ATI RN
Critical Care Nursing Questions and Answers PDF Questions
Question 1 of 9
The nurse is assigned to care for a patient who is a non-na tive English speaker. What is the best way to communicate with the patient and family to provide updates and explain procedures?
Correct Answer: B
Rationale: The correct answer is B: Contact the hospital’s interpreter service for someone to translate. This is the best option as it ensures accurate communication between the nurse, patient, and family. Hospital interpreters are trained professionals who can accurately convey medical information, ensuring understanding and informed decision-making. Using Google search (A) may result in inaccurate information and is not reliable for medical communication. Asking a resident (C) who is fluent may not guarantee accuracy in medical terminology. Using a young family member (D) as a translator can lead to miscommunication due to potential language barriers or lack of medical knowledge. Overall, option B is the most appropriate and ethical choice for effective communication in a healthcare setting.
Question 2 of 9
While caring for a patient with a pulmonary artery cathete r, the nurse notes the pulmonary artery occlusion pressure (PAOP) to be significantly higher than previously recorded values. The nurse assesses respirations to be unlabored at 16 breat hs/min, oxygen saturation of 98% on 3 L of oxygen via nasal cannula, and lungs clear to auscultation bilaterally. What is the priority nursing action?
Correct Answer: B
Rationale: The correct answer is B: Notify the physician immediately of the assessment findings. The significantly higher PAOP could indicate a potential complication or a change in the patient's condition that needs immediate medical attention. By notifying the physician, further assessment and interventions can be initiated promptly to address the underlying cause. Increasing supplemental oxygen (choice A) may not directly address the elevated PAOP, obtaining a chest x-ray (choice C) may delay urgent intervention, and zero referencing the catheter (choice D) is not a priority in this situation. Notifying the physician ensures timely and appropriate management of the patient's condition.
Question 3 of 9
The nurse is using presence to reduce the anxiety of a critically ill patient. What nursing behavior demonstrates an effective use of presence?
Correct Answer: C
Rationale: The correct answer is C because maintaining eye contact with the patient during explanations is a non-verbal way to show attentiveness and empathy, which can help reduce the patient's anxiety. This behavior demonstrates active listening and engagement, making the patient feel heard and understood. A: Staying in the patient's room to complete documentation is not an effective use of presence as it does not involve direct interaction with the patient. B: Having a conversation in the patient's room that excludes the patient is also not an effective use of presence as it does not involve engaging with the patient. D: Focusing on specific nursing care tasks while in the patient's room, although important, may not necessarily demonstrate presence in reducing the patient's anxiety.
Question 4 of 9
A 6-year-old child is alert but quiet when brought to the emergency center with periorbital ecchymosis and ecchymosis behind the ears. The nurse suspects potential child abuse and continues to assess the child for additional manifestations of a basilar skull fracture. What assessment finding would be consistent with a basilar skull fracture?
Correct Answer: C
Rationale: The correct answer is C: Rhinorrhoea or otorrhoea with Halo sign. This finding is consistent with a basilar skull fracture because it indicates a cerebrospinal fluid (CSF) leak from the skull base. The Halo sign refers to a ring of CSF surrounded by blood, which can be seen on a white absorbent pad. This specific sign is a classic indicator of a basilar skull fracture, as the CSF leakage from the ears or nose can be tinged with blood due to the fracture disrupting nearby blood vessels. For the other choices: A: Hematemesis and abdominal distention are not typical manifestations of a basilar skull fracture. They are more indicative of gastrointestinal issues or internal bleeding. B: Asymmetry of the face and eye movements can be seen with facial nerve or orbital injuries, but it is not specific to a basilar skull fracture. D: Abnormal position and movement of the arm are not directly related to a
Question 5 of 9
A patient has just been admitted to the ICU after being in a severe auto accident and losing one of her legs. Her husband has his hand over his heart and complains of a rapid heart rate. The nurse recognizes his condition as a sign of which stage of the general adaptation syndrome to stress?
Correct Answer: A
Rationale: The correct answer is A: Alarm stage. The husband's rapid heart rate indicates the initial alarm reaction to stress, characterized by physiological arousal. This stage involves the body's fight-or-flight response to a stressor. In this scenario, the husband is experiencing the physiological effects of the stressful situation, such as the auto accident and loss of a limb. The other choices are incorrect because: B: Exhaustion stage occurs if stress continues without relief, leading to depletion of resources and increased vulnerability to illness. C: Resistance stage is the body's attempt to adapt and cope with the stressor after the initial alarm reaction. D: Adaptation stage is not a recognized stage in the general adaptation syndrome model.
Question 6 of 9
A patient in a critical care unit has increased stress from the constant noise and light levels. What nursing intervention best attenuates these sources of stress?
Correct Answer: B
Rationale: The correct answer is B: Dimming lights during the night. This intervention helps reduce stress by creating a more calming environment, promoting rest and sleep. Constant observation (choice A) may increase stress due to lack of privacy. Frequent group rounds (choice C) may disrupt rest. Use of tile floors (choice D) is unrelated to addressing noise and light stress.
Question 7 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 8 of 9
A patient is having difficulty weaning from mechanical ve ntilation. The nurse assesses the patient and notes what potential cause of this difficult weaning?
Correct Answer: B
Rationale: The correct answer is B: Hemoglobin of 8 g/dL. Low hemoglobin levels can lead to inadequate oxygen delivery to tissues, causing respiratory distress and difficulty weaning from mechanical ventilation. This is due to reduced oxygen-carrying capacity leading to increased work of breathing. A: Cardiac output of 6 L/min is within normal range and not directly related to difficulty weaning from mechanical ventilation. C: Negative sputum culture and sensitivity indicate absence of respiratory infection but not a direct cause of difficulty weaning. D: White blood cell count of 8000 is within normal range and not a direct cause of difficulty weaning.
Question 9 of 9
Palliation care includes what goals? (Select all that apply.)
Correct Answer: A
Rationale: The correct answer is A (Pain relief) because palliative care aims to provide comfort and improve the quality of life for individuals with serious illnesses. Pain relief is a crucial goal in palliative care to alleviate physical suffering. Nausea relief (B) is also commonly addressed in palliative care, but it is not a universal goal. Psychological support (C) is an important aspect of palliative care but is not always a primary goal. Withdrawal of life-support interventions (D) is not a goal of palliative care, as palliative care focuses on symptom management and improving quality of life, not hastening death.