Comprehensive: Critical Care Mid-Term Exam (ch 1-12) *Q&A* (100% Correct) 2025/2026 |VERIFIED|

Comprehensive: Critical Care Mid-Term Exam (ch 1-12) *Q&A* (100% Correct) 2025/2026 |VERIFIED| 1. How does the body compensate for metabolic acidosis in critically ill patients? The body compensates for metabolic acidosis primarily through respiratory compensation, where increased ventilation helps to blow off carbon dioxide, thus reducing the concentration of hydrogen ions. 2. What is the main goal of mechanical ventilation in patients with ARDS (acute respiratory distress syndrome)? The primary goal of mechanical ventilation in ARDS is to maintain adequate oxygenation while minimizing ventilator-associated lung injury by using low tidal volumes and positive end-expiratory pressure (PEEP). 3. How does sepsis lead to multi-organ dysfunction syndrome (MODS)? Sepsis triggers a systemic inflammatory response, releasing cytokines and other mediators that disrupt endothelial function, leading to vascular leakage, hypoperfusion, and tissue injury, ultimately resulting in MODS. 4. What are the hallmark signs of hypovolemic shock? Hallmark signs of hypovolemic shock include hypotension, tachycardia, reduced urine output, cold and clammy skin, and altered mental status due to insufficient circulating volume. 5. Explain the concept of oxygen delivery (DO2) and its relation to critical care. Oxygen delivery (DO2) is the amount of oxygen transported to tissues per minute. It depends on cardiac output and the oxygen content of the blood. In critical care, maintaining adequate DO2 is crucial for preventing tissue hypoxia. 6. How does the body respond to an increase in systemic vascular resistance (SVR) in the context of shock? 1 An increase in SVR typically results in a compensatory increase in blood pressure and afterload to maintain perfusion. However, prolonged high SVR can lead to decreased cardiac output and tissue hypoxia. 7. What role does nitric oxide play in critically ill patients with sepsis? Nitric oxide acts as a vasodilator and plays a significant role in sepsis by reducing systemic vascular resistance, potentially contributing to hypotension and poor perfusion in critically ill patients. 8. What are the primary criteria for diagnosing acute kidney injury (AKI) in the ICU setting? The primary criteria for diagnosing AKI include a rise in serum creatinine by ≥0.3 mg/dL within 48 hours or a reduction in urine output to 0.5 mL/kg/hr for more than 6 hours. 9. Describe the pathophysiology of diabetic ketoacidosis (DKA) in critically ill patients. DKA is characterized by insulin deficiency, leading to increased lipolysis, ketone body production, and metabolic acidosis. It is commonly triggered by infection, trauma, or non-compliance with insulin therapy in critically ill patients. 10. What is the role of lactate measurement in critically ill patients? Lactate is a marker of tissue hypoxia and inadequate perfusion. Elevated lactate levels indicate anaerobic metabolism and are often used to guide resuscitation and monitor the severity of shock. 11. Explain the mechanism of action of vasopressors in the management of shock. Vasopressors act by constricting blood vessels and increasing systemic vascular resistance, which helps raise blood pressure and improve perfusion to vital organs during shock states. 12. In the context of fluid resuscitation in critical care, what is the role of crystalloids versus colloids? Crystalloids, such as saline and lactated Ringer's, are often used as the first-line therapy for fluid resuscitation due to their ability to expand the intravascular volume. Colloids are used in more severe cases to restore plasma volume but are less frequently utilized due to cost and potential complications. 13. What is the primary cause of ventilator-associated pneumonia (VAP) in critically ill patients? 2 The primary cause of VAP is the aspiration of bacteria from the oropharynx into the lower respiratory tract, often facilitated by the presence of endotracheal tubes or mechanical ventilation. 14. How does the acute respiratory distress syndrome (ARDS) affect pulmonary compliance? ARDS leads to decreased pulmonary compliance due to alveolar flooding, inflammation, and surfactant dysfunction, which results in stiff lungs and difficulty in expanding the alveoli during inspiration. 15. What is the significance of central venous pressure (CVP) monitoring in critically ill patients? CVP monitoring provides insight into the patient’s volume status and right ventricular function, guiding fluid management and assessing the adequacy of preload in patients with shock or respiratory distress. 16. How does hyperkalemia affect the cardiac conduction system in critically ill patients? Hyperkalemia can cause changes in the resting membrane potential, leading to decreased excitability of myocardial cells, slowed conduction, and potentially life-threatening arrhythmias such as ventricular fibrillation. 17. What are the main principles of the ABCDE approach in managing critically ill patients? The ABCDE approach emphasizes the systematic management of Airway, Breathing, Circulation, Disability (neurological status), and Exposure (assessing for signs of trauma or other abnormalities). 18. What is the role of corticosteroids in the management of septic shock? Corticosteroids may be used in septic shock to help restore adrenal function, reduce inflammation, and improve vascular responsiveness to catecholamines, especially in patients with adrenal insufficiency. 19. Explain how blood gas abnormalities such as respiratory acidosis or alkalosis can indicate specific types of respiratory failure. Respiratory acidosis (elevated CO2) typically indicates hypoventilation or obstructive respiratory failure, while respiratory alkalosis (low CO2) suggests hyperventilation or restrictive lung disease. 20. What is the impact of anemia on oxygen delivery in critically ill patients? 3 Anemia reduces the oxygen-carrying capacity of the blood, leading to a decrease in overall oxygen delivery (DO2). This can compromise tissue oxygenation, especially in critically ill patients with low cardiac output. 21. How does the inflammatory response contribute to capillary leak syndrome in critically ill patients? The inflammatory response increases vascular permeability, causing proteins and fluids to leak from capillaries into the interstitial spaces, leading to edema and reduced effective circulatory volume. 22. What is the role of blood pressure management in preventing secondary brain injury in traumatic brain injury (TBI) patients? Maintaining adequate blood pressure ensures sufficient cerebral perfusion pressure (CPP), which is critical for preventing secondary brain injury due to hypoperfusion, especially in TBI patients. 23. How does the body react to a sudden decrease in cardiac output during shock? The body activates compensatory mechanisms, such as increased heart rate, vasoconstriction, and enhanced sympathetic nervous system activity to maintain perfusion to vital organs despite a decreased cardiac output. 24. In what ways does acute liver failure contribute to coagulopathy in critically ill patients? Acute liver failure impairs the production of clotting factors, leading to a deficiency in coagulation proteins and an increased risk of bleeding, often exacerbated in the ICU setting by hemodynamic instability. 25. How can the management of blood glucose levels influence outcomes in critically ill patients? Tight glycemic control can reduce the risk of infections, improve wound healing, and lower the incidence of sepsis and multi-organ failure in critically ill patients, although it requires careful monitoring to avoid hypoglycemia. 26. What is the pathophysiology behind the development of cardiac arrhythmias in critically ill patients? Cardiac arrhythmias in critically ill patients can be caused by electrolyte imbalances, ischemia, autonomic dysfunction, and hypoxia, which alter the normal electrical conduction of the heart. 27. Why is early goal-directed therapy (EGDT) important in the management of sepsis? 4 5 EGDT involves timely intervention with fluid resuscitation, vasopressor support, and targeted therapy to optimize hemodynamics and oxygen delivery, which has been shown to reduce mortality in sepsis patients. 28. What factors contribute to the development of acute respiratory failure in patients with chronic obstructive pulmonary disease (COPD)? Acute respiratory failure in COPD patients is often triggered by infection, non-compliance with medications, or exposure to environmental pollutants, leading to increased airway obstruction and impaired gas exchange. 29. What is the mechanism by which excessive fluid administration can worsen pulmonary edema in heart failure patients? Excessive fluid administration increases blood volume, leading to increased venous return and pulmonary congestion, which exacerbates pulmonary edema in heart failure patients with compromised cardiac output. 30. How does the use of sedatives and analgesics affect critically ill patients in the ICU? Sedatives and analgesics can provide comfort, reduce anxiety, and prevent pain, but excessive use may lead to respiratory depression, prolonged mechanical ventilation, and increased risk of delirium in critically ill patients. 31. What are the potential complications associated with central line placement in critically ill patients? Complications include infection, bleeding, pneumothorax, thrombosis, and damage to surrounding structures such as arteries and nerves. 32. How does the pathophysiology of anaphylaxis contribute to shock in critically ill patients? Anaphylaxis causes massive histamine release, leading to vasodilation, increased vascular permeability, and severe hypotension, all of which can result in shock if not rapidly treated. 6 33. What are the benefits of using prone positioning in patients with ARDS? Prone positioning helps improve ventilation-perfusion matching, redistribute lung fluids, and reduce the effects of ventilator-induced lung injury, leading to improved oxygenation in ARDS patients. 34. How can mechanical ventilation lead to ventilator-induced lung injury (VILI)? VILI occurs when high tidal volumes or excessive pressure cause overdistention of alveoli, leading to inflammation, injury to the alveolar-capillary membrane, and worsening gas exchange. 35. What is the role of continuous renal replacement therapy (CRRT) in critically ill patients with acute kidney injury (AKI)? CRRT is used in critically ill patients with AKI to provide gentle, continuous fluid removal and solute clearance, which is less likely to cause hemodynamic instability compared to intermittent hemodialysis. 36. How does systemic inflammatory response syndrome (SIRS) lead to organ failure? SIRS triggers the release of inflammatory mediators that disrupt cellular function, leading to endothelial dysfunction, microvascular thrombosis, and impaired tissue perfusion, all of which contribute to organ failure. 37. Why is hyperventilation used as a management strategy in patients with elevated intracranial pressure (ICP)? Hyperventilation reduces CO2 levels, causing cerebral vasoconstriction, which decreases blood volume and thus ICP, providing temporary relief in patients with elevated intracranial pressure. 38. What is the difference between hypovolemic and cardiogenic shock in terms of pathophysiology and treatment? 7 Hypovolemic shock is due to insufficient blood volume, while cardiogenic shock is caused by pump failure. Treatment for hypovolemic shock focuses on fluid resuscitation, while cardiogenic shock requires inotropic support and careful fluid management. 39. What factors increase the risk of developing stress ulcers in critically ill patients? Risk factors include mechanical ventilation, coagulopathy, shock, sepsis, and the use of medications such as corticosteroids and NSAIDs, all of which increase gastric acid production and decrease mucosal protection. 40. Explain the concept of the "circulatory collapse" in shock states. Circulatory collapse refers to the failure of the circulatory system to maintain adequate tissue perfusion due to extreme hypotension, vasodilation, or impaired myocardial function, leading to cellular hypoxia and organ failure. 41. How does the body attempt to compensate for respiratory alkalosis? The body compensates for respiratory alkalosis by reducing renal bicarbonate excretion, helping to restore the acid-base balance by increasing bicarbonate retention. 42. What is the role of ultrasound in assessing fluid status in critically ill patients? Ultrasound is used to assess heart function, inferior vena cava (IVC) collapsibility, and pleural effusions, which help estimate fluid status, guide fluid resuscitation, and identify conditions like right heart failure. 43. What is the importance of glycemic control in critically ill patients with diabetes mellitus? 8 Maintaining tight glucose control helps prevent hyperglycemia-related complications, such as infections and impaired wound healing, while also reducing the risk of hypoglycemia, which can be dangerous in critically ill patients. 44. How does the management of hypercapnia differ in patients with chronic obstructive pulmonary disease (COPD)? In COPD patients, gradual correction of hypercapnia is preferred to avoid sudden changes in blood gases, which can lead to respiratory alkalosis or worsen respiratory drive suppression. 45. What is the role of the Glasgow Coma Scale (GCS) in assessing neurological function in critically ill patients? The GCS is used to assess a patient's level of consciousness by evaluating eye opening, verbal response, and motor response, helping guide interventions and monitor changes in neurological status. 46. What are the critical components of fluid resuscitation in burn patients? Burn patients require immediate fluid resuscitation with crystalloids, primarily lactated Ringer's solution, to restore intravascular volume and prevent shock. The Parkland formula is often used to estimate the required fluid amount. 47. How does the use of diuretics influence fluid balance in critically ill patients with heart failure? Diuretics are used to reduce fluid overload in heart failure patients by promoting renal excretion of sodium and water, helping to reduce pulmonary congestion and edema while maintaining hemodynamic stability. 48. What are the potential risks associated with the overuse of vasopressors in shock patients? Overuse of vasopressors can lead to tissue ischemia, especially in the gastrointestinal tract, kidneys, and extremities, due to excessive vasoconstriction that limits blood flow to these organs. 9 49. How does hypoxia affect cellular metabolism in critically ill patients? Hypoxia shifts cellular metabolism from aerobic to anaerobic pathways, leading to increased lactate production and acidosis, which can worsen organ dysfunction and complicate critical illness. 50. What is the significance of the "nursing process" in the management of critically ill patients? The nursing process involves assessment, diagnosis, planning, implementation, and evaluation, ensuring that critical care nurses provide holistic and evidence-based care tailored to the unique needs of each critically ill patient. 51. How does the concept of "early mobilization" benefit critically ill patients? Early mobilization helps improve muscle strength, reduce the risk of delirium, and promote faster recovery by maintaining circulation, reducing ventilator days, and improving overall outcomes in critically ill patients. 52. What are the primary causes of metabolic alkalosis in critically ill patients? Metabolic alkalosis can result from excessive vomiting, prolonged nasogastric suction, diuretic use, or the administration of alkali medications, leading to a loss of hydrogen ions or an increase in bicarbonate levels. 53. What are the long-term effects of critical illness polyneuropathy (CIP) on recovery? CIP leads to muscle weakness, impaired mobility, and prolonged recovery, affecting the patient's ability to perform activities of daily living and increasing the need for long-term rehabilitation post-ICU discharge. Family members have a need for information. Which interventions best assist in meeting this need? A.Handing family members a pamphlet that explains all of the critical care equipment B. Providing a daily update of the patient's progress and facilitating communication with the intensivist C. Telling them that you are not permitted to give them a status report but that they can be present at 4:00 PM for family rounds with the intensivist B D. Writing down a list of all new medications and doses and giving the list to family members during visitation The nurse is a member of a committee to design a critical care unit in a new building. Which design trend would best facilitate family-centered care? A.Ensure that the patient's room is large enough and has adequate space for a sleeper sofa and storage for family members' personal belongings. B. Include a diagnostic suite in close proximity to the unit so that the patient does not have to travel far for testing. C. Incorporate a large waiting room on the top floor of the hospital with a scenic view and amenities such as coffee and tea. D. Provide access to a scenic garden for meditation. A 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? A. Ask a family member to help you bathe the patient, and discuss the family structure with the family member during the procedure. B. Because the patient is unconscious, complete care as quickly and quietly as possible. C. Tell the patient the day and time, and that you are providing a bath. Reassure the patient that you are there. C D. Turn the television on to the evening news so that you and the patient can be updated to current events. Sleep often is disrupted for critically ill patients. Which nursing intervention is most appropriate to promote sleep and rest? A. Consult with the pharmacist to adjust medication times to allow periods of sleep or rest between intervals. B. Encourage family members to talk with the patient whenever they are present in the room. C. Keep the television on to provide white noise and distraction. D. Leave the lights on in the room so that the patient is not frightened of his or her surroundings. A 10 Family assessment is essential to meet family needs. Which of the following must be assessed first to assist the nurse in providing family-centered care? A. Assessment of patient and family's developmental stages and needs B. Description of the patient's home environment C. Identification of immediate family, extended family, and decision makers D. Observation and assessment of how family members function with each other C Critical illness often results in family conflicts. Which scenario is most likely to result in the greatest conflict? A. A 21-year-old college student of divorced parents hospitalized with multiple trauma. She resides with her mother. The parents are amicable with each other and have similar values. The father blames the daughter's boyfriend for causing the accident. B. A 36-year-old male admitted for a ruptured cerebral aneurysm. He has been living with his 34-year-old girlfriend for 8 years, and they have a 4-year-old daughter. He does not have a written advance directive. His parents arrive from out-of-state and are asked to make decisions about his health care. He has not seen them in over a year. C. A 58-year-old male admitted for coronary artery bypass surgery. He has been living with his same-sex partner for 20 years in a committed relationship. He has designated his sister, a registered nurse, as his health c B Which nursing interventions would best support the family of a critically ill patient? A. Encourage family members to stay all night in case the patient needs them. B. Give a condition update each morning and whenever changes occur. C. Limit visitation from children into the critical care unit. D. Provide beverages and snacks in the waiting room. B Which intervention is appropriate to assist the patient in coping with admission to the critical care unit? A. Allowing unrestricted visiting by several family members at one time B. Explaining all procedures in easy-to-understand terms C. Providing back massage and mouth care D. Turning down the alarm volume on the cardiac monitor B 11 9. The constant noise of a ventilator, monitor alarms, and infusion pumps predisposes the patient to: A. Anxiety. B. Pain. C. Powerlessness. D. Sensory overload. D Which of the following statements about family assessment is false? A. Assessment of structure (who comprises the family) is the last step in assessment. B. Interaction among family members is assessed. C. It is important to assess communication among family members to understand roles. D. Ongoing assessment is important, because family functioning may change during the course of illness. A Which intervention about visitation in the critical care unit is true? A. The majority of critical care nurses implement restricted visiting hours to allow the patient to rest. B. Children should never be permitted to visit a critically ill family member. C. Visitation that is individualized to the needs of patients and family members is ideal. D. Visiting hours should always be unrestricted. C Elderly patients who require critical care treatment are at risk for increased mortality, functional decline, or decreased quality of life after hospitalization. Assuming each of these patients was discharged from the hospital, which of the following patients is at greatest risk for decreased functional status and quality of life? A. A 70-year-old man who had coronary artery bypass surgery. He developed complications after surgery and had difficulty being weaned from mechanical ventilation. He required a tracheostomy and gastrostomy. He is being discharged to a long-term acute care hospital. He is a widower. B. A 79-year-old woman admitted for exacerbation of heart failure. She manages her care independently but needed diuretic medications adjusted. She states that she is compliant with her medications but sometimes forgets to take them. She lives with her 82-year-old spouse. Both consider themselves to be independen A 12 Patients often have recollections of the critical care experience. Which is likely to be the most common recollection of patients who required endotracheal intubation and mechanical ventilation? A. Difficulty in communicating B. Inability to get comfortable C. Pain D. Sleep disruption A Many critically ill patients experience anxiety. The nurse can reduce anxiety with which approach? A. Ask family members to limit their visitation to 2-hour periods in morning, afternoon, and evening. B. Explain the unit routine. C. Explain procedures before and while you are doing them. D. Suction Mr. J.'s endotracheal tube immediately when he starts to cough. C The intensive care nurse is working on a committee to reduce noise in the unit. Which recommendation should the nurse propose first? A. Change telephones to blinking lights instead of audible ringtones. B. Invest in call lights that page the nursing staff instead of beeping. C. Recommend that nurses turn off cardiac monitors on stable patients. D. Soundproof the pneumatic tube system. D The nurse is assigned to care for a patient who is a non-native English speaker. What is the best way to communicate with the patient and family to provide updates and explain procedures? A. Conduct a Google search on the computer to identify resources for the patient and family in their native language. Print these for their use. B. Contact the hospital's interpreter service for someone to translate. C. Get in touch with one of the residents who you know is fluent in the native language and ask him if he can come up to the unit. B D. Use the patient's 8-year-old child who is fluent in both English and the native language to translate for you. 13 Family assessment can be challenging, and each nurse may obtain additional information regarding family structure and dynamics. What is the best way to share this information from shift to shift? A. Create an informal family information sheet that is kept on the bedside clipboard. That way, everyone can review it quickly when needed. B. Develop a standardized reporting form for family information that is incorporated into the patient's medical record and updated as needed. C. Require that the charge nurse have a detailed list of information about each patient and family member. Thus, someone on the unit is always knowledgeable about potential issues. D. Try to remember to discuss family structure and dynamics as part of the change-of-shift report. B The spouse 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. The spouse demands, "I want you to reassign us to another nurse. His current nurse is not in the room enough to make sure everything is okay." The nurse recognizes that this response most likely is due to the spouse's A. Desire to pursue a lawsuit if the assignment is not changed. B. Inability to participate in the husband's care. C. Lack of prior experience in a critical care setting. D. Sense of loss of control of the situation. D Open visitation policies are expected by many professional organizations. Which statement reflects adherence to current recommendations? A. Allow animals on the unit; however, these can only be "therapy" animals through the hospital's pet therapy program. B. Allow family visitation throughout the day except at change of shift and during rounds. C. Determine, in collaboration with the patient and family, who can visit and when. Facilitate open visitation policies. D. Permit open visitation by adults 18 years of age and older; limit visits of children to 1 hour. C The VALUE mnemonic is a helpful strategy to enhance communication with family members of critically ill patients. Which of the following statements describes a VALUE strategy? A. View the family as guests on the unit. B. Acknowledge family emotions. 14 C. Learn as much as you can about family structure and function. D. Use a trained interpreter if the family does not speak English. B Changing visitation policies can be challenging. The nurse manager recognizes which of the following as an effective strategy for promoting changes in practice? A. Ask the clinical nurse specialist to lead a journal club on open visitation after each nurse is tasked to read one research article about visitation. B. Discuss the pros and cons of open visitation at the next staff meeting. C. Invite the nurses with the most experience to develop a revised policy. D. Task the unit-based nurse practice council to invite volunteers to serve on the council to revise the current policy toward more liberal visitation. D Nursing strategies to help families cope with the stress of critical illness include: (Select all that apply.) A.. Asking the family to leave during the morning bath to promote the patient's privacy. B. Encouraging family members to make notes of questions they have for the physician during family rounds. C. If possible, providing continuity of nursing care. D. Providing a daily update of the patient's condition to the family spokesperson. E. Ensuring that a waiting room stocked with snacks is nearby. B, C, D Family presence is encouraged during resuscitation and invasive procedures. Which findings about this practice have been reported in the literature? (Select all that apply.) A. Families benefit by witnessing that everything possible was done. B. Families report reduced anxiety and fear about what is being done to the patient. C. Presence encourages family members to seek litigation for improper care. D. Presence reduces nurses' involvement in explaining things to the family. E. Families report that staff conversations during this time were distressing. A, B Noise in the critical care unit can have negative effects on the patient. Which of the following interventions assists in reducing noise levels in the critical care setting? (Select all that apply.) A. Ask the family to bring in the patient's iPod or other device with favorite music. 15 B. Invite a volunteer harpist to play on the unit on a regular basis. C. Remodel the unit to have two-patient rooms to facilitate nursing care. D. Remodel the unit to install acoustical ceiling tiles. E. Turn the volume of equipment alarms as low as they can be adjusted, and "off" if possible. D A, B, It is important for critically ill patients to feel safe. Which nursing strategies help the patient to feel safe in the critical care setting? (Select all that apply.) A. Allow family members to remain at the bedside. B. Consult with the charge nurse before making any patient care decisions. C. Provide informal conversation by discussing your plans for after work. D. Respond promptly to call bells or other communication for assistance. E. Inform the patient that you have cared for many similar patients. A, D The critical care environment is often stressful to a critically ill patient. Identify stressors that are common. (Select all that apply.) A. Alarms that sound from various devices B. Bright fluorescent lighting C. Lack of day-night cues D. Sounds from the mechanical ventilator E. Visiting hours tailored to meet individual needs A, B, C, D To reduce relocation stress in patients transferring out of the intensive care unit, the nurse can (Select all that apply.) A. Ask the nurses on the intermediate care unit to give the family a tour of the new unit. B. Contact the intensivist to see if the patient can stay one additional day in the critical care unit so that he and his family can adjust better to the idea of a transfer. C. Ensure that the patient will be located near the nurses' station in the new unit. D. Invite the nurse who will be assuming the patient's care to meet with the patient and family in the critical care unit prior to transfer. E. Help the patient and family focus on the positive meaning of a transfer. A, D, E 16 The critical care environment is stressful to the patient. Which interventions assist in reducing this stress? (Select all that apply.) A. Adjust lighting to promote normal sleep-wake cycles. B. Provide clocks, calendars, and personal photos in the patient's room. C. Talk to the patient about other patients you are caring for on the unit. D. Tell the patient the day and time when you are providing routine nursing interventions. E. Allow unlimited visitation tailored to the patient's individual needs. A, B, E Which of the following professional organizations best supports critical care nursing practice? A. American Association of Critical-Care Nurses B. American Heart Association C. American Nurses Association D. Society of Critical Care Medicine A A nurse has been working as a staff nurse in the surgical intensive care unit for 2 years and is interested in certification. Which credential would be most applicable for the nurse to seek? A. ACNPC-AG b. CNML c. CCRN d. PCCN C The main purpose of certification is to a. assure the consumer that you will not make a mistake. b. 17 prepare for graduate school. c. promote magnet status for your facility. d. validate knowledge of critical care nursing. The synergy model of practice focuses on a. D allowing unrestricted visiting for the patient 24 hours a day. b. holistic and alternative therapies. c. the needs of patients and their families, which drive nursing competency. d. patients' needs for energy and support. C The family of your critically ill patient tells you that they have not spoken with the physician in over 24 hours and that they have some questions they want clarified. During morning rounds, you convey this concern to the attending intensivist and arrange a meeting with the family at 4:00 PM. Which competency of critical care nursing does this represent? a. Advocacy and moral agency in solving ethical issues b. Clinical judgment and clinical reasoning skills c. Collaboration with patients, families, and team members d. Facilitation of learning for patients, families, and team members C 18 The AACN Standards for Acute and Critical Care Nursing Practice use what framework to guide critical care nursing practice? a. Evidence-based practice b. Healthy work environment c. National Patient Safety Goals d. Nursing process D The charge nurse is responsible for making the patient assignments on the critical care unit. An experienced, certified nurse is assigned to care for the acutely ill patient with sepsis who also requires continuous renal replacement therapy and mechanical ventilation. The nurse with less than 1 year of experience is assigned to two patients who are more stable. This assignment reflects implementation of the a. crew resource management model. b. National Patient Safety Goals. c. Quality and Safety Education for Nurses (QSEN) model. d. synergy model of practice. D The vision of the American Association of Critical-Care Nurses is a health care system driven by a. a healthy work environment. b. care from a multiprofessional team under the direction of a critical care physician. 19 c. the needs of critically ill patients and families. d. respectful, healing, and humane environments. C The most important outcome of effective communication is to a. demonstrate caring practices to family members. b. ensure that patient teaching is done. c. meet the diversity needs of patients. d. reduce patient errors. D You are caring for a critically ill patient whose urine output has been low for 2 consecutive hours. After a thorough patient assessment, you call the intensivist with report. Which information do you convey regarding background? a. Urine output of 40 mL/2 hours b. Current vital signs and history of aortic aneurysm repair 4 hours ago c. A statement that the patient is possibly hypovolemic d. A request for IV fluids B The family members of a critically ill patient bring a copy of the patient's living will to the hospital, which identifies the patient's wishes regarding health care. You discuss contents of the living will with the 20 patient's physician. This is an example of implementation of which of the AACN Standards of Professional Performance? a. Acquires and maintains current knowledge of practice b. Acts ethically on the behalf of the patient and family c. Considers factors related to safe patient care d. Uses clinical inquiry and integrates research findings in practice B Which of the following assists the critical care nurse in ensuring that care is appropriate and based on research? a. Clinical practice guidelines b. Computerized physician order entry c. Consulting with advanced practice nurses d. Implementing Joint Commission National Patient Safety Goals A Comparing the patient's current (home) medications with those ordered during hospitalization and communicating a complete list of medications to the next provider when the patient is transferred within an organization or to another setting are strategies to: a. improve accuracy of patient identification. b. prevent errors related to look-alike and sound-alike medications. c. 21 reconcile medications across the continuum of care. d. reduce harms associated with the administration of anticoagulants. C As part of nursing management of a critically ill patient, orders are written to keep the head of the bed elevated at 30 degrees, awaken the patient from sedation each morning to assess readiness to wean from 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 a. bundle of care. b. clinical practice guideline. c. patient safety goal. d. quality improvement initiative. A You work in an intermediate care unit and have asked to be involved in developing new guidelines to prevent pressure ulcers in your patient population. The nurse manager tells you that you do not yet have enough experience to be on the prevention task force and that your ideas will be rejected by others. This situation is an example a. a barrier to handoff communication. b. a work environment that is unhealthy. c. ineffective decision making. d. nursing practice that is not evidence-based. B 22 Which of the following statements describes the core concept of the synergy model of practice? a. All nurses must be certified in order to have the synergy model implemented. b. Family members must be included in daily interdisciplinary rounds. c. Nurses and physicians must work collaboratively and synergistically to influence care. d. Unique needs of patients and their families influence nursing competencies. D A nurse who plans care based on the patient's gender, ethnicity, spirituality, and lifestyle is said to a. be a moral advocate. b. facilitate learning. c. respond to diversity. d. use clinical judgment. C Which of the following is a National Patient Safety Goal? (Select all that apply.) a. Accurately identify patients. b. Eliminate the use of patient restraints. c. Reconcile medications across the continuum of care. d. Reduce risks of health care-acquired infection. 23 e. Reduce costs associated with hospitalization. A, C, D Which of the following is (are) official journal(s) of the American Association of Critical-Care Nurses? (Select all that apply.) a. American Journal of Critical Care b. Critical Care Clinics of North America c. Critical Care Nurse d. Critical Care Nursing Quarterly e. Critical Care Nursing Management A, C The first critical care units were (Select all that apply.) a. burn units. b. coronary care units. c. recovery rooms. d. neonatal intensive care units. e. high-risk OB units. B, C 24 Which of the following nursing activities demonstrates implementation of the AACN Standards of Professional Performance? (Select all that apply.) a. Attending a meeting of the local chapter of the American Association of Critical-Care Nurses in which a continuing education program on sepsis is being taught b. Collaborating with a pastoral services colleague to assist in meeting spiritual needs of the patient and family c. Participating on the unit's nurse practice council d. Posting an article from Critical Care Nurse on the management of venous thromboembolism for your colleagues to read e. Using evidence-based strategies to prevent ventilator-associated pneumonia A, B, C, D, E Which scenarios contribute to effective handoff communication at change of shift? (Select all that apply.) a. The nephrology consultant physician is making rounds and asks you for an update on the patient's status and to assist in placing a central line for hemodialysis. b. The noise level is high because twice as many staff members are present and everyone is giving report in the nurses' station. c. The unit has decided to use a standardized checklist/tool for change-of-shift reports and patient transfers. d. You and the oncoming nurse conduct a standardized report at the patient's bedside and review key assessment findings. e. The off-going nurse is giving the patient medications at the same time as giving handoff report to the oncoming nurse. C, D 25 Which strategy is important in addressing issues associated with the aging workforce? (Select all that apply.) a. Allowing nurses to work flexible shift durations b. Encouraging older nurses to transfer to an outpatient setting that is less stressful c. Hiring nurse technicians who are available to assist with patient care, such as turning the patient d. Remodeling patient care rooms to include devices to assist in patient lifting e. Developing a staffing model that accurately reflects the unit's needs. A, C, D Which of the following strategies will assist in creating a healthy work environment for the critical care nurse? (Select all that apply.) a. Celebrating improved outcomes from a nurse-driven protocol with a pizza party b. Implementing a medication safety program designed by pharmacists c. Modifying the staffing pattern to ensure a 1:1 nurse/patient ratio d. Offering quarterly joint nurse-physician workshops to discuss unit issues e. Using the Situation-Background-Assessment-Recommendation (SBAR) technique for handoff communication A, D, E The nurse chooses which method and concentration of oxygen administration until intubation is established in a patient who has sustained a cardiopulmonary arrest? 26 A. Bag-valve-mask at FiO2 of 100% B. Bag-valve-mask at FiO2 of 50% C. Mouth-to-mask ventilation with supplemental oxygen D. Non-rebreather mask at FiO2 of 100% A Laypersons should use which device to treat lethal ventricular dysrhythmias that occur outside a hospital setting? A. Automatic external defibrillator B. Carbon dioxide detector C. Pocket mask D. Transcutaneous pacemaker A When doing manual ventilations during a code, the nurse would administer ventilations following which guideline? A. Approximately 8 to 10 breaths per minute B. During the fifth chest compression C. Every 3 seconds or 20 times per minute D. While compressions are stopped A The patient has been admitted to a critical care unit with a diagnosis of acute myocardial infarction. Suddenly the monitor alarms and the screen shows a flat line. What action should the nurse take first? A. Administer epinephrine by intravenous push. B. Begin chest compressions. C. Check patient for unresponsiveness. D. Defibrillate at 360 J. C During a code, the nurse would place paddles for anterior defibrillation in what locations? A. Second intercostal space, left sternal border and fourth intercostal space, left midclavicular line B. Second intercostal space, right sternal border and fourth intercostal space, left midaxillary line C. Second intercostal space, right sternal border and fifth intercostal space, left midclavicular line 27 D. Fourth intercostal space, right sternal border and fifth intercostal space, left midclavicular line C During cardioversion, the nurse would synchronize the electrical charge to coincide with which wave of the ECG complex? A. P B. R C. S D. T B The nurse knows that in advanced cardiac life support, the secondary survey includes steps A-B-C-D, in which "D" refers to: A. Defibrillate. B. Differential diagnosis. C. Diltiazem intravenous push. D. Do not resuscitate. B The patient is diagnosed with abrupt onset of supraventricular tachycardia (SVT). The nurse prepares which medication to administer to the patient? A. Adenosine B. Amiodarone C. Diltiazem D. Procainamide A The code team has just defibrillated a patient in ventricular fibrillation. Following CPR for 2 minutes, what is the next action to take? A. Administer amiodarone. B. Administer lidocaine. C. Assess rhythm and pulse. D. Prepare for transcutaneous pacing. C 28 The patient's monitor shows bradycardia (heart rate of 40 beats/min) and frequent premature ventricular contractions (PVCs) with a measured blood pressure of 85/50 mm Hg. The nurse anticipates the use of which drug? A. Atropine 0.5 to 1 mg intravenous push B. Dopamine drip—continuous infusion C. Lidocaine 1 mg/kg intravenous push D. Transcutaneous pacemaker A The monitor technician notifies the nurse "stat" that the patient has a rapid, chaotic rhythm that looks like ventricular tachycardia. What is the nurse's first action? A. Call a code overhead. B. Check the patient immediately. C. Go to the nurses' station and look at the rhythm strip. D. Take the crash cart to the room. B Which rhythm would be an emergency indication for the application of a transcutaneous pacemaker? A. Asystole B. Bradycardia (heart rate 40 beats/min), normotensive and alert C. Bradycardia (heart rate 50 beats/min) with hypotension and syncope D. Supraventricular tachycardia (heart rate 150 beats/min), hypotensive C A patient is admitted to the coronary care unit with an inferior wall myocardial infarction and develops symptomatic bradycardia with premature ventricular contractions every third beat (trigeminy). The nurse knows to prepare to administer which drug? A. Amiodarone B. Atropine C. Lidocaine D. Magnesium B A patient develops frequent ventricular ectopy. The nurse prepares to administer which drug? 29 A. Adenosine B. Atropine C. Lidocaine D. Magnesium C It is determined that the patient needs a transcutaneous pacemaker until a transvenous pacemaker can be inserted. What is the most appropriate nursing intervention? A. Apply conductive gel to the skin. B. Provide adequate sedation and analgesia. C. Recheck leads to make sure that the rhythm is asystole. D. Set the milliamperes to 2 mA below the capture level. B The nurse needs to evaluate arterial blood gases before the administration of which drug? A. Calcium chloride B. Magnesium sulfate C. Potassium D. Sodium bicarbonate D During a code situation, the nurse would prepare to use which preferred intravenous fluid? A. 5% dextrose in 0.45% normal saline B. 5% dextrose in water C. Dopamine infusion D. Normal saline D A nursing home patient is admitted to the critical care unit with a severe case of pneumonia. No living will or designation of health care surrogate is noted on the chart. In the event this patient needs intubation and/or cardiopulmonary resuscitation, what should be the nurse's action? A. Activate the code team, but initiate a "slow" code. B. Call the nursing home to determine the patient's or family's wishes. C. Code the patient for 5 minutes and then cease efforts. 30 D. Initiate intubation and/or cardiopulmonary resuscitation efforts. D A patient is brought to the critical care unit after a motor vehicle crash. On admission, the patient reports dyspnea and chest pain. Upon examination, the nurse notes a lack of breath sounds on the left side and a tracheal shift. The patient suddenly experiences cardiac arrest. What assessment by the nurse takes priority? A. Heart tones B. Lung sounds C. Peripheral pulses D. Neurological status B The patient has pulseless electrical activity (PEA). What action by the nurse takes priority? A. Begin high-quality CPR. B. Assist with chest tube placement. C. Prepare equipment for a pericardiocentesis. D. Attach the patient to a transcutaneous pacemaker. A What is the major reason for using a treatment to lower body temperature after cardiac arrest to promote better neurological recovery? A. Hypothermia decreases the metabolic rate by 7% for each decrease of 1C. B. Lower body temperatures are beneficial in patients with low blood pressure. C. Temperatures of 40C may reduce neurological impairment. D. The lower body temperature leads to decreased oxygen delivery. A The patient has a transcutaneous pacemaker in place. Pacemaker spikes followed by QRS complexes are noted on the cardiac rhythm strip. To determine if the pacemaker is working, the nurse must do which of the following? A. Obtain a 12-lead electrocardiogram (ECG). B. Call for a pacemaker interrogation. C. Palpate the pulse. D. Run a 2-minute monitor strip for analysis. C 31 A patient has been successfully converted from ventricular tachycardia with a pulse to a sinus rhythm. Upon further assessment, it is noted that the patient is hypotensive. The appropriate treatment for her hypotension may include (Select all that apply) A. Adenosine. B. Dopamine infusion. C. Magnesium. D. Normal saline infusion. E. Sodium bicarbonate. B, D A patient is admitted to the critical care unit with bradycardia at a heart rate of 39 beats/min and frequent premature ventricular contractions. The nurse notes that the patient is lethargic and reports dizziness for the past 12 hours. Which of the following are acceptable initial treatments for this patient? (Select all that apply.) A. Atropine B. Epinephrine C. Lidocaine D. Transcutaneous pacemaker E. Magnesium sulfate infusion A, D Ventricular fibrillation should initially be treated by which of the following? (Select all that apply) A. Administration of amiodarone, followed by defibrillation at 360 J B. Atropine 1 mg, followed by defibrillation at 200 J C. Defibrillation at 200 J with biphasic defibrillation D. Defibrillation at 360 J with monophasic defibrillation E. Dopamine continuous infusion. C, D Which code drugs can be given safely through an endotracheal tube? (Select all that apply) A. Adenosine B. Atropine 32 C. Epinephrine D. Vasopressin E. Amiodarone B, C, D Which of the following statements about defibrillation are correct? (Select all that apply) A. Early defibrillation (if warranted) is recommended before other actions. B. It is not necessary to ensure that personnel are clear of the patient if hands-off defibrillation is used. C. It is not necessary to synchronize the defibrillation shocks. D. Paddles/patches can be placed anteriorly and posteriorly on the chest. E. All models of defibrillators are the same for standardization. A, C, D Postresuscitation goals include which of the following? (Select all that apply) A. Control dysrhythmias B. Maintain airway C. Maintain blood pressure D. Wean off oxygen E. Early ambulation A, B, C Which of the following are documented as part of the cardiopulmonary arrest record? (Select all that apply) A. Medication administration times B. Defibrillation times, joules, outcomes C. Rhythm strips of cardiac rhythm(s) noted D. Signatures of recorder and other personnel E. Model of defibrillator used. A, B, C, D Benefits of having the family present during resuscitation include which of the following? (Select all that apply) A. Facilitates the grief process 33 B. Lets the family see that everything is being done C. Sustains patient-family relationships D. Allows the staff easy access to ask for organ transplant E. Provides a sense of closure A, B, C, E The nurse should call the rapid response team for which patients? (Select all that apply) A. 53-year-old with pneumonia and severe respiratory distress B. 17-year-old with apnea following a severe head injury C. 24-year-old experiencing a severe asthmatic attack with stridor D. 73-year-old patient with bradycardia of 40 beats per minute E. 52-year-old patient with no palpable pulse A, C, D The nurse is caring for a patient who is on a cardiac monitor. The nurse realizes that the sinus node is the pacemaker of the heart because it is a. the fastest pacemaker cell in the heart. b. the only pacemaker cell in the heart. c. the only cell that does not affect the cardiac cycle. d. located in the left side of the heart. A The nurse is caring for a patient who is on a cardiac monitor. The nurse realizes that the sinus node is the pacemaker of the heart because it is a. the fastest pacemaker cell in the heart. b. the only pacemaker cell in the heart. c. the only cell that does not affect the cardiac cycle. d. located in the left side of the heart. B The normal rate for the SA node when the patient is at rest is a. 40 to 60 beats per minute. b. 60 to 100 beats per minute. 34 c. 20 to 40 beats per minute. d. more than100 beats per minute. B The nurse caring for patients with cardiac monitoring understands that when an electrical signal is aimed directly at the positive electrode, the inflection will be: a. negative. b. upside down. c. upright. d. equally positive and negative. C The patient is admitted with a condition that requires cardiac rhythm monitoring. To apply the monitoring electrodes, the nurse must first a. apply a moist gel to the chest. b. make certain that the electrode gel is dry. c. avoid soaps to avoid skin irritation. d. clip chest hair if needed. D The nurse using cardiac monitoring understands that each horizontal box on the electrocardiogram (ECG) paper indicates a. 200 milliseconds or 0.20 seconds duration. b. 40 milliseconds or 0.04 seconds duration. c. 3 seconds duration. d. millivolts of amplitude. B The nurse is examining the patient's cardiac rhythm strip in lead II and notices that all of the P waves are upright and look the same except one that has a different shape and is inverted. The nurse realizes that the P wave with the abnormal shape is probably a. from the SA node because all P waves come from the SA node. b. from some area in the atria other than the SA node. c. indicative of ventricular depolarization. 35 d. normal even though it is inverted in lead II. B The nurse caring for patients on cardiac monitors assesses the patient with a prolonged QT interval for a. electrolyte disturbances such as hypokalemia. b. symptomatic bradycardias. c. the development of lethal dysrhythmias. d. difficulty maintaining the blood pressure. C The patient has an irregular heart rhythm. To determine an accurate heart rate, the nurse would first a. identify the markers on the ECG paper that indicate a 6-second strip. b. count the number of small boxes between two consecutive P waves. c. count the number of small boxes between two consecutive QRS complexes. d. divides the number of complexes in a 6-second strip by 10. A The nurse is calculating the rate for a regular rhythm. There are 20 small boxes between each P wave and 20 small boxes between each R wave. What is the ventricular rate? a. 50 beats/min b. 75 beats/min c. 85 beats/min d. 100 beats/min B The patient is admitted with a fever and rapid heart rate. The patient's temperature is 103° F (39.4° C). The nurse places the patient on a cardiac monitor and finds the patient's atrial and ventricular rates are above 105 beats per minute. P waves are clearly seen and appear normal in configuration. QRS complexes are normal in appearance and 0.08 seconds wide. The rhythm is regular, and blood pressure is normal. The nurse should focus on providing: a. medications to lower heart rate. b. treatment to lower temperature. c. treatment to lower cardiac output. d. treatment to reduce heart rate. B 36 The nurse notices sinus bradycardia on the patient's cardiac monitor. The nurse should a. give atropine to increase heart rate. b. begin transcutaneous pacing of the patient. c. start a dopamine infusion to stimulate heart function. d. assess for hemodynamic instability. D The patient's heart rate is 165 beats per minute. The cardiac monitor shows a rapid rate with narrow QRS complexes. The P waves cannot be seen, but the rhythm is regular. The patient's blood pressure has dropped from 124/62 mm Hg to 78/30 mm Hg. The patient's skin is cold and diaphoretic, and the patient is complaining of nausea. The nurse prepares the patient for a. administration of beta blockers. b. administration of atropine. c. transcutaneous pacemaker insertion. d. emergent cardioversion. D The nurse is reading the cardiac monitor and notes that the patient's heart rhythm is extremely irregular and that there are no discernible P waves. The ventricular rate is 90 beats per minute, and the patient is hemodynamically stable. The nurse realizes that the patient's rhythm is a. atrial fibrillation. b. atrial flutter. c. atrial flutter with rapid ventricular response. d. junctional escape rhythm. A The patient's heart rhythm shows an inverted P wave with a PR interval of 0.06 seconds. The heart rate is 54 beats per minute. The nurse recognizes the rhythm is due to the a. loss of sinus node activity. 37 b. increased rate of the AV node. c. increased rate of the SA node. d. decreased rate of the AV node. A The patient is having premature ventricular contractions (PVCs). The nurse's greatest concern should be: a. the proximity of the R wave of the PVC to the T wave of a normal beat. b. the fact that PVCs are occurring, because they are so rare. c. whether the number of PVCs is decreasing. d. whether the PVCs are wider than 0.12 seconds. A The nurse notices ventricular tachycardia on the heart monitor. When the patient is assessed, the patient is found to be unresponsive with no pulse. The nurse should a. treat with intravenous amiodarone or lidocaine. b. begin cardiopulmonary resuscitation and advanced life support. c. provide electrical cardioversion. d. ignore the rhythm because it is benign. B The nurse is talking with the patient when the monitor alarms and shows a wavy baseline without a PQRST complex. The nurse should a. defibrillate the patient immediately. b. initiate basic life support. c. initiate advanced life support. d. assess the patient and the electrical leads. D The nurse notices that the patient has a first-degree AV block. Everything else about the rhythm is normal. The nurse should a. prepare to place the patient on a transcutaneous pacemaker. 38 b. give the patient atropine to shorten the PR interval. c. monitor the rhythm and patient's condition. d. give the patient an antiarrhythmic medication. The nurse understands that in a third-degree AV block a. every P wave is conducted to the ventricles. b. some P waves are conducted to the ventricles. c. none of the P waves are conducted to the ventricles. d. the PR interval is prolonged. C C The patient is asymptomatic but is diagnosed with second-degree heart block Mobitz I. The patient is on digitalis medication at home. The nurse should expect that a. the patient has had an anterior wall myocardial infarction. b. the physician will order the digitalis to be continued in the hospital. c. a digitalis level would be ordered upon admission. d. the patient will require a transcutaneous pacemaker. C The patient is scheduled to have a permanent pacemaker implanted. The patient asks the nurse, "How long will the battery in this thing last?" The nurse should answer, a. "Life expectancy is about 1 year. Then it will need to be replaced." b. "Pacemaker batteries can last up to 25 years with constant use." c. "Battery life varies depending on usage, but it can last up to 10 years." d. "Pacemakers are used to treat temporary problems, so the batteries don't last long." C The patient has a permanent pacemaker inserted. The provider has set the pacemaker to the demand mode at a rate of 60 beats per minute. The nurse realizes that a. the pacemaker will pace only if the patient's intrinsic heart rate is less than 60 beats per minute. b. the demand mode often competes with the patient's own rhythm. 39 c. the demand mode places the patient at risk for the R-on-T phenomenon. d. the fixed-rate mode is safer and is the mode of choice. A The patient has a permanent pacemaker in place with a demand rate set at 60 beats/min. The cardiac monitor is showing a heart rate of 44 beats/min with no pacemaker spikes. The nurse recognizes this as: a. normal pacemaker function. b. failure to capture. c. failure to pace. d. failure to sense. C The rhythm on the cardiac monitor is showing numerous pacemaker spikes, but no P waves or QRS complexes following the spikes. The nurse recognizes this as: a. normal pacemaker function. b. failure to capture. c. failure to pace. d. failure to sense. B The normal width of the QRS complex is which of the following? (Select all that apply.) a. 0.06 to 0.10 seconds. b. 0.12 to 0.20 seconds. c. 1.5 to 2.5 small boxes. d. 3.0 to 5.0 small boxes. e. 0.04 seconds or greater. A, C Which of the following are common causes of sinus tachycardia? (Select all that apply.) a. Hyperthyroidism b. Hypovolemia c. Hypothyroidism d. Heart Failure 40 e. Sleep A, B, D Sinus bradycardia is a symptom of which of the following? (Select all that apply.) a. Calcium channel blocker medication b. Beta blocker medication c. Athletic conditioning d. Hypothermia e. Hyperthyroidism A, B, C, D The nurse is caring for a patient who has atrial fibrillation. Sequelae that place the patient at greater risk for mortality/morbidity include which of the following? (Select all that apply.) a. Stroke b. Ashman beats c. Pulmonary emboli d. Prolonged PR interval e. Decreased cardiac output A, C, E The patient is in third-degree heart block (complete heart block) and is symptomatic. The treatment for this patient is which of the following? (Select all that apply.) a. Transcutaneous pacemaker b. Atropine IV c. Temporary transvenous pacemaker d. Permanent pacemaker e. Amiodarone IV A, C, D The nurse is caring for a patient who is on a cardiac monitor. The nurse realizes that the sinus node is the pacemaker of the heart because it is 41 a. the fastest pacemaker cell in the heart. b. the only pacemaker cell in the heart. c. the only cell that does not affect the cardiac cycle. d. located in the left side of the heart. A One of the functions of the atrioventricular (AV) node is to a. pace the heart if the ventricles fail. b. slow the impulse arriving from the SA node. c. send the impulse to the SA node. d. allow for ventricular filling during systole. B The patient is admitted with a suspected acute myocardial infarction (AMI). In assessing the 12-lead electrocardiogram (ECG) changes, which findings would indicate to the nurse that the patient is in the process of an evolving Q wave myocardial infarction (MI)? a. ST-segment elevation on ECG and elevated CPK-MB or troponin levels b. Depress