Deck 68: Nursing Management: Critical Care Environment

Question 1

Which SvO₂ value indicates that the patient has a balanced oxygen supply and demand?

A) 20%
B) 35%
C) 60%
D) 90%

Answer 1

60%

Question 2

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

Answer 2

The left hand is cooler than the right hand.

Question 3

A young man was admitted 2 days ago to the critical care unit (CCU)in critical condition with multiple traumas following an automobile accident.His wife and his parents have been at the hospital constantly since his admission,rotating short visits with the patient.While in the waiting room,they jump up each time the CCU door is opened.To assist the patient's family members to cope with their anxiety,what should the nurse do?

A) Allow one member of the family most important to the patient to stay with the patient continuously.
B) Provide frequent information about the patient's condition and the management of his care.
C) Invite the family members to participate in a multidisciplinary care conference for the patient.
D) Refer the family to social services for financial planning to manage the expenses of the patient's care.

Answer 3

Provide frequent information about the patient's condition and the management of his care.

Question 4

To meet the nutritional needs of a patient with extensive burns in the CCU,why should the nurse primarily suggest enteral feedings?

A) Because enteral feedings are less expensive than parenteral nutrition
B) Because complications of enteral feedings are fewer than those associated with parenteral nutrition
C) Because nutrition provided via the gastrointestinal tract helps maintain gut integrity and prevent translocation of bacteria
D) Because the patient has limited vascular access for parenteral nutrition because of other intravenous and arterial lines needed for monitoring

Question 5

During hemodynamic monitoring,the nurse finds that a patient has a decreased cardiac output (CO)without change in pulmonary artery wedge pressure (PAWP)or systemic vascular resistance (SVR).The nurse identifies which of the following factors as most likely responsible for the decreased output?

A) Decreased stroke volume (SV)
B) Decreased heart rate (HR)
C) Increased right atrial pressure
D) Increased mean arterial pressure (MAP)

Question 6

A patient is admitted to the emergency department comatose with suspected head and neck injuries after falling from a roof.Which of the following devices does the nurse anticipate will maintain the airway patency in the patient?

A) A tracheostomy tube
B) An oropharyngeal airway
C) A nasal endotracheal (ET)tube
D) An oral ET tube

Question 7

A patient with left ventricular failure is admitted to the CCU.The nurse evaluates that the patient's condition is improving when hemodynamic monitoring reveals which of the following information?

A) Increased SVR
B) Increased PVR
C) Decreased MAP
D) Decreased pulmonary artery occlusive pressure (PAOP)

Question 8

A patient in heart failure following an acute myocardial infarction has a pulmonary artery flow-directed catheter inserted.Following the administration of medications to decrease preload and afterload,the nurse determines that the medications have been effective when hemodynamic measurements reveal which of the following findings?

A) Increased SVR
B) Increased central venous pressure
C) Increased pulmonary vascular resistance (PVR)
D) Decreased PAWP

Question 9

A patient has an arterial pressure catheter placed in the radial artery for access for frequent arterial sampling for blood gas analysis.When the low-pressure alarm is activated,what should the nurse assess the patient for?

A) Cardiac dysrhythmias
B) Thrombus formation around the catheter
C) Signs of impaired circulation to the hand
D) Signs of inflammation around the insertion site

Question 10

The SvO₂ is decreasing in a patient with hemodynamic monitoring who has a severe pancreatitis.Arterial blood gases (ABG)indicate that the arterial partial pressure of oxygen (PaO₂)is unchanged,and the hemoglobin and CO₂ are stable.To determine the cause of the decreased SvO₂,what should the nurse assess in the patient?

A) HR
B) Temperature
C) Urinary output
D) Level of consciousness

Question 11

When assisting with insertion of a pulmonary artery catheter,how does the nurse identify that the catheter is correctly placed?

A) A normal pulmonary artery waveform is observed on the monitor.
B) A typical PAOP waveform is observed on the monitor.
C) The systemic arterial pressure tracing appears on the monitor.
D) It has been inserted 22 cm from the jugular vein insertion site.

Question 12

To ensure accuracy in measurement of blood pressure with an invasive monitoring catheter,what should the nurse do?

A) Balance and calibrate the monitoring equipment every hour.
B) Ensure that the patient is lying supine with the head of the bed flat.
C) Position the zero-reference stopcock line level with the phlebostatic axis.
D) Position the limb with the catheter insertion site at zero reference of the stopcock line.

Question 13

How often should all oral suction equipment and tubing be changed for a patient who is on a mechanical ventilator?

A) Every 4 hours
B) Every 12 hours
C) Every 24 hours
D) Every 72 hours

Question 14

The nurse identifies a collaborative problem of potential for arterial trauma secondary to displacement of the balloon for a patient with an IABP.What is an appropriate nursing action for this problem?

A) Administer prophylactic heparin as ordered.
B) Check the insertion site for bleeding every hour.
C) Measure the patient's urinary output every hour.
D) Keep the head of the bed elevated 30 to 45 degrees.

Question 15

An intra-aortic balloon pump (IABP)is being used for a patient who is in cardiogenic shock.Which of the following assessment findings indicates to the nurse that the goals of treatment with the IABP are being met?

A) A CO₂ of 2 L/min
B) An SV of 40 mL/beat
C) HR 110 beats/min
D) Urinary output 100 mL/hour

Question 16

To inflate the cuff of an ET when the patient is on mechanical ventilation,what should the nurse do?

A) Inflate the cuff with 10 mL of air.
B) Inject air into the cuff to a pressure of 20 mm Hg.
C) Inject air into the cuff until no leak is heard at peak inspiratory pressure.
D) Inflate the cuff until the pilot balloon cannot be easily compressed with the fingers.

Question 17

A patient with hemodynamic monitoring has a blood pressure of 94/68 mm Hg,HR of 130 beats/min,CO₂ of 4.8 L/min,and mixed venous oxygen saturation (SvO₂)of 64%.In analyzing the patient's hemodynamic measurements,the nurse calculates his SV at which of the following findings?

A) 23 mL/beat
B) 37 mL/beat
C) 42 mL/beat
D) 59 mL/beat

Question 18

To prevent complications during the insertion of a pulmonary artery flow-directed catheter,it is important for the nurse to monitor which of the following parameters?

A) Cardiac activity
B) Coagulation status
C) Wave pressure tracings
D) Fluid and electrolyte status

Question 19

The nurse identifies a nursing diagnosis of disturbed sensory perception related to sleep deprivation for a patient in the CCU.What is an appropriate nursing intervention for this problem?

A) Cluster nursing activities and plan uninterrupted rest periods.
B) Administer prescribed sedatives or hypnotics at bedtime to promote sleep.
C) Silence the alarms on monitoring equipment to allow the patient to take 30- to 40-minute naps.
D) Explain to the patient the types of noise in the environment and reasons that the noise is necessary.

Question 20

A patient with severe heart failure has a ventricular assist device (VAD)implanted.Which of the following should be included when developing the plan of care?

A) Teaching the patient the reason for continuous bed rest
B) Preparing the patient to have the VAD in place permanently
C) Monitoring the surgical incision for signs of infection
D) Administering immunosuppressive medications

Question 21

The charge nurse evaluates the care that a new registered nurse (RN)staff member provides to a patient receiving mechanical ventilation.Which action by the new RN indicates the need for more education?

A) Turns the FIO₂ up to 100% before suctioning
B) Asks for assistance to turn the patient to the prone position
C) Secures a bite block in place using adhesive tape
D) Positions the patient with the head of the bed at 10 degrees

Question 22

A patient with an oral endotracheal tube has a nursing diagnosis of risk for aspiration related to presence of artificial airway.What is an appropriate nursing intervention for the patient?

A) Perform oral suctioning frequently and before cuff deflation.
B) Remove the bite block and perform oral hygiene every 2 hours.
C) Maintain cuff pressure at minimal occluding volume to prevent gastric secretions from entering the trachea.
D) Use chest physiotherapy to move secretions to large airways,where they can be suctioned.

Question 23

A patient with a subarachnoid hemorrhage is intubated and placed on a mechanical volume-cycled ventilator in the spontaneous intermittent mandatory volume mode,FIO₂ 40%,rate 14,tidal volume 700,with 10 cm of PEEP.Which of the following indicates a need for the nurse to notify the physician?

A) Respiratory rate of 18 breaths/min
B) O₂ saturation of 94%
C) Increased jugular vein distension
D) Greenish brown nasogastric tube drainage

Question 24

Which of the following is a measurement that would indicate to the nurse that the patient is ready to be weaned off of mechanical ventilation?

A) Respiratory rate 22 beats/min
B) Minute ventilation of 12 L/min
C) Negative inspiratory force of -85 cm H₂O
D) Positive expiratory pressure of 50 cm H₂O

Question 25

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

A) HR is 58 beats/min.
B) MAP is 55 mm Hg.
C) SVR is elevated.
D) PAOP is low.

Question 26

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

A) The patient has not been suctioned for the last 6 hours.
B) The lungs have occasional audible expiratory wheezes.
C) The respiratory rate is 32 breaths/min.
D) The pulse oximeter shows arterial oxygenation of 95%.

Question 27

When the ventilator alarm sounds,the nurse finds the patient sitting up in bed holding the ET.What is the first intervention the nurse should initiate?

A) Establish a patent airway.
B) Call the physician to reinsert the tube.
C) Activate the resuscitation protocol of the institution.
D) Manually ventilate the patient with 100% oxygen and a bag-valve-mask.

Question 28

When weaning a patient who has COPD from mechanical ventilation,which patient assessment indicates that the weaning protocol should be discontinued?

A) The patient HR is 98 beats/min.
B) The patient's spontaneous tidal volume is 500 mL.
C) The patient's oxygen saturation is 91%.
D) The patient respiratory rate is 32 breaths/min.

Question 29

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

A) Zero-balance the transducer.
B) Inflate the pulmonary artery balloon.
C) Notify the physician.
D) Change the flush system.

Question 30

A patient has a nursing diagnosis of risk for injury related to asynchrony with the ventilator secondary to anxiety.Initially,what should the nurse do?

A) Verbally coach the patient to breathe with the ventilator.
B) Sedate the patient with morphine or lorazepam (Ativan).
C) Use a manual resuscitation bag with 100% oxygen to rapidly ventilate the patient.
D) Increase the ventilator rate to override the patient's efforts at breathing.

Question 31

Which action by a new RN who is caring for a patient with an intra-aortic balloon catheter inserted in the left femoral artery will require immediate intervention by the CCU charge nurse?

A) Checks the patient's pedal pulses every 30 minutes
B) Elevates the head of the patient's bed to 90 degrees
C) Turns the patient onto the left side
D) Informs the patient to take deep breaths

Question 32

While assessing a patient with a central venous catheter in place in the left subclavian vein,the nurse notes that the catheter insertion site is red and tender and that the patient's temperature is 38.8°C.The nurse will plan to implement which of the following?

A) Change the flush system and monitor the site.
B) Administer analgesics and antibiotics.
C) Discontinue the catheter,and culture the tip.
D) Check the site frequently for any swelling.

Question 33

Which finding represents a normal SV when monitoring hemodynamic parameters?

A) 25 mL/beat
B) 50 mL/beat
C) 100 mL/beat
D) 200 mL/beat

Question 34

A patient with acute respiratory failure is receiving assist-control mechanical ventilation with a PEEP of 10 cm H₂O and has an artery line and pulmonary artery catheter.Which of the following indicates that a change in the ventilator settings may be required?

A) Decreased pulmonary artery pressure (PAP)
B) Decreased MAP
C) Increased PAOP
D) Increased HR

Question 35

An older adult patient who has been in the CCU for a week is preparing for transfer to the step-down unit when the nurse notices that the patient has new-onset restlessness and confusion.The patient's physiological status is stable and otherwise unchanged.What should the nurse do?

A) Inform the receiving nurse,and proceed with the transfer.
B) Notify the health care provider,and postpone the transfer.
C) Administer as-needed lorazepam,and proceed with the transfer.
D) Obtain an order to restrain the patient,and proceed with the transfer.

Question 36

While suctioning a patient with an ET,the nurse notes the occurrence of premature ventricular contractions on the patient's cardiac monitor.What is the most appropriate nursing action on observing this finding?

A) Lower the suction pressure to 60 mm Hg.
B) Ventilate the patient with 100% oxygen with a bag-valve-mask.
C) Notify the physician of the need for antidysrhythmic medications.
D) Provide an explanation of the suctioning procedure to decrease the patient's anxiety.

Question 37

Which action by a new RN working in the CCU indicates that the education regarding care of the patient receiving manual ventilation with 10 cm of PEEP has been effective?

A) Suctions the patient every 2 hours
B) Tapes the connection between the ventilator tubing and the endotracheal tube
C) Uses a closed-suction technique to suction the patient
D) Changes the ventilator circuit tubing routinely every 24 hours

Question 38

A patient with chronic obstructive pulmonary disease (COPD)is in acute respiratory failure and has been placed on mechanical ventilation.Four hours after mechanical ventilation is initiated,the patient's ABG results include a pH of 7.50,PaO₂ of 80 mm Hg,arterial partial pressure of carbon dioxide (PaCO₂)of 29 mm Hg,and bicarbonate of 23 mmol/L.The nurse will anticipate the need to do which of the following?

A) Increase the FIO₂.
B) Increase the tidal volume.
C) Decrease the respiratory rate.
D) Leave the ventilator on the current settings.