Critical Care Final Review

The prescriber orders a Heparin infusion 25,000 units/250 cc D5W to be initiated at 12 units/kg/hr minutes. Patient weight: 190 lbs How many mL/hr will the nurse set the volumetric pump for?

10.4

400 L of 0.45% NS to be infused over 6 hours. Drop factor: 15 drops/mL What is the flow rate in drops/ minute

17 drops/ minute

The prescriber orders KCL 10meq/100cc D5W to infuse over thirty minutes. How many mL/hr wil the nurse set the volumetric pump for?

200

The prescriber orders Precedex infusion 200 mcg/50 mL to begin at 0.4mcg/kg/hr Patient's weight: 120 pounds How many mL/ hr will the nurse set the volumetric pump for?

3.3 mL/hr

The prescriber orders Ditiazem 20mg IVP STAT. Available: Ditiazem 25mg/ 5mL How many mLs will the nurse administer?

4

The prescriber orders: Amoxil 200 mg orally four times a day Available: Amoxil 250mg/ 5ml How many mL will the nurse administer per dose?

4 mL

The prescriber orders an Amiodarone bolus 150 mg/100 cc D5W to be infuse over 10 minutes. How many mL /hr will the nurse set the volumetric pump for?

600

Which finding would indicates a decrease in pressure with mechanical ventilation?

a .Kinked tubing b. Increased lung compliance c. Decrease in lung compliance d. Plugged airway tube

A client in the CCU has a swan-ganz catheter. His cardiac output is 3.5, assuming a normal fluid volume status, The nurse can anticipate what pharmacological intervention?

a. A 40 mg Lasix (Furosemide) bolus b. A Dobutamine (Dobutrex) drip c. A Levophed (Norepinephrine) drip d. A Nitroglycerine (Tridil) drip

Which patient listed below would be the most at risk for the development of an aortic aneurysm?

a. A 60 year-old male with a history of atherosclerosis b. A 40 year old male wit a history of HTN c. A 55 year old female with a history of COPD d. A 77 year old female with a history of diabetes

A nurse assesses a patient who us cardiogenic shock. What statement best indicates the nurse's understanding of cardiogenic shock?

a. A decrease of cardiac output and evidence of tissue hypoxia in the presence of adequate intravascular volume. b. A increase in cardiac output with evidence of inadequate circulating blood volume. c. Severe vasodilatition caused by inflammatory cytokinins. d. Due to severe hypersensitivity reaction resulting in massive vasodilation.

A patient in a septic shock. Which of the following indicates inadequate tissue perfusion?

a. A mixed venous sample with saturation level of 55% and a Lactate level of 8 mmol/L b. A mixed venous sample with saturation level of 70% and a Lactate level of 1.5 mmol/L c. A mixed venous sample with saturation level of 75% and a Lactate level of 2 mmol/L d. An arterial blood gas with a PCO2 of 50 and lactate level of 0.5 mmol/L

Which of the following suggests inhalation injury in the burn client?

a. A negative carboxyhemoglobin level b. Thick white sputum produced when coughing c. Signed nasal hair d. A pulse oximetry reading of 95%

The ICU nurse is caring for a client who was admitted with a diagnosis of smoke inhalation. The nurse knows that this client is at increased risk for which of the following ?

a. Acute respiratory distress syndrome b. Transfusion related lung Injury c. pneumothorax d. Tracheobronchitis

The nurse is caring for a patient diagnosed with septic shock. Which of the following interventions need to be implemented with the first hour diagnosis?

a. Administer Tylenol b. Send Lactic acid levels c. Administer oral antibiotics d. Apply s cooling blanket c. Administer oral antibiotics

A client is recovering in the hospital from cardiac surgery. The nurse has identified the diagnosis of risk for ineffective airway clearance related to pulmonary secretions. What

a. Administration of bronchodilators by nebulizer b. Administration of inhaled corticosteroids by metered dose inhaler (MDI) c. Clients consistent performance of deep breathing and coughing exercises. d. Clients active participation in the cardiac rehabilitation program.

Mr. Raj is in the hospital for a myocardial infarction. He has a history of CAD, atrial fibrillation, COPD, Diabetes and mild kidney disease. What finding/ symptom would be most concerning to the nurse?

a. An arterial blood gas with a PaCOP2 reading of 47 and PH of 7.39 b. Blood test showing a positive Troponin with decreasing creatine-kinase levels. c. The patient awakens at 1 am with nausea and GI upset. d. An irregular heart rhythm a rate of 67.

A client with an occluded coronary artery is admitted and has an emergency percutoneous Transluminal coronary angioplasty(PTCA). The client is admitted to the cardiac critical care unit after procedure. The complication for which the nurse should monitor the client include which of the following?

a. Bleeding at the insertion site b. Left ventricular hypertrophy c. Post procedure low level chest pressure d.Rare to occasional premature ventricular beats

A victim has sustained a blunt force trauma to the chest. A pulmonary contusion is suspected. Which of the following clinical manifestations correlate with a moderate pulmonary contusion?

a. Blood -tinged sputum b. Bradypnea c. Respiratory alkalosis d. Productive cough

The staff educator is presenting a workshop on valvular disorders. When discussing the pathophysiology of aortic regurgitation, the educator describes what consequence of this disorder?

a. Cardiac Tamponade b. Right sided heart failure c. Left ventricular hypertrophy d. Ventricular insufficiency

In the diuretic phase of AKI( Acute Kidney Injury) the nurse is monitoring for which of the following complications?

a. Dehydration b. Constipation c. Periorbital edema d. Fluid volume overload

The 62 year old client is admitted to the hospital vomiting bright red blood(BRB). He has a Hx of ETOH abuse and admits to the drinking a pint of Vodka a day. The nurse would anticipate which order as a priority?

a. Discuss with the client his readiness to quit drinking. b. Type and Screen for 4 units of PRBC'S(Packed red blood cells) c. Start the approved alcohol detoxification protocol. d. Start a intravenous vasopressor.

The ESRD(End Stage Renal Disease) client goes to the out-patient dialysis treatment center for his routine dialysis tells the nurse he has been nauseous and vomiting for 3 days. He ha a history of congestive heart failure and takes daily digoxin. He is at increased risk for which complication during dialysis.

a. Dysthymias b. Bleeding c. Hypertenson d. Hyperglycemia

The nurse is caring for an adult client who has gone into ventricular fibrillation. When assisting with defibrillation the client, What must the nurse do?

a. Ensure that the defibrillator is set in synchronized mode. b. Apply ultrasound gel c. Call " all clear" once before discharging the defibrillator. d. Maintain firm contact between paddles and client skin.

Which of the following best describes prophylactic shock.

a. Excessive fluid loss caused by dehydration or hemorrhage. b. Vasodilatory state caused by massive histamine release. c. A low flow state cussed by myocardial infarction d. Systematic infection leading to cellular edema

A client who involved in a workplace accident suffered a penetrating wound of the chest that led respiratory failure. What goal of treatment should the care team prioritize when planning this client's care?

a. Facilitation of long term intubation. b. Restoration of adequate gas exchange c. Attainment of effective coping d. Self-management of oxygen therapy

A client has been admitted to a burn intensive care unit with extensive full thickness burns over 25% of the body. After ensuring cardiopulmonary stability, What would be the nurse's immediate PRIORITY concern when planning this client's care?

a. Fluid status b. Risk of infection c. Nutritional status d. Initiation of physical therapy e. Psychological coping c. Nutritional status

When caring for a client with acute respiratory failure, the nurse should expect to focus on resolving which set of problems?

a. Hypo tension, hyperglycemia, and hypercapnia b. Hyperventilation, hypertension, and hypocapnia c. Low HCO3 levles, hypocapnia, and hyperventilation d. Hypercapnia, hypo ventilation, and hypoxemia

In caring for a patient post-cardiac arrest who is 8 hours into the cooled phase of hypothermia therapy which sign would be the most concerning to the nurse?

a. Hypokalemia b.Slight twitching of the sternocleidomastoid muscle. c. A core body temperature reflective of hypothermia d.A positive troponin A. Hypokalemia

A nurse educator is teaching students the types of shock and associated causes. Which combination of shock type and causative factors are correct? Select all the apply

a. Hypovolemic shock blood loss b. Cardiogenic shock, myocardial infarction c. Anaphylactic shock, nuts d. Neurogenic shock. multiple sclerosis

Which ventilator mode provides full ventilatory support by delivering a preset tidal volume and respiratory rate?

a. IMV b. SIMV c. Assist control d.Pressure support c. Assist control

How does the Intra -aortic balloon pump help with myocardial function?

a. Improves cardiac function by decreasing after load and augmenting coronary filling. b. Decreases preload while increasing after load thereby helping with cardiac output. c. It inflates during systole and deflates during diastole, which improves cardiac output. d. By completely taking over the action of the left ventricle thereby allowing the heart to recover.

A client has sustained severe burn injury and its though to have an impaired intestinal mucosal barrier. What intervention will best assist in avoiding increased intestinal permeability and permeability and prevent early endotoxin translocation?

a. Initiating TPN(Total parental nutrition) b. Administration of prophylactic antibiotics c. Early enteral feeding d. Administration of stool softener c. Early enteral feeding

A client is post open heart surgery(CABG) for coronary artery disease. He had a history of hypertension, PTCA and diabetes. Prior to surgery his blood glucose was managed by Metformin(Glucophage). Immediately post operation his blood glucose was measured at 190. He is still intubated and has an oral gastric tube. As the nurse caring for him you would expect what intervention?

a. Intermediately resume his Metformin (Glucophage) b. Anticipate an insulin drip to maintain his blood glucose below 180. c. Continue to closely monitor and alert the provider if the blood glucose goes above 200. d. Give Lantus ( Insulin Glargine)and obtain an order for sliding scale insulin coverage.

A client diagnosed with acute respiratory failure is suspected of developing acute respiratory distress syndrome( ARDS). The client is restless and has a low oxygen saturation level. If the client's condition does not improve and the oxygen saturation level continues to decrease, What procedure will the nurse expect to assist which in order to help the client breathe more easily?

a. Intubate the client and control breathing with mechanical ventilation b. Increase oxygen administration c. Administer a large dose of furosemide (Lasix) IVP stat. d. Schedule the client for pulmonary surgery.

The nursing instructor is discussing shock with the senior nursing students . The instructor tells the students that shock is a life -threatening condition. What else should the instructor tell the students about all shock states?

a. It causes respiratory distress syndrome. b. It begins when peripheral blood flow is inadequate. c. It is a state of inadequate tissue perfusion. d. It is component of any trauma.

What is the first sign of peritonitis for a client receiving peritoneal dialysis?

a. Leakage of dialysate fluid through the catheter site b. Cloudy dialysate drainage c. Abdominal pain d. Increased retention of fluid a. Leakage of dialysate fluid through the catheter site

A patient with congestive heat failure has gained 5lbs. over the last week. He has +2 pitting edema and hepatomegaly. He most likely has..

a. Left sided heart failure b. Liver disease c. Corpulmonade d. The beginning stages of cardiogenic shock.

Which ABG abnormality is commonly associated with a patient who is in the compensatory phase of shock

a. Metabolic alkolosis b. Respiratory acidosis c. Respiratory alkolosis d. Metabolic acidosis D. Metabolic acidosis

Continuous Renal Replacement Therapy(CRRT) is indicated for client with or chronic renal failure who are?

a. Oliguric b. Clinically unstable for traditional hemodialysis. c. Transitioning to home hemodialysis. d. No answer test provided.

An adult client with third -degree AV block is admitted to the cardiac care unit and placed on continuous cardiac monitoring. What rhythm characteristic will the ECG most likely show?

a. P waves appear in 1:1 ratio with QRS complexes. b.PR interval gradually lengthens until a QRS complex is dropped. c. More P was than QRS complexes PRI varies. d. PR interval is constant.

When assessing a client's potential for pulmonary emboli, what finding by the nurse indicates possible deep vein thrombosis?

a. Pain in the feet b. Inability to dorsiflex c. Negative Homan's sign d. Pain in the calf d. Pain in the calf

A client admitted to the hospital following a motor vehicle crash has suffered a flail chest. The nurse assesses the client for what most common clinical manifestation of flail chest ?

a. Paradoxical chest movement b. Cyanosis c. Hypertension d. Wheezing

The nurse is assessing and adult client following a motor vehicle accident. The nurse observes that the client has an increased use of necessary muscles and is reporting chest pain and shortness of breath. The nurse should recognize the possibility of what condition?

a. Pneumothorax b. Cardiac ischemia c. Pericardial d. Aspiration a. Pneumothorax

A 65 year old male patient is brought into the hospital by ambulance complaining of chest pains. He has a history of previous myocardial infarction. Once attached to the monitor you determine he is in a junctional rhythm. His heart rate is 43 bpm and his blood pressure is 77/50. What emergency measures are most likely to be ordered by the provider?

a. Position his bed in a reverse Trendelenburg position b. Administer sublingual Nitroglycerine c. Administer Amiodarone PO. d. Administer Atropine IV push

The nurse is caring for a client with a T 5 injury who has Spinal Shock. The nurse would expect to observe which assessment findings?

a. Positive Babinski along with spatic extremities b. A positive oculocephalic reflex c. Absent reflexes along with spatic extremities d. A paralytic ileus

A patient is being cared for in the Neurological Intensive Care Unit following a spinal cord injury to C2. Which intervention should be the priority?

a. Prepare the patient for intubation ensuring a jaw - trust maneuver is utilized. b.Place the patient on BIPAP therapy until the spine can be stabilized. c. Apply a 100% non- re breather mask to keep the pulse oximetry above 95%. d. Ensure that the neck brace is in place prior to the application of halo traction.

What is the correct interpretation of the above telemetry strip?

a. Pulse less electrical activity b. One of the monitoring leads has fallen off. c. Ventricular fibrillation d. Torsades de pointes c. Ventricular fibrillation

The nurse is assessing a client who, after an extensive surgical procedure, is at risk for developing acute respiratory distress syndrome(ARDS). The nurse assesses for which most common sign of ARDS?

a. Rapid onset of severe dyspnea b. Inspiratory crackles c. Bilateral wheezing d. Cyanosis

A client has been admitted to ICU after sustaining burns from a house fire. His burns are located in the groin area and both thighs have circumferential burns, When assessing the client's legs distal to the wounds the nurse must be aware of which complication is the most at risk for?

a. Referred pain b. Compartment syndrome c. Cellulitis d. Burn- shock state

The nurse is caring for a client experiencing Autonomic Dysreflexia. What manifestations will the nurse expect to find in this client?

a. Respiratory distress and projectile vomiting b. Bradycardia and hypertension c. Tachycardia and agitation d. Third spacing and hyperthermia

The nurse is assessing a head trauma Client utilizing the Glasgow Coma Scale. The client has a score of 4. This would indicate?

a. Severe brain injury b. Moderate brain injury c. Mild brain injury d. Normal function A. Severe brain injury

Positive end-expiratory pressure(PEEP) therapy has which effect on the heart?

a. Tachycardia b. Increased blood pressure c. Reduced cardiac output

The patient with a chest tube is being transported to X-ray. Which complication may occur if the chest tube is clampled during transportation?

a. Tension Pneumothorax b. Cardiac tamponade c. Flail chest d. Pulmonary contusion A. Tension Pneumothorax

The ICU nurse caring for a patient in shock is administering vasoactive medications per orders. The nurse should administer this medication in what way?

a. Through central venous line b. By a gravity infusion IV set c. By IV push for rapid onset d. Through a peripheral line

A patient is admitted to the emergency department after a motorcycle accident. Upon assessment, the patient's vital signs reveal blood pressure of 80/60 mm Hg, heart rate of 145 beats per minute and oxygen saturation of 75%. Which medical order for this patient will the nurse complete first?

a. Two large bore IVs and begin crystalloid fluids b.Initiate a norepinephrine infusion c. Send a CBC d. 100% oxygen via a nonrebreather mask

The most serious complication of increased intracranial pressure is?

a. Ventricular dysthymias b. Coma c. Neurogenic pulmonary edema d. Brain stem herniation

A client the nurse is caring for has a permanent pacemaker implanted with the identification code beginning with VV1. What does this indicate?

a. Ventricular paced, ventricular sensed, inhibited b. Variable paced, ventricular sensed, inhibited c. Ventricular sensed, ventricular situated, implanted d. Variable sensed, variable paced, inhibited

A patient is admitted to the emergency department with deep partial- thickness burns over 35 % of the body. What IV solution will be started initially?

a. lactated Ringer's solution b. dextrose 5% with saline solution c. dextrose 5% with water d. 45 normal saline solution a. lactated Ringer's solution

The nurse is interpreting blood gases for a client with acute respiratory distress syndrome(ARDS). Which set of blood gas values indicates respiratory acidosis?

a. pH 7.30, PaCO2 30, HCO3 16 b. pH 7.20, PaCO2 50, HCO3 18 C.pH 7.49, PaCO2 30, HCO3 25 d. pH 7.25, PaCO2 48, HCO3 24 D. pH 7.25, PaCO2 48, HCO3 24

A physician stated to the nurse that the client has fluid in the pleural space and will need a thorocentesis. The nurse expects the physician to document this fluid as

a. pleural effusion b. pneumothorax c. hemothorax d. consolidation

A client who has undergone a valve replacement with a mechanical valve prosthesis is due to be discharged home. During discharge teaching, the nurse should discuss the importance of antibiotic prophylaxis prior to which of the following?

a.Exposure to immunosuppressed individuals b. During influenza season c. Dental procedures involving manipulation of gingival tissues d. Before taking vaccinations

The nurse is caring for a client on a ventilator. Which nursing care measures should the nurse plan on when caring for the client . Pick all that apply.

a.Head of the bed at least 30 degrees. b. Oral care c. DVT and GI prophylaxis d. Endotrachael suctioning Q2 hours e. Daily interruption of sedation

The nurse should monitor a client receiving mechanical ventilation for which of the following complications?

a.Pneumonia b. Immunosupression c. Decreased cardiac output d.Pulmonary emboli

The MD has ordered to keep the post-op neurosurgical patient's head, neck and shoulders in alignment. The nurse knows this is to?

a.Promote venous return b. Prevent aspiration c. To increase intracranial pressure d. Prevent papilledema

ECMO VV therapy can best be describes as:

a.Removing blood from the body to cleanse it from inflammatory mediators and returning it. b. Removing from the body, oxygenating the blood and returning it to the body. c. Offloading the left ventricle by as much as 5 liters per minute d. Augmenting coronary perfusion during diastole.

You are caring for a client status post lung resection. When assessing your clinet you find that the bubbling in the water-seal chamber for the chest tubes is more than you expected. What should you check when bubbling in the water -seal chamber is excessive?

a.See if the chest tube is clogged. b. See if the wall suction unit has malfunctioned c. See if a kink has developed in the tubing d.See if there are leaks in the system

A client with pneumonia and renal insufficiency is being treated with intravenous antibiotics . Which laboratory test should be monitored for renal failure? Pick all that apply.

a.Sodium level b. Creatinine c. Antibiotic Peak and Trough levels d. Hemoglobin A1C A.Sodium level B. Creatinine C. Antibiotic Peak and Trough levels

The nurse is caring for a client who is scheduled to undergo mechanical valve replacement. Client education should include one of the following?

a.Steroid therapy b. Use of IV diuretics c. Long term antibiotic use d. Long term anticoagulant therapy