A patient with a 10-year history of heart failure presents to the emergency department reporting severe shortness of breath. Assessment reveals crackles throughout the lung fields and labored breathing. The patient takes beta blockers, ACE inhibitors, and diuretics as directed. What treatment strategies does the nurse plan to implement for immediate short-term management? (Select all that apply.)
Intraaortic balloon pump
Ventricular assist device
During cardioversion, the nurse would synchronize the electrical charge to coincide with which wave of the ECG complex?
The patient is diagnosed with abrupt onset of supraventricular tachycardia (SVT). The nurse prepares which medication to administer to the patient?
During a code situation, the nurse would prepare to use which preferred intravenous fluid?
5% Dextrose in 0.45 normal saline
5% Dextrose in water
The patient presents to the ED with severe chest discomfort. A cardiac catheterization and angiography shows an 80% occlusion of the left main coronary artery. Which procedure will be most likely performed on this patient?
A patient develops frequent ventricular ectopy. The nurse prepares to administer which drug?
All of the following are major criteria for brain death EXCEPT no
response to pain
cranial nerve reflexes
A patient who is undergoing withdrawal of mechanical ventilation appears anxious and agitated. The patient is on a continuous morphine infusion and has an additional order for lorazepam (Ativan) 1 to 2 mg IV as needed (prn). The patient has received no lorazepam (Ativan) during this course of illness. What is the most appropriate nursing intervention to control agitation?
Administer lorazepam (Ativan) 1 mg IV now
Administer fentanyl (Duragesic) 25 mg IV bolus.
Request an order for a paralytic agent.
Increase the rate of the morphine infusion by 50%.
In the healthy individual, pain and anxiety: (Select all that apply.)
decrease stress levels
help remove one from harm.
limit sympathetic nervous system activity.
activate the sympathetic nervous system (SNS).
increase performance levels
Which of the following statements about defibrillation are correct? (Select all that apply.)
Early defibrillation (if warranted) is recommended before other actions.
It is not necessary to ensure that personnel are clear of the patient if hands-off defibrillation is used.
It is not necessary to synchronize the defibrillation shocks.
Paddles/patches can be placed anteriorly and posteriorly on the chest.
Family assessment is essential to meet family needs. Which of the following must be assessed first to assist the nurse in providing family-centered care?
Identification of immediate family, extended family, and decision makers
Description of the patient’s home environment
Assessment of patient and family’s developmental stages and needs
Observation and assessment of how family members function with each other
If pericardial tamponade is suspected during a code, which of the following procedures will be performed?
Emergency insertion of a chest tube
Needle inserted into pericardial sac to aspirate fluid
Needle inserted into third intercostal space to decompress the lungs
Following insertion of a central venous catheter, the nurse obtains a stat chest x-ray film to verify proper catheter placement. The radiologist reports to the nurse: “The tip of the catheter is located in the superior vena cava.” What is the best interpretation of these results by the nurse?
The physician should be called to advance the catheter into the pulmonary artery.
The catheter position increases the risk of ventricular dysrhythmias.
The catheter is not positioned correctly and should be removed.
The distal tip of the catheter is in the appropriate position.
The assessment of pain and anxiety is a continuous process. When critically ill patients exhibit signs of anxiety, the nurse’s first priority is to
reassess the patient hourly to determine whether symptoms resolve on their own.
The patient has a transcutaneous pacemaker in place. Pacemaker spikes followed by QRS complexes are noted on the cardiac rhythm strip. To determine if the pacemaker is working, the nurse must do which of the following?
Obtain a 12-lead electrocardiogram (ECG).
Call for a pacemaker interrogation
Palpate the pulse
Run a 2-minute monitor strip for analysis.
A 75-year-old patient, who suffered a massive stroke 3 weeks ago, has been unresponsive and has required ventilatory support since the time of the stroke. The physician has approached the spouse regarding placement of a permanent feeding tube. The spouse states that the patient never wanted to be kept alive by tubes and personally didn’t want what was being done. After holding a family conference with the spouse, the medical team concurs, and the feeding tube is not placed. This situation is an example of
withdrawal of life support.
withholding life support.
Changing visitation policies can be challenging. The nurse manager recognizes which of the following as an effective strategy for promoting changes in practice?
Invite the nurses with the most experience to develop a revised policy.
Discuss the pros and cons of open visitation at the next staff meeting.
Task the unit-based nurse practice council to invite volunteers to serve on the council to revise the current policy toward more liberal visitation.
Ask the clinical nurse specialist to lead a journal club on open visitation after each nurse is tasked to read one research article about visitation.
A patient is admitted to the critical care unit with bradycardia at a heart rate of 39 beats/min and frequent premature ventricular contractions. Upon assessment, you note that she is lethargic and has complained of dizziness for the past 12 hours. Which of the following are acceptable treatments for symptomatic bradycardia? (Select all that apply.)
Comparing the patient’s current (home) medications with those ordered during hospitalization and communicating a complete list of medications to the next provider when the patient is transferred within an organization or to another setting are strategies to:
improve accuracy of patient identification.
prevent errors related to look-alike and sound-alike medications.
reconcile medications across the continuum of care.
reduce harms associated with the administration of anticoagulants.
The monitor technician notifies the nurse "stat" that the patient has a rapid, chaotic rhythm that looks like ventricular tachycardia. What is the nurse’s first action?
Call a code overhead.
Check the patient immediately.
Go to the nurse’s station and look at the rhythm strip.
Take the crash cart to the room
The patient has an implanted cardioverter-defibrillator (ICD). He goes into sustained VF and loses consciousness. The responding RN should:
avoid touching the patient in case the ICD fires.
call the code team, but tell them that the patient cannot be defibrillated.
initiate a code and prepare to defibrillate the patient.
prepare to administer adenosine intravenously.
It is important for critically ill patients to feel safe. Which nursing strategies help the patient to feel safe in the critical care setting? (Select all that apply.)
Inform the patient that you have cared for many similar patients.
Consult with the charge nurse before making any patient care decisions.
Allow family members to remain at the bedside
Provide informal conversation by discussing your plans for after work.
Respond promptly to call bells or other communication for assistance.
Family presence is encouraged during resuscitation and invasive procedures. Which findings about this practice have been reported in the literature? (Select all that apply.)
Presence encourages family members to seek litigation for improper care.
Families benefit by witnessing that everything possible was done.
Families report that staff conversations during this time were distressing.
Presence reduces nurses’ involvement in explaining things to the family.
Families report reduced anxiety and fear about what is being done to the patient.
A patient has been successfully converted from ventricular tachycardia with a pulse to a sinus rhythm. Upon further assessment, it is noted that the patient is hypotensive. The appropriate treatment for her hypotension may include (Select all that apply)
normal saline infusion.
The patient has a rhythm but not pulse or blood pressure. Possible causes of this patient condition include: (Choose all that apply.)
The patient is in VF. The nurse must defibrillate immediately. She must know what type of defibrillator is available and determine how many joules to use. She knows that she needs: (Choose all that apply.)
100 joules (biphasic).
200 joules (biphasic).
300 joules (monophasic)
360 joules (monophasic).
The patient is in ventricular tachycardia (VT) unresponsive to conventional treatment (epinephrine or vasopressin). Comparing the following drugs, which would be the most appropriate to use next?
Elderly patients who require critical care treatment are at risk for increased mortality, functional decline, or decreased quality of life after hospitalization. Assuming each of these patients was discharged from the hospital, which of the following patients is at greatest risk for decreased functional status and quality of life?
A 79-year-old woman admitted for exacerbation of heart failure. She manages her care independently but needed diuretic medications adjusted. She states that she is compliant with her medications but sometimes forgets to take them. She lives with her 82-year-old spouse. Both consider themselves to be independent and support each other.
An 84-year-old woman who had stents placed to treat coronary artery occlusion. She has diabetes that has been managed, lives alone, and was driving prior to hospitalization. She was discharged home within 3 days of the procedure.
A 90-year-old man admitted for a carotid endarterectomy. He lives in an assisted living facility (ALF) but is cognitively intact. He is the “social butterfly” at all of the events at the ALF. He is hospitalized for 4 days and discharged to the ALF.
A 70-year-old man who had coronary artery bypass surgery. He developed complications after surgery and had difficulty being weaned from mechanical ventilation. He required a tracheostomy and gastrostomy. He is being discharged to a long-term acute care hospital. He is a widower.
The [blank_start]antecubital[blank_end] vein should be the first target for IV access.
Which rhythm would be an emergency indication for the application of a transcutaneous pacemaker?
Bradycardia (heart rate 40 beats/min) normotensive and alert
Bradycardia (heart rate 50 beats/min) with hypotension and syncope
[blank_start]sodium bicarbonate[blank_end] is beneficial in treating preexisting metabolic acidosis, hyperkalemia, or overdosage of tricyclic antidrepressant or phenobarbital.
The nurse is preparing to obtain a right atrial pressure (RAP/CVP) reading. What are the most appropriate nursing actions? (Select all that apply.)
Compare measured pressures with other physiological parameters.
Inflate the balloon with 3 mL of air and record the pressure tracing.
Zero reference the transducer system at the level of the phlebostatic axis.
Flush the central venous catheter with 20 mL of sterile saline.
Obtain the right atrial pressure measurement during end exhalation.
Both the electroencephalogram (EEG) monitor and the Bispectral Index Score (BIS) or Patient State Index (PSI) analyzer monitors are used to assess patient sedation levels in critically ill patients. The BIS and PSI monitors are simpler to use because they