Complex MS Cardiovascular Exam

What are the signs and symptoms of Angina?

• Chest pain lasting < 15 minutes

• Chest pain radiatin to the Left arm and jaw

• Diaphoresis

• Relief of symptoms with NTG administration

• Brought on by exertion and stress

A MI is more lethal to a younger person than an older person

• True

• False

A woman experiencing a MI's symptoms may differ from a man in what ways?

• More Fatigue

• More nausea

• Back Pain

• Diaphoresis

ST elevations on leads V1, V2, V3 and V4 indicate a:

• Anterior MI

• Lateral MI

• Posterior MI

• Septal MI

A lateral MI would be observed in what EKG leads?

• V1-V4

• V5 and V6

• Lead 2

• Lead 1

ST elevation in this lead indicates an Inferior MI

• Lead 1

• Lead 2

• V1-V4

• V5 and V6

What does the Acronym MONA stand for when referring to care for a MI patient?

Which would be a contraindication for the use of clot busting drugs such as Streptokinase/TPA?

• ST elevation

• Chest pain greater than 30 minutes

• Diabetes

• Recent trauma or surgery in past 10 days

Revascularization of the Coronary Artery after a cardiac cath might cause:

• Abrupt cessation of pain

• More severe pain initially, then reduction of pain within 12 hours

• Sudden onset of dysrhyhtmias

• Resolution of ST elevations

Non- STEMI patients:

• Should receive clot-busting therapy within 30 minutes of admit to ER

• Should be sent to the cath lab within 120 minutes of admit to ER

• Should receive clot-busting therapy within 90 minutes of admit to ER

• Should be sent to the cath lab withing 90 minutes of admit to ER

What is the priority assessment for a patient following CABG (coronary bypass graft) surgery?

• Blood Pressure

• Pulse

• Respirations

• Temperature

Why is it important to put a cardiac post-op patient on stool softeners or laxatives?

• Hard stools can cause anal fissures and blood loss

• Constipation can decrease bowel motility, causing fluid back up and edema putting more work on the hear

• Constipation may cause the pt to strain during BMs causing the Valsalva Manuver which could affect the heart

• After surgery pts are put on high doses of opiates causing constipation

What medication can be given to reduce the retention of water and sodium as a result of aldosterne production which will put less work on the heart?

• Lisinopril (zestril)

• Procardia

• Metoprolol (Lopressor)

• Nitroglycerin

What are the signs and symptoms of Left sided heart failure?

• JVD

• Crackles and dyspnea

• Oliguria

• Dependent edema

• Ascites

What are the signs and symptoms of Right sided heart failure?

• JVD

• Crackles and dyspnea

• Oliguria

• Dependent edema

• Ascites

What is the hallmark sign of pulmonary edema?

• Crackles in the lungs

• Collapsed lung/atelectasis

• Dyspnea

• Frothy pink tinged sputum

• Use of accessory muscles to breathe

The ejection fraction is the % of blood ejected from the ventricles of the heart with each beat and is used as an assessment of cardiac function. If the ventricles can hold 70 ml of blood but only eject 25 mL of blood, the EJ fraction is _____ which is normal/abnormal

• 36 % and normal

• 36% and abnormal

• 40 % and normal

• 40% and abnormal

A BNP reading of 90 indicates imminent heart failure

• True

• False

The therapeutic serum levels for Lanoxin (digoxin) are

What are the differences betwen Heart Failure and Cardiogenic Shock?

• Increase in preload and afterload

• Decrease in tissue perfusion

• Decrease in CO

• Decrease in contractility

• Ischemia to organs

Your patient has a BP of 100/50. Their MAP is ______ which is/isn't sufficent for proper tissue perfusion

• 50, is sufficient

• 50, is not sufficient

• 67, is sufficient

• 67, is not sufficient

Physicians use a Swan-Ganz catheter to measure the pulmonary artery pressure on your patient. The readings are: SPAP: 28, DPAP: 12. Your patient has_____________ and needs______________

• A normal PAP and just needs to be monitored

• Pulmonary hypotension and needs a fluid bolus

• Pulmonary hypertension and treatment with NTG and diuretics

You can administer medications through a Swan-Ganz catheter

• True

• False

During Hemodynamic Monitoring, you notice the PAP go to 10/4. Your initial itervenion is:

• Sit the patient upright at 30 degrees

• Administer dopamin 5-20mcg/kg/min to cause vasocontriction

• Administer a fluid bolus

• Administer NTG

Levophed (norepinepherine) is a vasoconstrictor used to increase blood pressure. What advantage does this drug have over dopamine?

• It can be administered via IV for quicker results

• It does not cause tachycardia

• It does not cause hypertension

• It does not constrict the CA so angina is not a side effect

Why would a patient be perscribed Dobutmine (dobutrex)?

• Hypertension

• Pulmonary edema

• Cardiogenic shock

• Angina

Nitroglycerin acts by decreasing ____________ and increasing ____________

• Preload, contractility

• Afterload, contratility

• Preload, cardiac output

• Afterload, cardiac output

A patient is on arterial pressre monitoring. The nurse notices the patiens systolic BP increases by between 10 and 15 mm of Hg upon exhalation. This could indicate:

• Pulmonay edema

• MI

• Cardiogenic shock

• Cardiac tamponade

The following signs and symptoms are possible with cardiac tampoade

• JVD

• Hypotension

• Muffled heart sounds

• Paradoxical pulse

• A feeling of fulless in the chest

What would be an appropriate treatment for Cardiac Tamponade?

• Thoracentesis

• Administer diuretics

• ACE inhibitors

• Performing a pericardial window procedure

The most common cause of thoracic and abdominal aneurysms is hyperlipidemia

• True

• False

The following are s/s of thoracic aneurysms

• Cough/ loss of voice

• Pain

• Hypovolemic shock

• Pulsating mass under skin

• Dyspnea

The blood pressure of a pt who has come out of surgery from a thoracic aneurysm should be between ________ and _______

More than half of the patiets diagnosed with abdominal aneurysms use tobacco

• True

• False

A patients systolic blood pressure must be kept below ________ to decrease the risk of aneurysm ruputure

• 120

• 110

• 100

A dissecting aorta may be difficult to diagnose because its signs and symptoms mimic a

• Angina attack

• Hypertensive crisis

• MI

• Stroke

When doing hemodynamic monitoring, you know you are getting a good PAP reading by observing:

• A good rhythm

• The dicrotic notch in the waves

• Your patient's vital signs remain stable

• Don't remember

During hemodynamic monitoring, the transducer that transmits the PAP to an electrical signal should be placed

• At heart level

• Higher than the heart

• Lower than the heart

• I was in the bathroom when she talked about that

The antidote for digoxin toxicity is

• Digibind

• Protamine sulfate

• Vitamin K

• Narcan

Beta blockers should be used cautiously in patients with

• History of stroke

• Asthma

• Cancer

• HTN

What drug can cause hyperkalemia?

• Beta blockers

• Calcium channel blockers

• Nitrates

• ACE inhibitors

Common indications for using a intra-aortic balloon pump are

• Pt awaiting a cardiac transplant

• Recovery from a MI

• Cardiogenic shock

• HTN

The IABP is placed in the ascending aorta

• True

• Fase

What would be the main post procedure assessment after having a IABP inserted?

• Bleeding at the site of insertion

• UO

• Pulse assessments

• BP

What date is the pinning ceremony this year?

• December 10th

• December 12th

• December 17th

• Who cares?

Krispen is the most amazing test creator in the universe

• True

• False

The pericardial sac usually contains less than 50 mL of fluid

• True

• False

Normal urine output is _______mL and hour