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aa Orgo > Medsurg hesi 3 cardiac > Flashcards

Medsurg hesi 3 cardiac Flashcards

1
Q

If a pharmacological stress test is prescribed, a medication such as ____ or ____ is given to stress the heart instead of walking on the treadmill

A

adenosine or dobutamine

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2
Q

before a cardiac stress test, the client should

A

fast for 2 hours (including caffeine)

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3
Q

involves special indwelling catheters, which provide information about blood volume and perfusion, fluid status, and how well the heart is pumping.

A

Hemodynamic monitoring

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4
Q

Hemodynamic monitoring involves special indwelling catheters, which provide information about blood volume and perfusion, fluid status, and

A

how well the heart is pumping

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5
Q

Hemodynamic monitoring: Arterial lines provide continuous information about

A

changes in blood pressure

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6
Q

Hemodynamic monitoring: Arterial lines permit the

A

withdrawal of samples of arterial blood

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7
Q

Hemodynamic monitoring: Arterial lines are not used for

A

IV fluid administration

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8
Q

Hemodynamic monitoring: The PA catheter is inserted into a large vein and threaded through the

A

right atria and ventricle into a branch of the pulmonary artery.

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9
Q

Hemodynamic monitoring: PA catheters have multiple lumens, ports, and components that allow for various hemodynamic measurements, blood sampling, and

A

infusion of IV fluids

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10
Q

CABG

A

coronary artery bypass graft

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11
Q

Hemodynamic monitoring: The intravascular volume in older adult clients is often reduced. Therefore, the nurse should anticipate

A

lower hemodynamic values, particularly if dehydration is a complication

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12
Q

Hemodynamic monitoring: Line insertion: position the client

A

supine or trendelenburg

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13
Q

hemodynamic pressure lines must be calibrated to read __ atmospheric pressure.

A

zero

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14
Q

Increased or decreased preload: Crackles in lungs

A

increase

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15
Q

Increased or decreased preload: JVD

A

increase

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16
Q

Increased or decreased preload: Hepatomegaly

A

increase

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17
Q

Increased or decreased preload: Peripheral edema

A

increase

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18
Q

Increased or decreased preload: Taut skin turgor

A

increase

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19
Q

Increased or decreased preload: Poor skin turgor

A

Decreased

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20
Q

Increased or decreased preload: Dry mucous membranes

A

Decreased

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21
Q

Increased or decreased AFTERload: Cool extremities

A

increase

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22
Q

Increased or decreased AFTERload: Weak peripheral pulses

A

increase

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23
Q

Increased or decreased AFTERload: Warm extremities

A

Decreased

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24
Q

Increased or decreased AFTERload: Bounding peripheral pulses

A

Decreased

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25
Q

Place the client in ___ position prior to recording hemodynamic values.

A

supine (Head of bed can be elevated 15° to 30°)

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26
Q

Hemodynamic monitoring: Administer vasopressors (___) for vasodilation secondary to sepsis

A

dopamine

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27
Q

Hemodynamic monitoring: Plaque or a clot can become dislodged during the procedure: Use __ for flushing system.

A

NS

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28
Q

also called a cardiac catheterization

A

coronary angiogram

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29
Q

an invasive diagnostic procedure used to evaluate the presence and degree of coronary artery blockage

A

coronary angiogram (cardiac catheterization)

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30
Q

coronary angiogram (cardiac catheterization) is an invasive diagnostic procedure used to

A

evaluate the presence of coronary artery blockage

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31
Q

In addition to a heart assessment, Angiography also can be done on the lower extremities to determine

A

blood flow and areas of blockage

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32
Q

Angiography involves the insertion of a catheter into a ____ vessel and threading it into the right or left side of the heart

A

femoral (sometimes a brachial)

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33
Q

Angiography involves the insertion of a catheter into a femoral (sometimes a brachial) vessel and

A

threading it into the right or left side of the heart

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34
Q

coronary angiogram (cardiac catheterization): Coronary artery narrowings and/or occlusions are identified by the

A

injection of contrast media under fluoroscopy.

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35
Q

coronary angiogram (cardiac catheterization): after the procedure, position the leg

A

straight

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36
Q

coronary angiogram (cardiac catheterization): anesthesia

A

local anesthetic

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37
Q

coronary angiogram (cardiac catheterization): Pressure (a sandbag) can be placed on the incision to

A

prevent bleeding

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38
Q

can result from fluid accumulation in the pericardial sac

A

Cardiac tamponade

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39
Q

Cardiac tamponade: Manifestations include hypotension, jugular venous distention, muffled heart sounds, and

A

paradoxical pulse

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40
Q

paradoxical pulse

A

variance of 10 mm Hg or more in systolic blood pressure between expiration and inspiration

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41
Q

variance of 10 mm Hg or more in systolic blood pressure between expiration and inspiration

A

paradoxical pulse

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42
Q

coronary angiogram (cardiac catheterization): if after the procedure the patient has flank pain and hypotension, they may have ___ ___

A

Retroperitoneal Bleeding

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43
Q

Vascular Access: Using veins in the ___ is not appropriate for older adult clients.

A

hand

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44
Q

___ catheters are appropriate for any fluids due to rapid hemodilution

A

Central

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45
Q

Tunneled and implanted catheters require ___ removal.

A

surgical

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46
Q

Nontunneled percutaneous central catheter: Length of use

A

short term only

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47
Q

Peripherally inserted central catheter: Length of use

A

up to 1 year

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48
Q

PICC insertion: Apply an initial dressing of gauze and replace with a ____ dressing within 24 hr.

A

transparent

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49
Q

Tunneled central catheter: Length of use

A

long term

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50
Q

Tunneled central catheter: dressing

A

none is needed (the skin forms a barrier)

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51
Q

Vascular access: comprised of a small reservoir covered by a thick septum

A

implanted port

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52
Q

Implanted port: Access with a ___ (Huber) needle

A

noncoring

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53
Q

cordlike

A

Phlebitis

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54
Q

Nontunneled catheters require an intact ____ ___ (tunneled catheters do not)

A

sterile dressing

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55
Q

Phlebitis tx: discontinue IV and apply

A

warm compress

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56
Q

Catheter Thrombosis/Emboli: to flush it use a __ mL or larger syringe to avoid excess pressure per square inch (PSI) that could cause catheter fracture/rupture

A

10 ml

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57
Q

Infiltration is fluid leaking into surrounding subcutaneous tissue, and extravasation is unintentional infiltration of a

A

vesicant medication that causes tissue damage

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58
Q

Putting pressure on the vein just beyond the tip of the catheter should stop the IV flow. If
flow is not affected,

A

the fluid is probably going into the subcutaneous tissue

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59
Q

Do not use hand veins for ___ medication

A

vesicant

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60
Q

Have the client hold breath while the tubing is changed to avoid

A

air embolism

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61
Q

If the client has sudden shortness of breath, place in ____ on ___ side, give oxygen, and notify the provider (to trap and aspirate air).

A

Trendelenburg on left side

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62
Q

Vascular access: When removing the dressing, pull from

A

distal to proximal (to prevent dislodging of the catheter)

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63
Q

Apply a ___ monitor if the client is on a telemetry unit and/or needs continuous cardiac monitoring

A

Holter

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64
Q

a fault within the heart’s natural pacemaker due to some kind of obstruction in the electrical conduction system of the heart.

A

heart block

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65
Q

DYSRHYTHMIA: Bradycardia: medication: A____ and I_____

A

Atropine and isoproterenol

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66
Q

DYSRHYTHMIA: Atrial fibrillation, supraventricular tachycardia (SVT) or ventricular tachycardia with pulse: medications

A

Amiodarone, adenosine, and verapamil

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67
Q

DYSRHYTHMIA: A fib: Meds: A__ A___ and V___

A

Amiodarone, adenosine, and verapamil

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68
Q

DYSRHYTHMIA: supravent tacy: Meds: A__ A___ and V___

A

Amiodarone, adenosine, and verapamil

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69
Q

DYSRHYTHMIA: Ventricular tachy with pulse: meds: A__ A___ and V___

A

Amiodarone, adenosine, and verapamil

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70
Q

Which dysrhythmias are treated with defibrillation:

A

Ventricular tachy with no pulse and V fib

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71
Q

DYSRHYTHMIA: Ventricular tachy with no pulse and V fib: meds: A___ L___ E___

A

Amiodarone
lidocaine
epinephrine

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72
Q

the delivery of a direct countershock to the heart synchronized to the QRS complex.

A

Cardioversion

73
Q

Cardioversion is the delivery of a direct countershock to the heart synchronized to the

A

QRS complex

74
Q

the delivery of an unsynchronized, direct countershock to the heart

A

Defibrillation

75
Q

Defibrillation is the delivery of an

A

unsynchronized, direct countershock to the heart

76
Q

Defibrillation stops all

A

electrical activity of the heart, allowing the SA node to take over and reestablish a rhythm

77
Q

Elective treatment of atrial dysrhythmias, supraventricular tachycardia, and ventricular tachycardia with a pulse

A

Cardioversion

78
Q

for 4 to 6 weeks prior to cardioversion therapy, clients who have atrial fibrillation of unknown duration must receive

A

anticoagulation (to prevent dislodgement of thrombi)

79
Q

____ is held for 48 hr prior to elective cardioversion.

A

Digoxin

80
Q

___ is indicated for cardiac asystole or other pulseless rhythms

A

CPR

81
Q

Defibrillate the client immediately for ____

A

V fib

82
Q

Cardioversion can dislodge blood clots, potentially causing

A

embolism

83
Q

Decreased cardiac output and heart failure: Provide medications to increase output (____ agents)

A

inotropic

84
Q

Complications of Cardioversion

A

embolism

heart failure

85
Q

It is used only in emergency resuscitation of a client who does not have pacing wires inserted.

A

External (transcutaneous) pacemaker

86
Q

Pacemaker leads are attached directly to the heart during open-heart surgery

A

Epicardial pacemaker

87
Q

Epicardial pacemaker: Wires run externally through the chest incision and may be attached to an

A

external impulse generator if needed

88
Q

pacemaker that’s commonly used during and immediately following open-heart surgery.

A

Epicardial pacemaker

89
Q

Pacing wires are threaded through a large central vein (subclavian, jugular, or femoral) and lodged into the wall of the right ventricle (ventricular pacing), right atrium (atrial pacing), or both chambers (dual chamber pacing)

A

Endocardial (transvenous)

90
Q

Pacemaker modes: Fixed rate (asynchronous) – Fires at a constant rate without

A

regard for the heart’s electrical activity

91
Q

Pacemaker modes: Demand mode (synchronous) – Detects the heart’s electrical impulses and fires at a preset rate only
if

A

the heart’s intrinsic rate is below a certain level

92
Q

Temporary pacemaker: after the procedure the client is not permitted to

A

shower (the box must stay dry)

93
Q

The pacemaker battery will last about __ years

A

10

94
Q

ECG: Assess the client for ___, which may indicate that the generator is pacing the diaphragm

A

hiccups

95
Q

Wear ___ when handling pacemaker leads

A

gloves

96
Q

Insulate pacemaker terminals and leads with nonconductive material when not in use
(i.e. ___ ___).

A

rubber gloves

97
Q

____ pacemakers are used only in a controlled facility with telemetry for continuous ECG monitoring

A

Temporary

98
Q

Notify the provider if heart rate is less than ___ ___ ___ the pacemaker rate.

A

five beats below

99
Q

pacemaker orders for sexual activity

A

Resume sexual activity as desired, avoiding positions that put stress on the incision site

100
Q

Never place items that generate a ____ field directly over the pacemaker generator.

A

magnetic

101
Q

Pacemakers: some dx tests, like ___ might be contraindicated

A

MRI

102
Q

Causes of pacemaker malfunction include insufficient pacemaker settings, lead wire placement and function, battery function, myocardial damage, and

A

electrolyte imbalance.

103
Q

Pacer spikes should be adequate in number and occur

A

directly before P or QRS complexes.

104
Q

Pacer spikes that occur on the _ ___ can cause life-threatening arrhythmias

A

T wave

105
Q

Pace maker: Unintended electrical stimulation of chest muscles results in hiccups and muscle twitching and may lead to ___ ____

A

cardiac tamponade

106
Q

Atherectomy – used to break up and remove

A

plaques within cardiac vessels

107
Q

placement of a mesh-wire device to hold an artery open and prevent restenosis

A

stent

108
Q

involves inflating a balloon to dilate the arterial lumen and the adhering plaque, thus widening the arterial lumen.

A

angioplasty,

109
Q

the goal of angioplasty

A

widen the artery (using a balloon)

110
Q

angioplasty can include

A

the use of a stent

111
Q

PCI (which includes angioplasty, stent, atherectomy) is most effective when performed

A

within 90 minutes of chest pain

112
Q

PCI (which includes angioplasty, stent, atherectomy) may be used as an alternative to

A

CABG

113
Q

Before PCI, administer premedications as prescribed (____ medications)

A

antiplatelet

114
Q

a short hollow tube placed inside the artery or vein at the insertion site

A

The catheter sheath

115
Q

After angioplasty, the catheter sheath may be left in for access, so that

A

the angioplasty may be repeated, if needed (for restenosis or perforation).

116
Q

Client who had a stent placement receives anticoagulation therapy for

A

6 to 8 weeks

117
Q

Client who had a PCI: A___ D___

A

Artery dissection

118
Q

Artery dissection can be a complication of

A

PCI

119
Q

Perforation of an artery by the catheter may cause cardiac tamponade or require emergency bypass surgery

A

Artery dissection

120
Q

Cardiac tamponade: Administer IV fluids to manage

A

hypotension

121
Q

post PCI: External bleeding at the insertion site: position the leg

A

straight

122
Q

Retroperitoneal bleeding after PCI: assess for ___ and ___ pain

A

hypotension and flank pain

123
Q

CABG does not alter the ____ process

A

atherosclerotic

124
Q

CABG is most effective when a client has sufficient ____ function

A

ventricular

125
Q

Post CABG: Instruct the client to ___ the ___ when coughing and deep breathing

A

splint the incision

126
Q

Medications frequently discontinued for CABG: ____ 2 to 3 days before surgery

A

Diuretics

127
Q

amiodarone

A

antidysrhythmic

128
Q

diltiazem

A

CCB

129
Q

Before CABG: clients who have diabetes and are insulin-dependent usually receive

A

half the regular insulin dose

130
Q

CABG: A cardioplegic solution is used to

A

stop the heart

131
Q

Post CABG: Assist the client to a chair within

A

24 hours

132
Q

Post CABG: Ambulate the client 25 to 100 ft by

A

first postoperative day.

133
Q

Post CABG: Monitor chest tube drainage: Volume exceeding ___ mL/hr could be a sign of possible hemorrhage and should be
reported to the surgeon.

A

150

134
Q

Post CABG: Anginal pain often radiates and is unaffected by

A

breathing

135
Q

Post CABG: Walking one block or climbing two flights of stairs symptom-free generally indicates that

A

it is safe for the client to resume normal sexual activity.

136
Q

Hypothermia can cause metabolic

A

acidosis

137
Q

Hypothermia tx: Administer ____ if prescribed.

A

vasodilators

138
Q

Post CABG: Assure the client that ____ing is common following surgery.

A

shivering

139
Q

cardiac tamponade tx: Pericardiocentesis is avoided because

A

blood may have clotted

140
Q

peripheral Bypass graft surgery aims to restore adequate blood flow to the

A

areas affected by peripheral artery disease.

141
Q

If peripheral bypass surgery fails to restore circulation, the client may need to undergo

A

amputation of the limb

142
Q

after peripheral bypass surgery: Throbbing pain is experienced due to

A

an increase in blood flow to extremity

143
Q

after peripheral bypass surgery: Ischemic pain is often difficult to relieve with

A

opioid administration

144
Q

after peripheral bypass surgery: to prevent reocclusion administer

A

anticoagulants (warfarin, heparin, etc)

145
Q

after peripheral bypass surgery: Maintain bed rest for

A

18 to 24 hr

146
Q

after peripheral bypass surgery: Discourage the client from ___ for long periods of time.

A

sitting for long periods of time.

147
Q

after peripheral bypass surgery: Apply antiembolic stockings to

A

promote venous return.

148
Q

after peripheral bypass surgery: Assess for worsening pain, swelling, and tense or taut skin. This could indicate

A

compartment syndrome

149
Q

The continuum from angina to myocardial infarction (MI) is termed

A

acute coronary syndrome

150
Q

Research shows improved outcomes following an MI in clients treated with aspirin, ___ __, and ___ ___

A

beta blockers and ace inhibitors

151
Q

angina that occurs with exercise or emotional stress

A

stable

152
Q

stable angina is best relieved by

A

nitro

153
Q

angina is due to a coronary artery spasm, often occurring during periods of rest.

A

variant

154
Q

Pain unrelieved by rest or nitroglycerin and lasting for more than 15 min differentiates an MI from

A

angina

155
Q

Ischemia is ____. An infarction results in ____ damage.

A

reversible

permanent

156
Q

_______ MIs are more common in older adults, women, and clients who have diabetes mellitus.

A

non-Q-wave MI

157
Q

MI is relieve by ___ medications

A

opioid

158
Q

Angina symptoms last less than

A

15 min

159
Q

Associated with nausea, epigastric distress, dyspnea, anxiety, diaphoresis

A

MI

160
Q

enzymes released with cardiac muscle injury: Earliest marker of injury to cardiac or skeletal muscle

A

Myoglobin

161
Q

enzymes released with cardiac muscle injury: Levels no longer evident after 24 hr.

A

Myoglobin

162
Q

enzymes released with cardiac muscle injury: Any positive value indicates damage to cardiac tissue and should be reported

A

Troponin I or T

163
Q

ECG findings that indicate ischemia

A

ST depression or T wave inversion

164
Q

ST-segment elevation indicates

A

injury

165
Q

abnormal Q-wave indicates

A

necrosis

166
Q

Also known as exercise electrocardiography

A

stress test

167
Q

Radioisotopes cannot reach areas with decreased or absent perfusion, and the areas appear as “cold spots.”

A

Thallium scan

168
Q

MI patient: cluster nursing interventions to

A

conserve the patient’s energy

169
Q

_____ is a common side effect of nitro

A

headache

170
Q

Remind the client to notify the provider immediately if shortness of breath, edema, weight gain, or cough occur. What med is this?

A

beta blocker

171
Q

Thrombolytic agents: For best results, give within _ hr of infarction.

A

6

172
Q

Thrombolytic agent contraindication: h/o

A

CVA

173
Q

____ prevents vasoconstriction. Due to this and antiplatelet effects, it should be administered with nitroglycerin at the onset of chest pain.

A

aspirin

174
Q

taking aspirin: Tell the client to report

A

ringing in the ears.

175
Q

Heart failure: administration of vasopressors and/or positive inotropes to

A

increase cardiac output and to maintain organ perfusion

176
Q

Heart failure: administration of morphine, diuretics, and/or nitroglycerin to

A

decrease preload

177
Q

Ischemic mitral regurgitation – evidenced by development of a new ___ ___

A

cardiac murmur

178
Q

An inferior wall MI may lead to an injury to the AV node, resulting in bradycardia and

A

second-degree AV heart block

179
Q

An anterior wall MI may lead to an injury to the ventricle, resulting in premature ventricular contractions, bundle branch, or

A

complete heart block

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