Medical Surgical Critical Care

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Sample questions from Medical Surgical Critical Care

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

1. 1.In the emergency department, a client with chest pressure becomes pale and diaphoretic. Which action should the nurse take first?

   • A.Administer the prescribed morphine
   • B.Obtain a 12-lead ECG
   • C.Prepare the client for a stress test
   • D.Ask the client to describe the pain on a 0-to-10 scale

   Rationale: A 12-lead ECG should be obtained promptly to identify acute ischemia and guide time-sensitive treatment. Morphine may be prescribed but is not the first step before rapid assessment; pain assessment is useful but must not delay ECG acquisition. A stress test is not appropriate during acute chest pain.

2. 2.A client with heart failure is admitted with increasing dyspnea and crackles. Refer to the client's chart. Which finding best indicates that the client is responding to IV diuretic therapy?

   • A.Urine output increases and crackles diminish
   • B.Weight increases by 1.2 kg in 24 hours
   • C.Oxygen saturation falls from 93% to 88%
   • D.Heart rate rises from 96/min to 118/min

   Rationale: The chart shows urine output increasing from 20 mL/hr at 0800 to 70 mL/hr at 1000, with fewer crackles, which indicates diuresis and improving pulmonary congestion. The rising heart rate, falling oxygen saturation, and weight gain instead suggest deterioration or persistent fluid overload. Trend assessment is more informative than relying on a single finding.

3. 3.At change of shift, a client with atrial fibrillation is receiving an anticoagulant. Which findings require prompt follow-up for possible bleeding? Select all that apply.

   • A.Pink urine
   • B.Small bruise at a recent venipuncture site that is not enlarging
   • C.New severe headache
   • D.Black, tarry stool
   • E.Gum bleeding that continues after oral care

   Rationale: Melena, a new severe headache, hematuria, and persistent gum bleeding can indicate clinically important bleeding in an anticoagulated client. A small, stable venipuncture bruise is common, though it should be monitored. New neurologic symptoms warrant urgent assessment because of possible intracranial hemorrhage.

4. 4.A client with an acute myocardial infarction has a prescribed sublingual nitroglycerin dose. Which assessment finding requires the nurse to withhold the medication and notify the provider?

   • A.The client's heart rate is 88/min
   • B.The client has an oxygen saturation of 95%
   • C.The client took sildenafil 6 hours ago
   • D.The client reports pain rated 7 on a 0-to-10 scale

   Answer and rationale are in the full material.

5. 5.A client with suspected acute coronary syndrome is receiving initial care. Which actions are appropriate? Select all that apply.

   • A.Establish IV access and obtain ordered cardiac biomarkers
   • B.Obtain a 12-lead ECG promptly
   • C.Place the client on continuous cardiac monitoring
   • D.Assess allergies and contraindications before administering prescribed medications
   • E.Encourage the client to walk to reduce anxiety

   Answer and rationale are in the full material.