Critical Care Nursing A Holistic Approach 10th Edition by Patricia Gonce Morton – Test Bank A+

Description

The physician has just told a patient that he has stage 4 lung cancer and likely has only months to live. After the physician leaves, the patient, who is visibly shaken, asks the nurse, “Couldn’t the doctor be wrong? Is it really that bad?” The nurse explains to him that, although there is no way to know for certain how the disease will progress, the stage of his lung cancer is the most serious. The nurse also indicates that the cancer has spread to other organs in his body, meaning that the odds of recovery are not good. The patient then asks that the nurse not tell his wife, who is in the waiting room, about the diagnosis just yet. Later the patient’s wife enters the room and, seeing that he is asleep, asks the nurse if there is any update on the patient’s condition. The nurse explains that the doctor talked to the patient earlier and that the patient can provide details once he wakes up. Which ethical principle or principles has the nurse exercised in this situation? Select all that apply.
	A)	Justice
	B)	Fidelity
	C)	Veracity
	D)	Nonmaleficence

2.	Before administering a new medication to a patient, the nurse explains to her the adverse effects she may experience as a result of the medication and asks whether the patient has any questions about the medication. When the patient indicates that she understands the risks involved, the nurse has her sign a document and proceeds with the treatment. The nurse’s action is an example of which of the following?
	A)	Obtaining informed consent
	B)	Ensuring confidentiality
	C)	Observing the principle of nonmaleficence
	D)	Acting with fairness

3.	A patient is at severe risk of forming life-threatening clots in his thoracic region following surgery. The physician has prescribed an anticoagulant medication. The patient has had a negative experience with anticoagulants in the past and refuses the medication. Which two ethical principles are in conflict with each other in this situation?
	A)	Fidelity vs. justice
	B)	Maleficence vs. beneficence
	C)	Veracity vs. autonomy
	D)	Beneficence vs. autonomy

4.	A patient in the ICU recently experienced a myocardial infarction that resulted in an aneurysm of the ventricular wall. The patient’s cardiovascular surgeon has determined that the aneurysm is irreparable. In this situation, an attempt to repair the rupture via laparoscopic surgery would be considered which of the following?
	A)	Palliative
	B)	Curative
	C)	Medically futile
	D)	Beneficent

5.	The family of a patient in a coma is struggling to decide whether to remove the patient from a ventilator. What would be the most appropriate intervention?
	A)	Explain the statistical odds that the patient will regain consciousness.
	B)	Facilitate a care conference with the family.
	C)	Leave the family alone to make their decision.
	D)	Distribute copies of the American Nurses Association Code of Ethics to the family.

6.	A patient complains of severe pain and requests an increase in dose of her pain medication. Her husband, however, does not want the patient’s pain medication increased, as he is worried about her becoming dependent on the medication. Which principle(s) from the ANA Code of Ethics would be most appropriate for the nurse to apply in this situation? Select all that apply.
	A)	The nurse’s primary commitment is to the patient.
	B)	The nurse collaborates with other health professionals and the public.
	C)	The nurse owes the same duties to self as to others.
	D)	The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.

7.	A nurse learns that a patient in the ICU who is scheduled to undergo a liver transplant has a history of alcoholism. Which principle or principles from the ANA Code of Ethics would be most appropriate for the nurse to apply while caring for this patient? Select all that apply.
	A)	The nurse practices with compassion and respect unrestricted by considerations of the nature of the health problem.
	B)	The nurse’s primary commitment is to the patient.
	C)	The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.
	D)	The nurse participates in establishing, maintaining, and improving health care environments.

8.	A nurse works in an ICU in which she routinely sees physicians neglecting the care of patients who do not have health insurance. She feels angry about the unfairness of this situation but also powerless to do anything because she fears the loss of her job. Which of the following best describes what the nurse is experiencing?
	A)	Medical futility
	B)	Nonmaleficence
	C)	Moral distress
	D)	Paternalism

9.	An elderly patient who is about to have open-heart surgery has verbally instructed the nurse that she does not want her life to be extended by a ventilator after the surgery. The patient’s advance directive, however, indicates that she would prefer to receive all life-support measures. The nurse suspects that the patient has dementia. Which of the following questions would be most appropriate for the nurse to ask in the assessment stage of ethical decision making?
	A)	What are the ethical issues related to continuing or removing life-support measures for this patient?
	B)	Who should be involved in making the decision regarding life-support measures for this patient?
	C)	Is this patient mentally competent to make decisions about use of life support?
	D)	What educational changes can be made in the ICU to resolve similar ethical challenges related to life support measures in the future?

10.	A patient who had provided an advance directive indicating that he should not be resuscitated was allowed to die when his heart stopped beating shortly after his admission to the ICU. The family of the patient has disputed the authenticity of the advance directive and filed a complaint with the hospital. Which intervention would be most appropriate to address this ethical dilemma?
	A)	Ethics rounds involving the medical staff involved in the patient’s care
	B)	Review by the hospital’s institutional ethics committee
	C)	An individual patient ethics conference with the family
	D)	Review of the ANA Code of Ethics by the patient’s nurse

11.	The nurse has learned about the application of ethical principles in nursing. How does this knowledge facilitate the practice of nursing for the individual nurse?
	A)	It is mandated by accreditation agencies.
	B)	It is a component of bioethical theory.
	C)	It assists in defining good nursing care.
	D)	It assists in determining the legal basis of decisions.

12.	The family wishes to continue all aspects of care for a terminally and critically ill patient in the interests of justice and nonmaleficence. The health care team believes that further sophisticated and technical interventions are futile and that the focus of care should be shifted to provision of comfort, dignity, and palliative care. Neither the family nor the health care team is willing to compromise any portion of their stances. The patient is unresponsive. This situation is an example of what kind of problem?
	A)	Ethical dilemma
	B)	Recalcitrant family
	C)	Biotechnology effects
	D)	Paternalism

13.	The nurse consistently applies guidelines for safe administration of medications during patient care. This practice is an example of the application of what ethical principle?
	A)	Justice
	B)	Veracity
	C)	Beneficence
	D)	Paternalism

14.	In determining which patient is to be transferred from the CCU to make room for a new admission, the nurse considers the relative benefit of continued CCU care related to eventual outcomes for each patient and compares them. The nurse does not consider factors such as ethnicity or socioeconomic status. This situation is an example of application of which ethical principle?
	A)	Paternalism
	B)	Veracity
	C)	Beneficence
	D)	Justice

15.	The health care team is considering a change in the treatment plan for a critically ill patient. As this change is considered, the dangers and possible outcomes for continuing with the same plan of care as well as those for the proposed change are thoroughly discussed. The beliefs and values of the patient and family are included. What is this situation an example of?
	A)	Inability to make independent decisions
	B)	Positive leadership action by the nurse
	C)	Application of informed consent
	D)	Risk–benefit analysis

16.	A patient is admitted to the CCU with active advance directives that include refusal of enteral feeding by tubes. When the physician writes an order for the insertion of a feeding tube, the nurse refuses to comply. This refusal is an example of adherence to what ethical principle?
	A)	Nursing Practice Act
	B)	Patient Bill of Rights
	C)	Patient autonomy
	D)	Patient advocacy

17.	While caring for a critically ill patient, the nurse identifies an ethical dilemma and seeks the advice of the agency’s Ethics Committee. This scenario is an example of what kind of nursing action?
	A)	Inability to make independent decisions
	B)	Behavior mandated by protocols
	C)	Appropriate use of resources
	D)	Fear of autonomous action

18.	The family of a critically ill patient has said that the patient would not have wanted prolonged life support. The patient has been ventilator-dependent for several weeks and is not expected to improve. The physician states that, as the expert in health care, he knows best, and the patient will remain on the ventilator. What behavior is the physician exercising?
	A)	Routine medical care
	B)	Respect for autonomy
	C)	Expert paternalism
	D)	Biomedical ethics

19.	In delivering patient care, the nurse bases a decision upon the ANA Code of Ethics for Nurses. This is an example of what?
	A)	Inability to make independent decisions
	B)	Behavior mandated by protocols
	C)	Appropriate use of resources
	D)	Fear of autonomous action

20.	While caring for a critically ill patient, the nurse observes the family discussing funeral arrangements across the bed of the patient, who is intubated and sedated but awake. The family signs Do Not Resuscitate (DNR) request paperwork and leaves. The patient manages to communicate to the nurse that he does not want to die. What is the most appropriate nursing action?
	A)	Adhere to the wishes of the family, since the patient is probably incompetent.
	B)	Call a multidisciplinary conference with the family to resolve this conflict.
	C)	Destroy the Do Not Resuscitate paperwork, since the patient wants to live.
	D)	Apply the ethical principles of nonmaleficence and paternalism to the situation.

21.	Before a surgical procedure, the patient signs a document called an informed consent. What ethical principle is central to the use of informed consent?
	A)	Autonomy
	B)	Fidelity
	C)	Nonmaleficence
	D)	Beneficence

1.	A nurse in the ICU not only is excellent in providing care for her patients but has also earned the credential of CCRN and is tireless in lobbying for federal legislation that protects patients’ rights. She is also the first nurse in the ICU to recognize problems with process and to develop solutions. However, this nurse’s husband has begun to complain that he never sees her, and she feels like she has lost touch with her teenage daughter. Which professional practice attribute or attributes does this nurse demonstrate? Select all that apply.
	A)	Passion
	B)	Mastery
	C)	Balance
	D)	Action

2.	A nurse in the ICU is known for the personal care and attention he gives to each of his patients. He takes time to learn his patients’ names and the names of their families. He is especially gentle when drawing blood from children or administering injections to older patients. He is also good at leaving his work concerns at work and focusing on his family when at home. However, his lack of interest in pursuing further credentials and his lack of initiative in tackling problems that arise in the ICU have limited his career opportunities. Which professional practice attribute or attributes does this nurse demonstrate? Select all that apply.
	A)	Values
	B)	Mastery
	C)	Balance
	D)	Action

3.	A nurse in the ICU has a natural rapport with her patients, communicates well with her colleagues, always strives to improve her practices by learning from more experienced nurses, and always shows up for her shift on time. Which characteristic of this nurse is the hallmark of excellence?
	A)	Natural rapport with patients
	B)	Effective communication with colleagues
	C)	Always striving to improve her practices
	D)	Punctuality

4.	A nurse in the ICU is known for working hard to improve the care that she and others provide. When asked what motivates her to work so hard, she explains that she has a picture of what an ideal ICU looks like—a place where patients feel well cared for, where health professionals work seamlessly together, and where nurses derive deep satisfaction from their work. Which element of practice excellence best characterizes this nurse’s perspective?
	A)	Values
	B)	Action
	C)	Mastery
	D)	Vision

5.	A nurse in the ICU loves her job and is known to volunteer her time for fundraising for health care charities and for promoting public health initiatives in her community. She also loves to share her knowledge of physiology and medicine with her patients. Unfortunately, however, she often shares information that is outdated or not supported by evidence. Which element is this nurse most lacking?
	A)	Mastery
	B)	Passion
	C)	Action
	D)	Vision

6.	A nurse in the ICU has earned several advanced credentials in nursing and is working on her master’s degree in nursing. Although she loves gaining knowledge, she often finds herself unmotivated in her day-to-day duties as a nurse. Which element of excellence in practice is this nurse most lacking?
	A)	Mastery
	B)	Values
	C)	Passion
	D)	Balance

7.	An ICU has recently won the Beacon Award for Critical Care Excellence. Which element of excellence most contributed to the ICU being recognized with this award?
	A)	Values
	B)	Vision
	C)	Mastery
	D)	Action

8.	A nurse in the ICU has recently undertaken an initiative to improve oral care in the critically ill patient. This is an example of which of the following?
	A)	Practice alert
	B)	Specialty certification
	C)	Personal mastery
	D)	Nursing professionalism

9.	A nurse in the ICU is extremely efficient in performing her tasks but often realizes at the end of the day that she has not taken the time to make eye contact with her patients. Which element of practice excellence is this nurse lacking?
	A)	Action
	B)	Balance
	C)	Mastery
	D)	Vision

10.	A nurse takes a genuine interest in her patients and is highly attentive to their needs. She consistently checks on her patients and takes time to listen to their concerns. Which value, central to nursing, is this nurse demonstrating?
	A)	Caring
	B)	Patience
	C)	Honesty
	D)	Justice

11.	A critical care nurse defines herself as a professional and her practice as a profession. What is the best justification for this perception?
	A)	Perceived as such by the general public and by peers
	B)	Defined as such by the Nursing Practice Act
	C)	Requires a specialized body of knowledge and competent skills
	D)	The nurse has completed a baccalaureate degree in nursing.

12.	Members of a profession are expected to engage in lifelong learning and continual improvement. Which nursing behavior most clearly demonstrates these behaviors?
	A)	Attending mandatory annual skills validation at work
	B)	Organizing a fundraiser for diabetes mellitus research
	C)	Maintaining a subscription to several professional journals
	D)	Volunteering to take blood pressures at a health screening event

13.	One of the behaviors necessary in the practice of critical care nursing is the ability to think independently and to apply the principles of critical thinking. Which personal characteristic or action is most likely to foster development of independent and critical thinking?
	A)	Continuing one’s education voluntarily
	B)	Seeking promotion within administrative structures
	C)	Adhering absolutely to policy and procedure rules
	D)	Delivering care based solely on physician orders

14.	The nurse manager of an ICU is designing a career ladder and wants to include demonstration of professional development as criteria. Which nursing behavior most clearly demonstrates independent professional development?
	A)	Arrives to work on time and always accepts a difficult patient care assignment
	B)	Volunteers to help others when the unit is particularly busy
	C)	Belongs to more than one professional organization and is an officer in one
	D)	Maintains current certification in basic life support for health care professionals

15.	A critical care nurse has a personal goal to become an excellent critical care nurse. What does the nurse need to understand about the development of excellence?
	A)	Consists of strict attention to provision of patient and family safety
	B)	Measuring criteria are dynamic and change as the nurse develops.
	C)	Requires merely hard work and continued education
	D)	Mandated by employer rather than being a personal goal

16.	A nurse in a critical care unit observes that communication in the unit is not fully honest and straightforward, in that people do not confront others who are not meeting expected care standards. The nurse proposes an improvement strategy for this problem. What outcome is most likely?
	A)	The less-than-competent staff members will be encouraged to leave.
	B)	Improved collaborative communication will result in improved patient safety.
	C)	Staff will have less need to check on each other’s work.
	D)	Patients’ families will make fewer complaints to the patient representative.

17.	Part of establishing and fostering excellence is practicing in congruence with one’s values. What value central and unique to nursing is believed to be a primary drive toward excellence in the profession of nursing?
	A)	Caring
	B)	Justice
	C)	Paternalism
	D)	Duty of the individual

18.	A group of nurses is complaining about working conditions in their hospital and in nursing in general. What strategy could these nurses use to improve the situation?
	A)	Articulate a vision of the future to the administration and policymakers.
	B)	Continue to complain in the hopes that the administration will do something.
	C)	Refuse to serve on planning committees since conditions are so bad.
	D)	Seek employment elsewhere to avoid current conditions.

19.	The critical care nurse is unable to read a physician’s writing. From prior experience, the nurse knows that this physician is likely to express anger and use inappropriate language when called with questions about his orders. What does this situation illustrate about the development of excellence in critical care nursing?
	A)	A common stumbling block for nurses is inappropriate and abusive treatment by others.
	B)	Part of the development of excellence is mastery of skilled communication under stress.
	C)	Physicians are not part of the development of excellence in critical care nursing practice.
	D)	This situation demonstrates the need to adhere to protocols and not the development of excellence.

20.	One of the goals of an ICU is that all nurses be certified in a specialty. What is the most significant benefit that specialty certification has been shown to have?
	A)	Usually results in a pay raise in forward-thinking agencies
	B)	Can take the place of continued education and is less expensive
	C)	Validates and recognizes development of personal excellence
	D)	Adds a cachet to one’s résumé and achievement records

1.	A pregnant woman in her third trimester is in the ICU for minor trauma to her right arm and leg as a result of a car wreck. Her injuries appear to be superficial, but her nose begins bleeding profusely immediately after the nurse places a nasotracheal tube. What is the most likely explanation for the bleeding?
	A)	Internal hemorrhaging from trauma
	B)	Hemophilia
	C)	Rupture of the mucosa, which are extra fragile during pregnancy
	D)	Improper placement of tube

2.	An obese woman was admitted to the ICU for diabetic coma caused by advanced diabetic ketoacidosis. On recovering, the patient mentions to the nurse that she missed her last period and has felt nauseated in recent weeks. In reviewing her chart, the nurse compares her current test results with those from her last admission to the hospital, about 3 months ago. She notes that the woman’s red blood cell count has increased by 20%, her systolic blood pressure has increased by 10 mm Hg, her resting heart rate has increased from 85 to 105 bpm, and her creatinine clearance has increased from 90 to 130 mL/min. Which of these changes is consistent with those that normally accompany pregnancy? Select all that apply.
	A)	20% increase in red blood cells
	B)	10 mm Hg increase in systolic blood pressure
	C)	Increase in resting heart rate from 85 to 105 bpm
	D)	Increase in creatinine clearance from 90 to 130 mL/min

3.	A woman in her ninth month of pregnancy is in the ICU, recovering from surgery to remove a stage 1 tumor from her brain. She is still under the effects of general anesthesia. As the nurse is taking her vital signs, the woman regurgitates some fluid from her mouth. What is the most likely cause of the regurgitation?
	A)	Esophageal cancer
	B)	Displacement of the esophageal sphincter
	C)	Airway obstruction
	D)	Congenital defect of the esophagus

4.	Blood work results of a pregnant woman in her third trimester in the ICU have recently been delivered, and the nurse is reviewing them. The woman has a hematocrit of 35%, a white blood cell count of 4,000/mm3, and a fibrinogen level of 500 mg/dL. She also has a blood pressure reading of 118/70 mm Hg. Which of these is in the normal range for a pregnant woman? Select all that apply.
	A)	Hematocrit of 35%
	B)	White blood cell count of 4,000/mm3
	C)	Fibrinogen level of 500 mg/dL
	D)	Blood pressure of 118/70 mm Hg

5.	A pregnant woman has arrived at the ICU with a blood pressure reading of 170/115, pronounced edema in her hands and feet, and proteinuria. Which condition does the woman most likely have?
	A)	Severe preeclampsia
	B)	Preeclampsia
	C)	Disseminated intravascular coagulation
	D)	HELLP syndrome

6.	A patient who experienced severe preeclampsia during her pregnancy has just delivered her baby in the ICU. She has been receiving magnesium sulfate therapy to prevent seizures. Which of the following would be the correct nursing intervention in this situation?
	A)	Discontinue the magnesium sulfate therapy immediately.
	B)	Continue the magnesium sulfate therapy for 2 hours after delivery.
	C)	Continue the magnesium sulfate therapy for 24 hours after delivery.
	D)	Explain to the patient that she will have to remain on magnesium sulfate therapy for the rest of her life.

7.	A patient with severe preeclampsia in the ICU has recently had a seizure. She is currently receiving magnesium sulfate therapy. What intervention can the nurse make to reduce the risk for future seizures in this patient?
	A)	Turn off the overhead lights in the room.
	B)	Stop the magnesium sulfate therapy.
	C)	Have the physician prescribe hydralazine to her.
	D)	Place a wedge under the woman’s right hip.

8.	A woman in her seventh month of pregnancy presents to the ICU with hemolysis, elevated liver enzymes, and a low platelet count. Which condition does this woman most likely have, and what is a proper intervention?
	A)	Severe preeclampsia; magnesium sulfate therapy
	B)	Disseminated intravascular coagulation; broad-spectrum antibiotics
	C)	Amniotic fluid embolism; intubation and ventilation with 100% oxygen
	D)	HELLP syndrome; antihypertensive agents

9.	The nurse is working with a patient with severe preeclampsia and acute respiratory distress syndrome (ARDS). The patient is receiving mechanical ventilation using positive end-expiratory pressure. Which nursing intervention would be most appropriate in this situation?
	A)	Position the patient on her side.
	B)	Turn off the overhead light.
	C)	Evaluate the patient for neurological symptoms of seizure.
	D)	Perform CPR.

10.	A pregnant woman has been admitted to the ICU with disseminated intravascular coagulation (DIC). She exhibits tachycardia, tachypnea, temperature instability, increased cardiac output, and decreased peripheral resistance. What is the most likely underlying cause of DIC in this situation and what is the best intervention?
	A)	Preeclampsia; antihypertensive agents
	B)	Sepsis; broad-spectrum antibiotics
	C)	Amniotic fluid embolism; intubation and ventilation with 100% oxygen
	D)	Abruptio placentae; prompt delivery of the fetus

11.	A pregnant woman who is due to give birth in 2 weeks is shot in the shoulder during a robbery. Estimated blood loss at the scene was 500 mL, and she lost another 500 mL during surgical repair. The patient is admitted to the CCU and is in a supine position. Which initial assessment findings would the nurse anticipate?
	A)	Vital signs consistent with compensated shock
	B)	Slightly high pulse and blood pressure, alert and oriented, skin warm
	C)	Severe and constant lower abdominal pain
	D)	Severe tachycardia and hypotension, obtunded, skin cool and pale

12.	A pregnant woman was admitted to the CCU for monitoring after an elective surgical procedure. Arterial blood gases are as follows: pH 7.48, PaCO2 27, HCO3 ion 21, PaO2 108, SaO2 100%. Respiratory rate is slightly elevated. The patient is receiving oxygen by mask at 40% and maintenance intravenous fluids. What is the most important nursing action?
	A)	Reduce inhaled oxygen because the PaO2 and SaO2 are too high.
	B)	Medicate for pain because the acid–base balance indicates respiratory alkalosis.
	C)	Consider intubation and mechanical ventilation to support gas exchange.
	D)	Continue the current plan of care, as results are within normal limits.

13.	A pregnant woman is admitted to a CCU after a motor vehicle crash. She is endotracheally intubated and mechanically ventilated. Respiratory assessment reveals diminished lung sounds at posterior bases, decreased functional residual capacity, and increased spontaneous tidal volume. What is the highest-priority nursing action?
	A)	Obtain orders for ventilator setting adjustments to compensate for the abnormal findings.
	B)	Suction the patient via the endotracheal tube to stimulate cough.
	C)	Continue the present plan of care, as the findings are expected.
	D)	Obtain orders for an inhaled bronchodilator for bronchospasm.

14.	A pregnant woman is admitted to the CCU after a traumatic incident. The nurse is concerned that the patient may be having significant and unidentified blood loss. Which assessment findings could indicate significant blood loss?
	A)	Slightly decreased hemoglobin and hematocrit
	B)	Urine output less than 40 mL/hr
	C)	Elevated creatinine and urea clearance rates
	D)	Slightly low serum creatinine and blood urea nitrogen

15.	A woman who is 8 months pregnant is being assessed on a routine clinic visit. Which assessment findings require further assessment and treatment?
	A)	Blood pressure increased by 10 points from previous visit
	B)	Blood pressure 150/95 mm Hg
	C)	1+ edema of lower extremities
	D)	Urine output 750 mL in 24 hours

16.	A pregnant woman at 30 weeks’ gestation is in the CCU with severe eclampsia. She is experiencing pulmonary edema, severe oliguria, and hypotension and continues to have seizures. She is endotracheally intubated, supported by a mechanical ventilator, and is receiving intravenous magnesium sulfate at 3 g/hr; the serum magnesium level is 8 mg/dL. She is beginning spontaneous early labor. What is the most important intervention?
	A)	Administer medication to delay the onset of labor, as the baby is preterm.
	B)	Increase the dose of magnesium sulfate to control seizures.
	C)	Facilitate delivery of the baby, as eclampsia is worsening.
	D)	Administer high-dose diuretics for the pulmonary edema.

17.	The nurse is caring for a pregnant woman with severe preeclampsia. Based on the pathophysiology of severe preeclampsia, the nurse expects what changes in assessment data?
	A)	Pulmonary edema from capillary leakage or diminished left ventricular function
	B)	Increased urine output from glomerular capillary damage
	C)	Decreased serum creatinine from increased urine output
	D)	Decreased serum aspartate aminotransferase (AST) from liver damage

18.	A pregnant woman with severe preeclampsia is receiving intravenous magnesium sulfate at 3 g/hr. Her serum magnesium level is 7 mg/dL. What is the most important nursing assessment?
	A)	Decreased incidence and frequency of seizures
	B)	Decreased respiratory rate and hyporeflexia
	C)	Increased urine output greater than 40 mL/hr
	D)	Flushing of skin and diaphoresis

19.	A pregnant woman with severe preeclampsia is being managed with intravenous magnesium sulfate. Which nursing assessment would indicate that the dose of magnesium sulfate would need to be increased?
	A)	Increased frequency of seizures
	B)	Hyporeflexia and diaphoresis
	C)	Serum magnesium level of 16 mg/dL
	D)	Increased drowsiness and flushed skin

20.	A woman is admitted to CCU after delivery of a retained demised fetus from abruptio placentae. The patient develops disseminated intravascular coagulation (DIC). What findings are present in DIC?
	A)	Diminished platelets and elevated partial thromboplastin time
	B)	Elevated white blood cell count and elevated immature neutrophils
	C)	Diminished clotting time and prothrombin time
	D)	Elevated fibrinogen and diminished fibrinogen split products

21.	The nurse is monitoring a pregnant woman who is at high risk for the development of disseminated intravascular coagulation (DIC). What physical assessment findings would indicate DIC?
	A)	Urine clear without sediment at 40 mL/hr
	B)	Oozing blood from all intravenous sites
	C)	All vital signs within expected parameters for pregnancy
	D)	Absence of elevated protein in urine or serum

22.	During a patient’s cesarean section delivery of twin girls, the patient had a sudden onset of dyspnea and cyanosis with a drop in blood pressure, and then developed cardiac arrest. Based on these clinical events, the nurse suspects what complication?
	A)	Disseminated intravascular coagulation
	B)	Amniotic fluid embolism
	C)	Uterine prolapse
	D)	Massive myocardial infarction

23.	A pregnant woman who is close to term is admitted to the emergency room after being involved in a motor vehicle crash. Within moments, she experiences a cardiopulmonary arrest. What is a nursing priority in the care of this woman?
	A)	Initiate cardiopulmonary resuscitation as for any patient.
	B)	Monitor fetal heart tones continuously.
	C)	During care, place a 2-inch wedge under the patient’s right hip.
	D)	Administer oxygen by nasal cannula at 2 L/min.

24.	A pregnant woman is admitted to the emergency room after a motor vehicle crash. She is unresponsive and covered with blood. A cervical spine collar and back board are in place. What should the nurse assess first?
	A)	Airway, breathing, circulation, and level of consciousness
	B)	Vital signs and urine output and protein
	C)	Fetal heart sounds, movement, and position
	D)	External and internal bleeding symptoms

25.	A pregnant woman at term who is being cared for in the CCU after a traumatic injury goes into labor. She is critically ill and somewhat unstable. What is the best nursing action to support this patient?
	A)	Assign a nurse to be her labor coach and stay with the patient.
	B)	Contact the patient’s planned labor coach to be with the patient.
	C)	Sedate the patient so that the labor will not interfere with other care.
	D)	Immediately prepare for an emergency cesarean section.

1.	A patient is receiving moderate IV sedation during a procedure. Which of the following statements accurately describes the expected condition of the patient in this situation? Select all that apply.
	A)	The patient can respond verbally to questions.
	B)	The patient can maintain a patent airway.
	C)	The patient has increased anxiety.
	D)	The patient’s vital signs fluctuate dramatically.
	E)	The patient will remember all details of the experience.
	F)	The patient will require longer than usual for postoperative recovery.

2.	An elderly patient in the ICU is receiving an anesthetic that is expected to allow him to maintain his own patent airway and to respond to verbal commands during a procedure. However, the patient has a history of complications related to anesthesia, and thus the anesthesiologist will be observing the patient during the procedure in case the patient develops apnea or an obstructed airway or the level of anesthesia needs to be changed to meet the patient’s needs. This type of anesthesia is known as which of the following?
	A)	Moderate sedation
	B)	Monitored anesthesia care
	C)	Deep sedation
	D)	General anesthesia

3.	A nurse is entering the room of a patient who has just come from surgery and is recovering from general anesthesia. What method should the nurse use to determine changes in cognitive function of the patient?
	A)	Interview with the surgeon
	B)	Patient’s response to the stir-up regimen
	C)	Interview with the patient’s family
	D)	Mini-Cog test

4.	A patient is transported to the PACU following a surgical procedure in which he received nitrous oxide for general anesthesia. What should the patient be receiving to prevent diffusion hypoxia?
	A)	Moderate IV sedation
	B)	Reversal agent
	C)	Blood products
	D)	Supplemental oxygen

5.	A patient with chronic obstructive pulmonary disease arrives in the ICU following surgery with general anesthesia. This patient will likely require ventilator support for which purpose?
	A)	To prevent hypoventilation
	B)	To reverse hypotension
	C)	To suppress the patient’s urge to vomit
	D)	To ease postoperative pain

6.	A patient arrives in the ICU following open-heart surgery. The patient is recovering from general anesthesia and is receiving supplemental oxygen. The nurse learns from the anesthesia provider’s report that the patient lost much blood during the surgery. The nurse knows as well that the patient had fasted before the surgery, per standard procedures. Which complication is this patient most likely to experience following surgery?
	A)	Hypothermia
	B)	Hypoventilation
	C)	Hypotension
	D)	Hypoxemia

7.	A neonate arrives at the ICU following surgery for repair of a cleft palate. The nurse learns from the anesthesiologist’s report that the patient received general anesthesia and that little blood was lost during the surgery. What is the most likely postsurgical complication for this patient, and what intervention should the nurse immediately implement?
	A)	Hypothermia; heated blankets and warm IV fluids
	B)	Hypotension; intravenous fluids
	C)	Hypoxemia; supplemental oxygen
	D)	Hypoventilation; stir-up regimen

8.	A patient arrives in the ICU following surgery to her eyes. She received opioids during the surgery. What complication is this patient most likely to experience, and what is the correct intervention for the nurse to perform?
	A)	Postoperative nausea and vomiting; perform the stir-up regimen
	B)	Hypothermia; cover the patient with warm blankets
	C)	Hypothermia; give the patient a cold IV solution
	D)	Postoperative nausea and vomiting; position the patient on her side, with head and neck extended

9.	A patient in the ICU received opioid analgesics during surgery and has just been given naloxone, an opioid antagonist, following surgery. What complication is this patient most likely to experience, and what is the correct nursing intervention?
	A)	Severe pain; administer an analgesic drug immediately
	B)	Severe pain; administer an analgesic drug after 30 minutes
	C)	Severe hypotension; administer IV fluids immediately
	D)	Severe hypotension; raise the head of the patient’s bed to 60 degrees

10.	A patient is brought to the ICU following surgery. This patient has a history of peptic ulcers. As the patient wakes up from general anesthesia, he complains of severe pain and asks for pain medication as soon as possible. What would be the best analgesic drug for this patient in this situation?
	A)	Toradol
	B)	Patient-controlled analgesia
	C)	Intravenous opioid drugs
	D)	Epidural opioid drugs

11.	A patient returns to the ICU following surgery. The nurse notes that the patient received the anesthetic agent pipecuronium bromide before surgery. What dysrhythmia should the nurse expect to find in this patient?
	A)	Bradycardia
	B)	Tachycardia
	C)	Atrial fibrillation
	D)	AV dissociation

12.	A patient who is scheduled for a surgical procedure with regional anesthesia asks the nurse to explain the anesthesia. What nursing statement is most accurate?
	A)	It involves a deep coma assisted by inhaled medications.
	B)	It is an induced state of calm or sleep at varying levels.
	C)	It produces analgesia and paresthesia in a specific body part.
	D)	The anesthetic is injected into the lumbar intrathecal space.

13.	A patient who will undergo correction of a dislocated joint in the emergency department asks the nurse what type of anesthesia will be used. What is the most appropriate nursing response?
	A)	General anesthesia
	B)	Deep sedation
	C)	Regional anesthesia
	D)	Peripheral nerve block

14.	A patient is to undergo a surgical procedure and needs to be unconscious for the procedure. What anesthetic agent is most appropriate?
	A)	Inhaled halothane
	B)	Subcutaneous lidocaine
	C)	Intravenous midazolam
	D)	Intravenous succinylcholine

15.	A patient needs to have a small laceration sutured. What is the most appropriate analgesia for this procedure?
	A)	Inhaled nitrous oxide and oxygen
	B)	Intravenous atropine
	C)	Subcutaneous lidocaine
	D)	Intravenous propofol

16.	A patient has just had a procedure with moderate sedation as the anesthesia used. During the immediate recovery period, what is the most important nursing action?
	A)	Begin range-of-motion exercises.
	B)	Initiate incentive spirometry.
	C)	Monitor vital signs.
	D)	Insert nasogastric tube.

17.	The nurse is caring for a patient recovering from general anesthesia for repair of a cardiac valve. When the patient arrives from the operating room, what nursing assessment is most important?
	A)	Cardiac monitor pattern
	B)	Wound site assessment
	C)	Airway security
	D)	Patient position

18.	Immediately after general anesthesia, one of the nursing interventions is to elevate the head of the bed. What is the best nursing rationale for this procedure?
	A)	Provides patient comfort
	B)	Reassures the family
	C)	Hastens anesthesia recovery
	D)	Contributes to gas exchange

19.	A patient is recovering from spinal anesthesia. During the immediate recovery period, the nurse notices an increase in pulse and respiration rates and disorientation and increasing agitation. What nursing assessment should be performed first?
	A)	Sensation of feet and legs
	B)	Whether a stir-up procedure has been performed
	C)	History of adverse reactions to medications
	D)	Current pulse oximetry value

20.	The patient is recovering from general anesthesia and has a pulse oximeter reading of 82%. The nurse implements the stir-up regimen. What does this regimen include?
	A)	Assess vital signs every 15 minutes.
	B)	Administer a narcotic antagonist.
	C)	Elevate the patient’s legs 45 degrees.
	D)	Encourage the patient to turn, cough, and deep breathe.

21.	A patient in the postanesthesia recovery period is to be extubated. Why does the nurse suction the oral pharynx before extubation?
	A)	Reduces the risk of laryngospasm
	B)	Increases mucosal moisture
	C)	Increases patient comfort
	D)	Decreases nausea and vomiting

22.	A patient with a history of muscular dystrophy is in the immediate postanesthesia period and begins to experience muscle rigidity, hypercarbia, tachycardia, sweating, and labile blood pressure. What vital sign should the nurse assess first?
	A)	Temperature
	B)	Apical pulse
	C)	Respiratory rate
	D)	Pulse pressure

23.	A patient in the immediate postoperative period is experiencing significant hypotension. What are the most likely causes? Select all that apply.
	A)	Blood or fluid loss
	B)	Reaction to opioids
	C)	Intraoperative myocardial infarction
	D)	Acute renal failure
	E)	Severe hypothermia
	F)	Early hypoxemia

1.	The patient is complaining of chest pain. The nurse asks several questions to determine the likelihood that this pain is cardiac in origin. What patient response is most likely to indicate cardiac pain?
	A)	Started suddenly and was at maximum intensity from the start
	B)	Accompanied by no other symptoms, such as nausea
	C)	Painful area is the size of a clenched fist and substernal.
	D)	Described as stabbing and knifelike pain

2.	As part of the general physical assessment of a patient with cardiac disease, the nurse assesses central and peripheral pulses. What is the most accurate statement about pulse assessment?
	A)	All pulses should be assessed bilaterally at the same time.
	B)	A pulse that is weak and thready would be scaled +4.
	C)	Pulsus alternans varies in intensity with every other beat.
	D)	Absence of posterior tibial pulses is a normal variant.

3.	The nurse is auscultating a patient’s heart sounds. What best describes a normal finding?
	A)	S2 is heard best at the second intercostal space to the right of the sternum.
	B)	S2 is heard equally at all areas across the precordium and apex.
	C)	S1 usually disappears after 25 to 35 years of age.
	D)	S3 is caused by retrograde blood flow though an incompetent valve.

4.	A patient has been determined to have a new heart murmur. The best description of the cause of a cardiac murmur is what?
	A)	The patient had rheumatic heart disease as a child.
	B)	A murmur is caused by the flow of blood through a narrow or incompetent valve or septum.
	C)	A murmur indicates a ruptured ventricular septum from myocardial disease or infarction.
	D)	A murmur occurs normally secondary to turbulent blood flow in children and young adults.

5.	The patient is to undergo a diagnostic electrophysiology study. The nurse should tell the patient and family that the purpose of this study is what?
	A)	Identify blockages of coronary arteries.
	B)	Measure volumes and pressures in cardiac chambers.
	C)	Evaluate the efficacy of antiarrhythmic drugs and devices.
	D)	Evaluate patient response to pharmacologically elevated heart rates.

6.	The patient is undergoing an echocardiogram for diagnosis of cardiac valve dysfunction. What factor is most likely to result in an accurate echocardiogram?
	A)	The patient has chronic obstructive pulmonary disease (COPD).
	B)	The technologist performing the test is very experienced.
	C)	The patient is very obese, with large pendulous breasts.
	D)	The echocardiogram machine is several years old.

7.	The nurse is caring for a patient using a 5-lead continuous cardiac monitor system. To monitor lead V6, where does the nurse place the chest electrode?
	A)	Fourth intercostal space on right sternal border
	B)	Right shoulder on muscle tissue close to bone
	C)	Left shoulder on muscle tissue close to bone
	D)	Fifth intercostal space on left mid-axillary line

8.	The nurse is applying electrodes to the patient’s chest for use in continuous cardiac rhythm monitoring. When applying these electrodes, what placement will the nurse use to ensure maximum accuracy?
	A)	In the fold beneath the breast tissue
	B)	Directly over the clavicle
	C)	In the intercostal spaces
	D)	Over the clavicle/humerus joint

9.	A patient is on continuous cardiac rhythm monitoring. The nurse notices that the low-rate alarm is sounding frequently. What nursing action takes the highest priority?
	A)	Assess monitor alarm limits for appropriate setting.
	B)	Check contact with skin for all electrodes.
	C)	Assess patient’s level of consciousness and vital signs.
	D)	Check connections between lead wires and electrodes.

10.	The nurse is using the cardiac monitor tracing to evaluate cardiac function. The QRS interval is 0.14 seconds in width. How does the nurse interpret this finding?
	A)	Normal rate and rhythm
	B)	Slowed conduction through the atria
	C)	Left ventricular bundle branch block
	D)	Slowed ventricular depolarization

11.	A patient in the CCU is suspected of having coronary artery disease (CAD) following myocardial infarction. Which blood test or tests would be most pertinent in evaluating this patient’s condition? Select all that apply.
	A)	Red blood cell count
	B)	Low-density lipoproteins
	C)	Prothrombin time
	D)	Triglycerides
	E)	White blood cell count
	F)	High-density lipoproteins

12.	A patient in the CCU is suspected to have had a myocardial infarction. His blood work results have arrived, and the nurse is reviewing them. Which results would indicate myocardial infarction? Select all that apply.
	A)	Elevated troponins
	B)	CK-MB isoenzyme at 10% of total creatine kinase
	C)	C-reactive protein serum value of 6 mg/dL
	D)	Decreased levels of D-dimer

13.	A patient is being discharged from the CCU, and the cardiologist would like to monitor her cardiac activity over the coming month. This patient typically experiences infrequent dysrhythmias and is willing to wear electrodes, carry a recorder, and keep a diary. Which type of cardiac monitoring would be most appropriate for this patient?
	A)	Holter monitoring
	B)	Event (continuous loop) monitoring
	C)	Implantable loop monitoring
	D)	Signal-averaged electrocardiography

14.	A patient in the CCU must perform exercise stress testing. Which of the following would be the most appropriate intervention for the nurse to make in preparing the patient for this test?
	A)	Provide the patient with a cup of coffee to help him be alert during the testing.
	B)	Continue the patient on beta blockers throughout the test.
	C)	Explain to the patient that he may have to continue exercising after angina develops.
	D)	Feed the patient an hour before the test so that he has plenty of energy.

15.	A patient in the CCU will undergo a diagnostic electrophysiology study. Which complication should the nurse monitor for during this procedure?
	A)	Bleeding
	B)	Vascular damage
	C)	Lethal dysrhythmias
	D)	Cardiac arrest

16.	A nurse in the CCU must assess a patient’s cardiac rhythm strip. Which of the following represents the first three steps in this assessment in correct order?
	A)	Look for P waves, measure the PR interval, evaluate the QRS interval.
	B)	Evaluate the QRS complex, examine the ST segment, identify the rhythm.
	C)	Determine atrial and ventricular heart rates, examine the rhythm to see if it is regular, look for P waves.
	D)	Look for P waves, examine the rhythm to see if it is regular, determine atrial and ventricular heart rates.

17.	A patient in the CCU who is undergoing ECG monitoring has impulses originating at the sinoatrial node at a rate of 75 bpm, a shortest RR interval of 0.69 seconds, and a longest RR interval of 0.84 seconds. The P wave is regular. Which sinus rhythm does this patient exhibit?
	A)	Sinus tachycardia
	B)	Sinus bradycardia
	C)	Sinus dysrhythmia
	D)	Sinus arrest

18.	A patient in the CCU has been found on examination by ECG to have a bundle branch block. Which of the following should the nurse expect to see on this patient’s ECG?
	A)	Tall, pointed P waves in leads II, III, and aVF
	B)	Broad, notched P waves in leads I, II, and aVL
	C)	A tall R wave in V1 and progressively smaller R waves through V6
	D)	A broad QRS complex with two peaks (RSR¢)

19.	A patient in the CCU exhibits a tall, narrow, and peaked T wave on ECG. The nurse recognizes that this is most likely an early sign of which of the following?
	A)	Hypokalemia
	B)	Hyperkalemia
	C)	Hypocalcemia
	D)	Hypercalcemia

20.	A patient in the CCU is undergoing arterial pressure monitoring, and the bedside physiological monitor alarm sounds. Which of the following should the nurse do? Select all that apply.
	A)	Check to see whether the catheter is kinked.
	B)	Check to see whether the stopcocks are turned the wrong way.
	C)	Add IV solution through the arterial pressure monitoring system.
	D)	Make sure that there is sufficient pressure in the pressure bag.

1.	A patient in the CCU with chronic heart failure is prescribed an ACE inhibitor. What side effects should the nurse mention to him? Select all that apply.
	A)	Angioderma
	B)	Cough
	C)	Rebound tachycardia
	D)	Hyperkalemia
	E)	Night sweats
	F)	Anxiety

2.	A CCU nurse who works frequently with cardiac patients is putting together a teaching plan to follow when she instructs these patients on how to live with heart failure. Which points should she include in this plan? Select all that apply.
	A)	Discontinue medications once you are feeling better, to avoid adverse effects.
	B)	Take your medications about the same time every day.
	C)	Avoid pepper and spices.
	D)	Remove the saltshaker from your table.
	E)	The best time to weigh yourself is in the afternoon.
	F)	Try to perform 15 to 20 minutes of continuous activity each day.

3.	A patient with chronic cardiac failure in the CCU is on an ACE inhibitor but still has significant pitting edema in his extremities. Which medication, in addition to the ACE inhibitor, is the physician likely to prescribe to this patient?
	A)	Digoxin
	B)	A loop diuretic
	C)	b-blocker
	D)	Calcium channel blocker

4.	A patient presents to the CCU with acute, decompensated heart failure. The nurse observes that this patient has chronic obstructive pulmonary disease and hypotension. She eats a low-sodium diet and drinks alcohol excessively. Which of the following are contributing factors to this patient’s heart failure? Select all that apply.
	A)	Chronic obstructive pulmonary disease
	B)	Hypotension
	C)	Low-sodium diet
	D)	Excessive alcohol intake

5.	A patient is in the CCU with dilated cardiomyopathy and asymptomatic right-sided chronic heart failure. What finding will the nurse most likely discover in her assessment of this patient?
	A)	Mitral regurgitation murmur
	B)	Cheyne-Stokes respiratory pattern
	C)	Unilateral crackles
	D)	Rales

6.	A nurse in the CCU must assess a cardiac patient’s fluid status. Which of the following is the best method for him to use?
	A)	Having the patient measure and record all liquids taken in and all urine excreted
	B)	Weighing the patient daily
	C)	Pulse oximetry
	D)	Radionuclide ventriculography

7.	A patient presents to the CCU with shortness of breath on exertion. Which diagnostic study would be best for ruling out pneumonia or COPD as the cause of the patient’s symptoms?
	A)	Echocardiography
	B)	Radionuclide ventriculography
	C)	Pulse oximetry
	D)	Chest radiography

8.	A patient in the CCU with chronic heart failure experiences shortness of breath even when at rest. When he stands up and walks across the room, his shortness of breath worsens. Which class of heart failure does this patient exhibit, according to the New York Heart Association (NYHA) Functional Classification of Heart Failure?
	A)	Class I
	B)	Class II
	C)	Class III
	D)	Class IV

9.	A patient in the CCU has clear evidence of structural heart failure, as he lacks contractility in his left ventricle and his ejection fraction is only 37%. However, he has never shown any signs or symptoms of heart failure. According to the American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines for Stages of Heart Failure, which stage of heart failure best characterizes this patient’s condition?
	A)	Stage A
	B)	Stage B
	C)	Stage C
	D)	Stage D

10.	A patient presents to the CCU with cardiac heart failure resulting from atrial tachycardia. Which of the following explains how atrial tachycardia can cause heart failure?
	A)	Premature ventricular beats leading to sudden death
	B)	Increase in muscle mass in ventricle
	C)	Pulmonary embolus leading to acute right-sided heart failure
	D)	Shortened diastole leading to decreased filling and diastolic dysfunction

11.	The nurse is caring for a patient who has been admitted with a diagnosis of heart failure. What does the term “heart failure” mean?
	A)	It is characterized by rales and alveolar edema.
	B)	It results from damage caused by acute myocardial infarction.
	C)	It is a general clinical syndrome with many etiologies.
	D)	All patients have similar symptoms.

12.	A patient has been diagnosed with left ventricular heart failure. What physical findings would the nurse expect?
	A)	Enlarged liver
	B)	Peripheral edema
	C)	Pulmonary rales
	D)	Enlarged spleen

13.	An elderly patient with uncontrolled hypertension and atrial fibrillation with rapid ventricular response is admitted with a diagnosis of heart failure. He has crepitant pulmonary rales and his chest x-ray shows pulmonary congestion. The patient probably has what type of heart failure?
	A)	Left ventricular systolic failure
	B)	Left ventricular diastolic failure
	C)	Right ventricular failure
	D)	Combination heart failure

14.	A patient has been admitted with acute left systolic heart failure secondary to acute myocardial infarction. The patient has dyspnea and orthopnea and a cardiac rhythm of sinus tachycardia. The physiologic dysfunction for this type of heart failure is what?
	A)	Impaired contractility of the left ventricle
	B)	Impaired compliance of the left ventricle
	C)	Cardiac valve disease
	D)	Acute myocardial infarction

15.	A patient has been admitted with right heart failure. The physiologic basis of right heart failure is what?
	A)	Left heart failure
	B)	Impaired right cardiac output
	C)	Pulmonary hypertension
	D)	Acute pulmonary embolus

16.	A patient has been diagnosed with acute left heart failure secondary to acute myocardial infarction and increased afterload. What changes in assessment findings does the nurse expect to find?
	A)	Elevated pulmonary capillary wedge pressure
	B)	Normal or low blood pressure
	C)	Enlarged liver and spleen
	D)	Lungs clear to auscultation

17.	A patient with heart failure is being monitored with a pulmonary artery catheter to assess cardiac output and its components. What pattern of results would indicate a need for immediate intervention?
	A)	Heart rate, preload, contractility, and afterload are balanced and cardiac output is normal.
	B)	Heart rate is rapid, preload is reduced, contractility and afterload are normal, and cardiac output is reduced.
	C)	Heart rate is rapid, preload is high, contractility is high, afterload is low, and cardiac output is normal.
	D)	Heart rate is low, preload is high, contractility is high, afterload is low, and cardiac output is normal.

18.	A patient has been diagnosed with chronic heart failure, compensated. What symptoms would the nurse expect to find?
	A)	Frothy sputum progressing to pink frothy sputum
	B)	Severe hypotension when supine
	C)	Mild dyspnea on exertion or when supine
	D)	4+ pitting edema of the lower extremities when dependent

19.	A patient with long-standing hypertension has a viral upper respiratory illness and is self-medicating with over-the-counter medications. The patient complains of severe dyspnea with activity and has new-onset crepitant rales and pitting edema of the lower extremities. In evaluating the patient’s medications, what medication should the nurse look for in particular?
	A)	Furosemide (Lasix)
	B)	Nonsteroidal anti-inflammatory medications (NSAIDs)
	C)	Hydrochlorothiazide diuretic (HCTZ)
	D)	Angiotensin-converting enzyme (ACE) inhibitor

20.	A patient with heart failure is being discharged. What discharge instruction should the nurse emphasize most?
	A)	Date and time of next medical appointment
	B)	Dietary alterations to reduce sodium intake
	C)	Structured exercise program
	D)	Maintaining weight within 1 to 2 pounds

21.	For a patient with heart failure, maintenance of a steady weight is an important goal. The nurse should teach the patient that which of the following is the most accurate method for monitoring fluid volume changes?
	A)	Intake and output, with 24-hour totals and trends
	B)	Daily weight at the same time every day
	C)	Daily assessment of peripheral edema
	D)	Periodic assessment of serum electrolyte values

22.	A patient with heart failure has been started on an ACE inhibitor. What lab value related to the ACE inhibitor would concern the nurse?
	A)	Elevated serum potassium
	B)	Elevated CK-MB
	C)	Diminished sodium
	D)	Increased prothrombin time

23.	A patient receiving an ACE inhibitor has a blood pressure of 85/50 mm Hg. The patient is asymptomatic otherwise. What is the best nursing action?
	A)	Hold the medication because the blood pressure is too low.
	B)	Recheck the blood pressure in 1 hour.
	C)	Administer the medication because the patient is asymptomatic.
	D)	Reschedule time of medication administration to hour of sleep.

24.	The patient is prescribed hydralazine and a nitrate for management of heart failure. The patient tells the nurse he has trouble taking medications that must be taken several times a day. What intervention will be the most helpful to the patient?
	A)	Stress the importance of taking medications as prescribed.
	B)	Ask the physician to change his therapy to long-acting medications that can be taken less often.
	C)	Ask the physician to change his therapy to other drug classes at the same frequencies.
	D)	Inform the physician that the patient is not taking his prescribed medications.

25.	A patient with heart failure is taking an ACE inhibitor and a diuretic as prescribed but continues to be symptomatic. What patient behavior would explain lack of achievement of therapeutic goals?
	A)	Exercises regularly (walking and water aerobics)
	B)	Diet of mostly canned food and soda pop
	C)	Does not drink any alcoholic beverages
	D)	Takes medications as prescribed

26.	A patient with heart failure comes to the clinic for a routine monitoring visit. What findings would indicate achievement of therapeutic goals?
	A)	Lungs have crepitant rales.
	B)	Complains of dyspnea on exertion
	C)	Has pitting edema of lower extremities
	D)	Weight is within 2 pounds of ideal weight.

1.	A patient in the ICU experiences difficulty breathing in during exercise following trauma to his sternum. Which muscle involved in respiration was likely injured in this patient, leading to this condition?
	A)	Diaphragm
	B)	Sternocleidomastoid
	C)	External intercostal
	D)	Scalene

2.	The nurse is explaining to a young patient with asthma how air is conducted from his nose through his airways to the alveoli in his lungs. Which of the following represents the correct order of airways?
	A)	Nasopharynx, oropharynx, trachea, bronchi, bronchioles
	B)	Trachea, nasopharynx, oropharynx, bronchi, bronchioles
	C)	Trachea, bronchi, bronchioles, nasopharynx, oropharynx
	D)	Oropharynx, nasopharynx, trachea, bronchioles, bronchi

3.	The nurse is explaining to a patient in the ICU who has experienced a pneumothorax the role of the alveoli in respiration. The nurse should mention that which of the following are present in the alveoli? Select all that apply.
	A)	Macrophages
	B)	Surfactant
	C)	Epiglottis
	D)	Bronchus

4.	A premature infant is experiencing infant respiratory distress syndrome in the NICU. The nurse recognizes that this condition is most likely caused by which of the following?
	A)	Defective type I alveolar cells
	B)	An obstruction at the right bronchus
	C)	Negative intrapleural pressure
	D)	Immature type II alveolar cells

5.	A patient is experiencing poor perfusion in his right thorax as a result of suspected partially occluded arteries. Occlusion in which artery or arteries would cause this? Select all that apply.
	A)	Aorta
	B)	Internal mammary
	C)	Subclavian
	D)	Intercostal

6.	A patient in the ICU with chronic obstructive pulmonary disease has mucous secretions throughout her respiratory system. Her breathing is highly labored. What is the primary cause of her labored breathing?
	A)	Decreased airway resistance due to increased airway diameter
	B)	Excessive surfactant
	C)	Increased airway resistance due to decreased airway diameter
	D)	Increased lung compliance

7.	A patient with pulmonary edema is experiencing respiratory distress. The nurse recognizes that which factor affecting gas exchange is most likely responsible for the patient’s dyspnea?
	A)	Surface area available for diffusion
	B)	Thickness of the alveolar-capillary membrane
	C)	Partial pressure of alveolar gas
	D)	Solubility and molecular weight of the gas

8.	A patient is recovering from severe altitude sickness after a failed attempt to climb Mount Everest. Which factor affecting gas exchange was most likely responsible for the patient’s illness?
	A)	Surface area available for diffusion
	B)	Thickness of the alveolar-capillary membrane
	C)	Partial pressure of alveolar gas
	D)	Solubility and molecular weight of the gas

9.	A patient in the ICU with pneumothorax is experiencing a ventilation-perfusion imbalance. Which type of imbalance is the patient most likely experiencing?
	A)	Physiological shunt
	B)	Anatomical shunt
	C)	Alveolar dead space
	D)	Silent unit

10.	A patient in the ICU experiences an asthma attack after a guest brings her a flower arrangement. Stimulation of which receptors is most associated with the patient’s asthma attack?
	A)	Stretch receptors
	B)	Peripheral chemoreceptors
	C)	Irritant receptors
	D)	Juxtacapillary receptors

11.	The patient has experienced a mediastinal shift to the left. Several structures or functions will be compromised by this condition. What is the most significant effect?
	A)	Right lung will be compressed.
	B)	Cardiac output will be diminished.
	C)	Point of maximal impulse will be displaced.
	D)	Jugular venous distention will occur.

12.	The patient has experienced a mechanical obstruction of the lower trachea from a mucous plug. What is the priority nursing action?
	A)	Obtain arterial blood gas results.
	B)	Deep suction the patient.
	C)	Turn onto left side and elevate head.
	D)	Increase tidal volume on ventilator.

13.	The patient has experienced a toxic inhalation injury that has significantly damaged his type II alveolar cells. The nurse should expect to find which of the following?
	A)	Impaired gas exchange and atelectasis
	B)	Bronchospasm and wheezing
	C)	Laryngospasm and stridor
	D)	Eupnea and bradycardia

14.	The patient has experienced an acute embolus in the thorax. An embolus in which artery is most likely to significantly compromise gas exchange?
	A)	Left main bronchial artery
	B)	Right peripheral bronchial arteriole
	C)	Left peripheral pulmonary arteriole
	D)	Right main pulmonary artery

15.	The patient has suffered a stab wound to the chest, interrupting the integrity of the pleura with loss of negative pleural pressure and interruption of the contact between the visceral and parietal pleural surfaces. What is the most significant effect of this trauma?
	A)	Pleuritic chest pain
	B)	Displaced diaphragm
	C)	Crepitus over ribs
	D)	Compromised gas exchange

16.	The patient is recovering from acute pulmonary disease. The nurse is comparing his current assessment findings with older ones. What currently increased assessment finding would indicate achievement of therapeutic goals?
	A)	Pulmonary compliance
	B)	Effort of breathing
	C)	Pressure support
	D)	Airway resistance

17.	The patient is exhibiting poor gas exchange. Four factors influence gas exchange across the alveolar membrane. What condition related to the four factors could be interfering with gas exchange?
	A)	Oxygen at 100%
	B)	35% of the alveoli are filled with fluid.
	C)	Oxygen delivered under pressure
	D)	Alveolar membranes are 0.3 microns thick.

18.	The patient is experiencing a ventilation–perfusion mismatch and compromised gas exchange. Correcting ventilation–perfusion mismatch entails what actions?
	A)	Decreasing anatomic dead space with intubation
	B)	Decreasing alveolar dead space with positive-pressure ventilation
	C)	Increasing alveolar perfusion with platelet therapy
	D)	Increasing apex ventilation with high tidal volumes

19.	The patient is in severe metabolic acidosis from diabetic ketoacidosis. Based on the oxyhemoglobin dissociation curve, what change in the plan of care does the nurse expect?
	A)	Reduction of inhaled oxygen as hemoglobin is fully saturated
	B)	Use of positive-pressure ventilation to improve alveolar expansion
	C)	Increase in inhaled oxygen as hemoglobin saturation is low
	D)	Increase in ventilation rate to help excrete carbon dioxide

20.	After a drug overdose, a patient has very slow and shallow respirations. What stimulation of chemoreceptors or lung receptors will result in an increase in respiratory rate?
	A)	Decreased carbon dioxide levels at central chemoreceptors
	B)	PaO2 less than 60 at peripheral chemoreceptors
	C)	Normal airway resistance perceived by stretch receptors
	D)	Lack of stimulation of irritant receptors

1.	A patient with Duchenne’s muscular dystrophy requires an intermittent short-term therapy to maintain alveolar ventilation. The patient is not a candidate for aggressive mechanical ventilation as provided through an artificial airway. Which of the following would be the most appropriate treatment for this patient?
	A)	Manual resuscitator
	B)	Negative-pressure ventilator
	C)	Volume ventilator
	D)	Pressure ventilator

2.	A patient in the ICU is on a volume ventilator. The nurse recognizes that which of the following are true for this type of ventilator? Select all that apply.
	A)	Peak inspiratory pressure varies from breath to breath and must be monitored closely.
	B)	Amount of pressure depends on patient’s lung compliance and patient-ventilator resistance factors.
	C)	The device fits like a tortoise shell, forming a seal over the chest.
	D)	Exhaled tidal volume must be monitored closely.
	E)	Volume varies based on changes in resistance or compliance.
	F)	Small tidal volumes are used at frequencies greater than 100 breaths/minute.

3.	A patient has recently arrived in the ICU following cardiac arterial bypass graft surgery and has not yet emerged from anesthesia. He requires full ventilatory support. Which ventilation mode should the nurse use for this patient?
	A)	Pressure support ventilation mode
	B)	Synchronized intermittent mandatory ventilation mode
	C)	Pressure-controlled ventilation mode
	D)	Assist-control mode

4.	A patient with acute respiratory distress syndrome (ARDS) requires mechanical ventilation but is at risk for barotrauma due to decreased lung compliance. Which mode of ventilation should the nurse use with this patient?
	A)	Pressure support ventilation mode
	B)	Synchronized intermittent mandatory ventilation mode
	C)	Pressure-controlled ventilation mode
	D)	Assist-control mode

5.	A patient with acute respiratory distress syndrome (ARDS) has been receiving ventilation in assist-control mode for the past 48 hours. The fraction of inspired oxygen (FiO2) is set to 70% and tidal volume is set to 15 mL/kg of body weight. What complication or complications should the nurse be most concerned about in this situation? Select all that apply.
	A)	Barotrauma
	B)	Oxygen toxicity
	C)	Volutrauma
	D)	Hypoxemia

6.	A patient with acute respiratory distress syndrome (ARDS) is receiving pressure-controlled ventilation with positive end-expiratory pressure (PEEP) of 10 cm H2O. Which of the following nursing interventions will help protect this patient from one of the complications of PEEP?
	A)	Administration of antihypertensive medication
	B)	Increased administration of IV fluids
	C)	BiPAP ventilation via full facemask
	D)	Increase tidal volume to 20 mL/kg of body weight

7.	A patient with chronic obstructive pulmonary disease has just been started on pressure-controlled ventilation with positive end-expiratory pressure (PEEP) of 18 cm H2O. The fraction of inspired oxygen is set to 50%. Which of the following is a sign of tension pneumothorax that the nurse should watch for?
	A)	An abrupt decrease in peak inspiratory pressure
	B)	Tracheal deviation from the midline
	C)	Syncope
	D)	Bradypnea

8.	A patient in the ICU has been on assist-control ventilation via endotracheal intubation for 24 hours but will need to be shifted to a long-term ventilation method. Which of the following would be the most appropriate treatment for this patient?
	A)	Iron lung
	B)	Manual resuscitator
	C)	Tracheostomy tube
	D)	Pressure-controlled ventilation via endotracheal intubation

9.	A patient in the CCU is on a ventilator with oral intubation. The nurse notices that a pressure sore is forming on the patient’s lip where it comes into contact with the endotracheal tube. Which nursing action would be most appropriate?
	A)	Reposition the endotracheal tube from one side to the other
	B)	Retape the endotracheal tube
	C)	Use twill tape
	D)	Place an oral bite block in the patient’s mouth

10.	A patient in the ICU failed long-term ventilation weaning via CPAP trials. What is the next intervention that should take place?
	A)	The T-piece trial should be performed.
	B)	The patient should be switched to SIMV method.
	C)	The patient should be rested on the ventilator for 24 hours.
	D)	The patient should be switched to the SIMV plus PSV method.

11.	The patient is scheduled for a lobectomy. As part of preoperative teaching, the nurse stresses the importance of coughing and deep breathing postoperatively. What positive outcome from this procedure does the nurse expect?
	A)	Thicker and less mobile secretions
	B)	Lower incidence of atelectasis
	C)	Increased risk for pneumonia
	D)	Increased need for pain medication

12.	The patient has consolidation of his right lateral lower lung segments and is receiving chest physiotherapy. What position is best for draining this portion of the lung?
	A)	Semi-Fowler’s
	B)	Supine
	C)	Left side-lying
	D)	Right side-lying

13.	The patient is receiving supplemental oxygen therapy. What finding most clearly demonstrates achievement of one of the goals of oxygen therapy?
	A)	Therapy is discontinued after 3 days.
	B)	Increased respiratory rate and depth
	C)	Verbalization of relief of dyspnea
	D)	Reduction of arterial carbon dioxide pressure

14.	The patient is receiving supplemental oxygen therapy. What finding would be most indicative of a life-threatening complication of oxygen therapy?
	A)	Increased somnolence
	B)	Eupneic respirations
	C)	SaO2 100%
	D)	Skin irritation under mask

15.	The nurse is assisting with endotracheal intubation. In what circumstance would the nurse question the use of nasotracheal intubation?
	A)	Confused patient
	B)	Fractured mandible
	C)	Acute sinusitis
	D)	Possible cervical spine fracture

16.	After pulmonary surgery, the patient returns to the critical care unit with a left pleural chest tube in place connected to a disposable three-chamber unit that is connected to suction at negative 20 cm H2O. What must the nurse ensure so that the goal for chest tube placement is met?
	A)	The water-seal chamber has the amount of water defined by the manufacturer.
	B)	The suction control chamber has vigorous bubbling at all times.
	C)	The drainage unit is prepared using sterile water only.
	D)	Suction is applied between negative 10 and 20 cm H2O.

17.	A critically ill patient has an intravenous line inserted into the left subclavian vein. After the procedure, what nursing intervention is used to detect the most serious complication of this procedure?
	A)	Connection of ordered intravenous fluids
	B)	Compatibility evaluation for fluids infused
	C)	Use of a semipermeable plastic site dressing
	D)	Auscultation of bilateral breath sounds

18.	The patient is to undergo chest tube placement. What is the best nursing intervention to prevent a complication of this procedure?
	A)	Facilitate chest tube removal on day 3.
	B)	Use the supine position during chest tube removal.
	C)	Premedicate with an intravenous opioid.
	D)	Keep drainage tubing off the bed.

19.	A patient with asthma is receiving a bronchodilator medication. If this therapy is helpful to the patient, the nurse would expect to find which of the following?
	A)	Increased productiveness of cough
	B)	More intense wheezing
	C)	Persistent tachycardia
	D)	Reduced peak expiratory flow rate

20.	A patient being supported with endotracheal intubation and mechanical ventilation is increasingly agitated. What is the most appropriate nursing intervention?
	A)	Administer neuromuscular blockade medication.
	B)	Administer a benzodiazepine.
	C)	Obtain arterial blood gas measurement.
	D)	Ask a family member to stay with the patient.

21.	A patient in severe congestive heart failure is at risk for the development of acute respiratory failure and is receiving supplemental oxygen therapy. What nursing assessment parameter is most indicative of acute respiratory failure?
	A)	Dependent pitting edema that is worsening
	B)	New onset of systolic gallop
	C)	Conversion to atrial fibrillation
	D)	Arterial PaO2 45 mm Hg

22.	The patient is being well supported with a positive-pressure mechanical ventilator. Because of the mechanism of action of this type of ventilator, what common complication does the nurse watch for?
	A)	Diminished cardiac output
	B)	Increased somnolence
	C)	Deep venous thrombosis
	D)	Reduced patient control

23.	The patient is being supported with a positive-pressure mechanical ventilator. The machine in use is a volume-cycled ventilator. Relative to the functioning of this ventilator, what nursing assessment is most important?
	A)	Continuous pulse oximetry
	B)	Vital signs per unit protocol
	C)	Respiratory rate
	D)	Peak inspiratory pressure

24.	The patient is being supported with a positive-pressure mechanical ventilator set to a synchronized intermittent mandatory ventilation (SIMV) rate of 8 breaths per minute. What situation, if found by the nurse, would indicate a ventilator malfunction?
	A)	SIMV rate 8, patient rate 30, total rate 38 breaths per minute
	B)	SIMV rate 6, patient rate 2, total rate 8 breaths per minute
	C)	SIMV rate 8, patient rate 0, total rate 8 breaths per minute
	D)	SIMV rate 8, patient rate 8, total rate 16 breaths per minute

25.	The patient is being supported with mechanical ventilation and is requiring very high levels of inspired oxygen to maintain his arterial blood gases at acceptable levels. In an attempt to reduce the amount of oxygen required, positive end-expiratory pressure (PEEP) at 5 cm H2O is added to the ventilator settings. What is the most important effect of PEEP?
	A)	Increases number of open alveoli
	B)	Increases patient comfort
	C)	Assists in ventilator weaning
	D)	Compensates for tubing resistance

26.	The patient is being supported by mechanical ventilation and is not maintaining adequate oxygenation on current settings. Positive end-expiratory pressure (PEEP) has just been increased from 10 to 12 cm H2O. What nursing assessment finding best indicates that the patient is not tolerating this change?
	A)	Increased cardiac output
	B)	Increased blood pressure
	C)	Significant hypotension
	D)	Increased pulmonary compliance

27.	A patient with multiple trauma and several other comorbidities is being supported with endotracheal intubation and mechanical ventilation and is scheduled for a tracheostomy. The family questions the appropriateness of this procedure. In explaining the rationale for the procedure to the family, what is the most important nursing point?
	A)	There is a physician’s order for the procedure.
	B)	Unit protocol mandates tracheostomy after a patient has been intubated for 7 days.
	C)	A tracheostomy will greatly increase the patient’s comfort.
	D)	Tracheostomies at 3 to 7 days result in fewer ventilated days.

28.	As part of the care of a mechanically ventilated patient, the nurse provides oral and subglottic suctioning every 2 hours. What is the best rationale for this nursing action?
	A)	Stimulates cough and deep breathing
	B)	Reduces pulmonary microbial colonization
	C)	Maintains oral mucosal moisture
	D)	Part of Universal Precautions protocols

29.	The patient has been on a mechanical ventilator for 2 weeks. Weaning from mechanical ventilation is to start today. Based on the length of time that the patient has been ventilated, what information should the nurse emphasize to the patient and the family?
	A)	Extubation is expected later today, as the patient is relatively young.
	B)	Delays and setbacks are expected before independence is achieved.
	C)	The best method is continuous positive airway pressure (CPAP).
	D)	Elevation of the head of the bed will provide for the most patient comfort.

1.	An elderly male patient in the ICU is diagnosed with acute kidney injury. This patient demonstrates a decreased glomerular filtration rate and lowered urine sodium concentration, as well as increased BUN and serum creatinine levels. The nurse observes that the patient takes several minutes to empty his bladder when he uses the bathroom. His blood pressure and blood glucose levels are normal. What should the nurse suspect as the cause of this patient’s acute kidney injury?
	A)	Tubular necrosis as a result of accumulation of radiocontrast dye in the renal tubular cells
	B)	Obstruction of the flow of urine due to benign prostatic hypertrophy
	C)	Lack of perfusion due to congestive heart failure
	D)	Hypotension due to systemic inflammatory response to sepsis

2.	A patient develops toxic acute tubular necrosis (ATN) as a result of exposure to a radiocontrast dye. Which of the following should the nurse most expect to observe in this patient as this condition progresses beyond the onset phase?
	A)	Normal potassium levels
	B)	Duration of 7 to 14 days
	C)	Normal urine concentrating function
	D)	Normal urine volume

3.	A patient with acute kidney injury (AKI) demonstrates blue mottling of the skin in her fingers. What other finding would tend to indicate that the cause of this condition is intrarenal?
	A)	Distended bladder
	B)	Edema
	C)	Strep throat infection
	D)	Kinked Foley catheter

4.	A patient with acute kidney injury (AKI) demonstrates oliguria, a urine osmolality of 550 mOsm/kg H2O, increased urine specific gravity, urine sodium of 15 mEq/L, and a BUN:creatinine ratio of 23:1. Which of the following is a cause of AKI that would best fit with these findings?
	A)	Congestive heart failure
	B)	Nephrotoxicity due to aminoglycoside antibiotics
	C)	Hypertension
	D)	Retroperitoneal tumor

5.	A patient is concerned about her steadily worsening chronic kidney disease and asks the nurse at what point she will require dialysis or renal transplantation. Which of the following should the nurse mention?
	A)	When your urine albumin-to-creatinine ratio is greater than 25 mg/g
	B)	When your urine output is less than 0.5 mL/kg/h × 6 h
	C)	When your glomerular filtration rate (GFR) falls below 15 mL/min/1.73 m2
	D)	When your urine osmolality is greater than 500 mOsm/kg H2O

6.	A patient with chronic kidney disease is receiving an ACE inhibitor. The nurse understands that this medication helps slow the progression of this disease through what process?
	A)	It lowers the level of blood glucose.
	B)	It prevents nephron hyperfiltration.
	C)	It increases the urine output.
	D)	It filters waste from the blood.

7.	A patient with prerenal acute kidney injury is oliguric. The nurse is administering an IV bolus to the patient. What should be of primary concern to the nurse while performing this task?
	A)	Restricting the patient’s protein intake
	B)	Monitoring the patient’s potassium level
	C)	Evaluating the patient for signs of nephrotoxicity
	D)	Preventing fluid overload

8.	A patient with acute kidney injury (AKI) complains of a headache. He vomits several times and breathes deeply and rapidly. His heart rate is 110 bpm, and his serum potassium level is elevated. The nurse recognizes in this patient which condition commonly associated with AKI?
	A)	Fluid overload
	B)	Anemia
	C)	Metabolic acidosis
	D)	Pericarditis

9.	A patient with chronic kidney disease has a serum potassium level of 5 mEq/L and no changes on the ECG. What is the proper nursing intervention?
	A)	Administer sodium polystyrene as an enema.
	B)	Administer IV calcium gluconate.
	C)	Administer IV insulin and dextrose.
	D)	Begin dialysis.

10.	A patient has been diagnosed with prerenal acute renal failure. What condition most likely caused this situation?
	A)	Toxic levels of medications
	B)	Poststreptococcal glomerulonephritis
	C)	Severe sepsis and shock
	D)	Benign prostatic hypertrophy

11.	The patient is in hypovolemic shock, with mean arterial pressures below 90 mm Hg and a very low urine output. An IV drip of norepinephrine is prescribed to keep blood pressure above 90 mm Hg. No other therapy is initiated. What effect on kidney function does the nurse expect?
	A)	Improvement in renal perfusion secondary to improved blood pressure
	B)	Reduction in urine output secondary to constriction of renal arteries
	C)	Augmentation of water reabsorption from distal tubular fluid
	D)	Decrease in urine sodium concentration to critically low levels

12.	In a patient with acute ischemic tubular necrosis, urine output has increased from below normal to very high. What is the nursing priority of care during this phase of renal failure?
	A)	Restrict fluid intake
	B)	Monitor serum potassium
	C)	De-emphasize dialysis
	D)	Monitor serum creatinine

13.	A patient with a history of diabetes mellitus has had a procedure using radiocontrast dye. The patient’s laboratory results include high urine sodium, urine with muddy-brown granular casts and tubular epithelial cells, and increased blood urea nitrogen (BUN) and serum creatinine. Renal ultrasonography is normal. Urine volume is normal. Which treatment does the nurse anticipate?
	A)	Increased fluids
	B)	Renal stent placement
	C)	Irrigation of urinary catheter
	D)	Diuretic therapy

14.	A patient in intensive care with acute tubular necrosis from a toxic ingestion has been started on renal replacement therapy. The family expresses concern that the patient will not be able to afford dialysis after discharge from the hospital. In responding to the family, what should the nurse consider?
	A)	The family is in crisis and unable to respond rationally.
	B)	Toxic acute tubular necrosis has a higher likelihood of complete healing.
	C)	Since the patient is currently oliguric, renal replacement therapy is indicated.
	D)	The patient is unlikely to survive this illness, so the cost of long-term dialysis is not an issue.

15.	A patient has just been diagnosed with type 2 diabetes mellitus. During teaching, what strategy should the nurse emphasize as protective of kidney cells?
	A)	Monitoring glycosylated hemoglobin every 3 months
	B)	Strict adherence to prescribed weight-loss diet
	C)	Restriction of sodium-containing beverages and food
	D)	Strict control of serum glucose levels with diet and medication

16.	A patient with chronic renal disease is involved in a motor vehicle crash and experiences severe hypovolemia. In caring for this patient in the CCU, which of the following is the most important for the nurse to monitor?
	A)	Blood pressure
	B)	Fluid volume recovery
	C)	Urine output
	D)	Cardiac dysrhythmias

17.	A patient has been diagnosed with chronic renal failure. What closely associated pathophysiologies should the nurse assess for? Select all that apply.
	A)	Hypertension
	B)	Arteriosclerotic disease
	C)	Traumatic injury
	D)	Type 2 diabetes mellitus
	E)	Preeclampsia
	F)	Type 1 diabetes mellitus

18.	A patient in oliguric renal failure is receiving IV furosemide (Lasix). What nursing assessment has the highest priority?
	A)	Daily weights
	B)	Intake and output
	C)	Serum potassium
	D)	Blood urea nitrogen

19.	A patient with chronic renal disease has mild metabolic acidosis with a pH 7.30 and bicarbonate level 16 mEq/L. What treatment does the nurse anticipate?
	A)	IV sodium bicarbonate
	B)	Reduction of respiratory rate
	C)	Sodium citrate and citric acid (Bicitra)
	D)	Massive IV fluids

20.	A patient with chronic renal failure also has chronic anemia, arteriosclerotic disease, and diabetes mellitus. The patient asks the nurse why the anemia is persisting. In answering the patient’s question, what should the nurse most consider?
	A)	The patient most likely has preexisting chronic anemia.
	B)	Erythropoietin is primarily produced in the kidney.
	C)	The patient is receiving low-dose aspirin therapy.
	D)	Chronic renal failure results in persistent uremia.

21.	The nurse is teaching a patient with chronic renal failure and diabetes mellitus about nutrition. What should be included?
	A)	Calorie restriction based on ideal body weight is necessary.
	B)	Sodium and potassium should be supplemented while on dialysis.
	C)	Renal diet restrictions take the place of those for diabetes mellitus.
	D)	Moderate protein restriction is recommended while otherwise healthy.

1.	An elderly male patient in the ICU is diagnosed with acute kidney injury. This patient demonstrates a decreased glomerular filtration rate and lowered urine sodium concentration, as well as increased BUN and serum creatinine levels. The nurse observes that the patient takes several minutes to empty his bladder when he uses the bathroom. His blood pressure and blood glucose levels are normal. What should the nurse suspect as the cause of this patient’s acute kidney injury?
	A)	Tubular necrosis as a result of accumulation of radiocontrast dye in the renal tubular cells
	B)	Obstruction of the flow of urine due to benign prostatic hypertrophy
	C)	Lack of perfusion due to congestive heart failure
	D)	Hypotension due to systemic inflammatory response to sepsis

2.	A patient develops toxic acute tubular necrosis (ATN) as a result of exposure to a radiocontrast dye. Which of the following should the nurse most expect to observe in this patient as this condition progresses beyond the onset phase?
	A)	Normal potassium levels
	B)	Duration of 7 to 14 days
	C)	Normal urine concentrating function
	D)	Normal urine volume

3.	A patient with acute kidney injury (AKI) demonstrates blue mottling of the skin in her fingers. What other finding would tend to indicate that the cause of this condition is intrarenal?
	A)	Distended bladder
	B)	Edema
	C)	Strep throat infection
	D)	Kinked Foley catheter

4.	A patient with acute kidney injury (AKI) demonstrates oliguria, a urine osmolality of 550 mOsm/kg H2O, increased urine specific gravity, urine sodium of 15 mEq/L, and a BUN:creatinine ratio of 23:1. Which of the following is a cause of AKI that would best fit with these findings?
	A)	Congestive heart failure
	B)	Nephrotoxicity due to aminoglycoside antibiotics
	C)	Hypertension
	D)	Retroperitoneal tumor

5.	A patient is concerned about her steadily worsening chronic kidney disease and asks the nurse at what point she will require dialysis or renal transplantation. Which of the following should the nurse mention?
	A)	When your urine albumin-to-creatinine ratio is greater than 25 mg/g
	B)	When your urine output is less than 0.5 mL/kg/h × 6 h
	C)	When your glomerular filtration rate (GFR) falls below 15 mL/min/1.73 m2
	D)	When your urine osmolality is greater than 500 mOsm/kg H2O

6.	A patient with chronic kidney disease is receiving an ACE inhibitor. The nurse understands that this medication helps slow the progression of this disease through what process?
	A)	It lowers the level of blood glucose.
	B)	It prevents nephron hyperfiltration.
	C)	It increases the urine output.
	D)	It filters waste from the blood.

7.	A patient with prerenal acute kidney injury is oliguric. The nurse is administering an IV bolus to the patient. What should be of primary concern to the nurse while performing this task?
	A)	Restricting the patient’s protein intake
	B)	Monitoring the patient’s potassium level
	C)	Evaluating the patient for signs of nephrotoxicity
	D)	Preventing fluid overload

8.	A patient with acute kidney injury (AKI) complains of a headache. He vomits several times and breathes deeply and rapidly. His heart rate is 110 bpm, and his serum potassium level is elevated. The nurse recognizes in this patient which condition commonly associated with AKI?
	A)	Fluid overload
	B)	Anemia
	C)	Metabolic acidosis
	D)	Pericarditis

9.	A patient with chronic kidney disease has a serum potassium level of 5 mEq/L and no changes on the ECG. What is the proper nursing intervention?
	A)	Administer sodium polystyrene as an enema.
	B)	Administer IV calcium gluconate.
	C)	Administer IV insulin and dextrose.
	D)	Begin dialysis.

10.	A patient has been diagnosed with prerenal acute renal failure. What condition most likely caused this situation?
	A)	Toxic levels of medications
	B)	Poststreptococcal glomerulonephritis
	C)	Severe sepsis and shock
	D)	Benign prostatic hypertrophy

11.	The patient is in hypovolemic shock, with mean arterial pressures below 90 mm Hg and a very low urine output. An IV drip of norepinephrine is prescribed to keep blood pressure above 90 mm Hg. No other therapy is initiated. What effect on kidney function does the nurse expect?
	A)	Improvement in renal perfusion secondary to improved blood pressure
	B)	Reduction in urine output secondary to constriction of renal arteries
	C)	Augmentation of water reabsorption from distal tubular fluid
	D)	Decrease in urine sodium concentration to critically low levels

12.	In a patient with acute ischemic tubular necrosis, urine output has increased from below normal to very high. What is the nursing priority of care during this phase of renal failure?
	A)	Restrict fluid intake
	B)	Monitor serum potassium
	C)	De-emphasize dialysis
	D)	Monitor serum creatinine

13.	A patient with a history of diabetes mellitus has had a procedure using radiocontrast dye. The patient’s laboratory results include high urine sodium, urine with muddy-brown granular casts and tubular epithelial cells, and increased blood urea nitrogen (BUN) and serum creatinine. Renal ultrasonography is normal. Urine volume is normal. Which treatment does the nurse anticipate?
	A)	Increased fluids
	B)	Renal stent placement
	C)	Irrigation of urinary catheter
	D)	Diuretic therapy

14.	A patient in intensive care with acute tubular necrosis from a toxic ingestion has been started on renal replacement therapy. The family expresses concern that the patient will not be able to afford dialysis after discharge from the hospital. In responding to the family, what should the nurse consider?
	A)	The family is in crisis and unable to respond rationally.
	B)	Toxic acute tubular necrosis has a higher likelihood of complete healing.
	C)	Since the patient is currently oliguric, renal replacement therapy is indicated.
	D)	The patient is unlikely to survive this illness, so the cost of long-term dialysis is not an issue.

15.	A patient has just been diagnosed with type 2 diabetes mellitus. During teaching, what strategy should the nurse emphasize as protective of kidney cells?
	A)	Monitoring glycosylated hemoglobin every 3 months
	B)	Strict adherence to prescribed weight-loss diet
	C)	Restriction of sodium-containing beverages and food
	D)	Strict control of serum glucose levels with diet and medication

16.	A patient with chronic renal disease is involved in a motor vehicle crash and experiences severe hypovolemia. In caring for this patient in the CCU, which of the following is the most important for the nurse to monitor?
	A)	Blood pressure
	B)	Fluid volume recovery
	C)	Urine output
	D)	Cardiac dysrhythmias

17.	A patient has been diagnosed with chronic renal failure. What closely associated pathophysiologies should the nurse assess for? Select all that apply.
	A)	Hypertension
	B)	Arteriosclerotic disease
	C)	Traumatic injury
	D)	Type 2 diabetes mellitus
	E)	Preeclampsia
	F)	Type 1 diabetes mellitus

18.	A patient in oliguric renal failure is receiving IV furosemide (Lasix). What nursing assessment has the highest priority?
	A)	Daily weights
	B)	Intake and output
	C)	Serum potassium
	D)	Blood urea nitrogen

19.	A patient with chronic renal disease has mild metabolic acidosis with a pH 7.30 and bicarbonate level 16 mEq/L. What treatment does the nurse anticipate?
	A)	IV sodium bicarbonate
	B)	Reduction of respiratory rate
	C)	Sodium citrate and citric acid (Bicitra)
	D)	Massive IV fluids

20.	A patient with chronic renal failure also has chronic anemia, arteriosclerotic disease, and diabetes mellitus. The patient asks the nurse why the anemia is persisting. In answering the patient’s question, what should the nurse most consider?
	A)	The patient most likely has preexisting chronic anemia.
	B)	Erythropoietin is primarily produced in the kidney.
	C)	The patient is receiving low-dose aspirin therapy.
	D)	Chronic renal failure results in persistent uremia.

21.	The nurse is teaching a patient with chronic renal failure and diabetes mellitus about nutrition. What should be included?
	A)	Calorie restriction based on ideal body weight is necessary.
	B)	Sodium and potassium should be supplemented while on dialysis.
	C)	Renal diet restrictions take the place of those for diabetes mellitus.
	D)	Moderate protein restriction is recommended while otherwise healthy.