CMC PRACTICE QUESTIONS – AACN

While caring for a patient with a 3:1 IABP, the nurse notes: A. decreased urine output as well as increased urea and CR levels; the nurse should increase the time to 2: B. lack of pulse in the proximal extremity; the nurse should apply pressure to the insertion site. C. blood in the IABP tube; the nurse should disconnect the balloon catheter from the IABP D. bleeding from the insertion site; the nurse should anticipate the need for an emergency fasciotomy A. incorrect. Decreased urine flow with increasing BUN and CR levels with an IABP in place indicates renal artery obstruction. The nurse should plan the removal. B. incorrect. the absence of a pulse distal to the insertion site indicates complete occlusion of the femoral artery. Applying pressure to the insertion site will worsen the obstruction. C. CORRECT. The presence of blood in the BPIA tube indicates balloon rupture. Continuing to allow the BPIA to inflate and deflate increases the size of the tear, causing more bleeding. the nurse should plan to remove or replace the BPIA catheter. D. incorrect. A fasciotomy would be indicated if the patient has increased fluid accumulation in the extremity causing significant damage to the limb. An abdominal interventricular blood pressure (IAP) is currently 3:1 when the patient suddenly goes into ventricular fibrillation. In addition to resuscitation measures, the nurse should: A. change trigger for internal resuscitation or pressure measurements. B. increase time to 1:1 to increase coronary artery perfusion pressure. C. place pump on standby until spontaneous circulation returns. D. Estimate the BPIA time to chest compressions at 1:2. - Correct Answer A. Correct. The BPIA will not be able to synchronize correctly when a patient is in ventricular fibrillation. placing the trigger system in an internal or pressure holder will generate the pressure generated during compressions B. incorrect. Attempting to reset the IABP timing to 1:1 will be counterproductive, as it will not be able to fire properly. C. incorrect. There is a significant risk of clot formation in the BPIA when placed in an upright position for an indefinite period of time. D. incorrect. The main goal during resuscitation measures is to try to circulate the blood volume as effectively as possible. there is no need to estimate the IABP time. The nurse reviews the list of home medications for her a patient admitted with severe chest pain. EKG and serial blood tests are negative, so a stress test is scheduled. Which of the following medications can cause a false positive stress test result? A. digitalis (digoxin) B. potassium chloride (K-Dur) C. sotalol (Betapace) D. diltiazem (Cardiazem) – CORRECT ANSWER A. correct. digitalis can cause false-positive ECG changes during stress testing. There is an association between the development of ST-segment depression during stress testing. The mechanism of this ECG change is unclear. In addition, digitalis should be avoided on the day of testing because of negative chronotropic effects. B. incorrect. C & D. incorrect. Beta-blockers and calcium channel blockers dampen the heart rate response to exercise and may prevent you from reaching your target maximum heart rate. They should be discontinued on the day of the test. A patient is admitted to the hospital with elevated troponin levels and ST segment elevation in leads II, III, and aVF. Which of the following medications should the nurse plan to administer first? A. enoxaparin (Lovenox) B. streptokinase (strepase) C. alteplase (Activase) D. reteplase (Retavase) – CORRECT ANSWER D A. incorrect. Enoxaparin is an alternative to heparin in patients with unstable angina, NSTEMI or DVT. B. incorrect. Streptokinase is indicated in cases of acute arterial thrombosis or embolism, or AV cannula occlusion. C. incorrect. Alteplase is indicated in cases of acute ischemic stroke or acute massive pulmonary embolism D. correct. Reteplase is indicated for AMI when fibrinolytics are indicated. Which of the following is characteristic of diastolic heart failure? A. inability of the heart muscle to relax. B. expansion of the ventricular cavities. C. increased filling of the left ventricle. D. decreased ability of the ventricle to contract. – CORRECT ANSWER A. correct. in diastolic heart failure, the left ventricle is unable to relax, leading to signs and symptoms of heart failure, but the patient maintains preserved EF because the muscle retains its ability to contract. B. incorrect. Dilation of the ventricular chambers is a sign of systolic heart failure. C. incorrect. Diastolic heart failure is a filling abnormality of the heart. The heart muscle does not relax normally and the heart may fill very slowly or asynchronously. If the left ventricle does not relax properly or is thick and stiff, it does not fill as well as it should, and blood is drawn into the left atrium and eventually the lungs. D. incorrect. Decreased ventricular contractility is a symptom of overstretching of the heart muscle in patients with cardiomyopathy. After a STEMI, the nurse hears a late systolic murmur at the apex. The nurse should suspect that the finding is due to the recent onset of a: A. right bundle branch block B. left bundle branch block C. papillary muscle tear D. calcium plaque rupture – CORRECT ANSWER C A. incorrect. a BBD will cause an electrical delay in conduction due to a wide S2 split. B. incorrect. an LBBB will cause an electrical delay in ventricular conduction due to a paroxysmal S2 split C. correct. A rupture of the papillary muscle cord is the result of ischemia of the tissue supplying the mitral valve. a systolic murmur is heard due to mitral regurgitation. D. incorrect. Plaque rupture will cause occlusion of the coronary artery that will not directly cause a new systolic murmur.