211 FINAL
The normal width of the QRS complex is which of the following? (Select all that apply.) a 0.06 to 0.10 seconds. b 0.12 to 0.20 seconds. c 1.5 to 2.5 small boxes. d 3.0 to 5.0 small boxes. e 0.04 seconds or greater.
a 0.06 to 0.10 seconds. c 1.5 to 2.5 small boxes.
In trauma patients, enteral nutrition via nasogastric tube feedings into the small bowel is best initiated within what time frame following the injury? a 24 hours b 48 hours c 7 days d 72 hours
a 24 hours
The patient has a permanent pacemaker inserted. The provider has set the pacemaker to the demand mode at a rate of 60 beats per minute. How does the nurse interpret this? a The pacemaker will pace only if the patient's intrinsic heart rate is less than 60 beats per minute. b The demand mode often competes with the patient's own rhythm. c The demand mode places the patient at risk for the R-on-T phenomenon. d The fixed rate mode is safer and is the mode of choice.
a The pacemaker will pace only if the patient's intrinsic heart rate is less than 60 beats per minute.
The charge nurse is supervising the care of four critical care patients being monitored using invasive hemodynamic modalities. Which patient should the charge nurse evaluate first? a. A patient in cardiogenic shock with a cardiac output (CO) of 2.0 L/min b. A patient with a pulmonary artery systolic pressure (PAP) of 20 mm Hg c. A hypovolemic patient with a central venous pressure (CVP) of 6 mm Hg d. A patient with a pulmonary artery occlusion pressure (PAOP) of 10 mm Hg
a. A patient in cardiogenic shock with a cardiac output (CO) of 2.0 L/min
A patient is admitted to the hospital with multiple trauma and extensive blood loss. The nurse assesses vital signs to be BP 80/50 mm Hg, heart rate 135 beats/min, respirations 36 breaths/min, cardiac output (CO) of 2 L/min, systemic vascular resistance of 3000 dynes/sec/cm 5 , and a hematocrit of 20%. The nurse anticipates administration of which the following therapies or medications? a. Blood transfusion b. Furosemide c. Dobutamine infusion d. Dopamine hydrochloride infusion
a. Blood transfusion
The nurse is caring for a 100-kg patient being monitored with a pulmonary artery catheter. The nurse assesses a blood pressure of 90/60 mm Hg, heart rate 110 beats/min, respirations 36/min, oxygen saturation of 89% on 3 L of oxygen via nasal cannula. Bilateral crackles are audible upon auscultation. Which hemodynamic value requires immediate action by the nurse? a. Cardiac index (CI) of 1.2 L/min/m 3 b. Cardiac output (CO) of 4 L/min c. Pulmonary vascular resistance (PVR) of 80 dynes/sec/cm 5 d. Systemic vascular resistance (SVR) of 1800 dynes/sec/cm 5
a. Cardiac index (CI) of 1.2 L/min/m 3
Which of the following devices is best suited to deliver 65% oxygen to a patient who is spontaneously breathing? a. Face mask with non-rebreathing reservoir b. Low-flow nasal cannula c. Simple face mask d. Venturi mask
a. Face mask with non-rebreathing reservoir
When performing an initial pulmonary artery occlusion pressure (PAOP), what are the best nursing actions? (Select all that apply.) a. Inflate the balloon for no more than 8 to 10 seconds while noting the waveform change. b. Inflate the balloon with air, recording the volume necessary to obtain a reading. c. Maintain the balloon in the inflated position for 8 hours following insertion. d. Zero reference and level the air-fluid interface of the transducer at the level of the phlebostatic axis. e. Inflate and deflate the balloon on an hourly schedule
a. Inflate the balloon for no more than 8 to 10 seconds while noting the waveform change. b. Inflate the balloon with air, recording the volume necessary to obtain a reading. d. Zero reference and level the air-fluid interface of the transducer at the level of the phlebostatic axis.
The nurse is caring for a patient following insertion of a left subclavian central venous catheter (CVC). Which action by the nurse best reduces the risk of catheter-related bloodstream infection (CRBSI)? a. Review daily the necessity of the central venous catheter. b. Cleanse the insertion site daily with isopropyl alcohol. c. Change the pressurized tubing system and flush bag daily. d. Maintain a pressure of 300 mm Hg on the flush bag.
a. Review daily the necessity of the central venous catheter.
When it is noted that a patient's endotracheal tube is not secured tightened, the respiratory care practitioner assists the nurse in taping the tube. After the tube is retaped, the nurse auscultates the patient's lungs and notes that the breath sounds over the left lung fields are absent. The nurse suspects is the cause of this finding? a. The endotracheal tube is in the right mainstem bronchus. b. The patient has a left pneumothorax. c. The patient has aspirated secretions during the procedure. d. The stethoscope earpiece is clogged with wax.
a. The endotracheal tube is in the right mainstem bronchus.
How does malnutrition contributes to infection risk? a Hampering normal gastrointestinal motility b Impairing immune function c Increasing blood glucose d Increasing drug interactions
b Impairing immune function
The patient is admitted with a fever and rapid heart rate and a temperature of 103° F (39.4° C).The nurse places the patient on a cardiac monitor and finds the patient's atrial and ventricular rates are above 105 beats per minute. P waves are clearly seen and appear normal in configuration. QRS complexes are normal in appearance and 0.08 seconds wide. The rhythm is regular, and blood pressure is normal. What should be the nurse's initial focus? a Medications to lower heart rate b Treatment to lower temperature c Treatment to lower cardiac output d Treatment to reduce heart rate
b Treatment to lower temperature
The correct order of actions for a patient starting enteral nutrition with a feeding tube is: (Put a comma and space between each answer choice.) a. Initiate tube feeding b. Insert feeding tube c. Flush tube to verify patency d. Obtain chest radiograph e. Assess residuals
b. Insert feeding tube d. Obtain chest radiograph c. Flush tube to verify patency a. Initiate tube feeding e. Assess residuals
The patient scheduled to have a permanent pacemaker implanted asks the nurse, "How long will the battery in this thing last?" What answer should the nurse provide? a "Life expectancy is about 1 year. Then it will need to be replaced." b "Pacemaker batteries can last up to 25 years with constant use." c "Battery life varies depending on usage, but it can last up to 10 years." d "Pacemakers are used to treat temporary problems so the batteries don't last long."
c "Battery life varies depending on usage, but it can last up to 10 years."
The patient has a permanent pacemaker in place with a demand rate set at 60 beats/min. The cardiac monitor is showing a heart rate of 44 beats/min with no pacemaker spikes. How does the nurse interpret this? a Normal pacemaker function b Failure to capture c Failure to pace d Failure to sense
c Failure to pace
When assessing the 12-lead electrocardiogram (ECG) or a rhythm strip, it is helpful to understand that the electrical activity is viewed in relation to the positive electrode of that particular lead. What is the effect on the inflection when an electrical signal is aimed directly at the positive electrode? a Negative b Upside down c Upright d Equally positive and negative
c Upright
The charge nurse is supervising care for a group of patients monitored with a variety of invasive hemodynamic devices. Which patient should the charge nurse evaluate first? a. A patient with a central venous pressure (RAP/CVP) of 6 mm Hg and 40 mL of urine output in the past hour b. A patient with a left radial arterial line with a BP of 110/60 mm Hg and slightly dampened arterial waveform c. A patient with a pulmonary artery occlusion pressure of 25 mm Hg and an oxygen saturation of 89% on 3 L of oxygen via nasal cannula d. A patient with a pulmonary artery pressure of 25/10 mm Hg and an oxygen saturation of 94% on 2 L of oxygen via nasal cannula
c. A patient with a pulmonary artery occlusion pressure of 25 mm Hg and an oxygen saturation of 89% on 3 L of oxygen via nasal cannula
The nurse working on the night shift when notices sinus bradycardia on the patient's cardiac monitor. What initial action should the nurse take? a Give atropine to increase heart rate. b Begin transcutaneous pacing of the patient. c Start a dopamine infusion to stimulate heart function. d Assess for hemodynamic instability.
d Assess for hemodynamic instability.
The patient is to start total parenteral nutrition (TPN). The nurse knows to prepare which site for catheter insertion? a Basilic vein b Femoral artery c Radial artery d Subclavian vein
d Subclavian vein
A patient is being mechanically ventilated in the synchronized intermittent mandatory ventilation mode at a rate of 4 breaths/min. Spontaneous respirations are 12 breaths/min. The patient receives a dose of morphine sulfate, and now respirations decrease to 4 breaths/min. What adjustments may need to be made to the patient's ventilator settings? a. Add positive end-expiratory pressure (PEEP). b. Add pressure support. c. Change to assist/control ventilation at a rate of 4 breaths/min. d. Increase the synchronized intermittent mandatory ventilation respiratory rate.
d. Increase the synchronized intermittent mandatory ventilation respiratory rate.
The nurse is preparing to obtain a pulmonary artery occlusion pressure (PAOP) reading for a patient who is mechanically ventilated. Ensuring that the air-fluid interface is at the level of the phlebostatic axis, what is the best nursing action? a. Place the patient in the supine position and record the PAOP immediately after exhalation. b. Place the patient in the supine position and document the average PAOP obtained after three measurements. c. Place the patient with the head of bed elevated 30 degrees and document the average PAOP pressure obtained. d. Place the patient with the head of bed elevated 30 degrees and record the PAOP just before the increase in pressures during inhalation.
d. Place the patient with the head of bed elevated 30 degrees and record the PAOP just before the increase in pressures during inhalation.
Which statement(s) about total parenteral nutrition is (are) true? (Select all that apply.) a Assessing fluid volume status and preventing infection are important nursing considerations. b Fingerstick glucose levels are assessed every 6 hours and prn. c Total parenteral nutrition is administered through a feeding tube and pump. d Total parenteral nutrition, with added lipids, provides adequate levels of protein, carbohydrates, and fats. e Soy-based lipids should not be given if propofol is prescribed.
A. Assessing fluid volume status and preventing infection are important nursing considerations. B. Fingerstick glucose levels are assessed every 6 hours and prn. D. Total parenteral nutrition, with added lipids, provides adequate levels of protein, carbohydrates, and fats. E. Soy-based lipids should not be given if propofol is prescribed.
Upon entering the room of a patient with a right radial arterial line, the nurse assesses the waveform to be slightly dampened and notices blood to be backed up into the pressure tubing. What is the best action by the nurse? a. Check the inflation volume of the flush system pressure bag. b. Disconnect the flush system from the arterial line catheter. c. Zero reference the transducer system at the phlebostatic axis. d. Reduce the number of stopcocks in the flush system tubing.
a. Check the inflation volume of the flush system pressure bag.
The nurse is preparing to obtain a right atrial pressure (RAP/CVP) reading. What are the most appropriate nursing actions? (Select all that apply.) a. Compare measured pressures with other physiological parameters. b. Flush the central venous catheter with 20 mL of sterile saline. c. Inflate the balloon with 3 mL of air and record the pressure tracing. d. Obtain the right atrial pressure measurement during end exhalation. e. Zero reference the transducer system at the level of the phlebostatic axis.
a. Compare measured pressures with other physiological parameters. d. Obtain the right atrial pressure measurement during end exhalation. e. Zero reference the transducer system at the level of the phlebostatic axis.
What does oxygen saturation (SaO 2 ) represent? a. Alveolar oxygen tension. b. Oxygen that is chemically combined with hemoglobin. c. Oxygen that is physically dissolved in plasma. d. Total oxygen consumption.
b. Oxygen that is chemically combined with hemoglobin
The nurse is caring for a mechanically ventilated patient being monitored with a left radial arterial line. During the inspiratory phase of ventilation, the nurse assesses a 20 mm Hg decrease in arterial blood pressure. What is the best interpretation of this finding by the nurse? a. The mechanical ventilator is malfunctioning. b. The patient may require fluid resuscitation. c. The arterial line may need to be replaced. d. The left limb may have reduced perfusion.
b. The patient may require fluid resuscitation.
In evaluating a patient's nutrition, the nurse would monitor which blood test as the most sensitive indicator of protein synthesis and catabolism? a Albumin b BUN c Prealbumin d Triglycerides
c Prealbumin
A patient's status deteriorates and mechanical ventilation is now required. The pulmonologist wants the patient to receive 10 breaths/min from the ventilator but wants to encourage the patient to breathe spontaneously in between the mechanical breaths at his own tidal volume. This mode of ventilation is referred to by what term? a. Assist/control ventilation b. Controlled ventilation c. Intermittent mandatory ventilation d. Positive end-expiratory pressure
c. Intermittent mandatory ventilation
The nurse caring for a patient with an endotracheal tube understands that endotracheal suctioning is needed to facilitate removal of secretions. What additional information is the nurse aware of concerning this intervention? a. It decreases intracranial pressure. b. It depresses the cough reflex. c. It is done as indicated by patient assessment. d. It is more effective if preceded by saline instillation to loosen secretions.
c. It is done as indicated by patient assessment.
The nurse is caring for a mechanically ventilated patient with a pulmonary artery catheter who is receiving continuous enteral tube feedings. When obtaining continuous hemodynamic monitoring measurements, what is the best nursing action? a. Do not document hemodynamic values until the patient can be placed in the supine position. b. Level and zero reference the air-fluid interface of the transducer with the patient in the supine position and record hemodynamic values. c. Level and zero reference the air-fluid interface of the transducer with the patient's head of bed elevated to 30 degrees and record hemodynamic values. d. Level and zero reference the air-fluid interface of the transducer with the patient supine in the side-lying position and record hemodynamic values.
c. Level and zero reference the air-fluid interface of the transducer with the patient's head of bed elevated to 30 degrees and record hemodynamic values.
While neuromuscular blocking agents are used in the management of some ventilated patients what is their primary mode of action? a. Analgesia b. Anticonvulsant c. Paralysis d. Sedation
c. Paralysis
A mode of pressure-targeted ventilation that provides positive pressure to decrease the workload of spontaneous breathing through what action by the endotracheal tube? a. Continuous positive airway pressure b. Positive end-expiratory pressure c. Pressure support ventilation d. T-piece adapter
c. Pressure support ventilation
The nurse is talking with the patient when the monitor alarms and shows a wavy baseline without a PQRST complex. The nurse should take what action immediately? a Defibrillate the patient immediately. b Initiate basic life support. c Initiate advanced life support. d Assess the patient and the electrical leads.
d Assess the patient and the electrical leads.
The patient is admitted with a condition that requires cardiac rhythm monitoring. To apply the monitoring electrodes, the nurse must first take what action? a Apply a moist gel to the chest. b Make certain that the electrode gel is dry. c Avoid soaps to avoid skin irritation. d Clip chest hair if needed.
d Clip chest hair if needed.
A patient who is receiving continuous enteral feedings has just vomited 250 mL of milky green fluid. What is the most likely cause of the vomiting? a A bowel obstruction b Developed an ileus c Gastrointestinal bleeding d Tube feeding intolerance
d Tube feeding intolerance
The nurse is caring for a patient with an admitting diagnosis of congestive failure. While attempting to obtain a pulmonary artery occlusion pressure in the supine position, the patient becomes anxious and tachypneic. What is the best action by the nurse? a. Limit the patient's supine position to no more than 10 seconds. b. Administer anxiety medications while recording the pressure. c. Encourage the patient to take slow deep breaths while supine. d. Elevate the head of the bed 45 degrees while recording pressures.
d. Elevate the head of the bed 45 degrees while recording pressures.
The amount of effort needed to maintain a given level of ventilation is referred to using what term? a. Compliance b. Resistance c. Tidal volume d. Work of breathing
d. Work of breathing
What is the normal rate for the SA node when the patient is at rest? a 40 to 60 beats per minute b 60 to 100 beats per minute c 20 to 40 beats per minute d More than 100 beats per minute
b 60 to 100 beats per minute
Following insertion of a pulmonary artery catheter (PAC), the physician orders the nurse to obtain a blood sample for mixed venous oxygen saturation (SvO 2 ). Which action by the nurse best ensures the obtained value is accurate? a. Zero referencing the transducer at the level of the phlebostatic axis following insertion b. Calibrating the system with a central venous blood sample and arterial blood gas value c. Ensuring patency of the catheter using a 0.9% normal saline solution pressurized at 300 mm Hg d. Using noncompliant pressure tubing that is no longer than 36 to 48 inches and has minimal stopcocks
b. Calibrating the system with a central venous blood sample and arterial blood gas value
The nursing is caring for a patient who has had an arterial line inserted. To reduce the risk of complications, what is the priority nursing intervention? a. Apply a pressure dressing to the insertion site. b. Ensure all tubing connections are tightened. c. Obtain a portable x-ray to confirm placement. d. Restrain the affected extremity for 24 hours.
b. Ensure all tubing connections are tightened.
In addition to residual stomach volume, what other evidence suggests feeding intolerance? a Abdominal distention b Absence of tympany on percussion c Active bowel sounds d Elevated blood glucose by fingerstick
a Abdominal distention
Which nursing actions are most important for a patient with a right radial arterial line? (Select all that apply.) a. Checking the circulation to the right hand every 2 hours b. Maintaining a pressurized flush solution to the arterial line setup c. Monitoring the waveform on the monitor for dampening d. Restraining all four extremities with soft limb restraints e. Ensuring all junctions are tightly connected
a. Checking the circulation to the right hand every 2 hours b. Maintaining a pressurized flush solution to the arterial line setup c. Monitoring the waveform on the monitor for dampening
Electrocardiogram (ECG) paper contains a standardized grid where the horizontal axis measures time and the vertical axis measures voltage or amplitude. The nurse must understand that each horizontal box indicates what? a 200 milliseconds or 0.20 seconds duration b 40 milliseconds or 0.04 seconds duration c 3 seconds duration d Millivolts of amplitude
b 40 milliseconds or 0.04 seconds duration
The nurse is calculating the rate for a regular rhythm. There are 20 small boxes between each P wave and 20 small boxes between each R wave. What is the ventricular rate? a 50 beats/min b 75 beats/min c 85 beats/min d 100 beats/min
b 75 beats/min
The patient's heart rate is 70 beats per minute with the P waves coming after the QRS complex. The nurse correctly determines that the patient is demonstrating what heart rhythm? a A normal junctional rhythm b An accelerated junctional rhythm c A junctional tachycardia d Atrial fibrillation
b An accelerated junctional rhythm
The nurse notices ventricular tachycardia on the heart monitor. When the patient is assessed, the patient is found to be unresponsive with no pulse. The nurse should take what action immediately? a Treat with intravenous amiodarone or lidocaine. b Begin cardiopulmonary resuscitation and advanced life support. c Provide electrical cardioversion. d Ignore the rhythm since it is benign.
b Begin cardiopulmonary resuscitation and advanced life support.
Which intervention(s) is (are) critical during intravenous lipid administration? (Select all that apply.) a Assessing glucose levels b Changing the tubing every 24 hours c Holding lipids when administering antibiotics through the same line d Monitoring triglyceride levels e Maintaining elevation of the head of the bed
b Changing the tubing every 24 hours d Monitoring triglyceride levels
What are the risks of total parenteral nutrition? (Select all that apply.) a Diarrhea b Elevated blood sugar c Infection at the catheter site d Volume overload e Aspiration
b Elevated blood sugar c Infection at the catheter site d Volume overload
The primary health care provider writes an order to discontinue a patient's left radial arterial line. When discontinuing the patient's invasive line, what is the priority nursing action? a. Apply an air occlusion dressing to insertion site. b. Apply pressure to the insertion site for 5 minutes. c. Elevate the affected limb on pillows for 24 hours. d. Keep the patient's wrist in a neutral position.
b. Apply pressure to the insertion site for 5 minutes.
Which of the following situations may result in a low cardiac output and low cardiac index? (Select all that apply.) a. Exercise b. Hypovolemia c. Myocardial infarction d. Shock e. Fever
b. Hypovolemia c. Myocardial infarction d. Shock
While caring for a patient with a small bowel obstruction, the nurse assesses a pulmonary artery occlusion pressure (PAOP) of 1 mm Hg and hourly urine output of 5 mL. The nurse anticipates which therapeutic intervention? a. Diuretics b. Intravenous fluids c. Negative inotropic agents d. Vasopressors
b. Intravenous fluids
What is an early signs of the effect of hypoxemia on the nervous system? a. Cyanosis b. Restlessness c. Tachycardia d. Tachypnea
b. Restlessness
The patient is asymptomatic but is diagnosed with second-degree heart block Mobitz I. The patient is on digitalis medication at home. The nurse should expect that action to be taken? a The patient has had an anterior wall myocardial infarction. b The physician will order the digitalis to be continued in the hospital. c A digitalis level would be ordered upon admission. d The patient will require a transcutaneous pacemaker.
c A digitalis level would be ordered upon admission.
The patient is admitted with sinus pauses causing periods of loss of consciousness. The patient is currently asymptomatic, awake and alert, but fatigued and answers questions appropriately. When admitting this patient, what should be the nurse's initial action? a Prepare the patient for temporary pacemaker insertion. b Prepare the patient for permanent pacemaker insertion. c Assess the patient's medication profile. d Apply transcutaneous pacemaker paddles.
c Assess the patient's medication profile.
A patient is being fed through a nasogastric tube placed in the stomach. The nurse would carry out which intervention to minimize aspiration risk? a Add blue dye to the formula. b Assess the residual every hour. c Elevate the head of the bed 30 degrees. d Provide feedings via continuous infusion.
c Elevate the head of the bed 30 degrees.
The QT interval is the total time taken for ventricular depolarization and repolarization. Prolongation of the QT interval will result in what outcome? a Decreased risk of lethal dysrhythmias b Increase in heart rate c Increase in the risk of lethal dysrhythmias. d Will only be measured with irregular rhythms.
c Increase in the risk of lethal dysrhythmias.
Following insertion of a central venous catheter, the nurse obtains a stat chest x-ray film to verify proper catheter placement. The radiologist reports to the nurse: "The tip of the catheter is located in the superior vena cava." What is the best interpretation of these results by the nurse? a. The catheter is not positioned correctly and should be removed. b. The catheter position increases the risk of ventricular dysrhythmias. c. The distal tip of the catheter is in the appropriate position. d. The physician should be called to advance the catheter into the pulmonary artery.
c. The distal tip of the catheter is in the appropriate position.
Which of the following are common causes of sinus tachycardia? (Select all that apply.) a Hyperthyroidism b Hypovolemia c Hypothyroidism d Heart Failure e Sleep
a Hyperthyroidism b Hypovolemia d Heart Failure
The nurse notices that a patient is in first-degree AV block but everything else about the rhythm is normal. The nurse should be prepared to take what action? a Placing the patient on a transcutaneous pacemaker. b Giving the patient atropine to shorten the PR interval. c Monitor the rhythm and patient's condition. d Giving the patient an antiarrhythmic medication.
c Monitor the rhythm and patient's condition.
A patient is being mechanically ventilated in the synchronized intermittent mandatory ventilation mode at a rate of 4 breaths/min. Spontaneous respirations are 12 breaths/min. After receiving a dose of morphine sulfate, respirations decrease to 4 breaths/min. Which acid-base disturbance will likely occur? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis
c. Respiratory acidosis
The primary care provider orders the following mechanical ventilation settings for a patient who weighs 75 kg and whose spontaneous respiratory rate is 22 breaths/min. What arterial blood gas abnormality may occur if the patient continues to be tachypneic at these ventilator settings? Settings: Tidal volume: 600 mL (8 mL per kg) FiO 2 : 0.5 Respiratory rate: 14 breaths/min Mode assist/control Positive end-expiratory pressure: 10 cm H 2 O a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis
d. Respiratory alkalosis
Which of the following statements is true about insulin and parenteral nutrition? (Select all that apply.) a Amount of parenteral insulin is adjusted based on the previous 24-hour laboratory values. b Insulin may be added to a parenteral nutrition solution. c Subcutaneous insulin is used on a sliding scale during parenteral nutrition. d Supplemental insulin is rarely required for patients receiving parenteral nutrition. e Lingering hyperglycemia after parenteral nutrition has been stopped requires continuing insulin.
a Amount of parenteral insulin is adjusted based on the previous 24-hour laboratory values. b Insulin may be added to a parenteral nutrition solution. c Subcutaneous insulin is used on a sliding scale during parenteral nutrition.
The nurse is reading the cardiac monitor and notes that the patient's heart rhythm is extremely irregular and there are no discernible P waves. The ventricular rate is 90 beats per minute, and the patient is hemodynamically stable. The nurse realizes that the patient is demonstrating what rhythm? a Atrial fibrillation b Atrial flutter c Atrial flutter with rapid ventricular response d Junctional escape rhythm
a Atrial fibrillation
The patient is in chronic junctional escape rhythm with no atrial activity noted. Studies have demonstrated normal AV node function. This patient may be a candidate for which type of pacing? a Atrial pacing b Ventricular pacing c Dual-chamber pacing d Transcutaneous pacing
a Atrial pacing
Sinus bradycardia is a symptom of which of the following? (Select all that apply.) a Calcium channel blocker medication b Beta-blocker medication c Athletic conditioning d Hypothermia e Hyperthyroidism
a Calcium channel blocker medication b Beta-blocker medication c Athletic conditioning d Hypothermia
The patient has an irregular heart rhythm. To determine an accurate heart rate, the nurse will take what action first? a Identify the markers on the ECG paper that indicate a 6-second strip. b Count the number of large boxes between two consecutive P waves. c Count the number of small boxes between two consecutive QRS complexes. d Divide the number of complexes in a 6-second strip by 10.
a Identify the markers on the ECG paper that indicate a 6-second strip
The patient is in third-degree heart block (complete heart block) and is symptomatic. The treatment for this patient is which of the following? (Select all that apply.) a Transcutaneous pacemaker b Atropine IV c Temporary transvenous pacemaker d Permanent pacemaker e Amiodarone IV
a Transcutaneous pacemaker c Temporary transvenous pacemaker d Permanent pacemaker
The nurse is preparing for insertion of a pulmonary artery catheter (PAC). During insertion of the catheter, what are the priority nursing actions? (Select all that apply.) a. Allay the patient's anxiety by providing information about the procedure. b. Ensure that a sterile field is maintained during the insertion procedure. c. Inflate the balloon during the procedure when indicated by the physician. d. Monitor the patient's cardiac rhythm throughout the entire procedure. e. Obtain informed consent by informing the patient of procedural risks.
a. Allay the patient's anxiety by providing information about the procedure. b. Ensure that a sterile field is maintained during the insertion procedure. c. Inflate the balloon during the procedure when indicated by the physician. d. Monitor the patient's cardiac rhythm throughout the entire procedure.
A patient's ventilator settings are adjusted to treat hypoxemia. The fraction of inspired oxygen is increased from .60 to .70, and the positive end-expiratory pressure is increased from 10 to 15 cm H 2 O. Shortly after these adjustments, the nurse notes that the patient's blood pressure drops from 120/76 mm Hg to 90/60 mm Hg. What is the most likely cause of this decrease in blood pressure? a. Decrease in cardiac output b. Hypovolemia c. Increase in venous return d. Oxygen toxicity
a. Decrease in cardiac output
The rhythm on the cardiac monitor is showing numerous pacemaker spikes, but no P waves or QRS complexes following the spikes. The nurse realizes this as what? a Normal pacemaker function b Failure to capture c Failure to pace d Failure to sense
b Failure to capture
A patient with a history of emphysema, diabetes, and hyperlipidemia is in the critical care unit on a ventilator. The nutrition assessment notes that the patient has a protein and vitamin deficiency and is underweight. Which formula for nutritional assessment is most appropriate? a Renal specific formula b Higher protein formula c High medium-chain triglyceride formula d Lactose-free formula
b Higher protein formula
A patient with acute pancreatitis is started on parenteral nutrition. The student nurse listed possible interventions for this patient. Which intervention needs correction before finalizing the plan of care? a Change the intravenous tubing every 24 hours. b Infuse antibiotics through the intravenous line. c Monitor the blood glucose every 6 hours. d Monitor the fluid and electrolyte balance.
b Infuse antibiotics through the intravenous line.
The nurse is examining the patient's cardiac rhythm strip in lead II and notices that all of the P waves are upright and look the same except one that has a different shape and is inverted. The nurse realizes that the P wave with the abnormal shape is probably a result of what? a Originating from the SA node since all P waves come from the SA node. b Originating from some area in the atria other than the SA node. c Ventricular depolarization. d Normal firing even though it is inverted in lead II.
b Originating from some area in the atria other than the SA node.
A 65-year-old patient admitted to the progressive care unit with a diagnosis of community- acquired pneumonia, has a history of chronic obstructive pulmonary disease and diabetes. A set of arterial blood gases obtained on admission without supplemental oxygen shows pH 7.35; PaCO 2 55 mm Hg; bicarbonate 30 mEq/L; PaO 2 65 mm Hg. These blood gases reflect what condition? a. Hypoxemia and compensated metabolic alkalosis. b. Hypoxemia and compensated respiratory acidosis. c. Normal oxygenation and partly compensated metabolic alkalosis. d. Normal oxygenation and uncompensated respiratory acidosis.
b. Hypoxemia and compensated respiratory acidosis.
The nurse returns from the cardiac catheterization laboratory with a patient following insertion of a pulmonary artery catheter and assists in transferring the patient from the stretcher to the bed. Prior to obtaining a cardiac output, which action is most important for the nurse to complete? a. Document a pulmonary artery catheter occlusion pressure. b. Zero reference the transducer system at the phlebostatic axis. c. Inflate the pulmonary artery catheter balloon with 1 mL air. d. Inject 10 mL of 0.9% normal saline into the proximal port.
b. Zero reference the transducer system at the phlebostatic axis
The nurse understands what to be true of a third-degree AV block? a Every P wave is conducted to the ventricles b Some P waves are conducted to the ventricles c None of the P waves are conducted to the ventricles d The PR interval is prolonged
c None of the P waves are conducted to the ventricles
A patient has been admitted to the critical care unit after a stroke. After "failing" a swallow study, the patient is placed on enteral feedings. Following placement of a nasogastric tube for tube feeding, what is the next critical step? a Administer medications. b Cap off and wait 24 hours before starting feedings. c Obtain a chest radiograph. d Start the tube feeding.
c Obtain a chest radiograph.
The nurse notes that the patient's arterial blood gas levels indicate hypoxemia. The patient is not intubated and has a respiratory rate of 22 breaths/min. what is the nurse's first intervention to relieve hypoxemia? a. Call the physician for an emergency intubation procedure. b. Obtain an order for bilevel positive airway pressure (BiPAP). c. Provide for oxygen administration. d. Suction secretions from the oropharynx.
c. Provide for oxygen administration
A patient is receiving enteral tube feedings and has developed drug-nutrient interactions. The nurse recognizes which drug as having the potential for causing drug-nutrient reactions? a Aspirin b Enoxaparin c Ibuprofen d Phenytoin
d Phenytoin
The nurse is caring for a patient with a left radial arterial line, and a pulmonary artery catheter inserted into the right subclavian vein. Which action by the nurse best ensures the safety of the patient being monitored with invasive hemodynamic monitoring lines? a. Document all waveform values. b. Limit the pressure tubing length. c. Zero reference the system daily. d. Ensure alarm limits are turned on.
d. Ensure alarm limits are turned on
Why is the sinus node identified as the pacemaker of the heart? a It contains the fastest pacemaker cell in the heart. b It has the only pacemaker cell in the heart. c It contains the only cell that does not affect the cardiac cycle. d It is located in the left side of the heart.
a It contains the fastest pacemaker cell in the heart.
The patient's heart rhythm shows an inverted P wave with a PR interval of 0.06 seconds. The heart rate is 54 beats per minute. The nurse recognizes the rhythm as a junctional escape rhythm, and understands that the rhythm is due to what cause? a Loss of sinus node activity b Increased rate of the AV node c Increased rate of the SA node d Decreased rate of the AV node
a Loss of sinus node activity
Because of the location of the AV node, the possible P waveforms that are associated with junctional rhythms include which of the following? (Select all that apply.) a No P wave b Inverted P wave c Shortened PR interval d P wave after the QRS complex e Normal P wave and PR interval
a No P wave b Inverted P wave c Shortened PR interval d P wave after the QRS complex
The nurse is caring for a patient diagnosed with atrial fibrillation. Sequelae that place the patient at greater risk for mortality/morbidity include which of the following? (Select all that apply.) a Stroke b Ashman beats c Pulmonary emboli d Prolonged PR interval e Decreased cardiac output
a Stroke c Pulmonary emboli e Decreased cardiac output
Which statement is true about a patient diagnosed with sinus arrhythmia? a The heart rate varies, dependent on vagal tone and respiratory pattern. b Immediate treatment is essential to prevent death. c Sinus arrhythmia is not well tolerated by most patients. d PR and QRS interval measurements are prolonged.
a The heart rate varies, dependent on vagal tone and respiratory pattern.
The patient is having premature ventricular contractions (PVCs). What is the nurse's greatest concern? a The proximity of the R wave of the PVC to the T wave of a normal beat. b The fact that PVCs are occurring, because they are so rare. c If the number of PVCs are decreasing. d If the PVCs are wider than 0.12 seconds.
a The proximity of the R wave of the PVC to the T wave of a normal beat.
What statement is true about calorie-dense feedings? (Select all that apply.) a They are most useful in heart failure and liver disease. b They are most useful in malabsorption syndromes. c They contain 2 kcal/mL and 70 g protein/L. d They include increased fiber. e They are especially good for patients with lung disease
a They are most useful in heart failure and liver disease. c They contain 2 kcal/mL and 70 g protein/L.
The nurse is caring for a patient following insertion of a left subclavian central venous catheter (CVC). Which assessment finding 2 hours after insertion by the nurse warrants immediate action? a. Diminished breath sounds over left lung field b. Localized pain at catheter insertion site c. Measured central venous pressure of 5 mm Hg d. Slight bloody drainage around insertion site
a. Diminished breath sounds over left lung field
What is one of the functions of the atrioventricular (AV) node? a Pacing the heart if the ventricles fail b Slowing the impulse arriving from the SA node c Sending the impulse to the SA node d Allowing for ventricular filling during systole
b Slowing the impulse arriving from the SA node
The nurse is educating a patient's family member about a pulmonary artery catheter (PAC). Which statement by the family member best indicates understanding of the purpose of the PAC? a. "The catheter will provide multiple sites to give intravenous fluid." b. "The catheter will allow the primary health care provider to better manage fluid therapy." c. "The catheter tip comes to rest inside my brother's pulmonary artery." d. "The catheter will be in position until the heart has a chance to heal."
b. "The catheter will allow the primary health care provider to better manage fluid therapy."
What important nutritional consideration should be addressed in the elderly population? a Decreased protein requirements. b Increasing caloric requirements with age. c Potential for drug-nutrient interaction related to polypharmacy. d Presence of other diseases that decrease caloric needs.
c Potential for drug-nutrient interaction related to polypharmacy.
A patient's feeding tube has been successfully placed in the small intestine with continuous flow tube feeding. The nurse knows that this approach was chosen because of what physiological process? a Intermittent feedings cause increased nausea and vomiting. b The increased filling of the stomach increases absorption. c The intestinal mucosa normally receives nutrients from the stomach in peristaltic waves. d This will prevent malabsorption syndrome.
c The intestinal mucosa normally receives nutrients from the stomach in peristaltic waves.
The nurse is caring for a patient with an arterial monitoring system. The nurse assesses the patient's noninvasive cuff blood pressure to be 70/40 mm Hg. The arterial blood pressure measurement via an intraarterial catheter in the same arm is assessed by the nurse to be 108/70 mm Hg. What is the best action by the nurse? a. Activate the rapid response system. b. Place the patient in Trendelenburg position. c. Assess the cuff for proper arm size. d. Administer 0.9% normal saline bolus.
c. Assess the cuff for proper arm size
The patient's heart rate is 165 beats per minute and the cardiac monitor shows a rapid rate with narrow QRS complexes. The P waves cannot be seen, but the rhythm is regular. The patient's blood pressure has dropped from 124/62 to 78/30; skin is cold and diaphoretic and the patient is reporting nausea. The nurse prepares the patient for what intervention? a Administration of beta-blockers b Administration of atropine c Transcutaneous pacemaker insertion d Emergent cardioversion
d Emergent cardioversion
A patient is being ventilated and has been started on enteral feedings with a nasogastric small- bore feeding tube. What is the primary reason the nurse must frequently assess tube placement? a To assess for paralytic ileus b To maintain the patency of the feeding tube c To monitor for skin breakdown on the nose d To prevent aspiration of the feedings
d To prevent aspiration of the feedings
What objective data is used to determine whether nutrition goals are not being met? a Hyperglycemia, normovolemia, and increased protein level b Overhydration, hypoglycemia, and weight gain c Weight gain, inconsistent glucose, and normovolemia d Weight loss, elevated glucose, and dehydration
d Weight loss, elevated glucose, and dehydration
The nurse is caring for a patient with a pulmonary artery catheter. Assessment findings include a blood pressure of 85/40 mm Hg, heart rate of 125 beats/min, respiratory rate 35 breaths/min, and arterial oxygen saturation (SpO 2 ) of 90% on a 50% venturi mask. Hemodynamic values include a cardiac output (CO) of 1.0 L/min, central venous pressure (CVP) of 1 mm Hg, and a pulmonary artery occlusion pressure (PAOP) of 3 mm Hg. The nurse questions which of the following primary health care provider's order? a. Titrate supplemental oxygen to achieve a SpO 2 > 94%. b. Infuse 500 mL 0.9% normal saline over 1 hour. c. Obtain arterial blood gas and serum electrolytes. d. Administer furosemide 20 mg intravenously.
d. Administer furosemide 20 mg intravenously.
What risk is the rationale for the recommendation of endotracheal rather than nasotracheal intubation? a. Basilar skull fracture b. Cervical hyperextension c. Impaired ability to "mouth" words d. Sinusitis and infection
d. Sinusitis and infection
After coronary artery bypass graft surgery a patient is transported to the surgical intensive care unit at noon and placed on mechanical ventilation. How should the nurse interpret the patient's initial arterial blood gas levels? pH 7.31 PaCO 2 48 mm Hg Bicarbonate 22 mEq/L PaO 2 115 mm Hg O 2 saturation 99% a. Normal arterial blood gas levels with a high oxygen level b. Partly compensated respiratory acidosis, normal oxygen c. Uncompensated metabolic acidosis with high oxygen levels d. Uncompensated respiratory acidosis; hyperoxygenated
d. Uncompensated respiratory acidosis; hyperoxygenated
While caring for a patient with a pulmonary artery catheter, the nurse notes the pulmonary artery occlusion pressure (PAOP) to be significantly higher than previously recorded values. The nurse assesses respirations to be unlabored at 16 breaths/min, oxygen saturation of 98% on 3 L of oxygen via nasal cannula, and lungs clear to auscultation bilaterally. What is the priority nursing action? a. Increase supplemental oxygen and notify respiratory therapy. b. Notify the physician immediately of the assessment findings. c. Obtain a stat chest x-ray film to verify proper catheter placement. d. Zero reference and level the catheter at the phlebostatic axis.
d. Zero reference and level the catheter at the phlebostatic axis.
