Review Practice Exercise 3

Emergency Nursing Principles and Management > Adult Health

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Practice Exercise 3

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Total Questions : 5

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Question 1:

A. Immediately following the return of spontaneous circulation (ROSC) in a patient, which of the following are primary goals of post-resuscitation care? Select all that apply

A. Optimizing ventilation and oxygenation. B. Identifying and treating the underlying cause of the cardiac arrest. C. Maintaining a systolic blood pressure below 90 mmHg to prevent organ damage. D. Inducing therapeutic hypothermia in all patients. E. Performing a detailed neurological assessment.

Answer and Explanation

Choice A:

Optimizing ventilation and oxygenation: Adequate oxygen delivery is critical to prevent secondary brain injury and organ dysfunction after cardiac arrest. Oxygen saturation should be kept between 94–99% to avoid both hypoxia and hyperoxia, which can be harmful.

Choice B:

Identifying and treating the underlying cause of the cardiac arrest: Addressing reversible causes such as myocardial infarction, electrolyte imbalances, or pulmonary embolism prevents recurrence. This step is essential for long-term survival and improved patient outcomes.

Choice C:

Maintaining a systolic blood pressure below 90 mmHg to prevent organ damage: Hypotension reduces perfusion to the brain and heart, worsening post-arrest injury. The target is to maintain systolic BP ≥ 90 mmHg or MAP ≥ 65 mmHg to support organ function.

Choice D:

Inducing therapeutic hypothermia in all patients: Targeted temperature management is not appropriate for every post-ROSC patient; it is mainly used in comatose patients to reduce neurological injury. Awake, responsive patients generally do not require this intervention.

Choice E:

Performing a detailed neurological assessment: Neurological status provides important information about the extent of brain recovery and guides further interventions. This includes assessing consciousness, pupil reaction, and motor responses.Rationale for incorrect answers:

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Question 2:

What is the primary benefit of targeted temperature management in post-resuscitation care for comatose patients?

A. It prevents a secondary cardiac arrest. B. It reduces cerebral metabolic rate and protects the brain from ischemic injury. C. It improves a patient's renal function. D. It is a definitive treatment for the underlying cause of the arrest.

Answer and Explanation

Choice A:

It prevents a secondary cardiac arrest: While TTM may stabilize some physiological processes, its primary purpose is neuroprotection, not direct prevention of another arrest.

Choice B:

It reduces cerebral metabolic rate and protects the brain from ischemic injury: Cooling slows neuronal metabolism, decreases oxygen demand, and reduces the cascade of chemical reactions that lead to further brain cell death after ischemia. This improves the likelihood of better neurological recovery.Rationale for incorrect answers:

Choice C:

It improves a patient's renal function: TTM does not directly improve kidney function; post-arrest renal issues are managed with supportive care and treatment of underlying causes.

Choice D:

It is a definitive treatment for the underlying cause of the arrest: TTM does not treat the cause of arrest; it is an adjunctive therapy alongside investigations and interventions to correct the cause.

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Question 3:

Which of the following are key components of hemodynamic support in the post-resuscitation period? Select all that apply

A. Titrating vasopressors to maintain a mean arterial pressure (MAP) greater than 65 mmHg. B. Administering a large bolus of IV fluids to all patients. C. Monitoring for signs of cardiogenic shock. D. Using an EKG to monitor for myocardial ischemia and arrhythmias. E. Avoiding the use of inotropes to prevent an increase in myocardial oxygen demand.

Answer and Explanation

Choice A:

Titrating vasopressors to maintain a MAP greater than 65 mmHg: Adequate blood pressure supports oxygen delivery to vital organs, particularly the brain and heart. Vasopressors like norepinephrine are adjusted to meet individual patient needs.

Choice B:

Administering a large bolus of IV fluids to all patients: Fluid therapy should be individualized; excessive fluids can worsen outcomes, especially in patients with poor cardiac function.

Choice C:

Monitoring for signs of cardiogenic shock: Cardiac arrest survivors are at high risk for pump failure, so early identification of hypotension, low urine output, or poor perfusion is critical for timely intervention.

Choice D:

Using an EKG to monitor for myocardial ischemia and arrhythmias: Continuous monitoring helps detect rhythm disturbances or ischemic changes, guiding both acute management and prevention of re-arrest.Rationale for incorrect answers:

Choice E:

Avoiding the use of inotropes to prevent an increase in myocardial oxygen demand: Inotropes may be necessary in cases of low cardiac output despite adequate preload and afterload; their use is guided by patient status, not avoided outright.

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Question 4:

A nurse is performing a neurological assessment on a patient who remains unresponsive after ROSC. The nurse notes the absence of the gag reflex, and the pupils are fixed and dilated. These findings indicate:

A. The patient is likely to have a full neurological recovery. B. The patient is likely suffering from a mild concussion. C. Significant anoxic brain injury has occurred. D. The patient is responding normally to sedation.

Answer and Explanation

Choice A:

The patient is likely to have a full neurological recovery: The absence of key brainstem reflexes strongly predicts poor neurological outcome, not recovery.

Choice B:

The patient is likely suffering from a mild concussion: A concussion does not cause fixed, dilated pupils or absent brainstem reflexes; these are signs of severe injury.

Choice C:

Significant anoxic brain injury has occurred: After cardiac arrest, prolonged lack of oxygen can cause widespread neuronal death, particularly affecting brainstem reflexes. Fixed, dilated pupils and absent gag reflex indicate severe brain injury, which often has a poor recovery outcome.Rationale for incorrect answers:

Choice D:

The patient is responding normally to sedation: Sedation may depress some reflexes, but fixed and dilated pupils with absent gag reflex generally indicate structural brain injury rather than drug effects, especially if sedation has worn off.

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Question 5:

When managing ventilation for a post-resuscitation patient, what is the recommended target for a partial pressure of carbon dioxide (PCO2)?

A. Hypocarbia (PCO2 less than 35 mmHg) to cause cerebral vasoconstriction. B. Hypercarbia (PCO2 greater than 45 mmHg) to cause cerebral vasodilation. C. Maintaining normocarbia (PCO2 between 35-45 mmHg) to avoid cerebral ischemia or edema. D. There is no specific target for PCO2 as it does not affect cerebral blood flow.

Answer and Explanation

Choice A:

Hypocarbia (PCO₂ less than 35 mmHg) to cause cerebral vasoconstriction: While hypocarbia does cause vasoconstriction, it reduces cerebral blood flow and can worsen ischemia.

Choice B:

Hypercarbia (PCO₂ greater than 45 mmHg) to cause cerebral vasodilation: Hypercarbia increases intracranial pressure due to vasodilation, which can exacerbate cerebral edema.

Choice C:

Maintaining normocarbia (PCO₂ between 35–45 mmHg) to avoid cerebral ischemia or edema: Normocarbia supports stable cerebral perfusion without causing excessive vasoconstriction or vasodilation. Tight control of ventilation helps protect the brain after ROSC.Rationale for incorrect answers:

Choice D:

There is no specific target for PCO₂ as it does not affect cerebral blood flow: This is incorrect because PCO₂ directly influences cerebral vessel diameter and blood flow.

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