(Test Bank) Introduction To Critical Care Nursing

Sole, 7

Nursing

Test Bank

7th Edition

• $15.00 $50.00

---

Description

Test Bank for Introduction To Critical Care Nursing, The downloadable file consists of 332 pages, and the total size of the file is 3.63 MB. Purchase now only for highly discounted price.

Author(s): Sole

---

---

Study Note Preview

NURSINGTB.COM Chapter 01: Overview of Critical Care Nursing Sole: Introduction to Critical Care Nursing, 7th Edition MULTIPLE CHOICE 1. Which of the following professional organizations best supports critical care nursing practice? a. American Association of Critical -Care Nurses b. American Heart Association c. American Nurses Association d. Society of Critical Care Medicine ANS: A The American Association of Critical -Care Nurses is the specialty organization that supports and represents critical care nurses. The American Heart Association supports cardiovascular initiatives. The American N urses Association supports all nurses. The Society of Critical Care Medicine represents the multiprofessional critical care team under the direction of an intensivist. DIF: Cognitive Level: Remember/Knowledge REF: p. 5 OBJ: Discuss the purposes and funct ions of the professional organizations that support critical care practice. TOP: Nursing Process Step: N/A MSC: NCLEX Client Needs Category: Safe and Effective Care Environment 2. A nurse has been working as a staff nurse in the surgical intensive care unit for 2 years and is interested in certification. Which credential would be most applicable for the nurse to seek? a. ACNPC -AG b. CNML c. CCRN d. PCCN ANS: C The CCRN certification is appropriate for nurses in bedside practice who care for critically ill patients. The ACNPC -AG certification is for acute care nurse practitioners. The CNML is for critical care nurse managers or leaders. The PCCN certification is for staff nurses working in progressive care, intermediate care, or step -down unit settings. DIF: Cognitive Level: Remember/Knowledge REF: p. 6 OBJ: Explain certification options for critical care nurses. TOP: Nursing Process Step: N/A MSC: NCLEX Client Needs Category: Safe and Effective Care Environment 3. The main purpose of certification is to a. assure the consumer that you will not make a mistake. b. prepare for graduate school. c. promote mag net status for your facility. d. validate knowledge of critical care nursing. ANS: D NURSINGTB.COM INTRODUCTION TO CRITICAL CARE NURSING 7TH EDITION SOLE TEST BANK NURSINGTB.COM Certification assists in validating knowledge of the field, promotes excellence in the profession, and helps nurses to maintain their knowledge of critical care nursin g. Certification helps to assure the consumer that the nurse has a minimum level of knowledge; however, it does not ensure that care will be mistake -free. Certification does not prepare one for graduate school; however, achieving certification demonstrates motivation for achievement and professionalism. Magnet facilities are rated on the number of certified nurses; however, that is not the purpose of certification. DIF: Cognitive Level: Remember/Knowledge REF: p. 6 OBJ: Explain certification options for critical care nurses. TOP: Nursing Process Step: N/A MSC: NCLEX Client Needs Category: Safe and Effective Care Environment 4. The synergy model of practice focuses on a. allowing unrestricted visiting for the patient 24 hours a day. b. holistic and alternative therapies. c. the needs of patients and their families, which drive nursing competency. d. patients’ needs for energy and support. ANS: C The synergy model of practice states that the needs of patients and families influence and drive competencies of nurses. Nursing practice based on the synergy model would involve tailored visiting to meet the patient’s and family’s needs and the applicatio n of alternative therapies if desired by the patient, but that is not the primary focus of the model. DIF: Cognitive Level: Remember/Knowledge REF: p. 6 OBJ: Describe standards of professional practice for critical care nursing. TOP: Nursing Process Step: N/A MSC: NCLEX Client Needs Category: Safe and Effective Care Environment 5. The family of your critically ill patient tells you that they have not spoken with the physician in over 24 hours and that they have some questions they want clarified. During morning rounds, you convey this concern to the attending intensivist and arrange a meeting with the family at 4:00 PM. Which competency of critical care nursi ng does this represent? a. Advocacy and moral agency in solving ethical issues b. Clinical judgment and clinical reasoning skills c. Collaboration with patients, families, and team members d. Facilitation of learning for patients, families, and team members ANS: C Although one might consider that all of these competencies are being addressed, communication and collaboration with the family and physician best exemplify the competency of colla boration. DIF: Cognitive Level: Analyze/Analysis REF: p. 6 | Fig 1 -3 | Box 1 -1 OBJ: Describe standards of professional practice for critical care nursing. TOP: Nursing Process Step: N/A MSC: NCLEX Client Needs Category: Safe and Effective Care Environm ent 6. The AACN Standards for Acute and Critical Care Nursing Practice use what framework to guide critical care nursing practice? a. Evidence -based practice NURSINGTB.COM INTRODUCTION TO CRITICAL CARE NURSING 7TH EDITION SOLE TEST BANK NURSINGTB.COM b. Healthy work environment c. National Patient Safety Goals d. Nursing process ANS: D The AACN Standards for Acute and Critical Care Nursing Practice delineate the nursing process as applied to critically ill patients: collect data, determine diagnoses, identify expected outcomes, develop a plan of care, implement interventions, and evaluate care. AACN promotes a healthy work environment, but this is not included in its standar ds. The Joint Commission has established National Patient Safety Goals, but these are not the AACN standards. DIF: Cognitive Level: Remember/Knowledge REF: p. 6 OBJ: Describe standards of professional practice for critical care nursing. TOP: Nursing Proc ess Step: N/A MSC: NCLEX Client Needs Category: Safe and Effective Care Environment 7. The charge nurse is responsible for making the patient assignments on the critical care unit. An experienced, certified nurse is assigned to care for the acutely ill patient with sepsis who also requires continuous renal replacement therapy and mechanical ventilation. The nurse with less than 1 year of experience is assigned to two patients who are more stable. This assignment reflects implementation of the a. crew res ource management model. b. National Patient Safety Goals. c. Quality and Safety Education for Nurses (QSEN) model. d. synergy model of practice. ANS: D This assignment demonstrates nursing care to meet the needs of the patient. The synergy model notes that the nurse competencies are matched to the patient characteristics. Crew resource management concepts are related to team training; National Patient Saf ety Goals are specified by The Joint Commission to promote safe care but do not incorporate the synergy model. The Quality and Safety Education for Nurses initiative involves targeted education of undergraduate and graduate nursing students on quality and safety concepts. DIF: Cognitive Level: Analyze/Analysis REF: p. 6 OBJ: Describe standards of professional practice for critical care nursing. TOP: Nursing Process Step: N/A MSC: NCLEX Client Needs Category: Safe and Effective Care Environment 8. The vision of the American Association of Critical -Care Nurses is a health care system driven by a. a healthy work environment. b. care from a multiprofessional team under the direction of a critical care physician. c. the needs of critically ill patients and families. d. respectful, healing, and humane environments. ANS: C NURSINGTB.COM INTRODUCTION TO CRITICAL CARE NURSING 7TH EDITION SOLE TEST BANK NURSINGTB.COM The AACN vision is a health care system driven by the ne eds of critically ill patients and families where critical care nurses make their optimum contributions. AACN promotes initiatives to support a healthy work environment as well as respectful and healing environments, but that is not the organization’s visi on. The Society of Critical Care Medicine (SCCM) promotes care from a multiprofessional team under the direction of a critical care physician. DIF: Cognitive Level: Remember/Knowledge REF: p. 5 OBJ: Discuss the purposes and functions of the professional organizations that support critical care practice. TOP: Nursing Process Step: N/A MSC: NCLEX Client Needs Category: Safe and Effective Care Environment 9. The most important outcome of effective com munication is to a. demonstrate caring practices to family members. b. ensure that patient teaching is done. c. meet the diversity needs of patients. d. reduce patient errors. ANS: D Many errors are directly attributed to faulty communication. Effective communication has been identified as an essential strategy to reduce patient errors and resolve issues related to patient care delivery. Communication may demonstrate caring practices, address diversity needs, and be used for patient/family teaching; however, the main outcome of effective communication is patient safety. DIF: Cognitive Level: Remember/Knowledge REF: p. 9 OBJ: Describe quality and safety initiatives related to critical care nursing. TOP: Nursing Process Step: N/A MSC: NCLEX Client Needs Category: Safe and Effective Care Environment 10. You are caring for a critically ill patient whose urine output has been low for 2 consecutive hours. After a thorough patient assessment, you call the intensivist with report. Which information do you convey regarding background? a. Urine output of 40 mL/2 hours b. Current vital signs and history of aortic aneurysm repair 4 hours ago c. A statement that the patient is possibly hypovolemic d. A request for IV fluids ANS: B The history and vital signs are part of the background. Information regarding the low urine output is the situation. Information regarding possible hypovolemia is part of the nurse’s assessment, and the suggestion for fluids is the recommendation. DIF: Cognitive Level: Analyze/Analysis REF: p. 9 OBJ: Describe quality and safety initiatives related to critical care nursing. TOP: Integrated Process: Communication MSC: NCLEX Client Needs Category: Safe and Effective Care Environment 11. The family memb ers of a critically ill patient bring a copy of the patient’s living will to the hospital, which identifies the patient’s wishes regarding health care. You discuss contents of the living will with the patient’s physician. This is an example of implementati on of which of the AACN Standards of Professional Performance? NURSINGTB.COM INTRODUCTION TO CRITICAL CARE NURSING 7TH EDITION SOLE TEST BANK NURSINGTB.COM a. Acquires and maintains current knowledge of practice b. Acts ethically on the behalf of the patient and family c. Considers factors related to safe patient care d. Uses clinical inquiry and integrates research findings in practice ANS: B Discussing end -of-life issues is an example of a nurse acting ethically on behalf of the patient and family. The example does not relate to acquiring knowledge, promoting patient safety, or using research in practice. DIF: Cognitive Level: Analyze/Analysis REF: p. 6 | Box 1 -2 OBJ: Describe standards of care and performance for critical care nursing. TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Safe and Effective Care Environment 12. Which of the following assists the cri tical care nurse in ensuring that care is appropriate and based on research? a. Clinical practice guidelines b. Computerized physician order entry c. Consulting with advanced practice nurses d. Implementing Joint Commission National Patient Safety Goals ANS: A Clinical practice guidelines are being implemented to ensure that care is appropriate and based on research. Some physician order entry pathways, but not all, are based on research recom mendations. Some advanced practice nurses, but not all, are well versed in evidence -based practices. The National Patient Safety Goals are recommendations to reduce errors using evidence -based practices. DIF: Cognitive Level: Analyze/Analysis REF: p. 8 OBJ: Describe standards of professional practice for critical care nursing. TOP: Nursing Process Step: N/A MSC: NCLEX Client Needs Category: Safe and Effective Care Environment 13. Comparing the patient’s cu rrent (home) medications with those ordered during hospitalization and communicating a complete list of medications to the next provider when the patient is transferred within an organization or to another setting are strategies to: a. improve accuracy of patient identification. b. prevent errors related to look -alike and sound -alike medications. c. reconcile medications across the continuum of care. d. reduce harms associated with the administration of anticoagulants. ANS: C These are steps recommended in the National Patient Safety Goals to reconcile medications across the continuum of care. Improving accuracy of patient identification is another Nat ional Patient Safety Goal. Preventing errors related to look -alike and sound -alike medications is done to improve medication safety, but is not related to transferring the patient between settings. Reducing harms associated with the administration of antic oagulants is another National Patient Safety Goal. DIF: Cognitive Level: Understand/Comprehension REF: p. 7 | Box 1 -3 OBJ: Describe quality and safety initiatives related to critical care nursing. NURSINGTB.COM INTRODUCTION TO CRITICAL CARE NURSING 7TH EDITION SOLE TEST BANK NURSINGTB.COM TOP: Nursing Process Step: N/A MSC: NCLEX Client Needs Category: Safe and Effective Care Environment 14. As part of nursing management of a critically ill patient, orders are writ ten to keep the head of the bed elevated at 30 degrees, awaken the patient from sedation each morning to assess readiness to wean from mechanical ventilation, and implement oral care protocols every 4 hours. These interventions are done as a group to reduc e the risk of ventilator -associated pneumonia. This group of evidence -based interventions is often called a a. bundle of care. b. clinical practice guideline. c. patient safety goal. d. quality improvement initiative. ANS: A A group of evidence -based interventions done as a whole to improve outcomes is termed a bundle of care. This is an example of the ventilator bundle. Oftentimes these bundles are derived from clinical practice guidelines and are monitored for compliance as part of quality improvement initiatives. At some point, these may become part of patient safety goals. DIF: Cognitive Level: Remember/Knowledge REF: p. 7 | Box 1 -3 OBJ: Describe quality and safety initiatives related to critical care nursing. TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Safe and Effective Care Environment 15. You work in an intermediate care unit and have asked to be involved in developing new guidelines to prevent pressure ulcers in your patient p opulation. The nurse manager tells you that you do not yet have enough experience to be on the prevention task force and that your ideas will be rejected by others. This situation is an example of a. a barrier to handoff communication. b. a work environme nt that is unhealthy. c. ineffective decision making. d. nursing practice that is not evidence -based. ANS: B These are examples of an unhealthy work environment. A healthy work environment values communication, collaboration, and effective decision making. It also has authentic leadership. It is not an example of handoff communication, which is communication that occurs to transition patient care from one staff member to another. Neither does it relate to ineffective decision making. As a nurse, you can still implement evidence -based practice, but your influence in the unit is limited by the unhealthy work environ ment. DIF: Cognitive Level: Analyze/Analysis REF: pp. 8 -9 OBJ: Describe standards of professional practice for critical care nursing. TOP: Nursing Process Step: N/A MSC: NCLEX Client Needs Category: Safe and Effective Care Environment 16. Which of th e following statements describes the core concept of the synergy model of practice? a. All nurses must be certified in order to have the synergy model implemented. b. Family members must be included in daily interdisciplinary rounds. c. Nurses and physicians must work collaboratively and synergistically to influence NURSINGTB.COM INTRODUCTION TO CRITICAL CARE NURSING 7TH EDITION SOLE TEST BANK NURSINGTB.COM care. d. Unique needs of patients and their families influence nursing competencies. ANS: D The synergy model of practice is care based on the unique needs and characteristics of the patient and family members. Although critical care certification is based on the synergy model, the model does not specifically address certification. Inclusion of f amily members into the daily rounds is an example of implementation of the synergy model. With the focus on patients and family members with nurse interaction, the synergy model does not address physician collaboration. DIF: Cognitive Level: Apply/Applica tion REF: p. 6 OBJ: Describe standards of professional practice for critical care nursing. TOP: Integrated Process: Caring MSC: NCLEX Client Needs Category: Safe and Effective Care Environment 17. A nurse who plans care based on the patient’s gender, ethnicity, spirituality, and lifestyle is said to a. be a moral advocate. b. facilitate learning. c. respond to diversity. d. use clinical judgment. ANS: C Response to diversity considers all of these aspects when planning and implementing care. A moral agent helps resolve ethical and clinical concerns. Consideration of these factors does not necessarily facilitate learning. Clinical judgment uses other facto rs as well. DIF: Cognitive Level: Understand/Comprehension REF: p. 5 OBJ: Describe standards of professional practice for critical care nursing. TOP: Nursing Process Step: Planning MSC: NCLEX Client Needs Category: Psychosocial Integrity MULTIPLE RESPONSE 1. Which of the following is a National Patient Safety Goal? (Select all that apply. ) a. Accurately identify patients. b. Eliminate the use of patient restraints. c. Reconcile medications across the continuum of care. d. Reduce risks of health care –acquired infection. e. Reduce costs associated with hospitalization. ANS: A, C, D All except for eliminating the use of restraints and reducing costs are current National Patient Safety Goals. Hospitals have policies regarding the use of restraints and are attempting to reduce the use of restraints; however, this is not a National Patie nt Safety Goal. Many facilities are actively working on cost reduction, but this is not a National Patient Safety Goal either. DIF: Cognitive Level: Remember/Knowledge REF: p. 7 | Box 1 -3 OBJ: Describe quality and safety initiatives related to critical c are nursing. NURSINGTB.COM INTRODUCTION TO CRITICAL CARE NURSING 7TH EDITION SOLE TEST BANK NURSINGTB.COM TOP: Nursing Process Step: N/A MSC: NCLEX Client Needs Category: Safe and Effective Care Environment 2. Which of the following is (are) official journal(s) of the American Association of Critical -Care Nurses? (Select all that apply. ) a. American Journal of Critical Care b. Critical Care Clinics of North America c. Critical Care Nurse d. Critical Care Nursing Quarterly e. Critical Care Nursing Management ANS: A, C American Journal of Critical Care and Critical Care Nurse are two official AACN publications. Critical Care Clinics, Critical Care Nursing Quarterly, and Critical Care Nursing Management are not AACN publications. DIF: Cognitive Level: Remember/Knowledge REF: p. 5 OBJ: Discuss the purposes and functions of the professional organizations that supp ort critical care practice. TOP: Nursing Process Step: N/A MSC: NCLEX Client Needs Category: Safe and Effective Care Environment 3. The first critical care units were ( Select all that apply. ) a. burn units. b. coronary care units. c. recovery rooms. d. neonatal intensive care units. e. high-risk OB units. ANS: B, C Recovery rooms and coronary care units were the first units designated to care for critically ill patients. Burn, neonatal intensive care, and high -risk OB units were e stablished as specialty units evolved. DIF: Cognitive Level: Remember/Knowledge REF: p. 3 OBJ: Define critical care nursing. TOP: Nursing Process Step: N/A MSC: NCLEX Client Needs Category: Safe and Effective Care Environment 4. Which of the following nursing activities demonstrates implementation of the AACN Standards of Professional Performance? ( Select all that apply. ) a. Attending a meeting of the local chap ter of the American Association of Critical -Care Nurses in which a continuing education program on sepsis is being taught b. Collaborating with a pastoral services colleague to assist in meeting spiritual needs of the patient and family c. Participating on the unit’s nurse practice council d. Posting an article from Critical Care Nurse on the management of venous thromboembolism for your colleagues to read e. Using evidence -based strategies to prevent ventilator -associated pneumonia ANS: A, B, C, D, E NURSINGTB.COM INTRODUCTION TO CRITICAL CARE NURSING 7TH EDITION SOLE TEST BANK NURSINGTB.COM All answers are correct. Attending a program to learn about sepsis —Acquires and maintains current knowledge and competency in patient care. Collaborating with pastoral services —Collaborates with the health care team to provide care in a healing, humane, and caring environment. Posting information for others —Contributes to the professional development of peers and other health care providers. Nurse practice council —Provides leadership in the practice setting. Evidence -based practices —Uses clinical inquiry in practice. DIF: Cognitive Level: Remember/Knowledge REF: p. 4 OBJ: Describe standards of professional practice for critical care nursing. TOP: Nursing Process Step: N/A MSC: NCLEX Client Needs Category: Safe and Effective Care Environment 5. Which scenarios contribute to effective handoff communication at change of shift? ( Select all that apply. ) a. The nephrology consultant physician is making rounds and asks you for an upd ate on the patient’s status and to assist in placing a central line for hemodialysis. b. The noise level is high because twice as many staff members are present and everyone is giving report in the nurses’ station. c. The unit has decided to use a standardized checklist/tool for change -of-shift reports and patient transfers. d. You and the oncoming nurse conduct a standardized report at the patient’s bedside and review key assessment findings. e. The off -going nurse i s giving the patient medications at the same time as giving handoff report to the oncoming nurse. ANS: C, D A reporting tool and bedside report improve handoff communication by ensuring standardized communication and review of assessment findings. Condu cting report at the bedside also reduces noise that commonly occurs at the nurses’ station during a change of shift. The nephrologist has created an interruption that can impede handoff with the next nurse. Likewise, noise in the nurses’ station can cause distractions that can impair concentration and listening. Giving medications at the same time as handoff report could lead to serious errors both in medication administration and in the report itself. DIF: Cognitive Level: Analyze/Analysis REF: pp. 9 -10 OBJ: Describe quality and safety initiatives related to critical care nursing. TOP: Nursing Process Step: N/A MSC: NCLEX Client Needs Category: Safe and Effective Care Environment 6. Which strategy is im portant in addressing issues associated with the aging workforce? ( Select all that apply. ) a. Allowing nurses to work flexible shift durations b. Encouraging older nurses to transfer to an outpatient setting that is less stressful c. Hiring nurse technicians who are available to assist with patient care, such as turning the patient d. Remodeling patient care rooms to include devices to assist in p atient lifting e. Developing a staffing model that accurately reflects the unit’s needs. ANS: A, C, D NURSINGTB.COM INTRODUCTION TO CRITICAL CARE NURSING 7TH EDITION SOLE TEST BANK NURSINGTB.COM Modifying the work environment to reduce physical demands is one strategy to assist the aging workforce. Examples include overhead lifts to prevent ba ck injuries. Twelve -hour shifts can be quite demanding; therefore, allowing nurses flexibility in choosing shifts of shorter duration is a good option as well. Adequate staffing, including both registered nurses and nonlicensed assistive personnel to help with nursing and nonnursing tasks, is helpful. Encouraging experienced, knowledgeable critical care nurses to leave the critical care unit is not wise as the unit loses the expertise of this group. DIF: Cognitive Level: Analyze/Analysis REF: pp. 16 -17 OBJ: Identify current trends and issues in critical care nursing. TOP: Nursing Process Step: N/A MSC: NCLEX Client Needs Category: Safe and Effective Care Environment 7. Which of the following strategies will assist in creating a healthy work environment for the critical care nurse? ( Select all that apply. ) a. Celebrating improved outcomes from a nurse -driven protocol with a pizza party b. Implementing a medication safety program designed by pharmacists c. Modifying the staffing pattern to ensure a 1:1 nurse/patient ratio d. Offering quarterly joint nurse -physician workshops to discuss unit issues e. Using the Situation -Background -Assessment -Recommendation (SBAR) technique for ha ndoff communication ANS: A, D, E Meaningful recognition, true collaboration, and skilled communication are elements of a healthy work environment. Implementing a medication safety program enhances patient safety, but if done without nursing input, it co uld have negative outcomes. Staffing should be adjusted to meet patient needs and nurse competencies, not have predetermined ratios that are unrealistic and possibly unneeded. DIF: Cognitive Level: Apply/Application REF: pp. 8 -9 OBJ: Describe standards of professional practice for critical care nursing. TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Safe and Effective Care Environment NURSINGTB.COM INTRODUCTION TO CRITICAL CARE NURSING 7TH EDITION SOLE TEST BANK NURSINGTB.COM Chapter 02: Patient and Family Response to the Critical Care Experience Sole: Introduction to Critical Care Nursing, 7th Edition MULTIPLE CHOICE 1. Family members have a need for information. Which interventions best assist in meeting this need? a. Handing family members a pamphlet that explains all of the critical care equipment b. Providing a daily update of the patient’s progress and facilitating communication with the intensivist c. Telling them that you are not permitted to give them a status report but that they can be present at 4:00 PM for family rounds with the intensivist d. Writing down a list of all new medications and doses and giving the list to family members during visitation ANS: B The nurse can give a status report related to the patient’s condition and current treatment plan as well as ensure that the family has daily meeting time with the intensivist for an update on diagnoses, prognoses, and the like. Pamphlets are helpful; howev er, the nurse should also explain the equipment that is at this patient’s bedside and not assume that everyone can read and understand written material. Limiting the information to that provided by the physician is unnecessary and will not meet the family’ s information needs. Most family members are concerned about the patient’s general condition and treatment plan. They do not want or need a detailed list of medications, doses, or other treatments. DIF: Cognitive Level: Apply/Application REF: p. 23 OBJ: Describe common family needs and family -centered nursing interventions. TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Psychosocial Integrity 2. The nurse is a member of a committee to design a critical care unit in a new building. Which design trend would best facilitate family -centered care? a. Ensure that the patient’s room is large enough and has adequate space for a sleeper sofa and storage for family m embers’ personal belongings. b. Include a diagnostic suite in close proximity to the unit so that the patient does not have to travel far for testing. c. Incorporate a large waiting room on the top floor of the hospital with a scenic view and amenities such as coffee and tea. d. Provid e access to a scenic garden for meditation. ANS: A NURSINGTB.COM INTRODUCTION TO CRITICAL CARE NURSING 7TH EDITION SOLE TEST BANK NURSINGTB.COM New unit design trends to promote family -centered care include patient rooms that provide a larger family space and comfortable furniture and storage to promote open visitation, including overnight stays in the patient’s room. Ready access to diagnostic te sting, including portable equipment, is an important trend; however, the purpose for this is to prevent the need for transport, not to foster family -centered care. A waiting room in close proximity to the unit with amenities is a nice feature; however, it does not need to be large if adequate space is incorporated into the patient’s room. A scenic garden for meditation may assist in reducing family members’ stress, but proximity to the patient is the greatest need. DIF: Cognitive Level: Apply/Application REF: p. 19 OBJ: Describe common family needs and family -centered nursing interventions. TOP: Nursing Process Step: Planning MSC: NCLEX Client Needs Category: Psychosocial Integrity 3. The nurse is caring for a patient who sustained a head injury and is unresponsive to painful stimuli. Which intervention is most appropriate while bathing the patient? a. Ask a family member to help you bathe the patient, and discuss the family structure with the family member during the procedure. b. Because the patient is unconscious, complete care as quickly and quietly as possible. c. Tell the patient the day and time, and that you are providing a bath. Reassure the patient that you are there. d. Turn the television on to the evening news so that you and the patient can be updated to current events. ANS: C Although unconscious, many patients can hear, understand, and respond to stimuli. Therefore, it is important to converse with the patient and reorient her to the environment. Some, but not all, family members may want to get involved in direct care; it is not known if this individual is a willing participant, and talking about who’s who in the family is inappropriate while providing direct care to the patient. Although the patient is unconsciou s, communication and simple conversations remain important interventions. Use of the television to provide sensory input that the patient regularly enjoys is a nursing intervention, but turning on the news for the sake of the nurse is not appropriate. DIF: Cognitive Level: Apply/Application REF: p. 20 OBJ: Describe stressors in the critical care environment and strategies to reduce them. TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Psychosocial Integrity 4. Sleep oft en is disrupted for critically ill patients. Which nursing intervention is most appropriate to promote sleep and rest? a. Consult with the pharmacist to adjust medication times to allow periods of sleep or rest between intervals. b. Encourage family members to talk with the patient whenever they are present in the room. c. Keep the television on to provide white noise and distraction. d. Leave the lights on in the room so that the patient is not frightened of his or her surroundings . ANS: A NURSINGTB.COM INTRODUCTION TO CRITICAL CARE NURSING 7TH EDITION SOLE TEST BANK NURSINGTB.COM Planning care to promote periods of uninterrupted rest is important. Consulting with the pharmacist to adjust a medication schedule is an excellent example of this intervention. It is important for family members to communicate with the patient ; however, rest periods must be scheduled. Family members can be present in the room while remaining quiet during these scheduled times. The television may be useful if it is part of the patient’s normal routine for sleep; however, it does not consistently provide white noise or distraction. Lights should be dimmed during scheduled rest periods and at night to facilitate sleep and rest. DIF: Cognitive Level: Apply/Application REF: p. 20 OBJ: Discuss the impact of critical care hospitalization on the patient and family. TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Physiological Integrity —Basic Care and Comfort 5. Family assessment is essential to meet family needs. Which of the following must be assessed first to assist the nurse in providing family -centered care? a. Assessment of patient and family’s developmental stages and needs b. Description of the patient’s home environment c. Identification of immediate family, extended family, and decision makers d. Observation and assessment of how family members function with each other ANS: C Assessment of the family structure is the fir st step and is essential before specific interventions can be designed. It identifies immediate family, extended family, and decision makers in the family. Structural assessment also includes ethnicity and religion. The developmental assessment is done aft er the structural assessment and includes the developmental stages of the patient and family. Functional assessment is also important to assess how family members function with each other; however, it is not done first. Assessment of the home environment i s important when identifying discharge planning needs. DIF: Cognitive Level: Apply/Application REF: p. 21 OBJ: Discuss the impact of critical care hospitalization on the patient and family. TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Psychosocial Integrity 6. Critical illness often results in family conflicts. Which scenario is most l ikely to result in the greatest conflict? a. A 21 -year-old college student of divorced parents hospitalized with multiple trauma. She resides with her mother. The parents are amicable with each other and have similar values. The father blames the daughter’ s boyfriend for causing the accident. b. A 36 -year-old male admitted for a ruptured cerebral aneurysm. He has been living with his 34 -year-old girlfriend for 8 years, and they have a 4 -year-old daughter. He does not have a written advance directive. His parents arrive from out -of-state and are as ked to make decisions about his health care. He has not seen them in over a year. c. A 58 -year-old male admitted for coronary artery bypass surgery. He has been living with his same -sex partner for 20 years in a committed relationship. He has designated h is sister, a registered nurse, as his health care proxy in a written advance directive. d. A 78 -year-old female admitted with gastrointestinal bleeding. Her hemoglobin is decreasing to a critical level. She is a Jehovah’s Witness and refuses the treatment NURSINGTB.COM INTRODUCTION TO CRITICAL CARE NURSING 7TH EDITION SOLE TEST BANK NURSINGTB.COM of a blood transfusion. She is capable of making her own decisions and has a clearly written advance directive declining any transfusions. Her son is upset with her and tells her she is “committing suicide.” ANS: B Each of these situations may result i n family conflict. The situation with the unmarried 36-year-old male without a written advance directive results in his distant parents being legally responsible for his health care decisions. Because of his long -standing commitment with his partner and la ck of recent contact with his parents, this scenario is likely to cause the most conflict. The parents may make decisions based on their wishes, as they may not be knowledgeable of the patient’s wishes. The supportive parents of the college student may create conflict with the boyfriend, but the parents’ ongoing friendship and shared values will assist in reducing conflict. The male admitted for bypass surgery, although in a same -sex relationship, has clearly identified whom he wants to make health care dec isions for him. The elderly female may have conflict with her son; however, she is capable of making her own decisions and has a written advance directive to support her decisions. DIF: Cognitive Level: Analyze/Analysis REF: p. 22 OBJ: Discuss the impact of critical care hospitalization on the patient and family. TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Psychosocial Integrity 7. Which nursing interventions would best support the family of a critically ill patien t? a. Encourage family members to stay all night in case the patient needs them. b. Give a condition update each morning and whenever changes occur. c. Limit visitation from children into the critical care unit. d. Provide beverages and snacks in the waiting room. ANS: B The need for information is one of the highest identified by family members of critically ill patients. A planned condition update h elps the family know what to expect. New room designs provide space for family members to spend the night if desired; however, if the patient is stable, family members should be encouraged to sleep at home to ensure that they are well rested and can suppor t the patient. Restriction of children in the critical care unit is not supported by research evidence. Child visitation should be individualized based on the needs and wishes of the patient and family. Beverages and snacks are important but not as importa nt as information. DIF: Cognitive Level: Analyze/Analysis REF: p. 23 OBJ: Describe common family needs and family -centered nursing interventions. TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Psychosocial Integrity 8. Which intervention is appropriate to assist the patient in coping with admission to the critical care unit? a. Allowing unrestricted visiting by several family members at one time b. Explaining all procedures in easy -to-understand terms c. Providing back massage and mouth care d. Turning down the alarm volume on the cardiac monitor ANS: B NURSINGTB.COM INTRODUCTION TO CRITICAL CARE NURSING 7TH EDITION SOLE TEST BANK NURSINGTB.COM Communication and explanations of procedures are priority interventions to help patients cope with admission. Comfort is an important intervention but not the priority. Noise control is an important intervention but not the priority. Open visitation is recommended; however, the number of family members may need to be limited to promote rest and sl eep. DIF: Cognitive Level: Analyze/Analysis REF: p. 20 OBJ: Describe stressors in the critical care environment and strategies to reduce them. TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Psychosocial Integrity 9. The constant noise of a ventilator, monitor alarms, and infusion pumps predisposes the patient to: a. anxiety. b. pain. c. powerlessness. d. sensory overload. ANS: D Constant noise is a source of sensory overload. Pain and lack of information contribute to anxiety. Noise does not cause physical pain. Lack of involvement in care causes powerlessness. DIF: Cognitive Level: Remember/Knowledge REF: p. 18 OBJ: Describe stressors in the critical care environment and strategies to reduce them. TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Psychosocial Integrity 10. Which of the follo wing statements about family assessment is false? a. Assessment of structure (who comprises the family) is the last step in assessment. b. Interaction among family members is assessed. c. It is important to assess communication among family members to understand roles. d. Ongoing assessment is important, because family functioning may change during the course of illness. ANS: A Assessment of structure should be done first so that the nu rse can identify such things as who comprises the family and who assumes leadership and decision -making responsibilities. This assessment also assists in identifying which individuals are most important to the patient and how many people may be seeking inf ormation. Family member interaction must be assessed, so this answer is true. Family member communication must be assessed, so this answer is true. Ongoing assessment of family is necessary as functions may change, so this answer is true. DIF: Cognitive Level: Remember/Knowledge REF: p. 21 OBJ: Describe common family needs and family -centered nursing interventions. TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Psychosocial Integrity 11. Which intervention about visi tation in the critical care unit is true? a. The majority of critical care nurses implement restricted visiting hours to allow the patient to rest. NURSINGTB.COM INTRODUCTION TO CRITICAL CARE NURSING 7TH EDITION SOLE TEST BANK