Question 1

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 use the interpreter services of the agency.These individuals are trained and knowledgeable.If the nurse conducted a search on the computer,he or she would not know if the information retrieved was valid,nor would the nurse 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 or her abilities to translate.In addition,the resident's availability is likely to be limited.Although the child might be able to translate,the nurse cannot ensure that the child is translating health care concepts correctly.

Question 2

Family assessment is essential 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 3

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 4

Patients often have recollections of the critical care experience.Which is likely to be the most common recollection of patients 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 5

Which intervention is appropriate to assist the patient in coping 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 6

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 36-year-old male without a written advance directive results in his distant parents being legally responsible for his health care 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 the parents' 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 whom he wants to make health care decisions for him.The elderly female may have conflict with her son; however,she is capable of making her own decisions and has a written advance directive to support her decisions.

Question 7

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

Accepted Answer

Open visitation is considered best practice.Limiting visitation is not supported by research.Facilities should develop visitation schedules in collaboration with the patient and family.Animals do not need to be limited to therapy animals.Many patients benefit from the presence of personal pets brought to the unit according to hospital policy.Although many units restrict visitation during report and rounds for confidentiality,family-centered facilities will encourage family participation during report and rounds.Children should not be banned arbitrarily from the unit or have hours limited.

Question 8

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

Accepted Answer

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

Question 9

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,limited social support,and a transfer 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 10

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.

Question 11

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

Accepted Answer

Anxiety is reduced when procedures are explained before completing them and when the nurse continues to talk to the patient during them.Limiting visitation has not been demonstrated by research to benefit patients.Explaining the unit routine is important but is not as specific to the patient as explaining a procedure right before doing it.Providing physical care is vital to critically ill patients,but may or may not reduce anxiety.

Question 12

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.A planned condition update helps the family know what to expect.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 13

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 14

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 inappropriate while providing direct care to the patient.Although the patient 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 15

The spouse 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.The spouse demands,"I want you to reassign us to another nurse.His current nurse is not in the room enough to make sure everything is okay." The nurse recognizes that this response most likely is due to the spouse'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 unknown whether the spouse had a prior negative experience.

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 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 when 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 18

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 19

The intensive care nurse is working on a committee to reduce noise in the unit.Which recommendation should the nurse propose first?

Accepted Answer

The pneumatic tube system is extremely loud at 88dB[A] and should be the first proposal as it will have the biggest impact on noise on the unit.Call light systems typically ring at the 48-63 dB[A] range and are also a significant cause of noise,but not as much as the pneumatic tube system.Telephones are also noisy,ringing at 60-67 dB[A].Nurses should never shut off monitor alarms as this is a patient safety issue.

Question 20

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.

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