Professional Practice in Critical Care Exam Answer Key - 761 Verified Questions

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Professional Practice in Critical Care

Exam Answer Key

Course Introduction

This course provides an in-depth exploration of professional practice within the critical care environment, focusing on the advanced skills, knowledge, and interdisciplinary communication required for effective patient management in high-acuity settings. Students will examine best practices in clinical decision-making, ethical considerations, leadership, and the application of evidence-based interventions to support critically ill patients. Emphasis is placed on collaboration within multidisciplinary teams, critical thinking, and the adaptation of care to complex and rapidly changing clinical scenarios, preparing learners to deliver safe, holistic, and patient-centered care in critical care settings.

Recommended Textbook

Priorities in Critical Care Nursing 7th Edition by Urden

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27 Chapters

761 Verified Questions

761 Flashcards

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Chapter 1: Caring for the Critically Ill Patient

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14 Verified Questions

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Sample Questions

Q1) The AACN has developed short directives that can be used as quick references for clinical use that are known as

A) Critical Care Protocol.

B) Practice Policies.

C) Evidence-Based Research.

D) Practice Alerts.

Answer: D

Q2) According to Kupperschmidt, to become a skilled communicator, one must (Select all that apply)

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

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Chapter 2: Ethical and Legal Issues

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Sample Questions

Q1) In the ethical decision-making process, after the identification of alternative options has been established,

A) an outcome for each action must be predicted.

B) the team must determine which options to present to the patient or family.

C) the choice of one option compromises the option not chosen.

D) "no action" is not an option in this step of the decision-making process.

Answer: A

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

Q3) Ethical decisions are best made by

A) following the guidelines of a framework or model.

B) having the client discuss alternatives with the physician or nurse.

C) prioritizing the greatest good for the greatest number of persons.

D) careful consideration by the Ethics Committee after all diagnostic data are reviewed.

Answer: A

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Page 4

Chapter 3: Patient and Family Education

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Sample Questions

Q1) According to Malcolm Knowles' andragogy, which of the following are characteristics of the adult learner?

A) Autonomy

B) Experience

C) Instructor-driven assessments

D) Peer-directed motivation

E) Individualism

Answer: A, B, E

Q2) During which phase do HIPAA, advance directives, and visitation policies occur for the patient or family members?

A) Transfer to a different level of care

B) End-of-life care

C) Initial contact or first visit

D) Continuous care

Answer: C

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Chapter 4: Psychosocial and Spiritual Alterations and Management

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Sample Questions

Q1) _____ occurs when the critical illness is so severe that the patient or family becomes overwhelmed.

A) Anxiety

B) Spiritual distress

C) Stress overload

D) Hopelessness

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

Q3) A patient with ineffective coping may manifest which of the following behaviors?

A) Refusal to participate in care

B) Feelings that his or her body has betrayed him or her

C) Acceptance and ownership of problems

D) Disruption in the perception of the body

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Chapter 5: Sleep Alterations

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Sample Questions

Q1) Where are EMG leads placed to detect muscle atonia?

A) Scalp

B) Intercostal

C) Anterior tibialis

D) Chin

Q2) _____ 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

Q3) _____ is a diagnostic test used to determine sleep disturbances.

A) Electrooculography

B) Electromyography

C) Electroencephalography

D) Polysomnography

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Page 7

Chapter 6: Nutritional Alterations

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Sample Questions

Q1) The loss of exocrine function of pancreatitis results in A) anorexia.

B) obesity.

C) malabsorption.

D) hyperglycemia.

Q2) A patient is admitted to the critical care unit with severe malnutrition as a result of hepatic failure.A triple-lumen central venous catheter is placed in the right subclavian vein, and TPN is started.For which of the following complications should the patient be evaluated immediately after insertion of the catheter?

A) Pneumothorax

B) Hypoglycemia

C) Central venous thrombosis

D) Pulmonary aspiration

Q3) A patient with poorly controlled diabetes mellitus is to be started on enteral tube feeding.What type of formula would be most appropriate?

A) Whole proteins and glucose polymers

B) Concentrated in calories

C) Low sodium

D) High fat, low carbohydrate

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8

Chapter 7: Gerontological Alterations

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Sample Questions

Q1) 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.

Q2) An older patient is started on amitriptyline to control depression.The nurse knows to monitor for (Select all that apply)

A) impaired psychomotor function.

B) irregular heart rate.

C) polyuria.

D) pulmonary edema.

Q3) Age-related pulmonary changes that may affect this patient include A) increased tidal volumes.

B) weakening of intercostal muscles and the diaphragm.

C) improved cough reflex.

D) decreased sensation of the glottis.

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9

Chapter 8: Pain and Pain Management

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Sample Questions

Q1) The use of PCA infusion pumps allows the patient to

A) act preemptively by administering a bolus of medication when pain begins.

B) choose between the use of opioids or NSAID medication to control pain.

C) decrease the risk of respiratory depression.

D) control pain medication in 2-hour increments.

Q2) 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.

Q3) Which of the following assessment findings might indicate respiratory depression after opioid administration?

A) Flushed, diaphoretic skin

B) Shallow respirations with a rate of 24 breaths/min

C) Tense, rigid posture

D) Sleep apnea

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10

Chapter 9: Sedation, Agitation and Delirium Management

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Sample Questions

Q1) A patient was admitted into the critical care unit 3 days ago.She has just been weaned from mechanical ventilation.She suddenly becomes confused, seeing nonexistent animals in her room and pulling at her gown.Which of the following interventions is indicated to adequately monitor the patient during haloperidol use?

A) Continuous bispectral index (BIS) monitoring

B) Continuous electrocardiographic (ECG) monitoring

C) Continuous pulse oximetry

D) Continuous electrocardiogram (ECG) monitoring

Q2) A 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.The nurse's first intervention for this patient would be to

A) administer midazolam (Versed) 5 mg by intravenous push immediately.

B) assess the patient to see if a physiologic reason exists for his agitation.

C) obtain a stat arterial blood gas level; his agitation indicates he is becoming increasingly hypoxic.

D) apply soft wrist restraints to keep him from pulling out the endotracheal tube.

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Chapter 10: End of Life Care

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Sample Questions

Q1) 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

Q2) A patient was admitted to the critical care unit after having a CVA and MI.The patient has poor activity tolerance, falls in and out of consciousness, and has poor verbal skills.The patient has been resuscitated four times in the past 6 hours.The patient does not have advance directives.Family members are at the bedside.Who should the physician approach to discuss decisions of care and possible DNR status?

A) The patient

B) The family

C) The hospital legal system

D) The hospital ethics committee

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Chapter 11: Cardiovascular Clinical Assessment and Diagnostic Procedures

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Sample Questions

Q1) Which of the following is most often found in ventricular dysrhythmias?

A) Retrograde P waves

B) Wide QRS complexes

C) No P waves

D) An inverted T wave

Q2) Pulsus paradoxus may be seen on intra-arterial blood pressure monitoring when

A) there is a decrease of more than 10 mm Hg in the arterial waveform before inhalation.

B) there is a single, nonperfused beat.

C) the waveform demonstrates tall, tented T waves.

D) the pulse pressure is greater than 20 mm Hg on exhalation.

Q3) The Allen test is used before radial arterial line placement to assess

A) collateral circulation to the hand.

B) patency of the radial artery.

C) neurologic function of the hand.

D) pain sensation at the insertion point.

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13

Chapter 12: Cardiovascular Disorders

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Sample Questions

Q1) Which of the following assessment findings is most specific for acute onset of pulmonary edema?

A) Pulmonary crackles

B) Peripheral edema

C) Pink, frothy sputum

D) Elevated central venous pressure

Q2) Dyspnea with wheezing, a nonproductive cough, and pulmonary crackles that progress to the gurgling sounds of pulmonary edema is described as

A) dyspnea.

B) orthopnea.

C) paroxysmal nocturnal dyspnea.

D) cardiac asthma.

Q3) Which of the following clinical manifestations are indicative of left ventricular failure?

A) Cool, pale extremities

B) Jugular venous distention

C) Liver tenderness

D) Weak peripheral pulses

E) Rales

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14

Chapter 13: Cardiovascular Therapeutic Management

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Sample Questions

Q1) The most common complication of fibrinolytic therapy is

A) reperfusion chest pain.

B) lethargy.

C) bleeding.

D) heart blocks.

Q2) The predominant form of percutaneous coronary intervention (PCI)is

A) Rotablator.

B) stents.

C) directional coronary atherectomy (DCA).

D) balloon angioplasty (PTCA).

Q3) Which of the following patients would be a candidate for fibrinolytic therapy?

A) The patient chest pain started 8 hours ago. She has a diagnosis of NSTEMI.

B) The patient chest pain started 3 hours ago, and her ECG shows a new left bundle branch block.

C) The patient presents to the emergency department with chest pain of 30 minutes' duration. She has a history of cerebrovascular accident 1 month ago.

D) The patient has a history of unstable angina. He has been experiencing chest pain with sudden onset.

E) The patient chest pain started 1 hour ago, and his ECG shows ST elevation.

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Page 15

Chapter 14: Pulmonary Clinical Assessment and Diagnostic Procedures

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46 Verified Questions

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Sample Questions

Q1) A patient is admitted to the critical care unit with acute respiratory failure secondary to COPD.The patient has a 15-year history of emphysema and bronchitis.On inspection, the nurse observes that the patient is experiencing air trapping.While auscultating the chest, the nurse notes the presence of coarse, rumbling, low-pitched sounds in the right middle and lower lobes.On percussion of the lung fields, a patient with emphysema will predictably exhibit which tone?

A) Resonance

B) Hyperresonance

C) Tympany

D) Dullness

Q2) 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 16

Chapter 15: 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 single most important measure to prevent the spread of infection between staff and patients is

A) respiratory isolation.

B) hand washing.

C) use of PPE.

D) antibiotics.

Q2) Medical management of patient with status asthmaticus that supports oxygenation and ventilation include

A) oxygen therapy.

B) bronchodilators.

C) corticosteroids.

D) antibiotics.

E) intubation and mechanical ventilation.

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Chapter 16: Pulmonary Therapeutic Management

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Sample Questions

Q1) A patient was admitted to the critical care unit with acute respiratory failure.The patient has been on a ventilator for 3 days and is being considered for weaning.The ventilator high-pressure alarm keeps going off.When you enter the room, the ventilator inoperative alarm sounds.Which of the following criteria would indicate that the patient is not tolerating weaning?

A) A decrease in heart rate from 92 to 80 beats/min

B) An SpO<sub>2</sub> of 92%

C) An increase in respiratory rate from 22 to 38 breaths/min

D) Spontaneous tidal volumes of 300 to 350 mL

Q2) Which of the following arterial blood gas values would indicate a need for oxygen therapy?

A) PaO<sub>2</sub> of 80 mm Hg

B) PaCO<sub>2</sub> of 35 mm Hg

C) HCO<sub>3</sub><sup>-</sup> of 24 mEq

D) SaO<sub>2</sub> of 87%

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 17: Neurologic Clinical Assessment and Diagnostic

Procedures

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Sample Questions

Q1) The oculovestibular reflex, or cold caloric test,

A) should not be performed on an unconscious patient because of the risk of aspiration.

B) has an abnormal response of rapid nystagmus-like deviation to the side of the body that is tested.

C) is a routine test of the nursing neurologic examination.

D) is one of the final clinical assessments of brainstem function.

Q2) Which of the following procedures is the diagnostic study of choice for acute head injury?

A) Magnetic resonance imaging

B) Computed tomography

C) Transcranial Doppler

D) Electroencephalography

Q3) Decerebrate posturing (abnormal extension)indicates dysfunction in which area of the central nervous system?

A) Cerebral cortex

B) Thalamus

C) Cerebellum

D) Brainstem

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Chapter 18: Neurologic Disorders and Therapeutic Management

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Sample Questions

Q1) Nonencapsulated tumors tend to infiltrate brain tissue.These tumors can arise in any part of brain connective tissue and infiltrate primarily cerebral hemisphere tissue.These tumors grow rapidly and are difficult to excise completely.The tumors described are classified as

A) angiomas.

B) pituitary adenomas.

C) meningiomas.

D) gliomas.

Q2) A patient's ICP is 34 mm Hg, and his cerebral perfusion pressure is 65 mm Hg.Which of the following is the most appropriate intervention?

A) These are normal values, and no interventions are required.

B) Administer mannitol 1 to 2 g/kg IV.

C) Have the patient lie flat in bed.

D) Suction the patient to see if improving his airway will help his ICP.

Q3) Causes of metabolic coma include A) trauma.

B) ischemic stroke.

C) drug overdose.

D) intracerebral hemorrhage.

Page 20

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Chapter 19: Kidney Clinical Assessment and Diagnostic

Procedures

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Sample Questions

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) Which of the following auscultatory parameters may exist in the presence of hypovolemia?

A) Hypertension

B) Third or fourth heart sound

C) Orthostatic hypotension

D) Vascular bruit

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.

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21

Chapter 20: Kidney Disorders and Therapeutic Management

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Sample Questions

Q1) 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.

Q2) To control azotemia, the recommended nutritional intake of protein is

A) .5 to 1.0 g/kg/day.

B) 1.2 to 1.5 g/kg/day.

C) 1.7 to 2.5 g/kg/day.

D) 2.5 to 3.5 g/kg/day.

Q3) What is a continuous venovenous hemodialysis filter permeable to?

A) Electrolytes

B) Red blood cells

C) Protein

D) Lipids

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22

Chapter 21: Gastrointestinal Clinical Assessment and Diagnostic Procedures

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Sample Questions

Q1) Upon auscultation, the nurse hears borborygmi.This is a change in the patient's condition.The nurse suspects the patient maybe experiencing A) a complete ileus.

B) early intestinal obstruction.

C) abnormality of blood flow.

D) peritonitis.

Q2) Identify anatomic structures that are found in the left lower quadrant.

A) Distended uterus

B) Cecum and appendix

C) Left ureter

D) Portion of the descending colon

E) Sigmoid colon

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 22: Gastrointestinal Disorders and Therapeutic Management

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Sample Questions

Q1) Signs and symptoms of an anastomotic leak include

A) pneumonia.

B) subcutaneous emphysema.

C) bleeding.

D) atelectasis.

Q2) Which of the following medications is/are given to help control ammonia levels in a patient with acute liver failure (ALF)?

A) Insulin

B) Vitamin K

C) Lactulose

D) Benzodiazepines

Q3) 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.

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Page 24

Chapter 23: Endocrine Clinical Assessment and Diagnostic Procedures

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Sample Questions

Q1) When evaluating the patient for a pituitary tumor, attention on the computed tomography scan should be focused on the A) frontal lobe.

B) sella turcica.

C) temporal lobe.

D) anterior fossa.

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.The patient is complaining of headache and blurred vision.The nurse knows that these are signs that may indicate A) kidney stones.

B) diabetes insipidus.

C) hypoglycemia.

D) hyperglycemia.

Q3) A normal HbA<sub>1</sub>c level for a normal person is

A) less than 5.4%.

B) less than 6.5%.

C) between 5.4% and 6.5%.

D) between 3% and 5.4%.

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Chapter 24: Endocrine Disorders and Therapeutic Management

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Sample Questions

Q1) Characteristics of diabetes insipidus (DI)are

A) hyperglycemia and hyperosmolarity.

B) hyperglycemia and peripheral edema.

C) intense thirst and passage of excessively large quantities of dilute urine.

D) peripheral edema and pulmonary crackles.

Q2) A patient was admitted to the critical care unit with diabetic ketoacidosis (DKA).Glucose is 349 mg/dL, K<sup>+</sup> is 3.7 mEq/L, and pH is 7.10.Which of the following interventions would you expect?

A) NS 1.5 L IV fluid bolus

B) Insulin infusion at 5 units/hr

C) Sodium bicarbonate 50 mmol IV push

D) Vasopressin 10 units IM every 3 hr

E) Potassium 20 mEq/L of IV fluid

Q3) As a patient with diabetic ketoacidosis receives insulin and fluids, the nurse knows careful assessment must be given to which of the following electrolytes?

A) Potassium

B) Sodium

C) Phosphorus

D) Calcium

Page 26

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Chapter 25: Trauma

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Sample Questions

Q1) 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.

Q2) Major trauma patients are at a high risk of developing deep venous thrombosis and pulmonary embolism because of A) blood stasis.

B) hypernatremia.

C) injury to the intimal surface of the vessel.

D) hyperosmolarity.

E) hypercoagulopathy.

F) immobility.

Q3) The most important aspect of a secondary survey is to A) check circulatory status.

B) check electrolyte profile.

C) insert a urinary catheter.

D) obtain patient history.

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Chapter 26: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome

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Sample Questions

Q1) The difference between primary and secondary multiple organ dysfunction syndrome (MODS)is that primary MODS is the result of

A) widespread systemic inflammation that results in dysfunction of organs not involved in the initial insult.

B) direct organ injury.

C) disorganization of the immune system response.

D) widespread disruption of the coagulation system.

Q2) A patient has been on the medical floor for 1 week after a vaginal hysterectomy.A urinary catheter was inserted.Complete blood cell count results have revealed escalating white blood cell counts.The patient is transferred to the critical care unit when her condition deteriorates.Septic shock is diagnosed.The medical management of the patient's condition is aimed toward

A) limiting fluids to minimize the possibility of congestive heart failure.

B) finding and eradicating the cause of infection.

C) discontinuing invasive monitoring as a possible cause of sepsis.

D) administering vasodilator substances to increase blood flow to vital organs.

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28

Chapter 27: Hematologic Disorders and Oncologic Emergencies

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Sample Questions

Q1) A patient was admitted to the critical care unit with gram-negative sepsis 5 days ago.Today there is continual oozing from his intravenous sites, and ecchymosis of the skin is noted beneath his automatic blood pressure cuff.On his laboratory work, his platelets are normal, and his international normalized ratio is elevated.What other laboratory value would be most valuable in definitively diagnosing the patient's condition?

A) Fibrin split products

B) D-Dimer level

C) Bleeding time

D) White blood cell count

Q2) Sickle cell anemia is not prevalent in persons of which descent?

A) West African

B) Sole European

C) Middle Eastern

D) Asian or Pacific Islander

Q3) Which of the following would be appropriate for treating hypocalcemia?

A) Calcium gluconate

B) Insulin

C) Sodium bicarbonate

D) Dialysis

Page 29

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