Page 176 - Critical Care Nursing Demystified

Chapter 3 CARE OF THE PATIENT WITH CRITICAL CARDIAC AND VASCULAR NEEDS 161

CORRECT ANSWERS AND RATIONALES

1. D. This enzyme is found in cardiac tissue and will rapidly increase with the onset of a
myocardial infarction.
2. A. Furosemide (Lasix) is a loop diuretic, which should increase urinary output. Oliguria
is scant or severely decreased urinary output.
3. C, D, and E are some of the signs and symptoms of left-sided heart failure, which backs
up into the lungs. A, B, and F are indicators of right-sided heart failure, which is caused
by systemic congestion.
4. D. Unstable angina increases in intensity and occurs more frequently with longer
events. Stable angina is predictable; the patient can tell you when it is going to occur.
Variant or Prinzmetal’s angina is atypical and occurs at rest.
5. B. Bruits are associated with turbulence of blood flow and are auscultated in 50% of
patients with an AAA. Otherwise the patient is asymptomatic. A is more associated with
angina, and C is associated with stroke. Numbness and tingling in the lower extremities
is usually due to a decreased blood supply to the lower extremities from hemorrhage
into the peritoneal cavity.
6. A. The BNP is a significant diagnostic and monitoring tool for HF. Any value greater than
400 pg/mL indicates significant HF. Although all of the additional laboratory values
may be elevated (sodium and potassium) or decreased (pH) in HF, BNP is the most ac-
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7. C. An increased PAWP (PAOP) is consistent with fluid buildup in the lungs and inability
of the left side of the heart to pump to the body. A would be correct if this patient had a
right ventricular infarction causing right-sided heart failure. The BP and oxygen satura-
tion are usually lower in left-sided HF.
8. B. An ST segment MI is one that is usually referred to as a smaller, less severe type where
the enzymes are elevated but the depth of tissue death has not penetrated all three
muscular coats. The ECG changes are not permanent; therefore, a trained practitioner
would not see a “Q” wave that is permanent on the ECG.
9. A. Even though this potassium level is on the low side and it will go even lower without
potassium supplementation. The other values are within normal limits.
10. C, D, and E. Because there is a progressive downward spiral in the BP and a dramatic
increase in the HR and RR with rhythm disturbances, this patient could be experiencing
cardiogenic shock and tamponade. In shock, the heart fails to keep the BP elevated to
nourish the tissues, so the HR elevates causing tachycardias and tachydysrhythmias.
The same sequela can occur when the heart is compressed and no blood can enter or
exit as in a cardiac tamponade as well as an aneurysm, where the heart pumping can
be compromised by lack of pumping in the ballooned out or weakened areas. Peri-
carditis is noted by a friction rub and elevated temperature with constant, dull chest
pain. Syncope could look like the above but it is associated with activity, which this
patient is not doing in an acute situation. Acute respiratory failure would look like the
above if the BP were elevated.