Exam (elaborations)
Critical Care Final Exam – Questions/Answers
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- Critical Care
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Critical Care Final Exam – Questions/Answers
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Critical Care Final Exam – Questions/AnswersImportant Skills of the Critical Care Nurse Correct Ans - The critical
care nurse must be able to deliver high quality care skillfully using all
appropriate technologies while incorporating psychosocial and other holistic
approaches as appropriate to time and condition of the patient.
Role as Patient Advocate:
-The nurse provides more information as needed, clarifies points, reinforces
information and provides support during the decision making process.
Learning Domains Correct Ans - • Psychomotor- step by step guide
• Cognitive- simple to complex
• Affective - feelings, attitudes, value
Fidelity Correct Ans - This is faithfulness and promise keeping to
patients. Confidentiality and Privacy are elements of fidelity.
Veracity Correct Ans - This is truth-telling is important in critical care.
It's important when soliciting informed consent b/c the patient needs to be
aware of all the potential risks and benefits.
Autonomy Correct Ans - Can be viewed as the freedom to make
decisions about one's own body without coercion or interference from others.
Nonmaleficence Correct Ans - This is an ethical principle that states
that a nurse must prevent harm and correct harmful situations.
Justice Correct Ans - Health care is not a right guaranteed by the US
Constitution, it is the access to health care that should be provided to all
people.
Ethical Dilemma Correct Ans - The most common kind of ethical
dilemma encountered in the critical care setting is forgoing treatment and
allocating scarce resources.
Criteria for defining moral and ethical dilemmas are
1.) Awareness of various options
2.) An issue that has options
,3.) Two or more options with true or good aspects with the choice of one
option compromising the option not chosen.
Legal Obligation of the Nurse Correct Ans - Nursing is defined as
1.) The protection, promotion, and optimization of health and abilities
2.) Prevention of illness and injury
3.) Alleviation of suffering thru the diagnosis and treatment of human
responses
4.) Advocacy in the care of individuals, families, communities, and
populations.
Negligence Correct Ans - This is failing to act as an ordinarily prudent
person would under similar circumstances. There must have been a duty or
obligation to conform to some standard, which was breached causing some
damage or injury. There must be 4 elements of negligence
1.) That the nurse had a duty to care for the patient
2.) That the nurse breached the duty
3.) That the breach caused harm that would not have occurred in the absence
of negligence and
4.) That the plaintiff should be compensated for the resulting damages.
Assault Correct Ans - This is any intentional act that creates
reasonable apprehension of immediate harmful or offensive contact with the
plaintiff. No actual contact is needed.
Breach Correct Ans - This is any intentional act that brings about
actual harmful or offensive contact with the plaintiff.
Malpractice Correct Ans - This is a professional misconduct or the
failure to meet the requisite standard of care. Malpractice requires that the
alleged wrongdoer have a special standing as a professional.
Normal Assessment Findings of the Elderly Correct Ans - o Brain-
decrease size in the brain and number of neurons, changes in
neurotransmitter turnover
o Eyes- decreased visual acuity
o Heart- decreased ventricular compliance, prolonged rate of relaxation
o Liver- decrease in blood flow thru the liver
o Peripheral NS- increase in tremors, decreased fine motor skills
,o Integumentary- decreased SC tissue, decreased number of Eccrine and
sebaceous glands, decreased turgor, and decreased connective tissue
o Ear- decreased hearing
o Aortic arch and arteries- decreased baroreceptor sensitivity, decreased
artery compliance
o Lungs- decreased chest wall compliance, increased lung compliance,
decreased muccocilliary clearance
o Kidney- decreased GFR, decreased renal blood flow
o GI- delayed emptying of liquids, decreased peristalsis, decreased gastric acid
secretion
o MS- decreased lean body mass, decreased mobility of skeletal joints,
thinning of vertebral cartilage, bone demineralization
Hypoventilation Correct Ans - o (Can lead to acidosis) leading to
hypercarbia (PaCO2 > 45 mm Hg) may result from the following:
o Inadequate respiratory drive secondary to the effects of residual anesthesia,
such as opioids, sedatives, and general anesthesia inhalation agents
o Inadequate functioning of respiratory muscles causing inadequate tidal
volume due to residual neuromuscular blockade
o Chronic pulmonary disease, such as COPD, which may require postoperative
ventilator support
o Laryngospasm or upper airway obstruction from general anesthesia
o Inadequate reversal of neuromuscular blockade
o Institute "stir-up" regimen to stimulate the patient in the immediate
postoperative period. Assess ability to maintain head lift for 5 seconds.
o Should be able to breath on their own
o These should be pushes by a doctor
Hypotension Correct Ans - o Most common cardiovascular
complication postoperative due to decreased blood volume resulting from
preoperative fasting and intraoperative blood loss.
o Intervention is indicated if the pressure decreases by more than 30% of the
baseline blood pressure.
o Internal catheter can be used to monitor BP, most of the time it will be a cuff
If you check and its low:
• Double check number (manually)
• Check size off cuff
o Check patients blood pressure for orthostatic hypotension in the supine
position with the head of the bed raised 60 degrees unless contraindicated
, The HOB raised will cause a decrease in blood pressure if orthostatic
hypotension is present
o Other causes:
General and regional anesthesia
• Spinal and epidural anesthetics cause vasodilation and decrease blood
pressure resulting from the sympathetic blockade
• Opioids cause histamine release and vasodilation
• Barbiturates and anesthetic inhalation agents cause myocardial depression
o Opioid administration
o Cardiac dysrhythmias
SVT and marked Bradycardia can cause a decrease in cardiac output leading
to hypotension
o Sepsis
o Pulmonary embolism
o Transfusion reaction
o NPO for many hours with no fluids before can lead to hypotension
o Some surgeries require the patient to be slightly hypotensive to keep the BP
down
Malignant Hyperthermia Correct Ans - o Hypermetabolic response to
an anesthetic triggering agent resulting in skeletal muscle damage,
hyperthermia, and death if untreated.
o Needs to be caught quickly and treated quickly
Stop anesthetic, give 100% o2, cool patient, and give Dantrolene muscle
relaxant.
o This is genetic (autosomal dominant gene), most people are not aware.
Important part of family history.
o MH is triggered in *susceptible patients* by halogenated inhalational
anesthetic agents and the depolarizing muscle relaxant succinylcholine.
o More prevalent in people with muscular abnormalities, such as muscular
dystrophy.
o Biopsy of the muscle and tested against different anesthetic agent can
determine susceptibility.
o Pathophysiology:
MH susceptible skeletal muscle is exposed to an MH triggering agent, and
calcium is released at an abnormally high rate resulting in excessive muscle
contraction, increased metabolism, high oxygen consumption, high CO2
production, and heat production.
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