Download Critical Care Assessment Test

PROFESSIONAL SERVICES
CLINICAL DIVISION
CRITICAL CARE ASSESSMENT TEST
1.
Q waves and ST segment elevation diagnostic for anterior wall MI would be seen in which of
the following leads?
a)
b)
c)
d)
2.
I and a VL
II, III, and a VF
V1 and V6
V1, V3, V4, V5, & V6
A 65-year-old man with a history of chronic obstructive pulmonary disease (COPD) is
admitted to the ICU with a chief complaint of increasing dyspnea over the past several days.
His chest X-ray in the ER shows bilateral fine infiltrates. His clinical presentation includes a
respiratory rate of 32, barrel chest with accessory muscle use, and pursed-lip breathing.
What would this patient’s arterial blood gas analysis be expected to show?
a)
b)
c)
d)
3.
The patient’s condition deteriorates and he is intubated and placed on a ventilator. The
settings are tidal volume = 900 ml, RR = 20, PEEP = 5cm H2O, and FiO2 = 30%. His arterial
blood gas analysis results show ph = 7.55, paCO2 = 30mm Hg, PaO2 = 70mm Hg, SaO2 =
91% and HCO3 = 35mEq/L. What is the most likely cause of the acid-base disturbance?
a)
b)
c)
d)
4.
Acidosis, hypoxemia, and hypoventilation
Acidosis, hyperemia, and hyperventilation
Alkalosis, hypoxemia, and hypoventilation
Alkalosis, hyperemia, and hyperventilation
Hypoxemia
Lactic acidosis
Nasogastric suction
Overventilation
What would be the most appropriate treatment to correct the acid-base imbalance?
a) Increase the respiratory rate
b) Administer aluminum chloride
c) Decrease the respiratory rate
d) Increase the FiO2
5.
The care plan for a patient with an acute inferior wall MI should indicate that the patient has
an increased potential for which of the following?
I.
II.
III.
IV.
Sinus bradycardia
Sinus tachycardia
Left-sided heart failure
Atrioventricular heart block
a)
b)
c)
d)
6.
The potential for intracranial hemorrhage in a patient receiving thrombolytic therapy is
greatest in patients with which of the following characteristics?
a)
b)
c)
d)
7.
Anticoagulation with warfarin (Coumadin)
Administration of low-molecular-weight heparin
Thrombectomy
Streptokinase infusion
The type of renal failure caused by a back-leak of glomerular filtrate is:
a)
b)
c)
d)
9.
Weight greater than 100kg, age older than 65,and presence of hypertension
Weight less than 70kg, age older than 65, and presence of hypertension
Weight greater than 100kg, female sex, and postmenopausal
Female sex, age older than 65, and presence of hypotension
After MI and echocardiogram shows a left ventricular thrombus. Treatment of this condition
would include:
a)
b)
c)
d)
8.
I and II
II and III
III and IV
I and IV
Prerenal failure
Postrenal failure
Intrarenal failure
Obstructive renal failure
The goal of stress ulcer therapy is to:
a)
b)
c)
d)
Inhibit bicarbonate secretion
Control gastric pH
Reduce endogenous prostaglandins
Stimulate histamine release
10. Which of the following is the most important intervention in managing intracranial pressure
monitoring using an intraventricular cannula?
a)
b)
c)
d)
Maintaining the intracranial pressure at 20mm Hg
Zero-balancing the transducer only if erroneous readings are suspected
Maintaining a closed system to prevent contamination
Maintaining the transducer at the phlebostatic axis
11. In a patient with sepsis the nurse would expect to find:
a)
b)
c)
d)
Increased BP, decreased SVR, and decreased LVEF
Decreased BP, Increased CO, and increased SVR
Increased LV end-diastolic volume, increased HR, and increased CO
Decreased LV end-diastolic volume, increased LVEF and increased SVR
12. The initial intervention for a patient with an acute MI with a junctional rhythm at a rate of 60
and hypotension should be to:
a)
b)
c)
d)
Place the patient in a supine position with legs elevated
Administer a 250 ml bolus of lactated ringers solution
Administer atropine 0.5 mg IVP
Initiate transcutaneous pacing at a rate of 60 beats/min
13. Ninety minutes after administration of streptokinase for acute MI, the patient states he has
chest pain. Rales are present at both bases, and ST segment elevation is increased. The
patient is currently on a heparin drip at 1040 units/hr (15 units/kg/hr) and nitroglycerine at
90 mcg/hr. Which of the following is the most appropriate treatment at this time?
a)
b)
c)
d)
Increase the heparin drip to 1200 units/ hr
Repeat streptokinase administration
Administer tissue plasminogen activatior (tPA)
Repeat administration of aspirin
14. Inverse I:E ratio ventilation (IRV), which is the opposite of a normal ventilatory pattern, is
used to allow a greater time for oxygen diffusion. An important patient care aspect related to
IRV is that it:
a)
b)
c)
d)
Requires a pulmonary artery catheter
Requires that patients be kept sedated and paralyzed
Can only be performed in select centers
Requires 1:1 nursing care
15. Endotracheal tube cuff pressures greater than 25cm H2O may result in:
a)
b)
c)
d)
Mucosal ulceration
Aspitation
Self-extubation
Infection
16. Which method of renal replacement therapy will be used to treat a patient who is moderately
catabolic and hemodynamically unstable?
a)
b)
c)
d)
Continuous arteriovenous hemofiltration (CAVH)
Hemodialysis
Slow continuous ultrafiltration (SCUF)
Peritoneal dialysis
17. Findings in a patient with unstable angina who is currently experiencing angina would
typically include:
a)
b)
c)
d)
Absence of ST segment and T wave changes
ST segment elevation and Q waves
ST segment depression
ST segment elevation
18. An 18-year-old patient is admitted to the ICU after sustaining closed-head trauma. The
critical care nurse observes otorrhea. Which nursing intervention is appropriate at this time?
a)
b)
c)
d)
Apply pressure to the area
Apple gentle suction
Assess the drainage for the presence of glucose
Pack the ear firmly with sterile dressings
19. A patient is admitted to the CCU after receiving streptokinase in the emergency department
for ST segment elevation in leads II, III, and a VF. Which of the following best indicates
reperfusion?
a)
b)
c)
d)
Reduction and relief of chest pain
Presence of premature ventricular contractions
Variable ST segment elevation and depression
Nausea and diaphoresis
20. To increase renal blood flow and increase cardiac perfusion in the septic patient, dopamine is
infused at _________mcg/kg/min.
a)
b)
c)
d)
2-4
6-8
10-12
14-16
21. An injury directly below the point of head trauma with a concomitant laceration at the
opposite pole of impact is called a:
a)
b)
c)
d)
Diffuse axonal injury
Coup/ contrecoup injury
Hematoma
Concussion
22. Which of the following indicates failure of therapy for unstable angina and the need for
emergent coronary intervention?
a) A single anginal episode lasting 20 minutes on nonparental medication
b) Recurrent 5-minute anginal episodes during a 24-hour period on nonparenteral
medication
c) Recurrent angina persisting for over 1 hour on parenteral medication
d) Any recurrence of angina within 24 hours on parenteral therapy
23. A patient intubated and on mechanical ventilation for 2 weeks is losing tidal volume with
each breath, as air is escaping through his mouth. His cuff pressure is 20cm H2O. His
saturation by pulse oximeterhas decreased from 93% to 88%. What intervention should be
instituted initially?
a)
b)
c)
d)
Reintubate with double-lumen endotracheal tube
Use minimal-leak technique for cuff
Schedule for a traceostomy
Reintubate with a foam cuffed tube
24. A victim of a motor vehicle crash is admitted to the ICU. He has sustained blunt trauma to
his chet from hitting the steering wheel. He was ejected from the vehicle and then it rolled
over him. He is on a ventilator, and, after a couple of hours, the peak inspiratory pressure
alarm is activated. The patient is now agitated and restless, his pulse oximeter reading is
dropping, and he has decreased breath sounds on the right side with dullness to percussion
and a mediastinal shift to the left.
I.
What intervention should the nurse anticipate?
a)
b)
c)
d)
MRI
CT
Surgery
Chest tube placement
25. Vigorous bubbling suddenly appearing in the water-seal chamber of the chest tubedrainage
system indicates the patient most likely has:
a)
b)
c)
d)
Pulmonary edema
A leak in the system
Bronchopleural fistula
Pulmonary contusion
26. What intervention is the most appropriate in this situation?
a)
b)
c)
d)
MRI
Thoracotomy
Troubleshooting the chest tube drainage system
Another chest tube placement
27. At which of the following pulmonary capillary wedge pressures would the nurse expect to
hear fine bibasilar rales?
a)
b)
c)
d)
4-6 mm Hg
8-10 mm Hg
15-18 mm Hg
20-24 mm Hg
28. The critical care nurse anticipates which of the following interventions for a patient within
the first 24 hours after a cerebral event caused by an embolus?
a)
b)
c)
d)
Head of the bed flat
Anticoagulation therapy
Out of bed in chair 1 hour three times a day
Epidural catheter to monitor intracranial dynamics
29. Which of the following medications used in the treatment of heart failure and pulmonary
edema reduces both preload and afterload, as well as sympathetic overdrive?
a)
b)
c)
d)
Digoxin
Furosemide
Morphine
Captopril
30. A 24-year-old man is admitted with an acute asthma attack. His blood gases are pH = 7.32,
PaCO2 = 50, PaO2 = 65, and SaO2 = 91% on 35% oxygen. Based on these results, the nurse
would:
a)
b)
c)
d)
Increase the oxygen percentage (FiO2)
Give bronchodilator therapy
Plan for intubation
Give an intermittent positive pressure breathing (IPPB) treatment
31. An early laboratory finding characteristic of acute pancreatitis is:
a)
b)
c)
d)
Elevated serum calcium value
Decreased white blood cell count
Decreased blood glucose level
Elevated serum amylase value
32. Laboratory data 24 to 48 hours after toxic ingestion of acetaminophen will likely demonstrate
elevation of serum levels of:
a)
b)
c)
d)
Total bilirubin
Alkaline phosphatase
Amylase
Glucose
33. A patient has been on relatively high doses of nitroprusside for 3 days to control his
hypertension, despite attempts to wean using labetalol and nifedipine. On the previous shift
the patient was alert, oriented, and cooperative, with a Glascow Coma Scale score of 15. The
patient is becoming increasingly confused and combative. Blood pressure is now 130/74 mm
Hg with a heart rate of 110 beats/ min that is attributed to agitation. The patient’s skin is
warm and pink with a capillary refill time of 1 second. Lungs are clear with an oxygen
saturation of 96% on room air. Which of the following should be obtained?
a) A psychiatric consultation
b) An arterial blood gas analysis
c) A thiocyanate level
d) A complete blood cell count
34. The critical care nurse is told that a patient with an intracranial hemorrhage is being admitted
to the ICU. When planning for care of this patient, the nurse knows that the first priority will
be to assess.
a)
b)
c)
d)
Vital signs
Pupillary response
Motor and sensory ability
Level of consciousness
35. Which of the following medications causes the greatest increase in myocardial contractility?
a)
b)
c)
d)
Dobutamine
Dopamine
Epinephrine
Norepinephrine
36. Which of the following diagnostic tests would the critical car nurse anticipate for the patient
with intracranial hemorrhage?
a)
b)
c)
d)
Lumbar puncture
Cerebral angiography
Computed Tomography
Myelography
37. The most frequent postoperative complication associated with thoracoabdominal aneurysm
repair is:
a)
b)
c)
d)
Pulmonary insufficiency
Myocardial infarction
Paralysis
Cerebrovascular accident
38. In patients with acetaminophen overdose, oral N-acetylcydsteine (NAC) is administered:
a)
b)
c)
d)
As long as the serum acetamiophen level remains elevated
Until the serum acetaminophen level is reduced
For 24 hours after the ingestion
For an 18-dose course
39. Which of the following methods of pulmonary toilet is appropriate for the patient who has
had repair of an aortic aneurysm?
a) Coughing and deep breathing exercises every 2 hours using pillow splinting
b) Sitting the patient out of bed in a chair for every hour each shift to perform coughing
and deep breathing exercises
c) Rigorous suctioning via a nasal airway every 4 hours
d) Sitting the patient in a chair for intermittent positive-pressure breathing treatments
every 4 hours
40. Clinical findings of a tension pneumothorax are:
a)
b)
c)
d)
Neck vein distention a tracheal deviation away from the affected side
Tracheal deviation toward the affected side and agitation
Increased respiratory effort and decreased heart rate
Increased cardiac output and cyanosis
41. A 53-year old patient is admitted to the ICU 3 weeks after a mild upper respiratory tract
infection. The patient is diagnosed with Guillain-Barre syndrome(GBS). Which of the
following interventions would the critical care nurse not anticipate?
a)
b)
c)
d)
Mechanical ventilation for paralysis if respiratory muscles
Hemodynamic monitoring for assessing autonomic nervous system dysfunction
Patient-controlled analgesia for acute pain
Indwelling urinary catheter for bladder atony
42. The amount of energy recommended for the initial defibrillation attempt of a patient in
ventricular fibrillation is _______________joules.
a)
b)
c)
d)
100
200
300
360
43. If administration of an initial 6-mg dose of adenosine (Adenocard) does not slow the
ventricular response of a patient with Wolff-Parkinson-White syndrome, it is appropriate to
administer:
a)
b)
c)
d)
Another 6 mg of adenosine within 2 minutes
A second dose of 12 mg of adenosine
Verapamil, 5 mg
Verapamil, 10 mg
44. A patient is admitted to the ICU with a serum glucose value of 1172 mg/dl, hyperosmolality,
hypokalemia, oliguria, tachycardia, and poor skin tugor. The first intervention in caring for
this patient should be administration of:
a)
b)
c)
d)
Insulin
Normal Saline
Potassium
Albumin
45. Which of the following outcomes best demonstrates effective treatment of supraventricular
tachycardia?
a)
b)
c)
d)
Improved cardiac output
Decrease in heart rate
Decrease in myocardial oxygen demand
Return of trial kick
46. A patient with hypertrophic cardiomyopathy has a pulmonary capillary wedge pressure
(PCWP) of 24mm Hg and cardiac output of 3.0 L/min. The respiratory rate is 30
breaths/min and labored, with coarse rales throughout all lung fields. Heart rate is 124
administering?
I.
II.
III.
Dobutamine infusion
Propranolol
Ditiazem
a)
b)
c)
d)
I only
I and II
II and III
I, II, and III
47. A patient who was in a motor vehicle crash has a BP of 80/50 mm Hg, heart rate of 126
beats/min, and respiratory rate of 28 breaths/min. The 12-lead ECG demonstrates sinus
tachycardia with atrial premature contractions. Jugular veins are flat. Heart tones are
normal with no S3 or S4. Breath sounds are equal and clear but shallow. Which of the
following is the most likely cause of the patient’s hypotension?
a)
b)
c)
d)
Cardiac tamponade
Hemothorax
Pneumothorax
Right ventriculat contusion
48. After a repair of a ventricular stab wound, a patient is having 6 to 10 premature ventricular
contractions per minute. Treatments should include:
I.
II.
III.
IV.
Lidocaine bolus and infusion at 2 to 4 mg/ min
Ventricular pacing
KCl, 10mEq/hr prn for serum potassium value less than 4.2 mEq/L
Nitoglycerin, 50 mg/250D5W, to maintain systolic BP greater than 100mm/ Hg
a)
b)
c)
d)
I and II
II and III
III and IV
I and III
49. Three days after chest tube insertion for a tension pneumothorax, the nurse observes no
bubbling or fluctuation in the water-seal chamber. This finding may indicate all of the
following except:
a)
b)
c)
d)
Bronchopleural fistula
Tube obstruction
Re-expansion of the lung
Kinked tubing
50. The classic symptom of aortoiliac occlusive disease is:
a)
b)
c)
d)
Intermittent claudication
Nonhealing leg ulcers
A pulsatile mass over the iliac artery
2+ pulses noted at both the femoral and popliteal sites