Critical Care Nursing A Holistic Approach 10th Edition by Patricia Gonce Morton -Test Bank

1. A patient has just been admitted to the ICU after being in a severe auto accident and losing one of her legs. Her husband has his hand over his heart and complains of a rapid heart rate. The nurse recognizes his condition as a sign of which stage of the general adaptation syndrome to stress? A) Alarm stage B) Exhaustion stage C) Resistance stage D) Adaptation stage 2. The nurse observes that an elderly woman, whose granddaughter has been admitted to the ICU, is struggling to manage her two great-grandsons, who are toddlers, in the waiting room. What is the most likely explanation for the woman's inability to manage the children in this situation? A) She is senile. B) She is in the exhaustion stage of the general adaptation syndrome to stress. C) She is assuming the role of caregiver in place of the patient, a role she is not used to. D) She has macular degeneration and cannot see well. 3. A nurse needs to communicate with a patient's family regarding consent to treat an unconscious patient in the ICU. Which member of the group should the nurse approach first? A) A man she recognizes as the patient's brother B) A teenage boy who approaches the nurse C) A woman who originally escorted the patient in D) A woman in the group whom the others look at and call over when the nurse approaches 4. A new nurse has recently joined the ICU from a different hospital, which had a much stricter policy regarding visiting hours. She expresses concern about the impact of open visiting hours on patient well-being. Which of the following would be the best explanation for the purpose of open visiting hours? Select all that apply. A) To better provide rest and quiet B) To strengthen the relationship between the family and health care provider C) To control the number of visitors for a patient D) To provide an undisturbed environment E) To decrease the patient's anxiety F) To increase the satisfaction of the family with the experience 5. A nurse observes that a 38-year-old single father whose 11-year-old daughter is in the ICU is struggling to explain to his 6-year-old son the likelihood that the daughter will die. The young boy asks what will happen to his sister when she dies, but the father breaks down in tears and seems unable to respond. Which of the following would be the most appropriate intervention for the nurse to make? A) Suggest that the father contact his pastor, rabbi, or other spiritual leader for counsel for him and his son B) Sit down with the father and son and share her own religious beliefs C) Ask the patient's doctor to explain to the father the odds of the daughter surviving D) Leave the father and son to grieve alone 6. A patient is experiencing severe pain, despite receiving pain medication for the past 24 hours. The patient's wife expresses concern about this to the nurse. Which response by the nurse would be most empowering to the patient's family? A) Explain that the doctor is an expert on pain medication and that the current level of medication is the best. B) Recommend that the family members take turns massaging the patient's feet to distract from the pain. C) Encourage the family to request that the physician evaluate the patient's pain control. D) Ask the family to wait another 24 hours to see whether the patient's pain level will go down. 7. The sister of a patient in the ICU has been at the patient's bedside non-stop for 48 hours. The nurse suggests to her that she return home to rest. Which of the following is the proper rationale for the nurse making such a suggestion? A) The sister is in the way of the health care providers. B) The patient may become annoyed by her continual presence. C) The patient will recover more easily in peace and quiet. D) The sister needs to maintain her own health during this time. 8. A young man has just arrived at the ICU from out of town and received news that his girlfriend, who is admitted there, likely only has a few days left to live. Which of the following would be the best approach for the nurse to take in caring for the needs of this young man? A) Recommending that he go home and rest B) Giving him unrestricted visiting hours with the patient C) Suggesting that he meet with the hospital chaplain D) Recommending that he ask the doctor to evaluate the patient's pain control measures 9. A family of a young girl who has been diagnosed with leukemia has travelled 12 hours by car to admit her to the ICU and be with her during her treatment. Which aspect of the critical care family assistance program would most likely be needed by this family initially? A) Educational materials B) Weekly group family information sessions C) Hospitality programs D) Pet therapy 10. A Muslim woman is admitted to the ICU after suffering severe burns over most of her body. Which of the following would be the most appropriate measure for the nurse, a woman, to take in respect for the cultural practices of this patient? A) Insist that only a female doctor be assigned to this patient. B) Ensure that no pork products are included in the patient's diet. C) Ensure that direct eye contact is not made with the patient's husband. D) Ask the patient's husband what religious and cultural preferences should be considered in the patient's care. 11. A client has been admitted after experiencing multiple trauma and is intubated and sedated. When the five members of the immediate family arrive, they are anxious, angry, and very demanding. They all speak loudly at once and ask for many services and answers. What is the best nursing response? A) Ask the family to leave until visiting hours begin. B) Take them to a private area for initial explanations. C) Page security to have them removed from unit. D) Show them to the client's bedside and leave them alone. 12. The client has been in the CCU for several weeks and has been very unstable. One family member stays at the bedside constantly and even naps in a bedside chair. The nurse understands that the family member is exhibiting which family member response to critical illness? A) Exhibiting extreme distrust of the health care team B) Seeking evidence for future legal or punitive action C) Trying to maintain a level of control over the situation D) Experiencing extreme fatigue from constant stress 13. The nurse is caring for a very seriously ill patient in the CCU. The family visits sporadically, stays for only a short time, and does not ask many questions. How could the nurse best begin to involve the family in the patient's care? A) Ask one family member to assist with the patient's bath. B) Encourage family members to stay longer at each visit. C) Focus nursing efforts on the patient's legal next of kin. D) Ask the family to complete the Critical Care Family Needs Inventory. 14. As part of the admission process, the nurse asks several questions about family relationships. The nurse bases these actions on which rationale? A) Assessing family relationships is an initial step in including the family in patient care. B) These questions are part of the admission assessment tool required by this CCU. C) The nurse has a natural curiosity and wishes to know how the family members relate for her own knowledge. D) There is an ongoing research study to identify variant family patterns related to disease incidence. 15. On their first visit to a critically ill patient, family members stand in the doorway of the room, making no effort to approach the patient. What is the most appropriate nursing action? A) Instruct the family where the patient can be touched and what to say. B) Engage the family in social conversation to ease them into the milieu. C) Use visiting hours to explain to the family the general status of the patient. D) Leave the family to adjust to the situation when they are ready. 16. A critically ill patient is not expected to survive this admission. The family asks the nurse how the patient is doing. When answering this question, what should the nurse include? A) Emphasize that the patient is young and strong and may still survive. B) Refer the family to the physician for all details and answers. C) Give specific information such as descending trends in parameters. D) Ask if the family has determined which funeral home will be called. 17. A patient's family is exhibiting increasingly impaired coping as the patient's condition deteriorates. The nurse asks the family to state the biggest concern from their perspective. What is the most important rationale for this question? A) The question indicates active listening on the part of the nurse. B) The question is used as a way to validate the family's knowledge. C) The question clarifies the nurse's understanding of current family needs. D) The question promotes problem definition, which helps define the degree of family understanding. 18. The nurse recommends that the family of a critically ill patient seek help from the Critical Care Family Assistance Program. What benefit for the family does the nurse anticipate? A) Reduction of health care cost B) More physical comfort C) Multidisciplinary support D) Health promotion information 19. While interacting with the family of a critically ill patient, the nurse suggests that the family must be feeling very anxious and perhaps angry. How does this nursing action benefit the family? A) Removes the focus of the conversation from the patient B) Focusing on feelings helps the family avoid delayed grief and unhealthy coping C) Gives validation of need for psychological counseling D) Reduces family insistence for patient progress information 20. The nurse is caring for a patient from a very different cultural group. In delivering care, how can the nurse best demonstrate cultural sensitivity? A) Ask the family about their cultural beliefs and customs that may apply. B) Assume that the patient and family will adjust to the hospital culture. C) Inform the patient and family that the routines of the hospital take precedence. D) Do a literature search on the patient's culture to determine beliefs. Answer Key 1. A 2. C 3. D 4. B, E, F 5. A 6. C 7. D 8. B 9. C 10. D 11. B 12. C 13. D 14. A 15. A 16. C 17. D 18. C 19. B 20. A 1. A nurse is working with a patient who is near death and experiencing delirium. Which of the following would be an appropriate course of action for this nurse to take in caring for this patient? Select all that apply. A) Instruct the patient in pursed-lip breathing. B) Provide oxygen support for the patient. C) Arrange supportive psychotherapy. D) Give the patient benzodiazepines. E) Give the patient neuroleptics. 2. The husband of a terminally ill patient is upset at the sight of his wife continuing to linger on the brink of death. He has heard of end-of-life sedation and wonders whether it would be appropriate for his wife. Which of the following should the nurse mention as criteria for use of end-of-life sedation? Select all that apply. A) The patient is experiencing unbearable and unmanageable pain. B) The patient is only hours or days away from death. C) The patient has requested it. D) It is standard procedure for patients with a terminal illness. 3. A patient in the ICU has entered a coma state, and someone must make a decision about whether to continue life-supporting measures for the patient. No living will exists for this patient. Who is the person legally authorized to make this decision? A) The patient's wife, who is the executor of his estate B) The patient's brother, who is his designated health care proxy C) The patient's physician, who has been managing his care from admittance D) The patient's nurse, who has been assigned to him on a daily basis 4. The mother of a patient has requested that she and the rest of the family be allowed to be present in the patient's room in the event that the patient requires resuscitation. The nurse, however, is reluctant to comply with this. What is the most likely reason she does not want the family in the room during resuscitation? A) Family members who are present during resuscitations may experience more anxiety. B) Family members present during resuscitation are more likely to sue. C) The nurse is new and is not comfortable with having the family present. D) A dedicated staff person is required to attend to the family during resuscitation. 5. A teenage boy is near death in the ICU after being involved in a severe car accident. His mother and stepfather are in his room visiting him now. His father and stepmother have arrived in the waiting room and are asking to see the patient. A few days ago, the nurse observed the boy's father and mother arguing loudly in the patient's room. She has also observed that the boy's muscles tighten and his breathing and heart rate increase when his father is near his bed. Which of the following would be the best action for the nurse to take? A) Ask the father and stepmother to wait until the current visitors have left. B) Ask the mother and stepfather to leave so that the father and stepmother can visit. C) Allow the father and stepmother to go into the patient's room but accompany them. D) Tell the father and stepmother that they are not allowed to visit the patient. 6. A patient in the ICU has ovarian cancer that has metastasized to her stomach and other organs. The physician believes the patient only has days to survive. Which of the following would be a realistic goal for the care of the patient that the nurse could suggest to the family? A) Eliminate the cancer cells by starting the patient on chemotherapy. B) Slow the rate of growth of the cancer by starting the patient on radiation therapy. C) Keep the patient free of pain by increasing the patient's pain medication. D) Restore gastrointestinal function to the client via surgical intervention. 7. A 10-year-old girl has just died in the ICU. The nurse is now questioning the patient's physician to learn more details about the patient's death to communicate to the family. Which stage of notification is the nurse currently in? A) Preparation B) Inform C) Support D) Afterwards 8. The family of a patient who is near death makes the difficult decision to allow the physician to administer a pain-relieving drug to the patient with the intention of making the patient more comfortable, despite the fact that the drug may increase the risk for complications that could lead to the patient's death. The principle involved in the family's decision is known as which of the following? A) Principle of moral distress B) Principle of palliative care C) Principle of unintended consequences D) Principle of double effect 9. Which of the following is the best example of moral distress? A) A patient's family has decided to end mechanical ventilation of the patient, but the nurse has trouble implementing their decision. B) A patient's family has decided to continue mechanical ventilation for the patient, but the nurse disagrees and discontinues the ventilation on her own initiative. C) A patient's family has decided to end mechanical ventilation of the patient, and the nurse implements their decision but later feels guilty. D) A patient's family has decided to continue mechanical ventilation for the patient, and the nurse implements their decision, although she disagrees with it. 10. A patient who is near the end of his life is to be extubated, according to the wishes of his family. Which of the following would be the best action for the nurse to take to support the patient? A) Ask the family to leave the room during the extubation. B) Hold a family conference to ask the family to reconsider their decision. C) Administer opioids to the patient to reduce pain and discomfort. D) Administer antibiotics to the patient to prevent infection. 11. The nurse is caring for a critically ill patient who is expected to die despite the best efforts of the health care team. What aspect of a critical care unit may most interfere with effective nursing care of this dying patient? A) View of patient as disease or in terms of technology B) Critical illness has a high expectation of death C) Constant family presence at the bedside D) Multidisciplinary management of patient 12. The nurse cares for critically ill patients in a busy trauma unit. The nurse manager has instituted a program to incorporate principles of palliative care into the care of all patients in the unit. What is the best reason for this inclusion? A) Most of the patients in critical care will die, so palliative care will be necessary. B) Primary palliative care focuses on relief of suffering and improvement of quality of life. C) This action has been mandated by the nurse manager and must be implemented. D) Palliation is another way of managing pain control in critical care. 13. A patient has been admitted to critical care for management of exacerbation of a chronic illness. During this admission, the patient's condition deteriorates and death is deemed imminent. A Do Not Resuscitate (DNR) order has been written and agreed to by the family. Considering the principles of palliative care, what is the most appropriate nursing action? A) Transfer the patient to the step-down unit since DNR patients are not eligible for critical care. B) Encourage the family to reduce their visits so that they will not have to witness the patient's deterioration. C) Assess the patient and family for specific spiritual needs at this phase of life and death. D) Discontinue all supportive care to hasten the inevitable death of the patient and reduce costs. 14. The patient has severe pulmonary edema following an acute myocardial infarction and is receiving intravenous diuretics to ease breathing. The nurse understands that this intervention is considered to be what? A) Definitive B) Curative C) Cause-and-effect–based D) Palliative 15. The nurse is caring for a patient approaching the end of life. What symptom common at the end of life would the nurse most expect? A) Diminished pain B) Hypotension C) Tachycardia D) Dyspnea 16. The nurse is caring for a critically ill patient who is dying and complaining of dyspnea while receiving supplemental oxygen. What is the most effective nursing intervention to alleviate the patient's symptoms? A) Increasing room temperature B) Encouraging unlimited visits C) Closing blinds and drapes D) Providing a fan blowing on face 17. The nurse is caring for a patient who is dying. The patient has persistent full depression. What is the most appropriate nursing action? A) Understand that depression is normal at the end of life. B) Facilitate use of antidepressant medications. C) Encourage the patient to discuss life achievements. D) Increase family visiting time and frequency. 18. A nurse is caring for a critically ill patient who has identified an unrelated friend as his closest relative. What is the nurse's most appropriate action in this situation? A) Treat the friend as the patient's family. B) Do not allow the friend to visit as he is not family. C) Adhere to the legal definition of next of kin. D) Identify the next-closest-related family member. 19. The nurse is preparing for a family conference with the family of a critically ill patient. What will best help the nurse to prepare? A) Complete knowledge about the status of the patient B) Knowing which members of the family will attend C) Knowing the goal of the conference D) Skill in therapeutic communication 20. The nurse had been caring for a critically ill patient for several days, and the patient has just died. After completing end-of-life care of the patient and family, the nurse asks to take a short break. What is the best response by the charge nurse? A) Ask the nurse to wait to take a break until after she admits another patient. B) Deny the nurse a break, as the unit is particularly busy and the nurse cannot be spared. C) Arrange for the nurse to have psychological counseling for inability to handle stress. D) Ask another staff nurse to cover this nurse's duties and allow her to take a break. Answer Key 1. D, E 2. A, B 3. B 4. C 5. A 6. C 7. A 8. D 9. A 10. C 11. A 12. B 13. C 14. D 15. D 16. D 17. B 18. A 19. C 20. D 1. A patient's physician writes a medication order to administer 20 mEq of potassium chloride to a patient. The ICU nurse misreads the order as 200 mEq of potassium and administers this amount of medication to the patient. As a result, the patient dies. This situation is an example of which of the following? A) A questionable medical order B) Negligent supervision C) Ordinary negligence D) Gross negligence 2. A family member of a patient files a complaint against an ICU nurse, claiming that the nurse improperly transferred the patient from a wheelchair to the hospital bed, resulting in a back injury to the patient. Assuming that the nurse's due process rights are observed, which of the following actions would be most advisable for the nurse? A) Plan to appeal to a court if the State Board of Nursing rules against her. B) Sue the State Board of Nursing if her license is suspended before she is found guilty. C) Acquire legal counsel and have him or her question the board's witnesses. D) Continue nursing practice if her license is suspended, as such a suspension violates her constitutional rights. 3. The ex-husband of a patient asks the ICU nurse a question about the medical history of the patient. The nurse retrieves the patient's file, opens it, and relates some of the patient's personal information to the ex-husband. When the ex-husband asks to see the patient's file, the nurse hands it to him, although he is not authorized by the patient to see this information. What is the most accurate characterization of the nurse's action? A) A criminal act against the patient B) A breaking of the rule of personal liability C) A violation of the HIPAA Privacy Rule D) A case of respondeat superior 4. A nurse is accused of professional negligence because she improperly operated a ventilator, resulting in a patient's death. The prosecution presents an expert witness to show that operating such a ventilator is within the standard of care for a reasonable nurse. Which aspect of negligence is the prosecution attempting to establish? A) Duty B) Breach of duty C) Causation D) Damages 5. A jury involved in a malpractice suit must decide how much to compensate a patient for the emotional distress caused her by incomplete anesthesia during surgery. To which element of malpractice is this decision related? A) Duty B) Breach of duty C) Causation D) Damages 6. A nurse is going to volunteer her nursing skills and time at a hospital other than the one in which she is employed. Which of the following is true regarding potential liability related to the nurse's actions while volunteering? Select all that apply. A) The nurse should carry her own malpractice insurance. B) The hospital at which she is volunteering will protect her with its own professional liability insurance. C) The hospital at which she is employed will protect her with its professional liability insurance even when she is working off the job. D) There is no liability protection available for a nurse who is volunteering on her own time. E) The doctrine of respondeat superior does not apply in this situation. F) The captain of the ship doctrine applies in this situation. 7. A nurse is charged with medical malpractice because she neglected to attend to a patient in the ICU whose heart stopped and whose heart monitor alarm was clearly heard by the nurse. The jury finds that the hospital was liable because of understaffing the ICU and that the nurse was liable because she should have responded to the patient whose heart stopped, regardless of the fact that she had been ordered by a physician to tend to another patient. Which types of liability did the jury uphold? Select all that apply. A) Captain of the ship doctrine B) Rule of personal liability C) Corporate liability D) Criminal liability 8. A physician has written a medication order for a patient that includes penicillin. When the nurse receives the order, she refuses to administer the medicine because she knows that the patient is allergic to it. What is the most accurate way to describe this situation? A) A questionable medication order B) A medication error C) A case of respondeat superior D) A case of negligent supervision 9. A patient in the ICU dies as a result of a defective defibrillator. The nurse did not become aware of the defect until after the patient's death. Which of the following is true in this situation? A) Defibrillators are not currently regulated in the United States. B) The nurse is permitted but not required to report the malfunction to the FDA. C) The nurse is required to report the malfunction to the FDA. D) The nurse is likely liable in the patient's death. 10. A 10-year-old girl has been admitted to the ICU after she suffered a severe laceration on her arm. Due to heavy hemorrhaging, the child needs a blood transfusion. Her parents, however, who are Jehovah's Witnesses, do not believe in blood transfusions and refuse the treatment. What would be the best action for the nurse to take? A) Assist the physician in performing a blood transfusion for the girl, against her parents' wishes. B) Refuse to assist the physician in performing a blood transfusion, to respect the parents' wishes. C) Consult the hospital's risk management department before acting. D) Schedule a conference with the parents to explain why an infusion is medically necessary. 11. While caring for patients, the nurse completely documents the care given. This nursing action is defined by what kind of law? A) Administrative B) Civil C) Tort D) Criminal 12. Nursing practice is defined by the Nursing Practice Act, administered by the State Board of Nursing. Which nursing behavior would be least likely to be addressed by the State Board of Nursing? A) Qualifications for licensure B) Investigation of complaints C) Nursing excellence awards D) Protection of patient safety 13. The physician has ordered a medication that is contraindicated for the patient. The nurse, after discussion with the physician and the pharmacy, refuses to administer the medication. Upon what legal principle does the nurse base this refusal? A) Respondeat superior B) Captain of the ship C) Corporate liability D) Rule of personal liability 14. The nurse caring for a sedated patient leaves the side rails down when leaving the room and the patient falls, breaking her hip. Why is this considered to be malpractice by negligence? A) The patient had requested the side rails be left down. B) The nurse assumed that the family would watch the patient. C) This is breach of duty resulting in patient harm. D) There will probably be a suit brought by the family. 15. A nurse has been called before the State Board of Nursing for accusations of malpractice. As part of his defense, the nurse states that he was unaware of several provisions of the Nursing Practice Act. Why is this defense statement valid or invalid? A) Invalid: The nurse has a legal duty to know the contents of the Nursing Practice Act. B) Invalid: Nursing Practice Acts vary widely in content from version to version and state to state. C) Valid: The nurse did not know he was violating the Nursing Practice Act at the time of his actions. D) Valid: The nurse was under the supervision of his charge nurse at the time of his actions 16. The nurse is caring for a critically ill patient. Which action by the nurse could most likely be considered malpractice? A) Assessing for allergies before administering medications B) Consistent failure to complete adequate hand hygiene C) Strict adherence to the visiting hours policies of the unit D) Encouraging the patient to ask questions of the physician 17. The nurse has been accused of negligence resulting in patient harm. She was not informed about the complaint, and her employment was terminated before a hearing before the State Board of Nursing. What best legal recourse does the nurse have? A) Safe harbor provision in state law B) Fifth Amendment of the U.S. Constitution C) Civil and tort law allows the nurse to sue the accuser. D) Automatic dismissal of case by the State Board of Nursing 18. A nurse who commonly works on a general medical-surgical floor is asked to work briefly in a critical care unit. The charge nurse, based on the legal principle of vicarious liability, should give this nurse which patient assignment? A) Admit day-of-surgery patient after open heart surgery B) Three stable patients awaiting transfer to medical units C) Patient with hemodynamic monitoring and unstable vital signs D) Patient whose care requires frequent titration of vasoactive medications 19. After receiving an injury as a result of negligent care by a physician, the patient brings suit against the hospital, the physician, and all of the members of the health care team who participated in his care. Based on the principle of respondeat superior, the hospital is liable for the actions of whom? A) Nurse working in her usual assignment at hospital B) Non-employee physician practicing in the hospital C) Nurse on temporary assignment from an agency D) Nurse doing volunteer work at another agency 20. A patient in CCU is critically and terminally ill. The family has made a written request that no cardiopulmonary resuscitation (CPR) take place. The patient is well known to the physician, who does not agree with the family's assessment of the situation. While the physician is discussing the situation with the family and before agreement, the patient experiences a cardiopulmonary arrest. Legally, what is the most appropriate nursing action? A) Proceed as though a DNR order has been written, since such an order is anticipated. B) Take no action and page the patient's physician to ask for an immediate decision over the telephone. C) Initiate CPR and page the patient's physician to come to the care unit. D) Take no action and page the patient's family to return to the care unit immediately. 21. A patient has been critically ill for several weeks and a Do Not Resuscitate (DNR) order was written several days ago. The patient's status has improved, and he is now eligible for transfer to a general nursing unit and is awake and alert. What is the most appropriate nursing action? A) Initiate risk-reduction teaching to prevent recurrence of instability. B) Ask the patient, family, and physician to review the DNR order. C) Increase the frequency of monitoring of vital signs to ensure safety. D) Encourage the patient to get more rest in preparation for transfer. 22. A terminally ill patient is admitted to the CCU for stabilization and palliative procedures. The nurse encourages this awake and alert patient to complete paperwork for advance directives. What is the best rationale for this nursing action? A) Required by the admission protocol for the hospital and the unit B) Allows the patient to express his or her choices for some treatment decisions C) Prevents estranged family from interfering with competent patient decisions D) Allows the physician to apply his or her best judgment for care decisions 23. A critical care nurse has administered an intravenous sedative in an excessive dose to a patient. The patient experiences a cardiopulmonary arrest, and the family complains to the State Board of Nursing. After investigation and a hearing, the Board finds that the nurse was guilty of malpractice and disciplines the nurse. This situation is an example of what? A) Medication errors are the most common reason for State Board of Nursing action. B) An unusual and rare incidence of lack of judgment by a nurse in a stressful situation C) Absence of the application of due process for the nurse by the State Board of Nursing D) A family looking for an opportunity for litigation Answer Key 1. B 2. A 3. D 4. C 5. B 6. C, E 7. A, C 8. B 9. C 10. C 11. A 12. C 13. D 14. C 15. A 16. B 17. B 18. B 19. A 20. C 21. B 22. B 23. A