Solution Manual for Understanding the Essentials of Critical Care Nursing, 3rd Edition

Name: Solution Manual for Understanding the Essentials of Critical Care Nursing, 3rd Edition
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Solution Manual for Understanding the Essentials of Critical Care Nursing, 3rd Edition helps you reinforce learning with in-depth, accurate solutions.

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DECISION-MAKING CASE SUMMARIES
CASE
NAME
OVERVIEW MAJOR CASE
DECISIONS
Jim Edgerly Mr. Jim Edgerly is a 28-year-old
man who presents to the ED
front desk with complaints of
heart palpitations and
lightheadedness. Symptoms
have been present for about
one hour, and Mr. Edgerly
drove himself to the ED. He has
no significant medical or
surgical history and currently
takes only a daily multivitamin.
Mr. Edgerly exercises regularly,
does not use tobacco or
recreational drugs, and
consumes 2-3 alcoholic drinks
per day.
1. Identifying and responding to
dysrhythmias
2. Prioritizing medication
administration
3. Monitoring for side effects of
treatments
4. Identifying and responding to
changes in patient condition
5. Assessing for stabilization of
vital signs and hemodynamics
6. Recognizing a need for
additional patient teaching
Estimated Case Length: 1 hour
Difficulty Level: High
Learning Objectives:
 Describe the characteristics of supraventricular tachycardia (SVT).
 Prioritize the nursing interventions for stable SVT.
 Prioritize the nursing interventions for unstable SVT.
 Present pertinent patient education regarding the management of SVT.
 Provide discharge teaching for a patient who has experienced SVT.
Questions Correct Answers
1. After obtaining vital signs
and placing the patient on a
continuous cardiac monitor,
what should your next
actions be? Select all that
apply.
Obtain IV access
Perform a 12-lead EKG
2. A 12-lead EKG is quickly
performed. It reveals that the
Sudden onset and termination
CRITICAL CARE NURSING #1:
SUPRAVENTRICULAR TACHYCARDIA

patient is experiencing
supraventricular tachycardia
(SVT) with a heart rate of
170 beats per minute. SVT
is characterized by which of
the following? Select all that
apply.
Re-entry rhythm
Possible palpitations and syncope
3. The ER physician
confirms that Mr. Edgerly is
experiencing SVT. Which of
the following measures may
the physician choose as an
initial treatment option?
Vasovagal maneuver
4. The initial intervention
proves unsuccessful in
terminating Mr. Edgerly’s
SVT, so the ED physician
decides to administer
adenosine (Adenocard).
Which of the following
guidelines should you follow
when administering this
medication? Select all that
apply.
Monitor the patient’s cardiac rhythm during administration for
run of asystole prior to conversion to sinus rhythm.
Administer adenosine via rapid IV push, followed by 20 ml
normal saline via rapid IV push.
Inform the patient that he may become flushed, experience
chest pain, and feel lightheaded following administration.
5. Mr. Edgerly continues in
SVT at 180 beats per
minute. He begins to lose
consciousness. As the ED
nurse, what is your next
step?
Prepare for synchronized electrocardioversion at 50 joules
6. As the team prepares for
electrocardioversion, which
of the following nursing
actions are appropriate?
Place one defibrillator pad on the patient’s right upper chest and
the second either on the lower left chest or the back under the
left shoulder blade.
7. Mr. Edgerly converts to
sinus rhythm on the monitor
after one shock. What
should be your first action
after this successful
conversion?
Palpate the carotid artery for a pulse
8. Mr. Edgerly’s vital signs
stabilize, with BP 113/60, P
Pharmacological rate control with either beta blockers or
calcium channel blockers

80 sinus rhythm, RR 16, and
O2 sat 98% on room air. Mr.
Edgerly is admitted for
cardiology consult and
observation.
Later, when you have the
opportunity to obtain a more
thorough health history, Mr.
Edgerly reveals that he has
experienced similar
palpitations and
lightheadedness in the past,
with approximately six
episodes in the last three
months.
What potential future
interventions should Mr.
Edgerly anticipate for this
dysrhythmia? Select all that
apply.
Ablation therapy
Ongoing outpatient management with a cardiologist
Pharmacological rate control with either beta blockers or
calcium channel blockers
9. Mr. Edgerly is discharged
the following day. His
discharge medications include
a multivitamin and metoprolol
(Toprol XL) 25 mg daily. He
has a scheduled appointment
with a cardiologist.
Which of the following options
would be considered essential
patient education for Mr.
Edgerly? Select all that
apply.
Teaching Mr. Edgerly how to palpate and time his carotid or
radial pulse
Teaching Mr. Edgerly to hold metoprolol and notify his physician
if his pulse is less than 60 bpm
Teaching Mr. Edgerly about the potential triggers/etiologies of
SVT
Teaching Mr. Edgerly vasovagal maneuvers
Teaching Mr. Edgerly to call 911 if he becomes lightheaded
during an episode of SVT

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DECISION-MAKING CASE SUMMARIES
CASE
NAME
OVERVIEW MAJOR CASE
DECISIONS
Duncan
McLaughlin
Mr. Duncan McLaughlin is a 64-
year-old man who presents to
the ED front desk with
diaphoresis, nausea, and chest
discomfort extending down his
left arm and into his jaw.
Symptoms have been present
for about one hour, and Mr.
McLaughlin drove himself to the
ED. He has a history of
hypertension, hyperlipidemia,
GERD, hypothyroidism, and
Type II diabetes. Mr.
McLaughlin is a 40-pack year
smoker and consumes 1-2
beers on weekdays and 6-8
beers on weekend days.
1. Identifying and responding to
symptoms of MI
2. Monitoring for side effects of
medication
3. Assessing for and responding
to complications of a medical
procedure
4. Responding to patient
questions
5. Identifying and responding to
changes in patient condition
6. Recognizing a need for
additional patient teaching
Estimated Case Length: 1 hour
Difficulty Level: High
Learning Objectives:
 Prioritize nursing actions for the care of a patient with myocardial infarction.
 Identify and describe diagnostic findings associated with an ST elevation myocardial
infarction.
 Discuss the nurse’s responsibilities when caring for a patient following cardiac
catheterization.
 Identify essential discharge teaching for a client who has undergone coronary
intervention.
Questions Correct Answers
1. As Mr. McLaughlin’s
triage nurse, which of the
following actions should be
your priority? Select all that
apply.
Place Mr. McLaughlin on the continuous cardiac monitor
Start oxygen via nasal cannula
2. Which of the following
diagnostic tests will most
accurately and quickly
Troponin and CPK
CRITICAL CARE NURSING #2: MYOCARDIAL
INFARCTION

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determine whether acute
coronary syndrome is the
cause of Mr. McLaughlin’s
symptoms?
3. The 12-lead ECG reveals
ST segment elevations in
leads I, aVL, and V2–V5.
The ER physician writes the
following order:
“Nitroglycerin 0.4 mg SL for
chest pain. May repeat q5
minutes x 3. Notify MD for
ongoing chest discomfort.”
What are the appropriate
nursing actions for this
medication?
Check the patient’s BP before and after medication
administration
4. Which of the following
statements is true regarding
ST elevation myocardial
infarction (STEMI)?
STEMI is considered a transmural infarction.
5. Mr. McLaughlin’s BP
drops to 85/49 after the first
dose of SL nitroglycerin. Mr.
McLaughlin also continues
to have chest pain. Given
these circumstances, what
should be your next course
of action?
Notify the healthcare provider and prepare to administer IV
fluids
6. Which of the following
diagnostic tests would be
essential to obtain before
cardiac catheterization?
PT/INR/PTT, CBC, and basic metabolic profile
7. During the initial post-
catheterization exam, you
note that the fingers on Mr.
McLaughlin’s right hand are
cool and capillary refill is >
3.0 seconds. Mr.
McLaughlin’s compression
band has been in place for 1
hour. What is the priority
nursing action?
Notify the healthcare provider

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8. The day after his cardiac
catheterization, Mr.
McLaughlin’s urine output is
10 ml/h and his creatinine is
2.4 (baseline 1.3). When told
about these results, Mr.
McLaughlin says, “My
kidneys have always been
fine. What happened?” What
is your best response?
“The dye from a cardiac catheterization can sometimes affect
the kidneys.”
9. Which type of rhythm is
Mr. McLaughlin
experiencing?
Atrial fibrillation
10. What should be the
healthcare team’s immediate
action to treat this unstable
rhythm?
Synchronized electrocardioversion
11. What specific
information regarding
clopidogrel (Plavix) should
be reinforced with this
patient? Select all that
apply.
You should not take omeprazole with this medication.
You should take this medication with a baby aspirin.
12. As part of discharge
education, you note that Mr.
McLaughlin had not been
taking his preadmission
prescribed medications.
What is the best way for you
to address this situation with
Mr. McLaughlin?
“Could you share with me why you were not taking the
medications that were prescribed for you?”

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DECISION-MAKING CASE SUMMARIES
CASE
NAME
OVERVIEW MAJOR CASE
DECISIONS
Robert
Barnes
Mr. Robert Barnes is a 70-year-
old male who was admitted to
the ICU from the emergency
department for community-
acquired pneumonia. One week
prior to admission he began
complaining of feeling tired and
a dull ache in his right chest
when coughing. His wife
brought him to the ED today
because he did not seem to
know where he was, had a
fever, was coughing repeatedly
and breathing rapidly.
1. Administering medications
2. Selecting oxygen therapy
3. Implementing priority nursing
actions
4. Interpreting and responding to
laboratory results
5. Assisting with emergency
intubation
6. Responding to questions from
the patient’s family
7. Responding to ventilator alarms
8. Communicating with an
intubated patient
9. Implementing nutrition
strategies
10. Recognizing risk factors for
extubation
11. Extubating the patient
Estimated Case Length: 1 hour
Difficulty Level: High
Learning Objectives:
 Identify the manifestations of acute respiratory failure.
 Describe indications for the use of noninvasive ventilation.
 Explain the indications for and complications associated with mechanical ventilation.
 Discuss nursing responsibilities when caring for a patient receiving mechanical
ventilation.
 Identify readiness to wean in the ventilated patient.
Questions Correct Answers
1. The antibiotics for Mr.
Barnes arrive from the
pharmacy. You see that he
has been prescribed both
ceftriaxone and
azithromycin. What is your
best course of action?
Plan to administer the ceftriaxone over 30 minutes, immediately
followed by the azithromycin
CRITICAL CARE NURSING #3: RESPIRATORY
FAILURE

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2. Mr. Barnes is receiving
high-flow oxygen therapy
with an FiO2 of 80% at 60
L/min. Which of the following
are reasons why high-flow
therapy would be more
appropriate for Mr. Barnes
than lower flow rate therapy
by mask? Select all that
apply.
High-flow therapy may also provide some positive end-
expiratory pressure (PEEP).
High-flow oxygen can be delivered by nasal cannula and may
be more comfortable.
Oxygen delivery is more variable with low-flow therapy because
room air is mixed with the inspired gas.
Patients receiving high-flow oxygen can often cough and speak
more easily than patients receiving low-flow mask therapy.
3. When you assess Mr.
Barnes 15 minutes after the
high-flow oxygen has been
instituted, he has a
respiratory rate of 36 and an
oxygen saturation of 88%.
He is restless and
complaining that someone is
hammering on his roof.
Which of the following is the
appropriate course of
action?
Notify the physician of these findings
4. The physician is notified
of Mr. Barnes’s status and
requests that ABGs be
drawn.
When the ABG results
arrive, they are as follows:
pH 7.28, PCO2 50, PO2 60,
and HCO3 25. How should
you respond?
Inform the physician and team of the ABG results and anticipate
possible intubation
5. The physician decides
that Mr. Barnes requires
immediate intubation and
mechanical ventilation.
Which of the following is a
nursing responsibility prior to
and during emergent
intubation of Mr. Barnes?
Verify that a CO2 detector is used to determine placement of the
endotracheal tube
6. Following intubation, Mr.
Barnes is placed on a
ventilator. When his wife
“The ventilator will help your husband breathe until the
antibiotics begin to work.”

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arrives at his bedside and
sees the ventilator, she
asks, “How is that machine
going to make my husband
better?” What is your best
response?
7. The low pressure/low
minute volume alarm on the
mechanical ventilator begins
to sound. What should be
your first response to the
alarm?
Check the ventilator tubing for disconnection
8. After Mr. Barnes begins to
awaken from the intubation,
he looks at you and is trying
to say something while
pointing at his mouth and
pumping his fist. What
should you do? Select all
that apply.
Explain to Mr. Barnes that there is a tube in his throat that is
helping him breathe
Tell Mr. Barnes to blink once for yes and twice for no, then ask
him yes-or-no questions
9. Mr. Barnes remains
awake, anxious, and trying
to speak while reaching for
the endotracheal tube in his
mouth. The goal for Mr.
Barnes following intubation
is light sedation. Currently,
he is receiving IV propofol at
20 mcg/kg/min. What should
you do next?
Increase the rate of the propofol to 30 mcg/kg/min
10. The morning following
Mr. Barnes’s admission, the
multidisciplinary team is
reviewing his care to decide
whether he should begin
enteral feeding. Since
admission, Mr. Barnes’s
orogastric tube has been
attached to low continuous
suction. Which of the
following findings related to
the orogastric tube should
you mention to the team
because it will likely
Placement of the orogastric tube has not been verified by x-ray.

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influence the decision of
when to begin feedings?
11. Three days later, Mr.
Barnes is showing clinical
response to his antibiotics
and the team is considering
weaning then extubating
him. Which of the following
would indicate that Mr.
Barnes is at high risk for
failure to successfully wean
from ventilation at this time?
He is 70 years old and has a maximum inspiratory pressure of –
25 cm H2O.
12. The healthcare team
determines that Mr. Barnes
is ready to be extubated.
Which of the following
actions should you take prior
to and following his
extubation? Select all that
apply.
Turn off the orogastric tube feeding prior to extubation
Notify the physician and respiratory therapist immediately if Mr.
Barnes develops stridor

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