2021 HESI Critical Care Final Exam - 100

2021 HESI Critical Care Final Exam - 100 % Correct Questions and Answers Included - Passed - A+ Rated Guide Critical care HESI – 55 questions • Cardiac

o SVT: supraventricular tachycardia

▪ No p waves seen

▪ Treatment:

• Adenosine – give 6mg, then 12mg, then another 12mg • Cardioversion if pt not tolerating rhythm • Don’t defibrillate!!!▪ Have someone bring crash cart to room

o Atrial fibrillation:

▪ Chaotic atrial activity ▪ Irregularly irregular

▪ Controlled: vent rate < 100

• On digoxin at home and has controlled a fib look at digoxin level

▪ Uncontrolled: vent rate > 100

▪ P waves are fibrillatory ▪ High risk for clots give anticoagulant ▪ Common in elderly

▪ Holiday heart syndrome: alcohol and emotional stress

o Atrial flutter:

▪ Ventricular rhythm stays regular ▪ Sawtooth waves ▪ Cardiovert!

o Asystole: flat line

▪ Patient is essentially dead ▪ Give CPR and epi ▪ Pulse is gone ▪ Patient in asystole for 20 minutes talk to family, patient is dead

• 3

rd degree heart block ▪ Look at patient’s blood pressure, bradycardia ▪ Give atropine, epinephrine, pacemaker

• Alcoholic EKG

▪ Wide QRS and flat T = life threatening ▪ Flat T means hypokalemia

• Peaked t waves are usually from hyperkalemia

o STEMI: ST elevation myocardial infarction

▪ Give thrombolytics within 4 hours of onset

• MI vs. Indigestion

▪ Classic symptoms of MI: dull chest pain radiating down left arm

▪ Women, elderly, pt’s with hx of DM may not have classic

symptoms, instead:

• N/V

• Belching • Indigestion • Diaphoresis 1 / 2

• Dizziness • Fatigue

o New nurse on cardiac unit:

▪ Assign pt with sinus arrhythmia going for a stress test

▪ Don’t assign:

• Torsades • V tach • V fib

• Pulmonary artery catheter insertion, swan insertion

▪ Priority is monitoring the pressures ▪ When it gets into right ventricle watch for arrhythmias ▪ Sterile field

• Hand is cold and decreased capillary refill – call physician because clot may be

forming, don’t do an Allen test

• Radial artery line and pt has decreased cap refill call the physician
• Hemorrhagic stroke

▪ Do not give tPa!!!

• Ischemic stroke

▪ Look at BP before giving alteplase

• Cardiac tamponade

▪ Muffled heart sounds ▪ Jugular venous distention ▪ Hypertension

▪ Tx: pericardial centesis

• Vasodilation medications

▪ Morphine ▪ Lidocaine

• Dopamine

▪ Vasopressor and will increase BP ▪ Increases renal flow at low doses ▪ So if low dose renal dose • Increases vasodilation of artery no higher than 5 mcg/kg/min

o DIC: first sign is often gums bleeding

▪ PT/INR

• Heart failure

▪ BNP should be less than 100, if it’s over 100 it’s indicative of heart failure, lung dysfunction

• Pacemaker is firing and nothing is happening

▪ Look at sensitivity/sync mode of pacemaker, possibly increase rate

o IABP: intraaortic balloon pump

▪ Pt condition is improving with IABP when you see a decreased wedge pressure, and an increased cardiac output

o CVP: for monitoring

▪ Need transducer hooked up and at phlebostatic axis

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