Critical Care Exam 1 SG Questions And Answers With Verified Solutions

Which of the following statements about pain is NOT true? a. pain is a uniquely subjective experience and therefore it is whatever the patient says it is and exists whenever the patient says it does. b. pain is a global experience, meaning it has sensory, affective, cognitive, behavioral, and physiologic components. c. physiologic data is the best way to assess patients' pain. d. the experience of pain is associated with potential or actual threats to physiologic integrity. e. unmanaged pain is associated with adverse patient outcomes in all domains of human experience. - c Nurses understand that managing pain in critically ill patients while crucial can be challenging for the following reasons: a. Patients often have diminished ability to communicate. b. Patients are often coping with multiple stressors which may heighten their perception of pain. c. Patients in ICU settings are often drug-seeking making it difficult to distinguish actual pain from reported pain. d. a and b only e. All of the above - d The nurse understands that neuropathic pain is believed to be driven by peripheral or central nervous system dysfunction and can occur in the absence of actual tissue inflammation or damage. Which of the following patients is most at risk for experiencing neuropathic pain? a. A 62 year old patient with poorly controlled diabetes. b. A 36 year old patient with a chest tube for a tension pneumothorax c. A 68 year old patient with urinary retention and a history of BPH, with bladder scan demonstrating approximately 850 cc urine d. A 42 year old patient who is post-op day 1 from a cholecystectomy e. An 18 year old patient with a post-op wound infection - a The nurse understands that patient report is the best way to assess pain. However, Mr. Jones has significant cognitive impairment that prevents him from participating in the process. The nurse knows that the following may be non-verbal indicators that Mr. Jones is experiencing pain: a. He has become increasingly agitated over the past hour b. He ate all of his breakfast and lunch but is refusing dinner c. He stiffened and grabbed the side rails when the nurse and PCT attempted to assist him out of bed d. He grimaces when he changes positions in bed e. All of the above - e The nurse understands that opioids are associated with many side effects. The most concerning side effect in patients with complex illness conditions is respiratory depression. Which of the following are the most reliable indicators of respiratory depression? a. A new onset of extreme agitation and hypertension in a previously quiet normo-tensive (BP within normal limits) patient b. Respiratory rate of 8/minute, elevated C02, decreased O2 saturation c. A rise in oxygen saturation, fall in C02 levels and tachycardia d. Somnolence, lack of appetite, and difficulty ambulating e. History of opioid addiction, change in level of consciousness, respiratory rate 12/minute - b he nurse has just completed inter-shift handover of care. Which of the following patients on the nurse's assignment is at risk for altered levels of consciousness (sedation/agitation)? a. A 74 year old woman with a history of COPD, CHF, and diabetes transferred to the unit following hip replacement surgery b. A 55 year old man with a history of ETOH admitted with pneumonia c. An 18 year old man status post appendectomy readmitted with high fever, hypotension, and intractable nausea and vomiting d. A 46 year old woman with metastatic breast cancer who was just started on hydromorphone via patient-controlled analgesia pump e. All of the above - e The nurse understands that in order to enhance patient safety, the most important step before administering a sedative is: a. To assess and treat modifiable factors (such as electrolyte imbalances, pain, hypoxia) that may be contributing to agitation b. To apply soft restraints c. To create a soothing environment by turning off the lights and playing classical music in the patient's room d. To teach the patient deep breathing to promote relaxation e. To send all family visitors home as they are likely increasing the patient's agitation - a Which of the following statements regarding management of agitation/sedation is true? a. All sedating meds have analgesic properties. Therefore, administering both pain medications and sedatives to a patient is always contraindicated. b. Spontaneous breathing trials (SBT) or awakening trials (SAT) are considered best practice for deeply sedated patients in an ICU setting c. Benzodiazepines are considered the best choice for sedation in critically ill patients because of the low risk of delirium. d. Propofol is the sedative of choice in non-intubated patients due to its reliable amnesic and analgesic effects, and low risk of respiratory depression. e. Central alpha agonists such as clonidine are contraindicated for agitation associated with alcohol withdrawal. - b The nurse understands that delirium is a global impairment of cognitive processes and represents acute brain dysfunction. Which of the following factors are reliable indicators of delirium? a. Physical agitation b. Paranoid delusions c. An acute change in mental status or persistent fluctuations in mental status d. Inattention e. C and D - e The nurse understands that a long-acting benzodiazepine would be contraindicated in the treatment of delirium in all of the following situations, except: a. An elderly patient with heart failure b. A patient with multiple co-morbidities c. A patient with delirium tremens (DTs) due to ETOH withdrawal d. A patient with dementia e. A patient with COPD admitted with pneumonia - c A common nerve injury for patients placed in the supine position during an operation is: a. Brachial plexus injury b. Obturator nerve injury c. Heel decubitus d. Pulmonary emobli - a Specifically in the lateral position, preventive measures INCLUDE: a. Pillows between the knees and feet b. Extra padding if the patient is thin c. Padding under the dependent ankle and knee d. A&C e. All of the above - d In the lithotomy position, legs must be raised and lowered slowly in order to: a. Prevent the patient from falling off the bed b. Allow blood volume changes to adjust and prevent torsion injuries c. Reduce the potential for nerve damage to the brachial plexus d. Allow adequate lung expansion - b Which below BEST describes the optimum patient position during the operative procedure: a. Provides access and exposure, maintains circulatory and respiratory functions with access to IV lines and monitoring equipment, and does not compromise neuromuscular structures b. Provides optimum access and exposure to the surgical site, with no permanent compromise to neuromuscular structures c. Provides access for the surgeon, does not compromise the neuromuscular structures and maintains an adequate airway for the anesthetist d. Maintains circulatory and respiratory functions and maintains body alignment - a The preprocedure verification process reviews which of the following (SELECT ALL THAT APPLY): a. The patient's insurance b. The patient's correct identity c. The correct site being operated on d. The correct procedure e. Blood type - bcd When is the surgical time out is performed, this is the second of three checklists performed in the perioperative setting: a. When the patient enters the room b. Immediately before skin incision c. Immediately before draping of the patient d. Immediately before the patient is positioned and prepped - b When is a surgical site marking performed and by whom: a. In the preop clinic the day before the surgery by the NP b. In the surgical admission suit by the surgical admission nurse c. In the surgical admission suit by a licensed practitioner that is involved in the surgery d. In the operating room during the first check list by the circulating nurse - c Nursing interventions for maintaining normothermia in the perioperative patient takes place (SELECT ALL THAT APPLY): a. Before surgery in the surgical admission suit (SAS) b. In the surgical waiting area upon check-in at the hospital before going to the surgical admission suit (SAS) c. In the operating room d. In the post anesthesia care unit (PACU) - acd Adverse outcomes that result from hypothermia in the perioperative patient include all of the following EXCEPT: a. Increased blood loss b. Decreased risk of postoperative shivering c. Increased risk of surgical site infections d. Myocardial ischemia - b The causes of unplanned perioperative hypothermia include all of the following EXCEPT: a. General anesthesia induced heat loss b. Patient age c. The room temperature being set above 70 degrees F d. Oxygen saturation e. B&C - c Which of the following are potential adverse outcomes of ineffective nurse care handovers? a. Delays in diagnosis b. Increased cost and length of stay c. Patient dissatisfaction d. Nursing care based on inaccurate or incomplete information e. All the above - e The majority of adverse events during TCs are related to which of the following issues? a. Family members refusal to be involved in patient care b. Ineffective communication and information among caregivers c. Inaccuracy of patient provided information d. Lack of willingness of disciplines to work collaboratively e. Insurance companies' reimbursement policies - b According to Holly and Poletick, aside from conveying patient information what other purpose does shift report or intershift handover of care serve? Check all that apply. a. Provides nurses with opportunities to provide and receive support from colleagues b. Increases team cohesion by through social interactions that lead to shared values and development of a group identity c. Provides nurses an opportunity to gossip about other members of the health care team d. Provide a venue to orient new nurses to the unit culture e. Provide opportunities for nurses to develop workarounds of unit policies they don't like - abd Which characteristics of patient care handovers or TCs were most consistently related to adverse outcomes? Check all that apply. a. Inconsistency in content included b. Lack of respect for the roles of other disciplines c. Unstructured format d. Including health care providers outside of nursing in information exchange e. Variability in patient health literacy levels - ac Bedside shift reports have been promoted (and supported by evidence) as a way to improve communication during patient handover at change of shift. Which of the following have been cited as potential drawbacks of this approach? Check all that apply. a. Lack of focus on medications, leading to more med errors b. A dramatic increase in length of time for change of shift, leading to increased costs related to overtime c. Patients' and families' general unwillingness to be involved in information exchange d. Nurses' concerns about protecting patient privacy e. Nurses' discomfort related to discussing topics of a sensitive nature in front of non-nurses - de According to Ong et al., what challenges are unique to intrahospital transfers (versus intershift handover)? Check all that apply. a. The coordination effort required in patient transportation b. The difficulty in sharing information across disciplines and department c. Lack of standardization in the content and process of information sharing d. Lack of training on handover practices and communication skills e. Differences in expectations, expertise, work processes and culture among different units or departments - abe Which of the following interventions has been associated with decreases in adverse events associated with patient care handovers during intrahospital transfers? Check all that apply. a. Use of a dedicated ICU liaison nurse to facilitate transfers to and from the ICU setting b. Having supervisors observe and evaluate in real time, nurses exchange information during patient care handovers c. Use of a specialized transport team for inter- and intrahospital transfers of critical care patients d. Mandating that all information exchange take place in electronic format only e. Having the referring team send a transfer form that must be filled out by the physician before the handover of care - ac Which of the following are core elements in discharge teaching of patient and families? Check all that apply. a. Reviewing disease conditions and the results of pertinent test results b. Reviewing and reconciling medications c. Advising the patient not to take any medications that he was taking before hospitalization d. Reinforcing signs and symptoms that warrant notification of health care provider and providing contact information for the appropriate providers e. Encouraging the patient to use the internet as his primary source for reliable information about his condition and its treatment. - abd Recommendations for improving outcomes of discharge teaching emphasize a patient-centered approach. Which of the following are consistent with this type of approach? Check all that apply. a. Asking the family to step out of the room, so that the patient will be the center of attention during teaching. b. Assessing the patient's baseline level of understanding (health literacy) c. Tailoring the discharge instruction to the patient's characteristics and situation. d. Including a method of assessing patient learning, such as teach-back e. Discouraging involvement of other disciplines to avoid confusing the patient - bcd Adverse outcomes of poorly managed hospital discharges include which of the following? a. Unplanned hospital readmission or use of emergency/urgent care b. Patient and caregiver inability to manage at home c. Adverse medication events d. Lack of recommended follow-up e. All of the above - e According to the Institute of Medicine Report (IOM) in 2001 there are 6 core ingredients of high quality health care. Which of the following is (are) NOT on that list? (Check all that apply). a. Patient-centered care b. Highly specialized care delivered exclusively in specialty care clinics c. Care that emphasizes patient safety d. Efficiency e. Care provided exclusively by physician-led teams - be According to Kitson et al., the following are common core elements of PCC across health policy, medicine and nursing disciplines. (Check all that apply) a. Patient and family member involvement b. Policies and an environment that support PCC c. Requirement that all patients complete advance directives d. Open, effective communication between patient and provider and among members of health care team e. A "zero tolerance" policy for deviations from established protocols, policies, and procedures - abd Kitson and colleagues concluded that although there was consensus around some facets of PCC, there were differences among the disciplines with respect to areas of focus on PCC. Which statement best summarizes the unique focus of nursing as it applies to PCC? a. Primary importance on the individual nurse-patient relationship b. Personal qualities such as politeness, being respectful, and having good manners, are more important than competence in delivering patient care c. Focus on the patient, not on the caregiver or family members d. Protecting the patient from interference by other disciplines e. The need for a systematic and comprehensive assessment of patient needs and respect for patient values and preferences - e Based on the readings and your experience to-date, which of the following concepts are essential to patient-centered care planning? (Check all that apply) a. The nurse is the sole expert in the care planning process b. Respect and dignity are foundational to the care planning process; including honoring patient perspectives, values, beliefs, choices, cultural background c. Communication that is timely, transparent, accurate and complete among all members of the health care team d. If patients are non-compliant with care recommendations it is always due to a knowledge deficit on their part e. The patient and family are essential members of the health care team and should be included in the assessment, planning, execution and evaluation of care - bce Which of the following are examples of transitions in care (TC)? (Check all that apply). a. Patient is admitted to the hospital from home b. Patient is transferred from the Cardiac Intensive Care Unit to a general medical floor within the same hospital c. Nursing change of shift d. Patient is discharged home e. Patient is transferred to a skilled nursing facility for rehab following a hip replacement. - abcde Why has TC emerged as a high priority area in health care reform? a. Hospitals want to reduce the number of lawsuits b. Insurance companies are reluctant to advocate for safe, effective TC c. Effective management of TC has the potential to reduce the cost and improve the quality of health care d. Physician groups are advocating for the creation of a physician sub-specialty designed to manage TC - c According to Coleman (2003), which of the following are components of effective TCs? (Check all that apply) a. A detailed follow-up plan b. Effective written and oral communication among health care providers within and across settings c. Medication reconciliation d. Comprehensive patient/caregiver teaching/education e. Each care provider having his/her own specific care plan that addresses only their unique concerns for that patient - abcd In order to manage TCs effectively which of the following are important to include in the teaching plan for the patient? (Check all that apply) a. Signs indicating that the patient's situation has deteriorated and warrants further intervention b. The names, roles, and contact information for who to contact for problems or concerns c. What to expect upon transfer, discharge, or next site of care d. Including family members and/or informal caregivers in the teaching plan e. Instructions for any follow-up care, such as lab work, tests or procedures, appointments - abcde Which of the following are barriers to effective management of TCs? (Check all that apply) a. Frequent exclusion of patients and caregivers as participants in care planning b. Growing reliance of institution-based care providers c. Lack of professional training in skills needed to effectively manage TCs d. Electronic medical records designed to be shared among various providers and care settings e. Lack of formal, standardized methods of communicating across care settings - abce Which of the following adverse events are associated with ineffective management of TCs? (Check all that apply). a. Higher hospital readmission rates b. Medication errors c. Failure of patient to seek attention for worsening condition d. Increased stress and burden on caregivers e. Decreased satisfaction among patients, caregivers or family members, and health care providers - abcde The overall goal of psychosocial and spiritual nursing interventions is to facilitate the patient and family's ability to engage their internal resources of hope, energy, empowerment, and will to live, in order to optimize coping with critical illness. True False - true which of the following statements about "acute stress response"is/are accurate? Select all that apply. a. Total suppression of the acute stress response is an important nursing function. b. The acute stress response is a maladaptive response to stress. c. The acute stress response is a protective response, designed to mobilize the body to deal with threats to survival. d. The acute stress response is a non-specific response, meaning the physiologic processes are similar regardless of the source of stress. - cd which of the following statements about coping strategies is NOT accurate? a. Coping strategies are intentional processes aimed at adapting to stressors. b. Coping strategies are learned and practiced over a lifetime. c. Coping strategies are automatic, inflexible, and cannot be taught. d. Coping strategies are considered ineffective if they hinder a person's ability to adapt. - c which of the following are potential sources of stress for critically ill patients? a. sleep deprivation b. loss of dignity c. financial worry d. ICU environment and routine e. All of the above - e which of the following factors influence a patient's response to stressors? Select all that apply. a. his/her perception of the stressor(s) b. relevance or applicability of previous coping strategies c. level of intelligence d. magnitude, number, and nature, of the stressors (how many, how strong, chronic or acute) e. gender - abd which of the following are potential adverse outcomes of ineffective management of psychosocial and spiritual concerns? a. Patient disengagement form care/treatment processes b. Patient and family having an adversarial relationship with the health care team c. Patient's inability to focus, absorb new information or learn new tasks d. impaired or delayed recovery e. all of the above - e which of the following would be considered essential elements of holistic nursing care of critically ill patients? Select all that apply. a. interventions aimed at preserving and enhancing patient's dignity b. complete devotion to the patient and family, by the nurse, without regard for his/her own well-being c. Inclusion of verbal and nonverbal indications of compassion and empathy in approach to patient care d. Focusing on spiritual and psychosocial concerns only after physiologic homeostasis has been completely restored e. Recommending routine consultations with the unit-based chaplain on all critically ill patients - ac which of the following statements about REM sleep is/are accurate? Select all that apply. a. Sympathetic nervous system predominates b. Parasympathetic nervous system predominates c. heart rate and blood pressure decrease d. protein synthesis and tissue repair occur e. patients with cardiac disease may be more at risk for adverse events during this stage. - ae Which of the following statements about NREM sleep is/are accurate? Select all that apply. a. sympathetic system predominates b. parasympathetic system predominates c. heart rate and blood pressure are variable d. protein synthesis and tissue repair occur e. patients are less able to respond to decreases in oxygen and carbon dioxide levels during this stage - bd sleep disturbance in critically ill patients is defined as insufficient duration or stages of sleep that results in: a. irritable and non-compliant patients b. adaptation of the environment to promote sleep c. discomfort that interferes with quality of life d. excessive sleep that prevents patient participation in self-care activities - c