Week 1 EAQ/HESIs Flashcards
__________________ (UA) is defined by at least one of the following: severe, new onset (less than six weeks) chest pain, chest pain at rest that lasts more than ten minutes, or crescendo-pattern (worsening in severity or frequency) chest pain
Unstable angina
The ST-segment of an electrocardiogram (ECG) waveform reflects the heart’s ability to ___________ (prepare for the next contraction)
repolarize
A myocardial infarction (MI) is usually due to a ______ that partially or totally obstructs the flow of blood in a coronary vessel. It is a consequence of severe prolonged myocardial ischemia, and injury that initially causes myocardial cell dysfunction, and eventually myocardial cell death.
clot
For a patient presenting with chest pain in an Emergency Department (ED) setting, determining whether the patient is a candidate for reperfusion is a priority. Which of the following is MOST important in identifying candidates for reperfusion?
Taking a 12-lead ECG
Drawing blood for serum cardiac biomarkers
Assessing for the presence of signs and symptoms consistent with MI
Determining the presence of risk factors associated with coronary artery disease (CAD)
Ensuring that no more than six hours has elapsed since onset of chest pain
Taking a 12-lead ECG
Mr. Whiting’s presenting ECG revealed ST-segment elevation, and ST-segment elevation myocardial infarction (STEMI) is suspected. ST upsloping elevation in leads II, III, and aVF is consistent with injury in which part of the heart?
Anteroseptal wall
Lateral wall
Inferior wall
Inferior wall
Because Mr. Whiting is undergoing fibrinolytic reperfusion, specific interventions apply. These include: Select all that apply
observing for dysrhythmias
observing for evidence of bleeding
avoiding unnecessary venipuncture
protection from injury
encouraging movement at the infusion site
observing for allergic reaction
ensuring readiness for defibrillation as needed
observing for dysrhythmias
observing for evidence of bleeding
avoiding unnecessary venipuncture
protection from injury
observing for allergic reaction
ensuring readiness for defibrillation as needed
After MI, if a patient complained of chest pain characteristic of pericarditis, you would auscultate his chest for which of the following?
A pericardial friction rub
A third heart sound (S3)
A fourth heart sound (S4)
A new murmur
A pericardial friction rub
A pericardial friction rub is commonly heard in pericarditis, due to inflammation of the parietal and visceral layers of the pericardium. It is a high-pitched sound, heard better with a diaphragm chest piece, and often described as coarse or scratchy. Other signs and symptoms of pericarditis include joint pain, fever, night sweats, and weakness.
To assess for a pericardial friction rub, you would help a patient assume which position?
Left lateral with knees flexed
Supine with knees flexed
Semi-Fowler’s with legs elevated
Fowler’s and leaning forward
Fowler’s and leaning forward
When auscultating for a pericardial friction rub, the chest piece of the stethoscope is placed at which location?
Apex of the heart
Left sternal border
Right and left second intercostal spaces
Base of the heart
Left sternal border
With acute pericarditis, changes may also be noted on the patient’s ECG. Which of the following ECG changes is most helpful in identifying acute pericarditis?
Sinus tachycardia
Prolonged QT interval
ST-segment elevation in all leads
ST-segment elevation in all leads except AVR
ST-segment elevation in all leads except AVR
ST-segment elevation in all leads except AVR is characteristic of pericarditis. With acute pericarditis, ST-segment elevation occurs in all leads that record the endocardial surfaces of the ventricles. This includes all leads except AVR. In acute pericarditis, AVR typically has a negative deflection or ST-segment depression.
Lopressor (metoprolol) belongs to which category of drugs?
Analgesics
Beta-blockers
Anticoagulants
Anti-platelet agents
Beta-blockers
When monitoring a patient receiving Lopressor (metoprolol), you expect to observe which of the following effects? Select all that apply
Decrease in blood pressure
Increase in blood pressure
Decrease in heart rate
Increase in heart rate
Decrease in blood pressure
Decrease in heart rate
Morphine, a narcotic analgesic, is commonly used to alleviate chest pain. When used with a patient having chest pain, other therapeutic actions of morphine include:
Select all that apply
decrease in respiratory rate
decrease in anxiety
reduction in preload
decrease in anxiety
reduction in preload
ECG monitor currently displays which rhythm?
sinus tachycardia
ECG monitor displays which rhythm?
premature ventricular contractions
Which of the following reflects an expected therapeutic effect of lidocaine?
Decrease in heart rate
Decrease in premature ventricular contractions (PVCs)
Decrease in blood pressure
Decrease in chest pain
Decrease in premature ventricular contractions (PVCs)
__________________ is a life-threatening dysrhythmia characterized by a chaotic rhythm and rate, and pulselessness.
Ventricular fibrillation
Mr. Whiting’s shortness of breath, bilateral basilar crackles, and abnormal chest x-ray are a result of failure of the _____ ventricle to function properly, secondary to infarction. The presence of a third heart sound (S3, an extra heard sound, heard in early diastole) is also consistent with left ventricular failure.
left
To alleviate stress on the heart and pulmonary congestion, you anticipate that the physician will order which of the following?
Lidocaine IV drip
Lasix (furosemide) IV push
Intropin (dopamine) IV drip
Lasix (furosemide) IV push
cardiogenic shock usually occurs when the heart has lost 40% of its ___________ ability.
pumping
Early recognition and treatment of cardiogenic shock is critical. In patients at risk for cardiogenic shock, which of the following signs often appears early as the heart fails?
Increase in urine output
Pulse deficit
Change in level of consciousness
Change in level of consciousness
A decrease in cardiac output results in poor perfusion and oxygenation. A change in level of consciousness, due to hypoxia from inadequate perfusion of the brain, is often an early sign of cardiogenic shock. Ongoing assessment of level of consciousness is indicated in all patients after acute MI. Confusion and irritability may be early signs of a failing heart and cardiogenic shock.
What is the rationale for the concurrent use of Intropin (dopamine) and Nipride (nitroprusside)?
Nipride (nitroprusside) balances the vasoconstricting effect of Intropin (dopamine)
Nipride (nitroprusside) potentiates the action of Intropin (dopamine)
Intropin (dopamine) balances the vasoconstricting effect of Nipride (nitroprusside)
Intropin (dopamine) potentiates the action of Nipride (nitroprusside)
Nipride (nitroprusside) balances the vasoconstricting effect of Intropin (dopamine)
You start Mr. Whiting’s Intropin (dopamine) IV drip. In evaluating the effectiveness of the Intropin (dopamine) IV drip, you observe for:
Select all that apply
an increase in heart rate
a decrease in blood pressure
an increase in urine output
a decrease in dysrhythmias
an increase in heart rate
an increase in urine output
You prepare the Nipride (nitroprusside) IV drip, which must be:
prepared with normal saline as the drug diluent
in a glass container
protected from light
wrapped in a heated container
protected from light
You are aware that Nipride (nitroprusside), if administered over a period of days, can cause:
renal shutdown
cyanide poisoning
metabolic acidosis
hyperglycemia
cyanide poisoning
Primacor (milrinone) is ordered. Which of the following is expected as the drug’s primary therapeutic effect?
Significant increase in blood pressure
Significant increase in heart rate
Significant increase in cardiac output
Significant increase in cardiac output
With infusion of Primacor (milrinone), you observe for which of the following adverse effects?
Cardiogenic shock
Ventricular dysrhythmias
Pulmonary embolus
Atrial dysrhythmias
Ventricular dysrhythmias
The physician decides to insert an intraaortic balloon pump (IABP) at a 1:1 assist mode. The balloon will be positioned in the descending thoracic aorta below the left subclavian artery, and above the renal arteries.
The IABP is a ________________ device. In the 1:1 assist mode, every beat of Mr. Whiting’s heart will be assisted.
circulatory assist
The IABP [balloon pump] is intended to assist Mr. Whiting’s failing heart by reducing ______________________ and enhancing myocardial oxygenation.
left ventricular workload
You prepare Mr. Whiting for percutaneous insertion of the intraaortic balloon pump (IABP) catheter. The procedure will be done at his bedside. Mr. Whiting’s skin is cleansed and hair is clipped in preparation of catheter insertion at the:
aorta
femoral artery
carotid artery
radial artery
femoral artery
After insertion, you will observe Mr. Whiting’s intraaortic balloon inflating during __________.
systole
diastole
diastole
The intraaortic balloon pump (IABP) is designed to decrease afterload and increase coronary artery perfusion. Inflation of the balloon during diastole, the relaxation phase of the heartbeat during which the coronary arteries fill with blood, will force blood backward. This diastolic augmentation will enhance coronary flow and myocardial oxygenation.
You will observe Mr. Whiting’s intraaortic balloon deflating just before __________.
systole
diastole
systole
The intraaortic balloon pump (IABP) is designed to decrease afterload and increase coronary artery perfusion. Deflation of the balloon just before systole, the contraction phase of the heartbeat, will assist the left ventricle by reducing afterload (the resistance the left ventricle must pump against). The workload of the heart, and myocardial oxygen consumption, will be reduced.
Which of the following is routinely used during intraaortic balloon pump (IABP) therapy to avoid complications?
Dobutrex (dobutamine)
Lasix (furosemide)
Dextran 40
Pepcid (famotidine)
Dextran 40
Low-molecular-weight Dextran (Dextran 40), a volume expander with hemodilution properties, is used concurrently with intraaortic balloon pump (IABP) therapy to prevent thrombus formation along the IABP catheter, and to promote sufficient venous flow in the affected lower extremity.
Which of the following would you recognize as an ominous sign when attempting to wean Mr. Whiting from the intraaortic balloon pump (IABP)?
Drop in systolic pressure to 106 mm Hg
Fall in cardiac index (CI) to 2.3 L/minute/m2
Pulmonary artery occlusion pressure (PAOP/PCWP) of 20 mm Hg
Increase in heart rate to 80 beats per minute
Pulmonary artery occlusion pressure (PAOP/PCWP) of 20 mm Hg
An increase in pulmonary artery occlusion pressure (PAOP/PCWP) from 9 mm Hg to 20 mm Hg would need to be reported immediately. It would indicate that Mr. Whiting’s heart was not yet able to function effectively without balloon assistance.
Diltiazem hydrochloride’s purpose is to __________ the heart rate
slow down
________ vision indicates digoxin toxicity
Yellow
Within which period of time would a nurse advise the client to anticipate pain relief will begin when nitroglycerin sublingual tablets are prescribed for a client with the diagnosis of angina?
1 to 3 minutes
4 to 5 seconds
30 to 45 seconds
10 to 15 minutes
1 to 3 minutes
Which outcome would the nurse use to determine the effectiveness of sublingual nitroglycerin?
Relief of anginal pain
Improved cardiac output
Decreased blood pressure
Ease in respiratory effort
Relief of anginal pain
Which adverse effect would a nurse monitor for in a client taking clopidogrel?
Nausea
Epistaxis
Chest pain
Elevated temperature
Epistaxis
Which advice would the nurse include in a teaching plan to reduce the side effects of diltiazem?
Lie down after meals.
Avoid dairy products in diet.
Take the medication with an antacid.
Change slowly from sitting to standing.
Change slowly from sitting to standing.
Which therapeutic effect is associated with digoxin prescribed to a client with heart failure?
Reduces edema
Increases cardiac conduction
Increases rate of ventricular contractions
Slows and strengthens cardiac contractions
Slows and strengthens cardiac contractions
Which response indicates that sublingual nitroglycerin prescribed for a client with unstable angina is effective?
Pain subsides as a result of arteriole and venous dilation.
Pulse rate increases because the cardiac output has been stimulated.
Sublingual area tingles because sensory nerves are being triggered.
Capacity for activity improves as a response to increased collateral circulation.
Pain subsides as a result of arteriole and venous dilation.
Which pain relief medication would the nurse expect to find in the plan of care of a client with a myocardial infarction admitted to the cardiac intensive care unit?
Morphine
Diazepam
Midazolam
Oxycodone
Morphine
Morphine is the medication of choice for a myocardial infarction because it relieves pain quickly and reduces anxiety. It also decreases cardiac workload. Diazepam is a muscle relaxant that may be used for its sedative effect; it is not effective for the severe pain associated with a myocardial infarction. Midazolam is a hypnotic that may be used to reduce fear and restlessness; it is not effective for the severe pain associated with a myocardial infarction. Oxycodone is an orally administered analgesic; an analgesic that is administered via the intravenous, not the oral, route provides more immediate pain relief.
