Critical Care Practice Worksheet

I. Multiple Choice

1. The ICU nurse is caring for a sedated client on a ventilator. The ventilator alarm is beeping
persistently for low pressure despite the fact the client is calm and has stable vitals. What is
the most appropriate action for the RN to take first?

Suction secretions
Check the tubing for holes
Call respiratory therapy
Continue to monitor

2. The ICU nurse is taking care of a client who sustained a head injury due to a motorcycle
accident. In the morning, the client is responsive to pain and assumes a decorticate position.
After 4 hours, which assessment would indicate to the nurse that the client needs immediate
intervention?

The client displays purposeful movement when the nurse performs a sternal
rub.
The client extends his arms and legs when the nurse rubs his sternum.
The client flails his arms and legs when a noxious stimulus is applied.
The client moves his fingers upon request.

3. The critical care nurse is caring for a client receiving hemodynamic monitoring. After
reviewing the client's central venous pressure, the nurse should take which action based on the
client's 0100 CVP reading? See the image below.

Assess the client for fluid volume overload

Obtain a prescription for saline fluid bolus
Document the findings and continue to monitor
Place the client in a side-lying position
II. Choose the correct term for each definition:

A. Fraction of inspired oxygen (FiO2)

B. Peak Inspiratory Pressure (PIP)
C. End-Tidal Carbon Dioxide (ETCO2)
D. Room Air
E. Tidal Volume
F. Positive End Expiratory Pressure

_____4. The highest level of pressure in the lungs during inhalation.

_____5. The amount of pressure in the alveoli at the end of expiration.

_____6. How much oxygen the patient is getting. 21-100%.

_____7. The amount of air that is inhaled during one respiratory cycle.

_____8. The partial pressure of CO2 detected at the end of exhalation.

_____9. The atmospheric air we breathe under normal circumstances. It has an FiO2 of 21%.

A. Volume-controlled
B. Pressure-controlled
C. CPAP
D. BiPAP

_____10. There is continuous positive airway pressure, while the patient controls their
respiratory rates and volumes.

_____11. The Lungs are inflated to a certain pressure.

_____12. There is a positive airway pressure, set at different pressures for inspiration and
expiration.

_____13. There is a certain volume of airway pressure, set at different pressures for inspiration
and expiration.
14. Complete the table below:
A. Client coughing
B. Gagging
C. Tubing is disconnected
D. Bronchospasm
E. Fighting the ventilator
F. Loose connections
G. ETT occlusion
H.Kink in the tubing
I. Leak
J. Extubation
K. Increased secretions
L. Thick secretion
M. Cuffed or trach is deflated
N. Water in ventilator circuit
O. Poorly fitting CPAP/BiPAP mask

Causes of High Ventilator Alarms Causes of Low Ventilator Alarms

15. Label each of the devices with the correct name:

____________________________

____________________________

____________________________
____________________________

16. ___________ are primarily found in vascular smooth muscle, and when activated causes
peripheral vasoconstriction which increases the SVR.

17. Most often used in cold shock, ______________ acts on beta-1 receptors at low doses, and
alpha-1 receptors at high doses.

18. ______________ is most often used in warm shock. It acts on alpha-1 receptors which
causes peripheral vasoconstriction increases the BP, and therefore increases cardiac output

19. List three uses for milrinone:

____________________________

____________________________

____________________________
 Critical Care Answer Key

1. Answer: B

Choice B is the correct answer. If the patient’s presentation and vitals are stable, the
nurse should check for any apparent equipment malfunction. If no air leaks or kinks are
immediately identifiable, the nurse should call respiratory therapy or the rapid response
team (RRT). Persistent alarms despite stable vitals may indicate the patient is trying to
talk, or is developing a pneumothorax from increased intrathoracic pressure, or is
biting/gagging on the endotracheal tube, or is experiencing bronchospasms. These
alarms should never be ignored or turned off, as they may indicate early signs of a
change in the patient’s condition.

Choice A is incorrect. The nurse should assess the patient and breath sounds before
performing suction.

Choice C is incorrect. The nurse should assess the patient, suction if needed, check the
ventilator and tubing, remove excess water from the pipe, and check the endotracheal
cuff pressure. If no clear cause for alarm, the nurse should then remove the patient from
the ventilator and manually ventilate with an Ambu bag, then call respiratory therapy
(STAT). After that, the nurse can continue to assess until mechanical ventilation is
resumed.

Choice D is incorrect. Alarms should not be ignored or silenced. If unable to determine

the cause of fear, the nurse should call for assistance.

2. Answer: B

Choice B is correct. Extension of the arms and legs indicates decerebrate posturing, an
indication of increased intracranial pressure. The nurse should intervene when the client
displays this.

Choice A is incorrect. Purposeful movement when a painful stimulus is applied

indicates an improvement in the client’s condition.

Choice C is incorrect. Aimless flailing of the client's extremities would mean an

improvement in the client’s condition and would not need an intervention from the
 nurse.

Choice D is incorrect. This means that the client can follow simple commands. This
indicates that the client’s condition is improving and would not need any intervention
from the nurse.

3. Answer: A

Choice A is correct. The normal central venous pressure (CVP) is 2-8 mmHg. CVP
measures the amount of fluid that returns to the right atrium (or preload). This client's
CVP has been trending upward, and the nurse should assess the client for
hypervolemia, specifically, manifestations of right-sided heart failure.

Choices B, C, and D are incorrect. Infusing additional volume may be detrimental. This
would be an appropriate intervention for a client with a low CVP. These values are
abnormal, and the nurse should not document and continue to monitor. This value
requires action on the part of the nurse. The side-lying position is unnecessary for this
client, and if the assessment confirms fluid volume overload, the client should be
positioned as high-Fowlers.

4. Answer: B

5. Answer: F

6. Answer: A

7. Answer: E

8, Answer: C

9. Answer: D

10. Answer: C

11. Answer: B

12. Answer: D

13. Answer: A
14.

15. PIV

Swann-ganz

Trach

ETT

16. Alpha-1 adrenergic receptors are primarily found in vascular smooth muscle, and when
activated causes peripheral vasoconstriction which increases the SVR.

17. Most often used in cold shock, epinephrine acts on beta-1 receptors at low doses, and
alpha-1 receptors at high doses.

18. Noreipinephrine is most often used in warm shock. It acts on alpha-1 receptors which
causes peripheral vasoconstriction increases the BP, and therefore increases cardiac output

19.

● Cardiogenic shock
● Decreased cardiac output
● Congenital/acquired heart defects