Critical Care Test 2
What should the nurse include in the plan of care for a patient being prepared for electrical cardioversion? Select all that apply.
-Obtain informed consent from the patient -Record a 12lead ECG and vital signs -Sedate the patient.
A patient in the CCU is suspected to have had a myocardial infarction. His blood work results have arrived, and the nurse is reviewing them. Which results would indicate myocardial infarction? Select all that apply.
-elevated troponins -CK-MB isoenzyme at 10% of total creatine kinase -C-reactive protein serum value of 6 mg/dL
A patient with left main coronary artery disease (CAD) experiences persistent angina. She would like to exercise more, but is limited by shortness of breath and angina. Her physician believes that she is a good candidate for coronary artery bypass graft. The nurse recognizes that which of the following are indications for coronary artery bypass graft (CABG) surgery in this situation?
-having left main CAD -having persistent angina -limited exercise tolerance
A patient in the CCU is suspected of having coronary artery disease (CAD) following myocardial infarction. Which blood test or tests would be most pertinent in evaluating this patient's condition?
-low density lipoproteins -triglycerides -high density lipoproteins
A patient in the CCU has been found on examination by ECG to have a bundle branch block. Which of the following should the nurse expect to see on this patient's ECG?
A broad QRS complex with two peaks (RSR)
You have how many minutes to fix cardiogenic shock?
90
The patient is receiving intraaortic balloon pump (IABP) counterpulsation. What is an indication for this therapy?
Hypotension after ST elevation myocardial infarction refractory to other therapy
A patient with severe coronary artery disease is scheduled for coronary artery bypass graft surgery. As part of the preoperative teaching, the nurse explains the surgery. Which of the following statements about this procedure is true?
A piece of saphenous vein will be used to go around the diseased part of the artery
A nurse is working with multiple heart patients in the critical care unit. What information in the patients charts would indicate intraaortic balloon pump (IABP) counterpulsation? Select all that apply.
A) Cardiogenic shock subsequent to acute myocardial infarction B) Low cardiac output following cardiac surgery C) Unstable angina
A patient requires a pacemaker that will pace his atria, sense electrical activity in his atria, and inhibit the response to sensed events. Which mode of pacemaker would he need?
AAI
The physician has ordered fibrinolytic agents for a patient with coronary artery disease. What patient diagnosis would the nurse most expect?
Acute ST segment elevation myocardial infarction
A pregnant patient in the CCU who recently was in a motor vehicle accident suddenly complains of an intense chest pain that she describes as ripping before passing out. On auscultation, the nurse hears the murmur of aortic regurgitation. What condition does the woman most likely have?
Aortic dissection
The nurse is caring for a patient undergoing intra aortic balloon pump (IABP) counterpulsation. What patient symptom most requires immediate nursing intervention?
Balloon is inflating during ventricular systole
A patient is admitted with complications and exacerbation of symptoms from dilated cardiomyopathy. Which easily treated factor might account for the change in the patients condition?
Chronic alcohol abuse
The patient is scheduled to undergo a percutaneous cardiac intervention (PCI). What patient history would the nurse least expect to find
Coronary artery lesions less than 70% narrowing
A nurse is assessing a client's cardiac rhythm strip. The nurse recognizes the initial steps of evaluating the strip occur in which order?
Determine atrial and ventricular heart rates, examine the rhythm to see if it is regular, inspect for P waves
What laboratory value is most likely to indicate renal failure?
Elevated serum creatinine
A young adult collapses during a sporting event. Cardiopulmonary resuscitation is successful, and the patient is admitted with a diagnosis of possible hypertrophic cardiomyopathy. What nursing assessment is a priority for this patient?
Evaluation for dyspnea and heart murmur
A patient has a permanent pacemaker and complains of redness and swelling over the site of the generator implantation. The patient also has fever and leukocytosis. What is the most appropriate nursing action
Facilitate administration of IV antibiotics
A female patient has just undergone a percutaneous coronary intervention (PCI). What symptom, if found by the nurse, requires immediate intervention?
Frank bleeding from the femoral insertion site
Oliguria, proteinuria, hematuria, and cola colored urine are all signs of what?
Glomerulonephritis
___________-most common following infections by strains of Group A beta-hemolytic strep
Glomerulonephritis
A patient with heart failure is being monitored with a pulmonary artery catheter to assess cardiac output and its components. What pattern of results would indicate a need for immediate intervention?
Heart rate is rapid, preload is reduced, contractility and afterload are normal, andcardiac output is reduced.
A patient is being treated for hypertrophic cardiomyopathy. During discharge teaching, what is the most important information to include?
Make an appointment for genetic screening and counseling
A patient is experiencing a malfunction with his permanent implanted pacemaker, and the nurse is examining his electrocardiogram strip. The patients pacemaker has a ventricular unipolar catheter and is in VVI mode. Which of the following findings should the nurse be most concerned about?
Pacing spikes absent
A patient who had a transvenous pacemaker placed in the subclavian vein 24 hours ago is experiencing pleuritic pain, hypotension, and respiratory distress. What complication does the nurse suspect in this patient?
Pneumothorax
A patient is being treated with the intraaortic balloon pump (IABP). What effect of the balloon is most important?
Reduction of left ventricular workload
A patient in the CCU who is undergoing ECG monitoring has impulses originating at the sinoatrial node at a rate of 75 bpm, a shortest RR interval of 0.69 seconds, and a longest RR interval of 0.84 seconds. The P wave is regular. Which sinus rhythm does this patient exhibit?
Sinus dysrhythmias
What change on the electrocardiogram indicates that ischemia of the tissue is occuring?
T wave inversion
. A patient calls emergency services with complaints of crushing chest and left shoulder pain. He should be instructed to:
Take 325 mg of aspirin
The patient has undergone a percutaneous coronary intervention (PCI) for relief of coronary stenosis secondary to arteriosclerotic heart disease. During discharge teaching, what patient statement most indicates the need for reteaching?
This procedure means that my heart disease is cured
a bridge to transplant
VAD
A nurse is performing an EKG on a client with a past history of myocardial infarction (MI) who is now experiencing severe chest pain. The nurse anticipates which rhythm pattern would confirm only the past MI and not one occurring at the present/
abnormal Q waves accompanied by normal ST segment
how to administer atropine?
administer one injection (2mg) then wait 10-15 min and administer 2 more is pt symptoms worsen
A patient is recovering in the CCU following off-pump coronary artery bypass graft (OPCABG) surgery involving the internal mammary artery graft. What nursing intervention is most important for the first 48 hours following surgery for this patient?
administration of anticoagulant therapy
A patient in the CCU is experiencing premature atrial contractions following coronary artery bypass graft surgery. Which of the following would be the most appropriate nursing intervention?
administration of potassium and magnesium
A patient in the CCU is recovering from coronary artery bypass graft (CABG) surgery. He has had multiple graft surgeries in the past. For this latest surgery, the patient's radial artery was used in the graft. What complication should the nurse most expect to observe in this patient?
arterial spasm
A patient is admitted for repair of an abdominal aortic aneurysm and begins to complain of severe abdominal pain and a sense of impending doom. What assessment should the nurse perform first?
blood pressure
Cardiomyopathy, valvular problems, severe heart failure, and myocarditis can cause
cardiogenic shock
You see this rhythm (VFIB) from a client who is being admitted with a myocardial infarction. What should the nurse do first?
check for pulse
The nurse is caring for a patient who has just had coronary artery bypass grafting and is experiencing significant hypotension. What nursing assessment would best confirm that the hypotension is related to blood loss?
chest tube drainage in excess of 200 mL/hr
A patient presents to the CCU with acute, decompensated heart failure. The nurse observes that this patient has chronic obstructive pulmonary disease and hypotension. She eats a lowsodium diet and drinks alcohol excessively. Which of the following are contributing factors to this patients heart failure? Select all that apply.
chronic obstructive pulmonary disease
A nurse is caring for several clients with cardiac malfunctions. The nurse anticipates which client will receive a permanent pacemaker?
chronic, intermittent complete heart block
A patient is being evaluated for possible permanent pacemaker implantation. Which of the following would be the best indication for permanent pacemaker implantation in this patient?
chronic, intermittent complete heart block
A patient receiving a blood transfusion in the ICU has developed relative hypocalcemia. What is the most likely cause for the hypocalcemia?
citrate binding to calcium
A nurse is caring for a patient during radiofrequency ablation. What nursing interventions would most likely put the patient at ease?
communicating with the patient about the progress of the procedure
A nurse in the CCU must assess a patient's cardiac rhythm strip. Which of the following represents the first three steps in this assessment in correct order?
determine atrial and ventricular heart rates, examine the rhythm to see if it is regular, look for P waves
What is a continuous venovenous hemodialysis filter permeable to?
electrolytes
A patient has been diagnosed with acute left heart failure secondary to acute myocardial infarction and increased afterload. What changes in assessment findings does the nurse expect to find?
elevated pulmonary wedge pressure
A client has been admitted to the coronary care unit with a diagnosis of MI. He had been in NSR since admission. Now the nurse notes on the monitor that P waves are present with one P wave per QRS complex. Each PPR interval measures 0.26 seconds. Which is he experiencing?
first degree heart block
A patient with cardiac failure is being prepped to receive a ventricular assist device for circulatory support. What procedure should the nurse expect the patient to undergo in the future?
heart transplantation
A nurse working with a patient with a Novacor ventricular assist device (VAD) for longterm circulatory support recognizes that this patient is at risk for thromboembolic events. Which of the following is the best intervention for this patient?
heparin infusions initially, which is gradually replaced by warfarin therapy
A client in the critical care unit exhibits a tall, narrow, and peaked t wave on electrocardiogram. The nurse recognizes that this is most likely an early sign of which electrolyte abnormality?
hyperkalemia
A patient in the CCU exhibits a tall, narrow, and peaked T wave on ECG. The nurse recognizes that this is most likely an early sign of which of the following?
hyperkalemia
A patient with renal impairment is found to have a positive Chvosteks sign. What additional information should the nurse assess for?
hypocalcemia
A patient in the ICU has acute renal failure and is an alcoholic. Which electrolyte imbalance would the nurse most expect to find in this patient?
hypomagnesemia
A patient has been admitted with acute left systolic heart failure secondary to acute myocardial infarction. The patient has dyspnea and orthopnea and a cardiac rhythm of sinus tachycardia. The physiologic dysfunction for this type of heart failure is what?
impaired contractility of the left ventricle
A patient has been admitted with right heart failure. The physiologic basis of right heart failure is what?
impaired right cardiac output
The nurse is caring for a patient who has been admitted with a diagnosis of heart failure. What does the term heart failure mean?
it is a general clinical syndrome with many etiologies
An elderly patient with uncontrolled hypertension and atrial fibrillation with rapid ventricular response is admitted with a diagnosis of heart failure. He has crepitant pulmonary rales and his chest xray shows pulmonary congestion. The patient probably has what type of heart failure?
left ventricular diastolic failure
A patient has been diagnosed with chronic heart failure, compensated. What symptoms would the nurse expect to find?
mild dyspnea on exertion or when supine
A patient is in the CCU with dilated cardiomyopathy and asymptomatic rightsided chronic heart failure. What finding will the nurse most likely discover in her assessment of this patient?
mitral regurgitation murmur
A client is on a cardiac monitor. The nurse notes the QRS interval is 0.14 seconds. The nurse recognizes this indicates which action of the client's heart?
normal rate and rhythm
Upon assessment of a third degree heart block on the monitor, what should the nurse do first?
place the transcutaneous pacing pads on the client
A nurse caring for a client with hypocalcemia should expect to find which change on the electrocardiogram?
prolonged QT interval
A nurse reviews a client's laboratory results and notes the potassium level is 2.5 mEq/L. Which pattern should the nurse observe on the electrocardiogram as a result of the lab value?
prominent U waves
A patient has been diagnosed with left ventricular heart failure. What physical findings would the nurse expect?
pulmonary rales
A patient who has just has coronary artery bypass surgery has developed tachycardia, a low-grade fever, and an elevated total white blood cell count. What additional sign or symptom would support the nurse's suspicion of a postoperative infection?
purulent drainage from the chest incision
_______-may have severe hypertension which contributes to a significant cause of renal failure
pyelonephritis
A patient recovering in the CCU following coronary artery bypass graft (CABG) surgery complains of pain in his chest. The patient underwent a sternotomy incision during the surgery. Which of the following types of pain would indicate angina—which may indicate graft failure—as opposed to typical pain resulting from the sternotomy?
radiates to arms
A patient with severe coronary artery disease has persistent angina that is refractory to medical management at maximum drug doses and has severe compromise of activities of daily living from the angina. The patient has had several coronary artery bypass surgeries and has been told that he is not a candidate for any further surgeries or percutaneous interventions such as stents. In discussing options for further therapy, what should the nurse include that would offer the patient the most hope?
referral to the transmyocardial laser revascularization program for evaluation
A patient recovering from cardiopulmonary bypass surgery is shivering. For what reason should the nurse be concerned about the shivering?
shivering increases myocardial workload
The patient has just had a transvenous cardiac pacemaker lead inserted into the subclavian vein. What patient symptom, if found by the nurse, would most indicate a possible complication unique to the use of the subclavian vein?
sudden respiratory distress, hypoxia, and hypotension
What do you treat pyelonephritis with?
sulfanomides and fluids
A patient in the CCU has an abdominal aortic aneurysm that is 7 cm in diameter. The nurse recognizes that which of the following is the most appropriate treatment for this patient?
surgical repair
Leads I, II, and III is telling you the view of what?
the heart
One therapeutic measure for treating hyperkalemia is the administration of dextrose and regular insulin. How do these agents lower potassium?
they force potassium out of the serum and into the cells, thus causing potassium to lower
Congestive Heart Failure would lead to what type of pleural effusion
transudative
What medication do you give for cardiogenic shock?
vasoconstrictors (dopamine, epi, norepi, phenylephrine
A patient with heart failure comes to the clinic for a routine monitoring visit. What findings would indicate achievement of therapeutic goals?
weight is within 2 pounds of ideal weight
A patient with a history of hypertension has been admitted for surgical repair of a thoracic aneurysm. What symptom would indicate probable acute dissection of the aneurysm?
wide mediastinum on chest x-ray
