CCRN questions exam 2
2. A patient presents with a productive cough, hypoxemia, a fever, hypotension, tachycardia,
and tachypnea. Hypoxemia was corrected with the administration of oxygen. Which of the
following should be done next?
A. Administer antibiotics.
B. Start a vasopressor.
C. Collect a sputum culture.
D. Initiate 0.9 normal saline. - ANS(D) Correcting the
hypotension (with isotonic fluid resuscitation in order to maintain
organ perfusion) is the priority at this time. Antibiotics (choice
(A)) will need to be started after blood cultures are obtained. A
vasopressor (choice (B)) may not be needed if the MAP is restored
with fluids. Although a sputum culture (choice (C)) may be
indicated, blood cultures need to be drawn first so that antibiotics
can be given (within the first hour, if possible).
10. A patient has a history of chronic respiratory failure secondary to COPD and now has
acute respiratory failure secondary to pneumonia. Upon arrival at the critical care unit, his
ABGs were a pH of 7.29, a PaCO 2 of 77, a PaO 2 of 51, and an HCO 3 of 31. He is
receiving noninvasive ventilation with settings that read as follows: FiO 2 0.40, IPAP 12 cm,
and EPAP 5 cm. After 1 hour of therapy, the patient's ABG results are a pH of 7.20, a PaCO
2 of 89, a PaO 2 of 48, and an HCO 3 of 32. What is the correct evaluation of this data?
A) Alveolar hyperventilation is getting worse; the BiPAP settings need adjustment.
B) Metabolic acidosis is worse; the FiO 2 needs to be increased.
C) Alveolar hypoventilation is getting worse; the patient needs to be intubated.
D) The pH is acceptable for a patient with COPD; continue the current therapy. - ANSC. The
patient did not
respond to noninvasive ventilation since the PaCO 2 increased, respiratory acidosis is worse,
and severe hypoxemia was
not corrected. BiPAP should not be continued. The issue is not metabolic acidosis. The pH is
not acceptable.
20. A patient is alert and is receiving mechanical ventilation with the following settings:
assist-control mode at 10 breaths/minute, FiO 2 0.40, and PEEP 5 cm H 2 O pressure. Vital
signs include a 18 breaths/minute, with norepinephrine at 7 mcg/min for the past 4 hours. The
patient has tolerated repositioning in bed and a head of bed elevation up to 90°. Which of the
following would be an appropriate next step in terms of mobility for this patient?
A) Allow the patient to sit on the edge of the bed, with assistance.
B) Reduce the head of bed elevation to 45°.
C) Maintain the patient's current level of mobility.
D) Help the patient stand and pivot to a chair. - ANSA. This patient tolerated
the current activity with head of bed elevation in high
Fowler's position and is now ready to progress to sitting without back support with his legs
dangling. This patient does not have contraindications to mobility progression; therefore,
reducing the patient's mobility (choice (B)) or maintaining the patient's current level of
mobility (choice (C)) would not provide progress. Although
, the patient might be able to progress to weight-bearing and sitting in a chair, it is best to go
step-by-step and then reassess, not to proceed directly to weight-bearing (as choice (D)
suggests).
21. A 70 kg patient with ARDS is mechanically ventilated with the following settings: FiO 2
70%, tidal volume 450 mL, assist-control mode 10 breaths/minute, and PEEP 20 cm H 2 O
pressure. On these settings, the patient's PaO 2 is 76 mmHg and the PaCO 2 is 58 mmHg.
The patient's core temperature is 37°C, his heart rate is 116 beats/minute, and his B/P is
78/58. Which of the following interventions should the nurse now anticipate?
A) Decrease PEEP to decrease the intrathoracic pressure.
B) Administer a 500 mL fluid bolus of normal saline.
C) Initiate a norepinephrine drip to maintain a SBP of 80 mmHg.
D) Increase the tidal volume to 750 mL. - ANSB. The primary problem is
hypotension, and it should be treated with fluids. Although a reduction of PEEP would most
likely increase the B/P, it would result in derecruitment of alveoli and hypoxemia. A
norepinephrine drip should be initiated only if fluids alone do not correct the hypotension. An
increase in the tidal volume would not increase the B/P and would cause volutrauma in a
patient with ARDS.
23. A 70 kg patient with ARDS is intubated and mechanically ventilated. The patient is on
continuous infusions of an opiate, a sedative, and neuromuscular blocking drugs. The plateau
pressure is 45 cm H 2 O. The PaO 2 is 60 mmHg. The physician orders the following
ventilator settings: SIMV mode, tidal volume 700 mL, rate 12 breaths/minute, FiO 2 1.00,
and PEEP 15 cm H 2 O pressure. Which of the following needs to be discussed with the
physician?
A) the ventilator mode
B) the tidal volume
C) the PEEP
D) the FiO 2 - ANSB. This patient with ARDS
needs to receive 4-5 mL/kg tidal volume in order to prevent volutrauma. This patient is
receiving 10 mL/kg tidal volume, and
this level needs to be reduced. The mode of ventilation and both the
PEEP and the FiO 2 settings are acceptable.
31. Which of the following nursing behaviors is usually most helpful to patients and families
regarding end-of-life decisions?
A) avoiding the use of words such as "death," "dying," and "suffering" B) consulting the
clergy for support
C) acting as an arbitrator between family members
D) requesting that only 1 person be the spokesperson - ANSC. When end-of-life
decisions are required, a certain amount of family conflict usually occurs. An experienced
nurse knows how to arbitrate in these
matters. Choice (A) is not an effective strategy. The clergy may be consulted but only if this
is the family's wish. A request that only 1 person be the spokesperson is an effective strategy
for routine
communication with a large family. However, when end-of-life decisions are necessary, all
stakeholders need to have a voice.
2. A patient presents with a productive cough, hypoxemia, a fever, hypotension, tachycardia,
and tachypnea. Hypoxemia was corrected with the administration of oxygen. Which of the
following should be done next?
A. Administer antibiotics.
B. Start a vasopressor.
C. Collect a sputum culture.
D. Initiate 0.9 normal saline. - ANS(D) Correcting the
hypotension (with isotonic fluid resuscitation in order to maintain
organ perfusion) is the priority at this time. Antibiotics (choice
(A)) will need to be started after blood cultures are obtained. A
vasopressor (choice (B)) may not be needed if the MAP is restored
with fluids. Although a sputum culture (choice (C)) may be
indicated, blood cultures need to be drawn first so that antibiotics
can be given (within the first hour, if possible).
10. A patient has a history of chronic respiratory failure secondary to COPD and now has
acute respiratory failure secondary to pneumonia. Upon arrival at the critical care unit, his
ABGs were a pH of 7.29, a PaCO 2 of 77, a PaO 2 of 51, and an HCO 3 of 31. He is
receiving noninvasive ventilation with settings that read as follows: FiO 2 0.40, IPAP 12 cm,
and EPAP 5 cm. After 1 hour of therapy, the patient's ABG results are a pH of 7.20, a PaCO
2 of 89, a PaO 2 of 48, and an HCO 3 of 32. What is the correct evaluation of this data?
A) Alveolar hyperventilation is getting worse; the BiPAP settings need adjustment.
B) Metabolic acidosis is worse; the FiO 2 needs to be increased.
C) Alveolar hypoventilation is getting worse; the patient needs to be intubated.
D) The pH is acceptable for a patient with COPD; continue the current therapy. - ANSC. The
patient did not
respond to noninvasive ventilation since the PaCO 2 increased, respiratory acidosis is worse,
and severe hypoxemia was
not corrected. BiPAP should not be continued. The issue is not metabolic acidosis. The pH is
not acceptable.
20. A patient is alert and is receiving mechanical ventilation with the following settings:
assist-control mode at 10 breaths/minute, FiO 2 0.40, and PEEP 5 cm H 2 O pressure. Vital
signs include a 18 breaths/minute, with norepinephrine at 7 mcg/min for the past 4 hours. The
patient has tolerated repositioning in bed and a head of bed elevation up to 90°. Which of the
following would be an appropriate next step in terms of mobility for this patient?
A) Allow the patient to sit on the edge of the bed, with assistance.
B) Reduce the head of bed elevation to 45°.
C) Maintain the patient's current level of mobility.
D) Help the patient stand and pivot to a chair. - ANSA. This patient tolerated
the current activity with head of bed elevation in high
Fowler's position and is now ready to progress to sitting without back support with his legs
dangling. This patient does not have contraindications to mobility progression; therefore,
reducing the patient's mobility (choice (B)) or maintaining the patient's current level of
mobility (choice (C)) would not provide progress. Although
, the patient might be able to progress to weight-bearing and sitting in a chair, it is best to go
step-by-step and then reassess, not to proceed directly to weight-bearing (as choice (D)
suggests).
21. A 70 kg patient with ARDS is mechanically ventilated with the following settings: FiO 2
70%, tidal volume 450 mL, assist-control mode 10 breaths/minute, and PEEP 20 cm H 2 O
pressure. On these settings, the patient's PaO 2 is 76 mmHg and the PaCO 2 is 58 mmHg.
The patient's core temperature is 37°C, his heart rate is 116 beats/minute, and his B/P is
78/58. Which of the following interventions should the nurse now anticipate?
A) Decrease PEEP to decrease the intrathoracic pressure.
B) Administer a 500 mL fluid bolus of normal saline.
C) Initiate a norepinephrine drip to maintain a SBP of 80 mmHg.
D) Increase the tidal volume to 750 mL. - ANSB. The primary problem is
hypotension, and it should be treated with fluids. Although a reduction of PEEP would most
likely increase the B/P, it would result in derecruitment of alveoli and hypoxemia. A
norepinephrine drip should be initiated only if fluids alone do not correct the hypotension. An
increase in the tidal volume would not increase the B/P and would cause volutrauma in a
patient with ARDS.
23. A 70 kg patient with ARDS is intubated and mechanically ventilated. The patient is on
continuous infusions of an opiate, a sedative, and neuromuscular blocking drugs. The plateau
pressure is 45 cm H 2 O. The PaO 2 is 60 mmHg. The physician orders the following
ventilator settings: SIMV mode, tidal volume 700 mL, rate 12 breaths/minute, FiO 2 1.00,
and PEEP 15 cm H 2 O pressure. Which of the following needs to be discussed with the
physician?
A) the ventilator mode
B) the tidal volume
C) the PEEP
D) the FiO 2 - ANSB. This patient with ARDS
needs to receive 4-5 mL/kg tidal volume in order to prevent volutrauma. This patient is
receiving 10 mL/kg tidal volume, and
this level needs to be reduced. The mode of ventilation and both the
PEEP and the FiO 2 settings are acceptable.
31. Which of the following nursing behaviors is usually most helpful to patients and families
regarding end-of-life decisions?
A) avoiding the use of words such as "death," "dying," and "suffering" B) consulting the
clergy for support
C) acting as an arbitrator between family members
D) requesting that only 1 person be the spokesperson - ANSC. When end-of-life
decisions are required, a certain amount of family conflict usually occurs. An experienced
nurse knows how to arbitrate in these
matters. Choice (A) is not an effective strategy. The clergy may be consulted but only if this
is the family's wish. A request that only 1 person be the spokesperson is an effective strategy
for routine
communication with a large family. However, when end-of-life decisions are necessary, all
stakeholders need to have a voice.
