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A nurse fails to recognize an intubated patient's need for suctioning. The endotracheal tube becomes clogged, and the patient has a respiratory arrest. What type of negligence may be present? a. Assessment failure b. Planning failure c. Implementation failure d. Evaluation failure

a

A nurse providing care for a patient with a recent tracheostomy notes the presence of an ulceration or wound at the tracheotomy site. The nature of the ulceration or wound clearly indicates it has been present for at least several days. The nurse finds no documentation regarding the ulceration or wound since the insertion of the tracheostomy tube 12 days earlier. This situation an example of what legal situations? a. Assessment and implementation failure b. Failure to appropriately diagnose c. Failure to follow practitioners orders d. Planning and evaluation failure

a

A patient is admitted with diminished to absent breath sounds on the right side, tracheal deviation to the left side, and asymmetric chest movement. These findings are indicative of which disorder? a. Tension pneumothorax b. Pneumonia c. Pulmonary fibrosis d. Atelectasis

a

A patient just involved in a motor vehicle accident has sustained blunt chest trauma as part of his injuries. The nurse notes absent breath sounds on the left side. A left-sided pneumothorax is suspected and is further validated when assessment of the trachea reveals what finding? a. A shift to the right b. A shift to the left c. No deviation d. Subcutaneous emphysema

a

A patient was admitted several weeks ago with an acute myocardial infarction and subsequently underwent coronary artery bypass grafting surgery. Since a cardiac arrest 5 days ago, the patient has been unresponsive. An electroencephalogram shows no meaningful brain activity. The patient is placed on a morphine drip to alleviate suspected operative pain and assist in sedation. The patient continues to grimace and fight the ventilator. What nursing intervention would be appropriate? a. Increase the morphine dosage until no signs of pain or discomfort are present. b. Increase the morphine drip, but if the patient's respiratory rate drops below 10 breaths/min, return to the original dosage. c. Gradually decrease the morphine and switch to Versed to avoid respiratory depression. d. Ask the family to leave the room because their presence is causing undue stress to the patient.

a

A patient was admitted to the critical care unit after having a cerebrovascular accident (CVA) and myocardial infarction (MI). The patient has poor activity tolerance, falls in and out of consciousness, and has poor verbal skills. The patient has been resuscitated four times in the past 6 hours. The patient does not have advance directives. Family members are at the bedside. Who should the practitioner approach to discuss decisions of care and possible do-not-resuscitate (DNR) status? a. Patient b. Family c. Hospital legal system d. Hospital ethics committee

a

A patient's arterial line waveform has become damped. What action should the nurse take to correct the situation? a. Check for kinks, blood, and air bubbles in the pressure tubing. b. Prepare for a normal saline fluid challenge for hypotension. c. Discontinue the arterial line as it has become nonfunctional. d. Check the patient's lung sounds for a change in patient condition.

a

A patient's bedside electrocardiogram (ECG) strips show the following changes: increased PR interval; increased QRS width; and tall, peaked T waves. Vital signs are temperature 98.2° F; heart rate 118 beats/min; blood pressure 146/90 mm Hg; and respiratory rate 18 breaths/min. The patient is receiving the following medications: digoxin 0.125 mg PO every day; D51/2 normal saline with 40 mEq potassium chloride at 125 mL/hr; Cardizem at 30 mg PO q8h; and aldosterone at 300 mg PO q12h. The practitioner is notified of the ECG changes. What orders should the nurse expect to receive? a. Change IV fluid to D51/2 normal saline and draw blood chemistry. b. Give normal saline with 40 mEq of potassium chloride over a 6-hour period. c. Hold digoxin and draw serum digoxin level. d. Hold Cardizem and give 500 mL normal saline fluid challenge over a 2-hour period.

a

A physician orders removal of the central venous catheter (CVC) line. The patient has a diagnosis of heart failure with chronic obstructive pulmonary disease. The nurse would place the patient in what position for this procedure? a. Supine in bed b. Supine in a chair c. Flat in bed d. Reverse Trendelenburg position

a

Developing an organizational policy that supports unobstructed access to the ethics committee by health care team members is one example of a proactive approach to dealing with what issue? a. Moral distress b. Surrogate decision-makers c. Paternalism d. Patient advocacy

a

Ethical decisions are best made by performing which action? a. Following the guidelines of a framework or model b. Having the patient discuss alternatives with the practitioner or nurse c. Prioritizing the greatest good for the greatest number of persons d. Studying by the Ethics Committee after all diagnostic data are reviewed

a

Patient education for a patient with a Holter monitor should include which instruction? a. Keep a diary of activities, symptoms, and any medications that are taken. b. Do not drink coffee while the recorder is on. c. Do not take a bath but a shower is alright. d. Carry the monitor in a purse or backpack.

a

Pulsus paradoxus may be noted on the bedside monitor when what is observed? a. A decrease of more than 10 mm Hg in the arterial waveform during inhalation b. A single, nonperfused beat on the electrocardiogram (ECG) waveform c. Tall, tented T waves on the ECG waveform d. An increase in pulse pressure greater than 20 mm Hg on exhalation

a

The nurse is performing a pulmonary assessment on a patient with a pleural effusion. Which finding is unexpected? a. Increased diaphragmatic excursion b. Decreased tactile fremitus c. Dull percussion tones d. Pleural friction rub

a

The nurse is using the SFNO approach to case analysis to facilitate ethical decision making. What justification criteria may be used to help explain the reasons for selection of one option over another? a. Effectiveness b. Usefulness c. Legal ramifications d. Economics

a

The nurse is using the SFNO approach to case analysis to facilitate ethical decision making. Which question is important to ask when considering stakeholders? a. Are there reasons to give priority to one stakeholder over another? b. Will the stakeholders abide by the decision? c. Will the stakeholders want to be present during the ethics consultation? d. Do the stakeholders understand how to use the SFNO model?

a

The nurse performs inspection of the oral cavity as part of a focused pulmonary assessment to check for evidence of what condition? a. Hypoxia b. Dyspnea c. Dehydration d. Malnutrition

a

The patient is admitted with a diagnosis of cardiogenic shock. The patient's heart rate (HR) is 135 beats/min with weak peripheral pulses. The patient has bilaterally crackles in the bases of the lungs. O2 saturation is 90% on 4L/NC. The practitioner orders diuretics and vasodilators. What response should the nurse expect after starting the medications? a. Decreased preload and afterload b. Increased preload and afterload c. Decreased preload and increased afterload d. Increased preload and decreased afterload

a

The patient received a blood transfusion based on test results of critically low hemoglobin. The nurse records vital signs (VS) per hospital protocol. One hour after the transfusion was started, the nurse records VS as temperature (T) 102F, pulse (P) 110, respirations (R) 24, blood pressure (BP) 136/88. The nurse continues to administer the blood. This situation an example of what legal situation? a. Malpractice b. Assault c. Battery d. Libel

a

The patient's admitting 12-lead ECG shows wide, M-shaped P waves. What diagnosis could be responsible for this finding? a. Mitral stenosis b. Chronic pulmonary disease c. Hypotension d. Pericarditis

a

The physician is going to place a central venous catheter. Which anatomic site is associated with a lower risk of infection? a. Subclavian vein b. External jugular vein c. Internal jugular vein d. Femoral vein

a

The principle of respect for persons incorporates what additional concepts? a. Confidentiality and privacy b. Truth and reflection c. Autonomy and justice d. Beneficence and nonmaleficence

a

What are the two basic ethical principles underlying the provision of health care? a. Beneficence and nonmaleficence b. Veracity and beneficence c. Fidelity and nonmaleficence d. Veracity and fidelity

a

What element of malpractice is based on the existence of a nurse-patient relationship? a. Duty b. Breach c. Damages d. Harm caused by the breach

a

What is a powerful influence when the decision-making process is dealing with recovery or a peaceful death? a. Hope b. Religion c. Culture d. Ethics

a

What is an injury resulting from the failure to meet an ordinary duty called? a. Negligence b. Malpractice c. Assault d. Battery

a

What is the difference between ethics and morals? a. Ethics is more concerned with the "why" of behavior. b. Ethics provides a framework for evaluation of the behavior. c. Ethics is broader in scope than morals. d. Ethics concentrates on the right or wrong behavior based on religion and culture values.

a

When assessing a patient with PVCs, the nurse knows that the ectopic beat is multifocal because it appears in what way? a. In various shapes in the same lead b. With increasing frequency c. Wider than a normal QRS d. On the T wave

a

When assessing a patient, the use of observation is referred to as what technique? a. Inspection b. Palpation c. Percussion d. Auscultation

a

Which diagnostic tool can be used to detect structural heart abnormalities? a. Echocardiogram b. Electrocardiogram (ECG) c. Exercise stress test d. 24-hour Holter monitor

a

Which lead is best to monitor a patient? a. Varies based on the patient's clinical condition and recent clinical history b. Lead aVF c. Lead V1 d. Lead II

a

Which statement best describes the definition of assault? a. An intentional act that causes the patient to believe that harm may have been done b. A statement that causes injury to the patient's standing in the community c. Negligence that results in harm to a spousal relationship d. An intentional act that brings about harm or offensive contact with the patient

a

Which statement made by a patient would indicate the need for further education before an electrophysiology procedure? a. "I need to take all my heart medications the morning of the procedure." b. "The doctor is going to make my heart beat wrong on purpose." c. "I will be awake but relaxed during the procedure." d. "I will be x-rayed during the procedure."

a

Which statement regarding the use of cuff blood pressures is true? a. Cuff pressures may be unreliable when a patient is in shock. b. Cuff pressures are more accurate than arterial line pressures. c. Cuff pressures and arterial line pressures should be nearly identical. d. Cuff pressures should not be compared to arterial line pressures.

a

Why is a new-onset of atrial fibrillation serious? a. It increases the patient's risk for a stroke. b. It increases the patient's risk for a deep venous thrombosis. c. It may increase cardiac output to dangerous levels. d. It indicates the patient is about to have a myocardial infarction.

a

Why is the Allen test performed before placement of a radial arterial line placement? a. To evaluate collateral circulation to the hand b. To estimate patency of the radial artery c. To appraise the neurologic function of the hand d. To assess the sensitivity of the insertion point

a

Zeroing the pressure transducer on hemodynamic monitoring equipment occurs when the displays reads which number? a. 0 b. 250 c. 600 d. 760

a

In what condition are bronchophony, egophony, and whispering pectoriloquy increased? a. Pneumonia with consolidation b. Pneumothorax c. Asthma d. Bronchiectasis

a Voice sounds are increased in pneumonia with consolidation because there is increased vibration through material. Bronchophony and whispering pectoriloquy are heard as clear transmission of sounds on auscultation; egophony is heard as an "a" sound when the patient is saying "e."

How does the patient history assist the nurse in developing the management plan? (Select all that apply.) a. Provides direction for the rest of the assessment b. Exposes key clinical manifestations c. Aids in developing the plan of care d. The degree of the patient's distress determines the extent of the interview e. Determines length of stay in the hospital setting

a,b,c,d

A patient with end-stage chronic airflow limitation is receiving palliative care. The nurse notes increase in respiratory rate, use of accessory muscles to breathe, and distress on the patient's face. What interventions should the nurse implement? (Select all that apply.) a) Increase the morphine drip. b) Assess the oxygen connections and liter flow. c) Elevate the head of the bed. d) Administer naloxone IV. e) Administer an ordered benzodiazepine.

a,b,c,e

Which of the following are considerations when making the decision to allow family at the bedside during resuscitation efforts? (Select all that apply.) a. The patient's wishes b. Experience of the staff c. The family's need to participate in all aspects of the patient's care d. State regulatory issues e. Seeing the resuscitation may confirm the impact of decisions made or delayed

a,b,c,e

Which conditions will commonly reveal breath sounds with inspiration greater than expiration on assessment? (Select all that apply.) a. Normal lung b. Bronchiectasis c. Emphysema d. Acute bronchitis e. Diffuse pulmonary fibrosis

a,b,d

Which situations are early signs of an ethical dilemma? (Select all that apply.) a. Disagreements among health care team members b. Failure to discuss end-of-life issues with patient c. Aggressive pain management d. Belief that treatment is harmful e. Following the patient's advance directive despite family objections f. Providing hope to the patient's family

a,b,d

In one study found that greater family satisfaction with withdrawal of life support was associated with which of the following measures? (Select all that apply.) a. The patient appearing comfortable b. A chance to voice concerns c. Discussions were held in the patient's room d. The process was well explained e. Adequate privacy during withdrawal of life support

a,b,d,e

A nurse notes that a patient's trachea is deviated to the left side. What condition could cause this to occur? (Select all that apply.) a) Atelectasis in the left lung b) Pneumothorax in the right lung c) Bilateral pneumonia d) Pleural effusion on the left side e) Bronchiectasis in the left lung

a,b,e

Deviation of the trachea occurs in which conditions? (Select all that apply.) a. Pneumothorax b. Pulmonary fibrosis c. Chronic obstructive pulmonary disease d. Emphysema e. Pleural effusion

a,b,e

Which actions by a nurse demonstrate the act of battery? (Select all that apply.) a. Performing cardiopulmonary resuscitation (CPR) on a patient with a do-not-resuscitate (DNR) order b. Threatening to punch someone c. Sexual misconduct with a patient d. Drawing blood without the patient's consent e. Threatening to restrain a patient for not using his or her call light for mobility assistance

a,c,d

Which of the following is/are criteria for defining an ethical dilemma? (Select all that apply.) a. An awareness of different options b. An issue in which only one viable option exists c. The choice of one option compromises the option not chosen d. An issue that has different options

a,c,d

What elements or criteria must be present for negligence cases to go forward? (Select all that apply.) a. Duty to another person b. Acknowledgement of wrong doing c. Harm that would not have occurred in the absence of the breach d. Breach of duty e. Damages that have a monetary value

a,c,d,e

The nurse is caring for a patient with a pancreas transplant. Which statement made by the patient indicates the need for further teaching? a. "I no longer need to monitor my blood glucose levels." b. "I will need to have periodic pancreas biopsies." c. "I may feel the urge to urinate frequently." d. "I will give urine samples to monitor for rejection."

a. "I no longer need to monitor my blood glucose levels."

A patient who has received a transplant is being taught about azathioprine. Which statement made by the patient would indicate the teaching was effective? a. "I will notify my health care provider if my gums start to bleed." b. "I will make sure to increase the amount of fiber in my diet." c. "I realize I may have an increase in hair growth." d. "I know the flulike symptoms will go away as I get used to the drug."

a. "I will notify my health care provider if my gums start to bleed."

A nurse is providing care to a patient on fibrinolytic therapy. Which of the following statements from the patient warrants further assessment and intervention by the nurse? a. "My back is killing me!" b. "There is blood on my toothbrush!" c. "Look at the bruises on my arms!" d. "My arm is bleeding where my IV is!"

a. "My back is killing me!"

Which statement would indicate that a patient who has received an organ transplant understands the teaching about immunosuppressive medications? a. "My drug dosages will be lower because the medications enhance each other." b. "I will be less prone to side effects because I will be taking more than one drug." c. "Lower doses of these medications put me at greater risk for infection." d. "Taking more than one medication will put me at risk for developing allergies."

a. "My drug dosages will be lower because the medications enhance each other."

In the acute phase after ST segment elevation myocardial infarction (STEMI), fibrinolytic therapy is used in combination with heparin to recanalize the coronary artery. What dosage is the initial heparin bolus? a. 60 units/kg maximum 5000 units b. 30 units/kg maximum 3000 units c. 25 units/kg maximum of 2500 units d. 12 units/kg maximum of 1000 units

a. 60 units/kg maximum 5000 units

The nurse is caring for a patient in hypovolemic shock secondary to cirrhosis of the liver. The nurse understands that this type of shock results from shifting of fluid into the abdominal cavity. What is the resulting hypovolemia called? a. Absolute hypovolemia b. Distributive hypovolemia c. Relative hypovolemia d. Compensatory hypovolemia

a. Absolute hypovolemia

A patient suddenly develops a wide QRS complex tachycardia. The patient's heart rate is 220 beats/min and regular; blood pressure is 96/40 mm Hg; and respiratory rate is 22 breaths/min, and the patient is awake without complaint except for palpitations. Which of the following interventions would be best to try first? a. Adenosine 6 mg rapid IV push b. Lidocaine 1 mg/kg IV push c. Verapamil 5 mg IV push d. Digoxin 0.5 mg IV push

a. Adenosine 6 mg rapid IV push

The nurse is caring for a patient in septic shock due secondary to pneumonia. The nurse knows that evidence-based guidelines for the treatment of septic shock include which interventions? (Select all that apply.) a. Administer norepinephrine to maintain mean arterial pressure of 65 mm Hg. b. Administer low-dose dopamine to maintain urine output greater than 30 mL/h. c. Start enteral nutrition within the first 48 hours after diagnosis of septic shock. d. Administer 30 mL/kg crystalloid for hypotension or lactate greater than or equal to 4 mmol/L. e. Perform an adrenocorticotropic hormone (ACTH) stimulation test to identify patients who need hydrocortisone

a. Administer norepinephrine to maintain mean arterial pressure of 65 mm Hg. c. Start enteral nutrition within the first 48 hours after diagnosis of septic shock. d. Administer 30 mL/kg crystalloid for hypotension or lactate greater than or equal to 4 mmol/L.

A patient is admitted with hypertrophic cardiomyopathy. The nurse would expect the medical management of this patient to include which intervention? a. Administration of beta-blockers b. Administration of positive inotropes c. Plans for intensive exercise regimen d. Plans for an aortic valve replacement

a. Administration of beta-blockers

What two medications are commonly prescribed at discharge for patients who have had a coronary artery stent placed? a. Aspirin and prasugrel b. Aspirin and abciximab c. Clopidogrel and eptifibatide d. Tirofiban and tricagrelor

a. Aspirin and prasugrel

A nurse is caring for a patient in septic shock due to urinary sepsis. Which pathophysiologic mechanism results in septic shock? a. Bacterial toxins lead to vasodilation. b. White blood cells are released to fight invading bacteria. c. Microorganisms invade organs such as the kidneys and heart. d. Decreased red blood cell production and fluid loss

a. Bacterial toxins lead to vasodilation.

A nurse is caring for a patient who is receiving sirolimus. The nurse knows to monitor the patient for what side effect? a. Bleeding b. Diarrhea c. Rigors d. Hypotension

a. Bleeding

A patient is being admitted with septic shock. The nurse appreciates that the key to treatment is finding the cause of the infection. Which cultures would the nurse obtain before initiating antibiotic therapy? (Select all that apply.) a. Blood cultures 2 b. Wound cultures c. Urine cultures d. Sputum cultures e. Complete blood count (CBC) with differential

a. Blood cultures 2 b. Wound cultures c. Urine cultures d. Sputum cultures

Potential recipients are matched with donors based on what factors? (Select all that apply.) a. Blood type b. Human leukocyte antigen c. Race d. Socioeconomic status e. Severity of illness f. Location of recipient g. Waiting time on the list

a. Blood type b. Human leukocyte antigen e. Severity of illness f. Location of recipient g. Waiting time on the list

A patient is admitted with a massive head trauma. The patient is unresponsive and on mechanical ventilation. The electroencephalogram (EEG) is negative for brain waves. The family has agreed to organ donation. How would this organ donor be classified? a. Brain-dead donor b. Donation after cardiac death c. Living related donor d. Living unrelated donor

a. Brain-dead donor

A patient has been admitted with septic shock due to urinary sepsis. The practitioner inserts a pulmonary artery (PA) catheter. Which hemodynamic value would the nurse expect to note to support this diagnosis? a. Cardiac output (CO) of 8 L/min b. Right atrial pressure (RAP) of 17 mm Hg c. Pulmonary artery occlusion pressure (PAOP) of 23 mm Hg d. Systemic vascular resistance (SVR) of 1100 dyne/s/cm-5

a. Cardiac output (CO) of 8 L/min

After a pancreatic transplant with bladder exocrine drainage, the nurse would anticipate which order? a. Continuous bladder irrigation b. Intermittent insulin injections c. Removal of the nasogastric tube as soon as the patient is alert d. Daily hematocrit and hemoglobin levels

a. Continuous bladder irrigation

Which clinical manifestations are indicative of left ventricular failure? (Select all that apply.) a. Cool, pale extremities b. Jugular venous distention c. Liver tenderness d. Weak peripheral pulses e. Rales

a. Cool, pale extremities d. Weak peripheral pulses e. Rales

Which mechanisms responsible for a myocardial infarction (MI)? (Select all that apply.) a. Coronary artery thrombosis b. Plaque rupture c. Coronary artery spasm near the ruptured plaque d. Preinfarction angina e. Hyperlipidemia

a. Coronary artery thrombosis b. Plaque rupture c. Coronary artery spasm near the ruptured plaque

Which clinical manifestation is usually the first symptom of peripheral arterial disease (PAD)? a. Cramping when walking b. Thrombophlebitis c. Pulmonary embolism d. Cordlike veins

a. Cramping when walking

Which physiologic effects can be associated with physical exercise? (Select all that apply.) a. Decreased LDL cholesterol b. Increased HDL cholesterol c. Decreased triglycerides d. Increased insulin resistance e. Decreased incidence of depression

a. Decreased LDL cholesterol b. Increased HDL cholesterol c. Decreased triglycerides e. Decreased incidence of depression

Which nursing problem would be appropriate for a patient who has received a kidney transplant? a. Deficient fluid volume b. Excess fluid volume c. Urinary retention d. Decreased cardiac output

a. Deficient fluid volume

Which finding is a reliable indicator of reperfusion after fibrinolytic therapy? a. Dysrhythmias b. Q waves c. Elevated ST segments d. Immediate rapid decrease in cardiac biomarkers

a. Dysrhythmias

What are the clinical manifestations of right-sided heart failure? a. Elevated central venous pressure and sacral edema b. Pulmonary congestion and jugular venous distention c. Hypertension and chest pain d. Liver tenderness and pulmonary edema

a. Elevated central venous pressure and sacral edema

A patient is being admitted with cardiogenic shock secondary to acute heart failure. In addition to a diuretic, which medication would the nurse anticipate the practitioner ordering for the patient? a. Epinephrine b. Nitroprusside c. Dobutamine d. Nitroglycerine

a. Epinephrine

What psychologic factors contribute to long-term mechanical ventilation dependence? (Select all that apply.) a. Fear b. Delirium c. Lack of confidence d. Depression e. Trust in the stuff

a. Fear b. Delirium c. Lack of confidence d. Depression

A patient has had a kidney transplant. The nurse knows that monitoring of which parameter would have the highest priority? a. Fluid volume b. Electrolytes c. Complete blood count d. Temperature

a. Fluid volume

Which interventions minimize the complications associated with suctioning an artificial airway? (Select all that apply.) a. Hyperoxygenate the patient prior to the start of the procedure b. Hyperoxygenate the patient after each pass of the suction catheter c. Limit the duration of each suction pass to 20 seconds d. Instill 5 to 10 mL of normal saline to facilitate secretion removal e. Use intermittent suction to avoid damaging tracheal tissue

a. Hyperoxygenate the patient prior to the start of the procedure b. Hyperoxygenate the patient after each pass of the suction catheter

A patient is admitted with an acute inferior myocardial infarction (MI). A 12-lead electrocardiogram (ECG) is done to validate the area of infarction. Which leads on the ECG would correlate with an inferior wall MI? a. II, III, aVF b. V5 to V6, I, aVL c. V2 to V4 d. V1 to V2

a. II, III, aVF

The nurse is caring for a patient in cardiogenic shock. The nurse recognizes that the patient's signs and symptoms are the result of what problem? a. Inability of the heart to pump blood forward b. Loss of circulating volume and subsequent decreased venous return c. Disruption of the conduction system when reentry phenomenon occurs d. Suppression of the sympathetic nervous system

a. Inability of the heart to pump blood forward

The patient is 72 hours postoperative for a coronary artery bypass graft (CABG). The patient's vital signs include temperature 103° F, heart rate 112, respiratory rate 22, blood pressure 134/78 mm Hg, and O2 saturation 94% on 3L nasal cannula. The nurse suspects that the patient has developed what problem? a. Infection and notifies the physician immediately b. Infection, which is common postoperatively, and monitors the patient's condition c. Cardiac tamponade and notifies the physician immediately d. Delirium caused by the elevated temperature

a. Infection and notifies the physician immediately

A patient has been admitted with hypovolemic shock due to traumatic blood loss. Which nursing measure can best facilitate the administration of large volumes of fluid? a. Inserting a large-diameter peripheral intravenous catheter b. Positioning the patient in the Trendelenburg position c. Encouraging the patient to drink at least 240 mL of fluid each hour d. Administering intravenous fluids under pressure with a pressure bag

a. Inserting a large-diameter peripheral intravenous catheter

A patient was admitted following an aspiration event on the medical-surgical floor. The patient is receiving 40% oxygen via a simple facemask. The patient has become increasingly agitated and confused. The patient's oxygen saturation has dropped from 92% to 84%. The nurse notifies the practitioner about the change in the patient's condition. What interventions should the nurse anticipate? a. Intubation and mechanical ventilation b. Change in antibiotics orders c. Suction and reposition the patient d. Orders for a sedative

a. Intubation and mechanical ventilation

Which statement describes the assist-control mode of ventilation? a. It delivers gas at preset volume, at a set rate, and in response to the patient's inspiratory efforts. b. It delivers gas at a preset volume, allowing the patient to breathe spontaneously at his or her own volume. c. It applies positive pressure during both ventilator breaths and spontaneous breaths. d. It delivers gas at preset rate and tidal volume regardless of the patient's inspiratory efforts.

a. It delivers gas at preset volume, at a set rate, and in response to the patient's inspiratory efforts.

A patient is admitted with a brain and spinal cord injury secondary to a motor vehicle crash. The nurse is monitoring the patient for signs of neurogenic shock. Clinical findings in neurogenic shock are related to which pathophysiologic process? a. Loss of sympathetic nervous system innervation b. Parasympathetic nervous system stimulation c. Injury to the hypothalamus d. Focal injury to cerebral hemispheres

a. Loss of sympathetic nervous system innervation

Which oxygen delivery device is considered a low-flow system? a. Nasal cannula b. Simple face mask c. Reservoir cannula d. Air-entrainment nebulizer

a. Nasal cannula

Which oxygen administration device can deliver oxygen concentrations of 90%? a. Nonrebreathing mask b. Nasal cannula c. Partial rebreathing mask d. Simple mask

a. Nonrebreathing mask

A patient is diagnosed with third-degree heart failure. The nurse reviews the patient's medication list. Which classifications of drugs should be avoided with this patient? (Select all that apply.) a. Nonsteroidal antiinflammatory drugs (NSAIDs) b. Antidysrhythmics c. Angiotensin-converting enzyme (ACE) inhibitors d. Calcium channel blockers e. Beta-blockers

a. Nonsteroidal antiinflammatory drugs (NSAIDs) b. Antidysrhythmics d. Calcium channel blockers

Which federal laws regulate the medical and surgical therapy involved with organ transplantation? (Select all that apply.) a. Omnibus Budget Reconciliation Act b. Uniform Anatomical Gift Act c. Hospital Conditions of Participation-Organ Donations d. Medical Examiner Laws e. Uniform Determination of Death Act

a. Omnibus Budget Reconciliation Act c. Hospital Conditions of Participation-Organ Donations

Which route for endotracheal (ET) tube placement is usually used in an emergency intubation? a. Orotracheal b. Nasotracheal c. Nasopharyngeal d. Trachea

a. Orotracheal

A patient is admitted after a lung transplant. The nurse knows the patient is at risk for developing pneumonia. What parameter would be a priority for the nurse to monitor? a. Oxygen saturation b. Chest tube output c. Intake and output d. Blood pressure

a. Oxygen saturation

Medical management of a patient with status asthmaticus includes which treatments? (Select all that apply.) a. Oxygen therapy b. Bronchodilators c. Corticosteroids d. Antibiotics e. Intubation and mechanical ventilation

a. Oxygen therapy b. Bronchodilators c. Corticosteroids e. Intubation and mechanical ventilation

A patient has been admitted with anaphylactic shock due to an unknown allergen. The nurse understands that the decrease in the patient's cardiac output is the result of which mechanism? a. Peripheral vasodilation b. Increased venous return c. Increased alveolar ventilation d. Decreased myocardial contractility

a. Peripheral vasodilation

A patient is undergoing ventricular pacing via a transvenous pacing lead. The nurse notes a pacing artifact, but it is not followed by a QRS on the electrocardiogram (ECG) monitoring. Which nursing intervention may correct this situation? a. Position the patient on the left side b. Decrease the milliamperes as ordered c. Increase the rate as ordered d. Monitor the patient in a different lead

a. Position the patient on the left side

Nursing management of the patient with acute lung failure includes which interventions? (Select all that apply.) a. Positioning the patient with the least affected side up b. Providing adequate rest between treatments c. Performing percussion and postural drainage every 4 hours d. Controlling fever e. Pharmaceutical medications to control anxiety

a. Positioning the patient with the least affected side up b. Providing adequate rest between treatments d. Controlling fever e. Pharmaceutical medications to control anxiety

Which nursing intervention should be used to optimize oxygenation and ventilation in the patient with acute lung failure? a. Provide adequate rest and recovery time between procedures. b. Position the patient with the good lung up. c. Suction the patient every hour. d. Avoid hyperventilating the patient.

a. Provide adequate rest and recovery time between procedures.

Which hemodynamic alteration is the most common cause of a decrease in cardiac output in the postoperative cardiovascular patient? a. Reduced preload b. Increased afterload c. Increased contractility d. Bradycardia

a. Reduced preload

When assessing an intubated patient, the nurse notes normal breath sounds on the right side of the chest and absent breath sounds on the left side of the chest. What problem should the nurse suspect? a. Right mainstem intubation b. Left pneumothorax c. Right hemothorax d. Gastric intubation

a. Right mainstem intubation

An elderly patient is admitted with pneumonia. This morning the patient is febrile, tachycardic, tachypneic, and confused. The nurse suspects the patient may be developing what problem? a. Sepsis b. Delirium c. Adult respiratory distress syndrome d. Acute kidney injury

a. Sepsis

The nurse is caring for a patient who has had a recent heart transplant. Which signs and symptoms would alert the nurse that the patient is rejecting the transplant? (Select all that apply.) a. Shortness of breath b. Tolerance of exercise c. Disturbance in mood d. Decreased weight e. Pulmonary crackles f. Onset of hypertension g. Sudden onset of edema

a. Shortness of breath c. Disturbance in mood e. Pulmonary crackles g. Sudden onset of edema

Which statement regarding the difference between stable and unstable angina is accurate? a. Stable angina responds predictably well to nitrates. b. Stable angina is not precipitated by activity. c. Stable angina has a low correlation to coronary artery disease (CAD). d. Stable angina is a result of coronary artery spasm.

a. Stable angina responds predictably well to nitrates.

A nurse is preparing a patient for a liver transplant. The patient asks which stage of the procedure is the longest and most difficult. What would the nurse tell the patient? a. Stage 1—recipient hepatectomy b. Stage 2—vascular anastomoses c. Stage 3—biliary anastomosis d. Stage 4—induction therapy

a. Stage 1—recipient hepatectomy

What two pathogens are most frequently associated with ventilator-associated pneumonia? a. Staphylococcus aureus and Pseudomonas aeruginosa b. Escherichia coli and Haemophilus influenzae c. Acinetobacter baumannii and Haemophilus influenzae d. Klebsiella spp. and Enterobacter spp.

a. Staphylococcus aureus and Pseudomonas aeruginosa

What are the clinical manifestations associated with oxygen toxicity? (Select all that apply.) a. Substernal chest pain that increases with deep breathing b. Moist cough and tracheal irritation c. Pleuritic pain occurring on inhalation, followed by dyspnea d. Increasing CO2 e. Sore throat and eye and ear discomfort

a. Substernal chest pain that increases with deep breathing c. Pleuritic pain occurring on inhalation, followed by dyspnea e. Sore throat and eye and ear discomfort

What are the most common presenting signs and symptoms associated with a pulmonary embolism (PE)? a. Tachycardia and tachypnea b. Hemoptysis and evidence of deep vein thromboses c. Apprehension and dyspnea d. Right ventricular failure and fever

a. Tachycardia and tachypnea

What condition develops when air enters the pleural space from the lung on inhalation and cannot exit on exhalation? a. Tension pneumothorax b. Sucking chest wound c. Open pneumothorax d. Pulmonary interstitial empyema

a. Tension pneumothorax

How does a percutaneous transluminal coronary angioplasty (PTCA) improve blood flow? a. The balloon stretches the vessel wall, fractures the plaque, and enlarges the vessel lumen. b. Medication is delivered through the catheter that dissolves the plague and enhances vessel patency. c. The balloon removes blood clots from the vessel improving patency of the vessel. d. The balloon compresses the plaque against the vessel wall enlarging the vessel lumen.

a. The balloon stretches the vessel wall, fractures the plaque, and enlarges the vessel lumen.

Who determines the medical suitability of the patient for organ donation? a. The organ procurement organization (OPO) coordinator b. The patient's family c. The admitting health care provider d. The transplant team

a. The organ procurement organization (OPO) coordinator

Adenosine is an antidysrhythmic agent that is given primarily what reason? a. To convert supraventricular tachycardias b. To suppress premature ventricular contractions (PVCs) c. To treat second and third degree AV blocks d. To coarsen ventricular fibrillation so that defibrillation is effective

a. To convert supraventricular tachycardias

Which of the following are complications of endotracheal tubes? (Select all that apply.) a. Tracheoesophageal fistula b. Cricoid abscess c. Tracheal stenosis d. Tube obstruction e. Hemorrhage

a. Tracheoesophageal fistula b. Cricoid abscess c. Tracheal stenosis d. Tube obstruction

The nurse is caring for a patient after a heart transplant. Which finding would the nurse anticipate after cardiac transplantation? a. Two P waves on the electrocardiogram (ECG) b. High cardiac output c. Anginal pain d. Resting heart rate of 60 to 70 beats/min

a. Two P waves on the electrocardiogram (ECG)

Identify complications with the above rhythm strip. a. Undersensing from a pacemaker b. Oversensing from a pacemaker c. ICD firing caused by VF d. Atrial pacing failure to capture

a. Undersensing from a pacemaker

A transvenous pacemaker is inserted through the right subclavian vein and threaded into the right ventricle. The pacemaker is placed on demand at a rate of 70. What is the three letter code for this pacing mode? a. VVI b. AOO c. DDD d. VAT

a. VVI

The nurse is caring for a patient after a lung transplant. Which intervention would be a priority for the nurse? a. Wean the patient from the ventilator. b. Maintain hypotensive levels. c. Start corticosteroid therapy. d. Initiate pulmonary function studies.

a. Wean the patient from the ventilator.

The Model for End-Stage Liver Disease (MELD) formula is used to calculate risk of 3-month mortality in patients 12 years old or older. What criteria is part of the MELD formula? a. Whether the patient has undergone hemodialysis at least twice in the past 2 weeks b. The number of organs in which metastasis has occurred following hepatocellular carcinoma c. The presence or absence of intractable pruritus d. The number of hours the patient is expected to live without a transplant

a. Whether the patient has undergone hemodialysis at least twice in the past 2 weeks

Why do women have higher mortality rates from acute myocardial infarction (MI) than men? a. Women wait longer to seek medical care. b. Women have more risk factors for coronary artery disease than men. c. Women have a higher risk of coronary spasm than men. d. Women have smaller hearts than men.

a. Women wait longer to seek medical care.

A nurse is performing an assessment on a patient's lungs. While performing percussion on the left lung, the nurse notes a low-pitched resonant sound. This is compatible with what disease process? a) Asthma b) Bronchitis c) Emphysema d) Pneumothorax

b

A patient asks why he had to take a deep breath when the radiology technician took his chest radiograph. Which statement is the best response? a. "Deep breaths get the chest wall closer to the machine." b. "When the lungs are filled with air, you get a clearer picture." c. "Taking a deep breath decreases the error caused by motion." d. "Holding your breath makes the heart appear larger."

b

A patient is admitted with acute lung failure secondary to emphysema. Percussion of the lung fields will predictably exhibit which tone? a. Resonance b. Hyperresonance c. Tympany d. Dullness

b

A patient is admitted with chest pain, and his electrocardiogram shows elevated ST segments. The nurse bases her plan of care on the nursing diagnosis of pneumonia. What type of negligence may be present? a. Assessment failure b. Planning failure c. Implementation failure d. Evaluation failure

b

A patient presents with atrial flutter with an atrial rate of 280 beats/min and a ventricular rate of 70 beats/min. Which statement best explains this discrepancy in rates? a. The ventricles are too tired to respond to all the atrial signals. b. The atrioventricular (AV) node does not conduct all the atrial signals to the ventricles. c. Some of the atrial beats are blocked before reaching the AV node. d. The ventricles are responding to a ventricular ectopic pacemaker.

b

A patient reports that he has been having "indigestion" for the last few hours. Upon further review the nurse suspects the patient is having of chest pain. Cardiac biomarkers and a 12-lead electrocardiogram (ECG) are done. What finding is most significant in diagnosing an acute coronary syndrome (ACS) within the first 3 hours? a. Inverted T waves b. Elevated troponin I c. Elevated B-type natriuretic peptide (BNP) d. Indigestion and chest pain

b

A patient with a potassium level of 2.8 mEq/L is given 60 mEq over a 12-hour period. A repeat potassium level is obtained, and the current potassium level is 3.2 mEq/L. In addition to administering additional potassium supplements, what intervention should now be considered? a. Discontinue spironolactone b. Drawing a serum magnesium level c. Rechecking the potassium level d. Monitoring the patient's urinary output

b

A patient with a serum potassium level of 6.8 mEq/L may exhibit what type of electrocardiographic changes? a. A prominent U wave b. Tall, peaked T waves c. A narrowed QRS d. Sudden ventricular dysrhythmias

b

A patient with heart failure may be at risk for hypomagnesemia as a result of which factor? a. Pump failure b. Diuretic use c. Fluid overload d. Hemodilution

b

A patient's wife has been informed by the practitioner that her spouse has permanent quadriplegia. The wife states that she does not want anyone to tell the patient about his injury. The patient asks the nurse about what has happened. The nurse has conflicting emotions about how to handle the situation. What is the nurse experiencing? a. Autonomy b. Moral distress c. Moral doubt d. Moral courage

b

A positive signal-averaged electrocardiogram (ECG) indicates that a patient is at risk for what problem? a. Myocardial infarction b. Sudden cardiac death c. Coronary artery disease d. Stroke

b

During an admission assessment of a patient, it is noted that the patient's chest diameter is greater than expected. This finding suggests what condition? Pneumothorax Chronic obstructive pulmonary disease Pneumonia Pulmonary hypertension

b

During your admission assessment, you note that a patient's chest diameter is greater than expected. This suggests what condition? a) Pneumothorax b) Chronic obstructive pulmonary disease c) Pneumonia d) Pulmonary hypertension

b

Hospice care is an option that should be considered, especially in end-stage illness. Hospice care can help families with which issue(s)? a. Organ and tissue donations b. Symptom management and family support c. Procurement of advance directives and living wills d. Legal and voluntary euthanasia

b

In caring for a patient receiving palliative care, antiemetics are used in the treatment of what problem? a. Dyspnea b. Nausea and vomiting c. Anxiety d. Edema

b

Institutional ethics committees (IECs) review ethical cases that are problematic for the practitioner. What is the major function of an IEC? a. Consultation with purely binding recommendations b. Support and education to health care providers c. Conflict resolution for moral dilemmas d. Recommendations that are binding in all cases

b

Mechanical contraction of the heart occurs during which phase of the cardiac cycle? a. Phase 0 b. Phase 2 c. Phase 3 d. Phase 4

b

On returning from the cardiac catheterization laboratory, the patient asks if he can get up in the chair. What should the nurse tell the patient? a. "You cannot get up because you may pass out." b. "You cannot get up because you may start bleeding." c. "You cannot get up because you may fall." d. "You cannot get up until you urinate."

b

Recommendations for creating a supportive atmosphere during end-of-life discussions include which intervention? a. Telling the family when and where the procedure will occur b. Beginning the conversation by inquiring about the emotional state of the family c. Ending the conversation by inquiring about the emotional state of the family d. Recommendations that the family not be present when the procedure occurs

b

The ability to practice as a licensed professional nurse is a privilege granted by what entity? a. Employee contract b. State legislature c. State boards of nursing d. Congress

b

The nurse and the patient's daughter are aware that the patient has a do-not-resuscitate (DNR) order, but when he stops breathing, the daughter screams, "Save my daddy!" This is an example of a conflict between which two ethical principles? a) Beneficence and veracity b) Beneficence and nonmaleficence c) Nonmaleficence and veracity d) Nonmaleficence and justice

b

The nurse is assessing a patient admitted with shortness of breath. Upon percussion of the anterior chest wall, the nurse notes a very loud and long booming sound. Which disorder is this finding suggestive of? a) Bronchitis b) Emphysema c) Pulmonary edema d) Pleural effusion

b

The nurse is performing a pulmonary assessment on a patient with acute bronchitis. Which finding is unexpected? a. Rasping productive cough b. Decreased tactile fremitus c. Resonant percussion tones d. Crackles and wheezes

b

The patient's admitting 12-lead ECG shows tall, peaked P waves. What diagnosis could be responsible for this finding? a. Mitral stenosis b. Pulmonary edema c. Ischemia d. Pericarditis

b

What does the P wave component of the electrocardiographic waveform represent? a. Atrial contraction b. Atrial depolarization c. Sinus node discharge d. Ventricular contraction

b

What effect does ventricular tachycardia have on cardiac output? a. Increases cardiac output due to an increase in ventricular filling time b. Decreases cardiac output due to a decrease in stroke volume c. Increases cardiac output due to an increase in preload d. Decreases cardiac output due to a decrease in afterload

b

What is negligence called when it applies to an individual who is a professional? a. Breach b. Malpractice c. Duty d. Harm

b

What is the first step of the ethical decision-making process? a. Consulting with an authority b. Identifying the health problem c. Delineating the ethical problem from other types of problems d. Identifying the patient as the primary decision maker

b

What is the initial intervention in a patient with sinus tachycardia with the following vital signs: heart rate, 136 beats/min; blood pressure, 102/60 mm Hg; respiratory rate, 24 breaths/min; temperature, 99.2° F; SpO2, 94% on oxygen 2 L/min by nasal cannula? a. Administer adenosine IV push. b. Identify the cause. c. Administer nitroglycerine 0.4 mg sublingual. d. Administer lidocaine 75 mg IV push.

b

What is the major factor influencing the patient's response to atrial flutter? a. Atrial rate b. Ventricular response rate c. PR interval d. QRS duration

b

What is the most common complaint heard from families of dying patients? a. Poor nursing care b. Inadequate communication c. Lack of consistent plan of care d. Confusion among health care team members

b

What is the most common complication of a central venous catheter (CVC)? a. Air embolus b. Infection c. Thrombus formation d. Pneumothorax

b

What is the physiologic effect of left ventricular afterload reduction? a. Decreased left atrial tension b. Decreased systemic vascular resistance c. Increased filling pressures d. Decreased cardiac output

b

What type of atrioventricular (AV) block can be described as a gradually lengthening PR interval until ultimately the final P wave in the group fails to conduct? a. First-degree AV block b. Second-degree AV block, type I c. Second-degree AV block, type II d. Third-degree AV block

b

When assessing a patient, the use of touch to judge the character of the body surface and underlying organs is known as what technique? a. Inspection b. Palpation c. Percussion d. Auscultation

b

When assessing the pulmonary arterial waveform, the nurse notices dampening. After tightening the stopcocks and flushing the line, the nurse decides to calibrate the transducer. What are two essential components included in calibration? a. Obtaining a baseline blood pressure and closing the transducer to air b. Leveling the air-fluid interface to the phlebostatic axis and opening the transducer to air c. Having the patient lay flat and closing the transducer to air d. Obtaining blood return on line and closing all stopcocks

b

When auscultating a patient's lungs, the nurse notes breath sounds that sound like popping in the small airways. What should the nurse document in the patient's record? a. Sonorous wheezes b. Crackles c. Sibilant wheezes d. Pleural friction rub

b

When auscultating for breath sounds, which statement is true? a) Place the patient in the left lateral position to better hear abnormal breath sounds. b) Use a systematic approach to assess and contrast all areas of the lungs. c) The bell of the stethoscope should be used to assess for normal breath sounds. d) Breath sounds should be assessed on expiration.

b

Which action best reflects the concept of beneficence within the critical care setting? a. Advocating for equitable health care b. Promoting for safe patient care c. Ensuring equal access for those with the same condition or diagnosis d. Confirming technologic advances are available to all in a given community

b

Which criteria are representative of the patient in normal sinus rhythm? a. Heart rate, 64 beats/min; rhythm regular; PR interval, 0.10 second; QRS, 0.04 second b. Heart rate, 88 beats/min; rhythm regular; PR interval, 0.18 second; QRS, 0.06 second c. Heart rate, 54 beats/min; rhythm regular; PR interval, 0.16 second; QRS, 0.08 second d. Heart rate, 92 beats/min; rhythm irregular; PR interval, 0.16 second; QRS, 0.04 second

b

Which electrocardiographic (ECG) abnormality is most often found in ventricular dysrhythmias? a. Retrograde P waves b. Wide QRS complexes c. No P waves d. An inverted T wave

b

Which of the following is most indicative of decreased left ventricular preload? a. Increased pulmonary artery occlusion pressure (PAOP) b. Decreased pulmonary artery occlusion pressure (PAOP) c. Increased central venous pressure (CVP) d. Decreased central venous pressure (CVP)

b

Which of the following statements about comfort care is accurate? a. Withholding and withdrawing life-sustaining treatment are distinctly different in the eyes of the legal community. b. Each procedure should be evaluated for its effect on the patient's comfort before being implemented. c. Only the patient can determine what constitutes comfort care for him or her. d. Withdrawing life-sustaining treatments is considered euthanasia in most states.

b

Which portion of the electrocardiogram (ECG) is most valuable in diagnosing atrioventricular (AV) conduction disturbances? a. P wave b. PR interval c. QRS complex d. QT interval

b

Which serum lipid value is a significant predictor of future acute myocardial infarction (MI) in persons with established coronary artery atherosclerosis? a. High-density lipoprotein (HDL) b. Low-density lipoprotein (LDL) c. Triglycerides d. Very-low-density lipoprotein

b

Which situation would be considered a failure of proper implementation? a. Not identifying and analyzing symptoms appropriately b. Not documenting the patient's response to pain medication c. Not recognizing a malfunctioning chest tube d. Not asking the patient about code or no code wishes

b

Which statement best describes the concept of paternalism? a. Encouraging the patient to ambulate after surgery b. Demanding the patient get out of bed to sit in a chair c. Following the patient's advance directive despite family objections d. Administering antibiotics for a viral infection

b

Which statement expresses the correct order when working with an invasive pressure monitor? a. Level the transducer, locate the phlebostatic axis, zero the transducer, and take the reading. b. Locate the phlebostatic axis, level the transducer, zero the transducer, and take the reading. c. Take the reading, level the transducer, locate the phlebostatic axis, and zero the transducer. d. Locate the phlebostatic axis, zero the transducer, level the transducer, and take the reading.

b

Which statement is accurate regarding a nurse's job description? a. As long as the nurse follows the American Nurses Association Standards of Care, the job description is irrelevant in a negligence allegation. b. Job descriptions must be reflective of the accepted standard of care. c. Institution-specific job descriptions are not legally acceptable. d. Job descriptions should be vague in describing nursing functions to avoid claims of negligence.

b

Which statement is true regarding assessment of breath sounds? a) Place the patient in the left lateral position to better hear abnormal breath sounds. b) Use a systematic approach to assess and contrast all areas of the lungs. c) The bell of the stethoscope should be used to assess for normal breath sounds. d) Breath sounds should be assessed on expiration.

b

Which statement regarding organ donation is accurate? a. Organ donation is a choice only the patient can make for him- or herself. b. Hospitals must have written protocols for the identification of potential organ donors. c. Organ donation must be requested by the nurse caring for the dying patient. d. Individual institutional policies govern how organ donation requests are made.

b

While conducting a physical assessment on a patient with chronic obstructive pulmonary disease (COPD), the nurse notes that the patient's breathing is rapid and shallow. What is this type of breathing pattern called? a. Hyperventilation b. Tachypnea c. Obstructive breathing d. Bradypnea

b

Why is mixed venous oxygen saturation (SVO2) monitoring helpful in the management of the critically ill patient? a. It facilitates oxygen saturation monitoring at the capillary level. b. It can detect an imbalance between oxygen supply and metabolic tissue demand. c. It assesses the diffusion of gases at the alveolar capillary membrane. d. It estimates myocardial workload during heart failure and acute pulmonary edema.

b

In normal respiration, inspiration is longer than expiration. In which disorders will inspiration be equal to expiration? (Select all that apply.) a) Pneumothorax b) Pneumonia with consolidation c) Pulmonary fibrosis d) Atelectasis e) Effusion

b,c

Nurses in the intensive care unit are having a high incidence of burnout after a period in which several long-term patients died in the unit despite having received aggressive care. Which strategies can the nurse manager implement to help the staff deal with these issues? (Select all that apply.) a) A meeting regarding cardiopulmonary resuscitation (CPR) performance b) An educational program on futility of care and withdrawal of support c) A program on stress management and burnout d) Developing clear polices and guidelines concerning end-of-life care e) Implementing a reward or bonus program for the staff

b,c,d

A patient has bronchial breath sounds over the peripheral lung fields. What condition could cause this? (Select all that apply.) a) Asthma b) Lung mass with exudate c) Bronchitis d) Pulmonary edema e) Bronchospasms

b,d

Which statement made by a patient who has received an organ transplant indicates that the teaching was effective? a. "I will finally be able to eat a regular diet." b. "I will establish a routine for checking any skin changes." c. "I will check my blood pressure regularly to make sure it's not too high." d. "After my drug regimen is established, I won't have to worry about rejection."

b. "I will establish a routine for checking any skin changes."

What is the therapeutic blood level for theophylline (Xanthines)? a. 5 to 10 mg/dL b. 10 to 20 mg/dL c. 20 to 30 mg/dL d. 35 to 45 mg/dL

b. 10 to 20 mg/dL

Which dosage of dopamine results in stimulation of beta1 receptors and increased myocardial contractility? a. 1 mcg/kg/min b. 5 mcg/kg/min c. 15 mcg/kg/min d. 20 mcg/kg/min

b. 5 mcg/kg/min

A patient with acute lung failure has been on a ventilator for 3 days and is being considered for weaning. The ventilator high-pressure limit alarm keeps alarming. What would cause this problem? a. A leak in the patient's endotracheal (ET) tube cuff b. A kink in the ventilator tubing c. The patient is disconnected from the ventilator d. A faulty oxygen filter

b. A kink in the ventilator tubing

Which statement is correct concerning endotracheal tube cuff management? a. The cuff should be deflated every hour to minimize pressure on the trachea. b. A small leak should be heard on inspiration if the cuff has been inflated using the minimal leak technique. c. Cuff pressures should be kept between 20 to 30 mm Hg to ensure an adequate seal. d. Cuff pressure monitoring should be done once every 24 hours.

b. A small leak should be heard on inspiration if the cuff has been inflated using the minimal leak technique.

Not every patient with end-stage liver disease is a candidate for receiving a transplant. Which conditions are contraindications to a kidney transplant? (Select all that apply.) a. Malignancy during the past 5 years b. Active infectious process c. Advanced cardiopulmonary disease d. Recreational drug use e. Nonadherence to current medical regimen

b. Active infectious process c. Advanced cardiopulmonary disease d. Recreational drug use e. Nonadherence to current medical regimen

The nurse is caring for a patient in shock with an elevated lactate level. Which order should the nurse question in the management of this patient? a. Start an insulin drip for blood sugar greater than 180 mg/dL. b. Administer sodium bicarbonate to keep arterial pH greater than 7.20. c. Start a norepinephrine drip to keep mean arterial blood pressure greater than 65 mm Hg. d. Administer crystalloid fluids.

b. Administer sodium bicarbonate to keep arterial pH greater than 7.20.

Through what mechanism does enalapril decrease blood pressure? a. Direct arterial vasodilation b. Block the conversion of angiotensin I to angiotensin II c. Increase fluid excretion at the loop of Henle d. Peripheral vasoconstriction and central vasodilation.

b. Block the conversion of angiotensin I to angiotensin II

For which situation does a patient with acute lung failure require a bronchodilator? a. Excessive secretions b. Bronchospasms c. Thick secretions d. Fighting the ventilator

b. Bronchospasms

A trauma victim has sustained right rib fractures and pulmonary contusions. Auscultation reveals decreased breath sounds on the right side. Bulging intercostal muscles are noted on the right side. Heart rate (HR) is 130 beats/min, respiratory rate (RR) is 32 breaths/min, and breathing is labored. In addition to oxygen administration, what procedure should the nurse anticipate? a. Thoracentesis b. Chest tube insertion c. Pericardiocentesis d. Emergent intubation

b. Chest tube insertion

A patient has been admitted with hypovolemic shock due to blood loss. Which finding would the nurse expect to note to support this diagnosis? a. Distended neck veins b. Decreased level of consciousness c. Bounding radial and pedal pulses d. Widening pulse pressure

b. Decreased level of consciousness

Which mechanism is responsible for the augmentation of coronary arterial blood flow and increased myocardial oxygen supply seen with the intraaortic balloon pump? a. The vacuum created in the aorta as a result of balloon deflation b. Diastolic inflation with retrograde perfusion c. Forward flow to the peripheral circulation d. Inflation during systole to augment blood pressure

b. Diastolic inflation with retrograde perfusion

Which anticoagulant enhances the activity of antithrombin III and does not require activated partial thromboplastin time (aPTT) or activated clotting time (ACT) monitoring? a. Heparin b. Enoxaparin c. Bivalirudin d. Argatroban

b. Enoxaparin

A patient was admitted with acute lung failure secondary to pneumonia. What is the single most important measure to prevent the spread of infection between staff and patients? a. Place the patient in respiratory isolation. b. Ensure everyone is using proper hand hygiene. c. Use personal protective equipment. d. Initiate prompt administration of antibiotics.

b. Ensure everyone is using proper hand hygiene.

Patient safety precautions when working with oxygen include which action? a. Observing for signs of oxygen-associated hyperventilation b. Ensuring the oxygen device is properly positioned c. Removal of all oxygen devices when eating d. Administration of oxygen at the nurse's discretion

b. Ensuring the oxygen device is properly positioned

A patient is admitted after she develops disseminated intravascular coagulation (DIC) after a vaginal delivery. The nurse knows that DIC is known to occur in patients with retained placental fragments. What is the pathophysiologic consequence of DIC? a. Hypersensitivity response to an antigen b. Excessive thrombosis and fibrinolysis c. Profound vasodilatation d. Loss of intravascular volume

b. Excessive thrombosis and fibrinolysis

A patient has been admitted with septic shock related to tissue necrosis. The nurse knows the initial goal for medical management for this patient is which intervention? a. Limiting fluids to minimize the possibility of heart failure b. Finding and eradicating the cause of infection c. Discontinuing invasive monitoring as a possible cause of sepsis d. Administering vasodilator substances to increase blood flow to vital organs

b. Finding and eradicating the cause of infection

A patient in cardiogenic shock is being treated in the critical care unit. Which findings would the nurse expect to note in the patient to support this diagnosis? (Select all that apply.) a. Warm, dry skin b. Heart rate greater than 100 beats/min c. Weak, thready pulse d. Increased right atrial pressure e. Decreased pulmonary artery occlusion pressure

b. Heart rate greater than 100 beats/min c. Weak, thready pulse d. Increased right atrial pressure

A patient was taken to surgery for a left lung resection. The patient returned to the unit 30 minutes ago. Upon completion of the assessment, the nurse notices that the chest tube has drained 150 mL of red fluid in the past 30 minutes. The nurse contacts the physician and suspects that the patient has developed what complication? a. Pulmonary edema b. Hemorrhage c. Acute lung failure d. Bronchopleural fistula

b. Hemorrhage

Nursing interventions after angioplasty would include which of the following? (Select all that apply.) a. Elevating the head of the bed to 45 degrees b. Hydration as a renal protection measure c. Assessing pedal pulses on the involved limb every 15 minutes for the first 2 hours after the procedure d. Monitoring the vascular hemostatic device for signs of bleeding e. Educating the patient on the necessity of staying supine for 1 to 2 hours after the procedure

b. Hydration as a renal protection measure c. Assessing pedal pulses on the involved limb every 15 minutes for the first 2 hours after the procedure d. Monitoring the vascular hemostatic device for signs of bleeding

Which signs and symptoms would indicate successful reperfusion after administration of a fibrinolytic agent? (Select all that apply.) a. Gradual decrease in chest pain b. Intermittent, multifocal premature ventricular contractions c. Rapid resolution of ST elevation d. Rapid rise in creatine kinase MB fraction

b. Intermittent, multifocal premature ventricular contractions c. Rapid resolution of ST elevation d. Rapid rise in creatine kinase MB fraction

Which statements regarding rotation therapies are accurate? (Select all that apply.) a. Continuous lateral rotation therapy (CLRT) can be effective for improving oxygenation if used for at least 18 hours/day. b. Kinetic therapy can decrease the incidence of ventilator-acquired pneumonia in neurologic and postoperative patients. c. Use of rotational therapy eliminates the need for other pressure ulcer prevention strategies. d. CLRT helps avoid hemodynamic instability secondary to the continuous, gentle turning of the patient. e. CLRT has minimal pulmonary benefits for critically ill patients.

b. Kinetic therapy can decrease the incidence of ventilator-acquired pneumonia in neurologic and postoperative patients. e. CLRT has minimal pulmonary benefits for critically ill patients.

Many barriers exist to increasing the number of organ donors to meet today's growing need. Which barriers are related to hospital factors? (Select all that apply.) a. Limited resources b. Lack of interest c. Failure to approve protocols d. Nurses' attitudes e. Delay in termination of life support

b. Lack of interest c. Failure to approve protocols d. Nurses' attitudes e. Delay in termination of life support

The organ procurement organization coordinator writes orders to initiate standard donor care. Which interventions are parts of standard donor care? (Select all that apply.) a. Continue administration of osmotic agents and diuretics. b. Maintain head of bed at 30 to 40 degrees elevation. c. Continue routine pulmonary suctioning and side-to-side body positioning. d. Warming blanket to maintain body temperature above 36.5° C. e. Maintain mean arterial pressure less than 70 mm Hg.

b. Maintain head of bed at 30 to 40 degrees elevation. c. Continue routine pulmonary suctioning and side-to-side body positioning. d. Warming blanket to maintain body temperature above 36.5° C.

Which medication can cause bronchospasms and should be administered with a bronchodilator? a. Beta-2 agonist b. Mucloytics c. Anticholinergic agents d. Xanthines

b. Mucloytics

Which calcium channel blocker is beneficial in the treatment of patients with coronary artery disease or ischemic stroke? a. Nifedipine b. Nicardipine c. Clevidipine d. Diltiazem

b. Nicardipine

The nurse is caring for a patient who what just admitted with septic shock. The nurse knows that certain interventions should be completed within 3 hours of time of presentation. Which intervention would be a priority for the nurse to implement upon receipt of a practitioner's order? a. Administer fresh frozen plasma b. Obtain a serum lactate level c. Administer epinephrine d. Measure central venous pressure

b. Obtain a serum lactate level

Which diagnostic criteria is indicative of mild adult respiratory distress syndrome (ARDS)? a. Radiologic evidence of bibasilar atelectasis b. PaO2/FiO2 ratio less than or equal to 200 mm Hg c. Pulmonary artery wedge pressure greater than 18 mm Hg d. Increase in static and dynamic compliance

b. PaO2/FiO2 ratio less than or equal to 200 mm Hg

When analyzing the electocardiogram (ECG) strip of the patient with a pacemaker, the nurse notices there is a spike before each QRS complex. What is this phenomenon indicative of? a. 60-cycle electrical interference; check equipment b. Pacing artifact; the pacemaker is sensing and capturing c. Electrical artifact; the pacemaker is not sensing d. Patient movement; check electrodes

b. Pacing artifact; the pacemaker is sensing and capturing

The nurse is caring for a patient with multiple-organ dysfunction syndrome (MODS). The nurse understands that earlier nutritional support is critical for the patient to prevent profound weight loss. Why does this occur in patient MODS? a. Patient experiences hypometabolism. b. Patient experiences hypermetabolism. c. Patient experiences anorexia. d. Patient has gut dysfunction.

b. Patient experiences hypermetabolism.

When is a patient a candidate for a surgical repair of an abdominal aortic aneurysm (AAA)? a. Size is 1 cm b. Patient experiencing symptoms c. Aneurysm size unchanged over several years d. Size less than 4 cm

b. Patient experiencing symptoms

What is the preferred initial treatment of an acute myocardial infarction? a. Fibrinolytic therapy b. Percutaneous coronary intervention (PCI) c. Coronary artery bypass surgery (CABG) d. Implanted Cardioverter defibrillator (ICD)

b. Percutaneous coronary intervention (PCI)

What parameter must be assessed frequently in the patient with an intraaortic balloon in place? a. Skin turgor in the affected extremity b. Peripheral pulses distal to the insertion site c. Blood pressures in both arms and legs d. Oxygen saturation

b. Peripheral pulses distal to the insertion site

A nursing instructor is discussing the difference between primary and secondary multiple-organ dysfunction syndrome (MODS) with a nursing student. Which statement indicates the student understood the information? a. Primary MODS is the result of inflammation in organs not involved in the initial insult. b. Primary MODS is the result of a direct organ injury. c. Primary MODS is due to a disorganization of the inflammatory immune system response. d. Primary MODS is due to disruption of the coagulation system.

b. Primary MODS is the result of a direct organ injury.

What nursing interventions should be included in the nursing management of the patient receiving a neuromuscular blocking agent? a. Withholding all sedation and narcotics b. Protecting the patient from the environment c. Keeping the patient supine d. Speaking to the patient only when necessary

b. Protecting the patient from the environment

What is the major hemodynamic consequence of a massive pulmonary embolus? a. Increased systemic vascular resistance leading to left heart failure b. Pulmonary hypertension leading to right heart failure c. Portal vein blockage leading to ascites d. Embolism to the internal carotids leading to a stroke

b. Pulmonary hypertension leading to right heart failure

A patient was admitted with acute lung failure. The patient has been on a ventilator for 3 days and is being considered for weaning. Which criteria would indicate that the patient is ready to be weaned? a. FiO2 greater than 50% b. Rapid shallow breathing index less than 105 c. Minute ventilation greater than 10 L/min d. Vital capacity/kg greater than or equal to 15 mL

b. Rapid shallow breathing index less than 105

A nurse is discussing the concept of shock with a new graduate nurse. Which statement indicates the new graduate nurse understood the information? a. Shock is a physiologic state resulting in hypotension and tachycardia. b. Shock is an acute, widespread process of inadequate tissue perfusion. c. Shock is a degenerative condition leading to organ failure and death. d. Shock is a condition occurring with hypovolemia that results in hypotension.

b. Shock is an acute, widespread process of inadequate tissue perfusion.

A patient has been admitted with a neurologic disorder. With which disorder should the nurse be the most vigilant for the development of neurogenic shock? a. Ischemic stroke b. Spinal cord injury c. Guillain-Barré syndrome d. Brain tumor

b. Spinal cord injury

Which intervention is an essential aspect of the patient teaching plan for the patient with chronic heart failure? a. Instructing the patient to call the practitioner prior to dental surgery b. Stressing the importance of compliance with diuretic therapy c. Instructing the patient to take nitroglycerin if chest pain occurs d. Teaching the patient how to take an apical pulse

b. Stressing the importance of compliance with diuretic therapy

A patient with acute lung failure has been on a ventilator for 3 days and is being considered for weaning. When entering the room, the ventilator inoperative alarm sounds. What action should the nurse take FIRST? a. Troubleshoot the ventilator until the problem is found. b. Take the patient off the ventilator and manually ventilate. c. Call the respiratory therapist for help. d. Silence the ventilator alarms until the problem is resolved.

b. Take the patient off the ventilator and manually ventilate.

Which description best describes the pain associated with aortic dissection? a. Substernal pressure b. Tearing in the chest, abdomen, or back c. Numbness and tingling in the left arm d. Stabbing in the epigastric area

b. Tearing in the chest, abdomen, or back

Which patients would be a candidate for fibrinolytic therapy? (Select all that apply.) a. The patient's chest pain started 8 hours ago. She has a diagnosis of non-ST-elevation myocardial infarction (NSTEMI). b. The patient's chest pain started 3 hours ago, and her electrocardiogram (ECG) shows a new left bundle branch block. c. The patient presents to the emergency department with chest pain of 30 minutes' duration. She has a history of cerebrovascular accident 1 month ago. d. The patient has a history of unstable angina. He has been experiencing chest pain with sudden onset. e. The patient's chest pain started 1 hour ago, and his ECG shows ST elevation.

b. The patient's chest pain started 3 hours ago, and her electrocardiogram (ECG) shows a new left bundle branch block. e. The patient's chest pain started 1 hour ago, and his ECG shows ST elevation.

Which of the following statements regarding beta-blockers is correct? a. They increase heart rate and are contraindicated in tachydysrhythmias. b. They result in bronchospasm and should not be used in patients with chronic obstructive pulmonary disease (COPD). c. They increase cardiac output and help with left ventricular failure. d. They are helpful in increasing atrioventricular node conduction and are used in heart blocks.

b. They result in bronchospasm and should not be used in patients with chronic

Which ventilator phase variable initiates the change from exhalation to inspiration? a. Cycle b. Trigger c. Flow d. Pressure

b. Trigger

What dysrhythmia is most frequently associated with sudden cardiac death? a. Premature ventricular contractions b. Ventricular tachycardia c. Third degree heart block d. Asystole

b. Ventricular tachycardia

The possibility of microshock when handling a temporary pacemaker can be minimized by which intervention? a. Decreasing the milliamperes b. Wearing gloves c. Positioning the patient on the left side d. Wearing rubber-soled shoes

b. Wearing gloves

A 55-year-old patient is scheduled for a stress test. What is the estimation of the patient's maximal predicted heart rate? a. 65 beats/min b. 155 beats/min c. 165 beats/min d. 265 beats/min

c

A nurse is making assignments for the oncoming shift. Which assignment would be appropriate for the patient who is actively dying? a) Assign the dying patient to a float nurse so the family will not associate the death experience with unit personnel. b) Assign the nurse with the dying patient to an unstable patient so the nurse will not have to spend time with the dying patient's family. c) Assign the dying patient to a nurse with whom the family has built a relationship, and assign the nurse to a stable patient as well. d) Assign the dying patient to a nurse who has been off work for 2 or more days so he or she will have the energy to care for the patient's and family's needs, and assign the nurse to a stable patient as well.

c

A patient becomes unresponsive. The patient's heart rate is 32 beats/min in an idioventricular rhythm; blood pressure is 60/32 mm Hg; SpO2 is 90%; and respiratory rate is 14 breaths/min. Which intervention would the nurse do first? a. Notify the physician and hang normal saline wide open. b. Notify the physician and obtain the defibrillator. c. Notify the physician and obtain a temporary pacemaker. d. Notify the physician and obtain a 12-lead ECG.

c

A patient has a history of respiratory problems. The nurse is assessing the patient's chest and notes that the sternum and lower ribs are displaced posteriorly, creating a pit-shaped depression in the chest. What is this finding called? a) Barrel chest b) Kyphosis c) Pectus excavatum d) Pectus carinatum

c

A patient has just had a chest tube removed. While securing the dressing, you notice that the patient is having difficulty breathing. Upon examination, you note that the trachea has shifted to the left side. These findings are suggestive of which complication? a) Acute lung failure b) Aspiration of secretions c) A pneumothorax d) Atelectasis

c

A patient is admitted with acute lung failure secondary to chronic obstructive pulmonary disease (COPD). Upon inspection of the patient, the nurse observes that the patient's fingers appear discolored. What does this finding indicate the presence of? a. Clubbing b. Central cyanosis c. Peripheral cyanosis d. Chronic tuberculosis

c

A patient is admitted with an exacerbation of chronic obstructive pulmonary disease (COPD). The nurses notes that the patient has difficulty getting breath out. Which phrase best describes the patient's breathing pattern? a. Deep sighing breaths without pauses b. Rapid, shallow breaths c. Normal breathing pattern interspersed with forced expirations d. Irregular breathing pattern with both deep and shallow breaths

c

A patient is getting heparin by intravenous infusion. The nurse received an order to increase the heparin infusion rate and obtain a partial thromboplastin time (PTT) in 1 hour. The PTT was drawn correctly and revealed a critically elevated level. The nurse was busy with another patient and failed to report the critical result to the physician within 30 minutes according to the facility's policy. Subsequently, the patient sustained a massive intracerebral bleed. What type of negligence may be present? a. Assessment failure b. Planning failure c. Implementation failure d. Evaluation failure

c

A patient presents with chest trauma from a motor vehicle accident. Upon assessment, the nurse documents that the patient is complaining of dyspnea, shortness of breath, tachypnea, and tracheal deviation to the right. In addition, the patient's tongue is blue-gray. Based on this assessment data, what additional assessment findings would the nurse expect to find? a. Kussmaul breathing pattern b. Absent breath sounds in the right lower lung fields c. Absent breath sounds in the left lung fields d. Diminished breath sounds in the right upper lung fields

c

A patient was admitted several weeks ago with an acute myocardial infarction and subsequently underwent coronary artery bypass grafting surgery. Since a cardiac arrest 5 days ago, the patient has been unresponsive. An electroencephalogram shows no meaningful brain activity. After a family conference, the practitioner orders a do-not-resuscitate (DNR) order, and palliative care is begun. How does this affect the patient's treatment? a. The patient will continue to receive the same aggressive treatment short of resuscitation if he has another cardiac arrest. b. All treatment will be stopped, and the patient will be allowed to die. c. All attempts will be made to keep the patient comfortable without prolonging his life. d. The patient will be immediately transferred to hospice.

c

A patient was admitted several weeks ago with an acute myocardial infarction and subsequently underwent coronary artery bypass grafting surgery. Since a cardiac arrest 5 days ago, the patient has been unresponsive. An electroencephalogram shows no meaningful brain activity. The decision is made to remove the patient from the ventilator. Which of the following statements is most accurate? a. The cardiac monitor should be left on so everyone will know when the patient has died. b. Opioids, sedatives, and neuromuscular blocking agents should be discontinued just before removing the ventilator. c. The family and health care team should decide the best method for removing the ventilator terminal wean versus immediate extubation. d. If terminal weaning is selected, the family should be sent to the waiting room until the ventilator has actually been removed.

c

A patient with end-stage renal disease is refusing any further treatments. Which response is appropriate for the nurse to make? a) "Why do you want to stop treatment? Don't you realize you will die?" b) "Are you giving up? What will your family say?" c) "You want to stop dialysis? Is there something about it that is bothering you?" d) "This is your decision. I will get the paperwork."

c

A patient's wife has been informed by the practitioner that her spouse has permanent quadriplegia. The wife states that she does not want anyone to tell the patient about his injury. The patient asks the nurse about what has happened. Based on which ethical principles does the nurse answer the patient's questions? a. Veracity b. Justice c. Autonomy d. Nonmaleficence

c

A practitioner is suggesting treatments to a patient that are contrary to the patient's preferences. What is this practice called? a. Invaluable deficiency b. Physiologic uselessness c. Ethical futility d. Situational insufficiency

c

After a myocardial infarction, a patient presents with an increasing frequency of premature ventricular contractions (PVCs). The patient's heart rate is 110 beats/min, and electrocardiogram (ECG) indicates a sinus rhythm with up to five unifocal PVCs per minute. The patient is alert and responsive and denies any chest pain or dyspnea. What action should the nurse take next? a. Administer lidocaine 100 mg bolus IV push stat. b. Administer Cardizem 20 mg IV push stat. c. Notify the physician and monitor the patient closely. d. Nothing; PVCs are expected in this patient.

c

After admission a patient shares with the nurse a concern that her adult children will not be able to reach agreement on what to do if she is no longer able to make decisions for herself. The nurse informs the patient that it is possible to grant authority to one person to make decision through which mechanism? a. Court-appointed guardian b. Do-not-resuscitate order c. Durable power of attorney for health care d. Living will

c

By what action can critical care nurses can best enhance the principle of autonomy? a. Presenting only the information to prevent relapse in a patient b. Assisting with only tasks that cannot be done by the patient c. Providing the patient with all of the information and facts d. Guiding the patient toward the best choices for care

c

Disagreement and distress among practitioners, nurse practitioners, and critical care nurses can lead to what issue? a. Moral indignation b. Ethical resentment c. Moral distress d. Interprofessional anguish

c

During transport to the operating room for mitral valve replacement, a patient with a signed consent form says that she does not want to go through with the surgery and asks to be returned to her room. What is the best response from the nurse? a. "The operating room is prepared; let's not keep the surgeon waiting." b. "You have the right to cancel surgery, but it could be weeks before you are rescheduled." c. "You sound frightened; tell me what you are thinking." d. "Your preoperative medications will have you feeling more relaxed in a minute; it will be OK."

c

Haloperidol are traditionally been used to managed which symptom? a. Anxiety b. Dyspnea c. Delirium d. Pain

c

Most chest radiographs of critically ill patients are obtained using a portable chest radiograph machine. What is the difference between a chest radiograph taken in the radiology department and one taken in the critical care unit? a. Portable chest radiographs are usually clearer. b. Only posterior views can be obtained in the critical care unit. c. The sharpness of the structures is decreased with a portable chest radiograph. d. Chest radiographs taken in radiology enlarge some thoracic structures.

c

The nurse is caring for a patient with respiratory failure. The nurse notes the patient's diaphragmatic excursing is 8 cm. What coexisting conditions could account for this finding? a. Asthma and emphysema b. Hepatomegaly and ascites c. Atelectasis and pleural effusion d. Pneumonia and pneumothorax

c

The nurse is observing a new graduate listen to a patient's lungs. Which action by the new graduate indicates a need to review auscultation skills? a. The nurse starts at the apices and moves to the bases. b. The nurse compares breath sounds from side to side. c. The nurse listens during inspiration. d. The nurse listens posteriorly, laterally, and anteriorly.

c

The nurse is performing a pulmonary assessment on a patient with pulmonary fibrosis. Which finding is unexpected? a. Diminished thoracic expansion b. Tracheal deviation to the most affected side c. Hyperresonant percussion tones d. Decreased breath sounds

c

To accurately measure the heart rate of a patient in normal sinus rhythm, which technique would be the most accurate? a. The number of R waves in a 6-second strip b. The number of large boxes in a 6-second strip c. The number of small boxes between QRS complexes divided into 1500 d. The number of large boxes between consecutive R waves divided into 300

c

Truth-telling is an example of what ethical principle? a. Justice b. Beneficence c. Autonomy d. Nonmaleficence

c

Two nurses are talking about a patient's condition in the cafeteria. In doing so, these nurses could be accused of what? a. Failure to take appropriate action b. Failure to timely communicate patient findings c. Failure to preserve patient privacy d. Failure to document patient information

c

What assessment technique uses the creation of sound waves across the body surface to determine abnormal densities? a. Inspection b. Palpation c. Percussion d. Auscultation

c

What characteristic is associated with junctional escape rhythms? a. Irregular rhythm b. Rate greater than 100 beats/min c. P wave may be present or absent d. QRS greater than 0.10 seconds

c

What is the effect of preload on cardiac output? a. As preload increases, cardiac output increases. b. As preload increases, cardiac output decreases. c. As preload increases, cardiac output increases until it overstretches the ventricle and cardiac output decreases. d. Increased preload has no effect on cardiac output.

c

What is the formula for calculating mean arterial pressure (MAP)? a. Averaging three of the patient's blood pressure readings over a 6-hour period b. Dividing the systolic pressure by the diastolic pressure c. Adding the systolic pressure and two diastolic pressures and then dividing by 3 d. Dividing the diastolic pressure by the pulse pressure

c

What is the rationale for giving the patient additional fluids after a cardiac catheterization? a. Fluids help keep the femoral vein from clotting at the puncture site. b. The patient had a nothing-by-mouth order before the procedure. c. The radiopaque contrast acts as an osmotic diuretic. d. Fluids increase cardiac output.

c

When performing a 12-lead electrocardiogram (ECG), how many wires are connected to the patient? a. 3 b. 5 c. 10 d. 12

c

Which chest wall deformity is characterized by an increase in anteroposterior (AP) diameter with displacement of the sternum forward and the ribs outward? a. Funnel chest b. Pigeon breast c. Barrel chest d. Harrison's groove

c

Which diagnostic test is most effective for measuring overall heart size? a. 12-lead electrocardiography b. Echocardiography c. Chest radiography d. Vectorcardiography

c

Which noninvasive imaging technique is useful in diagnosing complications of a myocardial infarction (MI)? a. 12-lead ECG b. CT c. MRI d. Echocardiography

c

Which of the electrocardiogram (ECG) findings would be positive for an inferior wall myocardial infarction (MI)? a. ST segment depression in leads I, aVL, and V2 to V4 b. Q waves in leads V1 to V2 c. Q waves in leads II, III, and aVF d. T-wave inversion in leads V4 to V6, I, and aVL

c

While palpating a patient's lungs the nurse notes fremitus over the patient's trachea but not the lung periphery. What do these findings indicate? a. Bilateral pleural effusion b. Bronchial obstruction c. A normal finding d. Apical pneumothorax

c

Why is restraining a competent patient against his or her wishes considered an intentional tort? a. The nurse did not document the patient's need for restraints. b. The nurse failed to get a physician's order for restraints. c. The nurse touched the patient in an unauthorized manner. d. The nurse do not inform the patient that the restraints were needed.

c

Why is the measurement of the QT interval important? a. It facilitates rhythm identification and is best assessed in Lead II. b. It helps differentiate myocardial ischemia from infarction. c. An increasing QT interval increases the risk of torsades de pointes. d. A decreasing QT interval increases the risk of torsades de pointes.

c

A patient is admitted in respiratory distress secondary to pneumonia. The nurse knows that obtaining a history is very important. What is the appropriate intervention at this time for obtaining this data? a. Collect an overview of past medical history, present history, and current health status. b. Do not obtain any history at this time. c. Curtail the history to just a few questions about the patient's chief complaint and precipitating events. d. Complete the history and then provide measures to assist the patient to breathe easier.

c The initial presentation of the patient determines the rapidity and direction for the interview. For a patient in acute distress, the history should be curtailed to just a few questions about the patient's chief complaint and the precipitating events.

Depending on the patient's risk for the recurrence of pulmonary embolism (PE), how long may a patient remain on warfarin once they are discharged from the hospital? a. 1 to 3 months b. 3 to 6 months c. 3 to 12 months d. 12 to 36 months

c. 3 to 12 months

The nurse developing a patient education plan for the patient with endocarditis. What information would be included in the plan? a. Endocarditis is a viral infection that is easily treated with antibiotics. b. The risk of this diagnosis is occlusion of the coronary arteries. c. A long course of antibiotics is needed to treat this disorder. d. Complications are rare after antibiotics have been started.

c. A long course of antibiotics is needed to treat this disorder.

The Passy-Muir valve is contraindicated in which patient? a. A patient who is trying to relearn normal breathing patterns b. A patient who has minimal secretions c. A patient with laryngeal or pharyngeal dysfunction d. A patient who wants to speak while on the ventilator

c. A patient with laryngeal or pharyngeal dysfunction

Which therapeutic measure would be the most effective in treating hypoxemia in the presence of intrapulmonary shunting associated with acute respiratory distress syndrome (ARDS)? a. Sedating the patient to blunt noxious stimuli b. Increasing the FiO2 on the ventilator c. Administering positive-end expiratory pressure (PEEP) d. Restricting fluids to 500 mL per shift

c. Administering positive-end expiratory pressure (PEEP)

Which oxygen therapy device should is used in a patient requiring the delivery of a precise low FiO2? a. Simple mask b. Nasal cannula c. Air-entrainment mask d. Partial rebreathing mask

c. Air-entrainment mask

A patient was admitted to the critical care unit with acute respiratory failure. The patient has been on a ventilator for 3 days and is being considered for weaning. Which criteria would indicate that the patient is not tolerating weaning? a. A decrease in heart rate from 92 to 80 beats/min b. An SpO2 of 92% c. An increase in respiratory rate from 22 to 38 breaths/min d. Spontaneous tidal volumes of 300 to 350 mL

c. An increase in respiratory rate from 22 to 38 breaths/min

The nursing management plan for a patient with angina would include which intervention? a. Immediate administration of antiplatelet therapy b. Teaching the patient how to perform the Valsalva maneuver c. Assessment and documentation of chest pain episodes d. Administration of prophylactic lidocaine for ventricular ectopy

c. Assessment and documentation of chest pain episodes

What is the most common complication of fibrinolytic therapy? a. Reperfusion chest pain b. Lethargy c. Bleeding d. Heart blocks

c. Bleeding

Use of oxygen therapy in the patient who is hypercapnic may result in which situation? a. Oxygen toxicity b. Absorption atelectasis c. Carbon dioxide retention d. Pneumothorax

c. Carbon dioxide retention

The nurse is teaching a patient about antiviral medications. The patient asks what is the most common viral infection in transplant recipients. What should the nurse tell the patient? a. Influenza b. Respiratory syncytial virus c. Cytomegalovirus (CMV) d. Parainfluenza

c. Cytomegalovirus (CMV)

A patient is admitted after she develops disseminated intravascular coagulation (DIC) after a vaginal delivery. Which laboratory value would the nurse expect to note to support this diagnosis? a. Decreased fibrinogen degradation products b. Decreased D-dimer concentrations c. Decreased platelet counts d. Increased serum glucose levels

c. Decreased platelet counts

A patient was admitted 3 days ago with an acute myocardial infarction (MI). The patient complains of fatigue, not sleeping the past two nights, and change in appetite. Based on these findings the nurse suspects the patient may be experiencing which problem? a. Angina b. Anxiety c. Depression d. Endocarditis

c. Depression

A patient is admitted with an acute myocardial infarction (MI). What common complication should the nurse anticipate in this patient? a. Pulmonary edema b. Cardiogenic shock c. Dysrhythmias d. Deep vein thrombosis

c. Dysrhythmias

The nurse is caring for a patient after a liver transplant. Which finding would be of most concern to the nurse? a. Increased serum glucose b. Low aspartate aminotransferase (AST) and alanine aminotransferase (ALT) c. Elevated prothrombin time d. Decreased blood urea nitrogen and creatinine

c. Elevated prothrombin time

A patient is admitted with a fever of unknown origin. The patient is complaining of fatigue, malaise, joint pain, and shivering. The patient's vital signs include temperature, 103° F; heart rate, 90 beats/min; respiratory rate, 22 breaths/min; blood pressure, 132/78; and oxygen saturation, 94% on 2L nasal cannula. The patient has developed a cardiac murmur. The nurse suspects that the patient has developed which problem? a. Coronary artery disease b. Heart failure c. Endocarditis d. Pulmonary embolus

c. Endocarditis

A patient has been newly diagnosed with stable angina. He tells the nurse he knows a lot about his diagnosis already because his father had the same diagnosis 15 years ago. The nurse asks him to state what he already knows about angina. Which response indicates the need for additional education? a. He should stop smoking. b. He can no longer drink colas or coffee. c. He can no longer get a strong back massage. d. He should take stool softeners to prevent straining.

c. He can no longer get a strong back massage.

Which finding confirms the diagnosis of a pulmonary embolism (PE)? a. Low-probability ventilation-perfusion (V/Q) scan b. Negative pulmonary angiogram c. High-probability V/Q scan d. Absence of vascular markings on the chest radiograph

c. High-probability V/Q scan

What nursing intervention can minimize the complications of suctioning? a. Inserting the suction catheter no more than 5 inches b. Premedicating the patient with atropine c. Hyperoxygenating the patient with 100% oxygen d. Increasing the suction to 150 mm Hg

c. Hyperoxygenating the patient with 100% oxygen

A patient has developed septic shock. The nurse knows that the patient is at risk for gastrointestinal dysfunction. What happens to the gastrointestinal tract in the patient with septic shock? a. Anorexia leads to loss of gastric enzymes b. Lack of food ingestion leads to intestinal hypomotility c. Hypoperfusion results in loss of gut barrier function d. Low cardiac output causes decreased hydrochloric acid secretion

c. Hypoperfusion results in loss of gut barrier function

A patient is being admitted from the emergency department (ED) with cardiogenic shock secondary to unstable angina unresponsive to medications. The patient was intubated and ventilated in the ED. Which intervention should the nurse prepare to initiate when the practitioner arrives in the unit? a. Administration of sodium bicarbonate b. Rapid infusion of crystalloids c. Insertion of an intraaortic balloon pump (IABP) d. Insertion of dialysis catheters for continuous renal replacement therapy (CRRT)

c. Insertion of an intraaortic balloon pump (IABP)

What is the medical treatment for a pneumothorax greater than 15%? a. Systemic antibiotics to treat the inflammatory response b. An occlusive dressing to equalize lung pressures c. Interventions to evacuate the air from the pleural space d. Mechanical ventilation to assist with re-expansion of the collapsed lung

c. Interventions to evacuate the air from the pleural space

Which cause of hypoxemia is the result of blood passing through unventilated portions of the lungs? a. Alveolar hypoventilation b. Dead space ventilation c. Intrapulmonary shunting d. Physiologic shunting

c. Intrapulmonary shunting

A patient has developed septic shock. The nurse knows that the clinical manifestations of ischemic hepatitis show up 1 to 2 days after the insult. Which finding would the nurse expect to note to support this diagnosis? a. Elevated serum creatinine b. Decreased bilirubin c. Jaundice d. Decreased serum transaminase

c. Jaundice

A patient is admitted with massive head trauma. The patient is unresponsive and on mechanical ventilation. The electroencephalogram (EEG) is negative for brain waves. The family has agreed to organ donation. Which organs would not be considered for transplant? a. Heart b. Lung c. Liver d. Kidney

c. Liver

A patient is admitted with massive head trauma. The patient is unresponsive and on mechanical ventilation. The electroencephalogram (EEG) is negative for brain waves. The family has agreed to organ donation. When the nurse turns the patient's head quickly from side to side, the patient's eyes do not move. The nurse knows this is the result of the loss of what reflex? a. Oculovestibular b. Corneal c. Oculocephalic d. Pupillary

c. Oculocephalic

Assessment of a patient with pericarditis may reveal which signs and symptoms? a. Ventricular gallop and substernal chest pain b. Narrowed pulse pressure and shortness of breath c. Pericardial friction rub and pain d. Pericardial tamponade and widened pulse pressure

c. Pericardial friction rub and pain

The nurse is caring for a patient with left-sided heart failure. The nurse suspects the patient is developing pulmonary edema. Which finding would confirm the nurse's suspicions? a. Pulmonary crackles b. Peripheral edema c. Pink, frothy sputum d. Elevated central venous pressure

c. Pink, frothy sputum

A patient has been admitted with anaphylactic shock due to an unknown allergen. The nurse understands that the patient is probably having an immunoglobulin E (IgE)-mediated response as a result of what physiologic mechanism? a. Direct activation of mast cells and basophils b. Nonimmunologic stimulation of biochemical mediators c. Repeat exposure to an antigen in the presence of preformed IgE antibodies d. Activation of the systemic inflammatory response

c. Repeat exposure to an antigen in the presence of preformed IgE antibodies

The nurse is caring for a patient with systemic inflammatory response syndrome (SIRS) due to pneumonia. What is SIRS due to infection called? a. Infectivity b. Anaphylaxis c. Sepsis d. Acute respiratory distress syndrome (ARDS)

c. Sepsis

A patient was admitted in acute lung failure. The patient is receiving 40% oxygen via a simple facemask. The morning chest radiography study reveals right lower lobe pneumonia. Which test would the nurse expect the practitioner to order to identify the infectious pathogen? a. CBC with differential b. Wound culture of surgical site c. Sputum Gram stain and culture d. Urine specimen

c. Sputum Gram stain and culture

A patient is connected to an external temporary pulse generator. What does the sensitivity control regulate? a. The time interval between the atrial and ventricular pacing stimuli b. The amount of electrical current and is measured in milliamperes c. The ability of the pacemaker to detect the heart's intrinsic electrical activity d. The number of impulses that can be delivered to the heart per minute

c. The ability of the pacemaker to detect the heart's intrinsic electrical activity

Which statement about coronary artery disease (CAD) is accurate? a. There is a low correlation between modifiable risk factors and CAD. b. The onset of CAD occurs in middle age women sooner than men of the same age. c. There is an association between development of specific risk factors and CAD. d. The lower the C-reactive protein level the higher the risk for a coronary event.

c. There is an association between development of specific risk factors and CAD.

What happens to patients that meet criteria for imminent death? a. They are placed on life support and referred to the organ procurement organizations. b. They are referred to the organ procurement organizations at the time of their death. c. They are referred to the organ procurement organizations in a timely manner. d. They are referred to a practitioner to make the decision if they are candidates for organ donation.

c. They are referred to the organ procurement organizations in a timely manner.

Why are vasopressors used cautiously in the treatment of critical care patients? a. They cause vasoconstriction of the smooth muscles. b. They cause vasodilation of the smooth muscles. c. They increase afterload. d. They decrease preload.

c. They increase afterload.

A patient presents with severe substernal chest pain. The patient exclaims, "This is the most severe pain I have ever felt!" The patient reports that the pain came on suddenly about 2 hours ago and that three sublingual nitroglycerin tablets have not relieved the pain. The 12-lead electrocardiogram (ECG) reveals only the following abnormalities: T-wave inversion in leads I, aVL, V4, and V5; pathologic Q waves in leads II, III, and aVF; ST segment elevation in leads V1, V2, V3, and V4. Which statement is accurate about this patient? a. This patient has an old lateral wall infarction. b. This patient is having an inferior wall infarction. c. This patient is having an acute anterior wall infarction. d. This patient is having a posterior wall infarction.

c. This patient is having an acute anterior wall infarction.

A patient is admitted for palliative care for end-stage heart failure. What is the nurse's primary goal when caring for this patient? a. To reverse heart failure with the use of diuretics b. To increase activity tolerance c. To manage symptoms and relieve pain d. To increase cardiac output related to alteration of contractility

c. To manage symptoms and relieve pain

Which airway would be the most appropriate for a patient requiring intubation longer than 21 days? a. Oropharyngeal airway b. Esophageal obturator airway c. Tracheostomy tube d. Endotracheal intubation

c. Tracheostomy tube

The nurse is caring for a patient with sepsis due to necrotic tissue. The nurse knows that necrotic tissue can stimulate the inflammatory immune response. Which biochemical mediator is secreted in response to endotoxin or tissue injury? a. Arachidonic acid metabolite b. Platelet-activating factor c. Tumor necrosis factor d. Interleukin

c. Tumor necrosis factor

What is an indication for a pneumonectomy? a. Peripheral granulomas b. Bronchiectasis c. Unilateral tuberculosis d. Single lung abscess

c. Unilateral tuberculosis

A patient with coronary artery disease (CAD) is admitted with chest pain. The patient is suddenly awakened with severe chest pain. Three nitroglycerin sublingual tablets are administered 5 minutes apart without relief. A 12-lead electrocardiograph (ECG) reveals nonspecific ST segment elevation. The nurse suspects the patient may have which disorder? a. Silent ischemia b. Stable angina c. Unstable angina d. Prinzmetal angina

c. Unstable angina

A patient has an implantable cardioverter defibrillator (ICD) for chronic ventricular tachydysrhythmias. What action should the nurse take when the patient's rhythm deteriorates to ventricular fibrillation? a. Apply an external defibrillator to the patient. b. Call a code and start cardiopulmonary resuscitation (CPR) on the patient. c. Wait for the ICD to defibrillate the patient. d. Turn the ICD off and administer epinephrine.

c. Wait for the ICD to defibrillate the patient.

A new-onset myocardial infarction (MI) can be recognized by what electrocardiogram (ECG) change? a. Q waves b. Smaller R waves c. Widened QRS d. ST segment elevation

d

A night nurse is notified by the laboratory that the patient has a critical magnesium level of 1.1 mEq/L. The patient has a do-not-resuscitate order. The nurse does not notify the practitioner because of the patient's code status. In doing so, the nurse is negligent for what? a. Failure to analyze the level of care needed by the patient b. Failure to respect the patient's wishes c. Wrongful death d. Failure to take appropriate action

d

A nurse is obtaining the history of a patient who reveals that he had a myocardial infarction (MI) 5 years ago. When the admission 12-lead electrocardiogram (ECG) is reviewed, Q waves are noted in leads V3 and V4 only. Which conclusion is most consistent with this situation? a. The patient may have had a posterior wall MI. b. The patient must have had a right ventricular MI. c. The admission 12-lead ECG was done incorrectly. d. The patient may have had an anterior MI.

d

A patient is admitted for exacerbation of asthma. When auscultating for breath sounds, which finding would confirm this diagnosis? a) Vesicular breath sounds throughout all lung fields b) Muffled breath sounds with localized crackles c) Absent breath sounds in the bases; crackles on expiration d) Distant breath sounds with audible wheezing

d

A patient is admitted with acute respiratory failure secondary to pneumonia. Upon auscultation, the nurse hears creaking, leathery, coarse breath sounds in the lower anterolateral chest area during inspiration and expiration. This finding is indicative of what condition? a. Emphysema b. Atelectasis c. Pulmonary fibrosis d. Pleural effusion

d

A patient returns from the cardiac catheterization laboratory after angioplasty and stent placement (ECG changes had indicated an inferior wall myocardial infarction in progress). Which lead would best monitor this patient? a. Varies based on the patient's clinical condition and recent clinical history b. Lead V3 c. Lead V1 d. Lead II

d

A patient tells the nurse to call his family and tell them they need to come so they can say their goodbyes. The patient is sure he will not be here tomorrow because his grandparent is waiting for him. What is the patient exhibiting? a. Anxiety b. Delirium c. Metabolic derangement d. Near-death awareness

d

A patient was admitted several weeks ago with an acute myocardial infarction and subsequently underwent coronary artery bypass grafting surgery. Since a cardiac arrest 5 days ago, the patient has been unresponsive. An electroencephalogram shows no meaningful brain activity. The patient does not have an advance directive. Which statement would be the best way to approach the family regarding his ongoing care? a. "I will refer this case to the hospital ethics committee, and they will contact you when they have a decision." b. "What do you want to do about the patient's care at this point?" c. "Dr. Smith believes that there is no hope at this point and recommends do-not-resuscitate status." d. "What would the patient want if he knew he were in this situation?"

d

A patient's central venous pressure (CVP) reading suddenly increased from 10 to 48 mm Hg. His lungs are clear except for fine rales at the bases. What should the nurse do next? a. Nothing as this reading is still within normal limits. b. Place a STAT call into the physician. c. Administer ordered prn Lasix. d. Check the level of the transducer.

d

In which situation did the nurse disregard the patient's right to privacy? a. Informing the physician that the patient was verbalizing suicidal thoughts b. Notifying the health department of a patient's tuberculosis diagnosis c. Reporting possible dependent-adult abuse to the police d. Warning a visitor to wear gloves when giving a back rub because the patient is HIV positive

d

On the way to surgery, a patient expresses doubt about proceeding with the planned procedure. The patient states that the doctor did not explain it very well and she would like to talk to her again before starting the procedure. The nurse knows the surgery schedule is very tight, reassures the patient that everything will be all right, and administers the preoperative sedation. This scenario describes what possible type of negligence? a. Assessment failure b. Planning failure c. Implementation failure d. Evaluation failure

d

ST segment monitoring for ischemia has gained increasing importance with the advent of thrombolytic therapy. What is the most accurate method for monitoring the existence of true ischemic changes? a. Biomarkers b. Echocardiogram c. 5-lead ECG d. 12-lead ECG

d

The patient has a heart rate (HR) of 84 beats/min and a stroke volume (SV) of 65 mL. Calculate the cardiac output (CO). a. 149 mL b. 500 mL c. 4650 mL d. 5460 mL

d

The patient's condition has deteriorated to the point where she can no longer make decisions about her own care. Which nursing interventions would be most appropriate? a. Obtain a verbal do-not-resuscitate (DNR) order from the practitioner. b. Continue caring for the patient as originally ordered because she obviously wanted this. c. Consult the hospital attorney for recommendations on how to proceed. d. Discuss with the family what the patient's wishes would be if she could make those decisions herself.

d

What assessment technique involves having the patient breathe in and out slowly with an open mouth? a. Inspection b. Palpation c. Percussion d. Auscultation

d

What is the best action a nurse could take to prevent allegations of malpractice? a. Carrying malpractice insurance b. Clarifying orders with the nursing supervisor c. Delegating care to nursing assistants d. Providing care according to standards of practice

d

What is the legal standard of care for a nurse's actions? a. Minimal competency under the state Nurse Practice Act b. The ability to distinguish what is right or wrong for the patient c. The demonstration of satisfactory knowledge of policies and procedures d. The care that an ordinary prudent nurse would perform under the same circumstances

d

What is the proper sequencing of an assessment of the pulmonary system? a) Inspection, auscultation, palpation, and percussion b) Inspection, palpation, auscultation, and percussion c) Inspection, auscultation, percussion, and palpation d) Inspection, palpation, percussion, and auscultation

d

What is the sequence for auscultation of the anterior chest? a. Right side, top to bottom, then left side, top to bottom b. Left side, top to bottom, then right side, top to bottom c. Side to side, bottom to top d. Side to side, top to bottom

d

What is the target range for an international normalized ratio (INR)? a. 1.0 to 2.0 b. 1.5 to 3.0 c. 1.5 to 2.5 d. 2.0 to 3.0

d

What major clinical finding present in a patient with ventricular fibrillation (VF)? a. Hypertension b. Bradycardia c. Diaphoresis d. Pulselessness

d

What parameter is used to assess the contractility of the left side of the heart? a. Pulmonary artery occlusion pressure b. Left atrial pressure c. Systemic vascular resistance d. Left ventricular stroke work index

d

Which blood test standardizes prothrombin time (PT) results among worldwide clinical laboratories? a. aPTT b. ACT c. HDL d. INR

d

Which cardiac biomarker is elevated in decompensated heart failure? a. Triglycerides b. Troponin I c. Troponin T d. B-type natriuretic peptide (BNP)

d

Which condition can cause an artificial increase in the pulmonary artery occlusion pressure (PAOP)? a. Aortic regurgitation b. Aortic stenosis c. Mitral stenosis d. Mitral regurgitation

d

Which condition is an example of a disorder with increased tactile fremitus? a. Emphysema b. Pleural effusion c. Pneumothorax d. Pneumonia

d

Which ethical principle is most important when soliciting informed consent from a patient? a. Nonmaleficence b. Fidelity c. Beneficence d. Veracity

d

Which findings would be reasons to abort an exercise stress test? a. Ventricular axis of +90 degrees b. Increase in blood pressure c. Inverted U wave d. ST segment depression or elevation

d

Which intervention should be strictly followed to ensure accurate cardiac output readings? a. Inject 5 mL of iced injectate at the beginning of exhalation over 30 seconds. b. Inject 10 mL of warmed injectate into the pulmonary artery port three times. c. Ensure at least 5° C difference between injectate and the patient temperature. d. Administer the injectate within 4 seconds during inspiration.

d

Which lung sounds would be most likely heard in a patient experiencing an asthma attack? a. Coarse rales b. Pleural friction rub c. Fine crackles d. Expiratory wheezes

d

Which statement describes the major difference between tachypnea and hyperventilation? a. Tachypnea has increased rate; hyperventilation has decreased rate. b. Tachypnea has decreased rate; hyperventilation has increased rate. c. Tachypnea has increased depth; hyperventilation has decreased depth. d. Tachypnea has decreased depth; hyperventilation has increased depth.

d

Which statement regarding the Code of Ethics for Nursing is accurate? a. The Code of Ethics for Nurses is usurped by state or federal laws. b. It allows the nurse to focus on the good of society rather than the uniqueness of the patient. c. The Code of Ethics for Nurses was recently adopted by the American Nurses Association. d. It provides society with a set of expectations of the nursing profession.

d

While participating in rounds, a nurse is interrupted by the wife of a ventilated patient, who informs the nurse that her husband is having difficulty breathing. The patient is found to be disconnected from the ventilator and unresponsive when the nurse enters the room after rounds. The alarm mode on the ventilator had been turned off. This situation an example of what legal situation? a. Assault b. Battery c. Injury d. Malpractice

d

You are caring for a patient admitted with asthma. During your assessment, you would expect to find which abnormality? a) "Funnel chest" b) Right tracheal shift c) Dull percussive sounds d) Decreased fremitus

d

A patient who has received a transplant is being taught about cyclosporine. Which statement made by the patient would indicate the teaching was effective? a. "I know this drug prevents my immune system from working." b. "If I find the capsules are hard to swallow, I'll take the liquid." c. "I will need to watch for bruising." d. "I will need to monitor my blood pressure."

d. "I will need to monitor my blood pressure."

At what size is an aortic aneurysm evaluated for surgical repair or stent placement? a. 2 cm b. 4 cm c. 5 cm d. >5 cm

d. >5 cm

A patient is admitted with a massive head trauma. The patient is unresponsive and on mechanical ventilation. The electroencephalogram is negative for brain waves. The family has agreed to organ donation. How would the nurse check for the absence of cerebral motor reflexes? a. Performing a sternal rub b. Applying needle pricks to fingers and toes c. Clapping hands near the ears d. Applying pressure to the nail beds or supraorbital ridge

d. Applying pressure to the nail beds or supraorbital ridge

A patient is admitted after a positive exercise treadmill test with a diagnosis of coronary artery disease (CAD) and stable angina. Radiographic tests show that the patient has blockage in the left main coronary artery and four other vessels. The nurse anticipates that the patient's treatment plan will include what treatment or procedure? a. Medical therapy b. PCI c. TAVR d. CABG

d. CABG

Patient is admitted with heart failure. The patient has developed dyspnea with wheezing, a nonproductive cough, and pulmonary crackles that progress to the gurgling sounds of pulmonary edema. The nurse suspects the patient may be developing with problem? a. Dyspnea b. Orthopnea c. Paroxysmal nocturnal dyspnea d. Cardiac asthma

d. Cardiac asthma

To select the correct size of an oropharyngeal airway, the nurse should ensure the airway extends from which area to which area? a. Tip of the nose to the ear lobe b. Middle of the mouth to the ear lobe c. Tip of the nose to the middle of the trachea d. Corner of the mouth to the angle of the jaw

d. Corner of the mouth to the angle of the jaw

The nurse is caring for a patient in cardiogenic shock. Which hemodynamic parameters would the nurse expect to note to support this diagnosis? a. Increased right atrial pressure b. Decreased pulmonary artery wedge pressure c. Increased cardiac output d. Decreased cardiac index

d. Decreased cardiac index

A patient has been admitted with the diagnosis of acute respiratory distress syndrome (ARDS). Arterial blood gasses (ABGs) revealed an elevated pH and decreased PaCO2. The patient is becoming fatigued, and the practitioner orders a repeat ABG. Which set of results would be indicative of the patient's current condition? a. Elevated pH and decreased PaCO2 b. Elevated pH and elevated PaCO2 c. Decreased pH and decreased PaCO2 d. Decreased pH and elevated PaCO2

d. Decreased pH and elevated PaCO2

A patient with a known penicillin allergy develops anaphylactic shock after a dose of ampicillin was given in error. Which medication would the nurse administer first? a. Methylprednisolone b. Gentamicin c. Atropine d. Epinephrine

d. Epinephrine

A patient is admitted after a femorotibial bypass graft. What nursing action is critical in the immediate postoperative period? a. Frequent assessment of the skin b. Hourly assessment of intake and output c. Monitoring for ST segment changes d. Frequent pulse checks to the affected limb

d. Frequent pulse checks to the affected limb

Which value, when elevated, places the patient at lowest risk for coronary artery disease (CAD)? a. Very-low-density lipoproteins (VLDLs) b. Triglycerides c. Low-density lipoproteins (LDLs) d. High-density lipoproteins (HDLs)

d. High-density lipoproteins (HDLs)

A patient with liver failure manifested by portal hypertension and ascites is hospitalized and waiting for a liver transplant. Which order should the nurse question? a. Low-sodium diet b. Low-protein diet c. ABO typing d. Human leukocyte antigen tissue typing

d. Human leukocyte antigen tissue typing

Rejection that occurs within hours after the transplantation and results in immediate graft failure is referred to as what type of rejection? a. Acute b. Intermediate c. Chronic d. Hyperacute

d. Hyperacute

Which laboratory value indicates a heightened risk for the development of coronary artery disease (CAD)? a. Total cholesterol level of 170 mg/dL b. HDL cholesterol level of 30 mg/dL c. Triglyceride level of 120 mg/dL d. LDL cholesterol level >190 mg/dL

d. LDL cholesterol level >190 mg/dL

Patients with left-sided pneumonia may benefit from placing them in which position? a. Reverse Trendelenburg b. Supine c. On the left side d. On the right side

d. On the right side

A patient is admitted with an acute inferior myocardial infarction (MI). A 12-lead electrocardiogram (ECG) is done to validate the area of infarction. Which finding on the ECG is most conclusive for infarction? a. Inverted T waves b. Tall, peaked T waves c. ST segment depression d. Pathologic Q waves

d. Pathologic Q waves

What nursing intervention can facilitate the prevention of aspiration? a. Observing the amount given in the tube feeding b. Assessing the patient's level of consciousness c. Encouraging the patient to cough and to breathe deeply d. Positioning a patient in a semirecumbent position

d. Positioning a patient in a semirecumbent position

Which statement best describes the effects of positive-pressure ventilation on cardiac output? a. Positive-pressure ventilation increases intrathoracic pressure, which increases venous return and cardiac output. b. Positive-pressure ventilation decreases venous return, which increases preload and cardiac output. c. Positive-pressure ventilation increases venous return, which decreases preload and cardiac output. d. Positive-pressure ventilation increases intrathoracic pressure, which decreases venous return and cardiac output.

d. Positive-pressure ventilation increases intrathoracic pressure, which decreases venous return and cardiac output.

What is the preset positive pressure used to augment the patient's inspiratory effort known as? a. Positive end-expiratory pressure (PEEP) b. Continuous positive airway pressure (CPAP) c. Pressure control ventilation (PCV) d. Pressure support ventilation (PSV)

d. Pressure support ventilation (PSV)

What is the rationale for administrating a fibrinolytic agent to a patient experiencing acute ST-elevation myocardial infarction (STEMI)? a. Dilation of the blocked coronary artery b. Anticoagulation to prevent formation of new emboli c. Dissolution of atherosclerotic plaque at the site of blockage d. Restoration of blood flow via lysis of the thrombus

d. Restoration of blood flow via lysis of the thrombus

Which arterial blood gas (ABG) values would indicate a need for oxygen therapy? a. PaO2 of 80 mm Hg b. PaCO2 of 35 mm Hg c. HCO of 24 mEq d. SaO2 of 87%

d. SaO2 of 87%

Which classification of dysrhythmia is most common with an inferior wall infarction in the first hour after ST segment elevation myocardial infarction (STEMI)? a. Sinus tachycardia b. Multifocal PVCs c. Atrial fibrillation d. Sinus bradycardia

d. Sinus bradycardia

A patient has been admitted in hypertensive crisis. Which medication would the nurse expect the practitioner to order for this patient? a. Digitalis b. Vasopressin c. Verapamil d. Sodium nitroprusside

d. Sodium nitroprusside

A patient is admitted with left-sided heart failure and a blood pressure of 220/118 mm Hg. Which drug will be most effective in decreasing the blood pressure and reducing afterload? a. Dopamine b. Verapamil c. Propranolol d. Sodium nitroprusside

d. Sodium nitroprusside

The nurse is caring for a patient with these vital signs: blood pressure 220/110, pulse 108, respiratory rate 24, temperature 103° F, and oxygen saturation of 94% on oxygen 2L nasal cannula. The patient is responsive and denies chest pain. The physician has ordered a work-up for coronary artery disease (CAD). These findings are suggestive of which diagnosis? a. Silent ischemia b. Prehypertension c. Stage 1 hypertension d. Stage 2 hypertension

d. Stage 2 hypertension

A patient was admitted after a left pneumonectomy. The patient is receiving 40% oxygen via a simple facemask. The morning chest radiography study reveals right lower lobe pneumonia. After eating breakfast, the patient suddenly vomits and aspirates. What action should the nurse take next? a. Lavage the airway with normal saline. b. Place the patient supine in a semi-Fowler position. c. Manually ventilate the patient. d. Suction the airway.

d. Suction the airway.

The nurse is developing a patient education plan for a patient with valvular heart disease. Which instruction would be included as part of that plan? a. Increase fluid intake to increase cardiac output. b. Take sodium replacement tablets to replace sodium lost with diuretics. c. Increase daily activity until shortness of breath occurs. d. Take prophylactic antibiotics before undergoing any invasive procedure.

d. Take prophylactic antibiotics before undergoing any invasive procedure.

Noninvasive emergency pacing is best achieved via the use of which type of temporary pacing? a. Transvenous (endocardial) b. Epicardial c. Transthoracic d. Transcutaneous

d. Transcutaneous

Supplemental oxygen administration is usually effective in treating hypoxemia related which situation? a. Physiologic shunting b. Dead space ventilation c. Alveolar hyperventilation d. Ventilation-perfusion mismatching

d. Ventilation-perfusion mismatching