Deck 65: Critical Care

Question 1

After surgery for an abdominal aortic aneurysm,a patient's central venous pressure (CVP)monitor indicates low pressures. Which action should the nurse take?

A)Administer IV diuretic medications.
B)Increase the IV fluid infusion per protocol.
C)Increase the infusion rate of IV vasodilators.
D)Elevate the head of the patient's bed to 45 degrees.

Answer 1

Increase the IV fluid infusion per protocol.

Question 2

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

A)Fast flush the arterial line.
B)Check the left hand for pallor.
C)Assess for cardiac dysrhythmias.
D)Re-zero the monitoring equipment.

Answer 2

Assess for cardiac dysrhythmias.

Question 3

The nurse notes premature ventricular contractions (PVCs)while suctioning a patient's endotracheal tube. Which next action by the nurse is indicated?

A)Plan to suction the patient more frequently.
B)Decrease the suction pressure to 80 mm Hg.
C)Give antidysrhythmic medications per protocol.
D)Stop and ventilate the patient with 100% oxygen.

Answer 3

Stop and ventilate the patient with 100% oxygen.

Question 4

While close family members are visiting,a patient has a respiratory arrest,and resuscitation is started. Which action by the nurse is best?

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

Question 5

Which nursing action is needed when preparing to assist with the insertion of a pulmonary artery catheter?

A)Determine if the cardiac troponin level is elevated.
B)Auscultate heart sounds before and during insertion.
C)Place the patient on NPO status before the procedure.
D)Attach cardiac monitoring leads before the procedure.

Question 6

When caring for a patient with pulmonary hypertension,which parameter will the nurse use to directly evaluate the effectiveness of the treatment?

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

Question 7

Which hemodynamic parameter best reflects the effectiveness of drugs that the nurse gives to reduce a patient's left ventricular afterload?

A)Mean arterial pressure (MAP)
B)Systemic vascular resistance (SVR)
C)Pulmonary vascular resistance (PVR)
D)Pulmonary artery wedge pressure (PAWP)

Question 8

While waiting for heart transplantation,a patient with severe cardiomyopathy has a ventricular assist device (VAD)implanted. When planning care for this patient,the nurse should anticipate

A)preparing the patient for a permanent VAD.
B)administering immunosuppressive medications.
C)teaching the patient the reason for complete bed rest.
D)monitoring the surgical incision for signs of infection.

Question 9

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

A)The patient was last suctioned 6 hours ago.
B)The patient's oxygen saturation drops to 93%.
C)The patient's respiratory rate is 32 breaths/min.
D)The patient has occasional audible expiratory wheezes.

Question 10

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

A)Urine output of 25 mL/hr
B)Heart rate of 110 beats/minute
C)Cardiac output (CO) of 5 L/min
D)Stroke volume (SV) of 40 mL/beat

Question 11

The nurse is caring for a patient who has an intraaortic balloon pump in place. Which action should be included in the plan of care?

A)Avoid the use of anticoagulant medications.
B)Measure the patient's urinary output every hour.
C)Provide passive range of motion for all extremities.
D)Position the patient supine with head flat at all times.

Question 12

While assisting with the placement of a pulmonary artery (PA)catheter,the nurse notes that the catheter is correctly placed when the balloon is inflated and the monitor shows a

A)typical PA pressure waveform.
B)tracing of the systemic arterial pressure.
C)tracing of the systemic vascular resistance.
D)typical PA wedge pressure (PAWP) tracing.

Question 13

A patient who has been in the intensive care unit for 4 days has disturbed sensory perception from sleep deprivation. Which action should the nurse include in the plan of care?

A)Administer prescribed sedatives or opioids at bedtime to promote sleep.
B)Cluster nursing activities so that the patient has uninterrupted rest periods.
C)Silence the alarms on the cardiac monitors to allow 30- to 40-minute naps.
D)Eliminate assessments between 2200 and 0600 to allow uninterrupted sleep.

Question 14

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

A)The right hand feels cooler than the left hand.
B)The mean arterial pressure (MAP) is 77 mm Hg.
C)The system is delivering 3 mL of flush solution per hour.
D)The flush bag and tubing were last changed 2 days previously.

Question 15

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

A)obtain a portable chest x-ray.
B)use an end-tidal CO₂ monitor.
C)auscultate for bilateral breath sounds.
D)observe for symmetrical chest movement.

Question 16

The central venous oxygen saturation (ScvO₂)is decreasing in a patient who has severe pancreatitis. To determine the possible cause of the decreased ScvO₂,the nurse assesses the patient's

A)lipase level.
B)temperature.
C)urinary output.
D)body mass index.

Question 17

The intensive care unit (ICU)nurse educator determines that teaching a new staff nurse about arterial pressure monitoring has been effective when the nurse

A)balances and calibrates the monitoring equipment every 2 hours.
B)positions the zero-reference stopcock line level with the phlebostatic axis.
C)ensures that the patient is supine with the head of the bed flat for all readings.
D)rechecks the location of the phlebostatic axis with changes in the patient's position.

Question 18

The nurse notes thick,white secretions in the endotracheal tube (ET)of a patient who is receiving mechanical ventilation. Which intervention will most directly treat this finding?

A)Reposition the patient every 1 to 2 hours.
B)Increase suctioning frequency to every hour.
C)Add additional water to the patient's enteral feedings.
D)Instill 5 mL of sterile saline into the ET before suctioning.

Question 19

When monitoring the effectiveness of treatment for a patient with a large anterior wall myocardial infarction,the most pertinent measurement for the nurse to obtain is

A)central venous pressure (CVP).
B)systemic vascular resistance (SVR).
C)pulmonary vascular resistance (PVR).
D)pulmonary artery wedge pressure (PAWP).

Question 20

To maintain proper cuff pressure of an endotracheal tube (ET)when the patient is on mechanical ventilation,the nurse should

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

Question 21

When evaluating a patient with a central venous catheter,the nurse observes that the insertion site is red and tender to touch and the patient's temperature is 101.8° F. What should the nurse plan to do?

A)Discontinue the catheter and culture the tip.
B)Use the catheter only for fluid administration.
C)Change the flush system and monitor the site.
D)Check the site more frequently for any swelling.

Question 22

The nurse responds to a ventilator alarm and finds the patient lying in bed gasping and holding the endotracheal tube (ET)in her hand. Which action should the nurse take next?

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

Question 23

The nurse educator is evaluating the care that a new registered nurse (RN)provides to a patient receiving mechanical ventilation. Which action by the new RN indicates the need for more education?

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

Question 24

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

A)Verbally coach the patient to breathe with the ventilator.
B)Sedate the patient with the ordered PRN lorazepam (Ativan).
C)Manually ventilate the patient with a bag-valve-mask device.
D)Increase the rate for the ordered propofol (Diprivan) infusion.

Question 25

An 81-yr-old patient who has been in the intensive care unit (ICU)for a week is now stable and transfer to the progressive care unit is planned. On rounds,the nurse notices that the patient has new onset confusion. The nurse will plan to

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

Question 26

The family members of a patient who has 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)Explain ICU visitation policies and encourage family visits.
B)Escort the family from the waiting room to the patient's bedside.
C)Describe the patient's injuries and the care that is being provided.
D)Invite the family to participate in an interprofessional care conference.

Question 27

The nurse notes that a patient's endotracheal tube (ET),which was at the 22-cm mark,is now at the 25-cm mark,and the patient is anxious and restless. Which action should the nurse take next?

A)Check the O₂ saturation.
B)Offer reassurance to the patient.
C)Listen to the patient's breath sounds.
D)Notify the patient's health care provider.

Question 28

Four hours after mechanical ventilation is initiated,a patient's arterial blood gas (ABG)results include a pH of 7.51,PaO₂ of 82 mm Hg,PaCO₂ of 26 mm Hg,and HCO₃- of 23 mEq/L (23 mmol/L). The nurse will anticipate the need to

A)increase the FIO₂.
B)increase the tidal volume.
C)increase the respiratory rate.
D)decrease the respiratory rate.

Question 29

A patient's vital signs are pulse 90,respirations 24,and BP 128/64 mm Hg,and cardiac output is 4.7 L/min. The patient's stroke volume is _____ mL. (Round to the nearest whole number.)

Question 30

The nurse is caring for a patient who has an intraaortic balloon pump (IABP)after a massive heart attack. When assessing the patient,the nurse notices blood backing up into the IABP catheter. In which order should the nurse take the following actions? (Put a comma and a space between each answer choice [A,B,C,D].)

A)Confirm that the IABP console has turned off.
B)Assess the patient's vital signs and orientation.
C)Obtain supplies for insertion of a new IABP catheter.
D)Notify the health care provider of the IABP malfunction.

Question 31

The nurse is caring for a patient who has an arterial catheter in the left radial artery for arterial pressure-based cardiac output (APCO)monitoring. Which information obtained by the nurse requires a report to the health care provider?

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

Question 32

After change-of-shift report,which patient should the progressive care nurse assess first?

A)Patient who was extubated this morning and has a temperature of 101.4°F (38.6°C)
B)Patient with bilevel positive airway pressure (BiPAP) for obstructive sleep apnea and a respiratory rate of 16
C)Patient with arterial pressure monitoring who is 2 hours post-percutaneous coronary intervention and needs to void
D)Patient who is receiving IV heparin for a venous thromboembolism and has a partial thromboplastin time (PTT) of 101 sec

Question 33

When assisting with oral intubation of a patient who is having respiratory distress,in which order will the nurse take these actions? (Put a comma and a space between each answer choice [A,B,C,D,E].)

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

Question 34

A nurse is weaning a 68-kg patient who has chronic obstructive pulmonary disease (COPD)from mechanical ventilation. Which patient assessment finding indicates that the weaning protocol should be stopped?

A)The patient's heart rate is 97 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 450 mL.

Question 35

A patient with respiratory failure has arterial pressure-based cardiac output (APCO)monitoring and is receiving mechanical ventilation with peak end-expiratory pressure (PEEP)of 12 cm H₂O. Which information indicates that a change in the ventilator settings may be required?

A)The arterial pressure is 90/46.
B)The stroke volume is increased.
C)The heart rate is 58 beats/minute.
D)The stroke volume variation is 12%.

Question 36

The nurse educator is evaluating the performance of a new registered nurse (RN)who is providing care to a patient who is receiving mechanical ventilation with 15 cm H₂O of peak end-expiratory pressure (PEEP). Which action indicates that the new RN is safe?

A)The RN plans to suction the patient every 1 to 2 hours.
B)The RN uses a closed-suction technique to suction the patient.
C)The RN tapes the connection between the ventilator tubing and the ET.
D)The RN changes the ventilator circuit tubing routinely every 48 hours.

Question 37

After change-of-shift report on a ventilator weaning unit,which patient should the nurse assess first?

A)Patient who failed a spontaneous breathing trial and has been placed in a rest mode on the ventilator
B)Patient who is intubated and has continuous partial pressure end-tidal CO₂ (PETCO₂) monitoring
C)Patient who was successfully weaned and extubated 4 hours ago and has no urine output for the last 6 hours
D)Patient with a central venous O₂ saturation (ScvO₂) of 69% while on bilevel positive airway pressure (BiPAP)

Question 38

The nurse is caring for a patient with a subarachnoid hemorrhage who is intubated and placed on a mechanical ventilator with 10 cm H₂O of peak end-expiratory pressure (PEEP). When monitoring the patient,the nurse will need to notify the health care provider immediately if the patient develops

A)O2 saturation of 93%.
B)green nasogastric tube drainage.
C)respirations of 20 breaths/minute.
D)increased jugular venous distention.

Question 39

A patient who is receiving positive pressure ventilation is scheduled for a spontaneous breathing trial (SBT). Which finding by the nurse is most likely to result in postponing the SBT?

A)New ST segment elevation is noted on the cardiac monitor.
B)Enteral feedings are being given through an orogastric tube.
C)Scattered rhonchi are heard when auscultating breath sounds.
D)hydromorphone (Dilaudid) is being used to treat postoperative pain.

Question 40

The nurse is caring for a patient receiving a continuous norepinephrine IV infusion. Which patient assessment finding indicates that the infusion rate may need to be adjusted?

A)Heart rate is slow at 58 beats/min.
B)Mean arterial pressure (MAP) is 56 mm Hg.
C)Systemic vascular resistance (SVR) is elevated.
D)Pulmonary artery wedge pressure (PAWP) is low.