Test Bank Understanding the Essentials of Critical Care Nursing ( 2nd Edition ) Perrin MacLeod

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Perrin, Understanding the Essentials of Critical Care Nursing, 2/e
Chapter 2

Question 1
Type: MCSA
The nurse identifies a patient in the critical care unit as having “resiliency.” What characteristic has the nurse identified in the patient?
1. Motivation to reduce anxiety through positive self-talk
2. Ability to bounce back quickly after an insult
3. Physical strength to endure extreme physical stressors
4. Ability to return to a state of equilibrium
Correct Answer: 2
Rationale 1: This is not a definition of resiliency.
Rationale 2: The correct definition of “resiliency” is the ability to bounce back quickly after an insult. The degree of resiliency is placed along a continuum between being unable to mount a response to having strong reserves.
Rationale 3: This is not a definition of resiliency.
Rationale 4: This is not a definition of resiliency.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 2-1: Explain the characteristics of the critically ill patient described in the AACN Synergy Model.

Question 2
Type: MCSA
While caring for a patient in the critical care unit, the nurse realizes that the patient’s care needs must be a balance between the patient’s long-term prognosis and the family’s expectations of recovery. Which of the AACN Synergy Model’s characteristics does this situation describe?
1. Complexity
2. Predictability
3. Participation in care
4. Resource availability
Correct Answer: 1
Rationale 1: This situation describes the characteristic of complexity that is the intricate entanglement of two or more systems; for example, a patient’s illness with complex family dynamics.
Rationale 2: This situation does not describe predictability.
Rationale 3: This situation does not describe participation in care.
Rationale 4: This situation does not described resource availability.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 2-1: Explain the characteristics of the critically ill patient described in the AACN Synergy Model.

Question 3
Type: MCSA
The nurse realizes that which stressor is one of the primary concerns of critically ill patients and should be routinely included during assessments?
1. Inability to control elimination
2. Lack of family support
3. Hunger
4. Altered ability to communicate
Correct Answer: 4
Rationale 1: The inability to control elimination is not identified as a primary concern of critically ill patients.
Rationale 2: Lack of family support is not identified as a primary concern of critically ill patients.
Rationale 3: Hunger is not identified as a primary concern of critically ill patients.
Rationale 4: Altered ability to communicate is identified as a primary concern of critically ill patients.
Global Rationale:

Cognitive Level: Applying
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 2-2: Discuss the concerns expressed by critically ill patients.

Question 4
Type: MCMA
A patient has just completed a preoperative education session prior to undergoing coronary artery bypass surgery. Which patient statements indicate that teaching has been effective?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. “I understand that I will have to blink my eyes to respond after the breathing tube is in my throat.”
2. “I will be given frequent mouth care to help me when I am thirsty.”
3. “I will be able to move about freely in bed and into the chair without help while connected to the electronic equipment for monitoring.”
4. “I may need something to help me rest due to the unfamiliar lights and sounds of the ICU unit.”
5. “I might not behave like my usual self after the surgery but it will be because of the medications and my illness.”
Correct Answer: 1,2,4,5
Rationale 1: An alternate method of communication discussed in advance of tube placement will assist in better communication after the tube is inserted to aid the breathing process.
Rationale 2: While intubated, oral hygiene is needed to prevent mucosal drying due to the inability of the patient to take oral fluids.
Rationale 3: This statement indicates that additional teaching is required because the patient will not be able to move freely in bed and into a chair without assistance while being electronically monitored.
Rationale 4: Due to environmental lights, sounds, and difference in sleeping environment, additional aids, such as drug management, may be needed to assist the patient to rest at night.
Rationale 5: A patient concern in the critical care area is the inability to control self. This statement indicates the patient’s understanding of the teaching.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 2-2: Discuss the concerns expressed by critically ill patients.

Question 5
Type: MCSA
When providing care to critically ill patients, whether they are responsive or unresponsive, the nurse should:
1. Clearly explain what care is to be done before starting the activity.
2. Perform the activity and then let the patient rest without explaining the care.
3. Make sure the patient always responds and is cooperative before giving care.
4. Explain to the family that the patient will not understand or remember any of the discomfort associated with care.
Correct Answer: 1
Rationale 1: By explaining to both the responsive and unresponsive patient, the nurse provides orientation, reassurance, respect, and assessment of the patient’s mental status. Seeking permission and apologizing if discomfort is involved will also minimize the stress of the critically ill patient by allowing the patient to hear what is about to occur. Even the unresponsive patient has been known to explain procedures, conversations, and feelings once he or she has awakened.
Rationale 2: If the patient is not informed, autonomy and the right to choose have been violated; in addition, the stress of the unknown may be perceived incorrectly by the patient as an assault.
Rationale 3: Some unresponsive patients will never respond; therefore, the care would not be performed as needed. Cooperation is also not possible in some cases whereby the patient has altered thinking. Although the nurse desires these, the care should not be stopped just because they cannot be obtained. Explaining should still be done and the care should proceed as needed.
Rationale 4: The nurse cannot always reassure the family that the patient will not remember.
Global Rationale:

Cognitive Level: Applying
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 2-3: Describe strategies a nurse might utilize to communicate with a ventilated patient.

Question 6
Type: MCSA
Which communication strategy is most appropriate for a critical care nurse to use when communicating with a ventilated patient? The nurse should:
1. Use professional terminology and provide the patient with detailed information.
2. Use simple language and explain in other terms if the patient does not seem to understand.
3. Provide minimal information so the patient is not overwhelmed.
4. Discuss issues primarily with the family because the patient is unlikely to understand the information.
Correct Answer: 2
Rationale 1: Individuals who are not familiar with health care often do not understand professional language. Confusion and a lack of understanding often result if the information is presented only with professional terminology.
Rationale 2: Simple layman’s language of information is better understood and repeating or rephrasing gives the patient a better understanding when in a stressful situation.
Rationale 3: Minimal disclosure of information will increase the stress of the patient by increasing confusion and concerns from the lack of understanding about the illness or treatment process. Complete disclosure is the right of the patient and the obligation of health care professionals.
Rationale 4: Disclosing information or communicating only with the patient’s family denies the patient the right of choice and the respect or dignity expected. Legally and ethically, except under very specific restrictions, the patient has a right to know, and it is the health care professional’s responsibility to explain clearly for informed consent to occur.
Global Rationale:

Cognitive Level: Applying
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 2-3: Describe strategies a nurse might utilize to communicate with a ventilated patient.

Question 7
Type: MCSA
During an assessment, a ventilated patient begins to frown and wiggle about in bed. Which assessment strategy would be most helpful for the nurse to validate these observations?
1. Glasgow Scale
2. Maslow’s hierarchy levels
3. Critical-Care Pain Observation Tool (CPOT)
4. Vital signs trends
Correct Answer: 3
Rationale 1: The Glasgow Coma Scale will identify the level of consciousness present to evaluate the sedation level that is used with patients who are intubated. But this scale does not identify the source of the problem that has increased the patient’s facial changes or movement.
Rationale 2: Maslow’s hierarchy of needs prioritizes needs based on essential to higher level functions in the body, and it would not help identify the source of the changes noted in the patient.
Rationale 3: The CPOT pain scale will identify if pain is present and the degree of effectiveness of drug management in a patient who cannot speak due to intubation.
Rationale 4: Vital signs might tell the nurse that a change has occurred but it does not indicate the source of the discomfort or problem.
Global Rationale:

Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Reduction of Risk Potential
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 2-4: Explain the use of sedation, pain, and delirium scales with critically ill patients.

Question 8
Type: MCMA
Which parameters indicate that a patient in the intensive care unit being mechanically ventilated is ready for an interruption in sedation? The patient:
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Had a MAP of 75 and heart rate of 76
2. Was sleeping but awakened with verbal stimuli
3. Frowned when turned but otherwise showed no muscular tension
4. Activated the ventilator alarms but the alarms stopped spontaneously
5. Is receiving neuromuscular blocking agents to ensure adequate ventilation
Correct Answer: 1,2,3,4
Rationale 1: Hemodynamic stability is one criterion that indicates daily weaning of sedatives should be automatically attempted.
Rationale 2: Awakening with verbal stimuli indicates that daily weaning of sedatives should be attempted.
Rationale 3: Control of pain is an indication that daily weaning of sedatives should be attempted.
Rationale 4: Patient-ventilator synchrony is an indication that daily weaning of sedatives should be attempted.
Rationale 5: Receiving neuromuscular blocking agents indicates that daily weaning of sedatives should not be attempted.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and Parenteral Therapies
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 2-4: Explain the use of sedation, pain, and delirium scales with critically ill patients.

Question 9
Type: MCSA
A patient scores positive on the Confusion Assessment Method of the Intensive Care Unit (CAM-ICU). Which nursing diagnosis would have the highest priority based on this positive score?
1. Injury, Risk for
2. Family Processes, Altered
3. Social Interaction, Impaired
4. Memory Impaired
Correct Answer: 1
Rationale 1: Injury falls into the Safety/Security level, which is the highest priority according to Maslow’s hierarchy of needs.
Rationale 2: This nursing diagnosis would not be a priority for the patient in the intensive care unit.
Rationale 3: This nursing diagnosis would not be a priority for the patient in the intensive care unit.
Rationale 4: This nursing diagnosis would not be a priority for the patient in the intensive care unit.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Diagnosis
Learning Outcome: 2-4: Explain the use of sedation, pain, and delirium scales with critically ill patients.

Question 10
Type: MCSA
Which nursing actions would be appropriate when a nurse is initiating an infusion of morphine sulfate for a post-operative patient who is experiencing pain?
1. Anticipate that the patient will begin to experience the effect of the morphine 15 minutes after the start of the infusion.
2. Provide additional intermittent boluses of morphine sulfate if the patient experiences breakthrough pain.
3. Complete the Critical-Care Pain Observation Tool scale 5 minutes after increasing the infusion rate each time.
4. Begin the infusion at the lowest ordered dose and increase the rate every 30 minutes if the patient continues to have pain.
Correct Answer: 2
Rationale 1: The desired effects should become apparent 5 minutes after intravenous administration.
Rationale 2: A critically ill patient often will receive an IV bolus of an analgesic followed by an ongoing infusion of the pain medication with intermittent boluses and increases in infusion until the drug attains steady state and the patient experiences pain relief.
Rationale 3: Assessing the patient 5 minutes after increasing the infusion rate each time might be too soon to assess for pain control.
Rationale 4: When IV infusion rates are repeatedly increased versus the administration of intermittent boluses as a means of responding to acute pain, the risk for excessive analgesia dosing exists.

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