TEST BANK FOR Understanding the Essentials of Critical Nursing Care 2nd Edition By Kathleen Perrin

TEST BANK FOR Understanding the Essentials of Critical Nursing Care 2nd Edition By Kathleen Perrin Chapter 1 What Is Critical Care? 1) Identify who of the following patients suffers from critical illness. A 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 accident whose VS are: BP 124/74, P 74, R 18. 4. On chronic dialysis with no urine output and whose VS are: BP 98/50, P 108, R 12. Answer: 2 Explanation: 1. Acute bronchospasm can present a life-threatening situation, which can jeopardize a patientʹs survival. #1, #3, and #4 are examples of non-life-threatening situations. Nursing Process: Assessment Cognitive Level: Analysis Category of Need: Physiological Integrity–Physiological Adaptation 2. Acute bronchospasm can present a life-threatening situation, which can jeopardize a patientʹs survival. #1, #3, and #4 are examples of non-lifethreatening situations. Nursing Process: Assessment Cognitive Level: Analysis Category of Need: Physiological Integrity–Physiological Adaptation 3. Acute bronchospasm can present a life-threatening situation, which can jeopardize a patientʹs survival. #1, #3, and #4 are examples of non-lifethreatening situations. Nursing Process: Assessment Cognitive Level: Analysis Category of Need: Physiological Integrity–Physiological Adaptation 4. Acute bronchospasm can present a life-threatening situation, which can jeopardize a patientʹs survival. #1, #3, and #4 are examples of non-lifethreatening situations. Nursing Process: Assessment Cognitive Level: Analysis Category of Need: Physiological Integrity–Physiological Adaptation Learning Outcome: 1-1: Define critical care 2) Of the following patients, who should be cared for in a critical care unit? A patient: (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 Answer: 1, 4 Explanation: 1. (Note: This requires multiple responses to be correct.) Critical care units are cost-efficient units for caring for patients with specific organ system failure. Although the organ failing in #4 is obvious, patients with 1 | P a g eacetaminophen overdose often suffer liver failure as a consequence. #2 and #3 present patient concerns of a noncritical nature. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Physiological Integrity–Physiological Adaptation 2. (Note: This requires multiple responses to be correct.) Critical care units are cost-efficient units for caring for patients with specific organ system failure. Although the organ failing in #4 is obvious, patients with acetaminophen overdose often suffer liver failure as a consequence. #2 and #3 present patient concerns of a noncritical nature. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Physiological Integrity–Physiological Adaptation 3. (Note: This requires multiple responses to be correct.) Critical care units are cost-efficient units for caring for patients with specific organ system failure. Although the organ failing in #4 is obvious, patients with acetaminophen overdose often suffer liver failure as a consequence. #2 and #3 present patient concerns of a noncritical nature. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Physiological Integrity–Physiological Adaptation 4. (Note: This requires multiple responses to be correct.) Critical care units are cost-efficient units for caring for patients with specific organ system failure. Although the organ failing in #4 is obvious, patients with acetaminophen overdose often suffer liver failure as a consequence. #2 and #3 present patient concerns of a noncritical nature. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Physiological Integrity–Physiological Adaptation Learning Outcome: 1-1: Define critical care 3) A hospital in a small rural town would be able 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 Answer: 3 Explanation: 1. #1 and #2 describe more advanced and inclusive critical care abilities; #4 is not likely at all because most hospitals have some critical care areas. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Safe, Effective Care Environment–Management of Care 2. #1 and #2 describe more advanced and inclusive critical care abilities; #4 is not likely at all because most hospitals have some critical care areas. Nursing Process: Evaluation Cognitive Level: Application 2 | P a g eCategory of Need: Safe, Effective Care Environment–Management of Care 3. #1 and #2 describe more advanced and inclusive critical care abilities; #4 is not likely at all because most hospitals have some critical care areas. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Safe, Effective Care Environment–Management of Care 4. #1 and #2 describe more advanced and inclusive critical care abilities; #4 is not likely at all because most hospitals have some critical care areas. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Safe, Effective Care Environment–Management of Care Learning Outcome: 1-2: State the three levels of care provided in critical care units 4) A nurse employed in an ʺopenʺ 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. Answer: 1 Explanation: 1. #2, #3, and #4 refer to ʺclosedʺ ICUs. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Safe, Effective Care Environment–Management of Care 2. #2, #3, and #4 refer to ʺclosedʺ ICUs. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Safe, Effective Care Environment–Management of Care 3. #2, #3, and #4 refer to ʺclosedʺ ICUs. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Safe, Effective Care Environment–Management of Care 4. #2, #3, and #4 refer to ʺclosedʺ ICUs. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Safe, Effective Care Environment–Management of Care Learning Outcome: 1-3: Compare and contrast ʺopenʺ and ʺclosedʺ critical care units 5) According to the Institute of Medicine, technology increases the likelihood of errors in critical care units 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. Answer: 2 Explanation: 1. #1, #3, and #4 have not been identified to increase the likelihood of errors in the critical care unit. 3 | P a g eNursing Process: Evaluation Cognitive Level: Comprehension Category of Need: Safe, Effective Care Environment–Management of Care 2. #1, #3, and #4 have not been identified to increase the likelihood of errors in the critical care unit. Nursing Process: Evaluation Cognitive Level: Comprehension Category of Need: Safe, Effective Care Environment–Management of Care 3. #1, #3, and #4 have not been identified to increase the likelihood of errors in the critical care unit. Nursing Process: Evaluation Cognitive Level: Comprehension Category of Need: Safe, Effective Care Environment–Management of Care 4. #1, #3, and #4 have not been identified to increase the likelihood of errors in the critical care unit. Nursing Process: Evaluation Cognitive Level: Comprehension Category of Need: Safe, Effective Care Environment–Management of Care Learning Outcome: 1-4: Explain why critical care units are one of the most common sites for health care errors 6) Which of the following is a common example of installing forcing functions or system level firewalls in order to prevent errors? 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. Answer: 4 Explanation: 1. #1 and #3 are examples of avoiding reliance on vigilance; #2 is an example of utilizing constraints. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Physiological Integrity–Pharmacological and Parenteral Therapies 2. #1 and #3 are examples of avoiding reliance on vigilance; #2 is an example of utilizing constraints. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Physiological Integrity–Pharmacological and Parenteral Therapies 3. #1 and #3 are examples of avoiding reliance on vigilance; #2 is an example of utilizing constraints. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Physiological Integrity–Pharmacological and Parenteral 4 | P a g eTherapies 4. #1 and #3 are examples of avoiding reliance on vigilance; #2 is an example of utilizing constraints. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Physiological Integrity–Pharmacological and Parenteral Therapies Learning Outcome: 1-4: Explain why critical care units are one of the most common sites for health care errors 7) The increased use of technology in critical care units has resulted in which of the following consequences 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 Answer: 2 Explanation: 1. #1, #3, and #4 have not been demonstrated as outcomes resulting from increased technology use. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Physiological Integrity–Physiological Adaptation 2. #1, #3, and #4 have not been demonstrated as outcomes resulting from increased technology use. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Physiological Integrity–Physiological Adaptation 3. #1, #3, and #4 have not been demonstrated as outcomes resulting from increased technology use. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Physiological Integrity–Physiological Adaptation 4. #1, #3, and #4 have not been demonstrated as outcomes resulting from increased technology use. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Physiological Integrity–Physiological Adaptation Learning Outcome: 1-4: Explain why critical care units are one of the most common sites for health care errors 8) Completion of a preoperative checklist is an operationalized example of which of the following recommendations issued by the Institute of Medicine? 1. Utilizing constraints 2. Simplifying key processes 3. Avoiding reliance on vigilance 4. Standardizing key processes Answer: 3 5 | P a g eExplanation: 1. #1, #2, and #4 are additional recommendations issued by the Institute of Medicine. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Safe, Effective Care Environment–Management of Care 2. #1, #2, and #4 are additional recommendations issued by the Institute of Medicine. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Safe, Effective Care Environment–Management of Care 3. #1, #2, and #4 are additional recommendations issued by the Institute of Medicine. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Safe, Effective Care Environment–Management of Care 4. #1, #2, and #4 are additional recommendations issued by the Institute of Medicine. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Safe, Effective Care Environment–Management of Care Learning Outcome: 1-4: Explain why critical care units are one of the most common sites for health care errors 9) Which of the following actions should the nurse complete first after realizing that an incorrect dose of medication has been administered to a patient? (Select all that apply.) 1. Documentation of the error 2. Notification of the physician 3. Notification of the patient and family 4. Preparation for a root cause analysis Answer: 1, 2, 3, 4 Explanation: 1. (Note: This requires multiple responses to be correct.) Although they are all correct, #2 should be completed first and a plan developed to ensure that the patient is not harmed. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Safe, Effective Care Environment–Management of Care 2. (Note: This requires multiple responses to be correct.) Although they are all correct, #2 should be completed first and a plan developed to ensure that the patient is not harmed. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Safe, Effective Care Environment–Management of Care 3. (Note: This requires multiple responses to be correct.) Although they are all correct, #2 should be completed first and a plan developed to ensure that the patient is not harmed. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Safe, Effective Care Environment–Management of Care 4. (Note: This requires multiple responses to be correct.) Although they are all correct, #2 should be completed first and a plan developed to ensure that the patient is not harmed. Nursing Process: Evaluation Cognitive Level: Application 6 | P a g eCategory of Need: Safe, Effective Care Environment–Management of Care Learning Outcome: 1-4: Explain why critical care units are one of the most common sites for health care errors 10) 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 ʺclosed unitʺ model. Answer: 3 Explanation: 1. #1, #2, and #4 are not correct. 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. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Safe, Effective Care Environment–Management of Care 2. #1, #2, and #4 are not correct. 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. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Safe, Effective Care Environment–Management of Care 3. #1, #2, and #4 are not correct. 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. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Safe, Effective Care Environment–Management of Care 4. #1, #2, and #4 are not correct. 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. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Safe, Effective Care Environment–Management of Care Learning Outcome: 1-5: Describe the relationship between the patient and the nurse in the AACNʹs synergy model 11) The competent critical care nurse demonstrates an understanding of patient advocacy by taking which of the following actions? (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 patient placement after hospitalization 4. Encouraging and supporting a patientʹs spouse in preparing for a family meeting Answer: 1, 2, 3, 4 Explanation: 1. (Note: This requires multiple responses to be correct.) #1, #2, #3, and #4 all indicate ways in which the new critical care nurse could demonstrate an understanding of patient advocacy. Nursing Process: 7 | P a g eEvaluation Cognitive Level: Analysis Category of Need: Psychosocial Integrity 2. (Note: This requires multiple responses to be correct.) #1, #2, #3, and #4 all indicate ways in which the new critical care nurse could demonstrate an understanding of patient advocacy. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Psychosocial Integrity 3. (Note: This requires multiple responses to be correct.) #1, #2, #3, and #4 all indicate ways in which the new critical care nurse could demonstrate an understanding of patient advocacy. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Psychosocial Integrity 4. (Note: This requires multiple responses to be correct.) #1, #2, #3, and #4 all indicate ways in which the new critical care nurse could demonstrate an understanding of patient advocacy. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Psychosocial Integrity Learning Outcome: 1-5: Describe the relationship between the patient and the nurse in the AACNʹs synergy model 12) A nurse is preparing to communicate an issue about patient care to a physician using the SBAR technique. Which of the following phrases is an appropriate initial statement? 1. ʺI am concerned about…ʺ 2. ʺThe patientʹs immediate history is…ʺ 3. ʺI think the problem is…ʺ 4. ʺI would like you to …ʺ Answer: 1 Explanation: 1. #2, #3, and #4 are statements pertinent to other portions of the SBAR. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Safe, Effective Care Environment–Management of Care 2. #2, #3, and #4 are statements pertinent to other portions of the SBAR. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Safe, Effective Care Environment–Management of Care 3. #2, #3, and #4 are statements pertinent to other portions of the SBAR. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Safe, Effective Care Environment–Management of Care 4. #2, #3, and #4 are statements pertinent to other portions of the SBAR. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Safe, Effective Care Environment–Management of Care Learning Outcome: 1-7: Describe ways to enhance communications and collaboration among members of the health care team 8 | P a g e13) The nurse would include which statement for ʺA - Assessmentʺ in the SBAR technique for communication? 1. ʺI think the problem is…ʺ 2. The patientʹs vital signs are…ʺ 3. ʺThe patientʹs treatments are…ʺ 4. ʺI would like you to…ʺ Answer: 1 Explanation: 1. #1 is correct. #2, #3, #4 are statements pertinent to other portions of the SBAR. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Safe, Effective Care Environment–Management of Care 2. #1 is correct. #2, #3, #4 are statements pertinent to other portions of the SBAR. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Safe, Effective Care Environment–Management of Care 3. #1 is correct. #2, #3, #4 are statements pertinent to other portions of the SBAR. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Safe, Effective Care Environment–Management of Care 4. #1 is correct. #2, #3, #4 are statements pertinent to other portions of the SBAR. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Safe, Effective Care Environment–Management of Care Learning Outcome: 1-7: Describe ways to enhance communications and collaboration among members of the health care team 14) To complete an SBAR communication about a patient issue, the nurse should use which of the following statements? 1. ʺThe patientʹs immediate history is…ʺ 2. ʺThe patientʹs physical findings are…ʺ 3. ʺI am requesting that you…ʺ 4. ʺI have assessed the patient personally.ʺ Answer: 3 Explanation: 1. #3 is correct. #1, #2, #4 are statements pertinent to other portions of the SBAR. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Safe, Effective Care Environment–Management of Care 2. #3 is correct. #1, #2, #4 are statements pertinent to other portions of the SBAR. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Safe, Effective Care Environment–Management of Care 3. #3 is correct. #1, #2, #4 are statements pertinent to other portions of the SBAR. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Safe, Effective Care Environment–Management of Care 4. #3 is correct. #1, #2, #4 are statements pertinent to other portions of the SBAR. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Safe, Effective Care Environment–Management of Care Learning Outcome: 1-7: Describe ways to enhance communications and collaboration among 9 | P a g emembers of the health care team 15) Nurses must be able to collaborate with other members of the health care team in order to effect optimal outcomes in patient care. The nurse understands that characteristics of emotional maturity within the profession include: (Select all that apply.) 1. Being a lifelong learner. 2. Actively identifying best practices. 3. Maintaining current skills. 4. Overlooking oneʹs own shortcomings. Answer: 1, 2, 3 Explanation: 1. (Note: This requires multiple responses to be correct.) #4 does not describe an attribute of emotional maturity in nursing. Nursing Process: Assessment Cognitive Level: Comprehension Category of Need: Psychosocial Integrity 2. (Note: This requires multiple responses to be correct.) #4 does not describe an attribute of emotional maturity in nursing. Nursing Process: Assessment Cognitive Level: Comprehension Category of Need: Psychosocial Integrity 3. (Note: This requires multiple responses to be correct.) #4 does not describe an attribute of emotional maturity in nursing. Nursing Process: Assessment Cognitive Level: Comprehension Category of Need: Psychosocial Integrity 4. (Note: This requires multiple responses to be correct.) #4 does not describe an attribute of emotional maturity in nursing. Nursing Process: Assessment Cognitive Level: Comprehension Category of Need: Psychosocial Integrity Learning Outcome: 1-7: Describe ways to enhance communications and collaboration among members of the health care team 16) A nurse might utilize a variety of informal power bases in the health care setting. These include: (Select all that apply.) 1. Information. 2. Expertise. 3. Goodwill. 4. Observatio n. Answer: 1, 2, 3 Explanation: 1. (Note: This requires multiple responses to be correct.) Observation, although important, is not considered to be a form of power. Nursing Process: Assessment Cognitive Level: Analysis Category of Need: Psychosocial Integrity 2. (Note: This requires multiple responses to be correct.) Observation, although important, is not considered to be a form of power. Nursing Process: Assessment 10 | P a g eCognitive Level: Analysis Category of Need: Psychosocial Integrity 3. (Note: This requires multiple responses to be correct.) Observation, although important, is not considered to be a form of power. Nursing Process: Assessment Cognitive Level: Analysis Category of Need: Psychosocial Integrity 4. (Note: This requires multiple responses to be correct.) Observation, although important, is not considered to be a form of power. Nursing Process: Assessment Cognitive Level: Analysis Category of Need: Psychosocial Integrity Learning Outcome: 1-7: Describe ways to enhance communications and collaboration among members of the health care team 17) When a nurse encourages a patient who has experienced a motor vehicle crash to cough and deep -breathe even the patient does not initially want to, the nurse is placing a priority on which of the following ethical principles? 1. Beneficence 2. Nonmaleficence 3. Respect for persons 4. Justic e Answer: 2 Explanation: 1. According to ethicists, nonmaleficence should take precedence over beneficence because it is more important to avoid doing harm to patients than to attempt to benefit them. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Physiological Integrity–Physiological Adaptation 2. According to ethicists, nonmaleficence should take precedence over beneficence because it is more important to avoid doing harm to patients than to attempt to benefit them. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Physiological Integrity–Physiological Adaptation 3. According to ethicists, nonmaleficence should take precedence over beneficence because it is more important to avoid doing harm to patients than to attempt to benefit them. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Physiological Integrity–Physiological Adaptation 4. According to ethicists, nonmaleficence should take precedence over beneficence because it is more important to avoid doing harm to patients than to attempt to benefit them. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Physiological Integrity–Physiological Adaptation Learning Outcome: 1-8: Explain why some health care providers believe that critically ill patients cannot give informed consent 11 | P a g e18) When a nurse forcibly inserts a nasogastric tube against the patientʹs wishes, the nurse can be held liable for: 1. Assault. 2. Battery. 3. Civil penalties. 4. Malpractic e. Answer: 2 Explanation: 1. When the nurse treats or touches a patient without consent, it is battery. Nursing Process: Implementation Cognitive Level: Application Category of Need: Physiological Integrity–Physiological Adaptation 2. When the nurse treats or touches a patient without consent, it is battery. Nursing Process: Implementation Cognitive Level: Application Category of Need: Physiological Integrity–Physiological Adaptation 3. When the nurse treats or touches a patient without consent, it is battery. Nursing Process: Implementation Cognitive Level: Application Category of Need: Physiological Integrity–Physiological Adaptation 4. When the nurse treats or touches a patient without consent, it is battery. Nursing Process: Implementation Cognitive Level: Application Category of Need: Physiological Integrity–Physiological Adaptation Learning Outcome: 1-8: Explain why some health care providers believe that critically ill patients cannot give informed consent 19) The nurse is aware that decision-making capacity is likely to be impaired for patients who: (Select all that apply.) 1. Are depressed. 2. Are being medicated for severe pain. 3. Do not understand their medical condition. 4. Have been diagnosed with septic shock. Answer: 1, 2, 3, 4 Explanation: 1. (Note: This requires multiple responses to be correct.) In each case, the patient is unable to meet at least one of the three components of informed consent. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Physiological Integrity–Physiological Adaptation 2. (Note: This requires multiple responses to be correct.) In each case, the patient is unable to meet at least one of the three components of informed consent. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Physiological Integrity–Physiological Adaptation 3. (Note: This requires multiple responses to be correct.) In each case, the patient is unable to meet at least one of the three components of informed consent. Nursing Process: 12 | P a g eEvaluation Cognitive Level: Analysis Category of Need: Physiological Integrity–Physiological Adaptation 4. (Note: This requires multiple responses to be correct.) In each case, the patient is unable to meet at least one of the three components of informed consent. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Physiological Integrity–Physiological Adaptation Learning Outcome: 1-8: Explain why some health care providers believe that critically ill patients cannot give informed consent 20) 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. Answer: 4 Explanation: 1. #1, #2, and #3 are actions that nurses believe unrestrained patients may accomplish and which may result in harm to the patients. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Physiological Integrity–Physiological Adaptation 2. #1, #2, and #3 are actions that nurses believe unrestrained patients may accomplish and which may result in harm to the patients. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Physiological Integrity–Physiological Adaptation 3. #1, #2, and #3 are actions that nurses believe unrestrained patients may accomplish and which may result in harm to the patients. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Physiological Integrity–Physiological Adaptation 4. #1, #2, and #3 are actions that nurses believe unrestrained patients may accomplish and which may result in harm to the patients. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Physiological Integrity–Physiological Adaptation Learning Outcome: 1-8: Explain why some health care providers believe that critically ill patients cannot give informed consent 21) For a nurse to be found guilty of negligence, which of the following must be demonstrated? That the patient: 1. Was assaulted. 2. Was not consulted before being touched. 3. Suffered a wrongful death. 4. Incurred damages. 13 | P a g eAnswer: 4 Explanation: 1. In order to prove negligence, a duty must be owed; a duty must have been breached; the breach of duty caused injury to the patient; and there were damages. Nursing Process: Evaluation Cognitive Level: Comprehension Category of Need: Safe, Effective Care Environment–Management of Care 2. In order to prove negligence, a duty must be owed; a duty must have been breached; the breach of duty caused injury to the patient; and there were damages. Nursing Process: Evaluation Cognitive Level: Comprehension Category of Need: Safe, Effective Care Environment–Management of Care 3. In order to prove negligence, a duty must be owed; a duty must have been breached; the breach of duty caused injury to the patient; and there were damages. Nursing Process: Evaluation Cognitive Level: Comprehension Category of Need: Safe, Effective Care Environment–Management of Care 4. In order to prove negligence, a duty must be owed; a duty must have been breached; the breach of duty caused injury to the patient; and there were damages. Nursing Process: Evaluation Cognitive Level: Comprehension Category of Need: Safe, Effective Care Environment–Management of Care Learning Outcome: 1-8: Explain why some health care providers believe that critically ill patients cannot give informed consent 22) Moral distress among critical care nurses is associated with: (Select all that apply.) 1. Providing aggressive care to patients who cannot benefit. 2. Having no voice in clinical decision making. 3. Realizing that nurses maintain power in bedside decision making. 4. Knowing the right thing to do but not being able to do it. Answer: 1, 2, 4 Explanation: 1. (Note: This requires multiple responses to be correct.) #3 lacks accuracy according to nursesʹ reports in studies. Nursing Process: Evaluation Cognitive Level: Comprehension Category of Need: Physiological Integrity–Basic Care and Comfort 2. (Note: This requires multiple responses to be correct.) #3 lacks accuracy according to nursesʹ reports in studies. Nursing Process: Evaluation Cognitive Level: Comprehension Category of Need: Physiological Integrity–Basic Care and Comfort 3. (Note: This requires multiple responses to be correct.) #3 lacks accuracy according to nursesʹ reports in studies. Nursing Process: Evaluation Cognitive Level: Comprehension Category of Need: Physiological Integrity–Basic Care and Comfort 4. (Note: This requires multiple responses to be 14 | P a g ecorrect.) #3 lacks accuracy according to nursesʹ reports in studies. Nursing Process: Evaluation Cognitive Level: Comprehension Category of Need: Physiological Integrity–Basic Care and Comfort Learning Outcome: 1-9: Analyze why moral distress might be a significant concern for critical care nurses 23) When a nurse employs conscientious refusal to participate, the nurse should be aware that: (Select all that apply.) 1. Consequences may involve employer sanction. 2. It may lead to dismissal from a nursing position. 3. Nursing administrators are largely supportive. 4. State boards of nursing protect the nurse in this situation. Answer: 1, 2 Explanation: 1. (Note: This requires multiple responses to be correct.) Although some nursing administrators are supportive, this is not a widely held view (#3). #4 is not universally true. Therefore, the nurse must be aware of the state nurse practice act. Nursing Process: Implementation Cognitive Level: Analysis Category of Need: Psychosocial Integrity 2. (Note: This requires multiple responses to be correct.) Although some nursing administrators are supportive, this is not a widely held view (#3). #4 is not universally true. Therefore, the nurse must be aware of the state nurse practice act. Nursing Process: Implementation Cognitive Level: Analysis Category of Need: Psychosocial Integrity 3. (Note: This requires multiple responses to be correct.) Although some nursing administrators are supportive, this is not a widely held view (#3). #4 is not universally true. Therefore, the nurse must be aware of the state nurse practice act. Nursing Process: Implementation Cognitive Level: Analysis Category of Need: Psychosocial Integrity 4. (Note: This requires multiple responses to be correct.) Although some nursing administrators are supportive, this is not a widely held view (#3). #4 is not universally true. Therefore, the nurse must be aware of the state nurse practice act. Nursing Process: Implementation Cognitive Level: Analysis Category of Need: Psychosocial Integrity Learning Outcome: 1-10: Prioritize measures that a nurse might utilize to prevent compassion fatigue 24) Which of the following symptoms seen in a nurse would suggest compassion fatigue? (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 15 | P a g esituations Answer: 1, 4 Explanation: 1. (Note: This requires multiple responses to be correct.) #2 and #3 are opposing behaviors and are not indicative of compassion fatigue. Nursing Process: Evaluation Cognitive Level: Comprehension Category of Need: Psychosocial Integrity 2. (Note: This requires multiple responses to be correct.) #2 and #3 are opposing behaviors and are not indicative of compassion fatigue. Nursing Process: Evaluation Cognitive Level: Comprehension Category of Need: Psychosocial Integrity 3. (Note: This requires multiple responses to be correct.) #2 and #3 are opposing behaviors and are not indicative of compassion fatigue. Nursing Process: Evaluation Cognitive Level: Comprehension Category of Need: Psychosocial Integrity 4. (Note: This requires multiple responses to be correct.) #2 and #3 are opposing behaviors and are not indicative of compassion fatigue. Nursing Process: Evaluation Cognitive Level: Comprehension Category of Need: Psychosocial Integrity Learning Outcome: 1-10: Prioritize measures that a nurse might utilize to prevent compassion fatigue Chapter 2 Care of the Critically Ill Patient 1) ʺResiliencyʺ in the American Association of Critical-Care Nurses synergy model refers to a personʹs: 1. Motivation to reduce anxiety through positive self-talk. 2. Ability to bounce back quickly after an insult. 3. Physical strength to endure extreme physical stressors. 4. Ability to return to a state of equilibrium. Answer: 2 Explanation: 1. The correct definition of ʺresiliencyʺ is the ability to bounce back quickly after an insult. The degree of resiliency is placed along a continuum between being unable to mount a response to having strong reserves. Other characteristics of this model include: vulnerability, stability, complexity, predictability, resource availability, participation in care, and participation in decision making. #1 and #3 do not define resiliency and are not related to the synergy model patient characteristics. #4, ʺstability,ʺ is defined as the ability to return to a state of equilibrium and range between unresponsive to therapies and at high risk for death to stable and responsive to therapy. Nursing Process: Planning Cognitive Level: Comprehension Category of Need: Safe, Effective Care Environment–Management of Care 2. The correct definition of ʺresiliencyʺ is the ability to bounce back quickly after an insult. The degree of resiliency is placed along a continuum between being unable to mount a response to having strong reserves. Other characteristics of this model include: vulnerability, stability, complexity, predictability, resource 16 | P a g eavailability, participation in care, and participation in decision making. #1 and #3 do not define resiliency and are not related to the synergy model patient characteristics. #4, ʺstability,ʺ is defined as the ability to return to a state of equilibrium and range between unresponsive to therapies and at high risk for death to stable and responsive to therapy. Nursing Process: Planning Cognitive Level: Comprehension Category of Need: Safe, Effective Care Environment–Management of Care 3. The correct definition of ʺresiliencyʺ is the ability to bounce back quickly after an insult. The degree of resiliency is placed along a continuum between being unable to mount a response to having strong reserves. Other characteristics of this model include: vulnerability, stability, complexity, predictability, resource availability, participation in care, and participation in decision making. #1 and #3 do not define resiliency and are not related to the synergy model patient characteristics. #4, ʺstability,ʺ is defined as the ability to return to a state of equilibrium and range between unresponsive to therapies and at high risk for death to stable and responsive to therapy. Nursing Process: Planning Cognitive Level: Comprehension Category of Need: Safe, Effective Care Environment–Management of Care 4. The correct definition of ʺresiliencyʺ is the ability to bounce back quickly after an insult. The degree of resiliency is placed along a continuum between being unable to mount a response to having strong reserves. Other characteristics of this model include: vulnerability, stability, complexity, predictability, resource availability, participation in care, and participation in decision making. #1 and #3 do not define resiliency and are not related to the synergy model patient characteristics. #4, ʺstability,ʺ is defined as the ability to return to a state of equilibrium and range between unresponsive to therapies and at high risk for death to stable and responsive to therapy. Nursing Process: Planning Cognitive Level: Comprehension Category of Need: Safe, Effective Care Environment–Management of Care Learning Outcome: 2-1: Explain the characteristics of the critically ill patient described in the AACN synergy model 2) Which of the following is the AACNʹs synergy model patient characteristic described as ʺthe intricate entanglement of two or more systemsʺ? 1. Complexity 2. Predictability 3. Participation in care 4. Resource availability Answer: 1 Explanation: 1. #2, #3, and #4 are other terms used in the synergy model. Nursing Process: Planning Cognitive Level: Comprehension Category of Need: Psychosocial Integrity 2. #2, #3, and #4 are other terms used in the synergy model. Nursing Process: Planning 17 | P a g eCognitive Level: Comprehension Category of Need: Psychosocial Integrity 3. #2, #3, and #4 are other terms used in the synergy model. Nursing Process: Planning Cognitive Level: Comprehension Category of Need: Psychosocial Integrity 4. #2, #3, and #4 are other terms used in the synergy model. Nursing Process: Planning Cognitive Level: Comprehension Category of Need: Psychosocial Integrity Learning Outcome: 2-1: Explain the characteristics of the critically ill patient described in the AACN synergy model 3) Which of the following stressors is one of the primary concerns of critically ill patients and should therefore be included routinely in patient assessments? 1. Inability to control elimination 2. Lack of family support 3. Hunger 4. Altered ability to communicate Answer: 4 Explanation: 1. Other items included in Cornockʹs categories are: being thirsty, having tubes in the mouth and nose, being restricted by tubes/lines, being unable to sleep, and not being able to control themselves. #1, #2, and #3 are incorrect. Although the inability to control elimination is similar to not being able to control oneʹs self, the interpretation by Cornock does not include this aspect as a stressor. Lack of family support and hunger were not identified as stressors by his research. Nursing Process: Assessment Cognitive Level: Application Category of Need: Psychosocial Integrity 2. Other items included in Cornockʹs categories are: being thirsty, having tubes in the mouth and nose, being restricted by tubes/lines, being unable to sleep, and not being able to control themselves. #1, #2, and #3 are incorrect. Although the inability to control elimination is similar to not being able to control oneʹs self, the interpretation by Cornock does not include this aspect as a stressor. Lack of family support and hunger were not identified as stressors by his research. Nursing Process: Assessment Cognitive Level: Application Category of Need: Psychosocial Integrity 3. Other items included in Cornockʹs categories are: being thirsty, having tubes in the mouth and nose, being restricted by tubes/lines, being unable to sleep, and not being able to control themselves. #1, #2, and #3 are incorrect. Although the inability to control elimination is similar to not being able to control oneʹs self, the interpretation by Cornock does not include this aspect as a stressor. Lack of family support and hunger were not identified as stressors by his research. Nursing Process: Assessment Cognitive 18 | P a g eLevel: Application Category of Need: Psychosocial Integrity 4. Other items included in Cornockʹs categories are: being thirsty, having tubes in the mouth and nose, being restricted by tubes/lines, being unable to sleep, and not being able to control themselves. #1, #2, and #3 are incorrect. Although the inability to control elimination is similar to not being able to control oneʹs self, the interpretation by Cornock does not include this aspect as a stressor. Lack of family support and hunger were not identified as stressors by his research. Nursing Process: Assessment Cognitive Level: Application Category of Need: Psychosocial Integrity Learning Outcome: 2-2: Discuss the concerns expressed by critically ill patients 4) A patient has just completed a preoperative education session prior to undergoing coronary artery bypass surgery. Which statement by the patient would indicate that he needs additional teaching by the nurse? (Select all that apply.) 1. ʺI understand that I will have to blink my eyes to respond after the breathing tube is in my throat.ʺ 2. ʺI will be given frequent mouth care to help me when I am thirsty.ʺ 3. ʺI will be able to move about freely in bed and into the chair without help while connected to the electronic equipment for monitoring.ʺ 4. ʺI may need something to help me rest due to the unfamiliar lights and sounds of the ICU unit.ʺ Answer: 1, 2, 4 Explanation: 1. (Note: This requires multiple responses to be correct.) The question is asking for the response that reflects inaccurate information. #3 reflects that the patient did not understand the physical limitations and the need for assistance when moving and getting in and out of bed. #1, #2, and #4 are correct understanding of the limitation required by the patient in ICU. Alternate method of communication discussed in advance of tube placement will assist in better communication after the tube is inserted to assist the breathing process. While intubated, oral hygiene is needed to prevent mucosal drying due to the inability of the patient to drink. Due to environmental lights, sounds, and difference in sleeping environment, additional aids, such as drug management, may be needed to assist the patient to rest at night. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Safe, Effective Care Environment–Management of Care 2. (Note: This requires multiple responses to be correct.) The question is asking for the response that reflects inaccurate information. #3 reflects that the patient did not understand the physical limitations and the need for assistance when moving and getting in and out of bed. #1, #2, and #4 are correct understanding of the limitation required by the patient in ICU. Alternate method of communication discussed in advance of tube placement will assist in better communication after the tube is inserted to assist the breathing process. While intubated, oral hygiene is needed to prevent mucosal drying due to the inability of the patient to drink. Due to environmental lights, sounds, and difference in sleeping environment, additional aids, such as drug management, may be needed to assist the patient to rest at night. Nursing Process: Evaluation Cognitive Level: Analysis 19 | P a g eCategory of Need: Safe, Effective Care Environment–Management of Care 3. (Note: This requires multiple responses to be correct.) The question is asking for the response that reflects inaccurate information. #3 reflects that the patient did not understand the physical limitations and the need for assistance when moving and getting in and out of bed. #1, #2, and #4 are correct understanding of the limitation required by the patient in ICU. Alternate method of communication discussed in advance of tube placement will assist in better communication after the tube is inserted to assist the breathing process. While intubated, oral hygiene is needed to prevent mucosal drying due to the inability of the patient to drink. Due to environmental lights, sounds, and difference in sleeping environment, additional aids, such as drug management, may be needed to assist the patient to rest at night. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Safe, Effective Care Environment–Management of Care 4. (Note: This requires multiple responses to be correct.) The question is asking for the response that reflects inaccurate information. #3 reflects that the patient did not understand the physical limitations and the need for assistance when moving and getting in and out of bed. #1, #2, and #4 are correct understanding of the limitation required by the patient in ICU. Alternate method of communication discussed in advance of tube placement will assist in better communication after the tube is inserted to assist the breathing process. While intubated, oral hygiene is needed to prevent mucosal drying due to the inability of the patient to drink. Due to environmental lights, sounds, and difference in sleeping environment, additional aids, such as drug management, may be needed to assist the patient to rest at night. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Safe, Effective Care Environment–Management of Care Learning Outcome: 2-2: Discuss the concerns expressed by critically ill patients 5) When providing care to critically ill patients, whether they are responsive or unresponsive, the nurse should: 1. Clearly explain what care is to be done before starting the activity. 2. Perform the activity then let the patient rest without explaining the care. 3. Make sure the patient always responds and is cooperative before giving care. 4. Explain to the family that the patient will not understand or remember any of the discomfort associated with care. Answer: 1 Explanation: 1. By explaining to both the responsive and unresponsive patient, the nurse provides orientation, reassurance, respect, and assessment of the patientʹs mental status. Seeking permission and apologizing if discomfort is involved will also minimize the stress of the critically ill patient by hearing what is about to occur. Even the unresponsive patient has been known to explain procedures, conversations, and feelings once they have awakened. #2 is incorrect. If the patient is not informed, autonomy and the right to choose have been violated; in addition the stress of the unknown may be perceived incorrectly by the patient as an assault. #3 is incorrect. Some unresponsive patients will never respond; therefore, the care would not be performed as needed. Cooperation is also not possible in some cases whereby the patient has altered thinking. Although the nurse desires these, the care should not be stopped just because they cannot be 20 | P a g eobtained. Explaining should still be done and the care should proceed as needed. #4 is incorrect: The nurse cannot always reassure the family that the patient will not remember. Nursing Process: Implementation Cognitive Level: Application Category of Need: Psychosocial Integrity 2. By explaining to both the responsive and unresponsive patient, the nurse provides orientation, reassurance, respect, and assessment of the patientʹs mental status. Seeking permission and apologizing if discomfort is involved will also minimize the stress of the critically ill patient by hearing what is about to occur. Even the unresponsive patient has been known to explain procedures, conversations, and feelings once they have awakened. #2 is incorrect. If the patient is not informed, autonomy and the right to choose have been violated; in addition the stress of the unknown may be perceived incorrectly by the patient as an assault. #3 is incorrect. Some unresponsive patients will never respond; therefore, the care would not be performed as needed. Cooperation is also not possible in some cases whereby the patient has altered thinking. Although the nurse desires these, the care should not be stopped just because they cannot be obtained. Explaining should still be done and the care should proceed as needed. #4 is incorrect: The nurse cannot always reassure the family that the patient will not remember. Nursing Process: Implementation Cognitive Level: Application Category of Need: Psychosocial Integrity 3. By explaining to both the responsive and unresponsive patient, the nurse provides orientation, reassurance, respect, and assessment of the patientʹs mental status. Seeking permission and apologizing if discomfort is involved will also minimize the stress of the critically ill patient by hearing what is about to occur. Even the unresponsive patient has been known to explain procedures, conversations, and feelings once they have awakened. #2 is incorrect. If the patient is not informed, autonomy and the right to choose have been violated; in addition the stress of the unknown may be perceived incorrectly by the patient as an assault. #3 is incorrect. Some unresponsive patients will never respond; therefore, the care would not be performed as needed. Cooperation is also not possible in some cases whereby the patient has altered thinking. Although the nurse desires these, the care should not be stopped just because they cannot be obtained. Explaining should still be