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T e s t B a n k F o r I n t r o d u c t i o n t o C r i t i c a l C a r e
N u r s i n g 8 t h E d i t i o n b y M a r y L o u S o l e ; D e b o r a h
G o l d e n b e r g K l e i n ; M a r t h e J . M o s e l e y
Complete Test bank, All Chapters are included. 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. Organ donation
Chapter 6. Comfort and sedation
Chapter 7. Nutritional therapy
Chapter 8. Dysrhythmia interpretation and
management
Chapter 9. Hemodynamic monitoring
Chapter 10. Ventilatory assistance
Chapter 11. Rapid response teams and code
management
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, 8th Edition MULTIPLE CHOICE 1. Which of the following professional organizations best supports critical care nursi ng 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 N urses Association supports all nurses. The Society of Critical Care Medicine represents the multiprofessional critical care team under the directi on of an intensivist. DIF: Cognitive Level: Knowledge OBJ: Discuss the purposes and functions of the professional organizations that su pport critical care practice. TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment 2. A nurse has been working as a staff nurse in the surgical intensive care unit for 2 year s and is interested in certification. Which credential would be most applicable for her t o seek? a. ACNPC b. CCNS c. CCRN d. PCCN ANS: C The CCRN certification is appropriate for nurses in bedside practice wh o care for critically ill patients. The ACNPC certification is for acute care nurse practitioners. Th e CCNS certification is for critical care clinical nurse specialists. The PCCN certi fication is for staff nurses working in progressive care, intermediate care, or step-down unit settings. DIF: Cognitive Level: Application OBJ: Explain certification options for critical care nurses. TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Ef fective Care Environment 3. What is the main purpose of certification for critical care nursing? a. To assure the consumer that critical nurses will not make a mistake. b. To help prepare the critical care nurse for graduate school. c. To assist in promoting magnet status for a facility. d. To validate a nurse’s knowledge of critical care nursing. ANS: D abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test
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www.nursylab.com Certification assists in validating knowledge of the field, promot es excellence in the profession, and helps nurses to maintain their knowledge of critical care nursing. Certi fication helps to assure the consumer that the nurse has a minimum level of knowledge; however, i t does not ensure that care will be mistake- free. Certification does not prepare one for graduate school; however, achieving certification demonstrates motivation for achievement a nd professionalism. Magnet facilities are rated on the number of certified nurs es; however, that is not the purpose of certifi cation. DIF: Cognitive Level: Analysis OBJ: Explain certification options for critical care nurses. TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment 4. What is the focus of the synergy model of practice? a. Allowing unrestricted visiting for the patient 24 hours each day. b. Providing holistic and alternative therapies. c. Considering the needs of patients and their families, which drives nursing competency. d. Addressing the patients’ needs for energy and support. ANS: C The synergy model of practice states that the needs of patients and families influ ence 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 application of altern ative therapies if desired by the patient, but that is not the primary focus of the model. DIF: Cognitive Level: Application OBJ: Describe standards of professional practice for critical care nursing. TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment 5. The family of your critically ill patient tells you that they have not spoken with the physic ian in over 24 hours and they have some questions that they want clarified. During morning rounds, you convey this concern to the attending intensivist and arrange for her to meet with the family at 4:00 PM in the conference room. Which competency of critical care nurs ing 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 Altho ugh 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: Analysis OBJ: Describe standards of professiona l practice for critical care nursing. TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment 6. The AACN Standards for Acute and Critical Care Nursing Practice uses what fram ework to guide critical care nursing practice? a. Evidence- based practice abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test
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www.nursylab.com 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, id entify expected outcomes, develop a plan of care, implement interventions, and evaluate care. A ACN promotes a healthy work environment, but this is not included in the Standards. The Joint Commission has established National Patient Safety Goals, but these are not the AA CN Standards. DIF: Cognitive Level: Understand OBJ: Describe standards of prof essional practice for critical care nursing. TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment 7. The charge nurse is responsible for making the patient assignments on the critical ca re unit. She assigns the experienced, cert ified nurse to care for the acutely ill patient diagnosed with sepsis who also requires continuous renal replacement therapy and mechanical ventila tion. She assigns the nurse with less than 1 year of experience to two patients who are more s table. This ass ignment reflects implementation of what guiding framework? 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. C rew resource management concepts 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 educa tion to undergraduate and graduate nursing students to learn quality an d safety concepts. DIF: Cognitive Level: Analysis OBJ: Describe standards of professional practice for critical care nursing. TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment 8. The vision of the American Association of Critical- Care Nurses is a healthcare system driven by achieving what goal? a. Maintaining a healthy work environment. b. Providing care from a multiprofessional team under the direction of a critical ca re physician. c. Effectively meeting the needs of critically ill patients and families. d. Creating respectful, healing, and humane environments. ANS: C abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test
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www.nursylab.com The AACN vision is a healthcare system driven by the needs of critically ill patien ts and families where critical care nurses make their optimum contributions. AACN pro motes initiatives to support a healthy work environment as well as respectful and healing environments, but that is not the organization’s vision. The SCCM promotes care from a multiprofessional team under the direction of a critical care physician. DIF: Cognitive Level: Knowledge OBJ: Discuss the purposes and functions of the professional organizations that support critical care practice. TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment 9. What is the most important outcome of effective communication? a. Demonstrating caring practices to family members. b. Ensuring that patient teaching is provided c. Meeting the diversity needs of patients. d. Reducing patient errors. ANS: D Many errors are directly attributed to faulty communication. Effective communic ation has been identified as an essential strategy to reduce patient errors and resolve i ssues related to patient care delivery. Communication may demonstrate caring practices, be used for patient/family teaching, and address diversity needs; however, the main outcome of effe ctive communication is patient safety. DIF: Cognitive Level: Analysis OBJ: Describe quality and safety initiatives related to critical care nursing . TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment 10. The nurse is caring for a critically ill patient whose urine output has been low for 2 consecutive hours. After a thorough patient assessment, you call the primary care provi der with the following report. Dr. Smith, I’m calling about Mrs. P., your 65- year-old patient in CCU 10. Her urine output for the past 2 hours totaled only 40 mL. She arrived from surgery to repair an aortic aneurysm 4 hours ago and remains on mechanical ventilation. In the past 2 hours, her heart rate has increased from 80 to 100 beats per minute and her blood pressure has decreased from 128/82 to 100/70 mm Hg. She is being given an infusion of normal saline at 100 mL per hour. Her right atrial pressure through the subclavian central line is low at 3 mm Hg. Her urine is concentrated. Her BUN and creatinine levels have been stable and in normal range. Her abdominal dressing is dry with no indication of bleeding. My assessment suggests that Mrs. P. is hypovolemic and I would like you to consider increasing her fluids or giving her a fluid challenge. Using the SBAR model for communication, the information the nurse gives about the patient’s history and vital signs is appropriate for what part of the model? a. Situation b. Background c. Assessment d. Recommendation 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. abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test
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www.nursylab.com DIF: Cognitive Level: Understand OBJ: Describe quality and safety initiatives related to critical care nursing . TOP: Nursing Process Step: Assessment MSC: NCLEX: Safe and Effective Care Environment 11. The family members of a critically ill, 90 -year-old patient bring in a copy of the patient’s living will to the hospital, which identifies the patient’s wishes regarding health c are. The nurse discusses the 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 patie nt 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: Analysis OBJ: Describe standards of care and performance for critical care nursing. TOP: Nursing Process Step: Implementation MSC: NCLEX: Safe and Effective Care Environment 12. Which of the following assists the critical care nurse in ensuring that care is appr opriate 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 appropr iate and based on research. Some physician order entry pathways, but not all, are based on research recom mendations. 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: Analysis OBJ: Describe standards of professional practice for critical care nursing. TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment 13. Comparing the patient’s current (home) medications with those ordered during hospitali zation and communicating a complete list of medications to the next care provider when the patie nt is transferred within an organization or to another setting are strategies tow ard best achieving what patient related goal? a. Improving accuracy of patient identification. b. Preventing errors related to look-alike and sound- alike medications. c. Reconciling medications across the continuum of care. d. Reducing harms associated with administration of anticoagulants. ANS: C abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test
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www.nursylab.com These are steps recommended in the National Patient Safety Goals to reconcile medicat ions 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, not medication reconciliation. Reducing harms associ ated with administration of anticoagulants is another National Patient Safety Goal. DIF: Cognitive Level: Comprehension OBJ: Describe quality and safety initiatives related to critical care nursing . TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment 14. As part of nursing management of a critically ill patient, orders are written t o 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 e very 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 referred to using what term? 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 pa rt of quality improvement initiatives. At some point, these may become part of patient safety goals. DIF: Cognitive Level: Analysis OBJ: Describe quality and safety initiatives related to critical care nursing . TOP: Nursing Process Step: Implementation MSC: NCLEX: Safe and Effective Care Environment 15. A nurse who works in an intermediate care unit has experienced high nursing turnover. The nurse manager is often considered to be an autocratic leader by staff members and t hat leadership style is contributing to turnover. The nurse asks to be involved in developing new guidelines to prevent pressure ulcers in the patient population. The nurse manager suggests that the nurse has not yet had enough experience to be on the prevention task force. This situation and setting is an example of what form of ineffective leadership? a. Creating a barrier to inter -staff communication. b. Supporting a work environment that is unhealthy. c. Displaying ineffective decision making. d. Demonstrating 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 leade rship. 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 environ ment. DIF: Cognitive Level: Analysis abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test
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www.nursylab.com OBJ: Describe standards of professional practice for critical care nursing. TOP: Nursing Process Step: N/A MSC: NCLEX: 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 t he synergy model, the model does not specifically address certification. Inclusion of f amily 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: Application OBJ: Describe standards of professional practice for critical care nursing. TOP: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 17. A nurse who plans care based on the patient’s gender, ethnicity, spirituality, and life style is said to demonstrate what focus? a. Becoming a moral advocate. b. Facilitating all forms of learning. c. Responding to diversity. d. Using effective 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 fa ctors does not necessarily facilitate learning. Clinical judgment uses other factors as we ll. DIF: Cognitive Level: Comprehension OBJ: Describe standards of professional practice for critical care nursing. TOP: Nursing Process Step: Planning MSC: NCLEX: 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 use of patient restraints. c. Reconcile medications across the continuum of care. d. Reduce risks of healthcare -acquired infection. ANS: A, C, D abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test
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www.nursylab.com All except for eliminating use of restraints are current National Patient Safety Goals. Hospitals have policies regarding use of restraints and are attempting to reduce t he use of restraints; however, this is not a National Patient Safety Goal. DIF: Cognitive Level: Knowledge OBJ: Describe quality and safety initiatives related to critical care nursing . TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment 2. Which of the following is (are) official journal(s) of the American Associati on of Critical -Care N urses? (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 ANS: A, C American Journal of Critical Care and Critical Care Nurse are two official AACN publications. Critical Care Clinics and Critical Care Nursing Quarterly are not AACN publications. DIF: Cognitive Level: Knowledge OBJ: Discuss the purposes and functions of the professional organizations that su pport critical care practice. TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment 3. What were identified as the first critical care units? (Select al l 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 cr itically ill patients. Burn, high risk OB and neonatal intensive care units were established as spec ialty units evolved. DIF: Cognitive Level: Knowledge OBJ: Define criti cal care nursing. TOP: Nursing Process Step: N/A MSC: NCLEX: 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 con tinuing education program on sepsis is being taught b. Collaborating with a pastoral services colleague to assist in meeting spiritual need s of the patient and family c. Participating on the unit’s nurse practice council d. Posting an article from Criti cal Care Nurse on management of venous thromboembolism for your colleagues to read e. Using evidence- based strategies to prevent ventilator -associated pneumonia abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test abirb.com/test
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