HIGH ACUITY EXAM 1: MODULE 1 QUESTIONS AND CORRECT
ANSWERS
1. Stressors in
• Wires, tubes, machines
the Critical
• Eflcient and expeditious life-sustaining interventions
Care Envi-
• Increased stress and anxiety due to no-notice or short-notice admit
ronment
• Sensory stimulation
• Loss of privacy
• Sensory overload, noise, sensory deprivation
• Lack of physical contact (other than clinical)
• Legal documents preserving pt's right to determine their care by
2. Advance
permitting pt to make decisions about healthcare ahead of time in case
Direc- tives
pt unable to make decisions later.
• May be d/t illness, age, trauma, or court determination.
• If pt deemed incompetent, nurse must ID pt's surrogate
decision maker and contact surrogate to make healthcare decisions
on pt's behalf.
3. Living Will • Written directive from a competent pt to family and healthcare team
members concerning pt's wishes in the event they're unable to express
wishes in the future.
• Only applies to limited situations that it describes. Become ettective only
if pt both terminally ill or permanently comatose and incompetent to
communicate wishes
4. Durable Power • Legal document allowing pt to appoint surrogate decision maker
of Attorney while they're still competent.
(POA) • Surrogate, known as healthcare agent or proxy, allows pt to ID
trusted friend or relative who can make tx and health care decisions in
case they can't.
• Ex: Son being POA for mother who has severe dementia and
cannot make decisions for herself
5. DNR Orders • Decision to resuscitate pt is decision made with physician, pt, and family.
1/
18
,HIGH ACUITY EXAM 1: MODULE 1 QUESTIONS AND CORRECT
ANSWERS
Consent of competent pt or pt surrogate required when DNR decision
made and order is written.
• Once DNR decision made, order written, signed, and dated by
physician.
• If oflcial DNR order not present and pt codes, pt considered full code.
2/
18
, HIGH ACUITY EXAM 1: MODULE 1 QUESTIONS AND CORRECT
ANSWERS
6. Right to • Some courts unwilling to rule against religious-based decisions of
Refuse a pt to refuse tx but most likely will if welfare of dependent child is at stake.
Treatment • Exceptions to informed consent requirements include emergency
situations and pt waiving right to informed consent by stating they
don't want info about tx.
7. Withdrawal • HCPs have become more comfy recommending rejection or
of termination of tx but often met w/ resistance by pt family
Treatment • Distinction made btwn termination of tx and termination of care.
Ending tx is not the same as giving up. Pts who aren't being "treated"
still need competent and sensitive nursing and medical care.
• Palliative care provides pain relief and symptom management and
better QOL for those nearing EOL
8. Brain Death • Dittering legal definitions of death. Ultimately, the physician (or
sometimes the NP) is the one who calls the death.
• Symptoms of death include absence of pulse, RR, heartbeat, and BP;
pupils fixed and dilated; incontinence of stool and urine; waxen color;
decreased body temp; lack of brain stem reflexes; and flat EEG.
• Pt who is brain dead is legally dead w/ no legal duty to continue tx
them. Not necessary to obtain court approval to discontinue life
support.
• Before terminating life support, determine if pt is organ donor or not.
9. Organ Donation • Every state has the opportunity to make decision and be an organ
donor.
Designated spot on driver's license.
• Many states recently enacted "required request" laws. Attempt to
increase supply of organs for transplantation by requiring hospital
personnel to ask pt's families about organ gift at time of pt's death.
10. Oklahoma Hierarchy
Surro- gacy
3/
18
ANSWERS
1. Stressors in
• Wires, tubes, machines
the Critical
• Eflcient and expeditious life-sustaining interventions
Care Envi-
• Increased stress and anxiety due to no-notice or short-notice admit
ronment
• Sensory stimulation
• Loss of privacy
• Sensory overload, noise, sensory deprivation
• Lack of physical contact (other than clinical)
• Legal documents preserving pt's right to determine their care by
2. Advance
permitting pt to make decisions about healthcare ahead of time in case
Direc- tives
pt unable to make decisions later.
• May be d/t illness, age, trauma, or court determination.
• If pt deemed incompetent, nurse must ID pt's surrogate
decision maker and contact surrogate to make healthcare decisions
on pt's behalf.
3. Living Will • Written directive from a competent pt to family and healthcare team
members concerning pt's wishes in the event they're unable to express
wishes in the future.
• Only applies to limited situations that it describes. Become ettective only
if pt both terminally ill or permanently comatose and incompetent to
communicate wishes
4. Durable Power • Legal document allowing pt to appoint surrogate decision maker
of Attorney while they're still competent.
(POA) • Surrogate, known as healthcare agent or proxy, allows pt to ID
trusted friend or relative who can make tx and health care decisions in
case they can't.
• Ex: Son being POA for mother who has severe dementia and
cannot make decisions for herself
5. DNR Orders • Decision to resuscitate pt is decision made with physician, pt, and family.
1/
18
,HIGH ACUITY EXAM 1: MODULE 1 QUESTIONS AND CORRECT
ANSWERS
Consent of competent pt or pt surrogate required when DNR decision
made and order is written.
• Once DNR decision made, order written, signed, and dated by
physician.
• If oflcial DNR order not present and pt codes, pt considered full code.
2/
18
, HIGH ACUITY EXAM 1: MODULE 1 QUESTIONS AND CORRECT
ANSWERS
6. Right to • Some courts unwilling to rule against religious-based decisions of
Refuse a pt to refuse tx but most likely will if welfare of dependent child is at stake.
Treatment • Exceptions to informed consent requirements include emergency
situations and pt waiving right to informed consent by stating they
don't want info about tx.
7. Withdrawal • HCPs have become more comfy recommending rejection or
of termination of tx but often met w/ resistance by pt family
Treatment • Distinction made btwn termination of tx and termination of care.
Ending tx is not the same as giving up. Pts who aren't being "treated"
still need competent and sensitive nursing and medical care.
• Palliative care provides pain relief and symptom management and
better QOL for those nearing EOL
8. Brain Death • Dittering legal definitions of death. Ultimately, the physician (or
sometimes the NP) is the one who calls the death.
• Symptoms of death include absence of pulse, RR, heartbeat, and BP;
pupils fixed and dilated; incontinence of stool and urine; waxen color;
decreased body temp; lack of brain stem reflexes; and flat EEG.
• Pt who is brain dead is legally dead w/ no legal duty to continue tx
them. Not necessary to obtain court approval to discontinue life
support.
• Before terminating life support, determine if pt is organ donor or not.
9. Organ Donation • Every state has the opportunity to make decision and be an organ
donor.
Designated spot on driver's license.
• Many states recently enacted "required request" laws. Attempt to
increase supply of organs for transplantation by requiring hospital
personnel to ask pt's families about organ gift at time of pt's death.
10. Oklahoma Hierarchy
Surro- gacy
3/
18
