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Test Bank Critical Care Nursing Holistic Approach 10th Edition, Morton
Chapter 1- Critical Care Nursing Practice
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
D) Response to diversity
Chapter 2- The Patients Experience With Critical illness
1. The critical care unit environment is very stressful for patients, families, and staff. What nursing action is directed at reducing environmental stress?
A) Constant evaluation of patient status
B) Limiting visits to immediate family
C) Bathing all patients during hours of sleep
D) Maintaining quiet during hours of sleep
2. A patient is transferred to the ICU from the Birth Center of the hospital in the middle of the night after experiencing complications during delivery of her baby. The patients husband is anxious and explains to the ICU nurse that he doesnt understand why his wife has been moved to the ICU. She is going to die, isnt she? he asks the nurse. What is the nurses 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 patient is admitted to the ICU with injuries sustained from a fall from a third-story window. The patient is conscious, his breathing is labored, and he is bleeding heavily from the abdomen. He groans constantly and complains of severe pain, but his movements are minimal. His heart rate is elevated. Which of these is a sign that he is in the second phase of the stress response? Select all that apply.
A) Bleeding heavily from his abdomen
B) Labored, slow breathing
C) Severe pain
D) Elevated heart rate
E) Minimal movement
4. A patient 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 patient in pain. Which of the following are likely stressors for the patient? Select all that apply.
A) His daughters conversation
B) His daughters effleurage
C) The beeping of the heart monitor
D) The dim lighting of the room
E) The cries of the other patient from the hall
5. A patient in the ICU is complaining that he is not sleeping well at night because of anxiety. Which of the following would be the most helpful intervention for the nurse to make?
A) Provide the patient with a bath immediately following his first 90-minute REM sleep cycle.
B) Increase the patients pain medication.
C) Provide the patient with 5 minutes of effleurage and then minimize disruptions.
D) Monitor the patients brain waves by polysomnography to determine his sleep pattern.
6. A nurse walks into a patients room and begins preparing a syringe to perform a blood draw on the patient. The nurse observes that the patient 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) Proceed with blood draw as quickly as possible, to get it over with.
B) Offer to come back later to perform the blood draw.
C) Encourage the patient to deep breathe.
D) Describe briefly the blood draw procedure and explain why it is necessary.
7. A 15-year-old boy is in the ICU and preparing for an appendectomy. He is clearly anxious and fidgets with his IV constantly. He complains that he doesnt 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 patients 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 patient in detail what the appendectomy will consist of.
8. A nurse in a burn unit observes that a patient is tensed up and frowning but silent. The nurse asks the patient, Can you tell me what you are thinking now? The patient responds, I cant take this pain any more! I feel like Im about to die. What would be the best response for the nurse to give to the patient, considering that the patient is already receiving the maximum amount pain medication that is safe?
A) Try to get rid of those negative thoughtsthey 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 patient on mechanical ventilation is experiencing severe agitation due to being on the ventilator. Which nursing intervention would be best?
A) Performing breathing exercises with the patient
B) Offering the patient a patient-controlled analgesic device
C) Asking the physician to prescribe an antianxiety medication
D) Offering the patient the patients own MP3 player to listen to
10. A 10-year-old female patient in ICU receiving chemotherapy has requested that her dog be allowed to visit her. She is currently sharing a room with another patient. The nurse knows that the hospital does allow for pet visits with owners, but has strict guidelines. Which of the following scenarios is most likely to be permitted?
A) The girls father may bring the dog in on a leash for a 20-minute visit.
B) The girls sister may bring the dog in with a shirt on (to prevent shedding) for an overnight stay.
C) The girls mother may bring the dog in on a leash for a visit as long as he has had all his vaccinations.
D) The dog may be brought in for a brief visit once the girl is moved to a private room.
Chapter 3- The Familys Experience With Critical Illness
1. A patient has just been admitted to the ICU after being in a severe auto accident and losing one of her legs. Her husband has his hand over his heart and complains of a rapid heart rate. The nurse recognizes his condition as a sign of which stage of the 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 womans inability to manage the children in this situation?
A) She is senile.
B) She is in the exhaustion stage of the general adaptation syndrome to stress.
C) She is assuming the role of caregiver in place of the patient, a role she is not used to.
D) She has macular degeneration and cannot see well.
3. A nurse needs to communicate with a patients family regarding consent to treat an unconscious patient in the ICU. Which member of the group should the nurse approach first?
A) A man she recognizes as the patients brother
B) A teenage boy who approaches the nurse
C) A woman who originally escorted the patient in
D) A woman in the group whom the others look at and call over when the nurse approaches
4. A new nurse has recently joined the ICU from a different hospital, which had a much stricter policy regarding visiting hours. She expresses concern about the impact of open visiting hours on patient well-being. Which of the following would be the best explanation for the purpose of open visiting hours? Select all that apply.
A) To better provide rest and quiet
B) To strengthen the relationship between the family and health care provider
C) To control the number of visitors for a patient
D) To provide an undisturbed environment
E) To decrease the patients anxiety
F) To increase the satisfaction of the family with the experience
5. A nurse observes that a 38-year-old single father whose 11-year-old daughter is in 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 of the following 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 for him and his son
B) Sit down with the father and son and share her own religious beliefs
C) Ask the patients doctor to explain to the father the odds of the daughter surviving
D) Leave the father and son to grieve alone
6. A patient is experiencing severe pain, despite receiving pain medication for the past 24 hours. The patients wife expresses concern about this to the nurse. Which response by the nurse would be most empowering to the patients family?
A) Explain that the doctor is an expert on pain medication and that the current level of medication is the best.
B) Recommend that the family members take turns massaging the patients feet to distract from the pain.
C) Encourage the family to request that the physician evaluate the patients pain control.
D) Ask the family to wait another 24 hours to see whether the patients pain level will go down.
7. The sister of a patient in the ICU has been at the patients bedside non-stop for 48 hours. The nurse suggests to her that she return home to rest. Which of the following is the proper rationale for the nurse making such a suggestion?
A) The sister is in the way of the health care providers.
B) The patient may become annoyed by her continual presence.
C) The patient will recover more easily in peace and quiet.
D) The sister needs to maintain her own health during this time.
8. A young man has just arrived at the ICU from out of town and received news that his girlfriend, who is admitted there, likely only has a few days left to live. Which of the following would be the best approach for the nurse to take in caring for the needs of this young man?
A) Recommending that he go home and rest
B) Giving him unrestricted visiting hours with the patient
C) Suggesting that he meet with the hospital chaplain
D) Recommending that he ask the doctor to evaluate the patients pain control measures
9. A family of a young girl who has been diagnosed with leukemia has travelled 12 hours by car to admit her to the ICU and be with her during her treatment. Which aspect of the critical care family assistance program would most likely be needed by this family initially?
A) Educational materials
B) Weekly group family information sessions
C) Hospitality programs
D) Pet therapy
10. A Muslim woman is admitted to the ICU after suffering severe burns over most of her body. Which of the following would be the most appropriate measure for the nurse, a woman, to take in respect for the cultural practices of this patient?
A) Insist that only a female doctor be assigned to this patient.
B) Ensure that no pork products are included in the patients diet.
C) Ensure that direct eye contact is not made with the patients husband.
D) Ask the patients husband what religious and cultural preferences should be considered in the patients care.
Chapter 4- Patient and Family Education in Critical Care
1. An elderly man whose wife has just been admitted to the ICU following congestive heart failure is concerned about how passage of the Affordable Care Act will impact the care of his wife. Which of the following are expected outcomes of this legislation that it would be appropriate for the nurse to share with the man? Select all that apply.
A) The new legislation will result in a shortage of experienced critical care nurses.
B) The new legislation will require health care workers to meet higher quality standards related to patient care.
C) The new legislation will make it more challenging to meet the educational goals of patients and families.
D) The new legislation will increase the length of stay of patients in the hospital.
E) The new legislation will shift the payment structure for hospitals and health care providers from a traditional fee-for-service model to an incentive model.
2. A young couple whose 5-year-old daughter has been admitted to the ICU approaches the nurse with looks of concern on their faces. They express frustration to the nurse that they have not been able to speak with either the physician or the surgeon and are confused as to what the next steps are for their daughters treatment. What would be the best intervention for the nurse to make in this situation?
A) Offer to get ice chips for the couple to give to their daughter to empower them.
B) Make sure that they have the cell phone numbers of the physician and surgeon.
C) Teach the couple about the pathophysiology of the daughters disease.
D) Arrange a patient care conference with the couple and the health care team.
3. A nurse sees a group of physicians who are making teaching rounds in the hall of the ICU heading toward the room of one of her patients. The patient, who currently has a visitor, has given approval in the past to have teaching groups visit. What should the nurse do in this situation?
A) Explain to the group of physicians that the patient currently has a visitor and ask whether they could come by later.
B) Ask the visitor to leave so that the teaching group can discuss the patients case.
C) Allow the teaching group to enter the patients room, as he has already given approval for them to visit.
D) Instruct the physicians to give clear explanations of the medical jargon they use.
4. The nurse is working with a patient from India who is recovering from a myocardial infarction. When the nurse asks the patient whether she has had a myocardial infarction before, the patient seems confused and appears not to understand the nurse, although the patient does speak English. Which of the 4 Cs of Culture should the nurse use to better communicate with this patient?
5. A nurse needs to obtain informed consent from a deaf patient before a spinal tap procedure is performed. Which of the following would be the best method for the nurse to use to ensure effective communication?
A) Explain the procedure verbally, speaking slowly so that the patient can read lips.
B) Have a trained oral interpreter interpret for the nurse.
C) Have the patient carefully read a printed copy of the informed consent document.
D) Use diagrams to explain to the patient the details of the procedure.
6. A nurse is explaining to a patient how radiation therapy works to kill cancer cells. She begins by explaining how there are different types of cells in the body that reproduce at different rates. She then explains what cancer cells are and how they reproduce. Finally, she explains how radiation therapy uniquely targets cancer cells. This approach takes advantage of which domain of learning?
D) Demonstration/return demonstration
7. A young man is recovering from anaphylactic shock caused by a bee sting. The nurse is trying to instruct the patient on how to use an epinephrine autoinjector (EpiPen), but the patient seems uninterested in learning. The nurse then explains how having the EpiPen with him at all times and knowing how to use it could not only save his life someday but also will give him a greater sense of security and safety. Which adult learning principle is the nurse using? Select all that apply.
A) The learners self-concept
B) The learners life experience
C) Readiness to learn
D) Motivation to learn
E) The need to know
8. In attempting to teach a patient how to clean around the surgical sutures on his abdomen upon discharge to home, the nurse determines that applying the principle of the learners self-concept would be most effective with this patient. Which of the following is the best example of an application of that principle in this situation?
A) Relating to the patient a story about another patient who failed to properly clean his sutures and the outcome
B) Explaining that failure to properly clean around the suture site could result in serious infection
C) Commenting that learning to properly clean his suture site could give the man skills that would better prepare him for a career in health care
D) Mentioning to the patient that, if he would prefer, he can watch a video on the hospitals website on how to clean around a suture site
9. A nurse needs to explain to a patient about the possible side effects the patient may experience related to the pain medication she is now beginning while in the ICU and which she will be continuing upon discharge. Which method would be the most effective way to teach this to the patient?
A) In a planned teaching session, in which the nurse covers medication-related side effects, dietary restrictions, and activity restrictions
B) Via a brochure that the patient can take with her on discharge
C) By briefly explaining the side effects while administering the medication to the patient
D) By relating a story about another patient who had a severe adverse reaction to this medication
10. A nurse needs to evaluate a patients understanding of how to administer an IV medication at home. Which of the following would be the best method for evaluation?
A) The nurse explaining the procedure to the patient and family using diagrams
B) The nurse having the patient and family members demonstrate the procedure themselves
C) The nurse explaining the procedure while performing it on the patient
D) The nurse referring the patient to a computer-based educational library that has an interactive program
Chapter 5- Relieving Pain and Providing Comfort
1. A patient is in the ICU after suffering multiple trauma from a car wreck that occurred 24 hours ago. The patient feels pain from many sources, including lacerations on the arm, a fractured femur, a tension headache from the stress of the accident, lower back pain from a sports injury 30 years ago, nasal irritation from an endotracheal tube, and joint aches from ongoing arthritis. The nurse recognizes which of the following as the most likely instances of chronic pain? Select all that apply.
A) Lacerations on arm
B) Fractured femur
C) Tension headache
D) Lower back pain from old sports injury
E) Irritation in throat from endotracheal tube
F) Arthritis in joints
2. A Nepali man is in the ICU recovering from spinal surgery to remove a malignant tumor. He does not speak English, and struggles to communicate with the nurse by using hand motions. His family is constantly at his bedside, speaking with him in Nepalese. Frequently, he puts on headphones and listens to music on his MP3 player. His wife occasionally massages his feet. Which of the following factors is most likely exacerbating this patients pain?
A) Inability to communicate with the nurse
B) Constant presence of his family
C) Listening to music
D) His wife massaging his feet
3. A nurse is caring for a patient in the ICU who is recovering from coronary artery bypass graft surgery. Over the course of the next few days, the nurse will be responsible for changing a dressing over the surgical incision site, having the patient change positions in bed, assisting with tracheal suctioning, and assisting with drain removal. The nurse should anticipate that the patient will most likely perceive pain resulting from these procedures in which order, from least painful to most?
A) Changing the dressing, position change in bed, tracheal suctioning, drain removal
B) Position change in bed, changing the dressing, drain removal, tracheal suctioning
C) Drain removal, tracheal suctioning, position change in bed, changing the dressing
D) Tracheal suctioning, position change in bed, changing the dressing, drain removal
4. A patient in the ICU is receiving intravenous opioid analgesia following myocardial infarction. Despite receiving continuous infusion of the opioid, the patient is grimacing and asks for an increase in the medication level. Consulting the medical chart, the nurse recognizes that this patient has a history of opioid addiction. What would be the most appropriate intervention?
A) Immediately take the patient off of the opioid and give him Tylenol.
B) Leave the patient on the opioid at the current dose level.
C) Increase the dose of opioid to provide more effective pain relief.
D) Reduce the dose of opioid and offer to turn on the television as a distraction from the pain.
5. A patient with no history of opioid abuse is receiving opioid analgesia intravenously in the ICU for severe pain from extensive third-degree burns. The patient and his family are concerned about the likelihood of developing an addiction to the medication. What would be the best response on the part of the nurse?
A) Stop the opioid infusion immediately and use only nonpharmacological means of analgesia.
B) Begin tapering off the medication gradually.
C) Explain that the risk for addiction is low and that opioids are necessary for the patients level of pain.
D) Explain that addiction is likely but cannot be avoided and suggest a rehabilitation program following discharge.
6. A nurse is working with an elderly patient with Alzheimers disease and congestive heart failure in the ICU. Which of the following methods of pain assessment would be essential to include in this situation, according to the American Geriatric Society?
A) No assessment is appropriate; the patient should be started on a standardized protocol for analgesia for Alzheimers patients
B) The verbal zero to ten scale
C) The word descriptor scale
D) Assessment of behavior and family observations
7. A patient in the ICU with renal dysfunction is to begin receiving intravenous opioids and a nonsteroidal anti-inflammatory drug (NSAID) for severe pain. The medication is expected to be administered for at least seven days. Which NSAID would be most appropriate for this patient? Select all that apply.
A) Ketorolac (Toradol)
B) Indomethacin (Indocin)
C) Celecoxib (Celebrex)
D) Rofecoxib (Vioxx)
8. A nurse is working with a cancer patient who has chronic pain related to her illness. The nurse must administer fentanyl to the patient in the form of a transdermal patch. Which of the following should the nurse do in administering this medication?
A) Use lotion to prepare the skin where the patch will be applied.
B) Wear gloves when handling the patch.
C) Apply the patch over a wound or abrasion, if possible, to maximize absorption.
D) Leave old patches on the patients bedside table for the doctor to examine later.
9. A patient in the ICU is receiving an intravenous opioid infusion for pain, but is experiencing anxiety due to being on mechanical ventilation. The physician has decided to prescribe a sedative for the patient. The patients health history indicates an allergy to soy products. Which sedative should be avoided in this situation?
10. An elderly patient in the ICU is receiving intravenous opioid analgesia for pain. The nurse observes that the patients respiratory rate has decreased to 8 breaths per minute. Which nursing intervention would be most appropriate?
A) Administer naloxone intravenously very slowly.
B) Administer diazepam immediately.
C) Increase the dose of opioid.
D) Massage the patients feet to stimulate her breathing.
Chapter 6- Palliative Care and End-of-Life Issues in Critical Care
1. A nurse is working with a patient who is near death and experiencing delirium. Which of the following would be an appropriate course of action for this nurse to take in caring for this patient? Select all that apply.
A) Instruct the patient in pursed-lip breathing.
B) Provide oxygen support for the patient.
C) Arrange supportive psychotherapy.
D) Give the patient benzodiazepines.
E) Give the patient neuroleptics.
2. The husband of a terminally ill patient is upset at the sight of his wife continuing to linger on the brink of death. He has heard of end-of-life sedation and wonders whether it would be appropriate for his wife. Which of the following should the nurse mention as criteria for use of end-of-life sedation? Select all that apply.
A) The patient is experiencing unbearable and unmanageable pain.
B) The patient is only hours or days away from death.
C) The patient has requested it.
D) It is standard procedure for patients with a terminal illness.
3. A patient in the ICU has entered a coma state, and someone must make a decision about whether to continue life-supporting measures for the patient. No living will exists for this patient. Who is the person legally authorized to make this decision?
A) The patients wife, who is the executor of his estate
B) The patients brother, who is his designated health care proxy
C) The patients physician, who has been managing his care from admittance
D) The patients nurse, who has been assigned to him on a daily basis
4. The mother of a patient has requested that she and the rest of the family be allowed to be present in the patients room in the event that the patient requires resuscitation. The nurse, however, is reluctant to comply with this. What is the most likely reason she does not want the family in the room during resuscitation?
A) Family members who are present during resuscitations may experience more anxiety.
B) Family members present during resuscitation are more likely to sue.
C) The nurse is new and is not comfortable with having the family present.
D) A dedicated staff person is required to attend to the family during resuscitation.
5. A teenage boy is near death in the ICU after being involved in a severe car accident. His mother and stepfather are in his room visiting him now. His father and stepmother have arrived in the waiting room and are asking to see the patient. A few days ago, the nurse observed the boys father and mother arguing loudly in the patients room. She has also observed that the boys muscles tighten and his breathing and heart rate increase when his father is near his bed. Which of the following would be the best action for the nurse to take?
A) Ask the father and stepmother to wait until the current visitors have left.
B) Ask the mother and stepfather to leave so that the father and stepmother can visit.
C) Allow the father and stepmother to go into the patients room but accompany them.
D) Tell the father and stepmother that they are not allowed to visit the patient.
6. A patient in the ICU has ovarian cancer that has metastasized to her stomach and other organs. The physician believes the patient only has days to survive. Which of the following would be a realistic goal for the care of the patient that the nurse could suggest to the family?
A) Eliminate the cancer cells by starting the patient on chemotherapy.
B) Slow the rate of growth of the cancer by starting the patient on radiation therapy.
C) Keep the patient free of pain by increasing the patients pain medication.
D) Restore gastrointestinal function to the client via surgical intervention.
7. A 10-year-old girl has just died in the ICU. The nurse is now questioning the patients physician to learn more details about the patients death to communicate to the family. Which stage of notification is the nurse currently in?
8. The family of a patient who is near death makes the difficult decision to allow the physician to administer a pain-relieving drug to the patient with the intention of making the patient more comfortable, despite the fact that the drug may increase the risk for complications that could lead to the patients death. The principle involved in the familys decision is known as which of the following?
A) Principle of moral distress
B) Principle of palliative care
C) Principle of unintended consequences
D) Principle of double effect
9. Which of the following is the best example of moral distress?
A) A patients family has decided to end mechanical ventilation of the patient, but the nurse has trouble implementing their decision.
B) A patients family has decided to continue mechanical ventilation for the patient, but the nurse disagrees and discontinues the ventilation on her own initiative.
C) A patients family has decided to end mechanical ventilation of the patient, and the nurse implements their decision but later feels guilty.
D) A patients family has decided to continue mechanical ventilation for the patient, and the nurse implements their decision, although she disagrees with it.
10. A patient who is near the end of his life is to be extubated, according to the wishes of his family. Which of the following would be the best action for the nurse to take to support the patient?
A) Ask the family to leave the room during the extubation.
B) Hold a family conference to ask the family to reconsider their decision.
C) Administer opioids to the patient to reduce pain and discomfort.
D) Administer antibiotics to the patient to prevent infection.
Chapter 7- Ethical Issues in Critical Care Nursing
1. The physician has just told a patient that he has stage 4 lung cancer and likely has only months to live. After the physician leaves, the patient, who is visibly shaken, asks the nurse, Couldnt the doctor be wrong? Is it really that bad? The nurse explains to him that, although there is no way to know for certain how the disease will progress, the stage of his lung cancer is the most serious. The nurse also indicates that the cancer has spread to other organs in his body, meaning that the odds of recovery are not good. The patient then asks that the nurse not tell his wife, who is in the waiting room, about the diagnosis just yet. Later the patients wife enters the room and, seeing that he is asleep, asks the nurse if there is any update on the patients condition. The nurse explains that the doctor talked to the patient earlier and that the patient can provide details once he wakes up. Which ethical principle or principles has the nurse exercised in this situation? Select all that apply.
2. Before administering a new medication to a patient, the nurse explains to her the adverse effects she may experience as a result of the medication and asks whether the patient has any questions about the medication. When the patient indicates that she understands the risks involved, the nurse has her sign a document and proceeds with the treatment. The nurses action is an example of which of the following?
A) Obtaining informed consent
B) Ensuring confidentiality
C) Observing the principle of nonmaleficence
D) Acting with fairness
3. A patient is at severe risk of forming life-threatening clots in his thoracic region following surgery. The physician has prescribed an anticoagulant medication. The patient has had a negative experience with anticoagulants in the past and refuses the medication. Which two ethical principles are in conflict with each other in this situation?
A) Fidelity vs. justice
B) Maleficence vs. beneficence
C) Veracity vs. autonomy
D) Beneficence vs. autonomy
4. A patient in the ICU recently experienced a myocardial infarction that resulted in an aneurysm of the ventricular wall. The patients cardiovascular surgeon has determined that the aneurysm is irreparable. In this situation, an attempt to repair the rupture via laparoscopic surgery would be considered which of the following?
C) Medically futile
5. The family of a patient in a coma is struggling to decide whether to remove the patient from a ventilator. What would be the most appropriate intervention?
A) Explain the statistical odds that the patient will regain consciousness.
B) Facilitate a care conference with the family.
C) Leave the family alone to make their decision.
D) Distribute copies of the American Nurses Association Code of Ethics to the family.
6. A patient complains of severe pain and requests an increase in dose of her pain medication. Her husband, however, does not want the patients pain medication increased, as he is worried about her becoming dependent on the medication. Which principle(s) from the ANA Code of Ethics would be most appropriate for the nurse to apply in this situation? Select all that apply.
A) The nurses primary commitment is to the patient.
B) The nurse collaborates with other health professionals and the public.
C) The nurse owes the same duties to self as to others.
D) The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.
7. A nurse learns that a patient in the ICU who is scheduled to undergo a liver transplant has a history of alcoholism. Which principle or principles from the ANA Code of Ethics would be most appropriate for the nurse to apply while caring for this patient? Select all that apply.
A) The nurse practices with compassion and respect unrestricted by considerations of the nature of the health problem.
B) The nurses primary commitment is to the patient.
C) The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.
D) The nurse participates in establishing, maintaining, and improving health care environments.
8. A nurse works in an ICU in which she routinely sees physicians neglecting the care of patients who do not have health insurance. She feels angry about the unfairness of this situation but also powerless to do anything because she fears the loss of her job. Which of the following best describes what the nurse is experiencing?
A) Medical futility
C) Moral distress
9. An elderly patient who is about to have open-heart surgery has verbally instructed the nurse that she does not want her life to be extended by a ventilator after the surgery. The patients advance directive, however, indicates that she would prefer to receive all life-support measures. The nurse suspects that the patient has dementia. Which of the following questions would be most appropriate for the nurse to ask in the assessment stage of ethical decision making?
A) What are the ethical issues related to continuing or removing life-support measures for this patient?
B) Who should be involved in making the decision regarding life-support measures for this patient?
C) Is this patient mentally competent to make decisions about use of life support?
D) What educational changes can be made in the ICU to resolve similar ethical challenges related to life support measures in the future?
10. A patient who had provided an advance directive indicating that he should not be resuscitated was allowed to die when his heart stopped beating shortly after his admission to the ICU. The family of the patient has disputed the authenticity of the advance directive and filed a complaint with the hospital. Which intervention would be most appropriate to address this ethical dilemma?
A) Ethics rounds involving the medical staff involved in the patients care
B) Review by the hospitals institutional ethics committee
C) An individual patient ethics conference with the family
D) Review of the ANA Code of Ethics by the patients nurse
Chapter 8- Legal Issues in Critical Care Nursing
1. A patients physician writes a medication order to administer 20 mEq of potassium chloride to a patient. The ICU nurse misreads the order as 200 mEq of potassium and administers this amount of medication to the patient. As a result, the patient dies. This situation is an example of which of the following?
A) A questionable medical order
B) Negligent supervision
C) Ordinary negligence
D) Gross negligence
2. A family member of a patient files a complaint against an ICU nurse, claiming that the nurse improperly transferred the patient from a wheelchair to the hospital bed, resulting in a back injury to the patient. Assuming that the nurses due process rights are observed, which of the following actions would be most advisable for the nurse?
A) Plan to appeal to a court if the State Board of Nursing rules against her.
B) Sue the State Board of Nursing if her license is suspended before she is found guilty.
C) Acquire legal counsel and have him or her question the boards witnesses.
D) Continue nursing practice if her license is suspended, as such a suspension violates her constitutional rights.
3. The ex-husband of a patient asks the ICU nurse a question about the medical history of the patient. The nurse retrieves the patients file, opens it, and relates some of the patients personal information to the ex-husband. When the ex-husband asks to see the patients file, the nurse hands it to him, although he is not authorized by the patient to see this information. What is the most accurate characterization of the nurses action?
A) A criminal act against the patient
B) A breaking of the rule of personal liability
C) A violation of the HIPAA Privacy Rule
D) A case of respondeat superior
4. A nurse is accused of professional negligence because she improperly operated a ventilator, resulting in a patients death. The prosecution presents an expert witness to show that operating such a ventilator is within the standard of care for a reasonable nurse. Which aspect of negligence is the prosecution attempting to establish?
B) Breach of duty
5. A jury involved in a malpractice suit must decide how much to compensate a patient for the emotional distress caused her by incomplete anesthesia during surgery. To which element of malpractice is this decision related?
B) Breach of duty
6. A nurse is going to volunteer her nursing skills and time at a hospital other than the one in which she is employed. Which of the following is true regarding potential liability related to the nurses actions while volunteering? Select all that apply.
A) The nurse should carry her own malpractice insurance.
B) The hospital at which she is volunteering will protect her with its own professional liability insurance.
C) The hospital at which she is employed will protect her with its professional liability insurance even when she is working off the job.
D) There is no liability protection available for a nurse who is volunteering on her own time.
E) The doctrine of respondeat superior does not apply in this situation.
F) The captain of the ship doctrine applies in this situation.
7. A nurse is charged with medical malpractice because she neglected to attend to a patient in the ICU whose heart stopped and whose heart monitor alarm was clearly heard by the nurse. The jury finds that the hospital was liable because of understaffing the ICU and that the nurse was liable because she should have responded to the patient whose heart stopped, regardless of the fact that she had been ordered by a physician to tend to another patient. Which types of liability did the jury uphold? Select all that apply.
A) Captain of the ship doctrine
B) Rule of personal liability
C) Corporate liability
D) Criminal liability
8. A physician has written a medication order for a patient that includes penicillin. When the nurse receives the order, she refuses to administer the medicine because she knows that the patient is allergic to it. What is the most accurate way to describe this situation?
A) A questionable medication order
B) A medication error
C) A case of respondeat superior
D) A case of negligent supervision
9. A patient in the ICU dies as a result of a defective defibrillator. The nurse did not become aware of the defect until after the patients death. Which of the following is true in this situation?
A) Defibrillators are not currently regulated in the United States.
B) The nurse is permitted but not required to report the malfunction to the FDA.
C) The nurse is required to report the malfunction to the FDA.
D) The nurse is likely liable in the patients death.
10. A 10-year-old girl has been admitted to the ICU after she suffered a severe laceration on her arm. Due to heavy hemorrhaging, the child needs a blood transfusion. Her parents, however, who are Jehovahs Witnesses, do not believe in blood transfusions and refuse the treatment. What would be the best action for the nurse to take?
A) Assist the physician in performing a blood transfusion for the girl, against her parents wishes.
B) Refuse to assist the physician in performing a blood transfusion, to respect the parents wishes.
C) Consult the hospitals risk management department before acting.
D) Schedule a conference with the parents to explain why an infusion is medically necessary.
Chapter 9- Building a Professional Practice
1. A nurse in the ICU not only is excellent in providing care for her patients but has also earned the credential of CCRN and is tireless in lobbying for federal legislation that protects patients rights. She is also the first nurse in the ICU to recognize problems with process and to develop solutions. However, this nurses husband has begun to complain that he never sees her, and she feels like she has lost touch with her teenage daughter. Which professional practice attribute or attributes does this nurse demonstrate? Select all that apply.
2. A nurse in the ICU is known for the personal care and attention he gives to each of his patients. He takes time to learn his patients names and the names of their families. He is especially gentle when drawing blood from children or administering injections to older patients. He is also good at leaving his work concerns at work and focusing on his family when at home. However, his lack of interest in pursuing further credentials and his lack of initiative in tackling problems that arise in the ICU have limited his career opportunities. Which professional practice attribute or attributes does this nurse demonstrate? Select all that apply.
3. A nurse in the ICU has a natural rapport with her patients, communicates well with her colleagues, always strives to improve her practices by learning from more experienced nurses, and always shows up for her shift on time. Which characteristic of this nurse is the hallmark of excellence?
A) Natural rapport with patients
B) Effective communication with colleagues
C) Always striving to improve her practices
4. A nurse in the ICU is known for working hard to improve the care that she and others provide. When asked what motivates her to work so hard, she explains that she has a picture of what an ideal ICU looks likea place where patients feel well cared for, where health professionals work seamlessly together, and where nurses derive deep satisfaction from their work. Which element of practice excellence best characterizes this nurses perspective?
5. A nurse in the ICU loves her job and is known to volunteer her time for fundraising for health care charities and for promoting public health initiatives in her community. She also loves to share her knowledge of physiology and medicine with her patients. Unfortunately, however, she often shares information that is outdated or not supported by evidence. Which element is this nurse most lacking?
6. A nurse in the ICU has earned several advanced credentials in nursing and is working on her masters degree in nursing. Although she loves gaining knowledge, she often finds herself unmotivated in her day-to-day duties as a nurse. Which element of excellence in practice is this nurse most lacking?
7. An ICU has recently won the Beacon Award for Critical Care Excellence. Which element of excellence most contributed to the ICU being recognized with this award?
8. A nurse in the ICU has recently undertaken an initiative to improve oral care in the critically ill patient. This is an example of which of the following?
A) Practice alert
B) Specialty certification
C) Personal mastery
D) Nursing professionalism
9. A nurse in the ICU is extremely efficient in performing her tasks but often realizes at the end of the day that she has not taken the time to make eye contact with her patients. Which element of practice excellence is this nurse lacking?
10. A nurse takes a genuine interest in her patients and is highly attentive to their needs. She consistently checks on her patients and takes time to listen to their concerns. Which value, central to nursing, is this nurse demonstrating?
Chapter 10- The Critically Ill Pediatric Patient
1. A child in the ICU exhibits tachycardia, tachypnea, hypertension, and low pulse pressure in the extremities. Which of these signs is the best indicator of inadequate perfusion of blood?
D) Low pulse pressure
2. A 12-month-old child is admitted to the ICU after being found abandoned in a hot car. The child is responsive, but the nurse notices that the anterior fontanelle of the child is sunken. Which of the following conditions should the nurse suspect in this situation?
B) Increased intracranial pressure
C) Fluid overload
3. An ICU nurse, in testing the reflexes of a 3-month-old baby girl, strokes the lateral aspect of the sole of the foot to test for possible nerve damage. In response, the child fans her toes and dorsiflexes her big toe. What is the name of this reflex, and is the childs response normal?
A) Moro reflex; abnormal
B) Rooting reflex; normal
C) Grasp reflex; abnormal
D) Babinski reflex; normal
4. A nurse in the ICU observes paradoxical irritability, meningeal irritability, and nuchal rigidity in a 5-year-old girl. She suspects meningitis. What other finding or findings would support this belief? Select all that apply.
A) Positive Babinski reflex
B) Positive Moro reflex
C) Positive Brudzinskis sign
D) Positive Kernigs sign
5. A newborn baby involved in an auto accident has been admitted to the ICU and is currently being assessed by a nurse in a drafty, cool room. The nurse notes mottling on the infants skin, a progression of coolness toward the trunk, peripheral cyanosis, normal blood pressure, low pulse pressure, and tachycardia. Given the circumstances, which of the following are reliable signs that the infant is in shock? Select all that apply.
A) Mottled skin
B) Progression of coolness toward the trunk
C) Peripheral cyanosis
D) Normal blood pressure
E) Low pulse pressure
6. A nurse working with an infant patient observes that the child, who has a nasogastric tube, is grunting on expiration, wheezing, and seesaw breathing. The nurse recognizes that the infant is most likely experiencing which condition?
A) Respiratory distress due to obstructed nasal passages
B) Respiratory arrest due to obstruction of the glottis
C) Epileptic seizure due to overstimulation
D) Shock due to loss of blood
7. A 2-year-old is admitted to the ICU due to severe dehydration. The mother of the child is distraught and feels guilty that she took a long walk with her child in the sun earlier in the day. She said that she and the rest of the family had no issues with dehydration. What would be the best response for the nurse to give the mother?
A) Children his age should have limited sun exposure and should be covered with sunscreen.
B) The mother should regularly test the specific gravity of the childs urine to determine whether he is adequately hydrated.
C) Children are at increased risk for dehydration due to a higher percentage of total-body water.
D) The mother should look for taut skin and edema as signs of dehydration in her child.
8. A 6-year-old girl who is in the ICU for an unrelated reason confides in the nurse that her father sometimes hits her. Which of the following findings would most likely indicate abuse in this situation?
A) A bruise on her knee
B) A bruise on the bottom of her foot
C) A bruise on her abdomen
D) A bruise on her face
9. A 12-year-old boy is experiencing severe pain following emergency surgery in the ICU. He is visibly frustrated and restless. His parents would like to achieve a steady state of pain relief for their son and to give him a sense of some control over the pain. Which pain relief method would be most appropriate in this situation?
A) Distraction by means of a video game
10. The nurse observes that a child in the ICU who has been admitted following an auto accident is visibly stressed and crying. The child has a broken arm, which has been splinted, and is receiving analgesics. No other injuries have been found. When the nurse performs a pain assessment test with the child, the child refuses to cooperate. The patients mother is hysterical and is frantically pacing next to the bed. What is the most likely cause of the childs distress?
A) Fear of further medical interventions
B) The mothers communicated anxiety
C) Pain from the broken arm
Chapter 11- The Critically Ill Pregnant Woman
1. A pregnant woman in her third trimester is in the ICU for minor trauma to her right arm and leg as a result of a car wreck. Her injuries appear to be superficial, but her nose begins bleeding profusely immediately after the nurse places a nasotracheal tube. What is the most likely explanation for the bleeding?
A) Internal hemorrhaging from trauma
C) Rupture of the mucosa, which are extra fragile during pregnancy
D) Improper placement of tube
2. An obese woman was admitted to the ICU for diabetic coma caused by advanced diabetic ketoacidosis. On recovering, the patient mentions to the nurse that she missed her last period and has felt nauseated in recent weeks. In reviewing her chart, the nurse compares her current test results with those from her last admission to the hospital, about 3 months ago. She notes that the womans red blood cell count has increased by 20%, her systolic blood pressure has increased by 10 mm Hg, her resting heart rate has increased from 85 to 105 bpm, and her creatinine clearance has increased from 90 to 130 mL/min. Which of these changes is consistent with those that normally accompany pregnancy? Select all that apply.
A) 20% increase in red blood cells
B) 10 mm Hg increase in systolic blood pressure
C) Increase in resting heart rate from 85 to 105 bpm
D) Increase in creatinine clearance from 90 to 130 mL/min
3. A woman in her ninth month of pregnancy is in the ICU, recovering from surgery to remove a stage 1 tumor from her brain. She is still under the effects of general anesthesia. As the nurse is taking her vital signs, the woman regurgitates some fluid from her mouth. What is the most likely cause of the regurgitation?
A) Esophageal cancer
B) Displacement of the esophageal sphincter
C) Airway obstruction
D) Congenital defect of the esophagus
4. Blood work results of a pregnant woman in her third trimester in the ICU have recently been delivered, and the nurse is reviewing them. The woman has a hematocrit of 35%, a white blood cell count of 4,000/mm3, and a fibrinogen level of 500 mg/dL. She also has a blood pressure reading of 118/70 mm Hg. Which of these is in the normal range for a pregnant woman? Select all that apply.
A) Hematocrit of 35%
B) White blood cell count of 4,000/mm3
C) Fibrinogen level of 500 mg/dL
D) Blood pressure of 118/70 mm Hg
5. A pregnant woman has arrived at the ICU with a blood pressure reading of 170/115, pronounced edema in her hands and feet, and proteinuria. Which condition does the woman most likely have?
A) Severe preeclampsia
C) Disseminated intravascular coagulation
D) HELLP syndrome
6. A patient who experienced severe preeclampsia during her pregnancy has just delivered her baby in the ICU. She has been receiving magnesium sulfate therapy to prevent seizures. Which of the following would be the correct nursing intervention in this situation?
A) Discontinue the magnesium sulfate therapy immediately.
B) Continue the magnesium sulfate therapy for 2 hours after delivery.
C) Continue the magnesium sulfate therapy for 24 hours after delivery.
D) Explain to the patient that she will have to remain on magnesium sulfate therapy for the rest of her life.
7. A patient with severe preeclampsia in the ICU has recently had a seizure. She is currently receiving magnesium sulfate therapy. What intervention can the nurse make to reduce the risk for future seizures in this patient?
A) Turn off the overhead lights in the room.
B) Stop the magnesium sulfate therapy.
C) Have the physician prescribe hydralazine to her.
D) Place a wedge under the womans right hip.
8. A woman in her seventh month of pregnancy presents to the ICU with hemolysis, elevated liver enzymes, and a low platelet count. Which condition does this woman most likely have, and what is a proper intervention?
A) Severe preeclampsia; magnesium sulfate therapy
B) Disseminated intravascular coagulation; broad-spectrum antibiotics
C) Amniotic fluid embolism; intubation and ventilation with 100% oxygen
D) HELLP syndrome; antihypertensive agents
9. The nurse is working with a patient with severe preeclampsia and acute respiratory distress syndrome (ARDS). The patient is receiving mechanical ventilation using positive end-expiratory pressure. Which nursing intervention would be most appropriate in this situation?
A) Position the patient on her side.
B) Turn off the overhead light.
C) Evaluate the patient for neurological symptoms of seizure.
D) Perform CPR.
10. A pregnant woman has been admitted to the ICU with disseminated intravascular coagulation (DIC). She exhibits tachycardia, tachypnea, temperature instability, increased cardiac output, and decreased peripheral resistance. What is the most likely underlying cause of DIC in this situation and what is the best intervention?
A) Preeclampsia; antihypertensive agents
B) Sepsis; broad-spectrum antibiotics
C) Amniotic fluid embolism; intubation and ventilation with 100% oxygen
D) Abruptio placentae; prompt delivery of the fetus
Chapter 12- The Critically Ill Older Patient
1. The nurse is working with a patient in the ICU who has presbycusis. Which of the following would the nurse likely find with this client? Select all that apply.
A) Impairment of discrimination ability
C) A gray shadow in the center of the visual area
D) Balance problems during transfer
2. An elderly patient is recovering in the ICU after surgery. When the nurse notices that the patient has not touched his food, she asks him why he is not eating. He complains that the food is too bland and that his mouth is dry. Which of the following interventions should the nurse make to help the patient enjoy his meal? Select all that apply.
A) Use liberal seasonings in his food.
B) Vary his position in the bed.
C) Measure his creatinine clearance.
D) Offer him sugar-free candies before his meal.
3. A nurse is bathing an elderly patient in the ICU. The patient has fine wrinkling, looseness, and sagging in her skin. Which of the following should the nurse do to best care for the patients skin? Select all that apply.
A) Scrub the patients skin vigorously with a loofah to exfoliate.
B) Lather the patient with plenty of soap.
C) Immerse the patient for 10 minutes daily.
D) Use an emollient after bathing.
4. An elderly patient in the ICU has been on bed rest for the past 48 hours, has had decreased intake of food and fluids, and is taking multiple medications. Which of the following conditions is the patient especially prone to, given her situation? Select all that apply.
C) Muscle atrophy
D) Decreased glomerular filtration rate
E) Malignant lesions
5. An elderly patient in the ICU broke her foot when she attempted to stand on it after having been on bed rest for 2 weeks. The nurse, who was assisting the patient as she stood, was surprised at how easily the woman sustained the injury. Which of the following factors most likely predisposed this patient to the injury she sustained?
A) Lack of balance
B) Mental confusion
C) Decreased bone mineral density
D) Pernicious anemia
6. An elderly patient in the ICU presents with atrial tachycardia. The nurse also observes that the patient appears anorexic. Which of the following conditions would best explain these symptoms?
A) Diabetes mellitus
C) Pernicious anemia
7. An older adult patient in the ICU has diabetes. Which intervention could the nurse perform that would best prevent complications related to this disease?
A) Have the patient rise from his bed and bear weight.
B) Offer the patient sugar-free candy.
C) Bathe the patients feet daily and apply emollient.
D) Reposition the patient often in bed.
8. An elderly patient in the ICU has hyperthyroidism. As the nurse is talking with her, she suddenly becomes c
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