Cardiovascular

Question 1

Hypovolemic shock

Answer 1

S/S: pale, diaphoretic, restless
Nursing knowledge: patients are hypotensive, tachycardia, tachypnea
Nursing actions: give oxygen, narrowing pulse pressure

Question 2

Polyarteritis Nodosa

Answer 2

Inflammation of the small arteries causing a diminished blood
Treatment: Cortisol

Question 3

Cardiac catheterization

Answer 3

Inspection of pain at site, report of chest pain, lightheaded and nausea immediately following catheterization should be reported to PCP
This uses dye contrast to assess for artery obstruction. Complications include allergic reactions, lactic acidosis ( due to use of Metformin(glucophage), glucophage should be discontinued 24-48 hours prior to and exposure to dye) and kidney failure( dye increases kidney damage)

Question 4

Catheter insertion

Answer 4

Should never be withdrawn and inserted when resistance is felt. Rather stop he insertion and ask patient to take a deep breathe— this helps relax the urethral muscles and facilitate passage through the prostate gland

Question 5

Withdrawing blood from a PICC LINE

Answer 5

Discard 3ml-5ml of blood to prevent contamination of blood sample with iv fluid and medications
Use 10ml syringe to flush port
Apply a push -pause technique to reduce the risk of clot formation and damage to catheter

Question 6

Venous insufficiency

Answer 6

Elevate legs not dangle

Question 7

Arterial insufficiency

Answer 7

Dangle legs in dependent position not elevate

Question 8

Beta blocker (LOL to my 4Bs: bradycardia, bronchospasm, blood sugar, blood pressure)

Answer 8

Never MISS !!!!!!!!!
Bradycardia ( decrease heart rate: notify PCP if HR is less than 50) Bronchospasm ( Do not give to asthmatic patients: it increases resistance of airway)
Blood pressure decreases
Blood sugar masked( hyperglycemia)

Question 9

Hypertensive crisis

Answer 9

Notify PCP
Administer prescribe antihypertensive crisis
Elevate HOB 15-30 to prevent increase ICP
No need to administer fluid because it expands blood volume which in turns increases ICP

Question 10

Atorvastatin

Answer 10

Huge category X, advice patient to use contraception while taking atorvastatin.
MONITOR LFT at least yearly. Follow low fat diet. Effective for everyone

Question 11

ACE inhibitors- angiotensin converting enzymes inhibitors —e.g. Lisinopril, captopril

Answer 11

blocks the release of aldosterone and by doing that promote the retention of potassium .
Avoid food high in potassium
Common side effects of ACE inhibitors include orthostatic blood pressure(dizziness), dry cough, hyperkalemia, and angioedema( worst: report immediately)

Question 12

Tartrazine (yellow food coloring)

Answer 12

No aspirin

Question 13

Aerobic exercise( cardio exercise)

Answer 13

Regular aerobic exercise are usually recommended over isometric exercise ( heavy weight lifting) and rowing because they can cause a dangerous rise in blood pressure

Question 14

Warfarin(Coumadin)
Question? The nurse notes that a client taking warfarin sodium ( Coumadin) has an international normalized ratio (INR) of 2.8, what should the nurse do?

Answer 14

The Normal INR is 1.3 to 2.0. The treatment goal of warfarin sodium is to raise the INR to an appropriate value. An INR of 2 to 3 is appropriate for most clients, although for some clients the target 🎯 INR is 3 to 4. 5.
if the INR is above the recommended range, warfarin should be ⬇️ decrease . If the INR is a 2.8, the nurse should plan to administer the same dosage as prescribe.
CONTRAINDICATIONS for WARFARIN!!!!!!
Active peptic ulcers
Alcohol 🍺 use
Recent injuries
Warfarin PT normal values is 9.6 to 11.8

Question 15

Below the knee amputation

Answer 15

PostOp Care
>Elevate limb to minimized edema but do not elevate for more than 24 hours because of hip flexion
> During the first 24 hours, you may lie the patient prone for 30 minute 3 times per day for a short period of time

Question 16

Cardio version

Answer 16

Administer sedatives/ hypnotic
Instruct client that medications may cause dizziness or drowsiness
Withhold digitalis 48 hours before procedure to prevent ventricular fibrillation after cardio version

Question 17

Immediate Treatment for MI

Answer 17

Mnemonic ( MONA) 
M: Morphine Sulfate
O: Oxygen 
N: Nitroglycerin 
A: ASA

Question 18

Treatment for CHF

Answer 18

Mnemonics's ( UNLOAD FAST) 
U: sit upright
N: Nitro
L: lasix
O: Oxygen 
A: aminophyline 
D: Digoxin

F:Fluid decrease
A: Afterload decrease
S: sodium decrease
T: tests, dig levels, ABG, K

Question 19

Pack Red blood cells administration

Answer 19

Prime the tubing with 0.9% sodium chloride to reduce hemolysis.
Infuse one unit of red blood cell over 4 hours
Use 18-20 gauge needle
Take baseline vitals signs
Verify with another nurse

Question 20

Hydralazine hydrochloride(apresoline)

Answer 20

Fast acting antihypertensive : helps to relax smooth muscle. S/E: headache, angina,tachycardia, palpitations, sodium retention, anorexia, and lupus erythematosus-like syndrome( sore throat, fever, muscle joint aches and rash)

Question 21

Ginkgo

Answer 21

Is an anti-platelet, an a CNS stimulate given dementia syndrome. There is increase risk with NSAIDS

Question 22

Clopidogrel ( plavix)

Answer 22

Anticoagulant.
Increase risk of hypertension, needs periodic blood test. Also med should be taken the same time each day
Increases risk of bleeding

Question 23

Hyperkalemia

Answer 23

MURDER
M: muscle weakness ( metabolic acidosis)
U: urine, oliguria, Anuria
R: respiratory distress ( respiratory acidosis
D: decrease cardiac contractility
E: elevated T waves (ECG changes)
R: reflexes, hyperreflexia.

Question 24

Hypokalemia,

Answer 24

Vomiting, use of steroids

Question 25

PVC

Answer 25

Patient complains of a lump in the throat

Question 26

Cardiac tamponade

Answer 26

Large amount of pericardial fluid cause the heart to be squeezed and unable to contract effectively. Heart tones become muffled, cardiac output and blood pressure drop, pulse increases and the client develops jugular vein distention, pulsus paradoxus, and narrowed pulses. 
3MAIN ASSESSMENT 
Narrowed pulse pressure
Muffled heart sounds
Distended neck vein

Question 27

B-type natriuretic peptide (BNP)

Answer 27

Are made and stored and release primary by the ventricles, they are produce in response to stretching of the ventricles due to the increase blood volume and higher level of extra fluid that accompany heart failure. Elevation of BNP >100pg/mL helps to distinguish cardiac from respiratory causes of dyspnea.

Question 28

CK-MB

Answer 28

Specific diagnostic of myocardial infarction

Question 29

Thoracic aortic aneurysm

Answer 29

This can put pressure on the esophagus and cause dysphasia indicating that aneurysm has increase in size and may need further intervention

Question 30

Abdominal aortic aneurysm

Answer 30

Repair of aneurysm can be done via femoral percutaneous placement of a stent graft. PostOp priority is to monitor for graft leakage or separation. Manifestation of graft leakage include: echymosis of the groin, penis, scrotum, or perineum, increased abdominal girth, tachycardia, weak or absent peripheral pulse, decrease hematocrit and hemoglobin, increase pain in the pelvis, back or groin, and decrease urinary output( due to inadequate perfusion to the kidney leading to hypotension)

Question 31

Storm bite

Answer 31

Non dangerous in kids, also known as salmon patch or angel kiss. Pt and parent needs teaching. Goes away after a year

Question 32

PAD( peripheral artery disease)

Answer 32

Decrease blood flow to organs 
Intermittent claudication
Decrease peripheral pulses 
Cool, dry, shinny skin
Gangrene
Thick brittle nails 
Ulcers. 
Teaching for PAD 
Smoking cessation, regular exercise, low sodium diet
Tight glucose control( diabetic) 
Instruct patient to never apply direct heat to extremities due to the risk of a burn from decrease sensitivity.  They do not feel it.

Question 33

Chest drainage

Answer 33

Anything drainage >100ml/hr should be reported to PCP

Question 34

Left sided heart failure

Answer 34

Pulmonary congestion(lungs congestion) : pulmonary edema, dyspnea, orthopnea, PND( paroxysmal nocturnal dyspnea) and crackles 
Cardiomegaly which result: displaced PMI and S3 sound

Question 35

Right sided heart failure

Answer 35

Systemic venous congestion:
Jugular vein distention
Hepatomegaly, splenomegaly, as it’s and edema of lower extremities
Dyspnea on exertion

Question 36

aPTT

Answer 36

Normal value is 25-35 for patient not being anticoangulated
however heparin infusion are titrated to obtain a therapeutic value of aPTT typically 1.5-2.5 times the normal value, so the expected therapeutic value for aPTT is 46-70 seconds, if higher than this, the patient is at risk for bleeding.

Question 37

ECG Strips

Answer 37

HR( 60-100)
P waves: should be present before QRS
PR interval: 0.10-0.20 (<5 small squares)
QRS: <0.12
Prolonged PR interval indicate first degree av node block.

Question 38

Ventricular tachycardia

Answer 38

Can be pulseless or have a pulse
A pulseless V-tach or V-fib ( defribrilate)
An unstable client in a V-tach with pulse( treat with synchronized cardioversion)
The stable client in V-tach with a pulse ( treat with amiodarone, procainamide or sotalol)

Question 39

Aortic abdominal aneurysm

Answer 39

A bruit, swishing or buzzing sound that indicates turbulent blood flow in the aneurysm, best heard at the bell of the steothoscope. It can be heard in the periumbilical or epigastric area slightly left of the midline

Question 40

D-Dimer

Answer 40

Order for patient with pulmonary embolism

Question 41

Lower extremity DVT

Answer 41

Unilateral edema, calf pain or tenderness to touch, warmth, and erythema, and a low grade temperature

Question 42

Poor skin turgor or skin tenting

Answer 42

Indicate dehydration

Question 43

Central venous pressure (CVP):

Answer 43

a normal CVP is 2-8 mmHg. An elevated CVP indicated right ventricular failure or fluid volume overload.

Question 44

Coronary arteriogram

Answer 44

Pt are require to be NPO prior to IV line
Dye used
Pt are require to lie flat to maintain hemostasis of the femoral artery

Question 45

Contraindication for thrombolytics

Answer 45

Prior intracranial hemorrhage 
Structural cerebrovascular lesion
Ischemic stroke within 3months ( except within 3hours 
Suspected aortic dissection 
Active bleeding or bleeding diathesis 
Significant head trauma within 3month

Question 46

Transfusion reactions

Answer 46

If an adverse blood transfusion reaction is suspected, the first action is to stop the infusion, and infusion of normal saline through a different port for the CVC is typically started, a client assessment and notification of the HCP are also required

Question 47

Heart attack in elderly women

Answer 47

Most often present with atypical symptoms such as nausea, vomiting, belching, indigestion, diaphoresis, dizziness and fatigue

Question 48

Pulmonary edema

Answer 48

Dyspnea

Cough production of pink frothy sputum

Question 49

Infective endocarditis (IE)

Answer 49

A vegetation over the valves breaks off and embolized to various organ, resulting in a life threatening complications which includes:
Stroke
Spinal cord ischemia: paralysis of both legs
Ischemia to extremities: pain, pallor, and cold foot or arm
Intestinal infarction: abdominal pain
Splenic infarction: left upper quadrant pain
Septic pulmonary emboli
Osler nodes
Splinter hemorrhage
Petechiae