Advanced Clinical Nursing Practice
Chapter Exam Questions
Course Introduction
Advanced Clinical Nursing Practice is designed to deepen registered nurses' clinical expertise and leadership abilities through an integration of theoretical knowledge, evidence-based practice, and advanced assessment skills. The course emphasizes critical decision-making in complex patient care scenarios, interdisciplinary collaboration, and the application of advanced pathophysiology, pharmacology, and diagnostic reasoning. Students will engage with diverse case studies and simulated clinical experiences to enhance their competencies in managing acute and chronic health conditions across various healthcare settings. By the end of the course, participants will be equipped to deliver high-quality, patient-centered care, lead clinical innovation, and contribute effectively to healthcare teams in advanced nursing roles.
Recommended Textbook
Introduction to Critical Care Nursing 6th Edition by Mary Lou Sole
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21 Chapters
756 Verified Questions
756 Flashcards
Source URL: https://quizplus.com/study-set/2011
Page 2
Chapter 1: Overview of Critical Care Nursing
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Sample Questions
Q1) The vision of the American Association of Critical-Care Nurses is a healthcare system driven by:
A) a healthy work environment.
B) care from a multiprofessional team under the direction of a critical care physician.
C) the needs of critically ill patients and families.
D) respectful, healing, and humane environments.
Answer: C
Q2) As part of nursing management of a critically ill patient,orders are written to keep the head of the bed elevated at 30 degrees,awaken the patient from sedation each morning to assess readiness to wean from mechanical ventilation,and implement oral care protocols every 4 hours.These interventions are done as a group to reduce the risk of ventilator-associated pneumonia.This group of evidence-based interventions is often called a:
A) bundle of care.
B) clinical practice guideline.
C) patient safety goal.
D) quality improvement initiative.
Answer: A
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3
Chapter 2: Patient and Family Response to the Critical Care Experience
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Sample Questions
Q1) Open visitation policies are expected by many professional organizations.Which statement reflects adherence to current recommendations?
A) Allow animals on the unit; however, these can only be "therapy" animals through the hospital's pet therapy program.
B) Allow family visitation throughout the day except at change of shift and during rounds.
C) Determine, in collaboration with the patient and family, who can visit and when. Facilitate open visitation policies.
D) Permit open visitation by adults 18 years of age and older; limit visits of children to 1 hour.
Answer: C
Q2) Which nursing interventions would best support the family of a critically ill patient?
A) Encourage family members to stay all night in case the patient needs them.
B) Give a condition update each morning and whenever changes occur.
C) Limit visitation from children into the critical care unit.
D) Provide beverages and snacks in the waiting room.
Answer: B
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Chapter 3: Ethical and Legal Issues in Critical Care Nursing
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23 Verified Questions
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Sample Questions
Q1) Which of the following statements about resuscitation is true?
A) Family members should never be present during resuscitation.
B) It is not necessary for a physician to write "do not resuscitate" orders in the chart if a patient has a healthcare surrogate.
C) "Slow codes" are ethical and should be considered in futile situations if advanced directives are not available.
D) Withholding "extraordinary" resuscitation is legal and ethical if specified in advance directives and physician orders.
Answer: D
Q2) A specific request made by a competent person that directs medical care related to life-prolonging procedures if the patient loses capacity to make decisions is called a:
A) do not resuscitate order.
B) healthcare proxy.
C) informed consent.
D) living will.
Answer: D
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Chapter 4: End-Of-Life Care in the Critical Care Unit
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Sample Questions
Q1) A patient who is undergoing withdrawal of mechanical ventilation appears anxious and agitated.The patient is on a continuous morphine infusion and has an additional order for lorazepam ( Ativan )1 to 2 mg IV as needed ( prn ).The patient has received no lorazepam (Ativan)during this course of illness.What is the most appropriate nursing intervention to control agitation?
A) Administer fentanyl ( Duragesic ) 25 mg IV bolus.
B) Administer lorazepam ( Ativan ) 1 mg IV now.
C) Increase the rate of the morphine infusion by 50%.
D) Request an order for a paralytic agent.
Q2) To prevent any unwanted resuscitation after life-sustaining treatments have been withdrawn,the nurse should ensure that:
A) do-not-resuscitate (DNR) orders are written before discontinuation of the treatments.
B) the family is not allowed to visit until the death occurs.
C) DNR orders are written as soon as possible after the discontinuation of the treatments.
D) the change-of-shift report includes the information that the patient is not to be resuscitated.
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Chapter 5: Comfort and Sedation
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Sample Questions
Q1) A patient requires neuromuscular blockade ( NMB )as part of treatment of refractive increased intracranial pressure.The nursing care for this patient includes: (Select all that apply.)
A) administration of sedatives concurrently with neuromuscular blockade.
B) dangling the patient's feet over the edge of the bed and assisting the patient to sit up in a chair at least twice each day.
C) ensuring that deep vein thrombosis prophylaxis is initiated.
D) providing interventions for eye care, oral care, and skin care.
Q2) The nurse wishes to assess the quality of a patient's pain.Which of the following questions is appropriate to obtain this assessment if the patient is able to give a verbal response?
A) "Is the pain constant or intermittent?"
B) "Is the pain sharp, dull, or crushing?"
C) "What makes the pain better? Worse?"
D) "When did the pain start?"
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Chapter 6: Nutritional Support
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Sample Questions
Q1) A patient who is receiving continuous enteral feedings has just vomited 250 mL of milky green fluid.This is a concern because this most likely demonstrates that the patient has:
A) a bowel obstruction.
B) developed an ileus.
C) gastrointestinal bleeding.
D) tube feeding intolerance.
Q2) A patient is having complications from abdominal surgery and remains NPO.Because enteral tube feedings are not possible,the decision is to initiate parenteral feedings.What are the major complications for this therapy?
A) Aspiration pneumonia and sepsis
B) Fluid and electrolyte imbalances and sepsis
C) Fluid overload and pulmonary edema
D) Hypoglycemia and renal insufficiency
Q3) Objective data designating that the nutrition goals are not being met include:
A) hyperglycemia, normovolemia, and increased protein level.
B) overhydration, hypoglycemia, and weight gain.
C) weight gain, inconsistent glucose, and normovolemia.
D) weight loss, elevated glucose, and dehydration.
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Page 8
Chapter 7: Dysrhythmia Interpretation and Management
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59 Verified Questions
59 Flashcards
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Sample Questions
Q1) The patient's heart rhythm shows an inverted P wave with a PR interval of 0.06 seconds.The heart rate is 54 beats per minute.The nurse recognizes the rhythm as a junctional escape rhythm,and understands that the rhythm is due to the:
A) loss of sinus node activity.
B) increased rate of the AV node.
C) increased rate of the SA node.
D) decreased rate of the AV node.
Q2) The nurse notices that the patient has a first-degree AV block.Everything else about the rhythm is normal.The nurse should:
A) prepare to place the patient on a transcutaneous pacemaker.
B) give the patient atropine to shorten the PR interval.
C) monitor the rhythm and patient's condition.
D) give the patient an antiarrhythmic medication.
Q3) One of the functions of the atrioventricular (AV)node is to:
A) pace the heart if the ventricles fail.
B) slow the impulse arriving from the SA node.
C) send the impulse to the SA node.
D) allow for ventricular filling during systole.
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Chapter 8: Hemodynamic Monitoring
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Sample Questions
Q1) The physician writes an order to discontinue a patient's left radial arterial line.When discontinuing the patient's invasive line,what is the priority nursing action?
A) Apply an air occlusion dressing to insertion site.
B) Apply pressure to the insertion site for 5 minutes.
C) Elevate the affected limb on pillows for 24 hours.
D) Keep the patient's wrist in a neutral position.
Q2) The nurse is preparing to measure the thermodilution cardiac output (TdCO)in a patient being monitored with a pulmonary artery catheter.Which action by the nurse best ensures the safety of the patient?
A) Ensure the transducer system is zero referenced at the level of the phlebostatic axis.
B) Avoid infusing vasoactive agents in the port used to obtain the TdCO measurement.
C) Maintain a pressure of 300 mm Hg on the flush solution using a pressure bag.
D) Limit the length of the noncompliant pressure tubing to a maximum 48 inches.
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10
Chapter 9: Ventilatory Assistance
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Sample Questions
Q1) The nurse is assisting with endotracheal intubation of the patient and recognizes that the procedure will be done in what order:
(Put a comma and space between each solve choice.)
A)Assess balloon on endotracheal tube for symmetry and leaks.
B)Assess lung fields for bilateral expansion.
C)Inflate balloon of endotracheal tube.
D)Insert endotracheal tube with laryngoscope and blade.
E)Suction oropharynx.
Q2) The nurse notes that the patient's arterial blood gas levels indicate hypoxemia.The patient is not intubated and has a respiratory rate of 22 breaths/min.The nurse's first intervention to relieve hypoxemia is to:
A) call the physician for an emergency intubation procedure.
B) obtain an order for bilevel positive airway pressure (BiPAP).
C) notify the provider of values and obtain order for oxygen.
D) suction secretions from the oropharynx.
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Chapter 10: Rapid Response Teams and Code Management
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31 Verified Questions
31 Flashcards
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Sample Questions
Q1) Which of the following are documented as part of the cardiopulmonary arrest record? (Select all that apply.)
A) Medication administration times
B) Defibrillation times, joules, outcomes
C) Rhythm strips of cardiac rhythm(s) noted
D) Signatures of recorder and other personnel
E) None of above
Q2) The patient has been admitted to a critical care unit with a diagnosis of acute myocardial infarction.Suddenly his monitor alarms and the screen shows a flat line.What action should the nurse take first?
A) Administer epinephrine by intravenous push.
B) Begin chest compressions.
C) Check patient for unresponsiveness.
D) Defibrillate at 360 J.
Q3) Post-resuscitation goals include which of the following? (Select all that apply.)
A) Control dysrhythmias
B) Maintain airway
C) Maintain blood pressure
D) Wean off oxygen
Page 12
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Chapter 11: Shock, sepsis, and Multiple Organ Dysfunction Syndrome
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34 Verified Questions
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Sample Questions
Q1) The nurse is administering both crystalloid and colloid intravenous fluids as part of fluid resuscitation in a patient admitted in severe sepsis.What findings assessed by the nurse indicate an appropriate response to therapy?
A) Normal body temperature
B) Balanced intake and output
C) Adequate pain management
D) Urine output of 0.5 mL/kg/hr
Q2) The nurse is caring for a patient admitted with cardiogenic shock.Hemodynamic readings obtained with a pulmonary artery catheter include a pulmonary artery occlusion pressure (PAOP)of 18 mm Hg and a cardiac index (CI)of 1.0 L/min/m².What is the priority pharmacological intervention?
A) Dobutamine (Dobutrex)
B) Furosemide (Lasix)
C) Phenylephrine (Neo-Synephrine)
D) Sodium nitroprusside (Nipride)
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Chapter 12: Cardiovascular Alterations
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Sample Questions
Q1) A patient is admitted to the emergency department with clinical indications of an acute myocardial infarction.Symptoms began 3 hours ago.The facility does not have the capability for percutaneous coronary intervention.Given this scenario,what is the priority intervention in the treatment and nursing management of this patient?
A) Administer thrombolytic therapy unless contraindicated
B) Diurese aggressively and monitor daily weight
C) Keep oxygen saturation levels at least 88%
D) Maintain heart rate above 100 beats/min
Q2) Percutaneous coronary intervention is contraindicated for patients with lesions in which coronary artery?
A) Right coronary artery
B) Left coronary artery
C) Circumflex
D) Left main coronary artery
Q3) An essential aspect of teaching that may prevent recurrence of heart failure is:
A) notifying the physician if a 2-lb weight gain occurs in 24 hours.
B) compliance with diuretic therapy.
C) taking nitroglycerin if chest pain occurs.
D) assessment of an apical pulse.
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Page 14
Chapter 13: Nervous System Alterations
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35 Verified Questions
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Sample Questions
Q1) The nurse admits a patient to the critical care unit following a motorcycle crash.Assessment findings by the nurse include blood pressure 100/50 mm Hg,heart rate 58 beats/min,respiratory rate 30 breaths/min,and temperature of 100.5°.The patient is lethargic,responds to voice but falls asleep readily when not stimulated.Which nursing action is most important to include in this patient's plan of care?
A) Frequent neurological assessments
B) Side to side position changes
C) Range of motion to extremities
D) Frequent oropharyngeal suctioning
Q2) The nurse responds to a high heart rate alarm for a patient in the neurological intensive care unit.The nurse arrives to find the patient sitting in a chair experiencing a tonic-clonic seizure.What is the best nursing action?
A) Assist the patient to the floor and provide soft head support.
B) Insert a nasogastric tube and connect to continuous wall suction.
C) Open the patient's mouth and insert a padded tongue blade.
D) Restrain the patient's extremities until the seizure subsides.
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Chapter 14: Acute Respiratory Failure
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Sample Questions
Q1) The nurse is caring for a patient with cystic fibrosis (CF)and understands that treatment consists of which of the following? (Select all that apply.)
A) Airway clearance therapies
B) Antibiotic therapy
C) Nutritional support
D) Tracheostomy
Q2) Select the strategies for preventing deep vein thrombosis (DVT)and pulmonary embolus (PE).(Select all that apply.)
A) Graduated compression stockings
B) Heparin or low-molecular weight heparin for patients at risk
C) Sequential compression devices
D) Strict bed rest
Q3) The basic underlying pathophysiology of acute respiratory distress syndrome results from:
A) a decrease in the number of white blood cells available.
B) damage to the right mainstem bronchus.
C) damage to the type II pneumocytes, which produce surfactant.
D) decreased capillary permeability.
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Chapter 15: Acute Kidney Injury
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Sample Questions
Q1) A normal urine output is considered to be:
A) 80 to 125 mL/min.
B) 180 L/day.
C) 80 mL/min.
D) 1 to 2 L/day.
Q2) Conditions that produce acute kidney injury by directly acting on functioning kidney tissue are classified as intrarenal.The most common intrarenal condition is:
A) prolonged ischemia.
B) exposure to nephrotoxic substances.
C) acute tubular necrosis (ATN).
D) hypotension for several hours.
Q3) The critical care nurse is responsible for monitoring the patient receiving continuous renal replacement therapy (CRRT).In doing so,the nurse should:
A) assess that the blood tubing is warm to the touch.
B) assess the hemofilter every 6 hours for clotting.
C) cover the dialysis lines to protect them from light.
D) use clean technique during vascular access dressing changes.
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Chapter 16: Hematological and Immune Disorders
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Sample Questions
Q1) The patient is admitted with anemia and active bleeding.The nurse suspects intravascular disseminated coagulation ( DIC ).Definitive diagnosis of DIC is made by evidence of:
A) a decrease in fibrin degradation products.
B) an increased D-dimer level.
C) thrombocytopenia.
D) low fibrinogen levels.
Q2) Although monocytes may circulate for only 36 hours,they can survive for months or even years as tissue macrophages.Monocytes found in the liver are called:
A) alveolar macrophages.
B) Kupffer's cells.
C) histiocytes.
D) monokines.
Q3) Cases of primary immunodeficiency are usually related to:
A) aging.
B) nutritional deficiencies.
C) malignancies.
D) a single gene defect.
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Chapter 17: Gastrointestinal Alterations
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Sample Questions
Q1) The nurse is caring for a patient who is being treated for peptic ulcer disease.Suddenly,the patient yells that her abdomen is "killing" her.The nurse notes that the patient's abdomen is rigid.The nurse should:
A) call the provider immediately.
B) give the patient pain medication.
C) remove the NG tube.
D) give the patient an antacid.
Q2) The patient is admitted with the diagnosis of GI bleeding.The patient's heart rate is 140 beats per minute,and his blood pressure is 84/44 mm Hg.These values may indicate:
A) a need for hourly vital signs.
B) approximately 25% loss of total blood volume.
C) resolution of hypovolemic shock.
D) increased blood flow to the skin, lungs, and liver.
Q3) Lactulose is considered the first-line treatment for hepatic encephalopathy and works by:
A) causing ammonia to enter the bloodstream via the colon.
B) trapping ammonia in the bowel for excretion.
C) causing constipation and inhibiting the excretion of ammonia.
D) creating an alkaline environment in the bowel.
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Page 19
Chapter 18: Endocrine Alterations
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Sample Questions
Q1) A patient is admitted to the oncology unit with a small cell lung carcinoma.During the admission,the patient is noted to have a significant decrease in urine output accompanied by shortness of breath,edema,and mental status changes.The nurse is aware that this clinical presentation is consistent with:
A) adrenal crisis.
B) diabetes insipidus.
C) myxedema coma.
D) syndrome of inappropriate secretion of antidiuretic hormone (SIADH).
Q2) The most significant clinical finding of acute adrenal crisis associated with fluid and electrolyte balance is:
A) fluid volume excess.
B) hyperglycemia.
C) hyperkalemia
D) hypernatremia
Q3) Acute adrenal crisis is caused by:
A) acute renal failure.
B) deficiency of corticosteroids.
C) high doses of corticosteroids.
D) overdose of testosterone.
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Page 20
Chapter 19: Trauma and Surgical Management
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Sample Questions
Q1) Which of the following findings require immediate nursing interventions related to the assessment of a patient with a traumatic brain injury? (Select all that apply.)
A) Mean arterial pressure 48 mm Hg
B) Elevated serum blood alcohol level
C) Non-reactive pupils
D) Respiratory rate of 10 breaths per minute
Q2) A 36-year-old driver was pulled from a car after it collided with a tree and the gas tank exploded.What assessment data suggest the patient suffered tissue damage consistent with a blast injury?
A) Blood pressure 82/60, heart rate 122, respiratory rate 28.
B) Crackles (rales) on auscultation of bilateral lung fields.
C) Responsive only to painful stimuli.
D) Irregular heart rate and rhythm.
Q3) Which of the following injuries would result in a greater likelihood of internal organ damage and risk for infection?
A) A fall from a 6-foot ladder onto the grass
B) A shotgun wound to the abdomen
C) A knife wound to the right chest
D) A motor vehicle crash in which the driver hits the steering wheel
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Page 21
Chapter 20: Burns
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Sample Questions
Q1) The nurse is caring for a patient with burns to the hands,feet,and major joints.The nurse plans care to include which of the following? (Select all that apply.)
A) Applying splints that maintain the extremity in an extended position
B) Implementing passive or active range-of-motion exercises
C) Keeping the limbs as immobile as possible
D) Wrapping fingers and toes individually with bandages
Q2) The nurse is caring for a patient with an electrical injury.The nurse understands that patients with electrical injury are at a high risk for acute kidney injury secondary to:
A) hypervolemia from burn resuscitation.
B) increased incidence of ureteral stones.
C) nephrotoxic antibiotics for prevention of infection.
D) release of myoglobin from injured tissues.
Q3) An autograft is used to optimally treat a partial- or full-thickness wound that: (Select all that apply.)
A) involves a joint.
B) involves the face, hands, or feet.
C) is infected.
D) requires more than 2 weeks for healing.
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Page 22
Chapter 21: Solid Organ Transplantation
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Sample Questions
Q1) The nurse obtains initial vital signs on a patient 2 weeks posttransplant who presents for follow-up monitoring to the outpatient transplant clinic.Which assessment finding by the nurse requires immediate action?
A) Blood pressure of 100/60 mm Hg
B) Serum creatinine of 1.5 mg/dL
C) Hemoglobin of 9.2 gm/dL
D) Tenderness over graft site
Q2) The transplant clinic nurse is educating a group of transplant recipients on health promotion and maintenance.What is the priority statement by the nurse?
A) "Adhere to all future scheduled appointments with the clinic."
B) "Obtain annual vaccinations for pneumonia from your physician."
C) "Report all routine lab results to your primary care physician."
D) "Notify the transplant clinic of all future hospital admissions."
Q3) Which statement best represents appropriate donor-to-recipient criteria for liver transplantation?
A) Blood type and HLA tissue type
B) HLA tissue type and body type
C) Body type and body size
D) Blood type and donor history
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Page 23