Critical Care Nursing Practice Exam

cardiologist told pt and family that dx is hypertrophic cardiomyopathy; what cause this condition is?

"inherited condition. you should give serious consideration to having family members screened for it"

which statement from pt indicates good understanding of dx of coronary disease?

"pain in my chest gets worse each time it happens. i think that there is more dmg to my heart vessels as time goes on"

normal cardiac index?

1.2

nurse calculate pao2/fio2 ratio for the following values: PaO2 78, FiO2 0.6 (60%)

130; meets criteria for ARDS

care for neutropenic pt is same for all immunocompromised pt. desires pt outcome related to medical and nursing interventions include absence of infection, negative culture, and an absolute neutrophil count of?

1500 cell/mcl or higher

what is normal cardiac index?

2.5-4.0

nurse provide postoperative care to pt who had transphenoidal hypophysectomy for benign pituitary tumor. the nurse administers replacement hydrocortisone, thyroid hormone and vasopressin. the nurse evaluates that vasopressin replacement is effective when:

2L of urine are produced in 24 hr peroid

normal cardiac output?

4-8L/min

normal artery occlusion pressure?

6-12

normal rates of the SA node when the patient is at rest is

60-100 beats per minute

20 small boxes between each p wave and 20 boxes between each r waves; what's the ventricular rate?

75 0.04x20 = .08 60/.08 = 75

what is normal pulmonary diastolic pressure?

8-15

normal SVR?

800-1200

systemic vascular resistance normal values?

800-1200

pt with ICP of 18, bp is 140/90, MAP is 108; what is cerebral perfusion pressure?

90

normal PVR?

< 250

caring for pt c insertion of IABP for cardiogenic shock unresponsive to therapy, which hemodynamic parameter is best indicates an appropriate response to therapy?

CI 2.5

which statement best describe lung allocation score (LAS) used to prioritize lung tansplant recipients?

LAS based on lab values, dx test, med dx

how to calculate for CPP?

MAP - ICP = CPP

nurse assess pt c ARDS, assessment expected is?

PAOP of 10mm and PaO2 of 55

the patient's heart rate is 70 beats per minute, but the p waves come after the QRS complex. The nurse correctly determines that the patient's heart rhythm is:

accelerated junctional rhythm

MD order stress test for pt c activity intolerance, which drug to be used?

adenosine

pt c renal transplant recipient in post-anestheisa care unit. vitals: 125/70, 115/min, 24 rr, 95% c 3L/min O2 via NC, 97.8 degrees, and CVP 2mm hg, best action by nurse?

admin fluid replacement therapy; monitor intake and output closely

clinical senario represents hyperacute rejection?

an implanted renal transplant that, upon reperfusion, becomes cyanotic

manual vent during a code, the nurse would admin ventilations following which guideline?

approx 8-10 breaths/min

critical nurse is responsible for monitoring the patient receiving continuous renal replacement therapy (CRRT). in doing so, the nurse should:

assess that blood tubing is warm to touch

nurse assessing pt c pancreatitis, in doing so, nurse

assesses symptoms that could indicate involvement of the stomach

which of the following statement about family assessment is false?

assessment of structure (who comprises the family) is the last step in assessment

pt c lymphoma and has normal wbc; nurse understands pt is:

at risk for infection

pt c brain dead, 30 mins into shift, vitals 75/50, 85, 12, 99% 93.8 degrees; which MD order should be implemented first?

begin phenylephride (neo-synephrine) for SBP < 90

management of DKA and hyperosmolar hyperglycemic syndrome, when is IV solution that contains dextrose be started?

blood glucose reaches 250 mg/dl

which rhythm would be an emergency indication for the application of a transcutaneous pacemaker

bradycardia (hr 50 beats/min) c hypotension and syncope

as part of nursing management of critically ill patient, orders are written to keep the head of the bed elevated at 30 degrees, awaken the patient from sedation each morning to assess readiness to wean from mech vent, and implement oral care protocol every 4 hours. These intervention are done as a group to reduce the risk of vent-associated pneumonia. This group of evidence-based interventions is often called:

bundle of care

pt c end stage liver disease; nurse knows that pt at risk for hyperdynamic circulation and varies. which of the following assessment indicates hyperdynamic status?

cardiac output of 8L/min

nurse is educating pt family member about pulmonary artery catheter. which statement by the family member best indicates understanding of the purpose of the PAC?

cath will allow physician to better manage fluid therapy

pt c head trauma following a fall. pt vitals 112/min, 88/50; poor skin turgor, dry MM, pt confused and restless. labs 115 na, 50bun, cr 1.8; consistent c which disorder?

cerebral salt wasting

liver detoxifies the blood by:

converting fat-soluble compounds to water-soluble compounds

what is myocardial infarction?

death of cardiac muscle from lack of O2

what would be seen in a patient c myxedema coma

decreased reflexes

pt new onset of slurred speech and r sided weakness, what priority action?

determine time of symptom onset

nurse is caring for pt who has arterial line inserted; to reduce risk of complications, what is the priority nursing intervention?

ensure all tubing connections are tightened

during insertion of pulmonary artery cath, physician ask nurse to assist by inflating the balloon with 1.5cc of air. As the MD advances the cat, the nurse notice premature vent contraction on the monitor. what is the best action?

ensure lidocaine hydrochloride IV is immediately available.

which intervention is appropriate to assist the patient to cope with admission to the critical care unit

explaining all procedures in easy-to-understand terms

patient on vent, using critical care pain observation tool; which of the following assessment would indicate the greatest likelihood of pain and need for nursing intervent?

fighting the vent

pt remains npo from abdominal surgery complication; ET tube feeding not possible; therefore need parenteral feeding. major complication for this therapy?

fluid and electrolyte imblances and sepsis

daily weight recorded for pt. urine < IV and oral intake. yesterday was 97.5kg and am is 99kg. nurse understands that this corresponds to:

fluid retention of 1.5L

nurse is examining the patient's cardiac rhythm strip in lead II and notice all P waves are upright and look the same except one that has a different shape and is inverted. the nurse realizes that P wave with abnormal shape is probably:

from some area in the atria other than SA node

which nursing interven would best support the family of a critically ill patient?

give condition update each morning and whenever changes occur

blood work includes h/h, nurse understands that

hematocrit values does not change substantially during the first few hours

PaCo2 of 48mmhg is associated with

hyperventilation

pt who underwent pituitary surgery 12 hrs ago, nurse will give priority monitoring to which?

hypovolemic shock

nurse examines the pt CBC, nurse notice elevated in eosinophil count. nurse realizes that eosinophil becomes elevated:

in response to allergen and parasites

patient is being mech vent in the synchronized intermittent mandatory vent mode at a rate of 4 breath/min. His spontaneous respirations are 12 breath/min. He rec'd a dose of morphine sulfate, and his resp decrease to 4 breath/min. What adjustments may need to be made to the patient's vent settings?

increase the synchronized intermittent mandatory vent respiratory rate

tissue damage from brain injury activates inflammatory response that increases the pt's risk for

infection

asthma exacerbation, what tx?

inhaled bronchodilators and IV corticosteroids?

a patient's feeding tube has been successfully placed in small intestine with continuous flow tube feeding. the nurse knows that this approach was chosen because:

intestinal mucosa normally rc'd nutrient from stomach in peristaltic waves

pt is admitted c complaint of general malaise and fatigue c decrease urinary output; pt uralysis shows coarse, muddy brown granular casts and hematuria; nurse determines pt has

intrarenal disease, probably acute tubular necrosis

pt admit after collapsing end of summer marathon. pt lethargic, hr 110, rr 30/min, bp 78/46; admit what?

lactated ringer's bolus

18 YO sustain multiple traumatic injuries from MVA; bp 80/60, pt should be treated at which level trauma center?

level I

patient's heart rhythm shows an inverted p wave with PR interval of 0.06 seconds. the heart rate is 54 beats per minute. The nurse recognize the rhythm as a junctional escape rhythm, and understands that the rhythm is due to the

loss of sinus node activity

pt turned prone as tx for ARDS, nurse understands priority nursing concern for this pt is which of the following?

management and protection of the airway

charge nurse has a vigileo pulse contour cardiac output monitoring system available for use in the surgical intensive unit. For which patient is used of this device most appropriate?

mech vent patient admitted following a repair of acute bowel obstruction

65 YO pt c history of metastatic lung carcinoma has been unresponsive to chemo. the medical team has determined that there are no additional tx available that will prolong life or improve the quality of life in any meaningful way. Despite the poor prognosis, the pt continues to rc'd chemo and full nutrition support. what is this example of end of life concept?

medical futility

PaO2/FiO2 = 200-300, ARDS severity?

mild

PaO2/FiO2 = 100-200, ARDS severity?

moderate

pt c skull fracture c GCS of 3, vitals 100/70, 55 hr, rr 10, O2 @ 94% on 3L NC; what nursing action?

monitor for patent airway

pt c end stage HF is experiencing considerable dyspnea. which med is appropriate?

morphing, 5 mg IV, and initiate continuous morphine infusion

during tx and management of trauma pt, maintaining tissue perfusion, oxygenation, and nutritional support are strategies to prevent:

multisystem organ dysfunction

pt admitted c angina attack. nurse anticipates which drug regimen to be initiated?

nitro, o2, beta blockers

nurse assessing pt who admitted c abdominal pain. detects abdominal masses, the nurse

nurse has pt take a deep breath

neuromuscular blocking agents are used in the management of some vent patient. their primary mode of action is

paralysis

neuromuscular blocking agents are used in the management of some vent patient; their primary mdoe of action is

paralysis

pt admitted c dx of unstable angina. nurse knows that physiological mech present is most likely which of the following?

partial occlusion of coronary artery c thrombus

nurse is caring for mech vent patient being monitored with L radial arterial line. during the inspiratory phase of vent, the nurse assesses a 20 mm hg decrease in art blood pressure. what is the best interpretation of this finding by the nurse?

patient may require fluid restriction

which patient at greatest risk for malabsorption of protein?

patient with ileitis

pt has pulseless electrical activity; MD decide cause of PEA is pericardial tamponade. appropriate tx is?

pericardiocentesis

pt c AKI and being tx with hemodialysis, pt ask if he will need dialysis for rest of his life, which is best response?

recovery is possible, but takes several month

the most important outcome of effective communication is to:

reduce patient error

slow continuous ultrafiltration is also known as isolated ultrafiltration and used to:

remove plasma water in case of volume overload

renal transplant pt c acute rejection episode. how to know kidneys will be rejected?

renal biopsy

pt c ACRDS, identifies risk for ineffective airway clearance; what intevention?

reposition q 2 hrs

fluid resuscitation can be assessed best in trauma pt by monitoring and trending which of the following tests?

serum lactate level

PaO2/FiO2 = <100, ARDS severity?

severe

many critically ill patients experience anxiety. the nurse can reduce anxiety with which approach?

state, "mr J, it's time to turn you. I'm going to ask another nurse to come in and help me. We will turn you to your left. During the turn, I'm going to inspect the skin on your back and rub some lotion on your back. This should help you feel better."

patient on tube feeding require xray for cough eval; to reduce risk of aspiration, the nurse:

stops feeding 10-15 minutes before placing flat to obtain the radiograph

d/c pt c asthma, part of d/c instructions, the nurse instruct pt to prevent exacerbation by

taking all asthma meds as prescribed

PEEP is a mode of vent assist that produces the following condition:

there is pressure remaining in the lungs at the end of expiration that is measured in cm H2O

nurse caring for pt 70kg in hypovolemic shock. upon initial assessment, nurse notes bp 90/50, HR 125/min, rr 32/min, central venous pressure (CVP/RAP) of 3 mm hg, urine 5cc past hr. following MD rounds, nurse review orders and question which?

titrate dopamine IV for bp < 90 SBP

best way to administer benzo intermittently is?

titrate to a predefined endpoint using a standard sedation scale

SaO2 represents

total oxygen consumption

pt c head trauma, what his important assessment to assist nurse in early ID of endocrine disorder commonly associated c this condition?

urine osmolarity

minor vessel injury, primary hemostasis is acheived

usually

which of the following statement about resuscitation is true?

withholding "extraordinary" resuscitation is legal and ethical if specified in advance directives and physician orders.

working in an intermediate care unit that has experienced high nursing turn over. the nurse manager is often considered to be an autocratic leader by staff members and her leadership style is contributing to turnover. you have asked to involve in developing new guidelines to prevent pressure ulcers in your patient population. The nurse manager tells you that you do not yet have enough experience to be on the prevention task force. this situation and setting is an example of:

work environment that is unhealthy