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Introduction To Critical Care Nursing 7th

Edition TEST BANK
Chapter01:OverviewofCriticalCareNursing
Sole:Introductionto CriticalCareNursing,7thEdition
MULTIPLECHOICE
1. Whichofthefollowingprofessionalorganizationsbestsupportscriticalcarenursingpractice?
a. AmericanAssociationof Critical-CareNurses
b. AmericanHeartAssociation
c. AmericanNursesAssociation
d. SocietyofCriticalCareMedicine
ANS:A
The American Association of Critical-Care Nurses is the specialty organization that
supportsand represents critical care nurses. The American Heart Association supports
cardiovascularinitiatives.TheAmericanNursesAssociationsupportsallnurses.TheSocietyofCriti
calCareMedicine represents the multiprofessional critical care team under the direction of
anintensivist.
DIF: CognitiveLevel:Remember/Knowledge REF:p. 5

OBJ:Discuss the purposes and functions of the professional organizations that support critical
carepractice. TOP:NursingProcess Step:N/A
MSC:NCLEXClientNeedsCategory:SafeandEffectiveCareEnvironment
2. Anursehas beenworking as astaff nurseinthesurgical intensivecareunit for2

yearsandisinterestedincertification.Whichcredential wouldbemostapplicable forthenurseto
seek?
a. ACNPC-AG
b. CNML
c. CCRN
d. PCCN
ANS:C
TheCCRNcertificationisappropriatefornursesinbedside practicewho careforcritically
illpatients. The ACNPC-AG certification is for acute care nurse practitioners. The CNML is
forcritical care nurse managers or leaders. The PCCN certification is for staff nurses working
inprogressivecare, intermediatecare, or step-downunit settings.
DIF: CognitiveLevel:Remember/Knowledge REF: p. 6

OBJ: Explaincertificationoptionsforcriticalcarenurses.
TOP:NursingProcessStep:N/AM
SC:NCLEXClientNeedsCategory:Safeand Effective Care Environment
3. Themainpurposeof certification isto

a. assuretheconsumerthatyouwillnot makeamistake.
b. prepareforgraduateschool.
c. promotemagnetstatusforyour facility.
d. validateknowledgeofcriticalcarenursing.
ANS:D
Certification assists in validating knowledge of the field, promotes excellence in

theprofession, and helps nurses to maintain their knowledge of critical care nursing.
Certificationhelps to assure the consumer that the nurse has a minimum level of knowledge;
however, itdoes not ensure that care will be mistake-free. Certification does not prepare one
for graduateschool; however, achieving certification demonstrates motivation for
achievement
andprofessionalism.Magnetfacilitiesareratedonthenumberofcertifiednurses;however,thatisnott
hepurposeof certification.
DIF: CognitiveLevel:Remember/Knowledge REF: p. 6

OBJ: Explaincertificationoptionsforcriticalcarenurses.
4. Thesynergymodelof practicefocuseson
a. allowingunrestricted visiting forthepatient 24hours aday.
b. holisticandalternativetherapies.
c. theneedsofpatients and theirfamilies,which drivenursingcompetency.
d. patients’needsforenergyandsupport.
ANS:C
The synergy model of practice states that the needs of patients and families influence
anddrive competencies of nurses. Nursing practice based on the synergy model would
involvetailored visiting to meet the patient’s and family’s needs and the application of
alternativetherapiesif desired by thepatient,but that is not theprimary focus of themodel.
DIF: CognitiveLevel:Remember/Knowledge REF:p.

6OBJ:Describestandardsofprofessionalpracticeforcriticalcarenursing.
TOP:NursingProcessStep: N/A
MSC: NCLEX ClientNeedsCategoN ryU:R
SSafIN
eG
anTdBE
.CfO
feM
ctive Care Environment
5. The family of your critically ill patient tells you that they have not spoken with the
physicianin over 24 hours and that they have some questions they want clarified. During
morningrounds, you convey this concern to the attending intensivist and arrange a meeting
with thefamilyat 4:00PM. Which competencyofcriticalcarenursing doesthis represent?
a. Advocacy andmoralagencyinsolvingethicalissues
b. Clinicaljudgmentandclinicalreasoningskills
c. Collaborationwithpatients,families,andteammembers
d. Facilitationoflearningforpatients,families,and teammembers
ANS:C
Although one might consider that all of these competencies are being
addressed,communicationandcollaborationwiththefamilyandphysicianbestexemplif
ythecompetencyofcollaboration.
DIF: CognitiveLevel:Analyze/Analysis REF:p. 6 | Fig 1-3 | Box 1-

1OBJ:Describestandards of professionalpracticefor criticalcarenursing.
6. TheAACNStandards
forAcuteandCriticalCareNursingPracticeusewhatframeworktoguidecritical carenursing
practice?
a. Evidence-basedpractice
b. Healthywork environment
c. NationalPatientSafety Goals
d. Nursingprocess
ANS:D
The AACN Standards for Acute and Critical Care Nursing Practice delineate the
nursingprocessas
appliedtocriticallyillpatients:collectdata,determinediagnoses,identifyexpectedoutcomes,
develop a plan of care, implement interventions, and evaluate care. AACNpromotes a healthy
work environment, but this is not included in its standards. The JointCommission has
established National Patient Safety Goals, but these are not the AACNstandards.

7. Thecharge nurseisresponsiblefor makingthepatientassignmentsonthecriticalcareunit.An

experienced, certified nurse is assigned to care for the acutely ill patient with sepsis
whoalsorequirescontinuousrenalreplacementtherapyandmechanicalventilation.Thenursewithle
ssthan1yearofexperienceisassignedtotwopatientswhoaremorestable.Thisassignmentreflects
implementation ofthe
a. crewresourcemanagementmodel.
b. NationalPatientSafety Goals.
c. QualityandSafetyEducationforNurses (QSEN)model.
d. synergymodelofpractice.
ANS:D
This assignment demonstrates nursing care to meet the needs of the patient. The
synergymodel notes that the nurse competencies are matched to the patient characteristics.
Crewresource management concepts are related to team training; National Patient Safety
Goals arespecified by The Joint Commission to promote safe care but do not incorporate the
synergymodel. The Quality and Safety Education for Nurses initiative involves targeted
education ofundergraduateand graduate nursing studentson quality and safety concepts.
DIF: CognitiveLevel:Analyze/Analysis REF:p.

8. ThevisionoftheAmerican AssociationofCritical-CareNursesis ahealthcaresystemdrivenby

a. ahealthyworkenvironment.
b. carefroma multiprofessionalteam underthe directionofacritical carephysician.
c. theneedsof criticallyillpatientsandfamilies.
d. respectful,healing,andhumaneenvironments.
ANS:C
The AACN vision is a health care system driven by the needs of critically ill patients
andfamilies where critical care nurses make their optimum contributions. AACN
promotesinitiatives to support a healthy work environment as well as respectful and
healingenvironments, but that is not the organization’s vision. The Society of Critical Care
Medicine(SCCM) promotes care from a multiprofessional team under the direction of a
critical carephysician.

9. Themostimportant outcomeofeffectivecommunicationisto
a. demonstratecaringpracticestofamilymembers.
b. ensurethatpatient teachingisdone.
c. meetthediversityneeds ofpatients.
d. reducepatienterrors.
ANS:D
Many errors are directly attributed to faulty communication. Effective communication
hasbeenidentifiedasanessentialstrategytoreducepatienterrorsandresolveissuesrelatedtopatie
nt care delivery. Communication may demonstrate caring practices, address
diversityneeds, and be used for patient/family teaching; however, the main outcome of
effectivecommunicationis patient safety.

9OBJ:Describequalityandsafetyinitiativesrelatedtocriticalcarenursing.
TOP:NursingProcessStep:N/A
10. Youarecaringfora criticallyillpatientwhoseurineoutputhas beenlowfor2consecutivehours.

After a thorough patient assessment, you call the intensivist with report.
Whichinformationdo you convey regarding background?
a. Urineoutput of 40mL/2hours
b. Currentvitalsignsandhistoryofaorticaneurysmrepair4hoursago
c. Astatementthatthepatientispossiblyhypovolemic
d. Arequestfor IVfluids
ANS:B
Thehistoryand vitalsignsarepartofthe background.Informationregarding thelowurineoutput
is the situation. Information regarding possible hypovolemia is part of the
nurse’sassessment,and the suggestion for fluids isthe recommendation.

9OBJ:Describe quality and safety initiatives related to critical care
nursing.TOP:IntegratedProcess:Communication
11. The family members of a critically ill patient bring a copy of the patient’s living will to
thehospital, which identifies the patient’s wishes regarding health care. You discuss contents
ofthe living will with the patient’s physician. This is an example of implementation of which
oftheAACN Standards of Professional Performance?
a. Acquiresandmaintainscurrentknowledgeofpractice
b. Actsethicallyonthe behalfofthe patientandfamily
c. Considersfactorsrelatedtosafepatientcare
d. Usesclinicalinquiryand integratesresearchfindingsinpractice
ANS:B
Discussingend-of-lifeissuesisanexampleof anurseactingethically onbehalfofthepatientand
family. The example does not relate to acquiring knowledge, promoting patient safety,
orusingresearch in practice.
DIF: CognitiveLevel:Analyze/Analysis REF:p. 6 | Box 1-

2OBJ:Describestandardsof careand performancefor critical care nursing.
TOP:NursingProcessStep:Implementation
12. Whichofthefollowingassists thecriticalcarenursein ensuringthatcareisappropriate

andbasedon research?
a. Clinicalpracticeguidelines
b. Computerizedphysicianorderentry
c. Consultingwithadvancedpracticenurses
d. ImplementingJointCommissionNationalPatientSafetyGoals
ANS:A
Clinicalpracticeguidelines arebeingimplemented toensurethatcareis appropriateand basedon
research. Some physician order entry pathways, but not all, are based on
researchrecommendations.Someadvancedpracticenurses, butnot all, arewell versed in
evidence-basedpractices.TheNationalPatientSafetyGoalsarerecommendationstoreduceerrors
using evidence-based practiNcU
esR.

13. Comparing the patient’s current (home) medications with those ordered during
hospitalizationand communicating a complete list of medications to the next provider when
the patient istransferredwithin an organization orto another setting arestrategies to:
a. improveaccuracyofpatientidentification.
b. preventerrorsrelatedto look-alikeandsound-alikemedications.
c. reconcilemedicationsacrossthecontinuumofcare.
d. reduceharmsassociatedwiththeadministrationofanticoagulants.
ANS:C
These are steps recommended in the National Patient Safety Goals to reconcile
medicationsacrossthecontinuumofcare.Improvingaccuracy
ofpatientidentificationisanotherNationalPatient Safety Goal. Preventing errors related to look-
alike and sound-alike medications isdone to improve medication safety, but is not related to
transferring the patient betweensettings. Reducing harms associated with the administration
of anticoagulants is anotherNationalPatient SafetyGoal.
DIF: CognitiveLevel:Understand/Comprehension REF:p. 7 | Box 1-

3OBJ:Describequalityandsafetyinitiativesrelatedto criticalcarenursing.
14. As part of nursing management of a critically ill patient, orders are written to keep the head
ofthe bed elevated at 30 degrees, awaken the patient from sedation each morning to
assessreadiness to wean from mechanical ventilation, and implement oral care protocols
every 4hours. These interventions are done as a group to reduce the risk of ventilator-
associatedpneumonia.This group ofevidence-basedinterventions is often called a
a. bundleofcare.
b. clinicalpracticeguideline.
c. patientsafetygoal.
d. qualityimprovementinitiative.
ANS:A
A group of evidence-based interventions done as a whole to improve outcomes is termed
abundle of care. This is an example of the ventilator bundle. Oftentimes these bundles
arederived from clinical practice guidelines and are monitored for compliance as part of
qualityimprovementinitiatives. Atsomepoint,thesemaybecome partofpatientsafety goals.
DIF: CognitiveLevel:Remember/Knowledge REF:p. 7 | Box 1-

3OBJ:Describequalityandsafetyinitiativesrelatedto criticalcarenursing.
15. You work in an intermediate care unit and have asked to be involved in developing
newguidelines to prevent pressure ulcers in your patient population. The nurse manager tells
youthat you do not yet have enough experience to be on the prevention task force and that
yourideaswill berejected byothers.TN
hiUsRsSitIuNaGtiToBn.CisOaMn exampleof
a. abarriertohandoffcommunication.
b. aworkenvironment thatisunhealthy.
c. ineffectivedecisionmaking.
d. nursingpracticethatisnotevidence-based.
ANS:B
These are examples of an unhealthy work environment. A healthy work environment
valuescommunication,collaboration,andeffectivedecisionmaking.Italsohas
authenticleadership.It is not an example of handoff communication, which is communication
that occurs totransition patient care from one staff member to another. Neither does it relate
to ineffectivedecision making. As a nurse, you can still implement evidence-based practice,
but yourinfluencein theunit is limited by the unhealthy work environment.
DIF: CognitiveLevel:Analyze/Analysis REF:pp. 8-

16. Which of the following statements describes the core concept of the synergy model
ofpractice?
a. Allnursesmust becertified inorder tohavethesynergy modelimplemented.
b. Familymembersmustbeincludedindailyinterdisciplinaryrounds.
c. Nursesandphysiciansmustworkcollaboratively andsynergisticallytoinfluence
care.
d. Uniqueneedsofpatientsand theirfamiliesinfluencenursingcompetencies.
ANS:D
The synergy model of practice is care based on the unique needs and characteristics of
thepatient and family members. Although critical care certification is based on the
synergymodel, the model does not specifically address certification. Inclusion of family
members intothe daily rounds is an example of implementation of the synergy model. With
the focus onpatients and family members with nurse interaction, the synergy model does not
addressphysiciancollaboration.
DIF: CognitiveLevel:Apply/Application REF:p.

TOP:IntegratedProcess: Caring
17. A nurse who plans care based on the patient’s gender, ethnicity, spirituality, and lifestyle
issaid to
a. beamoraladvocate.
b. facilitatelearning.
c. respondtodiversity.
d. useclinicaljudgment.
ANS:C
Responsetodiversityconsidersalloftheseaspectswhenplanningandimplementingcare. Amoral
agent helps resolve ethical and clinical concerns. Consideration of these factors
doesnotnecessarily facilitate learning. Clinicaljudgment uses otherfactors aswell.
DIF: CognitiveLevel:Understand/Comprehension REF:p.
TOP:NursingProcessStep: Planning
MSC:NCLEXClientNeedsCategory:Psychosocial Integrity
MULTIPLERESPONSE
1. Whichofthe followingisaNationalPatientSafety Goal?(Selectall thatapply.)

a. Accuratelyidentifypatients.
b. Eliminatetheuseofpatientrestraints.
c. Reconcilemedicationsacrossthecontinuumofcare.
d. Reducerisksofhealthcare–acquiredinfection.
e. Reducecostsassociated withhospitalization.
ANS:A,C,D
Allexceptfor eliminatingtheuseofrestraints andreducingcostsarecurrentNationalPatientSafety
Goals. Hospitals have policies regarding the use of restraints and are attempting toreduce the
use of restraints; however, this is not a National Patient Safety Goal.
Manyfacilitiesareactivelyworkingoncostreduction,butthisisnotaNationalPatientSafetyGoaleit
her.
DIF: CognitiveLevel:Remember/Knowledge REF:p. 7 | Box 1-

3OBJ:Describequality andsafetyinitiativesrelatedto criticalcarenursing.
2. Whichofthefollowing is(are)officialjournal(s) of
theAmericanAssociationofCritical-CareNurses? (Select all that apply.)
a. AmericanJournalofCriticalCare
b. CriticalCareClinics ofNorthAmerica
c. CriticalCareNurse
d. CriticalCareNursingQuarterly
e. CriticalCareNursingManagement
ANS:A,C
American Journal of Critical Care and Critical Care Nurse are two official
AACNpublications. Critical Care Clinics, Critical Care Nursing Quarterly, and
Critical CareNursingManagementarenot AACN publications.

3. Thefirstcriticalcareunitswere(Selectallthat apply.)
a. burnunits.
b. coronarycareunits.
c. recoveryrooms.
d. neonatalintensive careunits.
e. high-riskOB units.
ANS:B, C
Recoveryroomsandcoronarycareunitswerethefirstunitsdesignatedtocareforcritically illpatients.
Burn, neonatal intensive care, and high-risk OB units were established as specialtyunits
evolved.

3OBJ: Definecriticalcare nursing.
TOP:NursingProcessStep:N/AMSC:NCLEXClientNeedsCategory:Safe
andEffectiveCareEnvironment
4. Whichofthefollowingnursingactivities
demonstratesimplementationoftheAACNStandardsofProfessionalPerformance?
(Select all that apply.)
a. Attendingameeting ofthelocal chapterofthe American Association of
Critical-CareNursesinwhichacontinuingeducationprogramonsepsisisbeingtaught
b. Collaboratingwithapastoralservicescolleaguetoassistinmeetingspiritualneedsofthep
atient and family
c. Participatingontheunit’snursepracticecouncil
d. Posting an article from Critical Care Nurse on the management of
venousthromboembolismforyourcolleagues to read
e. Usingevidence-basedstrategiestopreventventilator-associatedpneumonia
ANS:A,B,C, D,E
All answers are correct. Attending a program to learn about sepsis—Acquires and
maintainscurrent knowledge and competency in patient care. Collaborating with
pastoralservices—Collaborates with the health care team to provide care in a healing,
humane, andcaring environment. Posting information for others—Contributes to the
professionaldevelopment of peers and other health care providers. Nurse practice council—
Providesleadership in the practice setting. Evidence-based practices—Uses clinical inquiry
inpractice.

5. Which scenarios contribute to effective handoff communication at change of shift? (Select

allthat apply.)
a. The nephrology consultant physician is making rounds and asks you for an
updateonthepatient’s statusand toassistin placinga centrallinefor hemodialysis.
b. Thenoise levelis high becausetwiceasmany staffmembers
arepresentandeveryoneis giving reportin thenurses’station.
c. The unit has decided to use a standardized checklist/tool for change-of-shift
reportsandpatient transfers.
d. Youandtheoncomingnurseconductastandardizedreportatthepatient’sbedsideandrevi
ewkey assessment findings.
e. Theoff-going nurseis givingthepatientmedications
atthesametimeasgivinghandoffreport to theoncoming nurse.
ANS:C, D .
Areportingtoolandbedsidereportimprovehandoffcommunicationbyensuring
standardizedcommunication and review of assessment findings. Conducting report at the
bedside alsoreduces noise that commonly occurs at the nurses’ station during a change of
shift. Thenephrologisthas created an interruptionthat canimpedehandoff withthenextnurse.
Likewise,noiseinthenurses’stationcan cause distractionsthatcanimpair
concentrationandlistening. Giving medications at the same time as handoff report could lead
to serious errorsbothin medication administration and in thereport itself.
DIF: CognitiveLevel:Analyze/Analysis REF:pp. 9-

10OBJ:Describequalityandsafetyinitiativesrelatedtocriticalcarenursing.
6. Which strategy is important in addressing issues associated with the aging workforce?
(Selectall that apply.)
a. Allowingnursestoworkflexibleshiftdurations
b. Encouragingoldernursestotransfertoanoutpatientsettingthatislessstressful
c. Hiringnursetechnicianswhoareavailableto
assistwithpatientcare,suchasturningthepatient
d. Remodelingpatientcare roomstoinclude devicestoassist inpatientlifting
e. Developingastaffingmodelthataccuratelyreflectstheunit’sneeds.
ANS:A,C,D
Modifying the work environment to reduce physical demands is one strategy to assist
theaging workforce. Examples include overhead lifts to prevent back injuries. Twelve-hour
shiftscan be quite demanding; therefore, allowing nurses flexibility in choosing shifts of
shorterduration is a good option as well. Adequate staffing, including both registered nurses
andnonlicensedassistivepersonnelto helpwithnursing andnonnursing tasks, ishelpful.
Encouragingexperienced,knowledgeable
criticalcarenursestoleavethecriticalcareunitisnotwiseas the unit loses the expertise ofthis
group.
DIF: CognitiveLevel:Analyze/Analysis REF:pp. 16-17

OBJ: Identifycurrenttrendsandissuesincritical carenursing.
7. Whichofthefollowingstrategies
willassistincreatingahealthyworkenvironmentforthecriticalcarenurse?(Select all that
apply.)
a. Celebratingimprovedoutcomesfroma nurse-drivenprotocolwithapizza party
b. Implementingamedicationsafetyprogramdesignedby pharmacists
c. Modifyingthestaffingpatternto ensure a1:1nurse/patientratio
d. Offeringquarterly jointnurse-physician workshopsto discussunit issues
e. Using the Situation-Background-Assessment-Recommendation (SBAR)
techniqueforhandoff communication
ANS:A,D,E
Meaningful recognition, true collaboration, and skilled communication are elements of
ahealthy work environment. Implementing a medication safety program enhances
patientsafety, but if done without nursing input, it could have negative outcomes. Staffing
should beadjustedtomeetpatient
needsandnursecompetencies,nothavepredeterminedratiosthatareunrealistic and possibly
unneededN .
DIF: CognitiveLevel:Apply/Application REF:pp. 8-


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Introduction To Critical Care Nursing 7th

DIF: CognitiveLevel:Remember/Knowledge REF:p. 5

2. Anursehas beenworking as astaff nurseinthesurgical intensivecareunit for2

DIF: CognitiveLevel:Remember/Knowledge REF: p. 6

3. Themainpurposeof certification isto

Certification assists in validating knowledge of the field, promotes excellence in

DIF: CognitiveLevel:Remember/Knowledge REF: p. 6

DIF: CognitiveLevel:Remember/Knowledge REF:p.

DIF: CognitiveLevel:Analyze/Analysis REF:p. 6 | Fig 1-3 | Box 1-

DIF: CognitiveLevel:Remember/Knowledge REF:p.

7. Thecharge nurseisresponsiblefor makingthepatientassignmentsonthecriticalcareunit.An

DIF: CognitiveLevel:Analyze/Analysis REF:p.

8. ThevisionoftheAmerican AssociationofCritical-CareNursesis ahealthcaresystemdrivenby

DIF: CognitiveLevel:Remember/Knowledge REF:p. 5

DIF: CognitiveLevel:Remember/Knowledge REF:p.

10. Youarecaringfora criticallyillpatientwhoseurineoutputhas beenlowfor2consecutivehours.

DIF: CognitiveLevel:Analyze/Analysis REF:p.

DIF: CognitiveLevel:Analyze/Analysis REF:p. 6 | Box 1-

12. Whichofthefollowingassists thecriticalcarenursein ensuringthatcareisappropriate

DIF: CognitiveLevel:Analyze/Analysis REF:p.

DIF: CognitiveLevel:Understand/Comprehension REF:p. 7 | Box 1-

DIF: CognitiveLevel:Remember/Knowledge REF:p. 7 | Box 1-

DIF: CognitiveLevel:Analyze/Analysis REF:pp. 8-

DIF: CognitiveLevel:Apply/Application REF:p.

1. Whichofthe followingisaNationalPatientSafety Goal?(Selectall thatapply.)

DIF: CognitiveLevel:Remember/Knowledge REF:p. 7 | Box 1-

DIF: CognitiveLevel:Remember/Knowledge REF:p. 5

DIF: CognitiveLevel:Remember/Knowledge REF:p.

DIF: CognitiveLevel:Remember/Knowledge REF:p.

5. Which scenarios contribute to effective handoff communication at change of shift? (Select

DIF: CognitiveLevel:Analyze/Analysis REF:pp. 9-

DIF: CognitiveLevel:Analyze/Analysis REF:pp. 16-17

DIF: CognitiveLevel:Apply/Application REF:pp. 8-

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