Page 470 - Critical Care Nursing Demystified

CORRECT ANSWERS AND RATIONALES 455

Chapter 3

1. C. Variant angina is caused by coronary artery spasm. To make the arteries less respon-
sive to spasm a calcium channel blocker is generally used.
2. A. Hypertension is modifiable with diet, exercise, weight loss, and medications. The oth-
ers are what one is born with (family history, race) or inevitable (aging).
3. D. Crackles indicate left-sided failure as they are caused by increased pressure in the
left ventricle backing up into the pulmonary circuit. All other signs are from peripheral
venous congestion.
4. B and E. Any recent surgery or trauma is a contraindication because of increased inci-
dence of bleeding in patients. An ST segment MI is an indication for thrombolytic therapy.
Venipunctures should be decreased in frequency, and central lines must be monitored
for bleeding but are not a contraindication. Pressure must be held longer and the site
observed for further bleeding. Age is not a deterrent to administering thrombolytics.
5. C. Since the diastolic pressure goes down to zero in this reading and the patient is hav-
ing ventricular dysrhythmias, the catheter is probably in the right ventricle. The nurse
could try to wedge the catheter to float it back into the PA. It is impossible for a PAC to
go into the left side of the heart; therefore, A and D are incorrect. A right atrial pressure
would be a mean value and much lower than the RV or PA pressures. It also would not
go down to a zero reading.
6. C. Since patients with an orthotopic transplant have denervated hearts, they have to Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
rely on circulating catecholamines to increase their heart rates and this takes several
minutes. A temporary pacemaker and dobutamine are usually only used immediately
postoperative and patients do not go home on these devices as the norm. They also
have two P waves: one from the donor and their own native P wave.
7. B. Deep palpation is contraindicated in this instance as the pulsating mass could be an
AAA. Deep palpation could cause it to rupture.
8. A. A dampened pressure is either from the central vein or the PCWP (PAOP). This pres-
sure is too high to be CVP, which is around 2–6 mm Hg, so it is a PCWP (PAOP). If the
nurse leaves it in this position, it blocks off distal blood flow to the lungs creating a
pulmonary infarction. If the catheter migrates to the RV, the pressures would not be
dampened but would have large fluctuations from 30 to 0 and can have premature
ventricular contractions (PVCs) to boot. There is most definitely cause for concern in
this instance as a pulmonary infarct can be caused by a wedged catheter.
9. C. All OHS patients have temporary pacemakers as a quick access to heart rate if edema
causes heart blocks and bradycardias. The other choices are most common in heart
transplantation.
10. D. Fluid from aortic stenosis would back up into the left ventricle creating left ventricu-
lar hypertrophy for a period of time. The ventricle would have to work hard to maintain
BP. A murmur would be heard over the right 2nd ICS.