Perrin, Understanding the Essentials of Critical Care Nursing, 2/e

Type: MCSA

Which patient would the nurse identify as experiencing a critical illness? The patient:

1. With chronic airflow limitation whose VS are BP 110/72, P 110, R 16

2. With acute bronchospasm and whose VS are BP 100/60, P 124, R 32

3. Who was involved in a motor vehicle crash whose VS are BP 124/74, P 74, R 18

4. On hemodialysis for chronic renal failure with no urine output and whose VS are BP 98/50, P 108, R 12

Correct Answer: 2

Rationale 1: The blood pressure and respiratory rate are considered within normal limits. The heart rate is slightly elevated. Based upon these vital signs, this patient is not critically ill.

Rationale 2: Acute bronchospasm can present a life-threatening situation, which can jeopardize a patient’s survival. The patient’s pulse and respiratory rate are elevated, which could indicate a critical illness.

Rationale 3: According to the vital signs, this patient is not critically ill despite being in a motor vehicle crash.

Rationale 4: The patient on receiving hemodialysis for chronic renal failure is not considered critically ill unless another disease process or health issue develops. The patient’s vital signs are consistent with someone with chronic renal failure.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1-1: Define critical care.

Question 2

Type: MCMA

Of the following patients, which will the nurse expect to be transferred to a critical care unit? The patient:

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. With an acetaminophen overdose

2. Suffering from acute mental illness

3. With chronic renal failure

4. With acute decompensated heart failure

5. With bacteremia from an infected foot wound

Correct Answer: 1,4,5

Rationale 1: Critical care units are cost-efficient units for caring for patients with specific organ system failure. Patients with acetaminophen overdose often suffer liver failure as a consequence.

Rationale 2: A patient with acute mental illness would not receive care in a critical care unit. This health problem would be considered noncritical.

Rationale 3: Even though critical care units are cost-efficient units for caring for patients with specific organ system failure, chronic renal failure is not a disease process necessitating the critical care environment.

Rationale 4: The patient with acute decompensated heart failure would receive care in a critical care unit. This patient has a specific organ that has failed.

Rationale 5: Bacteremia can affect many organs and lead to multisystem organ failure. This patient would receive care in a critical care unit.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1-1: Define critical care.

Question 3

Type: MCSA

The nurse, employed in a hospital in a small rural town, would expect to provide which level of care in the critical care unit?

1. Level I

2. Level II

3. Level III

4. It is unlikely that the hospital would have a critical care unit.

Correct Answer: 3

Rationale 1: This level of care is provided most likely within teaching hospitals and not in a rural facility.

Rationale 2: This level is able to provide comprehensive critical care for most disorders but the unit may not be able to care for specific types of patients. It is unlikely that this level of care would be available in a small rural facility.

Rationale 3: Level III facilities provide initial stabilization of critically ill patients but limited ability to provide comprehensive critical care. A limited number of patients who require routine care may remain in the facility but written policies should be in place determining which patients require transfer and where they ought to be transferred. This level of care is most likely provided in a small rural facility.

Rationale 4: Most hospitals have some level of critical care area.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1-2: State the three levels of care provided in critical care units.

Question 4

Type: MCSA

The nurse, providing patient care in an “open” ICU, would most likely be working with a:

1. Multidisciplinary team with physicians who are also responsible for patients on other units

2. Multidisciplinary team that includes a physician employed by the hospital

3. Physician in charge of patient care who is a specialist in critical care

4. Primary care physician who must consult a critical care specialist

Correct Answer: 1

Rationale 1: In an open ICU, nurses, pharmacists, and respiratory therapists are ICU based but the physicians directing patient care may have other obligations. These physicians may or may not choose to consult an intensivist to assist with the management of their ICU patients.

Rationale 2: This does not describe an open ICU.

Rationale 3: This does not describe an open ICU.

Rationale 4: This does not describe an open ICU.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1-3: Compare and contrast “open” and “closed” critical care units.

Question 5

Type: MCSA

The nurse, providing care to patients in a critical care unit, realizes that technology increases the likelihood of errors when:

1. It relies heavily on human decision making.

2. Devices are programmed to function without double checks.

3. It makes the workload seem overwhelming to health care providers.

4. There is uniform equipment throughout each facility.

Correct Answer: 2

Rationale 1: This is not identified as increasing the likelihood of errors in the critical care unit.

Rationale 2: Technology changes the tasks people do by shifting the workload and eliminating human decision making.

Rationale 3: This is not identified as increasing the likelihood of errors in the critical care unit.

Rationale 4: This is not identified as increasing the likelihood of errors in the critical care unit.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1-4: Explain why critical care units are one of the most common sites for health care errors.

Question 6

Type: MCSA

What will the nurse identify as an example of an installed forcing functions or a system level firewall to prevent errors when providing patient care?

1. Prior to administration of insulin, two nurses check the dose.

2. Prior to obtaining a medication, height, weight, and allergies are recorded.

3. All medications are checked by two nurses prior to administration.

4. Undiluted potassium chloride is not available on critical care units.

Correct Answer: 4

Rationale 1: This is not an example of an installed forcing function or a system level firewall.

Rationale 2: This is not an example of an installed forcing function or a system level firewall.

Rationale 3: This is not an example of an installed forcing function or a system level firewall.

Rationale 4: This is an example of an installed forcing function or a system level firewall.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1-4: Explain why critical care units are one of the most common sites for health care errors.

Question 7

Type: MCSA

The nurse realizes that the increased use of technology in critical care units has resulted in which consequence for patient care?

1. Decreased risk of errors in patient care

2. Decreased therapeutic nurse-patient communication

3. Improved overall patient satisfaction with care

4. Improved patient safety across the entire spectrum

Correct Answer: 2

Rationale 1: This has not been demonstrated as an outcome resulting from an increased use of technology in critical care units.

Rationale 2: This has been demonstrated as an outcome resulting from an increased use of technology in critical care units.

Rationale 3: This has not been demonstrated as an outcome resulting from an increased use of technology in critical care units.

Rationale 4: This has not been demonstrated as an outcome resulting from an increased use of technology in critical care units.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 1-4: Explain why critical care units are one of the most common sites for health care errors.

Question 8

Type: MCSA

The nurse in the critical care area is completing a preoperative checklist before sending a patient for surgery. This nurse’s activity is an example of which recommendation issued by the Institute of Medicine?

1. Utilizing constraints

2. Simplifying key processes

3. Avoiding reliance on vigilance

4. Standardizing key processes

Correct Answer: 3

Rationale 1: Completing a preoperative checklist is not an example of utilizing constraints.

Rationale 2: Completing a preoperative checklist is not an example of simplifying key processes.

Rationale 3: Completing a preoperative checklist is an example of avoiding reliance on vigilance.

Rationale 4: Completing a preoperative checklist is not an example of standardizing key processes.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1-4: Explain why critical care units are one of the most common sites for health care errors.

Question 9

Type: MCMA

Which actions should the nurse complete after realizing that an incorrect dose of medication has been administered to a patient?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Notify the patient and family

2. Notify the physician

3. Document the error

4. Prepare for an analysis of the error

5. Keep the notification of the error silent

Correct Answer: 1,2,3,4

Rationale 1: In a critical care unit that has embraced a culture of safety, practitioners have a responsibility to their patients to make their errors known, have them corrected, and share them with the patient and family.

Rationale 2: In a critical care unit that has embraced a culture of safety, practitioners have a responsibility to their patients to make their errors known, have them corrected, and share them with other practitioners.

Rationale 3: In a critical care unit that has embraced a culture of safety and practice, improvement is a goal rather than punishment. The reporting of errors results in the examination of the factors that contributed to the error and changes practice patterns.

Rationale 4: In a critical care unit that has embraced a culture of safety and practice, improvement is a goal rather than punishment. The reporting of errors results in the examination of the factors that contributed to the error and changes practice patterns.

Rationale 5: Withholding information about a medication error is not creating a culture of safety.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1-4: Explain why critical care units are one of the most common sites for health care errors.

Question 10

Type: MCSA

The nurse working within the AACN Synergy Model realizes that optimal patient outcomes are realized when:

1. Highly qualified nurses care for patients in highly technical settings.

2. Nurses agree to work overtime to cover unit staffing needs.

3. Staff nurse competency is matched with patient needs.

4. Patient care is delivered within a “closed unit” model.

Correct Answer: 3

Rationale 1: The AACN Synergy Model does not state that nurses need to be highly qualified to care for patients in highly technical settings.

Rationale 2: The AACN Synergy Model does not state that nurses agree to work overtime to cover unit staffing needs.

Rationale 3: The underlying assumption of the Synergy Model is that optimal patient outcomes occur when the needs of the patient and family are matched with the competencies of the nurse.

Rationale 4: The AACN Synergy Model does not state the type of care area in which patient care is to be delivered.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1-5: Describe the relationship between the patient and the nurse in the AACN’s Synergy Model.

Question 11

Type: MCMA

The competent critical care nurse demonstrates an understanding of patient advocacy by taking which actions?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Maintaining attendance at the bedside with the patient during a physician visit

2. Assisting and supporting the patient and family as they reveal their needs

3. Alerting the physician to concerns about client placement after hospitalization

4. Encouraging and supporting a patient’s spouse in preparing for a family meeting

5. Seeing the big picture when planning patient care

Correct Answer: 1,2,3,4

Rationale 1: The nurse realizes that the patient may be vulnerable and need support to obtain what is needed from the health care system.

Rationale 2: The nurse realizes that the patient may be vulnerable and need support to obtain what is needed from the health care system.

Rationale 3: The nurse realizes that the patient may be vulnerable and need support to obtain what is needed from the health care system.

Rationale 4: The nurse realizes that the patient may be vulnerable and need support to obtain what is needed from the health care system.

Rationale 5: This is not demonstrating patient advocacy.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1-5: Describe the relationship between the patient and the nurse in the AACN’s Synergy Model.

Question 12

Type: MCSA

A nurse is preparing to communicate an issue about patient care to a physician using the SBAR technique. Which phrase is an appropriate initial statement?

1. “I am concerned about…”

2. “The patient’s immediate history is…”

3. “I think the problem is…”

4. “I would like you to …”

Correct Answer: 1

Rationale 1: This is an appropriate initial statement using the SBAR technique.

Rationale 2: This is not an appropriate initial statement using the SBAR technique.

Rationale 3: This is not an appropriate initial statement using the SBAR technique.

Rationale 4: This is not an appropriate initial statement using the SBAR technique.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1-7 Describe ways to enhance communication and collaboration among members of the health care team.

Question 13

Type: MCSA

The nurse includes which statement for “A – Assessment” in the SBAR technique for communication?

1. “I think the problem is…”

2. “The patient’s vital signs are…”

3. “The patient’s treatments are…”

4. “I would like you to…”

Correct Answer: 1

Rationale 1: This is an appropriate statement for assessment using the SBAR technique for communication.

Rationale 2: This is not an appropriate statement for assessment using the SBAR technique for communication.

Rationale 3: This is not an appropriate statement for assessment using the SBAR technique for communication.

Rationale 4: This is not an appropriate statement for assessment using the SBAR technique for communication.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1-7: Describe ways to enhance communications and collaboration among members of the health care team.

Question 14

Type: MCSA

When concluding SBAR communication about a patient issue, the nurse will use which statement?

1. “The patient’s immediate history is…”

2. “The patient’s physical findings are…”

3. “I am requesting that you…”

4. “I have assessed the patient personally.”

Correct Answer: 3

Rationale 1: This statement would not be used when concluding SBAR communication.

Rationale 2: This statement would not be used when concluding SBAR communication.

Rationale 3: This statement would be used when concluding SBAR communication.

Rationale 4: This statement would not be used when concluding SBAR communication.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1-7: Describe ways to enhance communications and collaboration among members of the health care team.

Question 15

Type: MCMA

In order to collaborate with other members of the health care team to effect optimal outcomes in patient care, the nurse utilizes the characteristics of emotional maturity which include:

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Maintaining current skills

2. Being a lifelong learner

3. Actively identifying best practices

4. Overlooking one’s own shortcomings

5. Willing to take responsibility for failures

Correct Answer: 1,2,3,5

Rationale 1: This is an attribute of emotional maturity in nursing.

Rationale 2: This is an attribute of emotional maturity in nursing.

Rationale 3: This is an attribute of emotional maturity in nursing.

Rationale 4: This is not an attribute of emotional maturity in nursing.

Rationale 5: This is an attribute of emotional maturity in nursing.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1-7: Describe ways to enhance communications and collaboration among members of the health care team.

Question 16

Type: MCMA

Which informal power bases will the nurse use in the health care setting?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Expertise

2. Goodwill

3. Information

4. Observation

5. Collaboration

Correct Answer: 1,2,3

Rationale 1: Expertise is an informal power base.

Rationale 2: Goodwill is an informal power base.

Rationale 3: Information is an informal power base.

Rationale 4: Observation, although important, is not an informal power base.

Rationale 5: Collaboration is not an informal power base.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1-7: Describe ways to enhance communications and collaboration among members of the health care team.

Question 17

Type: MCSA

The nurse caring for a patient would ensure that the patient has consented to care by providing what to the patient?

1. A consent form to sign to receive medications

2. A consent form to sign to have dressings changed

3. A consent form to sign to be turned in bed

4. An explanation of a dressing to be changed

Correct Answer: 4

Rationale 1: Consent is usually implied rather than written for routine procedures like most medication administration.

Rationale 2: Consent is usually implied rather than written for routine procedures like dressing changes.

Rationale 3: Consent is usually implied rather than written for routine procedures like turning.

Rationale 4: If the nurse does not ask the patient for consent, the nurse should explain the procedure.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1-8: Explain why some health care providers believe that critically ill patients cannot give informed consent.

Question 18

Type: MCSA

If a nurse forcibly inserts a nasogastric tube against a patient’s wishes, the nurse can be held liable for:

1. Negligence

2. Malpractice

3. Damages

4. Battery

Correct Answer: 4

Rationale 1: Forcibly inserting a nasogastric tube against a patient’s wishes is not negligence.

Rationale 2: Forcibly inserting a nasogastric tube against a patient’s wishes is not malpractice.

Rationale 3: It cannot be determined if forcibly inserting a nasogastric tube against a patient’s wishes will result in damages.

Rationale 4: When the nurse treats or touches a patient without consent, it is battery.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1-8: Explain why some health care providers believe that critically ill patients cannot give informed consent.

Question 19

Type: MCMA

The nurse is aware that decision-making capacity is likely to be impaired for a patient who:

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Is being medicated for severe pain

2. Does not understand the medical condition

3. Has been diagnosed with septic shock

4. Is depressed

5. Asks questions about identified treatments

Correct Answer: 1,2,3,4

Rationale 1: The patient must be capable of rational thought and be able to recognize what the prospective treatment involves.

Rationale 2: Understanding the health condition is one component of informed consent.

Rationale 3: It is common for health care providers and family members to question the decision-making ability of critically ill patients. Many critically ill patients lack the capacity to give informed consent.

Rationale 4: Patients who are depressed may not be capable of thinking clearly.

Rationale 5: Asking questions about identified treatments is not a characteristic of a patient with impaired decision-making ability.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1-8: Explain why some health care providers believe that critically ill patients cannot give informed consent.

Question 20

Type: MCSA

The nurse is aware that restraining a patient is most likely to result in the patient:

1. Pulling out an endotracheal tube

2. Pulling out an intravenous line

3. Disconnecting ventilator tubing

4. Developing a nosocomial infection

Correct Answer: 4

Rationale 1: The use of a restraint will not cause the patient to pull out an endotracheal tube.

Rationale 2: The use of a restraint will not cause the patient to pull out an intravenous line.

Rationale 3: The use of a restraint will not cause the patient to disconnect ventilator tubing.

Rationale 4: When people are restrained, they are more likely to develop nosocomial infections.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Safety and Infection Control

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1-8: Explain why some health care providers believe that critically ill patients cannot give informed consent.

Question 21

Type: MCSA

For a nurse to be found guilty of negligence, it must be demonstrated that the patient:

1. Was assaulted

2. Incurred damages

3. Suffered a wrongful death

4. Was not consulted before being touched

Correct Answer: 2

Rationale 1: Assault does not need to be demonstrated to prove negligence.

Rationale 2: In order to prove negligence, damages must have occurred to the patient.

Rationale 3: Suffering a wrongful death does not need to be demonstrated to prove negligence.

Rationale 4: Consultation before being touched does not need to be demonstrated to prove negligence.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1-8: Explain why some health care providers believe that critically ill patients cannot give informed consent.

Question 22

Type: MCMA

Moral distress among critical care nurses is associated with:

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Having no voice in clinical decision making

2. Providing aggressive care to patients who cannot benefit

3. Realizing that nurses maintain power in bedside decision making

4. Knowing the right thing to do but not being able to do it

5. Leaving employment as a critical care nurse

Correct Answer: 1,2,4,5

Rationale 1: Nurses consistently state that when they do not have a voice in the decision making, they feel powerless, which contributes to moral distress.

Rationale 2: Nurses consistently state that when they cannot find meaning in the patients’ or families’ suffering this contributes to moral distress.

Rationale 3: This will not contribute to moral distress.

Rationale 4: Moral distress is when a nurse knows the right thing to do, yet institutional constraints such as lack of resources or personal authority would prevent the nurse from doing it.

Rationale 5: As many as half of critical care nurses may have left a unit due to moral distress.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 1-9: Analyze why moral distress might be a significant concern for critical care nurses.

Question 23

Type: MCMA

When a nurse employs conscientious refusal to participate, the nurse should be aware that:

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. It may lead to dismissal from a nursing position.

2. Consequences may involve employer sanction.

3. Nursing administrators are largely supportive.

4. State boards of nursing protect the nurse in this situation.

5. The patient will support the nurse’s decision.

Correct Answer: 1,2

Rationale 1: The repercussions for the nurse of employing conscientious refusal may include dismissal from the current nursing position.

Rationale 2: The nurse must also consider the amount of support that will be received from the administration of the institution.

Rationale 3: Institutions vary from being supportive of conscientious refusal and changing their institutional policies to support it, to being legally required by some states to allow nurses to utilize it, to being able to dismiss the nurse who utilizes it.

Rationale 4: Institutions vary from being supportive of conscientious refusal and changing their institutional policies to support it, to being legally required by some states to allow nurses to utilize it, to being able to dismiss the nurse who utilizes it.

Rationale 5: If the patient and family have developed a relationship with the nurse, they may wish the nurse to remain with them beyond the decision-making phase to see the planned action accomplished and to help them cope with the consequences of their decision.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1-10: Prioritize measures that a nurse might utilize to prevent compassion fatigue.

Question 24

Type: MCMA

Which symptoms seen in a nurse would suggest compassion fatigue?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Difficulty separating work from personal life

2. Excessive high tolerance for frustration

3. Having a completely laissez-faire attitude

4. Decreased functioning in nonprofessional situations

5. Dreads working with certain types of patients

Correct Answer: 1,4,5

Rationale 1: This is a symptom of compassion fatigue.

Rationale 2: This is not a symptom of compassion fatigue.

Rationale 3: This is not a symptom of compassion fatigue.

Rationale 4: This is a symptom of compassion fatigue.

Rationale 5: This is a symptom of compassion fatigue.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1-10: Prioritize measures that a nurse might utilize to prevent compassion fatigue.

Question 25

Type: MCMA

The nurse is providing care to patients in a Level II general critical care unit. For which types of patient problems will this nurse most likely provide care?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Exacerbation of heart failure

2. Wound infection

3. Burns over 50% of total body surface

4. Kidney transplant

5. Reattachment of a traumatic amputation of the left leg

Correct Answer: 1,2

Rationale 1: A Level II critical care area is where comprehensive care for most disorders will be provided. Exacerbation of heart failure would not be considered specialized care.

Rationale 2: A Level II critical care area is where comprehensive care for most disorders will be provided. A wound infection would not be considered specialized care.

Rationale 3: A Level II critical care area is where comprehensive care for most disorders will be provided. The unit may not be able to care for specific types of patients and transfer arrangements to Level I facilities must be in place for patients with the specific disorders for which the unit does not provide care such as a burn unit.

Rationale 4: A Level II critical care area is where comprehensive care for most disorders will be provided. The unit may not be able to care for specific types of patients and transfer arrangements to Level I facilities must be in place for patients with the specific disorders for which the unit does not provide care such as a transplant unit.

Rationale 5: A Level II critical care area is where comprehensive care for most disorders will be provided. The unit may not be able to care for specific types of patients and transfer arrangements to Level I facilities must be in place for patients with the specific disorders for which the unit does not provide care such as a trauma unit.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Safety and Infection Control

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1-2: State the three levels of care provided in critical care units.

Question 26

Type: MCMA

A patient is admitted to an “open” intensive care unit. In addition to the nurse, which health care providers will assist in the care of this patient?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Pharmacist

2. Respiratory therapist

3. Attending physician

4. Dietician

5. Social worker

Correct Answer: 1,2,3

Rationale 1: In an open ICU, pharmacists are ICU based.

Rationale 2: In an open ICU, respiratory therapists are ICU based.

Rationale 3: In an open ICU, the physicians directing patient care may have other obligations. These physicians may or may not choose to consult an intensivist to assist with the management of their ICU patients.

Rationale 4: Dieticians are not identified as patient care staff in an open intensive care unit.

Rationale 5: The social worker is not identified as patient care staff in an open intensive care unit.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1-3: Compare and contrast “open” and “closed” critical care units.

Question 27

Type: MCMA

The critical care nurse is identifying patients at risk for safety and medical errors. Which patients would the nurse identify as being at risk for these issues?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Patient in isolation with MRSA

2. Patient who does not understand English

3. Patient with end stage renal disease and a respiratory rate of 8 per minute

4. Patient recovering from pacemaker insertion

5. Patient with pulmonary edema

Correct Answer: 1,2,3

Rationale 1: The most vulnerable of unstable ICU patients who are at highest risk for medical error include patients in isolation.

Rationale 2: The most vulnerable of unstable ICU patients who are at highest risk for medical error include patients with limited English proficiency.

Rationale 3: The most vulnerable of unstable ICU patients who are at highest risk for medical error include patients at end of life.

Rationale 4: Recovering from pacemaker insertion is not identified as being a member of a vulnerable population.

Rationale 5: Being treated for pulmonary edema is not identified as being a member of a vulnerable population.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1-4: Explain why critical care units are one of the most common sites for health care errors.

Question 28

Type: MCMA

The nurse manager of a critical care unit is explaining the AACN Synergy Model to the critical care nurses. What will the manager include as basic parts of this model?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Based on the patients’ characteristics

2. Based on the competencies of the nurses

3. Patient outcomes will be measured

4. The nurses’ assessment of patient outcomes will be measured

5. Reduction of cost to provide critical care services to patients

Correct Answer: 1,2,3,4

Rationale 1: This model is based on the patients’ characteristics.

Rationale 2: This model is based on the nurses’ competencies.

Rationale 3: This model is based on outcomes derived from the patient.

Rationale 4: This model is based on outcomes derived from the nurse.

Rationale 5: Cost reduction strategies are not a part of the AACN Synergy Model.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1-5: Describe the relationship between the patient and the nurse in the AACN’s Synergy Model.

Question 29

Type: MCMA

While completing a self-evaluation, the critical care nurse compares personal practice to the competencies identified by the AACN Synergy Model. Which behaviors are consistent with those in the Synergy Model?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Seeks out research studies to update protocols

2. Approaches patient care by looking at the “big picture”

3. Ensures family members are comfortable when visiting critical care patients

4. Encourages patient families to discuss issues with the physician

5. Telling the next shift that a patient needs help with understanding instructions

Correct Answer: 1,2,3,4

Rationale 1: This behavior demonstrates the competency of clinical inquiry.

Rationale 2: This behavior demonstrates the competency of clinical judgment.

Rationale 3: This behavior demonstrates the competency of caring.

Rationale 4: This behavior demonstrates the competency of advocacy.

Rationale 5: This behavior does not demonstrate an AANC competency for nurses in a critical care area.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1-6: Discuss the competencies of critical care nurses as defined by the Synergy Model.

Question 30

Type: MCMA

What would be appropriate reasons for an Intensive Care Unit intensivist to call a huddle?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Make care providers aware of a change in a patient’s situation.

2. Communicate a critical issue about a patient.

3. Make an assignment change.

4. Discuss concerns about a patient’s status or care.

5. Plan care for the shift.

Correct Answer: 1,2,3,4

Rationale 1: Huddles are used so that team members may regain situation awareness.

Rationale 2: Huddles are used so that team members may discuss critical issues.

Rationale 3: Huddles are used so that team members may assign resources.

Rationale 4: Huddles are used so that team members may express concerns.

Rationale 5: Huddles are not used to plan care for the shift.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1-7: Describe ways to enhance communication and collaboration among members of the health care team.

Question 31

Type: MCMA

The nurse manager, concerned that several staff nurses are experiencing moral distress, is planning to implement the 4 A’s to Rise Above Moral Distress. What are the steps in this tool?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Ask

2. Affirm

3. Assess

4. Act

5. Assert

Correct Answer: 1,2,3,4

Rationale 1: Ask is a step in the 4 A’s to Rise Above Moral Distress tool.

Rationale 2: Affirm is a step in the 4 A’s to Rise Above Moral Distress tool.

Rationale 3: Assess is a step in the 4 A’s to Rise Above Moral Distress tool.

Rationale 4: Act is a step in the 4 A’s to Rise Above Moral Distress tool.

Rationale 5: Assert is not a step in the 4 A’s to Rise Above Moral Distress tool.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1-9: Analyze why moral distress might be a significant concern for critical care nurses.

Question 32

Type: MCMA

The critical care nurse is experiencing psychologic symptoms of compassion fatigue. What strategies will the nurse use to enhance psychological well-being?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Make time for recreational activities.

2. Practice yoga for relaxation.

3. Plan to take a walk in the park at least once a week.

4. Monitor food and beverage intake.

5. Darken the room and limit activities before sleep.

Correct Answer: 1,2,3

Rationale 1: Sustaining a balance between work and play enhances psychological well-being.

Rationale 2: Developing an effective relaxation method enhances psychological well-being.

Rationale 3: Maintaining contact with nature enhances psychological well-being.

Rationale 4: Monitoring food and beverage intake is a strategy to enhance physical well-being.

Rationale 5: Utilizing healthy methods to induce sleep is a strategy to enhance physical well-being.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1-10: Prioritize measures that a nurse might utilize to prevent compassion fatigue.

Perrin, Understanding the Essentials of Critical Care Nursing, 2/e Test Bank

Copyright 2012 by Pearson Education, Inc.