What orders do you expect from the physician to decrease the risk of contrast induced nephropathy in a patient who has been identified as at risk?
Pre-operative hydration with intravenous normal saline
When setting up a pressure monitoring system for an arterial line, what kind of tubing is used to transmit pressure waves from the patient to the transducer?
Non-compliant
An occlusion of which coronary artery will decrease blood supply to the SA node?
Right coronary artery
What radiology practice decreases x-ray exposure to staff?
Observation of ALARA protocol
Post PCI, your patient complains of increasing chest pain, nausea, vomiting and hypotension. What would be your FIRST intervention?
Obtain STAT 12 lead EKG
A right heart catheterization is on the schedule. What type of condition might this procedure be used to identify?
Pulmonary hypertension
Which assessment should be performed to establish baseline hand perfusion in a candidate for radial access?
Allen’s test
You are caring for a patient who is prepping for PCI. This patient has received 3 sublingual doses of nitroglycerin but continues to have ongoing chest pain. What medication would you expect to be ordered?
IV nitroglycerin
During inflation, what helps determine the dilation force of a balloon?
Compliance of the balloon
Which of the following medications would the nurse MOST LIKELY expect the patient to be prescribed after an acute coronary event?
Aspirin and Brilinta
For a patient with an acute myocardial infarction, what lab value is MOST pertinent?
Troponin
A perforation occurs during PCI. Which of the following is MOST important to have readily available?
Covered stent, pericardiocentesis tray, ECHO
A cardiologist has performed a radial approach to access the coronary arteries. What dod you expect to see on the radiographic image screen as the catheter approaches the coronary arteries?
Catheter traveling through the brachiocephalic artery to the aorta
The physician selectively engages the conus branch of the RCA. What change inn the waveform would you anticipate?
A dampened arterial waveform
What vessel supplies oxygenated blood to the right atrium?
Pulmonary veins
In what order would you apply sterile surgical attire?
Apply sterile gown, insert hands inn gloves, hand tie to staff member
Why is cardiac index better than cardiac output for the assessment of cardiac function when considering variation between individuals?
Cardiac index takes into account the patient’s body surface area
Which lab finding is MOST suggestive of increased risk of contrast induced nephropathy?
40 ml/min estimated GFR
After successful revascularization of a totally occluded RCA, which of the following complications should the circulating nurse prepare for?
Arrythmias
Your STEMI patient tells you they drive to the hospital after experiencing acute onset chest pain. What coaching would you give this patient if this occurs in the future?
call 911
You have been tasked with administering moderate sedation to a patient in the cardiac catheterization lab. What tasks are your priority?
Counting respirations, readying suction, observing chest rise and fall
Which statement made by the patient after a cardiac stent placement indicates patient education was effective?
I will take Brilinta twice a day with food
While performing a PCI, you notice contrast staining the pericardium. The patient experiences chest pain, acute hypotension, and tachycardia. What emergent intervention should you prepare?
Pericardidocentesis
During transfer of care post-procedure, what should you do with the receiving nurse to decrease the chance of missing a hematoma or bleeding?
View the sheath insertion site
How is radiation exposure to staff monitored?
Wearing film badge dosimeters
The physician states he wishes to perform a FFR (Fractional Flow Reserve) on a suspect lesion in the RCA. What medication would you anticipate preparing for this procedure?
Adenosine
A hematoma is found when handing off patient care to recovery nurse. What IMMEDIATE actions can be taken to ensure that the hematoma does not progress?
Apply pressure to access site
Your patient is newly prescribed Brilinta post PCI. What piece of education is MOST important before discharge?
Take Brilinta twice a day and do not miss any doses
What does the dicrotic notch represent on the arterial waveform?
Closure of the aortic valve
Which medications should be ready for the physician to be given intracoronary when experiencing slow flow phenomenon?
Diltiazem (Cardizem), Nipride (sodium nitroprusside), Cardene (Nicardipine)
What finding would be MOST concerning post sheath removal?
Hematoma at insertion site
In order to calculate Fick cardiac output which of the following saturations do you need?
AO and PA
What is the FIRST action you should take if a patient who is receiving moderate sedation has the following vital signs: HR 82, SpO2 93%, RR 18, elevated end tidal CO2 and begins snoring?
Open airway with head tilt/chin lift
What intervention do you expect would be ordered for a patient with a blood pressure of 128/83, elevated right atrial, left ventricular, and pulmonary artery pressures, along with SOB, adventitious lung sounds, and SpO2 87%?
Lasix
What size wires are usually utilized in coronary balloon angioplasty?
0.014 x 180
Which cardiac pressure findings are consistent with aortic stenosis?
LV pressure is greater than the AO pressure
A patient has just had a cardiovascular procedure and arrives in the recovery area with a sheath in place in the right groin. Their ACT in the lab was 357. What important patient education should be given prior to sheath removal?
The patient’s head must remain on the pillow and the right leg must remain straight
What type and amount of IV fluids should a patient receive before cardiac catheterization to reduce the risk of contrast induced nephropathy?
500ml of 0.9 NS
You are assessing a patient with left-sided heart failure. What is an early finding for this patient?
Shortness of breath
In addition to ST elevation, which new ECG finding is suggestive of acute MI?
LBBB
Normal QRS length?
0.08 – 0.12
What post-procedure findings should be IMMEDIATELY communicated to the cardiologist?
Absent pedal pulses with blueish toes
After a procedure during which heparin was administered, what finding is suggestive of HIT?
Decrease in platelets by 50%
What catheter would BEST engage the right coronary artery?
JR4
What type of contrast is associated with fewer adverse clinical events?
Low-osmolar contrast
What PRIMARY reperfusion treatment is preferred for a patient with an acute STEMI who is NOT a candidate for cardiac catheterization?
Fibrinolytic infusion
To calibrate the transducer at the level of the phlebostatic axis where would the nurse position the transducer?
The level of the right atrium
After PCI, a patient has a radial compression device in place. What should you do if you palpate a diminished pulse, cool fingers and the patient reports numbness in their hand?
Reduce the amount of compression
What size is a 6F catheter
2 mm
What is the difference between a guiding catheter and a diagnostic catheter?
Guiding catheters have wire braiding
Prior to draping the patient for a cardiovascular procedure, how should the skin be prepared for the insertion of a catheter?
Cleansed with chlorhexadine prep
When putting on a sterile gown, how should you initially grasp it?
Grasp the inside of the neckline and lift it away from the wrapper
Which statement made by a patient post coronary stent placement indicates successful understanding of patient education?
I made an appointment for cardiovascular rehab
Post PCI your patient is started on Brilinta. What important side effect should you make them aware of?
Shortness of Breath SOB
What is the mechanism of action of Aspirin?
Antiplatelet agent
When considering cardiac output, what is stroke volume?
The amount of blood ejected into the aorta from the left ventricle during systole
As the circulating nurse, what should you wear to protect yourself from radiation?
*WRONG* Lead thyroid collar, cap, eye protection, and humoral shield -Lead thyroid collar, apron, and eye protection – Non-leaded apron, humoral shield, and surgical mask – Non-leaded collar, apron, humoral shield, badge, and mask
Why is scatter radiation a safety concern?
*WRONG* It causes leakage radiation from the radiation source or equipment – It is the main source of radiation exposure for patients and staff – It is the primary beam of radiation from the collider to the patient – It causes leakage from the radiation source or equipment
What is the normal range for cardiac output?
*WRONG* 5-9 liters/min – 4 – 8 L/min -6 – 10 L/min -8 – 12 L/min
In patients with a right to left shunt, in which chamber would you expect to record the lower oxygen saturation?
*WRONG* Right Atrium – Pulmonary Artery – Left Ventricle – Left Atrium
What procedure helps the interventional cardiologist make accurate measurements of a coronary artery?
*WRONG* Standard angiography – Intravascular ultrasound – Transesophageal echo – Intracardiac echocardiography
Where is the LIMA take-off located?
*WRONG* AORTA – Innominate artery – Left Subclavian artery -Right Subclavian artery
A 65 year old male arrives in the cardiovascular lab. He has a history of CAD in his family, he smokes and he has hyperlipidemia. After the procedure, he wants to know what is the MOST important thing he can do to help reverse his disease process?
*WRONG* Take medication as prescribed – Stop Smoking – Improve diet – Practice stress management
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