NURS 571 MIDTERM QUESTIONS AND ANSWERS
What is high sensitivity troponin and when to use? - Answers - first line test for cardiac
cell damage
used for initial injury
What is CKMB - Answers - CK isoenzyme specific to cardiac muscle tissue (MI)
When should CKMB be used? - Answers - for suspicion of secondary ischemia after
an initial infarct
normal level for Troponin I - Answers - <0.04
normal level for CKMB - Answers - 3-5% of total CK
What is BNP - Answers - B-type natriuretic peptide
Normal BNP levels - Answers - <100 pg/mL
Differential for chest pain - Answers - Consider:
Myocardium- angina, MI, myocarditis, heart failure
Pericardium- pericarditis
Aorta- dissecting aortic aneurysm
Trachea and bronchi- bronchitis
Parietal pleura- pericarditis, pneumonia, pneumothorax, pleural effusion, pulmonary
embolus
Chest wall- costochondritis, herpes zoster
Esophagus- reflux, esophageal spasm, esophageal tear
Referred pain from elsewhere- cervical arthritis, biliary colic, gastritis
Psych: anxiety attacks
Revascularization in under ____ minutes - Answers - 90
Initial diagnostics for chest pain - Answers - 12-lead EKG
Troponin q3h x3 at least
BNP - HF
CBC - baseline H&H and Plts
PTT, PT/INR - baseline coagulation status
BMP - renal function and lytes
TSH, Mg, and Phos
ECHO
Cath
,Requirements for STEMI dx - Answers - new ST elevation in 2 contiguous leads of
>0.1 mV except V2&V3
elevated troponin
STEMI findings in V2-V3 - Answers - >0.2mV in >40yo M
>0.25 mV in <40 yo M
>0.15 mV in women
Difference between NSTEMI and unstable angina - Answers - NSTEMI involves
Elevated Cardiac Bio markers (cell death)
NSTEMI & unstable angina tx - Answers - Dual antiplatelet therapy
Full-dose AC
High-intensity statin
BB
Nitrates
oxygen
pain medication
Dual antiplatelet therapy - Answers - DAPT
Aspirin (325 x1 = daily 81mg)
AND
P2Y2 inhibitor
clopidogrel or ticagrelor
full dose AC - Answers - SQ lovenox 1mg/kg BID
if PCI planned of low GFR use heparin gtt
50-70 units/kg bolus plus 12units/kg/hr titrated to PTT 1.5-2.5 x baseline
High-intensity statin - Answers - atorvastatin 40-80 mg or rosuvastatin 20-40 mg
Considerations for BB avoiding BB use - Answers - HR <60
SBP <100
EF <30%
PR >240 ms
2nd or 3rd degree HB
active asthma or reactive airway disease
COPD
Cocaine use
When is NGT contraindicated? - Answers - RV infarct b/c it reduces preload
Absolute contraindications for fibrinolytic therapy - Answers - Any prior ICH
known structural cerebral vascular lesions
known malignant intracranial neoplasm
Ischemic stroke <3mo unless <4.5 h
, suspected aortic dissection
active bleeding
significant closed head or facial trauma within 3mo
severe uncontrolled hypertension (unresponsive to therapy)
Identification of LBBB - Answers - QRS is negatively deflected in V1
Identification of RBBB - Answers - QRS is positively deflected in V1
Relative contraindications for fibrinolytic therapy - Answers - Hx of chronic, severe,
poorly controlled HTN
SBP >180 or DBP >110
Hx of ischemic stork >3mo
dementia
other known intracranial pathology
traumatic or prolonged >10min CPR
major surgery in last 3 wks
internal bleeding within 4 wks
noncompressible vascular punctures
pregnacy
active peptic ulcer
oral AC therapy
In cocaine induced STEMI use _____ instead of ______ - Answers - benzodiazepines;
BB
How long should a patient be on DAPT? - Answers - 1 year at least
A 72-year-old patient with a history of CAD presents to the ER with unstable angina.
TIMI score is 5. The nurse practitioner should expect which of the following is the next
step in the care for this patient?
A. coronary angiography
B. CABG
C. notify family that death is imminent
D. tPA - Answers - A. coronary angiography
A 49-year-old patient presents to the ER and is diagnosed with NSTEMI. The nurse
practitioner can expect which of the following to be included in the initial treatment plan?
a. tPA
b. ASA, clopidogrel, and enoxaparin
c. norvasc
d. CABG - Answers - b. ASA, clopidogrel, and enoxaparin
All of the following are appropriate treatments for a patient with cocaine-induced STEMI,
except:
Beta-blockers
What is high sensitivity troponin and when to use? - Answers - first line test for cardiac
cell damage
used for initial injury
What is CKMB - Answers - CK isoenzyme specific to cardiac muscle tissue (MI)
When should CKMB be used? - Answers - for suspicion of secondary ischemia after
an initial infarct
normal level for Troponin I - Answers - <0.04
normal level for CKMB - Answers - 3-5% of total CK
What is BNP - Answers - B-type natriuretic peptide
Normal BNP levels - Answers - <100 pg/mL
Differential for chest pain - Answers - Consider:
Myocardium- angina, MI, myocarditis, heart failure
Pericardium- pericarditis
Aorta- dissecting aortic aneurysm
Trachea and bronchi- bronchitis
Parietal pleura- pericarditis, pneumonia, pneumothorax, pleural effusion, pulmonary
embolus
Chest wall- costochondritis, herpes zoster
Esophagus- reflux, esophageal spasm, esophageal tear
Referred pain from elsewhere- cervical arthritis, biliary colic, gastritis
Psych: anxiety attacks
Revascularization in under ____ minutes - Answers - 90
Initial diagnostics for chest pain - Answers - 12-lead EKG
Troponin q3h x3 at least
BNP - HF
CBC - baseline H&H and Plts
PTT, PT/INR - baseline coagulation status
BMP - renal function and lytes
TSH, Mg, and Phos
ECHO
Cath
,Requirements for STEMI dx - Answers - new ST elevation in 2 contiguous leads of
>0.1 mV except V2&V3
elevated troponin
STEMI findings in V2-V3 - Answers - >0.2mV in >40yo M
>0.25 mV in <40 yo M
>0.15 mV in women
Difference between NSTEMI and unstable angina - Answers - NSTEMI involves
Elevated Cardiac Bio markers (cell death)
NSTEMI & unstable angina tx - Answers - Dual antiplatelet therapy
Full-dose AC
High-intensity statin
BB
Nitrates
oxygen
pain medication
Dual antiplatelet therapy - Answers - DAPT
Aspirin (325 x1 = daily 81mg)
AND
P2Y2 inhibitor
clopidogrel or ticagrelor
full dose AC - Answers - SQ lovenox 1mg/kg BID
if PCI planned of low GFR use heparin gtt
50-70 units/kg bolus plus 12units/kg/hr titrated to PTT 1.5-2.5 x baseline
High-intensity statin - Answers - atorvastatin 40-80 mg or rosuvastatin 20-40 mg
Considerations for BB avoiding BB use - Answers - HR <60
SBP <100
EF <30%
PR >240 ms
2nd or 3rd degree HB
active asthma or reactive airway disease
COPD
Cocaine use
When is NGT contraindicated? - Answers - RV infarct b/c it reduces preload
Absolute contraindications for fibrinolytic therapy - Answers - Any prior ICH
known structural cerebral vascular lesions
known malignant intracranial neoplasm
Ischemic stroke <3mo unless <4.5 h
, suspected aortic dissection
active bleeding
significant closed head or facial trauma within 3mo
severe uncontrolled hypertension (unresponsive to therapy)
Identification of LBBB - Answers - QRS is negatively deflected in V1
Identification of RBBB - Answers - QRS is positively deflected in V1
Relative contraindications for fibrinolytic therapy - Answers - Hx of chronic, severe,
poorly controlled HTN
SBP >180 or DBP >110
Hx of ischemic stork >3mo
dementia
other known intracranial pathology
traumatic or prolonged >10min CPR
major surgery in last 3 wks
internal bleeding within 4 wks
noncompressible vascular punctures
pregnacy
active peptic ulcer
oral AC therapy
In cocaine induced STEMI use _____ instead of ______ - Answers - benzodiazepines;
BB
How long should a patient be on DAPT? - Answers - 1 year at least
A 72-year-old patient with a history of CAD presents to the ER with unstable angina.
TIMI score is 5. The nurse practitioner should expect which of the following is the next
step in the care for this patient?
A. coronary angiography
B. CABG
C. notify family that death is imminent
D. tPA - Answers - A. coronary angiography
A 49-year-old patient presents to the ER and is diagnosed with NSTEMI. The nurse
practitioner can expect which of the following to be included in the initial treatment plan?
a. tPA
b. ASA, clopidogrel, and enoxaparin
c. norvasc
d. CABG - Answers - b. ASA, clopidogrel, and enoxaparin
All of the following are appropriate treatments for a patient with cocaine-induced STEMI,
except:
Beta-blockers
