[DOCUMENT TITLE]
,Week 1
Chapter 66
1. A 68-year-old patient has been in the intensive care unit for 4 days and has a nursing diagnosis of disturbed
sensory perception related to sleep deprivation. Which action should the nurse include in the plan of care?
a Administer prescribed sedatives or opioids at bedtime to promote sleep.
.
b Cluster nursing activities so that the patient has uninterrupted rest periods.
.
c. Silence the alarms on the cardiac monitors to allow 30- to 40-minute naps.
d Eliminate assessments between 0100 and 0600 to allow uninterrupted sleep.
.
ANS: B
2. Which hemodynamic parameter is most appropriate for the nurse to monitor to determine the effectiveness of
medications given to a patient to reduce left ventricular afterload?
a Mean arterial pressure (MAP)
.
b Systemic vascular resistance (SVR)
.
c. Pulmonary vascular resistance (PVR)
d Pulmonary artery wedge pressure (PAWP)
.
ANS: B
3. While family members are visiting, a patient has a respiratory arrest and is being resuscitated. Which action by
the nurse is best?
a Tell the family members that watching the resuscitation will be very stressful.
.
b Ask family members if they wish to remain in the room during the resuscitation.
.
c. Take the family members quickly out of the patient room and remain with them.
d Assign a staff member to wait with family members just outside the patient room.
.
ANS: B
4. Following surgery for an abdominal aortic aneurysm, a patients central venous pressure (CVP) monitor indicates
low pressures. Which action is a priority for the nurse to take?
a Administer IV diuretic medications.
.
b Increase the IV fluid infusion per protocol.
.
, c. Document the CVP and continue to monitor.
d Elevate the head of the patients bed to 45 degrees.
.
ANS: B
5. When caring for a patient with pulmonary hypertension, which parameter is most appropriate for the nurse to
monitor to evaluate the effectiveness of the treatment?
a Central venous pressure (CVP)
.
b Systemic vascular resistance (SVR)
.
c. Pulmonary vascular resistance (PVR)
d Pulmonary artery wedge pressure (PAWP)
.
ANS: C
6. The intensive care unit (ICU) nurse educator will determine that teaching about arterial pressure monitoring for a
new staff nurse has been effective when the nurse
a balances and calibrates the monitoring equipment every 2 hours.
.
b positions the zero-reference stopcock line level with the phlebostatic axis.
.
c. ensures that the patient is supine with the head of the bed flat for all readings.
d rechecks the location of the phlebostatic axis when changing the patients position.
.
ANS: B
7. When monitoring for the effectiveness of treatment for a patient with a large anterior wall myocardial infarction,
the most important information for the nurse to obtain is
a central venous pressure (CVP).
.
b systemic vascular resistance (SVR).
.
c. pulmonary vascular resistance (PVR).
d pulmonary artery wedge pressure (PAWP).
.
ANS: D
8. Which action is a priority for the nurse to take when the low pressure alarm sounds for a patient who has an
arterial line in the left radial artery?
a Fast flush the arterial line.
.
b Check the left hand for pallor.
,Week 1
Chapter 66
1. A 68-year-old patient has been in the intensive care unit for 4 days and has a nursing diagnosis of disturbed
sensory perception related to sleep deprivation. Which action should the nurse include in the plan of care?
a Administer prescribed sedatives or opioids at bedtime to promote sleep.
.
b Cluster nursing activities so that the patient has uninterrupted rest periods.
.
c. Silence the alarms on the cardiac monitors to allow 30- to 40-minute naps.
d Eliminate assessments between 0100 and 0600 to allow uninterrupted sleep.
.
ANS: B
2. Which hemodynamic parameter is most appropriate for the nurse to monitor to determine the effectiveness of
medications given to a patient to reduce left ventricular afterload?
a Mean arterial pressure (MAP)
.
b Systemic vascular resistance (SVR)
.
c. Pulmonary vascular resistance (PVR)
d Pulmonary artery wedge pressure (PAWP)
.
ANS: B
3. While family members are visiting, a patient has a respiratory arrest and is being resuscitated. Which action by
the nurse is best?
a Tell the family members that watching the resuscitation will be very stressful.
.
b Ask family members if they wish to remain in the room during the resuscitation.
.
c. Take the family members quickly out of the patient room and remain with them.
d Assign a staff member to wait with family members just outside the patient room.
.
ANS: B
4. Following surgery for an abdominal aortic aneurysm, a patients central venous pressure (CVP) monitor indicates
low pressures. Which action is a priority for the nurse to take?
a Administer IV diuretic medications.
.
b Increase the IV fluid infusion per protocol.
.
, c. Document the CVP and continue to monitor.
d Elevate the head of the patients bed to 45 degrees.
.
ANS: B
5. When caring for a patient with pulmonary hypertension, which parameter is most appropriate for the nurse to
monitor to evaluate the effectiveness of the treatment?
a Central venous pressure (CVP)
.
b Systemic vascular resistance (SVR)
.
c. Pulmonary vascular resistance (PVR)
d Pulmonary artery wedge pressure (PAWP)
.
ANS: C
6. The intensive care unit (ICU) nurse educator will determine that teaching about arterial pressure monitoring for a
new staff nurse has been effective when the nurse
a balances and calibrates the monitoring equipment every 2 hours.
.
b positions the zero-reference stopcock line level with the phlebostatic axis.
.
c. ensures that the patient is supine with the head of the bed flat for all readings.
d rechecks the location of the phlebostatic axis when changing the patients position.
.
ANS: B
7. When monitoring for the effectiveness of treatment for a patient with a large anterior wall myocardial infarction,
the most important information for the nurse to obtain is
a central venous pressure (CVP).
.
b systemic vascular resistance (SVR).
.
c. pulmonary vascular resistance (PVR).
d pulmonary artery wedge pressure (PAWP).
.
ANS: D
8. Which action is a priority for the nurse to take when the low pressure alarm sounds for a patient who has an
arterial line in the left radial artery?
a Fast flush the arterial line.
.
b Check the left hand for pallor.
