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The physician has ordered a high-sensitivity C-reactive protein (hs-CRP) drawn on a patient. The results of this test will allow the nurse to evaluate the role of what process that is implicated in the development of atherosclerosis?
- A. Immunosuppression
- B. Inflammation
- C. Infection
- D. Hemostasis
Correct Answer: B
Rationale: High-sensitivity CRP is a protein produced by the liver in response to systemic inflammation. Inflammation is thought to play a role in the development and progression of atherosclerosis.
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The patient has a homocysteine level ordered. What aspects of this test should inform the nurses care? Select all that apply.
- A. A 12-hour fast is necessary before drawing the blood sample
- B. Recent inactivity can depress homocysteine levels
- C. Genetic factors can elevate homocysteine levels
- D. A diet low in folic acid elevates homocysteine levels
- E. An ECG should be performed immediately before drawing a sample
Correct Answer: A,C,D
Rationale: Genetic factors and a diet low in folic acid, vitamin B6, and vitamin B12 are associated with elevated homocysteine levels. A 12-hour fast is necessary before drawing a blood sample for an accurate serum measurement. An ECG is unnecessary and recent inactivity does not influence the results of the test.
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.
The cardiac care nurse is reviewing the conduction system of the heart. The nurse is aware that electrical conduction of the heart usually originates in the SA node and then proceeds in what sequence?
- A. SA node to bundle of His to AV node to Purkinje fibers
- B. SA node to AV node to Purkinje fibers to bundle of His
- C. SA node to bundle of His to Purkinje fibers to AV node
- D. SA node to AV node to bundle of His to Purkinje fibers
Correct Answer: D
Rationale: The normal electrophysiological conduction route is SA node to AV node to bundle of His to Purkinje fibers.
The critical care nurse is caring for a patient with a pulmonary artery pressure monitoring system. The nurse is aware that pulmonary artery pressure monitoring is used to assess left ventricular function. What is an additional function of pulmonary artery pressure monitoring systems?
- A. To assess the patients response to fluid and drug administration
- B. To obtain specimens for arterial blood gas measurements
- C. To dislodge pulmonary emboli
- D. To diagnose the etiology of chronic obstructive pulmonary disease
Correct Answer: A
Rationale: Pulmonary artery pressure monitoring is an important tool used in critical care for assessing left ventricular function (cardiac output), diagnosing the etiology of shock, and evaluating the patients response to medical interventions, such as fluid administration and vasoactive medications. Pulmonary artery monitoring is preferred for the patient with heart failure over central venous pressure monitoring. Arterial catheters are useful when arterial blood gas measurements and blood samples need to be obtained frequently. Neither intervention is used to clear pulmonary emboli.
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.