Critical Care
Define: Cauterization
Destruction of tissue by burning
What do people who believe in Buddha is the best way to deal with suffering?
Detachment
The nurse is preparing a client with acute kidney injury (AKI) f or hemodialysis in the intensive care unit (ICU). Which assessment should the nurse obtain prior to beginning the procedure?
Weight using the ICU bed scales
The nurse is caring for a client in the intensive care unit who is receiving mechanical ventilation due to acute respiratory failure. The family asks when the client will be extubated. Which information should the nurse provide?
When the patient performs spontaneous breathing in between mechanical ventilation
A client in the intensive care unit receives a STAT prescription for mannitol IV for cerebral edema post closed head injury. Which action should the nurse implement when preparing to administer the medication?
Use a filtered needle to draw up the medication and an in-line filter during infusion. It is a large sugar crystal molecule at room temperature.
A client reports shortness of breath and chest pressure radiating down the left arm. The client is receiving 2 liters of oxygen via nasal cannula and has two saline lock intravenous catheters. The nurse performs a 12 lead electrocardiogram (ECG) that shows ST segment elevation in leads II, III, aVF, and V4R. Which action should the nurse implement first?
Infuse 0.9% sodium chloride bolus
The nurse is caring for a client who is diagnosed withdiabetic ketoacidosis (DKA). The client reports abdominal pain and nausea, and presents with fruity-scented breath. The nurse performs a finger stick blood glucose with a reading too high to register. Which intervention is most important for the nurse to implement?
Initiate a one liter IV bolus of 0.9% sodium chloride
Two days following cardiac bypass surgery, the nurse places a client's mediastinal chest tube to water seal. The client is using the incentive spirometer hourly while awake. Which assessment finding warrants intervention by the nurse?
Water seal level 2cm below the fill line
The nurse is caring for a client with severe sepsis related to a ruptured appendix.The clientis diaphoretic and reports lower extremity spasms. The nurse observes respirations that are uneven and labored. Arterial blood gas (ABG) results are pH 7.60, PaCO2 25 mmHg, HCO3 24 mEq/L, and PaO2 24 mmHg. Which assessment finding warrants immediate intervention by the nurse?
Intercostal muscle contraction
The nurse is caring for a client admitted to the critical care unit with multiple traumatic injuries sustained in a motor vehicle collision. The client has a Glasgow Coma Score of 6. Which intervention should the nurse prepare for the client?
Intubation with mechanical ventilation
A client with diabetic ketoacidosis is admitted to the intensive care unit and is manifesting respirations that are rapid and deep. Which descriptive term should the nurse use to document the client's breathing pattern?
Kussmaul respirations
A client with syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is admitted to the intensive care unit with a serum sodium level of 112 mEq/L or mmol/L. Which protocol prescription should the nurse implement first?
Obtain serum sodium every 4 hours
How often should you verify placement of a PA catheter?
Once a shift
What can the use of normal saline prior to suctioning cause?
Oxygen desaturation Backwash deeper into the lungs Increased intracranial pressure Excessive coughing Bronchospasm
What do crackles compromise?
Oxygenation
Define: Cistacurium
Paralytic during surgery
What is the diagnostic criteria for systemic inflammatory response syndrome?
2/4 criteria are present... 1.) Abnormal vital signs 2.) Arterial blood gases 3.) WBC
What is a normal arterial BP?
70-100mmHg
A client falls off a ladder approximately 15 feet high and is admitted to the ICU for observation due to a small intracranial bleed noted in the left occipital area of the brain as observed on the CT Scan done in the emergency department. The client has been stable for the past 12 hours. The client reports to the nurse a new onset of pain in the left shoulder. Which action should the nurse do next?
Perform an abdominal assessment
Define: Kehr's sign
Acute pain in the tip of the shoulder due to the presence of blood or irritants in the peritoneal cavity when a person is lying down & legs are elevated
A client who experienced an intracranial hemorrhage is receiving cistracurium to induce a pharmacological state of paralysis. Which intervention should the nurse implement during the therapeutic paralysis?
Administer a sedating medication
The nurse reports findings to the healthcare provider for a client who is admitted to the intensive care unit today with chronic obstructive pulmonary disease (COPD). When the nurse completes the report using the SBAR format, which statement best supports the nurse's reason for calling the healthcare provider?
Prescription for additional respiratory treatment
What is indicated if a waveform of a PA catheter is dampened or flat?
Air bubbles Clots Tubing is kinked
The nurse is caring for a client admitted to the intensive care unit with a traumatic brain injury from a motor vehicle collision. The client is experiencing increased intracranial pressure (ICP). The healthcare provider explains to the family that the client needs to go to surgery for decompressive craniectomy. Which information should the nurse explain to the client?
An over-lying cranial bone flap is removed to allow swelling brain tissue to expand
What are pacemakers & defibrillators able to cause?
Bleeding into the pericardial sac which causes a high risk for cardiac tamponade
A client returns to the intensive care unit (ICU) after having a permanent pacemaker inserted. Which finding should the nurse observe for during the immediate hours after insertion?
Beck's Triad
The cardiac monitor alarms and the nurse finds a client with no palpable carotid pulse and no spontaneous respirations. The cardiac monitor displays a normal sinus rhythm. Which intervention should the nurse implement?
Begin chest compressions at 120/min
What complication can happen after a thyroidectomy?
Bleeding into the soft tissue around the incision site causing inspiratory stridor & laryngospasm
A client reports to the nurse feeling achy and weak, being tired and coughing all the time, frequent headaches and experiencing night sweats. The client's assessment is significant for crackles scattered throughout the lungs, dependent peripheral edema +3/+4, S3 and S4 heart sounds, temperature of 102.4° F(39.1° C), heart rate of 110 beats/minute, respirations of 20 breaths/minute, and blood pressure of 105/60 mmHg with a mean arterial pressure of (75). Which diagnostic procedure should the nurse prepare to do first?
Blood culture
Define: Cardiac tamponade
Blood or fluid fills the space between the heart & its sac
Define: Decompressive craniectomy
Brain surgery that removes a portion of the skull
What should you give a client experiencing epilepsy?
CNS depressant
The nurse is caring for a client who is recently extubated in the post anesthesia care unit (PACU). The client has humidified oxygen per mask and suddenly develops stridor and respiratory difficulty. Which action should the nurse implement?
Call a rapid response team for emergency airway management
A client who returns to the postoperative unit after a total thyroidectomy suddenly becomes short of breath and develops stridor. What action should the nurse implement first?
Call the rapid response team for emergency assistance
What is the effect if blood sugar continues to rise?
Change in level of consciousness
The nurse is caring for a client who is receiving mechanical ventilation for acute respiratory distress syndrome (ARDS). The ventilator is alarming continuously indicating high peak pressures for the client. Which pathologic changes in the client is causing the ventilator alarms?
Decreased lung compliance
What does acute respiratory syndrome cause?
Decreased lung compliance, stiffer lung
A client with chronic kidney disease (CKD) is admitted for strict fluid restriction. Which assessment finding requires additional nursing action?
Crackles in the lungs
Define: Intercostal muscle contraction
Critical sign of respiratory muscle fatigue which is likely to lead to acute respiratory failure
The nurse is caring for a client who is 4 days postoperative for abdominal surgery. The client reports acute onset of difficulty breathing. The nurse obtains the vital signs which include a heart rate of 120 beats/minute and respirations of 35 breaths/minute. Which diagnostic test should the nurse prepare the client to expect the healthcare provider to prescribe?
D-dimer blood test
A client diagnosed with gastric ulcers is admitted for a cauterization procedure. Which finding(s) should the nurse report to the healthcare provider? (Select all that apply.)
Decreased level of consciousness Decreased urine output
What is the effect of a low ADH?
Dehydration & increased serum Sodium
What are symptoms of a pulmonary embolism?
Difficulty breathing Tachypnea Tachycardia
Define: Cardiomyopathy
Disease of the heart muscle
Define: Mannitol
Diuretic
What way do females stab?
Downwards
What do buddhist believe after life?
Dying is natural & we are reincarnated
What indicates ineffective endocarditis?
Edema & S1/S3 sounds
What are signs of sepsis?
Elevated HR, temperature, & RR Low BP
The nurse is caring for a client who is demonstrating signs of impending death. The family is experiencing emotional distress as the client's condition declines. Which information should the nurse provide the family to facilitate the process?
Encourage the family to give the patient permission to die
Define: Aortic abdominal aneurysm
Enlargement of the aorta
Define: Allen test
Evaluates circulation to the wrist
What indicates the patient should not take blood for ABG?
Failed Allen test
The nurse assists the healthcare provider with the insertion of a pulmonary artery (PA)catheter for a client presenting with cardiogenic shock. Which action is most important for the nurse to take to prevent life-threatening complications from pulmonary artery monitoring?
Fast flush the PA distal port for no more than 2 seconds
How do you verify placement of a PA catheter?
Fast-flush square waveform test/dynamic frequency response test
What is the initial treatment for hypotension in clients with septic shock?
Fluid resuscitation
According to the paramedic's report, the victim of a motor vehicle collision was sitting in the passenger seat on the left side of the vehicle. The vehicle was stopped at a traffic light when the vehicle was hit on the left side by another vehicle traveling at speeds exceeding 60 mph (97 kmh). The client reports slight tenderness and achiness on (L) side of thorax and body. The significant assessment findings include: weak and thready pulse; diffuse abdominal pain, tenderness and guarding present upon palpation; skin is diaphoretic and extremities cool to touch, capillary refill +4 in extremities, and bruising is present in the (L) flank area and progresses towards the abdomen. Vital signs are temperature- 97.2° F (36.2° C), pulse- 110 beats/minute, respirations- 22 breaths/minute, blood pressure 84/46 mmHg, MAP- (57), and pulse oximetry 90% on 2 lpm O2 via nasal cannula.
Fractured liver & ruptured spleen
Define: Respiratory alkalosis
HCO3 & pH is increased while the CO2 is decreased
The triage nurse is assessing a victim of a stab wound. According to the paramedics, the victim was stabbed by a male attacker. The knife blade is 6 inches (7.2 cm) in length and 1 inch (2.5 cm) in width. The "point of entry" of the stab wound is two inches above and left of the victim's xiphoid process. Which vital organ(s) are at an increased risk of being in the direct path of injury?
Heart Lungs Diaphragm
Define: D-dimer blood test
Helps to rule out harmful blood clots
The nurse is preparing to suction an intubated client's endotracheal tube (ETT). Which action should the nurse do first prior to suctioning the client's ETT?
Hyper-oxygenate with 100% FiO2 for 30 seconds
What does a pointed T test indicate?
Hyperkalemia
What do morphine & nitroglycerin cause?
Hypotension
What is a late sign of hypovolemic shock?
Hypotension Decline in consciousness Low urine output
The nurse receivesreport for a client with a history of heroin and alcohol abuse who has right arm cellulitis from a puncture wound. 0.9% sodium chloride is infusing at 50 mL/hr and oxygen at 2 liters per nasal canula. The client is flushed, diaphoretic, and slow to respond to verbal stimuli. Vital signs include oxygen saturation 94%, temperature 101° F (38.3° C), heart rate 124 beats/minute, respirations 26 breaths/minute, and blood pressure 88/24 mmHg. Which intervention should the nurse implement first?
Increase IV fluids to 150mL/min
What is indicated if the water seal level is below or above the fill line?
Increased work of breathing which can lead to pneumothorax
Define: Infective endocarditis
Infection of the endocardial surface of the heart, usually the heart valves
The nurse is collecting a sample for arterial blood gases (ABGs) for a client with hypoxia due to cardiomyopathy. Which should the nurse assess prior to obtaining the arterial blood sample?
Ulnar blood flow
Define: Extravasation
Leakage outside of the intended area
Why would you place sterile saline in an ETT prior to suctioning?
Loosen secretions
A client who arrived in the emergency department is experiencing status epilepticus. Which medication should the nurse administer immediately?
Lorazepam IV
A client with a demand pacemaker has a telemetry tracing with a pacing spike but no corresponding QRS complex. The client's myocardium is illiciting a QRS after a delay of several seconds. Which telemetry interpretation should the nurse conclude?
Loss of capture
What is indicated if there is a pacemaker spike that does not produce a QRS complex?
Loss of capture
Why do people with diabetes have an increased urinary output?
Low ADH
What does an elevated ST segment indicate?
MI
A client diagnosed with heart failure has hemodynamic monitoring in place. Which actions should the nurse perform to obtain accurate readings from the hemodynamic monitor?
Measure the pressure readings in between the breaths Calibrate it to 0 at the start of each shift Place transducer at the atrial & pulmonary levels
The nurse is caring for a client who underwent surgical repair of the aorta after sustaining injuries in a fall. Which finding indicates improved blood flow after the surgery?
Movement of the lower extremities
Define: Laryngospasm
Muscle spasm in the vocal cords
What requires immediate chest compressions?
No pulse or RR
What does a white-out on a chest x-ray indicate?
Pulmonary edema and density in the lungs
What is a common postoperative complication?
Pulmonary embolism
Define: Cardiac bypass surgery
Redirects blood around a blocked section of your heart
Define: Nitroprusside
Reduces BP
The nurse is analyzing an arterial blood gas (ABG) of a client who is mechanicallly ventilated. The ABG results are pH- 7.52; paCO2- 30 mmHg; HCO3- 28 mEq/liter. How should the nurse interpret this blood gas?
Respiratory alkalosis
A client diagnosed with an end-stage terminal illness has decided to discontinue treatment. The client has become very detached and does not want to participate in the plan of care. Which action should the nurse implement first?
Review the clients medical record for choice of religious preference
What precaution should a patient be on with a high sodium?
Seizure precautions
Define: Beck's triad
Signs of pericardial tamponade with low arterial BP, distended neck veins, & muffled heart sounds
What does dopamine cause if extravasation occurs?
Soft tissue necrosis
Two days after surgical repair of an aortic abdominal aneurysm (AAA), the cardiac monitor is displaying sinus bradycardia and blood pressure 82/40 mmHg. Nitroprusside is infusing at 10 mcg/kg/min and 0.9% sodium chloride at 100 mL/hr. Which intervention should the nurse implement first?
Stop the nitroprusside infusion
Define: Stridor
Strained, high-pitched sound heard on inspiration caused by obstruction in the pharynx or larynx
Which intervention should the nurse perform prior to the removal of an endotracheal tube from a client?
Suction the tube thoroughly
Define: Anastomosis
Surgical connection between an artery & a vein
Define: Thyroidectomy
Surgical removal of the thyroid gland
What reflects blood loss greater than 1000mL?
Systolic <100mmHg HR >120bpm
What way do males stab?
Upwards
What is the purpose of an IV fluid bolus?
To fill the right ventricle for the heart to pump
What is the purpose of Kussmaul respirations?
To let go of CO2
A chest X-ray is prescribed for a client with possible adult respiratory distress syndrome (ARDS). Which radiographic finding represents the pathological processes of pulmonary edema and consolidation of the lungs as ARDS progresses ?
White-out appearance
Define: Respiratory acidosis
pH & CO2 are increased
Define: Cardiogenic shock
pump failure, occurs when heart is so inefficient that it cannot sustain adequate circulation
