Nursing Care of the Critically Ill Review Questions
Course Introduction
Nursing Care of the Critically Ill provides an in-depth exploration of the principles and practices essential for managing patients in critical and intensive care settings. The course emphasizes advanced assessment skills, evidence-based interventions, and the use of life-sustaining technologies. Students will learn to identify and prioritize the complex needs of critically ill patients, manage emergencies, and collaborate effectively within interdisciplinary healthcare teams. Key topics include hemodynamic monitoring, mechanical ventilation, pharmacologic management, and ethical considerations in end-of-life care. Through case studies, simulations, and clinical experiences, students will develop the competence and confidence required to deliver safe, compassionate, and high-quality care to patients experiencing life-threatening health conditions.
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) Working with individuals of other professions to maintain a climate of mutual respect and shared values best describes the concept of
A) interprofessional teamwork and team-based care.
B) values and ethics for interprofessional practice.
C) interprofessional communication.
D) roles and responsibilities for collaborative practice.
Answer: B
Q2) According to Kupperschmidt,to become a skilled communicator,one must A) become candid.
B) become reflective.
C) set goals and develop action plans.
D) survey the team.
E) become aware of self-deception.
Answer: A,B,E
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) 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
Q2) The first step of the ethical decision-making process is
A) consulting with an authority.
B) identifying the health problem.
C) delineating the ethical problem from other types of problems.
D) identifying the client as the primary decision maker.
Answer: B
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Page 4
Chapter 3: Legal Issues
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Sample Questions
Q1) Which of the following statements is true regarding a nurse's job description?
A) As long as the nurse follows the American Nurses Association Standards of Care, the job description is irrelevant in a negligence allegation.
B) Job descriptions must be reflective of the accepted standard of care.
C) Institution-specific job descriptions are not legally acceptable.
D) Job descriptions should be vague in describing nursing functions to avoid claims of negligence.
Answer: B
Q2) Which of the following statements best describes the definition of assault?
A) An intentional act that causes the patient to believe harm may be done
B) A statement that causes injury to the patient's reputation or standing in the community
C) Negligence or malpractice that results in harm to a spousal relationship
D) An intentional act that brings about harm or offensive contact with the patient
Answer: A
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Chapter 4: Genetics and Genomics in Critical Care
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Sample Questions
Q1) To achieve a consistent distance across the width of the DNA strand,the nucleotide base guanine (G)can only be paired with:
A) adenine (A).
B) thymine (T).
C) cytosine (C).
D) sex chromosome X.
Q2) Which of the following would be classified as a single-gene disorder?
A) Down syndrome
B) Marfan syndrome
C) Cystic fibrosis
D) Type 2 diabetes
E) Sickle cell disease
F) Cardiovascular atherosclerotic diseases
Q3) 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.
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Chapter 5: Patient and Family Education
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Sample Questions
Q1) Which of the following issues should be addressed with patients who have been unconscious?
A) Sensations
B) Pathophysiology
C) Rehabilitation
D) Attitudes
Q2) The first step of the teaching-learning process involves
A) gathering data to assist in the assessment of learning needs.
B) identifying major learning needs for the patient.
C) identifying learning needs related to medical diagnosis.
D) evaluating the effects of prior teaching.
Q3) The content and method of presentation in the critical care unit vary because A) of the different admitting diagnoses.
B) of the uniqueness of each patient's clinical and emotional status.
C) all patients are on ventilators and cannot talk.
D) patients are heavily sedated and may not comprehend teaching.
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Chapter 6: Psychosocial and Spiritual Alterations and Management
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Sample Questions
Q1) An adult patient sustains third- and fourth-degree burns to more than 70% of her body related to a house fire.The patient begins a pattern of behavior similar to that of a young child,in which she repeatedly whines and throws "temper tantrums" in an attempt to keep her nurse at the bedside.The patient's coping mechanism is consistent with A) regression.
B) identity disturbance.
C) denial.
D) trust.
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
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8
Chapter 7: Sleep Alterations and Management
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Sample Questions
Q1) _____ is the external element that has the most significant effect on circadian rhythms.
A) Lower body temperature
B) Light
C) Melatonin cycle
D) Background noise
Q2) The primary determinant in the efficacy of CPAP in patients with OSA is
A) compliance.
B) weight.
C) tonsil size.
D) respiratory effort.
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) The nutritional alteration most frequently encountered in hospitalized patients is A) respiratory quotient (RQ).
B) protein-calorie malnutrition.
C) fat-calorie malnutrition.
D) gluconeogenesis.
Q2) A patient has a new order for intermittent nasogastric feedings every 4 hours.The nasogastric tube is placed by the nurse.The best method for confirming the placement of the tube before feeding would be to
A) obtain radiography of the abdomen.
B) check the pH of fluid aspirated from the tube.
C) auscultate the left upper quadrant of the abdomen while injecting air into the tube.
D) auscultate the right upper quadrant of the abdomen while injecting air into the tube.
Q3) An effect of malnutrition on respiratory function is
A) decreased surfactant.
B) increased vital capacity.
C) decreased PaCO<sub>2</sub>.
D) tachypnea.
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10
Chapter 9: Pain and Pain Management
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Sample Questions
Q1) A patient states that he has been taking Demerol 50 mg tablets four times a day for the past 5 years,but they are not working like they use to.The nurse is concerned that the patient has developed
A) addiction to Demerol.
B) physical dependence and tolerance.
C) physical dependence and addiction.
D) a method to withdraw himself off the medication.
Q2) The patient has received ketamine for its analgesic effects.The patient suddenly states,"I feel like I am floating and can see everything you are doing.I am not in control."
The nurse is aware that this is caused by the ketamine and is known as the
A) hallucination state.
B) guided imagery and will help relieve pain.
C) dissociative state.
D) recommended effect of ketamine.
Q3) 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.
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Page 11
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) Which of the following drugs is used for sedation in patients experiencing withdrawal syndrome?
A) Dexmedetomidine
B) Hydromorphone
C) Diazepam
D) Clonidine
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Page 12
Chapter 11: End-Of-Life Issues
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Sample Questions
Q1) A patient was admitted to the critical care unit several weeks ago with an acute myocardial infarction and subsequently underwent coronary artery bypass grafting surgery.Since a cardiac arrest 5 days ago,the patient has been unresponsive.An electroencephalogram shows no meaningful brain activity.The patient does not have an advance directive.Which of the following statements would be the best way to approach the family regarding his ongoing care?
A) "I will refer this case to the hospital ethics committee, and they will contact you when they have a decision."
B) "What do you want to do about the patient's care at this point?"
C) "Dr. Smith believes that there is no hope at this point and recommends DNR status."
D) "What would the patient want if he knew he were in this situation?"
Q2) A patient tells the nurse to call his family and tell them they need to come so they can say their goodbyes.The patient is sure he will not be here tomorrow because his grandparent is waiting for him.This is an example of
A) signs and symptoms of anxiety.
B) signs and symptoms of delirium.
C) the need for hospice care.
D) near-death awareness.
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Chapter 12: Cardiovascular Anatomy and Physiology
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Sample Questions
Q1) Which of the following structures is the primary pacemaker of the heart?
A) Ventricular tissue
B) Atrioventricular node
C) Sinoatrial node
D) Purkinje fibers
Q2) The final repolarization phase of the action potential is
A) phase 1.
B) phase 2.
C) phase 3.
D) phase 4.
Q3) An echocardiogram reveals an ejection fraction of 55%.On the basis of this information,the patient's cardiac function is A) adequate.
B) mildly decreased.
C) moderately decreased.
D) severely decreased.
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Chapter 13: Cardiovascular Clinical Assessment
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Sample Questions
Q1) A patient was admitted on the night shift with a diagnosis of acute myocardial infarction.Upon auscultation,the nurse hears a harsh,holosystolic murmur along the left sternal border.The nurse notifies the physician immediately because the symptoms indicate the patient has developed
A) papillary muscle rupture.
B) tricuspid stenosis.
C) ventricular septal rupture.
D) pericardial friction rub.
Q2) The nurse assesses the dorsalis pedis and posterior tibial pulses as weak and thready.Indicate the correct documentation for the pulse volume that the nurse would use.
A) 0
B) 1+
C) 2+
D) 3+
Q3) A patient's blood pressure is 90/72 mm Hg.What is the patient's pulse pressure?
A) 40 mm Hg
B) 25 mm Hg
C) 18 mm Hg
D) 12 mm Hg
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Chapter 14: Cardiovascular Diagnostic Procedures
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Sample Questions
Q1) 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
Q2) A patient with ventricular fibrillation (VF)is
A) hypertensive.
B) bradypneic.
C) diaphoretic.
D) pulseless.
Q3) Which of the following interventions should be strictly followed to ensure accurate cardiac output readings?
A) Use 5 mL of iced injectate only.
B) Inject the fluid into the pulmonary artery port only.
C) Ensure a difference of at least 5° C between injectate temperature and the patient's body temperature.
D) Administer the injectate within 4 seconds.
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Page 16
Chapter 15: Cardiovascular Disorders
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Sample Questions
Q1) Which of the following clinical manifestations is usually the first symptom of peripheral arterial disease (PAD)?
A) Cramping when walking
B) Thrombophlebitis
C) Pulmonary embolism
D) Cordlike veins
Q2) Medical management of hypertrophic cardiomyopathy includes A) beta-blockers.
B) positive inotropes.
C) an intensive exercise regimen.
D) aortic valve replacement.
Q3) 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.
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Chapter 16: Cardiovascular Therapeutic Management
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Sample Questions
Q1) A pacemaker is connected to an external temporary pulse generator.The sensitivity control
A) determines heart rate to muscle activity.
B) determines the milliamperes needed to achieve capture.
C) regulates the ability of the pacemaker to detect the heart's intrinsic electrical activity.
D) allows for selection of intervals between atria and ventricles.
Q2) 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) A nurse is providing care to a patient on fibrinolytic therapy.Which of the following statements from the patient warrants further assessment and intervention by the critical care nurse?
A) "My back is killing me!"
B) "There is blood on my toothbrush!"
C) "Look at the bruises on my arms!"
D) "My arm is bleeding where my IV is!"
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Page 18
Chapter 17: Pulmonary Anatomy and Physiology
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Sample Questions
Q1) The trachea divides into the right and left mainstem bronchi at what point?
A) Posterior larynx
B) Cricoid cartilage
C) Epiglottis
D) Major carina
Q2) Which of the following arteries has the lowest oxygen concentration?
A) Aorta
B) Subclavian
C) Carotid
D) Pulmonary
Q3) Which of the following is a passive event in a spontaneously breathing patient?
A) Coughing
B) Inhalation
C) Exhalation
D) Yawning
Q4) Which nerve stimulates movement of the diaphragm?
A) Musculocutaneous nerve
B) Phrenic nerve
C) Median nerve
D) Axillary nerve
Page 19
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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) While conducting a physical assessment,you note that the patient's breathing is rapid and shallow.This type of breathing pattern is known as A) hyperventilation.
B) tachypnea.
C) obstructive breathing.
D) bradypnea.
Q3) The use of 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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Sample Questions
Q1) Which blood gas parameter is the acid-base component that reflects kidney function?
A) pH
B) PaO<sub>2</sub>
C) PaCO<sub>2</sub>
D) HCO<sub>3</sub>-
Q2) A patient's assessment data present as follows: pH,7.10; PaCO<sub>2</sub>,60 mm Hg; PaO<sub>2</sub>,40 mm Hg; HCO<sub>3</sub>-,24 mEq/L; RR,34 breaths/min; HR,128 beats/min; and BP,180/92 mm Hg.This condition is best described as
A) uncompensated respiratory acidosis.
B) uncompensated metabolic acidosis.
C) compensated metabolic acidosis.
D) compensated respiratory acidosis.
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) A pneumothorax greater than 15% requires
A) systemic antibiotics to treat the inflammatory response.
B) an occlusive dressing to equalize lung pressures.
C) interventions to evacuate the air from the pleural space and facilitate re-expansion of the collapsed lung.
D) mechanical ventilation to assist with re-expansion of the collapsed lung.
Q2) The two most common causes of hospital-acquired pneumonia in the United States are
A) Staphylococcus aureus and Pseudomonas aeruginosa
B) Escherichia coli and Haemophilus influenzae
C) methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa
D) Klebsiella spp. and Enterobacter spp.
Q3) A patient with acute respiratory failure may require a bronchodilator if which of the following occurs?
A) Excessive secretions
B) Bronchospasms
C) Thick secretions
D) Fighting the ventilator
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22
Chapter 21: Pulmonary Therapeutic Management
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Sample Questions
Q1) Complications of ETT tubes include
A) tracheoesophageal fistula.
B) cricoid abscess.
C) tracheal stenosis.
D) tube obstruction.
E) tube displacements.
Q2) Patient safety precautions when working with oxygen involve
A) observation for signs of oxygen-introduced hyperventilation.
B) restriction of smoking.
C) removal of all oxygen devices when eating to prevent aspiration.
D) administration of oxygen at the nurse's discretion.
Q3) The therapeutic blood level for theophylline (Xanthines)is
A) 5 to 10 mg/dL.
B) 10 to 20 mg/dL.
C) 20 to 30 mg/dL.
D) 35 to 45 mg/dL.
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Chapter 22: Neurologic Anatomy and Physiology
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Q1) A patient has coherent speech but the words are illogical.Which part of the brain has been affected?
A) The cerebellum
B) The Broca area
C) The Wernicke area
D) The hypothalamus
Q2) A person with a cerebellar lesion will have difficulty with A) breathing.
B) equilibrium.
C) memory.
D) speech.
Q3) Cranial nerves IX,X,XI,and XII are located in which section of the brainstem?
A) Midbrain
B) Pons
C) Medulla oblongata
D) Reticular formation
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Page 24
Chapter 23: Neurologic Clinical Assessment and Diagnostic
Procedures
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Q1) Testing of extraocular eye movements assesses
A) pupillary response to light.
B) function of the three cranial nerves of the eye.
C) the ability of the eyes to accommodate to a closer moving object.
D) the oculocephalic reflex.
Q2) Identify the sites for monitoring ICP.
A) Intraventricular space
B) Epidural space
C) Jugular veins
D) Subdural space
E) Parenchyma
Q3) Symptoms of late stages of intracranial hypertension include
A) decreased perfusion of cerebral tissue.
B) widening pulse pressure values.
C) increased perfusion pressure across the blood-brain barrier.
D) decreased intracranial pressure.
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Chapter 24: Neurologic Disorders and Therapeutic Management
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Sample Questions
Q1) Appropriate therapy for ischemic stroke depends on rapid completion of which diagnostic study?
A) Magnetic resonance imaging
B) Noncontrast computed tomography
C) Contrast computed tomography
D) Lumbar puncture
Q2) Which statement is true regarding the occurrence of SAHs?
A) Greater occurrence in men than women younger than the age of 40 years old
B) Greater occurrence in men than women older than the age of 40 years old
C) 90% of SAHs are caused by traumatic injury
D) Hemorrhage from SAHs have a better survival rate than hemorrhage from AVM
Q3) 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
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Page 26
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 is most indicative of renal failure?
A) Elevated blood-urea-nitrogen
B) Congestive heart failure
C) Peripheral edema
D) Elevated creatinine
Q3) When renin eventually stimulates angiotensin II,the adrenal glands then secrete A) aldosterone.
B) potassium.
C) ADH.
D) vasopressin.
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Chapter 26: Kidney Clinical Assessment and Diagnostic Procedures
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Q1) 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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Sample Questions
Q1) 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.
Q2) A patient has been hospitalized for a subtotal gastrectomy.After the procedure,an infection developed that eventually had to be treated with gentamicin,an aminoglycoside antibiotic.After 3 days of administration,oliguria occurred,and subsequent laboratory values indicated elevated BUN and creatinine levels.The patient is transferred to the critical care unit with acute tubular necrosis.The fluid that is removed each hour is not called urine; it is known as
A) convection.
B) diffusion.
C) replacement fluid.
D) ultrafiltrate.
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29
Chapter 28: Gastrointestinal Anatomy and Physiology
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Sample Questions
Q1) Which component of gastric juice is necessary for the breakdown of proteins?
A) HCl
B) Pepsin
C) Intrinsic factor
D) Potassium
Q2) Which laboratory value is reflective of hepatocellular dysfunction?
A) Elevated blood glucose level
B) High levels of unconjugated bilirubin
C) Decreased prothrombin time
D) Decreased partial thromboplastin time
Q3) The pancreas has both exocrine and endocrine properties.Which of the following are produced by the exocrine function?
A) Gastrin
B) Trypsin
C) Amylase
D) Lipase
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Chapter 29: Gastrointestinal Clinical Assessment and Diagnostic Procedures
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Sample Questions
Q1) A 78-year-old patient was admitted to the critical care unit with cirrhosis of the liver.Nursing management of the patient after the liver scan should include
A) encouraging her to drink at least 500 mL of fluids after the procedure.
B) keeping her flat in bed for 12 hours after the procedure.
C) instructing her that she will need to keep flat and still for approximately 60 minutes during the procedure.
D) administering cleansing enemas.
Q2) 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.
Q3) A 78-year-old patient was admitted to the critical care unit with cirrhosis of the liver.In cirrhosis of the liver,which of the following laboratory values is expected to drop?
A) Albumin
B) Total bilirubin
C) Alkaline phosphatase
D) Aspartate aminotransferase
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Chapter 30: Gastrointestinal Disorders and Therapeutic Management
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Q1) A patient with a 10-year history of alcoholism was admitted to the critical care unit with the diagnosis of acute pancreatitis.Based on the diagnosis,the patient A) is at risk for hypovolemic shock from plasma volume depletion.
B) requires observation for hypoglycemia and hypercalcemia.
C) should be started on enteral feedings after the nasogastric tube is placed.
D) is placed on a fluid restriction to avoid the fluid sequestration.
Q2) 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.
Q3) The patient at risk for GI hemorrhage should be monitored for which of the following signs and symptoms?
A) Metabolic acidosis and hypovolemia
B) Decreasing hemoglobin and hematocrit
C) Hyperkalemia and hypernatremia
D) Hematemesis and melena
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Chapter 31: Endocrine Anatomy and Physiology
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Q1) When large amounts of ADH are released,the patient's sodium levels will be A) increased.
B) decreased.
C) unaffected.
D) altered inversely with potassium.
Q2) The gland called the "master gland" that has the most influence over all areas of body functioning is the A) hypothalamus.
B) pancreas.
C) thyroid.
D) pituitary.
Q3) The nurse knows that when levels of T? and T? are elevated,the pituitary gland inhibits
A) thyroglobulin.
B) thyroid-releasing hormone (TRH).
C) thyroid-stimulating hormone (TSH).
D) calcitonin.
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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 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
Q3) 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.
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Page 34
Chapter 33: Endocrine Disorders and Therapeutic Management
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Q1) Patients with central DI are treated with A) vasopressin.
B) insulin.
C) glucagon.
D) propylthiouracil.
Q2) A patient with diabetes in the critical care unit is at risk for developing diabetic ketoacidosis (DKA)secondary to A) excess insulin administration.
B) inadequate food intake.
C) physiologic and psychologic stress.
D) increased release of antidiuretic hormone (ADH).
Q3) A patient with hyperglycemic hyperosmolar syndrome (HHS)has a serum glucose level of 400 mg/dL and a serum sodium level of 138 mEq/L.The intravenous fluid of choice would be
A) D5W.
B) 0.45% NS.
C) 0.9% NS.
D) D5/NS.
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Chapter 34: Trauma
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Q1) A patient with a Le Fort III facial fracture has been admitted to the ICU.Which of the following statements is true regarding this type of facial fracture?
A) They are frequently associated with cerebrospinal fluid leaks.
B) They are not as severe as Le Forte I and II injuries.
C) The patient's airway is not usually compromised.
D) Patients with these injuries are not at risk for hemorrhagic shock.
Q2) A patient's condition has deteriorated.Changes in condition include trachea shift,absence of breath sounds on the left side,and hypotension.The nurse suspects that the patient has developed a(n)
A) cardiac tamponade.
B) hemothorax.
C) open pneumothorax.
D) ruptured diaphragm.
Q3) The majority of falls accounting for traumatic injury occur in what population?
A) Construction workers
B) Adolescents
C) Older adults
D) Young adults
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Chapter 35: Shock,sepsis,and Multiple Organ Dysfunction Syndrome
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Q1) Evidence-based guidelines for the treatment of septic shock include which of the following?
A) Fluid resuscitation to maintain central venous pressure at 8 mm Hg or greater
B) Low-dose dopamine for renal protection
C) High-dose corticosteroids
D) Administration of activated protein C
E) Achieve central venous oxygen saturation of 70% or more
Q2) The gastrointestinal system is a common target organ for MODS related to A) anorexia.
B) limited or absent food ingestion.
C) disruption of the mucosal barrier from hypoperfusion.
D) a decrease in hydrochloric acid secretion.
Q3) Signs of hypovolemia in the trauma patient include A) distended neck veins.
B) a decreased level of consciousness.
C) bounding radial and pedal pulses.
D) a widening pulse pressure.
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Page 37
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 patient's symptoms are most likely attributable to
A) blood loss associated with burns and wound care.
B) hemodynamic stability related to adequate fluid resuscitation.
C) over-resuscitation related to overestimation of the TBSA involved.
D) under-resuscitation because of probable inhalation injury.
Q2) A patient involved in a house fire is brought by ambulance to your emergency department.He is breathing spontaneously but appears agitated.He does not respond appropriately to questions.You assume he has inhaled carbon monoxide and has carbon monoxide (CO)poisoning.Your first action is to
A) ask the physician to order a STAT chest radiograph to rule out a pneumothorax.
B) apply a pulse oximeter to one of his unburned fingers.
C) call the local hyperbaric chamber to check on its availability.
D) administer 100% high-flow oxygen via a nonrebreathing mask.
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38
Chapter 37: Organ Donation and Transplantation
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Q1) 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."
Q2) The longest and most difficult part of the recipient hepatectomy is
A) stage 1.
B) stage 2.
C) stage 3.
D) grade 1.
Q3) Which of the following goals would be a priority after lung transplantation?
A) Wean the patient from the ventilator.
B) Maintain hypotensive levels.
C) Start corticosteroid therapy.
D) Initiate pulmonary function studies.
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Chapter 38: Hematologic Disorders and Oncologic Emergencies
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Q1) Pulmonary embolism,a serious complication of HIT,is manifested by which of the following clinical signs?
A) Blanching of fingers and toes and loss of peripheral pulses
B) Chest pain, pallor, and confusion
C) Headache, impaired speech, and loss of motor function
D) Dyspnea, pleuritic pain, and rales
Q2) Place these pathophysiologic mechanisms of DIC in the order in which they occur.
1)Activation of the fibrinolytic system
2)Breakdown of thrombi; spontaneous hemorrhage
3)Consumption of coagulation factors; failure of regulatory mechanisms
4)Endothelial damage; release of tissue factor
5)Thrombin formation; clots form along epithelial walls
A) 4, 5, 3, 1, 2
B) 4, 1, 3, 2, 5
C) 5, 1, 2, 4, 3
D) 2, 3, 1, 5, 4
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Chapter 39: The Obstetric Patient
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Sample Questions
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) A 35-year-old multiparous woman was admitted to the hospital at 36 weeks' gestation for nausea,vomiting,and severe epigastric pain.On admission,her vital signs were as follows: pulse,90 beats/min; blood pressure,165/100 mm Hg; respiratory rate,18 breaths/min; and temperature,99.4° F.The patient reported blurred and double vision and a severe headache.The fetal heart rate was normal.She was placed on bed rest.Urine analysis revealed proteinuria.Her vital signs 6 hours later were as follows: pulse,88 beats/min; blood pressure,185/105 mm Hg; respirations,16 breaths/min; and temperature,98.4° F.The fetal heart rate was normal.Severe pre-eclampsia was diagnosed.Treatment goals of severe pre-eclampsia include
A) maintaining maternal blood pressure greater than 140/90 mm Hg.
B) delaying delivery of the fetus as long as possible.
C) preventing maternal seizures, which may compromise fetal oxygenation.
D) limiting fluid intake to avoid postpartum edema.
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Chapter 40: The Pediatric Patient
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Q1) The upper airway of an infant is different from that of an adult in that the infant's
A) epiglottis is located lower than an adult's.
B) tongue is larger, and it fills the oral cavity.
C) larynx is tubular shaped with its narrowest portion at the epiglottis.
D) airway is more rigid than an adult's.
Q2) 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.
Q3) The key to effective pain management is to perform a(n)
A) behavioral assessment.
B) pain assessment.
C) physical assessment.
D) activity assessment.
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Chapter 41: The Older Adult Patient
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Q1) Which of the following nonsteroidal anti-inflammatory drugs (NSAIDs)has the side effect of renal failure,HTN,heart failure,and GI bleed in the elderly population?
A) Indomethacin
B) Ketorolac
C) Aspirin greater than 325 mg
D) Naproxen
Q2) A 68-year-old patient has been admitted to the coronary care unit after an inferior myocardial infarction.Age-related changes in myocardial pumping ability may be evidenced by
A) increased contractility.
B) decreased contractility.
C) decreased left ventricle afterload.
D) increased cardiac output.
Q3) Chemical changes in a drug that renders it active or inactive is known as A) absorption.
B) metabolism.
C) excretion.
D) distribution.
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Chapter 42: The Perianesthesia Patient
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Q1) 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
Q2) What medication may be used to treat laryngeal edema?
A) Racemic epinephrine
B) Succinylcholine
C) Albuterol
D) Morphine
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