NUR-202 Final Exam Review Questions
with Latest Update
Preload - Answer-Volume in the heart before it contracts
Afterload - Answer-The force that the heart is working against
Treatment for decreased preload - Answer-Fluids
Treatment for increased preload - Answer-Diuretics
Low volume causes the HR to ____. - Answer-Increase (tachycardia)
Treatment to decrease afterload - Answer-Vasodilators
Treatment to increase afterload - Answer-Vasoconstrictors
What does valve disease cause? - Answer-Decreased cardiac output
Types of valve diseases - Answer-Aortic Regurg
Mitral Regurg
Aortic Stenosis
Mitral Stenosis
Aortic Regurgitation s/s - Answer-Palpitations, dyspnea, fatigue, angina, tachycardia,
blowing murmur
Mitral Regurgitation s/s - Answer-Fatigue, dyspnea, palpitations, a-fib, neck vein
distention, pitting edema, high pitched murmur
Aortic Stenosis s/s - Answer-dyspnea, angina, syncope on exertion, fatigue, harsh
murmur
Mitral Stenosis s/s - Answer-fatigue, dyspnea, hemoptysis, hepatomegaly, neck vein
distension, pitting edema, a-fib, rumbling diastolic murmur
CABG: nursing care - Answer-Done to increase perfusion to heart due to a blockage.
Patient will come back with chest tubes and pacer wires. Will have post-op pain; we
need them to participate in care after (I.S. d/t risk PNA, encourage ambulation). The
patient should not come back with an arrhythmia!
Post-CABG Drainage Expected - Answer-Up to *150 ml/hr* if mediastinal tube (if none,
think about tamponade) (if more than 175 ml/hr, call doc)
, Pericarditis - Answer-Chronic vs acute. Will have pain that improves when sitting
forward. NSAIDs help to decrease inflammation around sac. Pericarditis increases risk
for pericardial effusions. May hear pericardial rub.
Pericardial Effusions - Answer-Fluid leaking into sac; risk for tamponade
Cardiac Tamponade - Answer-S/S: hypotension (sac filling with fluid and CO
decreases), increased pressures in heart --> JVD, dyspnea, muffled heart tones. Can
be at risk after cardiac surgery.
Aortic Aneurysms - Answer-Typically pain free until pressing on surrounding organs.
Class most at risk for aneurysms is HTN, smokers, DM, artherosclerosis due to weaker
vessels. Can be thoracic (upper back pain), abd (abd pain or lower back pain). S/s that
aneurysm getting larger: pain, pulsating, hoTn, dissecting causes excruciating pain (and
would have s/s hypovolemic shock if dissecting). Tx is graft - for abd aortic repair, it's
between renal and femoral arteries, so if it shifts down, it can occlude lower extremities.
If it moves up, it can block renal arteries. Don't bend or lift post op to prevent graft
moving.
Cardiac output formula - Answer-HR x SV
Tx for fast rhythyms - Answer-BBs, adenosine (for SVT), CCBs. If unstable: cardiovert
Tx for slow rhythyms - Answer-Atropine, pacemaker.
Pulseless patient care - Answer-FIRST - do CPR, defibrillator. AED is used when the
patient is pulseless. Checks the rhythm to see if shockable.
Permanent Pacemakers - post-op instructions - Answer-No arms above shoulders, no
heavy lifting, keep HR diary (HR should not drop below set rate - pt to notify if it does).
Don't get the incision wet. No pressure over the pacemaker, especially until healed.
Never turned off - can't be turned off.
Temporary Pacemakers - nursing care - Answer-External. Painful! Sedate patient. Only
used until transvenous or perm done.
Shock Patho - Answer-Massive vasodilation. Not enough O2 delivery to tissue. Cells
start to die d/t hypoperfusion. There is anaerobic metabolism causing lactic acid to build
up. Acidotic process. MAP is decreased.
Hypovolemic Shock - Answer-We need volume!
Cardiogenic Shock - Answer-It's a pump problem. There is enough volume.
What are the 3 distributive shocks? - Answer-Neurogenic, Anaphylactic, Septic Shocks
