Exam 1 Critical Care Week 1 and 2 Questions and Correct Answers.

Exam 1 Critical Care Week 1 and 2 Questions and Correct Answers A patient in the ICU with acute respiratory distress syndrome (ARDS) complains of worsening dyspnea. Which of the following physiological changes associated with ARDS are most responsible for this patient's impaired ventilation? Select all that apply. A) Decreased lung compliance B) Pulmonary hypertension C) Vasoconstriction of the pulmonary vascular bed D) Increased airway resistance E) Cyanosis F) Multisystem organ dysfunction - Correct Answers: A, D A patient with acute respiratory distress syndrome (ARDS) demonstrates unmistakable signs of pneumothorax. What is the next intervention that the nurse should implement? A) Increase the peak end-expiratory pressure (PEEP). B) Administer an inotropic agent. C) Elevate the head of the bed to 35 degrees. D) Assist with a chest tube insertion. - Correct Answers: D A nurse is the only one in the ICU who has not achieved certification in critical care nursing. She often will ask her fellow nurses what to do in caring for a patient because she doubts the accuracy of her knowledge and her intuition. She loves her work but wishes she could do it with a greater level of competence. What is the most important effect that obtaining certification would likely have on the nurse's practice? A) Recognition by peers B) Increase in salary and rank C) More flexibility in seeking employment D) Increased confidence in making decisions - Correct Answers: D A hospital interviews two different candidates for a position in the ICU. Both candidates have around 10 years of experience working in the ICU. Both have excellent interpersonal skills and highly positive references. One, however, has certification in critical care nursing. Which of the following is the most compelling and accurate reason for the hospital to hire the candidate with certification? A) The certified nurse will have more knowledge and expertise. B) The certified nurse will behave more ethically. C) The certified nurse will be more caring toward patients. D) The certified nurse will work more collaboratively with other nurses. - Correct Answers: A . A nurse is caring for an elderly man recently admitted to the ICU following a stroke. She assesses his cognitive function using a new cognitive assessment test she learned about in a recent article in a nursing journal. She then brings a cup of water and a straw to the patient because she observes that his lips are dry. Later, she has the patient sit in a wheelchair and takes him to have some blood tests performed. He objects at first, saying that he can walk on his own, but the nurse explains that it is hospital policy to use the wheelchair. That evening, she recognizes signs of an imminent stroke in the patient and immediately pages the physician. Which action taken by the nurse is the best example of evidence-based practice? A) Giving the patient a cup of water B) Transferring the patient in a wheelchair C) Using the cognitive assessment test D) Recognizing signs of imminent stroke and paging the physician - Correct Answers: c A nurse is on a committee that is trying to reduce the occurrence of hospital-acquired infections in the ICU. Her role is to conduct research to find which interventions have been shown to be most effective in reducing these infections. She consults many different sources and finds conflicting information. Which of the following sources should she consider the most authoritative? A) AACN expert panel report B) A meta-analysis of randomized controlled trials in the American Journal of Nursing C) A systematic review of qualitative studies in the Journal of Advanced Nursing D) A single randomized controlled trial in the American Journal of Critical Care - Correct Answers: B A physician visits a patient in the ICU while the nurse is out. The patient complains that the pain medication is not effective and that he would like to receive an increased dose. The physician has the nurse paged and consults with him in the hallway regarding the patient's request for stronger pain medication. The nurse explains that patient was started on a morphine drip only 20 minutes ago and that the drug has not had time to take effect yet. The physician agrees and tells the patient to give it just a bit more time. Which component of a healthy work environment is most evident in this scenario? A) Skilled communication B) Appropriate staffing C) True collaboration D) Meaningful recognition - Correct Answers: C A patient in the ICU has recently been diagnosed with diabetes mellitus. Before being discharged, this patient will require detailed instructions on how to manage her diet, how to self-inject insulin, and how to handle future diabetic emergencies. Which nurse competency is most needed in this situation? A) Clinical judgment B) Advocacy and moral agency C) Caring practices D) Facilitation of learning - Correct Answers: D An elderly patient is admitted to the ICU with stage IV lung cancer, diabetes mellitus, and congestive heart failure. The health care team assembled to care for her is large and diverse, including an oncologist, a pulmonologist, an endocrinologist, a cardiologist, and others. The patient is not expected to survive more than a few weeks, and her husband is overwhelmed with stress and grief. Which nurse competency or competencies are most needed in this situation? Select all that apply. A) Clinical judgment B) Caring practices C) Collaboration D) Response to diversity - Correct Answers: B,D The American Association of Critical-Care Nurses (AACN) sponsors certification in critical care nursing for several critical care subspecialties. What is the most important benefit of such certification for the profession of nursing? A) Provides positive publicity for nursing B) Validates nurses' expert knowledge and practice C) Mandated by government regulations D) Demonstrates basic knowledge in the field - Correct Answers: B The nurse cites evidence-based practice as a rationale for a patient care decision. What is the best description of evidence-based practice? A) Decisions based on expert legal testimony B) Use of best available research data C) Evolution of nursing practice over time D) Individual optimization of patient outcomes - Correct Answers: B A nurse wishes to practice using the Synergy Model developed by the American Association of Critical-Care Nurses (AACN). What nursing behavior best supports use of this model? A) Attending mandatory hospital-wide in-service programs B) Self-directed study of best practice for the patients she cares for C) Gathering demographic data on the patients admitted to the unit D) Participating in a research study as a data collector - Correct Answers: B As part of the Synergy Model, the nurse has identified a patient characteristic of resiliency. What patient behavior demonstrates resiliency? A) Dysfunctional grieving behaviors after receiving bad news B) Developing a list of questions for the physician C) Denial of any possible negative outcomes for a procedure D) Assigning blame to others for undesired outcomes of illness - Correct Answers: B A patient is admitted to the critical care unit after receiving a mechanical heart implantation. In making a nursing assignment, the charge nurse best demonstrates application of the Synergy Model by assigning which nurse to care for this patient? A) A newly hired new graduate nurse, for the experience B) A nurse with a patient in the next room, for proximity C) The most senior nurse on the unit, for political reasons D) The nurse with most experience with this device, for expertise - Correct Answers: D A Muslim patient has been admitted to the critical care unit with complications after childbirth. Based on the Synergy Model, which nurse would be the most inappropriate to assign to care for this patient? A) New graduate female nurse B) Most experienced female nurse C) New graduate male nurse D) Female nurse with postpartum experience - Correct Answers: C The critical care unit environment is very stressful for patients, families, and staff. What nursing action is directed at reducing environmental stress? A) Constant evaluation of patient status B) Limiting visits to immediate family C) Bathing all patients during hours of sleep D) Maintaining quiet during hours of sleep - Correct Answers: D A patient is transferred to the ICU from the Birth Center of the hospital in the middle of the night after experiencing complications during delivery of her baby. The patient's husband is anxious and explains to the ICU nurse that he doesn't understand why his wife has been moved to the ICU. "She is going to die, isn't she?" he asks the nurse. What is the nurse's best response? A) Explain that every measure will be taken to provide his wife with the best care possible. B) Explain that the nurse is fully trained and has years of experience. C) Offer the husband a place to relax. D) Have appropriate staff discuss his health insurance with him. - Correct Answers: A A patient is admitted to the ICU with injuries sustained from a fall from a third-story window. The patient is conscious, his breathing is labored, and he is bleeding heavily from the abdomen. He groans constantly and complains of severe pain, but his movements are minimal. His heart rate is elevated. Which of these is a sign that he is in the second phase of the stress response? Select all that apply. A) Bleeding heavily from his abdomen B) Labored, slow breathing C) Severe pain D) Elevated heart rate E) Minimal movement - Correct Answers: C, D The nurse understands that a patient being cared for in a critical care unit experiences an acute stress response. What nursing action best demonstrates understanding of the physiological parts of the initial stress response? A) Adequate pain control B) Intravenous sedation C) Treatment for elevated blood pressure D) Ignoring an elevated glucose level - Correct Answers: A The nurse is caring for a patient who is orally intubated and on a mechanical ventilator. The nurse believes that the patient is experiencing excess anxiety. For this patient, what behavior best indicates anxiety? A) Restlessness B) Verbalization C) Increased respiratory rate D) Glasgow Coma Scale score of 3 - Correct Answers: A The nurse is caring for a critically ill patient with a very concerned family. Given that the family is under high stress, what nursing intervention will best ameliorate their stress while preserving independence? A) Encourage the family to participate in patient care tasks. B) Teach the family to ask questions of the health care team. C) Ask the family to select a family representative for communication. D) Limit visits to immediate family members for limited times. - Correct Answers: B A critically ill patient who is intubated and agitated is restrained with soft wrist restraints. Based on research findings, what is the best nursing action? A) Maintain the restraints to protect patient safety. B) Remove the restraints periodically to check skin integrity. C) Remove the restraints periodically for range of motion. D) Assess and intervene for causes of agitation. - Correct Answers: D A patient has just been admitted to the ICU after being in a severe auto accident and losing one of her legs. Her husband has his hand over his heart and complains of a rapid heart rate. The nurse recognizes his condition as a sign of which stage of the general adaptation syndrome to stress? A) Alarm stage B) Exhaustion stage C) Resistance stage D) Adaptation stage - Correct Answers: A A nurse needs to communicate with a patient's family regarding consent to treat an unconscious patient in the ICU. Which member of the group should the nurse approach first? A) A man she recognizes as the patient's brother B) A teenage boy who approaches the nurse C) A woman who originally escorted the patient in D) A woman in the group whom the others look at and call over when the nurse approaches - Correct Answers: D A client has been admitted after experiencing multiple trauma and is intubated and sedated. When the five members of the immediate family arrive, they are anxious, angry, and very demanding. They all speak loudly at once and ask for many services and answers. What is the best nursing response? A) Ask the family to leave until visiting hours begin. B) Take them to a private area for initial explanations. C) Page security to have them removed from unit. D) Show them to the client's bedside and leave them alone. - Correct Answers: B As part of the admission process, the nurse asks several questions about family relationships. The nurse bases these actions on which rationale? A) Assessing family relationships is an initial step in including the family in patient care. B) These questions are part of the admission assessment tool required by this CCU. C) The nurse has a natural curiosity and wishes to know how the family members relate for her own knowledge. D) There is an ongoing research study to identify variant family patterns related to disease incidence. - Correct Answers: A On their first visit to a critically ill patient, family members stand in the doorway of the room, making no effort to approach the patient. What is the most appropriate nursing action? A) Instruct the family where the patient can be touched and what to say. B) Engage the family in social conversation to ease them into the milieu. C) Use visiting hours to explain to the family the general status of the patient. D) Leave the family to adjust to the situation when they are ready. - Correct Answers: A A critically ill patient is not expected to survive this admission. The family asks the nurse how the patient is doing. When answering this question, what should the nurse include? A) Emphasize that the patient is young and strong and may still survive. B) Refer the family to the physician for all details and answers. C) Give specific information such as descending trends in parameters. D) Ask if the family has determined which funeral home will be called. - Correct Answers: C A young couple whose 5-year-old daughter has been admitted to the ICU approaches the nurse with looks of concern on their faces. They express frustration to the nurse that they have not been able to speak with either the physician or the surgeon and are confused as to what the next steps are for their daughter's treatment. What would be the best intervention for the nurse to make in this situation? A) Offer to get ice chips for the couple to give to their daughter to empower them. B) Make sure that they have the cell phone numbers of the physician and surgeon. C) Teach the couple about the pathophysiology of the daughter's disease. D) Arrange a patient care conference with the couple and the health care team. - Correct Answers: D A nurse needs to obtain informed consent from a deaf patient before a spinal tap procedure is performed. Which of the following would be the best method for the nurse to use to ensure effective communication? A) Explain the procedure verbally, speaking slowly so that the patient can read lips. B) Have a trained oral interpreter interpret for the nurse. C) Have the patient carefully read a printed copy of the informed consent document. D) Use diagrams to explain to the patient the details of the procedure. - Correct Answers: B The nurse is teaching a patient who is not a native English speaker. As the nurse gives complex explanations, the patient nods and smiles. What is the best nursing intervention to ensure patient understanding? A) Assume that the patient's nods indicate understanding. B) Ask a family member to interpret to the patient. C) Use pictures whenever possible in the teaching. D) Ask the patient to restate the information conveyed. - Correct Answers: D 1. The physician has just told a patient that he has stage 4 lung cancer and likely has only months to live. After the physician leaves, the patient, who is visibly shaken, asks the nurse, "Couldn't the doctor be wrong? Is it really that bad?" The nurse explains to him that, although there is no way to know for certain how the disease will progress, the stage of his lung cancer is the most serious. The nurse also indicates that the cancer has spread to other organs in his body, meaning that the odds of recovery are not good. The patient then asks that the nurse not tell his wife, who is in the waiting room, about the diagnosis just yet. Later the patient's wife enters the room and, seeing that he is asleep, asks the nurse if there is any update on the patient's condition. The nurse explains that the doctor talked to the patient earlier and that the patient can provide details once he wakes up. Which ethical principle - Correct Answers: B, C A patient is at severe risk of forming life-threatening clots in his thoracic region following surgery. The physician has prescribed an anticoagulant medication. The patient has had a negative experience with anticoagulants in the past and refuses the medication. Which two ethical principles are in conflict with each other in this situation? A) Fidelity vs. justice B) Maleficence vs. beneficence C) Veracity vs. autonomy D) Beneficence vs. autonomy - Correct Answers: D patient in the ICU recently experienced a myocardial infarction that resulted in an aneurysm of the ventricular wall. The patient's cardiovascular surgeon has determined that the aneurysm is irreparable. In this situation, an attempt to repair the rupture via laparoscopic surgery would be considered which of the following? A) Palliative B) Curative C) Medically futile D) Beneficent - Correct Answers: C The family of a patient in a coma is struggling to decide whether to remove the patient from a ventilator. What would be the most appropriate intervention? A) Explain the statistical odds that the patient will regain consciousness. B) Facilitate a care conference with the family. C) Leave the family alone to make their decision. D) Distribute copies of the American Nurses Association Code of Ethics to the family. - Correct Answers: B A nurse works in an ICU in which she routinely sees physicians neglecting the care of patients who do not have health insurance. She feels angry about the unfairness of this situation but also powerless to do anything because she fears the loss of her job. Which of the following best describes what the nurse is experiencing? A) Medical futility B) Nonmaleficence C) Moral distress D) Paternalism - Correct Answers: C n elderly patient who is about to have open-heart surgery has verbally instructed the nurse that she does not want her life to be extended by a ventilator after the surgery. The patient's advance directive, however, indicates that she would prefer to receive all life-support measures. The nurse suspects that the patient has dementia. Which of the following questions would be most appropriate for the nurse to ask in the assessment stage of ethical decision making? A) What are the ethical issues related to continuing or removing life-support measures for this patient? B) Who should be involved in making the decision regarding life-support measures for this patient? C) Is this patient mentally competent to make decisions about use of life support? D) What educational changes can be made in the ICU to resolve similar ethical challenges related to life support measures in the future? - Correct Answers: C A patient who had provided an advance directive indicating that he should not be resuscitated was allowed to die when his heart stopped beating shortly after his admission to the ICU. The family of the patient has disputed the authenticity of the advance directive and filed a complaint with the hospital. Which intervention would be most appropriate to address this ethical dilemma? A) Ethics rounds involving the medical staff involved in the patient's care B) Review by the hospital's institutional ethics committee C) An individual patient ethics conference with the family D) Review of the ANA Code of Ethics by the patient's nurse - Correct Answers: B The nurse consistently applies guidelines for safe administration of medications during patient care. This practice is an example of the application of what ethical principle? A) Justice B) Veracity C) Beneficence D) Paternalism - Correct Answers: C In determining which patient is to be transferred from the CCU to make room for a new admission, the nurse considers the relative benefit of continued CCU care related to eventual outcomes for each patient and compares them. The nurse does not consider factors such as ethnicity or socioeconomic status. This situation is an example of application of which ethical principle? A) Paternalism B) Veracity C) Beneficence D) Justice - Correct Answers: D A patient is admitted to the CCU with active advance directives that include refusal of enteral feeding by tubes. When the physician writes an order for the insertion of a feeding tube, the nurse refuses to comply. This refusal is an example of adherence to what ethical principle? A) Nursing Practice Act B) Patient Bill of Rights C) Patient autonomy D) Patient advocacy - Correct Answers: D While caring for a critically ill patient, the nurse observes the family discussing funeral arrangements across the bed of the patient, who is intubated and sedated but awake. The family signs Do Not Resuscitate (DNR) request paperwork and leaves. The patient manages to communicate to the nurse that he does not want to die. What is the most appropriate nursing action? A) Adhere to the wishes of the family, since the patient is probably incompetent. B) Call a multidisciplinary conference with the family to resolve this conflict. C) Destroy the Do Not Resuscitate paperwork, since the patient wants to live. D) Apply the ethical principles of nonmaleficence and paternalism to the situation. - Correct Answers: B Before a surgical procedure, the patient signs a document called an informed consent. What ethical principle is central to the use of informed consent? A) Autonomy B) Fidelity C) Nonmaleficence D) Beneficence - Correct Answers: A A patient in the ICU is receiving intravenous opioid analgesia following myocardial infarction. Despite receiving continuous infusion of the opioid, the patient is grimacing and asks for an increase in the medication level. Consulting the medical chart, the nurse recognizes that this patient has a history of opioid addiction. What would be the most appropriate intervention? A) Immediately take the patient off of the opioid and give him Tylenol. B) Leave the patient on the opioid at the current dose level. C) Increase the dose of opioid to provide more effective pain relief. D) Reduce the dose of opioid and offer to turn on the television as a distraction from the pain. - Correct Answers: C The nurse is developing a policy and procedure for pain management in a critical care unit. Based on national standards, what should the nurse include? A) Pain assessment in critical care must depend on vital sign monitoring as patients are not verbal. B) Continuous intravenous opioids are preferred over as-needed dosing. C) Intravenous sedation of agitated patients takes priority over pain control. D) Pain control is an independent nursing function and responsibility. - Correct Answers: b According to national standards, pain in critically ill patients should be assessed at regular intervals using a variety of methods. What statement about pain assessment is true? A) Absence of physical signs or behaviors is equivalent to absence of pain. B) Many of the factors in critical care combine to invalidate patient self-report of pain. C) Behavioral observation and physiological parameters should be considered along with the patient's report. D) The family has a more accurate assessment of pain than the patient. - Correct Answers: C A patient in the ICU has entered a coma state, and someone must make a decision about whether to continue life-supporting measures for the patient. No living will exists for this patient. Who is the person legally authorized to make this decision? A) The patient's wife, who is the executor of his estate B) The patient's brother, who is his designated health care proxy C) The patient's physician, who has been managing his care from admittance D) The patient's nurse, who has been assigned to him on a daily basis - Correct Answers: B Which of the following is the best example of moral distress? A) A patient's family has decided to end mechanical ventilation of the patient, but the nurse has trouble implementing their decision. B) A patient's family has decided to continue mechanical ventilation for the patient, but the nurse disagrees and discontinues the ventilation on her own initiative. C) A patient's family has decided to end mechanical ventilation of the patient, and the nurse implements their decision but later feels guilty. D) A patient's family has decided to continue mechanical ventilation for the patient, and the nurse implements their decision, although she disagrees with it. - Correct Answers: A . A patient who is near the end of his life is to be extubated, according to the wishes of his family. Which of the following would be the best action for the nurse to take to support the patient? A) Ask the family to leave the room during the extubation. B) Hold a family conference to ask the family to reconsider their decision. C) Administer opioids to the patient to reduce pain and discomfort. D) Administer antibiotics to the patient to prevent infection. - Correct Answers: C The patient has severe pulmonary edema following an acute myocardial infarction and is receiving intravenous diuretics to ease breathing. The nurse understands that this intervention is considered to be what? A) Definitive B) Curative C) Cause-and-effect-based D) Palliative - Correct Answers: D The nurse is caring for a patient approaching the end of life. What symptom common at the end of life would the nurse most expect? A) Diminished pain B) Hypotension C) Tachycardia D) Dyspnea - Correct Answers: D The nurse is preparing for a family conference with the family of a critically ill patient. What will best help the nurse to prepare? A) Complete knowledge about the status of the patient B) Knowing which members of the family will attend C) Knowing the goal of the conference D) Skill in therapeutic communication - Correct Answers: C The nurse had been caring for a critically ill patient for several days, and the patient has just died. After completing end-of-life care of the patient and family, the nurse asks to take a short break. What is the best response by the charge nurse? A) Ask the nurse to wait to take a break until after she admits another patient. B) Deny the nurse a break, as the unit is particularly busy and the nurse cannot be spared. C) Arrange for the nurse to have psychological counseling for inability to handle stress. D) Ask another staff nurse to cover this nurse's duties and allow her to take a break. - Correct Answers: D A patient in the critical care unit is on a ventilator and requires nutritional support, likely for 3 weeks. This patient has a transected spinal cord at C4. Which would be the best choice of nutritional support for this patient? A) Nasogastric tube B) Nasoduodenal tube C) Gastrostomy tube D) Total parenteral nutrition - Correct Answers: B A patient with gastric cancer must receive long-term nutritional support. Due to the cancer, the patient has impaired gastric function and delayed gastric emptying, but the remainder of her gastrointestinal tract is intact and functional. Which of the following would be the best choice of nutritional support for this patient? A) Jejunostomy tube B) Nasoduodenal tube C) Gastrostomy tube D) Central parenteral nutrition - Correct Answers: A A patient with Crohn's disease is receiving enteral feeding. The nurse administers an elemental formula to the patient. What is the best rationale for this choice? A) Lower cost B) Pleasant taste C) Easier to digest D) More complete nutrition - Correct Answers: C A patient is receiving enteral feeding via a nasogastric tube of a polymeric formula. Under what conditions should the nurse discontinue enteral feeding? Select all that apply. A) Three instances of gastric residual volume of 175 mL B) Regurgitation C) Two instances of gastric residual volume of 600 mL D) Vomiting E) Aspiration F) Diarrhea - Correct Answers: B, C, D, E A patient with severe hemorrhagic pancreatitis requires long-term nutritional support. Which of the following would be the best form of nutritional support for this patient? A) Nasoduodenal tube B) Gastrostomy tube C) Total parenteral nutrition D) Peripheral parenteral nutrition - Correct Answers: C A patient with anorexia nervosa requires parenteral nutrition support. This patient demonstrates signs of marasmus. What intervention should the nurse make to prevent a complication for which this patient is at increased risk? A) Limiting of initial dextrose dosing B) Depletion of potassium before TPN initiation C) Proper hand hygiene D) Change of TPN solution bag every 24 hours - Correct Answers: A A patient with a serious illness is being cared for in a CCU. Considering energy expenditure during illness and the potential for healing, what is most appropriate nursing action? A) Maintain complete bed rest with minimal activity B) Ensure complete pharmacological sedation C) Limit visits to immediate family only D) Facilitate nutrition assessment and delivery - Correct Answers: D . A critically ill patient is being evaluated for nutritional support using the enteral route. What contraindication for enteral feedings does the nurse assess for? A) Lack of evidence of severe malnutrition B) Ability to chew and swallow C) Evidence of prolonged ileus D) Presence of intravenous access - Correct Answers: C . A patient is being fed continuously through a nasogastric tube. According to unit policy, the nurse checks tube placement regularly. What method is most accurate? A) Air insufflation and auscultation over the stomach B) Inspection of tube aspirate for color and consistency C) Measuring gastric pH after holding feeding 60 minutes D) Obtaining a radiograph of the upper abdomen - Correct Answers: D A critically ill patient is receiving intravenous total parenteral nutrition (TPN). The patient is also being supported by several constant IV vasoactive medications, is pharmacologically sedated and paralyzed with constant IV medications, and is receiving three antimicrobial mediations by intermittent IV infusion. The nurse ensures that the TPN is infusing into a separate line and not mixing with any other fluid or medication. What is the best rationale for this precaution? A) Complies with hospital and unit policy B) Prevents risk of contamination and precipitation C) Contains trace amounts of electrolytes D) Contains high fat concentrations - Correct Answers: B A patient is receiving total parenteral nutrition (TPN). To monitor for the development of a complication directly related to the composition of the TPN, what intervention does the nurse initiate? A) Vital signs every 15 minutes B) Strict adherence to hand hygiene protocol C) Continuous capnography D) Frequent monitoring of blood glucose - Correct Answers: D