TEST BANK Priorities in Critical Care Nursing, 9th
Edition, Linda D. Urden, Kathleen M. Stacy, Chapters
1 - 27, Complete || Complete Guide A+
1. A patient with septic shock has a pulmonary artery catheter in place. Which combination of
hemodynamic parameters is most consistent with distributive shock and indicates the need for
vasopressor therapy despite adequate fluid resuscitation?
A. Cardiac index (CI) 2.8 L/min/m², systemic vascular resistance index (SVRI) 1200 dyn-sec-cm-m²,
pulmonary artery wedge pressure (PAWP) 8 mm Hg
B. CI 4.2 L/min/m², SVRI 600 dyn-sec-cm-m², PAWP 12 mm Hg
C. CI 2.0 L/min/m², SVRI 1800 dyn-sec-cm-m², PAWP 18 mm Hg
D. CI 3.5 L/min/m², SVRI 800 dyn-sec-cm-m², PAWP 4 mm Hg
Answer: B
Rationale: Distributive shock (e.g., septic) typically presents with a normal or high CI (due to
compensatory tachycardia and fluid resuscitation) and low SVRI (vasodilation). PAWP is usually normal
or low. Option B shows high CI and low SVRI with normal PAWP, indicating vasoplegia requiring
vasopressors. Option A has normal SVRI, option C shows low CI and high SVRI (cardiogenic), and
option D has low PAWP suggesting hypovolemia.
2. During pressure-controlled ventilation, the nurse observes that the delivered tidal volume has
decreased by 30% over the past hour while peak inspiratory pressure remains constant. What is
the most likely explanation for this change?
A. Development of auto-PEEP due to insufficient expiratory time
B. Decreased lung compliance from worsening pulmonary edema
C. Partial obstruction of the endotracheal tube by secretions
D. Increased patient respiratory effort triggering additional breaths
Answer: B
Rationale: In pressure-controlled ventilation, tidal volume is directly proportional to compliance and the
pressure gradient (set pressure minus total PEEP). If peak pressure is constant but tidal volume
decreases, compliance must have decreased. Worsening pulmonary edema reduces compliance.
Auto-PEEP (A) would decrease the effective driving pressure, but it would typically also increase peak
pressure if constant flow or volume? Actually, in pressure control, auto-PEEP reduces tidal volume but
peak pressure is set; however, auto-PEEP would not necessarily keep peak pressure constant. Partial
obstruction (C) would increase resistance and might decrease tidal volume, but peak pressure is set and
would remain constant only if the ventilator adjusts? In pressure control, peak pressure is fixed;
obstruction would reduce flow and tidal volume, but also the ventilator may not maintain constant
pressure if resistance is high? Typically, in pressure control, the ventilator delivers a set pressure; if
resistance increases, flow decreases and tidal volume may drop, but the set pressure is still achieved.
However, decreased compliance is a more common cause. Increased patient effort (D) would increase
tidal volume, not decrease it.
Page 1
,3. A patient with traumatic brain injury (TBI) has an intracranial pressure (ICP) of 28 mm Hg and
cerebral perfusion pressure (CPP) of 50 mm Hg. Mean arterial pressure (MAP) is 78 mm Hg.
Which intervention should the nurse question if ordered?
A. Administer 50 g of mannitol intravenously
B. Elevate the head of bed to 30 degrees
C. Initiate a propofol infusion at 50 mcg/kg/min
D. Administer a 500 mL bolus of 0.9% normal saline
Answer: D
Rationale: CPP = MAP - ICP. Current CPP is 50 mm Hg, which is below the target of 60-70 mm Hg. To
improve CPP, either MAP must be increased or ICP decreased. Administering a bolus of normal saline
(D) is unlikely to significantly increase MAP and may worsen cerebral edema due to its isotonic nature;
hypertonic saline would be preferred. Mannitol (A) reduces ICP, head elevation (B) promotes venous
drainage, and propofol (C) reduces cerebral metabolic demand and ICP. Thus, the normal saline bolus
is not the best intervention and may be questioned.
4. A patient in the ICU develops new-onset atrial fibrillation with rapid ventricular response (heart
rate 150 bpm). The blood pressure is 85/48 mm Hg, and the patient is confused. Which
intervention should the nurse anticipate as the priority?
A. Administer adenosine 6 mg rapid IV push
B. Prepare for synchronized cardioversion
C. Start an amiodarone infusion at 1 mg/min
D. Give metoprolol 5 mg IV over 2 minutes
Answer: B
Rationale: The patient is hemodynamically unstable (hypotension, altered mental status) due to the
tachyarrhythmia. Synchronized cardioversion is the treatment of choice for unstable atrial fibrillation.
Adenosine (A) is used for narrow-complex tachycardias and is unlikely to convert atrial fibrillation.
Amiodarone (C) and metoprolol (D) are rate-control or rhythm-control medications that take time to
work and are not appropriate for unstable patients.
5. A nurse is assessing a patient receiving propofol sedation. The patient's Richmond
Agitation-Sedation Scale (RASS) score is -4, and the patient does not respond to voice but responds
to physical stimulation. The nurse notes a heart rate of 55 bpm, blood pressure 90/60 mm Hg, and
respiratory rate of 8 breaths per minute on a ventilator. What is the nurse's priority action?
A. Increase the propofol infusion rate
B. Administer a 500 mL bolus of lactated Ringer's solution
C. Hold the propofol infusion and reassess
D. Administer atropine 0.5 mg IV
Answer: C
Rationale: A RASS of -4 indicates deep sedation, and the patient has bradycardia and hypotension, likely
due to propofol's side effects (vasodilation, negative inotropy, bradycardia). The priority is to hold the
propofol infusion to allow the patient to lighten and improve hemodynamics. Increasing the infusion (A)
would worsen the situation. Fluid bolus (B) may help but is secondary to stopping the causative agent.
Atropine (D) treats bradycardia but does not address the underlying cause.
Page 2
,6. A patient with acute respiratory distress syndrome (ARDS) is on volume-controlled ventilation
with a tidal volume of 6 mL/kg ideal body weight, PEEP of 12 cm HO, and FiO of 0.7. Arterial
blood gas shows pH 7.25, PaCO 60 mm Hg, PaO 55 mm Hg. Which ventilator adjustment is most
appropriate?
A. Increase tidal volume to 8 mL/kg
B. Increase PEEP to 15 cm HO
C. Increase respiratory rate to 25 breaths/min
D. Increase FiO to 1.0
Answer: C
Rationale: The ABG shows hypercapnic respiratory acidosis (pH <7.35, PaCO ‚ >45) and hypoxemia
(PaO 55 on FiO 0.7, PaO/FiO ratio ~79, consistent with severe ARDS). The priority is to address the
acidosis. Increasing the respiratory rate (C) will increase minute ventilation and lower PaCO.
Increasing tidal volume (A) would risk ventilator-induced lung injury; low tidal volume is standard.
PEEP (B) may improve oxygenation but not acidosis. FiO (D) may help oxygenation but does not
address the acidosis. The PEEP is already high; increasing further may cause hemodynamic
compromise.
7. A patient with acute kidney injury (AKI) due to sepsis is receiving continuous venovenous
hemofiltration (CVVH). The nurse notes that the patient's serum potassium has decreased from 4.5
to 3.2 mEq/L over 8 hours. Which intervention should the nurse implement?
A. Decrease the ultrafiltration rate
B. Increase the potassium concentration in the replacement fluid
C. Administer 40 mEq of potassium chloride IV over 1 hour
D. Obtain a stat ECG and hold all potassium-containing fluids
Answer: B
Rationale: Hypokalemia during CVVH is often due to excessive removal of potassium in the filtrate. The
appropriate intervention is to increase the potassium concentration in the replacement fluid to match the
patient's needs. Decreasing ultrafiltration rate (A) may not address the potassium loss. Administering IV
potassium (C) may be necessary but adjusting the replacement fluid is more proactive and continuous.
Holding potassium (D) is inappropriate for hypokalemia.
8. A patient admitted with diabetic ketoacidosis (DKA) has a serum glucose of 650 mg/dL,
potassium 5.8 mEq/L, and bicarbonate 10 mEq/L. After starting intravenous fluids and an insulin
infusion, which laboratory value should be monitored most closely to prevent a life-threatening
complication?
A. Serum sodium
B. Serum potassium
C. Serum phosphate
D. Serum creatinine
Answer: B
Rationale: In DKA, total body potassium is depleted despite initial hyperkalemia due to acidosis. As
insulin drives potassium into cells and acidosis corrects, serum potassium can drop rapidly, leading to
hypokalemia and arrhythmias. Therefore, potassium must be monitored closely and replaced as needed.
Sodium (A) may change but is less critical acutely. Phosphate (C) may also drop but hypophosphatemia
Page 3
, is less immediately life-threatening. Creatinine (D) reflects renal function but is not the most urgent.
9. A patient with a history of heart failure with reduced ejection fraction (HFrEF) is admitted with
acute decompensation. The nurse reviews the medication orders. Which order should the nurse
question?
A. Furosemide 40 mg IV every 12 hours
B. Metoprolol succinate 50 mg PO daily
C. Lisinopril 10 mg PO daily
D. Spironolactone 25 mg PO daily
Answer: B
Rationale: In acute decompensated HF, beta-blockers (especially long-acting ones like metoprolol
succinate) may be held or reduced because they can worsen hemodynamics by decreasing contractility
and heart rate. While beta-blockers are beneficial in chronic HF, during acute exacerbation they may be
temporarily withheld. Furosemide (A) is appropriate for volume overload, lisinopril (C) is an ACE
inhibitor that reduces afterload, and spironolactone (D) is an aldosterone antagonist used in HFrEF.
However, spironolactone should be used cautiously with renal impairment, but it is not automatically
questioned.
10. A patient is being considered for organ donation after brain death. The family is hesitant and
asks the nurse, "Will our loved one feel any pain during the organ recovery?" Which response by
the nurse is most appropriate?
A. No, because the brain is no longer functioning, so your loved one cannot feel pain.
B. Yes, but we will give strong pain medication to prevent any suffering.
C. I understand your concern; however, after brain death, the body cannot perceive pain because the brain is
dead.
D. The organ recovery team will ensure that your loved one is comfortable.
Answer: C
Rationale: Brain death is the irreversible cessation of all brain function, including the brainstem.
Therefore, the patient cannot feel pain or have any awareness. Option A is correct but less empathetic;
option C acknowledges the family's concern and provides accurate information. Options B and D are
incorrect because pain perception requires brain function. The nurse should provide clear,
compassionate education.
11. A patient with acute respiratory distress syndrome (ARDS) is on volume-controlled ventilation
with plateau pressure of 32 cm H2O and PaO2/FiO2 ratio of 150. Which intervention is most likely
to improve oxygenation while minimizing ventilator-induced lung injury?
A. Increase positive end-expiratory pressure (PEEP) to 20 cm H2O and perform a recruitment maneuver
B. Switch to pressure-controlled ventilation with inverse ratio
C. Administer inhaled nitric oxide at 20 ppm continuously
D. Initiate prone positioning for 16 hours per day
Answer: A
Rationale: In ARDS with high plateau pressure, increasing PEEP (with recruitment) can improve
oxygenation by recruiting collapsed alveoli without necessarily increasing plateau pressure if done
carefully. Prone positioning is effective but not first-line. Nitric oxide and inverse ratio ventilation are
Page 4
Edition, Linda D. Urden, Kathleen M. Stacy, Chapters
1 - 27, Complete || Complete Guide A+
1. A patient with septic shock has a pulmonary artery catheter in place. Which combination of
hemodynamic parameters is most consistent with distributive shock and indicates the need for
vasopressor therapy despite adequate fluid resuscitation?
A. Cardiac index (CI) 2.8 L/min/m², systemic vascular resistance index (SVRI) 1200 dyn-sec-cm-m²,
pulmonary artery wedge pressure (PAWP) 8 mm Hg
B. CI 4.2 L/min/m², SVRI 600 dyn-sec-cm-m², PAWP 12 mm Hg
C. CI 2.0 L/min/m², SVRI 1800 dyn-sec-cm-m², PAWP 18 mm Hg
D. CI 3.5 L/min/m², SVRI 800 dyn-sec-cm-m², PAWP 4 mm Hg
Answer: B
Rationale: Distributive shock (e.g., septic) typically presents with a normal or high CI (due to
compensatory tachycardia and fluid resuscitation) and low SVRI (vasodilation). PAWP is usually normal
or low. Option B shows high CI and low SVRI with normal PAWP, indicating vasoplegia requiring
vasopressors. Option A has normal SVRI, option C shows low CI and high SVRI (cardiogenic), and
option D has low PAWP suggesting hypovolemia.
2. During pressure-controlled ventilation, the nurse observes that the delivered tidal volume has
decreased by 30% over the past hour while peak inspiratory pressure remains constant. What is
the most likely explanation for this change?
A. Development of auto-PEEP due to insufficient expiratory time
B. Decreased lung compliance from worsening pulmonary edema
C. Partial obstruction of the endotracheal tube by secretions
D. Increased patient respiratory effort triggering additional breaths
Answer: B
Rationale: In pressure-controlled ventilation, tidal volume is directly proportional to compliance and the
pressure gradient (set pressure minus total PEEP). If peak pressure is constant but tidal volume
decreases, compliance must have decreased. Worsening pulmonary edema reduces compliance.
Auto-PEEP (A) would decrease the effective driving pressure, but it would typically also increase peak
pressure if constant flow or volume? Actually, in pressure control, auto-PEEP reduces tidal volume but
peak pressure is set; however, auto-PEEP would not necessarily keep peak pressure constant. Partial
obstruction (C) would increase resistance and might decrease tidal volume, but peak pressure is set and
would remain constant only if the ventilator adjusts? In pressure control, peak pressure is fixed;
obstruction would reduce flow and tidal volume, but also the ventilator may not maintain constant
pressure if resistance is high? Typically, in pressure control, the ventilator delivers a set pressure; if
resistance increases, flow decreases and tidal volume may drop, but the set pressure is still achieved.
However, decreased compliance is a more common cause. Increased patient effort (D) would increase
tidal volume, not decrease it.
Page 1
,3. A patient with traumatic brain injury (TBI) has an intracranial pressure (ICP) of 28 mm Hg and
cerebral perfusion pressure (CPP) of 50 mm Hg. Mean arterial pressure (MAP) is 78 mm Hg.
Which intervention should the nurse question if ordered?
A. Administer 50 g of mannitol intravenously
B. Elevate the head of bed to 30 degrees
C. Initiate a propofol infusion at 50 mcg/kg/min
D. Administer a 500 mL bolus of 0.9% normal saline
Answer: D
Rationale: CPP = MAP - ICP. Current CPP is 50 mm Hg, which is below the target of 60-70 mm Hg. To
improve CPP, either MAP must be increased or ICP decreased. Administering a bolus of normal saline
(D) is unlikely to significantly increase MAP and may worsen cerebral edema due to its isotonic nature;
hypertonic saline would be preferred. Mannitol (A) reduces ICP, head elevation (B) promotes venous
drainage, and propofol (C) reduces cerebral metabolic demand and ICP. Thus, the normal saline bolus
is not the best intervention and may be questioned.
4. A patient in the ICU develops new-onset atrial fibrillation with rapid ventricular response (heart
rate 150 bpm). The blood pressure is 85/48 mm Hg, and the patient is confused. Which
intervention should the nurse anticipate as the priority?
A. Administer adenosine 6 mg rapid IV push
B. Prepare for synchronized cardioversion
C. Start an amiodarone infusion at 1 mg/min
D. Give metoprolol 5 mg IV over 2 minutes
Answer: B
Rationale: The patient is hemodynamically unstable (hypotension, altered mental status) due to the
tachyarrhythmia. Synchronized cardioversion is the treatment of choice for unstable atrial fibrillation.
Adenosine (A) is used for narrow-complex tachycardias and is unlikely to convert atrial fibrillation.
Amiodarone (C) and metoprolol (D) are rate-control or rhythm-control medications that take time to
work and are not appropriate for unstable patients.
5. A nurse is assessing a patient receiving propofol sedation. The patient's Richmond
Agitation-Sedation Scale (RASS) score is -4, and the patient does not respond to voice but responds
to physical stimulation. The nurse notes a heart rate of 55 bpm, blood pressure 90/60 mm Hg, and
respiratory rate of 8 breaths per minute on a ventilator. What is the nurse's priority action?
A. Increase the propofol infusion rate
B. Administer a 500 mL bolus of lactated Ringer's solution
C. Hold the propofol infusion and reassess
D. Administer atropine 0.5 mg IV
Answer: C
Rationale: A RASS of -4 indicates deep sedation, and the patient has bradycardia and hypotension, likely
due to propofol's side effects (vasodilation, negative inotropy, bradycardia). The priority is to hold the
propofol infusion to allow the patient to lighten and improve hemodynamics. Increasing the infusion (A)
would worsen the situation. Fluid bolus (B) may help but is secondary to stopping the causative agent.
Atropine (D) treats bradycardia but does not address the underlying cause.
Page 2
,6. A patient with acute respiratory distress syndrome (ARDS) is on volume-controlled ventilation
with a tidal volume of 6 mL/kg ideal body weight, PEEP of 12 cm HO, and FiO of 0.7. Arterial
blood gas shows pH 7.25, PaCO 60 mm Hg, PaO 55 mm Hg. Which ventilator adjustment is most
appropriate?
A. Increase tidal volume to 8 mL/kg
B. Increase PEEP to 15 cm HO
C. Increase respiratory rate to 25 breaths/min
D. Increase FiO to 1.0
Answer: C
Rationale: The ABG shows hypercapnic respiratory acidosis (pH <7.35, PaCO ‚ >45) and hypoxemia
(PaO 55 on FiO 0.7, PaO/FiO ratio ~79, consistent with severe ARDS). The priority is to address the
acidosis. Increasing the respiratory rate (C) will increase minute ventilation and lower PaCO.
Increasing tidal volume (A) would risk ventilator-induced lung injury; low tidal volume is standard.
PEEP (B) may improve oxygenation but not acidosis. FiO (D) may help oxygenation but does not
address the acidosis. The PEEP is already high; increasing further may cause hemodynamic
compromise.
7. A patient with acute kidney injury (AKI) due to sepsis is receiving continuous venovenous
hemofiltration (CVVH). The nurse notes that the patient's serum potassium has decreased from 4.5
to 3.2 mEq/L over 8 hours. Which intervention should the nurse implement?
A. Decrease the ultrafiltration rate
B. Increase the potassium concentration in the replacement fluid
C. Administer 40 mEq of potassium chloride IV over 1 hour
D. Obtain a stat ECG and hold all potassium-containing fluids
Answer: B
Rationale: Hypokalemia during CVVH is often due to excessive removal of potassium in the filtrate. The
appropriate intervention is to increase the potassium concentration in the replacement fluid to match the
patient's needs. Decreasing ultrafiltration rate (A) may not address the potassium loss. Administering IV
potassium (C) may be necessary but adjusting the replacement fluid is more proactive and continuous.
Holding potassium (D) is inappropriate for hypokalemia.
8. A patient admitted with diabetic ketoacidosis (DKA) has a serum glucose of 650 mg/dL,
potassium 5.8 mEq/L, and bicarbonate 10 mEq/L. After starting intravenous fluids and an insulin
infusion, which laboratory value should be monitored most closely to prevent a life-threatening
complication?
A. Serum sodium
B. Serum potassium
C. Serum phosphate
D. Serum creatinine
Answer: B
Rationale: In DKA, total body potassium is depleted despite initial hyperkalemia due to acidosis. As
insulin drives potassium into cells and acidosis corrects, serum potassium can drop rapidly, leading to
hypokalemia and arrhythmias. Therefore, potassium must be monitored closely and replaced as needed.
Sodium (A) may change but is less critical acutely. Phosphate (C) may also drop but hypophosphatemia
Page 3
, is less immediately life-threatening. Creatinine (D) reflects renal function but is not the most urgent.
9. A patient with a history of heart failure with reduced ejection fraction (HFrEF) is admitted with
acute decompensation. The nurse reviews the medication orders. Which order should the nurse
question?
A. Furosemide 40 mg IV every 12 hours
B. Metoprolol succinate 50 mg PO daily
C. Lisinopril 10 mg PO daily
D. Spironolactone 25 mg PO daily
Answer: B
Rationale: In acute decompensated HF, beta-blockers (especially long-acting ones like metoprolol
succinate) may be held or reduced because they can worsen hemodynamics by decreasing contractility
and heart rate. While beta-blockers are beneficial in chronic HF, during acute exacerbation they may be
temporarily withheld. Furosemide (A) is appropriate for volume overload, lisinopril (C) is an ACE
inhibitor that reduces afterload, and spironolactone (D) is an aldosterone antagonist used in HFrEF.
However, spironolactone should be used cautiously with renal impairment, but it is not automatically
questioned.
10. A patient is being considered for organ donation after brain death. The family is hesitant and
asks the nurse, "Will our loved one feel any pain during the organ recovery?" Which response by
the nurse is most appropriate?
A. No, because the brain is no longer functioning, so your loved one cannot feel pain.
B. Yes, but we will give strong pain medication to prevent any suffering.
C. I understand your concern; however, after brain death, the body cannot perceive pain because the brain is
dead.
D. The organ recovery team will ensure that your loved one is comfortable.
Answer: C
Rationale: Brain death is the irreversible cessation of all brain function, including the brainstem.
Therefore, the patient cannot feel pain or have any awareness. Option A is correct but less empathetic;
option C acknowledges the family's concern and provides accurate information. Options B and D are
incorrect because pain perception requires brain function. The nurse should provide clear,
compassionate education.
11. A patient with acute respiratory distress syndrome (ARDS) is on volume-controlled ventilation
with plateau pressure of 32 cm H2O and PaO2/FiO2 ratio of 150. Which intervention is most likely
to improve oxygenation while minimizing ventilator-induced lung injury?
A. Increase positive end-expiratory pressure (PEEP) to 20 cm H2O and perform a recruitment maneuver
B. Switch to pressure-controlled ventilation with inverse ratio
C. Administer inhaled nitric oxide at 20 ppm continuously
D. Initiate prone positioning for 16 hours per day
Answer: A
Rationale: In ARDS with high plateau pressure, increasing PEEP (with recruitment) can improve
oxygenation by recruiting collapsed alveoli without necessarily increasing plateau pressure if done
carefully. Prone positioning is effective but not first-line. Nitric oxide and inverse ratio ventilation are
Page 4
