TESTBANK CRITICAL CARE NURSING: A HOLISTIC APPROACH 11TH EDITION MORTON FONTAINE COMPLETE, Exams of Nursing

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TESTBANK CRITICAL CARE NURSING: A

HOLISTIC APPROACH 11TH EDITION

MORTON FONTAINE COMPLETE GUIDE

LATEST UPDATE 2024 GRADED A+

Chapter 1 Critical Care Nursing Practice: Promoting Excellence-Caring,Collaboration Evidence Multiple Choice

1. A nurse is the only one in the ICU who has not achieved certification in critical care

nursing. She often will ask her fellow nurses what to do in caring for a patient because she doubts the accuracy of her knowledge and her intuition. She loves her work but wishes she could do it with a greater level of competence. What is the most important effect that obtaining certification would likely have on the nurses practice?

A) Recognition by peers

B) Increase in salary and rank

C) More flexibility in seeking employment

D) Increased confidence in making decisions

2. A hospital interviews two different candidates for a position in the ICU. Both

candidateshave around 10 years of experience working in the ICU. Both have excellent interpersonal skills and highly positive references. One, however, has certification in critical care nursing. Which of the following is the most compelling and accurate reason for the hospital to hire the candidate with certification?

A) The certified nurse will have more knowledge and expertise.

B) The certified nurse will behave more ethically.

C) The certified nurse will be more caring toward patients.

D) The certified nurse will work more collaboratively with other nurses.

3. A nurse is caring for an elderly man recently admitted to the ICU following a stroke. She

assesses his cognitive function using a new cognitive assessment test she learned about ina recent article in a nursing journal. She then brings a cup of water and a straw to the patient because she observes that his lips are dry. Later, she has the patient sit in a wheelchair and takes him to have some blood tests performed. He objects at first, saying that he can walk on his own, but the nurse explains that it is hospital policy to use the wheelchair. That evening, she recognizes signs of an imminent stroke in the patient and immediately pages the physician. Which action taken by the nurse is the best example of evidence-based practice?

A) Giving the patient a cup of water

B) Transferring the patient in a wheelchair

C) Using the cognitive assessment test

4. A nurse is on a committee that is trying to reduce the occurrence of hospital-acquired

infections in the ICU. Her role is to conduct research to find which interventions have been shown to be most effective in reducing these infections. She consults many differentsources and finds conflicting information. Which of the following sources should she consider the most authoritative? A) AACN expert panel report B) A meta-analysis of randomized controlled trials in the American Journal of Nursing C) A systematic review of qualitative studies in the Journal of Advanced Nursing D) A single randomized controlled trial in the American Journal of Critical Care

5. A nurse who has been recently hired to manage the nursing staff of the ICU is

concernedat the lack of evidence-based practice she sees among the staff. Which of the following would be the best step for her to take to promote incorporating evidence into clinical practice?

A) Only hire nurses certified in critical care nursing.

B) Leave copies of several different nursing journals in the nurses lounge.

C) Demonstrate to the staff the best nursing-related search terms to use in Google

orYahoo!

D) Introduce the staff to the PubMed search engine and assign them topics to

researchon it.

6. A physician visits a patient in the ICU while the nurse is out. The patient complains

thatthe pain medication is not effective and that he would like to receive an increased dose. The physician has the nurse paged and consults with him in the hallway regarding the patients request for stronger pain medication. The nurse explains that patient was startedon a morphine drip only 20 minutes ago and that the drug has not had time to take effectyet. The physician agrees and tells the patient to give it just a bit more time. Which component of a healthy work environment is most evident in this scenario?

A) Skilled communication

B) Appropriate staffing

C) True collaboration

D) Meaningful recognition

B) Appropriate staffing

C) Authentic leadership

D) Meaningful recognition

8. An ICU nurse has provided excellent care for a 6-year-old girl who had been admitted to

the ICU for a head injury. The nurse was attentive not only to the needs of the patient butalso went out of her way to care for the needs of the girls family. According to research, which of the following forms of recognition would the nurse value the most?

A) A card from the girls family

B) A plaque from the ICU physicians naming her as Nurse of the Year

C) A letter of commendation from the hospitals administration

D) A bouquet of flowers from her supervisor

9. A patient in the ICU has recently been diagnosed with diabetes mellitus. Before being

discharged, this patient will require detailed instructions on how to manage her diet, howto self-inject insulin, and how to handle future diabetic emergencies. Which nurse competency is most needed in this situation?

A) Clinical judgment

B) Advocacy and moral agency

C) Caring practices

D) Facilitation of learning

10. An elderly patient is admitted to the ICU with stage IV lung cancer, diabetes mellitus,

andcongestive heart failure. The health care team assembled to care for her is large and diverse, including an oncologist, a pulmonologist, an endocrinologist, a cardiologist, and others. The patient is not expected to survive more than a few weeks, and her husband is overwhelmed with stress and grief. Which nurse competency or competencies are most needed in this situation? Select all that apply.

A) Clinical judgment

B) Caring practices

C) Collaboration

D) Response to diversity

11. An Ethiopian man with AIDS has recently been admitted to the ICU with a case of

pneumonia. The man is new to the U.S. and has no health insurance. He would likely beeligible for the states Medicaid coverage, but does not understand how to access this coverage. Which competency or competencies are most needed in this situation? Select all that apply

A) Clinical judgment

B) Advocacy and moral agency

C) Collaboration

D) Systems thinking

E) Response to diversity

F) Clinical inquiry

12. A nurse decides to seek certification in critical care nursing. What is the most

importantbenefit for the individual nurse in becoming certified in a specialty?

A) It will result in a salary increase.

B) It is required to work in critical care.

C) It demonstrates the nurses personal expertise.

D) It is mandated by employers.

13. The American Association of Critical-Care Nurses (AACN) sponsors certification in

critical care nursing for several critical care subspecialties. What is the most importantbenefit of such certification for the profession of nursing?

A) Provides positive publicity for nursing

B) Validates nurses expert knowledge and practice

C) Mandated by government regulations

D) Demonstrates basic knowledge in the field

14. A nurse has achieved certification in critical care nursing. What is the most

importanteffect that this certification will have on the nurses practice?

A) Recognition by peers

B) Increase in salary and rank

C) More flexibility in seeking employment

D) Increased confidence in critical thinking

15. The nurse cites evidence-based practice as a rationale for a patient care decision. What

isthe best description of evidence-based practice?

A) Decisions based on expert legal testimony

B) Use of best available research data

C) Evolution of nursing practice over time

D) Individual optimization of patient outcomes

16. The nurse caring for a critically ill patient implements several components of care.

Whatcomponent is an example of the use of evidence-based practice?

A) Use of a protocol for admission of a patient to the unit

B) Application of an insulin sliding scale method from research

C) Checking the patients armband before giving a medication

D) Limiting visits to immediate family only for 2 hours a day

17. The nurse wishes to increase the use of evidence-based practice in the critical care

unit where he works. What is a significant barrier to the implementation of evidence- basedpractice?

A) Use of computerized records by the hospital

B) Health Information Privacy and Portability Act (HIPPA)

C) Lack of knowledge about literature searches

D) Strong collaborative relationships in the work setting

18. The nurse has identified an increase in medication errors in the critical care unit over

thepast several months. What aspect of medication procedures should be evaluated first?

A) Adherence to procedures by nursing staff

B) Clarity of interdisciplinary communication

C) Number of new employees on the unit

D) Changes in administration procedures

19. A critical care unit has decided to implement several measures designed to improve

intradisciplinary and interdisciplinary collaboration. In addition to an expected improvement in patient outcomes, what is the most important effect that should resultfrom these measures?

A) Identification of incompetent practitioners

B) Improvement in manners on the unit

C) Increased staff retention

D) Less discussion in front of patients and families

20. A nurse wishes to practice using the Synergy Model developed by the American

Association of Critical-Care Nurses (AACN). What nursing behavior best supports use of this model?

A) Attending mandatory hospital-wide in-service programs

B) Self-directed study of best practice for the patients she cares for

C) Gathering demographic data on the patients admitted to the unit

D) Participating in a research study as a data collector

21. As part of the Synergy Model, the nurse has identified a patient characteristic

ofresiliency. What patient behavior demonstrates resiliency?

A) Dysfunctional grieving behaviors after receiving bad news

B) Developing a list of questions for the physician

C) Denial of any possible negative outcomes for a procedure

D) Assigning blame to others for undesired outcomes of illness

22. A patient is admitted to the critical care unit after receiving a mechanical heart

implantation. In making a nursing assignment, the charge nurse best demonstrates application of the Synergy Model by assigning which nurse to care for this patient?

A) A newly hired new graduate nurse, for the experience

B) A nurse with a patient in the next room, for proximity

C) The most senior nurse on the unit, for political reasons

D) The nurse with most experience with this device, for expertise

23. A Muslim patient has been admitted to the critical care unit with complications after

childbirth. Based on the Synergy Model, which nurse would be the most inappropriate toassign to care for this patient?

A) New graduate female nurse

B) Most experienced female nurse

C) New graduate male nurse

D) Female nurse with postpartum experience

24. Todays critical care nursing environment is constantly changing. What nursing

behaviorbest illustrates awareness of current events affecting critical care nursing?

A) Participating in the hospitals efforts to recruit new nurses

B) Volunteering to serve on a disaster response planning committee

C) Adhering to content taught in basic nursing program

D) Attending hospital-mandated in-services without other education

Answer Key

1. D

2. A

3. C

4. B

5. D

6. C

7. B

8. A

9. D

10. B, C

11. B, D, E

12. C

13. B

14. D

15. B

16. B

17. C

18. B

19. C

20. B

21. B

22. D

23. C

24. B

Chapter 2: The Patient’s Experience With Critical Illness

1. The critical care unit environment is very stressful for patients, families, and staff.

Whatnursing action is directed at reducing environmental stress?

A) Constant evaluation of patient status

B) Limiting visits to immediate family

C) Bathing all patients during hours of sleep

D) Maintaining quiet during hours of sleep

2. A patient is transferred to the ICU from the Birth Center of the hospital in the middle of

the night after experiencing complications during delivery of her baby. The patients husband is anxious and explains to the ICU nurse that he doesnt understand why his wifehas been moved to the ICU. She is going to die, isnt she? he asks the nurse. What is the nurses best response?

A) Explain that every measure will be taken to provide his wife with the best care

possible.

B) Explain that the nurse is fully trained and has years of experience.

C) Offer the husband a place to relax.

D) Have appropriate staff discuss his health insurance with him.

3. A patient is admitted to the ICU with injuries sustained from a fall from a third-story

window. The patient is conscious, his breathing is labored, and he is bleeding heavily from the abdomen. He groans constantly and complains of severe pain, but his movements are minimal. His heart rate is elevated. Which of these is a sign that he is inthe second phase of the stress response? Select all that apply.

A) Bleeding heavily from his abdomen

B) Labored, slow breathing

C) Severe pain

D) Elevated heart rate

E) Minimal movement

4. A patient in the ICU is recovering from open-heart surgery. The nurse enters his room

and observes that his daughter is performing effleurage on his arms and talking in a lowvoice about an upcoming family vacation that is planned. The room is dimly lit, and shehears the constant beeping of his heart monitor. From the hall she hears the cries of a patient in pain. Which of the following are likely stressors for the patient? Select all thatapply.

A) His daughters conversation

B) His daughters effleurage

C) The beeping of the heart monitor

D) The dim lighting of the room

E) The cries of the other patient from the hall

5. A patient in the ICU is complaining that he is not sleeping well at night because of

anxiety. Which of the following would be the most helpful intervention for the nurse to make?

A) Provide the patient with a bath immediately following his first 90-minute

REMsleep cycle.

B) Increase the patients pain medication.

C) Provide the patient with 5 minutes of effleurage and then minimize disruptions.

D) Monitor the patients brain waves by polysomnography to determine his

sleeppattern.

6. A nurse walks into a patients room and begins preparing a syringe to perform a blood

draw on the patient. The nurse observes that the patient is firmly gripping the side of thebed, averting her eyes, and sweating from her forehead when she sees the needle. What would be the best intervention for the nurse to make?

A) Proceed with blood draw as quickly as possible, to get it over with.

B) Offer to come back later to perform the blood draw.

C) Encourage the patient to deep breathe.

D) Describe briefly the blood draw procedure and explain why it is necessary.

7. A 15-year-old boy is in the ICU and preparing for an appendectomy. He is clearly

anxious and fidgets with his IV constantly. He complains that he doesnt want to be thereand he is sick of everyone telling him what to do. What would be the best way for the nurse to address this patients anxiety?

A) Use physical restraints to keep him from pulling out his IV.

B) Offer him the remote to the television.

C) Lower the head of his bed so that he can rest more easily.

D) Explain to the patient in detail what the appendectomy will consist of.

8. A nurse in a burn unit observes that a patient is tensed up and frowning but silent. The

nurse asks the patient, Can you tell me what you are thinking now? The patient responds,I cant take this pain any more! I feel like Im about to die. What would be the best response for the nurse to give to the patient, considering that the patient is already receiving the maximum amount pain medication that is safe?

A) Try to get rid of those negative thoughtsthey only make it worse.

B) Try thinking instead, This pain will go away; I can overcome it.

C) Your pain medication is already at the highest possible dose.

D) Would you like me to raise the head of your bed?

9. A patient on mechanical ventilation is experiencing severe agitation due to being on

theventilator. Which nursing intervention would be best?

A) Performing breathing exercises with the patient

B) Offering the patient a patient-controlled analgesic device

C) Asking the physician to prescribe an antianxiety medication

D) Offering the patient the patients own MP3 player to listen to

10. A 10 - year-old female patient in ICU receiving chemotherapy has requested that her

dogbe allowed to visit her. She is currently sharing a room with another patient. The nurse knows that the hospital does allow for pet visits with owners, but has strict guidelines. Which of the following scenarios is most likely to be permitted?

A) The girls father may bring the dog in on a leash for a 20 - minute visit.

B) The girls sister may bring the dog in with a shirt on (to prevent shedding) for

anovernight stay.

C) The girls mother may bring the dog in on a leash for a visit as long as he has had all

his vaccinations.

D) The dog may be brought in for a brief visit once the girl is moved to a private room.

11. The nurse understands that a patient being cared for in a critical care unit experiences

anacute stress response. What nursing action best demonstrates understanding of the physiological parts of the initial stress response?

A) Adequate pain control

B) Intravenous sedation

C) Treatment for elevated blood pressure

D) Ignoring an elevated glucose level

12. A critically ill patient experiences stress and anxiety from many factors. Treatment of

thepatient focuses on reducing stressors and providing supportive care such as nutrition, oxygenation, pain management, control of anxiety, and specific care of the illness or injury. What is the best rationale for these interventions?

A) Helps to support the patients immune system

B) Part of good nursing care

C) Mandated by hospital policy

D) Reassures the patient and family

13. A patient in a critical care unit has increased stress from the constant noise and

lightlevels. What nursing intervention best attenuates these sources of stress?

A) Need for constant observation and evaluation

B) Dimming lights during the night

C) Frequent nursing group rounds for all patients

D) Use of tile floors for ease in cleaning

14. The nurse is caring for a patient who is orally intubated and on a mechanical

ventilator. The nurse believes that the patient is experiencing excess anxiety. For this patient, whatbehavior best indicates anxiety?

A) Restlessness

B) Verbalization

C) Increased respiratory rate

D) Glasgow Coma Scale score of 3

15. The critical care unit environment is very stressful for patients, families, and staff.

Whatnursing action is directed at reducing environmental stress?

A) Constant expert evaluation of patient status

B) Limiting visits to immediate family

C) Bathing all patients during hours of sleep

D) Maintaining a quiet environment during hours of sleep

16. The nurse wishes to enhance sleep cycles in her critically ill patient. Research has

shownthat which nursing action improves sleep in critically ill patients?

A) Repositioning every 2 hours

B) Hypnotic medications

C) Five-minute back effleurage

D) Adequate pain control

17. The nurse is caring for a critically ill patient with a very concerned family. Given that the

family is under high stress, what nursing intervention will best ameliorate their stress while preserving independence?

A) Encourage the family to participate in patient care tasks.

B) Teach the family to ask questions of the health care team.

C) Ask the family to select a family representative for communication.

D) Limit visits to immediate family members for limited times.

18. While caring for a critically ill patient, the nurse knows that fostering patient control

overthe environment is a method for stress reduction. What nursing intervention gives the patient the most environmental control while still adhering to best practice principles?

A) Ask the patient whether he or she wants to get out of bed.

B) Give the patients bath at the same time every day.

C) Explain painful procedures only after giving pain medication.

D) Choose menu items for the patient to ensure a balanced diet.

19. The nurse is using presence to reduce the anxiety of a critically ill patient. What

nursingbehavior demonstrates an effective use of presence?

A) Staying in the patients room to complete documentation

B) Having a conversation in the patients room that excludes the patient

C) Maintaining eye contact with the patient during explanations

D) Focusing on specific nursing care tasks while in the patients room

20. The nurse is caring for a critically ill patient who can speak. The nurse notices that

thepatient is demonstrating behaviors indicative of anxiety but is silent. What nursing strategy would give the nurse the most information about the patients feelings?

A) Explain procedures to the patient and family.

B) Ask the patient to share his or her internal dialogue.

C) Encourage the patient to nap before visiting hours.

D) Ensure that the patient has adequate pain control.

21. The patient is undergoing a necessary but painful procedure that is greatly increasing

heranxiety. The nurse decides to use guided imagery to help alleviate the patients anxiety. What is a key part of this technique?

A) Provide the patient with an external focus point such as a picture.

B) Have the patient take slow, shallow breaths while staring at a focus point.

C) Have the patient remember tactile sensations of a pleasant experience.

D) Encourage the patient to consciously relax all of her muscles.

22. One of the strategies shown to reduce perception of stress in critically ill patients and

their families is support of spirituality. What nursing action is most clearly supportive ofthe patients spirituality?

A) Referring patients to the Catholic chaplain

B) Providing prayer booklets to patients and families

C) Asking about beliefs about the universe

D) Avoiding discussing religion with those of other faiths

23. A critically ill patient tells the nurse that he is not afraid to die because he believes in

reincarnation. What is the most appropriate nursing response?

A) What if reincarnation is not real?

B) This belief gives you strength.

C) I dont believe in reincarnation.

D) You shouldnt base your hopes on such a belief.

24. A critically ill patient who is intubated and agitated is restrained with soft wrist

restraints.Based on research findings, what is the best nursing action?

A) Maintain the restraints to protect patient safety.

B) Remove the restraints periodically to check skin integrity.

C) Remove the restraints periodically for range of motion.

D) Assess and intervene for causes of agitation.

Answer Key

1. D

2. A

3. C, E

4. C, E

5. C

6. D

7. B

8. B

9. D

10. D

11. A

12. A

13. B

14. A

15. D

16. C

17. B

18. B

19. C

20. B

21. C

22. C

23. B

24. D

Chapter 3 The Family’s Experience With Critical Illness

1. A patient has just been admitted to the ICU after being in a severe auto accident and

losing one of her legs. Her husband has his hand over his heart and complains of a rapidheart rate. The nurse recognizes his condition as a sign of which stage of the general adaptation syndrome to stress?

A) Alarm stage

B) Exhaustion stage

C) Resistance stage

D) Adaptation stage

2. The nurse observes that an elderly woman, whose granddaughter has been admitted to

theICU, is struggling to manage her two great-grandsons, who are toddlers, in the waiting room. What is the most likely explanation for the womans inability to manage the children in this situation?

A) She is senile.

B) She is in the exhaustion stage of the general adaptation syndrome to stress.

C) She is assuming the role of caregiver in place of the patient, a role she is not used to.

D) She has macular degeneration and cannot see well.

3. A nurse needs to communicate with a patients family regarding consent to treat an

unconscious patient in the ICU. Which member of the group should the nurse approachfirst?

A) A man she recognizes as the patients brother

B) A teenage boy who approaches the nurse

C) A woman who originally escorted the patient in

D) A woman in the group whom the others look at and call over when the

nurseapproaches

4. A new nurse has recently joined the ICU from a different hospital, which had a much

stricter policy regarding visiting hours. She expresses concern about the impact of openvisiting hours on patient well-being. Which of the following would be the best explanation for the purpose of open visiting hours? Select all that apply.

A) To better provide rest and quiet

B) To strengthen the relationship between the family and health care provider

C) To control the number of visitors for a patient

D) To provide an undisturbed environment

E) To decrease the patients anxiety

F) To increase the satisfaction of the family with the experience

5. A nurse observes that a 38-year-old single father whose 11-year-old daughter is in the

ICU is struggling to explain to his 6 - year-old son the likelihood that the daughter will die.

The young boy asks what will happen to his sister when she dies, but the father breaks down in tears and seems unable to respond. Which of the following would be the mostappropriate intervention for the nurse to make?

A) Suggest that the father contact his pastor, rabbi, or other spiritual leader for

counselfor him and his son

B) Sit down with the father and son and share her own religious beliefs

C) Ask the patients doctor to explain to the father the odds of the daughter surviving

D) Leave the father and son to grieve alone

6. A patient is experiencing severe pain, despite receiving pain medication for the past 24

hours. The patients wife expresses concern about this to the nurse. Which response by thenurse would be most empowering to the patients family?

A) Explain that the doctor is an expert on pain medication and that the current level

ofmedication is the best.

B) Recommend that the family members take turns massaging the patients feet

todistract from the pain.

C) Encourage the family to request that the physician evaluate the patients pain control.

D) Ask the family to wait another 24 hours to see whether the patients pain level

willgo down.

7. The sister of a patient in the ICU has been at the patients bedside non-stop for 48

hours.The nurse suggests to her that she return home to rest. Which of the following is the proper rationale for the nurse making such a suggestion?

A) The sister is in the way of the health care providers.

B) The patient may become annoyed by her continual presence.

C) The patient will recover more easily in peace and quiet.

D) The sister needs to maintain her own health during this time.

8. A young man has just arrived at the ICU from out of town and received news that his

girlfriend, who is admitted there, likely only has a few days left to live. Which of the following would be the best approach for the nurse to take in caring for the needs of thisyoung man?

A) Recommending that he go home and rest

B) Giving him unrestricted visiting hours with the patient

C) Suggesting that he meet with the hospital chaplain

D) Recommending that he ask the doctor to evaluate the patients pain control measures

9. A family of a young girl who has been diagnosed with leukemia has travelled 12 hours by

car to admit her to the ICU and be with her during her treatment. Which aspect of the critical care family assistance program would most likely be needed by this family initially?

A) Educational materials

B) Weekly group family information sessions

C) Hospitality programs

D) Pet therapy

10. A Muslim woman is admitted to the ICU after suffering severe burns over most of her

body. Which of the following would be the most appropriate measure for the nurse, a woman, to take in respect for the cultural practices of this patient?

A) Insist that only a female doctor be assigned to this patient.

B) Ensure that no pork products are included in the patients diet.

C) Ensure that direct eye contact is not made with the patients husband.

D) Ask the patients husband what religious and cultural preferences should

beconsidered in the patients care.

11. A client has been admitted after experiencing multiple trauma and is intubated and

sedated. When the five members of the immediate family arrive, they are anxious, angry,and very demanding. They all speak loudly at once and ask for many services and answers. What is the best nursing response?

A) Ask the family to leave until visiting hours begin.

B) Take them to a private area for initial explanations.

C) Page security to have them removed from unit.

D) Show them to the clients bedside and leave them alone.

12. The client has been in the CCU for several weeks and has been very unstable. One family

member stays at the bedside constantly and even naps in a bedside chair. The nurse understands that the family member is exhibiting which family member response to critical illness?

A) Exhibiting extreme distrust of the health care team

B) Seeking evidence for future legal or punitive action

C) Trying to maintain a level of control over the situation

D) Experiencing extreme fatigue from constant stress

13. The nurse is caring for a very seriously ill patient in the CCU. The family visits

sporadically, stays for only a short time, and does not ask many questions. How could thenurse best begin to involve the family in the patients care?

A) Ask one family member to assist with the patients bath.

B) Encourage family members to stay longer at each visit.

C) Focus nursing efforts on the patients legal next of kin.

D) Ask the family to complete the Critical Care Family Needs Inventory.

14. As part of the admission process, the nurse asks several questions about

familyrelationships. The nurse bases these actions on which rationale?

A) Assessing family relationships is an initial step in including the family in

patientcare.

B) These questions are part of the admission assessment tool required by this CCU.

C) The nurse has a natural curiosity and wishes to know how the family members

relatefor her own knowledge.

D) There is an ongoing research study to identify variant family patterns related

todisease incidence.

15. On their first visit to a critically ill patient, family members stand in the doorway of

theroom, making no effort to approach the patient. What is the most appropriate nursing action?

A) Instruct the family where the patient can be touched and what to say.

B) Engage the family in social conversation to ease them into the milieu.

C) Use visiting hours to explain to the family the general status of the patient.

D) Leave the family to adjust to the situation when they are ready.

16. A critically ill patient is not expected to survive this admission. The family asks the nurse

how the patient is doing. When answering this question, what should the nurse include?

A) Emphasize that the patient is young and strong and may still survive.

B) Refer the family to the physician for all details and answers.

C) Give specific information such as descending trends in parameters.

D) Ask if the family has determined which funeral home will be called.

17. A patients family is exhibiting increasingly impaired coping as the patients condition

deteriorates. The nurse asks the family to state the biggest concern from their perspective.What is the most important rationale for this question?

A) The question indicates active listening on the part of the nurse.

B) The question is used as a way to validate the familys knowledge.

C) The question clarifies the nurses understanding of current family needs.

D) The question promotes problem definition, which helps define the degree of

familyunderstanding.

18. The nurse recommends that the family of a critically ill patient seek help from the

CriticalCare Family Assistance Program. What benefit for the family does the nurse anticipate?

A) Reduction of health care cost

B) More physical comfort

C) Multidisciplinary support

D) Health promotion information

19. While interacting with the family of a critically ill patient, the nurse suggests that

thefamily must be feeling very anxious and perhaps angry. How does this nursing action

benefit the family?

A) Removes the focus of the conversation from the patient

B) Focusing on feelings helps the family avoid delayed grief and unhealthy coping

C) Gives validation of need for psychological counseling

D) Reduces family insistence for patient progress information

20. The nurse is caring for a patient from a very different cultural group. In delivering

care,how can the nurse best demonstrate cultural sensitivity?

A) Ask the family about their cultural beliefs and customs that may apply.

B) Assume that the patient and family will adjust to the hospital culture.

C) Inform the patient and family that the routines of the hospital take precedence.

D) Do a literature search on the patients culture to determine beliefs.

Answer Key

1. A

2. C

3. D

4. B, E, F

5. A

6. C

7. D

8. B

9. C

10. D

11. B

12. C

13. D

14. A

15. A

16. C

17. D

18. C

19. B

20. A

Chapter 4 Patient and Family Education in Critical Care

1. An elderly man whose wife has just been admitted to the ICU following congestive heart

failure is concerned about how passage of the Affordable Care Act will impact the care of his wife. Which of the following are expected outcomes of this legislation that it would be appropriate for the nurse to share with the man? Select all that apply.

A) The new legislation will result in a shortage of experienced critical care nurses.

B) The new legislation will require health care workers to meet higher quality

standardsrelated to patient care.

C) The new legislation will make it more challenging to meet the educational goals of

patients and families.

D) The new legislation will increase the length of stay of patients in the hospital.

E) The new legislation will shift the payment structure for hospitals and health

careproviders from a traditional fee-for-service model to an incentive model.

2. A young couple whose 5-year-old daughter has been admitted to the ICU approaches

thenurse with looks of concern on their faces. They express frustration to the nurse that theyhave not been able to speak with either the physician or the surgeon and are confused as to what the next steps are for their daughters treatment. What would be the best intervention for the nurse to make in this situation?

A) Offer to get ice chips for the couple to give to their daughter to empower them.

B) Make sure that they have the cell phone numbers of the physician and surgeon.

C) Teach the couple about the pathophysiology of the daughters disease.

D) Arrange a patient care conference with the couple and the health care team.

3. A nurse sees a group of physicians who are making teaching rounds in the hall of the ICU

heading toward the room of one of her patients. The patient, who currently has a visitor, has given approval in the past to have teaching groups visit. What should the nurse do in this situation?

A) Explain to the group of physicians that the patient currently has a visitor and

askwhether they could come by later.

B) Ask the visitor to leave so that the teaching group can discuss the patients case.

C) Allow the teaching group to enter the patients room, as he has already

givenapproval for them to visit.

D) Instruct the physicians to give clear explanations of the medical jargon they use.

4. The nurse is working with a patient from India who is recovering from a myocardial

infarction. When the nurse asks the patient whether she has had a myocardial infarction before, the patient seems confused and appears not to understand the nurse, although thepatient does speak English. Which of the 4 Cs of Culture should the nurse use to better communicate with this patient?

A) Call

B) Cause

C) Cope

D) Concern

5. A nurse needs to obtain informed consent from a deaf patient before a spinal tap

procedure is performed. Which of the following would be the best method for the nurse touse to ensure effective communication?

A) Explain the procedure verbally, speaking slowly so that the patient can read lips.

B) Have a trained oral interpreter interpret for the nurse.

C) Have the patient carefully read a printed copy of the informed consent document.

D) Use diagrams to explain to the patient the details of the procedure.

6. A nurse is explaining to a patient how radiation therapy works to kill cancer cells. She

begins by explaining how there are different types of cells in the body that reproduce at different rates. She then explains what cancer cells are and how they reproduce. Finally,she explains how radiation therapy uniquely targets cancer cells. This approach takes advantage of which domain of learning?

A) Affective

B) Psychomotor

C) Cognitive

D) Demonstration/return demonstration

7. A young man is recovering from anaphylactic shock caused by a bee sting. The nurse is

trying to instruct the patient on how to use an epinephrine autoinjector (EpiPen), but the patient seems uninterested in learning. The nurse then explains how having the EpiPen with him at all times and knowing how to use it could not only save his life someday but also will give him a greater sense of security and safety. Which adult learning principle isthe nurse using? Select all that apply.

A) The learners self-concept

B) The learners life experience

C) Readiness to learn

D) Motivation to learn

E) The need to know

8. In attempting to teach a patient how to clean around the surgical sutures on his

abdomen upon discharge to home, the nurse determines that applying the principle of the learners self-concept would be most effective with this patient. Which of the following is the bestexample of an application of that principle in this situation?

A) Relating to the patient a story about another patient who failed to properly clean

hissutures and the outcome

B) Explaining that failure to properly clean around the suture site could result in

seriousinfection

C) Commenting that learning to properly clean his suture site could give the man

skillsthat would better prepare him for a career in health care

D) Mentioning to the patient that, if he would prefer, he can watch a video on

thehospitals website on how to clean around a suture site

9. A nurse needs to explain to a patient about the possible side effects the patient may

experience related to the pain medication she is now beginning while in the ICU and which she will be continuing upon discharge. Which method would be the most effective way to teach this to the patient?

A) In a planned teaching session, in which the nurse covers medication-related

sideeffects, dietary restrictions, and activity restrictions

B) Via a brochure that the patient can take with her on discharge

C) By briefly explaining the side effects while administering the medication to the

patient

D) By relating a story about another patient who had a severe adverse reaction to

thismedication

10. A nurse needs to evaluate a patients understanding of how to administer an IV

medicationat home. Which of the following would be the best method for evaluation?

A) The nurse explaining the procedure to the patient and family using diagrams

B) The nurse having the patient and family members demonstrate the

procedurethemselves

C) The nurse explaining the procedure while performing it on the patient

D) The nurse referring the patient to a computer-based educational library that has

aninteractive program

11. Teaching patients and families is an important part of critical care nursing. What factor

intodays critical care unit is a barrier to this education function?

A) Large numbers of inexperienced nurses

B) Serious illness of patients

C) Increased computer support

D) Use of specialty educators

12. The nurse is caring for a critically ill patient. On the previous shift, a nurse documented

unable to teach due to critical illness. What is the best nursing action by the current nurseto address the patients teaching and learning needs?

A) Realize that the patient is too ill to accept teaching at this time.

B) Look for opportunities for teaching, such a procedure explanation.

C) Focus all teaching efforts on the family to the exclusion of the patient.

D) Alter the plan of care to delay teaching until transfer to step-down unit.

13. After several weeks, a critically ill patient has progressed well and is being transferred to

a step-down unit. What normal patient response does the nurse anticipate?

A) Relief

B) Thankfulness

C) Anxiety

D) Indifference

14. The nurse is teaching a patient and family in the patients critical care room. The

criticalcare unit is busy and noisy. What nursing action will best enhance learning?

A) Explain the material simply using simple terms.

B) Give all explanations via commercial teaching brochures.

C) Close the door to the patients room.

D) Ask the family not to interrupt with questions.

15. The nurse is teaching a patient who is not a native English speaker. As the nurse gives

complex explanations, the patient nods and smiles. What is the best nursing interventionto ensure patient understanding?

A) Assume that the patients nods indicate understanding.

B) Ask a family member to interpret to the patient.

C) Use pictures whenever possible in the teaching.

D) Ask the patient to restate the information conveyed.

16. The nurse is teaching a patient newly diagnosed with diabetes mellitus how to manage

asliding-scale insulin protocol. What portion of this interaction indicates patient learning?

A) The sliding scale insulin protocol

B) Patients questions to the nurse

C) Nurses demonstration of use of the protocol

D) Patients verbalization of a flash of insight

17. When teaching a patient and family, the nurse wishes to use the affective domain

oflearning. What nursing action is most likely to involve the affective domain?

A) Presenting facts from simple to complex

B) Giving clear directions about when to call the physician

C) Using a nonthreatening approach

D) Using demonstration/redemonstration approach

18. The nurse is teaching a patient newly diagnosed with diabetes mellitus how to inject

insulin and chooses to use a demonstration/redemonstration technique. What domain oflearning is the nurse chiefly using?

A) Cognitive

B) Affective

C) Psychomotor

D) Educative

19. The nurse is teaching a patient newly diagnosed with cardiovascular disease how to

reduce risk factors. The nurse begins by explaining why this information is important forthe patient. What principle of adult learning is the nurse applying?

A) Need to know

B) Learners self-concept

C) Learners life experience

D) Motivation to learn

20. The nurse is teaching a group of patients newly diagnosed with cardiovascular

disease.What action demonstrates application of the adult learning principle of learners life experience?

A) Beginning with an explanation of why the material is important

B) Creating a learning situation that is self-directed and independent

C) Using case scenarios and problem-solving exercises

D) Applying content to real-life situations and actions

21. The nurse is assessing learning by a critically ill patient and family. What is the best

method of assessment?

A) Written test

B) Specific questions

C) Open-ended questions

D) Literacy assessment

Answer Key

1. B, E

2. D

3. A

4. A

5. B

6. C

7. D, E

8. D

9. C

10. B

11. A

12. B

13. C

14. C

15. D

16. D

17. C

18. C

19. A

20. C

21. C