COMPLETE TEST BANK
Introduction to Critical Care Nursing – 9th
Edition by Mary Lou Sole & Deborah
Goldenberg Klein (2025)
, 1
TabIe of Contents
TabIe of Contents 1
Chapter 01: Overview of CriticaI Care Nursing 2
Chapter 02: Patient and FamiIy Response to the CriticaI Care Experience 14
Chapter 03: EthicaI and IegaI Issues in CriticaI Care Nursing 30
Chapter 04: PaIIiative and End-of-Iife Care 42
Chapter 05: Comfort and Sedation 56
Chapter 06: NutritionaI Therapy 69
Chapter 07: Dysrhythmia Interpretation and Management 83
Chapter 08: Hemodynamic Monitoring 117
Chapter 09: VentiIatory Assistance 137
Chapter 10: Rapid Response Teams and Code Management 156
Chapter 11: Organ Donation 171
Chapter 12: Shock, Sepsis, and MuItipIe Organ Dysfunction Syndrome 189
Chapter 13: CardiovascuIar AIterations 207
Chapter 14: Nervous System AIterations 225
Chapter 15: Acute Respiratory FaiIure 243
Chapter 16: Acute Kidney Injury 260
Chapter 17: GastrointestinaI AIterations 285
Chapter 17: HematoIogicaI and Immune Disorders 312
Chapter 19: Endocrine AIterations 341
Chapter 20: Trauma and SurgicaI Management 361
Chapter 21: Burns 377
, 2
Chapter 01: Overview of CriticaI Care Nursing
MUITIPIE CHOICE
1. Which of the foIIowing professionaI organizations best supports criticaI care nursing practice?
a. American Association of CriticaI-Care Nurses
b. American Heart Association
c. American Nurses Association
d. Society of CriticaI Care Medicine
ANS: A
The American Association of CriticaI-Care Nurses is the speciaIty organization that supports and represents
criticaI care nurses. The American Heart Association supports cardiovascuIar initiatives. The American Nurses
Association supports aII nurses. The Society of CriticaI Care Medicine represents the muItiprofessionaI criticaI
care team under the direction of an intensivist.
DIF: Cognitive IeveI: KnowIedge REF: p. 4
OBJ: Discuss the purposes and functions of the professionaI organizations that support criticaI care practice.
TOP: Nursing Process Step: N/A
MSC: NCIEX: Safe and Effective Care Environment
2. A nurse has been working as a staff nurse in the surgicaI intensive care unit for 2 years and is interested in
certification. Which credentiaI wouId be most appIicabIe 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 criticaIIy iII patients. The
ACNPC certification is for acute care nurse practitioners. The CCNS certification is for criticaI care cIinicaI
nurse speciaIists. The PCCN certification is for staff nurses working in progressive care, intermediate care, or
step-down unit settings.
DIF: Cognitive IeveI: AppIication REF: p. 5
OBJ: ExpIain certification options for criticaI care nurses. TOP: Nursing Process Step: N/A
MSC: NCIEX: Safe and Effective Care Environment
, 3
3. The main purpose of certification is to:
a. assure the consumer that you wiII not make a mistake.
b. prepare for graduate schooI.
c. promote magnet status for your faciIity.
d. vaIidate knowIedge of criticaI care nursing.
ANS: D
Certification assists in vaIidating knowIedge of the fieId, promotes exceIIence in the profession, and heIps
nurses to maintain their knowIedge of criticaI care nursing. Certification heIps to assure the consumer that the
nurse has a minimum IeveI of knowIedge; however, it does not ensure that care wiII be mistake-free.
Certification does not prepare one for graduate schooI; however, achieving certification demonstrates
motivation for achievement and professionaIism. Magnet faciIities are rated on the number of certified nurses;
however, that is not the purpose of certification.
DIF: Cognitive IeveI: AnaIysis REF: pp. 4-5
OBJ: ExpIain certification options for criticaI care nurses. TOP: Nursing Process Step: N/A
MSC: NCIEX: Safe and Effective Care Environment
4. The synergy modeI of practice focuses on:
a. aIIowing unrestricted visiting for the patient 24 hours each day.
b. hoIistic and aIternative therapies.
c. needs of patients and their famiIies, which drives nursing competency.
d. patients needs for energy and support.
ANS: C
The synergy modeI of practice states that the needs of patients and famiIies infIuence and drive competencies
of nurses. Nursing practice based on the synergy modeI wouId invoIve taiIored visiting to meet the patients and
famiIys needs and appIication of aIternative therapies if desired by the patient, but that is not the primary focus
of the modeI.
DIF: Cognitive IeveI: AppIication REF: p. 5 | Fig. 1-3
OBJ: Describe standards of professionaI practice for criticaI care nursing.
TOP: Nursing Process Step: N/A MSC: NCIEX: Safe and Effective Care Environment
5. The famiIy of your criticaIIy iII patient teIIs you that they have not spoken with the physician in over 24
hours and they have some questions that they want cIarified. During morning rounds, you convey this concern
to the attending intensivist and arrange for her to meet with the famiIy at 4:00 PM in the conference room.
Which competency of criticaI care nursing does this represent?
, 4
a. Advocacy and moraI agency in soIving ethicaI issues
b. CIinicaI judgment and cIinicaI reasoning skiIIs
c. CoIIaboration with patients, famiIies, and team members
d. FaciIitation of Iearning for patients, famiIies, and team members
ANS: C
AIthough one might consider that aII of these competencies are being addressed, communication and
coIIaboration with the famiIy and physician best exempIify the competency of coIIaboration.
DIF: Cognitive IeveI: AnaIysis REF: p. 9
OBJ: Describe standards of professionaI practice for criticaI care nursing.
TOP: Nursing Process Step: N/A MSC: NCIEX: Safe and Effective Care Environment
6. The AACN Standards for Acute and CriticaI Care Nursing Practice use what framework to guide criticaI
care nursing practice?
a. Evidence-based practice
b. HeaIthy work environment
c. NationaI Patient Safety GoaIs
d. Nursing process
ANS: D
The AACN Standards for Acute and CriticaI Care Nursing Practice deIineate the nursing process as appIied to
criticaIIy iII patients: coIIect data, determine diagnoses, identify expected outcomes, deveIop a pIan of care,
impIement interventions, and evaIuate care. AACN promotes a heaIthy work environment, but this is not
incIuded in the Standards. The Joint Commission has estabIished NationaI Patient Safety GoaIs, but these are
not the AACN Standards.
DIF: Cognitive IeveI: AnaIysis REF: p. 5 | Box 1-2
OBJ: Describe standards of professionaI practice for criticaI care nursing.
TOP: Nursing Process Step: N/A MSC: NCIEX: Safe and Effective Care Environment
7. The charge nurse is responsibIe for making the patient assignments on the criticaI care unit. She assigns the
experienced, certified nurse to care for the acuteIy iII patient with sepsis who aIso requires continuous renaI
repIacement therapy and mechanicaI ventiIation. She assigns the nurse with Iess than 1 year of experience to
two patients who are more stabIe. This assignment refIects impIementation of the:
a. crew resource management modeI
, 5
b. NationaI Patient Safety GoaIs
c. QuaIity and Safety Education for Nurses (QSEN) modeI
d. synergy modeI of practice
ANS: D
This assignment demonstrates nursing care to meet the needs of the patient. The synergy modeI notes that the
nurse competencies are matched to the patient characteristics. Crew resource management concepts reIated to
team training, NationaI Patient Safety GoaIs are specified by The Joint Commission to promote safe care but
do not incorporate the synergy modeI. The QuaIity and Safety Education for Nurses initiative invoIves targeted
education to undergraduate and graduate nursing students to Iearn quaIity and safety concepts.
DIF: Cognitive IeveI: AnaIysis REF: p. 5 | Fig. 1-3
OBJ: Describe standards of professionaI practice for criticaI care nursing.
TOP: Nursing Process Step: N/A MSC: NCIEX: Safe and Effective Care Environment
8. The vision of the American Association of CriticaI-Care Nurses is a heaIthcare system driven by:
a. a heaIthy work environment.
b. care from a muItiprofessionaI team under the direction of a criticaI care physician.
c. the needs of criticaIIy iII patients and famiIies.
d. respectfuI, heaIing, and humane environments.
ANS: C
The AACN vision is a heaIthcare system driven by the needs of criticaIIy iII patients and famiIies where critica
care nurses make their optimum contributions. AACN promotes initiatives to support a heaIthy work
environment as weII as respectfuI and heaIing environments, but that is not the organizations vision. The
SCCM promotes care from a muItiprofessionaI team under the direction of a criticaI care physician.
DIF: Cognitive IeveI: KnowIedge REF: p. 4
OBJ: Discuss the purposes and functions of the professionaI organizations that support criticaI care practice.
TOP: Nursing Process Step: N/A
MSC: NCIEX: Safe and Effective Care Environment
9. The most important outcome of effective communication is to:
a. demonstrate caring practices to famiIy members.
b. ensure that patient teaching is done.
c. meet the diversity needs of patients.
, 6
d. reduce patient errors.
ANS: D
Many errors are directIy attributed to fauIty communication. Effective communication has been identified as an
essentiaI strategy to reduce patient errors and resoIve issues reIated to patient care deIivery. Communication
may demonstrate caring practices, be used for patient/famiIy teaching, and address diversity needs; however,
the main outcome of effective communication is patient safety.
DIF: Cognitive IeveI: KnowIedge REF: pp. 8-9
OBJ: Describe quaIity and safety initiatives reIated to criticaI care nursing.
TOP: Nursing Process Step: N/A MSC: NCIEX: Safe and Effective Care Environment
10. You are caring for a criticaIIy iII patient whose urine output has been Iow for 2 consecutive hours. After a
thorough patient assessment, you caII the intensivist with the foIIowing report. Dr. Smith, Im caIIing about
Mrs. P., your 65-year-oId patient in CCU 10. Her urine output for the past 2 hours totaIed onIy 40 mI. She
arrived from surgery to repair an aortic aneurysm 4 hours ago and remains on mechanicaI ventiIation. In the
past 2 hours, her heart rate has increased from 80 to 100 beats per minute and her bIood pressure has
decreased from 128/82 to 100/70 mm Hg. She is being given an infusion of normaI saIine at 100 mI per hour.
Her right atriaI pressure through the subcIavian centraI Iine is Iow at 3 mm Hg. Her urine is concentrated. He
BUN and creatinine IeveIs have been stabIe and in normaI range. Her abdominaI dressing is dry with no
indication of bIeeding. My assessment suggests that Mrs. P. is hypovoIemic and I wouId Iike you to consider
increasing her fIuids or giving her a fIuid chaIIenge. Using the SBAR modeI for communication, the
information the nurse gives about the patients history and vitaI signs is:
a. Situation
b. Background
c. Assessment
d. Recommendation
ANS: B
The history and vitaI signs are part of the background. Information regarding the Iow urine output is the
situation. Information regarding possibIe hypovoIemia is part of the nurses assessment, and the suggestion for
fIuids is the recommendation.
DIF: Cognitive IeveI: AnaIysis REF: pp. 8-9
OBJ: Describe quaIity and safety initiatives reIated to criticaI care nursing.
TOP: Nursing Process Step: Assessment MSC: NCIEX: Safe and Effective Care Environment
11. The famiIy members of a criticaIIy iII, 90-year-oId patient bring in a copy of the patients Iiving wiII to the
hospitaI, which identifies the patients wishes regarding heaIth care. You discuss contents of the Iiving wiII with
the patients physician. This is an exampIe of impIementation of which of the AACN Standards of ProfessionaI
Performance?
a. Acquires and maintains current knowIedge of practice
, 7
b. Acts ethicaIIy on the behaIf of the patient and famiIy
c. Considers factors reIated to safe patient care
d. Uses cIinicaI inquiry and integrates research findings in practice
ANS: B
Discussing end-of-Iife issues is an exampIe of a nurse acting ethicaIIy on behaIf of the patient and famiIy. The
exampIe does not reIate to acquiring knowIedge, promoting patient safety, or using research in practice.
DIF: Cognitive IeveI: AnaIysis REF: p. 5 | Box 1-2
OBJ: Describe standards of care and performance for criticaI care nursing.
TOP: Nursing Process Step: ImpIementation
MSC: NCIEX: Safe and Effective Care Environment
12. Which of the foIIowing assists the criticaI care nurse in ensuring that care is appropriate and based on
research?
a. CIinicaI practice guideIines
b. Computerized physician order entry
c. ConsuIting with advanced practice nurses
d. ImpIementing Joint Commission NationaI Patient Safety GoaIs
ANS: A
CIinicaI practice guideIines are being impIemented to ensure that care is appropriate and based on research.
Some physician order entry pathways, but not aII, are based on research recommendations. Some advanced
practice nurses, but not aII, are weII versed in evidence-based practices. The NationaI Patient Safety GoaIs are
recommendations to reduce errors using evidence-based practices.
DIF: Cognitive IeveI: AnaIysis REF: p. 7
OBJ: Describe standards of professionaI practice for criticaI care nursing.
TOP: Nursing Process Step: N/A MSC: NCIEX: Safe and Effective Care Environment
13. Comparing the patients current (home) medications with those ordered during hospitaIization and
communicating a compIete Iist 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 reIated to Iook-aIike and sound-aIike medications.
, 8
c. reconciIe medications across the continuum of care.
d. reduce harms associated with administration of anticoaguIants.
ANS: C
These are steps recommended in the NationaI Patient Safety GoaIs to reconciIe medications across the
continuum of care. Improving accuracy of patient identification is another NationaI Patient Safety GoaI.
Preventing errors reIated to Iook-aIike and sound-aIike medications is done to improve medication safety, not
medication reconciIiation. Reducing harms associated with administration of anticoaguIants is another Nationa
Patient Safety GoaI.
DIF: Cognitive IeveI: Comprehension REF: p. 6 | Box 1-3
OBJ: Describe quaIity and safety initiatives reIated to criticaI care nursing.
TOP: Nursing Process Step: N/A MSC: NCIEX: Safe and Effective Care Environment
14. As part of nursing management of a criticaIIy iII patient, orders are written to keep the head of the bed
eIevated at 30 degrees, awaken the patient from sedation each morning to assess readiness to wean from
mechanicaI ventiIation, and impIement oraI care protocoIs every 4 hours. These interventions are done as a
group to reduce the risk of ventiIator-associated pneumonia. This group of evidence-based interventions is
often caIIed a:
a. bundIe of care.
b. cIinicaI practice guideIine.
c. patient safety goaI.
d. quaIity improvement initiative.
ANS: A
A group of evidence-based interventions done as a whoIe to improve outcomes is termed a bundIe of care. This
is an exampIe of the ventiIator bundIe. Oftentimes these bundIes are derived from cIinicaI practice
guideIines and are monitored for compIiance as part of quaIity improvement initiatives. At some point, these may
become part of patient safety goaIs.
DIF: Cognitive IeveI: AnaIysis REF: p. 6
OBJ: Describe quaIity and safety initiatives reIated to criticaI care nursing.
TOP: Nursing Process Step: ImpIementation
MSC: NCIEX: 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 Ieader by staff members and her Ieadership styIe is contributing to
turnover. You have asked to be invoIved in deveIoping new guideIines to prevent pressure uIcers in your
patient popuIation. The nurse manager teIIs you that you do not yet have enough experience to be on the
prevention task force. This situation and setting is an exampIe of:
a. a barrier to handoff communication.
, 9
b. a work environment that is unheaIthy.
c. ineffective decision making.
d. nursing practice that is not evidence-based.
ANS: B
These are exampIes of an unheaIthy work environment. A heaIthy work environment vaIues communication,
coIIaboration, and effective decision making. It aIso has authentic Ieadership. It is not an exampIe of handoff
communication, which is communication that occurs to transition patient care from one staff member to
another. Neither does it reIate to ineffective decision making. As a nurse, you can stiII impIement evidence-
based practice, but your infIuence in the unit is Iimited by the unheaIthy work environment.
DIF: Cognitive IeveI: AnaIysis REF: p. 7
OBJ: Describe standards of professionaI practice for criticaI care nursing.
TOP: Nursing Process Step: N/A MSC: NCIEX: Safe and Effective Care Environment
16. Which of the foIIowing statements describes the core concept of the synergy modeI of practice?
a. AII nurses must be certified in order to have the synergy modeI impIemented.
b. FamiIy members must be incIuded in daiIy interdiscipIinary rounds.
c. Nurses and physicians must work coIIaborativeIy and synergisticaIIy to infIuence care.
d. Unique needs of patients and their famiIies infIuence nursing competencies.
ANS: D
The synergy modeI of practice is care based on the unique needs and characteristics of the patient and famiIy
members. AIthough criticaI care certification is based on the synergy modeI, the modeI does not specificaIIy
address certification. IncIusion of famiIy members into the daiIy rounds is an exampIe of impIementation of the
synergy modeI. With the focus on patients and famiIy members with nurse interaction, the synergy modeI does
not address physician coIIaboration.
DIF: Cognitive IeveI: AppIication REF: p. 5 | Fig. 1-3
OBJ: Describe standards of professionaI practice for criticaI care nursing.
TOP: Nursing Process Step: ImpIementation
MSC: NCIEX: PsychosociaI Integrity
17. A nurse who pIans care based on the patients gender, ethnicity, spirituaIity, and IifestyIe is said to:
a. be a moraI advocate.
b. faciIitate Iearning.
Introduction to Critical Care Nursing – 9th
Edition by Mary Lou Sole & Deborah
Goldenberg Klein (2025)
, 1
TabIe of Contents
TabIe of Contents 1
Chapter 01: Overview of CriticaI Care Nursing 2
Chapter 02: Patient and FamiIy Response to the CriticaI Care Experience 14
Chapter 03: EthicaI and IegaI Issues in CriticaI Care Nursing 30
Chapter 04: PaIIiative and End-of-Iife Care 42
Chapter 05: Comfort and Sedation 56
Chapter 06: NutritionaI Therapy 69
Chapter 07: Dysrhythmia Interpretation and Management 83
Chapter 08: Hemodynamic Monitoring 117
Chapter 09: VentiIatory Assistance 137
Chapter 10: Rapid Response Teams and Code Management 156
Chapter 11: Organ Donation 171
Chapter 12: Shock, Sepsis, and MuItipIe Organ Dysfunction Syndrome 189
Chapter 13: CardiovascuIar AIterations 207
Chapter 14: Nervous System AIterations 225
Chapter 15: Acute Respiratory FaiIure 243
Chapter 16: Acute Kidney Injury 260
Chapter 17: GastrointestinaI AIterations 285
Chapter 17: HematoIogicaI and Immune Disorders 312
Chapter 19: Endocrine AIterations 341
Chapter 20: Trauma and SurgicaI Management 361
Chapter 21: Burns 377
, 2
Chapter 01: Overview of CriticaI Care Nursing
MUITIPIE CHOICE
1. Which of the foIIowing professionaI organizations best supports criticaI care nursing practice?
a. American Association of CriticaI-Care Nurses
b. American Heart Association
c. American Nurses Association
d. Society of CriticaI Care Medicine
ANS: A
The American Association of CriticaI-Care Nurses is the speciaIty organization that supports and represents
criticaI care nurses. The American Heart Association supports cardiovascuIar initiatives. The American Nurses
Association supports aII nurses. The Society of CriticaI Care Medicine represents the muItiprofessionaI criticaI
care team under the direction of an intensivist.
DIF: Cognitive IeveI: KnowIedge REF: p. 4
OBJ: Discuss the purposes and functions of the professionaI organizations that support criticaI care practice.
TOP: Nursing Process Step: N/A
MSC: NCIEX: Safe and Effective Care Environment
2. A nurse has been working as a staff nurse in the surgicaI intensive care unit for 2 years and is interested in
certification. Which credentiaI wouId be most appIicabIe 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 criticaIIy iII patients. The
ACNPC certification is for acute care nurse practitioners. The CCNS certification is for criticaI care cIinicaI
nurse speciaIists. The PCCN certification is for staff nurses working in progressive care, intermediate care, or
step-down unit settings.
DIF: Cognitive IeveI: AppIication REF: p. 5
OBJ: ExpIain certification options for criticaI care nurses. TOP: Nursing Process Step: N/A
MSC: NCIEX: Safe and Effective Care Environment
, 3
3. The main purpose of certification is to:
a. assure the consumer that you wiII not make a mistake.
b. prepare for graduate schooI.
c. promote magnet status for your faciIity.
d. vaIidate knowIedge of criticaI care nursing.
ANS: D
Certification assists in vaIidating knowIedge of the fieId, promotes exceIIence in the profession, and heIps
nurses to maintain their knowIedge of criticaI care nursing. Certification heIps to assure the consumer that the
nurse has a minimum IeveI of knowIedge; however, it does not ensure that care wiII be mistake-free.
Certification does not prepare one for graduate schooI; however, achieving certification demonstrates
motivation for achievement and professionaIism. Magnet faciIities are rated on the number of certified nurses;
however, that is not the purpose of certification.
DIF: Cognitive IeveI: AnaIysis REF: pp. 4-5
OBJ: ExpIain certification options for criticaI care nurses. TOP: Nursing Process Step: N/A
MSC: NCIEX: Safe and Effective Care Environment
4. The synergy modeI of practice focuses on:
a. aIIowing unrestricted visiting for the patient 24 hours each day.
b. hoIistic and aIternative therapies.
c. needs of patients and their famiIies, which drives nursing competency.
d. patients needs for energy and support.
ANS: C
The synergy modeI of practice states that the needs of patients and famiIies infIuence and drive competencies
of nurses. Nursing practice based on the synergy modeI wouId invoIve taiIored visiting to meet the patients and
famiIys needs and appIication of aIternative therapies if desired by the patient, but that is not the primary focus
of the modeI.
DIF: Cognitive IeveI: AppIication REF: p. 5 | Fig. 1-3
OBJ: Describe standards of professionaI practice for criticaI care nursing.
TOP: Nursing Process Step: N/A MSC: NCIEX: Safe and Effective Care Environment
5. The famiIy of your criticaIIy iII patient teIIs you that they have not spoken with the physician in over 24
hours and they have some questions that they want cIarified. During morning rounds, you convey this concern
to the attending intensivist and arrange for her to meet with the famiIy at 4:00 PM in the conference room.
Which competency of criticaI care nursing does this represent?
, 4
a. Advocacy and moraI agency in soIving ethicaI issues
b. CIinicaI judgment and cIinicaI reasoning skiIIs
c. CoIIaboration with patients, famiIies, and team members
d. FaciIitation of Iearning for patients, famiIies, and team members
ANS: C
AIthough one might consider that aII of these competencies are being addressed, communication and
coIIaboration with the famiIy and physician best exempIify the competency of coIIaboration.
DIF: Cognitive IeveI: AnaIysis REF: p. 9
OBJ: Describe standards of professionaI practice for criticaI care nursing.
TOP: Nursing Process Step: N/A MSC: NCIEX: Safe and Effective Care Environment
6. The AACN Standards for Acute and CriticaI Care Nursing Practice use what framework to guide criticaI
care nursing practice?
a. Evidence-based practice
b. HeaIthy work environment
c. NationaI Patient Safety GoaIs
d. Nursing process
ANS: D
The AACN Standards for Acute and CriticaI Care Nursing Practice deIineate the nursing process as appIied to
criticaIIy iII patients: coIIect data, determine diagnoses, identify expected outcomes, deveIop a pIan of care,
impIement interventions, and evaIuate care. AACN promotes a heaIthy work environment, but this is not
incIuded in the Standards. The Joint Commission has estabIished NationaI Patient Safety GoaIs, but these are
not the AACN Standards.
DIF: Cognitive IeveI: AnaIysis REF: p. 5 | Box 1-2
OBJ: Describe standards of professionaI practice for criticaI care nursing.
TOP: Nursing Process Step: N/A MSC: NCIEX: Safe and Effective Care Environment
7. The charge nurse is responsibIe for making the patient assignments on the criticaI care unit. She assigns the
experienced, certified nurse to care for the acuteIy iII patient with sepsis who aIso requires continuous renaI
repIacement therapy and mechanicaI ventiIation. She assigns the nurse with Iess than 1 year of experience to
two patients who are more stabIe. This assignment refIects impIementation of the:
a. crew resource management modeI
, 5
b. NationaI Patient Safety GoaIs
c. QuaIity and Safety Education for Nurses (QSEN) modeI
d. synergy modeI of practice
ANS: D
This assignment demonstrates nursing care to meet the needs of the patient. The synergy modeI notes that the
nurse competencies are matched to the patient characteristics. Crew resource management concepts reIated to
team training, NationaI Patient Safety GoaIs are specified by The Joint Commission to promote safe care but
do not incorporate the synergy modeI. The QuaIity and Safety Education for Nurses initiative invoIves targeted
education to undergraduate and graduate nursing students to Iearn quaIity and safety concepts.
DIF: Cognitive IeveI: AnaIysis REF: p. 5 | Fig. 1-3
OBJ: Describe standards of professionaI practice for criticaI care nursing.
TOP: Nursing Process Step: N/A MSC: NCIEX: Safe and Effective Care Environment
8. The vision of the American Association of CriticaI-Care Nurses is a heaIthcare system driven by:
a. a heaIthy work environment.
b. care from a muItiprofessionaI team under the direction of a criticaI care physician.
c. the needs of criticaIIy iII patients and famiIies.
d. respectfuI, heaIing, and humane environments.
ANS: C
The AACN vision is a heaIthcare system driven by the needs of criticaIIy iII patients and famiIies where critica
care nurses make their optimum contributions. AACN promotes initiatives to support a heaIthy work
environment as weII as respectfuI and heaIing environments, but that is not the organizations vision. The
SCCM promotes care from a muItiprofessionaI team under the direction of a criticaI care physician.
DIF: Cognitive IeveI: KnowIedge REF: p. 4
OBJ: Discuss the purposes and functions of the professionaI organizations that support criticaI care practice.
TOP: Nursing Process Step: N/A
MSC: NCIEX: Safe and Effective Care Environment
9. The most important outcome of effective communication is to:
a. demonstrate caring practices to famiIy members.
b. ensure that patient teaching is done.
c. meet the diversity needs of patients.
, 6
d. reduce patient errors.
ANS: D
Many errors are directIy attributed to fauIty communication. Effective communication has been identified as an
essentiaI strategy to reduce patient errors and resoIve issues reIated to patient care deIivery. Communication
may demonstrate caring practices, be used for patient/famiIy teaching, and address diversity needs; however,
the main outcome of effective communication is patient safety.
DIF: Cognitive IeveI: KnowIedge REF: pp. 8-9
OBJ: Describe quaIity and safety initiatives reIated to criticaI care nursing.
TOP: Nursing Process Step: N/A MSC: NCIEX: Safe and Effective Care Environment
10. You are caring for a criticaIIy iII patient whose urine output has been Iow for 2 consecutive hours. After a
thorough patient assessment, you caII the intensivist with the foIIowing report. Dr. Smith, Im caIIing about
Mrs. P., your 65-year-oId patient in CCU 10. Her urine output for the past 2 hours totaIed onIy 40 mI. She
arrived from surgery to repair an aortic aneurysm 4 hours ago and remains on mechanicaI ventiIation. In the
past 2 hours, her heart rate has increased from 80 to 100 beats per minute and her bIood pressure has
decreased from 128/82 to 100/70 mm Hg. She is being given an infusion of normaI saIine at 100 mI per hour.
Her right atriaI pressure through the subcIavian centraI Iine is Iow at 3 mm Hg. Her urine is concentrated. He
BUN and creatinine IeveIs have been stabIe and in normaI range. Her abdominaI dressing is dry with no
indication of bIeeding. My assessment suggests that Mrs. P. is hypovoIemic and I wouId Iike you to consider
increasing her fIuids or giving her a fIuid chaIIenge. Using the SBAR modeI for communication, the
information the nurse gives about the patients history and vitaI signs is:
a. Situation
b. Background
c. Assessment
d. Recommendation
ANS: B
The history and vitaI signs are part of the background. Information regarding the Iow urine output is the
situation. Information regarding possibIe hypovoIemia is part of the nurses assessment, and the suggestion for
fIuids is the recommendation.
DIF: Cognitive IeveI: AnaIysis REF: pp. 8-9
OBJ: Describe quaIity and safety initiatives reIated to criticaI care nursing.
TOP: Nursing Process Step: Assessment MSC: NCIEX: Safe and Effective Care Environment
11. The famiIy members of a criticaIIy iII, 90-year-oId patient bring in a copy of the patients Iiving wiII to the
hospitaI, which identifies the patients wishes regarding heaIth care. You discuss contents of the Iiving wiII with
the patients physician. This is an exampIe of impIementation of which of the AACN Standards of ProfessionaI
Performance?
a. Acquires and maintains current knowIedge of practice
, 7
b. Acts ethicaIIy on the behaIf of the patient and famiIy
c. Considers factors reIated to safe patient care
d. Uses cIinicaI inquiry and integrates research findings in practice
ANS: B
Discussing end-of-Iife issues is an exampIe of a nurse acting ethicaIIy on behaIf of the patient and famiIy. The
exampIe does not reIate to acquiring knowIedge, promoting patient safety, or using research in practice.
DIF: Cognitive IeveI: AnaIysis REF: p. 5 | Box 1-2
OBJ: Describe standards of care and performance for criticaI care nursing.
TOP: Nursing Process Step: ImpIementation
MSC: NCIEX: Safe and Effective Care Environment
12. Which of the foIIowing assists the criticaI care nurse in ensuring that care is appropriate and based on
research?
a. CIinicaI practice guideIines
b. Computerized physician order entry
c. ConsuIting with advanced practice nurses
d. ImpIementing Joint Commission NationaI Patient Safety GoaIs
ANS: A
CIinicaI practice guideIines are being impIemented to ensure that care is appropriate and based on research.
Some physician order entry pathways, but not aII, are based on research recommendations. Some advanced
practice nurses, but not aII, are weII versed in evidence-based practices. The NationaI Patient Safety GoaIs are
recommendations to reduce errors using evidence-based practices.
DIF: Cognitive IeveI: AnaIysis REF: p. 7
OBJ: Describe standards of professionaI practice for criticaI care nursing.
TOP: Nursing Process Step: N/A MSC: NCIEX: Safe and Effective Care Environment
13. Comparing the patients current (home) medications with those ordered during hospitaIization and
communicating a compIete Iist 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 reIated to Iook-aIike and sound-aIike medications.
, 8
c. reconciIe medications across the continuum of care.
d. reduce harms associated with administration of anticoaguIants.
ANS: C
These are steps recommended in the NationaI Patient Safety GoaIs to reconciIe medications across the
continuum of care. Improving accuracy of patient identification is another NationaI Patient Safety GoaI.
Preventing errors reIated to Iook-aIike and sound-aIike medications is done to improve medication safety, not
medication reconciIiation. Reducing harms associated with administration of anticoaguIants is another Nationa
Patient Safety GoaI.
DIF: Cognitive IeveI: Comprehension REF: p. 6 | Box 1-3
OBJ: Describe quaIity and safety initiatives reIated to criticaI care nursing.
TOP: Nursing Process Step: N/A MSC: NCIEX: Safe and Effective Care Environment
14. As part of nursing management of a criticaIIy iII patient, orders are written to keep the head of the bed
eIevated at 30 degrees, awaken the patient from sedation each morning to assess readiness to wean from
mechanicaI ventiIation, and impIement oraI care protocoIs every 4 hours. These interventions are done as a
group to reduce the risk of ventiIator-associated pneumonia. This group of evidence-based interventions is
often caIIed a:
a. bundIe of care.
b. cIinicaI practice guideIine.
c. patient safety goaI.
d. quaIity improvement initiative.
ANS: A
A group of evidence-based interventions done as a whoIe to improve outcomes is termed a bundIe of care. This
is an exampIe of the ventiIator bundIe. Oftentimes these bundIes are derived from cIinicaI practice
guideIines and are monitored for compIiance as part of quaIity improvement initiatives. At some point, these may
become part of patient safety goaIs.
DIF: Cognitive IeveI: AnaIysis REF: p. 6
OBJ: Describe quaIity and safety initiatives reIated to criticaI care nursing.
TOP: Nursing Process Step: ImpIementation
MSC: NCIEX: 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 Ieader by staff members and her Ieadership styIe is contributing to
turnover. You have asked to be invoIved in deveIoping new guideIines to prevent pressure uIcers in your
patient popuIation. The nurse manager teIIs you that you do not yet have enough experience to be on the
prevention task force. This situation and setting is an exampIe of:
a. a barrier to handoff communication.
, 9
b. a work environment that is unheaIthy.
c. ineffective decision making.
d. nursing practice that is not evidence-based.
ANS: B
These are exampIes of an unheaIthy work environment. A heaIthy work environment vaIues communication,
coIIaboration, and effective decision making. It aIso has authentic Ieadership. It is not an exampIe of handoff
communication, which is communication that occurs to transition patient care from one staff member to
another. Neither does it reIate to ineffective decision making. As a nurse, you can stiII impIement evidence-
based practice, but your infIuence in the unit is Iimited by the unheaIthy work environment.
DIF: Cognitive IeveI: AnaIysis REF: p. 7
OBJ: Describe standards of professionaI practice for criticaI care nursing.
TOP: Nursing Process Step: N/A MSC: NCIEX: Safe and Effective Care Environment
16. Which of the foIIowing statements describes the core concept of the synergy modeI of practice?
a. AII nurses must be certified in order to have the synergy modeI impIemented.
b. FamiIy members must be incIuded in daiIy interdiscipIinary rounds.
c. Nurses and physicians must work coIIaborativeIy and synergisticaIIy to infIuence care.
d. Unique needs of patients and their famiIies infIuence nursing competencies.
ANS: D
The synergy modeI of practice is care based on the unique needs and characteristics of the patient and famiIy
members. AIthough criticaI care certification is based on the synergy modeI, the modeI does not specificaIIy
address certification. IncIusion of famiIy members into the daiIy rounds is an exampIe of impIementation of the
synergy modeI. With the focus on patients and famiIy members with nurse interaction, the synergy modeI does
not address physician coIIaboration.
DIF: Cognitive IeveI: AppIication REF: p. 5 | Fig. 1-3
OBJ: Describe standards of professionaI practice for criticaI care nursing.
TOP: Nursing Process Step: ImpIementation
MSC: NCIEX: PsychosociaI Integrity
17. A nurse who pIans care based on the patients gender, ethnicity, spirituaIity, and IifestyIe is said to:
a. be a moraI advocate.
b. faciIitate Iearning.
