Priorities in Critical Care Nursing 6th Edition by Linda D. Urden – Test Bank

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INSTANT DOWNLOAD COMPLETE TEST BANK WITH ANSWERS

 

Priorities in Critical Care Nursing 6th Edition by Linda D. – Test Bank

 

Sample  Questions

 

Urden: Priorities in Critical Care Nursing, 6th Edition

 

Chapter 06: Nutritional Alterations

 

Test Bank

 

MULTIPLE CHOICE

 

  1. A patient with acute pancreatitis is to be started on enteral tube feeding. What type of formula would be most appropriate?
a. Low protein
b. Low sodium
c. Low carbohydrate
d. Low fat

 

ANS:   D

A low-fat enteral formula has the least likelihood of stimulating pancreatic secretion.

 

DIF:    Cognitive Level: Comprehension       REF:    54

OBJ:    Nursing Process: Intervention TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. A patient has a new order for intermittent nasogastric feedings every 4 hours. The nasogastric tube is placed by the nurse. The best method for confirming the placement of the tube before feeding would be to:
a. obtain an x-ray of the abdomen.
b. check the pH of fluid aspirated from the tube.
c. auscultate the left upper quadrant of the abdomen while injecting air into the tube.
d. auscultate the right upper quadrant of the abdomen while injecting air into the tube.

 

ANS:   A

Once the tube is placed, correct location must be confirmed before feedings are started and regularly throughout the course of enteral feedings. Radiographs are the most accurate way of assessing tube placement.

 

DIF:    Cognitive Level: Application  REF:    57

OBJ:    Nursing Process: Assessment  TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. A person with a body mass index (BMI) of 32 would be considered:
a. obese.
b. overweight.
c. of normal weight.
d. underweight.

 

ANS:   A

A person is considered obese when he or she is more than 40% over ideal body weight or has a BMI greater than 30.

 

DIF:    Cognitive Level: Comprehension       REF:    Table 6-2

OBJ:    Nursing Process: Assessment  TOP:    Nutrition

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. Diet therapy for a hypertensive person 1 day after a myocardial infarction would include all the following except:
a. small, frequent meals.
b. a low-cholesterol diet.
c. a low-salt diet.
d. a fluid-restricted diet.

 

ANS:   D

Fluid restriction is generally not needed in the patient who has had a myocardial infarction. Small, frequent meals lessen the cardiac workload. Low-cholesterol and low-salt diets are appropriate for reducing hypercholesterolemia in arteriosclerotic disease and controlling hypertension, respectively.

 

DIF:    Cognitive Level: Analysis       REF:    49

OBJ:    Nursing Process: Implementation       TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. Two types of protein-caloric malnutrition are kwashiorkor and marasmus. Kwashiorkor results in:
a. weight loss and muscle wasting.
b. low levels of serum proteins, low lymphocyte count, and hair loss.
c. elevated serum albumin and increased creatinine excretion in the urine.
d. hyperpigmentation and a hard, easily palpated liver margin.

 

ANS:   B

Kwashiorkor results in low levels of serum proteins, low lymphocyte count, low immunity and edema from low plasma oncotic pressure, and hair loss.

 

DIF:    Cognitive Level: Comprehension       REF:    48

OBJ:    Nursing Process: Assessment  TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. The patient history plays an important role in assessing the patient’s nutritional status. Significant laboratory and clinical findings in the patient with cardiovascular disease include:
a. low levels of high-density lipoprotein (HDL) cholesterol and transferrin.
b. elevated low-density lipoprotein (LDL) cholesterol and decreased subcutaneous fat.
c. elevated sodium levels and a soft, fatty liver on palpation.
d. elevated triglycerides and decreased abdominal fat.

 

ANS:   B

Laboratory and clinical findings in the patient with cardiovascular disease include elevated total cholesterol and triglycerides, as well as cardiac cachexia (muscle and subcutaneous fat wasting).

 

DIF:    Cognitive Level: Synthesis     REF:    Box 6-4

OBJ:    Nursing Process: Assessment  TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. Proteins serve the function of:
a. maintaining osmotic pressure.
b. providing minerals in the body.
c. maintaining blood glucose.
d. providing cellular energy.

 

ANS:   A

Proteins are the basis for lean body mass and are important for chemical reactions, transportation of other substances, preservation of immune function, and maintenance of osmotic pressure (albumin) and blood neutrality (buffers) in the body.

 

DIF:    Cognitive Level: Knowledge  REF:    48

OBJ:    Nursing Process: Intervention TOP:    Nutrition

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. Obtaining height and weight measurements for the critically ill patient:
a. should be deferred until the medical condition stabilizes.
b. should be measured, rather than obtained through patient or family report.
c. requires consistent weights in pounds.
d. requires weight, but height can be deferred.

 

ANS:   B

Height and current weight are essential anthropometric measurements that should be measured, rather than obtained through patient or family report. The most important reason for obtaining anthropometric measurements is to detect changes in the measurements over time (e.g., response to nutritional therapy).

 

DIF:    Cognitive Level: Comprehension       REF:    48

OBJ:    Nursing Process: Assessment  TOP:    Nutrition

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. A patient on mechanical ventilation is receiving total parenteral nutrition (TPN). Which of the following is true?
a. Excessive calorie intake can cause an increase in PaCO2.
b. The patient’s head should remain elevated at 15 degrees.
c. Lipid intake should be maintained at greater than 2 g/kg per day.
d. TPN is preferred over the use of enteral feeding .

 

ANS:   A

Excessive calorie intake can raise PaCO2 sufficiently to make it difficult to wean a patient from the ventilator. A balanced regimen with both lipids and carbohydrates providing the nonprotein calories is optimal for the patient with respiratory compromise, and the patient needs to be reassessed continually to ensure that caloric intake is not excessive.

 

DIF:    Cognitive Level: Application  REF:    50

OBJ:    Nursing Process: Assessment  TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. A primary nutritional intervention for hypertension is:
a. decreasing carbohydrates.
b. limiting sodium.
c. increasing protein.
d. increasing fluids.

 

ANS:   B

For hypertensive cardiac disease, sodium chloride restriction is recommended. Some individuals are more salt-sensitive than others, and this salt sensitivity contributes to hypertension.

 

DIF:    Cognitive Level: Application  REF:    49

OBJ:    Nursing Process: Implementation       TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. An effect of malnutrition on respiratory function is:
a. decreased surfactant.
b. increased vital capacity.
c. decreased PaCO2.
d. tachypnea.

 

ANS:   A

Malnutrition has extremely adverse effects on respiratory function, decreasing both surfactant production and vital capacity.

 

DIF:    Cognitive Level: Comprehension       REF:    50

OBJ:    Nursing Process: Assessment  TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. What is the rationale for careful intake and output for the patient with pulmonary alterations?
a. Fluid retention occurs with tachypnea.
b. Hemodilution may cause deleterious hypernatremia.
c. Fluid volume excess can lead to right-sided heart failure.
d. Excessive fluid losses may lead to dehydration and hypovolemic shock.

 

ANS:   C

Pulmonary edema and failure of the right side of the heart may result from fluid volume excess, which can further worsen the status of the patient with respiratory compromise.

 

DIF:    Cognitive Level: Synthesis     REF:    50

OBJ:    Nursing Process: Evaluation   TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. The patient who has sustained a head injury has increased nutritional needs related to the:
a. decrease in metabolism as a result of coma.
b. decrease in blood sugar from a lack of dietary supplementation.
c. anabolism and wound healing.
d. hypermetabolism and catabolism associated with the injury.

 

ANS:   D

Patients with neurological alterations have increased needs because of hypermetabolism and catabolism after head injury.

 

DIF:    Cognitive Level: Analysis       REF:    Box 6-6

OBJ:    Nursing Process: Evaluation   TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. Mr. K is receiving corticosteroid treatment for chronic obstructive pulmonary disease. The nurse should be prepared to treat the patient as needed for episodes of:
a. hyponatremia.
b. hyperalbuminemia.
c. hyperkalemia.
d. hyperglycemia.

 

ANS:   D

Hyperglycemia is a common complication in patients receiving corticosteroids.

 

DIF:    Cognitive Level: Synthesis     REF:    51

OBJ:    Nursing Process: Assessment  TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Nutrition

 

  1. Which of the following nutritional interventions is a priority for the patient with renal disease?
a. Increase fluids to replace losses.
b. Encourage potassium-rich foods to replace losses.
c. Ensure an adequate amount of protein to prevent catabolism.
d. Limit all nutrients to account for altered renal excretion.

 

ANS:   C

The patient with renal disease must receive an adequate amount of protein to prevent catabolism of body tissues to meet energy needs. Approximately 1.5 g to 1.8 g protein/kg per day is required.

 

DIF:    Cognitive Level: Evaluation   REF:    52

OBJ:    Nursing Process: Implementation       TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. Prevention of pulmonary aspiration is best accomplished by:
a. administering intermittent feedings.
b. adding thickening agents to the tube feeding solution.
c. suctioning the patient hourly.
d. elevating the head of the bed 30-45 degrees.

 

ANS:   D

To reduce the risk of pulmonary aspiration during enteral tube feeding, keep the patient’s head elevated 30 to 45 degrees during feedings, unless contraindicated.

 

DIF:    Cognitive Level: Evaluation   REF:    Table 6-4

OBJ:    Nursing Process: Implementation       TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Reduction of Risk Potential

 

  1. Mr. F is admitted to the critical care unit with severe malnutrition as a result of hepatic failure. A triple-lumen central venous catheter is placed in the right subclavian vein and TPN is started. For which of the following complications should Mr. F be evaluated immediately after insertion of the catheter?
a. Pneumothorax
b. Arterial cannulation
c. Central venous thrombosis
d. Pulmonary aspiration

 

ANS:   A

Central vein TPN carries an increased risk of sepsis, as well as potential insertion-related complications, such as pneumothorax and hemothorax.

 

DIF:    Cognitive Level: Synthesis     REF:    Table 6-5

OBJ:    Nursing Process: Evaluation   TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Nutrition

 

  1. Mr. F is admitted to the critical care unit with severe malnutrition as a result of hepatic failure. A triple-lumen central venous catheter is placed in the right subclavian vein and TPN is started. On the third day of infusion, Mr. F has symptoms of fever and chills. Which of the following complications should be suspected?
a. Air embolism
b. Pneumothorax
c. Central venous thrombosis
d. Catheter-related sepsis

 

ANS:   D

Signs and symptoms of catheter-related sepsis include fever, chills, glucose intolerance, and positive blood cultures.

 

DIF:    Cognitive Level: Evaluation   REF:    Table 6-5

OBJ:    Nursing Process: Evaluation   TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Nutrition

 

  1. Mr. F is admitted to the critical care unit with severe malnutrition as a result of hepatic failure. A triple-lumen central venous catheter is placed in the right subclavian vein and TPN is started. Which of the following dietary restrictions should be maintained for Mr. F?
a. Fat and magnesium
b. Protein and sodium
c. Carbohydrate and potassium
d. Protein and calcium

 

ANS:   B

Protein should be restricted because it contributes to the development of encephalopathy; sodium should be restricted because it contributes to the development of edema.

 

DIF:    Cognitive Level: Analysis       REF:    53

OBJ:    Nursing Process: Implementation       TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. Which of the following medical interventions may be initiated with the onset of hyperglycemia?
a. Discontinuing the infusion
b. Adding insulin to the TPN
c. Weaning from the TPN over a 6-hour period
d. Starting an infusion of 0.9% normal saline

 

ANS:   B

One method for controlling hyperglycemia in the patient receiving TPN is to add insulin to the infusion.

 

DIF:    Cognitive Level: Application  REF:    Table 6-5

OBJ:    Nursing Process: Implementation       TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Nutrition

 

  1. Which of the following interventions is appropriate for the prevention of regurgitation of tube feeding formula?
a. Keep the tracheostomy cuff deflated during tube feedings.
b. Place the patient in the right lateral decubitus position to promote gastric emptying.
c. Stop the feeding temporarily during chest physiotherapy.
d. Place the patient in prone position to improve draining from mouth.

 

ANS:   C

To prevent regurgitation of tube feeding formula, consider giving feeding into small bowel rather than stomach; keep head elevated 30-45 degrees during feedings; and stop feedings temporarily during treatments such as chest physiotherapy.

 

DIF:    Cognitive Level: Synthesis     REF:    Table 6-4

OBJ:    Nursing Process: Implementation       TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. Ms. G’s feeding tube is occluded and cannot be flushed. The nurse knows that the best irrigant for feeding tube occlusion is:
a. cola.
b. pancreatic enzyme.
c. water.
d. juice.

 

ANS:   C

Although cranberry juice or cola beverages are sometimes used to reduce the incidence of tube occlusion, water is the preferred irrigant because it has been shown to be superior in maintaining tube patency.

 

DIF:    Cognitive Level: Application  REF:    Table 6-4

OBJ:    Nursing Process: Implementation       TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. To calculate fluid balance accurately, the nurse will use:
a. accurate intake and output records.
b. serial hematocrit readings.
c. ankle circumference measurements.
d. weekly weights.

 

ANS:   A

Maintaining careful intake and output records allows accurate assessment of fluid balance.

 

DIF:    Cognitive Level: Application  REF:    50

OBJ:    Nursing Process: Implementation       TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. When determining the appropriate diet for a patient with a neurological disorder, the nurse must assess for:
a. eye-hand coordination.
b. ability to swallow.
c. readiness to eat.
d. fine motor ability.

 

ANS:   B

Patients with neurological disorders often have an impaired gag reflex and thus their ability to swallow should be assessed when determining an appropriate diet for the patient.

 

DIF:    Cognitive Level: Evaluation   REF:    51

OBJ:    Nursing Process: Implementation       TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Reduction of Risk Potential

 

  1. For the malnourished patient with heart failure, which of the following are good food choices for several small meals daily?
a. Cheeseburgers and fresh vegetables
b. Salads and bread
c. Soups and beverages
d. Cheese and ice cream

 

ANS:   D

It is important to concentrate nutrients into as small a volume as possible and to serve small amounts frequently, rather than three large meals daily. The individual should be encouraged to consume calorie-dense foods and supplements. Good choices include meats and poultry, cheeses, yogurt, frozen yogurt, and ice cream.

 

DIF:    Cognitive Level: Evaluation   REF:    49

OBJ:    Nursing Process: Implementation       TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

COMPLETION

 

  1. The nutritional alteration most frequently encountered in the hospitalized patient is ________-_______ _________.

ANS:

protein-calorie malnutrition

The nutritional alteration most frequently encountered in the hospitalized patient is protein-calorie malnutrition.

 

DIF:    Cognitive Level: Comprehension       REF:    48

OBJ:    Nursing Process: Diagnosis     TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. Sodium and fluid restrictions ordered for the patient with heart failure are primarily aimed at reducing __________.

ANS:

preload

Sodium restriction applies in the treatment of the patient with heart failure because water follows sodium. Fluids should be restricted to 1500 to 2000 mL/day.

 

DIF:    Cognitive Level: Application  REF:    49

OBJ:    Nursing Process: Implementation       TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

MULTIPLE RESPONSE

 

  1. Which of the following signs would alert the nurse to possible nutritional alterations? (Select all that apply)
a. Impaired wound healing
b. Edema
c. Hair loss
d. Muscle wasting

 

ANS:   A, B, C, D

All of these signs are indicative of impaired nutrition.

 

DIF:    Cognitive Level: Application  REF:    Box 6-2

OBJ:    Nursing Process: Assessment  TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. In the patient with renal disease, which of the following elements should be restricted? (Select all that apply)
a. Fluid
b. Protein
c. Carbohydrates
d. Fats
e. Phosphorus

 

ANS:   A, B, E

The kidneys are responsible for the balance of fluids, protein, and other nutrients. When the kidneys are functioning suboptimally, dietary intake of those substances must be restricted.

 

DIF:    Cognitive Level: Analysis       REF:    52

OBJ:    Nursing Process: Implementation       TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

MATCHING

 

Match the formula type with the clinical example:

a. Anorexia from chronic illness
b. Sepsis
c. Inflammatory bowel disease
d. Liver disease

 

 

  1. Polymeric

 

  1. Concentrated

 

  1. Elemental

 

  1. High-nitrogen

 

  1. ANS: A DIF:    Cognitive Level: Application  REF:    Table 6-3

OBJ:    Nursing Process: Assessment  TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. ANS: D DIF:    Cognitive Level: Application  REF:    Table 6-3

OBJ:    Nursing Process: Assessment  TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. ANS: C DIF:    Cognitive Level: Application  REF:    Table 6-3

OBJ:    Nursing Process: Assessment  TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. ANS: B DIF:    Cognitive Level: Application  REF:    Table 6-3

OBJ:    Nursing Process: Assessment  TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

Match the disease state with the appropriate diet:

a. High protein; can be high in antioxidants; can be enriched with arginine, glutamine, or omega-3 fatty acids
b. Concentrated in calories; low sodium, potassium, magnesium, phosphorus, and vitamins A and D
c. Low carbohydrate, high fat, concentrated in calories
d. Enriched in BCAA; low sodium
e. High fat, low carbohydrate (most contain fiber and fructose)

 

 

  1. Pulmonary dysfunction

 

  1. Critical care, wound healing

 

  1. Hepatic failure

 

  1. Glucose intolerance

 

  1. Renal failure

 

  1. ANS: C DIF:    Cognitive Level: Analysis       REF:    Table 6-3

OBJ:    Nursing Process: Assessment  TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. ANS: A DIF:    Cognitive Level: Analysis       REF:    Table 6-3

OBJ:    Nursing Process: Assessment  TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. ANS: D DIF:    Cognitive Level: Analysis       REF:    Table 6-3

OBJ:    Nursing Process: Assessment  TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. ANS: E DIF:    Cognitive Level: Analysis       REF:    Table 6-3

OBJ:    Nursing Process: Assessment  TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. ANS: B DIF:    Cognitive Level: Analysis       REF:    Table 6-3

OBJ:    Nursing Process: Assessment  TOP:    Nutrition

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

Urden: Priorities in Critical Care Nursing, 6th Edition

 

Chapter 07: Gerontological Alterations

 

Test Bank

 

MULTIPLE CHOICE

 

Mr. Y, 68 years old, has been admitted to the coronary care unit after an inferior myocardial infarction.

 

  1. Age-related changes in myocardial pumping ability may be evidenced by:
a. increased contractility.
b. decreased contractility.
c. decreased left ventricle afterload.
d. increased cardiac output.

 

ANS:   B

Myocardial collagen content increases with age. Collagen is the principal noncontractile protein occupying the cardiac interstitium. Increased myocardial collagen content renders the myocardium less compliant.

 

DIF:    Cognitive Level: Comprehension       REF:    Table 7-1

OBJ:    Nursing Process: Assessment  TOP:    Gerontology

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

Mr. Y, 68 years old, has been admitted to the coronary care unit after an inferior myocardial infarction.

 

  1. Age-related pulmonary changes that may affect Mr. Y include:
a. increased tidal volumes.
b. weakening of intercostal muscles and the diaphragm.
c. improved cough reflex.
d. decreased sensation of the glottis.

 

ANS:   B

Strength of the diaphragm and both external and internal intercostal muscles decreases with age. During aging, skeletal muscle progressively atrophies and its energy metabolism decreases, which may partially account for the declining strength of the respiratory muscles.

 

DIF:    Cognitive Level: Comprehension       REF:    Table 7-1

OBJ:    Nursing Process: Assessment  TOP:    Gerontology

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

Mr. Y, 68 years old, has been admitted to the coronary care unit after an inferior myocardial infarction.

 

  1. Dopamine 5 mcg/kg per minute has been ordered for Mr. Y. What nursing implications should be considered when administering this drug to an older patient?
a. No changes are noted in older patients with this drug.
b. Drug effect is enhanced by increased receptor site action.
c. Increased breakdown by liver hepatocytes occurs, increasing dosage requirements.
d. Drug metabolism and detoxification are slowed, increasing the risks of drug toxicity.

 

ANS:   D

The decreasing ability of the older patient’s liver to metabolize drugs increases the risks of drug toxicity. This reduced drug-metabolizing capacity is caused by a reduction in the activity of the drug-metabolizing enzyme system, microsomal ethanol oxidizing system, and decrease in total liver blood flow.

 

DIF:    Cognitive Level: Application  REF:    Table 7-4

OBJ:    Nursing Process: Intervention TOP:    Gerontology

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

Mr. Y, 68 years old, has been admitted to the coronary care unit after an inferior myocardial infarction.

 

  1. When caring for Mr. Y, the nurse plans increased attention to skin integrity because of the:
a. thickening of the epidermal skin layer.
b. loss of sebaceous glands.
c. increased fragility from loss of protective subcutaneous layers.
d. decreased melanocyte production.

 

ANS:   C

The nurse may also find multiple ecchymotic areas because of decreased protective subcutaneous tissue layers, increased capillary fragility, and flattening of the capillary bed, which predispose older adults to developing ecchymoses.

 

DIF:    Cognitive Level: Comprehension       REF:    72

OBJ:    Nursing Process: Intervention TOP:    Gerontology

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

Mr. Y, 68 years old, has been admitted to the coronary care unit after an inferior myocardial infarction.

 

  1. Mr. Y awakens during the night confused and disoriented. This may be in part because of:
a. impaired sensation of peripheral receptors.
b. increased nerve impulse conduction resulting in increased anxiety.
c. changes in neurotransmitter levels, leading to a desynchronization in neurotransmission.
d. inevitable dementia.

 

ANS:   C

It is suggested that age-related changes in neurotransmitter levels may cause a desynchronization in neurotransmission, thereby affecting many neurological functions. Acetylcholine, dopamine, serotonin, glutamate, and gamma-aminobutyric acid all decrease with increasing age.

 

DIF:    Cognitive Level: Comprehension       REF:    70

OBJ:    Nursing Process: Diagnosis     TOP:    Gerontology

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. An older patient is admitted to the hospital with acute onset of mental changes and recent falls. The nurse knows that the most common cause of mental changes is:
a. over medication.
b. infection.
c. cerebral vascular accident.
d. electrolyte imbalance.

 

ANS:   B

Infections in the older adult initially appear as an acute onset of mental status changes, anorexia, urinary incontinence, falls, or generalized weakness. Urinary tract infections and pneumonia are also common infections that should be ruled out.

 

DIF:    Cognitive Level: Application  REF:    70

OBJ:    Nursing Process: Diagnosis     TOP:    Gerontology

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. An older patient is started on an angiotensin-converting enzyme (ACE) inhibitor. The nurse knows to monitor for:
a. hyperkalemia.
b. irregular heart rate.
c. confusion.
d. pulmonary edema.

 

ANS:   A

In the critically ill older adult, drugs such as digoxin, ACE II inhibitors, and angiotensin II receptor blockers have delayed excretion, increased serum concentration, and more prolonged duration of action because their excretion parallels glomerular filtration rate, which decreases with age.

 

DIF:    Cognitive Level: Application  REF:    72

OBJ:    Nursing Process: Evaluation   TOP:    Gerontology

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. The nurse is teaching an older patient about the signs and symptoms of a myocardial infarction. Which statement by the patient would indicate that the teaching was effective?
a. “The pain in my chest may last a long time.”
b. “I will feel like I have an elephant sitting on the center of my chest.”
c. “The chest pain will be sharp and over the center of my chest.”
d. “The pain may not be severe and may not be in my chest.”

 

ANS:   D

Studies have shown that symptoms of chest pain were absent in up to 50% of older adult patients who sustained a myocardial infarction. Others have also reported that chest pain in the older adult is less intense, of shorter duration, and originates in other areas of the chest besides the substernal region.

 

DIF:    Cognitive Level: Analysis       REF:    65

OBJ:    Nursing Process: Evaluation   TOP:    Gerontology

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. Which of the following would be a normal assessment finding for an older patient?
a. Inability to remember what was eaten yesterday
b. An increase in resting heart rate
c. Hypoactive bowel sounds
d. Brisk papillary response to light

 

ANS:   A

An older person may have problems with short-term memory, but long-term memory is intact. Resting heart rate decreases. Although gastrointestinal motility changes occur, bowel sounds remain unchanged. Pupillary response to light slows down.

 

DIF:    Cognitive Level: Application  REF:    70

OBJ:    Nursing Process: Assessment  TOP:    Gerontology

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. An older patient is admitted to the hospital with a hip fracture. Which of the following nursing interventions would be a priority?
a. Facilitate frequent deep breathing.
b. Palpate pedal pulses.
c. Perform neurological checks.
d. Frequently offer liquids to drink.

 

ANS:   A

Although all the items are important, older persons are more susceptible to atelectasis and pulmonary infection because of respiratory changes. Nursing care needs to be provided to prevent those complications.

 

DIF:    Cognitive Level: Analysis       REF:    Table 7-1

OBJ:    Nursing Process: Intervention TOP:    Gerontology

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. An older patient is starting a new medication that is metabolized in the liver and excreted by the kidneys. Which is the best assessment to monitor the patient’s ability to tolerate the medication?
a. Liver function tests
b. Drug side effects experienced by the patient
c. Kidney function tests
d. Therapeutic drug levels

 

ANS:   B

It is well documented that older persons are more susceptible to drug side effects and adverse effects. Although the liver’s ability to metabolize drugs is decreased, no changes in liver function test results occur.

 

DIF:    Cognitive Level: Analysis       REF:    72

OBJ:    Nursing Process: Evaluation   TOP:    Gerontology

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. An older patient is receiving a nephrotoxic medication. Which of the following would be a priority for the nurse to monitor?
a. Electrocardiogram
b. Lung sounds
c. Blood pressure
d. Level of consciousness

 

ANS:   C

Because of the decreased number of nephrons and decreased glomerular filtration rate, an older patient’s kidneys are more susceptible to damage from nephrotoxic drugs. The senescent kidney is more susceptible to injury by hypotensive episodes because of the age-related decrease in renal blood flow and reduced pressure gradient across the afferent arteriole.

 

DIF:    Cognitive Level: Analysis       REF:    69

OBJ:    Nursing Process: Intervention TOP:    Gerontology

MSC:   NCLEX: Physiological Integrity Physiological Adaptation

 

  1. Which of the following can be a normal assessment finding for an older patient?
a. Asymptomatic dysrhythmias
b. Decreased urine output
c. Increased respiratory effort
d. Difficulty problem solving

 

ANS:   A

The incidence of asymptomatic cardiac dysrhythmias increases in older patients. Common dysrhythmias are atrial fibrillation, atrial flutter, or paroxysmal supraventricular tachycardia, premature ventricular contractions, and atrioventricular conduction disturbances. All the other findings are abnormal.

 

DIF:    Cognitive Level: Analysis       REF:    66

OBJ:    Nursing Process: Assessment  TOP:    Gerontology

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. Which of the following will remain unchanged in an older person when he or she exercises?
a. Cardiac output
b. Heart rate
c. Blood pressure
d. Heart rhythm

 

ANS:   A

In healthy older individuals there is no age-associated decline in cardiac output during exercise. The maximal heart rate decreases, but the stroke volume increases to compensate.

 

DIF:    Cognitive Level: Comprehension       REF:    Table 7-1

OBJ:    Nursing Process: Assessment  TOP:    Gerontology

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. A critically ill older adult is placed on a continuous infusion of high-dose loop diuretic for diuresis. The nurse knows to monitor for:
a. hyperkalemia.
b. bradycardia.
c. metabolic acidosis.
d. hyperchloremic alkalosis.

 

ANS:   C

The rate of absorption, time to peak plasma concentration, and clearance of loop diuretics is reduced, which may necessitate high dosing regimens to facilitate diuresis. This poses an increased risk of metabolic acidosis. The patient should be monitored for hypokalemia, tachycardia, and hypochloremic alkalosis with loop diuretics.

 

DIF:    Cognitive Level: Application  REF:    69

OBJ:    Nursing Process: Evaluation   TOP:    Gerontology

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. Because of the changes in the ventricles of the elderly patient’s brain, the nurse institutes precautions for which of the following?
a. Bleeding
b. Seizure
c. Falling
d. Confusion

 

ANS:   C

The dilation of the ventricles results in a decrease in the number of Purkinje cells and loss of cells in the vestibular system.

 

DIF:    Cognitive Level: Synthesis     REF:    Table 7-1

OBJ:    Nursing Process: Implementation       TOP:    Gerontology

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. Changes in the elderly patient’s renal function may alter serum concentrations of medication because of:
a. delayed excretion.
b. alterations in urinary pH.
c. increased filtration.
d. adverse drug reactions.

 

ANS:   A

Drugs associated with management of common disorders seen in critically ill patients—such as digoxin, angiotensin II–converting enzyme inhibitors, and angiotensin-II receptor blockers—show delayed excretion, increased serum concentration, and more prolonged duration of action in the elderly because their excretion parallels glomerular filtration rate (which decreases with age).

 

DIF:    Cognitive Level: Application  REF:    72

OBJ:    Nursing Process: Evaluation   TOP:    Gerontology

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. The nurse would implement which of the following interventions to help prevent esophagitis in an elderly patient?
a. Encourage intake of fluids.
b. Offer a liquid diet.
c. Offer several small meals daily.
d. Encourage ambulation and elevate the head of the bed.

 

ANS:   D

Changes in esophageal motility may predispose the patient to erosion of the esophageal wall (recurrent esophagitis) because food remains in the esophagus longer. In addition, bed rest and reclining in a supine position for a prolonged period can cause esophageal reflux, which can also lead to esophagitis.

 

DIF:    Cognitive Level: Application  REF:    69

OBJ:    Nursing Process: Implementation       TOP:    Gerontology

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. Changes in the diaphragm and accessory and abdominal muscles have what effect on the elderly patient?
a. Decreased residual volume
b. Decreased tidal volume
c. Increased residual volume
d. Increased tidal volume

 

ANS:   C

Increased weakness of the diaphragm and abdominal and accessory muscles leads to decreased ability to inhale and exhale.

 

DIF:    Cognitive Level: Analysis       REF:    68

OBJ:    Nursing Process: Assessment  TOP:    Gerontology

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. Calcification of costal cartilage is demonstrated on an elderly patient’s admission chest radiograph. The nurse will plan careful, regular assessment of:
a. thoracic wall excursion.
b. respiratory rate.
c. breath sounds.
d. oxygen saturation.

 

ANS:   A

With advancing age the chest wall (thoracic skeleton) and vertebrae undergo a small degree of osteoporosis, and at the same time the costal cartilages that connect the rib cage together become calcified and stiff. These changes may produce kyphosis and reduced chest wall compliance, respectively. The functional effect is a decrease in thoracic wall excursion.

 

DIF:    Cognitive Level: Analysis       REF:    68

OBJ:    Nursing Process: Assessment  TOP:    Gerontology

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

COMPLETION

 

  1. Mineral loss associated with a decrease in bone mass is referred to as __________.

ANS:

osteoporosis

Mineral loss associated with a decrease in bone mass is referred to as osteoporosis.

 

DIF:    Cognitive Level: Knowledge  REF:    72

OBJ:    Nursing Process: Diagnosis     TOP:    Gerontology

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

MULTIPLE RESPONSE

 

  1. Which of the following contribute to a higher risk for myocardial ischemia in the older patient? (Select all that apply)
a. Increased diastolic filling pressures
b. Decreased intracellular free calcium
c. Thinning left ventricular wall thickness
d. Increased myocardial collagen content
e. Increased myocardial oxygen consumption

 

ANS:   A, D, E

Increased myocardial collagen leads to decreased compliance.

 

DIF:    Cognitive Level: Application  REF:    65

OBJ:    Nursing Process: Diagnosis     TOP:    Gerontology

MSC:   NCLEX: Physiological Integrity

 

  1. The nurse should be alert for immune deficiencies in the older patient because of which of the following? (Select all that apply)
a. Nutritional deficiencies
b. Presence of chronic illnesses
c. Insertion of invasive devices
d. Decreased total lung capacity
e. Increased peristaltic action in the esophagus

 

ANS:   A, B, C

Older patients are at higher risk for infection because of the likely presence of protein-calorie malnutrition, poor dentition, swallowing difficulties that can lead to aspiration, and chronic illnesses that leave the patient in a vulnerable state.

 

DIF:    Cognitive Level: Application  REF:    71

OBJ:    Nursing Process: Diagnosis     TOP:    Gerontology

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. Muscle rigidity in the elderly is seen primarily in: (Select all that apply)
a. hands and wrists.
b. neck and shoulders.
c. hips and knees.
d. back and ankles.

 

ANS:   B, C

Muscle rigidity increases in the elderly, especially in the neck, shoulders, hips, and knees, possibly causing changes in range of motion.

 

DIF:    Cognitive Level: Knowledge  REF:    72

OBJ:    Nursing Process: Assessment  TOP:    Gerontology

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

Urden: Priorities in Critical Care Nursing, 6th Edition

 

Chapter 09: Sedation and Delirium Management

 

Test Bank

 

MULTIPLE CHOICE

 

  1. To ensure patient comfort and respiratory function during a bedside procedure, which of the following might be used?
a. General anesthesia
b. Moderate sedation
c. Local anesthesia
d. Deep sedation

 

ANS:   B

Moderate sedation with analgesia (also known as conscious sedation or procedural sedation) is drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.

 

DIF:    Cognitive Level: Application  REF:    Box 9-1

OBJ:    Nursing Process: Planning      TOP:    Sedation Management

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. In assessing an agitated patient who has been in a motor vehicle accident, the nurse will first rule out:
a. psychosis.
b. delirium.
c. pain.
d. infection.

 

ANS:   C

The first step in assessing the agitated patient is to rule out any sensations of pain.

 

DIF:    Cognitive Level: Comprehension       REF:    95

OBJ:    Nursing Process: Evaluation   TOP:    Sedation Management

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. One advantage to the use of propofol (Diprivan) for conscious sedation is that it:
a. is long acting and will provide sedation for several hours.
b. has a very short half-life and will have a short duration of action.
c. has few drug interactions with other medications.
d. has a low risk of sensitivity for most patients.

 

ANS:   B

The clinical advantage of propofol is its very short half-life and rapid elimination from the body. It does not have active metabolites.

 

DIF:    Cognitive Level: Comprehension       REF:    98

OBJ:    Nursing Process: Planning      TOP:    Sedation Management

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient who is undergoing continuous administration of sedation has become unresponsive. The nurse will first assess for:
a. oversedation.
b. brain herniation.
c. cerebral hemorrhage.
d. drug interaction.

 

ANS:   A

Oversedation is recognized as a state of unintended patient unresponsiveness in which the patient resides in a state of suspended animation that resembles general anesthesia.

 

DIF:    Cognitive Level: Analysis       REF:    95

OBJ:    Nursing Process: Evaluation   TOP:    Sedation Management

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The family is asking about the fact that the patient was suddenly disoriented and showed inappropriate behavior 2 days earlier but is now alert and oriented. The nurse explains to them that this was an instance of:
a. overmedication.
b. inadequate analgesia.
c. delirium.
d. psychosis.

 

ANS:   C

Delirium is described as a reversible global impairment of cognitive processes, usually of sudden onset, coupled with disorientation, impaired short-term memory, altered sensory perception (hallucinations), abnormal thought processes, and inappropriate behavior.

 

DIF:    Cognitive Level: Comprehension       REF:    101

OBJ:    Nursing Process: Assessment  TOP:    Sedation Management

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. A patient who has been deeply sedated for a prolonged interval must be monitored for:
a. complications of immobility.
b. drastic weight loss.
c. restlessness and anxiety.
d. altered mentation.

 

ANS:   A

Prolonged deep sedation is associated with significant complications of immobility, including pressure ulcers, thromboemboli, gastric ileus, nosocomial pneumonia, and delayed weaning from mechanical ventilation.

 

DIF:    Cognitive Level: Application  REF:    101

OBJ:    Nursing Process: Implementation       TOP:    Sedation Management

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. For the safety of the patient who is sedated with midazolam (Versed), the nurse will be sure to have available:
a. naloxone (Narcan).
b. flumazenil (Romazicon).
c. glucagons.
d. naltrexone (ReVia).

 

ANS:   B

Flumazenil is the antidote used to reverse benzodiazepine overdose in symptomatic patients, if needed.

 

DIF:    Cognitive Level: Application  REF:    98

OBJ:    Nursing Process: Planning      TOP:    Sedation Management

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is careful to monitor the patient’s withdrawal from benzodiazepines, knowing that abrupt cessation can put the patient at risk for:
a. seizures.
b. addiction.
c. circulatory collapse.
d. hypertensive crisis.

 

ANS:   A

Flumazenil should be avoided in patients with benzodiazepine dependence because rapid withdrawal can induce seizures.

 

DIF:    Cognitive Level: Comprehension       REF:    101

OBJ:    Nursing Process: Planning      TOP:    Sedation Management

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. Which of the following medications has a weak amnesic effect?
a. Diazepam (Valium)
b. Midazolam (Versed)
c. Propofol (Diprivan)
d. Lorazepam (Ativan)

 

ANS:   C

Benzodiazepines are sedative-hypnotics with powerful amnesic properties that inhibit reception of new sensory information. Propofol is not a reliable amnesic, and patients sedated with only propofol can have vivid recollections of their experiences.

 

DIF:    Cognitive Level: Application  REF:    98

OBJ:    Nursing Process: Planning      TOP:    Sedation Management

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. In preparing to administer propofol for sedation, the nurse will:
a. piggy-back the medication into the primary infusion line.
b. interrupt the primary infusion during the administration of the drug and then resume the primary infusion.
c. secure a dedicated intravenous (IV) line and change all tubing every 12 hours.
d. administer the infusion through one port of a central line.

 

ANS:   C

The lipid emulsion of propofol can act as a potential medium for bacterial growth. Administration requires a dedicated IV line, and all IV solution and tubing must be changed every 12 hours.

 

DIF:    Cognitive Level: Application  REF:    98

OBJ:    Nursing Process: Implementation       TOP:    Sedation Management

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. Due to the properties of sedatives, during rapid infusion the nurse will be sure to monitor:
a. blood pressure.
b. heart rate.
c. respiratory rate.
d. temperature.

 

ANS:   A

Propofol shares with other sedatives the propensity for causing hypotension when delivered rapidly.

 

DIF:    Cognitive Level: Application  REF:    Table 9-2

OBJ:    Nursing Process: Evaluation   TOP:    Sedation Management

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The family is very frightened that the patient’s sedation is being suspended each day. The nurse explains that this is to:
a. allow the patient to communicate with the staff.
b. reduce the risk of dependence and complications.
c. evaluate the need for intravenous access.
d. minimize the expense of continuous administration of sedation.

 

ANS:   B

Intubated patients who were woken up daily by turning off their sedative infusions experienced a lower rate of complications and lower levels of posttraumatic stress disorder.

 

DIF:    Cognitive Level: Application  REF:    101

OBJ:    Nursing Process: Evaluation   TOP:    Sedation Management

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The family asks why the agitated patient, who is receiving haloperidol (Haldol), is undergoing electrocardiographic (ECG) monitoring, because there is no evidence of a “heart attack.” The nurse explains:
a. “There is concern that the agitation may trigger cardiac problems.”
b. “Haldol is being given to control agitation and there is some risk of cardiac changes related to the medication.”
c. “It is routine for everyone in the critical care unit to undergo ECG monitoring at all times.”
d. “The ECG strips will document that there is no cardiac problem for the patient.”

 

ANS:   B

ECG monitoring is recommended during the use of haloperidol (Haldol) because neuroleptic agents produce dose-dependent QT interval prolongation, with an increased incidence of ventricular dysrhythmias.

 

DIF:    Cognitive Level: Comprehension       REF:    102

OBJ:    Nursing Process: Implementation       TOP:    Sedation Management

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The most accurate and objective method of assessing and recording levels of sedation and agitation is:
a. consensus among nursing staff assigned to the patient.
b. use of standardized scoring systems.
c. documentation of motor activities.
d. patient self-reports.

 

ANS:   B

The use of scoring systems to assess and record levels of sedation and agitation is now strongly recommended.

 

DIF:    Cognitive Level: Application  REF:    95

OBJ:    Nursing Process: Assessment  TOP:    Sedation Management

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. To implement and monitor the results of an effective and prudent plan for analgesia and sedation in the critically ill intubated patient, there must be:
a. at least four providers of care to create consensus for the plan.
b. a deadline by which the plan must have been completed.
c. a stated, observable, and/or measurable goal for the analgesia and sedation.
d. certification of special skills for all providers involved in the patient’s care.

 

ANS:   C

It is recommended that a goal for analgesia and sedation be established for all critically ill, intubated, mechanically ventilated patients. Once the sedation goal is articulated and documented, the ongoing use of a validated assessment scale is recommended to facilitate consistency of implementation among all critical care practitioners.

 

DIF:    Cognitive Level: Comprehension       REF:    95

OBJ:    Nursing Process: Planning      TOP:    Sedation Management

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. Which of the following medications would have an advantage in sedating the patient with head injury?
a. Diazepam
b. Morphine
c. Midazolam
d. Propofol

 

ANS:   D

Propofol quickly crosses the blood-brain barrier, slows cerebral metabolism, and decreases elevated intracranial pressure.

 

DIF:    Cognitive Level: Analysis       REF:    98

OBJ:    Nursing Process: Implementation       TOP:    Sedation Management

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. During the second week of stay in the critical care unit, the patient has the following laboratory results: potassium, 6.0 mmol/L; CO2, 36 mEq/L; Cl, 103 mEq/L; HCO3, 38 mEq/L; and dark reddish urine. The nurse recognizes that these results may signal which of the following?
a. Severe infection
b. Toxic shock syndrome
c. Propofol infusion syndrome
d. Hepatitis

 

ANS:   C

Propofol infusion syndrome is a rare complication of prolonged high-dose propofol administration. It occurs more commonly in children than in adult critically ill patients. The syndrome includes cardiac arrest, myocardial failure, metabolic acidosis, rhabdomyolysis, and hyperkalemia, which occur on day 4 or 5 following very high-dose propofol infusion.

 

DIF:    Cognitive Level: Evaluation   REF:    98

OBJ:    Nursing Process: Assessment  TOP:    Sedation Management

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The patient’s wife is confused about why her husband, who is undergoing alcohol withdrawal symptoms, is wearing a clonidine patch on his arm containing the same blood pressure medication that she takes at home. The nurse will explain to her:
a. “Although it is most commonly given to control blood pressure, clonidine can also be used to manage alcohol withdrawal.”
b. “Your husband is under great stress here in the critical care unit, and we want to make sure that his blood pressure doesn’t get too high.”
c. “The medication is given to enhance the pain-relieving effects of the other drugs that he is being given.”
d. “We are giving the drug so that his blood pressure will not get so high that he has seizures.”

 

ANS:   A

Clonidine (Catapres) is an older a2 -agonist, that may be administered as a transdermal patch, as adjunctive therapy, for patients with alcohol use disorder; it is not used for sedation.

 

DIF:    Cognitive Level: Application  REF:    100

OBJ:    Nursing Process: Implementation       TOP:    Sedation Management

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. To achieve ventilator synchrony in the mechanically ventilated patient with acute respiratory distress syndrome, which level of sedation might be most effective?
a. Light
b. Moderate
c. Conscious
d. Deep

 

ANS:   D

Deep sedation is used when the patient must be unresponsive in order for necessary care to be delivered safely.

 

DIF:    Cognitive Level: Application  REF:    Box 9-1

OBJ:    Nursing Process: Planning      TOP:    Sedation Management

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. When administering propofol over an extended period, it is important to monitor which of the following?
a. Serum triglyceride level
b. Sodium and potassium levels
c. Platelet count
d. Acid-base balance

 

ANS:   A

Prolonged use of propofol may cause an elevated triglyceride level because of its high lipid content.

 

DIF:    Cognitive Level: Analysis       REF:    98

OBJ:    Nursing Process: Assessment  TOP:    Sedation Management

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The major side effect of benzodiazepines is:
a. hypertension.
b. respiratory depression.
c. renal failure.
d. phlebitis at the IV site.

 

ANS:   B

The major side effects of benzodiazepines include hypotension and respiratory depression. These side effects are dose related.

 

DIF:    Cognitive Level: Comprehension       REF:    98

OBJ:    Nursing Process: Assessment  TOP:    Sedation Management

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. Which of the following drugs is used for management of patients experiencing alcohol withdrawal syndrome?
a. Dexmedetomidine
b. Hydromorphone
c. Morphine
d. Lorazepam (Ativan)

 

ANS:   D

Management of alcohol withdrawal involves close monitoring of AWS-related agitation and administration of IV benzodiazepines, generally diazepam (Valium) or lorazepam (Ativan).

 

DIF:    Cognitive Level: Knowledge  REF:    102

OBJ:    Nursing Process: Intervention TOP:    Sedation Management

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. Ms. J has been in the critical care unit for 3 days and has just been weaned from mechanical ventilation. She suddenly becomes confused, seeing nonexistent animals in her room and pulling at her gown. The drug of choice for treating Ms. J is:
a. diazepam.
b. haloperidol.
c. lorazepam.
d. propofol.

 

ANS:   B

The patient is experiencing delirium and haloperidol is the drug of choice for treating delirium.

 

DIF:    Cognitive Level: Evaluation   REF:    102

OBJ:    Nursing Process: Planning      TOP:    Sedation Management

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

MULTIPLE RESPONSE

 

  1. Which of the following complications can result from oversedation? (Select all that apply)
a. Pressure ulcers
b. Thromboemboli
c. Gastric ileus
d. Hospital-acquired pneumonia
e. Delayed weaning from mechanical ventilation

 

ANS:   A, B, C, D, E

Oversedation can result in a multitude of complications.

 

DIF:    Cognitive Level: Synthesis     REF:    95

OBJ:    Nursing Process: Planning      TOP:    Sedation Management

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

MATCHING

 

Match the following terms with the correct definition.

a. Light sedation
b. Moderate sedation
c. Deep sedation
d. Confusion Assessment Method for the Intensive Care Unit (CAM-ICU)
e. Intensive Care Delirium Screening Checklist (ICDSC)

 

  1. Used when the procedure or treatment requires the patient to be unresponsive

 

  1. Used to assess delirium in the mechanically ventilated patient; includes information from the previous 24 hours

 

  1. Used to relieve anxiety while allowing the patient to remain responsive

 

  1. Used in conjunction with analgesia to ensure patient comfort during painful procedures

 

  1. Used to assess delirium in the mechanically ventilated patient; includes information for a specific point in time

 

  1. ANS: C DIF:    Cognitive Level: Comprehension       REF:    Box 9-1

OBJ:    Nursing Process: Assessment  TOP:    Sedation Management

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. ANS: E DIF:    Cognitive Level: Comprehension       REF:    101

OBJ:    Nursing Process: Assessment  TOP:    Sedation Management

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. ANS: A DIF:    Cognitive Level: Comprehension       REF:    Box 9-1

OBJ:    Nursing Process: Assessment  TOP:    Sedation Management

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. ANS: B DIF:    Cognitive Level: Comprehension       REF:    Box 9-1

OBJ:    Nursing Process: Assessment  TOP:    Sedation Management

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. ANS: D DIF:    Cognitive Level: Comprehension       REF:    101

OBJ:    Nursing Process: Assessment  TOP:    Sedation Management

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation