Quiz 1 question
VAD short term or long term?
Long term- hold patient over until heart transplant is available. Small device gives patient mobility
A nurse knows that the major clinical use of dobutamine (Dobutrex) is to 1. increase cardiac output. 2. prevent sinus bradycardia. 3. treat hypotension. 4. treat hypertension.
1. Dobutamine increases cardiac output for clients with acute heart failure and those undergoing cardiopulmonary bypass surgery. Physicians may use epinephrine hydrochloride, another catecholamine agent, to treat sinus bradycardia. Physicians use many of the catecholamine agents, including epinephrine, isoproterenol, and norepinephrine, to treat acute hypotension. They don't use catecholamine agents to treat hypertension because catecholamine agents may raise blood pressure
Which measurement should a nurse use to monitor the respiratory status of a client with pulmonary edema? 1. Arterial blood gas (ABG) analysis 2. Pulse oximetry 3. Skin color assessment 4. Lung sounds
1. ABG RATIONALE: ABG analysis is the best measure for determining the extent of hypoxia caused by pulmonary edema and for monitoring the effects of therapy. Although a nurse can use any of the options to detect pulmonary changes, assessment of skin color and assessment of lung fields commonly are subject to interpretation by practitioners. The use of pulse oximetry is unreliable, especially in the case of severe vasoconstriction as is present in pulmonary edema.
80. Which drug is most commonly used to treat cardiogenic shock? 1. Dopamine 2. Enalapril (Vasotec) 3. Furosemide (Lasix) 4. Metoprolol (Lopressor)
1. Dopamine, a sympathomimetic drug, improves myocardial contractility and blood flow through vital organs by increasing perfusion pressure. Enalapril is an angiotensin-converting enzyme inhibitor that directly lowers blood pressure. Furosemide is a diuretic and doesn't have a direct effect on contractility or tissue perfusion. Metoprolol is a beta-adrenergic blocker that slows heart rate and lowers blood pressure; neither is a desired effect in the treatment of cardiogenic shock
76. The nurse determines that a client at risk for the development of cardiogenic shock would present with which of the following? 1. Decreased heart rate 2. Decreased cardiac index 3. Decreased blood pressure 4. Decreased cerebral blood flow
2. The cardiac index, a figure derived by dividing the cardiac output by the client's body surface area, is used for identifying whether the cardiac output is meeting a client's needs. Heart rate, blood pressure, and decreased cerebral blood flow are less useful in detecting the risk of cardiogenic shock. Lisko, Susan (2013-10-01). NCLEX-RN Questions and Answers Made Incredibly Easy (Nclexrn Questions & Answers Made Incredibly Easy) (Kindle Locations 1646-1648). LWW. Kindle Edition.
A client with a history of myocardial infarction is admitted with shortness of breath, anxiety, and slight confusion. Assessment findings include a regular heart rate of 120 beats/minute, audible third and fourth heart sounds, blood pressure of 84/64 mm Hg, bibasilar crackles on lung auscultation, and a urine output of 5 ml over the past hour. The nurse anticipates preparing the client for transfer to the intensive care unit and pulmonary artery catheter insertion because: 1. the client is experiencing heart failure. 2. the client is going into cardiogenic shock. 3. the client shows signs of aneurysm rupture. 4. the client is in the early stage of right-sided heart failure.
2. the client is going into cardiogenic shock This client's findings indicate cardiogenic shock, which occurs when the heart fails to pump properly, impeding blood supply and oxygen flow to vital organs. Cardiogenic shock also may cause cold, clammy skin and generalized weakness, fatigue, and muscle pain as poor blood flow causes lactic acid to accumulate and prevents waste removal. Left-sided and right-sided heart failure eventually cause venous congestion with jugular vein distention and edema as the heart fails to pump blood forward. A ruptured aneurysm causes severe hypotension and a quickly deteriorating clinical status from blood loss and circulatory collapse; this client has low but not severely decreased blood pressure. Also, in ruptured aneurysm, deterioration is more rapid and full cardiac arrest is common
Following a left anterior myocardial infarction, a client undergoes insertion of a pulmonary artery catheter. Which finding most strongly suggests left-sided heart failure? 1. Decreased central venous pressure 2. Increase in the cardiac index 3. Increased pulmonary artery diastolic pressure 4. Decreased mean pulmonary artery pressure
3. Increased pulmonary artery diastolic pressure suggests left-sided heart failure. Central venous pressure increases in heart failure rather than decreases. The cardiac index decreases in heart failure. The mean pulmonary artery pressure increases in heart failure.
75. Which of the following parameters increases as myocardial oxygen consumption increases? 1. Preload, afterload, and cerebral blood flow 2. Preload, afterload, and renal blood flow 3. Preload, afterload, contractility, and heart rate 4. Preload, afterload, cerebral blood flow, and heart rate
3. Myocardial oxygen consumption increases as preload, afterload, contractility, and heart rate increase. Cerebral blood flow and renal blood flow don't directly affect myocardial oxygen consumption.
If medical treatment for cardiopulmonary fails, the RN should prepare the client for wich of the following 1. Cardiac catheterization 2. Coronary artery bypass graft (CABG) 3. Heart transplantation 4. Intra-aortic balloon pump
3. The only definitive treatment for cardiomyopathy that can't be controlled medically is a heart transplant because the damage to the heart muscle is irreversible. Cardiac catheterization is an invasive diagnostic procedure for coronary artery disease. CABG is a surgical intervention used for atherosclerotic vessels. An IABP is an invasive treatment that assists the failing heart; however, it's only a temporary solution.
A client with a history of an anterior wall myocardial infarction is being transferred from the coronary care unit (CCU) to the cardiac step-down unit (CSU). While giving a report to the CSU nurse, the CCU nurse says, "His pulmonary artery wedge pressures have been in the high normal range." The CSU nurse should be especially observant for: 1. hypertension. 2. high urine output. 3. dry mucous membranes. 4. pulmonary crackles.
4. High pulmonary artery wedge pressures are diagnostic for left-sided heart failure. With left-sided heart failure, pulmonary edema can develop causing pulmonary crackles. In left-sided heart failure, hypotension may result and urine output will decline. Dry mucous membranes aren't directly associated with elevated pulmonary artery wedge pressures.
Which of the following is used as a diagnosic and monitoring device for the severity of a shock state? 1. Arterial line 2.Indwelling catheter 3. Intra-aortic balloon pump (IABP) 4. Pulmonary artery catheter
4. Pulmonary artery catheter helps determine the course of treatment
76. The nurse determines that a client at risk for the development of cardiogenic shock would present with which of the following? 1. Decreased heart rate 2. Decreased cardiac index 3. Decreased blood pressure 4. Decreased cerebral blood flow
76. 2. The cardiac index, a figure derived by dividing the cardiac output by the client's body surface area, is used for identifying whether the cardiac output is meeting a client's needs. Heart rate, blood pressure, and decreased cerebral blood flow are less useful in detecting the risk of cardiogenic shock.
78. Which diagnostic study can determine when cellular metabolism becomes anaerobic and when pH decreases? 1. Arterial blood gas (ABG) levels 2. Complete blood count (CBC) 3. Electrocardiogram (ECG) 4. Lung scan
78. 1. ABG levels reflect cellular metabolism and indicate hypoxia. A CBC is performed to determine various constituents of venous blood. An ECG shows the electrical activity of the heart. A lung scan is performed to view functionality of the lungs. .
The nurse is checking the client's central venous pressure. The nurse should place the zero of the manometer at the: A.Phlebostatic axis B.Point of maximum impulse (PMI) C. Erb's point D.Tail of Sphence
A is correct. The nurse should place the zero of the manometer at the phlebostatic axis (located at the fifth intercostal space mid-axillary line) when checking the central venous pressure. Answers B, C, and D are incorrect methods for determining the central venous pressure.
11. Norepinephrine (Levophed) has been prescribed for a patient who was admitted with dehydration and hypotension. Which patient information indicates that the nurse should consult with the health care provider before administration of the norepinephrine? a. The patient's central venous pressure is 3 mm Hg. b. The patient is receiving low dose dopamine (Intropin). c. The patient is in sinus tachycardia at 100 to 110 beats/min. d. The patient has had no urine output since being admitted.
ANS: A Adequate fluid administration is essential before administration of vasopressors to patients with hypovolemic shock. The patient's low central venous pressure indicates a need for more volume replacement. The other patient data are not contraindications to norepinephrine administration. DIF: Cognitive Level: Application REF: 1733-1735 | 1736 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
15. A patient with septic shock has a BP of 70/46 mm Hg, pulse 136, respirations 32, temperature 104° F, and blood glucose 246 mg/dL. Which of these prescribed interventions will the nurse implement first? a. Give normal saline IV at 500 mL/hr. b. Infuse drotrecogin- (Xigris) 24 mcg/kg. c. Start insulin drip to maintain blood glucose at 110 to 150 mg/dL. d. Titrate norepinephrine (Levophed) to keep mean arterial pressure (MAP) at 65 to 70 mm Hg.
ANS: A Because of the low systemic vascular resistance (SVR) associated with septic shock, fluid resuscitation is the initial therapy. The other actions also are appropriate and should be initiated quickly as well. DIF: Cognitive Level: Application REF: 1735-1737 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
1. A patient with septic shock has a urine output of 20 mL/hr for the past 3 hours. The pulse rate is 120 and the central venous pressure and pulmonary artery wedge pressure are low. Which of these orders by the health care provider will the nurse question? a. Give furosemide (Lasix) 40 mg IV. b. Increase normal saline infusion to 150 mL/hr. c. Administer hydrocortisone (SoluCortef) 100 mg IV. d. Prepare to give drotrecogin alpha (Xigris) 24 mcg/kg/hr.
ANS: A Furosemide will lower the filling pressures and renal perfusion further for the patient with septic shock. The other orders are appropriate. DIF: Cognitive Level: Application REF: 1724-1726 | 1731 | 1733 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
2. A patient with shock of unknown etiology whose hemodynamic monitoring indicates BP 92/54, pulse 64, and an elevated pulmonary artery wedge pressure has the following collaborative interventions prescribed. Which intervention will the nurse question? a. Infuse normal saline at 250 mL/hr. b. Keep head of bed elevated to 30 degrees. c. Give nitroprusside (Nipride) unless systolic BP <90 mm Hg. d. Administer dobutamine (Dobutrex) to keep systolic BP >90 mm Hg.
ANS: A The patient's elevated pulmonary artery wedge pressure indicates volume excess. A normal saline infusion at 250 mL/hr will exacerbate this. The other actions are appropriate for the patient. DIF: Cognitive Level: Application REF: 1719 | 1721-1722 | 1735 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
. Which of these findings is the best indicator that the fluid resuscitation for a patient with hypovolemic shock has been successful? a. Hemoglobin is within normal limits. b. Urine output is 60 mL over the last hour. c. Pulmonary artery wedge pressure (PAWP) is normal. d. Mean arterial pressure (MAP) is 65 mm Hg.
ANS: B Assessment of end organ perfusion, such as an adequate urine output, is the best indicator that fluid resuscitation has been successful. The hemoglobin level, PAWP, and MAP are useful in determining the effects of fluid administration, but they are not as useful as data indicating good organ perfusion. DIF: Cognitive Level: Application REF: 1733-1735 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
The physician orders lisinopril (Zestril) and furosemide (Lasix) to be administered concomitantly to the client with hypertension. The nurse should A.Question the order. B.Administer the medications. C. Administer them separately. D.Contact the pharmacy.
Answer B is correct. Zestril is an ACE inhibitor and is frequently given with a diuretic such as Lasix. There is no need to question the order, give the drugs separately, or contact the pharmacy, so answers A, C, and D are incorrect.
23. Which information about a patient who is receiving vasopressin (Pitressin) to treat septic shock is most important for the nurse to communicate to the heath care provider? a. The patient's heart rate is 108 beats/min. b. The patient is complaining of chest pain. c. The patient's peripheral pulses are weak. d. The patient's urine output is 15 mL/hr.
ANS: B Because vasopressin is a potent vasoconstrictor, it may decrease coronary artery perfusion. The other information is consistent with the patient's diagnosis and should be reported to the health care provider but does not indicate a need for a change in therapy. DIF: Cognitive Level: Application REF: 1735-1736 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
7. A patient with cardiogenic shock has the following vital signs: BP 86/50, pulse 126, respirations 30. The PAWP is increased and cardiac output is low. The nurse will anticipate a. infusion of 5% human albumin. b. administration of furosemide (Lasix) IV. c. titration of an epinephrine (Adrenalin) drip. d. administration of hydrocortisone (SoluCortef).
ANS: B The PAWP indicates that the patient's preload is elevated and furosemide is indicated to reduce the preload and improve cardiac output. Epinephrine would further increase heart rate and myocardial oxygen demand. Normal saline infusion would increase the PAWP further. Hydrocortisone might be used for septic or anaphylactic shock. DIF: Cognitive Level: Application REF: 1735 | 1736 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
The client admitted with angina is given a prescription for nitroglycerine. The client should be instructed to: A.Replenish her supply every 3 months. B.Take one every 15 minutes if pain occurs. C.Leave the medication in the brown bottle. D. Crush the medication and take it with water.
Answer C is correct. The client should leave the medication in the brown bottle because light deteriorates the medication. The supply should be replenished every 6 months, so answer A is incorrect. One tablet should be taken every 5 minutes times three, so answer B is incorrect. If the pain does not subside, the client should report to the emergency room. The medication should be taken sublingually and should not be crushed, so answer D is incorrect.
2. When the nurse is assessing a patient who is receiving a nitroprusside (Nipride) infusion to treat cardiogenic shock, which finding indicates that the medication is effective? a. No heart murmur is audible. b. Skin is warm, pink, and dry. c. Troponin level is decreased. d. Blood pressure is 90/40 mm Hg.
ANS: B Warm, pink, and dry skin indicates that perfusion to tissues is improved. Since nitroprusside is a vasodilator, the blood pressure may be low even if the medication is effective. Absence of a heart murmur and a decrease in troponin level are not indicators of improvement in shock. DIF: Cognitive Level: Application REF: 1721 | 1723 | 1733-1735 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
8. The emergency department (ED) receives notification that a patient who has just been in an automobile accident is being transported to your facility with anticipated arrival in 1 minute. In preparation for the patient's arrival, the nurse will obtain a. 500 mL of 5% albumin. b. lactated Ringer's solution. c. two 14-gauge IV catheters. d. dopamine (Intropin) infusion.
ANS: C A patient with multiple trauma may require fluid resuscitation to prevent or treat hypovolemic shock, so the nurse will anticipate the need for 2 large bore IV lines to administer normal saline. Lactated Ringer's solution should be used cautiously and will not be ordered until the patient has been assessed for possible liver abnormalities. Although colloids may sometimes be used for volume expansion, crystalloids should be used as the initial therapy for fluid resuscitation. Vasopressor infusion is not used as the initial therapy for hypovolemic shock. DIF: Cognitive Level: Application REF: 1731 | 1732 | 1733 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
3. A patient with massive trauma and possible spinal cord injury is admitted to the emergency department (ED). Which finding by the nurse will help confirm a diagnosis of neurogenic shock? a. Cool, clammy skin b. Inspiratory crackles c. Apical heart rate 48 beats/min d. Temperature 101.2° F (38.4° C)
ANS: C Neurogenic shock is characterized by hypotension and bradycardia. The other findings would be more consistent with other types of shock. DIF: Cognitive Level: Comprehension REF: 1721-1722 | 1723 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
5. After receiving 1000 mL of normal saline, the central venous pressure for a patient who has septic shock is 10 mm Hg, but the blood pressure is still 82/40 mm Hg. The nurse will anticipate the administration of a. nitroglycerine (Tridil). b. drotrecogin alpha (Xigris). c. norepinephrine (Levophed). d. sodium nitroprusside (Nipride).
ANS: C When fluid resuscitation is unsuccessful, vasopressor drugs are administered to increase the systemic vascular resistance (SVR) and improve tissue perfusion. Nitroglycerin would decrease the preload and further drop cardiac output and BP. Drotrecogin alpha may decrease inappropriate inflammation and help prevent systemic inflammatory response syndrome, but it will not directly improve blood pressure. Nitroprusside is an arterial vasodilator and would further decrease SVR. DIF: Cognitive Level: Application REF: 1731 | 1733-1735 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
4. A patient with cardiogenic shock is cool and clammy and hemodynamic monitoring indicates a high systemic vascular resistance (SVR). Which action will the nurse anticipate taking? a. Increase the rate for the prescribed dopamine (Intropin) infusion. b. Decrease the rate for the prescribed nitroglycerin (Tridil) infusion. c. Decrease the rate for the prescribed 5% dextrose in water (D5W) infusion. d. Increase the rate for the prescribed sodium nitroprusside (Nipride) infusion.
ANS: D Nitroprusside is an arterial vasodilator and will decrease the SVR and afterload, which will improve cardiac output. Changes in the D5W and nitroglycerin infusions will not directly increase SVR. Increasing the dopamine will tend to increase SVR. DIF: Cognitive Level: Application REF: 1733-1734 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
A nurse is caring for a client experiencing dyspnea, dependent edema, hepatomegaly, crackles, and jugular vein distention. What condition should the nurse suspect? 1. Pulmonary embolism 2. Heart failure 3. Cardiac tamponade 4. Tension pneumothorax
Heart failure A client with heart failure has decreased cardiac output caused by the heart's decreased pumping ability. A buildup of fluid occurs, causing dyspnea, dependent edema, hepatomegaly, crackles, and jugular vein distention. A client with pulmonary embolism experiences acute shortness of breath, pleuritic chest pain, hemoptysis, and fever. A client with cardiac tamponade experiences muffled heart sounds, hypotension, and elevated central venous pressure. A client with tension pneumothorax has a deviated trachea and absent breath sounds on the affected side as well as dyspnea and jugular vein distention.
Following a left anterior myocardial infarction, a client undergoes insertion of a pulmonary artery catheter. Which finding most strongly suggests left-sided heart failure? Decreased central venous pressure 2. Increase in the cardiac index 3. Increased pulmonary artery diastolic pressure 4. Decreased mean pulmonary artery pressure
Increased pulmonary artery diastolic pressure RATIONALE: Increased pulmonary artery diastolic pressure suggests left-sided heart failure. Central venous pressure increases in heart failure rather than decreases. The cardiac index decreases in heart failure. The mean pulmonary artery pressure increases in heart failure.
Is Intraortic balloon pump long term or short term?
Short term- emergency
A woman with severe mitral stenosis and mitral regurgitation has a pulmonary artery catheter inserted. The physician orders pulmonary artery pressure monitoring, including pulmonary capillary wedge pressures. The purpose of this is to help asses the: a. degree of coronary artery stenosis b. peripheral arterial pressure c. pressure from fluid within the left ventricle d. oxygen and carbon dioxide concentrations in the blood
The pulmonary artery pressures are used to assess the heart's ability to receive and pump blood. The pulmonary capillary wedge pressure reflects the left ventricular end-diastolic pressure and guides the physician in determining fluid management for the client. The degree of coronary artery stenosis is assessed during a cardiac catheterization. The peripheral arterial pressure assessed with an arterial line. The oxygen and carbon dioxide concentrations in the arterial blood can be measured by an arterial blood gas determination.
A patient has central venous oxygen saturation/mixed venous oxygen saturation (ScvO2/SvO2) of 52%, CO of 4.8 L/min, SpO2of 95%, and an unchanged hemoglobin level. What should the nurse assess the patient for? a. Dysrhythmias b. Pain on movement c. Pulmonary edema d. Signs of septic shock
b. Pain on movement With normal CO arterial oxyenation and HgB the factor that is responibe for the decrease in SvO2 is increased O2 consuption caused by increase metabolic demands of pain
21. What are ventricular assist devices (VADs) designed to do for the patient? a. Provide permanent, total circulatory support when the left ventricle fails b. Partially or totally support circulation temporarily until a donor heart can be obtained c. Support circulation only when patients cannot be weaned from cardiopulmonary bypass d. Reverse the effects of circulatory failure in patients with acute myocardial infarction (MI) in cardiogenic shock
b. Partially or totally support circulation temporarily until a donor heart can be obtained VAD can partially or totally support circulation until the heart recovers and can be weaned from cardiac bypass or until a donor heart can be obtained. VAD are long term solution, but not a permanent one
19. What should the nurse do to prevent arterial trauma during the use of the IABP? a. Reposition the patient every 2 hours. b. Check the site for bleeding every hour. c. Prevent hip flexion of the cannulated leg. d. Cover the insertion site with an occlusive dressing.
c. Prevent hip flexion of the cannulated leg. IABP is inserted into the femoral artery. Compromised distal circulation and so the leg needs to be immobilized. Reposition the patien is limited to side-lying or supine and log roll (for daily CXR balloon placement) HOB never above 45 degrees--balloon filled with helium is if you raise the HOB the balloon will float up and lodge too far in aorta Asses for bleeding
Which description accurately describes the continuous CO (CCO) method and not the intermittent bolus thermodilution CO (TDCO) method of determining CO? a. Room temperature or cold normal saline is injected rapidly. b. The TDCO method is easier and faster than the CCO method. c. The digital measurements reflect the average CO every 30 to 60 seconds. d Systemic vascular resistance (SVR) can be calculated each time CO is measured.
c. The digital measurements reflect the average CO every 30 to 60 seconds. the continuous CO method determining CO uses heat exchange catheter that produces and detects change in temp. The bedside side computer displays digital measurements every 30-60sec that reflect the average CO for the pas 3 to 6 minutes Fluild bulous are not neede, as with the intermeniten bl
17. A patient with which disorder would benefit from the use of the intraaortic balloon pump (IABP)? a. An insufficient aortic valve b. A dissecting thoracic aortic aneurysm c. Generalized peripheral vascular disease d. Acute myocardial infarction with cardiogenic shock
d. Acute myocardial infarction with cardiogenic shock The counter pulsation of the intraaortic balloon pump increase diastolic arterial pressure forces blood back into the coronary arteries and main branches of the aortic arch, increasing coronary artery perfusion pressure and blood flow to the myocardium IABP cause drop in aortic pressure right before systole inflate on diastole, deflate on systole to maintain heart pressure
20. A patient who is hemodynamically stable has an order to wean the IABP. How should the nurse accomplish this? a. Decrease the augmentation pressure to zero. b. Stop the machine since hemodynamic parameters are satisfactory. c. Stop the infusion flow through the catheter when weaning is initiated. d. Change the pumping ratio from 1:1 to 1:2 or 1:3 until the balloon is removed.
d. Change the pumping ratio from 1:1 to 1:2 or 1:3 until the balloon is removed. Weaning the IABP involves reduceing the pumping to every second or thrid heartbeat until the IABP catheter is removed. The pumping and infusion flow are continued to reduce the risk of thrombus formation around the catheter until it is removed
Which statement about the function of the IABP is accurate? a. Deflation of the balloon allows the HR to increase. b. A primary effect of the IABP is increased systolic blood pressure. c. The rapid deflation of the intraaortic balloon causes a decreased preload. d. During intraaortic counterpulsation, the balloon is inflated during diastole.
d. During intraaortic counter pulsation, the balloon is inflated during diastole. During intaaortic counter pulsation, the balloon of the IABP is inflated during diastole and deflated during systole. This causes a decrease HR decrease peak systolic pressure and decrease afterload
In preparing the patient for insertion of a pulmonary artery catheter, what should the nurse do? a. Place the patient in high Fowler's position. b. Obtain an informed consent from the patient. c. Perform an Allen test to confirm adequate ulnar artery perfusion. d. Ensure that the patient has continuous electrocardiographic (ECG) monitoring.
d. Ensure that the patient has continuous electrocardiographic (ECG) monitoring. Rational: need ECG because PA cath has risk of dysrytmias, particularly when the cath reaches the ventricles Health care provider responsibility to obtain consent Pt. placed in supine
