Mod 6 - Sedation, EOL, Trauma, Shock

A restrained (lap and shoulder harness) occupant involved in an MVC can receive what types of injuries from the restraints?

a) lumbar fractures
b) pulmonary contusions
c) facial injuries
d) femur fractures
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Terms in this set (40)
A restrained (lap and shoulder harness) occupant involved in an MVC can receive what types of injuries from the restraints?

a) lumbar fractures
b) pulmonary contusions
c) facial injuries
d) femur fractures
b) pulmonary contusions
A person comes into the triage room who has been impaled by a knife in the upper abdomen. The triage nurse immediately calls for help. Which of the following actions should be implemented by the nurse in relation to the knife?

a) manipulate the knife to facilitate assessment of injured organs
b) stabilize the knife without removal and minimal manipulation
c) remove the knife and apply pressure
d) disarm the person with the knife
b) stabilize the knife without removal and minimal manipulation
Structures slipping in the opposite direction to each other is a force known as

a) deceleration
b) acceleration
c) compression
d) shearing
d) shearing
During the secondary assessment, the patient becomes hemodynamically unstable. The nurse should immediately:

a) finish the secondary survey, looking for potential etiologies of instability
b) restart at the beginning of the secondary survey
c) stop the secondary survey and reinstitute the primary survey
d) reevaluate patency and flow rates of IVs
c) stop the secondary survey and reinstitute the primary survey
The nurse suspects that a patient has had an overdose of lorazepam (Ativan). Which reversal agent is appropriate?

a) Naloxone (Narcan) 0.4 mg IV, diluted
b) Flumazenil (Romazicon) 2 mg IV
c) Flumazenil (Romazicon) 0.2 mg IV
d) Naloxone (Narcan) 0.4 mg IM
c) Flumazenil (Romazicon) 0.2 mg IV
A mechanically ventilated patient has been on a propofol (Diprivan) drip for sedation for 6 days. The morning laboratory report shows a K+ level of 6.0 with blood gases: pH 7.30, pO2 92, pCO2 42, and HCO3 15. Which action should the nurse take first?

a) Turn off the propofol.
b) Increase the rate on the ventilator.
c) Wait for the rest of the morning laboratory work and notify the health care provider (HCP).
d) Administer a prn dose of K+ STAT.
a) Turn off the propofol.
The nurse is performing a "sedation vacation" on a mechanically ventilated patient on a midazolam (Versed) drip. After 15 minutes, the patient's blood pressure and respiratory rate alarms are sounding. Which action should the nurse perform first?

a) Turn the midazolam drip back on.
b) Auscultate heart sounds.
c) Notify the health care provider (HCP).
d) Silence the alarms and continue to observe the patient.
a) Turn the midazolam drip back on.
The nurse is administering IV haloperidol (Haldol) to a patient and notices a new onset of QT prolongation. The nurse realizes that this could cause what problem?

a) Hypertension
b) Dysrhythmias
c) Gastric reflux
d) Sleepiness
b) Dysrhythmias
A patient is having bronchoscopy performed with procedural sedation. The nurse notes that the patient is responding appropriately to verbal commands and then going back to sleep. Vital signs are heart rate 102, blood pressure 110/50, respiratory rate 18, and nonlaboured breathing. Which action is appropriate for the nurse to perform?

a) Notify the physician that the patient is not adequately sedated for this procedure.
b) Increase the amount of sedation the patient is receiving.
c) Document the findings and continue to monitor the patient.
d) Decrease the amount of sedation the patient is receiving.
c) Document the findings and continue to monitor the patient.
An intubated patient with acute respiratory distress syndrome is experiencing ventilator asynchrony. It is determined that the patient must be started on sedation. The ICU nurse knows that the most appropriate sedation medication for use with this patient includes which medication?

a) Haloperidol
b) Propofol
c) Midazolam
d) Lorazepam
b) Propofol
Which finding is a characteristic of deep sedation? a) Patient requires assistance in maintaining a patent airway. b) Spontaneous ventilations are adequate. c) Patient is unarousable even by painful stimulation. d) Patient responds to verbal commands.a) Patient requires assistance in maintaining a patent airway.A patient with acute respiratory distress syndrome has been in deep sedation with high-dose propofol infusion for 48 hours. The nurse recognizes that the patient is at risk for the development of propofol infusion syndrome (PIS). To determine the potential for PIS, what laboratory value should be monitored? a) Potassium level b) Triglyceride level c) Creatinine level d) Low-density lipoprotein levelb) Triglyceride levelDelirium represents a global impairment of cognitive processes and is best characterized by which finding? a) A gradual onset, disorientation, and inappropriate behavior b) Impaired long-term memory, depression, and agitation c) An acute onset, disorientation, and hallucinations d) Aphasia, apraxia, and agnosiac) An acute onset, disorientation, and hallucinationsElectrocardiographic (ECG) monitoring is recommended with haloperidol administration because neuroleptic agents such as haloperidol can cause which dysrhythmia? a) Atrioventricular reentrant tachycardia b) Sinus node dysfunction and bradycardia c) PR-interval prolongation and atrioventricular (AV) block formations d) QTc-interval prolongation and torsades de pointesd) QTc-interval prolongation and torsades de pointesThe nurse and the patient's daughter are aware that the patient has a do-not-resuscitate (DNR) order, but when he stops breathing, the daughter screams, "Save my daddy!" This is an example of a conflict between which two ethical principles? a) Nonmaleficence and justice b) Beneficence and veracity c) Nonmaleficence and veracity d) Beneficence and nonmaleficenced) Beneficence and nonmaleficenceA nurse is making assignments for the oncoming shift. Which assignment would be appropriate for the patient who is actively dying? a) Assign the dying patient to a nurse who has been off work for 2 or more days so he or she will have the energy to care for the patient's and family's needs, and assign the nurse to a stable patient as well. b) Assign the dying patient to a nurse with whom the family has built a relationship, and assign the nurse to a stable patient as well. c) Assign the dying patient to a float nurse so the family will not associate the death experience with unit personnel. d) Assign the nurse with the dying patient to an unstable patient so the nurse will not have to spend time with the dying patient's family.b) Assign the dying patient to a nurse with whom the family has built a relationship, and assign the nurse to a stable patient as well.A patient with end-stage renal disease is refusing any further treatments. Which response is appropriate for the nurse to make? a) "Why do you want to stop treatment? Don't you realize you will die?" b) "This is your decision. I will get the paperwork." c) "Are you giving up? What will your family say?" d) "You want to stop dialysis? Is there something about it that is bothering you?"d) "You want to stop dialysis? Is there something about it that is bothering you?"Nurses in the intensive care unit are having a high incidence of burnout after a period in which several long-term patients died in the unit despite having received aggressive care. Which strategies can the nurse manager implement to help the staff deal with these issues? (Select all that apply, one, some, or all.) Select all that apply. a) A meeting regarding cardiopulmonary resuscitation (CPR) performance b) An educational program on futility of care and withdrawal of support c) A program on stress management and burnout d) Developing clear polices and guidelines concerning end-of-life care e) Implementing a reward or bonus program for the staffb) An educational program on futility of care and withdrawal of support c) A program on stress management and burnout d) Developing clear polices and guidelines concerning end-of-life careA patient with end-stage chronic airflow limitation is receiving palliative care. The nurse notes increase in respiratory rate, use of accessory muscles to breathe, and distress on the patient's face. What interventions should the nurse implement? (Select all that apply, one, some, or all.) Select all that apply. a) Elevate the head of the bed. b) Assess the oxygen connections and liter flow. c) Administer naloxone IV. d) Increase the morphine drip. e) Administer an ordered benzodiazepine.a) Elevate the head of the bed. b) Assess the oxygen connections and liter flow. d) Increase the morphine drip. e) Administer an ordered benzodiazepine.A spinal cord injured patient is complaining of numbness on the left side and is unable to move the right and left arms. The nurse notes that the patient can feel temperature and pain only on the left side during a neurologic assessment. The nurse suspects the patient may be experiencing which type of injury? a) Anterior cord syndrome b) Posterior cord syndrome c) Brown-Séquard syndrome d) Central cord syndromec) Brown-Séquard syndromeA nurse is developing a plan of care for a patient with a T5 spinal cord injury that includes a bowel and bladder regimen. The nurse knows that this is important because patients with this type of injury are at risk for what complication? a) Autonomic dysreflexia b) Hemorrhagic shock c) Spinal shock d) Neurogenic shocka) Autonomic dysreflexiaA nurse is caring for a patient with blunt chest trauma after a motor vehicle accident. The patient starts to complain of pain from the chest to the shoulder and a sense of impending doom. Upon assessing the patient, the nurse notes that the patient has diminished breath sounds on the left side, jugular vein distention, and tracheal deviation to the right. The nurse anticipates the which intervention? a) Administration of pain medications b) Insertion of an indwelling urinary catheter c) Obtaining a chest radiograph d) Insertion of a chest tubed) Insertion of a chest tubeWhich interventions would be included in the primary survey of a trauma patient? (Select all that apply, one, some, or all.) Select all that apply. a) Evaluate ventilation and gas exchange by inspection, palpation, and auscultation. b) Open the airway to look for loose teeth, vomit, or foreign objects using a head-tilt, chin-lift technique. c) Remove all clothing to inspect body surfaces and cover to provide warmth. d) Locate peripheral and central pulses. e) Assess patient's level of consciousness.??? a) Evaluate ventilation and gas exchange by inspection, palpation, and auscultation. c) Remove all clothing to inspect body surfaces and cover to provide warmth. d) Locate peripheral and central pulses. e) Assess patient's level of consciousness. ???The nurse is performing a secondary survey on a trauma patient. The nurse uses the mnemonic AMPLE to obtain the patient's pertinent past history. What does AMPLE stand for? (Select all that apply, one, some, or all.) Select all that apply. a) Last meal b) Allergies c) Pregnancy d) Environmental factors e) Medical history??? a) Last meal b) Allergies c) Pregnancy d) Environmental factors ???A patient has suffered a traumatic brain injury (TBI). Less than 48 hours later, the patient is on ventilatory support with continuous intracranial pressure and hemodynamic monitoring. Which Glasgow Coma Scale (GCS) score correlates with this patient's condition? a) 7 b) 13 c) 9 d) 11a) 7In a patient with a head trauma, Battle sign is indicative of which type of injury? a) Concussion b) Cerebral hematoma c) Contusion d) Skull fractured) Skull fractureA patient is admitted for a transient ischemic attack with left-sided weakness. During the admission assessment, the patient states he is also experiencing absentmindedness, vomiting, and intermittent photophobia. The patient is on warfarin (Coumadin) therapy. The patient cannot recall any significant injury involving a blow to his head. Based on this information, what is the most likely cause of his symptoms? a) Epidural hematoma b) Subacute subdural hematoma c) Chronic subdural hematoma d) Acute subdural hematomac) Chronic subdural hematomaA patient is admitted for a spinal cord injury (SCI) after a 10-foot fall from a rooftop where he landed on his buttocks. What type of injury would the nurse expect to see with this SCI? a) Rotation b) Axial loading c) Hyperextension d) Hyperflexionb) Axial loadingA patient with blunt trauma to the upper abdomen has a positive Kehr sign. This finding is indicative of which problem? a) Ruptured diaphragm b) Ruptured bladder c) Ruptured spleen d) Ruptured kidneyc) Ruptured spleenWhat is a priority nursing diagnosis for the patient in shock regardless of the phase or type? a) Deficient fluid volume b) Imbalanced nutrition: less than body requirements c) Ineffective tissue perfusion d) Ineffective breathing patternc) Ineffective tissue perfusionA postoperative patient has a heart rate of 110 beats/min and blood pressure (BP) of 110/80 mm Hg (previously 130/60 mm Hg). Urine output has been 20 mL/h for the past 3 hours, capillary filling time is 5 seconds, the skin is cool, the neck veins are flattened, and the patient is complaining of thirst. The nurse suspects the may be experiencing which disorder? a) Anaphylaxis b) Cardiogenic shock c) Cardiac tamponade d) Hypovolemic shockd) Hypovolemic shockThe nurse notes that the patient's arterial blood gases reflect hypoxia, respiratory alkalosis, scattered crackles, and distended jugular veins. Heart tones are distant, but an S3 and S4 are noted despite scant amounts of concentrated urine output. The nurse anticipates the administration of which therapy? a) Amiodarone b) Sodium bicarbonate c) Isotonic saline d) Furosemided) FurosemideThe nurse is developing a care plan for the patient in cardiogenic shock. What is the goal for therapy? a) Decreasing afterload b) Increasing systemic vascular resistance (SVR) c) Increasing myocardial workload d) Increasing preloada) Decreasing afterloadA nurse is working on a spinal cord injury unit and has just finished shift report. Which patient should be seen first? a) 18-year-old woman whose dose of low-molecular-weight heparin is due b) 28-year-old woman who is complaining of being cold c) 24-year-old man who has not had a bowel movement since yesterday d) 32-year-old man whose blood pressure is 84/40 mm Hg and heart rate is 60 beats/mind) 32-year-old man whose blood pressure is 84/40 mm Hg and heart rate is 60 beats/minA nurse is consulting with a multidisciplinary team regarding renal impairment from sepsis. Which statement regarding kidney dysfunction is true? a) An increased creatinine level is the earliest sign of kidney impairment. b) Hypotensive episodes do not affect kidney function. c) Elevated peak levels of antibiotics can lead to kidney impairment. d) Increased production of erythropoietin may result in kidney impairment.c) Elevated peak levels of antibiotics can lead to kidney impairment.Which type of shock has the following hemodynamic manifestations: increased cardiac output (CO), increased cardiac index (CI), decreased right atrial pressure (RAP), decreased systemic vascular resistance (SVR), and decreased pulmonary artery occlusion pressure (PAOP)? a) Septic b) Cardiogenic c) Anaphylactic d) Neurogenica) SepticWhich parameters are clinical manifestations of cardiogenic shock? a) Decreased right atrial pressure b) Decreased cardiac index to less than 2.2 L/min/m2 c) Decreased systemic vascular resistance d) Decreased pulmonary artery occlusion pressureb) Decreased cardiac index to less than 2.2 L/min/m2Which shock state includes hypotension despite adequate fluid resuscitation along with perfusion abnormalities such as lactic acidosis, oliguria, or acute change in mentation? a) Neurogenic b) Septic c) Anaphylactic d) Cardiogenicb) SepticWhich laboratory value provides information regarding the severity of impaired perfusion and helps determine the adequacy of therapies in the patient with septic shock and multiple-organ dysfunction syndrome (MODS)? a) Serum albumin b) Serum glucose c) Serum lactate d) Serum creatininec) Serum lactateWhat therapies may be administered to decrease oxygen demand in the patient with multiple-organ dysfunction syndrome? a) Antipyretics and sedative agents b) Diuretics and antidysrhythmic agents c) Crystalloids and antibiotics d) Vasoactive and positive inotropic agentsa) Antipyretics and sedative agents