Medical-Surgical Nursing Exam 13

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1. In relation to the structure of the larynx, the cricoid cartilage is

  1. the only complete cartilaginous ring in the larynx.
    The cricoid cartilage is located below the thyroid cartilage.
  2. used in vocal cord movement with the thyroid cartilage.
    The arytenoid cartilages are used in vocal cord movement with the thyroid cartilage.
  3. the largest of the cartilage structures.
    The thyroid cartilage is the largest of the cartilage structures; part of it forms the Adam’s apple.
  4. the valve flap of cartilage that covers the opening to the larynx during swallowing.
    The epiglottis is the valve flap of cartilage that covers the opening to the larynx during swallowing.

2. Which respiratory volume is the maximum volume of air that can be inhaled after maximal expiration?

  1. Inspiratory reserve volume
    Inspiratory reserve volume is normally 3000 mL.
  2. Tidal volume
    Tidal volume is the volume of air inhaled and exhaled with each breath.
  3. Expiratory reserve volume
    Expiratory reserve volume is the maximum volume of air that can be exhaled forcibly after a normal exhalation.
  4. Residual volume
    Residual volume is the volume of air remaining in the lungs after a maximum exhalation.

3. The individual who demonstrates displacement of the sternum is described as having a

  1. pigeon chest.
    Pigeon chest may occur with rickets, Marfan’s syndrome, or severe kyphoscoliosis.
  2. barrel chest.
    A barrel chest is seen in patients with emphysema as a result of over-inflation of the lungs.
  3. funnel chest.
    A funnel chest occurs when there is a depression in the lower portion of the sternum.
  4. kyphoscoliosis.
    Kyphoscoliosis is characterized by elevation of the scapula and a corresponding S-shaped spine.

4. When the nurse auscultates chest sounds that are harsh and cracking, sounding like two pieces of leather being rubbed together, she records her finding as

  1. pleural friction rub.
    A pleural friction rub is heard secondary to inflammation and loss of lubricating pleural fluid.
  2. crackles.
    Crackles are soft, high-pitched, discontinuous popping sounds that occur during inspiration.
  3. sonorous wheezes.
    Sonorous wheezes are deep, low-pitched rumbling sounds heard primarily during expiration.
  4. sibilant wheezes.
    Sibilant wheezes are continuous, musical, high-pitched, whistle-like sounds heard during inspiration and expiration.

5. Which of the following terms is used to describe hemorrhage from the nose?

  1. Epistaxis
    Epistaxis is due to rupture of tiny, distended vessels in the mucous membrane of any area of the nose.
  2. Xerostomia
    Xerostomia refers to dryness of the mouth.
  3. Rhinorrhea
    Rhinorrhea refers to drainage of a large amount of fluid from the nose.
  4. Dysphagia
    Dysphagia refers to difficulties in swallowing.

6. The herpes simplex virus (HSV-1), which produces a cold sore (fever blister), has an incubation period of

  1. 2-12 days.
    HSV-1 is transmitted primarily by direct contact with infected secretions.
  2. 0-3 months.
    The time period 0-3 months exceeds the incubation period.
  3. 20-30 days.
    The time period 20-30 days exceeds the incubation period.
  4. 3-6 months.
    The time period 3-6 months exceeds the incubation period.

7. Another term for clergyman’s sore throat is

  1. chronic granular pharyngitis.
    In clergyman’s sore throat, the pharynx is characterized by numerous swollen lymph follicles.
  2. aphonia.
    Aphonia refers to the inability to use one’s voice.
  3. atrophic pharyngitis.
    Atrophic pharyngitis is characterized by a membrane that is thin, white, glistening, and at times wrinkled.
  4. hypertrophic pharyngitis.
    Hypertrophic pharyngitis is characterized by general thickening and congestion of the pharyngeal mucous membrane.

8. Which type of sleep apnea is characterized by lack of airflow due to pharyngeal occlusion?

  1. Obstructive
    Obstructive sleep apnea occurs usually in men, especially those who are older and overweight.
  2. Simple
    Types of sleep apnea do not include a simple characterization.
  3. Mixed
    Mixed sleep apnea is a combination of central and obstructive apnea with one apneic episode.
  4. Central
    In central sleep apnea, the patient demonstrates simultaneous cessation of both airflow and respiratory movements.

9. When the patient who has undergone laryngectomy suffers wound breakdown, the nurse monitors him very carefully because he is identified as being at high risk for

  1. carotid artery hemorrhage.
    The carotid artery lies close to the stoma and may rupture from erosion if the wound does not heal properly.
  2. pulmonary embolism.
    Pulmonary embolism is associated with immobility.
  3. dehydration.
    Dehydration may lead to poor wound healing and breakdown.
  4. pneumonia.
    Pneumonia is a risk for any postoperative patient.

10. Which of the following terms refers to lung tissue that has become more solid in nature due to a collapse of alveoli or infectious process?

  1. Consolidation
    Consolidation occurs during an infectious process such as pneumonia.
  2. Atelectasis
    Atelectasis refers to collapse or airless condition of the alveoli caused by hypoventilation, obstruction to the airways, or compression.
  3. Bronchiectasis
    Bronchiectasis refers to chronic dilation of a bronchi or bronchi in which the dilated airway becomes saccular and a medium for chronic infection.
  4. Empyema
    Empyema refers to accumulation of purulent material in the pleural space.

11. Which of the following community-acquired pneumonias demonstrates the highest occurrence during summer and fall?

  1. Legionnaires’ disease
    Legionnaires’ disease accounts for 15% of community-acquired pneumonias.
  2. Streptococcal (pneumococcal) pneumonia
    Streptococcal pneumonia demonstrates the highest occurrence in winter months.
  3. Mycoplasma pneumonia
    Mycoplasma pneumonia demonstrates the highest occurrence in fall and early winter.
  4. Viral pneumonia
    Viral pneumonia demonstrates the greatest incidence during winter months.

12. When interpreting the results of a Mantoux test, the nurse explains to the patient that a reaction occurs when the intradermal injection site shows

  1. redness and induration.
    The site is inspected for redness and palpated for hardening.
  2. drainage.
    Drainage at the site does not indicate a reaction to the tubercle bacillus.
  3. tissue sloughing.
    Sloughing of tissue at the site of injection does not indicate a reaction to the tubercle bacillus.
  4. bruising.
    Bruising of tissue at the site may occur from the injection, but does not indicate a reaction to the tubercle bacillus.

13. Which of the following actions is most appropriate for the nurse to take when the patient demonstrates subcutaneous emphysema along the suture line or chest dressing 2 hours after chest surgery?

  1. Record the observation.
    Subcutaneous emphysema occurs after chest surgery as the air that is located within the pleural cavity is expelled through the tissue opening created by the surgical procedure.
  2. Apply a compression dressing to the area.
    Subcutaneous emphysema is a typical post-operative finding in the patient after chest surgery.
  3. Measure the patient’s pulse oximetry.
    Subcutaneous emphysema is absorbed by the body spontaneously after the underlying leak is treated or halted.
  4. Report the finding to the physician immediately.
    Subcutaneous emphysema results from air entering the tissue planes.

14. Which of the following types of lung cancer is characterized as fast growing and tending to arise peripherally?

  1. Large cell carcinoma
    Large cell carcinoma is a fast-growing tumor that tends to arise peripherally.
  2. Bronchioalveolar carcinoma
    Bronchioalveolar cell cancer arises from the terminal bronchus and alveoli and is usually slow-growing.
  3. Adenocarcinoma
    Adenocarcinoma presents as peripheral masses or nodules and often metastasizes.
  4. Squamous cell carcinoma
    Squamous cell carcinoma arises from the bronchial epithelium and is more centrally located.

15. Which of the following methods is the best method for determining nasogastric tube placement in the stomach?

  1. X-ray
    Radiologic identification of tube placement in the stomach is most reliable.
  2. Observation of gastric aspirate
    Gastric fluid may be grassy green, brown, clear, or odorless while an aspirate from the lungs may be off-white or tan. Hence, checking aspirate is not the best method of determining nasogastric tube placement in the stomach.
  3. Testing of pH of gastric aspirate
    Gastric pH values are typically lower or more acidic than that of the intestinal or respiractory tract, but not always.
  4. Placement of external end of tube under water
    Placement of external end of tube under water and watching for air bubbles is not a reliable method for determining nasogastric tube placement in the stomach.

16. Which of the following types of lung cancer is the most prevalent carcinoma of the lung for both men and women?

  1. Adenocarcinoma
    Adenocarcinoma presents more peripherally as peripheral masses or nodules and often metastasizes.
  2. Large cell carcinoma
    Large cell carcinoma is a fast-growing tumor that tends to arise peripherally.
  3. Squamous cell carcinoma
    Squamous cell carcinoma is more centrally located and arises more commonly in the segmental and subsegmental bronchi in response to repetitive carcinogenic exposures.
  4. Small cell carcinoma
    Small cell carcinomas arise primarily as proximal lesions, but may arise in any part of the tracheobronchial tree.

17. Emphysema is described as:

  1. A disease of the airways characterized by destruction of the walls of overdistended alveoli. Emphysema is a category of COPD.
  2. A disease that results in a common clinical outcome of reversible airflow obstruction.
    Asthma is the disease described.
  3. The presence of cough and sputum production for at least a combined total of two or three months in each of two consecutive years.
    Bronchitis is the disease described.
  4. Chronic dilatation of a bronchus or bronchi
    Bronchiectasis is the condition described.

18. Which of the following is the most important risk factor for development of Chronic Obstructive Pulmonary Disease?

  1. Cigarette smoking
    Pipe, cigar and other types of tobacco smoking are also risk factors.
  2. Occupational exposure
    While a risk factor, occupational exposure is not the most important risk factor for development of COPD.
  3. Air pollution
    Air pollution is a risk factor for development of COPD, but it is not the most important risk factor.
  4. Genetic abnormalities
    A deficiency of alpha-antitrypsin is a risk factor for development of COPD, but it is not the most important risk factor.

19. Which type of chest configuration is typical of the patient with COPD?

  1. Barrel chest
    “Barrel chest” results from fixation of the ribs in the inspiratory position.
  2. Pigeon chest
    Pigeon chest results from a displaced sternum.
  3. Flail chest
    Flail chest results when the ribs are fractured.
  4. Funnel chest
    Funnel chest occurs when there is a depression in the lower portion of the sternum and is associated with Mafan’s syndrome or rickets.

20. In which stage of COPD is the forced expiratory volume (FEV1) < 30%?

  1. III
    Stage III patients demonstrate FEV1 < 30% with respiratory failure or clinical signs of right heart failure
  2. II
    Stage II patients demonstrate FEV1 between > 30% and 80%
  3. I
    Stage I is mild COPD with FEV1 < 70%.
  4. O
    Stage O is characterized by normal spirometry

21. Of the following oxygen administration devices, which has the advantage of providing high oxygen concentration?

  1. Non-rebreather mask
    The non-rebreather mask provides high oxygen concentration but is usually poor fitting.
  2. Venturi mask
    The Venturi mask provides low levels of supplemental oxygen.
  3. Catheter
    The catheter is an inexpensive device that provides a variable fraction of inspired oxygen and may cause gastric distention.
  4. Face tent
    A face tent provides a fairly accurate fraction of inspired oxygen, but is bulky and uncomfortable. It would not be the device of choice to provide high oxygen concentration.

22. Which of the following ranges identifies the amount of pressure within the endotracheal tube cuff that is believed to prevent both injury and aspiration?

  1. 20-25 mm Hg water pressure.
    Usually the pressure is maintained at less than 25 cm water pressure to prevent injury and at more than 20 cm water pressure to prevent aspiration.
  2. 10-15 mm Hg water pressure.
    A measure of 10–15 mm Hg water pressure would indicate that the cuff is underinflated.
  3. 30-35 mm Hg water pressure.
    A measure of 30–35 mm Hg water pressure would indicate that the cuff is overinflated.
  4. 0-5 mm Hg water pressure
    A measure of 0-5 mm Hg water pressure would indicate that the cuff is underinflated.

23. When performing endotracheal suctioning, the nurse applies suctioning while withdrawing and gently rotating the catheter 360 degrees for which of the following time periods?

  1. 10-15 seconds
    In general, the nurse should apply suction no longer than 10-15 seconds because hypoxia and dysrhythmias may develop, leading to cardiac arrest.
  2. 30-35 seconds
    Applying suction for 30-35 seconds is hazardous and may result in the patient’s developing hypoxia, which can lead to dysrhythmias and, ultimately, cardiac arrest.
  3. 20-25 seconds
    Applying suction for 20-25 seconds is hazardous and may result in the patient’s developing hypoxia, which can lead to dysrhythmias and, ultimately, cardiac arrest.
  4. 0-5 seconds
    Applying suction for 0-5 seconds would provide too little time for effective suctioning of secretions.

24. In general, chest drainage tubes are not used for the patient undergoing

  1. Pneumonectomy
    Usually, no drains are used for the pneumonectomy patient because the accumulation of fluid in the empty hemithorax prevents mediastinal shift.
  2. Lobectomy
    With lobectomy, two chest tubes are usually inserted for drainage, the upper for air and the lower for fluid
  3. Wedge resection
    With wedge resection, the pleural cavity usually is drained because of the possibility of an air or blood leak
  4. Segmentectomy
    With segmentectomy, drains are usually used because of the possibility of an air or blood leak.

25. Which term is used to describe the ability of the heart to initiate an electrical impulse?

  1. Automaticity
    Automaticity is the ability of specialized electrical cells of the cardiac conduction system to initiate an electrical impulse.
  2. Contractility
    Contractility refers to the ability of the specialized electrical cells of the cardiac conduction system to contract in response to an electrical impulse.
  3. Conductivity
    Conductivity refers to the ability of the specialized electrical cells of the cardiac conduction system to transmit an electrical impulse from one cell to another.
  4. Excitability
    Excitability refers to the ability of the specialized electrical cells of the cardiac conduction system to respond to an electrical impulse.

26. The nurse auscultates the apex beat at which of the following anatomical locations?

  1. Fifth intercostal space, midclavicular line
    The left ventricle is responsible for the apex beat or the point of maximum impulse, which is normally palpable in the left midclavicular line of the chest wall at the fifth intercostal space.
  2. Mid-sternum
    The right ventricle lies anteriorly, just beneath the sternum.
  3. 2” to the left of the lower end of the sternum
    Use of inches to identify the location of the apex beat is inappropriate based upon variations in human anatomy.
  4. 1” to the left of the xiphoid process
    Auscultation below and to the left of the xiphoid process will detect gastrointestinal sounds, but not the apex beat of the heart.

27. Which of the following terms describes the amount of blood ejected per heartbeat?

  1. Stroke volume
    Stroke volume is determined by preload, afterload, and contractility.
  2. Cardiac output
    Cardiac output is the amount of blood pumped by each ventricle during a given period and is computed by multiplying the stroke volume of the heart by the heart rate.
  3. Ejection fraction
    Ejection Fraction is the percentage of the end-diastolic volume that is ejected with each stroke, measured at 42–50% in the normal heart.
  4. Afterload
    Afterload is defined as the pressure that the ventricular myocardium must overcome to eject blood during systole and is one of the determinants of stroke volume.

28. When measuring the blood pressure in each of the patient’s arms, the nurse recognizes that in the normal adult, the pressures

  1. differ no more than 5 mm Hg between arm pressures.
    Normally, in the absence of disease of the vasculature, there is a difference of no more than 5 mm Hg between arm pressures.
  2. must be equal in both arms.
    The pressures in each arm do not have to be equal in order to be considered normal.
  3. may vary 10 mm Hg or more between arms.
    Pressures that vary more than 10 mm Hg between arms indicate an abnormal finding.
  4. may vary, with the higher pressure found in the left arm.
    The left arm pressure is not anticipated to be higher than the right as a normal anatomical variant.

29. Central venous pressure is measured in which of the following heart chambers?

  1. Right atrium
    The pressure in the right atrium is used to assess right ventricular function and venous blood return to the heart.
  2. Left atrium
    The left atrium receives oxygenated blood from the pulmonary circulation.
  3. Left ventricle
    The left ventricle receives oxygenated blood from the left atrium.
  4. Right ventricle
    The right ventricle is not the central collecting chamber of venous circulation.

30. Which of the following ECG characteristics is usually seen when a patient’s serum potassium level is low?

  1. U wave
    The U wave is an ECG waveform characteristic that may reflect Purkinje fiber repolarization. It is usually seen when a patient’s serum potassium level is low.
  2. T wave
    The T wave is an ECG characteristic reflecting repolarization of the ventricles. It may become tall or “peaked” if a patient’s serum potassium level is high.
  3. P wave
    The P wave is an ECG characteristic reflecting conduction of an electrical impulse through the atria.
  4. QT interval
    The QT interval is an ECG characteristic reflecting the time from ventricular depolarization to repolarization.

31. Which of the following ECG waveforms characterizes conduction of an electrical impulse through the left ventricle?

  1. QRS complex
    The QRS complex represents ventricular depolarization
  2. P wave
    The P wave is an ECG characteristic reflecting conduction of an electrical impulse through the atria.
  3. PR interval
    The PR interval is a component of an ECG tracing reflecting conduction of an electrical impulse through the AV node.
  4. QT interval
    The QT interval is an ECG characteristic reflecting the time from ventricular depolarization to repolarization.

32. When the nurse observes that the patient’s heart rate increases during inspiration and decreases during expiration, the nurse reports that the patient is demonstrating

  1. sinus dysrhythmia.
    Sinus dysrhythmia occurs when the sinus node creates an impulse at an irregular rhythm.
  2. normal sinus rhythm.
    Normal sinus rhythm occurs when the electrical impulse starts at a regular rate and rhythm in the SA node and travels through the normal conduction pathway.
  3. sinus bradycardia.
    Sinus bradycardia occurs when the sinus node regularly creates an impulse at a slower-than-normal rate.
  4. sinus tachycardia.
    Sinus tachycardia occurs when the sinus node regularly creates an impulse at a faster-than-normal rate.

33. Which of the following terms is used to describe a tachycardia characterized by abrupt onset, abrupt cessation, and a QRS of normal duration?

  1. Paroxysmal atrial tachycardia
    PAT is often caused by a conduction problem in the AV node and is now called AV nodal reentry tachycardia.
  2. Sinus tachycardia
    Sinus tachycardia occurs when the sinus node regularly creates an impulse at a faster-than-normal rate.
  3. Atrial flutter
    Atrial flutter occurs in the atrium and creates an atrial rate between 250-400 times per minute.
  4. Atrial fibrillation
    Atrial fibrillation causes a rapid, disorganized, and uncoordinated twitching of atrial musculature.

34. When the nurse observes an ECG tracing on a cardiac monitor with a pattern in lead II and observes a bizarre, abnormal shape to the QRS complex, the nurse has likely observed which of the following ventricular dysrhythmias?

  1. Premature ventricular contraction                                                                                                                A PVC is an impulse that starts in a ventricle before the next normal sinus impulse.
  2. Ventricular bigeminy
    Ventricular bigeminy is a rhythm in which every other complex is a PVC.
  3. Ventricular tachycardia
    Ventricular tachycardia is defined as three or more PVCs in a row, occurring at a rate exceeding 100 beats per minute.
  4. Ventricular fibrillation
    Ventricular fibrillation is a rapid but disorganized ventricular rhythm that causes ineffective quivering of the ventricles.

35. Premature ventricular contractions are considered precursors of ventricular tachycardia when they

  1. occur at a rate of more than six per minute.
    When PVCs occur at a rate of more than six per minute they indicate increasing ventricular irritability and are considered forerunners of ventricular tachycardia (VT).
  2. occur during the QRS complex.
    PVCs are dangerous when they occur on the T wave.
  3. have the same shape.
    PVCs are dangerous when they are multifocal (have different shapes).
  4. are paired with a normal beat.
    A PVC that is paired with a normal beat is termed bigeminy.

36. When no atrial impulse is conducted through the AV node into the ventricles, the patient is said to be experiencing which type of AV block?

  1. Third degree
    In third degree heart block, two impulses stimulate the heart—one stimulates the ventricles and one stimulates the atria.
  2. First degree
    In first degree heart block, all the atrial impulses are conducted through the AV node into the ventricles at a rate slower than normal.
  3. Second degree, type I
    In second degree AV block, type I, all but one of the atrial impulses are conducted through the AV node into the ventricles.
  4. Second degree, type II
    In second degree AV block, type II, only some of the atrial impulses are conducted through the AV node into the ventricles.

37. Which of the following terms refers to chest pain brought on by physical or emotional stress and relieved by rest or medication?

  1. angina pectoris
    Angina pectoris is a symptom of myocardial ischemia.
  2. atherosclerosis
    Atherosclerosis is an abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and lumens.
  3. atheroma
    Atheromas are fibrous caps composed of smooth muscle cells that form over lipid deposits within arterial vessels.
  4. ischemia
    Ischemia is insufficient tissue oxygenation and may occur in any part of the body.

38. Of the following risk factors, which is considered modifiable?

  1. Diabetes mellitus
    While diabetes mellitus cannot be cured, blood sugars and symptomatology can be managed through healthy heart living.
  2. Gender
    Gender is considered a non-modifiable risk factor.
  3. Race
    Race is considered a non-modifiable risk factor.
  4. Increasing age
    Increasing age is considered a non-modifiable risk factor.

39. When the patient with known angina pectoris complains that he is experiencing chest pain more frequently even at rest, the period of pain is longer, and it takes less stress for the pain to occur, the nurse recognizes that the patient is describing

  1. unstable angina.
    Unstable angina is also called crescendo or pre-infarction angina and indicates the need for a change in treatment.
  2. intractable angina.
    Intractable or refractory angina produces severe, incapacitating chest pain that does not respond to conventional treatment.
  3. variant angina.
    Variant angina is described as pain at rest with reversible ST-segment elevation and is thought to be caused by coronary artery vasospasm.
  4. refractory angina.
    Intractable or refractory angina produces severe, incapacitating chest pain that does not respond to conventional treatment.

40. Heparin therapy is usually considered therapeutic when the patient’s activated partial thromboplasin time (aPTT) is how many times normal?

  1. 1.5 to 2
    The amount of heparin administered is based on aPTT results, which should be obtained in follow-up to any alteration of dosage.
  2. .5 to 1
    The patient’s aPTT value would have to be greater than .5 to 1 times normal to be considered therapeutic.
  3. 2.5 to 3
    An aPTT value that is 2.5 to 3 times normal would be too high to be considered therapeutic.
  4. .25 to .75                                                                                                                                                        The patient’s aPTT value would have to be greater than .25 to .75 times normal to be considered therapeutic.

41. 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?

  1. Hyperkalemia
    Hyperkalemia is indicated by mental confusion, restlessness, nausea, weakness, and dysrhythmias (tall, peaked T waves).
  2. Hypercalcemia
    Hypercalcemia would likely be demonstrated by asystole.
  3. Hypomagnesemia
    Hypomagenesemia would likely be demonstrated by hypotension, lethargy, and vasodilation.
  4. Hyponatremia
    Hyponatremia would likely be indicated by weakness, fatigue, and confusion without change in T wave formation.

42. 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?

  1. 60 minutes
    The sixty minute interval is known as “door to balloon time” for performance of PTCA on a diagnosed MI patient.
  2. 30 minutes
    The thirty minute interval is known as “door to needle” time for administration of thrombolytics post MI.
  3. 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.
  4. 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.

43. Which of the following statements reflect a goal of rehabilitation for the patient with an MI:

  1. To improve the quality of life
    Overall, cardiac rehabilitation is a complete program dedicated to extending and improving quality of life.
  2. 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.
  3. 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.
  4. To prevent another cardiac event
    An immediate objective of rehabilitation of the MI patient is to prevent another cardiac event.

44. Which of the following methods to induce hemostasis after sheath removal post Percutaneous Transluminal Coronary Angioplasty is the least effective?

  1. 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.
  2. 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.
  3. 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.
  4. Application of a pneumatic compression device (e.g., Fem-StopTM)
    Application of a pneumatic compression device post PTCA has been demonstrated to be effective.

45. A long-term effect of which of the following procedures post acute MI induces angioneogenesis?

  1. 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.
  2. Bracytherapy
    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.
  3. Atherectomy
    Atherectomy is an invasive interventional procedure that involves the removal of the atheroma, or plaque, from a coronary artery.
  4. 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).

46. Which of the following medications are used to reverse the effects of heparin?

  1. Protamine sulfate
    Protamine sulfate is known as the antagonist to heparin.
  2. Streptokinase
    Streptokinase is a thrombolytic agent.
  3. Clopidigrel (Plavix)
    Clopidigrel (Plavix) is an antiplatelet medication that is given to reduce the risk of thrombus formation post coronary stent placement.
  4. Aspirin
    The antiplatelet effect of aspirin does not reverse the effects of heparin.

47. Which of the following terms refers to leg pain that is brought on walking and caused by arterial insufficiency?

  1. Intermittent claudication
    Intermittent claudication is leg pain that is brought on by exercise and relieved by rest.
  2. Dyspnea
    Dyspnea is the patient’s subjective statement of difficulty breathing.
  3. Orthopnea
    Orthopnea is the inability of the patient to breathe except in the upright (sitting) position.
  4. Thromboangitis obliterans
    Thomroangitis obliterans is a peripheral vascular disease also known as Burger’s disease.

48. 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?

  1. Hypermagnesemia
    Untreated hypomagnesemia may result in coma, apnea, cardiac arrest.
  2. Hypokalemia
    Signs and symptoms of hypokalemia include signs of digitalis toxicity and dysrhythmias (U wave, AV block, flat or inverted T waves).
  3. Hyperkalemia
    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).
  4. Hypomagnesemia
    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.

49. 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:

  1. 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.
  2. 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.
  3. Overhydration
    Overhydration is manifested by high urine output with low specific gravity.
  4. Anuria
    The anuric patient does not produce urine.

50. When the valve used in valve replacement surgery is made from the patient’s own heart valve, which of the following terms is used?

  1. Autograft
    An example of autograft is found when the surgeon excises the pulmonic valve and uses it for an aortic valve replacement.
  2. Allograft
    Allograft refers to replacement using human tissue and is a synonym for homograft.
  3. Homograft
    Homograft refers to replacement using human tissue and is a synonym for allograft.
  4. Xenograft                                                                                                                                            Xenograft refers to replacement of tissue from animal tissue.

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