1. A pt present to the ED with complaints of chest pain. The 12-lead EKG reveals
ST segment elevation in leads I and aVL. The initial BP is 112/69 and decreases
to a systolic of 60 mmHg following a dose of nitroglycerin 0.4mg SL. The next
most appropriate intervention is to:
A. Complete a f...
CEN Exam 3 Questions and Answers 1. A pt present to the ED with co mplaints of chest pain. The 12 -lead EKG reveals ST segment elevation in leads I and aVL. The initial BP is 112/69 and decreases to a systolic of 60 mmHg following a dose of nitroglycerin 0.4mg SL. The next most appropriate intervention is to: A. Complete a fibrinolytic check sheet B. Initiate a dopamine drip for blood pressure control C. Obtain a R sided EKG D. Administer a 0.9% NS bolus IV Ans- D. Administer a 0.9% NS bolus IV Pts can be sensitive to vasodilation effects of nitroglycerin. Initial i ntevention is the administration of a fluid bolus for the hypotension that occurs secondary to nitroglycerin 2. A pt presents to the triage nurse complaining of a sudden onset of chest pressure that has never been experienced before. The 12 lead EKG shows ST segment elevation in leads V1 -V6. This ST segment pattern is consistent with an occlusion in which coronary artery?: A. Left anterior descending artery B. Circumflex descending artery C. Posterior descending artery D. Right coronary artery Ans- A. Left anterior descending artery Occlusion of the LAD will show ST segment elevation in the septal (V1 -V2), anterior (V3 -V4), and lateral (I, aVL, V5 -V6) leads 3. A 68 y/o female presents to the ED with weakness, lightheadedness and nausea. She has not felt well for the past several hours but had to complete her workday before seeking medical care. She denies the presence of chest pain or shortness of breath. The most appropriate intervention during bedside triage is to: A. Instruct the pt to chew 325mg of ASA B. Complete the triage process, including obtaining past medical history, current medications and family history C. Obtain vascular access and draw necessary lab studies specific to cardiac biomarkers D. Preform a 12 lead EKG Ans- D. Preform a 12 lead EKG The pt is describing an atypical acute coronary syndrome (ACS) presentation. Women have a unique presentation of signs and symptoms, and their care is at risk of being delayed because of lack of early recognit ion. The 12 lead EKG should be completed within 10 mins of arrival at the ED 4. Which symptom points toward a diagnosis of abdominal aortic aneurysm?: A. Pulsatile mass B. Distant heart sounds C. Hypertension D. Subcutaneous emphysema Ans- A. Pulsat ile mass Although the presence of a pulsatile mass in the abdomen may not always occur in a pt with a AAA, when present, the nurse shoud be highly suspiscious of AAA and intervene immediately. Bedside ultrasound can assist in a rapid diagnosis 5. A pt ar rives to the ED and collapses in front of the triage desk. The pt does not have a pulse and is not breathing. CPR is initiated and the cardiac monitor displays ventricular tachycardia. The immediate action by the ED nurse is to?: A. Administer Amniodarone (Cordarone) 150mg IV B. Synchronize cardioversion with 200 J C. Defibrillate using biphasic defibrillator with 120 -200J D. Administer Sodium Bicarbonate 1 mEq/kg Ans- C. Defibrillate using biphasic defibrilator with 120 -200J
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