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Test Bank For Priorities in Critical Care Nursing 7th Edition, Linda. Note: This is not a text book. Description: ISBN-13: 978-0323320856, ISBN-10: 0323320856.

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Test Bank Priorities Critical Care Nursing 7th Edition, Linda

MULTIPLE CHOICE
Chapter 01: Caring for the Critically Ill Patient
1. Which of the following units can provide high quality and cost effective care for patients who are less complex, more stable, and have a decreased need for physiologic monitoring could be placed on?
a. intensive care units
b. triage units
c. progressive care units
d. medical surgical units
2. _____ have a broad depth of knowledge and expertise in their specialty area and manage complex clinical and system issues.
a. SCCMs
b. APNs
c. CNSs
d. AACNs
3. _____ are instrumental in ensuring care that is evidence based and that safety programs are in place.
a. CNSs
b. APNs
c. SCCMs
d. AACNs
4. The _____ administers many critical care certifications exams for registered nurses.
a. CNS
b. APN
c. SCCM
d. AACN
5. Emphasis is on human integrity and stresses the theory that the body, mind, and spirit are interdependent and inseparable. This statement describes which methodology of care?
a. Holistic care
b. Individualized care
c. Cultural care
d. Interdisciplinary care
6. The AACN has developed short directives that can be used as quick references for clinical use that are known as
a. Critical Care Protocol.
b. Practice Policies.
c. Evidence-Based Research.
d. Practice Alerts.
7. A specific therapy or care that is an option to what is considered conventional treatment of a condition is known as
a. Guided Imagery.
b. holistic care.
c. complementary care.
d. individualized care.
8. Animal assisted, guided imagery, and massage are all examples of
a. alternative therapy.
b. holistic care.
c. complementary care.
d. individualized care.
9. A patient was admitted to a rural ICU in Montana. Critical care nurses are assisting with monitoring and care of the patient from the closest major city. This is an example of
a. telemedicine.
b. tele-ICU.
c. tele-informatics.
d. tele-hospital.
10. Working with individuals of other professions to maintain a climate of mutual respect and shared values best describes the concept of
a. interprofessional teamwork and team-based care.
b. values and ethics for interprofessional practice.
c. interprofessional communication.
d. roles and responsibilities for collaborative practice.
Chapter 02: Ethical and Legal Issues
1. The difference between ethics and morals is that ethics
a. is more concerned with the “why” of behavior.
b. provides a framework for evaluation of the behavior.
c. is broader in scope than morals.
d. concentrates on the right or wrong behavior based on religion and culture values.
2. A client’s wife has been informed by the physician that her spouse has a permanent C2–C3 spinal injury, which has resulted in permanent quadriplegia. The wife states that she does not want the physician or nursing staff to tell the client about his injury. The client is awake, alert, and oriented when he asks his nurse to tell him what has happened. The nurse has conflicting emotions about how to handle the situation and is experiencing
a. autonomy.
b. moral distress.
c. moral doubt.
d. moral courage.
3. Critical care nurses can best enhance the principle of autonomy by
a. presenting only the information to prevent relapse in a patient.
b. assisting with only tasks that cannot be done by the patient.
c. providing the patient with all of the information and facts.
d. guiding the patient toward the best choices for care.
4. Which of the following ethical principles is most important when soliciting informed consent from a client?
a. Nonmaleficence
b. Fidelity
c. Beneficence
d. Veracity
5. Fidelity includes faithfulness and promise-keeping to clients, and it incorporates the added concepts of
a. confidentiality and privacy.
b. truth and reflection.
c. autonomy and paternalism.
d. beneficence and nonmaleficence.
6. Which statement best reflects the concept of allocation of resources within the critical care setting?
a. Limitations of resources force reexamination of goals of critical care for clients.
b. Care is provided equally to all those who need the resources.
c. Equal access is available for those with the same condition or diagnosis.
d. Technologic advances are available to most of those in a given community.
7. When deciding whether to withdraw or withhold treatment, it is important to
a. examine one’s own beliefs to guide the family to a correct decision.
b. approach the family with honesty and provide clear information.
c. simply follow the advance directive if available.
d. allow the physician to approach the family.
8. The Code of Ethics for Nursing provides a framework for the nurse in ethical decision making and
a. is usurped by state or federal laws.
b. allows the nurse to focus on the good of society rather than the uniqueness of the client.
c. was recently adopted by the American Nurses Association.
d. provides society with a set of expectations of the profession.
9. Ethical decisions are best made by
a. following the guidelines of a framework or model.
b. having the client discuss alternatives with the physician or nurse.
c. prioritizing the greatest good for the greatest number of persons.
d. careful consideration by the Ethics Committee after all diagnostic data are reviewed.
10. The first step of the ethical decision-making process is
a. consulting with an authority.
b. identifying the health problem.
c. delineating the ethical problem from other types of problems.
d. identifying the client as the primary decision maker.
Chapter 03: Patient and Family Education
1. A patient is scheduled for a cardiac catheterization this afternoon. The nurse wants to provide her with some basic information before going in the room to talk about her specific procedure. Which teaching strategy is most appropriate for this situation?
a. Discussion
b. Demonstration and practice
c. Audiovisual media
d. Written
2. A nurse has been progressively working with a patient on the exercises he needs to do at home when he is discharged. The nurse wants to ensure he will remember what to do when he is at home. Which teaching strategy is most appropriate for this situation?
a. Discussion
b. Demonstration and practice
c. Audiovisual media
d. Written
3. The first step of the teaching–learning process involves
a. gathering data to assist in the assessment of learning needs.
b. identifying major learning needs for the patient.
c. identifying learning needs related to medical diagnosis.
d. evaluating the effects of prior teaching.
4. Which of the following educational content areas is appropriate during the first hours of hospitalization?
a. Pathophysiology of the admitting diagnosis
b. Dietary modifications
c. Purpose of bedside equipment
d. Medication side effects
5. How should a nurse respond when a patient asks if he or she is going to die?
a. Avoid the question by leaving the room.
b. Defer the question to the physician.
c. Answer honestly and sensitively with information that is understandable and in simple terms.
d. Speak with the family first before answering the patient.
6. The content and method of presentation in the critical care unit vary because
a. of the different admitting diagnoses.
b. of the uniqueness of each patient’s clinical and emotional status.
c. all patients are on ventilators and cannot talk.
d. patients are heavily sedated and may not comprehend teaching.
7. A patient is admitted to the critical care unit with the onset of tuberculosis. He was diagnosed with HIV/AIDS 1 year ago. When talking to the patient about preventing the spread of tuberculosis, the patient tells the nurse that he has not followed precautions regarding tuberculosis for patients with HIV. Which educational objective is BEST stated for this patient?
a. Patient will know at least two ways to prevent the spread of tuberculosis within 1 week.
b. Patient will understand how HIV is spread within 3 days.
c. Patient will realize that improper precautions will spread his disease to others.
d. Patient will verbalize two methods of transmission for tuberculosis within 2 days.
8. Group discussions for patients are most effective if the patients
a. have a variety of medical diagnoses.
b. are in the acute phase of their illness.
c. are in the hospital only 3 days or less.
d. are at similar stages of adaptation.
9. According to Maslow’s hierarchy of needs, the need to know and understand information is considered
a. a high-level need.
b. a low-level need.
c. a physiologic need.
d. not important in a critical care setting.
10. The patient is asked to complete an admission form. The patient hands the form to his spouse and asks her to complete the form, stating, “I forgot my glasses.” The patient’s actions demonstrate:
a. functional health literacy.
b. word recognition test.
c. low health literacy.
d. reading comprehension test.
Chapter 04: Psychosocial and Spiritual Alterations and Management
1. According to the transactional theories on stress, what does a person do first when confronted by stress?
a. Determines coping mechanisms to deal with the stress
b. Determines the perceived degree of threat imposed
c. Determines what the response will be to the stress
d. Denies the stress exists
2. Which of the following reactions to stress resulting from a failure of a person’s will, strength, endurance, and courage?
a. Disturbed self-esteem
b. Regression
c. Hopelessness
d. PTSD
3. A patient with ineffective coping may manifest which of the following behaviors?
a. Refusal to participate in care
b. Feelings that his or her body has betrayed him or her
c. Acceptance and ownership of problems
d. Disruption in the perception of the body
4. Patients with an external locus of control
a. believe that they can influence the outcome of their illness.
b. should be forced to take control of their discharge planning.
c. usually start out with an internal locus of control until a major illness occurs.
d. believe that events are related to chance or fate.
5. A subjective state in which an individual see extremely limited or not alternatives and is unable to mobilize energy on his or her behalf is known as?
a. Hope
b. Hopelessness
c. Powerlessness
d. Loss of Control
6. Regression as a coping mechanism for critical care patients
a. is necessary to some degree to allow staff to administer care.
b. indicates deterioration of the physical state.
c. is adaptive when the patient calls the nurse every 15 minutes, even for trivial matters.
d. is best avoided to ensure successful recovery.
7. Which of the following concepts supports patients and helps them endure the physical and psychological insults of their critical illness?
a. Regression
b. Denial
c. Hope
d. Trust
8. Which of the following techniques may be used to enhance coping?
a. Encouraging the patient to let the staff have total control of the patient’s care
b. Encouraging denial of the illness
c. Letting the patient know everything will be all right
d. Fostering trust in the health care team
9. Interventions to help family members who are extremely upset include
a. encouraging the family to visit as much as possible.
b. conveying what the patient is experiencing to the family.
c. supporting the family members away from the bedside.
d. assuring the family that the staff will take care of the technical aspects of the patient’s care.
10. A patient has been admitted to the critical care unit with a severed spinal cord injury at the T2 level. The patient has been in halo traction with immobilization for the past week. The physician explains to the patient that the spinal cord has been severed and that the patient will not be able to walk again. The patient becomes overtly hostile to everyone. The patient is demonstrating
a. regression.
b. loss of autonomy.
c. ineffective coping.
d. hope.
Chapter 05: Sleep Alterations
1. Which stage of NREM sleep is associated with anabolic processes?
a. N1
b. N2
c. N3
d. N4
2. What occurs physiologically during REM sleep?
a. Growth hormone is secreted.
b. Metabolic needs are decreased.
c. Sympathetic nervous system predominates.
d. Heart rate and blood pressure decrease.
3. Interventions to help with circadian synchronization include
a. opening the window blinds.
b. encouraging the patient to take frequent naps during the day.
c. administering sedatives at bedtime.
d. keeping the patient awake during the early morning hours.
4. The patient has been in the critical care unit for 3 weeks and has been on an intra-aortic balloon pump for the past 3 days. The patient’s condition has been serious, and hourly assessments and vital signs have been necessary. The nursing staff has noted that the patient has been unable to achieve sleep for more than 30 minutes at a time. The patient has been given diazepam (Valium) prn. The anticipated effect of diazepam on the patient’s sleep is
a. a decrease in NREM stage 1.
b. an increase in NREM stage 3.
c. total NREM suppression.
d. REM suppression in larger doses.
5. The patient has been in the critical care unit for 3 weeks and has been on the intra-aortic balloon pump for the past 3 days. The patient’s condition has been serious, and hourly assessments and vital signs have been necessary. The nursing staff has noted that the patient has been unable to achieve sleep for more than 30 minutes at a time. The patient has been given diazepam (Valium) prn. Which techniques may assist in assessing the patient’s sleep pattern?
a. Correlating sleep time with vital signs
b. Documenting sleep periods of more than 90 minutes
c. Assessing degree of arousal on hourly checks
d. Observing the length of NREM sleep periods
6. Where are EMG leads placed to detect muscle atonia?
a. Scalp
b. Intercostal
c. Anterior tibialis
d. Chin.
7. Hypnotic benzodiazepines
a. promote deeper sleep stages.
b. can produce prolonged effects in older adults.
c. are metabolized more rapidly in the presence of steroids.
d. enhance short-term recall.
8. Which of the following patients would the nurse most strongly suspect of having obstructive sleep apnea?
a. A severely obese woman with diabetes
b. A moderately obese man who snores
c. A nonobese woman with hypertension
d. A severely obese man with renal dysfunction
9. Which of the following older patients demonstrates changes in sleep patterns attributable to central sleep apnea?
a. A patient who wakes up two to three times per night and is tired during the day
b. A patient who reports sleeping less soundly and not feeling rested
c. A patient who consistently awakens at 4 AM and goes to bed at 7 PM
d. A patient who has irregular respiration during sleep and whose inspiratory muscles intermittently fail
10. Sleep deprivation can result from which of the following?
a. CPAP machine use
b. Mechanical ventilation
c. Use of nonbenzodiazepine short-acting hypnotics
d. Use of analgesic medications to control pain
Chapter 06: Nutritional Alterations
1. A patient with poorly controlled diabetes mellitus is to be started on enteral tube feeding. What type of formula would be most appropriate?
a. Whole proteins and glucose polymers
b. Concentrated in calories
c. Low sodium
d. High fat, low carbohydrate
2. Most of the energy produced from carbohydrate metabolism is used to form what substance?
a. Galactose
b. Glycogen
c. Adenosine triphosphate
d. Antibodies
3. A patient has a new order for intermittent nasogastric feedings every 4 hours. The nasogastric tube is placed by the nurse. The best method for confirming the placement of the tube before feeding would be to
a. obtain radiography of the abdomen.
b. check the pH of fluid aspirated from the tube.
c. auscultate the left upper quadrant of the abdomen while injecting air into the tube.
d. auscultate the right upper quadrant of the abdomen while injecting air into the tube.
4. A person with a BMI of 28 would be considered
a. obese.
b. overweight or pre-obese.
c. of normal weight.
d. underweight.
5. Diet therapy for a person with hypertension 1 day after a myocardial infarction would include
a. three meals a day with two snacks.
b. a low-protein diet.
c. a low-salt, low-cholesterol diet.
d. a high-carbohydrate diet.
6. Two types of protein-caloric malnutrition are kwashiorkor and marasmus. Kwashiorkor results in
a. weight loss and muscle wasting.
b. low levels of serum proteins, low lymphocyte count, and hair loss.
c. elevated serum albumin and increased creatinine excretion in the urine.
d. hyperpigmentation and a hard, easily palpated liver margin.
7. The patient history plays an important role in assessing the patient’s nutritional status. Significant laboratory and clinical findings in the patient with cardiovascular disease include
a. low levels of high-density lipoprotein (HDL) cholesterol and transferrin.
b. elevated low-density lipoprotein (LDL) cholesterol and decreased subcutaneous fat.
c. elevated sodium levels and a soft, fatty liver on palpation.
d. normal triglyceride levels and the presence of S3 on auscultation.
8. Proteins serve the function of
a. maintaining osmotic pressure.
b. providing minerals in the body.
c. maintaining blood glucose.
d. providing a stored source of energy.
9. The loss of exocrine function of pancreatitis results in
a. anorexia.
b. obesity.
c. malabsorption.
d. hyperglycemia.
10. Obtaining height and weight measurements for the critically ill patient
a. should be deferred until the medical condition stabilizes.
b. should be measured rather than obtained through patient or family report.
c. requires consistent weights in pounds.
d. requires weight, but height can be deferred.
Chapter 07: Gerontological Alterations
1. A 68-year-old patient has been admitted to the coronary care unit after an inferior myocardial infarction. Age-related changes in myocardial pumping ability may be evidenced by
a. increased contractility.
b. decreased contractility.
c. decreased left ventricle afterload.
d. increased cardiac output.
2. Age-related pulmonary changes that may affect this patient include
a. increased tidal volumes.
b. weakening of intercostal muscles and the diaphragm.
c. improved cough reflex.
d. decreased sensation of the glottis.
3. A 68-year-old patient has been admitted to the coronary care unit after an inferior myocardial infarction. Dopamine 3 mcg/kg/min has been ordered for this patient. What nursing implications should be considered when administering this drug to an older patient?
a. No changes are noted in older patients with this drug.
b. Drug effect is enhanced by increased receptor site action.
c. Increased breakdown by liver hepatocytes occurs, increasing dosage requirements.
d. Drug metabolism and detoxification are slowed, increasing the risks of drug toxicity.
4. A 68-year-old patient has been admitted to the coronary care unit after an inferior myocardial infarction. When caring for this patient, the nurse will give increased attention to skin integrity because of the
a. thickening of the epidermal skin layer.
b. loss of sebaceous glands.
c. increased fragility from loss of protective subcutaneous layers.
d. decreased melanocyte production.
5. An older patient is admitted to the hospital with an acute onset of mental changes and recent falls. The nurse knows that the most common cause of mental changes is
a. hypoxia.
b. infection.
c. cerebrovascular accident.
d. electrolyte imbalance.
6. A nurse is teaching an older patient about the signs and symptoms of a myocardial infarction. Which statement by the patient would indicate that the teaching was effective?
a. “The pain in my chest may last a long time.”
b. “I will feel like I have an elephant sitting on the center of my chest.”
c. “The chest pain will be sharp and over the center of my chest.”
d. “The pain may not be severe and may not be in my chest.”
7. An older patient is starting a new medication that is metabolized in the liver and excreted by the kidneys. Which is the best assessment to monitor the patient’s ability to tolerate the medication?
a. Liver function tests
b. Drug side effects experienced by the patient
c. Kidney function tests
d. Therapeutic drug levels
8. An older patient is receiving a nephrotoxic medication. Which of the following would be a priority for the nurse to monitor?
a. Electrocardiogram
b. Lung sounds
c. Blood pressure
d. Level of consciousness
9. Which of the following can be a normal assessment finding for an older patient?
a. Asymptomatic dysrhythmias
b. Decreased urine output
c. Increased respiratory effort
d. Difficulty problem solving
10. Chemical changes in a drug that renders it active or inactive is known as
a. absorption.
b. metabolism.
c. excretion.
d. distribution.
Chapter 08: Pain and Pain Management
1. The subjective characteristic implies that pain is
a. an uncomfortable experience present only in the patient with an intact nervous system.
b. an unpleasant experience accompanied by crying and tachycardia.
c. activation of the sympathetic nervous system from an injury.
d. whatever the patient experiencing it says it is, occurring when that patient says it does.
2. The neural processes of encoding and processing noxious stimuli necessary but not sufficient for pain is known as
a. perception.
b. nociception.
c. transduction.
d. transmission.
3. Which of the following assessment findings might indicate respiratory depression after opioid administration?
a. Flushed, diaphoretic skin
b. Shallow respirations with a rate of 24 breaths/min
c. Tense, rigid posture
d. Sleep apnea
4. The patient is admitted to the CCU with hemodynamic instability and an allergy to morphine. The nurse anticipates that the physician will order which medication for severe pain?
a. Hydromorphone
b. Codeine
c. Fentanyl
d. Methadone
5. Which of the following combinations of drugs has been found to be effective in managing the pain associated with musculoskeletal and soft tissue inflammation?
a. Nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids
b. NSAIDs and antidepressants
c. Opioid agonists and opioid antagonists
d. Adjuvants and partial agonists
6. A patient underwent a thoracotomy 12 hours ago. The patient currently has an epidural catheter in place and is receiving continuous epidural analgesia with morphine. In addition to respiratory depression, the patient should be monitored for which of the following complications?
a. Urinary retention, undue somnolence, itching, nausea, and vomiting
b. Urinary incontinence, photophobia, headache, and skin rash
c. Apprehension, anxiety, restlessness, sadness, anger, and myoclonus
d. Gastric bleeding, nasal discharge, cerebrospinal fluid leak, and calf pain
7. Acute pain usually corresponds to
a. the healing process but should not exceed 9 months.
b. the healing process but should not exceed 6 months.
c. persistent pain more than 6 months after the healing process.
d. damage to the patient’s nervous system unrelated to the initial injury.
8. A patient complains of pain at his incision site. The nurse is aware that four processes are involved in nociception. The proper order of the processes is
a. transmission, perception, modulation, and transduction.
b. perception, modulation, transduction, and transmission.
c. modulation, transduction, transmission, and perception.
d. transduction, transmission, perception, and modulation.
9. Using a specific pain intensity scale in the CCU
a. eliminates the need for the subjectivity of the patient.
b. allows for one tool for all patient types.
c. provides consistency of assessment and documentation.
d. is not necessary because all pain is treated equally in the CCU.
10. The patient is sedated and breathing with the use of mechanical ventilation. The patient is unable to communicate any aspects of his pain to the nurse. The nurse knows that the best tool for pain assessment for this patient is
a. FLACC.
b. Wong-Baker FACES.
c. BIS.
d. BPS or CPOT.
Chapter 09: Sedation, Agitation and Delirium Management
1. To achieve ventilator synchrony in a mechanically ventilated patient with acute respiratory distress syndrome (ARDS), which level of sedation might be most effective?
a. Light
b. Moderate
c. Conscious
d. Deep
2. A patient has been taking benzodiazepines and suddenly develops respiratory depression and hypotension. After careful assessment, the nurse determines that the patient is experiencing benzodiazepine overdose. What is the nurse’s next step?
a. Decrease benzodiazepines to half the prescribed dose.
b. Increase IV fluids to 500 cc/hr for 2 hours.
c. Administer flumazenil (Romazicon).
d. Discontinue benzodiazepine and start propofol.
3. A 56-year-old patient is admitted to the critical care unit with acute respiratory distress syndrome (ARDS). The patient has been intubated and is mechanically ventilated. The patient is becoming increasingly agitated, and the high-pressure alarm on the ventilator has been frequently triggered. The nurse’s first intervention for this patient would be to
a. administer midazolam (Versed) 5 mg by intravenous push immediately.
b. assess the patient to see if a physiologic reason exists for his agitation.
c. obtain a stat arterial blood gas level; his agitation indicates he is becoming increasingly hypoxic.
d. apply soft wrist restraints to keep him from pulling out the endotracheal tube.
4. A 56-year-old patient is admitted to the critical care unit with acute respiratory distress syndrome (ARDS). The patient has been intubated and is mechanically ventilated. The patient is becoming increasingly agitated, and the high-pressure alarm on the ventilator has been frequently triggered. The patient continues to be very agitated, and the nurse can find nothing physiologic to account for the high-pressure alarm. The next step should be to
a. administer midazolam 5 mg by intravenous push immediately.
b. eliminate noise and other stimuli in the room and speak softly and reassuringly to him.
c. obtain a stat arterial blood gas level; his agitation indicates he is becoming increasingly hypoxic.
d. call respiratory therapy to replace this obviously malfunctioning ventilator.
5. A 56-year-old patient is admitted to the critical care unit with acute respiratory distress syndrome (ARDS). The patient has been intubated and is mechanically ventilated. The patient is becoming increasingly agitated, and the high-pressure alarm on the ventilator has been frequently triggered. Despite the nurse’s actions, the patient continues to be agitated, triggering the high-pressure alarm on the ventilator. Which of the following medications would be appropriate for sedation?
a. Midazolam 2 to 5 mg intravenous push (IVP) every 5 to 15 minutes until the patient is no longer triggering the alarm
b. Haloperidol 5 mg IVP stat
c. Propofol 5 mcg/kg/min by IV infusion
d. Fentanyl 25 mcg IVP over a 15-minute period
6. A 56-year-old patient is admitted to the critical care unit with acute respiratory distress syndrome (ARDS). The patient has been intubated and is mechanically ventilated. The patient is becoming increasingly agitated, and the high-pressure alarm on the ventilator has been frequently triggered. After the patient’s agitation is controlled, which of the following drugs would be most appropriate for long-term sedation?
a. Morphine 2 mg/hr continuous IV drip
b. Haloperidol 15 mcg/kg/min continuous IV infusion
c. Propofol 5 mcg/kg/min by IV infusion
d. Lorazepam 0.01 to 0.1 mg/kg/hr by IV infusion
7. When administering propofol over an extended period, it is important to monitor which of the following?
a. Serum triglyceride level
b. Sodium and potassium levels
c. Platelet count
d. Acid–base balance
8. A major side effect of benzodiazepines is
a. hypertension.
b. respiratory depression.
c. renal failure.
d. phlebitis at the IV site.
9. The major advantage of using propofol for short-term sedation is that it
a. has fewer side effects.
b. is slow to cross the blood–brain barrier.
c. has a shorter half-life and rapid elimination rate.
d. is an excellent amnesiac.
10. Which of the following drugs is used for sedation in patients experiencing withdrawal syndrome?
a. Dexmedetomidine
b. Hydromorphone
c. Diazepam
d. Clonidine
Chapter 10: End-of-Life Care
1. Which of the following statements about comfort care is accurate?
a. Withholding and withdrawing life-sustaining treatment are distinctly different in the eyes of the legal community.
b. Each procedure should be evaluated for its effect on the patient’s comfort before being implemented.
c. Only the patient can determine what constitutes comfort care for him or her.
d. Withdrawing life-sustaining treatments is considered euthanasia in most states.
2. _____ is a powerful influence when the decision-making process is dealing with recovery or a peaceful death.
a. Hope
b. Religion
c. Culture
d. Ethics
3. The patient’s condition has deteriorated to the point where she can no longer make decisions about her own care. Which of the following nursing interventions would be most appropriate?
a. Obtain a verbal DNR order from the physician.
b. Continue caring for the patient as originally ordered because she obviously wanted this.
c. Consult the hospital attorney for recommendations on how to proceed.
d. Discuss with the family what the patient’s wishes would be if she could make those decisions herself.
4. The two basic ethical principles underlying the provision of health care are
a. beneficence and nonmaleficence.
b. veracity and beneficence.
c. fidelity and nonmaleficence.
d. veracity and fidelity.
5. A patient was admitted to the critical care unit several weeks ago with an acute myocardial infarction and subsequently underwent coronary artery bypass grafting surgery. Since a cardiac arrest 5 days ago, the patient has been unresponsive. An electroencephalogram shows no meaningful brain activity. The patient does not have an advance directive. Which of the following statements would be the best way to approach the family regarding his ongoing care?
a. “I will refer this case to the hospital ethics committee, and they will contact you when they have a decision.”
b. “What do you want to do about the patient’s care at this point?”
c. “Dr. Smith believes that there is no hope at this point and recommends DNR status.”
d. “What would the patient want if he knew he were in this situation?”
6. A patient was admitted to the critical care unit several weeks ago with an acute myocardial infarction and subsequently underwent coronary artery bypass grafting surgery. Since a cardiac arrest 5 days ago, the patient has been unresponsive. An electroencephalogram shows no meaningful brain activity. After a family conference, the physician orders a DNR order, and palliative care is begun. This means
a. the patient will continue to receive the same aggressive treatment short of resuscitation if he has another cardiac arrest.
b. all treatment will be stopped, and the patient will be allowed to die.
c. all attempts will be made to keep the patient comfortable without prolonging his life.
d. the patient will be immediately transferred to hospice.
7. A patient was admitted to the critical care unit several weeks ago with an acute myocardial infarction and subsequently underwent coronary artery bypass grafting surgery. Since a cardiac arrest 5 days ago, the patient has been unresponsive. An electroencephalogram shows no meaningful brain activity. The patient is placed on a morphine drip to alleviate suspected operative pain and assist in sedation. The patient continues to grimace and fight the ventilator. What nursing intervention would be appropriate?
a. Increase the morphine dosage until no signs of pain or discomfort are present.
b. Increase the morphine drip, but if the patient’s respiratory rate drops below 10 breaths/min, return to the original dosage.
c. Gradually decrease the morphine and switch to Versed to avoid respiratory depression.
d. Ask the family to leave the room because their presence is causing undue stress to the patient.
8. A patient was admitted to the critical care unit several weeks ago with an acute myocardial infarction and subsequently underwent coronary artery bypass grafting surgery. Since a cardiac arrest 5 days ago, the patient has been unresponsive. An electroencephalogram shows no meaningful brain activity. The decision is made to remove the patient from the ventilator. Which of the following statements is most accurate?
a. The cardiac monitor should be left on so everyone will know when the patient has died.
b. Opioids, sedatives, and neuromuscular blocking agents should be discontinued just before removing the ventilator.
c. The family and health care team should decide the best method for removing the ventilator: terminal wean versus immediate extubation.
d. If terminal weaning is selected, the family should be sent to the waiting room until the ventilator has actually been removed.
9. A patient was admitted to the critical care unit after having a CVA and MI. The patient has poor activity tolerance, falls in and out of consciousness, and has poor verbal skills. The patient has been resuscitated four times in the past 6 hours. The patient does not have advance directives. Family members are at the bedside. Who should the physician approach to discuss decisions of care and possible DNR status?
a. The patient
b. The family
c. The hospital legal system
d. The hospital ethics committee
10. Organ donation
a. is a choice only the patient can make for him- or herself.
b. is mandated by legal and regulatory agencies.
c. must be requested by the nurse caring for the dying patient.
d. is controlled by individual institutional policies.
Chapter 11: Cardiovascular Clinical Assessment and Diagnostic Procedures
1. Which of the following conditions is usually associated with clubbing?
a. Central cyanosis
b. Peripheral cyanosis
c. Carbon monoxide poisoning
d. Acute hypoxemia
2. The abdominojugular reflux test determines the presence of
a. right ventricular failure.
b. hypoxemia.
c. liver failure.
d. pitting edema.
3. The purpose of the Allen test is to
a. assess adequate blood flow through the ulnar artery.
b. occlude the brachial artery and evaluate hypoxemia to the hand.
c. test the patency of an internal graft.
d. determine the size of needle to be used for puncture.
4. Evaluation of arterial circulation to an extremity is accomplished by assessing which of the following?
a. Homans sign
b. Skin turgor
c. Peripheral edema
d. Capillary refill
5. When checking the patient’s back, the nurse pushes her thumb into the patient’s sacrum. An indentation remains. The nurse charts that the patient has
a. sacral compromise.
b. delayed skin turgor.
c. pitting edema.
d. dehydration.
6. An assessment finding of pulsus alternans may indicate evidence of
a. left-sided heart failure.
b. jugular venous distention.
c. pulmonary embolism.
d. myocardial ischemia.
7. The presence of a carotid or femoral bruit may be evidence of
a. left-sided heart failure.
b. blood flow through a partially occluded vessel.
c. the early onset of pulmonary embolism.
d. myocardial rupture.
8. A 68-year-old patient is admitted to the critical care unit with reports of midchest pressure radiating into the jaw and shortness of breath when walking up stairs. The patient is admitted with a diagnosis of “rule out myocardial infarction.” The history portion of the assessment should be guided by
a. medical history.
b. history of prior surgeries.
c. presenting symptoms.
d. a review of systems.
9. A 68-year-old patient is admitted to the critical care unit with reports of midchest pressure radiating into the jaw and shortness of breath when walking up stairs. The patient is admitted with a diagnosis of “rule out myocardial infarction.” When inspecting the patient, the nurse notes that the patient needs to sit in a high Fowler position to breathe. This may indicate
a. pericarditis.
b. anxiety.
c. heart failure.
d. angina.
10. An 82-year-old patient is admitted into the critical care unit with a diagnosis of left-sided heart failure related to mitral stenosis. Physical assessment findings reveal tachycardia with an S3 and a 3/6 systolic murmur. The nurse knows that the presence of an S3 heart sound is
a. normal for a person this age.
b. a ventricular gallop.
c. a systolic sound.
d. heard best with the diaphragm of the stethoscope.
Chapter 12: Cardiovascular Disorders
1. Data concerning coronary artery disease (CAD) and specific risk factors have demonstrated
a. a low correlation of modifiable risk factors to CAD.
b. the onset of CAD in middle age.
c. an association between development of specific risk factors and CAD.
d. no decisive correlation between risk factors and CAD.
2. Which of the following values, when elevated, places the patient at lowest risk for CAD?
a. Very-low-density lipoproteins (VLDLs)
b. Triglycerides
c. Low-density lipoproteins (LDLs)
d. High-density lipoproteins (HDLs)
3. One differentiating factor between stable angina and unstable angina is that stable angina
a. responds predictably well to nitrates.
b. is not precipitated by activity.
c. has a low correlation to CAD.
d. is a result of coronary artery spasm.
4. Nursing management of the patient with angina is directed toward
a. immediate administration of antiplatelet therapy.
b. assessment of history of previous anginal episodes.
c. assessment and documentation of chest pain episodes.
d. administration of prophylactic lidocaine for ventricular ectopy.
5. One of the reasons that contributes to higher mortality rates from acute MI in women is:
a. waiting longer to seek medical care.
b. being younger when symptoms occur.
c. risk factors associated with MI are more stronger in women than men.
d. women have smaller hearts than men.
6. The most frequent dysrhythmia seen initially with sudden cardiac death is
a. premature ventricular contractions.
b. ventricular tachycardia.
c. ventricular fibrillation.
d. asystole.
7. Assessment of a patient with pericarditis may reveal which of the following signs and symptoms?
a. Ventricular gallop and substernal chest pain
b. Narrowed pulse pressure and shortness of breath
c. Pericardial friction rub and pain
d. Pericardial tamponade and widened pulse pressure
8. Clinical manifestations of right-sided heart failure include
a. elevated central venous pressure and sacral edema.
b. pulmonary congestion and jugular venous distention.
c. hypertension and chest pain.
d. liver tenderness and pulmonary edema.
9. An essential aspect of teaching that may prevent recurrence of heart failure is
a. notifying the physician if a 2-lb weight gain occurs in 24 hours.
b. compliance with diuretic therapy.
c. taking nitroglycerin if chest pain occurs.
d. assessment of an apical pulse.
10. In the acute phase after STEMI, fibrinolytic therapy is used in combination with heparin to recanalize the coronary artery. The initial heparin bolus is
a. 60 units/kg maximum 5000 units.
b. 30 units/kg maximum 3000 units.
c. 25 units/kg maximum of 2500 units.
d. 12 units/kg maximum of 1000 units.
Chapter 13: Cardiovascular Therapeutic Management
1. The possibility of microshock when handling a temporary pacemaker can be minimized by
a. decreasing the milliamperes.
b. wearing gloves.
c. positioning the patient on the left side.
d. wearing rubber-soled shoes.
2. In caring for a postoperative cardiovascular patient, the nurse knows that the most frequent cause of a decreased cardiac output is
a. reduced preload.
b. increased afterload.
c. increased contractility.
d. bradycardia.
3. A patient has an implantable cardioverter defibrillator (ICD) for chronic ventricular tachydysrhythmias. If the patient’s rhythm deteriorates to ventricular fibrillation,
a. an external defibrillator will need to be applied.
b. start CPR and call a code.
c. the ICD will defibrillate at a high energy level.
d. the ICD is programmed to cardiovert at a high energy level.
4. The mechanism of dilation with percutaneous transluminal coronary angioplasty (PTCA) is
a. stretching of the vessel wall, resulting in fracture of the plaque.
b. anticoagulation after the completion of the procedure, enhancing dilation.
c. plaque removal after balloon inflation.
d. compression of plaque against the vessel wall.
5. The rationale for administration of a fibrinolytic agent is
a. dilation of the blocked coronary artery.
b. anticoagulation to prevent formation of new emboli.
c. dissolution of atherosclerotic plaque at the site of blockage.
d. restoration of blood flow to the obstructed coronary artery via lysis of the thrombus.
6. A nurse is providing care to a patient on fibrinolytic therapy. Which of the following statements from the patient warrants further assessment and intervention by the critical care nurse?
a. “My back is killing me!”
b. “There is blood on my toothbrush!”
c. “Look at the bruises on my arms!”
d. “My arm is bleeding where my IV is!”
7. A reliable indicator of reperfusion after fibrinolytic therapy is
a. dysrhythmias.
b. Q waves.
c. elevated ST segments.
d. a rapid decrease in serum CK levels.
8. The most common complication of fibrinolytic therapy is
a. reperfusion chest pain.
b. lethargy.
c. bleeding.
d. heart blocks.
9. Which of the following mechanisms is responsible for the augmentation of coronary arterial blood flow and increased myocardial oxygen supply seen with the intra-aortic balloon pump?
a. The vacuum created in the aorta as a result of balloon deflation
b. Diastolic inflation with retrograde perfusion
c. Forward flow to the peripheral circulation
d. Inflation during systole to augment blood pressure
10. When an intra-aortic balloon is in place, it is essential for the nurse to frequently assess
a. for a pulse deficit.
b. peripheral pulses distal to the catheter insertion site.
c. bilateral blood pressures.
d. coronary artery perfusion.
Chapter 14: Pulmonary Clinical Assessment and Diagnostic Procedures
1. Why would the nurse perform an inspection of the oral cavity during a complete pulmonary assessment?
a. To provide evidence of hypoxia
b. To provide evidence of dyspnea
c. To provide evidence of dehydration
d. To provide evidence of nutritional status
2. Which of the following lung sounds would be most likely heard in a client experiencing an asthma attack?
a. Coarse rales
b. Pleural friction rub
c. Fine crackles
d. Expiratory wheezes
3. Which of the following describes the major difference between tachypnea and hyperventilation?
a. Tachypnea has increased rate; hyperventilation has decreased rate.
b. Tachypnea has decreased rate; hyperventilation has increased rate.
c. Tachypnea has increased depth; hyperventilation has decreased depth.
d. Tachypnea has decreased depth; hyperventilation has increased depth.
4. A patient presents with chest trauma from an MVA. Upon assessment, the nurse documents that the patient is complaining of dyspnea, shortness of breath, tachypnea, and tracheal deviation to the right. In addition, the client’s tongue is blue-gray. Based on the following data, what the nurse would expect to find?
a. PaO2 of 88 and PCO2 of 55
b. Absent breath sounds in all right lung fields
c. Absent breath sounds in all left lung fields
d. Diminished breath sounds in all fields
5. On assessment of a client, you note fremitus over the trachea but not in the lung periphery. You know that this most likely represents
a. bilateral pleural effusion.
b. bronchial obstruction.
c. a normal finding.
d. apical pneumothorax.
6. Normal anteroposterior (AP) diameter ranges from 1:2 to 5:7. An increase in AP diameter of the chest that is characterized by displacement of the sternum forward and the ribs outward is indicative of
a. a funnel chest.
b. a pigeon breast.
c. a barrel chest.
d. Harrison’s groove.
7. A patient is admitted to the unit in respiratory distress secondary to pneumonia. The nurse knows that obtaining a history is very important. What is the appropriate intervention at this time for obtaining this data?
a. Collect an overview of past medical history, present history, and current health status.
b. Do not obtain any history at this time.
c. Curtail the history to just a few questions about the client’s chief complaint and precipitating events.
d. Complete the history and then provide measures to assist the client to breathe easier.
8. While conducting a physical assessment, you note that the patient’s breathing is rapid and shallow. This type of breathing pattern is known as
a. hyperventilation.
b. tachypnea.
c. obstructive breathing.
d. bradypnea.
9. Which of the following is an example of a disorder with increased tactile fremitus?
a. Emphysema
b. Pleural effusion
c. Pneumothorax
d. Pneumonia
10. Auscultation of the anterior chest should be performed using which of the following sequences?
a. Right side, top to bottom, then left side, top to bottom
b. Left side, top to bottom, then right side, top to bottom
c. Side to side, bottom to top
d. Side to side, top to bottom
Chapter 15: Pulmonary Disorders
1. Which of the following causes of hypoxemia is the result of blood passing through unventilated portions of the lungs?
a. Alveolar hypoventilation
b. Dead space ventilation
c. Intrapulmonary shunting
d. Drug overdose
2. A patient with acute respiratory failure may require a bronchodilator if which of the following occurs?
a. Excessive secretions
b. Bronchospasms
c. Thick secretions
d. Fighting the ventilator
3. Supplemental oxygen administration is usually effective in treating hypoxemia related to
a. physiologic shunting.
b. dead space ventilation.
c. hypercapnia with a PaCO2 of 35 mm Hg.
d. ventilation/perfusion mismatching.
4. Which of the following nursing interventions should be used to optimize oxygenation and ventilation in the patient with acute respiratory failure?
a. Provide adequate rest and recovery time between procedures.
b. Position the patient with the good lung up.
c. Suction the patient every hour.
d. Avoid hyperventilating the patient.
5. A patient has been admitted to the critical care unit with the diagnosis of acute respiratory distress syndrome (ARDS). Arterial blood gasses (ABGs) revealed an elevated pH and decreased PaCO2. The patient is becoming fatigued, and the health care provider orders a repeat ABG. The nurse anticipates the following results
a. elevated pH and decreased PaCO2
b. elevated pH and elevated PaCO2
c. decreased pH and decreased PaCO2
d. decreased pH and elevated PaCO2
6. Which of the following diagnostic criteria is indicative of ARDS?
a. Radiologic evidence of bibasilar atelectasis
b. PaO2/FiO2 ratio less than or equal to 200 mm Hg
c. Pulmonary artery wedge pressure greater than 18 mm Hg
d. Increased static and dynamic compliance
7. Which of the following therapeutic measures would be the most effective in treating hypoxemia in the presence of intrapulmonary shunting associated with ARDS?
a. Sedating the patient to blunt noxious stimuli
b. Increasing the FiO2 on the ventilator
c. Administering positive-end expiratory pressure (PEEP)
d. Restricting fluids to 500 mL per shift
8. Patients with left-sided pneumonia may benefit from placing them in which of the following positions?
a. Reverse Trendelenburg
b. Supine
c. On the left side
d. On the right side
9. Aspiration can best be prevented by
a. observing the amount given in the tube feeding.
b. assessing the patient’s level of consciousness.
c. encouraging the patient to cough and to breathe deeply.
d. positioning a patient in a semirecumbent position.
10. The major hemodynamic consequence of a massive pulmonary embolus is
a. increased systemic vascular resistance leading to left heart failure.
b. pulmonary hypertension leading to right heart failure.
c. portal vein blockage leading to ascites.
d. embolism to the internal carotids leading to a stroke.
Chapter 16: Pulmonary Therapeutic Management
1. Which of the following arterial blood gas values would indicate a need for oxygen therapy?
a. PaO2 of 80 mm Hg
b. PaCO2 of 35 mm Hg
c. HCO3– of 24 mEq
d. SaO2 of 87%
2. Which of the following oxygen administration devices can deliver oxygen concentrations of 90%?
a. Nonrebreathing mask
b. Nasal cannula
c. Partial rebreathing mask
d. Simple mask
3. The most accurate and reliable control of FiO2 can be achieved through the use of a(n)
a. simple mask.
b. nonrebreathing circuit (closed).
c. air-entrainment mask.
d. nonrebreathing mask.
4. Use of oxygen therapy in the patient who is hypercapnic may result in
a. oxygen toxicity.
b. absorption atelectasis.
c. carbon dioxide retention.
d. pneumothorax.
5. The correct procedure for selecting an oropharyngeal airway is to:
a. measure from the tip of the nose to the ear lobe.
b. measure from the mouth to the ear lobe.
c. measure from the tip of the nose to the middle of the trachea.
d. measure the airway from the corner of the patient’s mouth to the angle of the jaw.
6. The finding of normal breath sounds on the right side of the chest and absent breath sounds on the left side of the chest in a newly intubated patient is probably caused by a
a. right mainstem intubation.
b. left pneumothorax.
c. right hemothorax.
d. gastric intubation.
7. Long-term ventilator management over 21 days is best handled through use of a(n)
a. oropharyngeal airway.
b. esophageal obturator airway.
c. tracheostomy tube.
d. endotracheal intubation.
8. Which of the following statements is correct concerning endotracheal tube cuff management?
a. The cuff should be deflated every hour to minimize pressure on the trachea.
b. A small leak should be heard on inspiration if the cuff has been inflated using the minimal leak technique.
c. Cuff pressures should be kept between 40 to 50 mm Hg to ensure an adequate seal.
d. Cuff pressure monitoring should be done once every 24 hours.
9. Nursing interventions to limit the complications of suctioning include
a. inserting the suction catheter no more than 5 inches.
b. premedicating the patient with atropine.
c. hyperoxygenating the patient with 100% oxygen.
d. increasing the suction to 150 mm Hg.
10. Which of the following levels would be classified as a low-flow system of oxygen administration?
a. O2 via nasal cannula at 4 L/min
b. O2 via nasal catheter at a FiO2 range of 60% to 75%
c. O2 via transtracheal catheter at 10 L/min
d. O2 via simple mask at 12 L/min.
Chapter 17: Neurologic Clinical Assessment and Diagnostic Procedures
1. A score of 6 on the Glasgow Coma Scale (GCS) indicates
a. a vegetative state.
b. paraplegia.
c. coma.
d. obtundation.
2. The GCS is an invalid measure for the patient with
a. hemiplegia.
b. Parkinson disease.
c. mental retardation.
d. intoxication.
3. Which of the following choices is an acceptable and recommended method of noxious stimulation?
a. Nipple pinch
b. Nail bed pressure
c. Supraorbital pressure
d. Sternal rub
4. Which of the following denotes the most serious prognosis?
a. Decorticate posturing
b. Decerebrate posturing
c. Absence of Babinski reflex
d. GCS score of 14
5. How much of a size difference between the two pupils is still considered normal?
a. 1 mm
b. 1.5 mm
c. 2 mm
d. 2.5 mm
6. An oval pupil is indicative of
a. cortical dysfunction.
b. intracranial hypertension.
c. hydrocephalus.
d. metabolic coma.
7. Decerebrate posturing (abnormal extension) indicates dysfunction in which area of the central nervous system?
a. Cerebral cortex
b. Thalamus
c. Cerebellum
d. Brainstem
8. The initial history for the neurologically impaired patient needs to be
a. limited to the chief complaint.
b. comprehensive, including events preceding hospitalization.
c. directed to level of consciousness and pupillary reaction.
d. information that only the patient can provide.
9. The most important aspect of the neurologic examination is
a. medical history.
b. physical examination.
c. level of consciousness.
d. pupillary responses.
10. Which of the following statements best describes assessment of arousal?
a. It measures content of consciousness and is a higher level function.
b. It is an evaluation of the reticular activating system and its connection with the thalamus and the cerebral cortex.
c. It becomes a valid parameter when the patient is able to respond to verbal stimuli, such as squeezing the hands on command.
d. Noxious stimuli are not to be used as an assessment parameter.
Chapter 18: Neurologic Disorders and Therapeutic Management
1. Causes of metabolic coma include
a. trauma.
b. ischemic stroke.
c. drug overdose.
d. intracerebral hemorrhage.
2. Emergency treatment of coma of unknown cause includes rapid intravenous administration of which three agents?
a. Epinephrine, hydrocortisone, and Benadryl
b. Dopamine, 10% dextrose in distilled water, and calcium chloride
c. Mannitol, dexamethasone, and sodium bicarbonate
d. Thiamine, glucose, and opioid antagonist
3. Which of the following patients has the best prognosis based on the cause of coma?
a. A 36-year-old man with closed head injury
b. A 50-year-old woman with hepatic encephalopathy
c. A 46-year-old woman with subarachnoid hemorrhage
d. A 72-year-old man with hypertensive intracerebral hemorrhage
4. Which assessment finding in a patient in coma 10 to 12 hours after cardiopulmonary arrest is indicative of unlikely survival?
a. Decorticate posturing
b. Absent pupillary light reflexes
c. Decerebrate posturing
d. Central hyperventilation
5. Corneal epithelial breakdown in the coma patient is prevented by instillation of saline or methylcellulose lubricating eyedrops every
a. 2 hours.
b. 4 hours.
c. 8 hours.
d. 12 hours.
6. Appropriate therapy for ischemic stroke depends on rapid completion of which diagnostic study?
a. Magnetic resonance imaging
b. Noncontrast computed tomography
c. Contrast computed tomography
d. Lumbar puncture
7. Thrombolytic therapy with recombinant tissue plasminogen activator (rtPA) is now recommended for the management of ischemic stroke if administration can be instituted within how many hours of onset of stroke symptoms?
a. 1
b. 4
c. 6
d. 10
8. A patient presents with aphasia, decreased level of consciousness, and right-sided weakness. The patient has a history of heart disease, hyperlipidemia, and transient ischemic attacks. Based on the history, the nurse suspects that the patient has sustained which type of stroke?
a. Hemorrhagic stroke
b. Intracerebral hemorrhages
c. Subarachnoid hemorrhages
d. Ischemic stroke
9. Which statement is true regarding the occurrence of SAHs?
a. Greater occurrence in men than women younger than the age of 40 years old
b. Greater occurrence in men than women older than the age of 40 years old
c. 90% of SAHs are caused by traumatic injury
d. Hemorrhage from SAHs have a better survival rate than hemorrhage from AVM
10. One of the pathologic consequences of an unruptured cerebral aneurysm is that it can
a. shunt blood away from the surrounding tissues.
b. leak blood into the subarachnoid space.
c. damage the middle layer of the arterial wall.
d. place pressure on the surrounding tissues.
Chapter 19: Kidney Clinical Assessment and Diagnostic Procedures
1. Which of the following assessment findings would indicate fluid volume excess?
a. Venous filling of the hand veins greater than 5 seconds
b. Distended neck veins in the supine position
c. Presence of orthostatic hypotension
d. Third heart sound
2. Loss of albumin from the vascular space may result in
a. peripheral edema.
b. extra heart sounds.
c. hypertension.
d. hyponatremia.
3. Which of the following auscultatory parameters may exist in the presence of hypovolemia?
a. Hypertension
b. Third or fourth heart sound
c. Orthostatic hypotension
d. Vascular bruit
4. Percussion of kidneys is usually done to
a. assess the size and shape of the kidneys.
b. detect pain in the renal area.
c. elicit a fluid wave.
d. evaluate fluid status.
5. Differentiating ascites from distortion caused by solid bowel contents in the distended abdomen is accomplished by
a. assessing for bowel sounds in four quadrants.
b. palpation of the liver margin.
c. measuring abdominal girth.
d. the presence of a fluid wave.
6. The most important assessment parameters for evaluating the patient’s fluid status is to measure
a. daily weights.
b. urine and serum osmolality.
c. intake and output.
d. hemoglobin and hematocrit levels.
7. Which of the following parameters is indicative of volume overload?
a. Central venous pressure of 4 mm Hg
b. Pulmonary artery occlusion pressure (PAOP) of 18 mm Hg
c. Cardiac index of 2.5 L/min/m2
d. Mean arterial pressure of 40 mm Hg
8. As serum osmolality rises, intravascular fluid equilibrium will be maintained by the release of
a. ketones.
b. glucagon.
c. antidiuretic hormone.
d. potassium.
9. Which of the following urine values reflects a decreased ability of the kidneys to concentrate urine?
a. pH of 5.0
b. Specific gravity of 1.000
c. No casts
d. Urine sodium of 140 mEq/24 hr
10. A patient is admitted to the critical care unit in congestive heart failure secondary to renal insufficiency. The patient reports that over the past few weeks, his urine output has decreased, and he has developed peripheral edema and ascites. A diagnosis of renal failure is made. The nurse suspects the main cause of ascites is
a. hypervolemia.
b. dehydration.
c. volume overload.
d. liver damage.
Chapter 20: Kidney Disorders and Therapeutic Management
1. An elderly patient is in a motor vehicle accident and sustains a significant internal hemorrhage. Which category of renal failure is the patient at the greatest risk of developing?
a. Intrinsic
b. Postrenal
c. Prerenal
d. Acute tubular necrosis
2. Which of the following laboratory values is the most help in evaluating a patient for acute renal failure?
a. Serum sodium
b. Serum creatinine
c. Serum potassium
d. Urine potassium
3. Which of the following IV solutions is recommended for treatment of prerenal failure?
a. Dextrose in water
b. Normal saline
c. Albumin
d. Lactated Ringer solution
4. One therapeutic measure for treating hyperkalemia is the administration of dextrose and regular insulin. How do these agents lower potassium?
a. They force potassium out of the cells and into the serum, lowering it on a cellular level.
b. They promote higher excretion of potassium in the urine.
c. They bind with resin in the bowel and are eliminated in the feces.
d. They force potassium out of the serum and into the cells, thus causing potassium to lower.
5. Which of the following IV solutions is contraindicated for patients with kidney or liver disease or in lactic acidosis?
a. D5W
b. 0.9% NaCl
c. Lactated Ringer solution
d. 0.45% NaCl
6. To assess whether or not an arteriovenous fistula is functioning, what must be done and why?
a. Palpate the quality of the pulse distal to the site to determine whether a thrill is present; auscultate with a stethoscope to appreciate a bruit to assess the quality of the blood flow.
b. Palpate the quality of the pulse proximal to the site to determine whether a thrill is present; auscultate with a stethoscope to appreciate a bruit to assess the quality of the blood flow.
c. Palpate gently over the site of the fistula to determine whether a thrill is present; listen with a stethoscope over this site to appreciate a bruit to assess the quality of the blood flow.
d. Palpate over the site of the fistula to determine whether a thrill is present; check whether the extremity is pink and warm.
7. To remove fluid during hemodialysis, a positive hydrostatic pressure is applied to the blood and a negative hydrostatic pressure is applied to the dialysate bath. This process is known as
a. ultrafiltration.
b. hemodialysis.
c. reverse osmosis.
d. colloid extraction.
8. Which electrolytes pose the most potential hazard if not within normal limits for a person with renal failure?
a. Phosphorous and calcium
b. Potassium and calcium
c. Magnesium and sodium
d. Phosphorous and magnesium
9. A patient has been hospitalized for a subtotal gastrectomy. After the procedure, an infection developed that eventually had to be treated with gentamicin, an aminoglycoside antibiotic. After 3 days of administration, oliguria occurred, and subsequent laboratory values indicated elevated BUN and creatinine levels. The patient is transferred to the critical care unit with acute kidney injury (previously known as acute tubular necrosis). Which dialysis method would be most appropriate for the patient’s condition?
a. Peritoneal dialysis
b. Hemodialysis
c. Continuous renal replacement therapy
d. Continuous venovenous hemodialysis (CVVH)
10. A patient has been hospitalized for a subtotal gastrectomy. After the procedure, an infection developed that eventually had to be treated with gentamicin, an aminoglycoside antibiotic. After 3 days of administration, oliguria occurred, and subsequent laboratory values indicated elevated BUN and creatinine levels. The patient is transferred to the critical care unit with acute kidney injury (previously known as acute tubular necrosis). The fluid that is removed each hour is not called urine; it is known as
a. convection.
b. diffusion.
c. replacement fluid.
d. ultrafiltrate.

AND MUCH MORE