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","C"]

Explanation

B. stroke volume is the amount of blood ejected from the left ventricle with each contraction (systole) of the heart. Changes in stroke volume directly affect cardiac output. An increase in stroke volume leads to an increase in cardiac output, while a decrease in stroke volume results in a decrease in cardiac output. Factors that can affect stroke volume include preload, afterload, and contractility of the heart.

C. Heart rate refers to the number of heartbeats per minute. Heart rate directly affects cardiac output by determining how frequently the heart contracts and pumps blood. An increase in heart rate (tachycardia) leads to an increase in cardiac output, while a decrease in heart rate (bradycardia) results in a decrease in cardiac output. Factors such as sympathetic and parasympathetic nervous system activity, hormones, and medications can influence heart rate.

A. Respiratory rate does not directly affect stroke volume or heart rate but changes in respiratory rate can indirectly impact cardiac output through their effects on venous return and preload.

D. Blood pressure represents the force exerted by the blood against the walls of the arteries. While blood pressure does not directly affect cardiac output, it is influenced by cardiac output and systemic vascular resistance (SVR).

A. Provide 02 at 100% per non-rebreather mask. B. Initiate continuous electrocardiogram (ECG) monitoring C. Draw blood to type and crossmatch for transfusions. D. Insert two large-bore IV catheters.

Correct Answer is A

Explanation

A The first intervention should be to ensure adequate oxygenation, as hypoxia can exacerbate shock. Therefore, providing oxygen at 100% via a non-rebreather mask is the most critical initial step. This intervention helps to maximize the amount of oxygen delivered to the patient's lungs and subsequently to the rest of the body, supporting vital organ function while further assessments and interventions are prepared.

B Continuous ECG monitoring allows for the assessment of the patient's heart rhythm, rate, and any signs of dysrhythmias or cardiac ischemia. This intervention is important for detecting any life- threatening arrhythmias, such as ventricular tachycardia or fibrillation, which may require immediate intervention. While ECG monitoring is important, it may not be the highest priority intervention.

C Drawing blood for type and crossmatch is important for preparing for potential blood transfusions if significant blood loss is suspected. However, this intervention may take some time to process, and immediate stabilization of the patient's condition is paramount.

D Large-bore IV catheters allow for rapid infusion of fluids to restore intravascular volume and improve tissue perfusion. This intervention is critical for stabilizing the patient's hemodynamic status and takes precedence in the management of shock. However, oxygenation should take priority.

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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

Which of the following factors can directly affect cardiac output?

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

Explanation

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Correct Answer is A

Explanation

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