test 1 Flashcards by Frances T

The volume of the blood inside the left ventricle is a good measure of cardiac function. Which parameter describes the total volume of blood when the ventricles are fully relaxed?

Stroke Volume Index
Afterload
Mixed venous Oxygen saturation
Preload

Preload

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A physician stated: “We need to decrease the patient’s preload.” Which of the following interventions can reduce the preload? Choose the best answer.

Vasodilators
Vasoconstrictors
Blood expanders
Diuretics

Diuretics

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Effective bodily circulation depends on adequate blood volume and pressure. What is the general term that indicates the amount of pressure to be surpassed by the ventricles to eject the blood? Choose the best answer.

Afterload
Stroke Volume Index
Stroke Volume Variation
Right Ventricular End Diastolic Volume

Afterload

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A Cardiologist is concerned with an elevated blood pressure of one of his patients. The nurse would appropriately manage the elevated afterload with which of the following?

Nitrates
Adrenergic agonists
Inotropes
Chronotropes

Nitrates

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A patient is diagnosed with Essential Hypertension upon hospital admission. Which of the following factors will be directly affected by the diagnosis?

Pulmonary Vascular Resistance
Pulmonary Vascular Afterload
Left ventricular afterload
Right ventricular afterload

Left ventricular afterload

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A critical care nurse is describing the benefits of a Swan-Ganz Catheter. Which of the following parameters can be measured by Swan-Ganz Catheter?SATA

Central Venous Pressure
Pulmonary Artery Pressure
Central Arterial Pressure
Right atrium pressure

Central Venous Pressure
Pulmonary Artery Pressure
Right atrium pressure

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Pulmonary artery catheter is useful for measuring different pressures within the cardiovascular system. Which pressure is detected by the tip of the catheter if the balloon is not inflated?

Left ventricular end-diastolic pressure
Pulmonary artery pressure
Pulmonary vein pressure
Right atrium pressure

Pulmonary artery pressure

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A heart surgeon has determined that the Swan-Ganz catheter is in the proper location. He verbally ordered “Balloon up”. Which parameter can be measured when the balloon is inflated?

Pulmonary artery
Central venous pressure
Left ventricular end-diastolic pressure
Pulmonary vascular resistance

Left ventricular end-diastolic pressure

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A male patient was documented to have a severe cardiomyopathy. Which nursing care plan may help reduce worsening the patient’s heart condition?

Reduce left ventricular end-diastolic preload
Increase systemic Vascular Resistance
Elevate central venous pressure
Decrease SVO2

Reduce left ventricular end-diastolic preload

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A cardiac patient is being monitored for hemodynamic fluctuations. Which of the following best describes the strength of cardiac function?

Arterial Pressure
Cardiac Index
Cardiac Output
Pulmonary Artery Pressure

Cardiac Index

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A male patient with COVID Pneumonia suffered heart failure. Which of the following parameters would the nurse expect to be accurate?

Elevated systemic vascular resistance
Reduce pulmonary vascular resistance
Elevated SCVO2
Elevated pulmonary vascular resistance

Elevated pulmonary vascular resistance

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Which of the following is/are accurate descriptions of Stroke Volume?

Normally range: 60-130 ml/beat
Normal Range: 30-65 ml/min/m3
Amount of blood ejected per contraction
Amount of blood affected per minute.

Normally range: 60-130 ml/beat

- Amount of blood ejected per contraction

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Which of the following is/are accurate descriptions of Central Venous Pressure? SATA

Normal Range: 2-6 mmHg
Correlates with patient’s intravascular volume
Correlates with systemic vascular resistance
Correlates with right atrial pressure

Normal Range: 2-6 mmHg
Correlates with patient’s intravascular volume
Correlates with right atrial pressure

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A critical care nurse observed a Central Venous Pressure of 28 mmHg. Which physical assessment findings may be appreciated by the nurse?

Crackles
Sunken eyeballs
Moist lips
Tachycardia

Crackles

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Which of the following is true of Cardiac output?

Normal Value: 2.5-4.2 L/min/m3
Normal Value: 8-12 mmHg
Amount blood ejected out of ventricle per body surface area
Amount of blood ejected out of ventricle per minute

Amount of blood ejected out of ventricle per minute

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Which of the following is true of Pulmonary Artery Wedge Pressure?

Measures volume of blood in the right ventricle
Measures volume of blood in the left ventricle
Normal value: 8-12 mmHg
Resistance that must be overcome by the left ventricle.

Measures volume of blood in the left ventricle

Normal value: 8-12 mmHg

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A critical care nurse observed a Pulmonary Artery Wedge Pressure of 36 mmHg. Which of the following would the nurse consider is the causative factor?

Respiratory Failure
Heart Failure (8-12)
Liver Failure
renal failure

Heart Failure (8-12)

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A critical care nurse noted a Systemic Vascular Resistance (SVR) 1900 dynes/sec/cm3 (750-1500) . Which of the following is a correct interpretation?

Systemic vasoconstriction
Systemic vasodilation
Blood loss
Fluid overload.

Systemic vasoconstriction

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A physician ordered “verify consent for Pulmonary Artery Catheter Placement”. Which of the following is appropriate about this procedure. Select all that apply.

Patient acknowledge understanding of all risk and benefits
Nurse explains the purpose of the procedure
Nurse signs consent as a witness
Patient signs document for Artery Catheter Placement

Patient acknowledge understanding of all risk and benefits

- Nurse signs consent as a witness

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A nurse supervisor is to distribute multiple patients from the emergency department. Which of the following patients can be safely admitted to the Progressive Care Unit?

Interventional cardiac procedure patients
Patients awaiting heart transplant
Patients receiving titratable doses of vasoactive IV drugs
Patient being weaned from prolonged mechanical ventilation

Interventional cardiac procedure patients
Patients awaiting heart transplant
Patient being weaned from prolonged mechanical ventilation

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A critical care nurse manager has one available bed ready for patient management. Which of the following patients should receive priority admission?

S/P Appendectomy due to Ruptured Appendix
Gastric Bypass patient confused in the recovery room
Male patient with sudden lethargy with facial droop
Abdominal pain with jaundice

Male patient with sudden lethargy with facial droop

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A nursing director is evaluating the professional experiences of a critical care nurse applicant. Which of the following are necessary knowledge and skills required of a nurse for the critical care unit? Select all that apply

Strong understanding of pathologic basis of diseases
Wide range of pharmacotherapeutic expertise
Ability of collaborate with other health disciplines
High degree of judgment of signs and symptoms

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The intensive care unit has a diverse population of patient medical needs. A priority nurse action should be given to which type of patient condition?

Nutrition
Hemodynamic instability
Sleep deprivation
Acute severe pain

Hemodynamic instability

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Blood was oozing from a wound after removal of an arterial line catheter from the right upper extremity. What is the appropriate description for the wound?

Pressure ulcer
Skin tear
Incisional wound
abrasion

Incisional wound

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A confused patient accidentally pulled out a central venous catheter from his left arm. Which of the following are expected findings upon inspection of the injury? Choose the best answer. Pulsating blood Necrosis of the tissues around the wound Bright red blood Dark red blood

Dark red blood

A patient has a ruptured blister after removal of plastic tape on a central venous catheter. What layer of skin is exposed by the ruptured blister? Epidermis Dermis Subcutaneous Ecoderm

Dermis

A cardiac catheter RN is assisting a cardiologist inserting a swan-ganz catheter. The physician stated:”balloon up” this means what? Flush the central venous catheter Inflate the catheter with 1.5cc of air Aspirate the catheter of 1.5cc of air Flush the cordis

Inflate the catheter with 1.5cc of air

What is the normal value of systemic vascular resistance? 670-700 dynes/sec/cm3 500-1000 dynes/sec/cm3 >1400 dynes/sec/cm3 770-1500 dynes/sec/cm3

770-1500 dynes/sec/cm3

How much pressure is recommended to inflate a pressure bag to provide a 3cc/hr flush? 350 mmHg 375 mmHg 300 mmHg 325 mmHg

300 mmHg

What is the landmark for the phlebostatic axis? Crossing point between 4th rib and lateral mid-chest Crossing point between 4th intercostal space and lateral anterior chest Crossing point between 4th intercostal space and lateral mid-chest Crossing point between 4th rib and lateral posterior chest

Crossing point between 4th intercostal space and lateral mid-chest

From the image shown, what can be measured by the port inside the circle? Pulmonary Artery Pressure Pulmonary Artery Wedge Pressure (?) Central Venous Pressure SVO2

SVO2

From the image shown, what is the blood vessel accessed by the Swan-Ganz catheter? Left jugular vein Right jugular vein Left carotid artery Right carotid artery

Right jugular vein

The above tracing indicates movement of the Swan-Ganz Catheter while being inserted and “balloon is up” Pulmonary vein occluded pressure Pulmonary artery pressure Right atrial pressure Pulmonary artery wedge pressure

Pulmonary artery wedge pressure

Which pressure is being measured by the rhythm inside the circle? Left ventricle Right ventricle Right atrium Left atrium

Right ventricle

An arterial catheter was placed in the left femoral artery catheter. Which blood vessel should be assessed to determine adequate perfusion below the insertion site? Percuss left popliteal artery Auscultate left dorsalis pedis artery Palpate left femoral artery Palpate left dorsalis pedis artery

Palpate left dorsalis pedis artery

A central venous catheter was being inserted when the patient suddenly flexed his hip. Which muscle is responsible for hip flexion? Iliopsoas muscle Rectus femoris muscle Gluteus maximus muscle Adductor longus

Iliopsoas muscle

Identify the upward deflection at the tip of the arrow. Write the answer on the space provided.

Dicrotic notch

On the ECG shown above, describe which wave occurs at the tip of the arrow. a. ST segment b. P-wave c. QRS d. T-wave

P-wave

# Choose the events that occur with waveform being asked on Question 38. Select all that apply Responsible for the first heart sound Responsible for second heart sound Tricuspid and Mitral valves open Tricuspid and Mitral valves close

- Responsible for the first heart sound | - Tricuspid and Mitral valves close

A patient has a severely depressed heart function. Which of the following hemodynamic changes can be expected? Select all that apply. a. Low cardiac index b. High cardiac index c. High central venous pressure d. High pulmonary artery wedge pressure

- Low cardiac index - High central venous pressure - High pulmonary artery wedge pressure

The nurse is caring for a patient with septic shock. Which of the following assessments is most concerning to the nurse? The blood sugar is 138 The skin is warm and flushed The white blood cell count is 17,000 The patient has blood oozing around the catheter site

The patient has blood oozing around the catheter site

Before starting antibiotics on a patient with septic shock. What is one of the most important nursing actions? Make sure the client is on isotonic fluids Obtain an accurate temperature Obtain blood cultures Place the client ina negative pressure room

Obtain blood cultures

A patient in septic shock was noticed to have coffee-ground secretions via nasogastric tube. What is most important for the nurse to monitor? The client’s potassium and sodium level The client’s glucose and chloride level The client serum creatine and blood urea nitrogen (BUN) The client’s prothrombin time and partial thromboplastin time (PTT)

The client’s prothrombin time and partial thromboplastin time (PTT)

The nurse is caring for a patient in septic shock after aggressive fluid resuscitation. What is the assessment that shows the fluid resuscitation was effective? The client has a urine output of 225/ml per hour The client heartrate is now 56 beats per minute and regular The central venous pressure is 15mm The client’s pulse oximeter has improved from 88%-94%

The central venous pressure is 15mm

The nurse is teaching a group of student nurses the pathophysiology of septic shock, which of the following facts are correct? Select all that apply. In septic shock there is a decrease heart rate and blood pressure Septic shock can present with a high temperature or a subtherapeutic temperature Patients usually experience an initial increase in cardiac output CO and a decreased stroke volume The combined effects of mediators result in vasoconstriction and decreased capillary permeability Respiratory failure develops in 85% of patients with sepsis

Septic shock can present with a high temperature or a subtherapeutic temperature Patients usually experience an initial increase in cardiac output CO and a decreased stroke volume Respiratory failure develops in 85% of patients with sepsis

The next five questions are based on the previous scenario A 70 year old causian male patient is a direct admit from the nursing home. Mr. Smith is usually a pleasant, cooperative, client who previously had been alert, oriented x4. Vital signs are blood pressure 98/58, heart rate 118 and irregular, respiration 24 and shallow, temperature 39.9 c. The patient only knows his name at present. The client has warm to touch skin and diaphoretic, lung sounds on auscultation show crackles and rhonchi at the bases. Foley catheter is draining cloudy yellow urine with sediments. After the nurse has drawn the complete blood count (CBC) with differential, basic metabolic panel (BMP). Which of the following actions are incorrect when drawing the patient’s blood cultures? The nurse should use chlorhexidine using a circular motion, scrubbing for at least one minute on the site to be used. After using the chlorhexidine, the nurse should allow the prep area to dry for 30 seconds before drawing the blood culture. Blood cultures preferred draw site should be from the peripheral site not a line unless the line is suspected to being affected Blood cultures should always include an aerobic and anaerobic sample After drawing all the laboratory samples, what is the nurse’s next action? Take out the old foley catheter and send urine for culture Start an intravenous fluid of D5W Start a second intravenous line on the client Place the client on strict isolation .What is the most likely cause of the patient’s condition? Pneumonia Urosepsis Adult respiratory Distress Syndrome (ARDS) Endocarditis

The nurse should use chlorhexidine using a circular motion, scrubbing for at least one minute on the site to be used. Take out the old foley catheter and send urine for culture Urosepsis

The patient’s urine output has decreased to 20 mLs in the last four hours and the blood pressure is now 80/50 with a heart rate of 72 per minutes. What is the nurses’s priority action? Start an intravenous drip of vasopressin Start an intravenous drip of dopamine Start an intravenous drip of norepinephrine Start an intravenous drip of normal saline

Start an intravenous drip of normal saline

After initiation of appropriate intravenous drip, what is the nurses’s next action? Give intravenous push IVP corticosteroids Give IVP 50 mLs of 50% dextrose Give IVP 50 mLs of sodium bicarbonate Give IVP propranolol 10 mg

Give intravenous push IVP corticosteroids

A female patient was diagnosed with cardiogenic shock. Which of the following types of medications should the nurse anticipate be prescribed? Choose the best answer. Vasopressors Inotropes Antibiotics Vasodilators

Inotropes

A male patient was rushed to the emergency department due to multiple stab wounds. Which of the following shocks is to be expected immediately? Choose the best answer. Septic shock Neurogenic shock Cardiogenic shock Hypovolemic shock

Hypovolemic shock

A female patient was brought to the emergency department due to a physical assault. According to the witness, she was struck with an elongated object hitting her to the upper back . her blood pressure is low without signs of bleeding. What is a possible cause of hypotension? Septic shock Neurogenic shock Cardiogenic shock Hypovolemic shock

Neurogenic shock

A 15 year old girl was brought to the school clinic after accidentally ingesting a food she was allergic to. She was noted to be wheezing and drowsy. Her blood pressure is 85/62 mmHG. What is the possible explanation for the hypotension? Septic shock Anaphylactic shock Cardiogenic shock Hypovolemic shock

Anaphylactic shock

A 58-year-old male patient was brought to the critical care unit after a cardiac catheterization procedure. He was noted to have profuse sweating, tachycardia and hypotensive. Which nurse statement is to be reported to the cardiologist? “The patient might be suffering from an allergic reaction.” “Please evaluate our patient for a potential cardiogenic shock.” “A severe infection has complicated our patient.” “Unfortunately, this patient developed a big obstructive cancer after the procedure.”

“Please evaluate our patient for a potential cardiogenic shock.”

Scenario for question 21-25: A female patient who recovered from Septic Shock due to Urinary Tract Infection is having diarrhea with a fishy smell. She needed 2 months of intravenous Ciprofloxacin for the UTI. 21. Which nursing intervention is most appropriate? Send urine for urinalysis Collect stool and send to laboratory for C. difficile toxin analysis Switch ciprofloxacin to oral form Wear mask 22. What gastrointestinal disease can arise from overgrowth of ``` Clostridium difficile? Pseudomembranous Colitis Crohn's disease Ulcerative Colitis Inflammatory bowel syndrome ``` 23. Which antibiotics are the ideal for the answer on Question 22? Select all that apply. Penicillin Vancomycin Tigecycline Metronidazole 24. What is the recommended isolation precaution for the medical condition on Question 22? Airborne precaution Droplet precaution Enhanced precaution (airborne, croplet, contact precaution) Contact precaution 25. A nurse received a result of “positive C. difficile toxin found on a stool sample. Which nursing statement is most appropriate? “An increase of Vancomycin will handle this.” “Sulfonamides may need to be started and discontinue Vancomycin.” ‘Long term use of Antimicrobial medication must be investigated.” “Multiple powerful antibiotics must be inherited.”

Collect stool and send to laboratory for C. difficile toxin analysis Pseudomembranous Colitis Vancomycin Vancomycin Contact precaution ‘Long term use of Antimicrobial medication must be investigated.”

A patient was diagnosed with Neurogenic shock after a vehicular accident. Which of the following medications are most appropriate? Select all that apply. Dobutamine Normal saline bolus 3:1 ratio Dopamine Albumin 5% 500 ml

Dobutamine | Dopamine

``` A school nurse is responding to a 10-year-old boy who had an allergic reaction from an undetermined insect bite. The boy in moderate respiratory distress, wheezing and pale-looking skin. What is the next nursing action for this patient? Call 911 Administer epinephrine intramuscularly Notif parents immediately Administer oral diphenhydramine ```

Administer epinephrine intramuscularly

J.S. is a 67-year-old male is being seen at local urgent care center due to fever, shortness of breath and anorexia, and malaise. A rapid SARS-CoV2 test is negative for the virus. He has a gangrenous foot that was never managed dut to his fear of going to the hospital. His vital signs are BP: 96/72, HR: 118, RR: 30, O2 sat: 97%. 1. Based on the above information, which of the following should be considered by the nurse? Septic shock Severe sepsis Sepsis Systemic inflammatory response syndrome (SIRS) ``` 2. During the course of patient physical assessment, the nurse noted the patient to slump on the chair and suddenly became lethargic. What is the next nursing action? Obtain vital signs Draw blood for testing Immediately notify the physician on duty Provide oxygenation ``` ``` 3. A suspicion of septic shock is being considered for J.S. What is the initial nursing intervention for this patient? Call paramedics Ensure adequate airway Hemodynamic support Pain management ``` ``` 4. While awaiting for the paramedics to arrive, which of the following positions would benefit this patient? Reverse trendelenburg position Fowler's position Trendelenberg position Supine ``` 5. The primary nurse is discussing with the physician on duty the next course of action. What is the priority recommendation the nurse can contribute to the team? Wait for the patient to wake up Transfer patient to acute care hospital for higher level of care Obtain permission from family Discharge to home when stable

1. SIRS 2. Obtain V/S 3. Hemodynamic support 4. Trendelenburg's position 5. Transfer patient to acute care hospital for higher level of care

A female patient who had a long history of deep vein thrombosis of the left lower extremity was admitted due to moderate respiratory distress. He was placed on 6LMP of oxygen via nasal cannula which temporarily improved her O2 saturation. Suddenly, she complained of sudden chest and back pain and severe dyspnea with tachypnea. The physician suspected a pulmonary embolism as the cause of respiratory distress. ``` 1. Which of the following nursing assessments is indicated to prepare the patient for the definitive test for pulmonary embolism? Presence of metal implants Acrophobia Shellfish allergy Preferred antibiotic ``` ``` 2. An arterial blood gas (ABG) was drawn with the following results: pH: 7.48, pCO2: 30, pO2: 100, HCO3: 25. What can explain the ABG result? Choose the best answer. Fear and anxiety Oxygen via nasal cannula at 6 LPM Rapid breathing Chest and back pain ``` 3. The patient displayed drowsiness with shallow breaths. A repeat ABG was immediately drawn with the following results: pH: 7.25, pCO2: 38, pO2: 51, HCO3: 26. Which nurse statement would indicated understanding of the next priority nursing intervention? “Doctor , i have to perform abubagging (Bivalve mask) for our patient!” “I will call the MRI department for a stat schedule.” “Sodium bicarbonate has to be given now.” “If this is pulmonary embolism, we need to dissolve the clot.” 4. Which nursing action should be expected next? Prepare to resuscitate patient Prepare for emergency invasive positive pressure ventilation Prepare for emergency non-invasive positive pressure ventilation Prepare for musically induced coma ``` 5. In preparation for the procedure planned in Question 44, which medication should the prudent nurse from AUHS prepare? Select all that apply. Antibiotic Sedative Paralytic Normal saline bolus ```

1. Shellfish allergy 2. Rapid breathing 3. “Doctor , i have to perform abubagging (Bivalve mask) for our patient!” 4. Prepare for emergency invasive positive pressure ventilation 5. Sedative (Etomidate) , Paralytic (Vecuronium)

Which of the following causes hypoxemic respiratory failure? Select all that apply. Acute respiratory distress syndrome (ARDS) Pneumonia Toxic inhalation Pulmonary embolism COPD Asthma

All of the above

Which pharmacological management will have the most effect on improvement of respiratory distress on a patient who has pulmonary edema? Ceftazidime Atrovent Bumetanide (Diuretic!!) Dexamethasone

A female patient with COPD is suffering from moderate respiratory distress. Her O2 saturation is 90%. She refuses intubation and is currently on a simple face mask. Which device is most appropriate? Tracheostomy collar O2 conserving cannula Venturi mask Non-rebreather mask

A patient was diagnosed with ARDS. Which of the following is/are responsible for the patient emergency endotracheal intubation? Select all that apply. a. Fibrosis of alveolar membrane b. Pneumothorax c. Massive pulmonary edema d. Allergic reaction e. Near drowning f. Sepsis

ACEF

``` A patient intubated and on a respirator was noted to have a sudden drop on oxygen saturation while gagging. Which nursing intervention is most appropriate? Choose the best answer. Oral care Increase sedative Propofol as ordered In-line suctioning Call respiratory therapist ```

In-line suctioning