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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. aortic valve replacement range: 1.8 - 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:
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
medications to treat high cholesterol Answer:
- Atorvastatin (Lipitor)
- Ezetimibe (Zetia)
- Gemfibrozil (Lopid)
- Cholestyramine (Questran)
QUESTION
Lipitor (Atorvastatin) Answer:
- decreases LDL
- increases HDL
- take at the same time every day
- avoid grapefruit juice
- monitor liver function
QUESTION
Ezetimibe (Zetia) Answer:
- often used with other statins
- can cause abdominal pain
- monitor liver function
QUESTION
types of angina Answer:
- stable
- unstable
- intractable
- variant
- silent ischemia
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:
- 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
QUESTION
indications for management of STEMIs Answer:
- thrombolytic therapy (Alteplase) - dissolve thrombus
- administer within 30 minutes of presenting to hospital
- chest pain > 20 minutes
- < 6 hours from onset of chest pain
QUESTION
sinus rhythm Answer:
- considered to be a normal heart rhythm
- rate 60 - 100 bpm
- regular rhythm
- consistent P wave
- P wave prior to every QRS complex
- PR interval 0.12 - 0.20 seconds (SATA question)
QUESTION
sinus bradycardia characteristics Answer:
- rate <60 bpm
- regular rhythm
- consistent P wave
- P wave prior to every QRS complex
- PR interval 0.12 - 0.20 seconds
QUESTION
patient symptoms with sinus bradycardia Answer:
- 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
Answer: valve replacement with metal or tissue valves
QUESTION
mitral valve stenosis Answer:
- narrowing of the mitral valve
- blood flow through the valve is reduced
- usually caused by rheumatic endocarditis (strep throat)
QUESTION
symptoms of mitral valve stenosis Answer:
- hemoptysis
- wheezing
- shortness of breath on exertion
- possibly atrial fibrillation
- risk for stroke
QUESTION
treatment of mitral valve stenosis Answer: balloon angioplasty
QUESTION
symptoms of aortic valve stenosis Answer:
- angina
- fatigue
- hypertrophy of left ventricle
- high mortality rate
- systolic murmur
QUESTION
symptoms of aortic valve regurgitation Answer:
- water-hammer pulse
- dyspnea on exertion
- fatigue
- diastolic murmur
QUESTION
What is the most common cause of cardiac valve disorders? Answer: rheumatic heart disease (develops from strep throat)
QUESTION
medical management of valve disorders Answer:
- prophylactic antibiotics prior to invasive procedures or dental work
- treat the symptoms (vasodilators, ACE, betablockers, diuretics)
- daily weights*** (no more than 2.5-3lbs in 1 day or 5lbs in 1 week)
- sodium restriction
QUESTION
mechanical valve replacement patient education Answer:
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
normal PR interval on ECG Answer: 0.12 - 0.20 seconds
QUESTION
normal QRS complex on ECG Answer: 0.06 - 0.12 seconds
QUESTION
1 small box on ECG Answer: 0.04 seconds
QUESTION
ECG nursing considerations Answer:
- clip hair if needed (no shaving)
- change electrodes every 24 hours
- do not place electrodes over pacemakers, incisions, or planned incision sites
- remove ECG prior to MRI or other procedure
- educate patient about ECG box's purpose
QUESTION
cardiac stress test contraindications Answer:
- within 48 hours of MI***
- unstable angina
- uncontrolled dysrhythmias
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
