COMPLEX MED-SURG 1 VALUATION
EXAM WITH ALL ANSWERS
Standards vserve vas v__________ vfor vclinical vpractice. vThey v_________ v_____ vfor
vpatient vcare vand vprovide vmechanisms vfor vnurses vto v_____ vthe vachievement vof vpatient
vgoals v- vcorrect vanswer-guidelines; vestablish vgoals; vassess
The v_________ vof vpatients' villness vmakes vtheir vcare vthe vtop vpriority vof vcritical vcare
vnurses. v- vcorrect vanswer-acuteness
What vare vtwo vissues vthat vcritical vcare vnurses vface vbecause vof vthe vfast-paced
venvironment, vcritical vnature vof villness, vand vissues vsurrounding vlife vand vdeath vpatients?
v- vcorrect vanswer-Compassion vfatigue vand vMoral vdistress
3 vinitiatives vthat vfocus von vthe vquality vand vsafety vof vpatient vcare v(preventing verrors vand
vharm) v- vcorrect vanswer--Joint vCommission vNational vPatient vSafety vGoals
-Institute vfor vHealthcare vImprovement
-Quality vand vSafety vEducation vfor vNurses v(QSEN)
What vhas vthe vJoint vCommission videntified vas vnecessary vto vbe vaddressed vin vhospitals,
vlong-term vcare vfacilities, vand vother vagencies vthat vit vaccredits? v- vcorrect vanswer-
National vPatient vSafety vGoals
How vcan vcritical villnesses vand vthe vcritical vcare venvironment vaffect vthe vpatient's vfamily?
v- vcorrect vanswer-It vcan vcause vthe vfeelings vof:
-uncertainty
-loss vof vcontrol
-stress
-anxiety
,What vare vthe vbasic vpatient vfamily vneeds vin vthe vcritical vcare venvironment? v- vcorrect
vanswer-•Receiving vassurance
•Remaining vnear vthe vpatient
•Receiving vinformation
•Being vcomfortable
•Having vsupport vavailable
what vare vsome vnursing vinterventions vthat vcan vbe vimplemented vto vmeet vfamily vneeds
vand vreduce vfamily vmembers' vanxiety vand vstress? v- vcorrect vanswer-•Facilitate vvisitation
•Provide vinformation
•Encourage vfamily vinvolvement vin vpatient vcare
•Consider vfamily vpresence vduring vprocedures
(Open vvisitation vis vone vessential vintervention, vyet vit vis vcontroversial.)
What vaspects vof vthe vcritical vcare venvironment vcontribute vto vsensory voverload? v- vcorrect
vanswer-•Light.
•Noise v(PRIMARY).
•Loss vof vprivacy: v(Multiple vcaregivers, vMultiple vpeople vin vand vout vof vunit vand vroom).
•Acutely vchanging vmental vstatus
•Key vword: vinattention
•Types:
-Hyperactive—agitated, vcombative, vdisoriented
-Hypoactive—quiet vdelirium
-Mixed—fluctuating vbetween vthe vtwo
•Associated vwith vincreased vmortality vand vmorbidity v- vcorrect vanswer-Delirium
Risk vfactors vfor vdelirium v- vcorrect vanswer-•Older vthan v70 vyears
•Transfer vfrom va vnursing vhome
•History vof vdepression, vdementia, vstroke
•Alcohol vor vsubstance vabuse
•Electrolyte vimbalance
•Hypothermia vor vfever
•Renal vFailure
•Liver vdisease
•Cardiogenic vor vseptic vshock
•Human vImmunodeficiency vVirus v(HIV) vInfection
•Rectal vor vbladder vcatheters
•Tube vfeedings
•Central vVenous vCatheters
•Malnutrition
•Presence vof vphysical vrestraints
•Visual vor vhearing vimpairment
types vof vassessments, vgoals, vand vdrug vof vchoice vfor vdelirium v- vcorrect vanswer-
•Assessment
-Confusion vAssessment vMethod vfor vthe vICU v(CAM-ICU)
-Intensive vCare vDelirium vScreening vChecklist v(ICDSC)
•Goal—keep vthe vpatient vsafe
, •Drug vof vchoice—haloperidol
ABCDEF vBundle vfor vPreventing vDelirium v(" v* v"= vimportant) v- vcorrect vanswer-
•Awakening
•Breathing vCoordination***
•Choice vof vSedation****
•Delirium vmonitoring
•Early vmobility vand vexercise*****
•Family vengagement van vempowerment
The vnature vof vcritical villness vresults vin va vgreater vfrequency vof v________ v______. v-
vcorrect vanswer-ethical vissues
What vare vsome vethical vissue vthat vcritical vcare vnurses vconfront vin veveryday vpractice? v-
vcorrect vanswer--Informed vconsent vand vconfidentiality
-Withholding vor vwithdrawal vof vtreatment
•Know vwishes: vLiving vWill, vAdvanced vDirectives, vCode vStatus
-Organ vand vtissue vtransplantation
-Distribution vof vhealthcare vresources
-Appropriate vuse vof vtechnology
what vis vnurse vadvocacy? v- vcorrect vanswer-•Obligation vto vprotect vpatients
-Serve vas vpatient vadvocates
Several vsigns valert vthe vnurse vto vthe vpotential vemergence vof vethical vissues. vWhat vare
vsome vethical vdilemma vwarning vsigns? v- vcorrect vanswer-•Emotionally vcharged
•Significant vchange vin vpatient's vcondition
•Confusion vabout vfacts
•Hesitancy vabout vwhat vis vright
•Deviation vfrom vcustomary vpractice
•Need vfor vsecrecy vregarding vproposed vactions
The vnurse vrecognizes vwhich vstatement vas va vpotential vethical vissue?
A."The vphysician vexplained vmy vmother's vpoor vprognosis."
B."If vthe vbreathing vmachine vis vhelping vmy vmother, vwhy vis vthe vdoctor vasking vme
vabout vremoving vthe vbreathing vtube?"
C."My vmother vhas vdesignated vmy vbrother vto vmake vdecisions."
D."Can vI vassist vwith vsome vof vmy vmother's vcare?" v- vcorrect vanswer-B."If vthe vbreathing
vmachine vis vhelping vmy vmother, vwhy vis vthe vdoctor vasking vme vabout vremoving vthe
vbreathing vtube?"
**Rationale: vThis vanswer vindicates vsome vconfusion vand vhesitancy vabout vcare, vand va
vpossible vdeviation vfrom vnorms.
Autonomy v- vcorrect vanswer--Right vof vself-determination vconcerning vmedical vcare
EXAM WITH ALL ANSWERS
Standards vserve vas v__________ vfor vclinical vpractice. vThey v_________ v_____ vfor
vpatient vcare vand vprovide vmechanisms vfor vnurses vto v_____ vthe vachievement vof vpatient
vgoals v- vcorrect vanswer-guidelines; vestablish vgoals; vassess
The v_________ vof vpatients' villness vmakes vtheir vcare vthe vtop vpriority vof vcritical vcare
vnurses. v- vcorrect vanswer-acuteness
What vare vtwo vissues vthat vcritical vcare vnurses vface vbecause vof vthe vfast-paced
venvironment, vcritical vnature vof villness, vand vissues vsurrounding vlife vand vdeath vpatients?
v- vcorrect vanswer-Compassion vfatigue vand vMoral vdistress
3 vinitiatives vthat vfocus von vthe vquality vand vsafety vof vpatient vcare v(preventing verrors vand
vharm) v- vcorrect vanswer--Joint vCommission vNational vPatient vSafety vGoals
-Institute vfor vHealthcare vImprovement
-Quality vand vSafety vEducation vfor vNurses v(QSEN)
What vhas vthe vJoint vCommission videntified vas vnecessary vto vbe vaddressed vin vhospitals,
vlong-term vcare vfacilities, vand vother vagencies vthat vit vaccredits? v- vcorrect vanswer-
National vPatient vSafety vGoals
How vcan vcritical villnesses vand vthe vcritical vcare venvironment vaffect vthe vpatient's vfamily?
v- vcorrect vanswer-It vcan vcause vthe vfeelings vof:
-uncertainty
-loss vof vcontrol
-stress
-anxiety
,What vare vthe vbasic vpatient vfamily vneeds vin vthe vcritical vcare venvironment? v- vcorrect
vanswer-•Receiving vassurance
•Remaining vnear vthe vpatient
•Receiving vinformation
•Being vcomfortable
•Having vsupport vavailable
what vare vsome vnursing vinterventions vthat vcan vbe vimplemented vto vmeet vfamily vneeds
vand vreduce vfamily vmembers' vanxiety vand vstress? v- vcorrect vanswer-•Facilitate vvisitation
•Provide vinformation
•Encourage vfamily vinvolvement vin vpatient vcare
•Consider vfamily vpresence vduring vprocedures
(Open vvisitation vis vone vessential vintervention, vyet vit vis vcontroversial.)
What vaspects vof vthe vcritical vcare venvironment vcontribute vto vsensory voverload? v- vcorrect
vanswer-•Light.
•Noise v(PRIMARY).
•Loss vof vprivacy: v(Multiple vcaregivers, vMultiple vpeople vin vand vout vof vunit vand vroom).
•Acutely vchanging vmental vstatus
•Key vword: vinattention
•Types:
-Hyperactive—agitated, vcombative, vdisoriented
-Hypoactive—quiet vdelirium
-Mixed—fluctuating vbetween vthe vtwo
•Associated vwith vincreased vmortality vand vmorbidity v- vcorrect vanswer-Delirium
Risk vfactors vfor vdelirium v- vcorrect vanswer-•Older vthan v70 vyears
•Transfer vfrom va vnursing vhome
•History vof vdepression, vdementia, vstroke
•Alcohol vor vsubstance vabuse
•Electrolyte vimbalance
•Hypothermia vor vfever
•Renal vFailure
•Liver vdisease
•Cardiogenic vor vseptic vshock
•Human vImmunodeficiency vVirus v(HIV) vInfection
•Rectal vor vbladder vcatheters
•Tube vfeedings
•Central vVenous vCatheters
•Malnutrition
•Presence vof vphysical vrestraints
•Visual vor vhearing vimpairment
types vof vassessments, vgoals, vand vdrug vof vchoice vfor vdelirium v- vcorrect vanswer-
•Assessment
-Confusion vAssessment vMethod vfor vthe vICU v(CAM-ICU)
-Intensive vCare vDelirium vScreening vChecklist v(ICDSC)
•Goal—keep vthe vpatient vsafe
, •Drug vof vchoice—haloperidol
ABCDEF vBundle vfor vPreventing vDelirium v(" v* v"= vimportant) v- vcorrect vanswer-
•Awakening
•Breathing vCoordination***
•Choice vof vSedation****
•Delirium vmonitoring
•Early vmobility vand vexercise*****
•Family vengagement van vempowerment
The vnature vof vcritical villness vresults vin va vgreater vfrequency vof v________ v______. v-
vcorrect vanswer-ethical vissues
What vare vsome vethical vissue vthat vcritical vcare vnurses vconfront vin veveryday vpractice? v-
vcorrect vanswer--Informed vconsent vand vconfidentiality
-Withholding vor vwithdrawal vof vtreatment
•Know vwishes: vLiving vWill, vAdvanced vDirectives, vCode vStatus
-Organ vand vtissue vtransplantation
-Distribution vof vhealthcare vresources
-Appropriate vuse vof vtechnology
what vis vnurse vadvocacy? v- vcorrect vanswer-•Obligation vto vprotect vpatients
-Serve vas vpatient vadvocates
Several vsigns valert vthe vnurse vto vthe vpotential vemergence vof vethical vissues. vWhat vare
vsome vethical vdilemma vwarning vsigns? v- vcorrect vanswer-•Emotionally vcharged
•Significant vchange vin vpatient's vcondition
•Confusion vabout vfacts
•Hesitancy vabout vwhat vis vright
•Deviation vfrom vcustomary vpractice
•Need vfor vsecrecy vregarding vproposed vactions
The vnurse vrecognizes vwhich vstatement vas va vpotential vethical vissue?
A."The vphysician vexplained vmy vmother's vpoor vprognosis."
B."If vthe vbreathing vmachine vis vhelping vmy vmother, vwhy vis vthe vdoctor vasking vme
vabout vremoving vthe vbreathing vtube?"
C."My vmother vhas vdesignated vmy vbrother vto vmake vdecisions."
D."Can vI vassist vwith vsome vof vmy vmother's vcare?" v- vcorrect vanswer-B."If vthe vbreathing
vmachine vis vhelping vmy vmother, vwhy vis vthe vdoctor vasking vme vabout vremoving vthe
vbreathing vtube?"
**Rationale: vThis vanswer vindicates vsome vconfusion vand vhesitancy vabout vcare, vand va
vpossible vdeviation vfrom vnorms.
Autonomy v- vcorrect vanswer--Right vof vself-determination vconcerning vmedical vcare
