NURSING CLINICALS
Cardio/Neuro Unit
Review Exam
Q&A
2024
,1. A 65-year-old male patient with a history of hypertension, diabetes and
smoking is admitted to the hospital with chest pain and shortness of
breath. He is diagnosed with acute myocardial infarction (AMI) and is
scheduled for percutaneous coronary intervention (PCI). Which of the
following nursing interventions is most appropriate for this patient before
the procedure?
a) Administer oxygen, aspirin, nitroglycerin and morphine as prescribed.
b) Monitor vital signs, cardiac rhythm and oxygen saturation
continuously.
c) Educate the patient about the procedure, risks and benefits, and obtain
informed consent.
d) All of the above.*
Rationale: The patient with AMI needs immediate treatment to restore
blood flow to the ischemic myocardium and prevent further damage.
Oxygen, aspirin, nitroglycerin and morphine are given to reduce the
oxygen demand of the heart, prevent platelet aggregation, dilate the
coronary arteries and relieve pain. Vital signs, cardiac rhythm and oxygen
saturation are monitored to assess the patient's hemodynamic status and
detect any complications such as arrhythmias, hypotension or hypoxia.
Education and informed consent are essential to ensure that the patient
understands the procedure and its risks and benefits, and agrees to undergo
it.
2. A 50-year-old female patient with a history of migraine headaches is
admitted to the hospital with sudden onset of severe headache, nausea,
vomiting and photophobia. She is diagnosed with subarachnoid
hemorrhage (SAH) due to a ruptured cerebral aneurysm. Which of the
following nursing interventions is most appropriate for this patient during
the acute phase?
a) Elevate the head of the bed to 30 degrees and maintain a quiet and dark
environment.
b) Administer antihypertensive, anticonvulsant and analgesic medications
as prescribed.
c) Monitor neurological status, vital signs, intracranial pressure (ICP) and
fluid balance frequently.
d) All of the above.*
Rationale: The patient with SAH needs to be managed in a way that
, prevents further bleeding, reduces ICP, prevents seizures and relieves
pain. Elevating the head of the bed to 30 degrees helps to reduce venous
pressure and ICP, while maintaining a quiet and dark environment reduces
sensory stimuli that can trigger vasospasm or increase ICP.
Antihypertensive medications are given to lower blood pressure and
prevent rebleeding, anticonvulsant medications are given to prevent
seizures that can increase ICP or cause ischemia, and analgesic
medications are given to relieve pain and reduce anxiety. Neurological
status, vital signs, ICP and fluid balance are monitored frequently to
assess the patient's condition and detect any complications such as
hydrocephalus, cerebral edema or vasospasm.
3. A 40-year-old male patient with a history of epilepsy is admitted to the
hospital with recurrent tonic-clonic seizures. He is prescribed phenytoin
(Dilantin) as an anticonvulsant medication. Which of the following
nursing interventions is most appropriate for this patient while taking this
medication?
a) Monitor serum phenytoin levels regularly and adjust the dosage
accordingly.
b) Teach the patient to take the medication at the same time every day and
not to miss any doses.
c) Advise the patient to practice good oral hygiene and visit the dentist
regularly.
d) All of the above.*
Rationale: Phenytoin is a commonly used anticonvulsant medication that
can cause adverse effects such as gingival hyperplasia, nystagmus, ataxia,
rash and hepatotoxicity. Serum phenytoin levels need to be monitored
regularly and the dosage adjusted accordingly to maintain therapeutic
levels (10-20 mcg/mL) and avoid toxicity (>30 mcg/mL). The patient
should take the medication at the same time every day and not miss any
doses to prevent breakthrough seizures or withdrawal symptoms. The
patient should also practice good oral hygiene and visit the dentist
regularly to prevent or treat gingival hyperplasia, which is a common side
effect of phenytoin.
4. A 60-year-old female patient with a history of atrial fibrillation (AF) is
admitted to the hospital with dyspnea, fatigue and palpitations. She is
prescribed warfarin (Coumadin) as an anticoagulant medication. Which of
Cardio/Neuro Unit
Review Exam
Q&A
2024
,1. A 65-year-old male patient with a history of hypertension, diabetes and
smoking is admitted to the hospital with chest pain and shortness of
breath. He is diagnosed with acute myocardial infarction (AMI) and is
scheduled for percutaneous coronary intervention (PCI). Which of the
following nursing interventions is most appropriate for this patient before
the procedure?
a) Administer oxygen, aspirin, nitroglycerin and morphine as prescribed.
b) Monitor vital signs, cardiac rhythm and oxygen saturation
continuously.
c) Educate the patient about the procedure, risks and benefits, and obtain
informed consent.
d) All of the above.*
Rationale: The patient with AMI needs immediate treatment to restore
blood flow to the ischemic myocardium and prevent further damage.
Oxygen, aspirin, nitroglycerin and morphine are given to reduce the
oxygen demand of the heart, prevent platelet aggregation, dilate the
coronary arteries and relieve pain. Vital signs, cardiac rhythm and oxygen
saturation are monitored to assess the patient's hemodynamic status and
detect any complications such as arrhythmias, hypotension or hypoxia.
Education and informed consent are essential to ensure that the patient
understands the procedure and its risks and benefits, and agrees to undergo
it.
2. A 50-year-old female patient with a history of migraine headaches is
admitted to the hospital with sudden onset of severe headache, nausea,
vomiting and photophobia. She is diagnosed with subarachnoid
hemorrhage (SAH) due to a ruptured cerebral aneurysm. Which of the
following nursing interventions is most appropriate for this patient during
the acute phase?
a) Elevate the head of the bed to 30 degrees and maintain a quiet and dark
environment.
b) Administer antihypertensive, anticonvulsant and analgesic medications
as prescribed.
c) Monitor neurological status, vital signs, intracranial pressure (ICP) and
fluid balance frequently.
d) All of the above.*
Rationale: The patient with SAH needs to be managed in a way that
, prevents further bleeding, reduces ICP, prevents seizures and relieves
pain. Elevating the head of the bed to 30 degrees helps to reduce venous
pressure and ICP, while maintaining a quiet and dark environment reduces
sensory stimuli that can trigger vasospasm or increase ICP.
Antihypertensive medications are given to lower blood pressure and
prevent rebleeding, anticonvulsant medications are given to prevent
seizures that can increase ICP or cause ischemia, and analgesic
medications are given to relieve pain and reduce anxiety. Neurological
status, vital signs, ICP and fluid balance are monitored frequently to
assess the patient's condition and detect any complications such as
hydrocephalus, cerebral edema or vasospasm.
3. A 40-year-old male patient with a history of epilepsy is admitted to the
hospital with recurrent tonic-clonic seizures. He is prescribed phenytoin
(Dilantin) as an anticonvulsant medication. Which of the following
nursing interventions is most appropriate for this patient while taking this
medication?
a) Monitor serum phenytoin levels regularly and adjust the dosage
accordingly.
b) Teach the patient to take the medication at the same time every day and
not to miss any doses.
c) Advise the patient to practice good oral hygiene and visit the dentist
regularly.
d) All of the above.*
Rationale: Phenytoin is a commonly used anticonvulsant medication that
can cause adverse effects such as gingival hyperplasia, nystagmus, ataxia,
rash and hepatotoxicity. Serum phenytoin levels need to be monitored
regularly and the dosage adjusted accordingly to maintain therapeutic
levels (10-20 mcg/mL) and avoid toxicity (>30 mcg/mL). The patient
should take the medication at the same time every day and not miss any
doses to prevent breakthrough seizures or withdrawal symptoms. The
patient should also practice good oral hygiene and visit the dentist
regularly to prevent or treat gingival hyperplasia, which is a common side
effect of phenytoin.
4. A 60-year-old female patient with a history of atrial fibrillation (AF) is
admitted to the hospital with dyspnea, fatigue and palpitations. She is
prescribed warfarin (Coumadin) as an anticoagulant medication. Which of
