NCLEX CRITICAL CARE TEST 1 

NCLEX CRITICAL CARE TEST 1  Ch 1 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. 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. 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. 4.The synergy model of practice focuses on: a. allowing unrestricted visiting for the patient 24 hours each day. b . holistic and alternative therapies. c. needs of patients and their families, which drives nursing competency. d . patients’ needs for energy and support. ANS: C The synergy model of practice states that the needs of patients and families influence and drive competencies of nurses. Nursing practice based on the synergy model would involve tailored visiting to meet the patient’s and family’s needs and application of alternative therapies if desired by the patient, but that is not the primary focus of the model. 5.The family of your critically ill patient tells you that they have not spoken with the physician in over 24 hours and they have some questions that they want clarified. During morning rounds, you convey this concern to the attending intensivist and arrange for her to meet with the family at 4:00 PM in the conference room. Which competency of critical care nursing does this represent? a. Advocacy and moral agency in solving ethical issues b . Clinical judgment and clinical reasoning skills c. Collaboration with patients, families, and team members d . Facilitation of learning for patients, families, and team members ANS: C Although one might consider that all of these competencies are being addressed, communication and collaboration with the family and physician best exemplify the competency of collaboration. 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. 7.The charge nurse is responsible for making the patient assignments on the critical care unit. She assigns the experienced, certified nurse to care for the acutely ill patient with sepsis who also requires continuous renal replacement therapy and mechanical ventilation. She assigns the nurse with less than 1 year of experience to two patients who are more stable. This assignment reflects implementation of the: a. crew resource management model b . National Patient Safety Goals c. Quality and Safety Education for Nurses (QSEN) model d . synergy model of practice ANS: D This assignment demonstrates nursing care to meet the needs of the patient. The synergy model notes that the nurse competencies are matched to the patient characteristics. Crew resource management concepts related to team training, National Patient Safety Goals are specified by The Joint Commission to promote safe care but do not incorporate the synergy model. The Quality and Safety Education for Nurses initiative involves targeted education to undergraduate and graduate nursing students to learn quality and safety concepts. 8.The vision of the American Association of Critical-Care Nurses is a healthcare system driven by: a. a healthy work environment. b . care from a multiprofessional team under the direction of a critical care physician. c. the needs of critically ill patients and families. d . respectful, healing, and humane environments. ANS: C The AACN vision is a healthcare system driven by the needs of critically ill patients and families where critical care nurses make their optimum contributions. AACN promotes initiatives to support a healthy work environment as well as respectful and healing environments, but that is not the organization’s vision. The SCCM promotes care from a multiprofessional team under the direction of a critical care physician. 9.The most important outcome of effective communication is to: a. demonstrate caring practices to family members. b . ensure that patient teaching is done. c. meet the diversity needs of patients. d . reduce patient errors. ANS: D Many errors are directly attributed to faulty communication. Effective communication has been identified as an essential strategy to reduce patient errors and resolve issues related to patient care delivery. Communication may demonstrate caring practices, be used for patient/family teaching, and address diversity needs; however, the main outcome of effective communication is patient safety. 10.You are caring for a critically ill patient whose urine output has been low for 2 consecutive hours. After a thorough patient assessment, you call the intensivist with the following report. Dr. Smith, I’m calling about Mrs. P., your 65-year-old patient in CCU 10. Her urine output for the past 2 hours totaled only 40 mL. She arrived from surgery to repair an aortic aneurysm 4 hours ago and remains on mechanical ventilation. In the past 2 hours, her heart rate has increased from 80 to 100 beats per minute and her blood pressure has decreased from 128/82 to 100/70 mm Hg. She is being given an infusion of normal saline at 100 mL per hour. Her right atrial pressure through the subclavian central line is low at 3 mm Hg. Her urine is concentrated. Her BUN and creatinine levels have been stable and in normal range. Her abdominal dressing is dry with no indication of bleeding. My assessment suggests that Mrs. P. is hypovolemic and I would like you to consider increasing her fluids or giving her a fluid challenge. Using the SBAR model for communication, the information the nurse gives about the patient’s history and vital signs is: a.Situation b . Background c. Assessment d . Recommendation ANS: B The history and vital signs are part of the background. Information regarding the low urine output is the situation. Information regarding possible hypovolemia is part of the nurse’s assessment, and the suggestion for fluids is the recommendation. 11.The family members of a critically ill, 90-year-old patient bring in a copy of the patient’s living will to the hospital, which identifies the patient’s wishes regarding health care. You discuss contents of the living will with the patient’s physician. This is an example of implementation of which of the AACN Standards of Professional Performance? a.Acquires and maintains current knowledge of practice b . Acts ethically on the behalf of the patient and family c. Considers factors related to safe patient care d . Uses clinical inquiry and integrates research findings in practice ANS: B Discussing end-of-life issues is an example of a nurse acting ethically on behalf of the patient and family. The example does not relate to acquiring knowledge, promoting patient safety, or using research in practice. 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. 13.Comparing the patient’s current (home) medications with those ordered during hospitalization and communicating a complete list of medications to the next provider when the patient is transferred within an organization or to another setting are strategies to: ve accuracy of patient identification. b . prevent errors related to look-alike and sound-alike medications. c. reconcile medications across the continuum of care. d . reduce harms associated with administration of anticoagulants. ANS: C These are steps recommended in the National Patient Safety Goals to reconcile medications across the continuum of care. Improving accuracy of patient identification is another National Patient Safety Goal. Preventing errors related to look-alike and sound-alike medications is done to improve medication safety, not medication reconciliation. Reducing harms associated with administration of anticoagulants is another National Patient Safety Goal. 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: e 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. 15.You work in an intermediate care unit that has experienced high nursing turnover. The nurse manager is often considered to be an autocratic leader by staff members and her leadership style is contributing to turnover. You have asked to be involved in developing new guidelines to prevent pressure ulcers in your patient population. The nurse manager tells you that you do not yet have enough experience to be on the prevention task force. This situation and setting is an example of: a.a barrier to handoff communication. b . a work environment that is unhealthy. c. ineffective decision making. d . nursing practice that is not evidence-based. ANS: B These are examples of an unhealthy work environment. A healthy work environment values communication, collaboration, and effective decision making. It also has authentic leadership. It is not an example of handoff communication, which is communication that occurs to transition patient care from one staff member to another. Neither does it relate to ineffective decision making. As a nurse, you can still implement evidence-based practice, but your influence in the unit is limited by the unhealthy work environment. 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. 17.A nurse who plans care based on the patient’s gender, ethnicity, spirituality, and lifestyle is said to: a moral advocate. b . facilitate learning. 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. 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. 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 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. 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. 4.Which of the following nursing activities demonstrates implementation of the AACN Standards of Professional Performance? (Select all that apply.) Attending a meeting of the local chapter of the American Association of Critical-Care a. Nurses in which a continuing education program on sepsis is being taught b Collaborating with a pastoral services colleague to assist in meeting spiritual needs of the . patient and family c. Participating on the unit’s 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 sepsis—Acquires and maintains current knowledge and competency in patient care. Collaborating with pastoral services—Collaborates with the healthcare team to provide care in a healing, humane, and caring environment.Posting information for others—Contributes to the professional development of peers and other healthcare providers. Nurse practice council—Provides leadership in the practice setting. Evidence-based practices—Uses clinical inquiry in practice. 5.Which scenarios contribute to effective handoff communication at change of shift? (Select all that apply.) The nephrology consultant physician is making rounds and asks you to update her on the a. patient’s 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 nurse’s station. The unit has decided to use a standardized checklist/tool for change-of-shift reports and c. patient transfers. d You and the oncoming nurse conduct a standardized report at the patient’s 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 nurse’s station during a change of shift. The nephrologist has created an interruption that can impede handoff with the next nurse. Likewise, noise in the nurse’s station can cause distractions that can impair concentration and listening. 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 Hiring nurse technicians that are available to assist with patient care, such as turning the c. 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. 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. 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 Using the Situation-Background-Assessment-Recommendation (SBAR) technique for e. 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. Ch 2 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 patient’s progress and facilitating communication with the . intensivist Telling them that you are not permitted to give them a status report but that they can be c. 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 patient’s 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 patient’s 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 family’s information needs. Most family members are concerned about the patient’s general condition and treatment plan. They do not want or need a detailed list of medications, doses, or other treatments. 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? Ensure that the patient’s room is large enough and has adequate space for a sleeper sofa and a. 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. Incorporate a large waiting room on the top floor of the hospital with a scenic view and c. amenities such as coffee and tea. d . Provide access to a scenic garden for meditation. ANS: A 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 patient’s 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 patient’s room. A scenic garden for medication may assist in reducing family members’ stress, but proximity to the patient is the greatest need. 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? Ask a family member to help you bathe the patient, and discuss the family structure with the a. family member during the procedure. b . Because she is unconscious, complete care as quickly and quietly as possible. Tell the patient the day and time, and that you are bathing her. Reassure her that you are c. 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 who’s 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. 4.Sleep often is disrupted for critically ill patients. Which nursing intervention is most appropriate to promote sleep and rest? Consult with the pharmacist to adjust medication times to allow periods of sleep or rest a. 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. 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 patient’s 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. 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 family’s developmental stages and needs b . Description of the patient’s 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. 6.Critical illness often results in family conflicts. Which scenario is most likely to result in the greatest conflict? 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. a. The father blames the daughter’s boyfriend for causing the accident. 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 b 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. A 58-year-old male admitted for coronary artery bypass surgery. He has been living with his same-sex partner for 20 years in a committed relationship. He has designated his sister, a c. registered nurse, as his healthcare proxy in a written advance directive. A 78-year-old female admitted with gastrointestinal bleeding. Her hemoglobin is decreasing to a critical level. She is a Jehovah’s Witness and refuses the treatment of a blood transfusion. She is capable of making her own decisions and has a clearly written advance d directive declining any transfusions. Her son is upset with her and tells her she is . “committing suicide.”