Adult Three Exam Two Practice Questions
A critically ill patient has a living will in the chart. The patient's condition has deteriorated but the spouse wants "everything done" regardless of the patient's wishes. Which ethical principle is the spouse violating. a. Autonomy b. Beneficence c. Justice d. Nonmaleficence
A
A patient is admitted to the cardiac surgical ICU after cardiac surgery. Four hours after admission to the ICU at 4pm, the patient has stable VS and normal ABGs and is placed on a T-piece for ventilatory weaning. The following information pertains to the 1900 assessment. Restless Increased to 110 beats/min Respirations 36 breaths/min BP 156/98 Sinus tach 10 PVCs/min Elevated pulmonary artery pressure Loud crackles throughout New ABG Results: pH 7.28 PaCO2 46, Bicarb: 22, PaO2: 58, O2 88% What interdisciplinary staff member does the nurse notify to assist in the care of this patient while preparing to give this patient diuretics? a. respiratory therapist to adjust ventilator b. social worker to notify family c. phlebotomy to obtain another set of ABGs d. nursing assistant to help reposition the patient
A
A patient is admitted to the hospital with multiple trauma and extensive blood loss .The nurse assesses vital signs to be BP 80/50, HR 135, RR 36, cardiac output (CO) of 2 L/min, systemic vascular resistance of 3000 dynes/sec/cm-5, and a hematocrit of 20%. The nurse anticipates administration of which of the following therapies or medications? a. Blood transfusion b. Furosemide c. Dobutamine infusion d. Dopamine hydrochloride infusion
A
A patient's endotracheal tube is not secured tightly. The respiratory care practitioner assists the nurse in taping the tube. After the tube is retaped, the nurse auscultates the patient's lungs and notes that the breath sounds over the left lung fields are absent. The nurse suspects that a. the endotracheal tube is in the right mainstem bronchus b. the patient has a left pneumothorax c. the patient has aspirated secretions during the procedure d. the stethoscope earpiece is clogged with wax
A
A patient's ventilator settings are adjusted to treat hypoxemia. The fraction of inspired oxygen is increased from .60 to .70, and the positive end-expiratory pressure is increased from 10 to 15 cm H2O. Shortly after these adjustments, the nurse notes that the patient's blood pressure drops from 120/76 mm Hg to 90/60 mm Hg. What is the most likely cause of this decrease in blood pressure? a.Decrease in cardiac output b.Hypovolemia c.Increase in venous return d.Oxygen toxicity
A
A statement that provides a legally recognized description of an individual's desires regarding care at the end of life is a (an): a. advance directive b. guardianship ad litem c. health care proxy d. power of attorney
A
After receiving a handoff report from the night shift, the nurse completes the morning assessment of a patient with severe sepsis. Vital signs are BP 95/60, HR 110, RR 32, SpO2 96% on 45% oxygen via venturi mask, temp 101.5, CVP/RAP 2 mmHg, and urine output of 10mL for the past hour. The nurse initiates which provider prescription first? a. administer infusion of 500mL of 0/9% NS every 4 hours as needed if the CVP is less than 5 mmHg. b. Increase supplemental oxygen therapy to maintain SpO2 greater than 94% c. Administer 40 mg furosemide (lasix) intravenous as needed if the urine output is less than 30 mL/hr d. Administer acetaminophen (tylenol) 650 mg suppository per rectum as needed to treat temp greater than 101
A
The nurse is caring for a critically ill trauma patient who is expected to be hospitalized for an extended period. Which of the following nursing interventions would improve the patient's well-being and reduce anxiety the most? a. arrange for the patients dog to be brought into the unit (per protocol) b. provide aromatherapy with scents such as lavendar taht are known to help anxiety. c. Secure the harpist to come and play soothing music for an hour every afternoon d. wheel the patient out near the unit aquarium to observe tropical fish
A
All of the patients children are distressed by the possibility of removing life support from their mother. The child that is most upset tells the nurse this is the same as killing her. I thought you were supposed to help her. The nurse explains to the family a. This is a process of allowing your mother to die naturally after the injuries taht she sustained in a serious accident. b. The hospital would never allow us to do that kind of thing c. Let's talk about this calmly, and I will explain why assisted suicide is appropriate in this case d. She's lived a long and productive life
A
Chapter 12 Questions The nurse is caring for a patient admitted with hypovolemic shock. The nurse palpates thready brachial pulses but is unable to auscultate a blood pressure. What is the best nursing action? a. Assess the BP by doppler b. Estimate the systolic pressure as 60 mmHg c. Obtain an electronic BP monitor d. Record the BP as "not assessable"
A
Chapter 9 The nurse is caring for a 100kg patient being monitored with a pulmonary artery catheter. The nurse assesses a BP of 90/60 mmHg, heart rate of 110, respirations of 36/min, O2 sat of 89% on 3L of oxygen via nasal cannula. Bilateral crackles are audible upon auscultation. Which hemodynamic value requires immediate action by the nurse? a. Cardiac index of 1.2 L/min/m3 b. Cardiac output of 4 L/min c. Pulmonary vascular resistance (PVR) of 80 dynes/sec/cm-5 d. Systemic vascular resistance (SVR) of 1400 dynes/sec/cm-5
A
The American Nurses Credential Center Magnet Recognition Program supports many actions to ensure that nurses are engaged and empowered to participate in ethical decision making. Which of the following would assist nurses in being involved in research studies? a. Education on protection of human subjects b. Participation of staff nurses on ethics committees c. Written descriptions of how nurses participate in ethics programs d. Written policies and procedures related to response to ethical issues
A
The charge nurse is supervising the care of four critical care patients being monitored using invasive hemodynamic modalities. Which patient should the charge nurse evaluate first? a. A patient in cardiogenic shock with a CO of 2.0L/min b. A patient with a pulmonary artery systolic pressure of 20 c. A hypovolemic patient with a central venous pressures of 6 d. A patient with a pulmonary artery occlusion pressure of 10
A
The emergency department nurse admits a patient following a motor vehicle collision. Vital signs include BP 70/50, HR 140, RR 36, temp 101 F and oxygen saturation 95% on 3L of oxygen via nasal cannula. Laboratory results include hemoglobin of 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 patient's plan of care? a. Insertion of an 18 gauge peripheral IV line b. Application of cushioned heel protectors c. Implementation of fall precautions d. Implementation of universal precautions
A
The family is considering the withdrawal of life sustaining measures from the patient. The nurse knows that ethical principles for withholding or withdrawing life sustaining treatments include which of the following? a. Any treatment may be withdrawn and withheld, including nutrition, antibiotics, and blood products b. Doses of analgesic and anxiolytic medications must be adjusted carefully and should not exceed usual recommended limits c. Life sustaining treatments may be withdrawn while a patient is receiving paralytic agents d. The goal of withdrawal and withholding of treatments is to hasen death and thus relieve suffering
A
The nurse is caring for a 70 kg patient in septic shock wiht a pulmonary artery catheter. Which hemodynamic value indicates an appropriate response to therapy aimed at enhancing oxygen delivery to the organs and tissues? a. Arterial lactate level of 1.0 mEq/L b. Cardiac output of 2.5 L/min c. Mixed venous of 40 %
A
The nurse is caring for a mechanically ventilated patient following insertion of a left subclavian central venous catheter. Which action by the nurse best protects against the development of a central line associated bloodstream infection (CLABSI)? a. documentation of insertion date b. elevation of the head of bed c. assessment for weaning readiness d. appropriate sedation management
A
The nurse is caring for a patient admitted with cardiogenic shock. Hemodynamic readings obtained with a pulmonary artery catheter include a PAOP of 18 mmHg and a CI of 1.0 L/min. What is the prioritiy pharmacological intervention? a. Dobutamine b. Furosemide c. Phenylephrine d. Sodium nitropursside
A
The nurse is caring for a patient following insertion of a left subclavian central venous catheter. Which action by the nurse best reduces the risk catheter related bloodstream infection? a. Review daily the necessity of the central venous catheter b. Cleanse the insertion site daily with isopropyl alcohol c. Change the pressurized tubing system and flush bag daily d. Maintain a pressure of 300mmHg on the flush bag
A
The nurse is caring for a patient following insertion of a left subclavian ventral venous catheter (CVC). Which assessment finding 2 hours after insertion by the nurse warrants immediate action? a. Diminished breath sounds over left lung field b. Localized pain at catheter insertion site c. Measured central venous pressure of 5 mmHg d. Slight bloody drainage around insertion site
A
The nurse is caring for a patient following insertion of an IABP. for cardiogenic shock unresponsive to pharmacotherapy. Which hemodynamic parameter best indicates an appropriate response to therapy? a. CI of 2.5 b. Pulmonary artery diastolic pressure of 26 mmHg c. PAOP of 22 d. SVR of 1600
A
The nurse is caring for a patient in cardiogenic shock being treated with an intraaortic balloon pump. The family inquires about the primary reason for the device. What is the best statement by the nurse to explain the IABP? a. The action of the machine will improve blood supply to the damaged heart. b. The machine will beat for the damaged heart with every beat until it heals. c. The machine will help cleanse the blood of impurities that might damage the heart d. The machine will remain in place until the patient is ready for a heart transplant
A
To prevent any unwanted resuscitation after life sustaining treatments have been withdrawn, the nurse should ensure that a. DNR orders are written before the discontinuation of the treatments b. The family is not allowed to visit until death occurs c. DNR orders are written as soon as possible after the discontinuation of the treatments d. The change of shift report includes the information that the patient is not to be resuscitated
A
The nurse is caring for a patient in septic shock. The nurse assesses the patient to have a BP of 105/60, HR 110, RR 32, SpO2 95% on 45% supplemental oxygen via venturi mask, and a temp of 102. The physician orders stat administration of an antibiotic. Which additional physician order should the nurse complete first? a. Blood cultures b. Chest xray c. Foley insertion d. Serum electrolytes
A
The nurse is caring for a patient receiving IV ibuprofen for pain management. The nurse recognizes which laboratory assessment to be a possible side effect of the ibuprofen? a. Creatinine 3.1 b. Platelet count 350,000 c. WBC 13,550 d. ALT 25
A
The nurse is caring for a patient who is mechanically ventilated. As part of the nursing care, the nurse understands that: a. communication with intubated patients is often difficult b. controlled ventilation is the preferred mode for most patients c. patients with COPD wean easily from mechanical ventilationn d. wrist restraints are applied to all patients to avoid self extubation
A
The nurse is caring for an athlete with a possible cervical spine (C5) injury following a diving accident. The nurse assesses a BP of 70/50, HR 45 bpm, RR 26. The patient's skin is warm and flushed. What is the best interpretation of these findings by the nurse? a. the patient is developing neurogenic shock b. the patient is experiencing an allergic reaction c. the patient most likely has an elevated temperature d. the vital signs are normal for this patient
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. Elevated alveolar surfactant levels c. Increased lung compliance with increased FiO2 administration d. Respiratory acidosis associated with hyperventilation
A
Upon entering the room of a patient with a right radial arterial line, the nurse assesses the waveform to be slightly dampened and notices blood to be backed up into the pressure tubing. What is the best action by the nurse? a. Check the inflation volume of the flush system pressure bag b. Disconnect the flush system from the arterial line catheter c. Zero reference the transducer system at the phlebostatic axis d. Reduce the number of stopcocks in the flush system tubing
A
Which of the following devises is best suited to deliver 65% oxygen to a patient who is spontaneously breathing? a. Face mask with non-rebreathing reservoir b. Low flow nasal cannula c. Simple face mask d. Venturi mask
A
While monitoring a patient for signs of shock, the nurse understands which system assessment to be of priority? a. Central nervous system b. Gastrointestinal system c. Renal system d. Respiratory system
A
A patient is admitted to the cardiac care unit with an acute anterior myocardial infarction. The nurse assesses the patient to be diaphoretic and tachypneic, with bilateral crackles throughout both lung fields. Following insertion of a pulmonary artery catheter by the physician, which hemodynamic values is the nurse most likely to assess? a. High pulmonary artery diastolic pressure and low cardiac output b. Low pulmonary artery occlusive pressure and low cardiac output c. Low systemic vascular resistance and high cardiac output d. Normal cardiac output and low systemic vascular resistance
A In cardiogenic shock, CO and CI decrease. RAP, PAP, and PAOP increase and volume backs up into the pulmonary circulation and the right side of the heart.
A patient who is receiving continuous enteral feedings has just vomited 250 mL of milky green fluid. What action by the nurse takes priority? a. Notify the provider b. Assess the patient's lungs and oxygen saturation c. Stop the tube feeding d. Slow the rate of infustion
C
Warning signs that can assist the critical care nurse in recognizing that an ethical dilemma may exist include which of the following? SATA a. Family members are confused about what is happening to the patient b. Family members are in conflict as to the best treatment options They disagree with one another and cannot come to a consensus. c. The family asks that the patient not be told of treatment plans d. The patient's condition has changed dramatically for the worse and is not responding to conventional treatment. e. The physician is considering the use of a medication that is not approved to treat the patient's condition
A, B, C, D, E
The nurse is caring for a patient with severe neurological impairment following a massive stroke. The physician has ordered tests to determine brain death. The nurse understands that criteria for brain death include: SATA a. absence of cerebral blood flow b. absence of brainstem reflexes on neurological examination c. cheyne-stokes respirations d. flat electroencephalogram e. responding only to painful stimuli
A, B D
Which therapeutic interventions may be withdrawn or withheld from the terminally ill client? SATA a. antibiotics b. dialysis c. nutrition d. pain meds e. simple nursing interventions such as repositioning and hygiene
A, B, C
The nurse is preparing for insertion of a pulmonary artery catheter. During insertion of the catheter, what are the priority nursing actions? SATA a. Allay patient's anxiety, provide info about surgery b. Ensure sterile field is maintained c. Inflate the balloon during the procedure when indicated by the provider d. Monitor the patient's cardiac rhythm throughout the procedure e. Obtain informed consent by informing the patient of procedural risks
A, B, C, D
Which interventions can the nurse use to facilitate communication with patients and families who are in teh process of making decisions regarding end of life care options? SATA a. Communication of uniform messages from all health care team members b. An integrated plan of care that is developed collaboratively bt the patient, family, and health care team c. Facilitation of continuity of care through accurate shift to shift and transfer ereports. d. Limitation of time for families to express feelings in order to control family grief e. Reassuring the patient and family that they will not be abandoned as the goals of care shift from aggressive treatment to comfort care.
A, B, C, E
Which nursing actions are most important for a patient witha right radial arterial line? SATA a. Checking the circulation to the right hand every 2 hours b. Maintaining a pressurized flush solution to the arterial line setup c. Monitoring the waveform on the monitor for dampening d. Restraining all four extremities with soft limb restraints e. Ensuring all junctions remain tightly connected
A, B, C, E
When performing an initial pulmonary artery occlusion pressure (PAOP), what re the best nursing actions? SATA a. Inflate the balloon with air, recording the volume necessary to obtain a reading b. Inflate the balloon for no more than 8 to 10 seconds while noting the waveform change c. Maintain the balloon in the inflated position for 8 hours folowing insertion d. Zero reference and level the air-fluid interface of the transducer at the leve of the phlebostatic axis e. Inflate and deflate the balloon on an hourly schedule
A, B, D
Select interventions that may be included during terminal weaning include which of the following? SATA a complete extubation following ventilator withdrawal b. discontinuation of artificial ventilation but maintenance of the artificial airway c. discontinuation of anxiolytic and pain meds d. titration of ventilator support based upon blood gas determinations e. titration of ventilator support to minimal levels based upon patient assessment of comfort
A, B, E
The nurse is caring for a mechanically ventilated patient and responds to a high inspiratory pressure alarm. Recognizing possible causes for the alarm, the nurse assesses for which of the following? SATA a. Coughing or attempting to talk b.. Disconnection from the ventilator c. Kinks in the ventilator tubing d. Need for suctioning e. Spontaneous breathing
A, C, D
The nurse is caring for a patient whose condition has deteriorated and who is not responding to standard treatment. The physician calls for an ethical consultation with the family to discuss potential withdrawal of treatment versus aggressive treatment. The nurse understands that applying a model for ethical decision making invloves which of the following? SATA a. Burden vs benefit b. Family's wishes c. Patient's wishes d. Potential outcomes of treatment options e. Cost savings of withdrawing treatment
A, C, D
The nurse is caring for a patient admitted with shock. The nurse understands which assessment findings best assess tissue perfusion in a patient in shock? SATA a. Blood pressure b. Heart rate c. Level of consciousness d. Pupil response e. Respirations f. urine output
A, C, F
The nurse is preparing to obtain a right arterial pressure (RAP/CVP) reading. What are the most appropriate nursing actions? SATA a. Compare measured pressures with other physiological parameters. b. Flush the central venous catheter with 20mL of sterile saline c. Inflate the balloon with 3mL of air and record the pressure tracing d. Obtain the right atrial pressure measurement during end exhalation e. Zero reference the transducer system at the level of the phlebostatic axis
A, D, E
The most critical element of effective early end of life decision making is a. control of distressing symptoms, such as nausea, anxiety, and pain b. effective communication among the patient, family, and health care team throughout the course of the illness c. organizational support of palliative care principles d. the relocation of the dying patient from the critical care unit to a lower level of care
B
The nurse assesses a patient who is admitted for an overdose of sedatives. The nurse expects to find which acid-base alteration? a. Hyperventilation and respiratory acidosis b. Hypoventilation and respiratory acidosis c. Hypoventilation and respiratory alkalosis d. Respiratory acidosis and normal oxygen levels
B
A PaCO2 of 48 mmHg is associated with a. hyperventilation b. hypoventilation c. increased absorption of O2 d. increased excretion of HCO3
B
A patient is admitted to the cardiac surgical ICU after cardiac surgery with the following ABG levels. What action by the nurse is best? pH 7.4 PaCO2 40 Bicarb 24 PaO2: 95 O2 saturation: 97% Respirations: 20 breaths/min a. Call the provider to request rapid intubation b. Document the findings and continue to monitor c. Request that another set of ABGs be drawn and run d. Correlate the patient's O2 saturation with the ABGs
B
A patient is admitted to the progressive care unit with a diagnosis of community-acquired pneumonia. The patient has a history of COPD and diabetes. A set of arterial blood gases obtained on admission without supplemental oxygen shows pH of 7.35, PaCO2 55 mmHg, bicarb 30 mEq/L, PaO2 65 mmHg. These blood gases reflect: a. hypoxemia and compensated metabolic alkalosis b hypoxemia and compensated respiratory acidosis c. normal oxygenation and partly compensated metabolic alkalosis d. normal oxygenation and uncompensated respiratory acidosis
B
A patient is having complications from abdominal surgery and remains NPO. Because enteral tube feedings are not possible, the decision is to initiate parenteral feedings. What are the major complications for this therapy? a. Aspiration pneumonia and sepsis b. Sepsis and fluid and electrolyte imbalances c. Fluid overload and pulmonary edema d. Hypoglycemia and renal insufficiency
B
A patient is having difficulty weaning from mechanical ventilation. The nurse assesses the patient for which potential cause of this difficult weaning? a. CO of 0 L/min b. Hgb of 8 c. Negative sputum culture and sensitivity d. WBC count of 8000
B
A patient with end stage heart failure is experiencing considerable dyspnea. Appropriate palliative management of this symptom includes: a. administration of midazolam (versed) b. administration of morphine c. an increase in the amount of oxygen being delivered to the patient d. aggressive use of inotropic and vasoactive meds to improve heart function
B
After pulmonary artery catheter insertion, the nurse assesses a pulmonary artery pressure of 45/25 mmHg, a PAOP of 20 mmHg, a CO of 2.6 L/min, and a CI of 1.9. Which provider order is a priority? a. insert an indwelling urinary catheter b. begin a Dobutamine infusion c. obtain STAT cardiac enzymes and troponin
B
Following insertion of a pulmonary artery catheter, the provider requests the nurse obtain a blood sample for mixed venous oxygen saturation (SvO2). Which action by the nurse best ensures the obtained value is accurate? a. Zero referencing the transducer at the level of the phlebostatic axis following insertion b. Calibrating the system with a central venous blood sample and arterial blood gas value c. Ensuring patency of the catheter using a 0.9% normal saline solution pressurized at 300mmHg d. Using noncompliant pressure tubing that is no longer than 36 to 48 inches and has minimal stopcocks
B
One of the early signs of hypoxemia on the nervous system is: a. cyanosis b. restlessness c. agitation d. tachypnea
B
Oxygen saturation (SaO2) represents: a. alveolar oxygen tension b. oxygen that is chemically combined with hemoglobin c. oxygen that is physically dissolved in plasma d. total oxygen consumption
B
The nurse is administering IV norepinephrine at 5 mcg/kg/min via a 20 gauge peripheral IV catheter. Which assessment finding requires immediate action by the nurse? a. BP of 100/60 b. Swelling at the IV site c. HR of 110 bpm d. CVP of 8 mmHg
B
The nurse is assessing the patient's pain using the critical care plan observation tool. Which of the following assessments would indicate teh greatest likelihood of pain and need for nursing intervention? a. absence of vocal sounds b. fighting the ventilator c. moving legs in bed d. relaxed muscles in upper extremities
B
The nurse is caring for a 70 kg patient in hypovolemic shock. Upon initial assessment, the nurse notes a BP of 90/50, HR of 125, RR 32, CVP/RAP of 3, and urine output of 5 mL during the last hour. Following physician rounds, the nurse reviews the orders and questions which order? a. Administer acetaminophen 650 mg suppository prn q 6 hours for pain b. Titrate dopamine intravenously for BP less than 90 mmHg systolic c. Complete neurological assessment every 4 hours for the next 24 hours d. Administer furosemide 20 mg IV every 4 hours for a CVP greater than or equal to 20 mmHg
B
The nurse is caring for a critically ill patient on mechanical ventilation. The physician identifies the need for bronchoscopy., which requires informed consent. For the physician to obtain consent from the patient, the patient must be able to a. be weaned from mechanical ventilation b. have knowledge and competence to make the decision c. nod his head that it is okay to proceed d. read and write in English
B
The nurse is caring for a mechanically ventilated patient being monitored with a left radial arterial line. During the inspiratory phase of ventilation, the nurse assesses a 20 mmHg decrease in arterial blood pressure. What is the best interpretation of this finding by the nurse? a. The mechanical ventilator is malfunctioning b. The patient may require fluid resuscitation c. The arterial line may need to be replaced d. The left limb may have reduced perfusion
B
The nurse is caring for a patient in cardiogenic shock experiencing chest pain. Hemodynamic values assessed by the nurse include a CI of 2.5, HR of 70, and a systemic vascular resistance of 2200. Upon review of physician orders, which order is most appropriate for the nurse to initiate? a. Furosemide 20 mg IV every 4 hours as needed for CVP greater than or equal to 20 b. Nitroglycerin infusion titrated at a rate of 5 to 10 mcg/min as needed for chest pain c. Dobutamine infusion at a rate of 2 to 20 mcg/kg/min as needed for CI less than 2 L/min. d. Dopamine infustion at a rate of 5 to 10 mcg/kg/min to maintain a systolic BP of at least 90.
B
The nurse is caring for a patient who has been declared brain dead. The patient is considered a potential organ donor. To proceed with donation, the nurse understands that a. A signed donor card mandates that organs be retrieved in the event of brain death b. after brain death has been determined, perfusion and oxygenation of organs is maintained until organs can be removed in the operating room c. the health care proxy does not need to give consent for the retrieval of organs d. once a patient has been established as brain dead, life support is withdrawn and organs are retrieved
B
The nurse is caring for a patient who has had an arterial line inserted. To reduce the risk of complications, what is the priority nursing intervention? a. Apply a pressure dressing at the insertion site b. Ensure that all tubing connections are tightened. c. Obtain a portable x-ray to confirm placement d. Restrain the affected extremity for 24 hours
B
The nurse is caring for a patient who is declared brain dead and is an organ donor. The following events occur: 1300 diagnostic tests for brain death are completed. 1330 intensivist reviews diagnostic tests results and writes in the progress note that the patient is brain dead. 1400 Patient is taken to the operating room for organ retrieval. 1800 All organs have been retrieved for donation. The ventilator is discontinued. 1810 Cardiac monitor shows flatline. What is the official time of death recorded in the medical record. a. 1300 b. 1330 c. 1400 d. 1800 e. 1810
B
The nurse is caring for a patient with a left subclavian central venous catheter (CVC) and a left radial arterial line. Which assessment finding by the nurse requires immediate action? a. A dampened arterial line waveform b. Numbness and tingling in the left hand c. Slight bloody drainage at the subclavian insertion site d. Slight redness at subclavian insertion site
B
The nurse is caring for a patient with severe sepsis who was resuscitated with 3000mL of LR solution over the past 4 hours. Morning laboratory results show a hemoglobin of 8 g/dL and hematocrit of 28%. What is the best interpretation of these findings by the nurse? a. Blood transfusion with packed RBCs is required b. Hemoglobin and hematocrit results indicate hemodilution c. Fluid resuscitation has resulted in fluid volume overload d. Fluid resuscitation has resulted in third spacing of fluid
B
The nurse is caring for an elderly patient who is in cardiogenic shock. The patient has failed to respond to medical treatment. The intensivist in charge of the patient conducts a conference to explain that treatment options have been exhausted and to suggest that the patient can be given a "do not resuscitate" status. This scenario illustarates the concept of : a. brain death b. futility c. incompetence d. life-prolonging procedures
B
The nurse is educating a patient's family member about a pulmonary artery catheter. Which statement by the family member best indicates understanding of the purpose of the PAC? a. The catheter will provide multiple sites to give IV fluid b. The catheter will allow the provider to better manage fluid therapy c. The catheter tip comes to rest inside my brother's pulmonary artery d. The catheter will be in position until the heart has a chance to heal
B
The nurse is preparing to measure the thermodilution cardiac output (TdCO) in a patient being monitored with a pulmonary artery catheter. Which action by the nurse best ensures the safety of the patient? a. Ensure the transducer system is zero references at the level of the phleobostatic axis b. Avoid infusing vasoactive agents in the port used to obtain the TdCO measurement c. Maintain a pressure of 300 mmHg on the flush solution using a pressure bag d. Limit the length of the noncompliant pressure tubing to a maximum 48 inches
B
The nurse returns from the cardiac catheterization laboratory with a patient following insertion of a pulmonary artery catheter and assists in transferring the patient form the stretcher to the bed. BEfore obtaining a cardiac output, which action is most important for the nurse to complete? a. Document a pulmonary artery catheter occlusion pressure b. Zero reference the transducer system at the phlebostatic axis c. Inflate the pulmonary artery catheter balloon with 1mL of air d. Inject 10 mL of 0.9% NS into the proximal port
B
The nurse wishes to assess the quality of a patient's pain. Which of the following questions is appropriate to obtain this assessment if the patient is able to give a verbal response? a. Is the pain constant or intermittent? b. Is the pain sharp, dull, or crushing? c. What makes the pain better? Worse? d. When did the pain start?
B
The patient's spouse is very upset because his loved one, who is near death, has dyspnea and restlessness. The nurse explains that there are some ways to decrease this discomfort, including a. respiratory therapy treatments b. opioid medications given as needed c. incentive spirometry d. increased hydration
B
The patient's spouse tells the nurse that there is no point in continuing to visit at the bedside because the patient is unresponsive. The best response by the nurse is a. You're right. Your loved one is not aware of anything now. b. This seems to be very difficult for you. c. I'll call you if she starts responding again. d. Why dont you check to see ifa ny other family member would like to visit?
B
The provider write an order to discontinue a patient's left radial arterial line. When discontinuing the patient's invasive line, what is the priority nursing action? a. Apply an air occlusion dressing to insertion site b. Apply pressure to the insertion site for 5 mins c. Elevate the affected limb on pillow for 24 hours. d. Keep the patient's wrist in a neutral position.
B
WHile caring for a patient with a small bowel obstruction, the nurse assesses a pulmonary artery occlusion pressure (PAOP) of 1 mmHg and hourly urine output of 5ml. The nurse anticipates which therapeutic intervention? a. Diuretics b. Intravenous fluids c. Negative inotropic agenst d. vasopressors
B
Which nursing intervention would need to be corrected on a care plan for a patient in order to be consistent with the principles of effective end of life care? a control fo distressing symptoms such as dyspnea, nausea, and pain through the use of pharmacological and nonpharmacologica interventions b. Limitation of visitation to reduce the emotional distress experienced by family members c. Patient and family education on anticipated patient responses to withdrawal of therapy d. Provision of spiritual care resources as desired by the patient and family
B
Which of the following statements about palliative care is accurate? a. withholding and withdrawing life sustaining treatment are distinctly different in the eyes of the legal commnity b. reducing distressing symptoms is the primary goal of palliative care c. Only the patient can determine what constitutes palliative care for him or her d. Withdrawing life sustaining treatments is considered euthanasia in most states
B
The nurse has just completed administration of a 500mL bolus of 0;9% NS in a patient with hypovolemic shock. The nurse assesses the patient to be slightly confused with a mean arterial pressure of 50 mmHg, a HR of 110 bpm. urine output of 10 mL for the past hour, and a central venous pressure (CVP/RAP) of 3 mmHg. What is the best interpretation of these results by the nurse? a. Patient response to therapy is appropriate b. Additional interventions are indicated c. More time is needed to assess response d. Values are normal for the patient condition
B Assessed vital signs and hemodynamic values indicate decreased circulating volume. Additional intervention is needed because response to therapy is not appropriate, values are abnormal, and timely intervention is critical for a patient with low circulating blood volume.
The nurse has just completed an infusion of 1000 mL bolus of 0.9% NS in a patient with severe sepsis. One hour later, which laboratory result requires immediate nursing action? a. Creatinine 1.0 mg/dL b. Lactate 6 mmol/L c. Potassium 3.8 mEq/L d. Sodium 140 mEq/L
B LACTATE OVER 2 IS BAD!! It means cells are dying
Ten minutes following administration of an antibiotic, the nurse assesses a patient to have edematous lips, hoarseness, and expiratory stridor. Vital signs assessed by the nurse include blood pressure 70/40 mm Hg, heart rate 130 beats/min, and respirations 36/min. What is the priority intervention? a. Diphenhydramine 50 mg IV b. Epinephrine 3 to 5 mL of a 1:10,000 solution IV c. Methylprednisolone 125mg IV d. Ranitidine 50 mg IV
B Patient is exhibiting signs of anaphylaxis
The nurse utilizes which of the following strategies when encountering an ethical dilemma in practice? a. change of shift report updates b. ethics consultation services c. formal multiprofessional ethics committees d. pastoral care services e. social work consultation
B, C
The nurse is assisting with endotracheal intubation and understands that correct placement of the endotracheal tube in the trachea would be identified by which of the folowing? SATA a. Auscultation of air over epigastrium b. Equal bilateral breath sounds upon auscultation c. Position above the carina verified by chest xray d. Positive detection of carbon dioxide through CO2 detector devices e. Fogging of the endotracheal tube
B, C, D
Which of the following situations may result in a low cardiac output and low cardiac index? SATA a. Exercise b. Hypovolemia c. Myocardial Infarction d. Shock e. Fever
B, C, D
Select all of the factors taht may predispose the patient to respiratory acidosis. SATA a. Anxiety and fear b. Central nervous system depression c. Diabetic ketoacidosis d. Overdose of sedatives
B, D
A mode of pressure targeted ventilation that provides positive pressure to decrease the workload of spontaneous breathing through the endotracheal tube is a. continuous positive airway pressure b. positive end expiratory pressure c. pressure support ventilation d. T-piece adaptor
C
A nurse caring for a patient with a neurological impairment often must use painful stimuli to elicit the patient's response. The nurse uses subtle measures of painful stimuli, such as nailbed pressure. She neither slaps the patient nor pinches the nipple to elicit a response to pain. In this scenario, the nurse is exemplifying the ethical principle of a. beneficence b. fidelity c. nonmaleficience d. veracity
C
A patient is admitted after collapsing at the end of a summer marathon. The patient is lethargic, which a heart rate of 110, RR of 30, and a BP of 78/46. The nurse anticipates administering which therapeutic intervention? a. Human albumin infusion b. Hypotonic saline solution c. Normal saline 0/9% d. Packed RBCs
C
A patient is admitted to the cardiac surgical ICU after cardiac surgery. Four hours after admission to the surgical ICU at 4pm the patient has stable vital signs and normal ABGs and is placed on a T-piece for ventilatory weaning. The following information pertains to the 1900 assessment. Assessments and Vital Signs Restless Increased to 110 beats/min Respirations 36 breaths/min BP 156/98 Sinus tach 10 PVCs/min Elevated pulmonary artery pressure Loud crackles throughout New ABG Results: pH 7.28 PaCO2 46, Bicarb: 22, PaO2: 58, O2 88% What action by the nurse is best? a. Prepare for rapid intubation b. Increase oxygen being administered c. Prepare to administer a diuretic d. Change the ventilator settings
C
A patient is being fed through a nasogastric tube placed in his stomach. The nurse would carry out which intervention to minimize aspiration risk? a. Add blue due to the formla b. Assess the residual every hour c. Elevate the head of the bed 30 degrees d. Provide feedings via continuous infusion
C
A patient is being mechanically ventilated in the synchronized intermittent mandatory ventilation mode at a rate of 4 breaths/min. His spontaneous respirations are 12 breaths/min. HE receives a dose of morphine sulfate and his spontaneous respirations decrease to 4 breaths/min. Which acid base disturbance will likely occur? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis
C
A patient's status worsens and needs mechanical ventilation. The pulmonologist wants the patient to receive 10 breaths/min from the ventilator but wants to encourage the patient to breathe spontaneously between the mechanical breaths at his own tidal volume. This mode of ventilation is called: a. assist/control ventilation b. controlled ventilation c. intermittent mandatory ventilation d. positive end expiratory pressure
C
Chapter 3 questions Legal and ethical Ideally, an advance directive should be developed by the a. family if the patient is in critical condition b. patient as part of the hospital admission process c. patient before hospitalization d. patient's health care surrogate
C
Following insertion of a central venous catheter, the nurse obtains a stat chest xray to verify proper placement. The radiologist reports to the nurse: "The tip of the catheter is located in the superior vena cava." What is the best interpretation of these findings? a. The catheter is not positioned correctly and should be removed b. The catheter position increases the risk of ventricular dysrhythmias c. The distal tip of the catheter is in the appropriate position d. The physician should be called to advance the catheter into the pulmonary artery
C
The assessment of pain and anxiety is a continuous process. When critically ill patients exhibit signs of anxiety, the nurse's first priority is to a. administer antianxiety medications as ordered b. administer pain medications as ordered c. identify and treat the underlying cause d. reassess the patient hourly to determine whether symptoms resolve on their own
C
The charge nurse is supervising care for a group of patients monitored with a variety of invasive hemodynamic devices. Which patient should the charge nurse evaluate first? a. A patient with a central venous pressure (RAP/CVP) of 6 mmHg and 40 mL of urine output in the past hour b. A patient with a left radial arterial line with a BP of 110/60 and slightly dampened arterial waveform. c. A patient wiht a PAOP of 25mmHg and an oxygen sat of 89% on 3L of oxygen via nasal cannula d. A patient with a pulmonary artery pressure of 25/10 and an oxygen saturation of 94% on 2 L of oxygen via nasal cannula
C
The nurse is assessing the exhaled tidal volume (EVT) is a mechanically ventilated patient. The rationale for this assessment is to a. assess for tension pneumothorax b. assess the level of positive end expiratory pressure c. compare the tidal volume delivered with the tidal volume prescribed d. determine the patient's work of breathing
C
The nurse is caring for a mechanically ventilated patient with a pulmonary artery catheter who is receiving continuous enteral tube feedings. When obtaining continuous hemodynamic monitoring measurements, what is the best nursing action? a. Do not document hemodynamic values until after the patient can be placed in the supine position b. Level and zero reference the air fluid interface of the transducer with teh patient in the supine position and record hemodynamic values c. Level and zero reference of air fluid interface of the transducer with the patient's head of bed elevated at 30 degrees and record hemodynamic values d. Level and zero reference the air fluid interface of the transducer with teh patient supine in teh side lying position and record hemodynamic values
C
The nurse is caring for a mechanically ventilated patient. The providers are considering performing a tracheostomy because the patient is having difficulty weaning from mechanical ventilation. Related to tracheostomy, the nurse understands which of the following? a. Patient outcomes are better if the tracheostomy is done within a week of intubation b. Procedures performed in the operating room are associated with fewer complications c. The greatest risk after a percutaneous tracheostomy is accidental decannulation
C
The nurse is caring for a patient admitted with a traumatic brain injury following a motor vehicle crash. Several weeks later, the patient is still ventilator dependent and unresponsive to stimulation but occasionally takes a spontaneous breath. The physician explains to the family that the patient has severe neurological impairment and is not expected to recover consciousness. The nurse recognizes that this patient is a. an organ donor b. brain dead c. in a persistent vegetative state d. terminally ill
C
Which patient being cared for in the emergency department is most at risk for developing hypovolemic shock? a. a patient admitted with abdominal pain and an elevated white blood cell count b. a patient with a temp of 102 F and a general dermal rash c. a patient with a 2 day history of nausea, vomiting, and diarrhea d. a patient with slight rectal bleeding from inflamed hemorrhoids
C
The nurse is caring for a patient in spinal shock. Vital signs include BP 100/70, HR 70 bpm, RR 24, O2 saturation 95% on room air, and oral temp of 94.8 F. Which intervention is most important for the nurse to include in the patient's plan of care? a. Administration of atropine sulfate b. Application of 100% oxygen via face mask c. Application of slow rewarming measures d. Infusion of IV phenylephrine (Neo-synephrine)
C
The nurse is caring for a patient who is not responding to medical treatment. The intensivist holds a conference with the family, and a decision is made to withdraw life support. The nurse's religious beliefs are not in agreement with the withdrawal of life support. However, the nurse assists with the process to avoid confronting the charge nurse. Afterward, the nurse feels guilty for "killing the patient." This scenario is likely to cause a. abandonment b. family stress c. moral distress d. negligence
C
The nurse is caring for a patient with an arterial monitoring system. The nurse assesses the patient's noninvasive cuff blood pressure to be 70/40. The arterial BP measurement via an intraarterial catheter in the same arm is assessed by the nurse to be 108/70. What is the best action by the nurse? a. Activate the rapid response system b. Place the patient in Trendelenbur position c. Assess the cuff for proper arm size d. Administer 0;9% NS bolus
C
The nurse is caring for a patient with an endotracheal tube. The nurse understands that endotracheal suctioning is needed to facilitate removal of secretions and that the procedure: a. decreases intracranial pressure b. depresses the cough reflex c. is done as indicated by patient assessment d. is more effective if preceded by saline instillation
C
The nurse is caring for a patient with hyperactive delirium. The nurse focuses interventions toward keeping the patient: a. comfortable b. nourished c. safe d. sedated
C
The nurse is preparing to obtain a pulmonary artery occlusion pressure reading for a patient who is mechanically ventilated. Ensuring that the air-fluid interface is at the level of the phlebostatic axis, what is the best nursing action? a. Place the patient in the supine position and record the PAOP immediately after exhalation b. Place the patient in the supine position and document the average PAOP obtained after three measurements c.Place the patient with the head of bed elevated 30 degrees and record the PAOP just before the increase in pressures during inhalation.
C
The nurse is starting to administer a unit of packed red blood cells to a patient admitted in hypovolemic shock secondary to hemorrhage. Vital signs include BP 60/40, HR 150, RR 42, and temp 100.6. What is the best action by the nurse? a. Administer blood transfusion over at least 4 hours b. Notify the physician of the elevated temp c. Titrate rate of blood administration to patient response d. Notify the physician of the patient's heart rate
C
The nurse knows that which of the following statements about organ donation is true? a. Anyone who is comfortable approaching the family should discuss the option of organ donation. b. Brain death determination is required before organs can be retrieved for transplant c. Donation of selected organs after cardiac death is ethically acceptable d. Family members should consider the withdrawal of life support so that the patient can become an organ donor.
C
The nurse notes that the patient's ABG levels indicate hypozemia. The patient is not intubated and has a resp rate of 22. The nurse's first intervention to relieve hypoxemia is to: a. call the provider for an emergency intubation procedure b. obtain an order for BiPAP c. notify the provider of values and obtain a prescription for oxygen d. suction secretions from the oropharynx
C
The primary mode of action of neuromuscular blocking agents is: a. analgesia b. anticonvulsant c. paralysis d. sedation
C
When addressing an ethical dilemma, contextual, physiological, and personal factors of the situation must be considered. Which of the following is an example of a personal factor? a. The hospital has a policy that everyone must have an advance directive on the chart b. The patient has lost 20lbs in the past month and is fatigued all the time. c. The patient has told you what quality of life means and his or her wishes d. The physician considered care to be futile in a given situation
C
When assessing the patient for hypoxemia, the nurse recognizes that an early sign of the effect of hypoxemia on the cardiovascular system is a. heart block b restlessness c. tachycardia d. tachypnea
C
Which statement is true regarding the impact of culture on end of life decision making? a. Cultural beliefs should not take precedence over health care team decisions b. It is easy and common to assess cultural beliefs affecting end of life care in the ICU c. Culture and religious beliefs may affect end of life decision making d. Perspectives regarding end of life care are similar between and within religious groups
C
Which statement made by a staff nurse identifying guidelines for palliative care would need to be corrected? a. Basic nursing care is a critical element in palliative care b. Common conditions that require palliative management are nausea, agitation, and sleep disturbance c. Palliative care practice are reserved for the dying client d. Palliative care practices relieve symptoms that negatively affect the quality of life of a patient
C
Which statement regarding ethical concepts is true? a. A living will is the same as a health care proxy b. A signed donor card ensures that organ donation will occur in the event of brain death c. A surrogate is a competent adult designated by a person to make health care decisions in the event the person is incapacitated d. A persistent vegetative state is the same as brain death in most states
C
While inflating the balloon of a pulmonary artery catheter (PAC) with 1.0 mL of air to obtain a pulmonary artery occlusion pressure (PAOP), the nurse encounters resistance. What is the best nursing action? a. Add an additional 0.5 mL of air to the balloon and repeat the procedure. b. Advance the catheter with the balloon deflated and repeat the procedure. c. Deflate the balloon and obtain a chest x-ray study to determine line placement. d. Lock the balloon in the inflated position and flush the distal port of the PAC with normal saline.
C
The nurse is caring for a patient admitted following a motor vehicle crash. Over the past 2 hours, the patient has received 6 units of packed RBCs and 4 units of fresh frozen plasma by rapid infusion. To prevent complications, what is the priority nursing intervention? a. Administer pain medication b. Turn patien every 2 hours c. Assess core body temp d. Apply bilateral heel protectors
C Assess temp with blood transfusion ALWAYS
The nurse is caring for a patient in cardiogenic shock who is being treated with an infusion of dobutamine. The physician's order calls for the nurse 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 the calculated cardiac index for the patient is 4.6 L/min/m2. What is the best action by the nurse? a. Obtain a stat serum potassium level b. order a stat 12 lead echocardiogram c. Reduce the rate of dobutamine d. Assess the patient's hourly urine output
C Dobutamine is used to stimulate contractility and heart rate while causing vasodilation in low cardiac output states, improving overall cardiac performance.
The nurse is caring for a patient admitted to the critical care unit 48 hours ago with a diagnosis of severe sepsis. As part of this patient's care plan, what intervention is most important for the nurse to discuss with the multidisciplinary care team? a. Frequent turning b. Monitoring intake and output c. Enteral feedings d. Pain management
C Initiation of enteral feedings within 24 to 48 hours of admission is critical in reducing the risk of infection by assisting in maintaining the integrity of the intestinal mucosa.
A 75 year od patient who suffered a massive stroke 3 weeks ago, has been unresponsive and has required ventilatory support since the time of the stroke. The physician has approached the spouse regarding placement of a permanent feeding tube. The spouse states that the patient never wanted to be kept alive by tubes and personally didn't want what was being done. After holding a family conference with the spouse, the medical team concurs, and the feeding tube is not placed. This situation is an example of a. euthanasia b. palliative care c. withdrawal of life support d. withholding life support
D
A patient is admitted to the critical care unit following coronary artery bypass surgery. Two hours postop, the nurse assesses the following information: pulse is 120, BP is 70/50, pulmonary artery diastolic pressure is 2, cardiac output is 4, urine output is 250 mL/hr, chest drainage is 200 mL/hr. What is the best interpretation by the nurse? a. The assessed values are within normal limits b. The patient is at risk for developing cardiogenic shock c. The patient is at risk for developing fluid volume overload d. The patient is at risk for developing hypovolemic shock
D
The charge nurse has a pulse contour cardiac output monitoring system available for use in the surgical intensive care unit. For which patient is use of this devise most appropriate? a. A patient with a history of aortic insufficiency admitted with a postop MI b. A mechanically ventilated patient with cardiogenic shock being treated with an intraaortic balloon pump c. A patient with a history of atrial fibrillation having frequent episodes of paroxymal supraventricular tachycardia d. A mechanically ventilated patient admitted following repair of an acute bowel obstruction
D
A patient is being mechanically ventilated in the synchronized intermittent mandatory ventilation mode at a rate of 4 breaths/min. His spontaneous respirations are 12 breaths/min. He receives a dose of morphine sulfate and his respirations decrease to 4 breaths/mins. What adjustments may need to be made to the patient's ventilator settings? a. Add PEEP b. Add pressure support c. Change to assist/control ventilation at a rate of 4 breaths/min d. Increase synchronized intermittent mandatory ventilation respiratory rate
D
A patient is being ventilated and has been started on enteral feedings with a nasogastric small bore feeding tube. What is the primary reason the nurse must frequently assess tube placement? a. to assess for paralytic ileus b. to maintain the patency of the feeding tube c. to monitor for skin breakdown on the nose d. to prevent aspiration of the feedings
D
A patient presents to the ED demonstrating agitation and complaining of numbness and tingling in his fingers. His ABG levels reveal the following: pH 7.51, PaCO2 25, HCO3 25. The nurse interprets these blood gas values as: a. compensated metabolic alkalosis b. normal values c. uncompensated respiratory acidosis d. uncompensated respiratory alkalosis
D
A specific request made by a competent person taht directs medical care related to life-prolonging procedures in the event that person loses capacity to make decisions is called a a. DNR order b. health care proxy c. informed consent d. living wil
D
Beginning of CHAPTER 9 A patient has coronary artery bypass graft surgery and is transported to the surgical intensive care unit at noon and is placed on mechanical ventilation. Interpret the initial arterial blood gas levels pH: 7.31 PaCO2: 48 mmHg Bicarb: 22 mEq/L PaO2: 115 mmHg O2 Clock: 99% a. Normal arterial blood gas levels with a high oxygen level b. Partly compensated respiratory acidosis; normal oxygen c. Uncompensated metabolic acidosis with high oxygen levels d. Uncompensated respiratory acidosis; hyperoxygenated
D
Chapter 15 questions The nurse is caring for a patient with acute respiratory failure and indentifies "risk for ineffective airway clearance" as a nursing diagnosis. A nursing intervention relevant to this diagnosis is to a. elevate the HOB to 30 degrees b. obtain an order for venous thromboembolism prophylaxis c. provide adequate sedation d. reposition the patient every 2 hours
D
Current guidelines recommend the oral route for endotracheal intubation. The rationale for this recommendation is that nasotracheal intubation is associated with a greater risk for a. basilar skull fracture b. cervical hyperextension c. impaired ability to mouth words d. sinusitis and infection
D
During insertion of a pulmonary artery catheter, the provider asks the nurse to assist by inflating the balloon with 1.5 mL of air. As the provider advances the catheter, the nurse notices premature ventricular contractions on the monitor. What is the best action by the nurse?zero referencing a. Deflate the balloon while slowly withdrawing the catheter b. Instruct the patient to cough and deep breathe forcefully c. Inflate the catheter balloon with an additional 1 mL of air d. Ensure lidocaine hydrochloride IV is immediately available
D
During the initial stages of shock, what are the physiological effects of decreased cardiac output? a. Arterial vasodilation b. High urine output c. Increased parasympathetic stimulation d. Increased sympathetic stimulation
D
In assessing a patient, the nurse understands that an early sign of hypoxemia is a. clubbing of nail beds b. cyanosis c. hypotension d. restlessness
D
Mechanically vented patient has high pressure alarm sound. THe patient's oxygen saturation is decreasing and heart rate and respiratory rate are increasing. The nurse's priority action is to a. ask the resp therapist to get a new vent b. call the rapid response team to assess the patient c. continue to find the cause of the alarm and fix it d. manually ventilate the patient while calling for a resp therapist
D
PEEP is a mode of ventilatory assistance that produces the following condition: a. Each time the patient initiates a breath, the ventilator delivers a full preset tidal volume b. For each spontaneous breath taken by the patient, the tidal volume is determined by the patient's ability to generate negative pressure c. The patient must have a respiratory drive, or no breaths will be delivered d. There is pressure remaining in the lungs at the end of expiration that is measured in cm H2O
D
Pulse oximetry mesaures: a. arterial blood gases b. hemoglobin values c. oxygen consumption d. oxygen saturation
D
The amount of effort needed to maintain a given level of ventilation is termed: a. compliance b. resistance c. tidal volume d. work of breathing
D
The critical care nurse wants a better understanding of when to initiate an ethics consult. After attending an educational program, the nurse understands that the following situation would require an ethics consultation: a. Conflict has occurred between the physician and family regarding treatment decisions. A family conference is held, and the family and physician agree to a treatment plan that includes aggressive treatment for 24 hours followed by reevaluation b. Family members disagree as to a patient's course of treatment. The patient has designated health care proxy and has a written advance directive c. Patient postoperative coronary artery bypass surgery who sustained a cardiopulmonary arrest in the OR. He was successfully resuscitated , but now is not responding to treatment. He has a written advance directive, and his wife is now present. d. Patient with multiple trauma and is not responding to treatment. No family members are known, and the health are team is debating if care is futile.
D
The nurse has been administering 0.9% normal saline IV fluids in a patient with severe sepsis. To evaluate the effectiveness of fluid therapy, which physiological parameters would be most important for the nurse to assess? a. Breath sounds and capillary refill b. Blood pressure and oral temp c. Oral temperature and capillary refill d. Right atrial pressure and urine output
D
The nurse is administering both crystalloid and colloid intravenous fluids as part of fluid resuscitation in a patient admitted in severe sepsis. What findings assessed by the nurse indicate an appropriate response to therapy? a. Normal body temp b. balanced intake and output c. Adequate pain management d. Urine output of 0.5 mL/kg/hr
D
The nurse is caring for a critically ill patient with terminal cancer. The monitor alarms and shows a potentially lethal rhythm. The patient has no pulse. The patient does not have a DNR order written on the chart. What is the appropriate nursing action? a. Contact the attending physician immediately to determine if CPR should be initiated b. Contact the family immediately to determine if they want CPR to be started c. Give emergency medications but withhold intubation d. Initiate CPR and call a code
D
The nurse is caring for a patient in the early stages of septic shock. The patient is slightly confused and flushed with bounding peripheral pulses. Which hemodynamic values is the nurse most likely to see? a. High PAOP with high CO b. High SVR with low CO c. Low PAOP and low CO d. Low SVR and high CO
D
The nurse is caring for a patient whose vent settings include 15 cmH2O of PEEP. What complication does the nurse assess the patient for? a. Fluid overload secondary to decreased venous return b. High cardiac index secondary to more efficient ventricular function c. Hypoxemia secondary to prolonged positive pressure at expiration d. Low cardiac output secondary to increased intrathoracic pressure
D
The nurse is caring for a patient with a left radial arterial line and a pulmonary artery catheter inserted into the right subclavian vein. Which action by the nurse best ensures the safety of the patient being monitored with invasive hemodynamic monitoring lines? a. Document all waveform values b. Limit the pressure tubing length c. Zero reference the system daily d. Ensure alarm limits are turned on
D
The nurse is caring for a patient with a pulmonary artery catheter. Assessment findings include a BP of 85/40, HR of 125, RR of 35, and arterial oxygen saturation of 90% on a 50% venturi mask. Hemodynamic values include a CO of 1.0, CVP of 1, and PAOP of 3. The nurse questions which of the following physician's orders? a. Titrate supplemental oxygen to achieve SpO2 of greater than or equal to 94% b. Infuse 500 mL 0.9% NS over 1 hour c. Obtain arterial blood gas and serum electrolytes d. Administer furosemide 20mg IV
D
The nurse is caring for a patient with an admitting diagnosis of congestive heart failure. While attempting to obtain a pulmonary artery occlusion pressure in the supine position, the patient becomes anxious and tachypneic. What is the best action by the nurse? a. Limit the patient's supine position to no more than 10 secs b. Administer antianxiety medications while recording the pressure c. Encourage the patient to take slow, deep breaths while supine d. Elevate the head of the bed 45 degrees while recording pressures
D
The nurse is concerned that the patient will pull out the endotracheal tube. As part of the nursing management, the nurse obtains an order for a. arm binders or splints b. a higher dose of lorazepam c. propofol d. soft wrist restraints
D
The provider orders the following mechanical ventilation settings for a patient who weighs 75kg. The patient's spontaneous respiratory rate is 22 breaths/min. Which arterial blood gas abnormality may occur if the patient continues to be tachypneic at these ventilator settings? Tidal volume: 600 mL (8mL per kg) FiO2: 0.5 Resp Rate: 14 breaths/min PEEP: 10 cmH 2 O a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis
D
Which of the following organizations requires a mechanism to addressing ethical issues? a. American Association of Critical Care Nurses b. American Hospital Association c. Society of Critical Care MEdicine d. The Joint Commission
D
Which of the following statements about resuscitation is true? a. Family members should never be present during resuscitation b. It is not necessary for a physician to write "do not resuscitate" orders in the chart if a patient has a health care surrogate c. "Slow codes" are ethical and should be considered in futile situations if advanced directives are unavailable d. Withholding "extraordinary" resuscitation is legal and ethical if specified in advance directives and physician orders.
D
While caring for a patient with a pulmonary artery catheter, the nurse notes the PAOP to be significantly higher than previously recorded values. The nurse assesses resporations to be unlabored at 16 breaths/min, oxygen sat of 98% on 3L of O2 via nasal cannula, and lungs clear to auscultation bilaterally. What is the priority nursing action? a. Increase supplemental oxygen and notify respiratory therapy b. Notify the provider immediately of the assessment findings c. Obtain a stat chest xray film to verify proper catheter placement d. Zero reference and level the catheter at the phlebostatic axis
D
The nurse is caring for a patient admitted with the early stages of septic shock. The nurse assesses the patient to be tachypneic, with a respiratory rate of 32. ABG values assessed on admission are pH 7.50, CO2 28, HCO3 26,. Which diagnostic study result reviewed by the nurse indicates progression of the shock state? a. pH 7.40, CO2 40, HCO3 24 b. pH 7.45, CO2 45, HCO3 26 c. pH 7.35, CO2 40, HCO3 22 d. pH 7.30, CO2 45, HCO3 18
D As shock progresses along the continuum, acidosis ensues, caused by metablic acidosis, hypoxia, and anaerobic metabolism
The nurse is caring for a patient admitted with severe sepsis. Vital signs assessed by the nurse include BP 80/50, HR 120, RR 28, oral temp 102, and right atrial pressure (RAP) of 1 mmHg. Which intervention should the nurse carry out first? a. Acetaminophen suppository b. Blood cultures from two sites c. IV antibiotic administration d. Isotonic fluid challenge
D Early goal-directed therapy in severe sepsis includes administration of IV fluids to keep RAP/CVP at 8mm Hg or greater (but not greater than 15) and heart rate of less than 110 bpm. Fluid resuscitation to restore perfusion is the immediate priority.
Fifteen minutes after beginning a transfusion of O negative blood to a patient , there is a new onset of hematuria in the patient's foley catheter. What are the priority nursing actions? SATA a. Administer acetaminophen b. Document the patient's response c. Increase the rate of transfusion d. Notify the blood bank e. Notify the provider f. Stop the transfusion
D, E, F
