Advanced Practice Nursing in Acute Care Study Guide Questions
Course Introduction
This course focuses on the development of advanced practice nursing skills and clinical decision-making in acute care settings. Students will explore complex health conditions commonly encountered in hospitals and critical care environments, integrating evidence-based assessment, diagnostic reasoning, and intervention strategies. Emphasis is placed on collaborative interdisciplinary care, advanced pharmacology, and the management of acute and rapidly changing patient situations. Through case studies, simulation, and clinical practica, students will refine their competencies in delivering safe, high-quality care to acutely ill adults and older adults, preparing them for roles as advanced practice nurses in acute care settings.
Recommended Textbook
Priorities in Critical Care Nursing 7th Edition by Urden
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27 Chapters
761 Verified Questions
761 Flashcards
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Chapter 1: Caring for the Critically Ill Patient
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14 Verified Questions
14 Flashcards
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Sample Questions
Q1) Evidence-based nursing practice takes into account (Select all that apply)
A) clinical expertise of the nurse.
B) availability of staff and facility equipment.
C) research evidence on the topic.
D) patient knowledge of the disease.
E) patient preference regarding care
Answer: A, C, E
Q2) A stepwise decision-making flowchart for a specific care process is known as a(n) A) algorithm.
B) practice guideline.
C) protocol.
D) order set.
Answer: A
Q3) Animal assisted, guided imagery, and massage are all examples of A) alternative therapy.
B) holistic care.
C) complementary care.
D) individualized care.
Answer: C
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Page 3
Chapter 2: Ethical and Legal Issues
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Sample Questions
Q1) Fidelity includes faithfulness and promise-keeping to clients, and it incorporates the added concepts of
A) confidentiality and privacy.
B) truth and reflection.
C) autonomy and paternalism.
D) beneficence and nonmaleficence.
Answer: A
Q2) When deciding whether to withdraw or withhold treatment, it is important to A) examine one's own beliefs to guide the family to a correct decision.
B) approach the family with honesty and provide clear information.
C) simply follow the advance directive if available.
D) allow the physician to approach the family.
Answer: B
Q3) Critical care nurses can best enhance the principle of autonomy by A) presenting only the information to prevent relapse in a patient.
B) assisting with only tasks that cannot be done by the patient.
C) providing the patient with all of the information and facts.
D) guiding the patient toward the best choices for care.
Answer: C
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Page 4
Chapter 3: Patient and Family Education
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Sample Questions
Q1) A 79-year-old patient received a liver transplant 3 days ago.The patient is extubated and hemodynamically stable.His spouse is coming for a visit, and the nurse has some time to discuss immune suppression drug therapy with both of them.The patient is hearing and sight impaired.The spouse brought the patient's hearing aids 2 days ago and will bring the patient's glasses today.Which of the following teaching strategies would be least effective in the ICU setting?
A) Patient education channel
B) Written materials
C) Lecture
D) Discussion
Answer: C
Q2) The patient is asked to complete an admission form.The patient hands the form to his spouse and asks her to complete the form, stating, "I forgot my glasses." The patient's actions demonstrate:
A) functional health literacy.
B) word recognition test.
C) low health literacy.
D) reading comprehension test.
Answer: C
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Chapter 4: Psychosocial and Spiritual Alterations and Management
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25 Flashcards
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Sample Questions
Q1) Interventions to help family members who are extremely upset include
A) encouraging the family to visit as much as possible.
B) conveying what the patient is experiencing to the family.
C) supporting the family members away from the bedside.
D) assuring the family that the staff will take care of the technical aspects of the patient's care.
Q2) Which of the following concepts supports patients and helps them endure the physical and psychological insults of their critical illness?
A) Regression
B) Denial
C) Hope
D) Trust
Q3) Because the nature of the environment, _____ is a serious concern in the critical care environment.
A) family involvement
B) use of complementary therapies
C) sleep deprivation
D) calm environment
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Chapter 5: Sleep Alterations
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Sample Questions
Q1) A sufficient amount of sleep has been achieved when a person awakens
A) after 8 to 10 hours of uninterrupted sleep.
B) with external stimuli and gets through the day without feeling sleepy.
C) without external stimuli and gets through the day without feeling sleepy.
D) feeling rested in the morning and takes a nap in the afternoon.
Q2) During a sleep study, which of the following groups of information are gathered?
A) Airflow, snoring, and tonsil size
B) Electroencephalogram, electrocardiogram, and end-tidal carbon dioxide
C) Oxygen saturation, number of arousals, and airflow
D) Frequency of awakenings, REM speed, and apnea-hypopnea index
Q3) A patient was given the diagnosis of congestive heart failure (CHF)2 years ago.The patient complains of increased daytime sleepiness and states his support system has been complaining more and more about snoring.Central sleep apnea is suspected.Treatment depends on whether the patient has hypercapnic or nonhypercapnic central sleep apnea.The patient's primary treatment plan should include
A) CPAP.
B) bilevel positive airway pressure (BiPAP).
C) acetazolamide and medroxyprogesterone.
D) modafinil and zolpidem.
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Chapter 6: Nutritional Alterations
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Sample Questions
Q1) Most of the energy produced from carbohydrate metabolism is used to form what substance?
A) Galactose
B) Glycogen
C) Adenosine triphosphate
D) Antibodies
Q2) A primary nutritional intervention for hypertension is
A) decreasing carbohydrates.
B) limiting salt.
C) increasing protein.
D) increasing fluids.
Q3) A patient was admitted with ESRD and on hemodialysis.Which of the following elements should be restricted?
A) Fluid
B) Protein
C) Carbohydrates
D) Fats
E) Phosphorus
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8
Chapter 7: Gerontological Alterations
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Sample Questions
Q1) An older patient is starting a new medication that is metabolized in the liver and excreted by the kidneys.Which is the best assessment to monitor the patient's ability to tolerate the medication?
A) Liver function tests
B) Drug side effects experienced by the patient
C) Kidney function tests
D) Therapeutic drug levels
Q2) A 68-year-old patient has been admitted to the coronary care unit after an inferior myocardial infarction.When caring for this patient, the nurse will give increased attention to skin integrity because of the
A) thickening of the epidermal skin layer.
B) loss of sebaceous glands.
C) increased fragility from loss of protective subcutaneous layers.
D) decreased melanocyte production.
Q3) Chemical changes in a drug that renders it active or inactive is known as A) absorption.
B) metabolism.
C) excretion.
D) distribution.
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Page 9
Chapter 8: Pain and Pain Management
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Sample Questions
Q1) A patient states that he has been taking Demerol 50 mg tablets four times a day for the past 5 years, but they are not working like they use to.The nurse is concerned that the patient has developed
A) addiction to Demerol.
B) physical dependence and tolerance.
C) physical dependence and addiction.
D) a method to withdraw himself off the medication.
Q2) The patient is admitted to the CCU with hemodynamic instability and an allergy to morphine.The nurse anticipates that the physician will order which medication for severe pain?
A) Hydromorphone
B) Codeine
C) Fentanyl
D) Methadone
Q3) Acute pain usually corresponds to
A) the healing process but should not exceed 9 months.
B) the healing process but should not exceed 6 months.
C) persistent pain more than 6 months after the healing process.
D) damage to the patient's nervous system unrelated to the initial injury.
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Page 10
Chapter 9: Sedation, Agitation and Delirium Management
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20 Flashcards
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Sample Questions
Q1) A 56-year-old patient is admitted to the critical care unit with acute respiratory distress syndrome (ARDS).The patient has been intubated and is mechanically ventilated.The patient is becoming increasingly agitated, and the high-pressure alarm on the ventilator has been frequently triggered.Despite the nurse's actions, the patient continues to be agitated, triggering the high-pressure alarm on the ventilator.Which of the following medications would be appropriate for sedation?
A) Midazolam 2 to 5 mg intravenous push (IVP) every 5 to 15 minutes until the patient is no longer triggering the alarm
B) Haloperidol 5 mg IVP stat
C) Propofol 5 mcg/kg/min by IV infusion
D) Fentanyl 25 mcg IVP over a 15-minute period
Q2) A patient has been taking benzodiazepines and suddenly develops respiratory depression and hypotension.After careful assessment, the nurse determines that the patient is experiencing benzodiazepine overdose.What is the nurse's next step?
A) Decrease benzodiazepines to half the prescribed dose.
B) Increase IV fluids to 500 cc/hr for 2 hours.
C) Administer flumazenil (Romazicon).
D) Discontinue benzodiazepine and start propofol.
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Chapter 10: End of Life Care
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Sample Questions
Q1) The patient's condition has deteriorated to the point where she can no longer make decisions about her own care.Which of the following nursing interventions would be most appropriate?
A) Obtain a verbal DNR order from the physician.
B) Continue caring for the patient as originally ordered because she obviously wanted this.
C) Consult the hospital attorney for recommendations on how to proceed.
D) Discuss with the family what the patient's wishes would be if she could make those decisions herself.
Q2) Haloperidol is recommended as useful treatment of _____.
A) anxiety
B) dyspnea
C) delirium
D) pain
Q3) Hospice care can help families with
A) organ donations.
B) aggressive symptom management and family support.
C) writing advance directives and living wills.
D) legal euthanasia.
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Page 12
Chapter 11: Cardiovascular Clinical Assessment and Diagnostic Procedures
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88 Verified Questions
88 Flashcards
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Sample Questions
Q1) Contractility of the left side of the heart is measured by A) pulmonary artery wedge pressure.
B) left atrial pressure.
C) systemic vascular resistance.
D) left ventricular stroke work index.
Q2) An 82-year-old patient is admitted into the critical care unit with a diagnosis of left-sided heart failure related to mitral stenosis.Physical assessment findings reveal tachycardia with an S<sub>3</sub> and a 3/6 systolic murmur.The nurse knows that the presence of an S<sub>3</sub> heart sound is
A) normal for a person this age.
B) a ventricular gallop.
C) a systolic sound.
D) heard best with the diaphragm of the stethoscope.
Q3) The patient has an HR of 84 beats/min and an SV of 65 mL.Calculate the CO.
A) 149 mL
B) 500 mL
C) 4650 mL
D) 5460 mL
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Chapter 12: Cardiovascular Disorders
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30 Verified Questions
30 Flashcards
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Sample Questions
Q1) A patient is admitted for palliative care for end-stage heart failure.The nurse's primary goal is
A) to reverse heart failure with the use of diuretics.
B) to increase activity tolerance.
C) symptom management and relief of pain.
D) to increase cardiac output related to alteration of contractility.
Q2) Which of the following are mechanisms responsible for a myocardial infarction (MI)?
A) Coronary artery thrombosis
B) Plaque rupture
C) Coronary artery spasm near the ruptured plaque
D) Preinfarction angina
E) Hyperlipidemia
Q3) The nurse should anticipate which of the following as the most common complication after an MI?
A) Pulmonary edema
B) Cardiogenic shock
C) Dysrhythmias
D) Deep vein thrombosis
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14
Chapter 13: Cardiovascular Therapeutic Management
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Sample Questions
Q1) The possibility of microshock when handling a temporary pacemaker can be minimized by
A) decreasing the milliamperes.
B) wearing gloves.
C) positioning the patient on the left side.
D) wearing rubber-soled shoes.
Q2) Noninvasive emergency pacing is best achieved via the use of which type of temporary pacing?
A) Transvenous (endocardial)
B) Epicardial
C) Transthoracic
D) Transcutaneous
Q3) Vasopressors are used cautiously with critical care patients because they can cause
A) vasoconstriction of the smooth muscles.
B) vasodilation of the smooth muscles.
C) increased afterload of the heart.
D) decreased preload of the heart.
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Chapter 14: Pulmonary Clinical Assessment and Diagnostic Procedures
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46 Verified Questions
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Sample Questions
Q1) For which of the following conditions is a bronchoscopy indicated?
A) Pulmonary edema
B) Ineffective clearance of secretions
C) Upper gastrointestinal bleed
D) Instillation of surfactant
Q2) Which of the following lung sounds would be most likely heard in a client experiencing an asthma attack?
A) Coarse rales
B) Pleural friction rub
C) Fine crackles
D) Expiratory wheezes
Q3) A patient presents with chest trauma from an MVA.Upon assessment, the nurse documents that the patient is complaining of dyspnea, shortness of breath, tachypnea, and tracheal deviation to the right.In addition, the client's tongue is blue-gray.Based on the following data, what the nurse would expect to find?
A) PaO<sub>2</sub> of 88 and PCO<sub>2</sub> of 55
B) Absent breath sounds in all right lung fields
C) Absent breath sounds in all left lung fields
D) Diminished breath sounds in all fields
Page 16
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Chapter 15: Pulmonary Disorders
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Sample Questions
Q1) According to the National Association of Medical Direction of Respiratory Care
Consensus Panel prolonged mechanical ventilation has been defined as
A) "the need for ?30 consecutive days of mechanical ventilation for ?8 hours per day"
B) "the need for ?15 consecutive days of mechanical ventilation for ?12 hours per day"
C) "the need for ?21 consecutive days of mechanical ventilation for ?6 hours per day"
D) "the need for ?40 consecutive days of mechanical ventilation for ?4 hours per day"
Q2) A patient was admitted to the critical care unit after a left pneumonectomy.The patient is receiving 40% oxygen via a simple facemask.The morning chest radiography study reveals right lower lobe pneumonia.After eating breakfast, the patient suddenly vomits and aspirates.The single most important measure to prevent the spread of infection between staff and patients is
A) respiratory isolation.
B) hand washing.
C) use of PPE.
D) antibiotics.
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Chapter 16: Pulmonary Therapeutic Management
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Sample Questions
Q1) Which of the following should be used when suctioning a mechanically ventilated patient?
A) Three hyperoxygenation breaths (breaths at 100% FiO<sub>2</sub>)
B) Hyperinflation (breaths at 150% tidal volume)
C) Limit the number of passes to three.
D) Instill 5 to 10 mL of normal saline to facilitate secretion removal.
E) Use intermittent suction to avoid damaging tracheal tissue.
Q2) Nursing interventions to limit the complications of suctioning include
A) inserting the suction catheter no more than 5 inches.
B) premedicating the patient with atropine.
C) hyperoxygenating the patient with 100% oxygen.
D) increasing the suction to 150 mm Hg.
Q3) Which medication may be administered with a bronchodilator because it can cause bronchospasms?
A) b2-Agonists
B) Mucloytics
C) Anticholinergic agents
D) Xanthines
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Chapter 17: Neurologic Clinical Assessment and Diagnostic
Procedures
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Sample Questions
Q1) An oval pupil is indicative of
A) cortical dysfunction.
B) intracranial hypertension.
C) hydrocephalus.
D) metabolic coma.
Q2) A critical care patient is diagnosed with massive head trauma.The patient is receiving brain tissue oxygen pressure (PbtO<sub>2</sub>)monitoring.The nurse recognized that the goal of this treatment is to maintain PbtO<sub>2</sub>
A) greater than 20 mm Hg.
B) less than 15 mm Hg.
C) between 15 and 20 mm Hg.
D) between 10 and 20 mm Hg.
Q3) Which of the following statements best describes assessment of arousal?
A) It measures content of consciousness and is a higher level function.
B) It is an evaluation of the reticular activating system and its connection with the thalamus and the cerebral cortex.
C) It becomes a valid parameter when the patient is able to respond to verbal stimuli, such as squeezing the hands on command.
D) Noxious stimuli are not to be used as an assessment parameter.
Page 19
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Chapter 18: Neurologic Disorders and Therapeutic Management
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Sample Questions
Q1) Thrombolytic therapy with recombinant tissue plasminogen activator (rtPA)is now recommended for the management of ischemic stroke if administration can be instituted within how many hours of onset of stroke symptoms?
A) 1
B) 4
C) 6
D) 10
Q2) A patient has been admitted with an ischemic stroke.The patient received recombinant tissue plasminogen activator (rtPA)in the emergency department.The nurse checks the medication administration record to make sure the patient does not have which medications for the next 24 hours?
A) Aspirin
B) Sodium nitroprusside
C) Warfarin
D) Labetalol
E) Any antiplatelet drugs
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Chapter 19: Kidney Clinical Assessment and Diagnostic Procedures
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Sample Questions
Q1) A patient is admitted to the critical care unit in congestive heart failure secondary to renal insufficiency.The patient reports that over the past few weeks, his urine output has decreased, and he has developed peripheral edema and ascites.A diagnosis of renal failure is made.The nurse would expect to see elevated values in the following laboratory results: (Select all that apply).
A) BUN.
B) creatinine.
C) glucose.
D) hemoglobin and hematocrit.
E) protein.
Q2) As serum osmolality rises, intravascular fluid equilibrium will be maintained by the release of A) ketones.
B) glucagon.
C) antidiuretic hormone.
D) potassium.
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Chapter 20: Kidney Disorders and Therapeutic Management
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Sample Questions
Q1) What is the dose for low-dose dopamine?
A) 1 to 2 mcg/kg/min
B) 1 to 2 mg/kg/min
C) 2 to 3 mcg/kg/min
D) 2 to 3 mg/kg/min
Q2) The patient is a gravida 6, para 1.She is admitted after a cesarean section after an amniotic embolus.Her heart rate (HR)is more than 150 beats/min with a systolic BP less than 80 mm Hg.Her temperature is 38°C, and her condition has caused her to develop prerenal azotemia.The patient was fluid resuscitated through a double-lumen catheter, which was placed into her right femoral access, and started on vasopressors with a fair response (BP, 80/50 mm Hg; HR, 122 beats/min).Because of her diagnosis and a concern regarding fulminating sepsis, the patient was begun on CVVH. Identify three complications of CVVH therapy.
A) Fat emboli, increased ultrafiltration, and hypertension
B) Hyperthermia, overhydration, and power surge
C) Air embolism, decreased inflow pressure, and electrolyte imbalance
D) Blood loss, decreased outflow resistance, and acid-base imbalance
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Page 22
Chapter 21: Gastrointestinal Clinical Assessment and Diagnostic Procedures
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Sample Questions
Q1) When assessing the gastrointestinal system, the order of assessment progresses in which of the following?
A) Inspection, palpation, percussion, auscultation
B) Palpation, percussion, inspection, auscultation
C) Inspection, auscultation, percussion, palpation
D) Palpation, inspection, auscultation, percussion
Q2) A health care provider has ordered an MRI (magnetic resonance imaging)of the liver.The nurse's first action is to
A) prepare the patient psychologically and physically for the procedure.
B) monitor the patient's response to the procedure.
C) assess the patient after the procedure.
D) inform the patient's family of the results.
Q3) A 78-year-old patient was admitted to the critical care unit with cirrhosis of the liver.In cirrhosis of the liver, which of the following laboratory values is expected to drop?
A) Albumin
B) Total bilirubin
C) Alkaline phosphatase
D) Aspartate aminotransferase
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Chapter 22: Gastrointestinal Disorders and Therapeutic Management
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Q1) Esophagogastric varices are the result of
A) portal hypertension resulting in diversion of blood from a high-pressure area to a low-pressure area.
B) superficial mucosal erosions as a result of increased stress levels.
C) proulcer forces breaking down the mucosal resistance.
D) inflammation and ulceration secondary to nonsteroidal anti-inflammatory drug use.
Q2) Which of the following are clinical manifestations of pancreatitis?
A) Epigastric and abdominal pain
B) Nausea and vomiting
C) Diaphoresis
D) Jaundice
E) Hyperactive bowel sounds
F) Fever
Q3) Which of the following medications is/are given to help control ammonia levels in a patient with acute liver failure (ALF)?
A) Insulin
B) Vitamin K
C) Lactulose
D) Benzodiazepines
24
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Chapter 23: Endocrine Clinical Assessment and Diagnostic
Procedures
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Sample Questions
Q1) A hydration assessment consists of checking a variety of parameters, including A) skin turgor.
B) serum potassium level.
C) capillary refill.
D) serum protein level.
Q2) When evaluating the patient for a pituitary tumor, attention on the computed tomography scan should be focused on the
A) frontal lobe.
B) sella turcica.
C) temporal lobe.
D) anterior fossa.
Q3) Which of the following laboratory results is found in a patient with hyperglycemia?
A) Insulin level of 25 m/mL
B) Absence of ketones in the urine
C) Presence of ketones in the blood
D) Serum osmolality of 270 mOsm/kg H2O
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Chapter 24: Endocrine Disorders and Therapeutic Management
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Q1) In evaluating the patient's hyponatremia, the nurse understands the problem is
A) increased cortisol release.
B) decreased aldosterone release.
C) increased glucocorticoid release.
D) decreased glucagon release.
Q2) The primary intervention for hyperglycemic hyperosmolar syndrome (HHS)is A) rapid rehydration.
B) monitoring vital signs.
C) high-dose intravenous (IV) insulin.
D) hourly urine sugar and acetone testing.
Q3) Patients who have sustained head trauma or have undergone resection of a pituitary tumor have an increased risk of developing
A) type 1 diabetes.
B) type 2 diabetes.
C) DI.
D) myxedema coma.
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Chapter 25: Trauma
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Q1) Which of the following physiologic changes caused by aging is the most likely contributor to the high mortality rate in older trauma patients compared with younger trauma patients?
A) Deterioration of cerebral and motor skills
B) Poor vision and hearing
C) Diminished pain perception
D) Limited cardiovascular physiologic reserve in the elderly
Q2) A patient is admitted to the ICU for observation of his grade II splenic laceration.Which of the following signs and symptoms would suggest that he has had a delayed rupture of his splenic capsule and is now in hemorrhagic shock?
A) BP, 110/70 mm Hg; HR, 120 beats/min; Hct, 42 mg/dL; UO, 40 mL/hr; skin that is pink, warm, and dry with capillary refill of 3 seconds
B) BP, 90/70 mm Hg; HR, 140 beats/min; Hct, 21 mg/dL; UO, 10 mL/hr; pale, cool, clammy skin; confused
C) BP, 100/60 mm Hg; HR, 100 beats/min; Hct, 35 mg/dL; UO, 30 mL/hr; pale, cool, dry skin; alert and oriented
D) BP, 110/60 mm Hg; HR, 118 beats/min; Hct, 38 mg/dL; UO, 60 mL/hr; flushed, warm, diaphoretic skin; agitated and confused
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Chapter 26: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome
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Sample Questions
Q1) With anaphylactic shock, which mechanism results in a decreased cardiac output?
A) Peripheral vasodilation
B) Increased cardiac output
C) Decreased alveolar ventilation
D) Fluid retention resulting in congestive heart failure
Q2) One theory suggests that organ dysfunction in MODS occurs in a sequential or progressive pattern.Place the following organs in the order in which they are affected:
1)Bone marrow
2)Cardiac
3)Gut
4)Kidneys
5)Liver
6)Lungs
A) 6, 5, 2, 1, 3, 4
B) 5, 4, 6, 1, 2, 3
C) 6, 5, 3, 4, 2, 1
D) 6, 3, 4, 5, 2, 1
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Chapter 27: Hematologic Disorders and Oncologic Emergencies
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Sample Questions
Q1) Medication used to increase the level of fetal hemoglobin in the RBCs and reduce the concentration of sickle hemoglobin is known as
A) transfusion therapy.
B) hydroxyurea.
C) Kayexalate.
D) oxygen.
Q2) Sickle cell anemia is not prevalent in persons of which descent?
A) West African
B) Sole European
C) Middle Eastern
D) Asian or Pacific Islander
Q3) A patient is admitted into the critical care unit with symptoms of a low-grade fever, joint pain, tachycardia, hepatomegaly, photophobia, and an inability to follow commands.The patient is becoming more agitated and complaining of pain.The nurse suspects that the patient has
A) ITP.
B) heparin-induced thrombocytopenia.
C) sickle cell anemia.
D) DIC.
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