CEN Exam 5 with 100% Correct Answers 2024

1. A pt presents to the ED experiencing an anterior ST segment elevation MI. The pts vital signs are normal. The hospital is not equipped with a cardaic catheterization lab. The pt can be transferred to a cardaic catheterization lab within 60 mins. Which of the following would you anticipate for this pt?: A. A bolus of tissue plasminogen activator, followed by an infusion for fibrinolytic therapy B. Immediate transfer to the hospital with a cardiac catheterization lab for percutaneous coronary intervention C. A single bolus of tenecteplase (Tnkase) for fibrinolytic therapy D. A bolus of reteplase (Retavase), followed by a second bolus of reteplase 30 mins later for fibrinolytic therapy - B. Immediate transfer to the hospital with a cardiac catheterization lab for percutaneous coronary intervention In adult pts presenting with a STEMI of a hospital that does not have PCI capability, it is recommended that the pt be transferred immediately without fibrinolytics to a PCI center, instead of immediate fibrinolysis at the intial hospital with transfer onlu for ischemia driven PCI 2. An anxious pt arrives by ambulance following an acute onset of difficulty breathing. The pt is diaphoretic and denies chest pain. High-flow O2 by non-rebreather mask has been applied. Vitals: BP 210/140, HR 130, RR 32, SpO2 88%. In addition to initiating noninvasive ventilation to treat the pts difficulty breathing, the nurse anticipates the administration of which medication to further treat the pts symptoms?: A. Morphine (Morphine sulfate) B. Furosemide (Lasix) C. Initation of a continuous nitroglycerin infusion D. Acetylsalicylic acid (Aspirin) - C. Initation of a continuous nitroglycerin infusion Pts who present with acute pulmonary edema are typically markedly hypertensive and in acute respiratory distress. Rapid initiation of appropriate treatment is vital to reversing the neurohormonal surge and rescuing pts from respiratory and complete cardiac failure. Nitroglycerin is the most important first line medication in treatment of acute pulmonary edema and respiratory distress. The initation of continuous NTG infusion at low doses acts as a vasodilator, leading to decreased preload: at higher doses ( >100mcg/min) acts as a potent afterload reducer 3. An unrestrained driver is brought to the ED following a motor vehicle collision. The pt reports hitting their chest on the steering wheel and is complaining of chest pain across the front of their chest. There are no vital sign abnormalities and no other complaints of pain. The diagnosis of blunt cardiac injury is considered. The nurse anticipates an order for which of the following?: A. EKG B. Cardiac marker evaluation (CK or Troponin) C. Cardiac monitoring D. Chest radiograph - B. Cardiac marker evaluation (CK or Troponin) Not all trauma pts with blunt cardiac injury will have acute alterations in cardiac markers, and other organ injury may cause release of creatinine kinase and confound the diagnosis of blunt cardiac injury 4. Which of the following is a form of distributive shock?: A. Neurogenic B. Metabolic C. Respiratory D. Obstructive - A. Neurogenic 5. A pt presents following an acute onset of chest pain, dyspnea and severe diaphoresis, with near syncope. Assessment shows a pt in severe distress, with HR 110, BP 60/40 and RR 36 with bilateral rales. An EKG reveals ST segment elevation across the precordial leads. A diagnosis of acute MI with cardiogenic shock is made, and the pt is being prepared for transfer to the cardiac cath lab. The vasopressor of choice, based on this pts degree of hypotension is: A. Norepineprhine (Levophed) B. Dopamine (Inotropin) C. Dobutamine (Dobutrex) D. Vasopressin (Pitressin) - A. Norepineprhine (Levophed) The intial use of norepinephrine for marked hypotension, <70mmHg systolic is the current recommendation from the AHA 6. A pt presents with complaints of chest pain that radiates to the jaw, stating the pain is a 6/10. Other symptoms include nausea, dizziness, shortness of breath with clear lung sounds, and a sense of impending doom. The pain started 40 mins before arrival. Vitals: BP 116/58, HR 98, RR 20, SpO2 94%, T 98.6F. The 12 lead EKG shows inferior wall myocardial injury pattern. Which clinical presentations indicate the need to complete a right sided 12 lead EKG?: A. Shortness of breath with clear lung sounds B. Nausea and dizziness C. Chest pain with radiation to the jaw D. Sense of impending doom - A. Shortness of breath with clear lung sounds