1.ApatientishavingcomplicationsfromabdominalsurgeryandremainsNPO.Becauseenteral
tubefeedingsarenotpossible,thedecisionistoinitiateparenteralfeedings.Whata
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omplicationsforthistherapy - ANS-b. Fluidandelectrolyteimbalancesandsepsis
.Apatientisbeingventilatedandhasbeenstartedonenteralfeedingswithanasogastricsmallborefeedingtube.Whatistheprimaryreasonthenursemustfrequentlyassesstubeplacement
? - ANS-d. Topreventaspirationofthefeedings
3.Thepatientistostartparenteralnutrition.Thenurseknowstopreparewhichsiteforcatheterins
ertion? - ANS-d. Subclavianvein
4.Apatienthasbeenadmittedtothecriticalcareunitafterastroke.Afterfailingaswallowstudy,th
epatientisplacedonenteralfeedings.Followingplacementofanasogastrictubefortubefeedin
g,whatisthenextcriticalstep? - ANS-c. Obtainachestradiograph.
5.Apatientsfeedingtubehasbeensuccessfullyplacedinthesmallintestinewithcontinuousflo
wtubefeeding.Thenurseknowsthatthisapproachwaschosenbecause: - ANS-c.
theintestinalmucosanormallyreceivesnutrientsfromthestomachinperistalticwaves
6.Apatientisbeingfedthroughanasogastrictubeplacedinhisstomach.Thenursewouldcarryo
utwhichinterventiontominimizeaspirationrisk? - ANS-Elevatetheheadofthebed30degrees.
7.Apatientwhoisreceivingcontinuousenteralfeedingshasjustvomited250mLofmilkygreenfl
uid.Thisisaconcernbecausethismostlikelydemonstratesthatthepatienthas: - ANS-d. tube
feeding intolerance.
8.Apatientisreceivingenteralfeedingsandhasjustvomited250mLofmilkygreenliquid.Thenur
seholdsthetubefeeding,whichhadbeeninfusingat100mL/hr.Thenurseknowsthatthenextact
ionshouldbe: - ANS-d. recheck the residual in 2hours
9.Inadditiontoresidualstomachvolume,whatotherevidencesuggestsfeedingintolerance? -
ANS-a. Abdominal distention
10.Approximately5daysafterstartingtubefeedings,apatientdevelopsextremediarrhea.Asto
olspecimeniscollectedtocheckforwhichpossiblecause? - ANS-a. Clostridium difficile
11.Apatientwithacutepancreatitisisstartedonparenteralnutrition.Thestudentnurselistedpo
ssibleinterventionsforthispatient.Whichinterventionneedscorrectionbeforefinalizingthepla
nofcare? - ANS-b. Infuseantibioticsthroughtheintravenousline.
12.Inevaluatingapatientsnutrition,thenursewouldmonitorwhichbloodtestasthemostsensiti
veindicatorofproteinsynthesisandcatabolism? - ANS-c. Prealbumin
13.Apatientisreceivingenteraltubefeedingsandhasdevelopeddrugnutrientinteractions.Thenurserecognizeswhichdrugashavingthepotentialforcausingdrugnutrientreactions? - ANS-d. Phenytoin
14.Whichstatementistrueaboutnormalfunctionofthegastrointestinal(GI)tract? - ANS-d.
Without nutritional stimulation, mucosal villi atrophy.
15.An important nutritional consideration in the elderly population is: - ANS-c. potential
for drug-nutrient interaction related to polypharmacy.
16.Objectivedatadesignatingthatthenutritiongoalsarenotbeingmetinclude: - ANS-d.
weight loss, elevated glucose, and dehydration
17.In trauma patients ,enteral nutrition via nasogastric tube feedings into the small
bowel is best initiated within what time frame following the injury? - ANS-a. 24hours
18.Apatientwithahistoryofemphysema,diabetes,andhyperlipidemiaisinthecriticalcareunito
naventilator.Thenutritionassessmentnotesthatthepatienthasaproteinandvitamindeficienc
yandisunderweight.Whichformulafornutritionalassessmentismostappropriate? - ANS-b.
Fiber-addedformula
19.Selectthephysiologicalreasoningbehindenteraltherapyasthepreferredsourceofnutrition
altherapy - ANS-d. Gut mucosa is preserved.
20.Thenurseidentifieswhichpatientatgreatestriskformalabsorptionofprotein? - ANS-b.
The patient with ileitis
21.Thebestnursingapproachtopreventfeedingtubeobstructionis: - ANS-b.
flushthetubeevery4hourswith20to30mLoftapwater.
22.Patientsexperiencingseverephysiologicalstressincreasetheirnutritionalrequirementsto
: - ANS-c. 35kcal/kg/day
23.Malnutritioncontributestoinfectionriskby - ANS-b. impairing immune function
24.Apatient,whohasatubefeeding,requiresachestxraystudyforevaluationofacough.Toreducetheriskofaspiration,thenurse: - ANS-d.
stopsfeedings10to15minutesbeforeplacingflattoobtaintheradiograph.
1.Whichstatement(s)abouttotalparenteralnutritionis(are)true?(Selectallthatapply.) - ANSa.
Assessingfluidvolumestatusandpreventinginfectionareimportantnursingconsiderations.b.
Fingerstickglucoselevelsareassessedevery6hoursandprn.
d.
Totalparenteralnutrition,withaddedlipids,providesadequatelevelsofprotein,carbohydrates,
andfats.
2.Whichintervention(s)is(are)criticalduringintravenouslipidadministration?(Selectallthata
pply). - ANS-b. Changethetubingevery24hours.
d. Monitortriglyceridelevels.
3.Calorie-densefeedings:(Selectallthatapply.) - ANS-a. are most useful in heart failure
and liver disease.
4.Risksoftotalparenteralnutritioninclude:(Selectallthatapply.) - ANS-b.
elevatedbloodsugar.
c. infectionatthecathetersite.
d. volumeoverload.
5.Whichofthefollowingstatementsistrueaboutinsulinandparenteralnutrition?(Selectallthat
apply.) - ANS-a. Amountofparenteralinsulinisadjustedbasedontheprevious24-
hourlaboratoryvalues.
b. Insulinmaybeaddedtoaparenteralnutritionsolution.
c. Subcutaneousinsulinisusedonaslidingscaleduringparenteralnutrition.
Thecorrectorderofactionsforapatientstartingenteralnutritionwithafeedingtubeis:__ - ANSA.Initiatetubefeeding. B.Insertfeedingtube. C.Flushtubetoverifypatency.
D.Obtainchestradiograph. E.Assessresiduals. ANS: B,D,C,A,E
1.Apatienthascoronaryarterybypassgraftsurgeryandistransportedtothesurgicalintensivec
areunitatnoon.Heisplacedonmechanicalventilation.Interprethisinitialarterialbloodgaslevel
s:
pH7.31
PaCO248mmHg
Bicarbonate22mEq/L
PaO2115mmHg
O2saturation99% - ANS-d. Uncompensated
respiratory
acidosis;
hyperoxygenated
2.Thephysicianordersthefollowingmechanicalventilationsettingsforapatientwhoweighs75
kg.Thepatientsspontaneousrespiratoryrateis22breaths/min.Whatarterialbloodgasabnorm
alitymayoccurifthepatientcontinuestobetachypneicattheseventilatorsettings?
Settings:
Tidalvolume:600mL(8mLperkg)
FiO2:0.5
Respiratoryrate:14breaths/min
Modeassist/ control - ANS-d. Respiratoryalkalosis
3.Apatientsventilatorsettingsareadjustedtotreathypoxemia.Thefractionofinspiredoxygenis
increasedfrom.60to.70,andthepositiveendexpiratorypressureisincreasedfrom10to15cmH2O.Shortlyaftertheseadjustments,thenurs
enotesthatthepatientsbloodpressuredropsfrom120/76mmHgto90/60mmHg.Whatisthemo
stlikelycauseofthisdecreaseinbloodpressure? - ANS-a. Decrease in cardiac output
4.Thenurseiscaringforapatientwithanendotrachealtube.Thenurseunderstandsthatendotra
chealsuctioningisneededtofacilitateremovalofsecretionsandthattheprocedure: - ANS-c. is
done as indicated by patient assessment.
5.A65-year-oldpatientisadmittedtotheprogressivecareunitwithadiagnosisofcommunityacquiredpneumonia.Thepatienthasahistoryofchronicobstructivepulmonarydiseaseanddia
betes.Asetofarterialbloodgasesobtainedonadmissionwithoutsupplementaloxygenshowsp
H7.35;PaCO255mmHg;bicarbonate30mEq/L;PaO265mmHg.Thesebloodgasesreflect: -
ANS-hypoxemia and compensated respiratory acidosis
6.Apatientsstatusworsensandneedsmechanicalventilation.Thepulmonologistwantsthepat
ienttoreceive10breaths/minfromtheventilatorbutwantstoencouragethepatienttobreathesp
ontaneouslyinbetweenthemechanicalbreathsathisowntidalvolume.Thismodeofventilationi
scalled: - ANS-c. intermittent mandatory ventilation
7.Apatientsendotrachealtubeisnotsecuredtightly.Therespiratorycarepractitionerassiststh
enurseintapingthetube.Afterthetubeisretaped,thenurseauscultatesthepatientslungsandn
otesthatthebreathsoundsovertheleftlungfieldsareabsent.Thenursesuspectsthat: - ANS-a.
the endotracheal tube is in the right main stem bronchus.
8.Amodeofpressuretargetedventilationthatprovidespositivepressuretodecreasetheworkloadofspontaneousbr
eathingthroughtheendotrachealtubeis: - ANS-c. pressure support ventilation.
9.Neuromuscularblockingagentsareusedinthemanagementofsomeventilatedpatients.The
irprimarymodeofactionis: - ANS-c. paralysis
10.Oneoftheearlysignsoftheeffectofhypoxemiaonthenervoussystemis: - ANSrestlessness.
11.Theamountofeffortneededtomaintainagivenlevelofventilationistermed: - ANS-work of
breathing.
12.Whichofthefollowingdevicesisbestsuitedtodeliver65%oxygentoapatientwhoisspontan
eouslybreathing? - ANS-a. Face mask with non-rebreathing reservoir
13.Apatientisbeingmechanicallyventilatedinthesynchronizedintermittentmandatoryventila
tionmodeatarateof4breaths/min.Hisspontaneousrespirationsare12breaths/min.Hereceiv
esadoseofmorphinesulfate,andhisrespirationsdecreaseto4breaths/min.Whichacidbasedisturbancewilllikelyoccur? - ANS-Respiratory acidosis
14.Apatientisbeingmechanicallyventilatedinthesynchronizedintermittentmandatoryventila
tionmodeatarateof4breaths/min.Hisspontaneousrespirationsare12breaths/min.Hereceiv
esadoseofmorphinesulfate,andhisrespirationsdecreaseto4breaths/min.Whatadjustments
mayneedtobemadetothepatientsventilatorsettings? - ANSIncreasethesynchronizedintermittentmandatoryventilationrespiratoryrate
15.Currentguidelinesrecommendtheoralrouteforendotrachealintubation.Therationaleforth
isrecommendationisthatnasotrachealintubationisassociatedwithagreaterriskfor: - ANS-d.
sinusitisandinfection.
16.Oxygensaturation(SaO2)represents: - ANS-b. oxygen that is chemically combined
with hemoglobin.
17.Pulseoximetrymeasures: - ANS-d. oxygen saturation.
18.APaCO2of48mmHgisassociatedwith: - ANS-.b. hypoventilation.
19.Thenursenotesthatthepatientsarterialbloodgaslevelsindicatehypoxemia.Thepatientisn
otintubatedandhasarespiratoryrateof22breaths/min.Thenursesfirstinterventiontorelieveh
ypoxemiaisto: - ANS-c. notify the provider of values and obtain order for oxygen.
20.Apatientpresentstotheemergencydepartmentdemonstratingagitationandcomplainingo
fnumbnessandtinglinginhisfingers.Hisarterialbloodgaslevelsrevealthefollowing:pH7.51,P
aCO225,HCO325.Thenurseinterpretsthesebloodgasvaluesas: - ANS-d. uncompensated
respiratory alkalosis.
21.Positiveendexpiratorypressure(PEEP)isamodeofventilatoryassistancethatproducesthefollowingcondi
tion: - ANS-d. There is pressure remaining in the lungs at the end of expiration that is
measured in cm H2O.
22.Thenurseiscaringforapatientwhoismechanicallyventilated.Aspartofthenursingcare,the
nurseunderstandsthat: - ANS-a. communication with intubated patients is often difficult.
23.Apatientishavingdifficultyweaningfrommechanicalventilation.Thenurseassessesthepa
tientforapotentialcauseofthisdifficultweaning,whichincludes: - ANS-b. hemoglobinof8g/dL
24.A53-year-old,80-
kgpatientisadmittedtothecardiacsurgicalintensivecareunitaftercardiacsurgerywith
thefollowingarterialbloodgas(ABG)levels.Whatisthenursesinterpretationofthesevalues? -
ANS-c. Normal ABG val
25.A53-year-old,80-
kgpatientisadmittedtothecardiacsurgicalintensivecareunitaftercardiacsurgery.
Fourhoursafteradmissiontothesurgicalintensivecareunitat4PM,thepatienthasstablevitalsi
gnsand normalarterialbloodgases(ABGs),andisplacedonaTpieceforventilatoryweaning.Duringthenurses7
PM(1900)assessment,thepatientisrestless,heartratehasincreasedto110beats/min,respira
tionsare36
breaths/min,andbloodpressureis156/98mmHg.Thecardiacmonitorshowssinustachycardi
awith10
prematureventricularcontractions(PVCs)perminute.Pulmonaryarterypressuresareelevate
d.Thenurse
suctionsthepatientandobtainspink,frothysecretions.Loudcracklesareaudiblethroughoutlu
ngfields.
Thenursenotifiesthephysician,whoordersanABGanalysis,electrolytelevels,andaportablec
hestx-ray study.Howdoesthenurseinterpretthefollowingbloodgaslevels - ANS-Hypoxemia
and uncompensated respiratory acidosis
26.A53-year-old,80-
kgpatientisadmittedtothecardiacsurgicalintensivecareunitaftercardiacsurgery.
Fourhoursafteradmissiontothesurgicalintensivecareunitat4PM,thepatienthasstablevitalsi
gnsand normalarterialbloodgases(ABGs)andisplacedonaTpieceforventilatoryweaning.Duringthenurses7PM
(1900)assessment,thepatientisrestless,heartratehasincreasedto110beats/min,respiratio
nsare36
breaths/min,andbloodpressureis156/98mmHg.Thecardiacmonitorshowssinustachycardi
awith10
prematureventricularcontractions(PVCs)perminute.Pulmonaryarterypressuresareelevate
d.Thenurse
suctionsthepatientandobtainspink,frothysecretions.Loudcracklesareaudiblethroughoutlu
ngfields.The
nursenotifiesthephysician,whoordersanABGanalysis,electrolytelevels,andaportablechest
x-raystudy.
Incommunicatingwiththephysician,whichstatementindicatesthenurseunderstandswhatisli
kelyoccurring withthepatient? - ANS-My assessment indicates potential fluid overload
27.Thenurseiscaringforamechanicallyventilatedpatientandnotesthehighpressurealarmso
unding.The
nursecannotquicklyidentifythecauseofthealarmandnotesthepatientsoxygensaturationisde
creasing andheartrateandrespiratoryrateareincreasing.Thenursespriorityactionisto -
ANS-d. manually ventilate the patient while calling for a respiratory therapist
28.Thenurseiscaringforapatientwhoseventilatorsettingsinclude15cmH2Oofpositiveendexpiratory
pressure(PEEP).Thenurseunderstandsthatalthoughbeneficial,PEEPmayresultin: - ANSd. low cardiac output secondary to increased intrathoracic pressure
29.Whenassessingthepatientforhypoxemia,thenurserecognizesthatanearlysignoftheeffe
ct ofhypoxemiaonthecardiovascularsystemis - ANS-tachycardia
30.Thenurseiscaringforamechanicallyventilatedpatient.Thephysiciansareconsideringperf
orminga
tracheostomybecausethepatientishavingdifficultyweaningfrommechanicalventilation.Rel
atedto tracheostomy,thenurseunderstandswhichofthefollowing - ANS-The greatest risk
after a percutaneous tracheostomy is accidental decannulation
31.Thenurseisassessingtheexhaledtidalvolume(EVT)inamechanicallyventilatedpatient.T
he rationaleforthisassessmentisto: - ANS-compare the tidal volume delivered with the
tidal volume prescribed
1.Thenurseiscaringforamechanicallyventilatedpatientandrespondstoahighinspiratorypres
surealarm.
Recognizingpossiblecausesforthealarm,thenurseassessesforwhichofthefollowing - ANSCoughing or attempting to talk/
c. Kinks in the ventilator
Need for suctioning
Selectallofthefactorsthatmaypredisposethepatienttorespiratoryacidosi - ANS-Central
nervous system depression
Overdose of sedative
3.Thenurseisassistingwithendotrachealintubationandunderstandscorrectplacementofthe
endotrachealtubeinthetracheawouldbeidentifiedbywhichofthefollowing?(Selectallthatappl
y. - ANS-Equal bilateral breath sounds upon auscultation
Position above the carina verified by chest x-ray
Positive detection of carbon dioxide(CO2) through CO2 detector devices
1.Thenurseiscaringforamechanicallyventilatedpatientandischartingoutsidethepatientsroo
mwhenthe
ventilatoralarmsounds.Whatisthepriorityorderforthenursetocompletetheseactions:_____
__________,
_______________,_______________,_______________?(Putacommaandspacebetwe
eneachanswerchoice - ANS-Go to patients bedside.
After troubleshooting, connect back to mechanical ventilator and reassess patient.
Manually ventilate the patient while getting respiratory therapist
B.After troubleshooting, connect back to mechanical ventilator and reassess patient
2.Thenurseisassistingwithendotrachealintubationofthepatientandrecognizesthattheproce
durewill bed one in what order - ANS-Assess balloon on endotracheal tube for
symmetry and leaks
Suction oropharynx.
Insert endotracheal tube with laryngoscope and blade
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