Week 2
The patient's heart rate is 70 beats per minute with the P waves coming after the QRS complex. The nurse correctly determines that the patient is demonstrating what heart rhythm? A junctional tachycardia An accelerated junctional rhythm Atrial fibrillation A normal junctional rhythm
An accelerated junctional rhythm
The primary health care provider writes an order to discontinue a patient's left radial arterial line. When discontinuing the patient's invasive line, what is the priority nursing action? Apply an air occlusion dressing to insertion site. Elevate the affected limb on pillows for 24 hours. Keep the patient's wrist in a neutral position. Apply pressure to the insertion site for 5 minutes.
Apply pressure to the insertion site for 5 minutes.
The nurse is caring for a 70-kg patient in septic shock with a pulmonary artery catheter. Which hemodynamic value indicates an appropriate response to therapy aimed at enhancing oxygen delivery to the organs and tissues? Mixed venous (SvO2) of 40% Arterial lactate level of 1.0 mEq/L Cardiac index of 1.5 L/min/m2 Cardiac output of 2.5 L/min
Arterial lactate level of 1.0 mEq/L
The nurse is reading the cardiac monitor and notes that the patient's heart rhythm is extremely irregular and there are no discernible P waves. The ventricular rate is 90 beats per minute, and the patient is hemodynamically stable. The nurse realizes that the patient is demonstrating what rhythm? Junctional escape rhythm Atrial flutter with rapid ventricular response Atrial fibrillation Atrial flutter
Atrial fibrillation
The patient is in chronic junctional escape rhythm with no atrial activity noted. Studies have demonstrated normal AV node function. This patient may be a candidate for which type of pacing? Dual-chamber pacing Transcutaneous pacing Atrial pacing Ventricular pacing
Atrial pacing
The charge nurse has a Vigileo pulse contour cardiac output monitoring system available for use in the surgical intensive care unit. For which patient is use of this device most appropriate? A) A patient with a history of atrial fibrillation having frequent episodes of paroxysmal supraventricular tachycardia B) A mechanically ventilated patient admitted following repair of an acute bowel obstruction C) A mechanically ventilated patient with cardiogenic shock being treated with an intraaortic balloon pump D) A patient with a history of aortic insufficiency admitted with a postoperative myocardial infarction
B) A mechanically ventilated patient admitted following repair of an acute bowel obstruction
The nurse is caring for a mechanically ventilated patient with a pulmonary artery catheter who is receiving continuous enteral tube feedings. When obtaining continuous hemodynamic monitoring measurements, what is the best nursing action? A) Level and zero reference the air-fluid interface of the transducer with the patient supine in the side-lying position and record hemodynamic values. B) Level and zero reference the air-fluid interface of the transducer with the patient's head of bed elevated to 30 degrees and record hemodynamic values. C) Level and zero reference the air-fluid interface of the transducer with the patient in the supine position and record hemodynamic values. D) Do not document hemodynamic values until the patient can be placed in the supine position.
B) Level and zero reference the air-fluid interface of the transducer with the patient's head of bed elevated to 30 degrees and record hemodynamic values.
Following insertion of a central venous catheter, the nurse obtains a stat chest x-ray film to verify proper catheter placement. The radiologist reports to the nurse: "The tip of the catheter is located in the superior vena cava." What is the best interpretation of these results by the nurse? A) The catheter is not positioned correctly and should be removed. B) The distal tip of the catheter is in the appropriate position. C) The physician should be called to advance the catheter into the pulmonary artery. D) The catheter position increases the risk of ventricular dysrhythmias.
B) The distal tip of the catheter is in the appropriate position.
The nurse is preparing to measure the thermodilution cardiac output (TdCO) in a patient being monitored with a pulmonary artery catheter. Which action by the nurse best ensures the safety of the patient? A) Limit the length of the noncompliant pressure tubing to a maximum 48 inches. B) Ensure the transducer system is zero referenced at the level of the phlebostatic axis. C) Avoid infusing vasoactive agents in the port used to obtain the TdCO measurement. D) Maintain a pressure of 300 mm Hg on the flush solution using a pressure bag.
C) Avoid infusing vasoactive agents in the port used to obtain the TdCO measurement.
A patient is admitted with the diagnosis of unstable angina. The nurse knows that the physiological mechanism present is most likely which of the following? A) Complete occlusion of a coronary artery B) Vasospasm of a coronary artery C) Partial occlusion of a coronary artery with a thrombus D) Fatty streak within the intima of a coronary artery
C) Partial occlusion of a coronary artery with a thrombus
The nurse is caring for a 100-kg patient being monitored with a pulmonary artery catheter. The nurse assesses a blood pressure of 90/60 mm Hg, heart rate 110 beats/min, respirations 36/min, oxygen saturation of 89% on 3 L of oxygen via nasal cannula. Bilateral crackles are audible upon auscultation. Which hemodynamic value requires immediate action by the nurse? Cardiac index (CI) of 1.2 L/min/m3 Cardiac output (CO) of 4 L/min Pulmonary vascular resistance (PVR) of 80 dynes/sec/cm5 Systemic vascular resistance (SVR) of 1800 dynes/sec/cm5
Cardiac index (CI) of 1.2 L/min/m3
The patient presenting to the ED with severe chest discomfort is taken for cardiac catheterization and angiography that shows 80% occlusion of the left main coronary artery. Which procedure will be most likely followed? Percutaneous transluminal coronary angioplasty (PTCA) Coronary artery bypass graft surgery Transmyocardial revascularization Intracoronary stent placement
Coronary artery bypass graft surgery
The patient is admitted with a suspected acute myocardial infarction (MI). In assessing the 12-lead electrocardiogram (ECG) changes, which findings would indicate to the nurse that the patient is in the process of an evolving Q wave myocardial infarction(MI)? A) Depressed ST-segment on ECG and normal cardiac enzymes B) Depressed ST-segment on ECG and elevated total CPK C) Q wave on ECG with normal enzymes and troponin levels D) ST-segment elevation on ECG and elevated CPK-MB or troponin levels
D) ST-segment elevation on ECG and elevated CPK-MB or troponin levels
A patient was admitted in terminal heart failure and is not eligible for transplant. The family wants everything possible done to maintain life. Which procedure might be offered to the patient for this condition to increase the patient's quality of life? Nothing additional; medical management is the only option Left ventricular assist device (LVAD) Nothing, because the patient is in terminal heart failure Intraaortic balloon pump (IABP)
Left ventricular assist device (LVAD)
The patient's heart rhythm shows an inverted P wave with a PR interval of 0.06 seconds. The heart rate is 54 beats per minute. The nurse recognizes the rhythm as a junctional escape rhythm, and understands that the rhythm is due to what cause? Loss of sinus node activity Increased rate of the AV node Decreased rate of the AV node Increased rate of the SA node
Loss of sinus node activity
The nurse understands what to be true of a third-degree AV block? None of the P waves are conducted to the ventricles Every P wave is conducted to the ventricles Some P waves are conducted to the ventricles The PR interval is prolonged
None of the P waves are conducted to the ventricles
The patient is admitted with recurrent supraventricular tachycardia that the cardiologist believes to be related to an accessory conduction pathway or a reentry pathway. The nurse anticipates which procedure to be planned for this patient? Temporary transvenous pacemaker placement Radiofrequency catheter ablation Implantable cardioverter-defibrillator placement Permanent pacemaker insertion
Radiofrequency catheter ablation
The patient is having premature ventricular contractions (PVCs). What is the nurse's greatest concern? The proximity of the R wave of the PVC to the T wave of a normal beat. If the PVCs are wider than 0.12 seconds. If the number of PVCs are decreasing. The fact that PVCs are occurring, because they are so rare.
The proximity of the R wave of the PVC to the T wave of a normal beat.
