Critical Care Course-Final Exam
The nurse would assess a patient with complaints of chest pain for which of the following clinical manifestations associated with a myocardial infarction (MI)? (Select all that apply).
-Ashen skin -Diaphoresis -Nausea and vomiting -S3 or S4 heart sounds
The nurse is caring for a patient with exacerbation of heart failure on the Telemetry unit. During the morning assessment, the patient states that they are feeling palpitations and slight shortness of breath. The blood pressure is 98/54 mmHg when the unlicensed assistive personnel (UAP) brings the nurse an electrocardiographic (ECG) strip demonstrating the following rhythm: (SVT) After contacting the healthcare provider and the Rapid Response Team, what possible interventions would the nurse anticipate performing to manage the rhythm? (Select all that apply).
Administer 6 mg adenosine (AdenoCard) intravenously. Instruct the patient to perform a vagal maneuver.
A client with acute myocardial infarction and cardiogenic shock has the following vital signs: BP 86/50 mmHg, pulse 120 bpm, respirations 26 breaths/min. Hemodynamic monitoring reveals an elevated pulmonary artery wedge pressure (PAWP) and decreased cardiac output. Breath sounds demonstrate bilateral crackles over two-thirds of each lung field. The nurse will anticipate performing which intervention?
Administration of prescribed intravenous diuretics
Diuretic therapy with furosemide (Lasix) is ordered for a client with left-sided heart failure. The nurse compares the admission data obtained three days earlier with today's data. How would the nurse determine the medication is having its intended effect?
Breath sounds have improved.
How would the nurse differentiate a non-ST segment elevation myocardial infarction (NSTEMI) from unstable angina (UA)?
Cardiac biomarkers
A nurse cares for a patient who has a regular narrow cardiac rhythm of 158 beats/min. For which physiologic alterations would the nurse assess? (Select All that Apply)
Decrease in cardiac output, Increase in blood pressure, Decrease in urine output
A client with left ventricular failure is taking digoxin (Lanoxin) daily. What changes does the nurse expect to find if this medication is therapeutically effective? (Select all that apply).
Decreased heart rate., Decreased edema., Improved glomerular filtration rate.
Drug therapy for heart failure may include which of the following types of medications?
Diuretics, beta blockers, angiotensin receptor blockers (ARBs).
A client with a history of IV drug abuse presents with fever, flu symptoms, and a systolic murmur heard at the 5th intercostal space, left sternal border. What condition does the nurse suspect is occurring?
Endocarditis of the tricuspid valve.
Which of the following statements are true about the electrocardiographic (ECG) waveform in sinus rhythm? (Select all that apply).
Every QRS complex is preceded by a P wave., The ventricular heart rate is equal to atrial heart rate. The PR interval is less than 0.12 seconds but no greater than 0.20 seconds.
Match the type of myocardial infarction with the coronary artery occlusion causing it.
Lateral myocardial infarction- Right coronary artery Anterior myocardial infarction-Left anterior descending artery Inferior myocardial infarction-left circumflex artery
A client presents to the emergency department via ambulance complaining of 8 out of 10 substernal chest pain that radiates to the jaw and left shoulder. The pain started one hour ago. A twelve-lead electrocardiogram (ECG) demonstrates the following pattern: (V1 has ST segment elevation)
Left circumflex coronary artery
A patient becomes unresponsive. The patient's heart rate is 32 beats/min, bradycardic rhythm; blood pressure is 60/32 mm Hg; SpO2 is 90%; and respiratory rate is 14 breaths/min. Which intervention should the nurse do first?
Notify the physician and obtain a temporary pacemaker.
Which intervention is the most important determinant of survival in a patient with pulseless electrical activity (PEA)?
Performing high quality CPR to maintain organ perfusion.
What parameter must be assessed frequently in the patient with an intraaortic balloon in place?
Peripheral pulses distal to the insertion site
What clinical manifestations (signs and symptoms) would be observed in a client experiencing pulmonary edema? (Select all that apply).
Pink, frothy sputum Orthopneic positioning
A client presenting with third-degree atrioventricular (AV) heart block with a ventricular escape rate of 40 bpm is admitted to the critical care unit. Which physical assessment finding would be of GREATEST concern in this client?
SOB & crackles in the lungs
Which electrocardiographic (ECG) change is most important for the nurse to communicate to the health care provider when caring for a patient with chest pain?
ST segment elevation
Which laboratory result for a patient whose cardiac monitor displays the rhythm below is most important for the nurse to communicate to the health care provider?
Serum potassium 2.6 mEq/L.
A patient with a serum potassium level of 6.8 mEq/L may exhibit what type of electrocardiographic changes?
Tall, peaked T waves
Which factor is a major influence in the patient's response to atrial flutter?
Ventricular response rate
A client with history of chronic heart failure is hospitalized with severe dyspnea and a dry, hacking cough. There is pitting edema in both ankles. Vital signs are BP 170/100 mm Hg, HR 92 beats/min, and RR 28 breaths/min. Pulse oximetry on 3 liters by nasal cannula is 91%. The clinical manifestations suggest that the client is experiencing which condition?
impaired emptying of the right and left ventricles with decreased output.
Which clinical findings would most likely indicate decreased cardiac output in a client with chronic aortic valve regurgitation?
shortness of breath on minimal exertion and a diastolic murmur/Severe dyspnea on exertion and a diastolic murmur.
