Advanced Cardiopulm

The nurse is assessing the hemoglobin saturation of a patient after surgery using pulse oximetry. What are the possible causes for false low readings? Select all that apply.

Decreased peripheral flow Decreased hemoglobin Presence of hypothermia Presence of edema

The patient is taking a nonselective adrenergic agonist bronchodilator and has a history of coronary artery disease. What is a priority nursing intervention?

Monitoring patient for potential chest pain

The nurse is assisting a nurse practitioner with the wellness examination of a high school athlete and notes the cardiac rhythm strip has all the characteristics of normal sinus rhythm, except it is irregular. There is a pattern to the irregularity associated with the patient's breathing. How does the nurse respond to this finding?

Nothing, as this is a healthy rhythm

Which value indicates clinical hypoxemia and the need to increase oxygen delivery?

PaO2 of 65 mm Hg

Treatment for ARDS includes the ventilation strategy called permissive hypercapnia. This strategy requires:

a low tidal volume

where to listen for pericardial friction rub

left sternal border high fowlers, sitting forward

What to assess for ventricular failure

peripheral edema JVD distention shortness of breath hypotension

Which cardiac rhythm typically deteriorates into ventricular fibrillation?

Ventricular tachycardia

antidote for warfarin

Vitamin K

pericardial friction rub on ECG

ST-segment elevation in all leads except AVR

The bedside cardiac monitor alarms, and the patient suddenly becomes limp and unresponsive with no carotid pulse. What should the nurse do first?

Activate the code blue button calling for the code team

What causes pain in MI?

Chest pain is caused by tissue hypoxia in the myocardium.

The nurse auscultates popping, discontinuous sounds over the patient's anterior chest. How does the nurse classify these sounds?

Crackles

The nurse is teaching a patient with a new permanent pacemaker. Which statement by the patient indicates a need for further discharge education?

'I no longer need my heart pills.'

The nurse is caring for an older adult patient who is on continuous cardiac monitoring. The patient is watching the monitor and expresses concern about a wide area that has occurred twice in the last 10 minutes. The nurse recognizes that this is a premature ventricular contraction (PVC). Which statement by the nurse is appropriate?

'PVCs are common and increase as we get older.'

The nurse is teaching a patient about the synchronous demand pacemaker that has just been implanted for an episode of complete heart block. Which statement indicates the patient understands the teaching?

'When my pulse is less than the set rate, the pacemaker stimulates my heart to beat.'

The nurse is caring for a patient 2 hours after surgery. The patient has been vomiting and reports feeling dizzy. The nurse evaluates the electrocardiogram (ECG) rhythm seen in the image below. Which action by the nurse is priority?

Administer the prescribed antiemetic

The nurse is caring for a patient with a ventricular fibrillation. The patient has had three cycles of CPR after receiving an initial shock. When should the nurse plan to administer another shock?

After two more cycles of CPR

The nurse auscultates rhonchi. Which interventions can the nurse initiate to clear the rhonchi? Select all that apply.

Ask the patient to cough

The nurse is placing a telemetry monitor on a patient being admitted for surgery who has a history of coronary artery disease. The monitor shows sinus tachycardia with a rate of 144 beats/min. How does the nurse respond to this finding? Select all that apply.

Assess blood pressure and skin temperature Ask the patient if he or she is experiencing any chest pain or pressure Assess for jugular venous distention

The nurse notices this rhythm on a patient's cardiac monitor. Which action should the nurse take first? (v-tach)

Assess the patient's airway, breathing, and circulation

What is the impact of surfactant deficiency on the respiratory system?

Atelectasis

The nurse is caring for a patient diagnosed with supraventricular tachycardia associated with excessive beta-adrenergic stimulation. Which class of antidysrhythmic drugs does the nurse anticipate being ordered for this patient?

Class II Rationale Class IILinks to an external site. antidysrhythmics control dysrhythmias associated with excessive beta-adrenergic stimulation. Class I drugs are membrane stabilizing agents. Class III drugs lengthen the absolute refractory and prolong repolarization. Class IV drugs slow the flow of calcium into the cell during depolarization.

The nurse is caring for a patient who requires a 12-lead electrocardiogram (ECG). Which interventions should the nurse perform to ensure the best signal transmission? Select all that apply.

Clip hair in the area being used Avoid areas with scar tissue Clean and dry skin

The nurse is performing chest compressions on a patient in asystole. Another nurse enters the room with the defibrillator. What action by the first nurse is priority?

Continue compressions

The nurse is administering adenosine to a patient with supraventricular tachycardia. While administering the drug, the patient has a short period of asystole and then returns to normal sinus rhythm. What action by the nurse is priority?

Continue to monitor the patient Rationale Continuing to monitor the patient is important because a short period of asystoleLinks to an external site. is common after administration of adenosine. However, if asystole returns, the health care provider should be contacted. Atropine is not indicated for either rhythm. There is no need to place defibrillation pads because there is no indication of defibrillation.

A client with a diagnosis of myocardial infarction asks the nurse, "What is causing the pain I am having?" Which explanation would the nurse give?

Correct4 Inadequate oxygenation of the myocardium

Which assessment findings may indicate a tracheostomy tube is obstructed? Select all that apply.

Dyspnea Noisy respirations Difficulty inserting a suction catheter

Signs of air embolus

Dyspnea tachypnea cyanosis lightheadedness hypotension tachycardia

The nurse is caring for a patient who is using a non-rebreather mask. What action by the nurse is most important?

Frequent assessment that the oxygen source is functioning.

According to principles of the oxygen dissociation curve, what occurs when tissue pH is decreased?

Hemoglobin dissociates oxygen more rapidly.

A patient taking an oral theophylline drug is due for her next dose and has a blood pressure of 100/50 mm Hg and a heart rate of 110 beats/min. The patient is irritable. What is the nurse's best action?

Hold next dose and assess pt

The nurse is the second responder for a person who collapsed in a school and does not have a pulse. After retrieving the automated external defibrillator (AED), the nurse applies the pads, plugs them in, and starts the machine. The AED indicates the pulseless patient is in ventricular asystole. What is the nurse's priority action?

Start compressions

The nurse is caring for a patient with a tachydysrhythmia who asks why his chest hurts. The nurse should base the explanation on which information?

The diastole is shortened, and coronary perfusion is decreased.

when does cardiogenic shock occur

when heart has lost 40% of pumping ability

The health care provider calls the nurse with new prescriptions for a client with post MI who is already taking aspirin. Which med to clarify?

ibuprofen 200 mg

anterior wall infarction is a result of the occlusion of which arteries

left anterior descending sometimes left main those arteries perfuse the left atrium and left ventricle

A patient has the following ABG: pH 7.50, PaCO2 38, HCO3 30, PaO2 90 Interpret the ABG.

metabolic acidosis

The nurse is caring for a patient diagnosed with supraventricular tachycardia (SVT) with a nonsustained ventricular response. Which symptom does the nurse anticipate the patient to report?

occasional palpitations

PEEP

positive end expiratory pressure set between 5-15 cmH2O

Pressure Mode of ventilation

pressure= air pushed in until set pressure reached volume is variable better for damaged alveoli could damage healthy unnatural so required sedation and muscle relaxers

Antidote for heparin

protamine sulfate

Nipride (nitroprusside) administration

protect from light

Pt is actively having an MI and provider called in order. What order for interventions?

read back verbal order obtain blood pressure and heart rate give nitro give morphine consult Dr

When to be cautious in fibrinolytic reperfusion

recent trauma or surgery internal bleeding/stroke severe HT use of anticoagulants fam hx of bleeding disorder active peptic ulcer disease

The nurse is caring for a patient with a heart rate of 143 beats/min. Which manifestations does the nurse assess the patient for? Select all that apply.

syncope hypoventilation chest discomfort

What to look for on ECG changes caused by myocardial ischemia

tall, flattened, inverted, or biphasic T waves can indicate ischemia ST segment elevation or depression can indicate ischemia

TV

tidal volume volume of air for each breath 6-8 mL/kg for adults 4-6 for lung protective/ARDS can increase or decrease according to ABG level or condition

Which are considered to be adverse effects of albuterol (Proventil)? Select all that apply.

tremors tachycardia palpitations

What are typical postoperative concerns after a new tracheostomy?

tube obstruction tube dislodgement accidental decannulation

Volume mode of ventilation

volume- air pushed in until set volume reached pressure is variable works for healthy alveoli not good for tight lungs so set pressure limits then pt doesn't get full volume

Which drugs does the nurse anticipate may be used in the treatment of a patient with atrial fibrillation? Select all that apply.

warfarin heparin digoxen diltiazem amiodorone

When suctioning a tracheostomy or endotracheal tube, what nursing actions ensure safe and effective practice? Select all that apply.

reoxygenating the client with 100% oxygen for 30 seconds to 3 minutes before suctioning When suctioning, using a gentle twirling motion of the catheter If needed, repeating suctioning up to three passes

Which of the following hemodynamic parameters should be followed for a PE?

right atrial pressure (RAP) pulmonary artery pressure (PAP) pulmonary artery occlusion pressure (PAOP) cardiac output (CO)

Which artery is usually affected with an inferior wall infarction?

right coronary artery

The nurse is caring for a patient with advanced heart failure who develops asystole. The nurse corrects the graduate nurse when the graduate offers to perform which intervention?

Defibrillation

Which drug suppresses the release of histamine from mast cells?

Dexamethasone (Decadron)

Which information does the nurse include in the discharge teaching for a patient with a newly placed implantable cardioverter/defibrillator? Select all that apply.

Know how to perform cough cardiopulmonary resuscitation as instructed When using a cell phone, hold at least 6 inches from the generator using the opposite ear Avoid electromagnetic interference such as leaning directly over the alternator of a running car or boat

Where would blockage in large blood vessel that supplies the anterior wall of the left ventricle be?

Left Anterior Descending Coronary Artery (LAD)

A patient presents to the emergency room with acute bronchospasms caused by anaphylaxis. What classification of medication does the nurse anticipate administering?

A nonselective sympathomimetic

The nurse is receiving shift change report on a patient with an implantable cardioverter/defibrillator (ICD). Which test or activity, if ordered by the provider, would prompt the nurse to contact the provider immediately?

MRI

A patient has an abnormal PR segment on the electrocardiogram (ECG). What part of the heart does the nurse attribute to the abnormal wave?

AV node

A patient has the following ABG: pH 7.31, PaCO2 36, HCO3 18, PaO2 82 Interpret the ABG.

Metabolic alkalosis

The nurse is caring for a patient who is undergoing synchronized cardioversion. Which interventions are the nurse responsible for after the cardioversion? Select all that apply.

Monitoring for dysrhythmias Maintaining a patent airway Assessing the chest for burns from electrodes

Which noninvasive diagnostic test measures the amount of carbon dioxide present when a patient exhales?

Capnography

Which statement correctly differentiates cardioversion from defibrillation?

Cardioversion delivers a synchronized shock for ventricular tachycardia or supraventricular tachycardia.

The nurse observes this rhythm on the monitor of a patient who is unresponsive. What action should the nurse take first?

Check carotid pulse for 5 seconds

Which drug suppresses the release of histamine from mast cells?

Cromolyn sodium (NasalCrom)

When caring for a patient with premature ventricular contractions (PVCs), which electrolyte imbalances will contribute to this dysrhythmia and should therefore be monitored? Select all that apply.

Hypokalemia hypomagnesemia

The nurse is caring for a patient with a permanent ventricular pacemaker. Which of the following would indicate a need for additional assessment? Select all that apply.

Patient reports dizziness, feeling lightheaded, and lethargic There are pacer spikes on the T wave There is not a QRS complex after each pacer spike.

A patient has increased oxygen needs while performing strenuous exercise. In this case, what mechanism does the body employ to facilitate the release of oxygen from hemoglobin molecules?

Increased tissue carbon dioxide production

ST upsloping elevation in leads II, III, and aVF is consistent with injury in which part of the heart?

Inferior wall

The nurse notes ventricular fibrillation on a patient's cardiac monitor. What is the priority intervention at this time?

Initiate high-quality CPR

What is the greatest priority once a crash cart has been brought to a room when responding to a patient in ventricular fibrillation?

Perform defibrillation

A patient is transported to the emergency department because of supraventricular tachycardia. The patient is confused, and the peripheral pulses are weak. The vital signs are as follows: blood pressure of 78/35, pulse of 250, and no registration of oxygen saturation. Which action by the nurse is priority?

Prepare for synchronized cardioversion

The nurse enters a patient's room and notices a patient is confused, diaphoretic, and has a pulse rate of 41 bpm. Which action should the nurse take first?

Prepare to administer 0.5 mg of atropine intravenously A 0.5 mg IV of atropine is given to patients who are symptomatic for bradydysrhythmia when the underlying cause of the bradydysrhythmia is unknown. Chest compressions are not necessary because the patient has a pulse. Assessing the MAR should be done after the patient is stable or if the patient exhibits bradydysrhythmia without symptoms. Transcutaneous pacing is used for patients with symptomatic, atropine-refractory bradydysrhythmias or for patients with asystole.

The normal balance of the body's oxygen intake and delivery system can be disrupted when there is a problem with normal oxygen delivery. Which statement is true in these situations?

Oxygen administration will decrease the work of the heart to improve the delivery of oxygen to vital organs.

Which factors should be taken into consideration when determining the type of oxygen delivery system to be used for a patient? Select all that apply.

Oxygen concentration required by the patient Oxygen concentration achieved by a delivery system Importance of humidity

A patient is wearing a non-rebreather mask prescribed to deliver 100% fraction of inspired oxygen (FiO 2). Which conditions must be met to ensure that this concentration is delivered? Select all that apply.

Oxygen flow rate should be set at 10-15 L/min.One-way valve between the mask and reservoir should open during inhalation.

A nurse instructs a client to breathe deeply to open collapsed alveoli. What is the best explanation the nurse could offer to explain the relationship between alveoli and improved oxygenation?

Oxygen is exchanged for carbon dioxide in the alveolar membrane.

The nurse receives a report that a patient with a pacemaker has experienced loss of capture. Which situation is consistent with this?

Pacemaker spikes are noted, but no P wave or QRS complex follows

The nurse is providing cardiopulmonary resuscitation to a patient who was found in ventricular tachycardia with no pulse. The advanced cardiac life support (ACLS) team arrives. What is the nurse's priority responsibility at this time?

Provide information about the patient to the ACLS team

Which characteristic is unique to the right lung?

Responsible for 30% of the lung function

Factors that determine cardiac output

contractility, preload, afterload, and heart rate

Nipride warning after used over multiple days

cyanide poisoning

The nurse correctly identifies which medications as Class II antidysrhythmics used to decrease heart rate and conduction velocity? Select all that apply.

solatol esmolol Rationale Sotalol hydrochloride, esmolol hydrochloride, and propranolol hydrochloride are beta blockersLinks to an external site. that compete for beta receptor sites, thereby decreasing heart rate and conduction. Tocainide hydrochloride is a class 1B drug used to shorten repolarization. Amiodarone hydrochloride is a class III antidysrhythmic that lengthens the absolute refractory period and prolongs repolarization and action potential.

Why not to measure both carotid at both times

drop blood pressure or heart rate and could block blood flow to brain

Which are primary symptoms of a chronic obstructive pulmonary disease (COPD) condition? Select all that apply.

dyspnea mucus secretions bronchoconstriction

The nurse is analyzing the electrocardiographic rhythm of a patient and identifies an abnormal T wave. What problems are potential causes for this abnormality? Select all that apply.

electrolyte imbalance myocardial infarction ventricular hypertrophy

Which progressive lung disease is characterized by destroyed alveolar walls with air trapped in the over-expanded alveoli?

emphysema

FiO2

fraction of inspired oxygen

Which cardiac dysrhythmia results from a prolonged QT interval?

Torsades de pointe

Which situation is appropriate for a nurse to perform synchronized cardioversion? Select all that apply.

Unstable ventricular tachycardia (patient has a pulse) Symptomatic atrial tachydysrhythmias (SVT, afib, aflutter) Rationale Stable atrial tachydysrhythmias and unstable ventricular tachydysrhythmias should be treated with synchronized cardioversion. A stable atrial rhythm is first treated with medical therapies. If these therapies are not successful, synchronized countershock is used. The shock works during the cardiac depolarization; therefore, this intervention would not work for patients with ventricular fibrillation, asystole, or standstill. This method is also not performed for patients with premature ventricular contractions. p. 681

Examples of oxyhemoglobin dissociation curve RIGHT shift

acidemia increased CO2 hyperthermia increased 2.3 DPG

Examples of oxyhemoglobin dissociation curve LEFT shift

alkalemia decreased CO2 hypothermia decreased 2.3 DPG

A patient with atrial fibrillation with rapid ventricular response has received medication to slow the ventricular rate. The pulse is now 88 beats/min. For which additional therapy does the nurse plan?

anticoagulation

During auscultation of the heart, where would the nurse expect the first heart sound (S1) to be the loudest?

apex of the heart

A patient is admitted to the intensive care unit with an acute pulmonary embolism. What dysrhythmia would most likely contribute to this condition?

atrial fibrillation

What to evaluate before applying permanent pacemaker

baseline rhythm assess causes for short term brady: beta-blockers

Which procedure describes a tube inserted into the airway in order to view airway structures and obtain tissue samples for a biopsy?

bronchoscopy