SNLE Critical Care Nursing 2 — Questions and Answers
Question 1: What is the nursing management for a patient with acute respiratory distress syndrome (ARDS)?
- High tidal volume ventilation
- Low tidal volume ventilation (6 mL/kg), prone positioning, PEEP optimization, and conservative fluid management (Correct answer)
- No ventilator support needed
- Immediate extubation
Correct answer: Low tidal volume ventilation (6 mL/kg), prone positioning, PEEP optimization, and conservative fluid management
ARDS management: lung-protective ventilation (low tidal volume 6 mL/kg ideal body weight), appropriate PEEP to maintain oxygenation, prone positioning (12-16 hours/day improves oxygenation), conservative fluid management, sedation management, and monitoring for barotrauma.
Question 2: What does the nurse assess using the Richmond Agitation-Sedation Scale (RASS)?
- Pain level
- Level of sedation or agitation in critically ill patients, ranging from -5 (unarousable) to +4 (combative) (Correct answer)
- Respiratory function
- Cardiac rhythm
Correct answer: Level of sedation or agitation in critically ill patients, ranging from -5 (unarousable) to +4 (combative)
RASS rates sedation/agitation: +4 combative, +3 very agitated, +2 agitated, +1 restless, 0 alert and calm, -1 drowsy, -2 light sedation, -3 moderate sedation, -4 deep sedation, -5 unarousable. Target is typically 0 to -2 in ICU patients, adjusted to clinical needs.
Question 3: What is the priority nursing action during a cardiac arrest when the rhythm shows ventricular fibrillation?
- Administer atropine
- Initiate CPR and prepare for immediate defibrillation (Correct answer)
- Administer adenosine
- Wait for the rhythm to convert spontaneously
Correct answer: Initiate CPR and prepare for immediate defibrillation
Ventricular fibrillation (VF) is a shockable rhythm. Priority: immediate high-quality CPR, defibrillate as soon as possible (120-200J biphasic), resume CPR immediately after shock for 2 minutes, administer epinephrine after 2nd shock, and amiodarone after 3rd shock per ACLS protocol.
Question 4: What is the nurse's role in end-of-life care in the Saudi ICU?
- End-of-life discussions are not the nurse's responsibility
- Provide comfort measures, manage symptoms, support family communication, respect cultural/religious practices, and coordinate with the palliative care team (Correct answer)
- Withdraw all medications
- Only provide technical care
Correct answer: Provide comfort measures, manage symptoms, support family communication, respect cultural/religious practices, and coordinate with the palliative care team
ICU end-of-life nursing: provide dignified comfort care, manage pain and symptoms, support family (facilitate visits, communication with physicians), respect Islamic end-of-life practices (facing Qibla, Quran recitation), ensure Do Not Resuscitate orders are clear, and coordinate with palliative care and chaplaincy services.
Question 5: What nursing considerations apply when caring for a patient on continuous renal replacement therapy (CRRT)?
- No special nursing care needed
- Monitor hemodynamic stability, manage anticoagulation of the circuit, assess fluid balance hourly, monitor electrolytes, and troubleshoot alarms (Correct answer)
- Only check the machine once per shift
- CRRT requires no anticoagulation
Correct answer: Monitor hemodynamic stability, manage anticoagulation of the circuit, assess fluid balance hourly, monitor electrolytes, and troubleshoot alarms
CRRT nursing care: continuous hemodynamic monitoring (hypotension risk), circuit anticoagulation management (citrate or heparin), hourly fluid balance assessment, frequent electrolyte monitoring (especially calcium with citrate), catheter site assessment, temperature monitoring (heat loss), and filter/circuit lifespan tracking.
Question 6: What is the significance of elevated lactate levels in a critically ill patient?
- It indicates adequate oxygenation
- Elevated lactate (>2 mmol/L) indicates tissue hypoperfusion and is a marker of shock severity and mortality risk (Correct answer)
- It is normal in ICU patients
- It only indicates liver disease
Correct answer: Elevated lactate (>2 mmol/L) indicates tissue hypoperfusion and is a marker of shock severity and mortality risk
Elevated lactate indicates anaerobic metabolism due to tissue hypoperfusion (inadequate oxygen delivery). Lactate >2 mmol/L is concerning; >4 mmol/L indicates severe shock with high mortality risk. Serial lactate monitoring guides resuscitation adequacy — lactate clearance of >10% per hour is the goal.
SNLE Critical Care Nursing 2
What is the nursing management for a patient with acute respiratory distress syndrome (ARDS)?