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NSG 430 Exam 2 Practice Test – Community Nursing Focus., Exams of Nursing

NSG 430 Exam 2 Practice Test – Community Nursing Focus.

Typology: Exams

2024/2025

Available from 07/02/2025

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NSG 430 Exam 2 Practice Test –
Community Nursing Focus.
What it acute decompensated heart failure
Exacerbation of chronic heart failure
What are the clinical manifestations of acute decompensated heart failure
Fluid overload, SOB, fatigue
Symptoms of acute decompensated heart failure
Jugular Vein Distension (JVD)
edema
dyspnea
orthopnea
paroxysmal nocturnal dyspnea
N/V
weight gain or loss
hepamegaly
pulmonary rales
cardiac gallops S3 or S4
pleural effusion
What can acute decompensated heart failure lead to
pulmonary edema
What is acute kidney injury (AKI)?
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NSG 430 Exam 2 Practice Test –

Community Nursing Focus.

What it acute decompensated heart failure

Exacerbation of chronic heart failure

What are the clinical manifestations of acute decompensated heart failure

Fluid overload, SOB, fatigue

Symptoms of acute decompensated heart failure

Jugular Vein Distension (JVD)

edema

dyspnea

orthopnea

paroxysmal nocturnal dyspnea

N/V

weight gain or loss

hepamegaly

pulmonary rales

cardiac gallops S3 or S

pleural effusion

What can acute decompensated heart failure lead to

pulmonary edema

What is acute kidney injury (AKI)?

  • Abrupt reduction in renal function with elevated BUN and creatinine and Cystatin C levels (biomarker of kidney function).
  • Usually associated with oliguria (<30 mL/hr or <400 mL/day)
  • GFR decreases
  • Can be reversed if diagnosed and treated early

Types of AKI

Prerenal

Intrarenal

Postrenal

Labs to diagnose AKI

GFR

creatinine

electrolytes (particularly potassium)

Symptoms of AKI

Fatigue, dizziness, swelling, decreased urine output

oliguria (<500 ml urine), azotemia (increased urea in blood)

Interventions for AKI

treat underlying cause of AKI

fluid restrictions

nutrition

-enteral nutrition (low sodium, low potassium, high calcium)

-total parental nutrition (TPN)

medications

Other treatment of bradycardia

transcutaneous pacemaker if acute

Types of cardiomyopathy

dilated, hypertrophic, restrictive

dilated cardiomyopathy

disease of the heart muscle that causes the heart to become enlarged and to pump less strongly

mostly in elderly population

hypertrophic cardiomyopathy

heart muscle becomes enlarged and blocks blood flow

Affects young athletes

restrictive cardiomyopathy

heart muscle hardens, restricting the expansion of the heart, thus limiting the amount of blood it can pump to the rest of the body

most rare

Symptoms of cardiomyopathy

Breathlessness with exertion even at rest, swelling of the legs, ankles and feet, bloating of the abdomen due to fluid buildup, fatigue, irregular heartbeat, dizziness, lightheadedness and fainting.

cardiomyopathy medications

BP meds like beta blockers, ACE inhibitors and ARBS

Digoxin to improve heart contraction effectiveness

Diuretics -- to reduce BP

Blood thinners to prevent clots

acute coronary syndrome (angina)

-- stable resolves with rest

-- unstable does not resolve with rest

Treatment for acute coronary syndrome (angina)

nitroglycerine x 3 before 911

-- MONA

-- Morphine

-- Oxygen

-- Nitro

-- Aspirin 324 or 325 mg

Continuous Renal Replacement Therapy (CRRT)

method used to replace normal kidney function in patients who are hemodynamically unstable by circulating the patient's blood through a hemofilter and returning it to the patient

ICU 1:

endocarditis

inflammation of the inner lining of the heart

Kidney cancer surgery what to watch

-- no urine output -- strict I&O

-- infection -- temperature

kidney stones

renal calculi

Symptoms of kidney stones

colicky flank pain

hematuria

decreased urine output

nausea and vomiting

fever and chills

burning on urination

Priority intervention for kidney stones

pain management

Potassium lab values normal

3.5-5.0 mEq/L

BUN lab values normal

10-20 mg/dL

Creatinine lab values

0.6-1.2 mg/dL

ABG lab values

pH 7.35-7.

PaCO2 32-48mm Hg

HCO3- (bicarb) 22-26 mEq/L

PaOs 80-100 mm Hg

SaO2>95% (seen at 90%)

Base excess +2.0mEq/L

creatinine clearance lab values

Male: 97 to 137 mL/min (1.65 to 2.33 mL/s)

Female: 88 to 128 mL/min (14.96 to 2.18 mL/s).

GFR lab value

More than 90

mitral valve stenosis

narrowing of the mitral valve from scarring, usually caused by episodes of rheumatic fever

Symptoms of mitral stenosis

dyspnea, orthopnea, paroxysmal nocturnal dyspnea, dry cough, hemoptysis as pulmonary edema begins to occur, symptoms of RHF

treatment for mitral stenosis

patient education new pacemaker

--Keep their arm down for the first month

--follow up with cardiology closely,

--take your medications

--keep the site dry and clean

when to seek care if you have a pacemaker

· Dizzy or lightheaded

· Alarm or feel buzzing from pacemaker

· It heart rhythm is not at the paced level

pericarditis

-- bacterial

-- viral

-- fungal

Pericarditis S/S

chest pain worse when lying down, cough, fever, anxiety, FRICTION RUB

PVC (Premature Ventricular Contraction)

Big wide QRS

looks bizarre with what appears to be an extra QRS

Can lead to VTach can be dangerous

Causes of PVCs

--Digoxin toxicity, hypoxia, hypokalemia, fever, acidosis, exercise

--can be caused by caffeine, alcohol, hypertension and thyroid disease

-- check electrolytes especially potassium

PVC symptoms

palpitations or skipped heart beat

PVCs treatment

-None is asymptomatic

-If symptomatic: beta blockers or ablation

-- lifestyle changes

renal transplant

surgical implantation of a donor kidney into a patient with inadequate renal function

Signs of renal transplant rejection

Temperature higher than 100

Pain or tenderness over grafted kidney

2-3 lb wt gain in 24 hours

Edema

HTN

Malaise

Elevated BUN and creatinine

Deceased creatinine clearance

Elevated WBC

Rejection indicated by ultrasound or biopsy

R-region and radiation (where is it, where does it go?)

S-signs and symptoms (SOB, diaphoresis)

T-timing and responses to treatment (when start; better/worse)

Treatment for STEMI

--known as MONA (morphine, oxygen, nitroglycerin, and aspirin).

-- Remember in right ventricular infarctions do not use

nitroglycerin as it decreases preload.

-- anticoagulation such as heparin or enoxaparin.

-- antiplatelet therapy the standard of care is dual platelet therapy; such as, aspirin and clopidogrel.

-- reperfusion therapy

--The goal is door to balloon time within 90 minutes.

STEMI patient education

exercise, no alcohol, no tobacco, no stress

STEMI prescription

Niroglycerine

No ED drugs like Viagra or Cialis

Sinus Tachacardia

rate is above 100

SVT (supraventricular tachycardia)

Increased heart rhythm caused by impulses originating above the ventricles, as in the AV node

-- No discernible P wave

-- Rate 150 +

SVT treatment

-- vagal maneuver

-- Adenosine

SVT causes

-overexertion, emotional stress, deep inspiration, caffeine, tobacco, stimulants

-rheumatic heart disease, dig toxicity, CAD

tachycardia examples

o Patient in sinus tach HR of 120 came in because they are a visitor from out of town and it is June and they went hiking

-- DEHYDRATED

o Patient comes in with a heart rate of 140 who just did coke

-- Tachycardia is from the coke

Vascular access for renal replacement therapy

o AV fistula, temporary dialysis catheter, AV graft

AV fistula assessment

LISTEN to the bruit using a stethoscope to assess blood flow

-A continuous low-pitched bruit should be present.

-If it has disappeared or changed in tone, Notify physician.

unstable or pulseless

CPR

Amiodarone

Defib

Amiodarone (Cordarone)

--Antidysrhythmic agent.

--Prolongs repolarization

--relaxes smooth muscles

--decreases vascular resistance

--prevents conduction of unwanted electrical activity by

decreasing excitability of the heart tissue

IV / PO

For ventricular fibrillation and unstable ventricular tachycardia.

Amiodarone (Cordarone) nursing interventions

--Assess before admin pulmonary toxicity, hyper and

hypo thyroidism

--Monitor electrolytes: potassium, sodium, chloride

--Monitor chest x-ray, PFTs with diffusion capacity,

thyroid function tests

-- Monitor liver function studies: AST, ALT, bilirubin,

alkaline phosphatase

Amiodarone side effects

P eripheral neuropathy

P hotosensitivity

P ulmonary alveolitis

P igmentation of skin

P eripheral conversion of T4 to T3 inhibited (hypothyroid)

Atenolol (Tenormin)

o Beta blocker

o IV

o Evaluate blood pressure and heart rate before and after

o Side effects: hypotension, bradycardia

o Heart rate and blood pressure will decrease

Atropine

o Antidysrhythmic / anticholinergic

o Route IV / IM

o Assess before admin apical pulse, above 60

o Monitor for tachycardia and palpitations urinary retention

o Used to treat VFIB / SVT

o increased heart rate

Atropine side effects

Increased heart rate

hot as a hare

dry as a bone

--Drowsiness

Cardizem

o Calcium channel blocker

o Route PO IV

o Assess before admin

--blood pressure, heart rate, and cardiac monitor

--Assess BUN, Cr and AST, ALT

--Monitor for signs of heart failure, pulmonary

edema, weakness, dyspnea

o Side effects

--Dysrhythmia, edema, HF, bradycardia, hypotension,

palpitations, heart block

-- Decreased angina pectoris, dysrhythmias, B/P

Digoxin

o antidysrhythmic, cardiac glycoside

o Route PO IV

o Assess before admin monitor apical pulse 1 minute before admin > 60

o Side effects

--Dysrhythmias, hypotension, bradycardia, AV block,

Visual changes Headache, drowsiness, apathy,

confusion, disorientation, fatigue, depression,

hallucinations

o Decreased edema, pulse, respiration, crackles, improved contractility

Dobutamine

Beta 1 agonist

o Route IV

o Assess before admin BP and cardiac rhythm, ECG, pulmonary capillary wedge pressure (PCWP), cardiac output, CVP, and urinary output continuously during the administration

o Side effects

--Hypo and hyper tension

--Tachycardia

--Rash / Fever / Anaphylaxis

o Cardiac output increased contractility with decreased

fatigue and dyspnea

Epinephrine

o cardiac stimulant, vasopressor

o Route IV IM

o Assess before admin

--heart rate, cardiac rhythm, and blood pressure

o Side effects

--Palpitations

--Tachycardia & arrhythmias

--HTN

--Headache

--Tremor / weakness

--Pallor Sweating

--N/V

--Nervousness and Anxiety

--Tissue necrosis if it gets on skin

o Vasoconstrictor, cardiac stimulator, bronchodilator

Furosemide (Lasix)

o Loop diuretic

o Route PO, IM, IV

o Assess before admin BP and electrolytes, renal functions