BARRON'S CCRN 58 CARDIAC COMPREHENSIVE QUESTIONS WITH ANSWERS|33 PAGES
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BARRON\\\'S CCRN
The nurse caring for the patient after coronary artery bypass graft (CABG) surgery should:
a) Anticipate possible drop in BP during rewarming
b) Strip chest tubes hourly to maintain patency
c) Maintain Blood sugar 150-200 mg/dL with insulin infusion
d) Maintain serum potassium 3-4 mEq/dL to pre...
The nurse caring for the patient after coronary artery bypass graft (CABG)
surgery should:
a) Anticipate possible drop in BP during rewarming
b) Strip chest tubes hourly to maintain patency
c) Maintain Blood sugar 150-200 mg/dL with insulin infusion
d) Maintain serum potassium 3-4 mEq/dL to prevent arrhythmias - ✔ ✔
Answer A
As the patient's temperature rises, vasoconstriction that was present at lower
temperature decreases with a possible drop in BP. Chest tubes should not be
stripped. A blood sugar of 150-200 is too high for a post-op CABG surgery
patient. Serum potassium needs to be close to 4.0 mEq/dL and 3.0-4.0 is too
low
The patient develops PSVT, and synchronized cardioversion is being
considered. Which of the following would be a contraindication to the
cardioversion?
a) Digoxin level of 4.0 mg/dL
b) Potassium level of 5.1 mgEq/L
c) Magnesium level of 2.6 mg/dL
d) Creatinine level of 3.1 mg/dL - ✔ ✔ Answer A
,If synchronized cardioversion is attempted in the presence of digoxin toxicity,
ventricular tachycardia or fibrillation may result. The remaining 3 options
would not be contraindicated to synchronized cardioversion
The patient had an episode of chest pain at rest with ST elevation on the ECG.
The chest pain was relieved, and teh ST segments normalized after
administration of nitroglycerin sublingual. The patient most likely had:
a) Stable angina
b) ST-elevation MI
c) Prinzmetal's or variant angina
d) Wellen's syndrome - ✔ ✔ Answer C
ST segment elevation that normalizes and chest pain is relieved after
administration of nitroglycerin are indicative of Prinzmetal's angina. Stable
angina occurs with activity; it is predictable. STEMI does not respond to NTG
with normalization of ST segments and complete pain relief. Wellen's
syndrome does not present with ST elevation but rather a biphasic T-wave
specific to lead V1 and V2
The patient has acute right ventricular infarct and RV failure. Which of the
following is an indication that this patient's condition has improved?
a) The PAOP has decreased
b) The RA pressure has decreased
c) The RV pressure has increased
,d) The PA diastolic has decreased - ✔ ✔ Answer: B
The RA pressures are elevated in RV failure secondary to RV infarct, and a
decrease is evidence that treatment is effective. The PAOP is a left heart
pressure. It is often already low in the setting of RV infarct/failure since the
preload to the left heart drops. A further decrease is not warranted. An
increase in RV pressure is a sign of worsening RV failure. The PAD is already
low with RV infarct, and a further decrease is not desirable.
The nurse is caring for a patient with acute inferior wall MI, post-coronary
artery stent deployment. For optimal care of the patient, the nurse should:
a) administer an analgesic for acute back pain
b) Apply pressure dressing to groin
c) Continuously monitor the patient in lead II
d) Maintain the patient in a supine position - ✔ ✔ Answer: C
It is best practice to continuously monitor the patient status post PCI with
stent, in the lead that was most abnormal during the acute occlusion. Lead II
would most likely meet this criterion for the patient with an inferior wall MI.
The remaining interventions are NOT indicated for the patient post PCI.
The patient complains of chest pain with deep inspiration, worse when lying
supine. There is a frction rub on auscultation and sinus tachycardia. Which of
the following would you expect to find on the stat 12-lead EKG?
a) ST depression in V1-V4
b) ST elevation in II, III, aVF, and V2-V5
, c) ST depression rV2, rV3
d) ST elevation in II, III, aVF - ✔ ✔ Answer: B
The patient has pericarditis, and the expected EKG change is global ST
elevation. Choice (a) is seen in anteriror wall ishcemia or NSTEMI. Choice (c) is
associated with RV ischemia/infarct. Choice (d) is seen with acute inferior
wall STEMI
The patient complains of chest tightness, SOB, and difficulty breathing shortly
after the IV antibiotics is initiated. Hives have appeared across the face and
chest. Vital signs include BP 84/34, HR 130 min, sinus tachycardia, RR 28 with
wheezing, Sp02 94% on room air. Which of the following interventions are
most appropriate for the patient?
a) Stat ECG, aspirin, oxygen, pressor
b) Albuterol, steroids, 02, fluids
c) Fluids, 02, CT of the chest, 02, heparin
d) Epinephrine IM, steroids IV, Antihistamine, fluids - ✔ ✔ Answer D
The clinical signs and symptoms indicate an allergic reaction and anaphylatic
shock. The epinephrine, steroids, and antihistamine will couteract the effects
of the massice histamine release. Fluids will address the hypotension and
relative hypovolemia caused by massive dilation. The remaining responses
include options not indicated or helpful for anaphylaxis.
Which of the following clinical signs is most specific for cardiogenic
pulmonary edema?
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