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Critical care HESI final 2023
Critical care HESI – 55 questions
• Cardiac
o SVT: supraventricular tachycardia
▪ No p waves seen
▪ Treatment:
• Adenosine – give 6mg, then 12mg, then another 12mg
• Cardioversion if pt not tolerating rhythm
• Don’t defibrillate!!!
▪ Have someone bring crash cart to room
o Atrial fibrillation:
▪ Chaotic atrial activity
▪ Irregularly irregular
▪ Controlled: vent rate < 100
• On digoxin at home and has controlled a fib look at digoxin
level
▪ Uncontrolled: vent rate > 100
▪ P waves are fibrillatory
▪ High risk for clots give anticoagulant
▪ Common in elderly
▪ Holiday heart syndrome: alcohol and emotional stress
o Atrial flutter:
▪ Ventricular rhythm stays regular
▪ Sawtooth waves
▪ Cardiovert!
o Asystole: flat line
▪ Patient is essentially dead
▪ Give CPR and epi
, ▪ Pulse is gone
▪ Patient in asystole for 20 minutes talk to family, patient is dead
o 3rd degree heart block
▪ Look at patient’s blood pressure, bradycardia
▪ Give atropine, epinephrine, pacemaker
o Alcoholic EKG
▪ Wide QRS and flat T = life threatening
▪ Flat T means hypokalemia
o Peaked t waves are usually from hyperkalemia
o STEMI: ST elevation myocardial infarction
▪ Give thrombolytics within 4 hours of onset
o MI vs. Indigestion
▪ Classic symptoms of MI: dull chest pain radiating down left arm
▪ Women, elderly, pt’s with hx of DM may not have classic symptoms,
instead:
• N/V
• Belching
• Indigestion
• Diaphoresis
• Dizziness
• Fatigue
o New nurse on cardiac unit:
▪ Assign pt with sinus arrhythmia going for a stress test
▪ Don’t assign:
• Torsades
• V tach
• V fib
o Pulmonary artery catheter insertion, swan insertion
▪ Priority is monitoring the pressures
▪ When it gets into right ventricle watch for arrhythmias
▪ Sterile field
o Hand is cold and decreased capillary refill – call physician because clot may be
Critical care HESI final 2023
Critical care HESI – 55 questions
• Cardiac
o SVT: supraventricular tachycardia
▪ No p waves seen
▪ Treatment:
• Adenosine – give 6mg, then 12mg, then another 12mg
• Cardioversion if pt not tolerating rhythm
• Don’t defibrillate!!!
▪ Have someone bring crash cart to room
o Atrial fibrillation:
▪ Chaotic atrial activity
▪ Irregularly irregular
▪ Controlled: vent rate < 100
• On digoxin at home and has controlled a fib look at digoxin
level
▪ Uncontrolled: vent rate > 100
▪ P waves are fibrillatory
▪ High risk for clots give anticoagulant
▪ Common in elderly
▪ Holiday heart syndrome: alcohol and emotional stress
o Atrial flutter:
▪ Ventricular rhythm stays regular
▪ Sawtooth waves
▪ Cardiovert!
o Asystole: flat line
▪ Patient is essentially dead
▪ Give CPR and epi
, ▪ Pulse is gone
▪ Patient in asystole for 20 minutes talk to family, patient is dead
o 3rd degree heart block
▪ Look at patient’s blood pressure, bradycardia
▪ Give atropine, epinephrine, pacemaker
o Alcoholic EKG
▪ Wide QRS and flat T = life threatening
▪ Flat T means hypokalemia
o Peaked t waves are usually from hyperkalemia
o STEMI: ST elevation myocardial infarction
▪ Give thrombolytics within 4 hours of onset
o MI vs. Indigestion
▪ Classic symptoms of MI: dull chest pain radiating down left arm
▪ Women, elderly, pt’s with hx of DM may not have classic symptoms,
instead:
• N/V
• Belching
• Indigestion
• Diaphoresis
• Dizziness
• Fatigue
o New nurse on cardiac unit:
▪ Assign pt with sinus arrhythmia going for a stress test
▪ Don’t assign:
• Torsades
• V tach
• V fib
o Pulmonary artery catheter insertion, swan insertion
▪ Priority is monitoring the pressures
▪ When it gets into right ventricle watch for arrhythmias
▪ Sterile field
o Hand is cold and decreased capillary refill – call physician because clot may be
