(Test Bank) Critical Care Nursing A Holistic Approach

Morton, 11

Nursing

Test Bank

11th Edition

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Test Bank for Critical Care Nursing A Holistic Approach, The downloadable file consists of 372 pages, and the total size of the file is 2.46 MB. Purchase now only for highly discounted price.

Author(s): Morton

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Critical Care Nursing A Holistic Approach 11th Edition Morton Test Bank 1. A nurse has recently been transferred to the ICU and is excited about the new challenges. Which action will best improve his skills and confidence to care for his clients? A) Obtaining certification in critical care nursing B) Seeking a mentor from the current staff C) Subscribing to current critical care nursing journals D) Volunteering for extra hours 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 clients. 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 n ursing journal. She then brings a cup of water and a straw to the client because she observes that his lips are dry. Later, she has the client sit in a wheelchair and takes him to have some blood tests performed. He objects at first, saying that he can wal k 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 client and immediately pages the physician. Which action taken by the nurse is the best example of evidence -based practice? A) Giving the client a cup of water B) Transferring the client 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 recently been 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 cl inical practice? A) Only hire nurses certified in critical care nursing. B) Leave copies of various 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 client in the ICU while the nurse is out. The client complains that the pain medication is not effective and that he would like to receive an increased dose. The physician pages the nurse and consults with him in the hallway regarding the client's request for stronger pain medication. The nurse explains that client wa s 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 client to give it just a bit more time. Which component of a healthy work environment is most evident in this scenari o? A) Skilled communication B) Appropriate staffing C) True collaboration D) Meaningful recognition 7. A nurse in the ICU is responding to a client who has just gone into cardiac arrest. A moment later, the nurse is notified that another client has just gone into anaphylactic shock because of 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 clients. 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 inju ry. Not only was the nurse attentive to the needs of the client, but she also went out of her way to care for the needs of the girl's family. According to research, which of the following forms of recognition would the nurse value the most? A) A card from the girl's family B) A plaque from the ICU physicians naming her as “Nurse of the Year” C) A letter of commendation from the hospital's administration D) A bouquet of flowers from her supervisor 9. A client in the ICU has recently been diagnosed with diabetes mellitus. Before being discharged, this client 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 client 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 client 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 United States and has no health insurance. He would likely be eligible for the state's 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. A) Clinical judgment B) Advocacy and moral agency C) Collaboration D) Systems thinking E) Response to diversity F) Clinical inquiry 12. The critical care nurse recognizes that the ability to provide quality nursing care requires prioritizing many activities to ensure the client remains the main focus. What must the nurse guard against becoming a potential distraction? A) Increasing family demands B) Evidence -based practice information from questionable sources C) The presence of nuisance alarms D) Requests and suggestions from client's family members 13. The American Association of Critical -Care Nurses (AACN) sponsors certification in critical care nursing for several critical care subspecialties. What is the most important benefit of such certification for the profession of nursing? A) Provides positive publicity for nursing B) Validates nurses' expert knowledge and practice C) Mandated by government regulations D) Demonstrates basic knowledge in the field 14. A nurse is preparing to hand her clients to the next nurse when several alarms go off. What is the most appropriate action for the nurse to take? A) Asking the incoming nurse to help check the clients B) Starting with the closest client first until all alarms are addressed C) Starting with the client furthest away first until all alarms are addressed D) Responding to the alarm according to the intensity until all clients are cared for 15. The nurse is recommending a change in the way the staff performs dressing changes. What is the best rationale to use to convince the other nurses that a change is warranted? A) Participate in research to investigate the suggested change. B) A recent evidence -based practice project validated the effectiveness of the new method. C) Other facilities are already doing it with success. D) It is proven to be more cost-effective. 16. The nurse caring for a critically ill client implements several components of care. What component is an example of the use of evidence -based practice? A) Use of a protocol for admission of a client to the unit B) Application of an insulin sliding scale method from research C) Checking the client's armband before giving a medication D) Limiting visits to immediate family only for 2 hours a day 17. The nurse wishes to increase the use of evidence -based practice in the critical care unit where he works. What is a significant barrier to the implementation of evidence -based practice? A) Use of computerized records by the hospital B) Health Information Portability and Accountability Act (HIPAA) C) Lack of knowledge about literature searches D) Strong collaborative relationships in the work setting 18. The nurse has identified an increase in medication errors in the critical care unit over the past several months. What aspect of medication procedures should be evaluated first? A) Adherence to procedures by nursing staff B) Clarity of interdisciplinary communication C) Number of new employees on the unit D) Changes in administration procedures 19. A critical care unit has decided to implement several measures designed to improve intradisciplinary and interdisciplinary collaboration. In addition to an expected improvement in client outcomes, what is the most important effect that should result from these measures? A) Identification of incompetent practitioners B) Improvement in manners on the unit C) Increased staff retention D) Less discussion in front of clients and families 20. A nurse wishes to practice using the Synergy Model developed by the American Association of Critical -Care Nurses (AACN). What nursing behavior best supports use of this model? A) Attending mandatory hospital -wide in-service programs B) Self-directed study of best practice for the clients she cares for C) Gathering demographic data on the clients admitted to the unit D) Participating in a research study as a data collector 21. As part of the Synergy Model, the nurse has identified a client characteristic of resiliency. What client behavior demonstrates resiliency? A) Dysfunctional grieving behaviors after receiving bad news B) Developing a list of questions for the physician C) Denial of any possible negative outcomes for a procedure D) Assigning blame to others for undesired outcomes of illness 22. Rising costs and availability of adequate health care will continue to impact the health of a community. Which action by the nurse can help ensure that future clients will receive the health care they need? A) Advise clients of available health insurance options. B) Conduct information classes in the community about health insurance. C) Advocate for the client and family with the insurance company to obtain coverage for necessary care. D) Become a member of a nursing organization that can influence legislative activity. 23. A Muslim client has been admitted to the critical care unit with complications after birth. Based on the Synergy Model, which nurse would be the most inappropriate to assign to care for this client? A) New graduate female nurse B) Most experienced female nurse C) New graduate male nurse D) Female nurse with postpartum experience 24. Today's critical care nursing environment is constantly changing. What nursing behavior best illustrates awareness of current events affecting critical care nursing? A) Participating in the hospital's efforts to recruit new nurses B) Volunteering to serve on a disaster response planning committee C) Adhering to content taught in basic nursing program D) Attending hospital -mandated in-services without other education 25. A supervisor has noticed that a nurse appears to be resetting various alarms to preventing them from working correctly. Which action would be best for this supervisor to take? A) Talk to the nurse in private about the situation. B) Verify the situation with other senior staff nurses. C) Reset the alarms to the appropriate setting. D) Assign a mentor to work with this nurse. Answer Key 1. A 2. A 3. C 4. B 5. D 6. C 7. B 8. A 9. D 10. B, C 11. B, D, E 12. C 13. B 14. D 15. B 16. B 17. C 18. B 19. C 20. B 21. B 22. D 23. C 24. B 25. A Page 1 1. A critical care client is unusually combative and is refusing to cooperate. Vital signs demonstrate a temperature of 97.6°F, heart rate of 86 beats per minute, respiratory rate of 24 breaths per minute, and pulse oximetry of 98%. After reviewing the past 24 hours, which nursing care recommendation should the nurse do first? A) Change bath time from 9 p.m. to 4 a.m. B) Limit visits to immediate family. C) Reschedule all radiology exams for 1 a.m. D) Offer the client earplugs during time of sleep. 2. A client is transferred to the ICU from the Birth Center of the hospital in the middle of the night after experiencing complications during the birth of her baby. The client's husband is anxious and explains to the ICU nurse that he does not understand why his wife has been moved to the ICU. “She is going to die, isn't she?” he asks the nurse. What is the nurse's best response? A) Explain that every measure will be taken to provide his wife with the best care possible. B) Explain that the nurse is fully trained and has years of experience. C) Offer the husband a place to relax. D) Have appropriate staff discuss his health insurance with him. 3. A client is admitted to the ICU with injuries sustained from a fall. The client is conscious and has labored breathing and elevated heart rate. The client is reporting pain of 5 out of 10 on the pain scale. Which of the following interventions is the highest priority? A) Providing supplemental oxygen B) Preparing for radiological studies C) Ensuring pain relief D) Completing comprehensive assessment 4. A client in the ICU is recovering from open heart surgery. The nurse enters his room and observes that his daughter is performing effleurage on his arms and talking in a low voice about an upcoming family vacation that is planned. The room is dimly lit, and she hears the constant beeping of his heart monitor. From the hall, she hears the cries of a client in pain. Which of the following are likely stressors for the client? Select all that apply. A) His daughter's conversation B) His daughter's effleurage C) The beeping of the heart monitor D) The dim lighting of the room E) The cries of the other client from the hall Page 2 5. The nurse finds her work in the critical care unit to be rewarding and challenging, especially balancing family responsibilities with night shift duties. Which actions by the nurse are priorities to ensure her own well-being? Select all that apply. A) Get adequate sleep when off-duty. B) Use bright lights in nursing areas during night shifts away from client rooms. C) Ensure adequate snacks are available during shift. D) Avoid overtime and extra shifts. E) .Enlist the assistance of family members to help with family responsibilities. 6. A nurse walks into a client's room and begins preparing a syringe to perform a blood draw on the client. The nurse observes that the client is firmly gripping the side of the bed, averting her eyes, and sweating from her forehead when she sees the needle. What would be the best intervention for the nurse to make? A) Proceeding with blood draw as quickly as possible, to get it over with B) Offering to come back later to perform the blood draw C) Encouraging the client to deep breathe D) Describing briefly the blood draw procedure and explain why it is necessary 7. A 15 -year-old client is in the ICU and preparing for an appendectomy. He is clearly anxious and fidgets with his IV constantly. He complains that he does not want to be there, and he is sick of everyone telling him what to do. What would be the best way for the nurse to address this client's anxiety? A) Use physical restraints to keep him from pulling out his IV. B) Offer him the remote to the television. C) Lower the head of his bed so that he can rest more easily. D) Explain to the client in detail what the appendectomy will consist of. 8. A nurse in a burn unit observes that a client is tensed up and frowning but silent. The nurse asks the client, “Can you tell me what you are thinking now?” The client responds, “I can't take this pain anymore! I feel like I'm about to die.” What would be the best response for the nurse to give to the client, consi dering that the client is already receiving the maximum amount of pain medication that is safe? A) “Try to get rid of those negative thoughts —they only make it worse.” B) “Try thinking instead, 'This pain will go away; I can overcome it.'” C) “Your pain medication is already at the highest possible dose.” D) “Would you like me to raise the head of your bed?” 9. A client on mechanical ventilation is experiencing severe agitation because of being on the ventilator. Which nursing intervention would be best? A) Performing breathing exercises with the client B) Offering the client a patient -controlled analgesic device Page 3 C) Asking the physician to prescribe an anti-anxiety medication D) Offering the client her own MP3 player to listen to 10. A 10 -year-old female client in ICU receiving chemotherapy has requested that her dog be allowed to visit her. She is currently sharing a room with another client. What would be the best way for the nurse to address this request? A) Indicate a specific time for a 20-minute visit with the dog on a leash. B) Request approval for an overnight stay from the physician. C) Request official documentation of the dog's vaccinations for the record. D) Consult the hospital's policy for guidelines concerning this request. 11. The nurse understands that a client being cared for in a critical care unit experiences an acute stress response. What nursing action best demonstrates understanding of the physiologic parts of the initial stress response? A) Adequate pain control B) Intravenous sedation C) Treatment for elevated blood pressure D) Ignoring an elevated glucose level 12. A critically ill client experiences stress and anxiety from many factors. Treatment of the client focuses on reducing stressors and providing supportive care such as nutrition, oxygenation, pain management, control of anxiety, and specific care of the illness or injury. What is the best rationale for these interventions? A) Helps to support the client's immune system B) Part of good nursing care C) Mandated by hospital policy D) Reassures the client and family 13. A client in a critical care unit has increased stress from the constant noise and light levels. What nursing intervention best attenu ates these sources of stress? A) Need for constant observation and evaluation B) Dimming lights during the night C) Frequent nursing group rounds for all clients D) Use of tile floors for ease in cleaning 14. The nurse is caring for a client who is orally intubated and on a mechanical ventilator. The nurse believes that the client is experiencing excess anxiety. For this client, what behavior best indicates anxiety? A) Restlessness B) Verbalization C) Increased respiratory rate Page 4 D) Glasgow Coma Scale score of 3 15. A client was admitted to the ICU 24 hours ago with a fractured right humerus, bruised liver, and numerous superficial lacerations and hematomas following a motor vehicle accident. The client is refusing to get up and sit in a chair. What is the nurse's best response? A) Explain it is the doctor's order to help the client heal faster. B) Document the refusal and leave the client alone. C) Discuss the benefits of early mobilization with the client. D) Enlist the family members to help convince the client to get out of bed. 16. A client is complaining about a lack of sleep. Which action by the nurse will best assist this client sleep better? A) Reposition every 4 hours B) Hypnotic medications C) Five-minute back effleurage D) Adequate pain control 17. The nurse is caring for a critically ill client with a very concerned family. Given that the family is under high stress, what nursing intervention will best ameliorate their stress while preserving indep endence? A) Encourage the family to participate in client care tasks. B) Teach the family to ask questions of the health care team. C) Ask the family to select a family representative for communication. D) Limit visits to immediate family members for limited times. 18. While caring for a critically ill client, the nurse knows that fostering client control over the environment is a method for stress reduction. What nursing intervention gives the client the most environmental control while still adhering to best practice principles? A) Ask the client whether he or she wants to get out of bed. B) Give the client's bath at the same time every day. C) Explain painful procedures only after giving pain medication. D) Choose menu items for the client to ensure a balanced diet. 19. The nurse is using presence to reduce the anxiety of a critically ill client. What nursing behavior demonstrates an effective use of presence? A) Staying in the client's room to complete documentation B) Having a conversation in the client's room that excludes the client C) Maintaining eye contact with the client during explanations D) Focusing on specific nursing care tasks while in the client's room Page 5 20. The nurse is caring for a critically ill client who can speak. The nurse notices that the client is demonstrating behaviors indicative of anxiety but is silent. What nursing strategy would give the nurse the most information about the client's feelings? A) Explain procedures to the client and family. B) Ask the client to share his or her internal dialogue. C) Encourage the client to nap before visiting hours. D) Ensure that the client has adequate pain control. 21. A client has been transferred from another facility for specialized treatment. The client presents with a tracheostomy, a PICC line, postexploratory laparotomy, and redness and bruising around the wrists. What is the priority action by the nurse? A) Notify the health care provider of client's arrival. B) Complete the initial assessment of the client. C) Loosen the physical restraints. D) Remove the restraints immediately. 22. One of the strategies shown to reduce perception of stress in critically ill clients and their families is support of spirituality. What nursing action is most clearly supportive of the client's spirituality? A) Referring clients to the Catholic chaplain B) Providing prayer booklets to clients and families C) Asking about beliefs about the universe D) Avoiding discussing religion with those of other faiths 23. A critically ill client tells the nurse that he is not afraid to die because he believes in reincarnation. What is the most appropriate nursing response? A) “What if reincarnation is not real?” B) “This belief gives you strength.” C) “I don't believe in reincarnation.” D) “You shouldn't base your hopes on such a belief.” 24. A critically ill client who is intubated and agitated is restrained with soft wrist restraints. Based on research findings, what is the best nursing action? A) Maintain the restraints to protect client safety. B) Remove the restraints periodically to check skin integrity. C) Remove the restraints periodically for range of motion. D) Assess and intervene for causes of agitation. Page 6 25. The client is showing signs of confusion and is trying to pull out her IVs and Foley catheter. Which action should the nurse implement? Select all that apply. A) Apply a loose stockinette over the IV site. B) Apply loose restraints. C) Assess the client for pain. D) Recruit a family member to sit with the client at all times. E) Explain the purpose of each tube and device to the client. Page 7 Answer Key 1. D 2. A 3. A 4. C, E 5. A, B, D 6. D 7. B 8. B 9. D 10. D 11. A 12. A 13. B 14. A 15. C 16. C 17. B 18. B 19. C 20. B 21. C 22. C 23. B 24. D 25. A, C, E Page 1 1. A client has just been admitted to the ICU after a severe auto accident and losing one of the legs. The spouse has her hand over his heart and complains of a rapid heart rate. The nurse recognizes this condition as a sign of which stage of th e general adaptation syndrome to stress? A) Alarm stage B) Exhaustion stage C) Resistance stage D) Adaptation stage 2. The nurse observes that an elderly woman, whose granddaughter has been admitted to the ICU, is struggling to manage her two great -grandsons, who are toddlers, in the waiting room. What is the most likely explanation for the woman's inability to manage the children in this situation? A) She is confused with the visiting policies of the hospital. B) She is in the exhaustion stage of the general adaptation syndrome to stress. C) The children are not used to her being in charge. D) She has macular degeneration and cannot see well. 3. A nurse needs to communicate with a client's family regarding consent to treat an unconscious client in the ICU. Which member of the group should the nurse approach first? A) A man who identifies himself as the client's brother B) A teenage boy who approaches the nurse C) A woman who originally escorted the client in D) A woman in the group whom the others look at and call over when the nurse approaches 4. The elderly client has been moved to palliative care because of the worsening of his health and failure to respond to treatment. His wife is very distressed and wishes to take care of him. What is the best response from the nurse? A) Explain that the care is too complicated but she may sit with him as long as she wants. B) Request an order from the attending physician to allow her to assist. C) Ask the wife which tasks she would like to do. D) Transfer the client to hospice where she can actively participate in his care. 5. A nurse observes that a single father whose 11-year-old daughter is i n the ICU is struggling to explain to his 6 -year-old son the likelihood that the daughter will die. The young boy asks what will happen to his sister when she dies, but the father breaks down in tears and seems unable to respond. Which would be the most appropriate intervention for the nurse to make? A) Suggest that the father contact his pastor, rabbi, or other spiritual leader for counsel