Chapter 01: Caring for the Critically Ill Patient(FREE)

Chapter 01: Caring for the Critically Ill Patient

Test Bank

MULTIPLE CHOICE

1. Which of the following units can provide high quality and cost effective care for patients who are less complex, more stable, and have a decreased need for physiologic monitoring could be placed on?

a.

intensive care units

b.

triage units

c.

progressive care units

d.

medical surgical units

ANS: C

A growing trend in acute care settings is the designation of progressive care units, considered to be part of the continuum of critical care. In past years, patients who are placed on these units would have been exclusively in critical care units. However, with the use of additional technology and monitoring capabilities, newer care delivery models, and additional nurse education, these units are considered the best environment. The patients are less complex, more stable, have a decreased need for physiologic monitoring, and more self-care capabilities. They can serve as a bridge between critical care units and medical-surgical units, while providing high quality and cost effective care at the same time.

2. _____ have a broad depth of knowledge and expertise in their specialty area and manage complex clinical and system issues.

a.

SCCMs

b.

APNs

c.

CNSs

d.

AACNs

ANS: B

APNs have a broad depth of knowledge and expertise in their specialty area and manage complex clinical and systems issues. CNSs serve in specialty roles that use their clinical, teaching, research, leadership, and consultative abilities. SCCM stands for the Society of Critical Care Medicine. AACN is the American Association of Critical-Care Nurses.

3. _____ are instrumental in ensuring care that is evidence based and that safety programs are in place.

a.

CNSs

b.

APNs

c.

SCCMs

d.

AACNs

ANS: A

CNSs serve in specialty roles that use their clinical, teaching, research, leadership, and consultative abilities. They are instrumental in ensuring that care is evidence based and that safety programs are in place. APNs have a broad depth of knowledge and expertise in their specialty area and manage complex clinical and systems issues. SCCM stands for the Society of Critical Care Medicine. AACN is the American Association of Critical-Care Nurses.

4. The _____ administers many critical care certifications exams for registered nurses.

a.

CNS

b.

APN

c.

SCCM

d.

AACN

ANS: D

AACN is the American Association of Critical-Care Nurses. CNSs serve in specialty roles that use their clinical, teaching, research, leadership, and consultative abilities. They are instrumental in ensuring that care is evidence based and that safety programs are in place. APNs have a broad depth of knowledge and expertise in their specialty area and manage complex clinical and systems issues. SCCM stands for the Society of Critical Care Medicine.

5. Emphasis is on human integrity and stresses the theory that the body, mind, and spirit are interdependent and inseparable. This statement describes which methodology of care?

a.

Holistic care

b.

Individualized care

c.

Cultural care

d.

Interdisciplinary care

ANS: A

Holistic care focuses on human integrity and stresses that the body, mind, and spirit are interdependent and inseparable. Individualized care recognizes the uniqueness of each patient’s preferences, condition, and physiologic and psychosocial status. Cultural diversity in health care is not a new topic, but it is gaining emphasis and importance as the world becomes more accessible to all as the result of increasing technologies and interfaces with places and peoples. Interdisciplinary care is care among a variety of health care professionals with the patient’s health as the common goal.

6. The AACN has developed short directives that can be used as quick references for clinical use that are known as

a.

Critical Care Protocol.

b.

Practice Policies.

c.

Evidence-Based Research.

d.

Practice Alerts.

ANS: D

The AACN has promulgated several evidence-based practice summaries in the form of “Practice Alerts.” Evidence-based nursing practice considers the best research evidence on the care topic along with clinical expertise of the nurse, and patient preferences. Critical care protocol and practice policies are established by individual institutions.

7. A specific therapy or care that is an option to what is considered conventional treatment of a condition is known as

a.

Guided Imagery.

b.

holistic care.

c.

complementary care.

d.

individualized care.

ANS: C

Complementary therapies offer patients, families, and health care providers additional options to assist with healing and recovery. The term complementary was proposed to describe therapies that can be used to complement or support conventional treatments.

8. Animal assisted, guided imagery, and massage are all examples of

a.

alternative therapy.

b.

holistic care.

c.

complementary care.

d.

individualized care.

ANS: C

The term complementary was proposed to describe therapies that can be used to complement or support conventional treatments. Spirituality, prayer, guided imagery, massage, and animal-assisted therapy are all examples of complementary care. Alternative denotes that a specific therapy is an option or alternative to what is considered conventional treatment of a condition or state. Holistic care focuses on human integrity and stresses that the body, mind, and spirit are interdependent and inseparable. Individualized care recognizes the uniqueness of each patient’s preferences, condition, and physiologic and psychosocial status.

9. A patient was admitted to a rural ICU in Montana. Critical care nurses are assisting with monitoring and care of the patient from the closest major city. This is an example of

a.

telemedicine.

b.

tele-ICU.

c.

tele-informatics.

d.

tele-hospital.

ANS: B

Telemedicine was initially used in outpatient areas, remote rural geographic locations, and areas where there was a dearth of medical providers. Currently, there are tele-ICUs in areas where there are limited resources onsite. However, experts (critical care nurses, intensivists) are located in a central distant site.

10. Working with individuals of other professions to maintain a climate of mutual respect and shared values best describes the concept of

a.

interprofessional teamwork and team-based care.

b.

values and ethics for interprofessional practice.

c.

interprofessional communication.

d.

roles and responsibilities for collaborative practice.

ANS: B

Values and ethics for interprofessional practice mean working with individuals of other professions to maintain a climate of mutual respect and shared values. Roles and responsibilities for collaborative practice include using knowledge of one’s own role and the roles of other professions to appropriately assess and address the health care needs of the patients and populations served. Interprofessional communication includes communicating with patients, families, communities, and other health professionals in a responsive and responsible manner that supports a team approach to maintaining health and treatment of disease. Interprofessional teamwork and team-based care means applying relationship-building values and principles of team dynamics to perform effectively in different team roles to plan and deliver patient population-centered care that is safe, timely, efficient, effective, and equitable.

11. A stepwise decision-making flowchart for a specific care process is known as a(n)

a.

algorithm.

b.

practice guideline.

c.

protocol.

d.

order set.

ANS: A

An algorithm is a stepwise decision-making flowchart for a specific care process or processes. A practice guideline is usually created by an expert panel and developed by a professional organization. Protocols are more directive and rigid than guidelines, and providers are not supposed to vary from a protocol. An order set consists of preprinted provider orders that are used to expedite the order process after a standard has been validated through analytical review of practice and research.

12. _____ continues to be one of the most error-prone nursing interventions for critical care nurses.

a.

Inappropriate care

b.

Intimidating and disruptive clinician behavior

c.

Injury to patients by falls

d.

Medication administration

ANS: D

Medication administration continues to be one of the most error-prone nursing interventions for critical care nurses. Intimidating and disruptive clinician behaviors can lead to errors and preventable adverse patient outcomes. Patient safety has been described as an ethical imperative and one that is inherent in health care professionals’ actions and interpersonal processes; examples include inappropriate care and injury to patients by falls.

MULTIPLE RESPONSE

1. Evidence-based nursing practice takes into account (Select all that apply)

a.

clinical expertise of the nurse.

b.

availability of staff and facility equipment.

c.

research evidence on the topic.

d.

patient knowledge of the disease.

e.

patient preference regarding care

ANS: A, C, E

Evidence-based nursing practice considers the best research evidence on the care topic along with clinical expertise of the nurse and patient preferences. For instance, when determining the frequency of vital sign measurement, the nurse would use available research and nursing judgment (stability, complexity, predictability, vulnerability, and resilience of the patient). Availability of staff and facility equipment and the patient’s knowledge of the disease do not factor into evidence-based nursing practices.

2. According to Kupperschmidt, to become a skilled communicator, one must (Select all that apply)

a.

become candid.

b.

become reflective.

c.

set goals and develop action plans.

d.

survey the team.

e.

become aware of self-deception.

ANS: A, B, E

Kupperschmidt and colleagues posed a five-factor model for becoming a skilled communicator: becoming aware of self-deception, becoming authentic, becoming candid, becoming mindful, and becoming reflective, all of which lead to being a skilled communicator. The HWE model was offered by Blake, who suggested five steps: rallying the team, surveying the team, establishing work groups, setting goals and developing action steps, and celebrating successes along the way.