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Cardiovascular Emergencies, Exams of Nursing

A range of topics related to cardiovascular emergencies, including the management of conditions such as myocardial infarction, arrhythmias, heart failure, and shock. It provides information on the diagnosis, treatment, and prevention of these conditions, as well as the use of various medications and interventions. The document also discusses the importance of patient monitoring, the role of healthcare professionals in managing cardiovascular emergencies, and the potential complications that can arise. Overall, this document serves as a comprehensive resource for healthcare providers to effectively manage and address cardiovascular emergencies in a clinical setting.

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2024/2025

Available from 09/12/2024

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Download Cardiovascular Emergencies and more Exams Nursing in PDF only on Docsity! CCRN CERTIFICATION EXAM ACTUAL EXAM & PRACTICE EXAM QUESTIONS AND DETAILED CORRECT ANSWERS | A+ STUDYGUIDE 2025 A 57-year-old man was admitted to the critical care unit with a diagnosis of anteroseptal MI. A PA catheter was inserted, and initial readings were within normal limits. BP 140/92, HR 110 and regular, RR 24. Breath sounds equal and clear. 3 hrs after admission, the pt becomes restless with cool, pale skin. Now BP 110/72, HR 120, RR 28 and labored. Crackles are audible at the lung bases BL. The patient is given furosemide (Lasix) at 8 am. At 9 am, the PAOP drops to 8, with a drop in BP. Which of the following would be the most appropriate intervention at this time? A. Administer saline bolus. B. Decrease dobutamine drip rate. C. Increase nitroglycerin drip rate. D. Replace potassium. Correct Answer A. Administer saline bolus. What type of AV block is characterized by a progressive prolongation of the PR interval followed by a nonconducted P wave? A. First-degree AV block B. Second-degree AV block, type I C. Second-degree AV block, type II D. Third-degree AV block Correct Answer B. Second-degree AV block, type I A premature P wave buried in the T wave before a run of wide QRS complex tachycardia indicates that the wide QRS complex tachycardia is most likely which of the following? A. Supraventricular tachycardia with aberrancy B. Ventricular tachycardia C. Bundle branch block D. Wolff-Parkinson-White syndrome Correct Answer A. Supraventricular tachycardia with aberrancy Which of the following drugs are used for first-line therapy for chronic management of hypertension? A. ACE inhibitors and vasodilators B. Vasodilators and beta-blockers C. Diuretics and beta-blockers D. Diuretics and ACE inhibitors Correct Answer C. Diuretics and beta-blockers A 61-year-old man is admitted to the critical care unit from the cath lab. He has just had a PCI and stent insertion to the RCA. His leg is immobilized, and the HOB 30 degrees. Six hours later the patient is restless and complaining of back pain. The femoral sheath is intact in the right femoral area, and there is no evidence of bleeding or hematoma. Neck veins are flat with the HOB 30 degrees, and heart A. Arterial blood gases B. Capnography C. Hemoglobin and hematocrit D. Pulse oximetry Correct Answer D. Pulse oximetry Which of the following would not be recommended for diastolic dysfunction? A. Angiotensin receptor blockers B. Beta-blockers C. Inotropes D. Angiotensin-converting enzyme inhibitors Correct Answer C. inotropes Why does nitroprusside (Nipride) cause tachycardia? A. Stimulation of cardioacceleratory center B. Stimulation of alpha receptors C. Stimulation of baroreceptors D. Stimulation of renin-angiotensin-aldosterone system Correct Answer C. Stimulation of baroreceptors Aortic stenosis would elevate which of the following? A. Left ventricular systolic pressure B. Pulmonary artery systolic pressure C. Arterial systolic pressure D. Arterial diastolic pressure Correct Answer A. Left ventricular systolic pressure Which of the following does not predispose the patient to digitalis toxicity? A. Hypokalemia B. Hypercalcemia C. Hypomagnesemia D. Hyponatremia Correct Answer D. Hyponatremia Which of the following types of drugs can cause hypotension, hyperkalemia, angioedema, proteinuria, and cough? A. Beta-blockers B. Loop diuretics C. Calcium channel blockers D. Angiotensin-converting enzyme (ACE) inhibitors Correct Answer D. Angiotensin-converting enzyme (ACE) inhibitors Ashman's phenomenon is most likely to be evident in which of the following electrocardiogram changes? A. Second-degree atrioventricular block, type I (Wenckebach) B. Atrial fibrillation C. Sinus dysrhythmia D. Premature ventricular contraction Correct Answer B. A- fib Ashman's phenomenon is more likely to be evident in rhythms that are irregular; therefore having more short cycles after long cycles. The most likely rhythm to demonstrate Ashman's phenomenon is atrial fibrillation because it is irregularly irregular. Ashman's phenomenon is also evident in early premature atrial complexes. Again, Ashman's phenomenon occurs when a short cycle follows a long cycle. Which of the following is a clinical indication of diastolic dysfunction? A. S3 B. S4 C. Murmur D. Midsystolic click Correct Answer B. S4 Which of the following type of drug would be prescribed after a MI to aid in prevention of remodeling? A. Beta-blockers B. Calcium channel blockers C. Angiotensin-converting enzyme (ACE) inhibitors D. Anticoagulants Correct Answer C. ACE inhibitors Which of the following are clinical indications of bacterial endocarditis? A. Fever and new murmur B. Chest pain and pericardial friction rub C. Dyspnea and crackles D. Chest pain and syncope Correct Answer A. fever and new murmur Which of the following is the most common cause of death associated with an acute MI? A. Heart failure B. Ventricular dysrhythmias C. Pulmonary edema D. Thromboembolism Correct Answer B. Ventricular dysrhythmias If a murmur is audible at the same time that the carotid pulse is felt, the murmur is: A. systolic. B. diastolic. C. always normal. D. always pathologic. Correct Answer A. systolic Which drug has Class II and Class III properties? A. Verapamil (Calan) B. Propranolol (Inderal) C. Sotalol (Betapace) D. Tocainide (Tonocard) Correct Answer C. Sotalol (Betapace) The skin changes associated with chronic peripheral arterial disease are: A. thickened with brownish discoloration at the ankles. B. pale and shiny. C. ulcerations at the sides of the ankles. D. rubor when in dependent position. Correct Answer B. pale and shiny. If the air fluid meniscus of the zero reference port of the transducer of a pressure monitoring system is 2 inches below the phlebostatic axis, what effect would it have on pressure measurements? A. The pressures recorded would be falsely high by about 2 mm Hg. B. The pressures recorded would be falsely low by about 2 mm Hg. C. The pressures recorded would be falsely high by about 4 mm Hg. D. The pressures recorded would be falsely low by about 4 mm Hg. Correct Answer C. The pressures recorded would be falsely high by about 4 mm Hg. A patient is admitted to the coronary care unit in third- degree AV heart block with syncopal episodes. Which of the following defines syncope? A. Dizziness B. Ataxia C. Vertigo D. Transient loss of consciousness Correct Answer D. Transient loss of consciousness Clinical indications of a right tension pneumothorax include which of the following? A. Tracheal shift toward the right with diminished or absent breath sounds on the left B. Tracheal shift toward the left with diminished or absent breath sounds on the right C. Tracheal shift toward the left with diminished or absent breath sounds on the left D. Tracheal shift toward the right with diminished or absent breath sounds on the right Correct Answer B. Tracheal shift toward the left with diminished or absent breath sounds on the right A patient in the ED with complaints of chest pain. The 12- lead EKG shows ST elevation in leads V3 and V4. Occlusion of the affected coronary artery most likely would affect perfusion to which portion of the conduction system? A. Sinoatrial (SA) node B. Bachmann's bundle C. Atrioventricular (AV) node D. Bundle of His Correct Answer LAD so D. bundle of his Which of the following is the preferred lead for ST segment monitoring for a patient with a suspected RCA occlusion? A.I B. aVR C. III D. V1 Correct Answer c. III A. order a 12-lead EKG B. evaluate the patient for clinical indications of hypoperfusion. C. notify the physician. D. ask the patient to bear down as if having a bowel movement. Correct Answer B The onset of atrial fibrillation results in the loss of atrial kick. Loss of atrial kick may reduce the cardiac output by as much as 20-30%. This is especially true in patients whose cardiac output may be affected by long-standing cardiac disease, such as mitral valve disease. Assess the patient for clinical indications of hypoperfusion (e.g., cool skin, decreased urine output, narrowed pulse pressure, and hypotension). A patient has just returned from the cath lab. She had an angioplasty for occlusion of her RCA. She still has femoral artery and vein sheaths in place. The patient complains of chest pain that she rates 9/10 about an hour after she returns from the cath lab. Which of the following is indicated? A. Administer morphine IV. B. Administer nitroglycerin sublingual spray. C. Stop the heparin. D. Notify the physician Correct Answer D New-onset severe chest pain after percutaneous coronary intervention suggests acute closure of the dilated coronary artery. The patient needs to be returned to the cardiac catheterization laboratory for repeat dilation and probable insertion of stent. A 35-year-old woman underwent a mitral valve replacement. Her chest tube output has been approximately 125 mL/hr for the last 3 hours, and now the drainage has ceased suddenly. The immediate assessment reveals a significant decrease in BP, RAP 12, PAP 30/15 , PAOP 13. What other data would indicate the development of cardiac tamponade? A. Increased venous oxygen saturation (SvO2) B. Decreased UO C. Muffled heart sounds D. New holosystolic murmur at the sternum Correct Answer C Muffled heart sounds are a classic finding in cardiac tamponade. Remember the classic indications of cardiac tamponade referred to as Beck's triad: muffled heart sounds, jugular venous distention, and hypotension. Even though urine output is a sensitive indicator of cardiac output and in cardiac tamponade a decreased stroke volume results in a decreased cardiac output, by the time a nurse would notice the decreased urine output, the patient may have already had a cardiopulmonary arrest. The SvO2 actually would decrease because of the decrease in cardiac output. New holosystolic murmur at the lower left sternal border is a sign of ventricular septal rupture. A patient has had an inferior MI. He now has a new holosystolic murmur at apex, acute severe dyspnea, decreased cardiac index, and a normal cardiac silhouette on x-ray. Which of the following complications most likely is occurring in this patient? A. Acute mitral regurgitation B. Rupture of left ventricular free wall C. Ventricular septal rupture D. Acute aortic stenosis Correct Answer A With an inferior MI, the risk of the papillary muscles being affected is greater. The papillary muscles of the LV maintain normal mitral valve fxn. If damaged, acute mitral regurgitation occurs and is manifested by a new holosystolic murmur at the apex, acute pulmonary edema, and decreased cardiac output/index A patient with HF caused by diastolic dysfunction is prescribed carvedilol (Coreg). What type of drug is carvedilol? A. Calcium channel blocker B. Angiotensin-converting enzyme inhibitor C. Alpha- and noncardioselective beta-blocker D. Cardioselective beta-blocker Correct Answer C. Alpha- and noncardioselective beta-blocker A 52-year-old man is admitted to the critical care unit with a diagnosis of an acute MI. EKG shows ST elevation and T wave inversion in leads V2, V3, and V4. His history includes HTN, 80 pack-years of smoking, COPD, and HLD. Which of the following is the major advantage of minimally invasive direct coronary artery bypass grafting (MIDCABG)? A. Decreased cost B. Decreased length of stay C. Avoidance of cardiopulmonary bypass D. Less patient pain Correct Answer C. avoidance of cardiopulmonary bypass A patient arrives to the ED with a knife sticking out of his chest. He is stable at this time but complaining of pain at the knife insertion site. The physician is busy resuscitating another patient. What should be done? A. Remove the knife so that the wound can be cleansed. B. Remove the knife and apply a sterile, occlusive dressing. C. Leave the knife in but stabilize it with adhesive tape. D. Leave the knife in but apply a pressure dressing over it. Correct Answer C. Leave the knife in but stabilize it with adhesive tape. A 70-year-old woman, weighing 50 kg, comes to the ED complaining of chest pain and shortness of breath. EKG shows ventricular tachycardia HR 150. Which treatment is appropriate in this situation? A. Amiodarone (Cordarone) IV B. Verapamil HCl (Calan) IV C. Defibrillation beginning at 200 J D. Synchronized cardioversion beginning at 100 J Correct Answer D. Synchronized cardioversion beginning at 100 J A patient is admitted to the coronary care unit with third- degree AV heart block, and a transvenous temporary ventricular pacemaker is inserted. Four hours later the patient complains of dizziness while lying in bed. The monitor shows third-degree AV heart block with a ventricular rate of 52 beats/min and no pacing spikes. This indicates failure to pace, and the patient is taken to surgery for insertion of a DVI permanent pacemaker. Which of the following describes the function of a DVI pacemaker? A. Senses atrium and ventricle; paces ventricle; inhibited by QRS complex B. Senses atrium and ventricle; paces ventricle; triggered by QRS complex C. Paces atrium and ventricle; senses ventricle; inhibited by the QRS complex D. Paces and senses atrium and ventricle; inhibited by the P wave Correct Answer C. Paces atrium and ventricle; senses ventricle; inhibited by the QRS complex Shortly after returning from PCI, a patient begins to complain of chest pain similar in intensity and character to the pre-PCI pain. The pain is unresponsive to nitroglycerin infusion titration. The patient should be prepared for: A. return to cardiac catheterization for an additional procedure. B. emergency coronary artery bypass grafting. C. intraaortic balloon pump therapy. D. a catheterization of the right side of the heart. Correct Answer A. return to cardiac catheterization for an additional procedure. Which of the following would not be associated with a false-positive result for an acute MI using the total creatine kinase (CK)? A. Hypothyroidism B. Hemorrhagic stroke C. Cardioversion D. Ulcerative colitis Correct Answer D. Ulcerative colitis While auscultating the patient's heart, an S3 is noted. What does this heart sound indicate? A. Atrial contraction and propulsion of blood into a noncompliant ventricle B. Inflammation of the pericardium C. Opening of a defective semilunar valve D. Rapid ventricular filling into an already distended ventricle Correct Answer D. Rapid ventricular filling into an already distended ventricle Which of the following is the best hemodynamic parameter for assessing LV function? complex is 0.14 second wide, and the patient has had an anterior MI. Occlusion of the RCA would cause ST elevation in which leads? A. I, aVL B. II, III, aVF C. V1, V2 D. V5, V6 Correct Answer B. II, III, aVF Which of the following correlates with brain natriuretic peptide (BNP) levels? A. Venous oxygen saturation B. Pulmonary artery pressure C. Pulmonary artery occlusive pressure (PAOP) D. Systemic vascular resistance Correct Answer C. Pulmonary artery occlusive pressure (PAOP) A patient is receiving low-molecular-weight dextran after an aortofemoral bypass graft. What is the purpose of this therapy for this patient? A. Increase circulating volume B. Increase blood thrombogenicity C. Decrease platelet aggregation D. Decrease inflammation Correct Answer C. Decrease platelet aggregation Which of the following findings would occur in dilated cardiomyopathy? A. Murmur of mitral regurgitation B. Hypertension C. Elevated sedimentation rate D. Syncope Correct Answer A. Murmur of mitral regurgitation Which of the following would be contraindicated in a patient with Wolff-Parkinson-White (WPW) syndrome? A. Amiodarone (Cordarone) B. Lidocaine (Xylocaine) C. Adenosine (Adenocard) D. Verapamil (Calan) Correct Answer D. Verapamil (Calan) A 67-year-old woman with unstable angina is admitted to the cardiac unit. She has a history of DM and reports having had chest pain intermittently for 4 days. The EKG shows nonspecific ST changes. Which of the following studies is most diagnostic in identifying a MI in this patient? A. Elevated creatine kinase-myocardial bound (CK-MB) B. Elevated creatine kinase-muscle type (CK-MM) C. Elevated troponin I D. Lactate dehydrogenase 1 (LDH-1) greater than LDH-2 Correct Answer C. Elevated troponin I A patient is in cardiogenic shock and requires careful volume titration to enhance contractility. Which of the following ranges describes the most likely optimal PAOP in this patient? A. 0-5 mm Hg B. 10-15 mm Hg C. 15-20 mm Hg D. 20-25 mm Hg Correct Answer C. 15-20 mm Hg Which of the following drugs prescribed for a patient with stable angina does not decrease myocardial oxygen consumption? A. Beta-blocker B. Calcium channel blocker C. Nitrate D. Aspirin Correct Answer D. Aspirin Which of the following is the most common complication of infective endocarditis? A. Heart failure B. Emboli C. Myocarditis D. Pericarditis Correct Answer B. Emboli Which of the following is likely to correlate most directly with the need for electrical cardioversion for a tachydysrhythmia? A. Normal pain related to fractured femur B. Abnormal pain related to compartment syndrome C. Abnormal pain related to infection D. Abnormal pain related to lumbosacral plexus injury Correct Answer B. Abnormal pain related to compartment syndrome Which of the following medications is associated with thiocyanate toxicity? A. Nicardipine (Cardene) B. Captopril (Capoten) C. Metoprolol (Lopressor) D. Nitroprusside (Nipride) Correct Answer D. Nitroprusside (Nipride) patient is in cardiac and respiratory arrest. The selection of medications to reestablish cardiac function would stimulate the sympathetic nervous system beta1 receptors. This stimulation would result in increased automaticity and which of the following? A. Increased myocardial contractility B. Decreased left ventricular stroke work C. Decreased myocardial oxygen consumption D. Increased left ventricular afterload Correct Answer A. Increased myocardial contractility A 55-year-old man had a heart transplant 10 hours ago. Present assessment includes cold, clammy skin, jugular venous distention, bilateral crackles, and tachycardia. Vital signs are temperature 98.6° F, BP 80/60, HR 120 and RR 24 . Mediastinal tube drainage is approximately 50 mL/hr. He is diagnosed with decreased cardiac contractility. Which of the following would be an appropriate treatment for this patient? A. Beta-adrenergic stimulant (e.g., dobutamine) B. Diuretic (e.g., furosemide) C. Normal saline bolus D. Antibiotics Correct Answer A. Beta-adrenergic stimulant (e.g., dobutamine) Which vessel is used as a graft when the minimally invasive direct coronary artery bypass grafting (MIDCABG) procedure is performed? A. Internal thoracic artery B. Radial artery C. Gastroepiploic artery D. Saphenous vein Correct Answer A. Internal thoracic artery Which of the following may be useful in systolic dysfunction but may be detrimental in diastolic dysfunction? A. Beta-blockers B. Angiotensin-converting enzyme inhibitors C. Aldosterone antagonists D. Vasodilators Correct Answer D. Vasodilators A 90-year-old patient is admitted with acute respiratory distress. Vital signs are blood pressure 92/66 mm Hg, heart rate 132 beats/min and regular rhythm, and respiratory rate 36 breaths/min and labored. Auscultation of breath sounds reveals crackles to the scapular level bilaterally. Which of the following is the most likely pathophysiologic problem in this patient? A. Acute myocardial infarction B. Mild heart failure C. Massive pulmonary embolus D. Acute pulmonary edema Correct Answer D. Acute pulmonary edema Which of the following are two significant adverse effects of angiotensin-converting enzyme (ACE) inhibitors (e.g., captopril [Capoten])? A. Heart failure and hypokalemia B. Proteinuria and hyperkalemia C. Thrombocytopenia and hepatotoxicity D. Dysrhythmias and hyponatremia Correct Answer B. Proteinuria and hyperkalemia A patient has just returned to the critical care unit from the operating room. He has a VDD pacemaker. Which of the following is an accurate description of this type of pacemaker? A. atrium and ventricle are paced and sensed, atrial pacing can be inhibited by an intrinsic atrial impulse, and indicates an SpO2 of 84%. How should this patient be positioned? A. Head down, left side B. Head down, right side C. Head of bed elevated, left side D. Head of bed elevated, right side Correct Answer A. Head down, left side Envision a big air bubble in the patient's heart. Think: what position would decrease the movement of the air embolism out of the right side of the heart. Chose "Head down, left side." Oxygen delivery (DO2) is the product of which of the following? A. PaO2, hemoglobin, mean arterial pressure B. SaO2, hemoglobin, cardiac output C. SvO2, cardiac index, SaO2 D. PaO2, mean arterial pressure, SvO2 Correct Answer B. SaO2, hemoglobin, cardiac output Oxygen is delivered from the arterial end, so choose an option that has SaO2 Which of the following is the most significant complication of status asthmaticus? A. Pulmonary embolism B. Acute respiratory failure C. Hypertension D. Anaphylaxis Correct Answer B. Acute respiratory failure A 22-year-old man is admitted to the critical care unit after a motor vehicle collision. The emergency department nurse reports that he was unconscious at the scene of the accident, but he is now alert and oriented. Skull films show a linear fracture of the right temporal bone. He is at significant risk for: A. scalp hematoma. B. subdural hematoma. C. epidural hematoma. D. intracerebral hematoma. Correct Answer C. epidural hematoma. Linear fractures of the temporal bone frequently disrupt the middle meningeal artery and cause epidural hematoma. Patients with an epidural hematoma classically present with a short period of unconsciousness followed by a lucid interval and then rapid deterioration. An epidural hematoma is usually caused by arterial bleeding. A patient is admitted to the ICU after sustaining a concussion and blunt abdominal trauma to the right upper quadrant in a domestic dispute. The patient's vital signs are BP 145/86 mm Hg, pulse 86 beats/min, respiration 15 breaths/min, and temperature 98.8° F. The nurse is monitoring the patient's bowel sounds, abdominal tenderness, and abdominal girth frequently. Which of the following laboratory parameters is especially important for the nurse to closely monitor for bleeding in this patient? A. Platelet count B. Protime C. Hematocrit D. Mean corpuscular volume Correct Answer C. Hematocrit Common injuries resulting from blunt abdominal trauma can include injury to the liver, spleen, mesenteric vessels, pancreas, or kidneys. In a nonoperative approach to blunt abdominal trauma, observation and monitoring include serial hematocrits to evaluate for intra-abdominal bleeding. The platelet count does not fluctuate unless there is a disease process (e.g. cirrhosis, leukemia) or significant This case is an example of diabetes insipidus, which is caused by a lack of antidiuretic hormone (ADH). ADH causes water retention in the renal tubules but not sodium retention, so eliminate sodium retention. A lack of ADH causes water loss not water gain, so eliminate water gain. Diabetes insipidus does not have anything to do with aldosterone. The hypernatremia is a concentration effect caused by water loss. This sometimes is called hypovolemic hypernatremia. A patient is admitted with unstable angina. He has a long history of hypertension and coronary artery disease. The nurse notes a split S2on expiration and a single S2 on inspiration during cardiac auscultation. Blood pressure is 150/88 mm Hg, and heart rate is 88 beats/min. On the electrocardiogram, there is a normal-appearing P wave in front of each QRS complex, the PR interval measures 0.2 second consistently, and the QRS complexes measure 0.14 second. They are positive in V5 and V6 and negative in V1 and V2. These findings most likely indicate which of the following? A. Left bundle branch block (LBBB) B. Right bundle branch block (RBBB) C. Third-degree atrioventricular block D. Ventricular tachycardia Correct Answer A. Left bundle branch block (LBBB) Features of LBBB described here are a QRS complex greater than 0.12 second in duration and a QRS complex that is positive in leads V5 and V6 (consider these left ventricular leads) and negative in leads V1 and V2 (consider these right ventricular leads). LBBB causes a paradoxical splitting of S2. This means that it is split on expiration but not on inspiration. This is paradoxical because it is opposite of a normal physiologic split of S2, which is split on inspiration but not split on expiration Which of the following is not an indication for mechanical ventilation in patients with asthma? A. Respiratory alkalosis B. Cardiopulmonary arrest C. Respiratory muscle fatigue D. Hypercapnia and respiratory acidosis Correct Answer A. Respiratory alkalosis Respiratory alkalosis is seen early in asthma because of hyperventilation. A patient exhibiting nystagmus, ataxia, unsteady gait, and problems with rapid, alternating movements probably has a lesion in the: A. frontal lobe. B. pituitary gland. C. cerebellum. D. brainstem. Correct Answer C. cerebellum The pituitary is an endocrine gland that controls release of hormones within the body, so eliminate "pituitary gland." The brainstem contains the cardiac and respiratory centers, temperature, and other basic drives, so eliminate "brainstem." The frontal lobe controls voluntary motor function and behavior, so eliminate "frontal lobe." The cerebellum controls balance and coordination. Associate bellum with ballerina, who must balance to dance. Choose "cerebellum." Which route would be preferred for the rapid administration of fluids in hypovolemic shock? A. Central venous catheter B. Large-gauge, short peripheral catheter C. the parietal pleura by air in the pleural space. No lung markings can be seen in this area, and it is darker than the lung. A 55-year-old man is admitted to the critical care unit with upper gastrointestinal bleeding. Endoscopy identifies esophageal varices, but bleeding continues despite sclerosing. The physician inserts a Sengstaken-Blakemore tube. The family tells you that the patient has a long history of alcohol use, drinking about one half of a fifth of Jack Daniels every day. Which of the following are early indications of alcohol withdrawal syndrome for which the nurse should monitor? A. Diaphoresis, pruritus B. Marked tachycardia, marked hypertension C. Hyperthermia, dehydration D. Delirium, hallucinations Correct Answer A. Diaphoresis, pruritus Because the question says "early," look for the mildest symptoms. Diaphoresis, pruritus, mild tachycardia, mild hypertension, nausea, vomiting, visual disturbances, tremors, anxiety, agitation, and sleep disturbances are signs of early alcohol withdrawal syndrome. Options "Marked tachycardia, marked hypertension," "Hyperthermia, dehydration," and "Delirium, hallucinations" describe late signs. Altering the pH of the gastric secretions through the use of H2 receptor antagonists, antacids, and proton pump inhibitors contributes to which potential complication? A. Pulmonary embolism B. Pneumonia C. Stress ulcer D. Acid-base imbalance Correct Answer B. Pneumonia Gastric colonization is likely with a gastric pH of greater than 4. Pneumonia rates of patients receiving mechanical ventilation correlate directly with increased gastric pH levels. This is one of the risks of the use of H2 receptor antagonists, antacids, and proton pump inhibitors to prevent stress ulcers in intubated patients. You have a 76-year-old patient that is on a norepinephrine gtt. You notice the patient is complaining of severe pain and that the area around her IV is becoming translucent, cool to touch, and discolored. What stage is this and what medication should you administer to prevent extravasation? A. Stage 1, phentolamine B. Stage 4, hyaluronidase C. Stage 4, phentolamine D. Stage 3, dexrazoxane Correct Answer C. Stage 4, phentolamine The patient is experiencing Stage 4 infiltration and is on a vasopressor gtt; therefore, phentolamine is the drug of choice to counteracts the effects of infiltration/extravasation. Which of the following solutions would be most appropriate for initial fluid resuscitation of a patient with severe hypovolemia caused by several days of diarrhea and vomiting? A. An isotonic crystalloid B. A hypotonic crystalloid C. A hypertonic crystalloid D. A colloid Correct Answer A. An isotonic crystalloid A. It causes muscle weakness and fatigability. B. It is associated with demyelination of peripheral nerve fibers. C. It affects the nerve roots. D. It may result in adrenergic crisis. Correct Answer A. It causes muscle weakness and fatigability. Myasthenia gravis is a disorder of voluntary muscles caused by a defect in nerve impulse transmission at the neuromuscular junction. It causes muscle weakness and fatigability. A 42-year-old man is admitted to the critical care unit with smoke inhalation and acute respiratory distress syndrome (ARDS). He is intubated, and the following mechanical ventilation is initiated: fraction of inspired oxygen, 0.6; intermittent mandatory ventilation, 10 breaths/min; tidal volume, 450 ml; positive end-expiratory pressure (PEEP), 15 cm H2O. Arterial blood gases are pH, 7.39; PaCO2, 42 mm Hg; HCO3, 24 mEq/L; and PaO2, 70 mm Hg. The purpose of using PEEP in the treatment of this patient is which of the following? A. Increase pulmonary compliance. B. Decrease the chance of barotrauma. C. Increase alveolar surface tension. D. Decrease intrapulmonary shunt. Correct Answer D. Decrease intrapulmonary shunt. PEEP has three primary purposes: to increase the driving pressure of oxygen, to decrease surface tension and the work of breathing, and to decrease shunt by reopening collapsed alveoli. In ARDS, the purpose of PEEP is to open alveoli that have collapsed (called alveolar recruitment) and to keep alveoli open that are still open. The effect of this action is to decrease intrapulmonary shunt. Which ventilator mode requires close monitoring for auto- PEEP (positive end-expiratory pressure)? A. Intermittent mandatory ventilation B. Pressure support ventilation C. Pressure-controlled inverse ratio ventilation D. Pressure-regulated, volume-controlled ventilation Correct Answer C. Pressure-controlled inverse ratio ventilation Pressure-controlled inverse ratio ventilation, which flips the normal 2:1 inspiration/expiration ratio to make inspiration longer than expiration, allows trapping of air in the lungs. This inadvertent PEEP is called auto-PEEP. Which of the following best differentiates hypovolemic from cardiogenic shock? A. Increased systemic vascular resistance B. Decreased cardiac index C. Decreased urine output D. Decreased pulmonary artery occlusive pressure Correct Answer D. Decreased pulmonary artery occlusive pressure The cardiac index is decreased, the systemic vascular resistance is increased, and the urine output is decreased in hypovolemic and cardiogenic shock. The pulmonary artery occlusive pressure (PAOP) is decreased in hypovolemic shock but increased in cardiogenic shock. A patient develops carpopedal spasm and neuromuscular irritability manifested by Chvostek and Trousseau signs. Which electrolyte imbalance should you suspect? A. Hyperkalemia B. Hypercalcemia Your patient has an increase in venous oxygen saturation (SvO2) along with a decrease in oxygen consumption (VO2) and pH. What do you suspect? A. Early septic shock B. Cardiogenic shock C. Hemorrhagic shock D. Anaphylactic shock Correct Answer A. Early septic shock In the early or hyperdynamic phase of septic shock, oxygen delivery (DO2) is increased but the tissues cannot extract and use the oxygen, so VO2 is decreased and SvO2 is increased. Lactic acidosis occurs because the cells are hypoxic. In multiple organ dysfunction syndrome (MODS), clinical indications of respiratory failure include: A. increased pH. B. increased PaCO2. C. PaO2/FiO2 (fraction of inspired oxygen) ratio of greater than 300 mm Hg. D. narrow A:a gradient. Correct Answer B. increased PaCO2. Hypoventilation would cause the PaCO2 to increase. A 52-year-old patient with a history of alcoholism is admitted with massive esophageal bleeding. Which of the following would be an indication for the administration of blood in this patient? A. Hemoglobin less than 10 g/dl B. Hematocrit less than 30% C. Inability to control bleeding via endoscopic sclerosing therapy D. Symptoms of hypoperfusion such as chest pain or dyspnea Correct Answer D. Symptoms of hypoperfusion such as chest pain or dyspnea Clinical indications of hypoperfusion such as chest pain, dyspnea, or hypotension are indications that blood should be administered. Absolute hemoglobin or hematocrit levels are no longer indications because of the risk of blood- transmitted diseases. Inability to control bleeding is an indication for surgery. Which of the following are the major sources of intracranial hypertension after craniocerebral trauma? A. Cerebral edema and expanding lesions B. Hypervolemia and hyperthermia C. Hypovolemia and hypothermia D. Hydrocephalous and infection Correct Answer A. Cerebral edema and expanding lesions Cerebral edema and expanding lesions (e.g., hematoma) are the two major sources of increased intracranial pressure. A patient received one unit of packed cells. Which of the following would be the expected effects of the transfusion? A. Increase in hemoglobin by 0.5 g/dl and increase in hematocrit by 2% B. Increase in hemoglobin by 0.5 g/dl and increase in platelets by 50,000/mm3 C. Increase in hemoglobin by 1 g/dl and increase in hematocrit by 3% D. Increase in hemoglobin by 1 g/dl and increase in platelets by 50,000/mm3 Correct Answer C. Increase in hemoglobin by 1 g/dl and increase in hematocrit by 3% What would be the best laboratory test to evaluate this patient's glomerular filtration rate (GFR)? A. Blood urea nitrogen B. Serum creatinine C. Urine creatinine clearance D. Serum amylase Correct Answer C. Urine creatinine clearance The creatinine clearance rate reflects the GFR. Which of the following is the oxygen concentration to be used in patients with cardiopulmonary arrest? A. 40% B. 80% C. 100% D. 100% except for patients with chronic hypercapnia Correct Answer C. 100% One hundred percent (or as close as can be achieved) oxygen should be used in cardiopulmonary arrest. There is no contraindication to 100% oxygen in cardiopulmonary arrest. A 65-year-old man is admitted to the critical care unit with a diagnosis of septic shock. He has been receiving chemotherapy for lung cancer. His skin is warm and dry, and he is restless. His white blood cell count is elevated above normal. Hemoglobin, hematocrit, and red blood cell count are normal. Vital signs are blood pressure 80/50 mm Hg, heart rate 120 beats/min and regular, respiratory rate 32 breaths/min and regular, and temperature 39° C. Arterial blood gases reveal the following: pH7.25PaO260 mm HgPaCO225 mm HgHCO313 mEq/LOxygen saturation86% Dobutamine is started at 10 mcg/kg/min. Normal saline is infusing at 150 ml/hr. Which of the following would be most indicative of improvement in this patient? A. Increase in venous oxygen saturation (SvO2) B. Decrease in arterial lactate C. Increase in cardiac output D. Increase in urine output Correct Answer B. Decrease in arterial lactate Associate lactate with lactic acid. You know that a decrease in lactic acid would indicate less anaerobic metabolism. Adequate oxygen extraction and aerobic metabolism would decrease the lactic acid level. The physician has prescribed mannitol for a patient with intracranial hypertension. Which of the following is an important consideration when administering mannitol? A. The drug must be protected from light. B. The drug must be administered through an in-line filter. C. The drug must be administered into a central venous catheter. D. The drug must be refrigerated. Correct Answer B. The drug must be administered through an in-line filter. If a patient with a normal pH and temperature has a PaO2 of 60 mm Hg, his arterial oxygen saturation (SaO2) is closest to which of the following values? A. 75% B. 90% Prepare the patient for surgery. Correct Answer C. Initiate fibrinolytic therapy. Fibrinolytic therapy is contraindicated if dissecting thoracic aortic aneurysm is suspected. All of the other interventions are appropriate. Which of the following interventions would be helpful in prevention of aspiration in a patient receiving enteral feedings? A. Check for gastric residuals every 4 hours. B. Use a small-bore duodenal feeding tube. C. Use a high-fat feeding. D. Add blue food coloring to the enteral feeding. Correct Answer B. Use a small-bore duodenal feeding tube. A tube that is placed below the pylorus would decrease the risk of aspiration Which of the following would not cause an elevated creatine kinase-muscle/brain (CK-MB)? A. Myocarditis B. Heart failure C. Myocardial infarction D. Postcardiotomy Correct Answer B. Heart failure Any injury to the myocardium would cause elevation of cardiac isoenzymes. Myocarditis, myocardial infarction, and cardiotomy cause injury to the myocardium. The ability of the brain contents to be shifted to prevent intracranial hypertension when intracranial volume increases is referred to as: A. compensation. B. autoregulation. C. normalization. D. feedback. Correct Answer A. compensation. Remember the difference between compensation and autoregulation. Compensation relates to intracranial volumes and resultant pressure. Autoregulation relates to the ability of the cerebral vessels to change size to normalize blood flow Which of the following is not a therapeutic effect of nifedipine when used for angina? A. Decreased preload. B. Decreased afterload. C. Decreased contractility. D. Relieve vasospasm. Correct Answer C. Decreased contractility. Nifedipine decreases myocardial oxygen consumption by dilating veins and arteries, thereby decreasing preload and afterload. Nifedipine also decreases vasospasm and potential for vasospasm. Unlike diltiazem and verapamil, nifedipine does not significantly decrease contractility. Emergency decompression of a tension pneumothorax includes needle puncture at which of the following locations? A. Fifth intercostal space at the midclavicular line on the affected side B. Second intercostal space at the midclavicular line on the affected side C. Second intercostal space at the midaxillary line on the affected side Hypercalcemia Correct Answer B. Hypocalcemia Associate phosphorus and calcium with a seesaw. When one side of the seesaw is up, the other is down. This process is consistent with normal and abnormal kidney function. Choose "Hypocalcemia." You do not really need to know what Goodpasture syndrome is to answer the question correctly. A 65-year-old man is admitted to the critical care unit with a diagnosis of septic shock. He has been receiving chemotherapy for lung cancer. His skin is warm and dry, and he is restless. His white blood cell count is elevated above normal. Hemoglobin, hematocrit, and red blood cell count are normal. Vital signs are blood pressure 80/50 mm Hg, heart rate 120 beats/min and regular, respiratory rate 32 breaths/min and regular, and temperature 39° C. Arterial blood gases reveal the following: pH7.25PaO260 mm HgPaCO225 mm HgHCO313 mEq/LOxygen saturation86% What hemodynamic alteration should the nurse anticipate? A. Decreased cardiac output (CO) B. Increased venous oxygen saturation (SvO2) C. Increased systemic vascular resistance (SVR) D. Increased oxygen consumption Correct Answer B. Increased venous oxygen saturation (SvO2) Early septic shock is different from most forms of shock because the main problem is oxygen extraction rather than oxygen delivery. So think opposite of hypovolemic shock. CO is increased instead of decreased. SVR is decreased instead of increased. And the SvO2 is increased instead of decreased. The primary result of carbon monoxide poisoning is: A. hypoxia. B. hypercapnia. C. hypertension. D. metabolic acidosis. Correct Answer A. hypoxia A patient with myasthenia gravis develops hypoxemia with hypercapnia. What is the cause of hypoxemia in this patient? A. Alveolar hypoventilation B. Alveolar hyperventilation C. Diffusion defect D. Shunt Correct Answer A. Alveolar hypoventilation Alveolar hypoventilation causes hypoxemia and hypercapnia. Alveolar hyperventilation would cause hypocapnia. Diffusion defect or shunt would cause hypoxemia with normal or decreased PaCO2, depending on ventilation. Which of the following drugs stabilizes epithelial mast cells, thereby reducing the release of histamine? A. Triamcinolone B. Ipratropium bromide C. Cromolyn sodium D. Metaproterenol Correct Answer C. Cromolyn sodium Cromolyn is given by inhalation and prevents the degranulation of the mast cells with release of histamine. Cromolyn is a prophylactic agent. It has no effect in an acute asthmatic attack. Which of the following would not be used for hypertensive crisis in the presence of acute heart failure? morphine sulfate IV 30 min ago. The anterior left thigh is firm to touch, and the pain increases when the patient flexes his left leg. Further assessment reveals that swelling extends to the knee, and popliteal, posterior tibial, and dorsalis pedis pulses are not palpable. What should be done next? A. Call the physician and prepare for fasciotomy. B. Check pulses with a Doppler stethoscope. C. Call the physician and prepare for embolectomy. D. Check for Homans sign. Correct Answer B. Check pulses with a Doppler stethoscope. There appears to be an arterial occlusion, but before deciding to prepare for surgical procedures, the nurse should complete the assessment by using a Doppler stethoscope to see whether pulses are audible. Swelling makes it difficult to palpate pulses, but the pulses will be audible with a Doppler stethoscope if present. Homans sign is a sign of venous obstruction or phlebitis, which would not cause a loss of arterial pulses. A 50-year-old patient is transferred to the critical care unit from the emergency department. A rattlesnake bit him approximately 6 hours ago. He is having a severe reaction to the venom, and antivenom is being flown to the hospital. The patient is bleeding from his IV insertion sites and continues to seep blood from the wound. Treatment for disseminated intravascular coagulation in this particular case would include which of the following? A. Clotting factors and antivenom B. Clotting factors and heparin C. IV fluids and antivenom D. IV fluids and heparin Correct Answer A. Clotting factors and antivenom A 22-year-old man is admitted after a bicycle collision with a tree. He has a contusion on the right side of his head. An intraventricular catheter has been inserted via a burr hole to monitor his intracranial pressure (ICP). He develops respiratory depression and is intubated and mechanically ventilated. Which of the following is the most likely cause of an increase in ICP at this time? A. Positive pressure ventilation B. Hypocapnia caused by hyperventilation C. Sedation D. Cerebral dehydration caused by osmotic diuretics Correct Answer A. Positive pressure ventilation Positive pressure ventilation increases intrathoracic pressure, which leads to increased ICP. A 24-year-old man is admitted to the critical care unit after sustaining a pulmonary contusion in a motor vehicle collision. He has no history of cardiac or pulmonary disease. During the first 24 hours after admission, he has been complaining of increasing dyspnea, his respiratory rate has been increasing, and his oxygen saturation via pulse oximetry has been decreasing despite supplemental oxygen. Breath sound assessment reveals fine crackles bilaterally. Arterial blood gases reveal respiratory alkalosis and hypoxemia. Chest x-ray film reveals patchy infiltrates. Acute respiratory distress syndrome is diagnosed. Oxygen therapy is initiated, and arterial blood gases are monitored closely, but SaO2 continues to fall. Which of these oxygen delivery systems will provide the highest concentration of oxygen and indicated in this case? A. Face tent B. Nonrebreathing mask C. Nasal cannula D. Venturi mask Correct Answer B. Nonrebreathing mask a Y-connector to one Pleur-Evac. He is on a positive pressure ventilator, but he is to be weaned this morning. Why is it important to wean this patient as early as possible? A. The positive pressure of the ventilator may maintain the air leak. B. The positive pressure of the ventilator may increase bleeding. C. He is likely to be difficult to wean. D. So that he can be transferred out of the intensive care unit. Correct Answer A. The positive pressure of the ventilator may maintain the air leak. Positive pressure ventilation in this patient is likely to maintain an air leak. Patients after thoracotomy should be weaned as soon as possible. A patient has developed a third-degree atrioventricular block. Which of the following rates would be indicative of a ventricular escape rhythm? A. 20 to 40 beats/min B. 40 to 60 beats/min C. 60 to 80 beats/min D. 80 to 100 beats/min Correct Answer A. 20 to 40 beats/min The intrinsic rate of the Purkinje system is 20 to 40 beats/min. You also should remember that it is unreliable. Because the ventricles would be the last chance for an escape rhythm and you know that sinus and atrial rates are high, choose the slowest rate. Which of the following would not be included in the treatment of flail chest and other bony thoracic injuries? A. Chest tube B. Oxygen therapy C. Mechanical ventilation D. Pain management Correct Answer A. Chest tube Flail chest occurs when two or more ribs are fractured in two or more locations, there is a fractured sternum, or there is a poorly healed sternotomy. Treatment of flail chest includes pain management, internal stabilization using mechanical ventilation, and oxygen to maintain the arterial oxygen saturation at a minimum of 95%. Chest tubes are used for pneumothorax, hemothorax, or pleural effusion. Patients with flail chest or rib fractures sometimes may have a concurrent pneumothorax but flail chest alone is not an indication for a chest tube. A 54-year-old man has just returned to the critical care unit from the postanesthesia care unit. He has a 60-pack-year history of cigarette smoking and had a right lower lobectomy performed earlier today for treatment of lung cancer. He is still intubated and on a positive pressure mechanical ventilator. The next morning a short-term breathing trial is conducted. Spontaneous ventilatory parameters and arterial blood gases are measured in preparation for weaning and extubation. Which of the following ventilatory parameters are most indicative of the patient's ability to cough and clear his airways? A. Tidal volume and vital capacity B. Vital capacity and negative inspiratory pressure C. Tidal volume and minute ventilation D. Minute ventilation and maximal inspiratory pressure Correct Answer B. Vital capacity and negative inspiratory pressure The patient must be able to pull air into his lungs to be able to perform a forcible cough. Being able to pull a significant negative (inspiratory) pressure and take a deep SA blocks, second-degree AV block type I, and third- degree AV heart block at the level of the AV node would occur in right coronary artery occlusion and inferior myocardial infarction rather than in this example of left coronary artery occlusion and anterolateral myocardial infarction. A 70-year-old woman, weighing 50 kg, comes to the emergency department complaining of chest pain and shortness of breath. The electrocardiogram monitor shows ventricular tachycardia at a rate of 150 beats/min. Which treatment is appropriate in this situation? A. Amiodarone IV B. Verapamil HCl IV C. Defibrillation beginning at 200 J D. Synchronized cardioversion beginning at 100 J Correct Answer D. Synchronized cardioversion beginning at 100 J Treatment for an unstable ventricular tachycardia is sedation and synchronized cardioversion beginning at 100 J. Amiodarone would be used in stable ventricular tachycardia. Verapamil is used for supraventricular tachycardias and would be inappropriate for ventricular tachycardia. Defibrillation is indicated if the patient is pulseless. An elderly patient is admitted with pneumonia. This morning he is febrile, tachycardic, tachypneic, and confused. He is started on norepinephrin. You would monitor him closely for which of the following? A. Hypotension B. Bradycardia C. Bronchospasm D. Abdominal pain Correct Answer D. Abdominal pain Norepinephrine stimulates predominantly α receptors but also stimulates β receptors. Monitor the patient closely for indications of excessive vasoconstriction and ischemia, such as acrocyanosis, chest pain, abdominal pain, and decreased urine output. A 54-year-old man has just returned to the critical care unit from the postanesthesia care unit. He has a 60-pack-year history of cigarette smoking and had a right lower lobectomy performed earlier yesterday for treatment of lung cancer. The nurse notes diminished breath sounds in the left posterior base. What would these findings most likely indicate? A. Pleurisy B. Pneumonia C. Atelectasis D. Presence of chest tube Correct Answer C. Atelectasis Diminished breath sounds indicate diminished air flow. Atelectasis is the logical choice. Pleurisy causes a pleural friction rub. Pneumonia causes bronchial breath sounds. The chest tube does not cause any specific breath sound, though there may be gurgling audible if the suction is not clamped during auscultation A 50-year-old patient is transferred to the critical care unit from the emergency department. A rattlesnake bit him approximately 6 hours ago. He is having a severe reaction to the venom, and antivenom is being flown to the hospital. The patient is bleeding from his IV insertion sites and continues to seep blood from the wound. Which of the following diagnostic panels is suggestive of disseminated intravascular coagulation (DIC)? A. Decreased platelets, decreased fibrinogen, prolonged prothrombin time (PT), prolonged activated partial thromboplastin time (aPTT), prolonged thrombin time, increased fibrin degradation products (FDPs) B. Increased platelets, increased fibrinogen, normal PT, aPTT, normal thrombin time, increased fibrin degradation products (FDPs) Bradycardia, dry mucous membranes, oliguria Correct Answer B. Hypotension, tachycardia, oliguria Tachycardia, hypotension, oliguria, dry mucous membranes, and poor skin turgor would all be indications of dehydration. Even though thirst may be an indication of dehydration, it is frequently not seen in elderly patients, which makes hypotension, tachycardia, oliguria preferred over thirst, tachycardia, dry mucous membranes. A patient has just returned from surgery after a carotid endarterectomy. Why is asking him to smile and checking for symmetry of facial movement important? A. To assess the patient's level of consciousness. B. To detect injury to the facial nerve. C. To detect injury to the trigeminal nerve. D. To assess the patient's degree of cooperativeness. Correct Answer B. To detect injury to the facial nerve. Cranial nerve VII is located in the operative area and may be injured during surgery. A patient develops diabetes insipidus after a craniotomy. Which group of findings would be most characteristic of diabetes insipidus? A. Oliguria, low serum osmolality, hyponatremia, and high urine specific gravity B. Polyuria, high serum osmolality, hypernatremia, and low urine specific gravity C. Oliguria, high serum osmolality, hypernatremia, and low urine specific gravity D. Polyuria, low serum osmolality, hyponatremia, and high urine specific gravity Correct Answer B. Polyuria, high serum osmolality, hypernatremia, and low urine specific gravity A patient 5 days after an acute inferior myocardial infarction suddenly complains of severe dyspnea and palpitations. The patient appears anxious and diaphoretic. While completing the assessment of the patient, a loud holosystolic murmur at the apex that radiates to the axilla is noted. The patient also has crackles throughout the lung field but an S3 at the apex is not audible. Which of the following is most likely to be descriptive of the pulmonary artery occlusive pressure (PAOP) in this patient? A. An elevated v wave and an overestimate of the left ventricular end-diastolic pressure (LVEDP) B. A dampened v wave and an underestimate of the LVEDP C. A normal v wave and an accurate reflection of the LVEDP D. An elevated v wave and a direct correlation to the pulmonary artery diastolic pressure Correct Answer A. An elevated v wave and an overestimate of the left ventricular end-diastolic pressure (LVEDP) What is the priority of management in respiratory acidosis? A. Improve alveolar ventilation by treating the cause of hypoventilation. B. Buffer the acid with sodium bicarbonate. C. Improve oxygenation by administering oxygen. D. Decrease anxiety to increase PaCO2 level. Correct Answer A. Improve alveolar ventilation by treating the cause of hypoventilation. A 77-year-old woman reports explosive diarrhea for 48 hours. She is extremely lethargic. Mucous membranes are dry and sticky, and the urine is dark amber with a specific gravity of 1.035. Vital signs are temperature 38.2° C orally; heart rate 130 beats/min and regular; respiratory rate 26 breaths/min and regular; and blood pressure 90/74 mm Hg. Which of the following is of the most immediate concern? ventricle, there will be a disproportionate increase in pressure with an increase in volume in a noncompliant ventricle. Remember that compliance is the change in pressure for a given change in volume. Use of volumetric parameters measured with a right ejection fraction catheter would allow measurement of volumes as a reflection of preload. Which of the following would not be associated with a false-positive result for an acute myocardial infarction using the total creatine kinase (CK)? A. Hypothyroidism B. Hemorrhagic stroke C. Cardioversion D. Ulcerative colitis Correct Answer D. Ulcerative colitis CK may be elevated by chronic alcoholism, cardioversion, strokes, hypothyroidism, intramuscular injections, skeletal muscle injury, and trauma. Which of the following is a manifestation of left atrial enlargement on the electrocardiogram? A. Increased amplitude of the P wave on a rhythm strip B. Wide, notched P waves in lead II on 12-lead electrocardiogram C. Diphasic P wave in lead V1 on 12-lead electrocardiogram D. Tall, peaked P waves in lead II on 12-lead electrocardiogram Correct Answer B. Wide, notched P waves in lead II on 12-lead electrocardiogram Nutrition is an important component of the therapeutic regimen for a patient with hepatic failure. Which of the following is characteristic of the therapeutic diet for the patient with hepatic failure? A. High in protein and calories B. Restricted in protein and potassium C. High in sodium and vitamins D. Restricted in carbohydrates and fats Correct Answer A. High in protein and calories The blood pH is a measure of which of the following? A. Ability of the lungs to eliminate carbon dioxide B. Ability of the kidneys to eliminate nonvolatile acids C. The hydrogen ion concentration in the blood D. The balance between carbonic acid and hydrogen ions Correct Answer C. The hydrogen ion concentration in the blood The blood pH is an indirect and inverse measurement of the hydrogen ion concentration. If the pH goes up (i.e., alkalosis), the hydrogen concentration is down. If the pH goes down (i.e., acidosis), the hydrogen concentration is up. Blood pH is a reflection of the balance between carbonic acid (acid regulated by the lungs) and bicarbonate (base regulated by the kidneys) A 45-year-old woman is admitted with deep venous thrombosis and pulmonary embolism. She has received a heparin bolus and has been on a continuous heparin drip for 3 days. If the patient develops heparin-induced thrombocytopenia (HIT), what clinical sign would the nurse expect to see first? A. Surface bleeding from wounds and IV sites B. Hematuria C. Petechiae D. Bleeding from gums Correct Answer C. Petechia