questions and Answers
2 - CORRECT ANSWER- The nurse reviews assessment data on a group of patients. Which
patient should the nurse identify as experiencing a critical illness?
1. Chronic airflow limitation with VS: BP 110/72, P 110, R 16
2. Acute bronchospasm with VS: BP 100/60, P 124, R 32
3. Motor vehicle crash with VS: BP 124/74, P 74, R 18
4. Chronic renal failure on hemodialysis with no urine output with VS: BP 98/50, P 108, R 12
1,4,5 - CORRECT ANSWER- Which patient should the nurse expect to be transferred to a
critical care unit? Select all that apply.
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1. Experiences an acetaminophen overdose
2. Diagnosed with an acute mental illness
3. Receiving treatment for chronic renal failure
4. New onset of acute decompensated heart failure
5. Treatment for bacteremia from an infected foot wound
3 - CORRECT ANSWER- The nurse employed in a hospital in a small rural town would expect
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.
1 - CORRECT ANSWER- With which individuals should the nurse expect to provide patient care
in an "open" ICU?
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
2 - CORRECT ANSWER- What should the nurse who provides care to patients in a critical care
unit realize the role of technology is on the amount of errors?
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.
4 - CORRECT ANSWER- What should the nurse identify as an example of an installed forcing
function or a system-level firewall to prevent errors when providing patient care?
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.
2 - CORRECT ANSWER- The nurse realizes that the increased use of technology in critical
care units has resulted in which consequence for patient care?
1. Decreased risk of errors in patient care
2. Decreased therapeutic nurse-patient communication
,1. Utilizing constraints
2. Simplifying key processes
3. Avoiding reliance on vigilance
4. Standardizing key processes
1,2,3,4 - CORRECT ANSWER- Which actions should the nurse complete after realizing that an
incorrect dose of medication has been administered to a patient? Select all that apply.
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1. Notify the patient and family.
2. Notify the physician.
3. Document the error.
4. Prepare for an analysis of the error.
5. Keep the notification of the error silent.
3 - CORRECT ANSWER- 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 "closed unit" model.
1,2,3,4 - CORRECT ANSWER- Which actions by the critical care nurse demonstrate an
understanding of patient advocacy? Select all that apply.
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
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 client placement after hospitalization
4. Encouraging and supporting a patient's spouse in preparing for a family meeting
5. Seeing the big picture when planning patient care
1 - CORRECT ANSWER- A nurse is preparing to communicate an issue about patient care to a
physician using the SBAR technique. Which phrase is an appropriate initial statement?
1. "I am concerned about..."
2. "The patient's immediate history is..."
3. "I think the problem is..."
4. "I would like you to..."
1 - CORRECT ANSWER- Which statement should the nurse include for "A-Assessment" in the
SBAR technique for communication?
1. "I think the problem is..."
2. "The patient's vital signs are..."
3. "The patient's treatments are..."
4. "I would like you to..."
3 - CORRECT ANSWER- Which statement should the nurse use when concluding SBAR
communication about a patient issue?
1. "The patient's immediate history is..."
2. "The patient's physical findings are..."
3. "I am requesting that you..."
4. "I have assessed the patient personally."
1,2,3,5 - CORRECT ANSWER- The nurse collaborates with other members of the health care
team to effect optimal outcomes in patient care. Which characteristics of emotional maturity is
,5. Willing to take responsibility for failures
1,2,3 - CORRECT ANSWER- Which informal power bases should the nurse use in the health
care setting? Select all that apply.
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1. Expertise
2. Goodwill
3. Information
4. Observation
5. Collaboration
4 - CORRECT ANSWER- Which action ensures that a patient has consented to care?
1. Provide a consent form to sign to receive medications.
2. Ask the patient to sign a consent form to have dressings changed.
3. Discuss a consent form to sign to be turned in bed.
4. Explain how a dressing is to be changed.
4 - CORRECT ANSWER- For what can the nurse be held liable if forcibly inserting a nasogastric
tube against a patient's wishes?
1. Negligence
2. Malpractice
3. Damages
4. Battery
1,2,3,4 - CORRECT ANSWER- For which patient would decision-making capacity likely be
impaired? Select all that apply.
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1. Being medicated for severe pain
2. Does not understand the medical condition
3. Diagnosed with septic shock
4. Is depressed
5. Asks questions about identified treatments
4 - CORRECT ANSWER- Which condition is most likely to occur when a patient is restrained?
1. Pulling out an endotracheal tube
2. Pulling out an intravenous line
3. Disconnecting ventilator tubing
4. Developing a nosocomial infection
2 - CORRECT ANSWER- What must the patient demonstrate for a nurse to be found guilty of
negligence?
1. Was assaulted
2. Incurred damages
3. Suffered a wrongful death
4. Was not consulted before being touched
1,2,4,5 - CORRECT ANSWER- What is associated with moral distress in critical care nurses?
Select all that apply.
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1. Having no voice in clinical decision making
2. Providing aggressive care to patients who cannot benefit
3. Realizing that nurses maintain power in bedside decision making
4. Knowing the right thing to do but not being able to do it
, 2. Employer sanctions
3. Support from nursing administrators
4. Protection from the state boards of nursing
5. Support by the patient
1,4,5 - CORRECT ANSWER- Which symptoms indicate a nurse is experiencing compassion
fatigue? Select all that apply.
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1. Difficulty separating work from personal life
2. Excessively high tolerance for frustration
3. Having a completely laissez-faire attitude
4. Decreased functioning in nonprofessional situations
5. Dreads working with certain types of patients
1,2 - CORRECT ANSWER- The nurse is providing care to patients in a Level II general critical
care unit. For which types of patient problems will this nurse most likely provide care? Select all
that apply.
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1. Exacerbation of heart failure
2. Wound infection
3. Burns over 50% of total body surface
4. Kidney transplant
5. Reattachment of a traumatic amputation of the left leg
1,2,3 - CORRECT ANSWER- A patient is admitted to an "open" intensive care unit. In addition
to the nurse, which health care providers will assist in the care of this patient? Select all that
apply.
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1. Pharmacist
2. Respiratory therapist
3. Attending physician
4. Dietician
5. Social worker
1,2,3 - CORRECT ANSWER- The critical care nurse is identifying patients at risk for safety and
medical errors. Which patients should the nurse identify as being at risk for these issues? Select
all that apply.
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1. Patient in isolation with MRSA
2. Patient who does not understand English
3. Patient with end stage renal disease and a respiratory rate of 8 per minute
4. Patient recovering from pacemaker insertion
5. Patient with pulmonary edema
1,2,3,4 - CORRECT ANSWER- The nurse manager of a critical care unit is explaining the AACN
Synergy Model to the critical care nurses. What should the manager include as basic parts of
this model? Select all that apply.
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1. Based on the patients' characteristics
2. Based on the competencies of the nurses
3. Patient outcomes will be measured
4. The nurses' assessment of patient outcomes will be measured
5. Reduction of cost to provide critical care services to patients