Test Bank For Introduction To Critical Care Nursing, 6th Edition

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Chapter 1: Overview of Critical Care NursingChapter 1: Overview of Critical Care NursingTest BankMULTIPLE CHOICE1.Which of the following professional organizations best supports critical carenursing practice?a.AmericanAssociationofCritical-CareNursesb.AmericanHeartAssociationc.AmericanNursesAssociationd.SocietyofCriticalCareMedicineANS: AThe American Association of Critical-Care Nurses is the specialty organization thatsupports and represents critical care nurses. The American Heart Association supportscardiovascular initiatives. The American Nurses Association supports all nurses. TheSociety of Critical Care Medicine represents the multiprofessional critical care teamunder the direction of an intensivist.DIF: Cognitive Level: Knowledge REF: p. 4OBJ: Discuss the purposes and functions of the professional organizations that support criticalcare practice. TOP: Nursing Process Step: N/AMSC: NCLEX: Safe and Effective Care Environment2.A nurse has been working as a staff nurse in the surgical intensive care unit for 2years and is interested in certification. Which credential would be most applicable forher to seek?a.ACNPCb.CCNSc.CCRNd.PCCNANS: CThe CCRN certification is appropriate for nurses in bedside practice who care forcritically ill patients. The ACNPC certification is for acute care nurse practitioners.The CCNS certification is for critical care clinical nurse specialists. The PCCN

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certification is for staff nurses working in progressive care, intermediate care, or step-down unit settings.DIF: Cognitive Level: Application REF: p. 5OBJ: Explain certification options for critical care nurses. TOP: Nursing Process Step: N/AMSC: NCLEX: Safe and Effective Care Environment3.The main purpose of certification is to:a.assuretheconsumerthatyouwillnotmakeamistake.b.prepareforgraduateschool.c.promotemagnetstatusforyourfacility.d.validateknowledgeofcriticalcarenursing.ANS: DCertification assists in validating knowledge of the field, promotes excellence in theprofession, and helps nurses to maintain their knowledge of critical care nursing.Certification helps to assure the consumer that the nurse has a minimum level ofknowledge; however, it does not ensure that care will be mistake-free. Certificationdoes not prepare one for graduate school; however, achieving certificationdemonstrates motivation for achievement and professionalism. Magnet facilities arerated on the number of certified nurses; however, that is not the purpose ofcertification.DIF: Cognitive Level: Analysis REF: pp. 4-5OBJ: Explain certification options for critical care nurses. TOP: Nursing Process Step: N/AMSC: NCLEX: Safe and Effective Care Environment4.The synergy model of practice focuses on:a.allowingunrestrictedvisitingforthepatient24hourseachday.b.holisticandalternativetherapies.c.needsofpatientsandtheirfamilies,whichdrivesnursingcompetency.d.patients’needsforenergyandsupport.ANS: CThe synergy model of practice states that the needs of patients and families influenceand drive competencies of nurses. Nursing practice based on the synergy model wouldinvolve tailored visiting to meet thepatient’sandfamily’sneeds and application of

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alternative therapies if desired by the patient, but that is not the primary focus of themodel.DIF: Cognitive Level: Application REF: p. 5 | Fig. 1-3OBJ: Describe standards of professional practice for critical care nursing.TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment5.The family of your critically ill patient tells you that they have not spoken with thephysician in over 24 hours and they have some questions that they want clarified.During morning rounds, you convey this concern to the attending intensivist andarrange for her to meet with the family at 4:00 PM in the conference room. Whichcompetency of critical care nursing does this represent?a.Advocacyandmoralagencyinsolvingethicalissuesb.Clinicaljudgmentandclinicalreasoningskillsc.Collaborationwithpatients,families,andteammembersd.Facilitationoflearningforpatients,families,andteammembersANS: CAlthough one might consider that all of these competencies are being addressed,communication and collaboration with the family and physician best exemplify thecompetency of collaboration.DIF: Cognitive Level: Analysis REF: p. 9OBJ: Describe standards of professional practice for critical care nursing.TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment6.The AACN Standards for Acute and Critical Care Nursing Practice use whatframework to guide critical care nursing practice?a.Evidence-basedpracticeb.Healthyworkenvironmentc.NationalPatientSafetyGoalsd.NursingprocessANS: DThe AACNStandards for Acute and Critical Care Nursing Practice delineate thenursing process as applied to critically ill patients: collect data, determine diagnoses,identify expected outcomes, develop a plan of care, implement interventions, andevaluate care. AACN promotes a healthy work environment, but this is not included

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in the Standards. The Joint Commission has established National Patient Safety Goals,but these are not the AACN Standards.DIF: Cognitive Level: Analysis REF: p. 5 | Box 1-2OBJ: Describe standards of professional practice for critical care nursing.TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment7.The charge nurse is responsible for making the patient assignments on the criticalcare unit. She assigns the experienced, certified nurse to care for the acutely ill patientwith sepsis who also requires continuous renal replacement therapy and mechanicalventilation. She assigns the nurse with less than 1 year of experience to two patientswho are more stable. This assignment reflects implementation of the:a.crewresourcemanagementmodelb.NationalPatientSafetyGoalsc.QualityandSafetyEducationforNurses(QSEN)modeld.synergymodelofpracticeANS: DThis assignment demonstrates nursing care to meet the needs of the patient. Thesynergy model notes that the nurse competencies are matched to the patientcharacteristics. Crew resource management concepts related to team training, NationalPatient Safety Goals are specified by The Joint Commission to promote safe care butdo not incorporate the synergy model. The Quality and Safety Education for Nursesinitiative involves targeted education to undergraduate and graduate nursing studentsto learn quality and safety concepts.DIF: Cognitive Level: Analysis REF: p. 5 | Fig. 1-3OBJ: Describe standards of professional practice for critical care nursing.TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment8.The vision of the American Association of Critical-Care Nurses is a healthcaresystem driven by:a.ahealthyworkenvironment.b.carefromamultiprofessionalteamunderthedirectionofacriticalcarephysician.c.theneedsofcriticallyillpatientsandfamilies.d.respectful,healing,andhumaneenvironments.ANS: C

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The AACN vision is a healthcare system driven by the needs of critically ill patientsand families where critical care nurses make their optimum contributions. AACNpromotes initiatives to support a healthy work environment as well as respectful andhealing environments, but that is not theorganization’svision. The SCCM promotescare from a multiprofessional team under the direction of a critical care physician.DIF: Cognitive Level: Knowledge REF: p. 4OBJ: Discuss the purposes and functions of the professional organizations that support criticalcare practice. TOP: Nursing Process Step: N/AMSC: NCLEX: Safe and Effective Care Environment9.The most important outcome of effective communication is to:a.demonstratecaringpracticestofamilymembers.b.ensurethatpatientteachingisdone.c.meetthediversityneedsofpatients.d.reducepatienterrors.ANS: DMany errors are directly attributed to faulty communication. Effective communicationhas been identified as an essential strategy to reduce patient errors and resolve issuesrelated to patient care delivery. Communication may demonstrate caring practices, beused for patient/family teaching, and address diversity needs; however, the mainoutcome of effective communication is patient safety.DIF: Cognitive Level: Knowledge REF: pp. 8-9OBJ: Describe quality and safety initiatives related to critical care nursing.TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment10.You are caring for a critically ill patient whose urine output has been low for 2consecutive hours. After a thorough patient assessment, you call the intensivist withthe following report.Dr. Smith,I’mcalling about Mrs. P., your 65-year-old patient inCCU 10. Her urine output for the past 2 hours totaled only 40 mL. She arrived fromsurgery to repair an aortic aneurysm 4 hours ago and remains on mechanicalventilation. In the past 2 hours, her heart rate has increased from 80 to 100 beats perminute and her blood pressure has decreased from 128/82 to 100/70 mm Hg. She isbeing given an infusion of normal saline at 100 mL per hour. Her right atrial pressurethrough the subclavian central line is low at 3 mm Hg. Her urine is concentrated. HerBUN and creatinine levels have been stable and in normal range. Her abdominal

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dressing is dry with no indication of bleeding. My assessment suggests that Mrs. P. ishypovolemic and I would like you to consider increasing her fluids or giving her afluid challenge.Using the SBAR model for communication, the information the nursegives about thepatient’shistory and vital signs is:a.Situationb.Backgroundc.Assessmentd.RecommendationANS: BThe history and vital signs are part of the background. Information regarding the lowurine output is the situation. Information regarding possible hypovolemia is part of thenurse’sassessment, and the suggestion for fluids is the recommendation.DIF: Cognitive Level: Analysis REF: pp. 8-9OBJ: Describe quality and safety initiatives related to critical care nursing.TOP: Nursing Process Step: Assessment MSC: NCLEX: Safe and Effective Care Environment11.The family members of a critically ill, 90-year-old patient bring in a copy of thepatient’sliving will to the hospital, which identifies thepatient’swishes regardinghealth care. You discuss contents of the living will with thepatient’sphysician. Thisis an example of implementation of which of the AACN Standards of ProfessionalPerformance?a.Acquiresandmaintainscurrentknowledgeofpracticeb.Actsethicallyonthebehalfofthepatientandfamilyc.Considersfactorsrelatedtosafepatientcared.UsesclinicalinquiryandintegratesresearchfindingsinpracticeANS: BDiscussing end-of-life issues is an example of a nurse acting ethically on behalf of thepatient and family. The example does not relate to acquiring knowledge, promotingpatient safety, or using research in practice.DIF: Cognitive Level: Analysis REF: p. 5 | Box 1-2OBJ: Describe standards of care and performance for critical care nursing.TOP: Nursing Process Step: ImplementationMSC: NCLEX: Safe and Effective Care Environment

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12.Which of the following assists the critical care nurse in ensuring that care isappropriate and based on research?a.Clinicalpracticeguidelinesb.Computerizedphysicianorderentryc.Consultingwithadvancedpracticenursesd.ImplementingJointCommissionNationalPatientSafetyGoalsANS: AClinical practice guidelines are being implemented to ensure that care is appropriateand based on research. Some physician order entry pathways, but not all, are based onresearch recommendations. Some advanced practice nurses, but not all, are wellversed in evidence-based practices. The National Patient Safety Goals arerecommendations to reduce errors using evidence-based practices.DIF: Cognitive Level: Analysis REF: p. 7OBJ: Describe standards of professional practice for critical care nursing.TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment13.Comparing thepatient’scurrent (home) medications with those ordered duringhospitalization and communicating a complete list of medications to the next providerwhen the patient is transferred within an organization or to another setting arestrategies to:a.improveaccuracyofpatientidentification.b.preventerrorsrelatedtolook-alikeandsound-alikemedications.c.reconcilemedicationsacrossthecontinuumofcare.d.reduceharmsassociatedwithadministrationofanticoagulants.ANS: CThese are steps recommended in the National Patient Safety Goals to reconcilemedications across the continuum of care. Improving accuracy of patientidentification is another National Patient Safety Goal. Preventing errors related tolook-alike and sound-alike medications is done to improve medication safety, notmedication reconciliation. Reducing harms associated with administration ofanticoagulants is another National Patient Safety Goal.DIF: Cognitive Level: Comprehension REF: p. 6 | Box 1-3OBJ: Describe quality and safety initiatives related to critical care nursing.

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TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment14.As part of nursing management of a critically ill patient, orders are written to keepthe head of the bed elevated at 30 degrees, awaken the patient from sedation eachmorning to assess readiness to wean from mechanical ventilation, and implement oralcare protocols every 4 hours. These interventions are done as a group to reduce therisk of ventilator-associated pneumonia. This group of evidence-based interventions isoften called a:a.bundleofcare.b.clinicalpracticeguideline.c.patientsafetygoal.d.qualityimprovementinitiative.ANS: AA group of evidence-based interventions done as a whole to improve outcomes istermed abundle of care.This is an example of the ventilator bundle. Oftentimes thesebundles are derived from clinical practice guidelines and are monitored forcompliance as part of quality improvement initiatives. At some point, these maybecome part of patient safety goals.DIF: Cognitive Level: Analysis REF: p. 6OBJ: Describe quality and safety initiatives related to critical care nursing.TOP: Nursing Process Step: ImplementationMSC: NCLEX: Safe and Effective Care Environment15.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 andher leadership style is contributing to turnover. You have asked to be involved indeveloping new guidelines to prevent pressure ulcers in your patient population. Thenurse manager tells you that you do not yet have enough experience to be on theprevention task force. This situation and setting is an example of:a.abarriertohandoffcommunication.b.aworkenvironmentthatisunhealthy.c.ineffectivedecisionmaking.d.nursingpracticethatisnotevidence-based.ANS: B

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These are examples of an unhealthy work environment. A healthy work environmentvalues communication, collaboration, and effective decision making. It also hasauthentic leadership. It is not an example of handoff communication, which iscommunication that occurs to transition patient care from one staff member toanother. Neither does it relate to ineffective decision making. As a nurse, you can stillimplement evidence-based practice, but your influence in the unit is limited by theunhealthy work environment.DIF: Cognitive Level: Analysis REF: p. 7OBJ: Describe standards of professional practice for critical care nursing.TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment16.Which of the following statements describes the core concept of the synergy modelof practice?a.Allnursesmustbecertifiedinordertohavethesynergymodelimplemented.b.Familymembersmustbeincludedindailyinterdisciplinaryrounds.c.Nursesandphysiciansmustworkcollaborativelyandsynergisticallytoinfluencecare.d.Uniqueneedsofpatientsandtheirfamiliesinfluencenursingcompetencies.ANS: DThe synergy model of practice is care based on the unique needs and characteristics ofthe patient and family members. Although critical care certification is based on thesynergy model, the model does not specifically address certification. Inclusion offamily members into the daily rounds is an example of implementation of the synergymodel. With the focus on patients and family members with nurse interaction, thesynergy model does not address physician collaboration.DIF: Cognitive Level: Application REF: p. 5 | Fig. 1-3OBJ: Describe standards of professional practice for critical care nursing.TOP: Nursing Process Step: ImplementationMSC: NCLEX: Psychosocial Integrity17.A nurse who plans care based on thepatient’sgender, ethnicity, spirituality, andlifestyle is said to:a.beamoraladvocate.b.facilitatelearning.c.respondtodiversity.

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d.useclinicaljudgment.ANS: CResponse to diversity considers all of these aspects when planning and implementingcare. A moral agent helps resolve ethical and clinical concerns. Consideration of thesefactors does not necessarily facilitate learning. Clinical judgment uses other factors aswell.DIF: Cognitive Level: Comprehension REF: p. 3 | Box 1-1OBJ: Describe standards of professional practice for critical care nursing.TOP: Nursing Process Step: Planning MSC: NCLEX: Psychosocial IntegrityMULTIPLE RESPONSE1.Which of the following is a National Patient Safety Goal?(Select all that apply.)a.Accuratelyidentifypatients.b.Eliminateuseofpatientrestraints.c.Reconcilemedicationsacrossthecontinuumofcare.d.Reducerisksofhealthcare-acquiredinfection.ANS: A, C, DAll 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 useof restraints; however, this is not a National Patient Safety Goal.DIF: Cognitive Level: Analysis REF: p. 6 | Box 1-3OBJ: Describe quality and safety initiatives related to critical care nursing.TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment2.Which of the following is (are) official journal(s) of the American Association ofCritical-Care Nurses?(Select all that apply.)a.AmericanJournalofCriticalCareb.CriticalCareClinicsofNorthAmericac.CriticalCareNursed.CriticalCareNursingQuarterlyANS: A, CAmerican Journal of Critical CareandCritical Care Nurseare two official AACNpublications.Critical Care ClinicsandCritical Care Nursing Quarterlyare not AACNpublications.

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DIF: Cognitive Level: Knowledge REF: p. 4OBJ: Discuss the purposes and functions of the professional organizations that support criticalcare practice. TOP: Nursing Process Step: N/AMSC: NCLEX: Safe and Effective Care Environment3.The first critical care units were:(Select all that apply.)a.burnunits.b.coronarycareunitsc.recoveryrooms.d.neonatalintensivecareunits.ANS: B, CRecovery rooms and coronary care units were the first units designated to care forcritically ill patients. Burn and neonatal intensive care units were established asspecialty units evolved.DIF: Cognitive Level: Knowledge REF: p. 2 OBJ: Define critical care nursing.TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment4.Which of the following nursing activities demonstrates implementation of theAACN Standards of Professional Performance?(Select all that apply.)a.AttendingameetingofthelocalchapteroftheAmericanAssociationofCritical-CareNurswhichacontinuingeducationprogramonsepsisisbeingtaughtb.Collaboratingwithapastoralservicescolleaguetoassistinmeetingspiritualneedsofthepaandfamilyc.Participatingontheunit’snursepracticecouncild.PostinganarticlefromCriticalCareNurseonmanagementofvenousthromboembolismfocolleaguestoreade.Usingevidence-basedstrategiestopreventventilator-associatedpneumoniaANS: A, B, C, D, EAll answers are correct. Attending a program to learn about sepsis—Acquires andmaintains current knowledge and competency in patient care.Collaborating withpastoral services—Collaborates with the healthcare team to provide care in a healing,humane, and caring environment.Posting information for others—Contributes to theprofessional development of peers and other healthcare providers.Nurse practicecouncil—Provides leadership in the practice setting.Evidence-based practices—Usesclinical inquiry in practice.

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DIF: Cognitive Level: Analysis REF: p. 5 | Box 1-2OBJ: Describe standards of professional practice for critical care nursing.TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment5.Which scenarios contribute to effective handoff communication at change ofshift?(Select all that apply.)a.Thenephrologyconsultantphysicianismakingroundsandasksyoutoupdateheronthepastatusandassistinplacingacentrallineforhemodialysis.b.Thenoiselevelishighbecausetwiceasmanystaffmembersarepresentandeveryoneisgireportinthenurse’sstation.c.Theunithasdecidedtouseastandardizedchecklist/toolforchange-of-shiftreportsandpattransfers.d.Youandtheoncomingnurseconductastandardizedreportatthepatient’sbedsideandreviassessmentfindings.ANS: C, DA reporting tool and bedside report improve handoff communication by ensuringstandardized communication and review of assessment findings. Conducting report atthe bedside also reduces noise that commonly occurs at thenurse’sstation during achange of shift. The nephrologist has created an interruption that can impede handoffwith the next nurse. Likewise, noise in thenurse’sstation can cause distractions thatcan impair concentration and listening.DIF: Cognitive Level: Analysis REF: p. 8-9OBJ: Describe quality and safety initiatives related to critical care nursing.TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment6.Which strategy is important to addressing issues associated with the agingworkforce?(Select all that apply.)a.Allowingnursestoworkflexibleshiftdurationsb.Encouragingoldernursestotransfertoanoutpatientsettingthatislessstressfulc.Hiringnursetechniciansthatareavailabletoassistwithpatientcare,suchasturningthepatd.RemodelingpatientcareroomstoincludedevicestoassistinpatientliftingANS: A, C, DModifying the work environment to reduce physical demands is one strategy to assistthe aging workforce. Examples include overhead lifts to prevent back injuries.Twelve-hour shifts can be quite demanding; therefore, allowing nurses flexibility in

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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 tasksis helpful. Encouraging experienced, knowledgeable critical care nurses to leave thecritical care unit is not wise as the unit loses the expertise of this group.DIF: Cognitive Level: Analysis REF: p. 11OBJ: Identify current trends and issues in critical care nursing. TOP: Nursing Process Step: N/AMSC: NCLEX: Safe and Effective Care Environment7.Which of the following strategies will assist in creating a healthy work environmentfor the critical care nurse?(Select all that apply.)a.Celebratingimprovedoutcomesfromanurse-drivenprotocolwithapizzapartyb.Implementingamedicationsafetyprogramdesignedbypharmacistsc.Modifyingthestaffingpatterntoensurea1:1nurse/patientratiod.Offeringquarterlyjointnurse-physicianworkshopstodiscussunitissuese.UsingtheSituation-Background-Assessment-Recommendation(SBAR)techniqueforhandcommunicationANS: A, D, EMeaningful recognition, true collaboration, and skilled communication are elementsof a healthy work environment. Implementing a medication safety program enhancespatient safety, and if done without nursing input, could have negative outcomes.Staffing should be adjusted to meet patient needs and nurse competencies, not havepredetermined ratios that are unrealistic and possibly not needed.DIF: Cognitive Level: Analysis REF: p. 7OBJ: Describe standards of professional practice for critical care nursing.TOP: Nursing Process Step: ImplementationMSC: NCLEX: Safe and Effective Care EnvironmentChapter 2: Patient and Family Response to theCritical Care ExperienceChapter 2: Patient and Family Response to the Critical Care ExperienceTest BankMULTIPLE CHOICE1.Family members have a need for information. Which interventions best assist inmeeting this need?

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a.Handingfamilymembersapamphletthatexplainsallofthecriticalcareequipmentb.Providingadailyupdateofthepatient’sprogressandfacilitatingcommunicationwiththeintensivistc.Tellingthemthatyouarenotpermittedtogivethemastatusreportbutthattheycanbepres4:00PMforfamilyroundswiththeintensivistd.WritingdownalistofallnewmedicationsanddosesandgivingthelisttofamilymembersvisitationANS: BThe nurse can give a status report related to thepatient’scondition and currenttreatment plan as well as ensure that the family has daily meeting time with theintensivist for an update on diagnoses, prognoses, and the like. Pamphlets are helpful;however, the nurse should also explain the equipment that is at thispatient’sbedsideand not assume that everyone can read and understand written material. Limiting theinformation to that provided by the physician is unnecessary and will not meet thefamily’sinformation needs. Most family members are concerned about thepatient’sgeneral condition and treatment plan. They do not want or need a detailed list ofmedications, doses, or other treatments.DIF: Cognitive Level: Analysis REF: p. 20OBJ: Describe common family needs and family-centered nursing interventions.TOP: Nursing Process Step: ImplementationMSC: NCLEX: Psychosocial Integrity2.The nurse is a member of a committee to design a critical care unit in a newbuilding. Which design trend would best to facilitate family-centered care?a.Ensurethatthepatient’sroomislargeenoughandhasadequatespaceforasleepersofaandstorageforfamilymembers’personalbelongings.b.Includeadiagnosticsuiteincloseproximitytotheunitsothatthepatientdoesnothavetotfarfortesting.c.Incorporatealargewaitingroomonthetopfloorofthehospitalwithascenicviewandamesuchascoffeeandtea.d.Provideaccesstoascenicgardenformeditation.ANS: ANew unit design trends to promote family-centered care include larger patient roomsthat include a larger family space and comfortable furniture and storage to promoteopen visitation, including overnight stays in thepatient’sroom. Ready access to

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diagnostic testing, including portable equipment, is an important trend; however, thepurpose for this is to prevent the need for transport, not to foster family-centered care.A waiting room in close proximity to the unit with amenities is a nice feature;however, it does not need to be large if adequate space is incorporated into thepatient’sroom. A scenic garden for medication may assist in reducing familymembers’stress, but proximity to the patient is the greatest need.DIF: Cognitive Level: Analysis REF: Table 2-2OBJ: Describe common family needs and family-centered nursing interventions.TOP: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity3.The nurse is caring for a patient who sustained a head injury and is unresponsive topainful stimuli. Which intervention is most appropriate while bathing the patient?a.Askafamilymembertohelpyoubathethepatient,anddiscussthefamilystructurewiththfamilymemberduringtheprocedure.b.Becausesheisunconscious,completecareasquicklyandquietlyaspossible.c.Tellthepatientthedayandtime,andthatyouarebathingher.Reassureherthatyouarethed.Turnthetelevisionontotheeveningnewssothatyouandthepatientcanbeupdatedtocurevents.ANS: CAlthough unconscious, many patients can hear, understand, and respond to stimuli.Therefore, it is important to converse with the patient and reorient her to theenvironment. Some, but not all, family members may want to get involved in directcare; it is not known if this individual is a willing participant, and talking aboutwho’swho in the family is not appropriate while providing direct care to the patient.Although she is unconscious, communication and simple conversations remainimportant interventions. Use of the television to provide sensory input that the patientregularly enjoys is a nursing intervention, but turning on the news for the sake of thenurse is not appropriate.DIF: Cognitive Level: Application REF: p. 16OBJ: Describe stressors in the critical care environment and strategies to reduce them.TOP: Nursing Process Step: ImplementationMSC: NCLEX: Psychosocial Integrity4.Sleep often is disrupted for critically ill patients. Which nursing intervention is mostappropriate to promote sleep and rest?

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a.Consultwiththepharmacisttoadjustmedicationtimestoallowperiodsofsleeporrestbetwintervals.b.Encouragefamilymemberstotalkwiththepatientwhenevertheyarepresentintheroom.c.Keepthetelevisionontoprovide“white”noiseanddistraction.d.LeavethelightsonintheroomsothatthepatientisnotfrightenedofhisorhersurroundingANS: APlanning care to promote periods of uninterrupted rest is important. Consulting withthe pharmacist to adjust a medication schedule is an excellent example of thisintervention. It is important for family members to communicate with the patient;however, rest periods must be scheduled. Family members can be present in the roomwhile remaining quiet during these scheduled times. The television may be useful if itis part of thepatient’snormal routine for sleep; however, it does not consistentlyprovide“whitenoise”or distraction. Lights should be dimmed during scheduled restperiods and at night to facilitate sleep and rest.DIF: Cognitive Level: Analysis REF: p. 16OBJ: Discuss the impact of critical care hospitalization on the patient and family.TOP: Nursing Process Step: ImplementationMSC: NCLEX: Psychosocial Integrity5.Family assessment is essential in order to meet family needs. Which of thefollowing must be assessed first to assist the nurse in providing family-centered care?a.Assessmentofpatientandfamily’sdevelopmentalstagesandneedsb.Descriptionofthepatient’shomeenvironmentc.Identificationofimmediatefamily,extendedfamily,anddecisionmakersd.ObservationandassessmentofhowfamilymembersfunctionwitheachotherANS: CAssessment of the family structure is the first step and is essential before specificinterventions can be designed. It identifies immediate family, extended family, anddecision makers in the family. Structural assessment also includes ethnicity andreligion. The developmental assessment is done after the structural assessment andincludes the developmental stages of the patient and family. Functional assessment isalso important to assess how family members function with each other; however, it isnot done first. Assessment of the home environment is important when identifyingdischarge planning needs.

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DIF: Cognitive Level: Analysis REF: pp. 17-18OBJ: Discuss the impact of critical care hospitalization on the patient and family.TOP: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity6.Critical illness often results in family conflicts. Which scenario is most likely toresult in the greatest conflict?a.A21-year-oldcollegestudentofdivorcedparentshospitalizedwithmultipletrauma.Sherewithhermother.Theparentsareamicablewitheachotherandhavesimilarvalues.Thefathblamesthedaughter’sboyfriendforcausingtheaccident.b.A36-year-oldmaleadmittedforarupturedcerebralaneurysm.Hehasbeenlivingwithhisyear-oldgirlfriendfor8years,andtheyhavea4-year-olddaughter.Hedoesnothavewritteadvancedirectives.Hisparentsarrivefromout-of-stateandareaskedtomakedecisionsabohealthcare.Hehasnotseentheminoverayear.c.A58-year-oldmaleadmittedforcoronaryarterybypasssurgery.Hehasbeenlivingwithhisexpartnerfor20yearsinacommittedrelationship.Hehasdesignatedhissister,aregisterenurse,ashishealthcareproxyinawrittenadvancedirective.d.A78-year-oldfemaleadmittedwithgastrointestinalbleeding.Herhemoglobinisdecreasingcriticallevel.SheisaJehovah’sWitnessandrefusesthetreatmentofabloodtransfusion.Scapableofmakingherowndecisionsandhasaclearlywrittenadvancedirectivedecliningatransfusions.Hersonisupsetwithherandtellshersheis“committingsuicide.”ANS: BEach of these situations may result in family conflict. The situation with theunmarried couple without written advance directives results in the distant parentsbeing legally responsible for his healthcare decisions. Because of his long-standingcommitment with his partner, and lack of recent contact with his parents, this scenariois likely to cause the most conflict. The parents may make decisions based on theirwishes, as they may not be knowledgeable of thepatient’swishes. The supportiveparents of the college student may create conflict with the boyfriend, but their ongoingfriendship and shared values will assist in reducing conflict. The male admitted forbypass surgery, although in a same-sex relationship, has clearly identified who hewants to make healthcare decisions for him. The elderly female may have conflictwith her son; however, she is capable of making her own decisions and has writtenadvance directives to support her decisions.DIF: Cognitive Level: Analysis REF: pp. 17-18OBJ: Discuss the impact of critical care hospitalization on the patient and family.TOP: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

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7.Which nursing interventions would best support the family of a critically ill patient?a.Encouragefamilymemberstostayallnightincasethepatientneedsthem.b.Giveaconditionupdateeachmorningandwheneverchangesoccur.c.Limitvisitationfromchildrenintothecriticalcareunit.d.Providebeveragesandsnacksinthewaitingroom.ANS: BThe need for information is one of the highest identified by family members ofcritically ill patients. New room designs provide space for family members to spendthe night if desired; however, if the patient is stable, family members should beencouraged to sleep at home to ensure that they are well rested and can support thepatient. Restriction of children in the critical care unit is not supported by researchevidence. Child visitation should be individualized based on the needs and wishes ofthe patient and family. Beverages and snacks are important but not as important asinformation.DIF: Cognitive Level: Analysis REF: Box 2-2OBJ: Describe common family needs and family-centered nursing interventions.TOP: Nursing Process Step: ImplementationMSC: NCLEX: Psychosocial Integrity8.Which intervention is appropriate to assist the patient to cope with admission to thecritical care unit?a.Allowingunrestrictedvisitingbyseveralfamilymembersatonetimeb.Explainingallproceduresineasy-to-understandtermsc.Providingbackmassageandmouthcared.TurningdownthealarmvolumeonthecardiacmonitorANS: BCommunication and explanations of procedures are priority interventions to helppatients cope with admission. Comfort is an important intervention but not thepriority. Noise control is an important intervention but not the priority. Open visitationis recommended; however, the number of family members may need to be limited topromote rest and sleep.DIF: Cognitive Level: Analysis REF: pp. 20-21OBJ: Describe stressors in the critical care environment and strategies to reduce them.

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TOP: Nursing Process Step: ImplementationMSC: NCLEX: Psychosocial Integrity9.The constant noise of a ventilator, monitor alarms, and infusion pumps predisposesthe patient to:a.anxiety.b.pain.c.powerlessness.d.sensoryoverload.ANS: DConstant noise is a source of sensory overload. Pain and lack of informationcontribute to anxiety. Noise does not cause physical pain. Lack of involvement in carecauses powerlessness.DIF: Cognitive Level: Application REF: pp. 14-15OBJ: Describe stressors in the critical care environment and strategies to reduce them.TOP: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity10.Which of the following statements about family assessment is false?a.Assessmentofstructure(whocomprisesthefamily)isthelaststepinassessment.b.Interactionamongfamilymembersisassessed.c.Itisimportanttoassesscommunicationamongfamilymemberstounderstandroles.d.Ongoingassessmentisimportant,becausefamilyfunctioningmaychangeduringthecourseillness.ANS: AAssessment of structure should be done first so that the nurse can identify such thingsas who comprises the family and who assumes leadership and decision-makingresponsibilities. This assessment also assists in identifying which individuals are mostimportant to the patient and how many people may be seeking information. Familymember interaction must be assessed, so this answer is true. Family membercommunication must be assessed, so this answer is true. Ongoing assessment offamily is necessary as functions may change, so this answer is true.DIF: Cognitive Level: Application REF: pp. 16-17OBJ: Describe common family needs and family-centered nursing interventions.TOP: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity11.Which intervention about visitation in the critical care unit is true?

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a.Themajorityofcriticalcarenursesimplementrestrictedvisitinghourstoallowthepatienttb.Childrenshouldneverbepermittedtovisitacriticallyillfamilymember.c.Visitationthatisindividualizedtotheneedsofpatientsandfamilymembersisideal.d.Visitinghoursshouldalwaysbeunrestricted.ANS: CVisiting should be based on the needs of patients and their families. There may betimes that visiting needs to be limited (e.g., to allow the patient to rest); however, it isimportant to individualize visitation. Sometimes it is appropriate for children to visit;research has not found child visitation to be harmful to either the patient or the child.Visiting should be adjusted to patient needs.DIF: Cognitive Level: Analysis REF: pp. 21-22 | Box 2-2OBJ: Describe common family needs and family-centered nursing interventions.TOP: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity12.Elderly patients who require critical care treatment are at risk for increasedmortality, functional decline, or decreased quality of life after hospitalization.Assuming each of these patients was discharged from the hospital, which of thefollowing patients is at greatest risk for decreased functional status and quality of life?a.A70-year-oldwhohadcoronaryarterybypasssurgery.Hedevelopedcomplicationsaftersuandhaddifficultybeingweanedfrommechanicalventilation.Herequiredatracheostomyagastrostomy.Heisbeingdischargedtoalong-term,acutecarehospital.Heisawidower.b.A79-year-oldadmittedforexacerbationofheartfailure.Shemanageshercareindependentneededdiureticmedicationsadjusted.Shestatesthatsheiscompliantwithhermedicationssometimesforgetstotakethem.Sheliveswithher82-year-oldspouse.Bothconsiderthemstobeindependentandsupporteachother.c.A90-year-oldadmittedforacarotidendarterectomy.Helivesinanassistedlivingfacility(butiscognitivelyintact.Heisthe“socialbutterfly”atalloftheeventsattheALF.Heishospitalizedfor4daysanddischargedtotheALF.d.An84-year-oldwhohadstentsplacedtotreatcoronaryarteryocclusion.Shehasdiabetesthbeenmanaged,livesalone,andwasdrivingpriortohospitalization.Shewasdischargedhomwithin3daysoftheprocedure.ANS: AAlthough he is younger, the 70-year-old with the complicated critical care course,with limited social support, who is being discharged to a long-term acute care facility,is at greatest risk for decreased quality of life and functional decline. He will continue

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to need high-level nursing care and support for rehabilitation. The other cases areexamples of individuals with shorter hospital stays, uncomplicated courses, and socialsupport systems.DIF: Cognitive Level: Analysis REF: p. 17OBJ: Discuss the impact of critical care hospitalization on the patient and family.TOP: Nursing Process Step: Evaluation MSC: NCLEX: Growth and Development13.Patients often have recollections of the critical care experience. Which is likely themost common recollection from a patient who required endotracheal intubation andmechanical ventilation?a.Difficultycommunicatingb.Inabilitytogetcomfortablec.Paind.SleepdisruptionANS: AAlthough the patient may recall all of these potential experiences, recollection ofdifficult communication is most likely secondary to the endotracheal tube placement.DIF: Cognitive Level: Analysis REF: p. 16 | Box 2-1OBJ: Discuss the impact of critical care hospitalization on the patient and family.TOP: Nursing Process Step: Evaluation MSC: NCLEX: Psychosocial Integrity14.Many critically ill patients experience anxiety. The nurse can reduce anxiety withwhich approach?a.Askfamilymemberstolimittheirvisitationto2-hourperiodsinmorning,afternoon,andevYouknowthatthisisthebestapproachtoensureuninterruptedresttimeforthepatient.Telpatient,“Mr.J.,yourfamilyisinthewaitingroom.Theywillbepermittedtocomeinat2:0afteryoutakeashortnap.”b.Explaintheunitroutine.“Mr.J.,assessmentsaredoneevery4hours;patientsarebathedonnightshiftaround5:00AM;familymembersarepermittedtovisityouafterthephysicianstheirmorningrounds.Theycanspendtheday.Lightsareouteverynightat10:00PM.”c.State,“Mr.J.,it’stimetoturnyou.Iamgoingtoaskanothernursetocomeinandhelpme.willturnyoutoyourleftside.Duringtheturn,I’mgoingtoinspecttheskinonyourbackasomelotiononyourback.Thisshouldhelptomakeyoufeelbetter.”d.SuctionMr.J.’sendotrachealtubeimmediatelywhenhestartstocough.Tellhim,“Mr.J.,ytubeneedssuctioned;youshouldfeelbetterafterI’mdone.”ANS: C

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Anxiety is reduced when procedures are explained prior to completing them. In thisexample, the nurse clearly explains what will be done and what the patient can expectduring turning. Limiting family members, especially if they are already present in thehospital, is not an approach that will reduce anxiety. Family members can be presentin the room while allowing the patient to rest. It is important to orient the patient tothe unit, but the explanation of a“unitroutine”does not give the patient any controlover things such as bathing, sleep times, and visitors. Suctioning is important, butonly when indicated, which might not be with every coughing episode. Additionally,it is important to explain the procedure and tell the patient what to expect.DIF: Cognitive Level: Analysis REF: pp. 16-17OBJ: Describe stressors in the critical care environment and strategies to reduce them.TOP: Nursing Process Step: ImplementationMSC: NCLEX: Psychosocial Integrity15.Which statement is a likely response from someone who has survived a stay in thecritical care unit?a.“Idon’tremembermuchaboutbeingintheICU,butifIhadtobetreatedthereagain,itwookay.I’mgladIcanseemygrandchildrenagain.”b.“IfIgetthatsickagain,donottakemetothehospital.Iwouldratherdiethangothroughhabreathingtubeputinagain.”c.“MyfamilyisthrilledthatIamhome.IknowIneedsomeextraattention,butmychildrenhrearrangedtheirschedulestohelpmeout.”d.“SinceIhavebeentransferredoutoftheICU,Icannotgetenoughtoeat.Theydidn’tletmetheICU,soI’mmakingupforitnow.”ANS: ASurvivors of critical illness express a variety of concerns; however, most identify awillingness to undergo critical care treatment to prolong survival. Most survivors arenot going to decline treatment for future hospitalizations (B). Although thepatient’sfamily may be thrilled that he or she is home, challenges to family dynamics oftenoccur, especially if familymember’sschedules and routines are disrupted (C). Manypatients have poor appetites after discharge from critical care, not ravenous ones (D).DIF: Cognitive Level: Analysis REF: p. 17OBJ: Discuss the impact of critical care hospitalization on the patient and family.TOP: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

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16.The nurse is assigned to care for a patient who is a non-native English speaker.What is the best way to communicate with the patient and family to provide updatesand explain procedures?a.ConductaGooglesearchonthecomputertoidentifyresourcesforthepatientandfamilyinnativelanguage.Printthesefortheiruse.b.Contactthehospital’sinterpreterserviceforsomeonetotranslate.c.Getintouchwithoneoftheresidentsthatyouknowisfluentinthenativelanguageandaskhecancomeuptotheunit.d.Usethe8-yearoldchildwhoisfluentinbothEnglishandthenativelanguagetotranslatefoANS: BThe best approach when communicating with someone whose primary language is notEnglish is to contact the interpreter services of the agency. These individuals aretrained and knowledgeable. If the nurse conducted a search on the computer, shewould not know if the information retrieved was valid nor would she know if thepatient or family can read in their native language. Although one of the residentsmight be fluent in the language, you do not know his abilities to translate. In addition,his availability is likely to be limited. Although the child might be able to translate,the nurse cannot ensure that the child is translating healthcare concepts correctly.DIF: Cognitive Level: Analysis REF: p. 18OBJ: Discuss the impact of critical care hospitalization on the patient and family.TOP: Nursing Process Step: ImplementationMSC: NCLEX: Psychosocial Integrity17.Family assessment can be challenging and each nurse may obtain additionalinformation regarding family structure and dynamics. What is the best way to sharethis information from shift to shift?a.Createaninformalfamilyinformationsheetthatiskeptonthebedsideclipboard.Thatwayeveryonecanreviewitquicklywhenneeded.b.Developastandardizedreportingformforfamilyinformationthatisincorporatedintothepmedicalrecordandupdatedasneeded.c.Requirethatthechargenursehaveadetailedlistofinformationabouteachpatientandfamimember.Thus,someoneontheunitisalwaysknowledgeableaboutpotentialissues.d.Trytoremembertodiscussfamilystructureanddynamicsaspartofthechange-of-shiftrepANS: B

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A standardized method for gathering data about family structure and function andrecording it in an official document is the best approach. This strategy ensures thatdata are collected and kept in the medical record. Data are also easily retrievable byanyone who needs to know this information. Informal documentation is often kept toassist in follow-up and change-of-shift reporting; however, this strategy is notrecommended, as data collected are likely to vary and not be part of a permanentrecord. Although the charge nurse often has some information regarding families, theprimary responsibility for assessment and follow-up belongs to the bedside nurse.Family information should be shared at change of shift using a standardized format,not“tryto remember todiscuss….”DIF: Cognitive Level: Analysis REF: p. 18OBJ: Discuss the impact of critical care hospitalization on the patient and family.TOP: Nursing Process Step: ImplementationMSC: NCLEX: Psychosocial Integrity18.The wife of a patient who is hospitalized in the critical care unit followingresuscitation for a sudden cardiac arrest at work demands to meet with the nursingmanager. She states,“Iwant you to reassign my husband to another nurse. His currentnurse is not in the room enough to make sure he isokay.”The nurse recognizes thatthis response most likely is due to thewife’s:a.desiretopursuealawsuitiftheassignmentisnotchanged.b.inabilitytoparticipateinthehusband’scare.c.lackofpriorexperienceinacriticalcaresetting.d.senseoflossofcontrolofthesituation.ANS: DDemanding behaviors often occur when the family member has a sense of loss ofcontrol or has had adverse outcomes in a previous hospitalization. Prevention of alawsuit is not relevant to this scenario. No information is provided regarding whetherthe family member is participating in care or not. It is not known if she had a priornegative experience or not.DIF: Cognitive Level: Analysis REF: pp. 17-18OBJ: Discuss the impact of critical care hospitalization on the patient and family.TOP: Nursing Process Step: ImplementationMSC: NCLEX: Psychosocial Integrity

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19.Open visitation policies are expected by many professional organizations. Whichstatement reflects adherence to current recommendations?a.Allowanimalsontheunit;however,thesecanonlybe“therapy”animalsthroughthehospitherapyprogram.b.Allowfamilyvisitationthroughoutthedayexceptatchangeofshiftandduringrounds.c.Determine,incollaborationwiththepatientandfamily,whocanvisitandwhen.Facilitateovisitationpolicies.d.Permitopenvisitationbyadults18yearsofageandolder;limitvisitsofchildrento1hour.ANS: COpen visitation is recommended by both the Society of Critical Care Medicine(SCCM) and the American Association of Critical-Care Nurses. SCCM suggestsdeveloping visitation schedules in collaboration with the patient and family. Animalsdo not need to be limited to therapy animals. Many patients benefit by the presence oftheir personal pets that are brought to the unit according to hospital policy. Althoughmany units restrict visitation during report and rounds, the organizations encouragethat such restrictions be loosened. Many institutions encourage family participationduring report and rounds. Children should not be banned arbitrarily from the unit orhave hours limited.DIF: Cognitive Level: Analysis REF: pp. 21-22 | Box 2-2OBJ: Identify strategies for promoting visitation and family presence in the critical care setting.TOP: Nursing Process Step: ImplementationMSC: NCLEX: Psychosocial Integrity20.The VALUE mnemonic is a helpful strategy to enhance communication withfamily members of critically ill patients. Which of the following statements describesa VALUE strategy?a.Viewthefamilyasguestsontheunit.b.Acknowledgefamilyemotions.c.Learnasmuchasyoucanaboutfamilystructureandfunction.d.UseatrainedinterpreterifthefamilydoesnotspeakEnglish.e.Evaluateeachencounterwiththefamily.ANS: BThe VALUE mnemonic includes the following:V—Value what the family tells you.

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A—Acknowledge family emotions.L—Listen to the family members.U—Understand the patient as a person.E—Elicit (ask) questions of family members.DIF: Cognitive Level: Comprehension REF: pp. 20-21 | Box 2-3OBJ: Describe common family needs and family-centered nursing interventions.TOP: Nursing Process Step: ImplementationMSC: NCLEX: Psychosocial Integrity21.Changing visitation policies can be challenging. The nurse manager recognizes thefollowing as an effective strategy for promoting changes in practice:a.Asktheclinicalnursespecialisttoleadajournalclubonopenvisitationaftereachnurseisttoreadoneresearcharticleaboutvisitation.b.Discussprosandconsofopenvisitationatthenextstaffmeeting.c.Invitethenurseswiththemostexperiencetodeveloparevisedpolicy.d.Tasktheunit-basednursepracticecounciltoinvitevolunteerstoserveonthecounciltorevcurrentpolicytowardmoreliberalvisitation.ANS: DChanges in policy are most effective through willing champions as part of a unit-based, staff-led practice council. Discussion of evidence-based findings is important,but it is not logical to expect every nurse to read a research article and share findings.Discussion of pros and cons at a staff meeting is likely to be prolonged and based onopinion rather than evidence. Nurses with the most experience are not necessarily theones to develop a new policy. They may be the least likely to change; therefore, it isimportant to solicit volunteers from all staff members, not just the experienced ones.DIF: Cognitive Level: Analysis REF: pp. 21-22 | Box 2-2OBJ: Identify strategies for promoting visitation and family presence in the critical care setting.TOP: Nursing Process Step: ImplementationMSC: NCLEX: Psychosocial IntegrityMULTIPLE RESPONSE1.Nursing strategies to help families cope with the stress of critical illnessinclude:(Select all that apply.)a.askingthefamilytoleaveduringthemorningbathtopromotethepatient’sprivacy.b.encouragingfamilymemberstomakenotesofquestionstheyhaveforthephysicianduring

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rounds.c.ifpossible,providingcontinuityofnursingcare.d.providingadailyupdateofthepatient’sconditiontothefamilyspokesperson.ANS: B, C, DEncouraging families to formulate questions assists in family care. Continuity ofnursing care with consistent staff members assists in reducing stress. Communicationof patient condition update meets the need for information. Family members oftenwant to assist with simple activities of patient care, so limiting participation is theexception to this list.DIF: Cognitive Level: Application REF: pp. 18-19OBJ: Describe common family needs and family-centered nursing interventions.TOP: Nursing Process Step: ImplementationMSC: NCLEX: Psychosocial Integrity2.Family presence is encouraged during resuscitation and invasive procedures. Thenurse knows that nurses are often reluctant to allow this to occur, yet families oftenperceive benefits. Which findings have been reported in the literature?(Select all thatapply.)a.Familiesbenefitbywitnessingthateverythingpossiblewasdone.b.Familiesreportreducedanxietyandfearaboutwhatisbeingdonetothepatient.c.Presenceencouragesfamilymemberstoseeklitigationforimpropercare.d.Presencereducesnurses’involvementinexplainingthingstothefamily.ANS: A, BFamilies benefit from witnessing procedures and resuscitation. Being present helpsfamily members to remove doubt about the condition, witness that everything wasdone, and decrease anxiety about what is occurring. Increased litigation has not beenassociated with family presence. Policies and procedures are needed to facilitatefamily presence. A facilitator is needed, and it may initially require more nursinginvolvement. It does not eliminatenurses’responsibility for communicating with thefamily.DIF: Cognitive Level: Analysis REF: p. 22OBJ: Identify strategies for promoting visitation and family presence in the critical care setting.TOP: Nursing Process Step: ImplementationMSC: NCLEX: Psychosocial Integrity

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3.Noise in the critical care unit can have negative effects on the patient. Which of thefollowing interventions assists in reducing noise levels in the critical caresetting?(Select all that apply.)a.Askthefamilytobringinthepatient’si-Podorotherdevicewithfavoritemusic.b.Invitethevolunteerharpisttoplayontheunitonaregularbasis.c.Remodeltheunittohavetwo-patientroomstofacilitatenursingcare.d.Remodeltheunittoinstallacousticalceilingtiles.e.Turnthevolumeofequipmentalarmsaslowastheycanbeadjusted,and“off”ifpossible.ANS: A, B, DA personal device with favorite music and headphones can be helpful in reducingambient unit noise. Music therapy programs, such as harpists, can provide soothingsedative music that is often comforting to both patients and family members.Acoustical tiles help to reduce noise in the critical care setting and should be includedin remodeling plans as well as new unit construction. Multiple patients in a singleroom would increase noise levels and contribute to an increased risk of infection.Alarms on critical equipment must never be turned off. The volume should be loudenough that the alarm can be heard by the nurse if outside the room. The lowestsetting may not be loud enough, depending on the unit layout and patient assignment.DIF: Cognitive Level: Analysis REF: p. 15OBJ: Describe stressors in the critical care environment and strategies to reduce them.TOP: Nursing Process Step: ImplementationMSC: NCLEX: Psychosocial Integrity4.It is important for critically ill patients to feel safe. Which nursing strategies helpthe patient to feel safe in the critical care setting?(Select all that apply.)a.Allowfamilymemberstoremainatthebedside.b.Besuretoconsultwiththechargenursebeforemakinganypatientcaredecisions.c.Provideinformalconversationbydiscussingyourplansforafterwork.d.Respondpromptlytocallbellsorothercommunicationforassistance.ANS: A, DPatients feel safe when nurses exhibit technical competence, meet their needs, andprovide reorientation. Family member presence may also contribute to feeling safe.Consulting with the charge nurse before making decisions may be interpreted as

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incompetence or insecurity. Thenurse’spersonal activities should never be discussedwith patients.DIF: Cognitive Level: Analysis REF: p. 16OBJ: Describe stressors in the critical care environment and strategies to reduce them.TOP: Nursing Process Step: ImplementationMSC: NCLEX: Psychosocial Integrity5.The critical care environment is often stressful to a critically ill patient. Identifystressors that are common.(Select all that apply.)a.Alarmsthatsoundfromvariousdevicesb.Bright,fluorescentlightingc.Lackofday-nightcuesd.Soundsfromthemechanicalventilatore.VisitinghourstailoredtomeetindividualneedsANS: A, B, C, DAdjustment of visiting hours to meet needs of patients and families assists in reducingthe stress of critical illness. All other responses are environmental stressors thatincrease anxiety, affect sleep, and the like.DIF: Cognitive Level: Comprehension REF: pp. 15-16OBJ: Describe stressors in the critical care environment and strategies to reduce them.TOP: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity6.A patient and his family are excited that he is transferring from the critical care unitto the intermediate care unit. However, they are also fearful of the change inenvironment and nursing staff. To reduce relocation stress, the nurse can:(Select allthat apply.)a.askthenursesontheintermediatecareunittogivethefamilyatourofthenewunit.b.contacttheintensivisttoseeifthepatientcanstayoneadditionaldayinthecriticalcareunithatheandhisfamilycanadjustbettertotheideaofatransfer.c.ensurethatthepatientwillbelocatednearthenurse’sstationinthenewunit.d.invitethenursewhowillbeassumingthepatient’scaretomeetwiththepatientandfamilycriticalcareunitpriortotransfer.ANS: A, DPatients often have stress when they are moved from the safety of the critical careunit. Introducing the patient and his family to the nurse who will assume care and to

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the new environment are strategies to reduce relocation stress. Although the patientand his family may feel safer in a room near thenurse’sstation, bed placement isdetermined by a variety of factors and cannot be guaranteed. Beds in the critical careunit are at a premium, and once the physician has determined that the patient nolonger meets critical care admission requirements, it is essential that transfers be madeonce a bed on the intermediate care unit is available.DIF: Cognitive Level: Analysis REF: p. 17OBJ: Describe stressors in the critical care environment and strategies to reduce them.TOP: Nursing Process Step: ImplementationMSC: NCLEX: Psychosocial Integrity7.The critical care environment is stressful to the patient. Which interventions assistin reducing this stress?(Select all that apply.)a.Adjustlightingtopromotenormalsleep-wakecycles.b.Provideclocks,calendars,andpersonalphotosinthepatient’sroom.c.Talktothepatientaboutotherpatientsyouarecaringforontheunit.d.Tellthepatientthedayandtimewhenyouareprovidingroutinenursinginterventions.ANS: A, B, DManipulation of the environment, such as adjusting lighting, is helpful in promotingsleep and rest; clocks, calendars, photos, and other personal items promote orientationand personalize the environment; telling the patient the day and time and other currentevents assists in maintaining thepatient’sorientation. Conversations about otherpatients are private and should take place away from other patients.DIF: Cognitive Level: Analysis REF: pp. 15-16OBJ: Describe stressors in the critical care environment and strategies to reduce them.TOP: Nursing Process Step: ImplementationMSC: NCLEX: Psychosocial IntegrityChapter 3: Ethical and Legal Issues in CriticalCare NursingChapter 3: Ethical and Legal Issues in Critical Care NursingTest BankMULTIPLE CHOICE1.Ideally, an advance directive should be developed by the:

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