Exam 3: NSG 4100/ NSG 4100 – Latest 2026/2027 Update – Advanced Medical- Surgical Nursing | Questions and Verified Answers | 100 out of 100

Exam 3: NSG 4100/ NSG 4100 – Latest 2026/2027 Update – Advanced Medical- Surgical Nursing | Questions and Verified Answers | 100 out of 100 2026 / 2027 Academic Year Q: The nurse caring for a pt w/ and endotracheal tube recognizes several disadvantages of an endotracheal tube. What would the nurse recognize as a disadvantage? a. cognition is decreased b. Daily ABGs are necessary c. slight tracheal bleeding is anticipated d. the cough reflex is depressed D Q: What would the critical care nurse recognize as a condition that may indicate a pt's need to have a tracheotomy? a. a pt has a respiratory rate of 10 breaths/min b. a pt required permanent ventilation c. a pt exhibits sx of dyspnea d. a pt has respiratory acidosis B Q: The nurse is caring for a pt who is scheduled to have a thoracotomy. When planning preoperative teaching, what info should the nurse communicate to the pt? a. how to milk the chest tubing b. how to splint the incision when coughing c. how to take prophylactic antibiotics correctly d. how to manage the need for fluid restriction B Q: A nurse is educating a pt in anticipation of a procedure that will require a water-sealed chest drainage system. What should the nurse tell the pt and the family that this drainage system is used for? a. maintaining a positive chest-wall pressure b. monitoring pleural fluid osmolarity c. providing passive intrathoracic pressure d. removing excess air and fluid D Q: A pt is exhibiting signs of a pneumothorax following tracheostomy. The surgeon inserts a chest tube into the anterior chest wall. What should the nurse tell the family is the primary purpose of this chest tube? a. to remove air from the pleural space b. to drain copious sputum secretions c. to monitor bleeding around the lungs d. to assist with mechanical ventilation A Q: A pt's plan of care specifies postural drainage. What action should the nurse perform when providing this noninvasive therapy? a. administer the tx w/ the pt in a high Fowler's or semi-fowlers position b. perform the procedure immediately following the pt's meals c. apply percussion firmly to bare skin to facilitate drainage d. assist the pt into a position that will allow gravity to move secretions D Q: While assessing the pt, the nurse observes constant bubbling in the water-seal chamber of the pt's closed chest-drinagae system. What should the Nurs conclude? a. the system is functioning normally b. pt has a pneumothorax c. system has a leak d. chest tube is obstructed C Q: The nurse has admitted a pt who is scheduled for a thoracic resection. The nurse is providing preoperative teaching and is discussing several diagnostic studies that will be required prior to surgery. Which study will be performed to determine whether the panned resection will leave sufficient functioning lung tissue? a. pulmonary function studies b. exercise tolerance tests c. arterial blood gas values d. chest x-ray A Q: The nurse is discussing activity management w/ a pt who is postoperative following thoracotomy. What instructions should the nurse give to the pt regarding activity immediately following discharge? a. walk 1 mile 3-4x a week b. use wights daily to increase arm strength c. walk on a treadmill 30min daily d. perform shoulder exercises 5x daily D Q: The OR nurse is setting up a water-seal chest drainage system for a pt who has just had a thoracotomy. The nurse knows that the amount of suction in the system is determined by the water level. At what suction level should the nurse set the system? a. 20 cm H2O b. 15 cm H2O c. 10 cm H2O d. 5 cm H2O A Q: The nurse is caring for a client w/ and endotracheal tube who is on a ventilator. When assessing the client, the nurse knows to maintain what cuff pressure to maintain appropriate pressure on the tracheal wall? a. between 10-15 mm Hg b. between 15-20 mm Hg c. between 20-25 mm Hg d. between 25-30 mm Hg B Q: A nurse educator is reviewing the indications for chest drainage systems w/ a group of medical nurses. What indications should the nurses identify? Select all that apply. a. post thoracotomy b. spontaneous pneumothorax c. need for postural drainage d. chest trauma resulting in pneumothorax e. pleurisy A, B, D Q: The home care nurse is visiting a pt newly discharged home after a lobectomy. What would be most important for the home care nurse to assess? a. resumption of the pt's ADLs b. the family's willingness to care for the pt c. nutritional status and fluid balance d. s/s of respiratory complications D Q: A pt is being admitted to the preoperative holding area for a thoracotomy. Preoperative teaching includes what? a. correct use of a ventilator b. correct use of incentive spirometry c. correct use of a mini-nebulizer c. correct technique for rhythmic breathing B Q: A nurse is teaching a pt how to perform flow type incentive spirometry prior to his scheduled thoracic surgery. What instruction should the nurse provide to the pt? a. hold the spirometer at your lips and breathe in and out like you normally would b. when you're ready, blow hard into the spirometer for as long as you can c. take a deep breath and then blow short, forceful breaths into the spirometer d. breathe in deeply through the spirometer, hold your breath briefly, and then exhale D Q: The nurse is assessing a pt who has a chest tube in place for the treatment of a pneumothorax. The nurse observes that the water level in the water seal rises and falls in rhythm w/ the pt's respiration's. How should the nurse best respond to this assessment finding? a. gently reinsert the chest tube 1-2cm and observe if the water level stabilizes b. inform the physician property that there is an imminent leak in the drainage system c. encourage pt to do deep breathing and coughing exercises d. document that the chest drainage is operating as it is intended D Q: The home care nurse is assessing the home environment of a pt who will be discharged from the hospital shortly after his laryngectomy. The nurse should inform the pt that he may need to arrange for the installation of which system in his home? a. a humidification system b. an air conditioning system c. a water purification system d. a radiant heating system A Q: The nurse is caring for a pt whose recent unexplained weight loss and hx of smoking have prompted diagnostic testing for cancer. What sx is most closely associated w/ the early stages of laryngeal caner? a. hoarseness b. dyspnea c. dysphagia d. frequent nosebleeds A Q: The nurse is conducting a presurgical interview for a pt w/ laryngeal cancer. The pt states that he drinks approx 6-8 shots of vodka per day. it is imperative that the nurse inform the surgical team so the pt can be assessed for what? a. increased risk for infection b. delirium tremens c. depression d. non-adherence to postop care B Q: The nurse is caring for a pt who is post-op day 2 following a total laryngectomy for supraglottic cancer. The nurse should prioritize what assessment? a. assessment of body image b. assessment of jugular venous pressure c. assessment of carotid pulse d. assessment of swallowing ability D Q: The nurse is performing an assessment on a pt who has been diagnosed w/ cancer of the larynx. Part of the nurses assessment addresses the pt's general state of nutrition. Which lab values would be assessed when determine the nutritional status of the pt? Select all that apply. a. WBC count b. protein level c. albumin level d. platelet count e. glucose level B, C, E Q: The nurse recognizes that aspiration is a potential complication of a laryngectomy. How should the nurse best manage this risk? a. facilitate total parenteral nutrition (TPN) b. keep a complete suction setup at the bedside c. feed the pt several small meals daily d. refer the pt for occupational therapy B Q: The nurse is providing care for a pt who has just been admitted to the post surgical unit following a laryngecotomy. What assessment should the nurse prioritize? a. the pt's swallowing ability b. the pt's airway patency c. the pt's carotid pulses d. s/s of infection B Q: The nurse has noted the emergency of a significant amount of fresh blood at the drain site of a pt who is postoperative day 1 following total laryngecomy. How should the nurse respond to this development? a. remove the pt's drain and apply pressure w/ a sterile gauze b. assess the pt, reposition the pt supine, and apply wall suction to the drain c. rapidly assess the pt and notify the surgeon about the pt's bleeding d. administer a STAT dose of vitamin K to aid coagulation C The nurse is creating a care plan for a pt who is status post-total laryngectomy. Much of the plan consists of a ling-term postoperative communication plan for alaryngeal communication. What form of alaryngeal communication will likely be chosen? a. esophageal speech b. electric larynx c. tracheoesophageal puncture d. American sign language (ASL) C The nurse is performing preoperative teaching w/ a pt who has cancer of the larynx. After completing the pt teaching, what would be most important for the nurse to do? a. give the pt his/her cell phone number b. refer pt to a social worker or psychologist c. provide the pt w/ audiovisual materials about the surgery d. reassure the pt and family that everything will be alright C A pt's total laryngectomy has created a need for alaryngeal speech which will be achieved through the use of tracheoesophageal puncture. What action should the nurse describe to the pt when teaching him about this process? a. training on how to perform controlled bleeding b. use of an electronically enhanced artificial pahrynx c. insertion of a specialized nasogastric tube d. fitting for a voice prosthesis D A preoperative nurse is caring for a postop pt. The pt has a shallow respiratory pattern and is reluctant to cough or to begin mobilizing. The nurse should address the pt's increased risk for what complication? a. Acute respiratory distress syndrome (ARDS) b. atelectasis c. aspiration d. pulmonary embolism B A pt has been brought to the ED by the paramedics. The pt is suspected of having ARDS. What intervention should the nurse first anticipate? a. preparing to assist w/ intubating the pt b. setting up oxygen at 5L/min by nasal cannula c. performing deep suctioning d. setting up a nebulizer to administer corticosteroids A The nurse is caring for a pt who is scheduled for a lobectomy for diagnosis of lung cancer. Which assisting with a subclavian vein central line insertion, the nurse notes the pt's oxygen saturation rapidly dropping. The pt c/o SOB and becomes tachypneic. The nurse suspects a pneumothorax has developed. Further assessment findings supporting the present of a pneumothorax include what? a. diminished or absent breath sounds on the affected side b. paradoxical chest wall movement w/ respirations c. sudden loss of consciousness d. muddled heart sounds A An x-ray of a trauma pt reveals rib fractures and the pt is dx w/ a small flail chest injury. Which intervention should the nurse include in the pt's plan of care? a. suction the pt's airway secretions b. immobilize the ribs w/ an abdominal binder c. prepare the pt for surgery d. immediately sedate and intubate the pt A The nurse is assessing an adult pt following a MVA. The nurse observes that the pt has an increased use of accessory muscles and is complaining of chest pain and SOB. The nurse should recognize the possibility of what condition? a. Pneumothorax b. anxiety c. acute bronchitis d. aspiration A The nurse is caring for a pt suspected of having ARDS. What is the most likely diagnostic test ordered in the early stages of this ds to differentiate the pt's sx from those of a cardiac etiology? a. Carboxyhemoglobin level b. Brain natriuretic peptide (BNP) level c. C-reactive protein (CRP) level d. complete blood count B The school nurse is presenting a class on smoking cessation at the high school. A participant in the class asks the nurse about the risk of lung cancer in those who smoke. What response to risk for lung cancer in smokers is most accurate? a. the younger you are when you start smoking, the higher your risk of lung cancer b. the risk for lung cancer never decreases once you have smoked, which is why smokers need annual chest x-rays c. the risk for lung cancer is determines mostly by what type of cigarettes you smoke d. the risk for lung cancer depends on the other risk factors for cancer that you have A The nurse is assessing a pt who has a 35 pack-year hx of cigarette smoking. In light of this known risk factor for lung cancer, what statement should prompt the nurse to refer the pt for further assessment? a. lately, I have this cough that just never seems to go away b. I find that I don't have nearly the stamina that I used to c. I seem to get nearly every cold that goes around my workplace d. I never used to have any allergies, but now I think im developing allergies to dust and pet hair A When assessing for substances that are known to harm workers lungs, the occupational health nurse should assess their potential exposure to which of the following? a. organic acids b. propane c. asbestos d. gypsum C A pt presents to the ED stating she was in a boating accident about 3 hours ago. Now the pt has complaints of HA, fatigue, and the feeling that he just can't breathe enough. The nurse notes that the pt is restless and tachycardia with an elevated BP. This pt may be in the early stages of what respiratory problem? a. pneumoconiosis b. pleural effusion c. acute respiratory failure d. pneumonia C The nurse is caring for a 46 y/o pt recently diagnosed w/ the early stages of lung cancer. The nurse is aware that the preferred method of treating pt's w/ non small cell tumors is what? a. chemotherapy b. radiation c. surgical resection d. bronchoscope opening of the airway C A pt w/ thoracic trauma is admitted to the ICU. The nurse notes the pt's chest and neck are swollen and there is a crackling sensation when palpated. The nurse consequently identifies the presence of subcutaneous emphysema. If this condition becomes severe and threatens airway patency, what intervention is indicated? a. a chest tube b. a tracheostomy c. an endotracheal tube d. a feeding tube B The nurse is caring for a pt in the ICU admitted with ARDS after exposure to toxic fumes from a hazardous spill at work. The pt has become hypotensive. What is the cause of this complication to the ARDS tx? a. pulmonary hypotension due to decreased cardiac output b. severe and progressive pulmonary hypotension c. hypovolemia secondary to leakage of fluid into the interstitial spaces d. increased cardiac output from high levels of PEEP therapy C The occupational health nurse is assessing new employees at a company. What would be important to asses in employees with a potential occupational respiratory exposure to a toxin? Select all that apply. a. time frame of exposure b. type of respiratory protection used c. immunization status d. breath sounds e. intensity of exposure A, B, D, E A 54y/o man has just been diagnosed with small cell lung cancer. The pt asks the nurse why the doctor is not offering surgery as a treatment for his cancer. What fact about lung cancer tx should inform the nurses response? a. the cells in small cell cancer of the lung are not large enough to visualize in surgery b. small cell lung cancer is self-limiting in many pt's and surgery should be delayed c. pt's w/ small cell lung cancer are not normally stable enough to survive surgery d. small cell cancer of the lung grows rapidly and metastasizes early and extensively D A pt who involved in a workplace accident suffered a penetrating wound of the chest that led to acute respiratory failure. What goal of treatment should the care team prioritize when planning this pt's care? a. facilitation of long-term intubation b. restoration of adequate gas exchange c. attainment of effective coping d. self-management of oxygen therapy B A pt is brought to the ED by ambulance after a MVA in which the pt received bunt trauma to the chest. The pt is in acute respiratory failure, is intubated, and is transferred tot he ICU. What parameters of care should the nurse monitor closely? Select all that apply. a. coping b. level of consciousness c. oral intake d. arterial blood gases e. vital signs B, D, E A pt has just been diagnosed w/ lung cancer. After the physician discusses treatment options and leaves the room, the pt asks the nurse how the treatment is decided upon. What would be the nurses best response? a. the type of treatment depends not he pt's age and health status b. the type of treatment depends on what the pt wants when given the options c. the type of treatment depends on the cell type of the cancer, the stage of the cancer and the pt's health status d. the type of treatment depends on the discussion between the pt and Dr. of which tx is best C A pt in the ICU is post embolectomy after a PE. What assessment parameter does the nurse monitor most slowly on a pt who is postop following an embolectomy? a. pupillary response b. pressure in the vena cava c. white blood ell differential d. pulmonary arterial pressure D A firefighter was trapped in a fire and is admitted to the ICU for smoke inhalation. After 12 hrs, the firefighter is exhibiting signs of ARDS and is intubated. What other supportive measures are initiated in the pt with ARDS? a. psychological counseling b. nutritional support c. high-protein oral diet d. occupational therapy B A new employee asks the occupational health nurse about measures to prevent inhalation exposure of the substances. Which statement by the nurse will decrease the pt's exposure risk to toxic substances? a. position a fan blowing on the toxic substances to prevent the substance from becoming a stagnant in the air b. wear protecting attire and devices when working w/ a toxic substance c. make sure that you keep your immunizations UTD to prevent respiratory distress resting from toxins d. always wear a disposable paper face mask when you are working with inhale toxins D The preoperative nurse is writing a care plan for a pt who has retuned from surgery 2 hours prior. Which measure should the nurse implement to most decrease the pt's risk for developing pulmonary emboli (PE)? a. early ambulation b. increased dietary intake of protein c. maintaining the pt in a supine position d. administering aspirin with warfarin A A client presents to the walk-in clinic complaining of dry, irritating cough and production of a minute amount of mucus-like sputum. The pt c/o soreness in her chest in the sternal area. The nurse should suspect that the primary care provider will assess the pt for what health problem? a. pleural effusion b. pulmonary embolism c. tracheobronchitis d. tuberculosis C A pt is receiving thombolytic therapy for the treatment of pulmonary emboli. What is the best way for the nurse to assess the pt's oxygenation status at the bedside? a. obtain serial ABG samples b. monitor pulse oximetry readings c. test pulmonary function d. monitor incentive spirometry volumes B The nurse is caring for an 82 y/o pt w/ a diagnosis of tracheobronchitis. The pt beings c/o R-sided CP that gets worse when he coughs or breathes deeply. Vital signs are WNL. What would you suspect this pt is experiencing? a. traumatic pneumothorax b. empyema c. pleuritic pain d. myocardial infarction C The home care nurse is monitoring a pt discharged home after resolution of a pulmonary embolus. For what potential complication would the home care nurse be most closely monitoring this pt? a. s/s of pulmonary infection b. swallowing ability and signs of aspiration c. activity level and role performance d. residual effects of compromised oxygenation D A pt with emphysema is experiencing SOB. To relieve pt's sx, the nurse should assist her into what position? a. sitting upright, leaning forward slightly b. low fowler's, with he neck slightly hyperextended c. prone d. trendelenburg A A student nurse is preparing to care for a pt with bronchiectasis. The student nurse should recognize that this pt is likely to experience respiratory difficulties r/t what pathophysiologic process? a. intermittent episodes of acute bronchospasm b. alveolar dissension and impaired diffusion c. dilation of bronchi and bronchioles d. excessive gas exchange in the bronchioles C A pt arrives in the emergency department with an attack of acute bronchiectasis. Chest auscultation reveals the presence of copious secretions. What interventions should the nurse prioritize in the pt's care? a. oral administration of diuretics b. intravenous fluids to reduce the viscosity of secretions c. postural chest drainage d. pulmonary function testing C A nurse is documenting the results of assessment of a pt w/ bronchiectasis. What would the nurse most likely include in documentation? a. sudden onset of pleuritic chest pain b. wheezes on auscultation c. increased anterior-posterior (A-P) diameter d. clubbing of the fingers D A nurse is caring for a pt who has been admitted with an exacerbation of chronic bronchiectasis. The nurse should expect to assess the pt for which of the following clinical manifestations? a. copious sputum production b. pain on inspiration c. pigeon chest d. dry cough A A nurse is assessing a pt who is suspected of having bronchiectasis. The nurse should consider which of the following potential causes? Select all that apply. a. pulmonary HTN b. airway obstruction c. pulmonary infections d. genetic disorders d. atelectasis B, C, D A nurse is planning the care for a pt w/ bronchiectasis. What goal of care should the nurse prioritize? a. the pt will successfully mobilize pulmonary secretions b. the pt will maintain an oxygen saturation level of 98% c. the pt's pulmonary BP will decrease to within reference ranges d. the pt will resume prediagnosis level of function within 72 hours A An interdisciplinary team is planning the care of a pt with bronchiectasis. What aspected of care should the nurse anticipate? Select all the apply. a. occupational therapy b. antimicrobial therapy c. positive pressure isolation d. chest physiotherapy e. smoking cessation B, D, E A nurse is providing health education to the family of a pt w/ bronchiectasis. What should the nurse teach the pt's family members? a. the correct technique for chest palpation and auscultation b. techniques for assessing pt's fluid balance c. the technique for providing deep nasotracheal suctioning d. the correct technique for providing postural drainage D Which pt should the nurse prioritize as needing emergent tx, assuming no other injuries are present expect the ones outline below? a. a pt with a blunt chest trauma w/ some difficulty breathing b. a pt w/ a sore neck who was immobilized in the field on a backboard with a cervical collar c. a pt w/ a possible fractured tibia w/ adequate pedal pulses d. a pt with an acute onset of confusion A The UAP reports that a client who is 2 hrs post-left femoral percutaneous transluminal coronary angioplasty (PTCA) refuses to keep the affected limb straight. What should the nurse do? a. notify healthcare provider immediately b. instruct UAP to check client's pedal pulse c. tell UAP to transfer client to bedside chair d. explain to pt that the left leg must be kept straight D Which cardiac enzyme would the nurse expect to elevate first in a pt diagnosed w/ a MI? a. creatinine kinase (CK-MB) b. Lactate dehydrogenase (LDH) c. troponin d. white blood cells (WBCs) C The nurse is caring for a client diagnosed w/ MI who is experiencing CP. Which interventions should the nurse implement first? Select all that apply: a. administer Morphine intramuscularly (IM) b. administer an aspirin orally c. apply oxygen via nasal cannula d. place the client in a supine position e. administer nitroglycerin subcutaneously B, C The client is one-day postoperative coronary artery bypass surgery. The client complains of CP. Which intervention should the nurse implement first? a. mediate client with IV morphine b. assess client's chest dressing and VS c. encourage client to turn from side to side d. check client's telemetry monitor B The client diagnosed with MI is 6 hours post-right femoral PTCA, also known as balloon surgery. Which assessment data would require immediately intervention by the nurse? a. the client is keeping the affected extremity straight b. the pressure dressing to the right femoral area is dry c. the client is complaining of numbness in R foot d. the clients right pedal pulse is 3+ and bounding C Which client teachings should the nurse element for the client diagnosed w/ coronary after disease? Select all that apply: a. encourage a low-fat, low cholesterol diet b. instruct client to walk 30 mins/day c. decrease salt intake to 2g/day d. refer a counselor stress reduction techniques e. teach the client to increase fiber in the diet A, B, D, E The client shows ventricular fibrillation on the telemetry at the nurse's station. Which action should the telemetry nurse implement first? a. administer epinephrine IVP b. prepare to defibrillate client c. call a STAT code d. start cardiopulmonary resuscitation (CPR) C The client experiencing multifocal premature ventricular contractions. Which anti- dysrhythmic medication would the nurse expect the healthcare provider to order for the client? a. amiodarone b. atropine c. digoxin d. adenosine A The client exhibiting sinus bradycardia is complaining of syncope and weakness and has a BP of 98/60. Which collaborative treatment should the nurse anticipate being implemented? a. administer a thrombolytic medication b. assess the client's cardiovascular status c. prepare for insertion of a pacemaker d. obtain a permit for synchronized cardioversion C Which intervention should the nurse implement when defibrillating a client who is in ventricular fibrillation? a. defibrillate the client at 50, 100, and 200 joules b. do not remove oxygen source during defibrillation c. place petroleum jelly on defibrillation pad d. shout "all clear" prior to defibrillating the client D The client is exhibiting ventricular tachycardia. Which interventions should the nurse implement first? a. administer amiodarone, an antidysrhythmic IVP b. prepare to defibrillate the client c. assess the client apical pulse and BP d. start CPR C the nurse should report which assessment finding to the primary health care provider before initiating thrombolytic therapy in a client with pulmonary embolism? a. adventitious breath sounds b. temp of 99.4 orally c. BP 198/100 mm Hg d. respiratory rate 28 breaths/min C The ED is assessing a pt who has sustained a blunt injury to the chest wall. Which finding indicated the presence of a pneumothorax in this client? a. a low respiratory rate b. diminished breath sounds c. the presence of a barrel chest d. a sucking sound at the site of injury B A client with a chest injury has suffered flail chest. The nurse assesses the client for which most distinctive sign of flail chest? a. cyanosis b. hypotension c. paradoxical chest movement d. dyspnea, especially on exhalation C 56 y/o male pt has been admitted to the cardiac unit w exacerbations of HF sx. The nurse has given him a nursing dx of ↓CO r/t HF as evidenced by poor ejection fraction, weakness, edema, & ↓UO. Which of the following nursing interventions is most appropriate in this situation? a. administer stool softeners as ordered b. administer IV fluid boluses to increase urine output c. maintain pt in Trendelenburg position while in bed d. increase activity by encouraging ambulation C An adult pt w/ 3rd-degree AV block is admitted to the cardiac care unit and placed on continuous cardiac monitoring. What rhythm characteristic will the ECG most likely show? a. PP interval and RR interval are irregular b. PP interval is equal to RR interval c. fewer QRS complexes than P waves d. PR interval is constant C The Nurs is waiting a plan of care for a pt w/ a cardiac dysrhythmia what would be the most appropriate goal for the pt? a. maintain a resting HR below 70 bpm b. maintainability adequate control of CP c. maintain adequate cardiac output d. maintain normal cardiac structure C A pt has returned to the cardiac care unit after having a permanent pacemaker implantation. For which potential complications should the nurse most closely assess this pt? a. chest pain b. bleeding at implantation site c. malignant hyperthermia d. bradycardia B The nurse is caring for an adult pt who has gone into ventricular fibrillation. When assessing with defibrillating the pt, what must the nurse do? a. maintain firm contact between paddles and pt skin b. apply a layer of water as a conducting agent c. call all clear before discharging the defibrillator d. ensure the defibrillator is in sync mode A A pt who is a candidate for an implantable cardioverter defibrillator (ICD) asks the nurse about the purpose of this device. What would be the nurses best response? a. to detect and treat dysrhythmias such as ventricular fibrillation and ventricular tachycardia b. to detect and treat bradycardia, which is an excessively slowHR c. to detect and treat atrial fibrillation, in which your heart beats too quickly and inefficiently d. to shock your heart if you have a heart attack at home A The nurse is caring for a pt who has just had an implantable cardioverter defibrillator (ICD) placed. What is the priority area for the nurses assessment? a. assessing the pt's activity level b. facilitating trans thoracic echocardiography c. vigilant monitoring of the pt's ECG d. close monitoring of the pt's peripheral perfusion C During a pt's care conference, the team is discussing whether the pt is a candidate for cardiac conduction surgery. What would be the most important criterion for a pt to have this surgery? a. angina pectoris not responsive to other treatments b. decreased activity tolerance r/t decreased cardiac output c. atrial and ventricular tachycardias not responsible to other tx d. ventricular fibrillation not responsive to other tx C A nurse is caring for a pt who Is exhibiting ventricular tachycardia (VT). Because the pt is pulseless, the nurse should prepare for what intervention? a. defibrillation b. ECG monitoring c. implantation of a cardioverter defibrillator d. angioplasty A A pt converts from normal sinus rhythm at 80 bpm to atrial fibrillation w/ a ventricular response at 166 bpm. BP is 162/74 mm Hg. Respiratory rate is 20 breaths/min w/ normal chest expansion and clear lungs bilaterally. IV heparin and Cardizem are given. The nurse caring for the to understands that the main goal of tx Is what? a. decrease SA node conduction b. control ventricular HR c. improve oxygenation d. maintain anticoagulation B The nurse and the other members of the team are caring for a pt who covered to ventricular fibrillation (VF). The pt was defibrillation unsuccessfully and the pt remains in VF. According to national standards, the nurse should anticipate the administration of what medication? a. epinephrine 1 mg IV push b. lidocaine 100 mg IV push c. amiodarone 300 mg IV push d. sodium bicarbonate 1 amp IV push A The nurse is planning d/c teaching for a pt w a newly inserted permanent pacemaker. What is the priority teaching point for this pt? a. start lifting the arm above the shoulder right away to prevent chest all adhesion b. avoid cooking w microwave oven c. avoid exposure to high-voltage electrical generators d. avoid walking through store and library antitheft devices C A pt is brought to the ED and determined to be experiencing symptomatic sinus bradycardia. The nurse caring for this pt is aware the medication fo choice for tx of this dysrhythmia is administration of atropine. What guidelines will the nurse follow when administering atropine? a. administer atropine 0.5 mg as an IV bolus every 3-5mins to a maximum of 3.0 mg b. administer atropine as a continue infusion until sx resolve c. administer atropine as a continuous infusion to a maximum of 30 mg in 24 hrs d. administer atropine 1.0 mg sublingually A The ED nurse is caring for a pt who has gone into cardiac arrest. During external defibrillation, what action should the nurse perform? a. place gel pads over the apex and posterior chest for better conduction b. ensure no one is touching the pt at the time shock is delivered c. continue to ventilate the pt via endotracheal tube during the procedure d. allow at least 3 mins between shocks B A pt has undergone diagnostic testing and received a diagnosis of sinus bradycardia attributable to sinus node dysfunction. When planning this pt's care, what nursing dx is most appropriate? a. acute pain b. risk for unilateral neglect c. risk for activity intolerance d. risk for fluid volume excess C A pt is undergoing preoperative teaching before his cardiac surgery and the nurse is aware that a temporary pacemaker will be placed later that day. What is the nurses responsibility in the care of the pt's pacemaker? a. monitoring for pacemaker malfunction or batter failure b. determining when it is appropriate to remove the pacemaker c. making necessary changes to the pacemaker settings d. selecting alternatives to future pacemaker use A The nurse caring for a pt whose sudden onset of sinus bradycardia is not responding adequately to atropine. What might be the tx of choice for this pt? a. implanted pacemaker b. transcutaneous pacemaker c. ICD d. asynchronous defibrillator B The nurse is caring for a pt who has had a dysrhythmic event. The nurse is aware of the need to assess for signs of diminished cardiac output (CO). What change in status may signal to the nurse a decrease in CO? a. increased BP b. bounding peripheral pulses c. change in level of consciousness d. skin flushing C When planning the care of a pt w an impacted pacemaker, what assessment should the nurse prioritize? a. core body temperature b. heart rate and rhythm c. blood pressure d. oxygen saturation level B The nurse is assessing a pt who had a pacemaker implanted 4 weeks ago. During the pt's most recent follow-up appt, the nurse identifies data that suggest the pt may be socially isolated and depressed. What nursing dx is suggested by these date? a. decisional conflict r/t pacemaker implantation b. deficient knowledge r/t pacemaker implantation c. spiritual distress r/t pacemaker implantation d. ineffective coping r/t pacemaker implantation D The nurse is caring for a pt who is in the recovery room following the implantation of an ICD. The pt has developed ventricular tachycardia (VT). What should the nurse assess and document? a. ECG to compare time and onset of VT and onset of devices shock b. ECG so physician can see what type of dysrhythmia the pt has c. pt's LOV at the time of dysrhythmia d. pt's activity at time of dysthymia A The staff educator is teaching a CPR class. Which of the following aspects of defibrillation should the educator stress to the class? a. apply the paddles directly to pt's skin b. use a conducting medium between paddles and the skin c. always use a petroleum-based gel between paddles and skin d. any available liquid can be used between paddles and skin B During a CPR class, a participant asks about the difference between cardioversion and defibrillation. What would be the instructor's best response? a. cardioversion is done on a beating heart; defibrillation is not b. the difference is the timing of the delivery of the electric current c. defibrillation is synchronized with the electrical activity of the heart, but the cardioversion is not d. cardioversion is always attempted before defibrillation bc it has fewer risks B A pt calls his cardiologists office and talks to the nurse. He is concerned bc he feels he is being defibrillated too often. The nurse tells the pt to come to the office to be evaluated bc the nurse knows that the most frequent complication of ICD therapy is what? a. infection b. failure to capture c. premature battery depletion d. over sensing of dysrhythmias D Family members bring a pt to the ED w pale, cool skin, sudden midsternal CP unrelieved w rest and a hx of CAD. How should the nurse best interpret these initial data? a. the sx indicate angina and should be treated as such b. the sx indicate a pulmonary etiology rather than a cardiac etiology c. the sx indicate an acute coronary episode and should be treated as such d. tx should be determined pending the results of an exercise stress test C An OR nurse is preparing to assist w a coronary artery bypass graft (CABG). The OR nurse knows that the vessel most commonly used as source for a CABG is what? a. brachial artery b. brachial vein c. femoral artery d. great saphenous vein D A pt with an occluded coronary artery is admitted and has an emergency percutaneous transluminal coronary angioplasty (PTCA). The pt is admitted to the cardiac critical care unit after the PTCA. For what complication should the nurse most closely monitor the pt? a. hyperlipidemia b. bleeding at insertion site c. left ventricular hypertrophy d. congestive HF B The nurse is caring for a pt who is scheduled for cardiac surgery. What should the nurse include in pre-operative care? a. with the pt, clarify the surgical procedure that will be performed b. withhold the pt's scheduled meds for at least 12 hrs preoperatively c. inform the pt that health teaching will begin as soon as possible after surgery d. avoid discussing the pt's fears as not to exacerbate them A The OR nurse is explaining to a pt that cardiac surgery requires the absence of blood from the surgical field. At the same time, it is imperative to maintain perfusion of body organs and tissues. What technique for achieving these simultaneous goals should the nurse describe? a. coronary artery bypass graft (CABG) b. percutaneous transluminal angioplasty (PTCA) c. atherectomy d. cardiopulmonary bypass D The nurse has just admitted a 66y/o pt for cardiac surgery. The pt tearfully admits to the nurse that she is afraid of dying while undergoing surgery. What is the nurses best response? a. explore the factors underlying the pt's anxiety b. teach the pt guided imagery techniques c. obtain an order for a PRN benzodiazepine d. describe the procedure in greater detail A A pt w angina has been prescribed nitroglycerin. Before administering the drug, the nurse should inform the pt about what potential adverse effects? a. nervousness or paresthesia b. throbbing HA or dizziness c. drowsiness of blurred vision d. tinnitus or diplopia B A 48 y/o man presents to ED complaining of severe substernal CP radiating down left arm. He is admitted to the coronary care unit (CCU) with a diagnosis of myocardial infarction (MI). What nursing assessment activity is a priority on admission to the CCU? a. begin ECG monitoring b. obtain information about family hx of heart disease c. ausculate lung fields d. determine if pt smokes A The public health nurse is participating in a health fair and interviews a pt w a hx of HTN, who is currently smoking one pack of ciagrettes/day. She denies any of the most common manifestations of CAD. Based on these data, the nurse would expect the focuses of CAD tx most likely to be which of the following? a. drug therapy and smoking cessation b. diet and drug therapy c. diet therapy only d. diet therapy and smoking cessation D The nurse is working w a pt who had an MI and is now active in rehab. The nurse should teach the pt to cease activity if which of the following occurs? a. the pt experiences CP, palpitations, or dyspnea b. the pt experiences a noticeable increase in HR during activity c. the pt's oxygen saturation level drops below 96% d. the pt's respiratory rate exceeds 30 breaths/min A A pt w cardiovascular ds is being treated w amlodipine (Norvasc), a calcium channel blocking agent. The therapeutic effects of calcium channel blockers include which of the following? a. reducing the hearts workload by decreasing HR and myocardial contraction b. preventing platelet aggregating and subsequent thrombosis c. reducing myocardial oxygen consumption by blocking adrenergic stimulation to the heart d. increasing the efficiency of myocardial consumption, thus decreasing ischemia and relieving pain A The nurse is caring for a pt who is believed to have just experienced an MI. The nurse notes changes in the ECG of the pt. What change on an ECG most strongly suggests to the nurse that ischemia is occurring? a. P wave inversion b. T wave inversion c. Q wave changes with no change in ST or T wave d. P wave enlargement B An adult pt is admitted to the ED w/ CP. The pt states that he had developed unrelieved CP that was present for approximately 20 minutes before coming to the hospital. To minimize cardiac damage, the nurse should expect to administer which of the following interventions? a. thrombolytics, oxygen, NSAIDs b. morphine sulfate, oxygen, bed rest c. oxygen and beta-adrenergic blockers d. bed rest, albuterol nebulizer tx, and oxygen B The nurse is assessing a pt who was admitted to the critical care unit 3 hrs ago following cardiac surgery. The nurses most recent assessment reveals that the pt's left pedal pulses are not palpable and that the right pedal pulses are rated at +2. What is the nurses best response? a. document this expected assessment finding during the initial post-op period b. reposition pt w his left leg in a dependent position c. inform the pmts physician of this assessment finding d. administer an ordered dose of subcutaneous heparin C In preparation for cardiac surgery, a pt was taught about measures to prevent venous thromboembolism. What statement indicates the the pt clearly understood this education? a. I'll try to stay in bed for the first few days to allow myself to heal b. I'll make sure that I don't cross my legs when i'm resting in bed c. i'll keep pillow under my knees to help my blood circulate better d. I'll put on those compression stockings if I get pain in my calves B An ED nurse is assessing an adult woman for a suspected MI. When planning the assessment, the nurse should be cognizant of what s/s of MI that are particularly common in female pt's? Select all that apply: a. shortness of breath b. chest pain c. anxiety d. numbness e. weakness D, E A pt presents to the ED in distress and c/o crushing CP. What is the nurses priority for assessment? a. prompt initiation of an ECG b. auscultation fo the pt's point of maximal impulse (PMI) c. rapid assessment of the pt's peripheral pulses d. palpation of the pt'a cardiac apex A The ED nurse is caring for a pt with a suspected MI. What drug should the nurse anticipate administering to this pt? a. oxycodone b. warfarin c. morphine d. acetaminophen C The nurse is caring for a pt who has undergone percutaneous transluminal coronary angioplasty (PTCA). What is the major indicator of success for this procedure? a. increase in the size of artery's lumen b. decrease in arterial blood flow in relation to venous flow c. increase in the pt's resting HR d. increase in the pt's level of consciousness A Preoperative education is an important part of the nursing care of pt's having coronary artery revascularization. When explaining the pre-and post-operative regimens, the nurse would be sure to include education about which subject? a. sx of hypovolemia b. sx of low BP c. complications requiring graft removal d. intubation and mechanical ventilation` D A pt in the cardiac step-down unit has begun bleeding from the percutaneous coronary intervention (PCI) access site in her femoral region. What is the nurses most appropriate action? a. call for assistance and initiate cardiopulmonary resuscitation b. reposition the pt's leg in a nondependent position c. promptly remove the femoral sheath d. call for help and apply pressure to the access site D The nurse providing care for a pt post PTCA knows to monitor closely. For what complications should the nurse monitor the pt? Select all that apply: a. abrupt closure of the coronary artery b. venous insufficiency c. bleeding at the insertion site d. retroperitoneal bleeding e. arterial occlusion A, C, D, E A pt who is postop day 1 following a CABG has produced 20 mL of urine in the past 3 hours and the nurse has confirmed the patency of the urinary catheter. What is the nurses most appropriate action? a. document the pt's low urine output and monitor closely for the next several hours b. contact the dietician and suggest the need for increased oral fluid intake c. contact the pt's physician and suggest assessment of fluid balance and renal function d. increase the infusion rate of the pt's IV fluid to prompt an increase in renal function C A pt is recovering in the hospital from cardiac surgery. The nurse has identified the diagnosis of risk of ineffective airway clearance r/t pulmonary secretions. What intervention best addresses this risk? a. administration of bronchodilators by nebulizer b. administration of inhaled corticosteroids by metered dose inhaler (MDI) c. pt's consistent performance of deep breathing and coughing exercises d. pt's active participation in the cardiac rehab program C The nurse notes that a pt has developed a cough productive for mucoid sputum, is sport of breath, has cyanotic hands, and has noisy, moist-sounding, rapid breathing. These s/s are suggestive of what health problem? a. pericarditis b. cardiomyopathy c. pulmonary edema d. right ventricular hypertrophy C The nurse is assessing an older adult pt w/ numerous health problems. What assessment datum indicates an increase in the pt's risk for HF? a. pt takes Lasix (furosemide) 20 mg/day b. pt's potassium level is 4.7 mEq/L c. the pt is an African American d. the pt's age is greater than 65 y/o D The nurse caring fro an adult pt w/ HF who is prescribed digoxin. When assessing the pt for adverse effects, the nurse should assess for which of the following s/s? a. confusion and bradycardia b. uncontrolled diuresis and tachycardia c. numbness and tingling in extremities d. CP and SOB A The nurse is caring for a 68 y/o pt whom she suspects has digoxin toxicity. In addition to physical assessment, the nurse should collect what assessment datum? a. skin turgor b. potassium level c. WBC d. peripheral pulses B The triage nurse in the ED is performing a rapid assessment of a man w/ c/o severe CP and SOB. The pt is diaphoretic, pale, and weak. When the pt collapses, what should the nurse do first? a. check for a carotid pulse b. apply supplemental oxygen c. give two full breaths d. gently shake and shout, "Are you Ok?" D A pt presents to the ED c/o increasing SOB. The nurse assessing the pt notes a hx of left- sided HF. The pt is agitated and occasionally coughing up pink-tinged, foamy sputum. The nurse should recognize the s/s of what health problems? a. right-sided HF b. acute pulmonary edema c. pneumonia d. cardiogenic shock B A pt admitted to the medical unity w HF is exhibiting s/s of pulmonary edema. The nurse is aware that positioning will promote circulation. How should the nurse best position the pt? a. in a high fowlers position b. on the left side-lying position c. in a flat, supine position d. trendelenburg position A The Nurs has entered a pt's room and found the pt unresponsive and not breathing. What is the nurses next appropriate action? a. palpate carotid pulse b. illuminate pt's call light c. begin performing chest compressions d. activate the Emergency Response System (ERS) D The nurse overseeing care in the ICU reviews the shift report on 4 pt's. The nurse recognizes which pt to be at greatest risk for the development of cariogenic shock? a. the pt admitted w/ acute renal failure b. the pt admitted following an MI c. the pt admitted w/ malignant HTN d. the pt admitted following a stroke B When assessing the pt w/ pericardial effusion, the nurse will assess for pulsus paradoxus. Pulsus paradoxus is characterized by what assessment finding? a. a diastolic BP that is lower during exhalation b. a diastolic BP that is higher during inhalation c. a systolic BP that is higher during exhalation d. a systolic BP that is lower during inhalation D The cardiac monitor alarm alerts the critical care nurse that the pt is showing no cardiac rhythm on the monitor. The nurses rapid assessment suggests cardiac arrest. In providing cardiac resuscitation documentation, how will the nurse describe this initial absence of cardiac rhythm? a. pulseless electrical activity (PEA) b. ventricular fibrillation c. ventricular tachycardia d. asystole D A pt with HF has met with his PCP and begun tx with an angiotensin-converting enzyme (ACE) inhibitor. When the pt beigins tx, the nurse should prioritize what assessment? a. BP b. LOC c. assessment for nausea d. oxygen saturation A Cardiopulmonary resuscitation has be initiated on a pt who was found unresponsive. When performing chest compressions, the nurse should do which of the following? a. perform at least 100 chest compressions per minute b. pause to allow a colleague to provide a breath q10 compressions c. pause chest compressions to allow for vital signs monitoring q4-5 mins d. perform high-quality chest compressions as rapidly as possible A The critical care nurse is caring for a pt who is in cariogenic shock. What assessments must the nurse perform on this pt? Select all that apply: a. platelet level b. fluid status c. cardiac rhythm, d. action of meds e. sputum volume B, C, D A cardiovascular pt w/ a previous hx of pulmonary embolism (PE) is experiencing a sudden onset of dyspnea, rapid breathing, and CP. The nurse recognizes the characteristic s/s of a PE. What is the nurses best action? a. rapidly assess the pt's cardiopulmonary status b. arrange for an ECG c. increase height of pt's bed d. manage pt's anxiety A The nurse is caring for a pt who has developed obvious signs of pulmonary edema. What is the priority nursing action? a. lay the pt flat b. notify the family of the pt's critical state c. stay w the pt d. update the physician C A cardiac pt's resistance to left ventricular filling has caused blood to back up into the pt's circulatory system. What health problem is likely to result? a. acute pulmonary edema b. right-sided HF c. right ventricular hypertrophy d. left-sided HF A Diagnostic imaging reveals that the quantity of fluid in a client's pericardial sac is dangerously increased. The nurse should collaborate with the other members of the care team to prevent the development of what complication? a. pulmonary edema b. pericardiocentesis c. cardiac tamponade d. pericarditis C The nurse is caring for a pt with severe left ventricular dysfunction who has been identified as being at risk for sudden cardiac death. What medical intervention can be performed that may extend the survival of the pt? a. insertion of an implantable cardioverter defibrillator b. insertion of an implantable pacemaker c. administration for a calcium channel blocker d. administration of a beta-blocker A A nurse is closely monitoring a pt who has recently been diagnosed with an abdominal aortic aneurysm. What assessment finding would signal an impending rupture of the pt's aneurysm? a. sudden increase in BP and decrease in HR b. cessation of pulsating in an aneurysm that has previously been pulsating visibly c. sudden onset of severe back or abd pain d. new onset of hemoptysis C A pt with a recent diagnosis of ITP has asked the nurse why the care team has not chosen to administer platelets, stating, "I have low platelets, so why not give me a transfusion of exactly what i'm missing?" How should the nurse best respond? a. transfused platelets usually aren't beneficial bc they're rapidly destroyed in the body b. a platelet transfusions often blunts your body own production of platelets even further c. finding a matching donor for a platelet transfusion is exceedingly difficult d. a very small percentage f the platelets in a transfusion re actually functional A A pt w/ a hx of a-fib has contacted the clinic saying that she has accidentally overdosed on the prescribed warfarin (Coumadin). The nurse should recognize the possible need for what antidote? a. IVIG b. Factor X c. Vitamin K d. Factor VIII C An intensive care nurse is aware of the need to identify pt's who may be at risk of developing disseminated intravascular coagulation (DIC). Which fo the following ICU pt's most likely faces the highest risk of DIC? a. a pt w/ extensive burns b. a pt who has a dx of acute respiratory distress syndrome c. a pt who suffered multiple trauma in a. workplace accident d. a pt who is being teated for septic shock D A pt is being treated for DIC and the nurse has prioritized the nursing dx of Risk for Deficient Fluid Volume r/t Bleeding. How can the nurse best determine if goals of care relating to this diagnosis are being met? a. assess for edema b. assess skin integrity frequently c. assess the pt's LOC frequently d. closely monitor intake and output D A pt w/ a PE is being treated with a heparin infusion. What diagnostic finding suggests to the nurse that tx is effective? a. the pt's PT is within reference ranges b. arterial blood sampling tests positive for the presence of factor XIII c. the pt's platelet level is below 100,000/mm^3 d. the pt's activated partial thromboplastin time (aPTT) is 1.5 to 2.5 times the control value D The medical nurse is creating the care plan of an adult pt requiring mechanical ventilation. What nursing action is most appropriate? a. keep pt in a low fowler's position b. perform tracheostomy care at least oncer per day c. maintain continuous bedrest d. monitor cuff pressure every 8 hrs D The acute medical nurse is preparing to wean a pt from the ventilator. Which assessment parameter is most important for the nurse to assess? a. fluid intake for the last 24 hrs b. baseline ABG levels c. prior outcomes of weaning d. Electrocardiogram (ECG) results B The nurse is caring for a pt who is ready to be weaned from the ventilator. In preparing to assist in the collaborative process of weaning the pt from a ventilator, the nurse is aware that the weaning of the pt will progress in what order? a. removal from the ventilator, tube, then oxygen b. removal from oxygen, ventilator, then tube c. removal of tube, oxygen, then ventilator d. removal from oxygen, tube, then ventilator A A critical care nurse is caring for a client w an endotracheal tube who is on a ventilator. The nurse knows that meticulous airway management is necessary for this pt. What is the main rationale for this? a. maintaining a patent airway b. preventing need for suctioning c. maintain sterility of pt's airway d. increasing pt's lung compliance A The critical care nurse and the other members of the care team are assessing the patient to see if he is ready to be weaned from the ventilator. What are the most important predictors of successful weaning that the nurse should identify? a. stable VS and ABGs b. pulse ox above 80% and stable VS c. stable nutritional status and ABGs d. normal orientation and LOC A when the heart contracts to pump blood out(depolarization) systole the heart relaxes after contraction(repolarization) Diastole volume of blood ejected duringventricular contraction Stroke volume amount of blood the heartpumps from each ventricle per minutemeasured in liters per minute Cardiac output amount of ventricular stretch at the end ofdiastole. -initial stretching of the ventricles prior tocontraction. -the heart loading up for the next big squeeze of the ventricles during systole. Preload YOU CAN GIVE FLUIDS TO INCREASE THIS (systemic vascular resistance (SVR):amount of resistance the heart must overcome toopen the aortic valve and push the blood volumeout into the systemic circulation. Afterload VASOCONSTRICTION can increase this Measurement of the vena cava or rightatrium and reflects the filling pressure ofthe right ventricle (preload) right arterial pressure Central Venous Pressure • CVP 6 mm Hg indicates an elevated rightventricular preload. (Hypervolemic) • CVP 2 mm Hg indicates reduced right ventricular preload (hypovolemic) Central Venous Pressure - Used to obtain direct and continuous BP measurements - Frequent ABG measurements and blood samples. Arterial Blood Pressure Assess left ventricular function: - Right atrial pressure - Pulmonary artery pressure - Pulmonary artery wedge pressure Pulmonary Artery Pressure What do you not infuse into the monitoring systems? Dextrose Bathing with monitoring systems - Do not submerge the catheter site in water - Showering is permitted if the catheter andrelated tubing are placed in an impermeablecover. • Abnormal fast heart rate of more than 100beats per minute: .- Compensatory response to increased demandfor cardiac output or reduced stroke volume. - Sympathetic activation - Decreased parasympathetic activity Greater than 100 but less than 120 BPM Sinus Tachycardia What is a complication of the monitoring Pneumothorax Infection air embolism Cause of Sinus Tachycardia • Fever • Hyperthyroidism • Pain • Increased metabolism • Low blood pressure • Hypoxia Sinus tachycardia nursing interventions Assess for cause Preform vegal manuvers What meds can you give for sinus tachycardia CCB (adenosine) Beta Blockers (Propanalol) What can cause Sinus bradycardia? - Increased parasympathetic activity - Sleep - Drugs - Increased Stroke Volume - HTN - Physically Trained Individuals Less than 60 BPM Sinus Bradycardia Medications for bradycardia Atropine Dopamine (infusion) Epinephrine (infusion) Completely disorganized and irregularatrial rhythm accompanied by an irregularventricular rhythm of variable rate Atrial depolarizations are blocked at the AVNode, with a few reaching the ventricles andinitiating ventricular contractions. Causesthe atria to quiver rather than contractforcefully Atrial Fibrillation Atrial and ventricle rates during a fib Atrial rate is300 to 600 bpm; ventricular rate is usually120 to 200 bpm in untreated atrialfibrillation P wave during A Fib No discernible P waves, Cannot bemeasured, Irregular, and shape are referredas fibrillatory waves Etiology of A Fib - Increasing age - Hypertension - Diabetes - Obesity - Valvular heart disease - Heart failure - Obstructive sleep apnea - Alcohol consumption —moderate (1-3drinks/day) and high - Cardiac ischemia - Cardiac inflammatory disease (pericarditis,myocarditis,amyloidosis) - Myocardialhypertrophy, fibrosis, or dilation - Atrial remodeling- Postoperative cardiac surgery S/S of A Fib • Some patients are asymptomatic • Palpitations• Heart Failure • Shortness of Breath • Hypotension • Dyspnea on Exertion • Fatigue What is there a risk for in A Fib Thrombus formation As the nurse, what do you want the INR to stay at? 2.0-3.0 A Fib treatment Prevent emboli events Cardioversion Catheter ablation Regular atrial impulse at a ratebetween 250 and 400 bpm A flutter Atrial flutter treatment Adenosine antithrombin therapy electric cardioversion • The absence of impulse initiation in theheart results in electrical asystole. • Results in zero cardiac output Asystole Cause of Asystole • MI • Electrical Shock • Electrolyte Disturbances • Acidosis • Parasympathetic Activity Management of Asystole Intubation epinephrine The interval between the sinus beat precedingthe premature beat and the sinus beat followingthe premature beat is twice the regular interval PVC (Pre ventricular contractions) Causes of PVCs - Coronary Artery Disease - Drug Overdose - Electrolyte Disturbance - Hypokalemia,Hypomagnesemia - Caffeine, Nicotine, Alcohol - Heart Failure - Tachycardia - Digitalis Toxicity - Hypoxia - Acidosis Treatment for PVC Amiodarone Three or more consecutive ventricular complexes at a rate greater than 100 beatsper min Rate is regular but produces around 100-200 BPM Ventricular tachycardia Causes of ventricular tachycardia • Myocardial ischemia or infarction • Damage to the myocardium altersconduction times and pathways • High catecholamine levels • Abnormal Electrolytes Manifestations of ventricular tachycardia • Decrease of cardiac output resulting in lossof consciousness • Unresponsive • Pulseless or Pulse Management of ventricular tachycardia Intubation Defibrillation Cardioversion • Rapid, uncoordinated cardiac rhythm thatresults in ventricular quivering and lackeffective contraction • Decreased cardiac output resulting indecrease blood supply to other tissue Ventricular Fibrillation Causes of V Fib Accelerating V-Tach • Coronary Artery Disease • Acute MI • Cardiomyopathy • Acid-BaseImbalances • Electrical Shock V Fib manifestations • Pulseless • Loss of Consciousness • Apnea A disturbance in conduction between thesinus impulse and its associated ventricularresponse has been called atrioventricular(AV) block Heart Blocks Heart block manifestations - Vary with the ventricular rate and severity ofany underlying disease - Decreased heart rate - Decreased perfusion to organs 1st degree heart block p-r interval is greater than 1 large box treat with atropine 2nd degree heart block p wave present, occasionally without QRS, treat with atropine, grab electronic pacemaker 3rd degree heart block when the atrium & the ventricles are beating independently - Coronary plaque rupture that develops intoacute thrombus. - Prolonged or total disruption of blood flow to the myocardium Acute coronary syndrome Occlusion is partial, or the clot is dissolved beforethe death of myocardial tissue unstable angina • An abnormal accumulation of lipid, or fattysubstances, and fibrous tissue in the lining of arterialblood vessel walls .• These substances block and narrow the coronaryartery, resulting in decreasing blood flow to themyocardium Atherosclorisis Where do almost all artifacts occur? Left ventricle CM of acute coronary syndrome - Angina Pectoris • . Chest pain by ischemia - Mild indigestion to Choking - Heavy sensation in the upper chest- Feeling of impending death Triglyceride level less than 150 Total cholesterol less than 200 LDL le