Cardiovascular

The drowning victim is admitted to the intensive care unit (ICU) after being without oxygen for 10 minutes. When he was found, he did not have a pulse and was resuscitated at the site. Once return of spontaneous circulation (ROSC) occurred, he was transported to the hospital. He was found to be profoundly hypotensive and was fluid resuscitated in the ambulance. In the ICU, his Glasgow coma score is found to be 7. He is intubated and has a central line and a peripheral arterial catheter in place. Which constellation of symptoms concern the nurse the most?

The 38-year-old patient has increased intracranial pressure following a massive stroke. Select the vital signs that together indicate the patient is at an immediate risk for brainstem herniation.

The unconscious patient with elevated intracranial pressure secondary to an ischemic stroke has a jugular bulb catheter in place to monitor cerebral oxygenation (SJO₂). The patient’s oxygen saturation (read by peripheral pulse oximetry probe) is 98% on 30% FiO₂ administered via endotracheal tube. The SJO₂ is 85%. How does the nurse interpret these results?

The patient with global cerebral ischemia requires the placement of a jugular venous catheter to measure cerebral oxygen saturation. The nurse prepares the patient for the provider to insert the catheter into which location?

Determine the Cᴇᴏ₂ (cerebral oxygen extraction) for the patient receiving 100% FiO₂ whose jugular vein oximetry reads 54% and the peripheral pulse oximetry reads 92%. Input your answer using a whole number.

The patient is receiving therapeutic hypothermia treatment following a massive myocardial infarction with return of spontaneous circulation (ROSC) after 30 minutes of cardiopulmonary resuscitation (CPR). It is most important to plan care to address which complication of therapeutic hypothermia?

The nurse learns the patient who takes fosphenytoin was prescribed apixaban two months ago. The nurse assesses the patient for which complication caused by taking these two medications together?

The patient has been taking apixaban for 4 weeks. Which monitoring test does the nurse review to evaluate the efficacy of the medication?

The patient with severely elevated intracranial pressure that has been well-controlled with medication and CSF drainage is intubated and sedated; the most recent arterial blood results are as follows: pH = 7.32, pCO2 = 35 mm Hg, PaO2 = 58, HCO3- = 16, Base excess = -7. The nurse advocates for which order to change ventilatory support?

The 64-year-old male patient with chronic obstructive pulmonary disease related to a 42-pack-year history of smoking is receiving ipratropium bromide. Which symptom indicates the patient is experiencing an adverse effect of this medication?

Which statement by the patient with asthma indicates a need for further teaching?

The nurse plans care for the patient who is receiving theophylline for the treatment of refractory asthma. Which nursing intervention does the nurse include to assess for complications of the drug?

The patient receiving inhaled nitric oxide (iNO) for severe pulmonary hypertension experiences an abrupt decrease in oxygen saturation. Which action does the nurse take first?

The condition of the patient with a pulmonary hypertensive crisis due to pneumonia has improved. Which order does the nurse question?

The 66-year-old patient with congestive heart failure is brought to the emergency department (ED) via ambulance with complaints of respiratory distress and increasing oxygen requirement. Which assessment indicates the patient is experiencing acute respiratory distress syndrome (ARDS) rather than a congestive heart failure (CHF) exacerbation?

Upon auscultation of the anterior chest wall, the nurse notes a rubbing sound. Which action does the nurse take next?

The patient with a calcium level of 11.4 mEq/L is at risk for which life-threatening complication?

The nurse is reviewing a patient’s medications during discharge. Which further education can the nurse provide regarding spironolactone when the patient asks, “I thought that I took a furosemide pill for my water?”

The 40-week-gestation patient is brought to the emergency department in active labor. Which assessment alerts the nurse to an impending emergency?

Which patient does the emergency department nurse assess first?

Which patient characteristic prompts the nurse to hold the infusion of Lactated Ringer’s and contact the provider?

The patient receiving a rapid infusion of Lactated Ringer’s solution for dehydration calls out to report difficulty breathing and a racing heart. Upon assessment, the nurse notes decreased level of consciousness and severe hypotension. Which assessment does the nurse make first?

The patient receiving a continuous infusion of total parenteral nutrition (TPN) through a peripherally inserted central catheter (PICC) line reports sudden onset dizziness, dyspnea, and tachycardia. Upon assessment, the nurse notes the patient is difficult to arouse. The IV tubing is noted to be cracked and have air in it. Which action does the nurse take first?

The nurse suspects the patient has experienced an air embolism from the peripherally inserted central catheter (PICC). Place the steps the nurse takes to intervene in the correct order.

In the post-anesthesia care unit (PACU) 30 minutes after surgery, the patient is noted to have a blue tinge around the lips. Which action does the nurse take first?

The nurse is assessing the patient 4 hours after a cholecystectomy and notes the skin around the umbilicus to be blue. The nurse contacts the provider to report which positive sign?

The patient has not yet voided in the 3 hours following a total knee replacement surgery. Which action by the nurse is appropriate?

The patient underwent a femoral cardiac catheterization at 1000 today. The nurse informs the patient that he must remain supine in bed until which time at the earliest? Enter your answer using four-digit military time.

The nurse is checking on the patient who underwent cardiac catheterization via the femoral artery 2 hours after the procedure. The patient appears to be sleeping and the nurse notes that the bruise at the insertion site has increased in size since the last assessment. Which action does the nurse take first?

Following colon resection, the nurse is vigilant for which early symptoms of septic shock? Select all that apply.

The elderly patient receiving a continuous morphine infusion for the treatment of cancer pain is at risk for opioid-induced respiratory depression. The nurse selects which monitoring device to most quickly detect a change in the patient’s respiratory drive?

The patient receiving a continuous hydromorphone infusion for severe cancer pain is found to be unconscious with a respiratory rate of 7 breaths per minute. Which action does the nurse take first?

The patient is brought to the emergency department (ED) with sudden onset blindness and deafness. The patient is being guided in by his wife but is walking well. The nurse suspects the patient is experiencing which condition?

The patient has right-sided hemiplegia following a cerebrovascular accident. Interventions to prevent which complication are the priority of care?

Carotid duplex testing utilizes which type of energy?

The nurse elevates the legs of the patient with congestive heart failure who has significant dependent edema. Which rationale does the nurse give the patient for this intervention?

The patient with chronic renal failure has been prescribed erythropoietin. The nurse informs the patient the drug has which intended effect?

The patient underwent surgery for creation of a colostomy 2 days ago. Upon assessment, which stoma color prompts the nurse to document the finding and continue with the assessment?

The nurse ensures which laboratory study is collected regularly to monitor the effectiveness and safety of the patient's continuous unfractionated heparin infusion?

Which is a late sign of hypoxemia?

How many chest compressions per minute are performed during cardiopulmonary resuscitation of the adult?

The patient with chest pain is undergoing an electrocardiogram (ECG). Which ECG finding prompts the activation of the cardiac catheterization lab?

The hospitalized patient is found unresponsive and the cardiopulmonary monitor shows ventricular fibrillation. Upon assessment, no pulse or respiratory effort are appreciated. A code blue is called and the defibrillator is being brought to the room. Which initial intervention is appropriate?

The hospitalized patient is found to be in ventricular tachycardia on electrocardiogram. Upon assessment, no pulse or respiratory effort are noted. Which medication is administered first?

Which drug, if ordered for the patient with second-degree heart block, does the nurse hold and contact the provider?

The nurse is caring for the patient in cardiac arrest. Which rhythm, if found on electrocardiogram, does the nurse most anticipate to be treated with unsynchronized defibrillation?

The unresponsive patient in the emergency department is found on electrocardiogram to have pulseless electrical activity (PEA). The nurse most suspects which two causes of the patient's condition?

The patient who presented to the emergency department complaining of chest pain is found to have a heart rate of 32 beats per minute and a blood pressure of 90/50 mm Hg. The nurse prepares to administer which medication?

The patient's heart rate is 28 bpm and the systolic blood pressure is 80 mmHg. One dose of atropine 0.5 mg IV push has been administered with no response. The patient is unstable, but conscious. Which next intervention is appropriate? 

The patient with a heart rate of 50 bpm is found to have strong pulses and no other symptoms. Which action is most appropriate?