Critical Care Exam 1
When administering nitroglycerin, which possible outcome does the nurse need to monitor
the patient for?
A. Peripheral vasoconstriction with tissue necrosis
B. Increased afterload
C. Peripheral vasodilation
D. Increased preload - correct answer-C. peripheral vasodilation
A patient is admitted to the ICU with a pulmonary artery (PA) catheter in the left internal
jugular. During the nurse's shift, the PA pressure increases. What additional priority
assessment does the nurse need to perform next?
A. Assess the patient's urine output
B. Assess the patient's lung sounds
C. Assess the patient's blood pressure
D. Assess the patient's heart rhythm - correct answer-B. Assess the patient's lung sounds
The nurse is caring for a patient with an internal jugular central line and a left radial arterial
line. The patient asks the nurse why he needs two lines and what the difference is. What will
the nurse include in the explanation?
A. "The internal jugular line is only for medication administration and the arterial line monitors
your central venous pressure."
B. "The internal jugular line is for monitoring your central venous pressure and the arterial
line is only for medication administration."
C. "The internal jugular line is only for monitoring your central venous pressure and the
arterial line is for monitoring your blood pressure."
D. "The internal jugular line is for monitoring your central venous pressure and medication
administration. The arterial line is for monitoring your blood pressure." - correct answer-D.
"The internal jugular line is for monitoring your central venous pressure and medication
administration. The arterial line is for monitoring your blood pressure."
The nurse observes asystole on the patient's telemetry monitor. What is the nurse first
action?
A. Carry out defibrillation.
B. Notify the physician.
C. Assess the patient.
D. Administer atropine IV. - correct answer-C. Assess the patient.
When reviewing the patient's medication administration record (MAR) the notes the
medication atropine listed. The nurse understands that this medication is administered for
which problem?
,A. Symptomatic bradycardia
B. Symptomatic tachycardia
C. Supraventricular tachycardia
D. Ventricular dysthymias - correct answer-A. Symptomatic bradycardia
A patient has an intraaortic balloon pump (IABP) in the left groin. Which assessment finding
requires immediate action by the nurse?
A. Heart rate of 60 beats per minute
B. New onset confusion
C. Blood pressure of 90/55
D. Scant amount of blood on the left groin dressing - correct answer-B. New onset confusion
The nurse is caring for a patient with a congestive heart failure and a central venous
pressure (CVP) of 15.. The nurse administers 40mg Lasix IVP as per physician order. What
will the nurse monitor to evaluate the effectiveness of the treatment?
A. Assess the patient's skin turgor.
B. Patient reports feeling "better."
C. Central venous pressure increases to 20.
D. Central venous pressure decreases to 8. - correct answer-D. Central venous pressure
decreases to 8.
A patient who had an actue myocardial infarction 12 hours ago has hemodynamic
monitoring. While monitoring the patient, the nurse notes the patient's central venous
pressure is 12mmHg. What other assessment findings will the nurse anticipate? Select all
that apply.
A. Weight loss of 2 kg since admission
B. Peripheral edema
C. Dyspnea
D. Decreased skin turgor
E. Hypertension - correct answer-B. Peripheral edema
C. Dyspnea
E. Hypertension
A patient has arrived in the emergency room complaining of chest pain. The patient is
confused and does not remember when the chest pain started. What laboratory test results
in the highest priority in assisting the nurse in planning care for this patient?
A. Troponin 3.6 ng/mL
B. Creatinine 1.7 ng/mL
C. Creatine kinase (CK) 50 units/L
D. Potassium 3.1 mEq/L - correct answer-A. Troponin 3.6 ng/mL
The nurse observes asystole on the patient's telemetry monitor. What is the first action?
A. Carry out defibrillation
, B. Notify the physician
C. Assess the patient
D. Administer atropine IV - correct answer-C. Assess the patient
The nurse is caring for a patient with a mitral valve replacement who is now 3 hours post op.
The nurse recognizes that the patient had a synthetic mechanical valve implanted, but the
patient is not anti-coagulated upon return from surgery. What is the reason the patient would
require anti-coagulation?
A. The valve will not open if the patient is not anti-coagulated
B. The patient is at a greater risk for the development of endocarditis if they are not
anti-coagulated
C. The patient will be at a high risk for clot formation around the new valve without
anti-coagulation, which could lead to an increased risk of stroke.
D. These patients do not get anti-coagulated because they just had the surgical repair of the
malfunctioning valve. - correct answer-C. The patient will be at a high risk for clot formation
around the new valve without anti-coagulation, which could lead to an increased risk of
stroke.
Cardioversion - correct answer-controlled electrical discharge of energy at the peak of the
R-wave
pulse, tachycardia, SVT, v-tach with a pulse
*timed shock*
Defibrilation - correct answer-uncontrolled electrical discharge of energy ANYWHERE during
the cardiac cycle
pulseless, vtach without a pulse, ventricular fib, torsods
ECG/EKG (electrocardiogram) - correct answer-if there are no symptoms no need to treat =
may be their normal
QRS Complex - correct answer-depolarization of the ventricles
ST Segment - correct answer-Beginning of ventricule repolarization.
PR Interval - correct answer-Delay of AV node to allow for ventricular filling
T-Wave - correct answer-ventricular repolarization
P-Wave - correct answer-Depolariziation of the atria.
Normal Sinus Rhythm - correct answer-HR: 60-100 bpm
P-Wave: 1 P for every QRS
PR Interval: 0.12-0.20 sec
QRS: all the same shape <0.12
When administering nitroglycerin, which possible outcome does the nurse need to monitor
the patient for?
A. Peripheral vasoconstriction with tissue necrosis
B. Increased afterload
C. Peripheral vasodilation
D. Increased preload - correct answer-C. peripheral vasodilation
A patient is admitted to the ICU with a pulmonary artery (PA) catheter in the left internal
jugular. During the nurse's shift, the PA pressure increases. What additional priority
assessment does the nurse need to perform next?
A. Assess the patient's urine output
B. Assess the patient's lung sounds
C. Assess the patient's blood pressure
D. Assess the patient's heart rhythm - correct answer-B. Assess the patient's lung sounds
The nurse is caring for a patient with an internal jugular central line and a left radial arterial
line. The patient asks the nurse why he needs two lines and what the difference is. What will
the nurse include in the explanation?
A. "The internal jugular line is only for medication administration and the arterial line monitors
your central venous pressure."
B. "The internal jugular line is for monitoring your central venous pressure and the arterial
line is only for medication administration."
C. "The internal jugular line is only for monitoring your central venous pressure and the
arterial line is for monitoring your blood pressure."
D. "The internal jugular line is for monitoring your central venous pressure and medication
administration. The arterial line is for monitoring your blood pressure." - correct answer-D.
"The internal jugular line is for monitoring your central venous pressure and medication
administration. The arterial line is for monitoring your blood pressure."
The nurse observes asystole on the patient's telemetry monitor. What is the nurse first
action?
A. Carry out defibrillation.
B. Notify the physician.
C. Assess the patient.
D. Administer atropine IV. - correct answer-C. Assess the patient.
When reviewing the patient's medication administration record (MAR) the notes the
medication atropine listed. The nurse understands that this medication is administered for
which problem?
,A. Symptomatic bradycardia
B. Symptomatic tachycardia
C. Supraventricular tachycardia
D. Ventricular dysthymias - correct answer-A. Symptomatic bradycardia
A patient has an intraaortic balloon pump (IABP) in the left groin. Which assessment finding
requires immediate action by the nurse?
A. Heart rate of 60 beats per minute
B. New onset confusion
C. Blood pressure of 90/55
D. Scant amount of blood on the left groin dressing - correct answer-B. New onset confusion
The nurse is caring for a patient with a congestive heart failure and a central venous
pressure (CVP) of 15.. The nurse administers 40mg Lasix IVP as per physician order. What
will the nurse monitor to evaluate the effectiveness of the treatment?
A. Assess the patient's skin turgor.
B. Patient reports feeling "better."
C. Central venous pressure increases to 20.
D. Central venous pressure decreases to 8. - correct answer-D. Central venous pressure
decreases to 8.
A patient who had an actue myocardial infarction 12 hours ago has hemodynamic
monitoring. While monitoring the patient, the nurse notes the patient's central venous
pressure is 12mmHg. What other assessment findings will the nurse anticipate? Select all
that apply.
A. Weight loss of 2 kg since admission
B. Peripheral edema
C. Dyspnea
D. Decreased skin turgor
E. Hypertension - correct answer-B. Peripheral edema
C. Dyspnea
E. Hypertension
A patient has arrived in the emergency room complaining of chest pain. The patient is
confused and does not remember when the chest pain started. What laboratory test results
in the highest priority in assisting the nurse in planning care for this patient?
A. Troponin 3.6 ng/mL
B. Creatinine 1.7 ng/mL
C. Creatine kinase (CK) 50 units/L
D. Potassium 3.1 mEq/L - correct answer-A. Troponin 3.6 ng/mL
The nurse observes asystole on the patient's telemetry monitor. What is the first action?
A. Carry out defibrillation
, B. Notify the physician
C. Assess the patient
D. Administer atropine IV - correct answer-C. Assess the patient
The nurse is caring for a patient with a mitral valve replacement who is now 3 hours post op.
The nurse recognizes that the patient had a synthetic mechanical valve implanted, but the
patient is not anti-coagulated upon return from surgery. What is the reason the patient would
require anti-coagulation?
A. The valve will not open if the patient is not anti-coagulated
B. The patient is at a greater risk for the development of endocarditis if they are not
anti-coagulated
C. The patient will be at a high risk for clot formation around the new valve without
anti-coagulation, which could lead to an increased risk of stroke.
D. These patients do not get anti-coagulated because they just had the surgical repair of the
malfunctioning valve. - correct answer-C. The patient will be at a high risk for clot formation
around the new valve without anti-coagulation, which could lead to an increased risk of
stroke.
Cardioversion - correct answer-controlled electrical discharge of energy at the peak of the
R-wave
pulse, tachycardia, SVT, v-tach with a pulse
*timed shock*
Defibrilation - correct answer-uncontrolled electrical discharge of energy ANYWHERE during
the cardiac cycle
pulseless, vtach without a pulse, ventricular fib, torsods
ECG/EKG (electrocardiogram) - correct answer-if there are no symptoms no need to treat =
may be their normal
QRS Complex - correct answer-depolarization of the ventricles
ST Segment - correct answer-Beginning of ventricule repolarization.
PR Interval - correct answer-Delay of AV node to allow for ventricular filling
T-Wave - correct answer-ventricular repolarization
P-Wave - correct answer-Depolariziation of the atria.
Normal Sinus Rhythm - correct answer-HR: 60-100 bpm
P-Wave: 1 P for every QRS
PR Interval: 0.12-0.20 sec
QRS: all the same shape <0.12
