Question 1

A patient is taking Lisinopril 10mg. The nurse knows that the desired effect for this medication would be to?

Accepted Answer

The desired effect of this medication would be to decrease the blood pressure. Lisinopril is an ACE inhibitor drug which decreases blood pressure. Common adverse effects of this drug would include: hypotension, cough, hyperkalemia, headache, dizziness, fatigue, nausea and renal impairment.

Question 2

You are a RN attending to the patients in cardiac ICU. Monitoring of the patients shows the following changes. Which of these patients the nurse should attend first?

Accepted Answer

The nurse should first attend the patient whose monitor shows asystole.'. A monitor showing asystole indicates that the patient has undergone cardiac arrest which may be life-threatening; thus he should be attended to immediately. The patient 'C' is showing Wenckebach which should also be attended soon as he/she is liable to develop cardiac arrest or Stokes-Adams attack. The patient 'A' is having sinus bradycardia which needs attention but is not an emergency. Patient 'D' is having atrial fibrillation with a fast ventricular rate which gives discomfort due to palpitation but is not life-threatening and can be seen later.

Question 3

A cardiac nurse observing the monitor of patients identifies the following findings in the patients. Which of the patient would you attend first?

Accepted Answer

The patient 'A' should be attended to first as new onset ventricular tachycardia after myocardial infarction may be a life-threatening cardiac event. PSVT and acute AF are rarely life-threatening events and can be evaluated and sorted according to their hemodynamic status. Patients with first degree heart block are usually stable and do not need immediate attention.

Question 4

A nurse is caring for a patient on digoxin therapy. It is the responsibility of the nurse to know the signs and symptoms of digoxin toxicity. Which of the following is correct?

Accepted Answer

"Halo effect on vision, ventricular bigeminy, PVC, anorexia" are the correct signs and symptoms of digoxin toxicity. Signs and symptoms of digoxin toxicity include anorexia, bradycardia, halo effect on vision, nausea, vomiting, paroxysmal atrial tachycardia, premature ventricular contractions and ventricular bigeminy.

Question 5

A patient was being treated for congestive heart failure. She is getting ready for discharge with take home medication 40mg furosemide (Lasix) once a day. Which of the following should the nurse include in her teaching plan?

Accepted Answer

The nurse should include the signs and symptoms of hypokalemia in her teaching plan. Lasix is a loop diuretic that prevents the body from absorbing too much salt, allowing the salt to instead be passed in the urine. The patient should be instructed about the potassium-wasting properties of furosemide (Lasix). Patient should be instructed about photosensitivity and how to prevent dehydration. The patient must also be instructed about symptoms of hypotension as this may be an adverse effect.

Question 6

A patient with a history of atrial fibrillation goes to the emergency room with complaints of severe pain in his left lower limb for the last three hours. Now, it has progressed to loss of sensation and feelings of cold and numbness. What is the first action the nurse should take to manage this patient?

Accepted Answer

The nurse should do immediate heparinization with 5000 IU bolus and continuous infusion to maintain PTT > 60. The symptoms of this patient are highly suggestive of acute arterial occlusion.
Management of acute arterial occlusion:
•Immediate heparinization at 5000 IU bolus and continuous infusion to maintain PTT > 60
•In the absence of power and sensation - need emergent re-vascularization: for embolus - embolectomy; (ii) for thrombus - bypass
•In the presence of power and sensation - need work-up - including angiogram: for embolus - embolectomy; (ii) for thrombus - bypass
•Embolectomy: Fogarty catheter tied to fish embolus out of artery
•Bypass: bypass occlusion allowing blood flow to resume to distal site
•Identify and treat underlying cause
•Continue heparin post-op, start warfarin post-op day 1 for 3 months
•Re-perfusion phenomenon
•Toxic metabolites from ischemic muscle --> renal failure and multi-organ system failure

Question 7

The following patients arrived in emergency room and you are the attending cardiac nurse. Assessment of which of the following patients is a priority?

Accepted Answer

Assessment of the 70-year old male patient with left sided chest pain radiating to left arm accompanied by profuse sweating is a priority.. This patient appears to be suffering an acute myocardial infarction and is need of immediate intervention. Patient 'B' is most likely suffering from anxiety disorder and is not serious or life threatening. Patient 'C' is potentially suffering from a myocarditis or pericarditis and does not require urgent attention. Patient 'D' is suffering from angina which is also not an emergency and can be attended after the patient of myocardial infarction.

Question 8

In cardiac emergency you are attending to a 70-year old male patient complaining of acute severe chest pain radiating to left arm for last 2 hours and dyspnea. ECG of the patient was showing ST-segment elevation consistent with acute anterior wall myocardial infarction. Administration of which of the following agents is a priority nursing intervention in this patient?

Accepted Answer

Administering oxygen in this patient is the priority nursing intervention. The correct sequence of treatment for this patient is oxygen, streptokinase, and heparin. A Patient presenting with dyspnea and chest pain should first be administered oxygen inhalation. This patient is suffering from acute myocardial infarction presenting within 6 hours, so he is a candidate for thrombolytic therapy. He should be administered streptokinase followed by heparin. Nitroglycerine may not be needed in this patient.

Question 9

You are working in cardiac ICU as RN and have to take care of patients with cardiac arrhythmia. Which of the following patients will you attend first?

Accepted Answer

Ventricular tachycardia is an emergency condition and may be a life-threatening cardiac event thus needs immediate attention as well as defibrillation. CPR may also be necessary. First degree heart block and AF are rarely life-threatening events. The patient with AF should be evaluated for ventricular rate and attended as needed and sorted according to their hemodynamic status. Patients with myocardial infarction showing occasional ventricular ectopics are usually stable and do not need immediate attention.

Question 10

You have been called by the emergency nurse to help administer IV medication to the following patients. To which of the patient would you consider administering medication first?

Accepted Answer

The medication should be administered first to the 65-year old male patient diagnosed to have pulmonary edema to whom IV lasix (furosemide) is to be given, as this is an urgent case. .. The patient with acute myocardial infarction and should also be attended and given IV morphine urgently. However, he can wait for few minutes. Giving intravenous nitroglycerine is also important but not very urgent. Administering midazolam to a female with anxiety disorder is not urgent and can be attended to later.

Question 11

You are working as RN in cardiac emergency. Which patient would you see first?

Accepted Answer

The patient with a history of deep vein thrombosis presenting with acute onset dyspnea and pink frothy sputum is potentially suffering from pulmonary embolism and needs immediate treatment. Patient 'B' is most likely suffering from angina and needs to be attended promptly. Patient 'C' is suffering from postural hypotension and can be asked to lie down for a while before doing any intervention.

Question 12

You are a RN working in cardiac emergency and have been asked to triage the following patients before the cardiac physician attends to them. Which patient should be seen first by the emergency room physician?

Accepted Answer

The patient presenting with history of giddiness and syncope and showing sinus pause in ECG is the one who should see the cardiac physician first.. She is suffering from sinus arrest and thus is in need of urgent intervention. Patient 'B' is suffering from atrial fibrillation with fast ventricular rate. AF is rarely life threatening, however patients having fast ventricular rate should also be taken care of on urgent basis. Occasional ectopic ventricular beat in a patient of myocardial infarction is not a serious condition and can be attended later. Patient 'D' is suffering from anxiety and can be attended after seeing other patients.

Question 13

A patient with congestive heart failure is receiving digoxin (Lanoxin) and furosemide (Lasix). During the morning rounds, the patient complains of nausea and yellow vision. What should the nurse do first?

Accepted Answer

The nurse should first stop digoxin. The complaints of the patient are similar to digitalis toxicity. The digoxin must be withheld until the level is known. The nurse should check the pulse and record ECG to check the occurrence of any arrhythmias. His serum potassium level needs to be checked urgently and corrected immediately. The patient's serum digoxin level needs to be checked to evaluate the need for further treatment.

Question 14

A nurse should prioritize which of the following patients and provide immediate intervention?

Accepted Answer

The nurse should prioritize the patient with ventricular fibrillation because this is an emergency situation. A fractured shoulder, head trauma and abdominal pain can wait after the patient with VF has been stabilized.

Question 15

A patient is admitted to the emergency department with complaints of giddiness and syncope. His ECG demonstrates frequent sinus pauses. What should be the priority action the attending nurse should take?

Accepted Answer

The priority action by the nurse is to insert IV cannula and prepare isoprenaline for administering to this patient. The patient presenting with frequent sinus pauses definitely needs temporary pacemaker insertion. However, this should not be the first step. The first step should be to insert IV cannula and prepare isoprenaline to administer to the patient. Isoprenaline helps in buying time to prepare the patient for temporary pacemaker insertion. Decision about permanent pacemaker implantation cannot be taken at this moment. Oxygen and IV fluid does not play a significant role in this patient's treatment

Question 16

You are working as a RN in cardiac ICU. You are attending to a patient who is in asystole. What would be the of priority action taken by the attending nurse for this patient showing asystole?

Accepted Answer

The priority action taken by the nurse is to start CPR. CPR is the first step to be taken when a patient is in asystole. Intravenous atropine is often administered while doing CPR. Endotracheal intubation may be done later if needed; it is not required in all patients. A decision about intra-aortic balloon pump insertion is not feasible at this moment.

Question 17

A nurse is assisting a physician in treating a patient with ventricular tachycardia. Which of the following drugs should the nurse anticipate that the doctor would prescribe?

Accepted Answer

The nurse should anticipate that the doctor would prescribe amiodarone. Amiodarone is an antiarrhythmia agent used for various types of tachyarrhythmias, both ventricular and supraventricular (atrial) arrhythmias. Sodium bicarbonate is indicated for metabolic acidosis; dopamine is used for hypotension.

Question 18

You have been asked by the senior nurse to help in administering medication to the following patients, which patient should receive their medication first?

Accepted Answer

The patient to be administered their medication first is the patient presenting with dyspnea diagnosed to have pulmonary edema, which may be life threatening. Thus, furosemide must be given to him urgently. Patient 'A' is presenting with acute exacerbation of asthma which makes the patient distressed so, he is also in need of immediate nebulization. Patient 'C' is having hyperventilation which is not a life threatening condition and can be attended later. Patient 'D' has COPD and is a chronic condition which oxygen therapy can be adjusted a later time.

Question 19

A 42-year old male patient is being discharged from hospital after a mitral valve replacement surgery with a metallic valve. He has been prescribed warfarin. Teaching about which of the following things should be given priority by the nurse?

Accepted Answer

Teaching about using the electric shaver should be given priority by the nurse for this patient. Warfarin is an anticoagulant and one of the major side effects is bleeding. Safety razor involves risk of bleeding through cuts. Missed doses should not be compensated by taking the dose at next scheduled time, as this increases the risk of bleeding. It is not necessary to take this drug before meals.

Question 20

A patient with cyanosis is admitted to the emergency room without a diagnosis. Which of the nursing action is a priority in relation to oxygen administration?

Accepted Answer

The priority nursing action in relation to oxygen administration would be to administer oxygen at 2 liters per minute. Oxygen should not be administered at higher rates because if the patient is emphysemic and receives high flow oxygen, he will develop CO2 narcosis and the respiratory system will cease to function.

Quiz 1: Cardiac Medicine