ATI RN
Critical Care Nursing Cardiac Questions Questions
Question 1 of 9
The nurse cares for a terminally ill patient who is experiencing pain that is continuous and severe. How should the nurse schedule the administration of opioid pain medications?
Correct Answer: A
Rationale: The correct answer is A: Give around-the-clock routine administration of analgesics. This is the best approach for managing continuous and severe pain in a terminally ill patient. By providing scheduled doses of opioid pain medications, the nurse ensures a consistent level of pain relief, preventing peaks and troughs in pain control. This approach also helps in preventing the patient from experiencing unnecessary suffering. Choice B (PRN doses) may lead to inadequate pain control as the patient may wait too long before requesting medication. Choice C (keeping the patient sedated) is not appropriate as the goal is pain management, not sedation. Choice D (balancing pain control and respiratory rate) is important, but the priority should be on effectively managing the pain first.
Question 2 of 9
In the critically ill patient, an incomplete assessment and/or management of pain or anxiety may be hampered by which of the following? (Select all that apply.)
Correct Answer: A
Rationale: Step-by-step rationale: 1. Administration of neuromuscular blocking agents can hinder pain or anxiety assessment as it paralyzes the patient, preventing them from communicating discomfort. 2. Delirium may affect the patient's ability to express pain or anxiety, but it does not directly impede assessment and management. 3. Effective nurse communication and assessment skills facilitate, rather than hamper, pain or anxiety assessment. 4. Nonverbal patients can still communicate pain or anxiety through nonverbal cues, so they do not necessarily hinder assessment.
Question 3 of 9
The nurse is caring for a patient with acute respiratory dist ress syndrome who is hypoxemic despite mechanical ventilation. The primary care provider (PCP) orders a nontraditional ventilator mode as part of treatment. Despite sedation and aabnirba.lcgoems/tieas,t the patient remains restless and appears to be in discomfort. The nurse informs the PCP of this assessment and anticipates what order?
Correct Answer: C
Rationale: The correct answer is C: Neuromuscular blockade. 1. Neuromuscular blockade helps to achieve optimal ventilator synchrony by reducing patient-ventilator asynchrony and improving oxygenation in patients with acute respiratory distress syndrome (ARDS). 2. Despite sedation, the patient's restlessness and discomfort suggest inadequate ventilator synchrony, which can be addressed by neuromuscular blockade. 3. Continuous lateral rotation therapy (A) and prone positioning (D) are interventions for improving ventilation and oxygenation in ARDS but do not directly address patient-ventilator synchrony. 4. Guided imagery (B) is a non-pharmacological technique for relaxation and pain management, which may not address the underlying issue of ventilator synchrony in this case.
Question 4 of 9
A client is admitted to the hospital with a diagnosis of Type 2 diabetes mellitus and influenza. Which categories of illness should the nurse develop goals for the client's plan of care?
Correct Answer: A
Rationale: The correct answer is A: One chronic and one acute illness. This is because Type 2 diabetes mellitus is a chronic condition, while influenza is an acute illness. The nurse should develop goals addressing the management and control of the chronic condition (diabetes) as well as the treatment and recovery from the acute illness (influenza). This approach ensures comprehensive care that considers both the long-term management of the chronic illness and the immediate needs related to the acute illness. Choices B, C, and D are incorrect because they do not address the combination of chronic and acute illnesses presented in the scenario. Choice B focuses solely on two acute illnesses, which overlooks the ongoing management required for the chronic condition. Choice C combines an acute and an infectious illness, but fails to account for the chronic illness component. Choice D involves two chronic illnesses, neglecting the immediate care needed for the acute illness.
Question 5 of 9
The nurse is managing a donor patient six hours prior to th e scheduled harvesting of the patient’s organs. Which assessment finding requires imme diate action by the nurse?
Correct Answer: B
Rationale: The correct answer is B. The patient's pH of 7.30 indicates acidosis, PaCO2 of 38 mm Hg is low, and HCO3 of 16 mEq/L is also low, suggesting metabolic acidosis. This finding requires immediate action as untreated acidosis can lead to serious complications. Choice A (morning serum blood glucose of 128 mg/dL) is within normal range and does not require immediate action. Choice C (pulmonary artery temperature of 97.8°F) is a normal temperature and does not require immediate action. Choice D (central venous pressure of 8 mm Hg) is within normal range and does not require immediate action.
Question 6 of 9
When assisting with the placement of a pulmonary artery (PA) catheter, the nurse notes that the catheter is correctly placed when the monitor shows a:
Correct Answer: D
Rationale: Step-by-step rationale for Answer D being correct: 1. PA catheter measures PA pressures. 2. PAWP reflects left atrial pressure. 3. Correct placement shows typical PAWP tracing. 4. PA pressure waveform (A) is not specific to PAWP. 5. Systemic arterial pressure tracing (B) is unrelated. 6. Systemic vascular resistance tracing (C) is not monitored by PA catheter.
Question 7 of 9
An unresponsive 79-year-old is admitted to the emergency department (ED) during a summer heat wave. The patient’s core temperature is 105.4°F (40.8°C), blood pressure (BP) 88/50, and pulse 112. The nurse initially will plan to:
Correct Answer: A
Rationale: The correct answer is A: Apply wet sheets and a fan to the patient. This is the initial treatment for hyperthermia to aid in lowering the body temperature. Wet sheets help in evaporative cooling, while a fan enhances heat loss through convection. This approach is crucial in managing heat-related illnesses quickly. Choices B, C, and D are incorrect as they do not directly address the urgent need to reduce the patient's elevated core temperature. Providing O2, IV fluids, or acetaminophen can be considered later in the management, but the priority is to rapidly lower the body temperature in a hyperthermic patient to prevent further complications.
Question 8 of 9
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?
Correct Answer: A
Rationale: The correct answer is A. A decrease in the arterial pressure (hypotension) with a low diastolic pressure (46 mmHg) may indicate inadequate perfusion, possibly due to inadequate cardiac output from the mechanical ventilation. This suggests that a change in ventilator settings may be required to improve oxygenation and perfusion. Option B is incorrect because a heart rate of 58 beats/minute alone does not provide direct information on the patient's hemodynamic status. Option C is incorrect as an increased stroke volume would usually be a positive indicator; it does not necessarily indicate a need for changing the ventilator settings. Option D is incorrect as a stroke volume variation of 12% is within normal limits and does not necessarily require a change in ventilator settings.
Question 9 of 9
A patient with end-stage heart failure is experiencing consaibdirebr.caobmle/te dsty spnea. What is the appropriate pharmacological management of this symptom ?
Correct Answer: B
Rationale: The correct answer is B: Administration of morphine, 5 mg IV bolus, and initiation of a continuous morphine infusion. Morphine is the preferred pharmacological management for severe dyspnea in end-stage heart failure due to its potent analgesic and anxiolytic properties. Step-by-step rationale: 1. Morphine is a potent opioid that helps relieve dyspnea by reducing anxiety, decreasing respiratory drive, and improving overall comfort. 2. The initial IV bolus of 5 mg provides rapid relief of dyspnea. 3. Initiating a continuous morphine infusion ensures sustained relief of dyspnea. 4. Midazolam (choice A) is a benzodiazepine used for sedation and anxiety, but it is not the first-line treatment for dyspnea in this scenario. 5. Increasing the midazolam (choice C) or morphine (choice D) infusions by 100% dose increments hourly is not appropriate as