Table of Contents
x@ x@
,x@
Chapter 01: Overview of Critical Care Nursing
x@ x@ x@ x@ x@ x@ 2
Chapter 02: Patient and Family Response to the Critical Care Experie
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ 14
nce Chapter 03: Ethical and Legal Issues in Critical Care Nursing
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ 30
Chapter 04: Palliative and End-of-
x@ x@ x@ x@ 42
Life Care Chapter 05: Comfort and S
x@ x@ x @ x @ x @ x @ 56
edation Chapter 06: Nutritional Therapy
x@ x@ x@ x@ 69
Chapter 07: Dysrhythmia Interpretation and Management Ch
x@ x@ x@ x@ x@ x@ 83
apter 08: Hemodynamic Monitoring
x@ x@ x@ 117
Chapter 09: Ventilatory Assistance
x@ x@ x@ 137
Chapter 10: Rapid Response Teams and Code Management
x@ x@ x@ x@ x@ x@ x@ 156
Chapter 11: Organ Donation
x@ x@ x@ x@ 171
Chapter 12: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome
x@ x@ x@ x@ x@ x@ x@ x@ 189
Chapter 13: Cardiovascular Alterations
x@ x@ x@ x@ 207
Chapter 14: Nervous System Alteratio
x@ x@ x@ x@ 225
ns Chapter 15: Acute Respiratory Fail
x@ x@ x@ x@ x@ 243
ure Chapter 16: Acute Kidney Injur
x@ x @ x @ x @ x @ 260
y Chapter 17: Gastrointestinal Alteratio
x@ x@ x@ x@ 285
ns 312
Chapter 17: Hematological and Immune Disorders
x@ x@ x@ x@ x@ x@ 341
Chapter 19: Endocrine Alterations
x@ x@ x@ 361
Chapter 20: Trauma and Surgical Management Ch
x@ x@ x@ x@ x@ x@ 377
apter 21: Burns x@ x@
,Chapter 01: Overview of Critical Care Nursing
x@ x@ x@ x@ x@ x@
MULTIPLE CHOICE x@
1. Which of the following professional organizations best supports critical care nursing practice?
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
a. American Association of Critical-Care Nurses
x@ x@ x@ x@
b. American Heart Association x@ x@
c. American Nurses Association x@ x@
d. Society of Critical Care Medicine
x@ x@ x@ x@
ANS: A x@
The American Association of Critical-
x@ x@ x@ x@
Care Nurses is the specialty organization that supports and represents critical care nurses. The Ameri
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
can Heart Association supports cardiovascular initiatives. The American Nurses Association supports
x@ x@ x@ x@ x@ x@ x@ x@ x @ x@ x@
all nurses. The Society of Critical Care Medicine represents the multiprofessional critical care team
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x @ x@ x@
under the direction of an intensivist.
x@ x@ x@ x@ x@
DIF: Cognitive Level: Knowledge REF: p. 4
x@ x@ x@ x@ x@ x@
OBJ: Discuss the purposes and functions of the professional organizations that support critical care p
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
ractice. TOP: Nursing Process Step: N/A
x @ x@ x@ x@ x@
MSC: NCLEX: Safe and Effective Care Environment
x@ x@ x@ x@ x@ x@
2. A nurse has been working as a staff nurse in the surgical intensive care unit for 2 years and is i
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
nterested in certification. Which credential would be most applicable for her to seek?
x@ x @ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
a. ACNPC
b. CCNS
c. CCRN
d. PCCN
ANS: C x@
The CCRN certification is appropriate for nurses in bedside practice who care for critically ill patients
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
. The ACNPC certification is for acute care nurse practitioners. The CCNS certification is for critica
x@ x @ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
l care clinical nurse specialists. The PCCN certification is for staff nurses working in progressive car
x@ x@ x @ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
e, intermediate care, or step-down unit settings.
x@ x@ x@ x @ x@ x@
DIF: Cognitive Level: Application REF: p. 5
x@ x@ x@ x@ x@ x@
OBJ: Explain certification options for critical care nurses. TOP: Nursing Process Step:
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
N/A MSC: NCLEX: Safe and Effective Care Environment
x @ x@ x@ x@ x@ x@ x@
, 3. The main purpose of certification is to:
x@ x@ x@ x@ x@ x@
a. assure the consumer that you will not make a mistake.
x@ x@ x@ x@ x@ x@ x@ x@ x@
b. prepare for graduate school.
x@ x@ x@
c. promote magnet status for your facility.
x@ x@ x@ x@ x@
d. validate knowledge of critical care nursing.
x@ x@ x@ x@ x@
ANS: D x@
Certification assists in validating knowledge of the field, promotes excellence in the profession, and
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
helps nurses to maintain their knowledge of critical care nursing. Certification helps to assure the c
x @ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
onsumer that the nurse has a minimum level of knowledge; however, it does not ensure that
x@ x@ x @ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
care will be mistake-free.
x@ x@ x@
Certification does not prepare one for graduate school; however, achieving certification demonstrates
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x
@ motivation for achievement and professionalism. Magnet facilities are rated on the number of certifi
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
ed nurses; however, that is not the purpose of certification.
x@ x @ x@ x@ x@ x@ x@ x@ x@
DIF: Cognitive Level: Analysis REF: pp. 4-5
x@ x@ x@ x@ x@ x@
OBJ: Explain certification options for critical care nurses. TOP: Nursing Process Step:
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
N/A MSC: NCLEX: Safe and Effective Care Environment
x@ x@ x@ x@ x@ x@ x@
4. The synergy model of practice focuses on:
x@ x@ x@ x@ x@ x@
a. allowing unrestricted visiting for the patient 24 hours each day.
x@ x@ x@ x@ x@ x@ x@ x@ x@
b. holistic and alternative therapies.
x@ x@ x@
c. needs of patients and their families, which drives nursing competency.
x@ x@ x@ x@ x@ x@ x@ x@ x@
d. patients needs for energy and support.
x@ x@ x@ x@ x@
ANS: C x@
The synergy model of practice states that the needs of patients and families influence and drive
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
x@competencies of nurses. Nursing practice based on the synergy model would involve tailored visiting to
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
meet the patients and familys needs and application of alternative therapies if desired by the pati
x@ x@ x@ x@ x @ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
ent, but that is not the primary focus of the model.
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
DIF: Cognitive Level: Application REF: p. 5 | Fig. 1-3
x@ x@ x@ x@ x@ x@ x@ x@ x@
OBJ: Describe standards of professional practice for critical care nursing.
x@ x@ x@ x@ x@ x@ x@ x@ x@
TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
5. The family of your critically ill patient tells you that they have not spoken with the physicia
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
n in over 24 hours and they have some questions that they want clarified. During morning roun
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
ds, you convey this concern to the attending intensivist and arrange for her to meet with the f
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
amily at 4:00 PM in the conference room. Which competency of critical care nursing does this rep
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
resent?
x@ x@
,x@
Chapter 01: Overview of Critical Care Nursing
x@ x@ x@ x@ x@ x@ 2
Chapter 02: Patient and Family Response to the Critical Care Experie
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ 14
nce Chapter 03: Ethical and Legal Issues in Critical Care Nursing
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ 30
Chapter 04: Palliative and End-of-
x@ x@ x@ x@ 42
Life Care Chapter 05: Comfort and S
x@ x@ x @ x @ x @ x @ 56
edation Chapter 06: Nutritional Therapy
x@ x@ x@ x@ 69
Chapter 07: Dysrhythmia Interpretation and Management Ch
x@ x@ x@ x@ x@ x@ 83
apter 08: Hemodynamic Monitoring
x@ x@ x@ 117
Chapter 09: Ventilatory Assistance
x@ x@ x@ 137
Chapter 10: Rapid Response Teams and Code Management
x@ x@ x@ x@ x@ x@ x@ 156
Chapter 11: Organ Donation
x@ x@ x@ x@ 171
Chapter 12: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome
x@ x@ x@ x@ x@ x@ x@ x@ 189
Chapter 13: Cardiovascular Alterations
x@ x@ x@ x@ 207
Chapter 14: Nervous System Alteratio
x@ x@ x@ x@ 225
ns Chapter 15: Acute Respiratory Fail
x@ x@ x@ x@ x@ 243
ure Chapter 16: Acute Kidney Injur
x@ x @ x @ x @ x @ 260
y Chapter 17: Gastrointestinal Alteratio
x@ x@ x@ x@ 285
ns 312
Chapter 17: Hematological and Immune Disorders
x@ x@ x@ x@ x@ x@ 341
Chapter 19: Endocrine Alterations
x@ x@ x@ 361
Chapter 20: Trauma and Surgical Management Ch
x@ x@ x@ x@ x@ x@ 377
apter 21: Burns x@ x@
,Chapter 01: Overview of Critical Care Nursing
x@ x@ x@ x@ x@ x@
MULTIPLE CHOICE x@
1. Which of the following professional organizations best supports critical care nursing practice?
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
a. American Association of Critical-Care Nurses
x@ x@ x@ x@
b. American Heart Association x@ x@
c. American Nurses Association x@ x@
d. Society of Critical Care Medicine
x@ x@ x@ x@
ANS: A x@
The American Association of Critical-
x@ x@ x@ x@
Care Nurses is the specialty organization that supports and represents critical care nurses. The Ameri
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
can Heart Association supports cardiovascular initiatives. The American Nurses Association supports
x@ x@ x@ x@ x@ x@ x@ x@ x @ x@ x@
all nurses. The Society of Critical Care Medicine represents the multiprofessional critical care team
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x @ x@ x@
under the direction of an intensivist.
x@ x@ x@ x@ x@
DIF: Cognitive Level: Knowledge REF: p. 4
x@ x@ x@ x@ x@ x@
OBJ: Discuss the purposes and functions of the professional organizations that support critical care p
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
ractice. TOP: Nursing Process Step: N/A
x @ x@ x@ x@ x@
MSC: NCLEX: Safe and Effective Care Environment
x@ x@ x@ x@ x@ x@
2. A nurse has been working as a staff nurse in the surgical intensive care unit for 2 years and is i
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
nterested in certification. Which credential would be most applicable for her to seek?
x@ x @ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
a. ACNPC
b. CCNS
c. CCRN
d. PCCN
ANS: C x@
The CCRN certification is appropriate for nurses in bedside practice who care for critically ill patients
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
. The ACNPC certification is for acute care nurse practitioners. The CCNS certification is for critica
x@ x @ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
l care clinical nurse specialists. The PCCN certification is for staff nurses working in progressive car
x@ x@ x @ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
e, intermediate care, or step-down unit settings.
x@ x@ x@ x @ x@ x@
DIF: Cognitive Level: Application REF: p. 5
x@ x@ x@ x@ x@ x@
OBJ: Explain certification options for critical care nurses. TOP: Nursing Process Step:
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
N/A MSC: NCLEX: Safe and Effective Care Environment
x @ x@ x@ x@ x@ x@ x@
, 3. The main purpose of certification is to:
x@ x@ x@ x@ x@ x@
a. assure the consumer that you will not make a mistake.
x@ x@ x@ x@ x@ x@ x@ x@ x@
b. prepare for graduate school.
x@ x@ x@
c. promote magnet status for your facility.
x@ x@ x@ x@ x@
d. validate knowledge of critical care nursing.
x@ x@ x@ x@ x@
ANS: D x@
Certification assists in validating knowledge of the field, promotes excellence in the profession, and
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
helps nurses to maintain their knowledge of critical care nursing. Certification helps to assure the c
x @ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
onsumer that the nurse has a minimum level of knowledge; however, it does not ensure that
x@ x@ x @ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
care will be mistake-free.
x@ x@ x@
Certification does not prepare one for graduate school; however, achieving certification demonstrates
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x
@ motivation for achievement and professionalism. Magnet facilities are rated on the number of certifi
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
ed nurses; however, that is not the purpose of certification.
x@ x @ x@ x@ x@ x@ x@ x@ x@
DIF: Cognitive Level: Analysis REF: pp. 4-5
x@ x@ x@ x@ x@ x@
OBJ: Explain certification options for critical care nurses. TOP: Nursing Process Step:
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
N/A MSC: NCLEX: Safe and Effective Care Environment
x@ x@ x@ x@ x@ x@ x@
4. The synergy model of practice focuses on:
x@ x@ x@ x@ x@ x@
a. allowing unrestricted visiting for the patient 24 hours each day.
x@ x@ x@ x@ x@ x@ x@ x@ x@
b. holistic and alternative therapies.
x@ x@ x@
c. needs of patients and their families, which drives nursing competency.
x@ x@ x@ x@ x@ x@ x@ x@ x@
d. patients needs for energy and support.
x@ x@ x@ x@ x@
ANS: C x@
The synergy model of practice states that the needs of patients and families influence and drive
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
x@competencies of nurses. Nursing practice based on the synergy model would involve tailored visiting to
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
meet the patients and familys needs and application of alternative therapies if desired by the pati
x@ x@ x@ x@ x @ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
ent, but that is not the primary focus of the model.
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
DIF: Cognitive Level: Application REF: p. 5 | Fig. 1-3
x@ x@ x@ x@ x@ x@ x@ x@ x@
OBJ: Describe standards of professional practice for critical care nursing.
x@ x@ x@ x@ x@ x@ x@ x@ x@
TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
5. The family of your critically ill patient tells you that they have not spoken with the physicia
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
n in over 24 hours and they have some questions that they want clarified. During morning roun
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
ds, you convey this concern to the attending intensivist and arrange for her to meet with the f
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
amily at 4:00 PM in the conference room. Which competency of critical care nursing does this rep
x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@ x@
resent?