Critical Care Nursing Practice Questions

Critical Care Nursing Practice Questions Related

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The nurse is caring for a 48-year-old patient who is intubated and on a ventilator following extensive abdominal surgery. Although the patient is respo nsive, the nurse is not able to read the patient’s lips as the patient attempts to mouth the words. Which of the following assessment tools would be the most appropriate for the nu rse to use when assessing the patient’s pain level? (Select all that apply.)

  • A. The FACES scale
  • B. Pain Intensity Scale
  • C. The PQRST method
  • D. The Visual Analogue Scale
Correct Answer: A

Rationale: The correct answer is A: The FACES scale. This scale uses facial expressions to assess pain, making it suitable for a patient who is unable to verbalize. The nurse can show the patient a series of faces depicting varying levels of pain and ask them to point to the one that best represents their pain level. This method is non-verbal and easy for patients to understand.

The other choices are incorrect:
B: The Pain Intensity Scale requires the patient to rate their pain on a numerical scale, which may be difficult for a non-verbal patient.
C: The PQRST method is a mnemonic for assessing pain characteristics (provocation, quality, region, severity, timing), but it requires patient communication.
D: The Visual Analogue Scale involves marking a point on a line to indicate pain intensity, which is not suitable for a non-verbal patient.

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Four hours after mechanical ventilation is initiated for a patient with chronic obstructive pulmonary disease (COPD), the patient’s arterial blood gas (ABG) results include a pH of 7.51, PaO2 of 82 mm Hg, PaCO2 of 26 mm Hg, and HCO3 of 23 mEq/L (23 mmol/L). The nurse will anticipate the need to:

  • A. Increase the FIO2.
  • B. Increase the tidal volume.
  • C. Increase the respiratory rate.
  • D. Decrease the respiratory rate.
Correct Answer: D

Rationale: The correct answer is D: Decrease the respiratory rate. The ABG results show respiratory alkalosis with decreased PaCO2 and elevated pH. This indicates overventilation, so decreasing the respiratory rate will help normalize the PaCO2 and pH levels. Increasing the FIO2 (Choice A) is not needed as the PaO2 is within normal range. Increasing tidal volume (Choice B) can lead to further hyperventilation. Increasing the respiratory rate (Choice C) would exacerbate the respiratory alkalosis.

The condition of a critically ill patient with a living will has deteriorated. The patient’s partner wants “everything done,” regardless of the patient’s wishe s. Which ethical principle is the partner violating?

  • A. Autonomy
  • B. Beneficence
  • C. Justice
  • D. Nonmaleficence
Correct Answer: A

Rationale: The correct answer is A: Autonomy. Autonomy is the ethical principle that respects an individual's right to make decisions about their own care and treatment. In this scenario, the partner wanting "everything done" regardless of the patient's wishes violates the patient's autonomy by not honoring their previously expressed wishes outlined in the living will. This decision disregards the patient's right to make choices about their own healthcare. Choices B, C, and D are incorrect because:
B: Beneficence focuses on doing good for the patient, but in this case, the partner's actions are not necessarily in the patient's best interest.
C: Justice pertains to fairness and equal treatment, which is not directly relevant to the situation described.
D: Nonmaleficence is the principle of doing no harm, but in this scenario, the harm is not necessarily physical but rather a violation of the patient's autonomy.

A patient is being mechanically ventilated in the synchronized intermittent mandatory ventilation mode at a rate of 4 breaths/min. Spontaneous reabsiprbi.rcaotmio/tensst are 12 breaths/min. After receiving a dose of morphine sulfate, respirations decrease to 4 breaths/min. Which acid-base disturbance will likely occur?

  • A. Metabolic acidosis
  • B. Metabolic alkalosis
  • C. Respiratory acidosis
  • D. Respiratory alkalosis
Correct Answer: D

Rationale: The correct answer is D (Respiratory alkalosis). Morphine sulfate can cause respiratory depression, leading to decreased respiratory rate. In this case, the patient's breaths decrease from 12 to 4 breaths/min, indicating hypoventilation. With decreased ventilation, there is less CO2 elimination, resulting in respiratory alkalosis. The other choices can be ruled out: A (Metabolic acidosis) and B (Metabolic alkalosis) are less likely caused by morphine sulfate, and C (Respiratory acidosis) is incorrect because the scenario describes hypoventilation, not hyperventilation.

Peritoneal dialysis is different from hemodialysis in that peritoneal dialysis

  • A. is more frequently used for acute kidney injury.
  • B. uses the patient’s own semipermeable membrane (peritoneal membrane).
  • C. is not useful in cases of drug overdose or electrolyte imbalance.
  • D. is not indicated in cases of water intoxication.
Correct Answer: B

Rationale: The correct answer is B because peritoneal dialysis utilizes the patient's own semipermeable membrane, the peritoneal membrane, as the filtration surface. This allows for the exchange of waste products and excess fluids without the need for external dialysis equipment. Choice A is incorrect as peritoneal dialysis can be used for both acute and chronic kidney injury. Choice C is incorrect as peritoneal dialysis can help manage drug overdose and electrolyte imbalances. Choice D is incorrect as peritoneal dialysis can be used in cases of water intoxication to help remove excess fluids.

Acute kidney injury from postrenal etiology is caused by

  • A. obstruction of the flow of urine.
  • B. conditions that interfere with renal perfusion.
  • C. hypovolemia or decreased cardiac output.
  • D. conditions that act directly on functioning kidney tissue.
Correct Answer: A

Rationale: The correct answer is A because postrenal acute kidney injury is caused by obstruction of urine flow, leading to pressure build-up in the kidneys and subsequent damage. Obstructions can be due to conditions such as kidney stones, tumors, or enlarged prostate. Choices B, C, and D are incorrect as they relate to pre-renal and intrinsic renal causes of acute kidney injury, not specifically postrenal obstruction. B refers to decreased blood flow to the kidneys, C to low volume or poor heart function affecting kidney perfusion, and D to direct damage to kidney tissue, which do not characterize postrenal etiology.

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