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Heart nclex

cardiology nclex

A diagnosis of Hypertension is made by a blood pressure value greater than 140/90 obtained on two seperate occasions with orthostatic readings
Hypertension is classified as either Primary or Secondary
Often the client with hypertension will have no symptoms at all or might complain of an early morning headache and fatigue--name given is The silent killer, if left untreated, can lead to coranary disease, renal, and strokes
Managenment of HTN includes Diet, exercise, low fat, low cholestorl diet. If diet exercise unsucessfull MD might order diuretics and antihypertensives
Hypertensive drugs include but are not limited to. Diuretics, beta blockers, calcium channel blockers, angiotensin comverting enzyme inhibitors, angiotension receptor blockers
The SA node is considered the ______ pacer of the heart rate. main
The AV node ________ the impluse and ________ it to the Bundle of HIS recieves/transmits
Heart block is a condition in which The conduction system of the heart fails to conduct imppulses
How many different heart block degrees are there 3-first, second, third
1st degree heart block occursw when the_____ _____ continues to function normally but, transmission fails SA node
Clients in 1st degree heart block are usually asymptomatic. T or F T--although heart rate is irregullar transmission eventually reaches the ventricles
Second degree heart block is which impluses reach the ,________ but others do not. Ventricles
Third degree heart block or _________heart block none of the sinus impluses reach the ventricles Complete
Erratic heart rates, hyptension, seizures, cerbral ischemia or cardiac arrest. Would be charactristic of which heart block Third
Heart blocks are detected by which procedure? ECG
Therapeutic levels of Digoxin is 0.5-2.0 ng/ml. T or F True
IF digoxin exceeds greather 2.0 there considered toxic. T or F True
Signs and symptoms include what for Digoxin toxicity? Nausea, vomiting, and seeing halos around lights, HR <60bpm
Treatment for digoxin toxicity include. Hold Dig. administer K+ and if HR to low administer isoprel or atropine.
Its okay for a patient with a pacemaker to have a MRI. T or F False
Its okay to drive a car immediately after discharge post pacemaker insertion. False usually must wait several months.
When there is a blockage in one or more of the coronary artheries the client is considert to have a ____________ _________. Myocardial Infarction
The client can go into _________ ________ post MI. Cardiogenic shock
The most commonly reported S/S of and MI are. Substernal pain or pain over precordium lasting greater than 15mins, described as heavy, vise-like-radiating down left arm, not relieved by rest or nitro,
Pain that is accompanied by SOB, pallor, diaphoresis, dizziness, nausea and vomiting are characteristics of which cardiac disorder myocarial infarction
Myocardial infarction had decreased heart rate, decrease blood pressure, increased temperature and increased respiratory rate. T or F False-Increased heart rate,< bp, > temp, > RR
When experiencing Angina take ___nitro every ____ minutes. Do not exceed___ doses. Call 911 if more is needed. 1/5min/3
The most common diagnositc test to determine extent of an MI would be ECG and Serum enzymes and iso enzymes,
CK-MB is specific for damage to the myocaridum
The Troponin T and 1 are specific to Striated muscles and used to determine the severity of the attack
CRP are used with CK-MB to determine if the client had an acute MI and the serverity of the attack.
LDH is a nonspecific ensyme that is elevated with any muscle trauma.
Ventricluar Tachycardia is often seen in patients who experienced and MI it is characterized by what ECG changes Rapid rhythm, 0 P wave, rate 140-180 bpm. Lethal rhytmn if left untreated
Ventricular tachycardia is treated with O2 and medications to slow rate, and Heparin to prevent further thrombus and Morphine for pain
Ventricular Fibrillation (V-fib) associated with sudden cardiac arrest
V-fib ecg strip has a charactrestic ------- rythmn saw tooth
Treatment of V-fib is defibrillation.
Cardiac Catherizaation detects_______ associated with MI and dysrthymias blockages
It is not okay to administer dye to a patient with a shellfish allergy. T or F False
Nursing interventions include post cardiac cath. Bedrest with leg straight, pressure dressing, check distal pulsed, force fluids.
Cardiac tamponade happens when Blood is not drained from the mediastinal area, and fluid accumulates around the heart
A swan-ganz catheter monitors Central venous pressure, pulmonary artery wedge presure and radial arterial blood pressure
A diet post MI should include Low sodium, low fat and low cholesterol
Caffiene is okay to have. T or F T in small amounts
Nurse should check the PT/INR levels for Heparin. T or F False-PT/INR is for Coumadin, PTT is for Heparin
The antidote for Heparin is protamine sulfate
The antidote for coumadin is Vitamin K
B_______ disease results when spasms of the arteries and veins occur primarily in the lower extremities..... Buerger's
Symptoms of Buerger's disease are pallor of the extremities progressing to cyanosis, pain and parethesia
Management of Buerger's involves Buerger Allen exercises, vasodilators and oxygentation. T or F True, also encourage to stop smoking because smoking makes the condition worse
__________ occurs when there is inflammation of a vein with formation of a clot occurs. Thrombophlebitis
_________ sign is considered postitive is the cliet complains of pain on dorsiflexion of the foot. Homan's sign
If client is diagnosised with thrombophlebitis the patient should be placed on bedrest with warm, moist compresses to the leg
An ________ is ordered to reduce clotting anticoagulant
Raynaud's syndrome is defined by Vascular spasms brought on by exposure to the cold.
Most commonly affected areas of Raynaud's syndrome are The hands, nose and ears
Aneurysms are balloning of an artery
Greatest risk associated with an aneurysm are rupture and hemmorage
Three types of aneurysms are Fusiform, saccular, dissecting
The client with a abdominal aortic aneurysm complains of felling her heart beating in her abdomen or lower back pain
On ausculation of the abdomen a ______ can be heard with an abdominal aortic aneurysm bruit
Diagnosis of an abdominal aortic aneurysm is made by a ultrasound, arteriogram or abdominal xrays
How big should a aneurysm be to schedule and immediate surgery in centimeters 6 or more
Avoid palpating what in an client with a suspectedd abdominal aortic aneurysm abdomen
Most heart failures occur when the _____ ventricle fails to pump blood left
Left sided heart failure results in fluid backs up into lungs causeing pulmonary edema
Signs of pulmonary edema are frothy, pink-tinged sputum, sob and orthopnea possible JVD
Right sided CHF blood backs up into. peripheral areas
Signs of Right sided heart failure are pitting edema
CBC evaluates? level of oxygentatoion of the blood particulary the hemoglobin and hematocrit
Chest xray tells the nurse what about the heart? whether the heart is enlarged or an aneurysms are present
Anteriogram revels the presence of what? blockages and abnormalities, turbulent flow, in the vascular system
Cardiac catherization reveals blockages and abnormalities, turbulent flow, and arteriosclerotic heart disease.
ECG interperation indicated abnormalities in the the________ and _________ of the conduction system of the heart Rate and rhythm
What monitors the fluid volume status Central venous pressure monitoring
______(lab test) used to diagnose heart failure in clients with acute dyspnea or differate dyspnea found in those with lund disorders from those with CHF BNP-b-type natriuretic peptide
The nurse should check what when giving Diazoxide (Hyperstat) for hypertensive crisis. It causes an increase in this value. Blood glucose level
Diazoxide (hyperstat) is given by which route. IV push
When a client is placed on rosuvastatin (crestor) they should report muscle weakness-sign of rhabdomyositis
rosuvastatin (crestor) takes effect in how long One month
Which value should be reported immediately to an MD while recieving Lanoxin elixir in a 6 mo. old client, bp 126/80, BGL 110mg/dl, HR 60 bpm, RR 30 HR 60 bpm, bradycardia is associated with dig. toxicity
It is okay to put nitroglycerine in a different bottle other than the brown bottle it is prescribed in. T or F F-Removing may cause nitro to loose potency
The patient should replenish there nitro supply ever 6 months. T or F True
Which lab enzyme would be most specific for an diagnosis of a MI? Creatine phosphokinase or CK-MB, Troponin is also very reliable
Cliet with left-sided CHF should be assessed for edema in the feet, neck, hands or Sacrum Neck veins should be assessed for neck vein distention
at which point when checking central venous pressure. Phlebostatic axis, point of max impluse, Erb's point or Tail of Spence Phlebostatic axis which is located at the fifth intercostal space mid-axillary line.
The MD orders lisinopril and furosemide to be administered concomitantly to the client with HTN the nurse should...... Administer the meds
The best method of evaluating the amount of peripheral edema is to???? wiegh daily, measure extremity, measure I and O's, or check for pitting? Measure the extremity
Assessment findings for low cardiac output would be Hypotension, low urine output, cool extremities, larger than normal blood loss
Intervention for Low cardiac output may include IV crystalloids, RBC's, diuretics, inotropic drugs, vasopressor drugs
Assessment findings for Cardiac tamponade maybe decreased CT output, muffled heart sounds, pulsus paradoxus
Interventions for Cardiac tamponade. Removal of clot from CT or CT changed, if no CT pericardiocenties, or return to surgery
Assessment findings for Dysrthythmias may include Frequent PVC's, a-fib, bradycardic rhythms
Interventions for Dysrthymias Treat K+ imbalance,andtidysrythmic drugs, temporary pacer wires to increase heart rate or overdrive pace tachycardic rythms
Assessment findings for an Emboli dyspnea, faintness postivie lung scans,
Intervention fo Emboli Anticoagulant therapy, observe for neuro changes
Interventions for fever Blood, urine culture, antibiotic TX
Common vavular diseases include Mitral stenosis, mitral valve regurgitation, mitral valve prolapse, aortic regurgitation, aortic stenosis, pulmonary stenosis
Clinical findings of Mitral stenosis Dyspnea, fatigue, a-fib, heart failure, LOUD S!, diastolic murmur
Clinical findings of Mitral valve regurgitation-chronic fatigue, weakness, dyspnea with activity, systolic murmor or thrill or both
Clinical findings of Mitral valve regurgitation-acute pulmoanary edema and shock
Clinical findings of mitral valve prolapse palpitations, dyspnea, angina, sycompe
Clinical findings of aortic regurgitiation palpitations, angina, syncope, L=sided heart failure, visible apical pulse, soft S1 or presence of S3, systolic murmur at L sternal border
Aortic stenosis clinical findings Palpitations, anginia, syncope, Left-sided HF, decreased cardiac output, S4(oftened discovered in youth)
Pulmonary stenosis clinical findings syncope, angina, R-sided HF, systolic murmour at the L sternal border, split S2(congenital;rare)
Hypovolemic shock is caused by rapid loss of ________________. Fluid
Cardiogenic shock caused by MI, cardomyopathy, HF, pericardial tamponade, tension pneumothorax, pulmonary edema
Anaphylatic shock is caused by a _______ ______ to food or meds Allergy
Septic shock is when ______ _______ or ______ _______ bacteria are introduced causeing a systematic infection gram-negative/ gram postive bacteria
Neurogenic shock caused by Spinal cord injury spinal anethesia,severe pain medication and hypoglycemia
Assessment of shock include _____heart rate, restlessness, _____respiratory rate, _______urine output,_______ blood pressure cold clammy skin develoves Increased, increased, decreased, decreased
Late stage shock _____-________ respirations and anuria develop Cheyne-stokes
During and exam client reports recent occipital headaches, blurred vision, fatigue, and increasing edema. These findings could be hypertension
client asks " what is the prognosis for myocarditis?" a could response could be Recovery usually happens without any special treatment
Which interventions would be appropriate for acute stage of bacterial endocarditis patient? rest, analgesics, antibiotics
Why does a patient with hypertension need to have a urine sample checked for? Protein which may indicate the kidneys are affected.
Are Nitro, O2, morphine appropriate for a MI patient Yes, question Asprin if a patient has open stomach ulcer may cause GI bleeding.
rheumatic heart disease is frequently a result of streptococcal infection
What are priority nursing intervention during left sided heart failure exacerbation. High fowlers position, Oxygen, diuretics
Iv fluid would be harmfull to a client experiencing Left sided heart failure. T or F True
I will do weekely finger-stick monitoring of my sodium level, patient will need more education or understands More education
I will call my MD if I gain morre than two pounds a day. needs more education or understands Understands care
Which manifestations indicate cardia tamponade? Muffled heart sounds, headache, hypotension, vision changes, cool, diaphoretic skin, tachycardia clincial manifestations of cardiac tamponade include muffled heart sounds, tachycardia, low blood pressure and cool diaphoretic skin,
After a MI a client has concerns when is it safe to resume sex answer should be When your able to climb two flights of stairs comfortably.
A driver for a patient post TEE is needed after discharge? Yes or NO YES
Which med should you give if a patient with CAD develops chest pain, 1 tab nitro q15 times 3 doses or 0.4mg nitro IV push over 1-2 minutes 1 tab po q 15 minutes times 3, than call 911 if not effective, nitro is not given IV push ever.
Which diet choices are good for pt. with CAD...Mozzarella cheese, grilled chedder cheese sandwich, tomato juice, peanut butter sandwich, 2% milk, tortilla Out of the choices the best choices would be the moz cheese and tortilla, Chedder higher in fat, tomato juice high sodium, pb high fat content, skim milk perfered over 2%
The nurse assesses the left foot of a client with known CAD that has become suddenly cold, painfull, and pulseless. What is your next intervention? Call MD
Plans for nursing interventions for a client in the acute stage of bacterial endocarditis should include which nursing interventions. Antibiotics to combat the bacterial infection and analgesics for aches that may occur are appropriate interventions for acute-stage BE.
It is important to notify the MD of an allergy to shellfish while obtaining a cardiac history prior to coronary angiogram. T or F T
Which age group are most likely to aquire rheumatic fever young aduldts after an beta-hemolytic streptococcal upper respiratory infection.
Post CABG the patient should expect to have ? which devices, Chest tube, NG tube, ET tubes, IV, All of the above
Because a client with sinus bradycardia is experiencing hypotension, plans intervention include administration of what drugs. Atropine->used for sinus bradycardia which a patient is symptomatic
________ _______ is a dysrhytmia charc. by a very irritable atrium. The atria fire at a rate of 250-350 bpm. The waveforms resembles a saw tooth resemblance Atrial flutter
_________ _________ a lethal rhythm charc. by a chaotic rhythm that originates in the ventricles, it is unorganized and uncoordinated series of rapid impulses that cause the hearet to fibrillate rather than contract ventricular fibrillation
_____ ______ is an extremly irritable rhythm orginating in the atrium. There is a organized atrial activity Atrial fibrillation
____ _______ is a lethal rhythm that exists when three or more PVCs occur in a row at a rate greater thatn 100bpm Ventricular tachycardia
____ ____ is a heart rhythm in which the S-A node fires at fewer than 60bpm. It may be normal in a healthy athlete and goes untreated unless symptomatic. Sinus bradycardia
Sinus brady cardia is treat with which drug if symptomatic Atropine
A ____ degree heart block is a lethal rhytmn third
A _____ degree ______ _____ is a complete blockage of the atrial impulses into the bentricles third degree heart block...The block may be in the A-V node, bundle of His, or bundle branches resulting in the atria and ventricles beating independently of each other.
A patient post pacemaker insertion should be instructedd to stay on bed rest for _____ hours with minimal activity of the affected arm and shoulder to prevent ________ the leads of the pacemaker. 12 hours/ dislodgment
Ventricluar tachycardia and ventricular fibrillatioin are not lethal dysrhtymias that require immediated intervention to maintain life. False....they require interventions
Pacemaker placment is needed for sinus rhythm with a second-degree a-v block type 2 (Mobitz 2) true or false True
Sinus bradycardia usually goes unnoticed because the client can compensate for the decreased cardiac output. True or false true
Which patient should you assign to the licensed personal? ventricular tachycardia, sinus bradycardia, ventricular fibrillation, sinus rhythm with a second-degree A-V block type II(Mobitz II) Sinus bradycardia
which dysrhythmia is priority for the nurse to report 1st? Sinus rhythm with a 1st dree A-V block, suprventricular tachycardia (SVT), atrial fibrillation, Idioventricular rhythm (ventricluar escape rhythm? Idioventricular rhythm is a lethal rhythm in which there is a high pacemaker failure. No impulses are conducted to the ventricls from above the bundle of His
prioritize the patients in order whom should be taken care of first to last. Sinus bradycardia, atrial flutter, ventricular fibrillation, sinus tachycardia ventricular fibrillation, atrial flutter, sinus tachycardia, sinus bradycardia
In caring for a client with atrial flutter which of the following goals would have priority. Control the heart rate and maintain cardiac output.
Which of the following should the nurse include in the plan of care for a client with sinus tachycardia? Administer lidocaine, assess the client, administer atropine, cardioversion assess the client, and treat as needed the most commonly used drugs are beta blockers.
Define NANDA diagnosis ; Cardiac output decreased--- Inadequate blood pumped by the heart to meet metabolic demands of the body
Name some defining characteristics of Cardiac output, decreased Altered heart rate/rhythm, altered preload, altered after load, altered contractility,
Examples of altered heart rate/rhythm Dysrhythmias(tachycardia, bradycardia); palpitations;electrocardiographic changes
Altered preload- Jugular vein distention;fatige, edema, murmurs, increased/decreased central venous pressure (CVP), increased/decreased pulmonary artery wedge pressure (PAWP), wieght gain
Altered afterload- Cold/clammy skin, SOB/dyspnea, oliguria, prolonged capillary refill, decreased peripheral pulses, variations in blood pressure readings, increased/decreased systemic vascular resistance (SVR),>/< pulmonary vascular resisitance(PVR), skin color changes
Altered contractility- crackles, cough, orthopnea,noc. dyspnea, cardiac output<4L/min, cardiac index <2.5 L/Min, < EF, s3/s4 sounds
behavioral/emotional anxiety/ restlessness
hypo or hyper kalemia is common in heart c clients because of diuretic needs hypo
BNP, BMP, CBC which one is usefull in establishing or eliminating the diagnosis of heart failure in the client with dyspnea BNP
What is the best position for a patient with cardiac issues Semi-fowlers
Best meal for a client with cardiac disease would be small sodium-restricted, low cholesterol meals. Decreased sodium helps decrease fluid volum excess, low cholesterol diets help decrease atheroscleroses, smaller meals are easier to digest less cardiac output needed.
Created by: jensen1106



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