1. A pt presents to the ED complaining of a 2 day history of a dull substernal
ache that has continued to increase in intensity. The pt states that they had
some relief after taking nitro yesterday. Vitals: 114/68 BP, 68 HR, 22RR. The
EKG demonstrates a new onset of left bundle branch block. ...
CEN Exam 2 Questions and Answers 1. A pt presents to the ED complaining of a 2 day history of a dull substernal ache that has continued to increase in intensity. The pt states that they had some relief after taking nitro yesterday. Vitals: 114/68 BP, 68 HR, 22RR. The EKG demonstrates a ne w onset of left bundle branch block. The priority intervention for this pt is: A. Continue monitoring for development of ST segment elevation B. Serial cardiac markers C. Preparing the pt for transport to interventional cardiology D. Admission to a tele metry unit for observation Ans- C. Preparing the pt for transport to interventional cardiology New onset of a left bundle branch block is treated as ST segment elevation MI. The pt should be prepared for percutaneous transluminal coronary angioplasty and early reperfusion of the myocardium 2. During the completion of a 12 lead EKG, the nurse identifies excessive artifact in lead II and III. To resolve this technical difficulty, the nurse should: A. Change the R arm electrode B. Check for cable moveme nt C. Change the L Leg electrode D. Instruct the pt to momentarily hold their breath Ans- C. Change the L leg electrode The L leg electrode is common to both lead II and III. The development of artifact and decreased conductivity results when the con ducting gel in the electrode becomes dry 3. When determining the presence of ST segment elevation on an EKG, the ST segment is compared to which interval or segment of the EKG? A. P-R interval B. T-P interval C. Q-T interval D. P-R segment Ans- B. T-P interval T-P interval represents the interval between the end of ventricular re -
polarization and the beginning of atrial depolarization. This interval represents an absence of electrical heart activity and therefore is used as the isoelectric reference for the presence of ST segment elevation or depression 4. A middle aged pt presents to the ED via EMS. The pt states that they were awoken from sleep with midsternal chest pain approx 4 -5 hours ago. In the presence of an acute MI, the initial elevat ion of the troponin cardiac biomarkers occur within: A. 1-2 hours after onset of an AMI B. 4-8 hours after onset of an AMI C. 24 -30 hours after onset of an AMI D. 10 -24 hours after onset of an AMI Ans- B. 4-8 hours after onset of an AMI Troponin bi omarkers provide a bioassay to measure proteins found in the myofibrils of the heart muscle. Troponin are detectable based on assay 4 -8 hours after the AMI. Troponin levels will peak at 18 -24 hours following AMI 5. The nurse suspects a patient may have an acute aortic -dissection when, during the history taking process, the pt describes the pain as: A. Squeezing, burning epigastric pain that may radiate to the middle back area B. Right upper quadrant pain referred to right scapula and shoulder C. Sudden, severe tearing or ripping chest, interscapular or back pain D. Sharp, stabbing chest pain radiating to neck, arms or left shoulder Ans- C. Sudden, severe tearing or ripping chest, intrscapular or back pain This is a presentation of AAA
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