NURSING MED SURG MS EXAM 2 - JERSEY
COLLEGE 100%VERIFIED
1. WHAT ARE SOME REASONS YOU WOULD HAVE AN INCREASED HEART RATE?
PG 693 ✔
• Stimulation of the sympathetic nervous system (positive chronotropy)
• Conduction through the AV node (positive dromotropy)
• The force of myocardial contraction (positive inotropy)
• Dysrhythmias
• Exercise
• Anxiety
• Fever
• Administration of catecholamines(dopamine, aminophylline, dobutamine)
• Hypovolemia
• Shock
• Infection
• Respiratory issues (distress)
• Dyspnea
2. WHAT LAB RESULT WOULD TELL YOU YOUR PATIENT IS IN HEART FAILURE?
PG 675 ✔
• BNP(Brain Natriuretic Peptide) >than 100 pg/ml
• The BNP level is a key diagnostic indicator of HF; high levels are a sign of
high cardiac filling pressure and can aid in both the diagnosis and
management of HF
3. WHAT MEDICATION WOULD YOU USE FOR PERIPHERAL VASCULAR DISEASE?
PG 837 ✔
• Statins
• Vasodilators(pentoxifylline & cilostazol (Pletal)
• Antiplatelets or blood thinners:aspirin or clopidogrel (Plavix)
4. WHAT ARE THE SIGNS AND SYMPTOMS FOR PERICARDITIS? PG 791 ✔
• May be asymptomatic
• Chest pain- hook up to ECG first, then vitals, then cath lab for diagnostic
• Pain radiating to beneath the clavicle, neck or scapula
• Creaky or scratchy friction rub
• Mild fever
• Increase WBC count
• Anemia
• Elevated ESR or C-reactive protein level
• Nonproductive cough or hiccup
• Dyspnea
• Other S&S of heart failure
5. AFTER A STRESS TEST WHAT WOULD YOU FURTHER ASSESS YOUR PATIENT
, FOR? ✔
• chest pain, extreme fatigue, a decrease in BP or pulse rate, serious
dysrhythmias, or ST-segment changes on the ECG during the stress test.
, • Facial flushing, chest discomfort, anxiety, ischemia, ↑HR(vitals, ECG), rest,
atropine-dilates. ASSESS-ASSESS
• If chest discomfort persist during stress test: stop test, ECG, vitals
5. DEFINE MURMUR ✔
• SOUNDS CREATED BY ABNORMAL, TURBULENT FLOW OF BLOOD IN HEART
INTENSITY
A GRADING SYSTEM IS USED TO DESCRIBE THE INTENSITY OR LOUDNESS OF A MURMUR.
GRADE 1: VERY FAINT AND DIFFICULT FOR THE
INEXPERIENCED CLINICIAN TO HEAR GRADE 2: QUIET BUT
READILY PERCEIVED BY THE EXPERIENCED CLINICIAN GRADE
3: MODERATELY LOUD
GRADE 4: LOUD AND MAY BE ASSOCIATED WITH A THRILL
GRADE 5: VERY LOUD; HEARD WHEN STETHOSCOPE IS PARTIALLY OFF THE CHEST;
ASSOCIATED WITH A THRILL
GRADE 6: EXTREMELY LOUD; DETECTED WITH THE STETHOSCOPE OFF THE CHEST;
ASSOCIATED WITH A THRILL
6. PATIENT TEACHING BEFORE, DURING, AND AFTER, CARDIAC
CATHETERIZATION. ✔
NURSING RESPONSIBILITIES BEFORE CARDIAC CATHETERIZATION INCLUDE:
• INSTRUCTING THE PATIENT TO FAST, USUALLY FOR 8 TO 12 HOURS,
BEFORE THE PROCEDURE
• INFORMING PATIENT THAT IF CATHETERIZATION IS TO BE
PERFORMED AS AN OUTPATIENT PROCEDURE, A FRIEND, FAMILY
MEMBER, OR OTHER RESPONSIBLE PERSON MUST TRANSPORT
THE PATIENT HOME
• INFORMING THE PATIENT ABOUT THE EXPECTED DURATION OF THE
PROCEDURE AND ADVISING THAT IT WILL INVOLVE LYING ON A
HARD TABLE FOR LESS THAN 2 HOURS
• REASSURING THE PATIENT THAT IV MEDICATIONS ARE GIVEN TO
MAINTAIN COMFORT
• INFORMING THE PATIENT ABOUT SENSATIONS THAT WILL BE
EXPERIENCED DURING THE CATHETERIZATION. KNOWING
WHAT TO EXPECT CAN HELP THE PATIENT COPE WITH THE
EXPERIENCE. THE NURSE EXPLAINS THAT AN OCCASIONAL
POUNDING SENSATION (PALPITATION) MAY BE FELT IN THE
CHEST BECAUSE OF EXTRA HEARTBEATS THAT ALMOST ALWAYS
OCCUR, PARTICULARLY WHEN THE CATHETER TIP TOUCHES THE
ENDOCARDIUM. THE PATIENT MAY BE ASKED TO COUGH AND TO
BREATHE DEEPLY, ESPECIALLY AFTER THE INJECTION OF
CONTRAST AGENT. COUGHING MAY HELP DISRUPT A
DYSRHYTHMIA AND CLEAR THE CONTRAST AGENT FROM THE
ARTERIES. BREATHING DEEPLY AND HOLDING THE BREATH
HELP LOWER THE DIAPHRAGM FOR BETTER VISUALIZATION OF
HEART STRUCTURES. THE INJECTION OF A CONTRAST AGENT
, INTO EITHER SIDE OF THE HEART MAY PRODUCE A FLUSHED
FEELING THROUGHOUT THE BODY AND A SENSATION SIMILAR TO
THE NEED TO VOID, WHICH SUBSIDES IN 1 MINUTE OR LESS.
• ENCOURAGING THE PATIENT TO EXPRESS FEARS AND ANXIETIES.
THE NURSE PROVIDES EDUCATION AND REASSURANCE TO REDUCE
APPREHENSION.
COLLEGE 100%VERIFIED
1. WHAT ARE SOME REASONS YOU WOULD HAVE AN INCREASED HEART RATE?
PG 693 ✔
• Stimulation of the sympathetic nervous system (positive chronotropy)
• Conduction through the AV node (positive dromotropy)
• The force of myocardial contraction (positive inotropy)
• Dysrhythmias
• Exercise
• Anxiety
• Fever
• Administration of catecholamines(dopamine, aminophylline, dobutamine)
• Hypovolemia
• Shock
• Infection
• Respiratory issues (distress)
• Dyspnea
2. WHAT LAB RESULT WOULD TELL YOU YOUR PATIENT IS IN HEART FAILURE?
PG 675 ✔
• BNP(Brain Natriuretic Peptide) >than 100 pg/ml
• The BNP level is a key diagnostic indicator of HF; high levels are a sign of
high cardiac filling pressure and can aid in both the diagnosis and
management of HF
3. WHAT MEDICATION WOULD YOU USE FOR PERIPHERAL VASCULAR DISEASE?
PG 837 ✔
• Statins
• Vasodilators(pentoxifylline & cilostazol (Pletal)
• Antiplatelets or blood thinners:aspirin or clopidogrel (Plavix)
4. WHAT ARE THE SIGNS AND SYMPTOMS FOR PERICARDITIS? PG 791 ✔
• May be asymptomatic
• Chest pain- hook up to ECG first, then vitals, then cath lab for diagnostic
• Pain radiating to beneath the clavicle, neck or scapula
• Creaky or scratchy friction rub
• Mild fever
• Increase WBC count
• Anemia
• Elevated ESR or C-reactive protein level
• Nonproductive cough or hiccup
• Dyspnea
• Other S&S of heart failure
5. AFTER A STRESS TEST WHAT WOULD YOU FURTHER ASSESS YOUR PATIENT
, FOR? ✔
• chest pain, extreme fatigue, a decrease in BP or pulse rate, serious
dysrhythmias, or ST-segment changes on the ECG during the stress test.
, • Facial flushing, chest discomfort, anxiety, ischemia, ↑HR(vitals, ECG), rest,
atropine-dilates. ASSESS-ASSESS
• If chest discomfort persist during stress test: stop test, ECG, vitals
5. DEFINE MURMUR ✔
• SOUNDS CREATED BY ABNORMAL, TURBULENT FLOW OF BLOOD IN HEART
INTENSITY
A GRADING SYSTEM IS USED TO DESCRIBE THE INTENSITY OR LOUDNESS OF A MURMUR.
GRADE 1: VERY FAINT AND DIFFICULT FOR THE
INEXPERIENCED CLINICIAN TO HEAR GRADE 2: QUIET BUT
READILY PERCEIVED BY THE EXPERIENCED CLINICIAN GRADE
3: MODERATELY LOUD
GRADE 4: LOUD AND MAY BE ASSOCIATED WITH A THRILL
GRADE 5: VERY LOUD; HEARD WHEN STETHOSCOPE IS PARTIALLY OFF THE CHEST;
ASSOCIATED WITH A THRILL
GRADE 6: EXTREMELY LOUD; DETECTED WITH THE STETHOSCOPE OFF THE CHEST;
ASSOCIATED WITH A THRILL
6. PATIENT TEACHING BEFORE, DURING, AND AFTER, CARDIAC
CATHETERIZATION. ✔
NURSING RESPONSIBILITIES BEFORE CARDIAC CATHETERIZATION INCLUDE:
• INSTRUCTING THE PATIENT TO FAST, USUALLY FOR 8 TO 12 HOURS,
BEFORE THE PROCEDURE
• INFORMING PATIENT THAT IF CATHETERIZATION IS TO BE
PERFORMED AS AN OUTPATIENT PROCEDURE, A FRIEND, FAMILY
MEMBER, OR OTHER RESPONSIBLE PERSON MUST TRANSPORT
THE PATIENT HOME
• INFORMING THE PATIENT ABOUT THE EXPECTED DURATION OF THE
PROCEDURE AND ADVISING THAT IT WILL INVOLVE LYING ON A
HARD TABLE FOR LESS THAN 2 HOURS
• REASSURING THE PATIENT THAT IV MEDICATIONS ARE GIVEN TO
MAINTAIN COMFORT
• INFORMING THE PATIENT ABOUT SENSATIONS THAT WILL BE
EXPERIENCED DURING THE CATHETERIZATION. KNOWING
WHAT TO EXPECT CAN HELP THE PATIENT COPE WITH THE
EXPERIENCE. THE NURSE EXPLAINS THAT AN OCCASIONAL
POUNDING SENSATION (PALPITATION) MAY BE FELT IN THE
CHEST BECAUSE OF EXTRA HEARTBEATS THAT ALMOST ALWAYS
OCCUR, PARTICULARLY WHEN THE CATHETER TIP TOUCHES THE
ENDOCARDIUM. THE PATIENT MAY BE ASKED TO COUGH AND TO
BREATHE DEEPLY, ESPECIALLY AFTER THE INJECTION OF
CONTRAST AGENT. COUGHING MAY HELP DISRUPT A
DYSRHYTHMIA AND CLEAR THE CONTRAST AGENT FROM THE
ARTERIES. BREATHING DEEPLY AND HOLDING THE BREATH
HELP LOWER THE DIAPHRAGM FOR BETTER VISUALIZATION OF
HEART STRUCTURES. THE INJECTION OF A CONTRAST AGENT
, INTO EITHER SIDE OF THE HEART MAY PRODUCE A FLUSHED
FEELING THROUGHOUT THE BODY AND A SENSATION SIMILAR TO
THE NEED TO VOID, WHICH SUBSIDES IN 1 MINUTE OR LESS.
• ENCOURAGING THE PATIENT TO EXPRESS FEARS AND ANXIETIES.
THE NURSE PROVIDES EDUCATION AND REASSURANCE TO REDUCE
APPREHENSION.
