Test Bank Introduction Critical Care Nursing 7th Sole 2016 Graded A +

Test Bank Introduction Critical Care Nursing 7th Edition (Sole 2016 ) Table of Contents Table of Contents 1 Chapter 01: Overview of Critical Care Nursing Chapter 02: Patient and Family Response to the Critical Care Experience Chapter 03: Ethical and Legal Issues in Critical Care Nursing Chapter 04: Palliative and End-of-Life Care Chapter 05: Comfort and Sedation Chapter 06: Nutritional Therapy Chapter 07: Dysrhythmia Interpretation and Management Chapter 08: Hemodynamic Monitoring Chapter 09: Ventilatory Assistance Chapter 10: Rapid Response Teams and Code Management Chapter 11: Organ Donation Chapter 12: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome Chapter 13: Cardiovascular Alterations Chapter 14: Nervous System Alterations Chapter 15: Acute Respiratory Failure Chapter 16: Acute Kidney Injury Chapter 17: Gastrointestinal Alterations Chapter 17: Hematological and Immune Disorders Chapter 19: Endocrine Alterations Chapter 20: Trauma and Surgical Management Chapter 21: Burns 2 14 30 42 56 69 83 117 137 156 171 189 207 225 243 260 285 312 341 361 377 Test Bank Introduction Critical Care Nursing 7th Edition (Sole 2016 ) Chapter 01: Overview of Critical Care Nursing 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: Discussthe 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 Test Bank Introduction Critical Care Nursing 7th Edition (Sole 2016 ) 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 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 patients and familys 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? Test Bank Introduction Critical Care Nursing 7th Edition (Sole 2016 ) 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 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 Test Bank Introduction Critical Care Nursing 7th Edition (Sole 2016 ) 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 critica 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 organizations vision. The SCCM promotes care from a multiprofessional team under the direction of a critical care physician. DIF: Cognitive Level: Knowledge REF: p. 4 OBJ: Discussthe 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 practicesto family members. b. ensure that patient teaching is done. c. meet the diversity needs of patients. Test Bank Introduction Critical Care Nursing 7th Edition (Sole 2016 ) 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, Im 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. He 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 patients 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 nurses 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 11. The family members of a critically ill, 90-year-old patient bring in a copy of the patients living will to the hospital, which identifies the patients wishes regarding health care. You discuss contents of the living will with the patients physician. This is an example of implementation of which of the AACN Standards of Professional Performance? a. Acquires and maintains current knowledge of practice Test Bank Introduction Critical Care Nursing 7th Edition (Sole 2016 ) 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 patients 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. Test Bank Introduction Critical Care Nursing 7th Edition (Sole 2016 ) c. reconcile medications acrossthe 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 Nationa Patient Safety Goal. 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. Test Bank Introduction Critical Care Nursing 7th Edition (Sole 2016 ) 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 evidencebased 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. b. Family members must be included in daily interdisciplinary rounds. c. Nurses and physicians must work collaboratively and synergistically to influence care. d. Unique needs of patients and their families influence nursing competencies. ANS: D The synergy model of practice is care based on the unique needs and characteristics of the patient and family members. Although critical care certification is based on the synergy model, the model does not specifically address certification. Inclusion of family members into the daily rounds is an example of implementation of the synergy model. With the focus on patients and family members with nurse interaction, the synergy model does not address physician collaboration. DIF: Cognitive Level: Application REF: p. 5 | Fig. 1-3 OBJ: Describe standards of professional practice for critical care nursing. TOP: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 17. A nurse who plans care based on the patients gender, ethnicity, spirituality, and lifestyle is said to: a. be a moral advocate. b. facilitate learning. Test Bank Introduction Critical Care Nursing 7th Edition (Sole 2016 ) c. respond to diversity. d. use clinical judgment. ANS: C Response to diversity considers all of these aspects when planning and implementing care. A moral agent helps resolve ethical and clinical concerns. Consideration of these factors does not necessarily facilitate learning. Clinical judgment uses other factors as well. DIF: Cognitive Level: Comprehension REF: p. 3 | Box 1-1 OBJ: Describe standards of professional practice for critical care nursing. TOP: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity MULTIPLE RESPONSE 1. Which of the following is a National Patient Safety Goal? (Select all that apply.) a. Accurately identify patients. b. Eliminate use of patient restraints. c. Reconcile medications across the continuum of care. d. Reduce risks of healthcare-acquired infection. ANS: A, C, D All except for eliminating use of restraints are current National Patient Safety Goals. Hospitals have policies regarding use of restraints and are attempting to reduce the use of restraints; however, this is not a National Patient Safety Goal. DIF: Cognitive Level: Analysis 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 2. Which of the following is (are) official journal(s) of the American Association of Critical-Care Nurses? (Select all that apply.) a. American Journal of Critical Care b. Critical Care Clinics of North America c. Critical Care Nurse d. Critical Care Nursing Quarterly Test Bank Introduction Critical Care Nursing 7th Edition (Sole 2016 ) ANS: A, C American Journal of Critical Care and Critical Care Nurse are two official AACN publications. Critical Care Clinics and Critical Care Nursing Quarterly are not AACN publications. DIF: Cognitive Level: Knowledge REF: p. 4 OBJ: Discussthe 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 3. The first critical care units were: (Select all that apply.) a. burn units. b. coronary care units c. recovery rooms. d. neonatal intensive care units. ANS: B, C Recovery rooms and coronary care units were the first units designated to care for critically ill patients. Burn and neonatal intensive care units were established as specialty units evolved. DIF: Cognitive Level: Knowledge REF: p. 2 OBJ: Define critical care nursing. TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment 4. Which of the following nursing activities demonstratesimplementation of the AACN Standards of Professional Performance? (Select all that apply.) a. Attending a meeting of the local chapter of the American Association of Critical-Care Nurses in which a continuing education program on sepsis is being taught b. Collaborating with a pastoralservices colleague to assist in meeting spiritual needs of the patient and family c. Participating on the units nurse practice council d. Posting an article from Critical Care Nurse on management of venous thromboembolism for your colleagues to read e. Using evidence-based strategies to prevent ventilator-associated pneumonia ANS: A, B, C, D, E All answers are correct. Attending a program to learn about sepsisAcquires and maintains current knowledge Test Bank Introduction Critical Care Nursing 7th Edition (Sole 2016 ) and competency in patient care. Collaborating with pastoral servicesCollaborates with the healthcare team to provide care in a healing, humane, and caring environment. Posting information for othersContributes to the professional development of peers and other healthcare providers. Nurse practice councilProvides leadership in the practice setting. Evidence-based practicesUses clinical inquiry in practice. 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 5. Which scenarios contribute to effective handoff communication at change of shift? (Select all that apply.) a. The nephrology consultant physician is making rounds and asks you to update her on the patients status and assist in placing a central line for hemodialysis. b. The noise level is high because twice as many staff members are present and everyone is giving report in the nurses station. c. The unit has decided to use a standardized checklist/tool for change-of-shift reports and patient transfers. d. You and the oncoming nurse conduct a standardized report at the patients bedside and review key assessment findings. ANS: C, D A reporting tool and bedside report improve handoff communication by ensuring standardized communication and review of assessment findings. Conducting report at the bedside also reduces noise that commonly occurs at the nurses station during a change of shift. The nephrologist has created an interruption that can impede handoff with the next nurse. Likewise, noise in the nurses station can cause distractions that can impair concentration and listening. DIF: Cognitive Level: Analysis REF: p. 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 6. Which strategy is important to addressing issues associated with the aging workforce? (Select all that apply.) a. Allowing nurses to work flexible shift durations b. Encouraging older nurses to transfer to an outpatient setting that is less stressful c. Hiring nurse technicians that are available to assist with patient care, such as turning the patient d. Remodeling patient care rooms to include devices to assist in patient lifting ANS: A, C, D Modifying the work environment to reduce physical demands is one strategy to assist the aging workforce. Test Bank Introduction Critical Care Nursing 7th Edition (Sole 2016 ) Examples include overhead lifts to prevent back injuries. Twelve-hour shifts can be quite demanding; therefore, allowing nurses flexibility in choosing shifts of shorter duration is a good option as well. Adequate staffing, including non-licensed assistive personnel, to help with nursing and non-nursing tasks is helpful. Encouraging experienced, knowledgeable critical care nurses to leave the critical care unit is not wise as the unit loses the expertise of this group. DIF: Cognitive Level: Analysis REF: p. 11 OBJ: Identify current trends and issues in critical care nursing. TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment 7. Which of the following strategies will assist in creating a healthy work environment for the critical care nurse? (Select all that apply.) a. Celebrating improved outcomes from a nurse-driven protocol with a pizza party b. Implementing a medication safety program designed by pharmacists c. Modifying the staffing pattern to ensure a 1:1 nurse/patient ratio d. Offering quarterly joint nurse-physician workshops to discuss unit issues e. Using the Situation-Background-Assessment-Recommendation (SBAR) technique for handoff communication ANS: A, D, E Meaningful recognition, true collaboration, and skilled communication are elements of a healthy work environment. Implementing a medication safety program enhances patient safety, and if done without nursing input, could have negative outcomes. Staffing should be adjusted to meet patient needs and nurse competencies, not have predetermined ratios that are unrealistic and possibly not needed. DIF: Cognitive Level: Analysis REF: p. 7 OBJ: Describe standards of professional practice for critical care nursing. TOP: Nursing Process Step: Implementation MSC: NCLEX: Safe and Effective Care Environment Test Bank Introduction Critical Care Nursing 7th Edition (Sole 2016 ) Chapter 02: Patient and Family Response to the Critical Care Experience MULTIPLE CHOICE 1. Family members have a need for information. Which interventions best assist in meeting this need? a. Handing family members a pamphlet that explains all of the critical care equipment b. Providing a daily update of the patients progress and facilitating communication with the intensivist c. Telling them that you are not permitted to give them a status report but that they can be present at 4:00 PM for family rounds with the intensivist d. Writing down a list of all new medications and doses and giving the list to family members during visitation ANS: B The nurse can give a status report related to the patients condition and current treatment plan as well as ensure that the family has daily meeting time with the intensivist for an update on diagnoses, prognoses, and the like. Pamphlets are helpful; however, the nurse should also explain the equipment that is at this patients bedside and not assume that everyone can read and understand written material. Limiting the information to that provided by the physician is unnecessary and will not meet the familys information needs. Most family members are concerned about the patients general condition and treatment plan. They do not want or need a detailed list of medications, doses, or other treatments. DIF: Cognitive Level: Analysis REF: p. 20 OBJ: Describe common family needs and family-centered nursing interventions. TOP: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 2. The nurse is a member of a committee to design a critical care unit in a new building. Which design trend would best to facilitate family-centered care? a. Ensure that the patients room is large enough and has adequate space for a sleeper sofa and storage for family members personal belongings. b. Include a diagnostic suite in close proximity to the unit so that the patient does not have to travel far for testing. c. Incorporate a large waiting room on the top floor of the hospital with a scenic view and amenities such as coffee and tea. d. Provide access to a scenic garden for meditation. ANS: A Test Bank Introduction Critical Care Nursing 7th Edition (Sole 2016 ) New unit design trends to promote family-centered care include larger patient rooms that include a larger family space and comfortable furniture and storage to promote open visitation, including overnight stays in the patients room. Ready access to diagnostic testing, including portable equipment, is an important trend; however, the purpose for this is to prevent the need for transport, not to foster family-centered care. A waiting room in close proximity to the unit with amenities is a nice feature; however, it does not need to be large if adequate space is incorporated into the patients room. A scenic garden for medication may assist in reducing family members stress, but proximity to the patient is the greatest need. DIF: Cognitive Level: Analysis REF: Table 2-2 OBJ: Describe common family needs and family-centered nursing interventions. TOP: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity 3. The nurse is caring for a patient who sustained a head injury and is unresponsive to painful stimuli. Which intervention is most appropriate while bathing the patient? a. Ask a family member to help you bathe the patient, and discuss the family structure with the family member during the procedure. b. Because she is unconscious, complete care as quickly and quietly as possible. c. Tell the patient the day and time, and that you are bathing her. Reassure her that you are there. d. Turn the television on to the evening news so that you and the patient can be updated to current events. ANS: C Although unconscious, many patients can hear, understand, and respond to stimuli. Therefore, it is important to converse with the patient and reorient her to the environment. Some, but not all, family members may want to get involved in direct care; it is not known if this individual is a willing participant, and talking about whos who in the family is not appropriate while providing direct care to the patient. Although she is unconscious, communication and simple conversations remain important interventions. Use of the television to provide sensory input that the patient regularly enjoys is a nursing intervention, but turning on the news for the sake of the nurse is not appropriate. DIF: Cognitive Level: Application REF: p. 16 OBJ: Describe stressors in the critical care environment and strategies to reduce them. TOP: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 4. Sleep often is disrupted for critically ill patients. Which nursing intervention is most appropriate to promote sleep and rest? a. Consult with the pharmacist to adjust medication times to allow periods of sleep or rest between intervals. b. Encourage family members to talk with the patient whenever they are present in the room. c. Keep the television on to provide white noise and distraction. Test Bank Introduction Critical Care Nursing 7th Edition (Sole 2016 ) d. Leave the lights on in the room so that the patient is not frightened of his or her surroundings. ANS: A Planning care to promote periods of uninterrupted rest is important. Consulting with the pharmacist to adjust a medication schedule is an excellent example of this intervention. It is important for family members to communicate with the patient; however, rest periods must be scheduled. Family members can be present in the room while remaining quiet during these scheduled times. The television may be useful if it is part of the patients normal routine for sleep; however, it does not consistently provide white noise or distraction. Lights should be dimmed during scheduled rest periods and at night to facilitate sleep and rest. DIF: Cognitive Level: Analysis REF: p. 16 OBJ: Discuss the impact of critical care hospitalization on the patient and family. TOP: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 5. Family assessment is essential in order to meet family needs. Which of the following must be assessed first to assist the nurse in providing family-centered care? a. Assessment of patient and familys developmental stages and needs b. Description of the patients home environment c. Identification of immediate family, extended family, and decision makers d. Observation and assessment of how family members function with each other ANS: C Assessment of the family structure is the first step and is essential before specific interventions can be designed. It identifies immediate family, extended family, and decision makers in the family. Structural assessment also includes ethnicity and religion. The developmental assessment is done after the structural assessment and includes the developmental stages of the patient and family. Functional assessment is also important to assess how family members function with each other; however, it is not done first. Assessment of the home environment is important when identifying discharge planning needs. DIF: Cognitive Level: Analysis REF: pp. 17-18 OBJ: Discuss the impact of critical care hospitalization on the patient and family. TOP: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity 6. Critical illness often results in family conflicts. Which scenario is most likely to result in the greatest conflict? a. A 21-year-old college student of divorced parents hospitalized with multiple trauma. She resides with her mother. The parents are amicable with each other and have similar values. The father blames the daughters boyfriend for causing the accident. Test Bank Introduction Critical Care Nursing 7th Edition (Sole 2016 ) b. A 36-year-old male admitted for a ruptured cerebral aneurysm. He has been living with his 34- year-old girlfriend for 8 years, and they have a 4-year-old daughter. He does not have written advance directives. His parents arrive from out-of-state and are asked to make decisions about his health care. He has not seen them in over a year. c. A 58-year-old male admitted for coronary artery bypass surgery. He has been living with his samesex partner for 20 years in a committed relationship. He has designated his sister, a registered nurse, as his healthcare proxy in a written advance directive. d. A 78-year-old female admitted with gastrointestinal bleeding. Her hemoglobin is decreasing to a critical level. She is a Jehovahs Witness and refuses the treatment of a blood transfusion. She is capable of making her own decisions and has a clearly written advance directive declining any transfusions. Her son is upset with her and tells her she is committing suicide. ANS: B Each of these situations may result in family conflict. The situation with the unmarried couple without written advance directives results in the distant parents being legally responsible for his healthcare decisions. Because of his long-standing commitment with his partner, and lack of recent contact with his parents, this scenario is likely to cause the most conflict. The parents may make decisions based on their wishes, as they may not be knowledgeable of the patients wishes. The supportive parents of the college student may create conflict with the boyfriend, but their ongoing friendship and shared values will assist in reducing conflict. The male admitted for bypass surgery, although in a same-sex relationship, has clearly identified who he wants to make healthcare decisions for him. The elderly female may have conflict with her son; however, she is capable of making her own decisions and has written advance directives to support her decisions. DIF: Cognitive Level: Analysis REF: pp. 17-18 OBJ: Discuss the impact of critical care hospitalization on the patient and family. TOP: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity 7. Which nursing interventions would best support the family of a critically ill patient? a. Encourage family members to stay all night in case the patient needs them. b. Give a condition update each morning and whenever changes occur. c. Limit visitation from children into the critical care unit. d. Provide beverages and snacksin the waiting room. ANS: B The need for information is one of the highest identified by family members of critically ill patients. New room designs provide space for family members to spend the night if desired; however, if the patient is stable, family members should be encouraged to sleep at home to ensure that they are well rested and can support the patient. Restriction of children in the critical care unit is not supported by research evidence. Child visitation should be individualized based on the needs and wishes of the patient and family. Beverages and snacks are important but not as important as information. DIF: Cognitive Level: Analysis REF: Box 2-2 Test Bank Introduction Critical Care Nursing 7th Edition (Sole 2016 ) OBJ: Describe common family needs and family-centered nursing interventions. TOP: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 8. Which intervention is appropriate to assist the patient to cope with admission to the critical care unit? a. Allowing unrestricted visiting by several family members at one time b. Explaining all procedures in easy-to-understand terms c. Providing back massage and mouth care d. Turning down the alarm volume on the cardiac monitor ANS: B Communication and explanations of procedures are priority interventions to help patients cope with admission. Comfort is an important intervention but not the priority. Noise control is an important intervention but not the priority. Open visitation is recommended; however, the number of family members may need to be limited to promote rest and sleep. DIF: Cognitive Level: Analysis REF: pp. 20-21 OBJ: Describe stressors in the critical care environment and strategies to reduce them. TOP: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 9. The constant noise of a ventilator, monitor alarms, and infusion pumps predisposes the patient to: a. anxiety. b. pain. c. powerlessness. d. sensory overload. ANS: D Constant noise is a source of sensory overload. Pain and lack of information contribute to anxiety. Noise does not cause physical pain. Lack of involvement in care causes powerlessness. DIF: Cognitive Level: Application REF: pp. 14-15 OBJ: Describe stressors in the critical care environment and strategies to reduce them. TOP: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity 10. Which of the following statements about family assessment is false? Test Bank Introduction Critical Care Nursing 7th Edition (Sole 2016 ) a. Assessment of structure (who comprises the family) is the last step in assessment. b. Interaction among family membersis assessed. c. It is important to assess communication among family members to understand roles. d. Ongoing assessment is important, because family functioning may change during the course of illness. ANS: A Assessment of structure should be done first so that the nurse can identify such things as who comprises the family and who assumes leadership and decision-making responsibilities. This assessment also assists in identifying which individuals are most important to the patient and how many people may be seeking information. Family member interaction must be assessed, so this answer is true. Family member communication must be assessed, so this answer is true. Ongoing assessment of family is necessary as functions may change, so this answer is true. DIF: Cognitive Level: Application REF: pp. 16-17 OBJ: Describe common family needs and family-centered nursing interventions. TOP: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity 11. Which intervention about visitation in the critical care unit is true? a. The majority of critical care nurses implement restricted visiting hours to allow the patient to rest. b. Children should never be permitted to visit a critically ill family member. c. Visitation that is individualized to the needs of patients and family members is ideal. d. Visiting hours should always be unrestricted. ANS: C Visiting should be based on the needs of patients and their families. There may be times that visiting needs to be limited (e.g., to allow the patient to rest); however, it is important to individualize visitation. Sometimes it is appropriate for children to visit; research has not found child visitation to be harmful to either the patient or the child. Visiting should be adjusted to patient needs. DIF: Cognitive Level: Analysis REF: pp. 21-22 | Box 2-2 OBJ: Describe common family needs and family-centered nursing interventions. TOP: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity 12. Elderly patients who require critical care treatment are at risk for increased mortality, functional decline, or decreased quality of life after hospitalization. Assuming each of these patients was discharged from the hospital, which of the following patients is at greatest risk for decreased functional status and quality of life? Test Bank Introduction Critical Care Nursing 7th Edition (Sole 2016 ) a. A 70-year-old who had coronary artery bypass surgery. He developed complications after surgery and had difficulty being weaned from mechanical ventilation. He required a tracheostomy and gastrostomy. He is being discharged to a long-term, acute care hospital. He is a widower. b. A 79-year-old admitted for exacerbation of heart failure. She manages her care independently but needed diuretic medications adjusted. She states that she is compliant with her medications but sometimes forgets to take them. She lives with her 82-year-old spouse. Both consider themselves to be independent and support each other. c. A 90-year-old admitted for a carotid endarterectomy. He lives in an assisted living facility (ALF) but is cognitively intact. He is the social butterfly at all of the events at the ALF. He is hospitalized for 4 days and discharged to the ALF. d. An 84-year-old who had stents placed to treat coronary artery occlusion. She has diabetes that has been managed, lives alone, and was driving prior to hospitalization. She was discharged home within 3 days of the procedure. ANS: A Although he is younger, the 70-year-old with the complicated critical care course, with limited social support, who is being discharged to a long-term acute care facility, is at greatest risk for decreased quality of life and functional decline. He will continue to need high-level nursing care and support for rehabilitation. The other cases are examples of individuals with shorter hospital stays, uncomplicated courses, and social support systems. DIF: Cognitive Level: Analysis REF: p. 17 OBJ: Discuss the impact of critical care hospitalization on the patient and family. TOP: Nursing Process Step: Evaluation MSC: NCLEX: Growth and Development 13. Patients often have recollections of the critical care experience. Which is likely the most common recollection from a patient who required endotracheal intubation and mechanical ventilation? a. Difficulty communicating b. Inability to get comfortable c. Pain d. Sleep disruption ANS: A Although the patient may recall all of these potential experiences, recollection of difficult communication is most likely secondary to the endotracheal tube placement. DIF: Cognitive Level: Analysis REF: p. 16 | Box 2-1 OBJ: Discuss the impact of critical care hospitalization on the patient and family. TOP: Nursing Process Step: Evaluation MSC: NCLEX: Psychosocial Integrity Test Bank Introduction Critical Care Nursing 7th Edition (Sole 2016 ) 14. Many critically ill patients experience anxiety. The nurse can reduce anxiety with which approach? a. Ask family members to limit their visitation to 2-hour periods in morning, afternoon, and evening. You know that this is the best approach to ensure uninterrupted rest time for the patient. Tell the patient, Mr. J., your family is in the waiting room. They will be permitted to come in at 2:00 PM after you take a short nap. b. Explain the unit routine. Mr. J., assessments are done every 4 hours; patients are bathed on the night shift around 5:00 AM; family members are permitted to visit you after the physicians make their morning rounds. They can spend the day. Lights are out every night at 10:00 PM. c. State, Mr. J., its time to turn you. I am going to ask another nurse to come in and help me. We will turn you to your left side. During the turn, Im going to inspect the skin on your back and rub some lotion on your back. This should help to make you feel better. d. Suction Mr. J.s endotracheal tube immediately when he starts to cough. Tell him, Mr. J., your tube needs suctioned; you should feel better after Im done. ANS: C Anxiety is reduced when procedures are explained prior to completing them. In this example, the nurse clearly explains what will be done and what the patient can expect during turning. Limiting family members, especially if they are already present in the hospital, is not an approach that will reduce anxiety. Family members can be present in the room while allowing the patient to rest. It is important to orient the patient to the unit, but the explanation of a unit routine does not give the patient any control over things such as bathing, sleep times, and visitors. Suctioning is important, but only when indicated, which might not be with every coughing episode. Additionally, it is important to explain the procedure and tell the patient what to expect. DIF: Cognitive Level: Analysis REF: pp. 16-17 OBJ: Describe stressors in the critical care environment and strategies to reduce them. TOP: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 15. Which statement is a likely response from someone who has survived a stay in the critical care unit? a. I dont remember much about being in the ICU, but if I had to be treated there again, it would be okay. Im glad I can see my grandchildren again. b. If I get that sick again, do not take me to the hospital. I would rather die than go through having a breathing tube put in again. c. My family is thrilled that I am home. I know I need some extra attention, but my children have rearranged their schedules to help me out. d. Since I have been transferred out of the ICU, I cannot get enough to eat. They didnt let me eat in the ICU, so Im making up for it now. ANS: A Test Bank Introduction Critical Care Nursing 7th Edition (Sole 2016 ) Survivors of critical illness express a variety of concerns; however, most identify a willingness to undergo critical care treatment to prolong survival. Most survivors are not going to decline treatment for future hospitalizations (B). Although the patients family may be thrilled that he or she is home, challenges to family dynamics often occur, especially if family members schedules and routines are disrupted (C). Many patients have poor appetites after discharge from critical care, not ravenous ones (D). DIF: Cognitive Level: Analysis REF: p. 17 OBJ: Discuss the impact of critical care hospitalization on the patient and family. TOP: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity 16. The nurse is assigned to care for a patient who is a non-native English speaker. What is the best way to communicate with the patient and family to provide updates and explain procedures? a. Conduct a Google search on the computer to identify resources for the patient and family in their native language. Print these for their use. b. Contact the hospitals interpreter service for someone to translate. c. Get in touch with one of the residents that you know is fluent in the native language and ask him if he can come up to the unit. d. Use the 8-year old child who is fluent in both English and the native language to translate for you. ANS: B The best approach when communicating with someone whose primary language is not English is to contact the interpreter services of the agency. These individuals are trained and knowledgeable. If the nurse conducted a search on the computer, she would not know if the information retrieved was valid nor would she know if the patient or family can read in their native language. Although one of the residents might be fluent in the language, you do not know his abilities to translate. In addition, his availability is likely to be limited. Although the child might be able to translate, the nurse cannot ensure that the child istranslating healthcare concepts correctly. DIF: Cognitive Level: Analysis REF: p. 18 OBJ: Discuss the impact of critical care hospitalization on the patient and family. TOP: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 17. Family assessment can be challenging and each nurse may obtain additional information regarding family structure and dynamics. What is the best way to share this information from shift to shift? a. Create an informal family information sheet that is kept on the bedside clipboard. That way, everyone can review it quickly when needed. b. Develop a standardized reporting form for family information that is incorporated into the patients medical record and updated as needed. c. Require that the charge nurse have a detailed list of information about each patient and family member. Thus, someone on the unit is always knowledgeable about potential issues. Test Bank Introduction Critical Care Nursing 7th Edition (Sole 2016 ) d. Try to remember to discuss family structure and dynamics as part of the change-of-shift report. ANS: B A standardized method for gathering data about family structure and function and recording it in an official document is the best approach. This strategy ensures that data are collected and kept in the medical record. Data are also easily retrievable by anyone who needs to know this information. Informal documentation is often kept to assist in follow-up and change-of-shift reporting; however, this strategy is not recommended, as data collected are likely to vary and not be part of a permanent record. Although the charge nurse often has some information regarding families, the primary responsibility for assessment and follow-up belongs to the bedside nurse. Family information should be shared at change of shift using a standardized format, not try to remember to discuss . DIF: Cognitive Level: Analysis REF: p. 18 OBJ: Discuss the impact of critical care hospitalization on the patient and family. TOP: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 18. The wife of a patient who is hospitalized in the critical care unit following resuscitation for a sudden cardiac arrest at work demands to meet with the nursing manager. She states, I want you to reassign my husband to another nurse. His current nurse is not in the room enough to make sure he is okay. The nurse recognizes that this response most likely is due to the wifes: a. desire to pursue a lawsuit if the assignment is not changed. b. inability to participate in the husbands care. c. lack of prior experience in a critical care setting. d. sense of loss of control of the situation. ANS: D Demanding behaviors often occur when the family member has a sense of loss of control or has had adverse outcomesin a previous hospitalization. Prevention of a lawsuit is not relevant to this scenario. No information is provided regarding whether the family member is participating in care or not. It is not known if she had a prior negative experience or not. DIF: Cognitive Level: Analysis REF: pp. 17-18 OBJ: Discuss the impact of critical care hospitalization on the patient and family. TOP: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 19. Open visitation policies are expected by many professional organizations. Which statement reflects adherence to current recommendations? a. Allow animals on the unit; however, these can only be therapy animals through the hospitals pet Test Bank Introduction Critical Care Nursing 7th Edition (Sole 2016 ) therapy program. b. Allow family visitation throughout the day except at change of shift and during rounds. c. Determine, in collaboration with the patient and family, who can visit and when. Facilitate open visitation policies. d. Permit open visitation by adults 18 years of age and older; limit visits of children to 1 hour. ANS: C Open visitation is recommended by both the Society of Critical Care Medicine (SCCM) and the American Association of Critical-Care Nurses. SCCM suggests developing visitation schedulesin collaboration with the patient and family. Animals do not need to be limited to therapy animals. Many patients benefit by the presence of their personal pets that are brought to the unit according to hospital policy. Although many units restrict visitation during report and rounds, the organizations encourage that such restrictions be loosened. Many institutions encourage family participation during report and rounds. Children should not be banned arbitrarily from the unit or have hours limited. DIF: Cognitive Level: Analysis REF: pp. 21-22 | Box 2-2 OBJ: Identify strategies for promoting visitation and family presence in the critical care setting. TOP: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 20. The VALUE mnemonic is a helpful strategy to enhance communication with family members of critically ill patients. Which of the following statements describes a VALUE strategy? a. View the family as guests on the unit. b. Acknowledge family emotions. c. Learn as much as you can about family structure and function. d. Use a trained interpreter if the family does not speak English. e. Evaluate each encounter with the family. ANS: B The VALUE mnemonic includes the following: VValue what the family tells you. AAcknowledge family emotions. LListen to the family members. UUnderstand the patient as a person. Test Bank Introduction Critical Care Nursing 7th Edition (Sole 2016 ) EElicit (ask) questions of family members. DIF: Cognitive Level: Comprehension REF: pp. 20-21 | Box 2-3 OBJ: Describe common family needs and family-centered nursing interventions. TOP: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 21. Changing visitation policies can be challenging. The nurse manager recognizes the following as an effective strategy for promoting changes in practice: a. Ask the clinical nurse specialist to lead a journal club on open visitation after each nurse is tasked to read one research article about visitation. b. Discuss pros and cons of open visitation at the next staff meeting. c. Invite the nurses with the most experience to develop a revised policy. d. Task the unit-based nurse practice council to invite volunteers to serve on the council to revise the current policy toward more liberal visitation. ANS: D Changes in policy are most effective through willing champions as part of a unit-based, staff-led practice council. Discussion of evidence-based findings is important, but it is not logical to expect every nurse to read a research article and share findings. Discussion of pros and cons at a staff meeting is likely to be prolonged and based on opinion rather than evidence. Nurses with the most experience are not necessarily the ones to develop a new policy. They may be the least likely to change; therefore, it is important to solicit volunteers from all staff members, not just the experienced ones. DIF: Cognitive Level: Analysis REF: pp. 21-22 | Box 2-2 OBJ: Identify strategies for promoting visitation and family presence in the critical care setting. TOP: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity MULTIPLE RESPONSE 1. Nursing strategies to help families cope with the stress of critical illness include: (Select all that apply.) a. asking the family to leave during the morning bath to promote the patients privacy. b. encouraging family membersto make notes of questions they have for the physician during family rounds. c. if possible, providing continuity of nursing care. d. providing a daily update of the patients condition to the family spokesperson. Test Bank Introduction Critical Care Nursing 7th Edition (Sole 2016 ) ANS: B, C, D Encouraging families to formulate questions assists in family care. Continuity of nursing care with consistent staff members assists in reducing stress. Communication of patient condition update meets the need for information. Family members often want to assist with simple activities of patient care, so limiting participation is the exception to this list. DIF: Cognitive Level: Application REF: pp. 18-19 OBJ: Describe common family needs and family-centered nursing interventions. TOP: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 2. Family presence is encouraged during resuscitation and invasive procedures. The nurse knows that nurses are often reluctant to allow this to occur, yet families often perceive benefits. Which findings have been reported in the literature? (Select all that apply.) a. Families benefit by witnessing that everything possible was done. b. Families report reduced anxiety and fear about what is being done to the patient. c. Presence encourages family members to seek litigation for improper care. d. Presence reduces nurses involvement in explaining things to the family. ANS: A, B Families benefit from witnessing procedures and resuscitation. Being present helps family members to remove doubt about the condition, witness that everything was done, and decrease anxiety about what is occurring. Increased litigation has not been associated with family presence. Policies and procedures are needed to facilitate family presence. A facilitator is needed, and it may initially require more nursing involvement. It does not eliminate nurses responsibility for communicating with the family. DIF: Cognitive Level: Analysis REF: p. 22 OBJ: Identify strategies for promoting visitation and family presence in the critical care setting. TOP: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 3. Noise in the critical care unit can have negative effects on the patient. Which of the following interventions assists in reducing noise levels in the critical care setting? (Select all that apply.) a. Ask the family to bring in the patients i-Pod or other device with favorite music. b. Invite the volunteer harpist to play on the unit on a regular basis. c. Remodel the unit to have two-patient rooms to facilitate nursing care. d. Remodel the unit to install acoustical ceiling tiles. Test Bank Introduction Critical Care Nursing 7th Edition (Sole 2016 ) e. Turn the volume of equipment alarms as low as they can be adjusted, and off if possible. ANS: A, B, D A personal device with favorite music and headphones can be helpful in reducing ambient unit noise. Music therapy programs, such as harpists, can provide soothing sedative music that is often comforting to both patients and family members. Acoustical tiles help to reduce noise in the critical care setting and should be included in remodeling plans as well as new unit construction. Multiple patients in a single room would increase noise levels and contribute to an increased risk of infection. Alarms on critical equipment must never be turned off. The volume should be loud enough that the alarm can be heard by the nurse if outside the room. The lowest setting may not be loud enough, depending on the unit layout and patient assignment. DIF: Cognitive Level: Analysis REF: p. 15 OBJ: Describe stressors in the critical care environment and strategies to reduce them. TOP: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 4. It is important for critically ill patients to feel safe. Which nursing strategies help the patient to feel safe in the critical care setting? (Select all that apply.) a. Allow family members to remain at the bedside. b. Be sure to consult with the charge nurse before making any patient care decisions. c. Provide informal conversation by discussing your plans for after work. d. Respond promptly to call bells or other communication for assistance. ANS: A, D Patients feel safe when nurses exhibit technical competence, meet their needs, and provide reorientation. Family member presence may also contribute to feeling safe. Consulting with the charge nurse before making decisions may be interpreted as incompetence or insecurity. The nurses personal activities should never be discussed with patients. DIF: Cognitive Level: Analysis REF: p. 16 OBJ: Describe stressors in the critical care environment and strategies to reduce them. TOP: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 5. The critical care environment is often stressful to a critically ill patient. Identify stressors that are common. (Select all that apply.) a. Alarms that sound from various devices b. Bright, fluorescent lighting Test Bank Introduction Critical Care Nursing 7th Edition (Sole 2016 ) c. Lack of day-night cues d. Sounds from the mechanical ventilator e. Visiting hours tailored to meet individual needs ANS: A, B, C, D Adjustment of visiting hoursto meet needs of patients and families assists in reducing the stress of critical illness. All other responses are environmental stressors that increase anxiety, affect sleep, and the like. DIF: Cognitive Level: Comprehension REF: pp. 15-16 OBJ: Describe stressors in the critical care environment and strategies to reduce them. TOP: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity 6. A patient and his family are excited that he is transferring from the critical care unit to the intermediate care unit. However, they are also fearful of the change in environment and nursing staff. To reduce relocation stress the nurse can: (Select all that apply.) a. ask the nurses on the intermediate care unit to give the family a tour of the new unit. b. contact the intensivist to see if the patient can stay one additional day in the critical care unit so that he and his family can adjust better to the idea of a transfer. c. ensure that the patient will be located near the nurses station in the new unit. d. invite the nurse who will be assuming the patients care to meet with the patient and family in the critical care unit prior to transfer. ANS: A, D Patients often have stress when they are moved from the safety of the critical care unit. Introducing the patient and his family to the nurse who will assume care and to the new environment are strategies to reduce relocation stress. Although the patient and his family may feel safer in a room near the nurses station, bed placement is determined by a variety of factors and cannot be guaranteed. Beds in the critical care unit are at a premium, and once the physician has determined that the patient no longer meets critical care admission requirements, it is essential that transfers be made once a bed on the intermediate care unit is available. DIF: Cognitive Level: Analysis REF: p. 17 OBJ: Describe stressors in the critical care environment and strategies to reduce them. TOP: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 7. The critical care environment is stressful to the patient. Which interventions assist in reducing this stress? (Select all that apply.) a. Adjust lighting to promote normal sleep-wake cycles. Test Bank Introduction Critical Care Nursing 7th Edition (Sole 2016 ) b. Provide clocks, calendars, and personal photos in the patients room. c. Talk to the patient about other patients you are caring for on the unit. d. Tell the patient the day and time when you are providing routine nursing interventions. ANS: A, B, D Manipulation of the environment, such as adjusting lighting, is helpful in promoting sleep and rest; clocks, calendars, photos, and othe