NU335 Spring 2026 T2 CA CV Disorder Shock Emergency at Baton Rogue General School of Nursing
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Free NU335 Spring 2026 T2 CA CV Disorder Shock Emergency at Baton Rogue General School of Nursing Questions
A nurse is assessing a patient for a suspected anaphylactic reaction following administration of contrast media. Which finding requires an immediate nursing intervention?
- Urticaria
- Stridor
- Vomiting
- Hypotension
Explanation
Explanation
Stridor is a high-pitched, wheezing sound typically caused by upper airway obstruction, and it is a severe and life-threatening sign of anaphylaxis. This indicates respiratory distress and suggests that the airway is compromised. Stridor should be treated as an emergency in a patient with suspected anaphylaxis, as the airway can become completely obstructed, leading to respiratory failure. Immediate action, including administration of epinephrine, oxygenation, and possible airway management (e.g., intubation), is required。Correct Answer Is:
B. StridorA trauma patient in hypovolemic shock is brought to the emergency department. The nurse initiates two peripheral IV sites and begins fluid resuscitation with which fluids?
- Dextran
- D5W in 45% saline
- 3.0% saline
- 0.9% saline
Explanation
Explanation
In hypovolemic shock, the goal of fluid resuscitation is to restore circulating blood volume and improve tissue perfusion. The first-line fluid for initial resuscitation is typically 0.9% saline (normal saline), which is an isotonic crystalloid solution. This solution is used to expand blood volume and maintain electrolyte balance without significantly altering the osmolarity of the blood. It is safe, effective, and widely available for initial fluid resuscitation in trauma and shock situations。Correct Answer Is:
D. 0.9% salineThe nurse is caring for a patient who needs a valve replacement with a mechanical valve. Which information does the nurse need to include in patient teaching prior to surgery?
- Information regarding lifelong anticoagulation therapy.
- Antibiotic therapy for 6-8 weeks post-operative.
- Avoiding rigorous activity three years post-operative.
- Yearly EKG readings after valve replacement.
Explanation
Explanation
Patients who receive a mechanical heart valve are required to undergo lifelong anticoagulation therapy because mechanical valves carry a higher risk of forming blood clots. Anticoagulants like warfarin are commonly prescribed to reduce the risk of clot formation, and it is essential for the patient to be educated on the importance of regular monitoring (such as INR levels), adjusting medication dosages, and the long-term management of anticoagulation therapy. Proper education will help prevent complications such as stroke or embolism。Correct Answer Is:
A. Information regarding lifelong anticoagulation therapy.The nurse evaluates a patient with a newly implanted pacemaker. Based upon the EKG strip which area of the heart is being paced? See attachment.
- A Ventricle
- B Atrium
- C Atrioventricular node
- D Sinoatrial node
Explanation
Explanation
The presence of a paced spike followed by a wide QRS complex suggests that the pacemaker is pacing the ventricle. In ventricular pacing, the pacemaker stimulates the ventricle to contract, which is shown by the wide QRS complex that follows the pacing spike, as the electrical impulse travels through the ventricles instead of the normal conduction system。Correct Answer Is:
A. VentricleA patient has a 5-cm thoracic aortic aneurysm that was discovered during a routine chest x-ray. When obtaining a nursing history from the patient, it will be most important to ask about which symptom?
- Back or lumbar pain
- Difficulty swallowing
- Abdominal tenderness
- Changes in bowel habits
Explanation
Explanation
A thoracic aortic aneurysm (TAA) is an enlargement of the aorta in the chest area. One of the common symptoms associated with thoracic aortic aneurysms is back or lumbar pain. As the aneurysm enlarges, it may exert pressure on nearby structures, including nerves or tissues in the back, which can cause discomfort. The patient may report pain or tenderness in the back or lumbar region as a result of the aneurysm. It is important for the nurse to assess for this type of pain, as it could indicate progression or rupture of the aneurysm。Correct Answer Is:
A. Back or lumbar painA nurse in the emergency department is caring for a client who has acute toxicity from acetaminophen overdose. The nurse should prepare to administer which medication?
- Naloxone
- Acetylcysteine
- Flumazenil
- Vitamin K
Explanation
Explanation
Acetaminophen toxicity is a common cause of liver damage and acute liver failure, and the treatment of choice for acetaminophen overdose is acetylcysteine. Acetylcysteine works as a mucolytic agent and serves as a precursor to glutathione, which helps detoxify the harmful metabolite of acetaminophen, N-acetyl-p-benzoquinone imine (NAPQI). When administered early (ideally within 8 hours of the overdose), acetylcysteine significantly reduces the risk of liver damage and improves survival outcomes。Correct Answer Is:
B. AcetylcysteineThe nurse's priority in the care of a patient with a suspected acute aortic dissection will include which intervention to prevent rupture?
- Reduce anxiety.
- Increase myocardial contractility.
- Control blood pressure.
- Monitor for chest pain.
Explanation
Explanation
The priority intervention in the management of acute aortic dissection is to control blood pressure, specifically reducing systolic blood pressure to 120 mmHg or lower and managing heart rate to decrease the shearing forces on the aorta. Uncontrolled high blood pressure can increase the risk of rupture or worsening of the dissection, making it the most critical intervention to prevent further damage and improve the patient’s outcomes. Medications such as beta-blockers or vasodilators may be used to control blood pressure and reduce the strain on the aorta。Correct Answer Is:
C. Control blood pressure.A patient with tumor lysis syndrome is taking allopurinol. Which laboratory value should the nurse monitor to determine the effectiveness of the medication?
- Serum phosphate
- Uric acid level
- Serum potassium
- Blood urea nitrogen
Explanation
Explanation
Allopurinol is used in the management of tumor lysis syndrome (TLS), a condition where rapid cell destruction releases large amounts of uric acid into the bloodstream. Allopurinol works by inhibiting xanthine oxidase, the enzyme responsible for converting purines into uric acid. The nurse should monitor the uric acid level to assess the effectiveness of allopurinol in reducing uric acid levels, which helps to prevent the development of uric acid nephropathy (kidney damage caused by uric acid crystals) and other complications of TLS。Correct Answer Is:
B. Uric acid levelA patient diagnosed with pericarditis develops cardiac tamponade. Which collaborative intervention should the nurse anticipate for this patient?
- Diuretics
- Chest tube
- Paracentesis
- Pericardiocentesis
Explanation
Explanation
Cardiac tamponade occurs when there is an accumulation of fluid (usually blood or inflammatory fluid) in the pericardial sac, which exerts pressure on the heart and impairs its ability to pump effectively. The most effective and emergency treatment for relieving tamponade is pericardiocentesis, a procedure where a needle is used to aspirate the fluid from the pericardial sac. This immediately reduces the pressure on the heart, improving cardiac function and hemodynamic stability. This procedure is performed under imaging guidance, usually at the bedside, to avoid further complications。Correct Answer Is:
D. PericardiocentesisA patient experiences a lethal ventricular tachycardia. After aggressive resuscitation, the patient is revived with neurological status restored. What treatment would the nurse expect for this patient?
- Temporary pacemaker
- Intra-aortic balloon pump
- Permanent pacemaker
- Implantable cardioverter-defibrillator
Explanation
Explanation
A lethal ventricular tachycardia (VT) is a life-threatening arrhythmia that can cause sudden cardiac arrest if not treated immediately. After resuscitation and neurological recovery, the patient is at high risk for recurrent episodes of VT or other dangerous arrhythmias. An implantable cardioverter-defibrillator (ICD) is the most appropriate treatment to prevent sudden cardiac death. The ICD continuously monitors the heart's rhythm and can deliver a shock to restore normal rhythm if it detects a dangerous arrhythmia like VT or ventricular fibrillation。Correct Answer Is:
D. Implantable cardioverter-defibrillatorHow to Order
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