Chapter 01: Overview of Critical Care Nursing

MULTIPLE CHOICE

1. Which of the following professional organizations best supports critical care nursing practice?

a. American Association of Critical-Care Nurses

b. American Heart Association

c. American Nurses Association

d. Society of Critical Care Medicine

ANS: A

The American Association of Critical-Care Nurses is the specialty organization that supports and represents

critical care nurses. The American Heart Association supports cardiovascular initiatives. The American Nurses

Association supports all nurses. The Society of Critical Care Medicine represents the multiprofessional critical

care team under the direction of an intensivist.

DIF: Cognitive Level: Knowledge REF: p. 4

OBJ: Discussthe purposes and functions of the professional organizations that support critical care practice.

TOP: Nursing Process Step: N/A

MSC: NCLEX: Safe and Effective Care Environment

2. A nurse has been working as a staff nurse in the surgical intensive care unit for 2 years and is interested in

certification. Which credential would be most applicable for her to seek?

a. ACNPC

b. CCNS

c. CCRN

d. PCCN

ANS: C

The CCRN certification is appropriate for nurses in bedside practice who care for critically ill patients. The

ACNPC certification isfor acute care nurse practitioners. The CCNS certification is for critical care clinical

nurse specialists. The PCCN certification is for staff nurses working in progressive care, intermediate care, or

step-down unit settings.

DIF: Cognitive Level: Application REF: p. 5

OBJ: Explain certification optionsfor critical care nurses. TOP: Nursing Process Step: N/A

MSC: NCLEX: Safe and Effective Care Environment

3. The main purpose of certification is to:

a. assure the consumer that you will not make a mistake.

b. prepare for graduate school.

c. promote magnet status for your facility.

d. validate knowledge of critical care nursing.

ANS: D

Certification assists in validating knowledge of the field, promotes excellence in the profession, and helps

nursesto maintain their knowledge of critical care nursing. Certification helps to assure the consumer that the

nurse has a minimum level of knowledge; however, it does not ensure that care will be mistake-free.

Certification does not prepare one for graduate school; however, achieving certification demonstrates

motivation for achievement and professionalism. Magnet facilities are rated on the number of certified nurses;

however, that is not the purpose of certification.

DIF: Cognitive Level: Analysis REF: pp. 4-5

OBJ: Explain certification optionsfor critical care nurses. TOP: Nursing Process Step: N/A

MSC: NCLEX: Safe and Effective Care Environment

4. The synergy model of practice focuses on:

a. allowing unrestricted visiting for the patient 24 hours each day.

b. holistic and alternative therapies.

c. needs of patients and their families, which drives nursing competency.

d. patients needs for energy and support.

ANS: C

The synergy model of practice statesthat the needs of patients and families influence and drive competencies

of nurses. Nursing practice based on the synergy model would involve tailored visiting to meet the patients and

familys needs and application of alternative therapies if desired by the patient, but that is not the primary focus

of the model.

DIF: Cognitive Level: Application REF: p. 5 | Fig. 1-3

OBJ: Describe standards of professional practice for critical care nursing.

TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment

5. The family of your critically ill patient tells you that they have not spoken with the physician in over 24

hours and they have some questions that they want clarified. During morning rounds, you convey this concern

to the attending intensivist and arrange for her to meet with the family at 4:00 PM in the conference room.

Which competency of critical care nursing does this represent?

a. Advocacy and moral agency in solving ethical issues

b. Clinical judgment and clinical reasoning skills

c. Collaboration with patients, families, and team members

d. Facilitation of learning for patients, families, and team members

ANS: C

Although one might consider that all of these competencies are being addressed, communication and

collaboration with the family and physician best exemplify the competency of collaboration.

DIF: Cognitive Level: Analysis REF: p. 9

OBJ: Describe standards of professional practice for critical care nursing.

TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment

6. The AACN Standardsfor Acute and Critical Care Nursing Practice use what framework to guide critical

care nursing practice?

a. Evidence-based practice

b. Healthy work environment

c. National Patient Safety Goals

d. Nursing process

ANS: D

The AACN Standards for Acute and Critical Care Nursing Practice delineate the nursing process as applied to

critically ill patients: collect data, determine diagnoses, identify expected outcomes, develop a plan of care,

implement interventions, and evaluate care. AACN promotes a healthy work environment, but this is not

included in the Standards. The Joint Commission has established National Patient Safety Goals, but these are

not the AACN Standards.

DIF: Cognitive Level: Analysis REF: p. 5 | Box 1-2

OBJ: Describe standards of professional practice for critical care nursing.

TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment

7. The charge nurse is responsible for making the patient assignments on the critical care unit. She assigns the

experienced, certified nurse to care for the acutely ill patient with sepsis who also requires continuous renal

replacement therapy and mechanical ventilation. She assigns the nurse with less than 1 year of experience to

two patients who are more stable. This assignment reflects implementation of the:

a. crew resource management model

b. National Patient Safety Goals

c. Quality and Safety Education for Nurses(QSEN) model

d. synergy model of practice

ANS: D

This assignment demonstrates nursing care to meet the needs of the patient. The synergy model notes that the

nurse competencies are matched to the patient characteristics. Crew resource management conceptsrelated to

team training, National Patient Safety Goals are specified by The Joint Commission to promote safe care but

do not incorporate the synergy model. The Quality and Safety Education for Nurses initiative involves targeted

education to undergraduate and graduate nursing students to learn quality and safety concepts.

DIF: Cognitive Level: Analysis REF: p. 5 | Fig. 1-3

OBJ: Describe standards of professional practice for critical care nursing.

TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment

8. The vision of the American Association of Critical-Care Nurses is a healthcare system driven by:

a. a healthy work environment.

b. care from a multiprofessional team under the direction of a critical care physician.

c. the needs of critically ill patients and families.

d. respectful, healing, and humane environments.

ANS: C

The AACN vision is a healthcare system driven by the needs of critically ill patients and families where critica

care nurses make their optimum contributions. AACN promotes initiatives to support a healthy work

environment as well as respectful and healing environments, but that is not the organizations vision. The

SCCM promotes care from a multiprofessional team under the direction of a critical care physician.

DIF: Cognitive Level: Knowledge REF: p. 4

OBJ: Discussthe purposes and functions of the professional organizations that support critical care practice.

TOP: Nursing Process Step: N/A

MSC: NCLEX: Safe and Effective Care Environment

9. The most important outcome of effective communication is to:

a. demonstrate caring practicesto family members.

b. ensure that patient teaching is done.

c. meet the diversity needs of patients.

d. reduce patient errors.

ANS: D

Many errors are directly attributed to faulty communication. Effective communication has been identified as an

essential strategy to reduce patient errors and resolve issues related to patient care delivery. Communication

may demonstrate caring practices, be used for patient/family teaching, and address diversity needs; however,

the main outcome of effective communication is patient safety.

DIF: Cognitive Level: Knowledge REF: pp. 8-9

OBJ: Describe quality and safety initiatives related to critical care nursing.

TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment

10. You are caring for a critically ill patient whose urine output has been low for 2 consecutive hours. After a

thorough patient assessment, you call the intensivist with the following report. Dr. Smith, Im calling about

Mrs. P., your 65-year-old patient in CCU 10. Her urine output for the past 2 hours totaled only 40 mL. She

arrived from surgery to repair an aortic aneurysm 4 hours ago and remains on mechanical ventilation. In the

past 2 hours, her heart rate has increased from 80 to 100 beats per minute and her blood pressure has

decreased from 128/82 to 100/70 mm Hg. She is being given an infusion of normal saline at 100 mL per hour.

Her right atrial pressure through the subclavian central line is low at 3 mm Hg. Her urine is concentrated. He

BUN and creatinine levels have been stable and in normal range. Her abdominal dressing is dry with no

indication of bleeding. My assessment suggests that Mrs. P. is hypovolemic and I would like you to consider

increasing her fluids or giving her a fluid challenge. Using the SBAR model for communication, the

information the nurse gives about the patients history and vital signs is:

a. Situation

b. Background

c. Assessment

d. Recommendation

ANS: B

The history and vital signs are part of the background. Information regarding the low urine output is the

situation. Information regarding possible hypovolemia is part of the nurses assessment, and the suggestion for

fluids is the recommendation.

DIF: Cognitive Level: Analysis REF: pp. 8-9

OBJ: Describe quality and safety initiatives related to critical care nursing.

TOP: Nursing Process Step: Assessment MSC: NCLEX: Safe and Effective Care Environment

11. The family members of a critically ill, 90-year-old patient bring in a copy of the patients living will to the

hospital, which identifies the patients wishes regarding health care. You discuss contents of the living will with

the patients physician. This is an example of implementation of which of the AACN Standards of Professional

Performance?

a. Acquires and maintains current knowledge of practice

b. Acts ethically on the behalf of the patient and family

c. Considersfactorsrelated to safe patient care

d. Uses clinical inquiry and integratesresearch findings in practice

ANS: B

Discussing end-of-life issues is an example of a nurse acting ethically on behalf of the patient and family. The

example does not relate to acquiring knowledge, promoting patient safety, or using research in practice.

DIF: Cognitive Level: Analysis REF: p. 5 | Box 1-2

OBJ: Describe standards of care and performance for critical care nursing.

TOP: Nursing Process Step: Implementation

MSC: NCLEX: Safe and Effective Care Environment

12. Which of the following assists the critical care nurse in ensuring that care is appropriate and based on

research?

a. Clinical practice guidelines

b. Computerized physician order entry

c. Consulting with advanced practice nurses

d. Implementing Joint Commission National Patient Safety Goals

ANS: A

Clinical practice guidelines are being implemented to ensure that care is appropriate and based on research.

Some physician order entry pathways, but not all, are based on research recommendations. Some advanced

practice nurses, but not all, are well versed in evidence-based practices. The National Patient Safety Goals are

recommendations to reduce errors using evidence-based practices.

DIF: Cognitive Level: Analysis REF: p. 7

OBJ: Describe standards of professional practice for critical care nursing.

TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment

13. Comparing the patients current (home) medications with those ordered during hospitalization and

communicating a complete list of medications to the next provider when the patient is transferred within an

organization or to another setting are strategies to:

a. improve accuracy of patient identification.

b. prevent errorsrelated to look-alike and sound-alike medications.

c. reconcile medications across the continuum of care.

d. reduce harms associated with administration of anticoagulants.

ANS: C

These are steps recommended in the National Patient Safety Goals to reconcile medications across the

continuum of care. Improving accuracy of patient identification is another National Patient Safety Goal.

Preventing errorsrelated to look-alike and sound-alike medications is done to improve medication safety, not

medication reconciliation. Reducing harms associated with administration of anticoagulants is another Nationa

Patient Safety Goal.

DIF: Cognitive Level: Comprehension REF: p. 6 | Box 1-3

OBJ: Describe quality and safety initiatives related to critical care nursing.

TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment

14. As part of nursing management of a critically ill patient, orders are written to keep the head of the bed

elevated at 30 degrees, awaken the patient from sedation each morning to assess readiness to wean from

mechanical ventilation, and implement oral care protocols every 4 hours. These interventions are done as a

group to reduce the risk of ventilator-associated pneumonia. This group of evidence-based interventions is

often called a:

a. bundle of care.

b. clinical practice guideline.

c. patient safety goal.

d. quality improvement initiative.

ANS: A

A group of evidence-based interventions done as a whole to improve outcomes is termed abundle of care. This

is an example of the ventilator bundle. Oftentimes these bundles are derived from clinical practice guidelines

and are monitored for compliance as part of quality improvement initiatives. At some point, these may become

part of patient safety goals.

DIF: Cognitive Level: Analysis REF: p. 6

OBJ: Describe quality and safety initiatives related to critical care nursing.

TOP: Nursing Process Step: Implementation

MSC: NCLEX: Safe and Effective Care Environment

15. You work in an intermediate care unit that has experienced high nursing turnover. The nurse manager is

often considered to be an autocratic leader by staff members and her leadership style is contributing to

turnover. You have asked to be involved in developing new guidelines to prevent pressure ulcers in your

patient population. The nurse manager tells you that you do not yet have enough experience to be on the

prevention task force. This situation and setting is an example of:

a. a barrier to handoff communication.

b. a work environment that is unhealthy.

c. ineffective decision making.

d. nursing practice that is not evidence-based.

ANS: B

These are examples of an unhealthy work environment. A healthy work environment values communication,

collaboration, and effective decision making. It also has authentic leadership. It is not an example of handoff

communication, which is communication that occurs to transition patient care from one staff member to

another. Neither does it relate to ineffective decision making. As a nurse, you can still implement evidencebased practice, but your influence in the unit is limited by the unhealthy work environment.

DIF: Cognitive Level: Analysis REF: p. 7

OBJ: Describe standards of professional practice for critical care nursing.

TOP: Nursing Process Step: N/A MSC: NCLEX: Safe and Effective Care Environment