Critical Care Nursing NCLEX Questions

Critical Care Nursing NCLEX Questions Related

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The nurse is caring for a mechanically ventilated patient. T he primary care providers are considering performing a tracheostomy because the patienatb iirsb .hcoamv/itensgt difficulty weaning from mechanical ventilation. Related to tracheostomy, the nurse understands which of the following?

  • A. Patient outcomes are better if the tracheostomy is done within a week of intubation.
  • B. Percutaneous tracheostomy can be done safely at the b edside by the respiratory therapist.
  • C. Procedures performed in the operating room are associaabtirebd.c owmi/ttehs tf ewer complications.
  • D. The greatest risk after a percutaneous tracheostomy is accidental decannulation.
Correct Answer: C

Rationale: The correct answer is C: Procedures performed in the operating room are associated with fewer complications. This is because performing a tracheostomy in the operating room allows for better control of the environment, equipment, and expertise of the surgical team. In this setting, the risk of complications such as bleeding, infection, and injury to surrounding structures is minimized.

Choices A, B, and D are incorrect:
A: Patient outcomes are better if the tracheostomy is done within a week of intubation - This statement is not universally true and depends on individual patient factors. Timing of tracheostomy should be based on the patient's clinical condition and not a set timeline.
B: Percutaneous tracheostomy can be done safely at the bedside by the respiratory therapist - While percutaneous tracheostomy can be performed at the bedside, it is typically done by a trained physician or surgeon due to the potential risks and complications involved.
D: The greatest risk after a per

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A patient’s status deteriorates and mechanical ventilation i s now required. The pulmonologist wants the patient to receive 10 breaths/min from the ventilaabtirobr.c bomu/tt ewst ants to encourage the patient to breathe spontaneously in between the mechanical breaths at his own tidal volume. This mode of ventilation is referred to by what term?

  • A. Assist/control ventilation
  • B. Controlled ventilation
  • C. Intermittent mandatory ventilation
  • D. Positive end-expiratory pressure
Correct Answer: C

Rationale: Rationale:
1. Intermittent Mandatory Ventilation (IMV) allows the patient to breathe spontaneously between the preset mechanical breaths.
2. It provides a set number of breaths per minute while allowing the patient to initiate additional breaths at their own tidal volume.
3. IMV is a partial ventilatory support mode, providing a balance between controlled and spontaneous breathing.
4. Assist/Control Ventilation (A) provides full support with every breath initiated by the patient or the ventilator.
5. Controlled Ventilation (B) does not allow for spontaneous breaths by the patient.
6. Positive End-Expiratory Pressure (D) is a separate mode focusing on maintaining positive pressure at the end of expiration, not providing breaths.

The nurse uses subtle measures of painful stimuli, such as nailbed pressure to elicit a response from a neurologically impaired patient. By using this meth od rather than nipple pinching, the nurse is exemplifying what ethical principle?

  • A. Beneficence
  • B. Fidelity
  • C. Nonmaleficence
  • D. Veracity
Correct Answer: C

Rationale: The correct answer is C: Nonmaleficence. The nurse is demonstrating nonmaleficence by choosing a less harmful method (nailbed pressure) to assess pain in a neurologically impaired patient, instead of a more painful method (nipple pinching). Nonmaleficence is the ethical principle of avoiding harm or minimizing harm to the patient. In this scenario, the nurse is prioritizing the well-being and comfort of the patient by using a less invasive and painful method to elicit a response. Choices A, B, and D are incorrect because beneficence refers to doing good for the patient, fidelity to being loyal and maintaining trust, and veracity to truthfulness and honesty, none of which directly apply in this situation.

What nonpharmacological approaches to pain and/or anxie ty may best meet the needs of critically ill patients? (Select all that apply.)

  • A. Anaerobic exercise
  • B. Art therapy
  • C. Guided imagery
  • D. Music therapy
Correct Answer: B

Rationale: The correct answer is B: Art therapy. Art therapy can help critically ill patients express emotions, reduce anxiety, and cope with pain in a nonverbal way. It provides a creative outlet for self-expression and can improve overall well-being. Anaerobic exercise (A) may not be suitable for critically ill patients due to physical limitations. Guided imagery (C) may not be effective for all patients and requires a certain level of cognitive ability. Music therapy (D) can be beneficial, but art therapy is specifically known for its effectiveness in addressing emotional and psychological needs in critically ill patients.

When evaluating a patient with a central venous catheter, the nurse observes that the insertion site is red and tender to touch and the patient’s temperature is 101.8°F. What should the nurse plan to do next?

  • A. Give analgesics and antibiotics as ordered.
  • B. Discontinue the catheter and culture the tip.
  • C. Change the flush system and monitor the site.
  • D. Check the site more frequently for any swelling.
Correct Answer: B

Rationale: The correct answer is B: Discontinue the catheter and culture the tip. The patient's symptoms indicate a possible catheter-related infection. Discontinuing the catheter will prevent further infection spread. Culturing the tip will identify the specific pathogen causing the infection, guiding appropriate antibiotic therapy. Choice A is incorrect because giving analgesics alone will not address the underlying infection. Choice C is incorrect as changing the flush system is not a priority when infection is suspected. Choice D is incorrect as checking the site more frequently does not address the need for immediate action to address the infection.

Warning signs that can assist the critical care nurse in reco gnizing that an ethical dilemma may exist include which of the following? (Select all that apply.)

  • A. Family members are confused about what is happening to the patient.
  • B. Family members are in conflict as to the best treatmen t options. They disagree with each other and cannot come to consensus.
  • C. The family asks that the patient not be told of treatmenatb iprbl.aconms./t est
  • D. The patient’s condition has changed dramatically for the worse and is not responding to conventional treatment.
Correct Answer: A

Rationale: The correct answer is A because when family members are confused about the patient's condition or treatment, it can indicate a lack of communication or understanding, leading to a potential ethical dilemma. This confusion may result in conflicting views on what is best for the patient, potentially leading to disagreements and ethical conflicts.

Choice B is incorrect because although family conflict can lead to ethical dilemmas, it is not a direct warning sign that an ethical dilemma exists.

Choice C is incorrect because the family asking not to inform the patient about treatment is more related to communication preferences rather than a clear indication of an ethical dilemma.

Choice D is incorrect because a deteriorating patient condition, while concerning, does not directly signal an ethical dilemma unless there are specific ethical considerations involved in the treatment decisions.

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