CCN Exam 1 Questions With Complete Solutions
A 56-year-old man with acute respiratory distress syndrome
(ARDS) is on positive pressure ventilation (PPV). The patient's
cardiac index is 1.4 L/minute and pulmonary artery wedge
pressure is 8 mm Hg. What order by the physician is important
for the nurse to question?
A. Initiate a dobutamine (Dobutrex) infusion at 3
mcg/kg/minute.
B. Administer one unit of packed red blood cells over the next 2
hours.
C. Change the maintenance intravenous (IV) rate from 75 to 125
mL/hr.
D. Increase positive end-expiratory pressure (PEEP) from 10 to
15 cm H2O. Correct Answers D.
Patients on PPV and PEEP frequently experience decreased
cardiac output (CO) and cardiac index (CI). High levels of PEEP
increase intrathoracic pressure and cause decreased venous
return which results in decreased CO. Interventions to improve
CO include lowering the PEEP, administering crystalloid fluids
or colloid solutions, and use of inotropic drugs (e.g.,
dobutamine, dopamine). Packed red blood cells may also be
administered to improve CO and oxygenation if the hemoglobin
is less than 9 or 10 mg/dL.
A 64-year-old male patient admitted to the critical care unit for
gastrointestinal hemorrhage complains of feeling tense and
nervous. He appears restless with an increase in blood pressure
and pulse. If the physical assessment shows no other changes, it
,is most important for the critical care nurse to take which
action?
A. Administer prescribed IV dose of lorazepam (Ativan).
B. Stay with the patient and encourage expression of concerns.
C. Ask a family member to remain at the bedside with the
patient.
D. Teach the patient how to use guided imagery to reduce
anxiety. Correct Answers B.
Anxiety is a common problem for critically ill patients. The
nurse should first stay with the patient and encourage the patient
to express concerns and needs. After expression of feelings, the
nurse should determine the appropriate intervention if needed
(e.g., lorazepam, guided imagery, family presence) and closely
monitor the patient's hemodynamic parameters.
A 68-year-old male patient diagnosed with sepsis is orally
intubated on mechanical ventilation. Which action is most
important for the nurse to take?
A. Use the open-suctioning technique.
B. Administer morphine for discomfort.
C. Limit noise and cluster care activities.
D. Elevate the head of the bed 30 degrees. Correct Answers D.
The two major complications of endotracheal intubation are
unplanned extubation and aspiration. To prevent aspiration all
intubated patients and patients receiving enteral feedings must
have the head of the bed (HOB) elevated a minimum of 30 to 45
degrees unless medically contraindicated. Closed-suction
,technique is preferred over the open-suction technique because
oxygenation and ventilation are maintained during suctioning,
and exposure to secretions is reduced. The nurse should provide
comfort measures such as morphine to relieve anxiety and pain
associated with intubation. To promote rest and sleep the nurse
should limit noise and cluster activities.
A 70-year-old patient in the ICU has become agitated and
inattentive since his heart surgery. The nurse knows that this
ICU psychosis frequently occurs in individuals with pre-existing
dementia, history of alcohol abuse, and severe disease. What
interventions should the nurse provide this patient to improve
the patient's cognition (select all that apply)?
A. Improve oxygenation.
B. Provide a small amount of beer.
C. Have the family stay with the patient.
D. Enable the patient to sleep on a schedule with dim lights.
E. Decrease sensory overload by conversing away from patient's
room. Correct Answers A,D,E
ICU psychosis is from delirium in most ICU patients. Improving
oxygenation, enabling the patient to sleep, and decreasing
sensory overload along with orientation is all helpful in
improving the patient's cognition. The beer may or may not be
allowed for this patient, and the nurse should not assume that it
will help. Having a family member stay with the patient to
reorient the patient is helpful, but the family group may increase
sensory overload with conversations not involving the patient.
, A 72-year-old woman with aspiration pneumonia develops
severe respiratory distress. Which diagnostic finding would
indicate to the nurse that the patient has developed acute
respiratory distress syndrome (ARDS)?
A. PaO2 of 42 mm Hg on 80% FIO2
B. PaO2 of 64 mm Hg on 24% FIO2
C. PaCO2 of 31 mm Hg and pH 7.51
D. PaCO2 of 70 mm Hg and pH 7.29 Correct Answers A.
Refractory hypoxemia indicates ARDS. If the PaO2 is 42 mm
Hg on 80% FIO2, then the PaO2/FIO2 ratio is 52.5, indicating
ARDS (PaO2/FIO2 ratio < 200). PaCO2 of 31 mm Hg and pH
7.51 indicates respiratory alkalosis. If PaO2 of 64 mm Hg on
24% FIO2, the PaO2/FIO2 ratio is 267, which indicates an acute
lung injury (PaO2/FIO2 ratio between 200 to 300). PaCO2 of 70
mm Hg and pH 7.29 indicates respiratory acidosis.
(FIO2, Fraction of inspired oxygen,)
A patient develops increasing dyspnea and hypoxemia 2 days
after having cardiac surgery. To determine whether the patient
has acute respiratory distress syndrome (ARDS) or pulmonary
edema caused by left ventricular failure, the nurse will anticipate
assisting with
a. inserting a pulmonary artery catheter.
b. obtaining a ventilation-perfusion scan.
c. drawing blood for arterial blood gases.
d. positioning the patient for a chest radiograph. Correct
Answers ANS: A
Pulmonary artery wedge pressures are normal in the patient with
ARDS because the fluid in the alveoli is caused by increased
A 56-year-old man with acute respiratory distress syndrome
(ARDS) is on positive pressure ventilation (PPV). The patient's
cardiac index is 1.4 L/minute and pulmonary artery wedge
pressure is 8 mm Hg. What order by the physician is important
for the nurse to question?
A. Initiate a dobutamine (Dobutrex) infusion at 3
mcg/kg/minute.
B. Administer one unit of packed red blood cells over the next 2
hours.
C. Change the maintenance intravenous (IV) rate from 75 to 125
mL/hr.
D. Increase positive end-expiratory pressure (PEEP) from 10 to
15 cm H2O. Correct Answers D.
Patients on PPV and PEEP frequently experience decreased
cardiac output (CO) and cardiac index (CI). High levels of PEEP
increase intrathoracic pressure and cause decreased venous
return which results in decreased CO. Interventions to improve
CO include lowering the PEEP, administering crystalloid fluids
or colloid solutions, and use of inotropic drugs (e.g.,
dobutamine, dopamine). Packed red blood cells may also be
administered to improve CO and oxygenation if the hemoglobin
is less than 9 or 10 mg/dL.
A 64-year-old male patient admitted to the critical care unit for
gastrointestinal hemorrhage complains of feeling tense and
nervous. He appears restless with an increase in blood pressure
and pulse. If the physical assessment shows no other changes, it
,is most important for the critical care nurse to take which
action?
A. Administer prescribed IV dose of lorazepam (Ativan).
B. Stay with the patient and encourage expression of concerns.
C. Ask a family member to remain at the bedside with the
patient.
D. Teach the patient how to use guided imagery to reduce
anxiety. Correct Answers B.
Anxiety is a common problem for critically ill patients. The
nurse should first stay with the patient and encourage the patient
to express concerns and needs. After expression of feelings, the
nurse should determine the appropriate intervention if needed
(e.g., lorazepam, guided imagery, family presence) and closely
monitor the patient's hemodynamic parameters.
A 68-year-old male patient diagnosed with sepsis is orally
intubated on mechanical ventilation. Which action is most
important for the nurse to take?
A. Use the open-suctioning technique.
B. Administer morphine for discomfort.
C. Limit noise and cluster care activities.
D. Elevate the head of the bed 30 degrees. Correct Answers D.
The two major complications of endotracheal intubation are
unplanned extubation and aspiration. To prevent aspiration all
intubated patients and patients receiving enteral feedings must
have the head of the bed (HOB) elevated a minimum of 30 to 45
degrees unless medically contraindicated. Closed-suction
,technique is preferred over the open-suction technique because
oxygenation and ventilation are maintained during suctioning,
and exposure to secretions is reduced. The nurse should provide
comfort measures such as morphine to relieve anxiety and pain
associated with intubation. To promote rest and sleep the nurse
should limit noise and cluster activities.
A 70-year-old patient in the ICU has become agitated and
inattentive since his heart surgery. The nurse knows that this
ICU psychosis frequently occurs in individuals with pre-existing
dementia, history of alcohol abuse, and severe disease. What
interventions should the nurse provide this patient to improve
the patient's cognition (select all that apply)?
A. Improve oxygenation.
B. Provide a small amount of beer.
C. Have the family stay with the patient.
D. Enable the patient to sleep on a schedule with dim lights.
E. Decrease sensory overload by conversing away from patient's
room. Correct Answers A,D,E
ICU psychosis is from delirium in most ICU patients. Improving
oxygenation, enabling the patient to sleep, and decreasing
sensory overload along with orientation is all helpful in
improving the patient's cognition. The beer may or may not be
allowed for this patient, and the nurse should not assume that it
will help. Having a family member stay with the patient to
reorient the patient is helpful, but the family group may increase
sensory overload with conversations not involving the patient.
, A 72-year-old woman with aspiration pneumonia develops
severe respiratory distress. Which diagnostic finding would
indicate to the nurse that the patient has developed acute
respiratory distress syndrome (ARDS)?
A. PaO2 of 42 mm Hg on 80% FIO2
B. PaO2 of 64 mm Hg on 24% FIO2
C. PaCO2 of 31 mm Hg and pH 7.51
D. PaCO2 of 70 mm Hg and pH 7.29 Correct Answers A.
Refractory hypoxemia indicates ARDS. If the PaO2 is 42 mm
Hg on 80% FIO2, then the PaO2/FIO2 ratio is 52.5, indicating
ARDS (PaO2/FIO2 ratio < 200). PaCO2 of 31 mm Hg and pH
7.51 indicates respiratory alkalosis. If PaO2 of 64 mm Hg on
24% FIO2, the PaO2/FIO2 ratio is 267, which indicates an acute
lung injury (PaO2/FIO2 ratio between 200 to 300). PaCO2 of 70
mm Hg and pH 7.29 indicates respiratory acidosis.
(FIO2, Fraction of inspired oxygen,)
A patient develops increasing dyspnea and hypoxemia 2 days
after having cardiac surgery. To determine whether the patient
has acute respiratory distress syndrome (ARDS) or pulmonary
edema caused by left ventricular failure, the nurse will anticipate
assisting with
a. inserting a pulmonary artery catheter.
b. obtaining a ventilation-perfusion scan.
c. drawing blood for arterial blood gases.
d. positioning the patient for a chest radiograph. Correct
Answers ANS: A
Pulmonary artery wedge pressures are normal in the patient with
ARDS because the fluid in the alveoli is caused by increased
