NSG 4100- Focused on E3 Cardiac Exam Review Questions and A Level Marking Scheme Latest 2024/2025
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NSG 4100
Institution
NSG 4100
NSG 4100- Focused on E3 Cardiac Exam Review Questions and A Level Marking Scheme Latest 2024/2025
Sinus Tachycardia Nrsg Interventions - correct answer Assess and tx cause
Vagal stim. = bearing down
Withhold drugs which cause tachycardia = Atropine
Monitor for hemodynamic instability
Sinus...
NSG 4100- Focused on E3 Cardiac Exam Review
Questions and A Level Marking Scheme Latest
2024/2025
Sinus Tachycardia Nrsg Interventions - correct answer Assess and tx cause
Vagal stim. = bearing down
Withhold drugs which cause tachycardia = Atropine
Monitor for hemodynamic instability
Sinus Tachycardia Med. Mgmt - correct answer Determined by severity of sx and
directed and ID-ing/removing the cause
Synchronized Cardioversion = low energy (30-60joules) shock synchronized to the QRS
complex [tx of choice]
Ca Channel Blocker: Adenosine
-decreased Ca in SA and AV nodes = decreased HR and AV conduction
Sinus Bradycardia - correct answer <60 bpm
-Slowed impulse generated by the sinus node
SA is the heart's pacemaker with normal rate at 60-100BPM, AV rate is 40-60BPM
-Not tx-ed if pt is asymptomatic
Interpretation Characteristics
• Rate: Less than 60 bpm
• Rhythm: Regular
,• QRS Shape: Normal
• P Wave: Normal and Consistent Shape, always infront of QRS
• PR Interval: 0.12-0.20 seconds
Sinus Bradycardia Etiology - correct answer - Increased parasympathetic activity
- Lower metabolic needs: Sleep, Physically Trained Individuals (lowered O2 demands
d/t peak body performance), hypothyroid
- Vagal stimulation: vomiting, suctioning
- Drugs: Ca Channel blockers (Amiodarone, Nifedipine) Beta blockers (-lol), Lithium,
Histamine blockers, Anti-Depression Drugs, NM blockers, Amphetamines.
-Atropine is 1st line tx for tachycardia but may cause bradycardia
- Increased Stroke Volume (volume of blood ejected with contraction)
- HTN
Medications:
- Adrenergic Receptor (Epinephrine)
- Anticholinergic (Atropine): IV bolus, repeated Q3-5 min until max dose of 3 mg given
- Emergency Transcutaneous Pacing (if meds don't
Work): delivering pulses of electric current through the
Patient's chest, stimulating the heart to contract (Temporary till pacemaker placed)
Atrial Fibrillation (A-Fib) - correct answer • Atrial depolarization are blocked at the AV
Node,
With a few reaching the ventricles and initiating
Ventricular contractions.
• Causes atria to quiver rather than contract forcefully.
,• Completely disorganized and irregular atrial rhythm
Accompanied by an irregular ventricular rhythm of
Variable rate.
Rate: 300-600 BPM (Why B-Blockers are given)
Vent. Rate = 120-200BPM if un-tx
Irregular Rhythym
No discernable P-Wave, irregular, fibrillatory wave
Immeasurable PR interval
Red Flag: High risk for thrombus formation. TEE before cardioversion to ensure that a
clot is not dislodged when pt is shocked.
A. Fib Symptoms - correct answer • Some asymptomatic
• Palpitations/Irregular pulse d/t pulse deficit b/w apical and radial pulse b/c of lowered
diatole and lowered coronary artery perfusion time leads to increased MI risk and
angina.
• Heart Failure
• Shortness of Breath
• Hypotension: Atrium not contracting -> ventricles not filling -> decreased CO and
decrease BP
• Dyspnea on Exertion
• Fatigue
High risk of thrombi formation -> CVA/PE
HF d/t increased cardiac workload
A. Fib Nursing Interventions - correct answer H/P
Stroke risk assessment
Monitor labs (coags and H/H), keep INR b/w 2-3 to decrease risk of stroke/clot
formation
Electrical cardioversion if pt not responding to meds; TEE 1st to monitor for clot/thrombi
b/c it will dislodge once shocked.
A. Fib Treatment - correct answer Prevent emboli events with anticoags, possible
ablation if meds don't work
Electrical Cardioversion: use of electric current to "shock"
Heart back into a normal rhythm for hemodynamically unstable.
Do TEE first to look for thrombi
Pt on warfarin for 4wks d/t decreased atrial function
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