Test bank for critical care nursing a holistic approach 11th edition morton fontaine.pdf

Test Bank For Critical Care Nursing- A Holistic Approach
12th Edition Morton Fontaine
Chapters 1 - 56

Table of Contents
Part 1 The Concept of Holism Applied to Critical Care Nursing Practice
Chapter 1. Critical Care Nursing Practice: Promoting Excellence Through Caring, Collaboration, and Evidence
Chapter 2. The Patient’s Experience With Critical Illness
Chapter 3. The Family’s Experience With Critical Illness
Chapter 4. Patient and Family Education in Critical Care
Chapter 5. Relieving Pain and Providing Comfort
Chapter 6. Palliative Care and End-of-Life Issues in Critical Care
Part 2 Professional Practice Issues in Critical Care
Chapter 7. Ethical Issues in Critical Care Nursing
Chapter 8. Legal Issues in Critical Care Nursing
Chapter 9. Building a Professional Practice Model for Excellence in Critical Care Nursing
Part 3 Special Populations in Critical Care
Chapter 10. The Critically Ill Pediatric Patient
Chapter 11. The Critically Ill Pregnant Woman
Chapter 12. The Critically Ill Older Patient
Chapter 13. The Postanesthesia Patient
Part 4 Special Situations in Critical Care
Chapter 14. Rapid Response Teams and Transport of the Critically Ill Patient
Chapter 15. Disaster Management: Implications for the Critical Care Nurse
Part 5 Cardiovascular System
Chapter 16. Anatomy and Physiology of the Cardiovascular System
Chapter 17. Patient Assessment: Cardiovascular System
Chapter 18. Patient Management: Cardiovascular System
Chapter 19. Common Cardiovascular Disorders
Chapter 20. Heart Failure
Chapter 21. Acute Myocardial Infarction
Chapter 22. Cardiac Surgery
Part 6 Respiratory System
Chapter 23. Anatomy and Physiology of the Respiratory System
Chapter 24. Patient Assessment: Respiratory System

Chapter 25. Patient Management: Respiratory System
Chapter 26. Common Respiratory Disorders
Chapter 27. Acute Respiratory Distress Syndrome
Part 7 Renal System
Chapter 28. Anatomy and Physiology of the Renal System
Chapter 29. Patient Assessment: Renal System
Chapter 30. Patient Management: Renal System
Chapter 31. Acute Kidney Injury and Chronic Kidney Disease
Part 8 Nervous System
Chapter 32. Anatomy and Physiology of the Nervous System
Chapter 33. Patient Assessment: Nervous System
Chapter 34. Patient Management: Nervous System
Chapter 35. Common Neurosurgical and Neurological Disorders
Chapter 36. Traumatic Brain Injury
Chapter 37. Spinal Cord Injury
Part 9 Gastrointestinal System
Chapter 38. Anatomy and Physiology of the Gastrointestinal System
Chapter 39. Patient Assessment: Gastrointestinal System
Chapter 40. Patient Management: Gastrointestinal System
Chapter 41. Common Gastrointestinal Disorders
Part 10 Endocrine System
Chapter 42. Anatomy and Physiology of the Endocrine System
Chapter 43. Patient Assessment: Endocrine System
Chapter 44. Common Endocrine Disorders
Part 11 Hematological and Immune Systems
Chapter 45. Anatomy and Physiology of the Hematological and Immune Systems
Chapter 46. Patient Assessment: Hematological and Immune Systems
Chapter 47. Organ and Hematopoietic Stem Cell Transplantation
Chapter 48. Common Immunological Disorders
Chapter 49. Common Hematological Disorders
Part 12 Integumentary System

Chapter 50. Anatomy and Physiology of the Integumentary System
Chapter 51. Patient Assessment: Integumentary System
Chapter 52. Patient Management: Integumentary System
Chapter 53. Burns and Common Integumentary Disorders
Part 13 Multisystem Dysfunction
Chapter 54. Shock, Systemic Inflammatory Response Syndrome, and Multiple Organ Dysfunction Syndrome
Chapter 55. Trauma
Chapter 56. Drug Overdose and Poisoning

Chapter 1 Critical Care Nursing Practice: Promoting Excellence-Caring,Collaboration
Evidence
Multiple Choice
1. A nurse is the only one in the ICU who has not achieved certification in critical care
nursing. She often will ask her fellow nurses what to do in caring for a patient because
she doubts the accuracy of her knowledge and her intuition. She loves her work but
wishes she could do it with a greater level of competence. What is the most important
effect that obtaining certification would likely have on the nurses practice?
A) Recognition by peers
B) Increase in salary and rank
C) More flexibility in seeking employment
D) Increased confidence in making decisions
2. A hospital interviews two different candidates for a position in the ICU. Both candidates
have around 10 years of experience working in the ICU. Both have excellent interpersonal
skills and highly positive references. One, however, has certification in critical care nursing.
Which of the following is the most compelling and accurate reason for the hospital to hire
the candidate with certification?
A) The certified nurse will have more knowledge and expertise.
B) The certified nurse will behave more ethically.
C) The certified nurse will be more caring toward patients.
D) The certified nurse will work more collaboratively with other nurses.
3. A nurse is caring for an elderly man recently admitted to the ICU following a stroke. She
assesses his cognitive function using a new cognitive assessment test she learned about in a
recent article in a nursing journal. She then brings a cup of water and a straw to the patient
because she observes that his lips are dry. Later, she has the patient sit in a wheelchair and
takes him to have some blood tests performed. He objects at first, saying that he can walk
on his own, but the nurse explains that it is hospital policy to use the wheelchair. That
evening, she recognizes signs of an imminent stroke in the patient and immediately pages
the physician. Which action taken by the nurse is the best example of evidence-based
practice?
A) Giving the patient a cup of water
B) Transferring the patient in a wheelchair
C) Using the cognitive assessment test
D) Recognizing signs of imminent stroke and paging the physician

4. A nurse is on a committee that is trying to reduce the occurrence of hospital-acquired
infections in the ICU. Her role is to conduct research to find which interventions have been
shown to be most effective in reducing these infections. She consults many different
sources and finds conflicting information. Which of the following sources should she
consider the most authoritative?
A) AACN expert panel report
B) A meta-analysis of randomized controlled trials in the American Journal of Nursing
C) A systematic review of qualitative studies in the Journal of Advanced Nursing
D) A single randomized controlled trial in the American Journal of Critical Care
5. A nurse who has been recently hired to manage the nursing staff of the ICU is concerned
at the lack of evidence-based practice she sees among the staff. Which of the following
would be the best step for her to take to promote incorporating evidence into clinical
practice?
A) Only hire nurses certified in critical care nursing.
B) Leave copies of several different nursing journals in the nurses lounge.
C) Demonstrate to the staff the best nursing-related search terms to use in Google or
Yahoo!
D) Introduce the staff to the PubMed search engine and assign them topics to research
on it.
6. A physician visits a patient in the ICU while the nurse is out. The patient complains that
the pain medication is not effective and that he would like to receive an increased dose.
The physician has the nurse paged and consults with him in the hallway regarding the
patients request for stronger pain medication. The nurse explains that patient was started
on a morphine drip only 20 minutes ago and that the drug has not had time to take effect
yet. The physician agrees and tells the patient to give it just a bit more time. Which
component of a healthy work environment is most evident in this scenario?
A) Skilled communication
B) Appropriate staffing
C) True collaboration
D) Meaningful recognition
7. A nurse in the ICU is responding to a patient who has just gone into cardiac arrest. A
moment later, the nurse is notified that another patient has just gone into anaphylactic
shock due to a drug allergy. She is conflicted as to what to do, as she is the only nurse
available at the moment to tend to both patients. Which component of a healthy work
environment is lacking in this scenario?
A) Effective decision making

B) Appropriate staffing
C) Authentic leadership
D) Meaningful recognition
8. An ICU nurse has provided excellent care for a 6-year-old girl who had been admitted to
the ICU for a head injury. The nurse was attentive not only to the needs of the patient but
also went out of her way to care for the needs of the girls family. According to research,
which of the following forms of recognition would the nurse value the most?
A) A card from the girls family
B) A plaque from the ICU physicians naming her as Nurse of the Year
C) A letter of commendation from the hospitals administration
D) A bouquet of flowers from her supervisor
9. A patient in the ICU has recently been diagnosed with diabetes mellitus. Before being
discharged, this patient will require detailed instructions on how to manage her diet, how to
self-inject insulin, and how to handle future diabetic emergencies. Which nurse competency
is most needed in this situation?
A) Clinical judgment
B) Advocacy and moral agency
C) Caring practices
D) Facilitation of learning
10. An elderly patient is admitted to the ICU with stage IV lung cancer, diabetes mellitus, and
congestive heart failure. The health care team assembled to care for her is large and diverse,
including an oncologist, a pulmonologist, an endocrinologist, a cardiologist, and others. The
patient is not expected to survive more than a few weeks, and her husband is overwhelmed
with stress and grief. Which nurse competency or competencies are most needed in this
situation? Select all that apply.
B) Caring practices
C) Collaboration
D) Response to diversity
11. An Ethiopian man with AIDS has recently been admitted to the ICU with a case of
pneumonia. The man is new to the U.S. and has no health insurance. He would likely be
eligible for the states Medicaid coverage, but does not understand how to access this
coverage. Which competency or competencies are most needed in this situation? Select all
that apply.

B) Advocacy and moral agency
C) Collaboration
D) Systems thinking
E) Response to diversity
F) Clinical inquiry
12. A nurse decides to seek certification in critical care nursing. What is the most important
benefit for the individual nurse in becoming certified in a specialty?
A) It will result in a salary increase.
B) It is required to work in critical care.
C) It demonstrates the nurses personal expertise.
D) It is mandated by employers.
13. The American Association of Critical-Care Nurses (AACN) sponsors certification in
critical care nursing for several critical care subspecialties. What is the most important
benefit of such certification for the profession of nursing?
A) Provides positive publicity for nursing
B) Validates nurses expert knowledge and practice
C) Mandated by government regulations
D) Demonstrates basic knowledge in the field
14. A nurse has achieved certification in critical care nursing. What is the most important
effect that this certification will have on the nurses practice?
A) Recognition by peers
B) Increase in salary and rank
C) More flexibility in seeking employment
D) Increased confidence in critical thinking
15. The nurse cites evidence-based practice as a rationale for a patient care decision. What is
the best description of evidence-based practice?
A) Decisions based on expert legal testimony
B) Use of best available research data
C) Evolution of nursing practice over time
D) Individual optimization of patient outcomes

16. The nurse caring for a critically ill patient implements several components of care. What
component is an example of the use of evidence-based practice?
A) Use of a protocol for admission of a patient to the unit
B) Application of an insulin sliding scale method from research
C) Checking the patients armband before giving a medication
D) Limiting visits to immediate family only for 2 hours a day
17. The nurse wishes to increase the use of evidence-based practice in the critical care unit
where he works. What is a significant barrier to the implementation of evidence-based
practice?
A) Use of computerized records by the hospital
B) Health Information Privacy and Portability Act (HIPPA)
C) Lack of knowledge about literature searches
D) Strong collaborative relationships in the work setting
18. The nurse has identified an increase in medication errors in the critical care unit over the
past several months. What aspect of medication procedures should be evaluated first?
A) Adherence to procedures by nursing staff
B) Clarity of interdisciplinary communication
C) Number of new employees on the unit
D) Changes in administration procedures
19. A critical care unit has decided to implement several measures designed to improve
intradisciplinary and interdisciplinary collaboration. In addition to an expected
improvement in patient outcomes, what is the most important effect that should result
from these measures?
A) Identification of incompetent practitioners
B) Improvement in manners on the unit
C) Increased staff retention
D) Less discussion in front of patients and families
20. A nurse wishes to practice using the Synergy Model developed by the American Association
of Critical-Care Nurses (AACN). What nursing behavior best supports use of this model?
A) Attending mandatory hospital-wide in-service programs
B) Self-directed study of best practice for the patients she cares for

C) Gathering demographic data on the patients admitted to the unit
D) Participating in a research study as a data collector
21. As part of the Synergy Model, the nurse has identified a patient characteristic of
resiliency. What patient behavior demonstrates resiliency?
A) Dysfunctional grieving behaviors after receiving bad news
B) Developing a list of questions for the physician
C) Denial of any possible negative outcomes for a procedure
D) Assigning blame to others for undesired outcomes of illness
22. A patient is admitted to the critical care unit after receiving a mechanical heart
implantation. In making a nursing assignment, the charge nurse best demonstrates
application of the Synergy Model by assigning which nurse to care for this patient?
A) A newly hired new graduate nurse, for the experience
B) A nurse with a patient in the next room, for proximity
C) The most senior nurse on the unit, for political reasons
D) The nurse with most experience with this device, for expertise
23. A Muslim patient has been admitted to the critical care unit with complications after
childbirth. Based on the Synergy Model, which nurse would be the most inappropriate to
assign to care for this patient?
A) New graduate female nurse
B) Most experienced female nurse
C) New graduate male nurse
D) Female nurse with postpartum experience
24. Todays critical care nursing environment is constantly changing. What nursing behavior
best illustrates awareness of current events affecting critical care nursing?
A) Participating in the hospitals efforts to recruit new nurses
B) Volunteering to serve on a disaster response planning committee
C) Adhering to content taught in basic nursing program
D) Attending hospital-mandated in-services without other education
Answer Key
1. D

2. A
3. C
4. B
5. D
6. C
7. B
8. A
9. D
10. B, C
11. B, D, E
12. C
13. B
14. D
15. B
16. B
17. C
18. B
19. C
20. B
21. B
22. D
23. C
24. B

Chapter 2: The Patient’s Experience With Critical Illness
1. The critical care unit environment is very stressful for patients, families, and staff. What
nursing action is directed at reducing environmental stress?
A) Constant evaluation of patient status
B) Limiting visits to immediate family
C) Bathing all patients during hours of sleep
D) Maintaining quiet during hours of sleep
2. A patient is transferred to the ICU from the Birth Center of the hospital in the middle of
the night after experiencing complications during delivery of her baby. The patients
husband is anxious and explains to the ICU nurse that he doesnt understand why his wife
has been moved to the ICU. She is going to die, isnt she? he asks the nurse. What is the
nurses best response?
A) Explain that every measure will be taken to provide his wife with the best care
possible.
B) Explain that the nurse is fully trained and has years of experience.
C) Offer the husband a place to relax.
D) Have appropriate staff discuss his health insurance with him.
3. A patient is admitted to the ICU with injuries sustained from a fall from a third-story
window. The patient is conscious, his breathing is labored, and he is bleeding heavily from
the abdomen. He groans constantly and complains of severe pain, but his movements are
minimal. His heart rate is elevated. Which of these is a sign that he is in the second phase
of the stress response? Select all that apply.
A) Bleeding heavily from his abdomen
B) Labored, slow breathing
C) Severe pain
D) Elevated heart rate
E) Minimal movement
4. A patient in the ICU is recovering from open-heart surgery. The nurse enters his room
and observes that his daughter is performing effleurage on his arms and talking in a low
voice about an upcoming family vacation that is planned. The room is dimly lit, and she
hears the constant beeping of his heart monitor. From the hall she hears the cries of a
patient in pain. Which of the following are likely stressors for the patient? Select all that
apply.
A) His daughters conversation
B) His daughters effleurage
C) The beeping of the heart monitor
D) The dim lighting of the room

E) The cries of the other patient from the hall
5. A patient in the ICU is complaining that he is not sleeping well at night because of
anxiety. Which of the following would be the most helpful intervention for the nurse to
make?
A) Provide the patient with a bath immediately following his first 90-minute REM
sleep cycle.
B) Increase the patients pain medication.
C) Provide the patient with 5 minutes of effleurage and then minimize disruptions.
D) Monitor the patients brain waves by polysomnography to determine his sleep
pattern.
6. A nurse walks into a patients room and begins preparing a syringe to perform a blood
draw on the patient. The nurse observes that the patient is firmly gripping the side of the
bed, averting her eyes, and sweating from her forehead when she sees the needle. What
would be the best intervention for the nurse to make?
A) Proceed with blood draw as quickly as possible, to get it over with.
B) Offer to come back later to perform the blood draw.
C) Encourage the patient to deep breathe.
D) Describe briefly the blood draw procedure and explain why it is necessary.
7. A 15-year-old boy is in the ICU and preparing for an appendectomy. He is clearly anxious
and fidgets with his IV constantly. He complains that he doesnt want to be there and he is
sick of everyone telling him what to do. What would be the best way for the nurse to
address this patients anxiety?
A) Use physical restraints to keep him from pulling out his IV.
B) Offer him the remote to the television.
C) Lower the head of his bed so that he can rest more easily.
D) Explain to the patient in detail what the appendectomy will consist of.
8. A nurse in a burn unit observes that a patient is tensed up and frowning but silent. The
nurse asks the patient, Can you tell me what you are thinking now? The patient responds, I
cant take this pain any more! I feel like Im about to die. What would be the best response
for the nurse to give to the patient, considering that the patient is already receiving the
maximum amount pain medication that is safe?
A) Try to get rid of those negative thoughtsthey only make it worse.
B) Try thinking instead, This pain will go away; I can overcome it.
C) Your pain medication is already at the highest possible dose.
D) Would you like me to raise the head of your bed?

9. A patient on mechanical ventilation is experiencing severe agitation due to being on the
ventilator. Which nursing intervention would be best?
A) Performing breathing exercises with the patient
B) Offering the patient a patient-controlled analgesic device
C) Asking the physician to prescribe an antianxiety medication
D) Offering the patient the patients own MP3 player to listen to
10. A 10-year-old female patient in ICU receiving chemotherapy has requested that her dog be
allowed to visit her. She is currently sharing a room with another patient. The nurse
knows that the hospital does allow for pet visits with owners, but has strict guidelines.
Which of the following scenarios is most likely to be permitted?
A) The girls father may bring the dog in on a leash for a 20-minute visit.
B) The girls sister may bring the dog in with a shirt on (to prevent shedding) for an
overnight stay.
C) The girls mother may bring the dog in on a leash for a visit as long as he has had all
his vaccinations.
D) The dog may be brought in for a brief visit once the girl is moved to a private room.
11. The nurse understands that a patient being cared for in a critical care unit experiences an
acute stress response. What nursing action best demonstrates understanding of the
physiological parts of the initial stress response?
A) Adequate pain control
B) Intravenous sedation
C) Treatment for elevated blood pressure
D) Ignoring an elevated glucose level
12. A critically ill patient experiences stress and anxiety from many factors. Treatment of the
patient focuses on reducing stressors and providing supportive care such as nutrition,
oxygenation, pain management, control of anxiety, and specific care of the illness or injury.
What is the best rationale for these interventions?
A) Helps to support the patients immune system
B) Part of good nursing care
C) Mandated by hospital policy
D) Reassures the patient and family
13. A patient in a critical care unit has increased stress from the constant noise and light
levels. What nursing intervention best attenuates these sources of stress?

Critical Care Nursing: A Holistic Approach 11th Edition Morton Fontaine Test Bank
Ultimatestudyguide2021@gmail.com
A) Need for constant observation and evaluation
B) Dimming lights during the night
C) Frequent nursing group rounds for all patients
D) Use of tile floors for ease in cleaning
14. The nurse is caring for a patient who is orally intubated and on a mechanical ventilator.
The nurse believes that the patient is experiencing excess anxiety. For this patient, what
behavior best indicates anxiety?
A) Restlessness
B) Verbalization
C) Increased respiratory rate
D) Glasgow Coma Scale score of 3
15. The critical care unit environment is very stressful for patients, families, and staff. What
nursing action is directed at reducing environmental stress?
A) Constant expert evaluation of patient status
B) Limiting visits to immediate family
C) Bathing all patients during hours of sleep
D) Maintaining a quiet environment during hours of sleep
16. The nurse wishes to enhance sleep cycles in her critically ill patient. Research has shown
that which nursing action improves sleep in critically ill patients?
A) Repositioning every 2 hours
B) Hypnotic medications
C) Five-minute back effleurage
D) Adequate pain control
17. The nurse is caring for a critically ill patient with a very concerned family. Given that the
family is under high stress, what nursing intervention will best ameliorate their stress while
preserving independence?
A) Encourage the family to participate in patient care tasks.
B) Teach the family to ask questions of the health care team.
C) Ask the family to select a family representative for communication.
D) Limit visits to immediate family members for limited times.

18. While caring for a critically ill patient, the nurse knows that fostering patient control over
the environment is a method for stress reduction. What nursing intervention gives the
patient the most environmental control while still adhering to best practice principles?
A) Ask the patient whether he or she wants to get out of bed.
B) Give the patients bath at the same time every day.
C) Explain painful procedures only after giving pain medication.
D) Choose menu items for the patient to ensure a balanced diet.
19. The nurse is using presence to reduce the anxiety of a critically ill patient. What nursing
behavior demonstrates an effective use of presence?
A) Staying in the patients room to complete documentation
B) Having a conversation in the patients room that excludes the patient
C) Maintaining eye contact with the patient during explanations
D) Focusing on specific nursing care tasks while in the patients room
20. The nurse is caring for a critically ill patient who can speak. The nurse notices that the
patient is demonstrating behaviors indicative of anxiety but is silent. What nursing
strategy would give the nurse the most information about the patients feelings?
A) Explain procedures to the patient and family.
B) Ask the patient to share his or her internal dialogue.
C) Encourage the patient to nap before visiting hours.
D) Ensure that the patient has adequate pain control.
21. The patient is undergoing a necessary but painful procedure that is greatly increasing her
anxiety. The nurse decides to use guided imagery to help alleviate the patients anxiety.
What is a key part of this technique?
A) Provide the patient with an external focus point such as a picture.
B) Have the patient take slow, shallow breaths while staring at a focus point.
C) Have the patient remember tactile sensations of a pleasant experience.
D) Encourage the patient to consciously relax all of her muscles.
22. One of the strategies shown to reduce perception of stress in critically ill patients and their
families is support of spirituality. What nursing action is most clearly supportive of the
patients spirituality?
A) Referring patients to the Catholic chaplain
B) Providing prayer booklets to patients and families

C) Asking about beliefs about the universe
D) Avoiding discussing religion with those of other faiths
23. A critically ill patient tells the nurse that he is not afraid to die because he believes in
reincarnation. What is the most appropriate nursing response?
A) What if reincarnation is not real?
B) This belief gives you strength.
C) I dont believe in reincarnation.
D) You shouldnt base your hopes on such a belief.
24. A critically ill patient who is intubated and agitated is restrained with soft wrist restraints.
Based on research findings, what is the best nursing action?
A) Maintain the restraints to protect patient safety.
B) Remove the restraints periodically to check skin integrity.
C) Remove the restraints periodically for range of motion.
D) Assess and intervene for causes of agitation.
Answer Key
1. D
2. A
3. C, E
4. C, E
5. C
6. D
7. B
8. B
9. D
10. D
11. A
12. A
13. B

14. A
15. D
16. C
17. B
18. B
19. C
20. B
21. C
22. C
23. B
24. D

Chapter 3 The Family’s Experience With Critical Illness
1. A patient has just been admitted to the ICU after being in a severe auto accident and
losing one of her legs. Her husband has his hand over his heart and complains of a rapid
heart rate. The nurse recognizes his condition as a sign of which stage of the general
adaptation syndrome to stress?
A) Alarm stage
B) Exhaustion stage
C) Resistance stage
D) Adaptation stage
2. The nurse observes that an elderly woman, whose granddaughter has been admitted to the
ICU, is struggling to manage her two great-grandsons, who are toddlers, in the waiting
room. What is the most likely explanation for the womans inability to manage the children
in this situation?
A) She is senile.
B) She is in the exhaustion stage of the general adaptation syndrome to stress.
C) She is assuming the role of caregiver in place of the patient, a role she is not used to.
D) She has macular degeneration and cannot see well.
3. A nurse needs to communicate with a patients family regarding consent to treat an
unconscious patient in the ICU. Which member of the group should the nurse approach
first?
A) A man she recognizes as the patients brother
B) A teenage boy who approaches the nurse
C) A woman who originally escorted the patient in
D) A woman in the group whom the others look at and call over when the nurse
approaches
4. A new nurse has recently joined the ICU from a different hospital, which had a much
stricter policy regarding visiting hours. She expresses concern about the impact of open
visiting hours on patient well-being. Which of the following would be the best
explanation for the purpose of open visiting hours? Select all that apply.
A) To better provide rest and quiet
B) To strengthen the relationship between the family and health care provider
C) To control the number of visitors for a patient
D) To provide an undisturbed environment
E) To decrease the patients anxiety
F) To increase the satisfaction of the family with the experience
5. A nurse observes that a 38-year-old single father whose 11-year-old daughter is in the ICU is
struggling to explain to his 6-year-old son the likelihood that the daughter will die.

The young boy asks what will happen to his sister when she dies, but the father breaks
down in tears and seems unable to respond. Which of the following would be the most
appropriate intervention for the nurse to make?
A) Suggest that the father contact his pastor, rabbi, or other spiritual leader for counsel
for him and his son
B) Sit down with the father and son and share her own religious beliefs
C) Ask the patients doctor to explain to the father the odds of the daughter surviving
D) Leave the father and son to grieve alone
6. A patient is experiencing severe pain, despite receiving pain medication for the past 24
hours. The patients wife expresses concern about this to the nurse. Which response by the
nurse would be most empowering to the patients family?
A) Explain that the doctor is an expert on pain medication and that the current level of
medication is the best.
B) Recommend that the family members take turns massaging the patients feet to
distract from the pain.
C) Encourage the family to request that the physician evaluate the patients pain control.
D) Ask the family to wait another 24 hours to see whether the patients pain level will
go down.
7. The sister of a patient in the ICU has been at the patients bedside non-stop for 48 hours.
The nurse suggests to her that she return home to rest. Which of the following is the
proper rationale for the nurse making such a suggestion?
A) The sister is in the way of the health care providers.
B) The patient may become annoyed by her continual presence.
C) The patient will recover more easily in peace and quiet.
D) The sister needs to maintain her own health during this time.
8. A young man has just arrived at the ICU from out of town and received news that his
girlfriend, who is admitted there, likely only has a few days left to live. Which of the
following would be the best approach for the nurse to take in caring for the needs of this
young man?
A) Recommending that he go home and rest
B) Giving him unrestricted visiting hours with the patient
C) Suggesting that he meet with the hospital chaplain
D) Recommending that he ask the doctor to evaluate the patients pain control measures
9. A family of a young girl who has been diagnosed with leukemia has travelled 12 hours by car
to admit her to the ICU and be with her during her treatment. Which aspect of the critical
care family assistance program would most likely be needed by this family initially?
A) Educational materials

B) Weekly group family information sessions
C) Hospitality programs
D) Pet therapy
10. A Muslim woman is admitted to the ICU after suffering severe burns over most of her
body. Which of the following would be the most appropriate measure for the nurse, a
woman, to take in respect for the cultural practices of this patient?
A) Insist that only a female doctor be assigned to this patient.
B) Ensure that no pork products are included in the patients diet.
C) Ensure that direct eye contact is not made with the patients husband.
D) Ask the patients husband what religious and cultural preferences should be
considered in the patients care.
11. A client has been admitted after experiencing multiple trauma and is intubated and sedated.
When the five members of the immediate family arrive, they are anxious, angry, and very
demanding. They all speak loudly at once and ask for many services and answers. What is
the best nursing response?
A) Ask the family to leave until visiting hours begin.
B) Take them to a private area for initial explanations.
C) Page security to have them removed from unit.
D) Show them to the clients bedside and leave them alone.
12. The client has been in the CCU for several weeks and has been very unstable. One family
member stays at the bedside constantly and even naps in a bedside chair. The nurse
understands that the family member is exhibiting which family member response to critical
illness?
A) Exhibiting extreme distrust of the health care team
B) Seeking evidence for future legal or punitive action
C) Trying to maintain a level of control over the situation
D) Experiencing extreme fatigue from constant stress
13. The nurse is caring for a very seriously ill patient in the CCU. The family visits sporadically,
stays for only a short time, and does not ask many questions. How could the nurse best
begin to involve the family in the patients care?
A) Ask one family member to assist with the patients bath.
B) Encourage family members to stay longer at each visit.
C) Focus nursing efforts on the patients legal next of kin.
D) Ask the family to complete the Critical Care Family Needs Inventory.
14. As part of the admission process, the nurse asks several questions about family
relationships. The nurse bases these actions on which rationale?

A) Assessing family relationships is an initial step in including the family in patient
care.
B) These questions are part of the admission assessment tool required by this CCU.
C) The nurse has a natural curiosity and wishes to know how the family members relate
for her own knowledge.
D) There is an ongoing research study to identify variant family patterns related to
disease incidence.
15. On their first visit to a critically ill patient, family members stand in the doorway of the
room, making no effort to approach the patient. What is the most appropriate nursing
action?
A) Instruct the family where the patient can be touched and what to say.
B) Engage the family in social conversation to ease them into the milieu.
C) Use visiting hours to explain to the family the general status of the patient.
D) Leave the family to adjust to the situation when they are ready.
16. A critically ill patient is not expected to survive this admission. The family asks the nurse
how the patient is doing. When answering this question, what should the nurse include?
A) Emphasize that the patient is young and strong and may still survive.
B) Refer the family to the physician for all details and answers.
C) Give specific information such as descending trends in parameters.
D) Ask if the family has determined which funeral home will be called.
17. A patients family is exhibiting increasingly impaired coping as the patients condition
deteriorates. The nurse asks the family to state the biggest concern from their perspective.
What is the most important rationale for this question?
A) The question indicates active listening on the part of the nurse.
B) The question is used as a way to validate the familys knowledge.
C) The question clarifies the nurses understanding of current family needs.
D) The question promotes problem definition, which helps define the degree of family
understanding.
18. The nurse recommends that the family of a critically ill patient seek help from the Critical
Care Family Assistance Program. What benefit for the family does the nurse anticipate?
A) Reduction of health care cost
B) More physical comfort
C) Multidisciplinary support
D) Health promotion information
19. While interacting with the family of a critically ill patient, the nurse suggests that the
family must be feeling very anxious and perhaps angry. How does this nursing action

benefit the family?
A) Removes the focus of the conversation from the patient
B) Focusing on feelings helps the family avoid delayed grief and unhealthy coping
C) Gives validation of need for psychological counseling
D) Reduces family insistence for patient progress information
20. The nurse is caring for a patient from a very different cultural group. In delivering care,
how can the nurse best demonstrate cultural sensitivity?
A) Ask the family about their cultural beliefs and customs that may apply.
B) Assume that the patient and family will adjust to the hospital culture.
C) Inform the patient and family that the routines of the hospital take precedence.
D) Do a literature search on the patients culture to determine beliefs.
Answer Key
1. A
2. C
3. D
4. B, E, F
5. A
6. C
7. D
8. B
9. C
10. D
11. B
12. C
13. D
14. A
15. A
16. C
17. D
18. C
19. B
20. A

Chapter 4 Patient and Family Education in Critical Care
1. An elderly man whose wife has just been admitted to the ICU following congestive heart
failure is concerned about how passage of the Affordable Care Act will impact the care of
his wife. Which of the following are expected outcomes of this legislation that it would be
appropriate for the nurse to share with the man? Select all that apply.
A) The new legislation will result in a shortage of experienced critical care nurses.
B) The new legislation will require health care workers to meet higher quality standards
related to patient care.
C) The new legislation will make it more challenging to meet the educational goals of
patients and families.
D) The new legislation will increase the length of stay of patients in the hospital.
E) The new legislation will shift the payment structure for hospitals and health care
providers from a traditional fee-for-service model to an incentive model.
2. A young couple whose 5-year-old daughter has been admitted to the ICU approaches the
nurse with looks of concern on their faces. They express frustration to the nurse that they
have not been able to speak with either the physician or the surgeon and are confused as to
what the next steps are for their daughters treatment. What would be the best intervention
for the nurse to make in this situation?
A) Offer to get ice chips for the couple to give to their daughter to empower them.
B) Make sure that they have the cell phone numbers of the physician and surgeon.
C) Teach the couple about the pathophysiology of the daughters disease.
D) Arrange a patient care conference with the couple and the health care team.
3. A nurse sees a group of physicians who are making teaching rounds in the hall of the ICU
heading toward the room of one of her patients. The patient, who currently has a visitor,
has given approval in the past to have teaching groups visit. What should the nurse do in
this situation?
A) Explain to the group of physicians that the patient currently has a visitor and ask
whether they could come by later.
B) Ask the visitor to leave so that the teaching group can discuss the patients case.
C) Allow the teaching group to enter the patients room, as he has already given
approval for them to visit.
D) Instruct the physicians to give clear explanations of the medical jargon they use.

4. The nurse is working with a patient from India who is recovering from a myocardial
infarction. When the nurse asks the patient whether she has had a myocardial infarction
before, the patient seems confused and appears not to understand the nurse, although the
patient does speak English. Which of the 4 Cs of Culture should the nurse use to better
communicate with this patient?
A) Call
B) Cause
C) Cope
D) Concern
5. A nurse needs to obtain informed consent from a deaf patient before a spinal tap procedure
is performed. Which of the following would be the best method for the nurse to use to
ensure effective communication?
A) Explain the procedure verbally, speaking slowly so that the patient can read lips.
B) Have a trained oral interpreter interpret for the nurse.
C) Have the patient carefully read a printed copy of the informed consent document.
D) Use diagrams to explain to the patient the details of the procedure.
6. A nurse is explaining to a patient how radiation therapy works to kill cancer cells. She
begins by explaining how there are different types of cells in the body that reproduce at
different rates. She then explains what cancer cells are and how they reproduce. Finally,
she explains how radiation therapy uniquely targets cancer cells. This approach takes
advantage of which domain of learning?
A) Affective
B) Psychomotor
C) Cognitive
D) Demonstration/return demonstration
7. A young man is recovering from anaphylactic shock caused by a bee sting. The nurse is
trying to instruct the patient on how to use an epinephrine autoinjector (EpiPen), but the
patient seems uninterested in learning. The nurse then explains how having the EpiPen
with him at all times and knowing how to use it could not only save his life someday but
also will give him a greater sense of security and safety. Which adult learning principle is the
nurse using? Select all that apply.
A) The learners self-concept
B) The learners life experience
C) Readiness to learn

D) Motivation to learn
E) The need to know
8. In attempting to teach a patient how to clean around the surgical sutures on his abdomen
upon discharge to home, the nurse determines that applying the principle of the learners
self-concept would be most effective with this patient. Which of the following is the best
example of an application of that principle in this situation?
A) Relating to the patient a story about another patient who failed to properly clean his
sutures and the outcome
B) Explaining that failure to properly clean around the suture site could result in serious
infection
C) Commenting that learning to properly clean his suture site could give the man skills
that would better prepare him for a career in health care
D) Mentioning to the patient that, if he would prefer, he can watch a video on the
hospitals website on how to clean around a suture site
9. A nurse needs to explain to a patient about the possible side effects the patient may
experience related to the pain medication she is now beginning while in the ICU and which
she will be continuing upon discharge. Which method would be the most effective way to
teach this to the patient?
A) In a planned teaching session, in which the nurse covers medication-related side
effects, dietary restrictions, and activity restrictions
B) Via a brochure that the patient can take with her on discharge
C) By briefly explaining the side effects while administering the medication to the
patient
D) By relating a story about another patient who had a severe adverse reaction to this
medication
10. A nurse needs to evaluate a patients understanding of how to administer an IV medication at
home. Which of the following would be the best method for evaluation?
A) The nurse explaining the procedure to the patient and family using diagrams
B) The nurse having the patient and family members demonstrate the procedure
themselves
C) The nurse explaining the procedure while performing it on the patient
D) The nurse referring the patient to a computer-based educational library that has an
interactive program
11. Teaching patients and families is an important part of critical care nursing. What factor in
todays critical care unit is a barrier to this education function?

A) Large numbers of inexperienced nurses
B) Serious illness of patients
C) Increased computer support
D) Use of specialty educators
12. The nurse is caring for a critically ill patient. On the previous shift, a nurse documented
unable to teach due to critical illness. What is the best nursing action by the current nurse to
address the patients teaching and learning needs?
A) Realize that the patient is too ill to accept teaching at this time.
B) Look for opportunities for teaching, such a procedure explanation.
C) Focus all teaching efforts on the family to the exclusion of the patient.
D) Alter the plan of care to delay teaching until transfer to step-down unit.
13. After several weeks, a critically ill patient has progressed well and is being transferred to a
step-down unit. What normal patient response does the nurse anticipate?
A) Relief
B) Thankfulness
C) Anxiety
D) Indifference
14. The nurse is teaching a patient and family in the patients critical care room. The critical
care unit is busy and noisy. What nursing action will best enhance learning?
A) Explain the material simply using simple terms.
B) Give all explanations via commercial teaching brochures.
C) Close the door to the patients room.
D) Ask the family not to interrupt with questions.
15. The nurse is teaching a patient who is not a native English speaker. As the nurse gives
complex explanations, the patient nods and smiles. What is the best nursing intervention
to ensure patient understanding?
A) Assume that the patients nods indicate understanding.
B) Ask a family member to interpret to the patient.
C) Use pictures whenever possible in the teaching.
D) Ask the patient to restate the information conveyed.

16. The nurse is teaching a patient newly diagnosed with diabetes mellitus how to manage a
sliding-scale insulin protocol. What portion of this interaction indicates patient learning?
A) The sliding scale insulin protocol
B) Patients questions to the nurse
C) Nurses demonstration of use of the protocol
D) Patients verbalization of a flash of insight
17. When teaching a patient and family, the nurse wishes to use the affective domain of
learning. What nursing action is most likely to involve the affective domain?
A) Presenting facts from simple to complex
B) Giving clear directions about when to call the physician
C) Using a nonthreatening approach
D) Using demonstration/redemonstration approach
18. The nurse is teaching a patient newly diagnosed with diabetes mellitus how to inject
insulin and chooses to use a demonstration/redemonstration technique. What domain of
learning is the nurse chiefly using?
A) Cognitive
B) Affective
C) Psychomotor
D) Educative
19. The nurse is teaching a patient newly diagnosed with cardiovascular disease how to reduce
risk factors. The nurse begins by explaining why this information is important for the
patient. What principle of adult learning is the nurse applying?
A) Need to know
B) Learners self-concept
C) Learners life experience
D) Motivation to learn
20. The nurse is teaching a group of patients newly diagnosed with cardiovascular disease.
What action demonstrates application of the adult learning principle of learners life
experience?
A) Beginning with an explanation of why the material is important
B) Creating a learning situation that is self-directed and independent
C) Using case scenarios and problem-solving exercises

D) Applying content to real-life situations and actions
21. The nurse is assessing learning by a critically ill patient and family. What is the best
method of assessment?
A) Written test
B) Specific questions
C) Open-ended questions
D) Literacy assessment
Answer Key
1. B, E
2. D
3. A
4. A
5. B
6. C
7. D, E
8. D
9. C
10. B
11. A
12. B
13. C
14. C
15. D
16. D
17. C
18. C
19. A
20. C
21. C

Chapter 5 Relieving Pain and Providing Comfort
1. A patient is in the ICU after suffering multiple trauma from a car wreck that occurred 24
hours ago. The patient feels pain from many sources, including lacerations on the arm, a
fractured femur, a tension headache from the stress of the accident, lower back pain from a
sports injury 30 years ago, nasal irritation from an endotracheal tube, and joint aches from
ongoing arthritis. The nurse recognizes which of the following as the most likely instances
of chronic pain? Select all that apply.
A) Lacerations on arm
B) Fractured femur
C) Tension headache
D) Lower back pain from old sports injury
E) Irritation in throat from endotracheal tube
F) Arthritis in joints
2. A Nepali man is in the ICU recovering from spinal surgery to remove a malignant tumor.
He does not speak English, and struggles to communicate with the nurse by using hand
motions. His family is constantly at his bedside, speaking with him in Nepalese. Frequently,
he puts on headphones and listens to music on his MP3 player. His wife occasionally
massages his feet. Which of the following factors is most likely exacerbating this patients
pain?
A) Inability to communicate with the nurse
B) Constant presence of his family
C) Listening to music
D) His wife massaging his feet
3. A nurse is caring for a patient in the ICU who is recovering from coronary artery bypass
graft surgery. Over the course of the next few days, the nurse will be responsible for
changing a dressing over the surgical incision site, having the patient change positions in
bed, assisting with tracheal suctioning, and assisting with drain removal. The nurse should
anticipate that the patient will most likely perceive pain resulting from these procedures in
which order, from least painful to most?
A) Changing the dressing, position change in bed, tracheal suctioning, drain removal
B) Position change in bed, changing the dressing, drain removal, tracheal suctioning
C) Drain removal, tracheal suctioning, position change in bed, changing the dressing
D) Tracheal suctioning, position change in bed, changing the dressing, drain removal

4. A patient in the ICU is receiving intravenous opioid analgesia following myocardial
infarction. Despite receiving continuous infusion of the opioid, the patient is grimacing
and asks for an increase in the medication level. Consulting the medical chart, the nurse
recognizes that this patient has a history of opioid addiction. What would be the most
appropriate intervention?
A) Immediately take the patient off of the opioid and give him Tylenol.
B) Leave the patient on the opioid at the current dose level.
C) Increase the dose of opioid to provide more effective pain relief.
D) Reduce the dose of opioid and offer to turn on the television as a distraction from
the pain.
5. A patient with no history of opioid abuse is receiving opioid analgesia intravenously in the
ICU for severe pain from extensive third-degree burns. The patient and his family are
concerned about the likelihood of developing an addiction to the medication. What would
be the best response on the part of the nurse?
A) Stop the opioid infusion immediately and use only nonpharmacological means of
analgesia.
B) Begin tapering off the medication gradually.
C) Explain that the risk for addiction is low and that opioids are necessary for the
patients level of pain.
D) Explain that addiction is likely but cannot be avoided and suggest a rehabilitation
program following discharge.
6. A nurse is working with an elderly patient with Alzheimers disease and congestive heart
failure in the ICU. Which of the following methods of pain assessment would be essential to
include in this situation, according to the American Geriatric Society?
A) No assessment is appropriate; the patient should be started on a standardized
protocol for analgesia for Alzheimers patients
B) The verbal zero to ten scale
C) The word descriptor scale
D) Assessment of behavior and family observations
7. A patient in the ICU with renal dysfunction is to begin receiving intravenous opioids and a
nonsteroidal anti-inflammatory drug (NSAID) for severe pain. The medication is expected
to be administered for at least seven days. Which NSAID would be most appropriate for
this patient? Select all that apply.
A) Ketorolac (Toradol)
B) Indomethacin (Indocin)

C) Celecoxib (Celebrex)
D) Rofecoxib (Vioxx)
8. A nurse is working with a cancer patient who has chronic pain related to her illness. The
nurse must administer fentanyl to the patient in the form of a transdermal patch. Which of
the following should the nurse do in administering this medication?
A) Use lotion to prepare the skin where the patch will be applied.
B) Wear gloves when handling the patch.
C) Apply the patch over a wound or abrasion, if possible, to maximize absorption.
D) Leave old patches on the patients bedside table for the doctor to examine later.
9. A patient in the ICU is receiving an intravenous opioid infusion for pain, but is
experiencing anxiety due to being on mechanical ventilation. The physician has decided to
prescribe a sedative for the patient. The patients health history indicates an allergy to soy
products. Which sedative should be avoided in this situation?
A) Propofol
B) Midazolom
C) Diazepam
D) Lorazepam
10. An elderly patient in the ICU is receiving intravenous opioid analgesia for pain. The
nurse observes that the patients respiratory rate has decreased to 8 breaths per minute.
Which nursing intervention would be most appropriate?
A) Administer naloxone intravenously very slowly.
B) Administer diazepam immediately.
C) Increase the dose of opioid.
D) Massage the patients feet to stimulate her breathing.
11. The nurse is caring for an otherwise healthy victim of a motor vehicle crash who is
experiencing considerable pain. What factor indicates that the patient may be
experiencing acute pain?
A) It is associated with an acute and severe injury.
B) It is expected to resolve as the injury heals.
C) It requires treatment with intravenous opioids.
D) No chronic illnesses have been diagnosed.

12. The nurse is caring for a critically ill patient who has experienced multiple trauma. The
patient has high levels of pain from the injury and is receiving an intravenous opioid as
treatment. In managing the patients pain, what nursing action best demonstrates
understanding of other factors that exacerbate pain in the critically ill patient?
A) Provide supportive care without discussing it with the patient.
B) Limit visits to immediate family for a few minutes at a time.
C) Minimize care tasks during normal hours of sleep.
D) Give higher doses of intravenous opioid as needed.
13. Before turning and repositioning a critically ill patient, the nurse ensures that a pain
medication is administered. This action demonstrates the nurses understanding of what
phenomenon?
A) Research has shown that critically ill patients perceive turning as a painful
procedure.
B) The patient is ordered to receive pain medication every 4 to 6 hours.
C) This patient becomes very stiff when turned and the medication will be relaxing.
D) The nurse is not concerned that this patient will become addicted to the medication.
14. The patient is scheduled for a painful procedure. In addition to premedicating the patient
with an opioid drug, what other nursing action is most likely to alleviate the pain?
A) Give intravenous midazolam (Versed).
B) Monitor vital signs during the procedure.
C) Give explanations before and during the procedure.
D) Ask the family to wait outside during the procedure.
15. The nurse is caring for a patient who has required increasing doses of opioids to control
pain and expresses a concern that the patient is becoming addicted to the opioid. What
patient behavior would best support the nurses concern about addiction?
A) He needs more medication to control pain.
B) He has withdrawal symptoms when the medication is stopped.
C) He states that he dislikes the opioid as it makes him feel drugged.
D) He asks for another dose of the opioid to relieve anxiety and get a buzz.
16. The nurse is caring for a critically ill patient who has developed tolerance to an opioid
medication used for pain control. As the dose of the opioid is increased, the nurse
observes the patient closely for respiratory depression. If the patient has developed
tolerance to the opioid, what effect on the respiratory system does the nurse expect?

A) None
B) Depression
C) Stimulation
D) Exacerbation
17. The nurse is caring for a critically ill patient with serious pain and wishes to consult
national guidelines. What is the most comprehensive source for pain management
guidelines?
A) Web-based National Guideline Clearinghouse
B) American Association of Critical-Care Nurses
C) Society of Critical Care Medicine
D) Agency for Healthcare Research and Quality
18. The nurse is developing a policy and procedure for pain management in a critical care
unit. Based on national standards, what should the nurse include?
A) Pain assessment in critical care must depend on vital sign monitoring as patients are
not verbal.
B) Continuous intravenous opioids are preferred over as-needed dosing.
C) Intravenous sedation of agitated patients takes priority over pain control.
D) Pain control is an independent nursing function and responsibility.
19. According to national standards, pain in critically ill patients should be assessed at regular
intervals using a variety of methods. What statement about pain assessment is true?
A) Absence of physical signs or behaviors is equivalent to absence of pain.
B) Many of the factors in critical care combine to invalidate patient self-report of pain.
C) Behavioral observation and physiological parameters should be considered along
with the patients report.
D) The family has a more accurate assessment of pain than the patient.
20. The nurse is administering an intravenous opioid to manage a patients pain. What criteria
can the nurse use to determine the adequacy of therapy?
A) Minute ventilation is somewhat compromised.
B) Patient rates pain below 5 on scale of 1 to 10.
C) Minute ventilation is minimally compromised.
D) Patient rates pain below own predetermined goal.

21. A severely ill critical care patient is receiving intravenous opioids for pain management.
The physician adds a nonsteroidal anti-inflammatory drug (NSAID) to the patients plan of
care. The nurse understands that the most significant advantage of adding this drug is
what?
A) NSAIDs are cheaper than opioids while providing the same pain relief.
B) Inhibition of prostaglandin and histamine at the site of injury will relieve pain
without sedation.
C) NSAIDs are available without prescription.
D) Addiction and physical dependence are less of a problem with NSAIDs.
22. A critically ill patient is receiving acetaminophen (Tylenol) in combination with opioids for
pain management. Under what circumstances would the nurse question the use of
acetaminophen?
A) Normal liver function tests
B) Low platelet levels
C) Relative hypothermia
D) Reduced pain levels
23. The nurse is caring for a critically ill patient with high levels of pain. To potentiate
pharmacological pain relief, the nurse uses several nonpharmacological interventions.
What nursing strategies will be helpful in this situation? Select all that apply.
A) Frequent turning and repositioning
B) Earphones with music of the patients choice
C) Limiting visits to twice a day
D) Using guided imagery and distraction
E) Teaching the quieting reflex
F) Using therapeutic touch
Answer Key
1. D, F
2. A
3. A
4. C
5. C

6. D
7. C, D
8. B
9. A
10. A
11. B
12. C
13. A
14. C
15. D
16. A
17. A
18. B
19. C
20. D
21. B
22. C
23. B, D, E, F

Chapter 6 Palliative Care and End-of-Life Issues in Critical Care
1. A nurse is working with a patient who is near death and experiencing delirium. Which of
the following would be an appropriate course of action for this nurse to take in caring for
this patient? Select all that apply.
A) Instruct the patient in pursed-lip breathing.
B) Provide oxygen support for the patient.
C) Arrange supportive psychotherapy.
D) Give the patient benzodiazepines.
E) Give the patient neuroleptics.
2. The husband of a terminally ill patient is upset at the sight of his wife continuing to linger
on the brink of death. He has heard of end-of-life sedation and wonders whether it would
be appropriate for his wife. Which of the following should the nurse mention as criteria for
use of end-of-life sedation? Select all that apply.
A) The patient is experiencing unbearable and unmanageable pain.
B) The patient is only hours or days away from death.
C) The patient has requested it.
D) It is standard procedure for patients with a terminal illness.
3. A patient in the ICU has entered a coma state, and someone must make a decision about
whether to continue life-supporting measures for the patient. No living will exists for this
patient. Who is the person legally authorized to make this decision?
A) The patients wife, who is the executor of his estate
B) The patients brother, who is his designated health care proxy
C) The patients physician, who has been managing his care from admittance
D) The patients nurse, who has been assigned to him on a daily basis
4. The mother of a patient has requested that she and the rest of the family be allowed to be
present in the patients room in the event that the patient requires resuscitation. The nurse,
however, is reluctant to comply with this. What is the most likely reason she does not want
the family in the room during resuscitation?
A) Family members who are present during resuscitations may experience more
anxiety.
B) Family members present during resuscitation are more likely to sue.
C) The nurse is new and is not comfortable with having the family present.
D) A dedicated staff person is required to attend to the family during resuscitation.
5. A teenage boy is near death in the ICU after being involved in a severe car accident. His
mother and stepfather are in his room visiting him now. His father and stepmother have
arrived in the waiting room and are asking to see the patient. A few days ago, the nurse
observed the boys father and mother arguing loudly in the patients room. She has also

observed that the boys muscles tighten and his breathing and heart rate increase when his
father is near his bed. Which of the following would be the best action for the nurse to
take?
A) Ask the father and stepmother to wait until the current visitors have left.
B) Ask the mother and stepfather to leave so that the father and stepmother can visit.
C) Allow the father and stepmother to go into the patients room but accompany them.
D) Tell the father and stepmother that they are not allowed to visit the patient.
6. A patient in the ICU has ovarian cancer that has metastasized to her stomach and other
organs. The physician believes the patient only has days to survive. Which of the following
would be a realistic goal for the care of the patient that the nurse could suggest to the
family?
A) Eliminate the cancer cells by starting the patient on chemotherapy.
B) Slow the rate of growth of the cancer by starting the patient on radiation therapy.
C) Keep the patient free of pain by increasing the patients pain medication.
D) Restore gastrointestinal function to the client via surgical intervention.
7. A 10-year-old girl has just died in the ICU. The nurse is now questioning the patients
physician to learn more details about the patients death to communicate to the family.
Which stage of notification is the nurse currently in?
A) Preparation
B) Inform
C) Support
D) Afterwards
8. The family of a patient who is near death makes the difficult decision to allow the
physician to administer a pain-relieving drug to the patient with the intention of making
the patient more comfortable, despite the fact that the drug may increase the risk for
complications that could lead to the patients death. The principle involved in the familys
decision is known as which of the following?
A) Principle of moral distress
B) Principle of palliative care
C) Principle of unintended consequences
D) Principle of double effect
9. Which of the following is the best example of moral distress?
A) A patients family has decided to end mechanical ventilation of the patient, but the
nurse has trouble implementing their decision.
B) A patients family has decided to continue mechanical ventilation for the patient, but
the nurse disagrees and discontinues the ventilation on her own initiative.
C) A patients family has decided to end mechanical ventilation of the patient, and the

nurse implements their decision but later feels guilty.
D) A patients family has decided to continue mechanical ventilation for the patient, and
the nurse implements their decision, although she disagrees with it.
10. A patient who is near the end of his life is to be extubated, according to the wishes of his
family. Which of the following would be the best action for the nurse to take to support
the patient?
A) Ask the family to leave the room during the extubation.
B) Hold a family conference to ask the family to reconsider their decision.
C) Administer opioids to the patient to reduce pain and discomfort.
D) Administer antibiotics to the patient to prevent infection.
11. The nurse is caring for a critically ill patient who is expected to die despite the best efforts of
the health care team. What aspect of a critical care unit may most interfere with effective
nursing care of this dying patient?
A) View of patient as disease or in terms of technology
B) Critical illness has a high expectation of death
C) Constant family presence at the bedside
D) Multidisciplinary management of patient
12. The nurse cares for critically ill patients in a busy trauma unit. The nurse manager has
instituted a program to incorporate principles of palliative care into the care of all patients in
the unit. What is the best reason for this inclusion?
A) Most of the patients in critical care will die, so palliative care will be necessary.
B) Primary palliative care focuses on relief of suffering and improvement of quality of
life.
C) This action has been mandated by the nurse manager and must be implemented.
D) Palliation is another way of managing pain control in critical care.
13. A patient has been admitted to critical care for management of exacerbation of a chronic
illness. During this admission, the patients condition deteriorates and death is deemed
imminent. A Do Not Resuscitate (DNR) order has been written and agreed to by the
family. Considering the principles of palliative care, what is the most appropriate nursing
action?
A) Transfer the patient to the step-down unit since DNR patients are not eligible for
critical care.
B) Encourage the family to reduce their visits so that they will not have to witness the
patients deterioration.
C) Assess the patient and family for specific spiritual needs at this phase of life and
death.

D) Discontinue all supportive care to hasten the inevitable death of the patient and
reduce costs.
14. The patient has severe pulmonary edema following an acute myocardial infarction and is
receiving intravenous diuretics to ease breathing. The nurse understands that this
intervention is considered to be what?
A) Definitive
B) Curative
C) Cause-and-effectbased
D) Palliative
15. The nurse is caring for a patient approaching the end of life. What symptom common at
the end of life would the nurse most expect?
A) Diminished pain
B) Hypotension
C) Tachycardia
D) Dyspnea
16. The nurse is caring for a critically ill patient who is dying and complaining of dyspnea
while receiving supplemental oxygen. What is the most effective nursing intervention to
alleviate the patients symptoms?
A) Increasing room temperature
B) Encouraging unlimited visits
C) Closing blinds and drapes
D) Providing a fan blowing on face
17. The nurse is caring for a patient who is dying. The patient has persistent full depression.
What is the most appropriate nursing action?
A) Understand that depression is normal at the end of life.
B) Facilitate use of antidepressant medications.
C) Encourage the patient to discuss life achievements.
D) Increase family visiting time and frequency.
18. A nurse is caring for a critically ill patient who has identified an unrelated friend as his
closest relative. What is the nurses most appropriate action in this situation?
A) Treat the friend as the patients family.
B) Do not allow the friend to visit as he is not family.

C) Adhere to the legal definition of next of kin.
D) Identify the next-closest-related family member.
19. The nurse is preparing for a family conference with the family of a critically ill patient.
What will best help the nurse to prepare?
A) Complete knowledge about the status of the patient
B) Knowing which members of the family will attend
C) Knowing the goal of the conference
D) Skill in therapeutic communication
20. The nurse had been caring for a critically ill patient for several days, and the patient has
just died. After completing end-of-life care of the patient and family, the nurse asks to
take a short break. What is the best response by the charge nurse?
A) Ask the nurse to wait to take a break until after she admits another patient.
B) Deny the nurse a break, as the unit is particularly busy and the nurse cannot be
spared.
C) Arrange for the nurse to have psychological counseling for inability to handle stress.
D) Ask another staff nurse to cover this nurses duties and allow her to take a break.
Answer Key
1. D, E
2. A, B
3. B
4. C
5. A
6. C
7. A
8. D
9. A
10. C
11. A
12. B

13. C
14. D
15. D
16. D
17. B
18. A
19. C
20. D

Chapter 7 Ethical Issues in Critical Care Nursing
1. The physician has just told a patient that he has stage 4 lung cancer and likely has only
months to live. After the physician leaves, the patient, who is visibly shaken, asks the nurse,
Couldnt the doctor be wrong? Is it really that bad? The nurse explains to him that, although
there is no way to know for certain how the disease will progress, the stage of his lung
cancer is the most serious. The nurse also indicates that the cancer has spread to other
organs in his body, meaning that the odds of recovery are not good. The patient then asks
that the nurse not tell his wife, who is in the waiting room, about the diagnosis just yet. Later
the patients wife enters the room and, seeing that he is asleep, asks the nurse if there is any
update on the patients condition. The nurse explains that the doctor talked to the patient
earlier and that the patient can provide details once he wakes up. Which ethical principle or
principles has the nurse exercised in this situation? Select all that apply.
A) Justice
B) Fidelity
C) Veracity
D) Nonmaleficence
2. Before administering a new medication to a patient, the nurse explains to her the adverse
effects she may experience as a result of the medication and asks whether the patient has
any questions about the medication. When the patient indicates that she understands the
risks involved, the nurse has her sign a document and proceeds with the treatment. The
nurses action is an example of which of the following?
A) Obtaining informed consent
B) Ensuring confidentiality
C) Observing the principle of nonmaleficence
D) Acting with fairness
3. A patient is at severe risk of forming life-threatening clots in his thoracic region following
surgery. The physician has prescribed an anticoagulant medication. The patient has had a
negative experience with anticoagulants in the past and refuses the medication. Which two
ethical principles are in conflict with each other in this situation?
A) Fidelity vs. justice
B) Maleficence vs. beneficence
C) Veracity vs. autonomy
D) Beneficence vs. autonomy
4. A patient in the ICU recently experienced a myocardial infarction that resulted in an
aneurysm of the ventricular wall. The patients cardiovascular surgeon has determined that
the aneurysm is irreparable. In this situation, an attempt to repair the rupture via
laparoscopic surgery would be considered which of the following?
A) Palliative
B) Curative

C) Medically futile
D) Beneficent
5. The family of a patient in a coma is struggling to decide whether to remove the patient
from a ventilator. What would be the most appropriate intervention?
A) Explain the statistical odds that the patient will regain consciousness.
B) Facilitate a care conference with the family.
C) Leave the family alone to make their decision.
D) Distribute copies of the American Nurses Association Code of Ethics to the family.
6. A patient complains of severe pain and requests an increase in dose of her pain medication.
Her husband, however, does not want the patients pain medication increased, as he is
worried about her becoming dependent on the medication. Which principle(s) from the
ANA Code of Ethics would be most appropriate for the nurse to apply in this situation?
Select all that apply.
A) The nurses primary commitment is to the patient.
B) The nurse collaborates with other health professionals and the public.
C) The nurse owes the same duties to self as to others.
D) The nurse promotes, advocates for, and strives to protect the health, safety, and
rights of the patient.
7. A nurse learns that a patient in the ICU who is scheduled to undergo a liver transplant has a
history of alcoholism. Which principle or principles from the ANA Code of Ethics
would be most appropriate for the nurse to apply while caring for this patient? Select all
that apply.
A) The nurse practices with compassion and respect unrestricted by considerations of
the nature of the health problem.
B) The nurses primary commitment is to the patient.
C) The nurse promotes, advocates for, and strives to protect the health, safety, and
rights of the patient.
D) The nurse participates in establishing, maintaining, and improving health care
environments.
8. A nurse works in an ICU in which she routinely sees physicians neglecting the care of
patients who do not have health insurance. She feels angry about the unfairness of this
situation but also powerless to do anything because she fears the loss of her job. Which of
the following best describes what the nurse is experiencing?
A) Medical futility
B) Nonmaleficence
C) Moral distress
D) Paternalism

9. An elderly patient who is about to have open-heart surgery has verbally instructed the
nurse that she does not want her life to be extended by a ventilator after the surgery. The
patients advance directive, however, indicates that she would prefer to receive all life-
support measures. The nurse suspects that the patient has dementia. Which of the
following questions would be most appropriate for the nurse to ask in the assessment
stage of ethical decision making?
A) What are the ethical issues related to continuing or removing life-support measures
for this patient?
B) Who should be involved in making the decision regarding life-support measures for
this patient?
C) Is this patient mentally competent to make decisions about use of life support?
D) What educational changes can be made in the ICU to resolve similar ethical
challenges related to life support measures in the future?
10. A patient who had provided an advance directive indicating that he should not be
resuscitated was allowed to die when his heart stopped beating shortly after his admission
to the ICU. The family of the patient has disputed the authenticity of the advance directive
and filed a complaint with the hospital. Which intervention would be most appropriate to
address this ethical dilemma?
A) Ethics rounds involving the medical staff involved in the patients care
B) Review by the hospitals institutional ethics committee
C) An individual patient ethics conference with the family
D) Review of the ANA Code of Ethics by the patients nurse
11. The nurse has learned about the application of ethical principles in nursing. How does this
knowledge facilitate the practice of nursing for the individual nurse?
A) It is mandated by accreditation agencies.
B) It is a component of bioethical theory.
C) It assists in defining good nursing care.
D) It assists in determining the legal basis of decisions.
12. The family wishes to continue all aspects of care for a terminally and critically ill patient in
the interests of justice and nonmaleficence. The health care team believes that further
sophisticated and technical interventions are futile and that the focus of care should be
shifted to provision of comfort, dignity, and palliative care. Neither the family nor the
health care team is willing to compromise any portion of their stances. The patient is
unresponsive. This situation is an example of what kind of problem?
A) Ethical dilemma
B) Recalcitrant family
C) Biotechnology effects
D) Paternalism
13. The nurse consistently applies guidelines for safe administration of medications during

patient care. This practice is an example of the application of what ethical principle?
A) Justice
B) Veracity
C) Beneficence
D) Paternalism
14. In determining which patient is to be transferred from the CCU to make room for a new
admission, the nurse considers the relative benefit of continued CCU care related to
eventual outcomes for each patient and compares them. The nurse does not consider
factors such as ethnicity or socioeconomic status. This situation is an example of
application of which ethical principle?
A) Paternalism
B) Veracity
C) Beneficence
D) Justice
15. The health care team is considering a change in the treatment plan for a critically ill
patient. As this change is considered, the dangers and possible outcomes for continuing
with the same plan of care as well as those for the proposed change are thoroughly
discussed. The beliefs and values of the patient and family are included. What is this
situation an example of?
A) Inability to make independent decisions
B) Positive leadership action by the nurse
C) Application of informed consent
D) Riskbenefit analysis
16. A patient is admitted to the CCU with active advance directives that include refusal of
enteral feeding by tubes. When the physician writes an order for the insertion of a feeding
tube, the nurse refuses to comply. This refusal is an example of adherence to what ethical
principle?
A) Nursing Practice Act
B) Patient Bill of Rights
C) Patient autonomy
D) Patient advocacy
17. While caring for a critically ill patient, the nurse identifies an ethical dilemma and seeks the
advice of the agencys Ethics Committee. This scenario is an example of what kind of
nursing action?
B) Behavior mandated by protocols
C) Appropriate use of resources

D) Fear of autonomous action
18. The family of a critically ill patient has said that the patient would not have wanted
prolonged life support. The patient has been ventilator-dependent for several weeks and is
not expected to improve. The physician states that, as the expert in health care, he knows
best, and the patient will remain on the ventilator. What behavior is the physician
exercising?
A) Routine medical care
B) Respect for autonomy
C) Expert paternalism
D) Biomedical ethics
19. In delivering patient care, the nurse bases a decision upon the ANA Code of Ethics for
Nurses. This is an example of what?
B) Behavior mandated by protocols
C) Appropriate use of resources
D) Fear of autonomous action
20. While caring for a critically ill patient, the nurse observes the family discussing funeral
arrangements across the bed of the patient, who is intubated and sedated but awake. The
family signs Do Not Resuscitate (DNR) request paperwork and leaves. The patient
manages to communicate to the nurse that he does not want to die. What is the most
appropriate nursing action?
A) Adhere to the wishes of the family, since the patient is probably incompetent.
B) Call a multidisciplinary conference with the family to resolve this conflict.
C) Destroy the Do Not Resuscitate paperwork, since the patient wants to live.
D) Apply the ethical principles of nonmaleficence and paternalism to the situation.
21. Before a surgical procedure, the patient signs a document called an informed consent.
What ethical principle is central to the use of informed consent?
A) Autonomy
B) Fidelity
C) Nonmaleficence
D) Beneficence
Answer Key
1. B, C
2. A
3. D

4. C
5. B
6. A, D
7. A, B, C
8. C
9. C
10. B
11. C
12. A
13. C
14. D
15. D
16. D
17. C
18. C
19. C
20. B
21. A

Chapter 8 Legal Issues in Critical Care Nursing
1. A patients physician writes a medication order to administer 20 mEq of potassium
chloride to a patient. The ICU nurse misreads the order as 200 mEq of potassium and
administers this amount of medication to the patient. As a result, the patient dies. This
situation is an example of which of the following?
A) A questionable medical order
B) Negligent supervision
C) Ordinary negligence
D) Gross negligence
2. A family member of a patient files a complaint against an ICU nurse, claiming that the nurse
improperly transferred the patient from a wheelchair to the hospital bed, resulting in a back
injury to the patient. Assuming that the nurses due process rights are observed, which of the
following actions would be most advisable for the nurse?
A) Plan to appeal to a court if the State Board of Nursing rules against her.
B) Sue the State Board of Nursing if her license is suspended before she is found guilty.
C) Acquire legal counsel and have him or her question the boards witnesses.
D) Continue nursing practice if her license is suspended, as such a suspension violates
her constitutional rights.
3. The ex-husband of a patient asks the ICU nurse a question about the medical history of
the patient. The nurse retrieves the patients file, opens it, and relates some of the patients
personal information to the ex-husband. When the ex-husband asks to see the patients file,
the nurse hands it to him, although he is not authorized by the patient to see this
information. What is the most accurate characterization of the nurses action?
A) A criminal act against the patient
B) A breaking of the rule of personal liability
C) A violation of the HIPAA Privacy Rule
D) A case of respondeat superior
4. A nurse is accused of professional negligence because she improperly operated a ventilator,
resulting in a patients death. The prosecution presents an expert witness to show that
operating such a ventilator is within the standard of care for a reasonable nurse. Which
aspect of negligence is the prosecution attempting to establish?
A) Duty
B) Breach of duty
C) Causation
D) Damages
5. A jury involved in a malpractice suit must decide how much to compensate a patient for
the emotional distress caused her by incomplete anesthesia during surgery. To which
element of malpractice is this decision related?

A) Duty
B) Breach of duty
C) Causation
D) Damages
6. A nurse is going to volunteer her nursing skills and time at a hospital other than the one in
which she is employed. Which of the following is true regarding potential liability related to
the nurses actions while volunteering? Select all that apply.
A) The nurse should carry her own malpractice insurance.
B) The hospital at which she is volunteering will protect her with its own professional
liability insurance.
C) The hospital at which she is employed will protect her with its professional liability
insurance even when she is working off the job.
D) There is no liability protection available for a nurse who is volunteering on her own
time.
E) The doctrine of respondeat superior does not apply in this situation.
F) The captain of the ship doctrine applies in this situation.
7. A nurse is charged with medical malpractice because she neglected to attend to a patient in
the ICU whose heart stopped and whose heart monitor alarm was clearly heard by the
nurse. The jury finds that the hospital was liable because of understaffing the ICU and that
the nurse was liable because she should have responded to the patient whose heart stopped,
regardless of the fact that she had been ordered by a physician to tend to another patient.
Which types of liability did the jury uphold? Select all that apply.
A) Captain of the ship doctrine
B) Rule of personal liability
C) Corporate liability
D) Criminal liability
8. A physician has written a medication order for a patient that includes penicillin. When the
nurse receives the order, she refuses to administer the medicine because she knows that the
patient is allergic to it. What is the most accurate way to describe this situation?
A) A questionable medication order
B) A medication error
C) A case of respondeat superior
D) A case of negligent supervision
9. A patient in the ICU dies as a result of a defective defibrillator. The nurse did not become
aware of the defect until after the patients death. Which of the following is true in this
situation?
A) Defibrillators are not currently regulated in the United States.

IF YOU WANT THIS TEST BANK OR
SOLUTION MANUAL EMAIL ME
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CHAPTERS IN PDF FORMAT
IF YOU WANT THIS TEST BANK OR
SOLUTION MANUAL EMAIL ME
kevinkariuki227@gmail.com TO RECEIVE ALL
CHAPTERS IN PDF FORMAT

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