Nursing Care of the Acutely Ill Solved Exam Questions
Course Introduction
Nursing Care of the Acutely Ill focuses on the comprehensive assessment and management of patients experiencing sudden and severe health changes across the lifespan. This course equips students with the knowledge and clinical skills required to provide safe, effective, and holistic care in acute settings such as emergency departments, intensive care units, and other high-acuity environments. Emphasis is placed on rapid assessment, evidence-based interventions, critical thinking, prioritization, interprofessional collaboration, and the use of technology in acute care. Ethical considerations, patient advocacy, and communication with patients and their families during times of crisis are also explored, preparing students to deliver competent nursing care in complex and dynamic scenarios.
Recommended Textbook
Priorities in Critical Care Nursing 7th Edition by Linda D. Urden
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Page 2
Chapter 1: Critical Care Nursing Practice
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Sample Questions
Q1) A physician and nurse are performing a dressing change on an unresponsive patient in room I-14.The physician asks the nurse for an update on the patient in room I-13.The nurse should
A) give the update to the physician.
B) refuse to give the update because of HIPAA requirements.
C) give the update because the patient's unconscious state will not compromise confidentiality.
D) refuse to give the update because of OSHA requirements.
Answer: B
Q2) The term diversity encompasses the following:
A) ethnic sensitivity.
B) openness to different lifestyles.
C) values.
D) beliefs.
E) opinions.
Answer: A,B,C,D,E
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Page 3
Chapter 2: Ethical Issues
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Sample Questions
Q1) Place the following steps in ethical decision making in the order in which they should be carried out:
1)Identify the health problem.
2)Implement decisions.
3)Identify the decision maker.
4)Define the ethical issue.
5)Evaluate actions and decisions.
6)Gather additional information.
7)Examine moral and ethical principles.
8)Explore alternative options.
A) 1, 4, 6, 7, 8, 3, 2, 5
B) 1, 4, 3, 2, 5, 6, 7, 8
C) 1, 4, 2, 3, 5, 6, 7, 8
D) 4, 1, 3, 2, 5, 6, 7, 8
Answer: A
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4
Chapter 3: Legal Issues
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Sample Questions
Q1) While participating in critical care rounds,a nurse is interrupted by the wife of a ventilated patient,who informs the nurse that her husband is having difficulty breathing.The patient is found disconnected from the ventilator and unresponsive when the nurse enters the room after rounds; the alarm mode on the ventilator had been turned off.This is an example of
A) assault.
B) battery.
C) injury.
D) professional malpractice.
Answer: D
Q2) Which of the following defines the scope of practice for nursing?
A) Hospital policies
B) State Nurse Practice Act
C) State board of nursing
D) State Department of Health
Answer: B
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Page 5
Chapter 4: Genetics and Genomics in Critical Care
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Sample Questions
Q1) Philadelphia translocation is a specific chromosomal abnormality that occurs from a reciprocal translocation between chromosomes 9 and 22 where parts of these two chromosomes switch places.This abnormality is associated with which disease?
A) Hemophilia A
B) Chronic myelogenous leukemia
C) Obesity
D) Marfan syndrome
Q2) A specialized class of proteins that organizes the double-stranded DNA into what looks like a tightly coiled telephone cord is known as:
A) chromatids.
B) karyotype.
C) genomics.
D) histones.
Q3) The goal of the Human Genome Project was
A) to identify haplotype tags.
B) to expose untaggable SNPs and recombination hot spots.
C) to produce a catalog of human genome variation.
D) to map all the human genes.
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Chapter 5: Patient and Family Education
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Sample Questions
Q1) A 79-year-old patient received a liver transplant 3 days ago.The patient is extubated and hemodynamically stable.His spouse is coming for a visit,and the nurse has some time to discuss immune suppression drug therapy with both of them.The patient is hearing and sight impaired.The spouse brought the patient's hearing aids 2 days ago and will bring the patient's glasses today.Which of the following teaching strategies would be least effective in the ICU setting?
A) Patient education channel
B) Written materials
C) Lecture
D) Discussion
Q2) Group discussions for patients are most effective if the patients
A) have a variety of medical diagnoses.
B) are in the acute phase of their illness.
C) are in the hospital only 3 days or less.
D) are at similar stages of adaptation.
Q3) When writing goals and outcomes,it is important to incorporate
A) how intervention will occur.
B) a measurable or observable verb.
C) what the nurse will teach.
D) a brief description because this is only a guide on how to teach.
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Chapter 6: Psychosocial and Spiritual Alterations and Management
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Sample Questions
Q1) 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
Q2) Psychologic and spiritual interventions have the power to engage a patient's
A) hope.
B) fear.
C) will to survive.
D) energy.
E) ability to meet life's challenges.
Q3) Identify actions that a critical care nurse can take to decrease stressors at work.
A) Request temporary assignments in a less stressful setting.
B) Use self-reflection when feeling overwhelmed.
C) Maintain good physical health.
D) Ignore feelings of frustration and anger.
E) Use stress management techniques.
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Chapter 7: Sleep Alterations and Management
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Sample Questions
Q1) Sleep disturbance in critically ill patients is defined as insufficient duration or stages of sleep that results in
A) less sleep that promotes recovery.
B) discomfort and interferes with quality of life.
C) adaptation of the environment to promote sleep.
D) more sleep that promotes recovery.
Q2) 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
Q3) 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%
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Chapter 8: Nutrition Alterations and Management
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Sample Questions
Q1) Sodium and fluid restrictions ordered for the patient with heart failure are primarily aimed at reducing
A) use of medications.
B) weight.
C) cardiac workload.
D) serum lipids.
Q2) Which of the following signs would alert the nurse to possible nutritional alterations?
A) Impaired wound healing
B) Edema
C) Nail growth
D) Muscle atrophy
E) diaphoresis
Q3) The nutritional alteration most frequently encountered in hospitalized patients is A) respiratory quotient (RQ).
B) protein-calorie malnutrition.
C) fat-calorie malnutrition.
D) gluconeogenesis.
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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) Acute pain usually corresponds to
A) the healing process but should not exceed 9 months.
B) the healing process but should not exceed 6 months.
C) persistent pain more than 6 months after the healing process.
D) damage to the patient's nervous system unrelated to the initial injury.
Q3) Which of the following combinations of drugs has been found to be effective in managing the pain associated with musculoskeletal and soft tissue inflammation?
A) Nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids
B) NSAIDs and antidepressants
C) Opioid agonists and opioid antagonists
D) Adjuvants and partial agonists
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Chapter 10: Sedation,Agitation,Delirium: Assessment and Management
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Sample Questions
Q1) A patient was admitted into the critical care unit 3 days ago.She has just been weaned from mechanical ventilation.She suddenly becomes confused,seeing nonexistent animals in her room and pulling at her gown.Which of the following interventions are indicated to adequately monitor the patient during haloperidol use?
A) Continuous bispectral index (BIS) monitoring
B) Continuous electrocardiographic (ECG) monitoring
C) Continuous pulse oximetry
D) Continuous electrocardiogram (ECG) monitoring
Q2) A patient was admitted into the critical care unit 3 days ago.She has just been weaned from mechanical ventilation.She suddenly becomes confused,seeing nonexistent animals in her room and pulling at her gown.You suspect this patient is A) experiencing delirium or "ICU psychosis."
B) experiencing confusion caused by increased hypoxia.
C) hypocalcemic.
D) acting out to receive the attention she was getting while intubated.
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Page 12
Chapter 11: End-Of-Life Issues
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Sample Questions
Q1) Which of the following are considerations when making the decision to allow family at the bedside during resuscitation efforts?
A) The patient's wishes
B) Experience of the staff
C) The family's need to participate in all aspects of the patient's care
D) State regulatory issues
E) Seeing the resuscitation may confirm the impact of decisions made or delayed
Q2) Hospice care can help families with
A) organ donations.
B) aggressive symptom management and family support.
C) writing advance directives and living wills.
D) legal euthanasia.
Q3) Haloperidol is recommended as useful treatment of _____.
A) anxiety
B) dyspnea
C) delirium
D) pain
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Chapter 12: Cardiovascular Anatomy and Physiology
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Sample Questions
Q1) A patient is admitted to the critical care unit with a diagnosis of acute myocardial infarction.The monitor pattern reveals bradycardia.The patient weight is 70 kg and height is 5 feet,5 inches tall.Based on the above information; occlusion of which coronary artery most likely resulted in bradycardia from sinoatrial node ischemia?
A) Right
B) Left anterior descending
C) Circumflex
D) Dominant
Q2) The final repolarization phase of the action potential is
A) phase 1.
B) phase 2.
C) phase 3.
D) phase 4.
Q3) The outermost layer of the artery that helps strengthen and shape the vessel is the A) tunica.
B) intima.
C) adventitia.
D) media.
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14
Chapter 13: Cardiovascular Clinical Assessment
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Sample Questions
Q1) The presence of a carotid or femoral bruit may be evidence of
A) left-sided heart failure.
B) blood flow through a partially occluded vessel.
C) the early onset of pulmonary embolism.
D) myocardial rupture.
Q2) 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.
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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Chapter 14: Cardiovascular Diagnostic Procedures
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Sample Questions
Q1) A patient's CVP reading suddenly increased from 10 to 48 mm Hg.His lungs are clear except for fine rales at the bases.Immediate response should be which of the following?
A) Nothing; this reading is still within normal limits.
B) Place a stat call into the physician.
C) Administer ordered prn Lasix.
D) Check the transducer level.
Q2) A 52-year-old patient presents to the emergency department with reports of substernal chest pain.A history is taken; serum creatine kinase (CK)and lactate dehydrogenase (LDH)isoenzymes and serum lipid studies are ordered,as is a 12-lead ECG.Which of the following results is most significant in diagnosing an MI during the first 12 hours of chest pain?
A) ECG-inverted T waves
B) Serum enzymes-elevated LDH4
C) Serum enzymes-elevated CK-MB
D) Patient history-substernal chest pain
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16
Chapter 15: Cardiovascular Disorders
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Sample Questions
Q1) Assessment of a patient with pericarditis may reveal which of the following signs and symptoms?
A) Ventricular gallop and substernal chest pain
B) Narrowed pulse pressure and shortness of breath
C) Pericardial friction rub and pain
D) Pericardial tamponade and widened pulse pressure
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) In the acute phase after STEMI,fibrinolytic therapy is used in combination with heparin to recanalize the coronary artery.The initial heparin bolus is
A) 60 units/kg maximum 5000 units.
B) 30 units/kg maximum 3000 units.
C) 25 units/kg maximum of 2500 units.
D) 12 units/kg maximum of 1000 units.
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Chapter 16: Cardiovascular Therapeutic Management
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Sample Questions
Q1) A patient is admitted to the ICU after a positive exercise treadmill test with a diagnosis of CAD and stable angina.Radiographic test show that the patient has blockage in the left main coronary artery and four other vessels.The nurse anticipates that the patient will be scheduled for A) medical therapy antianginal medications.
B) PCI.
C) TAVR.
D) CABG.
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) 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 17: Pulmonary Anatomy and Physiology
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Sample Questions
Q1) Lack of surfactant can cause which of the following conditions?
A) Pulmonary embolus
B) Pulmonary hypertension
C) Pulmonary atelectasis
D) Pulmonary edema
Q2) Which nerve stimulates movement of the diaphragm?
A) Musculocutaneous nerve
B) Phrenic nerve
C) Median nerve
D) Axillary nerve
Q3) 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>
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Chapter 18: Pulmonary Clinical Assessment
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Sample Questions
Q1) A patient presents with chest trauma from an MVA.Upon assessment,the nurse documents that the patient is complaining of dyspnea,shortness of breath,tachypnea,and tracheal deviation to the right.In addition,the client's tongue is blue-gray.Based on the following data,what would the nurse would expect to find?
A) PaO<sub>2</sub> of 88 and PCO<sub>2</sub> of 55
B) Absent breath sounds in all right lung fields
C) Absent breath sounds in all left lung fields
D) Diminished breath sounds in all fields
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) The use of observation for assessment is known as
A) inspection.
B) palpation.
C) percussion.
D) auscultation.
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Page 20
Chapter 19: Pulmonary Diagnostic Procedures
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Q1) Which of the following chest radiography findings is consistent with a left pneumothorax?
A) Flattening of the diaphragm
B) Shifting of the mediastinum to the right
C) Presence of a gastric air bubble
D) Increased radiolucency of the left lung field
Q2) A 75-kg,5 foot,8 inch patient is on a ventilator.The physician or nurse practitioner states the patient may be ready for extubation.Orders for a negative inspiratory pressure (NIP)and force ventilatory capacity (FVC)tests are written.Which of the following results best suggests that the patient is ready for extubation?
A) NIP, -10; FVC, 4600
B) NIP, -18; FVC, 4700
C) NIP, -22; FVC, 4400
D) NIP, -24; FVC, 4800
Q3) V/Q scans are ordered to evaluate the possibility of which of the following?
A) Pulmonary emboli
B) Acute myocardial infarction
C) Emphysema
D) Acute respiratory distress syndrome
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Chapter 20: Pulmonary Disorders
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Sample Questions
Q1) The major hemodynamic consequence of a massive pulmonary embolus is
A) increased systemic vascular resistance leading to left heart failure.
B) pulmonary hypertension leading to right heart failure.
C) portal vein blockage leading to ascites.
D) embolism to the internal carotids leading to a stroke.
Q2) A patient has been admitted to the critical care unit with the diagnosis of acute respiratory distress syndrome (ARDS).Arterial blood gasses (ABGs)revealed an elevated pH and decreased PaCO<sub>2</sub>.The patient is becoming fatigued,and the health care provider orders a repeat ABG.The nurse anticipates the following results
A) elevated pH and decreased PaCO<sub>2</sub>
B) elevated pH and elevated PaCO<sub>2</sub>
C) decreased pH and decreased PaCO<sub>2</sub>
D) decreased pH and elevated PaCO<sub>2</sub>
Q3) Which of the following nursing interventions should be used to optimize oxygenation and ventilation in the patient with acute respiratory failure?
A) Provide adequate rest and recovery time between procedures.
B) Position the patient with the good lung up.
C) Suction the patient every hour.
D) Avoid hyperventilating the patient.
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Page 22
Chapter 21: Pulmonary Therapeutic Management
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Q1) Which of the following should be used when suctioning a mechanically ventilated patient?
A) Three hyperoxygenation breaths (breaths at 100% FiO<sub>2</sub>)
B) Hyperinflation (breaths at 150% tidal volume)
C) Limit the number of passes to three.
D) Instill 5 to 10 mL of normal saline to facilitate secretion removal.
E) Use intermittent suction to avoid damaging tracheal tissue.
Q2) Complications of ETT tubes include
A) tracheoesophageal fistula.
B) cricoid abscess.
C) tracheal stenosis.
D) tube obstruction.
E) tube displacements.
Q3) The ventilator variable that causes inspiration is called the A) cycle.
B) trigger.
C) flow.
D) pressure.
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23
Chapter 22: Neurologic Anatomy and Physiology
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Q1) Examples of small-molecule transmitters include
A) acetylcholine.
B) glucose.
C) norepinephrine.
D) dopamine.
E) epinephrine.
F) GABA receptors.
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) Substances most likely to pass across the blood-brain barrier have which of the following characteristics?
A) Low pH compared with body fluids
B) Lipid solubility
C) Large particle size
D) A close relation to toxic metabolites
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Chapter 23: Neurologic Clinical Assessment and Diagnostic
Procedures
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Q1) The clinical manifestations of the Cushing reflex are
A) bradycardia, systolic hypertension, and widening pulse pressure.
B) tachycardia, systolic hypotension, and tachypnea.
C) headache, nuchal rigidity, and hyperthermia.
D) bradycardia, aphasia, and visual field disturbances.
Q2) Which nuclear medicine studies are used to detect cerebrovascular disease,seizures,and tumors?
A) PET
B) MRI
C) MRA
D) SPECT
Q3) Considering anatomic location,which cranial nerve will be affected first by downward pressure onto the infratentorial structures?
A) III
B) VI
C) IX
D) X
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Page 25
Chapter 24: Neurologic Disorders and Therapeutic Management
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Q1) Which patient position is optimal to prevent elevated ICP pressures?
A) The head of the bed elevated 30 to 40 degrees
B) Supine with the patient's neck in a neutral alignment
C) Individualized head position to maximize cerebral perfusion pressure and minimize ICP measurements
D) The head of the bed elevated with flexion of the hips
Q2) A patient has been experiencing drowsiness,confusion,and slight focal deficits for 3 days.The CT report findings are negative.The patient is being prepared for a lumbar puncture.The nurse anticipates that the CSF would appear
A) cloudy.
B) bloody.
C) xanthochromic.
D) clear.
Q3) The target range for PaCO<sub>2</sub> when using hyperventilation to lower ICP is
A) 25 to 30 mm Hg.
B) 25 to 35 mm Hg.
C) 35 to 40 mm Hg.
D) 35 ± 2 mm Hg.
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Chapter 25: Kidney Anatomy and Physiology
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Q1) The following substances,among others,are found in a urine sample: urea,creatinine,sodium,chlorine,potassium,glucose,and bicarbonate ions.Which of the following could account for this abnormal finding?
A) Blood pressure of 76/30 mm Hg
B) Blood glucose of 456 mg/dL
C) Blood glucose of 36 mg/dL
D) Blood potassium level of 4.1 mEq/L
Q2) Which of the following is most indicative of renal failure?
A) Elevated blood-urea-nitrogen
B) Congestive heart failure
C) Peripheral edema
D) Elevated creatinine
Q3) If the patient's blood pressure drops,which of the following will help maintain adequate glomerular pressure?
A) Constriction of the afferent arteriole
B) Dilation of the efferent arteriole
C) Dilation of the collecting tubule
D) Constriction of the efferent arteriole
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Chapter 26: Kidney Clinical Assessment and Diagnostic
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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) The patient complains of a metallic taste and loss of appetite.The nurse is concerned that the patient has developed
A) glycosuria.
B) proteinuria.
C) myoglobin.
D) uremia.
Q3) 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
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Chapter 27: Kidney Disorders and Therapeutic Management
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Q1) A patient has 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) To control azotemia,the recommended nutritional intake of protein is
A) .5 to 1.0 g/kg/day.
B) 1.2 to 1.5 g/kg/day.
C) 1.7 to 2.5 g/kg/day.
D) 2.5 to 3.5 g/kg/day.
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Chapter 28: Gastrointestinal Anatomy and Physiology
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Q1) 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.
Q2) An important role of saliva is that it
A) washes away bacteria.
B) provides the body's main source of potassium.
C) contains hydrochloric acid for breakdown of protein.
D) stimulates the sympathetic nervous system.
Q3) When the ileum is distended,the ileogastric reflex inhibits A) gastric absorption.
B) absorption in the jejunum.
C) gastric motility.
D) ileum motility.
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Chapter 29: Gastrointestinal Clinical Assessment and Diagnostic Procedures
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Q1) Which radiographic test would be used to identify pseudocysts of the pancreas?
A) Plain film radiography
B) Abdominal ultrasonography
C) CT of abdomen
D) MRI of the abdomen
Q2) Inspection of the GI system should include the
A) mouth.
B) esophagus.
C) skin.
D) bladder.
E) abdomen.
Q3) Identify anatomic structures that are found in the right lower quadrant.
A) Sigmoid colon
B) Portion of the ascending colon
C) Portion of the descending colon
D) Distended bladder
E) Enlarged uterus
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Page 31
Chapter 30: Gastrointestinal Disorders and Therapeutic Management
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Q1) Which of the following interventions would you expect in the management of hepatic failure?
A) Benzodiazepines for agitation
B) Pulse oximetry and serial arterial blood gas measurements
C) Insulin drip for hyperglycemia and hyperkalemia
D) Monitor electrolyte blood levels
E) Assess for signs of cerebral edema
Q2) Signs and symptoms of an anastomotic leak include
A) pneumonia.
B) subcutaneous emphysema.
C) bleeding.
D) atelectasis.
Q3) Verification of feeding tube placement includes
A) auscultation for position.
B) aspiration of stomach contents.
C) x-ray study for confirmation.
D) gastric pH measurement.
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Page 32
Chapter 31: Endocrine Anatomy and Physiology
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Q1) A patient is admitted to the critical care unit after sustaining a head injury.Based on the injury,it is determined that there is a decrease in antidiuretic hormone (ADH).The major role of antidiuretic hormone is to regulate A) blood pressure.
B) fluid balance.
C) potassium.
D) homeostasis.
Q2) Which organ secretes catecholamine epinephrine and norepinephrine?
A) Adrenal cortex
B) Adrenal medulla
C) Anterior pituitary
D) Posterior pituitary
Q3) The alpha cells of the pancreas secrete A) glucagon.
B) insulin.
C) somatostatin.
D) pancreatic polypeptide hormone.
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Page 33
Chapter 32: Endocrine Clinical Assessment and Diagnostic
Procedures
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Q1) Which of the following laboratory results is found in a patient with hyperglycemia?
A) Insulin level of 25 ?/mL
B) Absence of ketones in the urine
C) Presence of ketones in the blood
D) Serum osmolality of 270 mOsm/kg H<sub>2</sub>O
Q2) A patient is being evaluated for thyroid dysfunction.His daily regular medications include aspirin,Lanoxin,and insulin.The nurse knows that the laboratory work may be affected by
A) the aspirin.
B) the Lanoxin.
C) the insulin.
D) none of the medications.
Q3) Which of the following laboratory findings is indicative of thyrotoxicosis?
A) Very low thyroid-stimulating hormone (TSH)
B) Decreased T? uptake ratio
C) Increased serum osmolality
D) Decreased urine osmolality
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Page 34
Chapter 33: Endocrine Disorders and Therapeutic Management
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Q1) The most common maintenance dose of intravenous insulin for a patient with hyperglycemic hyperosmolar syndrome (HHS)would be
A) 0.1 U/kg/hr.
B) 1.0 U/kg/hr.
C) 2.0 U/kg/hr.
D) 5.0 U/kg/hr.
Q2) In caring for a patient with a thyrotoxic crisis,the nurse would expect neurologic symptoms such as A) lethargy.
B) depression.
C) seizures.
D) agitation.
Q3) While a patient with SIADH is receiving hypertonic saline,the nurse assesses for signs that the saline must be stopped.These signs would include A) decreased CVP and decreased PAP.
B) bradycardia and thirst.
C) hypotension and wheezing.
D) hypertension and lung crackles.
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Chapter 34: Trauma
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Q1) Clinical manifestations of abdominal compartment syndrome include which of the following?
A) Decreased cardiac output
B) Decreased peripheral vascular resistance
C) Decreased urine output
D) Hypoxia
E) Bradycardia
F) Hypotension
Q2) A patient with multisystem trauma has been in the ICU for 6 days after sustaining a closed head injury,a right-sided pneumothorax,right rib fractures,a grade IV liver laceration,a pancreatic contusion,and a right acetabular fracture.The patient is still intubated and mechanically ventilated and has a chest tube,Foley catheter,and two abdominal drains.The patient's hemodynamic assessment reveals the following values: BP,94/66 mm Hg; HR,118 beats/min; T,38.7° C; CVP,5 cm H<sub>2</sub>O; wedge pressure,6 mm Hg; cardiac index,6.1; and systemic vascular resistance,450 dyns/sec.The patient is at the greatest risk to develop
A) respiratory failure.
B) infection.
C) venous thromboembolism
D) fat embolism syndrome.
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Chapter 35: Shock,sepsis,and Multiple Organ Dysfunction Syndrome
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Q1) A patient has been on the medical floor for 1 week after a vaginal hysterectomy.A urinary catheter was inserted.Complete blood cell count results have revealed escalating white blood cell counts.The patient is transferred to the critical care unit when her condition deteriorates.Septic shock is diagnosed.The medical management of the patient's condition is aimed toward
A) limiting fluids to minimize the possibility of congestive heart failure.
B) finding and eradicating the cause of infection.
C) discontinuing invasive monitoring as a possible cause of sepsis.
D) administering vasodilator substances to increase blood flow to vital organs.
Q2) A patient has been on the medical floor for 1 week after a vaginal hysterectomy.A urinary catheter was inserted.Complete blood cell count results have revealed escalating white blood cell counts.The patient is transferred to the critical care unit when her condition deteriorates.Septic shock is diagnosed.A pulmonary artery catheter is placed.Which of the following hemodynamic values would you expect to find?
A) Cardiac output of 8 L/min
B) Right atrial pressure of 17 mm Hg
C) Pulmonary artery wedge pressure of 23 mm Hg
D) Systemic vascular resistance of 1100
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Chapter 36: Burns
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Q1) A patient is brought to the emergency department after a house fire.He fell asleep with a lit cigarette,and the couch ignited.TBSA burn is estimated at 25% deep partial-thickness burns to areas of the chest,back,and left arm and 20% full-thickness burns to the right arm,right upper leg,and areas on the face.The patient is now in the intensive care burn unit with a heart rate of 140 beats/min,a urine output of 25 mL/hr,and clear lung sounds.The fluid resuscitation plan
A) should continue as planned; everything looks good.
B) IV rate should be decreased and more narcotics given.
C) IV rate should be increased and fluid status closely watched.
D) should be switched to packed red blood cells.
Q2) Roughly 80% of burns in children are classified as
A) radiation burns.
B) chemical burns.
C) electrical burns.
D) thermal burns.
Q3) Which zone is the site of the most severe damage?
A) Zone of coagulation
B) Peripheral zone
C) Zone of stasis
D) Zone of hyperemia
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Chapter 37: Organ Donation and Transplantation
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Q1) Which of the following federal laws regulate the medical and surgical therapy involved with organ transplantation?
A) Omnibus Budget Reconciliation Act
B) Uniform Anatomical Gift Act
C) Hospital Conditions of Participation-Organ Donations
D) Medical Examiner Laws
E) Uniform Determination of Death Act
Q2) Which statement made by a patient who has had a urinary diversion pancreas transplant indicates the need for further teaching?
A) "I no longer need to monitor my blood glucose levels."
B) "I will need to have periodic pancreas biopsies."
C) "I may feel the urge to urinate frequently."
D) "I will give urine samples to monitor for rejection."
Q3) A patient has had a kidney transplant.The nurse knows that monitoring which of the following would have the highest priority?
A) Fluid volume
B) Electrolytes
C) Complete blood count
D) Temperature
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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) A patient was admitted to the critical care unit with gram-negative sepsis 5 days ago.Today there is continual oozing from his intravenous sites,and ecchymosis of the skin is noted beneath his automatic blood pressure cuff.On his laboratory work,his platelets are normal,and his international normalized ratio is elevated.The primary treatment goal for this patient is to
A) maintain adequate organ perfusion.
B) suppress antibody response that is destroying platelets.
C) treat life-threatening metabolic disturbances.
D) begin hypothermic therapy to prevent cerebral hemorrhage.
Q3) 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
Page 40
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Chapter 39: The Obstetric Patient
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Q1) The patient has a congenital cardiac disorder and is experiencing complications that include dysrhythmias,heart failure,and thromboembolism.The nurse recognizes that these are symptoms of A) atrial septal defect.
B) ventricular septal defect.
C) patent ductus arteriosus.
D) mitral stenosis.
Q2) The most teratogenic of all viruses is A) rubella.
B) measles.
C) mumps.
D) HIV.
Q3) The most common cause of obstetric cardiac arrest in pregnancy is A) anesthetic complications.
B) idiopathic peripartum cardiomyopathy.
C) pregnancy-induced hypertension.
D) hemorrhage.
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41
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) Optimal treatment of a pediatric patient with status asthmaticus includes which of the following?
A) Placing the patient in the knee-chest position
B) Extending the neck to promote opening of the airway
C) Giving humidified oxygen
D) Giving ?-adrenergic therapy
E) Giving corticosteroids
Q3) The pathophysiologic consequences of respiratory syncytial virus include
A) replacement of the epithelium with nonciliated tissue, leading to submucosal edema and eventual necrosis.
B) necrosis of the alveoli, resulting in collapse.
C) inflammation of the diaphragm, resulting in alveolar hypoventilation.
D) bronchoconstriction, resulting in severe airflow obstruction.
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42
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) Which of the following contribute to a higher risk for myocardial ischemia in an older patient?
A) Increased diastolic filling pressures
B) Decreased intracellular free calcium
C) Thinning left ventricular wall thickness
D) Increased myocardial collagen content
E) Increased myocardial oxygen consumption
Q3) Which method is used to measure bone mineral density (BMD)and fracture prediction?
A) fracture risk assessment tool (FRAX)
B) Computed tomography
C) Dual-energy x-ray absorptiometry (DXA)
D) positron emission tomography (PET)
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43
Chapter 42: The Perianesthesia Patient
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Q1) Causes of a postoperative fever include
A) medication reactions.
B) hypotension.
C) blood transfusion reaction.
D) pulmonary emboli.
E) atelectasis.
Q2) When a patient emerges in a very restless state,the nurse must first assess for A) anxiety.
B) hypoxia.
C) hyponatremia.
D) gastric distention.
Q3) Which of the following is a common cause of postoperative hypertension?
A) Administration of morphine
B) Fluid overload
C) Bladder distention
D) Tachycardia
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