Test Bank for Priorities in Critical Care
Nursing 9th Edition Urden / All Chapters 1-
27 / Full Complete 2024
Section 1: Foundations of Critical Care (Questions 1-15)
1. A nurse is caring for a patient who is deemed to have decisional capacity. The patient
refuses a life-saving blood transfusion based on religious beliefs. The physician is frustrated
and asks the nurse to help convince the patient. What is the nurse's priority action?
A. Tell the patient they are making a mistake and will die without the transfusion.
B. Respect the patient's autonomy and ensure their decision is documented.
C. Ask the hospital ethics committee to override the patient's decision.
D. Administer the transfusion anyway as it is a life-saving measure.
Correct Answer: B
Rationale: Patient autonomy is a fundamental ethical principle. A patient with decisional
capacity has the right to refuse any treatment, even if it is life-saving. The nurse's role is to
advocate for the patient's wishes and ensure they are respected and documented. Convincing,
overriding, or immediately calling the ethics committee (which is done if there is a conflict, but
the patient's right is clear here) would violate the principle of autonomy.
2. A family member is constantly at the bedside of a comatose patient, asking many
questions and expressing anger towards the staff. What is the most appropriate nursing
intervention?
A. Limit the family member's visiting hours to give the patient rest.
B. Explain that the constant questions are interfering with patient care.
C. Recognize this as a potential sign of anticipatory grief and provide support and information.
D. Ask the family member to leave and return when they are calmer.
Correct Answer: C
Rationale: Anger and demanding behavior from family members in the ICU are often
manifestations of fear, anxiety, and anticipatory grief. The nurse should recognize this and
respond with empathy, providing clear, consistent information and emotional support. Limiting
visits or asking them to leave would be non-therapeutic and could worsen the situation.
3. Which of the following patients is at the highest risk for developing delirium in the ICU?
A. A 45-year-old patient admitted for a scheduled hernia repair.
B. A 78-year-old patient with a history of dementia, admitted with sepsis.
C. A 30-year-old patient with a fractured tibia.
D. A 60-year-old patient admitted for observation after a minor car accident.
, Correct Answer: B
Rationale: The risk factors for ICU delirium include advanced age, pre-existing cognitive
impairment (like dementia), and the presence of severe illness or infection (like sepsis). The 78-
year-old patient has multiple high-risk factors. The other patients have significantly lower risk
profiles.
4. A patient is admitted to the ICU with a diagnosis of acute respiratory distress syndrome
(ARDS). The nurse understands that the primary pathophysiological problem in ARDS is:
A. Increased pulmonary capillary permeability leading to noncardiogenic pulmonary edema.
B. Decreased left ventricular function leading to cardiogenic pulmonary edema.
C. Bronchoconstriction and excessive mucus production.
D. Loss of surfactant leading to alveolar collapse.
Correct Answer: A
Rationale: ARDS is characterized by a direct injury to the alveolar-capillary membrane,
which increases its permeability. This allows fluid, proteins, and other inflammatory mediators to
leak into the alveoli, causing noncardiogenic pulmonary edema, severe hypoxemia, and
decreased lung compliance. Option B describes cardiogenic pulmonary edema (heart failure).
Option C describes asthma or COPD. Option D describes neonatal respiratory distress syndrome.
5. The nurse is caring for a patient with a do-not-resuscitate (DNR) order. The patient's
heart rate suddenly drops to 30 bpm, and the patient becomes unresponsive. What is the
nurse's priority action?
A. Immediately begin chest compressions.
B. Call a code blue and start advanced cardiac life support (ACLS).
C. Withhold resuscitative efforts and provide comfort measures.
D. Call the physician to clarify the DNR order.
Correct Answer: C
Rationale: A DNR order specifically means that in the event of a cardiopulmonary arrest,
resuscitative efforts (like chest compressions, defibrillation, and intubation) will not be initiated.
The nurse's priority is to honor the patient's wishes, which means withholding resuscitation and
providing comfort-focused care.
6. Which of the following is a key component of the "FAST HUG" mnemonic for daily ICU
care?
A. Foley catheter care
B. Analgesia
C. Stress ulcer prophylaxis
D. Thromboprophylaxis
E. All of the above
, Correct Answer: E
Rationale: The FAST HUG mnemonic is a checklist for daily ICU care. It stands for:
Feeding, Analgesia, Sedation, Thromboprophylaxis, Head of bed elevation, Ulcer prophylaxis,
and Glucose control. Therefore, all options are correct components.
7. A patient's family is meeting with the healthcare team to discuss goals of care. The family
is in conflict about whether to continue aggressive treatment. What is the most appropriate
role for the nurse?
A. To make the decision for the family to reduce their stress.
B. To act as a facilitator, ensuring all voices are heard and providing information.
C. To side with the family member who agrees with the physician's recommendation.
D. To remain silent and let the physician handle the discussion.
Correct Answer: B
Rationale: The nurse's role in family meetings is often that of a facilitator and advocate.
This includes ensuring that all family members have a chance to speak, clarifying information,
and providing emotional support. The nurse should not make the decision for the family or take
sides.
8. The nurse is preparing to administer a neuromuscular blocking agent (NMBA) to a
patient. What is the most critical nursing intervention prior to administration?
A. Ensure the patient has a functioning IV line.
B. Verify the patient is adequately sedated and has a plan for analgesia.
C. Ensure a bag-valve-mask is at the bedside.
D. Document the patient's baseline respiratory rate.
Correct Answer: B
Rationale: NMBAs cause complete paralysis but have no sedative or analgesic properties.
Administering them to a patient who is not adequately sedated is an ethical and clinical violation,
as the patient would be fully aware but unable to move or communicate. Ensuring deep sedation
and analgesia before administering the NMBA is the absolute priority.
9. A patient is being mechanically ventilated. The low-pressure alarm is sounding. Which of
the following is the most likely cause?
A. Increased airway secretions.
B. A kink in the ventilator tubing.
C. A disconnection in the ventilator circuit.
D. Bronchospasm.
Correct Answer: C
Rationale: A low-pressure alarm indicates a leak or a disconnection in the system. The most
, common cause is a disconnection of the tubing from the patient or the ventilator. Increased
secretions, kinks, and bronchospasm would cause a high-pressure alarm.
10. Which of the following interventions is a primary strategy for preventing ventilator-
associated pneumonia (VAP)?
A. Administering prophylactic antibiotics.
B. Keeping the head of the bed elevated to 30-45 degrees.
C. Performing oral care with hydrogen peroxide.
D. Changing the ventilator circuit every 24 hours.
Correct Answer: B
Rationale: Elevating the head of the bed to 30-45 degrees is a cornerstone of VAP
prevention. It helps to prevent microaspiration of gastric contents. Prophylactic antibiotics are
not recommended, oral care should be with chlorhexidine or standard oral care, and ventilator
circuits should only be changed when soiled or malfunctioning.
11. A patient has an arterial line in place. When the nurse performs the square wave test,
the waveform is dampened. What does this indicate?
A. The system is over-damped, and the systolic pressure may read falsely high.
B. The system is optimally damped.
C. The system is over-damped, and the systolic pressure may read falsely low.
D. The system is under-damped, and the systolic pressure may read falsely high.
Correct Answer: C
Rationale: A dampened (over-damped) waveform from a square wave test indicates that
there is a problem in the system, such as a clot, air bubble, or kink. This causes the systolic
pressure to read falsely low, and the diastolic pressure to read falsely high.
12. A patient is receiving a continuous infusion of heparin for a pulmonary embolism. The
nurse should monitor which lab value most closely?
A. Prothrombin time (PT).
B. International normalized ratio (INR).
C. Activated partial thromboplastin time (aPTT).
D. Platelet count.
Correct Answer: C
Rationale: Unfractionated heparin therapy is monitored using the aPTT. The goal is to
maintain the aPTT at 1.5 to 2.5 times the control value. PT and INR are used to monitor warfarin
(Coumadin) therapy. Platelets should also be monitored for heparin-induced thrombocytopenia
(HIT), but aPTT is the primary measure of therapeutic effect.
13. Which of the following is a classic sign of increased intracranial pressure (ICP) in a
patient with a traumatic brain injury?
Nursing 9th Edition Urden / All Chapters 1-
27 / Full Complete 2024
Section 1: Foundations of Critical Care (Questions 1-15)
1. A nurse is caring for a patient who is deemed to have decisional capacity. The patient
refuses a life-saving blood transfusion based on religious beliefs. The physician is frustrated
and asks the nurse to help convince the patient. What is the nurse's priority action?
A. Tell the patient they are making a mistake and will die without the transfusion.
B. Respect the patient's autonomy and ensure their decision is documented.
C. Ask the hospital ethics committee to override the patient's decision.
D. Administer the transfusion anyway as it is a life-saving measure.
Correct Answer: B
Rationale: Patient autonomy is a fundamental ethical principle. A patient with decisional
capacity has the right to refuse any treatment, even if it is life-saving. The nurse's role is to
advocate for the patient's wishes and ensure they are respected and documented. Convincing,
overriding, or immediately calling the ethics committee (which is done if there is a conflict, but
the patient's right is clear here) would violate the principle of autonomy.
2. A family member is constantly at the bedside of a comatose patient, asking many
questions and expressing anger towards the staff. What is the most appropriate nursing
intervention?
A. Limit the family member's visiting hours to give the patient rest.
B. Explain that the constant questions are interfering with patient care.
C. Recognize this as a potential sign of anticipatory grief and provide support and information.
D. Ask the family member to leave and return when they are calmer.
Correct Answer: C
Rationale: Anger and demanding behavior from family members in the ICU are often
manifestations of fear, anxiety, and anticipatory grief. The nurse should recognize this and
respond with empathy, providing clear, consistent information and emotional support. Limiting
visits or asking them to leave would be non-therapeutic and could worsen the situation.
3. Which of the following patients is at the highest risk for developing delirium in the ICU?
A. A 45-year-old patient admitted for a scheduled hernia repair.
B. A 78-year-old patient with a history of dementia, admitted with sepsis.
C. A 30-year-old patient with a fractured tibia.
D. A 60-year-old patient admitted for observation after a minor car accident.
, Correct Answer: B
Rationale: The risk factors for ICU delirium include advanced age, pre-existing cognitive
impairment (like dementia), and the presence of severe illness or infection (like sepsis). The 78-
year-old patient has multiple high-risk factors. The other patients have significantly lower risk
profiles.
4. A patient is admitted to the ICU with a diagnosis of acute respiratory distress syndrome
(ARDS). The nurse understands that the primary pathophysiological problem in ARDS is:
A. Increased pulmonary capillary permeability leading to noncardiogenic pulmonary edema.
B. Decreased left ventricular function leading to cardiogenic pulmonary edema.
C. Bronchoconstriction and excessive mucus production.
D. Loss of surfactant leading to alveolar collapse.
Correct Answer: A
Rationale: ARDS is characterized by a direct injury to the alveolar-capillary membrane,
which increases its permeability. This allows fluid, proteins, and other inflammatory mediators to
leak into the alveoli, causing noncardiogenic pulmonary edema, severe hypoxemia, and
decreased lung compliance. Option B describes cardiogenic pulmonary edema (heart failure).
Option C describes asthma or COPD. Option D describes neonatal respiratory distress syndrome.
5. The nurse is caring for a patient with a do-not-resuscitate (DNR) order. The patient's
heart rate suddenly drops to 30 bpm, and the patient becomes unresponsive. What is the
nurse's priority action?
A. Immediately begin chest compressions.
B. Call a code blue and start advanced cardiac life support (ACLS).
C. Withhold resuscitative efforts and provide comfort measures.
D. Call the physician to clarify the DNR order.
Correct Answer: C
Rationale: A DNR order specifically means that in the event of a cardiopulmonary arrest,
resuscitative efforts (like chest compressions, defibrillation, and intubation) will not be initiated.
The nurse's priority is to honor the patient's wishes, which means withholding resuscitation and
providing comfort-focused care.
6. Which of the following is a key component of the "FAST HUG" mnemonic for daily ICU
care?
A. Foley catheter care
B. Analgesia
C. Stress ulcer prophylaxis
D. Thromboprophylaxis
E. All of the above
, Correct Answer: E
Rationale: The FAST HUG mnemonic is a checklist for daily ICU care. It stands for:
Feeding, Analgesia, Sedation, Thromboprophylaxis, Head of bed elevation, Ulcer prophylaxis,
and Glucose control. Therefore, all options are correct components.
7. A patient's family is meeting with the healthcare team to discuss goals of care. The family
is in conflict about whether to continue aggressive treatment. What is the most appropriate
role for the nurse?
A. To make the decision for the family to reduce their stress.
B. To act as a facilitator, ensuring all voices are heard and providing information.
C. To side with the family member who agrees with the physician's recommendation.
D. To remain silent and let the physician handle the discussion.
Correct Answer: B
Rationale: The nurse's role in family meetings is often that of a facilitator and advocate.
This includes ensuring that all family members have a chance to speak, clarifying information,
and providing emotional support. The nurse should not make the decision for the family or take
sides.
8. The nurse is preparing to administer a neuromuscular blocking agent (NMBA) to a
patient. What is the most critical nursing intervention prior to administration?
A. Ensure the patient has a functioning IV line.
B. Verify the patient is adequately sedated and has a plan for analgesia.
C. Ensure a bag-valve-mask is at the bedside.
D. Document the patient's baseline respiratory rate.
Correct Answer: B
Rationale: NMBAs cause complete paralysis but have no sedative or analgesic properties.
Administering them to a patient who is not adequately sedated is an ethical and clinical violation,
as the patient would be fully aware but unable to move or communicate. Ensuring deep sedation
and analgesia before administering the NMBA is the absolute priority.
9. A patient is being mechanically ventilated. The low-pressure alarm is sounding. Which of
the following is the most likely cause?
A. Increased airway secretions.
B. A kink in the ventilator tubing.
C. A disconnection in the ventilator circuit.
D. Bronchospasm.
Correct Answer: C
Rationale: A low-pressure alarm indicates a leak or a disconnection in the system. The most
, common cause is a disconnection of the tubing from the patient or the ventilator. Increased
secretions, kinks, and bronchospasm would cause a high-pressure alarm.
10. Which of the following interventions is a primary strategy for preventing ventilator-
associated pneumonia (VAP)?
A. Administering prophylactic antibiotics.
B. Keeping the head of the bed elevated to 30-45 degrees.
C. Performing oral care with hydrogen peroxide.
D. Changing the ventilator circuit every 24 hours.
Correct Answer: B
Rationale: Elevating the head of the bed to 30-45 degrees is a cornerstone of VAP
prevention. It helps to prevent microaspiration of gastric contents. Prophylactic antibiotics are
not recommended, oral care should be with chlorhexidine or standard oral care, and ventilator
circuits should only be changed when soiled or malfunctioning.
11. A patient has an arterial line in place. When the nurse performs the square wave test,
the waveform is dampened. What does this indicate?
A. The system is over-damped, and the systolic pressure may read falsely high.
B. The system is optimally damped.
C. The system is over-damped, and the systolic pressure may read falsely low.
D. The system is under-damped, and the systolic pressure may read falsely high.
Correct Answer: C
Rationale: A dampened (over-damped) waveform from a square wave test indicates that
there is a problem in the system, such as a clot, air bubble, or kink. This causes the systolic
pressure to read falsely low, and the diastolic pressure to read falsely high.
12. A patient is receiving a continuous infusion of heparin for a pulmonary embolism. The
nurse should monitor which lab value most closely?
A. Prothrombin time (PT).
B. International normalized ratio (INR).
C. Activated partial thromboplastin time (aPTT).
D. Platelet count.
Correct Answer: C
Rationale: Unfractionated heparin therapy is monitored using the aPTT. The goal is to
maintain the aPTT at 1.5 to 2.5 times the control value. PT and INR are used to monitor warfarin
(Coumadin) therapy. Platelets should also be monitored for heparin-induced thrombocytopenia
(HIT), but aPTT is the primary measure of therapeutic effect.
13. Which of the following is a classic sign of increased intracranial pressure (ICP) in a
patient with a traumatic brain injury?
