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Nrsg 468:Critical Care Nursing Question Paper

Nrsg 468:Critical Care Nursing

Course:Bachelor Of Science In Nursing

Institution: Kenya Methodist University question papers

Exam Year:2013

Critical Care Nursing (NRSG 468) 2ND TRIMESTER 2013

KENYA METHODIST UNIVERSITY

END OF 2''ND ''TRIMESTER 2013 (DAY) EXAMINATION
SCHOOL : MEDICINE & HEALTH SCIENCES
DEPARTMENT : NURSING
UNIT CODE : NRSG 468
UNIT TITLE : CRITICAL CARE NURSING
TIME : 2 HOUURS

Instructions:

Answer all the questions in the answer booklet provided.

PART I: (Multiple Choice Questions) (10 marks)

Question One

(For question (1-10) select the best response and write it on the answer booklet provided (correct response 1 marks)

Certification in critical care nursing indicates that a critical care nurse:

Is an advanced practice nurse in the care of acutely ill patients only.
May practice independently to provide symptom management for the critically ill.
Has earned a masters degree in the field of providing advanced critical care nursing.
Has practiced in critical care and successfully completed a test of critical care knowledge and manages patients with potential or actual life threatening condition.

Question Two

The critical care nurse recognizes that an ideal plan for family involvement includes:

A family member at the bedside at all times
Allowing family at the bedside at preset, brief intervals.
An individually devised plan with family involved with care and comfort measures.
Restriction of visiting in the ICU (Intensive Care Unit) because the environment is overwhelming to visitors.

Question Three

An early sign of acute respiratory failure is

Coma
Cyanosis
Restlessness
Paradoxic breathing

Question Four

The oxygen delivery system chosen for the patient in acute respiratory failure should:

Always be a low-flow device, such as a nasal cannula
Correct the PaO2 to a normal level as quickly as possible.
Administer positive pressure ventilation to prevent CO2 narcosis.
Maintain the PaO2 at 60mmHg or greater at the lowest O2 concentration possible.

Question Five

In a critically ill patient with "Hyperkalemia related to decreased renal excretion secondary to potassium conserving diuretic therapy," an appropriate expected outcome would be which of the following?

Bowel motility will be restored within 214 hours after beginning supplemental K+
Electrocardiogram (ECG) will show no cardiac arrhythmias within 48 hours after removing salt substitutes and other potassium – rich foods from diet.
ECG will show no cardiac arrhythmias within 24 hours after beginning supplemental K+.
Bowel motility will be restored within 24 hours after eliminating salt substitute and other K+ - rich foods from the diet.

Question Six

A patient is admitted to the ICU after neurosurgical removal of a pituitary tumor. A main priority in the postoperative care plan is:

Strict restriction of fluids
Accurate monitoring of intake and output.
Administration of hypertonic fluids.
Initiation of diuretic therapy.

Question Seven

An 18 year old patient is admitted to the ICU after sustaining closed head trauma. The critical care nurse observes otorrhea. Which nursing intervention is appropriate at this time?

Apply pressure at the area.
Apply gentle suction
Assess the drainage for the presence of glucose
Pack the ear firmly with sterile dressings.

Question Eight

A 25 year old patient in the ICU has a generalized tonic – clonic seizure. After the seizure has subsided, the critical care nurse expects the patient to exhibit which of the following characteristic behaviour?

Restlessness
Lethargy
Automatisms
Incontinence

Question Nine

In a patient with suspected mild hypoglycemia, what is the first intervention the critical care nurse should implement?

Give intravenous glucose STAT.
Obtain blood glucose level.
Determine last insulin dose and time administered.
Determine last oral intake.

Question Ten

Regarding electrocardiography, ECG chest leads/precordial lead includes:

V1 V2 V6
V1 V3 aVR
aVR, aVF, aVL
I, II, III

PART II: (Short Answer Questions). (30 marks)

Question One
State five (5) indications for admission of a patient to a critical care unit (CCU).

(5 marks)

Question Two
State the components of a focused neurological examination of a critically ill patient. (5 marks)

Question Three
Describe three patient barriers to pain assessment and management in critical care environment. (6 marks)

Question Four
List four common causes of fluid volume deficit and fluid volume overload. (4 marks)

Question Five
Determine the following acid base balance disorders. (4 marks)

PH 7.50 PCO2 30mmHg HCO-3 26 mmol/L
PH 7.30 PCO2 42mmHg HCO-3 20 mmol/L
PH 7.48 PCO2 42 mmHg HCo-3 32 mmol/L
Ph 7.29 PCO2 55 mmHg HCO-3 26 mmol/L

Question Six

By use of a diagram identify the waveforms found in a normal ECG. (3 marks)

Question Seven

Differentiate between Acute Renal failure and Chronic Renal failure. (3 marks)

PART III: Long Answer Question (30 marks)

Question One

Mr. Saru who is 50 years and weighs 70Kgs has been admitted to ICU with burns to his trunk, both right and left arms and the neck from an explosion.

What is the percentage of the burnt surface areas?

(2 marks)

Calculate the amount of IV fluid that will be administered to Mr. Saru in the first 24 hours.

(3 marks)

Mr. Saru is suspected to have had inhalational burns. State four signs of an inhalational burn.

(4 marks)

Nutritional status is a major concern when caring for a burnt client. List two specific dietary interventions used with burned clients.

(1 mark)

Question Two

Mr. Len is admitted to ICU with a diagnosis of traumatic brain injury, fractures on the right tibia and left femur secondary to road traffic accident one day ago. CT scan confirms Arachnoid hemorrhage.

Define traumatic brain injury.

(1 mark)

State three diagnostic procedures/lab tests that should be performed on Mr. Len.

(3 marks)

Discuss the nursing management of Mr. Len while admitted in ICU.

(10 marks)

Describe any two ethical principles that would guide the care of Mr. Len in ICU.

(6 marks)

Nrsg 468:Critical Care Nursing Question Paper

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