CC Exam 1

Ejection fraction

55%

A patient is admitted after surgery with a history of hyperthyroidism. The nurse suspects the patient may be developing thyroid storm. Which finding would confirm this suspicion? a. Tachycardia b. Hypotension c. Decreased appetite d. Hypothermia

A

The nurse is caring for a patient with a head injury who has developed diabetes insipidus (DI). What medication would the nurse expect to be prescribed for the patient? a. Vasopressin b. Insulin c. Glucagon d. Propylthiouracil

A

Which statements describe S1, the first heart sound? (Select all that apply.) a. It is associated with closure of the mitral and tricuspid valves. b. It is a high-pitched sound. c. It can be heard most clearly with the diaphragm of the stethoscope. d. The best listening point is in the aortic area. e. The "split" sound can best be detected in the tricuspid area

ABCE

A patient suddenly develops a wide QRS complex tachycardia. The patient's heart rate is 220 beats/min and regular; blood pressure is 96/40 mm Hg; and respiratory rate is 22 breaths/min, and the patient is awake without complaint except for palpitations. Which intervention should be tried first? a. Adenosine 6 mg rapid IV push b. Lidocaine 1 mg/kg IV push c. Verapamil 5 mg IV push d. Digoxin 0.5 mg IV push

ANS: A Adenosine (Adenocard) is an antidysrhythmic agent that remains unclassified under the current system. Adenosine occurs endogenously in the body as a building block of adenosine triphosphate (ATP). Given in intravenous boluses, adenosine slows conduction through the AV node, causing transient AV block. It is used clinically to convert supraventricular tachycardias and to facilitate differential diagnosis of rapid dysrhythmias.

Adenosine is an antidysrhythmic agent that is given primarily what reason? a. To convert supraventricular tachycardias b. To suppress premature ventricular contractions (PVCs) c. To treat second- and third-degree AV blocks d. To coarsen ventricular fibrillation so that defibrillation is effective

ANS: A Adenosine occurs endogenously in the body as a building block of adenosine triphosphate (ATP). Given in intravenous boluses, adenosine slows conduction through the atrioventricular (AV) node, causing transient AV block. It is used clinically to convert supraventricular tachycardias and to facilitate the differential diagnosis of rapid dysrhythmias.

Which condition is usually associated with clubbing? a. Cyanosis heart disease b. Carbon monoxide poisoning c. Peripheral cyanosis d. Decreased cardiac output

ANS: A Clubbing in the nail bed is a sign associated with long-standing central cyanotic heart disease or pulmonary disease with hypoxemia. Peripheral cyanosis, a bluish discoloration of the nail bed, is seen more commonly. Peripheral cyanosis results from a reduction in the quantity of oxygen in the peripheral extremities from arterial disease or decreased cardiac output. Clubbing is not associated with carbon monoxide poisoning.

Which hemodynamic alteration is the most common cause of a decrease in cardiac output in the postoperative cardiovascular patient? a. Reduced preload b. Increased afterload c. Increased contractility d. Bradycardia

ANS: A In most patients, reduced preload is the cause of low postoperative cardiac output. To enhance preload, volume may be administered in the form of crystalloid, colloid, or packed red blood cells.

Which finding is a reliable indicator of reperfusion after fibrinolytic therapy? a. Dysrhythmias b. Q waves c. Elevated ST segments d. Immediate rapid decrease in cardiac biomarkers

ANS: A Initially, when there is reperfusion, ischemic chest pain ceases abruptly as blood flow is restored. Another reliable indicator of reperfusion is the appearance of various "reperfusion" dysrhythmias. Premature ventricular contractions, bradycardias, heart block, ventricular tachycardia, and (rarely) ventricular fibrillation may occur.

How does a percutaneous transluminal coronary angioplasty (PTCA) improve blood flow? a. The balloon stretches the vessel wall, fractures the plaque, and enlarges the vessel lumen. b. Medication is delivered through the catheter that dissolves the plague and enhances vessel patency. c. The balloon removes blood clots from the vessel improving patency of the vessel. d. The balloon compresses the plaque against the vessel wall enlarging the vessel lumen

ANS: A Percutaneous transluminal coronary angioplasty involves the use of a balloon-tipped catheter that, when advanced through an atherosclerotic lesion (atheroma), can be inflated intermittently for the purpose of dilating the stenotic area and improving blood flow through it. The high balloon-inflation pressure stretches the vessel wall, fractures the plaque, and enlarges the vessel lumen.

A patient is admitted with hypertrophic cardiomyopathy. The nurse would expect the medical management of this patient to include which intervention? a. Administration of beta-blockers b. Administration of positive inotropes c. Plans for intensive exercise regimen d. Plans for an aortic valve replacement

ANS: A Pharmacologic management includes beta-blockers to decrease left ventricular workload, medications to control and prevent atrial and ventricular dysrhythmias, anticoagulation if atrial fibrillation or left ventricular thrombi are present, and finally drugs to manage heart failure

Which statement regarding the difference between stable and unstable angina is accurate? a. Stable angina responds predictably well to nitrates. b. Stable angina is not precipitated by activity. c. Stable angina has a low correlation to coronary artery disease (CAD). d. Stable angina is a result of coronary artery spasm.

ANS: A Stable angina is predictable and caused by similar precipitating factors each time; typically, it is exercise induced. Pain control is usually achieved by rest and by sublingual nitroglycerin within 5 minutes. Stable angina is the result of fixed lesions (blockages) of more than 75% of the coronary artery lumen and thus has a high correlation to CAD, not coronary spasm.

What are the clinical manifestations of right-sided heart failure? a. Elevated central venous pressure and sacral edema b. Pulmonary congestion and jugular venous distention c. Hypertension and chest pain d. Liver tenderness and pulmonary edema

ANS: A The common manifestations of right ventricular failure are the following: jugular venous distention, elevated central venous pressure, weakness, peripheral or sacral edema, hepatomegaly (enlarged liver), jaundice, and liver tenderness. Gastrointestinal symptoms include poor appetite, anorexia, nausea, and an uncomfortable feeling of fullness.

A patient is admitted with left-sided heart failure related to mitral stenosis. Physical assessment findings reveal an S3 and a 3/6 systolic murmur. The grading of a murmur as a 3/6 refers to which characteristics of the murmur? a. Intensity b. Tone c. Radiation d. Pitch

ANS: A The grading of a murmur as a 3/6 refers to the intensity or loudness of the murmur. Murmurs are graded on a scale of 1 to 6; the higher the number, the louder the murmur. Radiation refers to how far the sound spreads across the chest wall. Pitch refers to whether the tone of the murmur is high or low. Tone is not a characteristic used to describe a murmur.

6. A nurse is providing care to a patient on fibrinolytic therapy. Which statement from the patient warrants further assessment and intervention by the nurse? a. "My back is killing me!" b. "There is blood on my toothbrush!" c. "Look at the bruises on my arms!" d. "My arm is bleeding where my IV is!"

ANS: A The nurse must continually monitor for clinical manifestations of bleeding. Mild gingival bleeding and oozing around venipuncture sites are common and not causes for concern. However, severe lower back pain and ecchymoses are suggestive of retroperitoneal bleeding. If serious bleeding occurs, all fibrinolytic heparin therapies are discontinued, and volume expanders, coagulation factors, or both are administered.

Which statement best describes the purpose of the modified Allen test? a. To assess the adequacy of blood flow through the ulnar artery b. To evaluate oxygen saturation in the brachial and ulnar artery c. To assess the patency of an internal arteriovenous (AV) graft d. To determine the size of needle to be used for venipuncture

ANS: A The purpose of the modified Allen test is to assess the adequacy of blood flow to the hand through the ulnar artery before arterial cannulation. The modified Allen test does not assess oxygen saturation or the patency of an AV graft or determine the needle size for venipuncture

In the acute phase after STEMI, fibrinolytic therapy is used in combination with heparin to recanalize the coronary artery. What dosage is the initial heparin bolus? a. 60 units/kg maximum of 5000 units b. 30 units/kg maximum of 3000 units c. 25 units/kg maximum of 2500 units d. 12 units/kg maximum of 1000 units

ANS: A In the acute phase after ST segment elevation myocardial infarction, heparin is administered in combination with fibrinolytic therapy to recanalize (open) the coronary artery. For patients who will receive fibrinolytic therapy, an initial heparin bolus of 60 units/kg (maximum, 5000 units) is given intravenously followed by a continuous heparin drip at 12 units/kg/hr (maximum 1000 units/hr) to maintain an activated partial thromboplastin time between 50 and 70 seconds (1.5 to 2.0 times control

Which mechanisms are responsible for a myocardial infarction (MI)? (Select all that apply.) a. Coronary artery thrombosis b. Plaque rupture c. Coronary artery spasm near the ruptured plaque d. Preinfarction angina e. Hyperlipidemia

ANS: A, B, C The three mechanisms that block the coronary artery and are responsible for the acute reduction in oxygen delivery to the myocardium are: (1) plaque rupture, (2) new coronary artery thrombosis, and (3) coronary artery spasm close to the ruptured plaque

The neuroendocrine stress response produces which findings? (Select all that apply.) a. Elevated blood pressure b. Decreased gastric motility c. Tachycardia d. Heightened pain awareness e. Increased glucose

ANS: A, B, C, E

A patient is diagnosed with third-degree heart failure. The nurse reviews the patient's medication list. Which classifications of drugs should be avoided with this patient? (Select all that apply.) a. Nonsteroidal anti-inflammatory drugs (NSAIDs) b. Antidysrhythmics c. Angiotensin-converting enzyme (ACE) inhibitors d. Calcium channel blockers e. Beta-blockers

ANS: A, B, D Types of medications that have been found to worsen heart failure should be avoided, including most antidysrhythmics, calcium channel blockers, and nonsteroidal anti-inflammatory medications. Angiotensin-converting enzyme inhibitors and beta-blockers are used to treat heart failure

. Which clinical manifestations are indicative of left ventricular failure? (Select all that apply.) a. Cool, pale extremities b. Jugular venous distention c. Liver tenderness d. Weak peripheral pulses e. Rales

ANS: A, D, E Clinical manifestations of left ventricular failure include decreased peripheral perfusion with weak or diminished pulses; cool, pale extremities; and, in later stages, peripheral cyanosis. Over time, with progression of the disease state, the fluid accumulation behind the dysfunctional left ventricle elevates pulmonary pressures, contributes to pulmonary congestion and edema.

Which anticoagulant enhances the activity of antithrombin III and does not require aPTT or ACT monitoring? a. Heparin b. Enoxaparin c. Bivalirudin d. Argatroban

ANS: B

Which dosage of dopamine results in stimulation of beta1 receptors and increased myocardial contractility? a. 1 mcg/kg/min b. 5 mcg/kg/min c. 15 mcg/kg/min d. 20 mcg/kg/min

ANS: B At low dosages of 1 to 2 mcg/kg/min, dopamine stimulates dopaminergic receptors, causing renal and mesenteric vasodilation. Moderate dosages result in stimulation of beta1 receptors to increase myocardial contractility and improve cardiac output. At dosages greater than 10 mg/kg/min, dopamine predominantly stimulates alpha receptors, resulting in vasoconstriction that often negates both the beta-adrenergic and dopaminergic effects.

Through what mechanism does enalapril decrease blood pressure? a. Direct arterial vasodilation. b. Block the conversion of angiotensin I to angiotensin II. c. Increase fluid excretion at the loop of Henle. d. Peripheral vasoconstriction and central vasodilation

ANS: B Enalapril is an angiotensin-converting enzyme (ACE) inhibitors which produces vasodilation by blocking the conversion of angiotensin I to angiotensin II. Because angiotensin is a potent vasoconstrictor, limiting its production decreases peripheral vascular resistance. In contrast to the direct vasodilators and nifedipine, ACE inhibitors do not cause reflex tachycardia or induce sodium and water retention.

Which statement regarding beta-blockers is correct? a. They increase heart rate and are contraindicated in tachydysrhythmias. b. They result in bronchospasm and should not be used in patients with COPD. c. They increase cardiac output and help with left ventricular failure. d. They are helpful in increasing atrioventricular node conduction and are used in heart blocks.

ANS: B Knowledge of the effects of adrenergic-receptor stimulation allows for anticipation of not only the therapeutic responses brought about by beta-blockade but also the potential adverse effects of these agents. For example, bronchospasm can be precipitated by noncardioselective beta-blockers in a patient with chronic obstructive pulmonary disease secondary to blocking the effects of beta2 receptors in the lungs

What is the preferred initial treatment of an acute myocardial infarction? a. Fibrinolytic therapy b. Percutaneous coronary intervention (PCI) c. Coronary artery bypass surgery (CABG) d. Implanted cardioverter defibrillator (ICD)

ANS: B PCI is now preferred as the initial method of treatment for acute MI (primary PCI). PCI includes balloon angioplasty, atherectomy, and stent implantation, as well as a number of adjunctive devices used to facilitate successful revascularization in coronary vessels.

When checking the patient's back, the nurse pushes her thumb into the patient's sacrum. An indentation remains. What assessment finding should the nurse document? a. Sacral compromise b. Pitting edema c. Delayed skin turgor d. Dehydration

ANS: B Pitting edema occurs when an impression is left in the tissue when the thumb is removed. The dependent tissues within the legs and sacrum are particularly susceptible. Edema may be dependent, unilateral, or bilateral and pitting or nonpitting.

A patient is admitted with left-sided heart failure related to mitral stenosis. Physical assessment findings reveal an S3 and a 3/6 systolic murmur. Which statement about an S3 is accurate? a. It is normal for a person this age. b. It is synonymous with a ventricular gallop. c. It is only heard during systole. d. It is best heard best with the diaphragm of the stethoscope.

ANS: B S3 is an abnormal heart sound and is commonly referred to as a ventricular gallop. It is a low-pitched sound that occurs during diastole and is best heard with the bell of the stethoscope. The presence of an S3 may be normal in children, young adults, and pregnant women because of rapid filling of the ventricle in a young, healthy heart. However, an S3 in the presence of cardiac symptoms is an indicator of heart failure in a noncompliant ventricle with fluid overload.

A patient is admitted with a diagnosis of "rule out myocardial infarction." The patient reports midchest pressure radiating into the jaw and shortness of breath when walking up stairs. When inspecting the patient, the nurse notes that the patient needs to sit in a high Fowler position to breathe. The nurse suspects the patient may be experiencing what problem? a. Pericarditis b. Heart failure c. Anxiety d. Angina

ANS: B Sitting upright to breathe may be necessary for the patient with acute heart failure and leaning forward may be the least painful position for a patient with pericarditis.

Which mechanism is responsible for the augmentation of coronary arterial blood flow and increased myocardial oxygen supply seen with the intra-aortic balloon pump? a. The vacuum created in the aorta as a result of balloon deflation b. Diastolic inflation with retrograde perfusion c. Forward flow to the peripheral circulation d. Inflation during systole to augment blood pressure

ANS: B The blood volume in the aorta below the level of the balloon is propelled forward toward the peripheral vascular system, which may enhance renal perfusion. Subsequently, the deflation of the balloon just before the opening of the aortic valve creates a potential space or vacuum in the aorta, toward which blood flows unimpeded during ventricular ejection. This decreased resistance to left ventricular ejection, or decreased afterload, facilitates ventricular emptying and reduces myocardial oxygen demands.

A patient is admitted with a diagnosis of "rule out myocardial infarction." The patient reports midchest pressure radiating into the jaw and shortness of breath when walking up stairs. What factor influences the amount of history obtained during the admission assessment? a. Presence of cardiovascular risk factors b. Presenting symptoms c. Prior medical history d. Current medications

ANS: B The patient's presenting symptoms determines the amount of history that is obtained during the admission assessment. For a patient in acute distress, the history taking is shortened to just a few questions about the patient's chief complaint, precipitating events, and current medications.

The nurse is questioning the accuracy of the arterial catheter readings. Which two actions should the nurse perform to ensure the accuracy of the transducer? a. Obtain a cuff blood pressure and adjust the monitor to match. b. Level the transducer to the phlebostatic axis and zero the transducer. c. Have the patient laid flat and closing the transducer to air. d. Obtain blood return on the arterial line and closing all the stopcocks.

ANS: B To ensure accuracy of hemodynamic pressure readings, two baseline measurements are necessary; (1) calibration of the system to atmospheric pressure, also known as zeroing the transducer and (2) determination of the phlebostatic axis for transducer height placement, also called leveling the transducer.

Which dysrhythmia is most frequently associated with sudden cardiac death? a. Premature ventricular contractions b. Ventricular tachycardia c. Third-degree heart block d. Asystole

ANS: B When the onset of symptoms is rapid, the most likely mechanism of death is ventricular tachycardia, which degenerates into ventricular fibrillation.

Which signs and symptoms would indicate successful reperfusion after administration of a fibrinolytic agent? (Select all that apply.) a. Gradual decrease in chest pain b. Intermittent, multifocal premature ventricular contractions c. Rapid resolution of ST elevation d. Rapid rise in creatine kinase MB fraction

ANS: B, C, D A reliable indicator of reperfusion is the appearance of various "reperfusion" dysrhythmias such as premature ventricular contractions, bradycardia, heart block, and ventricular tachycardia. Rapid resolution of the previously elevated ST segment should occur. The serum concentration of creatine kinase rises rapidly and markedly, a phenomenon termed washout.

Which patients would be a candidate for fibrinolytic therapy? (Select all that apply.) a. The patient's chest pain started 8 hours ago. She has a diagnosis of NSTEMI. b. The patient's chest pain started 3 hours ago, and her ECG shows a new left bundle branch block. c. The patient presents to the emergency department with chest pain of 30 minutes' duration. She has a history of cerebrovascular accident 1 month ago. d. The patient has a history of unstable angina. He has been experiencing chest pain with sudden onset. e. The patient's chest pain started 1 hour ago, and his ECG shows ST elevation

ANS: B, E Eligibility criteria for administering fibrinolytics include chest pain of less than 12 hours' duration and persistent ST elevation. Exclusion criteria include recent surgery, cerebrovascular accident, and trauma.

A patient has been newly diagnosed with stable angina. He tells the nurse he knows a lot about his diagnosis already because his father had the same diagnosis 15 years ago. The nurse asks him to state what he already knows about angina. Which response indicates the need for additional education? a. "I should never have started smoking." b. "If I have chest pain, I need to rest." c. "I can no longer get a back massage." d. "I should take stool softeners."

ANS: C Longer term education of the patient and the family can begin. Points to cover include: (1) risk factor modification, (2) signs and symptoms of angina, (3) when to call the physician, (4) medications, and (5) dealing with emotions and stress. It is essential to teach avoidance of the Valsalva maneuver, which is defined as forced expiration against a closed glottis. This can be explained to the patient as "bearing down" during defecation or breath holding when repositioning in bed. Relaxation therapy and techniques including back rubs are encouraged when appropriate.

A patient with a serum potassium level of 6.8 mEq/L may exhibit what type of electrocardiographic changes? a. A prominent U wave b. A narrowed QRS c. Tall, peaked T waves d. Sudden ventricular dysrhythmias

ANS: C Normal serum potassium levels are 3.5 to 4.5 mEq/L. Tall, narrow peaked T waves are usually, although not uniquely, associated with early hyperkalemia and are followed by prolongation of the PR interval, loss of the P wave, widening of the QRS complex, heart block, and asystole. Severely elevated serum potassium (greater than 8 mEq/L) causes a wide QRS tachycardia. Hypokalemia can cause the development of ventricular dysrhythmias.

The nursing management plan for a patient with angina would include which intervention? a. Immediate administration of antiplatelet therapy b. Teaching the patient how to perform the Valsalva maneuver c. Assessment and documentation of chest pain episodes d. Administration of prophylactic lidocaine for ventricular ectopy

ANS: C Nursing interventions focus on early identification of myocardial ischemia, control of chest pain, recognition of complications, maintenance of a calm environment, and patient and family education. It is important to document the characteristics of the pain and the patient's heart rate and rhythm, blood pressure, respirations, temperature, skin color, peripheral pulses, urine output, mentation, and overall tissue perfusion. It is essential to teach avoidance of the Valsalva maneuver, which is defined as forced expiration against a closed glottis.

A patient is admitted with an acute myocardial infarction (MI). What common dysrhythmia should the nurse anticipate in this patient? a. Bradycardia b. Atrioventricular heart block c. Premature ventricular contractions d. Ventricular fibrillation

ANS: C Premature ventricular contractions (PVCs) are seen in almost all patients within the first few hours after MI. They are initially controlled through administration of oxygen to reduce myocardial hypoxia and by correcting acid-base or electrolyte imbalances. Other dysrhythmias can occur but not as frequently as PVCs.

What is the most common complication of fibrinolytic therapy? a. Reperfusion chest pain b. Lethargy c. Bleeding d. Heart blocks

ANS: C The most common complication related to thrombolysis is bleeding.

Why are vasopressors used cautiously in the treatment of critically ill cardiac care patients? a. They cause vasoconstriction of the smooth muscles. b. They cause vasodilation of the smooth muscles. c. They increase afterload. d. They decrease preload.

ANS: C Vasopressors are not widely used in the treatment of critically ill cardiac patients because the dramatic increase in afterload is taxing to a damaged heart. Vasopressin, also known as antidiuretic hormone, has become popular in the critical care setting for its vasoconstrictive effects. At higher doses, vasopressin directly stimulates V1 receptors in vascular smooth muscle, resulting in vasoconstriction of capillaries and small arterioles.

A patient is reporting increased chest pain when coughing, swallowing, and changing positions. Upon auscultation, a scratching or grating sound is heard in the apical area. Based on the symptoms, the nurse suspects the patient may have which condition? a. Mitral regurgitation b. Tricuspid regurgitation c. Aortic insufficiency d. Acute pericarditis

ANS: D A pericardial friction rub results from pericardial inflammation (pericarditis). The rub produces a grating or scratching sound that is both systolic and diastolic, corresponding with cardiac motion within the pericardial sac. It is often associated with chest pain, which can be aggravated by deep inspiration, coughing, swallowing, and changing position. A murmur would be heard if the patient had mitral regurgitation, aortic insufficiency, or tricuspid regurgitation.

The patient's condition has deteriorated to the point where she can no longer make decisions about her own care. Which nursing interventions would be most appropriate? a. Obtain a verbal DNR order from the practitioner. b. Continue caring for the patient as originally ordered because she obviously wanted this. c. Consult the hospital attorney for recommendations on how to proceed. d. Discuss with the family what the patient's wishes would be if she could make those decisions herself

ANS: D If the patient is not able to make end-of-life decisions for herself, her family members should be approached to discuss the next steps because they may have insight into what her wishes would be.

Which laboratory value indicates a heightened risk for the development of CAD? a. Total cholesterol level of 170 mg/dL b. HDL cholesterol level of 60 mg/dL c. Triglyceride level of 120 mg/dL d. LDL cholesterol level of 190 mg/dL

ANS: D Low-density lipoprotein (LDL) cholesterol is usually described as the "bad cholesterol" because high levels are associated with an increased risk of acute coronary syndrome (ACS), stroke, and peripheral arterial disease (PAD). High LDL levels initiate the atherosclerotic process by infiltrating the vessel wall and binding to the matrix of cells beneath the endothelium. Total cholesterol levels below 200 are considered normal. High-density lipoprotein (HDL) cholesterol levels greater 40 are at low risk of coronary artery disease. Triglyceride levels below 150 are considered normal.

The nurse is developing a patient education plan for a patient with heart failure secondary to valvular heart disease. Which instruction would be included as part of that plan? a. Increase fluid intake to increase cardiac output. b. Take sodium replacement tablets to replace sodium lost with diuretics. c. Increase daily activity until shortness of breath occurs. d. Take prophylactic antibiotics before undergoing any invasive procedure.

ANS: D Patients with valvular heart disease should be told to take prophylactic antibiotics before dental work or other invasive procedures. Patients with heart failure secondary to valvular heart disease should be instructed to maintain a fluid and sodium restriction, monitor fluid balance and daily weights, take diuretics as prescribed, and initiate activities to control breathlessness

A patient has been admitted with an inferior wall myocardial infarction. Which dysrhythmia is more prevalent in this type of infarction? a. Sinus tachycardia b. Ventricular fibrillation c. Atrial fibrillation d. Sinus bradycardia

ANS: D Sinus bradycardia (heart rate less than 60 beats/min) occurs in 30% to 40% of patients who sustain an acute myocardial infarction (MI). It is more prevalent with an inferior wall infarction in the first hour after ST segment elevation MI.

A patient is admitted with left-sided heart failure and a blood pressure of 220/118 mm Hg. Which drug will be most effective in decreasing the blood pressure and reducing afterload? a. Dopamine b. Verapamil c. Propranolol d. Sodium nitroprusside

ANS: D Sodium nitroprusside (Nipride) is a potent, rapidly acting venous and arterial vasodilator, particularly suitable for rapid reduction of blood pressure in hypertensive emergencies and perioperatively. It also is effective for afterload reduction in the setting of severe heart failure. The drug is administered by continuous intravenous infusion, with the dosage titrated to maintain the desired blood pressure and systemic vascular resistance.

5. What is the rationale for administrating a fibrinolytic agent to a patient experiencing acute ST-elevation myocardial infarction (STEMI)? a. Dilation of the blocked coronary artery b. Anticoagulation to prevent formation of new emboli c. Dissolution of atherosclerotic plaque at the site of blockage d. Restoration of blood flow via lysis of the thrombus

ANS: D The administration of a fibrinolytic agent results in the lysis of the acute thrombus, thus recanalizing, or opening, the obstructed coronary artery and restoring blood flow to the affected tissue. After perfusion is restored, adjunctive measures are taken to prevent further clot formation and reocclusion.

What is the rationale for administrating a fibrinolytic agent to a patient experiencing acute ST-elevation myocardial infarction (STEMI)? a. Dilation of the blocked coronary artery b. Anticoagulation to prevent formation of new emboli c. Dissolution of atherosclerotic plaque at the site of blockage d. Restoration of blood flow via lysis of the thrombus

ANS: D The administration of a fibrinolytic agent results in the lysis of the acute thrombus, thus recanalizing, or opening, the obstructed coronary artery and restoring blood flow to the affected tissue. After perfusion is restored, adjunctive measures are taken to prevent further clot formation and reocclusion.

A patient is admitted with an acute inferior myocardial infarction (MI). A 12-lead electrocardiogram (ECG) is done to validate the area of infarction. Which finding on the ECG is most conclusive for infarction? a. Inverted T waves b. Tall, peaked T waves c. ST segment depression d. Pathologic Q waves

ANS: D The changes in repolarization are seen by the presence of new Q waves. These new, pathologic Q waves are deeper and wider than tiny Q waves found on the normal 12-lead ECG.

Which intervention should be strictly followed to ensure accurate cardiac output readings? a. Use 5 mL of iced injectate and average two measurements together. b. Inject the fluid into the pulmonary artery port. c. Ensure at least 5°C between the injectate and body temperature. d. Administer the injectate within 4 seconds

ANS: D To ensure accurate readings, the difference between injectate temperature and body temperature must be at least 10°C, and the injectate must be delivered within 4 seconds, with minimal handling of the syringe to prevent warming of the solution. This is particularly important when iced injectate is used. Three CO values that are within a 10% mean range are obtained at one time and are averaged to calculate CO.

A patient has thyroid storm. The nurse is providing medication instruction for home. The patient asks "If I have a fever, should I take Tylenol or aspirin?" Which response would be the most appropriate? a. "Either one is fine because they do not affect the antithyroid medication." b. "Tylenol rather than aspirin because aspirin increases the amount of free thyroid hormone in circulation." c. "Aspirin rather than Tylenol because Tylenol increases the amount of free thyroid hormone in circulation." d. "They both prevent the antithyroid medication from working correctly. I would recommend an NSAID."

B

A patient was admitted to the critical care unit after having a CVA and MI. The patient has poor activity tolerance, falls in and out of consciousness, and has poor verbal skills. The patient has been resuscitated four times in the past 6 hours. The patient does not have advance directives. Family members are at the bedside. Who should the practitioner approach to discuss decisions of care and possible DNR status? a. Patient b. Family c. Hospital legal system d. Hospital ethics committee

B

What parameter must be assessed frequently in the patient with an intra-aortic balloon in place? a. Skin turgor in the affected extremity b. Peripheral pulses distal to the insertion site c. Blood pressures in both arms and legs d. Oxygen saturation

B

Which pathophysiologic mechanism occurs in the syndrome of inappropriate antidiuretic hormone (SIADH)? a. Hemoconcentration b. Dilutional hyponatremia c. Massive diuresis d. Hypermetabolism

B

Which mechanism is responsible for the augmentation of coronary arterial blood flow and increased myocardial oxygen supply seen with the intra-aortic balloon pump? a. The vacuum created in the aorta as a result of balloon deflation b. Diastolic inflation with retrograde perfusion c. Forward flow to the peripheral circulation d. Inflation during systole to augment blood pressure

B. The blood volume in the aorta below the level of the balloon is propelled forward toward the peripheral vascular system, which may enhance renal perfusion. Subsequently, the deflation of the balloon just before the opening of the aortic valve creates a potential space or vacuum in the aorta, toward which blood flows unimpeded during ventricular ejection. This decreased resistance to left ventricular ejection, or decreased afterload, facilitates ventricular emptying and reduces myocardial oxygen demands.

A patient is admitted for palliative care for end-stage heart failure. What is the nurse's primary goal when caring for this patient? a. To reverse heart failure with the use of diuretics b. To increase activity tolerance c. To manage symptoms and relieve pain d. To increase cardiac output related to alteration of contractility

C

A patient was admitted several weeks ago with an acute myocardial infarction and subsequently underwent coronary artery bypass grafting surgery. Since a cardiac arrest 5 days ago, the patient has been unresponsive. An electroencephalogram shows no meaningful brain activity. After a family conference, the practitioner writes a DNR order, and palliative care is begun. How does this affect the patient's treatment? a. The patient will continue to receive the same aggressive treatment short of resuscitation if he has another cardiac arrest. b. All treatment will be stopped, and the patient will be allowed to die. c. All attempts will be made to keep the patient comfortable without prolonging his life. d. The patient will be immediately transferred to hospice

C

A patient with coronary artery disease (CAD) is admitted with chest pain. The patient is suddenly awakened with severe chest pain. Three nitroglycerin sublingual tablets are administered 5 minutes apart without relief. A 12-lead electrocardiograph (ECG) reveals nonspecific ST segment elevation. The nurse suspects the patient may have which disorder? a. Silent ischemia b. Stable angina c. Unstable angina d. Prinzmetal angina

C

The nurse is caring for a patient with left-sided heart failure. The nurse suspects the patient is developing pulmonary edema. Which finding would confirm the nurse's suspicions? a. Pulmonary crackles b. Peripheral edema c. Pink, frothy sputum d. Elevated central venous pressure

C

What is the formula for calculating mean arterial pressure (MAP)? a. Averaging three of the patient's blood pressure readings over a 6-hour period b. Dividing the systolic pressure by the diastolic pressure c. Adding the systolic pressure and two diastolic pressures and then dividing by 3 d. Dividing the diastolic pressure by the pulse pressure

C

Which cardiac biomarker is a highly specific for myocardial damage? a. BNP b. CK-MB c. Troponin I d. Total calcium

C

Which nursing intervention should be initiated on all patients with the syndrome of inappropriate antidiuretic hormone (SIADH)? a. Placing the patient on an air mattress b. Encouraging oral fluids c. Initiating seizure precautions d. Applying soft restraints

C

While preparing a patient for a cardiac catheterization, the patient asks why it is necessary to drink additional fluids after a cardiac catheterization. Which response by the nurse is the most accurate? a. "To keep the femoral vein from clotting at the puncture site after the procedure" b. "To make sure your electrolytes stay in balance and prevent dysrhythmias" c. "To protect your kidneys from the damaging effects of the contrast medium" d. "To increase your cardiac output so you will not feel dizzy after the procedure"

C

A patient has recently been started on anticoagulation therapy for atrial fibrillation. What would be the target range for the INR? a. 1.0 to 2.0 b. 1.5 to 2.5 c. 1.5 to 3.0 d. 2.0 to 3.0

D

A patient is admitted with diabetic ketoacidosis (DKA). The nurse knows that the lack of insulin results in which process? a. Decreased glucagon release b. Decreased glycogenolysis c. Decreased ketone production d. Increased gluconeogenesis

D

A patient was admitted several weeks ago with an acute myocardial infarction and subsequently underwent coronary artery bypass grafting surgery. Since a cardiac arrest 5 days ago, the patient has been unresponsive. An electroencephalogram shows no meaningful brain activity. The patient does not have an advance directive. Which statement would be the best way to approach the family regarding his ongoing care? a. "I will refer this case to the hospital ethics committee, and they will contact you when they have a decision." b. "What do you want to do about the patient's care at this point?" c. "Dr. Smith believes that there is no hope at this point and recommends DNR status." d. "What would the patient want if he knew he were in this situation?"

D

A patient with a history of type 2 diabetes was admitted after aneurysm repair. The patient's serum glucose levels have been elevated for the past 2 days and the patient is concerned about becoming dependent on insulin. Which statement is the nurse's best response to the patient's concerns? a. "This surgery may have damaged your pancreas. We will have to do more evaluation." b. "Perhaps your diabetes was more serious from the beginning." c. "You will need to discuss this with your physician." d. "The stress on your body has temporarily increased your blood sugar levels."

D

The American Association of Critical-Care Nurses (AACN) has developed short directives that can be used as quick references for clinical use that are known as: a. critical care protocol. b. practice policies. c. evidence-based research. d. practice alerts.

D

The nurse is caring for a patient with type 1 diabetes who was admitted with complaints of increased lethargy. Serum laboratory values validate the diagnosis of diabetic ketoacidosis (DKA). Which statement best describes the rationale for administrating potassium supplements with the patient's insulin therapy? a. Potassium replaces losses incurred with diuresis. b. The patient has been in a long-term malnourished state. c. IV potassium renders the infused solution isotonic. d. Insulin drives the potassium back into the cells.

D

Which assessment technique is used to evaluate arterial circulation to an extremity? a. Dorsiflexion of the foot b. Pressing a finger into the skin c. Pinching of the skin d. Compression of the nail bed

D

Which professional organization administers critical care certification exams for registered nurses? a. State Board of Registered Nurses b. National Association of Clinical Nurse Specialist c. Society of Critical Care Medicine d. American Association of Critical-Care Nurses

D

ScvO2 vs SvO2

ScvO2 only measures venous blood returning from the upper half of the body, while SvO2 samples the true mixed venous blood leaving the right heart. Central (ScvO2) is normally slightly lower than mixed (SvO2), but is often higher than SvO2 in patients in shock

hemodynamic monitoring

Swan-Ganz values: CO 4-6 CVP 2-5 PAWP 5-12 CI Index 2-4 SVR 800-1400 SV 60-70

A patient with heart failure may be at risk for hypomagnesemia as a result of which factor? a. Pump failure b. Fluid overload c. Diuretic use d. Hemodilution

c

Which factor is a major influence in the patient's response to atrial flutter? a. Atrial rate b. PR interval c. Ventricular response rate d. QRS duration

c

hemodynamic monitoring a-line

provides continuous measurement of blood pressure and can be used for blood gases RAP- 2-6mmHg PAP 15-25mmHg