Deck 1: What Is Critical Care

Question 1

Which action ensures that a patient has consented to care?
1) Provide a consent form to sign to receive medications.
2) Ask the patient to sign a consent form to have dressings changed.
3) Discuss a consent form to sign to be turned in bed.
4) Explain how a dressing is to be changed.

Answer 1

4
Explanation: 1. Consent is usually implied rather than written for routine procedures like most medication administration.
2. Consent is usually implied rather than written for routine procedures like dressing changes.
3. Consent is usually implied rather than written for routine procedures like turning.
4. If the nurse does not ask the patient for consent, the nurse should explain the procedure.

Question 2

A nurse is preparing to communicate an issue about patient care to a physician using the SBAR technique. Which phrase is an appropriate initial statement?
1) "I am concerned about…"
2) "The patient's immediate history is…"
3) "I think the problem is…"
4) "I would like you to…"

Answer 2

1
Explanation: 1. This is an appropriate initial statement using the SBAR technique.
2. This is not an appropriate initial statement using the SBAR technique.
3. This is not an appropriate initial statement using the SBAR technique.
4. This is not an appropriate initial statement using the SBAR technique.

Question 3

For what can the nurse be held liable if forcibly inserting a nasogastric tube against a patient's wishes?
1) Negligence
2) Malpractice
3) Damages
4) Battery

Answer 3

4
Explanation: 1. Forcibly inserting a nasogastric tube against a patient's wishes is not negligence.
2. Forcibly inserting a nasogastric tube against a patient's wishes is not malpractice.
3. It cannot be determined if forcibly inserting a nasogastric tube against a patient's wishes will result in damages.
4. When the nurse treats or touches a patient without consent, it is battery.

Question 4

Which informal power bases should the nurse use in the health care setting? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Expertise
2) Goodwill
3) Information
4) Observation
5) Collaboration

Question 5

What should the nurse identify as an example of an installed forcing function or a system-level firewall to prevent errors when providing patient care?
1) Prior to administration of insulin, two nurses check the dose.
2) Prior to obtaining a medication, height, weight, and allergies are recorded.
3) All medications are checked by two nurses prior to administration.
4) Undiluted potassium chloride is not available on critical care units.

Question 6

The nurse reviews assessment data on a group of patients. Which patient should the nurse identify as experiencing a critical illness?
1) Chronic airflow limitation with VS: BP 110/72, P 110, R 16
2) Acute bronchospasm with VS: BP 100/60, P 124, R 32
3) Motor vehicle crash with VS: BP 124/74, P 74, R 18
4) Chronic renal failure on hemodialysis with no urine output with VS: BP 98/50, P 108, R 12

Question 7

Which condition is most likely to occur when a patient is restrained?
1) Pulling out an endotracheal tube
2) Pulling out an intravenous line
3) Disconnecting ventilator tubing
4) Developing a nosocomial infection

Question 8

Which patient should the nurse expect to be transferred to a critical care unit? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Experiences an acetaminophen overdose
2) Diagnosed with an acute mental illness
3) Receiving treatment for chronic renal failure
4) New onset of acute decompensated heart failure
5) Treatment for bacteremia from an infected foot wound

Question 9

The nurse working within the AACN Synergy Model realizes that optimal patient outcomes are realized when:
1) Highly qualified nurses care for patients in highly technical settings.
2) Nurses agree to work overtime to cover unit staffing needs.
3) Staff nurse competency is matched with patient needs.
4) Patient care is delivered within a "closed unit" model.

Question 10

The nurse collaborates with other members of the health care team to effect optimal outcomes in patient care. Which characteristics of emotional maturity is the nurse using? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Maintaining current skills
2) Being a lifelong learner
3) Actively identifying best practices
4) Overlooking one's own shortcomings
5) Willing to take responsibility for failures

Question 11

The nurse realizes that the increased use of technology in critical care units has resulted in which consequence for patient care?
1) Decreased risk of errors in patient care
2) Decreased therapeutic nurse-patient communication
3) Improved overall patient satisfaction with care
4) Improved patient safety across the entire spectrum

Question 12

With which individuals should the nurse expect to provide patient care in an "open" ICU?
1) Multidisciplinary team with physicians who are also responsible for patients on other units
2) Multidisciplinary team that includes a physician employed by the hospital
3) Physician in charge of patient care who is a specialist in critical care
4) Primary care physician who must consult a critical care specialist

Question 13

Which statement should the nurse include for "A-Assessment" in the SBAR technique for communication?
1) "I think the problem is…"
2) "The patient's vital signs are…"
3) "The patient's treatments are…"
4) "I would like you to…"

Question 14

Which actions by the critical care nurse demonstrate an understanding of patient advocacy? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Maintaining attendance at the bedside with the patient during a physician visit
2) Assisting and supporting the patient and family as they reveal their needs
3) Alerting the physician to concerns about client placement after hospitalization
4) Encouraging and supporting a patient's spouse in preparing for a family meeting
5) Seeing the big picture when planning patient care

Question 15

For which patient would decision-making capacity likely be impaired? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Being medicated for severe pain
2) Does not understand the medical condition
3) Diagnosed with septic shock
4) Is depressed
5) Asks questions about identified treatments

Question 16

Which statement should the nurse use when concluding SBAR communication about a patient issue?
1) "The patient's immediate history is…"
2) "The patient's physical findings are…"
3) "I am requesting that you…"
4) "I have assessed the patient personally."

Question 17

Which actions should the nurse complete after realizing that an incorrect dose of medication has been administered to a patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Notify the patient and family.
2) Notify the physician.
3) Document the error.
4) Prepare for an analysis of the error.
5) Keep the notification of the error silent.

Question 18

The nurse employed in a hospital in a small rural town would expect to provide which level of care in the critical care unit?
1) Level I
2) Level II
3) Level III
4) It is unlikely that the hospital would have a critical care unit.

Question 19

What should the nurse who provides care to patients in a critical care unit realize the role of technology is on the amount of errors?
1) It relies heavily on human decision making.
2) Devices are programmed to function without double checks.
3) It makes the workload seem overwhelming to health care providers.
4) There is uniform equipment throughout each facility.

Question 20

The nurse in the critical care area is completing a preoperative checklist before sending a patient for surgery. This nurse's activity is an example of which recommendation issued by the Institute of Medicine?
1) Utilizing constraints
2) Simplifying key processes
3) Avoiding reliance on vigilance
4) Standardizing key processes

Question 21

The nurse manager of a critical care unit is explaining the AACN Synergy Model to the critical care nurses. What should the manager include as basic parts of this model? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Based on the patients' characteristics
2) Based on the competencies of the nurses
3) Patient outcomes will be measured
4) The nurses' assessment of patient outcomes will be measured
5) Reduction of cost to provide critical care services to patients

Question 22

The critical care nurse discusses a patient's change in status with the health care provider, pharmacist, and physical therapist. Which QSEN competency is this nurse demonstrating?
1) Patient-centered care
2) Quality improvement
3) Evidence-based practice
4) Teamwork and collaboration

Question 23

The nurse plans to question a health care provider's choice of medication for a critically ill patient. Which statement demonstrates assertive communication?
1) "At times I think it would be wise to update the prescribing references that are used."
2) "I learned that this medication might not be effective with this health problem. Would you explain choosing it?"
3) "This patient is getting worse, and it is because someone prescribed an antiquated medication to treat the problem."
4) "I realize I am only a nurse, but I can read and I learned that this medication is a poor choice to treat this medical problem."

Question 24

The critical care nurse is identifying patients at risk for safety and medical errors. Which patients should the nurse identify as being at risk for these issues? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Patient in isolation with MRSA
2) Patient who does not understand English
3) Patient with end stage renal disease and a respiratory rate of 8 per minute
4) Patient recovering from pacemaker insertion
5) Patient with pulmonary edema

Question 25

What would be appropriate reasons for an intensive care unit intensivist to call a huddle? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Make care providers aware of a change in a patient's situation.
2) Communicate a critical issue about a patient.
3) Make an assignment change.
4) Discuss concerns about a patient's status or care.
5) Plan care for the shift.

Question 26

A patient is admitted to an "open" intensive care unit. In addition to the nurse, which health care providers will assist in the care of this patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Pharmacist
2) Respiratory therapist
3) Attending physician
4) Dietician
5) Social worker

Question 27

The nurse is providing care to patients in a Level II general critical care unit. For which types of patient problems will this nurse most likely provide care? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Exacerbation of heart failure
2) Wound infection
3) Burns over 50% of total body surface
4) Kidney transplant
5) Reattachment of a traumatic amputation of the left leg

Question 28

What must the patient demonstrate for a nurse to be found guilty of negligence?
1) Was assaulted
2) Incurred damages
3) Suffered a wrongful death
4) Was not consulted before being touched

Question 29

What might occur when a nurse employs conscientious refusal to participate? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Dismissal from a nursing position
2) Employer sanctions
3) Support from nursing administrators
4) Protection from the state boards of nursing
5) Support by the patient

Question 30

Which symptoms indicate a nurse is experiencing compassion fatigue? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Difficulty separating work from personal life
2) Excessively high tolerance for frustration
3) Having a completely laissez-faire attitude
4) Decreased functioning in nonprofessional situations
5) Dreads working with certain types of patients

Question 31

The nurse manager is planning the staffing budget for the next fiscal year. What action should the manager take to ensure that staffing is adequate?
1) Study the results of the organization's staffing evaluation.
2) Meet with other nurse managers to compare staffing needs.
3) Remember that nurses should not work more than 72 hours each week.
4) Review staff competency needs with the director of human resources.

Question 32

What is associated with moral distress in critical care nurses? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Having no voice in clinical decision making
2) Providing aggressive care to patients who cannot benefit
3) Realizing that nurses maintain power in bedside decision making
4) Knowing the right thing to do but not being able to do it
5) Leaving employment as a critical care nurse

Question 33

The nurse manager, concerned that several staff nurses are experiencing moral distress, is planning to implement the 4 A's to Rise Above Moral Distress. Which steps will the manager take? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Ask
2) Affirm
3) Assess
4) Act
5) Assert

Question 34

The critical care nurse is experiencing psychologic symptoms of compassion fatigue. What strategies should the nurse use to enhance psychological well-being? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Make time for recreational activities.
2) Practice yoga for relaxation.
3) Plan to take a walk in the park at least once a week.
4) Monitor food and beverage intake.
5) Darken the room and limit activities before sleep.

Question 35

The adult daughter of a client with end-stage kidney disease informs the health care provider that all interventions are to be provided even though the client is heard telling the spouse that "enough is enough." What should be done first when analyzing this situation?
1) Identify significant information.
2) Determine the decision maker for the client.
3) Estimate the resources needed for care.
4) Calculate the expense of providing care to the client.

Question 36

The nurse manager reviews the standards of self-care for caregivers during a staff meeting. Which staff nurse comment indicates that teaching about the standards has been effective?
1) "I will consider yoga classes."
2) "I will play tennis with my sister at least twice a week."
3) "I do love to read, but at times I review the events of the day and I'm distracted."
4) "Going to the zoo with my nephew might be a good idea if I'm not needed for overtime."

Question 37

While completing a self-evaluation, the critical care nurse compares personal practice to the competencies identified by the AACN Synergy Model. Which behaviors are consistent with those in the Synergy Model? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Seeks out research studies to update protocols
2) Approaches patient care by looking at the "big picture"
3) Ensures family members are comfortable when visiting critical care patients
4) Encourages patient families to discuss issues with the physician
5) Telling the next shift that a patient needs help with understanding instructions