critical care questions

experiencing ventricular fibrillation (Vfib)

decrease in cardiac output pulseless, unconscious, and unresponsive.

A patient is being intubated in the trauma bay after falling from a 20-ft deer stand. The doctor instructs the nurse to prepare intubation drugs. Which drug should the nurse administer first?

Propofol is a sedative agent, which needs to be administered first before a paralytic agent.

The nurse in the ICU is taking a client's CVP. All of the following are appropriate actions of the nurse when taking a CVP reading,

.Placing the client supine with the head of the bed elevated to no more than 45° Placing the transducer at the fourth intercostal space, mid-axillary line. Instruct the client to relax, not strain or cough during the reading

Normal cardiac output in a healthy adult is between

4 liters/minute (L/min) and 8 L/min.

A 70-year old man in the ICU experiences sudden cardiac arrest. The code team arrives and performs CPR. After about five minutes, the patient obtains a return of spontaneous circulation (ROSC). A carotid pulse is found, but femoral and radial pulses are not. What is this patient's approximate minimum systolic blood pressure

60 mmHg

The nurse is caring for a patient who has developed Malignant Hyperthermia. Which of the following actions should the nurse take?

Apply a cooling blanket Insert indwelling urinary catheter Administer prescribed Dantrolene

The nurse working at an emergency department in a children's hospital receives a 10-year-old school going client with nuchal rigidity, fever, and a positive Kernig's sign. What should be the nurse's next action?

Arrange for the child to be in droplet isolation.

The nurse is caring for a client with tracing on the electrocardiogram shown in the exhibit provided. The nurse should perform which priority action?

Assess the client's airway, breathing, and circulation ventricular fibrillation

In the ICU, the low-pressure ventilator alarm goes off. The nurse attends to the patient, checks the ventilator, and attempts to determine the cause of the signal. She is unable to identify the cause. Which action would the nurse initiate next?

Assess the client's vital signs

.Analyze the following ABG: pH 7.44, CO2 52, HCO3 42

Compensated metabolic alkalosis

While working in the cardiac intensive care unit, you are assessing a patient with left-sided heart failure. A sign off report from the prior shift indicates that the client's cardiac output has dropped to 2 L/min. Which of the following assessment findings do you expect in the patient?

Crackles Decreased urine output

A 78-year old man is admitted with sepsis. Which of the following should the nurse suspect the health care provider to order?

Crystalloids Blood cultures Abdominal x-ray Antibiotics Two large-bore IVs Vasopressors if shock persists

The ICU nurse is caring for a patient who is recovering from surgery. Which assessment data would suggest the patient's pain is poorly controlled?

Decreased cough Oliguria Hypoventilation Increased myocardial oxygen demand

While precepting a new nurse in the emergency department, you know she understands the steps for adult CPR when she places the following actions in which order?

Determine that the patient is unconscious. Check for a pulse for no longer than 10 seconds at the carotid artery. Initiate chest compressions. After 30 compressions, open the airway with the head tilt-chin lift maneuver. Deliver 2 rescue breaths.

A man is found lying on the ground, confused, covered with snow, and is brought to the emergency department to be treated. The nurse checks the client's temperature and notes that it is 88° F. The nurse also notes respirations of 10, the pulse of 50, and blood pressure of 79/52 mm Hg. The nurse understands that the client is suffering from

Moderate hypothermia

The nurse is caring for a client who has septic shock and has failed to respond to initial treatment. Which of the following infusions would the nurse anticipate if the client has a mean arterial pressure (MAP) of 54 mmHg?

Norepinephrine

The client in the ICU is experiencing an increased difficulty of breathing. ABGs for the client return showing PaO2 49 mmHg and oxygen saturation is 68%. The patient is on oxygen via facemask at 10 liters per minute. What should be the next action by the nurse?

Prepare to intubate the client.

The nurse is caring for a COPD patient in the Intensive Care Unit, who is having ABGs drawn every shift. The nurse knows that the sequence for interpreting this test includes the following steps

Examine the pH Examine the PaCO2 Examine the HCO3 Examine the PaO2

The nurse is giving a lecture on the complications of positive pressure ventilation. Which should be included as a potential cause of alveolar hypoventilation?

Excessive lung secretions

The nurse is teaching a group of students the causes of metabolic alkalosis. It would indicate a correct understanding of the student to state which condition causes this acid-base imbalance?

Excessive vomiting

The ICU nurse is taking care of a client who sustained a head injury due to a motorcycle accident. In the morning, the client is responsive to pain and assumes a decorticate position. After 4 hours, which assessment would indicate to the nurse that the client needs immediate intervention?

Extension of the arms and legs indicates decerebrate posturing, an indication of increased intracranial pressure.

The nurse in the ICU is using the Critical-Care Pain Observation Tool (CPOT) to evaluate the patient's pain. The patient was in a motor vehicle accident two days ago; he sustained a flail chest and fractured femur. He is intubated and on a mechanical ventilator. When using the CPOT, the nurse understands that the best indicator of the patient's pain is:

Facial expression

After discovering an unconscious 7-year-old, the LPN discovers that the child is not breathing and does not have a pulse. There is no immediate access to a call button. What should the nurse do first?

Give 2 minutes of CPR at a compression-ventilation ratio of 30:2.

The nurse is working in the emergency department when an elderly man is rushed in with complaints of dizziness, weakness, headache, and nausea. The patient's shirt is drenched in sweat. His son who accompanied him to the hospital tells the nurse that they were watching his 10-year-old grandson's baseball game when suddenly his dad complained of a severe headache and weakness. The nurse understands that based on the client's presentation and history, he is most likely suffering from:

Heat exhaustion

A patient that has suffered a third-degree burn injury a few hours ago involving 27% of total body surface area (TBSA) a few hours ago has been rushed to the emergency room. Which of the following should the nurse expect to find in this patient?

Hyponatremia Hyperkalemia Hypotension Edema in burned areas

The emergency department is packed with victims from a capsized ship. Almost all of the victims are suffering from hypothermia. The staff is busy treating their hypothermia with active warming methods. All of the following are active external rewarming methods,

Immersing the client in a 40°C bath. Placing the client on a warming blanket. Placing radiant lamps over the client.

You are the nurse in the emergency department who is caring for a patient who was just admitted with nausea, vomiting, and epigastric pain. You note a blood pressure of 98/60 mmHg and a heart rate of 108 beats per minute during your assessment. You note a pulsating mass in his abdomen. You know that which of the following interventions are indicated?

Insert an intravenous solution of Lactated Ringers Prepare for an abdominal ultrasound Closely monitor the patient's vital signs

You are caring for a client with chronic lung disease who is being maintained with mechanical ventilation. You just received this client's laboratory results, and the client's pH is 7.24. Which is the most appropriate nursing diagnosis for this client?

Respiratory acidosis related to chronic lung disease

The nurse is caring for a client who has septic shock. Which of the following findings would indicate that the client is meeting the treatment goals?

Septic shock is a life-threatening illness that may cause a client to have decreased perfusion. A client having a MAP of 65 mmHg or greater is one of the desired goals of septic shock. Thus, a MAP of 67 mmHg would be a favorable finding.

A 32-year-old man is admitted to the neurology floor after being admitted for sepsis. He has paraplegia and is bound to a wheelchair. What is the most probable cause of sepsis?

Since this patient uses a wheelchair, a pressure ulcer is the most likely cause of sepsis. If it is uncared for, it can develop into an infection and spread into the bloodstream.

The nurse is caring for a patient with septic shock presenting with a temperature of 102 degrees F, heart rate 98 beats/minute, and blood pressure of 126/84 mmHg. Which phase of septic shock is this patient experiencing?

The hyperdynamic phase is the first phase, occurring in the early or compensated stage of septic shock. In this phase, the blood pressure may still be within normal limits, but the heart rate and temperature increase due to increased cardiac output and systemic vasodilation. During this phase, nursing interventions include intravenous fluids to increase the peripheral vascular resistance and administration of prescribed antibiotics as soon as possible. Addressing septic shock appropriately at this stage significantly improves the outcomes.

The patient with septic shock presents with anasarca, weak pulses, decreased urine output, decreased responsiveness, and BP 88/52 mmHg, HR 160. The nurse would recognize these symptoms as indicators of which stage of shock?

The progressive stage occurs when compensatory mechanisms begin to fail. Signs/symptoms of the progressive stage include anasarca (generalized edema), decreased responsiveness, decreased urine output, weak pulses, hypotension, and tachycardia.

Which psychosocial interventions would be appropriate for a patient in the intensive care unit?

The use of clocks and calendars in the ICU helps with orientation and reduces the patient's risk of developing delirium.

Vecuronium Succinylcholine Rocuronium

These are all paralytic agents. Whatever paralytic agent the doctor orders will need to be given after the sedative

Malignant hyperthermia is a severe adverse medication reaction. The nurse should know to monitor for this adverse reaction when administering induction agents such as halothane and succinylcholine.

These medications can cause excess calcium to build up in the cells, resulting in the patient experiencing sustained skeletal muscle contractions. These contractions cause a hypermetabolic state, fever, and can lead to death.

Your client is a 50-year-old man who sustained an air embolism after the placement of a central venous catheter. You realize the patient was not properly positioned during the procedure. Which of the following could have prevented this incident from happening?

Trendelenburg position. In this position, the body is supine, or flat on the back, on a 15-30 degree incline with the feet elevated above the head

Analyze the following ABG: pH 7.19, CO2 36, HCO3 12

Uncompensated metabolic acidosis

Analyze the following ABG: pH 7.62, CO2 19, HCO3 24

Uncompensated respiratory alkalosis

Which of the following are potential causes of metabolic alkalosis?

Vomiting is a cause of metabolic alkalosis. There are a lot of acids in stomach contents, so losing those acids through vomiting leads to alkalosis. Antacids used in excess are a cause of metabolic alkalosis. Antacids have a lot of base in them, so taking too much leads to alkalosis

ROSC is detected by arterial pulse palpation and end-tidal CO2 monitoring.

When pulses are palpable, it can be clinically inferred that a patient with a carotid pulse has a systolic blood pressure (SBP) of at least 60 mmHg, the one with a femoral pulse has an SBP of at least 70 mmHg, and the one with a radial pulse has an SBP of at least 80 mmHg.

Infusing warmed IV fluids is an example of

active core warming, not an external rewarming

Lower cardiac output leads to

hypotension, pulmonary congestion, and fluid overload Crackles, rales, and rhonchi

moderate hyperthermia ( Stage II).

include decreased level of consciousness (LOC), hypoventilation, bradycardia, atrial fibrillation, hypovolemia, cessation of shivering, and possible hyperglycemia.

In critically ill clients on enteral nutrition, the safe range for gastric residual volume (GRV) is

less than or equal to 500mL

Suspected cases of bacterial meningitis

must be placed on drop let isolation

The nurse is caring for a patient with acute pulmonary edema. The nurse should do which of the following?

Acute pulmonary edema is a medical emergency and requires the nurse to act immediately. The nurse should administer the prescribed treatments of morphine and furosemide. Morphine will curb the patient's anxiety as well as decrease the amount of fluid returning to the heart (preload). Further, the nurse will need to stay with the patient, call for help, and notify the rapid response team.

The ICU nurse is caring for a patient who is receiving intermittent bolus feeds via a PEG tube. The nurse checks gastric residual volume (GRV) and finds that it is 220 mL. Which nursing action is appropriate?

Administer bolus as ordered

You are caring for a newly admitted obese patient in the ICU. The patient has a history of smoking. She states that her symptoms started early in life and are worse at night. She denies any history of recent fever or chills. You notice wheezing and stridor upon assessment. You expect the diagnosis for this patient will be:

Asthma

A nurse in the surgical ICU is taking care of a young man that was involved in a four-wheeling accident 4 hours ago. He was diagnosed with a grade two renal laceration, multiple rib fractures, and a concussion upon arrival. While performing the last head-to-toe assessment before the transfer, the nurse notices a small amount of bruising around the patient's umbilicus. What should the nurse do?

Bruising around the umbilicus is called Cullen's sign. This is important to identify after trauma because it indicates bleeding into the abdomen. The nurse needs to notify the surgeon immediately so the patient can be further assessed. The surgeon may monitor the patient medically or take him back into surgery.

The nurse is providing care to a client with an endotracheal tube that requires suctioning. While suctioning, the client's heart rate and respiratory rate increase. Which priority actions are appropriate for the nurse to take.

Check oxygen saturation Stop suctioning

You are the nurse working in the coronary care unit of the hospital. You are assessing the patient who is alert and oriented, respirations 12 and non-labored, and pulse rate 84 and regular. You look up at the monitor and see the rhythm. _________________________________________

Check to ensure the monitor leads are connected to the patient.

The ICU nurse is caring for a sedated patient on a pressure-cycled ventilator. The ventilator alarm is beeping persistently despite the patient's civil status and stable vitals. What is the most appropriate action for the RN to take first?

Check tubing for holes or kinks

The nurse is reviewing the laboratory results of assigned patients. Which of the following results would require immediate follow-up?

Creatinine 2.7 mg/dl for a patient receiving vancomycin Potassium 3.1 mEq/dl for a patient receiving bumetanide Calcium 10.8 mg/dl for a patient receiving hydrochlorothiazide

Irregular respiration, bradycardia, and widened pulse pressure are the three symptoms that make up Cushing's triad

Cushing's triad occurs when the intracranial pressure in the skull has increased, thus causing these symptoms to happen.

While taking care of a client with heart failure in the telemetry unit, the nurse notices the transition of his heart rhythm to the one shown in the exhibit. The client is on digoxin and furosemide. He is asymptomatic, his heart rate is 40 beats per minute, and his blood pressure is 110/60 mmHg. Which of the following interventions are appropriate?

Obtain digoxin level Check potassium level Notify the physician

The nurse is caring for a patient who experienced a myocardial infarction (MI) 24 hours ago. It would be necessary for the nurse to immediately notify the primary health care provider (PHCP) if the patient has which of the following?

Following a myocardial infarction (MI), the patient is at risk for developing pulmonary edema. This is caused by the heart's inability to eject blood, consequently caused by an insult to the myocardium. When caring for a patient with an MI, the nurse should monitor the patient for life-threatening ventricular arrhythmias as well as pulmonary edema. If a patient is experiencing this complication, they will develop crackles in the lung fields, tachypnea, and hypoxia.

A patient is rushed to the emergency department following a near-drowning episode at a local beach. Which conditions would the nurse anticipate to be present in the patient?

Following a near-drowning incident, the patient will most likely exhibit symptoms of hypoxia (decreased oxygen levels in the blood), hypercarbia (increased carbon dioxide levels in the blood), and acidosis (respiratory type) due to a prolonged period of having a lack of oxygen.

Malignant hyperthermia is a serious adverse reaction that can occur after the administration of which of the following medications? Select all that apply.

Halothane Succinylcholine

A nurse is concerned that one of her patients in the ICU unit has Cushing's triad related to increased ICP. What signs indicate Cushing's triad and what treatment should be considered?

Irregular respirations. bradycardia, and widening pulse pressure

Norepinephrine is a common prescription in treating septic shock

It increases vascular tone and the mean arterial pressure (MAP). One of the critical guidelines in treating sepsis is to maintain a mean arterial pressure ( MAP) of 65 mm Hg or more

The nurse cares for a newly admitted patient with a full-thickness burn over 25% of the total body surface area. The nurse should take which of the following actions?

Keep the patient on NPO status Obtain a 12-lead electrocardiogram Obtain an arterial blood glass (ABG)

The nurse is teaching a group of students the causes of hypokalemia. It would indicate a correct understanding of the student if they stated which condition causes this electrolyte imbalance

Metabolic alkalosis Cushing's syndrome

Which of the following are potential causes of respiratory acidosis

Pneumothorax Narcotic overdose