CCRN EXAM-with 100% verified solutions-

CCRN EXAM-with 100% verified solutions- A 59-year-old male is admitted complaining of chest pain and dyspnea. ST elevation and T wave inversion were seen on the EKG in V2, V3 and V4. IV thrombolytic therapy was started in ED. Indications of successful reperfusion would include all of the following except: (A) pain cessation (B) decrease in CK or troponin (C) reversal of ST segment elevation with return to baseline (D) short runs of ventricular tachycardia (B)Coronary artery reperfusion due to PCI or fibrinolysis results in an ELEVATION of creatinine kinase (CK) or troponin, not decrease. The theory is that the return of blood flow distal to the occlusion can result in 'reperfusion injury' of the muscle, elevating cardiac biomarkers. The other 3 choices are indicators of reperfusion: Pain cessation, reversal of ST segment elevation with return to baseline, short runs of ventricular tachycardia. Which of the following medication orders should the nurse question for the patient in question 1-reperfusion question-patient having an MI? (A) metoprolol (Lopressor) (B) aspirin (C) propranolol (Inderal) (D) heparin (C) The patient in the scenario is having an acute anterior wall MI. A beta blocker is beneficial for an acute MI as these agents decrease the work of the heart and increase the threshold for ventricular fibrillation. Propranolol, although a beta- adrenergic blocker like metoprolol, is NOT a cardio selective beta blocker. It affects beta receptors in heart muscle AND lung tissue. Therefore, it is more likely to cause bronchoconstriction than a cardio selective beta blocker. The other 3- cardio selective beta blocker, antiplatelet, and anticoagulation-are indicated in an acute MI. If heart block develops while caring for the patient in question 1 (pt. with an MI who went through reperfusion from PCI or fibrinolytic therapy), which of the following would it most likely be? (A) sinoatrial block (B) second degree, Type I (C) second degree, Type II (D) third degree, complete (C) The patient is having an acute anterior MI, which is generally due to LAD occlusion. The LAD supplies the HIS bundle, which could result in a second-degree, type II heart block. The other 3 types are due to SA node or AV node ischemia, which generally occur with an RCA occlusion — interior wall MI. Appropriate drug therapy for dilated cardiomyopathy is aimed toward: (A) decreasing contractility and decreasing preload and afterload (B) decreasing contractility and increasing preload and afterload (C) increasing contractility and increasing both preload and afterload (D) increasing contractility and decreasing both preload and afterload (D) Dilated cardiomyopathy is likely to result in systolic dysfunction, which decreases contractility, causes compensatory arterial constriction, and results in a higher left ventricular preload. To treat this, therapy is aimed at increasing contractility, decreasing afterload (arterial constriction), and decreasing preload that is too high. An 18-year-old is admitted with a history of syncopal episode at the mall and has a history of an eating disorder. The nurse notes a prolonged QT on the 12-lead EKG and anticipates a reduction in an electrolyte to be the cause. Which of the following is LEAST likely to cause this patient's problems? (A) sodium (B) magnesium (C) potassium (D) calcium (A) Abnormal sodium does NOT cause QT prolongation. In contrast, a low magnesium, potassium, or calcium, may cause QT prolongation and may result in TORSADES DE POINTES ventricular tachycardia and, if self-limiting, transient syncopal episodes. On the third day after admission for acute MI, a 67-year-old male complains of chest pain and develops a fever. The pain is worse with deep inspiration and is relieved when he leans forward. There are nonspecific ST changes in the precordial leads of the EKG. The nurse anticipates that the patient will most likely need treatment for: (A) thoracic aneurysm (B) Dressler's syndrome (C) reinfection (D) pleuritic (B) The pain described in the scenario is typical of the pain caused by pericarditis. Dressler's syndrome is the pericarditis that may result after an acute MI. A patient is admitted to the CCU after a PCI with stent. Femoral sheath is in place; site is dry with no hematoma. He suddenly complains of severe back pain. Neck veins are flat with head of bed 30 degrees, heart sounds are normal. Vital signs are BP 78/48, HR 124 and RR 26. What should the nurse suspect? (A) cardiac tamponade (B) retroperitoneal bleeding (C) coronary artery dissection (D) acute closure of the stented coronary artery (B) Retroperitoneal bleeding may cause signs of hypovolemia and hypovolemic shock as described in the scenario. It may be a complication of a PCI if the femoral artery is the access site during the procedure. Only this problem results in severe back pain; none of the other 3 choices results in back pain Your patient admitted with an NSTEMI develops acute shortness of breath, recurrence of chest pain, and a loud systolic murmur at the apex of the heart. Which of the following has most likely occurred? (A) the patient has developed acute mitral valve regurgitation (B) the patient has developed acute infarction (C) the patient has developed acute mitral wave stenosis (D) the patient has developed acute ventricular septal defect (A) The location of the murmur, at the apex of the heart (midclavicular, 5th ICS), is one clue to this answer. In addition, regurgitation occurs when the valve should be closed and the mitral valve should be closed during systole. Mitral stenosis, choice (C), occurs when the mitral valve is open. Additionally, mitral stenosis cannot be acute, it develops gradually.