Critical Care Nursing Exam Preparation: Comprehensive Questions and Answers, Exams of Nursing

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Solutions (Latest Update 2024)

A 56 yr-old male is admitted to the ICU with a blood pressure of 225/135 and complains of a headache and nausea. He reports he ran out of blood pressure meds three days ago, but also appears to be confused to the date and situation. What is the most appropriate treatment approach? - Correct Answer ✅ Rapidly lower the diastolic pressure to 100 with IV antihypertensive meds, then continue to gradually reduce the diastolic pressure to 85 with oral antihypertensive meds. The maximum initial decrease should be no more than 25% reduction from initial presenting value. Reducing the blood pressure too quickly can lead to cerebral edema or renal failure. A patient has sepsis, receives Lactated ringers 500ml IV bolus. Which finding indicate that this intervention is having it's intended effect? - Correct Answer ✅ ScvO2 of 72% Early goal directed therapy for sepsis includes early fluid resuscitation at 30 ml/kg to maintain a CVP of 8-12 or 12-15 if mechanically ventilated, MAP greater than 65, ScvO2 greater than 70%, and urine output greater than 0.5 kg/hr

Solutions (Latest Update 2024)

72 male patient in ICU for 6 days on the ventilator for treatment of a COPD exacerbation. He has been receiving VTE prophylaxis and subcutaneous Heparin since admission. Today his platelet count decreased significantly to 43,000 and was found to have new DVT on his right upper extremity. What do you suspect is the most likely cause of these findings? - Correct Answer ✅ HIT The hallmark sign of HIT is a significant decrease in platelet count over a 24 hours period (>50%) within 5-10 days of administering Heparin. The other hallmark sign is a new development of DVT despite being on VTE prophylaxis. TRALI: - Correct Answer ✅ is a complication from a blood transfusion reaction, which causes acute lung injury typically within 6 hours of a blood transfusion. 2 Hallmark signs of HIT: - Correct Answer ✅ Decrease in platelet count over a 24 hr period.

Solutions (Latest Update 2024)

New development of DVT despite being on VTE prophylaxis. Values in Early compensated Hypovolemic shock? - Correct Answer ✅ CO 4.0 L/min, HR 135, SV 65, SVR 1700, MAP 65 In hypovolemic states, circulating volume is depleted therefore preload and contractility are decreased which leads to a decrease in SV and CO. HR and SV increase as compensatory measure to preserve CO, MAP and cerebral perfusion. Post-renal failure values: - Correct Answer ✅ Urine output < 200; urine sodium 30; BUN: Creatinine ratio 15:1; urine specific gravity 1. BUN: Creatinine ratio is 15:1, but both the BUN & creatinine are elevated. Urine sodium is typically 1-40 mEq/L. What to do in the event of HIT: - Correct Answer ✅ Stop Heparin and administer an alternative direct thrombin inhibitor.

Solutions (Latest Update 2024)

Warfarin is contraindicated in HIT? T/F - Correct Answer ✅ True - there is also no evidence that shows protamine, corticosteroids, and benadryl are effective treatments for HIT Patients with right ventricular infarctions become preload dependent. Meds that decrease preload should be avoided - which meds are these? - Correct Answer ✅ Morphine, Nitro, Beta blockers and diuretics. Polymorphic ventricular tachycardia aka Torsades is treated by? - Correct Answer ✅ Magnesium Myocardial contusions generally impact which parts of the heart? and what would the values be? - Correct Answer ✅ Atria & right ventricle because of the position of the heart in the chest. PAOP 6, PA Pressure 40/24, RA Pressure 16 Neurogenic shock signs? - Correct Answer ✅ CVP: 3, CI: 2.5, SVR: 650, SBP: 88

Solutions (Latest Update 2024)

Neuro shock is associated with a loss of sympathetic tone causing extensive peripheral vasodilation. Clinical signs and symptoms include hypotension, a low SVR, low CVP and low normal CI What causes a larger than normal A wave on a PAOP? - Correct Answer ✅ Mitral stenosis - causes increased left atrial pressure during atrial contraction. Pulmonary HTN will result in what? - Correct Answer ✅ Elevated PA pressures but have no impact on PAOP. Infective Endocarditis can cause what kind of impairment? - Correct Answer ✅ Neurologic impairment. One of the risks of infective endocarditis is the bacterial strand breaking in the heart and throwing bacterial emboli forward into the lungs from the right side of the heart or to the brain/body from the left side of the heart.

Solutions (Latest Update 2024)

Neurologic impairment could be a sign? - Correct Answer ✅ Embolic ischemic stroke. Post bariatric surgery should avoid what kind of meds? - Correct Answer ✅ Extended release meds due to absorption concerns post-operatively Chlorpropamide is a what? - Correct Answer ✅ sulfonylurea drug that is used in DI as an antidiuretic. It is primarily a glucose lowering agent. (hypoglycemia) Will a cardiac transplant patient respond to atropine? - Correct Answer ✅ No - pacing is the best instrument for symptomatic bradycardia. Elevated urine osmolality; decreased serum osmolality; and decreased serum sodium is what symptom? - Correct Answer ✅ SIADH - causes retention of water. Urine production is minimal and concentrated & leads to an increased urine osmolality.

Solutions (Latest Update 2024)

What does Neo drug increase? - Correct Answer ✅ SVR - Peripheral constriction Treatment for narrow complex, regular rhythm? - Correct Answer ✅ Administer 6mg adenosine rapidly IVP Half life of metformin? - Correct Answer ✅ 6 hours - close monitoring is required to ensure the blood glucose level does not climb too quickly while dextrose is being administered. Most accurate reflection of daily fluid balance? - Correct Answer ✅ Record a daily weight at the same time each day. Wide mediastinum on chest x-ray, narrow pulse pressure, and hypotension are signs of what? - Correct Answer ✅ Cardiac tamponade A patient with hyponatremia would need what? - Correct Answer ✅ Help maintaining a safe environment. HypoNa impairs judgment, and causes confusion.

Solutions (Latest Update 2024)

Peritoneal dialysis works on the principles of both? - Correct Answer ✅ Diffusion and osmosis. HHNS leads to what? - Correct Answer ✅ Large fluid deficits and may require multiple liters of fluid, which is determined by the patient's level of dehydration and hyperosmolality. What parameters are consistent with Pulsus Paradoxes? - Correct Answer ✅ Decrease in SBP>10 during inspiration. Before administering rtPA what must happen? - Correct Answer ✅ Lower the BP to at least 185/110. An elevated BP prior to rtPA can cause hemorrhage. Ibutilide can cause what? - Correct Answer ✅ Torsades A person with disecting AAA would receive what drug? - Correct Answer ✅ PRN IV narcotic analgesia - BP management is a priority in the care of a patient with a dissecting AAA. Pain is the primary driver of HTN.

Solutions (Latest Update 2024)

Autonomic hyperreflexia is what? - Correct Answer ✅ This disorder is seen with spinal injuries occurring above the T spine. Cause of autonomic hyperreflexia? - Correct Answer ✅ Bladder obstruction, constipation, pressure ulcers, and pain. Usually when the noxious stimulus is identified and removed, the symptoms resolve. Checking urinary catheter for obstruction is the most appropriate next action. MEDS for asymptomatic left ventricular systolic dysfunction? - Correct Answer ✅ ACE or (ARB), beta-blockers and statins for all patients with a history of MI and for all patients with a reduced ejection fraction. What is the Z point technique? - Correct Answer ✅ is a method used to estimate ventricular end diastolic pressure. It is taken just before the closure of the mitral valve and is especially useful when an A wave does not exist on the PAOP tracing such as in atrial fib.

Solutions (Latest Update 2024)

Ascites position for relief? - Correct Answer ✅ Place pt on left side. DIC lab values? - Correct Answer ✅ Fibrinogen decreased FSP elevated Platelets decreased D-dimer elevated Decreased Albumin is an indicator of what? - Correct Answer ✅ Protein deficiency and poor nutrition, which are major contributors to poor wound healing. A continous infusion of Lorazepam for greater than 3 days can lead to an accumulation of? - Correct Answer ✅ Propylene glycol.

Solutions (Latest Update 2024)

Inability to communicate in full sentences may be a sign of what? - Correct Answer ✅ Severity of asthma (high risk) Management of high ICP includes? - Correct Answer ✅ Osmotic diuretics, hypertonic saline & antihypertensives. Causes increased left atrial pressure during atrial contraction

• results in a larger than normal A wave on the PAOP tracing?
• Correct Answer ✅ Mitral Stenosis Pulmonary htn will result in elevated PA pressures but have no impact on? - Correct Answer ✅ PAOP Elevated urine osmolality; decreased serum osmolality; decreased serum sodium? - Correct Answer ✅ SIADH Absolute contraindication for thrombolytic therapy? - Correct Answer ✅ Aortic dissection Crackles in bilateral lower lobes and a s3 heart sounds are indicative of what? Tx? - Correct Answer ✅ Fluid overload

Solutions (Latest Update 2024)

Furosemide 40 mg IV x 1 now Narrow pulse pressure - CO 3L/min, HR 135, SV 30, SVR 2100 are all signs of what? - Correct Answer ✅ Cardiogenic shock HUS is marked by what? - Correct Answer ✅ Renal failure Thrombocytopenia & hemolytic anemia DIC lab values? - Correct Answer ✅ Decreased Fibrinogen FSP elevated Platelets decreased D-dimer elevated HOB position for ICP?

Solutions (Latest Update 2024)

Other tx? - Correct Answer ✅ 45 degrees Increase sedation or mannitol as prescribed. Opening the Ventriculostomy drain requires specific orders? - Correct Answer ✅ True Brain death criteria? - Correct Answer ✅ Positive Apnea test Absent Oculovestibular and Oculocephalic reflex Respiratory acidosis ST elevation is indicative of what? - Correct Answer ✅ Cardiac ischemia and should be treated as myocardial infarction CDC indications for urinary catheter include: - Correct Answer ✅ end-of-life care, strict I&O, immobility, select

Solutions (Latest Update 2024)

surgical procedures, sacral wounds, urinary retention/obstruction A saddle embolus is life threatening and requires which immediate intervention? - Correct Answer ✅ IV thrombolytic for clot lysis. Subcutaneous and IV heparin inhibit thrombus growth and promote resolution of the formed clot, but will treat the a saddle pulmonary embolus. Indiscrimate pacing spikes indicate that the pacer is not what? - Correct Answer ✅ Not sensing or seeing the cardiac activity present. Sensitivity should be decreased. A sudden increase in left atrial diastolic pressure will result in? - Correct Answer ✅ Mitral regurgitation Late stages of shock results in what lab values? - Correct Answer ✅ Increased Potassium

Solutions (Latest Update 2024)

Decreased Bicarbonate Increased Lactic acid Juxtaglomerular cells secrete what? - Correct Answer ✅ Renin in response to reduced glomerular filtration pressure. Secondary adrenal insufficiency is caused by: - Correct Answer ✅ Long term steroid use, additional stress can overwhelm the hypothalamic -pitutary-adrenal system. Neosynephrine stimulates what? Side effects would include: - Correct Answer ✅ alpha receptors - causes vasoconstriction, resulting in increase BP Reflexive bradycardia Heptojugular Reflex is suggestive of which following condition? - Correct Answer ✅ Right sided heart failure

Solutions (Latest Update 2024)

Fever is associated with what? - Correct Answer ✅ Worse neuro outcomes. This is secondary to the increase in cerebral metabolism and oxygen consumption Low volume ventilation, less than 10 mL/kg to minimize what? - Correct Answer ✅ Pneumothorax - over inflation can cause volutrauma, which can lead to a spontaneous pneumothorax. Decreased right atrial pressure (RAP/CVP) could be caused by? - Correct Answer ✅ Sepsis High pressure alarm on ventilator is commonly caused by? - Correct Answer ✅ secretions or increased resistance in the airways.

Solutions (Latest Update 2024)

Major abdominal surgery may cause which pulmonary complication? - Correct Answer ✅ Atelectasis - tx would be pulmonary hygiene and chest x-ray What would minimize pancreatic stimulation? - Correct Answer ✅ Begin feedings via jejunal route - enteral feedings are preferred. Utilization of jejunal feedings maintain gut integrity and minimize pancreatic stimulation. QRS complex is upright in both leads? Negative deflection in both leads depicts an extreme? Negative QRS deflection in Lead 1 and positive deflection in Lead aVF are associated with? - Correct Answer ✅ Axis is normal Extreme Right axis deviation Right axis deviation

Solutions (Latest Update 2024)

Priority data to collect for delirium and changes in QTc? - Correct Answer ✅ CAM-ICU and 12 lead ECG Pacemaker setting in A-fib? - Correct Answer ✅ VVI Atria cannot be paced when in atrial fibrillation Alpha cells produce? Beta cells? Delta cells? - Correct Answer ✅ Glucagon Insulin Somatostatin

Solutions (Latest Update 2024)

Serum Osmolality of 320 is indicative of: - Correct Answer ✅ DI - profound dehydration will lead to an elevated serum osmolality because of water loss. Contraindications of rtPA include: - Correct Answer ✅ Gastro or other bleeding complications (within 3 months) First sign of problems from a shunt include: - Correct Answer ✅ change in LOC or mental status Ominous sign of acute asthma exacerbation: - Correct Answer ✅ Hypercapnia or elevated PaCO2 indicates patient is becoming fatigued and going into acute respiratory failure. Nephrogenic DI would cause what? - Correct Answer ✅ the kidneys not respond to ADH Lactated ringers at 100ml hr before and after procedure is often prescribed to prevent what? - Correct Answer ✅ Contrast induced nephropathy

Solutions (Latest Update 2024)

Keeping the TV (tidal volume) low is the best way to decrease pressures and avoid what? - Correct Answer ✅ Barometric trauma in ARDS Which of the following parameters most accurately estimates end-organ perfusion? - Correct Answer ✅ Urinary output, lactate, ScvO Aortic stenosis cause increased noise during systole and impaired outflow, leading to: - Correct Answer ✅ Pulmonary edema and crackles. Tx for neurogenic shock? - Correct Answer ✅ Vasoconstrictor (phenylephrine) over large volume of fluid resuscitation Liver failure labs: - Correct Answer ✅ Elevated bilirubin Decreased albumin elevated PTT, PT & INR

Solutions (Latest Update 2024)

When the liver fails: - Correct Answer ✅ ammonia levels build causing encephalopathy. Bilirubin levels rise causing jaundice and coagulation times often prolong putting patient at risk for bleeding. Patients with HIT may develop: - Correct Answer ✅ Thrombosis, DVT, PE, STROKE, MI, Renal impairment Vancomycin has a risk of nephrotoxicity and RN should monitor which lab value: - Correct Answer ✅ Elevated serum creatinine Cerebral insults include: - Correct Answer ✅ ipsilateral pupil changes and contralateral motor extremity changes. Diuretic phase of ATN would include which lab value: - Correct Answer ✅ Decreased urine osmolality Kernig's sign is indicative of: - Correct Answer ✅ Meningitis - pt cannot extend the knee when the hip is flexed.

Solutions (Latest Update 2024)

DKA patients have a profound decrease in what: - Correct Answer ✅ Fluids Pancreatitis leads to what? - Correct Answer ✅ ARDS, DIC, hypovolemic shock Glycopyrrolate is part of medical mgmnt for: - Correct Answer ✅ Respiratory failure in patient with chronic pulmonary dz. Thrombolytic therapy using rtPA is most common tx for: - Correct Answer ✅ ischemic stroke Inclusion criteria for thrombolytic therapy: - Correct Answer ✅ over the age of 18 less than 3 hours of onset CT scan verifying ischemic stroke

Solutions (Latest Update 2024)

Exclusion criteria for thrombolytic therapy: - Correct Answer ✅ Seizure activity with onset stroke symptoms major surgery or trauma past 3months Adverse effects of Increasing PEEP causes: - Correct Answer ✅ Hypotension Inattention, alterations in perception, disorganized thinking and memory impairment: - Correct Answer ✅ Delirium An elevated Lactate level would include which tx: - Correct Answer ✅ Central line and additional IV fluids ARDS defined as: - Correct Answer ✅ PaO2/FiO2 less than or equal to 300 with bilateral infiltrates on chest X-ray and refractory hypoxemia. P/F ratio less than 100: - Correct Answer ✅ Severe ARDS

Solutions (Latest Update 2024)

a STAT CT is first priority to dx what: - Correct Answer ✅ Hemorrhagic or ischemic event When P2 component is greater than the P1 indicates: - Correct Answer ✅ Poor brain compliance Venous Pulmonary HTN results from: - Correct Answer ✅ Left

• sided heart fx and ineffective pumping of blood. Pulmonary arterial HTN results from: - Correct Answer ✅ Vasoconstriction of vasculature leading to and within the lungs Management of Pancreatitis: - Correct Answer ✅ Preventing hypoxemia, resting pancreas, pain mgmnt, volume resuscitation. Inner layer of the heart muscle, between the endocardium? - Correct Answer ✅ Myocardium

Solutions (Latest Update 2024)

Higher cognitive functions (Impulsivity) and personality are controlled by what part of the brain: - Correct Answer ✅ Frontal lobe tachycardia, tachypnea, and left shoulder pain indicates possible what: - Correct Answer ✅ Anastomotic leak Intubation: FiO2 < 60% Maintain plateau pressures <30 Maintain Tidal volume < 8 - Correct Answer ✅ Goals for ventilated pts. Position with the HOB 30 degrees with midline neck alignment: - Correct Answer ✅ First line therapy for optimizing cerebral perfusion. Is Serum osmolality elevated or decreased in DI? - Correct Answer ✅ Elevated due to volume loss - the urine will be dilute (decreased urine osmo) and hemoconcentration with increased sodium levels.