Week 2: Dysrhythmias and CAD Flashcards
(37 cards)
A patient in the coronary care unit develops ventricular fibrillation. Which of the following actions should the nurse take first?
- Perform defibrillation.
- Initiate cardiopulmonary resuscitation.
- Prepare for synchronized cardioversion.
- Administer IV antidysrhythmic medications per protocol.
- Ventricular Fibrillation results in Unresponsive, pulseless and apneic state. If not treated rapidly, death will result
Requires immediate cardiopulmonary resuscitation and advanced cardiac life support measures with the use of defibrillation and definitive medication therapy
A patient has a diagnosis of acute myocardial infarction, and his cardiac rhythm is sinus bradycardia with six to eight premature ventricular contractions (PVCs) per minute. The pattern that the nurse recognizes as the most characteristic of PVCs is which of the following?
- An irregular rhythm
- An inverted T wave
- A wide, distorted QRS complex
- An increasingly long PR interval
- PVCs
A patient’s cardiac rhythm is sinus bradycardia with a heart rate of 34 beats/minute. If the bradycardia is symptomatic, which of the following findings should the nurse expect the patient to exhibit?
- Palpitations
- Hypertension
- Warm, flushed skin
- Shortness of breath
4.
What is an EKG?
Graphic tracing of electrical impulses produced by the heart. Waveforms represent activity of charged ions across cell membranes of myocardial cells
How does a normal rhythm electrical cycle move through the heart?
SA node, Atrial myocytes, AV node, AV bundle, Bundle branches, Purkinje fibres, Ventricular myocytes
Which plane of the heart do precordial leads view?
The 6 chest leads (precordial leads) (V1-V6)provide a horizontal view of the heart
The nurse instructs a patient about modifiable risk factors for coronary artery disease. Which statements indicate that teaching has been effective? (Select all that apply)
- I should stop smoking to reduce my risk of heart disease
- Restricting my activity reduces the onset of heart disease
- I should drink alcohol because this prevents hearts disease
- There is not much that can be done to prevent heart disease
- Obesity is a risk actor that I can change to reduce the onset of heart disease
1, 5
A patient is prescribed lovastatin (Mevacor) for hyperlipidemia. What should the nurse instruct the patient about this medication?
- Abstain from alcohol use while taking this drug
- Take the drug with meals to minimize gastric distress
- Promptly report muscle pain or tenderness to the physician
- Consume a diet that includes no more than 20% of calories from saturated fat.
- Lovastatin is a first line drug for treating hyperlipidemia and can cause myopathy. All patients should be instructed to report muscle pain and weakness or brown urine, which is an indication of muscle breakdown.
The nurse is caring for a patient with stable angina. Which assessment finding would be consistent with this medical diagnosis?
- Persistent ECG changes
- Increasing nocturnal pain
- Correlation between activity level and pain
- Evidence of impaired cardiac output such as weak peripheral pulses.
- Stable angina is the most common and predictable form of angina. It occurs with a predictable amount of activity or stress and usually occurs when the work of the heart is increased by physical exertion, exposure to the cold, or by stress.
The nurse is caring for a patient with acute coronary syndrome. Which nursing diagnosis should be the priority for this patient?
- Anxiety related to unknown outcome of disorder
- Decreased cardiac output related to myocardial ischemia
- Ineffective Health Maintenance related to lack of knowledge about coronary heart disease
- Ineffective tissue perfusion: cardiopulmonary related to underlying coronary heart disease
- Acute coronary syndrome is a dynamic state in ehich coronary blood flow is acutely reduced, but not fully occluded. Myocardial cells are injured by acute ischemia that redults. The most important goal of care is to reestablish tissue perfusion through the use of medication or surgery.
The nurse is caring for a patient recovering from a coronary angioplasty with stent placement. Which intervention is a priority for the patient at this time?
- Securing chest tubes to bedding
- Maintaining leg extension on the affected side
- Discontinuing intravenous lines when taking oral fluids
- Treating chest pain with intravenous morphine as needed
- The cardiac catheter used to insert the stent is usually inserted via the femoral artery, a large, high-pressure vessel. The leg is maintained in extension for a prescribed period after the procedure to reduce the risk of bleeding, hematoma formation, or clot formation at the insertion site.
The nurse is planning care for a patient with acute myocardial infarction. What goals should the nurse use to guide this patient’s care? (Select all that apply)
- Relieve chest pain
- Prevent complications
- Reduce blood viscosity
- Decrease cardiac workload
- Reduce myocardial damage
1,2,4,5
Immediate treatment goals for the patient with an acute myocardial infarction are to reduce chest pain, myocardial damage, decrease cardiac workload, and prevent complication. Blood viscosity is not implicated in the development of an acute MI, but plays a role in peripheral vascular resistance.
The nurse is determining nursing diagnoses appropriate for a patient scheduled for fibrinolytic therapy. Which nursing diagnosis would a priority for this patient?
- Anxiety
- Ineffective protection
- Risk for powerlessness
- Ineffective health maintenance
- Fibrinolytic therapy, administered to restore myocardial perfusion, disruts the clotting cascade and can lead to potentially serious bleeding. Establishing bleeding precautions is vital to preserve physiologic integrity. The diagnosis Ineffective protection would be the priority for this patient.
The nurse is reviewing laboratory results for a patient admitted with acute chest pain. Which laboratory value should cause the nurse the most concern?
- AST 65 units/L
- CK 320 units/L
- Hematocrit 35%
- APTT 35 seconds
- Creatine kinase is an important enzyme for celar function found principally in cardiac and skeletal muscle and the brain. CK levels rise rapidly with damage to these tissues, appearing in the serum 4-6 hours after an acute MI, peaking within 12-14 hours and then declining. The CK level correlates with the size of the infarction; the greater the amount of infarcted tissue, the higher the serum CK level.
AST is a liver enzyme
Which patient(s) are most at risk for developing coronary artery disease? Select-all-that-apply:*
A. A 25 year old patient who exercises 3 times per week for 30 minutes a day and has a history of cervical cancer.
B. A 35 year old male with a BMI of 30 and reports smoking 2 packs of cigarettes a day.
C. A 45 year old female that reports her father died at the age of 42 from a myocardial infraction.
D. A 29 year old that has type I diabetes.
B,C,D
A patient reports during a routine check-up that he is experiencing chest pain and shortness of breath while performing activities. He states the pain goes away when he rests. This is known as:*
A. Unstable angina
B. Variant angina
C. Stable angina
D. Prinzmetal angina
Keeping the patient in question 4 in mind: What type of diagnostic tests will the physician most likely order (at first) for this patient to evaluate the cause of the patient’s symptoms? Select-all-that-apply:*
A. EKG
B. Stress test
C. Heart catheterization
D. Balloon angioplasty
C
A, B,
A patient reports having crushing chest pain that radiates to the jaw. You administer sublingual nitroglycerin and obtain a 12 lead EKG. Which of the following EKG findings confirms your suspicion of a possible myocardial infraction?*
A. absent Q wave
B. QRS widening
C. absent P-wave
D. ST segment elevation
D
A patient is receiving treatment for stable coronary artery disease. The doctor prescribes the patient Plavix (anti platelet). What important information will you include in the patient’s teaching? Select-all-that-apply:*
A. If you are scheduled for any planned surgical procedures, let your doctor know you are taking Plavix because this medication will need to be discontinued 5-7 days prior to the procedure.
B. A normal side effect of this medication is a dry cough.
C. Avoid green leafy vegetables while taking Plavix.
D. Notify the doctor, immediately, if you develop bruising, problems urinating, or fever.
A, D
A patient calls the cardiac clinic you are working at and reports that they have taken 3 sublingual doses of Nitroglycerin as prescribed for chest pain, but the chest pain is not relieved. What do you educate the patient to do next?*
A. Take another dose of Nitroglycerin in 5 minutes.
B. Call 911 immediately
C. Lie down and rest to see if that helps with relieving the pain
D. Take two doses of Nitroglycerin in 5 minutes
B
A 67 year old woman with a history of CAD comes in with chest pain.
Her EKG shows premature atrial contraction
What are two reasons the nurse would insert and IV line?
In those with heart disease, PACs can be a warning of more serious dysrhythmias and her condition could quickly progress
Nurse would initiate to have IV access in case of cardiac arrest, for bolus fluid administration, and for administration of IV nitroglycerin (NTG) or other medications as needed.
Explain the purpose of administering an aspirin tablet for patients experiencing acute coronary syndrome. Why is “non–enteric-coated” aspirin specified? What would be a contraindication to administering aspirin?
Aspirin is effective in reducing mortality in MI due to its antiplatelet action
An enteric coating slows down the availability of aspirin, and in this case, it is desirable for the medication to be rapidly absorbed for rapid availability in the bloodstream.
Chewing the tablet also enhances the absorption.
Contraindications:
allergy to aspirin
active major bleeding or major bleeding within the past 2 weeks,
hemorrhagic stroke
active or recent gastric bleeding, ulcer disease,
acute bronchospasm
Lipitor is prescribed for a patient with a high cholesterol level. As the nurse, how do you educate the patient on how this drugs works on the body?*
A. Lipitor increases LDL levels and decreases HDL levels, total cholesterol, and triglyceride levels.
B. Lipitor decreases LDL, HDL levels, total cholesterol, and triglyceride levels.
C. Lipitor increases HDL levels, total cholesterol, and triglyceride levels.
D. Lipitor increases HDL levels and decreases LDL, total cholesterol, and triglyceride levels.
D
A patient taking Zocor (statin) is reporting muscle pain. You are evaluating the patient’s lab work and note that which of the following findings could cause muscle pain?*
A. Elevated potassium level
B. Elevated CPK (creatine kinase level)
C. Decreased potassium level
D. Decreased CPK (creatine kinase level)
B
A patient who has diabetes will be started on Metoprolol for medical management of coronary artery disease. Which of the following will you include in your discharge teaching about this medication?*
A. Check your heart rate regularly because Metoprolol can cause an irregular heart rate.
B. Check your glucose regularly because this medication can cause hyperglycemia.
C. Check your blood pressure regularly because this medication can cause hypertension.
D. Check your glucose regularly because this medication can mask the typical signs and symptoms of hypoglycemia.
D
