Nursing Management of Complex Health Problems
Pre-Test Questions
Course Introduction
This course focuses on the advanced principles and practices involved in the nursing management of patients with complex health problems. Students will explore the pathophysiology, assessment, and evidence-based interventions for individuals across the lifespan facing multiple and/or severe chronic conditions, acute exacerbations, or life-threatening illnesses. Emphasis is placed on clinical decision-making, interdisciplinary collaboration, patient and family education, and the use of technology in managing complex cases. The course prepares nurses to coordinate comprehensive care, prioritize interventions, and address ethical and legal issues in complex healthcare settings.
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) A stepwise decision-making flowchart for a specific care process is known as a(n) A) algorithm.
B) practice guideline.
C) protocol.
D) order set.
Answer: A
Q2) _____ are instrumental in ensuring care that is evidence based and that safety programs are in place.
A) CNSs
B) APNs
C) SCCMs
D) AACNs
Answer: A
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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Page 3
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) Failures and inadequacies in the health care facility's operation and organization are often misinterpreted as ethical issues.These issues are known as A) systems problems.
B) social problems.
C) ethical issues.
D) governmental problems.
Answer: A
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Chapter 3: Legal Issues
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Sample Questions
Q1) On the way to surgery,a patient expresses doubt about proceeding with the planned procedure.The patient states that the doctor did not explain it very well and she would like to talk to her again before starting the procedure.The nurse knows the surgery schedule is very tight,reassures the patient that everything will be all right,and administers the preoperative sedation.This scenario describes what possible type of negligence?
A) Assessment failure
B) Planning failure
C) Implementation failure
D) Evaluation failure
Answer: D
Q2) The best action nurses can take to prevent allegations of malpractice is A) carrying malpractice insurance.
B) clarifying orders with the nursing supervisor.
C) delegating care to nursing assistants.
D) providing care according to standards of practice.
Answer: D
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Page 5
Chapter 4: Genetics and Genomics in Critical Care
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Sample Questions
Q1) The process that is used to make polypeptide chains that constitute proteins can be written as:
A) RNA DNA protein.
B) DNA RNA protein.
C) protein RNA DNA.
D) protein DNA RNA.
Q2) 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.
Q3) 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.
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Chapter 5: Patient and Family Education
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Sample Questions
Q1) Learning domains are identified as:
A) knowledge, ability, and willingness to learn.
B) psychologic, skills, and knowledge.
C) knowledge, skills, and attitude.
D) skills, attitude, and psychologic.
Q2) According to Maslow's hierarchy of needs,the need to know and understand information is considered
A) a high-level need.
B) a low-level need.
C) a physiologic need.
D) not important in a critical care setting.
Q3) How should a nurse respond when a patient asks if he or she is going to die?
A) Avoid the question by leaving the room.
B) Defer the question to the physician.
C) Answer honestly and sensitively with information that is understandable and in simple terms.
D) Speak with the family first before answering the patient.
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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) 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) An intervention for a patient with learned helplessness is to A) maintain control of the environment.
B) set limits on the behavior.
C) maintain a routine schedule so that the patient can anticipate activities. D) prepare the patient for transfer to the medical floor.
Page 8
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Chapter 7: Sleep Alterations and Management
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Sample Questions
Q1) A patient was given the diagnosis of congestive heart failure (CHF)2 years ago.The patient complains of increased daytime sleepiness and states his support system has been complaining more and more about snoring.Central sleep apnea is suspected.Treatment depends on whether the patient has hypercapnic or nonhypercapnic central sleep apnea.The patient's primary treatment plan should include
A) CPAP.
B) bilevel positive airway pressure (BiPAP).
C) acetazolamide and medroxyprogesterone.
D) modafinil and zolpidem.
Q2) The patient has been in the critical care unit for 3 weeks and has been on an intra-aortic 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.The anticipated effect of diazepam on the patient's sleep is
A) a decrease in NREM stage 1.
B) an increase in NREM stage 3.
C) total NREM suppression.
D) REM suppression in larger doses.
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Page 9
Chapter 8: Nutrition Alterations and Management
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Sample Questions
Q1) Diet therapy for a person with hypertension 1 day after a myocardial infarction would include
A) three meals a day with two snacks.
B) a low-protein diet.
C) a low-salt, low-cholesterol diet.
D) a high-carbohydrate diet.
Q2) A patient who has sustained a head injury has increased nutritional needs related to the
A) decrease in metabolism as a result of coma.
B) decrease in blood sugar from a lack of dietary supplementation.
C) anabolism and wound healing.
D) hypermetabolism and catabolism associated with the injury.
Q3) Prevention of pulmonary aspiration is best accomplished by
A) administering intermittent feedings.
B) adding thickening agents to the tube feeding solution.
C) suctioning the patient hourly.
D) elevating the head of the bed 30 to 45 degrees.
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Chapter 9: Pain and Pain Management
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Sample Questions
Q1) 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.
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) The patient is sedated and breathing with the use of mechanical ventilation.The patient is unable to communicate any aspects of his pain to the nurse.The nurse knows that the best tool for pain assessment for this patient is A) FLACC.
B) Wong-Baker FACES.
C) BIS.
D) BPS or CPOT.
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Page 11
Chapter 10: Sedation,Agitation,Delirium: Assessment and Management
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Sample Questions
Q1) To achieve ventilator synchrony in a mechanically ventilated patient with acute respiratory distress syndrome (ARDS),which level of sedation might be most effective?
A) Light
B) Moderate
C) Conscious
D) Deep
Q2) A patient has been taking benzodiazepines and suddenly develops respiratory depression and hypotension.After careful assessment,the nurse determines that the patient is experiencing benzodiazepine overdose.What is the nurse's next step?
A) Decrease benzodiazepines to half the prescribed dose.
B) Increase IV fluids to 500 cc/hr for 2 hours.
C) Administer flumazenil (Romazicon).
D) Discontinue benzodiazepine and start propofol.
Q3) A major side effect of benzodiazepines is
A) hypertension.
B) respiratory depression.
C) renal failure.
D) phlebitis at the IV site.
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Chapter 11: End-Of-Life Issues
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Sample Questions
Q1) _____ is a powerful influence when the decision-making process is dealing with recovery or a peaceful death.
A) Hope
B) Religion
C) Culture
D) Ethics
Q2) Family members become dissatisfied and stressed because of a lack of _____ among health care providers.
A) care provided
B) communication
C) patient's prognosis
D) patient's outcome
Q3) Haloperidol is recommended as useful treatment of _____.
A) anxiety
B) dyspnea
C) delirium
D) pain
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Page 13
Chapter 12: Cardiovascular Anatomy and Physiology
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Sample Questions
Q1) Which of the following is an example of a physiologic shunt?
A) A ventricular septal defect
B) Blood returning from the inferior vena cava to the right atrium
C) A septal infarct
D) Thebesian vessels returning deoxygenated blood to the left ventricle
Q2) Which of the following is most descriptive of the capillary?
A) Large diameter, low pressure
B) Small diameter, high pressure
C) Large diameter, high pressure
D) Small diameter, low pressure
Q3) Which statement regarding the autonomic nervous system's role in the regulation of heart rate is true?
A) Parasympathetic influences increase heart rate.
B) Sympathetic influences are predominantly present.
C) Parasympathetic influences are only compensatory.
D) Both sympathetic and parasympathetic influences are normally active.
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Chapter 13: Cardiovascular Clinical Assessment
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Sample Questions
Q1) A nurse from the ICU receives a report from the ED nurse on a patient that includes a diagnosis of syncope unknown etiology.Orthostatic VS lying: 110/80 mm/Hg; sitting: 100/74 mm/Hg; standing: 92/40 mm/Hg.Based on this information,the nurse should monitor the patient's
A) breathing.
B) dietary intake.
C) peripheral pulses.
D) activity.
Q2) Heart murmurs are characterized by which of the following criteria?
A) Intensity
B) Location
C) Quality
D) Pitch
E) Pathologic cause
Q3) 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.
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Chapter 14: Cardiovascular Diagnostic Procedures
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Sample Questions
Q1) Which of the following diagnostic tests is most effective for measuring overall heart size?
A) Twelve-lead electrocardiography
B) Echocardiography
C) Chest radiography
D) Vectorcardiography
Q2) The physiologic effect of left ventricular afterload reduction is
A) decreased left atrial tension.
B) decreased systemic vascular resistance.
C) increased filling pressures.
D) decreased cardiac output.
Q3) What is the initial intervention in a patient with sinus tachycardia with the following vital signs: HR,136 beats/min; BP,102/60 mm Hg; RR,24 breaths/min; T,99.2° F; SpO<sub>2</sub>,94% on oxygen 2 L/min by nasal cannula?
A) Stat adenosine to decrease heart rate
B) Identification and correction of the cause of the increased heart rate
C) Sublingual nitroglycerine 0.4 mg
D) Lidocaine 75 mg IV push
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Chapter 15: Cardiovascular Disorders
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Sample Questions
Q1) Which of the following effects can be associated with physical exercise?
A) Decreased LDL cholesterol
B) Increased HDL cholesterol
C) Decreased triglycerides
D) Increased insulin resistance
E) Decreased incidence of depression
Q2) A patient is admitted for palliative care for end-stage heart failure.The nurse's primary goal is
A) to reverse heart failure with the use of diuretics.
B) to increase activity tolerance.
C) symptom management and relief of pain.
D) to increase cardiac output related to alteration of contractility.
Q3) One of the reasons that contributes to higher mortality rates from acute MI in women is:
A) waiting longer to seek medical care.
B) being younger when symptoms occur.
C) risk factors associated with MI are more stronger in women than men.
D) women have smaller hearts than men.
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17
Chapter 16: Cardiovascular Therapeutic Management
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Sample Questions
Q1) Surgical repair of an AAA occurs when the aneurysm is
A) greater than 5 cm and asymptomatic.
B) greater than 5 cm and symptomatic.
C) greater than 7 cm and asymptomatic.
D) greater than 7 cm and symptomatic.
Q2) Which of the following would indicate successful reperfusion after administration of a fibrinolytic agent?
A) Gradual decrease in chest pain
B) Intermittent, multifocal premature ventricular contractions
C) Rapid resolution of ST elevation
D) Rapid rise in creatine kinase MB fraction
Q3) 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.
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18
Chapter 17: Pulmonary Anatomy and Physiology
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Sample Questions
Q1) Under normal situations,the normal ventilation to perfusion ratio is 4:5 (0.8).Atelectasis can cause a shunt-producing ventilation/perfusion mismatch.This occurs primarily as a result of
A) perfusion exceeding ventilation.
B) ventilation exceeding perfusion.
C) an alveolus that is receiving ventilation but not perfusion.
D) an alveolus that is receiving perfusion but not ventilation.
Q2) Based on the oxyhemoglobin dissociation curve,respiratory acidosis will have which effect?
A) A shifting of the curve to the left
B) Increased oxygen saturation
C) Enhanced oxygen delivery at the tissue level
D) Hypothermia
Q3) The trachea divides into the right and left mainstem bronchi at what point?
A) Posterior larynx
B) Cricoid cartilage
C) Epiglottis
D) Major carina
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19
Chapter 18: Pulmonary Clinical Assessment
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Q1) Diaphragmatic excursion is a measurement of the difference in the level of the diaphragm on inspiration and expiration determined by percussion.It is increased in
A) atelectasis and emphysema.
B) hepatomegaly and ascites.
C) atelectasis and paralysis.
D) pneumonia and pneumothorax.
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) Normal anteroposterior (AP)diameter ranges from 1:2 to 5:7.An increase in AP diameter of the chest that is characterized by displacement of the sternum forward and the ribs outward is indicative of
A) a funnel chest.
B) a pigeon breast.
C) a barrel chest.
D) Harrison's groove.
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Page 20
Chapter 19: Pulmonary Diagnostic Procedures
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Sample Questions
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) 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
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Chapter 20: Pulmonary Disorders
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Sample Questions
Q1) A patient was admitted to the critical care unit after a left pneumonectomy.The patient is receiving 40% oxygen via a simple facemask.The morning chest radiography study reveals right lower lobe pneumonia.After eating breakfast,the patient suddenly vomits and aspirates.The first action that should be taken after the patient's aspiration event is
A) lavaging his airway with normal saline.
B) placing him on his back in a semi-Fowler position.
C) administering manual ventilations with a resuscitation bag.
D) suctioning his airway.
Q2) 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) The most common presenting signs and symptoms associated with PEs are
A) tachycardia and tachypnea.
B) hemoptysis and evidence of deep vein thromboses.
C) apprehension and dyspnea.
D) right ventricular failure and fever
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Page 22
Chapter 21: Pulmonary Therapeutic Management
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Sample Questions
Q1) 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.
Q2) Complications of ETT tubes include
A) tracheoesophageal fistula.
B) cricoid abscess.
C) tracheal stenosis.
D) tube obstruction.
E) tube displacements.
Q3) The Passy-Muir valve is contraindicated in patients
A) who are trying to relearn normal breathing patterns.
B) who experience low secretions.
C) with laryngeal or pharyngeal dysfunction.
D) who want to speak while on the ventilator.
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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) 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
Q3) The region of the brain that acts as a relay station for both motor and sensory activity is the
A) cerebrum.
B) cerebellum.
C) thalamus.
D) hypothalamus.
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Chapter 23: Neurologic Clinical Assessment and Diagnostic Procedures
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Q1) The most clinically significant ICP waveform is
A) A waves.
B) B waves.
C) C waves.
D) D waves.
Q2) The patient is ordered a CT scan with contrast.Which question should the nurse ask the conscious patient before the procedure?
A) Are you allergic to penicillin?
B) Are you allergic to iodine-based dye?
C) Are you allergic to latex?
D) Are you allergic to eggs?
Q3) Before performing the doll's eye or oculocephalic reflex,the nurse must verify
A) the absence of cervical injury.
B) the depth and rate of respiration.
C) a physician's order to perform the maneuver.
D) the patient's ability to follow a verbal command.
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Chapter 24: Neurologic Disorders and Therapeutic Management
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Q1) When an object is placed in the hand of a patient with neurologic impairment during assessment,the patient is unable to recognize the placement.This is termed tactile
A) homonymous hemianopsia.
B) aphasia
C) agnosia.
D) apraxia.
Q2) Which of the following is the most common complication after high-dose barbiturate therapy?
A) Hypothermia
B) Hypotension
C) Myocardial depression
D) Decreased CVP
Q3) A patient becomes flaccid with fixed and dilated pupils.The patient's ICP falls from 65 to 12 mm Hg.What should the nurse suspect is happening?
A) The patient is having a seizure.
B) The patient's brain has herniated.
C) The patient's cerebral edema is resolving.
D) The patient is excessively dehydrated from the mannitol.
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Chapter 25: Kidney Anatomy and Physiology
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Q1) Which of the following,if found in the urine,suggests damage to the glomerular membrane?
A) Creatinine
B) Bicarbonate ions
C) Sodium
D) Albumin
Q2) 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
Q3) The primary waste product(s)that are measured to determine kidney function is/are
A) urea and creatinine.
B) creatinine.
C) BUN and creatine.
D) BUN, sodium, and potassium.
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Chapter 26: Kidney Clinical Assessment and Diagnostic
Procedures
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Q1) 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 patient weight upon admission was 176 lb.The patient's weight the next day is 184 lb.What is the approximate amount of fluid retained with this weight gain?
A) 800 mL
B) 2200 mL
C) 3600 mL
D) 8000 mL
Q2) 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
Q3) 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.
Page 28
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Chapter 27: Kidney Disorders and Therapeutic Management
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Q1) An alert and oriented patient presents with a pulmonary artery wedge pressure of 4 mm Hg and a cardiac index of 0.8.The BUN is 44 mg/dL,creatinine is 3.2 mg/dL,and BP is 88/36 mm Hg.Urine output is 15 mL/hr.Lungs are clear to auscultation with no peripheral edema noted.Which of the following treatments would the physician most likely order?
A) Lasix 40 mg intravenous push
B) 0.9% normal saline at 125 mL/hr
C) Dopamine 15 ?g/kg/min
D) Transfuse 1 U of packed red blood cells
Q2) To prevent catheter-associated UTI (CAUTI),the nurse should
A) insert urinary catheters using aseptic techniques.
B) change the urinary catheter daily.
C) review the need for the urinary catheter daily and remove promptly.
D) flush the urinary catheter q8 hours to maintain patency.
E) avoid unnecessary use of indwelling urinary catheters.
Q3) What is a continuous venovenous hemodialysis filter permeable tO<sub>2</sub>
A) Electrolytes
B) Red blood cells
C) Protein
D) Lipids
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Chapter 28: Gastrointestinal Anatomy and Physiology
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Q1) Which component of gastric juice is necessary for the breakdown of proteins?
A) HCl
B) Pepsin
C) Intrinsic factor
D) Potassium
Q2) When the ileum is distended,the ileogastric reflex inhibits
A) gastric absorption.
B) absorption in the jejunum.
C) gastric motility.
D) ileum motility.
Q3) Stimulation of the parasympathetic nervous system produces which of the following effects on the gastrointestinal system?
A) Decreased peristalsis
B) Increased secretion of watery saliva
C) Decreased colonic activity
D) Increased release of gastrointestinal hormones
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Chapter 29: Gastrointestinal Clinical Assessment and Diagnostic Procedures
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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) 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
Q3) Identify anatomic structures that are found in the right upper quadrant.
A) Duodenum
B) Portion of the transverse colon
C) Liver
D) Stomach
E) Cecum
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Chapter 30: Gastrointestinal Disorders and Therapeutic Management
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Q1) 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
Q2) Which of the following can be used as pharmacologic method of treatment in acute variceal hemorrhage?
A) Histamine2 (H?) antagonists
B) Vasopressin
C) Solu-Medrol
D) Antacids
Q3) 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
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Chapter 31: Endocrine Anatomy and Physiology
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Q1) ADH works primarily at the A) liver.
B) pancreas.
C) stomach.
D) kidneys.
Q2) In the healthy body,a normal blood glucose level is maintained by A) insulin secretion.
B) cellular metabolism.
C) insulin-to-glucagon ratio.
D) insulin-to-thyroxine ratio.
Q3) Adequate thyroid function depends on A) the basal metabolic rate.
B) dietary intake of iodine.
C) colloid osmotic pressure.
D) sodium levels in the blood.
Q4) The endocrine system helps maintain equilibrium throughout the body via A) control of smooth muscle.
B) control of skeletal muscle.
C) hormones.
D) neuronal control.
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Chapter 32: Endocrine Clinical Assessment and Diagnostic
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Q1) Which of the following laboratory studies or diagnostic procedures is most useful in identifying central diabetes insipidus (DI)?
A) Skull radiographs
B) Serum glucose level
C) Water deprivation test
D) Antidiuretic hormone (ADH) stimulation test
Q2) A 16-year-old young woman is admitted to the critical care unit with severe hyperglycemia caused by new-onset type 1 diabetes mellitus.Which of the following signs and symptoms obtained as part of the patient's history might indicate the presence of hyperglycemia?
A) Recent episodes of tachycardia and missed heart beats
B) Decreased urine output accompanied by peripheral edema
C) Periods of hyperactivity with weight gain
D) Increased thirst and increased urinary output
Q3) 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.
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Chapter 33: Endocrine Disorders and Therapeutic Management
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Q1) A patient presenting with diabetes insipidus (DI)exhibits
A) hyperosmolality and hypernatremia.
B) hyperosmolality and hyponatremia.
C) hypo-osmolality and hypernatremia.
D) hypo-osmolality and hyponatremia.
Q2) The nurse knows that the patient with DKA will need
A) subcutaneous insulin.
B) IV insulin.
C) subcutaneous and IV insulin.
D) combination 70%/30% insulin.
Q3) The nurse knows that three signs of effective fluid replacement include
A) elevated central venous pressure (CVP), increased heart rate, and elevated pulmonary artery pressure (PAP).
B) elevated CVP, decreased heart rate, and elevated PAP.
C) normal CVP, decreased heart rate, and normal PAP.
D) decreased CVP, increased heart rate, and decreased PAP.
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Chapter 34: Trauma
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Q1) Patients immobilized because of spinal trauma are at a high risk for contractures.Preventive measures should include
A) consultation by PT and OT early in the treatment of the patient.
B) turning and repositioning the patient every 2 hours as ordered by the physician.
C) range of motion exercises 1 month after the spine has been stabilized.
D) removal of splints every 4 hours and at bedtime.
E) hand splints for patients with paraplegia.
F) hand and foot splints for patients with quadriplegia.
Q2) A patient is admitted to the ICU with a C5-C6 subluxation fracture.He is able to move his legs better than he can move his arms.Which of the following statements is true about his spinal cord injury?
A) He is likely to be in supraventricular tachycardia.
B) Hyperthermia is common in patients with spinal cord injury.
C) These patients do not usually require mechanical ventilation.
D) The patient has a central cord syndrome.
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Chapter 35: Shock,sepsis,and Multiple Organ Dysfunction Syndrome
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Q1) The patients at highest risk for neurogenic shock are those who have had A) a stroke.
B) a spinal cord injury.
C) Guillain-Barré syndrome.
D) a craniotomy.
Q2) Which medication is not recommended in the treatment of shock-related lactic acidosis?
A) Glucose
B) Sodium bicarbonate
C) Vasoconstrictor
D) Large quantity of crystalloids fluids
Q3) The key to treatment of septic shock is finding the cause of the infection.Which of the following cultures are obtained before antibiotic therapy is initiated?
A) Blood cultures x 2
B) Wound cultures
C) Urine cultures
D) Sputum cultures
E) CBC with differential
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Chapter 36: Burns
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Q1) Management of full-thickness burns includes
A) daily wound care without premedication of narcotics because the pain fibers are destroyed.
B) daily wound care with premedication of narcotics.
C) weekly wound care until all eschar is debrided.
D) surgical skin grafting within 8 hours of admission.
Q2) A patient is brought to the emergency department after a house fire.He fell asleep with a lit cigarette,and the couch ignited.What do you do first?
A) Clean the wounds and remove blisters.
B) Assess the airway and provide 100% oxygen.
C) Place a Foley catheter and assess for myoglobin.
D) Place a central intravenous access and provide antibiotics.
Q3) A red and white wound surface with blanching but no blister formation describes what depth of burn injury?
A) Superficial partial-thickness burn
B) Moderate partial-thickness burn
C) Deep dermal partial-thickness burn
D) Full-thickness burn
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Chapter 37: Organ Donation and Transplantation
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Q1) Patients meeting criteria for imminent death and cardiac death are to be
A) immediately placed on life support and referred to the organ procurement organizations.
B) referred to the organ procurement organizations at the time of their death.
C) referred to the organ procurement organizations in a timely manner.
D) referred to physician to make the decision if they are a candidate for organ donation.
Q2) A patient who has received a transplant is being taught about azathioprine.Which statement made by the patient would indicate the teaching was effective?
A) "I will notify my health care provider if my gums start to bleed."
B) "I will make sure to increase the amount of fiber in my diet."
C) "I realize I may have an increase in hair growth."
D) "I know the flulike symptoms will go away as I get used to the drug."
Q3) Which of the following nursing diagnoses would be appropriate for a patient who has received a kidney transplant?
A) Deficient fluid volume
B) Excess fluid volume
C) Urinary retention
D) Decreased cardiac output
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Chapter 38: Hematologic Disorders and Oncologic Emergencies
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Q1) Hydroxyurea is increased by what dosage until the maximum of 35 mg/kg is reached?
A) 5 mg/kg every 4 weeks
B) 10 mg/kg every 8 weeks
C) 5 mg/kg every 12 weeks
D) 15 mg/kg every 15 weeks
Q2) Which of the following does not play a role in thrombin inhibition?
A) Thromboxane A?
B) Antithrombin III
C) Protein S
D) Protein C
Q3) Which of the following would be appropriate for treating hypocalcemia?
A) Calcium gluconate
B) Insulin
C) Sodium bicarbonate
D) Dialysis
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Chapter 39: The Obstetric Patient
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Q1) Pre-eclampsia is characterized by widespread physiologic changes,including A) increase in circulating plasma volume.
B) vasospasms in the arterial system.
C) disseminated intravascular coagulation.
D) high systemic vascular resistance
Q2) The treatment plan for management of an obstetric patient with peripartum cardiomyopathy includes
A) oxygen therapy, pain management, and preload enhancement.
B) walking exercises, diuretics, and anticoagulants.
C) diuretics, digoxin, and anticoagulation.
D) fluid resuscitation, beta-blockers, and vasoconstrictors.
Q3) Complications of HELLP (hemolysis,elevated liver enzymes,and low platelet count)syndrome include
A) abruptio placentae, liver rupture, and pulmonary edema.
B) neutropenia, liver hemorrhage, and pulmonary edema.
C) disseminated intravascular coagulation (DIC), puerperal conditions, and chronic fatigue.
D) pulmonary edema, DIC, and cor pulmonale.
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Chapter 40: The Pediatric Patient
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Q1) 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
Q2) 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.
Q3) The normal cerebral perfusion pressure in an infant is
A) 50 mm Hg.
B) 40 to 60 mm Hg.
C) unknown.
D) 60 mm Hg.
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Chapter 41: The Older Adult Patient
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Q1) A 68-year-old patient has been admitted to the coronary care unit after an inferior myocardial infarction.Dopamine 3 mcg/kg/min has been ordered for this patient.What nursing implications should be considered when administering this drug to an older patient?
A) No changes are noted in older patients with this drug.
B) Drug effect is enhanced by increased receptor site action.
C) Increased breakdown by liver hepatocytes occurs, increasing dosage requirements.
D) Drug metabolism and detoxification are slowed, increasing the risks of drug toxicity.
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
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Chapter 42: The Perianesthesia Patient
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Q1) Oral intake is prohibited after anesthesia until A) the patient is ambulatory.
B) the patient is strong enough to hold a cup of water.
C) all nausea has ceased.
D) laryngeal and pharyngeal reflexes are fully regained.
Q2) The most definitive test for detecting malignant hyperthermia (MH)susceptibility is a(n)
A) creatine phosphokinase (CPK) test.
B) ionized calcium test.
C) core temperature reading.
D) skeletal muscle biopsy.
Q3) Snoring,stridor,nostril flaring,and intercostal retractions are clinical manifestations of A) angina.
B) airway obstruction.
C) pain.
D) sedation.
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