COMPLEX EXAM 1
Which statement made by a patient would indicate the need for further education before an electrophysiology procedure? "I need to take all my heart medications the morning of the procedure." "The doctor is going to make my heart beat wrong on purpose." "I will be awake but relaxed during the procedure." "I will be x-rayed during the procedure."
"I need to take all my heart medications the morning of the procedure."
A nurse is providing care to a patient on fibrinolytic therapy. Which of the following statements from the patient warrants further assessment and intervention by the nurse? "My back is killing me!" "There is blood on my toothbrush!" "Look at the bruises on my arms!" "My arm is bleeding where my IV is!"
"My back is killing me!"
A patient was admitted several weeks ago with an acute myocardial infarction and subsequently underwent coronary artery bypass grafting surgery. Since a cardiac arrest 5 days ago, the patient has been unresponsive. An electroencephalogram shows no meaningful brain activity. The patient does not have an advance directive. Which statement would be the best way to approach the family regarding his ongoing care? "I will refer this case to the hospital ethics Committee, and they will contact you when they have a decision." "What do you want to do about the patient's care at this point?" "Dr. Smith believes that there is no hope at this point and recommends do-not-resuscitate status." "What would the patient want if he knew he were in this situation?"
"What would the patient want if he knew he were in this situation?"
A patient asks why he had to take a deep breath when the radiology technician took his chest radiograph. Which statement is the best response? "Deep breaths get the chest wall closer to the machine." "When the lungs are filled with air, you get a clearer picture." "Taking a deep breath decreases the error caused by motion." "Holding your breath makes the heart appear larger."
"When the lungs are filled with air, you get a clearer picture."
On returning from the cardiac catheterization laboratory, the patient asks if he can get up in the chair. What should the nurse tell the patient? "You cannot get up because you may pass out." "You cannot get up because you may start bleeding." "You cannot get up because you may fall." "You cannot get up until you urinate."
"You cannot get up because you may start bleeding."
Zeroing the pressure transducer on hemodynamic monitoring equipment occurs when the displays reads which number? 0 250 600 760
0
Which mechanism is responsible for the augmentation of coronary arterial blood flow and increased myocardial oxygen supply seen with the intraaortic balloon pump? The vacuum created in the aorta as a result of balloon deflation Diastolic inflation with retrograde perfusion Forward flow to the peripheral circulation Inflation during systole to augment blood pressure
Diastolic inflation with retrograde perfusion
Which medication has a greater advantage for treatment of alcohol withdrawal syndrome (AWS) because of its longer half-life and high lipid solubility? Lorazepam Midazolam Propofol Diazepam
Diazepam
When performing a 12-lead electrocardiogram (ECG), how many wires are connected to the patient? 3 5 10 12
10
ST segment monitoring for ischemia has gained increasing importance with the advent of thrombolytic therapy. What is the most accurate method for monitoring the existence of true ischemic changes? Biomarkers Echocardiogram 5-lead ECG 12-lead ECG
12-lead ECG
A 55-year-old patient is scheduled for a stress test. What is the estimation of the patient's maximal predicted heart rate? 65 beats/min 155 beats/min 165 beats/min 265 beats/min
165 beats/min
The patient's condition has deteriorated to the point where she can no longer make decisions about her own care. Which nursing interventions would be most appropriate? Obtain a verbal do-not-resuscitate (DNR) order from the practitioner. Continue caring for the patient as originally ordered because she obviously wanted this. Consult the hospital attorney for recommendations on how to proceed. Discuss with the family what the patient's wishes would be if she could make those decisions herself.
Discuss with the family what the patient's wishes would be if she could make those decisions herself.
A patient with a potassium level of 2.8 mEq/L is given 60 mEq over a 12-hour period. A repeat potassium level is obtained, and the current potassium level is 3.2 mEq/L. In addition to administering additional potassium supplements, what intervention should now be considered? Discontinue spironolactone Drawing a serum magnesium level Rechecking the potassium level Monitoring the patient's urinary output
Drawing a serum magnesium level
A patient is admitted with an acute myocardial infarction (MI). What common complication should the nurse anticipate in this patient? Pulmonary edema Cardiogenic shock Dysrhythmias Deep vein thrombosis
Dysrhythmias
Which finding is a reliable indicator of reperfusion after fibrinolytic therapy? Dysrhythmias Q waves Elevated ST segments Immediate rapid decrease in cardiac biomarkers
Dysrhythmias
Which of the following statements about comfort care is accurate? Withholding and withdrawing life-sustaining treatment are distinctly different in the eyes of the legal community. Each procedure should be evaluated for its effect on the patient's comfort before being implemented. Only the patient can determine what constitutes comfort care for him or her. Withdrawing life-sustaining treatments is considered euthanasia in most states.
Each procedure should be evaluated for its effect on the patient's comfort before being implemented.
Which diagnostic tool can be used to detect structural heart abnormalities? Echocardiogram Electrocardiogram (ECG) Exercise stress test 24-hour Holter monitor
Echocardiogram
The nurse is using the SFNO approach to case analysis to facilitate ethical decision making. What justification criteria may be used to help explain the reasons for selection of one option over another? Effectiveness Usefulness Legal ramifications Economics
Effectiveness
What are the clinical manifestations of right-sided heart failure? Elevated central venous pressure and sacral edema Pulmonary congestion and jugular venous distention Hypertension and chest pain Liver tenderness and pulmonary edema
Elevated central venous pressure and sacral edema
A patient reports that he has been having "indigestion" for the last few hours. Upon further review the nurse suspects the patient is having of chest pain. Cardiac biomarkers and a 12-lead electrocardiogram (ECG) are done. What finding is most significant in diagnosing an acute coronary syndrome (ACS) within the first 3 hours? Inverted T waves Elevated troponin I Elevated B-type natriuretic peptide (BNP) Indigestion and chest pain
Elevated troponin I
A patient is admitted with acute respiratory distress syndrome (ARDS). The patient has been intubated and is mechanically ventilated. The patient is becoming increasingly agitated, and the high-pressure alarm on the ventilator has been frequently triggered. The patient continues to be very agitated, and the nurse can find nothing physiologic to account for the high-pressure alarm. What action should the nurse take next? Administer midazolam 5 mg by intravenous push immediately. Eliminate noise and other stimuli in the room and speak softly and reassuringly to the patient. Obtain an arterial blood gas to ensure the patient is not becoming more hypoxemic. Call the respiratory care practitioner to replace the malfunctioning ventilator.
Eliminate noise and other stimuli in the room and speak softly and reassuringly to the patient.
A patient is admitted with a fever of unknown origin. The patient is complaining of fatigue, malaise, joint pain, and shivering. The patient's vital signs include temperature, 103° F; heart rate, 90 beats/min; respiratory rate, 22 breaths/min; blood pressure, 132/78; and oxygen saturation, 94% on 2L nasal cannula. The patient has developed a cardiac murmur. The nurse suspects that the patient has developed which problem? Coronary artery disease Heart failure Endocarditis Pulmonary embolus
Endocarditis
Which anticoagulant enhances the activity of antithrombin III and does not require activated partial thromboplastin time (aPTT) or activated clotting time (ACT) monitoring? Heparin Enoxaparin Bivalirudin Argatroban
Enoxaparin
A practitioner is suggesting treatments to a patient that are contrary to the patient's preferences. What is this practice called? Invaluable deficiency Physiologic uselessness Ethical futility Situational insufficiency
Ethical futility
What is the difference between ethics and morals? Ethics is more concerned with the "why" of behavior. Ethics provides a framework for evaluation of the behavior. Ethics is broader in scope than morals. Ethics concentrates on the right or wrong behavior based on religion and culture values.
Ethics is more concerned with the "why" of behavior.
What is the target range for an international normalized ratio (INR)? 1.0 to 2.0 1.5 to 3.0 1.5 to 2.5 2.0 to 3.0
2.0 to 3.0
Which dosage of dopamine results in stimulation of beta1 receptors and increased myocardial contractility? 1 mcg/kg/min 5 mcg/kg/min 15 mcg/kg/min 20 mcg/kg/min
5 mcg/kg/min
The patient has a heart rate (HR) of 84 beats/min and a stroke volume (SV) of 65 mL. Calculate the cardiac output (CO). 149 mL 500 mL 4650 mL 5460 mL
5460 mL
In the acute phase after ST segment elevation myocardial infarction (STEMI), fibrinolytic therapy is used in combination with heparin to recanalize the coronary artery. What dosage is the initial heparin bolus? 60 units/kg maximum 5000 units 30 units/kg maximum 3000 units 25 units/kg maximum of 2500 units 12 units/kg maximum of 1000 units
60 units/kg maximum 5000 units
At what size is an aortic aneurysm evaluated for surgical repair or stent placement? 2 cm 4 cm 5 cm >5 cm
>5 cm
Pulsus paradoxus may be noted on the bedside monitor when what is observed? A decrease of more than 10 mm Hg in the arterial waveform during inhalation A single, nonperfused beat on the electrocardiogram (ECG) waveform Tall, tented T waves on the ECG waveform An increase in pulse pressure greater than 20 mm Hg on exhalation
A decrease of more than 10 mm Hg in the arterial waveform during inhalation
The nurse developing a patient education plan for the patient with endocarditis. What information would be included in the plan? Endocarditis is a viral infection that is easily treated with antibiotics. The risk of this diagnosis is occlusion of the coronary arteries. A long course of antibiotics is needed to treat this disorder. Complications are rare after antibiotics have been started.
A long course of antibiotics is needed to treat this disorder.
What is the formula for calculating mean arterial pressure (MAP)? Averaging three of the patient's blood pressure readings over a 6-hour period Dividing the systolic pressure by the diastolic pressure Adding the systolic pressure and two diastolic pressures and then dividing by 3 Dividing the diastolic pressure by the pulse pressure
Adding the systolic pressure and two diastolic pressures and then dividing by 3
A patient suddenly develops a wide QRS complex tachycardia. The patient's heart rate is 220 beats/min and regular; blood pressure is 96/40 mm Hg; and respiratory rate is 22 breaths/min, and the patient is awake without complaint except for palpitations. Which of the following interventions would be best to try first? Adenosine 6 mg rapid IV push Lidocaine 1 mg/kg IV push Verapamil 5 mg IV push Digoxin 0.5 mg IV push
Adenosine 6 mg rapid IV push
A patient has been taking benzodiazepines and suddenly develops respiratory depression and hypotension. After careful assessment, the nurse determines that the patient is experiencing benzodiazepine overdose. What is the nurse's next action? Decrease benzodiazepines to half the prescribed dose. Increase IV fluids to 500 cc/h for 2 hours. Administer flumazenil (Romazicon). Discontinue benzodiazepine and start propofol.
Administer flumazenil (Romazicon).
Which intervention should be strictly followed to ensure accurate cardiac output readings? Inject 5 mL of iced injectate at the beginning of exhalation over 30 seconds. Inject 10 mL of warmed injectate into the pulmonary artery port three times. Ensure at least 5° C difference between injectate and the patient temperature. Administer the injectate within 4 seconds during inspiration.
Administer the injectate within 4 seconds during inspiration.
A patient is admitted with hypertrophic cardiomyopathy. The nurse would expect the medical management of this patient to include which intervention? Administration of beta-blockers Administration of positive inotropes Plans for intensive exercise regimen Plans for an aortic valve replacement
Administration of beta-blockers
What is the stepwise decision-making flowchart for a specific care process named? Algorithm Practice guideline Protocol Order set
Algorithm
A patient was admitted several weeks ago with an acute myocardial infarction and subsequently underwent coronary artery bypass grafting surgery. Since a cardiac arrest 5 days ago, the patient has been unresponsive. An electroencephalogram shows no meaningful brain activity. After a family conference, the practitioner orders a do-not-resuscitate (DNR) order, and palliative care is begun. How does this affect the patient's treatment? The patient will continue to receive the same aggressive treatment short of resuscitation if he has another cardiac arrest. All treatment will be stopped, and the patient will be allowed to die. All attempts will be made to keep the patient comfortable without prolonging his life. The patient will be immediately transferred to hospice.
All attempts will be made to keep the patient comfortable without prolonging his life.
Which professional organization administers critical care certification exams for registered nurses? State Board of Registered Nurses National Association of Clinical Nurse Specialist Society of Critical Care Medicine American Association of Critical-Care Nurses
American Association of Critical-Care Nurses
Why is the measurement of the QT interval important? It facilitates rhythm identification and is best assessed in Lead II. It helps differentiate myocardial ischemia from infarction. An increasing QT interval increases the risk of torsades de pointes. A decreasing QT interval increases the risk of torsades de pointes.
An increasing QT interval increases the risk of torsades de pointes.
The nurse is using the SFNO approach to case analysis to facilitate ethical decision making. Which question is important to ask when considering stakeholders? Are there reasons to give priority to one stakeholder over another? Will the stakeholders abide by the decision? Will the stakeholders want to be present during the ethics consultation? Do the stakeholders understand how to use the SFNO model?
Are there reasons to give priority to one stakeholder over another?
What is the effect of preload on cardiac output? As preload increases, cardiac output increases. As preload increases, cardiac output decreases. As preload increases, cardiac output increases until it overstretches the ventricle and cardiac output decreases. Increased preload has no effect on cardiac output.
As preload increases, cardiac output increases until it overstretches the ventricle and cardiac output decreases.
What two medications are commonly prescribed at discharge for patients who have had a coronary artery stent placed? Aspirin and prasugrel Aspirin and abciximab Clopidogrel and eptifibatide Tirofiban and tricagrelor
Aspirin and prasugrel
A patient is admitted unit with acute respiratory distress syndrome (ARDS). The patient has been intubated and is mechanically ventilated. The patient is becoming increasingly agitated, and the high-pressure alarm on the ventilator has been frequently triggered. What action should be the nurse take first? Administer midazolam 5 mg by intravenous push immediately. Assess the patient to see if a physiologic reason exists for his agitation. Obtain an arterial blood gas level to ensure the patient is not hypoxemic. Apply soft wrist restraints to keep him from pulling out the endotracheal tube.
Assess the patient to see if a physiologic reason exists for his agitation.
The nursing management plan for a patient with angina would include which intervention? Immediate administration of antiplatelet therapy Teaching the patient how to perform the Valsalva maneuver Assessment and documentation of chest pain episodes Administration of prophylactic lidocaine for ventricular ectopy
Assessment and documentation of chest pain episodes
What does the P wave component of the electrocardiographic waveform represent? Atrial contraction Atrial depolarization Sinus node discharge Ventricular contraction
Atrial depolarization
A patient's wife has been informed by the practitioner that her spouse has permanent quadriplegia. The wife states that she does not want anyone to tell the patient about his injury. The patient asks the nurse about what has happened. Based on which ethical principles does the nurse answer the patient's questions? Veracity Justice Autonomy Nonmaleficence
Autonomy
Truth-telling is an example of what ethical principle? Justice Beneficence Autonomy Nonmaleficence
Autonomy
Which cardiac biomarker is elevated in decompensated heart failure? Triglycerides Troponin I Troponin T B-type natriuretic peptide (BNP)
B-type natriuretic peptide (BNP)
Recommendations for creating a supportive atmosphere during end-of-life discussions include which intervention? Telling the family when and where the procedure will occur Beginning the conversation by inquiring about the emotional state of the family Ending the conversation by inquiring about the emotional state of the family Recommendations that the family not be present when the procedure occurs
Beginning the conversation by inquiring about the emotional state of the family
What are the two basic ethical principles underlying the provision of health care? Beneficence and nonmaleficence Veracity and beneficence Fidelity and nonmaleficence Veracity and fidelity
Beneficence and nonmaleficence
What is the most common complication of fibrinolytic therapy? Reperfusion chest pain Lethargy Bleeding Heart blocks
Bleeding
Through what mechanism does enalapril decrease blood pressure? Direct arterial vasodilation Block the conversion of angiotensin I to angiotensin II Increase fluid excretion at the loop of Henle Peripheral vasoconstriction and central vasodilation.
Block the conversion of angiotensin I to angiotensin II
A patient is admitted after a positive exercise treadmill test with a diagnosis of coronary artery disease (CAD) and stable angina. Radiographic tests show that the patient has blockage in the left main coronary artery and four other vessels. The nurse anticipates that the patient's treatment plan will include what treatment or procedure? Medical therapy PCI TAVR CABG
CABG
A patient's bedside electrocardiogram (ECG) strips show the following changes: increased PR interval; increased QRS width; and tall, peaked T waves. Vital signs are temperature 98.2° F; heart rate 118 beats/min; blood pressure 146/90 mm Hg; and respiratory rate 18 breaths/min. The patient is receiving the following medications: digoxin 0.125 mg PO every day; D51/2 normal saline with 40 mEq potassium chloride at 125 mL/hr; Cardizem at 30 mg PO q8h; and aldosterone at 300 mg PO q12h. The practitioner is notified of the ECG changes. What orders should the nurse expect to receive? Change IV fluid to D51/2 normal saline and draw blood chemistry. Give normal saline with 40 mEq of potassium chloride over a 6-hour period. Hold digoxin and draw serum digoxin level. Hold Cardizem and give 500 mL normal saline fluid challenge over a 2-hour period.
Change IV fluid to D51/2 normal saline and draw blood chemistry.
A patient's arterial line waveform has become damped. What action should the nurse take to correct the situation? Check for kinks, blood, and air bubbles in the pressure tubing. Prepare for a normal saline fluid challenge for hypotension. Discontinue the arterial line as it has become nonfunctional. Check the patient's lung sounds for a change in patient condition.
Check for kinks, blood, and air bubbles in the pressure tubing.
A patient's central venous pressure (CVP) reading suddenly increased from 10 to 48 mm Hg. His lungs are clear except for fine rales at the bases. What should the nurse do next? Nothing as this reading is still within normal limits. Place a STAT call into the physician. Administer ordered prn Lasix. Check the level of the transducer.
Check the level of the transducer.
Which diagnostic test is most effective for measuring overall heart size? 12-lead electrocardiography Echocardiography Chest radiography Vectorcardiography
Chest radiography
Which of the following medications is used for sedation in patients experiencing withdrawal syndrome? Dexmedetomidine Hydromorphone Diazepam Clonidine
Clonidine
Which intervention is an effective nursing strategy to decrease the incidence of delirium? Restriction of visitors Early nutritional support Clustering of nursing care activities Bedrest
Clustering of nursing care activities
Prayer, guided imagery, and massage are all examples of what type of treatment? Alternative therapy Holistic care Complementary care Individualized care
Complementary care
The principle of respect for persons incorporates what additional concepts? Confidentiality and privacy Truth and reflection Autonomy and justice Beneficence and nonmaleficence
Confidentiality and privacy
Which clinical manifestation is usually the first symptom of peripheral arterial disease (PAD)? Cramping when walking Thrombophlebitis Pulmonary embolism Cordlike veins
Cramping when walking
Which statement regarding the use of cuff blood pressures is true? Cuff pressures may be unreliable when a patient is in shock. Cuff pressures are more accurate than arterial line pressures. Cuff pressures and arterial line pressures should be nearly identical. Cuff pressures should not be compared to arterial line pressures.
Cuff pressures may be unreliable when a patient is in shock.
The patient is admitted with a diagnosis of cardiogenic shock. The patient's heart rate (HR) is 135 beats/min with weak peripheral pulses. The patient has bilaterally crackles in the bases of the lungs. O2 saturation is 90% on 4L/NC. The practitioner orders diuretics and vasodilators. What response should the nurse expect after starting the medications? Decreased preload and afterload Increased preload and afterload Decreased preload and increased afterload Increased preload and decreased afterload
Decreased preload and afterload
Which of the following is most indicative of decreased left ventricular preload? Increased pulmonary artery occlusion pressure (PAOP) Decreased pulmonary artery occlusion pressure (PAOP) Increased central venous pressure (CVP) Decreased central venous pressure (CVP)
Decreased pulmonary artery occlusion pressure (PAOP)
What is the physiologic effect of left ventricular afterload reduction? Decreased left atrial tension Decreased systemic vascular resistance Increased filling pressures Decreased cardiac output
Decreased systemic vascular resistance
What effect does ventricular tachycardia have on cardiac output? Increases cardiac output due to an increase in ventricular filling time Decreases cardiac output due to a decrease in stroke volume Increases cardiac output due to an increase in preload Decreases cardiac output due to a decrease in afterload
Decreases cardiac output due to a decrease in stroke volume
A patient was admitted 5 days ago and has just been weaned from mechanical ventilation. The patient suddenly becomes confused, seeing nonexistent animals in the room and pulling at the bedding. The nurse suspects the patient may be experiencing what issue? Delirium Hypoxemia Hypocalcemia Sedation withdrawal
Delirium
Which statement best describes the concept of paternalism? Encouraging the patient to ambulate after surgery Demanding the patient get out of bed to sit in a chair Following the patient's advance directive despite family objections Administering antibiotics for a viral infection
Demanding the patient get out of bed to sit in a chair
A patient was admitted 3 days ago with an acute myocardial infarction (MI). The patient complains of fatigue, not sleeping the past two nights, and change in appetite. Based on these findings the nurse suspects the patient may be experiencing which problem? Angina Anxiety Depression Endocarditis
Depression
A patient was admitted to the critical care unit after having a cerebrovascular accident (CVA) and myocardial infarction (MI). The patient has poor activity tolerance, falls in and out of consciousness, and has poor verbal skills. The patient has been resuscitated four times in the past 6 hours. The patient does not have advance directives. Family members are at the bedside. Who should the practitioner approach to discuss decisions of care and possible do-not-resuscitate (DNR) status? Patient Family Hospital legal system Hospital ethics committee
patient
The American Association of Critical-Care Nurses (AACN) has developed short directives that can be used as quick references for clinical use that are known as Critical Care Protocol. Practice Policies. Evidence-Based Research. Practice Alerts.
practice alerts
During World War II, what type of wards were developed to care for critically injured patients? Intensive care Triage Shock Postoperative
shock
A physician orders removal of the central venous catheter (CVC) line. The patient has a diagnosis of heart failure with chronic obstructive pulmonary disease. The nurse would place the patient in what position for this procedure? Supine in bed Supine in a chair Flat in bed Reverse Trendelenburg position
supine in bed
Ethical decisions are best made by performing which action? Following the guidelines of a framework or model Having the patient discuss alternatives with the practitioner or nurse Prioritizing the greatest good for the greatest number of persons Studying by the Ethics Committee after all diagnostic data are reviewed
Following the guidelines of a framework or model
A patient is admitted after a femorotibial bypass graft. What nursing action is critical in the immediate postoperative period? Frequent assessment of the skin Hourly assessment of intake and output Monitoring for ST segment changes Frequent pulse checks to the affected limb
Frequent pulse checks to the affected limb
A patient was admitted 5 days ago and has just been weaned from mechanical ventilation. The patient suddenly becomes confused, seeing nonexistent animals in the room and pulling at the bedding. What is the medication of choice for treating this patient? Diazepam Haloperidol Lorazepam Propofol
Haloperidol
A patient has been newly diagnosed with stable angina. He tells the nurse he knows a lot about his diagnosis already because his father had the same diagnosis 15 years ago. The nurse asks him to state what he already knows about angina. Which response indicates the need for additional education? He should stop smoking. He can no longer drink colas or coffee. He can no longer get a strong back massage. He should take stool softeners to prevent straining. ANS: C
He can no longer get a strong back massage.
Which criteria are representative of the patient in normal sinus rhythm? Heart rate, 64 beats/min; rhythm regular; PR interval, 0.10 second; QRS, 0.04 second Heart rate, 88 beats/min; rhythm regular; PR interval, 0.18 second; QRS, 0.06 second Heart rate, 54 beats/min; rhythm regular; PR interval, 0.16 second; QRS, 0.08 second Heart rate, 92 beats/min; rhythm irregular; PR interval, 0.16 second; QRS, 0.04 second
Heart rate, 88 beats/min; rhythm regular; PR interval, 0.18 second; QRS, 0.06 second
Which value, when elevated, pUlaceSs thNe paTtient atOlowest risk for coronary artery disease (CAD)? Very-low-density lipoproteins (VLDLs) Triglycerides Low-density lipoproteins (LDLs) High-density lipoproteins (HDLs)
High-density lipoproteins (HDLs)
Which statement regarding organ donation is accurate? Organ donation is a choice only the patient can make for him- or herself. Hospitals must have written protocols for the identification of potential organ donors. Organ donation must be requested by the nurse caring for the dying patient. Individual institutional policies govern how organ donation requests are made.
Hospitals must have written protocols for the identification of potential organ donors.
What are the risk factors for delirium? Hypertension, alcohol abuse, and benzodiazepine administration Coma, hypoxemia, and trauma Dementia, hypertension, and pneumonia Coma, alcohol abuse, hyperglycemia
Hypertension, alcohol abuse, and benzodiazepine administration
A patient is admitted with an acute inferior myocardial infarction (MI). A 12-lead electrocardiogram (ECG) is done to validate the area of infarction. Which leads on the ECG would correlate with an inferior wall MI? II, III, aVF V5 to V6, I, aVL V2 to V4 V1 to V2
II, III, aVF
Which blood test standardizes prothrombin time (PT) results among worldwide clinical laboratories? aPTT ACT HDL INR
INR
What is the initial intervention in a patient with sinus tachycardia with the following vital signs: heart rate, 136 beats/min; blood pressure, 102/60 mm Hg; respiratory rate, 24 breaths/min; temperature, 99.2° F; SpO2, 94% on oxygen 2 L/min by nasal cannula? Administer adenosine IV push. Identify the cause. Administer nitroglycerine 0.4 mg sublingual. Administer lidocaine 75 mg IV push.
Identify the cause.
What is the first step of the ethical decision-making process? Consulting with an authority Identifying the health problem Delineating the ethical problem from other types of problems Identifying the patient as the primary decision maker
Identifying the health problem
When assessing a patient with PVCs, the nurse knows that the ectopic beat is multifocal because it appears in what way? In various shapes in the same lead With increasing frequency Wider than a normal QRS On the T wave
In various shapes in the same lead
What is the most common complaint heard from families of dying patients? Poor nursing care Inadequate communication Lack of consistent plan of care Confusion among health care team members
Inadequate communication
A patient was admitted several weeks ago with an acute myocardial infarction and subsequently underwent coronary artery bypass grafting surgery. Since a cardiac arrest 5 days ago, the patient has been unresponsive. An electroencephalogram shows no meaningful brain activity. The patient is placed on a morphine drip to alleviate suspected operative pain and assist in sedation. The patient continues to grimace and fight the ventilator. What nursing intervention would be appropriate? Increase the morphine dosage until no signs of pain or discomfort are present. Increase the morphine drip, but if the patient's respiratory rate drops below 10 breaths/min, return to the original dosage. Gradually decrease the morphine and switch to Versed to avoid respiratory depression. Ask the family to leave the room because their presence is causing undue stress to the patient.
Increase the morphine dosage until no signs of pain or discomfort are present.
What is the most common complication of a central venous catheter (CVC)? Air embolus Infection Thrombus formation Pneumothorax
Infection
The patient is 72 hours postoperative for a coronary artery bypass graft (CABG). The patient's vital signs include temperature 103° F, heart rate 112, respiratory rate 22, blood pressure 134/78 mm Hg, and O2 saturation 94% on 3L nasal cannula. The nurse suspects that the patient has developed what problem? Infection and notifies the physician immediately Infection, which is common postoperatively, and monitors the patient's condition Cardiac tamponade and notifies the physician immediately Delirium caused by the elevated temperature
Infection and notifies the physician immediately
Why is mixed venous oxygen saturation (SVO2) monitoring helpful in the management of the critically ill patient? It facilitates oxygen saturation monitoring at the capillary level. It can detect an imbalance between oxygen supply and metabolic tissue demand. It assesses the diffusion of gases at the alveolar capillary membrane. It estimates myocardial workload during heart failure and acute pulmonary edema.
It can detect an imbalance between oxygen supply and metabolic tissue demand.
Why is a new-onset of atrial fibrillation serious? It increases the patient's risk for a stroke. It increases the patient's risk for a deep venous thrombosis. It may increase cardiac output to dangerous levels. It indicates the patient is about to have a myocardial infarction.
It increases the patient's risk for a stroke.
Which statement regarding the Code of Ethics for Nursing is accurate? The Code of Ethics for Nurses is usurped by state or federal laws. It allows the nurse to focus on the good of society rather than the uniqueness of the patient. The Code of Ethics for Nurses was recently adopted by the American Nurses Association. It provides society with a set of expectations of the nursing profession.
It provides society with a set of expectations of the nursing profession.
Patient education for a patient with a Holter monitor should include which instruction? Keep a diary of activities, symptoms, and any medications that are taken. Do not drink coffee while the recorder is on. Do not take a bath but a shower is alright. Carry the monitor in a purse or backpack.
Keep a diary of activities, symptoms, and any medications that are taken.
Which laboratory value indicates a heightened risk for the development of coronary artery disease (CAD)? Total cholesterol level of 170 mg/dL HDL cholesterol level of 30 mg/dL Triglyceride level of 120 mg/dL LDL cholesterol level >190 mg/dL
LDL cholesterol level >190 mg/dL
A patient returns from the cardiac catheterization laboratory after angioplasty and stent placement (ECG changes had indicated an inferior wall myocardial infarction in progress). Which lead would best monitor this patient? Varies based on the patient's clinical condition and recent clinical history Lead V3 Lead V1 Lead II
Lead II
What parameter is used to assess the contractility of the left side of the heart? Pulmonary artery occlusion pressure Left atrial pressure Systemic vascular resistance Left ventricular stroke work index
Left ventricular stroke work index
When assessing the pulmonary arterial waveform, the nurse notices dampening. After tightening the stopcocks and flushing the line, the nurse decides to calibrate the transducer. What are two essential components included in calibration? Obtaining a baseline blood pressure and closing the transducer to air Leveling the air-fluid interface to the phlebostatic axis and opening the transducer to air Having the patient lay flat and closing the transducer to air Obtaining blood return on line and closing all stopcocks
Leveling the air-fluid interface to the phlebostatic axis and opening the transducer to air
Which statement expresses the correct order when working with an invasive pressure monitor? Level the transducer, locate the phlebostatic axis, zero the transducer, and take the reading. Locate the phlebostatic axis, level the transducer, zero the transducer, and take the reading. Take the reading, level the transducer, locate the phlebostatic axis, and zero the transducer. Locate the phlebostatic axis, zero the transducer, level the transducer, and take the reading.
Locate the phlebostatic axis, level the transducer, zero the transducer, and take the reading.
A patient is admitted with acute respiratory distress syndrome (ARDS). The patient has been intubated and is mechanically ventilated. The patient had become very agitated and required some sedation. After the patient's agitation is controlled, which medications would be most appropriate for long-term sedation? Morphine 2 mg/h continuous IV drip Haloperidol 15 mcg/kg/min continuous IV infusion Propofol 5 mcg/kg/min by IV infusion Lorazepam 0.01 to 0.1 mg/kg/h by IV infusion
Lorazepam 0.01 to 0.1 mg/kg/h by IV infusion
Which serum lipid value is a significant predictor of future acute myocardial infarction (MI) in persons with established coronary artery atherosclerosis? High-density lipoprotein (HDL) Low-density lipoprotein (LDL) Triglycerides Very-low-density lipoprotein
Low-density lipoprotein (LDL)
Which noninvasive imaging technique is useful in diagnosing complications of a myocardial infarction (MI)? 2-lead ECG CT MRI Echocardiography
MRI
Which nursing intervention continues to be one of the most error-prone for critical care nurses? Inappropriate care Intimidating and disruptive clinician behavior Injury to patients by falls Medication administration
Medication administration
A patient is admitted with acute respiratory distress syndrome (ARDS). The patient has been intubated and is mechanically ventilated. The patient is becoming increasingly agitated, and the high-pressure alarm on the ventilator has been frequently triggered. Despite the nurse's actions, the patient continues to be agitated, triggering the high-pressure alarm on the ventilator. Which medication would be appropriate to sedate the patient this time? Midazolam 2 to 5 mg intravenous push (IVP) every 5 to 15 minutes until the patient is no longer triggering the alarm Haloperidol 5 mg IVP stat Propofol 5 mcg/kg/min by IV infusion Fentanyl 25 mcg IVP over a 15-minute period
Midazolam 2 to 5 mg intravenous push (IVP) every 5 to 15 minutes until the patient is no longer triggering the alarm
Which condition can cause an artificial increase in the pulmonary artery occlusion pressure (PAOP)? Aortic regurgitation Aortic stenosis Mitral stenosis Mitral regurgitation
Mitral regurgitation
The patient's admitting 12-lead ECG shows wide, M-shaped P waves. What diagnosis could be responsible for this finding? Mitral stenosis Chronic pulmonary disease Hypotension Pericarditis
Mitral stenosis
Developing an organizational policy that supports unobstructed access to the ethics committee by health care team members is one example of a proactive approach to dealing with what issue? Moral distress Surrogate decision-makers Paternalism Patient advocacy
Moral distress
In caring for a patient receiving palliative care, antiemetics are used in the treatment of what problem? Dyspnea Nausea and vomiting Anxiety Edema
Nausea and vomiting
A patient tells the nurse to call his family and tell them they need to come so they can say their goodbyes. The patient is sure he will not be here tomorrow because his grandparent is waiting for him. What is the patient exhibiting? Anxiety Delirium Metabolic derangement Near-death awareness
Near-death awareness
Which calcium channel blocker is beneficial in the treatment of patients with coronary artery disease or ischemic stroke? Nifedipine Nicardipine Clevidipine Diltiazem
Nicardipine
After a myocardial infarction, a patient presents with an increasing frequency of premature ventricular contractions (PVCs). The patient's heart rate is 110 beats/min, and electrocardiogram (ECG) indicates a sinus rhythm with up to five unifocal PVCs per minute. The patient is alert and responsive and denies any chest pain or dyspnea. What action should the nurse take next? Administer lidocaine 100 mg bolus IV push stat. Administer Cardizem 20 mg IV push stat. Notify the physician and monitor the patient closely. Nothing; PVCs are expected in this patient.
Notify the physician and monitor the patient closely.
A patient becomes unresponsive. The patient's heart rate is 32 beats/min in an idioventricular rhythm; blood pressure is 60/32 mm Hg; SpO2 is 90%; and respiratory rate is 14 breaths/min. Which intervention would the nurse do first? Notify the physician and hang normal saline wide open. Notify the physician and obtain the defibrillator. Notify the physician and obtain a temporary pacemaker. Notify the physician and obtain a 12-lead ECG.
Notify the physician and obtain a temporary pacemaker.
What is a health condition primarily resolved by nursing interventions or therapies called? Nursing diagnosis Nursing interventions Nursing outcomes Nursing process
Nursing diagnosis
Designing therapeutic activities that move a patient from one state of health to another is an example of which of the following? Nursing diagnosis Nursing interventions Nursing outcomes Nursing process
Nursing interventions
What is the systematic decision-making model used by nurses termed? Nursing diagnosis Nursing interventions Nursing evaluations Nursing process
Nursing process
What characteristic is associated with junctional escape rhythms? Irregular rhythm Rate greater than 100 beats/min P wave may be present or absent QRS greater than 0.10 seconds
P wave may be present or absent
Which portion of the electrocardiogram (ECG) is most valuable in diagnosing atrioventricular (AV) conduction disturbances? P wave PR interval QRS complex QT interval
PR interval
When analyzing the electocardiogram (ECG) strip of the patient with a pacemaker, the nurse notices there is a spike before each QRS complex. What is this phenomenon indicative of? 60-cycle electrical interference; check equipment Pacing artifact; the pacemaker is sensing and capturing Electrical artifact; the pacemaker is not sensing Patient movement; check electrodes
Pacing artifact; the pacemaker is sensing and capturing
Patient is admitted with heart failure. The patient has developed dyspnea with wheezing, a nonproductive cough, and pulmonary crackles that progress to the gurgling sounds of pulmonary edema. The nurse suspects the patient may be developing with problem? Dyspnea Orthopnea Paroxysmal nocturnal dyspnea Cardiac asthma
Paroxysmal nocturnal dyspnea
A patient is admitted with an acute inferior myocardial infarction (MI). A 12-lead electrocardiogram (ECG) is done to validate the area of infarction. Which finding on the ECG is most conclusive for infarction? Inverted T waves Tall, peaked T waves ST segment depression Pathologic Q waves
Pathologic Q waves
When is a patient a candidate for a surgical repair of an abdominal aortic aneurysm (AAA)? Size is 1 cm Patient experiencing symptoms Aneurysm size unchanged over several years Size less than 4 cm
Patient experiencing symptoms
What is the preferred initial treatment of an acute myocardial infarction? Fibrinolytic therapy Percutaneous coronary intervention (PCI) Coronary artery bypass surgery (CABG) Implanted Cardioverter defibrillator (ICD)
Percutaneous coronary intervention (PCI)
Assessment of a patient with pericarditis may reveal which signs and symptoms? Ventricular gallop and substernal chest pain Narrowed pulse pressure and shortness of breath Pericardial friction rub and pain Pericardial tamponade and widened pulse pressure
Pericardial friction rub and pain
What parameter must be assessed frequently in the patient with an intraaortic balloon in place? Skin turgor in the affected extremity Peripheral pulses distal to the insertion site Blood pressures in both arms and legs Oxygen saturation
Peripheral pulses distal to the insertion site
Mechanical contraction of the heart occurs during which phase of the cardiac cycle? Phase 0 Phase 2 Phase 3 Phase 4
Phase 2
The nurse is caring for a patient with left-sided heart failure. The nurse suspects the patient is developing pulmonary edema. Which finding would confirm the nurse's suspicions? Pulmonary crackles Peripheral edema Pink, frothy sputum Elevated central venous pressure
Pink, frothy sputum
A patient is undergoing ventricular pacing via a transvenous pacing lead. The nurse notes a pacing artifact, but it is not followed by a QRS on the electrocardiogram (ECG) monitoring. Which nursing intervention may correct this situation? Position the patient on the left side Decrease the milliamperes as ordered Increase the rate as ordered Monitor the patient in a different lead
Position the patient on the left side
Which action best reflects the concept of beneficence within the critical care setting? Advocating for equitable health care Promoting for safe patient care Ensuring equal access for those with the same condition or diagnosis Confirming technologic advances are available to all in a given community
Promoting for safe patient care
By what action can critical care nurses can best enhance the principle of autonomy? Presenting only the information to prevent relapse in a patient Assisting with only tasks that cannot be done by the patient Providing the patient with all of the information and facts Guiding the patient toward the best choices for care
Providing the patient with all of the information and facts
The patient's admitting 12-lead ECG shows tall, peaked P waves. What diagnosis could be responsible for this finding? Mitral stenosis Pulmonary edema Ischemia Pericarditis
Pulmonary edema
What major clinical finding present in a patient with ventricular fibrillation (VF)? Hypertension Bradycardia Diaphoresis Pulselessness
Pulselessness
Which of the electrocardiogram (ECG) findings would be positive for an inferior wall myocardial infarction (MI)? ST segment depression in leads I, aVL, and V2 to V4 Q waves in leads V1 to V2 Q waves in leads II, III, and aVF T-wave inversion in leads V4 to V6, I, and aVL
Q waves in leads II, III, and aVF
A patient was admitted 5 days ago and has just been weaned from mechanical ventilation. The patient suddenly becomes confused, seeing nonexistent animals in the room and pulling at the bedding. What parameter should be monitored while the patient is haloperidol? Sedation level QTc-interval Oxygen saturation level Brain waves
QTc-interval
Which hemodynamic alteration is the most common cause of a decrease in cardiac output in the postoperative cardiovascular patient? Reduced preload Increased afterload Increased contractility Bradycardia
Reduced preload
A practitioner and nurse are performing a dressing change on an unresponsive patient in room 14. The practitioner asks the nurse for an update on the patient in room 13. Which action should the nurse take next? Give the update to the practitioner. Refuse to give the update because of Health Insurance Portability and Accountability Act (HIPAA) requirements. Give the update because the is patient's unconscious. Refuse to give the update because of Occupational Safety and Health Administration (OSHA) requirements.
Refuse to give the update because of Health Insurance Portability and Accountability Act (HIPAA) requirements.
What is a major side effect of benzodiazepines? Hypertension Respiratory depression Renal failure Phlebitis
Respiratory depression
What is the rationale for administrating a fibrinolytic agent to a patient experiencing acute ST-elevation myocardial infarction (STEMI)? Dilation of the blocked coronary artery Anticoagulation to prevent formation of new emboli Dissolution of atherosclerotic plaque at the site of blockage Restoration of blood flow via lysis of the thrombus
Restoration of blood flow via lysis of the thrombus
What are the two scales that are recommended for assessment of agitation and sedation in adult critically ill patients? Ramsay Scale and Riker Sedation-Agitation Scale (SAS) Ramsay Scale and Motor Activity Assessment Scale (MAAS) Riker Sedation-Agitation Scale (SAS) and the Richmond Agitation-Sedation Scale (RASS) Richmond Agitation-Sedation Scale (RASS) and Motor Activity Assessment Scale (MAAS)
Riker Sedation-Agitation Scale (SAS) and the Richmond Agitation-Sedation Scale (RASS)
Which findings would be reasons to abort an exercise stress test? Ventricular axis of +90 degrees Increase in blood pressure Inverted U wave ST segment depression or elevation
ST segment depression or elevation
A new-onset myocardial infarction (MI) can be recognized by what electrocardiogram (ECG) change? Q waves Smaller R waves Widened QRS ST segment elevation
ST segment elevation
What type of atrioventricular (AV) block can be described as a gradually lengthening PR interval until ultimately the final P wave in the group fails to conduct? First-degree AV block Second-degree AV block, type I Second-degree AV block, type II Third-degree AV block
Second-degree AV block, type I
When administering propofol over an extended period, what laboratory value should the nurse routinely monitor? Serum triglyceride level Sodium and potassium levels Platelet count Acid-base balance
Serum triglyceride level
What is the major advantage of using propofol as opposed to another sedative for short-term sedation? Fewer side effects Slower to cross the blood-brain barrier Shorter half-life and rapid elimination rate Better amnesiac properties
Shorter half-life and rapid elimination rate
Which classification of dysrhythmia is most common with an inferior wall infarction in the first hour after ST segment elevation myocardial infarction (STEMI)? Sinus tachycardia Multifocal PVCs Atrial fibrillation Sinus bradycardia
Sinus bradycardia
What is the most common contributing factor to the development of delirium in critically ill patients? Sensory overload Hypoxemia Electrolyte disturbances Sleep deprivation
Sleep deprivation
A patient has been admitted in hypertensive crisis. Which medication would the nurse expect the practitioner to order for this patient? Digitalis Vasopressin Verapamil Sodium nitroprusside
Sodium nitroprusside
A patient is admitted with left-sided heart failure and a blood pressure of 220/118 mm Hg. Which drug will be most effective in decreasing the blood pressure and reducing afterload? Dopamine Verapamil Propranolol Sodium nitroprusside
Sodium nitroprusside
Which statement regarding the difference between stable and unstable angina is accurate? Stable angina responds predictably well to nitrates. Stable angina is not precipitated by activity. Stable angina has a low correlation to coronary artery disease (CAD). Stable angina is a result of coronary artery spasm.
Stable angina responds predictably well to nitrates.
The nurse is caring for a patient with these vital signs: blood pressure 220/110, pulse 108, respiratory rate 24, temperature 103° F, and oxygen saturation of 94% on oxygen 2L nasal cannula. The patient is responsive and denies chest pain. The physician has ordered a work-up for coronary artery disease (CAD). These findings are suggestive of which diagnosis? Silent ischemia Prehypertension Stage 1 hypertension Stage 2 hypertension
Stage 2 hypertension
Which intervention is an essential aspect of the patient teaching plan for the patient with chronic heart failure? Instructing the patient to call the practitioner prior to dental surgery Stressing the importance of compliance with diuretic therapy Instructing the patient to take nitroglycerin if chest pain occurs Teaching the patient how to take an apical pulse
Stressing the importance of compliance with diuretic therapy
The physician is going to place a central venous catheter. Which anatomic site is associated with a lower risk of infection? Subclavian vein External jugular vein Internal jugular vein Femoral vein
Subclavian vein
A positive signal-averaged electrocardiogram (ECG) indicates that a patient is at risk for what problem? Myocardial infarction Sudden cardiac death Coronary artery disease Stroke
Sudden cardiac death
Institutional ethics committees (IECs) review ethical cases that are problematic for the practitioner. What is the major function of an IEC? Consultation with purely binding recommendations Support and education to health care providers Conflict resolution for moral dilemmas Recommendations that are binding in all cases
Support and education to health care providers
Hospice care is an option that should be considered, especially in end-stage illness. Hospice care can help families with which issue(s)? Organ and tissue donations Symptom management and family support Procurement of advance directives and living wills Legal and voluntary euthanasia
Symptom management and family support
The nurse is developing a patient education plan for a patient with valvular heart disease. Which instruction would be included as part of that plan? Increase fluid intake to increase cardiac output. Take sodium replacement tablets to replace sodium lost with diuretics. Increase daily activity until shortness of breath occurs. Take prophylactic antibiotics before undergoing any invasive procedure.
Take prophylactic antibiotics before undergoing any invasive procedure.
A patient with a serum potassium level of 6.8 mEq/L may exhibit what type of electrocardiographic changes? A prominent U wave Tall, peaked T waves A narrowed QRS Sudden ventricular dysrhythmias
Tall, peaked T waves
Which description best describes the pain associated with aortic dissection? Substernal pressure Tearing in the chest, abdomen, or back Numbness and tingling in the left arm Stabbing in the epigastric area
Tearing in the chest, abdomen, or back
A patient was admitted to a rural critical care unit in Montana. Critical care nurses are assisting with monitoring and care of the patient from the closest major city. What is this type of practice termed? Tele-nursing Tele-ICU Tele-informatics Tele-hospital
Tele-ICU
A patient is connected to an external temporary pulse generator. What does the sensitivity control regulate? The time interval between the atrial and ventricular pacing stimuli The amount of electrical current and is measured in milliamperes The ability of the pacemaker to detect the heart's intrinsic electrical activity The number of impulses that can be delivered to the heart per minute
The ability of the pacemaker to detect the heart's intrinsic electrical activity
A patient presents with atrial flutter with an atrial rate of 280 beats/min and a ventricular rate of 70 beats/min. Which statement best explains this discrepancy in rates? The ventricles are too tired to respond to all the atrial signals. The atrioventricular (AV) node does not conduct all the atrial signals to the ventricles. Some of the atrial beats are blocked before reaching the AV node. The ventricles are responding to a ventricular ectopic pacemaker.
The atrioventricular (AV) node does not conduct all the atrial signals to the ventricles.
How does a percutaneous transluminal coronary angioplasty (PTCA) improve blood flow? The balloon stretches the vessel wall, fractures the plaque, and enlarges the vessel lumen. Medication is delivered through the catheter that dissolves the plague and enhances vessel patency. The balloon removes blood clots from the vessel improving patency of the vessel. The balloon compresses the plaque against the vessel wall enlarging the vessel lumen.
The balloon stretches the vessel wall, fractures the plaque, and enlarges the vessel lumen.
A patient was admitted several weeks ago with an acute myocardial infarction and subsequently underwent coronary artery bypass grafting surgery. Since a cardiac arrest 5 days ago, the patient has been unresponsive. An electroencephalogram shows no meaningful brain activity. The decision is made to remove the patient from the ventilator. Which of the following statements is most accurate? The cardiac monitor should be left on so everyone will know when the patient has died. Opioids, sedatives, and neuromuscular blocking agents should be discontinued just before removing the ventilator. The family and health care team should decide the best method for removing the ventilator terminal wean versus immediate extubation. If terminal weaning is selected, the family should be sent to the waiting room until the ventilator has actually been removed.
The family and health care team should decide the best method for removing the ventilator terminal wean versus immediate extubation.
To accurately measure the heart rate of a patient in normal sinus rhythm, which technique would be the most accurate? The number of R waves in a 6-second strip The number of large boxes in a 6-second strip The number of small boxes between QRS complexes divided into 1500 The number of large boxes between consecutive R waves divided into 300
The number of small boxes between QRS complexes divided into 1500
A nurse is obtaining the history of a patient who reveals that he had an myocardial infarction (MI) 5 years ago. When the admission 12-lead electrocardiogram (ECG) is reviewed, Q waves are noted in leads V3 and V4 only. Which conclusion is most consistent with this situation? The patient may have had a posterior wall MI. The patient must have had a right ventricular MI. The admission 12-lead ECG was done incorrectly. The patient may have had an anterior MI.
The patient may have had an anterior MI.
What is the rationale for giving the patient additional fluids after a cardiac catheterization? Fluids help keep the femoral vein from clotting at the puncture site. The patient had a nothing-by-mouth order before the procedure. The radiopaque contrast acts as an osmotic diuretic. Fluids increase cardiac output.
The radiopaque contrast acts as an osmotic diuretic.
Most chest radiographs of critically ill patients are obtained using a portable chest radiograph machine. What is the difference between a chest radiograph taken in the radiology department and one taken in the critical care unit? Portable chest radiographs are usually clearer. Only posterior views can be obtained in the critical care unit. The sharpness of the structures is decreased with a portable chest radiograph. Chest radiographs taken in radiology enlarge some thoracic structures.
The sharpness of the structures is decreased with a portable chest radiograph.
Which statement about coronary artery disease (CAD) is accurate? There is a low correlation between modifiable risk factors and CAD. The onset of CAD occurs in middle age women sooner than men of the same age. There is an association between development of specific risk factors and CAD. The lower the C-reactive protein level the higher the risk for a coronary event.
There is an association between development of specific risk factors and CAD.
Why are vasopressors used cautiously in the treatment of critical care patients? They cause vasoconstriction of the smooth muscles. They cause vasodilation of the smooth muscles. They increase afterload. They decrease preload.
They increase afterload.
Which of the following statements regarding beta-blockers is correct? They increase heart rate and are contraindicated in tachydysrhythmias. They result in bronchospasm and should not be used in patients with chronic obstructive pulmonary disease (COPD). They increase cardiac output and help with left ventricular failure. They are helpful in increasing atrioventricular node conduction and are used in heart blocks.
They result in bronchospasm and should not be used in patients with chronic obstructive pulmonary disease (COPD).
A patient presents with severe substernal chest pain. The patient exclaims, "This is the most severe pain I have ever felt!" The patient reports that the pain came on suddenly about 2 hours ago and that three sublingual nitroglycerin tablets have not relieved the pain. The 12-lead electrocardiogram (ECG) reveals only the following abnormalities: T-wave inversion in leads I, aVL, V4, and V5; pathologic Q waves in leads II, III, and aVF; ST segment elevation in leads V1, V2, V3, and V4. Which statement is accurate about this patient? This patient has an old lateral wall infarction. This patient is having an inferior wall infarction. This patient is having an acute anterior wall infarction. This patient is having a posterior wall infarction.
This patient is having an acute anterior wall infarction.
Adenosine is an antidysrhythmic agent that is given primarily what reason? To convert supraventricular tachycardias To suppress premature ventricular contractions (PVCs) To treat second and third degree AV blocks To coarsen ventricular fibrillation so that defibrillation is effective
To convert supraventricular tachycardias
Why is the Allen test performed before placement of a radial arterial line placement? To evaluate collateral circulation to the hand To estimate patency of the radial artery To appraise the neurologic function of the hand To assess the sensitivity of the insertion point
To evaluate collateral circulation to the hand
A patient is admitted for palliative care for end-stage heart failure. What is the nurse's primary goal when caring for this patient? To reverse heart failure with the use of diuretics To increase activity tolerance To manage symptoms and relieve pain To increase cardiac output related to alteration of contractility
To manage symptoms and relieve pain
Noninvasive emergency pacing is best achieved via the use of which type of temporary pacing? Transvenous (endocardial) Epicardial Transthoracic Transcutaneous
Transcutaneous
A patient with coronary artery disease (CAD) is admitted with chest pain. The patient is suddenly awakened with severe chest pain. Three nitroglycerin sublingual tablets are administered 5 minutes apart without relief. A 12-lead electrocardiograph (ECG) reveals nonspecific ST segment elevation. The nurse suspects the patient may have which disorder? Silent ischemia Stable angina Unstable angina Prinzmetal angina
Unstable angina
A transvenous pacemaker is inserted through the right subclavian vein and threaded into the right ventricle. The pacemaker is placed on demand at a rate of 70. What is the three letter code for this pacing mode? VVI AOO DDD VAT
VVI
Which core competency for interprofessional practice can be described as working with individuals of other professions to maintain a climate of mutual respect and shared values? Interprofessional teamwork and team-based care Values and ethics for interprofessional practice Interprofessional communication Roles and responsibilities for collaborative practice
Values and ethics for interprofessional practice
Which lead is best to monitor a patient? Varies based on the patient's clinical condition and recent clinical history Lead aVF Lead V1 Lead II
Varies based on the patient's clinical condition and recent clinical history
What is the major factor influencing the patient's response to atrial flutter? Atrial rate Ventricular response rate PR interval QRS duration
Ventricular response rate
What dysrhythmia is most frequently associated with sudden cardiac death? Premature ventricular contractions Ventricular tachycardia Third degree heart block Asystole
Ventricular tachycardia
Which ethical principle is most important when soliciting informed consent from a patient? Nonmaleficence Fidelity Beneficence Veracity
Veracity
A patient has an implantable cardioverter defibrillator (ICD) for chronic ventricular tachydysrhythmias. What action should the nurse take when the patient's rhythm deteriorates to ventricular fibrillation? Apply an external defibrillator to the patient. Call a code and start cardiopulmonary resuscitation (CPR) on the patient. Wait for the ICD to defibrillate the patient. Turn the ICD off and administer epinephrine.
Wait for the ICD to defibrillate the patient.
The possibility of microshock when handling a temporary pacemaker can be minimized by which intervention? Decreasing the milliamperes Wearing gloves Positioning the patient on the left side Wearing rubber-soled shoes
Wearing gloves
Which electrocardiographic (ECG) abnormality is most often found in ventricular dysrhythmias? Retrograde P waves Wide QRS complexes No P waves An inverted T wave
Wide QRS complexes
Why do women have higher mortality rates from acute myocardial infarction (MI) than men? Women wait longer to seek medical care. Women have more risk factors for coronary artery disease than men. Women have a higher risk of coronary spasm than men. Women have smaller hearts than men.
Women wait longer to seek medical care.
The concept of diversity encompasses what thoughts and actions? (Select all that apply.) Sensitivity to ethnic differences Openness to different lifestyles Openness to different values Reticence to different beliefs Lack of concern regarding different opinions
a, b, c
Which mechanisms responsible for a myocardial infarction (MI)? (Select all that apply.) Coronary artery thrombosis Plaque rupture Coronary artery spasm near the ruptured plaque Preinfarction angina Hyperlipidemia
a, b, c
According to American Association of Critical-Care Nurses, what are the responsibilities of a critical care nurse? (Select all that apply.) Respecting the values, beliefs, and rights of the patient Intervening when the best interest of the patient is in question Helping the patient obtain necessary care Making decisions for the patient and patient's family Monitoring and safeguarding the quality of care the patient receives Acting as a gatekeeper for the patient, the patient's family, and other health care professionals
a, b, c, e
Which of the following are considerations when making the decision to allow family at the bedside during resuscitation efforts? (Select all that apply.) The patient's wishes Experience of the staff The family's need to participate in all aspects of the patient's care State regulatory issues Seeing the resuscitation may confirm the impact of decisions made or delayed
a, b, c, e
Which physiologic effects can be associated with physical exercise? (Select all that apply.) Decreased LDL cholesterol Increased HDL cholesterol Decreased triglycerides Increased insulin resistance Decreased incidence of depression
a, b, c, e
A patient is diagnosed with third-degree heart failure. The nurse reviews the patient's medication list. Which classifications of drugs should be avoided with this patient? (Select all that apply.) Nonsteroidal antiinflammatory drugs (NSAIDs) Antidysrhythmics Angiotensin-converting enzyme (ACE) inhibitors Calcium channel blockers Beta-blockers
a, b, d
Which situations are early signs of an ethical dilemma? (Select all that apply.) Disagreements among health care team members Failure to discuss end-of-life issues with patient Aggressive pain management Belief that treatment is harmful Following the patient's advance directive despite family objections Providing hope to the patient's family
a, b, d
In one study found that greater family satisfaction with withdrawal of life support was associated with which of the following measures? (Select all that apply.) The patient appearing comfortable A chance to voice concerns Discussions were held in the patient's room The process was well explained Adequate privacy during withdrawal of life support
a, b, d, e
Which complications can result from prolonged deep sedation? (Select all that apply.) Pressure ulcers Thromboembolism Diarrhea Nosocomial pneumonia Delayed weaning from mechanical ventilation Hypertension
a, b, d, e
According to Kupperschmidt, what factors are needed to become a skilled communicator? (Select all that apply.) Becoming candid Becoming reflective Setting goals Surveying the team Becoming aware of self-deception
a, b, e
Which of the following is/are criteria for defining an ethical dilemma? (Select all that apply.) An awareness of different options An issue in which only one viable option exists The choice of one option compromises the option not chosen An issue that has different options
a, c, d
What considerations are taken into account in evidence-based nursing practice? (Select all that apply.) Clinical expertise of the nurse Availability of staff and facility equipment Research evidence on the topic Patient knowledge of the disease Patient preference regarding care
a, c, e
Which clinical manifestations are indicative of left ventricular failure? (Select all that apply.) Cool, pale extremities Jugular venous distention Liver tenderness Weak peripheral pulses Rales
a, d, e
What type of practitioner has a broad depth of specialty knowledge and expertise and manages complex clinical and system issues? Registered nurses Advanced practice nurses Clinical nurse leaders Intensivists
advanced practice nurses
What type of therapy is an option to conventional treatment? Alternative Holistic Complementary Individualized
alternative
Nursing interventions after angioplasty would include which of the following? (Select all that apply.) Elevating the head of the bed to 45 degrees Hydration as a renal protection measure Assessing pedal pulses on the involved limb every 15 minutes for the first 2 hours after the procedure Monitoring the vascular hemostatic device for signs of bleeding Educating the patient on the necessity of staying supine for 1 to 2 hours after the procedure
b, c, d
Which signs and symptoms would indicate successful reperfusion after administration of a fibrinolytic agent? (Select all that apply.) Gradual decrease in chest pain Intermittent, multifocal premature ventricular contractions Rapid resolution of ST elevation Rapid rise in creatine kinase MB fraction
b, c, d
Which patients would be a candidate for fibrinolytic therapy? (Select all that apply.) The patient's chest pain started 8 hours ago. She has a diagnosis of non-ST-elevation myocardial infarction (NSTEMI). The patient's chest pain started 3 hours ago, and her electrocardiogram (ECG) shows a new left bundle branch block. The patient presents to the emergency department with chest pain of 30 minutes' duration. She has a history of cerebrovascular accident 1 month ago. The patient has a history of unstable angina. He has been experiencing chest pain with sudden onset. The patient's chest pain started 1 hour ago, and his ECG shows ST elevation.
b, e
What are the causes of delirium in critically ill patients? (Select all that apply.) Hyperglycemia Meningitis Cardiomegaly Pulmonary embolism Alcohol withdrawal syndrome Hyperthyroidism
b, e, f
What type of practitioner is instrumental in ensuring care that is evidence based and that safety programs are in place? Clinical nurse specialist Advanced practice nurse Registered nurses Nurse practitioners
clinical nurse specialist
To achieve ventilator synchrony in a mechanically ventilated patient with acute respiratory distress syndrome (ARDS), which level of sedation might be most effective? Light Moderate Conscious Deep
deep
Haloperidol are traditionally been used to managed which symptom? Anxiety Dyspnea Delirium Pain
delirium
A patient with heart failure may be at risk for hypomagnesemia as a result of which factor? Pump failure Diuretic use fluid overload hemodilution
diuretic use
Emphasis is on human integrity and stresses the theory that the body, mind, and spirit are interdependent and inseparable. This statement describes which methodology of care? Holistic care Individualized care Cultural care Interdisciplinary care
holistic care
What is a powerful influence when the decision-making process is dealing with recovery or a peaceful death? Hope Religion Culture Ethics
hope
A patient's wife has been informed by the practitioner that her spouse has permanent quadriplegia. The wife states that she does not want anyone to tell the patient about his injury. The patient asks the nurse about what has happened. The nurse has conflicting emotions about how to handle the situation. What is the nurse experiencing? Autonomy Moral distress Moral doubt Moral courage
moral distress
Disagreement and distress among practitioners, nurse practitioners, and critical care nurses can lead to what issue? Moral indignation Ethical resentment Moral distress Interprofessional anguish
moral distress
