Question 1

A patient who is being admitted in ICU requires a finger probe pulse oximeter. The priority nursing intervention for this patient is to:

Accepted Answer

The priority nursing intervention for this patient is to enquire if the patient has recently undergone a diagnostic test using intravenous dye. The pulse oximeter may record inaccurate readings if dye has been used for a diagnostic test. Dyes contain colored substances that tint the blood and give rise to inaccurate readings.

Question 2

A patient is being discharged from the hospital following a myocardial infarction. He is encouraged to practice frequent leg exercises and ambulate in the hallway as directed by his physician. Which of the following reflects the actual purpose of exercise in this patient?

Accepted Answer

The actual purpose of exercise is to prevent deep vein thrombosis. Exercise is important for all patients which are hospitalized to prevent deep vein thrombosis. Exercise promotes muscular contraction which increases venous return and prevents hemostasis in the lower limbs. The exercise done for this purpose is not vigorous enough to increase physical fitness, prevention of bedsores or constipation.

Question 3

A 69-year old male patient presents to emergency department with complaints of mid-sternal chest pain. Which of the following nursing actions should take priority?

Accepted Answer

The priority nursing action for a patient presenting to emergency in distress is always assessment of vital signs. This helps to know the extent of physical compromise and provides background information to plan further assessment and treatment. A complete medical history is definitely important; this should include onset of symptoms as well as history of similar complaints in the past. Recording an electrocardiogram is also important, but these are not the first priority. Similarly, cardiac and chest examination and auscultation may elicit useful information after vital signs are assessed.

Question 4

A nurse is explaining about foot care to a patient being discharged with peripheral vascular disease . Which of the following information should be included in instructions?

Accepted Answer

The instruction to avoid keeping the legs crossed must be included in the information. Patients with peripheral vascular disease should avoid crossing the legs because this can impede blood flow. Walking barefoot is not recommended as foot trauma may lead to serious infection. Heating pads are also liable to cause injury, which also increases the risk of infection. Skin lesions at risk for infection should not be ignored and the physician should be consulted for treatment.

Question 5

A patient with myocardial infarction on the cardiac telemetry unit suddenly goes into ventricular fibrillation. The advanced cardiac life support team arrives immediately and prepares to defibrillate. Which of the following is correct position for placement of the conductive gel pads?

Accepted Answer

The correct placement of gel pads is one gel pad to be placed to the right of the sternum, just below the clavicle and the other just left of the precordium. To defibrillate, the paddles are placed over the pads. The other options do not correspond with the position of the heart and are therefore not correct.

Question 6

A patient with previous history of congestive heart failure presents to the clinic with complaints of dyspnea. What should the nurse do first?

Accepted Answer

The priority action performed by the nurse should be to record the blood pressure. A patient with history of congestive heart failure and dyspnea may have pulmonary oedema, which can cause severe hypertension. Therefore, measuring the patient's blood pressure should be the first action. Lying down flat on the examination table is likely to worsen the dyspnea, and the patient may become more distressed. Drawing blood for chemistry and arterial blood gas analysis is required, but need not be a priority action before measuring blood pressure.

Question 7

A patient is receiving digoxin (Lanoxin) 0.25 mg daily for treatment of cardiac failure. The health care provider has written a new order to give metoprolol 25 mg. B.I.D. Before administering these medications, nurse is supposed to assess and keep the healthcare provider informed. Which of the following statistics is most important for the nurse to report to the healthcare provider?

Accepted Answer

A blood pressure of 90 over 60 should be reported immediately to the health care provider. Both digoxin and metoprolol decrease the heart rate and metoprolol affects blood pressure. Therefore, the heart rate and blood pressure must be within normal range. Heart rate should be in range of 60-100 per minute and systolic BP > 100 in order to safely administer both the medications together.

Question 8

A patient is being discharged from hospital seven days post myocardial infarction. He is curious to know why he must wait six weeks before having sexual intercourse. What is the best response by the nurse to this question?

Accepted Answer

"When you are able to climb two flights of stairs comfortably, it is generally safe to have sex." After myocardial infarction, there is a risk of cardiac rupture for about six weeks. Scar tissue generally forms by that time. The usual advice given by health care providers is to wait until the patient can tolerate climbing stairs.

Question 9

A patient has recently been prescribed nitroglycerin for treatment of angina. He calls the nurse and tells her that he is having frequent headaches. Which of the following responses to the patient is correct?

Accepted Answer

Nitroglycerin is a potent vasodilator and often produces unwanted side effects related to vasodilation such as headache, dizziness, and hypotension. Patients should be counselled, and the dose adjusted to minimize the side effects. Despite these side effects, nitroglycerine is effective at reducing myocardial oxygen consumption and increasing blood flow. The patient should not be instructed to stop the medication. Nitroglycerine does not cause brain hemorrhage.

Quiz 1: Cardiac Medicine