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UPDATED 2024/2025 CRITICAL CARE 1 QUESTIONS AND ANSWERS ALREADY PASSED A+

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The triage nurse is assessing a victim of a stab wound. According to the paramedics, the victim was stabbed by a male attacker. The knife blade is 6 inches (7.2 cm) in length and 1 inch (2.5 cm) in width. The "point of entry" of the stab wound is two inches above and left of the victim's xiphoid process. Which vital organ(s) are at an increased risk of being in the direct path of injury? - CORRECT ANSWER Heart Lungs Diaphragm What way do females stab? - CORRECT ANSWER Downwards What way do males stab? - CORRECT ANSWER Upwards A client reports to the nurse feeling achy and weak, being tired and coughing all the time, frequent headaches and experiencing night sweats. The client's assessment is significant for crackles scattered throughout the lungs, dependent peripheral edema +3/+4, S3 and S4 heart sounds, temperature of 102.4° F(39.1° C), heart rate of 110 beats/minute, respirations of 20 breaths/minute, and blood pressure of 105/60 mmHg with a mean arterial pressure of (75). Which diagnostic procedure should the nurse prepare to do first? - CORRECT ANSWER Blood culture Define: Infective endocarditis - CORRECT ANSWER Infection of the endocardial surface of the heart, usually the heart valves What indicates ineffective endocarditis? - CORRECT ANSWER Edema & S1/S3 sounds According to the paramedic's report, the victim of a motor vehicle collision was sitting in the passenger seat on the left side of the vehicle. The vehicle was stopped at a traffic light when the vehicle was hit on the left side by another vehicle traveling at speeds exceeding 60 mph (97 kmh). The client reports slight tenderness and achiness on (L) side of thorax and body. The significant assessment findings include: weak and thready pulse; diffuse abdominal pain, tenderness and guarding present upon palpation; skin is diaphoretic and extremities cool to touch, capillary refill +4 in extremities, and bruising is present in the (L) flank area and progresses towards the abdomen. Vital signs are temperature- 97.2° F (36.2° C), pulse- 110 beats/minute, respirations- 22 breaths/minute, blood pressure 84/46 mmHg, MAP- (57), and pulse oximetry 90% on 2 lpm O2 via nasal cannula. - CORRECT ANSWER Fractured liver & ruptured spleen The nurse is analyzing an arterial blood gas (ABG) of a client who is mechanicallly ventilated. The ABG results are pH- 7.52; paCO2- 30 mmHg; HCO3- 28 mEq/liter. How should the nurse interpret this blood gas? - CORRECT ANSWER Respiratory alkalosis Define: Respiratory alkalosis - CORRECT ANSWER HCO3 & pH is increased while the CO2 is decreased What is the effect if blood sugar continues to rise? - CORRECT ANSWER Change in level of consciousness What precaution should a patient be on with a high sodium? - CORRECT ANSWER Seizure precautions Why do people with diabetes have an increased urinary output? - CORRECT ANSWER Low ADH What is the effect of a low ADH? - CORRECT ANSWER Dehydration & increased serum Sodium A client with syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is admitted to the intensive care

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Uploaded on
June 29, 2023
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Written in
2022/2023
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Exam (elaborations)
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Questions & answers

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  • updated critical care 1

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CRITICAL CARE 1 2023 QUESTIONS
AND ANSWERS ALREADY PASSED A+
The triage nurse is assessing a victim of a stab wound. According to the

paramedics, the victim was stabbed by a male attacker. The knife blade is 6 inches

(7.2 cm) in length and 1 inch (2.5 cm) in width. The "point of entry" of the stab

wound is two inches above and left of the victim's xiphoid process. Which vital

organ(s) are at an increased risk of being in the direct path of injury? - CORRECT

ANSWER Heart

Lungs

Diaphragm

What way do females stab? - CORRECT ANSWER Downwards

What way do males stab? - CORRECT ANSWER Upwards

A client reports to the nurse feeling achy and weak, being tired and coughing all the

time, frequent headaches and experiencing night sweats. The client's assessment

is significant for crackles scattered throughout the lungs, dependent peripheral

edema +3/+4, S3 and S4 heart sounds, temperature of 102.4° F(39.1° C), heart

rate of 110 beats/minute, respirations of 20 breaths/minute, and blood pressure of

105/60 mmHg with a mean arterial pressure of (75). Which diagnostic procedure

should the nurse prepare to do first? - CORRECT ANSWER Blood culture

Define: Infective endocarditis - CORRECT ANSWER Infection of the

endocardial surface of the heart, usually the heart valves

What indicates ineffective endocarditis? - CORRECT ANSWER Edema & S1/S3

sounds

According to the paramedic's report, the victim of a motor vehicle collision was

sitting in the passenger seat on the left side of the vehicle. The vehicle was stopped

,CRITICAL CARE 1 2023 QUESTIONS
AND ANSWERS ALREADY PASSED A+
at a traffic light when the vehicle was hit on the left side by another vehicle traveling

at speeds exceeding 60 mph (97 kmh). The client reports slight tenderness and

achiness on (L) side of thorax and body. The significant assessment findings

include: weak and thready pulse; diffuse abdominal pain, tenderness and guarding

present upon palpation; skin is diaphoretic and extremities cool to touch, capillary

refill +4 in extremities, and bruising is present in the (L) flank area and progresses

towards the abdomen. Vital signs are temperature- 97.2° F (36.2° C), pulse- 110

beats/minute, respirations- 22 breaths/minute, blood pressure 84/46 mmHg, MAP-

(57), and pulse oximetry 90% on 2 lpm O2 via nasal cannula. - CORRECT

ANSWER Fractured liver & ruptured spleen

The nurse is analyzing an arterial blood gas (ABG) of a client who is mechanicallly

ventilated. The ABG results are pH- 7.52; paCO2- 30 mmHg; HCO3- 28 mEq/liter.

How should the nurse interpret this blood gas? - CORRECT ANSWER

Respiratory alkalosis

Define: Respiratory alkalosis - CORRECT ANSWER HCO3 & pH is increased

while the CO2 is decreased

What is the effect if blood sugar continues to rise? - CORRECT ANSWER

Change in level of consciousness

What precaution should a patient be on with a high sodium? - CORRECT

ANSWER Seizure precautions

Why do people with diabetes have an increased urinary output? - CORRECT

ANSWER Low ADH

, CRITICAL CARE 1 2023 QUESTIONS
AND ANSWERS ALREADY PASSED A+
What is the effect of a low ADH? - CORRECT ANSWER Dehydration &

increased serum Sodium

A client with syndrome of inappropriate secretion of antidiuretic hormone (SIADH)

is admitted to the intensive care unit with a serum sodium level of 112 mEq/L or

mmol/L. Which protocol prescription should the nurse implement first? -

CORRECT ANSWER Obtain serum sodium every 4 hours

The nurse is caring for a client who is demonstrating signs of impending death. The

family is experiencing emotional distress as the client's condition declines. Which

information should the nurse provide the family to facilitate the process? -

CORRECT ANSWER Encourage the family to give the patient permission to die

The nurse is caring for a client with severe sepsis related to a ruptured

appendix.The clientis diaphoretic and reports lower extremity spasms. The nurse

observes respirations that are uneven and labored. Arterial blood gas (ABG) results

are pH 7.60, PaCO2 25 mmHg, HCO3 24 mEq/L, and PaO2 24 mmHg. Which

assessment finding warrants immediate intervention by the nurse? - CORRECT

ANSWER Intercostal muscle contraction

Define: Intercostal muscle contraction - CORRECT ANSWER Critical sign of

respiratory muscle fatigue which is likely to lead to acute respiratory failure

Define: Cistacurium - CORRECT ANSWER Paralytic during surgery

A client who experienced an intracranial hemorrhage is receiving cistracurium to

induce a pharmacological state of paralysis. Which intervention should the nurse

implement during the therapeutic paralysis? - CORRECT ANSWER Administer

a sedating medication

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