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Test Bank For Critical Care Nursing: A Holistic Approach, 10th Edition

  • Nursing
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    Chapter 1 - Critical Care Nursing Practice 1. A nurse is the only one in the ICU who has not achieved certification in critical care nursing often will ask her fellow nurses what to do in caring for a patient because she doubts the acc of her knowledge and her intuition. She loves her work but wishes she could do it with a gre level of competence. What is the most important effect that obtaining certification would lik have on the nurse’s practice? A) Recognition by peers B) Increase in salary and rank C) More flexibility in seeking employment D) Increased confidence in making decisions 2. A hospital interviews two different candidates for a position in the ICU. Both candidates ha around 10 years of experience working in the ICU. Both have excellent interpersonal skills highly positive references. One, however, has certification in critical care nursing. Which of following is the most compelling and accurate reason for the hospital to hire the candidate w certification? A) The certified nurse will have more knowledge and expertise. B) The certified nurse will behave more ethically. C) The certified nurse will be more caring toward patients. D) The certified nurse will work more collaboratively with other nurses. 3. A nurse is caring for an elderly man recently admitted to the ICU following a stroke. She as his cognitive function using a new cognitive assessment test she learned about in a recent ar a nursing journal. She then brings a cup of water and a straw to the patient because she obse that his lips are dry. Later, she has the patient sit in a wheelchair and takes him to have some tests performed. He objects at first, saying that he can walk on his own, but the nurse explai it is h ospital policy to use the wheelchair. That evening, she recognizes signs of an imminen in the patient and immediately pages the physician. Which action taken by the nurse is the b example of evidence - based practice? A) Giving the patient a cup of water B) Transferring the patient in a wheelchair C) Using the cognitive assessment test D) Recognizing signs of imminent stroke and paging the physician 4. A nurse is on a committee that is trying to reduce the occurrence of hospital - acquired infect the ICU. Her role is to conduct research to find which interventions have been shown to be m

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    effective in reducing these infections. She consults many different sources and finds conflic information. Which of the following sources shou ld she consider the most authoritative? A) AACN expert panel report B) A meta - analysis of randomized controlled trials in the American Journal of Nursing C) A systematic review of qualitative studies in the Journal of Advanced Nursing D) A single randomized controlled trial in the American Journal of Critical Care 5. A nurse who has been recently hired to manage the nursing staff of the ICU is concerned at of evidence - based practice she sees among the staff. Which of the following would be the b for her to take to promote incorporating evidence into clinical practice? A) Only hire nurses certified in critical care nursing. B) Leave copies of several different nursing journals in the nurses’ lounge. C) Demonstrate to the staff the best nursing - related search terms to use in Google or Yah D) Introduce the staff to the PubMed search engine and assign them topics to research on 6. A physician visits a patient in the ICU while the nurse is out. The patient complains that the medication is not effective and that he would like to receive an increased dose. The physicia the nurse paged and consults with him in the hallway regarding the patient’s request for stro pain medication. The nurse explains that patient w as started on a morphine drip only 20 min ago and that the drug has not had time to take effect yet. The physician agrees and tells the p to give it just a bit more time. Which component of a healthy work environment is most evi this scena rio? A) Skilled communication B) Appropriate staffing C) True collaboration D) Meaningful recognition 7. A nurse in the ICU is responding to a patient who has just gone into cardiac arrest. A mome the nurse is notified that another patient has just gone into anaphylactic shock due to a drug She is conflicted as to what to do, as she is the only nurse available at the moment to tend to patients. Which component of a healthy work environment is lacking in this scenario? A) Effec tive decision making B) Appropriate staffing C) Authentic leadership D) Meaningful recognition 8. An ICU nurse has provided excellent care for a 6 - year - old girl who had been admitted to the for a head injury. The nurse was attentive not only to the needs of the patient but also went o

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    her way to care for the needs of the girl’s family. According to research, which of the follow forms of recognition would the nurse value the most? A) A card from the girl’s family B) A plaque from the ICU physicians naming her as “ Nurse of the Year ” C) A letter of commendation from the hospital’s administration D) A bouquet of flowers from her supervisor 9. A patient in the ICU has recently been diagnosed with diabetes mellitus. Before being disch this patient will require detailed instructions on how to manage her diet, how to self - inject in and how to handle future diabetic emergencies. Which nurse competency is most needed in situation? A) Clinical judgment B) Advocacy and moral agency C) Caring practices D) Facilitation of learning 10. An elderly patient is admitted to the ICU with stage IV lung cancer, diabetes mellitus, and congestive heart failure. The health care team assembled to care for her is large and divers including an oncologist, a pulmonologist, an endocrinologist, a cardiologist, and others. Th patient is not expected to survive more than a few weeks, and her husband is overwhelmed stress and grief. Which nurse competency or compe tencies are most needed in this situatio Select all that apply. A) Clinical judgment B) Caring practices C) Collaboration D) Response to diversity 11. An Ethiopian man with AIDS has recently been admitted to the ICU with a case of pneum The man is new to the U.S. and has no health insurance. He would likely be eligible for th Medicaid coverage, but does not understand how to access this coverage. Which competen competencies are most needed in this situation? Select all that appl y. A) Clinical judgment B) Advocacy and moral agency C) Collaboration D) Systems thinking E) Response to diversity

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    F) Clinical inquiry 12. A nurse decides to seek certification in critical care nursing. What is the most important be for the individual nurse in becoming certified in a specialty? A) It will result in a salary increase. B) It is required to work in critical care. C) It demonstrates the nurse’s personal expertise. D) It is mandated by employers. 13. The American Association of Critical - Care Nurses (AACN) sponsors certification in critic nursing for several critical care subspecialties. What is the most important benefit of such certification for the profession of nursing? A) Provides positive publicity for nursing B) Validates nurses’ expert knowledge and practice C) Mandated by government regulations D) Demonstrates basic knowledge in the field 14. A nurse has achieved certification in critical care nursing. What is the most important effe this certification will have on the nurse’s practice? A) Recognition by peers B) Increase in salary and rank C) More flexibility in seeking employment D) Increased confidence in critical thinking 15. The nurse cites evidence - based practice as a rationale for a patient care decision. What is t description of evidence - based practice? A) Decisions based on expert legal testimony B) Use of best available research data C) Evolution of nursing practice over time D) Individual optimization of patient outcomes 16. The nurse caring for a critically ill patient implements several components of care. What component is an example of the use of evidence - based practice? A) Use of a protocol for admission of a patient to the unit B) Application of an insulin sliding scale method from research C) Checking the patient’s armband before giving a medication D) Limiting visits to immediate family only for 2 hours a day

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    17. The nurse wishes to increase the use of evidence - based practice in the critical care unit wh works. What is a significant barrier to the implementation of evidence - based practice? A) Use of computerized records by the hospital B) Health Information Privacy and Portability Act (HIPPA) C) Lack of knowledge about literature searches D) Strong collaborative relationships in the work setting 18. The nurse has identified an increase in medication errors in the critical care unit over the p several months. What aspect of medication procedures should be evaluated first? A) Adherence to procedures by nursing staff B) Clarity of interdisciplinary communication C) Number of new employees on the unit D) Changes in administration procedures 19. A critical care unit has decided to implement several measures designed to improve intradisciplinary and interdisciplinary collaboration. In addition to an expected improveme patient outcomes, what is the most important effect that should result from these measures A) Identification of incompetent practitioners B) Improvement in manners on the unit C) Increased staff retention D) Less discussion in front of patients and families 20. A nurse wishes to practice using the Synergy Model developed by the American Associati Critical - Care Nurses (AACN). What nursing behavior best supports use of this model? A) Attending mandatory hospital - wide in - service programs B) Self - directed study of best practice for the patients she cares for C) Gathering demographic data on the patients admitted to the unit D) Participating in a research study as a data collector 21. As part of the Synergy Model, the nurse has identified a patient characteristic of resiliency patient behavior demonstrates resiliency? A) Dysfunctional grieving behaviors after receiving bad news B) Developing a list of questions for the physician C) Denial of any possible negative outcomes for a procedure D) Assigning blame to others for undesired outcomes of illness 22. A patient is admitted to the critical care unit after receiving a mechanical heart implantatio

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    making a nursing assignment, the charge nurse best demonstrates application of the Synerg Model by assigning which nurse to care for this patient? A) A newly hired new graduate nurse, for the experience B) A nurse with a patient in the next room, for proximity C) The most senior nurse on the unit, for political reasons D) The nurse with most experience with this device, for expertise 23. A Muslim patient has been admitted to the critical care unit with complications after childb Based on the Synergy Model, which nurse would be the most inappropriate to assign to ca this patient? A) New graduate female nurse B) Most experienced female nurse C) New graduate male nurse D) Female nurse with postpartum experience 24. Today’s critical care nursing environment is constantly changing. What nursing behavior b illustrates awareness of current events affecting critical care nursing? A) Participating in the hospital’s efforts to recruit new nurses B) Volunteering to serve on a disaster response planning committee C) Adhering to content taught in basic nursing program D) Attending hospital - mandated in - services without other education Answer Key 1. D 2. A 3. C 4. B 5. D 6. C 7. B 8. A 9. D 10. B, C 11. B, D, E

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    12. C 13. B 14. D 15. B 16. B 17. C 18. B 19. C 20. B 21. B 22. D 23. C 24. B Page 1 Chapter 2 - The Patient’s Experience With Critical illness 1. The critical care unit environment is very stressful for patients, families, and staff. What nur action is directed at reducing environmental stress? A) Constant evaluation of patient status B) Limiting visits to immediate family C) Bathing all patients during hours of sleep D) Maintaining quiet during hours of sleep 2. A patient is transferred to the ICU from the Birth Center of the hospital in the middle of the after experiencing complications during delivery of her baby. The patient’s husband is anxio explains to the ICU nurse that he doesn’t understand why his wife has been moved to the IC “ She is going to die, isn’t she? ” he asks the nurse. What is the nurse’s best response ? A) Explain that every measure will be taken to provide his wife with the best care possibl B) Explain that the nurse is fully trained and has years of experience. C) Offer the husband a place to relax.

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    D) Have appropriate staff discuss his health insurance with him. 3. A patient is admitted to the ICU with injuries sustained from a fall from a third - story windo patient is conscious, his breathing is labored, and he is bleeding heavily from the abdomen. groans constantly and complains of severe pain, but his movements are minimal. His heart r elevated. Which of these is a sign that he is in the second phase of th e stress response? Selec that apply. A) Bleeding heavily from his abdomen B) Labored, slow breathing C) Severe pain D) Elevated heart rate E) Minimal movement 4. A patient in the ICU is recovering from open - heart surgery. The nurse enters his room and observes that his daughter is performing effleurage on his arms and talking in a low voice ab upcoming family vacation that is planned. The room is dimly lit, and she hears the constant beeping of his heart monitor. From the hall she hears t he cries of a patient in pain. Which of following are likely stressors for the patient? Select all that apply. A) His daughter’s conversation B) His daughter’s effleurage C) The beeping of the heart monitor D) The dim lighting of the room E) The cries of the other patient from the hall 5. A patient in the ICU is complaining that he is not sleeping well at night because of anxiety. of the following would be the most helpful intervention for the nurse to make? A) Provide the patient with a bath immediately following his first 90 - minute REM sleep B) Increase the patient’s pain medication. C) Provide the patient with 5 minutes of effleurage and then minimize disruptions. D) Monitor the patient’s brain waves by polysomnography to determine his sleep pattern 6. A nurse walks into a patient’s room and begins preparing a syringe to perform a blood draw patient. The nurse observes that the patient is firmly gripping the side of the bed, averting he and sweating from her forehead when she sees the needle. What would be the best intervent the nurse to make? A) Proceed with blood draw as quickly as possible, to get it over with. B) Offer to come back later to perform the blood draw.

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    C) Encourage the patient to deep breathe. D) Describe briefly the blood draw procedure and explain why it is necessary. 7. A 15 - year - old boy is in the ICU and preparing for an appendectomy. He is clearly anxious a fidgets with his IV constantly. He complains that he doesn’t want to be there and he is sick o everyone telling him what to do. What would be the best way for the nurse to address this p anxiety? A) Use physical restraints to keep him from pulling out his IV. B) Offer him the remote to the television. C) Lower the head of his bed so that he can rest more easily. D) Explain to the patient in detail what the appendectomy will consist of. 8. A nurse in a burn unit observes that a patient is tensed up and frowning but silent. The nurse the patient, “ Can you tell me what you are thinking now? ” The patient responds, “ I can’t this pain any more! I feel like I’m about to die. ” What would be the best response for the nu give to the patient, considering that the patient is already receiving the maximum amount pa medication that is safe? A) “ Try to get rid of those negative thoughts — they only make it worse. ” B) “ Try think ing instead, ‘This pain will go away; I can overcome it.’ ” C) “ Your pain medication is already at the highest possible dose. ” D) “ Would you like me to raise the head of your bed? ” 9. A patient on mechanical ventilation is experiencing severe agitation due to being on the ven Which nursing intervention would be best? A) Performing breathing exercises with the patient B) Offering the patient a patient - controlled analgesic device C) Asking the physician to prescribe an antianxiety medication D) Offering the patient the patient’s own MP3 player to listen to 10. A 10 - year - old female patient in ICU receiving chemotherapy has requested that her dog be allowed to visit her. She is currently sharing a room with another patient. The nurse knows the hospital does allow for pet visits with owners, but has strict guidelines. Which of the following scenarios is m ost likely to be permitted? A) The girl’s father may bring the dog in on a leash for a 20 - minute visit. B) The girl’s sister may bring the dog in with a shirt on (to prevent shedding) for an ove stay. C) The girl’s mother may bring the dog in on a leash for a visit as long as he has had all vaccinations.

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    D) The dog may be brought in for a brief visit once the girl is moved to a private room. 11. The nurse understands that a patient being cared for in a critical care unit experiences an a stress response. What nursing action best demonstrates understanding of the physiological of the initial stress response? A) Adequate pain control B) Intravenous sedation C) Treatment for elevated blood pressure D) Ignoring an elevated glucose level 12. A critically ill patient experiences stress and anxiety from many factors. Treatment of the p focuses on reducing stressors and providing supportive care such as nutrition, oxygenation management, control of anxiety, and specific care of the illness or injury. What is the best rationale for these interventions? A) Helps to support the patient’s immune system B) Part of good nursing care C) Mandated by hospital policy D) Reassures the patient and family 13. A patient in a critical care unit has increased stress from the constant noise and light levels nursing intervention best attenuates these sources of stress? A) Need for constant observation and evaluation B) Dimming lights during the night C) Frequent nursing group rounds for all patients D) Use of tile floors for ease in cleaning 14. The nurse is caring for a patient who is orally intubated and on a mechanical ventilator. Th believes that the patient is experiencing excess anxiety. For this patient, what behavior bes indicates anxiety? A) Restlessness B) Verbalization C) Increased respiratory rate D) Glasgow Coma Scale score of 3 15. The critical care unit environment is very stressful for patients, families, and staff. What n action is directed at reducing environmental stress? A) Constant expert evaluation of patient status B) Limiting visits to immediate family

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    C) Bathing all patients during hours of sleep D) Maintaining a quiet environment during hours of sleep 16. The nurse wishes to enhance sleep cycles in her critically ill patient. Research has shown t which nursing action improves sleep in critically ill patients? A) Repositioning every 2 hours B) Hypnotic medications C) Five - minute back effleurage D) Adequate pain control 17. The nurse is caring for a critically ill patient with a very concerned family. Given that the f is under high stress, what nursing intervention will best ameliorate their stress while preser independence? A) Encourage the family to participate in patient care tasks. B) Teach the family to ask questions of the health care team. C) Ask the family to select a family representative for communication. D) Limit visits to immediate family members for limited times. 18. While caring for a critically ill patient, the nurse knows that fostering patient control over environment is a method for stress reduction. What nursing intervention gives the patient t most environmental control while still adhering to best practice principles? A) Ask the patient whether he or she wants to get out of bed. B) Give the patient’s bath at the same time every day. C) Explain painful procedures only after giving pain medication. D) Choose menu items for the patient to ensure a balanced diet. 19. The nurse is using presence to reduce the anxiety of a critically ill patient. What nursing be demonstrates an effective use of presence? A) Staying in the patient’s room to complete documentation B) Having a conversation in the patient’s room that excludes the patient C) Maintaining eye contact with the patient during explanations D) Focusing on specific nursing care tasks while in the patient’s room 20. The nurse is caring for a critically ill patient who can speak. The nurse notices that the pati demonstrating behaviors indicative of anxiety but is silent. What nursing strategy would g nurse the most information about the patient’s feelings? A) Explain procedures to the patient and family.

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    B) Ask the patient to share his or her internal dialogue. C) Encourage the patient to nap before visiting hours. D) Ensure that the patient has adequate pain control. 21. The patient is undergoing a necessary but painful procedure that is greatly increasing her a The nurse decides to use guided imagery to help alleviate the patient’s anxiety. What is a k of this technique? A) Provide the patient with an external focus point such as a picture. B) Have the patient take slow, shallow breaths while staring at a focus point. C) Have the patient remember tactile sensations of a pleasant experience. D) Encourage the patient to consciously relax all of her muscles. 22. One of the strategies shown to reduce perception of stress in critically ill patients and their families is support of spirituality. What nursing action is most clearly supportive of the pat spirituality? A) Referring patients to the Catholic chaplain B) Providing prayer booklets to patients and families C) Asking about beliefs about the universe D) Avoiding discussing religion with those of other faiths 23. A critically ill patient tells the nurse that he is not afraid to die because he believes in reincarnation. What is the most appropriate nursing response? A) “ What if reincarnation is not real? ” B) “ This belief gives you strength. ” C) “ I don’t believe in reincarnation. ” D) “ You shouldn’t base your hopes on such a belief. ” 24. A critically ill patient who is intubated and agitated is restrained with soft wrist restraints. on research findings, what is the best nursing action? A) Maintain the restraints to protect patient safety. B) Remove the restraints periodically to check skin integrity. C) Remove the restraints periodically for range of motion. D) Assess and intervene for causes of agitation. Answer Key 1. D 2. A

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    3. C, E 4. C, E 5. C 6. D 7. B 8. B 9. D 10. D 11. A 12. A 13. B 14. A 15. D 16. C 17. B 18. B 19. C 20. B 21. C 22. C 23. B 24. D Page 1 Chapter 3 - The Family’s Experience With Critical Illness 1. A patient has just been admitted to the ICU after being in a severe auto accident and losing o her legs. Her husband has his hand over his heart and complains of a rapid heart rate. The nu recognizes his condition as a si gn of which stage of the general adaptation syndrome to stres A) Alarm stage

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    B) Exhaustion stage C) Resistance stage D) Adaptation stage 2. The nurse observes that an elderly woman, whose granddaughter has been admitted to the IC struggling to manage her two great - grandsons, who are toddlers, in the waiting room. What most likely explanation for the woman’s inability to manage the children in this situation? A) She is senile. B) She is in the exhaustion stage of the general adaptation syndrome to stress. C) She is assuming the role of caregiver in place of the patient, a role she is not used to. D) She has macular degeneration and cannot see well. 3. A nurse needs to communicate with a patient’s family regarding consent to treat an unconsc patient in the ICU. Which member of the group should the nurse approach first? A) A man she recognizes as the patient’s brother B) A teenage boy who approaches the nurse C) A woman who originally escorted the patient in D) A woman in the group whom the others look at and call over when the nurse approach 4. A new nurse has recently joined the ICU from a different hospital, which had a much stricte regarding visiting hours. She expresses concern about the impact of open visiting hours on p well - being. Which of the following would be the best explanation for the purpose of open v hours? Select all that apply. A) To better provide rest and quiet B) To strengthen the relationship between the family and health care provider C) To control the number of visitors for a patient D) To provide an undisturbed environment E) To decrease the patient’s anxiety F) To increase the satisfaction of the family with the experience 5. A nurse observes that a 38 - year - old single father whose 11 - year - old daughter is in the ICU i struggling to explain to his 6 - year - old son the likelihood that the daughter will die. The youn asks what will happen to his sister when she dies, but the father breaks down in tears and se unable to respond. Which of the following would be the most appropriate intervention for th to make? A) Suggest that the father contact his pastor, rabbi, or other spiritual leader for counsel fo and his son

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    B) Sit down with the father and son and share her own religious beliefs C) Ask the patient’s doctor to explain to the father the odds of the daughter surviving D) Leave the father and son to grieve alone 6. A patient is experiencing severe pain, despite receiving pain medication for the past 24 hour patient’s wife expresses concern about this to the nurse. Which response by the nurse would most empowering to the patient’s family? A) Explain that the doctor is an expert on pain medication and that the current level of medication is t he best. B) Recommend that the family members take turns massaging the patient’s feet to distrac the pain. C) Encourage the family to request that the physician evaluate the patient’s pain control. D) Ask the family to wait another 24 hours to see whether the patient’s pain level will go 7. The sister of a patient in the ICU has been at the patient’s bedside non - stop for 48 hours. Th suggests to her that she return home to rest. Which of the following is the proper rationale fo nurse making such a suggestion? A) The sister is in the way of the health care providers. B) The patient may become annoyed by her continual presence. C) The patient will recover more easily in peace and quiet. D) The sister needs to maintain her own health during this time. 8. A young man has just arrived at the ICU from out of town and received news that his girlfri who is admitted there, likely only has a few days left to live. Which of the following would best approach for the nurse to take in caring for the needs of this young man? A) Recommending that he go home and rest B) Giving him unrestricted visiting hours with the patient C) Suggesting that he meet with the hospital chaplain D) Recommending that he ask the doctor to evaluate the patient’s pain control measures 9. A family of a young girl who has been diagnosed with leukemia has travelled 12 hours by c admit her to the ICU and be with her during her treatment. Which aspect of the critical care assistance program would most likely be needed by this family initially? A) Educational materials B) Weekly group family information sessions C) Hospitality programs D) Pet therapy

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    10. A Muslim woman is admitted to the ICU after suffering severe burns over most of her bod Which of the following would be the most appropriate measure for the nurse, a woman, to respect for the cultural practices of this patient? A) Insist that only a female doctor be assigned to this patient. B) Ensure that no pork products are included in the patient’s diet. C) Ensure that direct eye contact is not made with the patient’s husband. D) Ask the patient’s husband what religious and cultural preferences should be consider the patient’s care. 11. A client has been admitted after experiencing multiple trauma and is intubated and sedated the five members of the immediate family arrive, they are anxious, angry, and very deman They all speak loudly at once and ask for many services and answers. What is t he best nur response? A) Ask the family to leave until visiting hours begin. B) Take them to a private area for initial explanations. C) Page security to have them removed from unit. D) Show them to the client’s bedside and leave them alone. 12. The client has been in the CCU for several weeks and has been very unstable. One family member stays at the bedside constantly and even naps in a bedside chair. The nurse unders that the family member is exhibiting which family member response to crit ical illness? A) Exhibiting extreme distrust of the health care team B) Seeking evidence for future legal or punitive action C) Trying to maintain a level of control over the situation D) Experiencing extreme fatigue from constant stress 13. The nurse is caring for a very seriously ill patient in the CCU. The family visits sporadical stays for only a short time, and does not ask many questions. How could the nurse best beg involve the family in the patient’s care? A) Ask one family member to assist with the patient’s bath. B) Encourage family members to stay longer at each visit. C) Focus nursing efforts on the patient’s legal next of kin. D) Ask the family to complete the Critical Care Family Needs Inventory. 14. As part of the admission process, the nurse asks several questions about family relationshi nurse bases these actions on which rationale? A) Assessing family relationships is an initial step in including the family in patient care

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    B) These questions are part of the admission assessment tool required by this CCU. C) The nurse has a natural curiosity and wishes to know how the family members relate own knowledge. D) There is an ongoing research study to identify variant family patterns related to disea incidence. 15. On their first visit to a critically ill patient, family members stand in the doorway of the roo making no effort to approach the patient. What is the most appropriate nursing action? A) Instruct the family where the patient can be touched and what to say. B) Engage the family in social conversation to ease them into the milieu. C) Use visiting hours to explain to the family the general status of the patient. D) Leave the family to adjust to the situation when they are ready. 16. A critically ill patient is not expected to survive this admission. The family asks the nurse patient is doing. When answering this question, what should the nurse include? A) Emphasize that the patient is young and strong and may still surviv e. B) Refer the family to the physician for all details and answers. C) Give specific information such as descending trends in parameters. D) Ask if the family has determined which funeral home will be called. 17. A patient’s family is exhibiting increasingly impaired coping as the patient’s condition deteriorates. The nurse asks the family to state the biggest concern from their perspective. the most important rationale for this question? A) The question indicates active listening on the part of the nurse. B) The question is used as a way to validate the family’s knowledge. C) The question clarifies the nurse’s understanding of current family needs. D) The question promotes problem definition, which helps define the degree of family understanding. 18. The nurse recommends that the family of a critically ill patient seek help from the Critical Family Assistance Program. What benefit for the family does the nurse anticipate? A) Reduction of health care cost B) More physical comfort C) Multidisciplinary support D) Health promotion information 19. While interacting with the family of a critically ill patient, the nurse suggests that the fami be feeling very anxious and perhaps angry. How does this nursing action benefit the family

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    A) Removes the focus of the conversation from the patient B) Focusing on feelings helps the family avoid delayed grief and unhealthy coping C) Gives validation of need for psychological counseling D) Reduces family insistence for patient progress information 20. The nurse is caring for a patient from a very different cultural group. In delivering care, ho the nurse best demonstrate cultural sensitivity? A) Ask the family about their cultural beliefs and customs that may apply. B) Assume that the patient and family will adjust to the hospital culture. C) Inform the patient and family that the routines of the hospital take precedence. D) Do a literature search on the patient’s culture to determine beliefs. Answer Key 1. A 2. C 3. D 4. B, E, F 5. A 6. C 7. D 8. B 9. C 10. D 11. B 12. C 13. D 14. A 15. A 16. C 17. D 18. C 19. B 20. A

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    Page 1 Chapter 4 - Patient and Family Education in Critical Care 1. An elderly man whose wife has just been admitted to the ICU following congestive heart fa concerned about how passage of the Affordable Care Act will impact the care of his wife. W the following are expected outcomes of this legislation that it would be appropriate for the n share with the man? Select all that apply. A) The new legislation will result in a shortage of experienced critical care nurses. B) The new legislation will require health care workers to meet higher quality standards r to patient care. C) The new legislation will make it more challenging to meet the educational goals of pa and families. D) The new legislation will increase the length of stay of patients in the hospital. E) The new legislation will shift the payment structure for hospitals and health care prov from a traditional fee - for - service model to an incentive model. 2. A young couple whose 5 - year - old daughter has been admitted to the ICU approaches the nu with looks of concern on their faces. They express frustration to the nurse that they have not able to speak with either the physician or the surgeon and are confused as to what the next s for their daughter’s treatment. What would be the best intervention for the nurse to make in situation? A) Offer to get ice chips for the couple to give to their daughter to empower them. B) Make sure that they have the cell phone numbers of the physician and surgeon. C) Teach the couple about the pathophysiology of the daughter’s disease. D) Arrange a patient care conference with the couple and the health care team. 3. A nurse sees a group of physicians who are making teaching rounds in the hall of the ICU h toward the room of one of her patients. The patient, who currently has a visitor, has given ap in the past to have teaching groups visit. What should the nurse do in this situation? A) Explain to the group of physicians that the patient currently has a visitor and ask whet they could come by later. B) Ask the visitor to leave so that the teaching group can discuss the patient’s case. C) Allow the teaching group to enter the patient’s room, as he has already given approva them to visit.

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    D) Instruct the physicians to give clear explanations of the medical jargon they use. 4. The nurse is working with a patient from India who is recovering from a myocardial infarcti When the nurse asks the patient whether she has had a myocardial infarction before, the pati seems confused and appears not to understand the nurse, although the patient does speak En Which of the “4 C’s of Culture” should the nurse use to better communicate with this patien A) Call B) Cause C) Cope D) Concern 5. A nurse needs to obtain informed consent from a deaf patient before a spinal tap procedure i performed. Which of the following would be the best method for the nurse to use to ensure effective communication? A) Explain the procedure verbally, speaking slowly so that the patient can read lips. B) Have a trained oral interpreter interpret for the nurse. C) Have the patient carefully read a printed copy of the informed consent document. D) Use diagrams to explain to the patient the details of the procedure. 6. A nurse is explaining to a patient how radiation therapy works to kill cancer cells. She begin explaining how there are different types of cells in the body that reproduce at different rates then explains what cancer cells are and how they reproduce. Finally, she explains how radia therapy uniquely targets c ancer cells. This approach takes advantage of which domain of lea A) Affective B) Psychomotor C) Cognitive D) Demonstration/return demonstration 7. A young man is recovering from anaphylactic shock caused by a bee sting. The nurse is tryi instruct the patient on how to use an epinephrine autoinjector (EpiPen), but the patient seem uninterested in learning. The nurse then explains how having the EpiPen with him at all tim knowing how to use it could not only save his life someday but also will give him a greater of security and safety. Which adult learning principle is the nurse using? Select all that appl A) The learner’s self - concept B) The learner’s life experience C) Readiness to learn D) Motivation to learn

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    E) The need to know 8. In attempting to teach a patient how to clean around the surgical sutures on his abdomen upo discharge to home, the nurse determines that applying the principle of the learner’s self - con would be most effective with this patient. Which of the following is the best example of an application of that principle in this situation? A) Relating to the patient a story about another patient who failed to properly clean his su and the outcome B) Explaining that failure to properly clean around the suture site could result in serious infection C) Commenting that learning to properly clean his suture site could give the man skills th would better prepare him for a career in health care D) Mentioning to the patient that, if he woul d prefer, he can watch a video on the hospita website on how to clean around a suture site 9. A nurse needs to explain to a patient about the possible side effects the patient may experien related to the pain medication she is now beginning while in the ICU and which she will be continuing upon discharge. Which method would be the most effective way to teach this to patient? A) In a planned teaching session, in which the nurse covers medication - related side effec dietary restrictions, and act ivity restrictions B) Via a brochure that the patient can take with her on discharge C) By briefly explaining the side effects while administering the medication to the patien D) By relating a story about another patient who had a severe adverse reaction to this me 10. A nurse needs to evaluate a patient’s understanding of how to administer an IV medication home. Which of the following would be the best method for evaluation? A) The nurse explaining the procedure to the patient and family using diagrams B) The nurse having the patient and family members demonstrate the procedure themse C) The nurse explaining the procedure while performing it on the patient D) The nurse referring the patient to a computer - based educational library that has an interactive program 11. Teaching patients and families is an important part of critical care nursing. What factor in critical care unit is a barrier to this education function? A) Large numbers of inexperienced nurses B) Serious illness of patients C) Increased computer support

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    D) Use of specialty educators 12. The nurse is caring for a critically ill patient. On the previous shift, a nurse documented “ to teach due to critical illness. ” What is the best nursing action by the current nurse to add the patient’s teaching and learning needs ? A) Realize that the patient is too ill to accept teaching at this time. B) Look for opportunities for teaching, such a procedure explanation. C) Focus all teaching efforts on the family to the exclusion of the patient. D) Alter the plan of care to delay teaching until transfer to step - down unit. 13. After several weeks, a critically ill patient has progressed well and is being transferred to a down unit. What normal patient response does the nurse anticipate? A) Relief B) Thankfulness C) Anxiety D) Indifference 14. The nurse is teaching a patient and family in the patient’s critical care room. The critical c is busy and noisy. What nursing action will best enhance learning? A) Explain the material simply using simple terms. B) Give all explanations via commercial teaching brochures. C) Close the door to the patient’s room. D) Ask the family not to interrupt with questions. 15. The nurse is teaching a patient who is not a native English speaker. As the nurse gives com explanations, the patient nods and smiles. What is the best nursing intervention to ensure p understanding? A) Assume that the patient’s nods indicate understanding. B) Ask a family member to interpret to the patient. C) Use pictures whenever possible in the teaching. D) Ask the patient to restate the information conveyed. 16. The nurse is teaching a patient newly diagnosed with diabetes mellitus how to manage a sl scale insulin protocol. What portion of this interaction indicates patient learning? A) The sliding scale insulin protocol B) Patient’s questions to the nurse C) Nurse’s demonstration of use of the protocol

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    D) Patient’s verbalization of a flash of insight 17. When teaching a patient and family, the nurse wishes to use the affective domain of learni What nursing action is most likely to involve the affective domain? A) Presenting facts from simple to complex B) Giving clear directions about when to call the physician C) Using a nonthreatening approach D) Using demonstration/redemonstration approach 18. The nurse is teaching a patient newly diagnosed with diabetes mellitus how to inject insuli chooses to use a demonstration/redemonstration technique. What domain of learning is the chiefly using? A) Cognitive B) Affective C) Psychomotor D) Educative 19. The nurse is teaching a patient newly diagnosed with cardiovascular disease how to reduce factors. The nurse begins by explaining why this information is important for the patient. W principle of adult learning is the nurse applying? A) Need to know B) Learner’s self - concept C) Learner’s life experience D) Motivation to learn 20. The nurse is teaching a group of patients newly diagnosed with cardiovascular disease. Wh action demonstrates application of the adult learning principle of learner’s life experience? A) Beginning with an explanation of why the material is important B) Creating a learning situation that is self - directed and independent C) Using case scenarios and problem - solving exercises D) Applying content to real - life situations and actions 21. The nurse is assessing learning by a critically ill patient and family. What is the best metho assessment? A) Written test B) Specific questions C) Open - ended questions

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    D) Literacy assessment Answer Key 1. B, E 2. D 3. A 4. A 5. B 6. C 7. D, E 8. D 9. C 10. B 11. A 12. B 13. C 14. C 15. D 16. D 17. C 18. C 19. A 20. C 21. C Page 1 Chapter 5 - Relieving Pain and Providing Comfort 1. A patient is in the ICU after suffering multiple trauma from a car wreck that occurred 24 ho The patient feels pain from many sources, including lacerations on the arm, a fractured femu tension headache from the stress of the accident, lower back pain from a sports injury 30 ye

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    nasal irritation from an endotracheal tube, and joint aches from ongoing arthritis. The nurse recognizes which of the following as the most likely instances of chronic pain? Select all tha apply. A) Lacerations on arm B) Fractured femur C) Tension headache D) Lower back pain from old sports injury E) Irritation in throat from endotracheal tube F) Arthritis in joints 2. A Nepali man is in the ICU recovering from spinal surgery to remove a malignant tumor. H not speak English, and struggles to communicate with the nurse by using hand motions. His is constantly at his bedside, speaking with him in Nepalese. Frequently, he puts on headpho listens to music on his MP3 player. His wife occasionally massages his feet. Which of the following factors is most likely exacerbating this patient’s pain? A) Inability to communicate with the nurse B) Constant presence of his family C) Listening to music D) His wife massaging his feet 3. A nurse is caring for a patient in the ICU who is recovering from coronary artery bypass gra surgery. Over the course of the next few days, the nurse will be responsible for changing a d over the surgical incision site, having the patient change positions in bed, assisting with trac suctioning, and assisting with drain removal. The nurse should anticipate that the patient wi likely perceive pa in resulting from these procedures in which order, from least painful to mo A) Changing the dressing, position change in bed, tracheal suctioning, drain removal B) Position change in bed, changing the dressing, drain removal, tracheal suctioning C) Drain removal, tracheal suctioning, position change in bed, changing the dressing D) Tracheal suctioning, position change in bed, changing the dressing, drain removal 4. A patient in the ICU is receiving intravenous opioid analgesia following myocardial infarcti Despite receiving continuous infusion of the opioid, the patient is grimacing and asks for an increase in the medication level. Consulting the medical chart, the nurse recognizes that this has a history of opioid addiction. What would be the most appropriate intervention? A) Immediately take the patient off of the opioid and give him Tylenol. B) Leave the patient on the opioid at the current dose level. C) Increase the dose of opioid to provide more effective pain relief.

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    D) Reduce the dose of opioid and offer to turn on the television as a distraction from the 5. A patient with no history of opioid abuse is receiving opioid analgesia intravenously in the I severe pain from extensive third - degree burns. The patient and his family are concerned abo likelihood of developing an addiction to the medication. What would be the best response o part of the nurse? A) Stop the opioid infusion immediately and use only nonpharmacological means of anal B) Begin tapering off the medication gradually. C) Explain that the risk for addiction is low and that opioids are necessary for the patient of pain. D) Explain that addiction is likely but cannot be avoided and suggest a rehabilitation prog following discharge. 6. A nurse is working with an elderly patient with Alzheimer’s disease and congestive heart fa the ICU. Which of the following methods of pain assessment would be essential to include i situation, according to the American Geriatric Society? A) No assessment is appropriate; the patient should be started on a standardized protocol analgesia for Alzheimer’s patients B) The verbal zero to ten scale C) The word descriptor scale D) Assessment of behavior and family observations 7. A patient in the ICU with renal dysfunction is to begin receiving intravenous opioids and a nonsteroidal anti - inflammatory drug (NSAID) for severe pain. The medication is expected t administered for at least seven days. Which NSAID would be most appropriate for this patie Select all that apply. A) Ketorolac (Toradol) B) Indomethacin (Indocin) C) Celecoxib (Celebrex) D) Rofecoxib (Vioxx) 8. A nurse is working with a cancer patient who has chronic pain related to her illness. The nur must administer fentanyl to the patient in the form of a transdermal patch. Which of the foll should the nurse do in administering this medication? A) Use lotion to prepare the skin where the patch will be applied. B) Wear gloves when handling the patch. C) Apply the patch over a wound or abrasion, if possible, to maximize absorption. D) Leave old patches on the patient’s bedside table for the doctor to examine later.

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    9. A patient in the ICU is receiving an intravenous opioid infusion for pain, but is experiencing anxiety due to being on mechanical ventilation. The physician has decided to prescribe a sed for the patient. The patient’s health history indicates an allergy to soy products. Which seda should be avoided in this situation? A) Propofol B) Midazolom C) Diazepam D) Lorazepam 10. An elderly patient in the ICU is receiving intravenous opioid analgesia for pain. The nurse observes that the patient’s respiratory rate has decreased to 8 breaths per minute. Which nu intervention would be most appropriate? A) Administer naloxone intravenously very slowly. B) Administer diazepam immediately. C) Increase the dose of opioid. D) Massage the patient’s feet to stimulate her breathing. 11. The nurse is caring for an otherwise healthy victim of a motor vehicle crash who is experie considerable pain. What factor indicates that the patient may be experiencing acute pain? A) It is associated with an acute and severe injury. B) It is expected to resolve as the injury heals. C) It requires treatment with intravenous opioids. D) No chronic illnesses have been diagnosed. 12. The nurse is caring for a critically ill patient who has experienced multiple trauma. The pa has high levels of pain from the injury and is receiving an intravenous opioid as treatment. managing the patient’s pain, what nursing action best demonstrates understanding of other that exacerbate pain in the critically ill patient? A) Provide supportive care withou t discussing it with the patient. B) Limit visits to immediate family for a few minutes at a time. C) Minimize care tasks during normal hours of sleep. D) Give higher doses of intravenous opioid as needed. 13. Before turning and repositioning a critically ill patient, the nurse ensures that a pain medic administered. This action demonstrates the nurse’s understanding of what phenomenon? A) Research has shown that critically ill patients perceive turning as a painful procedure B) The patient is ordered to receive pain medication every 4 to 6 hours.

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    C) This patient becomes very stiff when turned and the medication will be relaxing. D) The nurse is not concerned that this patient will become addicted to the medication. 14. The patient is scheduled for a painful procedure. In addition to premedicating the patient w opioid drug, what other nursing action is most likely to alleviate the pain? A) Give intravenous midazolam (Versed). B) Monitor vital signs during the procedure. C) Give explanations before and during the procedure. D) Ask the family to wait outside during the procedure. 15. The nurse is caring for a patient who has required increasing doses of opioids to control pa expresses a concern that the patient is becoming addicted to the opioid. What patient behav would best support the nurse’s concern about addiction? A) He needs more medication to control pain. B) He has withdrawal symptoms when the medication is stopped. C) He states that he dislikes the opioid as it makes him feel drugged. D) He asks for another dose of the opioid to relieve anxiety and get a “ buzz.” 16. The nurse is caring for a critically ill patient who has developed tolerance to an opioid med used for pain control. As the dose of the opioid is increased, the nurse observes the patient for respiratory depression. If the patient has developed tolerance to the opioid, what effect respiratory system does the nurse expect? A) None B) Depression C) Stimulation D) Exacerbation 17. The nurse is caring for a critically ill patient with serious pain and wishes to consult nation guidelines. What is the most comprehensive source for pain management guidelines? A) Web - based National Guideline Clearinghouse B) American Association of Critical - Care Nurses C) Society of Critical Care Medicine D) Agency for Healthcare Research and Quality 18. The nurse is developing a policy and procedure for pain management in a critical care unit on national standards, what should the nurse include? A) Pain assessment in critical care must depend on vital sign monitoring as patients are verbal.

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    B) Continuous intravenous opioids are preferred over as - needed dosing. C) Intravenous sedation of agitated patients takes priority over pain control. D) Pain control is an independent nursing function and responsibility. 19. According to national standards, pain in critically ill patients should be assessed at regular intervals using a variety of methods. What statement about pain assessment is true? A) Absence of physical signs or behaviors is equivalent to absence of pain. B) Many of the factors in critical care combine to invalidate patient self - report of pain. C) Behavioral observation and physiological parameters should be considered along wi patient’s report. D) The family has a more accurate assessment of pain than the patient. 20. The nurse is administering an intravenous opioid to manage a patient’s pain. What criteria nurse use to determine the adequacy of therapy? A) Minute ventilation is somewhat compromised. B) Patient rates pain below 5 on scale of 1 to 10. C) Minute ventilation is minimally compromised. D) Patient rates pain below own predetermined goal. 21. A severely ill critical care patient is receiving intravenous opioids for pain management. T physician adds a nonsteroidal anti - inflammatory drug (NSAID) to the patient’s plan of car nurse understands that the most significant advantage of adding t his drug is what? A) NSAIDs are cheaper than opioids while providing the same pain relief. B) Inhibition of prostaglandin and histamine at the site of injury will relieve pain withou sedation. C) NSAIDs are available without prescription. D) Addiction and physical dependence are less of a problem with NSAIDs. 22. A critically ill patient is receiving acetaminophen (Tylenol) in combination with opioids fo management. Under what circumstances would the nurse question the use of acetaminophe A) Normal liver function tests B) Low platelet levels C) Relative hypothermia D) Reduced pain levels 23. The nurse is caring for a critically ill patient with high levels of pain. To potentiate pharmacological pain relief, the nurse uses several nonpharmacological interventions. Wh nursing strategies will be helpful in this situation? Select all that apply.

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    A) Frequent turning and repositioning B) Earphones with music of the patient’s choice C) Limiting visits to twice a day D) Using guided imagery and distraction E) Teaching the quieting reflex F) Using therapeutic touch Answer Key 1. D, F 2. A 3. A 4. C 5. C 6. D 7. C, D 8. B 9. A 10. A 11. B 12. C 13. A 14. C 15. D 16. A 17. A 18. B 19. C 20. D 21. B 22. C 23. B, D, E, F

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