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The nurse is caring for a patient who has central venous pressure (CVP) monitoring in place. The nurses most recent assessment reveals that CVP is 7 mm Hg. What is the nurses most appropriate action?
- A. Arrange for continuous cardiac monitoring and reposition the patient
- B. Remove the CVP catheter and apply an occlusive dressing
- C. Assess the patient for fluid overload and inform the physician
- D. Raise the head of the patients bed and have the patient perform deep breathing exercise, if possible
Correct Answer: C
Rationale: The normal CVP is 2 to 6 mm Hg. Many problems can cause an elevated CVP, but the most common is due to hypervolemia. Assessing the patient and informing the physician are the most prudent actions. Repositioning the patient is ineffective and removing the device is inappropriate.
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The nurse is conducting patient teaching about cholesterol levels. When discussing the patients elevated LDL and lowered HDL levels, the patient shows an understanding of the significance of these levels by stating what?
- A. Increased LDL and decreased HDL increase my risk of coronary artery disease
- B. Increased LDL has the potential to decrease my risk of heart disease
- C. The decreased HDL level will increase the amount of cholesterol moved away from the artery walls
- D. The increased LDL will decrease the amount of cholesterol deposited on the artery walls
Correct Answer: A
Rationale: Elevated LDL levels and decreased HDL levels are associated with a greater incidence of coronary artery disease.
The nurse is doing discharge teaching with a patient who has coronary artery disease. The patient asks why he has to take an aspirin every day if he doesnt have any pain. What would be the nurses best response?
- A. Taking an aspirin every day is an easy way to help restore the normal function of your heart
- B. An aspirin a day can help prevent some of the blockages that can cause chest pain or heart attacks
- C. Taking an aspirin every day is a simple way to make your blood penetrate your heart more freely
- D. An aspirin a day eventually helps your blood carry more oxygen that it would otherwise
Correct Answer: B
Rationale: An aspirin a day is a common nonprescription medication that improves outcomes in patients with CAD due to its antiplatelet action. It does not affect oxygen carrying capacity or perfusion. Aspirin does not restore cardiac function.
The nurse working on a cardiac care unit is caring for a patient whose stroke volume has increased. The nurse is aware that afterload influences a patients stroke volume. The nurse recognizes that afterload is increased when there is what?
- A. Arterial vasoconstriction
- B. Venous vasoconstriction
- C. Arterial vasodilation
- D. Venous vasodilation
Correct Answer: A
Rationale: Arterial vasoconstriction increases the systemic vascular resistance, which increases the afterload. Venous vasoconstriction decreases preload thereby decreasing stroke volume. Venous vasodilation increases preload.
The critical care nurse is caring for a patient who has had an MI. The nurse should expect to assist with establishing what hemodynamic monitoring procedure to assess the patients left ventricular function?
- A. Central venous pressure (CVP) monitoring
- B. Pulmonary artery pressure monitoring (PAPM)
- C. Systemic arterial pressure monitoring (SAPM)
- D. Arterial blood gases (ABG)
Correct Answer: B
Rationale: PAPM is used to assess left ventricular function. CVP is used to assess right ventricular function; SAPM is used for continual assessment of BP. ABG are used to assess for acidic and alkalotic levels in the blood.
A patient is brought into the ED by family members who tell the nurse the patient grabbed his chest and complained of substernal chest pain. The care team recognizes the need to monitor the patients cardiac function closely while interventions are performed. What form of monitoring should the nurse anticipate?
- A. Left-sided heart catheterization
- B. Cardiac telemetry
- C. Transesophageal echocardiography
- D. Hardwire continuous ECG monitoring
Correct Answer: D
Rationale: Two types of continuous ECG monitoring techniques are used in health care settings: hardwire cardiac monitoring, found in EDs, critical care units, and progressive care units; and telemetry, found in general nursing care units or outpatient cardiac rehabilitation programs. Cardiac catheterization and transesophageal echocardiography would not be used in emergent situations to monitor cardiac function.