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EXAM HINTS

  1. ACUTE COMPLEX NURSING CARE COURSE - 2017

  2. ACUTE CARDIAC NURSING CARE COURSE - 2017

Your principle lecturers for the above courses were Heather James and Anne Evans-Murray, with several guest lecturers on specialised subjects, such as Jason Brabant who covered cardiac catheter procedures, both investigative and therapeutic, and Helen Gunter our cardiac catheterisation specialist nurse educator.

Details of exams:
Acute complex care course
Date:   22nd July Saturday 
Time:   Commencing at 10.am
Venue:  Gold Coast Institute of TAFE (GCIT) Southport campus, Room 105/106.

Deferred exam:
Date: 
Time: 
Venue: Health Ed Professionals, Unit 12, 10 Enterprise Street, Molendinar

1. Exam Hints for Acute Complex Nursing Care Course
UNDERGRADUATE STUDENTS:
50 Multichoice questions (see hints below)
 Principles of oxygenation and respiratory distress  - compulsory

Short answers:
Answer 2 questions from the following:
1. Non invasive ventilation
2.Arterial Blood Gas Analysis
3.Angina 
4.Abdominal assessment
5. Pneumothorax and UWSD

Long Answer: worth 25 marks
Answer 1 question:
1. Respiratory /lung sounds / chest xray 
2. Neurological 

Advanced Life Support question - worth 20  marks 

You will be asked a long answer question relating to ALS, for example what would the management be and give the reasons (rationale) for your management of a patient who has arrested.

From the course you have learnt that cardiac arrests can be divided into a Fast or (shockable) and Slow (unshockable) arrhythmias. You need to study both arrests and have knowledge of the Australian Resuscitation Council guidelines. Would you also be able to give the rationale for the treatment of arrhythmias. For example what is the rationale for administering Adrenaline 1 mg for asystole or a slow cardiac arrest.

MASTERS STUDENTS:
50 Multichoice questions (see hints below)
Arterial blood Gas question - compulsory
Short answer: worth 5 marks each
Answer 3 questions from the following:  
1. Non invasive ventilation
2. Principles of oxygenation and respiratory distress
3. Angina 
4. Abdominal assessment
5. Pneumothorax  - Tension and UWSD

Long Answer: worth 20 marks each
Compulsory cardiac emergency question

Answer 1 question:
1. Respiratory /lung sounds / chest xray 
2. Neurological 

The following are general hints for both masters and undergraduates. Check that you understand the following concepts:

Blood gas analysis - can you analysis a blood gas, for example what would the following be:
pH 7.20, PaC02 70, HC03 24
Do you understand the concept of a low Pa02, when the patient is on a high 0xygen percentage = he might be on 40% oxygen and the Pa02 is below 80, then the patient has a VQ mismatch.
Pa02 and Sp02 concepts

Lung sounds - what lung sounds are heard in pneumothorax, or heart failure.

Glasgow coma scale and neurological assessment

Grey Turners and Cullen’s sign - what abdominal disorder is associated with these signs. 

Intercostal catheter nursing management

Chest pain differences - difference between stable and unstable angina and myocardial infarction

·         Can you recognise the basics of interpretation of chest x-rays such as costophrenic angle, CT ratio, silhouette sign etc.

·         Is density on the chest x-ray – white or black?

·         If a patient has a pneumothorax, what changes would be seen on the chest x-ray and if you were to auscultate his chest, what lung sounds would you hear (or not hear)?

·         If a patient has heart failure, what changes would be seen on the chest x-ray and if you were to auscultate his chest, what lung sounds would you hear (or not hear)?

If you want to practice your skills at answering multichoice questions, try the following:

If you hear crackles when you auscultate, they are usually caused by:

a)      narrowing of the small airways during inspiration

b)      narrowing of the large airways during expiration

c)       consolidation of the lung tissue

d)      fluid filled alveoli and late opening phase during inspiration                                    

Bronchial breath sounds heard over the periphery of the lungs may be due to:

a)      normal sounds

b)      emphysema

c)       pneumothorax

d)      consolidation

The client’s arterial blood gas analysis results were as follows:

       pH 7.24,                PCO2  58              HCO3 24  The analysis would be:

a)      respiratory acidosis with complete compensation

b)      metabolic acidosis with complete compensation

c)       respiratory acidosis with no compensation

d)      respiratory alkalosis with partial compensation

The normal range of HC03 is:

a)      2 to 5 mm Hg

b)      35 to 45 mm Hg.

c)       22 - 26 mEq/L

d)      100 to 150 mEq/L                                                                             

A pneumothorax on the chest x-ray is diagnosed by the presence of:
a)      white ( opacity) density with lung markings
b)       black density with no lung markings
c)      silhouette sign

A pneumothorax is best defined as:
a)      collection of air in the pleural cavity
b)      collection of blood in the lungs               
c)       collection of blood in the pleural cavity
d)      collection of blood and air in the pleural cavity

During abdominal assessment you note the patient is complaining of generalised abdominal pain,  and lying extremely still. Complaining the pain increases when they move. This may lead you to think the patient may have:

a)      acute bowel obstruction
b)      peritonitis
c)       acute pancreatitis
d)      abdominal aortic aneurysm

 A patient complains of left shoulder tip pain and tenderness of the left  upper quadrant after a motor vehicle accident.  The doctor suspects:
a)      gall bladder injury.
b)      liver haemorrhage
c)      large bowel haematoma and rupture
d)      spleen injury
 
  Troponin is a cardiac enzyme used to diagnostically differentiate between which of the following:
  1. an acute STEMI and stable angina
  2. an acute NSTEMI and unstable angina
  3. an acute STEMI and an acute NSTEMI
 
The width of the QRS complex in normal sinus rhythm is:
  1. equal to or less than 0.12 seconds
  2. equal to or greater than 0.12 seconds
  3. less than 0.12 seconds

PLEASE NOTE IF YOU ARE DOING THE DEFERRED EXAM YOU MUST LET ANNE OR HEATHER KNOW, AS THERE ARE LIMITED SPACES. 



2. Exam Hints for Acute Cardiac Nursing Care course 

The following are general hints relating to the multichoice questions only. You should have the topics for the short answer questions. 

Check that you understand the following concepts:

Wellen’s syndrome

Wolf Parkinson White syndrome - what do you see on the PQTST, what is the significance of this disorder?

Afterload and preload

Are you able to recognise the following arrhythmias:
  • Ventricular tachycardia/ Ventricular fibrillation
  • P mitrale
  • Junctional rhythm (masters only)
  • Atrial fibrillation
  • Supraventricular tachycardia
  • Heart Blocks -only for Masters students
  • Bigeminy

Important concepts: Do you understand the following?

ST elevation,

ST depression,

T wave inversion

Would you be able to draw an example of ST elevation, ST depression
What leads would you see infarction changes in an anterior MI or an Anterior MI

Are you familiar with the PQRST complex and be able to label and indicate its values, eg you should know the PT interval, QRS width.

You need to be able to recognise the J point and the QT interval, you don't need to know the QT values, but you should be able to label the QT interval. 

Are you able to relate to the significance of extra heart sounds?

Endocarditis - what are some of the unusual signs relating to Endocarditis?
Do you have an understanding of Ejection Fraction and Heart Failure,
How would Wolf Parkinson White Syndrome look like?

Where is the S1 heard the loudest, what is the significance of S3, where is a Diastolic murmur heard. 


Practice exam multichoice questions for cardiac exam:

A patient suffering from stable angina would most commonly show the following changes in their 12 lead ECG.
a)    ST elevation
b)    T wave inversion
c)    Q wave  
d)   normal T wave

A patient with the Long QT Interval Syndrome may have a past history of:
a)         syncope, or light-headedness
b)         past myocardial infarction
c)         high blood pressure
d)         irregular heart beat

A patient has a greater chance of cardiac arrest in Long QT Interval  Syndrome due to the:
a)         development of heart block arrhythmias
b)         development of episodes of polymorphic ventricular tachycardia.

In an acute anterior STEMI the ST elevation and Q waves will be present on leads:
a)     V1 to V4
b)     leads 11, 111, avF
c)     1 and avR

A patient with Wolff Parkinson White (WPW) syndrome may display the following on the 12 lead ECG.
a)         short QRS complex
b)         short PR interval, delta wave
c)         long PR interval, delta wave
d)         runs of wide complex tachycardia                                                       

 In an acute inferior STEMI the ST elevation and Q waves will be present in the following leads
a)   
V1 to V4
b)   V1 and V2
c)    1 and aVL
d)    11, 111, and aVF                    

 A systolic murmur can be heard:
a)    between S1 and S2
b)    between S1 and S4
c)    between S2 and S1
d)    throughout the cardiac cycle
​ 
 Beck’s Triad is associated with which condition?
a)      endocarditis
b)      pulmonary embolus
b)      acute myocardial infarction
c)       cardiac tamponade


 EXAM

Details of exams - Acute Cardiac Care Course:

Date: 15th July Saturday 
Time:  10 am 
Venue:  TAFE Southport

Deferred exam:
Date: 
Time: 10.00 am
Venue: Health Ed Professionals, Unit 12, 10 Enterprise Street, Molendinar

PLEASE NOTE IF YOU ARE DOING THE DEFERRED EXAM YOU MUST LET ANNE OR HEATHER KNOW, AS THERE ARE LIMITED SPACES.
UNDERGRADUATE STUDENTS:
56 multichoice questions
2 diagram questions

Short answer - worth 6 marks each.
Answer only 3 questions 

1. Chronic Heart Failure:
2. Takotsubo syndrome.  
3. Endocarditis.
4   Acute Cardiogenic Pulmonary Oedema. 
5. Long QT interval Syndrome.  
6. Pulmonary Embolus

Part 2.
Clinical Scenario - Case Study


Choose one case study: worth 25 marks
1. Atrial Fibrillation 
2. Acute Coronary Syndrome

Showing a good understanding of all aspects of AF or ACS.
A case outline will be given on the topic and you are expected to answer questions relating either to AF or ACS. Depending on the topic you have chosen. 
​
MASTERS STUDENTS
56 multichoice questions
2 diagram questions

Short answer questions - worth 10 marks each 
Answer 2 questions

1.  Acute Coronary Syndrome
2.  Endocarditis.
3.  Acute Cardiogenic Pulmonary Oedema.  
4.  Right ventricular myocardial Infarction.
5.  Cardiac tamponade
6.  Long QT interval Syndrome 

Long Answer - worth 20 marks each 
Answer 2 questions:

1. Chronic Heart Failure
2. Atrial Fibrillation
3. Takotsubo Syndrome
4. Pulmonary Embolus

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