Adv MS test 1
ST segment monitoring for ischemia has gained increasing importance with the advent of thrombolytic therapy. What is the most accurate method for monitoring the existence of true ischemic changes? a. 12-lead ECG b. Biomarkers c. Echocardiogram d. S-lead ECG
a. 12-lead ECG
What are manifestations of acute coronary syndrome (ACS)? (SATA) a. Unstable angina b. Dysrhythmia c. ST-segment elevation myocardial infarction (STEMI) d. Stable angina e. Non-ST segment elevation myocardial infarction
a. Unstable angina c. ST-segment elevation myocardial infarction (STEMI) e. Non-ST segment elevation myocardial infarction
The nurse is caring for a patient with a descending aortic dissection. Which assessment finding is most important to report to the health care provider? a. Blood pressure of 132/98 mm Hg b. Absent bowel sounds c. 25 mL of urine output over the past hour d. Weak pedal pulses
a. Blood pressure of 132/98 mm Hg
The nurse is caring for a patient with a descending aortic aneurysm. Which assessment finding is most important to report to the health care provider? a. Blood pressure of 158/98 mm hg b. Weak pedal pulses c. 25 ml of urine output over the past hour d. absent bowel sounds
a. Blood pressure of 158/98 mm hg
An unresponsive patient is admitted to the emergency department (ED) after falling through the ice while skating. Which assessment will the nurse obtain first? a. Breath sounds b. Heart rhythm c. Pulse d. Body temperature
a. Breath sounds
An Intra Aortic balloon pump (IABP) is being used for a patient who is cardiogenic shock. Which data indicate to the nurse that the goals of treatment with the IABP are being met? a. Cardiac output (CO) of 5 L/min b. Urine output of 25 mL/hr c. Stroke volume (SV) of 40 mL/beat d. Heart rate of 110 beats/min
a. Cardiac output (CO) of 5 L/min
A patient's ventilator settings are adjusted to treat hypoxemia. The fraction of inspired oxygen is increased from 60% to 70%, and the positive end-expiratory pressure is increased from 10 to 15 cm H2O. Shortly after these adjustments, the nurse notes that the patient's blood pressure drops from 120/70 mm Hg to 90/60 mm Hg. What is the most likely cause of this decrease in blood pressure? a. Decrease in cardiac output b. Oxygen toxicity c. Hypovolemia d. Increase in venous return
a. Decrease in cardiac output
The patient with acute respiratory distress syndrome (ARDS) would exhibit which of the following symptoms? a. Decreased PaO2 levels despite increased FiO2 administration b. Respiratory acidosis associated with hyperventilation c. Elevated alveolar surfactant levels d. Increased lung compliance with increased FiO2 administration
a. Decreased PaO2 levels despite increased FiO2 administration
A nurse cares for a patient for 4 hours of post-percutaneous coronary intervention (PCI). The nurse includes which assessments to best identify the most common complication at PCI? (SATA) → needs to be double check!! (Lewis pg. 715) a. Discomfort or pain report b. Electrocardiogram tracing c. Current WBC count d. Observation of the access site e. Pulse oximetry levels
a. Discomfort or pain report b. Electrocardiogram tracing c. Current WBC count d. Observation of the access site e. Pulse oximetry levels
A patient has cardiac catheterization using the femoral insertion site and returns to the recovery room. Which action by the new nurse demonstrates lack of understanding of the post-op care if this patient? a. Elevating the head of the bed b. Assessing the motor function of the patient's foot c. Resuming the pre procedure medications as prescribed d. Providing fluids by mouth
a. Elevating the head of the bed
A patient becomes apneic and pulseless. CPR has been initiated and the monitor shows asystole in two leads. Which of the following drugs would be used initially? a. Epinephrine b. Atropine c. Amiodarone d. Calcium gluconate
a. Epinephrine
Which statement regarding the difference between stable and unstable angina is accurate? a. Stable angina responds predictably well to nitrates. b. Stable angina is not precipitated by activity. c. Stable angina is a result of coronary artery spasm. d. Stable angina has a low correlation to coronary artery disease (CAD).
a. Stable angina responds predictably well to nitrates.
A nurse cares for a patient with a pulmonary embolism. Which assessment findings does the nurse associate with this condition? (SATA) a. Hemoptysis b. Anxiety c. Sudden chest pain d. Sudden headaches e. New onset dyspnea
a. Hemoptysis b. Anxiety c. Sudden chest pain e. New onset dyspnea
A patient with an non-ST segment elevation MI (NSTEMI) is receiving heparin. What is the purpose of heparin? a. Heparin will prevent the development of new clots in the coronary arteries b. Platelet aggregation is enhanced by iv heparin infusion c. Coronary artery plaque size and adherence are decreased with heparin d. Heparin will dissolve the clot that is blocking blood flow to the heart
a. Heparin will prevent the development of new clots in the coronary arteries
The nurse is caring for a client with fluid overload. The nurse assesses for which clinical manifestation of fluid overload? (SATA) a. Increased central venous pressure b. Edema to bilateral ankles c. Crackles upon auscultation d. Weight loss of five pounds overnight e. Decreased blood pressure
a. Increased central venous pressure b. Edema to bilateral ankles c. Crackles upon auscultation
Which risk factor should the nurse focus on when teaching a patient who has a 5 cm abdominal aortic aneurysm? a. Uncontrolled hypertension b. Abdominal trauma history c. Male gender d. Turner syndrome
a. Uncontrolled hypertension
Which risk factor should the nurse focus on when teaching a patient with a 5 cm abdominal aortic aneurysm? a. Uncontrolled hypertension b. Male gender c. Turner syndrome d. Abdominal trauma history
a. Uncontrolled hypertension
A patient reports to the nurse that his anginal pain is worse after activity. To help the patient understand this, the nurse explains that angina pectoris is a sign of which of the following? a. Myocardial Ischemia b. Coronary embolism c. Mitral insufficiency d. Myocardial Infarction
a. Myocardial Ischemia
A nurse is developing a discharged plan for a patient who has had a myocardial infarction. Planning for discharge for this patient should begin: a. On admission to the hospital b. 4 weeks after the onset of illness c. On discharge from the cardiac care unit d. On discharge from the hospital
a. On admission to the hospital
What is the preferred initial treatment of an acute myocardial infarction? a. Percutaneous coronary intervention (PCI) b. Coronary artery bypass graft (CABG) c. Fibrinolytic therapy (ICD) d. Implanted cardioverter defibrillator
a. Percutaneous coronary intervention (PCI)
The nurse on the unit notes the following rhythm on the heart monitor. The patient is unresponsive and not breathing. The nurse should a. Provide cardiopulmonary resuscitations b. Treat with intravenous amiodarone or lidocaine c. Ignore the rhythm because it is benign d. Provide electrocardioversion
a. Provide cardiopulmonary resuscitations
Which patient situation would the nurse anticipate possible Neuromuscular blockade medication to be ordered? (SATA) → needs to be double check!! a. Sedation b. Acute Respiratory Distress Syndrome (ARDS) c. Asynchronous Respirations on the ventilator d. Rapid Sequence Intubation e. Pain
a. Sedation b. Acute Respiratory Distress Syndrome (ARDS) c. Asynchronous Respirations on the ventilator d. Rapid Sequence Intubation
A patient with chest pain that is unrelieved by nitroglycerin is admitted to the coronary care unit (CCU) for observation and diagnosis. While the patient has continuous ecg monitoring what finding would most concern the nurse? a. St segment elevation b. Qrs complex changes c. Occasional PVCs d. A pr interval of 0.18 seconds
a. St segment elevation
What is an ability that is a primary difference in the skills of a certified critical care nurse compared with nurses certified in medical-surgical nursing? a. Use advanced technology to assess and maintain physiology function b. Detect and manage early complication of health problems c. Provide intensive psychological support to the patient and family d. Diagnose and treat-life threatening disease
a. Use advanced technology to assess and maintain physiology function
A nurse is caring for a patient who has a thoracic abdominal aneurysm repaired 2 days ago. Which of the following findings should the nurse consider unexpected and report to the physician immediately? a. Weakness and numbness in the lower extremities b. Abdominal pain at 5/10 on the numeric scale for the past two days c. Heart rate of 100 bpm after ambulating 200 feet d. Urine output of 2,000 mL in 24 hour
a. Weakness and numbness in the lower extremities
A strategy for preventing pulmonary embolism in patients at risk who cannot take anticoagulants is a. Administration of two aspirin tablets b. Insertion of a vena cava filter c. Infusion of thrombolytics d. Subcutaneous heparin administration every 12 hours.
b. Insertion of a vena cava filter
Which clinical manifestation most suggests a pneumothoraxin a trauma victim? a. Inspiratory crackles b. Absent breath sounds c. Pronounced crackles d. Dullness on percussion
b. Absent breath sounds
The nurse is reviewing emergency management protocols for patients in asystole. Which of the following actions should the nurse plan to take during this cardiac emergency? a. Administer IV amiodarone b. Administer IV epinephrine c. Perform defibrillation d. Prepare for transcutaneous pacing
b. Administer IV epinephrine
A patient has just returned to the nursing unit following a cardiac catheterization. What nursing intervention does the nurse perform first? a. Evaluate for urticaria and shortness of breath b. Assess insertion site for hematoma formation c. Administer pain medication d. Administer iv normal saline
b. Assess insertion site for hematoma formation
The nurse is caring for a patient on the unit and notices the rhythms attached. Identify the rhythm (EKG Strip) a. Unifocal premature ventricular contractions b. Atrial fibrillation c. Premature atrial contractions d. Ventricular tachycardia
b. Atrial fibrillation
A patient with a sinus node dysfunction has a permanent pacemaker inserted. Before discharge, what should the nurse include when teaching the patient? a. Avoid cooking with microwave ovens b. Avoid standing near anti theft device in doorways (it will turn off their pacemaker & die) c. Use mild analgesic to control the chest spasms caused by the pacing current d. Start lifting arm above that shoulder right away to prevent a "frozen shoulder"
b. Avoid standing near anti theft device in doorways (it will turn off their pacemaker & die)
Why should the critical care nurse include caregivers of the patient in the ICU as part of the healthcare team? a. Caregivers who are ignited are more likely to question the patient's quality of care b. Caregivers play a valuable role in the patient's recovery c. Caregivers are responsible for making health care decisions for the patients d. The cost of critical care will affect the entire family
b. Caregivers play a valuable role in the patient's recovery
The nurse is caring for a patient who intubated and mechanically ventilated. Which assessment findings lead the nurse to perform endotracheal suctioning? (SATA) a. Heart rate of 64 bpm b. Coarse rhonchi bilaterally c. Increased oxygen requirements d. Low pressure alarm beeping e. Increased incident of cough
b. Coarse rhonchi bilaterally c. Increased oxygen requirements e. Increased incident of cough
The nurse is caring for a client who suddenly develops the following rhythm on the monitor. Which of the following is the most appropriate initial action? (EKG Strip) a. Amiodarosone administration b. Defibrillation c. Cardioversion d. Epinephrine administration
b. Defibrillation
A patient reports that he has been having "indigestion" for the last few hours. Upon further review, the nurse suspects the patient is having chest pain. Cardiac biomarkers and a 12 lead electrocardiogram (ECG) are done. What finding is most significant in diagnosing an acute coronary syndrome (ACE) within the first 3 hours? a. Indigestion and chest pain b. Elevated troponin I c. Inversed T waves d. Elevated BNP
b. Elevated troponin I
The nurse is assisting with endotracheal intubation and understands that correct placement of the endotracheal tube in the trachea would be identified by which the following? (SATA) a. Auscultation of air over the epigastrium b. Equal bilateral breath sounds upon auscultation c. Symmetrical chest rest and fall d. Positive Instruction of carbon dioxide (CO2) through detector devices e. Fogging of the endotracheal tube
b. Equal bilateral breath sounds upon auscultation c. Symmetrical chest rest and fall d. Positive Instruction of carbon dioxide (CO2) through detector devices
A strategy for preventing pulmonary embolism in patient at risk who cannot take anticoagulants is a. Subcutaneous heparin administration every 12 hours b. Insertion of a vena cava filter c. Infusion of thrombolytics d. Administration of two aspirin tablets every 4 hours
b. Insertion of a vena cava filter
A patient was admitted following an aspiration event on the medical surgical floor. The patient is receiving 40% oxygen via a simple face mask. The patient has become increasingly agitated and confused. The patient's oxygen saturation has dropped from 92% to 84%. The nurse notifies the practitioner about the change in the patient's condition. What interventions should the nurse anticipate? a. Orders for a sedative b. Intubation and mechanical ventilation c. Suction and reposition the patient d. Change in antibiotics orders
b. Intubation and mechanical ventilation
Which of the following statements is true about central venous pressure? Sata a. Decreases in patients with right ventricular failure b. Is a measure of preload c. Increases in cases of hypervolemia d. Decrease in cases of hypovolemia e. Increases in patients with left ventricular failure
b. Is a measure of preload c. Increases in cases of hypervolemia d. Decrease in cases of hypovolemia
The nurse is caring for a patient who is being turned prone as part of treatment for acute respiratory distress syndrome (ARDS). The nurse understands that the priority nursing concern for this patient is which of the following? a. Psychological support to patient and family b. Management and protection of the airway c. Prevention of gastric aspiration d. Prevention of skin breakdown and nerve damage
b. Management and protection of the airway
The nurse is caring for mechanically ventilated patient and responds to a low inspiratory pressure alarm. Recognizing possible causes for the alarm, the nurse assesses for which of the following? (SATA) a. Kink on the tubing b. Partial extubation c. ETT cuff leak d. Disconnection from the ventilator e. Cough or attempting to talk
b. Partial extubation c. ETT cuff leak d. Disconnection from the ventilator
A mode of pressure targeted ventilation that provide positive pressure to decrease the workload of spontaneous breathing through the endotracheal tube is a. T piece adaptor b. Pressure support ventilation c. Positive end expiratory pressure d. Continuous positive airway pressure
b. Pressure support ventilation
What is the name of the valve that allows blood flow into the pulmonary artery? a. Mitral valve b. Pulmonic valve c. Tricuspid d. Aortic
b. Pulmonic valve
In caring for the patient with ARDS, what is the most characteristic sign the nurse would expect the patient to exhibit? a. Bronchial breath sounds b. Refractory hypoxemia c. Increased pulmonary artery wedge pressure (PAWP) d. Progressive hypercapnia
b. Refractory hypoxemia
Which assessment finding would lead the nurse to suspect the early onset of hypoxemia? a. Dysrhythmia b. Restlessness c. Central cyanosis d. Hypotension
b. Restlessness
A nurse provides oral care for a patient who is mechanically ventilated. What is the best rationale for providing this care? a. Routine oral care may reduce the risk of tooth decay b. Routine oral care may reduce the risk of pneumonia c. The patient's cavity requires regular moisture d. The patient is fully dependent on the nurse's actions
b. Routine oral care may reduce the risk of pneumonia
Which AV block image attached can be described as a gradually lengthening PR interval until ultimately the final P wave in the group fails to conduct? → needs to be double check!! a. Third degree block b. Second degree AV block, type I (PR interval it get short and longer not the same) c. Second degree AV block type II (PR interval is the same basically identical) d. First degree AV block (when the P is longer than it should be)
b. Second degree AV block, type I (PR interval it get short and longer not the same)
When assessing the patient for hypoxemia, the nurse recognizes that an early sign of the effect of hypoxemia on the cardiovascular system is a. Tachypnea b. Tachycardia c. Restlessness d. Heart block
b. Tachycardia
A patient who is being admitted to the emergency department with intermittent chest pain gives the following list of daily medications to the nurse. Which medication has the most immediate implications for the patient's care? a. Warfarin (Coumadin) b. Tadalafil c. Furosemide (Lasik) d. Diltiazem (Cardizem)
b. Tadalafil
A patient is scheduled to have CABG surgery. What should the nurse should explain is involved with the procedure? a. Reversed segments of a saphenous artery from the aorta will be anastomosed to the coronary artery distal to an obstruction b. The internal mammary artery will be detached from the chest wall and attached to a coronary artery distal to the stenosis c. A systemic graft will be used as a tube for blood flow from the aorta to a coronary artery distal to an obstruction d. A stenosis coronary artery will be resected and a synthetic arterial tube graft will be inserted to replace the diseased artery
b. The internal mammary artery will be detached from the chest wall and attached to a coronary artery distal to the stenosis
The nurse is caring for a patient who arrived in the emergency department with acute respiratory distress. Which assessment finding by the nurse requires the most rapid action? a. The patient PaCO2 is 45 mm Hg b. The patient's PaO2 is 33 mm Hg c. The patient's respirations are shallow d. The patient's respiratory rate is 32 breaths/min
b. The patient's PaO2 is 33 mm Hg
The nurse provides pre-procedure education to a patient scheduled to have cardiac catheterization. Which statement does the nurse include? a. "This procedure is performed at the bedside." b. "You may develop a headache but this is normal" c. "You may feel flushing, warmth, or palpitation during the procedure." d. "There may at first be some intense pain that resolves quickly."
c. "You may feel flushing, warmth, or palpitation during the procedure."
After receiving the change-end of the shift report on the medical unit, Which patient should the nurse assess first? a. A patient with pneumonia who has crackles bilaterally in the lung bases b. A patient with emphysema who has an oxygen saturation of 90% to 92% c. A patient with septicemia who has intercostal and suprasternal retractions d. A patient with cystic fibrosis who has thick green-colored sputum
c. A patient with septicemia who has intercostal and suprasternal retractions
A patient with which disorder would benefit from the use of the intra aortic balloon pump (IABP)? a. A dissecting thoracic aortic aneurysm b. An insufficient aortic valve c. Acute myocardial infarction with cardiogenic shock d. Generalized peripheral vascular disease
c. Acute myocardial infarction with cardiogenic shock
The nurse is caring for a patient with a pulmonary artery catheter. Assessment findings include a BP 85/40 mm Hg, HR of 125 bpm, RR 35 bpm, and arterial SpO2 of 90% on a 50% Venturi mask. Hemodynamic values include a cardiac output of 1.0 L/min and a central venous pressure of 1 mm Hg. The nurse questions which of the following physician's orders? a. Obtain arterial blood gas and serum electrolytes b. Infuse 500 mL 0.9% normal saline over 1 hour c. Administer furosemide (Lasix) 20 mg IV d. Tirate supplementary oxygen to achieve a SpO2 94%
c. Administer furosemide (Lasix) 20 mg IV
A trauma victim has sustained right rib fractures and pulmonary contusions. Auscultation reveals decreased breath sounds on the right side. Bulging intercostal muscles are noted on the right side. Heart rate (HR) is 130 beats/min, respiratory rate (RR) is 32 breaths/min, and breathing is labored. In addition to oxygen administration, what procedure should the nurse anticipate? a. Pericardiocentesis b. Thoracentesis c. Chest tube insertion d. Emergent intubation
c. Chest tube insertion
A patient present to the walk in clinic complaining of intermittent chest pain on exertion, which is eventually attributed to angina. The nurse should inform the patient that anginal is most often attributable to what cause? a. Decreased cardiac contractility b. Infarction of the myocardium c. Coronary arteriosclerosis d. Decreased cardiac output
c. Coronary arteriosclerosis
A patient admitted to the coronary care unit (CCU) with a stemi is restless and anxious. The blood pressure is 86/40 mm hg and the heart rate is 132 beats/min. Based on this information, which patient problem is the priority? a. Anxiety b. Acute pain c. Decreased cardiac output d. Stress management
c. Decreased cardiac output
A patient admitted to the coronary care unit (CCU)with a stemi is restless and anxious. The blood pressure is 86/40 mm hg and the heart rate is132 beats/min. Based on this information, which patient problem is the priority? a. Anxiety b. Acute pain c. Decreased cardiac output d. Stress management
c. Decreased cardiac output
The patient with acute respiratory distress syndrome (ARDS) would exhibit which of the following symptoms? a. Respiratory acidosis with hyperventilation b. Increased lung compliance with increased fio2 administration c. Decreasing pao2 levels despite increased fio2 administration d. Elevated alveolar surfactant levels
c. Decreasing pao2 levels despite increased fio2 administration
A patient has a cardiac catheterization using the femoral insertion site and returns to the recovery room. Which action by a new nurse demonstrates the lack of understanding of the post op care of this patient? a. Resuming pre procedure meds as prescribed b. Providing fluids by mouth c. Elevating head of the bed d. Assessing the motor function of the patient's foot
c. Elevating head of the bed
New onset atrial fibrillation can be serious for which reason? a. It indicates that the patient is about to have an MI b. It may increase cardiac output to dangerous levels c. It increases the risk of stroke and pulmonary embolism from atrial clots d. It increases the patient's risk of deep venous thrombosis
c. It increases the risk of stroke and pulmonary embolism from atrial clots
The nurse is questioning the accuracy of the arterial catheter readings, which two actions should the nurse perform to ensure the accuracy of the transducer? a. Obtain a cuff blood pressure and adjust the monitor to match b. Have the patient laid flat and closing the transducer to air c. Level the transducer to the phlebostatic axis and zero the transducer d. Obtain blood return on the arterial line and closing all the stopcocks
c. Level the transducer to the phlebostatic axis and zero the transducer
The nurse is caring for a mechanically ventilated patient and notes the high pressure alarm sounding. The nurse cannot quickly identify the cause of the alarm and notes the patient's oxygen saturation is decreasing and heart rate and respiratory rate are increasing. The nurse's priority action is to a. Ask the respiratory therapist to get a new ventilator b. Call the rapid response team to assess the patient c. Manually ventilate the patient while calling for the respiratory therapist d. Continue to find the cause of the alarm and fix it
c. Manually ventilate the patient while calling for the respiratory therapist
The nurse is concerned that a patient is at an increased risk of developing a pulmonary embolism and develops a plan of care for prevention to include which of the following? a. Oral care b. Bed rest with head of bed elevated c. Mobility d. Coughing and deep breathing
c. Mobility
A surgical repair is planned for a patient whohas 5.5-cm abdominal aortic aneurysm (AAA). On physical assessment of the patient, what shouldthe nurse expect to find. a. Weakness in the lower extremities progressing to paraplegia b. Severe back pain with flank ecchymosis c. Presence of a bruit in the periumbilical area d. Hoarseness and dysphagia
c. Presence of a bruit in the periumbilical area
Which statement regarding the difference between stable and unstable angina is accurate? a. Stable angina is a result of coronary artery spasm b. Stable angina is not precipitated by activity c. Stable angina responds predictable well to nitrates d. Stable angina has a low correlation to coronary artery
c. Stable angina responds predictable well to nitrates
A patient's status worsens and needs mechanical ventilation. The pulmonologist wants the patient to receive 10 breaths/min from the ventilator but wants to encourage the patient to breathe spontaneously between the mechanical breaths at his own tidal volume. This mode of ventilation is called a. assist/control ventilation b. Controlled ventilation c. Synchronized intermittent mandatory ventilation d. Positive end expiratory pressure
c. Synchronized intermittent mandatory ventilation
A patient has just returned to the nursing unit following a cardiac catheterization. What nursing intervention does the nurse perform first? a. (?) and shortness of breath b. Administer IV normal saline c. Administer pain medication d. Assess insertion sites for hematoma formation
d. Assess insertion sites for hematoma formation
A nurse is caring for a patient with a pneumothorax. A chest tube has been placed by the physician and is attached to a traditional water-seal drainage system. The nurse suspects possible leaks in the chest tube and pleural drainage system if they observe which of the following? a. Fluid in the water-seal chamber fluctuates with the patient's breathing b. The water level in the water-seal suction control chamber are decreased c. There is continuous bubbling in the water-seal chamber d. There is constant bubbling of water in the suction control chamber
c. There is continuous bubbling in the water-seal chamber
A nurse is caring for a patient with a pneumothorax. A chest tube has been placed by the physician and is attached to a traditional water-seal drainage system. The nurse suspects possible leaks in the chest tube and pleural drainage system if they observe which of the following? a. Fluid in the water-seal chamber fluctuates with the patient's breathing b. The water level in the water-seal suction control chamber are decreased c. There is continuous bubbling in the water-seal chamber- Intermittent Bubble (Normal); Continuous Bubble (Abnormal) in a water-seal chamber d. There is constant bubbling of water in the suction control chamber
c. There is continuous bubbling in the water-seal chamber- Intermittent Bubble (Normal); Continuous Bubble (Abnormal) in a water-seal chamber
The patient is admitted with a fever and rapid heart rate. The patient's temperature is 103f (39.4c). The nurse places the patient on a cardiac monitor and notices the patient...(cut off) → needs to be double check!! a. Medications to lower heart rate b. Treatment to reduce the blood pressure c. Treatment to lower temperature d. Treatment to lower cardiac output
c. Treatment to lower temperature
The main purpose of critical care certification is to a. prepare for graduate school b. Assure the consumer that you will c. Validate knowledge of critical care nursing d. Promote magnet status for your facility
c. Validate knowledge of critical care nursing
The nurse reviews a patient's ECG and notes narrow QRS waves. With regards to the cardiac cycle, what does the QRS waveform indicate? a. Atrial repolarization b. Atrial depolarization c. Ventricular depolarization d. Ventricular repolarization
c. Ventricular depolarization
During the patient's acute postoperative period following repair of an AAA, the nurse should ensure that which goal is achieved? a. Iv fluids are given to maintain urine output of 100 ml/hr b. The patient's bp is kept lower than the baseline to prevent leaking at the incision site c. Hypothermia is maintained to decrease oxygen needs d. BP and all peripheral pulses are assessed at least every hour
d. BP and all peripheral pulses are assessed at least every hour
The nurse is caring for four patients in the telemetry unit. Which patient should the nurse assess first? a. A patient with echocardiogram report that notes severe aortic stenosis b. A patient with a diagnosis of stable angina who calls with a report of chest pain 4/10 c. A patient who has a normal sinus rhythm admitted for intermittent tachycardia d. A patient with a rhythm change from sinus rhythm to ventricular fibrillation (V-fib and V-tach is deadly!!)
d. A patient with a rhythm change from sinus rhythm to ventricular fibrillation (V-fib and V-tach is deadly!!)
The nurse is caring for a patient with a chest tube for a pneumothorax. A family member trips on the tubing and pulls the chest tube out. The patient's HR increases to 140 bpm, and the SpO2 drops to 88%. There is an audible air leak at the insertion site. What should the nurse do? a. Assess lung sounds b. Notify the healthcare provider c. Apply an occlusive sterile dressing and secure it on 4 sides d. Apply an occlusive sterile dressing and secure it on 3 sides
d. Apply an occlusive sterile dressing and secure it on 3 sides
A nurse assesses a patient who is receiving from a thoracentesis. Which assessment finding is most concerning to the nurse? a. Respiratory rate of 25 breaths/min b. Expiratory wheezes in the upper and lower lobes c. Heart rate 115 beats/min d. Diminished breath sound on the affected side
d. Diminished breath sound on the affected side
A nurse is viewing the cardiac monitor in the patient's room and notes that the patient has just gone into the rhythm attached. The patient is unresponsive and pulseless. The nurse would prepare to do which of the following? a. Prepare the synchronized cardioversion b. Administer magnesium intravenously c. Administer amiodarone (Cordarone) intravenously d. Immediately defibrillate
d. Immediately defibrillate
A patient is being mechanically ventilated in the synchronized intermittent mandatory ventilation mode at a rate of 6 breaths/min. His spontaneous respirations are 17 breaths/min. He receives a dose of morphine sulfate and his respirations decrease to 6 breaths/min. What adjustments need to be made to the patient's ventilator settings? a. Change to assist/control ventilation at a rate of 4 breaths/min b. Add positive end expiratory pressure (PEEP) c. Add pressure support d. Increase the respiratory rate
d. Increase the respiratory rate
A nurse is teaching a nursing student about the modes of volume ventilation. Which statement regarding the assist control mode indicates the student understood the information? a. It delivers gas at a preset volume, allowing the patient to breathe spontaneously at his or her own volume b. It delivers gas at preset volume, at a set rate, and in response to the patient's inspiratory efforts c. It applies positive pressure during both ventilator breaths and spontaneous breaths d. It delivers gas at preset rate and pressure regardless of the patient's inspiratory efforts
d. It delivers gas at preset rate and pressure regardless of the patient's inspiratory efforts
Which of the following symptoms usually signifies rapid expansion and impending rupture of an abdominal aortic aneurysm? a. Stable angina b. Abdominal Indigestion c. Absent pedal pulse d. Lower back pain
d. Lower back pain
The nurse is concerned that a patient is at increased risk of developing a pulmonary embolism and develops a plan of care for prevention to include which of the following? a. Antiseptic oral care b. Bed rest with head of bed elevated c. Coughing and deep breathing d. Mobility
d. Mobility
A patient experienced a chest wall contusion as a result of being struck in the chest with a baseball bat. The emergency department nurse should be concerned if which finding is observed during the initial assessment? a. Large bruise on the chest b. Complaint of the chest wall pain c. Heart rate of 110 beats/min d. Paradoxical chest movement
d. Paradoxical chest movement
A nurse working in the ICU sees the following rhythm on the monitor. The nurse goes into the room and finds the patient cool, clammy, and in and out of consciousness. What priority action by the nurse? (EKG Strip) a. Document the finding and continue to monitor b. Prepare for defibrillation c. Begin chest compressions d. Prepare to administer atropine
d. Prepare to administer atropine
One of the early signs of hypoxemia in the nervous system is a. Cyanosis b. Tachycardia c. Tachypnea d. Restlessness
d. Restlessness
To determine whether a tension pneumothorax is developing in a patient with chest trauma, for what reason does the nurse assess the patient? a. Decreased movement and diminished breath sounds on the affected side b. Muffled and distant heart sounds with decreasing blood pressure c. Dull percussion sounds on the injured side d. Severe respiratory distress and tracheal deviation
d. Severe respiratory distress and tracheal deviation
Inability to communicate is distressing to patients in the critical care environment who cannot speak. The nurse should utilize all of the following methods to promote communication except: a. Computer keyboards b. Notepads c. Picture boards d. Speaking in a loud voice
d. Speaking in a loud voice
An unlicensed assistive personnel (UAP) is taking care of a patient with a chest tube. The nurse should intervene when she observes the UAP a. Reminding the patient to cough and deep breath every 2 hours b. looping the drainage tubing on the bed c. Securing the drainage container in an upright position d. Stripping or milking the chest tube to promote drainage
d. Stripping or milking the chest tube to promote drainage
Which hemodynamic parameter best reflects the effectiveness of drugs that the nurse gives to reduce a patient's left ventricular afterload? a. Pulmonary vascular resistance (PVR) b. Mean arterial pressure (MAP) c. Pulmonary artery wedge pressure (PAWP) d. Systemic vascular resistance (SVR)
d. Systemic vascular resistance (SVR)
A nurse is caring for a patient on a ventilator with ventilator settings with a preset tidal volume. Which best describes the tidal volume (VT) in this setting? a. The amount of oxygen in the surrounding air b. The number of breaths each minute c. The pressure needed for each breath of the patient d. The amount of air inhaled with each breath
d. The amount of air inhaled with each breath
Positive end-respiratory pressure (PEEP) is a mode of ventilatory assistance that produces the following conditions: a. For each spontaneous breath taken by the patient, the tidal volume is determined by the patient's ability to generate negative pressure. b. Each time the patient initiates a breath, the ventilator delivers a full present tidal volume c. The patient must have a respiratory drive, or no breaths will be delivered. d. There is pressure remaining in the lungs at the end of the expiration that is measured in cm H2O.
d. There is pressure remaining in the lungs at the end of the expiration that is measured in cm H2O.
The patient's arterial blood gas (ABG) values on room air are PaO2 70 mm hg, ph 7.31, PaCO2 52 mm hg, HCO3 24 meq/L. What is the interpretation of the patients ABG? → needs to be double check!! a. Compensated respiratory alkalosis b. Compensated respiratory acidosis c. Uncompensated metabolic alkalosis PaO2: 80-100, PaCO2: 35-45, HCO3: 22-28, pH: 7.35-4.5 d. Uncompensated respiratory acidosis (Because HCO3 is normal)
d. Uncompensated respiratory acidosis (Because HCO3 is normal)
To verify the correct placement of an endotracheal tube (ET) after insertion, the best initial action by the nurse is to a. Auscultate for bilateral breath sounds b. Observe for symmetrical chest movement c. Obtain a portable chest x ray d. Use an end tidal CO2 monitor
d. Use an end tidal CO2 monitor
The nurse is caring for mechanically ventilated patient and responds to a high inspiratory pressure alarm. Recognizing possible causes for the alarm, the nurse assesses for which of the following? (SATA) f. Kink in the ventilator tubing g. Spontaneous breathing h. Need for suctioning i. Disconnection from the ventilator j. Cough or attempting to talk
f. Kink in the ventilator tubing h. Need for suctioning j. Cough or attempting to talk
