A patient develops increasing dyspnea and hypoxemia 2 days after heart surgery. What procedure should the nurse anticipate assisting with to determine whether the patient has acute respiratory distress syndrome (ARDS) or pulmonary edema caused by heart failure?

Insertion of a pulmonary artery catheter

Obtaining a ventilation-perfusion scan

Drawing blood for arterial blood gases

Positioning the patient for a chest x-ray

Answer and Explanation

The Correct Answer is A

A. The insertion of a pulmonary artery catheter can help in assessing hemodynamic parameters and distinguishing between these two conditions. It provides direct measurement of pulmonary artery pressures, which can be elevated in the case of heart failure.

B. A ventilation-perfusion (V/Q) scan is used to evaluate ventilation and perfusion in the lungs. While it can help identify areas of ventilation-perfusion mismatch, it may not be the most appropriate initial test for distinguishing between ARDS and pulmonary edema.

C. Drawing blood for arterial blood gases is also a critical step as it helps in assessing the severity of hypoxemia and respiratory failure.

D. A chest x-ray can show the presence of bilateral opacities, which are indicative of ARDS when cardiac failure or fluid overload is not the primary cause. However, transthoracic echocardiography (TTE) is often performed to seek evidence of cardiac dysfunction when cardiogenic pulmonary edema cannot be excluded by clinical evaluation, laboratory findings, or imaging.

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Correct Answer is B

Explanation

B Metformin is an oral antidiabetic medication commonly used to treat type 2 diabetes. There is a potential risk of lactic acidosis when metformin is used in conjunction with contrast material, particularly in patients with underlying renal impairment. Contrast-induced nephropathy can exacerbate renal dysfunction, leading to increased levels of metformin and potentially increasing the risk of lactic acidosis. Therefore, metformin use before or after contrast administration should be carefully monitored, and in some cases, temporarily discontinued to reduce the risk of lactic acidosis.

A Atorvastatin is a statin medication commonly used to lower cholesterol levels. It does not have a direct interaction with contrast material used in cardiac catheterization. Therefore, it does not place the client at risk for acute kidney injury related to contrast-induced nephropathy (CIN).

C Carvedilol is a beta-blocker medication used to treat high blood pressure and heart failure. It does not have a direct interaction with contrast material used in cardiac catheterization. Therefore, it does not place the client at risk for acute kidney injury related to contrast-induced nephropathy (CIN).

D Nitroglycerin is a medication commonly used to relieve chest pain (angina) in patients with coronary artery disease. It does not have a direct interaction with contrast material used in cardiac catheterization. Therefore, it does not place the client at risk for acute kidney injury related to contrast- induced nephropathy (CIN).

A. Cardiac disease B. Renal insufficiency C. Stroke D. Familial hypercholesterolemia E. Atrial fibrillation F. Isolated systolic hypertension

Correct Answer is ["A","B","C","E"]

Explanation

A. Chronic hypertension is a significant risk factor for the development of various cardiac diseases, including coronary artery disease, left ventricular hypertrophy, heart failure, and arrhythmias. The increased workload on the heart caused by hypertension can lead to myocardial remodeling, impaired cardiac function, and ultimately heart disease.

B. Chronic hypertension can cause damage to the kidneys over time, leading to renal insufficiency or chronic kidney disease. The elevated blood pressure damages the delicate blood vessels in the kidneys, impairing their ability to filter waste products and regulate fluid and electrolyte balance. Persistent hypertension can ultimately lead to kidney dysfunction and renal failure.

C. Hypertension is a major risk factor for the development of stroke, particularly ischemic stroke (caused by a blockage in a blood vessel supplying the brain) and hemorrhagic stroke (caused by bleeding into the brain). Chronic hypertension can damage blood vessels in the brain, leading to the formation of blood clots or weakening of vessel walls, increasing the risk of stroke.

E. Chronic hypertension is a significant risk factor for the development of atrial fibrillation, a type of irregular heart rhythm characterized by rapid and chaotic electrical activity in the upper chambers of the heart (atria). The structural changes in the heart caused by hypertension, such as left atrial enlargement and fibrosis, can predispose individuals to atrial fibrillation.

D. Familial hypercholesterolemia is a genetic disorder characterized by high levels of LDL cholesterol in the blood. While chronic hypertension itself does not directly cause familial hypercholesterolemia, hypertension and hypercholesterolemia are often comorbid conditions that contribute to cardiovascular risk. Both conditions can lead to atherosclerosis, increasing the risk of heart disease and stroke.

F. Isolated systolic hypertension refers to elevated systolic blood pressure with normal diastolic blood pressure. While isolated systolic hypertension itself is a manifestation of hypertension, it is not a direct result of end-organ damage. However, if left untreated, isolated systolic hypertension can lead to complications such as stroke, heart failure, and kidney disease, which are consequences of end-organ damage from chronic hypertension.

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A patient develops increasing dyspnea and hypoxemia 2 days after heart surgery. What procedure should the nurse anticipate assisting with to determine whether the patient has acute respiratory distress syndrome (ARDS) or pulmonary edema caused by heart failure?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is collecting a medication history from a client who is scheduled to have a cardiac catheterization. Which of the following medications taken by the client interacts with contrast material and places the client at risk for acute kidney injury?

Correct Answer is B

Explanation

Which is(are) potential result(s) of end-organ damage from chronic hypertension? (Select all that apply.)

Correct Answer is ["A","B","C","E"]

Explanation

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