Critical Care Exam 3 MC
True/False: Most patients are unable to return to work or a productive life-style after their surgical transplant procedure.
False
You, the astute UTA CC RN are receiving report on a patient who has a serum K+ of 6.2 mEq/L. Why would calcium chloride/gluconate be given when a patient has hyperkalemia?
If the cardiac rhythm is abnormal (potentially lethal), calcium will help stabilize the cardiac cell membrane
Yearly health maintenance screening, for the life of the transplanted organ, is recommended because a. Chronic immunosuppression can cause malignant neoplasms. b. Hypoglycemia is common when immunosuppression drug doses are altered. c. Hyperlipidemia is common and untreatable; assess yearly for cardiovascular disease (CVD). d. Chronic immunosuppression can cause volume depletion from diarrhea.
a. Chronic immunosuppression can cause malignant neoplasms.
A patient who received 27% total body surface area (BSA) burns in a house fire was admitted to the burn unit. Which finding is the most sensitive early indicator of an inhalation injury? a. Hoarse voice b. Cyanotic oral mucosa c. Lethargy d. Singed eyebrows
a. Hoarse voice
A client who is performing peritoneal dialysis at home calls the clinic and reports that the outflow from the dialysis catheter seems to be decreasing in amount. The clinic nurse should ask which question first? a. "Have you had any diarrhea?" b. "Have you been constipated recently?" c. "Have you had any abdominal discomfort?" d. "Have you had an increased amount of flatulence?"
b. "Have you been constipated recently?"
Which options are likely the most important considerations in organ distribution? (Select all that apply.) a. Educational level of the recipient. b. Illness severity of the recipient. c. Survivability of the transplantation procedure. d. History of mental illness.
b. Illness severity of the recipient. c. Survivability of the transplantation procedure.
Exposure to a dry caustic chemical has caused a hand burn. Which intervention is appropriate in the emergency care for this injury? a. Brush away any residue and cover with a dry gauze. b. Irrigate the hand with copious amounts of tap water. c. Soak the hand in a saline solution for 15-30 minutes. d. Place the hand in an aloe gel filled glove for 2 hours.
b. Irrigate the hand with copious amounts of tap water.
A motorcycle rider's chest was thrown against his handle bars during a high-speed riding accident. Which assessment finding suggests a flail chest? a. Rib pain on palpation b. Paradoxical movement of the chest wall c. Use of accessory muscles on exhalation d. A "sucking" wound on the chest wall
b. Paradoxical movement of the chest wall
A client in the oliguric phase of an acute kidney injury has a serum potassium level of 6.0 mEq/L. The nurse should plan which action as a priority? a. Check the sodium level. b. Place the client on a cardiac monitor. c. Encourage increased vegetables in the diet. d. Allow an extra 500 mL of fluid intake to dilute the electrolyte concentration.
b. Place the client on a cardiac monitor.
While working on a power line, a person experienced a high-voltage electrical injury. The primary survey has been completed. Emergency management will likely be on injuries to the a. bones and muscles b. heart and spine c. brain and skin d. lungs and abdomen
b. heart and spine
A patient involved in an MVC presents with complete loss of movement and sensation below the clavicles. The priority nursing intervention is to monitor the patient for signs of a. neurogenic shock. b. hypercarbia. c. spinal shock. d. hypovolemia.
b. hypercarbia.
A patient with chronic kidney disease asks why he is anemic. The explanation to this patient should be that anemia is the result of: a. loss of blood in the urine. b. inadequate production of a hormone that stimulates production of red blood cells. c. deficiency of iron needed for production of red blood cells. d. development of a gastric ulcer and blood loss as a result of the ulcer.
b. inadequate production of a hormone that stimulates production of red blood cells.
A person's leg was pinned under a car for several hours and now has compartment syndrome. The trauma nurse identifies dark tea-colored urine as a sign of a. hyperkalemia. b. myoglobinuria. c. increasing troponin I levels. d. high specific gravity from increased urine output.
b. myoglobinuria.
The primary goal of vasoactive medication administration in the neurogenic shock patient is to a. enhance urinary output. b. restore vasomotor tone. c. increase cardiac output. d. raise systolic pressure.
b. restore vasomotor tone.
A nurse instructor is evaluating a nursing student for knowledge regarding care of a client with acute kidney injury. Which statement by the student demonstrates the need for further education about the diuretic phase of acute kidney injury? a. "The increase in urine output indicates the return of some renal function." b. "The diuretic phase develops about 14 days after the initial insult and lasts about 10 days." c. "The diuretic phase is characterized by an increase in urine output of about 500 mL in a 24-hour period." d. "The blood urea nitrogen (BUN) and creatinine levels will continue to rise during the first few days of diuresis."
c. "The diuretic phase is characterized by an increase in urine output of about 500 mL in a 24-hour period."
A patient acquired a C7 spinal cord injury after a diving accident. During the morning assessment the nurse notes that the patient is diaphoretic with a flushed face and neck. He is complaining of a severe headache, blurred vision and stuffy nose. After finding the blood pressure markedly elevated, which action should the nurse take next? a. Assess the urinary catheter for kinks. b. Loosen tight clothing. c. Sit patient upright; legs dangling. d. Notify the health care provider.
c. Sit patient upright; legs dangling.
This 80 kg. man is now diagnosed with CKD. What would be the best laboratory test to evaluate this patient's glomerular filtration rate (GFR)? a. Blood urea nitrogen b. Serum creatinine c. Urine creatinine clearance d. Serum amylase
c. Urine creatinine clearance
During early burn trauma care, patients are at greatest risk for complications related to a. Silver sulfadiazine (Silvadene) toxicity. b. iatrogenic infections c. altered capillary permeability. d. Curling's ulcer formation.
c. altered capillary permeability.
An 80 kg patient, who sustained major burns, needs a large volume of IV fluids in the initial 24 hours. Which additional assessment finding would indicate successful fluid resuscitation? a. CVP of 5 mm Hg. b. urinary output of 30 ml/hr. c. urinary output of 40 ml/hr. d. mean arterial pressure of 55 mm Hg.
c. urinary output of 40 ml/hr.
A nurse determines that additional patient teaching is needed when the recipient of a newly transplanted kidney says a. "the transplanted organ will never be accepted by my immune system as part of my body." b. "my immune system will forever consider the transplanted kidney as foreign." c. "taking immunosuppressant drugs will prevent rejection of my new kidney." d. "after a couple of years, I should be able to stop taking my immunosuppressant drugs."
d. "after a couple of years, I should be able to stop taking my immunosuppressant drugs."
A patient with a traumatic brain injury (TBI) exhibits S&S of increased intracranial pressure (ICP). Which is the priority nursing intervention for ICP reduction? a. Perform hourly neurological examinations. b. Administer a 1000 mL hypotonic crystalloid bolus. c. Provide high flow oxygen via a reservoir mask. d. Elevate the patient's head-of-bed 30 degrees.
d. Elevate the patient's head-of-bed 30 degrees.
A 24-year-old man has been diagnosed with pre-renal AKI as a result of severe hemorrhaging after a motor vehicle collision. Which of the following would be expected laboratory values for this patient? a. Low urinary osmolality, high urinary sodium concentration b. High urinary osmolality, high urinary sodium concentration c. Low urinary osmolality, low urinary sodium concentration d. High urinary osmolality, low urinary sodium concentration
d. High urinary osmolality, low urinary sodium concentration
A patient with CKD develops carpopedal spasm and neuromuscular irritability manifested by Chvostek's and Trousseau's signs. Which electrolyte imbalance should you suspect? a. Hypokalemia b. Hypercalcemia c. Hypermagnesemia d. Hyperphosphatemia
d. Hyperphosphatemia
A patient involved in a head-on collision has an abdominal wall contusion at the level of the lap belt. Based on this observation, the trauma nurse will assess the patient for potential a. thoracic aortic disruption. b. rib fractures. c. renal contusion. d. bowel rupture.
d. bowel rupture.
A nurse is caring for an 80 kg 20yr old admitted 2 days ago. His history includes frequent "huffing". After report, initial patient assessment reveals: 30 cc of urine for the last hour, 25 cc the previous hour Urine analysis: Sp gravity 1.000, + Casts in urine, + sodium in urine What type of AKI should the nurse suspect? Why? What stage are they in?
intrarenal (nephrotixic spray paint causes acute tubular necrosis, which is indicated by casts in the urine, pt is in the oliguric stage because UO < 0.5 mL/kg/hr)
An 80 kg patient involved in a house fire is admitted to the ED with burns to the right arm, anterior trunk and right leg. 1. Calculate the burn BSA. 2. How much IV fluid should be infused in the first 8 hours? 3. How much IV fluid should be administered per hour in the second 16 hours?
1. 45% 2. 3600 ml 3. 225 ml/hr
You, the astute UTA CC RN are receiving report on a patient who has a serum K+ of 6.2 mEq/L. The outgoing RN states that the patient was given Kayexalate (Sodium polystyrene sulfonate) for their elevated serum potassium. What other option exist for the treatment of hyperkalemia?
If cardiac abnormalities are present, the patient may need more urgent normalization of the serum K+. Glucose and Insulin may be given IVP.
You, the astute UTA CC RN are receiving report on a patient who has a serum K+ of 6.2 mEq/L. What should you assess first?
The cardiac rhythm (patient must be on the cardiac monitor! Likely a 12-lead EKG will be requested) because K+ can affect the cardiac rhythm
Which laboratory profile would be expected in a patient with a history of alcoholism and cirrhosis of the liver? a. Prolonged activated partial thromboplastin time (aPTT) and hypokalemia. b. Decreased alanine transaminase (ALT), decreased albumin. c. Decreased aspartate transaminase (AST), and hyperkalemia. d. Decreased bilirubin and increased alanine transaminase (ALT).
a. Prolonged activated partial thromboplastin time (aPTT) and hypokalemia.
A patient who suffered a blunt force injury to the side of the head (temporal region) is diagnosed with an epidural hematoma. Identify which description matches the diagnosis. a. Venous disorder; ↓ LOC and headache. b. Arterial trauma bleed; unconsciousness followed by alertness followed by ↓ LOC . c. Aneurysm rupture; sudden ↓ LOC . d. Hypertensive history; hemiparesis and slurred speech.
b. Arterial trauma bleed; unconsciousness followed by alertness followed by ↓ LOC .
A client is brought to the emergency department with partial thickness burns to his face, neck, arms, and chest after trying to put out a car fire. The nurse should implement which nursing actions for this client? (Select all that apply.) a. Restrict fluids. b. Assess for airway patency. c. Administer oxygen as prescribed. d. Place a cooling blanket on the client. e. Elevate extremities if no fractures are present. f. Prepare to give oral pain medication as prescribed.
b. Assess for airway patency. c. Administer oxygen as prescribed. e. Elevate extremities if no fractures are present.
In the patient with blunt chest trauma, what simple nursing intervention can be best used to screen for thoracic aorta injury? a. Measure the pulse pressure b. Bilateral upper extremity BP measurement c. BP cuff inflation to elicit carpal spasm d. SpO2 comparison of the right and left arm
b. Bilateral upper extremity BP measurement
An 80 year-old 80 kg patient presents with major burns to the face and body. He is intubated on arrival and placed on mechanical ventilation. He has been resuscitated with a large volume of IV fluids. Which additional assessment finding would cause the most concern for the ICU nurse? a. CVP of 5 mm Hg; peripheral edema. b. CVP of 18 mm Hg; crackles in lung bases. c. urinary output of 65 ml/hr; CVP 12 mm Hg. d. mean arterial pressure of 70 mm Hg.
b. CVP of 18 mm Hg; crackles in lung bases.
Rehabilitation of the spinal cord injury (SCI) patient should begin in which location? a. Progressive care unit b. Critical care unit c. Medical-surgical unit d. Rehabilitation unit
b. Critical care unit
A patient with cirrhosis of the liver is admitted with bleeding esophageal varices. Intravenous octreotide infusion is initiated, and endoscopy with sclerotherapy was performed. Despite these treatments, bleeding continues. A Sengstaken-Blakemore (SB) tube is inserted and is successfully controlling the bleeding from the varices. Later that evening, the patient suddenly develops extreme respiratory distress. What is the nurse's priority action? a. Obtain a stat arterial blood gas for analysis. b. Cut and remove the SB tube. c. Contact the physician immediately. d. Obtain a stat chest x-ray film.
b. Cut and remove the SB tube.
A patient has a history of alcoholism and cirrhosis of the liver. Vasopressin has been prescribed. What is the mechanism of action of this drug? a. Increases mesenteric blood flow to reduce ischemia. b. Decreases portal venous blood flow to decrease bleeding. c. Causes sodium and water retention to replace volume. d. Blocks histamine2 receptors to inhibit hydrochloric acid secretion.
b. Decreases portal venous blood flow to decrease bleeding.
A 23-year-old woman is beginning her second hemodialysis treatment for acute kidney injury. Suddenly she complains of headache and nausea. She is agitated and confused, and you notice twitching in her right hand. Which of the following is causing these findings? a. Uremia b. Dialysis disequilibrium syndrome c. Intracerebral hemorrhage d. Fluid overload
b. Dialysis disequilibrium syndrome
A patient is recovering from a stab wound to the right kidney. He is awake, alert and hemodynamically stable. The trauma nurse is unconcerned to note which assessment finding? a. RLQ rebound tenderness on palpation b. Ecchymosis along the right flank c. Left shoulder pain unassociated with arm movement d. Muffled heart sounds and distended neck veins
b. Ecchymosis along the right flank
A patient has a history of alcoholism and cirrhosis of the liver. Which medication, if prescribed, should the nurse not administer? (Select all that apply.) a. Albumin b. Lactated Ringers solution (RL) c. Normal Saline (NS) d. Acetaminophen e. Ibuprofen
b. Lactated Ringers solution (RL) d. Acetaminophen
A patient returns to the clinic one month after kidney transplantation surgery. Acute rejection is suspected. Which clinical manifestations are expected? (Select all that apply.) a. Flank pain b. Lower abdominal pain c. Increased weight d. Elevated GFR e. Decreased urine output f. Markedly elevated temperature
b. Lower abdominal pain c. Increased weight e. Decreased urine output
What is the difference between AKI and CKD?
CKD: GFR < 60 mL/min for >= 3 months, with or without kidney damage AKI: the kidney is not doing it's job of removing water and waste
You, the astute UTA CC RN are receiving report on a patient who has a serum K+ of 6.2 mEq/L. The outgoing RN states that the patient was given Kayexalate (Sodium polystyrene sulfonate) for their elevated serum potassium. Repeat K+, 4 hours later, is 6.2 mEq/L. What questions should you ask the outgoing RN?
How many bowel movements did the patient have? Does the patient have bowel sounds (is the gut working)? K will be removed only if the patient has bowel movements!!
A patient acquired a C7 spinal cord injury after a diving accident. The nurse will not administer which prescribed medication if neurogenic shock is suspected? a. Nitroprusside b. Dopamine c. Norepinephrine d. Phenylephrine
a. Nitroprusside
A client has chronic kidney disease (CKD) that does yet not require dialysis. Which comment to the nurse, if made by the client, indicates the need for further teaching? a. "I will reduce the sodium in my diet, and I can use salt substitutes to spice my food." b. "The amount of fluid I can have every day depends on the amount of urine I put out." c. "I will weigh myself on my bathroom scale every morning right after I have urinated." d. "I should report a gain in weight, trouble with my breathing, or increased leg swelling."
a. "I will reduce the sodium in my diet, and I can use salt substitutes to spice my food." (salt substitutes are usually potassium based, which could cause hyperkalemia)
A client undergoing hemodialysis begins to experience muscle cramping. What corrective action should the hemodialysis nurse caring for the client take? (Select all that apply.) a. Administer an isotonic solution. b. Increase the ultrafiltration rate. c. Decrease the ultrafiltration rate. d. Administer magnesium sulfate.
a. Administer an isotonic solution. c. Decrease the ultrafiltration rate.
A patient with a history of alcoholism and cirrhosis of the liver is admitted because of a sudden onset of confusion and lethargy. The nurse notes that asterixis is present. Which laboratory value is likely to be elevated? a. Ammonia levels b. Creatinine levels c. Potassium levels d. Amylase levels
a. Ammonia levels
As a result of a motor vehicle crash (MVC) a patient has sustained a cervical spinal cord injury. Which assessment findings, by the ICU nurse, would indicate that the patient is experiencing spinal shock? (Select all that apply.) a. Bladder dysfunction b. absence of sensation below the level of the injury c. BP 80/40; Pulse 42 d. diminished reflexes below the level of the injury e. systemic vasodilation f. flaccidity below the level of the injury
a. Bladder dysfunction b. absence of sensation below the level of the injury d. diminished reflexes below the level of the injury f. flaccidity below the level of the injury
A person was admitted to the ED following a fall from a 4 foot step-ladder. The patient complains of burning and weakness in the upper extremities, but is able to move the lower extremities. These findings best describe which type of incomplete spinal cord injury? a. Central cord syndrome c. Anterior cord syndrome d. Posterior cord syndrome e. Brown-Sequard syndrome
a. Central cord syndrome
A 34-year-old man is unconscious after falling from a roof. He responds purposefully to pain. The physician prepares to evaluate the oculocephalic reflex. What should be assessed before the oculocephalic reflex is evaluated? a. Cervical spine for injury b. Blood pressure for elevation c. Motor strength for weakness d. Gag reflex for absence
a. Cervical spine for injury
The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. Which actions should the nurse take? (Select all that apply.) a. Check the level of the drainage bag. b. Reposition the client to his or her side. c. Contact the health care provider (HCP). d. Place the client in good body alignment. e. Check the peritoneal dialysis system for kinks. f. Increase the flow rate of the peritoneal dialysis solution.
a. Check the level of the drainage bag. b. Reposition the client to his or her side. d. Place the client in good body alignment. e. Check the peritoneal dialysis system for kinks.
In the event of a tar burn, which immediate action should the nurse perform? (Select all that apply.) a. Cool the injury with water b. Remove adherent clothing c. Remove the tar from the burn injury d. Remove any hot tar saturated clothing
a. Cool the injury with water d. Remove any hot tar saturated clothing
A patient with a large amount of protein in the urine suggests damage to which portion of the nephron? a. Glomerulus b. Bowman's capsule c. Proximal convoluted tubule d. Collecting duct
a. Glomerulus
A nurse is performing an assessment on a client with acute kidney injury who is in the oliguric phase. During this phase, the nurse understands that which manifestations are associated findings? Select all that apply. a. Increased serum creatinine level b. A low and fixed urine specific gravity c. Increased blood urea nitrogen (BUN) level d. Low urine osmolality e. A urine output of 600 to 800 mL in a 24-hour period
a. Increased serum creatinine level b. A low and fixed urine specific gravity c. Increased blood urea nitrogen (BUN) level d. Low urine osmolality
A 42-year-old woman with chronic kidney disease is admitted to the emergency department with tachycardia, hypotension, dyspnea, S3, crackles, and frothy hemoptysis. Oxygen is being administered at 4 L/min via nasal cannula. Immediate management would include which of the following? (Select all that apply.) a. Initiate dialysis. b. Administer digoxin. c. Administer diuretics. d. Administer venous vasodilators.
a. Initiate dialysis. c. Administer diuretics.
A patient, with hepatic failure, has ascites and severe peripheral edema. She is vomiting and has developed metabolic alkalosis and hypokalemia. Which treatment would not be included in this patient's management? a. Loop diuretics b. Potassium supplements c. Antiemetic d. Infusion of IV albumin
a. Loop diuretics
The nurse is developing a care plan for a client with a circumferential burn injury of the extremity. The client problem states ineffective tissue perfusion. Which nursing intervention should the nurse include in the plan of care for the client? a. Monitor peripheral pulses every hour. b. Keep the extremities in a dependent position. c. Document any changes that occur in the pulse. d. Place pressure dressings and wraps around the burn sites.
a. Monitor peripheral pulses every hour.
A man was electrocuted with 440 volts of electrical current. An entry wound was noted in his left hand, and a large exit wound was noted on the sole of his right foot. After admission into the critical care unit, the nurse observes that the urine is brownish. A specimen is sent to the laboratory. What intervention is anticipated? a. Rapid IV fluid administration. b. Insertion of a double-lumen vascular catheter and hemodialysis. c. Furosemide administration. d. Initiation of a dobutamine drip at 2 mcg/kg/min.
a. Rapid IV fluid administration.
A patient with cirrhosis of the liver is admitted with hepatic encephalopathy. The patient is confused and lethargic. Asterixis is present. Which should be a primary concern in managing this patient's diet? a. Reduce protein intake. b. Reduce fluid intake. c. Reduce carbohydrate intake. d. Reduce potassium intake.
a. Reduce protein intake.
A person involved in an all-terrain vehicle crash sustained an injury to the neck after riding into a suspended cable. Which finding would suggest an expanding hematoma? a. Strained hoarse voice b. Bloody sputum c. Coughing d. Coarse crackles
a. Strained hoarse voice
A patient involved in a head-on collision has an abdominal wall contusion at the level of the lap belt. Eight hours after injury which assessment finding would lead the nurse to believe that the patient suffered from a bowel tear. a. Temp 102°F; WBC count 16,000/mm³; absent bowel sounds with diffuse abdominal tenderness b. BP 98/70 mm Hg; HR 131/min; RUQ pain c. Temp 100.2°F; WBC count 12,000/mm³; abd. tenderness around the contusion d. BP 111/52 mm Hg; HR 128/min; markedly elevated serum lactate level
a. Temp 102°F; WBC count 16,000/mm³; absent bowel sounds with diffuse abdominal tenderness
A patient has sustained a fractured femur. The patient is now complaining of excruciating pain that is not controlled with increased analgesia doses. The patient has a pedal pulse and is able to wiggle her toes. The trauma nurse knows that compartment syndrome (CS) a. can be present if the patient has a distal palpable pulse. b. cannot be present when a distal pulse is palpable. c. is an unlikely cause; the patient is likely addicted to pain meds. d. only occurs with lower leg fractures, such as the tibia.
a. can be present if the patient has a distal palpable pulse.
A patient with acute kidney injury has the following arterial blood gas results: pH 7.32, PaCO2 35 mm Hg, HCO3 18 mEq/L This acid/base imbalance is the result of the inability of the kidney to: a. excrete acid by-products of metabolism. b. excrete carbon dioxide. c. excrete bicarbonate ions. d. excrete calcium ions.
a. excrete acid by-products of metabolism.
A client who had cardiac surgery 24 hours ago has had a urine output averaging 20 mL/hour for 2 hours. The client received a single bolus of 500 mL of intravenous fluid. Urine output for the subsequent hour was 25 mL. Daily laboratory results indicate that the blood urea nitrogen level is 45 mg/dL and the serum creatinine level is 2.2 mg/dL. On the basis of these findings, the nurse would anticipate that the client is at risk for which problem? a. Hypovolemia b. Acute kidney injury c. Glomerulonephritis d. Urinary tract infection
b. Acute kidney injury
The nursing student is assigned to care for a client with a diagnosis of acute kidney injury (AKI), diuretic phase. The nursing instructor asks the student about the primary goal of the treatment plan for this client. Which goal, if stated by the nursing student, would indicate an adequate understanding of the treatment plan for this client? a. Prevent fluid overload. b. Prevent loss of electrolytes. c. Promote the excretion of wastes. d. Reduce the urine specific gravity.
b. Prevent loss of electrolytes.
A nurse is caring for a patient immediately after their renal transplant surgery. Urine output is strictly measured and the IV fluid rate is continually re-adjusted to deliver the volume lost in the previous hour's urine output. What is the rational for this intervention? a. Ensure electrolyte balance. b. Prevent prerenal ischemia. c. Reduction of renal artery thrombosis. d. Minimize recurrence of an ileus.
b. Prevent prerenal ischemia.
A patient in the oliguric phase of AKI is placed on fluid restrictions. The patient's total output for yesterday was 400 mL. Which of the following fluid volumes would be allowed for today? a. 300 mL b. 600 mL c. 1000 mL d. 1500 ml
c. 1000 mL
The patient has gained 1 kg since yesterday. How much fluid does this weight gain represent? a. 250 mL b. 500 mL c. 1000 mL d. 2000 mL
c. 1000 mL
An 80 kg man was electrocuted with 440 volts of electrical current at 0800. Upon arrival to the health-care facility, at 1000, the ED physician determines the burn BSA at 22%. How much IV fluid, per hour, should be infused (round to whole number)? a. 220 ml/hr. b. 440 ml/hr. c. 587 ml/hr. d. 293 ml/hr.
c. 587 ml/hr. (because you calculate from the initial burn time)
Assessment of the patient with a hepatic laceration includes serial abdominal examinations and hemoglobin (hgb) level measurement. What additional serial diagnostic studies would be relevant to the injury? a. Amylase and lipase levels b. White cell count c. ALT and coagulation studies d. Urinalysis
c. ALT and coagulation studies
An 80 year-old patient presents with major burns to the face and body. He is intubated on arrival and placed on mechanical ventilation. His high pressure ventilator alarm keeps sounding. Which additional assessment should the nurse perform first? a. Determine if the connection on the ventilator tubing is loose. b. Obtain a blood pressure; deliver more IV fluids if low. c. Check for secretions and auscultate the lungs. d. No additional assessment is needed; the nurse should turn off the alarm.
c. Check for secretions and auscultate the lungs.
A patient with a history of alcoholism and cirrhosis of the liver has been prescribed Lactulose. What is the purpose of this medication? a. Prevent gastrointestinal bleeding. b. Kill normal bowel flora. c. Decrease serum ammonia. d. Increase serum protein level.
c. Decrease serum ammonia.
Twelve hours after injury, which of the following is the priority nursing intervention for a patient with a cerebral contusion? a. Deep vein thrombosis prophylaxis b. Hyperventilation; keep CO2 24 mmHg c. Frequent neurological assessment d. Hypertonic saline administration
c. Frequent neurological assessment
While in the post anesthesia care unit (PACU), after their renal transplant surgery, a patient manifests a markedly elevated heart rate and temperature. Their measured WBC count is elevated. What may be occurring? a. Acute rejection. b. Graft versus host disease. c. Hyperacute rejection. d. T-cell mediated hyper-responsiveness.
c. Hyperacute rejection.
Serologic testing is performed after a healthcare worker (HCW) has a needlestick injury. Which result is expected if the HCW is protected against the Hepatitis B virus (HBV)? a. Positive Hepatitis B surface antigen (HBsAg) . b. Nonreactive Hepatitis B surface antigen (HBsAg). c. Positive Hepatitis B surface antibody (HBsAb). d. Negative Hepatitis B surface antibody (HBsAb.
c. Positive Hepatitis B surface antibody (HBsAb).
A 20-year-old patient, who suffered multiple traumatic injuries from an MVC, is awaiting transfer to the medical-surgical unit. Which finding, by the ICU nurse, would halt the transfer? a. The chest tube is still in place. b. Glasgow coma scale of 14. c. Post extubation PaCO2 is 55 mm Hg. d. Enteral feedings are at 50% of goal.
c. Post extubation PaCO2 is 55 mm Hg.
A patient, who fell 40 feet, arrives in the ICU on mechanical ventilation. Two hours after arrival the critical care nurse notes a distinct "rice krispies" sensation on chest palpation. The surgeon is notified because the nurse suspects a. intrathoracic bleeding b. inadvertent esophageal intubation c. a bronchial tear d. cervical cord compromise
c. a bronchial tear
A trauma center's designation level is a measure of a. staff member's commitment to trauma patient care. b. a trauma center's operating room and bed capacity. c. clinical resources available to care for trauma patients. d. compliance with the Joint Commission trauma standards.
c. clinical resources available to care for trauma patients.
A patient with cirrhosis of the liver is admitted with hepatic encephalopathy. He is nonresponsive to verbal stimuli at this time. Which intervention would not specifically decrease serum ammonia levels in a patient with hepatic encephalopathy? a. Administration of rifaximin b. Administration of lactulose c. Provision of adequate caloric intake d. Avoidance of all hepatotoxic agents
d. Avoidance of all hepatotoxic agents
An 80 kg. man is admitted with an acute myocardial infarction. Assessment reveals the following hemodynamic parameters: Pulmonary artery pressure = 34/24 mm Hg Pulmonary artery wedge pressure = 25 mm Hg Right atrial pressure (CVP) = 10 mm Hg Cardiac index (CI) = 1.8 L/min/m2 Which of the following would be of primary concern in evaluating the patient's renal status? a. PAP b. PAWP c. RAP d. CI
d. CI
A woman in a bar fight sustained a blow to the epigastrium. Which finding suggests a pancreatic injury? a. RLQ pain b. Positive FAST exam c. Low hemoglobin and hematocrit d. Elevated amylase and lipase level
d. Elevated amylase and lipase level
A patient returns to the clinic one month after kidney transplantation surgery. Acute rejection is suspected. Which treatment is indicated for this patient? a. Hemodialysis b. Anti-infective agents c. Removal of the transplanted kidney d. Increased dosing of immunosuppressant agents
d. Increased dosing of immunosuppressant agents
A patient fell against a glass tabletop and was admitted following a surgical repair of her neck from the jaw to the cricothyroid membrane. Identify the priority nursing intervention for this patient. a. Assessing blood pressure for hypertension. b. Checking the incision for signs of infection. c. Monitoring the surgical site for external bleeding. d. Listen for sounds of stridor.
d. Listen for sounds of stridor.
As a result of a motor vehicle crash (MVC), which occurred 48 hours ago, a patient has sustained a left femur fracture. Upon assessment the ICU nurse notes that the patient is now restless and diaphoretic. His respiratory rate is 32 b/min and he is complaining of dyspnea. Which additional findings would cause the nurse to suspect fat embolism syndrome (FES)? a. Erythema and swelling to the right lower extremity. b. A pericardial friction rub. c. Paresthesia and decreased mobility of the left leg. d. Petechiae found on the chest, neck and conjunctiva.
d. Petechiae found on the chest, neck and conjunctiva.
A 20-year-old was kicked in the anterior chest by a horse. He is alert with no complaints of dyspnea. SpO2 is 100% on room air, with a respiratory rate of 16, blood pressure 120/70, HR 88. What priority nursing intervention is needed next? a. Administer oxygen by face mask b. Infuse large amounts of isotonic solution c. Collect a urine specimen d. Place him on a cardiac monitor
d. Place him on a cardiac monitor
A patient with cirrhosis of the liver is admitted with hepatic encephalopathy. Which additional substance, other than protein, should be restricted in a patient with hepatic failure? a. Potassium b. Fat c. Carbohydrates d. Sodium
d. Sodium
A severely beaten patient presents with periorbital and post auricular ecchymosis. In addition, the nurse notes a clear nasal discharge. To determine the presence of cerebrospinal fluid (CSF) rhinorrhea, the trauma nurse will first a. send a swabbed sample to the lab for culturing. b. perform a bedside halo test. c. tape a "mustache pad" below the nose to collect drainage. d. evaluate the discharge for glucose.
d. evaluate the discharge for glucose.
A patient was admitted via the emergency department after an automobile collision in which his forehead struck the windshield. In this situation, the contrecoup injury would occur in the: a. temporal region. b. parietal region. c. frontal region. d. occipital region.
d. occipital region.
A severely beaten patient presents with periorbital and post auricular ecchymosis. This finding indicates a fracture of the a. bony orbits b. nasal bone c. cervical spine d. skull bone(s)
d. skull bone(s)