Patients in end-stage cardiomyopathy often exhibit which of the following symptoms of right-sided heart failure?
JVD stands for jugular venous distension, which is a sign of increased pressure in the right atrium and the superior vena cava. Hepatomegaly means enlargement of the liver, which can occur due to congestion of blood in the portal vein and the hepatic vein. Both JVD and hepatomegaly are common symptoms of right-sided heart failure, as they indicate fluid retention and backup in the systemic circulation12. Hypotension and oliguria are not specific to right-sided heart failure, as they can also occur in left-sided heart failure or other conditions that affect the cardiac output and renal perfusion. Hypertension and polyuria are unlikely to be seen in right-sided heart failure, as they indicate increased blood pressure and urine output, which are opposite to the effects of reduced cardiac function and fluid overload. Pulmonary edema and restlessness are more characteristic of left-sided heart failure, as they indicate fluid accumulation and impaired gas exchange in the lungs12.
Which of the following suggests acute peripheral arterial insufficiency?
Acute peripheral arterial insufficiency typically presents with sudden, severe pain at rest, which may be accompanied by other signs such as pallor, paresthesia, paralysis, pulselessness, and poikilothermia (the six P's). This condition indicates a critical reduction in blood flow to the affected extremity, requiring immediate medical attention. Reference: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.
A patient with a history of asthma presents with acute onset of dyspnea, a non-productive cough, and tachypne
a. He is very anxious, restless, and tachycardic. Which of the following is a first-line drug for these symptoms?
Beta-agonists are the first-line drugs for acute asthma exacerbations because they rapidly reverse bronchoconstriction and improve airflow. They act by stimulating beta-2 receptors in the smooth muscle of the airways, causing relaxation and dilation. Beta-agonists can be administered by inhalation, nebulization, or injection. Examples of beta-agonists include albuterol, levalbuterol, and terbutaline.
Management of Acute Asthma Exacerbations | AAFP: This article states that ''Quick-relief medicines include: Albuterol (ProAir HFA, Proventil-HFA, Ventolin HFA, others). Levalbuterol (Xopenex, Xopenex HFA).''
Asthma attack - Diagnosis and treatment - Mayo Clinic: This article states that ''If you're in the yellow zone, the plan will tell you how many puffs of your quick-relief medicine to take and how often you can repeat the dose. Young children or people who have difficulty with an inhaler use a device called a nebulizer to inhale the medicine in a mist. Quick-relief medicines include: Albuterol (ProAir HFA, Proventil-HFA, Ventolin HFA, others). Levalbuterol (Xopenex, Xopenex HFA).''
A patient admits to a nurse that he has struggled with depression and feelings of isolation and abandonment since moving into a nursing home last year,
but he has recently started taking an anti-depressant. The patient states, "Sometimes it takes everything I've got just to go on each day." Which of the
following is the nurse's best initial response?
This is the nurse's best initial response, as it expresses empathy, validates the patient's feelings, and assesses the patient's risk of suicide. Depression is a common and serious mental health condition that affects older adults, especially those living in nursing homes. Depression can cause persistent sadness, hopelessness, loss of interest, and suicidal thoughts or behaviors. The nurse should screen the patient for depression using a validated tool, such as the Patient Health Questionnaire (PHQ-9) 1, and ask about any suicidal ideation or plans. The nurse should also provide emotional support, education, and referral to appropriate resources for the patient.
B . ''Those feelings should resolve when the medication you've started has a chance to take effect.''
This is not the nurse's best initial response, as it dismisses the patient's feelings, implies that the patient just needs to wait for the medication to work, and does not address the patient's psychosocial needs. Antidepressants are one of the treatment options for depression, but they may take several weeks to show their full effect, and they may not work for everyone. The nurse should also explore other factors that may contribute to the patient's depression, such as social isolation, loss of autonomy, chronic illness, or grief, and offer interventions that may help the patient cope, such as counseling, psychotherapy, cognitive-behavioral therapy, or social activities.
C . ''I understand how you feel. We all get that way when we're depressed.''
This is not the nurse's best initial response, as it assumes that the nurse knows how the patient feels, minimizes the patient's experience, and generalizes the patient's condition. Depression is not a normal or inevitable part of aging, and it affects each person differently. The nurse should not compare the patient's feelings to their own or to others, but rather acknowledge and respect the patient's unique perspective and situation. The nurse should also avoid using words like ''we'' or ''you'' that may create a sense of distance or judgment, and instead use words like ''I'' or ''me'' that may convey a sense of empathy or rapport.
D . ''Have you talked to anyone about what is bothering you?''
This is not the nurse's best initial response, as it may sound like the nurse is trying to avoid listening to the patient, or that the patient is bothering the nurse with their problems. The nurse should not imply that the patient should talk to someone else, but rather show interest and willingness to listen to the patient. The nurse should also use open-ended questions that invite the patient to share more, such as ''How are you feeling today?'' or ''What has been on your mind lately?'' The nurse should also use active listening skills, such as nodding, paraphrasing, reflecting, or summarizing, to demonstrate understanding and engagement.
A patient has been declared brain dead. A nurse would like the family to consider organ donation but has never requested this from a family before. The best initial action by the nurse is to
When a patient has been declared brain dead, the appropriate initial action for a nurse who has not previously discussed organ donation with a family is to consult the organ donation liaison. These professionals are trained to handle sensitive conversations about organ donation and can provide the necessary support and information to the family, ensuring that the process is handled respectfully and in accordance with legal and ethical guidelines. Reference: =
CCRN (Adult) Certification Review Course Online: Professional Caring and Ethical Practice.
American Association of Critical-Care Nurses (AACN). (2024). CCRN Exam Handbook. Retrieved from AACN CCRN Exam Handbook
Adult CCRN/CCRN-E/CCRN-K Certification Review Course Online. AACN
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