Med Surg Adaptive Quizzing

A patient who sustains a neck injury from hitting the steering wheel in a motor vehicle collision is admitted to the emergency department. Which type of chest trauma is most likely to occur in this patient? Hemothorax 2 Pneumothorax 3 Pulmonary contusion Correct4 Tracheobronchial trauma

4 Tracheobronchial trauma typically occurs when a victim strikes his or her neck against the steering wheel during a car crash because of trauma to the mainstream bronchi. A hemothorax commonly occurs after blunt trauma or penetrating injuries due to massive blood loss. Any chest injury that results in air entry into the pleural space may cause a pneumothorax. A pulmonary contusion occurs most often by rapid deceleration during car crashes.

What is the sequence of events related to tension pneumothorax in their order of occurrence? 1. Compressing the blood vessels 2. Limiting of blood return 3. Decreasing the cardiac filling and cardiac output 4. Forcing air into the chest cavity and increasing the pressure

4, 1, 2, 3 Tension pneumothorax is a life-threatening condition, which may lead to death. The air is forced into the chest cavity and the pressure increases. This increased pressure compresses the blood vessels, resulting in the limiting of the blood return. Finally there is a decrease in the cardiac filling as well as the cardiac output.

The nurse is teaching a patient about self-management to prevent dysrhythmias caused by premature beats and ectopic rhythms. Which statement made by the patient indicates a need for further teaching? "I have to quit smoking." 2 "I have to limit alcohol intake." 3 "I have to manage stress and avoid getting tired." 4 "I have to drink coffee twice daily and other energy drinks to stay active."

4. A patient with premature beats and ectopic rhythms should not have caffeinated beverages and energy drinks because they can worsen dysrhythmias. Quitting smoking helps prevent dysrhythmias. Managing stress can prevent the risk of dysrhythmias. The patient should limit alcohol intake because alcohol may worsen the symptoms.

What does the nurse expect the surgeon to do to treat a suspected tension pneumothorax in a patient with chest trauma? Manage pain. 2 Place chest tubes. 3 Perform cricothyroidotomy. 4 Perform needle thoracotomy

4. A tension pneumothorax is a life-threatening complication in which air escapes into the chest cavity, causing a complete collapse of the affected lung. A large-bore needle thoracotomy is the initial and immediate intervention in this situation. Pain can be managed after lung re-inflation. Thoracotomy is followed by placing chest tubes. A cricothyroidotomy is performed in cases of tracheobronchial trauma.

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? Immediately notify the nurse practitioner. 2 Instruct the patient to follow up with his or her primary health care provider. 3 Move the electrodes and reevaluate the rhythm strip. 4 Nothing, as this is a healthy rhythm.

4. This is sinus arrhythmia which is frequently observed in healthy children and adults. The rate speeds up during inhalation and slows down during exhalation; this is considered a variant of normal sinus rhythm.

While doing a physical assessment of a patient with chest trauma, which findings would lead the nurse to suspect the patient has a tension pneumothorax? Select all that apply. Stridor 2 Cyanosis 3 Distended neck veins 4 Paradoxical chest movements 5 Hypertympanic sounds on percussion

5.

A patient has episodes of ventricular tachycardia. Which medication does the nurse anticipate administering? A. Amiodarone B. Digoxin C. Metoprolol D. Diltiazem

A Amiodarone, a class III antidysrhythmic, is suggested for use in life-threatening ventricular dysrhythmias. Digoxin, a cardiac glycoside, is used for heart failure and atrial fibrillation. Metoprolol, a beta-adrenergic blocker, and diltiazem, a calcium channel blocker, are useful for atrial fibrillation.

The nurse administers amiodarone to a patient with ventricular tachycardia. Which monitoring by the nurse is necessary with this drug? Select all that apply. A. Respiratory rate B. QT interval C. Heart rate D. Heart rhythm E. Urine output

B, C, D Amiodarone causes prolongation of the QT interval, which can precipitate dysrhythmia. Antidysrhythmic medications cause changes in cardiac rhythm and rate; therefore, monitoring of heart rate and rhythm is needed. Although it is always important to monitor respiratory rate and urine output, these assessments are not specific to amiodarone.

The nurse is caring for a patient with sinus tachycardia. For which underlying causes does the nurse assess? Select all that apply. A. Straining when moving the bowels B. Fever C.Use of a beta-adrenergic blocking drug D. Graves' disease E. Anxiety

B, C, E Sinus tachycardia results from sympathetic nervous system stimulation or parasympathetic inhibition, which increases the heart rate over 100 beats per minute. Causes may include anxiety, pain, stress, hyperthyroidism (Graves' disease), hypoxemia, and pulmonary embolism. Beta-adrenergic blocking drugs inhibit or block the sympathetic nervous system resulting in lower heart rates or bradycardia. Straining during defecation (Valsalva maneuver) may cause vagal stimulation of the heart with resulting bradycardia.

Which condition is a result of a hypereffective heart in a well-conditioned athlete? A. Arrhythmia B. Bradycardia C. Tachypnea D. Cardiac arrest

B. A hypereffective heart has a strong heart muscle that provides an adequate stroke volume and a low heart rate to achieve a normal cardiac output. Bradycardia occurs due to a hypereffective heart in a well-conditioned athlete. An arrhythmia is an irregular rate. Tachypnea is a key feature of sustained tachydysrythmias. A cardiac arrest is a temporary cessation of the heart.

Which traumatic condition of the chest may lead to subcutaneous emphysema? Hemothorax Correct2 Pneumothorax Incorrect3 Pulmonary contusion 4 Tension pneumothorax

B. A patient who has a pneumothorax may develop air under the subcutaneous tissues, which is referred to as subcutaneous emphysema. In a hemothorax, the patient may not develop subcutaneous emphysema, but may develop respiratory distress. Subcutaneous emphysema may not occur in patients who have pulmonary contusion, although hemorrhage and edema may occur between the alveoli. Extreme respiratory distress and cyanosis may occur in tension pneumothorax.

Which treatment modality is the focus during the management of an uncomplicated rib fracture? A. Splinting the chest B. Administering analgesics C. Stabilizing the chest surgically D. Applying positive pressure ventilation

B. An uncomplicated rib fracture can be managed by the administration of analgesics. Splinting the chest by tape or any other material is not preferred. Surgical stabilization is indicated for extreme cases of flail chest. Positive pressure ventilation is usually a preferred treatment modality to stabilize a flail chest.

Which precaution should the nurse follow when providing cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS) to a patient? A. Protective Isolation B. Standard Precautions C. Surgical asepsis with defibrillator D. Respiratory isolation during intubation

B. Standard Precautions and personal protective equipment must be used when there is risk of contact with blood and body fluids. Protective isolation is designed to protect the patient from pathogens in the environment. Surgical asepsis involves ridding an item of all pathogens, such as in the operating room, with sterilization procedures. A defibrillator is a "clean," not sterile, item. Respiratory isolation is used to prevent transmission of organisms by droplets, such as chickenpox or meningitis. The nurse may choose to use protective eyewear or a face shield during intubation or suctioning of the airway to protect from spraying blood and body fluids.

Which would be the initial radiographic findings in a patient with pulmonary contusion? A. No opacity in the lobes or parenchyma B. Hazy opacity in the lobes or parenchyma C. Highly dense opacity in the lobes or parenchyma D. Moderately dense opacity in the lobes or parenchyma

A. Initial assessment of the chest x-ray may not reveal any abnormalities, but a hazy opacity in the lobes or parenchyma may develop over several days and the density may increase as time progresses. Highly dense opacity or moderately dense opacity is seen at later stages of pulmonary contusion as the condition of the patient progresses.

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? A. "When my pulse is less than the set rate, the pacemaker stimulates my heart to beat." B. "My heart doesn't beat right, so the pacemaker will stimulate my heart to beat 60 times per minute." C. "When my heart beats fast, the pacemaker will correct it." D. "If I develop a life-threatening heart rhythm, the pacemaker will give me a shock to stop it."

A. Synchronous or demand pacemakers sense the patient's intrinsic or own rhythm. When the patient's heart rate is above the set rate, the pacemaker does not fire. When the heart rate is below the set rate, the pacemaker delivers an electrical impulse which stimulates the heart to beat. While there are antitachycardic pacemakers, they are not considered demand pacemakers. Pacemakers do not deliver shocks to terminate dysrhythmias; cardioverter/defibrillators do that.

. When caring for a patient with heart disease, which action may lead to serious bradydysrhythmias? Insertion of a Foley catheter Correct2 Oropharyngeal suctioning 3 Hip flexion greater than 90 degrees 4 Walking on a treadmill at a moderate pace

B Anything that causes the patient to perform the Valsalva maneuver (e.g., bear down, gag, or vomit) leads to vagal stimulation. Unintended vagal stimulation can result in serious bradydysrhythmias and should be avoided. Oropharyngeal suctioning causes the patient to gag and possibly vomit. Insertion of a Foley catheter, hip flexion, and moderate walking on a treadmill do not induce the Valsalva maneuver.

Which type of complication might the nurse expect in a patient who experienced cardiac arrest and is given cardiopulmonary resuscitation (CPR) Flail chest Incorrect2 Rib fracture 3 Pulmonary contusion 4 Tension pneumothorax

Flail chest

Which findings support the nurse's suspicion that a patient with rib fractures has a flail chest? Select all that apply. Dyspnea 2 Dry cough 3 Bradycardia 4 Hypotension 5 Paradoxical chest movement

1, 4,5 Patients with a flail chest may develop respiratory distress that leads to dyspnea. Hypotension is also seen in these patients. Paradoxical chest movements are observed in patients with a flail chest due to fractures of two neighboring ribs in two or more places. A dry cough is a symptom associated with pulmonary contusions. Bradycardia is not seen in patients with a flail chest; however, tachycardia is predominantly found in patients with a flail chest.

Which drugs does the nurse anticipate may be used in the treatment of a patient with atrial fibrillation? Select all that apply. Diltiazem 2 Warfarin 3 Digoxin 4 Phytonadione (vitamin K) 5 Amiodarone 6 Heparin

12356 Antidysrhythmic medications such as diltiazem, digoxin, and amiodarone are used to slow the heart rate and/or restore normal sinus rhythm. Anticoagulants such as heparin or warfarin are used to prevent emboli secondary to the loss of coordinated atrial contraction. Phytonadione is not used in atrial fibrillation because it can reverse the effects of warfarin and has no antidysrhythmic properties. Test-Taking Tip: Do not read information into questions, and avoid speculating. Reading into questions creates errors in judgment.

Which complications are associated with carotid sinus massage therapy? Select all that apply. Bradycardia Correct2 Cerebral damage Correct3 Ventricular fibrillation 4 Premature atrial complexes 5 Premature ventricular complexes

123 Supraventricular tachydysrhythmias are treated temporarily by carotid sinus massage therapy. Complications of this therapy include bradycardia, cerebral damage, and ventricular fibrillation. Premature atrial complexes are caused by irritated atrial tissue, which is not associated with carotid sinus massage therapy. Premature ventricular complexes are caused by irritated ventricular tissue, which is also not associated with carotid sinus massage therapy.

What is the correct order of events occurring in a patient with pulmonary contusion? 1. Hemorrhage and edema Correct 2. Reduction in lung movement Correct 3. Hypoxia and dyspnea Correct 4. Hazy opacity in the lobes or lung parenchyma

1234 Respiratory failure may develop in a patient with pulmonary contusion. Hemorrhage and edema occur in and between the alveoli, thereby reducing both lung movement and the area available for gas exchange. The patient experiences hypoxia and dyspnea. Hazy opacity in the lobes or lung parenchyma can develop over time

The nurse is assisting bystanders attempting to use an automatic external defibrillator (AED). They have begun CPR while the nurse prepares the AED. Place the steps for use of the AED in the correct order 1. Press the button to analyze the rhythm. 2. Place the AED pads on the victim's chest. 3. Resume CPR. 4. Announce "all clear, do not touch the victim." 5. Press the button to shock if indicated.

2, 4, 1, 5, 3 Place adhesive electrodes on the victim's upper-right and lower-left chest. Next, connect the pads to the AED and turn on the machine. The rescuer stops CPR and commands anyone present to cease contact with the victim to eliminate motion artifact during analysis of the rhythm. Next, press the "analyze" button on the machine, which may take up to 30 seconds. If the AED advises that a shock is necessary, press the shock button after announcing "all clear" again. Once the shock is delivered, CPR is resumed.

Which points does the nurse include in the discharge teaching for a patient with a newly placed implantable cardioverter/defibrillator? Select all that apply. Maintain Steri-Strips over the left anterior costal margin and upper abdominal area incision. Correct2 Avoid electromagnetic interference such as leaning directly over the alternator of a running car or boat. 3 Go to the emergency department if the defibrillator activates three successive times. 4 Remove the electrodes prior to showering or bathing and replace immediately afterwards. Correct5 When using a cell phone, hold at least 6 inches from the generator using the opposite ear. Correct6 Know how to perform cough cardiopulmonary resuscitation as instructed.

2, 5,6 Electromagnetic interference may inhibit tachydysrhythmia detection by inactivating the device. Caution should be used when in close proximity to a running alternator and when using a cell phone because they emit electromagnetic energy. During forceful coughs, increased pressure in the chest may avert a tachydysrhythmia or enhance circulation during a tachydysrhythmia. The surgical incision for the generator is in the left pectoral area. It is usually recommended that the patient seek medical attention immediately following single activation of the defibrillator, not waiting for three successive activations to occur. There are no external electrodes with an implanted cardioverter/defibrillator.

Which statements are true regarding the management of patients with a hemothorax? Select all that apply. Performing a single chest x-ray is required. 2 Close monitoring of chest tube drainage is needed. 3 Blood in the pleural spaces is confirmed by a chest x-ray. 4 Blood lost through the chest drainage system can be infused back. 5 Single chest tube would be needed for emptying blood from pleural space.

2,4 Chest tube drainage should be monitored closely for any blood loss. This would help in determining the effectiveness of treatment. Blood lost through chest drainage can be infused back into the patient if needed. Serial chest x-rays should be performed to help in determining the effectiveness of the treatment. Blood in the pleural space can be viewed in the chest x-ray, but for confirmation, a thoracentesis should be performed. Multiple chest tubes may be needed for emptying blood from the pleural space

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. Instruct the patient to ambulate as tolerated and continue to monitor. Correct2 Ask the patient if he or she is experiencing any chest pain or pressure. Correct3 Assess blood pressure and skin temperature. 4 Ask the patient to report any muscle cramps. Correct5 Assess for jugular venous distention.

2.3.5 A heart rate of 144 is a major concern in patients with coronary artery disease because it increases the workload of the heart, increasing myocardial oxygen demand. A heart rate of 144 may decrease ventricular filling time, stroke volume, and cardiac output, which decrease blood pressure and coronary perfusion pressure. These factors combined are likely to exacerbate ischemia, causing chest pain or pressure. Associated symptoms are pallor and cool skin temperature. Tachycardia may also lead to heart failure, manifested by distention of the jugular veins. The patient should be advised to limit activities to reduce cardiac workload. Muscle cramps are not associated with tachycardia or coronary artery disease.

A patient with recently diagnosed atrial fibrillation is being discharged with prescriptions for warfarin and amiodarone. When providing discharge teaching, which points does the nurse include? Select all that apply. It is very important to have a partial thromboplastin time (PTT) done at prescribed intervals. Correct2 If the dysrhythmia persists after 6 weeks, cardioversion will be scheduled. Correct3 Record blood pressure and pulse daily and bring the record to the follow-up appointment. Incorrect4 Weigh daily and notify your provider if a greater than 5-pound weight loss occurs. Correct5 Notify the provider if shortness of breath, cough, or fever occur. 6 Eat foods high in vitamin K.

23,5 If the amiodarone does not convert the atrial fibrillation to normal sinus rhythm, cardioversion is recommended. Coumadin is taken for 4-6 weeks prior to cardioversion. Side effects of amiodarone include bradycardia and hypotension, so the patient should be taught to assess and record pulse rate and blood pressure; it is valuable to the provider to see a record of vital signs. Shortness of breath, cough, pleuritic pain, and fever may indicate amiodarone-induced pulmonary toxicity. Labs to be evaluated with warfarin are prothrombin time and International Normalized Ratio (INR). Weight loss is not directly associated with atrial fibrillation or these medications. When taking warfarin, avoid foods high in vitamin K since vitamin K alters the anticoagulant effect of warfarin. STUDY TIP: Study goals should set out exactly what you want to accomplish. Do not simply say, "I will study for the exam." Specify how many hours, what day and time, and what material you will cover.

The nurse is caring for a patient with heart rate of 143 beats/min. For which manifestations does the nurse observe? Select all that apply A. Palpitations B. Increased energy C. Chest discomfort D. Flushing of the skin E. Hypotension

A, C, E. Tachycardia is a heart rate greater than 100 beats/min; the patient with a tachydysrhythmia may have palpitations; chest discomfort (pressure or pain from myocardial ischemia or infarction); restlessness and anxiety; pale, cool skin; and syncope ("blackout") from hypotension. Chest discomfort may occur because decreased time for diastole results in lower perfusion through the coronary arteries to the myocardium. Hypotension results from decreased time for ventricular filling, secondary to shortened diastole, and therefore reduced cardiac output and blood pressure. Reduced cardiac output and possible development of heart failure will cause fatigue.

Which patient is appropriate for the cardiac care unit charge nurse to assign to the float RN from the medical-surgical unit? The 64-year-old patient admitted for weakness who has a sinus bradycardia with a heart rate of 58 beats/min 2 The 71-year-old patient admitted for heart failure who is short of breath and has a heart rate of 120-130 beats/min 3 The 88-year-old patient admitted with an elevated troponin level who is hypotensive with a heart rate of 96 beats/min 4 The 92-year-old patient admitted with chest pain who has premature ventricular complexes and a heart rate of 102 beats/min

A.

Which statement by a student nurse about assessment findings for a patient with pneumothorax indicates a need for further teaching? A. "Hyporesonance is noted on percussion." B. "On auscultation, decreased breath sounds are noted." C."The involved side of the chest moves poorly with respiration." D. "Deviation of trachea away from side of injury may be noticed."

A. Assessment findings of pneumothorax involve hyperresonance on percussion. Hyporesonance may indicate an infection of the lungs. Reduced breath sounds on auscultation indicate reduced air entry into the lungs. Prominence of the involved side of the chest, which moves poorly with respiration, is seen in a pneumothorax. Deviation of the trachea away from the side of injury may be observed with a tension pneumothorax.

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? A. Defibrillation B. Cardiopulmonary resuscitation (CPR) C. Administration of epinephrine D. Administration of oxygen

A. Defibrillation interrupts the heart rhythm and allows normal pacemaker cells to take over. In asystole, there is no rhythm to interrupt; therefore, this intervention is not used. If drug therapy fails to restore effective rhythm, CPR is initiated. Epinephrine is used to increase heart rate in asystole. Hypoxia may be a cause of cardiac arrest; the administration of oxygen would be appropriate.

What is the greatest priority once a crash cart has been brought to a room when responding to a patient in ventricular fibrillation? A.Perform defibrillation. B. Administer epinephrine. C. Perform cardiac compressions. D. Provide rescue breathing

A. In cases of ventricular fibrillation, the earlier that defibrillation (asynchronous countershock) is performed, the greater the chance of survival. Defibrillation depolarizes a critical mass of myocardium simultaneously with the goal of restoring spontaneous circulation. Cardiac compressions, rescue breathing, and the administration of epinephrine follow defibrillation.

The nurse is caring for a patient with atrial fibrillation. In addition to an antidysrhythmic, what medication does the nurse plan to administer? A. Heparin B. Atropine C. Dobutamine D. Magnesium sulfate

A. The loss of coordinated atrial contractions in atrial fibrillation can lead to pooling of blood resulting in thrombus formation. The patient is at high risk for pulmonary embolism! Thrombi may form within the right atrium and then move through the right ventricle to the lungs. In addition, the patient is at risk for systemic emboli, particularly an embolic stroke, which may cause severe neurologic impairment or death. Heparin and other anticoagulants (e.g., enoxaparin and warfarin) are used to prevent thrombus development in the atrium and the consequence of embolization (i.e., stroke). Atropine is used to treat bradycardia and heart blocks; atrial fibrillation, unless controlled with medication, is typically rapid. Dobutamine is an inotropic agent used to improve cardiac output; it may cause tachycardia, thereby worsening atrial fibrillation. Although electrolyte levels are monitored in patients with dysrhythmia, magnesium sulfate is not used unless depletion is noted.

Which treatment strategy would be most beneficial to the patient with a hemothorax who has severe blood loss from the chest? A. Tracheotomy B. Open thoracotomy C. Cricothyroidotomy D. Needle thoracostomy

B An open thoracotomy is needed when there is severe blood loss from the chest or persistent bleeding in patients with a hemothorax. A tracheotomy and cricothyroidotomy may be required in patients with tracheobronchial trauma. A needle thoracostomy is used in the initial management of a tension pneumothorax. Test-Taking Tip: Do not worry if you select the same numbered answer repeatedly, because there usually is no pattern to the answers.

A patient is taking metoprolol for supraventricular tachycardia. Which statement by the patient warrants further investigation by the nurse? A. "I feel constipated since I've been in the hospital." B. "I got dizzy when walking to the bathroom earlier." C. "I have been more tired since I started taking this medicine." D. "My pulse seems to be slower and more regular than before."

B Beta-adrenergic blocking drugs decrease blood pressure, heart rate, and cardiac output; dizziness may occur with bradycardia or hypotension. This warrants further investigation because the patient may be taking the metoprolol when the heart rate is too low or may be rising too quickly, in which case the patient may require further education. Constipation and fatigue are possible side effects of metoprolol. The expected outcome when metoprolol is prescribed for atrial fibrillation or supraventricular tachycardia is a heart rate under 100 beats per minute.

A patient has severe pain from three rib fractures after a workplace accident. To facilitate adequate respiration, the nurse discusses which intervention with the provider? A. Administering opioid analgesics B. Intercostal nerve block C. Mechanical ventilation D. Splinting the ribs with tape

B Patients with severe pain often do not take deep breaths and thus do not maintain adequate ventilation. An intercostal nerve block is used for severe pain. Opioid analgesics suppress respiration and should be avoided. Splinting with tape is not done unless the fracture is complex, when seven or more ribs are involved, or if a flail chest is present. Mechanical ventilation is used as a last intervention after others have been attempted.

The nurse is caring for a patient with unstable angina whose cardiac monitor shows ventricular tachycardia. Which action is appropriate to implement first? A. Defibrillate the patient at 200 J. B. Check the patient for a pulse. C. Cardiovert the patient at 50 J. D. Give the patient IV lidocaine

B The nurse needs to assess the patient to determine stability before proceeding with further interventions. If the patient has a pulse and is relatively stable, elective cardioversion or antidysrhythmic medications may be prescribed. The drug of choice for stable ventricular tachycardia with a pulse is amiodarone. If the patient is pulseless or nonresponsive, the patient is unstable and defibrillation is used.

What is the priority nursing intervention for a patient with chest trauma that is suspected of having a pneumothorax? A. Managing pain B. Preparing for a chest tube insertion C. Maintaining good pulmonary hygiene D. Continuing respiratory failure assessment

B When a pneumothorax occurs, the air escapes into the pleural space due to a chest injury. The primary health care provider should immediately place the chest tube, which allows the air to escape and the lung to re-inflate. Therefore, the nurse should obtain the supplies and set up for a chest tube insertion. Pain management should be performed after placement of the chest tube. Pulmonary hygiene should be maintained to prevent pulmonary infections. Respiratory failure assessment is continued until the symptoms subside.

Which intervention is preferred for extreme cases of flail chest? Splinting 2 Surgical stabilization 3 Humidified oxygenation 4 Positive end expiratory pressure (PEEP)

B. Surgical stabilization is used only in extreme cases of flail chest. Splinting is not recommended because it further reduces the patient's ability to exert effectively to breathe and may contribute later to failure to wean from ventilator support. Providing humidified oxygen prevents the upper airway from drying out and may be used in patients with a flail chest, but it is the main intervention for patients with a severe flail chest. Patients with a flail chest and severe hypoxemia and hypercarbia are intubated and mechanically ventilated with PEEP.

Which finding supports the nurse's diagnosis that a patient on chest tube drainage shows signs of tension pneumothorax? A. Tachycardia and hypotension B. Cyanosis and distended neck veins C. Massive air leaks from tracheal lacerations D. Reduced breath sounds on auscultation and hyperresonance on percussion

B. The assessment findings of tension pneumothorax include cyanosis and distended neck veins. Flail chest may develop as a complication of cardiopulmonary resuscitation and may manifest as cyanosis dyspnea, tachycardia, and hypotension. Subcutaneous emphysema occurs in patients with tracheobronchial trauma due to massive air leaks from tracheal lacerations. Pneumothorax occurs due to blunt chest trauma, and its manifestations include reduced breath sounds on auscultation and hyperresonance on percussion.

Which teaching is essential for a patient who has had a permanent pacemaker inserted? A. Avoid talking on a cell phone. B. Avoid operating electrical appliances over the pacemaker. C. Avoid sexual activity. D. Do not take tub baths.

B. The patient should avoid operating electrical appliances directly over the pacemaker site because this may cause the pacemaker to malfunction. It is not necessary to avoid a telephone or a cell phone; radio transmitter towers, arc welding, and strong electromagnetic fields may pose a hazard. No hazard exists with sexual activity. Bathing and showering are permitted.

The nurse is teaching a patient who has been diagnosed with atrial fibrillation. Which food item does the nurse teach the patient to avoid? A. Sodium B. Caffeine C. Citrus products D Low-fiber foods

B. Caffeine Atrial fibrillation is a tachydysrhythmia by definition. Caffeine is a stimulant that can increase heart rate and should therefore be avoided. Sodium is restricted in patients with hypertension and heart failure, which does not always occur with atrial fibrillation. Citrus products are often restricted with kidney failure or hyperkalemia, and low-fiber foods are used with diarrhea

The registered nurse teaches a student nurse about the post-discharge self-care management of a patient hospitalized with tachycardia. Which instruction given by the student nurse shows ineffective learning? "Avoid alcohol intake." 2 "Develop strategies for stress management." 3 "Consult a mental health professional if you have anxiety." Correct4 "Include foods rich in caffeine which stimulate the central nervous system (CNS)."

Because the patient is recovering from tachycardia, the nurse should tell the patient to avoid taking substances that will increase the heart rate (such as caffeine). Alcohol should be avoided because it increases the heart rate. Patients are advised to develop strategies for stress management because stress can increase the heart rate. Consulting a mental health professional can help to alleviate anxiety, which will increase the heart rate.

What might be the cause of a tension pneumothorax? A. Rapid deceleration B. Open chest drainage C. Cardiopulmonary resuscitation D. Insertion of a central venous catheter

D. Insertion of a central venous catheter may cause a tension pneumothorax due to air leaking from the lung or into the chest wall. Rapid deceleration may cause pulmonary contusion and tracheobronchial trauma. Closed chest drainage may increase the risk of tension pneumothorax. Cardiopulmonary resuscitation may cause a flail chest.

Which condition may manifest in a patient with a completely collapsed lung due to entry of air into the chest cavity? A. Flail chest B. Pulmonary contusion C. Tension pneumothorax D. Tracheobronchial trauma

C In patients with tension pneumothorax, air enters forcefully into the chest cavity, resulting in increased pressure. This rise in the pressure may result in the complete collapse of the lungs. Flail chest occurs due to the fracture of two or more ribs in two or more places. Pulmonary contusion causes hemorrhage and edema between the alveoli. This reduces both lung movement and the area available for gaseous exchange, thus resulting in hypoxemia. Tracheobronchial trauma causes extensive air leakage, leading to subcutaneous emphysema.

The patient has had asymptomatic sinus bradycardia with a rate of 56 beats/min. The nurse notes the rate has dropped to 46 beats/min. What action does the nurse take? Notify the Rapid Response Team. 2 Administer atropine 0.5 mg IV push. Correct3 Assess blood pressure, skin color, and moisture. 4 Increase IV fluid flow rate

C Intervention for sinus bradycardia should be based on assessment of the patient's condition. The patient may remain asymptomatic. If the patient is symptomatic, the nurse may choose to increase the IV flow rate, administer atropine, or notify the Rapid Response Team, depending on the severity of symptoms.

The AED indicates the patient is in ventricular asystole. After checking for a carotid pulse and finding none, the nurse certified in basic life support knows the priority action is to A. Ensure everyone is "clear" for defibrillation. B. Initiate an airway in the patient. C. Start compressions. D. Place electrodes on the chest and initiate transcutaneous pacing

C The American Heart Association Guidelines for Basic Cardiac Life Support are to first provide cardiac compressions, then maintain the airway and begin rescue breathing (CAB). Compressions are the first priority because the desired outcome of resuscitation is the rapid return of a pulse, blood pressure, and consciousness. Ventricular asystole should never be defibrillated. Transcutaneous pacing is ineffective in asystole. Test-Taking Tip: Read every word of each question and option before responding to the item. Glossing over the questions just to get through the examination quickly can cause you to misread or misinterpret the real intent of the question.

A patient is brought into the emergency room with chest pain, shortness of breath, diaphoresis, and hypotension. The heart rate of the patient is 56 beats per minute. What is the immediate nursing intervention provided to stabilize the patient? A. Administering propranolol B. Administering digoxin C. Administering atropine D. Administering verapamil

C The administration of atropine along with intravenous fluids will increase intravascular volume and help to manage bradycardia. Beta-blockers such as propranolol are not administered to patients with bradycardia. Cardiac glycoside (digoxin) and calcium channel blockers (verapamil) will further decrease the heart rate and worsen the symptoms.

Which cardiac rhythm typically deteriorates into ventricular fibrillation? A. Atrial fibrillation B. Third-degree heart block C. Ventricular tachycardia D. Atrial flutter

C Ventricular tachycardia (VT) may occur in patients with ischemic heart disease, myocardial infarction (MI), cardiomyopathy, hypokalemia, hypomagnesemia, valvular heart disease, heart failure, drug toxicity, hypotension, or ventricular aneurysm. In patients who go into cardiac arrest, VT is commonly the initial rhythm before deteriorating into ventricular fibrillation (VF) as the terminal rhythm. Atrial fibrillation and flutter are not life-threatening rhythms. Third-degree heart block is related to ischemia or scarring in the atrioventricular node, which slows the rate, rather than making the heart irritable as in VT and fibrillation.

While the health care provider is at the bedside, the patient's heart rate increases from 82 to 176 beats/min and supraventricular tachycardia is noted on the cardiac monitor. The provider decides to do immediate carotid sinus massage. What is the nurse's role in this situation? Raise the side rails and place the bed in reverse Trendelenburg position. 2 Remove the pillow and place a rolled towel behind the neck. Correct3 Bring a defibrillator and resuscitative equipment to the bedside. 4 Obtain a stat chemistry profile prior to the procedure.

C. Serious dysrhythmias may occur as a result of carotid sinus massage. These include bradydysrhythmias, asystole, and ventricular fibrillation, which may result in brain injury. Because of this, a defibrillator and resuscitative equipment must be available during the procedure. The nurse prepares the patient with instruction to turn the head slightly away from the side to be massaged. Preparation does not include hyperextending the neck or placing the patient in reverse Trendelenburg position.

A patient with chronic obstructive pulmonary disease (COPD) reports acute difficulty breathing and right-side pleuritic pain. Auscultation reveals decreased breath sounds in the right lung field compared to the left lung field. Which possible condition does the nurse contact the provider for based on these assessment data? A. Tension pneumothorax B. Flail chest C. Pneumothorax D. Pulmonary embolism

C. Patients with COPD may have a spontaneous pneumothorax. Assessment findings frequently include reduced breath sounds on auscultation over the collapsed lung region, hyperresonance on percussion, deviation of the trachea, pleuritic pain, tachypnea, and subcutaneous emphysema. The provider or Rapid Response Team must be contacted immediately to evaluate the need for a chest tube to reexpand the lung.

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? A. Synchronized cardioversion B. Electrophysiology studies (EPS) C. Anticoagulation D. Radiofrequency ablation therapy

C. Because of the risk for thromboembolism, anticoagulation is necessary. The patient has stabilized; cardioversion is not needed at this time. EPS is indicated for recurring, symptomatic dysrhythmia. Ablation therapy is ordered for recurring and symptomatic atrial fibrillation.

Which complication should the nurse suspect if, while mechanically ventilating a patient with positive end-expiratory pressure (PEEP), the patient suddenly experiences extreme respiratory distress? A. Flail chest B. Hemothorax C. Pneumothorax D. Tension pneumothorax

D. Mechanical ventilation with PEEP may induce tension pneumothorax in a patient with chest trauma. Flail chest may occur as a complication of cardiopulmonary resuscitation. Hemothorax occurs as a result of blunt chest trauma or penetrating injuries. Pneumothorax may occur due to blunt chest trauma or in patients with chronic obstructive pulmonary disorder.

Which test or activity is contraindicated for patients with an implantable cardioverter/defibrillator? A. Radiation therapy B. Use of a microwave oven C. Computed tomography D. Magnetic resonance imaging

D. Patients with an ICD should avoid sources of strong electromagnetic fields, such as large electrical generators and radio and television transmitters. Magnetic resonance imaging (MRI) should not be used. Radiation therapy, microwave ovens, and CT scans are safe to use.

What amount of initial blood loss may necessitate a thoracotomy in a patient with a hemothorax? A, 250 mL B. 500 mL C. 750 mL D. 1000 mL

D. The minimum amount of blood loss required to perform a thoracotomy in a patient with a hemothorax is 1000 mL. Blood losses of 250 mL, 500 mL, or 750 mL do not indicate the need for a thoracotomy.

The nurse is caring for a patient on a telemetry unit with a regular heart rhythm and rate of 60 beats/min; a P wave precedes each QRS complex, and the PR interval is 0.24 second. Additional vital signs are as follows: blood pressure 118/68, respiratory rate 16, and temperature 98.8° F. All of these medications are available on the medication record. What action does the nurse take? A. Administer atropine. B. Administer digoxin. C. Administer clonidine. D. Continue to monitor

D. The patient is displaying normal sinus rhythm. Atropine is used in emergency treatment of symptomatic bradycardia. This patient has normal vital signs. Digoxin is used in the treatment of atrial fibrillation, which is, by definition, an irregular rhythm. Clonidine is used in the treatment of hypertension; a side effect is bradycardia.

Which Fowler's position is ideally recommended for a patient with pulmonary contusion? A. Low Fowler's B. High Fowler's C. Standard Fowler's D. Moderate Fowler's

D. The patient with pulmonary contusion is placed in a moderate Fowler's position to maintain ventilation and oxygenation. Low, high, and standard Fowler's positions do not ensure proper respiration and are not suitable

A patient admitted after using crack cocaine develops ventricular fibrillation. After determining unresponsiveness, which action does the nurse take next? Prepare for defibrillation. 2 Establish IV access. 3 Place an oral airway and ventilate. 4 Start cardiopulmonary resuscitation (CPR)

Defibrillating is the priority before any other resuscitative measures, according to Advanced Cardiac Life Support protocols. After immediate defibrillation, establish IV access, place an oral airway, and ventilate. CPR will be started after unsuccessful defibrillation.

Which parameters should the nurse monitor in patients with a flail chest? Select all that apply. Fluid intake Correct3 Blood pressure Correct4 Electrolyte balance Correct5 Arterial blood gases .

Patients with a flail chest are at increased risk for hypovolemia or shock. Therefore, fluid intake, vital signs such as blood pressure, and electrolyte balance should be monitored in this patient. This helps to manage the patient's condition immediately. Monitoring for blood loss would be beneficial in managing patients who have sustained a hemothorax. Monitoring arterial blood gases would be beneficial for patients with tension pneumothorax

Which type of chest trauma causes asymmetry of the thorax and hemodynamic instability? Flail chest Incorrect2 Hemothorax 3 Pneumothorax Correct4 Tension pneumothorax

Patients with tension pneumothorax have distended neck veins, asymmetry of the thorax, and hemodynamic instability. Flail chest, hemothorax, and pneumothorax do not cause asymmetry of the thorax and hemodynamic instability.

The primary health care provider is examining four patients. Which patient is in need of emergency needle thoracotomy? A. Flail Chest B. Rib fracture C. Pulmonary Contusion D. Tension Pneumothorax

D Immediate needle thoracotomy is indicated in Patient D, who has tension pneumothorax. In this procedure, a large-bore needle is inserted into the second intercostal space in the midclavicular line of the affected side. Then, a chest tube is placed into the fourth intercostal space and the other end is attached to a water seal drainage system until the lung re-inflates. Positive pressure ventilation and surgical stabilization are indicated for Patient A who has flail chest. The primary treatment for treating rib fracture in Patient B is pain management. Intercostal nerve block is used for severe pain management. Patient C, who has pulmonary contusion, may require mechanical ventilation with positive end expiratory pressure.

Which procedure would be beneficial in confirming a hemothorax in a patient who suffered blunt chest trauma? A. Palpation B. Percussion C. Auscultation D. Thoracentesis

D. A hemothorax is characterized by blood in the pleural space and is confirmed by thoracentesis. Palpation is a physical assessment method used to examine the size, tenderness, and location of organs in the body. Percussion is a method of tapping used to determine the condition of underlying structure. Auscultation is listening to internal sounds of the body.

Which type of chest trauma produces a hypertympanic sound on percussion of the affected area? A. Hemothorax B. Pneumothorax C. Pulmonary contusion D. Tension pneumothorax

D. A hypertympanic sound on percussion of the affected area is characteristic of tension pneumothorax. A hemothorax produces a dull sound on percussion. A pneumothorax produces a hyperresonant sound on percussion. A dull sound on percussion is seen in patients with a pulmonary contusion.

The nurse, while assessing a patient who just underwent a central venous access catheter insertion, notices cyanosis and absence of breath sounds on the same side. What complication should the nurse suspect? A. Flail chest B. Hemothorax C. Pulmonary contusion D. Tension pneumothorax

D. Cyanosis and absence of breath sounds on one side are findings in patients with a tension pneumothorax. Patients with a flail chest may experience paradoxical chest movements. Patients with a hemothorax may have massive blood loss. Patients with pulmonary contusions would have decreased breath sounds or crackles and wheezes.

Which finding in a computed tomography (CT) report of a patient with chest trauma indicates flail chest? A. Hemorrhage and edema B. Deviation of trachea away from the side of injury C. Tear in the tracheobronchial tree of the respiratory system D. Bilateral separation of the ribs from the cartilage connections

D. Flail chest may occur due to bilateral separation of the ribs from the cartilage connections, which would be revealed in the CT scan. Pneumothorax is associated with the deviation of trachea away from the side of injury. The CT scan also reveals hemorrhage and edema in patients with pulmonary contusion, but bilateral rib separation from the cartilage is not associated with pulmonary contusion. Tracheobronchial trauma is associated with a tear in the tracheobronchial tree of the patient's respiratory system.

Which is associated with "paradoxical chest wall movement"? A. Bilateral separation of the ribs from their cartilage B. Deviation of the trachea away from the side of the injury C. Forceful entry of air into the chest cavity causing collapse of the affected lung D. Inward movement of the thorax during inspiration with an outward movement during expiration

D. Flail chest results in paradoxical chest wall movement. It is the inward movement of the thorax during inspiration with outward movement during expiration. Bilateral separation of the ribs from their cartilage causes flail chest. Tension pneumothorax deviates the trachea away from the side of the injury. Forceful entry of air into the chest cavity causing collapse of the affected lung is related to tension pneumothorax.

Which condition should the nurse suspect in a patient who develops pneumothorax without any chest trauma? A. Atelectasis B. Pneumonia C. Acute respiratory distress syndrome D. Chronic obstructive pulmonary disease (COPD

D A patient with COPD may develop spontaneous pneumothorax without any chest trauma, which is called an open pneumothorax. Atelectasis, pneumonia, and acute respiratory syndrome do not lead to an open type of pneumothorax.

Which assessment findings indicate that a patient with pleuritic pain, tachypnea, and subcutaneous emphysema has pneumothorax? A. Dull percussion notes B. Paradoxical chest movement C. Increased breath sounds on auscultation D. Deviated trachea away from the side of injury

D. In patients with pneumothorax, the trachea deviates away from the affected side, causing tension pneumothorax. Hyperresonance is noticed on percussion. Dull sounds on percussion are noticed in patients with pulmonary contusion. Paradoxical chest movements are a characteristic feature of flail chest. Breath sounds are decreased on auscultation in patients with pneumothorax.

In caring for a patient following an acute myocardial infarction, what is the greatest priority when planning care? Wear TED hose and sequential compression devices while in bed. Correct2 Monitor for increased frequency of premature ventricular contractions. 3 Provide a low-fat, low-sodium diet. 4 Pad the oxygen tubing behind the ears

Increasing frequency of premature ventricular contractions following an acute myocardial infarction can lead to life-threatening ventricular dysrhythmias. Prophylaxis of venous thromboembolism, cardiac diet, and prevention of skin breakdown are important, but the greatest priority is the risk of life-threatening dysrhythmias.

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

Low serum levels of potassium and magnesium predispose the patient to PVCs. The other electrolyte imbalances may cause ECG changes but do not increase the risk for PVCs.

In teaching patients at risk for bradydysrhythmias, what information does the nurse include? "Avoid potassium-containing foods." 2 "Stop smoking and avoid caffeine." 3 "Take nitroglycerin for a slow heartbeat." Correct4 "Use a stool softener."

Patients at risk for bradydysrhythmias should avoid bearing down or straining during a bowel movement; the Valsalva maneuver can cause bradycardia. Taking a stool softener helps prevent this. Patients with renal failure and hyperkalemia are instructed to avoid potassium-containing foods; if risk for hypokalemia exists, such as with diuretic therapy, the patient is instructed to eat foods high in potassium. Smoking and caffeine increase heart rate; although all people should stop smoking, patients at risk for tachycardia, premature beats, and ectopic rhythms are instructed to stop smoking and avoid caffeine. Nitroglycerin is used to reduce oxygen demand in cardiac ischemia, not for bradycardia.

Which intervention provides safety during cardioversion? Setting the defibrillator at 200 joules 2 Obtaining informed consent Correct3 Setting the defibrillator to the synchronized mode 4 Administering oxygen

Setting the defibrillator to the synchronized mode avoids discharging the shock during the vulnerable period on the T wave, which may cause ventricular fibrillation. Cardioversion is performed with a lower rate of energy than 200 joules. Although it is imperative to obtain informed consent, this does not improve the safety of the procedure. Oxygen should be turned off because it presents a safety issue; fire could result

he nurse is caring for a patient with acute coronary syndrome (ACS) and atrial fibrillation who has a new prescription for metoprolol. Which monitoring is essential when administering the medication? ST segment Correct2 Heart rate 3 Troponin 4 Myoglobin

The effects of metoprolol are to decrease heart rate, blood pressure, and myocardial oxygen demand. ST segment elevation is consistent with MI; it does not address monitoring of metoprolol. Elevation in troponin is consistent with a diagnosis of MI but does not address needed monitoring for metoprolol. Elevation in myoglobin is consistent with myocardial injury in ACS but does not address needed monitoring related to metoprolol.

A patient on mechanical ventilation has a sudden onset of respiratory distress. The nurse auscultates absent breath sounds on the right side and observes a shift of the trachea to the left. The patient is cyanotic and has distended neck veins. Which priority action by the nurse is correct? Assess for correct placement of the endotracheal tube. Correct2 Notify the Rapid Response Team. 3 Remove the ventilator and manually ventilate the patient. 4 Request an order for arterial blood gases

This patient has symptoms of a tension pneumothorax, which may quickly be fatal if not treated appropriately. The initial action is to notify the Rapid Response Team. Endotracheal tubes generally become displaced into the right mainstem bronchus, causing absent breath sounds on the left. The other actions may be performed when the Rapid Response Team arrives.

What is the correct sequence of events in their order of occurrence, after tracheobronchial trauma? Trauma causes a laceration to the trachea. Correct 2. Massive air leaks are created from the injury. Correct 3. Air begins to enter into the chest cavity. Correct 4. Extensive subcutaneous emphysema occurs.

Tracheal laceration in tracheobronchial trauma may result in massive air leaks. This allows the entrance of air into the mediastinum. The development of extensive subcutaneous emphysema follows.

The nurse notes ventricular fibrillation on a patient's cardiac monitor. What is the priority intervention at this time? Initiate high-quality CPR. 2 Notify the health care provider. 3 Determine the respiratory rate. 4 Administer 100% oxygen by nonrebreather mask

n ventricular fibrillation, cardiac output, pulse, and respirations cease, resulting in the absence of systemic tissue perfusion; immediate defibrillation or high-quality CPR with defibrillation as soon as possible is indicated. The health care provider should be notified immediately after CPR is started. Determining the respiratory rate is not necessary because there is no rate to determine. Administration of oxygen is part of the resuscitation effort, but providing oxygen by mask will be ineffective because there is no respiration.