663 Critical Care

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Sample questions from 663 Critical Care

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.In the pediatric intensive care unit, a 3-month-old infant with bronchiolitis has become difficult to arouse. The monitor shows HR 72/min, RR 10/min with shallow respirations, BP 68/38 mm Hg, and SpO2 82% despite high-flow oxygen. Which action should the nurse take first?

   • A.Document the findings and reassess in 5 minutes.
   • B.Notify the respiratory therapist and wait for an assessment.
   • C.Increase the high-flow oxygen to the maximum setting.
   • D.Activate the rapid response team and prepare to support ventilation.

   Rationale: The infant has signs of impending respiratory failure, including bradypnea, bradycardia, decreased responsiveness, and severe hypoxemia, so immediate emergency assistance and ventilatory support are priorities. Increasing oxygen alone may not correct inadequate ventilation. Waiting for a respiratory therapist or delaying to document risks further deterioration.

2. 2.At change of shift in a 20-bed intensive care unit, the charge nurse assigns tasks to a registered nurse, a licensed practical nurse, and an experienced unlicensed assistive personnel (UAP). Which tasks are appropriate to delegate to the UAP? Select all that apply.

   • A.Assess a newly admitted client's orientation and pupil response.
   • B.Ambulate a stable postoperative client after the registered nurse confirms the activity plan.
   • C.Teach a family member how to use the call system before leaving the room.
   • D.Obtain and report the hourly urine output for a stable client receiving maintenance fluids.
   • E.Measure and report the temperature of a stable client receiving a blood transfusion.
   • F.Assist a stable, mechanically ventilated client with oral care after the registered nurse assesses the client.

   Rationale: A UAP may collect and report routine measurements, provide established hygiene care, and assist with planned mobility for stable clients; the registered nurse remains responsible for interpreting findings and supervising the task. Assessing a new admission requires nursing judgment, and teaching the family is the registered nurse's responsibility. Monitoring a client during a transfusion requires nursing assessment because a temperature change may indicate a reaction.

3. 3.Refer to the client's chart. Which actions should the nurse take now for this client with suspected sepsis and worsening perfusion? Select all that apply.

   • A.Administer the prescribed broad-spectrum antimicrobial promptly after cultures are obtained.
   • B.Activate the facility's sepsis response and notify the provider of the worsening perfusion.
   • C.Give an oral fluid challenge and withhold the IV bolus until the client can drink.
   • D.Obtain the prescribed blood cultures before the first antimicrobial dose, without delaying treatment unnecessarily.
   • E.Wait for the next scheduled vital-sign check before reporting the trend.
   • F.Begin the prescribed isotonic fluid bolus and closely reassess the client's response.

   Rationale: The chart shows deterioration from BP 104/66 to 86/50 mm Hg, HR 118 to 132/min, urine output of 15 mL/hr, elevated lactate of 4.2 mmol/L, and delayed capillary refill, which require urgent escalation and treatment. Cultures should be collected before antimicrobials when this can be done without delaying timely antimicrobial therapy, and the prescribed fluid bolus should be started with close reassessment. Waiting to report the trend or relying on oral fluids would delay needed treatment in a client with hypotension and impaired perfusion.

4. 4.In the coronary care unit, a 67-year-old client who is receiving a heparin infusion for a pulmonary embolism develops sudden severe back pain and new weakness in both legs. The blood pressure is 88/54 mm Hg, and the client appears pale. Which action should the nurse take first?

   • A.Raise the head of the bed and encourage deep breathing.
   • B.Stop the heparin infusion and notify the provider immediately.
   • C.Give the next scheduled dose of analgesic and reassess the pain.
   • D.Document the findings and request a routine physical therapy evaluation.

   Answer and rationale are in the full material.

5. 5.A provider prescribes an IV potassium chloride infusion for a 16-year-old client in the pediatric intensive care unit with a potassium level of 2.7 mEq/L. The client has a central venous catheter and continuous cardiac monitoring. Which action should the nurse take?

   • A.Mix the potassium into a hanging IV bag at the bedside.
   • B.Administer the potassium by IV push to correct the level rapidly.
   • C.Verify the prescribed concentration and rate, and use an infusion pump.
   • D.Delegate administration of the infusion to the unlicensed assistive personnel.

   Answer and rationale are in the full material.