CCRN Practice Test 1: Critical Care Nursing Exam Questions and Answers, Exams of Advanced Education

Download CCRN Practice Test 1: Critical Care Nursing Exam Questions and Answers and more Exams Advanced Education in PDF only on Docsity!

2024 CCRN PRACTICE TEST 1EXAM

WITH CORRECT ANSWERS







Which of the following would warrant an immediate call to the neurosurgeon postoperatively? (A) ICP 15 mmHg, cerebral perfusion pressure 100 mmHg (B) a temperature increase to 39.8°C from 37.2°C (C) a urine output of 100 mL in the past hour and a urine specific gravity of

(D) the patient arouses with voice and was previously aroused with shaking - A patient with abdominal trauma is experiencing acute left shoulder pain. Which of the following might cause this symptom? (A) diaphragmatic irritation (B) ruptured bladder (C) liver contusion (D) ruptured kidney - A nursing measure designed to optimize the cerebral perfusion pressure (CPP) involves: (A) turning the patient every hour. (B) preventing the MAP from becoming greater than 65 mmHg. (C) maintaining the PaCO, at less than 30 mmHg. (D) maintaining a neutral head position. - The physician orders intubation and mechanical ventilation for a patient with asthma. The patient's respiratory rate is 28 breaths/minute, and she is currently receiving 3 L/nasal cannula oxygen. Which of the following arterial blood gases best supports the decision to place an endotracheal tube? (A) pH 7.41; PaCO2 39 mmHg; PaO2 83 mmHg (B) pH 7.50; PaCO, 29 mmHg; PaO2 72 mmHg (C) pH 7.46; PaCO, 33 mmHg; PaO2 62 mmHg (D) pH 7.36; PaCO2 41 mmHg; PaO2 62 mmHg - A 22-year-old male patient, with a known history of Wolff-Parkinson-White (WPW) syndrome, developed preexcited atrial fibrillation (AF) at a rate of 170 beats/ minute. The nurse should anticipate the administration of which of the following medications? (A) adenosine (Adenocard) (B) diltiazem (Cardizem) (C) esmolol (Brevibloc)

(D) digoxin (Lanoxin) - Which of the following patients will most likely need hemodialysis? (A) the patient with a BUN of 88 mg/dL and a creatinine of 3.8 mg/dL (B) the patient with metabolic alkalosis and hypokalemia (C) the patient with an aspirin overdose, a BUN of 15 mg/dL, and a creatinine of 1.5 mg/dL (D) the patient with a serum potassium of 5.8 mEq/L and a normal ECG - A type 2 diabetic patient presents with a serum glucose of 1,050 mg/dL and negative ketones. Which of the following is the priority intervention for this patient? (A) insulin (B) bicarbonate (C) potassium (D) fluid replacement - A patient with acute pancreatitis has the following assessment: Vital signs: Temperature 37°C, BP 98/65, heart rate 110 beats/minute, respiratory rate 28 breaths/minute, SpO2 89%, FiO2 of 2 L/nasal cannula Labs: WBC count 19,000, hemoglobin 9.0 g/dL, hematocrit 40%, Na+ 145 mEq/L, K+ 3.0 mEq/L, Ca++ 7.8 mEq/L, glucose 220 mg/dL Assessment: Lungs with left lower lobe crackles, abdomen with Cullen's sign Which of the following additional conditions (along with pancreatitis) does this patient most likely have, and what intervention is needed? (A) hemorrhagic shock, stress hyperglycemia, hypoxemia; the patient needs blood (B) hypovolemic shock, diabetes, sepsis; the patient needs antibiotics (C) SIRS, hemorrhagic pancreatitis, MODS; the patient needs fluids (D) dehydration, ARDS, stress hyperglycemia; the patient needs intubation - A patient who is receiving intracranial pressure monitoring has sustained A- waves on the intracranial pressure (ICP) monitor. Which of the following interventions is contraindicated for this patient? (A) Discontinue opiate and sedating drugs. (B) Administer mannitol. (C) Infuse isotonic solutions. (D) Drain CSF from the ventricular catheter. - A patient arrives in the critical care unit 4 hours postpartum with bleeding that is thought to be secondary to severe uterine atony. Her blood pressure is 78/40, her heart rate is 140 beats/minute, and her respiratory rate is 30 breaths/minute. Her hemoglobin is 11.2 g/dL. Which of the following interventions is appropriate?

(A) This patient has lost 1,500-2,000 mL of blood and is at a high risk for DIC. Initiate fluid resuscitation, transfuse blood, and check the coagulation profile. (B) The patient has lost 500-1,000 mL of blood and is at a high risk for septic shock. Initiate fluid resuscitation, give pressors, and obtain blood cultures. (C) The patient has lost 250-500 mL of blood and is at a high risk for a pulmonary embolism. Initiate fluid resuscitation, get a chest CT scan, and obtain a D-dimer. (D) The patient has lost over 2,000 mL of blood and is at a high risk for uterine rupture. Initiate fluid resusci - The decision has been made to wean a patient from the ventilator. Which of the Tot following would be an indication to stop the weaning trial? (A) the development of a paradoxical breathing pattern with accessory muscle use (B) the patient remains disoriented with demonstrations of mild anxiety and agitation (C) a productive cough with activation of the ventilator alarm within the first 5 minutes of the weaning trial (D) an increase in heart rate from 82 beats/minute to 96 beats/minute within the first 5 minutes of the weaning trial - A patient presents with a blood pressure of 232/129 and acute chest pain. Which of the following would be the agent of choice to use for this patient? (A) nicardipine (Cardene) (B) labetalol (Normodyne) (C) nitroprusside (Nipride) (D) diltiazem (Cardizem) - Which of the following findings would be expected during chest auscultation of a patient with systolic heart failure? (A) an S4 heart sound at the apex of the heart (B) a systolic murmur at the apex of the heart (C) a diastolic murmur at the left sternal border (D) an S3 heart sound at the apex of the heart - After attending an educational session that reviewed drug dosing and provided a review of the literature, the nurse would like to start using the admission weight to calculate drug dosing during titration of vasoactive drugs rather than the current practice of using daily weights. What would be the most effective next step for the nurse to take to implement this change? (A) Begin the adaptation of the practice by using the admission weight for patients. (B) Identify the key stakeholders related to the proposed change in practice.

(C) Ask the attending physician on rounds what her thoughts are about the practice. (D) Discuss the educational session with nurse colleagues. - (B) Identify the key stakeholders related to the proposed change in practice. 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. - (D) Initiate 0.9 normal saline. A patient with a urinary tract infection presented with a temperature of 39°C (102.2°F), a heart rate of 132 beats/minute, a respiratory rate of 24 breaths/minute, a BP of 78/49 (a MAP of 59 mmHg), and a lactate of 2. mmol/L. The patient received 2 L of 0.9 NS within 1 hour. The BP is now 100/52 (the MAP is 68 mmHg), the heart rate is 118 beats/minute, the respiratory rate is 20 breaths/minute, and the lactate is 2.1 mmol/L. The patient requires treatment for: (A) bacteremia. (B) sepsis. (C) SIRS. (D) septic shock. - (B) sepsis. A patient is 48 hours post aortic valve replacement. Which of the following would be a major goal for this patient? (A) diuretic therapy (B) stabilizing the blood pressure (C) prophylactic antibiotics (D) preventing a thrombus - (D) preventing a thrombus A patient with hypoxic encephalopathy has been opening his eyes to touch for the past 24 hours. The patient now withdraws to painful stimuli, has developed unequal pupils, and has a positive Babinski reflex. Which of the following interventions should the nurse anticipate? (A) ventriculostomy, oxygen, steroids (B) sedation, vasopressin (Pitressin), thiazide diuretic (C) osmotic diuretic, intubation, and monitor the pCO (D) lumbar puncture and increase the FiO2 - (C) osmotic diuretic, intubation, and monitor the pCO A 19-year-old patient who was admitted with sickle cell crisis and acute kidney injury requests to use a phone to update her friends on her condition. The nurse's best response would be to:

(A) explain to the patient that calls can be made when she is transferred out of the critical care unit. (B) allow the patient to make the calls in order to meet the patient's need for social support. (C) explain to the patient that she needs to rest in order for the analgesic medication to take effect. (D) allow the patient to make the calls in order to reduce the patient's anxiety. - (B) allow the patient to make the calls in order to meet the patient's need for social support. The unit quality council wants to reduce the number of CAUTIS. Which of the following strategies has been demonstrated to reduce incidences of CAUTIS? (A) Remove the indwelling urinary catheter on day 3 post-op. (B) Place the drainage collection system on the patient's abdomen during transport. (C) Assess the competency of the staff using a simulated environment. (D) Avoid the use of intermittent straight catheterization. - (C) Assess the competency of the staff using a simulated environment. A patient has cardiogenic shock and cardiogenic pulmonary edema. Which of the following therapies would be most effective for this patient? (A) an intra-aortic balloon pump to increase coronary artery perfusion (B) a beta blocker to increase cardiac contractility (C) an alpha-adrenergic drug to increase coronary artery perfusion (D) angiotensin-converting enzyme inhibitors to decrease afterload - (A) an intra-aortic balloon pump to increase coronary artery perfusion The care team is considering whether a patient is a candidate for hospice care. Which of the following is a specific service provided by hospice care? (A) advance care planning (B) symptom management (C) care for a terminal illness (D) consideration of patient/family wishes - (C) care for a terminal illness 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 PaCO2 of 77, a PaO2 of 51, and an HCO3 of 31. He is receiving noninvasive ventilation with settings that read as follows: FiO2 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 PaCO2 of 89, a PaO2 of 48, and an HCO3 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, 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. - (C) Alveolar hypoventilation is getting worse; the patient needs to be intubated. Which of the following is true regarding plateau pressure? (A) It is a pressure that is used to calculate static compliance and reflects pressure in the lungs. (B) It is a pressure that is used to calculate vital capacity and reflects pressure in the lungs. (C) It is a pressure that is used to calculate dynamic compliance and reflects pressure in the airways. (D) It is a pressure that is used to measure tidal volume and reflects pressure in the airways. - (A) It is a pressure that is used to calculate static compliance and reflects pressure in the lungs. A patient is admitted with a salicylate overdose. Which of the following treatments is most effective for this patient? (A) N-acetylcysteine, support the airway, fluids (B) gastric lavage, an antidote, fluids (C) activated charcoal, urine alkalinization, dialysis (D) support the airway, gastric lavage, ethanol - (C) activated charcoal, urine alkalinization, dialysis Which of the following patients who have sustained multiple trauma is most likely how to have a poor outcome based on patient characteristics? (A) the college graduate (B) the owner of a successful business (C) the married man (D) the homeless man - (D) the homeless man Which of the following may be a reason to use restraints for a patient? (A) The patient is screaming obscenities. (B) The patient is spitting. (C) The patient is pulling at his central venous catheter. (D) The patient has an endotracheal tube. - (C) The patient is pulling at his central venous catheter. A patient has acute right ventricular infarct and RV failure. Which of the following is an indication that this patient's condition has improved? (A) The PAOP has decreased. (B) The RA pressure has decreased. (C) The RV pressure has increased. (D) The PA diastolic pressure has decreased. - (B) The RA pressure has decreased.

At 1 day status post AAA repair with a Dacron graft, the patient's serum BUN and creatinine increase, and the urine output decreases. Which of the following is the most likely etiology of these new patient findings? (A) acute renal failure (B) graft rejection (C) septic shock (D) acute hemorrhage - (A) acute renal failure A patient complains of chest pain with deep inspiration that is worse when lying supine. There is a friction rub upon auscultation and sinus tachycardia. Which of the following would you expect to find on the stat 12-lead ECG? (A) ST depression in V1-V (B) ST elevation in II, III, aVF and V2-V (C) ST depression in V2 and V (D) ST elevation in II, III, and aVF - (B) ST elevation in II, III, aVF and V2-V A trauma patient's morning labs return with the following values: Hemoglobin 8.2 g/dL; hematocrit 30%; platelets 50,000/mcL; PTT 50 seconds; INR 3.0 seconds; fibrinogen 150 mg/dL; fibrin split products 45 mcg/dL What is most likely the cause of this patient's lab profile? (A) autoimmune reaction (B) consumption of clotting factors (C) occult blood loss (D) drug reaction - (B) consumption of clotting factors A patient has a temporary transvenous VVI pacemaker with a set rate of 72 beats/minute and an mA output of 5. The monitor shows 1:1 pacing at the set rate. The physician asks the nurse to determine the capture threshold. Which of the following should the nurse do? (A) Slowly increase the sensitivity until the heart rate increases. (B) Slowly decrease the sensitivity until the capture is lost. (C) Slowly increase the mA output until the native beats are seen. (D) Slowly decrease the mA output until the capture is lost. - (D) Slowly decrease the mA output until the capture is lost. A patient is alert and is receiving mechanical ventilation with the following settings: assist-control mode at 10 breaths/minute, FIO2 0.40, and PEEP 5 cm H2O pressure. Vital signs include a BP of 104/58, a heart rate of 90 beats/minute, and a respiratory rate of 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. - (A) Allow the patient to sit on the edge of the bed, with assistance. A 70 kg patient with ARDS is mechanically ventilated with the following settings: FiO2 70%, tidal volume 450 mL, assist-control mode 10 breaths/minute, and PEEP 20 cm H2O pressure. On these settings, the patient's PaO2 is 76 mmHg and the PaCO2 is 58 mmHg. The patient's core temperature is 37°C, his heart rate is 116 beats/minute, and his BP 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. - (B) Administer a 500 mL fluid bolus of normal saline. Which of the following is accurate regarding nursing responsibilities related to brain death? (A) The nurse should report a loss of brain stem reflexes (gag, corneal) to the physician. (B) The nurse should obtain an order from the physician to call the organ procurement agency. (C) The nurse should request permission from the patient's family to remove the ventilator. (D) The nurse should ensure that the patient receives an EEG, a Transcranial Doppler ultrasound, and a cerebral angiogram to make the diagnosis of brain death. - (A) The nurse should report a loss of brain stem reflexes (gag, corneal) to the physician. 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 H2O. The PaO is 60 mmHg. The physician orders the following ventilator settings: SIMV mode, tidal volume 700 mL, rate 12 breaths/ minute, FiO2 1.00, and PEEP 15 cm H2O 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 FiO2 - (B) the tidal volume Which of the following is an appropriate strategy to use when providing mechanical ventilation to a patient with status asthmaticus? (A) Provide a long inspiratory time and a short expiratory time. (B) Utilize a PEEP setting of 10-15 cm.

(C) Use a lower respiratory rate. (D) Set the tidal volume to 10-12 mL/kg. - (C) Use a lower respiratory rate. Which of the following complications might the RN expect for a patient with an acute inferior MI? (A) new onset 2nd-degree Type II heart block (B) acute LV failure (C) reciprocal changes (ST depression) in leads V3-V (D) an acute systolic murmur, loudest over the apical area - (D) an acute systolic murmur, loudest over the apical area A patient is admitted with a serum calcium of 15.1 mEq/L. Which of the following interventions should the nurse anticipate? (A) ruling out hypermagnesemia and administering vitamin D (B) treating hypoalbuminemia (C) emergent hemodialysis and ruling out hyperphosphatemia (D) ruling out hypokalemia and then administering diuretics - (D) ruling out hypokalemia and then administering diuretics Which of the following patients is most likely to experience heart block? (A) a patient who has had a cardiac transplant (B) a patient who has had CABG surgery (C) a patient who has had mitral valve repair (D) a patient who has had ventricular septal defect repair - (C) a patient who has had mitral valve repair A patient with a head injury was admitted last night. This morning, she is increasingly less responsive, and her right pupil has become unresponsive to light. Now, her systolic pressure has increased, her heart rate has slowed, and her respirations have also slowed. These vital sign changes are referred to as: (A) Battle's sign. (B)Cushing's triad. (C) halo sign. (D) Chvostek sign. - (B)Cushing's triad. A 68-year-old patient is admitted with syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following lab findings and interventions would the nurse anticipate for this patient? (A) serum sodium low, serum osmolality low, urine output low; order for phenytoin (Dilantin) (B) serum sodium elevated, serum osmolality elevated, urine output low; order for Pitressin (C) serum sodium low, urine specific gravity low, urine output elevated; order for 3% saline

(D) serum sodium elevated, urine output elevated, hypokalemia, arterial pH low - (A) serum sodium low, serum osmolality low, urine output low; order for phenytoin (Dilantin) A patient with chronic alcohol abuse is admitted with a serum phosphorus of 1.8 mEq/L. The nurse will need to observe this patient closely for: (A) massive diarrhea. (B) hypoventilation. (C) tetany. (D) ventricular arrhythmias. - (B) hypoventilation. 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 - (C) acting as an arbitrator between family members A patient is receiving patient-controlled analgesia, an IV infusion of morphine at 1 mg per hour, and 2 mg of morphine every 15 minutes as PRN bolus doses. The patient is having episodes of sleep apnea and is arousable only by touch. Priority interventions include: (A) stopping the continuous infusion and giving a slow IV push of naloxone until the patient awakens. (B) decreasing the morphine continuous infusion rate to 0.5 mg per hour and continuing to monitor that rate. (C) discontinuing the PRN bolus doses and giving a 2 mg IV bolus of naloxone. (D) discontinuing PCA, checking the SpO2, and giving naloxone. - (A) stopping the continuous infusion and giving a slow IV push of naloxone until the patient awakens. Which of the following is contraindicated when providing enteral feeding? (A) checking for gastric residuals every 4 hours (B) using a small-bore duodenal feeding tube (C) keeping the head of the bed flat (D) ensuring that free water is provided - (C) keeping the head of the bed flat A patient presented with sepsis secondary to a urinary tract infection. After the initial administration of 30 mL/kg of isotonic crystalloid, the BP is 88/ (the MAP is 60 mmHg), the heart rate is 102 beats/minute, the respiratory rate is 22 breaths/minute, and the lungs are clear. What intervention is indicated at this time? (A) Decrease the rate of fluid administration. (B) Start a dobutamine (Dobutrex) infusion.

(C) Start a norepinephrine (Levophed) infusion. (D) Start a vasopressin infusion. - (C) Start a norepinephrine (Levophed) infusion. A patient who was admitted status post gunshot wound to the chest 2 days ago is now exhibiting signs of restlessness, hypertension, tachycardia, yawning, lacrimation, and rhinorrhea. Which of the following should be included in the nurse's plan of care? (A) Assess the patient further for a history of opiate abuse. (B) Provide scheduled pain medication. (C) Ensure that there is an order for sedation, and administer a sedative. (D) Discuss the need for an antihypertensive agent with the physician. - (A) Assess the patient further for a history of opiate abuse. A 74-year-old female reports explosive diarrhea for several days. She is lethargic, her mucous membranes are dry and sticky, she has had dark amber urine with 40 mL output in the past hour, her urine specific gravity is 1.035, her BUN is 65, and her creatinine is 2.9. Her vital signs are a temperature of 38°C, a heart rate of 130 beats/minute, a respiratory rate of 24 breaths/minute, and a BP of 90/40. Which of the following should the nurse anticipate administering? (A) antibiotics (B) nutrition (C) isotonic fluids (D) furosemide - (C) isotonic fluids Which of the following interventions has bow been demonstrated to prevent ventilator-associated pneumonia (VAP)? (A) Include chlorhexidine rinse or gel in the unit oral care protocol. (B) Discontinue tube feedings prior to placing the patient supine for repositioning. (C) Perform subglottic suctioning after cuff deflation. (D) Avoid use of a toothbrush for a patient with an endotracheal tube. - (A) Include chlorhexidine rinse or gel in the unit oral care protocol. A nurse is reviewing the lab results of a patient who was admitted with a stroke and a history of thyroid disease. The lab results include an Na* of 118 mEq/L, elevated TSH, and elevated LDH and CK. Which of the following patient signs/symptoms might the nurse anticipate? (A) a fever (B) tachycardia (C) elevated T3 and T (D) respiratory depression, hypoxemia - (D) respiratory depression, hypoxemia

A patient with a history of heart failure and MI presents following an episode of syncope. The assessment 2 hours later demonstrates: BP 134/64 (supine); 110/70 (sitting) Heart rate 115 beats/minute with a weak, thready pulse (supine); 130 beats/minute (sitting) RR 32 breaths/minute and shallow U/O 30 mL over the past 2 hours Breath sounds: clear This patient most likely requires: (A) vasodilators. (B) loop diuretics. (C) IV fluids. (D) vasopressors. - (C) IV fluids. Which of the following is an appropriate intervention when caring for a patient with a central venous catheter? (A) Use gauze dressing. (B) Provide a daily chlorhexidine bath. (C) Replace central lines weekly. (D) Disinfect access hubs prior to use by scrubbing the hubs for 5 seconds or less. - (B) Provide a daily chlorhexidine bath. A patient is status post stroke and has been advanced to oral feedings after successfully completing a swallow study. The nurse knows that the patient needs to be closely monitored for signs of pulmonary aspiration. Which of the following is the earliest indication that the patient may be aspirating his oral feedings? (A) coughing and tachypnea (B) positive sputum cultures (C) oxygen desaturation (D) right middle lobe infiltrate on a chest radiograph - (A) coughing and tachypnea While getting a 71-year-old male patient's history, the patient tells the nurse that he has mitral valve stenosis. Based on this information, the nurse would anticipate which of the following findings? (A) systolic murmur, sinus bradycardia (B) systolic murmur, atrial fibrillation (C) diastolic murmur, atrial fibrillation (D) diastolic murmur, sinus bradycardia - (C) diastolic murmur, atrial fibrillation Which of the following patients will require 0.9 NS at 1 mL/kg before and after a CT scan with an infusion of contrast media? (A) an elderly patient who is taking NSAIDS every 6 hours for arthritis (B) a patient with hypertension. (C) a male patient who is taking a beta-adrenergic blocker

(D) a patient with acute coronary syndrome - (A) an elderly patient who is taking NSAIDS every 6 hours for arthritis A patient was admitted status post motor vehicle crash. The patient sustained an intracranial bleed and is hypotensive and tachycardic. This patient's clinical status is most likely due to which of the following? (A) intracranial hemorrhage (B) neurogenic shock (C) shock from multiple trauma (D) brain herniation - (C) shock from multiple trauma A 19-year-old male patient was admitted with DKA for the third time in the past 4 months. The patient told the nurse that he is considering dropping out of college, that he cannot concentrate on his studies, that he has had insomnia, and that he is just "sick of it all." Which of the following would be the nurse's best response? (A) Consult with the physician regarding the initiation of an antidepressant. (B) Consult with an endocrinologist regarding the patient's symptoms. (C) Consult with the physician regarding a psychiatric consult. (D) Provide emotional support and encourage the patient to be positive. - (C) Consult with the physician regarding a psychiatric consult. Twelve hours after admission for a traumatic injury, a patient's arterial blood gas showed the following results: pH 7. pCO2 28 mmHg p02 68 mmHg HCO3 25 mmol/L Which of the following interventions is most appropriate at this time? (A) Consider intubation and assess the blood pressure. (B) Increase the FiO2 and assess the electrolytes. (C) Consider sedation and assess the blood sugar. (D) Increase the FiO2 and assess for pain. - (D) Increase the FiO2 and assess for pain. A patient is admitted postoperatively after surgery for a crush injury of the lower left leg that was sustained in a motor vehicle crash. Which of the following is indicated for the prevention of deep vein thrombosis? (A) compression stockings (B) a pneumatic compression device on the right extremity (C) daily low-molecular-weight heparin (D) daily warfarin - (C) daily low-molecular-weight heparin Abdominal auscultation of a patient with early mechanical bowel obstruction would likely reveal which of the following? (A) normal bowel sounds

(B) hyperactive bowel sounds (C) hypoactive bowel sounds (D) absent bowel sounds - (B) hyperactive bowel sounds A patient was admitted with an acute anterior wall myocardial infarction and suddenly develops a loud holosystolic murmur (that is loudest at the left sternal border, 5th intercostal space), tachypnea, and bibasilar crackles. Which of the following would provide the most definitive diagnosis for this problem? (A) decreased cardiac output (B) increased oxygen saturation in the pulmonary artery and the right ventricle (C) the central venous pressure is less than the pulmonary artery diastolic pressure (D) decreased arterial oxygen saturation - (B) increased oxygen saturation in the pulmonary artery and the right ventricle A patient who is receiving mechanical ventilation is also receiving a propofol drip at 50 mcg/kg/min in order to maintain a RASS score of -1 to -2. The patient becomes agitated with a RASS score of +3 and a behavioral pain scale (BPS) score of 10 (the range is 3-12). The SpO2 and breath sounds are unchanged. The blood pressure and the heart rate are somewhat high. Which of the following interventions would be appropriate? (A) Increase the propofol infusion to 60 mcg/kg/min. (B) Give lorazepam 2 mg IV. (C) Give morphine 2 mg IV. (D) Order an arterial blood gas STAT. - (C) Give morphine 2 mg IV. Which of the following statements related to the care of a patient with a chest tube is TRUE? (A) Clamp the tube during patient transport. (B) Position the tubing in a dependent loop. (C) Avoid high airway pressures. (D) Place the collection chamber onto the cart during transport. - (C) Avoid high airway pressures. Which of the following may be the result of pulmonary hypertension? (A) pulmonary valve stenosis (B) left ventricular failure (C) tricuspid regurgitation (D) increased lung compliance - (C) tricuspid regurgitation Which of the following interventions would a nurse anticipate for a patient with an intracerebral hemorrhage? (A) a STAT MRI of the brain (B) correction of coagulopathy

(C) surgical evacuation of the hematoma (D) nitroprusside (Nipride) for an immediate correction of hypertension - (B) correction of coagulopathy A patient with a history of alcohol abuse sustained a traumatic injury and was admitted to the ICU. Which of the following is most likely to prevent the development of delirium tremens (DTS) for this patient? (A) thiamine (B) phenobarbital (C) fluids (D) benzodiazepines - (D) benzodiazepines A patient is receiving a heparin infusion status post pulmonary embolism. The latest lab results reveal a sudden drop in the platelet count to 80,000/mcL from 280,000/ mcl the previous day. The nurse would anticipate receiving which of the following physician orders? (A) Begin an argatroban infusion. (B) Hold all anticoagulants. (C) Infuse platelets. (D) Continue heparin and order labs for heparin antibodies. - (A) Begin an argatroban infusion. A patient who has a complex diabetic ulcer is receiving negative-pressure wound therapy. Which of the following is a recommended nursing intervention for this patient? (A) Contact the provider if suction is lost for more than 4 hours. (B) Change the dressing daily. (C) Flush the tubing daily. (D) Change the wound VAC canister when it is full. - (D) Change the wound VAC canister when it is full. A nurse is preparing to suction a patient who is receiving mechanical ventilation and has a history of increased ICP due to a head injury. Which of the following interventions is contraindicated for this patient? (A) increasing the FiO2 to 100% during suctioning (B) providing sedation (C) limiting the procedure to 1 to 2 quick passes (D) stimulating coughing - (D) stimulating coughing A patient who was admitted with DKA is receiving treatment in the ICU, and he develops tachycardia, diaphoresis, and restlessness. Which of the following interventions is most likely needed? (A) Increase the insulin dose. (B) Obtain a stat 12-lead ECG. (C) Administer a glucose source. (D) Provide an increase in fluids. - (C) Administer a glucose source.

A 70-year-old patient is admitted with a serum glucose of 850 mg/dL, a history of type 2 diabetes, and an obtunded mental status. Which of the following laboratory findings would be expected? (A) pH 7.35, sodium 150 mEq/L, BUN 10 mEq/L (B) pH 7.25, potassium 3.2 mEq/L, serum osmolality 160 mOsm/kg (C) pH 7.35, potassium 5.9 mEq/L, sodium 128 mEq/L (D) pH 7.25, potassium 6.2 mEq/L, serum Burgosmolality 310 mOsm/kg - (C) pH 7.35, potassium 5.9 mEq/L, sodium 128 mEq/L A 28-year-old woman is in the ICU with a gunshot wound to the head. One week after admission, the physician has declared the patient brain-dead. The nurse is present when the diagnosis is shared with the patient's mother. What is one of the first issues the nurse needs to anticipate for this type of situation specifically? (A) the need to document this physician-family discussion (B) the need to initiate a discussion about organ donation (C) that the family may request a second opinion (D) that the hospital ethics committee should be contacted - (C) that the family may request a second opinion A 55-year-old male with a history of alcohol abuse is in the ICU status post upper GI bleeding. The bleeding was controlled with an upper endoscopy and the administration of proton-pump inhibitors. Currently, the patient is complaining of extreme pain at the site of a tibial abrasion he sustained prior to admission. The abrasion has a small area of blackened tissue with an area of reddened tissue (approximately 15 cm in size) surrounding the abrasion and purplish discoloration around the borders. The priority nursing intervention for this patient is to: (A) apply an ice pack to the abrasion. (B) administer an analgesic. (C) contact the provider to examine the abrasion. (D) cover the abrasion with sterile gauze. - (C) contact the provider to examine the abrasion. A patient develops SVT, and synchronized cardioversion is being considered. Which of the following would be a contraindication to the cardioversion? (A) a digoxin level of 4.0 mg/dL (B) a potassium level of 5.1 mEq/L (C) a magnesium level of 2.6 mg/dL (D) a creatinine level of 3.1 mg/dL - (A) a digoxin level of 4.0 mg/dL An orientee asks the preceptor how IABP therapy will benefit a patient who was just admitted from the cardiac catheterization suite. The preceptor's best response would be to explain IABP therapy will increase: (A) the patient's myocardial oxygen supply.

(B) coronary artery perfusion during systole. (C) the patient's left ventricular filling volume. (D) left ventricular diastolic pressure. - (A) the patient's myocardial oxygen supply. A shift of the oxyhemoglobin-dissociation curve to the right will result in: (A) improved SaO2. (B) worsening SaO2. (C) a decreased release of oxygen from the with hemoglobin. (D) a decreased release of 2,3-DPG in the serum. - (B) worsening SaO2. A patient in septic shock received a pulmonary artery catheter. Which of the following hemodynamic profiles would this patient most likely exhibit? (A) SVR 1,400 dynes/s/cm-5, cardiac output 5 L/min, SvO2 58% (B) SVR 1,800 dynes/s/cm-5, cardiac output 6 L/min, SvO2 60% (C) SVR 500 dynes/s/cm-5, cardiac output 7 L/min, SvO2 78% (D) SVR 700 dynes/s/cm-5, cardiac output 2 L/min, SvO2 68% - (C) SVR 500 dynes/s/cm-5, cardiac output 7 L/min, SvO2 78% A patient was admitted with a serum glucose of 498 mg/dL. After 2 hours of therapy with 5 units/hour of regular insulin, the patient's glucose is 478 mg/dL. Which of the following interventions is appropriate at this time? (A) Add subcutaneous sliding scale insulin coverage, and continue to monitor the patient. (B) Continue the insulin infusion at the current dose, and continue to monitor the patient. (C) Increase the insulin infusion to 7 units/ hour, and continue to monitor the patient. (D) Increase the insulin infusion to 10 units/hour, and continue to monitor the patient. - (D) Increase the insulin infusion to 10 units/hour, and continue to monitor the patient. A patient is admitted with a right cerebral hemispheric stroke. An assessment of this patient would reveal: (A) a dilated left pupil and left-sided paresis or plegia. (B) a dilated left pupil and right-sided paresis or plegia. (C) a dilated right pupil and left-sided paresis or plegia. (D) a dilated right pupil and right-sided paresis or plegia. - (C) a dilated right pupil and left-sided paresis or plegia. When there is a drop in the cardiac output, which of the following is a normal compensatory response? (A) increased myocardial oxygen extraction (B) decreased myocardial oxygen consumption (C) decreased heart rate

(D) increased myocardial oxygen delivery - (A) increased myocardial oxygen extraction A 19-year-old female is admitted to the critical care unit with type 1 diabetes. Her family reported that she was home with a "chest cold" today and became very lethargic after dinner. Her blood glucose is 490 mEq/dL, and her serum is positive for ketones. What is the most likely cause of this patient's current symptoms? (A) dietary noncompliance (B) an insulin omission (C) an infection (D) dehydration - (C) an infection Upon arrival at the ICU from the cardiac catheterization lab, where the patient had a diagnostic right heart catheterization and a percutaneous coronary intervention, the cardiologist informed the nurse that the patient had an elevated left ventricular filling pressure and a low cardiac output. Which of the following therapies would be beneficial for this patient? (A) left ventricular afterload reduction (B) heart rate reduction (C) left ventricular preload elevation (D) negative inotropic therapy - (A) left ventricular afterload reduction Which of the following assessment findings would indicate the presence of a massive hemothorax? (A) absent breath sounds on the affected side; hyperresonance to percussion; tracheal deviation toward the affected side (B) decreased excursion on the affected side; dullness to percussion; tracheal deviation toward the affected side (C) absent breath sounds on the affected side; dullness to percussion; tracheal deviation toward the unaffected side (D) decreased excursion on the unaffected side; hyperresonance to percussion; tracheal deviation toward the unaffected side - (C) absent breath sounds on the affected side; dullness to percussion; tracheal deviation toward the unaffected side A patient has acute renal failure secondary to septic shock, had prolonged hypotension, and now requires hemodialysis (since his BUN is 90 mg/dL and his creatinine is 9.2 mg/dL). Which of the following findings would the nurse expect this patient to have? (A) low urine osmolality, high urine sodium (B) high urine osmolality, high urine sodium (C) low urine osmolality, low urine sodium (D) high urine osmolality, low urine sodium - (A) low urine osmolality, high urine sodium

A patient had an episode of chest pain at rest with ST elevation on the ECG. The chest pain was relieved, and the ST segments were normalized after the administration of nitroglycerin sublingual. This patient most likely had: (A) stable angina. (B) an ST-elevation myocardial infarction. (C) Prinzmetal's, or variant, angina. (D) Wellens syndrome. - (C) Prinzmetal's, or variant, angina. A patient develops abdominal pain, shortness of breath, and a fever during the administration of a blood transfusion. What is the priority nursing intervention? (A) Administer oxygen. (B) Contact the physician. (C) Administer acetaminophen. (D) Stop the transfusion. - (D) Stop the transfusion. During initial shift rounds, the nurse notices that the patient has edema on her left hand (about 2 inches in diameter) above the insertion site of an IV that is infusing 0.9 normal saline. The patient also has blanched skin, and she denies having any pain. Which of the following is the appropriate assessment and intervention in addition to stopping the infusion? (A) The patient has a stage 2 infiltration. Restart the IV in her right extremity. (B) The patient has a stage 0 infiltration. Elevate the left extremity, and apply warm compresses. (C) The patient has a stage 1 infiltration. Check for blood return. (D) The patient has an extravasation. Contact the pharmacist for an antidote.

• (A) The patient has a stage 2 infiltration. Restart the IV in her right extremity. A patient has an esophageal balloon tube (Sengstaken-Blakemore) for the treatment of bleeding esophageal varices. What nursing assessment/intervention is specific to the care of a patient with this type of tube? (A) Ensure that suction is maintained. (B) Monitor for recurrent bleeding. (C) Initiate fluid resuscitation as needed. (D) Keep scissors at the bedside. - (D) Keep scissors at the bedside. A 28-year-old male patient with muscular dystrophy is admitted with acute respiratory failure secondary to heart failure. He tells the nurse that he is tired of frequent hospitalizations related to his disease and does not want invasive or noninvasive ventilation since he is tired of living. Which of the following would be the nurse's best response? (A) "You will need to sign a 'No CPR' form as soon as possible."

(B) "You are very uncomfortable right now, but you will feel differently when you are feeling better." (C) "This is an acute problem that can be resolved with treatment, allowing you to return home to your family." (D) "Have you discussed this decision with or your family and your physician?" - (D) "Have you discussed this decision with or your family and your physician?" Which of the following patients has delirium? (A) The patient has become lethargic and is inattentive. (B) The patient is unresponsive. (C) The patient is acutely agitated and attentive. (D) The patient's baseline mental status has not changed. - (A) The patient has become lethargic and is inattentive. A patient received 10 units of packed red blood cells for a traumatic injury. Which of the following therapies should the nurse anticipate? (A) platelets and fresh frozen plasma (B) protamine zinc (C) albumin (D) calcium and hetastarch - (A) platelets and fresh frozen plasma A patient has been receiving intravenous morphine PRN for postoperative pain. When entering the room to administer an antibiotic, the nurse notices that the patient's respiratory rate has decreased to 8 breaths/minute and that the patient requires shaking to arouse. What is a priority intervention at this time? (A) Administer naloxone (Narcan) 0.4 mg IV. (B) Call the cardiac arrest team. (C) Administer flumazenil (Romazicon) 0.2 mg IV. (D) Contact the physician for a change in the analgesic orders. - (A) Administer naloxone (Narcan) 0.4 mg IV A patient who was admitted for community-acquired pneumonia has a history of Parkinson's disease, and the nurse administers a screen for dysphagia prior to giving the patient anything by mouth. Which of the following is NOT a sign of a positive screen for dysphagia? (A) frequent throat clearing after the administration of water (B) weight loss (C) facial asymmetry (D) coughing after the administration of water - (B) weight loss An infection prevention nurse reported 5 new cases of Clostridium difficile over the past 2 weeks in the ICU. Which of the following is an effective strategy for preventing future infections in this unit? (A) Test all patients and staff for C. difficile colonization.

(B) Initiate the implementation of prophylactic antibiotic administration to all patients in the unit. (C) Place patients with documented C. difficile in airborne isolation. (D) Ensure that all staff understand the need for using soap and water for hand hygiene after contact with a patient. - (D) Ensure that all staff understand the need for using soap and water for hand hygiene after contact with a patient. A 59-year-old male is admitted with ST elevation in V2, V3, and V4. IV thrombolytic therapy was started in the Emergency Department. Indications of successful reperfusion would include all of the following EXCEPT: (A) the cessation of pain. (B) the absence of troponin elevation. (C) the reversal of ST segment elevation with a return to baseline. (D) short runs of ventricular tachycardia. - (B) the absence of troponin elevation. A patient with lung cancer is status post a right-sided thoracotomy with removal of the middle and lower right lung lobes. What is the main purpose of the patient's 2 chest tubes? (A) to provide normal ventilation (B) to restore negative pleural pressure (C) to improve lung compliance (D) to drain pleural fluid - (B) to restore negative pleural pressure The critical care leadership of a medical center with several ICUs has assembled a committee to decide how to implement the use of a new patient transfer device (that was recently purchased) in the critical care units. Which of the following would be an important initial action for this committee? (A) Benchmark area hospitals that have already implemented the use of the new device. (B) Consult with the manufacturer to see if printed user guides are available. (C) Check for any national safety warnings related to the new piece of equipment. (D) Include nurses from all units that will use the new patient transfer device on the committee. - (D) Include nurses from all units that will use the new patient transfer device on the committee. PEEP is beneficial for the treatment of patients with pneumonia, ALI, or ARDS due to which of the following effects? (A) a decrease in pulmonary shunt (B) an increase in dead space ventilation (C) an increase in alveolar recruitment (D) a decrease in capillary leak - (C) an increase in alveolar recruitment

A 79-year-old male comes to the critical care unit with left-sided paralysis and paresthesia, eye deviation to the right, and a dilated right pupil. He cannot remember falling and has no signs of physical trauma. His family states that he has been "acting differently" for approximately 1 month. The patient denies having a headache. Based on this information, he probably has which of the following? (A) a left-hemispheric epidural hematoma (B) a right-hemispheric subdural hematoma (C) a basilar skull fracture (D) central herniation - (B) a right-hemispheric subdural hematoma It is suspected that a patient has appendicitis with intestinal perforation. Which of the following descriptions of abdominal pain is most specific to peritoneal irritation? (A) The pain is lessened while lying still with knees flexed. (B) There is generalized pain of the abdominal area. (C) The pain lasts longer than 6 hours. (D) The pain is becoming increasingly severe. - (A) The pain is lessened while lying still with knees flexed. Which of the following best characterizes acute respiratory distress syndrome (ARDS)? (A) tachypnea, unilateral pulmonary edema on a chest X-ray (B) decreased lung compliance, hypercapnia, an infection (C) elevated PAOP, bilateral infiltrates on a chest X-ray, pO2 is less than 60 mmHg (D) refractory hypoxemia, decreased functional residual capacity (FRC), an acute physiological problem - (D) refractory hypoxemia, decreased functional residual capacity (FRC), an acute physiological problem A 23-year-old patient with head trauma begins to have polyuria with a urine output of 900 mL in 1 hour, a urine specific gravity of 1.001, and an elevated serum osmolality. Which of the following interventions would be expected for this patient? (A) Administer 3% saline. (B) Administer phenytoin. (C) Administer Pitressin. (D) Administer dextrose 5% in water. - (C) Administer Pitressin. A patient complains of chest tightness and shortness of breath shortly after an IV antibiotic is initiated. Hives have appeared across her face and chest. Her vital signs include a BP of 84/34, a heart rate of 130 beats/minute, sinus tachycardia, a respiratory rate of 28 breaths/minute with wheezing, and SpO2 94% on room air. Which of the following interventions is most. appropriate for this patient? (A) stat ECG, aspirin, oxygen, pressor

(B) albuterol, steroids, oxygen, fluids (C) fluids, oxygen, a CT scan of the chest, heparin (D) epinephrine IM, steroids IV, an antihistamine, fluids - (D) epinephrine IM, steroids IV, an antihistamine, fluids A patient presents with a mental status change and a history of headaches. His carboxyhemoglobin level is 45%, and the pulse oximeter is reading 98%. What is the priority treatment for this patient? (A) Provide 100% FiO2 (B) Provide mechanical ventilation. (C) Provide 40% FiO2. (D) Administer naloxone (Narcan). - (A) Provide 100% FiO2 A patient is admitted with chest pain and ST elevation in II, III, and aVF. He is receiving dobutamine at 10 mcg/kg/min and nitroglycerin at 20 mcg/min. His blood pressure is 90/60, and there is sinus tachycardia at 110 beats/minute. A pulmonary artery catheter is inserted, and the following values are obtained: RAP = 16 mmHg, PAOP=5 mmHg, PAP = 26/10 mmHg, cardiac index = 1.9 L/min/m2 The patient has jugular venous distention in a Semi-Fowler's position; tall, peaked P-waves are seen in lead II. Which of the following therapies is indicated for this patient? (A) Increase the dobutamine infusion to 20 mcg/kg/min, and infuse 50 mL of saline. (B) Begin a milrinone infusion at 0.5 mcg/kg/min after a loading dose of 50 mcg/kg. (C) Discontinue the nitroglycerin, and infuse 500 mL of normal saline. (D) Discontinue dobutamine, and start a dopamine infusion at 10 mcg/kg/min. - (C) Discontinue the nitroglycerin, and infuse 500 mL of normal saline. Which of the following is true about an epidural hematoma? (A) The patient's level of consciousness will change before pupillary changes occur. (B) It may occur up to a month after the injury. (C) There is a risk of uncal herniation of the brain. (D) Muscle weakness will occur on the side of the injury. - (C) There is a risk of uncal herniation of the brain. An 81-year-old male patient was admitted with sinus arrest. The cardiologist has recommended to the patient that he receive a permanent pacemaker. The patient, who has a history of hypertension and type 2 diabetes, told the physician that he does not want a pacemaker and that he would rather "let nature take its course." What would be the best approach for the nurse to take regarding this patient's decision?

(A) Explain to the patient that he might die without the pacemaker. (B) Explain the consequences of the patient's decision to his family, and advise them to persuade the patient to agree to the procedure. (C) Explore the reason for the patient's decision, and provide information on what is involved during the procedure and the usual recovery period. (D) Advise the patient that a "No CPR" order will be needed in order to limit treatment that will prevent his heart from stopping. - (C) Explore the reason for the patient's decision, and provide information on what is involved during the procedure and the usual recovery period. A nurse who is caring for a patient after coronary artery bypass graft (CABG) surgery should: (A) anticipate a possible drop in blood pressure during rewarming. (B) strip the chest tubes hourly to maintain patency. (C) maintain a blood sugar of 150-200 mg/dL with an insulin infusion. (D) maintain a serum potassium of 3.0-4.0 mEq/L to prevent arrhythmias. - (A) anticipate a possible drop in blood pressure during rewarming. Unlike a patient with systolic dysfunction, a patient with diastolic heart failure may benefit from: (A) digoxin. (B) a calcium channel blocker. (C) an ACE inhibitor. (D) dobutamine. - (B) a calcium channel blocker. A patient is admitted with bleeding esophageal varices. Which of the following is a sign of compensation for hypovolemic shock? (A) a decrease in renin secretion (B) an increase in the reabsorption of sodium and water (C) vasodilation (D) a capillary fluid shift to the interstitial space - (B) an increase in the reabsorption of sodium and water A patient with status asthmaticus requires mechanical ventilation. Which of the following needs to be utilized? (A) increased inspiratory phase (B) increased PEEP (C) increased expiratory phase (D) increased breath rate - (C) increased expiratory phase A patient has right middle and lower lobe bacterial pneumonia and is expectorating rust-colored sputum. Which of the following interventions is most appropriate for this patient? (A) Provide antibiotic therapy to cover MRSA. (B) Turn the patient to the left to prevent hypoxemia. (C) Withhold the enoxaparin that is prescribed for DVT prophylaxis.

(D) Maintain the head of the bed at less than 30°. - (B) Turn the patient to the left to prevent hypoxemia. A patient had a pulmonary artery catheter, and the following values were obtained on the initial shift assessment: Blood pressure 82/48, heart rate 126 beats/minute, pulmonary artery pressure 22/10, central venous pressure (CVP) 1 mmHg, pulmonary artery occlusion pressure 4 mmHg, cardiac output 3 L/minute, and systemic vascular resistance 1,600 dynes/s/cm-5 This patient requires the administration of: (A) a fluid bolus of 500 mL of 0.9 normal saline. (B) dopamine at 5 mcg/kg/min. (C) dobutamine (Dobutrex) at 10 mcg/kg/min. (D) nitroprusside (Nipride) at 1 mcg/kg/min. - (A) a fluid bolus of 500 mL of 0.9 normal saline. A patient has been admitted to the ICU with a diagnosis of esophageal varices and upper GI bleeding, the third such admission in the last year. She is hemodynamically stable, and there is no evidence of active bleeding at this time. Which of the following questions will provide the nurse with the information needed to ensure that her patient understands her diagnosis? (A) Why do you think you are sick? (B) When did you experience your first symptoms? (C) Does anyone else in your family have this bleeding problem? (D) Do you consume alcohol on a regular basis? - (A) Why do you think you are sick? A patient is demonstrating agitated behavior with a RASS score of +3. What is a priority assessment for this patient? (A) CAM-ICU (B) SpO2 (C) BPS (D) blood pressure - (B) SpO2 It is day 3 in the ICU for a 63-year-old female patient who presented with multiple trauma. She is receiving mechanical ventilation, status post repair of a lacerated liver, and she has had a chest tube insertion for a pneumothorax. Which of the following is appropriate for the patient at this time? (A) a chaplain consult (B) palliative care (C) a "No CPR" order (D) a hospice consult - (B) palliative care It is important to create a unit culture that is dedicated to patient safety, with a goal of zero patient falls. Which of the following strategies is the