CMC Therapeutic Interventions Exam-
Graded A
A patient with a history of head trauma 2 months ago presents with symptoms of stroke,
with onset 2 hours ago. Data are: BP 180/115, HR 112, RR 28, T 98.6 F, SpO2 95.
Results from the CT scans confirm a new onset of ischemic stroke. Which treatment
should the nurse anticipate?
Thrombolytics
Anticoagulants
Antihypertensives
Beta blocker - ANSWER-A- Anticoagulants
Rationale: Administration of anticoagulation is a treatment option for ischemic stroke.
This patient does not qualify for thrombolytic drugs due to DBP greater than 110 mm Hg
and the history of head trauma within 3 months. Patients with moderate hypertension
are usually not treated acutely.
As the nurse is assessing a patient with an emergently placed IABP, the patient
suddenly complains of a sharp pain 8/10 between the shoulder blades. The nurse
should anticipate:
An order for aggressive pain management
Rapid transport to the cath lab for PCI
Repositioning the balloon, because it migrated above the 2nd ICS
Removal of the balloon and surgical repair - ANSWER-D- Removal of the balloon and
surgical repair
Rationale: Shoulder blade pain most likely represents poor perfusion or ischemia to the
arterial vessels, which are indications for balloon removal and possible surgical repair if
arterial vessels are damaged. Although the balloon may have migrated, repositioning
alone may not correct the underlying etiology if the arterial vessels are damaged.
A patient is started on a P2Y12 receptor inhibitor for ACS. For which should the nurse
monitor?
Increased cerebral perfusion pressure (CPP)
Stroke
Na +130 mEq/L
WBC 3600/mm3 - ANSWER-D- WBC 3600/mm3
Rationale: The common major adverse effects of P2Y12 receptor inhibitors include
bleeding disorders, gastrointestinal upset, thrombotic thrombocytopenic purpura and
neutropenia
While managing a patient receiving mechanical ventilation, the nurse should understand
that positive pressure ventilation will
,Increase the cardiac index
decrease the QT interval
Increase the heart rate
Decrease the cardiac output - ANSWER-D- Decrease the cardiac output
Rationale: Positive pressure ventilation decreases cardiac output by decreasing preload
as as result of increased intrathoracic pressure
An external wearable defibrillator is applied to a patient preparing for discharge. The
patient becomes unresponsive and a pulse is not detected. The nurse should
Remove the external wearable defibrillator and initiate CPR
Perform defibrillation with the code cart defibrillator
Contact the device representative for additional instruction
Wait for further instructions from the external wearable defibrillator - ANSWER-A-
Remove the external wearable defibrillator and initiate CPR
Rationale: external wearable defibrillators detect life threatening ventricular fibrillation
and ventricular tachycardia. The device will not treat asystole or pulseless electrical
activity. In the event of unsuccessful treatment, the device or device battery should be
removed prior to beginning CPR to prevent inappropriate defibrillation. If
anterior/posterior pad placement is needed, the device should be removed.
The nurse is assigned a patient with a DDD pacemaker. Upon inspection of the
waveform, the nurse should interpret it as ____ and take what action?
Ventricular arrhythmia with atrial capture and assess for chest pain
Failure for ventricular capture and check the patient for responsiveness and pulses
Complete heart block with atrial capture and assess the vital signs
Failure for atrial capture and check the patient for responsive and pulses - ANSWER-B-
Failure for ventricular capture and check the patient for responsiveness and pulses
Rationale: The DDD system has a failure to capture or sense ventricular activity. All
ventricular spikes show absence of corresponding ventricular depolarization. No timing
circuit reset by intrinsic ventricular complexes. In DDD pacing, atrial and ventricular
leads are used for pacing and sensing. In response to sensed activity, the pacemaker
inhibits the packing stimulus; a sensed P wave in the atrium inhibits the atrial spike, and
a sensed R wave in the ventricle inhibits pacing spike.
Which patient is a candidate for transcatheter aortic valve replacement? A patient with
A history of radiation to chest
Mild aortic stenosis
Previous mechanical aortic valve
Moderate aortic regurgitation - ANSWER-A- A history of radiation to chest
Rationale: Patients with hostile chest due to radiation are at higher risk for bleeding if
conventional aortic valve replacement is performed. Transaortic valve replacement
(TAVR) can be considered an option. Aortic regurgitation is not an indicator for TAVR,
as it can not be performed in patients with mechanical valves. TAVR is not indicated for
mild aortic stenosis.
, A patient presents with an opioid overdose leading to an out of hospital PEA arrest.
After successful return of spontaneous circulation, the patient is unable to follow
commands. The patient would best benefit from a:
Discussion about foals of care
Cooling blanket
CT scan of head
Rapid infusion of IV fluids - ANSWER-B- Cooling blanket
Rationale: Post arrest targeted temperature management (TTM) at a constant between
32 and 26 degrees C is recommended for both in and out of hospital arrest with any
initial cardiac rhythm. TTM mitigates the harmful sequelae of brain anoxia and has been
shown to improve neurologic outcomes.
Which safety mechanism should be activated in an external wearable defibrillator
PRIOR to a shock being delivered?
Blue gel is released onto the chest wall
Audible gong sound followed buy "contact your provider"
Audible warning to stand clear
60 seconds of audible warning and physical vibrations - ANSWER-C- Audible warning
to stand clear
Rationale: If defibrillation is indicated, the device will audibly warrant bystanders to
stand clear to reduce the incidence of a bystander being shocked.
While weaning from the ventilator, the patient is placed on synchronized intermittent
mandatory ventilation (SIMV). Pressure Support (PS) is added to
Open the collapsed alveoli
Increase the functional residual capacity
Decrease tubing resistance
Reduce the incidence of bronchospasm - ANSWER-C- Decrease tubing resistance
Rationale: Pressure support is a spontaneous breathing mode used as the primary
method of ventilation in patients with stable respiratory drive to overcome any imposed
mechanical resistance
A patient admitted after carotid endarterectomy is wheezing. The nurse should assess
which of the following:
Operative note for bronchodilator
Tracheal deviation
Recent ABG results
History of COPD - ANSWER-B- Tracheal deviation
Rationale: An upper airway obstruction such as stridor or wheezing may be a sign of
internal bleeding and hematoma. An arterial bleed expanding quickly requires an
emergent return to the operating room
A pericardial catheter has been left in place post-pericardiocentesis. Which is MOST
LIKELY related to a post procedure complication?
Reaccumulating pericardial fluid
Hemodynamic instability
Graded A
A patient with a history of head trauma 2 months ago presents with symptoms of stroke,
with onset 2 hours ago. Data are: BP 180/115, HR 112, RR 28, T 98.6 F, SpO2 95.
Results from the CT scans confirm a new onset of ischemic stroke. Which treatment
should the nurse anticipate?
Thrombolytics
Anticoagulants
Antihypertensives
Beta blocker - ANSWER-A- Anticoagulants
Rationale: Administration of anticoagulation is a treatment option for ischemic stroke.
This patient does not qualify for thrombolytic drugs due to DBP greater than 110 mm Hg
and the history of head trauma within 3 months. Patients with moderate hypertension
are usually not treated acutely.
As the nurse is assessing a patient with an emergently placed IABP, the patient
suddenly complains of a sharp pain 8/10 between the shoulder blades. The nurse
should anticipate:
An order for aggressive pain management
Rapid transport to the cath lab for PCI
Repositioning the balloon, because it migrated above the 2nd ICS
Removal of the balloon and surgical repair - ANSWER-D- Removal of the balloon and
surgical repair
Rationale: Shoulder blade pain most likely represents poor perfusion or ischemia to the
arterial vessels, which are indications for balloon removal and possible surgical repair if
arterial vessels are damaged. Although the balloon may have migrated, repositioning
alone may not correct the underlying etiology if the arterial vessels are damaged.
A patient is started on a P2Y12 receptor inhibitor for ACS. For which should the nurse
monitor?
Increased cerebral perfusion pressure (CPP)
Stroke
Na +130 mEq/L
WBC 3600/mm3 - ANSWER-D- WBC 3600/mm3
Rationale: The common major adverse effects of P2Y12 receptor inhibitors include
bleeding disorders, gastrointestinal upset, thrombotic thrombocytopenic purpura and
neutropenia
While managing a patient receiving mechanical ventilation, the nurse should understand
that positive pressure ventilation will
,Increase the cardiac index
decrease the QT interval
Increase the heart rate
Decrease the cardiac output - ANSWER-D- Decrease the cardiac output
Rationale: Positive pressure ventilation decreases cardiac output by decreasing preload
as as result of increased intrathoracic pressure
An external wearable defibrillator is applied to a patient preparing for discharge. The
patient becomes unresponsive and a pulse is not detected. The nurse should
Remove the external wearable defibrillator and initiate CPR
Perform defibrillation with the code cart defibrillator
Contact the device representative for additional instruction
Wait for further instructions from the external wearable defibrillator - ANSWER-A-
Remove the external wearable defibrillator and initiate CPR
Rationale: external wearable defibrillators detect life threatening ventricular fibrillation
and ventricular tachycardia. The device will not treat asystole or pulseless electrical
activity. In the event of unsuccessful treatment, the device or device battery should be
removed prior to beginning CPR to prevent inappropriate defibrillation. If
anterior/posterior pad placement is needed, the device should be removed.
The nurse is assigned a patient with a DDD pacemaker. Upon inspection of the
waveform, the nurse should interpret it as ____ and take what action?
Ventricular arrhythmia with atrial capture and assess for chest pain
Failure for ventricular capture and check the patient for responsiveness and pulses
Complete heart block with atrial capture and assess the vital signs
Failure for atrial capture and check the patient for responsive and pulses - ANSWER-B-
Failure for ventricular capture and check the patient for responsiveness and pulses
Rationale: The DDD system has a failure to capture or sense ventricular activity. All
ventricular spikes show absence of corresponding ventricular depolarization. No timing
circuit reset by intrinsic ventricular complexes. In DDD pacing, atrial and ventricular
leads are used for pacing and sensing. In response to sensed activity, the pacemaker
inhibits the packing stimulus; a sensed P wave in the atrium inhibits the atrial spike, and
a sensed R wave in the ventricle inhibits pacing spike.
Which patient is a candidate for transcatheter aortic valve replacement? A patient with
A history of radiation to chest
Mild aortic stenosis
Previous mechanical aortic valve
Moderate aortic regurgitation - ANSWER-A- A history of radiation to chest
Rationale: Patients with hostile chest due to radiation are at higher risk for bleeding if
conventional aortic valve replacement is performed. Transaortic valve replacement
(TAVR) can be considered an option. Aortic regurgitation is not an indicator for TAVR,
as it can not be performed in patients with mechanical valves. TAVR is not indicated for
mild aortic stenosis.
, A patient presents with an opioid overdose leading to an out of hospital PEA arrest.
After successful return of spontaneous circulation, the patient is unable to follow
commands. The patient would best benefit from a:
Discussion about foals of care
Cooling blanket
CT scan of head
Rapid infusion of IV fluids - ANSWER-B- Cooling blanket
Rationale: Post arrest targeted temperature management (TTM) at a constant between
32 and 26 degrees C is recommended for both in and out of hospital arrest with any
initial cardiac rhythm. TTM mitigates the harmful sequelae of brain anoxia and has been
shown to improve neurologic outcomes.
Which safety mechanism should be activated in an external wearable defibrillator
PRIOR to a shock being delivered?
Blue gel is released onto the chest wall
Audible gong sound followed buy "contact your provider"
Audible warning to stand clear
60 seconds of audible warning and physical vibrations - ANSWER-C- Audible warning
to stand clear
Rationale: If defibrillation is indicated, the device will audibly warrant bystanders to
stand clear to reduce the incidence of a bystander being shocked.
While weaning from the ventilator, the patient is placed on synchronized intermittent
mandatory ventilation (SIMV). Pressure Support (PS) is added to
Open the collapsed alveoli
Increase the functional residual capacity
Decrease tubing resistance
Reduce the incidence of bronchospasm - ANSWER-C- Decrease tubing resistance
Rationale: Pressure support is a spontaneous breathing mode used as the primary
method of ventilation in patients with stable respiratory drive to overcome any imposed
mechanical resistance
A patient admitted after carotid endarterectomy is wheezing. The nurse should assess
which of the following:
Operative note for bronchodilator
Tracheal deviation
Recent ABG results
History of COPD - ANSWER-B- Tracheal deviation
Rationale: An upper airway obstruction such as stridor or wheezing may be a sign of
internal bleeding and hematoma. An arterial bleed expanding quickly requires an
emergent return to the operating room
A pericardial catheter has been left in place post-pericardiocentesis. Which is MOST
LIKELY related to a post procedure complication?
Reaccumulating pericardial fluid
Hemodynamic instability
