Critical Care Nursing Questions

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The nurse is caring for a patient with severe neurological impairment following a massive stroke. The primary care provider has ordered tests to detearbmirbi.ncoem b/treasit n death. The nurse understands that criteria for brain death includes what crite ria? (Select all that apply.)

  • A. Absence of cerebral blood flow.
  • B. Absence of brainstem reflexes on neurological examin ation.
  • C. Presents of Cheyne-Stokes respirations.
  • D. Confirmation of a flat electroencephalogram.
Correct Answer: A

Rationale: The correct answer is A: Absence of cerebral blood flow. Brain death is determined by the irreversible cessation of all brain functions, including blood flow to the brain. When there is no cerebral blood flow, the brain is unable to function, leading to brain death. This criterion is essential in diagnosing brain death as it indicates a complete loss of brain function.

Explanation for why the other choices are incorrect:
- B: Absence of brainstem reflexes on neurological examination is a common sign of brain death, but it is not the primary criterion.
- C: Presence of Cheyne-Stokes respirations is not indicative of brain death. It is a pattern of breathing that can be seen in various conditions, not specifically brain death.
- D: Confirmation of a flat electroencephalogram is a supportive test for brain death but not the primary criterion. The absence of brain activity on an EEG can help confirm brain death but is not as definitive as the absence of cerebral blood flow.

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The nurse cares for a patient with lung cancer in a home hospice program. Which action by the nurse is most appropriate?

  • A. Discuss cancer risk factors and appropriate lifestyle modifications.
  • B. Encourage the patient to discuss past life events and their meaning.
  • C. Teach the patient about the purpose of chemotherapy and radiation.
  • D. Accomplish a thorough head-to-toe assessment several times a week.
Correct Answer: B

Rationale: The correct answer is B because in a home hospice program, it is essential for the nurse to provide holistic care that includes addressing the patient's emotional and psychological needs. Encouraging the patient to discuss past life events and their meaning can help them process emotions, find closure, and improve their quality of life. This approach aligns with the principles of palliative care, which focus on enhancing comfort and well-being.

Choice A is incorrect because discussing cancer risk factors and lifestyle modifications may not be relevant or beneficial for a patient in a hospice program. Choice C is incorrect because chemotherapy and radiation are typically not part of hospice care, which focuses on comfort rather than curative treatments. Choice D is incorrect because a thorough head-to-toe assessment multiple times a week may not be necessary or appropriate for a patient in a hospice program.

The nurse caring for a mechanically ventilated patient note s the high pressure alarm sounding but cannot quickly identify the cause of the alarm. The nurasbeir bn.cootme/ste stht e patient’s oxygen saturation is decreasing and heart rate and respiratory rate are increasing. What is the nurse’s priority action?

  • A. Ask the respiratory therapist to get a new ventilator
  • B. Call the rapid response team to assess the patient
  • C. Continue to find the cause of the alarm and fix it
  • D. Manually ventilate the patient while calling for a respi ratory therapist
Correct Answer: B

Rationale: The correct answer is B. The nurse's priority is to ensure the patient's safety and well-being. Calling the rapid response team will allow for immediate assessment by a team of healthcare professionals to address the deteriorating condition. This step takes precedence over troubleshooting the ventilator or manually ventilating the patient. Asking for a new ventilator (A) or manually ventilating the patient (D) does not address the urgent need for a comprehensive assessment and intervention. Continuing to troubleshoot the alarm (C) can delay critical interventions needed for the patient's worsening condition. Thus, calling the rapid response team is the most appropriate action to address the escalating clinical situation promptly.

Slow continuous ultrafiltration is also known as isolated ultrafiltration and is used to

  • A. remove plasma water in cases of volume overload.
  • B. remove fluids and solutes through the process of convection.
  • C. remove plasma water and solutes by adding dialysate.
  • D. combine ultrafiltration, convection, and dialysis.
Correct Answer: A

Rationale: The correct answer is A because slow continuous ultrafiltration removes excess plasma water in cases of volume overload by applying a pressure gradient across a semipermeable membrane. This process helps to achieve fluid balance without removing solutes.

Choice B is incorrect because convection is not the primary mechanism of slow continuous ultrafiltration.

Choice C is incorrect as dialysate is not added in slow continuous ultrafiltration.

Choice D is incorrect as slow continuous ultrafiltration does not combine all three processes of ultrafiltration, convection, and dialysis.

Which of the following are components of the Institute for Healthcare Improvement’s (IHI’s) ventilator bundle? (Select all that apply.)

  • A. Interrupt sedation each day to assess readiness to extub aa bit re b.. c om/test
  • B. Maintain head of bed at least 30 degrees elevation.
  • C. Provide deep vein thrombosis prophylaxis.
  • D. Provide prophylaxis for peptic ulcer disease.
Correct Answer: A

Rationale: The correct answer is A because interrupting sedation daily to assess readiness to extubate is a key component of IHI's ventilator bundle to prevent ventilator-associated pneumonia. This practice helps prevent over-sedation, reduce the duration of mechanical ventilation, and decrease the risk of complications. The other choices, B, C, and D, are incorrect as they are not specific components of the IHI's ventilator bundle. Maintaining head of bed elevation, providing deep vein thrombosis prophylaxis, and prophylaxis for peptic ulcer disease are important aspects of critical care but are not directly related to the ventilator bundle protocol outlined by IHI.

The nurse is caring for an elderly patient who was admitted with renal insufficiency. An expected laboratory finding for this patient may be

  • A. an increased glomerular filtration rate (GFR).
  • B. a normal serum creatinine level.
  • C. increased ability to excrete drugs.
  • D. hypokalemia.
Correct Answer: B

Rationale: The correct answer is B: a normal serum creatinine level. In renal insufficiency, the kidneys are not able to filter waste products effectively, leading to an increase in serum creatinine levels. This is a common indicator of renal dysfunction.
A: An increased GFR would not be expected in renal insufficiency, as it signifies improved kidney function.
C: Increased ability to excrete drugs is not a typical finding in renal insufficiency, as impaired kidney function can lead to drug accumulation.
D: Hypokalemia is not directly related to renal insufficiency. It is more commonly associated with factors like diuretic use or gastrointestinal losses.

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