ENA Critical care
A hypotensive patient with urosepsis is not responding to fluid volume resuscitation. Which vasopressor should the nurse expect the physician to prescribe for this patient? A. Norepinephrine (Levophed) B. Phenylephrine (Neo-Synephrine) C. Epinephrine (Adrenalin) D. Vasopressin (Pitressin)
A
For a mechanically ventilated patient, which nursing intervention decreases the risk of developing ventilator-associated pneumonia? A. Regular oral care B. Use of the same suction catheter periodically C. Keeping the patient flat in bed D. Routine saline lavage
A
For a patient receiving a neuromuscular blocker, which mode of mechanical ventilation is indicated? A. Assist control B. Synchronized intermittent mandatory ventilation C. Continuous positive airway pressure D. Pressure control ventilation
A
In a patient with abdominal hypertension, what causes inadequate ventilation? A. Anatomical causes B. Shunting C. Muscular abnormalities D. Partial airway obstruction
A
In the emergency department, a patient presents with signs and symptoms of acute respiratory distress syndrome. Which tidal volume should you anticipate using for this patient initially? A. 6 mL/kg of ideal body weight B. 7 mL/kg of ideal body weight C. 8 mL/kg of ideal body weight D. 9 mL/kg of ideal body weight
A
In which disorder are the alveoli ventilated but not perfused? A. Cardiogenic shock B. Pulmonary contusion C. Atelectasis D. Traumatic brain injury
A
What causes stacking breaths in a patient on mechanical ventilation? A. Auto-positive end-expiratory pressure B. Barotrauma C. Infection D. Oxygen toxicity
A
What is the function of the thermistor lumen of a pulmonary artery catheter? A. It measures cardiac output. B. It measures right atrial pressure. C. It measures pulmonary artery systolic pressure. D. It measures pulmonary artery occlusion pressure (wedge pressure).
A
When caring for a patient on mechanical ventilation, the nurse should expect which ventilator setting to increase the patient's functional residual capacity? A. Inspiratory/expiratory ratio B. Positive end-expiratory pressure C. Sensitivity D. Positive inspiratory pressure
A
Which complication is associated with a radial artery line placement? A. Vasospasm B. Knotting C. Dysrhythmias D. Pneumothorax
A
Which intracranial pressure monitoring device allows for drainage and sampling of cerebrospinal fluid? A. Ventriculostomy catheter B. Subdural catheter C. Intraparenchymal probe D. Subarachnoid screw
A
Which patient is most likely to experience primary airway compromise? A. A patient with an inhalation injury B. A patient with a stroke C. A patient with a traumatic brain injury D. A patient with a cerebral aneurysm
A
Which ventilator setting can inactivate the surfactant in a patient's lungs? A. A fraction of inspired oxygen (FiO2) that exceeds 0.5 for a prolonged time B. Minute ventilations at 5 L per minute C. A sensitivity set at 2 cm of water D. An inspiratory/expiratory ratio of 1:2
A
A patient on mechanical ventilation is experiencing fluctuations in his arterial pH level. Which ventilator setting is likely to cause these fluctuations? A. Tidal volume B. Pressure-controlled ventilation C. Rate D. Fraction of inspired oxygen (FiO2)
C
A patient receiving mechanical ventilation has a leak from the endotracheal tube cuff. Which ventilator alarm alerts the nurse to this problem? A. Apnea B. Low oxygen pressure C. Low airway pressure D. High airway pressure
C
A patient with a history of cardiomyopathy arrives at the emergency department with shortness of breath, pink frothy sputum, and pulmonary crackles. Which device can provide the most valuable information to help guide therapy? A. An arterial catheter B. A central venous catheter C. A pulmonary artery catheter D. An intracranial pressure catheter
C
A patient with acute respiratory distress syndrome is likely to need which ventilatory adjunct? A. Pressure support ventilation B. Permissive hypercapnia C. Inverse ratio ventilation D. Pressure-controlled, volume variable ventilation
C
In a patient admitted with sepsis, the nurse should expect which laboratory finding? A. Decreased bilirubin level B. Elevated fibrinogen level C. Elevated liver enzyme levels D. Decreased hemoglobin level and hematocrit
C
In a patient with sepsis, the nurse should expect which laboratory test result to be decreased? A. Creatinine level B. Bilirubin level C. Platelet count D. Lactate level
C
The nurse is assessing a patient's ability to be weaned off mechanical ventilation. Which ventilator setting recognizes the patient's spontaneous respiratory effort? A. Positive inspiratory pressure B. Inspiratory/expiratory ratio C. Sensitivity D. Positive end-expiratory pressure
C
When preparing for central venous catheter placement, the nurse should tell the patient that which site is the most likely one for insertion? A. Radial artery B. Brachial vein C. Superior vena cava D. Pulmonary artery
C
Which finding is considered a manifestation of systemic inflammatory response syndrome? A. A white blood cell count of 11,500/mm3 B. A heart rate of 85 beats per minute C. A partial pressure of carbon dioxide (PaCO2) of 26 mm Hg D. A temperature of 96.8° F (36° C)
C
A nurse is being oriented to the emergency department. Which statement by the nurse demonstrates a correct understanding of the dicrotic notch on an arterial waveform? A. "A dicrotic notch represents the inotropic upstroke." B. "A dicrotic notch establishes the zero reference point on the central venous pressure reading." C. "A dicrotic notch represents the perfusion pressure." D. "A dicrotic notch separates the systolic and diastolic phases on the arterial waveform."
D
A patient is receiving pressure-controlled, volume variable mechanical ventilation. What is a disadvantage of this type of mechanical ventilation? A. The distending pressure of the lungs is limited. B. Inspiration is terminated when a certain pressure is achieved. C. It is associated with a risk of lung injury. D. Minute ventilation volume is not guaranteed.
D
The nurse is caring for a patient after pulmonary artery catheter insertion. Which complication may occur if the catheter migrates? A. Vasospasm B. Cardiac tamponade C. Pulmonary hypertension D. Premature ventricular contractions
D
When assessing a patient on mechanical ventilation, you discover absent breath sounds on one side and tracheal deviation. Which complication of mechanical ventilation should you suspect? A. Pneumonia B. Oxygen toxicity C. Auto-positive end-expiratory pressure D. Tension pneumothorax
D
Which measurement indicates hypoperfusion in a patient with sepsis? A. An abnormal blood pressure reading B. A central venous pressure of 10 mm Hg C. An elevated temperature measurement D. An elevated serum lactate level
D
Which patient needs a long expiratory time to be set for mechanical ventilation? A. A patient with pneumonia B. A patient with a pulmonary contusion C. A patient with a pneumothorax D. A patient with chronic obstructive pulmonary disease
D
Which statement best defines bacteremia? A. Bacteremia is the inflammatory response by a host to invasion by a microorganism. B. Bacteremia is the systemic inflammatory response specifically attributed to an infection or a presumed infection. C. Bacteremia is the presence or presumed presence of an infection as well as single or multiple organ dysfunction, hypoperfusion, or hypotension. D. Bacteremia is the presence of bacteria in the bloodstream.
D
A patient in the emergency department is diagnosed with acute respiratory distress syndrome. Why does this patient need immediate endotracheal intubation? A. Failure to maintain a patent airway B. Alveolar shunting C. Anticipated airway failure D. Dead space ventilation
B
A patient in the emergency department is started on permissive hypercapnia. The physician orders arterial blood gas analysis on this patient. Which arterial blood gas finding should you expect? A. pH of 7.15 B. pH of 7.25 C. pH of 7.35 D. pH of 7.45
B
A patient on mechanical ventilation is being boarded in the emergency department until a bed is available in the intensive care unit. This patient is most likely to receive which common mode of mechanical ventilation? A. Negative pressure B. Volume-controlled, pressure variable C. Pressure-controlled D. Pressure-controlled, volume variable
B
A patient with a traumatic brain injury from a motor vehicle crash arrives at the emergency department. Which findings suggest the need for placement of an intracranial pressure monitoring device? A. A Glasgow Coma Scale score of 10 and abnormal posturing B. Abnormal flexion and a systolic blood pressure of 80 mm Hg C. Under age 40 and a normal computed tomography scan D. A systolic blood pressure that exceeds 90 mm Hg and a Glasgow Coma Scale score of 7
B
A patient with sepsis has a blood pressure of 80 mm Hg despite receiving fluid resuscitation and high-dose vasopressors. Which therapy is the priority to improve this patient's blood pressure? A. Antibiotic therapy B. Hydrocortisone (Solu-Cortef) C. Endotracheal intubation D. Oxygen
B
The nurse is calculating the patient's cerebral perfusion pressure. The cerebral perfusion pressure should minimally be maintained at which target level? A. Less than 50 mm Hg B. 60 to 70 mm Hg C. 80 to 100 mm Hg D. More than 100 mm Hg
B
Which mode of mechanical ventilation lets the patient breathe at his or her own tidal volume? A. Pressure control ventilation B. Synchronized intermittent mandatory ventilation C. Assist control D. Continuous positive airway pressure
B
Which statement accurately describes the mean arterial pressure in relation to the brain? A. The mean arterial pressure is the resistance force within the brain. B. The mean arterial pressure is the driving force of blood supply to the brain. C. The mean arterial pressure is a measure of the relationship between the contents of the brain. D. The mean arterial pressure is a measure of the compensatory adjustment of brain components.
B
