Latest Update 2025, Graded A+
A patient with a coronary artery bypass graft (CABG) has a chest tube in place. The nurse suspects an air
leak, because the collection unit displays:
bubbling in the water seal chamber.
A patient has been admitted to the telemetry unit with infective endocarditis. During the nursing
assessment, the nurse notes the confirmatory findings of petechiae, splinter hemorrhages, and:
Osler's nodes.
A patient reports unrelenting, crushing chest pain; nausea; and dyspnea. The nurse suspects an acute
myocardial infarction. What change should the nurse expect to see on the patient's ECG?
ST-segment elevation
During an acute lateral myocardial infarction, changes will be seen in which ECG leads?
I, aVL, V5, V6
Acute pericarditis is most commonly associated with:
renal failure.
The primary sign that indicates an intraoperative stroke is:
seizures.
,Rather than impeding lung blood flow, pulmonary emboli composed of injure blood
vessels and cause acute respiratory distress syndrome (ARDS).
fat
The most common lethal arrhythmia in the first hour of a myocardial infarction-
v. fib
Evaluation of the comprehension of instructions given to a new nurse regarding the QT interval on an
ECG strip-
Beginning of QRS to end of T-wave- less than ó of preceding R-R interval- <.4, prolongation leads to
torsades
The mechanism of action for calcium channel blockers in the treatment of angina
allows blood vessels to relax and open
The primary classifications of physical traits that are manifested by patients with acute onset delirium
Restlessness, pacing, agitation, mood change, hallucination, uncooperative, reduced motor activity,
sluggishness, in a daze
Cardiovascular manifestations of adrenal insufficiency-
low bp, arrhythmias, CHF
An imaging test used to confirm the presence of hypercortisolism (Cushing's disease)
MRI
, A patient assessment reveals distended neck veins, pulsus paradoxus, and decreased systolic pressure.
This assessment is most consistent with:
cardiac tamponade.
The nurse is caring for a patient with severe sepsis and third-degree heart block. The patient is
hypotensive. The treatment for this life-threatening rhythm change includes:
transcutaneous pacing.
A patient is admitted to the ICU with suspected cervical spinal cord injury following a motor vehicle
accident. The most important nursing intervention for this patient is to:
immobilize his head.
The nurse assesses a patient's chest tube drainage 2 hours following thoracic surgery. The total drainage
in the system is 200 mL. The nurse knows that:
this is an excessive amount of drainage
The patient being admitted requires CRRT therapy. The nurse assigned to admit the patient has not
been educated on this therapy. The charge nurse adjusts the assignment so that a nurse with 3 years
experience in CRRT therapy is assigned to the patient. This type of
decision making is an example of:
the synergy model for patient care.
The patient diagnosed with acute tubular necrosis (ATN) and experiencing severe dehydration, sepsis,
and pneumonia is now in the polyureic stage of ATN. The most important nursing action is to: