Test Bank Introduction Critical Care Nursing 6th Edition, Sole
Chapter 1: Overview of Critical Care Nursing
1. Which of the following professional organizations best supports critical care nursing practice?
a. American Association of Critical-Care Nurses
b. American Heart Association
c. American Nurses Association
d. Society of Critical Care Medicine
2. A nurse has been working as a staff nurse in the surgical intensive care unit for 2 years and is interested in certification. Which credential would be most applicable for her to seek?
3. The main purpose of certification is to:
a. assure the consumer that you will not make a mistake.
b. prepare for graduate school.
c. promote magnet status for your facility.
d. validate knowledge of critical care nursing.
4. The synergy model of practice focuses on:
a. allowing unrestricted visiting for the patient 24 hours each day.
b. holistic and alternative therapies.
c. needs of patients and their families, which drives nursing competency.
d. patients’ needs for energy and support.
5. The family of your critically ill patient tells you that they have not spoken with the physician in over 24 hours and they have some questions that they want clarified. During morning rounds, you convey this concern to the attending intensivist and arrange for her to meet with the family at 4:00 PM in the conference room. Which competency of critical care nursing does this represent?
a. Advocacy and moral agency in solving ethical issues
b. Clinical judgment and clinical reasoning skills
c. Collaboration with patients, families, and team members
d. Facilitation of learning for patients, families, and team members
6. The AACN Standards for Acute and Critical Care Nursing Practice use what framework to guide critical care nursing practice?
a. Evidence-based practice
b. Healthy work environment
c. National Patient Safety Goals
d. Nursing process
7. The charge nurse is responsible for making the patient assignments on the critical care unit. She assigns the experienced, certified nurse to care for the acutely ill patient with sepsis who also requires continuous renal replacement therapy and mechanical ventilation. She assigns the nurse with less than 1 year of experience to two patients who are more stable. This assignment reflects implementation of the:
a. crew resource management model
b. National Patient Safety Goals
c. Quality and Safety Education for Nurses (QSEN) model
d. synergy model of practice
8. The vision of the American Association of Critical-Care Nurses is a healthcare system driven by:
a. a healthy work environment.
b. care from a multiprofessional team under the direction of a critical care physician.
c. the needs of critically ill patients and families.
d. respectful, healing, and humane environments.
9. The most important outcome of effective communication is to:
a. demonstrate caring practices to family members.
b. ensure that patient teaching is done.
c. meet the diversity needs of patients.
d. reduce patient errors.
10. You are caring for a critically ill patient whose urine output has been low for 2 consecutive hours. After a thorough patient assessment, you call the intensivist with the following report. Dr. Smith, I’m calling about Mrs. P., your 65-year-old patient in CCU 10. Her urine output for the past 2 hours totaled only 40 mL. She arrived from surgery to repair an aortic aneurysm 4 hours ago and remains on mechanical ventilation. In the past 2 hours, her heart rate has increased from 80 to 100 beats per minute and her blood pressure has decreased from 128/82 to 100/70 mm Hg. She is being given an infusion of normal saline at 100 mL per hour. Her right atrial pressure through the subclavian central line is low at 3 mm Hg. Her urine is concentrated. Her BUN and creatinine levels have been stable and in normal range. Her abdominal dressing is dry with no indication of bleeding. My assessment suggests that Mrs. P. is hypovolemic and I would like you to consider increasing her fluids or giving her a fluid challenge. Using the SBAR model for communication, the information the nurse gives about the patient’s history and vital signs is:
Chapter 2: Patient and Family Response to the Critical Care Experience
1. Family members have a need for information. Which interventions best assist in meeting this need?
a. Handing family members a pamphlet that explains all of the critical care equipment
b. Providing a daily update of the patient’s progress and facilitating communication with the intensivist
c. Telling them that you are not permitted to give them a status report but that they can be present at 4:00 PM for family rounds with the intensivist
d. Writing down a list of all new medications and doses and giving the list to family members during visitation
2. The nurse is a member of a committee to design a critical care unit in a new building. Which design trend would best to facilitate family-centered care?
a. Ensure that the patient’s room is large enough and has adequate space for a sleeper sofa and storage for family members’ personal belongings.
b. Include a diagnostic suite in close proximity to the unit so that the patient does not have to travel far for testing.
c. Incorporate a large waiting room on the top floor of the hospital with a scenic view and amenities such as coffee and tea.
d. Provide access to a scenic garden for meditation.
3. The nurse is caring for a patient who sustained a head injury and is unresponsive to painful stimuli. Which intervention is most appropriate while bathing the patient?
a. Ask a family member to help you bathe the patient, and discuss the family structure with the family member during the procedure.
b. Because she is unconscious, complete care as quickly and quietly as possible.
c. Tell the patient the day and time, and that you are bathing her. Reassure her that you are there.
d. Turn the television on to the evening news so that you and the patient can be updated to current events.
4. Sleep often is disrupted for critically ill patients. Which nursing intervention is most appropriate to promote sleep and rest?
a. Consult with the pharmacist to adjust medication times to allow periods of sleep or rest between intervals.
b. Encourage family members to talk with the patient whenever they are present in the room.
c. Keep the television on to provide “white” noise and distraction.
d. Leave the lights on in the room so that the patient is not frightened of his or her surroundings.
5. Family assessment is essential in order to meet family needs. Which of the following must be assessed first to assist the nurse in providing family-centered care?
a. Assessment of patient and family’s developmental stages and needs
b. Description of the patient’s home environment
c. Identification of immediate family, extended family, and decision makers
d. Observation and assessment of how family members function with each other
6. Critical illness often results in family conflicts. Which scenario is most likely to result in the greatest conflict?
a. A 21-year-old college student of divorced parents hospitalized with multiple trauma. She resides with her mother. The parents are amicable with each other and have similar values. The father blames the daughter’s boyfriend for causing the accident.
b. A 36-year-old male admitted for a ruptured cerebral aneurysm. He has been living with his 34-year-old girlfriend for 8 years, and they have a 4-year-old daughter. He does not have written advance directives. His parents arrive from out-of-state and are asked to make decisions about his health care. He has not seen them in over a year.
c. A 58-year-old male admitted for coronary artery bypass surgery. He has been living with his same-sex partner for 20 years in a committed relationship. He has designated his sister, a registered nurse, as his healthcare proxy in a written advance directive.
d. A 78-year-old female admitted with gastrointestinal bleeding. Her hemoglobin is decreasing to a critical level. She is a Jehovah’s Witness and refuses the treatment of a blood transfusion. She is capable of making her own decisions and has a clearly written advance directive declining any transfusions. Her son is upset with her and tells her she is “committing suicide.”
7. Which nursing interventions would best support the family of a critically ill patient?
a. Encourage family members to stay all night in case the patient needs them.
b. Give a condition update each morning and whenever changes occur.
c. Limit visitation from children into the critical care unit.
d. Provide beverages and snacks in the waiting room.
8. Which intervention is appropriate to assist the patient to cope with admission to the critical care unit?
a. Allowing unrestricted visiting by several family members at one time
b. Explaining all procedures in easy-to-understand terms
c. Providing back massage and mouth care
d. Turning down the alarm volume on the cardiac monitor
9. The constant noise of a ventilator, monitor alarms, and infusion pumps predisposes the patient to:
d. sensory overload.
10. Which of the following statements about family assessment is false?
a. Assessment of structure (who comprises the family) is the last step in assessment.
b. Interaction among family members is assessed.
c. It is important to assess communication among family members to understand roles.
d. Ongoing assessment is important, because family functioning may change during the course of illness.
Chapter 3: Ethical and Legal Issues in Critical Care Nursing
1. 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 healthcare surrogate.
2. A critically ill patient has a living will in his chart. His condition has deteriorated. His wife says she wants “everything done,” regardless of the patient’s wishes. Which ethical principle is the wife violating?
3. Which statement regarding ethical concepts is true?
a. A living will is the same as a healthcare 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 healthcare decisions in the event the person is incapacitated.
d. A persistent vegetative state is the same as brain death in most states.
4. 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 healthcare surrogate.
c. “Slow codes” are ethical and should be considered in futile situations if advanced directives are not available.
d. Withholding “extraordinary” resuscitation is legal and ethical if specified in advance directives and physician orders.
5. 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 they have exhausted treatment options and suggest that the patient be made a “do not resuscitate” status. This scenario illustrates the concept of:
a. brain death.
d. life-prolonging procedures.
6. The nurse is caring for a patient admitted with a traumatic brain injury following a motor vehicle crash. The patient’s Glasgow Coma Score is 3 and intermittently withdraws when painful stimuli are introduced. The patient is ventilator dependent and occasionally takes a spontaneous breath. The physician explains to the family that the patient has severe neurological impairment and he does not expect the patient 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.
7. A nurse caring for a patient with neurological impairment often must use painful stimuli to elicit a 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:
8. Which of the following organizations requires a mechanism for addressing ethical issues?
a. American Association of Critical-Care Nurses
b. American Hospital Association
c. Society of Critical Care Medicine
d. The Joint Commission
9. 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 withdrawal. However, she assists with the process to avoid confronting the charge nurse. Afterward she feels guilty and believes she “killed the patient.” This scenario is likely to cause:
b. family stress.
c. moral distress.
10. The nurse is caring for a patient who has been declared brain dead. The patient is considered a potential organ donor. In order 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 healthcare 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.
Chapter 4: End-of-Life Care in the Critical Care Unit
1. A patient who is undergoing withdrawal of mechanical ventilation appears anxious and agitated. The patient is on a continuous morphine infusion and has an additional order for lorazepam (Ativan) 1 to 2 mg IV as needed (prn). The patient has received no lorazepam (Ativan) during this course of illness. What is the most appropriate nursing intervention to control agitation?
a. Administer fentanyl (Duragesic) 25 mg IV bolus.
b. Administer lorazepam (Ativan) 1 mg IV now.
c. Increase the rate of the morphine infusion by 50%.
d. Request an order for a paralytic agent.
2. A 75-year-old 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:
b. palliative care.
c. withdrawal of life support.
d. withholding of life support.
3. What were the findings of the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT)?
a. Clear communication is typical in the relationships between most patients and healthcare providers.
b. Critical care units often meet the needs of dying patients and their families.
c. Disparities exist between patients’ care preferences and actual care provided.
d. Pain and suffering of patients at end of life is well controlled in the hospital.
4. 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. healthcare proxy.
d. power of attorney.
5. A 65-year-old patient with a history of metastatic lung carcinoma has been unresponsive to chemotherapy. The medical team has determined that there are no additional treatments available that will prolong life or improve the quality of life in any meaningful way. Despite the poor prognosis, the patient continues to receive chemotherapy and full nutrition support. This is an example of what end-of-life concept?
a. Medical futility
b. Palliative care
c. Terminal weaning
d. Withdrawal of treatment
6. Designated healthcare surrogates should base healthcare decisions on:
a. personal beliefs and values.
b. recommendations of family members and friends.
c. recommendations of the physician and healthcare team.
d. wishes previously expressed by the patient.
7. Which statement made by a staff nurse identifying guidelines for palliative care would need corrected?
a. Basic nursing care is a critical element in palliative care management.
b. Common conditions that require palliative management are nausea, agitation, and sleep disturbance.
c. Palliative care practices are reserved for the dying client.
d. Palliative care practices relieve symptoms that negatively affect the quality of life of a patient.
8. Which statement is true regarding the impact of culture on end-of-life decision making?
a. African-Americans prefer more conservative, less invasive care options during the end of life.
b. Caucasians prefer aggressive and more invasive care options during the end of life.
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.
9. 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 between the patient, family, and healthcare team throughout the course of the illness.
c. organizational support of palliative care principles.
d. relocation the dying patient from the critical care unit to a lower level of care.
10. A patient with end-stage heart failure is experiencing considerable dyspnea. Appropriate pharmacological management of this symptom includes:
a. administration of 6 mg of midazolam (Versed) and initiation of a continuous midazolam infusion.
b. administration of morphine, 5 mg IV bolus, and initiation of a continuous morphine infusion.
c. hourly increases of the midazolam (Versed) infusion by 100% dose increments.
d. hourly increases of the morphine infusion by 100% dose increments.
Chapter 5: Comfort and Sedation
1. Nociceptors differ from other nerve receptors in the body in that they:
a. adapt very little to continual pain response.
b. inhibit the infiltration of neutrophils and eosinophils.
c. play no role in the inflammatory response.
d. transmit only the thermal stimuli.
2. A 45-year-old male postsurgical patient is on a ventilator in the critical care unit. He has been tolerating the ventilator well and has not required any sedation. He becomes tachycardic and hypertensive. His respiratory rate has increased to 28 breaths/min. The ventilator is set on synchronized intermittent mandatory ventilation (SIMV) at a rate of 10 breaths/min. The patient has been suctioned recently via his endotracheal tube, and his airway is clear. He responds appropriately to the nurse’s commands. The nurse should:
a. assess the patient’s level of pain.
b. decrease the SIMV rate on the ventilator.
c. provide sedation as ordered.
d. suction the patient again.
3. 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 medication as ordered.
c. identify and treat the underlying cause.
d. reassess the patient hourly to determine whether symptoms resolve on their own.
4. Both the electroencephalogram (EEG) monitor and the Bispectral Index Score (BIS) or Patient State Index (PSI) analyzer monitors are used to assess patient sedation levels in critically ill patients. The BIS and PSI monitors are simpler to use because they:
a. can only be used on heavily sedated patients.
b. can only be used on pediatric patients.
c. provide raw EEG data and a numeric value.
d. require only five leads.
5. The nurse is caring for a patient who requires administration of a neuromuscular blocking agent to facilitate ventilation with non-traditional modes. The nurse understands that neuromuscular blocking agents provide:
a. antianxiety effects.
b. complete analgesia.
c. high levels of sedation.
d. no sedation or analgesia.
6. The patient is receiving neuromuscular blockade. Which nursing assessment indicates a target level of paralysis?
a. Glasgow Coma Scale score of 3
b. Train-of-four yields two twitches
c. Bispectral index of 60
d. CAM-ICU positive
7. 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. a Posey-type vest.
b. a higher dosage of lorazepam.
d. soft wrist restraints.
8. Neuromuscular blocking agents are used in the management of some ventilated patients. Their primary mode of action is:
9. The most important nursing intervention for patients who receive neuromuscular blocking agents is to:
a. administer sedatives in conjunction with the neuromuscular blocking agents.
b. assess neurological status every 30 minutes.
c. avoid interaction with the patient, because he or she won’t be able to hear.
d. restrain the patient to avoid self-extubation.
10. The best way to monitor agitation and effectiveness of treating it in the critically ill patient is to use a/the:
a. Confusion Assessment Method (CAM-ICU).
b. FACES assessment tool.
c. Glasgow Coma Scale.
d. scale such as Richmond Agitation Sedation Scale.
Chapter 6: Nutritional Support
1. 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. Fluid and electrolyte imbalances and sepsis
c. Fluid overload and pulmonary edema
d. Hypoglycemia and renal insufficiency
2. 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
3. The patient is to start parenteral nutrition. The nurse knows to prepare which site for catheter insertion?
a. Basilic vein
b. Femoral vein
c. Radial artery
d. Subclavian vein
4. A patient has been admitted to the critical care unit after a stroke. After “failing” a swallow study, the patient is placed on enteral feedings. Following placement of a nasogastric tube for tube feeding, what is the next critical step?
a. Administer medications.
b. Cap off and wait 24 hours before starting feedings.
c. Obtain a chest radiograph.
d. Start the tube feeding.
5. A patient’s feeding tube has been successfully placed in the small intestine with continuous flow tube feeding. The nurse knows that this approach was chosen because:
a. intermittent feedings cause increased nausea and vomiting.
b. the increased filling of the stomach increases absorption.
c. the intestinal mucosa normally receives nutrients from the stomach in peristaltic waves.
d. this will prevent malabsorption syndrome.
6. 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 dye to the formula.
b. Assess the residual every hour.
c. Elevate the head of the bed 30 degrees.
d. Provide feedings via continuous infusion.
7. A patient who is receiving continuous enteral feedings has just vomited 250 mL of milky green fluid. This is a concern because this most likely demonstrates that the patient has:
a. a bowel obstruction.
b. developed an ileus.
c. gastrointestinal bleeding.
d. tube feeding intolerance.
8. A patient is receiving enteral feedings and has just vomited 250 mL of milky green liquid. The nurse holds the tube feeding, which had been infusing at 100 mL/hr. The nurse knows that the next action should be:
a. connect the feeding tube to suction.
b. continue the tube feeding.
c. decrease the tube feeding.
d. recheck the residual in 2 hours.
9. In addition to residual stomach volume, what other evidence suggests feeding intolerance?
a. Abdominal distention
b. Absence of tympany on percussion
c. Active bowel sounds
d. Elevated blood glucose by fingerstick
10. Approximately 5 days after starting tube feedings, a patient develops extreme diarrhea. A stool specimen is collected to check for which possible cause?
a. Clostridium difficile
b. Escherichia coli
c. Occult blood
d. Ova and parasites
Chapter 7: Dysrhythmia Interpretation and Management
1. The nurse is caring for a patient who is on a cardiac monitor. The nurse realizes that the sinus node is the pacemaker of the heart because it is:
a. the fastest pacemaker cell in the heart.
b. the only pacemaker cell in the heart.
c. the only cell that does not affect the cardiac cycle.
d. located in the left side of the heart.
2. One of the functions of the atrioventricular (AV) node is to:
a. pace the heart if the ventricles fail.
b. slow the impulse arriving from the SA node.
c. send the impulse to the SA node.
d. allow for ventricular filling during systole.
3. The normal rate for the SA node when the patient is at rest is:
a. 40 to 60 beats per minute.
b. 60 to 100 beats per minute.
c. 20 to 40 beats per minute.
d. more than100 beats per minute.
4. When assessing the 12-lead electrocardiogram (ECG) or a rhythm strip, it is helpful to understand that the electrical activity is viewed in relation to the positive electrode of that particular lead. When an electrical signal is aimed directly at the positive electrode, the inflection will be:
b. upside down.
d. equally positive and negative.
5. The patient is admitted with a condition that requires cardiac rhythm monitoring. To apply the monitoring electrodes, the nurse must first:
a. apply a moist gel to the chest.
b. make certain that the electrode gel is dry.
c. avoid soaps to avoid skin irritation.
d. clip chest hair if needed.
6. Electrocardiogram (ECG) paper contains a standardized grid where the horizontal axis measures time and the vertical axis measures voltage or amplitude. The nurse must understand that each horizontal box indicates:
a. 200 milliseconds or 0.20 seconds duration.
b. 40 milliseconds or 0.04 seconds duration.
c. 3 seconds duration.
d. millivolts of amplitude.
7. The nurse is examining the patient’s cardiac rhythm strip in lead II and notices that all of the P waves are upright and look the same except one that has a different shape and is inverted. The nurse realizes that the P wave with the abnormal shape is probably:
a. from the SA node since all P waves come from the SA node.
b. from some area in the atria other than the SA node.
c. indicative of ventricular depolarization.
d. normal even though it is inverted in lead II.
8. The QT interval is the total time taken for ventricular depolarization and repolarization. Prolongation of the QT interval:
a. decreases the risk of lethal dysrhythmias.
b. usually occurs when heart rate increases.
c. increases the risk of lethal dysrhythmias.
d. can only be measured with irregular rhythms.
9. The patient has an irregular heart rhythm. To determine an accurate heart rate, the nurse first:
a. identifies the markers on the ECG paper that indicate a 6-second strip.
b. counts the number of large boxes between two consecutive P waves.
c. counts the number of small boxes between two consecutive QRS complexes.
d. divides the number of complexes in a 6-second strip by 10.
10. The nurse is calculating the rate for a regular rhythm. There are 20 small boxes between each P wave and 20 small boxes between each R wave. What is the ventricular rate?
a. 50 beats/min
b. 75 beats/min
c. 85 beats/min
d. 100 beats/min
Chapter 8: Hemodynamic Monitoring
1. The nurse is caring for a 100-kg patient being monitored with a pulmonary artery catheter. The nurse assesses a blood pressure of 90/60 mm Hg, heart rate 110 beats/min, respirations 36/min, oxygen saturation of 89% on 3 L of oxygen via nasal cannula. Bilateral crackles are audible upon auscultation. Which hemodynamic value requires immediate action by the nurse?
a. Cardiac index (CI) of 1.2 L/min/m3
b. Cardiac output (CO) of 4 L/min
c. Pulmonary vascular resistance (PVR) of 80 dynes/sec/cm-5
d. Systemic vascular resistance (SVR) of 1800 dynes/sec/cm-5
2. While caring for a patient with a small bowel obstruction, the nurse assesses a pulmonary artery occlusion pressure (PAOP) of 1 mm Hg and hourly urine output of 5 mL. The nurse anticipates which therapeutic intervention?
b. Intravenous fluids
c. Negative inotropic agents
3. The nursing 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 to the insertion site.
b. Ensure all tubing connections are tightened.
c. Obtain a portable x-ray to confirm placement.
d. Restrain the affected extremity for 24 hours.
4. While caring for a patient with a pulmonary artery catheter, the nurse notes the pulmonary artery occlusion pressure (PAOP) to be significantly higher than previously recorded values. The nurse assesses respirations to be unlabored at 16 breaths/min, oxygen saturation of 98% on 3 L of oxygen 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 physician immediately of the assessment findings.
c. Obtain a stat chest x-ray film to verify proper catheter placement.
d. Zero reference and level the catheter at the phlebostatic axis.
5. A patient is admitted to the hospital with multiple trauma and extensive blood loss. The nurse assesses vital signs to be BP 80/50 mm Hg, heart rate 135 beats/min, respirations 36 breaths/min, 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 the following therapies or medications?
a. Blood transfusion
b. Furosemide (Lasix)
c. Dobutamine (Dobutrex) infusion
d. Dopamine hydrochloride (Dopamine) infusion
6. After pulmonary artery catheter insertion, the nurse assesses a pulmonary artery pressure of 45/25 mm Hg, a pulmonary artery occlusion pressure (PAOP) of 20 mm Hg, a cardiac output of 2.6 L/min and a cardiac index of 1.9 L/min/m2. Which physician order is of the highest priority?
a. Apply 50% oxygen via venture mask.
b. Insert an indwelling urinary catheter.
c. Begin a dobutamine (Dobutrex) infusion.
d. Obtain stat cardiac enzymes and troponin.
7. 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 subclavian insertion site
d. Slight redness at subclavian insertion site
8. The physician writes 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 minutes.
c. Elevate the affected limb on pillows for 24 hours.
d. Keep the patient’s wrist in a neutral position.
9. Following insertion of a central venous catheter, the nurse obtains a stat chest x-ray film to verify proper catheter 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 results by the nurse?
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.
10. 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.
Chapter 9: Ventilatory Assistance
1. A patient has coronary artery bypass graft surgery and is transported to the surgical intensive care unit at noon. He is placed on mechanical ventilation. Interpret his initial arterial blood gas levels:
PaCO2 48 mm Hg
Bicarbonate 22 mEq/L
PaO2 115 mm Hg
O2 saturation 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
2. The physician orders the following mechanical ventilation settings for a patient who weighs 75 kg. The patient’s spontaneous respiratory rate is 22 breaths/min. What arterial blood gas abnormality may occur if the patient continues to be tachypneic at these ventilator settings?
Tidal volume: 600 mL (8 mL per kg)
Respiratory rate: 14 breaths/min
Positive end-expiratory pressure: 10 cm H2O
a. Metabolic acidosis
b. Metabolic alkalosis
c. Respiratory acidosis
d. Respiratory alkalosis
3. 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
c. Increase in venous return
d. Oxygen toxicity
4. 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 to loosen secretions.
5. A 65-year-old patient is admitted to the progressive care unit with a diagnosis of community-acquired pneumonia. The patient has a history of chronic obstructive pulmonary disease and diabetes. A set of arterial blood gases obtained on admission without supplemental oxygen shows pH 7.35; PaCO2 55 mm Hg; bicarbonate 30 mEq/L; PaO2 65 mm Hg. 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.
6. 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 in 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
7. 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.
8. 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 adapter.
9. Neuromuscular blocking agents are used in the management of some ventilated patients. Their primary mode of action is:
10. One of the early signs of the effect of hypoxemia on the nervous system is:
Chapter 10: Rapid Response Teams and Code Management
1. The nurse chooses which method and concentration of oxygen administration until intubation is established in a patient who has sustained a cardiopulmonary arrest?
a. Bag-valve-mask at FiO2 of 100%
b. Bag-valve-mask at FiO2 of 50%
c. Mouth-to-mask ventilation with supplemental oxygen
d. Non-rebreather mask at FiO2 of 100%
2. Laypersons should use which device to treat lethal ventricular dysrhythmias that occur outside a hospital setting?
a. Automatic external defibrillator
b. Carbon dioxide detector
c. Pocket mask
d. Transcutaneous pacemaker
3. When doing manual ventilations during a code, the nurse would administer ventilations following which guideline?
a. Approximately 8 to 10 breaths per minute
b. During the fifth chest compression
c. Every 3 seconds or 20 times per minute
d. While compressions are stopped
4. The patient has been admitted to a critical care unit with a diagnosis of acute myocardial infarction. Suddenly his monitor alarms and the screen shows a flat line. What action should the nurse take first?
a. Administer epinephrine by intravenous push.
b. Begin chest compressions.
c. Check patient for unresponsiveness.
d. Defibrillate at 360 J.
5. During a code, the nurse would place paddles for anterior defibrillation in what locations?
a. Second intercostal space, left sternal border and fourth intercostal space, left midclavicular line
b. Second intercostal space, right sternal border and fourth intercostal space, left midaxillary line
c. Second intercostal space, right sternal border and fifth intercostal space, left midclavicular line
d. Fourth intercostal space, right sternal border and fifth intercostal space, left midclavicular line
6. During cardioversion, the nurse would synchronize the electrical charge to coincide with which wave of the ECG complex?
7. The nurse knows that in advanced cardiac life support, the secondary survey includes steps A-B-C-D where “D” refers to:
b. differential diagnosis.
c. diltiazem intravenous push.
d. do not resuscitate.
8. The patient is diagnosed with abrupt onset of supraventricular tachycardia (SVT). The nurse prepares which medication that has a short half-life and is recommended to treat symptomatic SVT?
9. The code team has just defibrillated a patient in ventricular fibrillation. Following CPR for 2 minutes, what is the next action to take?
a. Administer amiodarone.
b. Administer lidocaine.
c. Assess rhythm and pulse.
d. Prepare for transcutaneous pacing.
10. The patient’s monitor shows bradycardia (heart rate of 40 beats/min) and frequent premature ventricular contractions (PVCs) with a measured blood pressure of 85/50 mm Hg. The nurse anticipates the use of which drug?
a. Atropine 0.5 to 1 mg intravenous push
b. Dopamine drip—continuous infusion
c. Lidocaine 1 mg/kg intravenous push
d. Transcutaneous pacemaker
Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome
1. 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 blood pressure by Doppler.
b. Estimate the systolic pressure as 60 mm Hg.
c. Obtain an electronic blood pressure monitor.
d. Record the blood pressure as “not assessable.”
2. The nurse has just completed an infusion of a 1000 mL bolus of 0.9% normal saline 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
3. The nurse has been administering 0.9% normal saline intravenous fluids as part of early goal-directed therapy protocols 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 temperature
c. Oral temperature and capillary refill
d. Right atrial pressure and urine output
4. A patient is admitted to the critical care unit following coronary artery bypass surgery. Two hours postoperatively, the nurse assesses the following information: pulse is 120 beats/min; blood pressure is 70/50 mm Hg; pulmonary artery diastolic pressure is 2 mm Hg; cardiac output is 4 L/min; 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.
5. A patient is admitted after collapsing at the end of a summer marathon. She is lethargic, with a heart rate of 110 beats/min, respiratory rate of 30 breaths/min, and a blood pressure of 78/46 mm Hg. The nurse anticipates administering which therapeutic intervention?
a. Human albumin infusion
b. Hypotonic saline solution
c. Lactated Ringer’s bolus
d. Packed red blood cells
6. 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 assess?
a. High pulmonary artery occlusive pressure and high cardiac output
b. High systemic vascular resistance and low cardiac output
c. Low pulmonary artery occlusive pressure and low cardiac output
d. Low systemic vascular resistance and high cardiac output
7. The nurse is caring for a patient admitted with severe sepsis. Vital signs assessed by the nurse include blood pressure 80/50 mm Hg, heart rate 120 beats/min, respirations 28 breaths/min, oral temperature of 102° F, and a right atrial pressure (RAP) of 1 mm Hg. Assuming physician orders, 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
8. 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 temperature 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
9. The nurse is caring for a patient admitted with cardiogenic shock. Hemodynamic readings obtained with a pulmonary artery catheter include a pulmonary artery occlusion pressure (PAOP) of 18 mm Hg and a cardiac index (CI) of 1.0 L/min/m2. What is the priority pharmacological intervention?
a. Dobutamine (Dobutrex)
b. Furosemide (Lasix)
c. Phenylephrine (Neo-Synephrine)
d. Sodium nitroprusside (Nipride)
10. 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 breaths/min. What is the priority intervention?
a. Diphenhydramine (Benadryl) 50 mg intravenously
b. Epinephrine 3 to 5 mL of a 1:10,000 solution intravenously
c. Methylprednisolone (Solu-Medrol) 125 mg intravenously
d. Ranitidine (Zantac) 50 mg intravenously
Chapter 12: Cardiovascular Alterations
1. The patient is admitted with a suspected acute myocardial infarction (MI). In assessing the 12-lead electrocardiogram (ECG) changes, which findings would indicate to the nurse that the patient is in the process of an evolving Q wave myocardial infarction(MI)?
a. ST-segment elevation on ECG and elevated CPK-MB or troponin levels
b. Depressed ST-segment on ECG and elevated total CPK
c. Depressed ST-segment on ECG and normal cardiac enzymes
d. Q wave on ECG with normal enzymes and troponin levels
2. The nurse is assessing a patient with left-sided heart failure. Which symptom would the nurse expect to find?
a. Dependent edema
b. Distended neck veins
c. Dyspnea and crackles
d. Nausea and vomiting
3. A patient is admitted with an acute myocardial infarction (AMI). The nurse knows that an angiotensin-converting enzymes (ACE) inhibitor should be started within 24 hours to reduce the incidence of which process?
a. Myocardial stunning
b. Hibernating myocardium
c. Myocardial remodeling
4. A patient presents to the emergency department (ED) with chest pain that he has had for the past 2 hours. He is nauseous and diaphoretic, and his skin is dusky in color. The electrocardiogram shows ST elevation in leads II, III, and aVF. Which therapeutic intervention would the nurse question?
a. Emergent pacemaker insertion
b. Emergent percutaneous coronary intervention
c. Emergent thrombolytic therapy
d. Immediate coronary artery bypass graft surgery
5. A patient is admitted with the diagnosis of unstable angina. The nurse knows that the physiological mechanism present is most likely which of the following?
a. Complete occlusion of a coronary artery
b. Fatty streak within the intima of a coronary artery
c. Partial occlusion of a coronary artery with a thrombus
d. Vasospasm of a coronary artery
6. A patient is admitted with an angina attack. The nurse anticipates which drug regimen to be initiated?
a. ACE inhibitors and diuretics
b. Morphine sulfate and oxygen
c. Nitroglycerin, oxygen, and beta-blockers
d. Statins, bile acid, and nicotinic acid
7. A patient with coronary artery disease is having a cardiac evaluation to assess for possible valvular disease. Which study best identifies valvular function and measures the size of the cardiac chambers?
a. 12-lead electrocardiogram
b. Cardiac catheterization
d. Electrophysiology study
8. A patient has elevated blood lipids. The nurse anticipates which classification of drugs to be prescribed for the patient?
a. Bile acid resins
b. Nicotinic acid
9. The patient is admitted with an acute myocardial infarction (AMI). Three days later the nurse is concerned that the patient may have a papillary muscle rupture. Which assessment data may indicate a papillary muscle rupture?
a. Gallop rhythm
c. S1 heart sound
d. S3 heart sound
10. While instructing a patient on what occurs with a myocardial infarction, the nurse plans to explain which process?
a. Coronary artery spasm.
b. Decreased blood flow (ischemia).
c. Death of cardiac muscle from lack of oxygen (tissue necrosis).
d. Sporadic decrease in oxygen to the heart (transient oxygen imbalance).
Chapter 13: Nervous System Alterations
1. The nurse admits a patient to the critical care unit following a motorcycle crash. Assessment findings by the nurse include blood pressure 100/50 mm Hg, heart rate 58 beats/min, respiratory rate 30 breaths/min, and temperature of 100.5°. The patient is lethargic, responds to voice but falls asleep readily when not stimulated. Which nursing action is most important to include in this patient’s plan of care?
a. Frequent neurological assessments
b. Side to side position changes
c. Range of motion to extremities
d. Frequent oropharyngeal suctioning
2. A patient with a head injury has an intracranial pressure (ICP) of 18 mm Hg. Her blood pressure is 144/90 mm Hg, and her mean arterial pressure (MAP) is 108 mm Hg. What is the cerebral perfusion pressure (CPP)?
a. 54 mm Hg
b. 72 mm Hg
c. 90 mm Hg
d. 126 mm Hg
3. While caring for a patient with a traumatic brain injury, the nurse assesses an ICP of 20 mm Hg and a CPP of 85 mm Hg. What is the best interpretation by the nurse?
a. Both pressures are high.
b. Both pressures are low.
c. ICP is high; CPP is normal.
d. ICP is high; CPP is low.
4. The nurse is caring for a mechanically ventilated patient with a sustained ICP of 18 mm Hg. The nurse needs to perform an hourly neurological assessment, suction the endotracheal tube, perform oral hygiene care, and reposition the patient to the left side. What is the best action by the nurse?
a. Hyperoxygenate during endotracheal suctioning.
b. Elevate the patient’s head of the bed 30 degrees.
c. Apply bilateral heel protectors after repositioning.
d. Provide rest periods between nursing interventions.
5. While caring for a patient with a basilar skull fracture, the nurse assesses clear drainage from the patient’s left naris. What is the best nursing action?
a. Have the patient blow the nose until clear.
b. Insert bilateral cotton nasal packing.
c. Place a nasal drip pad under the nose.
d. Suction the left nares until the drainage clears.
6. The nurse is caring for a patient who was hit on the head with a hammer. The patient was unconscious at the scene briefly but is now conscious upon arrival at the emergency department (ED) with a GCS score of 15. One hour later, the nurse assesses a GCS score of 3. What is the priority nursing action?
a. Stimulate the patient hourly.
b. Continue to monitor the patient.
c. Elevate the head of the bed.
d. Notify the physician immediately.
7. The nurse is caring for a patient with an ICP of 18 mm Hg and a GCS score of 3. Following the administration of mannitol (Osmitrol), which assessment finding by the nurse requires further action?
a. ICP of 10 mm Hg
b. CPP of 70 mm Hg
c. GCS score of 5
d. CVP of 2 mm Hg
8. The nurse is caring for a mechanically ventilated patient with a brain injury. Arterial blood gas values indicate a PaCO2 of 60 mm Hg. The nurse understands this value to have which effect on cerebral blood flow?
a. Altered cerebral spinal fluid production and reabsorption
b. Decreased cerebral blood volume due to vessel constriction
c. Increased cerebral blood volume due to vessel dilation
d. No effect on cerebral blood flow (PaCO2 of 60 mm Hg is normal)
9. The nurse assesses a patient with a skull fracture to have a Glasgow Coma Scale score of 3. Additional vital signs assessed by the nurse include blood pressure 100/70 mm Hg, heart rate 55 beats/min, respiratory rate 10 breaths/min, oxygen saturation (SpO2) 94% on oxygen at 3 L per nasal cannula. What is the priority nursing action?
a. Monitor the patient’s airway patency.
b. Elevate the head of the patient’s bed.
c. Increase supplemental oxygen delivery.
d. Support bony prominences with padding.
10. The nurse is caring for a patient who has a diminished level of consciousness and who is mechanically ventilated. While performing endotracheal suctioning, the patient reaches up in an attempt to grab the suction catheter. What is the best interpretation by the nurse?
a. The patient is exhibiting extension posturing.
b. The patient is exhibiting flexion posturing.
c. The patient is exhibiting purposeful movement.
d. The patient is withdrawing to stimulation.
Chapter 14: Acute Respiratory Failure
1. The nurse is caring for a patient with acute respiratory failure and identifies “Risk for Ineffective Airway Clearance” as a nursing diagnosis. A nursing intervention relevant to this diagnosis is:
a. Elevate head of bed to 30 degrees.
b. Obtain order for venous thromboembolism prophylaxis.
c. Provide adequate sedation.
d. Reposition patient every 2 hours.
2. 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
3. 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
4. Intrapulmonary shunting refers to:
a. alveoli that are not perfused.
b. blood that is shunted from the left side of the heart to the right and causes heart failure.
c. blood that is shunted from the right side of the heart to the left without oxygenation.
d. shunting of blood supply to only one lung.
5. When fluid is present in the alveoli:
a. alveoli collapse and atelectasis occurs.
b. diffusion of oxygen and carbon dioxide is impaired.
c. hypoventilation occurs.
d. the patient is in heart failure.
6. In assessing a patient, the nurse understands that an early sign of hypoxemia is:
a. clubbing of nail beds
7. The basic underlying pathophysiology of acute respiratory distress syndrome results from:
a. a decrease in the number of white blood cells available.
b. damage to the right mainstem bronchus.
c. damage to the type II pneumocytes, which produce surfactant.
d. decreased capillary permeability.
8. The nurse is caring for a patient with acute respiratory distress syndrome who is hypoxemic despite mechanical ventilation. The physician orders a nontraditional ventilator mode as part of treatment. Despite sedation and analgesia, the patient remains restless and appears to be in discomfort. The nurse informs the physician of this assessment and anticipates an order for:
a. continuous lateral rotation therapy.
b. guided imagery.
c. neuromuscular blockade.
d. prone positioning.
9. A patient presents to the emergency department in acute respiratory failure secondary to community-acquired pneumonia. The patient has a history of chronic obstructive pulmonary disease. The nurse anticipates which treatment to facilitate ventilation?
a. Emergency tracheostomy and mechanical ventilation
b. Mechanical ventilation via an endotracheal tube
c. Noninvasive positive-pressure ventilation (NPPV)
d. Oxygen at 100% via bag-valve-mask device
10. Which of the following acid-base disturbances commonly occurs with the hyperventilation and impaired gas exchange seen in severe exacerbation of asthma?
a. Metabolic acidosis
b. Metabolic alkalosis
c. Respiratory acidosis
d. Respiratory alkalosis
Chapter 15: Acute Kidney Injury
1. With sudden cessation of renal function, all body systems are affected by the inability to maintain fluid and electrolyte balance and eliminate metabolic waste. In critically ill patients, renal dysfunction:
a. is a very rare problem.
b. affects nearly two thirds of patients.
c. has a low mortality once renal replacement therapy has been initiated.
d. has little effect on morbidity, mortality, or quality of life.
2. The nurse is caring for a patient who has sustained blunt trauma to the left flank area, and is evaluating the patient’s urinalysis results. The nurse should become concerned when
a. creatinine levels in the urine are similar to blood levels of creatinine.
b. sodium and chloride are found in the urine.
c. urine uric acid levels have the same values as serum levels.
d. red blood cells and albumin are found in the urine.
3. A normal glomerular filtration rate is:
a. less than 80 mL/min.
b. 80 to 125 mL/min
c. 125 to 180 mL/min
d. more than 189 mL/min
4. A normal urine output is considered to be:
a. 80 to 125 mL/min.
b. 180 L/day.
c. 80 mL/min.
d. 1 to 2 L/day.
5. Renin plays a role in blood pressure regulation by:
a. activating the renin-angiotensin-aldosterone cascade.
b. suppressing angiotensin production.
c. decreasing sodium reabsorption.
d. inhibiting aldosterone release.
6. The nurse is caring for an elderly patient who was admitted with renal insufficiency. The nurse realizes that with advance age often comes declining renal function. An expected laboratory finding for this patient may be:
a. an increased glomerular filtration rate (GFR).
b. a normal serum creatinine level.
c. increased ability to excrete drugs.
7. The term used to describe an increase in blood urea nitrogen (BUN) and serum creatinine is:
c. acute kidney injury.
d. prerenal disease.
8. The most common cause of acute kidney injury in critically ill patients is:
b. fluid overload.
d. hemodynamic instability.
9. The nurse is caring for a patient who has undergone major abdominal surgery. The nurse notices that the patient’s urine output has been less than 20 mL/hour for the past 2 hours. It is 0200 in the morning. The patient’s blood pressure is 100/60 mm Hg, and the pulse is 110 beats per minute. Previously, the pulse was 90 beats per minute with a blood pressure of 120/80 mm Hg. The nurse should:
a. contact the provider and expect an order for a normal saline bolus.
b. wait until 0900 when the provider makes rounds to report the assessment findings.
c. continue to evaluate urine output for 2 more hours.
d. ignore the urine output, as this is most likely postrenal in origin.
10. Acute kidney injury from post renal etiology is caused by:
a. obstruction of the flow of urine.
b. conditions that interfere with renal perfusion.
c. hypovolemia or decreased cardiac output.
d. conditions that act directly on functioning kidney tissue.
Chapter 16: Hematological and Immune Disorders
1. Of the four major blood components, plasma:
a. is made up of circulating ions.
b. comprises about 55% of blood volume.
c. is transported to the cells by serum proteins.
d. comprises about 45% of blood volume.
2. Erythrocytes (RBCs) are flexible biconcave disks without nuclei whose primary component is an oxygen-carrying molecule called:
b. a reticulocyte.
3. Erythrocytes (RBCs) are generated from precursor stem cells under the influence of a growth factor called:
4. The nurse is caring for a patient who has undergone a splenectomy, and notices that the patient’s platelet count has increased. The nurse realizes that the increase is due to:
a. platelet response to infection.
b. stimulation secondary to erythropoietin.
c. the patient’s inability to store platelets.
d. the platelet’s 120-day life cycle.
5. The nurse examines the patient’s complete blood count with differential analysis and notices that the patient’s neutrophils are elevated, but the lymphocytes are lower than normal. The drop in lymphocyte count in the differential is most likely due to:
a. the increase in neutrophil count.
b. a new viral infection.
c. a decreased number of “bands.”
d. the lack of immature neutrophils.
6. The nurse is caring for a patient receiving chemotherapeutic agents, and notices that the patient’s neutrophils count is low. The nurse realizes that:
a. the patient has a bacterial infection.
b. a shift to the left is occurring.
c. chemotherapeutic agents alter the ability to fight infection.
d. neutrophils have a long life span and multiply slowly.
7. When examining the patient’s laboratory values, the nurse notices an elevation in the eosinophil count. The nurse realizes that eosinophils become elevated:
a. with acute bacterial infections.
b. in response to allergens and parasites.
c. when the spleen is removed.
d. in situations that do not require phagocytosis.
8. Although monocytes may circulate for only 36 hours, they can survive for months or even years as tissue macrophages. Monocytes found in the liver are called:
a. alveolar macrophages.
b. Kupffer’s cells.
9. Lymphocytes are made up of B cells and T cells. B cells:
a. mature in lymphoid tissue.
b. mediate humoral immunity.
c. migrate to the thymus gland.
d. destroy virus-infected cells.
10. The process by which the body actively produces cells and mediators that result in the destruction of the antigen is called:
a. passive immunity.
b. active immunity.
d. recognition of self as nonself.
Chapter 17: Gastrointestinal Alterations
1. The patient is admitted with constipation. In anticipation of treatment, the nurse prepares to:
a. give medications that will suppress the autonomic nervous system.
b. provide therapies that will innervate the autonomic nervous system.
c. teach the patient that the submucosa is the innermost part of the gut wall.
d. give medications intravenously since the submucosa has no blood vessels.
2. The nurse is assessing the patient and notices that his oral cavity is only slightly moist and contains a scant amount of thick saliva even though the patient’s fluid intake has been sufficient. The nurses realizes that the condition of the patient’s mouth is probably caused by:
a. thoughts of food.
b. sympathetic nerve stimulation.
c. overstimulation of the sublingual glands.
d. parasympathetic nerve stimulation.
3. The nurse is caring for a patient who has a peptic ulcer. To treat the ulcer and prevent more ulcers from forming, the nurse should be prepared to administer:
a. H2-histamine receptor blockers.
c. vagal stimulation.
d. vitamin B12.
4. The nurse is caring for a patient who is receiving several cardiac medications designed to stimulate the sympathetic nervous system, vitamin B12, and an H2 blocker. The nurse should do which of the following?
a. Assess for signs of peptic ulcer.
b. Be watchful for increased saliva production.
c. Evaluate for a decrease in potassium level.
d. Give the patient medications to prevent anemia.
5. After gastric bypass surgery, the patient is getting vitamin B12 via injection. The patient asks why he can’t get the vitamin by mouth. The nurse explains that:
a. the patient may not have enough intrinsic factor for normal absorption.
b. the patient would have to drink water, and the small intestine can’t handle water.
c. the vitamin is absorbed in the upper part of the small bowel and would travel too fast.
d. all vitamins are absorbed in the terminal ileum and it would take too long for B12.
6. The nurse is assessing the patient admitted with pancreatitis. In doing so, the nurse:
a. palpates the pancreas for size and shape.
b. emphasizes to the patient that pancreatic inflammation does not spread.
c. assesses symptoms that could indicate involvement of the stomach.
d. explains to the patient that back pain is not a sign of pancreatitis.
7. The nurse is caring for a patient with liver disease. When assessing the patient’s laboratory values, the nurse should:
a. disregard the level of conjugated bilirubin.
b. assess the indirect serum bilirubin.
c. call the provider immediately if the direct bilirubin is elevated.
d. be aware that unconjugated bilirubin is harmless.
8. The liver plays a major role in homeostasis by:
a. synthesizing factor I but not factor II.
b. synthesizing clotting factors without the need for vitamin K.
c. removing active clotting factors from the circulation.
d. synthesizing factor II but not factor I.
9. The liver detoxifies the blood by:
a. converting fat-soluble compounds to water-soluble compounds.
b. converting water-soluble compounds to fat-soluble compounds.
c. excreting fat-soluble compounds in feces.
d. metabolizing inactive toxic substances to active forms.
10. The patient is being admitted to the hospital. At home, the patient take an over-the-counter supplement of Vitamin D and is concerned because the doctor did not order that vitamin D to be given in the hospital. The nurse explains that
a. the body does not store vitamins so the doctor will have to be called.
b. the kidneys will produce enough vitamin D and that supplements are not needed.
c. over-the-counter supplements are never given in the hospital.
d. vitamins D is stored in the liver with a 10-month supply to prevent deficiency.
Chapter 18: Endocrine Alterations
1. A patient with type 1 diabetes who is receiving a continuous subcutaneous insulin infusion via an insulin pump contacts the clinic to report mechanical failure of the infusion pump. The nurse instructs the patient to begin monitoring for signs of:
a. adrenal insufficiency.
b. diabetic ketoacidosis.
c. hyperosmolar, hyperglycemic state.
2. Which of the following patients is at the highest risk for hyperosmolar hyperglycemic syndrome?
a. An 18-year-old college student with type 1 diabetes who exercises excessively
b. A 45-year-old woman with type 1 diabetes who forgets to take her insulin in the morning
c. A 75-year-old man with type 2 diabetes and coronary artery disease who has recently started on insulin injections
d. An 83-year-old, long-term care resident with type 2 diabetes and advanced Alzheimer’s disease who recently developed influenza
3. Which of the following laboratory values would be more common in patients with diabetic ketoacidosis?
a. Blood glucose >1000 mg/dL
b. Negative ketones in the urine
c. Normal anion gap
d. pH 7.24
4. Which of the following is a high-priority nursing diagnosis for both diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome?
a. Activity intolerance
b. Fluid volume deficient
d. Impaired nutrition, more than body requirements
5. The nurse is assigned to care for a patient who presented to the emergency department with diabetic ketoacidosis. A continuous insulin intravenous infusion is started, and hourly bedside glucose monitoring is ordered. The targeted blood glucose value after the first hour of therapy is:
a. 70 to 120 mg/dL.
b. a decrease of 25 to 50 mg/dL compared with admitting values.
c. a decrease of 50 to 75 mg/dL compared with admitting values.
d. less than 200 mg/dL.
6. A patient has been on daily, high-dose glucocorticoid therapy for the treatment of rheumatoid arthritis. His prescription runs out before his next appointment with his physician. Because he is asymptomatic, he thinks it is all right to withhold the medication for 3 days. What is likely to happen to this patient?
a. He will go into adrenal crisis.
b. He will go into thyroid storm.
c. His autoimmune disease will go into remission.
d. Nothing; it is appropriate to stop the medication for 3 days.
7. The nurse is caring for a 27-year-old patient with a diagnosis of head trauma. The nurse notes that the patient’s urine output has increased tremendously over the past 18 hours. The nurse suspects that the patient may be developing:
a. diabetes insipidus.
b. diabetic ketoacidosis.
c. hyperosmolar hyperglycemic syndrome.
d. syndrome of inappropriate secretion of antidiuretic hormone.
8. The nurse is providing postoperative care to a patient who underwent a transsphenoidal hypophysectomy for a benign pituitary tumor. The nurse administers replacement hydrocortisone, thyroid hormone, and vasopressin. The nurse evaluates that the vasopressin replacement is effective when:
a. the patient’s blood glucose is 110 mg/dL.
b. the patient maintains a core body temperature of 98.2° F (36.8° C).
c. the patient’s urine specific gravity decreases.
d. 2 liters of urine are produced in a 24-hour period.
9. In the management of diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome, when is an intravenous (IV) solution that contains dextrose started?
a. Never; normal saline is the only appropriate solution in diabetes management
b. When the blood sugar reaches 70 mg/dL
c. When the blood sugar reaches 150 mg/dL
d. When the blood glucose reaches 250 mg/dL
10. A 32-year-old patient is admitted to the critical care unit with a diagnosis of diabetic ketoacidosis. Following aggressive fluid resuscitation and intravenous (IV) insulin administration, the blood glucose begins to normalize. In addition to glucose monitoring, which of the following electrolytes requires close monitoring?
Chapter 19: Trauma and Surgical Management
1. Which of the following best defines the term traumatic injury?
a. All trauma patients can be successfully rehabilitated.
b. Traumatic injuries cause more deaths than heart disease and cancer.
c. Alcohol consumption, drug abuse, or other substance abuse contribute to traumatic events.
d. Trauma mainly affects the older adult population.
2. When providing information on trauma prevention, it is important to realize that individuals age 35 to 54 years are most likely to experience which type of trauma incident?
a. High-speed motor vehicle crashes
b. Poisonings from prescription or illegal drugs
c. Violent or domestic traumatic altercations
d. Work-related falls
3. An 18-year-old unrestrained passenger who sustained multiple traumatic injuries from a motor vehicle crash has a blood pressure of 80/60 mm Hg at the scene. This patient should be treated at which level trauma center?
a. Level I
b. Level II
c. Level III
d. Level IV
4. Which of the following injuries would result in a greater likelihood of internal organ damage and risk for infection?
a. A fall from a 6-foot ladder onto the grass
b. A shotgun wound to the abdomen
c. A knife wound to the right chest
d. A motor vehicle crash in which the driver hits the steering wheel
5. A 24-year-old unrestrained driver who sustained multiple traumatic injuries from a motor vehicle crash has a blood pressure of 80/60 mm Hg at the scene. The primary survey of this patient upon arrival to the ED:
a. includes a cervical spine x-ray study to determine the presence of a fracture.
b. involves turning the patient from side to side to get a look at his back.
c. is done quickly in the first few minutes to get a baseline assessment and establish priorities.
d. is a methodical head-to-toe assessment identifying injuries and treatment priorities.
6. The nurse has admitted a patient to the ED following a fall from a first-floor hotel balcony. The patient is 22 years old and smells of alcohol. The patient begins to vomit in the ED. Which of the following interventions is most appropriate?
a. Insert an oral airway to prevent aspiration and to protect the airway.
b. Offer the patient an emesis basin so that you can measure the amount of emesis.
c. Prepare to suction the oropharynx while maintaining cervical spine immobilization.
d. Send a specimen of the emesis to the laboratory for analysis of blood alcohol content.
7. Which of the following interventions would not be appropriate for a patient who is admitted with a suspected basilar skull fracture?
a. Insertion of a nasogastric tube
b. Insertion of an indwelling urinary catheter
c. Endotracheal intubation
d. Placement of an oral airway
8. The nurse is having difficulty inserting a large caliber intravenous catheter to facilitate fluid resuscitation to a hypotensive trauma patient. The nurse recommends which of the following emergency procedures to facilitate rapid fluid administration?
a. Placement of an intraosseous catheter
b. Placement of a central line placement
c. Insertion of a femoral catheter by a trauma surgeon
d. Rapid transfer to the operating room
9. In the trauma patient, symptoms of decreased cardiac output are most commonly caused by:
a. cardiac contusion.
b. cardiogenic shock.
d. pericardial tamponade.
10. A community-based external disaster is initiated after a tornado moved through the city. A nurse from the medical records review department arrives at the emergency department asking how she can assist. The best response by a nurse working for the trauma center would be to:
a. assign the nurse administrative duties, such as obtaining patient demographic information.
b. assign the nurse to a triage room with another nurse from the emergency department.
c. thank the nurse but inform her to return to her department as her skill set is not a good match for patients’ needs.
d. have the nurse assist with transport of patients to procedural areas.
Chapter 20: Burns
1. The optimal measurement of intravascular fluid status during the immediate fluid resuscitation phase of burn treatment is:
a. blood urea nitrogen.
b. daily weight.
c. hourly intake and urine output.
d. serum potassium.
2. In patients with extensive burns, edema occurs in both burned and unburned areas because of:
a. catecholamine-induced vasoconstriction.
b. decreased glomerular filtration.
c. increased capillary permeability.
d. loss of integument barrier.
3. Tissue damage from burn injury activates an inflammatory response that increases the patient’s risk for:
a. acute kidney injury.
b. acute respiratory distress syndrome.
d. stress ulcers.
4. The nurse is caring for a burn-injured patient who weighs 154 pounds, and the burn injury covers 50% of his body surface area. The nurse calculates the fluid needs for the first 24 hours after a burn injury using a standard fluid resuscitation formula of 4 mL/kg/% burn of intravenous (IV) fluid for the first 24 hours. The nurse plans to administer what amount of fluid in the first 24 hours?
a. 2800 mL
b. 7000 mL
c. 14 L
d. 28 L
5. The nurse is caring for a patient who has circumferential full-thickness burns of his forearm? A priority in the plan of care is :
a. Keeping the extremity in a dependent position
b. Active and passive range of motion every hour.
c. Preparing for an escharotomy as a prophylactic measure
d. Splinting the forearm
6. The patient asks the nurse if the placement of the autograft over his full-thickness burn will be the only surgical intervention needed to close his wound. The nurse’s best response would be:
a. “Unfortunately, an autograft skin is a temporary graft and a second surgery will be needed to close the wound.”
b. “An autograft is a biological dressing that will eventually be replaced by your body generating new tissue.”
c. “Yes, an autograft will transfer your own skin from one area of your body to cover the burn wound.”
d. “Unfortunately, autografts frequently do not adhere well to burn wounds and a xenograft will be necessary to close the wound.”
7. A patient admitted with severe burns to his face and hands is showing signs of extreme agitation. The nurse should explore the mechanism of burn injury possibly related to:
a. excessive alcohol use.
b. methamphetamine use.
c. posttraumatic stress disorder.
d. subacute delirium.
8. The nurse is caring for patient who has been struck by lightning. Because of the nature of the injury, the nurse assesses the patient for which of the following?
a. Central nervous system deficits
d. Stress ulcers
9. The nurse is providing care to manage the pain of a patient with burns. The physician has ordered opiates to be given intramuscularly. The nurse contacts the physician to change the order to intravenous administration because:
a. intramuscular injections cause additional skin disruption.
b. burn pain is so severe it requires relief by the fastest route available.
c. hypermetabolism limits effectiveness of medications administered intramuscularly.
d. tissue edema may interfere with drug absorption of injectable routes.
10. When paramedics notice singed hairs in the nose of a burn patient, it is recommended that the patient be intubated. What is the reasoning for the immediate intubation?
a. Carbon monoxide poisoning always occurs when soot is visible.
b. Inhalation injury above the glottis may cause significant edema that obstructs the airway.
c. The patient will have a copious amount of mucus that will need to be suctioned.
d. The singed hairs and soot in the nostrils will cause dysfunction of cilia in the airways.
AND MUCH MORE