The Heart Exam 1

Question 1

Bad trans fatty acid ex

Answer 1

Partially hydrogenated vegetable oils (processed foods)

Question 2

Bad saturated fats ex

Answer 2

Red meat, dark poultry, cheese, butter, coconut

Question 3

Good fat ex

Answer 3

Mono/poly unsaturated

Ex- canola oil, avocado, almonds, peanut butter

Omega 3 fatty acids

Ex- fish

Question 4

Fiber ex

Answer 4

Whole wheat, bran, fresh or dried fruit, veggies

Question 5

Metabolic syndrome

Answer 5

Risk for heart disease and diabetes. Must have 3 out of 5:

Central obesity
HTN
high triglycerides 
Low HDL
insulin resistant

Question 6

Nonatherosclerotic inflammatory disease (no CVD), young male, smokes, rest pain

Answer 6

Thromboangiitis Obliterans (Buergers disease)

Question 7

Woman complains of coldness and numbness that progressed to tingling, throbbing, aching pain; her nose and ears appear cyanotic

Answer 7

Raynaud’s phenomenon

Question 8

Nursing care for raynauds

Answer 8

Avoid cold, stress, caffeine, smoking (vasoconstrict), wear loose warm clothes, CCB (relax smooth muscle)

Question 9

Pt arm presents pale, cold, pulselessness and they complain of a tingling, severe pain

Answer 9

Arterial ishemia

anticoag, affected extremity flat or 15 degrees lower, monitor for bleeding, freq vitals

Question 10

Venous thromboembolism (VTE)

Answer 10

DVT and PE

Question 11

Risk for venous disorders

Answer 11

Venous stasis (CHF, pregnancy, immobility, obese, surgery post op)

Injury of endothelium (fracture, disease, IV meds)

Hyper coagulation

Question 12

SVT (superficial vein thrombosis) care

Answer 12

Phlebitis at iv site, remove cath, warm moist heat, elevate, NSAIDS

Varicose SVT
Anticoag, compression stockings, ambulate

Question 13

Drugs VTE

Answer 13

Vitamin k antagonist, thrombin inhibit., Xa inhibitors

Question 14

Interventions for PAC

Answer 14

Observe for worsening arrhythmia

Question 15

PSVT

Answer 15

Paroxysmal supraventricular tachycardia

150-250 bpm (faster than sinus tachycardia)
Will feel it
Decreased perfusion 
P wave can't be seen, QRS very close 
Tx adenosine

Question 16

PVC (premature ventricular contraction)

Answer 16

No p wave before each PVC, QRS wide (>0.12 secs) and abnormally shaped
Bigger concern when >6 PVC per minute

Question 17

Tx for PVC

Answer 17

Oxygen, check electrolytes, CCB, BB, amiodarone, anti dysthymics

Question 18

Ventricular tachycardia

Answer 18

Life threatening
Regular rhythm, no P waves
QRS is wide (>0.12) and slurred
Sx: lightheaded, dyspnea, palpitations, hypotension, angina, LOC (lack of perfusion to vital organs)

Question 19

V tach tx

Answer 19

If stable with pulse: give antidysrhythmic and tx cause, oxygen and IV

If unstable: synchronized cardio version

Vtach with no pulse: CPR and DEFIB!!!

Question 20

First degree heart block

Answer 20

Normal rate, rhythm, and QRS

Prolonged PR interval (>0.20) bc DELAY in conduction through AV node

Question 21

Second degree heart block

Answer 21

Some impulses blocked at AV node and don’t reach ventricles; p wave w/o QRS

Normal or slow HR

Tx with atropine if low HR

Question 22

Third degree (complete AV) block

Answer 22

Rate

Question 23

When is defibrillation used

Answer 23

As emergency for VFIB and PULSELESS vtach

Question 24

Synchronized cardioversion

Answer 24

Tx unstable tachydysrythmias
Lower joules than defib
SYNCH button on so fires shock on R WAVE
IV sedation
If become PULSELESS or vfib —> synch off and defib!!!!

Question 25

ICD

Answer 25

Implantable cardioverter defibrillator
For persistent v tach, survivor of spontaneous cardiac death (SCD)
Detects dysrhythmia and shocks
Still requires ANTIDYSRHYTHMIC MEDS!

Question 26

Indications for pacemaker

Answer 26

2nd and 3rd degree heart block, sick sinus syndrome, dysrhythmias, HF

Question 27

Pacemaker

Answer 27

Must SENSE/detect intrinsic electrical activity of heart and CAPTURE the myocardium causing it to depolarize

FIXED paces at FIXED rate regardless of intrinsic rhythm

Question 28

Pacemaker coding

Answer 28

First letter: chamber being paced

2nd: chamber being sensed
3rd: mode of response (I-inhibit or T-trigger, D-both)

Question 29

Nursing management of pacemaker

Answer 29

Monitor 24hrs after 
Avoid lifting arm until healed 
Site for bleeding & infection 
no magnetic fields 
Med alert bracelet

Question 30

1 treatment of Afib

Answer 30

CCB

Blocks calcium ions, slows SA and AV nodes, relaxes smooth muscle

Question 31

Hallmark s/s of patent ductus arteriosus (PDA)

Answer 31

Bounding pulse
Widening pulse pressure
Acyanotic

Question 32

Aortic stenosis

Answer 32

all of the blood from left ventricle can’t pump through aorta bc aortic valve stenosis causing obstruction.

Decreased CO, activity intolerance **(only tx where should lower activity), chest pain

Question 33

Congenital heart defect that may go from acyanotic to cyanotic

Answer 33

Pulmonary stenosis

Question 34

Coarctation of aorta

Answer 34

Narrowing in aorta where ductus arteriosus was causing decreased lower body perfusion (weak pulses), decreased CO, HTN, aneurysm

ACYANOTIC

Question 35

How does someone with transposition of the great arteries (closed circuit) survive

Answer 35

Keeping ductus arteriosus open using prostaglandins

Question 36

S/s pediatric HF

Answer 36

Pulmonary congestion: (tachypnea, dyspnea, nasal flare, grunt, activity intolerance (feeding, thermoreg) , cyanosis

Impaired myocardial function:
Tachycardia, fatigue, weakness, pale, cool, HYPOtension, decreased urinary output

Vascular congestion:
Peripheral edema, weight gain, ascites, neck vein distention