A patient returns from the cardiac catheterization laboratory after angioplasty and stent placement ...

The answer to question 1

B
If the monitored heart has a normal electrical axis, lead II displays a waveform that is predominantly upright, with a positive P wave and positive QRS waveform. P waves are usually easy to identify in lead II, and it is recommended for monitoring of atrial dysrhythmias. However, it is difficult to identify right bundle branch block (RBBB) and left bundle branch block (LBBB). The selection of an electrocardiographic monitoring lead is not a decision to be made casually or according to habit. The monitoring lead should be chosen with consideration of the patient's clinical condition and recent clinical history. Lead V1 is the optimal lead to select if the critical care nurse needs to analyze ventricular ectopy. V1 provides information to facilitate differentiation between RBBB versus LBBB pattern or distinguish between ventricular tachycardia and supraventricular tachycardia with aberrant conduction; determine whether premature ventricular contractions originate in the right or left ventricle, and clarify when ST segment changes are caused by the RBBB and when they are the result of ischemia. Lead V1 is excellent for this purpose. MCL1 is an uncommon lead choice today. It is used only if monitoring with a three-lead system such as on a transport monitor.

The answer to question 2

A
Esophagogastric varices are engorged and distended blood vessels of the esophagus and proximal stomach that develop as a result of portal hypertension secondary to hepatic cirrhosis, a chronic disease of the liver that results in damage to the liver sinusoids. Without adequate sinusoid function, resistance to portal blood flow is increased, and pressures within the liver are elevated. This leads to a rise in portal venous pressure (portal hypertension), causing collateral circulation to divert portal blood from areas of high pressure within the liver to adjacent areas of low pressure outside the liver, such as into the veins of the esophagus, spleen, intestines, and stomach.

The answer to question 3

B
Mucolytics may be administered with a bronchodilator because it can cause bronchospasms and inhibit ciliary function. Treatment is considered effective when bronchorrhea develops and coughing occurs. b2-Agonists are used to relax bronchial smooth muscle and dilate airways to prevent bronchospasms. Anticholinergic agents are used to block the constriction of bronchial smooth muscle and reduce mucus production. Xanthines are used to dilate bronchial smooth muscle and reverse diaphragmatic muscle fatigue.

The answer to question 4

D
Cerebrospinal fluid is normally a clear, colorless, odorless solution that contains 50 to 75 mg/dL of glucose, 5 to 25 mg/dL of protein, and no red blood cells.

The answer to question 5

D
The bicarbonate (HCO3-) is the acidbase component that reflects kidney function. The bicarbonate is reduced or increased in the plasma by renal mechanisms. The normal range is 22 to 26 mEq/L. pH measures the hydrogen ion concentration of plasma. PaO2 measures partial pressure of oxygen dissolved in arterial blood plasma. PaCO2 measures the partial pressure of carbon dioxide dissolved in arterial blood plasma.

The answer to question 6

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The answer to question 7

B
Palpation is the assessment technique that is most useful in detecting abdominal pathologic conditions. Both light and deep palpation of each organ and quadrant should be completed. Deep palpation is most helpful in detecting abdominal masses. Areas in which the patient complains of tenderness should be palpated last.

The answer to question 8

A
Expressive aphasia, also known as motor, Broca, or nonfluent aphasia, is primarily a deficit in language output or speech production. Global aphasia results when a massive lesion affects the motor and sensory speech areas. The patient cannot transform sounds into words and cannot comprehend spoken words. Receptive aphasia, also referred to as sensory, Wernicke, or fluent aphasia, occurs when the connection between the primary auditory cortex in the temporal lobe and the angular gyrus in the parietal lobe is destroyed. Lesions in the parietal lobe and in other cortical structures can result in apraxia, an inability to perform a learned movement voluntarily.

The answer to question 9

C
When the serum osmolality level increases, antidiuretic hormone is released from the posterior pituitary gland and stimulates increased water resorption in the kidney tubules. This expands the vascular space, returns the serum osmolality level back to normal, and results in more concentrated urine and an elevated urine osmolality level.

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