Clinical Decision Making in Critical Care
Mock Exam
Course Introduction
This course explores the complex processes involved in clinical decision making within the critical care environment. Emphasizing evidence-based practices, students will learn to assess, analyze, and synthesize patient data while considering physiological, psychological, and ethical factors. Through case studies, simulations, and collaborative discussions, the course develops advanced critical thinking skills essential for managing acute and life-threatening conditions. Students will also examine the roles of interdisciplinary teams and the application of clinical guidelines to improve patient outcomes in high-stakes 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) A patient was admitted to a rural ICU in Montana.Critical care nurses are assisting with monitoring and care of the patient from the closest major city.This is an example of A) telemedicine.
B) tele-ICU.
C) tele-informatics.
D) tele-hospital.
Answer: B
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
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3
Chapter 2: Ethical and Legal Issues
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16 Verified Questions
16 Flashcards
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Sample Questions
Q1) Which statement best reflects the concept of allocation of resources within the critical care setting?
A) Limitations of resources force reexamination of goals of critical care for clients.
B) Care is provided equally to all those who need the resources.
C) Equal access is available for those with the same condition or diagnosis.
D) Technologic advances are available to most of those in a given community.
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) The first step of the ethical decision-making process is
A) consulting with an authority.
B) identifying the health problem.
C) delineating the ethical problem from other types of problems.
D) identifying the client as the primary decision maker.
Answer: B
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Page 4
Chapter 3: Patient and Family Education
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24 Verified Questions
24 Flashcards
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Sample Questions
Q1) Which of the following educational content areas is appropriate during the first hours of hospitalization?
A) Pathophysiology of the admitting diagnosis
B) Dietary modifications
C) Purpose of bedside equipment
D) Medication side effects
Answer: C
Q2) Which of the following issues should be addressed with patients who have been unconscious?
A) Sensations
B) Pathophysiology
C) Rehabilitation
D) Attitudes
Answer: A
Q3) _____ often occur(s)during the initial ICU visit by the family.
A) Sensory deprivation
B) Discharge teaching
C) Repeated questioning
D) Stress and anxiety
Answer: D
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Chapter 4: Psychosocial and Spiritual Alterations and Management
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25 Verified Questions
25 Flashcards
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Sample Questions
Q1) Anxiety can cause emotional changes in the A) hypothalamus.
B) limbic system.
C) cerebral cortex.
D) pituitary gland.
Q2) An adult patient sustains third- and fourth-degree burns to more than 70% of her body related to a house fire.The patient begins a pattern of behavior similar to that of a young child, in which she repeatedly whines and throws "temper tantrums" in an attempt to keep her nurse at the bedside.The patient's coping mechanism is consistent with A) regression.
B) identity disturbance.
C) denial.
D) trust.
Q3) 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
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Chapter 5: Sleep Alterations
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23 Verified Questions
23 Flashcards
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Sample Questions
Q1) REM sleep comprises what percent of the sleep cycle?
A) 70% to 75%
B) 45% to 65%
C) 15% to 20%
D) 20% to 25%
Q2) Sleep deprivation can result from which of the following?
A) CPAP machine use
B) Mechanical ventilation
C) Use of nonbenzodiazepine short-acting hypnotics
D) Use of analgesic medications to control pain
Q3) 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
Q4) Interventions to help with circadian synchronization include
A) opening the window blinds.
B) encouraging the patient to take frequent naps during the day.
C) administering sedatives at bedtime.
D) keeping the patient awake during the early morning hours.
Page 7
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Chapter 6: Nutritional Alterations
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Sample Questions
Q1) Obtaining height and weight measurements for the critically ill patient
A) should be deferred until the medical condition stabilizes.
B) should be measured rather than obtained through patient or family report.
C) requires consistent weights in pounds.
D) requires weight, but height can be deferred.
Q2) Proteins serve the function of
A) maintaining osmotic pressure.
B) providing minerals in the body.
C) maintaining blood glucose.
D) providing a stored source of energy.
Q3) Which of the following medical interventions may be initiated with the onset of hyperglycemia?
A) Discontinuing the infusion
B) Adding insulin to the TPN
C) Weaning from the TPN over a 6-hour period
D) Starting an infusion of 0.9% normal saline
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Chapter 7: Gerontological Alterations
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12 Verified Questions
12 Flashcards
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Sample Questions
Q1) A 68-year-old patient has been admitted to the coronary care unit after an inferior myocardial infarction.Dopamine 3 mcg/kg/min has been ordered for this patient.What nursing implications should be considered when administering this drug to an older patient?
A) No changes are noted in older patients with this drug.
B) Drug effect is enhanced by increased receptor site action.
C) Increased breakdown by liver hepatocytes occurs, increasing dosage requirements.
D) Drug metabolism and detoxification are slowed, increasing the risks of drug toxicity.
Q2) Which of the following can be a normal assessment finding for an older patient?
A) Asymptomatic dysrhythmias
B) Decreased urine output
C) Increased respiratory effort
D) Difficulty problem solving
Q3) Age-related pulmonary changes that may affect this patient include
A) increased tidal volumes.
B) weakening of intercostal muscles and the diaphragm.
C) improved cough reflex.
D) decreased sensation of the glottis.
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9
Chapter 8: Pain and Pain Management
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Sample Questions
Q1) Using a specific pain intensity scale in the CCU
A) eliminates the need for the subjectivity of the patient.
B) allows for one tool for all patient types.
C) provides consistency of assessment and documentation.
D) is not necessary because all pain is treated equally in the CCU.
Q2) The neural processes of encoding and processing noxious stimuli necessary but not sufficient for pain is known as
A) perception.
B) nociception.
C) transduction.
D) transmission.
Q3) The use of PCA infusion pumps allows the patient to
A) act preemptively by administering a bolus of medication when pain begins.
B) choose between the use of opioids or NSAID medication to control pain.
C) decrease the risk of respiratory depression.
D) control pain medication in 2-hour increments.
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10
Chapter 9: Sedation, Agitation and Delirium Management
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Sample Questions
Q1) The most common contributing factor to the development of delirium in critically ill patients is
A) sensory overload.
B) hypoxemia.
C) electrolyte disturbances.
D) sleep deprivation.
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.
Q3) A major side effect of benzodiazepines is
A) hypertension.
B) respiratory depression.
C) renal failure.
D) phlebitis at the IV site.
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11
Chapter 10: End of Life Care
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Sample Questions
Q1) A patient tells the nurse to call his family and tell them they need to come so they can say their goodbyes.The patient is sure he will not be here tomorrow because his grandparent is waiting for him.This is an example of
A) signs and symptoms of anxiety.
B) signs and symptoms of delirium.
C) the need for hospice care.
D) near-death awareness.
Q2) 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.
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Chapter 11: Cardiovascular Clinical Assessment and Diagnostic Procedures
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88 Verified Questions
88 Flashcards
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Sample Questions
Q1) 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.Which of the following descriptions best describes the murmur heard with mitral stenosis?
A) High-pitched systolic sound
B) Medium-pitched systolic sound
C) High-pitched diastolic sound
D) Low-pitched diastolic sound
Q2) A physician orders removal of the central venous catheter (CVC)line.The patient has a diagnosis of heart failure with chronic obstructive pulmonary disease.The nurse would place the patient in what position for this procedure?
A) Supine in bed
B) Supine in a chair
C) Flat in bed
D) Reverse Trendelenburg position
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Chapter 12: Cardiovascular Disorders
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30 Verified Questions
30 Flashcards
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Sample Questions
Q1) Patient teaching regarding valvular heart disease should include which of the following?
A) Increase fluid intake to increase cardiac output.
B) Monitor and increase sodium intake to replace sodium lost with diuretics.
C) Increase daily activity until shortness of breath occurs.
D) Take prophylactic antibiotics before undergoing any invasive procedure.
Q2) One differentiating factor between stable angina and unstable angina is that stable angina
A) responds predictably well to nitrates.
B) is not precipitated by activity.
C) has a low correlation to CAD.
D) is a result of coronary artery spasm.
Q3) The most frequent dysrhythmia seen initially with sudden cardiac death is A) premature ventricular contractions.
B) ventricular tachycardia.
C) ventricular fibrillation.
D) asystole.
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14
Chapter 13: Cardiovascular Therapeutic Management
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30 Flashcards
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Sample Questions
Q1) When an intra-aortic balloon is in place, it is essential for the nurse to frequently assess
A) for a pulse deficit.
B) peripheral pulses distal to the catheter insertion site.
C) bilateral blood pressures.
D) coronary artery perfusion.
Q2) Which of the following would indicate successful reperfusion after administration of a fibrinolytic agent?
A) Gradual decrease in chest pain
B) Intermittent, multifocal premature ventricular contractions
C) Rapid resolution of ST elevation
D) Rapid rise in creatine kinase MB fraction
Q3) The rationale for administration of a fibrinolytic agent is
A) dilation of the blocked coronary artery.
B) anticoagulation to prevent formation of new emboli.
C) dissolution of atherosclerotic plaque at the site of blockage.
D) restoration of blood flow to the obstructed coronary artery via lysis of the thrombus.
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Chapter 14: Pulmonary Clinical Assessment and Diagnostic
Procedures
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46 Verified Questions
46 Flashcards
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Sample Questions
Q1) Normal anteroposterior (AP)diameter ranges from 1:2 to 5:7.An increase in AP diameter of the chest that is characterized by displacement of the sternum forward and the ribs outward is indicative of
A) a funnel chest.
B) a pigeon breast.
C) a barrel chest.
D) Harrison's groove.
Q2) Why would the nurse perform an inspection of the oral cavity during a complete pulmonary assessment?
A) To provide evidence of hypoxia
B) To provide evidence of dyspnea
C) To provide evidence of dehydration
D) To provide evidence of nutritional status
Q3) The creation of sound waves across the body surface to determine abnormal densities is known as
A) inspection.
B) palpation.
C) percussion.
D) auscultation.
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Chapter 15: Pulmonary Disorders
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24 Verified Questions
24 Flashcards
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Sample Questions
Q1) Supplemental oxygen administration is usually effective in treating hypoxemia related to
A) physiologic shunting.
B) dead space ventilation.
C) hypercapnia with a PaCO<sub>2</sub> of 35 mm Hg.
D) ventilation/perfusion mismatching.
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 first action that should be taken after the patient's aspiration event is
A) lavaging his airway with normal saline.
B) placing him on his back in a semi-Fowler position.
C) administering manual ventilations with a resuscitation bag.
D) suctioning his airway.
Q3) The most common presenting signs and symptoms associated with PEs are
A) tachycardia and tachypnea.
B) hemoptysis and evidence of deep vein thromboses.
C) apprehension and dyspnea.
D) right ventricular failure and fever
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Chapter 16: Pulmonary Therapeutic Management
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30 Verified Questions
30 Flashcards
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Sample Questions
Q1) Which of the following oxygen administration devices can deliver oxygen concentrations of 90%?
A) Nonrebreathing mask
B) Nasal cannula
C) Partial rebreathing mask
D) Simple mask
Q2) The assist-control mode of ventilation functions in which of the following manners?
A) It delivers gas at preset volume, at a set rate, and in response to the patient's inspiratory efforts.
B) It delivers gas at a preset volume, allowing the patient to breathe spontaneously at his or her own volume.
C) It applies positive pressure during both ventilator breaths and spontaneous breaths.
D) It delivers gas at preset rate and tidal volume regardless of the patient's inspiratory efforts.
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18
Chapter 17: Neurologic Clinical Assessment and Diagnostic Procedures
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43 Verified Questions
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Sample Questions
Q1) Studies have shown that the intraparenchymal catheter has a better result than the intraventricular catheter.Identify the answer that supports this statement.
A) The intraparenchymal catheter allows for CSF drainage.
B) The intraparenchymal catheter has increased monitoring time.
C) The intraparenchymal catheter has a longer insertion time for monitoring ICP.
D) The intraparenchymal catheter has decreased device-related complications.
Q2) With an intact oculocephalic reflex, the
A) patient's eyes move in the same direction the head is turned.
B) patient's eyes move in the opposite direction to the movement of the patient's head.
C) patient's eyes remain midline.
D) doll's eye reflex is absent.
Q3) Which of the following choices is an acceptable and recommended method of noxious stimulation?
A) Nipple pinch
B) Nail bed pressure
C) Supraorbital pressure
D) Sternal rub
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Page 19
Chapter 18: Neurologic Disorders and Therapeutic Management
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44 Verified Questions
44 Flashcards
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Sample Questions
Q1) A patient presents with aphasia, decreased level of consciousness, and right-sided weakness.The patient has a history of heart disease, hyperlipidemia, and transient ischemic attacks.Based on the history, the nurse suspects that the patient has sustained which type of stroke?
A) Hemorrhagic stroke
B) Intracerebral hemorrhages
C) Subarachnoid hemorrhages
D) Ischemic stroke
Q2) The osmotic diuretic that has been most effective in the reduction of increased ICP is A) mannitol.
B) furosemide (Lasix).
C) urea.
D) glycerol.
Q3) Which of the following independent nursing measures can assist in reducing increased ICP?
A) Decreasing the ventilator rate
B) Decreasing noxious stimuli
C) Frequent orientation checks
D) Administration of loop diuretics
Page 20
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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 is assessing the peripheral edema.The nurse presses two fingers over the tibial area, and it takes 1 minute before the indention disappears.The nurse would chart the following result:
A) +1 pitting edema.
B) +2 pitting edema.
C) +3 pitting edema.
D) +4 pitting edema.
Q2) A patient has been on complete bed rest for 3 days.The health care provider has ordered for the patient to sit at the bedside for meals.The patient complains of feeling dizzy and faint while sitting at the bedside.The nurse anticipates that the patient is experiencing
A) orthostatic hypertension.
B) orthostatic hypotension.
C) hypervolemia.
D) electrolyte imbalance.
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Chapter 20: Kidney Disorders and Therapeutic Management
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Sample Questions
Q1) A patient has acute kidney injury (previously known as acute tubular necrosis).The following blood work was noted: complete blood count shows a white blood cell count of 11,000 mm³, a hemoglobin of 8 g/dL, and a hematocrit of 30%.His chemistry panel shows serum potassium, 4.5 mg/dL; serum sodium, 135 mg/dL; serum calcium, 8.5 mg/dL; BUN, 20 mg/dL; and creatinine, 1.5 mg/dL.What laboratory value(s)need(s)to be treated most immediately and why?
A) Administration of 5% dextrose in water and insulin because the patient is hyperkalemic and needs this level reduced
B) Administration of Epogen to treat anemia
C) Administration of a broad-spectrum antibiotic to treat the elevated blood cell count
D) Administration of a calcium supplement for low calcium
Q2) Which of the following laboratory values is the most help in evaluating a patient for acute renal failure?
A) Serum sodium
B) Serum creatinine
C) Serum potassium
D) Urine potassium
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Page 22
Chapter 21: Gastrointestinal Clinical Assessment and Diagnostic Procedures
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Sample Questions
Q1) The best diagnostic test for the determination of upper gastrointestinal bleeding is A) endoscopic retrograde cholangiopancreatography (ERCP).
B) colonoscopy.
C) endoscopy.
D) angiography.
Q2) Identify anatomic structures that are found in the left upper quadrant.
A) Stomach
B) Spleen
C) Portion of the transverse and descending colon
D) Head of the pancreas
E) Body of the pancreas
Q3) Identify anatomic structures that are found in the left lower quadrant.
A) Distended uterus
B) Cecum and appendix
C) Left ureter
D) Portion of the descending colon
E) Sigmoid colon
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Page 23
Chapter 22: Gastrointestinal Disorders and Therapeutic Management
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Sample Questions
Q1) 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
Q2) A nursing priority for a patient with GI hemorrhage is
A) positioning the patient in a high-Fowler position.
B) airway protection.
C) irrigating the nasogastric tube with iced saline.
D) maintaining venous access so that fluids and blood can be administered.
Q3) The physician orders gastric lavage to control GI bleeding.The nurse has inserted a large-bore NG tube.What temperature and irrigating fluid would be used to obtain the best results?
A) Warm NS or water
B) Iced NS or water
C) Room temperature NS or water
D) Iced NS only
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Chapter 23: Endocrine Clinical Assessment and Diagnostic Procedures
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Sample Questions
Q1) A 16-year-old young woman is admitted to the critical care unit with severe hyperglycemia caused by new-onset type 1 diabetes mellitus.The patient is complaining of headache and blurred vision.The nurse knows that these are signs that may indicate A) kidney stones.
B) diabetes insipidus.
C) hypoglycemia.
D) hyperglycemia.
Q2) The nurse knows that an abnormal response to the ADH test would be
A) a slight increase in urine osmolality.
B) a decrease in urine output.
C) a decrease in serum osmolality.
D) no change in urine osmolality.
Q3) A normal HbA<sub>1</sub>c level for a normal person is
A) less than 5.4%.
B) less than 6.5%.
C) between 5.4% and 6.5%.
D) between 3% and 5.4%.
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Page 25
Chapter 24: Endocrine Disorders and Therapeutic Management
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Sample Questions
Q1) A patient in diabetic ketoacidosis is very lethargic and has a "funny" odor to his breath.The nurse would suspect this to be a result of A) alcohol intoxication.
B) hyperglycemia.
C) hyperphosphatemia.
D) acetone.
Q2) A patient with hyperglycemic hyperosmolar syndrome (HHS)has a serum glucose level of 400 mg/dL and a serum sodium level of 138 mEq/L.The intravenous fluid of choice would be
A) D5W.
B) 0.45% NS.
C) 0.9% NS.
D) D5/NS.
Q3) During the first 24 hours when the nurse administers hypertonic saline in a patient with SIADH, the serum sodium should be raised no more than A) 5 mEq/day.
B) 12 mEq/day.
C) 20 mEq/day.
D) 25 mEq/day.
Page 26
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Chapter 25: Trauma
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Sample Questions
Q1) A patient has sustained an epidural hematoma after a 10-foot fall from a roof.Which of the following is true about epidural hematomas?
A) They are usually arterial in nature.
B) They typically have a worse mortality rate than subdural hematomas.
C) They are associated with a permanent loss of consciousness.
D) Clinical signs and symptoms include bilateral pupil dilation.
Q2) The most important aspect of a secondary survey is to
A) check circulatory status.
B) check electrolyte profile.
C) insert a urinary catheter.
D) obtain patient history.
Q3) A strategy to minimize secondary brain injury in head-injured patients is
A) hyperventilation to keep PCO<sub>2</sub> less than 30.
B) fluid restriction to keep central venous pressure less than 6 cm H<sub>2</sub>O.
C) maintaining body temperature more than 37.5° C.
D) fluid resuscitation as needed to keep the systolic blood pressure greater than 90 mm Hg.
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Chapter 26: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome
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Sample Questions
Q1) The most common site for sepsis and septic shock is
A) the respiratory system.
B) the gastrointestinal system.
C) the genitourinary system.
D) the circulatory system.
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) The primary mechanism in the development of tumor lysis syndrome is
A) destruction of platelets by lymphocytic antibodies.
B) destruction of malignant cells through radiation or chemotherapy.
C) formation of heparin antibodies.
D) damage to the endothelium.
Q2) Which of the following previous medical conditions would indicate a patient at risk for developing HIT?
A) Sepsis
B) Deep vein thrombosis
C) Cardiac arrest
D) Pneumonia
Q3) 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.
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Page 29