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A 47-year-old male has been admitted to the CCU from the emergency room with a history of sudden diaphoresis, nausea, vomiting and radiating pain down his left arm. He reports no significant medical history, and has been a two PPD smoker since his early twenties. His admitting diagnosis is UA/NSTEMI and he is being prepped for cardiac catheterization for possible angioplasty with stent placement. What type of medication orders might the nurse see prior to his procedure? a. Clopidogrel and ASA b. Clopidogrel and prasugrel c. Clopidogrel and meperidine d. Prasugrel, ASA, and hyoscyamine ANS WERY ¥ a. Clopidogrel and ASA Agnes is a 65-year-old white female who has a history of pulmonary fibrosis with steroid use for the past two years with concomitant hypertension. She has been on oxygen therapy at 4L per nasal cannula for the past 3 years. Recently, her first great-grandchild was born, and she decided to quit smoking. Three days ago, she experienced nausea and dizziness and was admitted to the CCU with a diagnosis of acute myocardial infarction. During shift change, Agnes' low blood pressure alarm sounds. Upon assessment, she is diaphoretic and has severe dyspnea. What is the most likely cause of her symptoms? a. Exacerbation of pulmonary fibrosis b. Pulmonary embolism ec. Recurrent myocardial infaretion d. Papillary muscle rupture ANSWERV V d. Papillary muscle rupture Norman is a 65-year-old paraplegic who resides in a nursing home. He presents with a 3-day history of increased temperature, productive cough, and increased weakness. His caregiver states that he had developed a decubitis ulcer, and has not been able to tolerate sitting in his wheelchair, so has been in bed for the past week. Bibasilar crackles are audible on auscultation, with overall diminished breath sounds bilaterally. Obvious respiratory distress is apparent with tachypnea, suprasternal retractions and use of accessory muscles. Vitals: T- 100.2F, HR-120, RR-28, BP 104/50, 02 Sat on RA - 88%. An initial chest x-ray reveals the "spine sign" and a normal cardiac silhouette. What is the most likely cause of Norman's condition? b. HCAP c. NHAP d. HAP ANSWERV ¥ c. NHAP - Nursing home acquired pneumonia What does the finding of "spine sign" on a chest x-ray indicate? a, Pro-cxisting spinal injury b. Kyphosis c. Pneumonia d. Scoliosis ANSWERV ¥ ec. Pneumonia Ifa patient is suspected of having an episode of acute hypoglycemia, which of the following is NOT the most appropriate first intervention? a. Draw a STAT blood glucose level. b. Give the patient a % glass of orange juice. c. Give the patient [V dextrose or IM glucagon. d. Access to emergency medications ANSWERY ¥ c. Patient's socioeconomic status What is the most common site of rupture of a cerebral aneurysm with resulting subarachnoid hemorrhage (SAH)? a. Anterior cerebral artery b. Middle cerebral artery c. Anterior communicating artery d. Posterior communicating artery ANS WERV ¥ c. Anterior communicating artery Donna is a 43-year-old teacher who was admitted 6 days ago with a ruptured middle cerebral artery (MCA) aneurysm with subarachnoid hemorrhage (SAH). She underwent surgery for aneurysm clipping 12 hours after admission, and has had an excellent post-operative course. However, this morning, she complained of a severe headache, became acutely confused and quickly progressed to unresponsiveness. What is the likely cause for Donna's change of status? a. Expansion of her original SAH b. Uncal herniation c. Cerebral vasospasm d. Medication reaction ANSWERY ¥ c. Cerebral vasospasm Matthew is a 26-year-old who has been admitted to the ICU following a motor vehicle accident. Upon assessment, it is noted that he has a positive Cullen sign. What does this indicate? a. Basilar skull fracture b. Retroperitoneal hemorrhage c. Pelvic fracture d. Aortic tear ANS WERV ¥ b. Retroperitoncal hemorrhage If bowel sounds are audible when auscultating Matthew's lungs, what injury may he have sustained? a. Ruptured spleen b. Ruptured liver c. Diaphragmatic injury d. Gastric tear ANSWERV ¥ ec. Diaphragmatic injury Ifa patient sustains acute renal failure (ARF) secondary to cardiogenic shock, what type of renal failure is this considered? a. Intrinsic b. Prerenal c. Postrenal d. Iatrogenic ANSWERV V b. Prerenal The RIFLE classification system provides a definition and classification system for acute renal failure (ARF). What does the "R" in the RIFLE acronym refer to? a. Risk of renal dysfunction b. Rapid response to failure c. Role of dialysis a. Idiopathic thrombocytopenia purpura (ITP) b. Embolic stroke c. Sexual abuse d. Nursing home acquired pneumonia (NHAP) ANSWERV V ec. Sexual abuse Jerry is a 55-year-old veteran who has been admitted after a motor vehicle accident with multiple injuries. His friend reported that he had been using synthetic marijuana prior to the accident, and that he also sees a psychiatrist at the VA hospital for an unknown diagnosis. He stated that Jerry sometimes gets "hyper" for no reason, starts "ranting" and becomes violent. Of the following, which general psychiatric disorder is characterized by a pattern of aggression or violence which includes irritability, agitation, and violent behavior during manic or psychotic episodes? a. Schizophrenia b. Post-traumatic stress disorder (PTSD) c. Bipolar disorder d. Delusional disorder ANSWERV V c. Bipolar disorder Emily has been admitted to the ICU after being found unconscious on the street. She was found to be in diabetic ketoacidosis (DKA) with a blood sugar of 785. Emily is homeless, has had multiple admissions for DKA, and could benefit from use of an insulin pump, but says she has been repeatedly told, "Those are for rich people." What ethical principle supports Emily's right to have an insulin pump? a. Beneficence b. Nonmalficence c. Justice d. Autonomy ANSWERV V c. Justice Tonya is a 44-year-old with a history of substance abuse who has been admitted to the ICU status-post left lateral thoracotomy. She has been clean and sober for 14 years, and discussed her status with her physician prior to her surgery. When she arrives from the operating room, she is in a great deal of pain. Post-operative pain management orders are for acetaminophen only. When you ask the surgeon for an opioid for pain management, he states, "She's an addict. She doesn't need anything for pain." What should your first response be’? a. Report the doctor to administration b. Discuss the situation with the doctor privately c. Complain to the other nurses d. Ask another doctor to intervene ANSWERV ¥ b. Discuss the situation with the doctor privately What are the benefits of intra-aortic balloon (IAB) therapy for a patient with cardiogenic shock’? a. Increase afterload with balloon deflation and decrease diastolic augmentation with balloon inflation b. Decrease afterload with balloon inflation and decrease diastolic augmentation with balloon deflation c. Increase afterload with balloon inflation and decrease diastolic augmentation with balloon deflation d. Decrease aficrload with balloon deflation and increase diastolic augmentation with balloon inflation ANSWERV ¥ d. Decrease afterload with balloon deflation and increase diastolic augmentation with balloon inflation a. hypotension, flat neck veins, widened pulse pressure b. muffled heart sounds, minimal chest tube output, pulsus paradoxus c. hypertension, distended neck veins, narrow pulse pressure d. crackles, hypoxemia, $3 ANSWERV ¥ b. muffled heart sounds, minimal chest tube output, pulsus paradoxus other signs: neck veins distended, pulse pressure narrow, hypotension d- signs of elevated L heart pressure In the presence of blunt cardiac trauma, which finding supports the diagnosis of myocardial contusion? a. Cardiac dysrhythmias b. PMI shifted to the right c. Increased myoglobin d. Bounding pulses ANSWERV ¥ a. Cardiac dysrhythmias - can also monitor troponins c. increase myoglobin - more specific to skeletal muscle injury The patient develops chest pain with deep inspiration, a low-grade fever, and ST elevation in all leads three days post-MI. Treatment will include which of the following? a. Nitroglycerin drip b. PCL c. anti-inflammatory agents d. anticoagulation ANSWERV ¥ e. anti-inflammatory agents Pt has pericarditis (Dressler's syndrome) - responds well to anti-inflammatory agents. a, b, and c would be indicated for coronary artery occlusion A 66-year-old male presented with sudden-onset midsternal chest pain while sitting ina chair. The ECG demonstrated ST elevation of 2-3mm in V2 through V4. The patient's history includes cervical spine surgery two weeks ago. The hospital does not provide percutaneous coronary intervention (PCI). What is the treatment of choice? a. Administer of a fibrinolytic agent b. Emergent transfer to the nearest facility that performs PCL ec. Administer to the coronary care unit (CCU) d. Administration of enoxaparin (Lovenox) and morphine ANS WERYV ¥ b, Emergent transfer to the nearest facility that performs PCI a- typically used after reperfusion c - would not improve outcome d- enoxaparin is not reversible. ASA or heparin would be preferred. A patient had an episode of chest pain at rest with ST elevation on the ECG after the ingestion of cocaine. The chest pain was relieved, and the ST segments normalized after the administration of sublingual nitroglycerin. What did the patient most likely have? a. Stable angina b. Prinzmetal's or variant angina The patient is day 2 post-aortic valve replacement. In addition to preventing thrombus formation, the RN will anticipate which of the following as part of the patient's plan of care’? a. Close monitoring for ventricular arrhythmias b. Administration of diuretics to decrease preload c. Close monitoring for conduction disturbances d. Administration of positive inotropes to increase contractility ANSWERV Vv c. close monitoring for conduction disturbances The mitral, tricuspid, and aortic valves are near conduction pathways, and the need for temporary pacing needs to be considered The patient is admitted with ripping pain between the scapulae with a dissecting aortic ancurysm scen on the CT scan, In addition to preparation for immediate surgery, which agent is most likely to improve the outcome of the patient? a. nitroglycerin (Tridil) drip b. dopamine (Intropin) drip c. nitroprusside (Nipride) drip d. labetalol (Trandate) drip ANSWERV V 4. labetalol (Trandate) drip Aggressive blood pressure and heart rate control are priorities for a patient with aortic dissection The patient has an $3 at the apex of the heart on auscultation. What is most likely a part of the treatment plan? a. Coronary artery reperfusion b. Ieart rate control ¢, Pain management d. Left ventricular preload reduction ANSWERV V d. Left ventricular preload reduction $3 is due to elevated left ventricular pressure and heart failure ‘The patient is having non-sustained runs of torsades de pointes on the cardiac monitor. Which medication will most likely be ordered for this patient? a. Magnesium IV b. Potassium drip c. Amiodarone drip d. Synchronized cardioversion ANSWERV V a. Magnesium IV The patient, status post anterior MI, is scheduled for emergent surgery for ventricular septal defect repair. What will the nurse most likely hear on auscultation of this patient's chest? a. Diastolic murmur at the apex of the heart b. Systolic murmur at the left sternal border c. Diastolic murmur at the base of the heart d. Systolic murmur at the apex of the heart ANSWERV V b. Systolic murmur at the left sternal border The patient is status post insertion of a DDD permanent pacemaker. Which of the following indicates normal functioning of the pacemaker? d. Narrowing pulse pressures with inereased blood pressure ANS WERV ¥ e. Vasodilation with decreased blood pressure Warming results in vasodilation, which decreases both preload and blood pressure The monitor shows sustained ventricular tachycardia (VT). The patient's blood pressure is 112/60. The patient denies having dyspnea, pain, and dizziness. The nurse anticipates that immediate treatment will include: a. Anti-arrhythmic therapy b. Defibrillation c. Cardioversion d. Potassium ANSWERY V a. Anti-arrhythmic therapy The patient presents with acute ST elevation in V1-V4, blood pressure 84/62, atrial fibrillation 112/min, and respiratory rate 26 with crackles to the scapulae. Definitive treatment includes which of the following? a. Coronary artery reperfusion b. Dopamine at 5 meg/kg/min c. Cardioversion d. furosemide (Lasix) ANSWERV V a. Coronary artery reperfusion The patient has acute anterior STEMI with cardiogenic shock. Coronary artery reperfusion will restore blood flow and improve the outcome. The patient was admitted 6 hours ago with unstable angina and an ECG showing ST depression in leads I, LI, and aVI'. A nitroglycerin (Tridil) drip at 30 meg/min is infusing. Chest pain reoccured, a repeat ECG demonstrated ST elevation in leads I, HL, and aVF, and a right-sided ECG showed ST clevation in V3R and V4R. The patient's BP is 88/52, the HR is 92/min, and the lungs are clear. What are the priority interventions for this patient? a. Administer morphine for the pain, ad increase the nitroglycerin (Tridil) drip b. Discontinue the nitroglycerin drip, and start a fluid bolus c. Begin a dopamine drip, and give the patient a chewable aspirin d. Decrease the nitroglycerin drip, and administer morphine ANSWERV ¥ b. Discontinue the nitroglycerin drip, and start a fluid bolus The patient developed inferior wall STEMI with right ventricular (RV) infaract. Preload needs to be increased with fluids, and nitroglycerin, which decreases preload, should be discontinued. The patient presents with complaints of right leg and foot pain while at rest. The Ankle- Brachial index is 0.75. Which is an appropriate intervention for this patient? a. Apply warm compresses to the right lower leg and foot b. Elevate the right leg c. Place the bed in the reverse Trendelenburg position d. Give the patient morphine for the pain ANSWERY V¥ ce. Place the bed in the reverse Trendelenburg position The patient has acute peripheral arterial disease, and lowering the right leg will improve perfusion to the lower extremities a. third degree heart block; begin transcutaneous pacing b. type II second degree heart block; begin transcutaneous pacing c. type I second degree heart block; give atropine d. sinus bradycardia; give atropine ANSWERV ¥ a. third degree heart block; begin transcutaneous pacing The patient, whose cardiac rhythm had been sinus rhythm in the 90s, is now receiving mechanical ventilation for respiratory failure. The sinus rhythm changes to a narrow, complex, regulator tachycardia of 170/min with BP 78/40. After administering 2 doses of adenosine, the sinus rhythm and BP remain unchanged. The nurse anticipates which of the following interventions? a. fluid boluses b. vasopressor c. cardioversion d. repeat adenosine ANSWERV V¥ ce. cardioversion The patient is unstable d/t the tachyarrhythmia. Therefore, immediate restoration to sinus thythm with cardioversion is indicated. What is the primary effect of alpha adrenergic drugs? a. myocardial contractility b. arterial constriction c. bronchodilation d. arterial dilation ANS WER¥ ¥ b. arterial constriction Vasopressors (phenylephrine) are alpha adrenergic drugs that stimulate alpha receptors in arteries to constrict The patient was admitted with an anterior wall STEMI and recieved a stent in the lett anterior descending (LAD) artery. Which Icad should the nurse monitor for this patient afier the PCI procedure? a. b. V2 eT d. V6 ANSWERV ¥ b. V2 The patient develops hypotension, distended neck veins, and distant heart sounds post-op coronary artery bypass surgery. The mediastinal chest tube is noted to have minimal drainage. The nurse anticipates that the patient will need which of the following intervention? a. a return to the OR b. fluid bolus and pressors c. pericardiocentesis d. stripping the mediastinal tubing ANSWERY ¥ a. a return to the OR The patient has signs of cardiac tamponade, and there is evidence that the mediastinal tube is not draining the operative site A 29-year-old female patient has cardiomyopathy and NYHA class IV heart failure. An assessment includes a point of maximal impulse (PMI) shift to the left, an enlarged heart size, 
