Med-Surg Perfusion

Med Surg Perfusion

By Miranda Smith

Multiple Choice

A client presents with chest pain. Which finding would indicate the client is having an ACUTE myocardial infarction?

• ST-segment elevation on ECG
• Troponin 69

• Diaphoresis

• Elevated CK-MB

Indicates acute ischemia in your patient.

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ST-Elevation

Drag and Drop

For a client who is experiencing an acute MI, which interventions are appropriate?

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Heparin infusion

Aspirin

Nitroglycerin

Send to cath lab

Administering antibiotics

Performing a lumbar puncture

Prescribing antidepressants

Multiple Choice

What is the difference between a NSTEMI and a STEMI?

• NSTEMI is more severe than STEMI, with similar ECG findings.
• NSTEMI and STEMI are the same condition with no differences.
• STEMI occurs only in women, while NSTEMI occurs only in men.
• NSTEMI has no ST elevation on the EKG, but will still have elevated troponin.

Multiple Choice

Which laboratory test is more specific for diagnosing a myocardial infarction?

• CK-MB

• Troponin

• Myoglobin

• BNP

Multiple Choice

A client who presents to the ED with new-onset chest pain at rest. Which is the priority nursing intervention?

• Obtain EKG and administer aspirin

• Perform a detailed cardiac assessment

• Administer furosemide

• Obtain a chest xray

Multiple Choice

What is a characteristic of unstable angina?

• Pain occurs at rest and may not be relieved by nitroglycerin

• Pain lasts less than 5 min

• EKG shows ST segment elevation

• Complaints of crushing chest pain

Multiple Choice

A 58-year-old man presents to the ED with crushing substernal chest pain radiating to the left arm. ECG shows ST elevation in leads II, III, and aVF. What is your immediate priority as a nurse?

• Administer morphine sulfate

• Recheck EKG in 15 minutes

• Alert the MD and cath lab

• Administer morphine

Multiple Choice

You’re caring for a patient 12 hours post-STEMI. Which assessment finding should be reported to the healthcare provider immediately?

• HR 82 bpm

• Slight chest discomfort

• Shortness of breath and crackles in the lung

• BP 130/80

Multiple Choice

A client has just returned from a left heart cath via the right femoral artery. What is the nurses priority assessment?

• Monitor vital signs for arrhythmias.
• Assess the patient's level of consciousness.
• Check for signs of infection at the catheter site.
• Assess distal pulses and insertion site

Multiple Choice

The nurse notes a growing hematoma at the femoral insertion site and a drop in blood pressure. What is the most appropriate initial action?

• Apply direct pressure to the hematoma site.
• Apply a cold compress to the site.
• Elevate the leg above the heart.
• Administer pain medication immediately.

Multiple Choice

How long should a patient typically remain on bed rest following a femoral artery catheterization?

• 1 to 2 hours
• 12 to 24 hours
• 2 to 3 days
• 4 to 6 hours

Multiple Choice

Mr. Johnson, age 76, is admitted with acute shortness of breath, orthopnea, crackles in both lung bases, and bilateral lower extremity edema. His past medical history includes hypertension and coronary artery disease.

What is the nurse’s priority action?

• Encourage deep breathing exercises and ambulation.
• Perform a chest X-ray and wait for results.
• Position the HOB flat

• Administer prescribed furosemide IV

Multiple Choice

Ms. Lee, age 60, has left-sided heart failure. She reports increased fatigue and dyspnea on exertion. You note inspiratory crackles on auscultation.

Which findings is most consistent with left-sided heart failure?

• Decreased heart rate during exertion.
• Increased blood pressure at rest.
• Pitting edema in the lower extremities.
• Inspiratory crackles on auscultation.

Multiple Choice

Mr. Alvarez, age 68, is on digoxin for heart failure. During your assessment, you note he feels nauseous and has a heart rate of 50 bpm.

What is the nurse’s best action?

• Administer the digoxin as scheduled.
• Increase the dosage of digoxin.
• Encourage Mr. Alvarez to eat a large meal.
• Hold the digoxin and notify the healthcare provider.

Multiple Choice

Which diagnostic test is commonly used to confirm heart failure?

• Pro-BNP

• Electrocardiogram (ECG)
• Chest X-ray
• Echocardiogram

Multiple Choice

Mr. Lin, age 63, is admitted with worsening heart failure. You assess the following lab results:

BNP: 950 pg/mL

Sodium: 129 mEq/L (low)

Potassium: 3.8 mEq/L

Creatinine: 2.1 mg/dL (high)

What do these labs values suggest about his condition?

• Acute kidney injury without heart failure.
• Mild dehydration with elevated potassium levels.
• Stable heart condition with normal sodium levels.
• Worsening heart failure with hyponatremia and renal impairment.

Multiple Choice

Which is the most common symptom of peripheral arterial disease (PAD)?

• Swelling in the ankles
• Cold feet
• Numbness in the legs
• Intermittent claudication

Multiple Choice

Mr. Graham has a history of smoking and diabetes. He complains of leg pain when walking and cold feet. On assessment, you note diminished dorsalis pedis pulses.

Which additional finding would support a diagnosis of PAD?

• Normal pulse in the dorsalis pedis artery
• Swelling in the legs
• Increased hair growth on the legs
• Loss of hair and shiny skin

Multiple Choice

You're providing discharge teaching for a patient newly diagnosed with PAD.

Which statement indicates the patient needs further teaching?

• I should exercise regularly to improve circulation.
• I should soak my feet in warm water each night.

• I can take pain medication whenever I feel discomfort.
• I need to monitor my blood pressure regularly.

Multiple Choice

Identify the rhythm

• Atrial Fibrillation
• Atrial Flutter

• Ventricular Tachycardia
• Bradycardia

Multiple Choice

Identify the rhythm.

• Sinus Bradycardia

• Normal sinus rhythm
• First degree heart block

• Ventricular tachycardia

Multiple Choice

Identify the rhythm.

• Ventricular tachycardia

• Supraventricular Tachycardia

• Ventricular fibrillation

• Sinus Tachycardia

Multiple Choice

Which medication is most appropriate for this rhythm to give first?

• Adenosine

• Epinephrine

• Atropine

• Amiodarone

Multiple Choice

Which medication would be appropriate to treat this rhythm?

• Digoxin
• Diltiazem

• Adenosine
• Lidocaine

PR Intervals are > .20 sec

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​First Degree Heart Block

PR gets longer until a QRS complex is dropped

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​Second-Degree Type 1

PR Interval is the same, but there is a random drop of the QRS

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​Second Degree Type 2

P's and QRS's have no relationship

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​Third Degree Complete Heart Block

Multiple Choice

Which medication is indicated for this rhythm?

• Atropine

• Epinephrine

• Adenosine

• Lidocaine

Multiple Choice

Your client is found to have this rhythm. What should you do when you enter the room?

• Begin CPR

• Assess the patient

• Administer Epinephrine

• Defibrillate

Multiple Choice

You are assessing your client and determine your client does not have a pulse. You see this rhythm on the monitor. What should you do?

• Begin compressions

• Administer Epinephrine

• Cardiovert

• Nothing, this is normal

Multiple Choice

Review this EKG, Identify the rhythm and the appropriate treatment.

BP 82/45 (57), SpO2 85% on room air.

• Complete heart block- Need to pace

• Second degree heart block Type 1- Administer Atropine

• Second degree heart block Type 2- Administer Epinephrine

• Sinus Bradycardia- Administer Atropine

Multiple Choice

When a client is undergoing a right heart catheterization, which finding would the nurse need notify the provider?

• K 5.2 mEq/L

• proBNP 7500 pg/mL

• Troponin 180 ng/L

• Creatinine 2.5 mg/dL

Questions??