392TEST 1

A patient with a non-ST-segment-elevation mycocardial infarction (NSTEMI) is receiving heparin.  What is the purpose of the heparin?-Heparin will prevent the development of new clots in the coronary arteries.

When caring for a patient with acute coronary syndrome who has returned to the coronary care unit after having balloon angioplasty, the nurse obtains the following assessment data. Which data indicate the need for immediate intervention by the nurse?-Chest pain level 8 on a 10-point scale

A patient who has chest pain is admitted to the emergency department (ED), and all the following diagnostic tests are ordered.  Which on e will the nurse arrange to be completed first?-Electocardiogram (ECG)

During assessment of a 72-year-old with ankle swelling, the nurse notes jugular venous distention (JVD) with the head of the patient's bed elevated 45 degrees.  The nurse knows this finding indicates-elevated right atrial pressure

Intravenous sodium nitroprusside (Nipride) is ordered for a patient with acute pulmonary edema.  during the first hours of administration, the nurse will need to adjust the nitroprusside rate if the patient develops-a systolic BP < 90 mm Hg

A patient who has chronic heart failure tells the nurse, "I felt fine when I went to bed, but I woke up in the middle of the night feeling like I was suffocating!"  The nurse will document this assessment information as-Paroxysmal nocturnal dyspnea

The nurse working in the heart failure clinic will know that teaching for a 74-year-old patient with newly diagnosed heart failure has been effective when the patient-calls the clinic when the weight increases from 124 to 130 pounds in a week

Following an acute myocardial infarction, a perviously healthy 67-year-old develops clinical manifestations of heart failure. The nurse anticipates discharge teaching will include information about-angiotensin-converting enzyme (ACE) inhibitors

Which diagnostic test will be most useful to the nurse in determining whether a patient admitted with acute shortness of breath has heart failure.-B-type natriuretic peptide (BNP)

Which assessment finding in a patient admitted with acute decompensated heart failure (ADHF) requires the most rapid action by the nurse?-Oxygen saturation of 88%

the nurse is caring for a patient who is receiving IV furosemide (Lasix) and morphine for the treatment of acute decompensated heart failure (ADHF) with severe orthopnea.  When evaluating the patient response to the medications, the best indicator that the treatment has been effective is-decreased dyspnea with the head of bed at 30 degrees

Which topic will the nurse plan to include in discharge teaching for a patient with systolic hear failure and an ejection fraction of 38%?-Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors

When teaching the patient with heart failure about a 2000-mg sodium diet, the nurse explains that foods to be restricted include

-milk, yogurt, and other milk products

The nurse plans discharge teaching for a patient with chronic heart failure who has prescriptions for digoxin (Lanoxin) and hydrochlorothiazide (HydroDiuril).  Appropriate instructions for the patient include-notify the health care provider about any nausea (NEVER take digoxin if pulse is below 60)

A patient who has just been admitted with pulmonary edema is scheduled to receive these medications. Which medication should the nurse question?-carvedilol (Coreg) 3.125 mg

A patient with chronic heart failure who has prescriptions for a diuretic, an ACE-inhibitor, and a low-sodium diet tells the home health nurse about a 5-pound weight gain in the last 3 days.  The nurse's first action will be to-assess the patient for clinical manifestations of acute heart failure

After receiving change-of-shift report, which of these patients admitted with heart failure should the nurse assess first?  -A patient who is cool and clammy, with new-onset confusion and restlessness

An outpatient who has heart failure returns to the clinic after 2 weeks of therapy with carvedilol (Coreg). which of these assessment findings is most important for the nurse to report to the health care provider?-BP of 88/42 mm Hg

A patient who is receiving dobutamine (Dobutrex) fro the treatment of acute decompensated heart failure (ADHF) has the following nursing actions included in the plan of care.  Which action will be best for the RN to delegate to an experienced LPN/LVN?-Monitor the patient's BP and heart rate every hour

when admitting a patient with a myocardial infarction (MI) to the intensive care unit, which action should the nurse carry out first?-Attach the cardiac monitor

TEST 2 To determine whether there is delay in impulse conduction through the atria, the nurse will measure the length of the patient’s -P Wave

The nurse needs to estimate quickly the heart rate for a patient with a regular heart rhythm. Which method will be best to use?-Use the 3 second markers to count the number of QRS complexes in 6 seconds and multiply by 10

P wave not apparent, ventricular rate 162, r-r interval regular, p-r not measurable, QRS wide and distorted, QRS duration 0.18 seconds-Ventricular tachycardia

Atropine effective-Increase pt’s heart rate

Pace maker for a-fib-stimulates heart beat if it’s too low

Pacemaker teaching effective-won’t lift arm on side of the pacemaker

Cardioversion-Administer sedative before cardioverting

Athlete with sinus bradycardia, swim team-allow him to participate

Potassium normal level

Unconscious and pulseless-Defibrilate

EKG PVCs-Stress level and coffee use

Atrial flutter -12 lead EKG

No pulses, sinus tach, rate 102, apneic-CPR

Infective endocarditis-dentist visits

IE expect-New regurgitant murmur

Pericarditis-echocardiogram

Pericardial friction rub-listen with stethoscope diaphragm lower left sternal border

Acute pain pericarditis-Position in Fowler’s leaning on over bed table

Rheumatic fever-recent sore throat

Decrease risk of rheumatic fever by-getting treatment for strep

Mitral valve stenosis-assess for shortness of breath

Mitral valve replacement-need for labs for blood tests

IE-blood cultures from 2 sites

IE-sudden onset of left flank pain

MI chest pain with breathing-auscultate heart sounds

TEST 3

Balloon pump-Masure output hourly

Left radial arterial line take action when-left hand is cooler than the right hand

Hemodynamic monitoring teaching effective when-positions the zero reference stopcock line level with the phlebo axis

Disturbed sensory perception and disturbed sleep pattern-cluster nursing activities and uninterrupted rest periods

Not a treatment for cardiogenic shock-administration of blood product

Shock, check for perfusion by-LOC, urinary output, and BP

Stung by bee, respiratory distress-epinepherine

Shock is caused from-impaired tissue perfusion

Fluid recussitation with-normal saline

Intubated and making sounds-check cuff inflation on ETT

Pilot balloon is deflated with ventilator-nothing required for ventilation

Peep immediate intervention needed when-BP drops

Vent client becomes restless-check O2 sat

Suspect distributive shock in-MVA accident with severe head injury

Risk for acidosis-increase serum lactic acid

Bleeding internally, assess for shock by-asking what their normal HR is

Dopamine effective when-increase cardiac output

Distributive shock assess-are you normally this swollen

Suspect MODS when

-creatinite level is high

Ventilator, notify MD if-JVD

Nipride effective-skin is warm, dry, and pink

MVA client otw-prep for 2 14 gauge IV catheters

Vasopressin, notify MD if-pt c/o chest pain

Fluid recussitation successful when-UO is 60 mL over one hour

Septic shock, 20 mL/ 3 hr UO, pulse 120-question Lasix

TEST 4ICP 20 and CPP 85-ICP high and CPP normal

Clear nasal drainage-test it for glucose

Cerebral tissue swelling-elevate HOB 30 degrees

GCS-11

15 GCS drops to 13-notify MD of change

Seizures need to be treated beacause-Increase metabolic rate and ICP

Mannitol or furosemide-decreases ICP and increase UO

Decrease ICP -Mannitol

Basilar skull fracture-risk for meningitis

ICP through intracatheter-aseptic technique to prevent infection

When increase ICP-monitor fluid and electrolytes

Increase ICP-bradycardia

ARDS, inspiratory pressure alarm-assess airway

ARDS risk-older adult aspirated tube feeding

Intubated, ARDS, assess oxygenation and-consult with dietician

Encephalitis symptom-pain on flexion of neck

Meningitis-do you live in a crowded residence

Meningitis gloves and-surgical mask

Mannitol-I&O closely

Ventilation perfusion mismatch or hypoxemic respiratory failure-not caused by PE

Tripod position-decreases anterior posterior chest expansion

Mobilize secretions by-chest PT

Does not decrease work of breathing-NG tube

Common cause of cerebral edema-vasogenic

TEST 5Hepatic encephalopathy-irritable and lethargic

Impending coma with encephalopathy-extend arm and hand

Lactulose with cirrhosis-improve nervous system function

Ascites most important diagnosis-ineffective breathing

Esophageal varices-maintenance of the airway

Shunts increase the risk for-hepatic encephalopathy

Esophageal varices-Vasopressin infusion, balloon tamponade, ligation, shunting

Hepatitis refer for IG injection-caregiver who lives in household

Jaundice, liver function-Do you take any OTC drugs

Gullian Barre-immune system destroys myelin sheath

Clinical manifestations of GB-progressive ascending weakness and parathesia

GB-take things slowly for several months after leaving the hospital

Bell’s palsy and herpes-call MD if pain of herpes lesion occurs near the ear

Puncture wound, tetanus booster 7 year ago-tetanus booster

Trigeminal neuralgia-controllable facial twitching

Peripheral nerve repair postop priority-assess skin surrounding cast

Trigeminal neuralgia surgery-a small artery compressing the nerve will be relocated

Cirrhosis and vomiting worry about-bleeding esophageal varices

Mild liver disease, to assess for ascites-palpate abdomen for fluid wave

Asterixis-extend your arm, flex wrist up, extend fingers

Cirrhosis-Increase serum ammonia level

Decreased fecal urobilogen concentration-clay colored stools

Hepatitis A-May have been exposed when we ate shrimp last week

Sensory-discriminate between touch and pinprick stimuli

Halo traction-keep a wrench taped to halo incase CPR is needed

TEST 6Electrical burns risk for-cardiac dysrhythmias

Intubated for singed nasal hairs because-inhalation injury causes edema can cause breathing problems

Chemical burn priority-neutralize chemical

Skin integrity, most important thing to worry about is-infection

Inhalation injury, priority-100% humidified O2

Pulmonary tests for inhalation injury-ABG’s and bronchoscopy

Deep partial thickness-red, shiny, fluid filled blisters

Circumferential burn on extremity-monitor distal pulses

Hypovolemia -capillary permeability, fluid into interstitium

Fluid assessment-hourly UO

Restless-check O2 sat

Infection control with burn-PPE

Zantac with burn for-stress or curling’s ulcer

Kidney transplant, teaching neeed when-after a few years, I can stop taking medication

Burn, pain meds-drug and alcohol increase dose, increase dose b/c of metabolic rate, give before debridement

RN instruct LPN to-wash hands

Postrenal-renal calculi

Lasix AE-monitor I&OPrevent kidney damage

-no NSAIDS

Missed hemodialysis-acceptance of disease

Creatinine 2, UO 2000 mL/day-nonoliguric

HTN not controlled-Creatinine 1.9

Fluid restriction-abscense of crackles

AV fistula right arm-Take BP in left arm