Complex Med-Surg Exam 1 Questions & Answers Correct!!

Standards serve as __________ for clinical practice. They _________ _____ for patient care and provide mechanisms for nurses to _____ the achievement of patient goals - ANSWERSguidelines; establish goals; assess The _________ of patients' illness makes their care the top priority of critical care nurses. - ANSWERSacuteness What are two issues that critical care nurses face because of the fast-paced environment, critical nature of illness, and issues surrounding life and death patients? - ANSWERSCompassion fatigue and Moral distress 3 initiatives that focus on the quality and safety of patient care (preventing errors and harm) - ANSWERS-Joint Commission National Patient Safety Goals -Institute for Healthcare Improvement -Quality and Safety Education for Nurses (QSEN) What has the Joint Commission identified as necessary to be addressed in hospitals, long-term care facilities, and other agencies that it accredits? - ANSWERSNational Patient Safety Goals How can critical illnesses and the critical care environment affect the patient's family? - ANSWERSIt can cause the feelings of: -uncertainty -loss of control -stress -anxiety What are the basic patient family needs in the critical care environment? - ANSWERS•Receiving assurance •Remaining near the patient •Receiving information •Being comfortable •Having support available what are some nursing interventions that can be implemented to meet family needs and reduce family members' anxiety and stress? - ANSWERS•Facilitate visitation •Provide information •Encourage family involvement in patient care •Consider family presence during procedures (Open visitation is one essential intervention, yet it is controversial.) What aspects of the critical care environment contribute to sensory overload? - ANSWERS•Light. •Noise (PRIMARY). •Loss of privacy: (Multiple caregivers, Multiple people in and out of unit and room). •Acutely changing mental status •Key word: inattention •Types: -Hyperactive—agitated, combative, disoriented -Hypoactive—quiet delirium -Mixed—fluctuating between the two •Associated with increased mortality and morbidity - ANSWERSDelirium Risk factors for delirium - ANSWERS•Older than 70 years •Transfer from a nursing home •History of depression, dementia, stroke •Alcohol or substance abuse •Electrolyte imbalance •Hypothermia or fever •Renal Failure •Liver disease •Cardiogenic or septic shock •Human Immunodeficiency Virus (HIV) Infection •Rectal or bladder catheters •Tube feedings •Central Venous Catheters •Malnutrition •Presence of physical restraints •Visual or hearing impairment types of assessments, goals, and drug of choice for delirium - ANSWERS•Assessment -Confusion Assessment Method for the ICU (CAM-ICU) -Intensive Care Delirium Screening Checklist (ICDSC) •Goal—keep the patient safe •Drug of choice—haloperidol ABCDEF Bundle for Preventing Delirium (" * "= important) - ANSWERS•Awakening •Breathing Coordination*** •Choice of Sedation**** •Delirium monitoring •Early mobility and exercise***** •Family engagement an empowerment The nature of critical illness results in a greater frequency of ________ ______. - ANSWERSethical issues What are some ethical issue that critical care nurses confront in everyday practice? - ANSWERS-Informed consent and confidentiality -Withholding or withdrawal of treatment •Know wishes: Living Will, Advanced Directives, Code Status -Organ and tissue transplantation -Distribution of healthcare resources -Appropriate use of technology what is nurse advocacy? - ANSWERS•Obligation to protect patients -Serve as patient advocates Several signs alert the nurse to the potential emergence of ethical issues. What are some ethical dilemma warning signs? - ANSWERS•Emotionally charged •Significant change in patient's condition •Confusion about facts •Hesitancy about what is right •Deviation from customary practice •Need for secrecy regarding proposed actions The nurse recognizes which statement as a potential ethical issue? A."The physician explained my mother's poor prognosis." B."If the breathing machine is helping my mother, why is the doctor asking me about removing the breathing tube?" C."My mother has designated my brother to make decisions." D."Can I assist with some of my mother's care?" - ANSWERSB."If the breathing machine is helping my mother, why is the doctor asking me about removing the breathing tube?" **Rationale: This answer indicates some confusion and hesitancy about care, and a possible deviation from norms. Autonomy - ANSWERS-Right of self-determination concerning medical care Beneficence - ANSWERS-Duty to prevent harm, remove harm, and promote the good of another person Nonmaleficence - ANSWERSNot to intentionally inflict harm Justice - ANSWERS-Fair distribution of healthcare resources Veracity - ANSWERS-Truthfulness Fidelity - ANSWERS-Faithfulness to commitment Confidentiality - ANSWERS-Respect for right to control information •Nurses should assist in identifying the patient's ______ and collaborate with members of the multiprofessional team to address _______ ______. - ANSWERSwishes; ethical issues ___ _____ __________ mandates that a ______ mechanism be in place to address ethical issues; committees are one strategy and nurses can request an ________ _______ at any time. - ANSWERSThe Joint Commission; formal; ethical consult The nurse recognizes which situation may warrant an ethics consultation? A."We've met as a family and agree that we should withdraw life support." B."My mother has designated her minister as her healthcare surrogate." C."We've met as a family and want mother to be resuscitated if her heart stops." D."Mother never got around to completing her living will, so I think she would want everything done. My brother disagrees." - ANSWERSAnswer: D) "Mother never got around to completing her living will, so I think she would want everything done. My brother disagrees." **Rationale: Answers A through C show consensus and communication. Answer D identifies a potential conflict because the patient does not have an advance directive. Nurses have a DUTY TO TREAT patients and avoid ___________! - ANSWERSABANDONMENT! Nurses required to care for assigned patients - ANSWERSContractual relationship -Severing professional relationship when patient is in need of care -The nurse must ensure that patient care is arranged with another nurse, including breaks and lunch to avoid this - ANSWERSAbandonment -Nurse not required to practice if situation violates _____ or _________ beliefs. - ANSWERSmoral; religious (moral conflict) Decisions regarding life-sustaining treatment occur when: - ANSWERS-Patient is terminally ill -Deemed futile -Has been in a persistent vegetative state What are some factors to consider when contemplating or moving toward life support? - ANSWERS-Constitutional rights -Quality of life -Impact of advanced technology -Ordinary versus extraordinary care -Common, noninvasive, and tested treatment -Nutrition, hydration, antibiotics - ANSWERSOrdinary care -Complex, invasive, experimental treatment -ACLS, dialysis, unproved therapies - ANSWERSExtraordinary care It is important to know that life support does not result in a lack of care. __________ care to ensure comfort is initiated if life support is the route taken and through the withdrawal process. - ANSWERSPalliative "Withholding" life support means: - ANSWERSNot initiating life support "Withdrawing" life support means: - ANSWERSWeaning or removing life support What specifically is REQUIRED in order to NOT initiate a code for a patient? - ANSWERSDNR (Do Not Resuscitate) "Transferring to a competent individual the authority to perform a selected nursing task in a selected situation." (the nurse retains accountability) - ANSWERSDelegation "The distribution of work that each staff member is responsible for during a given shift or work period" - ANSWERSAssignment