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

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Chapter 1-Critical Care Nursing Practice1.AnurseistheonlyoneintheICUwhohasnotachievedcertificationincriticalcarenursingoftenwillaskherfellownurseswhattodoincaringforapatientbecauseshedoubtstheaccofherknowledgeandherintuition.Shelovesherworkbutwishesshecoulddoitwithagrelevelofcompetence.Whatisthemostimportanteffectthatobtainingcertificationwouldlikhaveonthenurse’spractice?A)RecognitionbypeersB)IncreaseinsalaryandrankC)MoreflexibilityinseekingemploymentD)Increasedconfidenceinmakingdecisions2.AhospitalinterviewstwodifferentcandidatesforapositionintheICU.Bothcandidateshaaround10yearsofexperienceworkingintheICU.Bothhaveexcellentinterpersonalskillshighlypositivereferences.One,however,hascertificationincriticalcarenursing.Whichoffollowingisthemostcompellingandaccuratereasonforthehospitaltohirethecandidatewcertification?A)Thecertifiednursewillhavemoreknowledgeandexpertise.B)Thecertifiednursewillbehavemoreethically.C)Thecertifiednursewillbemorecaringtowardpatients.D)Thecertifiednursewillworkmorecollaborativelywithothernurses.3.AnurseiscaringforanelderlymanrecentlyadmittedtotheICUfollowingastroke.Sheashiscognitivefunctionusinganewcognitiveassessmenttestshelearnedaboutinarecentaranursingjournal.Shethenbringsacupofwaterandastrawtothepatientbecausesheobsethathislipsaredry.Later,shehasthepatientsitinawheelchairandtakeshimtohavesometestsperformed.Heobjectsatfirst,sayingthathecanwalkonhisown,butthenurseexplaiitishospitalpolicytousethewheelchair.Thatevening,sherecognizessignsofanimmineninthepatientandimmediatelypagesthephysician.Whichactiontakenbythenurseisthebexampleofevidence-basedpractice?A)GivingthepatientacupofwaterB)TransferringthepatientinawheelchairC)UsingthecognitiveassessmenttestD)Recognizingsignsofimminentstrokeandpagingthephysician4.Anurseisonacommitteethatistryingtoreducetheoccurrenceofhospital-acquiredinfecttheICU.Herroleistoconductresearchtofindwhichinterventionshavebeenshowntobem

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effectiveinreducingtheseinfections.Sheconsultsmanydifferentsourcesandfindsconflicinformation.Whichofthefollowingsourcesshouldsheconsiderthemostauthoritative?A)AACNexpertpanelreportB)Ameta-analysisofrandomizedcontrolledtrialsintheAmericanJournalofNursingC)AsystematicreviewofqualitativestudiesintheJournalofAdvancedNursingD)AsinglerandomizedcontrolledtrialintheAmericanJournalofCriticalCare5.AnursewhohasbeenrecentlyhiredtomanagethenursingstaffoftheICUisconcernedatofevidence-basedpracticesheseesamongthestaff.Whichofthefollowingwouldbethebforhertotaketopromoteincorporatingevidenceintoclinicalpractice?A)Onlyhirenursescertifiedincriticalcarenursing.B)Leavecopiesofseveraldifferentnursingjournalsinthenurses’lounge.C)Demonstratetothestaffthebestnursing-relatedsearchtermstouseinGoogleorYahD)IntroducethestafftothePubMedsearchengineandassignthemtopicstoresearchon6.AphysicianvisitsapatientintheICUwhilethenurseisout.Thepatientcomplainsthatthemedicationisnoteffectiveandthathewouldliketoreceiveanincreaseddose.Thephysiciathenursepagedandconsultswithhiminthehallwayregardingthepatient’srequestforstropainmedication.Thenurseexplainsthatpatientwasstartedonamorphinedriponly20minagoandthatthedrughasnothadtimetotakeeffectyet.Thephysicianagreesandtellstheptogiveitjustabitmoretime.Whichcomponentofahealthyworkenvironmentismostevithisscenario?A)SkilledcommunicationB)AppropriatestaffingC)TruecollaborationD)Meaningfulrecognition7.AnurseintheICUisrespondingtoapatientwhohasjustgoneintocardiacarrest.AmomethenurseisnotifiedthatanotherpatienthasjustgoneintoanaphylacticshockduetoadrugSheisconflictedastowhattodo,assheistheonlynurseavailableatthemomenttotendtopatients.Whichcomponentofahealthyworkenvironmentislackinginthisscenario?A)EffectivedecisionmakingB)AppropriatestaffingC)AuthenticleadershipD)Meaningfulrecognition8.AnICUnursehasprovidedexcellentcarefora6-year-oldgirlwhohadbeenadmittedtotheforaheadinjury.Thenursewasattentivenotonlytotheneedsofthepatientbutalsowento

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herwaytocarefortheneedsofthegirl’sfamily.Accordingtoresearch,whichofthefollowformsofrecognitionwouldthenursevaluethemost?A)Acardfromthegirl’sfamilyB)AplaquefromtheICUphysiciansnamingheras“ NurseoftheYear”C)Aletterofcommendationfromthehospital’sadministrationD)Abouquetofflowersfromhersupervisor9.ApatientintheICUhasrecentlybeendiagnosedwithdiabetesmellitus.Beforebeingdischthispatientwillrequiredetailedinstructionsonhowtomanageherdiet,howtoself-injectinandhowtohandlefuturediabeticemergencies.Whichnursecompetencyismostneededinsituation?A)ClinicaljudgmentB)AdvocacyandmoralagencyC)CaringpracticesD)Facilitationoflearning10.AnelderlypatientisadmittedtotheICUwithstageIVlungcancer,diabetesmellitus,andcongestiveheartfailure.Thehealthcareteamassembledtocareforherislargeanddiversincludinganoncologist,apulmonologist,anendocrinologist,acardiologist,andothers.Thpatientisnotexpectedtosurvivemorethanafewweeks,andherhusbandisoverwhelmedstressandgrief.WhichnursecompetencyorcompetenciesaremostneededinthissituatioSelectallthatapply.A)ClinicaljudgmentB)CaringpracticesC)CollaborationD)Responsetodiversity11.AnEthiopianmanwithAIDShasrecentlybeenadmittedtotheICUwithacaseofpneumThemanisnewtotheU.S.andhasnohealthinsurance.HewouldlikelybeeligibleforthMedicaidcoverage,butdoesnotunderstandhowtoaccessthiscoverage.Whichcompetencompetenciesaremostneededinthissituation?Selectallthatapply.A)ClinicaljudgmentB)AdvocacyandmoralagencyC)CollaborationD)SystemsthinkingE)Responsetodiversity

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F)Clinicalinquiry12.Anursedecidestoseekcertificationincriticalcarenursing.Whatisthemostimportantbefortheindividualnurseinbecomingcertifiedinaspecialty?A)Itwillresultinasalaryincrease.B)Itisrequiredtoworkincriticalcare.C)Itdemonstratesthenurse’spersonalexpertise.D)Itismandatedbyemployers.13.TheAmericanAssociationofCritical-CareNurses(AACN)sponsorscertificationincriticnursingforseveralcriticalcaresubspecialties.Whatisthemostimportantbenefitofsuchcertificationfortheprofessionofnursing?A)ProvidespositivepublicityfornursingB)Validatesnurses’expertknowledgeandpracticeC)MandatedbygovernmentregulationsD)Demonstratesbasicknowledgeinthefield14.Anursehasachievedcertificationincriticalcarenursing.Whatisthemostimportanteffethiscertificationwillhaveonthenurse’spractice?A)RecognitionbypeersB)IncreaseinsalaryandrankC)MoreflexibilityinseekingemploymentD)Increasedconfidenceincriticalthinking15.Thenursecitesevidence-basedpracticeasarationaleforapatientcaredecision.Whatistdescriptionofevidence-basedpractice?A)DecisionsbasedonexpertlegaltestimonyB)UseofbestavailableresearchdataC)EvolutionofnursingpracticeovertimeD)Individualoptimizationofpatientoutcomes16.Thenursecaringforacriticallyillpatientimplementsseveralcomponentsofcare.Whatcomponentisanexampleoftheuseofevidence-basedpractice?A)UseofaprotocolforadmissionofapatienttotheunitB)ApplicationofaninsulinslidingscalemethodfromresearchC)Checkingthepatient’sarmbandbeforegivingamedicationD)Limitingvisitstoimmediatefamilyonlyfor2hoursaday

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17.Thenursewishestoincreasetheuseofevidence-basedpracticeinthecriticalcareunitwhworks.Whatisasignificantbarriertotheimplementationofevidence-basedpractice?A)UseofcomputerizedrecordsbythehospitalB)HealthInformationPrivacyandPortabilityAct(HIPPA)C)LackofknowledgeaboutliteraturesearchesD)Strongcollaborativerelationshipsintheworksetting18.Thenursehasidentifiedanincreaseinmedicationerrorsinthecriticalcareunitoverthepseveralmonths.Whataspectofmedicationproceduresshouldbeevaluatedfirst?A)AdherencetoproceduresbynursingstaffB)ClarityofinterdisciplinarycommunicationC)NumberofnewemployeesontheunitD)Changesinadministrationprocedures19.Acriticalcareunithasdecidedtoimplementseveralmeasuresdesignedtoimproveintradisciplinaryandinterdisciplinarycollaboration.Inadditiontoanexpectedimprovemepatientoutcomes,whatisthemostimportanteffectthatshouldresultfromthesemeasuresA)IdentificationofincompetentpractitionersB)ImprovementinmannersontheunitC)IncreasedstaffretentionD)Lessdiscussioninfrontofpatientsandfamilies20.AnursewishestopracticeusingtheSynergyModeldevelopedbytheAmericanAssociatiCritical-CareNurses(AACN).Whatnursingbehaviorbestsupportsuseofthismodel?A)Attendingmandatoryhospital-widein-serviceprogramsB)Self-directedstudyofbestpracticeforthepatientsshecaresforC)GatheringdemographicdataonthepatientsadmittedtotheunitD)Participatinginaresearchstudyasadatacollector21.AspartoftheSynergyModel,thenursehasidentifiedapatientcharacteristicofresiliencypatientbehaviordemonstratesresiliency?A)DysfunctionalgrievingbehaviorsafterreceivingbadnewsB)DevelopingalistofquestionsforthephysicianC)DenialofanypossiblenegativeoutcomesforaprocedureD)Assigningblametoothersforundesiredoutcomesofillness22.Apatientisadmittedtothecriticalcareunitafterreceivingamechanicalheartimplantatio

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makinganursingassignment,thechargenursebestdemonstratesapplicationoftheSynergModelbyassigningwhichnursetocareforthispatient?A)Anewlyhirednewgraduatenurse,fortheexperienceB)Anursewithapatientinthenextroom,forproximityC)Themostseniornurseontheunit,forpoliticalreasonsD)Thenursewithmostexperiencewiththisdevice,forexpertise23.AMuslimpatienthasbeenadmittedtothecriticalcareunitwithcomplicationsafterchildbBasedontheSynergyModel,whichnursewouldbethemostinappropriatetoassigntocathispatient?A)NewgraduatefemalenurseB)MostexperiencedfemalenurseC)NewgraduatemalenurseD)Femalenursewithpostpartumexperience24.Today’scriticalcarenursingenvironmentisconstantlychanging.Whatnursingbehaviorbillustratesawarenessofcurrenteventsaffectingcriticalcarenursing?A)Participatinginthehospital’seffortstorecruitnewnursesB)VolunteeringtoserveonadisasterresponseplanningcommitteeC)AdheringtocontenttaughtinbasicnursingprogramD)Attendinghospital-mandatedin-serviceswithoutothereducationAnswer Key1.D2.A3.C4.B5.D6.C7.B8.A9.D10.B,C11.B,D,E

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12.C13.B14.D15.B16.B17.C18.B19.C20.B21.B22.D23.C24.BPage 1Chapter 2-The Patient’s Experience WithCritical illness1.Thecriticalcareunitenvironmentisverystressfulforpatients,families,andstaff.Whatnuractionisdirectedatreducingenvironmentalstress?A)ConstantevaluationofpatientstatusB)LimitingvisitstoimmediatefamilyC)BathingallpatientsduringhoursofsleepD)Maintainingquietduringhoursofsleep2.ApatientistransferredtotheICUfromtheBirthCenterofthehospitalinthemiddleoftheafterexperiencingcomplicationsduringdeliveryofherbaby.Thepatient’shusbandisanxioexplainstotheICUnursethathedoesn’tunderstandwhyhiswifehasbeenmovedtotheIC“ Sheisgoingtodie,isn’tshe?”heasksthenurse.Whatisthenurse’sbestresponse?A)ExplainthateverymeasurewillbetakentoprovidehiswifewiththebestcarepossiblB)Explainthatthenurseisfullytrainedandhasyearsofexperience.C)Offerthehusbandaplacetorelax.

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D)Haveappropriatestaffdiscusshishealthinsurancewithhim.3.ApatientisadmittedtotheICUwithinjuriessustainedfromafallfromathird-storywindopatientisconscious,hisbreathingislabored,andheisbleedingheavilyfromtheabdomen.groansconstantlyandcomplainsofseverepain,buthismovementsareminimal.Hisheartrelevated.Whichoftheseisasignthatheisinthesecondphaseofthestressresponse?Selecthatapply.A)BleedingheavilyfromhisabdomenB)Labored,slowbreathingC)SeverepainD)ElevatedheartrateE)Minimalmovement4.ApatientintheICUisrecoveringfromopen-heartsurgery.Thenurseentershisroomandobservesthathisdaughterisperformingeffleurageonhisarmsandtalkinginalowvoiceabupcomingfamilyvacationthatisplanned.Theroomisdimlylit,andshehearstheconstantbeepingofhisheartmonitor.Fromthehallshehearsthecriesofapatientinpain.Whichoffollowingarelikelystressorsforthepatient?Selectallthatapply.A)Hisdaughter’sconversationB)Hisdaughter’seffleurageC)ThebeepingoftheheartmonitorD)ThedimlightingoftheroomE)Thecriesoftheotherpatientfromthehall5.ApatientintheICUiscomplainingthatheisnotsleepingwellatnightbecauseofanxiety.ofthefollowingwouldbethemosthelpfulinterventionforthenursetomake?A)Providethepatientwithabathimmediatelyfollowinghisfirst90-minuteREMsleepB)Increasethepatient’spainmedication.C)Providethepatientwith5minutesofeffleurageandthenminimizedisruptions.D)Monitorthepatient’sbrainwavesbypolysomnographytodeterminehissleeppattern6.Anursewalksintoapatient’sroomandbeginspreparingasyringetoperformablooddrawpatient.Thenurseobservesthatthepatientisfirmlygrippingthesideofthebed,avertingheandsweatingfromherforeheadwhensheseestheneedle.Whatwouldbethebestinterventthenursetomake?A)Proceedwithblooddrawasquicklyaspossible,togetitoverwith.B)Offertocomebacklatertoperformtheblooddraw.

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C)Encouragethepatienttodeepbreathe.D)Describebrieflytheblooddrawprocedureandexplainwhyitisnecessary.7.A15-year-oldboyisintheICUandpreparingforanappendectomy.HeisclearlyanxiousafidgetswithhisIVconstantly.Hecomplainsthathedoesn’twanttobethereandheissickoeveryonetellinghimwhattodo.Whatwouldbethebestwayforthenursetoaddressthispanxiety?A)UsephysicalrestraintstokeephimfrompullingouthisIV.B)Offerhimtheremotetothetelevision.C)Lowertheheadofhisbedsothathecanrestmoreeasily.D)Explaintothepatientindetailwhattheappendectomywillconsistof.8.Anurseinaburnunitobservesthatapatientistensedupandfrowningbutsilent.Thenursethepatient,“ Canyoutellmewhatyouarethinkingnow?”Thepatientresponds,“ Ican’tthispainanymore!IfeellikeI’mabouttodie.”Whatwouldbethebestresponseforthenugivetothepatient,consideringthatthepatientisalreadyreceivingthemaximumamountpamedicationthatissafe?A)“ Trytogetridofthosenegativethoughts—theyonlymakeitworse.”B)“ Trythinkinginstead,‘Thispainwillgoaway;Icanovercomeit.’”C)“ Yourpainmedicationisalreadyatthehighestpossibledose.”D)“ Wouldyoulikemetoraisetheheadofyourbed?”9.ApatientonmechanicalventilationisexperiencingsevereagitationduetobeingonthevenWhichnursinginterventionwouldbebest?A)PerformingbreathingexerciseswiththepatientB)Offeringthepatientapatient-controlledanalgesicdeviceC)AskingthephysiciantoprescribeanantianxietymedicationD)Offeringthepatientthepatient’sownMP3playertolistento10.A10-year-oldfemalepatientinICUreceivingchemotherapyhasrequestedthatherdogbeallowedtovisither.Sheiscurrentlysharingaroomwithanotherpatient.Thenurseknowsthehospitaldoesallowforpetvisitswithowners,buthasstrictguidelines.Whichofthefollowingscenariosismostlikelytobepermitted?A)Thegirl’sfathermaybringthedoginonaleashfora20-minutevisit.B)Thegirl’ssistermaybringthedoginwithashirton(topreventshedding)foranovestay.C)Thegirl’smothermaybringthedoginonaleashforavisitaslongashehashadallvaccinations.

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D)Thedogmaybebroughtinforabriefvisitoncethegirlismovedtoaprivateroom.11.Thenurseunderstandsthatapatientbeingcaredforinacriticalcareunitexperiencesanastressresponse.Whatnursingactionbestdemonstratesunderstandingofthephysiologicaloftheinitialstressresponse?A)AdequatepaincontrolB)IntravenoussedationC)TreatmentforelevatedbloodpressureD)Ignoringanelevatedglucoselevel12.Acriticallyillpatientexperiencesstressandanxietyfrommanyfactors.Treatmentofthepfocusesonreducingstressorsandprovidingsupportivecaresuchasnutrition,oxygenationmanagement,controlofanxiety,andspecificcareoftheillnessorinjury.Whatisthebestrationalefortheseinterventions?A)Helpstosupportthepatient’simmunesystemB)PartofgoodnursingcareC)MandatedbyhospitalpolicyD)Reassuresthepatientandfamily13.Apatientinacriticalcareunithasincreasedstressfromtheconstantnoiseandlightlevelsnursinginterventionbestattenuatesthesesourcesofstress?A)NeedforconstantobservationandevaluationB)DimminglightsduringthenightC)FrequentnursinggrouproundsforallpatientsD)Useoftilefloorsforeaseincleaning14.Thenurseiscaringforapatientwhoisorallyintubatedandonamechanicalventilator.Thbelievesthatthepatientisexperiencingexcessanxiety.Forthispatient,whatbehaviorbesindicatesanxiety?A)RestlessnessB)VerbalizationC)IncreasedrespiratoryrateD)GlasgowComaScalescoreof315.Thecriticalcareunitenvironmentisverystressfulforpatients,families,andstaff.Whatnactionisdirectedatreducingenvironmentalstress?A)ConstantexpertevaluationofpatientstatusB)Limitingvisitstoimmediatefamily

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C)BathingallpatientsduringhoursofsleepD)Maintainingaquietenvironmentduringhoursofsleep16.Thenursewishestoenhancesleepcyclesinhercriticallyillpatient.Researchhasshowntwhichnursingactionimprovessleepincriticallyillpatients?A)Repositioningevery2hoursB)HypnoticmedicationsC)Five-minutebackeffleurageD)Adequatepaincontrol17.Thenurseiscaringforacriticallyillpatientwithaveryconcernedfamily.Giventhatthefisunderhighstress,whatnursinginterventionwillbestamelioratetheirstresswhilepreserindependence?A)Encouragethefamilytoparticipateinpatientcaretasks.B)Teachthefamilytoaskquestionsofthehealthcareteam.C)Askthefamilytoselectafamilyrepresentativeforcommunication.D)Limitvisitstoimmediatefamilymembersforlimitedtimes.18.Whilecaringforacriticallyillpatient,thenurseknowsthatfosteringpatientcontroloverenvironmentisamethodforstressreduction.Whatnursinginterventiongivesthepatienttmostenvironmentalcontrolwhilestilladheringtobestpracticeprinciples?A)Askthepatientwhetherheorshewantstogetoutofbed.B)Givethepatient’sbathatthesametimeeveryday.C)Explainpainfulproceduresonlyaftergivingpainmedication.D)Choosemenuitemsforthepatienttoensureabalanceddiet.19.Thenurseisusingpresencetoreducetheanxietyofacriticallyillpatient.Whatnursingbedemonstratesaneffectiveuseofpresence?A)Stayinginthepatient’sroomtocompletedocumentationB)Havingaconversationinthepatient’sroomthatexcludesthepatientC)MaintainingeyecontactwiththepatientduringexplanationsD)Focusingonspecificnursingcaretaskswhileinthepatient’sroom20.Thenurseiscaringforacriticallyillpatientwhocanspeak.Thenursenoticesthatthepatidemonstratingbehaviorsindicativeofanxietybutissilent.Whatnursingstrategywouldgnursethemostinformationaboutthepatient’sfeelings?A)Explainprocedurestothepatientandfamily.

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B)Askthepatienttosharehisorherinternaldialogue.C)Encouragethepatienttonapbeforevisitinghours.D)Ensurethatthepatienthasadequatepaincontrol.21.ThepatientisundergoinganecessarybutpainfulprocedurethatisgreatlyincreasingheraThenursedecidestouseguidedimagerytohelpalleviatethepatient’sanxiety.Whatisakofthistechnique?A)Providethepatientwithanexternalfocuspointsuchasapicture.B)Havethepatienttakeslow,shallowbreathswhilestaringatafocuspoint.C)Havethepatientremembertactilesensationsofapleasantexperience.D)Encouragethepatienttoconsciouslyrelaxallofhermuscles.22.Oneofthestrategiesshowntoreduceperceptionofstressincriticallyillpatientsandtheirfamiliesissupportofspirituality.Whatnursingactionismostclearlysupportiveofthepatspirituality?A)ReferringpatientstotheCatholicchaplainB)ProvidingprayerbookletstopatientsandfamiliesC)AskingaboutbeliefsabouttheuniverseD)Avoidingdiscussingreligionwiththoseofotherfaiths23.Acriticallyillpatienttellsthenursethatheisnotafraidtodiebecausehebelievesinreincarnation.Whatisthemostappropriatenursingresponse?A)“ Whatifreincarnationisnotreal?”B)“ Thisbeliefgivesyoustrength.”C)“ Idon’tbelieveinreincarnation.”D)“ Youshouldn’tbaseyourhopesonsuchabelief.”24.Acriticallyillpatientwhoisintubatedandagitatedisrestrainedwithsoftwristrestraints.onresearchfindings,whatisthebestnursingaction?A)Maintaintherestraintstoprotectpatientsafety.B)Removetherestraintsperiodicallytocheckskinintegrity.C)Removetherestraintsperiodicallyforrangeofmotion.D)Assessandinterveneforcausesofagitation.Answer Key1.D2.A

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3.C,E4.C,E5.C6.D7.B8.B9.D10.D11.A12.A13.B14.A15.D16.C17.B18.B19.C20.B21.C22.C23.B24.DPage 1Chapter 3-The Family’s ExperienceWithCritical Illness1.ApatienthasjustbeenadmittedtotheICUafterbeinginasevereautoaccidentandlosingoherlegs.Herhusbandhashishandoverhisheartandcomplainsofarapidheartrate.ThenurecognizeshisconditionasasignofwhichstageofthegeneraladaptationsyndrometostresA)Alarmstage

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B)ExhaustionstageC)ResistancestageD)Adaptationstage2.Thenurseobservesthatanelderlywoman,whosegranddaughterhasbeenadmittedtotheICstrugglingtomanagehertwogreat-grandsons,whoaretoddlers,inthewaitingroom.Whatmostlikelyexplanationforthewoman’sinabilitytomanagethechildreninthissituation?A)Sheissenile.B)Sheisintheexhaustionstageofthegeneraladaptationsyndrometostress.C)Sheisassumingtheroleofcaregiverinplaceofthepatient,arolesheisnotusedto.D)Shehasmaculardegenerationandcannotseewell.3.Anurseneedstocommunicatewithapatient’sfamilyregardingconsenttotreatanunconscpatientintheICU.Whichmemberofthegroupshouldthenurseapproachfirst?A)Amansherecognizesasthepatient’sbrotherB)AteenageboywhoapproachesthenurseC)AwomanwhooriginallyescortedthepatientinD)Awomaninthegroupwhomtheotherslookatandcalloverwhenthenurseapproach4.AnewnursehasrecentlyjoinedtheICUfromadifferenthospital,whichhadamuchstricteregardingvisitinghours.Sheexpressesconcernabouttheimpactofopenvisitinghoursonpwell-being.Whichofthefollowingwouldbethebestexplanationforthepurposeofopenvhours?Selectallthatapply.A)TobetterproviderestandquietB)TostrengthentherelationshipbetweenthefamilyandhealthcareproviderC)TocontrolthenumberofvisitorsforapatientD)ToprovideanundisturbedenvironmentE)Todecreasethepatient’sanxietyF)Toincreasethesatisfactionofthefamilywiththeexperience5.Anurseobservesthata38-year-oldsinglefatherwhose11-year-olddaughterisintheICUistrugglingtoexplaintohis6-year-oldsonthelikelihoodthatthedaughterwilldie.Theyounaskswhatwillhappentohissisterwhenshedies,butthefatherbreaksdownintearsandseunabletorespond.Whichofthefollowingwouldbethemostappropriateinterventionforthtomake?A)Suggestthatthefathercontacthispastor,rabbi,orotherspiritualleaderforcounselfoandhisson

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B)SitdownwiththefatherandsonandshareherownreligiousbeliefsC)Askthepatient’sdoctortoexplaintothefathertheoddsofthedaughtersurvivingD)Leavethefatherandsontogrievealone6.Apatientisexperiencingseverepain,despitereceivingpainmedicationforthepast24hourpatient’swifeexpressesconcernaboutthistothenurse.Whichresponsebythenursewouldmostempoweringtothepatient’sfamily?A)Explainthatthedoctorisanexpertonpainmedicationandthatthecurrentlevelofmedicationisthebest.B)Recommendthatthefamilymemberstaketurnsmassagingthepatient’sfeettodistracthepain.C)Encouragethefamilytorequestthatthephysicianevaluatethepatient’spaincontrol.D)Askthefamilytowaitanother24hourstoseewhetherthepatient’spainlevelwillgo7.ThesisterofapatientintheICUhasbeenatthepatient’sbedsidenon-stopfor48hours.Thsuggeststoherthatshereturnhometorest.Whichofthefollowingistheproperrationalefonursemakingsuchasuggestion?A)Thesisterisinthewayofthehealthcareproviders.B)Thepatientmaybecomeannoyedbyhercontinualpresence.C)Thepatientwillrecovermoreeasilyinpeaceandquiet.D)Thesisterneedstomaintainherownhealthduringthistime.8.AyoungmanhasjustarrivedattheICUfromoutoftownandreceivednewsthathisgirlfriwhoisadmittedthere,likelyonlyhasafewdayslefttolive.Whichofthefollowingwouldbestapproachforthenursetotakeincaringfortheneedsofthisyoungman?A)RecommendingthathegohomeandrestB)GivinghimunrestrictedvisitinghourswiththepatientC)SuggestingthathemeetwiththehospitalchaplainD)Recommendingthatheaskthedoctortoevaluatethepatient’spaincontrolmeasures9.Afamilyofayounggirlwhohasbeendiagnosedwithleukemiahastravelled12hoursbycadmithertotheICUandbewithherduringhertreatment.Whichaspectofthecriticalcareassistanceprogramwouldmostlikelybeneededbythisfamilyinitially?A)EducationalmaterialsB)WeeklygroupfamilyinformationsessionsC)HospitalityprogramsD)Pettherapy

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10.AMuslimwomanisadmittedtotheICUaftersufferingsevereburnsovermostofherbodWhichofthefollowingwouldbethemostappropriatemeasureforthenurse,awoman,torespectfortheculturalpracticesofthispatient?A)Insistthatonlyafemaledoctorbeassignedtothispatient.B)Ensurethatnoporkproductsareincludedinthepatient’sdiet.C)Ensurethatdirecteyecontactisnotmadewiththepatient’shusband.D)Askthepatient’shusbandwhatreligiousandculturalpreferencesshouldbeconsiderthepatient’scare.11.Aclienthasbeenadmittedafterexperiencingmultipletraumaandisintubatedandsedatedthefivemembersoftheimmediatefamilyarrive,theyareanxious,angry,andverydemanTheyallspeakloudlyatonceandaskformanyservicesandanswers.Whatisthebestnurresponse?A)Askthefamilytoleaveuntilvisitinghoursbegin.B)Takethemtoaprivateareaforinitialexplanations.C)Pagesecuritytohavethemremovedfromunit.D)Showthemtotheclient’sbedsideandleavethemalone.12.TheclienthasbeenintheCCUforseveralweeksandhasbeenveryunstable.Onefamilymemberstaysatthebedsideconstantlyandevennapsinabedsidechair.Thenurseundersthatthefamilymemberisexhibitingwhichfamilymemberresponsetocriticalillness?A)ExhibitingextremedistrustofthehealthcareteamB)SeekingevidenceforfuturelegalorpunitiveactionC)TryingtomaintainalevelofcontroloverthesituationD)Experiencingextremefatiguefromconstantstress13.ThenurseiscaringforaveryseriouslyillpatientintheCCU.Thefamilyvisitssporadicalstaysforonlyashorttime,anddoesnotaskmanyquestions.Howcouldthenursebestbeginvolvethefamilyinthepatient’scare?A)Askonefamilymembertoassistwiththepatient’sbath.B)Encouragefamilymemberstostaylongerateachvisit.C)Focusnursingeffortsonthepatient’slegalnextofkin.D)AskthefamilytocompletetheCriticalCareFamilyNeedsInventory.14.Aspartoftheadmissionprocess,thenurseasksseveralquestionsaboutfamilyrelationshinursebasestheseactionsonwhichrationale?A)Assessingfamilyrelationshipsisaninitialstepinincludingthefamilyinpatientcare

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B)ThesequestionsarepartoftheadmissionassessmenttoolrequiredbythisCCU.C)Thenursehasanaturalcuriosityandwishestoknowhowthefamilymembersrelateownknowledge.D)Thereisanongoingresearchstudytoidentifyvariantfamilypatternsrelatedtodiseaincidence.15.Ontheirfirstvisittoacriticallyillpatient,familymembersstandinthedoorwayoftheroomakingnoefforttoapproachthepatient.Whatisthemostappropriatenursingaction?A)Instructthefamilywherethepatientcanbetouchedandwhattosay.B)Engagethefamilyinsocialconversationtoeasethemintothemilieu.C)Usevisitinghourstoexplaintothefamilythegeneralstatusofthepatient.D)Leavethefamilytoadjusttothesituationwhentheyareready.16.Acriticallyillpatientisnotexpectedtosurvivethisadmission.Thefamilyasksthenursepatientisdoing.Whenansweringthisquestion,whatshouldthenurseinclude?A)Emphasizethatthepatientisyoungandstrongandmaystillsurvive.B)Referthefamilytothephysicianforalldetailsandanswers.C)Givespecificinformationsuchasdescendingtrendsinparameters.D)Askifthefamilyhasdeterminedwhichfuneralhomewillbecalled.17.Apatient’sfamilyisexhibitingincreasinglyimpairedcopingasthepatient’sconditiondeteriorates.Thenurseasksthefamilytostatethebiggestconcernfromtheirperspective.themostimportantrationaleforthisquestion?A)Thequestionindicatesactivelisteningonthepartofthenurse.B)Thequestionisusedasawaytovalidatethefamily’sknowledge.C)Thequestionclarifiesthenurse’sunderstandingofcurrentfamilyneeds.D)Thequestionpromotesproblemdefinition,whichhelpsdefinethedegreeoffamilyunderstanding.18.ThenurserecommendsthatthefamilyofacriticallyillpatientseekhelpfromtheCriticalFamilyAssistanceProgram.Whatbenefitforthefamilydoesthenurseanticipate?A)ReductionofhealthcarecostB)MorephysicalcomfortC)MultidisciplinarysupportD)Healthpromotioninformation19.Whileinteractingwiththefamilyofacriticallyillpatient,thenursesuggeststhatthefamibefeelingveryanxiousandperhapsangry.Howdoesthisnursingactionbenefitthefamily

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A)RemovesthefocusoftheconversationfromthepatientB)FocusingonfeelingshelpsthefamilyavoiddelayedgriefandunhealthycopingC)GivesvalidationofneedforpsychologicalcounselingD)Reducesfamilyinsistenceforpatientprogressinformation20.Thenurseiscaringforapatientfromaverydifferentculturalgroup.Indeliveringcare,hothenursebestdemonstrateculturalsensitivity?A)Askthefamilyabouttheirculturalbeliefsandcustomsthatmayapply.B)Assumethatthepatientandfamilywilladjusttothehospitalculture.C)Informthepatientandfamilythattheroutinesofthehospitaltakeprecedence.D)Doaliteraturesearchonthepatient’sculturetodeterminebeliefs.Answer Key1.A2.C3.D4.B,E,F5.A6.C7.D8.B9.C10.D11.B12.C13.D14.A15.A16.C17.D18.C19.B20.A

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Page 1Chapter 4-Patient and Family Education inCritical Care1.AnelderlymanwhosewifehasjustbeenadmittedtotheICUfollowingcongestiveheartfaconcernedabouthowpassageoftheAffordableCareActwillimpactthecareofhiswife.Wthefollowingareexpectedoutcomesofthislegislationthatitwouldbeappropriateforthensharewiththeman?Selectallthatapply.A)Thenewlegislationwillresultinashortageofexperiencedcriticalcarenurses.B)Thenewlegislationwillrequirehealthcareworkerstomeethigherqualitystandardsrtopatientcare.C)Thenewlegislationwillmakeitmorechallengingtomeettheeducationalgoalsofpaandfamilies.D)Thenewlegislationwillincreasethelengthofstayofpatientsinthehospital.E)Thenewlegislationwillshiftthepaymentstructureforhospitalsandhealthcareprovfromatraditionalfee-for-servicemodeltoanincentivemodel.2.Ayoungcouplewhose5-year-olddaughterhasbeenadmittedtotheICUapproachesthenuwithlooksofconcernontheirfaces.Theyexpressfrustrationtothenursethattheyhavenotabletospeakwitheitherthephysicianorthesurgeonandareconfusedastowhatthenextsfortheirdaughter’streatment.Whatwouldbethebestinterventionforthenursetomakeinsituation?A)Offertogeticechipsforthecoupletogivetotheirdaughtertoempowerthem.B)Makesurethattheyhavethecellphonenumbersofthephysicianandsurgeon.C)Teachthecoupleaboutthepathophysiologyofthedaughter’sdisease.D)Arrangeapatientcareconferencewiththecoupleandthehealthcareteam.3.AnurseseesagroupofphysicianswhoaremakingteachingroundsinthehalloftheICUhtowardtheroomofoneofherpatients.Thepatient,whocurrentlyhasavisitor,hasgivenapinthepasttohaveteachinggroupsvisit.Whatshouldthenursedointhissituation?A)Explaintothegroupofphysiciansthatthepatientcurrentlyhasavisitorandaskwhettheycouldcomebylater.B)Askthevisitortoleavesothattheteachinggroupcandiscussthepatient’scase.C)Allowtheteachinggrouptoenterthepatient’sroom,ashehasalreadygivenapprovathemtovisit.

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D)Instructthephysicianstogiveclearexplanationsofthemedicaljargontheyuse.4.ThenurseisworkingwithapatientfromIndiawhoisrecoveringfromamyocardialinfarctiWhenthenurseasksthepatientwhethershehashadamyocardialinfarctionbefore,thepatiseemsconfusedandappearsnottounderstandthenurse,althoughthepatientdoesspeakEnWhichofthe“4C’sofCulture”shouldthenurseusetobettercommunicatewiththispatienA)CallB)CauseC)CopeD)Concern5.Anurseneedstoobtaininformedconsentfromadeafpatientbeforeaspinaltapprocedureiperformed.Whichofthefollowingwouldbethebestmethodforthenursetousetoensureeffectivecommunication?A)Explaintheprocedureverbally,speakingslowlysothatthepatientcanreadlips.B)Haveatrainedoralinterpreterinterpretforthenurse.C)Havethepatientcarefullyreadaprintedcopyoftheinformedconsentdocument.D)Usediagramstoexplaintothepatientthedetailsoftheprocedure.6.Anurseisexplainingtoapatienthowradiationtherapyworkstokillcancercells.Shebeginexplaininghowtherearedifferenttypesofcellsinthebodythatreproduceatdifferentratesthenexplainswhatcancercellsareandhowtheyreproduce.Finally,sheexplainshowradiatherapyuniquelytargetscancercells.ThisapproachtakesadvantageofwhichdomainofleaA)AffectiveB)PsychomotorC)CognitiveD)Demonstration/returndemonstration7.Ayoungmanisrecoveringfromanaphylacticshockcausedbyabeesting.Thenurseistryiinstructthepatientonhowtouseanepinephrineautoinjector(EpiPen),butthepatientseemuninterestedinlearning.ThenursethenexplainshowhavingtheEpiPenwithhimatalltimknowinghowtouseitcouldnotonlysavehislifesomedaybutalsowillgivehimagreaterofsecurityandsafety.Whichadultlearningprincipleisthenurseusing?SelectallthatapplA)Thelearner’sself-conceptB)Thelearner’slifeexperienceC)ReadinesstolearnD)Motivationtolearn

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E)Theneedtoknow8.Inattemptingtoteachapatienthowtocleanaroundthesurgicalsuturesonhisabdomenupodischargetohome,thenursedeterminesthatapplyingtheprincipleofthelearner’sself-conwouldbemosteffectivewiththispatient.Whichofthefollowingisthebestexampleofanapplicationofthatprincipleinthissituation?A)RelatingtothepatientastoryaboutanotherpatientwhofailedtoproperlycleanhissuandtheoutcomeB)ExplainingthatfailuretoproperlycleanaroundthesuturesitecouldresultinseriousinfectionC)CommentingthatlearningtoproperlycleanhissuturesitecouldgivethemanskillsthwouldbetterpreparehimforacareerinhealthcareD)Mentioningtothepatientthat,ifhewouldprefer,hecanwatchavideoonthehospitawebsiteonhowtocleanaroundasuturesite9.AnurseneedstoexplaintoapatientaboutthepossiblesideeffectsthepatientmayexperienrelatedtothepainmedicationsheisnowbeginningwhileintheICUandwhichshewillbecontinuingupondischarge.Whichmethodwouldbethemosteffectivewaytoteachthistopatient?A)Inaplannedteachingsession,inwhichthenursecoversmedication-relatedsideeffecdietaryrestrictions,andactivityrestrictionsB)ViaabrochurethatthepatientcantakewithherondischargeC)BybrieflyexplainingthesideeffectswhileadministeringthemedicationtothepatienD)Byrelatingastoryaboutanotherpatientwhohadasevereadversereactiontothisme10.Anurseneedstoevaluateapatient’sunderstandingofhowtoadministeranIVmedicationhome.Whichofthefollowingwouldbethebestmethodforevaluation?A)ThenurseexplainingtheproceduretothepatientandfamilyusingdiagramsB)ThenursehavingthepatientandfamilymembersdemonstratetheprocedurethemseC)ThenurseexplainingtheprocedurewhileperformingitonthepatientD)Thenursereferringthepatienttoacomputer-basededucationallibrarythathasaninteractiveprogram11.Teachingpatientsandfamiliesisanimportantpartofcriticalcarenursing.Whatfactorincriticalcareunitisabarriertothiseducationfunction?A)LargenumbersofinexperiencednursesB)SeriousillnessofpatientsC)Increasedcomputersupport

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D)Useofspecialtyeducators12.Thenurseiscaringforacriticallyillpatient.Onthepreviousshift,anursedocumented“toteachduetocriticalillness.”Whatisthebestnursingactionbythecurrentnursetoaddthepatient’steachingandlearningneeds?A)Realizethatthepatientistooilltoacceptteachingatthistime.B)Lookforopportunitiesforteaching,suchaprocedureexplanation.C)Focusallteachingeffortsonthefamilytotheexclusionofthepatient.D)Altertheplanofcaretodelayteachinguntiltransfertostep-downunit.13.Afterseveralweeks,acriticallyillpatienthasprogressedwellandisbeingtransferredtoadownunit.Whatnormalpatientresponsedoesthenurseanticipate?A)ReliefB)ThankfulnessC)AnxietyD)Indifference14.Thenurseisteachingapatientandfamilyinthepatient’scriticalcareroom.Thecriticalcisbusyandnoisy.Whatnursingactionwillbestenhancelearning?A)Explainthematerialsimplyusingsimpleterms.B)Giveallexplanationsviacommercialteachingbrochures.C)Closethedoortothepatient’sroom.D)Askthefamilynottointerruptwithquestions.15.ThenurseisteachingapatientwhoisnotanativeEnglishspeaker.Asthenursegivescomexplanations,thepatientnodsandsmiles.Whatisthebestnursinginterventiontoensurepunderstanding?A)Assumethatthepatient’snodsindicateunderstanding.B)Askafamilymembertointerprettothepatient.C)Usepictureswheneverpossibleintheteaching.D)Askthepatienttorestatetheinformationconveyed.16.Thenurseisteachingapatientnewlydiagnosedwithdiabetesmellitushowtomanageaslscaleinsulinprotocol.Whatportionofthisinteractionindicatespatientlearning?A)TheslidingscaleinsulinprotocolB)Patient’squestionstothenurseC)Nurse’sdemonstrationofuseoftheprotocol

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D)Patient’sverbalizationofaflashofinsight17.Whenteachingapatientandfamily,thenursewishestousetheaffectivedomainoflearniWhatnursingactionismostlikelytoinvolvetheaffectivedomain?A)PresentingfactsfromsimpletocomplexB)GivingcleardirectionsaboutwhentocallthephysicianC)UsinganonthreateningapproachD)Usingdemonstration/redemonstrationapproach18.Thenurseisteachingapatientnewlydiagnosedwithdiabetesmellitushowtoinjectinsulichoosestouseademonstration/redemonstrationtechnique.Whatdomainoflearningisthechieflyusing?A)CognitiveB)AffectiveC)PsychomotorD)Educative19.Thenurseisteachingapatientnewlydiagnosedwithcardiovasculardiseasehowtoreducefactors.Thenursebeginsbyexplainingwhythisinformationisimportantforthepatient.Wprincipleofadultlearningisthenurseapplying?A)NeedtoknowB)Learner’sself-conceptC)Learner’slifeexperienceD)Motivationtolearn20.Thenurseisteachingagroupofpatientsnewlydiagnosedwithcardiovasculardisease.Whactiondemonstratesapplicationoftheadultlearningprincipleoflearner’slifeexperience?A)BeginningwithanexplanationofwhythematerialisimportantB)Creatingalearningsituationthatisself-directedandindependentC)Usingcasescenariosandproblem-solvingexercisesD)Applyingcontenttoreal-lifesituationsandactions21.Thenurseisassessinglearningbyacriticallyillpatientandfamily.Whatisthebestmethoassessment?A)WrittentestB)SpecificquestionsC)Open-endedquestions

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D)LiteracyassessmentAnswer Key1.B,E2.D3.A4.A5.B6.C7.D,E8.D9.C10.B11.A12.B13.C14.C15.D16.D17.C18.C19.A20.C21.CPage 1Chapter 5-Relieving Pain and ProvidingComfort1.ApatientisintheICUaftersufferingmultipletraumafromacarwreckthatoccurred24hoThepatientfeelspainfrommanysources,includinglacerationsonthearm,afracturedfemutensionheadachefromthestressoftheaccident,lowerbackpainfromasportsinjury30ye

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nasalirritationfromanendotrachealtube,andjointachesfromongoingarthritis.Thenurserecognizeswhichofthefollowingasthemostlikelyinstancesofchronicpain?Selectallthaapply.A)LacerationsonarmB)FracturedfemurC)TensionheadacheD)LowerbackpainfromoldsportsinjuryE)IrritationinthroatfromendotrachealtubeF)Arthritisinjoints2.ANepalimanisintheICUrecoveringfromspinalsurgerytoremoveamalignanttumor.HnotspeakEnglish,andstrugglestocommunicatewiththenursebyusinghandmotions.Hisisconstantlyathisbedside,speakingwithhiminNepalese.Frequently,heputsonheadpholistenstomusiconhisMP3player.Hiswifeoccasionallymassageshisfeet.Whichofthefollowingfactorsismostlikelyexacerbatingthispatient’spain?A)InabilitytocommunicatewiththenurseB)ConstantpresenceofhisfamilyC)ListeningtomusicD)Hiswifemassaginghisfeet3.AnurseiscaringforapatientintheICUwhoisrecoveringfromcoronaryarterybypassgrasurgery.Overthecourseofthenextfewdays,thenursewillberesponsibleforchangingadoverthesurgicalincisionsite,havingthepatientchangepositionsinbed,assistingwithtracsuctioning,andassistingwithdrainremoval.Thenurseshouldanticipatethatthepatientwilikelyperceivepainresultingfromtheseproceduresinwhichorder,fromleastpainfultomoA)Changingthedressing,positionchangeinbed,trachealsuctioning,drainremovalB)Positionchangeinbed,changingthedressing,drainremoval,trachealsuctioningC)Drainremoval,trachealsuctioning,positionchangeinbed,changingthedressingD)Trachealsuctioning,positionchangeinbed,changingthedressing,drainremoval4.ApatientintheICUisreceivingintravenousopioidanalgesiafollowingmyocardialinfarctiDespitereceivingcontinuousinfusionoftheopioid,thepatientisgrimacingandasksforanincreaseinthemedicationlevel.Consultingthemedicalchart,thenurserecognizesthatthishasahistoryofopioidaddiction.Whatwouldbethemostappropriateintervention?A)ImmediatelytakethepatientoffoftheopioidandgivehimTylenol.B)Leavethepatientontheopioidatthecurrentdoselevel.C)Increasethedoseofopioidtoprovidemoreeffectivepainrelief.

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D)Reducethedoseofopioidandoffertoturnonthetelevisionasadistractionfromthe5.ApatientwithnohistoryofopioidabuseisreceivingopioidanalgesiaintravenouslyintheIseverepainfromextensivethird-degreeburns.Thepatientandhisfamilyareconcernedabolikelihoodofdevelopinganaddictiontothemedication.Whatwouldbethebestresponseopartofthenurse?A)StoptheopioidinfusionimmediatelyanduseonlynonpharmacologicalmeansofanalB)Begintaperingoffthemedicationgradually.C)Explainthattheriskforaddictionislowandthatopioidsarenecessaryforthepatientofpain.D)Explainthataddictionislikelybutcannotbeavoidedandsuggestarehabilitationprogfollowingdischarge.6.AnurseisworkingwithanelderlypatientwithAlzheimer’sdiseaseandcongestiveheartfatheICU.Whichofthefollowingmethodsofpainassessmentwouldbeessentialtoincludeisituation,accordingtotheAmericanGeriatricSociety?A)Noassessmentisappropriate;thepatientshouldbestartedonastandardizedprotocolanalgesiaforAlzheimer’spatientsB)TheverbalzerototenscaleC)TheworddescriptorscaleD)Assessmentofbehaviorandfamilyobservations7.ApatientintheICUwithrenaldysfunctionistobeginreceivingintravenousopioidsandanonsteroidalanti-inflammatorydrug(NSAID)forseverepain.Themedicationisexpectedtadministeredforatleastsevendays.WhichNSAIDwouldbemostappropriateforthispatieSelectallthatapply.A)Ketorolac(Toradol)B)Indomethacin(Indocin)C)Celecoxib(Celebrex)D)Rofecoxib(Vioxx)8.Anurseisworkingwithacancerpatientwhohaschronicpainrelatedtoherillness.Thenurmustadministerfentanyltothepatientintheformofatransdermalpatch.Whichofthefollshouldthenursedoinadministeringthismedication?A)Uselotiontopreparetheskinwherethepatchwillbeapplied.B)Weargloveswhenhandlingthepatch.C)Applythepatchoverawoundorabrasion,ifpossible,tomaximizeabsorption.D)Leaveoldpatchesonthepatient’sbedsidetableforthedoctortoexaminelater.

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9.ApatientintheICUisreceivinganintravenousopioidinfusionforpain,butisexperiencinganxietyduetobeingonmechanicalventilation.Thephysicianhasdecidedtoprescribeasedforthepatient.Thepatient’shealthhistoryindicatesanallergytosoyproducts.Whichsedashouldbeavoidedinthissituation?A)PropofolB)MidazolomC)DiazepamD)Lorazepam10.AnelderlypatientintheICUisreceivingintravenousopioidanalgesiaforpain.Thenurseobservesthatthepatient’srespiratoryratehasdecreasedto8breathsperminute.Whichnuinterventionwouldbemostappropriate?A)Administernaloxoneintravenouslyveryslowly.B)Administerdiazepamimmediately.C)Increasethedoseofopioid.D)Massagethepatient’sfeettostimulateherbreathing.11.Thenurseiscaringforanotherwisehealthyvictimofamotorvehiclecrashwhoisexperieconsiderablepain.Whatfactorindicatesthatthepatientmaybeexperiencingacutepain?A)Itisassociatedwithanacuteandsevereinjury.B)Itisexpectedtoresolveastheinjuryheals.C)Itrequirestreatmentwithintravenousopioids.D)Nochronicillnesseshavebeendiagnosed.12.Thenurseiscaringforacriticallyillpatientwhohasexperiencedmultipletrauma.Thepahashighlevelsofpainfromtheinjuryandisreceivinganintravenousopioidastreatment.managingthepatient’spain,whatnursingactionbestdemonstratesunderstandingofotherthatexacerbatepaininthecriticallyillpatient?A)Providesupportivecarewithoutdiscussingitwiththepatient.B)Limitvisitstoimmediatefamilyforafewminutesatatime.C)Minimizecaretasksduringnormalhoursofsleep.D)Givehigherdosesofintravenousopioidasneeded.13.Beforeturningandrepositioningacriticallyillpatient,thenurseensuresthatapainmedicadministered.Thisactiondemonstratesthenurse’sunderstandingofwhatphenomenon?A)ResearchhasshownthatcriticallyillpatientsperceiveturningasapainfulprocedureB)Thepatientisorderedtoreceivepainmedicationevery4to6hours.

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C)Thispatientbecomesverystiffwhenturnedandthemedicationwillberelaxing.D)Thenurseisnotconcernedthatthispatientwillbecomeaddictedtothemedication.14.Thepatientisscheduledforapainfulprocedure.Inadditiontopremedicatingthepatientwopioiddrug,whatothernursingactionismostlikelytoalleviatethepain?A)Giveintravenousmidazolam(Versed).B)Monitorvitalsignsduringtheprocedure.C)Giveexplanationsbeforeandduringtheprocedure.D)Askthefamilytowaitoutsideduringtheprocedure.15.Thenurseiscaringforapatientwhohasrequiredincreasingdosesofopioidstocontrolpaexpressesaconcernthatthepatientisbecomingaddictedtotheopioid.Whatpatientbehavwouldbestsupportthenurse’sconcernaboutaddiction?A)Heneedsmoremedicationtocontrolpain.B)Hehaswithdrawalsymptomswhenthemedicationisstopped.C)Hestatesthathedislikestheopioidasitmakeshimfeeldrugged.D)Heasksforanotherdoseoftheopioidtorelieveanxietyandgeta“ buzz.”16.Thenurseiscaringforacriticallyillpatientwhohasdevelopedtolerancetoanopioidmedusedforpaincontrol.Asthedoseoftheopioidisincreased,thenurseobservesthepatientforrespiratorydepression.Ifthepatienthasdevelopedtolerancetotheopioid,whateffectrespiratorysystemdoesthenurseexpect?A)NoneB)DepressionC)StimulationD)Exacerbation17.Thenurseiscaringforacriticallyillpatientwithseriouspainandwishestoconsultnationguidelines.Whatisthemostcomprehensivesourceforpainmanagementguidelines?A)Web-basedNationalGuidelineClearinghouseB)AmericanAssociationofCritical-CareNursesC)SocietyofCriticalCareMedicineD)AgencyforHealthcareResearchandQuality18.Thenurseisdevelopingapolicyandprocedureforpainmanagementinacriticalcareunitonnationalstandards,whatshouldthenurseinclude?A)Painassessmentincriticalcaremustdependonvitalsignmonitoringaspatientsareverbal.

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B)Continuousintravenousopioidsarepreferredoveras-neededdosing.C)Intravenoussedationofagitatedpatientstakespriorityoverpaincontrol.D)Paincontrolisanindependentnursingfunctionandresponsibility.19.Accordingtonationalstandards,painincriticallyillpatientsshouldbeassessedatregularintervalsusingavarietyofmethods.Whatstatementaboutpainassessmentistrue?A)Absenceofphysicalsignsorbehaviorsisequivalenttoabsenceofpain.B)Manyofthefactorsincriticalcarecombinetoinvalidatepatientself-reportofpain.C)Behavioralobservationandphysiologicalparametersshouldbeconsideredalongwipatient’sreport.D)Thefamilyhasamoreaccurateassessmentofpainthanthepatient.20.Thenurseisadministeringanintravenousopioidtomanageapatient’spain.Whatcriterianurseusetodeterminetheadequacyoftherapy?A)Minuteventilationissomewhatcompromised.B)Patientratespainbelow5onscaleof1to10.C)Minuteventilationisminimallycompromised.D)Patientratespainbelowownpredeterminedgoal.21.Aseverelyillcriticalcarepatientisreceivingintravenousopioidsforpainmanagement.Tphysicianaddsanonsteroidalanti-inflammatorydrug(NSAID)tothepatient’splanofcarnurseunderstandsthatthemostsignificantadvantageofaddingthisdrugiswhat?A)NSAIDsarecheaperthanopioidswhileprovidingthesamepainrelief.B)Inhibitionofprostaglandinandhistamineatthesiteofinjurywillrelievepainwithousedation.C)NSAIDsareavailablewithoutprescription.D)AddictionandphysicaldependencearelessofaproblemwithNSAIDs.22.Acriticallyillpatientisreceivingacetaminophen(Tylenol)incombinationwithopioidsfomanagement.UnderwhatcircumstanceswouldthenursequestiontheuseofacetaminopheA)NormalliverfunctiontestsB)LowplateletlevelsC)RelativehypothermiaD)Reducedpainlevels23.Thenurseiscaringforacriticallyillpatientwithhighlevelsofpain.Topotentiatepharmacologicalpainrelief,thenurseusesseveralnonpharmacologicalinterventions.Whnursingstrategieswillbehelpfulinthissituation?Selectallthatapply.

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A)FrequentturningandrepositioningB)Earphoneswithmusicofthepatient’schoiceC)LimitingvisitstotwiceadayD)UsingguidedimageryanddistractionE)TeachingthequietingreflexF)UsingtherapeutictouchAnswer Key1.D,F2.A3.A4.C5.C6.D7.C,D8.B9.A10.A11.B12.C13.A14.C15.D16.A17.A18.B19.C20.D21.B22.C23.B,D,E,F

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