Medical Diagnosis: Acute Kidney Injury, Hemodynamic Support, and Sedation, Exams of Nursing

Download Medical Diagnosis: Acute Kidney Injury, Hemodynamic Support, and Sedation and more Exams Nursing in PDF only on Docsity! 1 CCRN CRITICAL CARE REGISTERED NURSE EXAM LATEST QUESTIONS AND 100% CORRECT ANSWERS TEST BANK -Which of the following ventilator settings is most likely to decrease the work of breathing? A assist-control B pressure support C tidal volume D CPAP {{Ans- Answer: B Pressure support senses the beginning of the patient's spontaneous inspiration and provides a set pressure to assist the inspiratory effort. The primary purpose of the ventilator settings listed in choices (A), (C), and (D) is not to decrease the work of breathing. -A nurse is caring for a patient with an acute inferior wall MI, post coronary artery stent deployment. For optimal care of this patient, the nurse should: Select single answer choice. A administer an analgesic for acute back pain.clearYou selected. B apply a pressure dressing to the groin.clearYou did not select. C continuously monitor the patient in lead II. D maintain the patient in a supine position. {{Ans- Answer: C It is best practice to continuously monitor a patient, who is post coronary artery stent deployment, in the lead that was most abnormal during the acute occlusion. Lead II would most likely meet this criterion for a patient with an inferior wall MI. The remaining interventions are NOT indicated for a patientwho is post coronary artery stent deployment. -A patient with aortic regurgitation will have which of the following upon auscultation? Select single answer choice. 2 A a diastolic murmur, loudest at the fifth intercostal space, midclavicular a systolic murmur, loudest at the apex of the heart C a diastolic murmur, loudest at the second intercostal space, right sternal border The systolic pressure decreases due to a drop in the cardiac output; however, the diastolic pressure either stays the same or increases due to a compensatory increase in the systemic vascular resistance. The remaining choices are not found in the presence of cardiogenic shock. -Massive atelectasis occurs in the presence of acute respiratory distress syndrome (ARDS). What are the 2 causes of the atelectasis that is typical of ARDS? Select single answer choice. A a surfactant deficiency and pulmonary edema B increased pulmonary vascular resistance and increased pulmonary compliance C increased pulmonary compliance and pulmonary edema D mucus plugs and bronchospasm {{Ans- Answer: A ARDS destroys Type II alveolar cells, which results in decreased surfactant production. ARDS also results in capillary leak at normal left-sided heart pressures, which results in pulmonary edema. Both a surfactant deficiency and pulmonary edema lead to atelectasis. The remaining choices are not correct because increasedpulmonary compliance and mucus plugs are not features of ARDS. -A patient was admitted with an acute inferior wall STEMI. The physician advises the nurse to monitor the patient for signs of right ventricular (RV) infarction. Which of the following are signs of RV infarction? Select single answer choice. A S4 heart sound, lung crackles B hypotension, flat neck veins C hypertension, a systolic murmur D distended neck veins, clear lungs {{Ans- Answer: D If the RV contractility decreases, the pressure that is proximal to the right ventricle (which is the right atrial pressure) increases, resulting in distended neck veins. As the right heart fails, the left heart preloaddecreases, and the lungs are clear. -Which of the following is an effect of hypothermia? Select single answer choice. A a decrease in the SaO2 B a decrease in the blood pressure C an increase in the heart rate D a shift of the oxyhemoglobin dissociation curve to the left {{Ans- Answer: D Hypothermia shifts the oxyhemoglobin dissociation curve to the left, which inhibits the release of oxygen from hemoglobin, thereby resulting in a higher SaO2 than usual at the same PaO2. The remaining choices are not relatedto hypothermia. -It is important for a nurse to identify the signs of respiratory depression during procedural sedation. Which of the following is a LATE sign of respiratory depression? Select single answer choice. A a cough B SpO2 88% C ETCO2 of 50 mmHg per waveform capnography D sedation {{Ans- Answer: B A pulse oximetry decrease is a late sign of respiratory depression. A cough is not indicative of respiratory depression. An elevated ETCO2 per waveform capnography is an early sign of respiratory depression. Sedation precedes respiratory depression. -The most common cause of acute hepatic failure is: Select single answer choice. A alcohol abuse. B a salicylate overdose. C biliary obstruction. D an acetaminophen overdose. {{Ans- Answer: D Alcohol abuse results in chronic, not acute, hepatic failure. A salicylate overdose results in renal failure. Biliary obstruction may leadto pancreatitis or gallbladder disease. -Which of the following is most likely to lead to cardiopulmonary arrest for a patient with status asthmaticus? Select single answer choice. A bronchospasm. B thick, tenacious secretions. C hypoxemia. D air trapping. {{Ans- Answer: D Air trapping, due to the inability to effectively exhale, leads to chest hyperinflation, which in turn leads to decreased venous return and a precipitous drop in cardiac output. The remaining choices are seenwith status asthmaticus but are not directcauses of cardiopulmonary arrest. -The ECG demonstrates ST elevation in leads II, III, and aVF. The nurse needs to monitor the patient closely forwhich of the following? Select single answer choice. A tachycardia, lung crackles B sinus bradycardia, an acute systolic murmur in the fifth intercostal space, midclavicular C second-degree AV block (Type II), hypotension. D hypoxemia, an acute systolic murmur in the fifth intercostal space, left sternal border. {{Ans- Answer: B Complications that are likely to occur after an acute inferior wall MI include bradycardia secondary to ischemia to the SA node and/or the AV node and papillary muscle rupture or dysfunction due to the anatomical distance between the right coronary artery and the papillary muscle. The remaining choices are not common complications of an inferior wall MI. -Which of the following statements about delirium is accurate? Select single answer choice. This patient requires titration of FiO2 to maintain an SpO2greater than 0.90. Short-term mechanical ventilation may be needed for select patients who are in a similar situation. There is no indication of fluid overload, which may occur with transfusion-associated circulatory overload (TACO). Therefore, a diuretic, such as furosemide (Lasix), is not needed. Diphenhydramine (Benadryl) and subcutaneous epinephrine are not treatments for TRALI. -A patient with a history of chronic alcohol abuse was admitted in a stuporous state with an extremely elevated serum alcohol level. Which of the following will most likely be a part of the treatment plan for this patient? Select single answer choice. A naloxone, activated charcoal, sodium bicarbonate B flumazenil (Romazicon), lactulose, calcium gluconate. C dialysis, cooling, potassium. D fluids, thiamine, phosphate. {{Ans- Answer: D This patient has signs of acute alcohol poisoning with a history of chronic alcohol abuse. Fluids are needed to prevent hypovolemia. Chronic alcohol abuse leads to a thiamine deficiency. Therefore, thiamine is needed to prevent Wernicke encephalopathy. Hypophosphatemia is commonly seen in patients with chronic alcohol abuse. Therefore, the administration of phosphate is also indicated. The remaining 3 choices are notinterventions for alcohol poisoning. -Which of the following is indicative of a mixed acid-base disorder? Select single answer choice. A pH 7.18; PaCO2 25; PaO2 64; HCO3 11. B pH 7.33; PaCO2 29; PaO2 72; HCO3 15. C pH 7.35; PaCO2 61; PaO2 62; HCO3 41. D pH 7.25; PaCO2 36; PaO2 68; HCO3 18. {{Ans- Answer: B The decreased PaCO2 is evidence of respiratory alkalosis, and the decreased HCO3 is evidence of metabolic acidosis. A patient with sepsis or septic shock may present with this type of mixed acid-base disorder. Choice (A) is reflective of a patient who has metabolic acidosis with partial compensation. Choice (C) is reflective of a patient who has respiratory acidosis with full compensation. Choice (D) is reflectiveof apatient who has uncompensated metabolic acidosis. -A patient has an 18-gauge intravenous catheter in his right wrist. The nurse assessed the insertion site prior to administering an IV medication, and the nurse noticed that there was a red line up the arm above the insertion site, there was no swelling, the catheter blood return was brisk, and the site up the arm with the red line was tender to touch. Which assessment and intervention is appropriate at this time? Select single answer choice. A The patient has an extravasation; apply warm compresses over the insertion site. B The patient has a grade 2 infiltration; restart the IV, and apply cool compresses over the insertion site. C The patient has phlebitis; restart the IV with a 20-gauge catheter in the left arm. D The IV catheter is functional; give the IV medication, and reassess the catheter for blood return in an hour. {{Ans- Answer: C A red line above the insertion site, with tenderness, is a sign that the wall of the vein is inflamed, and the catheter needs to be removed. Reinsertion with a smaller gauge catheter is a strategy that can be used to prevent vein irritation. There is no evidence provided that this patient received a vesicant nor are there signs of an extravasation. Therefore, choice (A) is incorrect. The nurse's findings do not support an infiltration. Therefore, choice (B) is incorrect. The nurse should not administer the IV medication into avein withphlebitis. Therefore, choice (D) is also incorrect. -Which of the following treatments is appropriate for the corresponding overdose? Select single answer choice. A dialysis for a salicylate overdose B Romazicon for an opiate overdose. C a beta blocker for a cocaine overdose. D warming for a phencyclidine (PCP) overdose. {{Ans- Answer: A Dialysis may be initiated even before abnormal creatinine or GFR develop. The remaining choices are incorrect treatments forthe associated overdoses. -Which of the following would be LEAST likely to cause hypoglycemia for a patient with Type 1 diabetes? Select single answer choice. A late sepsis. B discontinuation of enteral feeding after a morning insulin dose. C a strenuous exercise session. D stress. {{Ans- Answer: D Stress will result in DKA rather than hypoglycemia. The remaining choices may cause hypoglycemia. -A patient with diastolic heart failure develops supraventricular tachycardia, with a heart rate of 220 beats/minute. The most dangerous hemodynamiceffect is a decrease in: Select single answer choice. A myocardial contractility. B coronary artery perfusion. c ejection fraction. D arterial oxygenation. {{Ans- Answer: B Diastolic heart failure results in a problem with left ventricular filling secondary to ventricular thickening, and myocardial contractility and the ejection fraction are maintained in diastolic heart failure. The rapid heart rate will decrease the filling time and worsen the left ventricular filling. Since coronary artery perfusion occurs during diastole, this arrhythmia may be life-threatening. -A 75-year-old patient develops frequent 6- to 10-second episodes of asystole, interspersed with normal sinus rhythm that is associated with hypotension. The priority intervention is: Select single answer choice. A transcutaneous pacing. B a fluid bolus. C transvenous pacing. . A vasopressors, inotropes, fluids. B epinephrine SQ, antihistamines, beta-1 blockers. C vasopressors, fluids, antibiotics. D epinephrine IM, antihistamines, corticosteroids. {{Ans- Answer: D Inotropes (choice (A)), beta-1 blockers (choice (B)), and antibiotics (choice (C)) are not appropriate treatmentoptions for anaphylaxis. -Which of the following is most likely to be the etiology of diabetic ketoacidosis (DKA) and to require further investigation? Select single answer choice. A an infection. B Type 2 diabetes. C pancreatitis. D steroid use. {{Ans- Answer: A The physiological stress of an infection may trigger DKA, even when the patient is compliant with the diabetes treatment plan. The remaining 3 choices are more often associated with HHS. -One hemodynamic benefit of intra-aortic balloon pump therapy is that: Select single answer choice. A balloon inflation prevents right-to-left shunt. B balloon deflation increases coronary artery perfusion. C balloon inflation optimizes aortic valve performance. D balloon deflation decreases left ventricular afterload. {{Ans- Answer: D Balloon deflation in the descending aortic arch right before systole creates a drop in afterload. When the balloon inflates during diastole, blood is displaced into the coronary arteries, increasing coronary artery perfusion. -Which of the following patient diagnoses has the greatest degree of predictability? Select single answer choice. A an acute inferior wall MI B septic shock. C heart failure. D acute leukemia. {{Ans- Answer: A Of the diagnoses listed, the diagnosis of an acute inferior wall MI has the greatest degree of predictability. Predictability is a patient characteristic that considers the degree to which the patient outcome is expected. The remaining 3 choices are more likely to involve unforeseen complications and are therefore are less predictable. -A patient presents with hypotension refractory to initial treatment, and a pulmonary artery catheter is placed. The hemodynamic profile demonstrates right atrial (RA) pressure 1 mmHg, pulmonary artery pressure (PAP) 19/6 mmHg, pulmonary artery occlusion pressure (PAOP) 4 mmHg, systemic vascular resistance (SVR) 1,500 dynes/sec/cm-5, and SvO255%. What is most likely the cause of this patient's hypotension, and what is the appropriate treatment? Select single answer choice. A hypovolemic shock; fluids B septicshock; vasopressors. C cardiogenic shock; IABP. D anaphylactic shock; epinephrine IM. {{Ans- Answer: A Volume depletion results in decreased preload. A compensatory response to volume depletion results in an increase in the SVR in an attempt to maintain pressure. Fluids will restore the filling pressure (preload), and the SVR will return to normal as compensatory mechanisms will no longer be needed. -A patient has right middle and lower lobe pneumonia. Which of the following is an appropriate intervention forthis patient? Select single answer choice. A Provide fluids and expectorants. B Maintain the patient in a supine position. C Withhold enteral nutrition. D Avoid turning the patient to his right side. {{Ans- Answer: D Gravity will increase perfusion to the dependent lung tissue. The "good" lung in this case is the left side. Turning the patient to his right side may precipitate hypoxemia by increasing perfusion to the side with greaterdisease. -A patient was admitted post motor vehicle accident with hypotension and an INR of 8. Which of the following needs to be administered to this patient? Select single answer choice. A protamine sulfate. B vitamin K. C heparin. D platelets. {{Ans- Answer: B This patient was most likely taking warfarin (Coumadin) prior to admission, which caused an elevated INR. Warfarin works by inhibiting the effects of vitamin K, thereby preventing the conversion of prothrombin to thrombin. A rapid reversal of warfarin with vitamin K is indicated since this patient is hypotensive post MVA and may have internal bleeding. The remaining choices willnot decrease the INR. -A patient with a history of thyroid disease was admitted with elevated TSH and decreased T3 and T4. Based on these lab results and the patient history, which of the following assessments would be expected forthis patient? Select single answer choice. A tremor, fever, respiratory alkalosis the patient's age. C the patient's sex. D ideal body weight. {{Ans- Answer: A The serum BUN is not needed to calculate the creatinine clearance. The remaining 3 values (as well as the serum creatinine) are used for this calculation. The creatinine clearance is the best clinical indicator of the glomerular filtration rate (GFR). -A 70 kg patient required intubation for status asthmaticus. A propofol infusion was started at 40 mcg/kg/min, and the patient appears calm. The ventilator settings are: FiO20.30, assist-control mode 12 breaths/minute, tidal volume 400 mL, and an increased peak flow rate. The patient's respiratory rate is 28 breaths/minute, and the SpO2 is 0.98. Which of the following interventions should the nurse anticipate? Select single answer choice. A Administer vecuronium (Norcuron) PRN. B Decrease the tidal volume. C Increase the assist-control rate. D Increase the FiO2. {{Ans- Answer: A The elevated respiratory rate needs to be immediately addressed since it puts the patient at risk for auto-PEEP. The goal of ventilation for a patient with status asthmaticus is to provide low breath rates, a short inspiratory time, and a longer expiratory time, as well as to prevent auto-PEEP. Although neuromuscular blocking agents should be avoided, if possible, the benefit of administering Norcuron PRN outweighs the risk in this particular situation. The tidal volume is already low, so choice (B) is incorrect. An increase in the assist-control rate would not be beneficial, so choice (C) is incorrect. This patient does not have hypoxemia. Therefore, an increase in the FiO2 is not indicated, which means that choice (D) is also incorrect. -A patient has a flattened diaphragm, as confirmed on a chest X-ray, and a decreased expiratory flow rate. This patient most likely has which of the following? Select single answer choice. A pulmonary embolism. B ARDS. C pneumonia. D obstructive pulmonary disease. {{Ans- Answer: D Of the choices available, only obstructive pulmonary disease results in a problem "getting air out," which in turn results in air trapping; the flattening of the diaphragm on the chest X-ray is a sign of air trapping. -What would be expected for a patient with intrarenal failure who requires hemodialysis? Select single answer choice. A low urine osmolality, low urine sodium. B high urine osmolality, low urine sodium. C low urine osmolality, high urine sodium. D high urine osmolality, high urine sodium. {{Ans- Answer: C Low urine osmolality and elevated urine sodium are signs of damage to the renal tubular basement membrane, which indicatesintrarenal failure. -PEEP therapy and mechanical ventilation are ordered for a patient with acute respiratory failure. Which of the following is a possible complication? Select single answer choice. A barotrauma. B atelectasis. C increased venous return. D decreased lung compliance. {{Ans- Answer: A The addition of positive end-expiratory pressure will increase alveolar recruitment, prevent atelectasis, and improve oxygenation. However, the increase in the intrathoracic pressure may lead to a pneumothorax or subcutaneous emphysema. -A patient's chest X-ray demonstrates a right upper lobe infiltrate. The mean arterial pressure (MAP) is 55 mmHg after fluid resuscitation, and the serum lactate is elevated. At this time, which of the following medications is a priority? Select single answer choice. A dopamine (Intropin) B norepinephrine (Levophed). C hydrocortisone (Solu-Cortef). D dobutamine (Dobutrex). {{Ans- Answer: B This patient has septic shock with organ dysfunction, as evidenced by signs of an infection, hypotension despite fluid resuscitation, and elevated serum lactate. A vasopressor is indicated at this point, and norepinephrine is the vasopressor of choice. There are no indications for the administration of the remaining drugs at this time. -Which of the following clinical findings is typical of compensatory shock? Select single answer choice. A hypotension B metabolic acidosis. C blood pressure is maintained. D organ failure. {{Ans- Answer: C During the earliest stage of shock (compensatory shock), the compensatory mechanisms are working to maintain the systemic blood pressure. The remaining 3 choices are seen in the progressive and refractory stages of shock. -A patient who is status post thoracic surgery has bubbling in the water seal drainage chamber of his chesttube. Which of the following interventions is indicated? Select single answer choice. A Avoid turning the patient onto his side. B B hypoventilation. c obtunded mental status. D positive blood cultures. {{Ans- Answer: C In order for a patient to derive benefits from noninvasive ventilation, the patient needs a spontaneous ventilatory effort and needs to be able to protect her airway. An obtunded mental status is a contraindication to the safe use of noninvasive ventilation. A patient with any of the other choices may benefit from this treatment option, and those choices do not represent contraindications to that form of treatment. -A patient presents with hypotension refractory to initial treatment, and a pulmonary artery catheter was placed. The hemodynamic profile revealed the following: right atrial (RA) pressure 10 mmHg, pulmonary artery pressure (PAP) 49/25 mmHg, pulmonary artery occlusion pressure (PAOP) 24 mmHg, systemic vascular resistance (SVR) 1,900 dynes/sec/cm-5, and SvO248%. What is most likely the cause of this patient's hypotension and the appropriate treatment for it? Select single answer choice. A hypovolemic shock; fluids. B septic shock; vasopressors. C cardiogenic shock; IABP. D anaphylactic shock; epinephrine IM. {{Ans- Answer: C This patient's hemodynamic profile includes an elevated RA pressure, PAP, PAOP, and SVR. This is reflective of cardiogenic shock. Mechanical support with an IABP is an effective treatment for this patient. The hemodynamic profiles of hypovolemic shock, septic shock, and anaphylactic shock would not include an elevated RA pressure, PAP, and/or PAOP. Also, the hemodynamic profile of a patient with septic shock or anaphylactic shock would include alow SVR. -Which of the following is most likely to result in a low SvO2? Select single answer choice. A hypothermia. B sepsis C a fever D neuromuscular blocking agents {{Ans- Answer: C A fever increases the metabolic rate and oxygen consumption, which may lead to a drop in the mixed venous oxygen saturation. The remaining choices may increase the SvO2 since they are associated with a decrease in oxygen utilization. -A patient's arterial line waveform on the bedside monitor appears overdamped. The nurse understands that this: Select single answer choice. A may be due to pinpoint air bubbles in the tubing/transducer system. B leads to a false high pressure reading. C may be due to add-on pressure tubing. D leads to a false low pressure reading. {{Ans- Answer: D An overdamped arterial line waveform leads to a false low pressure reading, and the arterial pressure reading from the monitor should not be used to assess and treat the patient until the overdamped waveform is corrected. The remaining 3 choices relate to an underdamped arterial line waveform. -A patient is being treated for status epilepticus, and he requires intubation and mechanical ventilation. Which of the following possible pathophysiological changes might the nurse anticipate? Select single answer choice. A hypokalemia. B decreased PaCO2.. C bradycardia D elevated creatine kinase (CK). {{Ans- Answer: D The destruction of skeletal muscle cells occurs secondary to seizure activity, which results in the release of creatine kinase (CK) into the serum. If skeletal muscle cell destruction is not controlled, the elevated CKs may lead to rhabdomyolysis and acute kidney injury. Neuromuscular blocking agents may be used to stop the skeletal muscle seizing and to prevent skeletal muscle damage. (Note that the patient may still be seizing when clinically paralyzed; therefore, continuous EEG monitoring is indicated to determine whether or not the patient is seizing.) Hyperkalemia, elevated PaCO2, and tachycardia are also associated with status epilepticus, which makes the remaining 3 choices incorrect. -A 19-year-old male was admitted with traumatic injuries secondary to a motor vehicle accident. The ECG demonstrates a sinus rhythm with a short PR interval and the presence of a slow rise of the initial upstroke of the QRS. This patient is at risk for developing which of the following? Select single answer choice. A pre-excited atrial fibrillation. B second-degree AV block, Type II. C third-degree AV block. D atrial flutter {{Ans- Answer: A This patient has Wolff-Parkinson-White (WPW) syndrome, as evidenced by a short PR interval with the presence of a delta wave (a slow rise of the initial upstroke of the QRS). The abnormal conduction pathway of WPW may result in a supraventricular tachycardia (SVT) or cause pre-excited atrial fibrillation (an irregular rhythm, rates of 150 beats/minute or greater, and a wide QRS). WPW does not cause the remaining arrhythmias listed in choices (B), (C), and (D). -A patient has a blood pressure of 78/40, a right atrial (RA) pressure of 1 mmHg, a pulmonary artery occlusion pressure (PAOP) of 4 mmHg, a systemic vascular resistance (SVR) of 1,800 dynes/s/cm-5, and a cardiac output (CO) of 3 L/min. Which of the following statements about this patient is correct? Select single answer choice. A The patient has septic shock; provide vasopressors. B The patient has cardiogenic shock; provide positive inotropes. C The patient has hypovolemic shock; provide fluid resuscitation. D The patient has right ventricular infarct; provide fluids. {{Ans- Answer: C The hemodynamic profile described in the question is that of hypovolemic shock. The SVR would not be elevated in septic shock, so choice (A) is incorrect. In cardiogenic shock, the PAOP would not be D Infuse platelets for thrombocytopenia. {{Ans- Answer: A Warming both blood products and fluids that are needed to treat a traumatic injury will prevent hypothermia and its related adverse effects. The remaining 3 choices are not indicated for treating a patient who requiresmassive fluid/transfusion therapy. -Which of the following patients is a candidate for an internal fecal management system (FMS)? Select single answer choice. A a patient with excoriated skin and frequent, incontinent liquid stool. B a patient with reddened skin and frequent, incontinent soft stools. C a patient who is status post large bowel resection. D a patient with diarrhea who can use the bedside commode. {{Ans- Answer: A An internal fecal management system (FMS) is indicated for a patient with excoriated skin and frequent, incontinent liquid stool. An external device is not an alternative since this type of device should not be applied over excoriated skin. An internal device cannot be used successfully if the stool is soft (since the catheter would clog) or if there has been recent large bowel surgery. For those reasons, choices (B) and (C) are incorrect. A patient who can use the bedside commode and whose stool is not involuntary is not a candidate for an FMS. Therefore, choice (D) is also incorrect. -A patient has been diagnosed with a fat embolism. Which of the following clinical findings is most likely present forthis patient? Select single answer choice. A deep vein thrombosis, hypoxemia. B a long bone fracture, petechiae. C pulmonary edema, hypotension. D positive D-dimer, delirium. {{Ans- Answer: B A patient with a long bone fracture has an increased chance of developing a fat embolism, and a petechiae rashmay develop—the resultof fat occluding the dermal capillaries. -A Jehovah's Witness was admitted with a bleeding, perforated gastric ulcer. The patient's hemoglobin and hematocrit have decreased. Which of the following interventions is most appropriate for this patient? Select single answer choice. A Explain the consequences of refusing blood transfusions. B Administer washed PRBCs. C Ask the patient to sign a "No CPR" order. D Administer platelets. {{Ans- Answer: A The health care team would need to explain the consequences of refusing blood transfusions, as well as possible options, and ensure that the patient and her family understand this information. The hospital legal team may need to get involved. Choices (B) and (D) are not acceptable to a Jehovah's Witness. A "No CPR" ordermay need to be discussed, but that is not the priority intervention at this time. -A patient is 5 days status post subarachnoid hemorrhage, and she develops a change in level of consciousness and hyponatremia. Which of the following orders should the nurse anticipate? Select single answer choice. A Administer furosemide (Lasix). B Infuse 3% saline. C Maintain the cerebral perfusion pressure (CPP) with 0.9 normal saline. D Obtain a CT scan of the brain. {{Ans- Answer: C This patient has signs of vasospasm, and maintaining the CPP (in order to prevent worsening of the vasospasm) is a priority. Administering a diuretic may lead to hypotension and could worsen the vasospasm. 3% saline is generally indicated for extreme hyponatremia or an increased ICP, neither of which are described in this scenario. Diagnosing vasospasm is done with a Transcranial Doppler, not with a CT scan. -To provide appropriate care for a patient who requires mechanical ventilation, the nurse needs to: Select single answer choice. A instill saline during suctioning. B maintain the patient in a supine position. C hyperoxygenate during suctioning. D deflate the ETT cuff every 4 hours. {{Ans- Answer: C The insertion of a suction catheter into a tracheal tube during a suctioning procedure may decrease the SaO2. Although oxygen desaturation may not occur during every suctioning procedure, it may occur unpredictably. Therefore, it is best practice to increase the FiO2to 1.00 prior to beginning the suctioning procedure. Most ventilators provide the FiO2 of 1.00 that is needed for hyperoxygenation for a predetermined amountof time (for example, 2 minutes). -A post-op patient is undergoing negative-pressure wound therapy. What is an appropriate nursing intervention forthis patient? Select single answer choice. A Contact the physician if there is blocked tubing. B Change the dressing daily. C Maintain the continuous negative pressure at -150 mmHg. D Discontinue negative-pressure wound therapy during the night. {{Ans- Answer: A The physician needs to be notified if it is suspected that the tubing is blocked (as evidenced by an alarm and/or a lack of drainage). The physician will order flushing of the tubing or discontinuation of the therapy and the application of a wet-to-damp dressing until therapy can be resumed. The remaining interventions are not appropriate during negative-pressure wound therapy. -Which of the following arrhythmias typically manifests itself before a person is 30 years old? Select single answer choice. A Wolff-Parkinson-White (WPW) syndrome. B ventricular tachycardia. C second-degree AV block, Type I. D atrial fibrillation. {{Ans- Answer: A WPW is a genetic conduction abnormality in which an abnormal conduction pathway allows a reentrant tachycardia pathway to bypass the normal AV node conduction pathway, resulting in supraventricular tachycardia. WPW is generally first diagnosed in those younger than 30 years old, and it can be cured is deficient, and potassium should be administered immediately. The remaining 3 choices are not indicated forthe treatmentof DKA. -A patient is receiving mechanical ventilation and is not able to follow commands. What is the preferred strategy for assessing this patient's pain? Select single answer choice. A Assess with the BPS. . B Assess with the RASS. c Assess with the NRS. D Assess with the CAM-ICU. {{Ans- Answer: A This patient cannot follow commands. Therefore, a valid behavioral assessment tool, such as the BPS or the CPOT, needs to be used. The RASS assesses for agitation, so choice (B) is incorrect. The NRS requires the patient to give a number rating to his or her pain, which this patient does not seem capable of doing. For that reason, choice (C) is incorrect. The CAM-ICU assesses the patient for delirium, not pain, so choice (D) is also incorrect. -Which of the following is a systemic effect of targeted temperature management (TTM) during the cooling phase? Select single answer choice. A increased cardiac output secondary to vasodilation. B decreased risk for infection secondary to increased neutrophil production. C hyperkalemia secondary to shivering. D hyperglycemia secondary to insulin resistance. {{Ans- Answer: D During the cooling (induction) phase of TTM, there is typically insulin resistance. Additionally, during this phase, there is vasoconstriction and decreased neutrophil production. During the rewarming phase, rebound hyperkalemiamay occur. -A patient presented to the Emergency Department with a history of palpitations and dyspnea, persisting on and off for 1 week. The heart monitor shows atrial fibrillation with rapid ventricular response, and the blood pressure is 112/70. Treatment will most likely include: Select single answer choice. A a calcium channel blocker and anticoagulation. B cardioversion and a beta blocker. C digoxin and aspirin. D amiodarone and oxygen. {{Ans- Answer: A The patient history seems to be one of intermittent atrial fibrillation over the past week. Controlling the heart rate (with a calcium channel blocker) and addressing potential left atrial clot formation (with anticoagulation) are the priority treatments. Cardioversion is reserved for an unstable patient. Digoxin may be used to control the heart rate (although the onset of that effect is slow), and aspirin is not an anticoagulant. Amiodarone may result in a conversion to sinus rhythm, but the administration of this drug should not be attempted until the patient has been anticoagulated. -A patient with hypoparathyroidism demonstrates a positive Chvostek sign and a positive Trousseau sign. What electrolyte imbalance (that is associated with hypoparathyroidism) is the most likely cause of these signs, and for what other potential sign (related to this electrolyte imbalance) does this patient need to be monitored for? Select single answer choice. A hypokalemia; arrhythmias. B hypercalcemia; kidney stones. C hypophosphatemia; hypoventilation. D hypocalcemia; laryngospasm. {{Ans- Answer: D Hypocalcemia is an electrolyte imbalance that is associated with hypoparathyroidism, and a positive Chvostek sign and/or a positive Trousseau sign are manifestations of hypocalcemia. Laryngospasm is another sign caused by hypocalcemia; therefore, this patient needs to be monitored for this sign as well. The remaining electrolyte imbalances are not associated with a diagnosis of hypoparathyroidism. -Which of the following are the best indicators for a diagnosis of septic shock? Select single answer choice. A an infection and SIRS. B an infection and a fever. C an infection and serum lactate 8. D an infection and a positive blood culture. {{Ans- Answer: C Elevated lactate is evidence of anaerobic metabolism, and it is the best indicator of septic shock of the choices listed. The remaining choices (SIRS, a fever, and a positive blood culture) may be present in sepsis, but they are not specific to a shock state. Additionally, septic shock may be present without signs of a feverora positive blood culture. -A patient is receiving positive inotropes, vasodilators, and diuretics. This patient most likely has which of the followingproblems? Select single answer choice. A right ventricular failure. B left ventricular systolic heart failure C papillary muscle rupture. D hypertrophic cardiomyopathy. {{Ans- Answer: B Positive inotropes increase contractility, vasodilators decrease afterload, and diuretics decrease preload. Since a patient with systolic heart failure has decreased contractilityand increased afterload and preload, these agents will be useful forthe treatmentof this problem. -A ventricular septal defect is most likely to have which of the following clinical findings? Select single answer choice. A diastolic murmur at the apex of the heart B systolic murmur at the fifth intercostal space, midclavicular C diastolic murmur at the base of the heart D systolic murmur at the fifth intercostal space, left sternal border {{Ans- Answer: D The murmur that is caused by a ventricular septal defect occurs during left ventricular ejection (systole) and is best heard at the fifth intercostal space, left sternal border. -A patient has a fever, and a lumbar puncture is positive for protein and WBCs. This patient most likely has a positive: -A patient has a pulmonary embolism with hypotension, hypoxemia (which requires the patient to be on 100% oxygen), and severe tachypnea. Which of the following would provide the quickest resolution of this patient's signs and symptoms? Select single answer choice. A the administration of heparin B intubation with mechanical ventilation C the administration of a fibrinolytic agent D fluid resuscitation {{Ans- Answer: C This patient's signs and symptoms are due to a massive pulmonary embolism. The administration of a fibrinolytic agent would dissolve the clot in a short period of time, with relief from the life-threatening symptoms. Anticoagulation with heparin will be needed, but the therapeutic effects are not immediate, so choice (A) does not represent the quickest resolution of this patient's signs and symptoms. The administration of a fibrinolytic agent as a first step could possibly eliminate the need for mechanical ventilation or fluid resuscitation. Forthat reason, choices (B) and (D) are incorrect. -A patient presents with left leg pain. The ankle brachial index (ABI) is 0.7. This patient would benefit from whichof the followinginterventions? Select single answer choice. A mechanical compression therapy B putting the legs in the dependent position C the administration of a beta-adrenergic blocker D elevating the leg {{Ans- Answer: B The clinical signs described in the question are indicative of peripheral artery occlusive disease. Putting the legs in the dependent position will aid perfusion. The remaining choices would not be beneficial. -Which of the following describes clinical signs of variant (Prinzmetal's) angina? Select single answer choice. A ST depression precipitated by activity B ST elevation, resolves with nitrate therapy C T-wave inversion, elevated troponin D ST depression, unrelenting chest pain {{Ans- Answer: B This type of angina is thought to be due to an arterial spasm at the point of coronary artery plaque, not due to plaque rupture. The ST elevation is transient because the spasm is relieved with nitrates; therefore, infarction does not occur. -The most specific clinical sign for the presence of brain death would include which of the following? Select single answer choice. A absent oculocephalic reflex B negative apnea test C coma D positive Babinski reflex {{Ans- Answer: A An absent oculocephalic reflex (the eyes remain midline or turn to the side of head rotation) is a sign of cranial nerve VIII damage and possible brain death. The apnea test is positive in the presence of brain death. While a coma is present during brain death, most patients in a coma do not have brain death. A positive Babinski reflex is a sign of uppermotor neuron damage, not brain death. -A patient was admitted to the ICU status post removal of a cancerous skin lesion on the right upper chest. The patient complained of intense pain surrounding the surgical area and the underlying muscle. There was initially minor redness surrounding the surgical area, but now there is an area of necrosis with purplish discoloration over the surrounding area. The initial wound culture was positive for clostridial myonecrosis. The nurse knows that: Select single answer choice. A the patient is at risk for developing anaphylactic shock. B the patient will require treatment for gas gangrene. C hyperbaric oxygen therapy is a priority treatment. D a single surgical debridement intervention will resolve the problem. {{Ans- Answer: B Clostridial myonecrosis is also known as gas gangrene. This patient most likely has necrotizing fasciitis, which may progress to septic shock, not anaphylactic shock, so choice (A) is incorrect. Hyperbaric oxygen therapy is not a priority treatment, but it may be useful for select patients. Since it is not a priority treatment, choice (C) is incorrect. Surgical debridement will be needed, not only initially, but repeatedly until the spread of the necrosis is resolved. -Prerenal failure may be precipitated by which of the following in high-risk patients? Select single answer choice. A acetaminophen B calcium channel blockers C beta blockers D NSAIDs {{Ans- Answer: D Chronic use of NSAIDs prevents dilation of the efferent renal arteriole, and this dilation may be needed when renal perfusion is stressed by hypovolemiaorother stressors. -A patient has a blood pressure of 78/40, a right atrial (RA) pressure of 13 mmHg, a pulmonary artery occlusion pressure (PAOP) of 5 mmHg, a systemic vascular resistance (SVR) of 1,900 dynes/sec/cm-5, and a cardiac output (CO) of 1.9 L/min. Which of the following statements about this patient is correct? Select single answer choice. A The patient has septic shock; provide vasopressors. B The patient has cardiogenic shock; provide positive inotropes. C The patient has hypovolemic shock; provide fluid resuscitation. D The patient has right ventricular infarct; provide fluids. {{Ans- Answer: D The hemodynamic profile described is that of right ventricular (RV) failure, which may be se condary to acute RV infarct. The elevated SVR is not typical of septic shock, which rules out choice (A). The low PAOP is not seen in cardiogenic shock, which rules out choice (B). The elevated RA pressure is not seen in hypovolemic shock, which rules out choice (C). -A patient has a blood pressure of 78/40, a right atrial (RA) pressure of 8 mmHg, a pulmonary artery occlusion pressure (PAOP) of 19 mmHg, a systemic vascular resistance (SVR) of 1,900 dynes/sec/cm-5, and a cardiac output (CO) of 1.9 L/min. Which of the following statements about this patient is correct? Select single answer choice. A The patient has septic shock; provide vasopressors. B pH 7.49; PaCO2 28; HCO3 25; PaO2 92 C pH 7.34; PaCO2 47; HCO3 28; PaO2 68 D pH 7.29; PaCO2 50; HCO3 25; PaO2 70 {{Ans- Answer: D The ABG results in choice (D) demonstrate hypoventilation, as evidenced by an uncompensated respiratory acidosis with mild hypoxemia. This patient needs assisted ventilation in order to prevent respiratory arrest. Choice (A) is a normal ABG result (a highly unlikely finding in a tachypneic patient with status asthmaticus). Although not considered normal, the ABG results in choice (B) and choice (C) would not indicate an immediateneed forintubation and mechanical ventilation. -A patient presents 1 month status post gastric bypass bariatric surgery with vomiting, a headache, diplopia, and memory loss. These are clinical signs of which of the following? Select single answer choice. A overeating. B an infection C malabsorption. D anastomosis leak. {{Ans- Answer: C These signs and symptoms are those of malabsorption, which results in vitamin deficiency and may occur after bariatric surgery. The remaining choices are not manifested by the signs and symptoms described in the question. -Which of the following is a priority treatment for an aortic dissection? Select single answer choice. A fluids and vasopressors. B intra-aortic balloon pump therapy and a transfusion. C aggressive management of hypertension and emergent surgery. D emergent aortic valve replacement and pain control. {{Ans- Answer: C Emergent surgery is essential for survival, and blood pressure control is essential preoperatively. A transfusion and pain control may be indicated, but the remaining therapies are not beneficial. -Which of the following clinical findings is indicative of impending brain herniation? Select single answer choice. A a cerebral perfusion pressure of 80 mmHg. B a change in the level of consciousness. C sustained A waves on an ICP tracing. D a Glasgow Coma Scale score of 13. {{Ans- Answer: C A waves are "awful." They are a sign of a sustained increase in the intracranial pressure (ICP), which, if not lowered, will result in brain stem herniation. A cerebral perfusion pressure (CPP) of 80 mmHg is normal. A change in the level of consciousness (LOC) is not normal, but that is not a sign of impending brain herniation. A Glasgow Coma Scale score of 13 is also not normal, but that is not a sign of impendingbrain herniation. -An orientee's patient experiences cardiac arrest and requires resuscitation. The preceptor, who is orienting the new nurse to the unit, sees that the orientee has placed the patient in the reverse Trendelenburg position. What would be the preceptor's best response at this time? Select single answer choice. A Immediately begin chest compressions. B Explain the problem with the current position to the orientee, and teach the orientee what the correct position should be. C Place the patient in a supine position D Ask the orientee why he put the patient in that position. {{Ans- Answer: C The preceptor needs to do what is best for the patient in this emergency situation. Beginning chest compressions with the head of the bed elevated would not be the best intervention for the patient. For that reason, choice (A) is incorrect. This is not the appropriate time to use the situation to coach the orientee. For that reason, choice (B) is incorrect. Discussing the orientee's rationale for putting the patient in that position would best be done at a later time. For that reason, choice (D) is also incorrect. -The hospital Nursing Practice Committee wants to provide criteria for the maintenance of a central venous catheter in order to decrease the CLABSI rate. Which of the following is a reason to maintain a central venous catheter? Select single answer choice. A The patient requires acute hemodialysis. B The patient requires frequent lab draws. C The patient is receiving mechanical ventilation. D The patient requires peripheral parenteral nutrition. {{Ans- Answer: A A patient who requires emergent hemodialysis (or CRRT) will need a central venous catheter (CVC). Each of the remaining choices alone is not a requirement formaintaining a CVC. -A patient assessment reveals a fever and nuchal rigidity. A lumbar puncture is done, and the cerebrospinal fluid (CSF) results include the following: clear in appearance, glucose 60 mg/dL, mildly elevated protein, mildly elevated WBC count, and opening pressure 150 cm H2O. Treatment for this patient will most likely includewhich of the following? Select single answer choice. A supportive care. B airborne isolation. C antibiotic therapy. D targeted temperature management. {{Ans- Answer: A Treatment for this patient includes supportive care (e.g., fluids, fever management). The clinical signs described indicate that this patient has meningitis, and the results of the lumbar puncture indicate that the meningitis is viral. Antibiotics are indicated for bacterial meningitis, not viral meningitis. Isolation and targeted temperature management are not indicated forviral meningitis. -A patient's bladder pressure has ranged between 15 and 20 mmHg over the past 12 hours. Which of the following interventions is indicated for this patient? Select single answer choice. A Level the pressure transducer at the midaxillary line. B Elevate the head of the bed to 45°. C Withhold analgesic and sedating drugs. D Optimize stool management. {{Ans- Answer: D Select single answer choice. A positive troponin, aortic valve damage. B pain with inspiration, pericardial friction rub. C retroperitoneal bleed, global ST elevation. D atrial fibrillation, mitral valve damage. {{Ans- Answer: A The chest bruise implies that the patient's chest struck the steering wheel. This in turn may have caused aortic valve trauma (trauma to the valve that is lying most anterior in the chest), or it may have caused myocardial traumadamage. -A patient with ST elevation in leads II, III, and aVF is most likely to develop a , whereas a patient with ST elevation in V1, V2, and V3 is most likely to develop. Select single answer choice. A second-degree AV block (Type II), a sinus exit block B second-degree AV block (Type II), a third-degree AV block. C third-degree AV block, a second-degree AV block (Type II). D second-degree AV block (Type II), sinus arrest. {{Ans- Answer: C ST elevation in leads II, III, and aVF is generally secondary to right coronary artery occlusion (an inferior wall MI), and in most of the population, the RCA supplies the AV node, so an occlusion of the RCA would result in complete heart block. ST elevation in V1 through V3 is indicative of left anterior descending artery occlusion. Since the left anterior descending artery supplies the main bundle of His in most of the population, occlusion of that artery would result in a second-degree AV block (Type II). -A patient sustained a crush injury at a construction site. The patient's urine is tea-colored with a urine output of 20 mL/hour. The creatine kinase (CK) is 20,000 U/L. The nurse should anticipate which of the following interventions? Select single answer choice. A the administration of 0.9 normal saline to maintain a urine output of 30 mL/hour. B pain management and preparation for emergent surgery. C the insertion of a dialysis catheter and immediate hemodialysis. D the administration of a loop diuretic and 50 mL of sodium bicarbonate. {{Ans- Answer: A The patient history and clinical presentation suggest the presence of rhabdomyolysis. The massive amount of creatine kinase that is released with massive skeletal muscle damage needs to be "flushed" through the renal tubules with aggressive fluid administration. -A 70 kg patient with ARDS is receiving mechanical ventilation with the following settings: assist-control mode, breath rate of 18 breaths/minute; FiO280%; Vt 350 mL; PEEP 5 cm H2O. An ABG was obtained, and it revealed the following: pH 7.33, PaCO2 50, PaO2 48, HCO3 26. Which of the following would the nurse anticipate increasing? Select single answer choice. A FiO2. B the breath rate. C the tidal volume (Vt). D PEEP. {{Ans- Answer: D The PEEP setting of 5 cm H2O is not sufficient for treating the severe hypoxemia of ARDS. Generally, at least 10 to 15 cm of PEEP is required. -A patient is status post motor vehicle accident. Which of the following assessments of this patient is part of the trauma second-line assessment? Select single answer choice. A Perform a neurological exam. B Evaluate oxygenation and ventilation. C Remove the patient's clothes, and provide warmth/cooling as needed. D Assess for and treat pain. {{Ans- Answer: D The assessment for and treatment of pain is considered a part of the second-line assessment of a trauma patient. The remaining 3 choices are part of the first-line assessment of a trauma patient. -The unit Quality Council is considering strategies for decreasing the number of indwelling urinary catheter days. Which of the following is a strategy that would accomplish this goal? Select single answer choice. A Standardize the indwelling urinary catheter products that are available on the unit. B Develop and implement an intermittent straight catheterization protocol. C Monitor compliance with maintaining the catheter drainage system below the bladder. D Develop an RN competency assessment that focuses on insertion technique. {{Ans- Answer: B The implementation of an intermittent straight catheterization protocol provides an alternative to inserting an indwelling urinary catheter (in the event that a patient is unable to void) and has been shown to decrease indwelling urinary catheter days. Choices (A) and (D) may improve or ensure aseptic insertion technique, while choice (C) may decrease infections, but none of these strategies will specifically decrease the numberof indwelling urinary catheter days. -A patient who was admitted yesterday afternoon is demonstrating frequent yawning and lacrimation. The nurse suspects withdrawal from which of the following substances? Select single answer choice. A cocaine B benzodiazepines. C alcohol. D heroin. {{Ans- Answer: D Yawning and lacrimation are signs of opioid withdrawal. These are not signs of withdrawal from the substances described in choices (A), (B), or(C). -A patient has global ST elevation and pain with deep inspiration. Which of the following medications should the nurse expect the physician to order? Select single answer choice. A morphine. B beta-adrenergic blocker. C nitrate. D nonsteroidal anti-inflammatory drug {{Ans- Answer: D hours. A vasopressor is only needed if the patient is unresponsive to an initial fluid administration of 30 mL/kg of crystalloids. Thus, choice (A) is incorrect. The central venous pressure is not required initially, but it may be considered if the patient is unresponsive to fluids. Thus, choice (B) i s incorrect. An indwelling urinary catheter is not required for all patients, and if it is needed, it is not always a priority. Thus, choice (C) is also incorrect. -A nurse preceptor is talking to an orientee and describing the importance of gentle milking and frequent assessments of the output of a mediastinal chest tube. Occlusion of a mediastinal chest tube may result in: Select single answer choice. A lung collapse. B tension pneumothorax. C cardiac tamponade. D coagulopathy. {{Ans- Answer: C The purpose of a mediastinal chest tube is to drain the mediastinal space of serosanguinous fluid post cardiac surgery. If the fluid cannot drain, cardiac tamponade may result. Pleural chest tube blockage may result in lung collapse or tension pneumothorax, so choices (A) and (B) are incorrect. Choice (D) is not related to mediastinal chest tube patency. -Which of the following patients most likely has delirium? Select single answer choice. A a patient who is attentive but is acutely agitated. B a patient who is unresponsive. C a patient who is lethargic and inattentive. D a patient who is angry {{Ans- Answer: C The patient described in choice (C) is demonstrating an acute change in the level of consciousness, altered mental status, and inattention, all of which are required in order to make the diagnosis of delirium. If the patient is attentive, as described in choice (A), delirium is not present. Unresponsiveness alone, as described in choice (B), does not meet the criteria for delirium. Anger, as described in choice (D), is not a characteristicof delirium. -A patient was admitted status post motor vehicle accident. Breath sounds are diminished on the right side, and the trachea is deviated to the left. The patient's vital signs include: a B/P of 80/54, a heart rate of 130 beats/minute, and a respiratory rate of 32 breaths/minute. Which of the following immediate interventions is indicated? Select single answer choice. A a right chest needle decompression. B fluids, pressors. C left-sided chest tube insertion. D endotracheal tube {{Ans- Answer: A The clinical signs described in the question are those of a tension pneumothorax. The immediate release of the trapped pleural air is indicated in order to restore venous return and an adequate cardiac output. Once the tension is relieved, the patient will require insertion of a pleural chest tube in order to restore lung inflation. -A 19-year-old presents with raccoon eyes and bruising behind his right ear after falling from a 1-story roof. The nurse notices clear fluid draining from his nose. What would lead the nurse to believe that the cleardrainage is CSF and not normal nasal drainage? Select single answer choice. A The drainage decreases after the patient blows his nose. B The drainage turns only yellow when placed on white gauze. C The drainage is positive for glucose. D The patient complains of the worst headache of his life. {{Ans- Answer: C This patient most likely has a basilar skull fracture, which results in a meningeal tear and leakage of cerebrospinal fluid (CSF). CSF consists of about 60% serum glucose and will therefore test positive for glucose. This patient should NOT blow his nose if a basilar skull fracture is suspected. Thus, choice (A) is incorrect. A positive "halo sign" is when the drainage turns yellow with a red spot in the middle; it would not only turn yellow. Thus, choice (B) is incorrect. A headache is not a sign that would differentiate CSF from normal nasal drainage. Thus, choice (D) is also incorrect. -A patient complains of boring abdominal pain. The abdomen is rigid with no rebound tenderness. Grey Turner's sign and Trousseau's sign are present. The amylase, lipase, WBC count, and serum glucose are elevated. Which of the following problems does this patient most likelyhave, and which intervention is most appropriate? Select single answer choice. A pancreatitis; antibiotic therapy. B hemorrhagic pancreatitis; a close pulmonary assessment. C bowel perforation; immediate surgery. D small bowel obstruction; gastric decompression. {{Ans- Answer: B The clinical signs described in the question are those of acute pancreatitis, and Grey Turner's sign indicates hemorrhagic pancreatitis. Acute pancreatitis may cause the release of phospholipase A, which destroys Type II alveolar cells. Elevation of the left diaphragm, left lower lobe atelectasis, left-sided pleural effusion, and ARDS are possible pulmonary complications of acute pancreatitis. -A patient was admitted with a 4-month history of numerous medical problems, and he is malnourished with a body mass index (BMI) of 15. Enteral feeding was initiated. The nurse should monitor this patient for whichof the following? Select single answer choice. A hypomagnesemia. B hypercalcemia. C hypoglycemia. D hyperphosphatemia {{Ans- Answer: A This patient is at risk for refeeding syndrome when adequate nutrition is provided after a long period of malnutrition. With the reintroduction of feeding after a prolonged period of starvation, magnesium (as well as phosphorus and potassium) shift intracellularly due to the total body depletion of magnesium (as well as phosphorus and potassium) during starvation. The remaining electrolyte abnormalities are not associated with refeeding syndrome. -A patient with chronic alcoholism presents with abdominal pain, lethargy, decreased deep tendon reflexes, and muscle weakness. What is a likely cause of this clinical presentation and a potential complication? Select single answer choice. A Select single answer choice. A The patient had a tracheostomy 5 days ago. B The problem for which the patient required mechanical ventilation is resolving. C The patient is breathing over the set ventilator breath rate. D The patient has been on a ventilator for 1 week. {{Ans- Answer: B Generally, when the problem for which a patient required mechanical ventilation is resolving, a spontaneous breathing trial is indicated. Having a tracheostomy is not an indication for initiating a spontaneous breathing trial, so choice (A) is incorrect. Breathing over the set ventilator breath rate could be a sign of distress and is not an indication for initiating a spontaneous breathing trial. Thus, choice (C) is incorrect. The length of time that a patient has been on a ventilator is not indication for initiating a spontaneous breathing trial, so choice (D) is also incorrect. -Which of the following problems is a contraindication to receiving the influenza vaccine? Select single answer choice. A COPD B Guillain-Barré syndrome. C cirrhosis. D chronic kidney disease {{Ans- Answer: B The influenza vaccine has been associated with the development of Guillain-Barré syndrome; therefore, the influenza vaccine needs to be avoided for patients who are at risk for developing GBS. The remaining problems do not pose contraindications to receiving the influenza vaccine. -A 65-year-old male complains of sharp left shoulder pain, and upon a clinical exam, he demonstrates abdominal distension with absent bowel sounds. This patient most likely has: Select single answer choice. A a ruptured spleen. B acute coronary syndrome. C abdominal aortic dissection. D retroperitoneal bleeding. {{Ans- Answer: A Sharp left shoulder pain (Kehr's sign) is a clinical sign that is caused by diaphragmatic irritation that occurs with splenic rupture. Abdominal distension and absent bowel sounds are also clinical signs of a ruptured spleen. The clinical problems listed in the remaining choices do not manifest the signs described in the question. -A patient with septic shock has refractory hypotension despite fluid resuscitation with crystalloids and high-dose norepinephrine(Levophed). Whatorder does the nurse anticipate immediately? Select single answer choice. A a sodium bicarbonate IV. B a phenylephrine infusion. C a vasopressin infusion. D IV steroids {{Ans- Answer: C A vasopressin infusion is the recommended next intervention for a patient who is refractory to fluids/a high-dose of the initial vasopressor. It is thought that the vasopressin decreases refractoriness of the alpha receptors in the arteries to catecholamines. Sodium bicarbonate as an infusion may be used if metabolic acidosis is severe and refractory to treatment, although it is not a first-line treatment. Thus, choice (A) is incorrect. Adding another pressor at this time, such as the one described in choice (B), is not an evidence-based solution. Thus, choice (B) is incorrect. Steroids may be needed if vasopressin is not effective and if the patient is thought to have corticosteroid deficiency secondary to septic shock. Since this is not the immediate orderthat is needed, choice (D) is also incorrect.