Download BARRON'S CCRN| 58 CARDIAC QUESTIONS WITH ANSWERS|33 PAGES and more Exams Nursing in PDF only on Docsity!
The nurse caring for the patient after coronary artery bypass graft (CABG) surgery should: a) Anticipate possible drop in BP during rewarming b) Strip chest tubes hourly to maintain patency c) Maintain Blood sugar 150-200 mg/dL with insulin infusion d) Maintain serum potassium 3-4 mEq/dL to prevent arrhythmias - โ โ Answer A As the patient's temperature rises, vasoconstriction that was present at lower temperature decreases with a possible drop in BP. Chest tubes should not be stripped. A blood sugar of 150-200 is too high for a post-op CABG surgery patient. Serum potassium needs to be close to 4.0 mEq/dL and 3.0-4.0 is too low The patient develops PSVT, and synchronized cardioversion is being considered. Which of the following would be a contraindication to the cardioversion? a) Digoxin level of 4.0 mg/dL b) Potassium level of 5.1 mgEq/L c) Magnesium level of 2.6 mg/dL d) Creatinine level of 3.1 mg/dL - โ โ Answer A
If synchronized cardioversion is attempted in the presence of digoxin toxicity, ventricular tachycardia or fibrillation may result. The remaining 3 options would not be contraindicated to synchronized cardioversion The patient had an episode of chest pain at rest with ST elevation on the ECG. The chest pain was relieved, and teh ST segments normalized after administration of nitroglycerin sublingual. The patient most likely had: a) Stable angina b) ST-elevation MI c) Prinzmetal's or variant angina d) Wellen's syndrome - โ โ Answer C ST segment elevation that normalizes and chest pain is relieved after administration of nitroglycerin are indicative of Prinzmetal's angina. Stable angina occurs with activity; it is predictable. STEMI does not respond to NTG with normalization of ST segments and complete pain relief. Wellen's syndrome does not present with ST elevation but rather a biphasic T-wave specific to lead V1 and V The patient has acute right ventricular infarct and RV failure. Which of the following is an indication that this patient's condition has improved? a) The PAOP has decreased b) The RA pressure has decreased c) The RV pressure has increased
c) ST depression rV2, rV d) ST elevation in II, III, aVF - โ โ Answer: B
The patient has pericarditis, and the expected EKG change is global ST elevation. Choice (a) is seen in anteriror wall ishcemia or NSTEMI. Choice (c) is associated with RV ischemia/infarct. Choice (d) is seen with acute inferior wall STEMI The patient complains of chest tightness, SOB, and difficulty breathing shortly after the IV antibiotics is initiated. Hives have appeared across the face and chest. Vital signs include BP 84/34, HR 130 min, sinus tachycardia, RR 28 with wheezing, Sp02 94% on room air. Which of the following interventions are most appropriate for the patient? a) Stat ECG, aspirin, oxygen, pressor b) Albuterol, steroids, 02, fluids c) Fluids, 02, CT of the chest, 02, heparin d) Epinephrine IM, steroids IV, Antihistamine, fluids - โ โ Answer D
The clinical signs and symptoms indicate an allergic reaction and anaphylatic shock. The epinephrine, steroids, and antihistamine will couteract the effects of the massice histamine release. Fluids will address the hypotension and relative hypovolemia caused by massive dilation. The remaining responses include options not indicated or helpful for anaphylaxis. Which of the following clinical signs is most specific for cardiogenic pulmonary edema?
a) S3 heart sound b) Lung crackles c) Respiratory rate 32 d) Hypoxemia - โ โ Answer: A An S3 heart sound is due to increase in left ventricular pressure, which is the cause of cardiogenic pulmonary edema. The other signs may be present in non-cardiogenic pulmonary edema (ARDS). Which of the following findings would be expected on chest auscultation of the patient with systolic heart failure? a) S4 at the apex of the heart b) A systolic murmur at the apex of the heart c) A diastolic murmur at the left sternal border d) S3 at the apex of the heart - โ โ Answer D
An S3 heart sound at the apex is thought to be due to high pressure within the LV presents in heart failure. S4 is usually due to hypertension or acute MI. A systolic murmur at the apex is usually due to mitral valve regurgitation. A diastolic murmur at the left sternal border is usually due to tricuspid valve disease Which of the following is a clinical sign of right heart failure? a) peripheral edema
BP is 90/60, sinus tachycardia at 110 minute. A pulmonary artery catheter is inserted and the following are obtained:
RAP= 16 PAOP= 5 PAP= 26/ Cardiac Index: 1.9 L/min The patient has JVD in a semi-fowlers position; Tall, peaked P-waves are seen in lead II. Which of the following therapies is indicated for this patient? a) Increase the Dobutamine infusion to 20 mcg/kg/minute, and infuse 50 mL b) Begin milrinone infusion at 0.5 mcg/kg/minute after a loading dose of 50 mcg/kg c) Discontinue the nitroglycerin and infuse 500 mL NS d) Discontinue dobutamine, and start a dopamine infusion at 10 mcg/kg/minute - โ โ Answer C
The patient is having an acute inferior MI. The elevated RAP, JVD, and tall peaked P-waves are clinical indications of RV failure, most likely secondary to RV infarct. Preload reduction (nitroglycerin) will further decrease LV filling and CO. Therefore, it should be discontinued, and fluid boluses will help to increase the LV preload. Dobutamine has a mild dilating effect and may further decrease the BP. Therefore, an increase in dose would not be
advisable. Starting milrinone would provide no benefits at this time. Dopamine 20 mcg/kg/min, not at 10 mcg/kg/min A patient was 48-hours post aortic valve replacement. Which of following would be a major goal for this patient? a) Diuretic therapy b) Stabilize blood pressure c) Prophylactic antibiotics d) Prevent thrombus - โ โ Answer: D
Clot formation on the valve is a major complication of valvular replacement, especially a mechanical valve. Therefore, anticoagulation will be needed. Fluid overload, labile BP, and infection are all possible complications. However, they are not as likely as thrombus formation and resultant stroke (if related to aortic valve) A patient with a history of heart failure and MI presents following an episode of syncope. The assessment 2 hours later demonstrates: BP 134/64 (supine); 110/70 (sitting) HR 115 with weak and thready pulse (supine) 130 (sitting) RR 32 and shallow Urine output 30 mL over the past 2 hours
Cardiogenic shock secondary to left ventricular failure will generally result in: a) Decreased afterload b) narrow pulse pressure c) decreased preload d) Widening pulse pressure - โ โ Answer: B
The systolic pressure decreases due to a drop in cardiac output; however, the diastolic pressure either stays the same or increases due to a compensatory increase of the systemic vascular resistance. The remaining choices are not found in cardiogenic shock. Desirable BP ranges vary depending on the neurological problem and need to be clarified with the physician. Which of the following BP ranges is correct? a) Treat BP for an acute ischemic stroke patient, not a candidate for thrombolytic therapy, if greater than 200-220 mmHg systolic or 100 mmHg diastolic b) Keep systolic BP greater than 180 mmHg for an acute ischemic stroke paient who is a candidate for thrombolytic therapy c) Keep systolic BP for a patient wit acute subarachnoid hemorrhage, preop 160-180 mmHg d) Keep systolic BP less than 120 mmHg to prevent vasospasms after a subarachnoid hemorrhage - โ โ Answer A
Abrupt lowering of the BO to normal in the presence of an acute schemic stroke may decrease perfusion to the area of injury and result in greater brain injury. Elevated BP is contraindicated for the patient who is a candidate for thrombolytic therapy. The patietn with acute SAH requires treatment of elevated BP pre-op in order to prevent further bleeding. The BP needs to be somewhate elevated after repair of acute SAH rather than <120 mmHG systolic as normal to low BP is thought to contribute to cerebral vasospasms. Despite emergent PCI and dobutamine infusion, the patietn with acute anterior wall MI remained hypotensive. An intra-aortic balloon (IAB) is inserted via left femoral artery. The immediate effect of IABP therapy is: a) decreased preload and myocardial oxygen consumption b) decreased preload and afterload c) decreased afterload and improved coronary artery perfusion d) decreased afterload and increased myocardial contractility - โ โ Answer C When the intra-aortic balloon closes right before systole begins, the LV afterload is decreased. When the balloon inflates during diastole, coronary artery perfusion is increased. Preload may eventually decrease as coronary artery perfusion increases and afterloa has decreased. However, this is an indirect effect of IAB therapy. The balloon does not directly increase myocardial contractility
On arrival to the ICU from the cardiac catheterization lab where the patient had a diagnostic right heart catheterization and a percutaneous coronary intervention, the cardiologist informed the nrse that the patient had an elevated left ventricular filling pressure and a low CO. Which of the following therapies would be beneficial for this patient? a) Left ventricular afterload reduction b) Heart rate reduction c) Left ventricular preload elevation d) Negative inotropic therapy - โ โ Answer A
An elevated LV filling pressure (PAOP) and a decrease in cardiac output would benefit from decreased SVR ( LV afterload). A vasodilating drug such as an ACE inhibitor (or mechanically with intra-aortic balloon therapy) would provide this effect. HR reducation might benefit diastolic filling but not necessarily help an elevated LV filling pressure. Elevation of the LV preload or negative inotropic therapy would make the problem worse. One hemodynamic benefit of intra-aortic balloon therapy is: a) Balloon inflation prevents right to left shunt b) Balloon deflation increases coronary artery perfusion c) Balloon inflation optimizes aortic valve performance d) Balloon deflation decreases left ventricular afterload - โ โ Answer: D
Balloon deflation in the descending aortic arch right before systole creates a drop in afterload. When the balloon inflates during diastole, blood is displaced into the coronary arteries, increasing coronary artery perfusion. Preload and afterload are affected by carious interventions. Which of the following statements is accurate? a) Afterload is increased by nitroglycerin b) Afterload is decreased by enalaprilat (Vasotec) c) Preload is increased by furosemide (Lasix) d) Preload is decreased with fluid administration - โ โ Answer B
Enalaprilat (Vasotec) is an angiotensin-converting enzyme inhibitor drug that prevents the conversion of angiotensin I to angiotensin II (a potent vasoconstrictor) and thereby causes vasodilation and a decrease in SVR. The other 3 choice are incorrect because afterload is decreased by nitroglycerin (high dose NTG) Preload is decreased by furosemide and is increased with fluids Priority treatment for aortic dissection requires which of the following? a) fluids and vasopressors b) intra-aortic balloon therapy and transfusion c) aggressive management of hypertension and emergent surgery d) emergent aortic valve replacement and pain control - โ โ Answer: C
prolonging the QT interval. The remaining choices are not effective treatments for torsade de pointes. The 75-year-old patient develops frequent 6 to 10 second episodes of asystole, interspersed with normal sinus rhythm that is associated with hypotension. The priority intervention is: a) Trans-cutaneous pacing b) Fluid bolus c) Trans-venous pacing d) Vasopressors - โ โ Answer: A
The rhythm described is sinus arrest. Because the patient is having serious signs and symptoms, the immediate treatment is transcutaneous pacing. Transvenous pacing may be done once the patient is stabilized. The remaining two choices are not indicated for sinus arrest. The ECG demonstrates ST elevation in leads II, III and aVF. The nurse needs to monitor the patient closely for which of the following? a) Tachycardia, lung crackles b) Sinus bradycardia, acute systolic murmur in the fifth intercostal space, midclavicular c) Second-degree heart block Type 2, hypotension d) Hypoxemia, acute systolic murmur, 5th intercostal space left sternal border - โ โ Answer: B
Complications likely to occur after an acute inferior wall MI include bradycardia secondary to ischemia to the SA and/or AV node, and papillary muscle rupture or dysfunction due to the anatomical distance between the right coronary artery and the papillary muscle. The remaining choices are not common complications of inferior MI. The nurse assessing a patient with acute coronary syndrome needs to know that: a) there are always acute ECG changes, chest pain, and positive troponin b) The standard of care for a NSTEMI is emergent reperfusion within 90 minutes c) The most common cause is plaque rupture and most common complication is arrhythmias d) it includes stable angina, unstable angina, NSTEMI, and STEMI - โ โ Answer C Chest pain may not always be present. Emergent reperfusion is not indicated for a NSTEMI. Stable angina is not considered ACS since it is not usually due to plaque rupture The patient has cardiogenic shock and cardiogenic pulmonary edema. Which of the following therapies would be most effective for this patient? a) Ventricular assist device to increase coronary artery perfusion b) Beta blocker to increase cardiac contractility c) Alpha-adrenergic drug to increase coronary artery perfusion
c) The pain is squeezing, going to the back, and associated with shortness of breath d) The pain is sharp, worse with deep inspiration, and relieved by turning to the side - โ โ Answer C
- Choice A is incorrect because pain due to CAD does not radiate to the right arm. Choice B is incorrect becuase it describes the pain of indigestion or acid reflux. Choice D is not correct becuase it describes the pain typical of pericarditis The patient is receiving amiodarone. Which of the following assessments are important? a) PR interval, renal function, blood pressure b) QRS interval liver function, lung sounds c) QT interval, thyroid function, HR d) ST segment, pulmonary function, urine ouput - โ โ Answer C
Amiodarone may prolong the QT interval, and a 200 mg tablet is estimated to contain about 75 mg of organic iodide. This may result in amiodaron-induced thyrotoxicosis (AIT) or amiodarone-induced hypothyroidism (AIH) both of which can develop in apparently normal thyroid glands or in glands with preexisting abnormalities. Amiodarone does not affect PR interval or renal function. It does not affect the QRS interval, liver function, or lung sounds. It also does not affect the ST segment or urine output. Amiodarone might decrease BP if a
large dose (300 mg) is given in a rapid IV to a patient with a pulse and could affect pulmonary function (fibrosis) when used orally for long periods of time. The patient is receiving positive inotropes, vasodilators, and diuretics. The patient most likely has which of the following problems? a) right ventricular failure b) left ventricular systolic heart failure c) papillary muscle rupture d) Hypertrophic cardiomyopathy - โ โ Answer: B
Positive inotropes increase contractility; vasodilators decrease afterload, and diuretics decrease preload. Since the patient with systolic heart failure has decreased contractility and increased afterload and preload, these agents will be useful for the treatment of this problem. The patient is status post motor vehicle accident with a large chest bruise. The nurse knows the patient needs to be assessed for which of the following? a) Positive troponin and aortic valve damage b) Pain with inspiration and pericardial friction rub c) Retroperitoneal bleed and global ST elevation d) Atrial fibrillation and mitral valve damage - โ โ Answer: A The chest bruise implies the patient's chest struck the steering wheel. This in turn may have caused aortic valve trauma (the valve lying most anterior in the chest), or caused myocardial trauma damage.
