Nokea
The nurse is relating the deficits in a patients synchronization of the atrial and ventricular events to his diagnosis. What are the physiologic characteristics of the nodal and Purkinje cells that provide this synchronization? Select all that apply.
- A. Loop connectivity
- B. Excitability
- C. Automaticity
- D. Conductivity
- E. Independence
Correct Answer: B,C,D
Rationale: Three physiologic characteristics of two types of specialized electrical cells, the nodal cells and the Purkinje cells, provide this synchronization: automaticity, or the ability to initiate an electrical impulse; excitability, or the ability to respond to an electrical impulse; and conductivity, the ability to transmit an electrical impulse from one cell to another. Loop connectivity is a distracter for this question. Independence of the cells has nothing to do with the synchronization described in the scenario.
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A nurse is preparing a patient for scheduled transesophageal echocardiography. What action should the nurse perform?
- A. Instruct the patient to drink 1 liter of water before the test
- B. Administer IV benzodiazepines and opioids
- C. Inform the patient that she will remain on bed rest following the procedure
- D. Inform the patient that an access line will be initiated in her femoral artery
Correct Answer: C
Rationale: During the recovery period, the patient must maintain bed rest with the head of the bed elevated to 45 degrees. The patient must be NPO 6 hours preprocedure. The patient is sedated to make him or her comfortable, but will not be heavily sedated, and opioids are not necessary. Also, the patient will have a peripheral IV line initiated preprocedure.
A patients declining cardiac status has been attributed to decreased cardiac action potential. Interventions will be aimed at restoring what aspect of cardiac physiology?
- A. The cycle of depolarization and repolarization
- B. The time it takes from the firing of the SA node to the contraction of the ventricles
- C. The time between the contraction of the atria and the contraction of the ventricles
- D. The cycle of the firing of the AV node and the contraction of the myocardium
Correct Answer: A
Rationale: This exchange of ions creates a positively charged intracellular space and a negatively charged extracellular space that characterizes the period known as depolarization. Once depolarization is complete, the exchange of ions reverts to its resting state; this period is known as repolarization. The repeated cycle of depolarization and repolarization is called the cardiac action potential.
A brain (B-type) natriuretic peptide (BNP) sample has been drawn from an older adult patient who has been experienced vital fatigue and shortness of breath. This test will allow the care team to investigate the possibility of what diagnosis?
- A. Pleurisy
- B. Heart failure
- C. Valve dysfunction
- D. Cardiomyopathy
Correct Answer: B
Rationale: The level of BNP in the blood increases as the ventricular walls expand from increased pressure, making it a helpful diagnostic, monitoring, and prognostic tool in the setting of HF. It is not specific to cardiomyopathy, pleurisy, or valve dysfunction.
The nurses assessment of an older adult client reveals the following data: Lying BP 144/82 mm Hg; sitting BP 121/69 mm Hg; standing BP 98/56 mm Hg. The nurse should consequently identify what nursing diagnosis in the patients plan of care?
- A. Risk for ineffective breathing pattern related to hypotension
- B. Risk for falls related to orthostatic hypotension
- C. Risk for ineffective role performance related to hypotension
- D. Risk for imbalanced fluid balance related to hemodynamic variability
Correct Answer: B
Rationale: Orthostatic hypotension creates a significant risk for falls due to the dizziness and lightheadedness that accompanies it. It does not normally affect breathing or fluid balance. The patients ability to perform normal roles may be affected, but the risk for falls is the most significant threat to safety.
A critically ill patient is admitted to the ICU. The physician decides to use intra-arterial pressure monitoring. After this intervention is performed, what assessment should the nurse prioritize in the plan of care?
- A. Fluctuations in core body temperature
- B. Signs and symptoms of esophageal varices
- C. Signs and symptoms of compartment syndrome
- D. Perfusion distal to the insertion site
Correct Answer: D
Rationale: The radial artery is the usual site selected. However, placement of a catheter into the radial artery can further impede perfusion to an area that has poor circulation. As a result, the tissue distal to the cannulated artery can become ischemic or necrotic. Vigilant assessment is thus necessary. Alterations in temperature and the development of esophageal varices or compartment syndrome are not high risks.