Essentials of Critical Care Nursing Chapter
2 Complete Study Guide and 100% Verified
Answers
‣ While caring for a patient in the critical care unit, the nurse realizes
that the patient's care needs must be a balance between the patient's
long-term prognosis and the family's expectations of recovery. Which of
the AACN Synergy Model's characteristics does this situation describe?
1. Complexity
2. Predictability
3. Participation in care
4. Resource availability . Answer: Correct Answer: 1
Rationale 1: This situation describes the characteristic of complexity that
is the intricate entanglement of two or more systems; for example, a
patient's illness with complex family dynamics.
Rationale 2: This situation does not describe predictability.
Rationale 3: This situation does not describe participation in care.
Rationale 4: This situation does not described resource availability.
‣ The nurse realizes that which stressor is one of the primary concerns of
critically ill patients and should be routinely included during
assessments?
1. Inability to control elimination
2. Lack of family support
3. Hunger
,4. Altered ability to communicate . Answer: Correct Answer: 4
Rationale 1: The inability to control elimination is not identified as a
primary concern of critically ill patients.
Rationale 2: Lack of family support is not identified as a primary
concern of critically ill patients.
Rationale 3: Hunger is not identified as a primary concern of critically ill
patients.
Rationale 4: Altered ability to communicate is identified as a primary
concern of critically ill patients.
‣ A patient has just completed a preoperative education session prior to
undergoing coronary artery bypass surgery. Which patient statements
indicate that teaching has been effective?
Note: Credit will be given only if all correct choices and no incorrect
choices are selected.
Standard Text: Select all that apply.
1. "I understand that I will have to blink my eyes to respond after the
breathing tube is in my throat."
2. "I will be given frequent mouth care to help me when I am thirsty."
3. "I will be able to move about freely in bed and into the chair without
help while connected to the electronic equipment for monitoring."
4. "I may need something to help me rest due to the unfamiliar lights and
sounds of the ICU unit."
5. "I might not behave like my usual self after the surgery but it will be
because of the medications and my illness." . Answer: Correct Answer:
1,2,4,5
, Rationale 1: An alternate method of communication discussed in
advance of tube placement will assist in better communication after the
tube is inserted to aid the breathing process.
Rationale 2: While intubated, oral hygiene is needed to prevent mucosal
drying due to the inability of the patient to take oral fluids.
Rationale 3: This statement indicates that additional teaching is required
because the patient will not be able to move freely in bed and into a
chair without assistance while being electronically monitored.
Rationale 4: Due to environmental lights, sounds, and difference in
sleeping environment, additional aids, such as drug management, may
be needed to assist the patient to rest at night.
Rationale 5: A patient concern in the critical care area is the inability to
control self. This statement indicates the patient's understanding of the
teaching.
‣ When providing care to critically ill patients, whether they are
responsive or unresponsive, the nurse should:
1. Clearly explain what care is to be done before starting the activity.
2. Perform the activity and then let the patient rest without explaining
the care.
3. Make sure the patient always responds and is cooperative before
giving care.
4. Explain to the family that the patient will not understand or remember
any of the discomfort associated with care. . Answer: Correct Answer: 1
Rationale 1: By explaining to both the responsive and unresponsive
patient, the nurse provides orientation, reassurance, respect, and
assessment of the patient's mental status. Seeking permission and
apologizing if discomfort is involved will also minimize the stress of the
2 Complete Study Guide and 100% Verified
Answers
‣ While caring for a patient in the critical care unit, the nurse realizes
that the patient's care needs must be a balance between the patient's
long-term prognosis and the family's expectations of recovery. Which of
the AACN Synergy Model's characteristics does this situation describe?
1. Complexity
2. Predictability
3. Participation in care
4. Resource availability . Answer: Correct Answer: 1
Rationale 1: This situation describes the characteristic of complexity that
is the intricate entanglement of two or more systems; for example, a
patient's illness with complex family dynamics.
Rationale 2: This situation does not describe predictability.
Rationale 3: This situation does not describe participation in care.
Rationale 4: This situation does not described resource availability.
‣ The nurse realizes that which stressor is one of the primary concerns of
critically ill patients and should be routinely included during
assessments?
1. Inability to control elimination
2. Lack of family support
3. Hunger
,4. Altered ability to communicate . Answer: Correct Answer: 4
Rationale 1: The inability to control elimination is not identified as a
primary concern of critically ill patients.
Rationale 2: Lack of family support is not identified as a primary
concern of critically ill patients.
Rationale 3: Hunger is not identified as a primary concern of critically ill
patients.
Rationale 4: Altered ability to communicate is identified as a primary
concern of critically ill patients.
‣ A patient has just completed a preoperative education session prior to
undergoing coronary artery bypass surgery. Which patient statements
indicate that teaching has been effective?
Note: Credit will be given only if all correct choices and no incorrect
choices are selected.
Standard Text: Select all that apply.
1. "I understand that I will have to blink my eyes to respond after the
breathing tube is in my throat."
2. "I will be given frequent mouth care to help me when I am thirsty."
3. "I will be able to move about freely in bed and into the chair without
help while connected to the electronic equipment for monitoring."
4. "I may need something to help me rest due to the unfamiliar lights and
sounds of the ICU unit."
5. "I might not behave like my usual self after the surgery but it will be
because of the medications and my illness." . Answer: Correct Answer:
1,2,4,5
, Rationale 1: An alternate method of communication discussed in
advance of tube placement will assist in better communication after the
tube is inserted to aid the breathing process.
Rationale 2: While intubated, oral hygiene is needed to prevent mucosal
drying due to the inability of the patient to take oral fluids.
Rationale 3: This statement indicates that additional teaching is required
because the patient will not be able to move freely in bed and into a
chair without assistance while being electronically monitored.
Rationale 4: Due to environmental lights, sounds, and difference in
sleeping environment, additional aids, such as drug management, may
be needed to assist the patient to rest at night.
Rationale 5: A patient concern in the critical care area is the inability to
control self. This statement indicates the patient's understanding of the
teaching.
‣ When providing care to critically ill patients, whether they are
responsive or unresponsive, the nurse should:
1. Clearly explain what care is to be done before starting the activity.
2. Perform the activity and then let the patient rest without explaining
the care.
3. Make sure the patient always responds and is cooperative before
giving care.
4. Explain to the family that the patient will not understand or remember
any of the discomfort associated with care. . Answer: Correct Answer: 1
Rationale 1: By explaining to both the responsive and unresponsive
patient, the nurse provides orientation, reassurance, respect, and
assessment of the patient's mental status. Seeking permission and
apologizing if discomfort is involved will also minimize the stress of the
