NURS 3501 WEEK 1 - INTRO TO CRITICAL CARE NCLEX PRACTICE QUESTIONS & ANSWERS

NURS 3501 WEEK 1 - INTRO TO CRITICAL CARE NCLEX PRACTICE QUESTIONS & ANSWERS NURS 3501 WEEK 1 - INTRO TO CRITICAL CARE NCLEX PRACTICE QUESTIONS & ANSWERS Ch 9: End of Life Care Practice Questions 1. The nurse is caring for a terminally ill patient who has 20-second periods of apnea followed by periods of deep and rapid breathing. The nurse documents this finding as a. agonal breathing. b. apneustic breathing. c. death-rattle respirations. d. Cheyne-Stokes respirations. 2. A 21-year-old is dying after an automobile accident. The family members want to donate the patients organs and ask the nurse how the decision about brain death is made. The nurse explains that the patient will be considered brain dead when a. the patient is flaccid and unresponsive. b. CPR is ineffective in restoring heartbeat. c. the patient is apneic and without brainstem reflexes. d. respiratory efforts cease and no apical pulse is audible. 3. A hospice patient is manifesting a decrease in all body system functions except for a heart rate of 124 and a respiratory rate of 28. The nurse explains to the family that these symptoms a. will continue to increase until death finally occurs. b. are a normal response before these functions decrease. c. indicate a reflex response to the slowing of other body systems. d. may be associated with an improvement in the patients condition. 4. A patient who has been diagnosed with metastatic cancer and has a poor prognosis plans a trip across the country to settle some issues with my sisters and brothers. The nurse recognizes that the patient is manifesting the psychosocial response of a. restlessness. b. yearning and protest. c. anxiety about unfinished business. d. fear of the meaninglessness of ones life. 5. The spouse of a patient with terminal lung cancer visits daily and cheerfully talks with the patient about vacation plans for the next year. When the nurse asks about any concerns, the spouse says, I’m busy at work, but otherwise things are fine. An appropriate nursing diagnosis is a. ineffective coping related to lack of grieving. b. anxiety related to complicated grieving process. c. caregiver role strain related to feeling overwhelmed. d. hopelessness related to knowledge deficit about cancer. 6. As the nurse admits a patient with severe heart failure to the hospital, the patient tells the nurse, If my heart or breathing stop, I do not want to be resuscitated. Which action is best for the nurse to take? a. Ask if these wishes have been discussed with the health care provider. b. Place a Do Not Resuscitate (DNR) notation in the patients care plan. c. Inform the patient that a notarized advance directive must be included in the record or resuscitation must be performed. d. Advise the patient to designate a person to make health care decisions when the patient is not able to make them independently. 7. A patient who is very close to death is very restless and keeps repeating, I am not ready to die. Which action is best for the nurse to take? a. Remind the patient that no one feels ready for death. b. Sit at the bedside and ask if there is anything the patient needs. c. Insist that family members remain at the bedside with the patient. d. Tell the patient that everything possible is being done to delay death. 8. A patient in a hospice program is experiencing continuous, increasing amounts of pain. The nurse caring for the patient plans the scheduling of opioid pain medications to provide a. around-the-clock routine administration of analgesics. b. PRN doses of medication whenever the patient requests. c. enough pain medication to keep the patient sedated and unaware of stimuli. d. analgesic doses that provide pain control without decreasing respiratory rate. 9. When caring for a patient with lung cancer in a home hospice program, it is important for the nurse to a. discuss cancer risk factors and appropriate lifestyle modifications. b. encourage the patient to discuss past life events and their meaning. c. accomplish a thorough head-to-toe assessment several times a week. d. educate the patient about the purpose of chemotherapy and radiation. 10. A hospice nurse who has become very close to a terminally ill patient and family is present in the home when the patient dies and feels saddened and tearful as the family members begin to cry. Which action should the nurse take at this time? a. Contact a grief counselor as soon as possible. b. Cry along with the patients family members. c. Leave the home as quickly as possible to allow the family to grieve privately. d. Consider whether working in hospice is desirable since patient losses are common. 11. A patient who is in the clinic for an immunization tells the nurse, My mother died 4 months ago, and I just cant seem to get over it. Im not sure it is normal to still think about her every day. Which nursing diagnosis is most appropriate? a. Hopelessness related to inability to resolve grief b. Complicated grieving related to unresolved issues c. Anxiety related to lack of knowledge about normal grieving d. Chronic sorrow related to ongoing distress about loss of mother 12. The family member of a dying patient tells the nurse, Mother doesnt really respond any more when I visit. I dont think she knows that I am here. Which response by the nurse is appropriate? a. You may need to cut back your visits for now to avoid overtiring your mother. b. Withdrawal may sometimes be a normal response when preparing to leave life. c. It will be important for you to stimulate your mother as she gets closer to dying. d. Many patients dont really know what is going on around them at the end of life. 13. Which of these patients is most appropriate for the nurse to refer to hospice care? a. A 60-year-old with lymphoma whose children are unable to discuss issues related to dying b. A 72-year-old with chronic severe pain as a result of spinal arthritis and vertebral collapse c. A 28-year-old with AIDS-related dementia who needs palliative care and pain management d. A 56-year-old with advanced liver failure whose family members can no longer care for him or her at home 14. A terminally ill patient is admitted to the hospital. Which action should the nurse include in the initial plan of care? a. Determine the patients wishes regarding end-of-life care. b. Emphasize the importance of addressing any family issues. c. Discuss the normal grief process with the patient and family. d. Encourage the patient to talk about any fears or unresolved issues. Ch 65: Critical Care Practice Questions 1. A patient has a nursing diagnosis of disturbed sensory perception related to sleep deprivation. Which action will the nurse include in the plan of care? a. Discontinue assessments during the night to allow uninterrupted sleep. b. Administer prescribed sedatives or opioids at bedtime to promote sleep. c. Silence the alarms on the cardiac monitors to allow 30- to 40-minute naps. d. Cluster nursing activities so that the patient has uninterrupted rest periods. 2. To determine the effectiveness of medications that a patient has received to reduce left ventricular afterload, which hemodynamic parameter will the nurse monitor? a. Central venous pressure (CVP) b. Systemic vascular resistance (SVR) c. Pulmonary vascular resistance (PVR) d. Pulmonary artery wedge pressure (PAWP) 3. While family members are visiting, a patient has a cardiac arrest and is being resuscitated. Which action by the nurse is best? a. Ask family members if they wish to remain in the room during the resuscitation. b. Explain to family members that watching the resuscitation will be very stressful. c. Assign a staff member to wait with family members just outside the patient room. d. Escort family members quickly out of the patient room and then remain with them. 4. Following surgery, a patients central venous pressure (CVP) monitor indicates low pressures. Which action will the nurse anticipate taking? a. Increase the IV fluid infusion rate. b. Administer IV diuretic medications. c. Elevate the head of the patients bed to 45 degrees. d. Document the CVP and continue to monitor. 5. When caring for a patient with pulmonary hypertension, which parameter will the nurse monitor to evaluate whether treatment has been effective? a. Mean arterial pressure (MAP) b. Central venous pressure (CVP) c. Pulmonary vascular resistance (PVR) d. Pulmonary artery wedge pressure (PAWP) 6. The intensive care unit (ICU) charge nurse will determine that teaching about hemodynamic monitoring for a new staff nurse has been effective when the new nurse a. positions the zero-reference stopcock line level with the phlebostatic axis. b. balances and calibrates the hemodynamic monitoring equipment every hour. c. rechecks the location of the phlebostatic axis when changing the patients position. d. ensures that the patient is lying supine with the head of the bed flat for all readings. 7. When monitoring for the effectiveness of treatment for a patient with left ventricular failure, the most important information for the nurse to obtain is a. mean arterial pressure (MAP). b. systemic vascular resistance (SVR). c. pulmonary vascular resistance (PVR). d. pulmonary artery wedge pressure (PAWP). 8. Which action should the nurse take when the low pressure alarm sounds for a patient who has an arterial line in the right radial artery? a. Check the right hand for pallor. b. Assess for cardiac dysrhythmias. c. Flush the arterial line with saline. d. Rezero the monitoring equipment. 9. When preparing to assist with the insertion of a pulmonary artery catheter, the nurse will plan to a. check cardiac enzymes before insertion. b. auscultate heart sounds during insertion. c. place the patient on NPO status before the procedure. d. attach cardiac monitoring leads before the procedure. 10. When assisting with insertion of a pulmonary artery (PA) catheter, the nurse identifies that the catheter is correctly placed when the a. monitor shows a typical PAWP tracing. b. PA waveform is observed on the monitor. c. systemic arterial pressure tracing appears on the monitor. d. catheter has been inserted to the 22-cm marking on the line. 11. Which assessment data obtained by the nurse when caring for a patient with a left radial arterial line indicates a need for the nurse to take action? a. The left hand is cooler than the right hand. b. The mean arterial pressure (MAP) is 75 mm Hg. c. The system is delivering only 3 mL of flush solution per hour. d. The flush bag and tubing were last changed 3 days previously. 12. The mixed venous oxygen saturation (SvO2) is decreasing in a patient who has severe pancreatitis. To determine the possible cause of the decreased SvO2, the nurse assesses the patients a. weight. b. amylase. c. temperature. d. urinary output. 13. An intraaortic balloon pump (IABP) is being used for a patient who is in cardiogenic shock. An assessment finding indicating to the nurse that the goals of treatment with the IABP are being met is a a. heart rate of 110 beats/min. b. urine output of 20 mL/hr. c. cardiac output (CO) of 5 L/min. d. stroke volume (SV) of 40 mL/beat. 14. When caring for a patient who has an intraaortic balloon pump in place, which action will be included in the plan of care? a. Avoid the use of anticoagulant medications. b. Keep the head of the bed elevated 45 degrees. c. Measure the patients urinary output every hour. d. Provide passive range of motion for all extremities. 15. While waiting for cardiac transplantation, a patient with severe heart failure has a ventricular assist device (VAD) implanted. When developing the plan of care, the nursing actions should include a. administration of immunosuppressive medications. b. monitoring the surgical incision for signs of infection. c. teaching the patient the reason for continuous bed rest. d. preparing the patient to have the VAD in place permanently. 16. To verify the correct placement of an endotracheal tube (ET) after insertion, the best initial action by the nurse is to a. auscultate for the presence of bilateral breath sounds. b. obtain a portable chest radiograph to check tube placement. c. observe the chest for symmetrical movement with ventilation. d. use an end-tidal CO2 monitor to check for placement in the trachea. 17. To inflate the cuff of an endotracheal tube (ET) when the patient is on mechanical ventilation, the nurse a. inflates the cuff until the pilot balloon is firm. b. inflates the cuff with a minimum of 10 mL of air. c. injects air into the cuff until a manometer shows 15 mm Hg pressure. d. injects air into the cuff until a slight leak is heard only at peak inflation. 18. Premature ventricular contractions (PVCs) occur while the nurse is suctioning a patients endotracheal tube. Which action by the nurse is best? a. Decrease the suction pressure to 80 mm Hg. b. Stop and ventilate the patient with 100% oxygen. c. Document the dysrhythmia in the patients chart. d. Give prescribed PRN antidysrhythmic medications. 19. Which assessment information obtained by the nurse when caring for a patient receiving mechanical ventilation indicates the need for suctioning? a. The respiratory rate is 32 breaths/min. b. The pulse oximeter shows a SpO2 of 93%. c. The patient has not been suctioned for the last 6 hours. d. The lungs have occasional audible expiratory wheezes. 20. The nurse notes thick, white respiratory secretions for a patient who is receiving mechanical ventilation. Which intervention will be most effective in resolving this problem? a. Suction the patient every hour. b. Reposition the patient every 2 hours. c. Add additional water to the patients enteral feedings. d. Instill 5 mL of sterile saline into the endotracheal tube (ET) before suctioning. 21. Four hours after mechanical ventilation is initiated for a patient with chronic obstructive pulmonary disease (COPD), the patients arterial blood gas (ABG) results include a pH of 7.50, PaO2 of 80 mm Hg, PaCO2 of 29 mm Hg, and HCO3 of 23 mEq/L (23 mmol/L). The nurse will anticipate the need to a. increase the FIO2. b. decrease the respiratory rate. c. increase the tidal volume (VT). d. leave the ventilator at the current settings. 22. A patient with respiratory failure has hemodynamic monitoring and is receiving mechanical ventilation with peak end-expiratory pressure (PEEP) of 10 cm H2O. Which information indicates that a change in the ventilator settings may be required? a. The arterial line shows a blood pressure of 90/46. b. The pulmonary artery pressure (PAP) is decreased. c. The cardiac monitor shows a heart rate of 58 beats/min. d. The pulmonary artery wedge pressure (PAWP) is increased. 23. When the nurse is weaning a patient who has chronic obstructive pulmonary disease (COPD) from mechanical ventilation, which patient assessment indicates that the weaning protocol should be discontinued? a. The patient heart rate is 98 beats/min. b. The patients oxygen saturation is 93%. c. The patient respiratory rate is 32 breaths/min. d. The patients spontaneous tidal volume is 500 mL. 24. The nurse is caring for a patient receiving a continuous norepinephrine (Levophed) IV infusion. Which patient assessment information indicates that the infusion rate may be too high? a. Heart rate is 58 beats/min. b. Mean arterial pressure is 55 mm Hg. c. Systemic vascular resistance (SVR) is elevated. d. Pulmonary artery wedge pressure (PAWP) is low. 25. When caring for the patient with a pulmonary artery pressure catheter, the nurse notes that the PA waveform indicates that the catheter is in the wedged position. Which action should the nurse take? a. Inflate the PA balloon. b. Change the flush system. c. Zero balance the transducer. d. Notify the health care provider. 26. While assessing a patient with a central venous catheter, the nurse notes the catheter insertion site is red and tender and the patients temperature is 101.8 F. The nurse will plan to a. administer analgesics and antibiotics. b. check the site frequently for any swelling. c. discontinue the catheter and culture the tip. d. change the flush system and monitor the site. 27. An elderly patient who has stabilized after being in the intensive care unit (ICU) for a week is preparing for transfer to the step-down unit when the nurse notices that the patient has new onset confusion. The nurse will plan to a. inform the receiving nurse and then transfer the patient. b. notify the health care provider and postpone the transfer. c. administer PRN lorazepam (Ativan) and cancel the transfer. d. obtain an order for restraints as needed and transfer the patient. 28. The family members of a patient who has just been admitted to the intensive care unit (ICU) with multiple traumatic injuries have just arrived in the ICU waiting room. Which action should the nurse take first? a. Immediately take the family members to the patients room. b. Discuss ICU visitation policies and encourage family visits. c. Describe the patients injuries and the care that is being provided. d. Invite the family to participate in a multidisciplinary care conference. 29. When caring for a patient who has an arterial catheter in the radial artery to monitor blood pressure, which information obtained by the nurse is most important to report to the health care provider? a. The patient has a positive Allen test. b. The mean arterial pressure (MAP) is 86 mm Hg. c. There is redness at the catheter insertion site. d. The dicrotic notch is visible in the waveform. 30. When the ventilator alarm sounds, the nurse finds the patient lying in bed holding the endotracheal tube (ET). Which action should the nurse take first? a. Offer reassurance to the patient. b. Activate the hospitals rapid response team. c. Call the health care provider to reinsert the tube. d. Manually ventilate the patient with 100% oxygen. 31. The nurse notes that a patients endotracheal tube (ET), which was at the 21-cm mark, is now at the 24-cm mark and the patient appears anxious and restless. Which action should the nurse take first? a. Listen to the patients lungs. b. Offer reassurance to the patient. c. Bag the patient at an FIO2 of 100%. d. Notify the patients health care provider. 32. When the charge nurse is evaluating the care that a new RN staff member provides to a patient receiving mechanical ventilation, which action by the new RN indicates the need for more education? a. The RN turns the FIO2 up to 100% before suctioning. b. The RN secures a bite block in place using adhesive tape. c. The RN positions the patient with the head of bed at 10 degrees. d. The RN asks for assistance to turn the patient to the prone position. 33. A patient who is receiving mechanical ventilation is anxious and is fighting the ventilator. Which action should the nurse take first? a. Ventilate the patient with a manual resuscitation bag. b. Verbally coach the patient to breathe with the ventilator. c. Sedate the patient with the ordered PRN lorazepam (Ativan). d. Increase the rate for the ordered propofol (Diprivan) infusion. 34. When the nursing supervisor is evaluating the performance of a new RN, which action indicates that the new RN is safe in providing care to a patient who is receiving mechanical ventilation with 10 cm of peak end-expiratory pressure (PEEP)? a. The RN plans to suction the patient every 2 hours. b. The RN uses a closed-suction technique to suction the patient. c. The RN tapes connection between the ventilator tubing and the ET. d. The RN changes the ventilator circuit tubing routinely every 24 hours. 35. A patient with a subarachnoid hemorrhage is intubated and placed on a mechanical ventilator. When monitoring the patient, the nurse will need to notify the health care provider if the patient develops a. oxygen saturation of 94%. b. respirations of 18 breaths/min. c. green nasogastric tube drainage. d. increased jugular vein distention (JVD).