NUR 421 Final Exam Questions and
Correct Answers
Warfarin (Coumadin) ✅PT/INR
Heparin ✅Aptt
Thrombolytics (TPA) ✅1. Breaks down the clot
2. Used when conventional therapy has failed
3. Contraindicated in Renal patients
4. Has NO ANTIDOTE
5. Increased risk for bleeding
6. Monitor fibrinogen levels (if less than 100 notify MD)
7. Monitor for signs of hemorrhage or intracranial bleeding
8. Good for submissive and Massive PE
9. Clot has to be less than 14 days old
Malignant Hyperthermia Clinical Manifestation ✅1. Muscle Rigidity/Spasms
2. Tachycardia
3. Hyperthermia
4. Dark Urine (coca-cola color)
5. Acidosis
6. Cardiac Dysrhythmias
7. Rapid raise in end rival CO2
8. HTN
9. Hypoxemia
MH Treatment ✅1. D/C Anesthesia and switch to a different one
2. Dantrolene: muscle relaxant that reduces calcium to be released
3. Cold IV fluids
4. Ice packs
5. Make sure SpO2 is greater than 95%
Retained Surgical Instruments Risk Factors ✅1. Patient with high BMI
2. Emergent procedure
3. Unexpected change during the procedure
4. Multiple surgical procedures
5. Staff turnover during the procedure
V-Fib (Ventricular Fibrillation) ✅1. Ventricles are having multiple chaotic impulses that
are firing rapidly
2. Blood is not effectively ejected out of the heart = DECREASED CO
,V-FIB Treatment ✅1. Chest compressions
2. DFIB
3. ACLS
4. EPI
5. AMiodarone
6. Maintain Airway
7. Have IV access for meds
V-Tach (Ventricular Tachycardia) ✅1. With pulse Treatment: Anti-rhythmic medication
(AMiodarone), Electrolyte Replacement, CARDIOVERSION if symptomatic
2. W/O pulse Treatment: CPR, DFIB, ACLS, Maintain airway, EPI
Asystole ✅1. No measurable electrical activity
2. Flat. Line
3. Confirm: Check patient first
4. NOT SHOCKABLE RHYTHM
Asystole treatment ✅1. CPR
2. ACLS
3. EPI
First Degree Block ✅1. Prolonged PR interval of greater than 0.20 sec
2. Usually self-resolving
Second Degree Heart Block : Type 1 Wenckebach (Morbitz 1) ✅1. PR interval gets
progressively long until QRS is dropped
2. Treatment if SYMPTOMATIC: Atropine if HR is less than 60 bpm
Second Degree Heart Block: Type 2 Morbitz 2 ✅1. Has a constant PR interval but
dropped QRS
Third Degree Heart Block (Complete Heart Block) ✅Totally irregular. The P's and the
QRS just don't match up. They are all over the place.
- AV Node is completely blocked
- Treatment: Supportive Care , treat causes, temporary pacing, permanent pacing
IVC Filter ✅- Used to prevent recurrent PE if the patient disqualifies from
anticoagulation therapy
(PVCs) Premature Ventricular Complexes ✅1. Originate in the ventricles
2. QRS = WIDE and BIZARRE
3. Can be unifocal or multifocal
4. Bigeminy ( every other beat)
, 5. Trigeminy (every third beat)
6. NO P WAVE
PJCs (Premature Junctional Contractions ✅1. P wave INVERTED or ABSENT
2. Early impulses from AV node
3. Rarely Symptomatic
4. Causes: Hypoxia, Digoxin Toxicity, Acute MI, Heart Surgery
PAC (Premature Atrial Complex) ✅1. P waves upright in front of QRS
2. Early beat from the ATRIA
3. Common causes: Coffee, Hypoxia, Digoxin Toxicity, Coronary Artery Disease
Atria pacing ✅- Spike is before the p wave
Ventricle pacing ✅- Spike is before the QRS complex
Atria and Ventricle Pacing ✅- Spike before the p and QRS
Arterial line (A-line) ✅1. BP monitoring
2. Inserted in the radial artery
3. NO IV meds given this route
4. Allen test done for placement
Allen Test ✅1. Done before insertion of the Arterial line
2. Ensures the ulnar artery is intact and provides sufficient blood flow
3. Assess Frequently for hand color, temperature, capillary refill
4. Normal color should return in 7- 10 seconds
5. Monitor of S/S of low perfusion
6. If A-line dislodges = loss of large amount of blood
7. Negative ALLEN TEST= Not safe for radial placement
RAP/CVP Monitoring ✅- Checks Preload (Right Atrium)
- CVP of > 6 = fluid overload
- CVP <2 = hypovolemic
PVR (pulmonary vascular resistance) ✅Right side Afterload
POAP (PAWP) ✅Right side pressure and preload of the left side
- When inflated wedge= gets pressure from the left side of the heart
SVR (systemic vascular resistance) ✅Best indicator of left sided afterload
L/R VSWI ✅Measures contractility
Correct Answers
Warfarin (Coumadin) ✅PT/INR
Heparin ✅Aptt
Thrombolytics (TPA) ✅1. Breaks down the clot
2. Used when conventional therapy has failed
3. Contraindicated in Renal patients
4. Has NO ANTIDOTE
5. Increased risk for bleeding
6. Monitor fibrinogen levels (if less than 100 notify MD)
7. Monitor for signs of hemorrhage or intracranial bleeding
8. Good for submissive and Massive PE
9. Clot has to be less than 14 days old
Malignant Hyperthermia Clinical Manifestation ✅1. Muscle Rigidity/Spasms
2. Tachycardia
3. Hyperthermia
4. Dark Urine (coca-cola color)
5. Acidosis
6. Cardiac Dysrhythmias
7. Rapid raise in end rival CO2
8. HTN
9. Hypoxemia
MH Treatment ✅1. D/C Anesthesia and switch to a different one
2. Dantrolene: muscle relaxant that reduces calcium to be released
3. Cold IV fluids
4. Ice packs
5. Make sure SpO2 is greater than 95%
Retained Surgical Instruments Risk Factors ✅1. Patient with high BMI
2. Emergent procedure
3. Unexpected change during the procedure
4. Multiple surgical procedures
5. Staff turnover during the procedure
V-Fib (Ventricular Fibrillation) ✅1. Ventricles are having multiple chaotic impulses that
are firing rapidly
2. Blood is not effectively ejected out of the heart = DECREASED CO
,V-FIB Treatment ✅1. Chest compressions
2. DFIB
3. ACLS
4. EPI
5. AMiodarone
6. Maintain Airway
7. Have IV access for meds
V-Tach (Ventricular Tachycardia) ✅1. With pulse Treatment: Anti-rhythmic medication
(AMiodarone), Electrolyte Replacement, CARDIOVERSION if symptomatic
2. W/O pulse Treatment: CPR, DFIB, ACLS, Maintain airway, EPI
Asystole ✅1. No measurable electrical activity
2. Flat. Line
3. Confirm: Check patient first
4. NOT SHOCKABLE RHYTHM
Asystole treatment ✅1. CPR
2. ACLS
3. EPI
First Degree Block ✅1. Prolonged PR interval of greater than 0.20 sec
2. Usually self-resolving
Second Degree Heart Block : Type 1 Wenckebach (Morbitz 1) ✅1. PR interval gets
progressively long until QRS is dropped
2. Treatment if SYMPTOMATIC: Atropine if HR is less than 60 bpm
Second Degree Heart Block: Type 2 Morbitz 2 ✅1. Has a constant PR interval but
dropped QRS
Third Degree Heart Block (Complete Heart Block) ✅Totally irregular. The P's and the
QRS just don't match up. They are all over the place.
- AV Node is completely blocked
- Treatment: Supportive Care , treat causes, temporary pacing, permanent pacing
IVC Filter ✅- Used to prevent recurrent PE if the patient disqualifies from
anticoagulation therapy
(PVCs) Premature Ventricular Complexes ✅1. Originate in the ventricles
2. QRS = WIDE and BIZARRE
3. Can be unifocal or multifocal
4. Bigeminy ( every other beat)
, 5. Trigeminy (every third beat)
6. NO P WAVE
PJCs (Premature Junctional Contractions ✅1. P wave INVERTED or ABSENT
2. Early impulses from AV node
3. Rarely Symptomatic
4. Causes: Hypoxia, Digoxin Toxicity, Acute MI, Heart Surgery
PAC (Premature Atrial Complex) ✅1. P waves upright in front of QRS
2. Early beat from the ATRIA
3. Common causes: Coffee, Hypoxia, Digoxin Toxicity, Coronary Artery Disease
Atria pacing ✅- Spike is before the p wave
Ventricle pacing ✅- Spike is before the QRS complex
Atria and Ventricle Pacing ✅- Spike before the p and QRS
Arterial line (A-line) ✅1. BP monitoring
2. Inserted in the radial artery
3. NO IV meds given this route
4. Allen test done for placement
Allen Test ✅1. Done before insertion of the Arterial line
2. Ensures the ulnar artery is intact and provides sufficient blood flow
3. Assess Frequently for hand color, temperature, capillary refill
4. Normal color should return in 7- 10 seconds
5. Monitor of S/S of low perfusion
6. If A-line dislodges = loss of large amount of blood
7. Negative ALLEN TEST= Not safe for radial placement
RAP/CVP Monitoring ✅- Checks Preload (Right Atrium)
- CVP of > 6 = fluid overload
- CVP <2 = hypovolemic
PVR (pulmonary vascular resistance) ✅Right side Afterload
POAP (PAWP) ✅Right side pressure and preload of the left side
- When inflated wedge= gets pressure from the left side of the heart
SVR (systemic vascular resistance) ✅Best indicator of left sided afterload
L/R VSWI ✅Measures contractility
