Critical Care Nursing Questions

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An elderly patient is admitted to the ICU with stage IV lung cancer, diabetes mellitus, and congestive heart failure. The health care team assembled to care for her is large and diverse, including an oncologist, a pulmonologist, an endocrinologist, a cardiologist, and others. The patient is not expected to survive more than a few weeks, and her husband is overwhelmed with stress and grief. Which nurse competency or competencies are most needed in this situation? Select all that apply.

  • A. Clinical judgment
  • B. Caring practices
  • C. Collaboration
  • D. Response to diversity
Correct Answer: B

Rationale: The correct answer is B: Caring practices. In this situation, the patient and her husband are dealing with complex medical conditions and emotional distress. Caring practices involve providing compassionate, empathetic, and supportive care to the patient and her family members during this difficult time. The nurse needs to show sensitivity, understanding, and emotional support to help them cope with their situation. Clinical judgment (A) is important but not the primary focus in this scenario. Collaboration (C) is essential in the interdisciplinary team, but caring practices take precedence in addressing the emotional needs. Response to diversity (D) is also important, but in this case, the focus is more on providing compassionate care rather than addressing cultural or social diversity issues.

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Positive end-expiratory pressure (PEEP) is a mode of ventaiblairbto.croym /atessst istance that produces which of the following conditions

  • A. Each time the patient initiates a breath, the ventilator d elivers a full preset tidal volume.
  • B. For each spontaneous breath taken by the patient, the tidal volume is determined by the patient’s ability to generate negative pressure.
  • C. The patient must have a respiratory drive, or no breaths will be delivered.
  • D. There is pressure remaining in the lungs at the end of eaxbiprbi.rcaotmio/tens tt hat is measured in cm H O.
Correct Answer: D

Rationale: The correct answer is D because positive end-expiratory pressure (PEEP) is a mode of ventilation where pressure is maintained in the lungs at the end of expiration. This helps prevent alveolar collapse and improves oxygenation. Option A is incorrect because PEEP does not deliver a full preset tidal volume with each breath initiation. Option B is incorrect because tidal volume in PEEP is not solely determined by the patient's ability to generate negative pressure. Option C is incorrect because in PEEP, breaths are delivered irrespective of the patient's respiratory drive.

A patients family is exhibiting increasingly impaired coping as the patients condition deteriorates. The nurse asks the family to state the biggest concern from their perspective.What is the most important rationale for this question?

  • A. The question indicates active listening on the part of the nurse.
  • B. The question is used as a way to validate the familys knowledge.
  • C. The question clarifies the nurses understanding of current family needs.
  • D. The question promotes problem definition, which helps define the degree of family understanding.
Correct Answer: C

Rationale: The correct answer is C because asking the family to state their biggest concern clarifies the nurse's understanding of the current family needs. This step allows the nurse to assess the specific areas where the family may require support or assistance, leading to more tailored interventions. By identifying the primary concern, the nurse can better address the family's emotional, informational, or practical needs.

Choice A is incorrect because the question is not solely about active listening; it serves a deeper purpose of assessment. Choice B is incorrect as the question goes beyond validating knowledge to understanding emotional and practical needs. Choice D is incorrect because the question focuses on identifying concerns rather than defining the degree of understanding.

To maintain proper cuff pressure of an endotracheal tube (ET) when the patient is on mechanical ventilation, the nurse should:

  • A. Inflate the cuff with a minimum of 10 mL of air.
  • B. Inflate the cuff until the pilot balloon is firm on palpation.
  • C. Inject air into the cuff until a manometer shows 15 mm Hg pressure.
  • D. Inject air into the cuff until a slight leak is heard only at peak inflation.
Correct Answer: D

Rationale: The correct answer is D because inflating the cuff until a slight leak is heard only at peak inflation ensures it is adequately sealed but not overinflated, preventing complications like tracheal injury or pressure necrosis. Choice A lacks specificity and can lead to overinflation. Choice B may result in overinflation as the firmness of the balloon is subjective. Choice C relies on a specific pressure reading, which may vary based on factors like tube size and patient anatomy, potentially leading to under- or overinflation.

When caring for a patient with pulmonary hypertension, which parameter is most appropriate for the nurse to monitor to evaluate the effectiveness of the treatment?

  • A. Central venous pressure (CVP)
  • B. Systemic vascular resistance (SVR)
  • C. Pulmonary vascular resistance (PVR)
  • D. Pulmonary artery wedge pressure (PAWP)
Correct Answer: C

Rationale: The correct answer is C: Pulmonary vascular resistance (PVR). PVR is the most appropriate parameter to monitor in a patient with pulmonary hypertension as it directly reflects the resistance in the pulmonary circulation. A decrease in PVR indicates a reduction in the constriction of blood vessels in the lungs, suggesting improvement in pulmonary hypertension. Monitoring CVP (A) is more relevant in assessing fluid status, SVR (B) is more indicative of systemic vascular tone, and PAWP (D) is useful in assessing left-sided heart function, but they are not as specific to evaluating the effectiveness of treatment for pulmonary hypertension.

A patient nearing death experiences increased secretions and noisy breathing. What is the nurse’s priority intervention?

  • A. Provide suctioning every hour.
  • B. Administer anticholinergic medications as prescribed.
  • C. Elevate the head of the bed and reposition frequently.
  • D. Restrict oral intake to minimize secretions.
Correct Answer: B

Rationale: The correct answer is B: Administer anticholinergic medications as prescribed. Anticholinergic medications can help dry up secretions and improve breathing in a patient nearing death. This intervention targets the underlying cause of increased secretions. Suctioning (choice A) may provide temporary relief but does not address the root issue. Elevating the head of the bed and repositioning (choice C) can help with comfort but do not directly address the secretions. Restricting oral intake (choice D) may lead to dehydration and discomfort without effectively managing the secretions. Administering anticholinergic medications is the priority as it directly targets the symptom of increased secretions, improving the patient's comfort and quality of life.

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