Critical Care Exam Questions and Correct Answers.

Critical Care Exam 1 Questions and Correct Answers Which of the following professional organizations best supports critical care nursing practice? - Correct Answers: American Association of Critical Care Nurses The synergy model of practice focuses on: - Correct Answers: Needs of patients and their families, which drives nursing competencies The family of your critically ill patient tells you that they have not spoken w/ the physician in over 24 hours and they have some questions that they want clarified. During morning rounds, you convey this concern to the attending intensivist and arrange for her to meet w/ the family at 4:00PM in the conference room. Which competency of critical care nursing does this represent? - Correct Answers: Collaboration w/ patients, families, and team members The AACN Standards for Acute and Critical Care Nursing Practice use what framework to guide critical care nursing practice? - Correct Answers: Nursing Process The charge nurse is responsible for making the patient assignments on the critical care unit. She assigns the experienced, certified nurse to care for the acutely ill patient w/ sepsis who also requires continuous renal replacement therapy and mechanical ventilation. She assigns the nurse w/ less than 1 year of experience to two patients who are more stable. This assignment reflects the implementation of the: - Correct Answers: Synergy model of practice Which of the following assists the critical care nurse in ensuring that care is appropriate and based on research? - Correct Answers: Clinical Practice Guidelines As part of nursing management of a critically ill patient, orders are written to keep the HOB elevated at 30 Degrees, awaken the patient from sedation each morning to assess readiness to wean form mechanical ventilation, and implement oral care protocols every 4 hours. These interventions are done as a group to reduce the risk of ventilator-associated pneumonia. This group of evidence-based interventions is often called a: - Correct Answers: Bundle of Care Family members have a need for information. Which interventions best assist in meeting this need? - Correct Answers: Providing a daily update of the patient's progress and facilitating communication w/ the intensivist The nurse is caring for a patient who sustained a head injury and is unresponsive to painful stimuli. Which intervention is most appropriate while bathing the patient? - Correct Answers: Tell the patient the day and time, and that you are bathing her. Reassure her that you are there. Critical Illness often results in family conflicts. Which scenario is most likely to result in the greatest conflict? - Correct Answers: A 36-year old male admitted for a ruptured cerebral aneurysm. He has been living w/ his 34-year old girlfriend for 8 years, and they have a 4 year old daughter. He does not have written advance directives. His parents arrive from out-of-state and are used to make decisions about his health care. He hs not seen them in over a year. Which intervention is appropriate to assist the patient to cope w/ admission to the critical care unit? - Correct Answers: Explaining all procedures in easy-to-understand terms The constant noise of ventilator, monitor alarms, and infusion pumps predisposes the patient to: - Correct Answers: Sensory Overload The nurse is assigned to care for a patient who is non-native English speaker. What is the best way to communicate w/ the patient and family to provide updates and explain procedures? - Correct Answers: Contact the hospital's interpreter serve for someone to translate The wife of a patient who is hospitalized in the critical care unit following resuscitation for a sudden cardiac arrest at work demands to meet with the nursing manager. She states, "I want you to reassign my husband to another nurse. His current nurse is not in the room enough to make sure he is okay." The nurse recognized that this response most likely is due to the wife's: - Correct Answers: Sense of loss of control of the situation Open visitation policies are expected by many professional organizations. Which statement reflects adherence to current recommendations? - Correct Answers: Determine, in collaboration with the patient and family, who can visit and when. Facilitate open visitation policies. A critically ill patient has a living will in his chart. His condition has deteriorated. His wife says she wants "everything done", regardless of the patient's wishes. Which ethical principle is the wife violating? - Correct Answers: Autonomy Which of the following statements about resuscitation is true? - Correct Answers: Withholding "extraordinary" resuscitation is legal and ethical if specified in advance directives and physician orders. The nurse is caring for an elderly patient who is in cariogenic shock. The patient has failed to respond to medical treatment. The intesivist in charge of the patient conducts a conference to explain that they have exhausted treatment options and suggest that the patient be made a "do not resuscitate" status. This scenario illustrates the concept of: - Correct Answers: Futility The nurse is caring for a patient admitted w/ a TBI following a motor vehicle accident. The patient's GCS is 3 and intermittently withdraws when painful stimuli are introduced. The patient is ventilator dependent and occasionally takes a spontaneous breath. The physician explains to the family that the patient has severe neurological impairment and he does not expect the patient to recover consciousness. The nurse recognizes that this patient is: - Correct Answers: In a persistent vegetative state The nurse is caring for a critically ill patient on mechanical ventilation. The physician identifies the need for a bronchoscopy, which requires informed consent. If the physician were to obtain consent form the patient, the patient must be able to: - Correct Answers: Have knowledge and competence to make the decision The nurse is caring for a critically ill patient w/ terminal cancer. The monitor alarms and shows V. Tach. The patient does not have a DNR order written on the chart. What is the appropriate nursing action? - Correct Answers: Initiate CPR and call a code A patient who is undergoing withdrawal of mechanical ventilation appears anxious and agitated. The patient is on a continuous morphine infusion and has an additional order for lorazepam (Ativan) 1 to 2 mg IV PRN. The patient has received no Ativan during this course of illness. What is the most appropriate nursing intervention to control agitation? - Correct Answers: Administer lorazepam (Ativan) 1mg IV now What were the finding of the SUPPORT study? - Correct Answers: Disparities exist between patients' care preferences and actual care provided Designated healthcare surrogates should base healthcare decisions on: - Correct Answers: Wishes previously expressed by the patient All of the patient's children are distressed by the possibility of removing life-support treatment from their mother. The child who is most upset tells the nurse, "This is the same as killing her! I thought you were supposed to help her!" The explains to the family: - Correct Answers: "This is a process of allowing your mother to die naturally after the injuries that she sustained in a serious accident." To prevent any unwanted resuscitation after life-sustaining treatment have been withdrawn, the nurse should ensure that: - Correct Answers: DNR orders are written before discontinuation of the treatments A 45 year old post surgical patient is on a ventilator in the critical care unit. He has been tolerating the ventilator well and has not required any sedation He becomes tachycardia and hypertensive. His respiratory rate has increased to 28 breaths/min. The ventilator is set on SIMV at a rate of 10 breaths/min. the patient has been suctioned recently via his ET Tube, and his airway is clear. He responds appropriately to the nurse's commands. The nurse should: - Correct Answers: Assess the patient's level of pain The assessment of pain and anxiety is a continuous process. When critically ill patients exhibit signs of anxiety, the nurse's first priority is to: - Correct Answers: Identify and treat the underlying case Both the EEG monitor and Bispectral Index Score (BIS) or Patient State Index (PSI) analyzer monitors are used to assess patient sedation levels in critically ill patients. The BIS and PSI monitors are simpler to use b/c they: - Correct Answers: Provide raw EEG data and a numeric value The patient is receiving neuromuscular blockade. Which nursing assessment indicates a target level of paralysis? - Correct Answers: Train-of-Four yields two twitches The most important nursing intervention for patients who receive neuromuscular blocking agents is to: - Correct Answers: Administer sedatives in conjunction w/ the neuromuscular blocking agents The nurse is caring for four patients on the progressive care unit. Which patient is at greatest risk for developing delirium? - Correct Answers: 86-year old from nursing home, postoperative from colon resection The nurse recognizes that which patient is likely to benefit most from PCA Pump? - Correct Answers: 59-year old postoperative elective bariatric surgery The patient is admitted w/ a suspected acute MI. In assessing the 12-lead ECG changes, which findings would indicate to the nurse that the patient is in the process of an evolving Q wave MI? - Correct Answers: ST-segment elevation on ECG and elevated CPK-MB or Troponin levels The nurse is assessing a patient w/ left-sided heart failure. Which symptoms would the nurse expect to find? - Correct Answers: Dyspnea and crackles A patient is admitted w/ the diagnosis of unstable angina. The nurse knows that the physiological mechanism present is most likely which of the following? - Correct Answers: Partial occlusion of a coronary artery w/ a thrombus A patient is admitted w/ an angina attack. The nurse anticipates which drug regimen to be initiated? - Correct Answers: Nitroglycerin, oxygen and beta-blockers A patient w/ CAD is having a cardiac evaluation to assess for possible valvular disease. Which study best identifies function and measures the size of the cardiac chambers? - Correct Answers: Echocardiogram A 72-year old patient is brought to the ED by her family. The family states that she's, "Just not herself." Her respirations are slightly labored, and her heart monitor shows sinus tachycardia (rate 110 bpm). w/ frequent PVCs. She denies any chest pain, jaw pain, back discomfort, or nausea. Her troponin levels are elevated, and her 12-lead ECG shows elevated ST segments in leads II, II, and AVF. The nurse knows that these symptoms are most likely associated w/ which diagnosis? - Correct Answers: Silent MI A patient present so the ED complaining of severe substernal chest pressure radiating to his left shoulder and back that started about 12 hours ago. The patient delayed coming to the ED since he was hoping the pain would go away. The patient's 12-lead ECG shows ST-segment depression in the inferior leads. Troponin and CK-MB are both elevated. The hospital does not have the capability for percutaneous coronary intervention. Thrombolysis is one possible treatment. Based on these data, the nurse understands that: - Correct Answers: The patient is not a candidate for thrombolysis The patient presents to the ED w/ severe chest discomfort. He is taken for cardiac catheterization and angiography that shows 80% occlusion of the left main coronary artery. Which procedure will be most likely followed? - Correct Answers: CABG Surgery A patient is admitted to the ED with clinical indicates of an acute MI. Symptoms began 3 hours ago. The facility does not have the capability for percutaneous coronary intervention. Given this scenario, what is the priority intervention in the treatment and nursing management of this patient? - Correct Answers: Administer thrombolytic therapy unless contraindicated A patient was admitted in terminal heart failure and is not eligible for transplant. The family wants everything possible done to maintain life. Which procedure might be offering to the patient for this condition to increase the patient's quality of life? - Correct Answers: LVAD The patient has undergone open chest surgery for coronary artery bypass grafting. One of the nurse's responsibilities is to monitor the patient for which common postoperative dysrhythmia? - Correct Answers: A. Fib or A. Flutter The nurse is providing care to a patient on fibrinolytic therapy. Which statement from the patient warrants further assessment and intervention by the critical care nurse? - Correct Answers: "My back is killing me!" Which scenarios contribute to effective handoff communication at change of shift? - Correct Answers: 1. The unit has decided to use a standardized checklist/tool for change of shift reports and patient transfers 2. You and the oncoming nurse conduct a standardized report at the patient's bedside and review key assessment findings Family presence is encouraged during resuscitation and invasive procedures. The nurse knows that nurses are often reluctant to allow this to occur, yet families often perceive benefits. Which findings have been reported in the literature? - Correct Answers: 1. Families report reduced anxiety and fear about what is being done to the patient 2. Families benefit by witnessing that everything possible was done Which therapeutic intervention may be withdrawn or withheld from the terminally ill client? - Correct Answers: 1. Antibiotics 2. Dialysis 3. Nutrition Identify the priority interventions for managing symptoms of an acute MI in the ED. - Correct Answers: 1. Oxygen therapy 2. Administration of morphine 3. Administration of nitroglycerin Which nursing intervention would be appropriate after angioplasty? - Correct Answers: 1. Assess pedal pulses on the involved limb every 15 minutes for 2 hours. 2. Monitor the vascular hemostatic device for signs of bleeding