Download NURS 305 Med Surg Exam Questions and Answers (680 Questions) Update 2023 and more Exams Medicine in PDF only on Docsity!
Questions) Update 2023
CABG - Correct Answer ✅Coronary Artery Bypass Graft
- *Bypass the clot providing other pathway for blood to reach heart
- Take graft from somewhere else in the body*
- Ie. arm or leg (you'll see an incision)
- Ie. Chest wall (no visible incision)
- watch for post-op infection CABG candidates - Correct Answer ✅1. Left main coronary artery disease pts make up 50% of CAGBs
- Proximal 3 vessel disease
- Multivessel disease w/ L ventricular dysfunction
- Angina affects ADLs and is not improved with medication
Questions) Update 2023
- Pt is not a candidate for a PCI (too difficult to access) Sternal Precautions - Correct Answer ✅No pulling or pushing up with arms when transferring No driving for 4 weeks post-operative No shoulder elevation above 90 degrees No lifting more than 10 lbs for 6 weeks following surgery. Pacer Wires - Correct Answer ✅- ASEPTIC wires put directly into the atria and ventricles of the heart during a CABG
- Regulate nodes to stop them from arrythmia/spasming when hands touch the heart during surgery Why might a patient be NPO - Correct Answer ✅- aspiration risk
- fasting before procedure
Questions) Update 2023
Discharge teaching -Knowing how to self administer medications -Preventing whatever brought them into the hospital in the first place -Discuss what new baseline is what is the most common reason for hospitalization in canada - Correct Answer ✅Cardiovascular Disease (stoke, angina, MI, peripheral artery disease/clotting, atherosclerosis) Atherosclerosis - Correct Answer ✅plaque build up in the arteries arteriosclerosis - Correct Answer ✅physical hardening of the artery walls Damage to Endothelial lining in vessels causes... - Correct Answer ✅1. impaired vasodilation = HTN = heart must work harder
Questions) Update 2023
- incr clotting risk
- Incr secretion of GROWTH FACTORS
- Incr oxidation of LDL fats
- Vessel lining becomes less permeable = edema = 'hides' fluid away from normal circulation = decr fluid vol/Bp = bad perfusion) 3 Stages of Development of Atherosclerosis - Correct Answer ✅1. Fatty Streak
- vessel's smooth muscle cells become filled with lipids
- Tx: anticholesterol/LDL drug
- Fibrous Plaque
- smooth muscle cell proliferates (multiplies) and begins the plaque
- pts with CAD cannot self-heal endothelium!
Questions) Update 2023
- Valve disorders, arrhythmias Things that increase O2 DEMAND/consumption - Correct Answer ✅- exercise
- anxiety
- Hyperthyroidism
- hyperthermia
- cardiomyopathy
- arrythmias (if incr HR)
- cocaine!!
- aortic stenosis cardiomyopathy - Correct Answer ✅the term used to describe all diseases of the heart muscle the myocardium, which results in impaired pumping (ie hypertrophy) aortic stenosis - Correct Answer ✅narrowing of the aortic valve opening
Questions) Update 2023
why might someone have perfect coronary arteries, but still have an MI? - Correct Answer ✅Blood loss (internal bleed, whatever)
- high SpO2 but low Hgb levels = all Hgb is saturated well, but there's barely any RBC left = not enough O2 delivered to body What age group do we assess for CAD? - Correct Answer ✅once at 20, then regularly 40- Nonmodifiable Risk Factors for CAD - Correct Answer ✅- gender (men)
- age
- genetics
- ethnicity
- SES
- mental health: stress, depression which gender has a higher risk for CAD? - Correct Answer ✅men, until age 65: then equal
Questions) Update 2023
(6.2+ even when treated: major risk!) Incr HDLs >1.5, decr LDLs <2. Symptoms of Cardiovascular Danger!! - Correct Answer ✅pain fatigue fluid retension arrhythmia dyspnea leg tenderness/redness dizziness/lightheaded lowered LOC arm and jaw pain ppd - Correct Answer ✅pack per day (smoking) Assessing chest pain - Correct Answer ✅- OPQRST
- if history of angina: is it the same or diff as previous pain?
Questions) Update 2023
- what precipitated/started it?
- have you taken nitro and did it work?
- get baseline vitals, and see baseline ECG if patient has been to hospital before
- assess attitude towards health Lab Tests to do on Cardiovascular (MI concern) pts - Correct Answer ✅CMGER (can michelle get each rat)
- Serum Cardiac Markers
- high CK (creatine kinase) indicates general muscle damage
- high CK MB indicates cardiac muscle damage specifically
- troponin
- myoglobin
- C-reactive Protein
- high CRP = inflammation, ie of the vessels or heart
Questions) Update 2023
echocardiography is used to assess - Correct Answer ✅ultrasound of the heart Assesses
- Ventricular Ejection Fraction
- heart MOVEMENT abnormality (dead tissue moves less)
- Valve function
- Checks for thrombus/clots
- Ischemia
- Effusion Pericardial Effusion - Correct Answer ✅accumulation of fluid in the pericardial cavity/sac angiography - Correct Answer ✅dye injected from catheter in femoral artery that goes to heart, x-ray imaging of blood vessels (ie coronary artery) taken assesses:
Questions) Update 2023
- Pressure in atria/ventricles
- Valve functions
- Ventricular function
- Coronary Arteries (blockages etc) Myoglobin vs. hemoglobin - Correct Answer ✅Hgb transports O2 around body Mgb acts as intracellular O2 storage site within the muscles STEMI and NSTEMI stand for - Correct Answer ✅ST elevation Myocardial Infarction Non-ST Elevation MI
- doesn't damage full thickness of myocardium acute coronary syndrome (ACS) - Correct Answer ✅sudden SET of symptoms of insufficient blood supply to the heart
Questions) Update 2023
- zone of injury
- zone of ischemia how long does it take to damage heart muscle from coronary occlusion? - Correct Answer ✅10 mins = hypoxia 20 mins = cell death begins (the heart can survive for 20 mins without O2) 5-6 hrs = full thickness necrosis
- lack of O2 = anaerobic cell metabolism takes over for aerobic = this produces lactic acid = acid irritates myocytes = pain signals sent which has greater cardiac specificity: Troponin or CK MB? - Correct Answer ✅troponin!! Creatinine Kinase (CK) rises within _____ hours, peaks at ___ hours, and returns to normal ______ days after an MI. - Correct Answer ✅rises 3-12 hrs after occlusion
Questions) Update 2023
peaks at 24 hours returns to normal 2-3 days later Troponin rises _____ hours during an MI, peaks at ______ hours, and returns to normal over _____ days - Correct Answer ✅rises within 3-12 hrs (same as CK) peaks 24-48 hours (later than CK) Returns norm over 5-14 days (longer than CK) The P wave represents - Correct Answer ✅atrial depolarization the QRS complex represents - Correct Answer ✅ventricular depolarization (and atrial REpolarization)
Questions) Update 2023
sites 2, 3 and aVF represent which section of the heart? - Correct Answer ✅Inferior (bottom of heart) When looking at V1 - V4 on an ECG, what area of the heart does it represent? - Correct Answer ✅Anterior / Septum (front) When looking at I, aVL, V5, V6, what heart area is it? - Correct Answer ✅Lateral When looking at V1, V2, and V3 on ECG, what does it represent? - Correct Answer ✅the POSTERIOR (back) of heart ST depression - Correct Answer ✅indicates ischemia ST elevation - Correct Answer ✅indicates myocardial infarction
Questions) Update 2023
ST segment elevation or depression is measured - Correct Answer ✅Based on how many mm different it is from the baseline (flat big between P and Q before QRS complex) Normal exercise stress test result? CAD patient result? - Correct Answer ✅Normally: HR will increase, but ECG will look the same CAD: ECG will have DIFFERENT WAVES from exertion!! how to do a stress test on a patient who cant run - Correct Answer ✅give pharmacological stress test: drugs that incr hearts O2 demand Stress Tests are used to assess - Correct Answer ✅- hearts functional ability
- ischemia
- efficacy of procedure/success
