CEN FINAL EXAM 1 Predictor test bank
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Which of the following assessments would be utilized in establishing a diagnosis of dissecting
aortic aneurysm?
a. Assessment of hepatojugular reflux
b. Auscultation of heart sounds
c. Measurement of BP in both arms
d. Auscultation of lung sounds
ANS: C
The difference in BP readings in the arms is often associated with dissecting aneurysms of the
ascending aorta, which results in lower BP in one arm over the other arm.
Which of the following therapies is recommended in patients who have a return of spontaneous
circulation (ROSC) after experiencing ventricular fibrillation (VF) cardiac arrest?
a. Permit moderate hypotension.
b. Maintain moderate hyperglycemia.
c. Employ moderate hyperventilation.
d. Cool to between 89.6 F to 93.2 F (32C to 34C)
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ANS: D
The 2005 AHA Guidelines for CPR and Emergency Cardiovascular care state that post-VF cardiac
arrest patients should be cooled to 89.6F to 93.2F (32C to 34C) for 12 to 24 hours. Research
demonstrates that these patients have improved survival and neurologic outcomes as a result.
Moderate hyperventilation is not indicated after VF arrest. Hyperventilation is indicated for
short-term use in patients who have acute cerebral herniation.
Preload refers to:
a. The volume of blood entering the left side of the heart
b. The volume of blood entering the right side of the heart
c. The pressure in the venous system that the heart must overcome to pump the blood
d. The pressure in the arterial system that the heart must overcome to pump the blood -
Answer ✓✓b
. Preload is the volume of blood that enters the right side of the heart. This volume stretches
the fibers in the heart prior to contraction. Preload is commonly measured as atrial pressure.
When suctioning during a cardiac arrest, suctioning should be limited to which of the following?
a. Less than 5 seconds
b. Less than 10 seconds
c. Less than 20 seconds
d. Less than 30 seconds - Answer ✓✓B.
According to the 2010 BLS and ACLS guidelines, suctioning for longer than 10 seconds may
result in pulling too much oxygen out of the airways resulting in hypoxemia.
You are caring for a 65 year old who collapsed outside of the hospital and was brought in to the
emergency department. During CPR, quantitative waveform capnography shows a PETCO2 level
< 10 mm HG. Which of the following is the correct response to this finding?
a. Do nothing; this is normal.
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b. Increase the amount of oxygen being delivered.
c. Attempt to improve the quality of CPR.
d. Decrease the amount of oxygen being delivered. - Answer ✓✓C.
Quantitative waveform capnography provides a good indication of the quality of CPR. Levels <
10 mm HG indicate either a problem with the quality of CPR or with the placement of the ETT.
EtCO2 levels of ≤10 mmHg predicted death in adult patients with cardiac arrest. Measurement
of EtCO2 varies directly with the cardiac output produced by chest compression . Goal is 35-
45mmg HG or 5-6% CO2.
You are caring for an 85 year old and are having trouble establishing an intravenous line. The ED
physician asks for an intraosseous needle to establish an IO line for medication administration.
Which of the following is TRUE about the intraosseous route of drug administration?
a. It should only be done on children under the age of 16.
b. It is preferred over the IV route of drug administration.
c. It should only be attempted after all other routes have been attempted.
d. Any drug or fluid can be administered via the IO route. - Answer ✓✓D.
Any drug that can be given via the IV route can also be given via the IO route. Although
commonly thought of in reference to pediatric patients, an IO route can be established on any
age person. IO access is the preferred route over the ETT but not IV route; it is often the easiest
route to establish while CPR is being done.
You have defibrillated the patient in ventricular fibrillation. The appropriate action to take next
is:
a. Do CPR for a 2-minute cycle.
b. Obtain an ECG to determine the rhythm.
c. Defibrillate again at a higher dose.
d. Give IV Epinephrine. - Answer ✓✓A.
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The 2010 ACLS guidelines no longer recommend the stacked defibrillation. Instead, a 2-minute
cycle of CPR should be done as the defibrillator is charging.
A 55-year-old patient is diagnosed with Acute Coronary Syndrome (ACS). The ED nurse should
expect to give medications to relieve pain and prevent clots. Assuming oxygen is needed, what
is the correct sequence for these frontline drugs?
a. Oxygen, Aspirin, Nitroglycerin, Morphine
b. Aspirin, Oxygen, Nitroglycerin, Morphine
c. Nitroglycerin, Oxygen, Aspirin, Morphine
d. Aspirin, Oxygen, Morphine, Nitroglycerin - Answer ✓✓A.
Oxygen should be the first drug given for the patient with ACS. Aspirin is the front line drug for
dissolving clots associated with ACS. Nitroglycerine is typically readily available and should be
administered third. Finally, for continued pain, morphine may be necessary. During the initial
assessment phase, the following steps should be accomplished for any patient at significant risk
for ACS:
•Airway, breathing, and circulation assessed
•Preliminary history and examination obtained
•12-lead ECG interpreted
•Resuscitation equipment brought to the bedside
•Cardiac monitor attached to patient
•Oxygen given
•IV access and blood work obtained
•Aspirin 162 to 325 mg given
•Nitrates and morphine given (unless contraindicated)
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