test questions

Question 1

Deflation of the balloon in an IABP should happen at which point?

Answer 1

The intra-aortic balloon deflates prior to ventricular contraction (systole) and forward flow. This occurs at the R wave of the ECG. The T wave and dicrotic notch occur during ventricular filling (diastole).

Question 2

Which phase of the cardiac cycle does the intra-aortic balloon pump inflate?

Answer 2

Beginning of ventricular diastole

Question 3

A patient with prolonged immobility should be monitored for:

Answer 3

Decrease in CVP
A physiological effect of prolonged bed rest is a decrease in circulating volume. Patients also may develop an increase in HR or reflex tachycardia, a negative nitrogen state, and a decrease in functional residual capacity.

Reflex tachycardia is when blood pressure decreases, the heart beats faster in an attempt to raise it.

Negative nitrogen balance is associated with burns, serious tissue injuries, fever, hyperthyroidism, wasting diseases, and during periods of fasting. This means that the amount of nitrogen excreted from the body is greater than the amount of nitrogen ingested.

Question 4

Ther nurse is caring for a patient with hypercalcemia. For which imbalance should the nurse observe?
1. Hyperkalemia
2. Low albumin
3. Hypermagnesemia
4. Hypophosphatemia

Answer 4

Hypokalemia.
Rare cases, an increase in albumin may cause a pseudohypercalcemia.
Hypercalcemia leads to urinary excretion of magnesium —> Hypomagnesemia
Hypophosphatemia associated with hypercalemia (inverse relationship)

Question 5

In the presence of blunt cardiac trauma, which finding supports a diagnosis of myocardial contusion?

Answer 5

Cardiac dysrhythmias

Dysrhythmias, in general occur secondary to the inflammatory process associated with the injury. A dysrhythmias in the setting of blank cardiac trauma always indicates a myocardia contusion until proven otherwise. Atrial dysrhythmias may be seen with right sided injuries. Ventricular disturbance are more likely seen after left-sided cardiac injuries.

Question 6

A patient is admitted following an overdose of methamphetamine. The nurse should anticipate:

Answer 6

observing for the development of rhabdomyolysis and monitoring renal function.

Patients who have taken methamphetamine are at risk for rhabdomyolysis. Aggressive volume resuscitation with IV crystalloid is indicated.

Question 7

A primary concern when caring for someone with pancreatitis is to closely monitor fluid and electrolyte levels closely, because

Answer 7

plasma volume is lost as pancreatic enzymes increase capillary permeability

Activated kinins in acute pancreatitis cause systemic vasodilation and increase capillary permeability, the latter of which promotes edema. Hypocalcemia, hypoglycemia, and dehydration are some of the features of pancreatitis.

Question 8

Which is normal compensatory response to a decrease in cardiac output?

Answer 8

Increased oxygen extraction

A decrease in cardiac output results in an increase in oxygen delivery and an increase in oxygen consumption. An increase in oxygen extraction is one way that the body compensates to meet oxygen needs when oxygen delivery to tissue is inadequate.

Question 9

What does A-a gradient evaluate?

Answer 9

A-a gradient evaluates shunt (the degree of oxygen that goes out of the systemic circulation without oxygenation). A-a gradient is also used to assess the integrity of the alveolar-capillary unit to determine the causes of low PaO2.

Question 10

Which ABG results indicate acute respiratory failure?

Answer 10

pO2 less than 60
pCO2 great than 45

Question 11

Which PA catheter findings should be anticipated in a patient with chronic emphysema?

Answer 11

Increased CVP.
Emphysema can cause cor pulmonale secondary to increase in pressure. Cor pulmonale is heart failure brought on by long-term high BP in the lung arterioles and RV. Cor pulmonale is characterized by increased pulmonary vascular resistance and right heart failure. It is associated with a decrease in left ventricular filling pressure, left ventricular stroke volume, and cardiac output.

Question 12

What is the rationale for using dobutamine (Dobutrex) at an infusion rate of 10-20 mcg/kg/min
for cardiogenic shock?

Answer 12

As a Beta-1 agonist, Dobutamin works by increasing contractility and cardiac output. It can potentially cause cardiac ischemia due to SNS stimulation. There is an expected increase in myocardial workload and consumption.

Question 13

Which laboratory results should be expected from a patient with severe acute pancreatitis?

Answer 13

Elevated serum amylase, hypocalcemia, and decreased total protein. Hypocalcemia is secondary to saponification of fat in retroperitoneum.

Question 14

Which life-threatening dysrhythmia is most frequently associated with heart failure?

Answer 14

Ventricular tachycardia.
Low EF leads to stretch and excitability of the ventricles. Heart failure can result in electrolyte shifts from diuretic therapy, which can exacerbate ventricular tachycardia.

Question 15

A ventilated patient is receiving tube feeding and has suspected aspiration. which pulmonary parameters should be expected?

Answer 15

Aspiration pneumonia causes an increase in peak inspiratory pressure due to decreased lung compliance or increased lung resistance. The exhaled tidal volume will decrease due to decreased lung compliance. Negative inspiratory force is an indicator of inspiratory muscle strength. Patients must be able to inhale an adequate inspiratory volume to build up intrathoracic pressure.

Question 16

Patient with chest pain, ST elevation on II, III, aVF, what short of HR might you expect to see?

Answer 16

Bradycardia d/t SA and AV node involvement. RCA is the dominant supply to the AV node and RCA is located in the left inferior and posterior ventricle.

Question 17

A patient is admitted with rhabdomylolysis. Serum creatinine kinase is 6500 units/L. Which should the nurse anticipate?

Answer 17

Administration of sodium bicarbonate. Urine alkalization is recommended for serum kinase greater than 6000 units/L. Urinary output should be maintained at least 2-3 ml/kg/hr.

Question 18

A patient was admitted with hepatic failure and severe dehydration. The patient is encephalopathic. Which treatment should the nurse anticipate?

Answer 18

Potassium replacement
Decrease in potassium may cause hepatic failure and encephalopathy. Normally, the lactate in LR gets converted to bicarbonate in the liver. However, in patients with the liver failure, the lactate cannot be broken down. Thus do not use LR to replace fluid.

Question 19

A patient with respiratory failure secondary to pneumonia appears confused and lethargic. The patient takes NSAIDS for arthritis. At present, BP and CVP are within acceptable ranges, mucous membranes are moist and skin turgor is normal. The serum sodium is 129 mEq/L, and serum osmolality is low. Which additional laboratory finding should the nurse anticipate?

Answer 19

This patient is demonstrating euvolemic hyponatremia, which is characterized by normal or excessive fluid volume. The most common cause of euvolemic hyponatremia is SIADH. Low BUN in SIADH occurs due to volume expansion, urea is distributed in total body water. In SIADH, potassium levels increase and sodium bicarbonate levels remain in range, despite the hypotonic expansion of body fluids. GFR is increased due to extra cellular water expansion. Therefore, serum creatinine decreases. Glucose levels are not affected by SIADH. Low Uric acid levels are usually seen during a period of hyponatremia in SIADH. An increase in excretion occurs due to volume expansion and a decrease in tubular reabsorption.