EVERY test bank/study guide question for Adult Health Exam 3

EVERY test bank/study guide question for Adult Health Exam 3 1. What is an ability that is a primary difference in the skills of a certified critical care nurse compared with nurses certified in medical-surgical nursing? a. Diagnose and treat life-threatening diseases b. Detect and manage early complications of health problems c. Provide intensive psychologic support to the patient and family d. Use advanced technology to assess and maintain physiologic function 1. d. One of the primary characteristics of critical care nurses that is different from those of generalist medical-surgical nurses is the use of advanced technology to measure physiologic parameters accurately to manage life-threatening complications. All nursing addresses human responses to health problems and requires knowledge of physiology, pathophysiology, pharmacology, and psychologic support to the patient and family. Diagnosis and treatment of lifethreatening diseases are roles of medicine. 2. Identify the rationale for the following four patients' admissions to the intensive care unit (ICU) based on the common three reasons why patients are admitted to the ICU. a. Patient with diabetic ketoacidosis b. Patient with nondisplaced skull fracture who is alert and oriented c. Postoperative patient with mitral valve replacement d. Comatose patient who had an anaphylactic reaction with cardiopulmonary arrest at home yesterday 2. a. 1; b. 2; c. 2; d. 3 3. What is a nursing intervention that is indicated for the patient in the ICU who has a nursing diagnosis of anxiety related to the ICU environment and sensory overload? a. Provide flexible visiting schedules for caregivers. b. Eliminate unnecessary alarms and overhead paging. c. Administer sedatives or psychotropic drugs to promote rest. d. Allow the patient to do as many self-care activities as possible 3. b. Anxiety in the intensive care unit (ICU) patient is related to the environment, which has unfamiliar equipment, high noise and light levels, and an intense pace of activity that leads to sensory overload. The nurse should eliminate as much of this source of stress as possible by muting phones, limiting overhead paging, setting alarms appropriate to the patient's condition, and eliminating unnecessary alarms during care when possible. Offering flexible visiting schedules for family members and providing as much autonomy in decisions about care as possible are indicated when impaired communication and loss of control contribute to the anxiety. Use of sedation to reduce anxiety should be carefully evaluated and implemented when nursing measures are not effective 4. Why should the critical care nurse include caregivers of the patient in the ICU as part of the health care team? a. The costs of critical care will affect the entire family. b. Caregivers play a valuable role in the patient's recovery. c. Caregivers are responsible for making health care decisions for the patient. d. Caregivers who are ignored are more likely to question the patient's quality of care. 4. b. The caregivers of the critically ill patient are very important in the recovery and well-being of the patient and the extent to which the family is involved and supported affects the patient's clinical course. Although the cost of planning and providing critical care is a concern to caregivers, it is not the major reason that caregivers are included in the patient's care. Caregivers may be responsible for making decisions about the patient's care only when the patient is unable to make personal decisions. Most caregivers have questions regarding the patient's quality of care because of anxiety and lack of information about the patient's condition 5. What factor will cause a decrease in cardiac output (CO)? a. Decreased afterload b. Decreased heart rate (HR) c. Increased stroke volume (SV) d. Decreased systemic vascular resistance (SVR) 5. b. Decreased heart rate (HR) causes decreased cardiac output (CO). The other options contribute to an increased CO. 6. The patient with shortness of breath is scheduled for an impedance cardiography to differentiate if the cause is cardiac or pulmonary. How should the nurse best explain this test to the patient? a. An invasive method of measuring CO b. Electricity is transmitted through the bones in the chest c. It will be most effective when the patient has generalized edema d. Thoracic fluid status is determined by changes in impedance with each heartbeat 6. d. Impedance cardiography (ICG) is noninvasive and transmits continuous or intermittent electric current through the chest that travels through the path of least resistance: the blood. Thoracic fluid status or impedance-based hemodynamic parameters (CO, stroke volume [SV], and systemic vascular resistance [SVR]) are calculated from the average impedance of fluid in the thorax. ICG measures the change in impedance in the ascending aorta and left ventricle over time. Generalized edema or third spacing interferes with accurate signals because of the excess volume. 7. The patient has experienced an increased preload, which supports an increase in CO. What nursing action contributes to an increased preload? a. Diuretic administration c. Increased fluid administration b. Intropin administration d. Calcium channel blocker administration 7. c. Increased fluid administration increases preload, which will increase CO. Diuretics will decrease preload. Intropin (dopamine) does not affect preload but increases CO with increased cardiac contractility. Calcium channel blockers do not affect preload but decrease contractility 8. During hemodynamic monitoring, the nurse finds that the patient has a decreased CO with unchanged pulmonary artery wedge pressure (PAWP), HR, and SVR. The nurse identifies that the patient has a decrease in what? a. Preload c. Contractility b. Afterload d. Stroke volume 8. c. CO is dependent on HR and SV. SV is determined by preload, afterload, and contractility. If CO is decreased and HR is unchanged, SV is the variable factor. If the preload (determined by pulmonary artery wedge pressure [PAWP]) and the afterload (determined by SVR) are unchanged, the factor that is changed is the contractility of the myocardium. 9. Before taking hemodynamic measurements, how must the nurse reference the monitoring equipment? a. Confirm that when pressure in the system is zero, the equipment reads zero. b. Position the stopcock nearest the transducer level with the phlebostatic axis. c. Place the transducer on the left side of the chest at the fourth intercostal space. d. Place the patient in a left lateral position with the transducer level with the top surface of the mattress. 9. b. Referencing hemodynamic monitoring equipment means positioning the monitoring equipment so that the zero reference point is at the vertical level of the left atrium of the heart. The port of the stopcock nearest the transducer is placed at the phlebostatic axis, the external landmark of the left atrium. The phlebostatic axis is the intersection of two planes: a horizontal line midchest, halfway between the outermost anterior and posterior surfaces, transecting a vertical line through the fourth intercostal space at the sternum. 10. Which statement is accurate? a. A pulmonary artery flow-directed catheter has a balloon at the distal tip that floats into the left atrium. b. In the absence of mitral valve impairment, the left ventricular end-diastolic pressure is reflected by the cardiac index. c. The pressure obtained when the balloon of the pulmonary artery catheter is inflated reflects the preload of the left ventricle. d. When a patient has an arterial catheter placed for arterial blood gas (ABG) sampling, the low pressure alarm must be activated to detect functioning of the line. 10. c. The pressure obtained when the balloon of the pulmonary artery catheter is inflated reflects the preload of the left ventricle. The pulmonary artery flow-directed catheter's balloon floats into the pulmonary artery. In the absence of mitral valve impairment, the left ventricular end-diastolic pressure or left ventricular preload is reflected by the PAWP. The low pressure alarm in the arterial catheter placed for arterial blood gas (ABG) sampling detects disconnection of the line, which is a medical emergency. 11. In preparing the patient for insertion of a pulmonary artery catheter, what should the nurse do? a. Place the patient in high Fowler's position. b. Obtain an informed consent from the patient. c. Perform an Allen test to confirm adequate ulnar artery perfusion. d. Ensure that the patient has continuous electrocardiographic (ECG) monitoring. 11. d. During insertion of a pulmonary artery catheter, it is necessary to monitor the electrocardiogram (ECG) continuously because of the risk for dysrhythmias,particularly when the catheter reaches the right ventricle. During the catheter insertion, the patient is placed supine with the head of the bed flat. It is the health care provider's responsibility to obtain informed consent regarding the catheter insertion. An Allen test to confirm adequate ulnar artery perfusion is performed before insertion of an arterial catheter in the radial artery for arterial pressure monitoring. 12. What is a rationale for the use of a pulmonary artery catheter instead of arterial pressure-based CO (APCO) monitoring? a. Coagulopathy b. Less infection risk c. Mechanical tricuspid or pulmonic valve d. Needs research for accuracy with more specific illnesses and treatments 12. d. Although arterial pressure-based CO (APCO) monitoring is in use with patients on mechanical (control mode) ventilation with fixed respiratory rates and there is less risk of infection, more research is needed to determine the accuracy of the measures in comparison to pulmonary artery pressure monitoring. Pulmonary artery pressure monitoring is contraindicated for patients with coagulopathy and mechanical tricuspid or pulmonic valves. 13. Which description accurately describes the continuous CO (CCO) method and not the intermittent bolus thermodilution CO (TDCO) method of determining CO? a. Room temperature or cold normal saline is injected rapidly. b. The TDCO method is easier and faster than the CCO method. c. The digital measurements reflect the average CO every 30 to 60 seconds. d Systemic vascular resistance (SVR) can be calculated each time CO is measured. 13. c. The continuous CO (CCO) method of determining CO uses a heat exchange catheter that produces and detects the change in temperature. The bedside computer displays digital measurements every 30 to 60 seconds that reflect the average CO for the past 3 to 6 minutes. Fluid boluses are not needed, as with intermittent bolus thermodilution CO (TDCO). This makes the CCO method faster, easier, and safer for the patient. SVR can be calculated with either method. 14. A patient in the ICU with hemodynamic monitoring has the following values. Blood pressure (BP): 90/68 mm Hg HR: 124 bpm PAWP: 22 mm Hg CO: 3.2 L/min Right atrial pressure (central venous pressure [CVP]): 14 mm Hg Pulmonary artery pressure: 38/20 mm Hg a. Calculate the additional values that can be determined from these findings. Mean arterial pressure (MAP) __________________________________________________ Pulmonary artery mean pressure (PAMP) _________________________________________ SV ________________________________________________________________________ SVR _______________________________________________________________________ b. What interpretation can the nurse make about the patient's circulatory status and cardiac function from these values? 14. a. Mean arterial pressure (MAP): 75 mm Hg = (90 mm Hg + 136 mm Hg)/3 Pulmonary artery mean pressure (PAMP): 26 mm Hg = (38 mm Hg + 40 mm Hg)/3 SV: 25.8 mL/beat = (3.2 L/min × 1000 mL)/124 bpm SVR: 1525 dynes/sec/cm-5 = (75 mm Hg - 14 mm Hg × 80/3.2 L/min) b. All of the changes in the hemodynamic parameters are characteristic findings in the patient with heart failure: increased pulmonary congestion and pressures; increased pressure in the left atrium and ventricle; increased SVR; and decreased stroke volume, CO, and systemic blood pressure (BP). 15. A patient has central venous oxygen saturation/mixed venous oxygen saturation (ScvO2 /SvO2 ) of 52%, CO of 4.8 L/min, SpO2 of 95%, and an unchanged hemoglobin level. What should the nurse assess the patient for? a. Dysrhythmias c. Pulmonary edema b. Pain on movement d. Signs of septic shock 15. b. The normal central venous oxygen saturation/mixed venous oxygen saturation (ScvO2 /SvO2) of 60% to 80% becomes decreased with decreased arterial oxygenation, low CO, low hemoglobin, or increased oxygen consumption. With normal CO, arterial oxygenation, and hemoglobin, the factor that is responsible for decreased ScvO2/SvO2 is increased oxygen consumption, which can result from increased metabolic rate, pain, movement, or fever. 16. The nurse observes a PAWP waveform on the monitor when the balloon of the patient's pulmonary artery catheter is deflated. What should the nurse recognize about this situation? a. The patient is at risk for embolism because of occlusion of the catheter with a thrombus. b. The patient is developing pulmonary edema that has increased the pulmonary artery pressure. c. The patient is at risk for an air embolus because the injected air cannot be withdrawn into the syringe. d. The catheter must be immediately repositioned to prevent pulmonary infarction or pulmonary artery rupture 16. d. When a pulmonary artery pressure tracing indicates a wedged waveform when the balloon is deflated, this indicates that the catheter has advanced and has become spontaneously wedged. If the catheter is not repositioned immediately, a pulmonary infarction or a rupture of a pulmonary artery may occur. If the catheter is becoming occluded, the pressure tracing becomes blunted and pulmonary edema and increased pulmonary congestion increase the pulmonary artery waveform. Balloon leaks found when injected air does not flow back into the syringe do not alter waveforms. 17. A patient with which disorder would benefit from the use of the intraaortic balloon pump (IABP)? a. An insufficient aortic valve c. Generalized peripheral vascular disease b. A dissecting thoracic aortic aneurysm d. Acute myocardial infarction with cardiogenic shock 17. d. The counterpulsation of the intraaortic balloon pump (IABP) increases diastolic arterial pressure, forcing blood back into the coronary arteries and main branches of the aortic arch, increasing coronary artery perfusion pressure and blood flow to the myocardium. The IABP also causes a drop in aortic pressure just before systole, decreasing afterload and myocardial oxygen consumption. These effects make the IABP valuable in treating unstable angina, acute myocardial infarction with cardiogenic shock, and a variety of surgical heart situations. Its use is