Critical Care Exam 2

The nurse is suctioning an intubated, mechanically ventilated patient. Complications that should be observed for include: 1. Dysrhythmias 2. Hyperthermia 3. Hematuria 4. Decreased urinary output

1. Dysrhythmias

A patient with ARDS is on a mechanical ventilator and is becoming increasingly restless with a heart rate of 128. The SaO2 is 88% and the ventilator settings are FiO2 50%; PEEP 8 cm; AC 10 with a total respiratory rate of 30; and a tidal volume of 700 mL. There are coarse rhonchi audible in all lung fields. The appropriate nursing action would be to: 1. Hyperoxygenate with 100% oxygen and suction the patient. 2. Administer the ordered neuromuscular blockade medications. 3. Increase the FiO2 to 60% and tidal volume to 750 mL for 2 minutes. 4. Increase the PEEP to 10 cm and sedate the patient.

1. Hyperoxygenate with 100% oxygen and suction the patient.

Which sign indicated the second phase of acute renal failure? A. Daily doubling of urine output (4 to 5 L/day) B. Urine output less than 400 ml/day C. Urine output less than 100 ml/day D. Stabilization of renal function

A. Daily doubling of urine output (4-5 L/Day) Daily doubling of the urine output indicates that the nephrons are healing. This means the patient is passing into the second phase (dieresis) of acute renal failure.

Which criterion is required before a patient can be considered for continuous peritoneal dialysis? A. The patient must be hemodynamically stable B. The vascular access must have healed C. The patient must be in a home setting D. Hemodialysis must have failed

A. The patient must be hemodynamically stable

Polystyrene sulfonate (Kayexalate) is used in renal failure to: A. Correct acidosis B. Reduce serum phosphate levels C. Exchange potassium for sodium D. Prevent constipation from sorbitol use

C. Exchange potassium for sodium

A patient in the intensive care unit is reported to be in the oliguric phase of intrinsic renal failure, which is reflected by: 1. Urine output of less then 400 mL/day 2. BUN and creatinine that may begin to increase slightly 3. Urinary output of up to 5 liters of urine each day 4. Abnormal laboratory values that can last from 6 months to a year in duration

Correct Answer: 1 Rationale 1: The oliguric phase may last 10 to 14 days during which the patient excretes less then 400 mL of urine/day. Rationale 2: The onset phase immediately follows the renal injury and lasts 2-4 days. The urine output is reduced by 20% and the BUN and creatinine may begin to increase slightly. Rationale 3: As a patient begins to regain renal function, the diuretic phase of intrinsic renal failure begins and urine output often increases up to 5 liters of urine each day. Rationale 4: The final phase of intrinsic renal failure is the recovery phase that typically lasts from 6 months to a year. During this phase, most patients' renal function and lab values slowly return to normal.

A critically ill patient is being evaluated for acute kidney injury. The nurse expects that which laboratory tests will be prescribed for this patient? Select all that apply. 1. Urinalysis 2. Blood-urea-nitrogen level 3. Serum creatinine 4. Arterial blood gases 5. Hemoglobin and hematocrit levels

Correct Answer: 1,2,3 Rationale 1: This laboratory test will be used to differentiate prerenal failure from intrinsic renal failure. Rationale 2: This blood test measures the amount of urea that is being filtered out of the blood by the kidneys. Rationale 3: This blood test assesses kidney function and is more accurate than the blood-urea-nitrogen level. Rationale 4: This blood test is not specific for renal function. Rationale 5: These levels are not specific for renal function.

The typical dietary plan for a patient with acute kidney injury would focus on provision of: 1. High fat, low protein 2. High carbohydrate, low protein 3. High protein, low sodium 4. High calorie, low carbohydrate

Correct Answer: 2 Rationale 1: A high-fat diet is not healthy for any patient population. A low-protein diet is not appropriate as this would cause the body to break down lean muscle mass for metabolic function. Rationale 2: Goals for nutritional intervention in the patient with acute kidney injury include preserving lean body mass, preventing metabolic alterations, and enhancing renal recovery by limiting uremic toxicity. Protein is allowed but limited because its catabolism may result in accumulation of toxic waste products (urea, phosphate, and potassium). Protein requirements can be calculated roughly based on the rise in the patient's BUN in 24 hours, and the amount of protein in the patient's diet can be based on this calculation. The remainder of the calories the patient requires is supplied as carbohydrates or lipids. Rationale 3: A high-protein diet is not appropriate as this would cause a lethal amount of toxic waste to accumulate in a renal failure patient. A low-sodium diet would be appropriate as this would aid in reducing fluid retention. Rationale 4: A high-caloric diet is not appropriate for this would contribute to unnecessary weight gain. Carbohydrates are needed for energy so restriction would be detrimental.

The intensive care nurse explains to a patient with acute kidney injury that the most effective method for reducing hyperkalemia is the use of: 1. Insulin plus glucose 2. Inhaled beta agonists 3. Sodium bicarbonate 4. Hemodialysis

Correct Answer: 4 Rationale 1: Insulin plus glucose lowers the total body concentration of potassium but temporarily shifts the potassium into the cells, allowing time to institute other interventions that will decrease the total body concentration of potassium. Rationale 2: Inhaled beta agonists lower the total body concentration of potassium, but temporarily shift the potassium into the cells, allowing time to institute other interventions that will decrease the total body concentration of potassium. Rationale 3: Sodium bicarbonate lowers the total body concentration of potassium, but temporarily shifts the potassium into the cells, allowing time to institute other interventions that will decrease the total body concentration of potassium. Rationale 4: Hemodialysis is the most effective method of adequately treating severe hyperkalemia. This method lowers the total body concentration of potassium.

Which of the following clients is at greatest risk for developing acute renal failure? A. A dialysis client who gets influenza B. A teenager who has an appendectomy C. A pregnant woman who has a fractured femur D. A client with diabetes who has a heart catheterization

D. A client with diabetes who has a heart catheterization

The most common reasons for initiating dialysis in acute kidney injury include which of the following? (Select all that apply.) a. Acidosis b. Hypokalemia c. Volume overload d. Hyperkalemia e. Uremia

a. Acidosis c. Volume overload d. Hyperkalemia e. Uremia

The nurse is caring for a mechanically ventilated patient. The nurse understands that strategies to prevent ventilator-associated pneumonia include which of the following? (Select all that apply.) a. Drain condensate from the ventilator tubing away from the patient. b. Elevate the head of the bed 30 to 45 degrees. c. Instill normal saline as part of the suctioning procedure. d. Perform regular oral care with chlorhexidine.

a. Drain condensate from the ventilator tubing away from the patient. b. Elevate the head of the bed 30 to 45 degrees. d. Perform regular oral care with chlorhexidine.

Complications common to patients receiving hemodialysis for acute kidney injury include which of the following? (Select all that apply.) a. Hypotension b. Dysrhythmias c. Muscle cramps d. Hemolysis e. Air embolism

a. Hypotension b. Dysrhythmias

Which of the following are components of the Institute for Healthcare Improvement's (IHI's) ventilator bundle? (Select all that apply.) a. Interrupt sedation each day to assess readiness to extubate. b. Maintain head of bed at least 30 degrees elevation. c. Provide deep vein thrombosis prophylaxis. d. Provide prophylaxis for peptic ulcer disease. e. Swab the mouth with foam swabs every 2 hours.

a. Interrupt sedation each day to assess readiness to extubate. b. Maintain head of bed at least 30 degrees elevation. c. Provide deep vein thrombosis prophylaxis. d. Provide prophylaxis for peptic ulcer disease.

The patient's potassium level is 7.0 mEq/L. Besides dialysis, which of the following actually reduces plasma potassium levels and total body potassium content safely in a patient with renal dysfunction? a. Kayexalate b. Kayexalate with sorbitol c. Regular insulin d. Calcium gluconate

a. Kayexalate

Noninvasive diagnostic procedures used to determine kidney function include which of the following? (Select all that apply.) a. Kidney, ureter, bladder (KUB) x-ray b. Renal ultrasound c. Magnetic resonance imaging (MRI) d. Intravenous pyelography (IVP) e. Renal angiography

a. Kidney, ureter, bladder (KUB) x-ray b. Renal ultrasound c. Magnetic resonance imaging (MRI)

The etiology of noncardiogenic pulmonary edema in acute respiratory distress syndrome (ARDS) is related to damage to the: a. alveolar-capillary membrane. b. left ventricle. c. mainstem bronchus. d. trachea.

a. alveolar-capillary membrane.

The critical care nurse is responsible for monitoring the patient receiving continuous renal replacement therapy (CRRT). In doing so, the nurse should: a. assess that the blood tubing is warm to the touch. b. assess the hemofilter every 6 hours for clotting. c. cover the dialysis lines to protect them from light. d. use clean technique during vascular access dressing changes.

a. assess that the blood tubing is warm to the touch.

The patient is admitted with acute kidney injury from a postrenal cause. Acceptable treatments for that diagnosis include: (Select all that apply.) a. bladder catheterization. b. increasing fluid volume intake. c. ureteral stenting. d. placement of nephrostomy tubes. e. increasing cardiac output.

a. bladder catheterization. c. ureteral stenting. d. placement of nephrostomy tubes.

The patient is in the critical care unit and will receive dialysis this morning. The nurse will: (Select all that apply.) a. evaluate morning laboratory results and report abnormal results. b. administer the patient's antihypertensive medications. c. assess the dialysis access site and report abnormalities. d. weigh the patient to monitor fluid status. e. give all medications except for antihypertensive medications.

a. evaluate morning laboratory results and report abnormal results. c. assess the dialysis access site and report abnormalities. d. weigh the patient to monitor fluid status.

Acute kidney injury from post renal etiology is caused by: a. obstruction of the flow of urine. b. conditions that interfere with renal perfusion. c. hypovolemia or decreased cardiac output. d. conditions that act directly on functioning kidney tissue.

a. obstruction of the flow of urine.

The nurse is caring for a mechanically ventilated patient and responds to a high inspiratory pressure alarm. Recognizing possible causes for the alarm, the nurse assesses for which of the following? (Select all that apply.) a.Coughing or attempting to talk b.Disconnection from the ventilator c.Kinks in the ventilator tubing d.Need for suctioning

a.Coughing or attempting to talk c.Kinks in the ventilator tubing d.Need for suctioning

The patient's serum creatinine level is 0.7 mg/dL. The expected BUN level should be: a. 1-2 mg/dL. b. 7-14 mg/dL. c. 10-20 mg/dL. d. 20-30 mg/dL.

b. 7-14 mg/dL

A normal glomerular filtration rate is: a. less than 80 mL/min. b. 80 to 125 mL/min c. 125 to 180 mL/min d. more than 189 mL/min

b. 80 to 125 mL/min

The nurse is caring for a postoperative patient with chronic obstructive pulmonary disease (COPD). Which assessment would be a cue to the patient developing postoperative pneumonia? a. Bradycardia b. Change in sputum characteristics c. Hypoventilation and respiratory acidosis d. Pursed-lip breathing

b. Change in sputum characteristics

The nursing is caring for a patient who has had an arterial line inserted. To reduce the risk of complications, what is the priority nursing intervention? a. Apply a pressure dressing to the insertion site. b. Ensure all tubing connections are tightened. c. Obtain a portable x-ray to confirm placement. d. Restrain the affected extremity for 24 hours.

b. Ensure all tubing connections are tightened.

Which of the following statements is true regarding oral care for the prevention of ventilator-associated pneumonia (VAP)? (Select all that apply.) a. Tooth brushing is performed every 2 hours for the greatest effect. b. Implementing a comprehensive oral care program is an intervention for preventing VAP. c. Oral care protocols should include oral suctioning and brushing teeth. d. Protocols that include chlorhexidine gluconate have been effective in preventing VAP.

b. Implementing a comprehensive oral care program is an intervention for preventing VAP. c. Oral care protocols should include oral suctioning and brushing teeth. d. Protocols that include chlorhexidine gluconate have been effective in preventing VAP.

The term used to describe an increase in blood urea nitrogen (BUN) and serum creatinine is: a. oliguria. b. azotemia. c. acute kidney injury. d. prerenal disease.

b. azotemia.

When fluid is present in the alveoli: a. alveoli collapse and atelectasis occurs. b. diffusion of oxygen and carbon dioxide is impaired. c. hypoventilation occurs. d. the patient is in heart failure.

b. diffusion of oxygen and carbon dioxide is impaired.

Peritoneal dialysis is different from hemodialysis in that peritoneal dialysis: a. is more frequently used for acute kidney injury. b. uses the patient's own semipermeable membrane (peritoneal membrane). c. is not useful in cases of drug overdose or electrolyte imbalance. d. is not indicated in cases of water intoxication.

b. uses the patient's own semipermeable membrane (peritoneal membrane).

The nurse is assisting with endotracheal intubation and understands correct placement of the endotracheal tube in the trachea would be identified by which of the following? (Select all that apply.) a.Auscultation of air over the epigastrium b.Equal bilateral breath sounds upon auscultation c.Position above the carina verified by chest x-ray d.Positive detection of carbon dioxide (CO2) through CO2 detector devices

b.Equal bilateral breath sounds upon auscultation c.Position above the carina verified by chest x-ray d.Positive detection of carbon dioxide (CO2) through CO2 detector devices

Oxygen saturation (SaO2) represents: a.alveolar oxygen tension. b.oxygen that is chemically combined with hemoglobin. c.oxygen that is physically dissolved in plasma. d.total oxygen consumption.

b.oxygen that is chemically combined with hemoglobin.

The patient has just returned from having an arteriovenous fistula placed. The patient asks, "When will they be able to use this and take this other catheter out?" The nurse should reply, a. "It can be used immediately so the catheter can come out anytime." b. "It will take 2 to 4 weeks to heal before it can be used." c. "The fistula will be usable in about 4 to 6 weeks." d. "The fistula was made using graft material so it depends on the manufacturer."

c. "The fistula will be usable in about 4 to 6 weeks."

Conditions that produce acute kidney injury by directly acting on functioning kidney tissue are classified as intrarenal. The most common intrarenal condition is: a. prolonged ischemia. b. exposure to nephrotoxic substances. c. acute tubular necrosis (ATN). d. hypotension for several hours.

c. acute tubular necrosis (ATN).

The basic underlying pathophysiology of acute respiratory distress syndrome results from: a. a decrease in the number of white blood cells available. b. damage to the right mainstem bronchus. c. damage to the type II pneumocytes, which produce surfactant. d. decreased capillary permeability

c. damage to the type II pneumocytes, which produce surfactant.

The patient is getting hemodialysis for the second time when he complains of a headache and nausea and, a little later, of becoming confused. The nurse realizes these are symptoms of: a. dialyzer membrane incompatibility. b. a shift in potassium levels. c. dialysis disequilibrium syndrome. d. hypothermia.

c. dialysis disequilibrium syndrome.

A patient's status worsens and needs mechanical ventilation. The pulmonologist wants the patient to receive 10 breaths/min from the ventilator but wants to encourage the patient to breathe spontaneously in between the mechanical breaths at his own tidal volume. This mode of ventilation is called: a.assist/control ventilation b.controlled ventilation c.intermittent mandatory ventilation d.positive end-expiratory pressure

c.intermittent mandatory ventilation The intermittent mandatory ventilation mode allows the patient to breathe spontaneously between breaths. The patient will receive a preset tidal volume at a preset rate. Any additional breaths that he initiates will be at his spontaneous tidal volume, which will likely be lower than the ventilator breaths. In assist/control ventilation, spontaneous effort results in a preset tidal volume delivered by the ventilator. Spontaneous effort during controlled ventilation results in patient/ventilator dyssynchrony. Positive end-expiratory pressure (PEEP) is application of positive pressure to breaths delivered by the ventilator. PEEP is an adjunct to both intermittent mandatory and assist/control ventilation.

The nurse is caring for a patient with acute kidney injury who is being treated with hemodialysis. The patient asks if he will need dialysis for the rest of his life. Which of the following would be the best response? a. "Unfortunately, kidney injury is not reversible; it is permanent." b. "Kidney function usually returns within 2 weeks." c. "You will know for sure if you start urinating a lot all at once." d. "recovery is possible, but it may take several months."

d. "recovery is possible, but it may take several months."

A normal urine output is considered to be: a. 80 to 125 mL/min. b. 180 L/day. c. 80 mL/min. d. 1 to 2 L/day.

d. 1 to 2 L/day.

Which of the following treatments may be used to dissolve a thrombus that is lodged in the pulmonary artery? a. Aspirin b. Embolectomy c. Heparin d. Thrombolytics

d. Thrombolytics

In assessing a patient, the nurse understands that an early sign of hypoxemia is: a. clubbing of nail beds b. cyanosis c. hypotension d. restlessness

d. restlessness

The nurse is assessing a patient. Which assessment would cue the nurse to the potential of acute respiratory distress syndrome (ARDS)? a. Increased oxygen saturation via pulse oximetry b. Increased peak inspiratory pressure on the ventilator c. Normal chest radiograph with enlarged cardiac structures d. PaO2/FiO2 ratio > 300

b. Increased peak inspiratory pressure on the ventilator

An acute exacerbation of asthma is treated with which of the following? a. Corticosteroids and theophylline by mouth b. Inhaled bronchodilators and intravenous corticosteroids c. Prone positioning or continuous lateral rotation d. Sedation and inhaled bronchodilators

b. Inhaled bronchodilators and intravenous corticosteroids

The patient with acute respiratory distress syndrome (ARDS) would exhibit which of the following symptoms? a. Decreasing PaO2 levels despite increased FiO2 administration b. Elevated alveolar surfactant levels c. Increased lung compliance with increased FiO2 administration d. Respiratory acidosis associated with hyperventilation

a. Decreasing PaO2 levels despite increased FiO2 administration

The nurse is caring for a patient with cystic fibrosis (CF) and understands that treatment consists of which of the following? (Select all that apply.) a. Airway clearance therapies b. Antibiotic therapy c. Nutritional support d. Tracheostomy

a. Airway clearance therapies b. Antibiotic therapy c. Nutritional support

Continuous renal replacement therapy (CRRT) differs from conventional intermittent hemodialysis in that: a. a hemofilter is used to facilitate ultrafiltration. b. it provides faster removal of solute and water. c. it does not allow diffusion to occur. d. the process removes solutes and water slowly.

d. the process removes solutes and water slowly.

Positive end-expiratory pressure (PEEP) is a mode of ventilatory assistance that produces the following condition: a.Each time the patient initiates a breath, the ventilator delivers a full preset tidal volume. b.For each spontaneous breath taken by the patient, the tidal volume is determined by the patient's ability to generate negative pressure. c.The patient must have a respiratory drive, or no breaths will be delivered. d.There is pressure remaining in the lungs at the end of expiration that is measured in cm H2O.

d.There is pressure remaining in the lungs at the end of expiration that is measured in cm H2O.