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

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?

A) Ask a family member to help you bathe the patient, and discuss the family structure with the family member during the procedure.
B) Because she is unconscious, complete care as quickly and quietly as possible.
C) Tell the patient the day and time, and that you are bathing her. Reassure her that you are there.
D) Turn the television on to the evening news so that you and the patient can be updated to current events.

Answer 1

Tell the patient the day and time, and that you are bathing her. Reassure her that you are there.

Question 2

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

A) anxiety.
B) pain.
C) powerlessness.
D) sensory overload.

Answer 2

sensory overload.

Question 3

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

A) Allowing unrestricted visiting by several family members at one time
B) Explaining all procedures in easy-to-understand terms
C) Providing back massage and mouth care
D) Turning down the alarm volume on the cardiac monitor

Answer 3

Explaining all procedures in easy-to-understand terms

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?

A) Conduct a Google search on the computer to identify resources for the patient and family in their native language. Print these for their use.
B) Contact the hospital's interpreter service for someone to translate.
C) Get in touch with one of the residents that you know is fluent in the native language and ask him if he can come up to the unit.
D) Use the 8-year old child who is fluent in both English and the native language to translate for you.

Question 5

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

A) Handing family members a pamphlet that explains all of the critical care equipment
B) Providing a daily update of the patient's progress and facilitating communication with the intensivist
C) Telling them that you are not permitted to give them a status report but that they can be present at 4:00 PM for family rounds with the intensivist
D) Writing down a list of all new medications and doses and giving the list to family members during visitation

Question 6

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

A) Ask family members to limit their visitation to 2-hour periods in morning, afternoon, and evening. You know that this is the best approach to ensure uninterrupted rest time for the patient. Tell the patient, "Mr. J., your family is in the waiting room. They will be permitted to come in at 2:00 PM after you take a short nap."
B) Explain the unit routine. "Mr. J., assessments are done every 4 hours; patients are bathed on the night shift around 5:00 AM; family members are permitted to visit you after the physicians make their morning rounds. They can spend the day. Lights are out every night at 10:00 PM."
C) State, "Mr. J., it's time to turn you. I am going to ask another nurse to come in and help me. We will turn you to your left side. During the turn, I'm going to inspect the skin on your back and rub some lotion on your back. This should help to make you feel better."
D) Suction Mr. J.'s endotracheal tube immediately when he starts to cough. Tell him, "Mr. J., your tube needs suctioned; you should feel better after I'm done."

Question 7

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

A) Consult with the pharmacist to adjust medication times to allow periods of sleep or rest between intervals.
B) Encourage family members to talk with the patient whenever they are present in the room.
C) Keep the television on to provide "white" noise and distraction.
D) Leave the lights on in the room so that the patient is not frightened of his or her surroundings.

Question 8

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

A) A 21-year-old college student of divorced parents hospitalized with multiple trauma. She resides with her mother. The parents are amicable with each other and have similar values. The father blames the daughter's boyfriend for causing the accident.
B) A 36-year-old male admitted for a ruptured cerebral aneurysm. He has been living with his 34-year-old girlfriend for 8 years, and they have a 4-year-old daughter. He does not have written advance directives. His parents arrive from out-of-state and are asked to make decisions about his health care. He has not seen them in over a year.
C) A 58-year-old male admitted for coronary artery bypass surgery. He has been living with his same-sex partner for 20 years in a committed relationship. He has designated his sister, a registered nurse, as his healthcare proxy in a written advance directive.
D) A 78-year-old female admitted with gastrointestinal bleeding. Her hemoglobin is decreasing to a critical level. She is a Jehovah's Witness and refuses the treatment of a blood transfusion. She is capable of making her own decisions and has a clearly written advance directive declining any transfusions. Her son is upset with her and tells her she is "committing suicide."

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?

A) Assessment of patient and family's developmental stages and needs
B) Description of the patient's home environment
C) Identification of immediate family, extended family, and decision makers
D) Observation and assessment of how family members function with each other

Question 10

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

A) Allow animals on the unit; however, these can only be "therapy" animals through the hospital's pet therapy program.
B) Allow family visitation throughout the day except at change of shift and during rounds.
C) Determine, in collaboration with the patient and family, who can visit and when. Facilitate open visitation policies.
D) Permit open visitation by adults 18 years of age and older; limit visits of children to 1 hour.

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?

A) A 70-year-old who had coronary artery bypass surgery. He developed complications after surgery and had difficulty being weaned from mechanical ventilation. He required a tracheostomy and gastrostomy. He is being discharged to a long-term, acute care hospital. He is a widower.
B) A 79-year-old admitted for exacerbation of heart failure. She manages her care independently but needed diuretic medications adjusted. She states that she is compliant with her medications but sometimes forgets to take them. She lives with her 82-year-old spouse. Both consider themselves to be independent and support each other.
C) A 90-year-old admitted for a carotid endarterectomy. He lives in an assisted living facility (ALF) but is cognitively intact. He is the "social butterfly" at all of the events at the ALF. He is hospitalized for 4 days and discharged to the ALF.
D) An 84-year-old who had stents placed to treat coronary artery occlusion. She has diabetes that has been managed, lives alone, and was driving prior to hospitalization. She was discharged home within 3 days of the procedure.

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?

A) Difficulty communicating
B) Inability to get comfortable
C) Pain
D) Sleep disruption

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?

A) Create an informal family information sheet that is kept on the bedside clipboard. That way, everyone can review it quickly when needed.
B) Develop a standardized reporting form for family information that is incorporated into the patient's medical record and updated as needed.
C) Require that the charge nurse have a detailed list of information about each patient and family member. Thus, someone on the unit is always knowledgeable about potential issues.
D) Try to remember to discuss family structure and dynamics as part of the change-of-shift report.

Question 14

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

A) Encourage family members to stay all night in case the patient needs them.
B) Give a condition update each morning and whenever changes occur.
C) Limit visitation from children into the critical care unit.
D) Provide beverages and snacks in the waiting room.

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:

A) desire to pursue a lawsuit if the assignment is not changed.
B) inability to participate in the husband's care.
C) lack of prior experience in a critical care setting.
D) sense of loss of control of the situation.

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?

A) View the family as guests on the unit.
B) Acknowledge family emotions.
C) Learn as much as you can about family structure and function.
D) Use a trained interpreter if the family does not speak English.
E) Evaluate each encounter with the family.

Question 17

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

A) "I don't remember much about being in the ICU, but if I had to be treated there again, it would be okay. I'm glad I can see my grandchildren again."
B) "If I get that sick again, do not take me to the hospital. I would rather die than go through having a breathing tube put in again."
C) "My family is thrilled that I am home. I know I need some extra attention, but my children have rearranged their schedules to help me out."
D) "Since I have been transferred out of the ICU, I cannot get enough to eat. They didn't let me eat in the ICU, so I'm making up for it now."

Question 18

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

A) The majority of critical care nurses implement restricted visiting hours to allow the patient to rest.
B) Children should never be permitted to visit a critically ill family member.
C) Visitation that is individualized to the needs of patients and family members is ideal.
D) Visiting hours should always be unrestricted.

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?

A) Ensure that the patient's room is large enough and has adequate space for a sleeper sofa and storage for family members' personal belongings.
B) Include a diagnostic suite in close proximity to the unit so that the patient does not have to travel far for testing.
C) Incorporate a large waiting room on the top floor of the hospital with a scenic view and amenities such as coffee and tea.
D) Provide access to a scenic garden for meditation.

Question 20

Which of the following statements about family assessment is false?

A) Assessment of structure (who comprises the family) is the last step in assessment.
B) Interaction among family members is assessed.
C) It is important to assess communication among family members to understand roles.
D) Ongoing assessment is important, because family functioning may change during the course of illness.

Question 21

The critical care environment is stressful to the patient.Which interventions assist in reducing this stress? (Select all that apply.)

A) Adjust lighting to promote normal sleep-wake cycles.
B) Provide clocks, calendars, and personal photos in the patient's room.
C) Talk to the patient about other patients you are caring for on the unit.
D) Tell the patient the day and time when you are providing routine nursing interventions.

Question 22

A patient and his family are excited that he is transferring from the critical care unit to the intermediate care unit.However,they are also fearful of the change in environment and nursing staff.To reduce relocation stress,the nurse can: (Select all that apply.)

A) ask the nurses on the intermediate care unit to give the family a tour of the new unit.
B) contact the intensivist to see if the patient can stay one additional day in the critical care unit so that he and his family can adjust better to the idea of a transfer.
C) ensure that the patient will be located near the nurse's station in the new unit.
D) invite the nurse who will be assuming the patient's care to meet with the patient and family in the critical care unit prior to transfer.

Question 23

The critical care environment is often stressful to a critically ill patient.Identify stressors that are common.(Select all that apply.)

A) Alarms that sound from various devices
B) Bright, fluorescent lighting
C) Lack of day-night cues
D) Sounds from the mechanical ventilator
E) Visiting hours tailored to meet individual needs

Question 24

Noise in the critical care unit can have negative effects on the patient.Which of the following interventions assists in reducing noise levels in the critical care setting? (Select all that apply.)

A) Ask the family to bring in the patient's i-Pod or other device with favorite music.
B) Invite the volunteer harpist to play on the unit on a regular basis.
C) Remodel the unit to have two-patient rooms to facilitate nursing care.
D) Remodel the unit to install acoustical ceiling tiles.
E) Turn the volume of equipment alarms as low as they can be adjusted, and "off" if possible.

Question 25

It is important for critically ill patients to feel safe.Which nursing strategies help the patient to feel safe in the critical care setting? (Select all that apply.)

A) Allow family members to remain at the bedside.
B) Be sure to consult with the charge nurse before making any patient care decisions.
C) Provide informal conversation by discussing your plans for after work.
D) Respond promptly to call bells or other communication for assistance.

Question 26

Nursing strategies to help families cope with the stress of critical illness include: (Select all that apply.)

A) asking the family to leave during the morning bath to promote the patient's privacy.
B) encouraging family members to make notes of questions they have for the physician during family rounds.
C) if possible, providing continuity of nursing care.
D) providing a daily update of the patient's condition to the family spokesperson.

Question 27

Family presence is encouraged during resuscitation and invasive procedures.The nurse knows that nurses are often reluctant to allow this to occur,yet families often perceive benefits.Which findings have been reported in the literature? (Select all that apply.)

A) Families benefit by witnessing that everything possible was done.
B) Families report reduced anxiety and fear about what is being done to the patient.
C) Presence encourages family members to seek litigation for improper care.
D) Presence reduces nurses' involvement in explaining things to the family.

Question 28

Changing visitation policies can be challenging.The nurse manager recognizes the following as an effective strategy for promoting changes in practice:

A) Ask the clinical nurse specialist to lead a journal club on open visitation after each nurse is tasked to read one research article about visitation.
B) Discuss pros and cons of open visitation at the next staff meeting.
C) Invite the nurses with the most experience to develop a revised policy.
D) Task the unit-based nurse practice council to invite volunteers to serve on the council to revise the current policy toward more liberal visitation.