Emergency and Critical Care Nursing
Textbook Exam Questions
Course Introduction
Emergency and Critical Care Nursing is a comprehensive course designed to equip nursing students with the theoretical knowledge and practical skills necessary to provide effective care to acutely ill and critically injured patients. The course covers principles of triage, rapid patient assessment, advanced life support, trauma management, and interventions for a variety of life-threatening conditions in emergency and intensive care unit settings. Students will learn to work as part of multidisciplinary teams, apply evidence-based practices, utilize critical thinking in high-pressure scenarios, and offer compassionate support to patients and their families. Emphasis is also placed on emergency preparedness, use of specialized medical equipment, and adherence to ethical and legal standards in emergency and critical care 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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Page 2
Chapter 1: Critical Care Nursing Practice
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Sample Questions
Q1) _____ continues to be one of the most error-prone nursing interventions for critical care nurses.
A) Inappropriate care
B) Intimidating and disruptive clinician behavior
C) Injury to patients by falls
D) Medication administration
Answer: D
Q2) The AACN has developed short directives that can be used as quick references for clinical use that are known as
A) Critical Care Protocol.
B) Practice Policies.
C) Evidence-Based Research.
D) Practice Alerts.
Answer: D
Q3) The systematic decision-making model used by nurses is known as
A) a nursing diagnosis.
B) nursing interventions.
C) nursing evaluations.
D) the nursing process.
Answer: D
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Chapter 2: Ethical Issues
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Sample Questions
Q1) 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
Q2) Which of the following contribute to the issues of the complexity to allocate health care availability and cost?
A) Increased number of physicians
B) Expanded technologies
C) Retirement of the baby boomers
D) Limited access to insurance
E) Escalating health care costs
F) Increases in special health care needs
G) Decreased number of qualified health care personnel
H) Increase in the drug manufacturing industry
Answer: B,C,E,F,G
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Chapter 3: Legal Issues
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Sample Questions
Q1) ______________ to the injured party is the first element of a malpractice case and is based on the existence of a nurse-patient relationship.
A) Duty
B) Breach
C) Damages
D) Harm caused by the breach
Answer: A
Q2) A patient is admitted with chest pain,and his electrocardiogram shows elevated ST segments.The nurse bases her plan of care on the nursing diagnosis of pneumonia.Which of the following would best describe the possible type of negligence present?
A) Assessment failure
B) Planning failure
C) Implementation failure
D) Evaluation failure
Answer: B
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5
Chapter 4: Genetics and Genomics in Critical Care
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Sample Questions
Q1) The study of heredity,particularly as it relates to the ability of genes to transfer heritable physical characteristics,is known as:
A) chromatids.
B) karyotype.
C) genetics.
D) histones.
Q2) Prader-Willi syndrome (PWS)is a caused by a lack of genetic material in 15q11.2-13.Approximately 70% of PWS is related to deletion.Based on this information,it can be determined that PWS is a A) chromosome disorder.
B) single gene disorder.
C) complex gene disorder.
D) multifactorial disorder.
Q3) When a genetic variant exists in greater than 1% of the population,it is considered a A) genetic mutation.
B) genetic polymorphism.
C) genetic deletion.
D) tandem repeat.
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6
Chapter 5: Patient and Family Education
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Sample Questions
Q1) 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.
Q2) Which of the following statements BEST describes the teaching-learning process?
A) It follows the distinct order of the nursing process, with each step of the process separate and without repetition.
B) It requires formal blocks of learning time that are planned during the shift.
C) It is a continuous activity that occurs during hospitalization and beyond.
D) It ends at the point of discharge.
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) Prolonged periods of anxious waiting,disrupted sleep patterns,witnessing emergency interventions,and financial concerns could put family members at risk for developing A) powerlessness.
B) hopelessness.
C) anxiety.
D) PTSD.
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 patient states,"I can't wait until I can get on my feet and walk again." Which defense mechanism is present in this statement?
A) Denial
B) PTSD
C) Regression
D) Trust
Q3) Anxiety can cause emotional changes in the A) hypothalamus.
B) limbic system.
C) cerebral cortex.
D) pituitary gland.
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Chapter 7: Sleep Alterations and Management
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Sample Questions
Q1) Which of the following patients would the nurse most strongly suspect of having obstructive sleep apnea?
A) A severely obese woman with diabetes
B) A moderately obese man who snores
C) A nonobese woman with hypertension
D) A severely obese man with renal dysfunction
Q2) Which of the following occur during REM sleep stages?
A) Vital signs remain at basal levels.
B) Dreams occur.
C) Myocardial infarction often occurs.
D) Sweating or shivering is common.
E) Growth hormone is released.
Q3) The primary determinant in the efficacy of CPAP in patients with OSA is A) compliance.
B) weight.
C) tonsil size.
D) respiratory effort.
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9
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 patient is admitted to the critical care unit with severe malnutrition as a result of hepatic failure.A triple-lumen central venous catheter is placed in the right subclavian vein,and TPN is started.On the third day of infusion,the patient develops symptoms of fever and chills.Which of the following complications should be suspected?
A) Air embolism
B) Pneumothorax
C) Central venous thrombosis
D) Catheter-related sepsis
Q3) Prevention of pulmonary aspiration is best accomplished by A) administering intermittent feedings.
B) adding thickening agents to the tube feeding solution.
C) suctioning the patient hourly.
D) elevating the head of the bed 30 to 45 degrees.
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Chapter 9: Pain and Pain Management
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Sample Questions
Q1) 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
Q2) C fibers are small-diameter,unmyelinated fibers that transmit what type of pain?
A) C fibers transmit diffuse, dull, aching pain.
B) C fibers conduct the rapid acute pain sensation described as prickling, sharp, and fast.
C) C fibers conduct diffuse, dull, aching pain.
D) C fibers transmit rapid acute pain sensation described as prickling, sharp, and fast.
Q3) 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.
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Chapter 10: Sedation,Agitation,Delirium: Assessment and Management
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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 major side effect of benzodiazepines is
A) hypertension.
B) respiratory depression.
C) renal failure.
D) phlebitis at the IV site.
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Page 12
Chapter 11: End-Of-Life Issues
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Sample Questions
Q1) Which of the following statements about comfort care is accurate?
A) Withholding and withdrawing life-sustaining treatment are distinctly different in the eyes of the legal community.
B) Each procedure should be evaluated for its effect on the patient's comfort before being implemented.
C) Only the patient can determine what constitutes comfort care for him or her.
D) Withdrawing life-sustaining treatments is considered euthanasia in most states.
Q2) Disagreement and distress among physicians,nurse practitioners,and critical care nurses can lead to
A) emotional distress only.
B) ethical distress only.
C) emotional and ethical distress.
D) pessimistic opinions of care.
Q3) Haloperidol is recommended as useful treatment of _____.
A) anxiety
B) dyspnea
C) delirium
D) pain
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13
Chapter 12: Cardiovascular Anatomy and Physiology
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Sample Questions
Q1) The outermost layer of the artery that helps strengthen and shape the vessel is the A) tunica.
B) intima.
C) adventitia.
D) media.
Q2) A patient is admitted to the critical care unit with right- and left-sided heart failure.The nurse's assessment reveals that the patient has 3+ pitting edema on the sacrum,blood pressure of 176/98 mm Hg,and bilateral crackles in the lungs.The patient is experiencing shortness of breath and chest discomfort.Increased afterload is probably present related to the patient's blood pressure.Which therapeutic measure will most likely decrease afterload in this patient?
A) Administration of vasodilators
B) Placement in high Fowler position
C) Elevation of extremities
D) Increasing intravenous fluids
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14
Chapter 13: Cardiovascular Clinical Assessment
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Sample Questions
Q1) Which of the following describe(s)S?,the first heart sound?
A) It is associated with closure of the mitral and tricuspid valves.
B) It is a high-pitched sound.
C) It can be heard most clearly with the diaphragm of the stethoscope.
D) The best listening point is in the aortic area.
E) The "split" sound can best be detected in the tricuspid area.
Q2) 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
Q3) Which of the following conditions is usually associated with clubbing?
A) Central cyanosis
B) Peripheral cyanosis
C) Carbon monoxide poisoning
D) Acute hypoxemia
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15
Chapter 14: Cardiovascular Diagnostic Procedures
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Sample Questions
Q1) After an MI,a patient presents with an increasing frequency of PVCs.The patient's heart rate is 110 beats/min,and ECG indicates a sinus rhythm with up to five unifocal PVCs per minute.Which of the following should be done? The patient is alert and responsive and denies any chest pain or dyspnea.
A) Administer lidocaine 100 mg bolus IV push stat.
B) Administer Cardizem 20 mg IV push stat.
C) Notify the physician and monitor the patient closely.
D) Nothing; PVCs are expected in this patient.
Q2) A patient with a potassium level of 2.8 mEq/L is given 60 mEq over a 12-hour period,and a repeat potassium level is obtained after the bolus.The current potassium level is 2.9 mEq/L.Which of the following should now be considered?
A) Stopping the patient's Aldactone
B) Drawing a serum magnesium level
C) Rechecking the potassium level
D) Monitoring the patient's urinary output
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Chapter 15: Cardiovascular Disorders
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Sample Questions
Q1) A patient is admitted to the ICU with diagnosis of fever of unknown origin.The patient is complaining of fatigue,malaise,joint pain,and shivering.VS include: T 103F,HR 90 beats/min,RR 22 breaths/min,BP 132/78,and O<sub>2</sub> sat 94% on 2L/NC.Blood cultures are ordered.The patient has a history of MI 3 months ago.The nurse suspects that the patient has developed
A) CAD.
B) heart failure.
C) endocarditis.
D) pulmonary embolus.
Q2) The most frequent dysrhythmia seen initially with sudden cardiac death is A) premature ventricular contractions.
B) ventricular tachycardia.
C) ventricular fibrillation.
D) asystole.
Q3) Nursing management of the patient with angina is directed toward A) immediate administration of antiplatelet therapy.
B) assessment of history of previous anginal episodes.
C) assessment and documentation of chest pain episodes.
D) administration of prophylactic lidocaine for ventricular ectopy.
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Page 17
Chapter 16: Cardiovascular Therapeutic Management
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Sample Questions
Q1) In caring for a postoperative cardiovascular patient,the nurse knows that the most frequent cause of a decreased cardiac output is
A) reduced preload.
B) increased afterload.
C) increased contractility.
D) bradycardia.
Q2) A reliable indicator of reperfusion after fibrinolytic therapy is
A) dysrhythmias.
B) Q waves.
C) elevated ST segments.
D) a rapid decrease in serum CK levels.
Q3) Which calcium channel blocker is easily titrated and beneficial in treating hypertension in patients with CAD or CVA?
A) Nifedipine (Procardia)
B) Nicardipine (Cardene)
C) Clevidipine (Cleviprex)
D) Diltiazem (Cardizem)
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18
Chapter 17: Pulmonary Anatomy and Physiology
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Sample Questions
Q1) The lobes are divided into 18 segments.How many are on the right lung?
A) 3
B) 8
C) 10
D) 15
Q2) Normally,the central chemoreceptors responsible for triggering ventilation changes respond to which of the following?
A) Increased PaCO<sub>2</sub>
B) Increased HCO<sub>3</sub>-
C) Decreased PaO<sub>2</sub>
D) Increased PaO<sub>2</sub>
Q3) Which of the following is considered physiologic dead space?
A) Respiratory bronchiole and unperfused alveoli
B) Trachea and perfused alveoli
C) Trachea and unperfused alveoli
D) Trachea and mainstem bronchi
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19
Chapter 18: Pulmonary Clinical Assessment
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Sample Questions
Q1) The adventitious breath sounds that sound like popping in the small airways or alveoli are
A) sonorous wheezes.
B) crackles.
C) sibilant wheezes.
D) pleural friction rubs.
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) Deviation of the trachea occurs in which of the following conditions?
A) Pneumothorax
B) Pulmonary fibrosis
C) Chronic obstructive pulmonary disease
D) Emphysema
E) Pleural effusion
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Chapter 19: Pulmonary Diagnostic Procedures
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Sample Questions
Q1) Risk factors that need to be considered with thoracentesis include
A) coagulation defects.
B) intra-aortic balloon pump.
C) pleural effusion.
D) uncooperative patient.
E) empyema.
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.Which of the following diagnoses would be most consistent with the above arterial blood gas values?
A) Acute pulmonary embolism
B) Acute myocardial infarction
C) Congestive heart failure
D) Chronic obstructive pulmonary disease
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Chapter 20: Pulmonary Disorders
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Sample Questions
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.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
Q2) Which of the following diagnostic criteria is indicative of ARDS?
A) Radiologic evidence of bibasilar atelectasis
B) PaO<sub>2</sub>/FiO<sub>2</sub> ratio less than or equal to 200 mm Hg
C) Pulmonary artery wedge pressure greater than 18 mm Hg
D) Increased static and dynamic compliance
Q3) Which of the following findings confirms the diagnosis of a PE?
A) Low-probability V/Q scan
B) Negative pulmonary angiogram
C) High-probability V/Q scan
D) Absence of vascular markings on the chest radiograph
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Page 22
Chapter 21: Pulmonary Therapeutic Management
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Q1) A patient was admitted to the critical care unit with acute respiratory failure.The patient has been on a ventilator for 3 days and is being considered for weaning.The ventilator high-pressure alarm keeps going off.When you enter the room,the ventilator inoperative alarm sounds.Which of the following criteria would indicate that the patient is ready to be weaned?
A) FiO<sub>2</sub> greater than 50%
B) Rapid shallow breathing index less than 105
C) Minute ventilation greater than 10 L/min
D) Vital capacity/kg greater than or equal to 15 mL
Q2) 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.
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Page 23
Chapter 22: Neurologic Anatomy and Physiology
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Q1) Which type of hematoma results from traumatic injury involving the middle meningeal artery?
A) Subdural
B) Epidural
C) Subarachnoid
D) Intercerebral
Q2) What percentage of the body's total resting cardiac output is used by the brain?
A) 5%
B) 10%
C) 20%
D) 40%
Q3) Which lobe of the brain deals primarily with sensory function?
A) Frontal lobe
B) Temporal lobe
C) Occipital lobe
D) Parietal lobe
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Chapter 23: Neurologic Clinical Assessment and Diagnostic
Procedures
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Q1) Identify the sites for monitoring ICP.
A) Intraventricular space
B) Epidural space
C) Jugular veins
D) Subdural space
E) Parenchyma
Q2) Which nuclear medicine studies are used to detect cerebrovascular disease,seizures,and tumors?
A) PET
B) MRI
C) MRA
D) SPECT
Q3) While starting an intravenous line on the right hand of an unconscious patient,the patient reaches over with his left hand and tries to remove the noxious stimuli.This response is called
A) decorticate posturing.
B) decerebrate posturing.
C) withdrawal.
D) localization.
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Chapter 24: Neurologic Disorders and Therapeutic Management
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Q1) Surgical placement of a ventriculoperitoneal shunt is used to treat A) hyponatremia.
B) intracerebral hemorrhage.
C) spontaneous intracerebral hemorrhage.
D) hydrocephalus.
Q2) 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
Q3) Which of the following patients has the best prognosis based on the cause of coma?
A) A 36-year-old man with closed head injury
B) A 50-year-old woman with hepatic encephalopathy
C) A 46-year-old woman with subarachnoid hemorrhage
D) A 72-year-old man with hypertensive intracerebral hemorrhage
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Chapter 25: Kidney Anatomy and Physiology
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Q1) The mobilization of calcium from bone stores is accomplished through the influence of which hormone?
A) Antidiuretic hormone (ADH)
B) Parathyroid hormone (PTH)
C) Thyroid-stimulating hormone (TSH)
D) Erythropoietin
Q2) To prevent acid-base disturbances,the ratio between carbonic acid and bicarbonate should be
A) 10 mEq of carbonic acid to 20 mEq of bicarbonate.
B) 20 mEq of carbonic acid to 10 mEq of bicarbonate.
C) 1 mEq of carbonic acid to 20 mEq of bicarbonate.
D) 20 mEq of carbonic acid to 1 mEq of bicarbonate.
Q3) The functional unit of the kidney is known as the A) Bowman capsule.
B) glomerulus.
C) nephron.
D) distal tubule.
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Chapter 26: Kidney Clinical Assessment and Diagnostic Procedures
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Q1) Which of the following assessment findings would indicate fluid volume excess?
A) Venous filling of the hand veins greater than 5 seconds
B) Distended neck veins in the supine position
C) Presence of orthostatic hypotension
D) Third heart sound
Q2) 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: .
A) BUN.
B) creatinine.
C) glucose.
D) hemoglobin and hematocrit.
E) protein.
Q3) 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
Page 28
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Chapter 27: Kidney Disorders and Therapeutic Management
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Q1) Which electrolytes pose the most potential hazard if not within normal limits for a person with renal failure?
A) Phosphorous and calcium
B) Potassium and calcium
C) Magnesium and sodium
D) Phosphorous and magnesium
Q2) Which of the following medications is considered a loop diuretic?
A) Acetazolamide (Diamox)
B) Furosemide (Lasix)
C) Mannitol
D) Metolazone (Zaroxolyn)
Q3) The most common site for short-term vascular access for immediate hemodialysis is the
A) subclavian artery.
B) subclavian vein.
C) femoral artery.
D) radial vein.
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Page 29
Chapter 28: Gastrointestinal Anatomy and Physiology
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Q1) The gastrointestinal system plays a vital role in detoxification and elimination of A) viruses.
B) chemical toxins.
C) drugs.
D) bacteria.
Q2) Which component of gastric juice is necessary for the breakdown of proteins?
A) HCl
B) Pepsin
C) Intrinsic factor
D) Potassium
Q3) Which layer of the large intestine consists of longitudinal and circular muscles?
A) Serosa layer
B) Muscularis layer
C) Submucosa layer
D) Mucosa layer
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Chapter 29: Gastrointestinal Clinical Assessment and Diagnostic Procedures
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Sample Questions
Q1) 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.
Q2) Steatorrhea is determined by which laboratory study?
A) Gastric acid stimulation
B) Urea breath test
C) Culture and sensitivity
D) Stool studies
Q3) Which of the following findings is considered an abnormal gastrointestinal assessment finding?
A) Visible peristaltic waves
B) Hyper-resonance of the intestine
C) High-pitched gurgling sounds in the small intestine
D) Dull sounds over the liver and spleen
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Page 31
Chapter 30: Gastrointestinal Disorders and Therapeutic Management
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Q1) Esophagectomy is usually performed for A) cancer of the proximal esophagus and gastroesophageal junction.
B) cancer of the distal esophagus and gastroesophageal junction.
C) cancer of the pancreatic head.
D) varices of the distal esophagus and gastroesophageal junction.
Q2) Signs and symptoms of an anastomotic leak include A) pneumonia.
B) subcutaneous emphysema.
C) bleeding.
D) atelectasis.
Q3) Roux-en-Y gastric bypass is
A) a restrictive type of bariatric surgery.
B) a malabsorptive type of bariatric surgery.
C) a combination of restrictive and malabsorption types of bariatric surgery.
D) standard operation for pancreatic cancer.
Q4) A major side effect of vasopressin is A) constipation.
B) diarrhea.
C) dysrhythmias.
D) bleeding.
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Chapter 31: Endocrine Anatomy and Physiology
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Q1) The effect of increased T? and T? on the body is
A) increased oxygen consumption and use.
B) lowering of the basal metabolic rate.
C) decreased cardiac output.
D) increased parasympathetic response.
Q2) Adequate thyroid function depends on
A) the basal metabolic rate.
B) dietary intake of iodine.
C) colloid osmotic pressure.
D) sodium levels in the blood.
Q3) When the brain perceives a stressful or threatening situation,the hypothalamus releases ________________________,which causes the anterior pituitary to release_____________________________.
A) cortisol; androgens.
B) corticotropin-releasing hormone; ACTH
C) ACTH; glucocorticoid hormone
D) ACTH; epinephrine
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Chapter 32: Endocrine Clinical Assessment and Diagnostic
Procedures
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Q1) Which of the following laboratory tests will measure thyroid function?
A) Total serum triiodothyronine
B) Total serum thyroxine
C) Free urine TSH
D) Total urine thyroxine
E) Thyroglobulin
F) Free thyroxine
Q2) 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.
Q3) Clinical signs and symptoms of Cushing syndrome include A) hirsutism.
B) rounded face.
C) hypotension.
D) decreased libido.
E) scleroderma.
F) fatigue and weakness.
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Chapter 33: Endocrine Disorders and Therapeutic Management
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Q1) A patient was admitted with diabetic ketoacidosis 1 hour ago and is on an insulin drip.Suddenly,the nurse notices frequent premature ventricular contractions (PVCs)on the electrocardiogram.The expected intervention would be to
A) administer a lidocaine bolus.
B) administer a lidocaine drip.
C) synchronize cardioversion.
D) evaluate electrolytes.
Q2) A patient has a 10-year history of diabetes mellitus.The patient is admitted to the critical care unit with complaints of increased lethargy.Serum laboratory values validate the diagnosis of diabetic ketoacidosis (DKA).Which of the following symptoms is most suggestive of DKA?
A) Irritability
B) Excessive thirst
C) Rapid weight gain
D) Peripheral edema
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Chapter 34: Trauma
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Q1) Which of the following statements is true about a patient with a blunt cardiac injury/cardiac contusion?
A) It will probably be diagnosed by pericardiocentesis.
B) Hemodynamic parameters will most likely show a low cardiac output and low systemic vascular resistance.
C) Treatment can require insertion of a temporary pacemaker for conduction control.
D) The only accurate way to evaluate cardiac contusion is to check the creatine phosphokinase fraction.
Q2) 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.
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Chapter 35: Shock,sepsis,and Multiple Organ Dysfunction Syndrome
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Q1) Which of the following hemodynamic parameters supports the diagnosis of cardiogenic shock?
A) Increased right atrial pressure
B) Decreased pulmonary artery wedge pressure
C) Increased cardiac output
D) Decreased cardiac index
Q2) Clinical manifestations of ischemic hepatitis show up 1 to 2 days after the insult.Which symptom below is indicative of hepatic insufficiency?
A) Elevated serum creatinine
B) Decreased bilirubin
C) Jaundice
D) Decreased serum transaminase
Q3) Immunoglobulin E (IgE)-mediated anaphylactic shock occurs as a result of A) direct activation of mast cells.
B) laryngeal edema.
C) an antigen entering on a repeat exposure, triggering a secondary immune response.
D) the systemic inflammatory response.
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Page 37
Chapter 36: Burns
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Q1) Which of the following is a leading cause of death in the hospitalized burn patient?
A) Smoke inhalation
B) Infection
C) Burn shock
D) Renal failure
Q2) A patient has full-thickness burns to his face,chest,back,and bilateral upper arms.He was injured less than 24 hours ago.He sustained these injuries in a house fire and is presumed to have inhaled smoke and sustained an inhalation injury as well.He was nasally intubated in the emergency department and placed on mechanical ventilatory support.He is now showing signs of increasing agitation and is demonstrating high peak airway (ventilatory)pressures.What is the likely cause in this change in his condition?
A) Uncontrolled pain
B) Hypovolemia
C) Hypoxemia and confusion
D) Decreased pulmonary compliance
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Chapter 37: Organ Donation and Transplantation
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Q1) Potential recipients are matched with donors based on A) blood type.
B) human leukocytic antigen.
C) race.
D) socioeconomic status.
E) severity of illness.
F) location of recipient.
G) waiting time on the list.
Q2) Many barriers exist to increasing the number of organ donors to meet today's growing need.Which of the following are barriers related to hospital factors?
A) Limited resources
B) Lack of interest
C) Failure to approve protocols
D) Nurses' attitudes
E) Delay in termination of life support
Q3) Who determines the medical suitability of the patient for organ donation?
A) The organ procurement organization (OPO) coordinator
B) The patient's family
C) The admitting health care provider
D) The transplant team
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Chapter 38: Hematologic Disorders and Oncologic Emergencies
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Q1) Hydroxyurea is increased by what dosage until the maximum of 35 mg/kg is reached?
A) 5 mg/kg every 4 weeks
B) 10 mg/kg every 8 weeks
C) 5 mg/kg every 12 weeks
D) 15 mg/kg every 15 weeks
Q2) Which of the following interventions would be appropriate for ITP?
A) Instituting a heparin infusion of 1000 U/hr
B) Instructing the patient to blow his or her nose carefully
C) Removing heparin from hemodynamic pressure monitoring systems
D) Administering isotonic saline intravenously
Q3) Clinical manifestations of ITP include which of the following?
A) Gingival bleeding
B) Retinal hemorrhage
C) Fluid retention
D) Muscle cramps
E) Petechial hemorrhages on legs
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Page 40
Chapter 39: The Obstetric Patient
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Q1) Complications of HELLP (hemolysis,elevated liver enzymes,and low platelet count)syndrome include
A) abruptio placentae, liver rupture, and pulmonary edema.
B) neutropenia, liver hemorrhage, and pulmonary edema.
C) disseminated intravascular coagulation (DIC), puerperal conditions, and chronic fatigue.
D) pulmonary edema, DIC, and cor pulmonale.
Q2) Which medication used in the advanced cardiac life support algorithm is not contraindicated in pregnancy?
A) Atropine
B) Epinephrine
C) Lidocaine
D) Sodium bicarbonate
Q3) According to research,the minimal viability parameters of an infant are
A)20 to 21 weeks' gestation and fetal weight between 500 and 1000 g.
B)22 to 23 weeks' gestation and fetal weight between 1000 and 15,000 g.
C)23 to 24 weeks' gestation and fetal weight between 500 and 1000 g.
D)24 to 25 weeks' gestation and fetal weight between 500 and 1200 g
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Chapter 40: The Pediatric Patient
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Q1) Causes associated with the diagnosis status epilepticus include A) high fever.
B) encephalitis.
C) metabolic disorder.
D) meningitis.
E) gradual weaning of anticonvulsant drugs.
Q2) The normal cerebral perfusion pressure in an infant is
A) 50 mm Hg.
B) 40 to 60 mm Hg.
C) unknown.
D) 60 mm Hg.
Q3) Initial treatment for hypoxia,acidosis,or hypothermia is A) vasopressin.
B) bronchodilators.
C) oxygenation and ventilation.
D) hydration.
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Page 42
Chapter 41: The Older Adult Patient
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Q1) Which of the following would be a normal assessment finding for an older patient?
A) Inability to remember what was eaten yesterday
B) An increase in resting heart rate
C) Hypoactive bowel sounds
D) Brisk papillary response to light
Q2) Which of the following will remain unchanged in an older person when he or she exercises?
A) Cardiac output
B) Heart rate
C) Blood pressure
D) Heart rhythm
Q3) A nurse is teaching an older patient about the signs and symptoms of a myocardial infarction.Which statement by the patient would indicate that the teaching was effective?
A) "The pain in my chest may last a long time."
B) "I will feel like I have an elephant sitting on the center of my chest."
C) "The chest pain will be sharp and over the center of my chest."
D) "The pain may not be severe and may not be in my chest."
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Chapter 42: The Perianesthesia Patient
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Q1) Which medication has a direct myocardial depressant effect on the heart?
A) Ketamine
B) Barbiturates
C) Succinylcholine
D) Opioids
Q2) The coughing maneuver in which a patient takes a deep breath and then performs multiple coughs on exhalation of that breath is known as the A) serial cough.
B) cascade cough.
C) sustained maximal cough.
D) deep cough.
Q3) What medication is a first-line therapy in treating bronchospasm?
A) Racemic epinephrine
B) Methylprednisolone
C) Albuterol
D) Morphine
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