Critical Care – Uworld Questions with
Answers and Rationales.
The emergency department nurse receives a client with extensive injuries
to the head and upper back. The nurse will perform what action to allow the
best visualization of the airway?
1. Head-tilt chin-lift in the supine position on a backboard
2. Head-tilt chin-lift in the Trendelenburg position
3. Jaw-thrust maneuver in semi-Fowler's position
4. Jaw-thrust maneuver in the supine position on a backboard - Correct
Answers 4
Clinical situations involving trauma should follow ABC: Airway, Breathing,
and Circulation. Airway assessment is particularly critical in clients with
injuries to the head, neck, and upper back. Injury to the upper back should
be treated as spinal trauma until the client has been cleared by an
Advanced Trauma Life Support-qualified health care provider. Until the
spine is appropriately assessed, the client should be placed on a
backboard and stabilized. The nurse should use the jaw-thrust maneuver to
avoid movement of an unstable spine. One provider should stabilize the
cervical vertebra allowing the second provider to articulate the jaw
independently of the spinal column.
(Option 1) Although use of the backboard is appropriate, the head-tilt chin-
lift should not be used as it involves manipulation of the neck without
proper stabilization. If the cervical vertebrae are fractured, the spinal cord
could be badly damaged.
(Option 2) The head-tilt chin-lift does not stabilize the alignment of the head
and neck and can cause spinal cord damage. In addition, the
Trendelenburg position causes the abdominal organs to shift toward the
diaphragm, which increases the work of breathing.
(Option 3) The jaw-thrust maneuver is appropriate, but stabilization of the
spine is best performed in the supine position, such as on the flat, hard
surface of a backboard.
,Educational objective: If there is any suspicion of spinal injury, the jaw-
thrust maneuver should be used for airway assessment to avoid any
shifting of unstable vertebrae and subsequent spinal cord damage.
The nurse is supervising a graduate nurse (GN) on a telemetry unit. An
assigned client develops asystole with no pulse, and emergency care
interventions are initiated. Which action by the GN would cause the
supervising nurse to intervene?
1. Administers IV epinephrine
2. Applies oxygen with bag-mask
3. Initiates chest compressions
4. Provides defibrillator shock - Correct Answers 4
The client in asystole has a total absence of ventricular electrical activity
and is pulseless, apneic, and unresponsive. The nurse should first verify
the monitor reading by assessing the client and palpating for a pulse, and
then call for help and initiate emergency care (ie, CPR, oxygenated
ventilation).
Defibrillation is not indicated when there is no electrical activity present (ie,
asystole) or when the heart muscle is not contracting despite an organized
rhythm (ie, pulseless electrical activity [PEA]). Defibrillation attempts to
convert lethal ventricular dysrhythmias (ie, ventricular fibrillation and
pulseless ventricular tachycardia) into an organized rhythm by passing an
electric shock through the heart. Defibrillation cannot create an organized
rhythm if there is no electrical activity in the heart (Option 4).
(Options 1, 2, and 3) Immediate interventions for asystole and PEA include
CPR and oxygenated ventilation. Advanced cardiovascular life-support
measures include epinephrine IV, placement of advanced airway (ie,
intubation), and treatment of reversible causes (eg, hypovolemia,
hyperkalemia).
When treating asystole or PEA, the absolute priority is providing
continuous, high-quality CPR and oxygenated ventilation until circulation
spontaneously returns or the client enters into a shockable rhythm.
Unfortunately, restoration of circulation may not be possible, and clients in
asystole often cannot be resuscitated.
,Educational objective: Asystole is characterized by a total absence of
ventricular electrical activity. The client is pulseless, apneic, and
unresponsive. Treatment includes CPR, oxygenated ventilation, and
advanced cardiovascular life-support measures (eg, epinephrine IV,
advanced airway). Defibrillation is not effective for treatment of asystole or
pulseless electrical activity.
A nurse is caring for an intubated client receiving a continuous sedative
infusion. Which interventions by the nurse reflect correct understanding of
preventing ventilator-acquired pneumonia? Select all that apply.
1. Elevating the head of the bed 30-45 degrees
2. Performing hourly in-line endotracheal suctioning
3. Practicing strict hand hygiene
4. Providing frequent oral care with chlorhexidine
5. Scheduling daily sedation vacations - Correct Answers 1, 3, 4, 5
Mechanically ventilated clients are at risk for developing ventilator-
associated pneumonia (VAP) due to sedation and impairment of natural
defenses (eg, coughing) by artificial airways. Interventions to reduce the
risk of VAP include:
- Elevating the head of the bed 30-45 degrees (ie, semi-Fowler position)
(Option 1)
- Providing oral care with antiseptic solutions (eg, chlorhexidine
mouthwash) and suctioning subglottic secretions (Option 4)
- Performing scheduled daily sedation vacations and maintaining
appropriate client sedation levels (Option 5)
- Practicing strict hand hygiene (Option 3)
(Option 2) Endotracheal suctioning should be performed only when
clinically indicated (eg, adventitious breath sounds, coughing, elevated
peak airway pressure). Frequent suctioning increases the risk for tracheal
and bronchial trauma, bleeding, and hypoxia.
Educational objective: Mechanically ventilated clients are at risk for
developing ventilator-associated pneumonia (VAP) due to sedation and use
of an artificial airway. VAP prevention includes elevating the head of the
bed 30-45 degrees, providing regular oral hygiene with chlorhexidine
solution, practicing strict hand hygiene, and performing daily sedation
vacations.
, The nurse observes a nursing student performing chest compressions on
an adult client. Which technique indicates that the student understands how
to provide high-quality chest compressions during cardiopulmonary
resuscitation?
1. Compressing the chest to a depth of at least 2 in (5 cm)
2. Pausing after each set of 15 compressions to allow for 2 rescue breaths
3. Placing the heel of the hand on the upper half of the client's sternum
4. Providing compressions at a rate of at least 80-100/min - Correct
Answers 1
The primary goal of cardiopulmonary resuscitation (CPR) is adequate
perfusion to the brain and vital organs. High-quality chest compressions for
adults are at least 2 in (5 cm) deep to adequately pump blood but no more
than 2.4 in (6 cm) deep to prevent unnecessary client injury (Option 1). The
chest should recoil completely after each compression to allow complete
refilling of the heart chambers, which promotes effective perfusion.
(Option 2) Interruption of compressions should be minimized; at least 60%
(preferably more) of the total resuscitation time should be made up of
compressions. For adults (and in single-rescuer CPR for any age), a cycle
of 30 compressions followed by 2 rescue breaths provides the best
outcome. If the client has an advanced airway, continuous compressions
and 10 breaths/min should be provided.
(Option 3) Correct hand placement is in the center of the chest, on the
lower half of the sternum (breastbone). Hand placement on the upper half
of the sternum does not provide adequate perfusion.
(Option 4) Studies have shown better client outcomes due to improved
perfusion with a compression rate of 100-120/min.
Educational objective: For high-quality adult cardiopulmonary resuscitation,
compressions should be in the center of the chest; at a rate of
100-120/min; and at least 2 in (5 cm) but no more than 2.4 in (6 cm) deep
for adequate perfusion without unnecessary client injury. Compression
interruption should be minimized (eg, 30 compressions to 2 rescue
breaths).
Answers and Rationales.
The emergency department nurse receives a client with extensive injuries
to the head and upper back. The nurse will perform what action to allow the
best visualization of the airway?
1. Head-tilt chin-lift in the supine position on a backboard
2. Head-tilt chin-lift in the Trendelenburg position
3. Jaw-thrust maneuver in semi-Fowler's position
4. Jaw-thrust maneuver in the supine position on a backboard - Correct
Answers 4
Clinical situations involving trauma should follow ABC: Airway, Breathing,
and Circulation. Airway assessment is particularly critical in clients with
injuries to the head, neck, and upper back. Injury to the upper back should
be treated as spinal trauma until the client has been cleared by an
Advanced Trauma Life Support-qualified health care provider. Until the
spine is appropriately assessed, the client should be placed on a
backboard and stabilized. The nurse should use the jaw-thrust maneuver to
avoid movement of an unstable spine. One provider should stabilize the
cervical vertebra allowing the second provider to articulate the jaw
independently of the spinal column.
(Option 1) Although use of the backboard is appropriate, the head-tilt chin-
lift should not be used as it involves manipulation of the neck without
proper stabilization. If the cervical vertebrae are fractured, the spinal cord
could be badly damaged.
(Option 2) The head-tilt chin-lift does not stabilize the alignment of the head
and neck and can cause spinal cord damage. In addition, the
Trendelenburg position causes the abdominal organs to shift toward the
diaphragm, which increases the work of breathing.
(Option 3) The jaw-thrust maneuver is appropriate, but stabilization of the
spine is best performed in the supine position, such as on the flat, hard
surface of a backboard.
,Educational objective: If there is any suspicion of spinal injury, the jaw-
thrust maneuver should be used for airway assessment to avoid any
shifting of unstable vertebrae and subsequent spinal cord damage.
The nurse is supervising a graduate nurse (GN) on a telemetry unit. An
assigned client develops asystole with no pulse, and emergency care
interventions are initiated. Which action by the GN would cause the
supervising nurse to intervene?
1. Administers IV epinephrine
2. Applies oxygen with bag-mask
3. Initiates chest compressions
4. Provides defibrillator shock - Correct Answers 4
The client in asystole has a total absence of ventricular electrical activity
and is pulseless, apneic, and unresponsive. The nurse should first verify
the monitor reading by assessing the client and palpating for a pulse, and
then call for help and initiate emergency care (ie, CPR, oxygenated
ventilation).
Defibrillation is not indicated when there is no electrical activity present (ie,
asystole) or when the heart muscle is not contracting despite an organized
rhythm (ie, pulseless electrical activity [PEA]). Defibrillation attempts to
convert lethal ventricular dysrhythmias (ie, ventricular fibrillation and
pulseless ventricular tachycardia) into an organized rhythm by passing an
electric shock through the heart. Defibrillation cannot create an organized
rhythm if there is no electrical activity in the heart (Option 4).
(Options 1, 2, and 3) Immediate interventions for asystole and PEA include
CPR and oxygenated ventilation. Advanced cardiovascular life-support
measures include epinephrine IV, placement of advanced airway (ie,
intubation), and treatment of reversible causes (eg, hypovolemia,
hyperkalemia).
When treating asystole or PEA, the absolute priority is providing
continuous, high-quality CPR and oxygenated ventilation until circulation
spontaneously returns or the client enters into a shockable rhythm.
Unfortunately, restoration of circulation may not be possible, and clients in
asystole often cannot be resuscitated.
,Educational objective: Asystole is characterized by a total absence of
ventricular electrical activity. The client is pulseless, apneic, and
unresponsive. Treatment includes CPR, oxygenated ventilation, and
advanced cardiovascular life-support measures (eg, epinephrine IV,
advanced airway). Defibrillation is not effective for treatment of asystole or
pulseless electrical activity.
A nurse is caring for an intubated client receiving a continuous sedative
infusion. Which interventions by the nurse reflect correct understanding of
preventing ventilator-acquired pneumonia? Select all that apply.
1. Elevating the head of the bed 30-45 degrees
2. Performing hourly in-line endotracheal suctioning
3. Practicing strict hand hygiene
4. Providing frequent oral care with chlorhexidine
5. Scheduling daily sedation vacations - Correct Answers 1, 3, 4, 5
Mechanically ventilated clients are at risk for developing ventilator-
associated pneumonia (VAP) due to sedation and impairment of natural
defenses (eg, coughing) by artificial airways. Interventions to reduce the
risk of VAP include:
- Elevating the head of the bed 30-45 degrees (ie, semi-Fowler position)
(Option 1)
- Providing oral care with antiseptic solutions (eg, chlorhexidine
mouthwash) and suctioning subglottic secretions (Option 4)
- Performing scheduled daily sedation vacations and maintaining
appropriate client sedation levels (Option 5)
- Practicing strict hand hygiene (Option 3)
(Option 2) Endotracheal suctioning should be performed only when
clinically indicated (eg, adventitious breath sounds, coughing, elevated
peak airway pressure). Frequent suctioning increases the risk for tracheal
and bronchial trauma, bleeding, and hypoxia.
Educational objective: Mechanically ventilated clients are at risk for
developing ventilator-associated pneumonia (VAP) due to sedation and use
of an artificial airway. VAP prevention includes elevating the head of the
bed 30-45 degrees, providing regular oral hygiene with chlorhexidine
solution, practicing strict hand hygiene, and performing daily sedation
vacations.
, The nurse observes a nursing student performing chest compressions on
an adult client. Which technique indicates that the student understands how
to provide high-quality chest compressions during cardiopulmonary
resuscitation?
1. Compressing the chest to a depth of at least 2 in (5 cm)
2. Pausing after each set of 15 compressions to allow for 2 rescue breaths
3. Placing the heel of the hand on the upper half of the client's sternum
4. Providing compressions at a rate of at least 80-100/min - Correct
Answers 1
The primary goal of cardiopulmonary resuscitation (CPR) is adequate
perfusion to the brain and vital organs. High-quality chest compressions for
adults are at least 2 in (5 cm) deep to adequately pump blood but no more
than 2.4 in (6 cm) deep to prevent unnecessary client injury (Option 1). The
chest should recoil completely after each compression to allow complete
refilling of the heart chambers, which promotes effective perfusion.
(Option 2) Interruption of compressions should be minimized; at least 60%
(preferably more) of the total resuscitation time should be made up of
compressions. For adults (and in single-rescuer CPR for any age), a cycle
of 30 compressions followed by 2 rescue breaths provides the best
outcome. If the client has an advanced airway, continuous compressions
and 10 breaths/min should be provided.
(Option 3) Correct hand placement is in the center of the chest, on the
lower half of the sternum (breastbone). Hand placement on the upper half
of the sternum does not provide adequate perfusion.
(Option 4) Studies have shown better client outcomes due to improved
perfusion with a compression rate of 100-120/min.
Educational objective: For high-quality adult cardiopulmonary resuscitation,
compressions should be in the center of the chest; at a rate of
100-120/min; and at least 2 in (5 cm) but no more than 2.4 in (6 cm) deep
for adequate perfusion without unnecessary client injury. Compression
interruption should be minimized (eg, 30 compressions to 2 rescue
breaths).
