Nursing Board Exam Reviewer Part 2 of 5
141. When the post-cardiac surgery patient demonstrates restlessness, nausea, weakness, and peaked T waves, the nurse reviews the patient’s serum electrolytes anticipating which abnormality?
Hyperkalemia is indicated by mental confusion, restlessness, nausea, weakness, and dysrhythmias (tall, peaked T waves).
Hypercalcemia would likely be demonstrated by asystole.
Hypomagenesemia would likely be demonstrated by hypotension, lethargy, and vasodilation.
Hyponatremia would likely be indicated by weakness, fatigue, and confusion without change in T wave formation.
142. In order to be effective, Percutaneous Transluminal Coronary Angioplasty (PTCA) must be performed within what time frame, beginning with arrival at the emergency department after diagnosis of myocardial infarction?
a) 60 minutes
The sixty minute interval is known as “door to balloon time” for performance of PTCA on a diagnosed MI patient.
b) 30 minutes
The thirty minute interval is known as “door to needle” time for administration of thrombolytics post MI.
c) 9 days
The time frame of nine (9) days refers to the time for onset of vasculitis after administration of Streptokinase for thrombolysis in an acute MI patient.
d) 6-12 months
The six to twelve month time frame refers to the time period during which streptokinase will not be used again in the same patient for acute MI.
143. Which of the following statements reflect a goal of rehabilitation for the patient with an MI:
a) To improve the quality of life
Overall, cardiac rehabilitation is a complete program dedicated to extending and improving quality of life.
b) To limit the effects and progression of atherosclerosis
An immediate objective of rehabilitation of the MI patient is to limit the effects and progression of atherosclerosis.
c) To return the patient to work and a pre illness lifestyle
An immediate objective of rehabilitation of the MI patient is to return the patient to work and a pre illness lifestyle.
d) To prevent another cardiac event
An immediate objective of rehabilitation of the MI patient is to prevent another cardiac event.
144. Which of the following methods to induce hemostasis after sheath removal post Percutaneous Transluminal Coronary Angioplasty is the least effective?
a) Application of a sandbag to the area
Several nursing interventions frequently used as part of the standard of care, such as applying a sandbag to the sheath insertion site, have not been shown to be effective in reducing the incidence of bleeding.
b) Application of a vascular closure device, such as AngiosealTM, VasosealTM, DuettTM, Syvek patchTM
Application of a vascular closure device has been demonstrated to be very effective.
c) Direct manual pressure
Direct manual pressure to the sheath introduction site has been demonstrated to be effective and was the first method used to induce hemostasis post PTCA.
d) Application of a pneumatic compression device (e.g., Fem-StopTM)
Application of a pneumatic compression device post PTCA has been demonstrated to be effective.
145. A long-term effect of which of the following procedures post acute MI induces angioneogenesis?
a) Transmyocardial laser revascularization
TNR procedures usually involves making 20 to 40 channels in ventricular muscle. It is thought that some blood flows into the channels, decreasing the ischemia directly. Within the next few days to months, the channels close as a result of the body’s inflammatory process of healing a wound and new blood vessels form as a result of the inflammatory process.
Brachytherapy involves the delivery of gamma or beta radiation by placing a radioisotope close to the lesion and has been shown to be effective in reducing the recurrence of obstruction, preventing vessell restenosis by inhibiting smooth muscle cell proliferation.
Atherectomy is an invasive interventional procedure that involves the removal of the atheroma, or plaque, from a coronary artery.
d) Stent placement
A stent is a woven stainless steel mesh that provides structural support to a vessel at risk of acute closure. Eventually, endothelium covers the stent and it is incorporated into the vessel wall. Because of the risk of thrombus formation in the stent, the patient receives antiplatelet medications (e.g., clopidigrel [Plavix]) therapy for 2 weeks and lifetime use of aspirin).
146. Which of the following medications are used to reverse the effects of heparin?
a) Protamine sulfate
Protamine sulfate is known as the antagonist to heparin.
Streptokinase is a thrombolytic agent.
c) Clopidigrel (Plavix)
Clopidigrel (Plavix) is an antiplatelet medication that is given to reduce the risk of thrombus formation post coronary stent placement.
The antiplatelet effect of aspirin does not reverse the effects of heparin.
147. Which of the following terms refers to leg pain that is brought on walking and caused by arterial insufficiency?
a) Intermittent claudication
Intermittent claudication is leg pain that is brought on by exercise and relieved by rest.
Dyspnea is the patient’s subjective statement of difficulty breathing.
Orthopnea is the inability of the patient to breathe except in the upright (sitting) position.
d) Thromboangitis obliterans
Thomroangitis obliterans is a peripheral vascular disease also known as Burger’s disease.
148. When the post-cardiac surgical patient demonstrates vasodilation, hypotension, hyporeflexia, slow gastrointestinal motility (hypoactive bowel sounds), lethargy, and respiratory depression, the nurse suspects which of the following electrolyte imbalances?
Untreated hypomagnesemia may result in coma, apnea, cardiac arrest.
Signs and symptoms of hypokalemia include signs of digitalis toxicity and dysrhythmias (U wave, AV block, flat or inverted T waves).
Signs of hyperkalemia include: mental confusion, restlessness, nausea, weakness, paresthesias of extremities, dysrhythmias (tall, peaked T waves; increased amplitude, widening QRS complex; prolonged QT interval).
Signs and symptoms of hypomagnesemia include: paresthesias, carpopedal spasm, muscle cramps, tetany, irritability, tremors, hyperexcitability, hyperreflexia, cardiac dysrhythmias (prolonged PR and QT intervals, broad flat T waves), disorientation, depression, and hypotension.
149. When the nurse notes that the post cardiac surgery patient demonstrates low urine output (< 25 ml/hr) with high specific gravity (> 1.025), the nurse suspects:
a) Inadequate fluid volume
Urine output of less than 25 ml/hr may indicate a decrease in cardiac output. A high specific gravity indicates increased concentration of solutes in the urine which occurs with inadequate fluid volume.
b) Normal glomerular filtration
Indices of normal glomerular filtration are output of 25 ml or greater per hour and specific gravity between 1.010 and 1.025.
Overhydration is manifested by high urine output with low specific gravity.
The anuric patient does not produce urine.
150. When the valve used in valve replacement surgery is made from the patient’s own heart valve, which of the following terms is used?
An example of autograft is found when the surgeon excises the pulmonic valve and uses it for an aortic valve replacement.
Allograft refers to replacement using human tissue and is a synonym for homograft.
Homograft refers to replacement using human tissue and is a synonym for allograft.
Xenograft refers to replacement of tissue from animal tissue.