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NURS 1020(Latest 2024/2025) Perfusion Exam
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While doing the hospital admission assessment for a slender older adult, the nurse observes pulsation of the abdominal aorta in the epigastric area. Which action would the nurse take? a. Teach the patient about aneurysms. b. Notify the hospital rapid response team. c. Instruct the patient to remain on bed rest. d. Document the finding in the patient record. d. Document the finding in the patient record. Feedback: Visible pulsation of the abdominal aorta is commonly observed in the epigastric area for thin individuals. The nurse would simply document the finding in the admission assessment. Unless there are other abnormal findings (such as a bruit, pain, or hyper/hypotension) associated with the pulsation, the other actions are not necessary. A patient is scheduled for a cardiac catheterization with coronary angiography. What information would the nurse provide before the procedure? a. It will be important not to move at all during the procedure.
b. A flushed feeling is common when the contrast dye is injected. c. Monitored anesthesia care will be provided during the procedure. d. Arterial pressure monitoring will be needed for 24 hours after the test. b. A flushed feeling is common when the contrast dye is injected. Feedback: A sensation of warmth or flushing is common when the contrast material is injected, which can be anxiety producing unless it has been discussed with the patient. The patient may receive a sedative drug before the procedure but monitored anesthesia care is not used. Arterial pressure monitoring is not routinely used after the procedure to monitor blood pressure. The patient is not immobile during cardiac catheterization and may be asked to cough or take deep breaths. The nurse notes that a patient who was admitted with heart failure has jugular venous distention (JVD) when lying flat. Which follow-up action would the nurse take? a. Encourage the patient to drink more liquids. b. Assess the apical and radial pulse for a pulse deficit. c. Observe the neck with the patient elevated 45 degrees. d. Have the patient bear down to perform the Valsalva maneuver. c. Observe the neck with the patient elevated 45 degrees. Feedback:
How would the nurse document a loud humming sound auscultated over the patient's abdominal aorta? a. Thrill b. Bruit c. Murmur d. Normal finding b. Bruit Feedback: A bruit is the sound created by turbulent blood flow in an artery. Auscultating a bruit in an artery is not normal and indicates pathology. Thrills are palpable vibrations felt when there is turbulent blood flow through the heart or in a blood vessel. A murmur is the sound caused by turbulent blood flow through the heart. A patient who developed chest pain 4 hours ago may be having a myocardial infarction. Which laboratory test result would be most helpful in indicating myocardial damage? a. Troponins b. Myoglobin c. Homocysteine (Hcy) d. Creatine kinase-MB (CK-MB) a. Troponins
Feedback: Cardiac troponins start to elevate 4 to 6 hours after myocardial injury and are highly specific to myocardium. They are the preferred diagnostic marker for myocardial infarction. High-sensitivity troponin (hs-cTnT, hs-cTnI) assays provide even earlier detection of a heart event, within 1-3 hours. Myoglobin rises in response to myocardial injury within 30 to 60 minutes but is nonspecific and rapidly cleared from the body, limiting its use in the diagnosis of myocardial infarction. Creatine kinase (CK-MB) increases 4 to 6 hours after myocardial injury but is rarely used now for diagnosis of acute MI. Homocysteine (Hcy) is an amino acid that is made during protein catabolism. Elevated levels of Hcy are linked to a higher risk of CVD, peripheral vascular disease, and stroke. When assessing a newly admitted patient, the nurse notes a murmur along the left sternal border. To obtain more information about the murmur, which action would the nurse take? a. Palpate the peripheral pulses. b. Determine the timing of the sound. c. Find the point of maximal impulse. d. Compare apical and radial pulse rates. c. Find the point of maximal impulse. Feedback:
A registered nurse (RN) is assessing a patient. Which action observed by charge nurse requires immediate intervention? a. The nurse presses on the skin over the tibia for 10 seconds to check for edema. b. The nurse palpates both carotid arteries simultaneously to compare pulse quality. c. The nurse documents a murmur heard along the right sternal border as a pulmonic murmur. d. The nurse places the patient in the left lateral position to check for the point of maximal impulse. b. The nurse palpates both carotid arteries simultaneously to compare pulse quality. Feedback: The carotid pulses should never be palpated at the same time to avoid vagal stimulation, dysrhythmias, and decreased cerebral blood flow. The charge nurse should intervene to stop this action immediately. The other assessment techniques also need to be corrected because they will provide inaccurate data. However, they are not immediately dangerous to the patient. Which action will the nurse implement for a patient who arrives for a calcium-scoring CT scan? a. Insert an IV catheter. b. Instruct the patient to lie still. c. Administer oral sedative medications.
d. Confirm that the patient has been fasting. b. Instruct the patient to lie still. Feedback: The patient should remain still during the scan. The procedure is rapid and involves little risk, so none of the other actions are necessary. Which information obtained by the nurse who is admitting the patient for magnetic resonance imaging (MRI) will be important to report to the health care provider before the MRI? a. The patient has an allergy to shellfish. b. The patient has a history of atherosclerosis. c. The patient has a permanent cardiac pacemaker. d. The patient took the prescribed heart medications today. c. The patient has a permanent cardiac pacemaker. Feedback:
The standard policy on the cardiac unit states, "Notify the health care provider for mean arterial pressure (MAP) less than 70 mm Hg." Which patient's status would the nurse report to the health care provider? a. Postoperative patient with a BP of 116/42 mm Hg. b. Newly admitted patient with a BP of 150/87 mm Hg. c. Patient with left ventricular failure who has a BP of 110/70 mm Hg. d. Patient with a myocardial infarction who has a BP of 140/86 mm Hg. a. Postoperative patient with a BP of 116/42 mm Hg. Feedback: The mean arterial pressure (MAP) is calculated using the formula MAP = (systolic BP + 2 diastolic BP)/3. The MAP for the postoperative patient is 67. The MAP in the other three patients is higher than 70 mm Hg. The nurse is admitting a patient for a cardiac catheterization and coronary angiogram. Which information is important for the nurse to communicate to the health care provider before the test? a. The patient's pedal pulses are +1. b. The patient is allergic to contrast dye. c. The patient had a heart attack 1 year ago. d. The patient has not eaten anything today.
b. The patient is allergic to contrast dye. Feedback: Patients who have allergies to contrast dye will require treatment with medications, such as corticosteroids and antihistamines before the angiogram. The other information may be communicated to the health care provider but will not require a change in the usual pre-cardiac catheterization orders or medications. An older adult patient who has just arrived in the emergency department has a pulse deficit of 46 beats. Which intervention would the nurse anticipate for this patient? a. Cardiac catheterization b. Hourly blood pressure checks c. Electrocardiographic monitoring d. Emergent synchronized cardioversion c. Electrocardiographic monitoring Feedback: Pulse deficit is a difference between simultaneously obtained apical and radial pulses. It indicates that there may be a cardiac dysrhythmia that would best be detected with ECG monitoring. Frequent BP monitoring, cardiac catheterization, and emergent cardioversion are used for diagnosis and/or treatment of cardiovascular disorders but would not be as helpful in determining the immediate reason for the pulse deficit.
Feedback: Gallop rhythms generate low-pitched sounds and are most easily heard with the bell of the stethoscope. Sounds associated with the mitral valve are accentuated by turning the patient to the left side, which brings the heart closer to the chest wall. The diaphragm of the stethoscope is best to use for the higher pitched sounds such as S and S2. A patient is being treated for heart failure. Which laboratory test result will the nurse review to determine the effects of the treatment? a. Troponin b. Homocysteine (Hcy) c. Low-density lipoprotein (LDL) d. B-type natriuretic peptide (BNP) d. B-type natriuretic peptide (BNP) Feedback: Levels of BNP are a marker for heart failure. The other laboratory results would assess for myocardial infarction (troponin) or the risk for coronary artery disease (Hcy and LDL).
A transesophageal echocardiogram (TEE) is planned for a patient hospitalized with possible endocarditis. Which action included in the standard TEE orders will the nurse need to accomplish first? a. Start an IV line. b. Start O2 per nasal cannula. c. Place the patient on NPO status. d. Give lorazepam (Ativan) 1 mg IV. c. Place the patient on NPO status. Feedback: The patient will need to be NPO for 6 hours preceding the TEE, so the nurse should place the patient on NPO status as soon as the order is received. The other actions also will need to be accomplished but not until just before or during the procedure. The nurse and assistive personnel (AP) on the telemetry unit are caring for four patients. Which action could the nurse delegate to the AP? a. Teaching a patient about exercise electrocardiography b. Attaching ECG monitoring electrodes after a patient bathes c. Monitoring a patient after a transesophageal echocardiogram d. Checking the patient's catheter site after a coronary angiogram b. Attaching ECG monitoring electrodes after a patient bathes
Indicate where the nurse will palpate the posterior tibial artery. a. 1 b. 2 c. 3 d. 4 c. 3 Feedback: The posterior tibial site is located behind the medial malleolus of the tibia. Which hemodynamic parameter most directly reflects the effectiveness of drugs given to reduce a patient's left ventricular afterload? a. Cardiac output (CO) b. Systemic vascular resistance (SVR) c. Pulmonary vascular resistance (PVR) d. Pulmonary artery wedge pressure (PAWP) b. Systemic vascular resistance (SVR) Feedback:
SVR reflects the resistance to left ventricular ejection, or afterload. Other parameters may be monitored but do not reflect left-sided afterload as directly. After surgery, a patient's central venous pressure (CVP) monitor indicates low pressures. Which action would the nurse take? a. Administer IV diuretic medications. b. Increase the IV fluid infusion per protocol. c. Increase the infusion rate of IV vasodilators. d. Elevate the head of the patient's bed to 45 degrees. b. Increase the IV fluid infusion per protocol. Feedback: A low CVP indicates decreased preload from hypovolemia and a need for an increase in the infusion rate. Diuretic administration will contribute to hypovolemia and elevation of the head or increasing vasodilators may decrease cerebral perfusion. Which parameter will the nurse use to evaluate changes in a patient's right ventricular afterload? a. Central venous pressure (CVP) b. Systemic vascular resistance (SVR) c. Pulmonary vascular resistance (PVR)
For accurate measurement of pressures, the zero-reference level would be at the phlebostatic axis. There is no need to rebalance and recalibrate monitoring equipment every 2 hours. Accurate hemodynamic readings are possible with the patient‘s head raised to 45 degrees or in the prone position. Alarms should be activated; if the pressure in the line falls (e.g., when the line is disconnected), the low-pressure alarm sounds immediately and notifies staff to promptly correct the problem. Which measurement would be the most sensitive indicator of cardiac function? a. Central venous pressure (CVP) b. Systemic vascular resistance (SVR) c. Pulmonary vascular resistance (PVR) d. Pulmonary artery wedge pressure (PAWP) d. Pulmonary artery wedge pressure (PAWP) Feedback: PAWP reflects left ventricular end diastolic pressure (or left ventricular preload) and is a sensitive indicator of cardiac function. The other values would also provide useful information, but the most definitive measurement of changes in cardiac function is the PAWP. Which action would the nurse take first when the low pressure alarm sounds for a patient who has an arterial line in the left radial artery?
a. Observe for dysrhythmias. b. Fast flush the arterial line. c. Check the left hand for pallor. d. Re-zero the monitoring equipment. a. Observe for dysrhythmias. Feedback: The low pressure alarm indicates a drop in the patient‘s blood pressure, which may be caused by dysrhythmias or line disconnection. There is no indication to re-zero the equipment. Pallor of the left hand would be caused by occlusion of the radial artery by the arterial catheter. Flushing the line would be useful if there is a dampened waveform. Which action would the nurse take when preparing to assist with the insertion of a pulmonary artery catheter? a. Determine if the cardiac troponin level is elevated. b. Place the patient on NPO status before the procedure. c. Auscultate heart sounds before and during catheter insertion. d. Assure that the cardiac monitor is visible during the procedure. d. Assure that the cardiac monitor is visible during the procedure. Feedback:
