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51 Cards in this Set
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A nurse is observing a patient during a cardiac catheterization procedure. During the procedure, the patient reports feeling chest flutters and have an irregular heartbeat. What should be the nurse’s initial action?
a. Immediately stop the procedure b. Reassure patient that those sensations are normal c. Administer oxygen by facemask d. Administer PRN antihistamine |
B. Reassure patient that those sensations are normal
Sensations that may be experienced during cardiac catheterization include palpitations as the catheter is passed up the left ventricle, and a feeling of heat or hot flash as the medium is injected into either side of the heart. (ch. 35, p 723) |
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A patient with a history of acute renal failure is about to have cardiac catheterization. The nurse caring for the patient should anticipate administering which medication before the procedure?
a. Furosemide b. Glucophage c. Mucomyst d. Acetaminophen |
C. Mucomyst
Fluids and acetylcysteine (mucomyst) may be given 12-24 hours before the procedure for renal protection. (ch. 35, p 723) |
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A nurse is preparing a care plan for a patient who just had returned from a cardiac catheterization procedure. Which of the following interventions should not be included in the care plan?
a. Maintain infusion of IV fluids b. Monitor neurovascular status c. Assist patient when ambulating d. Apply soft knee brace on insertion site |
C. Assist patient when ambulating
After cardiac catheterization, the patient is typically restricted to bed rest and the insertion site extremity is kept straight. A soft knee brace may be applied to prevent bending of the affected extremity. (ch. 35, p 723-724) |
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A patient with a recent episode of MI would manifest all of the following signs and symptoms, except:
a. Decreased temperature b. An S4 gallop c. Cool, diaphoretic skin d. Increased respiratory rate |
A. Decreased temperature
The patient with MI may experience a temperature elevation for several days after infarction in response to myocardial necrosis, indicating inflammatory response. (ch. 40, p 854) |
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A nurse just received an order to administer nitroglycerin for a patient with chest pain. Which of the following medications, if regularly taken by the patient, would contraindicate the use of nitroglycerin?
a. Digoxin b. Aspirin c. Sildenafil d. Carvedilol |
C. Sildenafil
Nitroglycerin should not be administered to patients taking drugs used to treat sexual dysfunction (sildenafil, tadalafil, vardenafil). Combined use of both drugs can result to significant (possibly fatal) interactions. (ch. 40, p 857) |
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A nurse is assessing a patient who received a prescribed dose of nitroglycerin 5 minutes ago. The patient’s current blood pressure is 90/40 mmHg. What should be the nurse’s next action?
a. Administer 4 baby aspirin b. Place patient in high-fowler’s position c. Administer another dose of nitroglycerin d. Lower the head of the bed |
D. Lower the head of the bed
If the patient’s BP is less than 100 mmHg systolic or 25 mmHg lower than the previous reading, lower the head of the bed and notify primary healthcare provider. Hypotension can be dramatic, and intensified by the upright position. (ch. 40, p 856-857) |
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A nurse is teaching a patient who is on long-term oral nitroglycerin therapy about proper drug administration. Which of the following patient statements indicate that further teaching is needed?
a. I can take an additional dose of the drug after 15 minutes if I’m still having chest pain b. I have to avoid swallowing the tablet c. Headache is a common side effect of the drug d. I have to call the doctor if I’m still having chest pain after taking 3 doses |
A. I can take an additional dose of the drug after 15 minutes if I’m still having chest pain
If the patient is experiencing some but not complete relief, another nitroglycerin tablet may be given in 5-minute increments (not 15 minutes) for up to 3 total doses. The tablet should be allowed to dissolve and avoid swallowing the tablet. (ch. 40, p 856-857) |
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A patient diagnosed with myocardial infarction is started on a prescribed dose of nitroglycerin. After initial dose of the drug, the patient reports having a headache. What should be the nurse’s most appropriate action?
a. Administer 2nd dose of nitroglycerin b. Give 2L oxygen by nasal cannula c. Administer Tylenol d. Elevate the patient’s legs |
C. Administer Tylenol
Headache is a frequent side effect of initial therapy. Acetaminophen may be administered to relieve the headache. (ch. 40, p 858) |
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A patient calls the local community clinic and complains of having pain. The patient reports taking nitroglycerin and aspirin regularly for pain management. Which question must the nurse ask the patient first?
a. Did you take your nitroglycerin yet? b. What are your latest vital signs? c. Where is the pain located? d. Do you have any bruises or any signs of bleeding? |
C. Where is the pain located?
Because chest pain can also be due to noncardiac conditions, thoroughly evaluate the nature and characteristics of chest pain. When assessing for symptoms, use alternative terms such as “discomfort”, heaviness”, or “indigestion”. (ch. 35, p 712) |
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Which of the following statements should the nurse consider when caring for a patient admitted for acute myocardial infarction?
a. Cardiogenic shock is the most common cause of death in patients with MI b. Vasodilators should not be administered for patients with acute MI c. Administer atropine to decrease O2 demand d. Patient should chew 4 baby aspirins to help relieve chest pain |
D. Patient should chew 4 baby aspirins to help relieve chest pain
Dysrhythmias are the most common cause of death in patients with MI. Vasodilators such as nitroglycerin should be administered for patients with MI. Atropine is not used for acute MI due to increased O2 demand effect of the drug. Aspirin 325 mg (or 4x “baby” 81 mg aspirin) needs to be chewed and should not be enteric-coated. (ch. 34, Lewis text) |
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A nurse is teaching a patient about instructions on how to take nitroglycerin at home. Which patient statement indicates that teaching has been successful?
a. I can take the drug 10 minutes before exercising b. I should call the doctor if my chest pain is not relieved 1 hour after taking 3 total doses of nitroglycerin c. I cannot take any other medication while I’m on nitroglycerin d. I should not take my medication if my diastolic BP is below 90 mmHg |
A. I can take the drug 10 minutes before exercising
Patients can use NTG prophylactically before undertaking an activity that is known to precipitate an angina attack. NTG should not be taken if systolic (not diastolic) BP is below 90 mmHg. (ch. 34; Lewis text) |
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A nurse is caring for a patient with CAD who is regularly taking atorvastatin (Lipitor). Which of the following assessment findings would help indicate that the patient is experiencing an adverse effect of the drug?
a. Patient weight loss of 3 lbs in 4 weeks b. Low LDL, and elevated HDL levels c. BP= 100/50, P=50, T=98.9, R=16 d. Elevated liver enzymes |
D. Elevated liver enzymes
Serious adverse effects of antihyperlipidemic (“statins”) drugs include liver damage and myopathy that can progress to breakdown of skeletal muscle. (ch. 34; Lewis text) |
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A nurse is performing home care teaching for a patient who experienced an acute MI. The patient asked the nurse if he can safely resume sexual relations with his partner. Which of the following should be the nurse’s response?
a. Refrain from any sexual activity for at least 4 weeks b. Prophylactic NTG and an erectile agent should be taken 2 hours before engaging in sexual activity c. Do you feel any chest pain or difficulty breathing after climbing 2 flights of stairs? d. How often do you have intercourse with your partner? |
C. Do you feel any chest pain or difficulty breathing after climbing 2 flights of stairs?
Sexual intercourse can be safely resumed if the patient has been able to achieve traditional parameters such as climbing 2 flights of stairs without chest pain or dyspnea. Erectile agents should not be used with NTG because severe hypotension and even death can occur. (ch. 40, p 872) |
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The nurse is caring for a diabetic patient 48 hours post-cardiac catheterization. Which of the following should the nurse assess to evaluate if the patient can safely continue taking Metformin?
a. Blood glucose level b. ABG c. BUN and creatinine d. BP and HR |
C. BUN and creatinine
IV contrast media that contain iodine pose a risk of acute renal failure. Patients undergoing surgery or procedure that involve use of contrast medium are instructed to temporarily discontinue Metformin before and 48-72 hours after the procedure and after serum creatinine has been checked and is WNL. (ch. 49; Lewis text) |
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Which of the following complications is associated with the use of glucophage for a patient undergoing a cardiac angiogram procedure?
a. Development of lactic acidosis b. Profound hyperglycemia due to use of contrast dye c. Liver toxicity d. Severe respiratory depression due to combination of glucophage and sedative |
A. Development of lactic acidosis
Combination of contrast medium and glucophage could cause the development of lactic acidosis. Drug should be discontinued the day before the procedure and 48-72 hours post-procedure. (ch. 49; Lewis text) |
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The nurse administered the 1st dose of NTG sublingual for a patient experiencing chest pain. The nurse should know that pain relief should be evident:
a. Within 1-3 minutes of taking the drug b. After administration of IV morphine c. After taking the 3 total doses of NTG d. At least 20 minutes after taking the drug |
A. Within 1-3 minutes of taking the drug
Pain relief with NTG use should begin within 1-2 minutes and should be clearly evident in 3-5 minutes. After 5 minutes, assess the patient’s pain level and vital signs. (ch. 40, p 856) |
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A nurse working in the telemetry unit is assessing the latest ECG readings for the patients in the unit. Which of the following cardiac rhythm indicates that a patient has recently experienced an MI?
a. Sinus bradycardia with premature junctional complex b. Asystole c. Normal sinus rhythm with 1st degree AV block d. Sinus tachycardia with premature ventricular contractions |
D. Sinus tachycardia with premature ventricular contractions
Sinus tachycardia with PVCs frequently occurs in the first few hours after an MI. With acute MI, PVCs may be considered warning dysrhythmias, possibly triggering ventricular tachycardia or ventricular fibrillation. (ch. 40, p 854; ch. 36, p 747-748) |
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A patient with acute MI has undergone cardiac catheterization, and coronary angioplasty with stents. The patient is receiving Plavix (antiplatelet), Prevacid (proton pump inhibitor), K-Dur (potassium supplement), and Colace (stool softener). Prior to administration of the medications, which of the following is the most important for the nurse to assess?
a. Blood pressure b. Serum potassium level c. Troponin/CK-MB level d. Peripheral pulses |
B. Serum potassium level
Since the patient is receiving potassium supplement, it is important to assess serum potassium level prior to administration of the medication. The patient has undergone procedure that uses contrast dye which can be renal toxic and could cause impaired renal function. Electrolyte levels are carefully monitored since imbalances can cause arrhythmias. (ch. 40, p 868) |
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A nurse performed medication and proper care teaching for a patient who underwent cardiac catheterization and PTCA with stent placement after experiencing an acute MI. Which patient statement indicates a need for further teaching?
a. I can take Plavix and aspirin in the morning b. I have to call my HCP if I gain 3 lbs in 1 week or 1-2 lbs overnight c. A service van will take me home since I should not be driving after surgery d. My knee surgery should be rescheduled for a later time |
C. A service van will take me home since I should not be driving after surgery
Patients should not be discharged to home alone. Assess whether the patient has family or friends to provide assistance. Dual antiplatelet therapy with aspirin and clopinogrel (Plavix) is usually prescribed for the patient after PTCA. (ch. 40, p 865, 868) |
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Which of the following medications should be withheld for a patient who is about to undergo elective cardioversion?
a. Lovenox b. Digoxin c. Glucophage d. Nitroglycerin |
B. Digoxin
If patient is taking digoxin, the drug is withheld for up to 48 hours before elective cardioversion. Digoxin increases ventricular irritability and puts the patient at risk for ventricular fibrillation after the countershock. (ch. 36, p 756) |
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Which of the following interventions should not be included in the plan of care for a patient with a chest tube?
a. Avoid clamping the chest tube for a long time b. Keep drainage system higher than the level of the patient’s chest c. Milking the tube to move blood clots and prevent obstruction d. Reposition patient who reports a “burning” pain in the chest |
B. Keep drainage system higher than the level of the patient’s chest
Drainage system should be kept lower than the patient’s chest level. Gentle hand-over-hand “milking” of the tube, with stopping between each hand hold, is used to move blood clots and prevent obstruction. (ch. 32, p 648-649) |
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A nurse is performing an assessment on a patient after a low-pressure alarm sounds on the patient’s ventilator. If the cause of the alarm couldn’t be determined by the nurse, what should be the most appropriate action?
a. Call a code b. Administer high-flow oxygen via non-rebreather mask c. Ventilate patient using an ambu-bag d. Reposition patient to high-fowler’s |
C. Ventilate patient using an ambu-bag
Mechanical ventilators have alarm systems that warn of a problem with either the patient or the ventilator. If the cause of the alarm can’t be determined, the patient should be manually ventilated using a resuscitation bag until the problem is corrected. (ch. 34, p 695) |
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During assessment, the nurse notes high-pitched noise during inspiration and excessive coughing for a patient who had an endotracheal tube removed several hours ago. Which of the following should be the initial action by the nurse?
a. Administer oxygen by nasal cannula b. Call rapid response team c. Place patient to high-fowler’s position d. Perform chest physiotherapy and deep breathing exercises |
B. Call rapid response team
Stridor, a high-pitched noise during inspiration caused by laryngospasm, is a late manifestation of a narrowed airway and requires prompt attention. Reintubation may be needed. (ch. 34, p 697) |
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A nurse is assessing a patient immediately after endotracheal tube insertion. Which initial nursing intervention should be implemented to verify proper tube placement?
a. Instill air into the endotracheal tube and listen for the air forced in the lungs b. Aspirate secretions and check for correct pH level c. Observe for chest movement d. Assess for any verbal impairment after tube insertion |
C. Observe for chest movement
The nurse should assess for lung sounds bilaterally, symmetrical chest movements, and air emerging from the ET tube. The most accurate way to verify placement is by checking end-tidal CO2 levels and by chest x-ray. (ch. 34, p 690) |
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The nurse is caring for a patient on a mechanical ventilator with an NG tube in place. Upon assessment, the nurse notes that the gastric aspirate from the NG tube has a pH level of 4.0. Based on the finding, what should be the most appropriate nursing action?
a. Ask physician for a STAT x-ray to check for placement b. Document finding c. Assess lung sounds d. Administer PRN dose of antacid |
D. Administer PRN dose of antacid
Stress ulcers occur in many patients receiving mechanical ventilation. These ulcers complicate the patient’s nutritional status and increase the risk for systemic infections. Antacids are often prescribed as soon as the patient is intubated. (ch. 34, p 696) |
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A critical care nurse is caring for a patient diagnosed with acute myocardial infarction receiving alteplase (activase) thrombolytic therapy. Which assessment finding, if noted for the patient, indicate that complications of therapy are occurring?
a. Blurry vision b. Tarry stools c. Sudden loss or reduced hearing d. Weight loss of 2 lbs in one day |
B. Tarry stools
Thrombolytic therapy dissolves thrombi in the coronary arteries and restores myocardial blood flow. Patients receiving thrombolytic therapy are at an increased risk for bleeding. Observe patient for signs of bleeding (hematuria, petechiae, tarry stools). (ch. 40, p 859) |
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Which of the following group of patients would be classified to have a superficial-thickness burn injury?
a. Patient with a blackened, and depressed wound with bony areas visible b. Patient who exhibits swelling and redness of the skin from prolonged sun exposure c. Patient with soft, dry eschar and moderate swelling of the affected area d. Patient with a deep red wound who reports having reduced sensation of the affected area |
B. Patient who exhibits swelling and redness of the skin from prolonged sun exposure
Superficial-thickness wounds are caused by prolonged exposure to low-intensity heat (sunburn) or short exposure to high intensity heat. Redness with mild edema, pain and increased heat sensitivity occurs as a result. (ch. 28, p 522) |
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A critical care nurse received an order to administer an H2 histamine blocker for a patient with a burn injury to the chest and abdominal area. The most appropriate rationale for giving the medication for the patient is:
a. To relieve bronchospasm secondary to the injury b. To facilitate air exchange in the lungs c. To prevent ulcer development d. Increase cardiac output and maintain adequate blood circulation |
C. To prevent ulcer development
Acute GI ulcer may develop within 24 hours after a sever burn injury because of reduced GI blood flow and mucosal damage. H2 histamine blockers and other drugs that protect the GI mucosal tissues help prevent this type of complication. (ch. 28, p 525) |
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A nurse in the emergency department performed an assessment on a patient who has a burn injury after being in contact with an exposed electrical wire. Assessment findings include black and depressed wound area with hard, inelastic eschar. The patient denies having any pain and there are no blisters noted. When documenting the findings, the nurse should classify the wound as:
a. Superficial partial-thickness b. Deep-full thickness c. Superficial d. Deep partial-thickness |
B. Deep-full thickness
Deep-full thickness wounds extend beyond the skin into underlying fascia, and tissues. These burns occur with flame, electrical, or chemical injuries. The wound is blackened, depressed, and sensation is completely absent. (ch. 28, p 521, 523) |
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Which laboratory test value would be present for a newly admitted patient who had a recent burn injury?
a. Elevated glucose level b. Decreased hemoglobin and hematocrit c. Elevated sodium level d. Low potassium level |
A. Elevated glucose level
Glucose levels are elevated as a result of the stress response and altered uptake across injured tissues. Hemoglobin and hematocrit levels are elevated due to fluid volume loss. (ch. 28, p 532) |
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A nursing diagnosis of “decreased cardiac output” has been assigned for a patient with a severe burn injury. Which of the following is an appropriate initial intervention for the patient with the specific nursing diagnosis?
a. Initiate blood transfusion therapy b. Place patient in trendelenburg position c. Start rapid infusion of IV fluids d. Administer digoxin as prescribed |
C. Start rapid infusion of IV fluids
Heart rate increases and cardiac output decreases because of the initial fluid shifts and hypovolemia that occur after a burn injury. Rapid infusion of IV fluids (fluid resuscitation) is needed to maintain sufficient blood volume for normal cardiac output. (ch. 28, p 524, 533) |
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A nursing diagnosis of “ineffective tissue perfusion” has been assigned for a patient with a severe burn injury. To accurately assess for improved blood perfusion during fluid replacement therapy, which non-invasive assessment technique would be most appropriate?
a. Check the urine output b. Assess blood pressure using a cuff c. Auscultate lung sounds d. Assess capillary refill |
A. Check urine output
Urine output is the most common and most sensitive non-invasive assessment parameter for cardiac output and tissue perfusion. (ch. 28, p 534) |
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A patient with a deep partial-thickness burn scheduled for a wound debridement asks the nurse what is done during the procedure. The most appropriate nursing response would be:
a. The procedure is done to artificially close the wound to facilitate healing b. Debridement is done to promote circulation to the affected extremity c. Dead tissue will be removed to prepare the wound for grafting d. It prevents potential swelling and necrosis of the affected extremity after the injury |
C. Dead tissue will be removed to prepare the wound for grafting
Debridement is the removal of eschar and other cellular debris to have the wound prepare itself for grafting and wound closure by a natural process. (ch. 28, p 539) |
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A triage nurse is reviewing assessment findings for several patients in the emergency department. Which of the following patients presents an emergent or life-threatening condition that needs immediate treatment?
a. 45-year-old patient with chest pain, hemoptysis, and is diaphoretic b. 75-year-old patient with new onset pneumonia c. 35-year-old patient presents with severe abdominal pain and dislocated shoulder d. 18-year-old patient with a sprained knee and a temperature of 99.0F |
A. 45-year-old patient with chest pain, hemoptysis, and is diaphoretic
A person that shows active hemorrhage, experiencing chest pain, and is diaphoretic would be prioritized as emergent. Emergent triage implies that a condition exists and poses immediate threat to life or limb. (ch. 10, p 131-132) |
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A critical care nurse performed an assessment on a patient who is on a mechanical ventilator. The assessment findings include rapid, and irregular respirations, absent breath sounds on the right lung, hypotension, and a notable jugular vein. Based on the findings, what should the nurse do next?
a. Document finding and continue monitoring the patient b. Increase the oxygen flow of the ventilator c. Prepare patient for chest decompression procedure d. Decrease the flow rate of the ventilator |
C. Prepare patient for chest decompression procedure
The main indication for chest decompression is clinical evidence of tension pneumothorax. Symptoms include decreased or absent breath sounds, respiratory distress, hypotension, jugular vein distention, and tracheal deviation. (ch. 10, p 137) |
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An off-duty nurse is the first on the scene of a motor vehicle accident. After calling for emergency responders, the nurse approaches a person who has a deep laceration on the right arm that is profusely bleeding. After applying direct and firm pressure, the nurse notes the presence of a radial pulse to quickly estimate blood pressure. Based on the finding, the estimated systolic BP of the patient is:
a. At least 60 mmHg b. At least 80 mmHg c. At least 70 mmHg d. At least 40 mmHg |
B. At least 80 mmHg
In a resuscitation situation, BP can be quickly and easily estimated by palpating for presence or absence of peripheral pulses. Presence of a radial pulse indicate systolic BP at least 80 mmHg. (ch. 10, p 137) |
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Which of the following is not a sign/symptom present in patients exposed to anthrax?
a. Fever with temperature greater than 100F b. Tachycardia c. Painful lesions d. Non-productive cough |
C. Painful lesions
Signs and symptoms for anthrax can occur within 7 days of infection and includes fever with temperature greater than 100F, chills, night sweats, tachycardia, non-productive cough, and a sore that starts as a raised bump and develops into a painless ulcer w/ a black area in the center. (ch. 25, p 454; CDC website) |
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A group of nurses works as first responders to a mass casualty event. Following the disaster triage system, which of the following people should be treated first?
a. Patient with multiple abrasions and contusions b. Patient with a closed fracture of the leg c. Patient with fixed and dilated pupils following a head trauma d. Patient with open pneumothorax and severe dypsnea |
D. Patient with open pneumothorax and severe dyspnea
In a disaster triage system, decisions are based on the likelihood of survival and consumption of available resources. Top priority goes to injuries that are life-threatening but survivable with minimal intervention. Conditions associated with a high mortality rate, would be assigned a low triage priority in a disaster situation, even if the person is conscious. (ch. 12, p 160-161) |
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Which of the following interventions should be included in the care plan of a patient exposed to the botulism toxin?
a. Initiate airborne precautions b. Administer antiviral medications c. Prepare patient for ET tube insertion d. Sterile wound cleansing |
C. Prepare patient for ET tube insertion
The respiratory failure and paralysis that occur with severe botulism may require a patient to be on a breathing machine (ventilator) for weeks or months. Botulism isn’t contagious through human-human contact. Standard precautions are followed when caring for patients with botulism. (ch. 25, p 454; CDC website) |
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Which of the following should healthcare providers consider when caring for a patient who is suspected of having a smallpox infection?
a. Condition is most contagious during the incubation period (7-17 days) b. Ciprofloxacin (Cipro) and Doxycycline are the treatment of choice for the condition c. It is a chronic condition that results in irreversible neurological damage d. N95 respirators are utilized during care of patients with the condition |
D. N95 respirators are utilized during care of patients with the condition
Standard, contact, and airborne precautions are initiated for patients with smallpox and PPE (gloves, gown, N95 respirator) should be used when handling contaminated clothes/material. Smallpox is an acute, contagious, and sometimes fatal disease caused by the variola virus. (ch. 25, p 454; CDC website) |
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Rapid response nurse evaluates patient response to resuscitation after defibrillation. The patient remains unresponsive and the nurse notes no palpable femoral pulse although ECG readings show normal sinus rhythm. What should be the nurse’s next action?
a. Assess for radial pulse b. Defibrillate patient c. Perform rapid chest compressions d. Assess placement of ECG leads |
C. Perform rapid chest compressions
Pulseless electrical activity (PEA) is characterized by no palpable pulse although electrical activity is displayed on the monitor. The treatment of pulseless electrical activity is similar to that for asystole. (ch 36, p 747) |
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A cardiac alert is assigned for a patient with chronic renal disease and MI. The patient is scheduled for STAT cardiac catheterization and results indicate that the patient requires CABG surgery. After cardiac catheterization procedure, the nurse reviews the patient’s lab values. Which finding would be of greatest concern prior to surgery?
a. Creatinine level = 2.8 b. Troponin level increased from 0.6 to 0.85 c. Elevated serum CK-MB level d. Platelet level = 130,000 |
A. Creatinine level = 2.8
An elevated creatinine level is a significant finding in a patient with renal insufficiency and has undergone a diagnostic procedure that utilizes the use of contrast dye. Serum cardiac markers such as troponin and CK-MB are expected to be elevated in patients with myocardial injury. (ch. 35, p 724; ch. 40, p 855) |
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The nurse caring for a patient admitted for acute MI is reviewing the most recent cardiac rhythm strip for the patient. Cardiac strip shows normal sinus rhythm with intervals of premature ventricular complexes. The patient is arousable and responsive to pain. Which action should the nurse perform first?
a. Give IV bolus of atropine b. Prepare for cardioversion c. Give amiodarone IVP d. Document findings as normal |
C. Give amiodarone IVP
With acute MI, PVCs may be considered warning dysrhythmias, possibly triggering V-tach or V-fib. With acute MI, PVCs are managed with by administering oxygen and amiodarone as prescribed. (ch. 36, p 748) |
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The nursing diagnosis of ineffective tissue (organ) perfusion is evident if a patient presents with which of the following diagnostic findings?
a. Pulmonary artery wedge pressure = 6 mmHg b. Mean arterial pressure = 50 mmHg c. Hemoglobin = 18 g/dL d. Central venous pressure = 8 mmHg |
B. Mean arterial pressure = 50 mmHg
A mean arterial pressure of at least 70 mmHg is necessary to maintain perfusion of major body organs, such as the kidneys and the brain. (Boot camp handout) |
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A patient presents with a stroke volume of 25 ml/beat and HR of 100. After calculating the patient’s cardiac output, which of the following would be the most appropriate intervention for the patient?
a. Document normal cardiac output finding b. Decrease IV fluids c. Administer IV sotalol d. Administer dobutamine IV |
D. Administer dobutamine IV
The patient’s cardiac output is below the normal range of 4-8L/min (2.5 L/min). Dobutamine is a beta-adrenergic agent used to improve myocardial contractility and increase cardiac output. (ch. 36, p 752) |
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A patient with a history of CAD and hyperlipidemia presents with fatigue, SOB, and distended neck veins. The primary healthcare provider scheduled the patient for evaluation of valvular heart disease after noting a/an ______ as an assessment finding.
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[Heart] murmur
Murmurs are pathologic heart sounds produced as a result of turbulent blood flow through diseased heart valves. They can occur during each phase of the cardiac cycle or can last throughout both phases. (ch. 35, p 719; ch. 37, p 779) |
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A patient with mitral valve stenosis admitted for unstable angina is scheduled for cardiac catheterization. Which of the following medications should the nurse administer for the patient before the procedure?
a. Levofloxacin b. Metformin c. Nitroglycerin d. Furosemide |
A. Levofloxacin
Prophylactic antibiotic therapy is required for all patients with valve disease before any invasive procedure. (ch. 37, p 781) |
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Which of the following should be the nurse’s first action when managing atrial fibrillation in a patient with valvular heart disease?
a. Administer calcium channel blocker b. Initiate unsynchronized countershock c. Administer epinephrine d. Perform high quality chest compressions |
A. Administer calcium channel blocker
The primary care provider usually starts therapy to first control the HR to maintain cardiac output and then attempt to restore normal sinus rhythm. Drugs used include calcium channel blockers or amiodarone for more difficult-to-control A-fib. (ch. 36, p 746; ch. 37, p 781) |
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Which of the following statements should not be included in the teaching of a patient with valvular heart disease about valve replacement surgery?
a. Lifelong anticoagulant therapy is required with mechanical valve replacement b. Oral anticoagulants should be taken at least 2 days before surgery c. Preoperative dental exam is needed before surgery d. A consent must be signed before the surgery |
B. Oral anticoagulants should be taken at least 2 days before surgery
Oral anticoagulants should be withheld for at least 72 hours before the procedure. If dental caries or periodontal disease is present, these problems must be resolved before valve replacement. (ch. 37, p 782) |
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EMT personnel brought a patient to the ER after a motor vehicle accident. The patient suffered multiple rib fractures and presents with dyspnea, cyanosis, increased HR, and decreased BP. The patient with flail chest would present with ________, where there is inward movement of lung area during inspiration as a result of the injury.
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Paradoxic chest movement
Paradoxic chest movement is the “sucking inward” of the loose chest area during inspiration and the “puffing out” of the same area during expiration. (ch. 34, p 698) |
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Assessment findings for a patient on a mechanical ventilator include notable jugular veins, absent lung sounds on the right side, and cyanosis. STAT chest x-ray confirms tension pneumothorax. Which of the following ABG findings would be present for the patient with the condition?
a. pH = 7.35, PCO2 = 28, HCO3 = 15 b. pH = 7.40, PCO2 = 47, HCO3 = 30 c. pH = 7.29, PCO2 = 62, HCO3 = 24 d. pH = 7.48, PCO2 = 26, HCO3 = 24 |
D. pH = 7.48, PCO2 = 26, HCO3 = 24
Tension pneumothorax, a rapidly developing and life-threatening complication, results from air leak in the lung or chest wall. Air forced into the chest cavity causes complete collapse of the affected lung. Pneumothorax is detectable on a CXR and ABG results indicate hypoxia and respiratory alkalosis. (ch. 34, p 699; boot camp handouts) |
