Test Bank for Understanding the Essentials of Critical Care Nursing 3rd Edition by Perrin

1) The nurse reviews assessment data on a group of patients. Which patient should the nurse identify as experiencing a critical illness?

A)  Acute bronchospasm with VS: BP 100/60, P 124, R 32

B)   Chronic airflow limitation with VS: BP 110/72, P 110, R 16

C)   Motor vehicle crash with VS: BP 124/74, P 74, R 18

D)  Chronic renal failure on hemodialysis with no urine output with VS: BP 98/50, P 108, R 12

1)

2) Which patient should the nurse expect to be transferred to a critical care unit? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.

A)  New onset of acute decompensated heart failure

B)   Treatment for bacteremia from an infected foot wound

C)   Experiences an acetaminophen overdose

D)  Diagnosed with an acute mental illnessE) Receiving treatment for chronic renal failure

2)

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

A) Level I B) Level II

C)   Level III

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

3)

4) With which individuals should the nurse expect to provide patient care in an "open" ICU?

A)  Physician in charge of patient care who is a specialist in critical care

B)   Multidisciplinary team with physicians who are also responsible for patients on other units

C)   Multidisciplinary team that includes a physician employed by the hospital

D)  Primary care physician who must consult a critical care specialist

4)

5) What should the nurse who provides care to patients in a critical care unit realize the role of technology is on the amount of errors?

A)  It relies heavily on human decision making.

B)   There is uniform equipment throughout each facility.

C)   Devices are programmed to function without double checks.

D)  It makes the workload seem overwhelming to health care providers.

5)

6) What should the nurse identify as an example of an installed forcing function or a system-level firewall to prevent errors when providing patient care?

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

B)   Undiluted potassium chloride is not available on critical care units.

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

D)  All medications are checked by two nurses prior to administration.

6)

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

A)  Decreased therapeutic nurse-patient communication

B)   Improved overall patient satisfaction with care

C)   Decreased risk of errors in patient care

D)  Improved patient safety across the entire spectrum

7)

8) 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?

            A) Simplifying key processes                                            B) Standardizing key processes

            C) Utilizing constraints                                                      D) Avoiding reliance on vigilance

8)

9) Which actions should the nurse complete after realizing that an incorrect dose of medication has been administered to a patient? Select all that apply.

Note: Credit will be given only if all correct choices and no incorrect choices are selected. A) Document the error.

B)   Notify the patient and family.

C)   Notify the physician.

D)  Prepare for an analysis of the error.

E)   Keep the notification of the error silent.

9)

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

A)  Staff nurse competency is matched with patient needs.

B)   Patient care is delivered within a "closed unit" model.

C)   Highly qualified nurses care for patients in highly technical settings.

D)  Nurses agree to work overtime to cover unit staffing needs.

10)

11) Which actions by the critical care nurse demonstrate an understanding of patient advocacy? Select all that apply.

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

A) Encouraging and supporting a patient's spouse in preparing for a family meeting B) Alerting the physician to concerns about client placement after hospitalization

C)   Maintaining attendance at the bedside with the patient during a physician visit

D)  Seeing the big picture when planning patient care

E)   Assisting and supporting the patient and family as they reveal their needs

11)

12) 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?

            A) "I would like you to…"                                                  B) "The patient's immediate history is…"

            C) "I am concerned about…"                                            D) "I think the problem is…"

12)

13) Which statement should the nurse include for "A-Assessment" in the SBAR technique for communication?

            A) "The patient's treatments are…"                                 B) "The patient's vital signs are…"

            C) "I would like you to…"                                                  D) "I think the problem is…"

13)

14) Which statement should the nurse use when concluding SBAR communication about a patient issue?

           A) "The patient's immediate history is…"                     B) "I am requesting that you…"

            C) "I have assessed the patient personally."                D) "The patient's physical findings are…"

14)

15) The nurse collaborates with other members of the health care team to effect optimal outcomes in patient care. Which characteristics of emotional maturity is the nurse using? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.

A)  Being a lifelong learner

B)   Maintaining current skills

C)   Willing to take responsibility for failures

D)  Actively identifying best practicesE) Overlooking one's own shortcomings

15)

16) Which informal power bases should the nurse use in the health care setting? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.

A) Information B) Goodwill

C)   Expertise

D)  Collaboration

E)   Observation

16)

22) What is associated with moral distress in critical care nurses? Select all that apply.

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

A) Providing aggressive care to patients who cannot benefit B) Knowing the right thing to do but not being able to do it

C)   Leaving employment as a critical care nurse

D)  Having no voice in clinical decision making

E)   Realizing that nurses maintain power in bedside decision making

22)

23) What might occur when a nurse employs conscientious refusal to participate? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.

A) Support from nursing administrators B) Support by the patient

C)   Employer sanctions

D)  Dismissal from a nursing position

E)   Protection from the state boards of nursing

23)

24) Which symptoms indicate a nurse is experiencing compassion fatigue? Select all that apply.

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

A) Decreased functioning in nonprofessional situations B) Dreads working with certain types of patients

C)   Having a completely laissez-faire attitude

D)  Excessively high tolerance for frustrationE) Difficulty separating work from personal life

24)

25) 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? Select all that apply.

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

A)  Burns over 50% of total body surface

B)   Reattachment of a traumatic amputation of the left leg

C)   Exacerbation of heart failure

D)  Wound infectionE) Kidney transplant

25)

26) 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? Select all that apply.

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

B)   Social worker

C)   Respiratory therapist

D)  Pharmacist

E)   Attending physician

26)

27) The critical care nurse is identifying patients at risk for safety and medical errors. Which patients should the nurse identify as being at risk for these issues? Select all that apply.

27)

28) The nurse manager of a critical care unit is explaining the AACN Synergy Model to the critical care nurses. What should the manager include as basic parts of this model? Select all that apply.

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

A)  Reduction of cost to provide critical care services to patients

B)   Based on the competencies of the nurses

C)   The nurses' assessment of patient outcomes will be measured

D)  Based on the patients' characteristics

E)   Patient outcomes will be measured

28)

29) 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? Select all that apply.

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

A)  Encourages patient families to discuss issues with the physician

B)   Telling the next shift that a patient needs help with understanding instructions

C)   Approaches patient care by looking at the "big picture"

D)  Seeks out research studies to update protocols

E)   Ensures family members are comfortable when visiting critical care patients

29)

30) What would be appropriate reasons for an intensive care unit intensivist to call a huddle? Select all that apply.

Note: Credit will be given only if all correct choices and no incorrect choices are selected. A) Make care providers aware of a change in a patient's situation.

B)   Plan care for the shift.

C)   Discuss concerns about a patient's status or care.

D)  Communicate a critical issue about a patient.

E)   Make an assignment change.

30)

31) 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. Which steps will the manager take? Select all that apply.

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

            A) Assert                       B) Affirm                     C) Ask                          D) Assess                      E) Act

31)

32) The critical care nurse is experiencing psychologic symptoms of compassion fatigue. What strategies should the nurse use to enhance psychological well-being? Select all that apply.

Note: Credit will be given only if all correct choices and no incorrect choices are selected. A) Practice yoga for relaxation.

B)   Make time for recreational activities.

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

D)  Darken the room and limit activities before sleep.

E)   Monitor food and beverage intake.

32)

33) The nurse manager is planning the staffing budget for the next fiscal year. What action should the manager take to ensure that staffing is adequate?

A)  Remember that nurses should not work more than 72 hours each week.

B)   Study the results of the organization's staffing evaluation.

C)   Meet with other nurse managers to compare staffing needs.

D)  Review staff competency needs with the director of human resources.

33)

34) The critical care nurse discusses a patient's change in status with the health care provider, pharmacist, and physical therapist. Which QSEN competency is this nurse demonstrating?

            A) Quality improvement                                                     B) Patient-centered care

            C) Evidence-based practice                                              D) Teamwork and collaboration

34)

35) The nurse plans to question a health care provider's choice of medication for a critically ill patient.

Which statement demonstrates assertive communication?

A)  "I learned that this medication might not be effective with this health problem. Would youexplain choosing it?"

B)   "I realize I am only a nurse, but I can read and I learned that this medication is a poor choiceto treat this medical problem."

C)   "At times I think it would be wise to update the prescribing references that are used."

D)  "This patient is getting worse, and it is because someone prescribed an antiquated medicationto treat the problem."

35)

36) The adult daughter of a client with end-stage kidney disease informs the health care provider that all interventions are to be provided even though the client is heard telling the spouse that "enough is enough." What should be done first when analyzing this situation? A) Calculate the expense of providing care to the client.

B)   Identify significant information.

C)   Estimate the resources needed for care.

D)  Determine the decision maker for the client.

36)

37) The nurse manager reviews the standards of self-care for caregivers during a staff meeting. Which staff nurse comment indicates that teaching about the standards has been effective?

A)  "I do love to read, but at times I review the events of the day and I'm distracted."

B)   "Going to the zoo with my nephew might be a good idea if I'm not needed for overtime."

C)   "I will consider yoga classes."

D)  "I will play tennis with my sister at least twice a week."

37)