l OM oAR cP SD | 57 81 9 35 7
HESI-MedSurg 2 Final Exam 2025-2026 LATEST
ALREADY GRADED A+
Cardiac 1.Electrical conduction through the heart, know the pathway that it takes ● The electrical impulse travels from the SA node through the atria to the atrioventricular (AV) node; this is know as conduction.● The electrical stimulation of the muscle cells of the atria causes them to contract.● The structure of the AV node slows the electrical impulse, giving the atria time to contract and fills the ventricles with blood.● The electrical impulse then travels very quickly through the bundle of His to the right and left bundle branches and the Purkinje fibers, located in the ventricular muscle.
- Someone who is getting a stress test, they are experiencing discomfort, chest pain
- CHF, classified 1 / 3
whats the best course of action ● Stop walking the test ● Take vitals signs ● See if that chest discomfort goes away at rest 3.Afib recommendation?● Medical management such as anticoagulant medications, controlling the entricular rate response with antiarrhythmic agents, and treating the arrhythmia as indicated so that it is converted to a sinus rhythm.● They will be on anticoagulants so they are on high risk for clotting disorders like stroke.● Keep the patient stress free ● Patient will need medications to control the heart rate like beta blockers or calcium channel blockers.● Patient will need medications that convert the heart rhythm or prevent atrial fibrillation.● Patient will need to maintain a heart healthy diet and maintain exercise.
4.Who gets an ICD? Whats the purpose?● Patients at high risk of VT or ventricular fibrillation and who would benefit from an ICD are those who have survived sudden cardiac death, which usually is caused by ventricular fibrillation, or have experienced spontaneous, symptomatic VT.● The ICD is an electronic device that detects and terminates life-threatening episodes of tachycardia or fibrillation, especially those that are ventricular origin.
l OM oAR cP SD | 57 81 935 7 MedSurg 2 Final Exam ● Right-sided heart failure can sometimes occur as a result of left-sided. The failure of these dual mechanisms is referred to as CHF. When the left ventricle fails, increased fluid pressure is transferred back through the lungs, leading to damage of the right side of the heart.● Classification I ○ No limitation of physical activity; ordinary activity does not cause fatigue, palpitation, or dyspnea ● Classification II ○ Slight limitation of physical activity; comfortable at rest, but ordinary physical activity causes fatigue, palpation, or dyspnea ● Classification III ○ Marked limitation of physical activity; comfortable at rest, but less than ordinary activity causes fatigue, palpitation, or dyspnea ● Classification IV ○ Unable to carry out any physical activity without discomfort; symptoms of cardiac insufficiency at rest; if any physical activity is undertaken, discomfort is increased 5.Dilated cardiomyopathy, pathological findings would we see in an echo ● The ventricle itself becomes enlarged or hypertrophic.● Microscopic examination of the muscle tissue shows diminished contractile elements of the muscle fibers and diffuse necrosis of myocardial cells. The result is poor systolic function. The structural changes decrease the amount of blood ejected from the ventricle with systole, increasing the amount of blood remaining in the ventricle after contraction ● In an echocardiogram, you will find an enlarged ventricle.
6.What do we do if a patient has cardiac tamponade, nurses most appropriate action
PRIORITIES
● Cardiac tamponade is compression of the heart resulting from fluid or blood within the pericardial sac.● In acute cardiac tamponade, the patient suddenly develops chest pain, tachypnea, and dyspnea. Pts typically will have tachycardia in response to low CO. Hypotension occurs from low CO. The pt may report chest discomfort or a feeling of fullness.
● CARDINAL SIGNS FOR CARDIAC TAMPONADE 2 / 3
l OM oAR cP SD | 57 81 9 35 7
- Know what troponin BNP, other cardiac biomarkers
- Endocarditis how do we diagnosis it how do we treat it, complications ● Infective
- Warfarin what is it used for, INR, antidote
- Digoxin what is it used for, dig levels, antidote
- / 3
● Myocardial cells that become necrotic from prolonged ischemia or trauma release specific enzymes such as creatine kinase and proteins such as myoglobin and troponin.● Troponin levels that are elevated are more than 0.02 ng/mL (normal).● CK levels that are elevated are more than 25 IU/L (normal 5-25 IU/L). ● Heart failure-> BNP
endocarditis ○ A microbial infection of the endothelial surface of the heart. The disease is rare, but it has a high mortality rate; approx 14% to 22% of patients die during their hospital stay, and up to 40% of patients die within 1 year of diagnosis.○ Strep A ○ The objective of treatment is to eradicate invading organisms through adequate doses of an appropriate antibiotic. Antibiotic therapy usually is given IV for 2 to 6 weeks.○ If you haven’t taken cultures yet for someone who is ruled pout with endocarditis, start them on a broad spectrum antibiotic until we get cultures back.● Rheumatic endocarditis ○ Occurs most often in school-age children, may develop after an episode of group A beta-hemolytic streptococcal pharyngitis.○ Prompt and effective treatment of “strep” throat with antibiotics can prevent development of rheumatic fever.
● It is usually used for atrial fibrillation as an anticoagulant.● Normal INR is 1.0; on warfarin INR is 2-3.5 ● Antidote for warfarin in vitamin K
● Digoxin increases the force of myocardial contraction and slows conduction through the atrioventricular node. ● Digoxin toxicity