Critical Care Nursing Exam Solutions
Course Introduction
Critical Care Nursing focuses on the specialized knowledge and skills required to care for patients with life-threatening conditions in intensive care settings. The course covers patient assessment, advanced monitoring techniques, emergency interventions, mechanical ventilation, pharmacological management, and ethical considerations in critical care. Students will learn to collaborate effectively within multidisciplinary teams, develop critical thinking and rapid decision-making abilities, and apply evidence-based practices to ensure optimal patient outcomes. Emphasis is placed on holistic care, communication with patients and families, and enhancing resilience in high-stress environments.
Recommended Textbook
Priorities in Critical Care Nursing 7th Edition by
Linda D. Urden
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42 Chapters
1239 Verified Questions
1239 Flashcards
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Chapter 1: Critical Care Nursing Practice
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Sample Questions
Q1) According to AACN,a critical care nurse's responsibilities include
A) respecting the values, beliefs, and rights of the patient.
B) intervening when the best interest of the patient is in question.
C) helping the patient obtain necessary care.
D) making decisions for the patient and patient's family.
E) monitoring and safeguarding the quality of care the patient receives.
F) acting as a gatekeeper for the patient, the patient's family, and other health care professionals.
Answer: A,B,C,E
Q2) Designing therapeutic activities that move a patient from one state of health to another is an example of
A) a nursing diagnosis.
B) nursing interventions.
C) nursing outcomes.
D) the nursing process.
Answer: B
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3
Chapter 2: Ethical Issues
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Sample Questions
Q1) Which of the following ethical principles is most important when soliciting informed consent from a client?
A) Nonmaleficence
B) Fidelity
C) Beneficence
D) Veracity
Answer: D
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) 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
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Chapter 3: Legal Issues
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Sample Questions
Q1) The legal standard of care for a nurse's actions is defined as
A) minimal competency under the Nurse Practice Act.
B) the ability to distinguish what is right or wrong for the patient.
C) the demonstration of satisfactory knowledge of policies and procedures.
D) providing reasonable, prudent care comparable to that of like practitioners.
Answer: D
Q2) Which of the following statements about defamation are true?
A) Defamation refers only to the spoken word.
B) Defamation is a communication that damages a person's reputation.
C) Defamation must be heard or seen by at least one other person.
D) The plaintiff is not required to prove damages.
E) The communication must be proven false and made with malice.
Answer: B,C,E
Q3) As a result of legal relationships that form from employment in critical care,professional nurses owe the
A) employer a willingness to work overtime when needed.
B) patient the provision of reasonable and prudent care.
C) physician the ability to carry out all written orders.
D) profession state membership in a nursing organization.
Answer: B
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Chapter 4: Genetics and Genomics in Critical Care
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Sample Questions
Q1) The patient is placed under general anesthesia for a carotid endarterectomy.During the surgery,the patient develops muscle contracture with skeletal muscle rigidity,acidosis,and elevated temperature.A possible cause for malignant hyperthermia is
A) a polymorphism in RYR1 at chromosome 19q13.1.
B) a variant in the VKOR1 gene.
C) a variant in the cytochrome P450 enzyme CYP2C9 gene.
D) halothane overdose.
Q2) Each chromosome consists of an unbroken strand of DNA inside the nucleus of the cell.This arrangement of human chromosomes is known as:
A) chromatids.
B) karyotype.
C) genomics.
D) histones.
Q3) An example of direct-to-consumer genomic testing is:
A) genetic testing through amniocentesis.
B) paternity testing from buccal swabs of the child and father.
C) biopsy of a lump for cancer.
D) drug testing using hair follicles.
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Page 6
Chapter 5: Patient and Family Education
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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
Q2) A nurse has been progressively working with a patient on the exercises he needs to do at home when he is discharged.The nurse wants to ensure he will remember what to do when he is at home.Which teaching strategy is most appropriate for this situation?
A) Discussion
B) Demonstration and practice
C) Audiovisual media
D) Written
Q3) During which phase do HIPAA,advance directives,and visitation policies occur for the patient or family members?
A) Transfer to a different level of care
B) End-of-life care
C) Initial contact or first visit
D) Continuous care
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Page 7
Chapter 6: Psychosocial and Spiritual Alterations and Management
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Sample Questions
Q1) Commonly used medications for withdrawal symptoms include
A) chlordiazepoxide and folic acid.
B) chlordiazepoxide and lorazepam.
C) lorazepam and promethazine.
D) promethazine and thiamine.
Q2) A patient has been admitted to the critical care unit with a severed spinal cord injury at the T2 level.The patient has been in halo traction with immobilization for the past week.The physician explains to the patient that the spinal cord has been severed and that the patient will not be able to walk again.The patient becomes overtly hostile to everyone.The patient is demonstrating
A) regression.
B) loss of autonomy.
C) ineffective coping.
D) hope.
Q3) Patients with an external locus of control
A) believe that they can influence the outcome of their illness.
B) should be forced to take control of their discharge planning.
C) usually start out with an internal locus of control until a major illness occurs.
D) believe that events are related to chance or fate.
Page 8
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Chapter 7: Sleep Alterations and Management
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Sample Questions
Q1) 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.
Q2) Identify the usual cycle of sleep onset.
A) NR1, NR2, NR3, NR2, REM
B) NR1, NR2, NR3, REM
C) NR1, NR2, NR3, NR1, REM
D) NR1, NR2, NR3, REM, NR3
Q3) Which stage of NREM sleep is associated with anabolic processes?
A) N1
B) N2
C) N3
D) N4
Q4) 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.
Page 9
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Chapter 8: Nutrition Alterations and Management
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Sample Questions
Q1) A person with a BMI of 28 would be considered A) obese.
B) overweight or pre-obese.
C) of normal weight.
D) underweight.
Q2) A primary nutritional intervention for hypertension is A) decreasing carbohydrates.
B) limiting salt.
C) increasing protein.
D) increasing fluids.
Q3) Patients with coronary artery disease should be taught about cholesterol.Which situation is most desirable?
A) Low levels of HDL cholesterol
B) Low levels of LDL cholesterol
C) Hypocholesterolemia
D) Low levels of both HDL and LDL cholesterol
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Chapter 9: Pain and Pain Management
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Q1) Which of the following patients is MOST likely to be experiencing a life-threatening opioid side effect?
A) Patient with respiratory rate of 10 breaths/min who is breathing deeply
B) Patient with a respiratory rate of 8 breaths/min who is snoring
C) Patient with blood pressure of 150/75 mm Hg and heart rate of 102 beats/min
D) Patient with a temperature of 100.5°F who is asleep but easily roused
Q2) 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.
Q3) The subjective characteristic implies that pain is
A) an uncomfortable experience present only in the patient with an intact nervous system.
B) an unpleasant experience accompanied by crying and tachycardia.
C) activation of the sympathetic nervous system from an injury.
D) whatever the patient experiencing it says it is, occurring when that patient says it does.
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Chapter 10: Sedation,Agitation,Delirium: Assessment and Management
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Sample Questions
Q1) To achieve ventilator synchrony in a mechanically ventilated patient with acute respiratory distress syndrome (ARDS),which level of sedation might be most effective?
A) Light
B) Moderate
C) Conscious
D) Deep
Q2) 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.After the patient's agitation is controlled,which of the following drugs would be most appropriate for long-term sedation?
A) Morphine 2 mg/hr continuous IV drip
B) Haloperidol 15 mcg/kg/min continuous IV infusion
C) Propofol 5 mcg/kg/min by IV infusion
D) Lorazepam 0.01 to 0.1 mg/kg/hr by IV infusion
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Chapter 11: End-Of-Life Issues
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Sample Questions
Q1) A patient was admitted to the critical care unit several weeks ago with an acute myocardial infarction and subsequently underwent coronary artery bypass grafting surgery.Since a cardiac arrest 5 days ago,the patient has been unresponsive.An electroencephalogram shows no meaningful brain activity.The patient is placed on a morphine drip to alleviate suspected operative pain and assist in sedation.The patient continues to grimace and fight the ventilator.What nursing intervention would be appropriate?
A) Increase the morphine dosage until no signs of pain or discomfort are present.
B) Increase the morphine drip, but if the patient's respiratory rate drops below 10 breaths/min, return to the original dosage.
C) Gradually decrease the morphine and switch to Versed to avoid respiratory depression.
D) Ask the family to leave the room because their presence is causing undue stress to the patient.
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Chapter 12: Cardiovascular Anatomy and Physiology
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Sample Questions
Q1) The contribution of atrial kick to ventricular filling is approximately A) 10%.
B) 20%.
C) 5%.
D) 45%.
Q2) Which step of impulse conduction is most conducive to atrial kick?
A) The firing of the sinoatrial node, which results in atrial depolarization
B) The conduction delay at the AV node, allowing time for filling
C) Conduction through the bundle of His, enhancing ventricular depolarization
D) Conduction to the Purkinje fibers, allowing for ventricular contraction
Q3) Depolarization of one myocardial cell will likely result in
A) completion of the action potential in that cell before a new cell can accept an impulse.
B) quick depolarization and spread to all of the heart.
C) depolarization of only cells superior to the initial depolarization.
D) depolarization of only cells inferior to the initial depolarization.
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Chapter 13: Cardiovascular Clinical Assessment
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Sample Questions
Q1) The nurse assesses the dorsalis pedis and posterior tibial pulses as weak and thready.Indicate the correct documentation for the pulse volume that the nurse would use.
A) 0
B) 1+
C) 2+
D) 3+
Q2) Abnormal heart sounds are labeled S? and S? and are referred to as __________ when auscultated during a tachycardic episode.
A) Korotkoff sounds
B) pulse pressure
C) murmurs
D) gallops
Q3) Evaluation of arterial circulation to an extremity is accomplished by assessing which of the following?
A) Homans sign
B) Skin turgor
C) Peripheral edema
D) Capillary refill
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Page 15
Chapter 14: Cardiovascular Diagnostic Procedures
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Sample Questions
Q1) The blood test used to standardize PT results among clinical laboratories worldwide is known as
A) aPTT.
B) ACT.
C) HDL.
D) INR.
Q2) A patient returns from the cardiac catheterization laboratory after angioplasty and stent placement (ECG changes had indicated an inferior wall myocardial infarction in progress).Which lead would best monitor this patient?
A) Varies based on the patient's clinical condition and recent clinical history
B) Lead MCL1
C) Lead V?
D) Lead II
Q3) A characteristic event in junctional dysrhythmias is
A) irregular rhythm.
B) rapid depolarization to the ventricles.
C) the spread of the impulse in two directions at once.
D) a widened QRS.
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Chapter 15: Cardiovascular Disorders
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Sample Questions
Q1) The classic description of pain associated with aortic dissection is
A) substernal pressure.
B) tearing in the chest, abdomen, or back.
C) numbness and tingling in the left arm.
D) patient is asymptomatic.
Q2) Which of the following cholesterol values indicates a heightened risk for the development of CAD?
A) Total cholesterol level of 170 mg/dL
B) HDL cholesterol level of 30 mg/dL
C) Triglyceride level of 120 mg/dL
D) LDL cholesterol level >190 mg/dL
Q3) Data concerning coronary artery disease (CAD)and specific risk factors have demonstrated
A) a low correlation of modifiable risk factors to CAD.
B) the onset of CAD in middle age.
C) an association between development of specific risk factors and CAD.
D) no decisive correlation between risk factors and CAD.
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Chapter 16: Cardiovascular Therapeutic Management
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Sample Questions
Q1) A pacemaker is connected to an external temporary pulse generator.The sensitivity control
A) determines heart rate to muscle activity.
B) determines the milliamperes needed to achieve capture.
C) regulates the ability of the pacemaker to detect the heart's intrinsic electrical activity. D) allows for selection of intervals between atria and ventricles.
Q2) A patient suddenly develops a wide QRS complex tachycardia.The patient's heart rate is 220 beats/min and regular; blood pressure is 96/40 mm Hg; and respiratory rate is 22 breaths/min,and the patient is awake without complaint except for palpitations.Which of the following interventions would be best to try first?
A) Adenosine 6 mg rapid IV push
B) Lidocaine 1 mg/kg IV push
C) Verapamil 0.5 mg IV push
D) Digoxin 0.25 mg IV push
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Chapter 17: Pulmonary Anatomy and Physiology
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Q1) The most important function of type I alveolar epithelial cells is
A) that they comprise 90% of total alveolar surface in the lungs for gas exchange.
B) the ability to produce, store, and secrete pulmonary surfactant.
C) the ability to trap foreign particles for autodigestion.
D) the maintenance, repair, and restoration of the mucociliary escalator.
Q2) Which pleura adheres to the lungs?
A) Parietal
B) Visceral
C) Intrapleural
D) Surfactant
Q3) Oxygen saturation of left atrial blood is normally between 96% and 99%.What is the explanation for less than 100% saturation?
A) As blood passes to the alveolar-capillary membrane, a predicted percentage of hemoglobin will not bind with oxygen.
B) During normal respiration, the majority of alveoli are not expanded.
C) Venous blood from the bronchial circulation is returned to the left atrium.
D) A small amount of blood leaks from the right atrium to the left atrium with each ventricular contraction.
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Chapter 18: Pulmonary Clinical Assessment
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Q1) Auscultation of the anterior chest should be performed using which of the following sequences?
A) Right side, top to bottom, then left side, top to bottom
B) Left side, top to bottom, then right side, top to bottom
C) Side to side, bottom to top
D) Side to side, top to bottom
Q2) While conducting a physical assessment,you note that the patient's breathing is rapid and shallow.This type of breathing pattern is known as A) hyperventilation.
B) tachypnea.
C) obstructive breathing.
D) bradypnea.
Q3) The use of touch to judge the character of the body surface and underlying organs is known as A) inspection.
B) palpation.
C) percussion.
D) auscultation.
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Chapter 19: Pulmonary Diagnostic Procedures
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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) On admission,a patient presents as follows: pH,7.38; respiratory rate,24 breaths/min,regular,pursed-lip breathing; PaO<sub>2</sub>,66 mm Hg; heart rate,112 beats/min,sinus tachycardia; PaCO<sub>2</sub>,52 mm Hg; blood pressure,110/68 mm Hg; HCO<sub>3</sub>-,24 mEq/L; and SpO<sub>2</sub>,90% on O<sub>2</sub> 2 L/min
nasal cannula.What treatment would the physician or nurse practitioner likely order for this patient?
A) Increase O<sub>2</sub> to 6 L/min.
B) Prepare for emergency intubation.
C) Administer 1 ampule of sodium bicarbonate.
D) Repeat ABG testing in 4 hours.
Q3) Preprocedural medications for a diagnostic bronchoscopy may include
A) aspirin for anticoagulation.
B) vecuronium to inhibit breathing.
C) codeine to decrease the cough reflex.
D) cimetidine to decrease hydrochloric acid secretion.
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Chapter 20: Pulmonary Disorders
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Q1) 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.
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.Which test would the nurse expect the health care provider to order to identify the infectious pathogen?
A) CBC with differential
B) Wound culture of surgical site
C) Sputum Gram stain and culture
D) Urine specimen
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Chapter 21: Pulmonary Therapeutic Management
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Q1) Which medication may be administered with a bronchodilator because it can cause bronchospasms?
A) ?2-Agonists
B) Mucloytics
C) Anticholinergic agents
D) Xanthines
Q2) A patient was taken to surgery for a left lung resection earlier today.The patient has been in the postoperative care unit for 30 minutes.When you are completing your assessment,you notice that the chest tube has drained 125 cc of red fluid in the past 30 minutes.The nurse contacts the physician and suspects that the patient has developed A) pulmonary edema.
B) hemorrhage.
C) acute lung failure.
D) bronchopleural fistula.
Q3) Long-term ventilator management over 21 days is best handled through use of a(n)
A) oropharyngeal airway.
B) esophageal obturator airway.
C) tracheostomy tube.
D) endotracheal intubation.
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Page 23
Chapter 22: Neurologic Anatomy and Physiology
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Q1) What percentage of the body's total resting cardiac output is used by the brain?
A) 5%
B) 10%
C) 20%
D) 40%
Q2) Which area of the ventricular system is usually cannulated for intracranial pressure monitoring?
A) Frontal horn of the lateral ventricle
B) Aqueduct of Sylvius
C) Foramen of Monro
D) Fourth ventricle
Q3) Which statement best describes the role of neuroglial cells?
A) They are fewer in number than neurons.
B) They provide support to the neuron in nutrients and structural formation.
C) They protect the CNS from nonmetabolic primary neoplasms.
D) They produce a steady supply of neurotransmitters.
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Chapter 23: Neurologic Clinical Assessment and Diagnostic Procedures
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Q1) A patient is being prepared for a neurologic work-up.Examinations include a CT scan,cerebral angiography,and lumbar puncture.The best position to place the patient in for a lumbar puncture is
A) supine.
B) reverse Trendelenburg.
C) high Fowler.
D) lateral recumbent position with her knees and head slightly tucked.
Q2) Cerebral infarction is a serious complication of which procedure?
A) Extracranial Doppler
B) Evoked potential testing
C) Myelography
D) Conventional angiography
Q3) The initial history for the neurologically impaired patient needs to be
A) limited to the chief complaint.
B) comprehensive, including events preceding hospitalization.
C) directed to level of consciousness and pupillary reaction.
D) information that only the patient can provide.
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Page 25
Chapter 24: Neurologic Disorders and Therapeutic Management
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Q1) Which of the following is the most common complication after high-dose barbiturate therapy?
A) Hypothermia
B) Hypotension
C) Myocardial depression
D) Decreased CVP
Q2) The stroke patient who has difficulty with speech has
A) expressive aphasia.
B) global aphasia
C) receptive aphasia.
D) apraxia.
Q3) Which assessment finding in a patient in coma 10 to 12 hours after cardiopulmonary arrest is indicative of unlikely survival?
A) Decorticate posturing
B) Absent pupillary light reflexes
C) Decerebrate posturing
D) Central hyperventilation
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Page 26
Chapter 25: Kidney Anatomy and Physiology
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Q1) The functional unit of the kidney is known as the A) Bowman capsule.
B) glomerulus.
C) nephron.
D) distal tubule.
Q2) Which of the following,if found in the urine,suggests damage to the glomerular membrane?
A) Creatinine
B) Bicarbonate ions
C) Sodium
D) Albumin
Q3) When renin eventually stimulates angiotensin II,the adrenal glands then secrete
A) aldosterone.
B) potassium.
C) ADH.
D) vasopressin.
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Chapter 26: Kidney Clinical Assessment and Diagnostic
Procedures
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Q1) 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.
Q2) Which of the following parameters is indicative of volume overload?
A) Central venous pressure of 4 mm Hg
B) Pulmonary artery occlusion pressure (PAOP) of 18 mm Hg
C) Cardiac index of 2.5 L/min/m²
D) Mean arterial pressure of 40 mm Hg
Q3) Loss of albumin from the vascular space may result in
A) peripheral edema.
B) extra heart sounds.
C) hypertension.
D) hyponatremia.
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Chapter 27: Kidney Disorders and Therapeutic Management
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Q1) 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.Why would this therapy be chosen for this patient?
A) Hyperdynamic patients can better tolerate abrupt fluid and solute changes.
B) It is the treatment of choice for patients with diminished renal perfusion who are unresponsive to diuretics.
C) It is indicated for patients who require large-volume removal for severe uremia or critical acid-base imbalances.
D) It is indicated for hemodynamically unstable patients, who are often intolerant of the abrupt fluid and solute changes that can occur with hemodialysis.
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Chapter 28: Gastrointestinal Anatomy and Physiology
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Q1) Which layer of the large intestine consists of longitudinal and circular muscles?
A) Serosa layer
B) Muscularis layer
C) Submucosa layer
D) Mucosa layer
Q2) The liver receives nutrient-rich blood from the gut,pancreas,spleen,and stomach from the
A) hepatic artery.
B) hepatic vein.
C) portal vein.
D) intralobular veins.
Q3) Liver failure may affect the synthesis of fibrinogen,resulting in A) jaundice.
B) fluid retention and ascites.
C) delayed clotting.
D) hepatomegaly.
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Chapter 29: Gastrointestinal Clinical Assessment and Diagnostic Procedures
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Q1) Identify anatomic structures that are found in the right upper quadrant.
A) Duodenum
B) Portion of the transverse colon
C) Liver
D) Stomach
E) Cecum
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) Which assessment technique is most useful in detecting abdominal pathologic conditions?
A) Percussion
B) Palpation
C) Inspection
D) Auscultation
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Chapter 30: Gastrointestinal Disorders and Therapeutic Management
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Q1) 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
Q2) To administer sucralfate through a gastric tube it should be
A) crushed and mixed with 10 mL of water.
B) dissolved in 10 mL of water to form a slurry.
C) mixed in 15 mL of water to form a solution.
D) administered as a whole pill with a 35-mL water flush.
Q3) Absorption of Prilosec and Prevacid occurs in the A) stomach.
B) duodenum.
C) jejunum.
D) cecum.
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Page 32
Chapter 31: Endocrine Anatomy and Physiology
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Q1) Insulin produces hypoglycemia.What other physiologic effect may occur when insulin is given?
A) Polyuria
B) Hypercalcemia
C) Hypokalemia
D) Cellular dehydration
Q2) Identify major functions of the thyroid hormones.
A) Increase the rate of glucose used by the cells
B) Decrease fat metabolism
C) Increase the body's demand for vitamins
D) Decrease cardiac output
E) Stimulate bone resorption
F) Increase serum cholesterol levels
Q3) A patient is brought to the hospital with a stab wound after a fight at a local bar.His alcohol level is twice the normal limit.The nurse would expect his serum osmolality to be
A) elevated.
B) decreased.
C) unaffected.
D) equal to his sodium level.
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Page 33
Chapter 32: Endocrine Clinical Assessment and Diagnostic
Procedures
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Q1) A patient is admitted to the critical care unit with critical hypotension,hyperkalemia,hyponatremia,and hypoglycemia.The most likely cause of this is
A) myxedema.
B) diabetes insipidus.
C) addisonian crisis.
D) Cushing syndrome.
Q2) When preparing the patient for a serum ADH level,the nurse must withhold
A) insulin and furosemide.
B) morphine and carbamazepine.
C) Lanoxin and potassium.
D) heparin and beta-blockers.
Q3) 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.
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Chapter 33: Endocrine Disorders and Therapeutic Management
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Q1) A patient with type 2 diabetes is admitted.He is very lethargic and hypotensive.A diagnosis of hyperglycemic hyperosmolar syndrome (HHS)is made based on laboratory values of
A) decreased serum glucose and increased serum ketones.
B) increased urine ketones and decreased serum osmolality.
C) increased serum osmolality and increased serum potassium.
D) increased serum osmolality and increased serum glucose.
Q2) The patient's temperature is 93° F rectally.The most appropriate intervention with this patient would be to
A) give aggressive therapy that includes warm peritoneal lavage.
B) allow the patient to maintain this body temperature to decrease oxygen demands.
C) use warming blankets to slowly warm the patient.
D) wait until the patient shivers to start warming.
Q3) Which of the following nursing interventions should be initiated on all patients with SIADH?
A) Placing the patient on an air mattress
B) Forcing fluids
C) Initiating seizure precautions
D) Applying soft restraints
Page 35
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Chapter 34: Trauma
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Q1) Patients immobilized because of spinal trauma are at a high risk for contractures.Preventive measures should include
A) consultation by PT and OT early in the treatment of the patient.
B) turning and repositioning the patient every 2 hours as ordered by the physician.
C) range of motion exercises 1 month after the spine has been stabilized.
D) removal of splints every 4 hours and at bedtime.
E) hand splints for patients with paraplegia.
F) hand and foot splints for patients with quadriplegia.
Q2) A patient is admitted to the ICU with a C5-C6 subluxation fracture.He is able to move his legs better than he can move his arms.Caring for the patient would include which of the following interventions?
A) Keeping the room cool, dark, and quiet
B) Administering intravenous methylprednisolone for the first 24 hours after the injury
C) Elevating the head of the bed 45 degrees
D) Resuscitating low blood pressure by only using intravenous fluid
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Chapter 35: Shock,sepsis,and Multiple Organ Dysfunction Syndrome
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Q1) The nursing measure that can best enhance large volumes of fluid replacement in hypovolemic shock is
A) insertion of a large-diameter peripheral intravenous catheter.
B) positioning the patient in the Trendelenburg position.
C) forcing at least 240 mL of fluid each hour.
D) administering intravenous lines under pressure.
Q2) Profound weight loss in patients with SIRS or MODS is the result of A) hypometabolism.
B) hypermetabolism.
C) hyperglycemia.
D) intolerance to enteral feedings.
Q3) Signs of hypovolemia in the trauma patient include A) distended neck veins.
B) a decreased level of consciousness.
C) bounding radial and pedal pulses.
D) a widening pulse pressure.
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Chapter 36: Burns
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Q1) A patient involved in a house fire is brought by ambulance to your emergency department.He is breathing spontaneously but appears agitated.He does not respond appropriately to questions.You assume he has inhaled carbon monoxide and has carbon monoxide (CO)poisoning.Your first action is to
A) ask the physician to order a STAT chest radiograph to rule out a pneumothorax.
B) apply a pulse oximeter to one of his unburned fingers.
C) call the local hyperbaric chamber to check on its availability.
D) administer 100% high-flow oxygen via a nonrebreathing mask.
Q2) Using the Parkland formula for fluid resuscitation and your knowledge of injury calculations using the "rule of nines," calculate the estimated fluid requirements during the first 8 hours for a 75-kg patient with full-thickness burns to the anterior chest,perineum,and entire right leg.
A) 2775 mL
B) 5550 mL
C) 8325 mL
D) 11,100 mL
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Chapter 37: Organ Donation and Transplantation
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Q1) A patient is admitted to the critical care unit with the diagnosis of massive head trauma caused by an MVA.The patient is unresponsive and on mechanical ventilation.EEG is negative for brain waves.The family has agreed to organ donation.The nurse turns the patient's head quickly from side to side.The eyes do not move.The nurse knows this is the result of a loss in the
A) oculovestibular reflex.
B) corneal and jaw reflexes.
C) oculocephalic reflex.
D) pupillary reflexes.
Q2) The longest and most difficult part of the recipient hepatectomy is
A) stage 1.
B) stage 2.
C) stage 3.
D) grade 1.
Q3) Which of the following goals would be a priority after lung transplantation?
A) Wean the patient from the ventilator.
B) Maintain hypotensive levels.
C) Start corticosteroid therapy.
D) Initiate pulmonary function studies.
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Page 39
Chapter 38: Hematologic Disorders and Oncologic Emergencies
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Q1) Medical intervention to prevent metabolic imbalances associated with tumor lysis syndrome includes
A) give Kayexalate for hypokalemia.
B) keep urine pH below 7.0.
C) fluid restriction.
D) dietary restriction of potassium and phosphorus foods.
Q2) Which of the following nursing interventions would be used if a patient was put under bleeding precautions?
A) Avoid injections as appropriate.
B) Encourage the patient to eat foods high in calcium and vitamin C
C) Use a soft toothbrush or toothettes for oral care.
D) Provide a therapeutic mattress and pad side rails.
E) Use an electric razor for shaving.
Q3) The high-risk period for developing HIT is
A) 5 to 10 hours after initiation of heparin.
B) 5 to 14 hours after initiation of heparin.
C) 5 to 14 days after initiation of heparin.
D) 30 to 60 days after initiation of heparin.
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Chapter 39: The Obstetric Patient
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Q1) A 35-year-old multiparous woman was admitted to the hospital at 36 weeks' gestation for nausea,vomiting,and severe epigastric pain.On admission,her vital signs were as follows: pulse,90 beats/min; blood pressure,165/100 mm Hg; respiratory rate,18 breaths/min; and temperature,99.4° F.The patient reported blurred and double vision and a severe headache.The fetal heart rate was normal.She was placed on bed rest.Urine analysis revealed proteinuria.Her vital signs 6 hours later were as follows: pulse,88 beats/min; blood pressure,185/105 mm Hg; respirations,16 breaths/min; and temperature,98.4° F.The fetal heart rate was normal.Severe pre-eclampsia was diagnosed.The patient is placed on a magnesium sulfate drip of 3 g/hr.After 1 hour,she has a recurrent seizure.The nurse should
A) administer another 2- to 4-g bolus of MgSO<sub>4</sub>.
B) adjust the MgSO<sub>4</sub> at a rate of 1 to 2 g/hr.
C) consider delivery.
D) intubate immediately and provide ventilatory support.
Q2) The most common obstetric cause of DIC is
A) pre-eclampsia.
B) abruptio placentae.
C) dead fetus syndrome.
D) amniotic fluid embolism.
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Chapter 40: The Pediatric Patient
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Q1) Central cyanosis is associated with A) visible cyanosis but normal arterial oxygen saturation.
B) desaturation of arterial blood.
C) reduced hemoglobin of 15 g/dL.
D) permanent cerebral hypoxia.
Q2) Causes associated with the diagnosis status epilepticus include A) high fever.
B) encephalitis.
C) metabolic disorder.
D) meningitis.
E) gradual weaning of anticonvulsant drugs.
Q3) Initial treatment for hypoxia,acidosis,or hypothermia is A) vasopressin.
B) bronchodilators.
C) oxygenation and ventilation.
D) hydration.
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Chapter 41: The Older Adult Patient
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Q1) The focus on the relief of suffering,in all of its dimensions,is referred to as
A) aggressive care
B) advance directives
C) hospice care
D) palliative care
Q2) An older patient is admitted to the hospital with a hip fracture.Which of the following nursing interventions would be a priority?
A) Facilitate frequent deep breathing.
B) Administer stool softeners.
C) Perform neurologic checks.
D) Frequently offer liquids to drink.
Q3) Which of the following sounds may be difficult for an older person to hear?
A) Telephone ringing
B) Clothes dryer running
C) Car horn honking
D) Child crying
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Chapter 42: The Perianesthesia Patient
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Q1) What is the principal depolarizing skeletal muscle relaxant?
A) Succinylcholine
B) Pancuronium
C) Mivacurium
D) Rocuronium
Q2) What medication is a first-line therapy in treating bronchospasm?
A) Racemic epinephrine
B) Methylprednisolone
C) Albuterol
D) Morphine
Q3) Snoring,stridor,nostril flaring,and intercostal retractions are clinical manifestations of A) angina.
B) airway obstruction.
C) pain.
D) sedation.
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