NUR 240 Final Exam
A critically ill patient is prescribed enteral feedings to begin after placement of the nasogastric tube is verified. What should the nurse identify as the goal for this method of nutrition? 1. Prevent infection 2. Avoid aspiration pneumonia 3. Enhance respiratory excursion 4. Reduce the need for pain medication
1
A nurse is preparing to communicate an issue about patient care to a physician using the SBAR technique. Which phrase is an appropriate initial statement? 1. "I am concerned about..." 2. "The patient's immediate history is..." 3. "I think the problem is..." 4. "I would like you to..."
1
A patient scores positive on the Confusion Assessment Method of the Intensive Care Unit (CAM-ICU). Which nursing diagnosis would have the highest priority based on this positive score? 1. Injury, Risk for 2. Family Processes, Altered 3. Social Interaction, Impaired 4. Memory Impaired Answer: 1
1
A patient with a right subclavian triple lumen catheter has a CVP reading of 18 mm Hg. For what symptoms should the nurse assess this patient? 1. Peripheral edema and jugular vein distention 2. Decreased peripheral pulses and cool extremities 3. Hypovolemia and hypotension 4. Orbital edema and disorientation
1
The adult daughter of a client with end-stage kidney disease informs the health care provider that all interventions are to be provided even though the client is heard telling the spouse that "enough is enough." What should be done first when analyzing this situation? 1. Identify significant information. 2. Determine the decision maker for the client. 3. Estimate the resources needed for care. 4. Calculate the expense of providing care to the client
1
The health care provider is preparing to insert a PA catheter. What action is a priority for the nurse? 1. The patient is in the Trendelenburg position to prevent air embolism. 2. The patient has received a dose of IV lidocaine. 3. The site has been cleaned with soap and water. 4. A tourniquet has been applied to the neck.
1
The nurse inserts a nasogastric tube and plans to confirm placement of the tube prior to starting enteral feedings. Which is the most accurate method for confirming tube placement? 1. Obtaining a radiological x-ray of the abdomen 2. Checking gastric aspirate for a pH of less than 7 3. Instilling 30 mL of air while listening with a stethoscope when placed over the fundus of the stomach 4. Determining the presence of carbon dioxide
1
The nurse manager is planning the staffing budget for the next fiscal year. What action should the manager take to ensure that staffing is adequate? 1. Study the results of the organization's staffing evaluation. 2. Meet with other nurse managers to compare staffing needs. 3. Remember that nurses should not work more than 72 hours each week. 4. Review staff competency needs with the director of human resources.
1
When providing care to critically ill patients, whether they are responsive or unresponsive, what should the nurse do? 1. Clearly explain what care is to be done before starting the activity. 2. Perform the activity and then let the patient rest without explaining the care. 3. Make sure the patient always responds and is cooperative before giving care. 4. Explain to the family that the patient will not understand or remember any of the discomfort associated with care.
1
Which nursing diagnosis should receive the highest priority when caring for a patient who is receiving total parenteral nutrition? 1. Infection, Risk for 2. Trauma, Risk for 3. Skin Integrity, Impaired 4. Fluid Volume, Risk for Imbalance
1
Which nursing intervention ensures an accurate cardiac output reading for a patient? 1. Administer the injectate within 4 seconds. 2. Use 5 cc of iced saline as the injectate. 3. Ensure that there is a difference of 10°C between the injectate temperature and the patient's body temperature. 4. Inject the fluid into the pulmonary artery distal port.
1
Which statement should the nurse include for "A-Assessment" in the SBAR technique for communication? 1. "I think the problem is..." 2. "The patient's vital signs are..." 3. "The patient's treatments are..." 4. "I would like you to..."
1
While caring for a patient in the critical care unit, the nurse realizes that the patient's care needs must be a balance between the patient's long-term prognosis and the family's expectations of recovery. Which AACN Synergy Model characteristic does this situation describe? 1. Complexity 2. Predictability 3. Participation in care 4. Resource availability
1
With which individuals should the nurse expect to provide patient care in an "open" ICU? 1. Multidisciplinary team with physicians who are also responsible for patients on other units 2. Multidisciplinary team that includes a physician employed by the hospital 3. Physician in charge of patient care who is a specialist in critical care 4. Primary care physician who must consult a critical care specialist
1
A patient in the critical care unit demonstrates increasing agitation. What should the nurse use to assess this patient's agitation level? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Sedation Assessment Scale (SAS) 2. Richmond Agitation-Sedation Scale (RASS) 3. Glasgow Scale 4. Reaction Level Scale 5. Ventilator Adjusted Motor Assessment Scoring Scale
1,2
After assessing a patient's hemodynamic parameters, the nurse determines that preload and afterload are both elevated. These findings are consistent with which health problems? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Pericardial tamponade 2. Constrictive pericarditis 3. Hypovolemia 4. Neurogenic shock 5. Mitral stenosis
1,2
The nurse is providing care to patients in a Level II general critical care unit. For which types of patient problems will this nurse most likely provide care? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Exacerbation of heart failure 2. Wound infection 3. Burns over 50% of total body surface 4. Kidney transplant 5. Reattachment of a traumatic amputation of the left leg
1,2
The nurse wants to assess the oxygenation status of a patient who has been experiencing a gastrointestinal bleed. How should the nurse complete this assessment? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Use pulse oximetry. 2. Send a blood sample for arterial blood gas analysis. 3. Auscultate lung sounds. 4. Evaluate cardiac rhythm strip. 5. Calculate mean arterial pressure.
1,2
What might occur when a nurse employs conscientious refusal to participate? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Dismissal from a nursing position 2. Employer sanctions 3. Support from nursing administrators 4. Protection from the state boards of nursing 5. Support by the patient
1,2
A patient is admitted to an "open" intensive care unit. In addition to the nurse, which health care providers will assist in the care of this patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Pharmacist 2. Respiratory therapist 3. Attending physician 4. Dietician 5. Social worker
1,2,3
The critical care nurse is experiencing psychologic symptoms of compassion fatigue. What strategies should the nurse use to enhance psychological well-being? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Make time for recreational activities. 2. Practice yoga for relaxation. 3. Plan to take a walk in the park at least once a week. 4. Monitor food and beverage intake. 5. Darken the room and limit activities before sleep.
1,2,3
The critical care nurse is identifying patients at risk for safety and medical errors. Which patients should the nurse identify as being at risk for these issues? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Patient in isolation with MRSA 2. Patient who does not understand English 3. Patient with end stage renal disease and a respiratory rate of 8 per minute 4. Patient recovering from pacemaker insertion 5. Patient with pulmonary edema
1,2,3
The nurse providing care to a patient who is unresponsive and being mechanically ventilated uses unintentional distractions. What is the nurse doing when providing care? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Singing 2. Humming 3. Joking 4. Talking to a colleague 5. Apologizing for causing pain
1,2,3
What should the nurse do to meet the needs of the critically ill patient's family members? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Express an attitude of hope, honesty, open communication, and caring 2. State specific facts about the patient's condition in a timely manner 3. Plan regular times for family visits throughout the day 4. Limit the number of visitors to significant others 5. Communicate to a single family member to cut down time wasted repeating information to all visitors
1,2,3
Which informal power bases should the nurse use in the health care setting? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Expertise 2. Goodwill 3. Information 4. Observation 5. Collaboration
1,2,3
For which patient would decision-making capacity likely be impaired? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Being medicated for severe pain 2. Does not understand the medical condition 3. Diagnosed with septic shock 4. Is depressed 5. Asks questions about identified treatments
1,2,3,4
The nurse assesses a critically ill patient utilizing the AACN Synergy Model's characteristics. Which characteristics are identified as impacting the outcome of a critically ill patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Participation in care 2. Resource availability 3. Stability 4. Complexity 5. Level of consciousness
1,2,3,4
The nurse assesses the nutritional needs of a patient in the intensive care unit. What information is essential for the nurse to obtain during this assessment? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Patient's current height and weight 2. Food allergies 3. Use of nutritional supplements 4. If the patient can swallow 5. Amount of water consumed each day
1,2,3,4
The nurse is a member of a committee that is designing improvements to the critical care waiting areas. What improvements should the nurse suggest to enhance the comfort of family members of critical care patients? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Plan for a large space to be used for the waiting areas. 2. Provide coffee and soft drinks in the waiting area. 3. Place televisions and DVD players in the waiting area. 4. Find space for sleeping rooms. 5. Use dark paint and minimal lighting in the waiting areas.
1,2,3,4
The nurse manager of a critical care unit is explaining the AACN Synergy Model to the critical care nurses. What should the manager include as basic parts of this model? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Based on the patients' characteristics 2. Based on the competencies of the nurses 3. Patient outcomes will be measured 4. The nurses' assessment of patient outcomes will be measured 5. Reduction of cost to provide critical care services to patients
1,2,3,4
The nurse manager, concerned that several staff nurses are experiencing moral distress, is planning to implement the 4 A's to Rise Above Moral Distress. Which steps will the manager take? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Ask 2. Affirm 3. Assess 4. Act 5. Assert
1,2,3,4
The nurse plans care for a critically ill patient. What should the nurse include to address the patient's major areas of concern? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Explain the purpose of the tube in the nose. 2. Explain the purpose of the tube in the mouth. 3. Determine a method of communication. 4. Explain the purpose of the intravenous tubes. 5. Ensure that the room lights will be turned off and alarms set to low volume.
1,2,3,4
The nurse plans to use music therapy to help reduce a critically ill patient's level of anxiety. What should the nurse do when using this complementary and alternative therapy? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Ask family members to identify the patient's preferred music. 2. Plan for the music to be played for 30 uninterrupted minutes. 3. Listen to the music in advance to make sure it does not have lyrics. 4. Ensure that the music beats are between 60 to 80 per minute. 5. Play the music from a CD player on the bedside table.
1,2,3,4
What strategies should the nurse use to communicate with an older adult patient who is intubated and being mechanically ventilated? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Make sure the patient is wearing eyeglasses. 2. Speak slowly. 3. Decide on which gestures mean "yes" and "no." 4. Have questions and possible answers ready so the patient can point to the response. 5. Ask several questions at a time to limit interruptions in rest periods.
1,2,3,4
What would be appropriate reasons for an intensive care unit intensivist to call a huddle? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Make care providers aware of a change in a patient's situation. 2. Communicate a critical issue about a patient. 3. Make an assignment change. 4. Discuss concerns about a patient's status or care. 5. Plan care for the shift.
1,2,3,4
Which actions by the critical care nurse demonstrate an understanding of patient advocacy? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Maintaining attendance at the bedside with the patient during a physician visit 2. Assisting and supporting the patient and family as they reveal their needs 3. Alerting the physician to concerns about client placement after hospitalization 4. Encouraging and supporting a patient's spouse in preparing for a family meeting 5. Seeing the big picture when planning patient care
1,2,3,4
Which actions should the nurse complete after realizing that an incorrect dose of medication has been administered to a patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Notify the patient and family. 2. Notify the physician. 3. Document the error. 4. Prepare for an analysis of the error. 5. Keep the notification of the error silent.
1,2,3,4
Which parameter indicates that a patient in the intensive care unit being mechanically ventilated is ready for an interruption in sedation? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. MAP of 75 and heart rate of 76 2. Awakens with verbal stimuli 3. Frowns when turned but otherwise shows no muscular tension 4. Activates the ventilator alarms, but the alarms stopped spontaneously 5. Receives neuromuscular blocking agents to ensure adequate ventilation
1,2,3,4
Which strategies should the nurse include in the plan of care when trying to minimize sleep disruptions for a patient in an ICU? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Instituting a short course of therapy for sleeping agents 2. Accurate scoring and vigilance in sedation and sedation scoring 3. Managing the environment to reduce lighting and sound 4. Minimizing staff interruptions during sleep periods 5. Scheduling treatments only during the day or at least 4 hours apart at night
1,2,3,4
While completing a self-evaluation, the critical care nurse compares personal practice to the competencies identified by the AACN Synergy Model. Which behaviors are consistent with those in the Synergy Model? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Seeks out research studies to update protocols 2. Approaches patient care by looking at the "big picture" 3. Ensures family members are comfortable when visiting critical care patients 4. Encourages patient families to discuss issues with the physician 5. Telling the next shift that a patient needs help with understanding instructions
1,2,3,4
The nurse collaborates with other members of the health care team to effect optimal outcomes in patient care. Which characteristics of emotional maturity is the nurse using? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Maintaining current skills 2. Being a lifelong learner 3. Actively identifying best practices 4. Overlooking one's own shortcomings 5. Willing to take responsibility for failures
1,2,3,5
A patient has just completed a preoperative education session prior to undergoing coronary artery bypass surgery. Which patient statements indicate that teaching has been effective? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. "I understand that I will have to blink my eyes to respond after the breathing tube is in my throat." 2. "I will be given frequent mouth care to help me when I am thirsty." 3. "I will be able to move about freely in bed and into the chair without help while connected to the electronic equipment for monitoring." 4. "I may need something to help me rest due to the unfamiliar lights and sounds of the ICU unit." 5. "I might not behave like my usual self after the surgery, but it will be because of the medications and my illness."
1,2,4,5
The charge nurse reviews information about patients received during morning report. Which patient is at risk for nutritional imbalances? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Client recovering from a myocardial infarction 2. Client receiving hemodialysis treatments 3 times a week 3. Client with slightly elevated liver enzymes 4. Client who is intubated for respiratory failure 5. Client recovering from extensive burns
1,2,4,5
What is associated with moral distress in critical care nurses? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Having no voice in clinical decision making 2. Providing aggressive care to patients who cannot benefit 3. Realizing that nurses maintain power in bedside decision making 4. Knowing the right thing to do but not being able to do it 5. Leaving employment as a critical care nurse
1,2,4,5
The nurse is planning to assess the blood pressure of a patient with a BMI of 40. Which approaches should the nurse use to correctly obtain this patient's blood pressure? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Use a cuff with a bladder that is 80% of the patient's arm circumference. 2. Use a thigh cuff. 3. Use an adult cuff on the patient's forearm. 4. Assess the blood pressure using the same approach each time. 5. Use an adult cuff on the patient's thigh.
1,3
When planning care to meet the needs of families of critically ill patients, the nurse should include which strategies by Miracle (2006)? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Information about how to contact the primary doctor if needed 2. Frequent verbal communication to clarify the purpose of unit, equipment, procedures, waiting areas, phones, and so on 3. Regular family conferences to meet patient goals and progress 4. A consistent nurse, and unified staff responses if that nurse is not available 5. A way to contact family through a specific family member by phone if needed
1,3,4
The nurse uses the Synergy Model patient characteristics to plan care for a patient in the intensive care area. Which observations indicate that these actions were effective? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Patient extubated two days earlier than expected 2. Patient expresses dissatisfaction with morning care 3. Patient states that he or she is feeling better and is eager to return home 4. Patient thanks the nursing staff for help with basic care needs 5. Patient rests between procedures and medication administration
1,3,4,5
A patient is experiencing reduced afterload. What should the nurse identify as causes for this finding? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Sepsis 2. Mitral stenosis 3. Reduced circulating blood volume 4. Vasodilator medications 5. Myocarditis
1,4
Which patient should the nurse expect to be transferred to a critical care unit? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Experiences an acetaminophen overdose 2. Diagnosed with an acute mental illness 3. Receiving treatment for chronic renal failure 4. New onset of acute decompensated heart failure 5. Treatment for bacteremia from an infected foot wound
1,4,5
Which symptoms indicate a nurse is experiencing compassion fatigue? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Difficulty separating work from personal life 2. Excessively high tolerance for frustration 3. Having a completely laissez-faire attitude 4. Decreased functioning in nonprofessional situations 5. Dreads working with certain types of patients
1,4,5
A patient has a blood pressure of 134/70 per blood pressure cuff and a blood pressure of 90/50 per arterial line. What action should the nurse take? 1. Discontinue the arterial line immediately. 2. Check the level of the transducer and relevel and rezero the system. 3. Do nothing because this is a normal variation between the two methods of measurement. 4. Begin the infusion of a dopamine drip.
2
A physician suggests that a patient being mechanically ventilated, needing immediate transport to CT scan, and having severe pain be given IV fentanyl (Sublimaze) rather than morphine sulfate for pain management. Why is fentanyl (Sublimaze) preferred? 1. Rapid administration does not have any hemodynamic consequences. 2. It has a more rapid onset and a shorter duration of action. 3. Weaning of a continuous infusion is never needed due to its short half-life. 4. It is not likely to cause respiratory depression
2
Members of the multidisciplinary care team review a patient's nutritional status and analyze assessment values. Which value would need additional investigation? 1. A serum albumin of more than 3.5 g/dL or 35 g/L 2. A weight increase of 1.5 kg in a day 3. A serum hemoglobin of 11.7 g/dL or 117 mmol/L 4. A prealbumin level of 35 mg/dL
2
The nurse administers haloperidol (Haldol) via IV push to a patient experiencing delirium. What is most important for the nurse to monitor in this patient? 1. Heart rate 2. QT interval 3. PR interval 4. Respiratory rate
2
The nurse cares for a patient recovering from surgery who is being mechanically ventilated and experiencing pain. Which approach should the nurse use first to assess this patient's pain? 1. Attempt an analgesic trial 2. Ask the patient if he or she is in pain 3. Observe the patient's face for grimacing 4. Ask a family member if the patient is in pain
2
The nurse identifies a patient in the critical care unit as having "resiliency." What characteristic has the nurse identified in the patient? 1. Motivation to reduce anxiety through positive self-talk 2. Ability to bounce back quickly after an insult 3. Physical strength to endure extreme physical stressors 4. Ability to return to a state of equilibrium
2
The nurse is monitoring a patient's pulmonary vascular resistance. Which value is the normal value? 1. 100-250 mm Hg 2. 10-250 dynes/sec/cm2 3. 400-800 mm Hg 4. 900-1,400 dynes/sec/cm2
2
The nurse manager reviews the standards of self-care for caregivers during a staff meeting. Which staff nurse comment indicates that teaching about the standards has been effective? 1. "I will consider yoga classes." 2. "I will play tennis with my sister at least twice a week." 3. "I do love to read, but at times I review the events of the day and I'm distracted." 4. "Going to the zoo with my nephew might be a good idea if I'm not needed for overtime."
2
The nurse plans to question a health care provider's choice of medication for a critically ill patient. Which statement demonstrates assertive communication? 1. "At times I think it would be wise to update the prescribing references that are used." 2. "I learned that this medication might not be effective with this health problem. Would you explain choosing it?" 3. "This patient is getting worse, and it is because someone prescribed an antiquated medication to treat the problem." 4. "I realize I am only a nurse, but I can read and I learned that this medication is a poor choice to treat this medical problem."
2
The nurse realizes that the increased use of technology in critical care units has resulted in which consequence for patient care? 1. Decreased risk of errors in patient care 2. Decreased therapeutic nurse-patient communication 3. Improved overall patient satisfaction with care 4. Improved patient safety across the entire spectrum
2
The nurse reviews assessment data on a group of patients. Which patient should the nurse identify as experiencing a critical illness? 1. Chronic airflow limitation with VS: BP 110/72, P 110, R 16 2. Acute bronchospasm with VS: BP 100/60, P 124, R 32 3. Motor vehicle crash with VS: BP 124/74, P 74, R 18 4. Chronic renal failure on hemodialysis with no urine output with VS: BP 98/50, P 108, R 12
2
What must the patient demonstrate for a nurse to be found guilty of negligence? 1. Was assaulted 2. Incurred damages 3. Suffered a wrongful death 4. Was not consulted before being touched
2
What should the nurse who provides care to patients in a critical care unit realize the role of technology is on the amount of errors? 1. It relies heavily on human decision making. 2. Devices are programmed to function without double checks. 3. It makes the workload seem overwhelming to health care providers. 4. There is uniform equipment throughout each facility.
2
Which communication strategy should the critical care nurse use when communicating with a ventilated patient? 1. Use professional terminology and provide the patient with detailed information. 2. Use simple language and explain in other terms if the patient does not seem to understand. 3. Provide minimal information so the patient is not overwhelmed. 4. Discuss issues primarily with the family because the patient is unlikely to understand the information.
2
Which nursing action would be appropriate when the nurse initiates an infusion of morphine sulfate for a post-operative patient who is experiencing pain? 1. Anticipate that the patient will begin to experience the effect of the morphine 15 minutes after the start of the infusion. 2. Provide additional intermittent boluses of morphine sulfate if the patient experiences breakthrough pain. 3. Complete the Critical-Care Pain Observation Tool scale 5 minutes after increasing the infusion rate each time. 4. Begin the infusion at the lowest ordered dose, and increase the rate every 30 minutes if the patient continues to have pain.
2
Which statement describing the needs of family members of critically ill patients has yet to be validated by research? 1. "Not knowing is the worst part" of waiting. 2. Families in the waiting room have no effect on patient outcomes. 3. "Hovering" in the proximity phase is characterized by confusion and tension. 4. A unified message from staff minimizes family stressors.
2
Which value should the nurse recognize is normal for a patient's cardiac output? 1. 6-9 L/min 2. 4-8 L/min 3. 8-10 L/min 4. 2-4 L/min
2
A patient asks the nurse, "What is blood pressure?" What should the nurse respond? 1. "A measurement that should always be 120/80 unless complications are present." 2. "The amount of pressure exerted on your veins by the blood." 3. "A measurement that takes into consideration the amount of blood that your heart is pumping and the size of the vessel diameter the heart must pump against." 4. "A complex measurement that should only be discussed with your health care provider."
3
A patient with a PA catheter has an SVO2 of 90%. For what should the nurse assess this patient? 1. Fever 2. Pain 3. Hypothermia 4. Anemia
3
A patient with an arterial line has an elevated partial thromboplastin time (PTT) and is not on anticoagulation therapy. What should the nurse do? 1. Take the patient for an immediate V/Q scan. 2. Assess for the presence of a deep vein thrombosis. 3. Change the heparinized saline solution in the pressure bag for the arterial line to a normal saline solution. 4. Ask for an order to begin Lovenox therapy.
3
A patient's hemodynamic parameters include the following: right atrial pressure (RAP) of 13 mm Hg, pulmonary artery wedge pressure (PAWP) of 8 mm Hg, systemic vascular resistance (SVR) of 1,000 dynes/sec/cm2, cardiac output (CO) of 4.9 L/min, cardiac index (CI) of 3.5 L/min, and pulmonary vascular resistance (PVR) of 280 dynes/sec/cm2. Which heart function should cause the nurse concern? 1. Afterload 2. Left heart contractility 3. Right heart contractility 4. Heart rate
3
A patient's systemic vascular resistance (SVR) has dangerously decreased. The nurse would expect to administer which medications? 1. Furosemide (Lasix) and dopamine 2. Nitroprusside and furosemide (Lasix) 3. Dopamine and norepinephrine (Levophed) 4. Nitroglycerin and digoxin (Lanoxin)
3
During an assessment, a ventilated patient begins to frown and wiggle about in bed. Which assessment strategy would be most helpful for the nurse to validate these observations? 1. Glasgow Scale 2. Maslow's hierarchy levels 3. Critical-Care Pain Observation Tool (CPOT) 4. Vital signs trends
3
Prior to the insertion of an arterial line in the radial artery, which assessment should the nurse perform? 1. Homan's test 2. Kernig's test 3. Allen's test 4. Leopold's maneuver
3
The nurse confirms medication orders and the schedule to administer a sedative to a patient with delirium. Which dosing schedule maximizes the effectiveness of the drugs? 1. Only in the early morning 2. Only at bedtime (HS) 3. Around the clock with higher dosages in the evening 4. Only on an as-needed (PRN) basis
3
The nurse employed in a hospital in a small rural town would expect to provide which level of care in the critical care unit? 1. Level I 2. Level II 3. Level III 4. It is unlikely that the hospital would have a critical care unit.
3
The nurse in the critical care area is completing a preoperative checklist before sending a patient for surgery. This nurse's activity is an example of which recommendation issued by the Institute of Medicine? 1. Utilizing constraints 2. Simplifying key processes 3. Avoiding reliance on vigilance 4. Standardizing key processes
3
The nurse is monitoring the PA pressure of a mechanically ventilated patient. When should the nurse obtain the measurement to accurately assess this pressure? 1. Whenever, because the timing does not matter 2. At the last clear waveform before the baseline drops 3. At the last clear waveform before the baseline rises 4. With the patient off of the ventilator
3
The nurse working within the AACN Synergy Model realizes that optimal patient outcomes are realized when: 1. Highly qualified nurses care for patients in highly technical settings. 2. Nurses agree to work overtime to cover unit staffing needs. 3. Staff nurse competency is matched with patient needs. 4. Patient care is delivered within a "closed unit" model.
3
Weekly group meetings are scheduled every Wednesday afternoon for the families of current intensive care patients. What should the nurse prepare in anticipation of the next meeting? 1. Visiting hours for the unit 2. Location of the waiting area 3. Equipment and treatments the patients receive 4. The schedule of when to telephone for patient status updates
3
When observing the waveform of an arterial line, the nurse notes the presence of a dicrotic notch. How should the nurse interpret this finding? 1. Pulmonic valve opening 2. Mitral valve closure 3. Aortic valve closure 4. Tricuspid valve closure
3
Which action has the highest priority for maintaining safety when caring for a patient with a PA catheter? 1. Obtain pressures per protocol. 2. Administer fluids and medications via pump. 3. Maintain asepsis when providing line care. 4. Obtain lab values as ordered.
3
Which observation indicates pulsus paradoxus on a patient's arterial pressure waveform? 1. The waveform has tall, tented waves. 2. The pulse pressure is above 20 mm Hg on exhalation. 3. There is a decrease of more than 10 mm Hg in the arterial waveform before inhalation. 4. There is a single, nonperfused beat.
3
Which statement should the nurse use when concluding SBAR communication about a patient issue? 1. "The patient's immediate history is..." 2. "The patient's physical findings are..." 3. "I am requesting that you..." 4. "I have assessed the patient personally."
3
A newly admitted patient receiving sedation is prescribed parenteral nutrition via a central line. Which action should the nurse take to prevent overfeeding of this patient? 1. Monitor daily weights 2. Use an infusion pump 3. Evaluate albumin levels 4. Question the order to infuse lipids
4
A patient being mechanically ventilated receives midazolam (Versed) for sedation. What findings indicate to the nurse that the patient is receiving an appropriate dose of this medication? 1. Awake with a respiratory rate of 38 and a heart rate of 132 2. Asleep but withdrawing from noxious stimuli with a heart rate of 80 3. Awake with a heart rate of 124 and attempting to pull out the IV 4. Asleep but awakening to light touch with a heart rate of 72
4
A patient has a lactate level of 8 mmol/L. What should this finding indicate to the nurse? 1. Carbon dioxide exchange 2. Underuse of oxygen 3. Glucose metabolism 4. Tissue hypoxia
4
A patient has mixed venous oxygen saturation (SVO2) of 52% with the following hemodynamic findings: CO of 4.8 L/min, SaO2 of 95%, and an unchanged hemoglobin level. For what should the nurse assess the patient? 1. Excessive sedation 2. Position of the PA catheter 3. Hypothermia 4. Pain
4
For what can the nurse be held liable if forcibly inserting a nasogastric tube against a patient's wishes? 1. Negligence 2. Malpractice 3. Damages 4. Battery
4
How should the nurse calculate a patient's mean arterial pressure (MAP)? 1. Divide the systolic pressure by the diastolic pressure. 2. Average three of the patient's blood pressures over a 6-hour period. 3. Divide the diastolic pressure by the pulse pressure. 4. Add the systolic pressure and two diastolic pressures and then divide by 3.
4
The critical care nurse discusses a patient's change in status with the health care provider, pharmacist, and physical therapist. Which QSEN competency is this nurse demonstrating? 1. Patient-centered care 2. Quality improvement 3. Evidence-based practice 4. Teamwork and collaboration
4
The nurse addresses the family needs of a critically ill patient. Which family need was not identified? 1. Proximity 2. Information 3. Assurance 4. Timeliness
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The nurse realizes that which stressor is one of the primary concerns of critically ill patients and should be routinely included during assessments? 1. Inability to control elimination 2. Lack of family support 3. Hunger 4. Altered ability to communicate
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The nurse suspects that a patient is experiencing cardiogenic shock. Which parameter indicates that the nurse's suspicion is correct? 1. Cardiac output of 8.9 L/min 2. Pulmonary artery wedge pressure (PAWP) of 8 mm Hg 3. Central venous pressure (CVP) of 5 mm Hg 4. Cardiac index (CI) of 1.8 L/min/m2
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What should the nurse do to correctly calculate cardiac output? 1. Only take two measurements and then average the two readings. 2. Take one measurement to prevent fluid volume overload. 3. Obtain five measurements and record the highest reading. 4. Take three to five measurements and take the average of the three readings that are within 10% of one another.
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What should the nurse identify as an example of an installed forcing function or a system-level firewall to prevent errors when providing patient care? 1. Prior to administration of insulin, two nurses check the dose. 2. Prior to obtaining a medication, height, weight, and allergies are recorded. 3. All medications are checked by two nurses prior to administration. 4. Undiluted potassium chloride is not available on critical care units.
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What should the nurse monitor in response to a change in SVO2 readings? 1. Potassium level 2. Glucose level 3. Sodium level 4. Hemoglobin level
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What should the nurse use to measure the contractility of the left side of a patient's heart? 1. Left atrial pressure 2. Pulmonary artery wedge pressure 3. Systemic vascular resistance 4. Left ventricular stroke work index
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Which action ensures that a patient has consented to care? 1. Provide a consent form to sign to receive medications. 2. Ask the patient to sign a consent form to have dressings changed. 3. Discuss a consent form to sign to be turned in bed. 4. Explain how a dressing is to be changed.
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Which condition is most likely to occur when a patient is restrained? 1. Pulling out an endotracheal tube 2. Pulling out an intravenous line 3. Disconnecting ventilator tubing 4. Developing a nosocomial infection
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