CCRN QUESTIONS & ANSWERS SCORED A+

Heparin: - Heparin inhibits the conversion of prothrombin into thrombin Heparin inactivates circulating thrombin Heparin inhibits the conversion of fibrinogen into fibrin Causes of Right side heart failure? - Acute RV infarct Pulmonary Embolism Septal defects Pulmonary stenosis/regurgitation COPD Pulmonary htn Left Ventricular fx The patient is receiving heparin infusion for the treatment of pulmonary embolism. There has been a 60% decrease in the platelet count and no clinical change. Which of the following is indicated? - Discontinue heparin and being argatroban. The patient most likely has HIT. Exposure to heparin needs to discontinued and a direct thrombin inhibitor started for continued anticoagulation. The patient presents one month status post gastric bypass bariatric surgery with vomiting, headache, diplopia, and memory loss. These are clinical signs of which of the following? - Malabsorption The signs and symptoms are those of malabsorption, which results in vitamin deficiency and may occur after bariatric surgery. The remaining choices are not manifested by the signs and symptoms described.The patient requires fluid resuscitation and 8 units of PRBC's status post traumatic injury. Which of the following interventions is most appropriate? - Warm blood products and crystalloids The nurse is caring for a patient with acute inferior wall MI, post-coronary artery stent deployment, For optimal care of the patient, the nurse should: - Continuously monitor the patient in lead II It is best practice to monitor the patient status post PCI with stent, in the lead that was most abnormal during the acute occlusion. The ECG demonstrates ST elevation in leads II, III and aVF. The nurse needs to monitor the patient closely for which of the following? - Complication likely to occur after an acute inferior wall MI include bradycardia secondary to ischemia to the SA and/or AV node, and papillary muscle rupture or dysfunction due to the anatomical distance between the RCA and the papillary muscle. Which of the following hemodynamic profiles would benefit from the aggressive fluid administration, pressers and antibiotics therapy? a. RAP: 1mm Hg; PAOP: 4 mmHg; SVR: 1800 dynes/sec; CO: 2L/min b. RAP: 5; PAOP: 7; SVR: 400; CO; 8L - B. the hemodynamic profile of RAP 5, PAOP 7, SVR 400 is typical of septic shock, and choice B would be the best approach. Which of the following is indicative of a mixed acid-base disorder? A. pH 7.18; PaCO2 25; PaO2 64; HCO3 11 B. pH 7.33; PaCO2 29; PaO2 72; HCO3 15 - The decrease in PaCO2 is evidence of respiratory alkalosis and the decreased HCO3 is evidenced of a metabolic acidosis. The pt with severe sepsis or septic shock may present with this mixed acid-base disorder. The patient with a temporary pacemaker develops pacemaker malfunction. The oriented is instructed to reposition the patient to try and correct the problem. The cardiac monitor most likely demonstrates? -Failure to capture (pacemaker without a QRS) may be corrected by repositioning the patient to the side. The patient with diastolic heart develops SVT, heart rate 220/min. The most dangerous hemodynamic effect is a decrease in: - coronary artery perfusion. Diastolic heart failure results in a problem with left ventricular FILLING secondary to ventricular thickening, and contractility and ejection are maintained in diastolic failure. The rapid heart rate will decrease filling time, worsen left ventricular filling and because coronary artery perfusion occurs during diastole, this arrhythmia may be life-threatening. The patient with oat cell carcinoma has the following clinical findings: low urine output, low serum osmolality, hyponatremia, and elevated urine sodium. The nurse anticipates which of the following as part of the treatment plan? - Phenytoin (Dilantin), 3% saline. The patient has signs of SIADH which results in production of excessive ADH. Dilantin will inhibit ADH secretion and 3% saline will increase serum sodium. Peep therapy and mechanical ventilation are ordered for the patient with acute respiratory failure. Which of the following is a possible complication? - Barotrauma The addition of positive end-expiratory pressure will increase alveolar recruitment, prevent atelectasis and improve oxygenation. However, the increase in intrathoracic pressure may lead to pneumothorax or subcutaneous emphysema. The postoperative thoracic surgery patient has bubbling in the water seal drainage chamber of the chest tube. Which of the following interventions is indicated? - avoid high airway pressures Bubbling in the water seal chamber is due to a pleural air leak, and high airway pressure will either prevent resolution of the current air leak or make it worse.Which clinical sign might patients with both systolic and diastolic heart failure have in common? - Lung crackles Both a problem with systolic (ejection problem) and diastolic (filling problem) will increase left heart pressure and cause cardiogenic pulmonary edema (lung crackles). Which of the following is most likely to result in a low Sv02? A. Hypotermia B. Fever C. Severe sepsis - Fever Fever increases metabolic rate and consumption, which may lead to a drop in mixed venous oxygen saturation. The nurse needs to assess adequacy of the tubing/catheter system for the arterial line. Which of the following interventions will best assess this? - Perform a square wave test Warming fluids and blood needed for traumatic injury will prevent hypothermia and its related adverse effects. Which of the following therapies should be avoided for the patient with cardiogenic shock? - high dose vasopressors Vasopressors increase left ventricular after load, which would increase myocardial work of a failing heart. The patient is status post repair of an aneurysm for subarachnoid hemorrhage. Which of the following interventions is indicated to prevent vasospasm? - Nimodipine (Nimotop) is a calcium channel blocker that is started immediately post-op to prevent arterial spasm of the brain.The patient presents with a rigid abdomen, rebound tenderness, and a free air in the peritoneum seen on KUB x-ray. Which of the following should the nurse anticipate? - Powell perforation; provide fluids, prepare for surgery. The clinical signs are those of bowel perforation. Which is the priority treatment for the pt with DKA who presents with hyperglycemia, ketosis, and normal serum potassium? - replace potassium The patient with DKA will have a low pH and metabolic acidosis. In a state of metabolic acidosis, hydrogen ions move into the intracellular space. In exchange, potassium leaves the intracellular space. The movement of K into the extracellular space results in hyperkalemia. Which of the following is a systemic effect of the therapeutic hypothermia during the cooling phase? - Hyperglycemia secondary to insulin resistance. During the cooling phase of clinical hypothermia there is typically insulin resistance. Additionally, during the phase there is vasoconstriction, decreased neutrophil production and during rewarming, rebound hyperkalemia may occur (not during the cooling phase). The patient presented to the ED with a history of palpitations and dyspnea, persisting on and off for one week. The heart monitor shows trail fibrillation with rapid ventricular response, blood pressure 112/70. Treatment will most likely include: - CCB and anticoagulation The patient history seems to be one of intermittent atrail fibrillation over the past week. Controlling rate and addressing potential left atrial clot formation are priority treatments. Which of the following clinical findings would you expect to find in the patient with septic shock? - Lactate 8, SvO2 85 Elevated lactate is evidence of anaerobic metabolism and elevated Sv02 is evidence of decreased oxygen utilization at the cellular level - both definitive for septic shock.The patient has a massive pulmonary embolism. Which of the following would be expected? - Hypotension, increased alveolar dead space. Massive pulmonary embolism results in sudden extremely elevated pulmonary pressures with resultant right ventricular failure and decreased left ventricular pressure. The drop in CO results in hypotension. The clot obstructs pulmonary perfusion which results in increase headspace ventilation. The patient presents with left leg pain; ankle-brachial index (ABI) is 0.7. The patient would benefit from which of the following interventions? - dependent position of legs The clinical signs are indicative of peripheral arterial occlusive disease. Dependent leg position will aid perfusion. Which of the following are clinical signs of variant (Prinzmetal's) angina? - ST-elevation, resolves with nitrate therapy. This type of angina is thought to be due to arterial spasm at the point of coronary artery plaque, not due to plaque rupture. The ST elevation is transient because the spasm is relieved with nitrates; therefore infarction does not occur. The most specific clinical sign for the presence of brain death would include which of the following? - Absent oculocephalic reflex If eyes remain midline or turn to the side of head rotation, it is a sign of cranial nerve VIII damage and possible brain death. The apnea test is positive in the presence of brain death; while coma is present during brain death, most patients with coma do not have brain death. The physician determines the patient has ARDS. The patient has developed refractory hypoxemia, bilateral infiltrates, and pulmonary edema on chest x-ray. What findings would be expected? a. increased lung compliance b. PAOP normal or low c. decreased cardiac output - b.The pulmonary edema of ARDS is due to lung capillary leak at normal or even low left heart pressure, unlike cariogenic pulmonary edema, which results in pulmonary edema at higher than normal left heart pressure. Priority treatment for aortic dissection requires which of the following? - Aggressive management of hypertension and emergent surgery. Emergent surgery is essential for survival, and blood pressure control is essential preoperatively. Pain control and transfusion may be indicated, but the remaining therapies are not beneficial. Inferior MI is associated with? - RCA occlusion AV conduction disturbances: 2nd- degree Type 1, 3rd- degree heart block, Sick sinus syndrome, and sinus bradycardia Development of systolic murmur: mitral valve regurgitation secondary to papillary muscle rupture Also associated with RV infarct and posterior MI Right Ventricular Infarct S&S: What to avoid: - JVD at 45 degrees High CVP Hypotension Usually clear lungs Bradyarrhythmias Avoid Preload reducers - nitrates, diuretics and caution with beta blockersAnterior MI Reciprocal changes in LAD? May develop? - reciprocal changes (ST depression) in inferior wall (II, III, aVF) may develop 2nd degree type II or RBBB (the LAD supplies the common bundle of HIS)...ominous sign. Higher mortality than inferior: Heart Failure Complications of PCI: - Stent thrombosis is most likely to be on the test (most incidents occur acutely within 24hours of stent placement or sub acutely within the first 30 days. Retroperitoneal bleed is most likely to be on test