Cardiac questions...

[gabriellegoss]

I just took my cardiac test today. 2 questions in particular are bothering me...

1. A nurse is caring for a patient who had just had a cardiac cath performed. Which of the following assessment findings would require immediate intervention?

A. Cold extremities bilaterally

B. New onset of slurred speech.

I chose A, but everyone I have spoken to has argued that B is the correct answer. Here is my rational for why I chose A, and not B.

I know that one of the complications of a cardiac cath is a thromboembolic event. This includes a stroke, and slurred speech is a sign of a stroke. However, a patient that is undergoing a cardiac cath will be sedated. In my experience, in the immediate post-op period (which is what I am assuming this question was referring to, because of the word "JUST"), the effects of the sedative (whichever one was used) would still be apparent, and the patient's speech will be slurred.

On the other hand, I know that your priority is to assess the patient's effected leg in contrast to the unaffected leg. However, I chose B because if something had happened in the heart that caused a dysrhythmia during the cardiac cath, or if bleeding was occuring internally, Cardiac Output would be decreased, thus decreasing perfusion to the BOTH lower extremities.

2. A nurse on a Tele floor walks into a patient's room to find the patient on the bathroom floor, clutching his chest. The patient is ashen and diaphoretic. What is the FIRST thing the nurse would do?

A. Measure Sp02

B. Go check the ECG monitor

C. Call for the RRT

I chose C. Here is why.

A. If a patient is ashen, they are not receiving enough oxygen, therefor a pulse ox is not going to be very helpful in this situation

B. If I were to walk into a room with a patient lying on the floor, seemingly having a heart attack, I would not leave the room to go take a look at his ECG

C. The RRT team can be of much help in this situation.

What do you guys think?

[nurseprnRN, BSN, RN]

One fer two.

1. "Cold" is not enough to warrant fast intervention. Had they said, "Cold, pulseless," that would be another matter. It's chilly in the cath lab, they get room temperature (cold) IV fluids, and people come back with cold hands and feet all the time. Note that some people reading this question will remember that a risk of cardiac cath is arterial embolus to the leg where they inserted the cath femorally; this will make them jump on B as the answer, as you did. However, they would be wrong, because a) it doesn't say "one leg," b) it doesn't say pulseless or pale, and c) it says (all, bilateral) extremities, plural, not just one. Nobody said anything about dysrhythmias, sedation, or evidence of bleeding, either. You ave read far to much into the question, plus you bit the bait on the common complication.

Any new onset change in neuro signs is a stat report; the answer is B.

2. C, absolutely. Calling for help is number one when you find someone with signs of MI.

[hodgieRN]

New onset slurred speech is by far the highest priority. Every seconds count with stroke. The clock start ticking at last seen normal, not at first assessment. Brain is more important than limb.

I look at this an intervention question. SpO2 and ECG monitor are assessment answers. Calling the RRT is an invention. In BLS, the first thing you do is tell someone to "call 911," then you proceed with compressions. In this situation, you call the RRT and then proceed.

[FineAgain]

Plus to me, the key word in the first question is "new" onset of slurred speech. Post anesthesia slurring (if any) would have been assessed in PACU. Just my two cents.

[nurseprnRN, BSN, RN]

Plus to me, the key word in the first question is "new" onset of slurred speech. Post anesthesia slurring (if any) would have been assessed in PACU. Just my two cents.

Maybe the question assumes the nurse is the first person to see this patient after he rolls out of the cath lab, regardless. Can't make assumptions with these kinds of questions.