PCCN Flashcards: Coronary Artery Perfusion

Questions and Answers

What characterizes Wernicke's aphasia?

Difficulty understanding language but ability to understand gestures and produce language.

The most appropriate first-line drug for treatment of a seizure is:

Midazolam (Versed)

Phenytoin (Dilantin)

Phenobarbital

Lorazepam (Ativan) (correct)

One complication that the nurse can protect the patient from within the first 24 hours after stroke is:

Aspiration (correct)

Speech abnormality

Decreased level of consciousness

Bleeding

Which of the following options is the most appropriate nursing action for a patient having a generalized grand mal seizure?

Position the patient on his or her side with head flexed forward Signup and view all the answers

Coronary artery perfusion is dependent upon:

Diastolic pressure Signup and view all the answers

What is the most common serious side effect of an ACE inhibitor for a post-STEMI patient?

Swelling of the tongue and face Signup and view all the answers

Which of the following best describes the fourth heart sound (S4)?

It occurs during late diastole when the atria contracts Signup and view all the answers

Which pathologic changes on a 12-lead ECG indicate myocardial ischemia?

ST-segment depression and T-wave inversion Signup and view all the answers

Positive inotropic agents are used to:

Improve cardiac output and tissue perfusion Signup and view all the answers

Which of the following is not considered a contraindication for alteplase use?

Current antibiotic use Signup and view all the answers

The two major components that determine blood pressure are:

Systemic vascular resistance (SVR) (afterload) and cardiac output Signup and view all the answers

The layer of the arterial vessel wall responsible for changes in the diameter of the artery is the:

Media Signup and view all the answers

Which of the following findings correspond to a patient in acute distress with respiratory symptoms?

Pulmonary congestion, low perfusion Signup and view all the answers

When listening to heart sounds, what does S1 signify?

The beginning of ventricular systole Signup and view all the answers

A patient with pulmonary edema has impaired diffusion due to:

Increased thickness of the alveolar capillary membrane Signup and view all the answers

What would the hemodynamic profile assessment of a patient in cardiogenic shock be?

Decreased cardiac index, increased preload, increased afterload Signup and view all the answers

Essential education at the time of discharge for a patient with severe peripheral vascular disease includes:

Smoking cessation counseling Signup and view all the answers

What results from a medication that dilates both the venous and arterial beds?

Decreased preload, decreased afterload Signup and view all the answers

Stable angina is best defined as:

Pain that has a predictable pattern over time Signup and view all the answers

The gold standard diagnostic tool for identifying coronary artery disease is:

Cardiac catheterization Signup and view all the answers

What is the most common complication after a STEMI?

Dysrhythmia Signup and view all the answers

What is the most common cause of heart failure in the US?

Ischemic heart disease Signup and view all the answers

Systolic left ventricular dysfunction is best defined as:

The impaired ability of the left ventricle to contract and effectively eject blood Signup and view all the answers

Neurohormonal responses in heart failure with long-term consequences include:

Increased activation of the sympathetic nervous system and the renin-angiotensin system Signup and view all the answers

Common medications used in the treatment of heart failure include:

ACE inhibitors, beta blockers Signup and view all the answers

What is the heart's primary compensatory response to chronic aortic stenosis?

Left ventricular hypertrophy Signup and view all the answers

Patients with pericardial effusions should be assessed for the development of which complication?

Tamponade Signup and view all the answers

Common causes of hypoxemia include:

Ventilation decreases Signup and view all the answers

The primary cause of hypercapnia is:

Abnormal alveolar minute ventilation Signup and view all the answers

Assessment of the patient with acute respiratory failure should include:

All of the above Signup and view all the answers

The patient goals for acute respiratory failure include:

Improve oxygenation greater than 60 mmHg Signup and view all the answers

The prevention of pulmonary emboli is geared toward prevention of:

Deep vein thrombus formation Signup and view all the answers

One major complication of pulmonary embolus is:

Pulmonary infarction Signup and view all the answers

The most common cardiac complication of post-thoracic (lung) surgery is:

Atrial fibrillation Signup and view all the answers

Which of the following parameters is used as an estimate of alveolar ventilation?

PaCO2 Signup and view all the answers

At which level of FiO2 support is oxygen toxicity thought to develop?

More than 50% for longer than 24-28 hrs Signup and view all the answers

Which of the following is a goal for positive end-expiratory pressure (PEEP) therapy?

To allow reduction in FiO2 support Signup and view all the answers

Which of the following is a complication of mechanical ventilation and positive end-expiratory pressure (PEEP) therapy?

Reduced cardiac output Signup and view all the answers

Pulmonary emboli produce all of the following physiologic changes except:

Left ventricular failure Signup and view all the answers

A patient just admitted to your floor from the PACU is agitated and has tingling of the fingers. ABG on room air reveals: pH 7.49, PaCO2 25, PaO2 95, HCO3 24. Which of the following is correct?

Uncompensated respiratory alkalosis Signup and view all the answers

In preparation for assisting a physician doing a thoracentesis, the patient should be positioned in which of the following manners?

Patient upright and slightly bent forward Signup and view all the answers

Which of the following is a complication after a bedside thoracentesis?

All of the above Signup and view all the answers

Which of the following indicates an active pleural air leak for a patient with a chest tube attached to a pleural drainage system?

Bubbling in the water-seal chamber Signup and view all the answers

Which type of condition can lead to a tension pneumothorax?

Closed pneumothorax Signup and view all the answers

A patient is one day following surgery for peripheral vascular disease. She is increasingly short of breath and develops a low-grade fever, hiccoughs, dyspnea, cough, tachycardia, and chest pain. Which of the following diagnoses is the most likely?

Pulmonary embolism Signup and view all the answers

The most sensitive and one of the earliest indicators of changes in intracranial pressure in a patient who is unresponsive is:

Change in pulse pressure Signup and view all the answers

Nursing interventions in the patient with pericarditis include all the following except?

Administering anticoagulants to prevent thrombus in the pericardium Signup and view all the answers

Which of the following are measures that would improve the cerebral perfusion pressure (CPP)?

Increase mean arterial pressure (MAP) Signup and view all the answers

A patient with a closed head injury has developed a fever of 104F (40C). The nurse understands that an increasing temperature:

May cause increased oxygen requirements of the brain tissue Signup and view all the answers

Epinephrine is indicated as the first-line drug for any pulseless condition because it has the following actions:

Inotropic and selectively shunts blood to brain and heart Signup and view all the answers

With increasing intracranial pressure (ICP), the patient's blood pressure will change. What is the blood pressure response to increasing ICP?

Systolic blood pressure will increase with a decrease in diastolic blood pressure Signup and view all the answers

The most common postoperative complication of coronary artery bypass (CABG) surgery is?

Atrial fibrillation Signup and view all the answers

An NSTEMI is differentiated from unstable angina by?

Cardiac biomarker elevation Signup and view all the answers

What are the signs of Cushing's triad, which indicates increasing intracranial pressure?

Elevated systolic blood pressure, decreased heart rate, widened pulse pressure Signup and view all the answers

After a spinal tap, the patient complains of severe headache, visual disturbances, and nausea. An autologous blood patch may be injected near the puncture site in order to:

Plug the puncture hole in the dura Signup and view all the answers

The nurse auscultates an S3 on a patient just admitted with NSTEMI. What does that indicate?

Fluid overload Signup and view all the answers

The primary function of beta blocker therapy in heart failure is to?

Block compensatory vasoconstriction and increase heart rate Signup and view all the answers

Two months after an ischemic stroke, a patient has difficulty understanding and producing language in speaking, reading, and writing but can understand gestures, pictures, and diagrams. This type of aphasia is:

Global Signup and view all the answers

Which of these is considered a first line drug of choice for acute pulmonary edema?

Oxygen, nitroglycerin, loop diuretics, and morphine Signup and view all the answers

Early symptoms of fluid overload and pulmonary edema are?

Complaint of shortness of breath and orthopnea Signup and view all the answers

What is a therapeutic range for anticoagulation for an elderly patient on warfarin for atrial fibrillation?

INR between 2.5 and 3.5 Signup and view all the answers

Which test would provide the most accurate information to diagnose a myocardial infarction after four days?

Troponin and its isomers (C, I, and T) Signup and view all the answers

What medications would the nurse anticipate for a patient with Type III aortic dissection for blood pressure control?

Metoprolol and lisinopril Signup and view all the answers

In assessing a patient on cyclosporine for antirejection, the nurse should monitor?

Serum creatinine Signup and view all the answers

Which nursing action is correct for a patient complaining of flank pain and showing signs of hypotension after a procedure?

Notify a physician immediately and stop anticoagulation therapy Signup and view all the answers

What is the antidote for warfarin overdose?

Vitamin K Signup and view all the answers

Which of the following increases the risk of abciximab induced coagulopathy?

Recent warfarin therapy Signup and view all the answers

A physiologic reason for sinus tachycardia is?

Tissue hypoxia Signup and view all the answers

What drug can be added to reduce preload in a patient with decompensated heart failure?

Spironolactone (Aldactone) Signup and view all the answers

In a normal heart, a decrease in heart rate should cause the stroke volume to:

Increase Signup and view all the answers

Beck's triad indicates which condition?

Cardiac tamponade Signup and view all the answers

Which condition would stimulate renin production?

Decreased blood pressure Signup and view all the answers

Cardiac ischemia on a 12-lead ECG is characterized by:

Inverted T wave Signup and view all the answers

Symptoms of acute endocarditis of the mitral valve cause?

Symptoms similar to heart failure Signup and view all the answers

With acute arterial insufficiency, the extremity will appear?

Cool with pale color Signup and view all the answers

An atrial septal defect is characterized by:

Shunting of blood returning from the lungs through the left atrium back to the right atrium Signup and view all the answers

Signs and symptoms of acute myocardial infarction may indicate?

Acute ventricular septal defect (VSD) with heart failure Signup and view all the answers

The jugular venous pulse is particularly valuable for assessing:

Right atrial function Signup and view all the answers

Which of the following vasodilators primarily dilates coronary arteries?

Diltiazem Signup and view all the answers

What medication may be helpful in the prevention of rupture of an abdominal aortic aneurysm?

Metoprolol (Lopressor) Signup and view all the answers

Which symptoms are consistent with cardiogenic shock?

Hypotension with systolic blood pressure less than 90 mm Hg Signup and view all the answers

During the treatment of supraventricular tachycardia, which medication is given rapidly intravenous (IV) push?

Adenosine (Adenocard) Signup and view all the answers

Which of the following ECG findings would you anticipate in an inferior wall MI?

Q wave formation and ST segment elevation in leads II, III, and aVF Signup and view all the answers

What possible problem should a nurse suspect if a patient develops shortness of breath after ambulating post-aortic aneurysm repair?

Pulmonary embolus Signup and view all the answers

A thoracic aortic aneurysm causes chest pain that?

Radiates through to the back Signup and view all the answers

The most common new-onset dysrhythmia seen in acute decompensated heart failure is:

Atrial fibrillation Signup and view all the answers

Which of the following is among the important aspects for developing a treatment plan from an arterial blood gas?

pH Signup and view all the answers

The most common ECG changes that occur during pulmonary embolus are?

Tachycardia Signup and view all the answers

The anterior left ventricle receives blood via the?

Left anterior descending coronary artery Signup and view all the answers

After pancreatic resection, what condition could acute shortness of breath indicate?

Acute respiratory distress syndrome Signup and view all the answers

For a patient with acute decompensated heart failure and pulmonary edema, what therapy will be started aside from oxygen therapy?

Diuretic therapy Signup and view all the answers

Patients with occlusion of the right coronary artery are at high risk for the development of Mobitz type I heart blocks because it supplies which part of the conduction system?

Artrioventricular (AV) node Signup and view all the answers

The amount of oxygen delivered to the tissues is determined by what factor?

All of the above Signup and view all the answers

What is the interpretation of an arterial blood gas with pH 7.55 and CO2 28?

Non-compensated respiratory alkalosis Signup and view all the answers

The findings of respiratory failure with a pH of 7.30 and elevated PaCO2 are consistent with:

Respiratory acidosis Signup and view all the answers

When assessing myocardial chest pain, which of the following is not a common characteristic of angina?

Pain that is intermittent and that comes and goes Signup and view all the answers

The major physiologic derangements in acute respiratory distress syndrome include:

All of the above Signup and view all the answers

Signs of venous peripheral vascular disease in the legs include?

Brown pigmentation at the ankles, warm legs, open area over the lateral malleolus Signup and view all the answers

A patient presents with pulmonary edema characterized by tachycardia, hypertension, and cough with frothy sputum. What initial treatments are most common?

Oxygen, nitroglycerin, loop diuretics, and morphine Signup and view all the answers

A hallmark of acute respiratory distress syndrome is:

Refractory hypoxemia Signup and view all the answers

The primary goal in treatment of acute respiratory distress syndrome is to:

Restore oxygenation Signup and view all the answers

The major early signs of respiratory failure include:

Increased respiratory rate, tachycardia, change in mental status Signup and view all the answers

Study Notes

Coronary Artery Perfusion

Dependent on diastolic pressure which creates a pressure gradient for blood flow.
Decreases in diastolic pressure diminish coronary artery blood flow.
Not impacted by systolic pressure, afterload, or systemic vascular resistance (SVR).

Post-STEMI Management

Common serious side effect of ACE inhibitors is swelling of the tongue and face, requiring immediate medical attention.
Nonproductive cough also occurs but is less severe.

Fourth Heart Sound (S4)

Indicates presence of a stiff left ventricle and occurs during late diastole when the atria contract.
Best heard with the bell of the stethoscope and signifies poor compliance, often associated with hypertension and other conditions.

Myocardial Ischemia on ECG

Characterized by ST-segment depression and T wave inversion, indicating subendocardial ischemia.
ST-segment elevation signifies acute injury, while Q-wave formation indicates total infarction.

Inotropic Agents

Used to improve cardiac output and enhance tissue perfusion by increasing myocardial contraction force.

Alteplase Contraindications

Current antibiotic use is not a contraindication; recent abdominal surgery, gastrointestinal bleed, and intracranial bleed are.

Determinants of Blood Pressure

Blood pressure is influenced by systemic vascular resistance (SVR) and cardiac output.
Equation: BP = SVR x cardiac output, maintains BP despite changes in resistance and output.

Arterial Vessel Wall Structure

The media layer contains smooth muscle responsible for controlling arterial tone and diameter changes.

Patient Assessment in Cardiac Distress

Presenting symptoms of pulmonary congestion due to rales, elevated jugular venous distention (JVD), and cool clammy skin denote low perfusion state.

Heart Sound S1

Signifies the beginning of ventricular systole and the opening of aortic and pulmonic valves.

Pulmonary Edema and Impaired Diffusion

Increased thickness of the alveolar-capillary membrane due to interstitial and alveolar edema hinders oxygen diffusion.

Anterior-wall STEMI in Cardiogenic Shock

Hemodynamic profile includes decreased cardiac index with increased preload and afterload due to vasoconstriction.

Education for Peripheral Vascular Disease

Smoking cessation counseling is crucial for improving symptoms alongside medication and walking regimens.

Effects of Vasodilation

Dilation of both venous and arterial beds leads to decreased preload and decreased afterload, impacting hemodynamics.

Definition of Stable Angina

Characterized by a predictable pattern of pain, typically induced by exertion and relieved by rest or nitrates.

Gold Standard for Coronary Artery Disease Diagnosis

Cardiac catheterization is the most reliable method for assessing coronary artery disease's location and severity.

Common Complications Post-STEMI

Dysrhythmia is the most frequent complication, with bradycardia or tachydysrhythmias following different STEMI locations.

Prevalent Causes of Heart Failure

Ischemic heart disease is the leading cause of heart failure in the US.

Systolic Left Ventricular Dysfunction

Defined as impaired ability to contract and eject blood effectively, leading to decreased ejection fraction.

Neurohormonal Response to Heart Failure

Increased activation of the sympathetic nervous system and renin-angiotensin system exacerbates heart failure.

Medications for Heart Failure

ACE inhibitors and beta blockers are essential for treatment, aiding in preload and afterload reduction.

Effects of Chronic Aortic Stenosis

Leads to left ventricular hypertrophy due to the increased workload over time.

Complications of Pericardial Effusions

Assessment for cardiac tamponade is crucial, as fluid buildup can compress the myocardium.

Nursing Interventions in Pericarditis

Focus on pain relief, monitoring for signs of tamponade, and avoiding anticoagulants due to bleeding risks.

Epinephrine in Pulseless Conditions

It is the first-line drug for its inotropic effects, enhancing contractility and redirecting blood flow to vital organs.

CABG Surgery Complications

Atrial fibrillation is the most common postoperative complication, occurring in about 33% of patients.### Postoperative Myocardial Edema
Can lead to atrial stretch, causing electrophysiological abnormalities.
Other complications: bleeding, stroke, ventricular fibrillation; however, these are less common.

NSTEMI vs Unstable Angina

NSTEMI is distinguished by cardiac biomarker elevation.
Both conditions may exhibit similar pain location and ST-T wave depression on ECG.
Unstable angina lacks cardiac enzyme changes, while NSTEMI results in elevated enzyme levels.

S3 Heart Sound in NSTEMI

The presence of an S3 heart sound indicates fluid overload in the left ventricle.
An S3 is abnormal in adults, signaling poor ventricular function.

Beta Blocker Therapy in Heart Failure

Primary function: to block compensatory vasoconstriction and regulate heart rate.
Reduces the actions of the sympathetic nervous system and afterload.

Symptoms of Fluid Overload

Patients may complain of shortness of breath and orthopnea.
Early signs include rales and hypoxia, but these are measured rather than patient-reported symptoms.

Warfarin Therapy in Atrial Fibrillation

Therapeutic INR range for anticoagulation: 2.5-3.5, regardless of age.
INR values less than 1.0 or greater than 4.5 are not therapeutic.

Monitoring Patients on Cyclosporine

Serum creatinine levels should be monitored closely to assess renal function.
Cyclosporine is eliminated through the kidneys and can cause renal injury.

Antidote for Warfarin Overdose

Vitamin K is the specific antidote for warfarin, counteracting its anticoagulant effects.

Sinus Tachycardia Causes

Commonly a compensatory response to tissue hypoxia.
Other triggers include fever and hypovolemia.

Medication to Reduce Preload in Heart Failure

Spironolactone (Aldactone) is an appropriate addition for managing volume overload.
Aldosterone inhibitors help decrease renal sodium reabsorption.

Renin Production Stimulation

Decreased blood pressure triggers renin secretion from the kidneys.
Renin initiation leads to vasoconstriction and sodium/water reabsorption.

Symptoms of Acute Endocarditis

Similar to heart failure, presenting as pulmonary pressure increases.
Requires treatment for both infection and potential heart failure.

Appearance of Extremity with Acute Arterial Insufficiency

Will appear cool and pale due to inadequate blood flow.

Presentation of Acute Ventricular Septal Defect

Following a septal wall infarction, may lead to acute heart failure signs like rales and decreased oxygen saturation.

Medications for Abdominal Aortic Aneurysm

Metoprolol (Lopressor) helps prevent aneurysm rupture through blood pressure management.

Rapid IV Medication for Supraventricular Tachycardia

Adenosine (Adenocard) is administered rapidly and may cause a brief sinus pause.

ECG Findings in Inferior Wall MI

Anticipated findings include Q waves and ST segment elevation in leads II, III, and aVF.

Thoracic Aortic Aneurysm Pain Characteristics

Typically presents as severe chest pain radiating to the back.

Common ECG Changes with Pulmonary Embolism

Tachycardia is a frequent finding, along with the potential for atrial fibrillation.

Anterior Left Ventricle Blood Supply

Supplied by the left anterior descending coronary artery, encompassing the anterior left ventricle and septum.

Risk of AV Node Ischemia with Right Coronary Artery Occlusion

Ischemia of the AV node can lead to Mobitz type I heart blocks.

Factors Determining Oxygen Delivery to Tissues

Oxygen delivery is influenced by cardiac output, hemoglobin levels, and oxygen saturation.

Characteristics of Angina

Typical angina is precipitated by exercise, described as pressure or tightness, and relieved with rest or nitroglycerin.
Intermittent pain that comes and goes is not characteristic of myocardial ischemia.

Signs of Venous Peripheral Vascular Disease

Include brown pigmentation at ankles, warm legs, and ulcers over the lateral malleolus.

Initial Treatments for Pulmonary Edema

Common treatments include oxygen, nitroglycerin, loop diuretics, and morphine for relief and fluid management.

Diagnostic Test for Myocardial Infarction After Days

Troponin levels and isomers remain elevated for up to two weeks and are the most accurate test after an MI.

Blood Pressure Control in Type III Aortic Dissection

Metoprolol (Lopressor) and lisinopril (Prinivil) are first-line medications for managing blood pressure.

Nursing Actions Post-Angioplasty with Flank Pain

Immediate notification of a physician and preparation for potential blood/IV fluid administration in case of a retroperitoneal bleed.

Contraindications for Abciximab Use

Recent warfarin therapy is a contraindication due to the increased risk of induced coagulopathy.### Warfarin Therapy and Abciximab
Abciximab contraindicated for patients with recent oral anticoagulation using warfarin, recent bleeding or stroke in the past 2 years, or a platelet count < 100,000.
Abciximab is used to prevent cardiac ischemia and re-occlusion after procedures like angioplasty and stenting.
It inhibits platelet aggregation and works synergistically with aspirin and low-dose heparin.

Cardiac Output and Heart Rate

Stroke volume increases with a decrease in heart rate due to prolonged filling time in the ventricle.

Beck's Triad

Beck's triad: hypotension, muffled heart sounds, and jugular venous distention (JVD) indicates cardiac tamponade.
Associated symptoms include tachycardia and narrow pulse pressure, signaling low cardiac output.

Cardiac Ischemia on ECG

Inverted T waves are the earliest sign of myocardial ischemia on a 12-lead ECG.
Other signs like ST segment elevation and Q wave development occur later in the ischemic process.

Atrial Septal Defect (ASD)

ASD leads to left-to-right shunt, causing pulmonary congestion and returning oxygenated blood back to the pulmonary circulation.

Jugular Venous Pulse

Valuable for assessing right atrial function; increased pulsations indicate right atrial overload or failure.

Diltiazem in Angina

Diltiazem, a non-dihydropyridine calcium channel blocker, primarily dilates coronary arteries and treats supraventricular tachycardia.

Cardiogenic Shock Symptoms

Characterized by hypotension (systolic BP < 90 mm Hg), tachycardia, dysrhythmias, and tachypnea due to reduced cardiac output.

Postoperative Shortness of Breath

Acute shortness of breath in a postoperative patient may indicate pulmonary embolism, especially after ambulation.

Atrial Fibrillation in Heart Failure

Atrial fibrillation is the most common new-onset dysrhythmia in patients experiencing acute decompensated heart failure.

Importance of pH in Arterial Blood Gas Analysis

pH is crucial for determining compensation and guiding treatment strategies for patients with respiratory or metabolic abnormalities.

Acute Respiratory Distress Syndrome (ARDS)

ARDS presents with acute shortness of breath, bilateral rales, and increased oxygen requirements due to an inflammatory response leading to fluid in the lungs.

Treatment Goals in Respiratory Failure

The primary treatment goal in ARDS is to restore oxygenation and manage associated complications effectively.

Prevention of Pulmonary Emboli

Aimed at preventing deep vein thrombus (DVT) formation, as most pulmonary emboli result from DVT.

Pulmonary Infarction from Emboli

Major complication of pulmonary embolism; occurs when a clot blocks blood flow to parts of the lung.

Common Cardiac Complication in Lung Surgery

Atrial fibrillation often arises after thoracic surgery due to pulmonary pressure changes leading to atrial stretch.

Alveolar Ventilation Estimate

PaCO2 level is a good estimate of alveolar ventilation; increased levels indicate respiratory failure.

Oxygen Toxicity Threshold

Oxygen toxicity can develop when FiO2 exceeds 50% for more than 24-28 hours, leading to complications like atelectasis from decreased surfactant.

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Description

This quiz focuses on the important relationship between diastolic pressure and coronary artery perfusion, a critical concept in cardiovascular nursing. Test your knowledge with questions related to key factors affecting blood flow within the coronary arteries.