EVERY test bank/study guide question for Adult Health Exam 3
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Course
Adult HeaLth
Institution
Adult HeaLth
EVERY test bank/study guide question for Adult Health Exam 3
1. What is an ability that is a primary difference in the skills of a certified critical care nurse compared with nurses
certified in medical-surgical nursing?
a. Diagnose and treat life-threatening diseases
b. Detect and manage early...
EVERY test bank/study guide question for
Adult Health Exam 3
1. What is an ability that is a primary difference in the skills of a certified critical
care nurse compared with nurses
certified in medical-surgical nursing?
a. Diagnose and treat life-threatening diseases
b. Detect and manage early complications of health problems
c. Provide intensive psychologic support to the patient and family
d. Use advanced technology to assess and maintain physiologic function
1. d. One of the primary characteristics of critical care nurses
that is different from those of generalist medical-surgical
nurses is the use of advanced technology to measure
physiologic parameters accurately to manage life-threatening
complications. All nursing addresses human responses to
health problems and requires knowledge of physiology,
pathophysiology, pharmacology, and psychologic support
to the patient and family. Diagnosis and treatment of lifethreatening
diseases are roles of medicine.
2. Identify the rationale for the following four patients' admissions to the intensive
care unit (ICU) based on the
common three reasons why patients are admitted to the ICU.
a. Patient with diabetic ketoacidosis
b. Patient with nondisplaced skull fracture who is alert
and oriented
c. Postoperative patient with mitral valve replacement
d. Comatose patient who had an anaphylactic reaction
with cardiopulmonary arrest at home yesterday
2. a. 1; b. 2; c. 2; d. 3
3. What is a nursing intervention that is indicated for the patient in the ICU who
has a nursing diagnosis of anxiety
related to the ICU environment and sensory overload?
a. Provide flexible visiting schedules for caregivers.
b. Eliminate unnecessary alarms and overhead paging.
c. Administer sedatives or psychotropic drugs to promote rest.
d. Allow the patient to do as many self-care activities as possible
3. b. Anxiety in the intensive care unit (ICU) patient is related
to the environment, which has unfamiliar equipment, high
noise and light levels, and an intense pace of activity that
leads to sensory overload. The nurse should eliminate as
much of this source of stress as possible by muting phones,
limiting overhead paging, setting alarms appropriate
to the patient's condition, and eliminating unnecessary
alarms during care when possible. Offering flexible
visiting schedules for family members and providing as
,much autonomy in decisions about care as possible are
indicated when impaired communication and loss of control
contribute to the anxiety. Use of sedation to reduce anxiety
should be carefully evaluated and implemented when
nursing measures are not effective
4. Why should the critical care nurse include caregivers of the patient in the ICU
as part of the health care team?
a. The costs of critical care will affect the entire family.
b. Caregivers play a valuable role in the patient's recovery.
c. Caregivers are responsible for making health care decisions for the patient.
d. Caregivers who are ignored are more likely to question the patient's quality of
care.
4. b. The caregivers of the critically ill patient are very important
in the recovery and well-being of the patient and the extent
to which the family is involved and supported affects the
patient's clinical course. Although the cost of planning and
providing critical care is a concern to caregivers, it is not the
major reason that caregivers are included in the patient's care.
Caregivers may be responsible for making decisions about
the patient's care only when the patient is unable to make
personal decisions. Most caregivers have questions regarding
the patient's quality of care because of anxiety and lack of
information about the patient's condition
5. What factor will cause a decrease in cardiac output (CO)?
a. Decreased afterload
b. Decreased heart rate (HR)
c. Increased stroke volume (SV)
d. Decreased systemic vascular resistance (SVR)
5. b. Decreased heart rate (HR) causes decreased cardiac
output (CO). The other options contribute to an
increased CO.
6. The patient with shortness of breath is scheduled for an impedance
cardiography to differentiate if the cause is
cardiac or pulmonary. How should the nurse best explain this test to the patient?
a. An invasive method of measuring CO
b. Electricity is transmitted through the bones in the chest
c. It will be most effective when the patient has generalized edema
d. Thoracic fluid status is determined by changes in impedance with each
heartbeat
6. d. Impedance cardiography (ICG) is noninvasive and
transmits continuous or intermittent electric current through
the chest that travels through the path of least resistance:
the blood. Thoracic fluid status or impedance-based
hemodynamic parameters (CO, stroke volume [SV], and
systemic vascular resistance [SVR]) are calculated from the
average impedance of fluid in the thorax. ICG measures the
,change in impedance in the ascending aorta and left ventricle
over time. Generalized edema or third spacing interferes
with accurate signals because of the excess volume.
7. The patient has experienced an increased preload, which supports an increase
in CO. What nursing action
contributes to an increased preload?
a. Diuretic administration c. Increased fluid administration
b. Intropin administration d. Calcium channel blocker administration
7. c. Increased fluid administration increases preload, which
will increase CO. Diuretics will decrease preload. Intropin
(dopamine) does not affect preload but increases CO with
increased cardiac contractility. Calcium channel blockers do not affect preload but
decrease contractility
8. During hemodynamic monitoring, the nurse finds that the patient has a
decreased CO with unchanged pulmonary
artery wedge pressure (PAWP), HR, and SVR. The nurse identifies that the patient
has a decrease in what?
a. Preload c. Contractility
b. Afterload d. Stroke volume
8. c. CO is dependent on HR and SV. SV is determined by
preload, afterload, and contractility. If CO is decreased and
HR is unchanged, SV is the variable factor. If the preload
(determined by pulmonary artery wedge pressure [PAWP])
and the afterload (determined by SVR) are unchanged, the
factor that is changed is the contractility of the myocardium.
9. Before taking hemodynamic measurements, how must the nurse reference the
monitoring equipment?
a. Confirm that when pressure in the system is zero, the equipment reads zero.
b. Position the stopcock nearest the transducer level with the phlebostatic axis.
c. Place the transducer on the left side of the chest at the fourth intercostal
space.
d. Place the patient in a left lateral position with the transducer level with the top
surface of the mattress.
9. b. Referencing hemodynamic monitoring equipment means
positioning the monitoring equipment so that the zero reference point is at the vertical
level of the left atrium of the heart. The port of the stopcock nearest the transducer is
placed at the phlebostatic axis, the external landmark of
the left atrium. The phlebostatic axis is the intersection of two planes: a horizontal line
midchest, halfway between the outermost anterior and posterior surfaces, transecting a
vertical line through the fourth intercostal space at the sternum.
10. Which statement is accurate?
a. A pulmonary artery flow-directed catheter has a balloon at the distal tip that
floats into the left atrium.
b. In the absence of mitral valve impairment, the left ventricular end-diastolic
pressure is reflected by the cardiac index.
c. The pressure obtained when the balloon of the pulmonary artery catheter is
, inflated reflects the preload of the left
ventricle.
d. When a patient has an arterial catheter placed for arterial blood gas (ABG)
sampling, the low pressure alarm must
be activated to detect functioning of the line.
10. c. The pressure obtained when the balloon of the pulmonary
artery catheter is inflated reflects the preload of the left ventricle. The pulmonary artery
flow-directed catheter's balloon floats into the pulmonary artery. In the absence of
mitral valve impairment, the left ventricular end-diastolic pressure or left ventricular
preload is reflected by the PAWP.
The low pressure alarm in the arterial catheter placed for arterial blood gas (ABG)
sampling detects disconnection of the line, which is a medical emergency.
11. In preparing the patient for insertion of a pulmonary artery catheter, what
should the nurse do?
a. Place the patient in high Fowler's position.
b. Obtain an informed consent from the patient.
c. Perform an Allen test to confirm adequate ulnar artery perfusion.
d. Ensure that the patient has continuous electrocardiographic (ECG) monitoring.
11. d. During insertion of a pulmonary artery catheter, it
is necessary to monitor the electrocardiogram (ECG) continuously because of the risk
for dysrhythmias,particularly when the catheter reaches the right ventricle. During the
catheter insertion, the patient is placed supine with the head of the bed flat. It is the
health care provider's
responsibility to obtain informed consent regarding the catheter insertion. An Allen test
to confirm adequate ulnar artery perfusion is performed before insertion of an arterial
catheter in the radial artery for arterial pressure monitoring.
12. What is a rationale for the use of a pulmonary artery catheter instead of
arterial pressure-based CO (APCO)
monitoring?
a. Coagulopathy
b. Less infection risk
c. Mechanical tricuspid or pulmonic valve
d. Needs research for accuracy with more specific illnesses and treatments
12. d. Although arterial pressure-based CO (APCO)
monitoring is in use with patients on mechanical (control
mode) ventilation with fixed respiratory rates and there is less risk of infection, more
research is needed to determine the accuracy of the measures in comparison to
pulmonary artery pressure monitoring. Pulmonary artery
pressure monitoring is contraindicated for patients with coagulopathy and mechanical
tricuspid or pulmonic valves.
13. Which description accurately describes the continuous CO (CCO) method and
not the intermittent bolus
thermodilution CO (TDCO) method of determining CO?
a. Room temperature or cold normal saline is injected rapidly.
b. The TDCO method is easier and faster than the CCO method.
c. The digital measurements reflect the average CO every 30 to 60 seconds.
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