, Table of Contents
Table of Contents 2
Chapter 01: Overview of Critical Care Nursing 3
Chapter 02: Patient and Family Response to the Critical Care Experience 15
Chapter 03: Ethical and Legal Issues in Critical Care Nursing 30
Chapter 04: Palliative and End-of-Life Care 42
Chapter 05: Comfort and Sedation 56
Chapter 06: Nutritional Therapy 69
Chapter 07: Dysrhythmia Interpretation and Management 83
Chapter 08: Hemodynamic Monitoring 117
Chapter 09: Ventilator Assistance 137
Chapter 10: Rapid Response Teams and Code Management 156
Chapter 11: Organ Donation 171
Chapter 12: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome 189
Chapter 13: Cardiovascular Alterations 207
Chapter 14: Nervous System Alterations 225
Chapter 15: Acute Respiratory Failure 243
Chapter 16: Acute Kidney Injury 260
Chapter 17: Gastrointestinal Alterations 285
Chapter 17: Hematological and Immune Disorders 312
Chapter 19: Endocrine Alterations 341
Chapter 20: Trauma and Surgical Management 361
Chapter 21: Burns 379
,Chapter 01: Overview Of Critical Care Nursing
MULTIPLE CHOICE
1. 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 CareMedicine
ANSWER: A
The American Association Of Critical-Care Nurses Is The Specialty Organization That Supports And
Represents Critical Care Nurses. The American Heart Association Supports Cardiovascular Initiatives. The
American Nurses Association Supports All Nurses. The Society Of Critical Care Medicine Represents The Multi
Professional Critical Care Team Under The Direction Of An Intensivist.
DIFFICULTY: COGNITIVE LEVEL: Knowledge REFER TO: PAGE; 4
OBJECTIVE: Discuss The Purposes And Functions Of The Professional Organizations That Support Critical Care
Practice.TOPIC: NURSING PROCESS STEP: N/A
MED SC: NCLEX: Safe And Effective Care Environment
2. 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 Her To Seek?
a. ACNPC
b. CCNS
c. CCRN
d. PCCN
ANSWER: C
The CCRN Certification Is Appropriate For Nurses In Bedside Practice Who Care For Critically Ill
Patients. The ACNPC Certification Is For Acute Care Nurse Practitioners. The CCNS Certification Is For
Critical Care Clinical Nurse Specialists. The PCCN Certification Is For Staff Nurses Working In Progressive
Care, Intermediate Care, Or Step-Down Unit Settings.
DIFFICULTY: COGNITIVE LEVEL: Application REFER TO: PAGE; 5
OBJECTIVE: Explain Certification Options For Critical Care Nurses. TOPIC:
NURSING PROCESS STEP: N/AMED SC: NCLEX: Safe And Effective Care
Environment
,3. 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.
ANSWER: D
Certification Assists In Validating Knowledge Of The Field, Promotes Excellence In The Profession, And
Helps Nurses To Maintain Their Knowledge Of Critical Care Nursing. Certification Helps To Assure The
Consumer That The Nurse Has A Minimum Level Of Knowledge; However, It Does Not Ensure That Care
Will Be Mistake-Free.
Certification Does Not Prepare One For Graduate School; However, Achieving Certification Demonstrates
Motivation For Achievement And Professionalism. Magnet Facilities Are Rated On The Number Of Certified
Nurses; However, That Is Not The Purpose Of Certification.
DIFFICULTY: COGNITIVE LEVEL: Analysis REFER TO: Ppage; 4-5
OBJECTIVE: Explain Certification Options For Critical Care Nurses. TOPIC:
NURSINGPROCESS STEP: N/AMED SC: NCLEX: Safe And Effective Care
Environment
4. The Synergy Model Of Practice Focuses On:
a. Allowing Unrestricted Visiting For The Patient 24 Hours Each Day.
b. Holistic And Alternative Therapies.
c. Needs Of Patients And Their Families, Which Drives Nursing Competency.
d. Patients Needs For Energy And Support.
ANSWER: C
The Synergy Model Of Practice States That The Needs Of Patients And Families Influence And Drive
Competencies Of Nurses. Nursing Practice Based On The Synergy Model Would Involve Tailored Visiting To
Meet The Patients And Familys Needs And Application Of Alternative Therapies If Desired By The Patient, But
That Is Not The Primary Focus Of The Model.
DIFFICULTY: COGNITIVE LEVEL: Application REFER TO: PAGE; 5 | Fig. 1-3
OBJECTIVE: Describe Standards Of Professional Practice For Critical Care Nursing.
TOPIC: NURSING PROCESS STEP: N/A MED SC: NCLEX: Safe And Effective Care Environment
5. The Family Of Your Critically Ill Patient Tells You That They Have Not Spoken With The Physician In
Over 24 Hours And They Have Some Questions That They Want Clarified. During Morning Rounds, You
Convey This Concern To The Attending Intensivist And Arrange For Her To Meet With The Family At 4:00
PM In The Conference Room. 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
ANSWER: C
Although One Might Consider That All Of These Competencies Are Being Addressed, Communication And
Collaboration With The Family And Physician Best Exemplify The Competency Of Collaboration.
DIFFICULTY: COGNITIVE LEVEL: Analysis REFER TO: PAGE; 9
OBJECTIVE: Describe Standards Of Professional Practice For Critical Care Nursing.
TOPIC: NURSING PROCESS STEP: N/A MED SC: NCLEX: Safe And Effective Care Environment
6. 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
ANSWER: D
The AACN Standards For Acute And Critical Care Nursing Practice Delineate The Nursing Process As
Applied To Critically Ill Patients: Collect Data, Determine Diagnoses, Identify Expected Outcomes, Develop
A Plan Of Care, Implement Interventions, And Evaluate Care. AACN Promotes A Healthy Work
Environment, But This Is Not Included In The Standards. The Joint Commission Has Established National
Patient Safety Goals, But These Are Not The AACN Standards.
DIFFICULTY: COGNITIVE LEVEL: Analysis REFER TO: PAGE; 5 | Box 1-2
OBJECTIVE: Describe Standards Of Professional Practice For Critical Care Nursing.
TOPIC: NURSING PROCESS STEP: N/A MED SC: NCLEX: Safe And Effective Care Environment
7. The Charge Nurse Is Responsible For Making The Patient Assignments On The Critical Care Unit. She
Assigns The Experienced, Certified Nurse To Care For The Acutely Ill Patient With Sepsis Who Also
Requires Continuous Renal Replacement Therapy And Mechanical Ventilation. She Assigns The Nurse With
Less Than 1 Year Of Experience 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
PracticeANSWER: 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 ToTeam 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.
DIFFICULTY: COGNITIVE LEVEL: Analysis REFER TO: PAGE; 5 | Fig. 1-3
OBJECTIVE: Describe Standards Of Professional Practice For Critical Care Nursing.
TOPIC: NURSING PROCESS STEP: N/A MED SC: 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.
ANSWER: 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.
DIFFICULTY: COGNITIVE LEVEL: Knowledge REFER TO: PAGE; 4
OBJECTIVE: Discuss The Purposes And Functions Of The Professional Organizations That Support Critical Care
Practice.TOPIC: NURSING PROCESS STEP: N/A
MED SC: 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.
,d. Reduce Patient Errors.
ANSWER: 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.
DIFFICULTY: COGNITIVE LEVEL: Knowledge REFER TO: Ppage; 8-9
OBJECTIVE: Describe Quality And Safety Initiatives Related To Critical Care Nursing.
TOPIC: NURSING PROCESS STEP: N/A MED SC: 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. PAGE;, 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. PAGE; Is Hypovolemic And I Would Like You To Considerincreasing 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
ANSWER: 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 ForFluids Is The Recommendation.
DIFFICULTY: COGNITIVE LEVEL: Analysis REFER TO: Ppage; 8-9
OBJECTIVE: Describe Quality And Safety Initiatives Related To Critical Care Nursing.
TOPIC: NURSING PROCESS STEP: Assessment MED SC: 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
,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
PracticeANSWER: 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.
DIFFICULTY: COGNITIVE LEVEL: Analysis REFER TO: PAGE; 5 | Box 1-2
OBJECTIVE: Describe Standards Of Care And Performance For Critical Care
Nursing.TOPIC: NURSING PROCESS STEP: Implementation
MED SC: 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
ANSWER: 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.
DIFFICULTY: COGNITIVE LEVEL: Analysis REFER TO: PAGE; 7
OBJECTIVE: Describe Standards Of Professional Practice For Critical Care Nursing.
TOPIC: NURSING PROCESS STEP: N/A MED SC: 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.
,c. Reconcile Medications Across The Continuum Of Care.
d. Reduce Harms Associated With Administration Of Anticoagulants.
ANSWER: 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
NationaPatient Safety Goal.
DIFFICULTY: COGNITIVE LEVEL: Comprehension REFER TO: PAGE; 6 | Box 1-3
OBJECTIVE: Describe Quality And Safety Initiatives Related To Critical Care Nursing.
TOPIC: NURSING PROCESS STEP: N/A MED SC: 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.
ANSWER: 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.
DIFFICULTY: COGNITIVE LEVEL: Analysis REFER TO: PAGE; 6
OBJECTIVE: Describe Quality And Safety Initiatives Related To Critical Care
Nursing.TOPIC: NURSING PROCESS STEP: Implementation
MED SC: 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.
, b. A Work Environment That Is Unhealthy.
c. Ineffective Decision Making.
d. Nursing Practice That Is Not Evidence-Based.
ANSWER: B
These Are Examples Of An Unhealthy Work Environment. A Healthy Work Environment Values
Communication, Collaboration, And Effective Decision Making. It Also Has Authentic Leadershipage; It Is Not
An Example Of Handoffcommunication, Which Is Communication That Occurs To Transition Patient Care
From One Staff MemberTo 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.
DIFFICULTY: COGNITIVE LEVEL: Analysis REFER TO: PAGE; 7
OBJECTIVE: Describe Standards Of Professional Practice For Critical Care Nursing.
TOPIC: NURSING PROCESS STEP: N/A MED SC: 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.
ANSWER: D
The Synergy Model Of Practice Is Care Based On The Unique Needs And Characteristics Of The Patient
And FamilyMembers. 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.
DIFFICULTY: COGNITIVE LEVEL: Application REFER TO: PAGE; 5 | Fig. 1-3
OBJECTIVE: Describe Standards Of Professional Practice For Critical Care
Nursing.TOPIC: NURSING PROCESS STEP: Implementation
MED SC: 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.
Table of Contents 2
Chapter 01: Overview of Critical Care Nursing 3
Chapter 02: Patient and Family Response to the Critical Care Experience 15
Chapter 03: Ethical and Legal Issues in Critical Care Nursing 30
Chapter 04: Palliative and End-of-Life Care 42
Chapter 05: Comfort and Sedation 56
Chapter 06: Nutritional Therapy 69
Chapter 07: Dysrhythmia Interpretation and Management 83
Chapter 08: Hemodynamic Monitoring 117
Chapter 09: Ventilator Assistance 137
Chapter 10: Rapid Response Teams and Code Management 156
Chapter 11: Organ Donation 171
Chapter 12: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome 189
Chapter 13: Cardiovascular Alterations 207
Chapter 14: Nervous System Alterations 225
Chapter 15: Acute Respiratory Failure 243
Chapter 16: Acute Kidney Injury 260
Chapter 17: Gastrointestinal Alterations 285
Chapter 17: Hematological and Immune Disorders 312
Chapter 19: Endocrine Alterations 341
Chapter 20: Trauma and Surgical Management 361
Chapter 21: Burns 379
,Chapter 01: Overview Of Critical Care Nursing
MULTIPLE CHOICE
1. 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 CareMedicine
ANSWER: A
The American Association Of Critical-Care Nurses Is The Specialty Organization That Supports And
Represents Critical Care Nurses. The American Heart Association Supports Cardiovascular Initiatives. The
American Nurses Association Supports All Nurses. The Society Of Critical Care Medicine Represents The Multi
Professional Critical Care Team Under The Direction Of An Intensivist.
DIFFICULTY: COGNITIVE LEVEL: Knowledge REFER TO: PAGE; 4
OBJECTIVE: Discuss The Purposes And Functions Of The Professional Organizations That Support Critical Care
Practice.TOPIC: NURSING PROCESS STEP: N/A
MED SC: NCLEX: Safe And Effective Care Environment
2. 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 Her To Seek?
a. ACNPC
b. CCNS
c. CCRN
d. PCCN
ANSWER: C
The CCRN Certification Is Appropriate For Nurses In Bedside Practice Who Care For Critically Ill
Patients. The ACNPC Certification Is For Acute Care Nurse Practitioners. The CCNS Certification Is For
Critical Care Clinical Nurse Specialists. The PCCN Certification Is For Staff Nurses Working In Progressive
Care, Intermediate Care, Or Step-Down Unit Settings.
DIFFICULTY: COGNITIVE LEVEL: Application REFER TO: PAGE; 5
OBJECTIVE: Explain Certification Options For Critical Care Nurses. TOPIC:
NURSING PROCESS STEP: N/AMED SC: NCLEX: Safe And Effective Care
Environment
,3. 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.
ANSWER: D
Certification Assists In Validating Knowledge Of The Field, Promotes Excellence In The Profession, And
Helps Nurses To Maintain Their Knowledge Of Critical Care Nursing. Certification Helps To Assure The
Consumer That The Nurse Has A Minimum Level Of Knowledge; However, It Does Not Ensure That Care
Will Be Mistake-Free.
Certification Does Not Prepare One For Graduate School; However, Achieving Certification Demonstrates
Motivation For Achievement And Professionalism. Magnet Facilities Are Rated On The Number Of Certified
Nurses; However, That Is Not The Purpose Of Certification.
DIFFICULTY: COGNITIVE LEVEL: Analysis REFER TO: Ppage; 4-5
OBJECTIVE: Explain Certification Options For Critical Care Nurses. TOPIC:
NURSINGPROCESS STEP: N/AMED SC: NCLEX: Safe And Effective Care
Environment
4. The Synergy Model Of Practice Focuses On:
a. Allowing Unrestricted Visiting For The Patient 24 Hours Each Day.
b. Holistic And Alternative Therapies.
c. Needs Of Patients And Their Families, Which Drives Nursing Competency.
d. Patients Needs For Energy And Support.
ANSWER: C
The Synergy Model Of Practice States That The Needs Of Patients And Families Influence And Drive
Competencies Of Nurses. Nursing Practice Based On The Synergy Model Would Involve Tailored Visiting To
Meet The Patients And Familys Needs And Application Of Alternative Therapies If Desired By The Patient, But
That Is Not The Primary Focus Of The Model.
DIFFICULTY: COGNITIVE LEVEL: Application REFER TO: PAGE; 5 | Fig. 1-3
OBJECTIVE: Describe Standards Of Professional Practice For Critical Care Nursing.
TOPIC: NURSING PROCESS STEP: N/A MED SC: NCLEX: Safe And Effective Care Environment
5. The Family Of Your Critically Ill Patient Tells You That They Have Not Spoken With The Physician In
Over 24 Hours And They Have Some Questions That They Want Clarified. During Morning Rounds, You
Convey This Concern To The Attending Intensivist And Arrange For Her To Meet With The Family At 4:00
PM In The Conference Room. 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
ANSWER: C
Although One Might Consider That All Of These Competencies Are Being Addressed, Communication And
Collaboration With The Family And Physician Best Exemplify The Competency Of Collaboration.
DIFFICULTY: COGNITIVE LEVEL: Analysis REFER TO: PAGE; 9
OBJECTIVE: Describe Standards Of Professional Practice For Critical Care Nursing.
TOPIC: NURSING PROCESS STEP: N/A MED SC: NCLEX: Safe And Effective Care Environment
6. 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
ANSWER: D
The AACN Standards For Acute And Critical Care Nursing Practice Delineate The Nursing Process As
Applied To Critically Ill Patients: Collect Data, Determine Diagnoses, Identify Expected Outcomes, Develop
A Plan Of Care, Implement Interventions, And Evaluate Care. AACN Promotes A Healthy Work
Environment, But This Is Not Included In The Standards. The Joint Commission Has Established National
Patient Safety Goals, But These Are Not The AACN Standards.
DIFFICULTY: COGNITIVE LEVEL: Analysis REFER TO: PAGE; 5 | Box 1-2
OBJECTIVE: Describe Standards Of Professional Practice For Critical Care Nursing.
TOPIC: NURSING PROCESS STEP: N/A MED SC: NCLEX: Safe And Effective Care Environment
7. The Charge Nurse Is Responsible For Making The Patient Assignments On The Critical Care Unit. She
Assigns The Experienced, Certified Nurse To Care For The Acutely Ill Patient With Sepsis Who Also
Requires Continuous Renal Replacement Therapy And Mechanical Ventilation. She Assigns The Nurse With
Less Than 1 Year Of Experience 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
PracticeANSWER: 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 ToTeam 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.
DIFFICULTY: COGNITIVE LEVEL: Analysis REFER TO: PAGE; 5 | Fig. 1-3
OBJECTIVE: Describe Standards Of Professional Practice For Critical Care Nursing.
TOPIC: NURSING PROCESS STEP: N/A MED SC: 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.
ANSWER: 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.
DIFFICULTY: COGNITIVE LEVEL: Knowledge REFER TO: PAGE; 4
OBJECTIVE: Discuss The Purposes And Functions Of The Professional Organizations That Support Critical Care
Practice.TOPIC: NURSING PROCESS STEP: N/A
MED SC: 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.
,d. Reduce Patient Errors.
ANSWER: 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.
DIFFICULTY: COGNITIVE LEVEL: Knowledge REFER TO: Ppage; 8-9
OBJECTIVE: Describe Quality And Safety Initiatives Related To Critical Care Nursing.
TOPIC: NURSING PROCESS STEP: N/A MED SC: 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. PAGE;, 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. PAGE; Is Hypovolemic And I Would Like You To Considerincreasing 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
ANSWER: 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 ForFluids Is The Recommendation.
DIFFICULTY: COGNITIVE LEVEL: Analysis REFER TO: Ppage; 8-9
OBJECTIVE: Describe Quality And Safety Initiatives Related To Critical Care Nursing.
TOPIC: NURSING PROCESS STEP: Assessment MED SC: 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
,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
PracticeANSWER: 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.
DIFFICULTY: COGNITIVE LEVEL: Analysis REFER TO: PAGE; 5 | Box 1-2
OBJECTIVE: Describe Standards Of Care And Performance For Critical Care
Nursing.TOPIC: NURSING PROCESS STEP: Implementation
MED SC: 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
ANSWER: 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.
DIFFICULTY: COGNITIVE LEVEL: Analysis REFER TO: PAGE; 7
OBJECTIVE: Describe Standards Of Professional Practice For Critical Care Nursing.
TOPIC: NURSING PROCESS STEP: N/A MED SC: 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.
,c. Reconcile Medications Across The Continuum Of Care.
d. Reduce Harms Associated With Administration Of Anticoagulants.
ANSWER: 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
NationaPatient Safety Goal.
DIFFICULTY: COGNITIVE LEVEL: Comprehension REFER TO: PAGE; 6 | Box 1-3
OBJECTIVE: Describe Quality And Safety Initiatives Related To Critical Care Nursing.
TOPIC: NURSING PROCESS STEP: N/A MED SC: 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.
ANSWER: 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.
DIFFICULTY: COGNITIVE LEVEL: Analysis REFER TO: PAGE; 6
OBJECTIVE: Describe Quality And Safety Initiatives Related To Critical Care
Nursing.TOPIC: NURSING PROCESS STEP: Implementation
MED SC: 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.
, b. A Work Environment That Is Unhealthy.
c. Ineffective Decision Making.
d. Nursing Practice That Is Not Evidence-Based.
ANSWER: B
These Are Examples Of An Unhealthy Work Environment. A Healthy Work Environment Values
Communication, Collaboration, And Effective Decision Making. It Also Has Authentic Leadershipage; It Is Not
An Example Of Handoffcommunication, Which Is Communication That Occurs To Transition Patient Care
From One Staff MemberTo 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.
DIFFICULTY: COGNITIVE LEVEL: Analysis REFER TO: PAGE; 7
OBJECTIVE: Describe Standards Of Professional Practice For Critical Care Nursing.
TOPIC: NURSING PROCESS STEP: N/A MED SC: 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.
ANSWER: D
The Synergy Model Of Practice Is Care Based On The Unique Needs And Characteristics Of The Patient
And FamilyMembers. 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.
DIFFICULTY: COGNITIVE LEVEL: Application REFER TO: PAGE; 5 | Fig. 1-3
OBJECTIVE: Describe Standards Of Professional Practice For Critical Care
Nursing.TOPIC: NURSING PROCESS STEP: Implementation
MED SC: 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.
