CCRN QUESTIONS WITH 100% CORRECT ANSWERS

CCRN QUESTIONS WITH 100% CORRECT ANSWERS The nurse is caring for a patient with acute inferior wall MI, post-coronary artery stent deployment, For optimal care of the patient, the nurse should: - Answer- Continuously monitor the patient in lead II It is best practice to monitor the patient status post PCI with stent, in the lead that was most abnormal during the acute occlusion. The ECG demonstrates ST elevation in leads II, III and aVF. The nurse needs to monitor the patient closely for which of the following? - Answer- Complication likely to occur after an acute inferior wall MI include bradycardia secondary to ischemia to the SA and/or AV node, and papillary muscle rupture or dysfunction due to the anatomical distance between the RCA and the papillary muscle. Which of the following hemodynamic profiles would benefit from the aggressive fluid administration, pressers and antibiotics therapy? a. RAP: 1mm Hg; PAOP: 4 mmHg; SVR: 1800 dynes/sec; CO: 2L/min b. RAP: 5; PAOP: 7; SVR: 400; CO; 8L - Answer- B. the hemodynamic profile of RAP 5, PAOP 7, SVR 400 is typical of septic shock, and choice B would be the best approach. Which of the following is indicative of a mixed acid-base disorder? A. pH 7.18; PaCO2 25; PaO2 64; HCO3 11 B. pH 7.33; PaCO2 29; PaO2 72; HCO3 15 - Answer- The decrease in PaCO2 is evidence of respiratory alkalosis and the decreased HCO3 is evidenced of a metabolic acidosis. The pt with severe sepsis or septic shock may present with this mixed acid- base disorder. The patient with a temporary pacemaker develops pacemaker malfunction. The oriented is instructed to reposition the patient to try and correct the problem. The cardiac monitor most likely demonstrates? - Answer- Failure to capture (pacemaker without a QRS) may be corrected by repositioning the patient to the side. The patient with diastolic heart develops SVT, heart rate 220/min. The most dangerous hemodynamic effect is a decrease in: - Answer- coronary artery perfusion. Diastolic heart failure results in a problem with left ventricular FILLING secondary to ventricular thickening, and contractility and ejection are maintained in diastolic failure. The rapid heart rate will decrease filling time, worsen left ventricular filling and because coronary artery perfusion occurs during diastole, this arrhythmia may be life-threatening. The patient is receiving heparin infusion for the treatment of pulmonary embolism. There has been a 60% decrease in the platelet count and no clinical change. Which of the following is indicated? - Answer- Discontinue heparin and being argatroban. The patient most likely has HIT. Exposure to heparin needs to discontinued and a direct thrombin inhibitor started for continued anticoagulation. The patient with oat cell carcinoma has the following clinical findings: low urine output, low serum osmolality, hyponatremia, and elevated urine sodium. The nurse anticipates which of the following as part of the treatment plan? - Answer- Phenytoin (Dilantin), 3% saline. The patient has signs of SIADH which results in production of excessive ADH. Dilantin will inhibit ADH secretion and 3% saline will increase serum sodium. Peep therapy and mechanical ventilation are ordered for the patient with acute respiratory failure. Which of the following is a possible complication? - Answer- Barotrauma The addition of positive end-expiratory pressure will increase alveolar recruitment, prevent atelectasis and improve oxygenation. However, the increase in intrathoracic pressure may lead to pneumothorax or subcutane