Professionalism in Nursing
The Essence of Critical Care
Essence of Critical Care Assessment Test
Please select the most appropriate answer(s).
Your Name:
1. The essence of critical care is:
A. showing up for work everyday
B. the balance between oxygen supply and demand
C. the balance between beer and kielbasa
D. none of the above
2. Determinants of cardiac output include:
A. heart and rate rhythm
B. preload
C. contractility
D. after load
E. all of the above
3. Oxygen supply to the body is determined by:
A. cardiac output
B. hemoglobin concentration
C. oxygen saturation
D. a, b, and c
E. Wasserott’s
4. According to the Gallop Poll, nurses routinely come out on top in patient customer relations, higher than physicians, dentists and members of clergy. Despite this favorable response, negative images of nursing still exist. Therefore in an attempt to promote nurses as key players in healthcare, we can:
A. Develop a better self image to ensure better public image
B. Speak to the public about what we do
C. Be a role model everywhere we go
D. All of the above
5. What two pacer modes will give the patient fixed atrial pacing?
A. DDD and DVI
B. DVI and AAI
C. DVI and AOO
D. AOO and AAI
6. To promote a positive image of the nursing profession, you need to be able to communicate effectively.
A. True
B. False
7. Conduction disturbances following OHS may be related to:
A. Manipulation of the conduction system
B. Cardiac edema
C. Electrolyte imbalance
D. All of the above
8. The mechanism that allows the patient ‘s intrinsic activity to be recognized by the pacemaker is:
A. Sensitivity
B. Capture
C. Millivolts
D. Threshold
9. People’s perception of you can lead to a positive or negative relationship. Perception, being more than how you look, includes:
A. Your attitude
B. Your affect
C. Your tone of voice
D. All of the above
10. Charles Jenkins, a 47 yo male with a history of aortic stenosis, is experiencing weakness, fatigue and decreased exercise tolerance. A cardiac catheterization revealed a 60mm pressure gradient across the aortic valve and calcification of the aortic ring. On POD #2, Mr. Jenkins developed a heart rate of 42 and his BP dropped to 84/20 and respirations were 22. A rhythm strip recorded showed:
A. Sinus bradycardia
B. Sick sinus syndrome
C. Mobitz II
D. Third degree heart block
11. Mr. Jenkins returned to surgery and had a permanent dual-chamber pacemaker implanted. The following strip was recorded in CTICU. It revealed:
A. Normal sinus rhythm
B. Left bundle branch block
C. P-wave tracking pacing or DDD pacing mode
D. Ventricular demand or DVI pacing mode
12. A magnet was placed over the dual pacer generator. Which pacing mode is produced after applying the magnet?
A. DDD
B. DOO
C. VVI
D. VOD
13. Certification can enhance one’s professional image and integrity. An offset of certification is:
A. Credibility within the nursing profession, along with recognition and positive self image
B. Value is monetary only
C. Has no professional value
D. None of the above
14. Stewardship is a process that:
A. Creates a collaborative environment , in which information is shared, people partner to learn and support each other and which leads to improved patient outcomes along the way.
B. Only works within a professional ladder hierarchy
C. Creates an antagonistic environment
D. Is no longer an acceptable practice in professional development
15. Oxygen demand of the body may be affected by:
A. temperature
B. muscle activity such as shivering
C. agitation
D. the work of breathing
E. all of the above
16. Without a pulmonary artery catheter, a nurse can evaluate the adequacy of cardiac output by assessing:
A. heart rate and blood pressure
B. peripheral pulses
C. skin temperature
D. urine output
E. acid-base balance
F. all of the above
G. it is impossible
17. Identify the following pacemaker strip:
A. AAI
B. VVI
C. DDD
18. When caring for a patient with epicardial wires and pacer:
A. Always wear gloves
B. Ensure all connections are secure
C. Do not defibrillate over the wires
D. All of the above
19. Patient/family discharge education for post permanent pacemaker insertion includes all of the following EXCEPT:
A. Avoid all microwave ovens
B. Do not scrub the insertion site
C. Call your doctor with an elevated temperature
20. Mr. Smith just had an AVR/CABG and has arrived in the CTICU. During his first hour post-op, his chest tubes drained 360ml, his urine output is 60ml, his heart rate rose to 106, his BP drifted to 92/60 and his arterial blood gas revealed a base excess of-4.5. Appropriate initial actions include:
A. Give sodium bicarbonate and increase the minute ventilation
B. administer volume, either 5% albumin or Lactated Ringers
C. Consult the blood transfusion protocol
D. Call the cardiac surgeon
E. All of the above
21. During the second hour post-op, Mr. Smith’s labs reveal hemoglobin of 8.1, an INR of 1.6, and a platelet count of 81K. His serum bicarbonate was 18.1 before you gave him sodium bicarbonate. The chest tubes have drained another 360ml. Appropriate further action includes:
A. transfuse packed red blood cells
B. make sure the Blood Bank is keeping 4 units of packed red blood cells available at all times
C. all of the above
D. ask the per diem to cover your patient while you go to dinner
22. During this third hour post-op, Mr. Smith’s bleeding seems to be slowing down (about 100ml over 30 minutes) but then he awoke abruptly, thrashing about in bed and causing both ventilator and heart rate alarms to go off. He looks a little blue and the PA tracing has become dampened. You are not sure of the cardiac output and are afraid that he is going to dislodge something or start bleeding again if he does not settle down. The phone is ringing and you suspect Dr. Stahl is calling for report. The best course of action is:
A. recruit help from your colleagues, even if you have to go to the “front” to get it
B. get muscle relaxant from the Pyxis
C. ask the Operating Room to send someone from Anesthesia over
D. once you get him quiet, gently pull back on the PA catheter 2-3 cm before flushing it
E. all of the above
F. bite your lip and try to handle the situation yourself
23. The “3 P’s” of patient care are:
A. paperwork, politics and paranoia
B. primping, preening and plastic surgery
C. checking regularly on the patient regarding “pain, potty, and positioning”
24. A patient should receive a blood transfusion when:
A. hemoglobin drops below 11
B. hemoglobin drops below 9
C. hemoglobin drops below 7
D. physiologic triggers, such as low perfusion to the brain, heart, intestines or kidneys, suggest the necessity
25. A drug used to treat post-op hypotension and low cardiac output that has no inotropic effect is:
A. Epinephrine
B. Phenylephrine
C. Ephedrine
D. all of the above
26. NTG post MI has what benefit?
A. Increases preload, decreases after load, decreases BP, elevates MVE demand
B. Decreases preload, increases after load, elevates BP, elevates MVE consumption
C. Decreases preload, decreases after load, elevates BP, decreases MVE delivery
D. Decreases preload, decreases after load, decreases BP, elevates MVE delivery
27. When educating the patient /family member regarding the patient’s use of non prescription herbal supplements, the following have been associated with excessive bleeding:
A. Omega 3, garlic
B. Omega 6 , garlic
C. Garlic, ginseng , basil
D. Garlic, ginseng, gingko
E. Garlic, ginger, Echinacea
28. Mr. Jones, age 44, arrives in the ED with c/o sudden SOB, dizziness, “heart pounding”. He has no history of similar presenting symptoms. Past medical history: MVR age 22, congenital disorder. TPR 98.7, 136 (irregular) 30. BP 90/70, Sat O2 91%, diaphoretic and anxious. BP is low because of:
A. PMH
B. fatigue
C. uncontrolled AF
29. Mr. Jones is given an IV dose of diltiazem, his heart rate continues at 128. Why is immediate cardioversion considered?
A. Age and gender
B. Lack of anticoagulation
C. Onset of AF less than 48 hours
D. Lack of adequate rate control with diltiazem
30. A drug that may cause intra coronary steal away from ischemic areas is:
A. Norepinephrine
B. Nitroprusside
C. Nicardipine
D. Enalaprilat
