Question 1

Four hours after mechanical ventilation is initiated for a patient with chronic obstructive pulmonary disease (COPD),the patient's arterial blood gas (ABG)results include a pH of 7.51,PaO₂ of 82 mm Hg,PaCO₂ of 26 mm Hg,and HCO₂- of 23 mEq/L (23 mmol/L).The nurse will anticipate the need to

Accepted Answer

The patient's PaCO₂ and pH indicate respiratory alkalosis caused by too high a respiratory rate.The PaO₂ is appropriate for a patient with COPD and increasing the respiratory rate and tidal volume would further lower the PaCO₂.

Question 2

After change-of-shift report,which patient should the progressive care nurse assess first?

Accepted Answer

The findings for this patient indicate high risk for bleeding from an elevated (nontherapeutic)PTT.The nurse needs to adjust the rate of the infusion (dose)per the health care provider's parameters.The patient with BiPAP for sleep apnea has a normal respiratory rate.The patient recovering from the percutaneous coronary intervention will need to be assisted with voiding and this task could be delegated to unlicensed assistive personnel.The patient with a fever may be developing ventilator-associated pneumonia,but addressing the bleeding risk is a higher priority.

Question 3

An 81-year-old patient who has been in the intensive care unit (ICU)for a week is now stable and transfer to the progressive care unit is planned.On rounds,the nurse notices that the patient has new onset confusion.The nurse will plan to

Accepted Answer

The patient's history and symptoms most likely indicate delirium associated with the sleep deprivation and sensory overload in the ICU environment.Informing the receiving nurse and transferring the patient is appropriate.Postponing the transfer is likely to prolong the delirium.Benzodiazepines and restraints contribute to delirium and agitation.

Question 4

When caring for a patient who has an arterial catheter in the left radial artery for arterial pressure-based cardiac output (APCO)monitoring,which information obtained by the nurse is most important to report to the health care provider?

Accepted Answer

Redness at the catheter insertion site indicates possible infection.The Allen test is performed before arterial line insertion,and a positive test indicates normal ulnar artery perfusion.A MAP of 86 is normal and the dicrotic notch is normally present on the arterial waveform.

Question 5

The nurse is caring for a patient with a subarachnoid hemorrhage who is intubated and placed on a mechanical ventilator with 10 cm H₂O of peak end-expiratory pressure (PEEP).When monitoring the patient,the nurse will need to notify the health care provider immediately if the patient develops

Accepted Answer

Increases in jugular venous distention in a patient with a subarachnoid hemorrhage may indicate an increase in intracranial pressure (ICP)and that the PEEP setting is too high for this patient.A respiratory rate of 20,O₂ saturation of 93%,and green nasogastric tube drainage are within normal limits.

Question 6

The nurse is caring for a patient receiving a continuous norepinephrine (Levophed)IV infusion.Which patient assessment finding indicates that the infusion rate may need to be adjusted?

Accepted Answer

Vasoconstrictors such as norepinephrine (Levophed)will increase SVR,and this will increase the work of the heart and decrease peripheral perfusion.The infusion rate may need to be decreased.Bradycardia,hypotension (MAP of 56 mm Hg),and low PAWP are not associated with norepinephrine infusion.

Question 7

When evaluating a patient with a central venous catheter,the nurse observes that the insertion site is red and tender to touch and the patient's temperature is 101.8° F.What should the nurse plan to do next?

Accepted Answer

The information indicates that the patient has a local and systemic infection caused by the catheter,and the catheter should be discontinued.Changing the flush system,giving analgesics,and continued monitoring will not help prevent or treat the infection.Administration of antibiotics is appropriate,but the line should still be discontinued to avoid further complications such as endocarditis.

Question 8

The nurse notes that a patient's endotracheal tube (ET),which was at the 22-cm mark,is now at the 25-cm mark and the patient is anxious and restless.Which action should the nurse take next?

Accepted Answer

The nurse should first determine whether the ET tube has been displaced into the right mainstem bronchus by listening for unilateral breath sounds.If so,assistance will be needed to reposition the tube immediately.The other actions are also appropriate,but detection and correction of tube malposition are the most critical actions.

Question 9

A patient's vital signs are pulse 87,respirations 24,and BP of 128/64 mm Hg and cardiac output is 4.7 L/min.The patient's stroke volume is _____ mL.(Round to the nearest whole number.)

Accepted Answer

The answer of A patient's vital signs are pulse 87,respirations...

Question 10

The nurse educator is evaluating the performance of a new registered nurse (RN)who is providing care to a patient who is receiving mechanical ventilation with 15 cm H₂O of peak end-expiratory pressure (PEEP).Which action indicates that the new RN is safe?

Accepted Answer

The closed-suction technique is used when patients require high levels of PEEP (>10 cm H₂O)to prevent the loss of PEEP that occurs when disconnecting the patient from the ventilator.Suctioning should not be scheduled routinely,but it should be done only when patient assessment data indicate the need for suctioning.Taping connections between the ET and the ventilator tubing would restrict the ability of the tubing to swivel in response to patient repositioning.Ventilator tubing changes increase the risk for ventilator-associated pneumonia (VAP)and are not indicated routinely.

Question 11

A nurse is weaning a 68-kg male patient who has chronic obstructive pulmonary disease (COPD)from mechanical ventilation.Which patient assessment finding indicates that the weaning protocol should be stopped?

Accepted Answer

Tachypnea is a sign that the patient's work of breathing is too high to allow weaning to proceed.The patient's heart rate is within normal limits,although the nurse should continue to monitor it.An oxygen saturation of 93% is acceptable for a patient with COPD.A spontaneous tidal volume of 450 mL is within the acceptable range.

Question 12

When caring for the patient with a pulmonary artery (PA)pressure catheter,the nurse observes that the PA waveform indicates that the catheter is in the wedged position.Which action should the nurse take next?

Accepted Answer

When the catheter is in the wedge position,blood flow past the catheter is obstructed,placing the patient at risk for pulmonary infarction.A health care provider or advanced practice nurse should be called to reposition the catheter.The other actions will not correct the wedging of the PA catheter.

Question 13

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 next?

Accepted Answer

Lack of information is a major source of anxiety for family members and should be addressed first.Family members should be prepared for the patient's appearance and the ICU environment before visiting the patient for the first time.ICU visiting should be individualized to each patient and family rather than being dictated by rigid visitation policies.Inviting the family to participate in a multidisciplinary conference is appropriate but should not be the initial action by the nurse.

Question 14

The nurse responds to a ventilator alarm and finds the patient lying in bed holding the endotracheal tube (ET).Which action should the nurse take next?

Accepted Answer

The nurse should ensure maximal patient oxygenation by manually ventilating with a bag-valve-mask system.Offering reassurance to the patient,notifying the health care provider about the need to reinsert the tube,and activating the rapid response team are also appropriate after the nurse has stabilized the patient's oxygenation.

Question 15

When assisting with oral intubation of a patient who is having respiratory distress,in which order will the nurse take these actions? (Put a comma and a space between each answer choice [A,B,C,D,E].)
A) Obtain a portable chest-x-ray.
B) Position the patient in the supine position.
C) Inflate the cuff of the endotracheal tube after insertion.
D) Attach an end-tidal CO₂ detector to the endotracheal tube.
E) Oxygenate the patient with a bag-valve-mask device for several minutes.

Accepted Answer

The answer of When assisting with oral intubation of a...

Question 16

The nurse educator is evaluating the care that a new registered nurse (RN)provides to a patient receiving mechanical ventilation.Which action by the new RN indicates the need for more education?

Accepted Answer

The head of the patient's bed should be positioned at 30 to 45 degrees to prevent ventilator-associated pneumonia.The other actions by the new RN are appropriate.

Question 17

A patient who is receiving positive pressure ventilation is scheduled for a spontaneous breathing trial (SBT).Which finding by the nurse is most important to discuss with the health care provider before starting the SBT?

Accepted Answer

Myocardial ischemia is a contraindication for ventilator weaning.The ST segment elevation is an indication that weaning should be postponed until further investigation and/or treatment for myocardial ischemia can be done.The other information will also be shared with the health care provider,but ventilator weaning can proceed when opioids are used for pain management,abnormal lung sounds are present,or enteral feedings are being used.

Question 18

After change-of-shift report on a ventilator weaning unit,which patient should the nurse assess first?

Accepted Answer

The decreased urine output may indicate acute kidney injury or that the patient's cardiac output and perfusion of vital organs have decreased.Any of these causes would require rapid action.The data about the other patients indicate that their conditions are stable and do not require immediate assessment or changes in their care.Continuous PETCO monitoring is frequently used when patients are intubated.The rest mode should be used to allow patient recovery after a failed SBT,and an ScvO₂ of 69% is within normal limits.

Question 19

A patient with respiratory failure has arterial pressure-based cardiac output (APCO)monitoring and is receiving mechanical ventilation with peak end-expiratory pressure (PEEP)of 12 cm H₂O.Which information indicates that a change in the ventilator settings may be required?

Accepted Answer

The hypotension suggests that the high intrathoracic pressure caused by the PEEP may be decreasing venous return and (potentially)cardiac output.The other assessment data would not be a direct result of PEEP and mechanical ventilation.

Question 20

A patient who is orally intubated and receiving mechanical ventilation is anxious and is "fighting" the ventilator.Which action should the nurse take next?

Accepted Answer

The initial response by the nurse should be to try to decrease the patient's anxiety by coaching the patient about how to coordinate respirations with the ventilator.The other actions may also be helpful if the verbal coaching is ineffective in reducing the patient's anxiety.

Quiz 66: Nursing Management: Critical Care

Four hours after mechanical ventilation is initiated for a patient with chronic obstructive pulmonary disease (COPD) ,the patient's arterial blood gas (ABG) results include a pH of 7.51,PaO₂ of 82 mm Hg,PaCO₂ of 26 mm Hg,and HCO₂- of 23 mEq/L (23 mmol/L) .The nurse will anticipate the need to

After change-of-shift report,which patient should the progressive care nurse assess first?

An 81-year-old patient who has been in the intensive care unit (ICU) for a week is now stable and transfer to the progressive care unit is planned.On rounds,the nurse notices that the patient has new onset confusion.The nurse will plan to

When caring for a patient who has an arterial catheter in the left radial artery for arterial pressure-based cardiac output (APCO) monitoring,which information obtained by the nurse is most important to report to the health care provider?

The nurse is caring for a patient with a subarachnoid hemorrhage who is intubated and placed on a mechanical ventilator with 10 cm H₂O of peak end-expiratory pressure (PEEP) .When monitoring the patient,the nurse will need to notify the health care provider immediately if the patient develops

The nurse is caring for a patient receiving a continuous norepinephrine (Levophed) IV infusion.Which patient assessment finding indicates that the infusion rate may need to be adjusted?

When evaluating a patient with a central venous catheter,the nurse observes that the insertion site is red and tender to touch and the patient's temperature is 101.8° F.What should the nurse plan to do next?

The nurse notes that a patient's endotracheal tube (ET) ,which was at the 22-cm mark,is now at the 25-cm mark and the patient is anxious and restless.Which action should the nurse take next?

A patient's vital signs are pulse 87,respirations 24,and BP of 128/64 mm Hg and cardiac output is 4.7 L/min.The patient's stroke volume is _____ mL.(Round to the nearest whole number.)

The nurse educator is evaluating the performance of a new registered nurse (RN) who is providing care to a patient who is receiving mechanical ventilation with 15 cm H₂O of peak end-expiratory pressure (PEEP) .Which action indicates that the new RN is safe?

A nurse is weaning a 68-kg male patient who has chronic obstructive pulmonary disease (COPD) from mechanical ventilation.Which patient assessment finding indicates that the weaning protocol should be stopped?

When caring for the patient with a pulmonary artery (PA) pressure catheter,the nurse observes that the PA waveform indicates that the catheter is in the wedged position.Which action should the nurse take next?

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 next?

The nurse responds to a ventilator alarm and finds the patient lying in bed holding the endotracheal tube (ET) .Which action should the nurse take next?

The nurse educator is evaluating the care that a new registered nurse (RN) provides to a patient receiving mechanical ventilation.Which action by the new RN indicates the need for more education?

A patient who is receiving positive pressure ventilation is scheduled for a spontaneous breathing trial (SBT) .Which finding by the nurse is most important to discuss with the health care provider before starting the SBT?

After change-of-shift report on a ventilator weaning unit,which patient should the nurse assess first?

A patient with respiratory failure has arterial pressure-based cardiac output (APCO) monitoring and is receiving mechanical ventilation with peak end-expiratory pressure (PEEP) of 12 cm H₂O.Which information indicates that a change in the ventilator settings may be required?

A patient who is orally intubated and receiving mechanical ventilation is anxious and is "fighting" the ventilator.Which action should the nurse take next?

Quiz 66: Nursing Management: Critical Care

Four hours after mechanical ventilation is initiated for a patient with chronic obstructive pulmonary disease (COPD) ,the patient's arterial blood gas (ABG) results include a pH of 7.51,PaO2 of 82 mm Hg,PaCO2 of 26 mm Hg,and HCO2- of 23 mEq/L (23 mmol/L) .The nurse will anticipate the need to

After change-of-shift report,which patient should the progressive care nurse assess first?

An 81-year-old patient who has been in the intensive care unit (ICU) for a week is now stable and transfer to the progressive care unit is planned.On rounds,the nurse notices that the patient has new onset confusion.The nurse will plan to

When caring for a patient who has an arterial catheter in the left radial artery for arterial pressure-based cardiac output (APCO) monitoring,which information obtained by the nurse is most important to report to the health care provider?

The nurse is caring for a patient with a subarachnoid hemorrhage who is intubated and placed on a mechanical ventilator with 10 cm H2O of peak end-expiratory pressure (PEEP) .When monitoring the patient,the nurse will need to notify the health care provider immediately if the patient develops

The nurse is caring for a patient receiving a continuous norepinephrine (Levophed) IV infusion.Which patient assessment finding indicates that the infusion rate may need to be adjusted?

When evaluating a patient with a central venous catheter,the nurse observes that the insertion site is red and tender to touch and the patient's temperature is 101.8° F.What should the nurse plan to do next?

The nurse notes that a patient's endotracheal tube (ET) ,which was at the 22-cm mark,is now at the 25-cm mark and the patient is anxious and restless.Which action should the nurse take next?

A patient's vital signs are pulse 87,respirations 24,and BP of 128/64 mm Hg and cardiac output is 4.7 L/min.The patient's stroke volume is _____ mL.(Round to the nearest whole number.)

The nurse educator is evaluating the performance of a new registered nurse (RN) who is providing care to a patient who is receiving mechanical ventilation with 15 cm H2O of peak end-expiratory pressure (PEEP) .Which action indicates that the new RN is safe?

A nurse is weaning a 68-kg male patient who has chronic obstructive pulmonary disease (COPD) from mechanical ventilation.Which patient assessment finding indicates that the weaning protocol should be stopped?

When caring for the patient with a pulmonary artery (PA) pressure catheter,the nurse observes that the PA waveform indicates that the catheter is in the wedged position.Which action should the nurse take next?

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 next?

The nurse responds to a ventilator alarm and finds the patient lying in bed holding the endotracheal tube (ET) .Which action should the nurse take next?

The nurse educator is evaluating the care that a new registered nurse (RN) provides to a patient receiving mechanical ventilation.Which action by the new RN indicates the need for more education?

A patient who is receiving positive pressure ventilation is scheduled for a spontaneous breathing trial (SBT) .Which finding by the nurse is most important to discuss with the health care provider before starting the SBT?

After change-of-shift report on a ventilator weaning unit,which patient should the nurse assess first?

A patient with respiratory failure has arterial pressure-based cardiac output (APCO) monitoring and is receiving mechanical ventilation with peak end-expiratory pressure (PEEP) of 12 cm H2O.Which information indicates that a change in the ventilator settings may be required?

A patient who is orally intubated and receiving mechanical ventilation is anxious and is "fighting" the ventilator.Which action should the nurse take next?

Four hours after mechanical ventilation is initiated for a patient with chronic obstructive pulmonary disease (COPD) ,the patient's arterial blood gas (ABG) results include a pH of 7.51,PaO₂ of 82 mm Hg,PaCO₂ of 26 mm Hg,and HCO₂- of 23 mEq/L (23 mmol/L) .The nurse will anticipate the need to

The nurse is caring for a patient with a subarachnoid hemorrhage who is intubated and placed on a mechanical ventilator with 10 cm H₂O of peak end-expiratory pressure (PEEP) .When monitoring the patient,the nurse will need to notify the health care provider immediately if the patient develops

The nurse educator is evaluating the performance of a new registered nurse (RN) who is providing care to a patient who is receiving mechanical ventilation with 15 cm H₂O of peak end-expiratory pressure (PEEP) .Which action indicates that the new RN is safe?

A patient with respiratory failure has arterial pressure-based cardiac output (APCO) monitoring and is receiving mechanical ventilation with peak end-expiratory pressure (PEEP) of 12 cm H₂O.Which information indicates that a change in the ventilator settings may be required?