Which patient meets a typical criterion for admission to the intensive care unit?
A patient whose vasopressor infusion needs frequent titration
✓
A patient awaiting surgery tomorrow for a stable wrist fracture
A patient who needs a daily dressing change on a leg wound
A patient with controlled diabetes who needs teaching on insulin
Correct Answer
A patient whose vasopressor infusion needs frequent titration
Titration of vasoactive infusions such as vasopressors is one of the therapies delivered in critical care, because the patient's blood pressure can change quickly and needs close monitoring. A patient awaiting surgery tomorrow for a stable wrist fracture is stable and can be cared for on a general unit. A patient who needs a daily dressing change on a leg wound needs routine nursing care, not intensive care. A patient with controlled diabetes who needs teaching on insulin is stable and does not need intensive monitoring.
Category: ICU Care and Ethics
Question 2
A ventilated patient has an irreversible brain injury, and the care team expects the patient to die. What should the staff nurse do about possible organ donation?
Ask the family at the bedside whether they will donate
Notify the local organ procurement organization
✓
Wait until the family raises the subject of donation
Delay any referral until after life support is withdrawn
Correct Answer
Notify the local organ procurement organization
When death is anticipated, the hospital calls the organ procurement organization, whose trained staff approach the family, explain the process and offer support. Asking the family at the bedside whether they will donate is something most hospitals bar staff nurses from doing, to avoid coercion and misinformation. Waiting until the family raises the subject of donation can mean the opportunity is lost and does not meet the referral expectation. Delaying any referral until after life support is withdrawn is too late, because the organization needs to be involved while death is anticipated.
Category: ICU Care and Ethics
Question 3
A ventilated patient never put treatment wishes in writing, and the family must decide whether to continue life support. What should guide their decision?
What each family member would want for themselves
The cost of continuing intensive care
What the patient would likely have wanted
✓
The preference of the most senior physician
Correct Answer
What the patient would likely have wanted
When wishes were never written down, decision-makers are asked to judge what the patient would have wanted, considering the patient's prior health and whether life-sustaining therapy could restore a quality of life the patient would accept. What each family member would want for themselves substitutes their own values for the patient's. The cost of continuing intensive care is not the standard for this decision. The preference of the most senior physician does not replace the patient's own values, although the team informs the discussion.
Category: ICU Care and Ethics
Question 4
A pulmonary artery catheter is used to measure the pulmonary artery occlusion pressure, often called the wedge pressure. Which pressure does this value reflect?
Right atrial pressure
Systemic arterial pressure
Intracranial pressure
Left atrial pressure
✓
Correct Answer
Left atrial pressure
Briefly inflating the catheter's balloon in a branch of the pulmonary artery blocks flow from behind, so the reading reflects pressure transmitted back from the left atrium, an indicator of left-sided filling. Right atrial pressure is measured as the central venous pressure, not the occlusion pressure. Systemic arterial pressure is measured with an arterial catheter or a cuff. Intracranial pressure is measured with a device placed in the skull.
Category: Hemodynamic Monitoring
Question 5
A patient has an intra-aortic balloon pump inserted through the right femoral artery. The nurse now finds a weaker pedal pulse in the right foot than earlier in the shift. What does this finding suggest?
Reduced blood flow to the leg, such as from a clot
✓
The balloon is deflating at the correct time
Fluid overload from IV infusions
An expected effect of bed rest
Correct Answer
Reduced blood flow to the leg, such as from a clot
A diminished pedal pulse on the side of the insertion sheath signals reduced arterial flow to the limb, most often from a clot forming around the catheter or sheath, or from the catheter itself narrowing the vessel, so the nurse reports it promptly and continues neurovascular checks. The balloon deflating at the correct time is a normal pump function and would not weaken a pulse in one foot. Fluid overload from IV infusions causes edema and crackles, not a new loss of a pulse on one side. An expected effect of bed rest does not include a weakening pulse in a single limb.
Category: Hemodynamic Monitoring
Question 6
A day after a large myocardial infarction, a patient develops crackles, an S3 heart sound, tachycardia, cool sweaty skin and a falling blood pressure. Which condition do these findings suggest?
Hypovolemic shock
Cardiogenic shock
✓
Anaphylactic shock
Neurogenic shock
Correct Answer
Cardiogenic shock
In cardiogenic shock, damaged heart muscle pumps poorly, so stroke volume and cardiac output fall and blood backs up into the lungs, causing crackles and an S3 with hypotension and compensatory tachycardia. Hypovolemic shock comes from lost volume, so the lungs are usually clear and there is no S3 from fluid backing up. Anaphylactic shock follows an allergen and causes hives, swelling and bronchospasm. Neurogenic shock follows a spinal cord injury and causes bradycardia with warm, dry skin.
Category: Hemodynamic Monitoring
Question 7
Which finding needs prompt follow-up in a patient receiving extracorporeal membrane oxygenation?
A steady hourly urine output
Warm skin with strong pulses in both feet
Oozing of blood around the cannula sites
✓
Clear breath sounds on both sides
Correct Answer
Oozing of blood around the cannula sites
Bleeding is a major complication of extracorporeal membrane oxygenation, along with clotting, infection and limb ischemia, so new oozing at the cannula sites is reported promptly. A steady hourly urine output shows adequate kidney perfusion. Warm skin with strong pulses in both feet shows good circulation to the limbs. Clear breath sounds on both sides are a reassuring finding.
Category: Hemodynamic Monitoring
Question 8
A patient with sepsis develops dyspnea, fine crackles and bilateral infiltrates on chest x-ray, and the provider suspects acute respiratory distress syndrome. Which finding fits this diagnosis?
Wheezing that clears after a bronchodilator
An infiltrate confined to a single lobe
Low blood oxygen that corrects quickly with a nasal cannula
Low blood oxygen that persists despite more supplemental oxygen
✓
Correct Answer
Low blood oxygen that persists despite more supplemental oxygen
Acute respiratory distress syndrome fills the alveoli with fluid, so gas exchange fails and the hypoxemia does not respond to supplemental oxygen. Wheezing that clears after a bronchodilator points to bronchospasm, as in asthma. An infiltrate confined to a single lobe suggests a localized pneumonia, while this syndrome produces bilateral infiltrates. Low blood oxygen that corrects quickly with a nasal cannula is the opposite of the refractory hypoxemia that defines the syndrome.
Category: Respiratory and Ventilator Care
Question 9
Right after an endotracheal tube is placed, which finding, along with a chest x-ray, helps confirm that the tube is in the trachea?
Carbon dioxide detected in the exhaled air
✓
Gurgling heard over the stomach
A rising heart rate
A drop in oxygen saturation
Correct Answer
Carbon dioxide detected in the exhaled air
Exhaled carbon dioxide comes from the lungs, so detecting it at the tube shows ventilation through the trachea; breath sounds in all lung fields and a chest x-ray complete the check. Gurgling heard over the stomach suggests the tube is in the esophagus. A rising heart rate is a nonspecific response and says nothing about tube position. A drop in oxygen saturation suggests a problem, possibly a misplaced tube, rather than confirming correct placement.
Category: Respiratory and Ventilator Care
Question 10
After a ventilated patient is repositioned, the nurse hears breath sounds on the right but none on the left, and the tube marking at the lips is now deeper than documented. What do these findings suggest?
The tube has slipped into the esophagus
The tube has advanced into the right main bronchus
✓
The cuff has leaked and needs more air
The ventilator rate is set too low
Correct Answer
The tube has advanced into the right main bronchus
The right main bronchus is wider, shorter and more vertical than the left, so a tube pushed too deep usually enters it and ventilates only the right lung. The nurse reports it at once so placement can be confirmed by chest x-ray and the tube repositioned. A tube that has slipped into the esophagus leaves breath sounds absent on both sides, often with gurgling over the stomach. A cuff that has leaked lets air escape around the tube, often with an audible leak, rather than silencing one lung. A ventilator rate set too low affects both lungs equally.
Category: Respiratory and Ventilator Care
Question 11
Ventilator care bundles include a daily pause in sedation. What is the purpose of this pause?
To allow the ventilator circuit to be changed
To let the sedative build up to a steady level
To assess neurological status and the continued need for intubation
✓
To give the patient a period of uninterrupted sleep
Correct Answer
To assess neurological status and the continued need for intubation
Stopping sedation at least daily lets the team check neurological function and judge whether the patient still needs the endotracheal tube, which can shorten time on the ventilator and lower the risk of ventilator-associated pneumonia. Allowing the ventilator circuit to be changed does not require stopping sedation. Letting the sedative build up to a steady level is the opposite of what a pause does. Giving the patient a period of uninterrupted sleep is not the goal, since the patient is being woken for assessment.
Category: Respiratory and Ventilator Care
Question 12
During a spontaneous breathing trial, which finding shows the patient is tolerating it?
Restlessness with a rising heart rate
Use of neck muscles to breathe and heavy sweating
Falling oxygen saturation with new anxiety
Effective breathing with no agitation and stable vital signs
✓
Correct Answer
Effective breathing with no agitation and stable vital signs
A successful trial means the patient breathes effectively without agitation or abnormal vital signs, which may lead to extubation. Restlessness with a rising heart rate signals distress, so the trial is stopped. Use of neck muscles to breathe and heavy sweating show increased work of breathing. Falling oxygen saturation with new anxiety shows the patient cannot yet breathe without full support.
Category: Respiratory and Ventilator Care
Question 13
A patient with a head injury develops a slowing heart rate, irregular respirations and a rising systolic blood pressure with a widening pulse pressure. What do these changes indicate?
Rising intracranial pressure
✓
Developing hypovolemic shock
An expected response to sedation
Improving cerebral perfusion
Correct Answer
Rising intracranial pressure
This combination is Cushing triad, a sign that intracranial pressure is rising and compressing the brainstem, and it needs prompt intervention. Developing hypovolemic shock causes a falling blood pressure with a fast heart rate. An expected response to sedation does not produce a widening pulse pressure and irregular breathing. Improving cerebral perfusion would not cause this pattern of vital sign changes.
Category: Neurological Care
Question 14
Which nursing measure helps reduce the brain's metabolic demand in a patient with increased intracranial pressure?
Playing the television to help keep the patient oriented
Keeping the room dim and quiet with limited visitors
✓
Encouraging many family members to visit at once
Scheduling frequent nonessential procedures
Correct Answer
Keeping the room dim and quiet with limited visitors
A low-stimulus environment, with dim lighting, little noise and limited visitors and procedures, lets the brain rest and avoids rises in intracranial pressure. Playing the television to help keep the patient oriented adds stimulation. Encouraging many family members to visit at once increases stimulation and activity in the room. Scheduling frequent nonessential procedures adds stress and can raise the pressure.
Category: Neurological Care
Question 15
A nasogastric tube is placed for a patient with acute upper GI bleeding. How is the tube usually managed?
Connected to continuous high suction
Clamped until the bleeding stops
Connected to low intermittent suction
✓
Connected to a continuous feeding pump
Correct Answer
Connected to low intermittent suction
Low intermittent suction drains blood and gastric contents slowly and steadily without injuring the stomach lining. Continuous high suction can pull the lining into the tube and damage it. Clamping the tube until the bleeding stops would leave blood and acid in the stomach. A continuous feeding pump is wrong because a patient with acute GI bleeding is kept NPO.
Category: GI and Renal Concerns
Question 16
A patient develops acute kidney injury after several days of severe vomiting and diarrhea. Which treatment addresses the cause?
A diuretic to flush the kidneys
Strict fluid restriction
A low-protein diet to rest the kidneys
IV fluid replacement to restore blood flow to the kidneys
✓
Correct Answer
IV fluid replacement to restore blood flow to the kidneys
Vomiting and diarrhea cause hypovolemia, so this is prerenal injury, and replacing the lost volume restores renal perfusion. A diuretic to flush the kidneys would remove more fluid and worsen the hypovolemia. Strict fluid restriction suits fluid overload, not a volume deficit. A low-protein diet to rest the kidneys does nothing to restore the blood flow that caused the injury.
Category: GI and Renal Concerns
Question 17
Why does a norepinephrine infusion raise a critically ill patient's risk of pressure injury?
It narrows blood vessels and reduces blood flow to the skin
✓
It causes the patient to sweat heavily
It thins the outer layer of the skin
It raises the body temperature
Correct Answer
It narrows blood vessels and reduces blood flow to the skin
Vasoactive drugs that constrict vessels reduce tissue perfusion, so skin under pressure gets even less oxygen and breaks down more easily. Causing the patient to sweat heavily is not the mechanism by which these drugs injure skin. Thinning the outer layer of the skin is linked to aging and long-term steroid use, not vasopressors. Raising the body temperature is not how vasoconstriction harms the skin.
Category: Skin and Mobility
Question 18
A ventilated patient's condition is now stable. Which approach helps prevent long-term loss of muscle mass and function?
Strict bed rest until the patient leaves the unit
Early mobility with physical and occupational therapists as tolerated
✓
Deeper sedation to reduce movement
Keeping the limbs in one position to protect lines
Correct Answer
Early mobility with physical and occupational therapists as tolerated
Early mobility, led by nursing with physical and occupational therapists, reduces muscle atrophy and has been linked to shorter stays and less disability after discharge. Strict bed rest until the patient leaves the unit allows atrophy and contractures to develop. Deeper sedation to reduce movement increases immobility. Keeping the limbs in one position to protect lines promotes contractures.
Category: Skin and Mobility
Question 19
A patient is too hemodynamically unstable to tolerate being turned. Which measure helps prevent a pressure injury?
Massaging reddened areas over bony prominences
A ring-shaped cushion under the sacrum
A specialty bed that redistributes pressure under the body
✓
Turning the patient twice as often as usual
Correct Answer
A specialty bed that redistributes pressure under the body
Specialty pressure-redistribution beds keep the patient from resting on one area continuously and are an option when turning is not tolerated. Massaging reddened areas over bony prominences can damage tissue further. A ring-shaped cushion under the sacrum concentrates pressure on the surrounding skin. Turning the patient twice as often as usual is not possible when the patient cannot tolerate turning.
Category: Skin and Mobility
Question 20
How does the nurse detect a developing contracture in a patient on prolonged bed rest?
By measuring the patient's daily weight
By checking capillary refill in the fingers
By asking about pain in the joints only
By comparing joint range of motion on both sides with earlier findings
✓
Correct Answer
By comparing joint range of motion on both sides with earlier findings
Comparing range of motion between sides and against baseline findings from earlier assessments reveals joints that are losing movement before a permanent contracture forms. Measuring the patient's daily weight tracks fluid balance, not joint movement. Checking capillary refill in the fingers assesses circulation. Asking about pain in the joints only misses painless loss of motion and is not possible for many sedated patients.
Category: Skin and Mobility