High Acuity Nursing 5th edition Wagner, Johnson, Hardin-Pierce Test Bank

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  • Published: 2009
  • ISBN-10: 0135049261
  • ISBN-13: 978-0135049266

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high acuity nursing 5th edition wagner test bank

Chapter 1

Wagner

Module 1 – High-Acuity Nursing

Learning Objectives

1-1.   Discuss the various health care environments in which high-acuity patients receive care.

1-2.   Identify the need for resource allocation and staffing strategies for high-acuity patients.

1-3.   Examine the use of technology in high-acuity environments.

1-4. Identify the components of a healthy work environment.

1-5. Discuss the importance of patient safety in the high-acuity environment.

 

 

LO: 1-1. Discuss the various health care environments in which high acuity patients receive care.

  1. The patient who has had surgery has called the nurse to his bedside. He reports his chest feels tight. The assessment reveals the patient has a respiratory rate of 29, inspiratory wheezes, and an oxygenation saturation of 81%.   When planning the room assignment, the nurse will take into consideration the fact the patient is likely considered
  2. Priority 1.
  3. Priority 2.
  4. Priority 3.
  5. Priority 4.

Answer: 1

Rationale: The patient who is Priority 1 is acutely ill and needs intensive treatment and monitoring that is not provided outside of the ICU. The manifestations are consistent with pulmonary emboli. Priority 2 refers to patients needing intensive monitoring and may potentially need additional interventions. Priority 2 patients are critically ill but have little chance of recovery from their illnesses. Priority 4 patients are not appropriate for ICU admission.

Cognitive Level: Analyzing

Nursing Process: Planning

Client Need: Safe Effective Care Environment

 

LO: 1-1. Discuss the various health care environments in which high-acuity patients receive care.

  1. The daughter of a terminally ill patient questions the placement of her father on the medical surgical care unit. The patient in question is in the final stages of the disease process. She requests he be placed in the intensive care unit. She reports concerns that her father may not receive the close observation on such a busy hospital unit. Which of the following actions is indicated by the nurse?
  2. Contact the physician.
  3. Notify the intensive care unit of an impending transfer.
  4. Attempt to move the patient to a less busy unit.
  5. Discuss the care that can be provided on the unit with the family member.

Answer: 4

Rationale: Movement of a terminally ill patient is likely not the best use of available resources. Discussing the care that can be offered to the patient is the best initial course of action. It is still too early in the management of the problem to contact the physician. The nurse does not have the authority to transfer the patient to the intensive care unit or to a less busy unit.

Cognitive Level: Analyzing

Nursing Process: Implementation

Client Need: Safe Effective Care Environment

 

LO: 1-1. Discuss the various health care environments in which high-acuity patients receive care.

  1. A nurse is contemplating a transfer to an intensive care unit. The nurse is reviewing her potential strengths and weaknesses. Which of the following characteristics of the nurse will be of the greatest benefit in the intensive care environment?
  2. feels comfortable in ever changing situations
  3. closely evaluates the pros and cons of each decision for a long period of time before making a decision
  4. excited about all new experiences
  5. quiet and introverted

Answer: 1

Rationale: The nurse in the intensive care unit must be open to ever changing situations. The nurse must be able to be flexible. The rapid changes in the intensive care unit do not allow for extended time when considering actions. Excitement about all experiences is a beneficial characteristic in healthcare but is not the most important factor for this particular care unit. The quiet and introverted nurse may not be a good match for the high paced high acuity care unit due to the need for teamwork and interaction.

 

LO: 1-2. Identify the need for resource allocation and staffing strategies for high-acuity patients.

  1. The registered nurse is working as charge nurse on a busy high acuity care unit. Unexpectedly, a coworker becomes ill and needs to leave. There is a period of time in which the unit is short staffed while the ill coworker’s replacement travels in to work. What action by the charge nurse is indicated?
  2. Assign the unlicensed assistive personnel to watch the monitors and call for help if a patient “gets into trouble.”
  3. Contact the house supervisor and ask for a float nurse to be sent to the unit.
  4. Continue to work until the replacement nurse arrives.
  5. Assign the less acute patients to be cared for by the unlicensed assistive personnel.

Answer: 2

Rationale: The unit is understaffed. Replacement help must be provided. It is inappropriate to wait for the replacement nurse. The unlicensed assistive personnel is able to only provide care under the direct supervision of the nurse. Allowing the unlicensed personnel to watch the monitors or to have the primary care assignments of patients is inappropriate.

Cognitive Level: Analysis

Nursing Process: Implementation

Client Need: Safe, Effective Care Environment

 

LO: 1-2. Identify the need for resource allocation and staffing strategies for high-acuity patients.

  1. A recent nursing school graduate reports having an interview with a magnet hospital. When preparing for the interview, the graduate nurse researches the concept of magnet status. Which of the following perceptions by the nurse indicate an adequate understanding?
  2. Magnet status facilities pay substantial recruitment bonuses.
  3. Magnet status is an accreditation from the National League for Nurses.
  4. Magnet status facilities promote the interests of professional nursing.
  5. Magnet status hospitals must meet the minimum state nurse to patient ratios.

Answer: 3

Rationale: Magnet status is a designation developed by the American Academy of Nursing. It is awarded to hospitals that are able to prove their commitment to professional nursing practices. The remaining statements are incorrect.

Nursing Process: Evaluating

Client Need: Safe, Effective Care Environment

Cognitive Level: Analyzing

 

LO: 1-2. Identify the need for resource allocation and staffing strategies for high-acuity patients.

  1. A team of nurses is developing a research study to evaluate patient outcomes. When planning the study which of the following factors is recognized and reviewed most often?
  2. patient age
  3. reports of pain
  4. severity of illness
  5. mortality

Answer: 4

Rationale: Mortality is the most commonly used predictor for patient outcomes. Pain and severity of illness are sometimes used but have a large subjective quality. Age may be reviewed but is not used as often.

Cognitive Level: Applying

Nursing Process: Assessment

Client Need: Health Promotion and Maintenance

 

LO: 1-3. Examine the use of technology in high acuity environments.

  1. The nursing student is shadowing an experienced registered nurse. During the experience, the nurse reviews information on her personal digital assistant. The nurse recognizes
  2. this equipment is used to determine the time medications should be administered.
  3. the equipment helps the nurse to review the patient’s past hospitalization records.
  4. the equipment offers accessible reference information to the nurse.
  5. the equipment is used to improve the speed of medication administration.

Answer: 3

Rationale: The personal digital assistant (PDA) is used to provide quick bedside information to the nurse. The device is not used to review past medical records. Although medication information may be reviewed using certain PDA programs, it does not schedule medications or reduce administration times.

Cognitive Level: Applying

Nursing Process: Diagnosis

Client Need: Health Promotion and Maintenance

 

LO: 1-3. Examine the use of technology in high acuity environments.

  1. A nurse who has recently started working on the intensive care unit voices concerns to his preceptor that all of the machines being used in the care of the patient are reducing his ability to establish a therapeutic relationship with the assigned patients. What response by the preceptor is indicated?
  2. “These feelings may be a sign that this is not the work environment for you.”
  3. “There are ways to increase your interaction with your assigned patients.”
  4. “I completely understand how you feel.”
  5. “Technology improves our patient outcomes.”

Answer: 2

Rationale: The use of technology can lead the nurse to feel distanced from the patient. There are strategies the nurse can use to personalize care. He should be reminded that the use of machines does not take away the need for nursing assessment and care. It may be premature to decide that this nurse is not suited to the intensive care work environment. Telling the nurse that “you understand” his feelings does little to meet his need for education. Technology does improve outcomes but the nurse has more immediate concerns.

Cognitive Level: Analyzing

Nursing Process: Implementation

Client Need: Safe, Effective Care Environment

 

 

LO: 1-3. Examine the use of technology in high acuity environments.

  1. A recently hired nurse has been overheard saying she does not need to check as closely on her assigned patients as there are many machines that will “just do it for you.” What action by the nurse manager is indicated?
  2. The nurse should have a notation placed in her file indicating a lack of due care to assigned patients.
  3. The nurse should receive a verbal warning.
  4. The nurse manager should plan a skills check off for the nurse.
  5. The nurse manager should meet and discuss the needed assessment for assigned patients.

Answer: 4

Rationale: The use of technology must be accompanied by nursing care and assessment. Failure to provide hands-on care may reflect over-reliance on technology. The nurse manager will need to assess the nurse’s perceptions of responsibilities related to these areas. It is premature to give a written or verbal warning to the nurse. At this time the nurse has not demonstrated a lack of clinical ability and a skills check off is premature.

Cognitive Level: Analyzing

Nursing Process: Planning

Client Need: Safe, Effective Care Environment

 

 

LO: 1-4. Identify the components of a healthy work environment.

  1. A nurse has sought the counsel of the nurse manager. The nurse who transferred to the intensive care environment 6 months ago reports feeling “burned out.”   The nurse voices curiosity about how this could happen after such a short time in the unit. The charge nurse’s response should contain which of the following information?
  2. The nurse most likely is not a good candidate for the intensive care unit.
  3. The nurse is having a delayed response to change in work environment.
  4. Burnout is not limited to long-term exposure to a work environment.
  5. Burnout cannot be predicted.

 

Answer: 3

Rationale: Burnout may result not only from remaining in a work environment for a long period of time but also from working in a stressful environment in which a great deal of flexibility is expected and patient conditions change rapidly. The nurse may still be a good candidate for the intensive care unit. There is no indication the nurse is not adapting to the change in work environment. Burnout can be linked to certain work environments.

Cognitive Level: Analyzing

Nursing Process: Planning

Client Need: Health Promotion and Maintenance

 

 

LO: 1-4. Identify the components of a healthy work environment.

  1. A group of nurses who work in the Emergency Department have been asked to meet with the unit manager’s office after three children died there after being in an automobile accident. One of the nurses questions the need to meet since they are feeling comfortable with their actions in the situation. What information should be provided to the nurses by the unit manager?
  2. Information obtained in the debriefing meeting will be used to assess the nurses’ actions for appropriateness.
  3. The meeting will enable the unit manager to make the determination of who is the best candidate to be charge nurse when the manager is away from the unit.
  4. The meeting will be used for input into the nurses’ annual pay increases.
  5. The meeting will be used to allow the nurses an opportunity to share their feelings about the events.

Answer: 4

Rationale: Debriefing sessions are used to allow the nurses a confidential location to explore their feelings and discuss the experience. These sessions are an effort to prevent stress related burnout. The sessions do not focus on locating future potential managers, determine pay levels or to identify problems with clinical performance.

Cognitive Level: Evaluating

Nursing Process: Implementation

Client Need: Psychological Integrity

 

 

LO: 1-4. Identify the components of a healthy work environment.

  1. A group of nurse managers are planning an in-service for new nurse managers. The AACN Standards for a Healthy Work Environment will be presented. Which of the following should be included in the information?
  2. Clinical skills are more important than communication skills.
  3. The critical partners in the organization are physicians, members of the administration and nurse managers.
  4. Staff nurses must embrace authentic leadership and value it to ensure an effectively running patient care unit.
  5. True collaboration must be promoted to ensure a healthy work environment.

Answer: 4

Rationale: The AACN Standards for a Healthy Work environment stress the value of true collaboration. Communication skills and clinical skills have equal importance. Critical partners in the organization must include all members of the nursing staff not simply management team members. The nurse leader must embrace authentic leadership and lead by example to ensure effectively running patient care areas.

Cognitive Level: Analyzing

Nursing Process: Planning

Client Need: Psychological Integrity

 

 

LO: 1-5. Discuss the importance of patient safety in the high acuity environment.

  1. A nurse has made an error. She/he is concerned about what will happen when the mistake is brought to light. What information should be provided to the nurse?
  2. “Errors are serious and will likely result in your termination.”
  3. “Errors are human and there is no need to dwell on them.”
  4. “I encourage nurses to avoid reporting small errors as this will just make a mountain out of a molehill.”
  5. “Error reporting is a way to ultimately improve performance.”

Answer: 4

Rationale: The current culture of healthcare considers error reporting the responsible action to take. Awareness of errors is a way to initiate performance improvement. Errors are human and should not result in termination. There is not enough information provided in the question to ascertain if the nurse has a history of mistakes that would warrant termination. It is important to process the information concerning the error, as it will prevent them from happening in the future. Errors both large and small must be reported.

Cognitive Level: Evaluating

Nursing Process: Implementation

Client Need: Safe, Effective Care Environment

 

 

LO: 1-5. Discuss the importance of patient safety in the high-acuity environment.

  1. A nurse is orienting to the critical care unit. The nurse notes the preceptor is accessing information from a PDA. The orienting nurse questions the use of the device. What statement by the preceptor is indicated?
  2. “The PDA is used to provide me with important information to deliver safe patient care.”
  3. “You are right, the PDA is time consuming.”
  4. “The PDA is utilized to increase the speed at which I deliver patient care.”
  5. “The PDA is used to make sure I am medicating the right patient.”

Answer: 1

Rationale: The PDA is used to provide information for patient care at the bedside. The type of information accessed with the PDA includes reference materials and drug data. The PDA is used to offer this information in a timely manner. The focus of the PDA is to promote patient safety not reduce work time. The PDA does not check patient information to ensure the right patient is being medicated.

Cognitive Level: Analyzing

Nursing Process: Implementation

Client Need: Safe, Effective Care Environment

 

LO: 1-5. Discuss the importance of patient safety in the high-acuity environment.

  1. A group of nurse managers are concerned about a series of recent errors made by several nurses in the critical care units. The nurses are seeking to reduce errors. What factors will help to promote patient safety? Select all that apply.
  2. pay increases
  3. increased unlicensed personnel for the unit
  4. reduced managerial input allowing staff nurses to assume more responsibility
  5. encouraging the nurses and physicians to collaborate on positive patient outcomes

Answer: 4

Rationale: Environmental factors that promote patient safety include positive nurse-physician relationships. Pay is not linked to reducing nursing errors. Staffing is important but positive patient outcomes and reduced errors are more closely linked to nurse-patient ratios. The nurse manager must be an integral part of the nursing unit. The unit experiencing errors will need more nurse manager input not less.

Cognitive Level: Analyzing

Nursing Process: Planning

Client Need: Safe, Effective Care Environment

high acuity nursing 5th edition wagner test bank

Table of Contents = 38 Chapters

Part I Special Topics

Module 1 High Acuity Nursing

Module 2 Holistic Care of the High Acuity Patient and Family (NEW)

Module 3 The Older Adult High Acuity Patient (NEW)

Module 4 Acute Pain in the High Acuity Patient

Part II Hematologic (Cellular Function)

Module 5 Determinants and Assessment of Hematologic Function (NEW)

Module 6 Alterations in Red Blood Cell Function and Hemostasis (NEW)

Module 7 Alterations in White Blood Cell Function (NEW)

Module 8 Alteration in Immune Response: Solid Organ and Hematopoietic Stem-Cell Transplantation

Part III Pulmonary Gas Exchange

Module 9 Determinants and Assessment of Pulmonary Gas Exchange

Module 10 Alterations in Pulmonary Gas Exchange

Module 11 Supporting Pulmonary Gas Exchange: Mechanical Ventilation

Part IV Cardiac Output

Module 12 Determinants and Assessment of Cardiac Output

Module 13 Assessment of Hemodynamic Status: Hemodynamic Monitoring

Module 14 Assessment of Cardiac Rhythm: Basic Electrocardiographic Rhythm Interpretation

Module 15 Alterations in Cardiac Output

Module 16 Alterations in Myocardial Tissue Perfusion

Part V Tissue Perfusion

Module 17 Determinants and Assessment of Oxygen Delivery and Oxygen Consumption

Module 18 Alterations in Oxygen Delivery and Consumption: Shock States

Module 19 Alterations in Tissue Perfusion: Multiple Organ Dysfunction Syndrome

Part VI Sensory Motor

Module 20 Determinants and Assessment of Cerebral Tissue Perfusion

Module 21 Alteration in Cerebral Tissue Perfusion: Acute Brain Attack

Module 22 Alteration in Sensory Perceptual Disorders: Acute Head Injury

Module 23 Alteration in Sensory Perceptual Function: Acute Spinal Cord Injury

Module 24 Sensory Motor Complications of Acute Illness (NEW)

Part VII Fluid and Electrolyte Balance

Module 25 Determinants and Assessment of Fluid and Electrolyte Balance (NEW)

Module 26 Alterations in Fluid and Electrolyte Balance

Module 27 Alteration in Renal Function: Renal Failure

Part VIII Metabolic: Regulation of Internal Environment

Module 28 Determinants and Assessment of Gastrointestinal, Hepatic, and Pancreatic Function (NEW)

Module 29 Alterations in Gastrointestinal Function

Module 30 Alterations in Hepatic Function

Module 31 Alterations in Pancreatic Function

Part IX Metabolic: Nutrition

Module 32 Determinants and Assessment of Nutrition and Metabolic Function (NEW)

Module 33 Alterations in Metabolism

Module 34 Alterations in Glucose Metabolism

Module 35 Determinants and Assessment of Injury (NEW)

Module 36 Alterations in Skin Integrity: Complex Wound Management

Module 37 Alteration in Skin Integrity: Acute Burn Injury

Module 38 Alteration in Multisystem Function: Multiple Trauma