SNLE Critical Care Nursing — Questions and Answers
Question 1: What does a hemodynamic reading of CVP 2 mmHg indicate?
- Fluid overload
- Hypovolemia (low intravascular volume) requiring fluid resuscitation (Correct answer)
- Normal fluid status
- Right heart failure
Correct answer: Hypovolemia (low intravascular volume) requiring fluid resuscitation
Central Venous Pressure (CVP) normal range is 2-8 mmHg. CVP of 2 mmHg (at the low end/below normal) suggests hypovolemia — decreased intravascular volume. The nurse should anticipate fluid resuscitation orders and assess for signs of dehydration and poor perfusion.
Question 2: What is the nurse's priority action when a patient's ventilator alarm sounds 'High Pressure'?
- Silence the alarm and continue monitoring
- Assess the patient immediately for secretions, kinking, biting, pneumothorax, or bronchospasm (Correct answer)
- Increase the tidal volume
- Remove the patient from the ventilator
Correct answer: Assess the patient immediately for secretions, kinking, biting, pneumothorax, or bronchospasm
High pressure alarm means increased resistance to airflow. Causes: secretions (suction needed), kinked/compressed tubing, patient biting tube (insert bite block), bronchospasm (administer bronchodilator), tension pneumothorax (emergency), or decreased lung compliance. Assess patient before the ventilator.
Question 3: What are the signs of cardiac tamponade?
- Hypertension and bradycardia
- Beck's triad: hypotension, distended neck veins, and muffled heart sounds (Correct answer)
- Peripheral edema only
- High urine output
Correct answer: Beck's triad: hypotension, distended neck veins, and muffled heart sounds
Cardiac tamponade presents with Beck's triad: hypotension (low cardiac output), distended jugular veins (impaired venous return), and muffled/distant heart sounds (fluid around heart). Additional signs: pulsus paradoxus (>10 mmHg BP drop during inspiration), tachycardia, and narrowed pulse pressure.
Question 4: What is the correct compression-to-ventilation ratio for adult CPR?
- 15:1
- 15:2
- 30:2 (Correct answer)
- 5:1
Correct answer: 30:2
Current AHA/Saudi Heart Association guidelines: 30 chest compressions to 2 ventilations for adult CPR (single or two rescuers with advanced airway). Compressions should be at least 5 cm deep, at a rate of 100-120/min, with full chest recoil. Minimize interruptions (<10 seconds).
Question 5: What is sepsis and what are the nursing priorities for early recognition?
- A localized infection with no systemic effects
- Life-threatening organ dysfunction caused by dysregulated host response to infection — monitor for SIRS criteria, lactate levels, and organ dysfunction (Correct answer)
- A type of surgical procedure
- A chronic condition with no urgency
Correct answer: Life-threatening organ dysfunction caused by dysregulated host response to infection — monitor for SIRS criteria, lactate levels, and organ dysfunction
Sepsis recognition (qSOFA): altered mental status, respiratory rate ≥22, systolic BP ≤100 mmHg. Nursing priorities: early recognition, obtain blood cultures BEFORE antibiotics, administer broad-spectrum antibiotics within 1 hour, aggressive fluid resuscitation (30 mL/kg crystalloid), monitor lactate, and assess organ function.
Question 6: How should a nurse manage a patient with an arterial line?
- No special monitoring needed
- Zero and level the transducer at the phlebostatic axis, monitor waveform, assess the site for bleeding/infection, and perform Allen's test before insertion (Correct answer)
- Only check blood pressure readings
- Remove if the patient moves
Correct answer: Zero and level the transducer at the phlebostatic axis, monitor waveform, assess the site for bleeding/infection, and perform Allen's test before insertion
Arterial line nursing care: zero/level transducer at phlebostatic axis (4th ICS, mid-axillary), verify waveform quality, maintain continuous flush system, assess insertion site (bleeding, infection, circulation distal to site), perform Allen's test before radial insertion, and never flush rapidly (risk of retrograde cerebral embolism).
SNLE Critical Care Nursing
What does a hemodynamic reading of CVP 2 mmHg indicate?