Week 1
Chapter 66
1. A 68-year-old patient has been in the intensive care unit for 4 days and has a nursing diagnosis of disturbed sensory perception related to sleep deprivation. Which action should the nurse include
...
Week 1
Chapter 66
1. A 68-year-old patient has been in the intensive care unit for 4 days and has a nursing diagnosis of disturbed sensory perception related to sleep deprivation. Which action should the nurse include in the plan of care?
a Administer prescribed sedatives or opioids at bedtime to promote sleep.
.
b Cluster nursing activities so that the patient has uninterrupted rest periods.
.
c. Silence the alarms on the cardiac monitors to allow 30- to 40-minute naps.
d Eliminate assessments between 0100 and 0600 to allow uninterrupted sleep.
.
ANS: B
2. Which hemodynamic parameter is most appropriate for the nurse to monitor to determine the effectiveness of medications given to a patient to reduce left ventricular afterload?
a Mean arterial pressure (MAP)
.
b Systemic vascular resistance (SVR)
.
c. Pulmonary vascular resistance (PVR)
d Pulmonary artery wedge pressure (PAWP)
.
ANS: B
3. While family members are visiting, a patient has a respiratory arrest and is being resuscitated. Which action by the nurse is best?
a Tell the family members that watching the resuscitation will be very stressful.
.
b Ask family members if they wish to remain in the room during the resuscitation.
.
c. Take the family members quickly out of the patient room and remain with them.
d Assign a staff member to wait with family members just outside the patient room.
.
ANS: B
4. Following surgery for an abdominal aortic aneurysm, a patients central venous pressure (CVP) monitor indicates low pressures. Which action is a priority for the nurse to take?
a Administer IV diuretic medications.
.
b Increase the IV fluid infusion per protocol.
.
c. Document the CVP and continue to monitor.
d Elevate the head of the patients bed to 45 degrees.
.
ANS: B
5. When caring for a patient with pulmonary hypertension, which parameter is most appropriate for the nurse to monitor to evaluate the effectiveness of the treatment?
a Central venous pressure (CVP)
.
b Systemic vascular resistance (SVR)
.
c. Pulmonary vascular resistance (PVR)
d Pulmonary artery wedge pressure (PAWP)
.
ANS: C
6. The intensive care unit (ICU) nurse educator will determine that teaching about arterial pressure monitoring for a new staff nurse has been effective when the nurse
CONTINUED..........
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