Critical Care-Exam 1 Questions
A critically ill patient has a living will in the chart. The patient's condition has deteriorated, but
the spouse wants "everything done," regardless of the patient's wishes. Which ethical
principle is the spouse violating?
a. Autonomy
b. Beneficence
c. Justice
d. Nonmaleficence - correct answer-a. Autonomy
A definitive diagnosis of pulmonary embolism can be made by
a. arterial blood gas (ABG) analysis.
b. chest x-ray examination.
c. pulmonary angiogram.
d. ventilation-perfusion scanning. - correct answer-c. pulmonary angiogram.
A mode of pressure-targeted ventilation that provides positive pressure to decrease the
workload of spontaneous breathing through the endotracheal tube is
a. continuous positive airway pressure.
b. positive end-expiratory pressure.
c. pressure support ventilation.
d. T-piece adapter. - correct answer-c. pressure support ventilation
A nurse caring for a patient with neurological impairment often must use painful stimuli to
elicit the patient's response. The nurse uses subtle measures of painful stimuli, such as
nailbed pressure. She neither slaps the patient nor pinches the nipple to elicit a response to
pain. In this scenario, the nurse is exemplifying the ethical principle of
a. beneficence.
b. fidelity.
c. nonmaleficence.
d. veracity. - correct answer-c. nonmaleficence.
A nurse has been working as a staff nurse in the surgical intensive care unit for 2 years and
is interested in certification. Which credential would be most applicable for the nurse to
seek?
a. ACNPC-AG
b. CNML
c. CCRN
d. PCCN - correct answer-c. CCRN
A nurse who plans care based on the patient's gender, ethnicity, spirituality, and lifestyle is
said to
a. be a moral advocate.
b. facilitate learning.
c. respond to diversity.
d. use clinical judgment. - correct answer-c. respond to diversity.
,A PaCO2 of 48 mm Hg is associated with
a. hyperventilation.
b. hypoventilation.
c. increased absorption of O2.
d. increased excretion of HCO3. - correct answer-b. hypoventilation.
A patient at high risk for pulmonary embolism is receiving enoxaparin. The nurse explains to
the patient:
a. "I'm going to contact the pharmacist to see if you can take this medication by mouth."
b. "This injection is being given to prevent blood clots from forming."
c. "This medication will dissolve any blood clots you might get."
d. "You should not be receiving this medication. I will contact the provider to get it stopped." -
correct answer-b. "This injection is being given to prevent blood clots from forming."
A patient has coronary artery bypass graft surgery and is transported to the surgical
intensive care unit at noon and is placed on mechanical ventilation. Interpret the initial
arterial blood gas levels
pH: 7.31
PaCO2: 48 mm Hg
Bicarbonate: 22 mEq/L
PaO2: 115 mm Hg
O2 saturation: 99%
a. Normal arterial blood gas levels with a high oxygen level
b. Partly compensated respiratory acidosis; normal oxygen
c. Uncompensated metabolic acidosis with high oxygen levels
d. Uncompensated respiratory acidosis; hyperoxygenated - correct answer-d.
Uncompensated respiratory acidosis; hyperoxygenated
A patient is admitted to the cardiac surgical intensive care unit after cardiac surgery with the
following arterial blood gas (ABG) levels. What action by the nurse is best?
pH: 7.4
PaCO2: 40 mm Hg
Bicarbonate: 24 mEq/L
PaO2: 95 mm Hg
O2 saturation: 97%
Respirations: 20 breaths/min
a. Call the provider to request rapid intubation.
b. Document the findings and continue to monitor.
c. Request that another set of ABGs be drawn and run.
d. Correlate the patient's O2 saturation with the ABGs. - correct answer-b. Document the
findings and continue to monitor.
A patient is admitted to the cardiac surgical intensive care unit after cardiac surgery. Four
hours after admission to the surgical intensive care unit at 4 PM, the patient has stable vital
signs and normal arterial blood gases (ABGs), and is placed on a T-piece for ventilatory
weaning. The following information pertains to the 1900 assessment.
,Assessments and Vital Signs Nursing Action
Restless Performs complete assessment
Increased to 110 beats/min Suctions patient for pink, frothy secretions
Respirations 36 breaths/min Obtains prescriptions from provider for ABGs, electrolyte levels,
and portable chest x-ray
Blood pressure 156/98 mm Hg
Sinus tachycardia
10 PVCs/min
Elevated pulmonary artery pressure
Loud crackles throughout
New ABGs:
pH: 7.28
PaCO2: 46 mm Hg
Bicarbonate: 22 mEq/L
PaO2: 58 mm Hg
O2 saturation: 88%
What action by the nurse is best?
a. Prepare for rapid intubation.
b. Increase the patient's o - correct answer-c. Prepare to administer a diuretic.
A patient is admitted to the cardiac surgical intensive care unit after cardiac surgery. Four
hours after admission to the surgical intensive care unit at 4 PM, the patient has stable vital
signs and normal arterial blood gases (ABGs), and is placed on a T-piece for ventilatory
weaning. The following information pertains to the 1900 assessment.
Assessments and Vital Signs Nursing Action
Restless Performs complete assessment
Increased to 110 beats/min Suctions patient for pink, frothy secretions
Respirations 36 breaths/min Obtains prescriptions from provider for ABGs, electrolyte levels,
and portable chest x-ray
Blood pressure 156/98 mm Hg
Sinus tachycardia
10 PVCs/min
Elevated pulmonary artery pressure
Loud crackles throughout
New ABGs:
pH: 7.28
PaCO2: 46 mm Hg
Bicarbonate: 22 mEq/L
PaO2: 58 mm Hg
O2 saturation: 88%
What interdisciplinary staff member does the nurse notify to assist in the care of this patien -
correct answer-a. Respiratory therapist to adjust ventilator
A patient is admitted to the hospital with multiple trauma and extensive blood loss. The nurse
assesses vital signs to be BP 80/50 mm Hg, heart rate 135 beats/min, respirations 36
, breaths/min, cardiac output (CO) of 2 L/min, systemic vascular resistance of 3000
dynes/sec/cm-5, and a hematocrit of 20%. The nurse anticipates administration of which the
following therapies or medications?
a. Blood transfusion
b. Furosemide
c. Dobutamine infusion
d. Dopamine hydrochloride infusion - correct answer-a. Blood transfusion
A patient is admitted to the progressive care unit with a diagnosis of community-acquired
pneumonia. The patient has a history of chronic obstructive pulmonary disease and
diabetes. A set of arterial blood gases obtained on admission without supplemental oxygen
shows pH 7.35; PaCO2 55 mm Hg; bicarbonate 30 mEq/L; PaO2 65 mm Hg. These blood
gases reflect:
a. hypoxemia and compensated metabolic alkalosis.
b. hypoxemia and compensated respiratory acidosis.
c. normal oxygenation and partly compensated metabolic alkalosis.
d. normal oxygenation and uncompensated respiratory acidosis. - correct answer-b.
hypoxemia and compensated respiratory acidosis.
A patient is being mechanically ventilated in the synchronized intermittent mandatory
ventilation mode at a rate of 4 breaths/min. His spontaneous respirations are 12 breaths/min.
He receives a dose of morphine sulfate, and his respirations decrease to 4 breaths/min.
What adjustments may need to be made to the patient's ventilator settings?
a. Add positive end-expiratory pressure (PEEP).
b. Add pressure support.
c. Change to assist/control ventilation at a rate of 4 breaths/min.
d. Increase the synchronized intermittent mandatory ventilation respiratory rate. - correct
answer-d. Increase the synchronized intermittent mandatory ventilation respiratory rate.
A patient is being mechanically ventilated in the synchronized intermittent mandatory
ventilation mode at a rate of 4 breaths/min. His spontaneous respirations are 12 breaths/min.
He receives a dose of morphine sulfate, and his spontaneous respirations decrease to 4
breaths/min. Which acid-base disturbance will likely occur?
a. Metabolic acidosis
b. Metabolic alkalosis
c. Respiratory acidosis
d. Respiratory alkalosis - correct answer-c. Respiratory acidosis
A patient is having difficulty weaning from mechanical ventilation. The nurse assesses the
patient for which potential cause of this difficult weaning?
a. Cardiac output of 6 L/min.
b. Hemoglobin of 8 g/dL.
c. Negative sputum culture and sensitivity.
d. White blood cell count of 8000. - correct answer-b. Hemoglobin of 8 g/dL.
A patient presents to the emergency department demonstrating agitation and complaining of
numbness and tingling in his fingers. His arterial blood gas levels reveal the following: pH
7.51, PaCO2 25, HCO3 25. The nurse interprets these blood gas values as:
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