Your STEMI patient returns from the Cath lab, after having Balloon Angioplasty percutaneously through their femoral artery. Which of the following Signs and Symptoms would be indicative of Cardiac Tamponade?
Low blood pressure
Bounding peripheral pulses
Beck's Triad
Clear S1, S2 heart sounds
Jugular veins are distended
Correct Answer : A,C,E
A. As the heart's ability to pump blood is compromised, blood pressure decreases.
B. Bounding pulses are associated with increased cardiac output, which is opposite to what occurs in cardiac tamponade.
C. Beck's Triad: This classic triad includes hypotension, muffled heart sounds, and jugular venous distention, all indicative of cardiac tamponade.
D. Muffled heart sounds are a characteristic of cardiac tamponade due to the fluid accumulation around the heart.
E. Jugular veins are distended: The increased pressure in the right atrium due to impaired ventricular filling leads to distended jugular veins.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. While the patient may experience pain, it is not the immediate priority. The primary concern is the possibility of the opioid effects returning, leading to respiratory depression.
B. Patient education is important, but it should be done after the patient is stable and out of immediate danger.
C. Building rapport is important, but the patient's immediate physiological needs take precedence.
D. Naloxone has a short half-life, meaning its effects can wear off before the opioid does. The patient needs to be closely monitored for signs of returning respiratory depression, which can be fatal.
Correct Answer is A
Explanation
A. Skinny, muscle-wasted appearance is more characteristic of emphysema, another type of COPD. Patients with chronic bronchitis often have a more ruddy complexion due to chronic hypoxia.
B. Dependent edema can occur due to right-sided heart failure, which is a complication of chronic bronchitis.
C. Production of large amounts of sputum is a hallmark symptom of chronic bronchitis.
D. Cyanotic Skin tone is also a common finding in patients with chronic bronchitis due to chronic hypoxia.
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