NSG223/ NSG 223 Exam 1: (New 2024/ 2025 Update) Med Surg II Review| Q&A, Exams of Nursing

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NSG223/ NSG 223 Exam 1: (New 2024/ 2025 Update) Med Surg II Review| Questions and Verified Answers| 100% Correct| A Grade – Herzing QUESTION INR ranges Answer: normal therapeutic range: 2.0 - 3.0 mitral valve replacement range: 2.0 - 3.5 aortic valve replacement range: 1.8 - 2.2 QUESTION aPTT therapeutic range Answer: 45 - 70 seconds QUESTION paroxysmal supraventricular tachycardia (PSVT) Answer: - bursts of ventricular ac- tivity (multiple QRS complexes) - rate: 150-200 - regular rhythm QUESTION causes for PSVT Answer: - hypoxia - nicotine - caffeine - stress QUESTION treatment for PSVT Answer: - valsalva maneuvers (carotid massage, bear down) - betablockers - adenosine - calcium channel blockers - cardiac ablation (destruction of cells causing irregularity) QUESTION premature ventricular contraction (PVC) Answer: - early contraction of the ventricles - only affects QRS complex QUESTION causes for PVC Answer: - stimulants - nicotine - alcohol - hypoxia - Digoxin toxicity - hypokalemia QUESTION treatments for PVC QUESTION stable angina Answer: - chronic - predictable - associated with activity - reversible ischemia - short duration (5-15 min) - pain decreases with rest - stable cardiac enzymes - treated with Nitroglycerin and lifestyle modifications QUESTION unstable angina Answer: - unpredictable - pain can occur at rest - increases in frequency - reversible ischemia - stable cardiac enzymes - treated with lifestyle changes and MONA (morphine, oxygen, nitro, aspirin) QUESTION cardiac labs Answer: - troponin - CK-MB - BNP QUESTION Nitroglycerin Answer: - lowers BP (usually not given if SBP <90) - vasodilator - improves blood flow to the heart QUESTION betablockers (LOLs) Answer: - slows heart rate (target 50-60 bpm) - lowers BP - do not stop abruptly - do not give to asthma patients QUESTION bleeding precautions Answer: - electric razor - soft tooth brush - watch for bruising - fall risk (do not play sports with grandchildren) - no IM injections - no rectal medications QUESTION NSTEMI (non-ST elevation myocardial infarction) Answer: - nearly total occlusion - irreversible damage - elevated cardiac enzymes - normal ECG or just a few abnormalities - pain not relieved with Nitroglycerin QUESTION STEMI (ST elevation myocardial infarction) Answer: - complete occlusion - irreversible damage - elevated cardiac enzymes - ECG changes (ST elevation) QUESTION signs and symptoms of MI Answer: - sudden crushing chest pain - unrelieved by rest and nitroglycerin - SOB - nausea - anxiety/restlessness - increased HR - cool, pale, moist skin QUESTION medical management of MI Answer: - MONA (morphine, oxygen, nitroglycerin, aspirin) - EKG - labs (cardiac enzymes) - anticoagulation - bedrest 12-24 hours - do not want pause to be more than 3 seconds - caused by low potassium or digoxin toxicity QUESTION premature atrial contraction (PAC) Answer: - extra contraction or ectopic beat before normal P wave - caused by stimulants, anxiety, hypoxia QUESTION atrial flutter Answer: - multiple atrial contractions (many P waves) - AV node protects the heart and does not allow extra P waves to affect rhythm - sawtooth appearance on ECG - REGULAR RHYTHM QUESTION atrial fibrillation Answer: - multiple atrial vibrations (no real P waves) - IRREGULAR RHYTHM QUESTION For what dysrhythmia can the telemetry alarm be turned off? Answer: atrial fibrilla- tion QUESTION risk factors for atrial fibrillation Answer: - hypertension - diabetes - obesity - heart failure - advanced age QUESTION Patient with atrial fibrillation and another risk factor are most at risk for what? Answer: stroke QUESTION management of atrial fibrillation Answer: - coumadin (oral) - check INR - Lovenox (Sub-Q) - Heparin (IV) - check aPTT - Amiodarone - check pulmonary function and renal tests QUESTION Amiodarone considerations Answer: - highly toxic to lungs and kidneys - obtain pulmonary function test - check renal tests - cannot take if allergic to iodine QUESTION mitral valve prolapse Answer: - improper closure of the mitral valve - valve leaflets protrude into left atrium QUESTION treatment for mitral valve prolapse Answer: valve replacement with metal or tissue valves QUESTION mitral valve regurgitation Answer: - mitral valve does not close properly - blood backflows into left atrium during systole - caused by degenerative changes or rheumatic disease QUESTION symptoms of mitral valve regurgitation Answer: - dyspnea - fatigue - weakness - decreased cardiac output - high-pitched systolic murmur QUESTION treatment for mitral valve regurgitation - must take anticoagulants long-term - increased risk of infection, endocarditis - cannot have MRI or go near magnets - must maintain good oral health - must take prophylactic antibiotics prior to invasive procedures or dental care QUESTION tissue valve replacement patient education Answer: - wear out more quickly - must take anticoagulants for 3 months - increased risk of infective endocarditis QUESTION dilated cardiomyopathy Answer: - most common form - significant dilation of ventricles - weak ventricle - caused by pregnancy, drug use, chemotherapy QUESTION hypertrophic cardiomyopathy Answer: - left ventricle muscle becomes enlarged - forceful contraction but less blood in ventricle - stiff ventricular walls - caused by hypertension, aortic stenosis QUESTION restrictive cardiomyopathy Answer: - rigid ventricular walls - impaired ventricular filling and stretch QUESTION symptoms of cardiomyopathy Answer: - slow progression of symptoms - dyspnea on exertion - dysrhythmias*** - cough - orthopnea - palpitations - fatigue - peripheral edema - dizziness QUESTION diagnostic tests for cardiomyopathy Answer: - echocardiogram*** - cardiac MRI - ECG - chest x-ray QUESTION medical management of cardiomyopathy Answer: - low sodium diet - exercise/rest regimen - anticoagulants - betablockers - diuretics - anti-dysrhythmics (Amiodarone) QUESTION What will nurse do if patient has weight loss of more than 2 pounds in 1 day, increased HR, and decreased BP? Answer: do not give diuretic, concern for dehydration QUESTION pulses paradoxus Answer: systolic BP drop of >10 during inspiration QUESTION treatment for rheumatic heart disease Answer: - antibiotics - bed rest - NSAIDs - steroids QUESTION treatment for infective endocarditis Answer: - IV antibiotics for 2-6 weeks - Amphotericin B (fungal infection) QUESTION QUESTION cardiac stress test information Answer: - patient walks on treadmill to stress the heart - if unable to walk, meds are given to stress the heart (Dobutamine) - test is stopped if target heartrate is reached or patient becomes unstable (dizzi- ness, chest pain, discomfort) QUESTION patient education prior to cardiac stress test Answer: - fast for 3 hours - avoid stimulants (caffeine, tobacco) - meds may be taken but beta blocker may be held - wear comfortable clothing - report chest pain to technician QUESTION cardiac catheterization information Answer: - patient remains awake - patient is NPO - catheter inserted into a great vessel - contrast used for left-sided procedure - monitor renal function - bedrest 2-8 hours post-procedure - observe access site for bleeding - monitor for chest pain post-procedure QUESTION blood flow through the heart Answer: Right Atrium > Tricuspid Valve > Right Ventricle > Pulmonary Valve > Pulmonary Artery > Lungs > Pulmonary Vein > Left Atrium > Bicuspid (Mitral) Valve > Left Ventricle > Aortic Valve > Aorta > Body > Superior and Inferior Vena Cava QUESTION automaticity cells Answer: pacemaker cells - initiate impulse in the heart QUESTION excitability Answer: ability to respond to a an electrical impulse/stimulus QUESTION conductivity Answer: ability to conduct/transmit electrical impulse QUESTION P wave represents Answer: atrial depolarization (contraction) QUESTION PR segment represents Answer: resting of electrical signal at AV node QUESTION QRS complex represents Answer: ventricular depolarization (contraction) - ventricular rate QUESTION ST segment represents Answer: relaxation before next contraction QUESTION T wave represents Answer: ventricular repolarization