CEN Exam 2 Study Questions and Answers Updated 2024 Graded A
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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. The pr...
CEN Exam 2 Study Questions and Answers Updated 2024 Graded A possiblea . . 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 telemetry unit for observation - 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 movement C. Change the L Leg electrode D. Instruct the pt to momentarily hold their breath - 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 conducting 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 - 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 elevation 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 - B. 4-8 hours after onset of an AMI Troponin biomarkers 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 - C. Sudden, severe tearing or ripping chest, intrscapular or back pain This is a presentation of AAA 6. You are assisting in the resuscitation of an elderly patient in cardiac arrest. A waveform capnography is in place and high -
quality CPR is being preformed. A sudden increase in the level of the end-total CO2 indicates: A. Need for deeper and faster chest compressions B. Need for additional dose of vasopressor, such as IV bolus EPI C. Presence of an irreversible cardiac arrest D. Return of spontaneous circulation - D. Return of spontaneous circulation It may be reasonable to use physiological parameters (quantitative waveform capnography, arterial relaxation diastolic pressure, arterial pressure monitoring and central venous oxygen sats) when feasible to monitor and optimize CPR quality, guide vasopressor therapy and detect return of spontaneous circulation 7. A Patient in cardiac arrest presents to the ED receiving CPR by EMS. The cardiac monitor displays sinus rhythm, but no palpable pulse can be detected. The most likely cause of this PEA is: A. Glucose level of 145 B. Potassium value of 1.3 C. Arterial pH of 7.36 D. Magnesium level of 3.0 - B. Potassium level of 1.3 Hypokalemia may cause PEA in a cardiac arrest pt. Electrical activity may be present in the heart muscles with absence of contractility. A normal potassium is 3.5 -5.0 8. Which of the following physiological conditions would result in the loss of ventricular capture for a patient being transcutaneously paced? A. Lactic acidosis B. Hypomagnesemia C. Metabolic alkalosis D. Hypokalemia - A. Lactic acidosis The presence of lactic acidosis resulting from decreased tissue oxygenation alters myocardial contractility, leading to a decreased ability to achieve ventricular capture 9. A pt arrives to the ED by EMS with a complaint of weakness and near syncope. The pmts HR is 24 and BP 80/60. The pt underwent a heart transplant 6 months ago and the cardiac monitor displays 3rd degree heart block. The ER nurse is aware the pt will imme diately require which med to increase the pts HR?: A. Atropine sulfate B. Isoproterenol C. Digoxin D. Amiodarone - B. Isoproterenol A transplanted heart will not respond to the drugs that act to block parasympathetic tone. Isoproterenol, glucagon or epi would increase the HR, but they do not act to block the parasympathetic tone. This is the most commonly used drug to increase the HR f ollowing a heart transplant 10. On examination of the febrile pt presenting to the ED with a chief complaint of "flulike symptoms" and
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