Question 1

When caring for the patient with a pulmonary artery pressure catheter, the nurse notes that the PA wave form indicates that the catheter is in the wedged position. Which action should the nurse take?

Accepted Answer

A)   Zero balance the transducer.
B)   Inflate the PA balloon.
C)   Notify the health care provider.
D)   Change the flush system. C

Question 2

A patient who has respiratory failure and is receiving mechanical ventilation has a nursing diagnosis of risk for injury related to asynchrony with the ventilator secondary to anxiety. The nurse's first action should be to

Accepted Answer

A)   verbally coach the patient to breathe with the ventilator.
B)   sedate the patient with the ordered PRN lorazepam (Ativan) .
C)   ventilate the patient with a manual resuscitation bag.
D)   increase the rate for the ordered propofol (Diprivan)  infusion. A

Question 3

An intra-aortic balloon pump (IABP) is being used for a patient who is in cardiogenic shock. An assessment finding indicating to the nurse that the goals of treatment with the IABP are being met is a

Accepted Answer

A)   cardiac output (CO)  of 2 L/min.
B)   stroke volume (SV)  of 40 ml/beat.
C)   heart rate 110 beats/min.
D)   urine output of 100 ml/hr. D

Question 4

A patient with left ventricular failure is admitted to the coronary care unit (CCU). When monitoring for the effectiveness of treatment, the most important information for the nurse to obtain is

Accepted Answer

A)   systemic vascular resistance (SVR) .
B)   pulmonary vascular resistance (PVR) .
C)   mean arterial pressure (MAP) .
D)   pulmonary artery wedge pressure (PAWP) .

Question 5

A patient with an oral endotracheal tube (ET) has a nursing diagnosis of risk for aspiration related to the presence of an artificial airway. The most appropriate nursing intervention for the patient is to

Accepted Answer

A)   maintain cuff pressure at minimal occluding volume to prevent gastric secretions from entering the trachea.
B)   perform oral suctioning frequently and before cuff deflation.
C)   remove the bite block and perform oral hygiene every 2 hours.
D)   use chest physiotherapy to move secretions to large airways where they can be suctioned.

Question 6

The charge nurse evaluates the care that a new RN staff member provides to a patient receiving mechanical ventilation. Which action by the new RN indicates the need for more education?

Accepted Answer

A)   The RN turns the FIO2 up to 100% before suctioning.
B)   The RN asks for assistance to turn the patient to the prone position.
C)   The RN secures a bite block in place using adhesive tape.
D)   The RN positions the patient with the head of bed at 10 degrees.

Question 7

The nurse develops the diagnosis of ineffective airway clearance related to thick respiratory secretions for a patient with respiratory failure who is receiving mechanical ventilation. Which intervention will be most effective in resolving this problem?

Accepted Answer

A)   Increase the amount of water in the patient's enteral feedings.
B)   Suction the patient more frequently.
C)   Instill 5 ml of sterile saline into the ET before suctioning.
D)   Turn the patient every 2 hours.

Question 8

The mixed venous oxygen saturation (SvO2) is decreasing in a patient with hemodynamic monitoring who has severe pancreatitis. The patient's PaO2 and cardiac output are stable. To determine the possible cause of the decreased SvO2, the nurse assesses the patient's

Accepted Answer

A)   weight.
B)   temperature.
C)   urinary output.
D)   amylase.

Question 9

Which assessment data obtained by the nurse when caring for a patient with a left radial arterial line indicates a need for the nurse to take action?

Accepted Answer

A)   The flush bag and tubing were last changed 3 days previously.
B)   The left hand is cooler than the right hand.
C)   The mean arterial pressure (MAP)  is 75 mm Hg.
D)   The system is delivering only 3 ml of flush solution per hour.

Question 10

When the ventilator alarm sounds, the nurse finds the patient lying in bed holding the endotracheal tube (ET). The first intervention by the nurse is to

Accepted Answer

A)   position the patient in a left lateral position.
B)   call the health care provider immediately to reinsert the tube.
C)   activate the hospital's rapid response team.
D)   manually ventilate the patient with 100% oxygen.

Question 11

An arterial catheter is inserted in the right brachial artery to monitor a patient's blood pressure. Which information obtained by the nurse indicates that a complication of arterial pressure monitoring may be occurring?

Accepted Answer

A)   The Allen test is positive.
B)   The mean arterial pressure (MAP)  is 102 mm Hg.
C)   The dicrotic notch is visible in the waveform.
D)   The right hand is numb.

Question 12

When assisting with insertion of a pulmonary artery (PA) catheter, the nurse identifies that the catheter is correctly placed when the

Accepted Answer

A)   PA waveform is observed on the monitor.
B)   monitor shows a typical PAWP tracing.
C)   systemic arterial pressure tracing appears on the monitor.
D)   catheter has been inserted to the 22-cm marking on the line.

Question 13

When preparing to assist with the insertion of a pulmonary artery catheter, the nurse will anticipate the need to

Accepted Answer

A)   place the patient on a cardiac monitor.
B)   administer diuretics before the procedure.
C)   auscultate heart sounds during insertion.
D)   check cardiac enzymes before insertion.

Question 14

During hemodynamic monitoring, the nurse finds that a patient has decreased cardiac output (CO) without changes in pulmonary artery wedge pressure (PAWP) or systemic vascular resistance (SVR). The nurse anticipates assisting with interventions to

Accepted Answer

A)   reduce stroke volume.
B)   increase heart rate.
C)   lower right atrial pressure (RAP) .
D)   reduce central venous pressure (CVP) .

Question 15

Several family members of a patient who has just been admitted to the intensive care unit (ICU) with multiple traumatic injuries have just arrived in the ICU waiting room. Which action should the nurse take first?

Accepted Answer

A)   Take the family member members to the patient's room.
B)   Describe the patient's injuries and the care that is being provided.
C)   Discuss ICU visitation policies and encourage family visits.
D)   Invite the family to participate in a multidisciplinary care conference.

Question 16

A patient is admitted to the emergency department comatose and apneic with suspected head and neck injuries after falling from a roof. Which equipment will the nurse anticipate needing for emergency airway maintenance?

Accepted Answer

A)   Nasal endotracheal (ET)  tube
B)   Oral ET tube
C)   Tracheostomy tube
D)   Oropharyngeal airway

Question 17

Which action by a new RN who is caring for a patient with an intraaortic balloon catheter inserted in the left femoral artery will require immediate intervention by the ICU charge nurse?

Accepted Answer

A)   The new RN checks the patient's pedal pulses every 30 minutes.
B)   The new RN elevates the head of the patient's bed to 90 degrees.
C)   The new RN turns the patient onto the left side.
D)   The new RN has the patient take deep breaths.

Question 18

The nurse identifies a nursing diagnosis of disturbed sensory perception related to sleep deprivation for a patient in the ICU. An appropriate nursing intervention for this problem is to

Accepted Answer

A)   cluster nursing activities so that the patient has uninterrupted rest periods.
B)   administer prescribed sedatives or opioids at bedtime to promote sleep.
C)   silence the alarms on the cardiac monitors to allow the patient to take 30- to 40-minute naps.
D)   discontinue assessments during the night to allow uninterrupted rest for the patient.

Question 19

To inflate the cuff of an endotracheal tube (ET) when the patient is on mechanical ventilation, the nurse

Accepted Answer

A)   uses the minimal occluding volume technique by inflating the cuff with 10 ml of air.
B)   injects air into the cuff until a manometer indicates a pressure of 15 mm Hg.
C)   injects air into the cuff until no leak is heard at the peak inspiratory pressure.
D)   inflates the cuff until the pilot balloon cannot be easily compressed with the fingers.

Question 20

A patient in heart failure following an acute myocardial infarction has a pulmonary artery catheter inserted. To determine whether the administration of drugs to decrease preload and afterload has been effective, the nurse should monitor the

Accepted Answer

A)   systemic vascular resistance (SVR) .
B)   central venous pressure (CVP) .
C)   pulmonary vascular resistance (PVR) .
D)   pulmonary artery wedge pressure (PAWP) .

Exam 66: Nursing Management: Critical Care