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FCCN A Grade Exam Questions & 100% Correct Answers
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FCCN A Grade Exam Questions & 100%Correct Answers
optimizing preload: if preload is low (pt is dry) give - ✔✔crystalloids (IV fluids)
colloids (albumin)
blood (PRBCs, plasma)
optimizing preload: If preload is high (pt is wet) give - ✔✔diuretics (lasix)
vasodilators (dilate veins)
dialysis (hemodialysis, CRRT)
your patient is experiencing angina. The provider requests nitroglycerin SL be given. What do
you anticipate will happen? - ✔✔blood pressure will decrease and preload will decrease
optimizing afterload: High after load = - ✔✔constricted arteries or "clamped
down" - decreases forward flow, cardiac output
conditions that affect afterload - ✔✔hypothermia, hypovolemia, cardiogenic shock
physical assessment for high afterload - ✔✔cool extremities, pale, mottled
treatment for high afterload - ✔✔ACE inhibitors, ARBs, morphine, re-warm if patient is cold
optimizing afterload = low afterload - ✔✔dilated arteries
,conditions that cause low afterload - ✔✔sepsis, neurogenic shock
physical assessment for low afterload - ✔✔flushed red skin, low BP
treatment for low afterload - ✔✔transfer to ICU for vasoconstrictors
ex. after first giving fluids to optimize preload, a septic patient may require vasoconstrictors to
increase afterload
optimize perfusion: Contractility - ✔✔if CO is low after fixing preload/afterload, a septic patient
may require vasoconstrictor to increase afterload. Only positive oral inotrope is digoxin This is a weak
inotrope. Strong IV inotropes can be given in the ICU.
First step in optimizing perfusion - ✔✔consider fluid status - too wet, too dry, or just right (preload)
second step in optimizing perfusion - ✔✔consider how clamped down the patient is -- too
clamped down, too dilated out, or just right. Use blood pressure for measurements (afterload)
Third step in optimizing perfusion - ✔✔consider "Squeeze" -- is the patient in heart
failure? (contractility)
The patient has developed new course crackles, mild shortness of breath with activity and distended
jugular veins. He has a history of congestive heart failure. He also has pitting edema in his
extremities. All of the assessments lead to the nurse to believe the patient has high preload. EXCEPT
course crackles
shortness of breath
distended juglar veins
edema - ✔✔edema
edema is not in blood vessels so it does not count!!!
, your patient has a dry mouth, tachycardia, and low urine output after diuresing 1.5 liters from lasix. He
also has weak pedal pulses and pale lower extremities. Which best describes the patient's
hemodynamics - ✔✔low preload and vasoconstriction
MAP = - ✔✔CO x resistance (SVR)
Patient with MAP = 60 can have high or low CO; high or low resistance ... - ✔✔so good BP does
not mean good perfusion
- want "co" pressure when possible
want "resistance pressure when vasodilated.
ex. putting neorepinephrine on dehydrated patient (bad thing to do!!!)
where do you place lead V1 - ✔✔fourth intercostal space at the R sternal border; chose
for arrhythmias (AFIB/Ectopy)
where do you place V2 - ✔✔fourth intercostal space at theL. sterna border
where do you place V3 - ✔✔midway between V2 and V4
where do you place V4 - ✔✔fifth intercostal space at midclavicular line
where do you place V5 - ✔✔directly lateral to V4 at the anterior axillary line
where do you place V6 - ✔✔directly lateral to v4 at the midaxillary line
limb lead III - ✔✔to monitor patient who currently does not have dysrhythmias or ischemia,
injury, infarction
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