Final Exam: NUR2502/ NUR 2502 (New 2023/ 2024 Update) Multidimensional Care III/ MDC 3 Exam| Questions and Verified Answers| 100% Correct| Grade A- Rasmussen
Final Exam: NUR2502/ NUR 2502 (New
2023/ 2024 Update) Multidimensional Care
III/ MDC 3 Exam| Questions and Verified
Answers| 100% Correct| Grade ARasmussen
QUESTION
plaque builds up on the inner walls of the arteries
Answer:
atherosclerosis
QUESTION
Causes of plaque build up
Answer:
▪ Cholesterol
▪ Smoking
▪ Uncontrolled diabetes
▪ Uncontrolled HTN
▪ Obesity
▪ Diet
▪ Lack of exercise
QUESTION
hardening of the arteries, happens with age, normal
Answer:
arteriosclerosis
QUESTION
What is HDL?
Answer:
good cholesterol, want it >60
QUESTION
What is LDL?
Answer:
bad cholesterol, want it <150
QUESTION
What are triglycerides?
Answer:
“sugary cholesterol”
QUESTION
Atherosclerosis and Arteriosclerosis can cause what conditions?
Answer:
peripheral arterial disease (PAD) – shiny hairless legs
peripheral vascular disease (PVD)
QUESTION
S/S: Peripheral Vascular Disease (PVD)
Answer:
▪ cool hands and feet
▪ bad pedal pulses
▪ leg pain
▪ decreased capillary refill
▪ mottled skin
QUESTION
How do you diagnose Peripheral Vascular Disease (PVD)?
Answer:
lower extremity doppler
QUESTION
Treatment: Peripheral Vascular Disease (PVD)
Answer:
▪ anticoagulants
▪ cath lab to have stent placement
▪ angioplasty
QUESTION
Patient Education: Peripheral Vascular Disease (PVD)
Answer:
▪ no crossing legs
▪ no pressure on legs, keep them in a dependent or dangling position
▪ no constrictive clothing
QUESTION
Types of valves
Answer:
-aortic
-mitral
-tricuspid
-pulmonic
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respiratory alkalosis
high pH, low CO2
pH: 7.35-7.45 acidic-basic
HCO3: 21-28 acidic-basic
CO2: 45-35 acidic-basic
metabolic acidosis
low pH, low HCO3
pH: 7.35-7.45 acidic-basic
HCO3: 21-28 acidic-basic
CO2: 45-35 acidic-basic
respiratory acidosis
low pH, high CO2
pH: 7.35-7.45 acidic-basic
HCO3: 21-28 acidic-basic
CO2: 45-35 acidic-basic
metabolic alkalosis
high pH, high HCO3
pH: 7.35-7.45 acidic-basic
HCO3: 21-28 acidic-basic
CO2: 45-35 acidic-basic
▪ change in condition make take priority over ABCs (ex: post op bleeding is priority over an O2 Sat% of 90%)
▪ pick the patient that is going to die first
Priority questions…something to consider
CPR, press the code button
You walk into your patient’s room and they don’t have a pulse, what are you going to do?
bag resuscitation, press the code button
You walk into your patient’s room and they are not breathing but have a pulse, what are you going to do?
▪ unconscious, pulseless
▪ shock them with the AED!
If you walk into a room with a patient that is in ventricular fibrillation (v fib)
▪ How will they present?
▪ What must we do to get them out of that state?
▪ make them bear down (valsalva maneuver)
▪ make them cough (vagal maneuver)
If you walk into a room and a patient is alert and oriented, speaking to you, has a pulse, but their cardiac monitor shows they are in ventricular tachycardia
▪ What are you going to do?
Supraventricular Tachycardia (SVT)
Which cardiac rhythm requires the patient to take adenosine?
▪ they may end up with a blood clot because the blood is pooling in the atria
What is our priority concern for a patient in atrial fibrillation (a-fib)?
control RVR for patient:
▪ give anticoagulants
▪ beta blockers, digoxin, diltiazem
▪ if meds don’t work…cardioversion (synchronized shock to re-start the rhythm)
▪ if cardioversion doesn’t work…ablation
Nursing Interventions: A-fib RVR
▪ chest pain
▪ SOB
▪ diaphoresis
▪ N/V
▪ hypertension
▪ tachycardia
▪ jaw pain, anxiety, indigestion (women)
▪ elevated troponin levels
▪ EKG changes – ST elevation
If you have a patient who comes into the ED and they are having an MI, what are the signs/symptoms? lab values to confirm this?
Oxygen – 1st
Nitro – given sublingual, 3 doses q 5 min (home), drip (hospital), drops BP (vasodilator)
Aspirin – antiplatelet, stops clotting, 325 mg, chew it
Morphine – calms the patient down, helps pain
Treatment: Myocardial Infarction
▪ CPK
▪ troponin
▪ CK-MB
▪ BNP
Name the cardiac enzymes
angioplasty
stent the artery
angiogram
remove clots
cardiac catheterization
Procedures: Myocardial Infarction (MI)
CABG (Coronary Artery Bypass Graft)
Procedure: Patient has an MI and extreme plaque build up
pericarditis
inflammation of the membrane surrounding the heart
heart can’t expand and contract properly (cardiac tamponade)
When you have pericarditis what are you at risk for?
pleural friction rub
What sounds will you hear in a patient with pericarditis?
pericardial effusion
accumulation of fluid in the pericardial cavity
Pericardialcentesis
Surgical treatment: Pericardial Effusion
aneurysm
a localized weak spot or balloon-like enlargement of the wall of an artery
Abdominal Aortic Aneurysm (AAA)
Which is the most common aneurysm?
▪ epigastric pain
▪ pulsating in the abdomen – do not push on it!
S/S: Abdominal Aortic Aneurysm (AAA)
immediately go to the OR for surgery
▪ pain between the scapulas (straight across the back)
S/S: Thoracic Aortic Aneurysm
monior BP periodically and check the size of it
no anticoagulants!!!
Non-emergent thoracic aortic aneurysm interventions
elevated BP 3 times in a six month period – documented by MD
How do we diagnose hypertension?
▪ lifestyle modifications (diet, exercise)
▪ record values at home
Patient Education: Hypertension
▪ obesity
▪ drugs
▪ alcohol
▪ age
▪ race (hispanic, african american)
▪ high cholesterol
▪ family Hx
▪ elevated LDL, decreased HDL
Risk Factors: Hypertension
primary – because of the pressure in the arteries only, usually hereditary
secondary – r/t kidney problems or other issues
What’s the difference between primary and secondary hypertension?
▪ ACE inhibitors
▪ Beta Blockers
▪ ARBs
▪ Calcium Channel lockers
Pharmacological Treatment: Hypertension
atherosclerosis
plaque builds up on the inner walls of the arteries
▪ Cholesterol
▪ Smoking
▪ Uncontrolled diabetes
▪ Uncontrolled HTN
▪ Obesity
▪ Diet
▪ Lack of exercise
Causes of plaque build up
arteriosclerosis
hardening of the arteries, happens with age, normal
good cholesterol, want it >60
What is HDL?
bad cholesterol, want it <150
What is LDL?
“sugary cholesterol”
What are triglycerides?
peripheral arterial disease (PAD) – shiny hairless legs
peripheral vascular disease (PVD)
Atherosclerosis and Arteriosclerosis can cause what conditions?
▪ cool hands and feet
▪ bad pedal pulses
▪ leg pain
▪ decreased capillary refill
▪ mottled skin
S/S: Peripheral Vascular Disease (PVD)
lower extremity doppler
How do you diagnose Peripheral Vascular Disease (PVD)?
▪ anticoagulants
▪ cath lab to have stent placement
▪ angioplasty
Treatment: Peripheral Vascular Disease (PVD)
▪ no crossing legs
▪ no pressure on legs, keep them in a dependent or dangling position
▪ no constrictive clothing
Patient Education: Peripheral Vascular Disease (PVD)
-aortic
-mitral
-tricuspid
-pulmonic
Types of valves
mitral valve due to increasing age
aortic valve
Which valves most commonly have issues?
valve regurgitation
backward flow of blood through a heart valve
valve stenosis
when valves become narrower than normal, impeding the flow of blood.
rheumatic fever
What are some reasons, besides age, patients might end up with mitral stenosis?
decreased cardiac output which leads to heart failure
When we have any damage to our valves, whether it be regurgitation or stenosis, what are we at risk for?
▪ mitral regurgitation: High pitched holosystolic murmur – begins at S1 and continue to S2
▪ aortic regurgitation: Blowing, decrescendo diastolic murmur
Murmur sounds associated with mitral regurgitation vs aortic regurgitation
▪ high pitched holosystolic murmur
▪ JVD
▪ SOB
▪ fatigue
▪ tachycardia
S/S: Mitral Regurgitation
endocarditis
inflammation of the inner lining of the heart
antibiotics
How do we FIRST treat endocarditis?
dental work
IV drugs
strep
Causes of Endocarditis
Transient Ischemic Attack (TIA) – why? because of microclots that get loose and travel
Complication of Endocarditis
left-sided heart failure aka CHF
Heart failure where it backs up to the lungs
▪ SOB
▪ decreased O2 Sat
▪ fluid around lungs
▪ fluid in lungs
▪ crackles
▪ potential confusion
▪ fatigue
▪ weakness
▪ impending doom
S/S: Left-Sided Heart Failure
▪ loop diuretics
▪ potassium sparing diuretics
▪ digoxin
▪ ACE inhibitors
▪ ARBs
▪ calcium channel blockers
Treatment: Left-Sided Heart Failure
▪ GI effects (anorexia, N/V)
▪ CNS depressant effects (fatigue, weakness, dizziness)
▪ Headache
▪Decreased HR and BP
▪Heart arrhythmia (paradoxical effect)
Adverse effects of Digoxin
▪ raise the head of the bed
▪ monitor I&O
▪ daily weight
▪ low sodium diet
▪ avoid NSAIDs
▪ fluid restriction
▪ instruct patient to seek help when weight gain > 2 lbs
Nursing Interventions/Patient Education: Heart Failure
▪ echocardiogram
▪ BNP lab value
How do we diagnose heart failure?
heart transplant – post op our biggest concern is REJECTION
Treatment: End Stage Heart Failure
iron deficiency anemia
anemia caused by inadequate iron intake, decreased RBC production
first: tell them to eat more in their diet! red meat
then can try supplements
then might need iron infusion or blood transfusion
Treatment: Iron Deficiency Anemia
▪ fatigue
▪ dyspnea
▪ pale
▪ weak
▪ SOB
All anemias, what will your patient present with?
leukemia
cancer of white blood cells, too many immature WBCs
infection; in the hospital we put them on neutropenic precautions which means reverse isolation (no live flowers, wash hands)
Leukemia patients are at risk for what?
▪ bone pain, joint pain
▪ fatigue
▪ bleeding gums
▪ bruising
▪ weight loss, decreased appetite
S/S: Leukemia
▪ chemotherapy
▪ stem cell transplant
▪ bone marrow transplant
Treatment: Leukemia
hemophilia
A hereditary disease where blood does not coagulate to stop bleeding; S/S: bleeding, bruising, joint pain
prolonged aPTT
How do you diagnose hemophilia?
▪ this condition is life-long
▪ electric razors
▪ soft tooth brushes
▪ don’t play sports
▪ bleeding precautions
Patient Education: Hemophilia
sickle cell anemia
a genetic disorder that causes abnormal hemoglobin, resulting in some red blood cells assuming an abnormal sickle shape
pain, they are having infarctions all over their body
Main symptom of Sickle Cell Anemia
▪ opioids, morphine
▪ IV fluids
▪ transfusions
▪ oxygen
▪ no restrictive clothing
▪ warmth
Treatment: Sickle Cell Anemia
Heparin-induced thrombocytopenia (HIT)
50% reduction in platelet count within 7-10 days of exposure of heparin
-Severe form results in global thromboembolism due to immune reaction with platelet factor 4
PLTs decrease by 50% in a 2 day period
How do you diagnose HIT?
platelet factor 4 (PF4) blood test
Diagnostic Test for Heparin-Induced Thrombocytopenia
Idiopathic Thrombocytopenic Purpura (ITP)
disorder in which a deficiency of platelets results in abnormal blood clotting, marked by tiny purple bruises (purpura) that form under the skin
Bruising, purpura
Most common s/s of ITP
PLT transfusions
Treatment: Idiopathic Thrombocytopenic Purpura
anything invasive like needlesticks, catheters, rectal tubes
therefore we want a central line or PICC so we aren’t constantly sticking needles in them
If your patient has thrombocytopenia, what are we going to try to avoid doing with this patient?
Vitamin K
What’s the antidote to warfarin (Coumadin)?
▪ avoid large amounts of dark leafy green vegetables
▪ avoid gingko biloba
Patient Education: Warfarin
PT/INR
How do we monitor warfarin?
▪ 2 nurses verifying the orders
▪ stay with the patient the first 15 min
▪ monitor vital signs 15 min after
▪ 4 hours start-finish
When we are giving patients blood transfusions, what is the protocol?
▪ stop the infusion
▪ start normal saline(NS), flush
▪ send bag and tubing to the lab for testing
What do you do if you notice a blood transfusion reaction? Fever, chills, headache…
Yes! You’ll just get some allergy meds first like benadryl
Can you still get blood products if you had an allergic reaction?
Yes! Even though they are at risk for overload we will give them some furosemide (Lasix) first. Weigh the risk with benefit
A patient has CHF and needs a blood transfusion, will we give them the blood?
▪ pneumonia – we can prevent this by telling them to cough, deep breathing, splinting pain, incentive spirometer
▪ paralytic ileus – r/t pain medication and anesthesia constipation
What are we most worried about post-op for anyone who has had surgery?
BPH (benign prostatic hyperplasia)
Age-associated prostate gland enlargement that can cause urination difficulty.
▪ prostatectomy
▪ TURP
▪ continuous bladder irrigation (CBI)
Treatment: BPH
Continuous Bladder Irrigation (CBI) – we want to see the output as light pink; we don’t want to see clots; color decreases over time
When a patient gets out of surgery for BPH what are we monitoring for?
lymphoma
cancer of the lymph nodes
lymphadenopathy (enlarged lymph nodes)
Most common symptom of lymphoma
Reed Steinberg cells – seen in Hodgkin’s Lymphoma
Difference between Hodgkin’s and NonHodgkins lymphoma
Lovenox (enoxaparin)
What meds do we typically give in the hospital to prevent DVTs?
hemophilia
hemorrhagic stroke
recent surgical procedure
ulcers, any bleeding issues…
Contraindications to blood thinners
ischemia
angina is pain caused from
Keep BP controlled to keep pressure off artery.
If we have a patient with an aortic aneurysm, what do we need to do to prevent aneurysm from growing?
sources;
https://www.gcu.edu/
https://yaveni.com/
https://www.rasmussen.edu/