Compiled Critical Care: Final Exams TEST BANK Question and Answers [100% Correct] 2025/2026 |UPDATED VERSION|

Compiled Critical Care: Final Exams TEST BANK Question and Answers [100% Correct] 2025/2026 |UPDATED VERSION| When families seek clarity and updates regarding a critically ill patient, which intervention most effectively meets this need? a. Distributing informational pamphlets that explain critical care equipment b. Providing consistent daily updates on the patient's status and encouraging communication with the attending physician c. Informing families that updates are unavailable until designated family rounds later in the day d. Sharing a detailed list of all medications and their doses with family members during visiting hours b. Providing consistent daily updates on the patient's status and encouraging communication with the attending physician As part of a committee designing a new critical care unit, which design element best supports family centered care? a. Creating spacious rooms equipped with a sleeper sofa and storage for family belongings b. Positioning diagnostic suites close to the unit to minimize patient transport c. Adding a rooftop waiting area with scenic views and access to refreshments d. Including access to a quiet meditation garden for family use a. Creating spacious rooms equipped with a sleeper sofa and storage for family belongings A patient with a head injury shows no response to painful stimuli. What is the most appropriate approach while giving a bath? a. Invite a family member to assist and use the time to discuss family dynamics b. Complete the task quickly and without unnecessary noise since the patient is unconscious c. Speak to the patient, mentioning the day and time, and explain the steps of the bath d. Turn on the television to provide background noise and maintain awareness of current events 1 c. Speak to the patient, mentioning the day and time, and explain the steps of the bath Sleep disturbances are common in critically ill patients. Which nursing intervention is most effective in improving rest? a. Collaborate with the pharmacist to adjust medication schedules, allowing uninterrupted rest b. Encourage families to maintain conversations with the patient during visiting hours c. Leave the television on as background noise to aid relaxation d. Keep the lights on to ensure the patient feels secure in their surroundings a. Collaborate with the pharmacist to adjust medication schedules, allowing uninterrupted rest To provide optimal family-centered care, what should the nurse assess first? a. The patient's developmental stage and associated family needs b. The layout and resources of the patient’s home environment c. Identification of key family members, extended relatives, and decision-makers d. Family interactions and communication patterns c. Identification of key family members, extended relatives, and decision-makers Which situation is likely to cause the most significant family conflict during a critical illness? a. A young adult with divorced but cooperative parents hospitalized after a car accident b. An adult male with a long-term partner and child, but no advance directive, whose estranged parents are tasked with medical decisions c. A middle-aged man in a same-sex partnership whose health care proxy is his sister, a registered nurse b. An adult male with a long-term partner and child, but no advance directive, whose estranged parents are tasked with medical decisions What is the most accurate approach to visiting policies in critical care? a. Most critical care nurses strictly enforce limited visitation to allow patient rest b. Children should be prohibited from visiting critically ill patients c. Tailoring visitation to the needs of both patients and families is ideal d. Visiting hours should always remain unrestricted 2 c. Tailoring visitation to the needs of both patients and families is ideal Among elderly patients recovering from critical care, who is at the greatest risk of functional decline? a. A widower discharged to a long-term facility after complications from heart surgery b. An elderly woman recovering from heart failure who requires occasional medication reminders but lives independently a. A widower discharged to a long-term facility after complications from heart surgery What is the most common memory reported by patients who experienced mechanical ventilation? a. Frustration from difficulty communicating b. Discomfort from being unable to reposition themselves c. Persistent pain d. Frequent disruptions to sleep a. Frustration from difficulty communicating Which nursing approach most effectively reduces anxiety in critically ill patients? a. Ask families to restrict their visits to short, scheduled periods b. Provide a thorough explanation of the unit's daily routine c. Explain procedures before and during their performance d. Perform endotracheal suctioning promptly when the patient shows signs of distress c. Explain procedures before and during their performance What should be the first priority when reducing noise levels in an ICU environment? a. Use visual signals like flashing lights instead of audible alerts on phones b. Replace beeping call lights with silent paging systems for nurses c. Turn off monitoring devices for stable patients to reduce unnecessary alarms d. Install soundproofing measures for pneumatic tube systems d. Install soundproofing measures for pneumatic tube systems 3 How should a nurse best communicate with a patient and family who speak a different language? a. Find and print translated resources online for their reference b. Contact the hospital's professional interpreter service c. Request assistance from a bilingual medical resident d. Ask the patient’s bilingual child to help translate medical updates b. Contact the hospital's professional interpreter service Which of the following professional organizations best supports critical care nursing practice? a. American Association of Critical-Care Nurses b. American Heart Association c. American Nurses Association d. Society of Critical Care Medicine a. American Association of Critical-Care Nurses Which nursing action best supports a critically ill patient’s family? a. Encourage them to stay overnight in case the patient needs them b. Provide condition updates regularly and after any changes occur c. Limit the presence of children in the critical care area d. Offer light refreshments and drinks in the family waiting area b. Provide condition updates regularly and after any changes occur What intervention best helps a patient cope with the stress of a critical care unit admission? a. Allow multiple family members to visit without restrictions b. Use simple language to explain all procedures to the patient c. Provide relaxing interventions like back massages and oral care d. Lower the alarm volume on monitoring devices to reduce stress b. Use simple language to explain all procedures to the patient 4 Continuous noise from equipment in a critical care setting predisposes patients to which condition? a. Heightened anxiety b. Persistent pain c. A sense of powerlessness d. Sensory overload d. Sensory overload Which statement about family assessment is incorrect? a. Assessing family structure is the last step in the evaluation process b. Observing interactions among family members is essential c. Communication patterns must be evaluated to clarify roles d. Continuous assessment is necessary as family dynamics can shift during an illness a. Assessing family structure is the last step in the evaluation process A nurse has been working as a staff nurse in the surgical intensive care unit for 2 years and is interested in certification. Which credential would be most applicable for the nurse to seek? a. ACNPC-AG b. CNML c. CCRN d. PCCN c. CCRN The main purpose of certification is to a. assure the consumer that you will not make a mistake. b. prepare for graduate school. c. promote magnet status for your facility. d. validate knowledge of critical care nursing. The synergy model of practice focuses on d. validate knowledge of critical care nursing. a. allowing unrestricted visiting for the patient 24 hours a day. 5 b. holistic and alternative therapies. c. the needs of patients and their families, which drive nursing competency. d. patients' needs for energy and support. nursing competency. c. the needs of patients and their families, which drive The family of your critically ill patient tells you that they have not spoken with the physician in over 24 hours and that they have some questions they want clarified. During morning rounds, you convey this concern to the attending intensivist and arrange a meeting with the family at 4:00 PM. Which competency of critical care nursing does this represent? a. Advocacy and moral agency in solving ethical issues b. Clinical judgment and clinical reasoning skills c. Collaboration with patients, families, and team members d. Facilitation of learning for patients, families, and team members families, and team members c. Collaboration with patients, The AACN Standards for Acute and Critical Care Nursing Practice use what framework to guide critical care nursing practice? a. Evidence-based practice b. Healthy work environment c. National Patient Safety Goals d. Nursing process d. Nursing process The charge nurse is responsible for making the patient assignments on the critical care unit. An experienced, certified nurse is assigned to care for the acutely ill patient with sepsis who also requires continuous renal replacement therapy and mechanical ventilation. The nurse with less than 1 year of experience is assigned to two patients who are more stable. This assignment reflects implementation of the a. crew resource management model. b. National Patient Safety Goals. c. Quality and Safety Education for Nurses (QSEN) model. d. synergy model of practice. d. synergy model of practice. 6 The vision of the American Association of Critical-Care Nurses is a health care 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. c. the needs of critically ill patients and families. 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. d. reduce patient errors. d. reduce patient errors. 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 report. Which information do you convey regarding background? a. Urine output of 40 mL/2 hours b. Current vital signs and history of aortic aneurysm repair 4 hours ago c. A statement that the patient is possibly hypovolemic d. A request for IV fluids b. Current vital signs and history of aortic aneurysm repair 4 hours ago The family members of a critically ill patient bring a copy of the patient's living will to the hospital, which identifies the patient's wishes regarding health care. You discuss contents of the living will with the patient's physician. This is an example of implementation of which of the AACN Standards of Professional Performance? a. Acquires and maintains current knowledge of practice 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 of the patient and family b. Acts ethically on the behalf 7 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 a. Clinical practice guidelines Comparing the patient's 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. c. reconcile medications across the continuum of care. d. reduce harms associated with the administration of anticoagulants. across the continuum of care. c. reconcile medications 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. a. bundle of care. You work in an intermediate care unit and 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 and that your ideas will be rejected by others. This situation is an example of a. a barrier to handoff communication. b. a work environment that is unhealthy. 8 c. ineffective decision making. d. nursing practice that is not evidence-based. b. a work environment that is unhealthy. 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. patients and their families influence nursing competencies. d. Unique needs of A nurse who plans care based on the patient's gender, ethnicity, spirituality, and lifestyle is said to a. be a moral advocate. b. facilitate learning. c. respond to diversity. d. use clinical judgment. c. respond to diversity. Which of the following is a National Patient Safety Goal? (Select all that apply.) a. Accurately identify patients. b. Eliminate the use of patient restraints. c. Reconcile medications across the continuum of care. d. Reduce risks of health care-acquired infection. e. Reduce costs associated with hospitalization. a. Accurately identify patients. c. Reconcile medications across the continuum of care. d. Reduce risks of health care-acquired infection. 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 9 c. Critical Care Nurse d. Critical Care Nursing Quarterly e. Critical Care Nursing Management c. Critical Care Nurse a. American Journal of Critical Care The first critical care units were (Select all that apply.) a. burn units. b. coronary care units. c. recovery rooms. d. neonatal intensive care units. e. high-risk OB units. c. recovery rooms. b. coronary care units. Which of the following nursing activities demonstrates implementation of the AACN Standards of Professional Performance? (Select all that apply.) a. Attending a meeting of the local chapter of the American Association of Critical-Care Nurses in which a continuing education program on sepsis is being taught b. Collaborating with a pastoral services colleague to assist in meeting spiritual needs of the patient and family c. Participating on the unit's nurse practice council d. Posting an article from Critical Care Nurse on the management of venous thromboembolism for your colleagues to read e. Using evidence-based strategies to prevent ventilator-associated pneumonia a. Attending a meeting of the local chapter of the American Association of Critical-Care Nurses in which a continuing education program on sepsis is being taught b. Collaborating with a pastoral services colleague to assist in meeting spiritual needs of the patient and family c. Participating on the unit's nurse practice council d. Posting an article from Critical Care Nurse on the management of venous thromboembolism for your colleagues to read e. Using evidence-based strategies to prevent ventilator-associated pneumonia 10 Which scenarios contribute to effective handoff communication at change of shift? (Select all that apply.) a. The nephrology consultant physician is making rounds and asks you for an update on the patient's status and to assist in placing a central line for hemodialysis. b. The noise level is high because twice as many staff members are present and everyone is giving report in the nurses' station. c. The unit has decided to use a standardized checklist/tool for change-of-shift reports and patient transfers. d. You and the oncoming nurse conduct a standardized report at the patient's bedside and review key assessment findings. e. The off-going nurse is giving the patient medications at the same time as giving handoff report to the oncoming nurse. c. The unit has decided to use a standardized checklist/tool for change-of-shift reports and patient transfers. d. You and the oncoming nurse conduct a standardized report at the patient's bedside and review key assessment findings. Which strategy is important in addressing issues associated with the aging workforce? (Select all that apply.) a. Allowing nurses to work flexible shift durations b. Encouraging older nurses to transfer to an outpatient setting that is less stressful c. Hiring nurse technicians who are available to assist with patient care, such as turning the patient d. Remodeling patient care rooms to include devices to assist in patient lifting e. Developing a staffing model that accurately reflects the unit's needs. f lexible shift durations a. Allowing nurses to work c. Hiring nurse technicians who are available to assist with patient care, such as turning the patient d. Remodeling patient care rooms to include devices to assist in patient lifting Which of the following strategies will assist in creating a healthy work environment for the critical care nurse? (Select all that apply.) a. Celebrating improved outcomes from a nurse-driven protocol with a pizza party b. Implementing a medication safety program designed by pharmacists c. Modifying the staffing pattern to ensure a 1:1 nurse/patient ratio 11 d. Offering quarterly joint nurse-physician workshops to discuss unit issues e. Using the Situation-Background-Assessment-Recommendation (SBAR) technique for handoff communication a. Celebrating improved outcomes from a nurse-driven protocol with a pizza party d. Offering quarterly joint nurse-physician workshops to discuss unit issues e. Using the Situation-Background-Assessment-Recommendation (SBAR) technique for handoff communication Family assessment can be challenging, and each nurse may obtain additional information regarding family structure and dynamics. What is the best way to share this information from shift to shift? a. Create an informal family information sheet that is kept on the bedside clipboard. That way, everyone can review it quickly when needed. b. Develop a standardized reporting form for family information that is incorporated into the patient's medical record and updated as needed. c. Require that the charge nurse have a detailed list of information about each patient and family member. Thus, someone on the unit is always knowledgeable about potential issues. d. Try to remember to discuss family structure and dynamics as part of the change-of-shift report. b. Develop a standardized reporting form for family information that is incorporated into the patient's medical record and updated as needed. The spouse of a patient who is hospitalized in the critical care unit following resuscitation for a sudden cardiac arrest at work demands to meet with the nursing manager. The spouse demands, "I want you to reassign us to another nurse. His current nurse is not in the room enough to make sure everything is okay." The nurse recognizes that this response most likely is due to the spouse's a. desire to pursue a lawsuit if the assignment is not changed. b. inability to participate in the husband's care. c. lack of prior experience in a critical care setting. d. sense of loss of control of the situation. d. sense of loss of control of the situation Open visitation policies are expected by many professional organizations. Which statement reflects adherence to current recommendations? a. Allow animals on the unit; however, these can only be "therapy" animals through the hospital's pet therapy program. b. Allow family visitation throughout the day except at change of shift and during rounds. 12 c. Determine, in collaboration with the patient and family, who can visit and when. Facilitate open visitation policies. d. Permit open visitation by adults 18 years of age and older; limit visits of children to 1 hour. Determine, in collaboration with the patient and family, who can visit and when. Facilitate open visitation policies. c. The VALUE mnemonic is a helpful strategy to enhance communication with family members of critically ill patients. Which of the following statements describes a VALUE strategy? a. View the family as guests on the unit. b. Acknowledge family emotions. c. Learn as much as you can about family structure and function. d. Use a trained interpreter if the family does not speak English. The VALUE mnemonic includes the following: V—Value what the family tells you. A—Acknowledge family emotions. L—Listen to the family members. U—Understand the patient as a person. E—Elicit (ask) questions of family members. b. Acknowledge family emotions. Changing visitation policies can be challenging. The nurse manager recognizes which of the following as an effective strategy for promoting changes in practice? a. Ask the clinical nurse specialist to lead a journal club on open visitation after each nurse is tasked to read one research article about visitation. b. Discuss the pros and cons of open visitation at the next staff meeting. c. Invite the nurses with the most experience to develop a revised policy. d. Task the unit-based nurse practice council to invite volunteers to serve on the council to revise the current policy toward more liberal visitation. d. Task the unit-based nurse practice council to invite volunteers to serve on the council to revise the current policy toward more liberal visitation. Nursing strategies to help families cope with the stress of critical illness include: (Select all that apply.) 13 a. asking the family to leave during the morning bath to promote the patient's privacy. b. encouraging family members to make notes of questions they have for the physician during family rounds. c. if possible, providing continuity of nursing care. d. providing a daily update of the patient's condition to the family spokesperson. e. ensuring that a waiting room stocked with snacks is nearby. b. encouraging family members to make notes of questions they have for the physician during family rounds. c. if possible, providing continuity of nursing care. d. providing a daily update of the patient's condition to the family spokesperson. Family presence is encouraged during resuscitation and invasive procedures. Which findings about this practice have been reported in the literature? (Select all that apply.) a. Families benefit by witnessing that everything possible was done. b. Families report reduced anxiety and fear about what is being done to the patient. c. Presence encourages family members to seek litigation for improper care. d. Presence reduces nurses' involvement in explaining things to the family. e. Families report that staff conversations during this time were distressing. witnessing that everything possible was done. a. Families benefit by b. Families report reduced anxiety and fear about what is being done to the patient. Noise in the critical care unit can have negative effects on the patient. Which of the following interventions assists in reducing noise levels in the critical care setting? (Select all that apply.) a. Ask the family to bring in the patient's iPod or other device with favorite music. b. Invite a volunteer harpist to play on the unit on a regular basis. c. Remodel the unit to have two-patient rooms to facilitate nursing care. d. Remodel the unit to install acoustical ceiling tiles. e. Turn the volume of equipment alarms as low as they can be adjusted, and "off" if possible. Ask the family to bring in the patient's iPod or other device with favorite music. b. Invite a volunteer harpist to play on the unit on a regular basis. d. Remodel the unit to install acoustical ceiling tiles. a. 14 It is important for critically ill patients to feel safe. Which nursing strategies help the patient to feel safe in the critical care setting? (Select all that apply.) a. Allow family members to remain at the bedside. b. Consult with the charge nurse before making any patient care decisions. c. Provide informal conversation by discussing your plans for after work. d. Respond promptly to call bells or other communication for assistance. e. Inform the patient that you have cared for many similar patients. remain at the bedside. d. Respond promptly to call bells or other communication for assistance. a. Allow family members to The critical care environment is often stressful to a critically ill patient. Identify stressors that are common. (Select all that apply.) a. Alarms that sound from various devices b. Bright fluorescent lighting c. Lack of day-night cues d. Sounds from the mechanical ventilator e. Visiting hours tailored to meet individual needs b. Bright fluorescent lighting c. Lack of day-night cues d. Sounds from the mechanical ventilator a. Alarms that sound from various devices To reduce relocation stress in patients transferring out of the intensive care unit, the nurse can (Select all that apply.) a. ask the nurses on the intermediate care unit to give the family a tour of the new unit. b. contact the intensivist to see if the patient can stay one additional day in the critical care unit so that he and his family can adjust better to the idea of a transfer. c. ensure that the patient will be located near the nurses' station in the new unit. d. invite the nurse who will be assuming the patient's care to meet with the patient and family in the critical care unit prior to transfer. e. help the patient and family focus on the positive meaning of a transfer. intermediate care unit to give the family a tour of the new unit. a. ask the nurses on the 15 d. invite the nurse who will be assuming the patient's care to meet with the patient and family in the critical care unit prior to transfer. e. help the patient and family focus on the positive meaning of a transfer. The critical care environment is stressful to the patient. Which interventions assist in reducing this stress? (Select all that apply.) a. Adjust lighting to promote normal sleep-wake cycles. b. Provide clocks, calendars, and personal photos in the patient's room. c. Talk to the patient about other patients you are caring for on the unit. d. Tell the patient the day and time when you are providing routine nursing interventions. e. Allow unlimited visitation tailored to the patient's individual needs. promote normal sleep-wake cycles. b. Provide clocks, calendars, and personal photos in the patient's room. e. Allow unlimited visitation tailored to the patient's individual needs. Ideally, an advance directive should be developed by the a. family if the patient is in critical condition. b. patient as part of the hospital admission process. c. patient before hospitalization. d. patient's health care surrogate. c. patient before hospitalization. a. Adjust lighting to A critically ill patient has a living will in the chart. The patient's condition has deteriorated, but the spouse wants "everything done," regardless of the patient's wishes. Which ethical principle is the spouse violating? a. Autonomy b. Beneficence c. Justice d. Nonmaleficence a. Autonomy Which statement regarding ethical concepts is true? 16 a. A living will is the same as a health care proxy. b. A signed donor card ensures that organ donation will occur in the event of brain death. c. A surrogate is a competent adult designated by a person to make health care decisions in the event the person is incapacitated. d. A persistent vegetative state is the same as brain death in most states. c. A surrogate is a competent adult designated by a person to make health care decisions in the event the person is incapacitated. Which of the following statements about resuscitation is true? a. Family members should never be present during resuscitation. b. It is not necessary for a physician to write "do not resuscitate" orders in the chart if a patient has a health care surrogate. c. "Slow codes" are ethical and should be considered in futile situations if advanced directives are unavailable. d. Withholding "extraordinary" resuscitation is legal and ethical if specified in advance directives and physician orders. d. Withholding "extraordinary" resuscitation is legal and ethical if specified in advance directives and physician orders. The nurse is caring for an elderly patient who is in cardiogenic shock. The patient has failed to respond to medical treatment. The intensivist in charge of the patient conducts a conference to explain that treatment options have been exhausted and to suggest that the patient be given a "do not resuscitate" status. This scenario illustrates the concept of a. brain death. b. futility. c. incompetence. d. life-prolonging procedures. b. futility. The nurse is caring for a patient admitted with a traumatic brain injury following a motor vehicle crash. Several weeks later, the patient is still ventilator dependent and unresponsive to stimulation but occasionally takes a spontaneous breath. The physician explains to the family that the patient has severe neurological impairment and is not expected to recover consciousness. The nurse recognizes that this patient is a. an organ donor. 17 b. brain dead. c. in a persistent vegetative state. d. terminally ill. c. in a persistent vegetative state. A nurse caring for a patient with neurological impairment often must use painful stimuli to elicit the patient's response. The nurse uses subtle measures of painful stimuli, such as nailbed pressure. She neither slaps the patient nor pinches the nipple to elicit a response to pain. In this scenario, the nurse is exemplifying the ethical principle of a. beneficence. b. fidelity. c. nonmaleficence. d. veracity. c. nonmaleficence. Which of the following organizations requires a mechanism for addressing ethical issues? a. American Association of Critical-Care Nurses b. American Hospital Association c. Society of Critical Care Medicine d. The Joint Commission d. The Joint Commission The nurse is caring for a patient who is not responding to medical treatment. The intensivist holds a conference with the family, and a decision is made to withdraw life support. The nurse's religious beliefs are not in agreement with the withdrawal of life support. However, the nurse assists with the process to avoid confronting the charge nurse. Afterward the nurse feels guilty for "killing the patient." This scenario is likely to cause a. abandonment. b. family stress. c. moral distress. d. negligence. c. moral distress. The nurse is caring for a patient who has been declared brain dead. The patient is considered a potential organ donor. To proceed with donation, the nurse understands that 18 a. a signed donor card mandates that organs be retrieved in the event of brain death. b. after brain death has been determined, perfusion and oxygenation of organs is maintained until organs can be removed in the operating room. c. the health care proxy does not need to give consent for the retrieval of organs. d. once a patient has been established as brain dead, life support is withdrawn and organs are retrieved. b. after brain death has been determined, perfusion and oxygenation of organs is maintained until organs can be removed in the operating room. The nurse is caring for a patient who is declared brain dead and is an organ donor. The following events occur: 1300 Diagnostic tests for brain death are completed. 1330 Intensivist reviews diagnostic test results and writes in the progress note that the patient is brain dead. 1400 Patient is taken to the operating room for organ retrieval. 1800 All organs have been retrieved for donation. The ventilator is discontinued. 1810 Cardiac monitor shows flatline. What is the official time of death recorded in the medical record? a. 1300 b. 1330 c. 1400 d. 1800 e. 1810 b. 1330 The nurse is caring for a critically ill patient on mechanical ventilation. The physician identifies the need for a bronchoscopy, which requires informed consent. For the physician to obtain consent from the patient, the patient must be able to a. be weaned from mechanical ventilation. b. have knowledge and competence to make the decision. c. nod his head that it is okay to proceed. d. read and write in English. b. have knowledge and competence to make the decision. The nurse is caring for a critically ill patient with terminal cancer. The monitor alarms and shows a potentially lethal rhythm. The patient has no pulse. The patient does not have a "do not resuscitate" order written on the chart. What is the appropriate nursing action? a. Contact the attending physician immediately to determine if CPR should be initiated. b. Contact the family immediately to determine if they want CPR to be started. 19 c. Give emergency medications but withhold intubation. d. Initiate CPR and call a code. d. Initiate CPR and call a code. When addressing an ethical dilemma, contextual, physiological, and personal factors of the situation must be considered. Which of the following is an example of a personal factor? a. The hospital has a policy that everyone must have an advance directive on the chart. b. The patient has lost 20 pounds in the past month and is fatigued all the time. c. The patient has told you what quality of life means and his or her wishes. d. The physician considers care to be futile in a given situation. quality of life means and his or her wishes c. The patient has told you what A specific request made by a competent person that directs medical care related to life-prolonging procedures in the event that person loses capacity to make decisions is called a a. "do not resuscitate" order. b. health care proxy. c. informed consent. d. living will. d. living will. The American Nurses Credential Center Magnet Recognition Program supports many actions to ensure that nurses are engaged and empowered to participate in ethical decision making. Which of the following would assist nurses in being involved in research studies? a. Education on protection of human subjects b. Participation of staff nurses on ethics committees c. Written descriptions of how nurses participate in ethics programs d. Written policies and procedures related to response to ethical issues of human subjects a. Education on protection The critical care nurse wants a better understanding of when to initiate an ethics consult. After attending an educational program, the nurse understands that the following situation would require an ethics consultation: 20 a. Conflict has occurred between the physician and family regarding treatment decisions. A family conference is held, and the family and physician agree to a treatment plan that includes aggressive treatment for 24 hours followed by reevaluation. b. Family members disagree as to a patient's course of treatment. The patient has designated a health care proxy and has a written advance directive. c. Patient postoperative coronary artery bypass surgery who sustained a cardiopulmonary arrest in the operating room. He was successfully resuscitated, but now is not responding to treatment. He has a written advance directive, and his wife is present. d. Patient with multiple trauma and is not responding to tr d. Patient with multiple trauma and is not responding to treatment. No family members are known, and the health care team is debating if care is futile. The nurse knows that which of the following statements about organ donation is true? a. Anyone who is comfortable approaching the family should discuss the option of organ donation. b. Brain death determination is required before organs can be retrieved for transplant. c. Donation of selected organs after cardiac death is ethically acceptable. d. Family members should consider the withdrawal of life support so that the patient can become an organ donor. c. Donation of selected organs after cardiac death is ethically acceptable. Warning signs that can assist the critical care nurse in recognizing that an ethical dilemma may exist include which of the following? (Select all that apply.) a. Family members are confused about what is happening to the patient. b. Family members are in conflict as to the best treatment options. They disagree with one another and cannot come to consensus. c. The family asks that the patient not be told of treatment plans. d. The patient's condition has changed dramatically for the worse and is not responding to conventional treatment. e. The physician is considering the use of a medication that is not approved to treat the patient's condition. a. Family members are confused about what is happening to the patient. b. Family members are in conflict as to the best treatment options. They disagree with one another and cannot come to consensus. c. The family asks that the patient not be told of treatment plans. 21 d. The patient's condition has changed dramatically for the worse and is not responding to conventional treatment. e. The physician is considering the use of a medication that is not approved to treat the patient's condition. The nurse is caring for a patient whose condition has deteriorated and who is not responding to standard treatment. The physician calls for an ethical consultation with the family to discuss potential withdrawal of treatment versus aggressive treatment. The nurse understands that applying a model for ethical decision making involves which of the following? (Select all that apply.) a. Burden versus benefit b. Family's wishes c. Patient's wishes d. Potential outcomes of treatment options e. Cost savings of withdrawing treatment c. Patient's wishes d. Potential outcomes of treatment options a. Burden versus benefit The nurse utilizes which of the following strategies when encountering an ethical dilemma in practice? (Select all that apply.) a. Change-of-shift report updates b. Ethics consultation services c. Formal multiprofessional ethics committees d. Pastoral care services e. Social work consultation b. Ethics consultation services c. Formal multiprofessional ethics committees The nurse is caring for a patient with severe neurological impairment following a massive stroke. The physician has ordered tests to determine brain death. The nurse understands that criteria for brain death include (Select all that apply.) a. absence of cerebral blood flow. b. absence of brainstem reflexes on neurological examination. 22 c. Cheyne-Stokes respirations. d. flat electroencephalogram. e. responding only to painful stimuli. a. absence of cerebral blood flow. b. absence of brainstem reflexes on neurological examination. d. flat electroencephalogram The nurse is caring for an 80-year-old patient who has been treated for gastrointestinal bleeding. The family has agreed to withhold additional treatment. The patient has a written advance directive specifying requests. The directive notes that the patient wants food and fluid to be continued. The nurse anticipates that several orders may be written to comply with this request, including which of the following? (Select all that apply.) a. "Do not resuscitate." b. Change antibiotic to a less expensive medication. c. Discontinue tube feeding. d. Stop any further blood transfusions. e. Water boluses every 4 hours with tube feeding. d. Stop any further blood transfusions. e. Water boluses every 4 hours with tube feeding. a. "Do not resuscitate." The nurse is caring for a 100-kg patient being monitored with a pulmonary artery catheter. The nurse assesses a blood pressure of 90/60 mm Hg, heart rate 110 beats/min, respirations 36/min, oxygen saturation of 89% on 3 L of oxygen via nasal cannula. Bilateral crackles are audible upon auscultation. Which hemodynamic value requires immediate action by the nurse? a. Cardiac index (CI) of 1.2 L/min/m3 b. Cardiac output (CO) of 4 L/min c. Pulmonary vascular resistance (PVR) of 80 dynes/sec/cm-5 d. Systemic vascular resistance (SVR) of 1400 dynes/sec/cm-5 L/min/m3 a. Cardiac index (CI) of 1.2 While caring for a patient with a small bowel obstruction, the nurse assesses a pulmonary artery occlusion pressure (PAOP) of 1 mm Hg and hourly urine output of 5 mL. The nurse anticipates which therapeutic intervention? 23 a. Diuretics b. Intravenous fluids c. Negative inotropic agents d. Vasopressors b. Intravenous fluids The nurse is caring for a patient who has had an arterial line inserted. To reduce the risk of complications, what is the priority nursing intervention? a. Apply a pressure dressing to the insertion site. b. Ensure that all tubing connections are tightened. c. Obtain a portable x-ray to confirm placement. d. Restrain the affected extremity for 24 hours. t ightened. b. Ensure that all tubing connections are While caring for a patient with a pulmonary artery catheter, the nurse notes the pulmonary artery occlusion pressure (PAOP) to be significantly higher than previously recorded values. The nurse assesses respirations to be unlabored at 16 breaths/min, oxygen saturation of 98% on 3 L of oxygen via nasal cannula, and lungs clear to auscultation bilaterally. What is the priority nursing action? a. Increase supplemental oxygen and notify respiratory therapy. b. Notify the provider immediately of the assessment findings. c. Obtain a stat chest x-ray film to verify proper catheter placement. d. Zero reference and level the catheter at the phlebostatic axis. catheter at the phlebostatic axis. d. Zero reference and level the A patient is admitted to the hospital with multiple trauma and extensive blood loss. The nurse assesses vital signs to be BP 80/50 mm Hg, heart rate 135 beats/min, respirations 36 breaths/min, cardiac output (CO) of 2 L/min, systemic vascular resistance of 3000 dynes/sec/cm-5, and a hematocrit of 20%. The nurse anticipates administration of which the following therapies or medications? a. Blood transfusion b. Furosemide c. Dobutamine infusion d. Dopamine hydrochloride infusion a. Blood transfusion 24 After pulmonary artery catheter insertion, the nurse assesses a pulmonary artery pressure of 45/25 mm Hg, a pulmonary artery occlusion pressure (PAOP) of 20 mm Hg, a cardiac output of 2.6 L/min and a cardiac index of 1.9 L/min/m2. Which provider order is of the highest priority? a. Apply 50% oxygen via Venturi mask. b. Insert an indwelling urinary catheter. c. Begin a dobutamine infusion. d. Obtain stat cardiac enzymes and troponin. c. Begin a dobutamine infusion. The nurse is caring for a patient with a left subclavian central venous catheter (CVC) and a left radial arterial line. Which assessment finding by the nurse requires immediate action? a. A dampened arterial line waveform b. Numbness and tingling in the left hand c. Slight bloody drainage at subclavian insertion site d. Slight redness at subclavian insertion site b. Numbness and tingling in the left hand The provider writes an order to discontinue a patient's left radial arterial line. When discontinuing the patient's invasive line, what is the priority nursing action? a. Apply an air occlusion dressing to insertion site. b. Apply pressure to the insertion site for 5 minutes. c. Elevate the affected limb on pillows for 24 hours. d. Keep the patient's wrist in a neutral position. minutes b. Apply pressure to the insertion site for 5 Following insertion of a central venous catheter, the nurse obtains a stat chest x-ray film to verify proper catheter placement. The radiologist reports to the nurse: "The tip of the catheter is located in the superior vena cava." What is the best interpretation of these results by the nurse? a. The catheter is not positioned correctly and should be removed. b. The catheter position increases the risk of ventricular dysrhythmias. c. The distal tip of the catheter is in the appropriate position. d. The physician should be called to advance the catheter into the pulmonary artery. t ip of the catheter is in the appropriate position. c. The distal 25 While inflating the balloon of a pulmonary artery catheter (PAC) with 1.0 mL of air to obtain a pulmonary artery occlusion pressure (PAOP), the nurse encounters resistance. What is the best nursing action? a. Add an additional 0.5 mL of air to the balloon and repeat the procedure. b. Advance the catheter with the balloon deflated and repeat the procedure. c. Deflate the balloon and obtain a chest x-ray study to determine line placement. d. Lock the balloon in the inflated position, and flush the distal port of the PAC with normal saline. c. Deflate the balloon and obtain a chest x-ray study to determine line placement. The nurse is caring for a patient following insertion of a left subclavian central venous catheter (CVC). Which assessment finding 2 hours after insertion by the nurse warrants immediate action? a. Diminished breath sounds over left lung field b. Localized pain at catheter insertion site c. Measured central venous pressure of 5 mm Hg d. Slight bloody drainage around insertion site a. Diminished breath sounds over left lung field The nurse is caring for a mechanically ventilated patient with a pulmonary artery catheter who is receiving continuous enteral tube feedings. When obtaining continuous hemodynamic monitoring measurements, what is the best nursing action? a. Do not document hemodynamic values until the patient can be placed in the supine position. b. Level and zero reference the air-fluid interface of the transducer with the patient in the supine position and record hemodynamic values. c. Level and zero reference the air-fluid interface of the transducer with the patient's head of bed elevated to 30 degrees and record hemodynamic values. d. Level and zero reference the air-fluid interface of the transducer with the patient supine in the side lying position and record hemodynamic values. c. Level and zero reference the air-fluid interface of the transducer with the patient's head of bed elevated to 30 degrees and record hemodynamic values. The nurse is educating a patient's family member about a pulmonary artery catheter (PAC). Which statement by the family member best indicates understanding of the purpose of the PAC? a. "The catheter will provide multiple sites to give intravenous fluid." 26 b. "The catheter will allow the provider to better manage fluid therapy." c. "The catheter tip comes to rest inside my brother's pulmonary artery." d. "The catheter will be in position until the heart has a chance to heal." allow the provider to better manage fluid therapy." b. "The catheter will The nurse is preparing to obtain a pulmonary artery occlusion pressure (PAOP) reading for a patient who is mechanically ventilated. Ensuring that the air-fluid interface is at the level of the phlebostatic axis, what is the best nursing action? a. Place the patient in the supine position and record the PAOP immediately after exhalation. b. Place the patient in the supine position and document the average PAOP obtained after three measurements. c. Place the patient with the head of bed elevated 30 degrees and document the average PAOP pressure obtained. d. Place the patient with the head of bed elevated 30 degrees and record the PAOP just before the increase in pressures during inhalation. d. Place the patient with the head of bed elevated 30 degrees and record the PAOP just before the increase in pressures during inhalation. The charge nurse is supervising care for a group of patients monitored with a variety of invasive hemodynamic devices. Which patient should the charge nurse evaluate first? a. A patient with a central venous pressure (RAP/CVP) of 6 mm Hg and 40 mL of urine output in the past hour b. A patient with a left radial arterial line with a BP of 110/60 mm Hg and slightly dampened arterial waveform c. A patient with a pulmonary artery occlusion pressure of 25 mm Hg and an oxygen saturation of 89% on 3 L of oxygen via nasal cannula d. A patient with a pulmonary artery pressure of 25/10 mm Hg and an oxygen saturation of 94% on 2 L of oxygen via nasal cannula c. A patient with a pulmonary artery occlusion pressure of 25 mm Hg and an oxygen saturation of 89% on 3 L of oxygen via nasal cannula The nurse is caring for a patient following insertion of a left subclavian central venous catheter (CVC). Which action by the nurse best reduces the risk of catheter-related bloodstream infection (CRBSI)? a. Review daily the necessity of the central venous catheter. b. Cleanse the insertion site daily with isopropyl alcohol. 27 c. Change the pressurized tubing system and flush bag daily. d. Maintain a pressure of 300 mm Hg on the flush bag. venous catheter. a. Review daily the necessity of the central During insertion of a pulmonary artery catheter, the provider asks the nurse to assist by inflating the balloon with 1.5 mL of air. As the provider advances the catheter, the nurse notices premature ventricular contractions on the monitor. What is the best action by the nurse? a. Deflate the balloon while slowly withdrawing the catheter. b. Instruct the patient to cough and deep-breathe forcefully. c. Inflate the catheter balloon with an additional 1 mL of air. d. Ensure lidocaine hydrochloride (IV) is immediately available. (IV) is immediately available. d. Ensure lidocaine hydrochloride Following insertion of a pulmonary artery catheter (PAC), the provider requests the nurse obtain a blood sample for mixed venous oxygen saturation (SvO2). Which action by the nurse best ensures the obtained value is accurate? a. Zero referencing the transducer at the level of the phlebostatic axis following insertion b. Calibrating the system with a central venous blood sample and arterial blood gas value c. Ensuring patency of the catheter using a 0.9% normal saline solution pressurized at 300 mm Hg d. Using noncompliant pressure tubing that is no longer than 36 to 48 inches and has minimal stopcocks b. Calibrating the system with a central venous blood sample and arterial blood gas value The nurse is caring for a 70-kg patient in septic shock with a pulmonary artery catheter. Which hemodynamic value indicates an appropriate response to therapy aimed at enhancing oxygen delivery to the organs and tissues? a. Arterial lactate level of 1.0 mEq/L b. Cardiac output of 2.5 L/min c. Mixed venous (SvO2) of 40% d. Cardiac index of 1.5 L/min/m2 a. Arterial lactate level of 1.0 mEq/L The nurse is caring for a patient with a pulmonary artery catheter. Assessment findings include a blood pressure of 85/40 mm Hg, heart rate of 125 beats/min, respiratory rate 35 breaths/min, and arterial 28 oxygen saturation (SpO2) of 90% on a 50% Venturi mask. Hemodynamic values include a cardiac output (CO) of 1.0 L/min, central venous pressure (CVP) of 1 mm Hg, and a pulmonary artery occlusion pressure (PAOP) of 3 mm Hg. The nurse questions which of the following physician's orders? a. Titrate supplemental oxygen to achieve a SpO2 94%. b. Infuse 500 mL 0.9% normal saline over 1 hour. c. Obtain arterial blood gas and serum electrolytes. d. Administer furosemide (Lasix) 20 mg intravenously. intravenously. d. Administer furosemide (Lasix) 20 mg The charge nurse has a pulse contour cardiac output monitoring system available for use in the surgical intensive care unit. For which patient is use of this device most appropriate? a. A patient with a history of aortic insufficiency admitted with a postoperative myocardial infarction b. A mechanically ventilated patient with cardiogenic shock being treated with an intraaortic balloon pump c. A patient with a history of atrial fibrillation having frequent episodes of paroxysmal supraventricular tachycardia d. A mechanically ventilated patient admitted following repair of an acute bowel obstruction mechanically ventilated patient admitted following repair of an acute bowel obstruction The provider prescribes a pulmonary artery occlusive pressure reading (PAOP) for a patient being monitored with a pulmonary artery catheter. Immediately after obtaining an occlusive pressure, the nurse notes the change in waveform indicated on the strip below. What are the best actions by the nurse? Figure from Geiter H, Jr.: Swan-Ganz Catheters. . Accessed April 2012. a. Turn the patient to the left side; obtain a stat portable chest x-ray. b. Place the patient supine; repeat zero referencing of the system. c. Document the wedge pressure; continue to monitor the patient. d. Perform an immediate dynamic response test; obtain a chest x-ray. d. A c. Document the wedge pressure; continue to monitor the patient. The nurse is caring for a patient with an arterial monitoring system. The nurse assesses the patient's noninvasive cuff blood pressure to be 70/40 mm Hg. The arterial blood pressure measurement via an 29 intraarterial catheter in the same arm is assessed by the nurse to be 108/70 mm Hg. What is the best action by the nurse? a. Activate the rapid response system. b. Place the patient in Trendelenburg position. c. Assess the cuff for proper arm size. d. Administer 0.9% normal saline bolus. c. Assess the cuff for proper arm size. The nurse is caring for a patient with an admitting diagnosis of congestive heart failure. While attempting to obtain a pulmonary artery occlusion pressure in the supine position, the patient becomes anxious and tachypneic. What is the best action by the nurse? a. Limit the patient's supine position to no more than 10 seconds. b. Administer antianxiety medications while recording the pressure. c. Encourage the patient to take slow, deep breaths while supine. d. Elevate the head of the bed 45 degrees while recording pressures. bed 45 degrees while recording pressures. d. Elevate the head of the The nurse returns from the cardiac catheterization laboratory with a patient following insertion of a pulmonary artery catheter and assists in transferring the patient from the stretcher to the bed. Before obtaining a cardiac output, which action is most important for the nurse to complete? a. Document a pulmonary artery catheter occlusion pressure. b. Zero reference the transducer system at the phlebostatic axis. c. Inflate the pulmonary artery catheter balloon with 1 mL air. d. Inject 10 mL of 0.9% normal saline into the proximal port. system at the phlebostatic axis. b. Zero reference the transducer The charge nurse is supervising the care of four critical care patients being monitored using invasive hemodynamic modalities. Which patient should the charge nurse evaluate first? a. A patient in cardiogenic shock with a cardiac output (CO) of 2.0 L/min b. A patient with a pulmonary artery systolic pressure (PAP) of 20 mm Hg c. A hypovolemic patient with a central venous pressure (CVP) of 6 mm Hg d. A patient with a pulmonary artery occlusion pressure (PAOP) of 10 mm Hg cardiogenic shock with a cardiac output (CO) of 2.0 L/min a. A patient in 30 The nurse is caring for a mechanically ventilated patient being monitored with a left radial arterial line. During the inspiratory phase of ventilation, the nurse assesses a 20 mm Hg decrease in arterial blood pressure. What is the best interpretation of this finding by the nurse? a. The mechanical ventilator is malfunctioning. b. The patient may require fluid resuscitation. c. The arterial line may need to be replaced. d. The left limb may have reduced perfusion. b. The patient may require fluid resuscitation. Upon entering the room of a patient with a right radial arterial line, the nurse assesses the waveform to be slightly dampened and notices blood to be backed up into the pressure tubing. What is the best action by the nurse? a. Check the inflation volume of the flush system pressure bag. b. Disconnect the flush system from the arterial line catheter. c. Zero reference the transducer system at the phlebostatic axis. d. Reduce the number of stopcocks in the flush system tubing. the flush system pressure bag. a. Check the inflation volume of The nurse is caring for a patient with a left radial arterial line and a pulmonary artery catheter inserted into the right subclavian vein. Which action by the nurse best ensures the safety of the patient being monitored with invasive hemodynamic monitoring lines? a. Document all waveform values. b. Limit the pressure tubing length. c. Zero reference the system daily. d. Ensure alarm limits are turned on. d. Ensure alarm limits are turned on. The nurse is preparing to measure the thermodilution cardiac output (TdCO) in a patient being monitored with a pulmonary artery catheter. Which action by the nurse best ensures the safety of the patient? a. Ensure the transducer system is zero referenced at the level of the phlebostatic axis. b. Avoid infusing vasoactive agents in the port used to obtain the TdCO measurement. c. Maintain a pressure of 300 mm Hg on the flush solution using a pressure bag. 31 b. Avoid infusing d. Limit the length of the noncompliant pressure tubing to a maximum 48 inches. vasoactive agents in the port used to obtain the TdCO measurement. When performing an initial pulmonary artery occlusion pressure (PAOP), what are the best nursing actions? (Select all that apply.) a. Inflate the balloon for no more than 8 to 10 seconds while noting the waveform change. b. Inflate the balloon with air, recording the volume necessary to obtain a reading. c. Maintain the balloon in the inflated position for 8 hours following insertion. d. Zero reference and level the air-fluid interface of the transducer at the level of the phlebostatic axis. e. Inflate and deflate the balloon on an hourly schedule to 10 seconds while noting the waveform change. a. Inflate the balloon for no more than 8 b. Inflate the balloon with air, recording the volume necessary to obtain a reading d. Zero reference and level the air-fluid interface of the transducer at the level of the phlebostatic axis The nurse is preparing to obtain a right atrial pressure (RAP/CVP) reading. What are the most appropriate nursing actions? (Select all that apply.) a. Compare measured pressures with other physiological parameters. b. Flush the central venous catheter with 20 mL of sterile saline. c. Inflate the balloon with 3 mL of air and record the pressure tracing. d. Obtain the right atrial pressure measurement during end exhalation. e. Zero reference the transducer system at the level of the phlebostatic axis. measured pressures with other physiological parameters. d. Obtain the right atrial pressure measurement during end exhalation. e. Zero reference the transducer system at the level of the phlebostatic axis. a. Compare The nurse is preparing for insertion of a pulmonary artery catheter (PAC). During insertion of the catheter, what are the priority nursing actions? (Select all that apply.) a. Allay the patient's anxiety by providing information about the procedure. b. Ensure that a sterile field is maintained during the insertion procedure. c. Inflate the balloon during the procedure when indicated by the provider. d. Monitor the patient's cardiac rhythm throughout the procedure. 32 a. Allay the patient's e. Obtain informed consent by informing the patient of procedural risks. anxiety by providing information about the procedure. b. Ensure that a sterile field is maintained during the insertion procedure. c. Inflate the balloon during the procedure when indicated by the provider. d. Monitor the patient's cardiac rhythm throughout the procedure. Which nursing actions are most important for a patient with a right radial arterial line? (Select all that apply.) a. Checking the circulation to the right hand every 2 hours b. Maintaining a pressurized flush solution to the arterial line setup c. Monitoring the waveform on the monitor for dampening d. Restraining all four extremities with soft limb restraints e. Ensuring all junctions remain tightly connected every 2 hours a. Checking the circulation to the right hand b. Maintaining a pressurized flush solution to the arterial line setup c. Monitoring the waveform on the monitor for dampening e. Ensuring all junctions remain tightly connected Which of the following situations may result in a low cardiac output and low cardiac index? (Select all that apply.) a. Exercise b. Hypovolemia c. Myocardial infarction d. Shock e. Fever b. Hypovolemia c. Myocardial infarction d. Shock A patient has coronary artery bypass graft surgery and is transported to the surgical intensive care unit at noon and is placed on mechanical ventilation. Interpret the initial arterial blood gas levels 33 pH: 7.31 PaCO2: 48 mm Hg Bicarbonate: 22 mEq/L PaO2: 115 mm Hg O2 saturation: 99% a. Normal arterial blood gas levels with a high oxygen level b. Partly compensated respiratory acidosis; normal oxygen c. Uncompensated metabolic a