Right heart Quiz prep
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| You are inflating the balloon on a Swan-Ganz catheter. You feel no resistance as you inflate and the syringe plunger does not passively spring back upon release. You should: | Aspirate 1.5 cc's (pull blood out because balloon has burst) and tape the port so no one else tries to inflate the ballon; notify the physician
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| You are advancing a Swan Ganz Catheter into an elderly lady with a dilated right heart. with balloon inflated the catheter passes easily from the IVC and RV but won't pass into the PA. Additional maneuvers include: | Have her inhale deeply and cough (this applies negative pressure, pulls more blood closer to PA and cough may push it into PA)
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| Which of the following would be correct regarding use of a guidewire with a Swan-Ganz catheter? Put an: a. 0.038 wire in the distal port; b. 0.014 wire in the proximal port; c. 0.025 wire in the proximal port; d. 0.025 wire in the distal port | d. 0.025 wire in the distal port
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| Swan-Ganz catheters should be connected to a continuous flush device which at 300mmHg infusion pressure will deliver approximately: | 3-8 ml flush/hour
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| What is the injectate port of a Swan-Ganz catheter for thermodilution? | Right atrium
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| Which of the following are possible complications of Swan-Ganz catheters? | Nosocomial infection, pulmonary hemorrhage, air embolism, catheter induced arrhythmia
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| Which of the following are possible complications of Swan-Ganz catheters? a. Pulmonary embolism; b. knotting of catheter; c.allergic reaction to latex balloon; d. Accidental removal by disoriented patient | all of the above
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| You are advancing a Swan-Ganz catheter from the right femoral approach and it goes up the SVC instead of the RA to the RV . What should you have the patient do? | Take a deep breath in. It will pull the catheter into the thoracic
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| What is the proper order of pressure sampling in a right heart pullback? | PCW to PA to RV to RA (the most distal portion is PCW)
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| True or False: Right heart pullbacks are never performed because flow directed catheters can only go with the flow | False: You can deflate and tug gently to pull back
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| What is the paceport on the Swan-Ganz catheter for? | Right ventricle
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| What is the VIP on the Swan-Ganz Catheter? | Venous Infusion Port - Right atrium
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| The thin black bands on the Swan-Ganz represents: | 10cm
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| The thick black band on the Swan-Ganz catheter represents: | 50 cm
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| What is the yellow port on the Swan-Ganz catheter for? | PA distal, to attach transducer
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| What is the port on the Swan-Ganz catheter that has an arrow and can be turned on and off? | the port to attach the 1.5 cc syringe for inflating the balloon
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| What is the red port on the Swan-Ganz catheter for? | It has electrical prongs that should not be bent and measures temperature
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| What is the VIP port on the Swan-Ganz catheter for? | Venous Infusion Port for medication such as Potassium Chloride
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| What is the blue port on the Swan-Ganz Catheter for? | To inject water; TDCO Thermal Dilution Cardiac Output
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| When nitroglycerin dilates peripheral veins it is | Decreasing preload
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| When nitroglycerin vasodilator coronary arteries it is | increasing oxygen supply
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| When nitroglycerin vasodilator peripheral arteries it is | Decreasing afterload
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| The most powerful use of nitroglycerin as a means to increase oxygen supply is to administer | Intracoronary 200 micrograms
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| Nitroglycerin is most like | Endothelial-derived relaxing factor
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| Side effects such as hypotension, headache and flushing of the skin are common with the administration of | Nitroglycerin
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| Nitroglycerin works by causing | Vasodilation
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| Nitroglycerin may be administered | sublingually, IV drip, intracoronary bolus, transdermally
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| The oral form of sustained release nitroglycerin is | Imdur
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| What is Imdur used to prevent? | Chest pain
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| How does NTG relieve angina? | Increases oxygen supply to the heart muscle
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| The body relaxes vascular smooth muscle in arterial walls by releasing its own supply of | Nitric oxide
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| Nitroglycerin tablets are stored | In amber, light protective bottles
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| Nitropaste is administered in what units of measure? | Inches
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| Your patient is Sharon a bunker, a war correspondent on leave from Afghanistan, tells you that when she put the Nitro bit under her tongue, it tingles. This | Is normal
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| Reversing a severe overdose of nitroglycerin may require use of | Catecholamines such as Epinephrine
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| IV NTG is stored in glass rather than plastic because | NTG is an activated by polyvinyl chloride plastic
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| Your patient Ms Coral Sea Cruz, a travel agent from Clearwater, is receiving transdermal nitroglycerin. She becomes hypotensive. Your first action is to | Wipe off the nitropaste
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| NTG is a | Vasodilator
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| Nitroglycerin would be contraindicated in | Severe hypotension
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| Your patient is pearly white, a dental hygienist from Fenton, is on IV nitro. She is complaining of a severe headache. you suspect | A common side effect of NTG
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| Which of the following is given sublingual? | Nitro stat
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| Triple therapy for angina includes NTG plus | A beta blocker and a calcium channel blocker
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| Nitroglycerin dilates | Arteries and arterioles larger than 100 micrometers
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| What is the maximum number of sublingual notes nitroglycerin tablets to be taken for an attack of angina pectoris? | 3
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| 1 inch of nitro paste went mint provides how much nitroglycerin? | 15 milligrams
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| The transdermal nitro patch provides | 2.5 - 14 milligrams per 24 hours
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| True or false a patient taking sublingual nitroglycerin should be instructed to take a second tablet after a period of 5 minutes if the pain is not relieved. | True
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| True or false apply a transdermal patch of nitroglycerin to any non hairy area of the body except the distal arms and legs | True
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| True or false always use lactated ringers to mix a nitro drip | False, only for saline
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| Nitrate tolerance involves activation of what compensatory mechanisms? | Renin angiotensin aldosterone system, sympathetic nervous system
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| Your patient mr. Titus a drum, is taking nitroglycerin, verapamil hydrochloride (calinl and warfarin sodium (coumadin). He is also taking an over-the-counter analgesic containing aspirin to relieve persistent, mild headache. What could be the cause? | Aspirin may potentiate the coumadin and could increase the risk of cerebral bleeding; the nitroglycerin may be causing the headaches
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| True or false amyl nitrate is associated with increased BP | False
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| What is amyl nitrite and what is it used for? | An ampule inhalant like smelling salts used to see how bad mitral valve regurgitation is. provocative study
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| Protamine | 1 milligram reverses 100 units heparin
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| Protamine reverses Hepburn in a ratio of 10 milligrams to 1000 units of heparin. The cardiologists Dr one and only wants you to reverse 7000 units of heparin. How much protein should you give? | 10 - 1000 drop two zeros example 70 milligrams
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| compared to unfractionated heparin, all the following are benefits of low molecular weight heparin EXCEPT: more cost effective, more effective anticoagulant, more predictable dosing, lower risk of bleeding complications, less need of laboratory monitoring | low molecular weight heparin is preferred but not more cost effective
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| Heparin inhibits clapping by inhibiting | Prothrombin conversion to thrombin
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| A serious complication of heparin use is | Heparin induced thrombocytopenia (HIT)
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| How much Catherine should be administered in Pediatrics left heart catheterization | 100 units per kilogram, one milligram per kilogram
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| What role does thrombin play in thrombus formation? | Promotes the conversion of fibrinogen to fibrin, activates coagulation cofactors, activates platelets, adheres to collagen
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| What limits unfractionated heparin as an adjunctive therapy in percutaneous coronary intervention | Does not inhibit friburn bound thrombin, does not inhibit platelet bound factor Xa
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| How do low-molecular-weight heparins offer a potential advantage over unfractionated heparin? | A more predictable anticoagulant effect, a reduced level of nonspecific protein binding, and more predictable pharmacokinetic profile
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| The pharmaceutical source for heparin is | Pork intestine or beef long
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| The pharmaceutical source for Angiomax is | Leech saliva
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| In human beings, heparin is secreted from | Mast cells
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| Heparin dosage may be adjusted using a sliding scale based on the | Activated clotting time
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| When used to prevent thrombosis, how many units of heparin should be added for every cc of flush solution? | 2 U
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| And IV infusion set left in place for intermittent injections is called a | Hep-Lock
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| ACLs guidelines recommend heparin in patients with acute injury pattern and unstable angina. What is the maximum heparin dose in patients over 70 kilograms? | Heparin 4000 Unit bolus IV followed by 1000 Units per hour IV drip
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| Your patient, mr. Quincy dents, has a seafood allergy and fish sensitivity. He may also be allergic to contrast and | Protamine
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| People allergic to seafood or eggs or diabetic or on NPH may be allergic to | Protamine
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| Which drug is contraindicated to reverse the effects of heparin in a patient that has an allergy to egg whites prior to a sheath removal? | Protamine sulfate
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| Which lab test is performed to verify protamine sulfate effect and what is what result is needed prior to sheath pull? | ACT, < 180 seconds
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| During a timeout, the cath lab staff is informed that the patient has HIT. Heparin was already dispensed on the cath table. The cardiology fellow proceeded to gain arterial access and administered 2000 units of unfractionated heparin. This is: | A JCAHO sentinel event and potentially life threatening
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| An alternative to ACT for measuring Heparin effect is: | Activated partial thromboplastin time. normal is 30-40 seconds
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| The top 5 high-alert medications identified by the Joint Commission sentinel event alerts are insulin, narcotics, injectable potassium chloride, sodium chloride solutions above 0.9% and | Heparin
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| The risk of anaphylaxis from the administration of protamine is greatest in patients who | Take NPH insulin because these patients have antibodies to protamine
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| List of flow directed catheter | Swan Ganz
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| The three ring control syringe is connected to the | Selective angiography of the RCA could be performed using a 6jr 4.5
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| A shepherd's crook right is a | Difficult shape of a native RCA
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| Which of the following could be considered an out of plane take off from a coronary artery | Anterior LMCA
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| Guidewire diameters are usually measured in | Thousandths of inches
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| Which needle size would be smallest and least traumatic to inject local subcutaneous anesthetic beneath the skin before deep infiltration with lidocaine and arterial puncture? | 25 gauge
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| Before catheters, needles and sheets are inserted into the patient they should be | Flushed with heparinized flush
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| What complication occurs from frequent and prolonged wedging of Swan Ganz catheters? | Pulmonary hemorrhage
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| The pressure tubing on the angiographic manifold is connected to | theTransducer
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| Cath EP procedures in the left atrium require a | Transseptal technique
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| Which of the following are potential complications associated with the Swan Ganz catheter? | Pulmonary hemorrhage, infection, allergic reaction to latex balloon, embolism from correr
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| What is the first thing to do after a guide wire is taken out of the catheter | Wife that wire down with wet guys to remove any thrombus
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| What anticoagulant is most likely to be administered as 2000 units intra-arterial early through the introducer sheets early in an elective cath procedure? | Heparin
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| Your patient Mr Mark decline, ACHS patient deteriorating rapidly, is being transferred to see see you. The catheter most likely to be left in place is a | Swan
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| Be able to identify the thermister port on the Swan Ganz catheter | Likely has a square you can turn to an ON or OFF position with an arrow
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| What are the two landmarks when palpating for femoral percutaneous puncture? | Iliac crest and symphysis pubis
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| What is attached to the rotating hemostatic valve on the front of the four port manifold? | A catheter
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| What is the distance between the proximal and distal ports of a Swan Ganz catheter? | 30 centimeters
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| The position has to cut through heavy muscle. Which scissors would be most appropriate to hand to her? | Curved Mayo
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| Swan Ganz catheter should be connected to a continuous flush device which at 300 mmHg infusion pressure will be deliver approximately | 3-8 ml flush/hour
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| The RAO projection provides the best imaging of which LV walls? | Anterior inferior
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| What can diminish the validity of ventriculography | Catheter tip too close to the mitral valve
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