Ch 13-MS3

Pulsus paradoxus may be noted on the bedside monitor when what is observed?

A decrease of more than 10 mm Hg in the arterial waveform during inhalation

What is the formula for calculating mean arterial pressure (MAP)?

Adding the systolic pressure and two diastolic pressures and then dividing by 3

Which intervention should be strictly followed to ensure accurate cardiac output readings?

Administer the injectate within 4 seconds during inspiration.

Why is the measurement of the QT interval important?

An increasing QT interval increases the risk of torsades de pointes.

What is the effect of preload on cardiac output?

As preload increases, cardiac output increases until it overstretches the ventricle and cardiac output decreases.

What does the P wave component of the electrocardiographic waveform represent?

Atrial depolarization

Which cardiac biomarker is elevated in decompensated heart failure?

B-type natriuretic peptide (BNP)

A patient's bedside electrocardiogram (ECG) strips show the following changes: increased PR interval; increased QRS width; and tall, peaked T waves. Vital signs are temperature 98.2° F; heart rate 118 beats/min; blood pressure 146/90 mm Hg; and respiratory rate 18 breaths/min. The patient is receiving the following medications: digoxin 0.125 mg PO every day; D51/2 normal saline with 40 mEq potassium chloride at 125 mL/hr; Cardizem at 30 mg PO q8h; and aldosterone at 300 mg PO q12h. The practitioner is notified of the ECG changes. What orders should the nurse expect to receive?

Change IV fluid to D51/2 normal saline and draw blood chemistry.

A patient's arterial line waveform has become damped. What action should the nurse take to correct the situation?

Check for kinks, blood, and air bubbles in the pressure tubing.

A patient's central venous pressure (CVP) reading suddenly increased from 10 to 48 mm Hg. His lungs are clear except for fine rales at the bases. What should the nurse do next?

Check the level of the transducer.

Which diagnostic test is most effective for measuring overall heart size?

Chest radiography

Which statement regarding the use of cuff blood pressures is true?

Cuff pressures may be unreliable when a patient is in shock.

The patient is admitted with a diagnosis of cardiogenic shock. The patient's heart rate (HR) is 135 beats/min with weak peripheral pulses. The patient has bilaterally crackles in the bases of the lungs. O2 saturation is 90% on 4L/NC. The practitioner orders diuretics and vasodilators. What response should the nurse expect after starting the medications?

Decreased preload and afterload

Which of the following is most indicative of decreased left ventricular preload?

Decreased pulmonary artery occlusion pressure (PAOP)

What is the physiologic effect of left ventricular afterload reduction?

Decreased systemic vascular resistance

What effect does ventricular tachycardia have on cardiac output?

Decreases cardiac output due to a decrease in stroke volume

A patient with heart failure may be at risk for hypomagnesemia as a result of which factor?

Diuretic use

A patient with a potassium level of 2.8 mEq/L is given 60 mEq over a 12-hour period. A repeat potassium level is obtained, and the current potassium level is 3.2 mEq/L. In addition to administering additional potassium supplements, what intervention should now be considered?

Drawing a serum magnesium level

Which diagnostic tool can be used to detect structural heart abnormalities?

Echocardiogram

A patient reports that he has been having "indigestion" for the last few hours. Upon further review the nurse suspects the patient is having of chest pain. Cardiac biomarkers and a 12-lead electrocardiogram (ECG) are done. What finding is most significant in diagnosing an acute coronary syndrome (ACS) within the first 3 hours?

Elevated troponin I

Which criteria are representative of the patient in normal sinus rhythm?

Heart rate, 88 beats/min; rhythm regular; PR interval, 0.18 second; QRS, 0.06 second

Which statement made by a patient would indicate the need for further education before an electrophysiology procedure?

I need to take all my heart medications the morning of the procedure."

Which blood test standardizes prothrombin time (PT) results among worldwide clinical laboratories?

INR

What is the initial intervention in a patient with sinus tachycardia with the following vital signs: heart rate, 136 beats/min; blood pressure, 102/60 mm Hg; respiratory rate, 24 breaths/min; temperature, 99.2° F; SpO2, 94% on oxygen 2 L/min by nasal cannula?

Identify the cause.

When assessing a patient with PVCs, the nurse knows that the ectopic beat is multifocal because it appears in what way?

In various shapes in the same lead

What is the most common complication of a central venous catheter (CVC)?

Infection

Why is mixed venous oxygen saturation (SVO2) monitoring helpful in the management of the critically ill patient?

It can detect an imbalance between oxygen supply and metabolic tissue demand.

Why is a new-onset of atrial fibrillation serious?

It increases the patient's risk for a stroke

Patient education for a patient with a Holter monitor should include which instruction?

Keep a diary of activities, symptoms, and any medications that are taken.

A patient returns from the cardiac catheterization laboratory after angioplasty and stent placement (ECG changes had indicated an inferior wall myocardial infarction in progress). Which lead would best monitor this patient?

Lead 2

What parameter is used to assess the contractility of the left side of the heart?

Left ventricular stroke work index

When assessing the pulmonary arterial waveform, the nurse notices dampening. After tightening the stopcocks and flushing the line, the nurse decides to calibrate the transducer. What are two essential components included in calibration?

Leveling the air-fluid interface to the phlebostatic axis and opening the transducer to air

Which statement expresses the correct order when working with an invasive pressure monitor?

Locate the phlebostatic axis, level the transducer, zero the transducer, and take the reading.

Which serum lipid value is a significant predictor of future acute myocardial infarction (MI) in persons with established coronary artery atherosclerosis?

Low-density lipoprotein (LDL)

Which noninvasive imaging technique is useful in diagnosing complications of a myocardial infarction (MI)?

MRI

Which condition can cause an artificial increase in the pulmonary artery occlusion pressure (PAOP)?

Mitral regurgitation

The patient's admitting 12-lead ECG shows wide, M-shaped P waves. What diagnosis could be responsible for this finding?

Mitral stenosis

After a myocardial infarction, a patient presents with an increasing frequency of premature ventricular contractions (PVCs). The patient's heart rate is 110 beats/min, and electrocardiogram (ECG) indicates a sinus rhythm with up to five unifocal PVCs per minute. The patient is alert and responsive and denies any chest pain or dyspnea. What action should the nurse take next?

Notify the physician and monitor the patient closely.

A patient becomes unresponsive. The patient's heart rate is 32 beats/min in an idioventricular rhythm; blood pressure is 60/32 mm Hg; SpO2 is 90%; and respiratory rate is 14 breaths/min. Which intervention would the nurse do first?

Notify the physician and obtain a temporary pacemaker.

Which portion of the electrocardiogram (ECG) is most valuable in diagnosing atrioventricular (AV) conduction disturbances?

PR interval

Mechanical contraction of the heart occurs during which phase of the cardiac cycle?

Phase 2

The patient's admitting 12-lead ECG shows tall, peaked P waves. What diagnosis could be responsible for this finding?

Pulmonary edema

What major clinical finding present in a patient with ventricular fibrillation (VF)?

Pulselessness

What characteristic is associated with junctional escape rhythms?

Pwave may be present or absent

Which of the electrocardiogram (ECG) findings would be positive for an inferior wall myocardial infarction (MI)?

Q waves in leads II, III, and aVF

Which findings would be reasons to abort an exercise stress test?

ST segment depression or elevation

A new-onset myocardial infarction (MI) can be recognized by what electrocardiogram (ECG) change?

ST segment elevation

What type of atrioventricular (AV) block can be described as a gradually lengthening PR interval until ultimately the final P wave in the group fails to conduct?

Second-degree AV block, type I

The physician is going to place a central venous catheter. Which anatomic site is associated with a lower risk of infection?

Subclavian vein

A positive signal-averaged electrocardiogram (ECG) indicates that a patient is at risk for what problem?

Sudden cardiac death

A physician orders removal of the central venous catheter (CVC) line. The patient has a diagnosis of heart failure with chronic obstructive pulmonary disease. The nurse would place the patient in what position for this procedure?

Supine in bed

A patient with a serum potassium level of 6.8 mEq/L may exhibit what type of electrocardiographic changes?

Tall, peaked T waves

A patient presents with atrial flutter with an atrial rate of 280 beats/min and a ventricular rate of 70 beats/min. Which statement best explains this discrepancy in rates?

The atrioventricular (AV) node does not conduct all the atrial signals to the ventricles.

To accurately measure the heart rate of a patient in normal sinus rhythm, which technique would be the most accurate?

The number of small boxes between QRS complexes divided into 1500

A nurse is obtaining the history of a patient who reveals that he had an myocardial infarction (MI) 5 years ago. When the admission 12-lead electrocardiogram (ECG) is reviewed, Q waves are noted in leads V3 and V4 only. Which conclusion is most consistent with this situation?

The patient may have had an anterior MI.

What is the rationale for giving the patient additional fluids after a cardiac catheterization?

The radiopaque contrast acts as an osmotic diuretic.

Most chest radiographs of critically ill patients are obtained using a portable chest radiograph machine. What is the difference between a chest radiograph taken in the radiology department and one taken in the critical care unit?

The sharpness of the structures is decreased with a portable chest radiograph.

Why is the Allen test performed before placement of a radial arterial line placement?

To evaluate collateral circulation to the hand

Which lead is best to monitor a patient?

Varies based on the patient's clinical condition and recent clinical history

What is the major factor influencing the patient's response to atrial flutter?

Ventricular response rate

Which electrocardiographic (ECG) abnormality is most often found in ventricular dysrhythmias?

Wide QRS complexes

A patient asks why he had to take a deep breath when the radiology technician took his chest radiograph. Which statement is the best response?

"When the lungs are filled with air, you get a clearer picture."

On returning from the cardiac catheterization laboratory, the patient asks if he can get up in the chair. What should the nurse tell the patient?

"You cannot get up because you may start bleeding."

Zeroing the pressure transducer on hemodynamic monitoring equipment occurs when the displays reads which number?

0

When performing a 12-lead electrocardiogram (ECG), how many wires are connected to the patient?

10

ST segment monitoring for ischemia has gained increasing importance with the advent of thrombolytic therapy. What is the most accurate method for monitoring the existence of true ischemic changes?

12-lead ECG

A 55-year-old patient is scheduled for a stress test. What is the estimation of the patient's maximal predicted heart rate?

165 beats/min

What is the target range for an international normalized ratio (INR)?

2.0 to 3.0

The patient has a heart rate (HR) of 84 beats/min and a stroke volume (SV) of 65 mL. Calculate the cardiac output (CO).

5460 ml