Nursing Elites

1. A nurse caring for several patients in the cardiac unit is told that one is scheduled for implantation of an automatic internal cardioverter-defibrillator. Which of the following patients is most likely to have this procedure?

• A. A patient admitted for myocardial infarction without cardiac muscle damage.
• B. A postoperative coronary bypass patient, recovering on schedule.
• C. A patient with a history of ventricular tachycardia and syncopal episodes.
• D. A patient with a history of atrial tachycardia and fatigue.

Correct answer: C

Rationale: The correct answer is a patient with a history of ventricular tachycardia and syncopal episodes. An automatic internal cardioverter-defibrillator is used to deliver an electric shock to the heart to terminate episodes of ventricular tachycardia and ventricular fibrillation. These patients are at high risk of life-threatening arrhythmias, which may result in syncope. Patients with atrial tachycardia and fatigue (Choice D) would not typically require an implantable cardioverter-defibrillator as their primary issue is related to atrial arrhythmias. Patients who have had a myocardial infarction without cardiac muscle damage (Choice A) or postoperative coronary bypass patients recovering on schedule (Choice B) are not necessarily at high risk for ventricular arrhythmias and would not be the primary candidates for an implantable cardioverter-defibrillator.

2. A 33-year-old male client with heart failure has been taking furosemide for the past week. Which of the following assessment cues below may indicate the client is experiencing a negative side effect from the medication?

• A. Weight gain of 5 pounds
• B. Edema of the ankles
• C. Gastric irritability
• D. Decreased appetite

Correct answer: D

Rationale: The correct answer is 'Decreased appetite.' Furosemide is a loop diuretic used for conditions like heart failure, where it helps reduce fluid retention. One common side effect of furosemide is hypokalemia, which can lead to decreased appetite among other symptoms. Hypokalemia is a low level of potassium in the blood, and its signs and symptoms include anorexia, fatigue, nausea, decreased GI motility, muscle weakness, dysrhythmias, reduced urine osmolality, and altered level of consciousness. Weight gain and ankle edema are actually expected outcomes of furosemide therapy due to its diuretic effect, which helps reduce edema and fluid overload. Gastric irritability is a nonspecific symptom that is not typically associated with furosemide use. Therefore, a decreased appetite is a key indicator of a potential negative side effect when assessing a client on furosemide therapy.

3. A patient with idiopathic pulmonary arterial hypertension (IPAH) is receiving nifedipine (Procardia). Which assessment would best indicate to the nurse that the patient's condition is improving?

• A. Blood pressure (BP) is less than 140/90 mm Hg.
• B. Patient reports decreased exertional dyspnea
• C. Heart rate is between 60 and 100 beats/minute
• D. Patient's chest x-ray indicates clear lung fields

Correct answer: B

Rationale: The correct answer is for the patient to report decreased exertional dyspnea. In idiopathic pulmonary arterial hypertension (IPAH), exertional dyspnea is a significant symptom indicating disease severity. Improvement in this symptom suggests that the medication, nifedipine, is effective in managing the condition. While nifedipine can affect blood pressure (choice A) and heart rate (choice C), these parameters are not specific indicators for monitoring IPAH improvement. Choice D, clear lung fields on the chest x-ray, does not directly correlate with the effectiveness of therapy for IPAH. Therefore, the most relevant assessment to monitor improvement in a patient with IPAH receiving nifedipine is a decrease in exertional dyspnea.

4. A client is brought into the emergency room where the physician suspects that he has cardiac tamponade. Based on this diagnosis, the nurse would expect to see which of the following signs or symptoms in this client?

• A. Fever, fatigue, malaise
• B. Hypotension and distended neck veins
• C. Cough and hemoptysis
• D. Numbness and tingling in the extremities

Correct answer: B

Rationale: Cardiac tamponade occurs when fluid or blood accumulates in the pericardium, preventing the heart from contracting properly. This leads to decreased cardiac output and is considered a medical emergency. Classic signs of cardiac tamponade include hypotension (low blood pressure) and distended neck veins due to the increased pressure around the heart. These signs result from the compromised ability of the heart to pump effectively. Choices A, C, and D are not typically associated with cardiac tamponade. Fever, fatigue, and malaise are non-specific symptoms that can be seen in various conditions. Cough and hemoptysis are more commonly associated with respiratory conditions, while numbness and tingling in the extremities are neurological symptoms not typically seen in cardiac tamponade.

5. A patient in the emergency room has a fractured left elbow and presents with an unequal radial pulse, swelling, and numbness in the left hand after waiting for 5 hours. What is the nurse's priority intervention?

• A. Place the patient in a supine position
• B. Ask the patient to rate his pain on a scale of 1 to 10.
• C. Wrap the fractured area with a snug dressing
• D. Start an IV in the other arm.

Correct answer: D

Rationale: The correct answer is to start an IV in the other arm. In this scenario, the patient is showing signs of Acute Compartment Syndrome, a serious condition that occurs due to increased pressure within a muscle compartment, leading to decreased blood flow and potential tissue damage. Starting an IV is crucial as the patient may require emergency surgery, such as a fasciotomy, to relieve the pressure and prevent further complications. Placing the patient in a supine position, asking about pain levels, or wrapping the fractured area, though important, are not the priority interventions in this critical situation where immediate medical intervention is necessary to prevent irreversible damage or loss of limb.

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