Week 1 EAQ/HESIs Flashcards
(43 cards)
__________________ (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
