KHYBER MEDICAL UNIVERSITY

BS NURSING(BSN)

Critical Care Nursing

Generic BSN semester VII
Final Paper 2016

Marks 70 Time

Note: Attempt all Questions

1. There can be variations in the minute ventilation in one of the following modes of ventilation as
the respiratory rate and tidal volume is determined by patient
A. Controlled Mandatory Ventilation
B. Synchronous Intermittent Mandatory Ventilation
C. Pressure Control Mode
D. Pressure Support Mode
2. One of the following modes of ventilation reduces the work of breathing by overcoming the
resistance created by ventilator tubing.
A. Controlled Mandatory Ventilation
B. Synchronous Intermittent Mandatory Ventilation
C. Assist Control Mode
D. Pressure support Mode
3. Which are the Ventilator Parameters adjusted to maintain the optimum Minute Ventilation?
A. FiO2
B. PEEP
C. Tidal Volume and Respiratory Rate
D. Both A and B
4. Minute ventilation is equal to
A. FiO2 X PEEP
B. FiO2/PEEP
C. Tidal Volume X Respiratory Rate
D. Tidal Volume/Respiratory Rate
5. The mode of ventilation which allows the patient to breathe spontaneously at his or her own
respiratory rate and depth between the ventilator breaths is
A. Controlled Mandatory Ventilation
B. Synchronous Intermittent Mandatory Ventilation
C. Assist Control Mode
D. Pressure Control Mode
6. One of the following modes of ventilation has the risk of patient getting respiratory alkalosis due
to hyperventilation.
 A. Controlled Mandatory Ventilation
B. Synchronous Intermittent Mandatory Ventilation
C. Assist Control Mode
D. Pressure Control Mode
7. One of the following modes of ventilation “locks out” the patients’ efforts to breathe
A. Controlled Mandatory Ventilation
B. Synchronous Intermittent Mandatory Ventilation
C. Assist Control Mode
D. Pressure Control Mode
8. An artificial airway like an endotracheal tube is used in the following type of ventilation

A. Positive Pressure
B. Negative pressure
C. Both A and B are correct
D. None of the above

9. Which one of the following is an indication for mechanical ventilation?

A. a postoperative patient with mild hypoxemia

B. a postoperative patient with head and neck surgery
C. a stroke patient with left hemiparesis and good consciousness
D. a pneumonia patient with dyspnea and hypoxemia despite oxygen therapy

10. Which one of the following is a complication related to mechanical ventilation?

A. diuresis
B. hypertension
C. pneumothorax
D. decrease intracranial pressure

11. An aspirated pneumonia patient received mechnical ventilation for 2 days, he is now on
SIMV mode with Tidal Volume 500 ml, rate 2/min, PEEP 5 cmHO, no pressure support,
FiO20.4 his saturation 99%. Which one of the following criteria is used for extubation?

A. high fever
B. adequate cough
C. respiratory scidosis with PaCO2 55 mmHg
D. stable hemodynamics

12. After extubation, What should be given to all of the patients?

A. oxygen
B. analgesics
C. sedative
D. breathing exercise

13. What are the characteristics of stable angina?

A. Chest pain that occurs with exertion and/or emotional stress

 B. Severe and crushing chest pain (>20 mins)
C. Chest pain that occurs at rest
D. Bradycardia

14. What is the pathogenesis of unstable angina?

A. Coronary artery vasospasm

B. Rupture of an atherosclerotic plaque with thrombosis and incomplete occlusion of a
coronary artery
C. Atherosclerosis of coronary arteries with >70% stenosis
D. Rupture of an atherosclerotic plaque with thrombosis and complete occlusion of a
coronary artery.

15. What is the key complication in the first 24 hours of an MI?

A. Fibrinous pericarditis
B. Coronary artery aneurysm
C. Arrhythmia
D. Mitral insufficiency

16. A client with chronic pain reports to you, the charge nurse, that the nurse have not been
responding to requests for pain medication. What is your initial action?

A. Check the MARs and nurses’ notes for the past several days.
B. Ask the nurse educator to give an in-service about pain management.
C. Perform a complete pain assessment and history on the client.
D. Have a conference with the nurses responsible for the care of this client
17. As the charge nurse, you are reviewing the charts of clients who were assigned to a newly
graduated RN. The RN has correctly charted dose and time of medication, but there is no
documentation regarding non-pharmaceutical measures. What action should you take first?
A. Make a note in the nurse’s file and continue to observe clinical performance
B. Refer the new nurse to the in-service education department.
C. Quiz the nurse about knowledge of pain management
D. Give praise for the correct dose and time and discuss the deficits in charting.
18. In caring for a young child with pain, which assessment tool is the most useful?
A. Simple description pain intensity scale
B. 0-10 numeric pain scale
C. Faces pain-rating scale
D. McGill-Melzack pain questionnaire
19. Which route of administration is preferred if immediate analgesia and rapid titration are
necessary?
A. Intraspinal
B. Patient-controlled analgesia (PCA)
C. Intravenous (IV)
D. Sublingual
20. In educating clients about non-pharmaceutical alternatives, which topic could you delegate to an
experienced LPN/LVN, who will function under your continued support and supervision?
A. Therapeutic touch
 B. Use of heat and cold applications
C. Meditation
D. Transcutaneous electrical nerve stimulation (TENS)
21. A client appears upset and tearful, but denies pain and refuses pain medication, because “my
sibling is a drug addict and has ruined out lives.” What is the priority intervention for this client?
A. Encourage expression of fears on past experiences
B. Provide accurate information about use of pain medication
C. Explain that addiction is unlikely among acute care clients
D. Seek family assistance in resolving this problem
22. The physician has ordered a placebo for a chronic pain client. You are newly hired nurse and you
feel very uncomfortable administering the medication. What is the first action that you should
take?
A. Prepare the medication and hand it to the physician
B. Check the hospital policy regarding use of the placebo.
C. Follow a personal code of ethics and refuse to give it.
D. Contact the charge nurse for advice
23. Which route of administration is preferable for administration of daily analgesics (if all body
systems are functional)?
A. IV
B. IM or subcutaneous
C. Oral
D. Transdermal
24. The nursing care plan is:
A. A written guideline for implementation and evaluation.
B. A documentation of client care.
C. A projection of potential alterations in client behaviors
D. A tool to set goals and project outcomes.
25. Critical Care Nursing is an area of specialised care. Collaborative interventions in the critical care
nursing are therapies that require:
A. Physician and nurse interventions.
B. Nurse and client interventions.
C. Client and Physician intervention.
D. Multiple health care professionals.
26. Which goal is the most appropriate for clients with diarrhea related to ingestion of an antibiotic
for an upper respiratory infection?
A. The client will wear a medical alert bracelet for antibiotic allergy.
B. The client will return to his or her previous fecal elimination pattern.
C. The client verbalizes the need to take an antidiarrheal medication PRN.
D. The client will increase intake of insoluble fiber such as grains, rice, and cereals.
27. A client with chronic pulmonary disease has a bluish tinge around the lips. The nurse charts
which term to most accurately describe the client’s condition?
A. Hypoxia
B. Hypoxemia
C. Cyanosis
D. Dyspnea
28. Kubler-Ross’s five successive stages of death and dying are:
A. Anger, bargaining, denial, depression, acceptance
B. Denial, anger, depression, bargaining, acceptance
C. Denial, anger, bargaining, depression acceptance
D. Bargaining, denial, anger, depression, acceptance
29. A terminally ill patient usually experiences all of the following feelings during the anger stage
except:
A. Rage
B. Envy
C. Numbness
D. Resentment
30. Nurses and other healthcare providers often have difficulty helping a terminally ill patient
through the necessary stages leading to acceptance of death. Which of the following strategies is
most helpful to the nurse in achieving this goal?
A. Taking psychology courses related to gerontology
B. Reading books and other literature on the subject of thanatology
C. Reflecting on the significance of death
D. None of the above
31. After having an I.V. line in place for 72 hours, a patient complains of tenderness, burning, and
swelling. Assessment of the I.V. site reveals that it is warm and erythematous. This usually
indicates:
A. Infection
B. Phlebitis
C. Infiltration
D. Bleeding
32. When positioned properly, the tip of a central venous catheter (CVP) should lie in the:
A. Superior vena cava
B. Basilica vein
C. Jugular vein
D. Subclavian vein
33. A Nurse at HMC is revising a client’s care plan. During which step of the nursing process does
such revision take place?
A. Assessment
B. Planning
C. Implementation
D. Evaluation
34. A male client is admitted to the hospital with blunt chest trauma after a motor vehicle accident.
The first nursing priority for this client would be to:
A. Assess the client’s airway
B. Provide pain relief
C. Encourage deep breathing and coughing
D. Splint the chest wall with a pillow
35. The nurse is assessing a postoperative adult patient. Which of the following should the nurse
document as subjective data?
A. Vital signs
 B. Laboratory test result
C. Patient’s description of pain
D. Electrocardiographic (ECG) waveforms
36. A female patient with a terminal illness is in denial. Indicators of denial include:
A. Shock to believe
B. Numbness
C. Patience
D. Preparatory grief
37. The doctor orders dextrose 5% in water, 1,000 ml to be infused over 8 hours. The I.V. tubing
delivers 15 drops per milliliter. The nurse in charge should run the I.V. infusion at a rate of:
A. 15 drop per minute
B. 21 drop per minute
C. 32 drop per minute
D. 125 drops per minute
38. When do coronary arteries primarily receive blood flow?
A. During inspiration
B. During diastole
C. During expiration
D. During systole
39. Which of the following is the most common symptom of myocardial infarction?
A. Chest pain
B. Dyspnea
C. Edema
D. Palpitations
40. Which of the following classes of medications maximizes cardiac performance in clients with
heat failure by increasing ventricular contractility?
A. Beta-adrenergic blockers
B. Calcium channel blockers
C. Diuretics
D. Inotropic agents
41. Stimulation of the sympathetic nervous system produces which of the following responses?
A. Bradycardia
B. Tachycardia
C. Hypotension
D. Decreased myocardial contractility
42. A classic sign of cardiogenic shock is
A. Bradycardia
B. Low blood pressure
C. Hyperactive bowel sounds
D. Increased urinary output
43. A person suffering from carbon monoxide poisoning
A. Presents with severe hypertension.
B. Appears intoxicated.
C. Appears hyperactive.
D. Will always present with a cherry red skin coloring
44. Which of the following is the presentation of hypovolemic shock?
A. Pulmonary edema
B. Hypotension
C. jugular vein distention
D. flat neck vein
45. Which of the following drug is indicted in cardiogenic shock?
A. Dopamine
B. Dobutamine
C. Norepinephrine
D. Phenylephrine
46. Which of the following drug is indicted to improve renal perfusion?
A. Dopamine
B. Dobutamine
C. Norepinephrine
D. Phenylephrine
47. Systematic approach to manage emergent or urgent situations, primary survey includes
assessing ABCD of the patient which means:
A. Airway, Breathing, Circulation, Dignity
B. Airway, Breathing, Circulation, Diagnosis
C. Airway, Breathing, Circulation, Disability
D. Airway, Breathing, Circulation, Defense
48. A 25 years old male working as a farmer has been bitten by a snake that has caused
severe irritation, pain at the site and respiratory distress generally. What can be the
possible diagnosis?
A. poisoning
B. skin allergy
C. anaphylactic reaction
D. Local inflammatory reaction
49. A substance causing poisoning can cause poisoning through which of the following
route?
A. Inhaled
B. absorbed
C. produced within the body
D. All of the above
50. Which of the following condition is coded as red in medical triage management?
A. vomiting fresh blood
B. high grade fever
C. closed fracture
D. persistent vomiting
51. Which of the following condition is coded as yellow in medical triage management?
A. vomiting fresh blood
B. high grade fever
C. closed fracture
D. persistant vomiting
52. A patient aged 40 has been received at the Emergency department who has multiple
penetrating head trauma. The patient is hypoxic and gasping and about to die. What
colour code will you give to this patient?
A. Red
B. Yellow
C. Green
D. Black
53. Another female patient has just arrived at the Emergency who is 50 years old and has got
acute chest pain radiating towards left arm with vital signs as 160/110, HR 105 and
Respiratory Rate 20/min. What color code will you give to this patient?
A. Red
B. Yellow
C. Green
D. Black
54. Medical Triage management should be based on the technique “START”. What does this
term mean?
A. Start Triage And Rapid Treatment
B. Simple Triage And Right Treatment
C. Simple Triage And Rapid Treatment
D. None of the above
55. The nurse is assessing a patient with ARDS. The client is on the ventilator with positive
end expiratory pressure and receiving oxygen via endotracheal tube. The nurse evaluates
the client’s blood gas (ABGs) as PaO2=50mmHg, PaCO2=35mmHg, HCO3=24 mEq/L,
PH=7.40. Which of the following indicates the patient is not receiving sufficient
oxygenation?
A. PaO2
B. PaCO2
C. HCO3
D. PH
56. Intra-aortic balloon pump (IABP) is a mechanical device that is used to________
A. increase myocardial oxygen demand
B. Decreasing cardiac output
C. increase myocardial oxygen supply
D. decrease myocardial oxygen supply
57. Intra-aortic balloon pump (IABP) consists of a cylindrical balloon that sits in the aorta
and counter-pulsates. The mechanism of work include as
A. it actively deflates in systole reducing forward blood flow by reducing afterload.
B. it actively inflates and deflates during systole to increase preload
C. actively inflates in diastole increasing blood flow to the coronary arteries.
D. actively inflates in diastole depleting blood flow to the coronary arteries.
58. Hemodynamic Monitoring consists of:
A. None-Invasive
B. Invasive
C. Both
 D. None of the above
59. The purpose of arterial lines are to:
A. Obtain frequent arterial blood gases
B. Infuse mediations
C. Monitor blood pressures continuously
D. Both A and C are correct
60. A young child has recently died at a ward. The family members are crying loud and
telling her past stories. What is this reaction of family called?
A. grief
B. mourning
C. bereavement
D. All of above