Critical Care Nursing NCLEX Questions

Critical Care Nursing NCLEX Questions Related

Review Critical Care Nursing NCLEX Questions related questions and content

The charge nurse has a Vigileo pulse contour cardiac output monitoring system available for use in the surgical intensive care unit. For which patient isa buisrbe.c oomf /ttehsits device most appropriate?

  • A. A patient with a history of aortic insufficiency admitte d with a postoperative myocardial infarction
  • B. A mechanically ventilated patient with cardiogenic sho ck being treated with an intraaortic balloon pump
  • C. A patient with a history of atrial fibrillation having frequent episodes of paroxysmal supraventricular tachycardia
  • D. A mechanically ventilated patient admitted following repair of an acute bowel obstruction
Correct Answer: B

Rationale: The correct answer is B because a mechanically ventilated patient with cardiogenic shock being treated with an intra-aortic balloon pump would benefit most from having a Vigileo pulse contour cardiac output monitoring system. This device provides continuous cardiac output monitoring and can help guide hemodynamic management in critically ill patients, especially those with hemodynamic instability like cardiogenic shock. It allows for real-time adjustments of fluid and vasoactive medications to optimize cardiac output and tissue perfusion.

Choice A is incorrect because a patient with a history of aortic insufficiency and postoperative myocardial infarction may not require continuous cardiac output monitoring like the patient in choice B. Choice C is incorrect as the patient with atrial fibrillation and paroxysmal supraventricular tachycardia does not necessarily need cardiac output monitoring. Choice D is also incorrect as a mechanically ventilated patient following repair of an acute bowel obstruction may not require continuous cardiac output monitoring unless there are specific complications.

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The family members of a critically ill, 90-year-old patient bring in a copy of the patient’s living will to the hospital, which identifies the patient’s wiasbhireb.sc orme/gteasrt ding health care. The nurse discusses the contents of the living will with the patient’s physician. This is an example of implementation of which of the AACN Standards of Pr ofessional Performance?

  • A. Acquires and maintains current knowledge of practice
  • B. Acts ethically on the behalf of the patient and family
  • C. Considers factors related to safe patient care
  • D. Uses clinical inquiry and integrates research findings i n practice
Correct Answer: C

Rationale: The correct answer is C: Considers factors related to safe patient care. The scenario involves the nurse discussing the patient's living will with the physician, which is essential for ensuring safe patient care by following the patient's preferences. This aligns with the AACN standard of considering factors related to safe patient care, as the nurse is actively involving all relevant parties in decision-making to provide care that is in line with the patient's wishes.

Explanation of why other choices are incorrect:
A: Acquires and maintains current knowledge of practice - While important, this choice does not directly relate to the scenario where the focus is on safe patient care through communication and collaboration.
B: Acts ethically on behalf of the patient and family - While ethics are important, the scenario is more about following the patient's wishes as outlined in the living will rather than making ethical decisions.
D: Uses clinical inquiry and integrates research findings in practice - While valuable in nursing practice, this choice does not directly apply to the scenario where

After the change-of-shift report, which patient should the progressive care nurse assess first?

  • A. Patient who was extubated in the morning and has a temperature of 101.4°F (38.6°C).
  • B. Patient with bilevel positive airway pressure (BiPAP) for sleep apnea whose respiratory rate is 16.
  • C. Patient with arterial pressure monitoring who is 2 hours post percutaneous coronary intervention and needs to void.
  • D. Patient who is receiving IV heparin for venous thromboembolism and has a partial thromboplastin time (PTT) of 98 seconds.
Correct Answer: D

Rationale: The correct answer is D. The patient receiving IV heparin with a PTT of 98 seconds is at risk for bleeding due to the therapeutic range of 60-80 seconds. Assessing this patient first is crucial to prevent potential bleeding complications. A high PTT indicates the blood is not clotting properly, increasing the risk of bleeding. Prompt assessment and possible adjustment of heparin infusion are needed.

A: The patient with a temperature of 101.4°F may have a fever but is not at immediate risk compared to the patient with a high PTT.
B: The patient on BiPAP with a respiratory rate of 16 is stable and does not require immediate assessment.
C: The patient post-percutaneous coronary intervention needing to void is a routine need and does not require immediate attention compared to the patient with a critical lab value.

The nurse is assisting with endotracheal intubation of the p atient and recognizes that the procedure will be done in what order? (Put a comma and s pace between each answer choice.)

  • A. Assess balloon on endotracheal tube for symmetry and laebairkb.sc.o m/test
  • B. Assess lung fields for bilateral expansion.
  • C. Inflate balloon of endotracheal tube.
  • D. Insert endotracheal tube with laryngoscope and blade.
Correct Answer: D

Rationale: The correct answer is D. The first step in endotracheal intubation is to insert the endotracheal tube with a laryngoscope and blade to visualize the vocal cords and guide the tube into the trachea. This ensures proper placement of the tube for effective ventilation. Assessing the balloon symmetry (Choice A) and lung fields (Choice B) would come after the tube is successfully inserted. Inflating the balloon of the endotracheal tube (Choice C) should be the last step to secure the tube in place.

A PaCO 2 of 48 mm Hg is associated with what outcome?

  • A. Hyperventilation
  • B. Hypoventilation
  • C. Increased absorption of O
  • D. Increased excretion of HCO
Correct Answer: B

Rationale: The correct answer is B: Hypoventilation. A PaCO2 of 48 mm Hg indicates an elevated level of carbon dioxide in the blood, which is typically seen in hypoventilation where the lungs are not effectively removing CO2. Hypoventilation leads to respiratory acidosis. Option A is incorrect because hyperventilation would decrease PaCO2 levels. Option C is incorrect as it does not directly relate to PaCO2 levels. Option D is incorrect as increased excretion of HCO3- would not directly affect PaCO2 levels.

Which findings have been reported in the literature as benefits of allowing family to be present during resuscitation and invasive procedures? (Selaebcirtb a.clolm t/hteastt apply.)

  • A. Families benefit by witnessing that everything possible was done.
  • B. Families report reduced anxiety and fear about what is being done to the patient.
  • C. Presence encourages family members to seek litigation for improper care.
  • D. Presence reduces nurses’ involvement in explaining th ings to the family.
Correct Answer: A

Rationale: Step 1: Families benefit by witnessing that everything possible was done during resuscitation and invasive procedures.
Step 2: This reassures families that healthcare providers are doing their best to save the patient.
Step 3: It can provide closure and comfort to families knowing that all efforts were made.
Step 4: This transparency can also help in the grieving process for families.
Summary: Choice A is correct because it highlights the emotional and psychological benefits for families. Choices B, C, and D are incorrect as they do not align with the positive impacts of allowing family presence during resuscitation and invasive procedures.

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