NCLEX Style Questions Oxygenation, & Cardiac
Which cardiac enzyme would the nurse expect to elevate first in a pt diagnosed w/an MI?
a. creatinine kinase (CK-MB)
b. Lactate dehydrogenase (LDH)
c. troponin
d. white blood cells (WBCs)
C-Troponin
While analyzing your client's telemetry strips you notice that their PR interval is 0.22. Is this normal? If not, what might it indicate?
*If R is far from P then you have a 1st degree
Upon assessment, you notice your patient has crackles in their lungs, dyspnea with SOB w/o exertion, and low O2. Your patient has a history of HTN, smoking, a-fib, and obesity.
What might be going on?
L sided HF- causing back up of fluids in pulmonary vasculature.
Tx: I/O, diuretics, vasodilators, raise HOB
You're looking at your patient and then glance at their heart monitor. You notice that your first line of treatment for this patient is magnesium.
What is V-fib? Specifically Torsades (de pointes) despite the answer from the book being isoproterol
The nurse caring for a pt w/ an endotracheal tube recognizes several disadvantages of an endotracheal tube. What would the nurse recognize as a disadvantage?
a. cognition is decreased
b. Daily ABGs are necessary
c. slight tracheal bleeding is anticipated
d. the cough reflex is depressed
D
This can cause issues for clearing secretions and can impede airway clearance.
An interdisciplinary team is planning the care of a pt with bronchiectasis. What aspect of care should the nurse anticipate? Select all the apply.
a. occupational therapy
b. antimicrobial therapy
c. positive pressure isolation
d. chest physiotherapy
e. smoking cessation
B, D, E
You are analyzing your client's telemetry strips and notice that their PR interval starts out normal at 0.16, then progresses to 0.2, 0.24, and then their QRS drops (aka-a ventricular beat is skipped). What might be going on here?
"Longer, longer, longer drop then you have a Wenckeback also known as a 2nd degree heart block-Mobitz Type I or Wenckeback.
So yes, it's known as multiple things:
-Second Degree Heart Block Type I
-Second Degree AV block
-Wenckeback
-Mobitz Type I
All of these are correct names for this issue.
In this type of block, the PR interval progressively lengthens until the QRS complex is dropped.
So, infection control is going to be huge so we ask that you wash your hands frequently, avoid crowded areas, and wear a mask if you have to be out. The risk of rejection is also extremely important. You'll be taking meds cyclosporin & Cellcept which can also make you immunosuppressed. It's important to monitor for s/s of rejection or infection and go to the ED immediately. Now, can you tell me in your own words what I just discussed with you?
What might we be educating on?
teaching for transplant recipient upon discharge
(specifically for this unit heart transplant or lung transplant)
monitor organ function-labs and presence of microemboli, maintain fluid balance- administer FFP and platelets, maintain skin integrity and bleeding precautions- NO IM, invasive procedures, look for petechiae, help with coping and grieving
What might we be monitoring for?
Nursing interventions for a patient with DIC
Complications for DIC can include:
multiple organ failure from the development of micro clots, tissues die then you can die :(
A pt is exhibiting signs of a pneumothorax following tracheostomy. The surgeon inserts a chest tube into the anterior chest wall. What should the nurse tell the family is the primary purpose of this chest tube?
a. to remove air from the pleural space
b. to drain copious sputum secretions
c. to monitor bleeding around the lungs
d. to assist with mechanical ventilation
pneumothorax-air in the lungs
hemothorax-blood in the lungs
the client will exhibit s/s including SOA and this can be seen on a CT/chest x-ray
A student nurse is preparing to care for a pt with bronchiectasis. The student nurse should recognize that this pt is likely to experience respiratory difficulties r/t what pathophysiologic process?
a. intermittent episodes of acute bronchospasm
b. alveolar dissension and impaired diffusion
c. dilation of bronchi and bronchioles
d. excessive gas exchange in the bronchioles
c. dilation of bronchi and bronchioles
Bronchiectasis is a condition where damage causes the tubes in your lungs (airways) to widen or develop pouches. It makes it hard to clear mucus out of your lungs and can cause frequent infections. Coughing a lot with pus and mucus is the main symptom of bronchiectasis. Bronchiectasis can’t be cured but can be managed with treatment.
Bronchiectasis (“bronk-ee-EK-tuh-sis”) is a lung condition where your airways (tubes going into your lungs) get damaged and widen. Damaged airways can’t clear mucus like they're supposed to. Bacteria then grows in the mucus, causing more inflammation and damage to your lungs. This makes you cough a lot as your body tries to remove the infected mucus.
You're looking at a telemetry strip. You notice that there are no P waves, the beat is irregularly irregular and what seems to be uncoordinated atrial activity. You notice the QRS complexes do not "march out", but are a normal size. Your ventricular response rate is variable. You go to check on your patient and notice their apical pulse is 88 and their radial pulse is 102.
This irregular, non-marching out rhythm sounds like atrial fibrillation. Your client may feel weak or dizzy. Consult MD and synchronized cardioversion may be necessary. This rhythm is not sustainable and should be handled quickly.
Your patient is displaying the following symptoms:
intense back pain
dropping BP
BP may be different in both arms
s/s of impending dissection of abdominal aortic aneurysm.
What are our interventions?
AAA repair (if caught in time- is a HUGE emergency)
lie flat for 6 hours, doppler assessment of peripheral pulses, assess access site for bleeding, hematoma, infection
Destruction of normal platelets and antiplatelet antibodies bind to platelets then destroyed by macrophages.
What does this describe?
Patho for ITP-
Idiopathic thrombocytopenic purpura
CBC, bone marrow biopsy might be done to dx.
LOW platelet count causes your blood not to clot. Some treatment may even involve removing the spleen.
A nurse is educating a pt in anticipation of a procedure that will require a water-sealed chest drainage system. What should the nurse tell the pt and the family that this drainage system is used for?
a. maintaining a positive chest-wall pressure
b. monitoring pleural fluid osmolarity
c. providing passive intrathoracic pressure
d. removing excess air and fluid
D
A traditional water-sealed chest drainage system contains 3 chambers:
-collection chamber
-water seal chamber
-wet suction control chamber
*intermittent bubbling indicates the system is functioning correctly.
The client is one-day postoperative coronary artery bypass surgery. The client complains of chest pain Which intervention should the nurse implement first?
a. mediate client with IV morphine
b. assess client's chest dressing and VS
c. encourage the client to turn from side to side
d. check client's telemetry monitor
B-assess the client's chest dressing and VS
You're analyzing a tele strip of a client who has a history of MI and notice that your PR intervals are consistently the same length, but there is a pattern of 1 or more non-conducted P waves. Is this a problem?
Yes, this is what is known as a 2nd degree Heart Block Type II
aka- Mobitz II
Most likely if you're seeing this you need to go lay eyes on your patient because they will be exhibiting symptoms including fatigue, dyspnea, and chest pain r/t decreased cardiac output.
If not corrected it could lead to hypotension, bradycardia, and hemodynamic instability.
A few things can cause this including MI/hx of MI, toxicity d/t beta blockers, or digitalis.
What assessment findings would prevent a pt with a PE from receiving thrombolytics?
active bleeding, increased BP, bleeding disorders, recent surgery, hx of intracranial hemorrhage
This line of medication can be used for asystole or pulseless v-tach.
Epinephrine
A nurse is teaching a pt how to perform flow-type incentive spirometry prior to his scheduled thoracic surgery. What instruction should the nurse provide to the pt?
a. hold the spirometer at your lips and breathe in and out like you normally would
b. when you're ready, blow hard into the spirometer for as long as you can
c. take a deep breath and then blow short, forceful breaths into the spirometer
d. breathe in deeply through the spirometer, hold your breath briefly, and then exhale
D-breathe in deeply through the spirometer, hold your breath briefly and then exhale
IN-centive spirometry so think breathing in. This seemingly silly device is very beneficial at preventing atelectasis post-surgery and possibly pneumonia. it helps to release fluid trapped in the alveoli in the lungs and allows for better breathing.
The client experiencing multifocal premature ventricular contractions. Which anti-dysrhythmic medication would the nurse expect the healthcare provider to order for the client?
a. amiodarone
b. atropine
c. digoxin
d. adenosine
A-amiodarone-class III antiarrhythmic
(aka-Cordarone, Pacerone is used to treat and restore heart rhythms and maintain a regular, steady HR)
You're looking at a telemetry strip where the rhythm is extremely irregular. There's no conclusive PR interval or P wave. The rate can't be determined and neither can the QRS complex. What might be going on here?
These sound like characteristics of V-fib or Ventricular fibrillation. This is a shockable rhythm and needs to be done immediately to have the client back into a normal heart rhythm.
What happens next?
If you have determined the patient is in V-fib, call a rapid STAT. You will need to d-fib at 120-200 joules (depending on your equipment), you may need to do good-quality CPR for 2 minutes. If these do not work you will give Epinephrine 1mg IV every 3-5 minutes followed by amiodarone or lidocaine (depending on if anything has worked)
Amiodarone 300mg; may repeat 150mg
Depending on the facility-may use lidocaine 1-1.5mg/kg if amiodarone is not available.
dyspnea, intercostal retractions, crackles, confusion, resp acidosis- 50/50 club, PCO2 usually in the 50's, PaO2-arterial sat 50's, 50/50 club = intubation
What might be going on here?
Expected CM for ARDS
Acute Respiratory Distress Syndrome
MONA!!!!!!!!
Medications for MI
While assessing the pt, the nurse observes constant bubbling in the water-seal chamber of the pt's closed chest-drainage system. What should the Nurse conclude?
a. the system is functioning normally
b. pt has a pneumothorax
c. system has a leak
d. chest tube is obstructed
C- the system has a leak.
There should be intermittent bubbling in the water-seal chamber-that means the system is working correctly.
If it is constantly bubbling that means it is not working correctly and there is a leak in the tubing or an issue with the client's lung.