CEN Exam 5 Study Questions and Answers Top Rated 2024 Updated
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1. A pt presents to the ED experiencing an anterior ST segment elevation MI. The pts vital signs are normal. The hospital is not equipped with a cardaic catheterization lab. The pt can be transferred to a cardaic catheterization lab within 60 mins. Which of the following would you anticipate for th...
CEN Exam 5 Study Questions and Answers Top Rated 2024 Updated . MUGWE [Date] [Course title] 1. A pt presents to the ED experiencing an anterior ST segment elevation MI. The pts vital signs are normal. The hospital is not equipped with a cardaic catheterization lab. The pt can be transferred to a cardaic catheterization lab within 60 mins. Which o f the following would you anticipate for this pt?: A. A bolus of tissue plasminogen activator, followed by an infusion for fibrinolytic therapy B. Immediate transfer to the hospital with a cardiac catheterization lab for percutaneous coronary intervention C. A single bolus of tenecteplase (Tnkase) for fibrinolytic therapy D. A bolus of reteplase (Retavase), followed by a second bolus of reteplase 30 mins later for fibrinolytic therapy - B. Immediate transfer to the hospital with a cardiac catheterization lab for percutaneous coronary intervention In adult pts presenting with a STEMI of a hospital that does not have PCI capability, it is recommended that the pt be transferred immediately without fibrinolytics to a PCI center, instead of immediate fibrinolysis at the intial hospital with transfer onl u for ischemia driven PCI 2. An anxious pt arrives by ambulance following an acute onset of difficulty breathing. The pt is diaphoretic and denies chest pain. High -flow O2 by non-rebreather mask has been applied. Vitals: BP 210/140, HR 130, RR 32, SpO2 88%. In addition to initiating noninvasive ventilation to treat the pts difficulty breathing, the nurse anticipates the administration of which medication to further treat the pts symptoms?: A. Morphine (Morphine sulfate) B. Furosemide (Lasix) C. Initation of a continuous nitroglycerin infusion D. Acetylsalicylic acid (Aspirin) - C. Initation of a continuous nitroglycerin infusion Pts who present with acute pulmonary edema are typically markedly hypertensive and in acute respiratory distress. Rapid initiation of appropriate treatment is vital to reversing the neurohormonal surge and rescuing pts from respiratory and complete cardiac failure. Nitroglycerin is the most important first line medication in treatment of acute pulmonary edema and respiratory distress. The initation of continuous NTG infusion at low doses acts as a vasodilator, leading to decreased preload: at higher doses ( >100mcg/min) acts as a potent afterload reducer 3. An unrestrained driver is brought to the ED following a motor vehicle collision. The pt reports hitting their chest on the steering wheel and is complaining of chest pain across the front of their chest. There are no vital sign abnormalities and no othe r complaints of pain. The diagnosis of blunt cardiac injury is considered. The nurse anticipates an order for which of the following?: A. EKG B. Cardiac marker evaluation (CK or Troponin) C. Cardiac monitoring D. Chest radiograph - B. Cardiac marker evaluation (CK or Troponin) Not all trauma pts with blunt cardiac injury will have acute alterations in cardiac markers, and other organ injury may cause release of creatinine kinase and confound the diagnosis of blunt cardiac injury 4. Which of the following is a form of distributive shock?: A. Neurogenic B. Metabolic C. Respiratory D. Obstructive - A. Neurogenic 5. A pt presents following an acute onset of chest pain, dyspnea and severe diaphoresis, with near syncope. Assessment shows a pt in severe distress, with HR 110, BP 60/40 and RR 36 with bilateral rales. An EKG reveals ST segment elevation across the preco rdial leads. A diagnosis of acute MI with cardiogenic shock is made, and the pt is being prepared for transfer to the cardiac cath lab. The vasopressor of choice, based on this pts degree of hypotension is: A. Norepineprhine (Levophed) B. Dopamine (Inotropin) C. Dobutamine (Dobutrex) D. Vasopressin (Pitressin) - A. Norepineprhine (Levophed) The intial use of norepinephrine for marked hypotension, <70mmHg systolic is the current recommendation from the AHA 6. A pt presents with complaints of chest pain that radiates to the jaw, stating the pain is a 6/10. Other symptoms include nausea, dizziness, shortness of breath with clear lung sounds, and a sense of impending doom. The pain started 40 mins before arriva l. Vitals: BP 116/58, HR 98, RR 20, SpO2 94%, T 98.6F. The 12 lead EKG shows inferior wall myocardial injury pattern. Which clinical presentations indicate the need to complete a right sided 12 lead EKG?: A. Shortness of breath with clear lung sounds B. Nausea and dizziness C. Chest pain with radiation to the jaw D. Sense of impending doom - A. Shortness of breath with clear lung sounds Classic right ventricular infarcts are associated with the absence of pulmonary congestion Think: RIGHT to my foot 7. Following the successful resuscitation of a pt in a cardiac arrest, which of the following findings is the best indicator high -quality CPR?: A. A compression depth of 1 1/2 inches B. Palpable pulses with the preformance of chest compressions during CPR C. A decrease of skin and mucus membrane cyanosis D. An increasing end tital Co2 level - D. An increasing end tital Co2 level An increasing end -tidal carbon dioxide level indicates increasing cellular perfusion with effective CPR or ROSC 8. During transcutaneous pacing for a pt in third -degree heart block, there is a loss of ventricular capture. Which is a significant physiological reason for loss of a pacemaker capture?: A. Metabolic alkalosis B. Hypomagnesemia C. Lactic acidosis D. Hypokalemia - C. Lactic acidosis Lactic acidosis alters the contractility of the myocardium, leading to decreased abilty to gain ventricular capture, this results in lack of tissue perfusion 9. A pt presents with complaints of lightheadedness, weakness and near syncope. The pts 12 lead EKG reveals the presence of 2:1 arterial flutter. The most appropriate intervention for this presentation with arterial flutter rhythm is to preform: A. Synchronized cardioversion at 50 joules B. Unsynchronized cardioversion at 120 joules C. Unsynchronized cardioversion at 50 joules D. Synchronized cardioversion at 120 joules - A. Synchronized cardioversion at 50 joules Synchronized cardioversion is reccomended for rhythms with a normal width QRS complex. A pt with new onset atrial flutter, who is experiencing chest pain, shortness of breath or other symptoms of instability should be considered for cardioversion. A -flutte r requires less energy to cardiovert than other dysrhythmias 10. In preparing to discharge a pt who has been given a prescription for nitroglycerin tablets 0.4mg SL PRN, the ED nurse acknowledges that the pt teaching has been effective when the pt states: A. " I am to take the tablets at least every 2 -3 mins when I experience chest pain" B. " I will call my doctor every time I need to take a tablet for my chest pain" C. " I should keep the tablets on my window sill in the kitchen so I can find them easily" D. " If my chest pain has not gone away after I have taken 2 tablets, I
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