Medical-Surgical Nursing Certification Exam REVIEW (Plantz et al.) / 2022
CHAPTER1 CardiovascularPearls ❍ What is the leading cause of death and
... [Show More] disease in the United States?
❍ What is the usual cause of an AMI (acute myocardial infarction)?
❍ What are the risk factors for coronary artery disease that cannot be modified? Gender (males higher risk), family history of heart disease, and increasing age.
❍ A medsurg nurse is discharging a patient who was diagnosed and treated for a heart attack. What are the risk factors for coronary artery disease than CAN be modified or treated to decrease this disease?
❍ What is the number one cause of preventable death in the United States? ❍ What is the most common symptom of aortic dissection?
Interscapular back pain. Classically is a sharp, tearing, severe pain.
❍ What side effect is expected with too rapid an infusion of procainamide?
Coronary artery disease (CAD), where arteries narrow from placques which partially or totally occlude the
coronary artery vasculature.
The coronary arteries develop a thrombus or blood clot formation at the site of a ruptured or narrow placque which
leads to acute symptoms of chest pain (angina), hypotension, and dysfunction of the heart. Treatment is directed at
reopening the artery and medical or surgical stabilization.
Diet (lower fat, salt), hypertension, obesity, diabetes, cigarette smoking, sedentary lifestyle, high levels of
triglycerides and low-density lipoprotein, and stress level (type A personality carries higher risks).
Cigarette smoking. A medsurg nurse, who convinces or assists their patients to stop smoking, does a tremendous
service for the patient and their family.
Hypotension. Other side effects include: myocardial depression, QRS/QT prolongation, V-fib, and torsade de
pointes.
❍ What are the adverse drug effects of lidocaine?
Drowsiness, nausea, vertigo, confusion, ataxia, tinnitus, muscle twitching, respiratory depression, and psychosis.
ECG changes may be seen also.
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2 Medical-Surgical Nursing Certification Examination Review ... ❍
When is dobutamine used in CHF?
❍ When is dopamine selected in CHF?
Vasoconstrictor and positive inotrope, is used to increase cardiac output, especially if shock is present.
❍ Key questions a medsurg nurse should ask patients regarding family history of cardiovascular disorders? Hypertension, coronary artery disease, vascular disease, sudden death (arrhythmia), or hyperlipidemia.
❍ What is sinus tachycardia?
Heart rate greater than 100 beats per minute and every QRS complex follows a P wave.
❍ What is sinus bradycardia?
Heart rate less than 60 beats per minute and every QRS complex follows a P wave.
❍ How is atrial flutter treated?
❍ What are the causes of atrial fibrillation?
❍ How is atrial fibrillation treated?
❍ What are some causes of SVT (supraventricular tachycardia)?
❍ Describe the key features of Mobitz I (Wenckebach) 2◦ AV block.
Potent inotrope with some vasodilation activity, used when heart failure is not accompanied by severe
hypotension. Dobutamine decreases afterload and increases contractility.
Initiate A-V nodal blockade with β-adrenergic or calcium channel blockers or with digoxin. If necessary, in a stable
patient, attempt chemical cardioversion with a class IA agent such as procainamide or quinidine after digitalization.
If such treatment fails, or if patient is unstable and requires immediate electrocardioversion, do so with 25–50 J.
Sedation should be considered prior to electrical cardioversion.
Hypertension, rheumatic heart disease, pneumonia, thyrotoxicosis, and ischemic heart disease are common causes.
Pericarditis, ETOH intoxication, PE, CHF, and COPD are other causes.
If patient is stable then control a fast ventricular rate with diltiazem bolus and/or IV infusion; consider digitalis,
and if indicated, convert with procainamide, quinidine, or verapamil. Synchronized cardioversion at 100–200 J in
an unstable patient requiring cardioversion. In a stable patient with a-fib of unclear duration, anticoagulation for
2–3 weeks should be considered prior to chemical or electrical cardioversion in order to decrease the chance of an
embolic stroke or other embolic problem.
SVT may be due to digitalis toxicity (25% of digitalis induced arrhythmias), pericarditis, MI, COPD, preexcitation
syndromes, mitral valve prolapse, rheumatic heart disease, pneumonia, drug and alcohol abuse.
... CHAPTER1 Cardiovascular Pearls 3
❍ Describe the features and treatment of Mobitz II 2◦ AV block.
Name five causes of mesenteric ischemia.
❍ What is the most common source for acute mesenteric ischemia.
❍ What is Buerger’s disease?
❍ What are contraindications to β-blockers?
❍ What are the three types of angina?
❍ A patient who is day 1 after an acute myocardial infarction (AMI), develops a new loud (4/6) systolic murmur along the left sternal border and pulmonary edema. Diagnosis?
❍ In a patient who has recently suffered an AMI, when would cardiac rupture be expected?
In the first 5 days, post-MI 50% of all ruptures occur, while 90% occur within the first 14 days post MI.
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Buerger’s disease is also called thromboangiitis obliterans, an inflammatory, nonatheromatous occlusive condition
that causes segmental lesions and thrombus formation in medium and small arteries with less blood flow to the
feet and legs, usually in heavy smokers, males in their 20s and 30s; symptoms are usually claudication, pain, cold
feet, eventual redness or cyanosis of legs, may lead to gangrene and amputation.
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Progressive prolongation of the PR interval over several heartbeats seen on the ECG or telemetry trip until atrial
impulse is not conducted, resulting in a skipped beat (QRS complex), then the sequence repeats itself. If
symptomatic, atropine, and possibly transcutaneous/transvenous pacing are indicated.
Constant PR interval. One or more beats fail to conduct interspersed with normally conducted P-waves. More
serious than Mobitz I. Treat with atropine and consider transcutaneous/transvenous pacing.
Arterial thrombosis at sites of atherosclerotic plaques, emboli from left atrium in patients with a-fib or rheumatic
heart disease who are not anticoagulated, arterial embolism most common to the superior mesenteric artery,
insufficient arterial flow, and venous thrombosis.
Arterial embolism 40–50%. Source is usually the heart, most often from a mural thrombus (recent MI often).
Most common point of obstruction is the superior mesenteric artery.
CHF, variant angina, AV block, COPD, asthma (relative), bradycardia, hypotension, and insulin dependent
diabetes mellitus (IDDM). Also, patients with recent cocaine use should not receive β-blockers.
Stable, unstable (has increased in frequency, duration, severity, or quality and occurs with minimal exertion and
rest), and Prinzmetal’s or variant (angina that occurs at rest or during sleep, long after exercise).
Ventricular septal rupture. Diagnosis is confirmed with Swan-Ganz catheterization or echo. Treatment
includes nitroprusside for afterload reduction and possible intra-aortic balloon pump followed by surgical
repair.
4 Medical-Surgical Nursing Certification Examination Review ... ❍
❍ A patient is readmitted to the floor 2 weeks post AMI with chest pain, fever, and pleuropericarditis. A pleural effusion is seen on CXR. Diagnosis?
❍ Can patients be retreated with streptokinase or APSAC? No, because antibodies persist for 6 months.
What is the most common symptom of acute pericarditis?
What physical findings are associated with acute pericarditis?
❍ What are the most common symptoms and signs of PE (pulmonary embolus)?
Dressler’s (postmyocardial infarction) syndrome which is caused by an immunologic reaction to myocardial
antigens.
Sharp or stabbing retrosternal or precordial chest pain, and the pain increases when supine and decreases when
sitting-up and leaning forward. Pain may be increased with movement and deep breaths. Other symptoms include
fever, dyspnea described as pain with inspiration, and dysphagia.
Pericardial friction rub is the most common. Rub is best heard at the left sternal border or apex in a sitting leaning
forward position. Other findings include fever and tachycardia.
Tachypnea (92%)
Chest Pain (88%)
Dyspnea (84%)
Anxiety (59%)
Tachycardia (44%)
Fever (43%)
DVT (32%)
Hypotension (25%).
Syncope (13%)
❍ What is the most common cause of mitral stenosis?
Rheumatic heart disease. The most common initial symptom is dyspnea.
❍ What are the most common causes of acute mitral regurgitation?
❍ What are the two most common causes of valvular aortic stenosis? Rheumatic heart disease and congenital bicuspid valve.
Rupture of the chordae tendineae, rupture of the papillary muscles, or perforation of the valve leaflets. Common
causes include AMI and infectious endocarditis.
... CHAPTER1 Cardiovascular Pearls 5
❍ What triad of symptoms is characteristic of aortic stenosis?
❍ What are the signs and symptoms of acute aortic regurgitation?
❍ What physical findings are characteristic of chronic aortic regurgitation?
❍ What is the most common cause of tricuspid stenosis? Rheumatic heart disease.
❍ What are the two conditions that significantly increase the risk for endocarditis?
❍
Bobbing of the head with systole, bounding carotid pulse (water-hammer), pistol shot sound, the to-and-fro
murmur of Duroziez’s sign over the femoral arteries, and capillary pulsation of the nailbeds (Quincke’s sign).
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Syncope, angina, and left heart failure. As the disease progresses, systolic BP decreases and pulse pressure
narrows.
Dyspnea, tachycardia, tachypnea, and chest pain. Causes include: infectious endocarditis, acute rheumatic fever,
trauma, spontaneous rupture of valve leaflets, or aortic dissection.
Having a damaged heart valve (congenital heart or heart valve disease, rheumatic fever, etc.) or having a prosthetic
heart valve.
... CHAPTER1 Cardiovascular Pearls 6 A loud regurgitant heart murmur or a murmur that has changed in intensity or type.
❍ What are Janeway lesions?
❍ What can a medsurg nurse do to help prevent endocarditis?
❍ Define a hypertensive emergency.
❍ Define a hypertensive urgency.
❍ Define uncomplicated hypertension.
❍ What lab findings would suggest a hypertensive emergency?
❍ In general, how quickly should severe elevations in BP (>210/130) be treated?
Use medications to decrease the diastolic blood pressure 20–30% over 30–60 minutes.
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What is the classic physical sign of endocarditis?
Purple-colored circular flat rashes (macules) on the palms or soles, due to embolic pieces of clot and infected
thrombi that break free of endocarditis and float to the distal circulation in the feet and hands. Other signs
include petechiae of the skin and mucous membranes and splinter hemorrhages under the nails.
Help screen for and identify patients at risk for endocarditis, such as those with heart valve disease or prosthetic
heart valves who are undergoing invasive procedures such as surgery of the GI or GU tract, gynecologic
procedures, childbirth, or dental work. Prophylactic antibiotic administration may be indicated depending upon
the risks involved and likelihood of bacteremia with subsequent endocarditis.
Increased BP with associated end-organ dysfunction or damage. A controlled drop in BP over 1 hour should be
attempted.
BP elevated to dangerous level, typically a diastolic greater than 115 mm Hg. Gradually reduce BP over 24–
48 hours.
Diastolic BP more than 90 but less than 115 mm Hg with no symptoms of end-organ damage. Does not require
acute treatment, but further management and testing is indicated.
UA—RBCs, red cell casts, and proteinuria.
BUN and CR—elevated (renal impairment).
X-ray—Aortic dissection, pulmonary edema, or coarctation of the aorta. ECG—
Left ventricular hypertrophy and cardiac ischemia.
... CHAPTER1 Cardiovascular Pearls 7 What drugs should be used to lower BP in a patient with thoracic aortic dissection?
What drug can be used for all hypertensive emergencies?
❍ What is the most common complication of nitroprusside?
❍ A patient presents with sudden onset of chest pain and back pain. Further work-up reveals an ischemic right leg. Diagnosis?
❍ What physical findings are suspicious for acute aortic dissection?
❍ In a patient with an abdominal mass and a suspected ruptured AAA, what x-ray study should be ordered?
❍ A cyanotic patient has a low oxygen saturation measured on ABG. What type of cyanosis does this patient have?
Central.
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Sodium nitroprusside, propranolol, or labetalol. An arterial line should be considered to closely monitor the blood
pressure.
Sodium nitroprusside (not DOC for eclampsia). Sodium nitroprusside works through production of cGMP which
relaxes smooth muscle. This results in decreased preload and afterload, decreased oxygen demand, slight
increased heart rate with no change in myocardial blood flow, cardiac output, or renal blood flow. Duration of
action is 1–2 minutes. Sometimes, ß-blockade is required to treat rebound tachycardia.
Hypotension. Thiocyanate toxicity with blurred vision, tinnitus, change in mental status, muscle weakness, and
seizures is seen more often in patients with renal failure and after prolonged infusions. Cyanide toxicity is
uncommon, it may occur with hepatic dysfunction, after prolonged infusions, and in rates greater than 10 μg/kg
per minute.
Suspect an acute aortic dissection when chest or back pain is associated with ischemic or neurologic defects. The
dissection progresses and causes occlusion of aortic vasculature such as the iliac or femoral artery resulting in loss
of flow and pulse.
BP differences between arms, cardiac tamponade, and aortic insufficiency murmur.
An abnormal ECG may also be present.
None. They should go to the OR ASAP if fairly certain of the diagnosis. About 60% of AAAs will have
“eggshell” calcifications and thus appear on lateral abdominal x-ray. If time allows, then a bedside ultrasound is
98% diagnostic of AAA but limited ability to detect leakage. Abdominal CT scan is most accurate and assists the
surgeon in identifying optimum treatment.
8 Medical-Surgical Nursing Certification Examination Review ... ❍ What is peripheral cyanosis?
❍ Name the two primary causes (groups) of peripheral cyanosis.
❍ Name the causes of central cyanosis. [Show Less]