Question 1

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?

Accepted Answer

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 not appropriate while providing direct care to the patient.Although she is unconscious,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.

Question 2

The constant noise of a ventilator,monitor alarms,and infusion pumps predisposes the patient to:

Accepted Answer

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.

Question 3

Which intervention is appropriate to assist the patient to cope with admission to the critical care unit?

Accepted Answer

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 sleep.

Question 4

The nurse is assigned to care for a patient who is a non-native English speaker.What is the best way to communicate with the patient and family to provide updates and explain procedures?

Accepted Answer

The best approach when communicating with someone whose primary language is not English is to contact the interpreter services of the agency.These individuals are trained and knowledgeable.If the nurse conducted a search on the computer,she would not know if the information retrieved was valid nor would she know if the patient or family can read in their native language.Although one of the residents might be fluent in the language,you do not know his abilities to translate.In addition,his availability is likely to be limited.Although the child might be able to translate,the nurse cannot ensure that the child is translating healthcare concepts correctly.

Question 5

Family members have a need for information.Which interventions best assist in meeting this need?

Accepted Answer

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; however,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.

Question 6

Many critically ill patients experience anxiety.The nurse can reduce anxiety with which approach?

Accepted Answer

Anxiety is reduced when procedures are explained prior to completing them.In this example,the nurse clearly explains what will be done and what the patient can expect during turning.Limiting family members,especially if they are already present in the hospital,is not an approach that will reduce anxiety.Family members can be present in the room while allowing the patient to rest.It is important to orient the patient to the unit,but the explanation of a "unit routine" does not give the patient any control over things such as bathing,sleep times,and visitors.Suctioning is important,but only when indicated,which might not be with every coughing episode.Additionally,it is important to explain the procedure and tell the patient what to expect.

Question 7

Sleep often is disrupted for critically ill patients.Which nursing intervention is most appropriate to promote sleep and rest?

Accepted Answer

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.

Question 8

Critical illness often results in family conflicts.Which scenario is most likely to result in the greatest conflict?

Accepted Answer

Each of these situations may result in family conflict.The situation with the unmarried couple without written advance directives results in the distant parents being legally responsible for his healthcare decisions.Because of his long-standing commitment with his partner,and lack 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 their 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 who he wants to make healthcare decisions for him.The elderly female may have conflict with her son; however,she is capable of making her own decisions and has written advance directives to support her decisions.

Question 9

Family assessment is essential in order to meet family needs.Which of the following must be assessed first to assist the nurse in providing family-centered care?

Accepted Answer

Assessment of the family structure is the first 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 after 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 is important when identifying discharge planning needs.

Question 10

Open visitation policies are expected by many professional organizations.Which statement reflects adherence to current recommendations?

Accepted Answer

Open visitation is recommended by both the Society of Critical Care Medicine (SCCM)and the American Association of Critical-Care Nurses.SCCM suggests developing visitation schedules in collaboration with the patient and family.Animals do not need to be limited to therapy animals.Many patients benefit by the presence of their personal pets that are brought to the unit according to hospital policy.Although many units restrict visitation during report and rounds,the organizations encourage that such restrictions be loosened.Many institutions encourage family participation during report and rounds.Children should not be banned arbitrarily from the unit or have hours limited.

Question 11

Elderly patients who require critical care treatment are at risk for increased mortality,functional decline,or decreased quality of life after hospitalization.Assuming each of these patients was discharged from the hospital,which of the following patients is at greatest risk for decreased functional status and quality of life?

Accepted Answer

Although he is younger,the 70-year-old with the complicated critical care course,with limited social support,who is being discharged to a long-term acute care facility,is at greatest risk for decreased quality of life and functional decline.He will continue to need high-level nursing care and support for rehabilitation.The other cases are examples of individuals with shorter hospital stays,uncomplicated courses,and social support systems.

Question 12

Patients often have recollections of the critical care experience.Which is likely the most common recollection from a patient who required endotracheal intubation and mechanical ventilation?

Accepted Answer

Although the patient may recall all of these potential experiences,recollection of difficult communication is most likely secondary to the endotracheal tube placement.

Question 13

Family assessment can be challenging and each nurse may obtain additional information regarding family structure and dynamics.What is the best way to share this information from shift to shift?

Accepted Answer

A standardized method for gathering data about family structure and function and recording it in an official document is the best approach.This strategy ensures that data are collected and kept in the medical record.Data are also easily retrievable by anyone who needs to know this information.Informal documentation is often kept to assist in follow-up and change-of-shift reporting; however,this strategy is not recommended,as data collected are likely to vary and not be part of a permanent record.Although the charge nurse often has some information regarding families,the primary responsibility for assessment and follow-up belongs to the bedside nurse.Family information should be shared at change of shift using a standardized format,not "try to remember to discuss… ."

Question 14

Which nursing interventions would best support the family of a critically ill patient?

Accepted Answer

The need for information is one of the highest identified by family members of critically ill patients.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 support 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 important as information.

Question 15

The wife of a patient who is hospitalized in the critical care unit following resuscitation for a sudden cardiac arrest at work demands to meet with the nursing manager.She states,"I want you to reassign my husband to another nurse.His current nurse is not in the room enough to make sure he is okay." The nurse recognizes that this response most likely is due to the wife's:

Accepted Answer

Demanding behaviors often occur when the family member has a sense of loss of control or has had adverse outcomes in a previous hospitalization.Prevention of a lawsuit is not relevant to this scenario.No information is provided regarding whether the family member is participating in care or not.It is not known if she had a prior negative experience or not.

Question 16

The VALUE mnemonic is a helpful strategy to enhance communication with family members of critically ill patients.Which of the following statements describes a VALUE strategy?

Accepted Answer

The VALUE mnemonic includes the following:
V-Value what the family tells you.
A-Acknowledge family emotions.
L-Listen to the family members.
U-Understand the patient as a person.
E-Elicit (ask)questions of family members.

Question 17

Which statement is a likely response from someone who has survived a stay in the critical care unit?

Accepted Answer

Survivors of critical illness express a variety of concerns; however,most identify a willingness to undergo critical care treatment to prolong survival.Most survivors are not going to decline treatment for future hospitalizations (B).Although the patient's family may be thrilled that he or she is home,challenges to family dynamics often occur,especially if family member's schedules and routines are disrupted (C).Many patients have poor appetites after discharge from critical care,not ravenous ones (D).

Question 18

Which intervention about visitation in the critical care unit is true?

Accepted Answer

Visiting should be based on the needs of patients and their families.There may be times that visiting needs to be limited (e.g.,to allow the patient to rest); however,it is important to individualize visitation.Sometimes it is appropriate for children to visit; research has not found child visitation to be harmful to either the patient or the child.Visiting should be adjusted to patient needs.

Question 19

The nurse is a member of a committee to design a critical care unit in a new building.Which design trend would best to facilitate family-centered care?

Accepted Answer

New unit design trends to promote family-centered care include larger patient rooms that include 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 testing,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 medication may assist in reducing family members' stress,but proximity to the patient is the greatest need.

Question 20

Which of the following statements about family assessment is false?

Accepted Answer

Assessment of structure should be done first so that the nurse 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 information.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.

Quiz 2: Patient and Family Response to the Critical Care Experience