Urden: Priorities in Critical Care Nursing, 5Th Edition

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Test Bank

Urden: Priorities in Critical Care Nursing, 5th Edition

Test Bank

Chapter 1: Caring for the Critically Ill Patient

MULTIPLE CHOICE

1. Which of the following best describes the difference between the roles of the CNS and the nurse practitioner (NP)/acute care nurse practitioner (ARNP)?

A. / The CNS has prescriptive authority and works with individual patients.
B. / The advanced registered nurse practitioner (ARNP) has prescriptive authority and works with groups of ABBREVIATION ONLY patients.
C. / The CNS works only as a consultant.
D. / The ARNP works only with families.

ANS: B

NPs and ARNPs manage clinical care of a group of patients and have various levels of prescriptive authority, depending on the state and practice area in which they work. They also provide care consistency, interact with families, plan for patient discharge, and provide teaching to patients, families, and other members of the heath care team.

DIF: Comprehension REF: 1

MSC: Client need: Safe and Effective Care Environment—Management of Care

2. The framework for critical care nurses is based on what authoritative standards?

A. / The Joint Commission on National Patient Safety Goals
B. / American Association of Critical-Care Nurses (AACN) Standards of Care
C. / American Hospital Association algorithms
D. / Centers for Disease Control and Prevention emergency preparedness guidelines

ANS: B

The AACN has established nursing standards to provide a framework for critical care nurses. The standards are authoritative statements that describe the level of care and performance by which the quality of nursing care can be judged. Standards serve as descriptions of expected nursing roles and responsibilities.

DIF: Knowledge REF: 1

MSC: Client need: Safe and Effective Care Environment—Coordinated Care

3. The rationale for using evidence-based practice is to:

A. / produce consistent, positive outcomes.
B. / justify the actions of providers.
C. / convince insurance companies to pay.
D. / provide legal protection for providers.

ANS: A

By basing practice on scientific findings, with their ability to explain and predict, nurses are able to provide research-based interventions with consistent, positive outcomes.

DIF: Comprehension REF: 2

MSC: Client need: Safe and Effective Care Environment—Coordinated Care

4. Practice Alerts promoted by the AACN are:

A. / descriptive warnings of hazardous practices.
B. / quick references for practice areas.
C. / notices of violations of the Nursing Practice Act.
D. / simulated situations for practicing difficult techniques.

ANS: B

The AACN has promulgated several practice summaries in the form of Practice Alerts. These alerts are short directives that can be used as a quick reference for practice areas (e.g., oral care, noninvasive blood pressure monitoring, ST segment monitoring). They are succinct and supported by evidence and address both nursing and multidisciplinary activities. Each alert includes the clinical information, followed by references that support the practice.

DIF: Comprehension REF: 2-3

MSC: Client need: Safe and Effective Care Environment—Coordinated Care

5. The nursing process differs from most other decision-making models because it is:

A. / evidence-based.
B. / cyclic.
C. / linear.
D. / culture bound.

ANS: B

The nursing process is a systematic decision-making model that is cyclic, not linear. By virtue of its evaluation phase, the nursing process incorporates a feedback loop that maintains quality control of its decision-making outputs. Similar to a problem-solving method, the nursing process begins with an assessment phase and offers an organized, systematic approach to clinical problems. Unlike a problem-solving method, however, the nursing process is continuous, not episodic.

DIF: Comprehension REF: 4

MSC: Client need: Safe and Effective Care Environment—Coordinated Care

6. A nursing diagnosis differs from a medical diagnosis because it describes:

A. / a health condition primarily resolved by nursing intervention.
B. / physical conditions that alter the patient’s ability to function.
C. / syndromes and diseases that do not require the use of pharmaceuticals.
D. / illnesses that are treated by collaborative effort.

ANS: A

The most essential and distinguishing feature of any nursing diagnosis is that it describes a health condition primarily resolved by nursing interventions or therapies.

DIF: Comprehension REF: 4

MSC: Client need: Safe and Effective Care Environment—Coordinated Care

7. Nursing diagnoses can be individualized to best describe the characteristics of a health problem as it manifests itself in a particular patient by:

A. / using the patient’s name in the plan.
B. / using qualifiers and/or specifiers.
C. / including cultural references.
D. / applying time limits for outcomes.

ANS: B

Some nursing diagnoses need accompanying qualifiers or specifiers based on the characteristics of the health problem as it manifests itself in a particular patient. For example, the diagnosis Fear needs specification of the object of the patient’s particular fear, such as death, pain, disfigurement, or malignancy.

DIF: Comprehension REF: 4

MSC: Client need: Safe and Effective Care Environment—Coordinated Care

8. To be useful, the patient care plan must have goals that are:

A. / universal.
B. / describable.
C. / measurable.
D. / unique.

ANS: C

Outcome criteria should be measurable. Outcome criteria consist of recognizable patient behaviors, statements, and physiologic parameters. Many of the phenomena assessed by critical care nurses in diagnosis and treatment are readily measurable, such as adequacy of spontaneous ventilation, cardiac output, and tissue perfusion. Outcome statements are made even more measurable by indicating the date and time of anticipated attainment of the outcome.

DIF: Comprehension REF: 4

MSC: Client need: Safe and Effective Care Environment—Coordinated Care

9. An algorithm used in the care and treatment of the critically ill patient is the:

A. / AACN Standards of Care.
B. / advanced cardiac life support algorithms published by the American Heart Association.
C. / state board of nursing state practice act.
D. / National League for Nursing’s Center for Nursing Advocacy Mission Statement.

ANS: B

An algorithm is a stepwise decision-making flowchart for a specific care process or processes. Algorithms are more focused than clinical pathways and guide the clinician through the “if, then” decision-making process, addressing patient responses to particular treatments. Well-known examples of algorithms are the advanced cardiac life support algorithms published by the American Heart Association.

DIF: Comprehension REF: 6

MSC: Client need: Safe and Effective Care Environment—Coordinated Care

10. A preprinted provider order document that has been validated through review of practice and research is a(n):

A. / algorithm.
B. / paradigm.
C. / order set.
D. / clinical pathway.

ANS: C

An order set consists of preprinted provider orders that are used to expedite the order process once a standard has been validated through analytic review of practice and research. Order sets complement and increase compliance with existing practice standards. Sets can also be used to represent the algorithm or protocol in order format.

DIF: Comprehension REF: 6

MSC: Client need: Safe and Effective Care Environment—Coordinated Care

11. The nurse best demonstrates an understanding of holistic care by:

A. / explaining the use of the continuous blood pressure monitoring device to the family.
B. / using active listening with a patient who is fearful and anxious.
C. / incorporating other disciplines into the plan of care.
D. / reviewing the list of home medications with a family member.

ANS: B

The critical care nurse must be able to deliver high-quality care skillfully, using all appropriate technologies, while incorporating psychosocial and other holistic approaches as appropriate given time and the patient’s condition.

DIF: Comprehension REF: 3

MSC: Client need: Psychosocial Integrity

12. Which of the following statements best demonstrates the nurse’s integration of objective data with knowledge gained from the patient’s subjective experience?

A. / “I can understand that it was uncomfortable for you to be drowsy after taking your pain medication on schedule, but that is not a sign of allergy to the drug.”
B. / “Here are the side effects of the medication you are taking.”
C. / “What medication did your previous doctor prescribe for this condition?”
D. / “Please do not take alcohol or other depressants with this medication.”

ANS: A

This statement indicates integration of objective data with knowledge gained from an understanding of the patient’s or group’s subjective experience.

DIF: Comprehension REF: 3

MSC: Client need: Psychosocial Integrity

13. Which of the following statements demonstrates the nurse’s ability to apply scientific knowledge to the processes of diagnosis and treatment?

A. / “Doing these exercises will probably help you gain strength and flexibility.”
B. / “This medication works by killing the bacteria that are causing your infection.”
C. / “God will help you get well if you pray hard enough.”
D. / “If your great-grandmother used this I’m sure it will be effective in relieving your headaches, too.”

ANS: B

The statement shows application of scientific knowledge (pathophysiology and pharmacology) to the processes of diagnosis and treatment.

DIF: Comprehension REF: 3

MSC: Client need: Psychosocial Integrity

14. Which of the following goal statements is the best statement of outcome?

A. / The patient will improve by Saturday.
B. / The patient will walk to the nurses’ station.
C. / The patient will give a return demonstration with no errors.
D. / The patient will tolerate ambulation across the room without assistance within 24 hours after surgery.

ANS: D

Outcome criteria should be measurable, desirable, and attainable, with full consideration given to patient/nurse resources.

DIF: Comprehension REF: 4

MSC: Client need: Psychosocial Integrity

MULTIPLE RESPONSE

15. The care that critically ill patients receive in hospitals is (choose two):

A. / mechanized.
B. / multidisciplinary.
C. / specialized.
D. / centralized.

ANS: B, C

Critical care today is provided to patients by a multidisciplinary team of health care professionals who have in-depth education in the specialty field of critical care.

DIF: Comprehension REF: 1

MSC: Client need: Physiological Integrity—Reduction of Risk Potential

16. Special capabilities that clinical nurse specialists (CNSs) bring to the care of the critically ill patient include (choose all that apply):

A. / providing routine bedside care.
B. / conducting research.
C. / offering spiritual support.
D. / consulting.
E. / writing prescriptions.

ANS: B, D

CNSs serve in specialty roles that require clinical, teaching, research, leadership, and consultative abilities.

DIF: Comprehension REF: 1

MSC: Client need: Physiological Integrity—Reduction of Risk Potential

17. Ways that critical care nurses can ensure that individual differences related to culture are incorporated into the planof care include (choose all that apply):

A. / asking the patient/family about cultural beliefs that may apply.
B. / asking the patient/family to comply with the hospital culture.
C. / developing a plan of care that is unique to the patient/family.
D. / using a standardized plan of care for consistency.
E. / formulating lists of cultural characteristics that apply to all group members.

ANS: A, B

Nurses must possess knowledge about biocultural, psychosocial, and linguistic differences in diverse populations to make accurate assessments. Interventions must then be tailored to address the uniqueness of each patient and family.

DIF: Comprehension REF: 3

MSC: Client need: Psychosocial Integrity

18. Protocols are distinguished from pathways or guidelines by which of the following (choose all that apply)?

A. / They are used in research.
B. / They are more directive and rigid.
C. / They have more flexibility in use.
D. / They are cyclic.

ANS: A, B

A protocol is a common tool in research studies. Protocols are more directive and rigid than pathways or guidelines, and providers should not vary from a protocol. Patients are screened carefully for specific entry criteria before being started on a protocol. The many national research protocols include those for cancer and chemotherapy studies.

DIF: Comprehension REF: 6

MSC: Client need: Safe and Effective Care Environment—Coordinated Care

19. Especially in a critical care unit, patient safety is an ethical imperative because (choose all that apply):

A. / surveillance is more prevalent and the nurses’ actions are scrutinized.
B. / the highly complex environment makes errors and accidents more likely.
C. / patients are vulnerable due to their compromised state.
D. / the high-technology setting decreases risk of errors and omissions.

ANS: B, C

Patient safety has been described as an ethical imperative, and one that is implied in health care professionals’ actions and interpersonal processes. Critical care units are prime examples of settings in which errors may occur because of the hectic, complex environment where the margins of error are narrow and the demands for safety are crucial. In this environment, patients are particularly vulnerable due to their compromised physiologic status, need for multiple technologic and pharmacologic interventions, and care by multiple providers who frequently work at a fast pace.

DIF: Comprehension REF: 6

MSC: Client need: Safe and Effective Care Environment—Coordinated Care

20. The regulations of the Health Insurance Portability and Accountability Act have which special implications for the provider of care in the critical care environment (choose two)?

A. / Privacy must be maintained in close working conditions.
B. / Only as much information as the patient/family needs should be disclosed.
C. / The care provider must be honest and accurate in reporting patient-related information.
D. / Confidentiality must be preserved when speaking with family members.

ANS: A, D

The Health Insurance Portability and Accountability Act of 1996 has created additional challenges for health care organizations and providers due to the stringent requirements of the law and the additional resources needed to meet these requirements. Most relevant for critical care clinicians is the requirement for privacy and confidentiality related to protection of health care data. This has implications when interacting with family members as well as others and when providing care in the oftentimes very close work environment, tight working spaces, and emergent situations. Clinicians are referred to their organizational policies and procedures for specific procedures and requirements in their particular work setting.

DIF: Comprehension REF: 7

MSC: Client need: Safe and Effective Care Environment—Coordinated Care