175Qw/exp (most part) CC Midterm- CONTAINS HEMODYN&RESPventilation

The nurse is caring for a patient who is on a cardiac monitor. The nurse realizes that the sinus node is the pacemaker of the heart because it is: A. The fastest pacemaker cell in the heart B. The only pacemaker cell in the heart C. The only cell that does not affect the cardiac cycle D. Located in the left side of the heart

A. The fastest pacemaker cell in the heart (60-100bpm)

The basic underlying pathophysiology of acute respiratory distress syndrome results from: A. Decrease in number of WBCs available B. Damage to right maintstem bronchus C. Damage to type II pneumocytes, which produce surfactant D. Decreased capillary permeability

C. Damage to type II pneumocytes Acute respiratory distress syndrome results in damage to the pneumocytes, increased capillary permeability, and noncardiogenic pulmonary edema.

While instructing a patient on what occurs with a myocardial infarction, the nurse plans to explain which process? A. Coronary artery spasm B. Decreased blood flow (ischemia) C. Death of cardiac muscle from lack of oxygen (tissue necrosis) D. Sporadic decrease in oxygen to the heart (transient oxygen imbalance)

C. Death of cardiac muscle from lack of oxygen (tissue necrosis) Acute myocardial infarction is death (tissue necrosis) of the myocardium that is caused by lack of blood supply from the occlusion of a coronary artery and its branches.

Central venous oxygen saturation (ScvO2)

Normal range: 65-85% Similar to SvO2 but measured in the distal portion of a central venous catheter proximal to the right atrium and before the point where the cardiac sinus returns deoxygenated blood from the myocardium, thus the reason for the discrepancy between SvO2 and ScvO2 normal ranges

The nurse knows that in advanced cardiac life support, the secondary survey includes steps A-B-C-D where D refers to: A. Defibrillate B. Differential diagnosis C. Diltiazem IV push D. Do not resuscitate

B. Differential diagnosis The A-B-C-D (airway, breathing, circulation, differential diagnosis) in the Advanced Cardiac Life Support (ACLS) secondary survey involves the performance of more in-depth assessments and interventions. Differential diagnosis involves investigation into the cause of the arrest. If a reversible cause is identified, a specific therapy can be initiated.

Which code drugs can be given safely through an endotracheal tube? (Select all that apply) A. Adenosine B. Atropine C. Epinephrine D. Vasopression

B,C,D Medications that can be administered through the endotracheal tube until IV access is established are atropine, epinephrine, lidocaine, and vasopressin.

The nurse calculates the PaO2/FiO2 ratio for the following values: PaO2 is 78 mm Hg; FiO2 is 0.6 (60%). A. 46.8, meets criteria of ARDS B. 130, meets criteria of ARDS C. 468, normal lung function D. Not enough date to compute ratio

B. 130, meets criteria of ARDS

The patient has undergone open chest surgery for coronary artery bypass grafting. One of the nurses responsibilities is to monitor the patient for which common postoperative dysrhythmia? A. Second degree heart block B. Atrial fibrillation or flutter C. Ventricular ectopy D. Premature junctional contractions

B. Atrial fibrillation or flutter

Oxygen saturation (SaO2) represents: A. Alveolar oxygen tension B. Oxygen that is chemically combined with hemoglobin C. Oxygen that is physically dissolved in plasma D. Total oxygen consumption

B. Oxygen that is chemically combined with hemoglobin

During cardioversion, the nurse would synchronize the electrical charge to coincide with which wave of the ECG complex? A. P B. R C. S D. T

B. R waves During cardioversion, the electrical shock is synchronized to deliver shock on the R wave. This is to prevent the shock from being delivered during repolarization (T wave). Ventricular fibrillation may occur if the shock is delivered on the T wave.

Acute myocardial infarction (AMI) can be classified as which of the following? (Select all that apply.) A. Angina B. Nonischemic C. Non Q wave D. Q wave

C,D

A patient develops frequent ventricular ectopy. The nurse prepares to administer which drug? A. Adenosine B. Atropine C. Lidocaine D. Magnesium

C. Lidocaine Lidocaine is an antidysrhythmic drug that suppresses ventricular ectopic activity.

A patient presents to the emergency department in acute respiratory failure secondary to community-acquired pneumonia. The patient has a history of chronic obstructive pulmonary disease. The nurse anticipates which treatment to facilitate ventilation? A. Emergency tracheostomy and mechanical ventilation B. Mechanical ventilation via and endotracheal tube C. Noninvasive positive pressure ventilation D. Oxygen at 100% via face-valve-mask device

C. Noninvasive positive pressure ventilation (NPPV) Noninvasive measures are often recommended in the initial treatment of the patient with chronic obstructive pulmonary disease to prevent intubation and ventilator dependence. The history of chronic obstructive pulmonary disease increases the risk for ventilator dependence, so noninvasive options are a priority. Bag-valve ventilation with 100% oxygen is not required at this time and could depress the respiratory drive that exists. Emergency tracheostomy is not indicated, as there is an indication of an obstructed airway.

The nurse is caring for a patient whose ventilator settings include 15 cm H2O of positive end-expiratory pressure (PEEP). The nurse understands that although beneficial, PEEP may result in: A. Fluid overload secondary to decreased venous return B. High cardiac index secondary to more efficient ventricular function C. Hypoxemia secondary to prolonged positive pressure at expiration D. Low cardiac output secondary to increased intrathoracic pressure

D. low cardiac output secondary to increased intrathoracic pressure Positive end-expiratory pressure, especially at higher levels, can result in a decreased cardiac output and index secondary to increased intrathoracic pressure, which impedes venous return. Fluid overload is not an expected finding. The cardiac index would likely decrease, not increase, along with cardiac output. PEEP is used to treat hypoxemia; it does not cause it.

Indications for monitoring SvO2 and ScvO2

For any critically ill or injured patient who has the potential to develop an imbalance between oxygen delivery and oxygen consumption or demand (i.e. trauma, acute respiratory distress syndrome, sepsis, complex cardiac surgery)

A 53-year-old, 80-kg patient is admitted to the cardiac surgical intensive care unit after cardiac surgery with the following arterial blood gas (ABG) levels. What is the nurses interpretation of these values? pH 7.4 PaCO2 40 mm Hg Bicarbonate 24 mEq/L PaO2 95 mm Hg O2 saturation 97% Respirations 20 breaths per minute

Normal ABG values

Mixed venous oxygen saturation (SvO2)

Normal range - 60-80% Provides an assessment of balance between oxygen supply and demand. Measured in the pulmonary artery. Higher values indicate increased O2 supply, decreased O2 demand, or the inability to extract oxygen from blood Lower values indicate decreased O2 supply from low hemoglobin, low CO, low SaO2, and/or increased O2 consumption

When performing an initial pulmonary artery occlusion pressure (PAOP), what are the best nursing actions? (Select all that apply.) A. Inflate the balloon for no more than 8-10 seconds while noting the waveform change B. Inflate the balloon with air, recording the volume necessary to obtain a reading C. Maintain the balloon in the inflated position for 8 hours following insertion D. Zero reference and level the air-fluid interface of the transducer at the level of the phlebostatic axis

A, B, D To obtain an accurate pulmonary artery occlusion pressure (PAOP), the transducer system should be zero referenced and leveled to ensure accurate readings, and the balloon should be inflated with enough air, for no more than 8 to 10 seconds until a change in waveform is noted. The volume of air necessary to inflate the balloon should be documented. Maintaining the balloon in the inflated position can lead to pulmonary infarction.

The patient has been in chronic heart failure for the past 10 years. He has been treated with beta-blockers and angiotensin-converting enzyme inhibitors as well as diuretics. His symptoms have recently worsened, and he presents to the ED with severe shortness of breath and crackles throughout his lung fields. His respirations are labored and arterial blood gases show that he is at risk for respiratory failure. Which of the following therapies may be used for acute, short-term management of the patient? (Select all that apply). A. Dobutamine B. Intraaortic balloon pump C. Nesiritide (natrecor) D. Ventricular assist device

A,B,C This patient is showing signs and symptoms of an acute exacerbation of heart failure. Dobutamine and nesiritide are medications administered for acute short-term management; mechanical assist with an intraaortic balloon pump also may be warranted.

Select the strategies for preventing deep vein thrombosis (DVT) and pulmonary embolus (PE). (Select all that apply.) A. Gradual compression stockings B. Heparin or low molecular weight heparin for patients at risk C. Sequential compression devices D. Strict bed rest

A,B,C Graduated compression stockings, sequential compression devices, and anticoagulation can reduce the risk for DVT. Physical activity can also reduce the risk; bed rest increases the risk.

The nurse is caring for a patient in acute respiratory failure and understands that the patient should be positioned: (Select all that apply.) A. High fowler's B. Side lying with head of bed elevated C. Sitting in chair D. Supine with bed flat

A,B,C Patients in respiratory distress are unable to tolerate a flat position. High Fowlers is appropriate. Side lying with head of bed elevated, sitting in a chair, and high Fowlers position are all appropriate ways to position the patient to facilitate gas exchange and comfort.

Post resuscitation goals include which of the following? (Select all that apply) A. Control dysrhythmias B. Maintain airway C. Maintain blood pressure D. Wean off oxygen

A,B,C Post-resuscitation goals include optimizing tissue perfusion by airway, blood pressure maintenance, oxygenation, and control of dysrhythmias.

The nurse is caring for a patient with cystic fibrosis (CF) and understands that treatment consists of which of the following? (Select all that apply.) A. Airway clearance therapies B. Antibiotic therapy C. Nutritional support D. Tracheostomy

A,B,C The three cornerstones of care for a patient with CF are antibiotic therapy, airway clearance, and nutritional support. A tracheostomy is not a standard treatment for CF.

A patient is admitted with an acute myocardial infarction (AMI). The nurse monitors for which potential complications? (Select all that apply.) A. Cardiac dysrhythmias B. Heart failure C. Pericarditis D. Ventricular rupture

A,B,C,D

Which of the following are documented as part of the cardiopulmonary arrest record? (Select all that apply.) A. Medication administration times B. Defibrillation times, joules, outcomes C. Rhythm strips of cardiac rhythms noted D. Signatures of recorder and other personnel

A,B,C,D Documentation includes the time the code is called, the time CPR is started, any actions that are taken, and the patients response (e.g., presence or absence of a pulse, heart rate, blood pressure, cardiac rhythm). Intubation and defibrillation (and the energy used) must be documented, along with the patients response. The time and sites of IV initiations, types and amounts of fluids administered, and medications given to the patient must be accurately recorded. Rhythm strips are recorded to document events and response to treatment. Signatures of those involved in the code effort, including the recorder, are essential.

Which of the following are components of the Institute for Healthcare Improvements (IHIs) ventilator bundle? (Select all that apply.) A. Interrupt sedation each day to assess readiness to extubate B. Maintain head of bed at least 30 degrees elevation C. Provide DVT prophylaxis D. Provide prophylaxis for PUD E. Swab mouth with foam swabs every 2 hours

A,B,C,D Options A, B, C, and D are components of the IHI ventilator bundle. Oral care with chlorhexidine has recently been added to the IHI bundle. Swabbing alone provides comfort care.

Which of the following are physiological effects of positive end-expiratory pressure (PEEP) used in the treatment of ARDS? (Select all that apply.) A. Increase functional residual capacity B. Prevent collapse of unstable alveoli C. Improve arterial oxygenation D. Open collapsed alveoli

A,B,C,D Ventilatory support for ARDS typically includes PEEP to restore functional residual capacity, open collapsed alveoli, prevent collapse of unstable alveoli, and improve arterial oxygenation.

Benefits of having family present during resuscitation include which of the following? A. Facilitates the grief process B. Letting family see that everything is being done C. Sustaining patient-family relationships D. Allows the staff easy acess for organ transplant E. Provides sense of closure

A,B,C,E Families who have been present during a code describe the benefits as knowing that everything possible was being done for their loved one, feeling supportive and helpful to the patient and staff, sustaining patient-family relationships, providing a sense of closure on a life shared together, and facilitating the grief process.

A patient is admitted to the critical care unit with bradycardia at a heart rate of 39 beats/min and frequent premature ventricular contractions. Upon assessment, you note that she is lethargic and has complained of dizziness for the past 12 hours. Which of the following are acceptable treatments for symptomatic bradycardia? (Select all that apply.) A. Atropine B. Epinephrine C. Lidocaine D. Transcutaneous pacemaker

A,B,D Administer atropine, 0.5 mg IV every 3 to 5 minutes to a total dose of 3 mg for symptomatic bradycardia. Transcutaneous pacing is also indicated for symptomatic bradycardia unresponsive to atropine. Epinephrine is considered as well. Lidocaine is contraindicated in bradycardia because it can depress conduction, which would be detrimental with a heart rate of 39 beats/min.

The nurse is caring for a mechanically ventilated patient. The nurse understands that strategies to prevent ventilator-associated pneumonia include which of the following? (Select all that apply.) A. Drain condensate from the ventilator tubing away from the patient B. Elevate HOB to 30-45 degrees C. Instill normal saline as part of suctioning procedure D. Perform regular oral care with chlorhexidine

A,B,D Condensate should be drained away from the patient to avoid drainage back into the patients airway. Prevention guidelines recommend elevating the head of bed at 30 to 45 degrees. Regular antiseptic oral care, with an agent such as chlorhexidine, reduces oropharyngeal colonization. Normal saline is not recommended as part of the suctioning procedure, and it may increase the risk for infection.

Identify the priority interventions for managing symptoms of an acute myocardial infarction (AMI) in the ED. (Select all that apply). A. Administration of morphine B. Administration of nutroglycerin C. Dopamine infusion D. Oxygen therapy

A,B,D The initial pain of AMI is treated with morphine sulfate administered intravenously. NTG may be given to reduce the ischemic pain of AMI. NTG increases coronary perfusion because of its vasodilatory effects. Oxygen administration is important for assisting the myocardial tissue to continue its pumping activity and for repairing the damaged tissue around the site of the infarct.

Identify diagnostic criteria for ARDS. (Select all that apply.) A. Bilateral infiltrates on chest x-ray study B. Decreased cardiac output C. PaO2/FiO2 ratio of less than 200 D. Pulmonary artery occlusion pressure of more than 18 mm Hg

A,C Diagnostic criteria for ARDS include bilateral infiltrates, or white out, on chest x-ray study and a low PaO2/FiO2 ratio. Decreased cardiac output and a high PAOP are seen in pulmonary edema associated with cardiac causes. Decreased cardiac output and a high PAOP are seen in pulmonary edema associated with cardiac causes.

The initial pain of AMI is treated with morphine sulfate administered intravenously. NTG may be given to reduce the ischemic pain of AMI. NTG increases coronary perfusion because of its vasodilatory effects. Oxygen administration is important for assisting the myocardial tissue to continue its pumping activity and for repairing the damaged tissue around the site of the infarct. A. Dysrhythmias are common occurrences B. Men have more atypical symptoms than women C. Midsternal chest pain is a common presenting symptom D. Some patients are asymptomatic

A,C,D Chest pain is a common presenting symptom in AMI. Dysrhythmias are commonly seen in AMI. Some individuals may have ischemic episodes without knowing it, thereby having a silent infarction. Women are more likely to have atypical signs and symptoms, such as shortness of breath, nausea and vomiting, and back or jaw pain.

The nurse is caring for a 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? (Select all that apply.) A. Coughing or attempting to talk B. Disconnection from ventilator C. Kinks in the ventilator tubing D. Need for suctioning

A,C,D Coughing, kinks, and mucus in the airway can cause the inspiratory pressure to increase; ventilator disconnects result in low-volume alarms. A disconnection from the ventilator would result in a low exhaled volume alarm, not a high-pressure alarm.

Which of the following statements about defibrillation are correct? (Select all that apply) A. Early defibrillation is recommended before other actions B. It is not necessary to ensure that personnel are clear of the patient if hands-off defibrillation is used C. It is not necessary to synchronize the defibrillation shocks D. Paddles/patches can be placed anteriorly and posteriorly on the chest

A,C,D Defibrillation is indicated as soon as possible because early defibrillation and CPR increase the chance of survival. Regardless of the method of defibrillation, all personnel must avoid contact with the patient or bed during the shock delivery. Shocks are delivered without synchronization. Anterior paddle placement is used most often; however, the alternative method is anteroposterior placement.

The nurse should call the rapid response EMS for which patients? (Select all that apply) A. 53 year old with pneumonia and severe respiratory distress B. 17 year old with apnea following a head injury C. 24 year old experiencing a severe asthmatic attack with stridor D. 73 year old patient with bradycardia (40 bpm) E. 52 year old with no palpable pulse

A,C,D Rapid response teams (RRTs) or medical emergency teams focus on addressing changes in a patients clinical condition before a cardiopulmonary arrest occurs.

The nurse is preparing to obtain a right atrial pressure (RAP/CVP) reading. What are the most appropriate nursing actions? (Select all that apply.) A. Compare measured pressures with other physiological parameters B. Flush the central venous catheter with 20mL of sterile saline C. Inflate the balloon with 3mL of air and record the pressure tracing D. Obtain the right atrial pressure measurement during end exhalation E. Zero reference the transducer system at the level of the phlebostatic axis

A,D,E To obtain an accurate right atrial pressure (RAP/CVP) reading, the transducer system should be zero referenced and leveled with the phlebostatic axis to ensure accurate readings; the value should be obtained during end exhalation, and any obtained measure should be evaluated in light of the patients physiological parameters and physical assessment. The catheter does not need to be flushed before measurement because continuous saline flush is part of the RAP system. There is no balloon with a right atrial pressure (RAP/CVP) catheter.

The charge nurse is supervising the care of four critical care patients being monitored using invasive hemodynamic modalities. Which patient should the charge nurse evaluate first? A. A patient in cardiogenic shock with a cardiac ouput of 2L/min B. A patient with a pulmonary artery systolic pressure (PAP) of 20 mm Hg C. Hypovolemic patient with a central venous pressure of 6mm Hg D. A patient with a pulmonary artery occlusion pressure of 10 mm HG

A. A patient in cardiogenic shock with a cardiac output of 2L/min A cardiac output of 2.0 L/min in a patient with cardiogenic shock warrants immediate assessment. A PAP of 20 mm Hg, CVP of 6 mm Hg, and a PAOP of 10 mm Hg are all within normal limits.

Laypersons should use which device to treat lethal ventricular dysrhythmias that occur outside a hospital setting? A. Automatice external defibrillator B. Carbon dioxide detector C. Pocket mask D. Transcutaneous packemakcer

A. AED Because of the ease of use and efficacy in treating lethal ventricular dysrhythmias, automatic external defibrillators are recommended to be placed in a variety of public settings where they may be used by laypersons.

The patient is diagnosed with abrupt onset of supraventricular tachycardia (SVT). The nurse prepares which medication that has a short half-life and is recommended to treat SVT? A. Adenosine B. Amiodarone C. Diltiazem D. Procainamide

A. Adenosine Adenosine is the initial drug of choice for the diagnosis and treatment of supraventricular dysrhythmias. Adenosine has an onset of action of 10 to 40 seconds and duration of 1 to 2 minutes; therefore, it is administered rapidly.

A patient is admitted to the emergency department with clinical indications of an acute myocardial infarction. Symptoms began 3 hours ago. The facility does not have the capability for percutaneous coronary intervention. Given this scenario, what is the priority intervention in the treatment and nursing management of this patient? A. Adminster thrombolytic therapy unless contraindicated B. Diurese aggressively and monitor daily weight C. Keep oxygen saturation levels at least 88% D. Maintain heart rate above 100bpm

A. Administer thrombolytic therapy unless contraindicated Medical treatment of AMI is aimed at relieving pain, providing adequate oxygenation to the myocardium, preventing platelet aggregation, and restoring blood flow to the myocardium through thrombolytic therapy or acute interventional therapy such as angioplasty. Since interventional cardiology is not available, thrombolytic therapy is indicated. Oxygen saturation should be maintained at higher levels to ensure adequate oxygenation to the heart muscle. An elevated heart rate increases oxygen demands and should be avoided. Diuresis is not indicated with this scenario.

The etiology of noncardiogenic pulmonary edema in acute respiratory distress syndrome (ARDS) is related to damage to the: A. Alveolar-capillary membrane B. Left ventricle C. Mainstem bronchus D. Trachea

A. Alveolar-capillary membrane Damage to the alveolar-capillary membrane results in noncardiogenic pulmonary edema. None of the other responses apply.

During rounds, the physician alerts the team that proning is being considered for a patient with acute respiratory distress syndrome. The nurse understands that proning is: A. An optimal treatment if the PaO2/FiO2 ratio is less than 100 B. Less of a risk for skin breakdown because the patient is face down C. Possible with minimal help from co-workers D. Used to provide continuous lateral rotational turning

A. An optimal treatment if the PaO2/FiO2 ratio is less than 100 Proning is considered if the PaO2/FiO2 ratio is low. The patient is not responding to treatment, and all options should be considered. The patient remains at risk for skin breakdown due to immobility; during proning, the risk is in the dependent areas such as the face. Proning is a labor-intensive procedure, and the nurse needs help from team members to ensure a safe turn, including protecting the airway. Continuous lateral rotation is a therapy done in the supine position with a specialized bed.

When doing manual ventilations during a code, the nurse would administer ventilations following which guideline? A. Approximately 8-10 breaths per minute B. During the fifth chest compression C. Every 3 seconds of 20 times per minute D. While compressions are stopped

A. Approximately 8-10 breaths per minute Manual ventilations are delivered one breath every 6 to 8 seconds or approximately 8 to 10 breaths per minute.

The nurse is caring for a 70-kg patient in septic shock with a pulmonary artery catheter. Which hemodynamic value indicates an appropriate response to therapy aimed at enhancing oxygen delivery to the organs and tissues? A. Arterial lactate level of 1.0 mEq/L B. Cardiac output of 2.5 L/min C. Mixed venous (SvO2) of 40% D. Cardiac index of 1.5 L/min/m^2

A. Arterial lactate leve of 1.0 mEq/L An arterial lactate level of 1.0 mEq/L is within normal limits and is indicative of normal oxygen delivery to the tissues. The cardiac output, mixed venous saturation, and cardiac index values are all below normal limits indicating inadequate cardiac output sufficient to provide oxygen delivery to the organs and tissues.

The patient's monitor shows bradycardia (heart rate of 40bpm) and frequent premature ventricular contractions with a measure blood pressure of 85/50 mm Hg. The nurse anticipates use of which drug? A. Atropine 0.5-1mg IV push B. Dopamine drip continuous infusion C. Lidocaine 1mg/kg IV push D. Transcutaneous pacemaker

A. Atropine 0.5-1mg IV push This patient is having PVCs secondary to bradycardia. Atropine is a first-line drug for bradycardia. Administer atropine, 0.5 mg IV every 3 to 5 minutes to a total dose of 3 mg. Atropine is not indicated in second-degree atrioventricular (AV) block type II or third-degree AV block.

The nurse chooses which method and concentration of oxygen administration until intubation is established in a patient who has sustained a cardiopulmonary arrest? A. Bag-valve-mask at FiO2 of 100% B. Bag-valve-mask at FiO2 at 50% C. Mouth-to-mask ventilation with supplemental oxygen D. Non-rebreather mask at FiO2 of 100%

A. Bag-valve-mask at FiO2 at 100% Oxygen can be delivered via mouth to mask or with a bag-valve device connected to a mask or endotracheal tube. During resuscitation efforts, 100% oxygen is administered.

A patient is admitted to the hospital with multiple trauma and extensive blood loss. The nurse assesses vital signs to be BP 80/50 mm Hg, heart rate 135 beats/min, respirations 36 breaths/min, cardiac output (CO) of 2 L/min, systemic vascular resistance of 3000 dynes/sec/cm-5, and a hematocrit of 20%. The nurse anticipates administration of which the following therapies or medications? A. Blood transfusion B. Furosemide C. Dobutamine infusion D. Dopamine

A. Blood transfusion Both hemodynamic parameters and the reported hematocrit value indicate hypovolemia and blood loss requiring volume resuscitation with blood products. Furosemide administration will worsen fluid volume status. Inotropic agents will not correct the underlying fluid volume deficit and anemia. Vasoconstrictors are contraindicated in a volume-depleted state.

The nurse is caring for a 100-kg patient being monitored with a pulmonary artery catheter. The nurse assesses a blood pressure of 90/60 mmHg, heart rate of 110bpm, respirations 36/min, oxygen saturation of 89% on 3L via nasal cannula. Bilateral crackles are audible upon auscultation. Which mhemodynamic value requires immediate action by the nurse? A. Cardiac index of 1.2L/min/m^3 B. Cardiac output of 4L/min C. Pulmonary vascular resistance (PVR) of 80 dynes/sec/cm^-5 D. Systemic vascular resistance (SVR) of 1800 dynes/sec/cm^-5

A. Cardiac index of 1.2L/min/m^3 combined with the identified clinical assessment findings indicate a low cardiac output with fluid overload (bilateral crackles) requiring intervention. The remaining hemodynamic values are within normal limits.

Upon entering the room of a patient with a right radial arterial line, the nurse assesses the waveform to be slightly dampened and notices blood to be backed up into the pressure tubing. What is the best action by the nurse? A. Check the inflation volume of the flush system pressure bag B. Disconnect the flush system from the arterial line catheter C. Zero reference the transduce system at the phlebostatic axis D. Reduce the number of stopcocks in the flush system tubing

A. Check the inflation volume of the flush system pressure bag To maintain the patency of the arterial line, the inflation volume of the flush system pressure bag should be inflated to 300 mm Hg to ensure a constant flow of fluid through the system, preventing backward flow of blood into the system tubing. Disconnecting the flush system from the arterial line is not appropriate and could increase the risk of infection to the patient. Zero referencing the system will not help clear the blood from the system tubing. Reducing the number of stopcocks helps reduce the risk of a disconnection that could lead to excessive blood loss.

The nurse is caring for a patient who is mechanically ventilated. As a part of the nursing care, the nurse understands that: A. Communication with intubated patients is often difficult B. Controlled ventilation is the preferred mode for most patients C. Patients with chronic obstructive pulmonary disease wean easily from mechanical ventilation D. Wrist restraints are applied to all patients to avoid self-extubation

A. Communication with intubated patients is often difficult

The patient presents to the ED with severe chest discomfort. He is taken for cardiac catheterization and angiography that shows 80% occlusion of the left main coronary artery. Which procedure will be most likely followed? A. Coronary artery bypass graft surgery B. Intracoronary stent placement C. Percutaneous transluminal coronary angioplasty (PTCA) D. Transmyocardial revascularization

A. Coronary artery bypass graft surgery Coronary artery bypass graft surgery is indicated for significant left main coronary occlusion (>50%).

A patients 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 patients blood pressure drops from 120/76 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. Hypovolemia C. Increase in venous return D. Oxygen toxicity

A. Decrease in cardiac output Positive end-expiratory pressure increases intrathoracic pressure and may result in decreased venous return. Cardiac output decreases as a result, and is reflected in the lower blood pressure. It is essential to assess the patient to identify optimal positive end-expiratory pressurethe highest amount that can be applied without compromising cardiac output. Although hypovolemia can result in a decrease in blood pressure, there is no indication that this patient has hypovolemia. As noted, higher levels of positive end-expiratory pressure may cause a decrease, not an increase, in venous return. Oxygen toxicity can occur in this case secondary to the high levels of oxygen needed to maintain gas exchange; however, oxygen toxicity is manifested in damage to the alveoli.

The patient with acute respiratory distress syndrome (ARDS) would exhibit which of the following symptoms? A. Decreasing PaO2 levels despite increased FiO2 administration B. Elevated alveolar surfactant levels C. Increased lung compliance with increased FiO2 administration D. Respiratory acidosis associated with hyperventilation

A. Decreasing PaO2 levels despite increased FiO2 administration Patients with ARDS often have hypoxemia refractory to treatment. Surfactant levels are often diminished in ARDS. Compliance decreases in ARDS. In early ARDS, hyperventilation may occur along with respiratory alkalosis.

The nurse is caring for a patient following insertion of a left subclavian central venous catheter (CVC). Which assessment finding 2 hours after insertion by the nurse warrants immediate action? A. Diminished breath sounds over left lung field B. Localized pain at catheter insertion site C. Measured central venous pressure of 5mmHg D. Slight bloody drainage around insertion site

A. Diminished breath sounds over left lung field Diminished breaths sounds over the lung field on the same side of the line insertion site may be indicative of a pneumothorax. A pneumothorax, which can develop slowly, is a major complication following insertion of central lines when the subclavian route is used. Localized pain at catheter insertion site is not the immediate priority in this scenario. A measured central venous pressure of 5 mm Hg is normal. Slight bloody drainage at the insertion site soon after the procedure does not require immediate action.

The nurse is caring for a patient with acute respiratory failure and identifies Risk for ineffective Airway Clearance as as a nursing diagnosis. A nursing intervention relevant to this diagnosis is: A. Elevate head of bed 30 degrees B. Obtain order for venous thromboembolism prophylaxis C. Provide adequate sedation D. Reposition patient every 2 hours

A. Elevate head of bed 30 degrees

A patient presents to the emergency department (ED) with chest pain that he has had for the past 2 hours. He is nauseous and diaphoretic, and his skin is dusky in color. The electrocardiogram shows ST elevation in leads II, III, and aVF. Which therapeutic intervention would the nurse question? A. Emergent pacemaker insertion B. Emergent percutaneous coronary intervention C. Emergent thrombolytic therapy D. Immediate coronary artery bypass graft surgery

A. Emergent pacemaker insertion The goals of management of AMI are to dissolve the lesion that is occluding the coronary artery and to increase blood flow to the myocardium. Options include emergent percutaneous intervention, such as angioplasty, emergent coronary artery bypass graft surgery, or thrombolytic therapy if the patient has been symptomatic for less than 6 hours. No data in this scenario warrant insertion of a pacemaker.

A patient has been prescribed nitroglycerin in the ED for chest pain. In taking the health history, the nurse will be sure to verify whether the patient has taken medications prior to admission for: A. Erectile dysfunction B. Prostate enlargement C. Asthma D. Peripheral vascular disease

A. Erectile dysfunction A history of the patients use of sildenafil citrate (Viagra) or similar medications taken for erectile dysfunction is necessary to know when considering NTG administration. These medications potentiate the hypotensive effects of nitrates; thus, concurrent use is contraindicated. It is also important to determine whether the patient has any food or drug allergies.

Which of the following devices is best suited to deliver 65% oxygen to a patient who is spontaneously breathing? A. Face mask with non-rebreathing reservoir B. Low flow nasal cannula C. Simple face mask D. Venturi mask

A. Face mask with nonrebreathing reservoir Face masks with reservoirs (partial rebreathing and non-rebreathing reservoir masks) provide oxygen concentration of 60% or higher. The addition of the reservoir increases the amount of oxygen available to the patient during inspiration and allows for the delivery of concentrations of 35% to 60% (partial rebreather) or 60% to 80% (non-rebreather) depending on the flowmeter setting, the fit of the mask, and the patients respiratory pattern. The high-flow nasal cannula, not the traditional low-flow models, can provide higher flows. The simple face mask can deliver flows up to 60%. The Venturi mask allows better regulation of oxygen concentration and generally does not deliver more than 60% oxygen.

What is the major reason for using a treatment to lower body temperature after cardiac arrest to promote better neurological recovery? A. Hypothermia decreases metabolci rate by 7% for each decrease of 1 C B. Lower body temperatures are beneficial in patients with lower BP C. Temperatures of 40 C may reduce neurological impairment D. The lower body temperature leads to decreased oxygen delivery

A. Hypothermia decreases metabolic rate by 7% for each decrease of 1 C Hypothermia decreases the metabolic rate by 6% to 7% for every decrease of 1 C in temperature; decreased metabolic rate may protect neurological function. Induced hypothermia to a core body temperature of 32o C to 34o C for 12 to 24 hours may be beneficial in reducing neurological impairment after cardiac arrest.

The patient has an irregular heart rhythm. To determine an accurate heart rate, the nurse first: A. identifies the markers on the ECG paper that indicate a six second strip B. Counts the number of large boxes between to consecutive P waves C. Counts the number of small boxes between two consecutive QRS complexes D. Divides the number of complexes in a 6-second strip by 10

A. Identifies the markers on the ECG paper that indicate a six second strip Six-second method: A quick and easy estimate of heart rate can be accomplished by counting the number of P waves or QRS waves within a 6-second strip to obtain atrial and ventricular heart rates per minute. This is the optimal method for irregular rhythms. Identify the lines above the ECG paper that represent 6 seconds, and count the number of P waves within the lines; then add a zero (multiply by 10) to identify the atrial heart rate estimate for 1 minute. Next, identify the number of QRS waves in the 6-second strip and again add a zero to identify the ventricular rate.

The nurse is caring for a patient who is being turned prone as part of treatment for acute respiratory distress syndrome. The nurse understands that the priority nursing concern for this patient is which of the following? A. Management and protection of the airway B. Prevention of gastric aspiration C. Prevention of skin breakdown D. Psychological support to patient and family

A. Management and protection of the airway All are important, but protection of the airway is the most important intervention if the patient is placed in the prone position.

Which of the following statements is true regarding venous thromboembolism (VTE) and pulmonary embolus (PE)? A. PE should be suspected in any patient who has unexplained cardiorespiratory complaints and risk factors for VTE B. Bradycardia and hyperventilation are classic symptoms of PE C. Dyspnea, chest pain, and hemoptysis occur in nearly all patients with PE. D. Most critically ill patients are at low risk for VTE and PE and do not require prophylaxis

A. PE should be suspected in any patient who has unexplained cardiorespiratory complaints and risk factors for VTE PE should be suspected in any patient who has unexplained cardiorespiratory complaints and risk factors for VTE. Dyspnea, hemoptysis, and chest pain have been called the classic signs and symptoms for PE, but the three signs and symptoms actually occur in less than 20% of cases. Bradycardia and hyperventilation are not classic signs of PE. Most critically ill patients are at high risk for VTE and all should receive prophylaxis.

The nurse is caring for a patient following insertion of a left subclavian central venous catheter (CVC). Which action by the nurse best reduces the risk of catheter-related bloodstream infection (CRBSI)? A. Reveiw daily the necessity of the central venous catheter B. Cleanse the insertion site daily with isopropyl alcohol C. Change the pressurized tubing system and flush bag daily D. Maintain a pressure of 300 mm Hg on the flush bag

A. Review daily the necessity of the central venous catheter Duration of the catheter is an independent risk factor for CRBSI, and removal of the catheter when not needed to guide treatment is associated with a reduction in mortality. Maintaining of the insertion site should be guided by institutional guidelines and is best accomplished with chlorhexidine skin antisepsis. Minimizing the number of times the flush system is opened by changing tubing no more frequently than every 72 to 96 hours reduces the risk of CRBSI. Maintaining a pressure of 300 mm Hg on the flush solution bag helps maintain the integrity of the invasive line and does not reduce the risk of infection.

The patient is admitted with a suspected acute myocardial infarction (MI). In assessing the 12-lead electrocardiogram (ECG) changes, which findings would indicate to the nurse that the patient is in the process of an evolving Q wave myocardial infarction(MI)? A. ST-segment elevation on ECG and elevated CPK-MB or troponin levels B. Depressed ST-segment on ECG and elevated total CPK C. Depressed ST-segment on ECG and normal cardiac enzymes D. Q wave on ECG with normal enzymes and troponin levels

A. ST-segment elevation on ECG and elevated CPK-MB or troponin levels

A patients endotracheal tube is not secured tightly. The respiratory care practitioner assists the nurse in taping the tube. After the tube is retaped, the nurse auscultates the patients lungs and notes that the breath sounds over the left lung fields are absent. The nurse suspects that: A. The endotracheal tube is in the right mainstem bronchus B. The patient has a left pneumothroax C. The patient has aspirated secretions during the procedure D. The stethoscope earpiece is clogged with wax

A. The endotracheal tube can become dislodged during repositioning and is likely in the right mainstem bronchus. It is important to reassess breath sounds after the retaping procedure. A pneumothorax would also result in diminished or absent breath sounds; however, it is not associated with repositioning the endotracheal tube. Aspiration may occur during the procedure but would be manifested in changes in chest x-ray, hypoxemia etc.

A patient presents to the ED complaining of severe substernal chest pressure radiating to his left shoulder and back that started about 12 hours ago. The patient delayed coming to the ED since he was hoping the pain would go away. The patients 12-lead ECG shows ST-segment depression in the inferior leads. Troponin and CK-MB are both elevated. The hospital does not have the capability for percutaneous coronary intervention. Thrombolysis is one possible treatment. Based on these data, the nurse understands that? A. The patient is not a candidate for thrombolysis B. The patient's history makes him a good candidate for thrombolysis C. Thrombolysis is appropriate for a candidate having a non Q wave MI D. Thrombolysis should be started immediately

A. The patient is not a candidate for thrombolysis To be eligible for thrombolysis, the patient must be symptomatic for less than 6 hours.

Which nursing actions are most important for a patient with a right radial arterial line? (Select all that apply.) A. Checking the circulation to the right hand every 2 hours B. Maintaining a pressurized flush solution to the arterial line setup C. Monitoring the waveform on the monitor for dampening D. Restraining all four extremities with soft limb restraints

ABC Options A, B, and C are required to ensure proper functioning of the arterial line. There is no need to restrain all extremities. Depending on the patients level of sedation, the right hand may need gentle restraint.

The nurse is preparing for insertion of a pulmonary artery catheter (PAC). During insertion of the catheter, what are the priority nursing actions? (Select all that apply.) A. Allay the patient's anxiety by providing information about the procedure B. Ensure that a sterile field is maintained during the insertion procedure C. Inflate the balloon during the procedure when indicated by the physician D. Monitor the patient's cardiac rhythm throughout the entire procedure E. Obtain informed consent by informint the patient of procedural risks

ABCD During insertion of a pulmonary artery catheter (PAC/Swan-Ganz), the nurse should allay the patients anxiety, ensure that the sterile field is maintained to decrease the risk of infection, inflate the balloon upon request of the physician to assist in catheter placement, and monitor for dysrhythmias that may occur as the catheter passes through the right ventricle. Informed consent may be witnessed by the nurse, but it is obtained by the physician and should occur before the procedure begins.

The nurse is assisting with endotracheal intubation and understands correct placement of the endotracheal tube in the trachea would be identified by which of the following? (Select all that apply.) A. Auscultation of air over the epigastrium B. Equal bilateral breath sounds upon auscultation C. Position above carina verified by chest x-ray D. Positive detection of CO2 through CO2 detector devices

B, C, D The position of the tube is assessed after intubation through auscultation of breath sounds, carbon dioxide testing, and chest x-ray. Auscultation of air over the epigastrium indicates placement in the esophagus rather than the trachea.

Which of the following statements is true regarding oral care for the prevention of ventilator-associated pneumonia (VAP)? (Select all that apply.) A. Tooth brushing is performed every 2 hours for greatest effect B. Implementing a comprehensive oral care program is an intervention for preventing VAP C. Oral care protocols should include oral suctioning and brushing teeth D. Protocols that include chlorhexidine gluconate have been effective in preventing VAP

B,C,D A comprehensive oral care protocol is an intervention for preventing VAP. It includes oral suction, brushing teeth every 12 hours, and swabbing. Chlorhexidine gluconate has been effective in patients who have undergone cardiac surgery.

A patient has been successfully converted from ventricular tachycardia with a pulse to a sinus rhythm. Upon further assessment, it is noted that she is hypotensive. The appropriate treatment for her hypotension may include:(Select all that apply.) A. Adenosine B. Dopamine infusion C. Magnesium D. Normal saline infusion E. Sodium Bicarbonate

B,D The patient may need fluid resuscitation; dopamine is indicated for hypotension once hypovolemia has been corrected.

Select all factors that may predispose the patient to respiratory acidosis: A. Anxiety and fear B. CNS depression C. Diabetic ketoacidosis D. Nasogastric suctioning E. Overdose of sedatives

B,E Central nervous system depression and drug overdose may result in hypoventilation and cause respiratory acidosis. Anxiety is a cause of hyperventilation and respiratory alkalosis. Diabetic ketoacidosis is a cause of metabolic acidosis. Nasogastric suctioning is a cause of metabolic alkalosis.

The nurse is calculating the rate for a regular rhythm. There are 20 small boxes between each P wave and 20 small boxes between each R wave. What is the ventricular rate? A. 50 bpm B. 75 bpm C. 85 bpm D. 100 bpm

B. 75 bpm The rule of 1500 is used to calculate the exact rate of a regular rhythm. The number of small boxes between the highest points of two consecutive R waves is counted, and that number of small boxes is divided into 1500 to determine the ventricular rate. 1500/20 = 75 beats/min. This method is accurate only if the rhythm is regular.

The physician writes an order to discontinue a patients left radial arterial line. When discontinuing the patients invasive line, what is the priority nursing action? A. Apply an air occlusion dressing to the insertion site B. Apply pressure to the insertion site for 5 minutes C. Elevate the affected limb on pillows for 24 hours D. Keep the patient's wrist in a neutral position

B. Apply pressure to the insertion site for 5 minutes Upon removal of an invasive arterial line, adequate pressure must be applied for at least 5 minutes to ensure adequate hemostasis. Application of an air occlusion dressing is not standard of care following removal of an arterial line. Elevation of the affected limb following removal of an arterial line is not a necessary intervention. Neutral wrist position is optimum while the catheter is in place and not necessary after catheter discontinuation.

A 74 year old patient is admitted to the coronary care unit with an inferior wall myocardial infarction and develops symptomatic bradycardia with premature ventricular contracts every third beat (trigeminy). The nurse knows to prepare to administer which drug? A. Amiodarone B. Atropine C. Lidocaine D. Magnesium

B. Atropine Atropine is used to increase the heart rate by decreasing the vagal tone. It is indicated for patients with symptomatic bradycardia.

The nurse is preparing to measure the thermodilution cardiac output (TdCO) in a patient being monitored with a pulmonary artery catheter. Which action by the nurse best ensures the safety of the patient? A. Ensure the transducer system is zero referenced at the level of the phlebostatic axis B. Avoid infusing vasoactive agents in the port used to obtain the TdCO measurement C. Maintain a pressure of 300 mm Hg of the flush solution using a pressure bag D. Limit the length of the noncomplaint pressure tubing to a maximum 48 inches

B. Avoid infusing vasoactive agents in the port used to obtain the TdCO measurement Avoiding infusing vasoactive agents into the port used to obtain the thermodilution cardiac output (TdCO) measurement prevents the patient from receiving a bolus of these agents during rapid infusion of the injectate solution. Ensuring zero referencing of the transducer, maintaining 300 mm Hg pressure of the system pressure bag, and limiting the length of the pressure tubing help to ensure the obtained measures are accurate and do not influence safety.

Following insertion of a pulmonary artery catheter (PAC), the physician orders the nurse to obtain a blood sample for mixed venous oxygen saturation (SvO2). Which action by the nurse best ensures the obtained value is accurate? A. Zero referencing the transducer at the level of the phlebostatic axis following insertion B. Calibrating the system with a central venous blood sample and arterial blood gas value C. Ensuring the patency of the catheter using a 0.9% normal saline solution pressurized at 300 mm Hg D. Using noncomplaint pressure tubing that is no longer than 36-48 inches and has minimal stopcocks

B. Calibrating the system with a central venous blood sample and arterial blood gas value To ensure that an accurate SvO2 is obtained, calibration of the invasive monitoring system (e.g., PAC) is accomplished upon insertion and requires both a central venous blood sample from the PAC and an arterial blood gas sample. This process is unique to the accuracy of venous oxygen saturation monitoring systems. Zero referencing the transducer at the level of the phlebostatic axis, ensuring patency of the catheter with a pressurized flush system, and using tubing of adequate length ensure accuracy of all hemodynamic monitoring systems.

The nurse is caring for a postoperative patient with chronic obstructive pulmonary disease (COPD). Which assessment would be a cue to the patient developing postoperative pneumonia? A. Bradycardia B. Change in sputum characteristics C. Hypoventilation and respiratory acidosis D. Pursed lip breathing

B. Change in sputum characteristics

The monitor technician notifies the nurse stat that the patient has a rapid, chaotic rhythm that looks like ventricular tachycardia. What is the nurse's first action? A. Call a code overhead B. Check the patient immediately C. Go to the nurse's station and look at the rhythm strip D. Take the crash cart to the room

B. Check the patient immediately The first intervention in this situation is to assess unresponsiveness by checking the patient.

The nurse is caring for a patient with a diagnosis of pulmonary embolism. The nurse understands that the most common cause of a pulmonary embolus is: A. Amniotic fluid embolus B. DVT from lower extremities C. Fat embolus from a long bone fracture D. Vegetation that dislodges from an infected central venous catheter

B. DVT from lower extremities

When fluid is present in alveoli: A. Alveoli collapse and atelectasis occurs B. Diffusion of oxygen and carbon dioxide is impaired C. Hypoventilation occurs D. The patient is in heart failure

B. Diffusion of oxygen and carbon dioxide is impaired Fluid prevents the diffusion of gases. It does not cause atelectasis or hypoventilation. Fluid can be present in the alveoli secondary to heart failure; however, there are other causes as well, such as acute respiratory distress syndrome.

The nurse is caring for a patient who has had an arterial line insert. To reduce the risk of complications, what is the priority nursing intervention? A. Apply a pressure dressing to the insertion site B. Ensure all tubing connections are tightened C. Obtain a portable x-ray to confirm placement D. Restrain the affected extremity for 24 hours

B. Ensure all tubing connections are tightened. Loose connections in hemodynamic monitoring can lead to a hemorrhage, a major complication of arterial pressure monitoring. Application of pressure dressing required only upon arterial line removal. Blood return is adequate confirmation of arterial line placement, x-ray studies are not performed to confirm placement. Limb restraint is not needed.

A patient is having difficulty weaning from mechanical ventilation. The nurse assesses the patient for a potential cause of this difficult weaning, which includes: A. Cardiac output 6 L/min B. Hemoglobin of 8 g/dL C. Negative sputum culture and sensitivity D. White blood cell count of 8000

B. Hemoglobin of 8 g/dL The low hemoglobin level will decrease oxygen-carrying capacity and may make weaning difficult. A cardiac output of 6 L/min is normal. A negative sputum culture indicates absence of lower respiratory infection, which should promote rather than hinder weaning. A white blood cell count of 8000 is normal and indicates absence of infection, which should promote rather than hinder weaning.

A PaCO2 of 48 mm Hg is associated with: A. Hyperventilation B. Hypoventilation C. Increased CO2 absorption D. Increased excretion of HCO3

B. Hypoventilation PaCO2 rises in patients with hypoventilation

The nurse assesses a patient who is admitted for an overdose of sedatives. The nurse expects to find which acid-base alteration? A. Hyperventilation and respiratory acidosis B. Hypoventilation and respiratory acidosis C. Hypoventilation and respiratory alkalosis D. Respiratory acidosis and normal oxygen levels

B. Hypoventilation and respiratory acidosis Hypoventilation is common after overdose and results in impaired elimination of carbon dioxide and respiratory acidosis. The overdose depresses the respiratory drive, which results in hypoventilation, not hyperventilation. Hypoxemia is expected secondary to depressed respirations.

A 65-year-old patient is admitted to the progressive care unit with a diagnosis of community-acquired pneumonia. The patient has a history of chronic obstructive pulmonary disease and diabetes. A set of arterial blood gases obtained on admission without supplemental oxygen shows pH 7.35; PaCO2 55 mm Hg; bicarbonate 30 mEq/L; PaO2 65 mm Hg. These blood gases reflect: A. Hypoxemia and compensated metabolic acidosis B. Hypoxemia and compensated respiratory acidosis C. Normal oxygenation and partly compensated metabolic alkalosis D. Normal oxygenation and uncompensated respiratory acidosis

B. Hypoxemia and compensated respiratory acidosis The PaO2 of 65 mm Hg is lower than normal range (80-100 mm Hg), indicating hypoxemia. The high PaCO2 indicates respiratory acidosis. The elevated bicarbonate indicates metabolic alkalosis. Because the pH is normal, the underlying acid-base alteration is compensated. Given the patients history of chronic pulmonary disease and a pH that is at the lower end of normal range, it can be determined that this patient is hypoxemic with fully compensated respiratory acidosis.

The nurse is assessing a patient. Which assessment would cue the nurse to the potential of acute respiratory distress syndrome (ARDS)? A. Increased oxygen saturation via pulse oximetry B. Increased peak inspiratory pressure on the ventilator C. Normal chest radiograph with enlarged cardiac structures D. PaO2/FiO2 ratio >300

B. Increased peak inspiratory pressure on the ventilator Increased peak inspiratory pressures are often early indicators of ARDS. Oxygen saturation decreases in ARDS. Chest x-ray study will show progressive infiltrates. In ARDS, a PaO2/FiO2 ratio less than 200 is a criterion.

An acute exacerbation of asthma is treated with which of the following? A. Corticosteroids and theophylline by mouth B. Inhaled bronchodilators and IV corticosteroids C. Prone positioning or continuous lateral rotation D. Sedation and inhaled bronchodilators

B. Inhaled bronchodilators and IV corticosteroids Inhaled bronchodilators and intravenous corticosteroids are standard treatment for the exacerbation of asthma; they promote dilation of the bronchioles and decreased inflammation of the airways. Proning and continuous lateral rotation are therapies to treat hypoxemia secondary to acute respiratory distress syndrome. Sedation is not recommended.

While caring for a patient with a small bowel obstruction, the nurse assesses a pulmonary artery occlusion pressure (PAOP) of 1 mm Hg and hourly urine output of 5ml. The nurse anticipates which therapeutic interventions? A. Diuretics B. Intravenous fluids C. Negative inotropic agents D. Vasopressors

B. Intravenous fluids Low pulmonary artery occlusion pressures usually indicate volume depletion, so intravenous fluids would be indicated. Administration of diuretics would worsen the volume status. C would not improve volume status. D will increase BP but is contraindicated in al low volume state.

The nurse is discharging a patient home following treatment for community-acquired pneumonia. As part of the discharge teaching, the nurse instructs: A. if you get the pneumonoccoal vaccine, you'll never get pneumonia again B. It is important for you to get an annual influenzea shot to reduce your risk of pneumonia C. Stay away from cold, drafty places because that increases your risk of pneumonia when you get home D. Since you've been treated for pneumonia, you know have immunity from getting it in the future

B. It is important for you to get an annual influenza shot to reduce your risk of pneumonia The influenza vaccine reduces the risk of pneumonia by over a half. The pneumococcal vaccine is important but only protects against pneumococcal infection. Cold, drafty environments will not cause infection. Immunity for pneumonia does not occur as a result of getting it.

A patient was admitted in terminal heart failure and is not eligible for transplant. The family wants everything possible done to maintain life. Which procedure might be offered to the patient for this condition to increase the patients quality of life? A. Intraaortic balloon pump (IABP) B. Left ventricular assist device C. Nothing, because the patient is in terminal heart failure D. Nothing additional, medical management is the only option

B. LVAD LVADs are capable of partial to complete circulatory support for short- to long-term use. At present, the LVAD is therapy for patients with terminal heart failure. It would provide better management than medical therapy alone. The IABP is for short-term management of acute heart failure.

The patient is admitted with an acute myocardial infarction (AMI). Three days later the nurse is concerned that the patient may have a papillary muscle rupture. Which assessment data may indicate a papillary muscle rupture? A. Gallop rhythm B. Murmur C. S1 heart sound D. S3 heart sound

B. Murmur The presence of a new murmur warrants special attention, particularly in a patient with an AMI. A papillary muscle may have ruptured, causing the valve to close incorrectly, which can be indicative of severe damage and impending complications.

The nurse is caring for a patient with a left subclavian central venous catheter (CVC) and a left radial arterial line. Which assessment finding by the nurse requires immediate action? A. A dampened arterial line waveform B. Numbness and tingling in the left hand C. Slightly bloody drainage at subclavian insertion site D. Slight redness at subclavian insertion site

B. Numbness and tingling Numbness and tingling in the left hand, which is the location of an arterial catheter, indicates possible neurovascular compromise and requires immediate action. A dampened waveform can indicate problems with arterial line patency but is not an emergent situation. Slight bloody drainage at the subclavian insertion site is not an unusual finding. Slight redness at the insertion site, while of concern, does not require immediate action

The nurse is assessing a patient with acute respiratory distress syndrome. An expected assessment is: A. Cardiac output of 10 L/min and low systemic vascular resistance B. PAOP of 10 mm Hg and PaO2 of 55 C. PAOP of 20 mm Hg and cardiac output of 3 L/min D. PAOP of 5 mm Hg and high systemic vascular resistance

B. PAOP of 10 mm Hg and PaO2 of 55 A normal PAOP with hypoxemia is an expected assessment finding in ARDS. Cardiac output of 10 L/min and low systemic vascular resistance are expected findings in sepsis. PAOP of 20 mm Hg and cardiac output of 3 L/min are expected findings in heart failure. PAOP of 5 mm Hg and high systemic vascular resistance are expected findings in hypovolemic shock.

The nurse is caring for a mechanically ventilated patient being monitored with a left radial arterial line. During the inspiratory phase of ventilation, the nurse assesses a 20 mm Hg decrease in arterial blood pressure. What is the best interpretation of this finding by the nurse? A. Mechanical ventilator is malfunctioning B. Patient may require fluid resuscitation C. The arterial line may need replaced D. The left limb may have reduced perfusion

B. Patient may require fluid resuscitation The increase in thoracic pressure that occurs during the inspiration phase of positive pressure ventilation decreases venous return, decreasing systolic blood pressure. A systolic blood pressure variation or decrease of more than 10 mm Hg in a mechanically ventilated patient is indicative of a patient who would respond to fluid resuscitation and improve tissue perfusion. There is no evidence to indicate the ventilator is malfunctioning, the arterial line needs to be replaced, or that the left limb may have reduced perfusion.

A 53-year-old, 80-kg patient is admitted to the cardiac surgical intensive care unit after cardiac surgery. Four hours after admission to the surgical intensive care unit at 4 PM, the patient has stable vital signs and normal arterial blood gases (ABGs) and is placed on a T-piece for ventilatory weaning. During the nurses 7 PM (1900) assessment, the patient is restless, heart rate has increased to 110 beats/min, respirations are 36 breaths/min, and blood pressure is 156/98 mm Hg. The cardiac monitor shows sinus tachycardia with 10 premature ventricular contractions (PVCs) per minute. Pulmonary artery pressures are elevated. The nurse suctions the patient and obtains pink, frothy secretions. Loud crackles are audible throughout lung fields. The nurse notifies the physician, who orders an ABG analysis, electrolyte levels, and a portable chest x-ray study. In communicating with the physician, which statement indicates the nurse understands what is likely occurring with the patient? A. May we have an order for cardiac enzymes? This patient is exhibiting signs of a myocardial infarction B. My assessment indicates potential fluid overload C. The patient is having frequent PVCs that are compromising the cardiac output D. The patient is having a hypertensive crisis, what medications would you like to order?

B. Potential fluid overload The crackles, high pulmonary artery pressure, and pink, frothy sputum indicate fluid volume overload. There are not any cues to suggest a myocardial infarction. The PVCs may be related to the surgery or hypoxemia; however, the blood pressure indicates adequate perfusion. The blood pressure is high secondary to fluid overload; treatment of the fluid overload will result in a decrease in blood pressure.

It is determined the patient needs a transcutaneous pacemaker until a transvenous pacemaker can be inserted. What is the most appropriate nursing intervention? A. Apply conductive gel to the skin B. Provide adequate sedation and analgesia C. Recheck leads to make sure that the rhythm is asystole D. Set the millimperes to 2mA below the capture level

B. Provide adequate sedation and analgesia The alert patient who requires transcutaneous pacing may experience some discomfort. Because the skeletal muscles are stimulated, as well as the heart muscle, the patient may experience a tingling, twitching, or thumping feeling that ranges from mildly uncomfortable to intolerable. Sedation, analgesia, or both may be indicated.

One of the early signs of the effect of hypoxemia on the nervous system is: A. Cyanosis B. Restlessness C. Tachycardia D. Tachypnea

B. Restlessness Decreased oxygenation to the nervous system may result in restlessness and agitationearly signs of hypoxemia. Cyanosis is a late sign. Tachycardia and tachypnea may occur, but CNS changes tend to occur earlier.

One of the functions of the AV node is to: A. Pace the heart if the ventricles fail B. Slow the impulse arriving from the SA node C. Send the the impulse to the SA node D. Allow for ventricular filling during systole

B. Slow the impulse arriving from the SA node The impulse from the SA node quickly reaches the atrioventricular (AV) node located in the area called the AV junction, between the atria and the ventricles. Here the impulse is slowed to allow time for ventricular filling during relaxation or ventricular diastole. The AV node has pacemaker properties and can discharge an impulse if the SA node (not the ventricle) fails. The electrical impulse is then rapidly conducted through the bundle of His to the ventricles (not the SA node) via the left and right bundle branches.

The nurse is educating a patients family member about a pulmonary artery catheter (PAC). Which statement by the family member best indicates understanding of the purpose of the PAC? A. The catheter will provide multiple sites to give IV fluid B. The catheter will allow the physician to better manage fluid therapy C. The catheter tip comes to rest inside my brother's pulmonary artery D. The catheter will be in position until the heart has a chance to heal

B. The catheter will allow the physician to better manage fluid therapy. A pulmonary artery catheter provides hemodynamic measurements that guide interventions that include appropriate fluid therapy. Even though a pulmonary catheter provides multiple intravenous access sites, this is not the primary purpose of the catheter. Although the catheter is positioned in the pulmonary artery, positioning is not the purpose of the catheter. The primary purpose of the catheter is not to aid in the healing of the heart but to guide therapy.

A patient at high risk for pulmonary embolism is receiving Lovenox. The nurse explains to the patient: A. I'm going to contact the pharmacist to see if this medication can be taken by mouth B. This injection is being given to prevent blood clots from forming C. This medication will dissolve any blood clots you might get D. You should not be receiving this medication. I will contact the physician to get it stopped.

B. This injection is being given to prevent blood clots from forming

Which of the following cardiac diagnostic tests would include monitoring the gag reflex before giving the patient anything to eat or drink? A. Barium swallow B. Transesophageal echocardiogram C. MUGA scan D. Stress test

B. Transesophageal echocardiogram In transesophageal echocardiography, an ultrasound probe is fitted on the end of a flexible gastroscope, which is inserted into the posterior pharynx and advanced into the esophagus. After the procedure, the patient is unable to eat until the gag reflex returns.

The patient is admitted with a fever and rapid heart rate. The patients temperature is 103 F (39.4 C).The nurse places the patient on a cardiac monitor and finds the patients atrial and ventricular rates are above 105 beats per minute. P waves are clearly seen and appear normal in configuration. QRS complexes are normal in appearance and 0.08 seconds wide. The rhythm is regular, and blood pressure is normal. The nurse should focus on providing: A. medications to lower heart rate B. Treatment to lower temperature C. Treatment to lower cardiac output D. Treatment to reduce heart rate

B. Treatment to lwoer temperature Sinus tachycardia results when the SA node fires faster than 100 beats per minute. Sinus tachycardia is a normal response to stimulation of the sympathetic nervous system. Sinus tachycardia is also a normal finding in children younger than 6 years. Both atrial and ventricular rates are greater than 100 beats per minute, up to 160 beats per minute, but may be as high as 180 beats per minute. Sinus tachycardia is regular or essentially regular. PR interval is 0.12 to 0.20 seconds. QRS interval is 0.06 to 0.10 seconds. P and QRS waves are consistent in shape. P waves are small and rounded. A P wave precedes every QRS complex, which is then followed by a T wave. The fast heart rhythm may cause a decrease in cardiac output because of the shorter filling time for the ventricles. Lowering cardiac out further may complicate the situation. The dysrhythmia itself is not treated, but the cause is identified and treated appropriately. For example, if the patient has a fever or is in pain, the infection or pain is treated appropriately.

The nurse returns from the cardiac catheterization laboratory with a patient following insertion of a pulmonary artery catheter and assists in transferring the patient from the stretcher to the bed. Prior to obtaining a cardiac output, which action is most important for the nurse to complete? A. Document a pulmonary artery catheter occlusion pressure B. Zero reference the transducer system at the phlebostatic axis C. Inflate the pulmonary artery catheter balloon with 1 mL of air D. Inject 10mL of 0.9% saline into the proximal port

B. Zero reference the transducer system at the phlebostatic axis To ensure accurate measurement, zero referencing of the transducer system is a priority action after moving a patient and should be completed prior to injecting 10 mL of room temperature 0.9% normal saline. A pulmonary artery catheter occlusion pressure should be documented before obtaining a cardiac output, but without zero referencing the system following movement of a patient, the obtained value may be inaccurate. Inflating the pulmonary artery catheter balloon with 1 mL of air, while appropriate, is not a step required prior to obtaining a cardiac output.

Which of the following situations may result in a low cardiac output and low cardiac index? (Select all that apply.) A. Exercise B. Hypovolemia C. Myocardial infarction D. Shock

BCD Hypovolemia, myocardial infarction, and shock often result in a decreased cardiac output. Cardiac output is usually increased with exercise.

Ventricular fibrillation should initially be treated with which of the following? A. Administration of amiodarone followed by defibrillation at 360 J B. Atropine 1mg, followed by defibrillation at 200 J C. Defibrillation at 200 J with biphasic defibrillation D. Defibrillation at 360 J with monophasic defibrillation

C,D If a biphasic defibrillator is available, use the dose at which that defibrillator has been shown to be effective for terminating VF (typically 120 to 200 J). If the dose is not known, use 200 J. If a monophasic defibrillator is available, use an initial shock of 360 J and use 360 J for subsequent shocks.

The charge nurse is supervising care for a group of patients monitored with a variety of invasive hemodynamic devices. Which patient should the charge nurse evaluate first? A. A patient with a central venous pressure of 6mmHg and 40mL of urine output in the past hour B. A patient with a left radial arterial line with a BP of 110/60 mm Hg and slightly dampened arterial waveform C. A patient with a pulmonary artery occlusion pressure of 25 mm Hg and oxygen saturation of 89% on 3 L oxygen via nasal cannula D. A patient with a pulmonary artery pressure of 25/10 mm Hg and an oxygen saturation of 94% on 2L of oxygen via nasal cannula

C. A patient with a pulmonary arter occlusion pressure of 25 mm Hg and oxygen saturation of 89% on 3L oxygen via nasal cannula A high pulmonary artery occlusion pressure of 25 mm Hg combined with low oxygen saturation is indicative of fluid volume overload and warrants priority action because the patient is at risk for hypoxemia. A CVP of 6 mm Hg with 40 mL of hourly urine output are acceptable assessment findings. A patient with a normal blood pressure and with a slightly dampened waveform does not require immediate action. A pulmonary artery pressure of 25/10 mmHg and a normal oxygen saturation does not require immediate treatment.

The physician orders a pharmacological stress test for a patient with activity intolerance. The nurse would anticipate that the drug of choice would be A. Dopamine B. Dobutamine C. Adenosine D. Atropine

C. Adenosine If a patient is unable physically to perform the exercise, a pharmacological stress test can be done. Adenosine is preferred over dobutamine because of its short duration of action and because reversal agents are not needed.

The nurse is caring for a patient with an arterial monitoring system. The nurse assesses the patients noninvasive cuff blood pressure to be 70/40 mm Hg. The arterial blood pressure measurement via an intraarterial catheter in the same arm is assessed by the nurse to be 108/70 mm Hg. What is the best action by the nurse? A. Activate the rapid response system B. Place the patient in the Trendelenburg position C. Assess the cuff for proper arm size D. Administer 0.9% normal saline bolus

C. Assess the cuff for proper arm size Under normal circumstances, a difference of 10 to 20 mm Hg or more between invasive and noninvasive blood pressure is expected, with the invasive value being higher than the noninvasive value. The cuff used for noninvasive measurement should be assessed for proper cuff size. Given that the invasive value is substantially higher, before initiating corrective actions based on a single noninvasive measurement, such as activating the rapid response system, placing the patient in Trendelenburg position, or administering a fluid bolus, further assessment and troubleshooting are necessary.

After pulmonary artery catheter insertion, the nurse assesses a pulmonary artery pressure of 45/25 mm Hg, a pulmonary artery occlusion pressure (PAOP) of 20 mm Hg, a cardiac output of 2.6 L/min and a cardiac index of 1.9 L/min/m2. Which physician order is of the highest priority? A. Apply 50% oxygen via venturi mask B. Insert an indwelling catheter C. Begin a dobutamine infusion D. Obtain stat cardiac enzymes and troponin

C. Begin a dobutamine infusion The pulmonary pressures are higher than normal, indicating elevated preload, and the cardiac index and output values are low. The priority order for the nurse to implement is to begin a dobutamine (Dobutrex) infusion to improve cardiac output, possibly reducing pulmonary artery occlusion pressures. The other treatments are important, but the dobutamine infusion is the most important at this time.

Intrapulmonary shunting refers to: A. alveoli that are not perfused B. Blood that is shunted from the left side of the heart to the right and causes heart failure C. Blood that is shunted from the right side of the heart to the left without oxygenation D. Shunting of blood supply to only one lung

C. Blood that is shunted from right side of heart to left without oxygenation

Which rhythm would be an emergency indication for the application of a transcutaneous pacemaker? A. Asystole B. Bradycardia normotensive and alert C. Bradycardia with hypotension and syncope D. Supraventricular tachycardia, hypotensive

C. Bradycardia with hypotension and syncope Transcutaneous (external noninvasive) cardiac pacing is used during emergencies to treat symptomatic bradycardia (hypotension, altered mental status, angina, pulmonary edema) that has not responded to atropine. This patient is symptomatic.

The patient has been admitted to a critical care unit with a diagnosis of acute myocardial infarction. Suddenly his monitor alarms and the screen shows a flat line. What action should the nurse take first? A. Administer epinephrine by IV push B. Begin chest compressions C. Check patient for unresponsiveness D. Defibrillate at 360 J

C. Check for unresponsiveness May be machine failure

The nurse is assessing the exhaled tidal volume in a mechanically ventilated patient. The rationale for this assessment is to: A. Assess for tension pneumothorax B. Assess the level of PEEP C. Compare the tidal volume delivered with tidal volume prescribed D. Determines the patient's work of breathing

C. Compare the tidal volume delivered with tidal volume prescribed The EVT is assessed to determine if the patient is receiving the tidal volume that is prescribed. Volume may be lost because of leaks in the ventilator circuit, around the endotracheal tube cuff, or around a chest tube. The assessment will not detect a pneumothorax and does not assess positive end-expiratory pressure or work of breathing.

The patient presents to the ED with sudden severe sharp chest discomfort radiating to his back and down both arms, as well as numbness in his left arm. While taking the patients vital signs, the nurse notices a 30-point discrepancy in systolic blood pressure between the right and left arm. Based on these findings, the nurse should: A. Contact the physician and report the cardiac enzyme results B. Contact the physician and prepare the patient for thrombolytic therapy C. Contact the physician immediately and begin prepping patient for surgery D. Give the patient aspirin and heparin

C. Contact the physician immediately and begin preppin patient for surgery These symptoms indicate the possibility of acute aortic dissection. Symptoms often mimic those of AMI or pulmonary embolism. Aortic dissection is a surgical emergency. Signs and symptoms

While inflating the balloon of a pulmonary artery catheter (PAC) with 1.0 mL of air to obtain a pulmonary artery occlusion pressure (PAOP), the nurse encounters resistance. What is the best nursing action? A. Add an additional 0.5mL of air to the balloon and repeat the procedure B. Advance the catheter with the balloon deflated and repeat the procedure C. Deflate the balloon and obtain a chest x-ray to determine line placement D. Lock the balloon in the inflated position and flush the distal port of the PAC with normal saline

C. Deflate the balloon and obtain a chest x-ray to determine line placement Balloon inflation should never be forced because the PAC may have migrated further into the pulmonary artery, creating resistance to balloon inflation. Verification of proper line placement is warranted to avoid pulmonary artery rupture. In addition, the PAC waveform should be observed to assist in identifying location of the tip of the PAC. In this scenario, adding additional air to the balloon will further risk pulmonary artery rupture. Advancing a pulmonary artery catheter is not within the nurses scope of practice. Flushing the distal port with saline may be indicated to ensure patency; however, the balloon of the PAC should never be locked in the inflated position as rupture of the pulmonary artery may occur.

The physician orders a pulmonary artery occlusive (PAOP) for a patient being monitored with a pulmonary artery catheter. Immediately after obtaining an occlusive pressure, the nurse notes the change in waveform indicated on the strip below. What are the best actions by the nurse? A. Turn the patient to the left side, obtain a stat portable chest x-ray B. Place the patient supine, repeat zero referencing of the system C. Document the wedge pressure, continue monitoring the patient D. Perform an immediate dynamic response test, obtain a chest x-ray

C. Document the wedge pressure, continue monitoring the patient After obtaining a pulmonary artery occlusive pressure and deflating the balloon, the monitor tracing indicates the waveform has returned to a normal pulmonary artery waveform. The nurse should document the occlusive value and continue monitoring the patient. Turning the patient to the left side, zero-referencing the system and performing a dynamic response test are not necessary as the waveform displayed is normal.

The nurse is assessing a patient with left-sided heart failure. Which symptom would the nurse expect to find? A. Dependent edema B. Distended neck veins C. Dyspnea and crackles D. Nausea and vomiting

C. Dyspnea and crackles In left-sided heart failure, signs and symptoms are related to pulmonary congestion. Dependent edema and distended neck veins are related to right-sided heart failure.

A patient with coronary artery disease is having a cardiac evaluation to assess for possible valvular disease. Which study best identifies valvular function and measures the size of the cardiac chambers? A. 12 lead ECG B. Cardiac catheterization C. Echocardiogram D. Electrophysiology study

C. Echocardiogram Echocardiography is a noninvasive, acoustic imaging procedure and involves the use of ultrasound to visualize the cardiac structures and the motion and function of cardiac valves and chambers.

The QT interval is the total time taken for ventricular depolarization and repolarization. Prolongation of the QT interval: A. decreases risk of lethal dysrhythmias B. Usually occurs when heart rate increases C. Increases the risk of lethal dysrhythmias D. Can only be measured with irregular rhythms

C. Increases the risk of lethal dysrhythmias The QT interval is measured from the beginning of the QRS complex to the end of the T wave. This interval measures the total time taken for ventricular depolarization and repolarization. Abnormal prolongation of the QT interval increases vulnerability to lethal dysrhythmias, such as ventricular tachycardia and fibrillation. Normally, the QT interval becomes longer with slower heart rates and shortens with faster heart rates, thus requiring a correction of the value (QTc). Generally, the QT interval is less than half the RR interval. QTc accuracy is based on a regular rhythm. In irregular rhythms such as atrial fibrillation, an average QTc may be necessary because the QT varies from beat to beat.

A strategy for preventing thromboembolism in patients at risk who cannot take anticoagulants is: A. Administration of two aspirin tablets every 4 hours B. Infusion of thrombolytics C. Insertion of a vena cava filter D. SQ heparin administration every 12 hours

C. Insertion of a vena cava filter A filter may be inserted as a prevention measure in patients who are at high risk for thromboembolism. Aspirin is not a preventive therapy. Thrombolytics are given to treat, not prevent, pulmonary embolism. Heparin is administered as a prophylaxis in acute care settings. Coumadin is given for long-term prevention in patients at high risk for VTE.

A patients 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 in between the mechanical breaths at his own tidal volume. This mode of ventilation is called: A. Assist/control B. Controlled C. Intermittent mandatory D. Positive end-expiratory pressure

C. Intermitten mandatory ventilation The intermittent mandatory ventilation mode allows the patient to breathe spontaneously between breaths. The patient will receive a preset tidal volume at a preset rate. Any additional breaths that he initiates will be at his spontaneous tidal volume, which will likely be lower than the ventilator breaths. In assist/control ventilation, spontaneous effort results in a preset tidal volume delivered by the ventilator. Spontaneous effort during controlled ventilation results in patient/ventilator dyssynchrony. Positive end-expiratory pressure (PEEP) is application of positive pressure to breaths delivered by the ventilator. PEEP is an adjunct to both intermittent mandatory and assist/control ventilation.

The nurse is caring for a patient with an endotracheal tube. The nurse understands that the endotracheal suctioning is needed to facilitate removal of secretions and that the procedure: A. Decreases intracranial pressure B. Depresses the cough reflex C. Is done as indicated by patient assessment D. Is more effective by saline instillation to loosen secretions

C. Is done as indicated by patient assessment Suctioning is performed as indicated by patients assessment. Suctioning is associated with increases in intracranial pressure; therefore, it is important to hyperoxygenate the patient prior to suctioning to reduce this complication. Suctioning can stimulate the cough reflex rather than depress this reflex. Saline instillation is associated with negative physiological outcomes and is not recommended as part of the suctioning procedure; it does not loosen secretions, which is a common misperception.

The nurse is caring for a mechanically ventilated patient with a pulmonary artery catheter who is receiving continuous enteral tube feedings. When obtaining continuous hemodynamic monitoring measurements, what is the best nursing action? A. Do not document hemodynamic values until the patient can be placed in the supine position B. Level and zero reference the air-fluid interface of the transducer with the patient in the supine position and record hemodynamic values C. Level and zero reference the air-fluid interface of the transducer with the patient's head of bed elevated 30 degrees and record hemodynamic values D. Level and zero reference the air-fluid interface of the transducer with patient supine in the side-lying position and record hemodynamic values

C. Level and zero reference the air-fluid interface of the transducer with the patient's head of bed elevated 30 degrees and record hemodynamic values Elevation of the head of bed is an important intervention to prevent aspiration and ventilator-associated pneumonia. Patients who require hemodynamic monitoring while receiving tube feedings should have the air-fluid interface of the transducer leveled with the phlebostatic axis while the head of bed is elevated to at least 30 degrees. Readings will be accurate. Supine positioning of a mechanically ventilated patient increases the risk of aspiration and ventilator-associated pneumonia and is contraindicated in this patient. Hemodynamic values can be accurately measured and trended in with the head of the bed elevated as high as 60 degrees. Even though hemodynamic values can be obtained in lateral positions, it is technically difficult and not accurate unless the positioning of the transducer is exact. Regardless, head of bed elevation is indicated for this patient.

A patient is admitted with an acute myocardial infarction (AMI). The nurse knows that an angiotensin-converting enzymes (ACE) inhibitor should be started within 24 hours to reduce the incidence of which process? A. Myocardial stunning B. Hibernating myocardium C. Myocardial remodeling D. Tachycardia

C. Myocardial remodeling Myocardial remodeling is a process mediated by angiotensin II, aldosterone, catecholamine, adenosine, and inflammatory cytokines, which causes myocyte hypertrophy and loss of contractile function in the areas of the heart distant from the site of infarctions. ACE inhibitors reduce the incidence of remodeling.

The nurse is caring for a patient with acute respiratory distress syndrome who is hypoxemic despite mechanical ventilation. The physician orders a nontraditional ventilator mode as part of treatment. Despite sedation and analgesia, the patient remains restless and appears to be in discomfort. The nurse informs the physician of this assessment and anticipates an order for: A. Continuous lateral rotation therapy B. Guided imagery C. Neuromuscular blockade D. Prone positioning

C. Neuromuscular blockade Paralysis and additional sedation may be needed if the patient requires nontraditional ventilation. Guided imagery is an excellent non-pharmacological approach to manage anxiety; however, the non-traditional mode of ventilation usually requires that the patient receive neuromuscular blockade. Prone positioning is a treatment for refractory hypoxemia but not indicated until the neuromuscular blockade has been tried.

A patient is admitted with an angina attack. The nurse anticipates which drug regimen to be initiated? A. ACE inhibitors and diuretics B. Morphine sulfate and oxygen C. Nitroglycerin, oxygen and beta blockers D. Statins, bile acid, and nicotonic acid

C. Nitroglycerin, oxygen, and beta blockers Conservative intervention for the patient experiencing angina includes nitrates, beta-blockers, and oxygen.

Neuromuscular blocking agents are used in the management of some ventilated patients. Their primary mode of action is: A. Analgesia B. Anticonvulsant C. Paralysis D. Sedation

C. Paralysis Neuromuscular blocking agents cause respiratory muscle paralysis. They do not have sedative, analgesic, or anticonvulsant effects.

A patient is admitted with the diagnosis of unstable angina. The nurse knows that the physiological mechanism present is most likely which of the following? A. Complete occlusion of a coronary artery B. Fatty streak within the intima of a coronary artery C. Partial occlusion of a coronary artery with a thrombus D. Vasospasm of a coronary artery

C. Partial occlusion of a coronary artery with a thrombus In unstable angina, some blood continues to flow through the affected coronary artery; however, flow is diminished related to partial occlusion. The pain in unstable angina is more severe, may occur at rest, and requires more frequent nitrate therapy.

A mode of pressure-targeted ventilation that provides positive pressure to decrease the workload of spontaneous breathing through the endotracheal tube is: A. CPAP B. PEEP C. Pressure support ventilation D. T-piece adapter

C. Pressure support ventilation Pressure support (PS) is a mode of ventilation in which the patients spontaneous respiratory activity is augmented by the delivery of a preset amount of inspiratory positive pressure. Positive end-expiratory pressure provides positive pressure at end expiration during mechanical breaths, and continuous positive airway pressure provides positive pressure during spontaneous breaths. The T-piece adapter is used to provide oxygen with spontaneous, unassisted breaths.

A definitive diagnosis of pulmonary embolism can be made by: A. ABG analysis B. Chest x-ray examination C. Pulmonary angiogram D. Ventilation perfusion scanning

C. Pulmonary angiogram

The patient is admitted with recurrent supraventricular tachycardia that the cardiologist believes to be related to an accessory conduction pathway or a reentry pathway. The nurse anticipates which procedure to be planned for this patient? A. Implantablle cardioverter-defibrillator placement B. Permanent pacemaker insertion C. Radiofrequency catheter ablation D. Temporary transvenous pacemaker placement

C. Radio frequency catheter ablation Radiofrequency catheter ablation is a method of interrupting a supraventricular tachycardia, a dysrhythmia caused by a reentry circuit, and an abnormal conduction pathway.

Which of the following acid-base disturbances commonly occurs with the hyperventilation and impaired gas exchange seen in severe exacerbation of asthma? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

C. Respiratory acidosis Although the patient with a severe exacerbation of asthma hyperventilates, gas exchange is impaired, which causes respiratory acidosis.

A patient is being mechanically ventilated in the synchronized intermittent mandatory ventilation mode at a rate of 4 breaths/min. His spontaneous respirations are 12 breaths/min. He receives a dose of morphine sulfate, and his respirations decrease to 4 breaths/min. Which acid-base disturbance will likely occur? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

C. Respiratory acidosis The morphine caused respiratory depression. As a result, the frequency and depth of respiration is compromised, which can lead to respiratory acidosis.

During a code, the nurse would place paddles for anterior defibrillation in what locations? A. Second intercostal space, left sternal border, and fourth intercostal space, left midclavicular line B. Second intercostal space, right sternal border and fourth intercostal space, left midaxillary line C. Second intercostal space, right sternal border and fourth intercostal space, left midaxillary line D. Fourth intercostal space, right sternal border and fifth intercostal space, left midclavicular line

C. Second intercostal space, right sternal border and fourth intercostal space, left midaxillary line Anterior paddle placement is used most often for defibrillation. In the anterior method, one paddle or adhesive electrode pad is placed at the second intercostal space to the right of the sternum, and the other paddle or adhesive electrode pad is placed at the fifth intercostal space, midaxillary line, to the left of the sternum.

A 72-year-old woman is brought to the ED by her family. The family states that shes just not herself. Her respirations are slightly labored, and her heart monitor shows sinus tachycardia (rate 110 beats/min) with frequent premature ventricular contractions (PVCs). She denies any chest pain, jaw pain, back discomfort, or nausea. Her troponin levels are elevated, and her 12-lead electrocardiogram (ECG) shows elevated ST segments in leads II, III, and AVF. The nurse knows that these symptoms are most likely associated with which diagnosis? A. Hypokalemia B. Non Q wave MI C. Silent myocardial infarction D. Unstable angina

C. Silent myocardial infarction Some individuals may have ischemic episodes without knowing it, thereby having a silent infarction. These can occur with no presenting signs or symptoms. Asymptomatic or nontraditional symptoms are more common in elderly persons, in women, and in diabetic patients.

When assessing the patient for hypoxemia, the nurse recognizes that an early sign of the effect of hypoxemia on the cardiovascular system is: A. heart block B. Restlessness C. Tachycardia D. Tachypnea

C. Tachycardia Tachycardia can occur as a compensatory mechanism to increase cardiac output and oxygenation.

The nurse is discharging a patient with asthma. As part of the discharge instruction, the nurse instructs the patient to prevent exacerbation by: A. Obtaining an appointment for follow up pulmonary function studies 1 week after discharge B. Limiting activity until patient is able to climb two flights of stairs C. Taking all asthma medications as prescribed D. Taking medications on a PRN basis according to symptoms

C. Taking all asthma medications as prescribed Exacerbation of asthma is often related to not adhering to the therapeutic regimen; patient teaching is essential. Follow-up studies will be determined by the physician. Activity is based on the patients activity tolerance and is not limited. Medications are taken regularly to avoid exacerbation. Only rescue medications are used on a prn basis.

A patient is brought to the critical care unit after a motor vehicle crash. On admission, the patient is complaining of dyspnea and chest pain. Upon examination, the nurse notes a lack of breath sounds on the left side and a tracheal shift. What would be the most likely diagnosis? A. Pericardial tamponade B. Symptomatic bradycardia C. Tension pneumothorax D. Unstable tachycardia

C. Tension pneumothorax A tension pneumothorax occurs when air enters the pleural space but cannot escape. Pressure increases in the pleural space and causes the lung to collapse. Symptoms of a tension pneumothorax include dyspnea, chest pain, tachypnea, tachycardia, and jugular venous distention.

When assessing the 12-lead electrocardiogram (ECG) or a rhythm strip, it is helpful to understand that the electrical activity is viewed in relation to the positive electrode of that particular lead. When an electrical signal is aimed directly at the positive electrode, the inflection will be: A. Negative B. Upside down C. Upright D. equally positive and negative

C. Upright

The code team has just defibrillated a patient in ventricular fibrillation. Following CPR for 2 minutes, what is the next action to take? A. Administer amiodarone B. Administer lidocaine C. Assess rhythm and pulse D. Prepare for transcutaneous pacing

C. assess rhythm and pulse Reassess the patient frequently. Check for return of pulse, spontaneous respirations, and blood pressure

The nurse notes that the patients arterial blood gas levels indicate hypoxemia. The patient is not intubated and has a respiratory rate of 22 breaths/min. The nurses first intervention to relieve hypoxemia is to: A. Call the physician for an emergency intubation procedure B. Obtain an order for bilevel positive airway (BiPAP) C. Notify the provider of values and obtain order for oxygen D. Suction secretions from the oropharynx

C. notify the provider of values and obtain and order for oxygen Oxygen is administered to treat or prevent hypoxemia. Oxygen should be considered a first-line treatment in cases of hypoxemia. Emergency intubation is not warranted at this time. BiPAP may be considered if administration of supplemental oxygen does not correct the hypoxemia. There is no indication that the patient requires suctioning.

The patient has a transcutaneous pacemaker in place. Pacemaker spikes followed by QRS complexes are noted on the cardiac rhythm strip. To determine if the pacemaker is working, the nuse must do which of the following? A. Obtain a 12-lead ECG B. Call for a pacemaker interrogation C. Palpate the pulse D. Run a 2-minute monitor strip for analysis

C. palpate the pulse The electrical and mechanical effectiveness of pacing is assessed. The electrical activity is noted by a pacemaker spike that indicates that the pacemaker is initiating electrical activity. The spike is followed by a broad QRS complex. Mechanical activity is noted by palpating a pulse during electrical activity

The patient has pulseless electrical activity. The doctor decides that the cause of the PEA is pericardial tamponade. What is the most appropriate treatment? A. Atropine B. Chest tube placement C. Pericardiocentesis D. Transcutaneous pacemaker

C. pericardiocentesis Pericardiocentesis, or needle aspiration of pericardial fluid, is performed to alleviate the pressure around the heart.

Following insertion of a central venous catheter, the nurse obtains a stat chest x-ray film to verify proper catheter placement. The radiologist reports to the nurse: The tip of the catheter is located in the superior vena cava. What is the best interpretation of these results by the nurse? A. The catheter is not positioned correctly and should be removed B. The catheter position increases risk of ventricular dysrhythmias C. The distal tip of the catheter is in the appropriate position D. The physician should be called to advance the catheter into the pulmonary artery

C. the distal tip of the catheter is in the appropriate position X-ray results indicate proper position of the catheter. The tip of the central venous catheter should rest just above the right atrium in the superior vena cava. The central venous catheter is positioned correctly in the superior vena cava. Dysrhythmias occur if the catheter migrates to the right ventricle. Central venous catheters are placed into great vessels of the venous system and not advanced into the pulmonary artery.

The charge nurse has a Vigileo pulse contour cardiac output monitoring system available for use in the surgical intensive care unit. For which patient is use of this device most appropriate? A. A patient with a history of aortic insufficiency admitted with a postoperative myocardial infarction B. A mechanically ventilated patient with cardiogenic shock being treated with an intraaortic balloon pumo C. A patient with a history of a fib having frequent episodes of paroxysmal supraventricular tachycardia D. A mechanically ventilated patient admitted following repair of an acute bowel obstruction

D. A mechanically ventilated patient admitted following repair of an acute bowel obstruction Pulse contour analysis systems provide stroke volume variation and pulse pressure variation data and are better predictors of fluid responsiveness in mechanically ventilated patients. A patient postoperative from repair of an acute bowel obstruction that is mechanically ventilated is an appropriate candidate for this method of monitoring. Aortic insufficiency, intraaortic balloon pump therapy, and the presence of cardiac dysrhythmias are conditions in which pulse contour analysis systems are either inaccurate or contraindicated.

The nurse is caring for a patient with a pulmonary artery catheter. Assessment findings include a blood pressure of 85/40 mm Hg, heart rate of 125 beats/min, respiratory rate 35 breaths/min, and arterial oxygen saturation (SpO2) of 90% on a 50% venturi mask. Hemodynamic values include a cardiac output (CO) of 1.0 L/min, central venous pressure (CVP) of 1 mm Hg, and a pulmonary artery occlusion pressure (PAOP) of 3 mm Hg. The nurse questions which of the following physicians order? A. titrate supplemental oxygen to achieve a SpO2 > 94% B. Infuse 500 mL 0.9% saline over 1 hour C. Obtain arterial blood gas and serum electrolytes D. Administer furosemide 20 mg IV

D. Administer furosemide 20 mg IV A central venous pressure of 1 mm Hg, pulmonary artery occlusion pressure of 1 mm Hg along with a blood pressure of 85/40 mm Hg and heart rate of 125 are indicative of a low volume state. Infusion of 500 mL of 0.9% normal saline will increase circulating fluid volume. Administration of furosemide (Lasix) is contraindicated and could further reduce circulating fluid volume. Titrating supplemental oxygen, obtaining serum blood gas and electrolyte samples, although not a priority, are appropriate interventions.

The nurse is caring for a patient with an admitting diagnosis of congestive failure. While attempting to obtain a pulmonary artery occlusion pressure in the supine position, the patient becomes anxious and tachypneic. What is the best action by the nurse? A. Limit the patient's supine position to no more than 10 seconds B. Administer anxiety medications while recording the pressure C. Encourage the patient to take slow, deep breaths while supine D. Elevate the HOB 45 degrees while recording pressures

D. Elevate the HOB 45 degrees while recording the pressures Hemodynamic parameters can be accurately measured and trended with the head of the bed elevated to 45 degrees as long as the zeroing stopcock is properly leveled to the phlebostatic axis. Elevating the head of the bed to 45 degrees would be the optimum position to obtain a pulmonary artery occlusion pressure for a patient that becomes anxious and tachypneic when flat. Administering anxiety medications is not standard of care for obtaining hemodynamic pressures. Encouraging slow deep breaths while supine may inappropriately alter hemodynamic readings by altering intrathoracic pressure.

The nurse is caring for a patient with a left radial arterial line, and a pulmonary artery catheter inserted into the right subclavian vein. Which action by the nurse best ensures the safety of the patient being monitored with invasive hemodynamic monitoring lines? A. Document all waveforms B. Limit the pressure tubing length C. Zero reference the system daily D. Ensure alarm limits are turned on

D. Ensure alarm limits are turned on When hemodynamic monitoring is being done, it is important to set alarm limits to alert the nurse to changes in the patients condition. Hemodyanamic values and waveforms are recorded at scheduled intervals and it is important that the tubing not be too long; however, alarm alerts are of highest priority. The lines are zero referenced per hospital policy, more frequently than daily.

During insertion of a pulmonary artery catheter, the physician asks the nurse to assist by inflating the balloon with 1.5 mL of air. As the physician advances the catheter, the nurse notices premature ventricular contractions on the monitor. What is the best action by the nurse? A. Deflate the balloon while slowly withdrawing the catheter B. Instruct the patient to cough and deep breathe forcefully C. Inflate the catheter balloon with an additional 1ml of air D. Ensure lidocaine hydrochloride (IV) is immediately available

D. Ensure lidocaine hydrochloride (IV) is immediately available During the insertion of the pulmonary artery catheter, ventricular dysrhythmias may occur as the catheter passes through the right ventricle. Treatment with lidocaine hydrochloride may be necessary to suppress the irritated ventricle and should be readily available. Withdrawing of the catheter is not within the scope of practice of the nurse and may not be necessary. Having the patient cough and deep-breathe will not correct the problem. The maximum volume of air necessary to inflate the balloon is 1.5 mL. Any additional volumes added may increase the risk of complications.

A patient is being mechanically ventilated in the synchronized intermittent mandatory ventilation mode at a rate of 4 breaths/min. His spontaneous respirations are 12 breaths/min. He receives a dose of morphine sulfate, and his respirations decrease to 4 breaths/min. What adjustments may need to be made to the patients ventilator settings? A. Add positive end expiratory pressure B. Add pressure support C. Change to assist/control ventilation at a rate of 4bpm D. Increase the synchronized intermittent mandatory ventilation respiratory rate

D. Increased the synchronized intermittent mandatory ventilation respiratory rae

A 90 year old nursing home patient is admitted to the critical care unit with a severe case of pneumonia. No living will or designation of healthcare surrogate is noted in the chart. In the event this patient needs intubation and or CPR, what should the nurse's action be? A. Activate the code team, but initiate a slow code B. Call the nursing home to determine the patient's or family's wishes C. Code the patient for 5 minutes and then cease efforts D. Initiate intubation and/or CPR resuscitation efforts

D. Initiate intubation and/or CPR resuscitation efforts In the absence of a written order from a physician to withhold resuscitative measures, resuscitation efforts must be initiated if indicated.

Percutaneous coronary intervention is contraindicated for patients with lesions in which coronary artery? A. Right coronary artery B. Left coronary artery C. Circumflex D. Left main coronary artery

D. Left main coronary artery Stenosis of the left mainstem artery is considered unacceptable for percutaneous intervention.

The nurse is concerned that a patient is at increased risk of developing a pulmonary embolus and develops a plan of care for prevention to include which of the following? A. Antiseptic oral care B. Bedrest with head of bed elevated C. Coughing and deep breathing D. Mobility

D. Mobility

During a code situation, the nurse would preapre to use which preferred IV fluid? A. 5% dextrose in 0.45 normal saline B. 5% dextrose in water C. Dopamine infusion D. Normal saline

D. Normal saline Normal saline is the preferred intravenous fluid during resuscitation efforts because it expands intravascular volume better than infusions containing dextrose.

Pulse oximetry measures: A. arterial blood gases B. Hemoglobin values C. Oxygen consumption D. Oxygen saturation

D. Oxygen saturation

The nurse is preparing to obtain a pulmonary artery occlusion pressure (PAOP) reading for a patient who is mechanically ventilated. Ensuring that the air-fluid interface is at the level of the phlebostatic axis, what is the best nursing action? A. Place the patient in the supine position and record the PAOP immediately after exhalation B. Place the patient in supine position and document the average PAOP obtained after 3 measurements C. Place the patient with the HOB elevated 30 degrees and document the average PAOP pressure obtained D. Place the patient with HOB elevated 30 degrees and record the PAOP just before the increase in pressure during inhalation

D. Place the patient with the HOB elevated 30 degrees and record the PAOP just before the increase in pressure during inhalation Pressures are highest when measured at end exhalation in the spontaneously breathing patient. In mechanically ventilated patients, pressures increase with inhalation and decrease with exhalation. Measurements are obtained just before the increase in pressure during inhalation. Supine positioning is contraindicated in the mechanically ventilated patient. The head of bed should be elevated to 30 degrees. Pulmonary artery occlusion pressure is not averaged, but measured during inhalation in the mechanically ventilated patient while appropriate positioning is maintained.

The physician orders the following mechanical ventilation settings for a patient who weighs 75 kg. The patients spontaneous respiratory rate is 22 breaths/min. What arterial blood gas abnormality may occur if the patient continues to be tachypneic at these ventilator settings? Settings: Tidal volume: 600 mL (8 mL per kg) FiO2: 0.5 Respiratory rate: 14 breaths/min Mode assist/control Positive end-expiratory pressure: 10 cm H2O A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

D. Respiratory alkalosis Assist/control ventilation may result in respiratory alkalosis, especially when the patient is breathing at a high rate. Each time the patient initiates a spontaneous breathin this case 22 times per minutethe ventilator will deliver 600 mL of volume.

In assessing a patient, the nurse understands that an early sign of hypoxemia is: A. clubbing of nail beds B. Cyanosis C. Hypotension D. Restlessness

D. Restlessness

Current guidelines recommed the oral route for endotracheal intubation. The rational for this recommendation is that nasotracheal intubation is associated with a greater risk for: A. Basilar skull fracture B. Cervical hyperextension C. Impaired ability to mouth words D. Sinusitis and infection

D. Sinusitis and infection Nasotracheal intubation is associated with an increased risk for sinusitis, which may contribute to ventilator-associated infection. Nasal intubation is contraindicated in patients with basilar skull fracture. The procedure is sometimes performed in patients with cervical spine injury; the procedure can be done without hyperextending the neck. Patients with nasotracheal tubes are generally more comfortable and have a greater ability to mouth words.

The nurse needs to evaluate arterial blood gases before administration of which drug? A. Calcium chloride B. Magnesium sulfate C. Potassium D. Sodium bicarbonate

D. Sodium bicarbonate Bicarbonate therapy should be guided by the bicarbonate concentration or calculated base deficit from arterial blood gas analysis or lab measurement

A patient has elevated blood lipids. The nurse anticipates which classification of drugs to be prescribed for the patient? A. Bile acid resins B. Nicotonic acid C. Nitroglycerin D. Statins

D. Statins The statins have been found to lower low-density lipoproteins (LDLs) more than other types of lipid-lowering drugs.

The nurse is caring for a mechanically ventilated patient. The physicians are considering performing a tracheostomy because the patient is having difficulty weaning from mechanical ventilation. Related to tracheostomy, the nurse understands which of the following? A. Patient outcomes are better if the tracheostomy is done within a week of intubation B. Percutaneous tracheostomy can be done safely at the bedise by the respiratory therapist C. Procedures performed in the operationg room are associated with fewer complications D. The greatest risk after a percutaneous tracheostomy is accidental decannulation

D. The greatest risk after a percutaneous tracheostomy is accidental decannulation Optimal timing of tracheostomy is not yet known. Percutaneous procedures done at the bedside are not associated with any higher risks than those done in the operating room. Trained physicians safely perform percutaneous tracheostomies at the bedside. The greatest risk for percutaneous tracheostomy is accidental decannulation because the trachea is not surgically attached.

Positive end-expiratory pressure (PEEP) is a mode of ventilatory assistance that produces the following condition: A. Each time the patient initiates a breath, the ventilator delivers a full preset tidal volume B. For each spontaneous breath taken by the patient, the tidal volume is determined by the patient's ability to generate negative pressure 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 expiration that is measured in cm H2O

D. There is pressure remaining in the lungs at the end of expiration that is measured in cm H2O

Which of the following treatments may be used to dissolve a thrombus that is lodged in the pulmonary artery? A. Aspirin B. Embolectomy C. Heparin D. Thrombolytics

D. Thrombolytics Thrombolytics are useful in the management of pulmonary embolus and are given to dissolve the clot. Heparin will prevent further clot formation, but it will not dissolve the clot. Aspirin is not a thrombolytic agent. An embolectomy is a surgical procedure to remove the clot. Heparin will prevent further clot formation, but it will not dissolve the clot.

Oxygen is administered to treat or prevent hypoxemia. Oxygen should be considered a first-line treatment in cases of hypoxemia. Emergency intubation is not warranted at this time. BiPAP may be considered if administration of supplemental oxygen does not correct the hypoxemia. There is no indication that the patient requires suctioning. A. Compensated metabolic alkalosis B. Normal values C. Uncompensated respiratory acidosis D. Uncompensated respiratory alkalosis

D. Uncompensated respiratory alkalosis The low PaCO2 and high pH values show respiratory alkalosis. The bicarbonate level is normal.

While caring for a patient with a pulmonary artery catheter, the nurse notes the pulmonary artery occlusion pressure (PAOP) to be significantly higher than previously recorded values. The nurse assesses respirations to be unlabored at 16 breaths/min, oxygen saturation of 98% on 3 L of oxygen via nasal cannula, and lungs clear to auscultation bilaterally. What is the priority nursing action? A. Increase supplemental oxygen and notify respiratory therapy B. Notify the physician immediately of the assessment findings C. Obtain a stat chest x-ray film to verify proper catheter placement D. Zero reference and level the catheter at the phlebostatic axis

D. Zero and level the catheter at the phlebostatic axis A hemodynamic value not supported by clinical assessment should be treated as questionable. To ensure the accuracy of hemodynamic readings, the catheter transducer system must be leveled at the phlebostatic axis and zero referenced. In this example, the catheter transducer system may be lower than the phlebostatic axis, resulting in erroneously higher pressures. Clinical manifestations do not support increasing supplemental oxygen. Clinical manifestations do not warrant physician intervention; aberrant values should be investigated further. An aberrant value warrants further investigation, which includes zero referencing and checking the level as an initial measure. A chest x-ray study is not warranted at this time.

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 patients oxygen saturation is decreasing and heart rate and respiratory rate are increasing. The nurses 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. Continue to find the cause of the alarm and fix it D. Manually ventilate the patient while calling for a respiratory therapist

D. manually ventilate the patient while calling for a respiratory therapist

The amount of effort needed to maintain a given level of ventilation is termed: A. Compliance B. Resistance C. Tidal volume D. Work of breathing

D. work of breathing Work of breathing is the amount of effort needed to maintain a given level of ventilation. Compliance is a measure of the distensibility, or stretchability, of the lung and chest wall. Resistance refers to the opposition to the flow of gases in the airways. Tidal volume is the volume of air in a typical breath.

A 53-year-old, 80-kg patient is admitted to the cardiac surgical intensive care unit after cardiac surgery. Four hours after admission to the surgical intensive care unit at 4 PM, the patient has stable vital signs and normal arterial blood gases (ABGs), and is placed on a T-piece for ventilatory weaning. During the nurses 7 PM (1900) assessment, the patient is restless, heart rate has increased to 110 beats/min, respirations are 36 breaths/min, and blood pressure is 156/98 mm Hg. The cardiac monitor shows sinus tachycardia with 10 premature ventricular contractions (PVCs) per minute. Pulmonary artery pressures are elevated. The nurse suctions the patient and obtains pink, frothy secretions. Loud crackles are audible throughout lung fields. The nurse notifies the physician, who orders an ABG analysis, electrolyte levels, and a portable chest x-ray study. How does the nurse interpret the following blood gas levels? pH 7.28 PaCO2 46 mm Hg Bicarbonate 22 mEq/L PaO2 58 mm Hg O2 saturation 88%

Hypoxemia with uncompensated respiratory acidosis

Increased SvO2 and ScvO2 levels

Indicate tissues are not using oxygen delivered, related to 4 physiologic reasons: 1. Shunting 2. Shift of oxyhemoglobin dissocation curve to the left results in increased affinity of hemoglobin for oxygen 3. Increased diffusion distance between capillaries and cells is present bc of intersitital edema 4. Cells are unable to use oxygen being delivered

Decreased SvO2 and ScvO2 levels

Result from a failure to deliver adequate oxygen to the tissues or increased oxygen consumption

A patient has coronary artery bypass graft surgery and is transported to the surgical intensive care unit at noon. He is placed on mechanical ventilation. Interpret his initial arterial blood gas levels: pH 7.31 PaCO2 48 mm Hg Bicarbonate 22 mEq/L PaO2 115 mm Hg O2 saturation 99% A. Normal arterial blood gas levels with a hugh oxygen level B. Partly compensated respiratory acidosis, normal oxygen C. Uncompensated metabolic acidosis with high oxygen levels D. Uncompensated respiratory acidosis, hyperoxygenated

The high PaO2 level reflects hyperoxygenation; the PaCO2 and pH levels show respiratory acidosis. The respiratory acidosis is uncompensated as indicated by a pH of 7.31 (acidosis) and a normal bicarbonate level. No metabolic compensation has occurred.

Normal ABG levels

pH - 7.35-7.45 PaO2 - 80-100 (lower is hypoxemia) PaCO2 - 35-45 HCO3 - 22-26