AACN CMC EXAM QUESTIONS

AACN CMC EXAM QUESTIONS

WITH 100% VERIFIED ANSWERS

Question : While caring for a patient with an IABP at 3:1, the

nurse notes:

• decreasing urine output as well as increasing BUN and CR

levels; the nurse should increase timing to 2:1

• absent pulses in the proximal extremity; the nurse should

apply pressure at the insertion site.

• blood in the IABP tubing; the nurse should disconnect the

balloon catheter from the IABP.

• blood oozing from the insertion site; the nurse should

anticipate the need for an emergency fasciotomy.

CORRECT ANSWER : A. incorrect. decreasing urine output

with increasing BUN and CR levels with an IABP in place indicates obstruction of the renal arteries. The nurse should plan for removal. B. incorrect. absent pulses distal to the insertion site indicates complete occlusion of the femoral artery. application of pressure to the insertion site will worsen the obstruction. C. correct. blood in the IABP tubing indicates a rupture of the balloon. Continuing to allow the IABP to inflate and deflate will increase the size of the rupture, causing more bleeding. the nurse should plan for removal or

exchange of the IABP catheter. D. incorrect. a fasciotomy would be indicated if the patient had an increase in fluid accumulation in the extremities causing significant injury to the limb.

Question : An IABP is currently at 3:1 when the patient suddenly goes into ventricular fibrillation. In addition to

resuscitative measures, the nurse should:

• change the trigger to internal or pressure support

resuscitative measures.

B. increase timing back to 1:1 to increase coronary artery

perfusion pressure.

• put the pump on standby until the return of spontaneous

circulation.

D. assess the IABP timing to chest compressions at 1:2.

CORRECT ANSWER : A. correct. the IABP will not be able

to time correctly when a patient is in V-Fib. by placing the system to trigger on internal or pressure support, it will generate off the pressure created during compressions. B.

incorrect. attempting to time the IABP back to 1:1 will be

counterproductive, as it will not be able to trigger correctly.

• incorrect. there is significant risk of clot forming on the

IABP when placed in stand for an indeterminate amount of time. D. incorrect. the primary goal during resuscitative measures is to attempt to circulate blood volume as effectively as possible. assessing the timing of the IABP is unnecessary.

Question : The nurse is reviewing the home medications list

for a patient admitted c/o severe chest pain. serial EKGs and blood testing are negative, so an exercise stress test is scheduled. which of the following medications may result in a false-positive finding on the stress test?

• digitalis (Digoxin)
• potassium chloride (K-Dur)
• sotalol (Betapace)
• diltiazem (Cardiazem)

CORRECT ANSWER : A. correct. digitalis can cause false-

positive EKG changes during a stress test. there is an association between the development of ST segment depression during stress testing. the mechanism of this EKG change is not clear. further, digitalis should be withheld on the day of the test because of its negative chronotropic effects.

• incorrect. C & D. incorrect. beta-blockers and calcium

channel blockers blunt the heart rate response to exercise and may prevent achievement of maximum predicted heart rate.they should be withheld on the day of the test.

Question : A patient is admitted with elevated troponin levels

and ST segment elevation in leads II, III, and aVF.Administration of which of the following should the nurse anticipate initially?

• enoxaparin (Lovenox)
• streptokinase (Strepase)
• alteplase (Activase)
• reteplase (Retavase)

CORRECT ANSWER : A. incorrect. enoxaparin is an

alternative to heparin in patients with unstable angina, NSTEMI or DVT. B. incorrect. streptokinase is indicated for acute arterial thrombosis or embolism, or occluded AV cannulas. C. incorrect. alteplase in indicated for acute ischemic stroke or acute massive pulmonary embolism. D.correct. reteplase is indicated for AMI when fibrinolytics are indicated.