lOMoAR cPSD| 57394295
MED SURGE 2 FINAL EXAM STUDY GUIDE |2025-2026 LATEST
UPDATED|REAL EXAM QUESTIONS AND ANSWERS | 100%
RATED CORRECT | 100% VERFIED SOLUTIONS | ALREADY
GRADED A+
Cardiac
1.Electrical conduction through the heart, know the pathway that it takes
● The electrical impulse travels from the SA node through the atria to the
atrioventricular (AV) node; this is know as
conduction.
● The electrical stimulation of the muscle
cells of the atria causes them to contract.
● The structure of the AV node slows the
electrical impulse, giving the atria time to
contract and fills the ventricles with
blood.
● The electrical impulse then travels very
quickly through the bundle of His to the
right and left bundle branches and the
Purkinje fibers, located in the ventricular muscle.
2. Someone who is getting a stress test, they are experiencing discomfort, chest pain
whats the best course of action
● Stop walking the test
● Take vitals signs
● See if that chest discomfort goes away at rest
3.Afib recommendation?
● Medical management such as anticoagulant medications, controlling the
entricular rate response with antiarrhythmic agents, and treating the arrhythmia
as indicated so that it is converted to a sinus rhythm.
● They will be on anticoagulants so they are on high risk for clotting disorders like
stroke.
● Keep the patient stress free
● Patient will need medications to control the heart rate like beta blockers or
calcium channel blockers.
● Patient will need medications that convert the heart rhythm or prevent atrial
fibrillation.
● Patient will need to maintain a heart healthy diet and maintain exercise.
4.Who gets an ICD? Whats the purpose?
● Patients at high risk of VT or ventricular fibrillation and who would benefit from an
ICD are those who have survived sudden cardiac death, which usually is caused
by ventricular fibrillation, or have experienced spontaneous, symptomatic VT.
, lOMoAR cPSD| 57394295
● The ICD is an electronic device that detects and terminates life-threatening
episodes of tachycardia or fibrillation, especially those that are ventricular origin.
5. CHF, classified
● Right-sided heart failure can sometimes occur as a result of left-sided. The failure
of these dual mechanisms is referred to as CHF. When the left ventricle fails,
increased fluid pressure is transferred back through the lungs, leading to damage
of the right side of the heart.
● Classification I
○ No limitation of physical activity; ordinary activity does not cause
fatigue, palpitation, or dyspnea ● Classification II
○ Slight limitation of physical activity; comfortable at rest, but
ordinary physical activity causes fatigue, palpation, or dyspnea ●
Classification III
○ Marked limitation of physical activity; comfortable at rest, but less
than ordinary activity causes fatigue, palpitation, or dyspnea ● Classification IV
○ Unable to carry out any physical activity without discomfort; symptoms of
cardiac insufficiency at rest; if any physical activity is undertaken,
discomfort is increased
5.Dilated cardiomyopathy, pathological findings would
we see in an echo
● The ventricle itself becomes enlarged or
hypertrophic.
● Microscopic examination of the muscle tissue
shows diminished contractile elements of the
muscle fibers and diffuse necrosis of
myocardial cells. The result is poor systolic
function. The structural changes decrease the
amount of blood ejected from the ventricle with
systole, increasing the amount of blood
remaining in the ventricle after contraction
● In an echocardiogram, you will find an
enlarged ventricle.
6.What do we do if a patient has cardiac tamponade, nurses most appropriate action
PRIORITIES
● Cardiac tamponade is compression of the heart resulting from fluid or blood
within the pericardial sac.
● In acute cardiac tamponade, the patient suddenly develops chest pain,
tachypnea, and dyspnea. Pts typically will have tachycardia in response to low
CO. Hypotension occurs from low CO. The pt may report chest discomfort or a
feeling of fullness.
● CARDINAL SIGNS FOR CARDIAC TAMPONADE
, lOMoAR cPSD| 57394295
7. Know what troponin BNP, other cardiac biomarkers
● Myocardial cells that become necrotic from prolonged ischemia or trauma
release specific enzymes such as creatine kinase and proteins such as
myoglobin and troponin.
● Troponin levels that are elevated are more than 0.02 ng/mL (normal).
● CK levels that are elevated are more than 25 IU/L (normal 5-25 IU/L). ● Heart
failure-> BNP
8. Endocarditis how do we diagnosis it how do we treat it, complications ● Infective
endocarditis
○ A microbial infection of the endothelial surface of the heart. The disease
is rare, but it has a high mortality rate; approx 14% to 22% of patients die
during their hospital stay, and up to 40% of patients die within 1 year of
diagnosis.
○ Strep A
○ The objective of treatment is to eradicate invading organisms through
adequate doses of an appropriate antibiotic. Antibiotic therapy usually is
given IV for 2 to 6 weeks.
○ If you haven’t taken cultures yet for someone who is ruled pout with
endocarditis, start them on a broad spectrum antibiotic until we get
cultures back.
● Rheumatic endocarditis
○ Occurs most often in school-age children, may develop after an episode
of group A beta-hemolytic streptococcal pharyngitis.
○ Prompt and effective treatment of “strep” throat with antibiotics can
prevent development of rheumatic fever.
9. Warfarin what is it used for, INR, antidote
● It is usually used for atrial fibrillation as an anticoagulant.
● Normal INR is 1.0; on warfarin INR is 2-3.5
● Antidote for warfarin in vitamin K
10. Digoxin what is it used for, dig levels, antidote
● Digoxin increases the force of myocardial contraction and slows conduction
through the atrioventricular node. ● Digoxin toxicity
○ Includes anorexia, nausea, visual disturbances (yellow rings), confusion,
and bradycardia
MED SURGE 2 FINAL EXAM STUDY GUIDE |2025-2026 LATEST
UPDATED|REAL EXAM QUESTIONS AND ANSWERS | 100%
RATED CORRECT | 100% VERFIED SOLUTIONS | ALREADY
GRADED A+
Cardiac
1.Electrical conduction through the heart, know the pathway that it takes
● The electrical impulse travels from the SA node through the atria to the
atrioventricular (AV) node; this is know as
conduction.
● The electrical stimulation of the muscle
cells of the atria causes them to contract.
● The structure of the AV node slows the
electrical impulse, giving the atria time to
contract and fills the ventricles with
blood.
● The electrical impulse then travels very
quickly through the bundle of His to the
right and left bundle branches and the
Purkinje fibers, located in the ventricular muscle.
2. Someone who is getting a stress test, they are experiencing discomfort, chest pain
whats the best course of action
● Stop walking the test
● Take vitals signs
● See if that chest discomfort goes away at rest
3.Afib recommendation?
● Medical management such as anticoagulant medications, controlling the
entricular rate response with antiarrhythmic agents, and treating the arrhythmia
as indicated so that it is converted to a sinus rhythm.
● They will be on anticoagulants so they are on high risk for clotting disorders like
stroke.
● Keep the patient stress free
● Patient will need medications to control the heart rate like beta blockers or
calcium channel blockers.
● Patient will need medications that convert the heart rhythm or prevent atrial
fibrillation.
● Patient will need to maintain a heart healthy diet and maintain exercise.
4.Who gets an ICD? Whats the purpose?
● Patients at high risk of VT or ventricular fibrillation and who would benefit from an
ICD are those who have survived sudden cardiac death, which usually is caused
by ventricular fibrillation, or have experienced spontaneous, symptomatic VT.
, lOMoAR cPSD| 57394295
● The ICD is an electronic device that detects and terminates life-threatening
episodes of tachycardia or fibrillation, especially those that are ventricular origin.
5. CHF, classified
● Right-sided heart failure can sometimes occur as a result of left-sided. The failure
of these dual mechanisms is referred to as CHF. When the left ventricle fails,
increased fluid pressure is transferred back through the lungs, leading to damage
of the right side of the heart.
● Classification I
○ No limitation of physical activity; ordinary activity does not cause
fatigue, palpitation, or dyspnea ● Classification II
○ Slight limitation of physical activity; comfortable at rest, but
ordinary physical activity causes fatigue, palpation, or dyspnea ●
Classification III
○ Marked limitation of physical activity; comfortable at rest, but less
than ordinary activity causes fatigue, palpitation, or dyspnea ● Classification IV
○ Unable to carry out any physical activity without discomfort; symptoms of
cardiac insufficiency at rest; if any physical activity is undertaken,
discomfort is increased
5.Dilated cardiomyopathy, pathological findings would
we see in an echo
● The ventricle itself becomes enlarged or
hypertrophic.
● Microscopic examination of the muscle tissue
shows diminished contractile elements of the
muscle fibers and diffuse necrosis of
myocardial cells. The result is poor systolic
function. The structural changes decrease the
amount of blood ejected from the ventricle with
systole, increasing the amount of blood
remaining in the ventricle after contraction
● In an echocardiogram, you will find an
enlarged ventricle.
6.What do we do if a patient has cardiac tamponade, nurses most appropriate action
PRIORITIES
● Cardiac tamponade is compression of the heart resulting from fluid or blood
within the pericardial sac.
● In acute cardiac tamponade, the patient suddenly develops chest pain,
tachypnea, and dyspnea. Pts typically will have tachycardia in response to low
CO. Hypotension occurs from low CO. The pt may report chest discomfort or a
feeling of fullness.
● CARDINAL SIGNS FOR CARDIAC TAMPONADE
, lOMoAR cPSD| 57394295
7. Know what troponin BNP, other cardiac biomarkers
● Myocardial cells that become necrotic from prolonged ischemia or trauma
release specific enzymes such as creatine kinase and proteins such as
myoglobin and troponin.
● Troponin levels that are elevated are more than 0.02 ng/mL (normal).
● CK levels that are elevated are more than 25 IU/L (normal 5-25 IU/L). ● Heart
failure-> BNP
8. Endocarditis how do we diagnosis it how do we treat it, complications ● Infective
endocarditis
○ A microbial infection of the endothelial surface of the heart. The disease
is rare, but it has a high mortality rate; approx 14% to 22% of patients die
during their hospital stay, and up to 40% of patients die within 1 year of
diagnosis.
○ Strep A
○ The objective of treatment is to eradicate invading organisms through
adequate doses of an appropriate antibiotic. Antibiotic therapy usually is
given IV for 2 to 6 weeks.
○ If you haven’t taken cultures yet for someone who is ruled pout with
endocarditis, start them on a broad spectrum antibiotic until we get
cultures back.
● Rheumatic endocarditis
○ Occurs most often in school-age children, may develop after an episode
of group A beta-hemolytic streptococcal pharyngitis.
○ Prompt and effective treatment of “strep” throat with antibiotics can
prevent development of rheumatic fever.
9. Warfarin what is it used for, INR, antidote
● It is usually used for atrial fibrillation as an anticoagulant.
● Normal INR is 1.0; on warfarin INR is 2-3.5
● Antidote for warfarin in vitamin K
10. Digoxin what is it used for, dig levels, antidote
● Digoxin increases the force of myocardial contraction and slows conduction
through the atrioventricular node. ● Digoxin toxicity
○ Includes anorexia, nausea, visual disturbances (yellow rings), confusion,
and bradycardia
