CEN Exam 4 Study Questions and Answers Graded A 2024
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1. A pt presents who had experienced chest pain but is now pain free. EKG's have been repeated twice, and troponin levels repeated at 4 hour intervals are within normal limits. The pt has no significant risk factor for heart disease. The nurse anticipates:
A. Admission to the ICU to rule out MI
...
CEN Exam 4 Study Questions and Answers Graded A 2024 , MUGWE [Date] [Course title] 1. A pt presents who had experienced chest pain but is now pain free. EKG's have been repeated twice, and troponin levels repeated at 4 hour intervals are within normal limits. The pt has no significant risk factor for heart disease. The nurse anticipates: A. Admission to the ICU to rule out MI B. Admission to the cardiac cath lab for eval of coronary anatomy C. That the pt will be discharged home, with instructions for close follow up with their PCP because the risk of an adverse coronary event is low D. Admission to the telemetry unit to rule out an MI - C. That the pt will be discharged home, with instructions for close follow up with their PCP because the risk of an adverse coronary event is low In adult pts with chest pain who demonstrates two negative findings for serial biomarkers, nonconcerning vital signs and nonischemic EKG findings, short term clinically relevant adverse cardiac events are rare and commonly iatrogenic, inpatient admission m ay not be beneficial 2. A pt who became unconscious during ascent while scuba diving arrives via EMS. The pt is unconscious and hypotensive. What is the most appropriate position in which to place this pt during their examination by physician?: A. Left lateral decubitus, head down B. Right lateral decubitus, head down C. Left lateral decubitus, head up D. Supine - A. Left lateral decubitus, head down Head down position prevents air from traveling through the right side of the heart into the pulmonary arteries, leading to a possible right ventricular outflow obstruction 3. In which pt would the nurse question on order for morphine sulfate?: A. A pt with aortic dissection B. A pt with a ST elevation MI C. A pt with unstable angina D. A pt with non -ST MI - D. A pt with non-ST MI An increase of mortality has been associated with the use of morphine sulfate in pts with non -ST segment elevation 4. Following the administration of 2L IV crystalloids, the ED nurse begins to administer IV dobutamine (Dobutrex) to a pt who has been diagnosed with a right ventricular infarction. The ED nurse identifies that this medication has been effective when the p t demonstrates which of the following?: A. Bradycardia B. Increase in blood pressure C. Presence of distended neck veins D. Onset of A -fib - B. Increase in blood pressure Pts who experience RVI as preload dependent and require additional fluids to increase their blood pressure. If the pts BP does not respond to the additional fluid administration, the administration of Dobutamine is indicated to increase the pts cardiac output, thereby increasing the BP 5. The nurse has instituted applied O2 and is to reduce the pts heart rate and blood pressure. Which of the following findings would be expected after applying oxygen, initiating 2 large bore IV's and administering IV beta blockers?: A. Difference of >20 mmHg blood pressure when comparing in both arms B. Chest pain radiating to left shoulder C. Orthopnea and JVD D. Petechial lesions on the pts palms or soles - A. Difference of >20 mmHg blood pressure when comparing in both arms Difference of >20mmHg BP in both arms is suggestive of aortic dissection. Treatment for aortic dissection incluides the insertion of 2 large caliber IV's, application of O2 and administration of beta -blockers to reduce the pts HR and BP 6. A 3 month old infant weighing 11lbs (5 kg) arrives to the ED in full cardiopulmonary arrest. The monitor shows V -fib. Good quality CPR is being preformed, and the infant has been defibrilated once. Which medication should be administered next?: A. Epi 0.05mg IV/IO B. Atropine 0.1mg IV/IO C. Amiodarone 25mg IV/IO D. Sodium Bicarbonate 5mEq IV - A. Epi 0.05mg IV/IO Epi is the first line drug for an infant in cardiac arrest because of V -fib. The correct dose is 0.01mg/kg (0.01x5= 0.05) 7. A pt in cardiopulmonary arrest remains in V -fib despite having been defibrillated 6 times, receieving good quality CPR, and the administration of Epi and Amiodarone. ABG reveals a pH of 7.02, PO2 96mmHg, pCO2 40mmHg. What other medication order should t he ED nurse anticipate next for this pt?: A. Adenosine 6mg B. Calcium Chloride 1g C. Vasopressin 40 units D. Sodium Bicarb 1mEq/kg - D. Sodium Bicarb 1mEq/kg Sodium bicarb is indicated for documented acidosis during cardiac arrest. Arterial gases indicate a pH of 7.0, or acidosis. Sodium bicarb will act as an alkalinizer to raise the pH to a value closer to a normal range (7.35 -7.45) 8. A pt presents via EMS in cardiopulmonary arrest. Chest compressions and bag -mask ventilation are being preformed. The cardiac monitor shows V -tach. While the defibrilator is charging for defibrillation, the nurse should ensure that: A. No one is touching the pt B. High -quality CPR is continued C. Oxygen delivery via nasal cannula continues at 6L/min D. The defibrilator pads have been plaed on the pt - B. High -quality CPR is continued AHA suggests that high -quality CPR is continued while the defibrilator is charging 9. A teenaged pt presents to triage stating they have the sensation that their heart is jumping out of their chesrt for the past several hours. The pt denies routine drug use and states they have been studying for end -of-
the-semester final exams for the pa st 3 days and took a pill to help him study. You palpate a radial pulse that is 170bpm and regular. Which of the following dysrhythmias would be suspected?: A. SVT
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