SOLE’S INTRODUCTION TO
CRITICAL CARE NURSING
9TH EDITION
• AUTHOR(S)MARY MAKIC
TEST BANK
1
Reference: Ch. 1 — Clinical Judgment Measurement Model
Stem: During the night shift, a newly licensed ICU nurse notices
a post-op patient’s blood pressure trending from 128/72 to
92/58 over 30 minutes, HR 112, RR 22, SpO₂ 95% on 2 L nasal
cannula. The patient appears mildly diaphoretic and reports
dizziness when sitting up. Which action should the nurse take
first?
Options:
A. Increase oxygen to 4 L via nasal cannula and recheck vitals in
15 minutes.
B. Raise the head of bed to 30° and call the surgeon for orders.
,C. Perform a focused assessment (lung sounds, skin perfusion,
orthostatics) and notify the RN preceptor/charge.
D. Start a 500 mL bolus of IV crystalloid immediately.
Correct Answer: C
Rationale — Correct (3–4 sentences): A focused assessment is
the priority to gather data (lung sounds, perfusion, orthostatics)
to determine etiology (bleeding, hypovolemia, cardiogenic
issue) before interventions or calling the surgeon. This aligns
with the Clinical Judgment Measurement Model emphasizing
data collection and interpretation prior to action. Notifying a
preceptor/charge after assessment escalates care appropriately.
Rationale — Incorrect:
A. Increasing oxygen without hypoxemia overlooks
haemodynamic causes and delays diagnostic assessment.
B. Raising HOB may worsen hypotension if volume depleted;
calling surgeon before assessment is premature.
D. Bolusing without confirming hypovolemia could precipitate
fluid overload if cardiogenic shock present.
Teaching Point: Always assess and interpret physiologic data
before selecting definitive interventions.
Citation: Makic, M. B. F. (2025). Sole’s Introduction to Critical
Care Nursing (9th ed.). Ch. 1.
2
Reference: Ch. 1 — Professional Organizations & Certification
Stem: An ICU nurse preparing for CCRN certification is juggling
,night shift study with heavy patient assignments. Unit
leadership asks staff to volunteer for a weekend quality-
improvement (QI) project. Which action best supports both
professional development and patient care?
Options:
A. Decline the QI project and prioritize exam study time.
B. Volunteer for the QI project and request schedule
adjustments for study.
C. Ask the charge nurse to remove the volunteer requirement,
citing certification needs.
D. Complete QI tasks on personal time only.
Correct Answer: B
Rationale — Correct: Volunteering promotes engagement with
professional organizations’ goals and QI experience—both
valuable for certification portfolios—while proactively
requesting schedule adjustments balances study needs and
patient safety. This reflects professional accountability and
healthy work environment principles.
Rationale — Incorrect:
A. Declining may protect study time but misses leadership and
QI experience linked to certification.
C. Asking removal is confrontational and neglects shared
responsibility in QI.
D. Doing QI on personal time risks burnout and violates healthy
work environment guidance.
Teaching Point: Balance professional development with self-
care—coordinate schedules for sustainable participation.
, Citation: Makic, M. B. F. (2025). Sole’s Introduction to Critical
Care Nursing (9th ed.). Ch. 1.
3
Reference: Ch. 1 — Standards & Quality/Safety Emphasis
Stem: A patient in the ICU has a central line. The nurse
discovers the dressing is loose and damp. The patient is afebrile
but has new leukocytosis (WBC 13,500). What is the nurse’s
priority action?
Options:
A. Replace the dressing using sterile technique and obtain blood
cultures per protocol.
B. Remove the central line immediately at the bedside.
C. Apply a sterile bandage over the dressing and document.
D. Notify the provider and wait for orders before touching the
dressing.
Correct Answer: A
Rationale — Correct: Replacing a compromised central line
dressing with strict sterile technique reduces infection risk and
aligns with standards; obtaining blood cultures per protocol
addresses the leukocytosis and potential line infection.
Immediate removal is not first-line unless frank infection or
instability. This reflects quality and safety priorities.
Rationale — Incorrect:
B. Immediate removal without provider input may be necessary
in severe infection, but first stabilize and follow protocol for
CRITICAL CARE NURSING
9TH EDITION
• AUTHOR(S)MARY MAKIC
TEST BANK
1
Reference: Ch. 1 — Clinical Judgment Measurement Model
Stem: During the night shift, a newly licensed ICU nurse notices
a post-op patient’s blood pressure trending from 128/72 to
92/58 over 30 minutes, HR 112, RR 22, SpO₂ 95% on 2 L nasal
cannula. The patient appears mildly diaphoretic and reports
dizziness when sitting up. Which action should the nurse take
first?
Options:
A. Increase oxygen to 4 L via nasal cannula and recheck vitals in
15 minutes.
B. Raise the head of bed to 30° and call the surgeon for orders.
,C. Perform a focused assessment (lung sounds, skin perfusion,
orthostatics) and notify the RN preceptor/charge.
D. Start a 500 mL bolus of IV crystalloid immediately.
Correct Answer: C
Rationale — Correct (3–4 sentences): A focused assessment is
the priority to gather data (lung sounds, perfusion, orthostatics)
to determine etiology (bleeding, hypovolemia, cardiogenic
issue) before interventions or calling the surgeon. This aligns
with the Clinical Judgment Measurement Model emphasizing
data collection and interpretation prior to action. Notifying a
preceptor/charge after assessment escalates care appropriately.
Rationale — Incorrect:
A. Increasing oxygen without hypoxemia overlooks
haemodynamic causes and delays diagnostic assessment.
B. Raising HOB may worsen hypotension if volume depleted;
calling surgeon before assessment is premature.
D. Bolusing without confirming hypovolemia could precipitate
fluid overload if cardiogenic shock present.
Teaching Point: Always assess and interpret physiologic data
before selecting definitive interventions.
Citation: Makic, M. B. F. (2025). Sole’s Introduction to Critical
Care Nursing (9th ed.). Ch. 1.
2
Reference: Ch. 1 — Professional Organizations & Certification
Stem: An ICU nurse preparing for CCRN certification is juggling
,night shift study with heavy patient assignments. Unit
leadership asks staff to volunteer for a weekend quality-
improvement (QI) project. Which action best supports both
professional development and patient care?
Options:
A. Decline the QI project and prioritize exam study time.
B. Volunteer for the QI project and request schedule
adjustments for study.
C. Ask the charge nurse to remove the volunteer requirement,
citing certification needs.
D. Complete QI tasks on personal time only.
Correct Answer: B
Rationale — Correct: Volunteering promotes engagement with
professional organizations’ goals and QI experience—both
valuable for certification portfolios—while proactively
requesting schedule adjustments balances study needs and
patient safety. This reflects professional accountability and
healthy work environment principles.
Rationale — Incorrect:
A. Declining may protect study time but misses leadership and
QI experience linked to certification.
C. Asking removal is confrontational and neglects shared
responsibility in QI.
D. Doing QI on personal time risks burnout and violates healthy
work environment guidance.
Teaching Point: Balance professional development with self-
care—coordinate schedules for sustainable participation.
, Citation: Makic, M. B. F. (2025). Sole’s Introduction to Critical
Care Nursing (9th ed.). Ch. 1.
3
Reference: Ch. 1 — Standards & Quality/Safety Emphasis
Stem: A patient in the ICU has a central line. The nurse
discovers the dressing is loose and damp. The patient is afebrile
but has new leukocytosis (WBC 13,500). What is the nurse’s
priority action?
Options:
A. Replace the dressing using sterile technique and obtain blood
cultures per protocol.
B. Remove the central line immediately at the bedside.
C. Apply a sterile bandage over the dressing and document.
D. Notify the provider and wait for orders before touching the
dressing.
Correct Answer: A
Rationale — Correct: Replacing a compromised central line
dressing with strict sterile technique reduces infection risk and
aligns with standards; obtaining blood cultures per protocol
addresses the leukocytosis and potential line infection.
Immediate removal is not first-line unless frank infection or
instability. This reflects quality and safety priorities.
Rationale — Incorrect:
B. Immediate removal without provider input may be necessary
in severe infection, but first stabilize and follow protocol for
