Understanding The Essentials of Critical Care Nursing 2Nd Edition Perrin Test Bank Full Chapter PDF

Understanding the Essentials of Critical
Care Nursing 2nd Edition Perrin Test

Bank
Visit to download the full and correct content document: https://testbankdeal.com/dow
nload/understanding-the-essentials-of-critical-care-nursing-2nd-edition-perrin-test-ban
k/
Perrin, Understanding the Essentials of Critical Care Nursing, 2/e
Chapter 7
Question 1
Type: MCSA
When teaching a patient with heart failure about ventricular remodeling, the nurse should recognize that
additional teaching is needed if the patient makes which statement? "Remodeling:
1. Leads to progressive worsening of heart function."
2. Can be described as an enlargement of the pumping chamber."
3. Occurs with an increase in blood pressure and results in weight gain."
4. Develops primarily because the heart is pumping harder."
Correct Answer: 4
Rationale 1: This is a correct statement about remodeling and no additional teaching is required.
Rationale 2: This is a correct statement about remodeling and no additional teaching is required.
Rationale 3: The long-term activation of sympathetic nervous system and the renin-angiotensin-aldosterone
system can lead to an increase in blood pressure and weight gain. This is a correct statement about remodeling and
no additional teaching is required.
Rationale 4: The heart is not pumping harder but rather the contractility or elasticity of the left ventricle is
decreased or stiffer in nature. This statement indicates more teaching is required.
Global Rationale:
Cognitive Level: Analyzing

Client Need: Physiological Integrity
Client Need Sub: Reduction of Risk Potential
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 7-1: Explain the pathophysiologic and neurohormonal mechanisms of heart failure.
Question 2
Type: MCMA
The nurse is reviewing a patient's medical history. Which factors in the history most likely contributed to the
patient's development of heart failure?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Perrin, Understanding the Essentials of Critical Care Nursing, 2/e Test Bank
Copyright 2012 by Pearson Education, Inc.
Standard Text: Select all that apply.
1. Hypertension
2. Diabetes mellitus
3. Drinking one or two alcoholic drinks daily
4. Being overweight
5. Ischemic heart disease
Correct Answer: 1,5
Rationale 1: Hypertension is identified as an etiology of heart failure.
Rationale 2: Diabetes is not a known cause of heart failure.
Rationale 3: Drinking moderately is not a known cause of heart failure.
Rationale 4: Being overweight is not a direct contributing factor to the development of heart failure.
Rationale 5: Ischemia to the heart is a known cause of heart failure.
Global Rationale:

Client Need Sub: Physiological Adaptation
Nursing/Integrated Concepts: Nursing Process: Assessment
Question 3
Type: MCSA
The nurse is assessing a patient for heart failure (HF). Which early findings would indicate decreased cardiac
output and a potential for fluid overload from heart failure?
1. Orthopnea, peripheral edema, crackles
2. Dizziness, syncope, palpitations
3. Pallor and/or cyanosis of extremities
4. PAWP of 12 and CVP of 6
Correct Answer: 1
Rationale 1: These symptoms reflect decreasing perfusion and accumulation of fluid in the pulmonary system,
which is not being effectively circulated by a failing heart.
Rationale 2: Dizziness, syncope, and palpitations are symptoms of end-organ hypoperfusion, not fluid overload.
These symptoms represent later symptoms of hypoxia from less blood being carried to distal organs, especially
the brain and the heart. The pulmonary backup of fluid occurs before the hypoxia.
Rationale 3: Pallor and/or cyanosis are seen in end-organ hypoperfusion, not a fluid overload situation. Distal
areas do not receive adequate arterial blood flow and the tissue becomes hypoxic quickly, which causes the pallor
or cyanosis from venous stasis.
Rationale 4: Pulmonary arterial wedge pressure and central venous pressure would increase with fluid overload
because the pressure of additional fluids must be overcome to circulate the blood.
Global Rationale:

Learning Outcome: 7-3: Differentiate between the manifestations of left- and right-sided heart failure.
Question 4
Type: MCSA
Which assessment finding indicates that a patient's heart failure (HF) is worsening?
1. An increase in O2 saturation to greater than 90%
2. A decrease in heart rate to 66 bpm
3. The onset of atrial fibrillation
4. Louder S1 and S2 heart sounds
Correct Answer: 3
Rationale 1: Oxygenation saturations will decline to less than 90% and not increase to more than 90%. Declining
O2 saturation levels reflect deteriorating pulmonary status from a buildup of fluids with pulmonary edema.
Rationale 2: Tachycardia increases to compensate for the decreasing O2 levels by trying to circulate what cells
are present, but at the same time increases the O2 demand by increased cardiac functioning.
Rationale 3: As heart failure continues to progress, less oxygenation occurs all over the body, especially the
myocardium, which is sensitive to the hypoxia and will result in dysrhythmias such as ventricular ectopy or atrial
fibrillation.
Rationale 4: The S1 and S2 sounds remain the same.
Global Rationale:

Question 5
Type: MCSA
A patient is very short of breath. Which finding should cause the nurse to be concerned that the shortness of
breath might be due to heart failure?
1. An echocardiogram that reflected increased right ventricular wall thickening
2. A B-type natriuretic peptide (BNP) of 300 pg/mL
3. A left ventricular ejection fraction (VEF) of 50%
4. A serum sodium of 135
Correct Answer: 2
Rationale 1: Echocardiogram would reflect left ventricular hypertrophy, not right ventricular enlargement.
Rationale 2: A BNP greater than 100 pg/mL suggests heart failure as a cause of dyspnea.
Rationale 3: Many patients with heart failure will have a reduced ejection fraction of less than 40%.
Rationale 4: Hyponatremia is commonly found in the patient with heart failure.
Global Rationale:

Learning Outcome: 7-4: Describe the hemodynamic findings indicative of heart failure
Question 6
Type: MCSA
Which finding would support the diagnosis of heart failure (HF)?

1. RA/CVP of 8 mm Hg
2. PAWP of 20 mm Hg
3. Cardiac index of 3
4. Peripheral vasodilation reflected by normalizing capillary refill times
Correct Answer: 2
Rationale 1: The RA/CVP are increased with rising pressures to push through the inadequate pumping that occurs
with heart failure from systemic venous pressure elevations from ascites and peripheral edema.
Rationale 2: With heart failure the backup of fluid from inadequate pumping results in increased PAWP because
the heart has to pump harder to push through the rising capillary pressures on the venous side from peripheral
edema and ascites.
Rationale 3: Cardiac output is decreased with heart failure because the preload volume continues to rise with a
less efficient pump to remove the blood.
Rationale 4: Peripheral vasoconstriction occurs and capillary refills are sluggish and delayed.
Global Rationale:

Learning Outcome: 7-4: Describe the hemodynamic findings indicative of heart failure.
Question 7
Type: MCSA
After teaching a patient with heart failure about beta blocking agents, the nurse recognizes that additional teaching
is needed when the patient states, "While taking the medication, I will:
1. Weigh myself every day."
2. Check my blood sugar regularly."
3. Notify my health care provider if I become increasingly short of breath."
4. Monitor myself daily for an increased heart rate and blood pressure."
Correct Answer: 4
Rationale 1: This is a correct statement that does not require additional instruction.
Rationale 4: Beta blocking agents will decrease the heart rate and blood pressure. This statement indicates that
additional teaching is needed.
Global Rationale:

Client Need Sub: Pharmacological and Parenteral Therapies
Learning Outcome: 7-5: Explain collaborative management of the patient with heart failure.
Question 8
Type: MCSA
The nurse should explain to a patient in heart failure that an aldosterone antagonist works by:
1. Reducing sodium and water retention
2. Filtering potassium out with the water in the renal tubules
3. Promoting the excretion of the urinary waste products urea and creatinine
4. Retaining calcium to improve the condition of blood vessels in the glomeruli
Correct Answer: 1
Rationale 1: An aldosterone antagonist removes water through the excretion of sodium and water through the
renal tubules.
Rationale 2: This is not the mechanism of an aldosterone antagonist.
Global Rationale:
Cognitive Level: Applying

Nursing/Integrated Concepts: Nursing Process: Implementation
Question 9
Type: MCSA
What would the nurse not expect to find in a patient who was experiencing acute decompensated heart failure
with pulmonary edema?
1. Dyspnea at rest, peripheral edema
2. Hypertension, bradycardia
3. Increased coughing, crackles
4. Decreased O2 saturation, increased PAWP
Correct Answer: 2
Rationale 1: These are symptoms of acute decompensated heart failure with pulmonary edema.
Rationale 2: Hypertension and bradycardia are not symptoms of pulmonary edema.
Rationale 3: Fluid can be heard on chest auscultation and coughing will increase when attempting to try to clear
the passageways of the backed-up fluid.
Rationale 4: Due to fluid in the capillary beds, less perfusion and ventilation occur, which lead to hypoxia and
increased pressures in the pulmonary artery.
Global Rationale:

Learning Outcome: 7-6: Describe the patient with acute decompensated heart failure.
Question 10
Type: MCSA
A patient in heart failure is to be started on an infusion of dobutamine (Dobutrex). What is most important for the
nurse to assess before starting the infusion? The patient's:
1. Breath sounds
2. Blood pressure
3. Level of consciousness
4. Urine output
Correct Answer: 2
Rationale 1: Breath sounds are not the most important for the nurse to assess before starting this infusion.
Rationale 2: Prior to initiation, before each titration, and at the peak action of dobutamine, the nurse must assess
blood pressure, heart rate, respiratory rate, and oxygen saturation. Frequent assessment of these parameters should
continue throughout the infusion period.
Rationale 3: Level of consciousness is not the most important for the nurse to assess before starting this infusion.
Rationale 4: Urine output is not the most important for the nurse to assess before starting this infusion.
Global Rationale:

Learning Outcome: 7-7: Describe collaborative management strategies appropriate for the patient with acute
decompensated heart failure.
Question 11
Type: MCSA
A patient in heart failure is being given a first dose of lisinopril (Prinivil) 10 mg PO. Which finding would cause
the nurse to question the administration of the first dose?
1. Heart rate 92 beats per minute
2. Blood pressure 100/72
3. Potassium 5.7 mEq/dL
4. Urine output 35 mL/hr
Correct Answer: 3
Rationale 1: This would not cause the nurse to question the first dose of the medication.
Rationale 3: Ace inhibitors increase the serum potassium and a further increase from 5.7 could be problematic so
the nurse should question the administration of this medication.
Global Rationale:

Nursing/Integrated Concepts: Nursing Process: Planning
Question 12
Type: MCMA
An 82-year-old patient is readmitted for heart failure (HF) 1 week after being discharged for the same diagnosis.
Which findings most likely contributed to the patient’s readmission?
1. Not knowing how or when to take medications
2. Not prescribed appropriate medications, including ACE inhibitors and beta blockers
3. No record of body weight since discharge
4. Not filling prescribed medications
5. Received the pneumococcal immunization during the last hospitalization
Correct Answer: 1,2,3,4
Rationale 1: Some studies indicate that older patients with heart failure have poor knowledge of appropriate
medication management.
Rationale 2: There is evidence that a significant number of older adults with heart failure do not receive
evidence-based, AHA-recommended care including angiotensin-converting enzymes (ACE) inhibitors and beta
blockers.
Rationale 3: Patient records indicate that daily weights are not consistently obtained.
Rationale 4: Pharmacy records indicate that prescriptions are not promptly refilled.
Rationale 5: Pneumococcal immunization is recommended and would not contribute to a readmission for the
diagnosis of heart failure.
Global Rationale:
Question 13
Type: MCSA
The nurse is caring for a patient with acute decompensated heart failure (HF) receiving BiPAP. While caring for
this patient, the nurse’s priority will be to:
1. Monitor the expiratory time to be sure that it always exceeds the inspiratory time.
2. Ensure that the mask does not fit too tightly on the patient's face to prevent skin breakdown.
3. Prepare for endotracheal intubation because BiPAP is used primarily to buy time for intubation.
4. Assess the patient for the development of gastric distention, nausea, and vomiting.
Correct Answer: 4
Rationale 1: This is not something that the nurse needs to monitor for the patient receiving BiPAP.
Rationale 2: Although important, this is not a priority for the nurse when caring for the patient receiving BiPAP.
Rationale 3: BiPAP provides end-expiratory pressure, further decreasing the work of breathing. It is not used
primarily to buy time for intubation.
Rationale 4: The nurse must assess the patient for complications resulting from this delivery method to include
gastric distention, nausea, vomiting, and aspiration.
Global Rationale:

Question 14
Type: MCSA
What is the most appropriate position for a patient in pulmonary edema with a blood pressure of 194/92?
1. Sitting upright with legs dependent
2. Dorsal recumbent
3. Head of the bed elevated 60 degrees
4. Torso flat, feet elevated
Correct Answer: 1
Rationale 1: A patient with a blood pressure of 194/92 is able to sit upright. Sitting upright with legs dependent
allows the patient to breathe more comfortably and prevents fluid from accumulating as easily in the lungs.
Rationale 2: This position would not aid with respiratory effort.
Rationale 3: Fluid still may accumulate in the lungs with the patient in this position.
Rationale 4: This position will encourage the accumulation of fluid in the patient’s lungs and increase dyspnea.
Global Rationale:

Question 15
Type: MCSA
The nurse notes that the QRS duration of a patient with a biventricular pacemaker is widening? What does this
most likely indicate?
1. Worsening of the patient's underlying cardiomyopathy
2. Loss of ventricular capture
3. Loss of ventricular synchronization
4. Battery failure
Correct Answer: 3
Rationale 1: This is not an indication that the patient’s underlying condition is getting worse.
Rationale 2: This does not indicate loss of ventricular capture.

Rationale 3: Widening of the QRS duration from the baseline may indicate a loss of ventricular synchronization.
Rationale 4: This does not indicate battery failure.
Global Rationale:

Question 16
Type: MCSA
A patient with heart failure has a decreasing cardiac output. The nurse will expect compensatory mechanisms to
be activated in order to:
1. Decrease the heart rate
2. Maintain perfusion to vital organs
3. Cause arteriolar vasodilation in nonessential vascular beds
4. Inhibit the release of aldosterone
Correct Answer: 2
Rationale 1: Compensatory mechanisms will increase the heart rate.
Rationale 2: As the heart function fails and cardiac output decreases, compensatory mechanisms are activated to
maintain perfusion to the vital organs.
Rationale 3: Compensatory mechanisms will cause arteriolar vasoconstriction in nonessential vascular beds.
Rationale 4: Compensatory mechanisms will lead to the release of aldosterone.
Global Rationale:

Question 17
Type: MCMA
While caring for a patient in heart failure, the nurse assesses an elevated blood pressure and significant peripheral
edema. These symptoms are caused by the renin-angiotensin-aldosterone system which:
1. Releases angiotensin II
2. Releases aldosterone
3. Decreases cardiac output
4. Decreases heart rate
5. Causes arteriolar vasodilation
Correct Answer: 1,2
Rationale 1: Activation of the renin-angiotensin-aldosterone system increases vasoconstriction through the

release of angiotensin II, a potent vasoconstrictor.
Rationale 2: Activation of the renin-angiotensin-aldosterone system increases water and sodium reabsorption
through the release of aldosterone.
Rationale 3: Activation of the renin-angiotensin-aldosterone system does not decrease cardiac output.
Rationale 4: Activation of the renin-angiotensin-aldosterone system does not decrease heart rate.
Rationale 5: Activation of the renin-angiotensin-aldosterone system does not cause arteriolar vasodilation.
Global Rationale:

Question 18
Type: MCMA
A patient is diagnosed with left-sided heart failure. When describing this disease process to the patient, the nurse
will include:
1. Pumping action of the heart is impaired.
2. Filling action of the heart is impaired.
3. Blood backs up in the left side of the heart.
4. Extra fluid can build up in the lungs.
5. Extra fluid can build up in the lower extremities.
Rationale 1: In left-sided heart failure, the pumping action or systolic action of the left ventricle is impaired.
Rationale 2: In left-sided heart failure, the ability of the left ventricle to fill or diastolic action of the left ventricle
is impaired.
Rationale 3: In left-sided heart failure, blood backs up from the left ventricle to the left atrium.
Rationale 4: In left-sided heart failure, fluid eventually builds up in the lungs.
Rationale 5: Extra fluid does not build up in the lower extremities in left-sided heart failure.
Global Rationale:

Learning Outcome: 7-2: Compare and contrast systolic and diastolic dysfunction.
Question 19
Type: MCMA
A patient is diagnosed with diastolic heart failure. The nurse realizes this type of heart failure is caused by:

1. Normal sized but hypertrophied left ventricle
2. Blood backing up into the right atrium
3. Loss of ventricular diastolic relaxation
4. Blood backing up into the left atrium
5. Excessive fluid in the lower extremities
Correct Answer: 1,2,3
Rationale 1: Diastolic dysfunction occurs when the ventricle is normal sized by hypertrophied.
Rationale 2: In diastolic heart failure, blood backs up from the right ventricle to the right atrium.
Rationale 3: In diastolic heart failure there is a loss of left ventricular diastolic relaxation.
Rationale 4: Blood does not back up into the left atrium in diastolic heart failure.
Rationale 5: Excessive fluid in the lower extremities does not cause diastolic heart failure.
Global Rationale:

Learning Outcome: 7-2: Compare and contrast systolic and diastolic dysfunction.
Question 20
Type: MCMA
Which finding would cause the nurse to suspect a patient with heart failure was experiencing end organ
hypoperfusion?
1. Confusion
2. Dropping blood pressure
3. Urine output 15 mL per hour
4. Heart rate 124
5. Peripheral edema
Rationale 1: Confusion is a manifestation of end organ hypoperfusion.
Rationale 2: Hypotension is a manifestation of end organ hypoperfusion.
Rationale 3: Decreased urinary output is a manifestation of end organ hypoperfusion.
Rationale 4: Tachycardia is a manifestation of end organ hypoperfusion.
Rationale 5: Peripheral edema is a manifestation of volume overload.
Global Rationale:

Question 21
Type: MCMA
While transferring a patient with heart failure from the bed to a chair the nurse stops and decides to keep the
patient in bed. What patient manifestations indicated to the nurse this patient’s status was deteriorating?
1. Respiratory rate 30
2. Heart rate 134 on the cardiac monitor
3. Gasping for breath
4. Productive cough
5. Jugular vein distention
Rationale 1: Tachypnea is an indication of worsening heart failure.
Rationale 2: Tachycardia is an indication of worsening heart failure.
Rationale 3: Dyspnea is an indication of worsening heart failure.
Rationale 4: A productive cough is not an indication that the heart failure is becoming worse.
Rationale 5: Jugular vein distention is not an indication that the heart failure is becoming worse.
Global Rationale:

Question 22
Type: MCSA
The central venous pressure of a patient with heart failure is slowly increasing. What does this finding suggest to
the nurse?
1. Right heart function is deteriorating.
2. Left heart function is deteriorating.
3. Fluid is backing up in the lungs.
4. Right heart function is improving.
Correct Answer: 1
Rationale 1: Elevations in right filling pressures, such as the central venous pressure, can cause systemic venous
pressure elevations leading to peripheral edema and ascites. These are symptoms of right heart failure.
Rationale 2: Elevated central venous pressure is not an indication of left heart function.
Rationale 3: An elevated central venous pressure does not assess left heart function.
Rationale 4: An elevated central venous pressure would indicate that right heart function is deteriorating and not
improving.
Global Rationale:

Question 23
Type: MCSA
A patient with heart failure begins to cough pink frothy sputum. Which pressure would the nurse assess to
confirm this manifestation?
1. Central venous pressure
2. Pulmonary capillary wedge pressure
3. Arterial pressure
4. Right arterial pressure
Correct Answer: 2
Rationale 1: Central venous pressure would not be used to confirm the patient’s symptom.
Rationale 2: The pulmonary capillary wedge pressure would be elevated in pulmonary edema. This is the
pressure that the nurse would assess to confirm the patient’s symptom.
Rationale 3: The arterial pressure would not be used to confirm the patient’s symptom.
Rationale 4: The right arterial pressure would not be used to confirm the patient’s symptom.
Global Rationale:

Question 24
Type: MCMA
The nurse is teaching a patient with heart failure nonpharmacological strategies to improve quality of life. What
will be included in these instructions?
1. Importance of smoking cessation
2. Reduce salt intake to 1 gram per day
3. Restrict caloric intake to attain recommended body weight
4. Attend cardiac rehabilitation sessions as prescribed
5. Ingest no more than three alcoholic drinks per day
Rationale 1: One nonpharmacological strategy to improve the quality of life in a patient with heart failure is to
stop smoking.
Rationale 2: Salt intake should be restricted to 2 to 3 grams per day.
Rationale 3: Weight reduction in obese patients is a nonpharmacological strategy to improve the quality of life in
the patient with heart failure.
Rationale 4: One nonpharmacological strategy to improve the quality of life in the patient with heart failure is to
attend cardiac rehabilitation.
Rationale 5: To improve the quality of life in patients with heart failure, alcohol intake should be restricted.
Global Rationale:

Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts: Teaching and Learning
Question 25
Type: MCMA
A patient a history of type 2 diabetes mellitus and heart failure is prescribed carvedilol (Coreg). What will the
nurse assess prior to administering this medication to the patient?
1. Blood pressure
2. Pulse
3. Blood glucose level
4. Lung sounds
5. Potassium level
Rationale 1: Prior to administering a beta blocker, the nurse should assess the patient’s blood pressure to ensure it
is adequate.
Rationale 2: Prior to administering a beta blocker, the nurse should assess the patient’s pulse to ensure it is
adequate.
Rationale 3: The blood glucose level should be monitored in the patient with diabetes because a beta blocker can
worsen glucose control and blunt symptoms of hypoglycemia.
Rationale 4: Lung sounds should be assessed in the patient with asthma and COPD prior to administering a beta
block because of bronchoconstriction effects. The patient does not have asthma or COPD.
Rationale 5: The potassium level does not need to be assessed prior to administering a beta blocker to the patient.
Global Rationale:

Question 26
Type: MCMA
What findings identified by the nurse on an assessment of a patient being treated for heart failure would cause the
nurse to notify the patient’s health care provider that the patient’s status was deteriorating?
1. S3 and S4 heart sounds
2. Oxygen saturation 80% on 4 liters oxygen nasal cannula
3. Urine output 10 mL over the last hour
4. Onset of production cough
5. Weight loss of 3 lbs from previous weight
Rationale 1: S3 and S4 heart sounds indicate the patient’s cardiac status is deteriorating.
Rationale 2: Reduced oxygen saturation is an indication that the patient’s pulmonary status is deteriorating.
Rationale 3: Poor urine output is an indication that the patient’s systemic status is deteriorating.
Rationale 4: Worsening cough is an indication that the patient’s pulmonary status is deteriorating.
Rationale 5: Weight loss is not an indication that the patient’s health status is deteriorating.
Global Rationale:

Question 27
Type: MCSA
A patient with heart failure is experiencing increased fatigue and has a weight gain of 1 kg. The nurse realizes this
patient is demonstrating signs of:
1. Systemic deterioration
2. Pulmonary deterioration
3. Cardiac deterioration
4. Renal deterioration
Correct Answer: 1
Rationale 1: Signs of systemic deterioration include weight gain and fatigue.
Rationale 2: Weight gain and fatigue are not signs of pulmonary deterioration.
Rationale 3: Weight gain and fatigue are not signs of cardiac deterioration.
Rationale 4: The renal status is not specifically assessed in the patient with heart failure.
Global Rationale:

Question 28
Type: MCMA
The nurse is preparing medications for the patient experiencing acute decompensated heart failure. Which
medications will be administered first to improve gas exchange for the patient?
1. Morphine sulfate
2. Nitroglycerin
3. Nesiritide (Natrecor)
4. Dobutamine (Dobutrex)
5. Milrinone (Primacor)
Correct Answer: 1,2
Rationale 1: This medication is used to reduce patient anxiety during acute decompensated heart failure.
Rationale 2: This medication is used to reduce preload and pulmonary wedge pressure.
Rationale 3: This medication is used for the patient with acute decompensated heart failure who has dyspnea at
rest and is not a medication that would be provided first.
Rationale 4: This medication is used to treat cardiogenic shock.
Rationale 5: This medication is used to treat cardiogenic shock.
Global Rationale:
Question 29
Type: MCMA
A patient has been receiving milrinone (Primacor) for cardiogenic shock from acute decompensated heart failure.
What findings indicate that this medication has been effective in the patient?
1. Increased cardiac output
2. Reduced pulmonary arterial wedge pressure
3. Dropping blood pressure
4. Onset of ventricular dysrhythmias
5. Respiratory rate 28 and regular
Correct Answer: 1,2
Rationale 1: An expected action of this medication is an increase in cardiac output.
Rationale 2: An expected action of this medication is a decrease in pulmonary arterial wedge pressure.
Rationale 3: Hypotension is a side effect of this medication and does not necessarily indicate that the medication
has been effective in the patient.
Rationale 4: Ventricular dysrhythmias are side effects of this medication and do not necessarily indicate that the
medication has been effective in the patient.
Rationale 5: This medication does not affect respiratory rate.
Global Rationale:

Question 30
Type: MCSA
A patient with heart failure is scheduled for an echocardiogram and cardiac catheterization. The nurse would
document that these diagnostic tests fulfill which heart failure core measure?
1. Evaluation of LVS
2. Discharge education
3. ACE-I or ARB for LVSD
4. Adult smoking cessation advice/counseling
Correct Answer: 1
Rationale 1: To fulfill this measure, the patient will have had left ventricular systolic function evaluated through
the use of an echocardiogram or cardiac catheterization before hospitalization, during hospitalization, or is
planned for after discharge.
Rationale 2: Tests to assess left ventricular systolic function are not included in the discharge education measure.
Rationale 3: Tests to assess left ventricular systolic function are not included in the ACE-I or ARB for LVSD
measure.
Rationale 4: Tests to assess left ventricular systolic function are not included in the adult smoking cessation
advice/counseling measure.
Global Rationale:

Nursing/Integrated Concepts: Communication and Documentation
Learning Outcome: 7-8: Define the core measures for heart failure management.
Question 31
Type: MCSA
The nurse is preparing adult smoking cessation material for a patient admitted with heart failure. What criteria did
the nurse use to determine that the patient should receive this material?
1. Patient smoked cigarettes any time during the last year prior to hospitalization
2. Patient uses chewing tobacco
3. Patient smokes five cigars a week
4. Patient stopped smoking five years prior to hospitalization
Correct Answer: 1
Rationale 1: For the Adult Smoking Cessation Advice/Counseling heart failure core measure, a smoker is defined
as someone who has smoked cigarettes anytime during the year prior to hospital arrival.
Rationale 2: The use of chewing tobacco is not included in the criteria for the Adult Smoking Cessation
Advice/Counseling for heart failure core measure.
Rationale 3: Smoking cigars is not included in the criteria for the Adult Smoking Cessation Advice/Counseling
for heart failure core measure.
Rationale 4: This is not the definition of a smoker for the Adult Smoking Cessation Advice/Counseling for heart
failure core measure.
Global Rationale:

Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Planning
Question 32
Type: MCMA
The nurse is preparing discharge instructions for a patient admitted with heart failure. What will the nurse include
in this teaching?
1. Permitted activity level
2. Diet
3. Prescribed medications
4. Importance of daily weight monitoring
5. Stress reduction strategies
Rationale 1: Permitted activity level should be included in discharge education for the patient with heart failure.
Rationale 2: Diet should be included in discharge education for the patient with heart failure.
Rationale 3: Medications should be included in discharge education for the patient with heart failure.
Rationale 4: Weight monitoring should be included in discharge education for the patient with heart failure.
Rationale 5: Stress reduction strategies are not identified as part of discharge education for the patient with heart
failure.
Global Rationale:

Client Need Sub:
Nursing/Integrated Concepts: Teaching and Learning
Another random document with
no related content on Scribd:
CHAPTER VI
Arrival in London. Conditions I found there. Preparations and Start.
reached London very early next morning, and drove

directly to the lodgings of my friend, Mr. Wellington
Lee, the only American resident in London whom I
knew. These were on a short street extending from the
Strand down to the river, a short distance west of
Temple Bar, the ancient city gate, which was then
standing. Who was Mr. Lee and what was he doing in London?
These were questions in which I had an interest of which I was as
yet entirely ignorant. The firm of Lee & Larned were the first
successful designers of steam fire-engines in this country. More than
seventy of these steamers had been built from their plans and under
their direction by the Novelty Iron Works in New York, and the fire
department of that city was completely equipped with them. One of
their engines had been sold to the city of Havre, and Mr. Lee had
gone over with it to test it publicly on its guaranteed performance. Mr.
Amos, one of the senior members of the great London engineering
firm of Easton, Amos & Sons, went over to Havre to witness this trial,
with a view to the manufacture of these steam fire-engines in
London. He was so much pleased that he determined to make the
fire-engines, and engaged Mr. Lee to take the direction of their
manufacture. So it came to pass that at this particular time Mr. Lee
was in London superintending the first manufacture of his steam fire-
engines by this firm.
After our salutations Mr. Lee said: “First of all I have something to
tell you.” Before relating this, I must mention something that I knew
before I sailed. About the time when the cargo of United States
exhibits started, the well-known Mason and Slidell incident occurred.
These gentlemen, commissioners sent by the Confederacy to
represent their cause before European governments, had sailed on a
British vessel flying the British flag. This vessel was overhauled on
the high seas by one of our cruisers, and the commissioners were
taken off and brought prisoners to New York. Mr. Lincoln made haste
to disavow this illegal proceeding, so singularly inconsistent with our
own principles of international law, and to make all the reparation in
his power. But a bitter feeling towards England was then growing in
the Northern States, and in a moment of resentment Congress
hastily passed a resolution repealing the law creating the Exhibition
Commission and making an appropriation for its expenses, and
Secretary Seward issued a proclamation dissolving the commission.
The vessel carrying the exhibits had been gone scarcely more than a
day when this action of Congress and Mr. Seward surprised the
country.
I now take up Mr. Lee’s narrative. The news of this action, carried
by a mail steamer, had reached London several days before the
arrival of the exhibits. Under the pressure of an urgent demand the
Royal Commission confiscated the space allotted to the United
States and parceled it out to British exhibitors. Mr. Holmes on his
arrival found not a spot in the Exhibition buildings on which to set his
foot. But he was a man of resources. He went before the
commission with an eminent Queen’s counsel, who made the point
that they had received no official notification of any such action by
the United States Government, but had proceeded on a mere
newspaper rumor, which they had no right to do; and there was the
United States assistant commissioner with his credentials and a
shipload of exhibits, and they must admit him.
The commissioners yielded most gracefully. They said: “Now, Mr.
Holmes, the American space is gone; we cannot restore that to you,
but there are unoccupied spots all over the Exhibition, and you may
take up any of these, and we will undertake that your whole exhibit
shall be well placed.” Upon this Mr. Holmes had gone to work and
had been able to find locations for every exhibit, except my engine.
Wellington Lee
“But only yesterday,” said Mr. Lee, “Mr. Holmes learned that an
engine ordered by the commission to drive the British exhibit of
looms, of which there were thirty-three exhibitors, had been
condemned by the superintendent of machinery, Mr. Daniel Kinnear
Clark, and ordered out of the building.” He added that Mr. Holmes
went directly to Mr. Clark and applied for the place for my engine, the
bedplate of which, thanks to my precipitate action, had arrived and
was then on a truck, in England called a lurry, waiting to be
unloaded. In answer to Mr. Clark’s questions, Mr. Holmes had given
him his personal assurance that I would be there, and the rest of the
engine would be there in ample time, and it would be all that he
could possibly desire; and on that assurance he had got the place for
me.
I informed Mr. Lee that I also had something to tell him. I then
gave him the situation as already related. He looked very grave.
When I had finished he said: “Well, you are in a hole, sure enough;
but come, let us get some breakfast, and then we will see what
Easton & Amos can do for you.” After eating my first English mutton-
chop in a chop-house on the Strand, I accompanied Mr. Lee to their
works in the Borough, a long distance away, on the south or Surrey
side of the Thames, to reach which we crossed the Southwark
bridge.
None of the partners had yet reached the office. Very soon Mr.
James Easton arrived. He was a young man about my own age. Mr.
Lee introduced me and told my story. The instant he finished Mr.
Easton came across the room and grasped my hand most cordially.
“That’s the kind of pluck I like,” said he; “we will see you through, Mr.
Porter; we will build this engine for you, whatever else may have to
wait.” Directly he added: “We have a good deal of ‘red tape’ here, but
it won’t do in this case. There will be no time to lose. Come with me.”
He then took me through the shops and introduced me to every
foreman, telling them what he had undertaken to do, and gave each
of them the same instruction, as follows: “Mr. Porter will come
directly to you with his orders. Whatever he wants done, you are to
leave everything else so far as may be necessary, and do his work
as rapidly as possible.”
As I listened to these orders, I could hardly believe my senses or
keep back the tears. Coming on top of the devotion of Mr. Holmes
they nearly overcame me. The sudden relief from the pressure of
anxiety was almost too much. It seemed to me to beat all the fairy
stories I had ever heard. This whole-hearted cordiality of the first
Englishman I had met gave me a high idea of the people as a whole,
which, I am happy to say, a residence of over six years in England
served only to increase.
Returning to the office, we found Mr. Lee, who said, “Now, Mr.
Porter, I think Mr. Holmes would like to see you.” Getting the
necessary directions, in due time I found myself in the Exhibition
building on Cromwell Road and in the presence of Mr. Holmes, who
received me joyfully and led me at once to Mr. Clark’s office. As he
opened the door, Mr. Clark looked up from his desk and exclaimed,
“Good morning, Mr. Holmes; where is that engine?” “Well,” replied
Mr. Holmes, “here is Mr. Porter, and the engine is here or on the
way.” Mr. Clark asked me a number of questions about the engine,
and finally how many revolutions per minute it was intended to make.
I replied, “One hundred and fifty.” I thought it would take his breath
away. With an expression of the greatest amazement he exclaimed:
“What! a hundred and fifty! B—b—b—but, Mr. Porter, have you had
any experience with such a speed as that?” I told him my experience
with the little engine, which did not seem to satisfy him at all. Finally
he closed the matter, or supposed he had done so, by saying: “I
cannot allow such a speed here; I consider it dangerous.” I decided
instantly in my own mind not to throw away all that I had come for;
but I made no sign, but humbly asked what speed I might employ.
After a little consideration Mr. Clark replied: “One hundred and
twenty revolutions; that must not be exceeded.” This he considered a
great concession, the usual speed of stationary engines being from
fifty to sixty revolutions. I meekly acquiesced, then made my plans
for one hundred and fifty revolutions, and said nothing to anybody. I
had no idea of the gravity of my offence. It was the first time since I
was a child that I had been ordered to do or not to do anything, and I
had no conception of orders except as given by myself. If there was
any risk, I assumed it gaily, quite unconscious how such a daredevil
defiance of authority would appear to an Englishman. Mr. Clark
showed me my location, and gave me an order for my engine-bed to
be brought in immediately, and also other parts of the engine as
soon as they arrived. Trucks generally, I was told, had to wait in the
crowd about ten days for their turn to be unloaded.
Charles T. Porter
A.D. 1862
I hurry over the time of erection. Everything arrived promptly and

the whole came together without a hitch, as I knew it would. The fly-
wheel and pulley and cylinder lagging I had left to be made in
England. I was at the works of Easton, Amos & Sons every morning
at 6 o’clock, and laid out the work for the day. I made the gauges for
boring the fly-wheel and pulley, which I had now learned how to do,
and adjusted everything about the engine myself, and knew it was
right.
I had a talk with the foreman of the pattern-shop about the best
thickness of felt on the cylinder to be covered by the mahogany
lagging, in the course of which I remarked, “It is the air that is the
real non-conductor.” “Yes,” he replied, “and felt, you know, is ‘air’.”
I learned several things I did not know before, among others how
the English made a steam-pipe joint, using parallel threads and a
backing-up nut, packed with long hemp which was filled with a putty
made of red and white lead rubbed together dry.
I had great luck in the way of a driving-belt. An American exhibitor
of india-rubber belting asked the privilege of exhibiting a belt in use
on my engine, which I was glad enough to have him do. Otherwise I
hardly know what I should have done. The widest English belts were
12 inches wide, double, and sewn together from end to end with five
rows of sheepskin lacing. The belt ran on the knobs of this lacing.
English machinists then knew nothing of the hold of belts by
excluding the air. The ends of all belts were united by lapping them
about two feet and sewing them through and through with this same
lacing. Fine pounding these joints would have made on the pulleys. I
got a governor belt from him also. Both belts were united by butt-
joints laced in the American fashion. I did this job myself, and,
indeed, I put the whole engine together mostly with my own hands,
although Easton, Amos & Sons sent two of their best fitters to help
me. I learned afterwards that I should have had a sorry time driving
my governor by a belt laced in the English way.
In spite of all efforts and all our good luck, we were not ready to
start until a week after the opening day, May 1, and the exhibitors
were in despair, for none of them believed that this new-fangled
American trap would work when it did start at the frightful speed of a
hundred and twenty revolutions per minute, which they had learned
from Mr. Clark it was to make. Finally one day after our noon dinner I
turned on the steam, and the governor rose at the speed of one
hundred and fifty revolutions precisely. It was immediately
surrounded by a dense crowd, every man of whom looked as if he
expected the engine to fly in pieces any instant.
It was not more than two minutes after it started when I saw Mr.
Clark coming with his watch in his hand. Some one had rushed to his
office and told him the Yankee engine was running away. The crowd
opened for him, and he came up to the engine and watched it for
some time, walking leisurely around it and observing everything
carefully from all points of view. He then counted it through a full
minute. At its close he turned to me and exclaimed, “Ah, Porter—
but,” slapping me cordially on the shoulder, “it’s all right. If you will
run as smoothly as this you may run at any speed you like.”
And so the high-speed engine was born, but neither Mr. Clark, nor
I, nor any human being then knew what it was that made it run so
smoothly.
I have since realized more and more what a grand man Mr. Clark
then showed himself to be. A small souled man might have regarded
the matter entirely from a personal point of view, and been furious at
my defiance of his authority. There are such men. I will show one to
the reader by and by. Officialism is liable to produce them. I was
quite unconscious of the risk in this respect that I was running. I have
always felt that I could not be too thankful that at this critical point I
fell into the hands of so noble a man as Daniel Kinnear Clark.
Mr. Porter’s Exhibit at the London International Exhibition, 1862
CHAPTER VII
My London Exhibit, its Success, but what was the matter? Remarkable Sale of the
Engine.
hus, as the result of a remarkable combination of

circumstances, upon which I look back with feelings
more of awe than of wonder, the high-speed system
made its appearance in the London International
Exhibition of 1862, installed in the midst of the British
machinery exhibit, under conditions more
advantageous than any which I could have imagined.
But the engine had a weak feature: it was wanting in an essential
respect, of which I was, and remained to the end, quite unconscious,
as will presently appear. Before entering on this subject I will give the
reader an idea of what the exhibit was like. The accompanying half-
tone from a photograph will, with the help of a little explanation,
make this quite real.
The location was in a narrow space between a side aisle and the
wall of the temporary wooden structure, 300 feet wide by nearly
1000 feet long, which formed the machinery hall. The engine was
crowded closely by looms on both sides. Here were shown together
the first high-speed engine, the first high-speed governor, and the
first high-speed indicator. My marine governor could not be
accommodated there, and had to be shown elsewhere. I was so
much afraid of deflection or vibration of the shaft that I shortened up
the length between the bearings and placed the driving-pulley on the
overhanging end of the shaft, which for the light work to be done
there answered sufficiently well. I showed also the largest and the
smallest sizes of my stationary-engine governors. These were belted
from the shaft to revolve so as to stand always in positions
coincident with those of the governor which regulated the engine.
On a table between the railing and the head of the engine I
showed mahogany sectional models of the valves at one end of the
cylinder in the engine exhibited, and of the now well-known Allen
slide valve, with double opening for admission made by a passage
over the exhaust-cup.
The Richards indicator is seen placed on the cylinder midway of its
length, and connected by pipes with the ends over the clearances,
so that in the familiar manner by means of a three-way cock the
opposite diagrams could be taken on the same sheet. After a few
days’ use I mistrusted that the lead lines were not correctly drawn,
and I took away these pipes, placing the indicator on the cylinder
itself, at the opposite ends alternately. The diagrams then taken
showed that the error from transmission through these pipes had
been even greater than I had feared. I have, of course, employed the
close connection ever since.
This identifies the time when the photograph was taken. It must
have been within a few days after starting.
The center of the eccentric coinciding with the crank, as already
stated, and the center line of the link being in the same horizontal
plane with that of the engine, I was able to take the motion of the
paper drum from the sustaining arms of the link instead of from the
cross-head. This was very convenient.
During the first two or three weeks the steam pressure was kept
up to 75 pounds, as intended, and I was able to get diagrams cutting
off quite early, which were then erroneously supposed to show
superior economy. But when all the steam-eaters had got in their
work the pressure could not be maintained much above 40 pounds,
and for that exhibition the day of fancy diagrams was over. Gwynne
& Co. showed a large centrifugal pump driven by a pair of engines
which always brought the pressure down at the rate of a pound a
minute. They were not allowed to run longer than fifteen minutes at a
time, but it took a long time after they stopped before the pressure
could be got up again even to 40 pounds. Whenever I took a
diagram somebody was always standing ready to take it away, and
so among my mementoes I have been able to find none cutting off
earlier than the one here represented. On the wall at the back I hung
the largest United States flag I could find, with a portrait of President
Lincoln. This seems all that needs to be said about the photograph
and the diagram.
INTERNATIONAL EXHIBITION, UNITED STATES DEPARTMENT

1862 DIAGRAM TAKEN FROM 1862
THE ALLEN ENGINE BY THE RICHARDS INDICATOR.
ENGINE, 8 INCHES BY 24 INCHES, REVOLUTIONS PER MINUTE, 150.
SCALE, 40 LBS. TO THE INCH.
But what was the matter? I will clear the way to answering this
question by relating the following incident: Six months later, with a
feeling of bitter disappointment, I contemplated my engine standing
alone where the place had been thronged with surging life. All the
other exhibits had been removed. This was left in stillness and
desolation, and I was making up my mind to the necessity of
shipping it home again, its exhibition to all appearance absolutely
fruitless—a failure, which I was utterly at a loss to comprehend,
when I had a call from Mr. James Easton, the same man who had
first welcomed me in England. His firm had perhaps the largest
exhibit in the Machinery Hall, of a waterfall supplied by a centrifugal
pump, and they had been frequent observers of the running of my
engine, which was quite near them. Mr. Easton bluntly asked me if I
thought my engine could be run 50 per cent. faster or at 225
revolutions per minute, because they had concluded that it could be,
and if I agreed with them they had a use for it themselves. Under the
circumstances I did not hesitate long about agreeing with them in
respect to both ability and price, and the sale was quickly concluded.
I noted an entire absence of any disposition to take an undue
advantage. Mr. Easton then told me that they were troubled with lack
of power every afternoon when the foundry blower was on, and had
long wanted to drive this blower independently. It needed to make
2025 revolutions per minute to give the blast they required, and they
had planned to drive it by a frictional gearing, nine to one, if my
engine could run at the necessary speed. So this most peculiar and
exceptional opportunity for its application, absolutely the only chance
for its sale that had appeared, and that at the very last moment,
prevented my returning home in disappointment. It is hardly
necessary to add that the engine proved completely successful. I
shall refer to it again.
The point of the incident is this: It established the fact, the
statement of which otherwise no one from the result would credit for
an instant, that, from the afternoon when the black and averted looks
of my loom exhibitors were changed to smiling congratulations down
to the close of the exhibition, the engine never once had a warm
bearing or was interrupted for a single moment. It was visited by
every engineer in England, and by a multitude of engine users, was
admired by every one, and won the entire confidence of all
observers in its speed, its regulation, and the perfection of its
diagrams; and yet in all that six months not a builder ever said a
word about building it, nor a user said a word about using it; and, as
week after week and month after month passed without a sign, I
became almost stupefied with astonishment and distress.
The explanation of this phenomenon was entirely simple, but I did
not know it, and there was no one to even hint it to me. I was among
a people whose fundamental ideas respecting steam-engines were
entirely different from those to which I had been accustomed, and I
knew nothing about them, and so could not address myself to them.
In the view of every Englishman a non-condensing engine was
rubbish. Those which were made were small, cheap affairs, mostly
for export. Neither a builder nor a user could regard a non-
condensing engine with the slightest interest.
Now I do not think that in my limited sphere of observation at
home I had ever seen a condensing stationary engine, except the
engine which pumped out the dry-dock at the Brooklyn Navy Yard. In
my mind condensing engines were associated with ships and
steamboats. At this exhibition also there were shown only non-
condensing engines. I did not think of the reason for this, that in this
part of London, far away from the Thames, no water could be had for
condensing purposes. I took it all as a matter of course, though I was
astonished at the queer lot of engines in the company of which I
found myself.
I was, of course, familiar with the development of the stationary
engine in England from the original type, in which the pressure of
steam below that of the atmosphere, and sometimes the pressure of
the atmosphere itself furnished the larger proportion of the power
exerted; but after all I carried with me my American ideas, which
were limited to non-condensing engines, and had no conception of
the gulf that separated my thoughts from those of the men about me.
My visitors always wound up with the same question, “How do you
drive your air-pump?” And in my innocence I uniformly replied, “The
engine is a non-condensing engine; it has no air-pump”; all
unconscious that every time I said that I was consigning the engine
to the rubbish heap. This reply was taken necessarily as a frank
admission that the high-speed engine was not adapted for
condensing. Of course, then, it had no interest for them. No doubt
many wondered why I should have troubled myself to show it there
at all. If I had thought more deeply I must have been struck by the
unvarying form of this question, always assuming the air-pump to be
a part of the engine, but which, of course, could not be used there,
and only inquiring how I worked it; and also by the fact that after
getting my answer the questioner soon departed, and I scarcely ever
saw the same visitor again. But I did not think deeply. Perhaps the
conditions of excitement were not favorable to reflection. All I thought
was that this same everlasting question, which at home I would
never have heard, was getting awfully monotonous. After a while this
annoying question came to be asked less and less frequently, and
also the engine attracted less and less attention. The engine had
failed in a vital respect, and I did not know it. That the fact of the
engine being non-condensing should have been an objection to it
never once entered my mind.
But I doubt if I could have bettered the matter, however alive to
this difficulty I might have been. I showed all I had yet accomplished.
In the minds of my visitors it no doubt appeared impossible to run an
air-pump successfully at such a speed; the water and air would be
churned into foam, and the valves would not close in time. This
objection I was not prepared to meet, for I had not thought on the
subject at all. Moreover, it could not have been met in any way
except by a practical demonstration. For that demonstration I had yet
to wait five years.
There were many things connected with this season which were
well worth remembering. One of these was the visit of the jury. It was
the only time I ever met Professor Rankine. There were two or three
Frenchmen on the jury, and they engaged in an animated discussion
of the question whether the steam could follow the piston at so great
a speed. I well remember the sharp exclamation with which
Professor Rankine put an end to this nonsense, when he had got
tired of it. “There is no limit to the speed at which steam will follow a
piston.”
One day I had a call from Mr. John Penn, Mr. William Fairbairn,
and Mr. Robert Napier, who came together on a visit of ceremony,
and presented me their cards. In return I presented to them the
cards of the engine. But their visit, like most others, closed with the
same inevitable question.
It was a delightful hour that Mr. F. W. Webb spent with me. He was
then assistant engineer of the London & Northwestern Railway under
Mr. Ramsbottom, afterwards Mr. Ramsbottom’s successor, and the
pioneer builder of compound-cylinder locomotives. He told me about
the new form of traveling-crane invented by Mr. Ramsbottom for the
shops at Crewe, which was driven by a flying-rope, a ³⁄₄-inch cotton
cord, and also of other inventions of Mr. Ramsbottom—among these
the automatic cylinder lubricator, in which the condensation of the
steam was so rapid, from the locomotive rushing through the
atmosphere, that only the water formed on the conical end of a bolt
was permitted to drop into the oil, other condensation running into a
circular trough and back through an external gooseneck pipe to the
steam-chest; and of their experiments to observe the rate of this
condensation. For this purpose they used soda-water bottles, which
they found capable of resisting a pressure of 200 pounds on the
square inch, and in which they could see the rapidity with which the
condensed water displaced the oil, thus leading to the above device
for limiting this action; also about the Ramsbottom piston rings,
which came to be, and still are, so largely used. These consist, as is
well known, of square wrought-iron rods, say ¹⁄₂ inch square, two for
each piston, sprung into grooves. What is not so generally known is
the way in which these rings were originated, which Mr. Webb then
described to me. As sold, these are not circular rings, but when
compressed in the cylinder they become truly circular and exert the
same pressure at every point. The original form was found for each
size in this way: A circular iron table was prepared, provided with a
large number of pulleys located radially and equidistant around its
edge. A ring having the section of the proposed rings, turned to the
size of the cylinder, and cut on one side, was laid on this table, and
cords were attached to it at equal distances passing over these
pulleys. Equal weights were hung on these cords, sufficient to
expand this ring to the extent desired. The form of the expanded ring
was then marked on the table, and to the lines thus obtained the
rings were then rolled. He told me also of the trough and scoop
invented by Mr. Ramsbottom, and now used the world over, for
refilling locomotive tanks while running at full speed. Being a
locomotive man, Mr. Webb did not ask about the way I drove my air-
pump.
Mr. Clark formed a scheme to indicate all the engines in the
exhibition, twenty-four in number, all English except mine, so far as I
remember, and employed my indicator for the purpose, the diagrams
being taken by myself. Only two exhibitors declined to have their
engines indicated. As I afterwards learned, most of the engines were
bought for use there, as exhibitors would not exhibit non-condensing
engines.
One of those who refused permission were Gwynne & Co., the
principal partner a nephew of my centrifugal-force friend of earlier
days. They exhibited a centrifugal pump supplying a waterfall. They
employed Mr. Zerah Colburn, then editor of The Engineer, to
investigate their pair of non-condensing engines and find out why
they used so much steam. He borrowed my indicator to make a
private test. Of course, I never saw the diagrams, but Mr. Colburn
informed me that by making some changes he had reduced the back
pressure to 7 pounds above the atmosphere, which he claimed to be
as good as could be expected. No material improvement in the
engines was to be observed, however.
Some of the diagrams taken on these tests exhibited almost
incredible faults. The only really good ones were from a pair of
engines made by Easton, Amos & Sons, also to drive a large
centrifugal pump, built for drainage purposes in Demerara, and
sustaining another waterfall. These showed the steam cut off sharply
at one third of the stroke by separately driven valves on the back of
the main slides. A mortifying feature of this work for myself was that
on testing the indicator Mr. Clark found that the area of the piston,
which was represented to be one quarter of a square inch, was really
considerably less than this, showing lamentable inaccuracy on the
part of the makers, as well as my own neglect to discover it. This
rendered the instrument valueless for measuring power, but it
showed the character of the diagrams all right.
The finest mechanical drawing I ever saw—or any one else, I think
—was shown in this exhibition. It was a drawing of the steamship
“Persia,” then the pride of the Cunard fleet, and was the only
mechanical drawing ever admitted to the walls of the National
Gallery, where it had appeared the year before. It represented side
and end elevations and plan, as well as longitudinal and cross-
sections, was painted and shaded in water-colors, and involved an
almost incredible amount of work. It was made by Mr. Kirkaldy, then
a draftsman in the employ of the Napiers, of Glasgow, the builders of
the vessel. I am tempted to refer to this, as it forms a prominent
datum point from which to measure the development of steam
navigation in the brief space of forty years. The vessel did not
possess a single feature, large or small, that now exists. It was of
only about 3000 tons burden. It was an iron ship built in the days of
the rapid transition from wood to steel. It was propelled by paddle-
wheels. These were driven by a pair of side-lever engines. The
engines had each a single cylinder. The steam pressure carried was
nominally 25 pounds above the atmosphere, but practically only from
15 to 20 pounds. Full pressure was not pretended to be maintained.
They had jet condensers. All forged work was of iron. The vessel
was steered by hand. The rigging, standing as well as running, was
of hemp. It was full bark-rigged.
Frederick E. Sickels

Understanding The Essentials of Critical Care Nursing 2Nd Edition Perrin Test Bank Full Chapter PDF

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Understanding The Essentials of Critical Care Nursing 2Nd Edition Perrin Test Bank Full Chapter PDF

Uploaded by

Copyright:

Available Formats

Understanding the Essentials of Critical

Care Nursing 2nd Edition Perrin Test

1. Leads to progressive worsening of heart function."

2. Can be described as an enlargement of the pumping chamber."

3. Occurs with an increase in blood pressure and results in weight gain."

4. Develops primarily because the heart is pumping harder."

Cognitive Level: Analyzing

3. Drinking one or two alcoholic drinks daily

5. Ischemic heart disease

Correct Answer: 1,5

Rationale 1: Hypertension is identified as an etiology of heart failure.

Rationale 2: Diabetes is not a known cause of heart failure.

Rationale 3: Drinking moderately is not a known cause of heart failure.

Rationale 5: Ischemia to the heart is a known cause of heart failure.

Cognitive Level: Analyzing

1. Orthopnea, peripheral edema, crackles

2. Dizziness, syncope, palpitations

3. Pallor and/or cyanosis of extremities

4. PAWP of 12 and CVP of 6

Cognitive Level: Analyzing

1. An increase in O2 saturation to greater than 90%

2. A decrease in heart rate to 66 bpm

3. The onset of atrial fibrillation

4. Louder S1 and S2 heart sounds

Cognitive Level: Analyzing

1. An echocardiogram that reflected increased right ventricular wall thickening

2. A B-type natriuretic peptide (BNP) of 300 pg/mL

3. A left ventricular ejection fraction (VEF) of 50%

4. A serum sodium of 135

Rationale 4: Hyponatremia is commonly found in the patient with heart failure.

Cognitive Level: Analyzing

Which finding would support the diagnosis of heart failure (HF)?

4. Peripheral vasodilation reflected by normalizing capillary refill times

Cognitive Level: Analyzing

1. Weigh myself every day."

2. Check my blood sugar regularly."

3. Notify my health care provider if I become increasingly short of breath."

Cognitive Level: Analyzing

1. Reducing sodium and water retention

2. Filtering potassium out with the water in the renal tubules

4. Retaining calcium to improve the condition of blood vessels in the glomeruli

Rationale 2: This is not the mechanism of an aldosterone antagonist.

Rationale 3: This is not the mechanism of an aldosterone antagonist.

Rationale 4: This is not the mechanism of an aldosterone antagonist.

Cognitive Level: Applying

1. Dyspnea at rest, peripheral edema

3. Increased coughing, crackles

4. Decreased O2 saturation, increased PAWP

Rationale 2: Hypertension and bradycardia are not symptoms of pulmonary edema.

Cognitive Level: Analyzing

Cognitive Level: Applying

1. Heart rate 92 beats per minute

2. Blood pressure 100/72

3. Potassium 5.7 mEq/dL

4. Urine output 35 mL/hr

Cognitive Level: Applying

Standard Text: Select all that apply.

1. Not knowing how or when to take medications

3. No record of body weight since discharge

4. Not filling prescribed medications

5. Received the pneumococcal immunization during the last hospitalization

Correct Answer: 1,2,3,4

Cognitive Level: Applying