1. Which of the following is an expected outcome of successful weaning
from mechanical ventilation?
A. Ability to maintain oxygen saturation above 90% without assistance
B. Increased need for sedation
C. Decreased tidal volume and respiratory rate
D. Increased use of the ventilator to ensure adequate ventilation
Answer: a) Ability to maintain oxygen saturation above 90% without
assistance
Rationale: Successful weaning from mechanical ventilation is
characterized by the patient’s ability to maintain adequate oxygenation
and ventilation without the need for assistance from the ventilator.
2. Which of the following is a priority for a nurse when caring for a
patient post-cardiac surgery?
,A. Early mobilization
B. Restricting all oral intake
C. Encouraging large amounts of fluid intake
D. Limiting patient interactions to reduce stress
Answer: a) Early mobilization
Rationale: Early mobilization post-cardiac surgery helps prevent
complications like deep vein thrombosis (DVT) and pulmonary
embolism (PE), and promotes recovery by improving circulation and
lung function.
3. Which of the following is an indication for the use of continuous renal
replacement therapy (CRRT)?
A. Severe hypokalemia
B. Acute kidney injury with hemodynamic instability
C. Chronic kidney disease
D. Fluid overload without renal failure
,Answer: b) Acute kidney injury with hemodynamic instability
Rationale: CRRT is used in critically ill patients with acute kidney injury
and hemodynamic instability because it allows for slower and more
controlled fluid and solute removal.
4. A nurse is caring for a patient who has undergone a thoracotomy.
What should the nurse prioritize during the postoperative period?
A. Monitoring for signs of infection at the incision site
B. Encouraging deep breathing exercises to prevent atelectasis
C. Administering pain medication to ensure patient comfort
D. Promoting early ambulation to prevent complications
Answer: b) Encouraging deep breathing exercises to prevent atelectasis
Rationale: Deep breathing exercises are essential to prevent atelectasis,
which can develop after thoracic surgery. They help expand the lungs
and promote adequate ventilation.
, 5. Which of the following is the most appropriate nursing intervention
for a patient experiencing delirium in the ICU?
A. Increase environmental stimuli to encourage orientation
B. Administer sedatives to calm the patient
C. Provide a quiet, low-stimulation environment
D. Restrict family visitation to promote rest
Answer: c) Provide a quiet, low-stimulation environment
Rationale: Delirium in the ICU can be exacerbated by excessive stimuli.
Creating a calm, low-stimulation environment helps reduce agitation and
may improve the patient's orientation.
6. Which of the following is a key priority for the nurse when caring for
a patient with acute respiratory failure?
A. Administering high-flow oxygen
B. Monitoring arterial blood gases (ABGs)
C. Encouraging oral intake of fluids
from mechanical ventilation?
A. Ability to maintain oxygen saturation above 90% without assistance
B. Increased need for sedation
C. Decreased tidal volume and respiratory rate
D. Increased use of the ventilator to ensure adequate ventilation
Answer: a) Ability to maintain oxygen saturation above 90% without
assistance
Rationale: Successful weaning from mechanical ventilation is
characterized by the patient’s ability to maintain adequate oxygenation
and ventilation without the need for assistance from the ventilator.
2. Which of the following is a priority for a nurse when caring for a
patient post-cardiac surgery?
,A. Early mobilization
B. Restricting all oral intake
C. Encouraging large amounts of fluid intake
D. Limiting patient interactions to reduce stress
Answer: a) Early mobilization
Rationale: Early mobilization post-cardiac surgery helps prevent
complications like deep vein thrombosis (DVT) and pulmonary
embolism (PE), and promotes recovery by improving circulation and
lung function.
3. Which of the following is an indication for the use of continuous renal
replacement therapy (CRRT)?
A. Severe hypokalemia
B. Acute kidney injury with hemodynamic instability
C. Chronic kidney disease
D. Fluid overload without renal failure
,Answer: b) Acute kidney injury with hemodynamic instability
Rationale: CRRT is used in critically ill patients with acute kidney injury
and hemodynamic instability because it allows for slower and more
controlled fluid and solute removal.
4. A nurse is caring for a patient who has undergone a thoracotomy.
What should the nurse prioritize during the postoperative period?
A. Monitoring for signs of infection at the incision site
B. Encouraging deep breathing exercises to prevent atelectasis
C. Administering pain medication to ensure patient comfort
D. Promoting early ambulation to prevent complications
Answer: b) Encouraging deep breathing exercises to prevent atelectasis
Rationale: Deep breathing exercises are essential to prevent atelectasis,
which can develop after thoracic surgery. They help expand the lungs
and promote adequate ventilation.
, 5. Which of the following is the most appropriate nursing intervention
for a patient experiencing delirium in the ICU?
A. Increase environmental stimuli to encourage orientation
B. Administer sedatives to calm the patient
C. Provide a quiet, low-stimulation environment
D. Restrict family visitation to promote rest
Answer: c) Provide a quiet, low-stimulation environment
Rationale: Delirium in the ICU can be exacerbated by excessive stimuli.
Creating a calm, low-stimulation environment helps reduce agitation and
may improve the patient's orientation.
6. Which of the following is a key priority for the nurse when caring for
a patient with acute respiratory failure?
A. Administering high-flow oxygen
B. Monitoring arterial blood gases (ABGs)
C. Encouraging oral intake of fluids
