Exam (elaborations) TEST BANK FOR Understanding the Essentials of Critical Nursing Care 2nd Edition By Kathleen Perrin

Chapter 1 What Is Critical Care? 1) Identify who of the following patients suffers from critical illness. A patient: 1. With chronic airflow limitation whose VS are: BP 110/72, P 110, R 16. 2. With acute bronchospasm and whose VS are: BP 100/60, P 124, R 32. 3. Who was involved in a motor vehicle accident whose VS are: BP 124/74, P 74, R 18. 4. On chronic dialysis with no urine output and whose VS are: BP 98/50, P 108, R 12. Answer: 2 Explanation: 1. Acute bronchospasm can present a life-threatening situation, which can jeopardize a patientʹs survival. #1, #3, and #4 are examples of non-life-threatening situations. Nursing Process: Assessment Cognitive Level: Analysis Category of Need: Physiological Integrity–Physiological Adaptation 2. Acute bronchospasm can present a life-threatening situation, which can jeopardize a patientʹs survival. #1, #3, and #4 are examples of non-life-threatening situations. Nursing Process: Assessment Cognitive Level: Analysis Category of Need: Physiological Integrity–Physiological Adaptation 3. Acute bronchospasm can present a life-threatening situation, which can jeopardize a patientʹs survival. #1, #3, and #4 are examples of non-life-threatening situations. Nursing Process: Assessment Cognitive Level: Analysis Category of Need: Physiological Integrity–Physiological Adaptation 4. Acute bronchospasm can present a life-threatening situation, which can jeopardize a patientʹs survival. #1, #3, and #4 are examples of non-life-threatening situations. Nursing Process: Assessment Cognitive Level: Analysis Category of Need: Physiological Integrity–Physiological Adaptation Learning Outcome: 1-1: Define critical care Understanding the Ess. of Critical Care Nursing (Perrin) -- CVC 12/3/08 -- Page 1 2) Of the following patients, who should be cared for in a critical care unit? A patient: (Select all that apply.) 1. With an acetaminophen overdose 2. Suffering from acute mental illness 3. With chronic renal failure 4. With acute decompensated heart failure Answer: 1, 4 Explanation: 1. (Note: This requires multiple responses to be correct.) Critical care units are cost-efficient units for caring for patients with specific organ system failure. Although the organ failing in #4 is obvious, patients with acetaminophen overdose often suffer liver failure as a consequence. #2 and #3 present patient concerns of a noncritical nature. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Physiological Integrity–Physiological Adaptation 2. (Note: This requires multiple responses to be correct.) Critical care units are cost-efficient units for caring for patients with specific organ system failure. Although the organ failing in #4 is obvious, patients with acetaminophen overdose often suffer liver failure as a consequence. #2 and #3 present patient concerns of a noncritical nature. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Physiological Integrity–Physiological Adaptation 3. (Note: This requires multiple responses to be correct.) Critical care units are cost-efficient units for caring for patients with specific organ system failure. Although the organ failing in #4 is obvious, patients with acetaminophen overdose often suffer liver failure as a consequence. #2 and #3 present patient concerns of a noncritical nature. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Physiological Integrity–Physiological Adaptation 4. (Note: This requires multiple responses to be correct.) Critical care units are cost-efficient units for caring for patients with specific organ system failure. Although the organ failing in #4 is obvious, patients with acetaminophen overdose often suffer liver failure as a consequence. #2 and #3 present patient concerns of a noncritical nature. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Physiological Integrity–Physiological Adaptation Learning Outcome: 1-1: Define critical care Understanding the Ess. of Critical Care Nursing (Perrin) -- CVC 12/3/08 -- Page 2 3) A hospital in a small rural town would be able to provide which level of care in the critical care unit? 1. Level I 2. Level II 3. Level III 4. It is unlikely that the hospital would have a critical care unit Answer: 3 Explanation: 1. #1 and #2 describe more advanced and inclusive critical care abilities; #4 is not likely at all because most hospitals have some critical care areas. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Safe, Effective Care Environment–Management of Care 2. #1 and #2 describe more advanced and inclusive critical care abilities; #4 is not likely at all because most hospitals have some critical care areas. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Safe, Effective Care Environment–Management of Care 3. #1 and #2 describe more advanced and inclusive critical care abilities; #4 is not likely at all because most hospitals have some critical care areas. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Safe, Effective Care Environment–Management of Care 4. #1 and #2 describe more advanced and inclusive critical care abilities; #4 is not likely at all because most hospitals have some critical care areas. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Safe, Effective Care Environment–Management of Care Learning Outcome: 1-2: State the three levels of care provided in critical care units 4) A nurse employed in an ʺopenʺ ICU would most likely be working with a: 1. Multidisciplinary team with physicians who are also responsible for patients on other units. 2. Multidisciplinary team that includes a physician employed by the hospital. 3. Physician in charge of patient care who is a specialist in critical care. 4. Primary care physician who must consult a critical care specialist. Answer: 1 Explanation: 1. #2, #3, and #4 refer to ʺclosedʺ ICUs. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Safe, Effective Care Environment–Management of Care 2. #2, #3, and #4 refer to ʺclosedʺ ICUs. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Safe, Effective Care Environment–Management of Care 3. #2, #3, and #4 refer to ʺclosedʺ ICUs. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Safe, Effective Care Environment–Management of Care 4. #2, #3, and #4 refer to ʺclosedʺ ICUs. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Safe, Effective Care Environment–Management of Care Learning Outcome: 1-3: Compare and contrast ʺopenʺ and ʺclosedʺ critical care units Understanding the Ess. of Critical Care Nursing (Perrin) -- CVC 12/3/08 -- Page 3 5) According to the Institute of Medicine, technology increases the likelihood of errors in critical care units when: 1. It relies heavily on human decision-making. 2. Devices are programmed to function without double-checks. 3. It makes the workload seem overwhelming to health care providers. 4. There is uniform equipment throughout each facility. Answer: 2 Explanation: 1. #1, #3, and #4 have not been identified to increase the likelihood of errors in the critical care unit. Nursing Process: Evaluation Cognitive Level: Comprehension Category of Need: Safe, Effective Care Environment–Management of Care 2. #1, #3, and #4 have not been identified to increase the likelihood of errors in the critical care unit. Nursing Process: Evaluation Cognitive Level: Comprehension Category of Need: Safe, Effective Care Environment–Management of Care 3. #1, #3, and #4 have not been identified to increase the likelihood of errors in the critical care unit. Nursing Process: Evaluation Cognitive Level: Comprehension Category of Need: Safe, Effective Care Environment–Management of Care 4. #1, #3, and #4 have not been identified to increase the likelihood of errors in the critical care unit. Nursing Process: Evaluation Cognitive Level: Comprehension Category of Need: Safe, Effective Care Environment–Management of Care Learning Outcome: 1-4: Explain why critical care units are one of the most common sites for health care errors Understanding the Ess. of Critical Care Nursing (Perrin) -- CVC 12/3/08 -- Page 4 6) Which of the following is a common example of installing forcing functions or system level firewalls in order to prevent errors? 1. Prior to administration of insulin, two nurses check the dose. 2. Prior to obtaining a medication, height, weight and allergies are recorded. 3. All medications are checked by two nurses prior to administration. 4. Undiluted potassium chloride is not available on critical care units. Answer: 4 Explanation: 1. #1 and #3 are examples of avoiding reliance on vigilance; #2 is an example of utilizing constraints. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Physiological Integrity–Pharmacological and Parenteral Therapies 2. #1 and #3 are examples of avoiding reliance on vigilance; #2 is an example of utilizing constraints. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Physiological Integrity–Pharmacological and Parenteral Therapies 3. #1 and #3 are examples of avoiding reliance on vigilance; #2 is an example of utilizing constraints. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Physiological Integrity–Pharmacological and Parenteral Therapies 4. #1 and #3 are examples of avoiding reliance on vigilance; #2 is an example of utilizing constraints. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Physiological Integrity–Pharmacological and Parenteral Therapies Learning Outcome: 1-4: Explain why critical care units are one of the most common sites for health care errors Understanding the Ess. of Critical Care Nursing (Perrin) -- CVC 12/3/08 -- Page 5 7) The increased use of technology in critical care units has resulted in which of the following consequences for patient care? 1. Decreased risk of errors in patient care 2. Decreased therapeutic nurse-patient communication 3. Improved overall patient satisfaction with care 4. Improved patient safety across the entire spectrum Answer: 2 Explanation: 1. #1, #3, and #4 have not been demonstrated as outcomes resulting from increased technology use. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Physiological Integrity–Physiological Adaptation 2. #1, #3, and #4 have not been demonstrated as outcomes resulting from increased technology use. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Physiological Integrity–Physiological Adaptation 3. #1, #3, and #4 have not been demonstrated as outcomes resulting from increased technology use. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Physiological Integrity–Physiological Adaptation 4. #1, #3, and #4 have not been demonstrated as outcomes resulting from increased technology use. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Physiological Integrity–Physiological Adaptation Learning Outcome: 1-4: Explain why critical care units are one of the most common sites for health care errors 8) Completion of a preoperative checklist is an operationalized example of which of the following recommendations issued by the Institute of Medicine? 1. Utilizing constraints 2. Simplifying key processes 3. Avoiding reliance on vigilance 4. Standardizing key processes Answer: 3 Explanation: 1. #1, #2, and #4 are additional recommendations issued by the Institute of Medicine. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Safe, Effective Care Environment–Management of Care 2. #1, #2, and #4 are additional recommendations issued by the Institute of Medicine. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Safe, Effective Care Environment–Management of Care 3. #1, #2, and #4 are additional recommendations issued by the Institute of Medicine. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Safe, Effective Care Environment–Management of Care 4. #1, #2, and #4 are additional recommendations issued by the Institute of Medicine. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Safe, Effective Care Environment–Management of Care Learning Outcome: 1-4: Explain why critical care units are one of the most common sites for health care errors Understanding the Ess. of Critical Care Nursing (Perrin) -- CVC 12/3/08 -- Page 6 9) Which of the following actions should the nurse complete first after realizing that an incorrect dose of medication has been administered to a patient? (Select all that apply.) 1. Documentation of the error 2. Notification of the physician 3. Notification of the patient and family 4. Preparation for a root cause analysis Answer: 1, 2, 3, 4 Explanation: 1. (Note: This requires multiple responses to be correct.) Although they are all correct, #2 should be completed first and a plan developed to ensure that the patient is not harmed. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Safe, Effective Care Environment–Management of Care 2. (Note: This requires multiple responses to be correct.) Although they are all correct, #2 should be completed first and a plan developed to ensure that the patient is not harmed. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Safe, Effective Care Environment–Management of Care 3. (Note: This requires multiple responses to be correct.) Although they are all correct, #2 should be completed first and a plan developed to ensure that the patient is not harmed. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Safe, Effective Care Environment–Management of Care 4. (Note: This requires multiple responses to be correct.) Although they are all correct, #2 should be completed first and a plan developed to ensure that the patient is not harmed. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Safe, Effective Care Environment–Management of Care Learning Outcome: 1-4: Explain why critical care units are one of the most common sites for health care errors Understanding the Ess. of Critical Care Nursing (Perrin) -- CVC 12/3/08 -- Page 7 10) The nurse working within the AACN Synergy Model realizes that optimal patient outcomes are realized when: 1. Highly qualified nurses care for patients in highly technical settings. 2. Nurses agree to work overtime to cover unit staffing needs. 3. Staff nurse competency is matched with patient needs. 4. Patient care is delivered within a ʺclosed unitʺ model. Answer: 3 Explanation: 1. #1, #2, and #4 are not correct. The underlying assumption of the synergy model is that optimal patient outcomes occur when the needs of the patient and family are matched with the competencies of the nurse. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Safe, Effective Care Environment–Management of Care 2. #1, #2, and #4 are not correct. The underlying assumption of the synergy model is that optimal patient outcomes occur when the needs of the patient and family are matched with the competencies of the nurse. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Safe, Effective Care Environment–Management of Care 3. #1, #2, and #4 are not correct. The underlying assumption of the synergy model is that optimal patient outcomes occur when the needs of the patient and family are matched with the competencies of the nurse. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Safe, Effective Care Environment–Management of Care 4. #1, #2, and #4 are not correct. The underlying assumption of the synergy model is that optimal patient outcomes occur when the needs of the patient and family are matched with the competencies of the nurse. Nursing Process: Evaluation Cognitive Level: Application Category of Need: Safe, Effective Care Environment–Management of Care Learning Outcome: 1-5: Describe the relationship between the patient and the nurse in the AACNʹs synergy model Understanding the Ess. of Critical Care Nursing (Perrin) -- CVC 12/3/08 -- Page 8 11) The competent critical care nurse demonstrates an understanding of patient advocacy by taking which of the following actions? (Select all that apply.) 1. Maintaining attendance at the bedside with the patient during a physician visit 2. Assisting and supporting the patient and family as they reveal their needs 3. Alerting the physician to concerns about patient placement after hospitalization 4. Encouraging and supporting a patientʹs spouse in preparing for a family meeting Answer: 1, 2, 3, 4 Explanation: 1. (Note: This requires multiple responses to be correct.) #1, #2, #3, and #4 all indicate ways in which the new critical care nurse could demonstrate an understanding of patient advocacy. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Psychosocial Integrity 2. (Note: This requires multiple responses to be correct.) #1, #2, #3, and #4 all indicate ways in which the new critical care nurse could demonstrate an understanding of patient advocacy. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Psychosocial Integrity 3. (Note: This requires multiple responses to be correct.) #1, #2, #3, and #4 all indicate ways in which the new critical care nurse could demonstrate an understanding of patient advocacy. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Psychosocial Integrity 4. (Note: This requires multiple responses to be correct.) #1, #2, #3, and #4 all indicate ways in which the new critical care nurse could demonstrate an understanding of patient advocacy. Nursing Process: Evaluation Cognitive Level: Analysis Category of Need: Psychosocial Integrity Learning Outcome: 1-5: Describe the relationship between the patient and the nurse in the AACNʹs synergy model Understanding the Ess. of Critical Care Nursing (Perrin) -- CVC 12/3/08 -- Page 9 12)