Deck 66: Nursing Management: Critical Care

Question 1

The ICU charge nurse will evaluate that teaching about hemodynamic monitoring for a new staff nurse has been effective when the new nurse

A) balances and calibrates the hemodynamic monitoring equipment every hour.
B) ensures that the patient is lying supine with the head of the bed flat for all readings.
C) positions the zero-reference stopcock line level with the phlebostatic axis.
D) positions the limb with the catheter insertion site at zero-reference of the stopcock line.

Answer 1

positions the zero-reference stopcock line level with the phlebostatic axis.

Question 2

A patient is admitted to the emergency department comatose and apneic with suspected head and neck injuries after falling from a roof. Which equipment will the nurse anticipate needing for emergency airway maintenance?

A) Nasal endotracheal (ET) tube
B) Oral ET tube
C) Tracheostomy tube
D) Oropharyngeal airway

Answer 2

Nasal endotracheal (ET) tube

Question 3

A patient with hemodynamic monitoring has a blood pressure of 94/68, heart rate of 130, and a cardiac output (CO) of 4.8 L/min. In analyzing the patient's hemodynamic measurements, the nurse calculates the stroke volume (SV) at ____ ml/beat.

A) 28
B) 37
C) 42
D) 59

Answer 3

37

Question 4

A patient in heart failure following an acute myocardial infarction has a pulmonary artery catheter inserted. To determine whether the administration of drugs to decrease preload and afterload has been effective, the nurse should monitor the

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

Question 5

A patient admitted to the ICU after experiencing a massive pulmonary embolism has an arterial catheter and a pulmonary artery catheter in place. When evaluating whether treatment has been effective in improving pulmonary hypertension, the nurse will monitor for

A) increased pulmonary artery pressure (PAP).
B) decreased pulmonary vascular resistance (PVR).
C) increased mean arterial pressure (MAP).
D) decreased pulmonary artery wedge pressure (PAWP).

Question 6

An intra-aortic 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) cardiac output (CO) of 2 L/min.
B) stroke volume (SV) of 40 ml/beat.
C) heart rate 110 beats/min.
D) urine output of 100 ml/hr.

Question 7

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

A) cluster nursing activities so that the patient has uninterrupted rest periods.
B) administer prescribed sedatives or opioids at bedtime to promote sleep.
C) silence the alarms on the cardiac monitors to allow the patient to take 30- to 40-minute naps.
D) discontinue assessments during the night to allow uninterrupted rest for the patient.

Question 8

The mixed venous oxygen saturation (SvO₂) is decreasing in a patient with hemodynamic monitoring who has severe pancreatitis. The patient's PaO₂ and cardiac output are stable. To determine the possible cause of the decreased SvO₂, the nurse assesses the patient's

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

Question 9

The nurse identifies a collaborative problem of potential for arterial trauma secondary to displacement of the balloon for a patient with an intraaortic balloon pump (IABP). An appropriate action by the nurse for this problem is to

A) measure the patient's urinary output every hour.
B) keep the head of the bed elevated 30 to 45 degrees.
C) administer prophylactic heparin as ordered.
D) check the insertion site for bleeding every hour.

Question 10

A patient with left ventricular failure is admitted to the coronary care unit (CCU). When monitoring for the effectiveness of treatment, the most important information for the nurse to obtain is

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

Question 11

A patient has an arterial pressure catheter placed in the right radial artery for access for frequent arterial sampling for blood gas analysis. When the low-pressure alarm is activated, the nurse's most appropriate action would be to

A) assess for cardiac dysrhythmias.
B) rezero the monitoring equipment.
C) check the right hand for pallor.
D) ask the patient about pain.

Question 12

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) 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) administration of immunosuppressive medications.

Question 13

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

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

Question 14

An arterial catheter is inserted in the right brachial artery to monitor a patient's blood pressure. Which information obtained by the nurse indicates that a complication of arterial pressure monitoring may be occurring?

A) The Allen test is positive.
B) The mean arterial pressure (MAP) is 102 mm Hg.
C) The dicrotic notch is visible in the waveform.
D) The right hand is numb.

Question 15

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

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

Question 16

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

A) uses the minimal occluding volume technique by inflating the cuff with 10 ml of air.
B) injects air into the cuff until a manometer indicates a pressure of 15 mm Hg.
C) injects air into the cuff until no leak is heard at the peak inspiratory pressure.
D) inflates the cuff until the pilot balloon cannot be easily compressed with the fingers.

Question 17

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

Question 18

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 mean arterial pressure (MAP) is 75 mm Hg.
D) The system is delivering only 3 ml of flush solution per hour.

Question 19

During hemodynamic monitoring, the nurse finds that a patient has decreased cardiac output (CO) without changes in pulmonary artery wedge pressure (PAWP) or systemic vascular resistance (SVR). The nurse anticipates assisting with interventions to

A) reduce stroke volume.
B) increase heart rate.
C) lower right atrial pressure (RAP).
D) reduce central venous pressure (CVP).

Question 20

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

A) place the patient on a cardiac monitor.
B) administer diuretics before the procedure.
C) auscultate heart sounds during insertion.
D) check cardiac enzymes before insertion.

Question 21

An elderly patient who has been in the ICU 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 physiologic status is stable and otherwise unchanged. The nurse should

A) inform the receiving nurse and proceed with the transfer.
B) notify the health care provider and postpone the transfer.
C) administer PRN lorazepam (Ativan) and proceed with the transfer.
D) obtain an order to restrain the patient and proceed with the transfer.

Question 22

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/minute.
D) The pulse oximeter shows an SpO₂ of 95%.

Question 23

When the ventilator alarm sounds, the nurse finds the patient lying in bed holding the endotracheal tube (ET). The first intervention by the nurse is to

A) position the patient in a left lateral position.
B) call the health care provider immediately to reinsert the tube.
C) activate the hospital's rapid response team.
D) manually ventilate the patient with 100% oxygen.

Question 24

While assessing a patient with a central venous catheter in place in the left subclavian vein, 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) 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 25

A patient with an oral endotracheal tube (ET) has a nursing diagnosis of risk for aspiration related to the presence of an artificial airway. The most appropriate nursing intervention for the patient is to

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

Question 26

A patient with a subarachnoid hemorrhage is intubated and placed on a mechanical volume-cycled ventilator in the spontaneous intermittent mandatory volume (SIMV) mode, FIO₂ 40%, rate 14, VT 700, with 10 cm of PEEP. When monitoring the patient, the nurse will need to notify the health care provider if the patient develops

A) respiratory rate of 18 breaths/min.
B) O₂ saturation of 94%.
C) increased jugular vein distension (JVD).
D) greenish-brown nasogastric tube drainage.

Question 27

When the nurse is weaning a patient who has 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 spontaneous tidal volume is 500 ml.
C) The patient's oxygen saturation is 91%.
D) The patient respiratory rate is 32 breaths/min.

Question 28

The nurse develops the diagnosis of ineffective airway clearance related to thick respiratory secretions for a patient with respiratory failure who is receiving mechanical ventilation. Which intervention will be most effective in resolving this problem?

A) Increase the amount of water in the patient's enteral feedings.
B) Suction the patient more frequently.
C) Instill 5 ml of sterile saline into the ET before suctioning.
D) Turn the patient every 2 hours.

Question 29

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

A) The new RN checks the patient's pedal pulses every 30 minutes.
B) The new RN elevates the head of the patient's bed to 90 degrees.
C) The new RN turns the patient onto the left side.
D) The new RN has the patient take deep breaths.

Question 30

A patient who has respiratory failure and is receiving mechanical ventilation has a nursing diagnosis of risk for injury related to asynchrony with the ventilator secondary to anxiety. The nurse's first action should be to

A) verbally coach the patient to breathe with the ventilator.
B) sedate the patient with the ordered PRN lorazepam (Ativan).
C) ventilate the patient with a manual resuscitation bag.
D) increase the rate for the ordered propofol (Diprivan) infusion.

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

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

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

Question 33

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

Question 34

The charge nurse evaluates 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 asks for assistance to turn the patient to the prone position.
C) The RN secures a bite block in place using adhesive tape.
D) The RN positions the patient with the head of bed at 10 degrees.

Question 35

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

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

Question 36

A patient with acute respiratory failure is receiving assist-control mechanical ventilation with peak end-expiratory pressure (PEEP) of 10 cm H₂O and has an arterial line and pulmonary artery catheter in place. Which information indicates that a change in the ventilator settings may be required?

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

Question 37

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, 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) increase the tidal volume (VT).
C) decrease the respiratory rate.
D) leave the ventilator on the current settings.

Question 38

While suctioning a patient with an endotracheal tube (ET), the nurse notes the occurrence of premature ventricular contractions (PVCs) on the patient's cardiac monitor. The most appropriate action by the nurse upon this finding is to

A) lower the suction pressure to 80 mm Hg.
B) ventilate the patient with 100% oxygen with a bag-valve mask.
C) notify the health care provider of the need for antidysrhythmic medications.
D) explain that occasional PVCs are expected.