Critical Care Test 2

Renin plays a role in blood pressure regulation by: A. inhibiting aldosterone release B. activating the renin-angiotensin-aldosterone cascade. C. suppressing angiotensin production. D. decreasing sodium reabsorption.

B

The most common cause of acute kidney injury in critically ill patients is A. fluid overload. B. sepsis. C. hemodynamic instability. D. medications.

B

A client has elevated blood urea nitrogen (BUN) and serum creatinine levels with a normal BUN/creatinine ratio. These levels most likely indicate: A. acute kidney injury, such as acute tubular necrosis (ATN). B. fluid resuscitation. C. hypovolemia. D. increased nitrogen intake.

A

A client is having a cardiac evaluation to assess for possible valvular disease. Which study best identifies valvular function and measures the size of the cardiac chambers? A. Echocardiogram B. 12-lead electrocardiogram C. Cardiac catheterization D. Electrophysiology study

A

A nurse completed an infusion of a 1000 mL bolus of normal saline to a client with severe sepsis. One hour later, which laboratory result would require the nurse's immediate attention? A. Lactate 6 mmol/L B. Creatinine 1.0 mg/dL C. Sodium 140 mEq/L D. Potassium 3.8 mEq/L

A

A nurse is caring for a client from a rehabilitation center with a preexisting complete cervical spine injury who is complaining of a severe headache. The nurse assesses: blood pressure 180/90 mm Hg, heart rate 60 beats/min, respirations 24 breaths/min, and 50 mL of urine via indwelling urinary catheter for the past 4 hours. What is the best action by the nurse? A. Assess for a kinked urinary catheter and assess for bowel impaction B. Administer acetaminophen as ordered for the headache C. Notify the provider of the patient's blood pressure D. Encourage the patient to take slow, deep breaths.

A

A strategy for preventing pulmonary embolism in patients at risk who cannot take anticoagulants is A. insertion of a vena cava filter B. infusion of thrombolytics C. subcutaneous heparin administration every 12 hours D. administration of two aspirin tablets every 4 hours

A

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

A

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

B

Identify the priority interventions for managing symptoms of an acute myocardial infarction (AMI) in the ED (select all that apply): Administration of nitroglycerin (NTG) Dopamine infusion Transfusion of packed red blood cells Administration of morphine Oxygen therapy

Administration of nitroglycerin (NTG) Administration of morphine Oxygen therapy

A client has severe sepsis with blood pressure 80/50 mm Hg, heart rate 120 beats/min, respirations 28 breaths/min, oral temperature of 101° F, and a right atrial pressure (RAP) of 1 mm Hg. Which intervention should the nurse carry out first? A. IV antibiotic administration B. Isotonic fluid challenge C. Blood cultures from two sites D. Acetaminophen suppository

B

A client is admitted with complaints of general malaise and fatigue, along with a decreased urinary output. The client's urinalysis shows coarse, muddy brown granular casts and hematuria. The nurse determines that the client has: A. a urinary tract infection. B. intrarenal disease, probably acute tubular necrosis. C. acute kidney injury from postrenal obstruction. D. acute kidney injury from a prerenal condition.

B

A client is having a stent placed and asks a nurse why it is necessary after having an angioplasty. Which response by the nurse is best? A. "The stent will remove any clots that are in the vessel and protect the heart muscle from damage." B. "The stent is inserted to enhance the results of the angioplasty, by helping to keep the vessel open and prevent it from closing again." C. "The angioplasty was a failure, so this procedure has to be done to fix the heart vessel." D. "This procedure is being done instead of using cholesterol-lowering medication to help keep the heart vessel open."

B

A client's serum creatinine level is 0.7 mg/dL. The expected BUN level should be A. 10 to 20 mg/dL B. 7 to 14 mg/dL C. 1 to 2 mg/dL D. 20 to 30 mg/dL

B

A nurse is caring for a mechanically ventilated client admitted with a traumatic brain injury. Which arterial blood gas value assessed by the nurse indicates optimal gas exchange for a client with this type of injury? A. pH 7.38; PaCO2 55 mm Hg; HCO3 22 mEq/L; PaO2 85 mm Hg B. pH 7.38; PaCO2 35 mm Hg; HCO3 24 mEq/L; PaO2 85 mm Hg C. pH 7.38; PaCO2 28 mm Hg; HCO3 26 mEq/L; PaO2 65 mm Hg D. pH 7.38; PaCO2 40 mm Hg; HCO3 24 mEq/L; PaO2 70 mm Hg

B

A patient at high risk for pulmonary embolism is receiving enoxaparin. The nurse explains to the patient: A. "You should not be receiving this medication. I will contact the provider to get it stopped." B. "This injection is being given to prevent blood clots from forming." C. "I'm going to contact the pharmacist to see if you can take this medication by mouth." D. "This medication will dissolve any blood clots you might get."

B

Acute kidney injury from postrenal etiology is caused by A. conditions that interfere with renal perfusion. B. obstruction of the flow of urine. C. hypovolemia or decreased cardiac output. D. conditions that act directly on functioning kidney tissue.

B

The nurse is caring for a client 5 days following clipping of an anterior communicating artery aneurysm for a subarachnoid hemorrhage. The nurse assesses the client to be more lethargic than the previous hour with a blood pressure of 85/50 mm Hg, heart rate 110 beats/min, respiratory rate 24 breaths/min, oxygen saturation (SpO2) 95% on 3 L/min oxygen via nasal cannula, and a temperature of 101.5°F. Which provider prescription should the nurse institute first? A. Blood cultures (2 specimens) for temperature >101°F B. 500 mL albumin infusion intravenously C. Acetaminophen (Tylenol) 650 mg per rectum D. Decadron 20 mg intravenous push every 4 hours

B

Which medication classification would a nurse anticipate a provider would prescribe for a client with hyperlipidemia? A. Beta blockers B. HMG-CoA reductase inhibitors (statins) C. Antibiotics D. Nitroglycerin

B

Which of the following acid-base disturbances commonly occurs with the hyperventilation and impaired gas exchange seen in severe exacerbation of emphysema? A. Respiratory alkalosis B. Respiratory Acidosis C. Metabolic acidosis D. Metabolic alkalosis

B

While caring for a client with a closed head injury, the nurse assesses the client to be alert with a blood pressure 130/90 mm Hg, heart rate 60 beats/min, respirations 18 breaths/min, and a temperature of 102°F. To reduce the risk of increased intracranial pressure (ICP) in this client, what is the priority? A. Maintain neutral head alignment and avoid extreme hip flexion B. Reduce ambient room temperature and administer antipyretics C. Insert an oral airway and monitor respiratory rate and depth D. Ensure adequate periods of rest between nursing interventions

B

You are caring for a patient who is being turned prone as part of treatment for acute respiratory distress syndrome. You understand that the priority nursing concern for this patient is which of the following? A. Prevention of gastric aspiration B. Management and protection of the airway C. Psychological support to patient and family D. Prevention of skin breakdown and nerve damage

B

A nurse is caring for a client who has sustained blunt trauma to the left flank area and is evaluating the client's urinalysis results. What finding would be most concerning for the nurse? A. Creatinine levels in the urine similar to blood levels of creatinine B. Urine uric acid levels similar to serum levels C. Red blood cells and albumin in the urine D. Sodium and chloride in the urine

C

A client is on intake and output (I&O), as well as daily weights. A nurse notes that output is considerably less than intake over the last shift, and daily weight is 1 kg more than yesterday. What would be a priority action of the nurse? A. Obtain an order to place the client on fluid restriction B. Draw a trough level after the next dose of antibiotic C. Assess the client's lungs D. Insert an indwelling catheter

C

A client with cardiogenic shock is being treated with an infusion of dobutamine. The physician's order indicates to titrate the infusion to achieve a cardiac index of greater than or equal to 2.5 L/min/m2. The nurse measures a cardiac output and notes that the calculated cardiac index for your patient is 4.9 L/min/m2. What is the nurse's priority action? A. Assess your patient's hourly urine output B. Order a stat 12-lead electrocardiogram per protocol C. Reduce the rate of dobutamine D. Obtain a stat serum potassium level per protocol

C

A nurse admits a client following a motor vehicle collision. Vital signs include blood pressure 70/50 mm Hg, heart rate 140 beats/min, respiratory rate 36 breaths/min, temperature 101° F and oxygen saturation (SpO2)95% on 3 L of oxygen per nasal cannula. Laboratory results include hemoglobin 6.0 g/dL, hematocrit 20%, and potassium 4.0 mEq/L. Based on this assessment, what is most important for the nurse to include in the client's plan of care? A. Implementation of fall precautions B. Application of cushioned heel protectors C. Insertion of an 18-gauge peripheral intravenous line D. Implementation of universal precautions

C

A nurse assesses a client with a skull fracture to have a Glasgow Coma Scale score of 3. Additional vital signs assessed by the nurse include blood pressure 100/70 mm Hg, heart rate 55 beats/min, respiratory rate 10 breaths/min, oxygen saturation (SpO2) 94% on oxygen at 3 L per nasal cannula. What is the priority nursing action? A. Support bony prominences with padding B. Elevate the head of the client's bed C. Monitor the patient's airway patency D. Increase supplemental oxygen delivery

C

A nurse care for a client in the ED with a suspected cervical spine injury. What is the priority nursing action? A. Remove cervical collar upon arrival to the ED B. Prepare for immediate endotracheal intubation C. Maintain proper head and neck alignment D. Keep the neck in the hyperextended position

C

A nurse is caring for a client in the ED who came in via ambulance after a severe motor vehicle accident. Suddenly, the client shouts with difficulty, "Awe! I have severe chest pain that goes around to my back! Please help me!" What type of aneurysm would the nurse anticipate to cause this symptom? A. Saccular aneurysm B. Fusiform aneurysm C. Dissecting aneurysm D. Pseudoaneurysm

C

A nurse is caring for a client who was hit on the head with a hammer. The client was unconscious at the scene briefly but is now conscious upon arrival at the emergency department with a GCS score of 15. One hour later, the nurse assesses a GCS score of 3. What is the priority action of the nurse? A. Lower the head of the bed B. Continue to monitor the client C. Notify the provider D. Stimulate the client hourly

C

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

C

A nurse is caring for a mechanically ventilated client with a sustained intracranial pressure (ICP) of 18 mm Hg. The nurse needs to perform an hourly neurological assessment, suction the endotracheal tube, perform oral hygiene care, and reposition the patient to the left side. What is the best action by the nurse? A. Apply bilateral heel protectors after repositioning B. Hyperoxygenate during endotracheal suctioning C. Provide rest periods between nursing interventions D. Elevate the patient's head of the bed 30 degrees

C

Daily weights are being recorded for the client with a urine output that has been less than the intravenous and oral intake. The weight yesterday was 97.5 kg. This morning it is 99 kg. A nurse understands that this corresponds to a(n) A. fluid loss of 0.5 liters. B. equal intake and output due to insensible losses. C. fluid retention of 1.5 liters. D. fluid loss of 1.5 liters.

C

During rounds, the provider alerts the team that proning is being considered for a patient with acute respiratory distress syndrome. The nurse understands that proning is A. used to provide continuous lateral rotational turning. B. less of a risk for skin breakdown because the patient is face down. C. an optional treatment to improve ventilation. D. possible with minimal help from coworkers.

C

The nurse calculates the PaO2/FiO2 ratio for the following values: PaO2 is 78 mm Hg; FiO2 is 0.6 (60%) and determines it to be: A. Not enough data to compute the ratio B. 46.8; meets criteria for ARDS C. 130; meets criteria for ARDS D. 468; normal lung function

C

The nurse is caring for a patient with acute respiratory distress syndrome who is hypoxemic despite mechanical ventilation. The provider prescribes a nontraditional ventilator mode as part of treatment. Despite sedation and analgesia, the patient remains restless and appears to be in discomfort. The nurse informs the provider of this assessment and anticipates an order for A. continuous lateral rotation therapy. B. prone positioning. C. neuromuscular blockade. D. guided imagery.

C

When fluid is present in the alveoli, A. alveoli collapse, and atelectasis occurs. B. hypoventilation occurs. C. diffusion of oxygen and carbon dioxide is impaired. D. the patient is in heart failure.

C

Which of the following treatments may be used to dissolve a thrombus that is lodged in the pulmonary artery? A. Embolectomy B. Aspirin C. Thrombolytics D. Heparin

C

A client is admitted with an acute myocardial infarction (AMI). A nurse knows that an angiotensin-converting enzyme (ACE) inhibitor should be started within 24 hours to reduce the incidence of which process? A. Hibernating myocardium B. Tachycardia C. Myocardial stunning D. Myocardial remodeling

D

A client is diagnosed with acute kidney injury and has been getting dialysis 3 days per week. The client complains of general malaise and is tachypneic. An arterial blood gas shows that the patient's pH is 7.19, with a PCO2 of 30 mm Hg and a bicarbonate level of 13 mEq/L. A nurse prepares to A. cancel tomorrow's dialysis session. B. administer morphine to slow the respiratory rate. C. prepare for intubation and mechanical ventilation. D. administer intravenous sodium bicarbonate.

D

A client presents to the emergency department (ED) with chest pain that they have had for the past 2 hours. The client is nauseated and diaphoretic, with dusky skin color. The electrocardiogram shows ST elevation in leads II, III, and aVF. Which therapeutic intervention would the nurse question as potentially inappropriate? A. Emergent percutaneous coronary intervention B. Emergent thrombolytic therapy C. Immediate coronary artery bypass graft surgery D. Permanent pacemaker insertion

D

A client with a complete spinal cord injury has a prescription for solumedrol 30 mg/kg over 15 minutes followed in 45 minutes with an infusion of 5.4 mg/kg/hr for 23 hours. What is the total 24-hour dose for the 70-kg client? A. 7,478 mg B. 5,978 mg C. 12,750 mg D. 10,794 mg

D

A client with a head injury has an intracranial pressure (ICP) of 18 mm Hg. The blood pressure is 144/90 mm Hg and mean arterial pressure (MAP) is 108 mm Hg. What is the cerebral perfusion pressure (CPP)? A. 54 mm Hg B. 126 mm Hg C. 72 mm Hg D. 90 mm Hg

D

A nurse is caring for a client in the ICU who requires a ventilator. The nurse is aware that a ventilator may increase the risk of a pneumothorax in the client who uses it. Which best describes how this machine can cause a pneumothorax? A. The endotracheal tube causes damage to the structures of the respiratory system, which leads to an air leak B. Increased oxygen delivered by the ventilator damages the lungs and leads to a pneumothorax C. The use of a ventilator is associated with an increase in the risk of infection, which ultimately breaks down lung tissue D. The pressure from the ventilator causes a rupture in the lung tissue

D

A nurse is caring for a client who has a diminished level of consciousness on mechanical ventilation. While performing endotracheal suctioning, the client reaches up in an attempt to grab the suction catheter. What is the best interpretation by the nurse? A. The patient is exhibiting flexion posturing B. The patient is withdrawing to stimulation C. The patient is exhibiting extension posturing D. The patient is exhibiting purposeful movement

D

A nurse is caring for a client who sustained a closed head injury. After insertion of a ventriculostomy, the nurse assesses the following vital signs: blood pressure 100/60 mm Hg, heart rate 52 beats/min, respiratory rate 24 breaths/min, oxygen saturation (SpO2) 97% on supplemental oxygen at 45% via Venturi mask, Glasgow Coma Scale score of 4, and intracranial pressure (ICP) of 18 mm Hg. Which order should the nurse institute first? A. Portable chest x-ray B. Ancef 1 g intravenous C. Seizure precautions D. Mannitol 1 g intravenous

D

A nurse is caring for a client with a new onset of slurred speech and right-sided weakness. What is the priority nursing action? A. Assess for the presence of a headache B. Determine the patient's drug allergies C. Assess the patient's general orientation D. Determine the time of symptom onset

D

A nurse is caring for a client with bacterial meningitis. To prevent the spread of nosocomial infections to other patients, what is the best action by the nurse? A. Dispose of all bloody dressings in biohazard bags B. Wash hands thoroughly before leaving the room C. Scrub the hub of all central line ports before use D. Implement droplet precautions upon admission

D

A nurse is caring for an athlete with a possible cervical spine (C5) injury following a diving accident. The nurse assesses a blood pressure of 70/50 mm Hg, heart rate 45 beats/min, and respirations 26 breaths/min. Your patient's skin is warm and flushed. What is your best interpretation of these findings? A. Homeostasis B. Hyperthermia C. Allergic reaction D. Neurogenic shock

D

A nurse is providing care to a client who is on fibrinolytic therapy. What statement from the client warrants further assessment and intervention by the critical care nurse? A. "Look at the bruises on my arms!" B. "There is blood on my toothbrush!" C. "My arm is bleeding where my IV is!" D. "I have an incredible headache!"

D

After receiving the handoff report from the day shift charge nurse, which client should the evening charge nurse assess first? A. A client with bacterial meningitis on droplet precautions B. A mechanically ventilated client with a GCS of 6 C. A client with meningitis complaining of photophobia D. A client with an intracranial pressure ICP of 20 mm Hg and an oral temperature of 104°F

D

An unconscious client with an opioid overdose is triaged in the ED. ABG values reflect respiratory acidosis. Which of the following interventions address the cause of this client's respiratory acidosis? A. Initiate BiPAP B. Give oxygen at 4 LPM C. Administer salmeterol D. Administer naloxone

D

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

D

The etiology of noncardiogenic pulmonary edema in acute respiratory distress syndrome (ARDS) is related to damage to the A. trachea. B. left ventricle. C. mainstem bronchus. D. alveolar-capillary membrane.

D

The nurse is caring for a patient with a diagnosis of pulmonary embolism. The nurse understands that the most common cause of a pulmonary embolus is A. fat embolus from a long bone fracture B. vegetation that dislodges from an infected central venous catheter C. amniotic fluid embolus D. deep vein thrombosis from lower extremities

D

Which client in the emergency department is the most at risk for developing hypovolemic shock? A. A client with slight rectal bleeding from inflamed hemorrhoids B. A client admitted with abdominal pain and an elevated white blood cell count C. A client with a temperature of 102° F and a general dermal rash D. A client with a 2-day history of nausea, vomiting, and diarrhea

D

Which nursing interventions would be appropriate after angioplasty? A. Instruct the patient to bend his or her knee every 15 minutes while the sheath is in place B. Maintain NPO status for 12 hours C. Elevate the head of the bed by 45 degrees for 6 hours D. Assess pedal pulses on the involved limb every 15 minutes for 1 to 2 hours

D

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

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

Which of the following are physiological effects of positive end-expiratory pressure (PEEP) used in the treatment of ARDS (select all that apply)? Prevents collapse of unstable alveoli Opens collapsed alveoli Increases functional residual capacity Improves arterial oxygenation Improves carbon dioxide retention

Prevents collapse of unstable alveoli Opens collapsed alveoli Increases functional residual capacity Improves arterial oxygenation

The most common reasons for initiating dialysis in acute kidney injury include which of the following (select all that apply)? Volume overload Hyperkalemia Hypokalemia Acidosis Uremia

Volume overload Hyperkalemia Acidosis Uremia