NURS 420 Quiz #2
a and c
Rationale: CVP should be anywhere from 2-6. CVP 10 is too high. - ANS-A CVP of 10 could
indicate... (Select all that apply)
a. Volume overload
b. Hypovolemia
c. Vasoconstriction
d. Vasodilation
a, b, c, and e
Rationale: Can only measure arterial BP with an A line - ANS-What can you measure with a PA
catheter? (Select all that apply)
a. CVP
b. Pulmonary Artery Pressure
c. PCWP/PAOP
d. Arterial Blood Pressure
e. Cardiac Output
d. Phlebostatic Axis - ANS-What is the level that the transducer is placed called?
a. Axis of Willis
b. Pilonidal Axis
c. Level with the Tragus of the Ear
d. Phlebostatic Axis
a. Failure to Sense - ANS-What type of pacing is displayed on a rhythm strip that shows a spike
in the middle of a P wave and another spike before a T wave?
a. Failure to Sense
b. Failure to Capture
c. Atrial Pacing
d. Failure to Pace
c. AV Pacing - ANS-What is displayed on a strip with spikes preceding every P wave and every
QRS?
a. Atrial Pacing
, b. Ventricular Pacing
c. AV Pacing
d. Failure to Sense
c. It indicates the ETT is in the trachea - ANS-Why is it important that the EZ Cap turns gold
after intubation?
a. It indicates the ETT is in the esophagus
b. It indicates the NG tube has been placed properly
c. It indicates the ETT is in the trachea
d. It indicates enough oxygen is being administered
a, c, and d - ANS-Your patient has been admitted with Pneumonia. Their ventilator settings read
A/C tV350ml- 15- 60%- +3PEEP. Which of the following statements is true? Select all that apply
a. The mode is Assist/Control
b. The respiratory rate is 14
c. The patient can initiate breaths on their own and they will get 350ml
d. The patient will get no fewer than 15 breaths per minute
a, b, and c - ANS-Uh-oh! Your patient's ventilator is sounding a high pressure alarm. What
should the nurse assess for (Select all that apply)
a. Secretions that need to be suctioned
b. Kink in tubing
c. Patient fighting the ventilator
d. Tube or cuff displacement or failure
e. Air leak
c. Ineffective tissue perfusion - ANS-What is a priority nursing diagnosis for the patient in shock
regardless of the phase or type?
a. Deficient fluid volume
b. Imbalanced nutrition: less than body requirements
c. Ineffective tissue perfusion
d. Ineffective breathing pattern
d. Hypovolemic shock - ANS-A postoperative patient has a heart rate of 110 beats/min and
blood pressure (BP) of 110/80 mm Hg (previously 130/60 mm Hg). Urine output has been 20
mL/h for the past 3 hours, capillary filling time is 5 seconds, the skin is cool, the neck veins are
flattened, and the patient is complaining of thirst. The nurse suspects the may be experiencing
which disorder?
a. Anaphylaxis
a and c
Rationale: CVP should be anywhere from 2-6. CVP 10 is too high. - ANS-A CVP of 10 could
indicate... (Select all that apply)
a. Volume overload
b. Hypovolemia
c. Vasoconstriction
d. Vasodilation
a, b, c, and e
Rationale: Can only measure arterial BP with an A line - ANS-What can you measure with a PA
catheter? (Select all that apply)
a. CVP
b. Pulmonary Artery Pressure
c. PCWP/PAOP
d. Arterial Blood Pressure
e. Cardiac Output
d. Phlebostatic Axis - ANS-What is the level that the transducer is placed called?
a. Axis of Willis
b. Pilonidal Axis
c. Level with the Tragus of the Ear
d. Phlebostatic Axis
a. Failure to Sense - ANS-What type of pacing is displayed on a rhythm strip that shows a spike
in the middle of a P wave and another spike before a T wave?
a. Failure to Sense
b. Failure to Capture
c. Atrial Pacing
d. Failure to Pace
c. AV Pacing - ANS-What is displayed on a strip with spikes preceding every P wave and every
QRS?
a. Atrial Pacing
, b. Ventricular Pacing
c. AV Pacing
d. Failure to Sense
c. It indicates the ETT is in the trachea - ANS-Why is it important that the EZ Cap turns gold
after intubation?
a. It indicates the ETT is in the esophagus
b. It indicates the NG tube has been placed properly
c. It indicates the ETT is in the trachea
d. It indicates enough oxygen is being administered
a, c, and d - ANS-Your patient has been admitted with Pneumonia. Their ventilator settings read
A/C tV350ml- 15- 60%- +3PEEP. Which of the following statements is true? Select all that apply
a. The mode is Assist/Control
b. The respiratory rate is 14
c. The patient can initiate breaths on their own and they will get 350ml
d. The patient will get no fewer than 15 breaths per minute
a, b, and c - ANS-Uh-oh! Your patient's ventilator is sounding a high pressure alarm. What
should the nurse assess for (Select all that apply)
a. Secretions that need to be suctioned
b. Kink in tubing
c. Patient fighting the ventilator
d. Tube or cuff displacement or failure
e. Air leak
c. Ineffective tissue perfusion - ANS-What is a priority nursing diagnosis for the patient in shock
regardless of the phase or type?
a. Deficient fluid volume
b. Imbalanced nutrition: less than body requirements
c. Ineffective tissue perfusion
d. Ineffective breathing pattern
d. Hypovolemic shock - ANS-A postoperative patient has a heart rate of 110 beats/min and
blood pressure (BP) of 110/80 mm Hg (previously 130/60 mm Hg). Urine output has been 20
mL/h for the past 3 hours, capillary filling time is 5 seconds, the skin is cool, the neck veins are
flattened, and the patient is complaining of thirst. The nurse suspects the may be experiencing
which disorder?
a. Anaphylaxis
