Deck 66: Nursing Management: Critical Care

Question 1

Premature ventricular contractions (PVCs) occur while the nurse is suctioning a patient's endotracheal tube. Which action by the nurse is best?

A) Decrease the suction pressure to 80 mm Hg.
B) Stop and ventilate the patient with 100% oxygen.
C) Document the dysrhythmia in the patient's chart.
D) Give prescribed PRN antidysrhythmic medications.

Answer 1

Stop and ventilate the patient with 100% oxygen.

Question 2

When preparing to assist with the insertion of a pulmonary artery catheter, the nurse will plan to

A) check cardiac enzymes before insertion.
B) auscultate heart sounds during insertion.
C) place the patient on NPO status before the procedure.
D) attach cardiac monitoring leads before the procedure.

Answer 2

attach cardiac monitoring leads before the procedure.

Question 3

The nurse notes thick, white respiratory secretions from a patient who is receiving mechanical ventilation. Which intervention will be most effective in resolving this problem?

A) Suction the patient every hour.
B) Reposition the patient every 2 hours.
C) Add additional water to the patient's enteral feedings.
D) Instill 5 mL of sterile saline into the endotracheal tube (ET) before suctioning.

Answer 3

Add additional water to the patient's enteral feedings.

Question 4

When assisting with insertion of a pulmonary artery ( PA ) catheter, the nurse identifies that the catheter is correctly placed when the

A) monitor shows a typical PAWP tracing.
B) PA waveform is observed on the monitor.
C) systemic arterial pressure tracing appears on the monitor.
D) catheter has been inserted to the 22-cm marking on the line.

Question 5

When monitoring for the effectiveness of treatment for a patient with left ventricular failure, the most important information for the nurse to obtain is

A) mean arterial pressure (MAP).
B) systemic vascular resistance (SVR).
C) pulmonary vascular resistance (PVR).
D) pulmonary artery wedge pressure (PAWP).

Question 6

To inflate the cuff of an endotracheal tube (ET) when the patient is on mechanical ventilation, the nurse

A) inflates the cuff until the pilot balloon is firm.
B) inflates the cuff with a minimum of 10 mL of air.
C) injects air into the cuff until a manometer shows 15 mm Hg pressure.
D) injects air into the cuff until a slight leak is heard only at peak inflation.

Question 7

The mixed venous oxygen saturation (SvO₂) is decreasing in a patient who has severe pancreatitis. To determine the possible cause of the decreased SvO₂, the nurse assesses the patient's

A) weight.
B) amylase.
C) temperature.
D) urinary output.

Question 8

Following surgery, a patient's central venous pressure (CVP) monitor indicates low pressures. Which action will the nurse anticipate taking?

A) Increase the IV fluid infusion rate.
B) Administer IV diuretic medications.
C) Elevate the head of the patient's bed to 45 degrees.
D) Document the CVP and continue to monitor.

Question 9

While waiting for cardiac transplantation, a patient with severe heart failure has a ventricular assist device (VAD ) implanted. When developing the plan of care, the nursing actions should include

A) administration of immunosuppressive medications.
B) monitoring the surgical incision for signs of infection.
C) teaching the patient the reason for continuous bed rest.
D) preparing the patient to have the VAD in place permanently.

Question 10

When caring for a patient with pulmonary hypertension, which parameter will the nurse monitor to evaluate whether treatment has been effective?

A) Mean arterial pressure (MAP)
B) Central venous pressure (CVP)
C) Pulmonary vascular resistance (PVR)
D) Pulmonary artery wedge pressure (PAWP)

Question 11

To verify the correct placement of an endotracheal tube (ET) after insertion, the best initial action by the nurse is to

A) auscultate for the presence of bilateral breath sounds.
B) obtain a portable chest radiograph to check tube placement.
C) observe the chest for symmetrical movement with ventilation.
D) use an end-tidal CO₂ monitor to check for placement in the trachea.

Question 12

Which assessment data obtained by the nurse when caring for a patient with a left radial arterial line indicates a need for the nurse to take action?

A) The left hand is cooler than the right hand.
B) The mean arterial pressure (MAP) is 75 mm Hg.
C) The system is delivering only 3 mL of flush solution per hour.
D) The flush bag and tubing were last changed 3 days previously.

Question 13

An intraaortic balloon pump (IABP) is being used for a patient who is in cardiogenic shock. An assessment finding indicating to the nurse that the goals of treatment with the IABP are being met is a

A) heart rate of 110 beats/min.
B) urine output of 20 mL/hr.
C) cardiac output (CO) of 5 L/min.
D) stroke volume (SV) of 40 mL/beat.

Question 14

Which assessment information obtained by the nurse when caring for a patient receiving mechanical ventilation indicates the need for suctioning?

A) The respiratory rate is 32 breaths/min.
B) The pulse oximeter shows a SpO₂ of 93%.
C) The patient has not been suctioned for the last 6 hours.
D) The lungs have occasional audible expiratory wheezes.

Question 15

While family members are visiting, a patient has a cardiac arrest and is being resuscitated. Which action by the nurse is best?

A) Ask family members if they wish to remain in the room during the resuscitation.
B) Explain to family members that watching the resuscitation will be very stressful.
C) Assign a staff member to wait with family members just outside the patient room.
D) Escort family members quickly out of the patient room and then remain with them.

Question 16

The intensive care unit (ICU) charge nurse will determine that teaching about hemodynamic monitoring for a new staff nurse has been effective when the new nurse

A) positions the zero-reference stopcock line level with the phlebostatic axis.
B) balances and calibrates the hemodynamic monitoring equipment every hour.
C) rechecks the location of the phlebostatic axis when changing the patient's position.
D) ensures that the patient is lying supine with the head of the bed flat for all readings.

Question 17

When caring for a patient who has an intraaortic balloon pump in place, which action will be included in the plan of care?

A) Avoid the use of anticoagulant medications.
B) Keep the head of the bed elevated 45 degrees.
C) Measure the patient's urinary output every hour.
D) Provide passive range of motion for all extremities.

Question 18

Which action should the nurse take when the low pressure alarm sounds for a patient who has an arterial line in the right radial artery?

A) Check the right hand for pallor.
B) Assess for cardiac dysrhythmias.
C) Flush the arterial line with saline.
D) Rezero the monitoring equipment.

Question 19

A patient has a nursing diagnosis of disturbed sensory perception related to sleep deprivation. Which action will the nurse include in the plan of care?

A) Discontinue assessments during the night to allow uninterrupted sleep.
B) Administer prescribed sedatives or opioids at bedtime to promote sleep.
C) Silence the alarms on the cardiac monitors to allow 30- to 40-minute naps.
D) Cluster nursing activities so that the patient has uninterrupted rest periods.

Question 20

To determine the effectiveness of medications that a patient has received to reduce left ventricular afterload, which hemodynamic parameter will the nurse monitor?

A) Central venous pressure (CVP)
B) Systemic vascular resistance (SVR)
C) Pulmonary vascular resistance (PVR)
D) Pulmonary artery wedge pressure (PAWP)

Question 21

Four hours after mechanical ventilation is initiated for a patient with chronic obstructive pulmonary disease ( COPD ), the patient's arterial blood gas ( ABG ) results include a pH of 7.50, PaO₂ of 80 mm Hg, PaCO₂ of 29 mm Hg, and HCO₃- of 23 mEq/L ( 23 mmol/L ). The nurse will anticipate the need to

A) increase the FIO₂.
B) decrease the respiratory rate.
C) increase the tidal volume ( VT ).
D) leave the ventilator at the current settings.

Question 22

When the nursing supervisor is evaluating the performance of a new RN, which action indicates that the new RN is safe in providing care to a patient who is receiving mechanical ventilation with 10 cm of peak end-expiratory pressure (PEEP)?

A) The RN plans to suction the patient every 2 hours.
B) The RN uses a closed-suction technique to suction the patient.
C) The RN tapes connection between the ventilator tubing and the ET.
D) The RN changes the ventilator circuit tubing routinely every 24 hours.

Question 23

While assessing a patient with a central venous catheter, the nurse notes the catheter insertion site is red and tender and the patient's temperature is 101.8° F. The nurse will plan to

A) administer analgesics and antibiotics.
B) check the site frequently for any swelling.
C) discontinue the catheter and culture the tip.
D) change the flush system and monitor the site.

Question 24

When the ventilator alarm sounds, the nurse finds the patient lying in bed holding the endotracheal tube (ET). Which action should the nurse take first?

A) Offer reassurance to the patient.
B) Activate the hospital's rapid response team.
C) Call the health care provider to reinsert the tube.
D) Manually ventilate the patient with 100% oxygen.

Question 25

A patient's vital signs are pulse 80, respirations 24, and BP of 124/60 mm Hg and cardiac output is 4.8 L/min. What is the patient's stroke volume? ____________________

Question 26

When caring for a patient who has an arterial catheter in the radial artery to monitor blood pressure, which information obtained by the nurse is most important to report to the health care provider?

A) The patient has a positive Allen test.
B) The mean arterial pressure (MAP) is 86 mm Hg.
C) There is redness at the catheter insertion site.
D) The dicrotic notch is visible in the waveform.

Question 27

In which order will the nurse take these actions when assisting with oral intubation of a patient who is having respiratory distress? Put a comma and space between each solve choice (a, b, c, d, etc.) ____________________

A) Obtain a portable chest-x-ray.
B) Place the patient in the supine position.
C) Inflate the cuff of the endotracheal tube.
D) Attach an end-tidal CO₂ detector to the endotracheal tube.
E) Oxygenate the patient with a bag-valve-mask system for several minutes.

Question 28

When caring for the patient with a pulmonary artery pressure catheter, the nurse notes that the PA waveform indicates that the catheter is in the wedged position. Which action should the nurse take?

A) Inflate the PA balloon.
B) Change the flush system.
C) Zero balance the transducer.
D) Notify the health care provider.

Question 29

The family members of a patient who has just been admitted to the intensive care unit (ICU) with multiple traumatic injuries have just arrived in the ICU waiting room. Which action should the nurse take first?

A) Immediately take the family members to the patient's room.
B) Discuss ICU visitation policies and encourage family visits.
C) Describe the patient's injuries and the care that is being provided.
D) Invite the family to participate in a multidisciplinary care conference.

Question 30

When the charge nurse is evaluating the care that a new RN staff member provides to a patient receiving mechanical ventilation, which action by the new RN indicates the need for more education?

A) The RN turns the FIO₂ up to 100% before suctioning.
B) The RN secures a bite block in place using adhesive tape.
C) The RN positions the patient with the head of bed at 10 degrees.
D) The RN asks for assistance to turn the patient to the prone position.

Question 31

The nurse is caring for a patient receiving a continuous norepinephrine ( Levophed ) IV infusion. Which patient assessment information indicates that the infusion rate may be too high?

A) Heart rate is 58 beats/min.
B) Mean arterial pressure is 55 mm Hg.
C) Systemic vascular resistance ( SVR ) is elevated.
D) Pulmonary artery wedge pressure ( PAWP ) is low.

Question 32

The nurse notes that a patient's endotracheal tube (ET), which was at the 21-cm mark, is now at the 24-cm mark and the patient appears anxious and restless. Which action should the nurse take first?

A) Listen to the patient's lungs.
B) Offer reassurance to the patient.
C) Bag the patient at an FIO₂ of 100%.
D) Notify the patient's health care provider.

Question 33

An elderly patient who has stabilized after being in the intensive care unit (ICU) for a week is preparing for transfer to the step down unit when the nurse notices that the patient has new onset confusion. The nurse will plan to

A) inform the receiving nurse and then transfer the patient.
B) notify the health care provider and postpone the transfer.
C) administer PRN lorazepam (Ativan) and cancel the transfer.
D) obtain an order for restraints as needed and transfer the patient.

Question 34

A patient who is receiving mechanical ventilation is anxious and is "fighting" the ventilator. Which action should the nurse take first?

A) Ventilate the patient with a manual resuscitation bag.
B) Verbally coach the patient to breathe with the ventilator.
C) Sedate the patient with the ordered PRN lorazepam (Ativan).
D) Increase the rate for the ordered propofol (Diprivan) infusion.

Question 35

A patient with a subarachnoid hemorrhage is intubated and placed on a mechanical ventilator. When monitoring the patient, the nurse will need to notify the health care provider if the patient develops

A) oxygen saturation of 94%.
B) respirations of 18 breaths/min.
C) green nasogastric tube drainage.
D) increased jugular vein distention ( JVD ).

Question 36

A patient with respiratory failure has hemodynamic monitoring and is receiving mechanical ventilation with peak end-expiratory pressure (PEEP) of 10 cm H₂O. Which information indicates that a change in the ventilator settings may be required?

A) The arterial line shows a blood pressure of 90/46.
B) The pulmonary artery pressure (PAP) is decreased.
C) The cardiac monitor shows a heart rate of 58 beats/min.
D) The pulmonary artery wedge pressure (PAWP) is increased.

Question 37

When the nurse is weaning a patient who has chronic obstructive pulmonary disease ( COPD ) from mechanical ventilation, which patient assessment indicates that the weaning protocol should be discontinued?

A) The patient heart rate is 98 beats/min.
B) The patient's oxygen saturation is 93%.
C) The patient respiratory rate is 32 breaths/min.
D) The patient's spontaneous tidal volume is 500 mL.