Priorities in Critical Care Nursing 6th edition Urden Test Bank

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  • Published: 2011
  • ISBN-10: 0323074618
  • ISBN-13: 978-0323074612

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priorities in critical care nursing 6th edition test bank

Urden: Priorities in Critical Care Nursing, 6th Edition

Chapter 01: Caring for the Critically Ill Patient

Test Bank

MULTIPLE CHOICE

1. Which of the following best describes the difference between the roles of the clinical nurse specialist (CNS) and the acute care nurse practitioner (ACNP)?

a.The CNS has prescriptive authority and works with individual patients.
b.The ACNP has prescriptive authority and works with groups of patients.
c.The CNS works only as a consultant.
d.The ACNP works only with families.

ANS: B

ACNPs manage clinical care of a group of patients and have various levels of prescriptive authority, depending on the state and practice area in which they work. They also provide care consistency; interact with families; plan for patient discharge; and provide teaching to patients, families, and other members of the heath care team.

DIF:Cognitive Level: ComprehensionREF:1

OBJ:Nursing Process: ImplementationTOP:Advanced Practice

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

2. The framework for critical care nurses is based on what authoritative standards?

a.The Joint Commission’s National Patient Safety Goals
b.American Association of Critical-Care Nurses (AACN) Standards of Care
c.American Hospital Association algorithms
d.Centers for Disease Control and Prevention Emergency Preparedness Guidelines

ANS: B

The AACN has established nursing standards to provide a framework for critical care nurses. The standards are authoritative statements that describe the level of care and performance by which the quality of nursing care can be judged. Standards serve as descriptions of expected nursing roles and responsibilities.

DIF:Cognitive Level: KnowledgeREF:1

OBJ:Nursing Process: ImplementationTOP:Standards of Care

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

3. The rationale for using evidence-based practice is to:

a.produce consistent, positive outcomes.
b.justify the actions of providers.
c.convince insurance companies to pay.
d.provide legal protection for providers.

ANS: A

By basing practice on scientific findings, with their ability to explain and predict, nurses are able to provide research-based interventions with consistent, positive outcomes.

DIF:Cognitive Level: ComprehensionREF:2

OBJ: Nursing Process: Implementation TOP: Evidence-based Practice

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

4. Practice Alerts promoted by the AACN are:

a.descriptive warnings of hazardous practices.
b.quick references for practice areas.
c.notices of violations of the Nursing Practice Act.
d.simulated situations for practicing difficult techniques.

ANS: B

The AACN has promulgated several practice summaries in the form of Practice Alerts. These alerts are short directives that can be used as a quick reference for practice areas (e.g., oral care, noninvasive blood pressure monitoring, ST-segment monitoring). They are succinct and supported by evidence and address both nursing and multidisciplinary activities. Each alert includes the clinical information, followed by references that support the practice.

DIF:Cognitive Level: ComprehensionREF:2

OBJ: Nursing Process: Implementation TOP: Evidence-based Practice

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

5. An algorithm used in the care and treatment of the critically ill patient is the:

a.AACN Standards of Care.
b.advanced cardiac life support algorithms published by the American Heart Association.
c.state board of nursing state practice act.
d.National League for Nursing’s Center for Nursing Advocacy Mission Statement.

ANS: B

An algorithm is a stepwise decision-making flowchart for a specific care process or processes. Algorithms are more focused than clinical pathways and guide the clinician through the “if, then” decision-making process, addressing patient responses to particular treatments. Well-known examples of algorithms are the advanced cardiac life support algorithms published by the American Heart Association.

DIF:Cognitive Level: ComprehensionREF:4

OBJ: Nursing Process: Implementation TOP: Care Management Tools

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

6. The nurse best demonstrates an understanding of holistic care by:

a.explaining the use of the continuous blood pressure monitoring device to the family.
b.using active listening with a patient who is fearful and anxious.
c.incorporating other disciplines into the plan of care.
d.reviewing the list of home medications with a family member.

ANS: B

The critical care nurse must be able to deliver high-quality care skillfully, using all appropriate technologies, while incorporating psychosocial and other holistic approaches, as appropriate, given time and the patient’s condition.

DIF:Cognitive Level: SynthesisREF:2

OBJ:Nursing Process: ImplementationTOP:Holistic Care

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

7. Which of the following activities has demonstrated an impact on decreasing distractions in the critical care unit?

a.Allowing no visitors into the unit while physicians make rounds.
b.Restricting visitors to only one at a time at the patient’s bedside.
c.Performing nurse-to-nurse handoffs at the nursing station.
d.Establishing a “no interruption zone” around the medication preparation area.

ANS: D

Medication administration continues to be one of the most error-prone nursing interventions for the critical care nurse. Many medication errors are related to system failures; specifically, distraction is a major factor. Various interventions have been created in an attempt to decrease medication errors. Most recently, a published study reported establishing a “no interruption zone” for medication safety in an intensive care unit. In this pilot study, there was a 40% decrease in interruptions from the baseline measurement.

DIF:Cognitive Level: AnalysisREF:5

OBJ:Nursing Process: ImplementationTOP:Patient Safety

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

8. Ways that critical care nurses can ensure that individual differences related to culture are incorporated into the plan of care include:

a.asking the patient/family about cultural beliefs that may apply.
b.asking the patient/family to comply with the hospital culture.
c.using a standardized plan of care for consistency.
d.formulating lists of cultural characteristics that apply to all group members.

ANS: A

Nurses must possess knowledge about biocultural, psychosocial, and linguistic differences in diverse populations to make accurate assessments. Interventions must then be tailored to address the uniqueness of each patient and family.

DIF:Cognitive Level: AnalysisREF:3

OBJ:Nursing Process: AssessmentTOP:Holistic Care

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

9. Which of the following is an example of a healthy work environment?

a.Physician belittling a nurse for not knowing a patient’s secondary diagnosis.
b.Nurse not following a physician’s order because she did not understand it.
c.Nurse collaborates with a physician regarding a patient’s need for palliative care.
d.Nurse rolling his/her eyes when asked a question by a new graduate nurse.

ANS: C

A nurse collaborating with a physician regarding a patient’s needs is an example of Standard II – True Collaboration.

DIF:Cognitive Level: AnalysisREF:Box 1-3

OBJ: Nursing Process: Assessment TOP: Healthy Work Environment

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

MULTIPLE RESPONSE

1. Critically ill patients receive better care in hospitals when they are: (Select all that apply)

a.mechanized.
b.multidisciplinary.
c.specialized.
d.holistic.

ANS: B, C, D

Critical care today is provided to patients by a multidisciplinary team of health care professionals who have in-depth education in the specialty field of critical care. It should be holistic in nature.

DIF:Cognitive Level: ComprehensionREF:2

OBJ:Nursing Process: ImplementationTOP:Holistic Care

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

2. Special capabilities that clinical nurse specialists (CNSs) bring to the care of the critically ill patient include: (Select all that apply)

a.providing routine bedside care.
b.conducting research.
c.offering spiritual support.
d.consulting.
e.providing discharge planning.

ANS: B, D

CNSs serve in specialty roles that require clinical, teaching, research, leadership, and consultative abilities.

DIF:Cognitive Level: ComprehensionREF:1

OBJ:Nursing Process: ImplementationTOP:Advanced Practice

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

3. Protocols are distinguished from pathways or guidelines by which of the following? (Select all that apply)

a.They are used in research.
b.They are more directive and rigid.
c.They have more flexibility in use.
d.They are cyclic.

ANS: A, B

A protocol is a common tool in research studies. Protocols are more directive and rigid than pathways or guidelines, and providers should not vary from a protocol. Patients are screened carefully for specific entry criteria before being started on a protocol. The many national research protocols include those for cancer and chemotherapy studies.

DIF:Cognitive Level: ApplicationREF:4

OBJ:Nursing Process: ImplementationTOP:Holistic Care

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

4. Especially in a critical care unit, patient safety is an ethical imperative because: (Select all that apply)

a.surveillance is more prevalent and the nurses’ actions are scrutinized.
b.the highly complex environment makes errors and accidents more likely.
c.patients are vulnerable because of their compromised state.
d.the high-technology setting decreases risk of errors and omissions.

ANS: B, C

Patient safety has been described as an ethical imperative, and one that is implied in health care professionals’ actions and interpersonal processes. Critical care units are prime examples of settings in which errors may occur because of the hectic, complex environment where the margins of error are narrow and the demands for safety are crucial. In this environment, patients are particularly vulnerable because of their compromised physiological status, need for multiple technological and pharmacological interventions, and care by multiple providers who frequently work at a fast pace.

DIF:Cognitive Level: ComprehensionREF:4

OBJ: Nursing Process: Planning

TOP:Patient Safety

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

5. The regulations of the Health Insurance Portability and Accountability Act have which special implications for the provider of care in the critical care environment? (Select all that apply)

a.Privacy must be maintained in close working conditions.
b.Only as much information as the patient/family needs should be disclosed.
c.The care provider must be honest and accurate in reporting patient-related information.
d.Confidentiality must be preserved when speaking with family members.

ANS: A, D

The Health Insurance Portability and Accountability Act of 1996 has created additional challenges for health care organizations and providers because of the stringent requirements of the law and the additional resources needed to meet these requirements. Most relevant for critical care clinicians is the requirement for privacy and confidentiality related to protection of health care data. This has implications for interacting with family members, as well as others, and for providing care in the oftentimes very close work environment, tight working spaces, and emergent situations. Clinicians are referred to their organizational policies and procedures for specific procedures and requirements in their particular work setting.

DIF:Cognitive Level: ApplicationREF:5

OBJ: Nursing Process: Planning

TOP:Confidentiality

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

priorities in critical care nursing 6th edition test bank