Critical Care Final

The nurse receives report from the previous shift, and documents that the patient is in sinus rhythm. The nurse is verifying patient identity and the patient does not respond to verbal or physical stimuli. The monitor still displays an organized rhythm, but the nurse is unable to palpate or auscultate a pulse. What is the next correct action?

• Contact the provider to report the change in patient condition

• Administer 1mg of epinephrine every 3-5 minutes

• Defibrilate at 200 joules

• The patient is in pulseless electrical activity and care should be provided based on code status

Which statement made by a new graduate nurse about invasive mechanical ventilation is incorrect?

• "Assist control mode refers to the patient receiving a set total lung capacity but the rate is maintained by the patient's own rate of breathing."

• Synchronized intermittent mandatory ventilation (SIMV) refers to the patient setting an independent rate but limited tidal volume based on the patient's own strength. A minimum rate is also used as a backup to prevent hypoventilation."

• "Continuous positive airway pressure will increase the residual capacity and keep the alveoli open. Rate and volume are controlled by the patient. This is one step in the weaning process."

• "Assist control mode controls both the rate and volume that are preset and delivered without the machine responding to any of the patient's own breaths."

A patient with ARDS is on a mechanical ventilator with a heart rate of 128, SaO2 is 88% and the ventilator settings are FiO2 50%; PEEP 8 cm; AC 10 with a total respiratory rate of 30; and a tidal volume of 700 mL. There are coarse rhonchi audible in all lung fields. The appropriate nursing action would be to:

• Administer the ordered neuromuscular blockade medications.

• Increase the PEEP to 10 cm and sedate the patient.

• Increase the FiO2 to 60% and tidal volume to 750 mL for 2 minutes.

• Hyperoxygenate with 100% oxygen and suction the patient.

Which nursing action would best optimize overall oxygenation and ventilation in the patient with acute respiratory distress syndrome (ARDS)?

• Hyperventilate the patient after suctioning

• Suction the patient every 30 minutes

• Provide adequate rest and recovery time between procedures.

• Administer sedation infrequently.

An older client is experiencing hypovolemic shock. Which action would be given the highest priority for this client?

• Establish intravenous access

• Bolus of 0.45% NS at a rate of 999ml/hr

• Administering analgesics for control of pain

• Complete health history

A client being treated for hypovolemic shock is prescribed a titrating dose of dopamine. Which evaluation will the nurse anticipate while administering this medication?

• Stabilization of fluid loss

• Urinary output of at least 3 mL/hour

• Increased cardiac output

• Decreased cardiac irritability

The nurse is caring for a client experiencing anaphylactic shock. Which of the following should be included in the plan of care for this client?

Select all that apply.

• Support the blood pressure.

• Maintain an adequate airway.

• Provide adequate oxygen supply

• Remove the source of infection.

• Remove the mechanical barrier to blood flow.

A six-year-old pediatric client, who recently underwent a tonsillectomy 27 hours prior, presented to the emergency department after an episode of severe coughing, resulting in continuous bright red bleeding from back of throat. The patient is hypotensive, pale and slow to respond. The patient is afebrile. The mother teaches critical care nursing and asks what type of shock her child is in, you respond with _______ shock.

• Septic

• Distributive

• Hypovolemic

• Cardiogenic

A patient with neurogenic shock is demonstrating symptomatic bradycardia. What action will the nurse take at this time?

• Administer 1mg Atropine

• Limit patient movement

• Administer phenylephrine as prescribed

• Prepare to administer crystalloids

A patient with acute lung injury is being started on enteral nutrition. Which interventions will the nurse provide to ensure nutritional support for this patient? Select all that apply.

• Discard any residual gastric contents during assessments

• Assess for gastric residuals with assessments or per facility policy.

• Keep the head of the bed elevated to at least 30 degrees

• Nutrition is not necessary for healing.

• Withhold the use of the nasogastric tube until radiographic placement is confirmed.