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Questions and Answers
Questions and Answers
When a patient is experiencing angina, the nurse administers nitroglycerin sublingually at what frequency?
When a patient is experiencing angina, the nurse administers nitroglycerin sublingually at what frequency?
every 5 minutes, maximum 3 doses
When administering medication to a patient with suspected myocardial infarction (MI), which of the following are beneficial effects of morphine? (Select all that apply)
When administering medication to a patient with suspected myocardial infarction (MI), which of the following are beneficial effects of morphine? (Select all that apply)
- Decreases afterload (correct)
- Decreases preload (correct)
- Decreases anxiety (correct)
- Increases heart rate
Which of the following are cardiac markers assessed in the patient experiencing angina or potential myocardial injury? (Select all that apply)
Which of the following are cardiac markers assessed in the patient experiencing angina or potential myocardial injury? (Select all that apply)
- Troponin (correct)
- CK-MB (correct)
- Creatinine
- Hemoglobin
What does ST elevation on the 12-lead ECG typically indicate?
What does ST elevation on the 12-lead ECG typically indicate?
Which factors may increase a patient's risk of developing coronary artery disease? (Select all that apply)
Which factors may increase a patient's risk of developing coronary artery disease? (Select all that apply)
Which of the following are typical signs and symptoms exhibited by patients with angina? (Select all that apply)
Which of the following are typical signs and symptoms exhibited by patients with angina? (Select all that apply)
Why is aspirin administered to a patient with suspected myocardial infarction?
Why is aspirin administered to a patient with suspected myocardial infarction?
What characterizes ventricular fibrillation (V fib)?
What characterizes ventricular fibrillation (V fib)?
According to the AHA guidelines for adult CPR, what is the correct compression: ventilation ratio and rate per minute?
According to the AHA guidelines for adult CPR, what is the correct compression: ventilation ratio and rate per minute?
According to American Heart Association guidelines, epinephrine 1 mg administered for ventricular fibrillation after the second defibrillation is true.
According to American Heart Association guidelines, epinephrine 1 mg administered for ventricular fibrillation after the second defibrillation is true.
When a patient is to receive defibrillation, which safety measures should be implemented? (Select all that apply)
When a patient is to receive defibrillation, which safety measures should be implemented? (Select all that apply)
If peripheral IV access cannot be established during cardiac arrest, what access should the nurse consider for rapid medication delivery?
If peripheral IV access cannot be established during cardiac arrest, what access should the nurse consider for rapid medication delivery?
Which cardiac risk factors were identified specific to Carl Shapiro? (Select all that apply)
Which cardiac risk factors were identified specific to Carl Shapiro? (Select all that apply)
During CPR, how often should the nurse assess the carotid pulse for return of spontaneous circulation (ROSC)?
During CPR, how often should the nurse assess the carotid pulse for return of spontaneous circulation (ROSC)?
If Carl Shapiro had proceeded into asystole after ventricular fibrillation, continuing to defibrillate would have been the appropriate intervention.
If Carl Shapiro had proceeded into asystole after ventricular fibrillation, continuing to defibrillate would have been the appropriate intervention.
What is the next drug the nurse should expect to administer to a patient in ventricular fibrillation after epinephrine?
What is the next drug the nurse should expect to administer to a patient in ventricular fibrillation after epinephrine?
If administering vasopressin, what dosage would the nurse expect to administer?
If administering vasopressin, what dosage would the nurse expect to administer?
When the nurse discovers a patient is not visibly breathing, what is the immediate priority?
When the nurse discovers a patient is not visibly breathing, what is the immediate priority?
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Study Notes
Study Notes
Angina Management
- Administer nitroglycerin sublingually every 5 minutes, up to 3 doses for acute angina.
- Nitroglycerin alleviates angina symptoms by dilating coronary arteries.
Morphine Use in Myocardial Infarction (MI)
- Morphine provides pain relief, reduces anxiety, and decreases preload and afterload.
- Monitor patients for side effects like hypotension and respiratory depression.
Cardiac Markers for Myocardial Injury
- Troponin and CK-MB are key cardiac markers for diagnosing MI.
- CK-MB is specific to heart muscle; CK-MM relates to skeletal muscle.
ECG Indicators
- ST elevation on a 12-lead ECG indicates myocardial injury and affects ST segment and T-wave.
Risk Factors for Coronary Artery Disease (CAD)
- Modifiable risk factors: cigarette smoking, metabolic syndrome.
- Non-modifiable risk factors: family history of CAD and age (>55 for women).
- Metabolic syndrome is defined by the presence of insulin resistance, central obesity, dyslipidemia, high blood pressure, and elevated C-reactive protein levels.
Symptoms of Angina
- Typical signs include substernal chest pain, shortness of breath (SOB), and diaphoresis.
- May also present with weakness, nausea/vomiting, and emotional denial.
Aspirin for Suspected MI
- Immediate administration of aspirin to prevent platelet aggregation in suspected MI patients unless allergic.
Ventricular Fibrillation (V-Fib)
- Characterized by irregular rhythm, a rate >300 bpm, and absence of recognizable QRS complexes.
CPR Guidelines
- Recommended compression to ventilation ratio is 30:2 at a rate of at least 100 compressions per minute.
- Epinephrine is administered for V-Fib after the second defibrillation every 3-5 minutes.
Defibrillation Protocol
- Ensure safety by clearing the bed, not having objects touch the bed, and removing supplemental oxygen to prevent fire hazards.
IV Access During Cardiac Arrest
- Intraosseous (IO) access is preferred when peripheral IV access fails, allowing for medication delivery without interrupting CPR.
Cardiac Risk Factors Specific to Carl Shapiro
- Identified risk factors include hypertension (HTN), cigarette smoking, and obesity.
- Non-modifiable factors include age, gender, and family history, while modifiable factors also encompass hyperlipidemia and physical inactivity.
Assessing for Return of Spontaneous Circulation (ROSC)
- The carotid pulse should be assessed every 2 minutes during CPR.
Asystole Intervention
- Continuing defibrillation is not appropriate if asystole occurs after V-Fib.
Pharmacological Protocol After Epinephrine
- Amiodarone is the next drug expected to be administered at 300 mg, with an additional 150 mg if necessary.
Vasopressin as Alternative to Epinephrine
- Administer 40 units of Pitressin (Vasopressin) intravenously/intraosseously in place of the first or second dose of epinephrine.
Immediate Action for Non-Breathing Patients
- Assess the carotid pulse immediately; if absent, begin chest compressions and initiate a code.
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