ATI RN
Critical Care Nursing Practice Questions Questions
Question 1 of 5
Which statement is true regarding oral care for the prevention of ventilator-associated pneumonia (VAP)? (Select all that apply.)
Correct Answer: B
Rationale: The correct answer is B. Implementing a comprehensive oral care program is an intervention for preventing VAP. This statement is true because proper oral care, including brushing teeth, oral suctioning, and using chlorhexidine gluconate, has been shown to reduce the risk of VAP by decreasing the colonization of pathogenic bacteria in the oral cavity. Regular oral care helps maintain oral hygiene and reduce the risk of aspiration of bacteria into the lungs, which is a common cause of VAP. Incorrect Answer Analysis: A: Tooth brushing every 2 hours may be excessive and could potentially cause harm to the oral mucosa, leading to increased risk of infection. C: While oral suctioning and brushing teeth are important components of oral care, the statement is not comprehensive enough to address the full range of interventions needed to prevent VAP. D: While chlorhexidine gluconate can be effective in preventing VAP, the statement implies that it is the only effective intervention, which is not true.
Question 2 of 5
After coronary artery bypass graft surgery a patient is transported to the surgical intensive care unit at noon and placed on mechanical ventilation. How sh ould the nurse interpret the patient�s initial arterial blood gas levels? pH 7.31 PaCO 48 mm Hg Bicarbonate 22 mEq/L PaO 115 mm Hg O saturation 99%
Correct Answer: B
Rationale: The correct answer is B: Partly compensated respiratory acidosis, normal oxygen. The pH of 7.31 indicates acidosis, the PaCO2 of 48 mm Hg shows respiratory acidosis, and the bicarbonate level of 22 mEq/L is slightly elevated, indicating the kidneys are compensating. The PaO2 of 115 mm Hg and oxygen saturation of 99% are normal, ruling out hypoxemia. Therefore, the patient is experiencing partly compensated respiratory acidosis. A: Normal arterial blood gas levels with a high oxygen level - Incorrect. The pH is low, indicating acidosis, which is not normal. C: Uncompensated metabolic acidosis with high oxygen level - Incorrect. Metabolic acidosis would have a primary issue with bicarbonate levels, which is not the case here. D: Uncompensated respiratory acidosis; hyperoxygenated - Incorrect. The oxygen levels are normal, ruling out hyperoxygenation.
Question 3 of 5
A nurse wishes to practice using the Synergy Model developed by the American Association of Critical-Care Nurses (AACN). What nursing behavior best supports use of this model?
Correct Answer: B
Rationale: The correct answer is B: Self-directed study of best practice for the patients she cares for. This choice aligns with the Synergy Model by promoting individualized patient care based on best practices. Self-directed study allows the nurse to enhance their knowledge and skills to provide optimal care tailored to each patient's unique needs. Attending mandatory in-service programs (A) may not directly support the individualized care approach. Gathering demographic data (C) is important but not specific to the Synergy Model's focus on patient acuity and nurse competencies. Participating in a research study (D) may contribute to evidence-based practice, but it does not directly relate to the Synergy Model's emphasis on aligning nurse competencies with patient needs.
Question 4 of 5
assessment, the patient is restless, heart rate has increased to 110 beats/min, respirations are 36 breaths/min, and blood pressure is 156/98 mm Hg. The cardiac monitor shows sinaubsir bt.acocmh/ytecsat rdia with 10 premature ventricular contractions (PVCs) per minute. Pulmonary artery pressures are elevated. The nurse suctions the patient and obtains pink, frothy secretio ns. Loud crackles are audible throughout lung fields. The nurse notifies the physician, w ho orders an ABG analysis, electrolyte levels, and a portable chest x-ray study. How d oes the nurse interpret the following blood gas levels? pH 7.28 PaCO 46 mm Hg Bicarbonate 22 mEq/L PaO 58 mm Hg O saturation 88% 2
Correct Answer: B
Rationale: The correct answer is B: Hypoxemia and uncompensated respiratory acidosis. Step-by-step rationale: 1. pH is low (7.28), indicating acidosis. 2. PaCO2 is elevated (46 mm Hg), indicating respiratory acidosis. 3. PaO2 is low (58 mm Hg), indicating hypoxemia. 4. Bicarbonate is within normal range (22 mEq/L), suggesting no compensation for the acidosis. 5. Oxygen saturation is low (88%), supporting the presence of hypoxemia. Summary: A: Incorrect - pH is low, not indicating compensated alkalosis. C: Incorrect - Various abnormalities in the blood gas levels are present. D: Incorrect - There is hypoxemia and uncompensated acidosis, not metabolic alkalosis.
Question 5 of 5
A patient is admitted to the ICU with injuries sustained from a fall from a third-story window. The patient is conscious, his breathing is labored, and he is bleeding heavily from the abdomen. He groans constantly and complains of severe pain, but his movements are minimal. His heart rate is elevated. Which of these is a sign that he is in the second phase of the stress response? Select all that apply.
Correct Answer: C
Rationale: The correct answer is C: Severe pain. In the second phase of the stress response (resistance phase), the body is trying to cope with the stressor. Severe pain is a sign of the body's response to the injury, indicating the activation of the stress response. Labored breathing and elevated heart rate are more likely to be signs of the initial phase (alarm phase) of the stress response. Bleeding heavily from the abdomen is a medical emergency and does not specifically indicate the stress response phase.
Similar Questions
Join Our Community Today!
Join Over 10,000+ nursing students using Nurselytic. Access Comprehensive study Guides curriculum for ATI-RN and 3000+ practice questions to help you pass your ATI-RN exam.
Subscribe for Unlimited Access