Critical Care Nursing Cardiac Questions

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The nurse is caring for a patient who has an intra-aortic balloon pump (IABP) following a massive heart attack. When assessing the patient, the nurse notices blood backing up into the IABP catheter. In which order should the nurse take the following actions?

  • A. Ensure that the IABP console has been turned off.
  • B. Assess the patient's vital signs and orientation.
  • C. Notify the healthcare provider of the IABP malfunction.
  • D. Obtain supplies for insertion of a new IABP catheter.
Correct Answer: A

Rationale: Correct Answer: A

Rationale:
1. Ensuring the IABP console is turned off is crucial to prevent further complications and stop potential harm to the patient.
2. By turning off the IABP console, the nurse can halt the pumping action, allowing assessment of the situation without interference.
3. This action takes priority over other steps as it addresses the immediate issue of blood backing up into the IABP catheter.
4. Once the console is turned off, the nurse can proceed with assessing the patient's vital signs, notifying the healthcare provider, and obtaining supplies if needed.

Summary of Incorrect Choices:
- Option B: Assessing vital signs and orientation is important, but addressing the malfunction of the IABP takes precedence to prevent harm.
- Option C: Notifying the healthcare provider is necessary, but first, the immediate issue of blood backing up into the catheter must be addressed.
- Option D: Obtaining supplies for a new catheter is premature without first addressing

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Which of the following is (are) official journal(s) of the A merican Association of Critical-Care Nurses? (Select all that apply.)

  • A. American Journal of Critical Care
  • B. Critical Care Clinics of North America
  • C. Critical Care Nurse
  • D. Critical Care Nursing Quarterly
Correct Answer: A

Rationale: Step-by-step rationale:
1. The American Association of Critical-Care Nurses (AACN) publishes the American Journal of Critical Care (AJCC).
2. The AJCC is a peer-reviewed journal that covers critical care nursing practice, research, and education.
3. The content in AJCC aligns with AACN's mission and standards for critical care nursing.
4. Hence, AJCC is an official journal of AACN.
Summary of other choices:
- B: Critical Care Clinics of North America - Not an official journal of AACN.
- C: Critical Care Nurse - Not an official journal of AACN.
- D: Critical Care Nursing Quarterly - Not an official journal of AACN.

An advantage of peritoneal dialysis is that

  • A. peritoneal dialysis is time intensive.
  • B. a decreased risk of peritonitis exists.
  • C. biochemical disturbances are corrected rapidly.
  • D. the danger of hemorrhage is minimal.
Correct Answer: B

Rationale: The correct answer is B: a decreased risk of peritonitis exists. Peritoneal dialysis involves the insertion of a catheter into the peritoneal cavity, which can introduce bacteria and increase the risk of peritonitis. However, compared to hemodialysis, peritoneal dialysis has a lower risk of bloodstream infections and vascular access-related complications, leading to a decreased risk of peritonitis. This advantage makes peritoneal dialysis a favorable option for some patients.
Incorrect choices:
A: peritoneal dialysis is actually less time-intensive compared to hemodialysis.
C: biochemical disturbances are corrected more gradually in peritoneal dialysis.
D: the danger of hemorrhage is not specific to peritoneal dialysis.

The nurse is managing a donor patient six hours prior to th e scheduled harvesting of the patient’s organs. Which assessment finding requires imme diate action by the nurse?

  • A. Morning serum blood glucose of 128 mg/dL
  • B. pH 7.30; PaCO 38 mm Hg; HCO 16 mEq/L 2 3
  • C. Pulmonary artery temperature of 97.8° F
  • D. Central venous pressure of 8 mm Hg
Correct Answer: B

Rationale: The correct answer is B. The patient's pH of 7.30 indicates acidosis, PaCO2 of 38 mm Hg is low, and HCO3 of 16 mEq/L is also low, suggesting metabolic acidosis. This finding requires immediate action as untreated acidosis can lead to serious complications.
Choice A (morning serum blood glucose of 128 mg/dL) is within normal range and does not require immediate action.
Choice C (pulmonary artery temperature of 97.8°F) is a normal temperature and does not require immediate action.
Choice D (central venous pressure of 8 mm Hg) is within normal range and does not require immediate action.

The nurse cares for an adolescent patient who is dying. The patient’s parents are interested in organ donation and ask the nurse how the decision about brain death is made. Which response by the nurse is most appropriate?

  • A. Brain death occurs if a person is flaccid and unresponsive.
  • B. If CPR is ineffective in restoring a heartbeat, the brain cannot function.
  • C. Brain death has occurred if there is no breathing and certain reflexes are absent.
  • D. If respiratory efforts cease and no apical pulse is audible, brain death is present.
Correct Answer: C

Rationale: The correct answer is C: Brain death has occurred if there is no breathing and certain reflexes are absent. Brain death is defined as the irreversible cessation of all functions of the entire brain, including the brainstem. The absence of breathing and certain reflexes, such as no response to painful stimuli or no pupillary response to light, are key indicators of brain death. This definition is crucial for determining eligibility for organ donation.

Incorrect choices:
A: Brain death occurs if a person is flaccid and unresponsive. Flaccidity and unresponsiveness are not specific criteria for diagnosing brain death.
B: If CPR is ineffective in restoring a heartbeat, the brain cannot function. The absence of a heartbeat alone does not indicate brain death.
D: If respiratory efforts cease and no apical pulse is audible, brain death is present. Respiratory cessation and the absence of pulse are not definitive signs of brain death.

The nurse is caring for a 100-kg patient being monitored with a pulmonary artery catheter. The nurse assesses a blood pressure of 90/60 mm Hg, hear t rate 110 beats/min, respirations 36/min, oxygen saturation of 89% on 3 L of oxygen via nasal cannula. Bilateral crackles are audible upon auscultation. Which hemodynamic value reqaubiirrbe.sco imm/temste diate action by the nurse?

  • A. Cardiac index (CI) of 1.2 L/min/m3
  • B. Cardiac output (CO) of 4 L/min
  • C. Pulmonary vascular resistance (PVR) of 80 dynes/sec/cm5
  • D. Systemic vascular resistance (SVR) of 1800 dynes/sec /cm5
Correct Answer: B

Rationale: The correct answer is B: Cardiac output (CO) of 4 L/min. In this scenario, the patient is presenting with signs of pulmonary congestion and hypoxemia, indicating possible cardiogenic pulmonary edema. As the cardiac output is a key indicator of how well the heart is functioning and delivering blood to the body, a low cardiac output can lead to inadequate tissue perfusion and worsen the patient's condition. Therefore, immediate action is required to address the low cardiac output to improve tissue perfusion and oxygenation.

Choices A, C, and D are incorrect as they do not directly address the primary concern of inadequate cardiac output in this patient. Cardiac index, pulmonary vascular resistance, and systemic vascular resistance are important parameters to monitor, but in this case, the priority is to address the low cardiac output to improve the patient's condition.

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