Pathophysiology in Critical Care
Textbook Exam Questions
Course Introduction
Pathophysiology in Critical Care explores the complex physiological processes and mechanisms underlying critical illness and severe injury. This course examines the disruptions to normal body function that lead to conditions such as shock, sepsis, acute respiratory distress syndrome (ARDS), multi-organ dysfunction, and other life-threatening scenarios frequently encountered in intensive care units. Students will analyze the pathogenesis of these disorders at cellular and systemic levels, and learn how understanding these pathways informs clinical assessment, monitoring, and treatment strategies in critical care settings. Emphasis is placed on the integration of pathophysiological concepts with evidence-based practice to support clinical decision-making and optimize patient outcomes.
Recommended Textbook
Introduction to Critical Care Nursing 7th Edition by Mary Lou Sole
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21 Chapters
757 Verified Questions
757 Flashcards
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Page 2
Chapter 1: Overview of Critical Care Nursing
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Sample Questions
Q1) You work in an intermediate care unit and have asked to be involved in developing new guidelines to prevent pressure ulcers in your patient population.The nurse manager tells you that you do not yet have enough experience to be on the prevention task force and that your ideas will be rejected by others.This situation is an example of
A) a barrier to handoff communication.
B) a work environment that is unhealthy.
C) ineffective decision making.
D) nursing practice that is not evidence-based.
Answer: B
Q2) Which of the following is (are)official journal(s)of the American Association of Critical-Care Nurses?
A) American Journal of Critical Care
B) Critical Care Clinics of North America
C) Critical Care Nurse
D) Critical Care Nursing Quarterly
E) Critical Care Nursing Management
Answer: A,C
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Page 3
Chapter 2: Patient and Family Response to the Critical Care Experience
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Sample Questions
Q1) Sleep often is disrupted for critically ill patients.Which nursing intervention is most appropriate to promote sleep and rest?
A) Consult with the pharmacist to adjust medication times to allow periods of sleep or rest between intervals.
B) Encourage family members to talk with the patient whenever they are present in the room.
C) Keep the television on to provide white noise and distraction.
D) Leave the lights on in the room so that the patient is not frightened of his or her surroundings.
Answer: A
Q2) Which intervention about visitation in the critical care unit is true?
A) The majority of critical care nurses implement restricted visiting hours to allow the patient to rest.
B) Children should never be permitted to visit a critically ill family member.
C) Visitation that is individualized to the needs of patients and family members is ideal.
D) Visiting hours should always be unrestricted.
Answer: C
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4
Chapter 3: Ethical and Legal Issues in Critical Care Nursing
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Sample Questions
Q1) The nurse is caring for a critically ill patient on mechanical ventilation.The physician identifies the need for a bronchoscopy,which requires informed consent.For the physician to obtain consent from the patient,the patient must be able to A) be weaned from mechanical ventilation.
B) have knowledge and competence to make the decision.
C) nod his head that it is okay to proceed.
D) read and write in English.
Answer: B
Q2) Which statement regarding ethical concepts is true?
A) A living will is the same as a health care proxy.
B) A signed donor card ensures that organ donation will occur in the event of brain death.
C) A surrogate is a competent adult designated by a person to make health care decisions in the event the person is incapacitated.
D) A persistent vegetative state is the same as brain death in most states.
Answer: C
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Chapter 4: End-Of-Life Care and Palliative Care in Critical Care Settings
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Sample Questions
Q1) The patient's spouse tells the nurse that there is no point in continuing to visit at the bedside because the patient is unresponsive.The best response by the nurse is
A) "You're right. Your loved one is not aware of anything now."
B) "This seems to be very difficult for you."
C) "I'll call you if she starts responding again."
D) "Why don't you check to see if any other family member would like to visit?"
Q2) Palliation may include
A) relieving pain.
B) relieving nausea.
C) psychological support.
D) withdrawing life-support interventions.
E) withholding tube feedings.
Q3) Designated health care surrogates should base health care decisions on A) personal beliefs and values.
B) recommendations of family members and friends.
C) recommendations of the physician and health care team.
D) wishes previously expressed by the patient.
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Page 6
Chapter 5: Comfort and Sedation
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Sample Questions
Q1) The nurse is concerned about the risk of alcohol withdrawal syndrome in a postoperative patient.Which statement by the nurse indicates understanding of management of this patient?
A) "Alcohol withdrawal is common; we see it all of the time in the trauma unit."
B) "There is no way to assess for alcohol withdrawal."
C) "This patient will require less pain medication."
D) "We have initiated the alcohol withdrawal protocol."
Q2) The best way to monitor agitation and effectiveness of treating it in the critically ill patient is to use a/the:
A) Confusion Assessment Method (CAM-ICU).
B) FACES assessment tool.
C) Glasgow Coma Scale.
D) Richmond Agitation Sedation Scale.
Q3) The patient is receiving neuromuscular blockade.Which nursing assessment indicates a target level of paralysis?
A) Glasgow Coma Scale score of 3
B) Train-of-four yields two twitches
C) Bispectral index of 60
D) CAM-ICU positive
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Page 7
Chapter 6: Nutritional Support
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Sample Questions
Q1) The correct order of actions for a patient starting enteral nutrition with a feeding tube is:
A) initiate tube feeding
B) insert feeding tube
C) flush tube to verify patency
D) obtain chest radiograph
E) assess residuals
Q2) A patient with a history of emphysema,diabetes,and hyperlipidemia is in the critical care unit on a ventilator.The nutrition assessment notes that the patient has a protein and vitamin deficiency and is underweight.Which formula for nutritional assessment is most appropriate?
A) Elemental protein formula
B) Fiber-added formula
C) High medium-chain triglyceride formula
D) Lactose-free formula
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Chapter 7: Dysrhythmia Interpretation and Management
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Sample Questions
Q1) One of the functions of the atrioventricular (AV)node is to
A) pace the heart if the ventricles fail.
B) slow the impulse arriving from the SA node.
C) send the impulse to the SA node.
D) allow for ventricular filling during systole.
Q2) Which of the following is true about a patient diagnosed with sinus arrhythmia?
A) The heart rate varies, dependent on vagal tone and respiratory pattern.
B) Immediate treatment is essential to prevent death.
C) Sinus arrhythmia is not well tolerated by most patients.
D) PR and QRS interval measurements are prolonged.
Q3) The nurse using cardiac monitoring understands that each horizontal box on the electrocardiogram (ECG)paper indicates
A) 200 milliseconds or 0.20 seconds duration.
B) 40 milliseconds or 0.04 seconds duration.
C) 3 seconds duration.
D) millivolts of amplitude.
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Chapter 8: Hemodynamic Monitoring
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Sample Questions
Q1) During insertion of a pulmonary artery catheter,the provider asks the nurse to assist by inflating the balloon with 1.5 mL of air.As the provider advances the catheter,the nurse notices premature ventricular contractions on the monitor.What is the best action by the nurse?
A) Deflate the balloon while slowly withdrawing the catheter.
B) Instruct the patient to cough and deep-breathe forcefully.
C) Inflate the catheter balloon with an additional 1 mL of air.
D) Ensure lidocaine hydrochloride (IV) is immediately available.
Q2) Which nursing actions are most important for a patient with a right radial arterial line?
A) Checking the circulation to the right hand every 2 hours
B) Maintaining a pressurized flush solution to the arterial line setup
C) Monitoring the waveform on the monitor for dampening
D) Restraining all four extremities with soft limb restraints
E) Ensuring all junctions remain tightly connected
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Chapter 9: Ventilatory Assistance
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Sample Questions
Q1) A patient's ventilator settings are adjusted to treat hypoxemia.The fraction of inspired oxygen is increased from 0.6 to 0.7,and the positive end-expiratory pressure is increased from 10 to 15 cm H<sub>2</sub>O.Shortly after these adjustments,the nurse notes that the patient's blood pressure drops from 120/76 mm Hg to 90/60 mm Hg.What is the most likely cause of this decrease in blood pressure?
A) Decrease in cardiac output
B) Hypovolemia
C) Increase in venous return
D) Oxygen toxicity
Q2) A PaCO<sub>2</sub> of 48 mm Hg is associated with A) hyperventilation.
B) hypoventilation.
C) increased absorption of O<sub>2</sub>.
D) increased excretion of HCO<sub>3</sub>.
Q3) The amount of effort needed to maintain a given level of ventilation is termed A) compliance.
B) resistance.
C) tidal volume.
D) work of breathing.
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Page 11
Chapter 10: Rapid Response Teams and Code Management
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Sample Questions
Q1) The patient is diagnosed with abrupt onset of supraventricular tachycardia (SVT).The nurse prepares which medication to administer to the patient?
A) Adenosine
B) Amiodarone
C) Diltiazem
D) Procainamide
Q2) During a code,the nurse would place paddles for anterior defibrillation in what locations?
A) Second intercostal space, left sternal border and fourth intercostal space, left midclavicular line
B) Second intercostal space, right sternal border and fourth intercostal space, left midaxillary line
C) Second intercostal space, right sternal border and fifth intercostal space, left midclavicular line
D) Fourth intercostal space, right sternal border and fifth intercostal space, left midclavicular line
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12
Chapter 11: Organ Donation
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Sample Questions
Q1) A patient presents to the outpatient transplant clinic stating,"I would like to donate one of my kidneys." What is the best response by the nurse?
A) "To be a living donor, you must be related to the recipient."
B) "You must be over the age of 30 to be a living donor."
C) "Living donor donation is coordinated by UNOS."
D) "Let us orient you to the process required to become a donor."
Q2) The charge nurse of a transplant unit is reviewing the clinical course of several transplant patients being cared for in the unit.Which patient assessed by the charge nurse requires immediate action?
A) Renal transplant recipient, 1 day post-op with a 3/10 pain level
B) Lung transplant recipient, 1 day post-op with a productive cough
C) Heart transplant recipient, 1 day post-op with a cardiac output of 4 L/min
D) Liver transplant recipient, 2 days post-op with a serum creatinine of 3.7 mg/dL
Q3) Which clinical scenario best represents hyperacute rejection?
A) A cardiac transplant patient with a 3-month history of shortness of breath
B) A lung transplant patient with small pustules that follow a dermatome
C) A liver transplant patient with several small lumps under the skin
D) An implanted renal transplant that, upon reperfusion, becomes cyanotic
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Page 13
Chapter 12: Shock,sepsis,and Multiple Organ Dysfunction Syndrome
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Sample Questions
Q1) The nurse is caring for a 70-kg patient in hypovolemic shock.Upon initial assessment,the nurse notes a blood pressure of 90/50 mm Hg,heart rate 125 beats/min,respirations 32 breaths/min,central venous pressure (CVP/RAP)of 3 mm Hg,and urine output of 5 mL during the past hour.Following physician rounds,the nurse reviews the orders and questions which order?
A) Administer acetaminophen 650-mg suppository prn every 6 hours for pain.
B) Titrate dopamine intravenously for blood pressure less than 90 mm Hg systolic.
C) Complete neurological assessment every 4 hours for the next 24 hours.
D) Administer furosemide 20 mg IV every 4 hours for a CVP greater than or equal to 20 mm Hg.
Q2) The nurse is caring for a mechanically ventilated patient following insertion of a left subclavian central venous catheter (CVC).Which action by the nurse best protects against the development of a central line-associated bloodstream infection (CLABSI)?
A) Documentation of insertion date
B) Elevation of the head of the bed
C) Assessment for weaning readiness
D) Appropriate sedation management
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Chapter 13: Cardiovascular Alterations
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Sample Questions
Q1) The provider prescribes a pharmacological stress test for a patient with activity intolerance.The nurse would anticipate that the drug of choice would be
A) dopamine.
B) dobutamine.
C) adenosine.
D) atropine.
Q2) A patient has elevated blood lipids.The nurse anticipates which classification of drugs to be prescribed for the patient?
A) Bile acid resins
B) Nicotinic acid
C) Nitroglycerin
D) Statins
Q3) Which statements are true regarding the symptoms of an AMI?
A) Dysrhythmias are common occurrences.
B) Men have more atypical symptoms than women.
C) Midsternal chest pain is a common presenting symptom.
D) Some patients are asymptomatic.
E) Patients may complain of jaw or back pain.
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15
Chapter 14: Nervous System Alterations
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Sample Questions
Q1) The nurse admits a patient to the emergency department with new onset of slurred speech and right-sided weakness.What is the priority nursing action?
A) Assess for the presence of a headache.
B) Assess the patient's general orientation.
C) Determine the patient's drug allergies.
D) Determine the time of symptom onset.
Q2) The nurse is preparing to administer 100 mg of phenytoin to a patient in status epilepticus.To prevent patient complications,what is the best action by the nurse?
A) Ensure patency of intravenous (IV) line.
B) Mix drug with 0.9% normal saline.
C) Evaluate serum K<sup>+</sup> level.
D) Obtain an IV infusion pump.
Q3) The provider prescribes fosphenytoin,1.5 g intravenous (IV)loading dose,for a 75-kg patient in status epilepticus.What is the most important action by the nurse?
A) Contact the admitting physician.
B) Administer the drug over 10 minutes.
C) Mix medication with 0.9% normal saline.
D) Administer via central line.
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16
Chapter 15: Acute Respiratory Failure
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Sample Questions
Q1) The nurse is caring for a patient with a diagnosis of pulmonary embolism.The nurse understands that the most common cause of a pulmonary embolus is
A) amniotic fluid embolus.
B) deep vein thrombosis from lower extremities.
C) fat embolus from a long bone fracture.
D) vegetation that dislodges from an infected central venous catheter.
Q2) The nurse is discharging a patient with asthma.As part of the discharge instruction,the nurse instructs the patient to prevent exacerbation by:
A) obtaining an appointment for follow-up pulmonary function studies 1 week after discharge.
B) limiting activity until the patient is able to climb two flights of stairs.
C) taking all asthma medications as prescribed.
D) taking medications on a "prn" basis according to symptoms.
Q3) An acute exacerbation of asthma is treated with which of the following?
A) Corticosteroids and theophylline by mouth
B) Inhaled bronchodilators and intravenous corticosteroids
C) Prone positioning or continuous lateral rotation
D) Sedation and inhaled bronchodilators
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Chapter 16: Acute Kidney Injury
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Sample Questions
Q1) The patient is admitted with complaints of general malaise and fatigue,along with a decreased urinary output.The patient's urinalysis shows coarse,muddy brown granular casts and hematuria.The nurse determines that the patient has:
A) acute kidney injury from a prerenal condition.
B) acute kidney injury from postrenal obstruction.
C) intrarenal disease, probably acute tubular necrosis.
D) a urinary tract infection.
Q2) The nurse is caring for a patient who has a temporary percutaneous dialysis catheter in place.In caring for this patient,the nurse should
A) apply a sterile gauze dressing to maintain sterility.
B) replace the transparent dressing every 10 days to prevent manipulation.
C) assess the catheter site for redness and/or swelling.
D) use the catheter for drawing blood samples to reduce patient discomfort.
Q3) An advantage of peritoneal dialysis is that
A) peritoneal dialysis is time intensive.
B) a decreased risk of peritonitis exists.
C) biochemical disturbances are corrected rapidly.
D) the danger of hemorrhage is minimal.
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Chapter 17: Hematological and Immune Disorders
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Sample Questions
Q1) The patient is admitted with multiple myeloma.The nurse assesses the patient and is aware that the symptom most unique to this disease is
A) fever.
B) night sweats.
C) bone pain.
D) lymph node enlargement.
Q2) The patient is admitted for chemotherapy,but the nurse notices laboratory values indicating that the patient is immunosuppressed.The nurse should
A) place the patient in a single room with a HEPA filtration system.
B) tell staff that hand washing is not recommended when working with this patient.
C) start as many intravenous lines as possible to provide potential antibiotics.
D) avoid the use of antimicrobial soaps when bathing and providing perineal care.
Q3) Of the four major blood components,plasma
A) is made up of circulating ions.
B) comprises about 55% of blood volume.
C) is transported to the cells by serum proteins.
D) comprises about 45% of blood volume.
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Chapter 18: Gastrointestinal Alterations
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Sample Questions
Q1) The nurse is caring for a patient who is being treated for peptic ulcer disease.Suddenly,the patient yells that the pain has become extreme.The nurse notes that the patient's abdomen is rigid.The nurse should
A) call the provider immediately.
B) give the patient pain medication.
C) remove the NG tube.
D) give the patient an antacid.
Q2) The patient is admitted with acute pancreatitis and is later diagnosed as having a pseudocyst.The nurse realizes that
A) surgery for pseudocysts must be done immediately.
B) a cholecystectomy is usually done when pseudocysts are found.
C) pseudocysts may resolve spontaneously, so surgery may be delayed.
D) pseudocysts require pancreatic resection, removing the entire pancreas.
Q3) The nurse is to assist the provider in performing bedside endoscopy on a patient.To prevent respiratory complications,the nurse places the patient
A) supine in Trendelenburg position.
B) in a left lateral reverse Trendelenburg position.
C) flat with the feet elevated.
D) in a semi-Fowler's position.
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Page 20
Chapter 19: Endocrine Alterations
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Sample Questions
Q1) Which of the following is a high-priority nursing diagnosis for both diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome?
A) Activity intolerance
B) Fluid volume deficient
C) Hyperthermia
D) Impaired nutrition, more than body requirements
Q2) Which of the following are appropriate nursing interventions for the patient in myxedema coma?
A) Administer levothyroxine as prescribed.
B) Encourage the intake of foods high in sodium.
C) Initiate passive rewarming interventions.
D) Monitor airway and respiratory effort.
E) Monitor urine osmolality.
Q3) The nurse is caring for a patient who underwent pituitary surgery 12 hours ago.The nurse will give priority to monitoring the patient carefully for which of the following?
A) Congestive heart failure
B) Hypovolemic shock
C) Infection
D) Volume overload
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Chapter 20: Trauma and Surgical Management
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Sample Questions
Q1) In the trauma patient,symptoms of decreased cardiac output are most commonly caused by
A) cardiac contusion.
B) cardiogenic shock.
C) hypovolemia.
D) pericardial tamponade.
Q2) Range-of-motion exercises,early ambulation,and adequate hydration are interventions to prevent
A) catheter-associated infection.
B) venous thromboembolism.
C) fat embolism.
D) nosocomial pneumonia.
Q3) Which of the following statements apply to trauma patients and their potential complications?
A) Indwelling urinary catheters are a source of infection.
B) Patients often develop infection and sepsis secondary to central line catheters.
C) Pneumonia is often an adverse outcome of mechanical ventilation.
D) Wounds require sterile dressings to prevent infection.
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22
Chapter 21: Burns
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Sample Questions
Q1) A patient admitted with severe burns to his face and hands is showing signs of extreme agitation.The nurse should explore the mechanism of burn injury possibly related to
A) excessive alcohol use.
B) methamphetamine use.
C) posttraumatic stress disorder.
D) subacute delirium.
Q2) A(An)____________________ often produces a superficial cutaneous injury but may cause cardiopulmonary arrest and transient but severe central nervous system deficits.
A) chemical burn
B) electrical burn
C) heat burn
D) infection
Q3) Tissue damage from burn injury activates an inflammatory response that increases the patient's risk for
A) acute kidney injury.
B) acute respiratory distress syndrome.
C) infection.
D) stress ulcers.
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