ATI RN
Critical Care Nursing Questions and Answers PDF Questions
Question 1 of 9
In which situation would a healthcare surrogate or proxy a ssume the end-of-life decision-making role for a patient?
Correct Answer: A
Rationale: The correct answer is A because in this situation, the patient is no longer able to make decisions for themselves due to being heavily sedated. The healthcare surrogate or proxy steps in to make decisions on behalf of the patient to ensure their comfort and well-being. Choice B is incorrect because the patient is competent and able to make their own decisions, so there is no need for a surrogate to take over decision-making. Choice C is incorrect because the patient is competent and has the right to make decisions about their own treatment, even if they go against medical recommendations. Choice D is incorrect because the patient is competent and receiving appropriate treatment for their pain and anxiety, so there is no need for a surrogate to intervene in this scenario.
Question 2 of 9
The nurse is caring for a patient who is being evaluated clianbiircba.clolmy/ tfeostr brain death by a primary care provider. Which assessment findings by the nurse sup port brain death?
Correct Answer: A
Rationale: The correct answer is A, absence of a corneal reflex, because in brain death, all brainstem reflexes, including the corneal reflex, are absent. This indicates complete loss of brain function. Choice B, unequal reactive pupils, is incorrect as it suggests some level of brainstem function. Choice C, withdrawal from painful stimuli, is also incorrect as it is a spinal reflex and can occur even in the absence of brain function. Choice D, core temperature of 100.8° F, is irrelevant to assessing brain death.
Question 3 of 9
The nurse is concerned about the risk of alcohol withdraw al syndrome in a 45-year-old postoperative patient. Which statement indicates an unders tanding of management of this patient?
Correct Answer: D
Rationale: The correct answer is D because initiating the alcohol withdrawal protocol shows an understanding of managing a patient at risk for alcohol withdrawal syndrome. This protocol involves carefully monitoring the patient's symptoms, providing appropriate medications, and ensuring a safe environment. Option A is incorrect as it downplays the seriousness of alcohol withdrawal. Option B is incorrect as there are assessment tools available for identifying alcohol withdrawal. Option C is incorrect as pain management should be tailored to the individual's needs, not necessarily lessened due to alcohol withdrawal risk.
Question 4 of 9
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?
Correct Answer: C
Rationale: The correct answer is C: Listen to the patient’s breath sounds. Moving from 22 cm to 25 cm may indicate ET tube migration. Checking breath sounds can confirm proper tube placement. A may not address the underlying issue. B could worsen the situation if the tube is misplaced. D is not urgent compared to assessing airway integrity.
Question 5 of 9
Which statement is true regarding venous thromboembolisambir b(.VcoTm/Ete)s ta nd pulmonary embolus (PE)?
Correct Answer: A
Rationale: The correct answer is A because PE should be suspected in patients with unexplained cardiorespiratory complaints and risk factors for VTE. This is important because PE can present with nonspecific symptoms, making it crucial to consider it in the differential diagnosis. Explanation: 1. PE can present with various symptoms, including dyspnea, chest pain, and hemoptysis, but these are not present in all patients. 2. Bradycardia and hyperventilation are not classic symptoms of PE, as it can present with tachycardia and other respiratory findings. 3. Critically ill patients are actually at higher risk for VTE and PE, so prophylaxis is typically recommended. In summary, choice A is correct because it emphasizes the importance of considering PE in patients with cardiorespiratory complaints and risk factors for VTE, while the other choices contain inaccuracies or incomplete information.
Question 6 of 9
An intra-aortic balloon pump (IABP) is being used for a patient who is in cardiogenic shock. Which assessment data indicate to the nurse that the goals of treatment with the IABP are being met?
Correct Answer: C
Rationale: The correct answer is C: Cardiac output (CO) of 5 L/min. In cardiogenic shock, the primary goal of using an IABP is to improve cardiac output to ensure adequate perfusion to vital organs. A cardiac output of 5 L/min indicates adequate blood flow and perfusion. Choice A is incorrect as urine output is not a direct indicator of cardiac function. Choice B is incorrect as a heart rate of 110 beats/minute alone does not provide information on the effectiveness of the IABP in improving cardiac output. Choice D is incorrect as stroke volume alone does not provide a comprehensive assessment of overall cardiac function.
Question 7 of 9
The nurse is caring for a mechanically ventilated patient an d is charting outside the patient’s room when the ventilator alarm sounds. What is the priorit y order for the nurse to complete these actions? (Put a comma and space between each answer choice.)
Correct Answer: C
Rationale: Step-by-step rationale for why choice C is correct: 1. Going to the patient’s bedside is the priority as it allows the nurse to assess the patient's condition directly. 2. By being at the bedside, the nurse can quickly evaluate the patient's breathing, vital signs, and other indicators for immediate action. 3. Direct assessment enables timely intervention and avoids delays in addressing potential life-threatening situations. 4. Checking for possible causes of the alarm and reconnection to the ventilator can follow, but assessing the patient's immediate needs takes precedence. In summary, choice C is correct because direct patient assessment is the fundamental step in responding to a ventilator alarm to ensure patient safety and timely intervention. Choices A, B, and D are incorrect as they focus on troubleshooting and technical aspects before directly assessing the patient's condition.
Question 8 of 9
The patient has been admitted to the hospital with nausea and vomiting that started 5 days earlier. Blood pressure is 80/44 mm Hg and heart rate is 122 beats/min; the patient has not voided in 8 hours, and the bladder is not distended. The nurse anticipates a prescription for “stat” administration of
Correct Answer: B
Rationale: The correct answer is B: fluid replacement with 0.45% saline. The patient's low blood pressure, tachycardia, and lack of urine output indicate hypovolemia. Fluid replacement with saline will help restore circulating volume, improve blood pressure, and support renal perfusion. A: Blood transfusion is not indicated as the primary issue is hypovolemia, not anemia. C: Inotropic agents are used to increase cardiac contractility but are not the initial treatment for hypovolemia. D: Antiemetics may help with symptoms but do not address the underlying issue of fluid loss and hypovolemia.
Question 9 of 9
A middle-aged patient tells the nurse, 'My mother died 4 months ago, and I just can’t seem to get over it. I’m not sure it is normal to still think about her every day.' Which nursing diagnosis is most appropriate?
Correct Answer: C
Rationale: The correct answer is C: Anxiety related to lack of knowledge about normal grieving. This is because the patient is expressing uncertainty and seeking validation for their feelings, indicating a lack of understanding about the grieving process. Choice A is incorrect as hopelessness typically involves feelings of despair and loss of motivation, which are not explicitly stated by the patient. Choice B is incorrect as complicated grieving involves specific unresolved issues related to the loss, which the patient did not mention. Choice D is incorrect as chronic sorrow is typically associated with ongoing feelings of sadness and longing, which are not explicitly expressed by the patient.