High Acuity Nursing Exam Preparation Guide
Course Introduction
High Acuity Nursing is designed to equip students with the knowledge and skills necessary to care for patients experiencing complex, life-threatening health conditions requiring intensive monitoring and interventions. This course emphasizes the assessment, diagnosis, and management of individuals in high acuity settings such as intensive care units, step-down units, and emergency departments. Students learn advanced concepts related to hemodynamics, respiratory support, neurological monitoring, and multi-system organ dysfunction, while developing critical thinking, rapid decision-making, and evidence-based practice strategies to optimize patient outcomes in high-stress environments.
Recommended Textbook
Priorities in Critical Care Nursing 7th Edition by Linda D. Urden
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42 Chapters
1239 Verified Questions
1239 Flashcards
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Chapter 1: Critical Care Nursing Practice
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Sample Questions
Q1) A patient was admitted to a rural ICU in Montana.Critical care nurses are assisting with monitoring and care of the patient from the closest major city.This is an example of A) telemedicine.
B) tele-ICU.
C) tele-informatics.
D) tele-hospital.
Answer: B
Q2) _____ are instrumental in ensuring care that is evidence based and that safety programs are in place.
A) CNSs
B) APNs
C) SCCMs
D) AACNs
Answer: A
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Chapter 2: Ethical Issues
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Sample Questions
Q1) Ethical decisions are best made by
A) following the guidelines of a framework or model.
B) having the client discuss alternatives with the physician or nurse.
C) prioritizing the greatest good for the greatest number of persons.
D) careful consideration by the Ethics Committee after all diagnostic data are reviewed.
Answer: A
Q2) The difference between withholding treatment and withdrawing treatment is that the decision to withhold treatment
A) is used when it has been determined that there is no hope for success from the onset of care.
B) reflects surrendering hope after all options have been unsuccessful.
C) requires a court order.
D) is an economical decision not a moral or ethical decision.
Answer: A
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Chapter 3: Legal Issues
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Sample Questions
Q1) After admission to the intensive care unit,a patient shares with the nurse a concern that her adult children will not be able to reach agreement on what to do if she is no longer able to make decisions for herself.The nurse informs the patient that it is possible to grant authority to one person to make decisions by procuring a A) court-appointed guardian.
B) do-not-resuscitate order.
C) durable power of attorney for health care.
D) living will.
Answer: C
Q2) A nurse fails to recognize an intubated patient's need for nasotracheal suctioning.The endotracheal tube becomes clogged,and the patient has a respiratory arrest.Which of the following best describes the type of negligence the nurse may be liable for?
A) Assessment failure
B) Planning failure
C) Implementation failure
D) Evaluation failure
Answer: A
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Chapter 4: Genetics and Genomics in Critical Care
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Sample Questions
Q1) Hemophilia A is an inherited disease.Which statements would be determined by the family pedigree regarding hemophilia A?
A) It is an X-linked disorder.
B) Sons have a 50% chance of having hemophilia.
C) It is a Y-linked disorder.
D) Daughters have a 50% chance of being a carrier of the trait.
E) Sons have a 25% chance of having hemophilia.
F) Daughters have a 50% chance of having hemophilia.
Q2) The study of all the genetic material within the cell and its impact on biological and physical characteristics is known as:
A) chromatids.
B) karyotype.
C) genomics.
D) histones.
Q3) The goal of the Human Genome Project was
A) to identify haplotype tags.
B) to expose untaggable SNPs and recombination hot spots.
C) to produce a catalog of human genome variation.
D) to map all the human genes.
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Page 6
Chapter 5: Patient and Family Education
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Sample Questions
Q1) A lack of true understanding can often be misread by the nurse as noncompliance.Which of the following statements demonstrate effective questioning methods to assess a patient's understanding?
A) "Do you take your heart medication every morning?"
B) "Can you tell me what you know about your different heart medications?"
C) "Do you take all your medications?"
D) "Do you ever miss taking your medication?"
Q2) Acute illness disrupts the patient's and family's normal routines.Coping mechanisms include
A) denial.
B) adaptation.
C) values.
D) anger.
E) disbelief.
Q3) Which of the following educational content areas is appropriate during the first hours of hospitalization?
A) Pathophysiology of the admitting diagnosis
B) Dietary modifications
C) Purpose of bedside equipment
D) Medication side effects
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Chapter 6: Psychosocial and Spiritual Alterations and Management
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Sample Questions
Q1) A patient with low self-esteem may manifest which of the following behaviors?
A) Refusal to participate in care
B) Feelings that his or her body has betrayed him or her
C) Acceptance and ownership of problems
D) Disruption in the perception of the body
Q2) Because of the nature of the environment,_____ is a serious concern in the critical care environment.
A) family involvement
B) use of complementary therapies
C) sleep deprivation
D) calm environment
Q3) Which of the following concepts supports patients and helps them endure the physical and psychological insults of their critical illness?
A) Regression
B) Denial
C) Hope
D) Trust
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Page 8
Chapter 7: Sleep Alterations and Management
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Sample Questions
Q1) Which of the following older patients demonstrates changes in sleep patterns attributable to central sleep apnea?
A) A patient who wakes up two to three times per night and is tired during the day
B) A patient who reports sleeping less soundly and not feeling rested
C) A patient who consistently awakens at 4 AM and goes to bed at 7 PM
D) A patient who has irregular respiration during sleep and whose inspiratory muscles intermittently fail
Q2) Which stage of NREM sleep is associated with anabolic processes?
A) N1
B) N2
C) N3
D) N4
Q3) REM sleep comprises what percent of the sleep cycle?
A) 70% to 75%
B) 45% to 65%
C) 15% to 20%
D) 20% to 25%
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Chapter 8: Nutrition Alterations and Management
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Sample Questions
Q1) A tracheostomy patient is experiencing regurgitation of tube feeding formula.The nurse's first priority should be
A) checking to make sure the tracheostomy cuff is inflated during tube feedings.
B) placing the patient in the right lateral decubitus position to promote gastric emptying.
C) discussing the use of metoclopramide to facilitate gastric motility with the physician.
D) placing the patient in prone position to improve draining from mouth.
Q2) A patient is admitted to the critical care unit with severe malnutrition as a result of hepatic failure.A triple-lumen central venous catheter is placed in the right subclavian vein,and TPN is started.On the third day of infusion,the patient develops symptoms of fever and chills.Which of the following complications should be suspected?
A) Air embolism
B) Pneumothorax
C) Central venous thrombosis
D) Catheter-related sepsis
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Chapter 9: Pain and Pain Management
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Sample Questions
Q1) The patient is admitted to the CCU with hemodynamic instability and an allergy to morphine.The nurse anticipates that the physician will order which medication for severe pain?
A) Hydromorphone
B) Codeine
C) Fentanyl
D) Methadone
Q2) Which of the following combinations of drugs has been found to be effective in managing the pain associated with musculoskeletal and soft tissue inflammation?
A) Nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids
B) NSAIDs and antidepressants
C) Opioid agonists and opioid antagonists
D) Adjuvants and partial agonists
Q3) Relaxation,distraction,guided imagery,and music therapy are all examples of A) physical techniques for pain management.
B) cognitive-behavioral techniques for pain management.
C) PCA management of pain.
D) equianalgesic management of pain.
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Chapter 10: Sedation,Agitation,Delirium: Assessment and Management
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Sample Questions
Q1) A major side effect of benzodiazepines is A) hypertension.
B) respiratory depression.
C) renal failure.
D) phlebitis at the IV site.
Q2) The two scales that are recommended for assessment of agitation and sedation in adult critically ill patients are the
A) Ramsay Scale and Riker Sedation-Agitation Scale (SAS).
B) Ramsay Scale and Motor Activity Assessment Scale (MAAS).
C) Riker Sedation-Agitation Scale (SAS) and the Richmond Agitation-Sedation Scale (RASS).
D) Richmond Agitation-Sedation Scale (RASS) and Motor Activity Assessment Scale (MAAS).
Q3) When administering propofol over an extended period,it is important to monitor which of the following?
A) Serum triglyceride level
B) Sodium and potassium levels
C) Platelet count
D) Acid-base balance
Page 12
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Chapter 11: End-Of-Life Issues
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Sample Questions
Q1) A patient was admitted to the critical care unit several weeks ago with an acute myocardial infarction and subsequently underwent coronary artery bypass grafting surgery.Since a cardiac arrest 5 days ago,the patient has been unresponsive.An electroencephalogram shows no meaningful brain activity.The decision is made to remove the patient from the ventilator.Which of the following statements is most accurate?
A) The cardiac monitor should be left on so everyone will know when the patient has died.
B) Opioids, sedatives, and neuromuscular blocking agents should be discontinued just before removing the ventilator.
C) The family and health care team should decide the best method for removing the ventilator: terminal wean versus immediate extubation.
D) If terminal weaning is selected, the family should be sent to the waiting room until the ventilator has actually been removed.
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Chapter 12: Cardiovascular Anatomy and Physiology
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Sample Questions
Q1) In a myocardial cell,the normal resting membrane potential is
A) 10 to 20 mV.
B) 30 to 40 mV.
C) -20 to -30 mV.
D) -80 to -90 mV.
Q2) Which statement regarding the autonomic nervous system's role in the regulation of heart rate is true?
A) Parasympathetic influences increase heart rate.
B) Sympathetic influences are predominantly present.
C) Parasympathetic influences are only compensatory.
D) Both sympathetic and parasympathetic influences are normally active.
Q3) The hemodynamic effects of a pericardial effusion include
A) increased ventricular ejection.
B) decreased ventricular filling.
C) myocardial ischemia.
D) increased afterload.
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14
Chapter 13: Cardiovascular Clinical Assessment
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Sample Questions
Q1) The purpose of the Allen test is to
A) assess adequate blood flow through the ulnar artery.
B) occlude the brachial artery and evaluate hypoxemia to the hand.
C) test the patency of an internal graft.
D) determine the size of needle to be used for puncture.
Q2) The presence of a carotid or femoral bruit may be evidence of
A) left-sided heart failure.
B) blood flow through a partially occluded vessel.
C) the early onset of pulmonary embolism.
D) myocardial rupture.
Q3) Which of the following describe(s)S?,the first heart sound?
A) It is associated with closure of the mitral and tricuspid valves.
B) It is a high-pitched sound.
C) It can be heard most clearly with the diaphragm of the stethoscope.
D) The best listening point is in the aortic area.
E) The "split" sound can best be detected in the tricuspid area.
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Chapter 14: Cardiovascular Diagnostic Procedures
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75 Flashcards
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Sample Questions
Q1) The patient's admitting 12-lead ECG shows peaked P waves.Which of the following admitting diagnoses could be responsible for this finding?
A) Mitral stenosis
B) Pulmonary edema
C) Ischemia
D) Pericarditis
Q2) Which of the following cardiac enzymes is a highly specific biomarker for myocardial damage?
A) CK-MB
B) Troponin I
C) Troponin T
D) LDH
Q3) A patient is in shock.In this patient,
A) cuff pressures may be unreliable.
B) cuff pressures are more accurate than A-line pressures.
C) cuff pressures and A-line pressures should be nearly identical.
D) A-lines should not be inserted.
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Chapter 15: Cardiovascular Disorders
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Sample Questions
Q1) Medical management of hypertrophic cardiomyopathy includes A) beta-blockers.
B) positive inotropes.
C) an intensive exercise regimen.
D) aortic valve replacement.
Q2) You are teaching a patient with endocarditis about his diagnosis.Which statement below is correct?
A) Endocarditis is a viral infection that is easily treated with antibiotics.
B) The risk of this diagnosis is occlusion of the coronary arteries.
C) A long course of antibiotics is needed to treat this disorder.
D) Complications are rare after antibiotics have been started.
Q3) The most frequent dysrhythmia seen initially with sudden cardiac death is A) premature ventricular contractions.
B) ventricular tachycardia.
C) ventricular fibrillation.
D) asystole.
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Chapter 16: Cardiovascular Therapeutic Management
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Sample Questions
Q1) A nurse is providing care to a patient on fibrinolytic therapy.Which of the following statements from the patient warrants further assessment and intervention by the critical care nurse?
A) "My back is killing me!"
B) "There is blood on my toothbrush!"
C) "Look at the bruises on my arms!"
D) "My arm is bleeding where my IV is!"
Q2) The rationale for administration of a fibrinolytic agent is
A) dilation of the blocked coronary artery.
B) anticoagulation to prevent formation of new emboli.
C) dissolution of atherosclerotic plaque at the site of blockage.
D) restoration of blood flow to the obstructed coronary artery via lysis of the thrombus.
Q3) The possibility of microshock when handling a temporary pacemaker can be minimized by
A) decreasing the milliamperes.
B) wearing gloves.
C) positioning the patient on the left side.
D) wearing rubber-soled shoes.
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18
Chapter 17: Pulmonary Anatomy and Physiology
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Sample Questions
Q1) You would expect a patient in diabetic ketoacidosis to exhibit which of the following?
A) Breathe faster to increase pH
B) Breathe slower to increase pH
C) Breathe faster to decrease pH
D) Breathe slower to decrease pH
Q2) The most important function of type I alveolar epithelial cells is
A) that they comprise 90% of total alveolar surface in the lungs for gas exchange.
B) the ability to produce, store, and secrete pulmonary surfactant.
C) the ability to trap foreign particles for autodigestion.
D) the maintenance, repair, and restoration of the mucociliary escalator.
Q3) The lymphatic system plays which of the following important roles?
A) Ridding lung tissue of excess CO<sub>2</sub>
B) Connecting the thebesian veins to the coronary circulation
C) Removing fluid from the lungs
D) Producing immune responses
E) Removing cell debris from the lungs
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19
Chapter 18: Pulmonary Clinical Assessment
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Sample Questions
Q1) A patient is admitted to the critical care unit with acute respiratory failure secondary to COPD.The patient has a 15-year history of emphysema and bronchitis.On inspection,the nurse notes that the patient is experiencing air trapping.While auscultating his chest,you note the presence of coarse,rumbling,low-pitched sounds in the right middle and lower lobes.Which of the following best describes the patient's breathing pattern?
A) Deep sighing breaths without pauses
B) Rapid, shallow breaths
C) Normal breathing pattern interspersed with forced expirations
D) Irregular breathing pattern with both deep and shallow breaths
Q2) A patient presents with chest trauma from an MVA.Upon assessment,the nurse documents that the patient is complaining of dyspnea,shortness of breath,tachypnea,and tracheal deviation to the right.In addition,the client's tongue is blue-gray.Based on the following data,what would the nurse would expect to find?
A) PaO<sub>2</sub> of 88 and PCO<sub>2</sub> of 55
B) Absent breath sounds in all right lung fields
C) Absent breath sounds in all left lung fields
D) Diminished breath sounds in all fields
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Chapter 19: Pulmonary Diagnostic Procedures
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Sample Questions
Q1) Nursing management of a patient undergoing a diagnostic procedure involves
A) positioning the patient for the procedure.
B) monitoring the patient's responses to the procedure.
C) monitoring vital signs.
D) teaching the patient about the procedure.
E) medicating the patient before and after procedure.
Q2) A patient is intubated,and sputum for culture and sensitivity is ordered.Which of the following is important for obtaining the best specimen?
A) After the specimen is in the container, dilute thick secretions with sterile water.
B) Apply suction when the catheter is advanced to obtain secretions from within the endotracheal tube.
C) Do not apply suction while the catheter is being withdrawn because this can contaminate the sample with sputum left in the endotracheal tube.
D) Do not clear the endotracheal tube of all local secretions before obtaining the specimen.
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Chapter 20: Pulmonary Disorders
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Q1) Weaning methods that are used in combination with each other include
A) SIMV with CPAP.
B) SIMV with PSV.
C) CPAP with PSV.
D) T-piece and PSV.
E) PEEP with CPAP.
Q2) A patient was admitted to the critical care unit after a left pneumonectomy.The patient is receiving 40% oxygen via a simple facemask.The morning chest radiography study reveals right lower lobe pneumonia.After eating breakfast,the patient suddenly vomits and aspirates.The patient becomes agitated,has decreased level of consciousness,and has an inability to maintain saturation.The nurse expects the next action will include
A) placing the patient on a mechanical ventilator.
B) change in antibiotics to control infection.
C) suctioning and repositioning.
D) administering a sedative to control anxiety.
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22
Chapter 21: Pulmonary Therapeutic Management
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Q1) Nursing interventions to limit the complications of suctioning include
A) inserting the suction catheter no more than 5 inches.
B) premedicating the patient with atropine.
C) hyperoxygenating the patient with 100% oxygen.
D) increasing the suction to 150 mm Hg.
Q2) Patient safety precautions when working with oxygen involve
A) observation for signs of oxygen-introduced hyperventilation.
B) restriction of smoking.
C) removal of all oxygen devices when eating to prevent aspiration.
D) administration of oxygen at the nurse's discretion.
Q3) A patient was admitted to the critical care unit with acute respiratory failure.The patient has been on a ventilator for 3 days and is being considered for weaning.The ventilator high-pressure alarm keeps going off.When you enter the room,the ventilator inoperative alarm sounds.What is the primary action the nurse would take?
A) Troubleshoot the ventilator until the problem is found.
B) Take the patient off the ventilator and manually ventilate her.
C) Call the respiratory therapist for help.
D) Silence the ventilator alarms until the problem is resolved.
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Chapter 22: Neurologic Anatomy and Physiology
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Q1) Which cranial nerves are responsible for motor functions of the eye?
A) Optic nerve
B) Oculomotor
C) Trochlear
D) Trigeminal
E) Abducens
F) Acoustic
Q2) Cranial nerves IX,X,XI,and XII are located in which section of the brainstem?
A) Midbrain
B) Pons
C) Medulla oblongata
D) Reticular formation
Q3) The large opening at the base of the cranium is known as the A) cisterna magna.
B) median foramen.
C) foramen magnum.
D) lateral foramen.
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Chapter 23: Neurologic Clinical Assessment and Diagnostic
Procedures
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Q1) The most clinically significant ICP waveform is
A) A waves.
B) B waves.
C) C waves.
D) D waves.
Q2) Considering anatomic location,which cranial nerve will be affected first by downward pressure onto the infratentorial structures?
A) III
B) VI
C) IX
D) X
Q3) Decerebrate posturing (abnormal extension)indicates dysfunction in which area of the central nervous system?
A) Cerebral cortex
B) Thalamus
C) Cerebellum
D) Brainstem
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Chapter 24: Neurologic Disorders and Therapeutic Management
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Q1) A patient has been experiencing drowsiness,confusion,and slight focal deficits for 3 days.The CT report findings are negative.The patient is being prepared for a lumbar puncture.The nurse anticipates that the CSF would appear
A) cloudy.
B) bloody.
C) xanthochromic.
D) clear.
Q2) The extrusion of cerebral tissue through the cranium is what type of herniation?
A) Transcalvarial
B) Uncal
C) Cingulate
D) Transtentorial
Q3) Nursing management of a patient with a clipped cerebral aneurysm receiving hypertensive hypervolemic hemodilution therapy includes
A) administering osmotic diuretics and vasodilator agents.
B) providing the patient with a quiet environment.
C) maintaining the patient's systolic blood pressure at 150 to 160 mm Hg.
D) keeping the patient's central venous pressure at 5 to 8 mm Hg.
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Chapter 25: Kidney Anatomy and Physiology
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Q1) The function of aldosterone is primarily
A) excretion of potassium through the renal tubules.
B) control of sodium and water.
C) regulation of bicarbonate.
D) reabsorption of sodium and potassium.
Q2) Ammonia,hydrogen,and ammonium are secreted in the A) loop of Henle.
B) collecting duct.
C) glomerulus.
D) proximal tubule.
Q3) Which electrolyte abnormality is evident early in the course of kidney failure?
A) Sodium
B) Potassium
C) Chloride
D) Phosphorus
Q4) When renin eventually stimulates angiotensin II,the adrenal glands then secrete A) aldosterone.
B) potassium.
C) ADH.
D) vasopressin.
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Chapter 26: Kidney Clinical Assessment and Diagnostic
Procedures
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Q1) Differentiating ascites from distortion caused by solid bowel contents in the distended abdomen is accomplished by
A) assessing for bowel sounds in four quadrants.
B) palpation of the liver margin.
C) measuring abdominal girth.
D) the presence of a fluid wave.
Q2) Which of the following assessment findings would indicate fluid volume excess?
A) Venous filling of the hand veins greater than 5 seconds
B) Distended neck veins in the supine position
C) Presence of orthostatic hypotension
D) Third heart sound
Q3) Percussion of kidneys is usually done to
A) assess the size and shape of the kidneys.
B) detect pain in the renal area.
C) elicit a fluid wave.
D) evaluate fluid status.
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Chapter 27: Kidney Disorders and Therapeutic Management
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Q1) Which of the following IV solutions is recommended for treatment of prerenal failure?
A) Dextrose in water
B) Normal saline
C) Albumin
D) Lactated Ringer solution
Q2) A patient who receives peritoneal dialysis is seen in the intensive care unit with a 3-day history of flulike symptoms,including muscle cramps and low blood pressure.Which complication of peritoneal dialysis is the most likely problem for this patient?
A) Dehydration
B) Peritonitis
C) Fluid obstruction
D) Hernias
Q3) Which of the following medications is considered a loop diuretic?
A) Acetazolamide (Diamox)
B) Furosemide (Lasix)
C) Mannitol
D) Metolazone (Zaroxolyn)
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Chapter 28: Gastrointestinal Anatomy and Physiology
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Q1) Which of the following statements are correct regarding epithelial cells of the gastric mucosa?
A) They prevent diffusion of hydrogen into the mucosa.
B) They secrete bicarbonate to neutralize hydrogen ions.
C) They have the ability to increase blood flow to facilitate removal of toxic metabolites.
D) They break down prostaglandins.
Q2) An important role of saliva is that it
A) washes away bacteria.
B) provides the body's main source of potassium.
C) contains hydrochloric acid for breakdown of protein.
D) stimulates the sympathetic nervous system.
Q3) What is the pH of gastric juices prior to being mixed with food?
A) 1.0
B) 3.0
C) 5.0
D) 7.0
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Chapter 29: Gastrointestinal Clinical Assessment and Diagnostic Procedures
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Q1) The most common location for a male to have a hernia is A) femoral.
B) umbilical.
C) inguinal.
D) abdominal.
Q2) The patient has just returned from a liver biopsy.The patient should be positioned on the
A) left side for 2 hours.
B) right side for 2 hours.
C) left side for 6 to 8 hours.
D) right side for 6 to 8 hours.
Q3) Which of the following diagnostic procedures is used to identify gallstones and hepatic abscesses?
A) Ultrasonography
B) Abdominal radiography
C) Angiography
D) Liver scan
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Chapter 30: Gastrointestinal Disorders and Therapeutic Management
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Q1) A patient is admitted with the diagnosis of acute pancreatitis.The nurse expects which of the following laboratory test results to be elevated?
A) Calcium
B) Serum amylase
C) Serum glucose
D) Potassium
E) WBC
F) Serum triglycerides
Q2) The physician orders gastric lavage to control GI bleeding.The nurse has inserted a large-bore NG tube.What temperature and irrigating fluid would be used to obtain the best results?
A) Warm NS or water
B) Iced NS or water
C) Room temperature NS or water
D) Iced NS only
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Chapter 31: Endocrine Anatomy and Physiology
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Q1) The endocrine system helps maintain equilibrium throughout the body via
A) control of smooth muscle.
B) control of skeletal muscle.
C) hormones.
D) neuronal control.
Q2) Identify major functions of the thyroid hormones.
A) Increase the rate of glucose used by the cells
B) Decrease fat metabolism
C) Increase the body's demand for vitamins
D) Decrease cardiac output
E) Stimulate bone resorption
F) Increase serum cholesterol levels
Q3) Adequate thyroid function depends on
A) the basal metabolic rate.
B) dietary intake of iodine.
C) colloid osmotic pressure.
D) sodium levels in the blood.
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Chapter 32: Endocrine Clinical Assessment and Diagnostic
Procedures
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Q1) When preparing the patient for a serum ADH level,the nurse must withhold
A) insulin and furosemide.
B) morphine and carbamazepine.
C) Lanoxin and potassium.
D) heparin and beta-blockers.
Q2) A patient with thyrotoxicosis may exhibit which of the following signs or symptoms?
A) Lethargy
B) Bradycardia
C) Constipation
D) Weight loss despite increased appetite
Q3) The nurse knows that a serum osmolality of 378 mOsm/kg indicates a patient who is A) overhydrated.
B) normal.
C) dehydrated.
D) hypokalemic.
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Chapter 33: Endocrine Disorders and Therapeutic Management
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Q1) Characteristics of diabetes insipidus (DI)are
A) hyperglycemia and hyperosmolarity.
B) hyperglycemia and peripheral edema.
C) intense thirst and passage of excessively large quantities of dilute urine.
D) peripheral edema and pulmonary crackles.
Q2) A patient who has type 2 diabetes is on the unit after aneurysm repair.His serum glucose levels have been elevated for the past 2 days.He is concerned that he is becoming dependent on insulin.The best response for the nurse would be
A) "This surgery may have damaged your pancreas. We will have to do more evaluation."
B) "Perhaps your diabetes was more serious from the beginning."
C) "You will need to discuss this with your physician."
D) "The stress on your body has temporarily increased your blood sugar levels."
Q3) An older patient presents with a serum glucose level of 900 mg/dL,hematocrit of 55%,and no serum ketones.Immediate attention must be given to
A) clotting factors.
B) rehydration.
C) administration of insulin.
D) sodium replacement.
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Chapter 34: Trauma
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Q1) A patient was thrown 30 feet from an open-top Jeep and straddled a row of mailboxes before she landed on the ground.She has an open pelvic fracture.The nurse admitting the patient into the ICU knows that
A) aggressive fluid and blood replacement will probably be needed.
B) the patient will probably be able to walk as soon as she is hemodynamically stable.
C) she will probably not need surgery to stabilize her fracture.
D) there is little likelihood of damage to the genitourinary or gastrointestinal tracts.
Q2) Clinical manifestations of abdominal compartment syndrome include which of the following?
A) Decreased cardiac output
B) Decreased peripheral vascular resistance
C) Decreased urine output
D) Hypoxia
E) Bradycardia
F) Hypotension
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Chapter 35: Shock,sepsis,and Multiple Organ Dysfunction Syndrome
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Q1) Laboratory values for DIC show abnormalities in A) liver function tests.
B) tests for renal function.
C) platelet counts.
D) blood glucose levels.
Q2) Profound weight loss in patients with SIRS or MODS is the result of A) hypometabolism.
B) hypermetabolism.
C) hyperglycemia.
D) intolerance to enteral feedings.
Q3) The patients at highest risk for neurogenic shock are those who have had A) a stroke.
B) a spinal cord injury.
C) Guillain-Barré syndrome.
D) a craniotomy.
Q4) When SIRS is the result of infection,it is called A) inflammation.
B) anaphylaxis.
C) sepsis.
D) pneumonia.
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Chapter 36: Burns
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Q1) A red and white wound surface with blanching but no blister formation describes what depth of burn injury?
A) Superficial partial-thickness burn
B) Moderate partial-thickness burn
C) Deep dermal partial-thickness burn
D) Full-thickness burn
Q2) A patient is brought to the emergency department after a house fire.He fell asleep with a lit cigarette,and the couch ignited.TBSA burn is estimated at 25% deep partial-thickness burns to areas of the chest,back,and left arm and 20% full-thickness burns to the right arm,right upper leg,and areas on the face.The patient is now in the intensive care burn unit with a heart rate of 140 beats/min,a urine output of 25 mL/hr,and clear lung sounds.The fluid resuscitation plan
A) should continue as planned; everything looks good.
B) IV rate should be decreased and more narcotics given.
C) IV rate should be increased and fluid status closely watched.
D) should be switched to packed red blood cells.
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Chapter 37: Organ Donation and Transplantation
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Q1) A patient is admitted to the critical care unit with the diagnosis of massive head trauma caused by a motor vehicle accident.The patient is unresponsive and on mechanical ventilation.The electroencephalogram is negative for brain waves.The family has agreed to organ donation.The nurse will check for the absence of cerebral motor reflexes by
A) performing a sternal rub.
B) needle pricks to fingers and toes.
C) clapping hands near the ears.
D) applying pressure to the nail beds or supraorbital ridge.
Q2) Which of the statements would indicate that a patient who has received an organ transplant understands the teaching about his or her immunosuppressive medications?
A) "My drug dosages will be lower because the medications enhance each other."
B) "I will be less prone to side effects because I will be taking more than one drug."
C) "Lower doses of these medications put me at greater risk for infection."
D) "Taking more than one medication will put me at risk for developing allergies."
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Chapter 38: Hematologic Disorders and Oncologic Emergencies
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Q1) Which of the following does not play a role in thrombin inhibition?
A) Thromboxane A?
B) Antithrombin III
C) Protein S
D) Protein C
Q2) A patient was admitted to the critical care unit with gram-negative sepsis 5 days ago.Today there is continual oozing from his intravenous sites,and ecchymosis of the skin is noted beneath his automatic blood pressure cuff.On his laboratory work,his platelets are normal,and his international normalized ratio is elevated.What other laboratory value would be most valuable in definitively diagnosing the patient's condition?
A) Fibrin split products
B) D-Dimer level
C) Bleeding time
D) White blood cell count
Q3) Type 2 heparin-induced thrombocytopenia is characterized by
A) formation of thrombi, causing vessel occlusion.
B) spontaneous epistaxis.
C) elevated prothrombin times.
D) massive peripheral ecchymoses.
Page 40
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Chapter 39: The Obstetric Patient
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Q1) Which medication is not commonly used during pulmonary dysfunction that occurs during pregnancy?
A) Antibiotics
B) ?-Adrenergic
C) Theophylline
D) Ipratropium
Q2) Which animal is the host for the protozoan Toxoplasma gondii?
A) Cattle
B) Pigs
C) Sheep
D) Cats
Q3) Which of the following physiologic changes are common in pregnant women?
A) Circulating blood volume decreases by 20% as it is diverted to the placenta.
B) Oxygen consumption increases to accommodate the fetus's needs.
C) Respiratory tidal volumes decrease because of the elevated diaphragm.
D) Gastric motility decreases because of displacement of gastrointestinal structures by the enlarged uterus.
E) The glomerular filtration rate increases as cardiac output rises.
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Chapter 40: The Pediatric Patient
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Q1) What is the circulating blood volume of a neonate?
A) 40 to 60 mL/kg
B) 75 to 80 mL/kg
C) 80 to 85 mL/kg
D) 65 to 70 mL/kg
Q2) A 4-year-old child is admitted to the critical care unit with fever,chills,headache,vomiting,lethargy,photophobia,and nuchal rigidity.The patient has been unable to eat,and tube feedings are to be initiated.The preferred method for determining the insertion length of the nasogastric tube is to measure from the
A) naris to ear to xiphoid process.
B) ear to the umbilicus.
C) naris to the xiphoid to ear.
D) naris to ear to a point between the xiphoid process and the umbilicus.
Q3) The pathophysiologic consequences of respiratory syncytial virus include
A) replacement of the epithelium with nonciliated tissue, leading to submucosal edema and eventual necrosis.
B) necrosis of the alveoli, resulting in collapse.
C) inflammation of the diaphragm, resulting in alveolar hypoventilation.
D) bronchoconstriction, resulting in severe airflow obstruction.
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Chapter 41: The Older Adult Patient
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Q1) Which of the following can contribute to an accelerated incidence of osteoporosis?
A) Immobility
B) Increase in calcium
C) Smoking
D) Decreased glucocorticoid secretion
E) Decreased intake of dietary calcium
Q2) Age-related pulmonary changes that may affect this patient include
A) increased tidal volumes.
B) weakening of intercostal muscles and the diaphragm.
C) improved cough reflex.
D) decreased sensation of the glottis.
Q3) An older patient is starting a new medication that is metabolized in the liver and excreted by the kidneys.Which is the best assessment to monitor the patient's ability to tolerate the medication?
A) Liver function tests
B) Drug side effects experienced by the patient
C) Kidney function tests
D) Therapeutic drug levels
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Chapter 42: The Perianesthesia Patient
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Q1) Which of the following antagonizes the effects of benzodiazepines?
A) Naloxone
B) Neostigmine
C) Fentanyl
D) Flumazenil
Q2) What medication may be used to treat laryngeal edema?
A) Racemic epinephrine
B) Succinylcholine
C) Albuterol
D) Morphine
Q3) Which stage of general anesthesia is known as surgical anesthesia?
A) Stage I
B) Stage II
C) Stage III
D) Stage IV
Q4) Postoperatively,dysrhythmias occur in patients
A) during the first minute.
B) during the first 2 minutes.
C) during the first 5 minutes.
D) at any time.
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