zTest 1 N360 Flashcards
When the patient is being examined for venous thromboembolism (VTE) in the calf, what diagnostic test should the nurse expect to teach the patient about first?
Duplex ultrasound
? are positively charged ions. Examples include sodium (Na + ), potassium (K + ), calcium (Ca 2+ ), and magnesium (Mg 2+ ) ions.
Cations . Examples include sodium (Na + ), potassium (K + ), calcium (Ca 2+ ), and magnesium (Mg 2+ ) ions.
where is CVP measured
superior vena cava at entry to rt atria
In DM why would K be high
Insulin lets K into cell
While taking a patient’s blood pressure, a nurse notices that a carpal spasm occurs. To diagnose a possible cause for the carpal spasm, the nurse should expect the primary health care provider to prescribe which level?
Trousseau’s sign (carpal spasm when blood pressure cuff is inflated for a few minutes) is indicative of hypocalcemia. It does not occur with changes in sodium, potassium, or magnesium levels. The nurse should expect the primary health care provider to prescribe a calcium level be drawn.
Hyponatrimea starts below where
below 136
A nurse is caring for a patient with a central venous access device. The patient manifests symptoms of embolism, including chest pain, dyspnea, hypotension, and tachycardia. Which interventions should be included in the immediate management of this patient? Select all that apply.
Pulmonary embolism is a complication of central venous access devices. The nurse should start oxygen therapy to relieve dyspnea. The catheter should be clamped to prevent further formation of emboli. As the signs suggest air embolism, the patient is placed on the left side with the head down. Administering anticoagulants and normal saline are required if the catheter is occluded, and they do not help in relieving a pulmonary embolus. Text Reference - p. 311
When planning care for adult patients, the nurse concludes that which oral intake is adequate to meet the daily fluid needs of a stable patient?
Daily fluid intake and output is usually 2000 to 3000 mL. This is sufficient to meet the needs of the body and replace both sensible and insensible fluid losses. These would include urine output and fluids lost through the respiratory system, skin, and gastrointestinal tract.
S2 is what valves closing
aortic and pulmonary slamming shut (meanwhile tricuspid and mitral are silently opening up)
Are cations positive or negative
Positive
What intravenous (IV) solution may be used to pull fluid into the intravascular space after the paracentesis?
After a paracentesis of 5 L or greater of ascites fluid, 25% albumin solution may be used as a volume expander. Normal saline, lactated Ringer’s, and 5% dextrose in 0.45% saline will not be effective for this action.
what is an ARB?
Angiotensin II Receptor Blockers
what drug increases stroke volume by improving contractility
digoxin
what shortens the QT interval
hypercalcemia
What does PQRST stand for (not ecg).
Using PQRST, the assessment data not volunteered by the patient is the radiation (R) of pain, the area in which the patient felt the pain and if it radiated. The precipitating event (P) was going to the bathroom and having a bowel movement. The quality of the pain (Q) was “like before I was admitted,” although a more specific description may be helpful. Severity of the pain (S) was the “worst chest pain ever,” although an actual number may be needed. Timing (T) is supplied by the patient describing when the pain occurred and that the patient had had this pain previously.
what causes subacute endocarditis
strep or other less virulent bacteria
What is a normal level of troponin t?
.2
Does captopril lower HR
No
what follows sugar
Na
Which lab findings for myocarditis
Elevated Viral titers moderate leukocytosis elevated CRP
The nurse is teaching the family of a patient recently diagnosed with coronary artery disease (CAD). Which information on health promotion would the nurse include?
Dietary modifications should include a decrease in saturated fat and cholesterol, as well as an increase in complex carbohydrates (whole grains, fruits, and vegetables) and fiber. A moderate physical activity program has to include isotonic exercises, such as walking, hiking, or jogging performed for at least 30 minutes on most week days. Consumption of alcohol and simple sugars will lead to an elevated triglyceride level. Isometric exercises, such as weight lifting, are recommended to increase muscle strength on two days per week only. Text Reference - p. 736
what electrolyte triggers contraction
calcium
What INR do you need for surgery
1
if on warfarin do not encourage the consumption of
dark leafy veg. they are high in Vit K.
what is the inverse to Calcium
phosphorous
The lipid profile of a patient is indicative of hyperlipidemia. A nurse advises the patient to consume a diet rich in high-density lipoproteins based on what rationale?
High-density lipoproteins and low-density lipoproteins are vehicles for mobilization of fats. HDLs contain fewer lipids than proteins and mobilize lipids from the arteries to the liver for metabolism, thereby preventing the deposition of lipids on the vessel wall. LDLs have more lipid content than proteins and tend to deposit lipids in the arterial walls. HDLs prevent the deposition of lipids and do not directly alter the vessel wall or make it noncompliant. HDLs do not interfere with the production or breakdown of LDLs. Text Reference - p. 733
monitoring a postoperative patient for venous thromboembolism (VTE). Which are probable clinical findings in a person with VTE?
Venous distension deep reddish color tenderness to pressure over the involved vein
what hormone regulates Na
aldosterone
how does an ARB work?
Angiotensin II receptor blockers inhibit a substance that causes blood vessels to narrow (constrict). As a result, blood vessels relax and widen (dilate), making it easier for blood to flow through the vessels, which reduces blood pressure. These medicines also increase the release of water and salt (sodium) to the urine, which in turn lowers blood pressure as well. Preventing the blood vessels from constricting helps improve blood flow, which reduces the backup of blood in the heart and lungs. It also decreases the pressure that the left ventricle of the heart must pump against. Angiotensin II receptor blockers also act directly on the hormones that regulate sodium and water balance.
? are substances whose molecules dissociate, or split into ions, when placed in water.
Electrolytes
What is the clinical use of a multiple gated acquisition (MUGA) scan?
It helps determine ejection fraction. A multiple gated acquisition nuclear scan determines ejection fraction. Ejection fraction less than 20% is associated with a 50% mortality rate within a year. Conduction disorders like tachycardia, bradycardia, and dysrhythmias are diagnosed by electrocardiogram. Endomyocardial biopsy at the right side of the heart helps identify infectious organisms in heart tissue. Doppler echocardiography helps evaluate the effectiveness of dilated cardiomyopathy.
Amiodarone- look it up, it is a drug
Life-threatening ventricular arrhythmias unresponsive to less toxic agents.
A female patient with critical limb ischemia has had peripheral artery bypass surgery to improve her circulation. What care should the nurse provide on postoperative day 1?
Assist the patient with walking several times
Asystole
Bad, probably negative outcome, mostly don’t shock cause it wouldn’t help
What drug interrupts vasoconstriction and aldosterone
ARB
A patient is prescribed a statin drug to decrease levels of low-density lipoproteins and triglycerides. Which symptoms should the nurse teach the patient to be observant for?
rash, myopathy, rhabdomyolysis, gastro disturbances.
A nurse is identifying obese women at risk of developing coronary artery disease in a community for health care research. What are the appropriate criteria for the selection of at-risk women?
Obesity is a major risk factor for the development of coronary artery diseases (CAD). Women below the age of 40 are generally premenopausal. The cardioprotective effects of estrogen make premenopausal women less susceptible for developing atherosclerosis, which can lead to CAD. Apple-shaped obesity is the type of obesity where there is more fat deposition around the abdomen. This condition is a major risk factor for development of coronary artery disease. Obesity in women is defined as having a body mass index of 30 or greater, which is a major risk factor for development of coronary artery disease. Evidence suggests that people having fat deposition around the thigh and hip regions (pear-shaped figure) are less susceptible to develop coronary artery disease than people having fat deposition around the abdomen (apple-shaped obesity). Obesity in women is defined as having a waist circumference more than 35 inches; therefore, the criterion should be “waist circumference greater than 35 inches.” Text Reference - p. 732
normal osmolarity is betwn what
275-295, more than 295 is water deficient
diarrhea dumps acid or bicarb buffer
bicarb buffer
A nurse reviews the admission history of a 59-year-old female patient admitted to the hospital with deep venous thrombosis in the left leg. Which finding from the health history increases the risk for the patient to develop this complication?Select all that apply.
The risk for developing thromboembolic complications continues for several weeks postoperatively. The risk is related to possible vascular injury with the procedure, altered fluid status, increased coagulability, and lessened mobility during and after surgery. The recent left knee joint replacement surgery is significant. Estrogen, a hormone used for relief of menopausal discomfort, increases clotting factors and enhances coagulation. Medications such as lipid-lowering agents (simvastatin) and proton pump inhibitors (omeprazole) do not increase the risk for thrombosis. Not smoking eliminates a risk factor. The abdominal hysterectomy performed 10 years earlier is not a current risk factor.
What is a good bnp level
less than 100
s/s hypocalcemia
increased neuromuscular excitability
positive chvostek sign
positive trousseau sign
cramps
twitching
hyperactive reflexes
seizures
dysrhythmias
A patient presents with mild to moderate symptoms of thromboangiitis obliterans (Buerger’s disease). Which intervention is most important to include on the patient’s plan for treatment?
Buerger’s disease occurs most commonly in young adults who are chronic smokers. The patient has only mild to moderate symptoms of the disease. Therefore, the best way to treat is to advise the patient to quit smoking and not use any nicotine replacement products. The consumption of these products will worsen the symptoms, which may lead to a need for limb amputation. The patient can be prescribed IV iloprost to improve rest pain, promote healing of ulcerations, and decrease the need for amputation. No particular diagnostic tests are available to detect this disease. Diagnosis may be based on clinical symptoms, such as inflamed arteries, involvement of distal vessels, and presence of ischemic ulcerations. A daily walk is beneficial to reduce hypertension and prevent other cardiovascular disorders.
The primary health care provider prescribes warfarin (Coumadin) for a patient with venous thromboembolism. Which information should the nurse include in the patient’s discharge teaching plan?
Teaching for a patient prescribed warfarin includes avoiding any trauma or injury that might cause bleeding, such as contact sports. Routine laboratory monitoring is needed to assess the therapeutic effect of the medication and whether a change in drug dose is needed. Do not increase daily intake of dark leafy vegetables because these foods are high in vitamin K. Garlic may affect blood clotting. Instruct the patient to consult with the health care provider about the use of garlic supplements along with warfarin.
when does systole happen
between s1 and s2
Nausea and anorexia are signs of what overdose
digoxin
The patient had myocarditis and now is experiencing fatigue, weakness, palpitations, and dyspnea at rest. The nurse assesses pulmonary crackles, edema, and weak peripheral pulses. Sinoatrial tachycardia is evident on the cardiac monitor. The Doppler echocardiography shows dilated cardiomyopathy. What collaborative and nursing care of this patient should be done to improve cardiac output and the quality of life?
Decrease preload and afterload Control heart failure by enhancing myocardial contractility The patient is experiencing dilated cardiomyopathy. To improve cardiac output and quality of life, drug, nutrition, and cardiac rehabilitation will be focused on controlling heart failure by decreasing preload and afterload and improving cardiac output, which will improve the quality of life. Relief of left ventricular outflow obstruction and improving ventricular filling by reducing ventricular contractility is done for hypertrophic cardiomyopathy. There are no specific treatments for restrictive cardiomyopathy, but interventions are aimed at improving diastolic filling and the underlying disease process. Text Reference - p. 827
How much KCl per hour?
10mEq per hour
The nurse finds that a patient with a tumor of the adrenal glands is feeling unusually sleepy. After receiving the prescription from the health care provider, which nursing action is most appropriate considering the fact that the patient is at risk of hypernatremia due to primary aldosteronism?
A tumor of the adrenal glands may cause hypersecretion of aldosterone, resulting in hypernatremia. Hypernatremia should be treated with a diuretic (to promote excretion of excess sodium) and with sodium-free intravenous fluids such as 5% dextrose in water (to dilute the sodium concentration). Sodium intake should also be restricted. Conivaptan is administered when treating hyponatremia. Potassium supplements are needed in cases of hypokalemia. Text Reference - p. 293
A patient has a severe blockage in the left coronary artery. The nurse knows that the cardiac structures that are most likely to be affected by this blockage include which of these?
left atrium, left vent, interventricular septum
A female patient who has type 1 diabetes mellitus has chronic stable angina that is controlled with rest. She states that over the past few months she has required increasing amounts of insulin. What goal should the nurse use to plan care that should help prevent cardiovascular disease progression?
If the Hgb A1C is kept below 7%, this means that the patient has had good control of her blood glucose over the past three months. The patient indicates that increasing amounts of insulin are being required to control her blood glucose. This patient may not be adhering to the dietary guidelines or therapeutic regimen, so teaching about how to maintain diet, exercise, and medications to maintain stable blood glucose levels will be needed to achieve this goal.
hypermagnesemia s/s
decreased neuromuscl excitation
diaphoresis,
diminished reflexes
hypotension
weakness
resp depression
bradycardia
dysrhythias
Cardiomyopathy. Which type has these Sx. dyspnea, Right HF, S3/4, emboli formation
restrictive
what supplies the av node and bundle of His
the right coronary artery.
A nurse measures the blood pressure of a patient. The systolic pressure is 120 mm Hg and the diastolic pressure is 60 mm Hg. What is the mean arterial pressure?
80mm/hg; Mean arterial pressure (MAP) is the average pressure within the arterial system that is felt by organs in the body. It does not refer to the mean of systolic and diastolic blood pressure. The mean arterial pressure can be calculated by (SBP + 2DBP) ÷ 3. Therefore, if the systolic blood pressure is 120 and the diastolic blood pressure is 60, the MAP should be (120+ 2x60)/3 which is equal to 120+120/3 = 80 mm Hg. Text Reference - p. 690
Cardiomyopathy. Which type has these Sx. exertional dyspnea, syncope, angina, signs of HF, S4, sudden death which is usually the first sign
Hypertrophic
A diabetic patient is being discharged after distal peripheral bypass surgery below the knee. Which instructions should the nurse include when talking to the patient and caregiver before discharge?
Encourage supervised exercise training Teach the importance of foot care Instruct the patient to visit a podiatrist if required
s3 is heard in what cardio myopathy
Dilated Cardiomyopathy caused because blood flowing into ventricle when blood is still in there
The nurse is caring for a patient who survived sudden cardiac death (SCD) that was brought on by a lethal ventricular dysrhythmia. To reassure the patient, which tests should the nurse explain will be performed to monitor the effectiveness of drug treatment?
exercise stress testing 24 hr holter Signal averaged electrocardiogram Electrophysiological study under fluoroscopy Because most SCD patients have lethal ventricular dysrhythmias associated with a high recurrence rate, they are closely monitored to assess when they are most likely to have a recurrence and to determine which drug therapies are most effective for them. This monitoring includes exercise stress testing, 24-hour Holter monitoring, signal-averaged electrocardiogram, and electrophysiological study done under fluoroscopy. Magnetic resonance imaging is not used to monitor for lethal dysrhythmias. Text Reference - p. 763
ref level of K
3.5-5
Common causes of dysrythmias
Alcohol ,acid base imbalance, tobacco, caffeine, herbal sups, near drowning, toxins, sepsis
When teaching a patient about physical activity guidelines following acute coronary syndrome, the nurse recommends isotonic (static) activities. What should isotonic activities require according to the FITT (frequency, intensity, type, and time) formula?
The FITT formula recommends isotonic activities that require a steady load on the heart, with careful attention not to increase the heart rate by more than 20 beats/minute over the resting heart rate, and that gradually increase in time and intensity. The FITT formula recommends limited isometric (dynamic) activities that rapidly increase the heart and blood pressure, but there is no FITT guideline that limits patients to stretching exercises only. Text Reference - p. 761
the nurse on a telemetry unit has just received change of shift report. which client should the nurse assess first?
client with new onset AFib
client in first degree heart block
client with new multifocal premature ventricular beats
client with new multifocal premature ventricular beats
The nurse understands that venous ulcers are characterized by which assessment findings?
delayed wound healing wounds proximal to the medial malleolus Lesions with delayed healing and located near or at the medial malleolus are classic findings associated with poor venous return and venous ulcers. A blue tinge to the skin is associated with decreased arterial oxygenation to the tissue. Venous ulcers have a bronze-brown pigmentation and cap refill is less than three seconds with venous disease. Well-defined edges are seen with arterial ulcers.
? are negatively charged ions.
Anions are negatively charged ions. Examples include bicarbonate (HCO3 − ), chloride (Cl − ), and phosphate (PO4 3− ) ions. Most proteins bear a negative charge and are thus anions.
What is a normal level of troponin i?
0.03
claudication
a condition in which cramping pain in the leg is induced by exercise, typically caused by obstruction of the arteries.
what is normal CVP
2-8
S/s of hypokalemia?
weakness
abdom distenstion
polyuria
dysrhythmia
what supplies the av node and bundle of His
the right coronary artery.
Which symptom is indicative of lipodermatosclerosis?
In lipodermatosclerosis, the skin on the lower leg is scarred and leathery, with brown discoloration. A swollen, blue, painful leg, or phlegmasia cerulea dolens, is a rare complication that may develop in a patient in the advanced stages of cancer.
ref level of bicarb
22-26
How long does digoxin take to work
Many hours maybe 30….verify*****
give aspirin 30min prior to what and why
niacin, prevent flushing
The first heart sound is what valves closing
S1 which is Tricuspid and Mitral slamming shut
The first heart sound is what valves closing
S1 which is Tricuspid and Mitral slamming shut
While performing patient teaching regarding hypercalcemia, which statements are appropriate?
A daily fluid intake of 3000 to 4000 mL is necessary to enhance calcium excretion and prevent the formation of renal calculi, a potential complication of hypercalcemia. Weight-bearing exercise does enhance bone mineralization. Tums are a calcium-based antacid that should not be used in patients with hypercalcemia.
A patient presents with claudication, pain in the legs and numbness of the feet. The patient is diagnosed with peripheral arterial disease (PAD). The nurse expects that what will be included in the patient’s treatment plan? 3 things
antiplatelet therapy exercise therapy nutritional therapy
A nurse is caring for a patient with malignant lung cancer who experiences weakness, lethargy, depressed reflexes, and bone pain. The nurse suspects the patient may have hypercalcemia. Which changes in the electrocardiogram indicate hypercalcemia? Select all that apply
Hypercalcemia may result from malignancies. Bone destruction due to tumor invasion may cause a release of calcium, leading to high levels of calcium in the blood. This causes altered transmembrane potentials affecting conduction time, and is manifested as a shortened ST segment and QT interval. An elongated ST segment and a prolonged QT interval are manifestations of hypocalcemia. A flattened or inverted T wave is a manifestation of hypokalemia. Text Reference - p. 299
A 68-year-old patient was admitted with abdominal pain, nausea, and severe diarrhea. Based on this information, the nurse assesses this patient for which primary acid-base imbalance?
Because gastric secretions are rich in hydrochloric acid, the patient with severe diarrhea will lose significant amounts of bicarbonate and is at increased risk for metabolic acidosis and a fall in pH. Metabolic alkalosis, respiratory alkalosis, and respiratory acidosis will not occur as a result of increased loss of bicarbonate.
What class of drug is captopril
ACE
ref level of Na
135-145
The nurse is reviewing the mechanisms of acid-base buffers in the body. The kidneys act as an acid-base buffer by which of these mechanisms? Select all that apply.
As a compensatory mechanism, the pH of the urine can decrease to 4 or increase to 8. To compensate for acidosis, the kidneys can reabsorb additional HCO3- and eliminate excess H+. Thus the pH of the blood increases and the pH of the urine decreases. Text Reference - p. 303
what causes dilated cardiomyopathy
idiopathic, genetic, inflammation, toxins- alcohol, pregnancy as well NOT CAUSED by ischemia or HTN
It is especially important for the nurse to assess for which clinical manifestation(s) in a patient with primary hypoparathyroidism? Select all that apply.
Primary hypoparathyroidism can result in a lack of parathyroid hormone, leading to hypocalcemia. Manifestations of low serum calcium levels include easy fatigability, depression, anxiety, confusion, numbness and tingling in extremities and the region around the mouth, hyperreflexia, muscle cramps, positive Chvostek’s and Trousseau’s signs, and others. Anorexia and depressed reflexes are manifestations of hypercalcemia. Text Reference - p. 300
The nurse anticipates that the typical fluid replacement for the patient experiencing hypovolemic shock to be which of the following?
Isotonic saline (0.9% NaCl) may be used when a patient has experienced both fluid and sodium losses or as vascular fluid replacement in hypovolemic shock. The nurse would not administer 0.45% saline, 5% dextrose in 0.45% saline, or dextran, as these are not appropriate for fluid replacement in hypovolemic shock. Text Reference - p. 308
a relaxed heart is in what phase
diastole
Na is usually where
outside- NaCl really.
What is a medication used for pericarditis
a. Heparin
b. Prednison
c. ibuprofen
d. potassium chloride
heparin
A flattened or inverted T wave is a manifestation of
hypokalemia
patient has been ill for a week with the coxsackie B virus. Upon assessment, the nurse hears this heart sound, which was not present at the previous shift’s assessment. What is the correct identification of this heart sound?
The hallmark finding in acute pericarditis, which is commonly caused by the coxsackie B virus, is the pericardial friction rub. The rub is a scratching, grating, high-pitched sound believed to result from friction between the roughened pericardial and epicardial surfaces. Both third and fourth heart sounds are low-pitched and galloping. A murmur is a swooshing sound.
what drug decreases preload and pulmonary congestion= which ultimately lessens cardiac workload and increases CO
diuretic
A nurse measures the blood pressure of a patient. The systolic pressure is 120 mm Hg and the diastolic pressure is 60 mm Hg. What is the mean arterial pressure?
80mm/hg; Mean arterial pressure (MAP) is the average pressure within the arterial system that is felt by organs in the body. It does not refer to the mean of systolic and diastolic blood pressure. The mean arterial pressure can be calculated by (SBP + 2DBP) ÷ 3. Therefore, if the systolic blood pressure is 120 and the diastolic blood pressure is 60, the MAP should be (120+ 2x60)/3 which is equal to 120+120/3 = 80 mm Hg. Text Reference - p. 690
The nurse preparing to administer a dose of potassium phosphate (Neutra-phos) would hold the medication after noting which laboratory value?
Calcium!. Phosphorus and calcium have inverse or reciprocal relationships, meaning that when calcium levels are high, phosphorus levels tend to be low. Therefore, administration of phosphorus will reduce a patient’s already abnormally low calcium level, which can result in life-threatening complications. Potassium phosphate will not have any effect on sodium, magnesium, or potassium levels.
normal EF is what ?
50-70%
Hypernatrimea starts where
Above 145
S/s hyperkalemia
weakness,
dysrhythmia
vomiting dumps acid or bicarb buffer
acid
when vegitation breaks off what is the visual sx
petechiae
what are the 3 anions
bicarb HCO3- chloride Cl- phospahte PO4^2-
What electrolyte triggers depolarizes
sodium
peaked T wave is from
hyperkalemia
A hospitalized patient is 2 days post myocardial infarction. What possible complications should the nurse monitor the patient for at this stage in recovery?
Dysrhythmia, heart failure, pericarditis, and cardiogenic shock are all serious complications that can arise immediately and several days after myocardial infarction. Dressler’s syndrome is also a possible complication post myocardial infarction but presents as pericarditis with effusion and fever that develops 4 to 6 weeks later.
captopril
ACE. HTN, CHF. Insomnia, Vertigo, Weakness
Repeated vomiting causes metabolic acidosis or alkolosis?
alkolosis
A patient is admitted to the hospital with a diagnosis of aortic valve stenosis. Which manifestation should the nurse expect when taking the health history?
Angina is one of the classic triad of manifestations that occurs on exertion in aortic valve stenosis. Angina occurs when the myocardial oxygen demand of the hypertrophied left ventricle exceeds oxygen supply. Fatigue, dyspnea, and weakness are clinical manifestations of chronic mitral valve regurgitation.
The nurse provides postprocedure care to a patient who was just admitted to an inpatient unit after cardiac catheterization. Which assessment does the nurse recognize as the highest priority?
The highest priority for a patient who has undergone cardiac catheterization, upon arrival to the nursing unit, is to first assess the catheterization site for signs of hemorrhage. Assessments of pain, blood pressure, and the IV site are all important assessments, but they are of lower priority than checking the cardiac catheterization site. Text Reference - p. 706
CO2
23-30
Mg level
1.6-2.6
what else besides CRP is an inflammatory marker
ESR
The nurse is assessing a patient who has peripheral artery disease (PAD). Which of these assessment findings is considered a classic symptom of lower extremity PAD?
The classic symptom of lower extremity PAD is intermittent claudication, which is ischemic muscle pain that is caused by exercise, resolves within 10 minutes or less with rest, and is reproducible. The ischemic pain is a result of the buildup of lactic acid from anaerobic metabolism. Once the patient stops exercising, the lactic acid is cleared and the pain subsides. Rest pain, skin ulcerations, and paresthesia in the feet and toes may develop with lower extremity PAD, but are not considered the classic symptoms.
Clinical manifestations of ?? include irritability, anxiety, abdominal cramping, diarrhea, weakness of lower extremities, paresthesias, and several ECG changes, including tall, peaked T waves.
hyperkalemia
which cardiomyopathy has emboli formation
retrictive cardiomyopathy
A diabetic patient underwent an ankle-brachial index (ABI) test. The result of the test is 1.10. How should the nurse interpret the test result?
The patient has falsely elevated ABI Ankle-brachial index (ABI) test is a screening tool for peripheral arterial disease. An ABI of 1.10 is a normal value in healthy adults. However, in diabetic patients the arteries are calcified and noncompressible, which often result in a falsely elevated ABI. An ABI of 1.10 does not indicate PAD. The value can be considered normal in healthy adults, but not in diabetic patients as their blood vessels are calcified and stiff. A borderline ABI has a value of 0.91-0.99. Text Reference - p. 835
how do you treat atrial dysrhythmias
Ca Channel Blockers B blockers, electrical cardioversion
a drug ending in PRIL is what type of drug
ACE Inhibitor
Coronary revascularization with coronary artery bypass graft (CABG) surgery is recommended for which patients?
Coronary revascularization with CABG is recommended for patients who have diabetes mellitus, have left main coronary artery or three-vessel disease, patients who are not candidates for percutaneous intervention and who have failed percutaneous intervention and continue to have chest pain, and those who are expected to have longer-term benefits with this surgery than with catheterization. Severe aortic stenosis is not an indicator for cardiac revascularization surgery. Text Reference - p. 752
What disease can bring on metabolic alkalosis (hormone related)
hyperaldosteronism
An abdominal x-ray report of an obese patient indicates a pulsatile mass in the periumbilical area. Further diagnostic tests confirm that the patient has an abdominal aortic aneurysm (> 6 cm). The nurse recognizes that aneurysms in the early phase are often difficult to diagnose for what reasons?
AAA often asymptomatic AAA mimic Sx of other diseases obesity might influence xray
The ABG values of a patient suggest respiratory alkalosis. The nurse recognizes what causes of respiratory alkalosis? Select all that apply
Respiratory alkalosis occurs when the plasma pH is increased and the PaCO2 is decreased. The most common causes of respiratory alkalosis are hypoxia, fever, and pulmonary emboli. These conditions are associated with hyperventilation. Pneumonia and COPD cause respiratory acidosis through hypoventilation. Text Reference - p. 304
Na
135-145
What is a normal level of CK-MB?
3-5%
help diagnose and monitor valvular heart disease progression
Doppler color-flow imaging and transesophageal echocardiography
The patient comes to the emergency department with severe, prolonged angina that is not immediately reversible. The nurse knows that if the patient once had angina related to a stable atherosclerostic plaque and the plaque ruptures, there may be occlusion of a coronary vessel and this type of pain. How will the nurse document this situation related to pathophysiology, presentation, diagnosis, prognosis, and interventions for this disorder?
The pain with ACS is severe, prolonged, and not easy to relieve. ACS is associated with deterioration of a once stable atherosclerotic plaque that ruptures, exposes the intima to blood, and stimulates platelet aggregation and local vasoconstriction with thrombus formation. The unstable lesion, if partially occlusive, will be manifest as unstable angina or NSTEMI. If there is total occlusion, it is manifest as STEMI.
what is balanced with chloride
bicarb
? phenomenon is characterized by vasospasm-induced color changes of the fingers, toes, ears, and nose.
Raynaud’s
what goes away with a cough
ronchi
dialated cardiomyopathy is what type of failure?
systolie- the heart just has trouble contracting which decreases the ejection fraction
What has friction rub
pericarditis
does metoprolol lower HR?
yes
The nurse is caring for a patient with acute pericarditis. Which assessment findings reflect a serious complication of this condition?
Chest pain, pulsus paradoxus, narrowed pulse pressure, JVD Cardiac tamponade develops as the pericardial effusion increases in volume. This results in compression of the heart. The speed of fluid accumulation affects the severity of clinical manifestations. The patient with cardiac tamponade may report chest pain and is often confused, anxious, and restless. As the compression of the heart increases, there is decreased cardiac output (CO), muffled heart sounds, and narrowed pulse pressure. The patient develops tachypnea and tachycardia. Neck veins usually are distended markedly because of increased jugular venous pressure, and pulsus paradoxus is present. Pulsus paradoxus is a decrease in systolic blood pressure (BP) during inspiration that is exaggerated in cardiac tamponade. Bradycardia and peripheral edema are not assessment findings associated with cardiac tamponade. Text Reference - p. 815
The charge nurse is reviewing the electrolyte laboratory study results for the unit’s assigned patients. Which patient would be at greatest risk for the potential development of hypomagnesemia?
Causes of hypomagnesemia include chronic alcoholism, diarrhea, vomiting, malabsorption syndromes, prolonged malnutrition, and nasogastric (NG) suction. See Table 17-9 for other causes. Lung cancer, hypertension, eclampsia, BPH, and UTIs are not causes of hypomagnesemia.
PAD s/s
Intermittent Claudication. People who have P.A.D. may have symptoms when walking or climbing stairs. These symptoms may include pain, numbness, aching, or heaviness in the leg muscles.
NOT SURE OF THESE : skin thin, shiny, and taut. hair loss on lower legs. distal pulses diminished or absent.
A nurse is assessing a patient with mitral stenosis. Which findings are likely during the nursing examination? Select all that apply.
Exertional dyspnea is caused by reduced lung compliance in mitral stenosis. Fatigue and palpitations are present because of atrial fibrillation. A low-pitched diastolic murmur is heard in mitral stenosis; however, it is best heard at the apex using the stethoscope. Syncope, nausea, and vomiting are not seen in patients with mitral stenosis.
The nurse provides postprocedure care to a patient who was just admitted to an inpatient unit after cardiac catheterization. Which assessment does the nurse recognize as the highest priority?
The highest priority for a patient who has undergone cardiac catheterization, upon arrival to the nursing unit, is to first assess the catheterization site for signs of hemorrhage. Assessments of pain, blood pressure, and the IV site are all important assessments, but they are of lower priority than checking the cardiac catheterization site. Text Reference - p. 706
prolonged diarrhea causes metabolic acidosis or alkolosis?
acidosis
The nurse is providing care to a patient with a blood pressure of 120/80 mm Hg. What is the patient’s pulse pressure? Record the answer using a whole number. __ mm Hg
Pulse pressure is calculated as the difference between the systolic blood pressure (SBP) and the diastolic blood pressure (DBP). It is normally about one third of the SBP. If the patient’s blood pressure is 120/80, the pulse pressure would be 120 – (minus) 80, which is equal to 40 mm Hg. Text Reference - p. 690
in trendelenburg what is elevated the feet or the head
feet
A patient was just diagnosed with acute arterial ischemia in the left leg secondary to atrial fibrillation. Which early clinical manifestation must be reported to the health care provider immediately to save the patient’s limb?
he health care provider must be notified immediately if any of the six Ps of acute arterial ischemia occurs to prevent ischemia from quickly progressing to tissue necrosis and gangrene. The six Ps are: paresthesia, pain, pallor, pulselessness, and poikilothermia, with paralysis being a very late sign, indicating the death of nerves to the extremity. Cramping in the leg is more common with varicose veins. The pain is not referred.
Too much Na what happens with depolarizes
rapid firing, not good.
Itchiness and cord-like texture are characteristics of ?
superficial venous thrombosis not VTE
Client started on warfarin after mech valve replacement. PT = 76 INR 5.5. What does the RN request from the provider
VIT K
A patient with a history of heart failure was admitted to the medical unit. The nurse will assess for clinical indications of excessive extracellular fluid (ECF) volume, including which of these? 3 things
Weight gain, full bounding pulse, engorged neck veins
In DM why would K be high
Insulin lets K into cell
What is cardioversion…need dr.
is a procedure that can restore a fast or irregular heartbeat to a normal rhythm. A fast or irregular heartbeat is called an arrhythmia (ah-RITH-me-ah). Arrhythmias can prevent your heart from pumping enough blood to your body.
What is a cTnl of 8.2mcg/L
A cardiac Troponin-I of >.003mcg- MI
What is a normal level of myoglobin?
90mcg
What does R on T mean?
R wave is on the T wave
how does an ACE work
Angiotensin converting enzyme (ACE) inhibitors are heart medications that widen or dilate your blood vessels to improve the amount of blood your heart pumps and lower blood pressure. ACE inhibitors also increase blood flow, which helps to decrease the amount of work your heart has to do.
K+ is usually where
inside
Theraputic range for INR for mechanical valves
2.5-3.5
A patient experiences pain in the calf while exercising and reports that the pain disappears after a few minutes of resting. The nurse recognizes the finding as most consistent with:
Ischemia resulting from partial blockage of an artery Claudication does not result from venous abnormalities
A nurse is providing postoperative care for a patient. The primary health care provider assesses the patient and advises the nurse to stop all intravenous fluids except for continuous maintenance fluids. Which fluid will the nurse administer as a maintenance fluid?
Maintenance fluids are hypotonic solutions as the body’s daily losses are hypotonic. The nurse should therefore administer 0.45% NaCl, which is hypotonic. Lactated Ringer’s solution is an isotonic solution and not used as a maintenance fluid, as it tends to expand the extracellular compartment. 5% dextrose in 0.9% saline is a hypertonic solution that expands intravascular volume and replaces extracellular fluid losses. 25% albumin solution is a plasma expander and not used as a maintenance fluid.
what drug is good for reducing afterload and increasing cardiac output
ACE
Is JVD in dilated or restrictive cardiomyopathy
both
helps diagnose aortic disorders.
Computed tomography scan with contrast gold
what happens to the heart with hypokalemia?
peaked Ts
Hct
x3 over Hgb
Hypercalcemia S/s
decreased neuromuscular excitation
anorexia,
nausea
constipation
weakness
dysrhythmia
When blood supply is available but decreased
ishemia
what causes acute endocarditis usually
staphylococcus aureus
defined as aches in the joints, joint pains, arthralgia of multiple joints, and multiple joint pain
polyarthralgia
The patient is admitted with metabolic acidosis. Which system is not functioning normally?
When the patient has metabolic acidosis , the kidneys are not combining H+ with ammonia to form ammonium or eliminating acid with secretion of free hydrogen into the renal tubule. The buffer system neutralizes hydrochloric acid by forming a weak acid. The hormone system is not related directly to acid-base balance. The respiratory system releases CO2 that combines with water to form hydrogen ions and bicarbonate. The hydrogen then is buffered by the hemoglobin.
Heparin measure
Put 25-39 seconds not 150
Which nursing interventions are appropriate when caring for a patient with hypercalcemia?
Hypercalcemia is treated by hydrating the patient and promoting urinary excretion of calcium. Therefore the nurse should administer loop diuretics such as furosemide to promote diuresis and should keep the patient hydrated by administering isotonic saline infusions. The nurse can also administer bisphosphonates to inhibit the activity of osteoclasts. The patient should be encouraged to drink at least 3000 to 4000 mL of fluid to promote calcium excretion and prevent kidney stones. The patient is encouraged to breathe into a paper bag if signs of hypocalcemia are evident. Text Reference - p. 299
(hyperosmolar). If ? fluid surrounds a cell, water leaves the cell to dilute ECF; the cell shrinks and may eventually die
hypertonic
Solutions in which the solutes are less concentrated than in the cells are termed
hypotonic (hypoosmolar).
What is chloride for
balancing
Hyperglycemia and presence of U wave reflect manifestations of ??
hypokalemia.
A patient with varicose veins has been prescribed compression stockings. How should the nurse teach the patient to use these?
The patient with varicose veins should apply stockings in bed, before rising in the morning. Stockings should not be worn continuously but they should not be removed several times daily. Dangling at the bedside before application is likely to decrease their effectiveness.
What do ARBs end with
*sartan
S2 is what valves closing
aortic and pulmonary slamming shut (meanwhile tricuspid and mitral are silently opening up)
what chemical is needed for cell buffering, nerve conduction, muscle function, and osmotic pressure?
K
An elongated ST segment and a prolonged QT interval are manifestations of
hypocalcemia.
ref level of chloride
96-106
How do you Take ACE Inhibitors?
ACE inhibitors are usually taken on an empty stomach one hour before meals. Follow the label directions on how often to take it. The number of doses you take each day, the time allowed between doses, and how long you need to take the medication will depend on the type of ACE inhibitor prescribed, as well as your condition. While taking this drug, have your blood pressure and kidney function checked regularly, as advised by your doctor. Never stop taking an ACE inhibitor, even if you feel that it is not working. If you are taking ACE inhibitors for heart failure, your heart failure symptoms may not improve right away. However, long-term use of ACE inhibitors helps manage chronic heart failure and reduces the risk that your condition will become worse.
what the tests for cardiomyopathy
Echo-cardiogram(best), CX, EKG, Bx of cardiac muscle
how long to get to the cath lab
90min
what chemical maintains osmotic pressure and transmits nerve impulses
Na
too much carbonic acid causes what sx
HA,
What is an increased WBC count
Leukocytosis
Which diagnostic study is used to assess congenital heart disease in a patient?
Real time 3-D echocardiography
1 liter of water is how many pounds?
2.2lbs
The nurse identifies a U wave on a patient’s electrocardiogram. Which dietary instruction will be beneficial to the patient?
The presence of a U wave in the patient’s electrocardiogram may indicate hypokalemia or repolarization of the Purkinje fibers. Hypokalemia can be caused by excessive sweating, diarrhea, or excessive laxative use. Bananas are a rich source of potassium. Therefore, increasing the consumption of bananas will be beneficial for the patient. Coconut oil increases digestion and bowel function. Raw and virgin coconut oil has a laxative effect and should not be recommended. Milk and milk products like cheese are rich in sodium but not in potassium. Omega-3 fatty acids help flush toxins out of the body. Therefore, increasing the consumption of omega-3 fatty acids would produce a laxative effect in the patient and potentiate hypokalemia. Text Reference - p. 696
Where does the LAD provide blood flow
Left anterior descending artery supplies blood to the left side of heart and part of right vent. lower portion of the right ventricle receives blood flow from the left anterior descending artery as well as the right coronary artery during diastole.
What is a VAD?
ventricular assist device. A ventricular assist device (VAD) is a mechanical pump that’s used to support heart function and blood flow in people who have weakened hearts. The device takes blood from a lower chamber of the heart and helps pump it to the body and vital organs, just as a healthy heart would.
omeprazole
proton pump inhibitor. HA, Diarrhea, abdominal pain. check for occult blood.
A patient is admitted to the hospital with a diagnosis of acute mitral valve regurgitation. What is the priority nursing intervention?
Auscultation of the lung sounds is the priority nursing intervention in acute mitral valve regurgitation. In acute mitral valve regurgitation there is a rapid increase in left atrial pressure and volume, which leads to pulmonary congestion, resulting in pulmonary edema and possible cardiogenic shock. Hemoptysis can occur with mitral valve stenosis, not acute mitral valve regurgitation. Lower extremity edema is a manifestation of tricuspid stenosis. Water-hammer pulse is a manifestation in chronic, severe aortic valve regurgitation.
What is sympathectomy
excision of a nerve or ganglion
What is a Q wave?
seen post MI….add more
ref level of phosphate
2.4- 4.4
What are some S/S of endocarditis
Osler nodes, splinter hemorrhages (black lines on teh nail), Janeway lesions (painless lesions on the hands, Roth spots (white areas in retina), weakness, anorexia, petechiae
What is lasix
Loop diuretic
What reveals decreased EF, altered valve function, and impaired pumping of ventricles
Trans-esophageal Echo
Which disease is a nonatherosclerotic, segmental, recurrent inflammatory disorder of small and medium-sized vascular vessels of the upper and lower extremities, leading to color and temperature changes of the limbs, intermittent claudication, rest pain, and ischemic ulcerations. It primarily occurs in men younger than 45 years old with a long history of tobacco or marijuana use.
Buerger’s Disease….Buerger’s disease treatment includes smoking cessation, trauma and cold temperature avoidance, and a walking program. Venous thrombosis is the formation of a thrombus in association with inflammation of the vein. Acute arterial ischemia is a sudden interruption in arterial blood flow to a tissue caused by embolism, thrombosis, or trauma.
hypomagnesemia s/s
increased neuromuscular excitation
positive chvostek and trousseaus signs
insomnia
nystagmus
tetany
seizures
dysrhythmias
The health care provider prescribes the bed position of reverse Trendelenberg for a patient with critical limb ischemia from severe chronic peripheral vascular disease. What is the desired effect of this intervention?
Reverse Trendelenberg positions the bed at a straight slant with the top of the bed higher than the foot. This position allows gravity to increase blood flow to dependent extremities. Blood pressure is not lowered significantly by this position. Meticulous hygiene is employed to prevent infection. An antiplatelet medication, such as aspirin, may be prescribed to prevent blood clot formation.
ref level of Mg
1.5-2.5
RN is caring for a pt post op CABG. What is the appropriate RN Dx ATT.
1- ineffective breathing pattern related to pain
- anticipatroy grieving related to poor prognosis
- deficient fluid volume related to fluid loss in surgery
- fear related to possibility of sudden cardiac death
1- ineffective breathing pattern related to pain
When assessing the patient with a multilumen central line, the nurse notices that the cap is off one of the lines. On assessment, the patient is in respiratory distress and the vital signs show hypotension and tachycardia. What is the nurse’s priority action?
The cap off the central line could allow entry of air into the circulation. For an air emboli, the priority is to administer oxygen; next, the catheter is clamped and the patient is positioned on the left side with the head down. Then the health care provider is notified.
why does it prevent flushing
blocks prostiglandins
Ventricular tachycardia pacing happens how
The vents are acting like the SA or AV nodes, but because of the block the vents pace themselves but only around 30 beats/min
Normal ejection fraction
50-75%
Sx of pericarditis
substernal pain, radiating to neck, aggravated by breathing or coughing, elecated WBC, fever, malaise. JVD, elecated CVP, muffled heart sounds,
The nurse notes that a patient with a serum potassium of 2. 8 mEq/L is at highest risk for
Potassium exerts a direct effect on the excitability of cardiac muscle tissue. Therefore an increased or low serum level of potassium can alter cardiac function and heart rhythm, resulting in dysrhythmias. Acute renal failure is not a complication of hypokalemia, but it may be seen with hyperkalemia. Metabolic alkalosis and malignant hypertension are not associated with hypokalemia.
What drug class ends in -lol?
Beta blockers
What are the lung sounds in HF
rales and crackles
what organ clears electrolytes
kidneys
what drug slows your heart rate and decreases the amount of work it has to do so it can heal
metoprolol or ACEs
How many generations in the lungs with how many branches each
~20 with 3 branches each covering 100m2
what are 2 types of diffusion that are passive
simple and facilitated
What should be included in the treatment plan of a patient with myocarditis who has hypotension and a low ejection fraction?
Anticoagulation therapy Digoxin Immunosuppressive agents A patient with myocarditis and hypotension will have a low ejection fraction, which may result in a thrombus formation. Anticoagulation therapy reduces the risk of thrombus formation from blood stasis. Digoxin improves myocardial contractility and reduces the heart rate. Myocarditis is considered an autoimmune disorder; therefore, immunosuppressive agents should be administered to reduce myocardial inflammation. Diuretics reduce the fluid volume; administering diuretics to a hypotensive patient may cause a further drop in blood pressure. Therefore, diuretics are not recommended. IV nitroprusside reduces the afterload and should not be given if the patient has hypotension.
ref level of Calcium ionized
4.6-5.3
Cardiomyopathy. Which type has these Sx. weakness, Left HF, S3, S4
Dilated
Besides insulin what escorts K into cells
catecholamines like norepi or epi
NSR with Uni-focal PVC
Premature ventricular contraction . Look at electrolytes. Everyone experiences this maybe drinking coffee.
Nurses working in ICUs look after critically ill patients. A majority of the patients are kept on mechanical ventilation. What are the conditions in which positive end-expiratory pressure (PEEP) is contraindicated?
Positive end-expiratory pressure (PEEP) is contraindicated or used with extreme caution in patients with highly compliant lungs (e.g., COPD), unilateral or non uniform disease, hypovolemia, and low CO. In these cases, the adverse effects of PEEP may outweigh any benefits. PEEP is used in pulmonary edema to provide a counter pressure opposing fluid extravasation. The classic indication for PEEP therapy is ARDS to promote alveolar ventilation.
What causes a decrease in cardiac depolarization, leading to a flattening of the P wave levels lead to rapid repolarization, evident as tall T waves and ST segment depression
High potassium/hyperkalemia
Diuretic therapy can cause what deficiency?
hypokalemia
The nurse will look for which manifestation of an acute aortic dissection?
Abrupt onset of excruciating chest or back pain
s4 is heard in what cardiomyopathy
Restricted cardiomyopathy because the heart does not stretch when blood flows in ventricle
Water-hammer pulse is a manifestation in chronic, severe
aortic valve regurgitation
what drug may cause visual disturbances
digoxin
What do statins cause
gastro, myopathy, rash, rhabdomyalysis
What complication should an RN worry about post 24hours STEMI
dysrhythmia
What is a positive inotrope
Positively inotropic agents increase the strength of muscular contraction.
what marker goes up when the heart is over stretched
BNP
When the septum is too thick and restricts blood flowing out of ventricle is called what
hypertrophic cardiomyopathy
what are the 4 cations
K, Mg, Na, Ca2,
The nurse is caring for a patient admitted with diabetes mellitus, malnutrition, and massive gastrointestinal (GI) bleeding. In analyzing the morning laboratory results, the nurse understands that a potassium level of 5.5 mEq/L could be caused by which factors in this patient? Select all that apply.
Hyperkalemia may result from hyperglycemia, renal insufficiency, or cell death. Diabetes mellitus, along with the stress of hospitalization and illness, can lead to hyperglycemia. Renal insufficiency is a complication of diabetes. Stored hemolyzed blood can cause hyperkalemia when large amounts are transfused rapidly. Malnutrition does not cause sodium excretion accompanied by potassium retention. Thus it is not a contributing factor to this patient’s potassium level. The patient with a massive GI bleed would have a nasogastric (NG) tube and not be eating. Text Reference - p. 296
Which diagnostic study helps detect the presence of vegetation on the heart valves in a patient with endocarditis?
Transesophageal echocardiogram. ransesophageal echocardiogram and two- or three-dimensional transthoracic echocardiograms help detect vegetation on the heart valves of a patient with infectious endocarditis. A chest x-ray helps identify changes in the heart; it cannot detect the presence of vegetation on the heart valves. Cardiac catheterization is used to examine the blood vessels; it cannot detect the presence of vegetation on the heart valves. An electrocardiogram may be used to identify first- or second-degree atrioventricular heart block in the patient; it cannot detect the presence of vegetation on the heart valves.
ref level of Ca2+
8.6-10.2
The nurse finds that the patient with renal disease is irritable and has an irregular pulse. ECG changes suggest severe hyperkalemia. What should be the first nursing intervention?
In case of severe hyperkalemia manifested by irritation, irregular pulse, and changes in ECG findings, the nurse should act immediately to prevent cardiac arrest. The nurse should administer intravenous calcium gluconate to reverse the membrane potential effects of extracellular fluid (ECF) potassium. Administering ion-exchange resins (to increase elimination of potassium) and intravenous insulin with glucose (to force potassium from ECF to intracellular fluid [ICF]) can be done once the patient is stable. Stopping all sources of dietary potassium is an important measure when hyperkalemia is mild. Text Reference - p. 297
what counteracts warfarin
Vit K
Who should get a biologic heart valve?
Women of child bearing age and older people because mechanical although more sturdy require anticoagulant therapy forever.
Indications of hypokalemia are
anorexia, nausea, vomiting, muscle weakness, pareesthesia, dysrhythmias, increased sensitivity to digitalis
8 foods with K
raisins, bananas, apricots, oranges, beans, potatoes, carrots, celery
what is the antedote to heparin
protamine sulfate
what is the antedote to coumadin
vitamin K
what chemistry may cause ventricular fibrilation
hyperkalemia
