Critical Care Nursing Practice, Exams of Nursing

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AANC American

Association of

Critical-Care Nurses

aps 3 Exam Test

Bank Questions and

Answers 100% Pass

AANC American Association of Critical-

Care Nurses aps 3 Exam Test Bank

Questions and Answers 100% Pass

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 - Answer>> 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 - Answer>> 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. - Answer>> 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. - Answer>> 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.

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

• Answer>> 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 - Answer>> 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 - Answer>> 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. - Answer>> 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 organizations 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. - Answer>> 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, Im calling about Mrs. P., your 65-year-old patient in CCU
11. 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 hypovol - Answer>> 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.

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 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

• Answer>> 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

• Answer>> 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 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. c. reconcile medications across the continuum of care. d. reduce harms associated with administration of anticoagulants.

• Answer>> 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: a. bundle of care. b. clinical practice guideline. c. patient safety goal. d. quality improvement initiative. - Answer>> 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. - Answer>> 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. - Answer>> 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 patients gender, ethnicity, spirituality, and lifestyle is said to: a. be a moral advocate. b. facilitate learning. c. respond to diversity. d. use clinical judgment. - Answer>> 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
18. 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. - Answer>> 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.

MULTIPLE CHOICE

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 - Answer>> 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. MULTIPLE CHOICE
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. - Answer>> 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.

MULTIPLE CHOICE

4. Which of the following nursing activities demonstrates implementation 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 pastoral services 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 - Answer>> ANS: A, B, C, D, E All answers are correct. Attending a program to learn about sepsisAcquires and maintains current knowledge 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. MULTIPLE CHOICE

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. - Answer>> 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. MULTIPLE CHOICE
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 - Answer>> 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. MULTIPLE CHOICE

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 - Answer>> 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.

1. Ideally, an advance directive should be developed by the: a. family, if the patient is in critical condition. b. patient as part of the hospital admission process. c. patient before hospitalization. d. patients healthcare surrogate. - Answer>> ANS: C Advance directives should be made and signed while a person is in good health and in a state of mind to make decisions about what should happen if he or she becomes incapacitated (e.g., during a critical illness). Families help to make decisions based on written advance directives, but families are not responsible for developing them for the patient. Developing advance directives during the admission process is not feasible, and the patient may not be capable of making an advance directive. The surrogate or proxy is one who has been already designated by a person to make healthcare decisions based on written advance directives.

2. A critically ill patient has a living will in his chart. His condition has deteriorated. His wife says she wants everything done, regardless of the patients wishes. Which ethical principle is the wife violating? a. Autonomy b. Beneficence c. Justice d. Nonmaleficence - Answer>> ANS: A Autonomy is respect for the individual and the ability of individuals to make decisions with regard to their own health and future. The wife is violating the patients autonomy in decision making. Beneficence consists of actions intended to benefit the patients or others. Justice is being fair. Nonmaleficence is the duty to prevent harm.
3. Which statement regarding ethical concepts is true? a. A living will is the same as a healthcare proxy. b. A signed donor card ensures that organ donation will occur in the event of brain death. c. A surrogate is a competent adult designated by a person to make healthcare decisions in the event the person is incapacitated. d. A persistent vegetative state is the same as brain death in most states. - Answer>> ANS: C

A surrogate is a competent adult designated by a person to make healthcare decisions if that person becomes incapacitated. A living will is a witnessed document that states a persons wishes regarding life-prolonging procedures, whereas a healthcare proxy is a person authorized by state statute to make healthcare decisions. In many states, consent by family members or healthcare proxy is required for organ donation even if an individual has a signed donor card. A persistent vegetative state is a permanent, irreversible unconscious condition that demonstrates an absence of voluntary action or cognitive behavior, or an inability to communicate or interact; brain death is cessation of brain function.

4. Which of the following statements about resuscitation is true? a. Family members should never be present during resuscitation. b. It is not necessary for a physician to write do not resuscitate orders in the chart if a patient has a healthcare surrogate. c. Slow codes are ethical and should be considered in futile situations if advanced directives are not available. d. Withholding extraordinary resuscitation is legal and ethical if specified in advance directives and physician orders. - Answer>> ANS: D Withholding resuscitation and other care is legal and ethical if based on the patients wishes. Formal orders should be written that specify what is to be done if a patient suffers a cardiopulmonary arrest. Family presence during resuscitation and invasive procedures should be encouraged. A written order for do not resuscitate must be documented in the medical record. The decision to write the order is made in collaboration with the healthcare surrogate. Slow codes sometimes occur in the clinical

setting while attempts are made to contact the healthcare surrogate or proxy; however, they are neither legal nor ethical. Specific written orders determine what is to be done for resuscitation efforts.

5. The nurse is caring for an elderly patient who is in cardiogenic shock. The patient has failed to respond to medical treatment. The intensivist in charge of the patient conducts a conference to explain that they have exhausted treatment options and suggest that the patient be made a do not resuscitate status. This scenario illustrates the concept of: a. brain death. b. futility. c. incompetence. d. life-prolonging procedures. - Answer>> ANS: B This is the definition of futility. Brain death is cessation of brain function and is not described in this scenario. Incompetence (in this chapter) is when a patient is unable to make decisions regarding healthcare treatment. A life-prolonging procedure is one that sustains, restores, or supplants a spontaneous vital function.
6. The nurse is caring for a patient admitted with a traumatic brain injury following a motor vehicle crash. The patients Glasgow Coma Score is 3 and intermittently withdraws when painful stimuli are introduced. The patient is ventilator dependent and occasionally takes a spontaneous breath. The physician explains to the family that the patient has severe neurological impairment and he does not expect the patient to recover consciousness. The nurse recognizes that this patient is:

a. an organ donor. b. brain dead. c. in a persistent vegetative state. d. terminally ill. - Answer>> ANS: C A persistent vegetative state is a permanent, irreversible unconscious condition that demonstrates an absence of voluntary action or cognitive behavior, or an inability to communicate or interact purposefully with the environment. She is not brain dead, as occasionally she reacts to painful stimuli and takes a spontaneous breath; therefore, she cannot be an organ donor at this time. Treatment of her condition may be considered futile; however, she would not be defined as terminally ill.

7. A nurse caring for a patient with neurological impairment often must use painful stimuli to elicit a patients response. The nurse uses subtle measures of painful stimuli, such as nailbed pressure. She neither slaps the patient nor pinches the nipple to elicit a response to pain. In this scenario, the nurse is exemplifying the ethical principle of: a. beneficence. b. fidelity. c. nonmaleficence. d. veracity. - Answer>> ANS: C Nonmaleficence is not to intentionally harm others. Beneficence demonstrates actions intended to benefit the patients or others.

Fidelity is the moral duty to be faithful to the commitments that one makes to others. Veracity is the obligation to tell the truth.

8. Which of the following organizations requires a mechanism for addressing ethical issues? a. American Association of Critical-Care Nurses b. American Hospital Association c. Society of Critical Care Medicine d. The Joint Commission - Answer>> ANS: D The Joint Commission requires that a formal mechanism be in place to address patients ethical concerns. The other organizations do not address formal ethics committees.
9. The nurse is caring for a patient who is not responding to medical treatment. The intensivist holds a conference with the family, and a decision is made to withdraw life support. The nurses religious beliefs are not in agreement with withdrawal. However, she assists with the process to avoid confronting the charge nurse. Afterward she feels guilty and believes she killed the patient. This scenario is likely to cause: a. abandonment. b. family stress. c. moral distress. d. negligence. - Answer>> ANS: C

Moral distress occurs when the nurse acts in a manner contrary to personal or professional values. Abandonment is defined as the unilateral severance of a professional relationship while a patient is still in need of health care. Family stress would not be impacted in this situation if the nurse responded appropriately during the procedure. Negligence is failure to act according to the standard of care.

10. The nurse is caring for a patient who has been declared brain dead. The patient is considered a potential organ donor. In order to proceed with donation, the nurse understands that: a. a signed donor card mandates that organs be retrieved in the event of brain death. b. after brain death has been determined, perfusion and oxygenation of organs is maintained until organs can be removed in the operating room. c. the healthcare proxy does not need to give consent for the retrieval of organs. d. once a patient has been established as brain dead, life support is withdrawn and organs are retrieved. - Answer>> ANS: B After brain death has been determined, the organs must be perfused to maintain viability. Therefore, the patient remains on life support even though he or she is legally dead. A signed donor card indicates the individuals wishes; however, most organ procurement agencies require family consent even if a donor card has been signed. In most states, the healthcare surrogate or proxy is required to give consent for organ donation. After brain death has been determined, perfusion and oxygenation of organs are maintained until organs can be removed in the operating room.--

11. The nurse is caring for a patient who is declared brain dead and is an organ donor. The following events occur: 1300 Diagnostic tests for brain death are completed. 1330 Intensivist reviews diagnostic test results and writes in the progress note that the patient is brain dead. 1400 Patient is taken to the operating room for organ retrieval. 1800 All organs have been retrieved for donation. The ventilator is discontinued. 1810 Cardiac monitor shows flatline. What is the official time of death recorded in the medical record? a. 1300 b. 1330 c. 1400 d. 1800 e. 1810 - Answer>> ANS: B The time of death is when brain death is confirmed and documented in the chart, even though the patients heart is still beating. Organs are retrieved after brain death has been documented.
12. The nurse is caring for a critically ill patient on mechanical ventilation. The physician identifies the need for a bronchoscopy, which requires informed consent. If the physician were to obtain consent from the patient, the patient must be able to: a. be weaned from mechanical ventilation. b. have knowledge and competence to make the decision.

c. nod his head that it is okay to proceed. d. read and write in English. - Answer>> ANS: B Informed consent requires that a person know what is to be done and have the competence to make an informed decision. Most critically ill patients do not have this capacity; however, an assessment should be made to determine the patients capacity. Some patients on mechanical ventilation are able to give written consent. Reading and writing in English are not requirements for informed consent.

13. The nurse is caring for a critically ill patient with terminal cancer. The monitor alarms and shows ventricular tachycardia. The patient does not have a do not resuscitate order written on the chart. What is the appropriate nursing action? a. Contact the attending physician immediately to determine if CPR should be initiated. b. Contact the family immediately to determine if they want CPR to be started. c. Give emergency medications but withhold intubation. d. Initiate CPR and call a code. - Answer>> ANS: D Because no orders have been written, it is imperative that a code be called. In this example, decisions regarding resuscitation status should be determined as soon as possible before a code event. The physician and family should be contacted immediately to determine treatment options, but CPR is not withheld. It is not appropriate to conduct a partial code by giving medications only.