A Day in the Life of a Critical Care Nurse Quiz

Quiz Answer Key and Fun Facts

1. Welcome to the Intensive Care Unit! First things first, the nurses must take handover. This is when the Nurse in Charge on the previous shift make a report on all the patients to the new shift, and patients are allocated to the nurses. But there are so many new words and terms! You and I are allocated a Level 3 patient - but what does this mean?

Answer: The patient is receiving support for more than one failing organ system

In the UK, we refer to the sickest patients, who require support for more than one failing organ system (e.g support of both their breathing and their kidney function) as being at Level 3. Level 2 patients are still very ill, but only require support for one failing organ system (e.g only their lungs are requiring treatment).

These patients may be treated on a High Dependency Unit. Finally, Level 1 patients are those able to be managed on a general ward.

2. Once we have received our patient and introduced ourselves, it is very important that the bedspace is checked to ensure all our vital equipment is nearby and in good working order. Which of the following pieces of equipment will probably not be in your bedspace - but must be immediately checked too?

Answer: Defibrillator

The defibrillator is usually in a central place accessible to anyone who needs to use it in a cardiac arrest. It is checked to make sure it is functioning correctly on every shift.

There are many checks to make in your bedspace, including the availability of oxygen, the presence of emergency airway equipment, that any pumps are on charge, that the bed is plugged in, that the alarms on the monitor are at satisfactory settings, checking the suction works...it's quite daunting the first few times you do it! These checks may seem tedious, but they are vital for patient safety.

3. There! Satisfied everything in our work space is in order, we must now assess our patient from top to toe. To do this, we use the ABCDE approach. This involves assessing the patient's airway, breathing, circulation, disability, and exposure. Which of the following methods would not generally be used to make an assessment of someones airway and breathing?

Answer: Taking a MAP reading

MAP refers to the Mean Arterial Pressure - or the amount of pressure exerted on the walls of the artery as blood circulates. It is a useful measure of cardiac (heart) function, but unrelated to airway and breathing assessment.

Instead, it would be more useful to listen to, or auscultate, the chest to listen for any unwanted sounds during breathing. As we have a Level 3 patient today, they are almost certainly going to be ventilated, so noting the ventilator settings will indicate how well the lungs are working. Similarly, looking at previous blood gas analyses will tell you how well the lungs are working, along with giving other vital information. Other important ways of making a respiratory assessment include observing skin colour, the amount of effort a patient is making to breathe, and their oxygen saturation levels.

4. Whilst assessing our patient's circulation, it is noted that she has a pulse rate of 112 beats per minute, instead of the normally acceptable 60-100 bpm. Which technical term do we use to describe a heart rate that is going too quickly?

Answer: Tachycardia

Tachycardia describes a heart rate generally quicker than 100 beats per minute.

Bradycardia describes a heart rate that is too slow - sources vary as to whether below 60 bpm or 50 bpm constitutes bradycardia.

Tachypnoea is an increased breathing rate. A normal breathing rate is generally between 12 and 20 breaths a minute.

Borborygmus is the scientific word for a rumbling stomach!

5. Assessing a patient's disability and exposure status incorporates quite a few things. Which of the following would we not do when assessing this aspect of our patient?

Answer: Make a referral for the patient to receive disability benefits

"Disability" is a term nurses use to refer to the assessment of neurological status, consciousness, and pain, whilst the "Exposure" part encompasses everything else we need to assess! So now we may take a look at how sedated our patient is, their blood glucose levels, their pupil size and reactions, observe any rashes, drips, and drains the patient may have, limb function, speech...this list is far from exhaustive!

6. I've decided to take an arterial blood sample to analyse. Helpfully, patients in Intensive Care usually have a line or cannula in their artery for easy access so no needles are involved! The machine tells me that the blood analysed has a pH of 7.30, a pCO2 level of 7.29 kPa, and a pO2 of 9.8 kPa. But what do all these numbers mean?!

Answer: That the patient is building up carbon dioxide, making her blood become acidic

Arterial blood gas analysis allows a number of aspects about the patient to be analysed quickly and easily. As well as giving readings for the acidity (pH), oxygen status (pO2) and pCO2 (carbon dioxide levels), it also tells us an estimated haemoglobin level, a blood glucose levels, and the levels of various electrolytes found in the body. There are others too, but this is only your first day, so don't worry about those just yet! Blood clotting is not measured in this way, however.

Blood pH should lie between 7.35 and 7.45. At 7.30, our patient is "acidotic" as the blood is more acidic than it should be. The carbon dioxide level given is very high at 7.29, which causes the blood to become more acidic.

The numbers given in the question are a bit extreme and solely used to illustrate respiratory acidosis at its most basic level - I am by no means a blood gas expert!

Many thanks to the player who pointed out that sometimes arterial gasses are measured in millimeters of mercury (mmHg). In my practice I have only used kilo-Pascals (kPa), so I have used this measurement unit here.

7. On the blood gas results, it was also found that our patient has a low potassium level. Outside of Intensive Care, potassium can be given in soluble tablet form. However, as our patient is on a ventilator and therefore cannot swallow, and we are continuously monitoring their vital signs, we are able to administer potassium via an infusion. Although potassium is vital for many biological processes, you must be very careful when administering it as it can be dangerous. What must you ensure before you administer potassium? (Assuming that it is correctly prescribed and you are giving it to the right patient at the right time.)

Answer: All of these

Potassium infusions are Controlled Drugs, and must be checked and administered by two registered nurses. They can only be given through a central line - never through a peripheral cannula - and via a syringe pump.

Patients with renal problems (particularly if they are not being dialysed or filtered) build up potassium levels as excretion is impaired, so extra caution must be taken in these patients.

Continuous cardiac monitoring is also very important. Potassium infusions can cause cardiac arrhythmias (where the heartbeat becomes erratic) if given incorrectly, so this must be looked out for.

8. Thankfully, we now have a quieter few minutes to be able to carry out some essential core nursing care. It's not all about machinery and medicines you know! You gather together a bowl of warm water, some gentle soap, some disposable wipes, and some clean sheets as we prepare to give our patient a wash and change the sheets. After washing her face and front, we roll our patient on to her side so her back may be washed and the sheet changed. As we do this, we notice that she has arrived on our Unit with a Grade 1 sacral pressure sore. How would you describe a Grade 1 pressure sore?

Answer: Reddening or marking of the skin, but no broken areas

Performing core nursing care not only allows our patients to remain clean, hygienic, and with a sense of "normality", but also gives nurses a chance to assess their patient, especially skin condition.

There are many factors which can contribute to a pressure sore developing: but they never, ever should. Regular repositioning of patients who aren't mobile, adequate nutrition, pressure relieving mattresses, and good hygiene are all simple nursing intervention which can prevent them.

Grade 1 sores are the mildest and most superficial; Grade 4 sores are very difficult to heal, and infection may easily set in.

9. Finally, it's lunchtime! And that means for our patient too. Because our patient is ventilated via a tube in their throat and is unconscious, we have to think of other ways of feeding her - her body requires many vital nutrients in order to heal. From the list below, which is NOT a way of feeding a patient?

Answer: TEG

PEG (percutaneous endoscopic gastrostomy) and NG (nasogastric) feeding are types of enteral feeding. This means feed enters the stomach via a tube, either through the nose (NG) or a small hole in the stomach wall (PEG). TPN (total parenteral nutrition) is given intravenously, and is called parenteral feeding as it does not enter the stomach. Instead, the TPN goes in to the general circulation.

TEG stands for Thromboelastograph. This is a type of blood test for clotting, and is nothing to do with feeding at all!

10. Our poor patient isn't having a good day! I notice that her blood pressure is lower than it was earlier, and her heart rate is higher. In fact, her pulse rate is higher than her blood pressure! What is the name of this clinical sign?

Answer: Portsmouth sign

Having a pulse rate that is higher than your systolic blood pressure (the top number on a blood pressure reading) is a sign that a person is really quite unwell, especially if there are other signs and symptoms too. When seen alongside pyrexia (fever), reduced urine output, confusion, or increasing oxygen needs, it is a classic sign of sepsis.

All of the places named in the answers are cities in the south of England. However, as far as I can tell (and all corrections gratefully received!) it is named after the University of Portsmouth, who developed the ALERT course for health professionals, which deals with managing acutely unwell adults.

11. Upon further examination, I find my patient is also pyrexial. This means...

Answer: She has a temperature higher than normal

Pyrexia describes a temperature above 38 degrees Celsius. The best way of bringing down a high temperature is to give paracetamol if possible, along with stripping back any excess bedding (whilst protecting their modesty of course!).

12. I have decided to inform the doctor, as her drop in blood pressure, raised heart rate, and pyrexia suggest our patient may be septic (have a severe infection). Which of these drugs is the doctor most likely to immediately prescribe for sepsis?

Answer: Penicillin

When sepsis is first suspected, it is wise to give a broad-spectrum antibiotic until the causative agent can be identified. This may be a penicillin-based drug - unless the patient is allergic, of course.

None of the other drugs are treatments for sepsis. Simvastatin is a cholesterol-lowering drug; prednisolone is a steroid (although this may be given to septic patients to help with inflammation); and phenytoin as a drug used for controlling and preventing seizures.

13. You should continue to talk to your patient, introducing yourself and explaining any procedures, even if they are sedated and unconscious.

Answer: True

It is unknown just how aware patients are when they are sedated or in a coma. Therefore, it is important to act and behave as though they ARE aware of their surroundings, and inform the patient about what you are doing. It is also a good idea to tell the patient the time, date and place from time to time, as research suggests this reduces the psychological effects of an Intensive Care stay.

14. It's nearly the end of a very long shift, hurrah! But before we get to go home, we need to make sure that all our documentation and nursing records are up to date. These are written or computerised records of care given, medications administered, and observations made. But why do you need to make sure you write everything down in a clear, concise way?

Answer: All of these options are correct

Remember: if it wasn't written down, it didn't happen. And should you (heaven forbid) end up in court with your patient, and your documentation was inadequate, false, or illegible, you won't have a leg to stand on...

15. Well done for surviving your first shift in the Intensive Care Unit! And what an eventful day it has been! In fact, you have been so busy that you have not yet given a drug that was due half an hour ago. It is an injection called dalteparin, and helps to prevent blood clots forming as the patient is not mobile. You quickly and carefully give the injection before handing over to the next nurse and heading for home. But first: what other measures can be taken to help prevent blood clots?

Answer: All of these

All of these, especially when used in combination, are effective in preventing blood clots. Yes, even patients who are on a ventilator can be stood and walked! Close work with the physiotherapists is vital for this to be done safely.

Blood clots (such as deep vein thrombosis, or pulmonary embolism) often occur as a result of being immobile, and hospital patients are especially susceptible to them. Preventing this occuring should be at the forefront of every nurse's mind.

Source: Author crazy baby

This quiz was reviewed by FunTrivia editor WesleyCrusher before going online.
Any errors found in FunTrivia content are routinely corrected through our feedback system.

Come on shift with me for the day as you learn about the work of a Critical Care/Intensive Care Nurse. Please bear in mind that British terms and spellings are used.

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