Critical Care Quiz 2
During report, the off going nurse reports that the patient is showing signs of cardiogenic shock. The nurse expects to find: Select All that apply A. Jugular Vein Distension (JVD) B.Bounding pulses C. Increased Systemic Vascular Resistance (SVR) D. Wheezing
A. Jugular Vein Distension (JVD) C. Increased Systemic Vascular Resistance (SVR)
A patient in the critical care unit has developed shock. What symptom or group of symptoms does the nurse expect to find in any type of shock? A. Tissue hypoxia B. Massive vasodilation C. Extreme blood loss D. Presence of enterotoxins
A. Tissue hypoxia
Education for a patient with chronic heart failure would include which information? The need for accurate daily weights Appropriate diet choices Signs of negative changes in cardiac symptoms and when to notify the physician All of the above
All of the above Education for a patient with acute or chronic heart failure caused by valvular dysfunction includes (1) information related to diet, (2) fluid restrictions, (3) the actions and side effects of heart failure medications, (4) the need for prophylactic antibiotics before undergoing any invasive procedures, and (5) when to call a health care provider to report a negative change in cardiac symptoms.
Which actions of ACE Inhibitors make them an ideal drug class in the treatment of HF? (Select all that apply) A.Decreases Contractility B. Increases Preload C. Decreases Afterload D. Prevents ventricular remodeling
C,D
A patient arrives on the unit in a shock state. The nurse understands that the lack of sufficient oxygen causes which of the following? A. Increased ATP production B. Insufficient production of lactic acid C. Cells revert to anaerobic metabolism D. Hyperperfusion
C. Cells revert to anaerobic metabolism
A patient has received 1L of NS over 15 minutes. A second L of NS is ordered as well as 2 units of PRBC. What should the nurse do first? A. Check the patient's core temperature B. Check the patient's B/P C. Check the patient's breath sounds D. Check the patient's foley for out put
C. Check the patient's breath sounds
A client has had a pulmonary artery catheter inserted. In performing hemodynamic monitoring with the catheter, the nurse will wedge the catheter to gain information about which of the following? A. Cardiac output B. Right atrial blood flow C. Left end-diastolic pressure D. Coronary artery blood flow
C. Left end-diastolic pressure
The patient has lost 2L of blood in the field after being stabbed in the chest. The nurse expects to find the following during the assessment A. B/P 112/78 B. Awake and Alert C. Pulse 158 D. Respirations 16
C. Pulse 158
Which parameters are clinical manifestations of cardiogenic shock? Decreased pulmonary artery occlusion pressure Decreased right atrial pressure Decreased systemic vascular resistance Decreased cardiac index to less than 2.2 L/min/m2
Decreased cardiac index to less than 2.2 L/min/m2 Initially, clinical manifestations reflect the decline in cardiac output. Clinical manifestations include cardiac index less than 2.2 L/min/m
The nurse is admitting a patient with severe community-acquired pneumonia. Select all interventions that are appropriate for this patient. Select all that apply. Start intravenous (IV) antibiotics. Place the patient on the monitor and obtain vital signs. Obtain sputum cultures and laboratory work. Inquire about allergies and current medications. Start a peripheral IV.
All
A mechanically ventilated patient has a fever, P/F ratio of 230, and a pulmonary artery occlusive pressure of 15 mm Hg. The patient is coughing and triggering the high-pressure alarm on the ventilator. The radiologist has notified the nurse that the patient's feeding tube is in the right lung, and the patient has developed bilateral infiltrates on the radiograph. The nurse is concerned that the patient is developing what problem? Acute pulmonary embolism Adult respiratory distress syndrome Pneumothorax Inadequate nutrition
Adult respiratory distress syndrome The patient is showing signs of acute respiratory distress syndrome brought on by the direct lung injury from the misplaced feeding tube. There is no evidence of a pulmonary embolism. A pneumothorax would have shown up on the radiograph as a unilateral problem, not a diffuse infiltrate. Nutrition is not the immediate concern at this moment.
Shock states affect which of the following. Select all that apply. A. Elimination B. Respiration C. Circulation D. Mentation
All are correct, shock effects every system of the body
Mr. Z is admitted with acute lung failure. Which statement describes appropriate action for optimizing his oxygenation and ventilation? Place Mr. Z in a supine position. Allow Mr. Z to rest in between nursing interventions. Perform vigorous postural drainage and chest percussion to facilitate secretion clearance. Make sure Mr. Z coughs every 2 hours even if he has no secretions.
Allow Mr. Z to rest in between nursing interventions. Allowing adequate rest between nursing interventions will minimize oxygen consumption. The supine position is not advantageous because of the risk of aspiration. Postural drainage and chest percussion have been found to be of little benefit, and coughing, unless secretions need to be expelled, should be avoided because it causes collapse of the smaller airways.
A patient complains of a sudden onset of itching and hives along with shortness of breath after initiation of an antibiotic infusion. You can hear audible wheezing. Which one of the following is the most likely explanation? Anaphylaxis Infection Multiple-organ dysfunction syndrome Septic shock
Anaphylaxis One of the criteria for anaphylaxis includes an acute onset of an illness (minutes to several hours) with involvement of the skin or mucosal tissue, or both (eg, generalized hives; pruritus or flushing; swollen lips, tongue, and uvula)
What therapies may be administered to decrease oxygen demand in the patient with multiple-organ dysfunction syndrome? Vasoactive and positive inotropic agents Diuretics and antidysrhythmic agents Crystalloids and antibiotics Antipyretics and sedative agents
Antipyretics and sedative agents Oxygen demand can be decreased in any of the following ways: administering sedation or paralytics, administering antipyretics and external cooling measures, and administering pain medications. Vasoactives, positive inotropes, crystalloids, and antidysrhythmics are used to support oxygen transport, not decrease oxygen demand.
A patient has been in the progressive care unit for 3 days with a diagnosis of pneumonia. The patient is being treated with antibiotics, 50% oxygen, and vigorous pulmonary toilet. Which diagnostic testing result would indicate early progression of the patient's condition to acute respiratory distress syndrome? PaO2/FiO2 ratio of 325 Arterial PaO2 of 58 mm Hg Arterial PaCO2 of 58 mm Hg Arterial blood pH of 7.29
Arterial PaO2 of 58 mm Hg Arterial blood gas analysis reveals a low PaO
A patient with pneumonia has been in the unit for 3 days. The medical plan includes antibiotics and oxygen therapy. Which finding would indicate the patient is developing acute respiratory distress syndrome (ARDS)? Sputum cultures are positive for Streptococcus pneumoniae. Arterial blood gas analysis reveals a low PaO2 despite increases in supplemental oxygen. Chest radiography shows evidence of pulmonary hypertension. High probability ventilation-perfusion scan.
Arterial blood gas analysis reveals a low PaO2 despite increases in supplemental oxygen. Arterial blood gas analysis reveals a low PaO
Which would be an expected chest tube assessment finding after thoracic surgery? Drainage of 150 mL/h for the first 4 hours after surgery Increase in air leak size during the first 24 hours after surgery Blood clots that would require careful milking of the chest tubes Serous draining in the immediate postoperative period
Blood clots that would require careful milking of the chest tubes If blood clots are present in the drainage tubing or an obstruction is present, the chest tubes may be carefully milked. Drainage will initially appear bloody, becoming serosanguineous and then serous over the first 2 to 3 days after surgery. Approximately 100 to 300 mL of drainage will occur during the first 2 hours after surgery, which will decrease to less than 50 mL/h over the next several hours. In the early phase, an air leak is commonly heard. As healing occurs, this leak should disappear.
Which therapy is included in the sepsis and septic shock management guidelines? Low-dose dopamine for renal protection Blood glucose maintenance around 150 mg/dL Erythropoietin administration for anemia Antithrombin therapy for deep vein thrombosis protection
Blood glucose maintenance around 150 mg/dL The sepsis guidelines recommend maintaining the patient's blood glucose around 150 mg/dL. Low-dose dopamine, erythropoietin, and antithrombin therapy are not recommended in severe sepsis or septic shock management.
A patient has been admitted following a motor vehicle collision in which the patient sustained multiple abrasions and bruising across the chest. Suddenly, the patient complains of difficulty breathing, the O2 saturation has dropped dramatically, there are decreased breath sounds on the left, and it appears that there is some tracheal deviation. What would be your next logical action? Notify the patient's practitioner and prepare for a stat V/Q scan. Start the patient on O2 at 4 L/min nasal cannula and prepare an aminophylline drip. Call the rapid response team and prepare for emergency insertion of a chest tube. Notify the patient's practitioner of these changes.
Call the rapid response team and prepare for emergency insertion of a chest tube. The signs and symptoms are classic indications of development of a pneumothorax. The characteristics that particularly differentiate this diagnosis are the bruising on the chest after motor vehicle accident (MVA) and the deviated trachea.
What is one strategy to prevent ventilator-associated pneumonia (VAP)? Maintain the head of the bed at 10 degrees. Perform oral care with peroxide daily. Conduct a spontaneous awakening trial daily. Assess readiness to extubate biweekly.
Conduct a spontaneous awakening trial daily. One strategy to prevent ventilator-associated pneumonia (VAP) is to conduct a spontaneous awakening trial daily. The head of the bed should be maintained at 30 to 45 degrees. Oral care should be performed with chlorhexidine. Readiness to extubate should be assessed at least daily.
Which finding is a clinical manifestation of left-sided heart failure? Increased cardiac output Decreased systemic vascular resistance Cool, pale extremities Vasodilatation of the arterial bed
Cool, pale extremities Failure of the left ventricle is defined as a disturbance of the contractile function of the left ventricle, resulting in a low cardiac output state. This leads to vasoconstriction of the arterial bed that raises systemic vascular resistance, a condition also described as "high afterload," and creates congestion and edema in the pulmonary circulation and alveoli. Patients presenting with left ventricular failure have one of the following: (1) decreased exercise tolerance, (2) fluid retention, or (3) discovery during examination of noncardiac problems. Clinical manifestations of left ventricular failure include decreased peripheral perfusion with weak or diminished pulses; cool, pale extremities; and in later stages, peripheral cyanosis.
Which statement is true regarding status asthmaticus? Initial arterial blood gas levels indicate severe hypoxemia and respiratory acidosis. Low-flow oxygen therapy should be used cautiously in patients with asthma. Small, frequent doses of bronchodilators should be started immediately. Corticosteroids, although useful in the treatment of status asthmaticus, usually require 6 to 8 hours to take effect.
Corticosteroids, although useful in the treatment of status asthmaticus, usually require 6 to 8 hours to take effect. The onset of action of corticosteroids is 6 to 8 hours. A patient in status asthmaticus often initially presents with alkalosis caused by tachypnea and hyperventilation, but as fatigue sets in, hypoventilation and hypercapnia result in acidosis. These patients often require high-flow oxygen therapy and high-dose bronchodilators.
In cardiogenic shock, blood volume is A. High B. Low C. Compromised D. Normal
D. Normal
The nurse understands that PAWP indirectly measures A. The diameter of the veins and arteries B. The ability of the heart to pump during systole C. PA systolic pressure D. The volume of blood entering the left ventricle during diastole
D. The volume of blood entering the left ventricle during diastole
The nurse is developing a care plan for the patient in cardiogenic shock. What is the goal for therapy? Increasing preload Decreasing afterload Increasing myocardial workload Increasing systemic vascular resistance (SVR)
Decreasing afterload The goal of therapy is to increase cardiac output by decreasing preload and afterload and increasing contractility. Increasing myocardial workload, preload, and systemic vascular resistance (SVR) would worsen cardiogenic shock.
What is a a major consequence of hematologic dysfunction during shock? Disseminated intravascular coagulation (DIC) Acute respiratory syndrome Microvascular thrombosis Thermoregulatory failure
Disseminated intravascular coagulation (DIC) Hematologic dysfunction occurs as a result of consumption of clotting factors, release of inflammatory cytokines, and dilutional thrombocytopenia. Disseminated intravascular coagulation (DIC) eventually may develop.
A nurse is consulting with a multidisciplinary team regarding renal impairment from sepsis. Which statement regarding kidney dysfunction is true? An increased creatinine level is the earliest sign of kidney impairment. Elevated peak levels of antibiotics can lead to kidney impairment. Hypotensive episodes do not affect kidney function. Increased production of erythropoietin may result in kidney impairment.
Elevated peak levels of antibiotics can lead to kidney impairment. The frequent use of nephrotoxic drugs (eg, antibiotics) during critical illness intensifies the risk of progressive kidney impairment. Elevated serum creatinine level is usually a late sign, but it is typically accepted as the index for kidney dysfunction. Early oliguria is likely caused by decreases in kidney perfusion related to shock-like states (with hypotension). Additional signs of kidney impairment may include decreased erythropoietin-induced anemia, vitamin D malabsorption, and altered fluid and electrolyte balance.
Which statement is TRUE regarding tracheostomy tube management? Cuff pressure should ensure total tracheal occlusion at all times. External humidification should be used to prevent respiratory tract irritation. Single-lumen tubes should be used for patients with secretion problems. Tracheostomy should be performed after 3 days of intubation.
External humidification should be used to prevent respiratory tract irritation. Tracheostomy should be performed if a patient has been intubated or is anticipated to be intubated for longer than 7 to 10 days. Double-lumen tubes have inner cannulas that can quickly be removed if they become obstructed, making the system safer for patients with significant secretion problems. Because the tracheostomy tube bypasses the upper airway system, warming and humidifying of air must be performed by external means. Cuffs can cause damage to the walls of the trachea.
A postoperative patient has a heart rate of 110 beats/min and blood pressure (BP) of 110/80 mm Hg (previously 130/60 mm Hg). Urine output has been 20 mL/h for the past 3 hours, capillary filling time is 5 seconds, the skin is cool, the neck veins are flattened, and the patient is complaining of thirst. The nurse suspects the may be experiencing which disorder? Hypovolemic shock Cardiac tamponade Cardiogenic shock Anaphylaxis
Hypovolemic shock The patient is experiencing hypovolemic shock as evidenced by decreased urine output, tachycardia, and increased capillary filling time. In cardiac tamponade, heart tones would be muffled and neck veins would be distended. In cardiogenic shock, the blood pressure (BP) would be elevated and the neck veins would be distended. With an allergic reaction, there would be signs of allergic response, such as urticaria, anxiety, and respiratory distress.
For the patient who lost 2L of blood, all of the following orders are present. What is the nursing priority? A. Apply oxygen via non-rebreather mask B. Instill 14 gauge IV and infuse 1L NS over 15 min C. Insert foley and monitor urine output D. Reinforce pressure dressing
Instill 14 gauge IV and infuse 1L NS. Although all of these orders would be expected, volume expansion is needed in hypovolemic shock. Review interventions for hypovolemic shock
A patient in the acute phase of systolic heart failure is admitted to the intensive care unit. Which interventions would the nurse anticipate? Select all that apply. Diuretics to lower systemic vascular resistance (SVR) Morphine for peripheral dilation and to decrease anxiety Nitroglycerin to decrease preload and afterload Dopamine to decrease contractility of the heart Nesiritide to decrease pulmonary artery occlusion pressure and dyspnea
Morphine for peripheral dilation and to decrease anxiety Nitroglycerin to decrease preload and afterload Nesiritide to decrease pulmonary artery occlusion pressure and dyspnea Morphine, nitroglycerine, and nesiritide are all used to treat patients in systolic heart failure. Diuretics will decrease preload, not systemic vascular reistance (SVR). Dopamine will increase myocardial contractility.
A patient is admitted with a diagnosis of near-drowning in an ice-covered lake. The nurse knows that a primary risk for this patient includes which complication? Severe sepsis Septic shock Disseminated intravascular coagulation Multiple-organ dysfunction syndrome (MODS)
Multiple-organ dysfunction syndrome (MODS) Examples of primary multiple-organ dysfunction syndrome (MODS) include the immediate consequences of posttraumatic pulmonary failure, thermal injuries, acute tubular necrosis, or invasive infections. These cellular or microcirculatory events may lead to a loss of critical organ function induced by failure of delivery of oxygen and substrates coupled with the inability to remove end products of metabolism.
A patient was admitted with pneumonia. A stat arterial blood gas (ABG) is obtained as the patient appears to be worsening, and the results show a PaO2 of 52 mm Hg. The rapid response team is called, and the patient's oxygen is increased to 100%. Which oxygen delivery system would be most appropriate? Nasal cannula Face mask Nonrebreather circuit Air entrainment mask
Nonrebreather circuit Oxygen delivery through a nasal cannula or simple face mask is variable and can deliver only 25% to 50% oxygen. An air entrainment mask is designed to provide a fixed FiO
A patient is in shock and is hypotensive. A vasoconstrictor is recommended to increase afterload and systemic vascular resistance (SVR). Which of the following medications is most appropriate? Nitroprusside (Nipride) Phenylephrine (Neo-Synephrine) Dobutamine (Dobutrex) Labetalol (Trandate)
Phenylephrine (Neo-Synephrine) Vasoconstrictor agents are used to increase afterload by increasing the systemic vascular resistance (SVR) and improving the patient's blood pressure level. Nitroprusside is a vasodilator, and dobutamine is an inotrope. Labetalol is a vasodilator used for
Which statement is true regarding the use of prone positioning in a patient with acute respiratory distress syndrome (ARDS)? It can be used safely in all patients. A strict schedule of turning every 2 hours must be adhered to for greatest success. Prone positioning improves perfusion to less damaged areas of the lung. It is not useful in mobilizing secretions.
Prone positioning improves perfusion to less damaged areas of the lung. In acute respiratory distress syndrome (ARDS), the dependent areas of lung tissue are most affected. The prone position allows perfusion of the healthier tissue. It is contraindicated in patients with head and spinal trauma and may cause edema. Care must be taken to keep the eyes moist and taped shut while the patient is prone to avoid corneal ulcerations.
A patient is scheduled to begin weaning from mechanical ventilation today. Which assessment would be the best indicator of the patient's readiness to be weaned? Minute ventilation greater than 10 L/min Respiratory rate at least 30/min FiO2 less than 50% Rapid shallow breathing index less than 105 (RSBI)
Rapid shallow breathing index less than 105 (RSBI) The rapid shallow breathing index (RSBI) is calculated using the minute ventilation and respiratory rate. The other parameters alone are not as predictive of weaning success.
Which laboratory value provides information regarding the severity of impaired perfusion and helps determine the adequacy of therapies in the patient with septic shock and multiple-organ dysfunction syndrome (MODS)? A. Serum glucose B. Serum lactate C. Serum albumin D. Serum creatinine
Serum lactate Serum lactate levels provide information regarding the severity of impaired perfusion and the presence of lactic acidosis. The values differ significantly in multiple-organ dysfunction syndrome (MODS) survivors and nonsurvivors.
Mr. G requires neuromuscular blockade to facilitate mechanical ventilation. Which statement is true about providing nursing care to paralyzed patients? Special safety precautions are needed as patients are unable to react to the environment. Pain medication is not required because neuromuscular blocking agents have an analgesic effect. Patients under the influence of neuromuscular blocking agents are not aware of activity around them. There is no mechanism for monitoring the level of blockade.
Special safety precautions are needed as patients are unable to react to the environment. Neuromuscular blocking agents only halt skeletal muscle movement and do not inhibit pain or awareness; they must be administered together with a sedative or anxiolytic agent. Patient safety is another concern because these patients cannot react to the environment. Special precautions are taken to protect patients at all times. The level of neuromuscular blockade can be monitored with a peripheral nerve stimulator.
The nurse is suctioning a patient's endotracheal tube and notices that the heart rate is dropping from 100 to 52 beats/min. What is the priority action? Increase the oxygen on the ventilator. Stop suctioning and give the patient some extra breaths. Administer atropine 0.5 mg intravenously (IV) per protocol. Increase the patient's IV fluids.
Stop suctioning and give the patient some extra breaths. The patient is experiencing a vagal response to suctioning. The procedure should be stopped immediately, and the patient should be provided extra breaths either manually or on the ventilator. Extra breaths will hyperoxygenate the patient and hopefully reverse the vagal response. Atropine is appropriate only if the patient is symptomatic and hyperoxygenation fails to reverse the bradycardia. Increasing IV fluids may or may not have any effect on the situation. Because the ventilator is already on 100% FiO
The nurse is caring for a patient who has experienced a pulmonary embolism (PE). Which statement is an important physiologic concept for the nurse to remember about this condition? The major hemodynamic compromise after PE is pulmonary hypertension. Hypercoagulability is the most significant predisposing factor for PE. Pulmonary system effects include bronchoconstriction and decreased alveolar dead space. Pulmonary vasodilation occurs as a result of mediators released at the injury site.
The major hemodynamic compromise after PE is pulmonary hypertension. Of the three predisposing factors (ie, hypercoagulability, injury to vascular endothelium, and venous stasis), endothelial injury appears to be the most significant. The effects on the pulmonary system are increased alveolar dead space, bronchoconstriction, and compensatory shunting. The major hemodynamic consequence of a pulmonary embolism (PE) is the development of pulmonary hypertension, which is part of the effect of a mechanical obstruction when more than 50% of the vascular bed is occluded. In addition, the mediators released at the injury site and the development of hypoxia cause pulmonary vasoconstriction, which further exacerbates pulmonary hypertension.
Which of the following modes of ventilation would be ideal for a patient with acuted respiratory distress sydrome (ARDS)? SIMV-Synchronized Iintermittent Mandatory Ventilation PCV-Pressure Control Ventilation CPAP plus pressure support An oscillator
Selected Answer: Correct PCV
The nurse is discussing the pharmacologic treatment of a pulmonary embolism (PE) with a nursing student. Which statement made by the nursing student indicates that the education was effective? "Heparin is administered to break down the existing clots." "Heparin is titrated to achieve a prothrombin time of two to three times the control value." "Heparin should be continued until the warfarin is started." "rt-PA can be used to treat patients with massive pulmonary embolism and hemodynamic instability."
"rt-PA can be used to treat patients with massive pulmonary embolism and hemodynamic instability." Recombinant tissue-type plasminogen activator (rt-PA) is a fibrinolytic reserved for severe pulmonary embolism (PE). Heparin is administered to prevent further clots from forming and has no effect on the existing clot. The heparin should be adjusted to maintain the activated partial thromboplastin time (aPTT) in the range of two to three times of upper normal. Warfarin should be started at the same time, and when the international normalized ratio (INR) reaches 3.0, the heparin should be discontinued. The INR should be maintained between 2.0 and 3.0.
Which of the following actions is an important part of oral care for an intubated patient? Select all that apply. Brushing the teeth and tongue with a soft-bristled toothbrush Using lemon glycerin swabs on the patient's lips and gums Using alcohol-based mouthwash every 2 hours Using a tonsil suction to keep secretions cleared out of the mouth Providing lip moisturizer as needed
-Brushing the teeth and tongue with a soft-bristled toothbrush -Using a tonsil suction to keep secretions cleared out of the mouth -Providing lip moisturizer as needed Oral care consists of brushing the patient's teeth with a soft toothbrush to reduce plaque, brushing the patient's tongue and gums with a foam swab to stimulate the tissue, and performing deep oropharyngeal suction to remove any secretions that have pooled above the patient's cuff. Lemon glycerin swabs and alcohol-based mouthwashes dry out the mouth and lips and are not recommended.
A patient is placed on a ventilator after cardiac arrest. What pressure should be maintained in the patient's cuff to prevent complications? 10 to 20 mm Hg 20 to 30 mm Hg 30 to 40 mm Hg 40 and 50 mm Hg
20 to 30 mm Hg Cuff pressures are maintained within 20 to 30 mm Hg (27 to 41 cm H
A nurse is working on a spinal cord injury unit and has just finished shift report. Which patient should be seen first? 24-year-old man who has not had a bowel movement since yesterday 28-year-old woman who is complaining of being cold 32-year-old man whose blood pressure is 84/40 mm Hg and heart rate is 60 beats/min 18-year-old woman whose dose of low-molecular-weight heparin is due
32-year-old man whose blood pressure is 84/40 mm Hg and heart rate is 60 beats/min The 32-year-old man is in danger of neurogenic shock and needs to be evaluated. Constipation is an issue, but a patient who has had it for 1 day is not the priority patient. The patient complaining of cold and the patient who needs low-molecular-weight heparin are important, but the hypotension coupled with the bradycardia signifies a problem with sympathetic nervous system integrity.
Decreased preload is associated with which of the following shock states? (Select all that apply) A.Hypovolemic B. Septic C. Cardiogenic D. Neurogenic
A,B,D
A patient is admitted with shortness of breath. Temperature is 39.5° C, blood pressure is 160/82 mm Hg, heart rate is 115 beats/min, and respiratory rate is 26 breaths/min. Chest radiography confirms the presence of right upper lobe pneumonia. Arterial blood gases reveal the following: (pH 7.27) (PaCO2 64 mm Hg) (HCO3 33 mEq/L) (PaO2 50 mm Hg) These findings are indicative of which disorder? Obstructive lung disease Acute lung failure Restrictive lung disease Acute respiratory distress syndrome
Acute lung failure Diagnosing and following the course of respiratory failure is best accomplished by arterial blood gas (ABG) analysis. ABG analysis confirms the level of PaCO
What is the most common cause of cardiogenic shock? Cardiopulmonary arrest Acute myocardial infarction Acute myocarditis Prolonged septic shock
Acute myocardial infarction The most common cause of cardiogenic shock is acute myocardial infarction (MI) resulting in the loss of 40% or more of the functional myocardium. It can occur with ST-elevation or non-ST-elevation MI.
Which location of a myocardial infarction (MI) poses the greatest risk of heart failure and cardiogenic shock? Inferior Anterior Lateral Right ventricular
Anterior Although all myocardial infarctions (MIs), including those located in the inferior wall, lateral wall, and right ventricular wall, can cause heart failure and cardiogenic shock, an anterior wall MI is of most concern. In an anterior wall MI, the occlusion is located in the left descending coronary artery, which supplies blood to the left ventricle. When large areas of myocardium are destroyed, left ventricular pump failure and cardiogenic shock frequently are the consequences.
Collaborative management for the patient with multiple-organ dysfunction syndrome includes decreasing oxygen demand with administration of which therapy? Vasoactive and positive inotropic medications Diuretics and antidysrhythmic medications Crystalloids and antibiotics Antipyretics and sedation
Antipyretics and sedation Oxygen demand can be decreased in any of the following ways: administering sedation or paralytics, administering antipyretics and external cooling measures, and administering pain medications. Vasoactives, positive inotropes, crystalloids, and antidysrhythmics are used to support oxygen transport, not decrease oxygen demand.
The sputum culture obtained on admission shows Streptococcus pneumoniae in a patient with a history of coronary artery disease and alcoholism. The nurse suspects the patient has developed which problem? Hospital-acquired pneumonia (HAP) Community-acquired pneumonia (CAP) Health care associated pneumonia Ventilator-associated pneumonia (VAP)
Community-acquired pneumonia (CAP) The patient has community-acquired pneumonia (CAP). The culture was obtained on admission,
The nurse is caring for a patient who was just placed on mechanical ventilation and is observing the patient's vital signs. The nurse knows that positive-pressure ventilation can lead to which problems? Select all that apply. Decreased cardiac output Decreased venous return Increased renal function Decreased intracranial pressure Increased hepatic function
Decreased cardiac output Decreased venous return Decreased intracranial pressure Positive-pressure ventilation increases intrathoracic pressure, which decreases venous return to the right side of the heart. Impaired venous return decreases preload, which results in a decrease in cardiac output (CO). As a secondary consequence, hepatic and renal dysfunction may occur. In addition, positive-pressure ventilation impairs cerebral venous return. In patients with impaired autoregulation, positive-pressure ventilation can result in increased intracranial pressure.
A patient is admitted with fever, hematuria, and new onset of a cardiac murmur. The patient has a history of intravenous drug abuse and complains of tender spots on the pads of her fingers. She has a low-grade fever, and the nurse notes an enlarged spleen on physical examination. What is the priority nursing diagnosis? Risk for infection related to invasive procedures Risk for anxiety related to lack of availability of narcotics Decreased cardiac output related to alteration in contractility Knowledge deficit related to discharge plans
Decreased cardiac output related to alteration in contractility Because the patient is experiencing endocarditis, the most important nursing diagnosis is decreased cardiac output related to alteration in contractility. Infection and anxiety are only potential problems, and although knowledge deficit is important, it is not the priority on admission.
The nurse notes that the patient's arterial blood gases reflect hypoxia, respiratory alkalosis, scattered crackles, and distended jugular veins. Heart tones are distant, but an S3 and S4 are noted despite scant amounts of concentrated urine output. The nurse anticipates the administration of which therapy? Isotonic saline Amiodarone Furosemide Sodium bicarbonate
Furosemide The patient is experiencing cardiogenic shock and would require furosemide. Administration of fluids (isotonic saline) and sodium bicarbonate would be contraindicated at this time. Amiodarone would only be indicated if the patient were having dysrhythmias.
What is a priority nursing diagnosis for the patient in shock regardless of the phase or type? Deficient fluid volume Ineffective breathing pattern Ineffective tissue perfusion Imbalanced nutrition: less than body requirements
Ineffective tissue perfusion Ineffective tissue perfusion is the priority nursing diagnosis for a patient in shock. Deficient fluid volume is important in hypovolemic shock. Ineffective breathing pattern and imbalanced nutrition are also important but are not the priority diagnosis.
Which statement is true regarding oxygen toxicity? It can occur in patients who inhale greater than 50% oxygen for more than 24 hours. It causes destruction of oxygen-free radicals. The most common presenting symptom is respiratory depression. Chest radiography is a useful tool for early diagnosis.
It can occur in patients who inhale greater than 50% oxygen for more than 24 hours. Oxygen toxicity can occur in any patient who breathes oxygen concentrations of greater than 50% for longer than 24 hours. The administration of higher-than-normal oxygen concentrations produces an overabundance of oxygen-free radicals. The first symptom is substernal chest pain that is exacerbated by deep breathing. Chest radiographs and pulmonary function tests show no abnormalities until symptoms are severe.
A patient is admitted for worsening heart failure (HF). While administering medications per practitioner order, the nurse assesses the patient's response. What is the goal of therapy for this patient? Managing fluid overload and improving cardiac output Increasing preload while decreasing afterload Enhancing the renin-angiotensin-aldosterone system (RAAS) Maximizing systemic vascular resistance
Managing fluid overload and improving cardiac output The goal of therapy is management of the fluid overload and improvement of cardiac output to promote adequate tissue perfusion. Although decreasing afterload is desired, increasing preload would worsen the heart failure (HF). Inhibiting, rather than enhancing, the renin-angiotensin-aldosterone system (RAAS) using medications such as angiotensin-converting-enzyme inhibitors will improve HF. In the same manner, decreasing, not maximizing, systemic vascular resistance (SVR) improves HF. SVR, which measures afterload, should be decreased in HF to lessen myocardial workload and improve cardiac output.
Translocation of bacteria from a "leaky gut" perpetuates an inflammatory focus in critically ill patients with systemic inflammatory response syndrome (SIRS)/multiple-organ dysfunction syndrome (MODS). What is the primary mechanism of bacterial translocation? Colonization of the oropharynx Mesenteric lymphatic transfer Proliferation of Bifidobacterium and Lactobacillus Gastrointestinal lesions
Mesenteric lymphatic transfer Translocation of normal gastrointestinal bacteria through a "leaky gut" into the systemic circulation initiates and perpetuates an inflammatory focus in critically ill patients. The gastrointestinal tract harbors organisms that present an inflammatory focus when carried from the gut via the intestinal lymphatics.
A patient has been on a non-rebreathing mask at 10 L/min for 4 days and is complaining of a dry cough, a stuffy nose, and substernal chest pain (pain score 6 of 10) that increases with deep breathing. The chest radiograph shows no changes, and the 12-lead electrocardiography (ECG) findings are normal. The nurse suspects the patient is experiencing which disorder? Hypercapnia Oxygen toxicity Unstable angina Absorption atelectasis
Oxygen toxicity The patient is experiencing oxygen toxicity from breathing high concentrations of oxygen for several days. Symptoms include substernal chest pain that is exacerbated by deep breathing, dry cough, nasal stuffiness, sore throat, and eye and ear discomforts. Symptoms of hypercapnia include headache and drowsiness. Although the patient has substernal chest pain that increases with deep breathing, this is not a sign of angina because the electrocardiography (ECG) findings are normal. Absorption atelectasis is manifested by decreased breath sounds and increased respiratory rate.
Which mode of ventilation uses low tidal volume in conjunction with normal respiratory rates to limit the effects of barotrauma in patients with adult respiratory distress syndrome (ARDS)? Assist control (A/C) ventilation Permissive hypercapnia Pressure control ventilation (PCV) Continuous positive airway pressure (CPAP)
Permissive hypercapnia Permissive hypercapnia is the mode with normal rates (not increased) and small tidal volumes to allow the CO
Class II hypovolemia is considered a 15% to 30% fluid volume loss. Falling cardiac output activates what compensatory response? Widened pulse pressure Increase urine sodium level Decreased urine osmolality and specific gravity Respiratory alkalosis
Respiratory alkalosis Class II hypovolemia occurs with a fluid volume loss of 15% to 30% or an actual volume loss of 750 to 1500 mL. The heart rate increases to more than 100 beats/min in response to increased sympathetic nervous system stimulation unless blocked by preexisting beta-blocker therapy. The pulse pressure narrows as the diastolic blood pressure increases because of vasoconstriction. The respiratory rate increases, and arterial blood gas specimens drawn during this phase reveal respiratory alkalosis. Urine sodium level decreases, and urinary osmolality and specific gravity increase as the kidneys start to conserve sodium and water.
Which clinical manifestation is associated with the exudative phase of acute respiratory distress syndrome (ARDS)? Increased work of breathing Increasing agitation Fine crackles Respiratory alkalosis
Respiratory alkalosis Respiratory alkalosis is one finding associated with the exudative phase of acute respiratory distress syndrome (ARDS). Increasing agitation, fine crackles, and increased work of breathing are associated with the fibroproliferative phase of ARDS.
Assessment of a patient with a hx of CAD reveals JVD, and ascites. The nurse recognizes these signs as: Left sided heart failure Right sided heart failure Myocardial infarction Ruptured AAA
Right sided heart failure
The physician orders rotation therapy for a patient experiencing acute lung injury. Which technique should be used for the therapy to be effective? Rotate patient 30 degrees side to side for 10 minutes every hour Prone patient for 2 hours every 6 hours Rotate patient 40 degrees per side for at least 18 hours per day Prone patient for 6 hours and supine for 6 hours
Rotate patient 40 degrees per side for at least 18 hours per day Studies have found that to achieve benefits, rotation must be aggressive, and the patient must be at least 40 degrees per side, with a total arc of at least 80 degrees, for at least 18 hours a day. Rotating the patient 30 degrees has not been shown to be effective. Placing the patient prone is not a form of rotation therapy. No clear standards are available on how long a patient should be placed prone.
Which type of shock has the following hemodynamic manifestations: increased cardiac output (CO), increased cardiac index (CI), decreased right atrial pressure (RAP), decreased systemic vascular resistance (SVR), and decreased pulmonary artery occlusion pressure (PAOP)? Septic Cardiogenic Anaphylactic Neurogenic
Septic Clinical manifestations of septic shock include increased cardiac output (CO) and cardiac index (CI), decreased systemic vascular resistance (SVR), decreased right atrial pressure (RAP), and decreased pulmonary artery occlusion pressure (PAOP).
Which shock state includes hypotension despite adequate fluid resuscitation along with perfusion abnormalities such as lactic acidosis, oliguria, or acute change in mentation? Neurogenic Cardiogenic Anaphylactic Septic
Septic Septic shock includes hypotension despite adequate fluid resuscitation along with the presence of perfusion abnormalities that may include, but are not limited to, lactic acidosis, oliguria, or an acute alteration in mental status. Patients who are receiving inotropic or vasopressor agents may not be hypotensive at the time that perfusion abnormalities are measured. Neurogenic, anaphylactic, and cardiogenic shock are not refractory to fluid resuscitation.
Which laboratory value provides information regarding the severity of impaired perfusion and helps determine the adequacy of therapies in the patient with septic shock and multiple-organ dysfunction syndrome (MODS)? Serum glucose Serum lactate Serum albumin Serum creatinine
Serum Lactate
On admission to the progressive care unit after a colon resection, the nurse assesses the patient's risk for venous thromboembolism (VTE). Prevention measures for VTE include which therapy? Bedrest Subcutaneous low-molecular-weight heparin (LMWH) Unfractionated heparin (UFH) infusion Inferior vena cava filter
Subcutaneous low-molecular-weight heparin (LMWH) Preventive measures include prophylactic anticoagulation with subcutaneous low-molecular-weight heparin (LMWH) or unfractionated heparin infusion (UFH), increasing mobility, and use of sequential compression devices placed on the lower extremities. Unfractioned heparin infusion and placement of an inferior vena cava filter are measures for management of a diagnosed VTE.
In regard to multiple-organ dysfunction syndrome, what factor causes disseminated intravascular coagulation (DIC); interstitial pneumonitis; acute kidney injury; and necrosis of the gastrointestinal tract, liver, and adrenal glands? Interleukin-1 TNF-α PAF Proteases
TNF-α
Which statement is true regarding complications of noninvasive ventilation (NIV)? Masks should allow moderate air leaks for patient comfort. Agitation while undergoing NIV should be treated aggressively with sedation. When using a full face mask, the patient's hands should not be restrained. Placement of a nasogastric tube is contraindicated.
When using a full face mask, the patient's hands should not be restrained. Insufflation of the stomach places the patient at risk for aspiration. A nasogastric tube is placed for decompression as necessary. Heavy sedation should be avoided. A patient who requires noninvasive ventilation with a face mask should never be restrained. The patient must be able to remove the mask if it becomes displaced or if the patient vomits. A properly fitted mask minimizes air leakage and discomfort for the patient.
In the early stages of pulmonary edema, which arterial blood gas pH would the nurse expect to find? pH of 7.38 pH of 7.34 pH of 7.50 pH of 7.26
pH of 7.50 In the early stage of pulmonary edema, respiratory alkalosis (pH > 7.45) may be present because of hyperventilation, which eliminates carbon dioxide. As the pulmonary edema progresses and gas exchange becomes impaired, acidosis (pH <7.35) and hypoxemia ensue. A chest radiograph usually confirms an enlarged cardiac silhouette, pulmonary venous congestion, and interstitial edema. Generally the nurse would not expect to see a normal pH (pH between 7.35 and 7.45).
