Perfusion Knowledge Check Questions (4 on exam)
A patient presents to the ED complaining of angina. on initial assessment the patients skin is wet, they are hypotensive, heart rate is tachy and respiratory rate is increased. what diagnostic tests should the nurse anticipate to be ordered right away for this patient? a. EKG b. x-ray c. blood culture d. orthostatic blood pressure
A
Which medications below are used in cardiogenic shock that provide a positive inotropic effect on the heart? (Select all that apply) A. Dobutamine B. Norepinephrine C. Nitroglycerin D. Sodium Nitroprussidde E. Dopamine
A, E
A client is admitted with an acute inferior-wall myocardial infarction (MI). During the admission interview, the client states that he stopped taking his metoprolol five days ago because he was feeling better. For which complication should the nurse monitor this client? A. Cardiogenic shock B. Ineffective myocardial tissue perfusion C. Sudden, acute pain D. Hypertension
A
A client is having frequent premature ventricular contractions. A nurse would place priority on assessment of which of the following items? A. Blood pressure and peripheral perfusion B. Sensation of palpitations C. Causative factors such as caffeine D. Precipitating factors such as infection
A
A nurse notes 2+ bilateral edema in the lower extremities of a client with myocardial infarction who was admitted 2 days ago. The nurse would plan to do which of the following next? A) Review the intake and output records for the last 2 days B) Change the time of diuretic administration from morning to evening C) Request a sodium restriction of 1 g/day from the physician D) Order daily weights starting the following morning
A
A patient is admitted with chest pain to the ER. The patient has been in the ER for 5 hours and is being admitted to your unit for overnight observation. From the options below, what is the most IMPORTANT information to know about this patient at this time? A. Troponin result and when the next troponin level is due to be collected B. Diet status C. Oxygen saturation D. CK result and when the next CK level is due to be collected
A
A client comes into the E.R. with acute shortness of breath and a cough that produces pink, frothy sputum. Admission assessment reveals crackles and wheezes, a BP of 85/46, a HR of 122 BPM, and a respiratory rate of 38 breaths/minute. The client's medical history included DM, HTN, and heart failure. Which of the following disorders should the nurse suspect? A. Pulmonary edema B. Pneumothorax C. Cardiac tamponade D. Pulmonary embolus
A
A patient with cardiogenic shock is experiencing severe hypotension and dyspnea. Current vital signs are BP 72/44, pulse 110, respirations 30 and SpO2 85%. Upon assessment you note bilateral crackles in the lungs and the patient is diaphoretic. After notifying the physician you receive the orders listed below. Which physician order would you be most concerned about? A. 1000 ml normal saline bolus stat B. Provide the patient BiPAP C. 5 mcg/kg/min Dobutamine IV stat D. 40mg Lasix IV stat
A
Which of the following classes of medications protects the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation? A) Beta-adrenergic blockers B) Calcium channel blockers C) Narcotics D) Nitrates
A
***The client has developed atrial fibrillation, with a ventricular rate of 150 beats per minute. The nurse should assess the client for which associated signs and/or symptoms? (Select all that apply.) a. Syncope b. Dizziness c. Palpitations d. Hypertension e. Flat neck veins
A, B, C
A hospital patient goes into cardiac arrest and a code blue is called immediately. Nurses in the room perform which of the following actions to improve efficacy of CPR (select all that apply): a) Lower the bed to waist height of the person performing compressions. b) Administer compressions to 1 inch depth. c) Insert a board underneath the patient or deflate the bed to achieve a hard surface below the patient. d) Administer compressions at a rate of 70 compressions per minute. e) Lower the bed to the height of the knees of the person performing compressions.
A, C
A new nurse is reading a 12 lead EKG on a patient who was admitted for acute heart failure presenting with an arrhythmia. while trying to interpret the EKG she notices that on some leads the QRS complex is going up, and some other QRS complexes are going down. the nurse should... (select all that apply) A. ask another nurse to help her read and interpret the EKGs. B. Know that the facing down QRS complexes are due to poor lead placement causing an inaccurate reading. C. Know that the leads are placed to get a multi-angle view of the heart causing down facing QRS complexes. D. be prepared to call a code because down facing QRS complexes are a signal that the patients heart is failing.
A, C
A patient has a history of heart failure. Which of the following statements by the patient indicates the patient may be experiencing heart failure exacerbation? (Select all that apply.) A. "I have noticed I gained 6 lbs this week." B. "I have not noticed any swelling in my legs or hands recently." C. "I have to prop myself up on a few pillows at night so that I can breathe." D. "I feel more energized than I have in a long time."
A, C
A patient is admitted for an acute myocardial infarction. The nurse is monitoring the patient for signs and symptoms associated with cardiogenic shock. Which of the following is associated with cardiogenic shock? (Select all that apply.) A) Cardiac index 1.5 L/min/m2 B) Warm, flushed skin C) Systolic blood pressure <90 mmHg D) Crackles in lung fields E) Increased BUN and Cr
A, C, D, E
Mr. Smith is a 75-year-old African American male. He was admitted to the ER for myocardial infarction. Mr. Smith has a family history of heart attacks and smokes three packs of cigarettes a day. What are Mr. Smiths' non-modifiable risk factors?(Select all that apply) A. Age B. Sedentary lifestyle C. Genetics D. Ethnicity E. Smoking F. Type 1 diabetes
A, C, D, F
A patient is complaining of chest pain. On the bedside cardiac monitor, you observe pronounce T-wave inversion. You obtain the patient's vital signs and find the following: Blood pressure 190/98, HR 110, oxygen saturation 96% on room air, and respiratory rate 20. Select-all-that-apply in regards to the MOST IMPORTANT nursing interventions you will provide based on the patient's current status: A. Obtain a 12-lead EKG B. Place the patient in supine position C. Assess urinary output D. Administer Nitroglycerin sublingual as ordered per protocol E. Collect cardiac enzymes as ordered per protocol F. Encourage the patient to cough and deep breath G. Administer Morphine IV as ordered per protocol H. Place patient on oxygen via nasal cannula I. No interventions are needed at this time
A, D, E, G
***You're educating a patient about the causes of a myocardial infarction. Which statement by the patient indicates they misunderstood your teaching and requires you to re-educate them? A. Coronary artery dissection can happen spontaneously and occurs more in women. B. The most common cause of a myocardial infarction is a coronary spasm from illicit drug use or hypertension. C. Patients who have coronary artery disease are at high risk for developing a myocardial infarction. D. Both A and B are incorrect.
B
A 46 year old male comes into the ED who appears to be extremely anxious, SOB, and states he has chest pain. Upon assessment, the nurse suspects that the patient is having an MI. Which preferred biomarker should the nurse suspect to be ordered to confirm the diagnoses of an MI? A. CK- MB B. Troponin I C. Troponin T D. Myoglobin
B
A client is wearing a continuous cardiac monitor which begins to sound its alarm. The nurse sees no electrocardiographic complexes on the screen. Which is the priority nursing action? A. Call a code. B. Check the client's status. C. Call the healthcare provider. D. Document the lack of complexes.
B
A client returns to his room following a cardiac catheterization. Which of the following assessments, if made by the nurse, would justify calling the physician? a. pain at the site of the catheter insertion b. absence of a pulse distal to the catheter insertion site c. drainage on the dressing covering the catheter insertion site d. redness at the catheter insertion site
B
A client with myocardial infarction suddenly becomes tachycardic, shows signs of air hunger, and begins coughing frothy, pink-tinged sputum. Which finding would the nurse anticipate when auscultating the client's breath sounds? A. Stridor B. Crackles C. Scattered ronchi D. Diminished breath sounds
B
A patient arrives at the emergency room complaining of severe chest pain. The nurse is preparing to administer morphine intravenously when the patient asks the nurse why they are getting morphine. Which of the following is the correct response by the nurse? a. "Morphine reduces the pain level by lowering your blood pressure." b. "Morphine reduces the cardiac oxygen demand while also reducing pain level." c. "Morphine is used to reduce anxiety, therefore reducing pain." d. "Morphine makes your blood thinner that will prevent clots from forming."
B
A patient presents to the emergency room with new symptoms of severe chest pain and shortness of breath. They are stable after receiving two doses of Nitroglycerin. While the nurse is discussing discharge teachings about acute heart failure, the patient states, "I already know this, I was diagnosed with chronic heart failure months ago". The best response by the nurse is: a) "You are right, there is not much difference between acute and chronic heart disease." b) "The symptoms you experienced today are new, which means your heart has a new baseline. Acute and chronic heart failure can have similar causes, but acute has a sudden onset of symptoms, whereas chronic is an on-going progression." c) "Chronic and acute heart failure are different because although they can have similar causes, in acute heart failure the heart is still able to perfuse at an appropriate rate, while in chronic it is not." d) "Since you already know about chronic heart failure we do not need to discuss it much more. You should continue to do the activities you were doing before." e) "Your previous diagnosis is likely incorrect. Acute heart failure does not often proceed chronic heart failure. A patient will have one or the other."
B
Patients with heart failure can experience episodes of exacerbation. All the patients below have a history of heart failure. Which of the following patients are at MOST risk for heart failure exacerbation? A. A 55 year old female who limits sodium and fluid intake regularly. B. A 73 year old male who reports not taking Amiodarone for one month and is experiencing atrial fibrillation. C. A 67 year old female who is being discharged home from heart valve replacement surgery. D. A 78 year old male who has a health history of eczema and cystic fibrosis.
B
The nurse is caring for an adult male patient who suddenly goes into cardiac arrest. The nurse begins CPR on the patient. What should the nurse NOT include in her CPR procedure? A. Assess for signs of breathing and pulse. B. Compress at a rate of at least 200/min. C. Compress chest at least 2 inches depth. D. Complete 30 compressions to every 2 ventilation breaths
B
Your client was diagnosed with an arterial embolus. The physician performed an emergency embolectomy. What is the nurse's highest priority? a. Administer anticoagulants b. Check pulses c. Listen to breath sounds d. Offer pain medication
B
Which patient(s) are most at risk for developing coronary artery disease? (Select-all-that-apply) A. A 25 year old patient who exercises 3 times per week for 30 minutes a day and has a history of cervical cancer. B. A 35 year old male with a BMI of 30 and reports smoking 2 packs of cigarettes a day. C. A 45 year old female that reports her father died at the age of 42 from a myocardial infraction. D. A 29 year old that has type I diabetes
B, C, D
***Which of the following patients are at high risk for developing a cardiac dysrhythmia? (Select all that apply) a. 21-year-old female presenting with a widespread rash of unknown cause. b. 67-year-old male presenting with a history of heart failure, crackles in the lungs, and a sodium blood level of 128. c. 54-year-old male who is being discharged home today after a knee replacement. d. 35-year-old male patient presenting with severe dehydration and history of bulimia. e. 79-year-old woman who is admitted after obtaining a fractured wrist and a head injury after a fall.
B, D
***You're caring for a patient with cardiogenic shock. Which finding below suggests the patient's condition is worsening? (Select all that apply) A. Blood pressure 95/68 B. Urinary output 20 mL/hr C. Cardiac Index 3.2 L/min/m2 D. Pulmonary artery wedge pressure 30 mmHg
B, D
A patient is being treated for cardiogenic shock. Which statement below best describes this condition? (Select all that apply) A. "The patient will experience an increase in cardiac output due to an increase in preload and afterload." B. "A patient with this condition will experience decreased cardiac output and decreased tissue perfusion." C. "This condition occurs because the heart has an inadequate blood volume to pump." D. "Cardiogenic shock leads to pulmonary edema."
B, D
The nurse is educating a patient with hypertension on lifestyle modifications to help control blood pressure. Which of the following would the nurse include in the teaching? A.) reduce amount of cigarettes smoked daily B.) DASH diet C.) only consume alcohol at meal times D.) exercise daily
B, D
You're precepting a new nurse. You ask the new nurse to list the purpose of why a patient with cardiogenic shock may benefit from an intra-aortic balloon pump. What responses below indicate the new nurse understands the purpose of an intra-aortic balloon pump? (Select all that apply:) A. "This device increases the cardiac afterload, which will increase cardiac output." B. "This device will help increase blood flow to the coronary arteries." C. "The balloon pump will help remove extra fluid from the heart and lungs." D. "The balloon pump will help increase cardiac output."
B, D
A patient presents to the clinic with emphysema. Their oxygen sats are at 91%, what actions should the nurse take to improve their oxygen levels? (Select all that apply.) A. Place the patient in the supine position B. Give them water C. Restrict their water intake D. Teach them about limiting their smoking E. Encourage pursed-lip breathing
B, E
***A 54 year old woman is brought into the ER by her son, she told the nurse that she was working in the garden when all of the sudden she felt very weak, was nauseous, and was having pain in her arm. What should be the nurse's first action? A. Rush patient to the cath lab to clear the blockage B. Administer nitrates and morphine C. Start a 12-lead ECG and draw blood to assess troponin D. Auscultate heart sounds and palpate dorsalis pedis pulse
C
***Which of the following cardiac conditions does a fourth heart sound (S4) indicate? A. Dilated aorta B. Normally functioning heart C. Decreased myocardial contractility D. Failure of the ventricle to eject all of the blood during systole
C
***You are a nurse in the emergency department that is educating a new nurse about the clinical manifestations of an acute myocardial infarction in women. Which statement by the new nurse demonstrates a need for further teaching? A) The patient may have symptoms of chest pain or a feeling of 'a rope being tied around them', nausea, vomiting, shortness of breath, or pain in the arms, back, or jaw. B) The patient may present with atypical symptoms such as discomfort in the upper abdomen or back, pain in the lower chest, extreme fatigue, lightheadedness, or fainting. C) The most common manifestations of an acute MI are reports of pain, or a feeling of squeezing in their chest that lasts for longer than several minutes. D) The patient may present with flu-like symptoms such as being short of breath without much, or any, activity
C
A nurse has been assigned four patients, which patient does the nurse recognize as being the highest priority? A. A 28 year old woman who is 12 weeks pregnant, her HR is 78, RR 18, BP 100/75 and is bleeding from her nose and has a large bruising on her left lower back. B. A 65 year old male who was involved in a motor vehicle accident last night, his left lower limb appears shorter than the right lower limb, has facial bruising and swelling, both peripheral pulses are pulpable. C. A 35 year old man with a urine output of 320ml in the last 24 hrs, jugular vein distention, complains of lethargy, and has trouble taking in breaths. D. A 17 year old girl who is confused, complains of chest pain, and rates her pain as an 8 on a pain rating scale of 0-10 (0 as the no pain, and 10 as worst pain).
C
A nurse is present in the room when a 75 y/o male admitted for unstable angina goes into cardiac arrest. The nurse has already pushed the code blue button alerting other staff to the arrest. While the nurse waits for the code team what is the nurse's priority action. A- pull up the pt chart to find pt code status B- retrieve the code cart (with necessary cardiac arrest medication and equipment) from the hall C- start compression only CPR D- give two breaths with BVM then start compression
C
The adaptations of a client with complete heart block would most likely include: A. Nausea and vertigo B. Flushing and slurred speech C. Syncope and slow ventricular rate D. Cephalalgia and blurred vision
C
The nurse is caring for a patient admitted to the ER with chest pain. He reports that chest pain developed while mowing the lawn and he stopped and rested but pain did not go away. Chest pain was relieved following administration of 2 sublingual nitroglycerine tablets. The nurse draws which conclusion about this client's status? A. Client most likely has a stable angina B.Client has a knowledge deficit because he did not take his nitroglycerine C. Client most likely has unstable angina D. Client most likely has acute MI
C
The nurse is monitoring the heart rhythm of a patient in cardiac arrest for a 'shockable' rhythm to restore cardiac function. Which best describes the 'shockable' waves of Ventricular Fibrillation? A. Multiple regular and identifiable P waves that appear before the QRS wave. B. Irregular 'quivering' of P waves before the QRS wave. C. Rapid irregular rhythm with unidentifiable P or QRS waves. D. Regular rhythm with unidentifiable P or QRS waves.
C
The nurse is watching the cardiac monitor and notices that a client's rhythm suddenly changes. There are no P waves, the QRS complexes are wide, the ventricular rate is regular but more than 140 beats per minute. The nurse determines that the client is experiencing which dysrhythmias? A- Sinus tachycardia B- Ventricular fibrillation C- Ventricular tachycardia D- Premature ventricular contractions
C
Which of the following compensatory mechanisms does the nurse understand occurs with ventricular valve disorders? a. Decreased atrial kick b. Atrial hypertrophy c. Ventricular hypertrophy d. Systolic hypertension
C
A patient is diagnosed with left-sided systolic dysfunction heart failure. Which of the following are expected findings with this condition? a) Echocardiogram shows an ejection fraction of 38%. b) Heart catheterization shows an ejection fraction of 65%. c) Patient has frequent episodes of nocturnal paroxysmal dyspnea. d) Options A and C are both expected findings with left-sided systolic dysfunction heart failure.
D
A 16 year-old patient is brought to the ER after a car accident. The patient's blood pressure is 105/58 mmHg, and further physical assessment reveals a ruptured spleen. The nurse should assess the patient for an early sign of decreased arterial pressure, such as: A) Disorientation and lethargy B) Increased temperature C) Wide pulse pressure D) Decreased peripheral pulse
D
A client has frequent bursts of ventricular tachycardia on the cardiac monitor. A nurse is most concerned with this dysrhythmia because: A. It is uncomfortable for the client, giving a sense of impending doom. B. It produces a high cardiac output that quickly leads to cerebral and myocardial ischemia. C. It is almost impossible to convert to a normal sinus rhythm. D. It can develop into ventricular fibrillation at any time.
D
A client with variant angina is scheduled to receive an oral calcium channel blocker twice daily. Which statement by the client indicates the need for further teaching? A) "I should notify my cardiologist if my feet or legs start to swell." B) "I am supposed to report to my cardiologist if my pulse rate decreases below 60." C) "Avoiding grapefruit juice will definitely be a challenge for me, since I usually drink it every morning with breakfast." D) "My spouse told me that since I have developed this problem, we are going to stop walking in the mall every morning."
D
A nurse notes that a client with sinus rhythm has a premature ventricular contraction that falls on the T wave of the preceding beat. The client's rhythm suddenly changes to one with no P waves or definable QRS complexes. Instead there are coarse wavy lines of varying amplitude. The nurse assesses this rhythm to be: A. Atrial fibrillation B. Asystole C. Ventricular tachycardia D. Ventricular fibrillation
D
Penny Dobbs is 64. She loves gardening and spends a lot of time outside. She recently built a terrarium of which she is very proud and her husband built her beautiful cabinets for it. She says they are very convenient and they make it possible for her to go the entire day without going into the house. She has had symptoms of stable angina for the last 5 years. After a recent appointment with her healthcare provider she states she wants to increase the dosage for her medication because it doesn't work anymore. What question does the nurse ask that may help Penny most? A. "Did you know that you can gain a tolerance to Nitrates if you take them at night?" B. "Have you considered talking to your doctor about Morphine, which can help with angina pain when Nitroglycerine does not work?" C. "Have you remembered to take rests while gardening, so that you do not overwork your heart?" D. "Did you remember what the doctor had said about keeping your Nitro in a dark place, away from light?"
D
The nurse is taking care of a 58-year-old male patient who just experienced a myocardial infarction 6 hours ago. The nurse recognizes that the incidence of which complication is greatest within the first 24 hours of sustaining an MI: A: Heart Failure B: Thromboembolism C: Ventricular Aneurysm and Rupture D: Dysrhythmias
D
The nurse observes sinus tachycardia with new-onset ST segment elevation on the ECG monitor of the client reporting chest pain. Which should be the nurse's priority intervention? A. Draw blood for cardiac enzymes STAT B. Call the cardiac catheterization lab C. Apply 1 inch of nitroglycerin paste topically D. Apply 4 liters of oxygen via nasal cannula
D
The nurse understands that a patient with cardiogenic shock is prone to alterations of gastrointestinal function. Which statement by the nurse demonstrates accurate understanding? A. "Shock increases gastric motility." B. "Respiratory acidosis occurs due to inability to remove lactic acid." C. "Metabolic alkalosis occurs due to inability to remove lactic acid." D. "Shock decreases gastric motility.
D
The physician's order says to administered Lasix 40 mg IV twice a day. The patient has the following morning labs: Na+ 148, BNP 900, K+ 2.0, and BUN 10. Which of the following is a nursing priority? A. Administer the Lasix as ordered B. Notify the physician of the BNP level C. Assess the patient for edema D. Hold the dose and notify the physician about the potassium level
D
Which is the primary consideration when preparing to administer thrombolytic therapy to a patient who is experiencing an acute myocardial infarction (MI)? A) History of heart disease B) Sensitivity to aspirin. C) Size and location of the MI. D) Time since onset of symptoms.
D
