Heparin: - Heparin inhibits the conversion of prothrombin into thrombin
Heparin inactivates circulating thrombin
Heparin inhibits the conversion of fibrinogen into fibrin
Causes of Right side heart failure? - Acute RV infarct
Pulmonary Embolism
Septal defects
Pulmonary stenosis/regurgitation
...
CCRN QUESTIONS
Heparin: - Heparin inhibits the conversion of prothrombin into thrombin
Heparin inactivates circulating thrombin
Heparin inhibits the conversion of fibrinogen into fibrin
Causes of Right side heart failure? - Acute RV infarct
Pulmonary Embolism
Septal defects
Pulmonary stenosis/regurgitation
COPD
Pulmonary htn
Left Ventricular fx
The patient is receiving heparin infusion for the treatment of pulmonary embolism. There has been a
60% decrease in the platelet count and no clinical change. Which of the following is indicated? -
Discontinue heparin and being argatroban.
The patient most likely has HIT. Exposure to heparin needs to discontinued and a direct thrombin
inhibitor started for continued anticoagulation.
The patient presents one month status post gastric bypass bariatric surgery with vomiting, headache,
diplopia, and memory loss. These are clinical signs of which of the following? - Malabsorption
The signs and symptoms are those of malabsorption, which results in vitamin deficiency and may occur
after bariatric surgery. The remaining choices are not manifested by the signs and symptoms described.
,The patient requires fluid resuscitation and 8 units of PRBC's status post traumatic injury. Which of the
following interventions is most appropriate? - Warm blood products and crystalloids
The nurse is caring for a patient with acute inferior wall MI, post-coronary artery stent deployment, For
optimal care of the patient, the nurse should: - Continuously monitor the patient in lead II
It is best practice to monitor the patient status post PCI with stent, in the lead that was most abnormal
during the acute occlusion.
The ECG demonstrates ST elevation in leads II, III and aVF. The nurse needs to monitor the patient closely
for which of the following? - Complication likely to occur after an acute inferior wall MI include
bradycardia secondary to ischemia to the SA and/or AV node, and papillary muscle rupture or
dysfunction due to the anatomical distance between the RCA and the papillary muscle.
Which of the following hemodynamic profiles would benefit from the aggressive fluid administration,
pressers and antibiotics therapy?
b. RAP: 5; PAOP: 7; SVR: 400; CO; 8L - B. the hemodynamic profile of RAP 5, PAOP 7, SVR 400 is
typical of septic shock, and choice B would be the best approach.
Which of the following is indicative of a mixed acid-base disorder?
A. pH 7.18; PaCO2 25; PaO2 64; HCO3 11
B. pH 7.33; PaCO2 29; PaO2 72; HCO3 15 - The decrease in PaCO2 is evidence of respiratory
alkalosis and the decreased HCO3 is evidenced of a metabolic acidosis. The pt with severe sepsis or
septic shock may present with this mixed acid-base disorder.
The patient with a temporary pacemaker develops pacemaker malfunction. The oriented is instructed to
reposition the patient to try and correct the problem. The cardiac monitor most likely demonstrates? -
, Failure to capture (pacemaker without a QRS) may be corrected by repositioning the patient to
the side.
The patient with diastolic heart develops SVT, heart rate 220/min. The most dangerous hemodynamic
effect is a decrease in: - coronary artery perfusion.
Diastolic heart failure results in a problem with left ventricular FILLING secondary to ventricular
thickening, and contractility and ejection are maintained in diastolic failure. The rapid heart rate will
decrease filling time, worsen left ventricular filling and because coronary artery perfusion occurs during
diastole, this arrhythmia may be life-threatening.
The patient with oat cell carcinoma has the following clinical findings: low urine output, low serum
osmolality, hyponatremia, and elevated urine sodium. The nurse anticipates which of the following as
part of the treatment plan? - Phenytoin (Dilantin), 3% saline.
The patient has signs of SIADH which results in production of excessive ADH. Dilantin will inhibit ADH
secretion and 3% saline will increase serum sodium.
Peep therapy and mechanical ventilation are ordered for the patient with acute respiratory failure.
Which of the following is a possible complication? - Barotrauma
The addition of positive end-expiratory pressure will increase alveolar recruitment, prevent atelectasis
and improve oxygenation. However, the increase in intrathoracic pressure may lead to pneumothorax or
subcutaneous emphysema.
The postoperative thoracic surgery patient has bubbling in the water seal drainage chamber of the chest
tube. Which of the following interventions is indicated? - avoid high airway pressures
Bubbling in the water seal chamber is due to a pleural air leak, and high airway pressure will either
prevent resolution of the current air leak or make it worse.
, Which clinical sign might patients with both systolic and diastolic heart failure have in common? -
Lung crackles
Both a problem with systolic (ejection problem) and diastolic (filling problem) will increase left heart
pressure and cause cardiogenic pulmonary edema (lung crackles).
Which of the following is most likely to result in a low Sv02?
A. Hypotermia
B. Fever
C. Severe sepsis - Fever
Fever increases metabolic rate and consumption, which may lead to a drop in mixed venous oxygen
saturation.
The nurse needs to assess adequacy of the tubing/catheter system for the arterial line. Which of the
following interventions will best assess this? - Perform a square wave test
Warming fluids and blood needed for traumatic injury will prevent hypothermia and its related adverse
effects.
Which of the following therapies should be avoided for the patient with cardiogenic shock? - high
dose vasopressors
Vasopressors increase left ventricular after load, which would increase myocardial work of a failing heart.
The patient is status post repair of an aneurysm for subarachnoid hemorrhage. Which of the following
interventions is indicated to prevent vasospasm? - Nimodipine (Nimotop)
is a calcium channel blocker that is started immediately post-op to prevent arterial spasm of the brain.
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