Hi guys, it's me Professor D and welcome back to my YouTube channel. On this video we're going to be covering cardiovascular disorders and we're going to zoom in on priority and delegations in regards to the cardiovascular disorder. So before we guys, before we guys, before we even get started guys, if you haven't done so already please be sure to like and subscribe below. Don't forget to go ahead and add me on your Instagram and TikTok, my handle is still the same, Nexus Nursing. Okay guys, without any further ado, let's get started.
First question. The nurse on the cardiac unit has received a shift report from the outgoing nurse. Which client should the nurse assess first?
One, the client who's just been brought to the unit from the emergency department with no reports of pain, excuse me, no reports of complaints. Two, the client who received pain medication 30 minutes ago for chest pain that was a level three on a one to 10 pain scale. Three, the client who had a cardiac cath in the morning and has palpable pedal pulses bilaterally. Or four, the client who has been turning on the call light frequently and stating her care has been neglected.
And guys, the first patient that you're going to see is number one. Don't be fooled when they tell you the patient doesn't have any complaints. They have not been assessed yet. And until you assess that patient, you have to assume that patient's unstable.
This patient's coming from the emergency department. We don't know what's going on with the patient except that they're not complaining of distress, but we have not assessed them yet. So that's the first patient who needs to be assessed because they haven't been assessed yet. Look at our other choices.
Choice two is a patient who had pain that was only a level three. and we gave them medication 30 minutes ago yes we have to go back and reassess to evaluate did the pain medication work but it's not a priority at least they were assessed choice number three patient just had a cardiac cath now remember after cardiac cath you always want to palpate the extremities because you want to make sure that the patient has a pulse in the lower extremities and the peripheral extremities you want to make sure that blood is circulating and look what it says the palpito pulse is palpable. So all the way down to the tips of their toes, where the foot is, that patient has circulation on both extremities.
So that's good. Okay. And choice number four, if that client has the energy to complain, they're not dying because all they're doing is complaining that their care is being neglected.
So yes, you have to go in and check with that patient, ask them, Hey, what's going on? What's being neglected. But Okay.
they're still stable. They're stable enough to be complaining that they're being ignored. But choice number one, that client who you have not seen yet, you have no idea what's going on with them, you have to assume they're stable until you assess them.
And that's why number one is the correct answer. All right. The nurse on the cardiac unit is preparing to administer medications after receiving the morning change of shift report.
Which medication should the nurse administer first? One, cardiac glycoside to the client with an apical pulse of 58. Two, loop diuretic to a client with a serum potassium of 3.2. Three, anti-dysrhythmic to a client in V-fib. Or four, a calcium channel blocker who had a blood pressure of 110 over 68. And the med that you're going to get first, guys, is number three, the anti-dysrhythmic to a client and V-fib.
V-fib is a medical emergency, guys. That patient is going to need their amiodarone or their lidocaine ASAP, okay? Whenever you get a question on what patient you're going to see first, who are you going to assess first, which medication you're going to get first, what they're really asking you, which one is the priority, which one can potentially kill the patient the fastest if they don't get it or they do get it depending on the situation that's provided. right so in for these set of questions number three by far that's a medication you're going to give first because that's the one that's life-threatening now let's look at our other choices choice number one cardiac glycoside to a patient with an apical pulse of 58 really so you mean to tell me that patient has an apical pulse less than 60 and you're gonna go get give them digoxin where Absolutely not.
Absolutely not. Remember, if that patient's apical pulse is less than 60, you are not going to give that cryoglycoside. You're not going to give that med. You're not going to give that dish.
You're going to hold that med and call the doctor and say, hey, I noticed you ordered this, but the patient's apical pulse is 58. I've withheld the medication. What do you want to do next? Okay?
So that's right. Choice two, giving a loop diuretic to a potassium level of 3.2. All right, guys, your potassium level is 3.5 to 5. Very narrow therapeutic range, 3.5 to 5. Patient with a potassium of 3.2, they are hypokalemic. So you mean to tell me a patient that's hypokalemic, that's hypo-kalemic, that already does not have enough potassium, you're going to go ahead and give them a loop diuretic that will make them lose potassium?
Does that make any sense? Absolutely not. You're not.
not going to do that. And then the last one, a calcium channel blocker to a patient of 110 over 68. So you can give the calcium channel blocker because it's higher than your 90 over 60. Absolutely. But this patient isn't going through hypertensive crisis.
That blood pressure is so high that you have to give that medication right away or they're going to die. But that patient is going through V-fib. If you don't give them that lidocaine or that amiodarone right away, absolutely, their heart can stop and they can die. So that's why choice number three is the correct answer. Which client should the tele-nurse assess first after receiving the morning shift report?
And guys, the correct answer is 4. That patient that has CHF and they have pink frothy sputum. Is pink frothy sputum an expected sign and symptom of CHF? No. What do we see pink frothy sputum in? We see that in pulmonary edema, okay?
Pulmonary edema is a complication of congestive heart failure. So we see that pink frothy sputum. What does that let us know?
That lets us know our patient's getting even worse. So this is the patient that we're going to see right away. Choices one, two, and three, those signs and symptoms that you see are expected signs and symptoms of the diagnosis. So for example, number one, we expect the patient to have an edematous calf when they have the DVT. Number two, we expect the patient to have heart palpitations when they have...
uh mitral valve stenosis number three we expect the patient to have intermittent claudication when they have arterial occlusive disease we don't want them to have those signs and symptoms but those are expected signs and symptoms of what they've been diagnosed with but for number four no pulmonary edema is not a sign of symptom of congestive heart failure that chf has gotten worse and now fluid is spilling into that patient's lungs and we have to address that right away The charge nurse is making assignments for clients on the cardiac unit. Which client should the charge nurse assign to a new graduate nurse? 1. The 44-year-old client diagnosed with MI. 2. 65-year-old client admitted with unstable angina.
Whenever you guys get a question on which patient would you give the graduate nurse, what they're really asking you is which patient is the most stable patient. Which patient would you treat as the LPN? Because remember, you only give the LPN the most stable patient. Same thing with new grad.
Yes, they may be an RN, but if they are a new RN, you're going to treat them like an LPN in the sense that you are always going to give them. the most stable patient because they don't have the experience yet to understand, you know, all of the signs and symptoms they need to be looking for to make sure the patient's not declining. They don't really know everything that they have to teach the patient.
So that's why you're going to treat them as an LPN and give them the most stable patient. So on this list, that patient that's going for cardiac cath, we don't even know why they're going for cardiac cath. All we know is they're going for cardiac cath. They are the most stable patient out of everybody else.
We have an MI, an... stable, so you know they're not stable, unstable angina, and of course chest pain. Those patients are not stable.
Next question. The charge nurse is making assignments for a 30-bed cardiac unit staffed with three registered nurses, three licensed practical nurses, and three unlicensed assistive personnels. Which assignment is most appropriate by the charge nurse? 1. Assign an RN to perform all steroid procedures. 2. Assign an LPN to give all IV medications.
The UAP can do morning care. They can do ADLs. They can brush the teeth. They can braid the patient.
They can brush your hair. Look at one. Assign an RN to perform all sterile procedures. Guys, remember in my video I did teaching you how to pass the NCLEX, I told you guys to stay away from all inclusives.
Words like all, only, never. Stay away from those unless you know that you know that you know that's the answer. Why aren't we going to give the RN? all the sterile procedures because you have LPNs. LPNs can do sterile procedures.
So why are you going to give that to the RN to do all the sterile procedures? It makes no sense. Choice number two, assign the LPN to give all IV medications. Why can't we do that? LPNs can give IV medications.
Yes, they can. But you want to know what kind of IV medications they can't give? They can't give piggybacks.
They can't give pushes. They can't give central lines. So we're not going to give the LPN all.
IV medications. Choice number four, assign the LPN to write care plans. Can LPN write care plans? No. They can follow the care plan, but writing the care plan is the responsibility of the RN and the RN alone.
So the only correct answer here is number three. The nurse on the cardiac unit is discussing a client with the case manager. Which information should the nurse share with the case manager? One, discuss personal information the client shared with the nurse in confidence.
Two, provide the case manager with any information that's required for continuity of care. 3. Explain that the client confidentiality prevents the nurse from disclosing information. Or 4. Ask the case manager to get the client's permission before sharing information. And guys, the correct answer is 2. Provide the case manager with any information that's required for continuity of care.
That's the job of the case manager, continuity of care to make sure that the patient doesn't fall between the cracks, to make sure when this patient is getting discharged, they have the home health that's been ordered and home health has been set up. The nurse is ready to go the very next day that the DME has been ordered. The DME is waiting for the patient at the house, that everything that the patient needs is ready to go and everything is scheduled.
That's what continuity of care is. So the patient does not fall in between the cracks. And. You're going to provide any information that will help with that continuity of care.
You're going to give that to the case manager so that they can do their job. The nurse assesses erratic electrical activity on the tele-reading while the client is talking to the nurse on the intercom system. Which tasks should the nurse instruct the UAP to implement? One, call a code blue immediately.
Two, check the client's telemetry leads. Three, find a nurse to check the client. Or four, remove the tele-monitor.
And guys, the correct answer is check the client's tele-leads. Listen, it says that the nurse is talking to the client. So obviously that client is not coding.
They're talking, okay? So if they're talking to the client, but the nurse looks at the leads and she sees erratic activity, most of the time, likely it's what? One of the leads fell off.
You send the UAP to go look at the lead. You're not going to send the UAP to go look for a nurse to go. All you're doing is delaying care when you do that. Just send them to go look at the lead. Okay.
Obviously that patient is not coding because they are talking to the nurse. So that's why number three is the correct answer. The charge nurse on the cardiac unit has to float a nurse to the emergency department for the shift.
Which nurse should be floated to the emergency department? One, the nurse who has four years of experience on the cardiac unit. Two, the nurse who has just transferred from critical care to the cardiac unit. Three, the nurse with one year of experience on the cardiac unit who has been on a week's sick leave.
Or four, the nurse who has worked in the operating room for two years. two years and in the cardiac unit for three years. And guys, the correct answer is two. The nurse who just transferred from the critical care unit to the cardiac unit. Whenever you guys get a test question asking you who you're going to float, You're always going to choose the nurse that has a background that's similar to where you have to float them to.
So if you look at this question, you're floating the nurse to where? The emergency department where patients are not stable. They're in critical condition. They're bad.
They're not stable. That's why they're in the emergency department. So that's why you're going to choose to the nurse that came from where? The critical care unit. She's used to dealing with patients who are not stable, who are severely unstable.
physiologically speaking. So that's why you're going to choose the nurse that has that critical care background versus the other nurses. Next question.
The client is in the cardiac intensive care unit on dopamine, a vasoconstrictor, and the blood pressure increases to 210 over one. 30. What intervention should the ICU nurse implement first? 1. DC the vasoconstrictor, dopamine.
Don't choose the answer that says assess. Here's why. obviously you assess enough to know that that infusion is harming the patient so the next thing you're going to do is intervention which is stopping that infusion that's the first thing you're going to do okay notifying the doctor you can do that afterwards and administering vasopressor hydrolysis, no assessed neurological status.
You can do that later. Matter of fact, after you stop that IV infusion, then you're going to assess your patient. Because with the blood pressure that high, that can cause the patient to have a stroke, right?
So then you're going to assess your patient, especially do the neural, make sure they didn't have a stroke. Then you call the doctor. Because when you call the doctor, you're able to tell the doctor, I stopped this medication because the blood pressure was high.
And here's what the patient looks like. Here are the vitals. Here's the patient's neurological status.
And you only know that. if you assess the patient before you call the doctor. So that's why you're going to stop whatever is offending the patient, then assess the patient, then call the doctor with your findings and await further instructions. The charge nurse is making the client assignments on the cardiac unit, on the, excuse me, on the cardiac critical care unit.
You guys know I can't speak. Which client should be assigned to the most experienced nurse? 1. The client with acute rheumatic fever, carditis, who does not want to stay on bedrest.
That is a medical emergency. That is a medical emergency. That is a life-threatening emergency.
This patient is not stable. You're going to give that to the most experienced nurse. The nurse is administering medications to clients on the cardiac critical care area. Which client should the nurse question administering the medication? One, the client receiving calcium channel blocker who's drinking a glass of grapefruit juice.
Two, the client receiving beta blockers who has apical pulse of 62 beats per minute. Three, the client receiving NSAIDs who just finished eating breakfast. Or four, the client receiving an oral anticoagulant who has an INR of 2.8.
And guys, the correct answer is one, the client that's getting calcium channel blocker and they're drinking grapefruit juice. Guys, that grapefruit juice will cause the liver to not metabolize the drug like it's supposed to, and it can cause the patient to have a toxic level. level of the calcium channel blocker and it could cause the patient to go into hypotensive crisis. Patient could go into shock because that blood pressure gets so low. So we're going to question that order.
Whenever you guys get a question about which order would you question, which medication would you question, what they're really asking you is which one's a wrong answer choice. And it's number one, that patient that's getting calcium channel blocker, but they're drinking grapefruit juice. We know grapefruit juice can cause the patient go through calcium channel blocker what toxicity and that's why number one's the correct answer now choice number two three and four are all good answers that's why we didn't choose it so let's let's look at this choice number two the client receiving a beta blocker who has apical pulse of 62 beats per minute that's good you We can give that beta blocker. It's higher. The apical pulse is higher than 60 beats per minute.
We can give that. Choice number two, the client that just ate and then took NSAIDs. Good. We want the patient to eat before they take the NSAIDs. that decreases their risk of what gastric ulcers choice number four patient receiving anticoagulant the inr is 2.8 that's good because the norm is what between two and three so 2.8 falls within that range that we want the patient to be wonderful next question Which client warrants immediate intervention by the nurse?
One, the client diagnosed with pericarditis who has chest pain with inspiration. Two, the client diagnosed with mitral valve regurgitation who has a thready peripheral. pulse. Three, the client diagnosed with Marfan syndrome who has pectus excavatum.
Or four, the client diagnosed with arteriosclerosis who has slurred speech and drooling. And guys, the correct answer is four, the client that has arteriosclerosis and they have slurred speech and drooling. Is slurred speech and drooling an expected side effect or excuse me, is that an expected symptom? Of arteriosclerosis? No.
What are we suspecting? If this patient starts having slurred speech and drooling and we know they have arteriosclerosis, we're suspecting a complication of arteriosclerosis, which is what? A CVA.
This patient most likely had a stroke. This is who we're going to assess first. Choices one, two, and three, all of these are expected symptoms of the diagnosis.
One, the patient has pericarditis. We expect the patient to have chest pain on inspiration. That is a symptom of pericarditis.
Two, mitral valve regurgitation. We expect that patient to have the thready peripheral pulse, the cool and clammy skin. Those are signs and symptoms of mitral valve regurgitation.
Three, Marfan syndrome. That patient, their chest being caved in or... or out, that is expected symptom of that Marfan syndrome.
Okay. But what is not expected symptom of their diagnosis is that patient that's having stirred speech and drooling when they have arteriosclerosis. We're thinking that that patient now had a what blood, blood clot.
They now had a stroke, a CVA. The charge nurse on the cardiac unit is making shift assignments. Which client should be assigned to the most experienced nurse? 1. The client diagnosed with mitral valve stenosis.
The client diagnosed with fulminant pulmonary edema. Guys, this is the most unstable patient. This is life-threatening. Airway, breathing, circulation. Their breathing is going to be affected.
This patient has what? Pulmonary edema. This is the most unstable patient.
So by far, this patient is the one that has to be given to the most experienced nurse. Whenever they ask you a question about who are you going to give to the most experienced nurse, they're really asking you which one is the most unstable patient. And for this question, it's number three.
The nurse and the UAP enter the client's room and discover that the client is unresponsive. Which action, according to the American Heart Association guidelines, should the nurse assign to the UAP first? 1. Ask the UAP to check whether the client is asleep.
You are going to do CPR on that patient. So you are going to put that patient in a recumbent position and you are going to do CPR and wait for that crash cart to come. Now, if the CNA was by themselves, then obviously they would be the one doing CPR.
But since it's two of you, you're the RN, you're going to do the CPR and you send them to go get the crash court, crash cart, excuse me. And you're not going to do number one. Why are you going to check to see if they're asleep in the question they tell you the patient's unresponsive? So that means. means you've already said, hey, Mr. Such and Such, are you okay?
You're shaking them and you're talking to them and they're unresponsive. We've already established that. So we know they're not sleeping, right? So our correct answer is number three.
And guys, I can't believe this. We're already at our last question. The elderly client on the cardiac unit has a DNR order written.
Which intervention should the nurse implement? One, continue the care for the client's needs as usual. Two, place notification of DNR in the client's chart.
Three, refer the client to a hospice organization. Or four, limit visitors to two at a time so as not to tire the client. And guys, the correct answer is one.
You're going to continue. to care for the client's needs as usual. A DNR has nothing to do with the care that you give the client. All that means is that if their heart stops, they don't want CPR and they don't want to be put on the vent, okay? They don't want artificial life-preserving measures.
Okay, but that has nothing to do with the care that the patient gets. You're going to continue the quality of care as always. And guys, that's it for cardio. If you guys want to see more cardio questions, please let me know. Leave, drop something in the comments and let me know what kind of cardio videos you want me to cover.
Or if you just want me to do another cardio video. as a whole. Guys, please don't forget, I have audio lessons available on my website where I cover an array of topics.
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