Chamberlain College of Nursing NURSING 324 Exam 1 critical care Latest Updated2022/2023 Qu, Exams of Nursing

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Chamberlain College of Nursing NURSING 324 Exam 1 critical

care Latest Updated2022/2023 Questions With Answers

1.When planning care for a client who is critically ill, what action should the nurse

implement to decrease the client's stress? a. Strictly limit visitors. b. Play soft soothing music. c. Set lighting for day/night cycles. *d .Plan care to minimize interactions with the client.

2. The nurse is caring for a client with terminal cancer. It is essential for

the nurse to consider which aspect of this client's care?

a. Requesting that the chaplain visit the client.

*b. Compliance with the client's living will.

c. Maintaining a soothing environment.

d. Frequent family visitation.

3. When caring for an older adult client in the critical care setting, how can the nurse

best assess for pain? a. Use the FACES Pain Scale. *b. Observe non-verbal cues. c. Use the visual analog scale. d. Ask the client for a pain score.

4. What finding would the nurse address first following the administration of an opioid

analgesic in a client who is critically ill?..AKA.. ……NOTES: THIS WAS SELECT ALL THAT APPLY: Correct answers are: Constipation, Purities, Respiratory depress, Urinary retention a. Hypotension b. Constipation c. Increased pain *d. Respiratory depression TYPE: MA

5. In caring for a terminally ill client during the ventilator weaning process, the

nurse should be alert for which signs of discomfort? (Select all that apply) *a. Dyspnea *b. Tachycardia c. Bradycardia d. Hypotension *e. Use of accessory muscles

6. When caring for a client in the critical care setting, which environmental factor

should the nurse control to reduce stress? *a. Noise b. Light c. Visitation

d. Lack of privacy

7. An intensive care nurse is receiving bedside report from members of the healthcare

team for further management of care. What information would require immediate action by the oncoming team? a. Wheezes are noted throughout lung fields on auscultation. *b. There is noted paradoxical thoracoabdominal movement. c. Client is on a ventilator that includes the use of heliox. d. Client has a prolonged exhalation.

8. A client reporting dyspnea and chest pain with inhalation is being prepared for a

high- resolution multidetector computed tomography angiography (MCDTA). What information would the nurse include in the plan of care? *a. The client should remain still during the diagnostic test b. This is a nonspecific test, which could be positive with infections also c. The client will have to have their legs available for the diagnostic test d. This is an invasive test; afterwards the client will have to lie still for 4 hour

9. What does the nurse understand has the most potential to be a risk factor for acute

respiratory distress syndrome in a client undergoing general anesthesia for surgery? a. Poor nutritional stasis *b. Aspiration of gastric contents c. Pregnancy d. Chronic bronchitis

10. A client is receiving corticosteroids for the development of acute respiratory distress

syndrome (ARDS). What would the nurse evaluate to determine the client is not developing side effects? a. Monitor for lower extremity edema b. Check skin turgor *c. Assess the client’s mouth for thrush d. Watch sclera for yellowing

11. A nurse is evaluating a post-operative client with chronic obstructive pulmonary

disease for surgical complications. What assessment finding would the nurse understand as a potential risk factor for the development of post-surgical acute respiratory distress syndrome to be for this client? *a. client is not orientated to person, place, or situation b. client’s last food prior to surgery was ten hours ago c. client states “sitting upright helps my breathing” d. Clubbing of the fingers

12. The nurse is caring for a client with acute respiratory distress syndrome (ARDS)

and is on mechanical ventilation. What is the primary reason the client is being mechanically ventilated? a. So the client is fed via nasogastric tube. b. So the client can be sedated and rest.

c. To maintain adequate blood pressure. *d. To manage the client’s respirations.

13.. A client with acute respiratory distress syndrome (ARDS) on mechanical ventilation

is becoming increasingly restless. The client’s heart rate is 128 beats/min and oxygen saturation is 88% on FiO2 of 50%. Coarse rhonchi are audible in all lung fields on auscultation. What action should the nurse implement? *a. Hyper-oxygenate with 100% oxygen and suction the client. b. Administer neuromuscular blockade as ordered. c. Increase PEEP to 10 and sedate the client. d. Increase FiO2 to 60% for five minutes.

14.. A nurse is analyzing a client’s lab values. What would the nurse understand factors

into the analysis of oxygen saturation levels of a client? a. D-dimer assay b. Glomerular filtration rate c. Percentage of neutrophils *d. Hemoglobin level

15. The nurse is caring for a client with a history of asthma who recently had surgery. The

nurse is suspecting possible acute respiratory failure. The client’s respiratory rate is 32 bpm and Sa02 is 88% on room air. The client is reporting pain at a level of 3 out of 10. Which action is a priority? *a. Apply oxygen device b. Position client upright. c. Provide pain medication as needed. d. Prepare for lab draw for hemoglobin level.

16. A geriatric client is seen in the clinic with a diagnosis of chronic obstructive

pulmonary disease (COPD). What assessment information does the nurse understand could affect oxygenation and would be a risk factor for the development for acute respiratory failure? a. Presence of a barrel chest in the client *b. Kyphosis c. Hemoglobin of 10.1 mg/dL d. Weight loss of 5 lbs in 6 months

17. A client presents to the Emergency Department (ED) with shortness of breath and use

of accessory muscles. Vital signs on admission are as follows: blood pressure of 130/88, heart rate of 102, respiratory rate of 30, oxygen sat 89%. Which assessment findings are early indications of worsening respiratory failure?

a. Subcutaneous crepitus, absent breath sounds, confusion b. Dyspnea, circumoral cyanosis, distal cyanosis c. Rales, distended neck veins, hypotension *d. Restlessness, confusion, tachypnea

18. Which assessment finding is consistent with this condition?

a. Subcutaneous crepitus, absent breath sounds, confusion b. Dyspnea, circumoral cyanosis, distal cyanosis c. Rales, jugular venous distention, hypotension *d. Agitation, disorientation, lethargy

19. Which response by the nurse demonstrates an understanding of the potential

outcomes for a client with respiratory failure and cardiogenic shock? a. “The survival rate of clients with these conditions is high." *b. “The survival rate decreases when more than one organ fails.” c. “The client should immediately be placed on the heart/lung transplant list.” d. “The client will recover from the respiratory failure but not from cardiogenic shock.”

20.. When evaluating the effects of mechanical ventilation for acute

respiratory distress syndrome (ARDS), it is most important for the nurse to document which information? a. Inspiration-to-expiration ration (I:E) b. Level of sedation *c. Peak plateau pressure d. Blood pressure

21.. Which statement by the client demonstrates an understanding of triggers that

may exacerbate and asthma attack? *a. "I will refrain from strenuous exercise and activity." b. "I will only smoke outside the house." c. "I will make sure my dog only sleeps in the house at night." d. "I will wear gloves when using cleaning agents in the house."

22. When assessing a client for ventilator-associated pneumonia (VAP), it is most

important for the nurse to report which findings to the healthcare provider? a. A leukocyte count of 10,200 cells/microlite b. A temperature of 37C c. A blood pressure of 121/

*d. A chest x-ray with localized infiltrates

23. When providing care for a client with acute respiratory failure secondary to

chronic obstructive pulmonary disease who is receiving frequent doses of albuterol, which action is most essential? …NOTES… This question was change: the Answer for it was: AUSCULTATE THE LUNGS….Was the correct answer *a. Cardiovascular assessment b. Strict I&O monitoring c. Frequent skin assessment d. Routine CBC evaluation

24. When planning care of a client who is intubated secondary to acute

respiratory failure, it is most important for the nurse to coordinate with which member of the healthcare team? a. Chaplain *b. Physical therapist c. Social worker d. Occupational therapist

25.. A client is scheduled for vena cava filter placement. Which information is most

important to obtain before the procedure? *a. Surgical consent b. Results from the ventilation-perfusion scan c. Pain, tenderness, edema, and warmth in bilateral upper extremities d. D-Dimer assay

26. The healthcare provider ordered IV heparin drip to infuse at 1200 units/hr. The

medication available is heparin 25,000 units in 500 mL NS. At what rate will the nurse set the infusion? mL/hr (If needed, round to the nearest whole number.) *a. 24 b. 240 c. 25 d. 48

27. The healthcare provider ordered an IV infusion of dopamine at 0.2 mcg/kg/min.

The client weighs 160 lb. How many mg is the client receiving per minute? mcg/min (If needed, round to the nearest whole number.) a. 14 *b. 15 c. 145 d. 35

28. The healthcare provider ordered dobutamine intravenously. The safe dose

range is 2 to 20 mcg/kg/min. The medication available dobutamine is 250 mg in 500 mL D5W. The client weighs 140

lb. What is the minimum therapeutic rate that the nurse will set the infusion? mL/hr (If needed, round to the nearest whole number.) a. 152 b. 16 *c. 15 d. 50

29. The nurse is caring for a client with a deep vein thrombosis. The nurse

understands that which assessment finding was a risk factor for this condition? a. Middle age b. African-American *c. Recent abdominal surgery d. Recent vaccination

30. A client with a deep vein thrombosis (DVT), is being treated with heparin. Which

lab value would be most important for the nurse to report to the healthcare provider? a. Prothrombin Time of 11 seconds *b. Activated partial thromboplastin of 10 seconds. c. International Normalized Ratio of 1 d. Red blood cell count of 4.

31. A client comes to the emergency department with possible pneumonia. What

assessment data should the nurse obtain first? a. Assess appetite *b. Auscultate lungs c. Obtain blood pressure d. Auscultate heart sounds

32. A client with chronic obstructive pulmonary disease who was hospitalized with acute

respiratory syndrome is being discharged on albuterol. Which information is most important for the nurse to provide to the client regarding this medication? *a. "Report increased nervousness or heart palpitations." b. "Rinse mouth with water after using inhaler." c. "Use daily to prevent airway issues." d. "Report nausea and vomiting after use."

33. The nurse is caring for a client with a pulmonary emboli who is in Acute

Respiratory Syndrome. The client has other medical conditions that prevent treatment with anticoagulation therapy. Which procedure can be used to treat this client? a. Vena cava filter *b. Catheter embolectomy c. Pulmonary angiography d. Ventilation-perfusion scan

*c.Administer first dose of antibiotics within 6 hours of admission.

34. A client comes to the Emergency Department (ED) with acute respiratory

failure. Which prescription would the nurse complete first? …..NOTES: THIS QUESTION THE ANSWER: O2, ABG, a. Order chest x-ray b. Obtain sputum sample *c. Obtain arterial blood gases d. Order pulmonary function test

35. To evaluate the effectiveness of albuterol in a client with an acute asthma

attack, which nursing assessment would be best? a. client's ability to speak without difficulty. *b. Peak expiratory flow reading compared with baseline. c. client's use of accessory muscles. d. Presence of pulses paradoxes.

36. A client comes to the clinic because of chest pain and dyspnea. Which question

is most important for the nurse to ask? ……NOTE: THE ANSWER WAS: WHEN DID THE PAIN START? a. "How many pillows do you sleep on at night?" *b. "Is your pain worse when you take in a deep breathe?" c. "Can you walk one block without shortness of breathe?" d. "Do you have asthma?" Type: MA

37. The nurse is caring for a client with pneumonia. To prevent complications, which

nursing action(s) should be initiated? [Select all that apply] a. Restrict oral intake to prevent fluid overload. *b. Obtain blood culture prior to starting antibiotics. *d. Administer flu vaccine prior to discharge. *e. Instruct client to take prescribed antibiotic until medication is gone.

38. The nurse is caring for a client with acute respiratory failure on mechanical

ventilation management. What is the priority nursing action? *a. Maintain oxygenation level of SpO2 90-94% b. Manage sedation c. Maintain fluid and electrolyte balance d. Maintain PaO2 of 55% 39.. A client receiving treatment for a pulmonary emboli has a pulse oximetry reading of 92%. What action should the nurse take? a. Increase oxygen flow rate to 4L/min *b. Document finding and continue to monitor. c. Notify healthcare provider of need for intubation. d. *Administer bronchodilator.

40. The client who is recovering from a pulmonary emboli asks the nurse why he is scheduled for a vena cava filter insertion. Which response by the nurse is best?

a. "It prevents clots from forming in your lower legs." b. "It filters your blood to remove impurities." *c. "A vena cava filter will prevent clots from your leg to cause another pulmonary emboli." d. "It administers clot busting drugs when it recognizes a clot has formed."

41. A client is admitted to the hospital with a medical diagnosis of chronic obstructive pulmonary disease and acute respiratory failure. Which signs and symptoms would the client most likely exhibit? *a. Dyspnea and chest tightness. b. Chest tightness and bradycardia. c. PaCO2 of 40 and PaO2 of 80. d. Hypertension and bradycardia. TYPE: MA HEAD UP -------------------------------------------------------------------------------------------------- HEAD UP ALL THAT APPLY STRAIGHT FROM TB CHAPER 14 THIS QUESTION WAS CHANGE 42. The nurse is caring for a client on a ventilator. To prevent pneumonia, the nurse would provide which instruction(s) to the healthcare team? [Select all that apply] a. Use saline to clean respiratory equipment *b. Administer omeprazole *c. Assess client for readiness to wean *d. Provide oral care with chlorahexidine e. Keep patient in the supine position TO THIS ONE INSTEAD

42. Which of the following statements is true regarding oral care for the prevention

of ventilator-associated pneumonia (VAP)? (Select all that apply.)

a. Tooth brushing is performed every 2 hours for the greatest effect.

b Implementing^ a^ comprehensive^ oral^ care^ program^ is^ an^ intervention^ for^ preventing

. VAP.

c. Oral^ care^ protocols^ should^ include^ oral^ suctioning^ and^ brushing^ teeth.

d

. Protocols^ that^ include^ chlorhexidine^ gluconate^ have^ been^ effective^ in^ preventing^ VAP.

ANS: B, C, D

43. A client with respiratory distress on NPPV with an FiO2 of 40% has the following ABG results: pH 7.50, PaO2 52 mmHg, PaCO2 29 mmHg, HCO3 22 mEq/L. Respirations are rapid and shallow. Which action should the nurse initiate first? a. Administer sodium bicarbonate IV push. b. Administer midazolam (Versed) IV push. c. Increase FiO2 to 70% and redraw ABGs in 30 minutes.

*d. Prepare client for intubation and mechanical ventilation.

44. The nurse caring for a client with acute respiratory failure develops a plan of care with a client outcome of decreased ventilatory demand. Which finding indicates this outcome has not yet been met? a. Respiratory rate of 12. b. Lungs sounds clear. c. Respirations irregular. *d. Muscle retractions.

45. The nurse is caring for a client on mechanical ventilation for acute respiratory distress syndrome. The client has a pH of 7.25. What action would the nurse expect the respiratory therapist to take first? a. Maintain high tidal volume. b. Maintain high end-inspiratory plateau pressure. *c. Increase respiratory rate until pH reading is >7.30. d. Decrease respiratory rate to 12 breathes per minute.
46. The nurse is assessing a client with chronic obstructive pulmonary disease whose pulse oximetry reading is 85% on room air. Which instruction would the nurse give to the licensed practical nurse (LPN)? a. "Administer oxygen and quickly increase rate to 10 L/min." b. "Prepare client for intubation and mechanical ventilation." c. "Apply oxygen and slowly increase to a flow rate of 3L/min."….NOTES..(NOT 4ML) d. "Apply oxygen via rebreather mask at 2L/min." 47. A client is admitted to the Emergency Department (ED) with respiratory distress and chest pain. An arterial blood gas (ABG) is obtained and the pH is 7.52. These assessment findings are consistent with which condition? NOTE: THIS ONE WAS CHANGE TO FAT FEMUR LONG BONE *a. Pulmonary embolus b. Narcotic overdose c. Chest trauma d. COPD 48. The nurse caring for a ventilated client would implement which action to prevent ventilator associated pneumonia (VAP) a. Elevate head of the bed at 90 degrees. b. Tooth brushing performed once a shift. *c. Sedation vacation to assess for readiness to wean. d. Instilling normal saline before suctioning the client. 49. A client admitted to the intensive care unit (ICU) with an overdose of aspirin has the following arterial blood gas (ABG) results: pH 7.30, PaO2 88 mmHg, PaCO2 38 mmHg, HCO 18 mEq/L, O2 sat 92%. The nurse understands that the client has which acid-base imbalance? a. Respiratory alkalosis b. Respiratory acidosis c. Metabolic alkalosis *d. Metabolic acidosis…

50. A client arrives to the Emergency Department (ED) with anxiety, dyspnea, and rhonchi throughout both lung fields. Partial arterial blood gas (ABG) results reveal the following: pH - 7. PaO2 - 78 on room air PaCO2 – 64…..FOR EXAM PACO2 WAS: 33…….,,,,,,,HEAP UP* PaHCO3 - 32…..FOR EXAM HCO3 WAS: 18 ................. HEAP UP* The nurse understands the client has which acid base imbalance? a. Compensated respiratory alkalosis b. Uncompensated respiratory alkalosis c. *c. Partially compensated metabolic acidosis ……BUT THE ANSWER WAS STILL THE BECAUSE WHEN EVERYTHING IS ABNORMAL THAT MAKE IT: PARTIALY MEATBOLIC ACIDOSI d. Partially compensated respiratory acidosis