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Chapter 1 Critical Care Nursing Practice: Promoting Excellence-Caring,Collaboration
Evidence
1. A nurse is the only one in the ICU who has not achieved certification in critical care
nursing. She often will ask her fellow nurses what to do in caring for a patient because
she doubts the accuracy of her knowledge and her intuition. She loves her work but
wishes she could do it with a greater level of competence. What is the most important
effect that obtaining certification would likely have on the nurses practice?
A) Recognition by peers
B) Increase in salary and rank
C) More flexibility in seeking employment
D) Increased confidence in making decisions
2. A hospital interviews two different candidates for a position in the ICU. Both candidates
have around 10 years of experience working in the ICU. Both have excellent
interpersonal skills and highly positive references. One, however, has certification in
critical care nursing. Which of the following is the most compelling and accurate reason
for the hospital to hire the candidate with certification?
A) The certified nurse will have more knowledge and expertise.
B) The certified nurse will behave more ethically.
C) The certified nurse will be more caring toward patients.
D) The certified nurse will work more collaboratively with other nurses.
3. A nurse is caring for an elderly man recently admitted to the ICU following a stroke. She
assesses his cognitive function using a new cognitive assessment test she learned about in
a recent article in a nursing journal. She then brings a cup of water and a straw to the
patient because she observes that his lips are dry. Later, she has the patient sit in a
wheelchair and takes him to have some blood tests performed. He objects at first, saying
that he can walk on his own, but the nurse explains that it is hospital policy to use the
wheelchair. That evening, she recognizes signs of an imminent stroke in the patient and
immediately pages the physician. Which action taken by the nurse is the best example of
evidence-based practice?
A) Giving the patient a cup of water
B) Transferring the patient in a wheelchair
C) Using the cognitive assessment test
D) Recognizing signs of imminent stroke and paging the physician
, 4. A nurse is on a committee that is trying to reduce the occurrence of hospital-acquired
infections in the ICU. Her role is to conduct research to find which interventions have
been shown to be most effective in reducing these infections. She consults many different
sources and finds conflicting information. Which of the following sources should she
consider the most authoritative?
A) AACN expert panel report
B) A meta-analysis of randomized controlled trials in the American Journal of Nursing
C) A systematic review of qualitative studies in the Journal of Advanced Nursing
D) A single randomized controlled trial in the American Journal of Critical Care
5. A nurse who has been recently hired to manage the nursing staff of the ICU is concerned
at the lack of evidence-based practice she sees among the staff. Which of the following
would be the best step for her to take to promote incorporating evidence into clinical
practice?
A) Only hire nurses certified in critical care nursing.
B) Leave copies of several different nursing journals in the nurses lounge.
C) Demonstrate to the staff the best nursing-related search terms to use in Google or
Yahoo!
D) Introduce the staff to the PubMed search engine and assign them topics to research
on it.
6. A physician visits a patient in the ICU while the nurse is out. The patient complains that
the pain medication is not effective and that he would like to receive an increased dose.
The physician has the nurse paged and consults with him in the hallway regarding the
patients request for stronger pain medication. The nurse explains that patient was started
on a morphine drip only 20 minutes ago and that the drug has not had time to take effect
yet. The physician agrees and tells the patient to give it just a bit more time. Which
component of a healthy work environment is most evident in this scenario?
A) Skilled communication
B) Appropriate staffing
C) True collaboration
D) Meaningful recognition
7. A nurse in the ICU is responding to a patient who has just gone into cardiac arrest. A
moment later, the nurse is notified that another patient has just gone into anaphylactic
shock due to a drug allergy. She is conflicted as to what to do, as she is the only nurse
available at the moment to tend to both patients. Which component of a healthy work
environment is lacking in this scenario?
A) Effective decision making
, B) Appropriate staffing
C) Authentic leadership
D) Meaningful recognition
8. An ICU nurse has provided excellent care for a 6-year-old girl who had been admitted to
the ICU for a head injury. The nurse was attentive not only to the needs of the patient but
also went out of her way to care for the needs of the girls family. According to research,
which of the following forms of recognition would the nurse value the most?
A) A card from the girls family
B) A plaque from the ICU physicians naming her as Nurse of the Year
C) A letter of commendation from the hospitals administration
D) A bouquet of flowers from her supervisor
9. A patient in the ICU has recently been diagnosed with diabetes mellitus. Before being
discharged, this patient will require detailed instructions on how to manage her diet, how
to self-inject insulin, and how to handle future diabetic emergencies. Which nurse
competency is most needed in this situation?
A) Clinical judgment
B) Advocacy and moral agency
C) Caring practices
D) Facilitation of learning
10. An elderly patient is admitted to the ICU with stage IV lung cancer, diabetes mellitus, and
congestive heart failure. The health care team assembled to care for her is large and
diverse, including an oncologist, a pulmonologist, an endocrinologist, a cardiologist, and
others. The patient is not expected to survive more than a few weeks, and her husband is
overwhelmed with stress and grief. Which nurse competency or competencies are most
needed in this situation? Select all that apply.
A) Clinical judgment
B) Caring practices
C) Collaboration
D) Response to diversity
11. An Ethiopian man with AIDS has recently been admitted to the ICU with a case of
pneumonia. The man is new to the U.S. and has no health insurance. He would likely be
eligible for the states Medicaid coverage, but does not understand how to access this
coverage. Which competency or competencies are most needed in this situation? Select
all that apply.
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