NSG-320 Cardiac 2024. Real Exam Questions with Answers. Already Graded A+, Exams of Nursing

Download NSG-320 Cardiac 2024. Real Exam Questions with Answers. Already Graded A+ and more Exams Nursing in PDF only on Docsity! NSG-320 Cardiac 2024. Real Exam Questions with Answers. Already Graded A+ 15 boxes together on a EGC strip equals how many seconds? - ANS3 seconds 3 causes of Venous Thromboembolism (VTE) : (Virchow's triad) - ANS1. Venous stasis 2. Damage of the endothelium (inner lining of the vein) 3. Hypercoagulability of the blood 5 boxes together on a EGC strip equals how many seconds? - ANS1 second A client with a history of chronic heart failure is hospitalized with severe dyspnea and a dry, hacking cough. Assessment findings include pitting edema in both ankles, BP 170/100 mm Hg, pulse 92 beats/minute, and respirations 28 breaths/minute. Which explanation, if made by the nurse, is most accurate? A. "The assessment indicates that venous return to the heart is impaired, causing a decrease in cardiac output." B. "The manifestations indicate impaired emptying of both the right and left ventricles, with decreased forward blood flow." C. "The myocardium is not receiving enough blood supply through the coronary arteries to meet its oxygen demand." D. "The patient's right side of the heart is failing to pump enough blood to the lungs to provide systemic oxygenation." - ANSB. "The manifestations indicate impaired emptying of both the right and left ventricles, with decreased forward blood flow." Rationale: The patient is experiencing acute decompensated heart failure with symptoms of both right- and left-sided heart failure. Left-sided heart failure prevents normal, forward blood flow and causes pulmonary congestion. Right-sided heart failure causes a backup of blood and results in venous congestion. A nurse is caring for an 82 year-old female client who is on dietary restrictions to manage fluid overload from congestive heart failure. The client is a practicing Muslim. What food is appropriate for the nurse to recommend? A. Pizza B. Hot dog C. Fish burger D. Hamburger E. Canned soup - ANSC. Fish Burger Pizza is high in sodium and would increase fluid retention. Hot dogs are high in sodium and would worsen fluid retention. A hamburger can contain beef & pork, so it would not be a good food choice. Canned foods are high in sodium and would cause more fluid retention. A patient with left-sided heart failure is prescribed oxygen at 4 L/min per nasal cannula, furosemide (Lasix), spironolactone (Aldactone), and enalapril (Vasotec). Which assessment should the nurse complete to best evaluate the patient's response to these drugs? A. Observe the clients skin turgor. B. Auscultate the client's lung sounds C. Measure the clients blood pressure D. Review the clients intake and output - ANSB. Auscultate the client's lung sounds Rationale: Left-sided heart failure will prevent normal blood flow and will cause blood to back up into the left atrium and into the pulmonary veins. The increased pulmonary pressure causes fluid extravasation from the pulmonary capillary bed into the interstitium and then the alveoli, which manifests as pulmonary congestion and edema. The most important assessment to determine if the drugs are improving the patient's condition is to auscultate lung sounds. The other assessments are important, but the best indicator of improvement of left ventricular function is a reduction in adventitious lung sounds (crackles). A-Fib will have what on an ECG strip? - ANSThey can have absent or extra P waves. Afterload - ANSResistance that the ventricles must overcome to eject blood through the valves and into the peripheral blood vessels. Atherosclerosis results from: - ANSThe deposit of cholesterol and lipids within the vessel walls and leads to progressive narrowing of the artery Atrial Fibrillation is... - ANS- Disorganized electrical activity in the atria - Can come from multiple different areas of the atrial myocardium - Absence or inconsistent P wave - Appears irregular, often changes speed of the heart rate - #1 undiagnosed heart problem Atypical Leg-Syndrome: - ANSSome patients either have no symptoms or present with atypical leg symptoms. These symptoms may occur in atypical locations (e.g., ankle, foot, hamstring, hip, knee, and shin). Symptoms include: - Burning - Heaviness - Pressure - Soreness - Tightness - Weakness - Skin ulcers Right: - Hepatomegaly - Renal failure - Skin ulcers Conditions that increase the workload of ventricles: - ANS- Anemia (decreased oxygen supply increases workload of heart to meet the demand) - Infection (increased oxygen demand) - Dysrhythmias (decreased CO and increased workload) - Obstructive sleep apnea - Pulmonary embolism (increased workload to pump blood into lungs) - Hypervolemia (increased preload increases workload) Critical Limb Ischemia: - ANS- Critical limb ischemia (CLI) is a condition characterized by chronic ischemic rest pain lasting more than 2 weeks, arterial leg ulcers, or gangrene of the leg as a result of PAD. Damaged Endothelium of VTE: - ANSDamage to the endothelium of the vein may be caused by: - Direct: (e.g., surgery, intravascular catheterization, trauma, fracture, burns, prior VTE) - Indirect (e.g., chemotherapy, vasculitis, sepsis, diabetes) injury to the vessel. - A damaged endothelium has decreased fibrinolytic properties, which predispose the patient to thrombus development. Diastolic Heart Failure (when the heart is relaxing, filling, repolarizing): - ANS- Heart wall becomes thick, decreasing the inside volume of the ventricle - Ventricles can't relax and fill properly that in turn - Decreases stroke volume and cardiac output Venous engorgement in the pulmonary and systemic circulation Each box on a ECG strip represents how many seconds? - ANS0.2 second Easy rhythm analysis - ANSCount the r-waves in the 6 second strip x by 10= heart rate Echocardiograms are used for: - ANS- Noninvasive test using ultrasound. - Used to diagnose Heart Failure, showing heart chamber enlargement, ventricular hypertrophy, and pericardial effusion. - Used to determine Ejection Fracture (percentage of blood ejected from the heart during systole). For a normal rhythm, you must have what type of interval between QRS complexes? - ANSEqual intervals between Heart failure can be associated with: - ANS- long-standing hypertension - coronary artery disease (CAD) - myocardial infarction (MI) - Metabolic syndrome - Advance age - Smoking Heart Failure can be classified in two different ways: - ANS1.Left or Right Sided, or both sides of the heart. This identifies which ventricle is failing. 2.Systolic, Diastolic, or Mixed which describes the specific way or how the heart muscle is failing Heart Failure Medical Interventions: - ANS- Treat underlying cause - Decrease morbidity and mortality - Improve cardiac output - Decrease and manage symptoms - Preserve organ function Heart failure: - ANSInability of the heart to maintain adequate cardiac output (CO) to meet the metabolic needs of itself & the body. This can lead to myocardial hypertrophy and cardiomyopathy. How can you reduce Afterload? - ANSVasodilators (nitrates, isosorbide), ACE inhibitors (Lisinopril), ARB's (Valsartan) How can you reduce Preload? - ANS- Eliminate table salt, restrict fluids to 2L a day, diuretics: lasix, bumetanide, thiazide diuretics. How to diagnose PAD: - ANS- Doppler Ultrasound: noninvasive; used to measure blood flow through blood vessels. - Angiography: uses contrast and fluoroscopy to examine blood vessels. How to Diagnose VTE: - ANS- Activated clotting time (ACT), activated partial thromboplastin time (aPTT), international normalized ratio (INR), bleeding time, platelet count: monitors patient's bleeding and clotting time; alterations if patient has underlying blood dyscrasia - D-Dimer: formed as a result of clot lysis; elevated suggests VTE; Normal results: <250 ng/mL (<250 mcg/L) - Venous compression ultrasound: abnormal findings when veins fail to collapse with application of external pressure, suggesting thrombus - Duplex ultrasound: determines location and extent of thrombus - Computed tomography venography: evaluates veins after contrast has been administered - Magnetic resonance venography: evaluates blood flow - Contrast venogram: X-ray determination of location and extent of clot using contrast media How to help prevent PAD: - ANS- Tobacco Cessation - Diabetes Management - Lipid Management - Hypertension Management How to prevent VTE: - ANS- Change position every two hours. - Unless contraindicated, flex and extend feet, knees, and hips at least every two hours while awake. - Sit in a chair for meals and ambulate at least four to six times per day. - Wear correctly-fitted graduated compression stockings consistently from hospital admission until discharge in surgical patients. How to treat Sinus Tachycardia - ANSVagal maneuver (Valsalva) - to slow HR - Bear Down - Face in ice cold water Hypercoagulability of VTE: - ANSHypercoagulability occurs when localized platelet aggregation and fibrin entrap RBCs, WBCs, and more platelets to form a thrombus. In a normal heart what conducts first? - ANSSA node Intermittent Claudication: - ANS- Ischemic muscle pain is caused by exercise, resolves within 10 minutes or less with rest, and is reproducible. - Ischemic pain is a result of the buildup of lactic acid from anaerobic metabolism. - Once the patient stops exercising, lactic acid clears and the pain subsides. Leading cause of PAD is: - ANSAtherosclerosis Left Sided Heart Failure: - ANS- Most cases of heart failure begin with Left sided/Ventricular HF - Causes include: HTN, CAD, valvular disease of the aortic or mitral valve - Decreased tissue perfusion from poor cardiac output, pulmonary congestion Length of the T-wave - ANSRepresents ventricular repolarization Maze Procedure: - ANSUsed for patients who have chronic A-Fib More forceful contraction increases: - ANSStroke Volume and Cardiac Output Neuropathy: - ANSParesthesia, or numbness or tingling, in the toes or feet may result from nerve tissue ischemia. Normal Level Range of Digoxin - ANS0.5- 1ng/mL Normal P-R Interval - ANS0.12- 0.20 seconds / 3-5 small squares The home care nurse visits a patient with chronic heart failure who is taking digoxin (Lanoxin) and furosemide (Lasix). The patient complains of nausea and vomiting. Which action is most appropriate for the nurse to take? A. Perform a dipstick urine test for protein. B. Notify the health care provider immediately C. Have the patient eat foods high in potassium D. Ask the patient to record a weight every morning - ANSB. Notify the health care provider immediately Rationale: Administration of furosemide increases excretion of potassium and may cause hypokalemia. The risk for digitalis toxicity increases if potassium levels are below normal and digoxin is administered. Signs and symptoms of digitalis toxicity include anorexia, nausea and vomiting, visual disturbances (such as "yellow" vision), and dysrhythmias. The length of the P-Wave - ANSRepresents atrial depolarization The length of the QRS complex - ANSRepresents ventricular depolarization and atrial repolarization The most common way to monitor the heart - ANSClient wears a 3 or 5 lead ECG - Leads are attached directly to the client and connect to a monitor - Also, the leads connect to a tele monitor that transmits the data to a bank of monitors where someone watches them for changes The SA node represents which waveform on the ekg? - ANSThe P-wave Treatment for patients with intermittent claudication - ANS- Exercise should be performed for 30 to 45 minutes/day, at least 3 times/week, for a minimum of 3 months. Treatment of Atrial Fibrillation: - ANSAntidysrhythmic medication Treatment of Bradycardia: - ANSAtropine Treatment of V-Fib: - ANS- Assess! - Call a CODE and start CPR and early defibrillation. - DO NOT LEAVE THE PATIENT - Start CPR within 30 seconds for best results - Medication as ordered Two types of heart failure of the left ventricle: - ANS1. Systolic heart failure Diastolic heart failure Venous Stasis of VTE: - ANS- Venous stasis occurs when the valves are dysfunctional or the muscles of the extremities are inactive. Ventricular Fibrillation: - ANS- Quivering of the ventricles= NO CARDIAC OUTPUT! - Medical Emergency!! Call 911 Ventricular Tachycardia (V-Tach) - ANS- When 3 of more Premature Ventricular Contractions occur consecutively. - Ventricular rate is greater than 100. - Causes: Hypoxemia, electrolyte imbalance, drug toxicity What are some nursing interventions to help improve the clients ability to oxygenate their blood? - ANS- Apply O2 - Raise head of the bed - CPAP What can result from the inability of the LV to empty during contraction and fill during relaxation? - ANS- Blood backs up into left atrium and pulmonary veins Increased pulmonary pressure causes fluid leakage →→ pulmonary congestion and edema What do you call a heart rate that is greater than 150? - ANSSinus Ventricular Tachycardia (SVT) What do you need to monitor when using Digoxin? - ANS- Monitor for signs of hypokalemia and hyperkalemia, since these can increase or decrease the effects of digoxin, respectively. - Monitor for early signs of toxicity: anorexia, nausea and vomiting, fatigue, headache, depression, visual changes. - Monitor for late signs of toxicity, such as dysrhythmias (e.g., bradycardia, atrioventricular block). What does a CPAP do? - ANSKeeps the airway from collapsing - Improves CO and EF by decreasing preload, afterload, and BP. What does it mean if someone is on a 12 lead ECG - ANS- This is used to diagnose specific types of dysrhythmias and heart attacks - This is a one time test that lasts about 1 minute - It is not used for continuous monitoring What is a B-Type Natriuretic Peptide? (BNP) - ANS- Used to diagnose heart failure, especially those with dyspnea - BNP is produced and released by the ventricles when the heart stretches with fluid overload. - Women have naturally higher levels than men, and obese pt's have lower levels compared to those with a healthy weight. - Levels increase during exacerbations and decrease with appropriate tx. What is the difference between A- Fib and A- Flutter? - ANSA- Fib is inconsistent P waves. A- Flutter is consistent P waves. What medications can enhance contractility? - ANS- Digoxin - Betablockers (Metoprolol) What types of medication should be used for CVD or PAD? - ANS- Antiplatelet/ Anticoagulants With heart failure there is a decrease in: - ANSCardiac Output from a decrease in Stroke Volume You have to have what wave followed by the QRS complex? - ANSP- wave