Rasmussen - MDC III - Final Exam With Complete Solution

Rasmussen - MDC III - Final Exam With Complete Solution respiratory alkalosis Correct Answer- high pH, low CO2 pH: 7.35-7.45 acidic-basic HCO3: 21-28 acidic-basic CO2: 45-35 acidic-basic metabolic acidosis Correct ...

Rasmussen - MDC III - Final Exam With Complete Solution respiratory alkalosis Correct Answer- high pH, low CO2 pH: 7.35-7.45 acidic-basic HCO3: 21-28 acidic-basic CO2: 45-35 acidic-basic metabolic acidosis Correct Answer- low pH, low HCO3 pH: 7.35-7.45 acidic-basic HCO3: 21-28 acidic-basic CO2: 45-35 acidic-basic respiratory acidosis Correct Answer- low pH, high CO2 pH: 7.35-7.45 acidic-basic HCO3: 21-28 acidic-basic CO2: 45-35 acidic-basic metabolic alkalosis Correct Answer- 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 Correct Answer- Priority questions...something to consider CPR, press the code button Correct Answer- 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 Correct Answer- 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! Correct Answer- 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) Correct Answer- 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) Correct Answer- 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 Correct Answer- 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 Correct Answer- 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 Correct Answer- 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 Correct Answer- Treatment: *Myocardial Infarction* ▪ CPK ▪ troponin ▪ CK-MB ▪ BNP Correct Answer- Name the cardiac enzymes angioplasty stent the artery angiogram remove clotscardiac catheterization Correct Answer- Procedures: *Myocardial Infarction (MI)* CABG (Coronary Artery Bypass Graft) Correct Answer- Procedure: Patient has an MI and extreme plaque build up pericarditis Correct Answer- inflammation of the membrane surrounding the heart heart can't expand and contract properly (*cardiac tamponade*) Correct Answer- When you have pericarditis what are you at risk for? pleural friction rub Correct Answer- What sounds will you hear in a patient with pericarditis? pericardial effusion Correct Answer- accumulation of fluid in the pericardial cavity Pericardialcentesis Correct Answer- Surgical treatment: *Pericardial Effusion* aneurysm Correct Answer- a localized weak spot or balloon-like enlargement of the wall of an artery Abdominal Aortic Aneurysm (AAA) Correct Answer- Which is the most common aneurysm? ▪ epigastric pain ▪ pulsating in the abdomen - do not push on it! Correct Answer- S/S: *Abdominal Aortic Aneurysm (AAA)* immediately go to the OR for surgery ▪ pain between the scapulas (straight across the back) Correct Answer- S/S: *Thoracic Aortic Aneurysm* monior BP periodically and check the size of it no anticoagulants!!! Correct Answer- Non-emergent thoracic aortic aneurysm interventionselevated BP 3 times in a six month period - documented by MD Correct Answer- How do we diagnose hypertension? ▪ lifestyle modifications (diet, exercise) ▪ record values at home Correct Answer- Patient Education: *Hypertension* ▪ obesity ▪ drugs ▪ alcohol ▪ age ▪ race (hispanic, african american) ▪ high cholesterol ▪ family Hx ▪ elevated LDL, decreased HDL Correct Answer- Risk Factors: *Hypertension* primary - because of the pressure in the arteries only, usually hereditary secondary - r/t kidney problems or other issues Correct Answer- What's the difference between primary and secondary hypertension? ▪ ACE inhibitors ▪ Beta Blockers ▪ ARBs ▪ Calcium Channel lockers Correct Answer- Pharmacological Treatment: *Hypertension* atherosclerosis Correct Answer- plaque builds up on the inner walls of the arteries ▪ Cholesterol ▪ Smoking ▪ Uncontrolled diabetes▪ Uncontrolled HTN ▪ Obesity ▪ Diet ▪ Lack of exercise Correct Answer- Causes of plaque build up arteriosclerosis Correct Answer- hardening of the arteries, happens with age, normal good cholesterol, want it >60 Correct Answer- What is HDL? bad cholesterol, want it <150 Correct Answer- What is LDL? "sugary cholesterol" Correct Answer- What are triglycerides? peripheral arterial disease (PAD) - shiny hairless legs peripheral vascular disease (PVD) Correct Answer- Atherosclerosis and Arteriosclerosis can cause what conditions? ▪ cool hands and feet ▪ bad pedal pulses ▪ leg pain ▪ decreased capillary refill ▪ mottled skin Correct Answer- S/S: *Peripheral Vascular Disease (PVD)* lower extremity doppler Correct Answer- How do you diagnose Peripheral Vascular Disease (PVD)? ▪ anticoagulants ▪ cath lab to have stent placement