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Dwayne Morise

Question: Mr. More demonstrates classic signs of chronic uncontrolled hypertension—headaches, dizziness, and nocturia. Initial diagnostic results show a BP reading of 180/122 mm Hg, HR 100 bpm, O2 saturation of 96%, elevated fasting blood glucose (250), an elevated BUN (28 mg/dL) and creatinine (2.2 mg/dL), protein in his urine, elevated LDL (180 mg/dL), decreased HDL (30 mg/dL), and elevated triglycerides (300 mg/dL). The results are consistent with possible kidney and heart damage

  1. Prior to admission to the unit, Mr. More’s BP is 180/122 mm Hg and he is complaining of a headache and blurry vision. These signs and symptoms combined with his laboratory results suggest a concern for which of the following?

  2. Hypertensive emergency

  3. B. Stroke

  4. C. Hypertension urgency

  5. D. Diabetes

  6. Answer: A.

Stroke is considered when there are signs of neurological damage such as weakness, loss of vision, dizziness, ataxia, or dysphasia.

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Question: 2. Upon admission, Mr. More’s BP continues to be elevated at 188/122 mm Hg. Which order is most important for the nurse to implement first?

  1. Administer labetalol 400 mg PO.

  2. B. Obtain a finger stick glucose reading.

  3. C. Begin oxygen via nasal cannula at

  4. 2 L. D. Administer Lipitor 40 mg PO.

  5. Answer: A

Not C

Answer: A Rationale: Mr. More’s antihypertensive medication is the priority to start to decrease his blood pressure and prevent risk of an acute event. A glucose level and administering his statin are important, but not immediate priorities. He doe

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Question: 3. On the basis of patient history and the results of diagnostic tests, what are the priority assessments for Mr. More? (Select all that apply.)

  1. Strict intake and output

  2. B. Vital signs

  3. C. Finger stick blood glucose

  4. D. Cranial nerve assessment

  5. E. Swallowing evaluation

  6. Answer: A, B, C

Frequent blood pressure assessments are necessary due to this hypertension. His creatinine and BUN were elevated initially indicating renal failure, so intake and output is a priority. His blood glucose was elevated on admission requiring continued monitoring. There are no acute neurological changes evident that would make cranial nerve assessment or swallowing evaluation a priority.

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Question: 4. Priority teaching needs for Mr. More include which of the following? (Select all that apply.)

  1. Anticoagulation therapy

  2. B. Smoking cessation

  3. C. DASH diet

  4. D. Slow posture changes

  5. E. Eat a banana a day

  6. Answer: B, C, D, E

: B Rationale: His care provider should give him parameters, but the patient should take his BP medication even if his BP is in the normal range to keep a consistent effect as long as he is asymptomatic. The rest of the statements are correct.

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Question: 5. Which statement by the patient about his medication regimen indicates the need for further teaching?

  1. “I will call my doctor if I am dizzy and short of breath.”

  2. B. “I will take my BP medication only if my blood pressure is up.”

  3. C. “One of my medications, Lasix, will make me urinate a lot.”

  4. D. “I am able to take my labetalol and lisinopril at the same time.”

  5. Answer: A, B, C

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  7. Question: A patient teaching plan should focus on which risk factors for atherosclerosis? (Select all that apply.)

  8. A. Obesity

  9. B. Hyperlipidemia

  10. C. Smoking

  11. D. Age

  12. E. Race

  13. Answer: Answer: C Rationale: This patient is within the range for elevated blood pressure. Hypertension can still be prevented with lifestyle changes or modifications such as DASH diet and an exercise regimen. Medications are not indicated until stage 1 hypertension if the patient is at high risk for adverse events or has had an adverse event. Testing for TOD is done after the diagnosis of hypertension is made.

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  15. Question: A nurse providing care for a patient whose BP readings are consistently 130/85 mm Hg should anticipate which medical plan of care?

  16. Diagnostic testing for TOD

  17. B. Initiation of anti-hypertensive therapy

  18. C. Modifications of diet and exercise

  19. D. Echocardiogram

  20. Answer: Answer: A, C, and E

Rationale: Ultrasonography can be done quickly and efficiently at the bedside to rule out aortic dissection. CT scan may also be done to definitively diagnose or rule out aortic dissection. An ECG is necessary to rule out MI. Aortic arteriography is a highly invasive and lengthy procedure at a time when quick and uncomplicated is essential. CXR cannot provide definitive diagnosis of aortic dissection.

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Question: A nurse is assessing a patient in the emergency department with the complaint of sudden onset of severe back pain, tachycardia, and hypotension. Which interventions should the nurse anticipate? (Select all that apply.)

  1. Electrocardiogram

  2. B. Aortic arteriography

  3. C. Ultrasonography

  4. D. Chest x-ray

  5. E. Computed tomography scan

  6. Answer: A, B, D

Smoking is the most modifiable risk factor.

Abdominal pain may indicate an emergent need for resection or progression toward aortic dissection.

Antihypertensives reduce blood pressure and the pressure placed on the aneurysm, therefore slowing the progression.

Crossing or elevating the legs increases the pressure in the intrathoracic and abdominal area.

Anticoagulation is not indicated in these patients.

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Question: Which statements by a patient with an AAA indicate that teaching has been effective? (Select all that apply.)

  1. “I need to quit smoking.”

  2. B. “I need to go to the emergency department immediately if I have new severe abdominal pain.”

  3. C. “The doctor may put me on blood thinners.”

  4. D. “I need to stay on my BP medication.”

  5. E. “I should keep my legs elevated whenever possible.”

  6. Answer: Answer: C

Rationale: Airway and breathing is the priority in this situation as PE can often cause a decrease in O2 saturation and severe SOB. After that, you would want to confirm that patient has working central line and/or IV access, check allergy status for heparin allergy, and then initiate ordered heparin bolus and continuous infusion to prevent further clot formation.

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Question: A patient has been admitted to the hospital for a PE. What is the priority nursing intervention?

  1. Insert an IV line.

  2. B. Begin heparin drip as ordered.

  3. C. Check oxygen saturation.

  4. D. Determine patient allergies.

  5. Answer: D

  6. Rationale: aPTT is used to monitor heparin effectiveness. A normal value indicates the need to increase the dose. INR evaluates warfarin dosing. Increased hematocrit and platelet count do not indicate bleeding. They may need evaluation but are not related to the recent DVT.

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  8. Question: The nurse is caring for a patient on a heparin drip who was admitted for DVT 2 days ago. Which laboratory value is most important to report to the provider immediately?

  9. A. A normal INR

  10. B. An increased hematocrit

  11. C. An increased platelet count

  12. D. A normal aPTT

  13. Answer: B. Severe lower back pain, decreased BP, decreased RBC

The patient is having an aortic dissection. The nurse identifies this due to classic clinical signs and symptoms. The shearing force and tearing of the aorta cause severe lower back or abdominal pain. BP decreases due to hypovolemia from blood loss from the central venous system. RBCs decrease due to profuse blood loss.

Sudden onset of severe and persistent pain described as “tearing “or “ripping” in the anterior chest or back and extending to the shoulders, epigastric area, or abdomen.

Diaphoresis, N/V, Faintness, and Tachycardia, (compensatory for low CO)

BP is often markedly different from one extremity to another & often decreases because of loss of blood going through that false lumen

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Question: 1. The nurse should intervene if a patient with AAA is noted to experience:

  1. Mild back pain, increased BP, decreased RBC

  2. B. Severe lower back pain, decreased BP, decreased RBC

  3. C. Intermittent lower back pain, decreased BP, decreased RBC

  4. D. Severe lower back pain, increased BP, increased RBC

  5. Answer: A, B, D, E

*Forget A

A: Bleeding risk with Coumadin should check for blood in urine to assess for internal bleeding; B, D: use electric razor, and avoid dangerous activities to reduce risk of bleeding; E: foods containing vitamin K increase platelet aggregation and have the opposite effect of warfarin, decreasing the medication’s effectiveness and increasing risk for clot formation. A hard toothbrush may cause bleeding

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Question: The nurse includes which information in the teaching plan about the management of warfarin? (Select all that apply.)

  1. Checking urine for blood

  2. B. Using an electric razor when shaving

  3. C. Using a hard toothbrush for effective plaque removal

  4. D. Avoiding any activity or sport that may cause traumatic injury

  5. E. Avoiding kale, spinach, collard greens, broccoli, okra, cabbage

  6. Answer: Answer: B Rationale: If the patient is experiencing new shortness of breath and a decrease in O2 there is concern for a PE, which is an emergency and needs immediate intervention. The redness and warmth in the lower calf of the right leg are normal signs and symptoms of the DVT. Nausea and diarrhea are unrelated to DVT. T

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  8. Question: 4. The nurse should intervene immediately if patient with DVT is noted to:

  9. A. Have redness and warmth in lower calf of right leg

  10. B. Experience new shortness of breath and a decrease in O2 sat

  11. C. Have pain and tenderness in right thigh

  12. D. Begin having nausea and diarrhea

  13. Answer: Back or flank pain is a classic symptom of aortic dissection. He is also noted to have a considerable drop in his blood pressure. This drop could be secondary to internal bleeding from a dissection. Patients with aortic dissection require immediate surgical intervention.

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  15. Question: Patient A: Mr. Albert is a 56-year-old white male with history of diabetes mellitus and hypertension. He was admitted for chest pain. His troponin levels have been negative. He is scheduled for a CT scan to rule out aortic dissection. He is now complaining of back pain, and his blood pressure is

  16. Answer: A, B, C

Chest pain

Nausea

Diaphoresis

A MI is a result of deceased blood flow through the coronary arteries resulting in damaged heart muscle and chest pain.

The resultant decrease in CO causes hypotension, nausea, and weak pulses.

The SNS is stimulated resulting in diaphoresis.

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Question: Chapter 32: Coordinating care for critically ill patients with CVS Dysfunction

Answer: C. Oxygen 2 L via nasal cannula

All actions are important, but the priority is to support the patient’s oxygenation—ABCs.

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Question: 1. The nurse monitors for which clinical manifestations in the patient diagnosed with MI? (Select all that apply.)

  1. Chest pain

  2. B. Nausea

  3. C. Diaphoresis

  4. D. Hypertension

  5. E. Bounding pulses

  6. Answer: C. Metoprolol IV push

:Metoprolol, a beta blocker, inhibits the response of the SNS, effectively decreasing HR and decreasing myocardial oxygen consumption.

Norepinephrine is a vasoconstrictor to help increase BP, but it will also increase SVR, increasing the workload of the heart.

Dobutamine increases cardiac contractility. Aspirin helps decrease clot formation.

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Question: 2. On arrival to the emergency department, the nurse caring for Mr. King receives several orders from the provider. Which order should the nurse implement first?

  1. Morphine sulfate 2 mg IV

  2. B. Nitroglycerin tab SL

  3. C. Oxygen 2 L via nasal cannula

  4. D. Aspirin 325 mg chewed

  5. Answer: C. Impaired tissue perfusion related to decreased circulating volume secondary to poor contractile function of myocardial muscle

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  7. Question: A treatment goal for Mr. King is to decrease myocardial workload. What order should the nurse anticipate to accomplish this goal?

  8. Norepinephrine IV drip

  9. B. Dobutamine IV drip

  10. C. Metoprolol IV push

  11. D. Aspirin 325 mg PO

  12. Answer: B, C

The balloon pump inflates during diastole to push blood into the coronaries to supply the heart with blood.

It deflates during systole to decrease SVR and help increase BP.

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Question: The nurse caring for the patient with cardiogenic shock incorporates which nursing diagnosis into the plan of care?

  1. Impaired tissue perfusion related to decreased circulating volume secondary to hypovolemia

  2. B. Impaired tissue perfusion related to decreased circulating volume secondary to peripheral vasodilation

  3. C. Impaired tissue perfusion related to decreased circulating volume secondary to poor contractile function of myocardial muscle

  4. D. Impaired tissue perfusion related to decreased circulating volume secondary to interrupted response of the sympathetic nervous system

  5. Answer: B. Tubing disconnected from the arterial line

All of the findings indicate a problem, but disconnected tubing may result in hemorrhage requiring immediate intervention. Intravenous medications through the arterial line should be stopped as soon as possible. A dampened or flat waveform requires assessment of positioning or air in the line. Redness at the site indicates possible inflation and may require the line be discontinued.

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Question: 5. What is the main purpose of the IABP? (Select all that apply.)

  1. Deflate during diastole to facilitate myocardial oxygen delivery.

  2. B. Inflate during diastole to facilitate myocardial oxygen delivery.

  3. C. Deflate during systole to decrease SVR.

  4. D. Inflate during systole to increase blood pressure.

  5. E. Deflate during systole to facilitate myocardial oxygen delivery.

  6. Answer: A

*GOT WRONG

All of the above patient situations are slightly abnormal, requiring attention, but a pulmonary artery catheter that remains in a wedge position may indicate the possibility of pulmonary artery occlusion requiring repositioning or discontinuation of the catheter.

Decreased mixed venous oxygen saturation and CO may indicate the need for volume or inotropic support.

The slightly increased SVR would need to be evaluated for cause, such as hypovolemia, and treated as necessary.

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Question: The nurse is managing the care of a patient with an arterial line. Which assessment finding warrants immediate intervention by the nurse?

  1. An overdamped waveform on the monitor

  2. B. Tubing disconnected from the arterial line

  3. C. IV medications being infused into an arterial line

  4. D. Redness at the arterial line insertion site

  5. Answer: C. Myocardial infarction

Troponin levels are the best laboratory indicator of MI. Atrial fibrillation and ventricular tachycardia are identified through an ECG. A common blood test for congestive heart failure is an elevated BNP.

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Question: The charge nurse is monitoring the care of several critically ill patients in the ICU. Which patient requires immediate intervention by the provider?

  1. The patient with a PA catheter remaining in the wedge position

  2. B. The patient with an SvO2 of 55%

  3. C. The patient with an SVR of 1,300

  4. D. The patient with a CO of 3.2

  5. Answer: A. Administer another nitroglycerin tablet.

Nitroglycerine can typically be repeated three times and should be attempted first.

Oxygen is not a treatment for pain. If unsure, the nurse could ask the charge nurse.

The provider should be informed of continued chest pain and the effectiveness or not of nitroglycerine

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Question: The nurse is reviewing the laboratory results of her patient and notes that a cardiac troponin level was drawn. This test was drawn to determine which diagnosis?

  1. Atrial fibrillation

  2. B. Ventricular tachycardia

  3. C. Myocardial infarction

  4. D. Congestive heart failure

  5. Answer: A. Apply oxygen.

: Oxygen is the first priority in an attempt to increase O2 levels and improve oxygen delivery to the heart. If diagnosed, the ECG and blood work have already been done, but the patient should be placed on contiguous monitoring and cardiac markers should be followed. Administering nitroglycerin should be second to relive pain and improve coronary blood flow.

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Question: A nurse is caring for a patient with a diagnosis of MI. The patient calls the nurse because he is experiencing chest pain. The nurse administers an SL nitroglycerin tablet as prescribed. After 5 minutes, the chest pain is unrelieved by the nitroglycerin. The next nursing action is which of the following?

  1. Administer another nitroglycerin tablet.

  2. B. Increase the flow rate of the oxygen.

  3. C. Contact the provider.

  4. D. Call the charge nurse.

  5. Answer: B

Inflating the balloon during diastole, improving coronary circulation, is pushed blood into the coronaries and systemic circulation

Inflating the balloon during systole increases resistance, harmful to CO; deflating the balloon during diastole does not have a beneficial effect on resistance.

Deflating the balloon during systole does not improve coronary circulation—it decreases SVR.

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Question: A 68-year-old male presents to the emergency department with complaints of crushing chest pain that radiates to the left shoulder. The patient is diagnosed with AMI. Admission orders include oxygen 2 L via nasal cannula, blood work, chest x-ray, 12-lead ECG, and SL nitroglycerin. What should be the nurse’s first action?

  1. Apply oxygen.

  2. B. Obtain the 12-lead ECG.

  3. C. Administer the nitroglycerin.

  4. D. Obtain the blood work.

  5. Answer: A

*Got wrong

Pulmonary artery catheter is a tool to evaluate treatment; the others are treatment modalities.

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Question: What action of IABP therapy supports cardiac function?

  1. Inflating the balloon during systole, increasing CO

  2. B. Inflating the balloon during diastole, improving coronary circulation

  3. C. Deflating the balloon during diastole, decreasing SVR

  4. D. Deflating the balloon during systole, improving coronary circulation

  5. Answer: B. Dopamine IV drip

The patient is hypotensive and needs immediate blood pressure support. Therefore, the Dopamine would be the first intervention. An ABG and potentially a second IV line would be necessary after starting dopamine. Lasix would be contraindicated as a diuretic would further lower the blood

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Question: The nurse understands that a/an is used in the evaluation of cardiogenic shock.

  1. PA catheter

  2. B. LVAD

  3. C. RVAD

  4. D. IABP

  5. Answer: Lasix

If a patient is hypotensive, they will not tolerate diuresis. Diuresis could worsen the hypotension and cardiac output.

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Question: 1. The nurse has received the following provider orders for a patient in cardiogenic shock with a blood pressure of 70/35 mm Hg. Which order should the nurse implement first?

  1. Lasix 40 mg IV push

  2. B. Dopamine IV drip

  3. C. Obtain ABG

  4. D. Insert second IV

  5. Answer: A. A diuretic to help decrease fluid volume overload

A low PAOP indicates decreased preload in the left heart typically requiring volume.

A vasoactive drip would increase BP but not affect volume.

An afterload reducer will decrease BP

A diuretic would further decrease the PAOP.

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Question: 2. In reviewing the above orders, it is a priority for the nurse to follow up with the provider about which order?

  1. Lasix

  2. B. Dopamine drip

  3. C. ABG

  4. D. Second IV

  5. Answer: B

*Got wrong

Prior to inserting an arterial line in the right radial artery, the provider performs an Allen test. A negative Allen test reveals poor circulation through the ulnar artery, making arterial line insertion unsafe. Other options such as the left radial artery would be considered after performing an Allen test on that side.

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Question: 4. The patient with a PA catheter has a low pulmonary artery occlusive pressure. On the basis of this information, what intervention should the nurse anticipate?

  1. A diuretic to help decrease fluid volume overload

  2. B. A vasoactive drip to help increase blood pressure

  3. C. A fluid bolus to help increase preload

  4. D. An afterload reducer to help decrease SVR

  5. Answer: Nitroglycerin

Arterial & Venous dilator

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Question: . Prior to inserting an arterial line in the right radial artery, the provider performs an Allen test. The nurse anticipates what intervention if the Allen test is negative?

  1. Insertion of the arterial line in the right radial artery

  2. B. Assessment of the circulation through the left ulnar artery

  3. C. Insertion of the arterial line in the left radial artery

  4. D. Insertion of a smaller-gauged catheter in the right radial artery

  5. Answer: Its catheter is inserted into the aorta via the femoral artery

Used to increase myocardial oxygen supply & decrease demand

Considered when drugs fail to improve CO

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Question: A client is admitted with chest pain and diaphoresis. The PCP examines the client and determines cardiogenic shock, r/t an earlier MI. Which medication is most likely to be prescribed by the PCP to reduce afterload and preload?

Dobutamine

Dopamine

Nitroglycerin

Morphine Sulfate

Answer: Dobutamine

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Question: What is true regarding Intra-Aortic Balloon pump (IABP) therapy?

It is used to decrease myocardial oxygen supply

It is used to increase myocardial oxygen demand

It is considered when drugs improve CO

Its catheter is inserted into the aorta via the femoral artery

Answer: Troponin

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Question: A client is suspected of having cardiogenic shock due to myocardial damage. Which medication is most likely to be prescribed by the HCP to increase contractility?

Dopamine

Dobutamine

Nitrogrlycerin

Morphine sulfate

Answer: JVD

Bradycardia

Hypotension

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