CPA 2: Critical Care Evolve
An adult patient suffered an anterior wall myocardial infarction (MI) 4 days ago. Today the patient is experiencing dyspnea and sitting straight up in bed. The nurse's assessment includes bibasilar crackles, an S3 heart sound with a heart rate of 125 beats/min. What condition are these signs and symptoms consistent with? A. Heart failure B. Papillary muscle rupture C. Pericarditis D. Pulmonary embolism
A
The initial drug recommended at the onset of acute myocardial infarction (AMI) to reduce platelet aggregation is: A. aspirin. B. lidocaine. C. nitroglycerin. D. oxygen.
A
The nurse educator is presenting a lecture on crystalloid fluid replacement therapy in shock states. Which statement by a nurse indicates that the teaching has been effective? a. Lactated Ringer's should not be infused if lactic acidosis is severe. b. 3 mL of crystalloid is administered to replace 10 mL of blood loss. c. Administration of colloids is preferred over crystalloids. d. Solutions of 0.45% normal saline are used routinely in shock.
A
The patient is admitted with a heart rate of 144 beats/min and a blood pressure of 88/42 mm Hg. The patient complains of generalized weakness and fatigue. He states, "Just let me sleep." The nurse determines that the presence of the patient's symptoms is due to: A. decreased cardiac output. B. the absence of ischemic heart disease. C. improved cardiac filling time, allowing the patient to relax. D. increased coronary artery filling time.
A
If the sinus node were diseased or ischemic and no longer firing as the heart's primary pacemaker, the nurse would anticipate which normal compensatory mechanism? A. Premature Junctional beats B. Junctional escape rhythm, rate of 45 C. Junctional tachycardia, rate of 100 D. Accelerated junctional rhythm, rate of 75
B
The nurse is caring for a patient in shock. Which is a priority action by the nurse? a. Ensure adequate cellular hydration. b. Maintain adequate tissue perfusion. c. Prevent third-spacing of fluids. d. Support mechanical ventilation.
B
The nurse is caring for an individual who is admitted for chest pain and shortness of breath. The patient states, "I can't believe I'm having chest pain. I'm a marathon runner and in good shape." During the night, the patient develops a sinus bradycardia with a heart rate of 40 beats/min. The nurse should: A. ignore this rate since the patient is an athlete. B. assess the patient for signs of decreased cardiac output. C. take the patient's temperature and expect to find hyperthermia. D. perform carotid massage (a maneuver to stimulate a vasovagal response).
B
The nurse is interpreting a patient's cardiac rhythm and notes that the PR interval is 0.16 seconds long. The nurse determines that this PR interval indicates: A. slower-than-normal conduction from the SA node through the AV node. B. normal conduction from the SA node through the AV node. C. faster-than-normal conduction from the SA node through the AV node. D. abnormally fast depolarization of the atria and ventricles.
B
The nurse is orienting a new RN to the ICU. The nurse begins to review orders recently entered by the cardiologist and to explain their rationale to the new RN. Medication orders include dobutamine (Dobutrex) 400 mg in 250 mL 5% dextrose in water titrated to keep cardiac index >2 L/min/m2. Which statement by the new RN indicates that teaching has been effective? A. "The cardiac index is the amount of blood pumped out by a ventricle per minute." B. "The cardiac index is the amount of blood ejected with each ventricular contraction." C. "The cardiac index is the pressure created by the volume of blood in the left heart." D. "The cardiac index is the measurement specific to the patient's size or body area."
D
What is the best action by the nurse to accurately record a thermodilution cardiac output (CO)? A. Place the patient prone, enter the computation constant, and obtain four successive measurements. B. Place the patient prone, elevate the backrest 30 degrees, and obtain three successive measurements. C. Place the patient supine, enter the computation constant, and obtain one value with the head of the bed elevated at 45 degrees. D. Position the patient supine, obtain three values within 10% of each other, and calculate the average cardiac output.
D
What is the best position for the nurse to place the patient in to obtain a right atrial pressure measurement? A. Left side-lying with the head of the bed elevated 30 degrees B. Prone, lying on the abdomen with slight head elevation C. Right side-lying with the head of the bed elevated 30 degrees D. Supine, either flat or with the head of the bed no more than 60 degrees
D
The patient is complaining of midsternal chest discomfort and nausea. The nurse calls for a 12-lead ECG and notices that the ST segment is newly elevated in two related leads. The nurse should: A. call the provider because the ST segment may indicate myocardial injury. B. continue to monitor the patient, as the ST segment is nondiagnostic. C. monitor the patient for increased signs of GI upset. D. assure the patient that the ST elevations are normal and of no concern.
A
The nurse needs to obtain a cardiac output measurement from a patient who has just had a pulmonary artery catheter inserted. What are important interventions for ensuring accurate pressure and cardiac output measurements? (SATA) A. Ensure rapid injection of fluid through the injectate port. B. Zero reference the transducer system at the phlebostatic axis. C. Inflate the pulmonary artery catheter balloon with 5 mL air. D. Use lactated Ringer's solution for the injectate.
A, B
The patient presents to the emergency department after having crushing chest pain for the past 5 hours. The ECG and laboratory work confirm suspicions of an acute myocardial infarction (AMI). Which findings would be the most conclusive that the patient is having an AMI? (Select all that apply.) A. ECG changes with ST-elevation B. Elevated CK-MB isoenzymes C. Elevated serum troponin levels D. Elevated urinary myoglobin level
A, B, C
Which statements related to the management of unstable angina are true? (Select all that apply.) A. Aspirin is given at the onset of each chest pain episode. B. Calcium channel blockers help to reduce symptoms. C. Early revascularization (e.g., angioplasty) may be helpful. D. It is best treated with rest and nitroglycerin.
A, B, C
After receiving handoff report from the night shift, the nurse completes the morning assessment of a patient with severe sepsis. Vital sign assessment notes blood pressure 95/60 mm Hg, heart rate 110 beats/min, respirations 32 breaths/min, oxygen saturation (SpO2)96% on 45% oxygen via Venturi mask, temperature 101.5° F, central venous pressure (CVP/RAP) 2 mm Hg, and urine output of 10 mL for the last hour. Given this report, the nurse obtains orders for treatment that include which of the following? Select all that apply. a. Administer infusion of 500 mL 0.9% normal saline every 4 hours as needed if the CVP is <5 mm Hg. b. Increase supplemental oxygen therapy to 60% Venturi mask. c. Administer 40 mg furosemide (Lasix) intravenously as needed if the urine output is less than 30 mL/hr. d. Administer acetaminophen (Tylenol) 650 mg suppository per rectum as needed to treat temperature >101° F.
A, D
The nurse is interpreting the rhythm strip of a patient and measures the QRS complex as being three small boxes in width. The nurse interprets this width as: A. 0.04 seconds. B. 0.10 seconds. C. 0.12 seconds. D. 0.16 seconds.
C
Which hemodynamic values should the nurse anticipate in a patient who is in the initial stages of septic shock state? a. Low heart rate; high blood pressure b. High heart rate; low right atrial pressure c. High PAOP; low cardiac output d. High SVR; normal blood pressure
B
The patient is admitted with the diagnosis of "Junctional Rhythm." The nurse places the patient on the cardiac monitor expecting to see: (SATA) A. P waves with a PR interval of 0.16 seconds. B. P waves with a PR interval less than 0.12 seconds. C. no P waves but a narrow QRS complex. D. P waves coming after the QRS complex. E. no P waves but a wide QRS complex.
B, C, D
The patient, who is being treated for hypercholesterolemia, complains of hot flashes and a metallic taste in the mouth. These are common side effects of: A. bile acid resins. B. clopidogrel. C. nicotinic acid. D. statins.
C
The patient is admitted with an anterior wall myocardial infarction. With this diagnosis, the nurse would expect to see Q waves in which leads? A. II B. III C. V3 D. V4 E. aVF
C, D
The most sensitive cardiac enzyme to assess myocardial necrosis is: A. CK. B. CK-MB. C. potassium. D. troponin I.
D
The nurse is caring for a patient admitted with severe sepsis. The physician orders include the administration of large volumes of isotonic saline solution as part of early goal-directed therapy. Which of the following best represents a therapeutic end point for goal-directed fluid therapy? a. Central venous pressure >8 mm Hg b. Heart rate >60 beats/min c. Mean arterial pressure >50 mm Hg d. Serum lactate level >6 mEq/L
A
The nurse is caring for a patient who is being monitored with a central venous catheter. In preparing to record a right atrial pressure reading, what is most important for the nurse to keep in mind when recording an accurate value? A. Record the pressure at the end of expiration. B. Low pressures indicate ventricular dysfunction. C. High pressures are likely to indicate hypovolemia. D. Zero referencing is not needed before every recording.
A
The nurse is educating a new RN on preparing a patient for assessment of cardiac output using an esophageal monitor. Which statement by the new RN indicates that teaching was effective? A. "The procedure involves a thin probe inserted into the esophagus." B. "Patients require deep sedation provided by an anesthesia provider." C. "The procedure immediately assesses right ventricular performance." D. "There are no absolute contraindications for the procedure."
A
The nurse notices ventricular tachycardia on the heart monitor. The nurse's first action should be to: A. determine patient responsiveness and presence of a pulse. B. immediately defibrillate the patient and provide CPR. C. administer intravenous amiodarone or lidocaine. D. cardiovert electrically into a more sustainable rhythm.
A
The patient presents to the emergency department with severe substernal chest discomfort. Cardiac enzymes are elevated and his ECG shows ST-segment depression in V2 and V3. This patient is most likely experiencing: A. non-Q-wave myocardial infarction (MI). B. pulmonary embolism. C. Q-wave myocardial infarction (MI). D. right ventricular infarction.
A
The patient with a pacemaker shows pacemaker spikes that are not followed by a QRS. The nurse interprets this as: A. failure to capture. B. failure to pace. C. failure to sense. D. demand mode.
A
What is the best understanding of mixed venous oxygen saturation by the nurse? A. An overall picture of oxygen delivery and oxygen consumption B. The amount of oxygen attached to each hemoglobin molecule C. The amount of oxygen perfusion taking place within the myocardium D. The amount of oxygen the lungs are able to mix with the blood
A
When checking a patient's pulmonary artery occlusion pressure, the nurse inflates the balloon as ordered, not inflating the balloon for more than 8 to 10 seconds. The patient asks the rationale behind the nurse's actions. Which statement should the nurse make? A. "Prolonged inflation can obstruct blood flow, resulting in ischemia." B. "Prolonged inflation increases the risk of catheter balloon rupture." C. "Prolonged inflation increases the likelihood of thermistor damage." D. "Prolonged inflation will reduce tension on the pulmonary artery wall."
A
Angiotensin-converting enzymes inhibitors (ACE inhibitors) should be started within 24 hours of acute myocardial infarction (AMI) to reduce the incidence of: A. hibernating myocardium. B. myocardial remodeling. C. myocardial stunning. D. tachycardia.
B
The nurse is calculating the rate for a regular rhythm. There are 20 small boxes before each R wave. The nurse interprets the rate to be: A. 50 beats/min. B. 75 beats/min. C. 85 beats/min. D. 100 beats/min.
B
The patient has a temporary transvenous, demand-type ventricular pacemaker. The rate on the pacemaker is set at 60 beats/min. Which of the following situations would be of concern? A. A paced rhythm of 60 beats/min is seen on the monitor; no other waveforms are seen. B. A pacemaker spike is seen on the T wave of the preceding beat. C. The patient's inherent (own) rate falls to 58 and the pacemaker fires. D. The patient's inherent rate is 70 beats/min; no pacemaker spikes are seen.
B
A 45-year-old male is visiting the wellness clinic and has been newly diagnosed as a stage I hypertensive patient. His blood pressure assessment over the past 6 months has consistently been 145/92 mm Hg. The patient asks, "What is blood pressure?" What is the best response by the nurse? A. "A complex measurement that should be discussed only with your physician." B. "A measurement that should be 120/80 mm Hg unless complications are present." C. "A measurement that takes into consideration the amount of blood your heart is pumping and the size of the vessel diameter the heart must pump against." D. "The amount of pressure exerted on the veins by the blood."
C
A 67-year-old female is admitted to the emergency department complaining of mid-back pain and shortness of breath for the preceding 2 hours. She also complains of nausea and states that she vomited twice before coming to the hospital. She denies any chest discomfort or arm pain. The presenting symptoms suggest that this patient may be: A. exhibiting flu symptoms. B. having an anxiety attack. C. having a myocardial infarction (MI). D. suffering from osteoporosis.
C
The nurse admits a patient to the coronary care unit in cardiogenic shock. The nurse anticipates administering which medication in an effort to improve cardiac output by increasing the contractile force of the heart? a. Dopamine (Intropin) b. Phenylephrine (Neo-Synephrine) c. Dobutamine (Dobutrex) d. Nitroprusside (Nipride)
C
The nurse is caring for a patient with hypovolemia. Which large volume crystalloid solution should the nurse anticipate the health care provider to order? Select all that apply. a. 5% dextrose b. Albumin c. Lactated Ringer's (LR) d. Normal saline
C
The nurse is speaking with the patient when the monitor shows that the patient is in ventricular fibrillation (VF). The nurse should: A. immediately defibrillate the patient. B. initiate basic life-support protocols and call for help. C. assess the patient and check the patient's monitor leads. D. initiate advanced life-support protocols as soon as possible.
C
The patient complains of being lightheaded and feeling a "fluttering" in his chest. The nurse places the patient on the heart monitor and notices an atrial tachycardia at a rate of 160 beats/min. The patient's blood pressure has dropped from 128/76 mm Hg to 92/46 mm Hg but appears stable at the lower pressure. The nurse should: A. prepare the patient for asynchronized defibrillation. B. give the patient digitalis IV and then call the provider. C. call the provider and prepare the patient for medical or electrical cardioversion. D. withhold beta blockers and calcium channel blockers.
C
What is the best action by the nurse to level and zero a hemodynamic monitoring system transducer? A. Level the air-fluid interface of the zeroing transducer at the height of the patient's mattress. B. Position the air-fluid interface of the zeroing transducer at the fifth intercostal space,midclavicular line. C. Position the air-fluid interface of the zeroing transducer at the phlebostatic axis (fourth intercostal space, midaxillary line). D. Level the air-fluid interface of the zeroing transducer at the second intercostal space, anterior-axillary line.
C
When an electrical signal in the heart is aimed directly at the positive electrode, the nurse interprets that the deflection seen on the 12-lead ECG or rhythm strip will be: A. equiphasic. B. negative. C. positive. D. invisible.
C
A patient is complaining of midsternal chest discomfort radiating down the right arm. The discomfort has been present for about 5 minutes. The patient is also asthmatic and allergic to calcium channel blockers. The medication of choice for this patient at this time is: A. isoptin. B. metoprolol. C. nifedipine. D. nitroglycerin sublingual.
D
The nurse is caring for a patient in neurogenic shock. Which should the nurse assess for? a. Tachycardia b. Hypertension c. Hypoventilation d. Vasodilation
D
The nurse is caring for a patient who has blood pooling in the capillary bed and arterial blood pressure too low to support perfusion of vital organs. Which symptoms should the nurse assess for? a. Acute respiratory distress syndrome (ARDS) b. Disseminated intravascular coagulation (DIC) c. Increased cerebral perfusion pressure d. Multisystem organ failure and/or dysfunction
D
The nurse is caring for a patient with possible distributive shock. Which should the nurse look for on assessment? a. Blood loss and actual hypovolemia. b. Decreased cardiac output. c. Third-spacing of fluids into peritoneal space. d. Vasodilation and relative hypovolemia.
D
