Critical Care Exam 1 Questions

Critical Care Exam 1 Questions You have just received change of shift report. Which patient should you assess first? a. 62 year-old man who is scheduled for a cardiac cath, and is ready to be transported now b. 58 year-old woman with COPD with an O2 saturation of 92% on 2 liters of O2, who is scheduled to be discharged home on O2 c. 36 year-old man admitted with an exacerbation of asthma with RR 36 at rest, and whose wheezing has diminished d. 72 year-old woman with history of asthma with HR 90 and is due for her beta-blocker Ans- C RR 36 and diminished wheezing indicative of respiratory distress and needs prompt attention You are about to handover patient care to your on-coming nurse colleague. Which patient requires the most immediate attention? 1.) 62 year-old man with COPD who has just completed his scheduled bronchodilator 2.) 68 year-old woman with type 2 diabetes who had CVA 2 days ago 3.) 72 year-old woman with history of asthma with HR 90 and is due for her beta-blocker 4.) 48 year-old man admitted with cellulitis of his right hand after a construction accident, currently on IV antibiotics, with a temperature of 101.8 Ans- 4 Cellulitis is serious infection, involving swelling of subcutaneous tissue, fluid displacement due to 3rd spacing. What else would you assess? You are assigned to care for a 58 year-old man who is scheduled for a cardiac angiogram during your shift. What actions should you take? Check all that apply. 1-Explain that the patient will receive short-acting anesthesia 2-Review the patient's allergies, specifically checking to see if he has an allergy to contrast dye 3-Inform the patient that his wife should stay at home until the procedure is finished, as family members often distract the team in the cath lab 4-Review and reconcile his medications. Confirm that he did not take his warfarin 5-Check the patient's most recent labs paying particular attention to the PT INR Ans- 2, 4, 5 Contrast dyes contain iodine and allergy could lead to anaphylactic response; might receive light sedation but needs to be awake and able to follow directions A 62 year-old man, who is s/p coronary artery bypass surgery, is about to be transferred from the ICU to the cardiac stepdown unit. What is the most effective way for the ICU (reporting) nurse and cardiac stepdown (receiving) nurse to ensure that essential patient information is conveyed? 1- A face-to-face verbal report with both nurses present in a quiet room 2- The ICU nurse will provide an audio-recorded report for future reference and documentation 3- The ICU nurse will document essential transfer information in the patient's medical record 4- The ICU nurse will accompany the patient to the stepdown unit and provide a face-to-face report, using a unit-approved, standardized guide Ans- 4 What is the most common outcome associated with poorly managed hospital discharge? Ans- Adverse Drug events The nurse is tracking data on a group of patients with heart failure, who have been discharged from the unit where you work and are now being followed in clinic. What is the best indicator that the nursing interventions of monitoring and teaching have been effective? 1- Eighty-five percent of patients have not gained weight 2- Seventy-five percent of family caregivers have reported watching an educational DVD 3- Five percent of patients have been readmitted to the hospital in the last 90 days 4- Eighty percent report that they are taking their medications Ans- 3 All are important but lower resource utilization is best indicator and one used by accrediting agencies, payors, etc. You are the nurse preparing to discharge a 46 year-old man with hypertension who was started on chlorothiazide. You ask the patient to share with you his understanding of his new medication. Which of the following statements indicates your teaching has been effective? Select all that apply. 1- I will weigh myself every day at the same time. 2- I will notify Charles, the nurse practitioner in my primary care doctor's office if I gain 3 pounds or more, have increased swelling in my feet and ankles, or feel more tired than usual. 3- I will reduce my medication if I feel very thirsty or dizzy. 4- I will wear sunscreen if I will be out in the sun for a long period of time. 5- If I want to drink alcohol, I will wait and take my medication right before I go to bed. Ans- 1, 2, 4 The following should NOT be used to reduce pressure, as it may increase friction injuries: A) rolled towels B) convoluted foam mattress overlay C) foam pads D) viscoelastic overlay Ans- A Rolled towels and sheets should not be used and may negate pressure-reducing function of other pads The MOST common cause of delayed surgical wound healing is: A) diabetes B) surgical site infection C) malnutrition D) impaired circulation Ans- B Purlent discharge, signs of infection, open wound. Can occur 30 days up to 1 year post op An adult Jehovah's' Witness patient is hemorrhaging and might die without transfusions, but he refused blood products prior to surgery. The correct procedure is? A) use volume replacement and fractionated blood cells only, as permitted by the religion B) contact family and ask permission C) ask legal authorities to grant permission D) give transfusions because the patient may die Ans- ANSWER: A This patients religion only permits fractions from red cells, white cells, platelets, and plasma. Some JW request no blood products at all The nurse is taking care of Ms. Smith. She is a 85 year old with severe congestive heart failure and has history of severe dementia and CVA. She has had multiple admissions for CHF exacerbation. Despite aggressive treatment, she remains dyspneic and is requiring high flow oxygen at 10L. During rounds, the team discusses sending the patient to the ICU due to her probable need for mechanical ventilation. As the nurse you are concerned that this plan of care is inappropriate, what is the best action? A. Discuss the concern with the physician and treatment team and recommend consultation with palliative care B. Call the patient's proxy and schedule a meeting with the physician C. Initiate an ethics consult immediately D. Communicate the concerns to the oncoming nurse during hand off of care Ans- A Jill Green is a 42-year-old mother of two who has been married for 17 years. She was diagnosed with ovarian cancer 2 years ago. After the initial diagnosis Jill had a total hysterectomy. For the last 2 years she has undergone intensive chemotherapy and radiation. Despite treatment, the ovarian cancer progressed to the late stage and metastasized to the lungs and bones. After collaborating with her healthcare providers, Jill has decided to pursue palliative care with a focus on comfort care.The home hospice RN is assigned to manage Jill's care. During the initial evaluation, the RN establishes a plan of care. Which problem should the nurse address first? A. The client's bowel and urination elimination pattern, the priority concern of the health care provider. B. The problem that the client identifies as the first priority, the problem that most concerns the client. C. The client's need for help with hygienic activities, the primary nursing diag