NUR 425 Exam 1 - Critical Care UPDATED ACTUAL Questions and CORRECT
Answers
If a patient is delirious and hitting you and Yes, because they are a danger to themselves and others. If they were delirious but
pulling out their wires, do you give them pleasant you would try to avoid the sedatives.
more sedatives even though sedatives
make delirium worse?
Which of the following is NOT a likely sign b. Decreased respiratory rate
of pain in a nonverbal patient?
a. Eyes clenched shut when turning the
patient
b. Decreased respiratory rate
c. Patient resists bending of her elbow
when you try to contract her arm
d. Heart rate of 120 in a 54 year old male
If a patient is already on phentenyol but assess everything first! are they laying on something?
have a CPOT of 7 and are grimacing, what
do you want to do before you give them
more pain meds?
, You walk into your intubated patient's room e. Look at the patient's facial expression and muscle tension
with an IV fentanyl drip at 25mcg/hour who
presents with the following:
Heart rate: 130
BP: 140/90
RR: 29
Which of the following should the nurse do
first?
a. Ask the patient to rank her pain on a
scale of 0-10
b. Increase the fentanyl drip rate per
protocol
c. Call the physician for additional pain
medication orders
d. Get a music therapy consult
e. Look at the patient's facial expression
and muscle tension
You walk into your intubated patient's room a. Ask the patient "Are you in pain?"
with an IV fentanyl drip at 25mcg/hour who
presents with the following:
Heart rate: 130
BP: 140/90
RR: 29, ventilator alarming
Hands clenched, brow narrowed, patient
eyes open and looking at you anxiously.
Which of the following should the nurse do
first?
a. Ask the patient "Are you in pain?"
b. Stop the fentanyl drip and request
orders for a new analgesic
c. Increase the fentanyl drip rate per
protocol
d. Tell the patient to calm down
e. Get a music therapy consult
Benzo of choice. Anterograde amnesia. Stored in the body and can accumulate over
Midazolam time and cause prolonged sedation. Respiratory depression, but not worried if on
ventilator. Potential for tolerance and withdrawal.
white lipid drug. Look out for hyperlipidemia. Rapid onset and rapid offset! Need to
Propofol intubate the patient and be ready for breathing problems. Hypotension. Nurse
cannot push unless under doctor supervision.
Fentenyl Analgesia with rapid onset and offset. Respiratory depression. Used with sedatives.
Ativan sedative that decreases REM sleep
CAM-ICU scale assessment scale for delirium
RASS sedation scale
CPOT critical care pain observation tool
BPS Behavior pain scale
Answers
If a patient is delirious and hitting you and Yes, because they are a danger to themselves and others. If they were delirious but
pulling out their wires, do you give them pleasant you would try to avoid the sedatives.
more sedatives even though sedatives
make delirium worse?
Which of the following is NOT a likely sign b. Decreased respiratory rate
of pain in a nonverbal patient?
a. Eyes clenched shut when turning the
patient
b. Decreased respiratory rate
c. Patient resists bending of her elbow
when you try to contract her arm
d. Heart rate of 120 in a 54 year old male
If a patient is already on phentenyol but assess everything first! are they laying on something?
have a CPOT of 7 and are grimacing, what
do you want to do before you give them
more pain meds?
, You walk into your intubated patient's room e. Look at the patient's facial expression and muscle tension
with an IV fentanyl drip at 25mcg/hour who
presents with the following:
Heart rate: 130
BP: 140/90
RR: 29
Which of the following should the nurse do
first?
a. Ask the patient to rank her pain on a
scale of 0-10
b. Increase the fentanyl drip rate per
protocol
c. Call the physician for additional pain
medication orders
d. Get a music therapy consult
e. Look at the patient's facial expression
and muscle tension
You walk into your intubated patient's room a. Ask the patient "Are you in pain?"
with an IV fentanyl drip at 25mcg/hour who
presents with the following:
Heart rate: 130
BP: 140/90
RR: 29, ventilator alarming
Hands clenched, brow narrowed, patient
eyes open and looking at you anxiously.
Which of the following should the nurse do
first?
a. Ask the patient "Are you in pain?"
b. Stop the fentanyl drip and request
orders for a new analgesic
c. Increase the fentanyl drip rate per
protocol
d. Tell the patient to calm down
e. Get a music therapy consult
Benzo of choice. Anterograde amnesia. Stored in the body and can accumulate over
Midazolam time and cause prolonged sedation. Respiratory depression, but not worried if on
ventilator. Potential for tolerance and withdrawal.
white lipid drug. Look out for hyperlipidemia. Rapid onset and rapid offset! Need to
Propofol intubate the patient and be ready for breathing problems. Hypotension. Nurse
cannot push unless under doctor supervision.
Fentenyl Analgesia with rapid onset and offset. Respiratory depression. Used with sedatives.
Ativan sedative that decreases REM sleep
CAM-ICU scale assessment scale for delirium
RASS sedation scale
CPOT critical care pain observation tool
BPS Behavior pain scale
