie flat for 6hrs
– Check for bleeding, pulses
– Legs remain extended (do not bend on surgical side)

Question 30

Define a heart murmur

Answer 30

Whoosh, turbulent blood flow

Question 31

Define AFIB manifestations

Answer 31

irregular rhythm

Question 32

PAD + toenails manifestations

Answer 32

Hard/thick, shiny legs, cold/cool legs with pain @ rest, clubbing

Question 33

Angina pectoris manifestations + triggers

Answer 33

Less than 15min w/ pain to the L arm, jaw/back = MI
– Triggers: stress, exertion on exercise

Question 34

Right-side ventricular failure (heart failure)

Answer 34

Ascites = liver problems

Question 35

Dosage calculations
Order: 1mg/kg/dose + Patient is 185lb
Available: 1mg/84.1kg

Answer 35

185lb/2.2kg = 84.9kg –> 84.1kg

Question 36

Order: 1600units/hr
Available: 25,000 units in D5W in 500mL

Answer 36

(500mL/25,000units) x (1600units/1hr) = 32mL/hr

Question 37

Coumadin + Heparin @ same time

Answer 37

Want the INR to increase to stop the Heparin

Question 38

Furosemide + HCTZ + Metolazone vs. Spironolactone

Answer 38

Furosemide, HCTZ, Metolazone = K-wasting
Spironolactone = K-sparing diuretic = wastes Na+, increase K

Question 39

Drugs that cause orthostatic hypotension

Answer 39

–Sartans
–Diloxetine
–Furosemide
–Clopidrel = DOES NOT cause this

Question 40

Interventions for cardiac ECG

Answer 40

– Asystole –> CPR + epinephrine
– VFIB –>
– VTACH = peaks + troughs WITH pulse –> vagal then cardioversion
– Torsades de Pointes = Magnesium

Question 41

What to look for STEMI vs. NSTEMI

Answer 41

STEMI = “Fireman/Pharrell hat”
NSTEMI = ST-segment depressions and/or T-wave inversions

Question 42

PAD S/Sx

Answer 42

Cold, intermittent claudication

Question 43

Cholesterol lab values

Answer 43

Total cholesterol: <200mg/dL
LDL: <100mg/dL
HDL: >60mg/dL
Triglycerides: <150mg/dL
Glucose: 70-100mg/dL

Question 44

Endocarditis interventions

Answer 44

– PICC/central line needed (especially for chemo patients)
– Antibiotics (ABX)

Question 45

Chronic venous insufficiency S/Sx + Interventions

Answer 45

PVD
Warm, edema (wet, sappy wounds)
Interventions: rest feet UP, browny color, wear stockings

Question 46

Propranolol
Dopamine

Answer 46

Propranolol = masks HYPOglycemia
Dopamine = increases BP