Chapter 01: Caring for the Critically Ill Patient
Urden: Priorities in Critical Care Nursing, 8th Edition

MULTIPLE CHOICE

	1.	What type of practitioner has a broad depth of specialty knowledge and expertise and manages complex clinical and system issues?
a.	Registered nurses	
b.	Advanced practice nurses	
c.	Clinical nurse leaders	
d.	Intensivists	

ANS:	B
Advanced practice nurses (APNs) have a broad depth of knowledge and expertise in their specialty area and manage complex clinical and systems issues. Intensivists are medical practitioners who manage the critical ill patient. Registered nurses (RNs) are generally direct care providers. Clinical nurse leaders (CNLs) generally do not manage system issues.

PTS:	1	DIF:	Cognitive Level: Remembering	OBJ:	Nursing Process Step: N/A
TOP:	Caring for the Critically Ill Patient	
MSC:	NCLEX: Safe and Effective Care Environment: Coordinated Care	

	2.	What type of practitioner is instrumental in ensuring care that is evidence based and that safety programs are in place?
a.	Clinical nurse specialist	
b.	Advanced practice nurse	
c.	Registered nurses	
d.	Nurse practitioners	

ANS:	A
Clinical nurse specialists (CNSs) serve in specialty roles that use their clinical, teaching, research, leadership, and consultative abilities. They are instrumental in ensuring that care is evidence based and that safety programs are in place. Advanced practice nurses (APNs) have a broad depth of knowledge and expertise in their specialty area and manage complex clinical and systems issues. Registered nurses are generally direct care providers. Nurse practitioners (NPs) manage direct clinical care of groups of patients.

PTS:	1	DIF:	Cognitive Level: Remembering	OBJ:	Nursing Process Step: N/A
TOP:	Caring for the Critically Ill Patient	
MSC:	NCLEX: Safe and Effective Care Environment: Coordinated Care	

	3.	Which professional organization administers critical care certification exams for registered nurses?
a.	State Board of Registered Nurses	
b.	National Association of Clinical Nurse Specialist	
c.	Society of Critical Care Medicine	
d.	American Association of Critical-Care Nurses	

ANS:	D
American Association of Critical-Care Nurses (AACN) administers certification exams for registered nurses. The State Board of Registered Nurses (SBON) does not administer certification exams. National Association of Clinical Nurse Specialists (NACNS) does not administer certification exams. Society of Critical Care Medicine (SCCM) does not administer nursing certification exams for registered nurses.

PTS:	1	DIF:	Cognitive Level: Remembering	OBJ:	Nursing Process Step: N/A
TOP:	Caring for the Critically Ill Patient	
MSC:	NCLEX: Safe and Effective Care Environment: Coordinated Care	

	4.	The American Association of Critical-Care Nurses (AACN) has developed short directives that can be used as quick references for clinical use that are known as:
a.	critical care protocol.	
b.	practice policies.	
c.	evidence-based research.	
d.	practice alerts.	

ANS:	D
The American Association of Critical-Care Nurses (AACN) has promulgated several evidence-based practice summaries in the form of “practice alerts.” Evidence-based nursing practice considers the best research evidence on the care topic along with clinical expertise of the nurse and patient preferences. Critical care protocol and practice policies are established by individual institutions.

PTS:	1	DIF:	Cognitive Level: Remembering	
OBJ:	Nursing Process Step: Planning	TOP:	Caring for the Critically Ill Patient
MSC:	NCLEX: Safe and Effective Care Environment: Coordinated Care	

	5.	What type of therapy is an option to conventional treatment?
a.	Alternative	
b.	Holistic	
c.	Complementary	
d.	Individualized	

ANS:	A
The term alternative denotes that a specific therapy is an option or alternative to what is considered conventional treatment of a condition or state. The term complementary was proposed to describe therapies that can be used to complement or support conventional treatments. Holistic care focuses on human integrity and stresses that the body, mind, and spirit are interdependent and inseparable. Individualized care recognizes the uniqueness of each patient’s preferences, condition, and physiologic and psychosocial status.

PTS:	1	DIF:	Cognitive Level: Remembering	
OBJ:	Nursing Process Step: Implementation		
TOP:	Caring for the Critically Ill Patient	
MSC:	NCLEX: Physiological Integrity: Basic Care and Comfort		

	6.	Guided imagery and massage are both examples of what type of treatment?
a.	Alternative therapy	
b.	Holistic care	
c.	Complementary care	
d.	Individualized care	

ANS:	C
The term complementary was proposed to describe therapies that can be used to complement or support conventional treatments. Guided imagery, massage, and animal-assisted therapy are all examples of complementary care. The term alternative denotes that a specific therapy is an option or alternative to what is considered conventional treatment of a condition or state. Holistic care focuses on human integrity and stresses that the body, mind, and spirit are interdependent and inseparable. Individualized care recognizes the uniqueness of each patient’s preferences, condition, and physiologic and psychosocial status.

PTS:	1	DIF:	Cognitive Level: Understanding	
OBJ:	Nursing Process Step: Implementation		
TOP:	Caring for the Critically Ill Patient	
MSC:	NCLEX: Physiological Integrity: Basic Care and Comfort		

	7.	A patient was admitted to a rural critical care unit in Montana. Critical care nurses are assisting with monitoring and care of the patient from the closest major city. What is this type of practice termed?
a.	Tele-nursing	
b.	Tele-ICU	
c.	Tele-informatics	
d.	Tele-hospital	

ANS:	B
Tele-ICU is a form of telemedicine. Telemedicine was initially used in outpatient areas, remote rural geographic locations, and areas where there was a dearth of medical providers. Currently, there are tele-ICUs in areas where there are limited resources on-site. However, experts (critical care nurses, intensivists) are located in a central distant site.

PTS:	1	DIF:	Cognitive Level: Understanding	
OBJ:	Nursing Process Step: Evaluation	TOP:	Caring for the Critically Ill Patient
MSC:	NCLEX: Physiological Integrity: Reduction of Risk Potential	

	8.	Which core competency for interprofessional practice can be described as working with individuals of other professions to maintain a climate of mutual respect and shared values?
a.	Interprofessional teamwork and team-based care	
b.	Values and ethics for interprofessional practice	
c.	Interprofessional communication	
d.	Roles and responsibilities for collaborative practice	

ANS:	B
Values and ethics for interprofessional practice mean working with individuals of other professions to maintain a climate of mutual respect and shared values. Roles and responsibilities for collaborative practice include using knowledge of one’s own role and the roles of other professions to appropriately assess and address the health care needs of the patients and populations served. Interprofessional communication includes communicating with patients, families, communities, and other health professionals in a responsive and responsible manner that supports a team approach to maintaining health and treatment of disease. Interprofessional teamwork and team-based care means applying relationship-building values and principles of team dynamics to perform effectively in different team roles to plan and deliver patient population-centered care that is safe, timely, efficient, effective, and equitable.

PTS:	1	DIF:	Cognitive Level: Remembering	OBJ:	Nursing Process Step: N/A
TOP:	Caring for the Critically Ill Patient	
MSC:	NCLEX: Safe and Effective Care Environment: Coordinated Care	

	9.	Which nursing intervention continues to be one of the most error-prone for critical care nurses?
a.	Inappropriate care	
b.	Intimidating and disruptive clinician behavior	
c.	Injury to patients by falls	
d.	Medication administration	

ANS:	D
Medication administration continues to be one of the most error-prone nursing interventions for critical care nurses. Intimidating and disruptive clinician behaviors can lead to errors and preventable adverse patient outcomes. Patient safety has been described as an ethical imperative and one that is inherent in health care professionals’ actions and interpersonal processes; examples include inappropriate care and injury to patients by falls.

PTS:	1	DIF:	Cognitive Level: Understanding	
OBJ:	Nursing Process Step: Implementation		
TOP:	Caring for the Critically Ill Patient	
MSC:	NCLEX: Safe and Effective Care Environment: Safety and Infection Control

	10.	A practitioner and nurse are performing a dressing change on an unresponsive patient in room 14. The practitioner asks the nurse for an update on the patient in room 13. Which action should the nurse take next?
a.	Give the update to the practitioner.	
b.	Refuse to give the update because of Health Insurance Portability and Accountability Act (HIPAA) requirements.	
c.	Give the update because the patient is unconscious.	
d.	Refuse to give the update because of Occupational Safety and Health Administration (OSHA) requirements.	

ANS:	B
Most specific to critical care clinicians is the privacy and confidentiality related to protection of health care data. This has implications when interacting with family members and others and the often very close work environments, tight working spaces, and emergency situations. A patient’s unconscious state is not a reason for another patient’s care to be discussed in his or her presence. Research shows hearing is the last sense to deteriorate. Occupational Safety and Health Administration (OSHA) has to do with safety in the workplace, not privacy and confidentiality.

PTS:	1	DIF:	Cognitive Level: Applying	
OBJ:	Nursing Process Step: Implementation		
TOP:	Caring for the Critically Ill Patient	
MSC:	NCLEX: Safe and Effective Care Environment: Coordinated Care	

	11.	Which units can provide high-quality and cost-effective care for patients who are less complex, more stable, and have a decreased need for physiologic monitoring?
a.	Intensive care units	
b.	Triage units	
c.	Progressive care units	
d.	Medical surgical units	

ANS:	C
A growing trend in acute care settings is the designation of progressive care units, considered to be part of the continuum of critical care. These units can serve as a bridge between intensive care units and medical-surgical units, while providing high-quality and cost-effective care at the same time. Patients who are ideal candidates for progressive care are less complex, more stable, have a decreased need for physiologic monitoring, and more self-care capabilities.

PTS:	1	DIF:	Cognitive Level: Understanding	OBJ:	Nursing Process Step: N/A
TOP:	Caring for the Critically Ill Patient	
MSC:	NCLEX: Safe and Effective Care Environment: Coordinated Care	

MULTIPLE RESPONSE

	1.	What considerations are taken into account in evidence-based nursing practice? (Select all that apply.)
a.	Clinical expertise of the nurse	
b.	Availability of staff and facility equipment	
c.	Research evidence on the topic	
d.	Patient knowledge of the disease	
e.	Patient preference regarding care	

ANS:	A, C, E
Evidence-based nursing practice considers the best research evidence on the care topic along with clinical expertise of the nurse and patient preferences. For instance, when determining the frequency of vital sign measurement, the nurse would use available research and nursing judgment (stability, complexity, predictability, vulnerability, and resilience of the patient). Availability of staff and facility equipment and the patient’s knowledge of the disease do not factor into evidence-based nursing practices.

PTS:	1	DIF:	Cognitive Level: Remembering	
OBJ:	Nursing Process Step: Planning	TOP:	Caring for the Critically Ill Patient
MSC:	NCLEX: Safe and Effective Care Environment: Coordinated Care	

	2.	The concept of diversity encompasses what thoughts and actions? (Select all that apply.)
a.	Sensitivity to ethnic differences	
b.	Openness to different lifestyles	
c.	Openness to different values	
d.	Reticence to different beliefs	
e.	Lack of concern regarding different opinions	

ANS:	A, B, C
Diversity includes not only ethnic sensitivity but also sensitivity to openness to difference lifestyles, opinions, values, and beliefs. Reticence and lack of concern are not part of the concept of diversity.

PTS:	1	DIF:	Cognitive Level: Evaluating	OBJ:	Nursing Process Step: N/A
TOP:	Caring for the Critically Ill Patient	
MSC:	NCLEX: Safe and Effective Care Environment: Coordinated Care	

	3.	According to Kupperschmidt, what factors are needed to become a skilled communicator? (Select all that apply.)
a.	Becoming candid	
b.	Becoming reflective	
c.	Setting goals	
d.	Surveying the team	
e.	Becoming aware of self-deception	

ANS:	A, B, E
Kupperschmidt and colleagues posed a five-factor model for becoming a skilled communicator: becoming aware of self-deception, becoming authentic, becoming candid, becoming mindful, and becoming reflective, all of which lead to being a skilled communicator.

PTS:	1	DIF:	Cognitive Level: Evaluating	OBJ:	Nursing Process Step: N/A
TOP:	Caring for the Critically Ill Patient	
MSC:	NCLEX: Safe and Effective Care Environment: Coordinated Care