Evidence-Based Practice in Critical Care Nursing, Exams of Nursing

Download Evidence-Based Practice in Critical Care Nursing and more Exams Nursing in PDF only on Docsity! Exam 1 - Module 1 (TextBank) A nurse is the only one in the ICU who has not achieved certification in critical care nursing. She often will ask her fellow nurses what to do in caring for a patient because she doubts the accuracy of her knowledge and her intuition. She loves her work but wishes she could do it with a greater level of competence. What is the most important effect that obtaining certification would likely have on the nurses practice? A) Recognition by peers B)Increase in salary and rank C)More flexibility in seeking employment D)Increased confidence in making decisions - D)Increased confidence in making decisions A hospital interviews two different candidates for a position in the ICU. Both candidates have around 10 years of experience working in the ICU. Both have excellent interpersonal skills and highly positive references. One, however, has certification in critical care nursing. Which of the following is the most compelling and accurate reason for the hospital to hire the candidate with certification? A)The certified nurse will have more knowledge and expertise. B)The certified nurse will behave more ethically. C)The certified nurse will be more caring toward patients. D)The certified nurse will work more collaboratively with other nurses. - A)The certified nurse will have more knowledge and expertise. A nurse is caring for an elderly man recently admitted to the ICU following a stroke. She assesses his cognitive function using a new cognitive assessment test she learned about in a recent article in a nursing journal. She then brings a cup of water and a straw to the patient because she observes that his lips are dry. Later, she has the patient sit in a wheelchair and takes him to have some blood tests performed. He objects at first, saying that he can walk on his own, but the nurse explains that it is hospital policy to use the wheelchair. That evening, she recognizes signs of an imminent stroke in the patient and immediately pages the physician. Which action taken by the nurse is the best example of evidence-based practice? A)Giving the patient a cup of water B)Transferring the patient in a wheelchair C)Using the cognitive assessment test D)Recognizing signs of imminent stroke and paging the physician - C)Using the cognitive assessment test A nurse is on a committee that is trying to reduce the occurrence of hospital-acquired infections in the ICU. Her role is to conduct research to find which interventions have been shown to be most effective in reducing these infections. She consults many different sources and finds conflicting information. Which of the following sources should she consider the most authoritative? A)AACN expert panel report B)A meta-analysis of randomized controlled trials in the American Journal of Nursing C)A systematic review of qualitative studies in the Journal of Advanced Nursing D)A single randomized controlled trial in the American Journal of Critical Care - B)A meta-analysis of randomized controlled trials in the American Journal of Nursing A nurse who has been recently hired to manage the nursing staff of the ICU is concerned at the lack of evidence-based practice she sees among the staff. Which of the following would be the best step for her to take to promote incorporating evidence into clinical practice? A)Only hire nurses certified in critical care nursing. B)Leave copies of several different nursing journals in the nurses lounge. C)Demonstrate to the staff the best nursing-related search terms to use in Google or Yahoo! D)Introduce the staff to the PubMed search engine and assign them topics to research on it. - D)Introduce the staff to the PubMed search engine and assign them topics to research on it. A physician visits a patient in the ICU while the nurse is out. The patient complains that the pain medication is not effective and that he would like to receive an increased dose. The physician has the nurse paged and consults with him in the hallway regarding the patients request for stronger pain medication. The nurse explains that patient was started on a morphine drip only 20 minutes ago and that the drug has not had time to take effect yet. The physician agrees and tells the patient to give it just a bit more time. Which component of a healthy work environment is most evident in this scenario? A)Skilled communication B)Appropriate staffing C)True collaboration D)Meaningful recognition - C)True collaboration A nurse in the ICU is responding to a patient who has just gone into cardiac arrest. A moment later, the nurse is notified that another patient has just gone into anaphylactic shock due to a drug allergy. She is conflicted as to what to do, as she is the only nurse available at the moment to tend to both patients. Which component of a healthy work environment is lacking in this scenario? A)Effective decision making B)Appropriate staffing C)Authentic leadership D)Meaningful recognition - B)Appropriate staffing An ICU nurse has provided excellent care for a 6-year-old girl who had been admitted to the ICU for a head injury. The nurse was attentive not only to the needs of the patient but also went out of her way to care for the needs of the girls family. According to research, which of the following forms of recognition would the nurse value the most? A)A card from the girls family B)A plaque from the ICU physicians naming her as Nurse of the Year C)A letter of commendation from the hospitals administration D)A bouquet of flowers from her supervisor - A)A card from the girls family A)Adherence to procedures by nursing staff B)Clarity of interdisciplinary communication C)Number of new employees on the unit D)Changes in administration procedures - B)Clarity of interdisciplinary communication A critical care unit has decided to implement several measures designed to improve intradisciplinary and interdisciplinary collaboration. In addition to an expected improvement in patient outcomes, what is the most important effect that should result from these measures? A)Identification of incompetent practitioners B)Improvement in manners on the unit C)Increased staff retention D)Less discussion in front of patients and families - C)Increased staff retention A nurse wishes to practice using the Synergy Model developed by the American Association of Critical-Care Nurses (AACN). What nursing behavior best supports use of this model? A)Attending mandatory hospital-wide in-service programs B)Self-directed study of best practice for the patients she cares for C)Gathering demographic data on the patients admitted to the unit D)Participating in a research study as a data collector - B)Self-directed study of best practice for the patients she cares for As part of the Synergy Model, the nurse has identified a patient characteristic of resiliency. What patient behavior demonstrates resiliency? A)Dysfunctional grieving behaviors after receiving bad news B)Developing a list of questions for the physician C)Denial of any possible negative outcomes for a procedure D)Assigning blame to others for undesired outcomes of illness - B)Developing a list of questions for the physician A patient is admitted to the critical care unit after receiving a mechanical heart implantation. In making a nursing assignment, the charge nurse best demonstrates application of the Synergy Model by assigning which nurse to care for this patient? A)A newly hired new graduate nurse, for the experience B)A nurse with a patient in the next room, for proximity C)The most senior nurse on the unit, for political reasons D)The nurse with most experience with this device, for expertise - D)The nurse with most experience with this device, for expertise A Muslim patient has been admitted to the critical care unit with complications after childbirth. Based on the Synergy Model, which nurse would be the most inappropriate to assign to care for this patient? A)New graduate female nurse B)Most experienced female nurse C)New graduate male nurse D)Female nurse with postpartum experience - C)New graduate male nurse Todays critical care nursing environment is constantly changing. What nursing behavior best illustrates awareness of current events affecting critical care nursing? A)Participating in the hospitals efforts to recruit new nurses B)Volunteering to serve on a disaster response planning committee C)Adhering to content taught in basic nursing program D)Attending hospital-mandated in-services without other education - B)Volunteering to serve on a disaster response planning committee The critical care unit environment is very stressful for patients, families, and staff. What nursing action is directed at reducing environmental stress? A)Constant evaluation of patient status B)Limiting visits to immediate family C)Bathing all patients during hours of sleep D)Maintaining quiet during hours of sleep - D)Maintaining quiet during hours of sleep A patient is transferred to the ICU from the Birth Center of the hospital in the middle of the night after experiencing complications during delivery of her baby. The patients husband is anxious and explains to the ICU nurse that he doesn't understand why his wife has been moved to the ICU. She is going to die, isn't she? he asks the nurse. What is the nurses best response? A)Explain that every measure will be taken to provide his wife with the best care possible. B)Explain that the nurse is fully trained and has years of experience. C)Offer the husband a place to relax. D)Have appropriate staff discuss his health insurance with him. - B)Explain that the nurse is fully trained and has years of experience. A patient is admitted to the ICU with injuries sustained from a fall from a third-story window. The patient is conscious, his breathing is labored, and he is bleeding heavily from the abdomen. He groans constantly and complains of severe pain, but his movements are minimal. His heart rate is elevated. Which of these is a sign that he is in the second phase of the stress response? Select all that apply. A)Bleeding heavily from his abdomen B)Labored, slow breathing C)Severe pain D)Elevated heart rate E)Minimal movement - C)Severe pain E)Minimal movement A patient in the ICU is recovering from open-heart surgery. The nurse enters his room and observes that his daughter is performing effleurage on his arms and talking in a low voice about an upcoming family vacation that is planned. The room is dimly lit, and she hears the constant beeping of his heart monitor. From the hall she hears the cries of a patient in pain. Which of the following are likely stressors for the patient? Select all that apply. A)His daughters conversation B)His daughters effleurage C)The beeping of the heart monitor D)The dim lighting of the room E)The cries of the other patient from the hall - C)The beeping of the heart monitor E)The cries of the other patient from the hall A patient in the ICU is complaining that he is not sleeping well at night because of anxiety. Which of the following would be the most helpful intervention for the nurse to make? A)Provide the patient with a bath immediately following his first 90-minute REM sleep cycle. B)Increase the patients pain medication. C)Provide the patient with 5 minutes of effleurage and then minimize disruptions. D)Monitor the patients brain waves by polysomnography to determine his sleep pattern. - C)Provide the patient with 5 minutes of effleurage and then minimize disruptions. A nurse walks into a patients room and begins preparing a syringe to perform a blood draw on the patient. The nurse observes that the patient is firmly gripping the side of the bed, averting her eyes, and sweating from her forehead when she sees the needle. What would be the best intervention for the nurse to make? A)Proceed with blood draw as quickly as possible, to get it over with. B)Offer to come back later to perform the blood draw. C)Encourage the patient to deep breathe. D)Describe briefly the blood draw procedure and explain why it is necessary. - D)Describe briefly the blood draw procedure and explain why it is necessary. A 15-year-old boy is in the ICU and preparing for an appendectomy. He is clearly anxious and fidgets with his IV constantly. He complains that he doesnt want to be there and he is sick of everyone telling him what to do. What would be the best way for the nurse to address this patients anxiety? A)Use physical restraints to keep him from pulling out his IV. B)Offer him the remote to the television. C)Lower the head of his bed so that he can rest more easily. D)Explain to the patient in detail what the appendectomy will consist of. - B)Offer him the remote to the television. A nurse in a burn unit observes that a patient is tensed up and frowning but silent. The nurse asks the patient, Can you tell me what you are thinking now? The patient responds, "I cant take this pain any more! I feel like I'm about to die. What would be the best response for the nurse to give to the patient, considering that the patient is already receiving the maximum amount pain medication that is safe?" A)Try to get rid of those negative thoughts they only make it worse. B)Try thinking instead, This pain will go away; I can overcome it. C)Maintaining eye contact with the patient during explanations D)Focusing on specific nursing care tasks while in the patients room - C)Maintaining eye contact with the patient during explanations The nurse is caring for a critically ill patient who can speak. The nurse notices that the patient is demonstrating behaviors indicative of anxiety but is silent. What nursing strategy would give the nurse the most information about the patients feelings? A)Explain procedures to the patient and family. B)Ask the patient to share his or her internal dialogue. C)Encourage the patient to nap before visiting hours. D)Ensure that the patient has adequate pain control. - B)Ask the patient to share his or her internal dialogue. The patient is undergoing a necessary but painful procedure that is greatly increasing her anxiety. The nurse decides to use guided imagery to help alleviate the patients anxiety. What is a key part of this technique? A)Provide the patient with an external focus point such as a picture. B)Have the patient take slow, shallow breaths while staring at a focus point. C)Have the patient remember tactile sensations of a pleasant experience. D)Encourage the patient to consciously relax all of her muscles. - C)Have the patient remember tactile sensations of a pleasant experience. One of the strategies shown to reduce perception of stress in critically ill patients and their families is support of spirituality. What nursing action is most clearly supportive of the patients spirituality? A)Referring patients to the Catholic chaplain B)Providing prayer booklets to patients and families C)Asking about beliefs about the universe D)Avoiding discussing religion with those of other faiths - C)Asking about beliefs about the universe A critically ill patient tells the nurse that he is not afraid to die because he believes in reincarnation. What is the most appropriate nursing response? A)What if reincarnation is not real? B)This belief gives you strength. C)I don't believe in reincarnation. D)You shouldn't base your hopes on such a belief. - B)This belief gives you strength. A critically ill patient who is intubated and agitated is restrained with soft wrist restraints. Based on research findings, what is the best nursing action? A)Maintain the restraints to protect patient safety. B)Remove the restraints periodically to check skin integrity. C)Remove the restraints periodically for range of motion. D)Assess and intervene for causes of agitation. - D)Assess and intervene for causes of agitation. An elderly man whose wife has just been admitted to the ICU following congestive heart failure is concerned about how passage of the Affordable Care Act will impact the care of his wife. Which of the following are expected outcomes of this legislation that it would be appropriate for the nurse to share with the man? Select all that apply. A)The new legislation will result in a shortage of experienced critical care nurses. B)The new legislation will require health care workers to meet higher quality standards related to patient care. C)The new legislation will make it more challenging to meet the educational goals of patients and families. D)The new legislation will increase the length of stay of patients in the hospital. E)The new legislation will shift the payment structure for hospitals and health care providers from a traditional fee-for-service model to an incentive model. - B)The new legislation will require health care workers to meet higher quality standards related to patient care. E)The new legislation will shift the payment structure for hospitals and health care providers from a traditional fee-for-service model to an incentive model. A young couple whose 5-year-old daughter has been admitted to the ICU approaches the nurse with looks of concern on their faces. They express frustration to the nurse that they have not been able to speak with either the physician or the surgeon and are confused as to what the next steps are for their daughters treatment. What would be the best intervention for the nurse to make in this situation? A)Offer to get ice chips for the couple to give to their daughter to empower them. B)Make sure that they have the cell phone numbers of the physician and surgeon. C)Teach the couple about the pathophysiology of the daughters disease. D)Arrange a patient care conference with the couple and the health care team. - D)Arrange a patient care conference with the couple and the health care team. A nurse sees a group of physicians who are making teaching rounds in the hall of the ICU heading toward the room of one of her patients. The patient, who currently has a visitor, has given approval in the past to have teaching groups visit. What should the nurse do in this situation? A)Explain to the group of physicians that the patient currently has a visitor and ask whether they could come by later. B)Ask the visitor to leave so that the teaching group can discuss the patients case. C)Allow the teaching group to enter the patients room, as he has already given approval for them to visit. D)Instruct the physicians to give clear explanations of the medical jargon they use. - A)Explain to the group of physicians that the patient currently has a visitor and ask whether they could come by later. The nurse is working with a patient from India who is recovering from a myocardial infarction. When the nurse asks the patient whether she has had a myocardial infarction before, the patient seems confused and appears not to understand the nurse, although the patient does speak English. Which of the 4 Cs of Culture should the nurse use to better communicate with this patient? A)Call B)Cause C)Cope D)Concern - A)Call A nurse needs to obtain informed consent from a deaf patient before a spinal tap procedure is performed. Which of the following would be the best method for the nurse to use to ensure effective communication? A)Explain the procedure verbally, speaking slowly so that the patient can read lips. B)Have a trained oral interpreter interpret for the nurse. C)Have the patient carefully read a printed copy of the informed consent document. D)Use diagrams to explain to the patient the details of the procedure. - B)Have a trained oral interpreter interpret for the nurse. A nurse is explaining to a patient how radiation therapy works to kill cancer cells. She begins by explaining how there are different types of cells in the body that reproduce at different rates. She then explains what cancer cells are and how they reproduce. Finally, she explains how radiation therapy uniquely targets cancer cells. This approach takes advantage of which domain of learning? A)Affective B)Psychomotor C)Cognitive D)Demonstration/return demonstration - C)Cognitive A young man is recovering from anaphylactic shock caused by a bee sting. The nurse is trying to instruct the patient on how to use an epinephrine autoinjector (EpiPen), but the patient seems uninterested in learning. The nurse then explains how having the EpiPen with him at all times and knowing how to use it could not only save his life someday but also will give him a greater sense of security and safety. Which adult learning principle is the nurse using? Select all that apply. A)The learners self-concept B)The learners life experience C)Readiness to learn D)Motivation to learn E)The need to know - D)Motivation to learn E)The need to know In attempting to teach a patient how to clean around the surgical sutures on his abdomen upon discharge to home, the nurse determines that applying the principle of the learners self-concept would be most effective with this patient. Which of the following is the best example of an application of that principle in this situation? A)Relating to the patient a story about another patient who failed to properly clean his sutures and the outcome B)Explaining that failure to properly clean around the suture site could result in serious infection B)Affective C)Psychomotor D)Educative - C)Psychomotor The nurse is teaching a patient newly diagnosed with cardiovascular disease how to reduce risk factors. The nurse begins by explaining why this information is important for the patient. What principle of adult learning is the nurse applying? A)Need to know B)Learners self-concept C)Learners life experience D)Motivation to learn - A)Need to know The nurse is teaching a group of patients newly diagnosed with cardiovascular disease. What action demonstrates application of the adult learning principle of learners life experience? A)Beginning with an explanation of why the material is important B)Creating a learning situation that is self-directed and independent C)Using case scenarios and problem-solving exercises D)Applying content to real-life situations and actions - C)Using case scenarios and problem-solving exercises The nurse is assessing learning by a critically ill patient and family. What is the best method of assessment? A)Written test B)Specific questions C)Open-ended questions D)Literacy assessment - C)Open-ended questions A nurse working in the ICU of a rural hospital is trying to make the case to the administration to create an RRT for the hospital. There have been a number of preventable deaths at the hospital recently. Which case provides the best support for the nurses argument that the hospital needs such a team? A)A patient died of cardiac arrest because medical staff did not respond quickly enough to his condition. B)A patient died of an overdose of medication due to a medication error. C)A patient died of an infection after a surgeon failed to scrub in properly before surgery. D)A patient died from head trauma after slipping on a wet surface in her room in the ICU - A)A patient died of cardiac arrest because medical staff did not respond quickly enough to his condition. An RRT has just been created at a hospital. An RN from the ICU has been appointed as the leader and is planning a training session for other members of the RRT. Which topics would be appropriate to include in the training? Select all that apply. A)The benefits of early rescue B)Triage skills and advanced cardiac life support C)Equipment needed for air transport of a patient between facilities D)Expectations of RRT members when responding to a call E)EMTALA guidelines for requirements for evaluating a patients suitability for transfer F)Guided imagery to assist patients dealing with severe pain - A)The benefits of early rescue B)Triage skills and advanced cardiac life support D)Expectations of RRT members when responding to a call A patient must be transferred from one hospital to another due to lack resources at the sending hospital needed by the patient. Which of the following conditions would incline the transport team of the hospital to choose ground transport as opposed to air? Select all that apply. A)Heavy rainfall is in the area. B)The hospitals are 20 miles apart. C)The patient needs a time-sensitive intervention. D)Traffic on the ground is minimal. - A)Heavy rainfall is in the area. B)The hospitals are 20 miles apart. D)Traffic on the ground is minimal. A patient with a spine injury is being transferred to another hospital. What special intervention should the nurse make to prepare the patient for air transport? A)Stabilize the patients back with a back board. B)Send the patients medical chart with him. C)Contact the receiving hospital to confirm that they have a bed for him. D)Conduct preflight screen for patient fear or anxiety related to flying - D)Conduct preflight screen for patient fear or anxiety related to flying The medical director of hospital has received several requests for patient transfers to other facilities. Based on the Emergency Medical Transfer Active Labor Act, which of the following cases would justify interfacility transfer? Select all that apply. A)A patient requires emergency coronary angioplasty and the sending hospital is not equipped to perform this service. B)The family of a patient severely injured in a car wreck in another state requests that the patient be transferred to a facility where they live. C)The administration of the hospital requests that a patient who lacks health insurance be transferred to a facility that can better absorb the cost of his care. D)A surgeon at the receiving hospital has unique experience performing a procedure that the patient requires. - A)A patient requires emergency coronary angioplasty and the sending hospital is not equipped to perform this service. B)The family of a patient severely injured in a car wreck in another state requests that the patient be transferred to a facility where they live. D)A surgeon at the receiving hospital has unique experience performing a procedure that the patient requires. A Medicare patient who has been in the ICU for 6 weeks is being transferred to a larger facility that can better support the costs of her care. The medical director at the sending hospital weighs the pros and cons of ground versus air transport and opts for air transport because of the long distance between the two hospitals. The receiving hospital is contacted, and approval is given to transfer the patient. The nurse attending the patient works with the transport team to make sure that all medical devices needed by the patient are available during the flight. The physician at the receiving hospital is waiting for the patient as soon as she arrives. Which part of the transfer plan failed in this situation? A)Determination of the appropriateness of the transfer B)Selection of mode of transport C)Communication between the sending and receiving hospitals D)Collaboration among health care team members at the sending hos - A)Determination of the appropriateness of the transfer The medical director of a hospital must decide whether to transfer a heart transplant patient by ground or air transport to another facility that can provide the care the patient needs. Which of the transfer is this decision made in? A)Phase one: Notification and acceptance by receiving facility B)Phase two: Preparation of the patient by the transport team C)Phase three: The transport process D)Phase four: Turnover of the patient to the receiving facility - A)Phase one: Notification and acceptance by receiving facility A patient is being prepared for transfer to another facility via air transport (phase two of transfer). Which of the following is a role of the transport nurse at this time? A)Suggest ground transport for the patient, as the receiving hospital is not far away. B)Screen the patient for fear or anxiety of flying. C)Call in an updated report on the patients status to the RN on the receiving unit. D)Delivery of patient belongings to the receiving staff. - B)Screen the patient for fear or anxiety of flying. A nurse in the ICU participates in an evaluation of a recent patient transport. In which phase of patient transfer does this occur? A)Phase two: Preparation of the patient by the transport team B)Phase three: The transport process C)Phase four: Turnover of the patient to the receiving facility D)Phase five: Post-transport continuous quality improvement monitoring - D)Phase five: Post-transport continuous quality improvement monitoring The transport nurse is accompanying her patient in transit by helicopter from one facility to another. Which of the following is an intervention the nurse would most likely be making at this time? A)Contacting the RN on the receiving unit to note a change in the patients vital signs B)Administering antiemetic medication to the patient to prevent air sickness C)Endotracheal intubation A)Two large-bore intravenous lines B)A cardiac defibrillator C)A cervical collar D)Supplemental oxygen therapy - C)A cervical collar A patient with severe blood loss from a motor vehicle crash is being transported by air transport for definitive care. During phase two of the transfer, what is the most important nursing action? A)Determine the route and method for transport. B)Evaluate the patient outcome after transport. C)Verify that the receiving facility will accept the patient. D)Start at least two large-bore intravenous lines. - D)Start at least two large-bore intravenous lines. A nurse is working with multiple heart patients in the critical care unit. What information in the patients charts would indicate intra-aortic balloon pump (IABP) counter pulsation? Select all that apply. A) Cardiogenic shock subsequent to acute myocardial infarction B) Low cardiac output following cardiac surgery C) Unstable angina D) Congestive heart failure and an incompetent aortic valve E) Severe peripheral vascular disease F) Aortic Aneurysm - A) Cardiogenic shock subsequent to acute myocardial infarction B) Low cardiac output following cardiac surgery C) Unstable angina A patient with cardiac failure is being prepped to receive a ventricular assist device for circulatory support. What procedure should the nurse expect the patient to undergo in the future? A) Intra-aortic balloon pump counter pulsation B) Heart transplantation C) Coronary artery bypass graft surgery D) Percutaneous transluminal coronary angioplasty - B) Heart transplantation A nurse working with a patient with a Novacor ventricular assist device (VAD) for longterm circulatory support recognizes that this patient is at risk for thromboembolic events. Which of the following is the best intervention for this patient? A) Heparin infusions indefinitely B) Warfarin therapy initially, which is gradually replaced by heparin infusions C) Warfarin therapy indefinitely D) Heparin infusions initially, which is gradually replaced by warfarin therapy - D) Heparin infusions initially, which is gradually replaced by warfarin therapy What should the nurse include in the plan of care for a patient being prepared for electrical cardioversion? Select all that apply. A) Obtain informed consent from the patient. B)Encourage the patient to eat a meal shortly before the procedure. C) Record a 12lead ECG and vital signs. D) Turn off the synchronizer mode button. E) Smear electrode gel between the two paddles on the chest. F) Sedate the patient. - A) Obtain informed consent from the patient. C) Record a 12lead ECG and vital signs. F) Sedate the patient. A nurse is caring for a patient during radiofrequency ablation. What nursing interventions would most likely put the patient at ease? A) Communicating with the patient about the progress of the procedure B) Connecting the patient to a cardiac monitor C) Placing a lead apron under the patients lower back D) Establishing a sterile field - A) Communicating with the patient about the progress of the procedure A patient is being evaluated for possible permanent pacemaker implantation. Which of the following would be the best indication for permanent pacemaker implantation in this patient? A) Myotonic muscular dystrophy with any degree of atrioventricular (AV) block B) Asymptomatic sinus node dysfunction C) Chronic, intermittent complete (bifascicular) heart block D)Transient AV block after acute myocardial infarction (MI) - C) Chronic, intermittent complete (bifascicular) heart block A patient requires a pacemaker that will pace his atria, sense electrical activity in his atria, and inhibit the response to sensed events. Which mode of pacemaker would he need? A) ADD B) VVI C) AAI D) VDD - C) AAI A patient who had a transvenous pacemaker placed in the subclavian vein 24 hours ago is experiencing pleuritic pain, hypotension, and respiratory distress. What complication does the nurse suspect in this patient? A) Perforation of ventricular wall B) Pneumothorax C) Lead dislodgment D) Phlebitis - B) Pneumothorax A patient is experiencing a malfunction with his permanent implanted pacemaker, and the nurse is examining his electrocardiogram strip. The patients pacemaker has a ventricular unipolar catheter and is in VVI mode. Which of the following findings should the nurse be most concerned about? A)Pacing spikes absent B) Pacing spike followed by a QRS complex C) Tall pacing spikes D) A narrow QRS - A)Pacing spikes absent What information should the nurse include when teaching a patient with incessant ventricular fibrillation who is being considered for an implantable cardioverter-defibrillator (ICD)? A) An ICD would be beneficial for this patient. B) An ICD would be reasonable to consider for this patient. C) An ICD may be considered but is questionable for this patient. D) An ICD would not be useful and may even be harmful for this patient. - D) An ICD would not be useful and may even be harmful for this patient. The physician has ordered fibrinolytic agents for a patient with coronary artery disease. What patient diagnosis would the nurse most expect? A) Posterior wall acute myocardial infarction B) Acute coronary syndrome without ST segment elevation C) Acute ST segment elevation myocardial infarction D) New onset of right bundle branch block - C) Acute ST segment elevation myocardial infarction The patient is receiving an intravenous drip of lidocaine hydrochloride to suppress ventricular arrhythmias. During repositioning of the patient, the intravenous tubing is dislodged from the pump and the patient receives a bolus of approximately 300 mg. The nurse stops the drip temporarily. What is the best nursing action to take next? A) Observe closely for hallucinations and hypotension. B) Reconnect drip at ordered rate per minute. C) Administer intravenous magnesium sulfate. D) Complete unusual occurrence report form. - A) Observe closely for hallucinations and hypotension. A patient calls emergency services with complaints of crushing chest and left shoulder pain. He should be instructed to: A) Take 325 mg acetaminophen. B) Take 325 mg of aspirin. C) Take an antacid. D) Drive to the ED. - B) Take 325 mg of aspirin.