Question 1

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

Accepted Answer

A SvO2 value of 60% indicates that the patient has a balance between oxygen supply and demand. SvO2 is the saturation of venous blood with oxygen and it reflects the balance between oxygen supply and demand at the tissue level. A value of 20%, 35%, or even 90% can indicate that there is an imbalance in oxygen supply and demand and may require further intervention.

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?

Accepted Answer

The left hand being cooler than the right hand suggests impaired circulation to the left hand, which could be due to complications from the arterial line, such as thrombosis or embolism. This requires immediate attention to prevent further complications.

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?

Accepted Answer

Providing frequent information about the patient's condition and management of care can help alleviate anxiety and provide reassurance to the family members. While allowing one member to stay with the patient continuously may be helpful, it may not always be feasible or practical in the CCU setting. Inviting the family to a care conference and referring them to social services may also be helpful, but addressing their immediate needs for information can be a priority.

Question 4

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

Accepted Answer

Enteral feedings, which provide nutrition via the gastrointestinal tract, help maintain gut integrity and prevent translocation of bacteria. This is especially important for patients with extensive burns, as they are at a higher risk for infections due to compromised skin barriers. Parenteral nutrition, which provides nutrition via the veins, does not offer this protective benefit and has a higher risk for complications such as infections and thrombosis. While enteral feedings may not necessarily be less expensive than parenteral nutrition, and the patient's limited vascular access may be a consideration, the primary reason for suggesting enteral feedings in this case is to maintain gut integrity and prevent infection.

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?

Accepted Answer

A decreased heart rate (HR) can lead to decreased cardiac output (CO) without affecting pulmonary artery wedge pressure (PAWP) or systemic vascular resistance (SVR), as CO is the product of heart rate and stroke volume.

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?

Accepted Answer

A nasal endotracheal (ET) tube is the best choice for maintaining airway patency in a comatose patient with suspected head and neck injuries. This is because it does not require manipulation of the head and neck as the oropharyngeal airway would, and it allows for mechanical ventilation if needed. Tracheostomy tubes are not typically used in the acute phase of injury, and an oral ET tube may interfere with potential diagnostic imaging of the head and neck.

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?

Accepted Answer

Left ventricular failure causes fluid to accumulate in the lungs, leading to increased PAOP. Therefore, a decrease in PAOP indicates improvement in the patient's condition. Increased SVR and PVR would indicate worsening condition, as the heart is working harder to pump against increased resistance in the vessels. Decreased MAP may indicate a drop in blood pressure and decreased perfusion to the organs.

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?

Accepted Answer

Decreased pulmonary artery wedge pressure (PAWP) indicates a decrease in left ventricular preload, which is a goal in heart failure management. Increased systemic vascular resistance (SVR) would increase afterload and could be detrimental in a patient with heart failure. Increased central venous pressure would suggest impaired right ventricular function. Increased pulmonary vascular resistance (PVR) would suggest worsening pulmonary hypertension, which is not a desired outcome in heart failure management.

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?

Accepted Answer

The answer of A patient has an arterial pressure catheter...

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?

Accepted Answer

The answer of The SvO₂ is decreasing in a patient...

Question 11

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

Accepted Answer

The answer of When assisting with insertion of a pulmonary...

Question 12

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

Accepted Answer

Positioning the zero-reference stopcock line level with the phlebostatic axis ensures that the transducer is at the correct anatomical reference point, which is crucial for accurate blood pressure measurement with an invasive monitoring catheter. This axis is considered the ideal reference point for intrathoracic pressure.

Question 13

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

Accepted Answer

Oral suction equipment and tubing for patients on mechanical ventilators should be changed every 24 hours to prevent infection and ensure proper functioning of the equipment. More frequent changes may be necessary if the equipment becomes visibly soiled or if the patient has a high risk of infection. However, less frequent changes may be appropriate if the patient's condition and risk factors do not warrant daily changes. Ultimately, the frequency of equipment changes should be determined by the healthcare provider in charge of the patient's care.

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?

Accepted Answer

The answer of The nurse identifies a collaborative problem of...

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?

Accepted Answer

Urinary output of 100 mL/hour indicates adequate perfusion to the kidneys, which is a goal of using an IABP in cardiogenic shock. The other options do not directly reflect the effectiveness of the IABP in supporting cardiac output and improving perfusion.

Question 16

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

Accepted Answer

Injecting air into the cuff until no leak is heard at peak inspiratory pressure ensures that the cuff is adequately sealed to prevent aspiration and optimize ventilation without overinflating the cuff, which could cause tracheal damage.

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?

Accepted Answer

Stroke Volume (SV) is the amount of blood ejected by the left ventricle in one cardiac cycle. To calculate SV using the CO (Cardiac Output) formula (CO = SV × HR), we need to know the patient's HR and CO.

CO = 4.8 L/min (given)
HR = 130 beats/min (given)

CO = SV × HR
4.8 L/min = SV × 130 beats/min
SV = 4.8 L/min ÷ 130 beats/min
SV ≈ 0.037 L/beat or 37 mL/beat (rounded to the nearest milliliter)

Therefore, the answer is B (37 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?

Accepted Answer

Cardiac activity is the correct answer because it is important to monitor the patient's cardiac activity during the insertion of a pulmonary artery flow-directed catheter to prevent complications such as arrhythmias or cardiac arrest.

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?

Accepted Answer

Cluster nursing activities and planned uninterrupted rest periods may help improve the patient's sleep pattern and reduce sleep disturbances. Administering sedatives or hypnotics without addressing the underlying cause of sleep deprivation may not help the patient in the long term. Silencing alarms on monitoring equipment may compromise patient safety, and explaining the types of noise in the environment is unlikely to improve the patient's sensory perception.

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?

Accepted Answer

Monitoring the surgical incision for signs of infection is crucial as any surgical procedure, including VAD implantation, carries a risk of infection.

Quiz 68: Nursing Management: Critical Care Environment

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

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?

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

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 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 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 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?

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

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

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

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?

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?

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

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?

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?

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 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?

Quiz 68: Nursing Management: Critical Care Environment

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

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?

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

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 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 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 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?

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

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

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

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?

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?

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

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?

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?

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 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?

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

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?