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AJN, American Journal of Nursing:
CE 7 HOURS Continuing Education TEST

Critical Care Nursing Update 2001

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CE TEST DIRECTIONS

Each of the questions or incomplete statements below is followed by suggested answers or completions. Select the one that is best in each case and darken the corresponding space on the answer form on page 50. Send the answer form with a check or money order for $15.00 to Lippincott Williams & Wilkins CE Department, 345 Hudson St., 16th Floor, New York, NY 10014. Note: The discounted processing fee for this test has been made possible through an educational grant from Wyeth-Ayerst Laboratories. You’ll be notified of your test results within six weeks. A passing score for this test is 75% (29 correct answers). If you pass, you will receive a certificate of completion; if you fail, you have the option of taking the test again at no additional cost. Lippincott Williams & Wilkins is accredited as a provider of CE in nursing by the American Nurses Credentialing Center’s Commission on Accreditation (AACN 9722, Category A) and is an approved provider of CE in Alabama, California, Florida, and Iowa (providers’ numbers: AL #ABNP0114, CA #CEP11749, FL #FBN2454, IA #75).

In accordance with Iowa Board of Nursing administrative rules governing grievances, a copy of your evaluation of the CE offering may be submitted directly to the Iowa Board of Nursing.

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GENERAL PURPOSE

To provide RNs with current information related to the care of patients who are critically ill.

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OBJECTIVES

After reading these articles and taking this test you’ll be able to:

* Outline the nursing care for children who have had cardiac surgery, and identify appropriate medications.

* Identify the signs of deep vein thrombosis (DVT) in neurotrauma patients and suggest measures for DVT prevention.

* Describe nursing interventions that can improve outcomes for patients following cardiac surgery.

* Discuss the latest revisions to the advanced cardiac life support (ACLS) guidelines.

* Discuss how immunonutrition can strengthen the immune systems of patients who have acute respiratory distress syndrome (ARDS).

* Identify the signs of impending respiratory failure and suggest appropriate intervention measures.

* Describe the use of ST-segment monitoring to provide early detection of myocardial infarction (MI).

* Explain the principles and uses of temporary and permanent cardiac pacemakers.

* Describe strategies to provide optimal care for patients who are both chronically and critically ill.

* List the signs of peripartum cardiomyopathy (PPCM), its risks, and treatment.

1. Which of the following is an immediate concern when caring for cardiac patients postoperatively?

a. Maintain adequate cardiac output.

b. Maintain a warm environment.

c. Keep the patient afebrile.

d. Keep the patient immobile.

2. A three-month-old baby who is six hours postop following repair of an atrioventricular-canal (AVC) defect develops low cardiac output. The most likely cause is

a. mitral valve prolapse.

b. mitral valve insufficiency.

c. atrial valve insufficiency.

d. atrial valve regurgitation.

3. Baby Carol is two hours postop following cardiac surgery. You can reduce the risk of pulmonary hypertension by minimizing

a. hyperthermia.

b. alkalosis.

c. hypocarbia.

d. hypoxia.

4. Immediately postop, following an AVC repair, Baby Frank experiences renal function abnormalities and fluid retention. The diuretic of choice to treat this development is

a. metolazone.

b. furosemide.

c. acetazolamide.

d. spironolactone.

5. Baby Sally develops CHF following cardiac surgery. You recognize that afterload must be increasing. Which of the following drugs would be most appropriate at this time?

a. angiotensin-converting enzyme

b. calcium channel blocker

c. β-blocker

d. angiotensin II receptor blocker

6. Which of the following patients is most likely to develop a DVT?

a. a 60-year-old black male who has the sickle-cell trait and hypertension

b. a 20-year-old Hispanic female who smokes and is taking oral contraceptives

c. a 70-year-old white male with lung cancer with metastases to the bone

d. a 25-year-old Asian female who has asthma, is G 3 and in labor

7. Virchow’s triad includes which of the following factors?

a. compartment syndrome, smoking, fracture

b. immobility, hypercholesteremia, hypertension

c. venous stasis, pedal edema, diabetes

d. vascular endothelial damage, stasis, coagulation changes

8. A 30-year-old female who is two weeks postpartum is hospitalized for DVT and placed on low-dose heparin. The risk for bleeding can be minimized by monitoring

a. complete blood count.

b. stools for occult blood.

c. skin for bruising.

d. activated thromboplastin time.

9. Optimal patient outcomes following cardiac surgery can best be achieved by

a. reducing risk factors prior to surgery.

b. hiring a private duty nurse.

c. introducing a care plan that involves the family prior to surgery.

d. allowing the patient to stay in the ICU until his condition improves.

10. Which patient is considered at high risk for postop complications following cardiac surgery?

a. a 55-year-old female who has ulcerative colitis

b. a 60-year-old male who has prostate cancer

c. a 55-year-old female who has a history of rheumatic heart disease

d. an 80-year-old female who has diabetes

11. Which of the following nursing interventions will assist patients to be proactive in cardiac recovery?

a. performing passive range-of-motion exercises soon after surgery

b. allowing patients to rest

c. showing patients how to turn from side to side and cough

d. encouraging the patient to show his emotions

12. Changes in drug treatments were recommended for the new ACLS guidelines based on

a. cost.

b. effectiveness.

c. availability.

d. administration method.

13. Amiodarone was added to the ACLS algorithms because it

a. causes peripheral vasoconstriction.

b. works on only one cardiac cycle phase.

c. has a higher proarrhythmic effect compared to other drugs.

d. is useful in treating both atrial and ventricular tachyarrhythmias.

14. Which of the following statements about vasopressin is true?

a. It’s secreted by the posterior pituitary gland.

b. It’s used to treat diabetes mellitus.

c. It’s a vasodilator.

d. It’s not as effective as epinephrine when treating acidosis.

15. According to the new ACLS algorithms, all of the following drugs can be used to treat wide-complex tachycardia except

a. amiodarone.

b. adenosine.

c. lidocaine.

d. procainamide.

16. Which of the following medications has been removed from the ACLS guidelines?

a. procainamide

b. lidocaine

c. bretylium

d. epinephrine

17. Which of the following conditions can trigger the development of ARDS?

a. diabetes

b. cardiac disease

c. pneumonia

d. HIV

18. Immunonutrition improves patient outcomes by

a. modulating linolenic acid permeability.

b. metabolizing essential nutrients.

c. maintaining pulmonary function.

d. enhancing wound healing.

19. The most suitable diet for a patient who has ARDS is one that’s

a. high in arginine, glutamine, omega-3 fatty acids, and nucleotides.

b. both isocaloric and isonitrogenous.

c. high in B-complex vitamins and carotene.

d. high in carbohydrates and low in linolenic acid and antioxidants.

20. Which of the following patients is at the greatest risk for developing respiratory failure?

a. a 54 year old who had a cerebrovascular accident today and has slurred speech

b. a 40 year old with DVT after the delivery of her son last week

c. a 33 year old who has a broken femur and has developed compartment syndrome

d. a 76 year old who was recently diagnosed with diabetes and hypertension

21. Prior to intubation, you should

a. obtain informed consent.

b. preoxygenate for five minutes.

c. suction the airway.

d. paralyze the patient.

22. One objective of performing rapid sequence intubation (RSI) is to

a. avoid cardiac tamponade.

b. perform the procedure quickly, regardless of pain level.

c. intubate a conscious patient with minimal discomfort.

d. intubate an unconscious patient so pain is avoided.

23. The goal of RSI is that the patient is

a. unconscious and completely paralyzed.

b. semi-conscious and partially paralyzed.

c. unconscious and partially paralyzed.

d. conscious and completely paralyzed.

24. Atropine is given prior to intubating a one-year-old child, to prevent

a. cardiac arrest.

b. pulseless electrical activity.

c. tachycardia.

d. bradycardia.

25. Which of the following statements is true regarding ST-segments?

a. Elevations of more than 1mm can suggest MI.

b. During acute cardiac events the ST segment is isoelectric.

c. The ST segment does not accurately predict MI.

d. Depressions of 2 mm can suggest MI.

26. One barrier to using continuous ST-segment monitoring for patients with acute coronary syndrome (ACS) is that the practice

a. is difficult to learn.

b. is expensive.

c. shows little benefit in reducing mortality and morbidity.

d. lacks standards and guidelines.

27. Which of the following patients would not benefit from continuous ST-segment monitoring?

a. a 70-year-old female who has a history of syndrome X and new onset of confusion

b. a 65-year-old male who has chest pain and left bundle branch block

c. a postmenopausal female who has heartburn

d. a young male who is delirious and may have ingested cocaine

28. A successful continuous ST-segment monitoring program will result in

a. increased reimbursement levels for cardiac procedures.

b. compliance with regulatory agencies’ mandates.

c. cost-effective alternatives to hospital admissions.

d. decreased comorbidity in patients with cardiac ischemia.

29. Which pacemaker is most likely to be used for a patient who becomes unconscious and has a junctional rate of 30?

a. transcutaneous pacer

b. transvenous pacer

c. epicardial wires

d. permanent pacer

30. When caring for patients with transcutaneous pacers, you should

a. allow the patient to move about the room.

b. check capture by palpating the radial pulse.

c. administer sedation as needed.

d. assess perfusion by monitoring pulse oximetry.

31. When caring for patients with transvenous pacers, you should

a. adjust the catheter placement as needed.

b. check vital signs once per shift.

c. check thresholds once per day.

d. evaluate the insertion site for redness.

32. Which of the following is characteristic of patients who are both chronically and critically ill?

a. obesity

b. uncomplicated hospitalizations

c. good health prior to a critical event

d. minimal physiologic reserve

33. A nursing priority when caring for patients who are chronically and critically ill is to

a. increase metabolic demands.

b. provide a low protein, high carbohydrate diet.

c. limit physical activity.

d. restore sleep–wake cycles.

34. Which of the following has been addressed as a priority by the AACN when caring for patients who are chronically and critically ill?

a. family-centered care

b. rapid weaning from the ventilator

c. maintaining sleep–wake patterns

d. meeting metabolic demands

35. Nursing goals, when caring for patients who are chronically ill, should include all of the following except

a. promoting independence.

b. providing hope.

c. limiting family interactions.

d. meeting physiologic needs.

36. Which of the following patients is most likely to develop PPCM?

a. a 32-year-old black patient, G 2, who has a BP of 160/100

b. a 25-year-old white patient in her third trimester who has a history of mitral valve prolapse

c. a 28-year-old Hispanic patient in her third trimester who is obese and has exertional dyspnea

d. a 35-year-old Asian patient who has a maternal aunt with a history of PPCM

37. Which non-pharmacologic intervention is recommended for patients who have PPCM?

a. potassium restriction

b. a high-protein diet

c. moderate exercise

d. increased fluid intake

38. Which of the following drugs is essential for patients who have PPCM?

a. oxygen

b. calcium channel blockers

c. aspirin

d. vasodilators

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Critical Care Nursing Update 2001

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OPINION SURVEY

Now that you’ve completed this continuing education activity, please take a few moments to complete the following opinion survey. Your comments are important to us and will help us to improve and plan future continuing education activities.

Directions: Select the response that most closely matches your opinion for each of the following questions. Record your answers by blackening the corresponding answer space on the Enrollment Form/Answer Form (Section C).

Did the learning objectives listed on page 48 of this supplement relate to the general purpose of this CE activity?

Yes

No

Did the content relate to the learning objectives of this CE activity?

Yes

No

Having completed this CE activity, do you think all of the learning objectives have been met?

Yes

No

Was this independent/home-study format an appropriate way to present this material?

Yes

No

Was the topic covered adequately?

Yes

No

Was the content organized and presented in a clear and logical manner?

Yes

No

Did the authors present material that is current to nursing practice?

Yes

No

The content of this CE activity was

too basic for me.

too advanced for me.

appropriate for me.

Did this CE activity meet your professional needs?

Yes

No

Why did you choose this CE activity?

Because of the topic

Because of the convenience of completing it at home

Because of the price

Other (please explain)

Have your personal objectives been met?

Yes

No

Are you certified in your specialty area?

Yes

No

If so, which organization awarded the certification?

How long did it take you to complete this CE activity?

What topics do you recommend for future CE activities?

© 2001 Lippincott Williams & Wilkins, Inc.

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