High acuity 2

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The patient has very low serum potassium and is to receive an IV bolus of potassium mixed 20 mEq in 50 mL. To give a total dose of 60 mEq potassium at the highest recommended rate, what is the maximum intravenous rate in mL per hour? (Round your answer to the nearest whole number.)

100

A child in the ICU has been diagnosed with Bartter syndrome, a rare genetic defect in the thick ascending limb of the loop of Henle that impairs the function of this structure. Which characteristic should the nurse expect in this patient, based on the function of the thick ascending limb of the loop of Henle? A) Excessive loss of sodium in urine B) Overly diluted urine C) Impaired reabsorption of water D) Decreased concentration of chloride ions in urine

A critically ill patient has arterial blood gas results of pH 7.6, PaCO2 40 mm Hg, and HCO3 30 mEq/L. With what medical situation do these results most clearly correlate? A) Excess nasogastric drainage B) Severe diarrhea C) Diabetic ketoacidosis D) Lobular pneumonia

A critically ill patient has developed multiple organ dysfunction syndrome (MODS). What should the nursing goal for management of the patient with impending MODS center on? A) Early normalization of SvO2 and acid-base balance B) Use of intravenous drotrecogin alfa (Xigris) C) Specific organ system support D) General intensive nursing care

A leading cause of death in critically ill patients is sepsis and septic shock. What nursing intervention is most directed toward preventing this life-threatening complication? A) Strict adherence to hand hygiene protocols B) Prompt initiation of isolation protocols C) Patient and family preventive teaching D) Sterile technique for care of intravenous sites

A nurse is assessing a patient with acute renal failure for pitting edema. She gently presses her finger into the edematous area on the patient's foot. She measures an indention of 8 mm, which slowly returns to baseline after about 3 minutes. Which level of pitting edema does this patient exhibit? A) 4+ (severe) B) 3+ (moderate) C) 2+ (mild) D) 1+ (trace)

A patient has a severe deficit of sodium and potassium. The nurse should expect impaired reabsorption of which substance in this patient? A) Glucose B) Water C) Urea D) Chloride

A patient has experienced an acute lung injury. What factors in the patient's history will probably increase his risk for developing adult respiratory distress syndrome (ARDS)? A) Smokes two packs a day B) Drinks one glass of wine on holidays C) Has a sedentary lifestyle D) Has no known chronic diseases

A patient has experienced multiple fractures, including pelvic and long bone fractures. After 72 hours, the patient complains of tachypnea and dyspnea and is found to have cyanosis, tachycardia, confusion, and fever. Laboratory analysis reveals a normal complete blood count except for thrombocytopenia and progressive respiratory insufficiency. What is the nursing care priority? A) Administer oxygen and monitor pulse oximetry. B) Initiate low-molecular-weight heparin therapy. C) Obtain cultures of all body substances. D) Initiate fall and seizure precautions.

A patient in the CCU is on a ventilator with oral intubation. The nurse notices that a pressure sore is forming on the patient's lip where it comes into contact with the endotracheal tube. Which nursing action would be most appropriate? A) Reposition the endotracheal tube from one side to the other B) Retape the endotracheal tube C) Use twill tape D) Place an oral bite block in the patient's mouth

A patient in the ICU has just undergone arterial blood gas testing. Her results are as follows: PaO2 is 90 mm Hg, pH is 7.43, PaCO2 is 24, and HCO3 is 19 mEq/L. Which of the following indicates this patient's condition? A) Respiratory alkalosis, fully compensated B) Respiratory acidosis, partially compensated C) Metabolic alkalosis, fully compensated D) Metabolic acidosis, partially compensated

A patient in the ICU is experiencing a flare-up of arthritis. A lack of fluid in which subcompartment of the body would contribute most directly to this condition? A) Transcellular B) Interstitial C) Plasma D) Intracellular

A patient in the ICU is experiencing an asthma attack. The room temperature is approximately 72°F. The patient has recently had symptoms of a cold. Which of the following is the most likely trigger for the woman's asthma attack? A) Upper respiratory infection B) Latex allergy C) Room temperature D) Pollen

A patient in the ICU is severely dehydrated. Which of the following findings would the nurse expect in this patient? A) Orthostatic hypotension on standing B) Third heart sound C) Pitting edema D) Rales

A patient in the ICU is suspected of having tuberculosis. The nurse understands that which diagnostic test will most likely be performed on this patient to confirm this suspicion? A) Sputum culture B) Thoracentesis C) Ventilation-perfusion scanning D) Pulmonary angiography

A patient in the ICU with a history of smoking is having tests performed to assess his respiratory function. Which test would be best for measuring the oxygenation of this patient's blood? A) SaO2 B) Pulse oximetry C) End-tidal carbon dioxide D) pH

A patient in the ICU with congestive heart failure demonstrates shortness of breath and complains of pleuritic chest pain. Which of the following conditions, associated with heart failure, should the nurse most suspect in this patient? A) Transudative pleural effusion B) Exudative pleural effusion C) Acute asthma D) Emphysema

A patient in the critical care unit has developed shock. What symptom or symptom group does the nurse expect to assess in any type of shock? A) Tissue hypoxia B) Massive vasodilation C) Extreme blood loss D) Presence of enterotoxins

A patient is admitted to the CCU after experiencing blunt trauma to the chest. Among other injuries, the patient has a flail chest on the left and several extremity fractures. About 12 hours after admission, the patient is tachypneic and complaining of shortness of breath. Breath sounds are present bilaterally with scattered fine crackles. Chest radiograph shows an ill-defined, patchy, ground-glass area of density on the left. If the patient has a pulmonary contusion, what is the nursing priority? A) Monitor pulse oximetry and arterial blood gases closely. B) Place an oral endotracheal tube immediately. C) Increase the amounts of intravenous crystalloid administration. D) Obtain sputum culture and sensitivity and Gram stain.

A patient is being monitored with continuous pulse oximetry. Under what circumstance would the nurse question the accuracy of the pulse oximetry reading? A) The patient is a victim of a fire in an enclosed space. B) Cardiac monitor pattern shows normal sinus rhythm. C) Extremities are warm and dry with intact pulses. D) Respiratory rate and pulse rate are elevated.

A patient is currently taking an aldosterone blocker, which reduces reabsorption of sodium. What other condition should the nurse expect to see as a result of the patient taking this medication? A) Hyperkalemia B) Increased hydrogen level C) Hypernatremia D) Edema

A patient is found to have low blood levels of magnesium. What effect should the nurse expect this to have in the patient? A) Impaired active transport via the sodium-potassium pump B) Alkalosis C) Stimulation of parathyroid hormone release D) Osmotic regulation

A patient on continuous venovenous hemofiltration with dialysis experiences a significant decrease in blood pressure. Which intervention would be most appropriate for the nurse to carry out? A) Decrease the amount of fluid removal. B) Decrease the infusion rate of replacement fluid. C) Administer heparin. D) Use a blood warmer to warm the dialysis lines.

A patient receiving a blood transfusion in the ICU has developed relative hypocalcemia. What is the most likely cause for the hypocalcemia? A) Citrate binding to calcium B) Loop diuretics C) Malabsorption syndrome D) Lack of vitamin D

A patient who is in the Emergency Department was attacked in a parking lot and suffered several stab wounds to various areas on the chest and abdomen; BP 100/60, heart rate 108, respiratory rate 20, pulse oximetry 98%. In order to counteract the blood loss and restore circulating volume for this patient, what priority intervention will the nurse perform? A) Start lactated Ringer's at 150 mL/hr. B) Start dopamine at 5 mcg/kg/min. C) Start an albumin infusion wide open. D) Start a unit of uncrossmatched blood.

A patient with a history of diabetes mellitus has had a procedure using radiocontrast dye. The patient's laboratory results include high urine sodium, urine with muddy-brown granular casts and tubular epithelial cells, and increased blood urea nitrogen (BUN) and serum creatinine. Renal ultrasonography is normal. Urine volume is normal. Which treatment does the nurse anticipate? A) Increased fluids B) Renal stent placement C) Irrigation of urinary catheter D) Diuretic therapy

A patient with acute kidney injury (AKI) demonstrates oliguria, a urine osmolality of 550 mOsm/kg H2O, increased urine specific gravity, urine sodium of 15 mEq/L, and a BUN:creatinine ratio of 23:1. Which of the following is a cause of AKI that would best fit with these findings? A) Congestive heart failure B) Nephrotoxicity due to aminoglycoside antibiotics C) Hypertension D) Retroperitoneal tumor

A patient with acute renal failure is in the ICU. Which of the following would best help the nurse assess the health of the patient's renal tubules? A) Sodium concentration of urine B) pH C) Clearance of inulin D) Urine output

A patient with acute respiratory distress syndrome (ARDS) has severe hypoxia refractory to high levels of oxygen and mechanical ventilation. What is the underlying pathophysiology most responsible for the hypoxia? A) Increased capillary permeability from mediator release B) Increased patchy infiltrate visible on chest x-ray C) Reduced pulmonary afterload effects D) Reduced pulmonary preload effects

A patient with acute respiratory distress syndrome (ARDS) in the ICU demonstrates diminished cardiac output, resulting in reduced oxygen delivery. Which of the following interventions will increase cardiac output in this patient by increasing contractility? A) Administration of norepinephrine B) Administration of dobutamine C) Administration of diuretics D) Hemoglobin transfusion

A patient with acute respiratory distress syndrome (ARDS) is being cared for in a CCU. The nurse implements the ventilator bundle of care. Which of the following statements about this action is true? A) Bundles of care strategies combine several strategies that have been shown to improve patient outcomes. B) A ventilator bundle is a group of ventilator equipment ordered together from respiratory care. C) Protocols for care are called bundles in critical care to differentiate them from routine care. D) Each bundle is a defined set of ventilator settings to be used for particular disease processes.

A patient with asthma is receiving a bronchodilator medication. If this therapy is helpful to the patient, the nurse would expect to find which of the following? A) Increased productiveness of cough B) More intense wheezing C) Persistent tachycardia D) Reduced peak expiratory flow rate

A patient with chronic kidney disease has a serum potassium level of 5 mEq/L and no changes on the ECG. What is the proper nursing intervention? A) Administer sodium polystyrene as an enema. B) Administer IV calcium gluconate. C) Administer IV insulin and dextrose. D) Begin dialysis.

A patient with chronic obstructive pulmonary disease is receiving supplemental oxygen at 2 L/min by nasal cannula. What should the nurse particularly watch for in this patient? A) Somnolence, cherry color of mucous membranes, bradypnea B) Tachypnea, dyspnea, pleuritic chest pain with cough C) Increased frequency of cough and elevated temperature D) Change in quality and color of sputum and general malaise

A tall, thin patient in his mid-twenties presents to the ICU with dyspnea, pleuritic chest pain, and a heart rate of 120 bpm. A chest radiograph shows a contralateral mediastinal shift. Which condition does this patient most likely have? A) Primary spontaneous pneumothorax B) Secondary spontaneous pneumothorax C) Traumatic pneumothorax D) Transudative pleural effusion

After a renal biopsy, what symptom indicates a significant complication of this procedure? A) Increasing hematuria B) Increased urine volume C) Heart rate 60 to 100 D) Mean arterial pressure 85

After pulmonary surgery, the patient returns to the critical care unit with a left pleural chest tube in place connected to a disposable three-chamber unit that is connected to suction at negative 20 cm H2O. What must the nurse ensure so that the goal for chest tube placement is met? A) The water-seal chamber has the amount of water defined by the manufacturer. B) The suction control chamber has vigorous bubbling at all times. C) The drainage unit is prepared using sterile water only. D) Suction is applied between negative 10 and 20 cm H2O.

An elderly resident of a long-term care facility is admitted to the CCU with acute pneumonia. What might be a factor increasing the risk of pneumonia for this patient? A) Takes a histamine-2 antagonist medication daily B) Has never smoked or lived with anyone who smoked C) Usually has a good appetite without swallowing difficulty D) Has his teeth cleaned every 6 months and brushes often

An elderly woman in the ICU has an indwelling urinary catheter and is being treated for a myocardial infarction. She is diabetic but is in the habit of having several glasses of orange juice each day. Her lab test results show that her urinary pH is 7.6. The nurse should suspect which of the following factors as the cause of the elevated pH level? A) A urinary tract infection B) Ketoacidosis caused by untreated diabetes C) Consumption of acidic foods D) Dehydration

An elderly woman in the ICU has chronic obstructive pulmonary disease (COPD), with FEV1 of 20%, and is worried about developing a serious illness that would cause complications with her COPD. Which of the following should the nurse recommend to the patient that could reduce her risk for serious illness or death by about 50%? A) Influenza vaccine B) Lung transplantation C) Heparin D) Lung volume reduction surgery

As part of a multiple trauma injury, a patient developed hemorrhagic hypovolemic shock, necessitating fluid resuscitation with massive amounts of intravenous crystalloid fluids and blood products as well as extensive surgical repair under general anesthesia. Twenty-four hours later, the patient develops hypoxia unresponsive to oxygen therapy and diffuse white, ground-glass infiltrates of the lung fields on a chest radiograph. Development of this complication has what effect on the patient's recovery? A) Significantly greater chance of death B) No change in outcome expectations C) Outcome depends on treatment. D) Lower chance of death

The nurse is caring for a patient who was run over by an automobile. The patient has hematuria on admission to the emergency department. What is the most likely cause of the hematuria? A) Kidney trauma B) Kidney stones C) Prostatic disease D) Toxic damage

The nurse is caring for a patient with hypovolemic shock who has had 6 units of packed red blood cells. Which of the following values would alert the nurse to a complication related to the administration of blood? A) Potassium level of 6.0 B) Hemoglobin of 13 C) Sodium level of 134 D) pH 7.37

The nurse is caring for a patient with renal disease and is monitoring fluid balance. What is the most accurate method for assessing fluid balance? A) Daily weights at same time of day B) Episodic intake and output totals C) Heart rate trends D) Jugular venous volume measurement

The nurse is caring for the patient with chest tubes. Which observation by the nurse is a priority concern? A) 250 mL/hr of blood in drainage collection system B) Pulse oximetry of 94% C) Blood pressure of 104/62 D) 30 mL/hr of urine output

The nurse is evaluating the chest radiograph of a critically ill patient and notices that the patient's trachea has shifted to the left of midline. What additional finding would confirm the presence of a pneumothorax? A) Absent or diminished breath sounds on the right B) Lung fields generally white on chest radiograph C) Lung fields dull to percussion on the right D) Blunting of costophrenic angles on chest radiograph

The nurse is evaluating the following arterial blood gas values: pH 7.35, PaO2 95 mm Hg, SaO2 95%, PaCO2 40 mm Hg, and HCO3 24 mEq/L. How does the nurse interpret these results? A) Normal B) Respiratory acidosis C) Metabolic acidosis D) Technical error

The nurse is explaining to a young patient with asthma how air is conducted from his nose through his airways to the alveoli in his lungs. Which of the following represents the correct order of airways? A) Nasopharynx, oropharynx, trachea, bronchi, bronchioles B) Trachea, nasopharynx, oropharynx, bronchi, bronchioles C) Trachea, bronchi, bronchioles, nasopharynx, oropharynx D) Oropharynx, nasopharynx, trachea, bronchioles, bronchi

The nurse understands that which of the following patients in the hospital is at the greatest risk for cardiogenic shock? A) The 76-year-old male patient with a history of diabetes mellitus and previous myocardial infarction (MI) B) The 42-year-old male who has mitral valve prolapse with a left ventricular ejection fraction of 65% C) The 52-year-old female with a recent small anteroseptal wall MI D) The 84-year-old female with hypertension

The patient has a low serum sodium level. Based on the major role of sodium in the body, the nurse would look for alterations in which of the following? A) Fluid balance B) Calcium balance C) Energy levels D) Pulmonary function

The patient has developed cardiogenic shock and is decompensating. What pattern of hemodynamic alterations does the nurse expect to find? A) High preload, high afterload, low cardiac index, tachycardia B) Low preload, low afterload, high cardiac index, bradycardia C) Low preload, high afterload, high cardiac index, tachycardia D) High preload, low afterload, high cardiac index, tachycardia

The patient has experienced a toxic inhalation injury that has significantly damaged his type II alveolar cells. The nurse should expect to find which of the following? A) Impaired gas exchange and atelectasis B) Bronchospasm and wheezing C) Laryngospasm and stridor D) Eupnea and bradycardia

The patient is being supported with mechanical ventilation and is requiring very high levels of inspired oxygen to maintain his arterial blood gases at acceptable levels. In an attempt to reduce the amount of oxygen required, positive end-expiratory pressure (PEEP) at 5 cm H2O is added to the ventilator settings. What is the most important effect of PEEP? A) Increases number of open alveoli B) Increases patient comfort C) Assists in ventilator weaning D) Compensates for tubing resistance

The patient is being well supported with a positive-pressure mechanical ventilator. Because of the mechanism of action of this type of ventilator, what common complication does the nurse watch for? A) Diminished cardiac output B) Increased somnolence C) Deep venous thrombosis D) Reduced patient control

The patient is experiencing respiratory acidosis. What nursing action is most likely to alleviate this condition? A) Suction the endotracheal tube. B) Reduce the respiratory rate on the ventilator. C) Administer intravenous bicarbonate. D) Increase the rate of crystalloid intravenous fluids.

The patient is in hypovolemic shock from traumatic massive blood loss and is tachypneic and tachycardic, with cool, clammy skin and weak and thready pulses. What additional assessment parameter would the nurse be least likely to find during stage one or early compensated shock? A) Hypotension B) Increased urine output C) Estimated blood loss greater than 30% D) Mild altered mental status

The patient is receiving supplemental oxygen therapy. What finding would be most indicative of a life-threatening complication of oxygen therapy? A) Increased somnolence B) Eupneic respirations C) SaO2 100% D) Skin irritation under mask

The patient is recovering from acute pulmonary disease. The nurse is comparing his current assessment findings with older ones. What currently increased assessment finding would indicate achievement of therapeutic goals? A) Pulmonary compliance B) Effort of breathing C) Pressure support D) Airway resistance

The patient requires urgent hemodialysis or continuous renal replacement therapy after a suicide attempt with a variety of antidepressants. What access route for the dialysis does the nurse anticipate? A) Vascular catheter B) Arteriovenous fistula C) Synthetic vascular graft D) Peritoneal dialysis catheter

A patient in the ICU is on a volume ventilator. The nurse recognizes that which of the following are true for this type of ventilator? Select all that apply. A) Peak inspiratory pressure varies from breath to breath and must be monitored closely. B) Amount of pressure depends on patient's lung compliance and patient-ventilator resistance factors. C) The device fits like a tortoise shell, forming a seal over the chest. D) Exhaled tidal volume must be monitored closely. E) Volume varies based on changes in resistance or compliance. F) Small tidal volumes are used at frequencies greater than 100 breaths/minute.

a, b

An older patient in the ICU has labored breathing and a history of smoking. The nurse suspects that he has chronic obstructive pulmonary disease (COPD). Which of the following signs would tend to confirm that the patient has COPD? Select all that apply. A) Increased anterior-posterior diameter of the chest B) The patient lying propped onto one side C) Deviation of the trachea from the midline D) Inspiration taking just as long as expiration

a, b

The nurse is explaining to a patient in the ICU who has experienced a pneumothorax the role of the alveoli in respiration. The nurse should mention that which of the following are present in the alveoli? Select all that apply. A) Macrophages B) Surfactant C) Epiglottis D) Bronchus

a, b

The nurse is working with a patient with suspected acute renal failure. Which of the assessments would provide accurate information about this patient's fluid balance? Select all that apply. A) Daily measure of patient's weight at the same time, using same scale B) Monitoring of intake and output every 1 to 2 hours C) Monitoring of blood sugar levels hourly D) Taking x-rays of the kidneys weekly

a, b

A patient has been admitted to the ICU following a car wreck in which she suffered blunt, penetrating trauma. She has lost quite a bit of blood and is in shock. Which of the following conditions should the nurse expect in this patient? Select all that apply. A) Hypotension B) Vasodilation of afferent arterioles C) Increased glomerular filtration rate D) Anuria E) Homeostasis F) Effective autoregulation

a, b d

A patient with acute respiratory distress syndrome (ARDS) has been receiving ventilation in assist-control mode for the past 48 hours. The fraction of inspired oxygen (FiO2) is set to 70% and tidal volume is set to 15 mL/kg of body weight. What complication or complications should the nurse be most concerned about in this situation? Select all that apply. A) Barotrauma B) Oxygen toxicity C) Volutrauma D) Hypoxemia

a, b, c

The nurse is administering an intravenous antibiotic infusion over 30 minutes for a patient with cellulitis of the left lower extremity. The patient states, "I am itching all over and am having trouble swallowing." What priority interventions by the nurse are necessary for this patient? Select all that apply. A) Stop the antibiotic infusion. B) Administer subcutaneous epinephrine. C) Administer diphenhydramine (Benadryl) IV. D) Switch to amoxicillin by mouth. E) Administer Ativan for the patient's anxiety.

a, b, c

A nursing assessment of a patient with hypovolemic shock is most likely to reveal what assessment findings? Select all that apply. A) Tachycardia B) Oliguria C) Disoriented to time and place D) Diuresis E) Bradycardia F) Hypotension

a, b, c, f

The patient in the ICU is being treated for left lower lobe pneumonia. What assessment findings by the nurse may indicate that the patient is developing systemic inflammatory response syndrome (SIRS)? Select all that apply. A) White blood cell count of 24,000/mm3 B) Respiratory rate of 24 C) Blood pressure of 100/60 D) Heart rate 96 E) Atrial fibrillation

a, b, d

A patient has been diagnosed with chronic renal failure. What closely associated pathophysiologies should the nurse assess for? Select all that apply. A) Hypertension B) Arteriosclerotic disease C) Traumatic injury D) Type 2 diabetes mellitus E) Preeclampsia F) Type 1 diabetes mellitus

a, b, d, f

A patient in the ICU with acute respiratory distress syndrome is at increased risk for ventilator-associated pneumonia (VAP). Which of the following interventions should the nurse implement for this patient? Select all that apply. A) Elevate the head of the bed 30 to 45 degrees. B) Weaning protocol C) Antibiotic therapy D) Deep vein thrombosis (DVT) prophylaxis E) Steroid administration F) Peptic ulcer prophylaxis

a, b, d, f

A patient in the ICU with acute respiratory distress syndrome (ARDS) complains of worsening dyspnea. Which of the following physiological changes associated with ARDS are most responsible for this patient's impaired ventilation? Select all that apply. A) Decreased lung compliance B) Pulmonary hypertension C) Vasoconstriction of the pulmonary vascular bed D) Increased airway resistance E) Cyanosis F) Multisystem organ dysfunction

a, c

A patient with severe anorexia is admitted to the ICU. Which of the following would the nurse expect to find in this patient? Select all that apply. A) Hypoproteinemia B) Decreased glomerular filtration rate C) Lower filtrate osmotic pressure D) Hyperglycemia

a, c

The nurse is working with a patient with a juxtaglomerular cell tumor, which accelerates the function of these cells. What effects should the nurse expect to see with this condition? Select all that apply. A) Increased renin production B) Decreased angiotensin I levels C) Constriction of smooth muscle surrounding arterioles D) Hypertension E) Decreased glomerular filtration rate F) Decreased urine production

a, c, d

A patient is admitted to the emergency department after he was hit by a car. The car was going about 30 mph and was braking at the time of impact. The patient was struck just above the right knee, fell forward over the hood of the car, striking his anterior chest, and then slipped off the hood of the car and hit the pavement head first. Based on the mechanism of injury and transfer of force, what injuries does the nurse most expect? Select all that apply. A) Fracture of left femur and damage to left knee B) Fractures of thoracic and lumbar spine C) Fractured ribs and cardiac and lung contusion D) Bilateral radial and humerus fractures E) Closed head injury and cervical spine fracture F) Bilateral clavicle and scapular fractures

a, c, e

A patient has just had a dual-lumen venous catheter inserted in his subclavian vein for hemodialysis for acute renal failure. What intervention or interventions should the nurse make in working with this patient? Select all that apply. A) Verify central line catheter placement radiographically before use. B) Inject all medications directly into the catheter. C) Leave the catheter unclamped to prevent clotting. D) Maintain sterile technique in handling vascular access. E) Observe catheter exit site for signs of inflammation.

a, d, e

A patient in the ICU is producing an increased amount of sputum and has a fever. The nurse suspects an infection. Which of the following characteristics of the patient's sputum would indicate a bacterial infection, as opposed to a viral infection? Select all that apply. A) Yellow B) Clear C) Blood-streaked D) Green E) Brown F) White

a, d, e

An elderly patient in the ICU with acute respiratory distress syndrome (ARDS) has developed sepsis. Which of the following interventions should the nurse implement to address the sepsis and its symptoms? Select all that apply. A) Antibiotic therapy B) Elevating head of the bed 30 to 45 degrees C) Weaning protocol D) Daily sedation withholding E) Steroid administration F) Activated protein C

a, e, f

A critically ill patient has arterial blood gas results of PaO2 60 mm Hg, SaO2 80%, pH 7.35, PaCO2 35 mm Hg, and HCO3 24 mEq/L. How does the nurse interpret these results? A) Hypoxemia and respiratory acidosis B) Hypoxemia and normal acid-base balance C) Normal oxygenation and metabolic acidosis D) Normal oxygenation and acid-base balance

A critically ill patient has developed acute renal failure and needs dialysis. Under what circumstance would the nurse question the use of continuous renal replacement therapy (CRRT)? A) Patient requires large amounts of hourly intravenous fluids B) Metabolic imbalances can be corrected with 3 hours of dialysis per day C) High risk of hemodynamic instability with dialysis D) Unlikely to tolerate rapid fluid shifts without destabilizing

A critically ill patient has developed septic shock. What pattern of hemodynamic values does the nurse expect to find? A) Low preload, high afterload, low cardiac index, tachycardia B) Low preload and afterload, high cardiac index, tachycardia C) High preload and afterload, low cardiac index, tachycardia D) Normal preload, low afterload, normal cardiac index, bradycardia

A critically ill patient has developed shock. What nursing assessment result indicates a normal compensatory mechanism? A) Reduction of respiratory depth B) Increase in systemic vascular resistance (SVR) C) Decrease in circulating catecholamines D) Increased stimulation of baroreceptors

A critically ill patient who is mechanically ventilated and has developed shock is in need of nutritional support. What route is preferred for this patient? A) Oral B) Enteral C) Parenteral D) Variable

A patient being mechanically ventilated with positive end-expiratory pressure and pressure support totaling 30 mm Hg has developed unequal chest expansion, absent breath sounds on the right, and tracheal deviation to the right. The patient is increasingly tachycardic, anxious, and agitated, and his pulmonary compliance is rapidly decreasing. What is the most appropriate nursing action? A) Obtain a chest x-ray to rule out pneumothorax. B) Inititate needle thoracotomy or chest tube insertion. C) Sedate the patient and evaluate ventilator settings. D) Obtain arterial blood gases to evaluate gas exchange.

A patient has been admitted to the CCU in severe distress with acute respiratory failure. Initial arterial blood gases are pH 7.33, PaCO2 65, HCO3 30, PaO2 65, SaO2 90. What is the most important nursing action? A) Administer oxygen at 100%. B) Prepare for intubation. C) Obtain arterial blood gases. D) Measure functional expiratory volume.

A patient has been admitted to the emergency department after being in a severe motor vehicle crash. The patient was a passenger and had a lap and seat belt in place. The patient is lethargic and moaning. Initial exposure and head-to-toe examination reveals scattered minor abrasions and contusions and bruising over the upper abdomen. The patient moans more when the abdomen is palpated, and the abdomen is rigid. Heart rate is 110, capillary refill is greater than 4 seconds, and blood pressure is 140/88 mm Hg. What is the nursing priority of care? A) Administer intravenous opioid for pain. B) Increase rate of intravenous crystalloid. C) Obtain CT of the abdomen. D) Prepare for immediate endotracheal intubation.

A patient has been involved in a motor vehicle accident. The patient, who was driving, was unrestrained by a seat belt when hitting the car in front of him. The patient is complaining of midsternal pain, restlessness, and difficulty breathing. What is the priority nursing diagnosis for this patient? A) Anxiety B) Impaired gas exchange C) Impaired circulation D) Pain

A patient has had an arteriovenous fistula placed for access for long-term hemodialysis. What nursing assessment result indicates a patent and functional fistula? A) Diminished intensity of palpated fistula thrill B) Clearly auscultated bruit over fistula C) Ability to draw blood from proximal vessel D) Full range of motion of joints below fistula

A patient has had an arteriovenous graft inserted for dialysis. What nursing physical examination finding indicates patency of the graft? A) Auscultation of a bruit over the renal artery B) Palpation of a thrill over the graft C) Distal pulses are 3+ to palpation D) Blood pressure within normal limits

A patient has significantly decreased creatinine clearance and an elevated serum creatinine. What does this value indicate to the nurse? A) Improved renal function B) Kidney damage from disease C) Muscle wasting D) Rhabdomyolysis

A patient in intensive care with acute tubular necrosis from a toxic ingestion has been started on renal replacement therapy. The family expresses concern that the patient will not be able to afford dialysis after discharge from the hospital. In responding to the family, what should the nurse consider? A) The family is in crisis and unable to respond rationally. B) Toxic acute tubular necrosis has a higher likelihood of complete healing. C) Since the patient is currently oliguric, renal replacement therapy is indicated. D) The patient is unlikely to survive this illness, so the cost of long-term dialysis is not an issue.

A patient in the ICU experiences difficulty breathing in during exercise following trauma to his sternum. Which muscle involved in respiration was likely injured in this patient, leading to this condition? A) Diaphragm B) Sternocleidomastoid C) External intercostal D) Scalene

A patient in the ICU is found to have a steady glomerular filtration rate (GFR) of 180 L/day. Over the first 3 days following admission, his urine volume averages 1 L per day. On the fourth day, however, his urine volume drops to almost zero, while his GFR remains constant. The nurse recognizes that which of the following is the most likely explanation of this phenomenon? A) Chronic kidney disease B) Abdominal compartment syndrome C) Renal artery stenosis D) Pulmonary edema

A patient in the ICU is scheduled to begin peritoneal dialysis for acute renal failure. The patient tells the nurse that he understands hemodialysis but is not familiar with peritoneal dialysis. He asks her what the difference between them is. The nurse explains that the biggest difference between these two approaches is which of the following? A) Peritoneal dialysis relies on diffusion whereas hemodialysis relies on active transport. B) The peritoneum of the body serves as the semipermeable membrane in peritoneal dialysis, whereas an extracorporeal semipermeable membrane is used in hemodialysis. C) Hemodialysis uses a Tenckhoff catheter, whereas peritoneal dialysis uses a venous catheter. D) Hemodialysis uses machines called cyclers to cycle the infusion and removal of blood, whereas peritoneal dialysis uses the body's own vascular system to do this.

A patient in the ICU with acute respiratory failure demonstrates dyspnea, headache, tachypnea, and tachycardia. Which of these symptoms distinguishes this patient's condition as acute hypercapnic respiratory failure, as opposed to acute hypoxemic respiratory failure? A) Dyspnea B) Headache C) Tachycardia D) Tachypnea

A patient in the ICU with chronic renal disease has just received his lab results. The nurse knows that one of the first functions to be lost in renal disease is the ability to concentrate urine. Which of the following lab results would indicate this loss of ability to concentrate the urine? A) A specific gravity of urine that varies between 1.001 and 1.022, depending on the patient's water balance B) Urine osmolality fixed within 150 mOsm of the simultaneously determined serum osmolality C) Urinary pH of 6.0 D) Urine volume of 1 L/day

A patient in the ICU with severe hypotension is experiencing acute renal failure and uremia and needs dialysis. She requires a large infusion of intravenous fluids regularly. The nurse recognizes that which method of dialysis would be best for this patient? A) Continuous venovenous hemofiltration (CVVH) B) Continuous venovenous hemofiltration with dialysis (CVVH/D) C) Intermittent hemodialysis D) Peritoneal dialysis

A patient is severely hyponatremic. What would be the best nursing action? A) Put the patient on dialysis. B) Administer 3% saline. C) Administer 0.33% saline solution. D) Administer 5% dextrose in water.

A patient on peritoneal dialysis develops a low-grade fever and complains of abdominal pain when fluid is being inserted. The nurse also observes that the peritoneal drainage fluid is cloudy. What intervention should the nurse make? A) Measure the patient's blood pressure. B) Begin the patient on antibiotic therapy. C) Assess the patient for signs of pulmonary congestion. D) Turn the patient from side to side.

A patient sustained an injury to the right arm after falling off a motorcycle. The patient is complaining of severe pain and is unable to feel the fingers of the right hand. Radial pulse is absent. What is the priority intervention by the nurse? A) Elevate the right arm above the level of the heart. B) Notify the physician. C) Apply ice packs to the affected area. D) Place the patient in Trendelenburg position.

A patient sustained injuries in a motor vehicle accident and is in the Emergency Department. A CT scan of the head and neck have been ordered. What part of the survey is this? A) Primary B) Secondary C) Tertiary D) Initial

A patient was in a serious motor vehicle crash. At the scene, what is the highest priority of care? A) Extrication from the vehicle B) Cervical spine protection C) Establishing two large-bore intravenous lines D) Collecting information about the crash

A patient who is critically ill is attached to a saturation of mixed venous oxygen monitor (SvO2) and has an SvO2 value that is trending downward and is currently below normal at 55%. What clinical abnormality should the nurse suspect? A) Increased cardiac output B) Fever and shivering C) Fluid volume overload D) Oversedation

A patient with Duchenne's muscular dystrophy requires an intermittent short-term therapy to maintain alveolar ventilation. The patient is not a candidate for aggressive mechanical ventilation as provided through an artificial airway. Which of the following would be the most appropriate treatment for this patient? A) Manual resuscitator B) Negative-pressure ventilator C) Volume ventilator D) Pressure ventilator

A patient with acute respiratory distress syndrome (ARDS) in the ICU is receiving high-frequency oscillation ventilation (HFOV). Which complication related to this intervention should the nurse be looking for? A) Volutrauma B) Pneumothorax C) Cyanosis D) Trapping of air in the alveoli

A patient with acute respiratory distress syndrome (ARDS) is receiving pressure-controlled ventilation with positive end-expiratory pressure (PEEP) of 10 cm H2O. Which of the following nursing interventions will help protect this patient from one of the complications of PEEP? A) Administration of antihypertensive medication B) Increased administration of IV fluids C) BiPAP ventilation via full facemask D) Increase tidal volume to 20 mL/kg of body weight

A patient with chronic kidney disease has a low body temperature. What is the best nursing response to this finding? A) Assess for signs of sepsis. B) Provide extra blankets. C) Give warm intravenous fluids. D) Reassess with a different thermometer.

A patient with chronic kidney disease is receiving an ACE inhibitor. The nurse understands that this medication helps slow the progression of this disease through what process? A) It lowers the level of blood glucose. B) It prevents nephron hyperfiltration. C) It increases the urine output. D) It filters waste from the blood.

A patient with chronic obstructive pulmonary disease has just been started on pressure-controlled ventilation with positive end-expiratory pressure (PEEP) of 18 cm H2O. The fraction of inspired oxygen is set to 50%. Which of the following is a sign of tension pneumothorax that the nurse should watch for? A) An abrupt decrease in peak inspiratory pressure B) Tracheal deviation from the midline C) Syncope D) Bradypnea

A patient with chronic renal disease is involved in a motor vehicle crash and experiences severe hypovolemia. In caring for this patient in the CCU, which of the following is the most important for the nurse to monitor? A) Blood pressure B) Fluid volume recovery C) Urine output D) Cardiac dysrhythmias

A patient with chronic renal failure also has chronic anemia, arteriosclerotic disease, and diabetes mellitus. The patient asks the nurse why the anemia is persisting. In answering the patient's question, what should the nurse most consider? A) The patient most likely has preexisting chronic anemia. B) Erythropoietin is primarily produced in the kidney. C) The patient is receiving low-dose aspirin therapy. D) Chronic renal failure results in persistent uremia.

A patient with pulmonary edema is experiencing respiratory distress. The nurse recognizes that which factor affecting gas exchange is most likely responsible for the patient's dyspnea? A) Surface area available for diffusion B) Thickness of the alveolar-capillary membrane C) Partial pressure of alveolar gas D) Solubility and molecular weight of the gas

A young man with spontaneous primary pneumothorax is given supplemental oxygen. What is the primary purpose for giving this patient supplemental oxygen? A) Oxygen reverses the formation of excess pleural fluid. B) Oxygen accelerates the rate of air resorption from the pleural space. C) Oxygen counteracts the hypoxemia associated with pneumothorax. D) Oxygen calms the patient.

After a drug overdose, a patient has very slow and shallow respirations. What stimulation of chemoreceptors or lung receptors will result in an increase in respiratory rate? A) Decreased carbon dioxide levels at central chemoreceptors B) PaO2 less than 60 at peripheral chemoreceptors C) Normal airway resistance perceived by stretch receptors D) Lack of stimulation of irritant receptors

An athlete has been admitted to the ICU for heat stroke and severe dehydration after participating in a marathon on a hot day. Which of the following would the nurse expect to find in this patient? A) Decreased serum osmolality B) Increased renin secretion C) Increased glomerular filtration rate D) Hypertension

An elderly male patient in the ICU is diagnosed with acute kidney injury. This patient demonstrates a decreased glomerular filtration rate and lowered urine sodium concentration, as well as increased BUN and serum creatinine levels. The nurse observes that the patient takes several minutes to empty his bladder when he uses the bathroom. His blood pressure and blood glucose levels are normal. What should the nurse suspect as the cause of this patient's acute kidney injury? A) Tubular necrosis as a result of accumulation of radiocontrast dye in the renal tubular cells B) Obstruction of the flow of urine due to benign prostatic hypertrophy C) Lack of perfusion due to congestive heart failure D) Hypotension due to systemic inflammatory response to sepsis

An elderly patient with community-acquired pneumonia has been admitted to the CCU. What nursing action will improve the patient's chances of survival? A) Obtain blood and sputum cultures on admission and 2 days after admission. B) Initiate intravenous antibiotic therapy within 8 hours after admission. C) Administer intravenous antibiotics for 7 full days. D) Initiate antibiotics only after culture results are known.

As part of a multiple trauma injury, the patient has suffered a closed fracture of the radius. What nursing assessment finding indicates a significant complication warranting immediate treatment? A) Swelling and pain over the fracture B) Loss of pulses distal to the fracture C) Ecchymosis over the fracture D) Deformity of forearm

As part of the care of a mechanically ventilated patient, the nurse provides oral and subglottic suctioning every 2 hours. What is the best rationale for this nursing action? A) Stimulates cough and deep breathing B) Reduces pulmonary microbial colonization C) Maintains oral mucosal moisture D) Part of Universal Precautions protocols

During a routine physical examination, the nurse palpates the patient's left kidney just below the costal margins on the posterior aspect of the trunk. What is the most appropriate nursing action? A) Document this normal finding. B) Obtain an order for renal diagnostics. C) Assess for toxic ingestion. D) Evaluate coagulation studies.

During physical examination of an ambulatory patient, the nurse finds elevated blood pressure, pulmonary crackles that do not clear with cough, jugular venous distention, liver congestion and enlargement, an S3 heart sound, and pitting edema of the feet and lower legs. What is the most likely cause of this group of findings? A) Fluid volume deficit B) Fluid volume excess C) Hyponatremia D) Leukocytosis

During the inspection phase of the physical examination, the nurse notices that the patient's chest wall is round, and the anterior-to-posterior diameter and the lateral diameter are equal. Based on this information, what disease process does the nurse suspect? A) Lobular pneumonia B) Chronic obstructive pulmonary disease C) Acute respiratory distress syndrome D) Respiratory syncytial virus

For a patient in cardiogenic shock, the physician has ordered an intravenous continuous infusion of dobutamine hydrochloride. What nursing assessment result demonstrates achievement of therapeutic goals? A) Blood pressure 120/70 mm Hg B) Urine output 30 to 40 mL/hr C) Arterial oxygen saturation 60% D) Heart rate 110 to 120 bpm

In a patient with acute ischemic tubular necrosis, urine output has increased from below normal to very high. What is the nursing priority of care during this phase of renal failure? A) Restrict fluid intake B) Monitor serum potassium C) De-emphasize dialysis D) Monitor serum creatinine

Infection and sepsis are significant complications of ARDS. Which nursing action has the highest priority in preventing infection and sepsis? A) Maintain plateau airway pressure below 30. B) Infuse enteral nutrition with minimal interruptions. C) Keep patient sedated to facilitate ventilation. D) Place in prone position every 2 to 4 hours.

The nurse is assigned to the care of a patient in the ICU who is in cardiogenic shock. What priority nursing intervention is necessary to conserve myocardial energy and decrease workload of the heart? A) Lactated Ringer's at 150 mL/hr B) Morphine sulfate 4 mg IV C) Furosemide (Lasix) 80 mg IV D) Epinephrine 1:1,000, 0.3 mL IV

The nurse is caring for a patient who has developed acute respiratory distress syndrome (ARDS) after smoke inhalation. Based on the pathologic changes in ARDS, the nurse expects what outcome during the first several hours? A) Improvement in airway patency with bronchodilator therapy B) Persistent and worsening hypoxia despite mechanical ventilation C) Evidence of hypercarbic respiratory failure with compensation D) General fluid volume deficit from capillary permeability increase

The nurse is explaining the underlying principles of dialysis to a patient who is starting peritoneal dialysis for the management of chronic renal failure. As part of the teaching, what physiologic process does the nurse explain produces the most waste product removal? A) Water molecule movement by osmosis B) Diffusion to a less concentrated area C) Active transport by an energy-driven process D) Increased osmotic gradient from the abdomen

The patient has a reduced clearance rate for a drug usually secreted by the nephrons. The nurse should assess for malfunction in which of the following? A) Osmosis in Bowman's capsule B) Active transport in distal tubules C) Filtration rate in glomerulus D) Rate of flow in collecting duct

The patient has an abnormally high level of serum potassium. What associated life-threatening alteration should the nurse look for? A) Gastrointestinal distress B) Cardiac dysrhythmias C) Muscle spasm D) Increased aldosterone

The patient has been on a mechanical ventilator for 2 weeks. Weaning from mechanical ventilation is to start today. Based on the length of time that the patient has been ventilated, what information should the nurse emphasize to the patient and the family? A) Extubation is expected later today, as the patient is relatively young. B) Delays and setbacks are expected before independence is achieved. C) The best method is continuous positive airway pressure (CPAP). D) Elevation of the head of the bed will provide for the most patient comfort.

The patient has experienced a mechanical obstruction of the lower trachea from a mucous plug. What is the priority nursing action? A) Obtain arterial blood gas results. B) Deep suction the patient. C) Turn onto left side and elevate head. D) Increase tidal volume on ventilator.

The patient has experienced a mediastinal shift to the left. Several structures or functions will be compromised by this condition. What is the most significant effect? A) Right lung will be compressed. B) Cardiac output will be diminished. C) Point of maximal impulse will be displaced. D) Jugular venous distention will occur.

The patient is being supported with a positive-pressure mechanical ventilator set to a synchronized intermittent mandatory ventilation (SIMV) rate of 8 breaths per minute. What situation, if found by the nurse, would indicate a ventilator malfunction? A) SIMV rate 8, patient rate 30, total rate 38 breaths per minute B) SIMV rate 6, patient rate 2, total rate 8 breaths per minute C) SIMV rate 8, patient rate 0, total rate 8 breaths per minute D) SIMV rate 8, patient rate 8, total rate 16 breaths per minute

The patient is exhibiting poor gas exchange. Four factors influence gas exchange across the alveolar membrane. What condition related to the four factors could be interfering with gas exchange? A) Oxygen at 100% B) 35% of the alveoli are filled with fluid. C) Oxygen delivered under pressure D) Alveolar membranes are 0.3 microns thick.

The patient is experiencing a ventilation-perfusion mismatch and compromised gas exchange. Correcting ventilation-perfusion mismatch entails what actions? A) Decreasing anatomic dead space with intubation B) Decreasing alveolar dead space with positive-pressure ventilation C) Increasing alveolar perfusion with platelet therapy D) Increasing apex ventilation with high tidal volumes

The patient is in hypovolemic shock, with mean arterial pressures below 90 mm Hg and a very low urine output. An IV drip of norepinephrine is prescribed to keep blood pressure above 90 mm Hg. No other therapy is initiated. What effect on kidney function does the nurse expect? A) Improvement in renal perfusion secondary to improved blood pressure B) Reduction in urine output secondary to constriction of renal arteries C) Augmentation of water reabsorption from distal tubular fluid D) Decrease in urine sodium concentration to critically low levels

The patient is scheduled for a lobectomy. As part of preoperative teaching, the nurse stresses the importance of coughing and deep breathing postoperatively. What positive outcome from this procedure does the nurse expect? A) Thicker and less mobile secretions B) Lower incidence of atelectasis C) Increased risk for pneumonia D) Increased need for pain medication

The patient's urinalysis shows proteinuria. What is the significance of this finding? A) Normal in late pregnancy B) Intrarenal acute renal failure C) Diminished glomerular filtration rate D) Compromised erythropoietin production

What nursing strategy implemented after a patient is admitted to the CCU will decrease the risk that he or she will develop hospital-acquired pneumonia? A) Verify that patients received a pneumococcal pneumonia vaccine before admission. B) Ensure that all members of the health care team follow hand hygiene protocols strictly. C) For patients who cannot eat normally, maintain NPO status. D) Maintain bed rest in supine position for all mechanically intubated patients.

Which of the following patients would be at highest risk for the development of deep vein thrombosis progressing to pulmonary embolus? A) Age 45, exercises daily, underwent elective knee repair surgery, high normal platelets B) Age 85, sedentary, somewhat dehydrated, underwent repair of a pelvic fracture, high normal platelets C) Age 26, athletic, underwent repair of a football injury, normal platelets D) Age 50, on aspirin and beta blockers, underwent open heart surgery, borderline low platelets

A patient has suffered a mild pulmonary contusion from a jet ski accident. What nursing interventions are appropriate for this patient? Select all that apply. A) Maintenance of chest tubes B) Frequent pulse oximetry monitoring C) Assessment of lung sounds every 2 hours D) Continuous epidural analgesia E) Maintainance of ventilatory support

b, c, d

A patient is experiencing poor perfusion in his right thorax as a result of suspected partially occluded arteries. Occlusion in which artery or arteries would cause this? Select all that apply. A) Aorta B) Internal mammary C) Subclavian D) Intercostal

b, c, d

he nurse is working with a 50-year-old patient with emphysema who smokes and eats poorly. Which of the following should she mention to the patient regarding her disease? Select all that apply. A) The disease may be reversible if the irritant causing inflammation can be identified. B) Lung volume reduction surgery may increase her respiratory function. C) Smoking cessation can slow the progress of COPD. D) Improving her nutritional state could increase her respiratory muscle strength.

b, c, d

The nurse is caring for a patient who is being mechanically ventilated. What strategies have been shown to prevent ventilator-acquired pneumonia (VAP)? Select all that apply. A) Routine prone positioning B) Elevate head of bed 30 degrees if not contraindicated C) Oral care with plaque removal every 2 to 4 hours D) Balanced nutrition by gastric tube E) Continuous subglottic suctioning of secretions F) Frequent turning and chest physiotherapy

b, c, e, f

A patient in the ICU presents with a fever, headache, malaise, and myalgia. The nurse suspects that the patient has a SARS infection. Which other finding or findings would tend to confirm this suspicion? Select all that apply. A) Mucus-producing cough B) Dyspnea C) Positive for human cytomegalovirus D) Lymphopenia

b, d

A patient with chronic renal failure has an arteriovenous fistula in her forearm for dialysis access. What intervention or interventions should the nurse make in working with this patient? Select all that apply. A) Take the patient's blood pressure on the forearm containing the fistula. B) Palpate the fistula for thrill every 8 hours. C) Draw blood samples from the vein that forms the fistula. D) Avoid placing any restraints on the access arm. E) Check access patency less frequently in hypotensive patients. F) Occlude the fistula vein using firm pressure in the event of postdialysis bleeding from the needle site.

b, d

A nurse is examining a patient on dialysis. Which of the following should she especially look for in this patient? A) The presence of a third heart sound B) Pitting edema C) Inflammation or infection near the access site D) Crackles on auscultation of lungs

A patient being supported with endotracheal intubation and mechanical ventilation is increasingly agitated. What is the most appropriate nursing intervention? A) Administer neuromuscular blockade medication. B) Administer a benzodiazepine. C) Obtain arterial blood gas measurement. D) Ask a family member to stay with the patient.

A patient has a condition resulting in malfunction of the proximal tubules of nephrons. What would the nurse expect to find? A) All urine values within normal limits B) Low levels of electrolytes in urine C) Reduction of drug clearance rates D) Decrease in urine urea levels

A patient has acute respiratory distress syndrome (ARDS) and is mechanically ventilated. The patient has not responded to high levels of oxygen and low positive-end expiratory pressure (PEEP), and the ventilator settings are being adjusted. What patient response or ventilator setting limit should the nurse look for to prevent ventilator-associated lung injury (VALI)? A) Positive end-expiratory pressure at least 30 cm H2O B) Fraction inspired oxygen set at 1.0 (100%) C) Measured airway plateau pressure below 30 cm H2O D) Respiratory rate between 12 and 20 breaths per minute

A patient has arterial blood gas results of pH 7.2, PaCO2 55 mm Hg, and HCO3 24 mEq/L. How does the nurse interpret these results? A) Metabolic acidosis B) Metabolic alkalosis C) Respiratory acidosis D) Respiratory alkalosis

A patient has arterial blood gas testing performed. His PaO2 is 83 mm Hg, SaO2 is 91%, pH is 7.5, PaCO2 is 24 mm Hg, and HCO3 is 22 mEq/L. Which of the following indicates this patient's condition? A) Respiratory acidosis with normal saturation (uncompensated) B) Metabolic alkalosis with low saturation (uncompensated) C) Respiratory alkalosis with low saturation (uncompensated) D) Metabolic alkalosis with low saturation (fully compensated)

A patient has been admitted to the CCU in respiratory failure from probable SARS pneumonia. Knowing that SARS is very contagious, in addition to ensuring strict hand hygiene by everyone, what is the most important nursing action? A) Provide adequate nutrition. B) Obtain blood and sputum cultures. C) Place patient in full isolation. D) Ensure adequate fluid balance.

A patient has been brought into the Emergency Department via ambulance with resuscitation efforts being performed. It is unlikely that the patient will survive the severe injuries sustained. Two adult children of the patient are present and are requesting to be with the patient at this time. What is the best response by the nurse? A) "I don't think you should see your loved one like this. Wouldn't you rather remember him the way he was?" B) "Our hospital doesn't allow more than one family member in with a patient. One of you can come in and one of you will have to wait in the waiting area." C) "You may come in with your parent and I will have someone stay with you to explain what is happening." D) "I have been through this many times and I promise you, it is a sight that you don't want to remember."

A patient has been diagnosed with prerenal acute renal failure. What condition most likely caused this situation? A) Toxic levels of medications B) Poststreptococcal glomerulonephritis C) Severe sepsis and shock D) Benign prostatic hypertrophy

A patient in her first trimester is in the ICU and is displaying signs of metabolic alkalosis. On speaking with the patient, the nurse learns that she has been experiencing much vomiting, diarrhea, and anxiety in the past week. The nurse should recognize that which of the following is the most likely cause of this acid-base imbalance? A) Pregnancy B) Diarrhea C) Vomiting D) Anxiety

A patient in oliguric renal failure is receiving IV furosemide (Lasix). What nursing assessment has the highest priority? A) Daily weights B) Intake and output C) Serum potassium D) Blood urea nitrogen

A patient in the ICU experiences an asthma attack after a guest brings her a flower arrangement. Stimulation of which receptors is most associated with the patient's asthma attack? A) Stretch receptors B) Peripheral chemoreceptors C) Irritant receptors D) Juxtacapillary receptors

A patient in the ICU failed long-term ventilation weaning via CPAP trials. What is the next intervention that should take place? A) The T-piece trial should be performed. B) The patient should be switched to SIMV method. C) The patient should be rested on the ventilator for 24 hours. D) The patient should be switched to the SIMV plus PSV method.

A patient in the ICU has been on assist-control ventilation via endotracheal intubation for 24 hours but will need to be shifted to a long-term ventilation method. Which of the following would be the most appropriate treatment for this patient? A) Iron lung B) Manual resuscitator C) Tracheostomy tube D) Pressure-controlled ventilation via endotracheal intubation

A patient in the ICU with chronic obstructive pulmonary disease has mucous secretions throughout her respiratory system. Her breathing is highly labored. What is the primary cause of her labored breathing? A) Decreased airway resistance due to increased airway diameter B) Excessive surfactant C) Increased airway resistance due to decreased airway diameter D) Increased lung compliance

A patient in the ICU with pneumonia and on mechanical ventilation is suspected to have pulmonary embolus. Which diagnostic study would be best for assessing for this condition? A) Chest radiography B) Ventilation-perfusion scanning C) Pulmonary angiography D) Bronchoscopy

A patient is admitted after an acute lung injury from smoke inhalation. If the patient develops acute respiratory distress syndrome (ARDS), what is the first symptom the nurse will find? A) Patchy infiltrate on chest x-ray B) Pulmonary capillary wedge pressure less than 18 C) Increasing tachypnea and air hunger D) Low plasma brain natriuretic peptide (BNP)

A patient is being treated for severe hypovolemic shock. Based on the primary treatment goal, what nursing intervention has the highest priority? A) Frequent measurement of vital signs B) Management of mechanical ventilation C) Rapid intravenous fluid administration D) Insertion of urinary drainage catheter

A patient is concerned about her steadily worsening chronic kidney disease and asks the nurse at what point she will require dialysis or renal transplantation. Which of the following should the nurse mention? A) When your urine albumin-to-creatinine ratio is greater than 25 mg/g B) When your urine output is less than 0.5 mL/kg/h × 6 h C) When your glomerular filtration rate (GFR) falls below 15 mL/min/1.73 m2 D) When your urine osmolality is greater than 500 mOsm/kg H2O

A patient is in shock and is exhibiting low blood pressure, low systemic vascular resistance (SVR), peripheral edema, pulmonary wheezing, tachycardia, and nausea and vomiting. What precipitating event does the nurse expect for this group of symptoms? A) Acute myocardial infarction B) Bacterial infectious illness C) Recent seafood meal D) Massive fluid loss

A patient is recovering from severe altitude sickness after a failed attempt to climb Mount Everest. Which factor affecting gas exchange was most likely responsible for the patient's illness? A) Surface area available for diffusion B) Thickness of the alveolar-capillary membrane C) Partial pressure of alveolar gas D) Solubility and molecular weight of the gas

A patient on renal dialysis in the ICU begins to develop worsening dyspnea, pleuritic chest pain, cough, apprehension, and pain. Moreover, the nurse observes that his right leg is swelling significantly. Which diagnostic study would be most appropriate for confirming a diagnosis of pulmonary embolus? A) Computed tomography (CT) angiogram B) Thoracentesis C) Ventilation-perfusion scan D) Arterial blood gas test

A patient who developed chronic renal failure after a severe hypotensive episode has just been told that dialysis will be necessary for the rest of her life. She and her family are very upset and crying. What is the best nursing intervention? A) Ask the family to leave, as they are upsetting the patient. B) Administer intravenous sedation to the patient. C) Encourage patient and family to express their feelings. D) Begin dialysis education immediately.

A patient with acute kidney injury (AKI) complains of a headache. He vomits several times and breathes deeply and rapidly. His heart rate is 110 bpm, and his serum potassium level is elevated. The nurse recognizes in this patient which condition commonly associated with AKI? A) Fluid overload B) Anemia C) Metabolic acidosis D) Pericarditis

A patient with acute kidney injury (AKI) demonstrates blue mottling of the skin in her fingers. What other finding would tend to indicate that the cause of this condition is intrarenal? A) Distended bladder B) Edema C) Strep throat infection D) Kinked Foley catheter

A patient with acute respiratory distress syndrome (ARDS) requires mechanical ventilation but is at risk for barotrauma due to decreased lung compliance. Which mode of ventilation should the nurse use with this patient? A) Pressure support ventilation mode B) Synchronized intermittent mandatory ventilation mode C) Pressure-controlled ventilation mode D) Assist-control mode

A patient with chronic renal disease has mild metabolic acidosis with a pH 7.30 and bicarbonate level 16 mEq/L. What treatment does the nurse anticipate? A) IV sodium bicarbonate B) Reduction of respiratory rate C) Sodium citrate and citric acid (Bicitra) D) Massive IV fluids

A patient with renal impairment is found to have a positive Chvostek's sign. What additional information should the nurse assess for? A) Hyperkalemia B) Hyponatremia C) Hypocalcemia D) Hypermagnesemia

A patient with worsening tachypnea and dyspnea has a PaO2/FiO2 ratio of 190, bilateral infiltrates on chest x-ray, pulmonary artery occlusive pressure (PAOP) of 15 mm Hg, and no indication of left atrial hypertension. Which of these findings indicates that the patient has acute respiratory distress syndrome (ARDS), as opposed to just acute lung injury (ALI)? A) PaO2/FiO2 ratio of 190 B) Bilateral infiltrates on chest x-ray C) PAOP of 15 mm Hg D) No indication of left atrial hypertension

A patient's lab results include a finding of glucose in the urine (glycosuria). What other lab result should the nurse expect in this patient? A) Decreased ketones in the urine B) Alkaline urinary pH C) Elevated blood glucose D) Decreased urine volume

An elderly patient in the ICU with chronic renal failure has just undergone surgery for a synthetic arteriovenous graft in her left forearm for dialysis access. The nurse recognizes that the most likely reason this patient received a graft instead of a fistula is which of the following? A) Thrombosis is less likely to occur with grafts than with fistulas. B) Fistulas are more prone to infection than are grafts. C) The patient's own blood vessels were not adequate for fistula formation. D) An aneurysm is more likely to occur in a fistula than in a graft.

As part of a major trauma, a patient has suffered a flail chest injury. What hallmark sign of flail chest does the nurse expect to find? A) Flail segment elevation during inhalation B) Evidence of rib fractures on chest radiograph C) Flail segment depression during inhalation D) Hypoxemia evident on arterial blood gases

During a motor vehicle accident, a patient sustained blunt trauma to the head and face, resulting in hairline skull fracture and a LeFort III maxillofacial fracture. The patient also has bruising across the chest and upper abdomen and multiple small superficial bleeding abrasions and lacerations. On admission to the emergency department, what is the nursing care priority? A) Apply direct pressure to bleeding areas. B) Assess neurologic status. C) Perform endotracheal intubation. D) Administer tetanus booster immunization.

On initial admission of a trauma victim to the emergency department, the nurse completes a primary survey. The patient is awake and tachypneic, is using accessory muscles of respiration, has unequal chest expansion, and is very anxious. There are absent breath sounds on the right and cyanosis on 100% oxygen, and the trachea is deviated to the left. What action takes the highest priority during the primary survey? A) Jaw thrust maneuver B) Suctioning the oral pharynx C) Chest tube insertion D) Assisting ventilation with bag-mask device

The nurse in the ICU is assigned to care for a patient with septic shock. What nursing interventions are necessary to prevent malnutrition and optimize cellular function in this patient? A) Administration of crystalloid solutions IV B) High calorie, low protein diet C) Enteral feedings D) Administration of multivitamins in the IV fluid

The nurse is assigned to a patient in the ICU who is on a ventilator for exacerbation of chronic obstructive pulmonary disease. What intervention by the nurse can prevent the development of multiple organ dysfunction syndrome? A) Suctioning the patient every 2 hours B) Enteral feedings C) Oral care every 2 hours D) Administration of total parenteral nutrition

The nurse is assisting with endotracheal intubation. In what circumstance would the nurse question the use of nasotracheal intubation? A) Confused patient B) Fractured mandible C) Acute sinusitis D) Possible cervical spine fracture

The nurse is caring for a patient who has undergone thoracic surgery. What assessment information would best support the nurse's suspicion of pulmonary consolidation? A) Vesicular lung sounds at bases B) Bronchial breath sounds over upper airway C) Egophony at left posterior base of lung D) Basal crackles that clear with cough

The nurse is caring for a patient with deep vein thrombosis of the left lower extremity. The patient exhibits a decrease in pulse oximetry readings from 98% to 86%, shortness of breath with a respiratory rate of 34, and is now disoriented to place. The nurse recognizes that these findings are caused by what complication? A) Pulmonary edema B) Cardiac tamponade C) Pulmonary embolus D) Tension pneumothorax

The patient has a low serum sodium level and a high serum potassium level. In normal compensation, what body function would increase? A) Proximal tubule reabsorption of sodium B) Conversion of angiotensin II to renin C) Secretion of aldosterone D) Response to diuretic therapy

The patient has been diagnosed with acute lung injury after submersion in contaminated ground water and probable aspiration. The patient has developed tachycardia, fever, and increased white blood cell count. What does the nurse anticipate will be added to the plan of care? A) Prophylactic antibiotics B) Nonsteroidal anti-inflammatory drugs (NSAIDs) C) Obtaining blood, sputum, urine cultures D) Intravenous controlled sedation

The patient has consolidation of his right lateral lower lung segments and is receiving chest physiotherapy. What position is best for draining this portion of the lung? A) Semi-Fowler's B) Supine C) Left side-lying D) Right side-lying

The patient has received a gunshot wound. To help predict the amount of damage, what information does the nurse collect? A) Location of the shooting B) Information about the shooter C) Type of weapon and caliber of bullet D) Whether the injury involved a felony

The patient is being monitored with an end-tidal CO2 monitor and has values trending upward. What acid-base abnormality should the nurse assess for? A) Metabolic acidosis B) Metabolic alkalosis C) Respiratory acidosis D) Respiratory alkalosis

The patient is being supported by mechanical ventilation and is not maintaining adequate oxygenation on current settings. Positive end-expiratory pressure (PEEP) has just been increased from 10 to 12 cm H2O. What nursing assessment finding best indicates that the patient is not tolerating this change? A) Increased cardiac output B) Increased blood pressure C) Significant hypotension D) Increased pulmonary compliance

The patient is experiencing a fluid volume overload from excess intravenous fluids. Assuming that normal kidney function exists, what hormone actions would the nurse expect? A) Hypothalamic secretion of antidiuretic hormone B) Adrenal secretion of renin C) Reduction of renin and aldosterone functions D) Increased conversion of angiotensin I to angiotensin II

The patient is experiencing metabolic acidosis. What kidney function is impaired? A) Hydrogen ion filtration by the glomerulus B) Electrochemical bicarbonate reabsorption C) Hydrogen ion secretion by the distal tubules D) Sodium reabsorption by bicarbonate

The patient is in severe metabolic acidosis from diabetic ketoacidosis. Based on the oxyhemoglobin dissociation curve, what change in the plan of care does the nurse expect? A) Reduction of inhaled oxygen as hemoglobin is fully saturated B) Use of positive-pressure ventilation to improve alveolar expansion C) Increase in inhaled oxygen as hemoglobin saturation is low D) Increase in ventilation rate to help excrete carbon dioxide

The patient is receiving continuous renal replacement therapy (CRRT). The rate of ultrafiltration shows a downward trend and coagulation of the filter is suspected. What is the most appropriate first nursing action? A) Immediately disconnect circuit from the patient. B) Decrease the rate of blood flow by pump. C) Use a saline bolus to diagnosis clot location and extent. D) Raise the ultrafiltration collection device.

The patient is receiving maintenance IV fluids, has no active fluid loss site, and has normal renal function. Based on the physiology of fluid volume balance, what IV fluid use does the nurse anticipate? A) Dextrose 5% in water B) 0.9% saline C) 0.45% saline D) 3% saline

The patient is receiving supplemental oxygen therapy. What finding most clearly demonstrates achievement of one of the goals of oxygen therapy? A) Therapy is discontinued after 3 days. B) Increased respiratory rate and depth C) Verbalization of relief of dyspnea D) Reduction of arterial carbon dioxide pressure

The patient is to undergo chest tube placement. What is the best nursing intervention to prevent a complication of this procedure? A) Facilitate chest tube removal on day 3. B) Use the supine position during chest tube removal. C) Premedicate with an intravenous opioid. D) Keep drainage tubing off the bed.

What laboratory value is most likely to indicate renal failure? A) Elevated blood urea nitrogen (BUN) B) Low hemoglobin and hematocrit C) Elevated serum creatinine D) Normal urine osmolarity

he nurse is assigned to a patient in the Emergency Department who exhibits paradoxical chest movement. What intervention by the nurse can help improve oxygenation in this patient? A) Elevate the head of the bed 30 degrees. B) Splint the chest with 3-inch surgical tape. C) Turn the patient with the injured side down. D) Place the patient in the prone position.

n developing the discharge plan for a patient who was treated in the hospital for anaphylactic shock related to a nonsteroidal anti-inflammatory (NSAID) allergy, what would be the most important information for the nurse to include? A) Adhere to dietary restrictions. B) Follow up in one month with the physician. C) Check labels of over-the-counter medications prior to taking. D) Have blood pressure checked on a regular basis.

A nurse has just received a clean-catch urine sample from the patient and is about to deliver it to the laboratory for analysis. She observes that it is dark yellow, has a cloudy or turbid appearance, and has an ammonia odor. Which of the following does the nurse suspect about the patient's condition based on her observations? Select all that apply. A) The patient is diabetic. B) The patient has above-normal creatinine clearance. C) The patient is dehydrated. D) The patient has proteinuria. E) The patient has intrarenal hemorrhaging. F) The patient has a renal infection.

c, f

A critically ill patient has an intravenous line inserted into the left subclavian vein. After the procedure, what nursing intervention is used to detect the most serious complication of this procedure? A) Connection of ordered intravenous fluids B) Compatibility evaluation for fluids infused C) Use of a semipermeable plastic site dressing D) Auscultation of bilateral breath sounds

A critically ill patient has arterial blood gas results of pH 7.35, PaCO2 55 mm Hg, and HCO3 28 mEq/L. How does the nurse interpret these results? A) Respiratory acidosis B) Metabolic alkalosis C) Partially compensated metabolic alkalosis D) Fully compensated respiratory acidosis

A critically ill patient is receiving continuous renal replacement therapy (CCRT) by continuous venovenous hemofiltration with dialysis (CVVHD) or continuous venovenous hemofiltration (CVVH). What difference in care of this patient does the nurse anticipate when compared with other methods of CCRT? A) Filtrate lost is equal to patient weight loss B) Differences are in brands of machines used C) Produced ultrafiltrate is not replaced D) Replacement fluid is necessary to maintain fluid balance

A patient develops toxic acute tubular necrosis (ATN) as a result of exposure to a radiocontrast dye. Which of the following should the nurse most expect to observe in this patient as this condition progresses beyond the onset phase? A) Normal potassium levels B) Duration of 7 to 14 days C) Normal urine concentrating function D) Normal urine volume

A patient has a reduced urine output. What situation will reduce glomerular filtration rate and hence urine output? A) Increase in mean arterial pressure to 100 mm Hg B) Decrease in hydrostatic pressure in Bowman's capsule C) Decrease in plasma protein concentrations D) Condition resulting in afferent arteriole constriction

A patient has arterial blood gas testing performed. Her PaO2 is 95 mm Hg, SaO2 is 90%, pH is 7.4, and HCO3 is 23 mEq/L. Which of these values should the nurse be most concerned about? A) PaO2 B) HCO3 C) pH D) SaO2

A patient has been admitted with severe dyspnea, orthopnea, and pleuritic chest pain. A chest x-ray shows a pleural effusion. In planning care for this patient, what action is most appropriate? A) Thoracentesis for all patients B) Diuretics and positive inotropes C) Low-fat, high-carbohydrate diet D) Oxygen therapy assessed by arterial blood gases

A patient has been diagnosed with septic shock and is receiving intravenous fluid resuscitation along with other therapies. What nursing assessment best indicates improvement in tissue perfusion? A) Mean arterial pressure 65 to 70 mm Hg B) SvO2 80% to 90% C) Skin warm and dry D) Arterial bicarbonate ion 22 to 24 mEq/L

A patient has experienced a cardiopulmonary arrest and is receiving cardiopulmonary resuscitation. As the nurse evaluates the effectiveness of this therapy, what value on arterial blood gases is most indicative of hypoventilation? A) Diminished PaO2 B) Diminished SaO2 C) Elevated HCO3 D) Elevated PaCO2

A patient has just been diagnosed with type 2 diabetes mellitus. During teaching, what strategy should the nurse emphasize as protective of kidney cells? A) Monitoring glycosylated hemoglobin every 3 months B) Strict adherence to prescribed weight-loss diet C) Restriction of sodium-containing beverages and food D) Strict control of serum glucose levels with diet and medication

A patient has recently arrived in the ICU following cardiac arterial bypass graft surgery and has not yet emerged from anesthesia. He requires full ventilatory support. Which ventilation mode should the nurse use for this patient? A) Pressure support ventilation mode B) Synchronized intermittent mandatory ventilation mode C) Pressure-controlled ventilation mode D) Assist-control mode

A patient has severe wheezing, air hunger, cyanosis, and anxiety and is given an inhaled bronchodilator. If the bronchodilator is effective, the nurse will find what direct effect after administration? A) Increased respiratory rate B) Increased heart rate C) Unchanged cough frequency D) Reduction of audible wheeze

A patient has suffered severe blunt trauma to the abdomen with bruising, diffuse pain, guarding, and rigidity evident. Damage to which structure is most likely? A) Stomach B) Bladder C) Large intestine D) Liver

A patient in severe congestive heart failure is at risk for the development of acute respiratory failure and is receiving supplemental oxygen therapy. What nursing assessment parameter is most indicative of acute respiratory failure? A) Dependent pitting edema that is worsening B) New onset of systolic gallop C) Conversion to atrial fibrillation D) Arterial PaO2 45 mm Hg

A patient in shock has developed systemic inflammatory response syndrome (SIRS). What is the most likely type of shock resulting in SIRS? A) Hypovolemic B) Septic C) Cardiogenic D) Any shock

A patient in the ICU has acute renal failure and is an alcoholic. Which electrolyte imbalance would the nurse most expect to find in this patient? A) Hypokalemia B) Hyperkalemia C) Hypermagnesemia D) Hypomagnesemia

A patient in the ICU was admitted about 24 hours ago with symptoms of acute respiratory distress syndrome (ARDS). He now demonstrates shortness of breath and a respiratory rate of 40 breaths per minute. His heart rate is 115 beats per minute. The nurse notes a bluish tinge in his fingertips. His chest x-ray shows patchy alveolar infiltrate. His body temperature is normal. Which stage of ARDS is this patient most likely in? A) Stage 1 B) Stage 2 C) Stage 3 D) Stage 4

A patient in the ICU with pneumothorax is experiencing a ventilation-perfusion imbalance. Which type of imbalance is the patient most likely experiencing? A) Physiological shunt B) Anatomical shunt C) Alveolar dead space D) Silent unit

A patient is being evaluated for development of chronic obstructive pulmonary disease. Which symptom is most likely to indicate this disease process? A) Clubbing of fingernails B) Chronically elevated carbon dioxide level C) Development of barrel chest D) Impaired expiratory air volume

A patient is experiencing a sudden drop in blood pressure with a mean arterial pressure ranging between 78 and 82 mm Hg. What effect on the functioning of the renal system does the nurse expect? A) Dilation of afferent renal arterioles B) Increase in glomerular filtration rate C) Dilation of efferent renal arterioles D) Reduction of glomerular filtration rate

A patient receiving continuous renal replacement therapy (CRRT) is placed on low-dose heparin for anticoagulation of the CRRT circuit. What laboratory result would cause the nurse to question the use of heparin? A) Normal total platelet count B) Partial thromboplastin time two times control C) Partial thromboplastin time normal D) Critically low total platelet count

A patient with acute respiratory distress syndrome (ARDS) demonstrates unmistakable signs of pneumothorax. What is the next intervention that the nurse should implement? A) Increase the peak end-expiratory pressure (PEEP). B) Administer an inotropic agent. C) Elevate the head of the bed to 35 degrees. D) Assist with a chest tube insertion.

A patient with acute respiratory distress syndrome (ARDS) has shown no improvement after 8 hours of mechanical ventilation set to maximize fraction of inspired oxygen. The patient is developing pulmonary hypertension. Which intervention would be best for reducing the negative effects of the pulmonary hypertension in this patient via selective pulmonary vasodilation? A) Nitric oxide B) Prophylactic antibiotic therapy C) Corticosteroids D) Neuromuscular blocking agents

A patient with acute respiratory distress syndrome (ARDS) has these arterial blood gas results: pH 7.33, PaCO2 50, HCO3 26, PaO2 80, SaO2 80. The patient is mechanically ventilated with 60% oxygen and positive-end expiratory pressure (PEEP) at 5 cm H2O. These arterial blood gas results, when compared to the previous day, show no improvement in oxygenation and increased PaCO2. When the nurse is assessing these results, what is most significant in evaluating the patient's progress? A) Patient isn't responding to conventional ventilation therapy. B) Development of metabolic alkalosis is compensatory. C) Inhaled oxygen and PEEP should be increased. D) Change in acid-base balance is ominous.

A patient with acute respiratory distress syndrome (ARDS) is receiving an inhaled bronchodilator. What nursing assessment indicates the most important expected outcome of the bronchodilator for this patient? A) Decreased audible wheezing B) Slight tachycardia during treatment C) Increase in mucus suctioned D) Reduction of peak airway pressure

A patient with acute respiratory distress syndrome (ARDS) is receiving mechanical ventilation. The patient's high airway pressure alarm sounds, and the nurse finds asymmetrical chest expansion and absent breath sounds on the right. What is the probable cause of this situation? A) Oversedation B) Need for suctioning C) Impending respiratory arrest D) Acute pneumothorax

A patient with multiple trauma and several other comorbidities is being supported with endotracheal intubation and mechanical ventilation and is scheduled for a tracheostomy. The family questions the appropriateness of this procedure. In explaining the rationale for the procedure to the family, what is the most important nursing point? A) There is a physician's order for the procedure. B) Unit protocol mandates tracheostomy after a patient has been intubated for 7 days. C) A tracheostomy will greatly increase the patient's comfort. D) Tracheostomies at 3 to 7 days result in fewer ventilated days.

A patient with prerenal acute kidney injury is oliguric. The nurse is administering an IV bolus to the patient. What should be of primary concern to the nurse while performing this task? A) Restricting the patient's protein intake B) Monitoring the patient's potassium level C) Evaluating the patient for signs of nephrotoxicity D) Preventing fluid overload

A patient with severe vascular fluid loss from third spacing is being treated with intravenous hypertonic saline in an attempt to pull fluid from the extravascular space to the vascular space. What nursing assessment result is most indicative of a serious complication of the use of intravenous hypertonic saline? A) Increased urine output B) Decreased peripheral edema C) Slightly elevated blood pressure D) Pulmonary adventitious sounds

A premature infant is experiencing infant respiratory distress syndrome in the NICU. The nurse recognizes that this condition is most likely caused by which of the following? A) Defective type I alveolar cells B) An obstruction at the right bronchus C) Negative intrapleural pressure D) Immature type II alveolar cells

It has been determined that a patient in the ICU has pleural effusion. Which intervention is needed at this point to distinguish between transudative and exudative pleural effusion? A) Chest x-ray B) CT scan C) Ultrasound D) Assessment of pleural fluid

On auscultating the patient's heart, the nurse hears a third heart sound. What condition would this finding be most indicative of? A) Renal artery stenosis B) A faulty stethoscope C) Hypotension D) Fluid overload

The nurse is assigned to care for a patient who was admitted 2 days previous after a four-wheeler accident. The patient sustained a closed fracture to the left femur and had an open reduction with internal fixation the same day. What is a priority for the nurse to assess for this patient? A) White blood count B) Urinary output C) Cardiac output D) Pulse oximetry

The nurse is completing a history on a patient with dyspnea. What characteristic of dyspnea is most indicative of pulmonary disease? A) Most severe when patient is supine B) Awakens patient from sleep at night C) Accompanied by anginal chest pain D) Most severe with exertion

The nurse is teaching a patient with chronic renal failure and diabetes mellitus about nutrition. What should be included? A) Calorie restriction based on ideal body weight is necessary. B) Sodium and potassium should be supplemented while on dialysis. C) Renal diet restrictions take the place of those for diabetes mellitus. D) Moderate protein restriction is recommended while otherwise healthy.

The nurse observes that an elderly patient's urine samples have become increasingly dark yellow. Which of the following would best explain this phenomenon? A) The patient is drinking too much water. B) The patient is diabetic. C) The patient is hypertensive. D) The patient is dehydrated.

The patient has been diagnosed with shock secondary to an antigen-antibody reaction. What collaborative intravenous intervention has the highest priority? A) Dobutamine B) Red blood cells C) Antimicrobials D) Epinephrine

The patient has experienced a significant drop in hemoglobin levels and is slightly tachycardic. The pulse oximetry value is 100% and arterial blood gas values are normal. What is the most important adverse physiologic effect that the nurse would expect? A) Polycythemia B) Diminished blood pressure C) Hyperalertness and hyperreflexia D) Diminished tissue oxygenation

The patient has experienced an acute embolus in the thorax. An embolus in which artery is most likely to significantly compromise gas exchange? A) Left main bronchial artery B) Right peripheral bronchial arteriole C) Left peripheral pulmonary arteriole D) Right main pulmonary artery

The patient has suffered a stab wound to the chest, interrupting the integrity of the pleura with loss of negative pleural pressure and interruption of the contact between the visceral and parietal pleural surfaces. What is the most significant effect of this trauma? A) Pleuritic chest pain B) Displaced diaphragm C) Crepitus over ribs D) Compromised gas exchange

The patient is being evaluated for renal disease. During the initial patient history, what system should the nurse focus on in addition to the renal system? A) Pulmonary and cardiac B) Neurologic and integumentary C) Psychological and social support D) All physical and other systems

The patient is being supported with a positive-pressure mechanical ventilator. The machine in use is a volume-cycled ventilator. Relative to the functioning of this ventilator, what nursing assessment is most important? A) Continuous pulse oximetry B) Vital signs per unit protocol C) Respiratory rate D) Peak inspiratory pressure

The patient is in decompensated cardiogenic shock. What collaborative intervention best addresses the central cause of cardiogenic shock? A) Mechanical ventilation B) Hemodynamic monitoring C) Pharmacologic sedation D) Intravenous nitrate infusion

The patient is scheduled to receive hemodialysis for 4 hours this morning, and several medications for chronic diseases are scheduled to be given now. All of the medications will be at least partially removed by dialysis. What is the best nursing action? A) Give all medications as scheduled. B) Give double doses of all medications. C) Withhold medications for today only. D) Administer medications after dialysis.

What symptom or factor would the nurse find in emphysema but not in chronic bronchitis? A) Cough, thick sputum B) Dyspnea with exertion C) History of smoking D) Hyperinflation of lungs

What would the nurse identify as the primary purpose for the administration of intravenous (IV) crystalloid fluids in the patient with hypovolemic shock? A) Decrease myocardial oxygen demand. B) Maximize oxygen-carrying capability. C) Increase capillary permeability. D) Restore circulating volume.

High acuity 2

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