LATEST CCS FINAL EXAM 2 LATEST EXAM ACTUAL EXAM 200 QUESTIONS AND CORRECTLY DETAILED

The critical care nurse can best enhance the principle of autonomy by: a. allowing the patient to do as much for himself or herself as possible. b. assisting with only those tasks that cannot be done by the patient. c. providing the patient with all information and facts. d. guiding the patient toward the best choices for care. - ANSWERS ANS: C Autonomy can be viewed as the freedom to make decisions about one's own body without the coercion or interference of others. Patients and families must have all the information about a certain situation to make an autonomous decision that is best for them. Allowing the patient to do as much for himself/herself as possible is the concept of self-care. 12. Injury resulting from the failure to meet an ordinary duty or standard of care is termed: a. negligence. b. malpractice. c. assault. d. battery. - ANSWERS ANS: A Injury resulting from the failure to meet an ordinary duty or standard of care is termed negligence. 7. Nurses in high acuity and emergency settings will be challenged by patients who have attempted suicide or are at risk for doing so. What patient type is least at risk for suicide? a. 23-year-old woman with stage IV breast cancer b. 76-year-old recently widowed man with end-stage chronic obstructive pulmonary disease c. 30-year-old woman with postpartum hemorrhage d. 42-year-old man with acquired immunodeficiency syndrome (AIDS) - ANSWERS ANS: C Depression is mentioned as a causal factor in up to 70% of suicide attempts by people age 15 to 24 years and by people older than 65 years. Suicide rates for persons with AIDS have been reported to be 66 times greater than those for the general population. Bio-psychological events that contribute to suicide may involve living within the limits of a chronic disease or a life-threatening illness. 12. What is the rationale for careful intake and output for the patient with pulmonary alterations? a. Fluid retention occurs with tachypnea. b. Hemodilution may cause deleterious hypernatremia. c. Fluid volume excess can lead to right-sided heart failure. d. Excessive fluid losses may lead to dehydration and hypovolemic shock. - ANSWERS ANS: C Pulmonary edema and failure of the right side of the heart may result from fluid volume excess, which can further worsen the status of the patient with respiratory compromise. 18. Mr. F is admitted to the critical care unit with severe malnutrition as a result of hepatic failure. A triple-lumen central venous catheter is placed in the right subclavian vein and TPN is started. On the third day of infusion, Mr. F has symptoms of fever and chills. Which of the following complications should be suspected? a. Air embolism b. Pneumothorax c. Central venous thrombosis d. Catheter-related sepsis - ANSWERS ANS: D Signs and symptoms of catheter-related sepsis include fever, chills, glucose intolerance, and positive blood cultures. 15. Which of the following nutritional interventions is a priority for the patient with renal disease? a. Increase fluids to replace losses. b. Encourage potassium-rich foods to replace losses. c. Ensure an adequate amount of protein to prevent catabolism. d. Limit all nutrients to account for altered renal excretion. - ANSWERS ANS: C The patient with renal disease must receive an adequate amount of protein to prevent catabolism of body tissues to meet energy needs. Approximately 1.5 g to 1.8 g protein/kg per day is required. 7. An older patient is started on an angiotensin-converting enzyme (ACE) inhibitor. The nurse knows to monitor for: a. hyperkalemia. b. irregular heart rate. c. confusion. d. pulmonary edema. - ANSWERS ANS: A In the critically ill older adult, drugs such as digoxin, ACE II inhibitors, and angiotensin II receptor blockers have delayed excretion, increased serum concentration, and more prolonged duration of action because their excretion parallels glomerular filtration rate, which decreases with age. 17. During the second week of stay in the critical care unit, the patient has the following laboratory results: potassium, 6.0 mmol/L; CO2, 36 mEq/L; Cl, 103 mEq/L; HCO3, 38 mEq/L; and dark reddish urine. The nurse recognizes that these results may signal which of the following? a. Severe infection b. Toxic shock syndrome c. Propofol infusion syndrome d. Hepatitis - ANSWERS ANS: C Propofol infusion syndrome is a rare complication of prolonged high-dose propofol administration. It occurs more commonly in children than in adult critically ill patients. The syndrome includes cardiac arrest, myocardial failure, metabolic acidosis, rhabdomyolysis, and hyperkalemia, which occur on day 4 or 5 following very high-dose propofol infusion. 6. A patient who has been deeply sedated for a prolonged interval must be monitored for: a. complications of immobility. b. drastic weight loss. c. restlessness and anxiety. d. altered mentation. - ANSWERS ANS: A Prolonged deep sedation is associated with significant complications of immobility, including pressure ulcers, thromboemboli, gastric ileus, nosocomial pneumonia, and delayed weaning from mechanical ventilation. 1. Which of the following complications can result from oversedation? (Select all that apply) a. Pressure ulcers b. Thromboemboli c. Gastric ileus d. Hospital-acquired pneumonia e. Delayed weaning from mechanical ventilation - ANSWERS ANS: A, B, C, D, E Oversedation can result in a multitude of complications. 7. For the safety of the patient who is sedated with midazolam (Versed), the nurse will be sure to have available: a. naloxone (Narcan). b. flumazenil (Romazicon). c. glucagons. d. naltrexone (ReVia). - ANSWERS ANS: B Flumazenil is the antidote used to reverse benzodiazepine overdose in symptomatic patients, if needed. 11. The patient's wife is very concerned about the fact that her dying husband is vomiting. Because he has not had any food in several days, this is confusing to her. The nurse explains to her: a. "The nausea may be due to the medication he is taking. We should discontinue it for a while and see if that helps." b. "As the body shuts down, the organ systems slow their work, and sometimes this causes nausea and vomiting due to intestinal obstruction." c. "There is no medication he can be given that will make him feel better at this point." d. "Would you like to fix him a nice hot bowl of soup and see if that helps any?" - ANSWERS ANS: B Nausea and vomiting are common and should be treated with antiemetics. The cause of nausea and vomiting may be intestinal obstruction. Treatment for decompression may be uncomfortable in dying patients, so its use should be weighed by considering the benefit/burden ratio. 20. A patient with a serum potassium level of 6.8 mEq/L may exhibit electrocardiographic changes of: a. a prominent U-wave. b. tall, peaked T-waves. c. a narrowed QRS. d. sudden ventricular dysrhythmias. - ANSWERS ANS: B Tall, narrow peaked T-waves are usually, although not uniquely, associated with early hyperkalemia and are followed by prolongation of the PR interval, loss of the P-wave, widening of the QRS complex, heart block, and asystole. Severely elevated serum potassium (greater than 8 mEq/L) causes a wide QRS tachycardia. 1. Which finding on the electrocardiogram (ECG) is most conclusive for infarction? a. Inverted T-waves b. Tall, peaked T-waves c. ST-segment depression d. Q-waves - ANSWERS ANS: D On the ECG, evidence of infarction is seen by the presence of pathological Q-waves. 8. Which of the following patients would be a good candidate for fibrinolytic therapy following an acute myocardial infarction? a. Postpartum woman, age 17, who delivered her first baby 1 hour ago b. Forty-nine-year-old man with no previous history of illness c. Sixty-nine-year-old woman who has been taking aspirin for arthritis for a decade d. Seventy-two-year-old man who experienced a stroke 1 month ago - ANSWERS ANS: B Increased risk of bleeding after the use of fibrinolytics constitutes the major exclusion criterion. Patients who have stable clots that might be disrupted by fibrinolytic therapy (clots secondary to recent surgery, trauma, or stroke) are generally not considered candidates. fibrinolytic therapy treatment for...... and time to be given - ANSWERS For stroke, 12h. For head trauma, 4.5h 18. A patient is being monitored by continuous electrocardiogram (ECG) after placement of a transvenous pacemaker. "Loss of capture" is seen on the ECG. Which nursing intervention may correct this situation? a. Position the patient on the left side. b. Decrease the milliamperes as ordered. c. Increase the rate as ordered. d. Monitor the patient in a different lead. - ANSWERS ANS: A "Loss of capture" most often can be attributed either to displacement of the pacing electrode or to an increase in threshold as a result of drugs, metabolic disorders, electrolyte imbalances, or fibrosis or myocardial ischemia at the site of electrode