Nokea
The critical care nurse is caring for a patient who has been experiencing bradycardia after cardiovascular surgery. The nurse knows that the heart rate is determined by myocardial cells with the fastest inherent firing rate. Under normal circumstances where are these cells located?
- A. SA node
- B. AV node
- C. Bundle of His
- D. Purkinje cells
Correct Answer: A
Rationale: The heart rate is determined by the myocardial cells with the fastest inherent firing rate. Under normal circumstances, the SA node has the highest inherent rate (60 to 100 impulses per minute).
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The nurse is caring for a patient who is undergoing an exercise stress test. Prior to reaching the target heart rate, the patient develops chest pain. What is the nurses most appropriate response?
- A. Administer sublingual nitroglycerin to allow the patient to finish the test
- B. Initiate cardiopulmonary resuscitation
- C. Administer analgesia and slow the test
- D. Stop the test and monitor the patient closely
Correct Answer: D
Rationale: Signs of myocardial ischemia would necessitate stopping the test. CPR would only be necessary if signs of cardiac or respiratory arrest were evident.
The physician has placed a central venous pressure (CVP) monitoring line in an acutely ill patient so right ventricular function and venous blood return can be closely monitored. The results show decreased CVP. What does this indicate?
- A. Possible hypovolemia
- B. Possible myocardial infarction (MI)
- C. Left-sided heart failure
- D. Aortic valve regurgitation
Correct Answer: A
Rationale: Hypovolemia may cause a decreased CVP. MI, valve regurgitation, and heart failure are less likely causes of decreased CVP.
The nurse is caring for a patient admitted with unstable angina. The laboratory result for the initial troponin I is elevated in this patient. The nurse should recognize what implication of this assessment finding?
- A. This is only an accurate indicator of myocardial damage when it reaches its peak in 24 hours
- B. Because the patient has a history of unstable angina, this is a poor indicator of myocardial injury
- C. This is an accurate indicator of myocardial injury
- D. This result indicates muscle injury, but does not specify the source
Correct Answer: C
Rationale: Troponin I, which is specific to cardiac muscle, is elevated within hours after myocardial injury. Even with a diagnosis of unstable angina, this is an accurate indicator of myocardial injury.
The nurse is performing an intake assessment on a patient with a new diagnosis of coronary artery disease. What would be the most important determination to make during this intake assessment?
- A. Whether the patient and involved family members understand the role of genetics in the etiology of the disease
- B. Whether the patient and involved family members understand dietary changes and the role of nutrition
- C. Whether the patient and involved family members are able to recognize symptoms of an acute cardiac problem and respond appropriately
- D. Whether the patient and involved family members understand the importance of social support and community agencies
Correct Answer: C
Rationale: During the health history, the nurse needs to determine if the patient and involved family members are able to recognize symptoms of an acute cardiac problem, such as acute coronary syndrome (ACS) or HF, and seek timely treatment for these symptoms. Each of the other listed topics is valid, but the timely and appropriate response to a cardiac emergency is paramount.
A critical care nurse is caring for a patient with a hemodynamic monitoring system in place. For what complications should the nurse assess? Select all that apply.
- A. Pneumothorax
- B. Infection
- C. Atelectasis
- D. Bronchospasm
- E. Air embolism
Correct Answer: A,B,E
Rationale: Complications from use of hemodynamic monitoring systems are uncommon, but can include pneumothorax, infection, and air embolism. Complications of hemodynamic monitoring systems do not include atelectasis or bronchospasm.