TEST BANK
Introduction to Critical Care Nursing
Mary Lou Sole, Deborah Klein,
7th Edition
9780323377034
,Table of content
Chapter 1. Overview of Critical Care Nursing
Chapter 2. Patient and Family Response to the Critical Care Experience
Chapter 3. Ethical and Legal Issues in Critical Care Nursing
Chapter 4. Palliative and End-of-Life Care
Chapter 5. Comfort and Sedation
Chapter 6. Nutritional Therapy
Chapter 7. Dysrhythmia Interpretation and Management
Chapter 8. Hemodynamic Monitoring
Chapter 9. Ventilatory Assistance
Chapter 10. Rapid Response Teams and Code Management
Chapter 11. Organ Donation
Chapter 12. Shock, Sepsis, and Multiple Organ Dysfunction Syndrome
Chapter 13. Cardiovascular Alterations
Chapter 14. Nervous System Alterations
Chapter 15. Acute Respiratory Failure
Chapter 16. Acute Kidney Injury
Chapter 17. Hematological and Immune Disorders
Chapter 18. Gastrointestinal Alterations
Chapter 19. Endocrine Alterations
Chapter 20. Trauma and Surgical Management
Chapter 21. Burns
,Chapter 01: Overview of Critical Care Nursing
Sole: Introduction to Critical Care Nursing, 7th Edition
MULTIPLE CHOICE
1. Which of the following professional organizations best supports critical care nursing practice?
a. American Association of Critical-Care Nurses
b. American Heart Association
c. American Nurses Association
d. Society of Critical Care Medicine
ANS: A
The American Association of Critical-Care Nurses is the specialty organization that supports
and represents critical care nurses. The American Heart Association supports cardiovascular
initiatives. The American Nurses Association supports all nurses. The Society of Critical Care
Medicine represents the multiprofessional critical care team under the direction of an
intensivist.
DIF: Cognitive Level: Remember/Knowledge REF: p. 5
OBJ: Discuss the purposes and functions of the professional organizations that support critical care
practice. TOP: Nursing Process Step: N/A
MSC: NCLEX Client Needs Category: Safe and Effective Care Environment
2. A nurse has been working as a staff nurse in the surgical intensive care unit for 2 years and is
interested in certification. Which credential would be most applicable for the nurse to seek?
a. ACNPC-AG
b. CNML
c. CCRN
d. PCCN
ANS: C
The CCRN certification is appropriate for nurses in bedside practice who care for critically ill
patients. The ACNPC-AG certification is for acute care nurse practitioners. The CNML is for
critical care nurse managers or leaders. The PCCN certification is for staff nurses working in
progressive care, intermediate care, or step-down unit settings.
DIF: Cognitive Level: Remember/Knowledge REF: p. 6
OBJ: Explain certification options for critical care nurses. TOP: Nursing Process Step: N/A
MSC: NCLEX Client Needs Category: Safe and Effective Care Environment
3. The main purpose of certification is to
a. assure the consumer that you will not make a mistake.
b. prepare for graduate school.
c. promote magnet status for your facility.
d. validate knowledge of critical care nursing.
ANS: D
, Certification assists in validating knowledge of the field, promotes excellence in the
profession, and helps nurses to maintain their knowledge of critical care nursing. Certification
helps to assure the consumer that the nurse has a minimum level of knowledge; however, it
does not ensure that care will be mistake-free. Certification does not prepare one for graduate
school; however, achieving certification demonstrates motivation for achievement and
professionalism. Magnet facilities are rated on the number of certified nurses; however, that is
not the purpose of certification.
DIF: Cognitive Level: Remember/Knowledge REF: p. 6
OBJ: Explain certification options for critical care nurses. TOP: Nursing Process Step: N/A
MSC: NCLEX Client Needs Category: Safe and Effective Care Environment
4. The synergy model of practice focuses on
a. allowing unrestricted visiting for the patient 24 hours a day.
b. holistic and alternative therapies.
c. the needs of patients and their families, which drive nursing competency.
d. patients’ needs for energy and support.
ANS: C
The synergy model of practice states that the needs of patients and families influence and
drive competencies of nurses. Nursing practice based on the synergy model would involve
tailored visiting to meet the patient’s and family’s needs and the application of alternative
therapies if desired by the patient, but that is not the primary focus of the model.
DIF: Cognitive Level: Remember/Knowledge REF: p. 6
OBJ: Describe standards of professional practice for critical care nursing.
TOP: Nursing Process Step: N/A
MSC: NCLEX Client Needs Category: Safe and Effective Care Environment
5. The family of your critically ill patient tells you that they have not spoken with the physician
in over 24 hours and that they have some questions they want clarified. During morning
rounds, you convey this concern to the attending intensivist and arrange a meeting with the
family at 4:00 PM. Which competency of critical care nursing does this represent?
a. Advocacy and moral agency in solving ethical issues
b. Clinical judgment and clinical reasoning skills
c. Collaboration with patients, families, and team members
d. Facilitation of learning for patients, families, and team members
ANS: C
Although one might consider that all of these competencies are being addressed,
communication and collaboration with the family and physician best exemplify the
competency of collaboration.
DIF: Cognitive Level: Analyze/Analysis REF: p. 6 | Fig 1-3 | Box 1-1
OBJ: Describe standards of professional practice for critical care nursing.
TOP: Nursing Process Step: N/A
MSC: NCLEX Client Needs Category: Safe and Effective Care Environment
6. The AACN Standards for Acute and Critical Care Nursing Practice use what framework to
guide critical care nursing practice?
a. Evidence-based practice
, b. Healthy work environment
c. National Patient Safety Goals
d. Nursing process
ANS: D
The AACN Standards for Acute and Critical Care Nursing Practice delineate the nursing
process as applied to critically ill patients: collect data, determine diagnoses, identify expected
outcomes, develop a plan of care, implement interventions, and evaluate care. AACN
promotes a healthy work environment, but this is not included in its standards. The Joint
Commission has established National Patient Safety Goals, but these are not the AACN
standards.
DIF: Cognitive Level: Remember/Knowledge REF: p. 6
OBJ: Describe standards of professional practice for critical care nursing.
TOP: Nursing Process Step: N/A
MSC: NCLEX Client Needs Category: Safe and Effective Care Environment
7. The charge nurse is responsible for making the patient assignments on the critical care unit.
An experienced, certified nurse is assigned to care for the acutely ill patient with sepsis who
also requires continuous renal replacement therapy and mechanical ventilation. The nurse with
less than 1 year of experience is assigned to two patients who are more stable. This
assignment reflects implementation of the
a. crew resource management model.
b. National Patient Safety Goals.
c. Quality and Safety Education for Nurses (QSEN) model.
d. synergy model of practice.
ANS: D
This assignment demonstrates nursing care to meet the needs of the patient. The synergy
model notes that the nurse competencies are matched to the patient characteristics. Crew
resource management concepts are related to team training; National Patient Safety Goals are
specified by The Joint Commission to promote safe care but do not incorporate the synergy
model. The Quality and Safety Education for Nurses initiative involves targeted education of
undergraduate and graduate nursing students on quality and safety concepts.
DIF: Cognitive Level: Analyze/Analysis REF: p. 6
OBJ: Describe standards of professional practice for critical care nursing.
TOP: Nursing Process Step: N/A
MSC: NCLEX Client Needs Category: Safe and Effective Care Environment
8. The vision of the American Association of Critical-Care Nurses is a health care system driven
by
a. a healthy work environment.
b. care from a multiprofessional team under the direction of a critical care physician.
c. the needs of critically ill patients and families.
d. respectful, healing, and humane environments.
ANS: C
, The AACN vision is a health care system driven by the needs of critically ill patients and
families where critical care nurses make their optimum contributions. AACN promotes
initiatives to support a healthy work environment as well as respectful and healing
environments, but that is not the organization’s vision. The Society of Critical Care Medicine
(SCCM) promotes care from a multiprofessional team under the direction of a critical care
physician.
DIF: Cognitive Level: Remember/Knowledge REF: p. 5
OBJ: Discuss the purposes and functions of the professional organizations that support critical care
practice. TOP: Nursing Process Step: N/A
MSC: NCLEX Client Needs Category: Safe and Effective Care Environment
9. The most important outcome of effective communication is to
a. demonstrate caring practices to family members.
b. ensure that patient teaching is done.
c. meet the diversity needs of patients.
d. reduce patient errors.
ANS: D
Many errors are directly attributed to faulty communication. Effective communication has
been identified as an essential strategy to reduce patient errors and resolve issues related to
patient care delivery. Communication may demonstrate caring practices, address diversity
needs, and be used for patient/family teaching; however, the main outcome of effective
communication is patient safety.
DIF: Cognitive Level: Remember/Knowledge REF: p. 9
OBJ: Describe quality and safety initiatives related to critical care nursing.
TOP: Nursing Process Step: N/A
MSC: NCLEX Client Needs Category: Safe and Effective Care Environment
10. You are caring for a critically ill patient whose urine output has been low for 2 consecutive
hours. After a thorough patient assessment, you call the intensivist with report. Which
information do you convey regarding background?
a. Urine output of 40 mL/2 hours
b. Current vital signs and history of aortic aneurysm repair 4 hours ago
c. A statement that the patient is possibly hypovolemic
d. A request for IV fluids
ANS: B
The history and vital signs are part of the background. Information regarding the low urine
output is the situation. Information regarding possible hypovolemia is part of the nurse’s
assessment, and the suggestion for fluids is the recommendation.
DIF: Cognitive Level: Analyze/Analysis REF: p. 9
OBJ: Describe quality and safety initiatives related to critical care nursing.
TOP: Integrated Process: Communication
MSC: NCLEX Client Needs Category: Safe and Effective Care Environment
11. The family members of a critically ill patient bring a copy of the patient’s living will to the
hospital, which identifies the patient’s wishes regarding health care. You discuss contents of
the living will with the patient’s physician. This is an example of implementation of which of
the AACN Standards of Professional Performance?
, a. Acquires and maintains current knowledge of practice
b. Acts ethically on the behalf of the patient and family
c. Considers factors related to safe patient care
d. Uses clinical inquiry and integrates research findings in practice
ANS: B
Discussing end-of-life issues is an example of a nurse acting ethically on behalf of the patient
and family. The example does not relate to acquiring knowledge, promoting patient safety, or
using research in practice.
DIF: Cognitive Level: Analyze/Analysis REF: p. 6 | Box 1-2
OBJ: Describe standards of care and performance for critical care nursing.
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Safe and Effective Care Environment
12. Which of the following assists the critical care nurse in ensuring that care is appropriate and
based on research?
a. Clinical practice guidelines
b. Computerized physician order entry
c. Consulting with advanced practice nurses
d. Implementing Joint Commission National Patient Safety Goals
ANS: A
Clinical practice guidelines are being implemented to ensure that care is appropriate and based
on research. Some physician order entry pathways, but not all, are based on research
recommendations. Some advanced practice nurses, but not all, are well versed in
evidence-based practices. The National Patient Safety Goals are recommendations to reduce
errors using evidence-based practices.
DIF: Cognitive Level: Analyze/Analysis REF: p. 8
OBJ: Describe standards of professional practice for critical care nursing.
TOP: Nursing Process Step: N/A
MSC: NCLEX Client Needs Category: Safe and Effective Care Environment
13. Comparing the patient’s current (home) medications with those ordered during hospitalization
and communicating a complete list of medications to the next provider when the patient is
transferred within an organization or to another setting are strategies to:
a. improve accuracy of patient identification.
b. prevent errors related to look-alike and sound-alike medications.
c. reconcile medications across the continuum of care.
d. reduce harms associated with the administration of anticoagulants.
ANS: C
These are steps recommended in the National Patient Safety Goals to reconcile medications
across the continuum of care. Improving accuracy of patient identification is another National
Patient Safety Goal. Preventing errors related to look-alike and sound-alike medications is
done to improve medication safety, but is not related to transferring the patient between
settings. Reducing harms associated with the administration of anticoagulants is another
National Patient Safety Goal.
DIF: Cognitive Level: Understand/Comprehension REF: p. 7 | Box 1-3
OBJ: Describe quality and safety initiatives related to critical care nursing.
, TOP: Nursing Process Step: N/A
MSC: NCLEX Client Needs Category: Safe and Effective Care Environment
14. As part of nursing management of a critically ill patient, orders are written to keep the head of
the bed elevated at 30 degrees, awaken the patient from sedation each morning to assess
readiness to wean from mechanical ventilation, and implement oral care protocols every 4
hours. These interventions are done as a group to reduce the risk of ventilator-associated
pneumonia. This group of evidence-based interventions is often called a
a. bundle of care.
b. clinical practice guideline.
c. patient safety goal.
d. quality improvement initiative.
ANS: A
A group of evidence-based interventions done as a whole to improve outcomes is termed a
bundle of care. This is an example of the ventilator bundle. Oftentimes these bundles are
derived from clinical practice guidelines and are monitored for compliance as part of quality
improvement initiatives. At some point, these may become part of patient safety goals.
DIF: Cognitive Level: Remember/Knowledge REF: p. 7 | Box 1-3
OBJ: Describe quality and safety initiatives related to critical care nursing.
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Safe and Effective Care Environment
15. You work in an intermediate care unit and have asked to be involved in developing new
guidelines to prevent pressure ulcers in your patient population. The nurse manager tells you
that you do not yet have enough experience to be on the prevention task force and that your
ideas will be rejected by others. This situation is an example of
a. a barrier to handoff communication.
b. a work environment that is unhealthy.
c. ineffective decision making.
d. nursing practice that is not evidence-based.
ANS: B
These are examples of an unhealthy work environment. A healthy work environment values
communication, collaboration, and effective decision making. It also has authentic leadership.
It is not an example of handoff communication, which is communication that occurs to
transition patient care from one staff member to another. Neither does it relate to ineffective
decision making. As a nurse, you can still implement evidence-based practice, but your
influence in the unit is limited by the unhealthy work environment.
DIF: Cognitive Level: Analyze/Analysis REF: pp. 8-9
OBJ: Describe standards of professional practice for critical care nursing.
TOP: Nursing Process Step: N/A
MSC: NCLEX Client Needs Category: Safe and Effective Care Environment
16. Which of the following statements describes the core concept of the synergy model of
practice?
a. All nurses must be certified in order to have the synergy model implemented.
b. Family members must be included in daily interdisciplinary rounds.
c. Nurses and physicians must work collaboratively and synergistically to influence
, care.
d. Unique needs of patients and their families influence nursing competencies.
ANS: D
The synergy model of practice is care based on the unique needs and characteristics of the
patient and family members. Although critical care certification is based on the synergy
model, the model does not specifically address certification. Inclusion of family members into
the daily rounds is an example of implementation of the synergy model. With the focus on
patients and family members with nurse interaction, the synergy model does not address
physician collaboration.
DIF: Cognitive Level: Apply/Application REF: p. 6
OBJ: Describe standards of professional practice for critical care nursing.
TOP: Integrated Process: Caring
MSC: NCLEX Client Needs Category: Safe and Effective Care Environment
17. A nurse who plans care based on the patient’s gender, ethnicity, spirituality, and lifestyle is
said to
a. be a moral advocate.
b. facilitate learning.
c. respond to diversity.
d. use clinical judgment.
ANS: C
Response to diversity considers all of these aspects when planning and implementing care. A
moral agent helps resolve ethical and clinical concerns. Consideration of these factors does
not necessarily facilitate learning. Clinical judgment uses other factors as well.
DIF: Cognitive Level: Understand/Comprehension REF: p. 5
OBJ: Describe standards of professional practice for critical care nursing.
TOP: Nursing Process Step: Planning
MSC: NCLEX Client Needs Category: Psychosocial Integrity
MULTIPLE RESPONSE
1. Which of the following is a National Patient Safety Goal? (Select all that apply.)
a. Accurately identify patients.
b. Eliminate the use of patient restraints.
c. Reconcile medications across the continuum of care.
d. Reduce risks of health care–acquired infection.
e. Reduce costs associated with hospitalization.
ANS: A, C, D
All except for eliminating the use of restraints and reducing costs are current National Patient
Safety Goals. Hospitals have policies regarding the use of restraints and are attempting to
reduce the use of restraints; however, this is not a National Patient Safety Goal. Many
facilities are actively working on cost reduction, but this is not a National Patient Safety Goal
either.
DIF: Cognitive Level: Remember/Knowledge REF: p. 7 | Box 1-3
OBJ: Describe quality and safety initiatives related to critical care nursing.
, TOP: Nursing Process Step: N/A
MSC: NCLEX Client Needs Category: Safe and Effective Care Environment
2. Which of the following is (are) official journal(s) of the American Association of
Critical-Care Nurses? (Select all that apply.)
a. American Journal of Critical Care
b. Critical Care Clinics of North America
c. Critical Care Nurse
d. Critical Care Nursing Quarterly
e. Critical Care Nursing Management
ANS: A, C
American Journal of Critical Care and Critical Care Nurse are two official AACN
publications. Critical Care Clinics, Critical Care Nursing Quarterly, and Critical Care
Nursing Management are not AACN publications.
DIF: Cognitive Level: Remember/Knowledge REF: p. 5
OBJ: Discuss the purposes and functions of the professional organizations that support critical care
practice. TOP: Nursing Process Step: N/A
MSC: NCLEX Client Needs Category: Safe and Effective Care Environment
3. The first critical care units were (Select all that apply.)
a. burn units.
b. coronary care units.
c. recovery rooms.
d. neonatal intensive care units.
e. high-risk OB units.
ANS: B, C
Recovery rooms and coronary care units were the first units designated to care for critically ill
patients. Burn, neonatal intensive care, and high-risk OB units were established as specialty
units evolved.
DIF: Cognitive Level: Remember/Knowledge REF: p. 3
OBJ: Define critical care nursing. TOP: Nursing Process Step: N/A
MSC: NCLEX Client Needs Category: Safe and Effective Care Environment
4. Which of the following nursing activities demonstrates implementation of the AACN
Standards of Professional Performance? (Select all that apply.)
a. Attending a meeting of the local chapter of the American Association of
Critical-Care Nurses in which a continuing education program on sepsis is being
taught
b. Collaborating with a pastoral services colleague to assist in meeting spiritual needs
of the patient and family
c. Participating on the unit’s nurse practice council
d. Posting an article from Critical Care Nurse on the management of venous
thromboembolism for your colleagues to read
e. Using evidence-based strategies to prevent ventilator-associated pneumonia
ANS: A, B, C, D, E
