Deck 2: Care of the Critically Ill Patient

Question 1

Which statement describing the needs of family members of critically ill patients has yet to be validated by research?
1) "Not knowing is the worst part" of waiting.
2) Families in the waiting room have no effect on patient outcomes.
3) "Hovering" in the proximity phase is characterized by confusion and tension.
4) A unified message from staff minimizes family stressors.

Answer 1

2
Explanation: 1. This statement is supported by research and is accurate to the findings about the family needs of the critically ill patient.
2. This is an incorrect statement that is not supported by research. In fact, family support has been proven to improve clinical outcomes.
3. This statement is supported by research.
4. This statement is supported by research.

Question 2

A patient has just completed a preoperative education session prior to undergoing coronary artery bypass surgery. Which patient statements indicate that teaching has been effective? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) "I understand that I will have to blink my eyes to respond after the breathing tube is in my throat."
2) "I will be given frequent mouth care to help me when I am thirsty."
3) "I will be able to move about freely in bed and into the chair without help while connected to the electronic equipment for monitoring."
4) "I may need something to help me rest due to the unfamiliar lights and sounds of the ICU unit."
5) "I might not behave like my usual self after the surgery, but it will be because of the medications and my illness."

Answer 2

1, 2, 4, 5
Explanation: 1. An alternate method of communication discussed in advance of tube placement will assist in better communication after the tube is inserted to aid the breathing process.
2. While intubated, oral hygiene is needed to prevent mucosal drying due to the inability of the patient to take oral fluids.
3. This statement indicates that additional teaching is required because the patient will not be able to move freely in bed and into a chair without assistance while being electronically monitored.
4. Due to environmental lights, sounds, and difference in sleeping environment, additional aids, such as drug management, may be needed to assist the patient to rest at night.
5. A patient concern in the critical care area is the inability to control self. This statement indicates the patient's understanding of the teaching.

Question 3

Which nursing action would be appropriate when the nurse initiates an infusion of morphine sulfate for a post-operative patient who is experiencing pain?
1) Anticipate that the patient will begin to experience the effect of the morphine 15 minutes after the start of the infusion.
2) Provide additional intermittent boluses of morphine sulfate if the patient experiences breakthrough pain.
3) Complete the Critical-Care Pain Observation Tool scale 5 minutes after increasing the infusion rate each time.
4) Begin the infusion at the lowest ordered dose, and increase the rate every 30 minutes if the patient continues to have pain.

Answer 3

2
Explanation: 1. The desired effects should become apparent 5 minutes after intravenous administration.
2. A critically ill patient will often receive an IV bolus of an analgesic followed by an ongoing infusion of the pain medication with intermittent boluses and increases in infusion until the drug attains steady state and the patient experiences pain relief.
3. Assessing the patient 5 minutes after increasing the infusion rate each time might be too soon to assess for pain control.
4. When IV infusion rates are repeatedly increased versus the administration of intermittent boluses as a means of responding to acute pain, the risk for excessive analgesia dosing exists.

Question 4

Which strategies should the nurse include in the plan of care when trying to minimize sleep disruptions for a patient in an ICU? Select all that apply.
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Instituting a short course of therapy for sleeping agents
2) Accurate scoring and vigilance in sedation and sedation scoring
3) Managing the environment to reduce lighting and sound
4) Minimizing staff interruptions during sleep periods
5) Scheduling treatments only during the day or at least 4 hours apart at night

Question 5

Which nursing diagnosis should receive the highest priority when caring for a patient who is receiving total parenteral nutrition?
1) Infection, Risk for
2) Trauma, Risk for
3) Skin Integrity, Impaired
4) Fluid Volume, Risk for Imbalance

Question 6

The nurse realizes that which stressor is one of the primary concerns of critically ill patients and should be routinely included during assessments?
1) Inability to control elimination
2) Lack of family support
3) Hunger
4) Altered ability to communicate

Question 7

While caring for a patient in the critical care unit, the nurse realizes that the patient's care needs must be a balance between the patient's long-term prognosis and the family's expectations of recovery. Which AACN Synergy Model characteristic does this situation describe?
1) Complexity
2) Predictability
3) Participation in care
4) Resource availability

Question 8

The nurse inserts a nasogastric tube and plans to confirm placement of the tube prior to starting enteral feedings. Which is the most accurate method for confirming tube placement?
1) Obtaining a radiological x-ray of the abdomen
2) Checking gastric aspirate for a pH of less than 7
3) Instilling 30 mL of air while listening with a stethoscope when placed over the fundus of the stomach
4) Determining the presence of carbon dioxide

Question 9

When providing care to critically ill patients, whether they are responsive or unresponsive, what should the nurse do?
1) Clearly explain what care is to be done before starting the activity.
2) Perform the activity and then let the patient rest without explaining the care.
3) Make sure the patient always responds and is cooperative before giving care.
4) Explain to the family that the patient will not understand or remember any of the discomfort associated with care.

Question 10

The nurse confirms medication orders and the schedule to administer a sedative to a patient with delirium. Which dosing schedule maximizes the effectiveness of the drugs?
1) Only in the early morning
2) Only at bedtime (HS)
3) Around the clock with higher dosages in the evening
4) Only on an as-needed (PRN) basis

Question 11

When planning care to meet the needs of families of critically ill patients, the nurse should include which strategies by Miracle (2006)? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Information about how to contact the primary doctor if needed
2) Frequent verbal communication to clarify the purpose of unit, equipment, procedures, waiting areas, phones, and so on
3) Regular family conferences to meet patient goals and progress
4) A consistent nurse, and unified staff responses if that nurse is not available
5) A way to contact family through a specific family member by phone if needed

Question 12

Which communication strategy should the critical care nurse use when communicating with a ventilated patient?
1) Use professional terminology and provide the patient with detailed information.
2) Use simple language and explain in other terms if the patient does not seem to understand.
3) Provide minimal information so the patient is not overwhelmed.
4) Discuss issues primarily with the family because the patient is unlikely to understand the information.

Question 13

The nurse identifies a patient in the critical care unit as having "resiliency." What characteristic has the nurse identified in the patient?
1) Motivation to reduce anxiety through positive self-talk
2) Ability to bounce back quickly after an insult
3) Physical strength to endure extreme physical stressors
4) Ability to return to a state of equilibrium

Question 14

Which parameter indicates that a patient in the intensive care unit being mechanically ventilated is ready for an interruption in sedation? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) MAP of 75 and heart rate of 76
2) Awakens with verbal stimuli
3) Frowns when turned but otherwise shows no muscular tension
4) Activates the ventilator alarms, but the alarms stopped spontaneously
5) Receives neuromuscular blocking agents to ensure adequate ventilation

Question 15

The nurse addresses the family needs of a critically ill patient. Which family need was not identified?
1) Proximity
2) Information
3) Assurance
4) Timeliness

Question 16

During an assessment, a ventilated patient begins to frown and wiggle about in bed. Which assessment strategy would be most helpful for the nurse to validate these observations?
1) Glasgow Scale
2) Maslow's hierarchy levels
3) Critical-Care Pain Observation Tool (CPOT)
4) Vital signs trends

Question 17

What should the nurse do to meet the needs of the critically ill patient's family members? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Express an attitude of hope, honesty, open communication, and caring
2) State specific facts about the patient's condition in a timely manner
3) Plan regular times for family visits throughout the day
4) Limit the number of visitors to significant others
5) Communicate to a single family member to cut down time wasted repeating information to all visitors

Question 18

A patient scores positive on the Confusion Assessment Method of the Intensive Care Unit (CAM-ICU). Which nursing diagnosis would have the highest priority based on this positive score?
1) Injury, Risk for
2) Family Processes, Altered
3) Social Interaction, Impaired
4) Memory Impaired

Question 19

Members of the multidisciplinary care team review a patient's nutritional status and analyze assessment values. Which value would need additional investigation?
1) A serum albumin of more than 3.5 g/dL or 35 g/L
2) A weight increase of 1.5 kg in a day
3) A serum hemoglobin of 11.7 g/dL or 117 mmol/L
4) A prealbumin level of 35 mg/dL

Question 20

The charge nurse reviews information about patients received during morning report. Which patient is at risk for nutritional imbalances? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Client recovering from a myocardial infarction
2) Client receiving hemodialysis treatments 3 times a week
3) Client with slightly elevated liver enzymes
4) Client who is intubated for respiratory failure
5) Client recovering from extensive burns

Question 21

What strategies should the nurse use to communicate with an older adult patient who is intubated and being mechanically ventilated? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Make sure the patient is wearing eyeglasses.
2) Speak slowly.
3) Decide on which gestures mean "yes" and "no."
4) Have questions and possible answers ready so the patient can point to the response.
5) Ask several questions at a time to limit interruptions in rest periods.

Question 22

A critically ill patient is prescribed enteral feedings to begin after placement of the nasogastric tube is verified. What should the nurse identify as the goal for this method of nutrition?
1) Prevent infection
2) Avoid aspiration pneumonia
3) Enhance respiratory excursion
4) Reduce the need for pain medication

Question 23

The nurse uses the Synergy Model patient characteristics to plan care for a patient in the intensive care area. Which observations indicate that these actions were effective? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Patient extubated two days earlier than expected
2) Patient expresses dissatisfaction with morning care
3) Patient states that he or she is feeling better and is eager to return home
4) Patient thanks the nursing staff for help with basic care needs
5) Patient rests between procedures and medication administration

Question 24

The nurse providing care to a patient who is unresponsive and being mechanically ventilated uses unintentional distractions. What is the nurse doing when providing care? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Singing
2) Humming
3) Joking
4) Talking to a colleague
5) Apologizing for causing pain

Question 25

The nurse assesses a critically ill patient utilizing the AACN Synergy Model's characteristics. Which characteristics are identified as impacting the outcome of a critically ill patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Participation in care
2) Resource availability
3) Stability
4) Complexity
5) Level of consciousness

Question 26

The nurse plans to use music therapy to help reduce a critically ill patient's level of anxiety. What should the nurse do when using this complementary and alternative therapy? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Ask family members to identify the patient's preferred music.
2) Plan for the music to be played for 30 uninterrupted minutes.
3) Listen to the music in advance to make sure it does not have lyrics.
4) Ensure that the music beats are between 60 to 80 per minute.
5) Play the music from a CD player on the bedside table.

Question 27

The nurse cares for a patient recovering from surgery who is being mechanically ventilated and experiencing pain. Which approach should the nurse use first to assess this patient's pain?
1) Attempt an analgesic trial
2) Ask the patient if he or she is in pain
3) Observe the patient's face for grimacing
4) Ask a family member if the patient is in pain

Question 28

The nurse administers haloperidol (Haldol) via IV push to a patient experiencing delirium. What is most important for the nurse to monitor in this patient?
1) Heart rate
2) QT interval
3) PR interval
4) Respiratory rate

Question 29

A patient in the critical care unit demonstrates increasing agitation. What should the nurse use to assess this patient's agitation level? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Sedation Assessment Scale (SAS)
2) Richmond Agitation-Sedation Scale (RASS)
3) Glasgow Scale
4) Reaction Level Scale
5) Ventilator Adjusted Motor Assessment Scoring Scale

Question 30

The nurse is a member of a committee that is designing improvements to the critical care waiting areas. What improvements should the nurse suggest to enhance the comfort of family members of critical care patients? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Plan for a large space to be used for the waiting areas.
2) Provide coffee and soft drinks in the waiting area.
3) Place televisions and DVD players in the waiting area.
4) Find space for sleeping rooms.
5) Use dark paint and minimal lighting in the waiting areas.

Question 31

The nurse plans care for a critically ill patient. What should the nurse include to address the patient's major areas of concern? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Explain the purpose of the tube in the nose.
2) Explain the purpose of the tube in the mouth.
3) Determine a method of communication.
4) Explain the purpose of the intravenous tubes.
5) Ensure that the room lights will be turned off and alarms set to low volume.

Question 32

The nurse assesses the nutritional needs of a patient in the intensive care unit. What information is essential for the nurse to obtain during this assessment? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Patient's current height and weight
2) Food allergies
3) Use of nutritional supplements
4) If the patient can swallow
5) Amount of water consumed each day

Question 33

Weekly group meetings are scheduled every Wednesday afternoon for the families of current intensive care patients. What should the nurse prepare in anticipation of the next meeting?
1) Visiting hours for the unit
2) Location of the waiting area
3) Equipment and treatments the patients receive
4) The schedule of when to telephone for patient status updates

Question 34

A physician suggests that a patient being mechanically ventilated, needing immediate transport to CT scan, and having severe pain be given IV fentanyl (Sublimaze) rather than morphine sulfate for pain management. Why is fentanyl (Sublimaze) preferred?
1) Rapid administration does not have any hemodynamic consequences.
2) It has a more rapid onset and a shorter duration of action.
3) Weaning of a continuous infusion is never needed due to its short half-life.
4) It is not likely to cause respiratory depression.

Question 35

A patient being mechanically ventilated receives midazolam (Versed) for sedation. What findings indicate to the nurse that the patient is receiving an appropriate dose of this medication?
1) Awake with a respiratory rate of 38 and a heart rate of 132
2) Asleep but withdrawing from noxious stimuli with a heart rate of 80
3) Awake with a heart rate of 124 and attempting to pull out the IV
4) Asleep but awakening to light touch with a heart rate of 72

Question 36

A newly admitted patient receiving sedation is prescribed parenteral nutrition via a central line. Which action should the nurse take to prevent overfeeding of this patient?
1) Monitor daily weights
2) Use an infusion pump
3) Evaluate albumin levels
4) Question the order to infuse lipids