,
,
,
,Test Bank - Introduction to Critical Care Nursing 8e (Sole) 5
b. National Patient Safety Goals
c. Quality and Safety Education for Nurses (QSEN) model
d. synergy model of practice
ANS: D
This assignment demonstrates nursing care to meet the needs of the patient. The synergy model notes that the
nurse competencies are matched to the patient characteristics. Crew resource management concepts related to
team training, National Patient Safety Goals are specified by The Joint Commission to promote safe care but
do not incorporate the synergy model. The Quality and Safety Education for Nurses initiative involves targeted
education to undergraduate and graduate nursing students to learn quality and safety concepts.
DIF: Cognitive Level: Analysis REF: p. 5 | Fig. 1-3
OBJ: Describe standards of professional practice for critical care nursing.
TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment
8. The vision of the American Association of Critical-Care Nurses is a healthcare system driven by:
a. a healthy work environment.
b. care from a multiprofessional team under the direction of a critical care physician.
c. the needs of critically ill patients and families.
d. respectful, healing, and humane environments.
ANS: C
The AACN vision is a healthcare system driven by the needs of critically ill patients and families where critica
care nurses make their optimum contributions. AACN promotes initiatives to support a healthy work
environment as well as respectful and healing environments, but that is not the organizations vision. The
SCCM promotes care from a multiprofessional team under the direction of a critical care physician.
DIF: Cognitive Level: Knowledge REF: p. 4
OBJ: Discuss the purposes and functions of the professional organizations that support critical care practice.
TOP: Nursing Process Step: N/A
MSC: NCLEX: Safe and Effective Care Environment
9. The most important outcome of effective communication is to:
a. demonstrate caring practices to family members.
b. ensure that patient teaching is done.
c. meet the diversity needs of patients.
,Test Bank - Introduction to Critical Care Nursing 8e (Sole) 6
d. reduce patient errors.
ANS: D
Many errors are directly attributed to faulty communication. Effective communication has been identified as an
essential strategy to reduce patient errors and resolve issues related to patient care delivery. Communication
may demonstrate caring practices, be used for patient/family teaching, and address diversity needs; however,
the main outcome of effective communication is patient safety.
DIF: Cognitive Level: Knowledge REF: pp. 8-9
OBJ: Describe quality and safety initiatives related to critical care nursing.
TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment
10. You are caring for a critically ill patient whose urine output has been low for 2 consecutive hours. After a
thorough patient assessment, you call the intensivist with the following report. Dr. Smith, Im calling about
Mrs. P., your 65-year-old patient in CCU 10. Her urine output for the past 2 hours totaled only 40 mL. She
arrived from surgery to repair an aortic aneurysm 4 hours ago and remains on mechanical ventilation. In the
past 2 hours, her heart rate has increased from 80 to 100 beats per minute and her blood pressure has
decreased from 128/82 to 100/70 mm Hg. She is being given an infusion of normal saline at 100 mL per hour.
Her right atrial pressure through the subclavian central line is low at 3 mm Hg. Her urine is concentrated. He
BUN and creatinine levels have been stable and in normal range. Her abdominal dressing is dry with no
indication of bleeding. My assessment suggests that Mrs. P. is hypovolemic and I would like you to consider
increasing her fluids or giving her a fluid challenge. Using the SBAR model for communication, the
information the nurse gives about the patients history and vital signs is:
a. Situation
b. Background
c. Assessment
d. Recommendation
ANS: B
The history and vital signs are part of the background. Information regarding the low urine output is the
situation. Information regarding possible hypovolemia is part of the nurses assessment, and the suggestion for
fluids is the recommendation.
DIF: Cognitive Level: Analysis REF: pp. 8-9
OBJ: Describe quality and safety initiatives related to critical care nursing.
TOP: Nursing Process Step: Assessment MSC: NCLEX: Safe and Effective Care Environment
11. The family members of a critically ill, 90-year-old patient bring in a copy of the patients living will to the
hospital, which identifies the patients wishes regarding health care. You discuss contents of the living will with
the patients physician. This is an example of implementation of which of the AACN Standards of Professional
Performance?
a. Acquires and maintains current knowledge of practice
,Test Bank - Introduction to Critical Care Nursing 8e (Sole) 7
b. Acts ethically on the behalf of the patient and family
c. Considers factors related to safe patient care
d. Uses clinical inquiry and integrates research findings in practice
ANS: B
Discussing end-of-life issues is an example of a nurse acting ethically on behalf of the patient and family. The
example does not relate to acquiring knowledge, promoting patient safety, or using research in practice.
DIF: Cognitive Level: Analysis REF: p. 5 | Box 1-2
OBJ: Describe standards of care and performance for critical care nursing.
TOP: Nursing Process Step: Implementation
MSC: NCLEX: Safe and Effective Care Environment
12. Which of the following assists the critical care nurse in ensuring that care is appropriate and based on
research?
a. Clinical practice guidelines
b. Computerized physician order entry
c. Consulting with advanced practice nurses
d. Implementing Joint Commission National Patient Safety Goals
ANS: A
Clinical practice guidelines are being implemented to ensure that care is appropriate and based on research.
Some physician order entry pathways, but not all, are based on research recommendations. Some advanced
practice nurses, but not all, are well versed in evidence-based practices. The National Patient Safety Goals are
recommendations to reduce errors using evidence-based practices.
DIF: Cognitive Level: Analysis REF: p. 7
OBJ: Describe standards of professional practice for critical care nursing.
TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment
13. Comparing the patients current (home) medications with those ordered during hospitalization and
communicating a complete list of medications to the next provider when the patient is transferred within an
organization or to another setting are strategies to:
a. improve accuracy of patient identification.
b. prevent errors related to look-alike and sound-alike medications.
,Test Bank - Introduction to Critical Care Nursing 8e (Sole) 8
c. reconcile medications across the continuum of care.
d. reduce harms associated with administration of anticoagulants.
ANS: C
These are steps recommended in the National Patient Safety Goals to reconcile medications across the
continuum of care. Improving accuracy of patient identification is another National Patient Safety Goal.
Preventing errors related to look-alike and sound-alike medications is done to improve medication safety, not
medication reconciliation. Reducing harms associated with administration of anticoagulants is another Nationa
Patient Safety Goal.
DIF: Cognitive Level: Comprehension REF: p. 6 | Box 1-3
OBJ: Describe quality and safety initiatives related to critical care nursing.
TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment
14. As part of nursing management of a critically ill patient, orders are written to keep the head of the bed
elevated at 30 degrees, awaken the patient from sedation each morning to assess readiness to wean from
mechanical ventilation, and implement oral care protocols every 4 hours. These interventions are done as a
group to reduce the risk of ventilator-associated pneumonia. This group of evidence-based interventions is
often called a:
a. bundle of care.
b. clinical practice guideline.
c. patient safety goal.
d. quality improvement initiative.
ANS: A
A group of evidence-based interventions done as a whole to improve outcomes is termed a bundle of care. This
is an example of the ventilator bundle. Oftentimes these bundles are derived from clinical practice guidelines
and are monitored for compliance as part of quality improvement initiatives. At some point, these may become
part of patient safety goals.
DIF: Cognitive Level: Analysis REF: p. 6
OBJ: Describe quality and safety initiatives related to critical care nursing.
TOP: Nursing Process Step: Implementation
MSC: NCLEX: Safe and Effective Care Environment
15. You work in an intermediate care unit that has experienced high nursing turnover. The nurse manager is
often considered to be an autocratic leader by staff members and her leadership style is contributing to
turnover. You have asked to be involved in developing new guidelines to prevent pressure ulcers in your
patient population. The nurse manager tells you that you do not yet have enough experience to be on the
prevention task force. This situation and setting is an example of:
a. a barrier to handoff communication.
,Test Bank - Introduction to Critical Care Nursing 8e (Sole) 9
b. a work environment that is unhealthy.
c. ineffective decision making.
d. nursing practice that is not evidence-based.
ANS: B
These are examples of an unhealthy work environment. A healthy work environment values communication,
collaboration, and effective decision making. It also has authentic leadership. It is not an example of handoff
communication, which is communication that occurs to transition patient care from one staff membe r to
another. Neither does it relate to ineffective decision making. As a nurse, you can still implement evidence-
based practice, but your influence in the unit is limited by the unhealthy work environment.
DIF: Cognitive Level: Analysis REF: p. 7
OBJ: Describe standards of professional practice for critical care nursing.
TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment
16. Which of the following statements describes the core concept of the synergy model of practice?
a. All nurses must be certified in order to have the synergy model implemented.
b. Family members must be included in daily interdisciplinary rounds.
c. Nurses and physicians must work collaboratively and synergistically to influence care.
d. Unique needs of patients and their families influence nursing competencies.
ANS: D
The synergy model of practice is care based on the unique needs and characteristics of the patient and family
members. Although critical care certification is based on the synergy model, the model does not specifically
address certification. Inclusion of family members into the daily rounds is an example of implementation of the
synergy model. With the focus on patients and family members with nurse interaction, the synergy model does
not address physician collaboration.
DIF: Cognitive Level: Application REF: p. 5 | Fig. 1-3
OBJ: Describe standards of professional practice for critical care nursing.
TOP: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity
17. A nurse who plans care based on the patients gender, ethnicity, spirituality, and lifestyle is said to:
a. be a moral advocate.
b. facilitate learning.
, Test Bank - Introduction to Critical Care Nursing 8e (Sole) 10
c. respond to diversity.
d. use clinical judgment.
ANS: C
Response to diversity considers all of these aspects when planning and implementing care. A moral agent helps
resolve ethical and clinical concerns. Consideration of these factors does not necessarily facilitate learning.
Clinical judgment uses other factors as well.
DIF: Cognitive Level: Comprehension REF: p. 3 | Box 1-1
OBJ: Describe standards of professional practice for critical care nursing.
TOP: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity
MULTIPLE RESPONSE
1. Which of the following is a National Patient Safety Goal? (Select all that apply.)
a. Accurately identify patients.
b. Eliminate use of patient restraints.
c. Reconcile medications across the continuum of care.
d. Reduce risks of healthcare-acquired infection.
ANS: A, C, D
All except for eliminating use of restraints are current National Patient Safety Goals. Hospitals have policies
regarding use of restraints and are attempting to reduce the use of restraints; however, this is not a National
Patient Safety Goal.
DIF: Cognitive Level: Analysis REF: p. 6 | Box 1-3
OBJ: Describe quality and safety initiatives related to critical care nursing.
TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment
2. Which of the following is (are) official journal(s) of the American Association of Critical-Care Nurses?
(Select all that apply.)
a. American Journal of Critical Care
b. Critical Care Clinics of North America
c. Critical Care Nurse
d. Critical Care Nursing Quarterly
,
,
,Test Bank - Introduction to Critical Care Nursing 8e (Sole) 5
b. National Patient Safety Goals
c. Quality and Safety Education for Nurses (QSEN) model
d. synergy model of practice
ANS: D
This assignment demonstrates nursing care to meet the needs of the patient. The synergy model notes that the
nurse competencies are matched to the patient characteristics. Crew resource management concepts related to
team training, National Patient Safety Goals are specified by The Joint Commission to promote safe care but
do not incorporate the synergy model. The Quality and Safety Education for Nurses initiative involves targeted
education to undergraduate and graduate nursing students to learn quality and safety concepts.
DIF: Cognitive Level: Analysis REF: p. 5 | Fig. 1-3
OBJ: Describe standards of professional practice for critical care nursing.
TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment
8. The vision of the American Association of Critical-Care Nurses is a healthcare system driven by:
a. a healthy work environment.
b. care from a multiprofessional team under the direction of a critical care physician.
c. the needs of critically ill patients and families.
d. respectful, healing, and humane environments.
ANS: C
The AACN vision is a healthcare system driven by the needs of critically ill patients and families where critica
care nurses make their optimum contributions. AACN promotes initiatives to support a healthy work
environment as well as respectful and healing environments, but that is not the organizations vision. The
SCCM promotes care from a multiprofessional team under the direction of a critical care physician.
DIF: Cognitive Level: Knowledge REF: p. 4
OBJ: Discuss the purposes and functions of the professional organizations that support critical care practice.
TOP: Nursing Process Step: N/A
MSC: NCLEX: Safe and Effective Care Environment
9. The most important outcome of effective communication is to:
a. demonstrate caring practices to family members.
b. ensure that patient teaching is done.
c. meet the diversity needs of patients.
,Test Bank - Introduction to Critical Care Nursing 8e (Sole) 6
d. reduce patient errors.
ANS: D
Many errors are directly attributed to faulty communication. Effective communication has been identified as an
essential strategy to reduce patient errors and resolve issues related to patient care delivery. Communication
may demonstrate caring practices, be used for patient/family teaching, and address diversity needs; however,
the main outcome of effective communication is patient safety.
DIF: Cognitive Level: Knowledge REF: pp. 8-9
OBJ: Describe quality and safety initiatives related to critical care nursing.
TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment
10. You are caring for a critically ill patient whose urine output has been low for 2 consecutive hours. After a
thorough patient assessment, you call the intensivist with the following report. Dr. Smith, Im calling about
Mrs. P., your 65-year-old patient in CCU 10. Her urine output for the past 2 hours totaled only 40 mL. She
arrived from surgery to repair an aortic aneurysm 4 hours ago and remains on mechanical ventilation. In the
past 2 hours, her heart rate has increased from 80 to 100 beats per minute and her blood pressure has
decreased from 128/82 to 100/70 mm Hg. She is being given an infusion of normal saline at 100 mL per hour.
Her right atrial pressure through the subclavian central line is low at 3 mm Hg. Her urine is concentrated. He
BUN and creatinine levels have been stable and in normal range. Her abdominal dressing is dry with no
indication of bleeding. My assessment suggests that Mrs. P. is hypovolemic and I would like you to consider
increasing her fluids or giving her a fluid challenge. Using the SBAR model for communication, the
information the nurse gives about the patients history and vital signs is:
a. Situation
b. Background
c. Assessment
d. Recommendation
ANS: B
The history and vital signs are part of the background. Information regarding the low urine output is the
situation. Information regarding possible hypovolemia is part of the nurses assessment, and the suggestion for
fluids is the recommendation.
DIF: Cognitive Level: Analysis REF: pp. 8-9
OBJ: Describe quality and safety initiatives related to critical care nursing.
TOP: Nursing Process Step: Assessment MSC: NCLEX: Safe and Effective Care Environment
11. The family members of a critically ill, 90-year-old patient bring in a copy of the patients living will to the
hospital, which identifies the patients wishes regarding health care. You discuss contents of the living will with
the patients physician. This is an example of implementation of which of the AACN Standards of Professional
Performance?
a. Acquires and maintains current knowledge of practice
,Test Bank - Introduction to Critical Care Nursing 8e (Sole) 7
b. Acts ethically on the behalf of the patient and family
c. Considers factors related to safe patient care
d. Uses clinical inquiry and integrates research findings in practice
ANS: B
Discussing end-of-life issues is an example of a nurse acting ethically on behalf of the patient and family. The
example does not relate to acquiring knowledge, promoting patient safety, or using research in practice.
DIF: Cognitive Level: Analysis REF: p. 5 | Box 1-2
OBJ: Describe standards of care and performance for critical care nursing.
TOP: Nursing Process Step: Implementation
MSC: NCLEX: Safe and Effective Care Environment
12. Which of the following assists the critical care nurse in ensuring that care is appropriate and based on
research?
a. Clinical practice guidelines
b. Computerized physician order entry
c. Consulting with advanced practice nurses
d. Implementing Joint Commission National Patient Safety Goals
ANS: A
Clinical practice guidelines are being implemented to ensure that care is appropriate and based on research.
Some physician order entry pathways, but not all, are based on research recommendations. Some advanced
practice nurses, but not all, are well versed in evidence-based practices. The National Patient Safety Goals are
recommendations to reduce errors using evidence-based practices.
DIF: Cognitive Level: Analysis REF: p. 7
OBJ: Describe standards of professional practice for critical care nursing.
TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment
13. Comparing the patients current (home) medications with those ordered during hospitalization and
communicating a complete list of medications to the next provider when the patient is transferred within an
organization or to another setting are strategies to:
a. improve accuracy of patient identification.
b. prevent errors related to look-alike and sound-alike medications.
,Test Bank - Introduction to Critical Care Nursing 8e (Sole) 8
c. reconcile medications across the continuum of care.
d. reduce harms associated with administration of anticoagulants.
ANS: C
These are steps recommended in the National Patient Safety Goals to reconcile medications across the
continuum of care. Improving accuracy of patient identification is another National Patient Safety Goal.
Preventing errors related to look-alike and sound-alike medications is done to improve medication safety, not
medication reconciliation. Reducing harms associated with administration of anticoagulants is another Nationa
Patient Safety Goal.
DIF: Cognitive Level: Comprehension REF: p. 6 | Box 1-3
OBJ: Describe quality and safety initiatives related to critical care nursing.
TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment
14. As part of nursing management of a critically ill patient, orders are written to keep the head of the bed
elevated at 30 degrees, awaken the patient from sedation each morning to assess readiness to wean from
mechanical ventilation, and implement oral care protocols every 4 hours. These interventions are done as a
group to reduce the risk of ventilator-associated pneumonia. This group of evidence-based interventions is
often called a:
a. bundle of care.
b. clinical practice guideline.
c. patient safety goal.
d. quality improvement initiative.
ANS: A
A group of evidence-based interventions done as a whole to improve outcomes is termed a bundle of care. This
is an example of the ventilator bundle. Oftentimes these bundles are derived from clinical practice guidelines
and are monitored for compliance as part of quality improvement initiatives. At some point, these may become
part of patient safety goals.
DIF: Cognitive Level: Analysis REF: p. 6
OBJ: Describe quality and safety initiatives related to critical care nursing.
TOP: Nursing Process Step: Implementation
MSC: NCLEX: Safe and Effective Care Environment
15. You work in an intermediate care unit that has experienced high nursing turnover. The nurse manager is
often considered to be an autocratic leader by staff members and her leadership style is contributing to
turnover. You have asked to be involved in developing new guidelines to prevent pressure ulcers in your
patient population. The nurse manager tells you that you do not yet have enough experience to be on the
prevention task force. This situation and setting is an example of:
a. a barrier to handoff communication.
,Test Bank - Introduction to Critical Care Nursing 8e (Sole) 9
b. a work environment that is unhealthy.
c. ineffective decision making.
d. nursing practice that is not evidence-based.
ANS: B
These are examples of an unhealthy work environment. A healthy work environment values communication,
collaboration, and effective decision making. It also has authentic leadership. It is not an example of handoff
communication, which is communication that occurs to transition patient care from one staff membe r to
another. Neither does it relate to ineffective decision making. As a nurse, you can still implement evidence-
based practice, but your influence in the unit is limited by the unhealthy work environment.
DIF: Cognitive Level: Analysis REF: p. 7
OBJ: Describe standards of professional practice for critical care nursing.
TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment
16. Which of the following statements describes the core concept of the synergy model of practice?
a. All nurses must be certified in order to have the synergy model implemented.
b. Family members must be included in daily interdisciplinary rounds.
c. Nurses and physicians must work collaboratively and synergistically to influence care.
d. Unique needs of patients and their families influence nursing competencies.
ANS: D
The synergy model of practice is care based on the unique needs and characteristics of the patient and family
members. Although critical care certification is based on the synergy model, the model does not specifically
address certification. Inclusion of family members into the daily rounds is an example of implementation of the
synergy model. With the focus on patients and family members with nurse interaction, the synergy model does
not address physician collaboration.
DIF: Cognitive Level: Application REF: p. 5 | Fig. 1-3
OBJ: Describe standards of professional practice for critical care nursing.
TOP: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity
17. A nurse who plans care based on the patients gender, ethnicity, spirituality, and lifestyle is said to:
a. be a moral advocate.
b. facilitate learning.
, Test Bank - Introduction to Critical Care Nursing 8e (Sole) 10
c. respond to diversity.
d. use clinical judgment.
ANS: C
Response to diversity considers all of these aspects when planning and implementing care. A moral agent helps
resolve ethical and clinical concerns. Consideration of these factors does not necessarily facilitate learning.
Clinical judgment uses other factors as well.
DIF: Cognitive Level: Comprehension REF: p. 3 | Box 1-1
OBJ: Describe standards of professional practice for critical care nursing.
TOP: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity
MULTIPLE RESPONSE
1. Which of the following is a National Patient Safety Goal? (Select all that apply.)
a. Accurately identify patients.
b. Eliminate use of patient restraints.
c. Reconcile medications across the continuum of care.
d. Reduce risks of healthcare-acquired infection.
ANS: A, C, D
All except for eliminating use of restraints are current National Patient Safety Goals. Hospitals have policies
regarding use of restraints and are attempting to reduce the use of restraints; however, this is not a National
Patient Safety Goal.
DIF: Cognitive Level: Analysis REF: p. 6 | Box 1-3
OBJ: Describe quality and safety initiatives related to critical care nursing.
TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment
2. Which of the following is (are) official journal(s) of the American Association of Critical-Care Nurses?
(Select all that apply.)
a. American Journal of Critical Care
b. Critical Care Clinics of North America
c. Critical Care Nurse
d. Critical Care Nursing Quarterly
