1
INTRODUCTION TO CRITICAL CARE NURSING 9/E SOLE TEST BANK
Chapter 1: Overview of Critical Care Nursing
Test Bank
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 Care Medicine
ANS: 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 multiprofessional critical care team under the direction of an
intensivist.
DIF: Cognitive Level: Knowledge REF: p. 4
OBJ: Discuss the purposes and functions of the professional organizations that support critical care
practice. TOP: Nursing Process Step: N/A
MSC: 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
ANS: 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.
DIF: Cognitive Level: Application REF: p. 5
OBJ: Explain certification options for critical care nurses. TOP: Nursing Process Step: N/A
MSC: 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.
ANS: D
1CERTIFICATION 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@$^%#63375424257420)(~*!7@969229)3198732093~9!8*&~62(*~98*~@&^@~98@7(&629319831
, 2
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.
DIF: Cognitive Level: Analysis REF: pp. 4-5
OBJ: Explain certification options for critical care nurses. TOP: Nursing Process Step: N/A
MSC: 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.
ANS: 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 patient’s and family’s needs and application of alternative
therapies if desired by the patient, but that is not the primary focus of the model.
DIF: Cognitive Level: Application REF: p. 5 | Fig. 1-3
OBJ: Describe standards of professional practice for critical care nursing.
TOP: Nursing Process Step: N/A MSC: 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
ANS: 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.
DIF: Cognitive Level: Analysis REF: p. 9
OBJ: Describe standards of professional practice for critical care nursing.
TOP: Nursing Process Step: N/A MSC: 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
2CERTIFICATION 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@$^%#63375424257420)(~*!7@969229)3198732093~9!8*&~62(*~98*~@&^@~98@7(&629319831
, 3
c. National Patient Safety Goals
d. Nursing process
ANS: 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.
DIF: Cognitive Level: Analysis REF: p. 5 | Box 1-2
OBJ: Describe standards of professional practice for critical care nursing.
TOP: Nursing Process Step: N/A MSC: 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 practice
ANS: 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 to team 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.
DIF: Cognitive Level: Analysis REF: p. 5 | Fig. 1-3
OBJ: Describe standards of professional practice for critical care nursing.
TOP: Nursing Process Step: N/A MSC: 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.
ANS: C
The AACN vision is a healthcare system driven by the needs of critically ill patients and
families where critical 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 organization’s vision. The SCCM promotes care from a
multiprofessional team under the direction of a critical care physician.
DIF: Cognitive Level: Knowledge REF: p. 4
3CERTIFICATION 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@$^%#63375424257420)(~*!7@969229)3198732093~9!8*&~62(*~98*~@&^@~98@7(&629319831
, 4
OBJ: Discuss the purposes and functions of the professional organizations that support critical care
practice. TOP: Nursing Process Step: N/A
MSC: 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.
ANS: 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.
DIF: Cognitive Level: Knowledge REF: pp. 8-9
OBJ: Describe quality and safety initiatives related to critical care nursing.
TOP: Nursing Process Step: N/A MSC: 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, I’m calling about Mrs. P., 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. Her 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. P. is hypovolemic and I would like you to consider increasing her fluids or giving her a
fluid challenge. Using the SBAR model for communication, the information the nurse gives
about the patient’s history and vital signs is:
a. Situation
b. Background
c. Assessment
d. Recommendation
ANS: 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 nurse’s
assessment, and the suggestion for fluids is the recommendation.
DIF: Cognitive Level: Analysis REF: pp. 8-9
OBJ: Describe quality and safety initiatives related to critical care nursing.
TOP: Nursing Process Step: Assessment MSC: NCLEX: Safe and Effective Care Environment
4CERTIFICATION 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@$^%#63375424257420)(~*!7@969229)3198732093~9!8*&~62(*~98*~@&^@~98@7(&629319831
, 5
11. The family members of a critically ill, 90-year-old patient bring in a copy of the patient’s
living will to the hospital, which identifies the patient’s wishes regarding health care. You
discuss contents of the living will with the patient’s physician. This is an example of
implementation of which of the AACN Standards of Professional Performance?
a. Acquires and maintains current knowledge of practice
b. Acts ethically on the behalf of the patient and family
c. Considers factors related to safe patient care
d. Uses clinical inquiry and integrates research findings in practice
ANS: 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.
DIF: Cognitive Level: Analysis REF: p. 5 | Box 1-2
OBJ: Describe standards of care and performance for critical care nursing.
TOP: Nursing Process Step: Implementation
MSC: 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
ANS: 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.
DIF: Cognitive Level: Analysis REF: p. 7
OBJ: Describe standards of professional practice for critical care nursing.
TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment
13. Comparing the patient’s current (home) medications with those ordered during hospitalization
and communicating a complete list of medications to the next provider when the patient is
transferred within an organization or to another setting are strategies to:
a. improve accuracy of patient identification.
b. prevent errors related to look-alike and sound-alike medications.
c. reconcile medications across the continuum of care.
d. reduce harms associated with administration of anticoagulants.
ANS: 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 National Patient Safety Goal.
5CERTIFICATION 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@$^%#63375424257420)(~*!7@969229)3198732093~9!8*&~62(*~98*~@&^@~98@7(&629319831
, 6
DIF: Cognitive Level: Comprehension REF: p. 6 | Box 1-3
OBJ: Describe quality and safety initiatives related to critical care nursing.
TOP: Nursing Process Step: N/A MSC: 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.
ANS: 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.
DIF: Cognitive Level: Analysis REF: p. 6
OBJ: Describe quality and safety initiatives related to critical care nursing.
TOP: Nursing Process Step: Implementation
MSC: 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.
ANS: B
These are examples of an unhealthy work environment. A healthy work environment values
communication, collaboration, and effective decision making. It also has authentic leadership.
It is not an example of handoff communication, which is communication that occurs to
transition patient care from one staff member to 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.
DIF: Cognitive Level: Analysis REF: p. 7
OBJ: Describe standards of professional practice for critical care nursing.
TOP: Nursing Process Step: N/A MSC: 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.
6CERTIFICATION 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@$^%#63375424257420)(~*!7@969229)3198732093~9!8*&~62(*~98*~@&^@~98@7(&629319831
INTRODUCTION TO CRITICAL CARE NURSING 9/E SOLE TEST BANK
Chapter 1: Overview of Critical Care Nursing
Test Bank
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 Care Medicine
ANS: 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 multiprofessional critical care team under the direction of an
intensivist.
DIF: Cognitive Level: Knowledge REF: p. 4
OBJ: Discuss the purposes and functions of the professional organizations that support critical care
practice. TOP: Nursing Process Step: N/A
MSC: 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
ANS: 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.
DIF: Cognitive Level: Application REF: p. 5
OBJ: Explain certification options for critical care nurses. TOP: Nursing Process Step: N/A
MSC: 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.
ANS: D
1CERTIFICATION 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@$^%#63375424257420)(~*!7@969229)3198732093~9!8*&~62(*~98*~@&^@~98@7(&629319831
, 2
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.
DIF: Cognitive Level: Analysis REF: pp. 4-5
OBJ: Explain certification options for critical care nurses. TOP: Nursing Process Step: N/A
MSC: 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.
ANS: 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 patient’s and family’s needs and application of alternative
therapies if desired by the patient, but that is not the primary focus of the model.
DIF: Cognitive Level: Application REF: p. 5 | Fig. 1-3
OBJ: Describe standards of professional practice for critical care nursing.
TOP: Nursing Process Step: N/A MSC: 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
ANS: 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.
DIF: Cognitive Level: Analysis REF: p. 9
OBJ: Describe standards of professional practice for critical care nursing.
TOP: Nursing Process Step: N/A MSC: 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
2CERTIFICATION 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@$^%#63375424257420)(~*!7@969229)3198732093~9!8*&~62(*~98*~@&^@~98@7(&629319831
, 3
c. National Patient Safety Goals
d. Nursing process
ANS: 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.
DIF: Cognitive Level: Analysis REF: p. 5 | Box 1-2
OBJ: Describe standards of professional practice for critical care nursing.
TOP: Nursing Process Step: N/A MSC: 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 practice
ANS: 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 to team 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.
DIF: Cognitive Level: Analysis REF: p. 5 | Fig. 1-3
OBJ: Describe standards of professional practice for critical care nursing.
TOP: Nursing Process Step: N/A MSC: 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.
ANS: C
The AACN vision is a healthcare system driven by the needs of critically ill patients and
families where critical 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 organization’s vision. The SCCM promotes care from a
multiprofessional team under the direction of a critical care physician.
DIF: Cognitive Level: Knowledge REF: p. 4
3CERTIFICATION 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@$^%#63375424257420)(~*!7@969229)3198732093~9!8*&~62(*~98*~@&^@~98@7(&629319831
, 4
OBJ: Discuss the purposes and functions of the professional organizations that support critical care
practice. TOP: Nursing Process Step: N/A
MSC: 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.
ANS: 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.
DIF: Cognitive Level: Knowledge REF: pp. 8-9
OBJ: Describe quality and safety initiatives related to critical care nursing.
TOP: Nursing Process Step: N/A MSC: 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, I’m calling about Mrs. P., 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. Her 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. P. is hypovolemic and I would like you to consider increasing her fluids or giving her a
fluid challenge. Using the SBAR model for communication, the information the nurse gives
about the patient’s history and vital signs is:
a. Situation
b. Background
c. Assessment
d. Recommendation
ANS: 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 nurse’s
assessment, and the suggestion for fluids is the recommendation.
DIF: Cognitive Level: Analysis REF: pp. 8-9
OBJ: Describe quality and safety initiatives related to critical care nursing.
TOP: Nursing Process Step: Assessment MSC: NCLEX: Safe and Effective Care Environment
4CERTIFICATION 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@$^%#63375424257420)(~*!7@969229)3198732093~9!8*&~62(*~98*~@&^@~98@7(&629319831
, 5
11. The family members of a critically ill, 90-year-old patient bring in a copy of the patient’s
living will to the hospital, which identifies the patient’s wishes regarding health care. You
discuss contents of the living will with the patient’s physician. This is an example of
implementation of which of the AACN Standards of Professional Performance?
a. Acquires and maintains current knowledge of practice
b. Acts ethically on the behalf of the patient and family
c. Considers factors related to safe patient care
d. Uses clinical inquiry and integrates research findings in practice
ANS: 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.
DIF: Cognitive Level: Analysis REF: p. 5 | Box 1-2
OBJ: Describe standards of care and performance for critical care nursing.
TOP: Nursing Process Step: Implementation
MSC: 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
ANS: 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.
DIF: Cognitive Level: Analysis REF: p. 7
OBJ: Describe standards of professional practice for critical care nursing.
TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment
13. Comparing the patient’s current (home) medications with those ordered during hospitalization
and communicating a complete list of medications to the next provider when the patient is
transferred within an organization or to another setting are strategies to:
a. improve accuracy of patient identification.
b. prevent errors related to look-alike and sound-alike medications.
c. reconcile medications across the continuum of care.
d. reduce harms associated with administration of anticoagulants.
ANS: 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 National Patient Safety Goal.
5CERTIFICATION 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@$^%#63375424257420)(~*!7@969229)3198732093~9!8*&~62(*~98*~@&^@~98@7(&629319831
, 6
DIF: Cognitive Level: Comprehension REF: p. 6 | Box 1-3
OBJ: Describe quality and safety initiatives related to critical care nursing.
TOP: Nursing Process Step: N/A MSC: 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.
ANS: 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.
DIF: Cognitive Level: Analysis REF: p. 6
OBJ: Describe quality and safety initiatives related to critical care nursing.
TOP: Nursing Process Step: Implementation
MSC: 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.
ANS: B
These are examples of an unhealthy work environment. A healthy work environment values
communication, collaboration, and effective decision making. It also has authentic leadership.
It is not an example of handoff communication, which is communication that occurs to
transition patient care from one staff member to 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.
DIF: Cognitive Level: Analysis REF: p. 7
OBJ: Describe standards of professional practice for critical care nursing.
TOP: Nursing Process Step: N/A MSC: 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.
6CERTIFICATION 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@$^%#63375424257420)(~*!7@969229)3198732093~9!8*&~62(*~98*~@&^@~98@7(&629319831
