Nursing Care of the Critically Ill Practice Exam
Course Introduction
This course focuses on the advanced nursing care required for critically ill patients in intensive care and emergency settings. It emphasizes the assessment, planning, intervention, and evaluation of care for adults and children experiencing life-threatening health problems, such as respiratory distress, sepsis, cardiac emergencies, and multi-organ failure. Students will learn to interpret clinical data, use advanced technology, manage complex pharmacological therapies, and collaborate within interdisciplinary teams. The course also highlights the psychological, ethical, and legal considerations involved in critical care, preparing nurses to deliver holistic and evidence-based care 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) Emphasis is on human integrity and stresses the theory that the body,mind,and spirit are interdependent and inseparable.This statement describes which methodology of care?
A) Holistic care
B) Individualized care
C) Cultural care
D) Interdisciplinary care
Answer: A
Q2) 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
Q3) Prayer,guided imagery,and massage are all examples of A) alternative therapy.
B) holistic care.
C) complementary care.
D) individualized care.
Answer: C
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Chapter 2: Ethical Issues
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Sample Questions
Q1) The difference between withholding treatment and withdrawing treatment is that the decision to withhold treatment
A) is used when it has been determined that there is no hope for success from the onset of care.
B) reflects surrendering hope after all options have been unsuccessful.
C) requires a court order.
D) is an economical decision not a moral or ethical decision.
Answer: A
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) 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) After admission to the intensive care unit,a patient shares with the nurse a concern that her adult children will not be able to reach agreement on what to do if she is no longer able to make decisions for herself.The nurse informs the patient that it is possible to grant authority to one person to make decisions by procuring a A) court-appointed guardian.
B) do-not-resuscitate order.
C) durable power of attorney for health care.
D) living will.
Answer: C
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Page 5
Chapter 4: Genetics and Genomics in Critical Care
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Sample Questions
Q1) 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.
Q2) Genetic disorders do not all have the same cause.Major categories of disorders include
A) single gene.
B) complex gene.
C) chromosome.
D) mitochondrial.
E) all of the above.
Q3) 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
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Page 6
Chapter 5: Patient and Family Education
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Sample Questions
Q1) A patient is scheduled for a cardiac catheterization this afternoon.The nurse wants to provide her with some basic information before going in the room to talk about her specific procedure.Which teaching strategy is most appropriate for this situation?
A) Discussion
B) Demonstration and practice
C) Audiovisual media
D) Written
Q2) A patient is admitted to the critical care unit with the onset of tuberculosis.He was diagnosed with HIV/AIDS 1 year ago.When talking to the patient about preventing the spread of tuberculosis,the patient tells the nurse that he has not followed precautions regarding tuberculosis for patients with HIV.Which educational objective is BEST stated for this patient?
A) Patient will know at least two ways to prevent the spread of tuberculosis within 1 week.
B) Patient will understand how HIV is spread within 3 days.
C) Patient will realize that improper precautions will spread his disease to others.
D) Patient will verbalize two methods of transmission for tuberculosis within 2 days.
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Chapter 6: Psychosocial and Spiritual Alterations and Management
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Sample Questions
Q1) 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 continually tries to get out of bed and states,"My legs are only sleeping." Which of the following nursing diagnoses would be appropriate for the patient?
A) Disturbed body image
B) Powerlessness
C) Situational low self-esteem
D) Ineffective role performance
Q2) A patient is admitted into the ICU with the diagnosis of gunshot wound to the head,suicide attempt.While the patient is in the ICU the nurse's interventions should include
A) limiting interaction with the patient due to antisocial behaviors exhibited by the suicidal attempt.
B) ignoring the patient's need to talk about the incident.
C) validating the patient's worth and self-esteem.
D) discontinuing any psychotropic medications.
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Chapter 7: Sleep Alterations and Management
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Q1) The patient has been in the critical care unit for 3 weeks and has been on the intraaortic balloon pump for the past 3 days.The patient's condition has been serious,and hourly assessments and vital signs have been necessary.The nursing staff has noted that the patient has been unable to achieve sleep for more than 30 minutes at a time.The patient has been given diazepam (Valium)prn.Which techniques may assist in assessing the patient's sleep pattern?
A) Correlating sleep time with vital signs
B) Documenting sleep periods of more than 90 minutes
C) Assessing degree of arousal on hourly checks
D) Observing the length of NREM sleep periods
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.
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Chapter 8: Nutrition Alterations and Management
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Sample Questions
Q1) Obtaining height and weight measurements for the critically ill patient
A) should be deferred until the medical condition stabilizes.
B) should be measured rather than obtained through patient or family report.
C) requires consistent weights in pounds.
D) requires weight, but height can be deferred.
Q2) A patient on mechanical ventilation is receiving total parenteral nutrition (TPN).Which of the following is true?
A) Excessive calorie intake can cause an increase in PaCO<sub>2</sub>.
B) The patient's head should remain elevated at 45 degrees to avoid aspiration.
C) Lipid intake should be maintained at greater than 2 g/kg/day.
D) TPN is preferred over the use of enteral feeding to avoid the complication of aspiration.
Q3) The patient's feeding tube is occluded and cannot be flushed.The nurse knows that the best irrigant for feeding tube occlusion is A) cola.
B) pancreatic enzyme.
C) water.
D) juice.
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Chapter 9: Pain and Pain Management
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Sample Questions
Q1) 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.
Q2) The neural processes of encoding and processing noxious stimuli necessary but not sufficient for pain is known as
A) perception.
B) nociception.
C) transduction.
D) transmission.
Q3) 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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11
Chapter 10: Sedation,Agitation,Delirium: Assessment and Management
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Sample Questions
Q1) A major side effect of benzodiazepines is A) hypertension.
B) respiratory depression.
C) renal failure.
D) phlebitis at the IV site.
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.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
Q3) Causes of delirium in critically ill patients include
A) hyperglycemia.
B) meningitis.
C) cardiomegaly.
D) pulmonary embolism.
E) alcohol withdrawal syndrome.
F) hyperthyroidism.
Page 12
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Chapter 11: End-Of-Life Issues
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Sample Questions
Q1) Which of the following statements apply to DNR orders?
A) DNR orders are often delayed because of difficulty predicting the time of death.
B) The patient's wishes are often not known or are vaguely stated.
C) A DNR order indicates that all care should be stopped.
D) End-of-life care skills are not emphasized in medical curricula.
E) DNR orders do not address pain management.
Q2) 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
Q3) Antiemetics should be used to treat
A) dyspnea.
B) nausea and vomiting.
C) anxiety.
D) edema.
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13
Chapter 12: Cardiovascular Anatomy and Physiology
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Sample Questions
Q1) 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.On the basis of this information,how would the nurse evaluate the patient's preload status?
A) The patient is hypovolemic and has too little preload.
B) The patient is experiencing CHF and has too little preload.
C) The patient is experiencing heart failure and has too much preload.
D) The patient is hypertensive and the preload is not a factor.
Q2) The final repolarization phase of the action potential is
A) phase 1.
B) phase 2.
C) phase 3.
D) phase 4.
Q3) In a myocardial cell,the normal resting membrane potential is
A) 10 to 20 mV.
B) 30 to 40 mV.
C) -20 to -30 mV.
D) -80 to -90 mV.
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Page 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) An 82-year-old patient is admitted into the critical care unit with a diagnosis of left-sided heart failure related to mitral stenosis.Physical assessment findings reveal tachycardia with an S? and a 3/6 systolic murmur.The nurse knows that the presence of an S? heart sound is
A) normal for a person this age.
B) a ventricular gallop.
C) a systolic sound.
D) heard best with the diaphragm of the stethoscope.
Q3) 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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Chapter 14: Cardiovascular Diagnostic Procedures
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Sample Questions
Q1) Which of the following conditions can cause an artificial increase in the PAOP/PCWP?
A) Aortic regurgitation
B) Aortic stenosis
C) Mitral stenosis
D) Mitral regurgitation
Q2) Which of the following findings would be indicative reasons to abort an exercise stress test?
A) Ventricular axis of +90
B) Increase in blood pressure
C) Inverted U wave
D) ST segment depression or elevation
Q3) 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.
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16
Chapter 15: Cardiovascular Disorders
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Sample Questions
Q1) A patient has been newly diagnosed with stable angina.He tells the nurse he knows a lot about his diagnosis already because his father had the same diagnosis 15 years ago.The nurse asks him to state what he already knows about angina.Which of the following responses by the patient indicates the need for additional education?
A) He should stop smoking.
B) He can no longer drink colas or coffee.
C) He can no longer get a strong back massage.
D) He should take stool softeners to prevent straining.
Q2) Which classification of dysrhythmia is most common with an inferior wall infarction in the first hour after STEMI?
A) Sinus tachycardia
B) Multifocal PVCs
C) Atrial fibrillation
D) Sinus bradycardia
Q3) Clinical manifestations of right-sided heart failure include
A) elevated central venous pressure and sacral edema.
B) pulmonary congestion and jugular venous distention.
C) hypertension and chest pain.
D) liver tenderness and pulmonary edema.
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Page 17
Chapter 16: Cardiovascular Therapeutic Management
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Sample Questions
Q1) Which anticoagulant(s)enhances activity of antithrombin III and does not require aPTT or ACT monitoring?
A) Heparin
B) Enoxaparin (Lovenox)
C) Bivalirudin (Angiomax)
D) Argatroban (Argatroban)
Q2) When an intra-aortic balloon is in place,it is essential for the nurse to frequently assess
A) for a pulse deficit.
B) peripheral pulses distal to the catheter insertion site.
C) bilateral blood pressures.
D) coronary artery perfusion.
Q3) Which of the following doses of dopamine (Intropin)results in stimulation of beta? receptors and increased myocardial contractility?
A) 1 mcg/kg/min
B) 5 mcg/kg/min
C) 15 mcg/kg/min
D) 20 mcg/kg/min
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18
Chapter 17: Pulmonary Anatomy and Physiology
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Sample Questions
Q1) The movement of air into and out of the lungs is termed A) ventilation.
B) respiration.
C) diffusion.
D) perfusion.
Q2) A patient is admitted to the critical care unit with an acute exacerbation of chronic emphysema.Respirations are 28 breaths/min.A pulmonary artery catheter is in place.Pulmonary artery systolic (PAS)is 38 mm Hg with a pulmonary artery mean (PAM)of 22 mm Hg.Blood gases reveal an uncompensated respiratory acidosis.The patient's work effort for breathing is increased related to the effect of emphysema,which is
A) increased lung compliance.
B) decreased lung recoil.
C) increased chest wall compliance.
D) widespread atelectasis.
Q3) Which of the following arteries has the lowest oxygen concentration?
A) Aorta
B) Subclavian
C) Carotid
D) Pulmonary
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Chapter 18: Pulmonary Clinical Assessment
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Sample Questions
Q1) The creation of sound waves across the body surface to determine abnormal densities is known as
A) inspection.
B) palpation.
C) percussion.
D) auscultation.
Q2) A patient is admitted to the critical care unit with acute respiratory failure secondary to COPD.The patient has a 15-year history of emphysema and bronchitis.On inspection,the nurse notes that the patient is experiencing air trapping.While auscultating his chest,you note the presence of coarse,rumbling,low-pitched sounds in the right middle and lower lobes.Which of the following best describes the patient's breathing pattern?
A) Deep sighing breaths without pauses
B) Rapid, shallow breaths
C) Normal breathing pattern interspersed with forced expirations
D) Irregular breathing pattern with both deep and shallow breaths
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Chapter 19: Pulmonary Diagnostic Procedures
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Q1) A patient is intubated,and sputum for culture and sensitivity is ordered.Which of the following is important for obtaining the best specimen?
A) After the specimen is in the container, dilute thick secretions with sterile water.
B) Apply suction when the catheter is advanced to obtain secretions from within the endotracheal tube.
C) Do not apply suction while the catheter is being withdrawn because this can contaminate the sample with sputum left in the endotracheal tube.
D) Do not clear the endotracheal tube of all local secretions before obtaining the specimen.
Q2) A patient's pulse oximeter alarm goes off.The monitor reads 82%.What is the first action the nurse should perform?
A) Prepare to intubate.
B) Assess the patient's condition.
C) Turn off the alarm and reapply the oximeter sensor.
D) Increase O<sub>2</sub> level to 4L/NC.
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21
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) Aspiration can best be prevented by
A) observing the amount given in the tube feeding.
B) assessing the patient's level of consciousness.
C) encouraging the patient to cough and to breathe deeply.
D) positioning a patient in a semirecumbent position.
Q3) A patient was admitted to the critical care unit after a left pneumonectomy.The patient is receiving 40% oxygen via a simple facemask.The morning chest radiography study reveals right lower lobe pneumonia.After eating breakfast,the patient suddenly vomits and aspirates.The single most important measure to prevent the spread of infection between staff and patients is
A) respiratory isolation.
B) hand washing.
C) use of PPE.
D) antibiotics.
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Page 22
Chapter 21: Pulmonary Therapeutic Management
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Q1) The assist-control mode of ventilation functions in which of the following manners?
A) It delivers gas at preset volume, at a set rate, and in response to the patient's inspiratory efforts.
B) It delivers gas at a preset volume, allowing the patient to breathe spontaneously at his or her own volume.
C) It applies positive pressure during both ventilator breaths and spontaneous breaths.
D) It delivers gas at preset rate and tidal volume regardless of the patient's inspiratory efforts.
Q2) Indications to support a pneumonectomy are
A) lesions confined to a single lobe.
B) bronchiectasis.
C) unilateral tuberculosis.
D) lung abscesses or cyst.
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Chapter 22: Neurologic Anatomy and Physiology
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Q1) A patient is admitted to the critical care unit after a stroke.The patient has an altered level of consciousness and garbled speech.A computed tomography scan is performed to determine the cause of the stroke,and a lumbar puncture is performed for analysis of CSF.Because the patient's speech is garbled,the nurse documents the occurrence of which type of aphasia?
A) Fluent
B) Receptive
C) Expressive
D) Global
Q2) Obstructive hydrocephalus can occur in the presence of
A) blockage in the arachnoid villi.
B) malformation of the falx cerebelli.
C) blockage of CSF flow in the ventricular system.
D) increased production of CSF with poor outlet.
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) Which of the following statements best describes assessment of arousal?
A) It measures content of consciousness and is a higher level function.
B) It is an evaluation of the reticular activating system and its connection with the thalamus and the cerebral cortex.
C) It becomes a valid parameter when the patient is able to respond to verbal stimuli, such as squeezing the hands on command.
D) Noxious stimuli are not to be used as an assessment parameter.
Q2) Results from which two procedures complement each other in the preoperative evaluation of the carotid arteries?
A) Ultrasound and magnetic resonance angiography
B) Conventional angiography and evoked potential
C) CT and magnetic resonance angiography
D) Transcranial Doppler and extracranial Doppler
Q3) An important intervention before and after a cerebral angiogram is
A) ensuring that the patient is adequately hydrated.
B) maintaining the patient on an NPO status.
C) administering antibiotics to the patient.
D) keeping the patient flat in bed for 24 hours.
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Chapter 24: Neurologic Disorders and Therapeutic Management
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Sample Questions
Q1) The stroke patient who has difficulty with speech has A) expressive aphasia.
B) global aphasia
C) receptive aphasia.
D) apraxia.
Q2) Nonencapsulated tumors tend to infiltrate brain tissue.These tumors can arise in any part of brain connective tissue and infiltrate primarily cerebral hemisphere tissue.These tumors grow rapidly and are difficult to excise completely.The tumors described are classified as
A) angiomas.
B) pituitary adenomas.
C) meningiomas.
D) gliomas.
Q3) Nursing management of a patient with a clipped cerebral aneurysm receiving hypertensive hypervolemic hemodilution therapy includes
A) administering osmotic diuretics and vasodilator agents.
B) providing the patient with a quiet environment.
C) maintaining the patient's systolic blood pressure at 150 to 160 mm Hg.
D) keeping the patient's central venous pressure at 5 to 8 mm Hg.
Page 26
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Chapter 25: Kidney Anatomy and Physiology
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Q1) Which type of intravenous fluid will not create a shift of fluids within the vascular space?
A) Hypertonic
B) Hypotonic
C) Isotonic
D) Osmotic pressure
Q2) Which of the following conditions would result in an increased release of renin?
A) Increased release of angiotensin I
B) Increased release of angiotensin II
C) Increased amount of sodium in the distal convoluted tubule
D) Reduced pressure in the glomerulus
Q3) Which electrolytes are cations?
A) Sodium, potassium, and chloride
B) Sodium, chloride, and bicarbonate
C) Bicarbonate, chloride, and calcium
D) Sodium, potassium, and magnesium
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Chapter 26: Kidney Clinical Assessment and Diagnostic
Procedures
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Q1) Percussion of kidneys is usually done to A) assess the size and shape of the kidneys.
B) detect pain in the renal area.
C) elicit a fluid wave.
D) evaluate fluid status.
Q2) Causes of the presence of myoglobin could include A) bleeding.
B) traumatic damage to the skeletal muscle.
C) asthmatic attack.
D) rhabdomyolysis.
E) cocaine abuse.
Q3) Which of the following may be present in the patient with significant fluid volume overload?
A) S3 or S4 may develop.
B) Distention of the hand veins will disappear if the hand is elevated.
C) When testing the quality of skin turgor, the skin will not return to the normal position for several seconds.
D) Tachycardia with hypotension may be present.
E) Dependent edema may be present.
28
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Chapter 27: Kidney Disorders and Therapeutic Management
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Q1) A patient with renal failure reports all of the following during the medical history.Which is most likely to have precipitated the patient's renal failure?
A) Recent computed tomography of the brain with and without contrast
B) A recent bout of congestive heart failure after an acute myocardial infarction
C) Twice-daily prescription of Lasix 40 mg by mouth
D) A recent bout of benign prostatic hypertrophy and transurethral resection of the prostate
Q2) 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
Q3) What is the dose for low-dose dopamine?
A) 1 to 2 mcg/kg/min
B) 1 to 2 mg/kg/min
C) 2 to 3 mcg/kg/min
D) 2 to 3 mg/kg/min
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Chapter 28: Gastrointestinal Anatomy and Physiology
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Q1) Which of the following statements are correct regarding epithelial cells of the gastric mucosa?
A) They prevent diffusion of hydrogen into the mucosa.
B) They secrete bicarbonate to neutralize hydrogen ions.
C) They have the ability to increase blood flow to facilitate removal of toxic metabolites.
D) They break down prostaglandins.
Q2) The gastrointestinal system plays a vital role in detoxification and elimination of A) viruses.
B) chemical toxins.
C) drugs.
D) bacteria.
Q3) The role of the liver in response to glycogen is to A) decrease blood sugar levels when insulin production is inadequate. B) synthesize amino acids.
C) break down the glycogen to glucose to maintain blood sugar levels.
D) produce amino acids.
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Chapter 29: Gastrointestinal Clinical Assessment and Diagnostic Procedures
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Q1) 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
Q2) When assessing the gastrointestinal system,the order of assessment progresses in which of the following ways?
A) Inspection, palpation, percussion, auscultation
B) Palpation, percussion, inspection, auscultation
C) Inspection, auscultation, percussion, palpation
D) Palpation, inspection, auscultation, percussion
Q3) Nursing management of the patient undergoing an angiogram includes
A) keeping the patient flat for 24 hours.
B) inserting a nasogastric tube before the procedure.
C) administering tap water enemas until clear.
D) checking the patient's pulse distal to the injection site every 15 minutes.
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Chapter 30: Gastrointestinal Disorders and Therapeutic Management
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Q1) Esophagogastric varices are the result of
A) portal hypertension resulting in diversion of blood from a high-pressure area to a low-pressure area.
B) superficial mucosal erosions as a result of increased stress levels.
C) proulcer forces breaking down the mucosal resistance.
D) inflammation and ulceration secondary to nonsteroidal anti-inflammatory drug use.
Q2) Which of the following disorders is the leading cause of upper GI hemorrhage?
A) Stress ulcers
B) Peptic ulcers
C) Nonspecific erosive gastritis
D) Esophageal varices
Q3) A patient with a 10-year history of alcoholism was admitted to the critical care unit with the diagnosis of acute pancreatitis.The physiologic alteration that occurs in acute pancreatitis is
A) uncontrolled hypoglycemia caused by an increased release of insulin.
B) loss of storage capacity for senescent red blood cells.
C) premature activation of inactive digestive enzymes, resulting in autodigestion.
D) release of glycogen into the serum, resulting in hyperglycemia.
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Chapter 31: Endocrine Anatomy and Physiology
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Q1) The release of hormones by the pituitary gland is under the control of the A) cerebellum.
B) occipital lobe.
C) temporal lobe.
D) hypothalamus.
Q2) 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
Q3) Insulin produces hypoglycemia.What other physiologic effect may occur when insulin is given?
A) Polyuria
B) Hypercalcemia
C) Hypokalemia
D) Cellular dehydration
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Chapter 32: Endocrine Clinical Assessment and Diagnostic Procedures
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Q1) Glycosylated hemoglobin levels provide information about A) the average blood glucose level over the previous 3 to 4 months.
B) blood glucose levels in comparison with serum hemoglobin.
C) serial glucose readings after ingestion of a concentrated glucose solution.
D) the difference between serum and urine glucose levels.
Q2) 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
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 weighs 140 kg and is 60 in.tall.The patient's blood sugar is being controlled by glipizide.As the nurse discusses discharge instructions,the primary treatment goal with this type 2 diabetes patient would be
A) signs of hypoglycemia.
B) proper injection technique.
C) weight loss.
D) increased caloric intake.
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).The treatment of DKA involves A) extensive hydration.
B) oral hypoglycemic agents.
C) large doses of IV insulin.
D) limiting food and fluids.
Q3) An expected finding in the patient with hypothyroidism would be A) increased T? .
B) anemia.
C) decreased thyroid stimulating hormone.
D) hyperglycemia.
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Chapter 34: Trauma
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Q1) 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
Q2) Motor vehicle crashes (MVCs)and falls are the greatest cause of A) spinal shock.
B) blunt thoracic trauma.
C) maxillofacial injuries
D) penetrating thoracic injuries.
Q3) Signs and symptoms associated with a flail chest include
A) tracheal deviation toward the unaffected side.
B) jugular venous distention.
C) paradoxical respiratory movement.
D) respiratory alkalosis.
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Chapter 35: Shock,sepsis,and Multiple Organ Dysfunction Syndrome
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Q1) Laboratory values for DIC show abnormalities in A) liver function tests.
B) tests for renal function.
C) platelet counts.
D) blood glucose levels.
Q2) A patient is admitted to the intensive care unit after she develops disseminated intravascular coagulation (DIC)after a vaginal delivery.DIC is known to occur in patients with retained placental fragments.What is the result of DIC?
A) Hypersensitive response to an antigen, resulting in anaphylaxis
B) Depletion of clotting factors and excessive fibrinolysis, resulting in simultaneous microvascular clotting and hemorrhage
C) Vasodilatation, resulting in hypotension
D) Septic shock, resulting in vasodilation and decreased perfusion
Q3) Which of the following drugs promotes bronchodilation and vasoconstriction?
A) Solu-Medrol
B) Gentamicin
C) Atropine
D) Epinephrine
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Chapter 36: Burns
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Q1) Which of the topical antimicrobial agents is commonly used as a broad-spectrum and fights against gram-positive and -negative bacteria?
A) Pure silver
B) Bacitracin
C) Mafenide acetate cream
D) Silver sulfadiazine
Q2) Which of the following causes can lead to excessive burn edema and shock in a patient with injuries totaling more than 50% -TBSA burn?
A) The heat from the burn leads to immediate vascular wall destruction and extravasation of intravascular fluid.
B) A positive interstitial hydrostatic pressure occurs in the dermis leading to burn wound edema.
C) Plasma colloid osmotic pressure is decreased because of protein leakage into the extravascular space.
D) Capillary permeability decreases in burned and unburned tissue, leading to hypovolemia.
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Chapter 37: Organ Donation and Transplantation
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Q1) Which statement made by a patient who has received an organ transplant indicates that the teaching was effective?
A) "I will finally be able to eat a regular diet."
B) "I will establish a routine for checking any skin changes."
C) "I will check my blood pressure regularly to make sure it's not too high."
D) "After my drug regimen is established, I won't have to worry about rejection."
Q2) According to the critical pathway developed by United Network for Organ Sharing,which of the following should be carried out by the critical care nurse?
A) Complete the operating room checklist.
B) Document the date and time of brain death.
C) Insert two large-bore IV catheters.
D) Maintain patient temperature between 36.5° and 37.5° C.
E) Notify the supervisor of pending donation.
Q3) Which of the following is an anticipated finding after cardiac transplantation?
A) Two P waves on the electrocardiogram (ECG)
B) High cardiac output
C) Anginal pain
D) Resting heart rate of 60 to 70 beats/min
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Chapter 38: Hematologic Disorders and Oncologic Emergencies
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Q1) 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.
Q2) The primary mechanism in the development of idiopathic thrombocytopenic purpura (ITP)is
A) destruction of platelets by lymphocytic antibodies.
B) destruction of malignant cells through radiation or chemotherapy.
C) formation of heparin antibodies.
D) damage to the endothelium.
Q3) Type 2 heparin-induced thrombocytopenia is characterized by A) formation of thrombi, causing vessel occlusion.
B) spontaneous epistaxis.
C) elevated prothrombin times.
D) massive peripheral ecchymoses.
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Chapter 39: The Obstetric Patient
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Q1) Maternal hypoxia is defined as a PaO<sub>2</sub> less than
A) 60 mm Hg.
B) 80 mm Hg.
C) 100 mm Hg.
D) 120 mm Hg.
Q2) Severe neonatal disorders associated with toxoplasmosis infections include A) microcephaly.
B) respiratory distress.
C) hydrocephalus.
D) dysrhythmias.
E) visual and hearing impairments.
Q3) Which medication used in the advanced cardiac life support algorithm is not contraindicated in pregnancy?
A) Atropine
B) Epinephrine
C) Lidocaine
D) Sodium bicarbonate
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Chapter 40: The Pediatric Patient
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Q1) The nurse is caring for a 6-month-old infant who has had an apparent life-threatening event (ALTE).The nurse is aware that treatment of the infant after ALTE will include all of the following EXCEPT
A) prone positioning.
B) supine positioning.
C) nasal continuous positive airway pressure.
D) continuous gavage feedings.
Q2) A 3-year-old patient is being admitted to the critical care unit with the diagnosis of head trauma as the result of a motor vehicle accident.The nurse knows that the primary complications of head injuries include A) infection.
B) seizures.
C) hemorrhage.
D) cerebral bleeding.
E) brain herniation.
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Chapter 41: The Older Adult Patient
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Q1) Age-related pulmonary changes that may affect this patient include A) increased tidal volumes.
B) weakening of intercostal muscles and the diaphragm.
C) improved cough reflex.
D) decreased sensation of the glottis.
Q2) A critically ill older adult is placed on a continuous infusion of high-dose loop diuretic for diuresis.The nurses knows to monitor for A) hyperkalemia.
B) bradycardia.
C) metabolic acidosis.
D) hyperchloremic alkalosis.
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 of the following antagonizes the effects of benzodiazepines?
A) Naloxone
B) Neostigmine
C) Fentanyl
D) Flumazenil
Q2) Management of an airway obstruction begins with immediate recognition and treatment.Place these nursing interventions in the appropriate order for initial care of a postanesthesia patient with airway obstruction.
1)Positive-pressure mask ventilation
2)Head tilt,chin lift maneuver (nonreactive patient)
3)Insertion of oropharyngeal or nasopharyngeal airway
4)Intubation with mechanical intubation
5)Stimulation of the patient
A) 1, 2, 3, 5, 4
B) 5, 2, 3, 1, 4
C) 2, 3, 1, 5, 4
D) 4, 2, 3, 1, 5
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