Part A: Pharmacological Treatment Match the medication (number) to the appropriate description (letter). Medication Medication Description 1. Epitfibatide (Integrilin) A. Drug of choice for angina attacks 2. Metoprolol (Lopressor) B. Bile acid sequestrant 3. Nitroglycerin C. Beta blocker 4. Heparin D. Calcium channel blocker 5. Cholestyramine (Questran) E. Thrombolytic 6. Clopidogrel (Plavix) F. Antiplatelet 7. Atorvastatin (Lipitor) G. Does not dissolve existing clots 8. Reteplase (Retavase) H. Glycoprotein IIb/IIIa inhibitor 9. Amlodipine (Norvasc) I. Long acting nitrate 10. Isosorbide Dinitrate (Isordil) J. Reduces cholesterol synthesis Part B: Signs and Symptoms of Heart Failure Match the following signs or symptoms (number) to the failing side of the heart (letter) that is causing it. Sign/Symptom Side of Heart Failure 1. Dry cough A. Left-side heart failure 2. Peripheral edema B. Right-side heart failure 3. Crackles 4. Hepatomegaly 5. Jugular vein distention 6. Dyspnea 7. Splenomegaly 8. Orthopnea Part E: Inflammatory and Infectious Cardiovascular Disorders Match the word (letter) with its definition (number). Word A. Induration with superficial vein thrombophlebitis B. Emboli C. Infective endocarditis D. Pericarditis E. Rheumatic heart disease Definition 1. Vein may feel like a cord 2. Sac surrounding the heart is inflamed 3. Inflammation of the heart lining caused by microorganism 4. Solid, liquid, gaseous masses of undissolved matter traveling with the current in a blood or lymphatic vessel 5. Severe damage to the heart from rheumatic fever REVIEW QUESTIONS—CONTENT REVIEW Choose the best answer unless directed otherwise. A. For a patient who experiences anaphylactic shock after receiving a medication, which of the following symptoms would the nurse anticipate? Select all that apply. 1. Chest pain 2. Hot, dry skin 3. Wheezing 4. Fever 5. Hypotension 6. Stridor B. The nurse is caring for a patient whose extremity may be fractured. Which of the following is the nurse's purpose in checking capillary refill of the extremity? 1. To evaluate arterial blood flow in the extremity 2. To evaluate venous blood flow in the extremity 3. To measure oxygen saturation of the blood 4. To identify peripheral edema C. During data collection, which of the following findings would indicate to the nurse that severe blood loss has occurred? 1. Normal, bounding pulse 2. Slow, strong pulse 3. Rapid, thready pulse 4. Slow, bounding pulse REVIEW QUESTIONS—TEST PREPARATION D. Which of the following monitoring is a priority for the nurse when caring for a patient with botulism exposure? 1. Gag reflex 2. Pupil response 3. Corneal reflex 4. Babinski response E. The nurse anticipates that treatment for an unconscious patient who has ingested 50 tablets of alprazolam (Xanax), a non-caustic substance, could include which of the following? 1. Administering an antiemetic 2. Administering activated charcoal 3. Administering an emetic 4. Encouraging fluids F. The nurse is caring for a patient who has hyperthermia. Which of the following indicates to the nurse that treatment has been effective? 1. Skin is cool and moist to touch. 2. Patient is alert and oriented. 3. Core body temperature is less than 94°F (34.4°C). 4. Core body temperature is greater than 101°F (38.3°C) G. The health care provider orders haloperidol (Haldol) 3 mg intramuscularly for a patient who is experiencing a psychiatric crisis. Haloperidol 5 mg/mL is available. How many milliliters should the nurse give? 1. 0.3 mL 2. 0.5 mL 3. 0.6 mL 4. 1.3 mL H. The nurse is collecting data on a patient with a large bleeding laceration. Which of the following vital sign data requires immediate action by the nurse? 1. Thready pulse at 116 2. Strong pulse at 84 3. Regular pulse at 60 4. Bounding pulse at 76 I. The nurse is admitting a trauma patient to the emergency department. Place in order of priority the areas for which data are collected as the nurse performs the primary survey. Use all options. 1. Circulation 2. Breathing 3. Airway 4. Disability 5. Exposure J. The nurse is caring for a patient who is bleeding from the radial artery. The nurse is applying direct pressure to the radial artery and has elevated the arm, but the wound continues to bleed. Which of the following actions should the nurse take immediately? 1. Apply pressure to the carotid artery. 2. Apply pressure to the brachial artery. 3. Apply pressure to the femoral artery. 4. Apply pressure to the temporal artery. K. The nurse is caring for a patient after anthrax exposure who has a hemorrhagic, necrotic cutaneous lesion and is febrile. Which of the following items is important for the nurse to use while providing care to the patient? Select all that apply. 1. Mask 2. Gown 3. Gloves 4. Hair net 5. Fit-tested N95 respirator 6. Shoe covers L. The nurse is caring for a patient with a narcotic overdose who is to receive naloxone (Narcan). Which observations of the patient would indicate to the nurse that the medication was effective? Select all that apply. 1. No response to verbal stimuli 2. Oriented to person and place 3. Follows commands 4. No response to painful stimuli 5. Hand grasps equal and strong 6. Pupils fixed M. The nurse is caring for a patient who was submerged in fresh water and nearly drowned. The nurse would evaluate treatment as being effective if the patient exhibited which of the following? Select all that apply. 1. Alertness 2. Apnea 3. Lethargy 4. Tachypnea 5. Respiratory rate of 16 6. Regular respiratory pattern

Part A: Pharmacological Treatment 

1. Epitfibatide (Integrilin) --> F. Antiplatelet
2. Metoprolol (Lopressor) --> C. Beta blocker
3. Nitroglycerin --> A. Drug of choice for angina attacks
4. Heparin --> G. Does not dissolve existing clots
5. Cholestyramine (Questran) --> B. Bile acid sequestrant
6. Clopidogrel (Plavix) --> H. Glycoprotein IIb/IIIa inhibitor
7. Atorvastatin (Lipitor) --> J. Reduces cholesterol synthesis
8. Reteplase (Retavase) --> E. Thrombolytic
9. Amlodipine (Norvasc) --> D. Calcium channel blocker
10. Isosorbide Dinitrate (Isordil) --> I. Long acting nitrate

 

Part B: Signs and Symptoms of Heart Failure

1. Dry cough --> A. Left-side heart failure

2. Peripheral edema --> B. Right-side heart failure

3. Crackles --> A. Left-side heart failure

4. Hepatomegaly --> B. Right-side heart failure

5. Jugular vein distention --> B. Right-side heart failure

6. Dyspnea --> A. Left-side heart failure

7. Splenomegaly --> B. Right-side heart failure

8. Orthopnea --> A. Left-side heart failure

 

Part E:

A. Induration with superficial vein thrombophlebitis --> 1. Vein may feel like a cord

B. Emboli --> 4. Solid, liquid, gaseous masses of undissolved matter traveling with the current in a blood or lymphatic vessel

C. Infective endocarditis --> 3. Inflammation of the heart lining caused by microorganism

D. Pericarditis --> 2. Sac surrounding the heart is inflamed

E. Rheumatic heart disease --> 5. Severe damage to the heart from rheumatic fever

 

A. For a patient who experiences anaphylactic shock after receiving a medication, which of the following symptoms would the nurse anticipate? Select all that apply. 

3. Wheezing

5. Hypotension

6. Stridor

 

B. The nurse is caring for a patient whose extremity may be fractured. Which of the following is the nurse's purpose in checking capillary refill of the extremity?

1. To evaluate arterial blood flow in the extremity

 

C. During data collection, which of the following findings would indicate to the nurse that severe blood loss has occurred?

3. Rapid, thready pulse

 

D. Which of the following monitoring is a priority for the nurse when caring for a patient with botulism exposure?

1. Gag reflex

 

E. The nurse anticipates that treatment for an unconscious patient who has ingested 50 tablets of alprazolam (Xanax), a non-caustic substance, could include which of the following? 

2. Administering activated charcoal

 

F. The nurse is caring for a patient who has hyperthermia. Which of the following indicates to the nurse that treatment has been effective? 

2. Patient is alert and oriented.

 

G. The health care provider orders haloperidol (Haldol) 3 mg intramuscularly for a patient who is experiencing a psychiatric crisis. Haloperidol 5 mg/mL is available. How many milliliters should the nurse give? 

3. 0.6 mL

 

H. The nurse is collecting data on a patient with a large bleeding laceration. Which of the following vital sign data requires immediate action by the nurse?

1. Thready pulse at 116

 

I. The nurse is admitting a trauma patient to the emergency department. Place in order of priority the areas for which data are collected as the nurse performs the primary survey. Use all options. 

3. Airway

2. Breathing

1. Circulation

4. Disability

5. Exposure

 

J. The nurse is caring for a patient who is bleeding from the radial artery. The nurse is applying direct pressure to the radial artery and has elevated the arm, but the wound continues to bleed. Which of the following actions should the nurse take immediately? 

2. Apply pressure to the brachial artery. 

 

K. The nurse is caring for a patient after anthrax exposure who has a hemorrhagic, necrotic cutaneous lesion and is febrile. Which of the following items is important for the nurse to use while providing care to the patient? Select all that apply. 

2. Gown

3. Gloves

4. Hair net 

 

L. The nurse is caring for a patient with a narcotic overdose who is to receive naloxone (Narcan). Which observations of the patient would indicate to the nurse that the medication was effective? Select all that apply.

2. Oriented to person and place 

3. Follows commands 

5. Hand grasps equal and strong

 

M. The nurse is caring for a patient who was submerged in fresh water and nearly drowned. The nurse would evaluate treatment as being effective if the patient exhibited which of the following? Select all that apply. 

1. Alertness

5. Respiratory rate of 16 

6. Regular respiratory pattern

Step-by-step explanation

A. Symptoms of anaphylaxis usually involve more than one part of the body such as the skin, mouth, eyes, lungs, heart, gut, and brain. Some symptoms include skin rashes and itching and hives, swelling of the lips, tongue or throat, shortness of breath, trouble breathing, wheezing (whistling sound during breathing). Chest pain, hot dry skin, and fever are not really common in anaphylaxis.

 

B. Arterial blood flow is assessed with capillary refill. (2, 3, 4) are not assessed with capillary refill.

 

C.   A rapid, thready pulse indicates compensation (rapid) and loss of blood volume (thready). (1, 2, 4) are incorrect. 

 

D. Morbidity and mortality are usually from pulmonary aspiration secondary to loss of the gag reflex. (2, 3, 4) are neurologic signs that would occur later with complications. The nurse's priority is monitoring that will prevent complications from occurring.

 

E. Activated charcoal might be given in this severe case to help absorb the medication. (1, 2, 4) would not be appropriate for a semiconscious patient.

 

F. Patient is alert and oriented. (1, 3, 4) are incorrect. Core body temperature should be within normal range. Skin should be warm and dry, not moist.

G. This is the formula we use:

Let us apply this formula in our question. 3 mg is our desired dose ordered by the provider and 5 mg of Haloperidol is the stock on hand.

(3 mg/5 mg) × 1 mL = 3/5 = 0.6 mL

 

H.  A rapid, thready pulse indicates compensation (rapid) and loss of blood volume (thready) requiring intervention by the nurse. (2) is a normal pulse finding. (3) This pulse rate is slow; tachycardia is expected with large amounts of blood loss. (4) A bounding pulse would not be noted with hemorrhage.

 

I. The primary survey is the initial assessment and management of a trauma patient. It is conducted to detect and treat actual or imminent life threats and prevent complications from these injuries. A systematic approach using ABCDE is used. Airway is the first priority;  you need to check that the airway is open and clear. Next is breathing; you now need to check if the casualty is breathing normally by placing your ear above their mouth, looking down their body and listening for sounds of breathing and see if you can feel their breath on your cheek. Next is circulation; once you have established they are breathing, look and check for any signs of severe bleeding. Next is disability: this entails assessing the neurological status. Lastly, exposure: for example, the chest should be fully exposed and inspected for any open wounds.

 

J.  The brachial artery is the proximal artery to the radial artery. (1, 3, 4) are not the most proximal arteries to the radial artery.

 

K. Because anthrax is not passed from person to person, it is not necessary to take airborne or droplet precautions when in close proximity to an infected individual, and there is no need to provide prophylaxis to close contacts of an infected patient.

 

L. Naloxone is a medicine that rapidly reverses an opioid overdose. It attaches to opioid receptors and reverses and blocks the effects of other opioids. Good response to naloxone is heralded when there is a normal neurological assessment.

 

M. The mechanism in acute drowning is hypoxemia and irreversible cerebral anoxia due to submersion in liquid. Rescue breaths as well as chest compressions are critical for successful resuscitation of these victims. Most drowning victims will have sustained cardiac arrest secondary to hypoxia. Therefore, to evaluate adequate treatment, the patient should show alertness, normal respiratory rate (12- 20 breaths per minute) and regular respiratory pattern.

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