Download MedSurg Exam Questions and Answers: Cardiovascular and Renal Systems and more Exams Nursing in PDF only on Docsity!
MED SURG FINAL EXAM ALL PRACICE QUESTIONS
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What is normal range for cholesterol, HDL, LDL
- CORRECT ANSWER Less than 200, above 40, less than 130
What is the desired INR range for people taking warfarin
What is an indicator of cardiac tamponade
- CORRECT ANSWER Blood pressure is 10 MM HG or higher on expiration then on inspiration
Patients scheduled for a coronary artery bypass graft should not take anticoagulants for at least blank prior to the surgery to prevent excessive bleeding
A patient is admitted with a diagnosis of Bradydysrhythmia. What assessment finding requires immediate intervention?
- CORRECT ANSWER The patient reports weakness and fatigue
Following insertion of a permanent pacemaker, a patient states they cannot get rid of these hiccups. Why is this potentially a problem?
- CORRECT ANSWER Hiccups may indicate that the pacemaker is stimulating the chest wall or diaphragm. This could indicate a complication such as lead wire perforation
Chapter 27 - CORRECT ANSWER
What is the normal range for creatine kinase? When are elevated levels first detectable after myocardial injury and what is expected duration of the elevated levels?
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- CORRECT ANSWER 30 to 170 units/L, 4 to 6 hours, 3 days
What is the normal range for troponin T? When are elevated levels first detectable after myocardial injury and what is expected duration of the elevated levels?
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blood volume and perfusion, fluid status and how well the heart is pumping. Arterial lines are placed in the radial (most common), brachial or femoral artery. What should you Monitor for? -
MED SURG FINAL EXAM ALL PRACICE QUESTIONS
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CORRECT ANSWER Monitor circulation in the limb with the arterial line. Such as capillary refill, temperature, color. Arterial lines are not used for IV fluid administration
The pulmonary artery (PA) catheter is inserted into a large vein (internal jugular, femoral, subclavian, brachial) and threaded through the right atria and ventricles into a branch of the pulmonary artery. PA catheters have multiple lumens, ports and components that allow for various hemodynamic measurements, blood sampling and - CORRECT ANSWER Infusion of IV fluids
What are the different lumens used for? - CORRECT ANSWER
What is the expected reference range for CVP (Central venous pressure) - CORRECT ANSWER 1 to 8 MM HG
What is the expected reference range for pulmonary artery systolic (PAS) - CORRECT ANSWER 15 to 26
What is the expected range for pulmonary artery diastolic (PAD) - CORRECT ANSWER 5 to 15
What is expected range for pulmonary artery wedge pressure (PAWP)? - CORRECT ANSWER 4 to 12
What is the expected range for cardiac output - CORRECT ANSWER 4 to 7 L/minute
What is expected range for mixed venous oxygen saturation - CORRECT ANSWER 60% to 80%
When should a nurse anticipate lower hemodynamic values? - CORRECT ANSWER In older patients especially if dehydration is a complication
What position should the patient be in with hemodynamic monitoring - CORRECT ANSWER Supine or Trendelenburg
MED SURG FINAL EXAM ALL PRACICE QUESTIONS
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What are manifestations of cardiac tamponade - CORRECT ANSWER hypotension
MED SURG FINAL EXAM ALL PRACICE QUESTIONS
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JVD
Muffled heart sounds
Paradoxical pulse
What are nursing actions for cardiac tamponade - CORRECT ANSWER 1. Notify the provider immediately
- Administer IV fluids to combat hypotension as prescribed
- Obtain a chest x-ray or echocardiogram to confirm diagnosis
- Prepare the client for pericardiocentesis
What is retroperitoneal bleeding - CORRECT ANSWER Bleeding into the abdominal cavity behind the peritoneum can occur due to femoral artery puncture (after an angiography)
What are nursing actions for retroperitoneal bleeding - CORRECT ANSWER 1. Assess for flank pain and hypotension
- Notify the provider immediately
- Administer IV fluids and blood products as prescribed
What are central catheter's appropriate for - CORRECT ANSWER Any fluids due to rapid hemodilution in the superior vena cava
What is post procedure care for a PICC - CORRECT ANSWER
What should you do if there's an occlusion in the access device that impedes flow - CORRECT ANSWER 1. Flush the line at least every 12 hours to maintain patency (3 mL for peripheral & 10 mL for central lines)
- Administer urokinase to lyse obstructions per facility protocol
- Flush implanted port after every use and at least once a month while implanted
What are nursing actions for a catheter thrombosis/emboli - CORRECT ANSWER 1. Flush the line per facility protocol
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- Use a 10 mL or larger syringe to avoid excessive pressure
What is treatment for infiltration and extravasation - CORRECT ANSWER 1. Remove using direct pressure with gauze sponge until bleeding stops
- Apply cool compress
- Elevation is optional
- Avoid starting a new IV site in the same extremity
What are nursing interventions to prevent an air embolism in a vascular access device - CORRECT ANSWER 1. Leave central lines clamped when not in use
- Have the patient hold breath while the tubing is changed
- If the patient has sudden SOB, place in Trendelenburg on left side, give oxygen and notify the provider
What are nursing interventions to prevent accidental dislodgment of a catheter - CORRECT ANSWER 1. Cover the extremity site with stretch netting
- Wrap a washcloth folded into thirds around the arm before applying a needed restraint
- When removing the dressing, pull from distal to proximal
Hemodynamic pressure lines should be calibrated to read atmospheric pressure as blank. - CORRECT ANSWER Zero. Zero transducer to room air
What kind of medication would you use for vasodilation secondary to sepsis - CORRECT ANSWER Dopamine (vasopressors)
Chapter 28 - CORRECT ANSWER
What are medications/electrical management for bradycardia - CORRECT ANSWER 1. Atropine and isoproterenol (antiarrhythmic and bronchodilator)
- Pacemaker
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What are medications/electrical management for a fib, SVT or VT with pulse - CORRECT ANSWER 1. Amiodarone, adenosine, verapamil (CCB)
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What are preprocedure nursing actions for a PCI (besides allergies, informed consent, blah blah) - CORRECT ANSWER 1. NPO at least eight hours if possible
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- Assess renal function prior to introduction of contrast dye
- Administer antiplatelet medications as prescribed
What are two medications that are administered during the intraprocedure for PCI - CORRECT ANSWER Midazolam (Versed) and fentanyl
What is post procedure nursing actions after a PCI - CORRECT ANSWER 1. Assess vitals every 15 minutes for one hour, every 30 minutes for one hour, every hour for four hours and then every four hours.
- Assess the groin site at the same intervals for bleeding and hematoma formation
- Assess for signs of thrombosis
- Maintain bed rest in a supine position with the leg straight for 4 to 6 hours ( or prescribed time)
- Monitor urine output
How long does a client with a stent replacement receive anticoagulation therapy - CORRECT ANSWER 6 to 8 weeks after
Perforation of an artery by the catheter may cause blank - CORRECT ANSWER Cardiac tamponade
What are clinical manifestations of anaphylaxis - CORRECT ANSWER chills
Fever
Rash
Wheezing
Tachycardia
Bradycardia
What are two medications that might be prescribed in the event of anaphylaxis - CORRECT ANSWER Diphenhydramine or epinephrine
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What are preprocedure medications for a CABG - CORRECT ANSWER 1. Anxiolytics: lorazepam and diazepam
- Prophylactic antibiotics
- Anticholinergic such as scopolamine
What are some important preprocedure teachings for a patient that is going to undergo a CABG
- CORRECT ANSWER 1. Endotracheal tube and mechanical ventilator for airway management for several hours following the surgery
- Inability to talk while endotracheal tube is in place
- Sternal incision and possible leg incision
- 1 to 2 mediastinal chest tubes
- Indwelling urinary catheter
- Pacemaker wires
- Hemodynamic monitoring devices
What are two medications that are discontinued before a CABG - CORRECT ANSWER 1. Diuretics 2 to 3 days before surgery
- Aspirin and other anticoagulants one week before surgery
What are medications that are often continued for CABG - CORRECT ANSWER Potassium supplements
Antidysrhythmic's
Antihypertensives
Insulin
Post procedure: what should you do with the patient within two hours following extubation - CORRECT ANSWER Dangle and turn the client from side to side as tolerated
What should you do within 24 hours after CABG - CORRECT ANSWER Assist the patient to a chair. Ambulate the patient 25 to 100 feet by first postoperative day
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How often should you assess neurological status after CABG - CORRECT ANSWER Every 30 to 60 minutes until the client awakens from anesthesia, then every 2 to 4 hours or per facility policy
Monitor chest tube patency and drainage. Measure drainage at least once an hour. Volume exceeding blank could be a sign of possible hemorrhage and should be reported to the surgeon
- CORRECT ANSWER 150 mL/hour
What kind of manifestations of pain might an older female patient show instead of chest pain - CORRECT ANSWER Dyspnea, indigestion
What is a heart healthy diet - CORRECT ANSWER Low-fat, low cholesterol, high-fiber, low-salt
What should the patient's activity level be after a CABG - CORRECT ANSWER
What can hypothermia cause - CORRECT ANSWER Vasoconstriction, metabolic acidosis and hypertension
What are indications of cardiac tamponade after a CABG - CORRECT ANSWER 1. Sudden decrease of chest tube drainage following heavy drainage
- JVD with clear lung sounds
- Equal PAWP & CVP values
Treatment of cardiac tamponade after a CABG involves - CORRECT ANSWER 1. Volume expansion
- Emergency sternotomy (Pericardiocentesis is avoided because blood may have clotted)
What is maximum potassium administration rate IV - CORRECT ANSWER 10 to 20 mEq/hour
How long should a patient remain NPO before a peripheral bypass graft - CORRECT ANSWER Eight hours
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- Explain that pedal pulses will be checked frequently
What are post procedure nursing interventions for a peripheral bypass graft - CORRECT ANSWER 1. Assess vitals every 15 minutes for one hour and then every hour after the first hour
- Administer anticoagulant therapy/antiplatelet therapy
- Maintain bed rest for 18 to 24 hours. The leg should be kept straight during this time
What are teaching points for foot inspection and care - CORRECT ANSWER
The graft may occlude due to reduced blood flow and clot formation. This occurs primarily in the first - CORRECT ANSWER 24 hours post operative
What kind of procedure is used for graft occlusion - CORRECT ANSWER Thrombectomy or thrombolytic therapy
What procedure is used for compartment syndrome - CORRECT ANSWER Fasciotomy
Chapter 35 - CORRECT ANSWER
What are physical assessment findings for peripheral artery disease - CORRECT ANSWER 1. Bruit over femoral and aortic artery's
- Decreased capillary refill of toes
- Decreased or non-palpable pulses
- Loss hair on lower calf, ankle and foot
- Dry, scaly, mottled skin
- Thick toenails
- Cold/cyanotic extremity
- Pallor of extremity with elevation
- Dependent Rubor
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- Muscle atrophy
- Ulcers and possible gangrene
