Chapter 19Critical Care My Nursing Test Banks

Chapter 19Critical Care

MULTIPLE CHOICE

1.The nurse determines that a clients cardiac output is normal. Which of the following values would be considered normal?

1.

1 L/min.

2.

3 L/min.

3.

6 L/min.

4.

15 L/min.

ANS: 3

Normal cardiac output is 4 to 8 L/min. This variation is due to the differences in body sizes of individuals. The values less than 4 L/min are low and the value of 15 L/min is extremely high.

PTS:1DIF:AnalyzeREF:Cardiac Output

2.A clients cardiac index is calculated to be 3.1 L/minute/m2. Which of the following could explain this clients cardiac index value?

1.

Acute myocardial infarction

2.

Cardiogenic shock

3.

This is a normal value

4.

Fever

ANS: 3

The normal cardiac index range is 2.5 to 4.2 L/min/m2. An index of 3.1 L/min/m2  is considered a normal value. Cardiac index is low with the diagnosis of acute myocardial infarction or cardiogenic shock. Cardiac index is elevated with a fever.

PTS:1DIF:AnalyzeREF:Cardiac Output

3.A client with an elevated cardiac index has received diuretic medication as prescribed. The nurse realizes that this medication will affect which cardiac parameter?

1.

Afterload

2.

Contractility

3.

Preload

4.

Stroke volume

ANS: 3

Preload is characterized by the amount of cardiac muscle fiber stretch preceding each contraction. Preload will decrease with the use of diuretics. Contractility is the force of ventricular contraction. Afterload is the pressure and forces opposing ventricular contraction. The stroke volume is the amount of blood pumped by the left ventricle in one contraction. Diuretics do not specifically impact contractility, afterload, or stroke volume.

PTS: 1 DIF: Analyze REF: Hemodynamic Monitoring: Preload

4.The nurse is caring for a client who is experiencing an increase in cardiac contractility. Which of the following will decrease contractility and reduce myocardial oxygen demand for this client?

1.

Administer Primacor as prescribed.

2.

Administer Digoxin as prescribed.

3.

Administer beta-blocker as prescribed.

4.

Administer potassium chloride as prescribed.

ANS: 3

Medications such as beta-blockers and calcium channel blockers will reduce myocardial oxygen demand, decreasing cardiac contractility. Medications such as Primacor, Digoxin, and potassium chloride will increase cardiac contractility.

PTS: 1 DIF: Analyze REF: Contractility

5.Which of the following interventions would ensure the accuracy of hemodynamic parameters and ensure an air-free system?

1.

Slowly flush the system after taking a blood sample.

2.

Loosen connections.

3.

Keep pressure bag inflated to 300 mmHg.

4.

Add extensions to the line.

ANS: 3

Interventions to ensure the accuracy of hemodynamic parameters and an air-free system include fast-flushing the system after taking a blood sample, keeping connections tight, keeping the pressure bag inflated to 300 mmHg, not adding extensions to the line, and periodically performing flick and flush to the tubing system.

PTS: 1 DIF: Apply REF: Measurement of Hemodynamic Parameters

6.A client is prescribed a vasoactive intravenous medication to maintain a normal blood pressure. Which of the following is not a vasoactive medication?

1.

Amiodarone

2.

Dopamine hydrochloride

3.

Nitroprusside sodium

4.

Norepinephrine

ANS: 1

Amiodarone is an antiarrhythmic medication that is used for life-threatening ventricular arrhythmias and management of supraventricular tachyarrhythmias. All of the other medications are classified as vasoactive.

PTS: 1 DIF: Analyze REF: Intra-Arterial Monitoring: Indications

7.A clients right atrial pressure is measured as being 6 mmHg. The nurse would document which of the following regarding this clients pressure?

1.

Right arterial pressure within normal limits

2.

Right arterial pressure below normal limits

3.

Right arterial pressure above normal limits

4.

Right arterial pressure unable to obtain

ANS: 1

The normal range for right atrial pressure or central venous pressure is 0 to 8 mmHg.The nurse would document right arterial pressure within normal limits. The other choices are incorrect interpretations of the clients right arterial pressure measurement.

PTS: 1 DIF: Apply REF: Pulmonary Artery Parameters

8.A client has an intraparenchymal probe inserted into his brain tissue. The nurse realizes an advantage of this type of intracranial monitoring device would be:

1.

low risk of intracerebral bleeding.

2.

low risk of infection.

3.

sturdy and will not break.

4.

an inexpensive method to monitor.

ANS: 2

The intraparenchymal probe is easy to insert and has a low risk of infection. The probe does have a risk of causing intracerebral bleeding. The catheter is fragile and may break. The equipment is expensive for this type of probe.

PTS: 1 DIF: Analyze REF: Types of Intracranial Pressure Monitoring

9.A client is diagnosed with increased intracranial pressure. Which of the following interventions can be used to reduce this pressure?

1.

Administer hypotonic intravenous fluids.

2.

Administer Mannitol.

3.

Keep head of the bed flat.

4.

Keep PaCO2 level above normal.

ANS: 2

Interventions to reduce increased intracranial pressure include administering an osmotic diuretic such as Mannitol. Hypotonic fluids should be avoided since cerebral edema could occur. The head of the bed should be raised to 30 to 45 degrees. A lower PCO2 level will reduce intracranial pressure.

PTS:1DIF:Apply

REF:Management of Patients with Increased Intracranial Pressure

10.A client who has an endotracheal tube is being considered for a tracheostomy. Which of the following criteria would support the placement of a tracheostomy in this client?

1.

Client is unable to maintain airway when extubated.

2.

Client has a history of diabetes mellitus.

3.

Client has been diagnosed with hypertension.

4.

Client is coughing and bucking the endotracheal tube.

ANS: 1

A tracheostomy tube would be indicated for clients who fail to wean rapidly, are unable to protect the airway for a prolonged period of time because of neurological problems, and have problems with oropharyngeal trauma. A history of diabetes mellitus or hypertension are not indications for the placement of a tracheostomy. Client coughing and bucking the endotracheal tube could be indications that the client can maintain the airway.

PTS:1DIF:AnalyzeREF:Tracheostomy

11.A client who is being mechanically ventilated has positive end expiratory pressure set at 20 cm of water. Which of the following should the nurse assess in this client?

1.

Hemothorax

2.

Pneumothorax

3.

Increased venous return

4.

Hypertension

ANS: 2

High levels of positive end expiratory pressure can cause pneumothorax or decreased venous return. Positive end expiratory pressure does not cause a hemothorax or hypertension.

PTS: 1 DIF: Apply REF: Additional Ventilator Settings and Modes

12.The nurse, planning care for a client who is mechanically ventilated, would plan to administer medication to prevent the onset of which of the following complications?

1.

Hyperglycemia

2.

Hypertension

3.

Stress ulcers

4.

Thrombophlebitis

ANS: 3

Stress ulcers are a complication of mechanical ventilation and often occur within 72 hours of illness. Prevention of stress ulcers in the mechanically ventilated client includes the prophylactic administration of proton pump inhibitors, histamine blockers, or sucralfate. Hyperglycemia and hypertension are not complications of receiving mechanical ventilation. Thrombophlebitis can occur in any client who is maintained on strict bed rest and is not necessarily being mechanically ventilated.

PTS: 1 DIF: Apply REF: Stress-Related Mucosal Disease

13.A client who is being mechanically ventilated has been receiving propofol (Diprivan) to enhance compliance. Which of the following will occur when the medication is discontinued and the client is removed from the ventilator?

1.

The client will demonstrate hypotension.

2.

The nurse will need to administer Narcan.

3.

The client will develop a dysrhythmia.

4.

The client will quickly gain consciousness.

ANS: 4

Propofol (Diprivan) is a sedative-hypnotic anesthetic used to enhance compliance with mechanical ventilation. When discontinued, the client will wake up quickly. Diprivan does not cause hypotension. Narcan is not needed to reverse Diprivan. Diprivan does not cause dysrhythmias.

PTS:1DIF:Analyze

REF: Table 19-7 Medications Commonly Used to Enhance Compliance with Mechanical Ventilation

14.A client has been participating in weaning from the ventilator for several days. Which of the following should be done to assist this client to regain strength?

1.

Provide full ventilatory support during the overnight hours.

2.

Withdraw medications to enhance compliance with mechanical ventilation.

3.

Conduct passive range of motion to all extremities.

4.

Assist to a sitting position and dangle legs off the side of the bed.

ANS: 1

Discontinuation of mechanical ventilation will not be successful if the client is exhausted from the weaning process. The client who requires several days of weaning should be allowed to rest on full ventilatory support during the overnight hours. The client should be weaned from medication used to enhance compliance with mechanical ventilation. Passive range of motion will not help increase the clients strength for the weaning process. Having the client in a sitting position with legs dangling off the side of the bed will not enhance the weaning process.

PTS: 1 DIF: Apply REF: Ventilatory Weaning: Indications

15.Which of the following nursing interventions would be appropriate for a client who has had an endotracheal tube removed?

1.

Evaluate arterial blood gas analysis 2 hours after extubation.

2.

Encourage the client to limit movement for the first day after extubation.

3.

Provide oral care immediately after extubation.

4.

Instruct the client that hoarseness will be present for at least 3 months.

ANS: 3

Interventions for a client who has been extubated include providing oral care immediately after extubation. Arterial blood gases should be analyzed within 30 to 60 minutes after extubation. The client should be encouraged to deep breathe, cough, and turn in bed frequently to mobilize secretions. Hoarseness should resolve within a few days and not in 3 months.

PTS:1DIF:ApplyREF:Nursing Management

MULTIPLE RESPONSE

1.The nurse is preparing the equipment needed for hemodynamic monitoring. Which of the following equipment should be included in preparation for monitoring? (Select all that apply.)

1.

Amplifier

2.

Flow and pressure system

3.

Monitor

4.

Pressure bag, fluid flush system, and tubing

5.

Transducer

6.

Arm board

ANS: 3, 4, 5

All hemodynamic monitoring of patients requires three necessary pieces of equipment: 1) a monitor; 2) a transducer; and 3) a combination of pressure bag, fluid flush device, and tubing system. The other items listed are not equipment needed for hemodynamic monitoring.

PTS: 1 DIF: Apply REF: Equipment for Hemodynamic Monitoring

2.The nurse is trying to determine the cause of a dampened waveform. Which of the following could cause a dampened waveform. (Select all that apply.)

1.

Air bubbles

2.

Blood clots

3.

Kinks

4.

Loose connections

5.

Use of shorter tubing

6.

Low blood pressure

ANS: 1, 2, 3, 4

Air bubbles, blood clots, kinks, and loose connections are all reasons for a dampened waveform. When a system is underdamped, one of the ways to correct the system is to obtain shorter tubing. Low blood pressure will not cause the waveform to be dampened.

PTS: 1 DIF: Analyze REF: Measurement of Hemodynamic Parameters

3.A clients pulmonary artery wedge pressure is 1 mmHg. Which of the following health problems can cause this low pressure? (Select all that apply.)

1.

Altered left ventricular function

2.

Dehydration

3.

Elevations in blood volume

4.

Hemorrhage

5.

Hypovolemia

6.

Peripheral edema

ANS: 2, 4, 5

The pulmonary artery wedge pressure will be abnormally low in patients who are hypovolemic, dehydrated, or hemorrhaging. Elevated levels occur in patients who have altered left ventricular function or elevations in blood volume. Peripheral edema does not impact the clients pulmonary artery wedge pressure.

PTS: 1 DIF: Analyze REF: Pulmonary Artery Pressure Monitoring

4.A client is determined to not be a candidate for intra-aortic balloon pump monitoring. Which of the following client conditions is the balloon pump contraindicated? (Select all that apply.)

1.

Aortic insufficiency

2.

Gastric ulcers

3.

Dissecting abdominal aortic aneurysm

4.

Severe peripheral vascular disease

5.

Absent femoral pulses

6.

Uncontrolled bleeding

ANS: 1, 3, 4, 5, 6

Contraindications for the use of an intra-aortic balloon pump include aortic insufficiency, dissecting abdominal aortic aneurysm, severe peripheral vascular disease, absent femoral pulses, and uncontrolled bleeding. Gastric ulcers is not a contraindication for the use of this pump.

PTS: 1 DIF: Analyze REF: Cardiac Assist Devices

5.Which of the following interventions would be appropriate for a client who is being mechanically ventilated? (Select all that apply.)

1.

Secure artificial airway.

2.

Auscultate lungs every 4 hours and as needed.

3.

Monitor endotracheal tube cuff pressure once per shift.

4.

Provide alternative form of communication.

5.

Apply vest and wrist restraints.

6.

Monitor arterial blood gas analysis results and adjust ventilator as needed.

ANS: 1, 2, 3, 4, 6

Nursing interventions appropriate for a client being mechanically ventilated include secure artificial airway, auscultate lungs every 4 hours and as needed, monitor endotracheal tube cuff pressure once per shift, provide alternative form of communication, monitor arterial blood gas analysis results, and adjust ventilator as needed. Soft wrist restraints can be applied if necessary. A vest restraint is not necessary.

PTS:1DIF:Apply

REF: Table 19-4 Nursing Management of Patients Requiring Mechanical Ventilation

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