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yolo1017 yolo1017
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6 years ago
A patient's bedside ECG strips show the following changes
 
  increased PR interval; increased QRS width; and tall, peaked T waves. Vital signs are T 98.2  F; HR 118 beats/min; BP 146/90 mm Hg; and RR 18 breaths/min. The patient is receiving the following medications: digoxin 0.125 mg PO every day; D51/2 normal saline with 40 mEq potassium chloride at 125 mL/hr; Cardizem at 30 mg PO q8h; and aldosterone at 300 mg PO q12h. The physician is notified of the ECG changes. What orders should the nurse expect to receive?
 
  a. Change IV fluid to D51/2 normal saline and draw blood chemistry.
  b. Give normal saline with 40 mEq of potassium chloride over a 6-hour period.
  c. Hold digoxin and draw serum digoxin level.
  d. Hold Cardizem and give 500 mL normal saline fluid challenge over a 2-hour period.

Question 2

Diaphragmatic excursion is a measurement of the difference in the level of the diaphragm on inspiration and expiration determined by percussion. It is increased in
 
  a. atelectasis and emphysema.
  b. hepatomegaly and ascites.
  c. atelectasis and paralysis.
  d. pneumonia and pneumothorax.

Question 3

A patient was admitted to the critical care unit after a left pneumonectomy. The patient is receiving 40 oxygen via a simple facemask. The morning chest radiography study reveals right lower lobe pneumoni
 
  a. After eating breakfast, the patient suddenly vomits and aspirates. The patient becomes agitated, has decreased level of consciousness, and has an inability to maintain saturation. The nurse expects the next action will include
 
  a. placing the patient on a mechanical ventilator.
  b. change in antibiotics to control infection.
  c. suctioning and repositioning.
  d. administering a sedative to control anxiety.

Question 4

A patient is admitted to the ICU after a positive exercise treadmill test with a diagnosis of CAD and stable angin
 
  a. Radiographic test show that the patient has blockage in the left main coronary artery and four other vessels. The nurse anticipates that the patient will be scheduled for
 
  a. medical therapy antianginal medications.
  b. PCI.
  c. TAVR.
  d. CABG.

Question 5

Preset positive pressure used to augment the patient's inspiratory effort is known as
 
  a. positive end-expiratory pressure (PEEP).
  b. continuous positive airway pressure (CPAP).
  c. pressure control ventilation (PCV).
  d. pressure support ventilation (PSV).

Question 6

A client just involved in a motor vehicle accident has sustained blunt chest trauma as part of his injuries
 
  The nurse assessment reveals absent breath sounds in the left lung field. A left-sided pneumothorax is suspected and is further validated when assessment of the trachea reveals
 
  a. a shift to the right.
  b. a shift to the left.
  c. no deviation.
  d. subcutaneous emphysema.

Question 7

A critically injured patient can be aroused only by vigorous and continuous external stimuli. The patient's level of consciousness is considered
 
  a. lethargic.
  b. obtunded.
  c. stuporous.
  d. comatose.
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wrote...
6 years ago
The answer to question 1

A
The electrocardiographic (ECG) changes are most consistent with hyperkalemia. Removing the potassium from the intravenous line and drawing laboratory values to check the potassium level is the best choice with the least chance of further harm. Digoxin toxicity can be suspected related to the prolonged PR interval, but hyperkalemia explains all the ECG changes. The patient is not hypotensive or bradycardic, so holding the Cardizem is not indicated.

The answer to question 2

C
Normal diaphragmatic excursion is 3 to 5 cm and is part of the percussion component of the physical examination. An assessment finding other than normal would indicate the need for further evaluation such as chest radiographic examination.

The answer to question 3

A
Nursing interventions include optimizing oxygenation and ventilation, preventing the spread of infection, providing comfort and emotional support, and maintaining surveillance for complications.

The answer to question 4

D
Early studies demonstrated coronary artery bypass graft surgery was more effective than medical therapy for improving survival in patients with left main or three-vessel coronary artery disease and at relieving anginal symptoms. Medical therapy is recommended if the ischemia is prevented by antianginal medications that are well tolerated by the patient. Surgical revascularization has been shown to be more efficacious than percutaneous coronary intervention in patients with multivessel or left main coronary disease. Transcatheter aortic valve replacement is a transformational therapy for patients who have severe aortic stenosis but who are extremely high-risk surgical candidates or who are inoperable by virtue of associated co-morbidities.

The answer to question 5

D
Preset positive pressure used to augment the patient's inspiratory efforts is known as pressure support ventilation. With continuous positive airway pressure, positive pressure is applied during spontaneous breaths; the patient controls rate, inspiratory flow, and tidal volume. Positive end-expiratory pressure is positive pressure applied at the end of expiration of ventilator breaths.

The answer to question 6

A
With a pneumothorax, the trachea shifts to the opposite side of the problem; with atelectasis, the trachea shifts to the same side as the problem. Subcutaneous emphysema is more commonly related to a pneumomediastinum and is not specifically related to the trachea but to air trapped in the mediastinum and general neck area.

The answer to question 7

C
Stuporous means the patient can be aroused only by vigorous and continuous external stimuli. Motor response is often withdrawal or localizing to stimulus. Obtunded means the patient displays dull indifference to external stimuli, and response is minimally maintained. Questions are answered with a minimal response. Lethargic means the patient displays a state of drowsiness or inaction in which the patient needs an increased stimulus to be awakened. Comatose means vigorous stimulation fails to produce any voluntary neural response in the patient.
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