Test bank for priorities in critical care nursing 5th edition urden

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Urden: Priorities in Critical Care Nursing, 5th Edition
Test Bank
Chapter 1: Caring for the Critically Ill Patient
MULTIPLE CHOICE
1. Which of the following best describes the difference between the roles of the CNS and the nurse
practitioner (NP)/acute care nurse practitioner (ARNP)?
A. The CNS has prescriptive authority and works with individual patients.
B. The advanced registered nurse practitioner (ARNP) has prescriptive authority and
works with groups of ABBREVIATION ONLY patients.
C. The CNS works only as a consultant.
D. The ARNP works only with families.
ANS: B
NPs and ARNPs manage clinical care of a group of patients and have various levels of
prescriptive authority, depending on the state and practice area in which they work. They also
provide care consistency, interact with families, plan for patient discharge, and provide teaching
to patients, families, and other members of the heath care team.
DIF: Comprehension
REF: 1
MSC: Client need: Safe and Effective Care Environment—Management of Care
2. The framework for critical care nurses is based on what authoritative standards?
A. The Joint Commission on National Patient Safety Goals
B. American Association of Critical-Care Nurses (AACN) Standards of Care
C. American Hospital Association algorithms
D. Centers for Disease Control and Prevention emergency preparedness guidelines
ANS: B
The AACN has established nursing standards to provide a framework for critical care nurses. The
standards are authoritative statements that describe the level of care and performance by which
the quality of nursing care can be judged. Standards serve as descriptions of expected nursing
roles and responsibilities.

DIF: Knowledge REF: 1
MSC: Client need: Safe and Effective Care Environment—Coordinated Care
3. The rationale for using evidence-based practice is to:
A. produce consistent, positive outcomes.
B. justify the actions of providers.
C. convince insurance companies to pay.
D. provide legal protection for providers.
ANS: A
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Full file at />By basing practice on scientific findings, with their ability to explain and predict, nurses are able
to provide research-based interventions with consistent, positive outcomes.
DIF: Comprehension
REF: 2
MSC: Client need: Safe and Effective Care Environment—Coordinated Care
4. Practice Alerts promoted by the AACN are:
A. descriptive warnings of hazardous practices.
B. quick references for practice areas.
C. notices of violations of the Nursing Practice Act.
D. simulated situations for practicing difficult techniques.
ANS: B
The AACN has promulgated several practice summaries in the form of Practice Alerts. These
alerts are short directives that can be used as a quick reference for practice areas (e.g., oral care,
noninvasive blood pressure monitoring, ST segment monitoring). They are succinct and
supported by evidence and address both nursing and multidisciplinary activities. Each alert
includes the clinical information, followed by references that support the practice.
DIF: Comprehension
REF: 2-3
MSC: Client need: Safe and Effective Care Environment—Coordinated Care

5. The nursing process differs from most other decision-making models because it is:
A. evidence-based.
B. cyclic.
C. linear.
D. culture bound.
ANS: B
The nursing process is a systematic decision-making model that is cyclic, not linear. By virtue of
its evaluation phase, the nursing process incorporates a feedback loop that maintains quality
control of its decision-making outputs. Similar to a problem-solving method, the nursing process
begins with an assessment phase and offers an organized, systematic approach to clinical
problems. Unlike a problem-solving method, however, the nursing process is continuous, not
episodic.
DIF: Comprehension
REF: 4
MSC: Client need: Safe and Effective Care Environment—Coordinated Care
6. A nursing diagnosis differs from a medical diagnosis because it describes:
A. a health condition primarily resolved by nursing intervention.
B. physical conditions that alter the patient’s ability to function.
C. syndromes and diseases that do not require the use of pharmaceuticals.
D. illnesses that are treated by collaborative effort.
ANS: A
The most essential and distinguishing feature of any nursing diagnosis is that it describes a health
condition primarily resolved by nursing interventions or therapies.
Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.


Full file at />DIF: Comprehension
REF: 4
MSC: Client need: Safe and Effective Care Environment—Coordinated Care
7. Nursing diagnoses can be individualized to best describe the characteristics of a health problem

as it manifests itself in a particular patient by:
A. using the patient’s name in the plan.
B. using qualifiers and/or specifiers.
C. including cultural references.
D. applying time limits for outcomes.
ANS: B
Some nursing diagnoses need accompanying qualifiers or specifiers based on the characteristics
of the health problem as it manifests itself in a particular patient. For example, the diagnosis Fear
needs specification of the object of the patient’s particular fear, such as death, pain,
disfigurement, or malignancy.
DIF: Comprehension
REF: 4
MSC: Client need: Safe and Effective Care Environment—Coordinated Care
8. To be useful, the patient care plan must have goals that are:
A. universal.
B. describable.
C. measurable.
D. unique.
ANS: C
Outcome criteria should be measurable. Outcome criteria consist of recognizable patient
behaviors, statements, and physiologic parameters. Many of the phenomena assessed by critical
care nurses in diagnosis and treatment are readily measurable, such as adequacy of spontaneous
ventilation, cardiac output, and tissue perfusion. Outcome statements are made even more
measurable by indicating the date and time of anticipated attainment of the outcome.
DIF: Comprehension
REF: 4
MSC: Client need: Safe and Effective Care Environment—Coordinated Care
9. An algorithm used in the care and treatment of the critically ill patient is the:
A. AACN Standards of Care.
B. advanced cardiac life support algorithms published by the American Heart

Association.
C. state board of nursing state practice act.
D. National League for Nursing’s Center for Nursing Advocacy Mission Statement.
ANS: B

Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.


Full file at />An algorithm is a stepwise decision-making flowchart for a specific care process or processes.
Algorithms are more focused than clinical pathways and guide the clinician through the “if,
then” decision-making process, addressing patient responses to particular treatments. Wellknown examples of algorithms are the advanced cardiac life support algorithms published by the
American Heart Association.
DIF: Comprehension
REF: 6
MSC: Client need: Safe and Effective Care Environment—Coordinated Care
10. A preprinted provider order document that has been validated through review of practice and
research is a(n):
A. algorithm.
B. paradigm.
C. order set.
D. clinical pathway.
ANS: C
An order set consists of preprinted provider orders that are used to expedite the order process
once a standard has been validated through analytic review of practice and research. Order sets
complement and increase compliance with existing practice standards. Sets can also be used to
represent the algorithm or protocol in order format.
DIF: Comprehension
REF: 6
MSC: Client need: Safe and Effective Care Environment—Coordinated Care
11. The nurse best demonstrates an understanding of holistic care by:

A. explaining the use of the continuous blood pressure monitoring device to the
family.
B. using active listening with a patient who is fearful and anxious.
C. incorporating other disciplines into the plan of care.
D. reviewing the list of home medications with a family member.
ANS: B
The critical care nurse must be able to deliver high-quality care skillfully, using all appropriate
technologies, while incorporating psychosocial and other holistic approaches as appropriate
given time and the patient’s condition.
DIF: Comprehension
REF: 3
MSC: Client need: Psychosocial Integrity
12. Which of the following statements best demonstrates the nurse’s integration of objective data
with knowledge gained from the patient’s subjective experience?
A. “I can understand that it was uncomfortable for you to be drowsy after taking your
pain medication on schedule, but that is not a sign of allergy to the drug.”
B. “Here are the side effects of the medication you are taking.”
C. “What medication did your previous doctor prescribe for this condition?”
D. “Please do not take alcohol or other depressants with this medication.”

Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.


Full file at />ANS: A
This statement indicates integration of objective data with knowledge gained from an
understanding of the patient’s or group’s subjective experience.
DIF: Comprehension
REF: 3
MSC: Client need: Psychosocial Integrity
13. Which of the following statements demonstrates the nurse’s ability to apply scientific knowledge

to the processes of diagnosis and treatment?
A. “Doing these exercises will probably help you gain strength and flexibility.”
B. “This medication works by killing the bacteria that are causing your infection.”
C. “God will help you get well if you pray hard enough.”
D. “If your great-grandmother used this I’m sure it will be effective in relieving your
headaches, too.”
ANS: B
The statement shows application of scientific knowledge (pathophysiology and pharmacology) to
the processes of diagnosis and treatment.
DIF: Comprehension
REF: 3
MSC: Client need: Psychosocial Integrity
14. Which of the following goal statements is the best statement of outcome?
A. The patient will improve by Saturday.
B. The patient will walk to the nurses’ station.
C. The patient will give a return demonstration with no errors.
D. The patient will tolerate ambulation across the room without assistance within 24
hours after surgery.
ANS: D
Outcome criteria should be measurable, desirable, and attainable, with full consideration given to
patient/nurse resources.
DIF: Comprehension
REF: 4
MSC: Client need: Psychosocial Integrity
MULTIPLE RESPONSE
15. The care that critically ill patients receive in hospitals is (choose two):
A. mechanized.
B. multidisciplinary.
C. specialized.
D. centralized.

ANS: B, C
Critical care today is provided to patients by a multidisciplinary team of health care professionals
who have in-depth education in the specialty field of critical care.

Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.


Full file at />DIF: Comprehension
REF: 1
MSC: Client need: Physiological Integrity—Reduction of Risk Potential
16. Special capabilities that clinical nurse specialists (CNSs) bring to the care of the critically ill
patient include (choose all that apply):
A. providing routine bedside care.
B. conducting research.
C. offering spiritual support.
D. consulting.
E. writing prescriptions.
ANS: B, D
CNSs serve in specialty roles that require clinical, teaching, research, leadership, and
consultative abilities.
DIF: Comprehension
REF: 1
MSC: Client need: Physiological Integrity—Reduction of Risk Potential
17. Ways that critical care nurses can ensure that individual differences related to culture are
incorporated into the plan of care include (choose all that apply):
A. asking the patient/family about cultural beliefs that may apply.
B. asking the patient/family to comply with the hospital culture.
C. developing a plan of care that is unique to the patient/family.
D. using a standardized plan of care for consistency.
E. formulating lists of cultural characteristics that apply to all group members.

ANS: A, B
Nurses must possess knowledge about biocultural, psychosocial, and linguistic differences in
diverse populations to make accurate assessments. Interventions must then be tailored to address
the uniqueness of each patient and family.
DIF: Comprehension
REF: 3
MSC: Client need: Psychosocial Integrity
18. Protocols are distinguished from pathways or guidelines by which of the following (choose all
that apply)?
A. They are used in research.
B. They are more directive and rigid.
C. They have more flexibility in use.
D. They are cyclic.
ANS: A, B
A protocol is a common tool in research studies. Protocols are more directive and rigid than
pathways or guidelines, and providers should not vary from a protocol. Patients are screened
carefully for specific entry criteria before being started on a protocol. The many national research
protocols include those for cancer and chemotherapy studies.

Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.


Full file at />DIF: Comprehension
REF: 6
MSC: Client need: Safe and Effective Care Environment—Coordinated Care
19. Especially in a critical care unit, patient safety is an ethical imperative because (choose all that
apply):
A. surveillance is more prevalent and the nurses’ actions are scrutinized.
B. the highly complex environment makes errors and accidents more likely.
C. patients are vulnerable due to their compromised state.

D. the high-technology setting decreases risk of errors and omissions.
ANS: B, C
Patient safety has been described as an ethical imperative, and one that is implied in health care
professionals’ actions and interpersonal processes. Critical care units are prime examples of
settings in which errors may occur because of the hectic, complex environment where the
margins of error are narrow and the demands for safety are crucial. In this environment, patients
are particularly vulnerable due to their compromised physiologic status, need for multiple
technologic and pharmacologic interventions, and care by multiple providers who frequently
work at a fast pace.
DIF: Comprehension
REF: 6
MSC: Client need: Safe and Effective Care Environment—Coordinated Care
20. The regulations of the Health Insurance Portability and Accountability Act have which special
implications for the provider of care in the critical care environment (choose two)?
A. Privacy must be maintained in close working conditions.
B. Only as much information as the patient/family needs should be disclosed.
C. The care provider must be honest and accurate in reporting patient-related
information.
D. Confidentiality must be preserved when speaking with family members.
ANS: A, D
The Health Insurance Portability and Accountability Act of 1996 has created additional
challenges for health care organizations and providers due to the stringent requirements of the
law and the additional resources needed to meet these requirements. Most relevant for critical
care clinicians is the requirement for privacy and confidentiality related to protection of health
care data. This has implications when interacting with family members as well as others and
when providing care in the oftentimes very close work environment, tight working spaces, and
emergent situations. Clinicians are referred to their organizational policies and procedures for
specific procedures and requirements in their particular work setting.
DIF: Comprehension
REF: 7

MSC: Client need: Safe and Effective Care Environment—Coordinated Care

Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.