NURS MISC critical care test 1 Testbank with all correct answers higlighted

NURS MISC critical care test 1 Testbank Best for Exam 1 prepping Chapter 1: Overview of Critical Care Nursing 1. Which of the following professional organizations best supports critical care nursing practice? a. American Association of Critical-Care Nurses b. American Heart Association c. American Nurses Association d. Society of Critical Care Medicine 2. A nurse has been working as a staff nurse in the surgical intensive care unit for 2 years and is interested in certification. Which credential would be most applicable for her to seek? a. ACNPC b. CCNS c. CCRN d. PCCN 3. The main purpose of certification is to: a. assure the consumer that you will not make a mistake. b. prepare for graduate school. c. promote magnet status for your facility. d. validate knowledge of critical care nursing. 4. The synergy model of practice focuses on: a. allowing unrestricted visiting for the patient 24 hours each day. b. holistic and alternative therapies. c. needs of patients and their families, which drives nursing competency. d. patients’ needs for energy and support. 5. The family of your critically ill patient tells you that they have not spoken with the physician in over 24 hours and they have some questions that they want clarified. During morning rounds, you convey this concern to the attending intensivist and arrange for her to meet with the family at 4:00 PM in the conference room. Which competency of critical care nursing does this represent? a. Advocacy and moral agency in solving ethical issues b. Clinical judgment and clinical reasoning skills c. Collaboration with patients, families, and team members d. Facilitation of learning for patients, families, and team members 6. The AACN Standards for Acute and Critical Care Nursing Practice use what framework to guide critical care nursing practice? a. Evidence-based practice b. Healthy work environment c. National Patient Safety Goals d. Nursing process 7. The charge nurse is responsible for making the patient assignments on the critical care unit. She assigns the experienced, certified nurse to care for the acutely ill patient with sepsis who also requires continuous renal replacement therapy and mechanical ventilation. She assigns the nurse with less than 1 year of experience to two patients who are more stable. This assignment reflects implementation of the: a. crew resource management model b. National Patient Safety Goals c. Quality and Safety Education for Nurses (QSEN) model d. synergy model of practice 8. The vision of the American Association of Critical-Care Nurses is a healthcare system driven by: a. a healthy work environment. b. care from a multiprofessional team under the direction of a critical care physician. c. the needs of critically ill patients and families. d. respectful, healing, and humane environments. 9. The most important outcome of effective communication is to: a. demonstrate caring practices to family members. b. ensure that patient teaching is done. c. meet the diversity needs of patients. d. reduce patient errors. 10. You are caring for a critically ill patient whose urine output has been low for 2 consecutive hours. After a thorough patient assessment, you call the intensivist with the following report. Dr. Smith, I’m calling about Mrs. P., your 65-year-old patient in CCU 10. Her urine output for the past 2 hours totaled only 40 mL. She arrived from surgery to repair an aortic aneurysm 4 hours ago and remains on mechanical ventilation. In the past 2 hours, her heart rate has increased from 80 to 100 beats per minute and her blood pressure has decreased from 128/82 to 100/70 mm Hg. She is being given an infusion of normal saline at 100 mL per hour. Her right atrial pressure through the subclavian central line is low at 3 mm Hg. Her urine is concentrated. Her BUN and creatinine levels have been stable and in normal range. Her abdominal dressing is dry with no indication of bleeding. My assessment suggests that Mrs. P. is hypovolemic and I would like you to consider increasing her fluids or giving her a fluid challenge. Using the SBAR model for communication, the information the nurse gives about the patient’s history and vital signs is: a. Situation b. Background c. Assessment d. Recommendation 11. The family members of a critically ill, 90-year-old patient bring in a copy of the patient’s living will to the hospital, which identifies the patient’s wishes regarding health care. You discuss contents of the living will with the patient’s physician. This is an example of implementation of which of the AACN Standards of Professional Performance? a. Acquires and maintains current knowledge of practice b. Acts ethically on the behalf of the patient and family c. Considers factors related to safe patient care d. Uses clinical inquiry and integrates research findings in practice 12. Which of the following assists the critical care nurse in ensuring that care is appropriate and based on research? a. Clinical practice guidelines b. Computerized physician order entry c. Consulting with advanced practice nurses d. Implementing Joint Commission National Patient Safety Goals 13. Comparing the patient’s current (home) medications with those ordered during hospitalization and communicating a complete list of medications to the next provider when the patient is transferred within an organization or to another setting are strategies to: a. improve accuracy of patient identification. b. prevent errors related to look-alike and sound-alike medications. c. reconcile medications across the continuum of care. d. reduce harms associated with administration of anticoagulants. 14. As part of nursing management of a critically ill patient, orders are written to keep the head of the bed elevated at 30 degrees, awaken the patient from sedation each morning to assess readiness to wean from mechanical ventilation, and implement oral care protocols every 4 hours. These interventions are done as a group to reduce the risk of ventilator-associated pneumonia. This group of evidence-based interventions is often called a: a. bundle of care. b. clinical practice guideline. c. patient safety goal. d. quality improvement initiative. 15. You work in an intermediate care unit that has experienced high nursing turnover. The nurse manager is often considered to be an autocratic leader by staff members and her leadership style is contributing to turnover. You have asked to be involved in developing new guidelines to prevent pressure ulcers in your patient population. The nurse manager tells you that you do not yet have enough experience to be on the prevention task force. This situation and setting is an example of: a. a barrier to handoff communication. b. a work environment that is unhealthy. c. ineffective decision making. d. nursing practice that is not evidence-based. 16. Which of the following statements describes the core concept of the synergy model of practice? a. All nurses must be certified in order to have the synergy model implemented. b. Family members must be included in daily interdisciplinary rounds. c. Nurses and physicians must work collaboratively and synergistically to influence care. d. Unique needs of patients and their families influence nursing competencies. 17. A nurse who plans care based on the patient’s gender, ethnicity, spirituality, and lifestyle is said to: a. be a moral advocate. b. facilitate learning. c. respond to diversity. d. use clinical judgment. 1. Which of the following is a National Patient Safety Goal? (Select all that apply.) a. Accurately identify patients. b. Eliminate use of patient restraints. c. Reconcile medications across the continuum of care. d. Reduce risks of healthcare-acquired infection. 2. Which of the following is (are) official journal(s) of the American Association of Critical-Care Nurses? (Select all that apply.) a. American Journal of Critical Care b. Critical Care Clinics of North America c. Critical Care Nurse d. Critical Care Nursing Quarterly 3. The first critical care units were: (Select all that apply.) a. burn units. b. coronary care units c. recovery rooms. d. neonatal intensive care units. 4. Which of the following nursing activities demonstrates implementation of the AACN Standards of Professional Performance? (Select all that apply.) a. Attending a meeting of the local chapter of the American Association of Critical-Care Nurses in which a continuing education program on sepsis is being taught b. Collaborating with a pastoral services colleague to assist in meeting spiritual needs of the patient and family c. Participating on the unit’s nurse practice council d. Posting an article from Critical Care Nurse on management of venous thromboembolism for your colleagues to read e. Using evidence-based strategies to prevent ventilator-associated pneumonia 5. Which scenarios contribute to effective handoff communication at change of shift? (Select all that apply.) a. The nephrology consultant physician is making rounds and asks you to update her on the patient’s status and assist in placing a central line for hemodialysis. b. The noise level is high because twice as many staff members are present and everyone is giving report in the nurse’s station. c. The unit has decided to use a standardized checklist/tool for change-of-shift reports and patient transfers. d. You and the oncoming nurse conduct a standardized report at the patient’s bedside and review key assessment findings. 6. Which strategy is important to addressing issues associated with the aging workforce? (Select all that apply.) a. Allowing nurses to work flexible shift durations b. Encouraging older nurses to transfer to an outpatient setting that is less stressful c. Hiring nurse technicians that are available to assist with patient care, such as turning the patient d. Remodeling patient care rooms to include devices to assist in patient lifting 7. Which of the following strategies will assist in creating a healthy work environment for the critical care nurse? (Select all that apply.) a. Celebrating improved outcomes from a nurse-driven protocol with a pizza party b. Implementing a medication safety program designed by pharmacists c. Modifying the staffing pattern to ensure a 1:1 nurse/patient ratio d. Offering quarterly joint nurse-physician workshops to discuss unit issues e. Using the Situation-Background-Assessment-Recommendation (SBAR) technique for handoff communication Chapter 2: Patient and Family Response to the Critical Care Experience 1. Family members have a need for information. Which interventions best assist in meeting this need? a. Handing family members a pamphlet that explains all of the critical care equipment b. Providing a daily update of the patient’s progress and facilitating communication with the intensivist c. Telling them that you are not permitted to give them a status report but that they can be present at 4:00 PM for family rounds with the intensivist d. Writing down a list of all new medications and doses and giving the list to family members during visitation 2. The nurse is a member of a committee to design a critical care unit in a new building. Which design trend would best to facilitate family-centered care? a. Ensure that the patient’s room is large enough and has adequate space for a sleeper sofa and storage for family members’ personal belongings. b. Include a diagnostic suite in close proximity to the unit so that the patient does not have to travel far for testing. c. Incorporate a large waiting room on the top floor of the hospital with a scenic view and amenities such as coffee and tea. d. Provide access to a scenic garden for meditation. 3. The nurse is caring for a patient who sustained a head injury and is unresponsive to painful stimuli. Which intervention is most appropriate while bathing the patient? a. Ask a family member to help you bathe the patient, and discuss the family structure with the family member during the procedure. b. Because she is unconscious, complete care as quickly and quietly as possible. c. Tell the patient the day and time, and that you are bathing her. Reassure her that you are there. d. Turn the television on to the evening news so that you and the patient can be updated to current events. 4. Sleep often is disrupted for critically ill patients. Which nursing intervention is most appropriate to promote sleep and rest? a. Consult with the pharmacist to adjust medication times to allow periods of sleep or rest between intervals. b. Encourage family members to talk with the patient whenever they are present in the room. c. Keep the television on to provide “white” noise and distraction. d. Leave the lights on in the room so that the patient is not frightened of his or her surroundings. 5. Family assessment is essential in order to meet family needs. Which of the following must be assessed first to assist the nurse in providing family-centered care? a. Assessment of patient and family’s developmental stages and needs b. Description of the patient’s home environment c. Identification of immediate family, extended family, and decision makers d. Observation and assessment of how family members function with each other 6. Critical illness often results in family conflicts. Which scenario is most likely to result in the greatest conflict? a. A 21-year-old college student of divorced parents hospitalized with multiple trauma. She resides with her mother. The parents are amicable with each other and have similar values. The father blames the daughter’s boyfriend for causing the accident. b. A 36-year-old male admitted for a ruptured cerebral aneurysm. He has been living with his 34-year-old girlfriend for 8 years, and they have a 4-year-old daughter. He does not have written advance directives. His parents arrive from out-of-state and are asked to make decisions about his health care. He has not seen them in over a year. c. A 58-year-old male admitted for coronary artery bypass surgery. He has been living with his same-sex partner for 20 years in a committed relationship. He has designated his sister, a registered nurse, as his healthcare proxy in a written advance directive. d. A 78-year-old female admitted with gastrointestinal bleeding. Her hemoglobin is decreasing to a critical level. She is a Jehovah’s Witness and refuses the treatment of a blood transfusion. She is capable of making her own decisions and has a clearly written advance directive declining any transfusions. Her son is upset with her and tells her she is “committing suicide.” 7. Which nursing interventions would best support the family of a critically ill patient? a. Encourage family members to stay all night in case the patient needs them. b. Give a condition update each morning and whenever changes occur. c. Limit visitation from children into the critical care unit. d. Provide beverages and snacks in the waiting room. 8. Which intervention is appropriate to assist the patient to cope with admission to the critical care unit? a. Allowing unrestricted visiting by several family members at one time b. Explaining all procedures in easy-to-understand terms c. Providing back massage and mouth care d. Turning down the alarm volume on the cardiac monitor 9. The constant noise of a ventilator, monitor alarms, and infusion pumps predisposes the patient to: a. anxiety. b. pain. c. powerlessness. d. sensory overload. 10. Which of the following statements about family assessment is false? a. Assessment of structure (who comprises the family) is the last step in assessment. b. Interaction among family members is assessed. c. It is important to assess communication among family members to understand roles. d. Ongoing assessment is important, because family functioning may change during the course of illness. 11. Which intervention about visitation in the critical care unit is true? a. The majority of critical care nurses implement restricted visiting hours to allow the patient to rest. b. Children should never be permitted to visit a critically ill family member. c. Visitation that is individualized to the needs of patients and family members is ideal. d. Visiting hours should always be unrestricted. 12. Elderly patients who require critical care treatment are at risk for increased mortality, functional decline, or decreased quality of life after hospitalization. Assuming each of these patients was discharged from the hospital, which of the following patients is at greatest risk for decreased functional status and quality of life? a. A 70-year-old who had coronary artery bypass surgery. He developed complications after surgery and had difficulty being weaned from mechanical ventilation. He required a tracheostomy and gastrostomy. He is being discharged to a long-term, acute care hospital. He is a widower. b. A 79-year-old admitted for exacerbation of heart failure. She manages her care independently but needed diuretic medications adjusted. She states that she is compliant with her medications but sometimes forgets to take them. She lives with her 82-year-old spouse. Both consider themselves to be independent and support each other. c. A 90-year-old admitted for a carotid endarterectomy. He lives in an assisted living facility (ALF) but is cognitively intact. He is the “social butterfly” at all of the events at the ALF. He is hospitalized for 4 days and discharged to the ALF. d. An 84-year-old who had stents placed to treat coronary artery occlusion. She has diabetes that has been managed, lives alone, and was driving prior to hospitalization. She was discharged home within 3 days of the procedure. 13. Patients often have recollections of the critical care experience. Which is likely the most common recollection from a patient who required endotracheal intubation and mechanical ventilation? a. Difficulty communicating b. Inability to get comfortable c. Pain d. Sleep disruption 14. Many critically ill patients experience anxiety. The nurse can reduce anxiety with which approach? a. Ask family members to limit their visitation to 2-hour periods in morning, afternoon, and evening. You know that this is the best approach to ensure uninterrupted rest time for the patient. Tell the patient, “Mr. J., your family is in the waiting room. They will be permitted to come in at 2:00 PM after you take a short nap.” b. Explain the unit routine. “Mr. J., assessments are done every 4 hours; patients are bathed on the night shift around 5:00 AM; family members are permitted to visit you after the physicians make their morning rounds. They can spend the day. Lights are out every night at 10:00 PM.” c. State, “Mr. J., it’s time to turn you. I am going to ask another nurse to come in and help me. We will turn you to your left side. During the turn, I’m going to inspect the skin on your back and rub some lotion on your back. This should help to make you feel better.” d. Suction Mr. J.’s endotracheal tube immediately when he starts to cough. Tell him, “Mr. J., your tube needs suctioned; you should feel better after I’m done.” 15. Which statement is a likely response from someone who has survived a stay in the critical care unit? a. “I don’t remember much about being in the ICU, but if I had to be treated there again, it would be okay. I’m glad I can see my grandchildren again.” b. “If I get that sick again, do not take me to the hospital. I would rather die than go through having a breathing tube put in again.” c. “My family is thrilled that I am home. I know I need some extra attention, but my children have rearranged their schedules to help me out.” d. “Since I have been transferred out of the ICU, I cannot get enough to eat. They didn’t let me eat in the ICU, so I’m making up for it now.” 16. The nurse is assigned to care for a patient who is a non-native English speaker. What is the best way to communicate with the patient and family to provide updates and explain procedures? a. Conduct a Google search on the computer to identify resources for the patient and family in their native language. Print these for their use. b. Contact the hospital’s interpreter service for someone to translate. c. Get in touch with one of the residents that you know is fluent in the native language and ask him if he can come up to the unit. d. Use the 8-year old child who is fluent in both English and the native language to translate for you. 17. Family assessment can be challenging and each nurse may obtain additional information regarding family structure and dynamics. What is the best way to share this information from shift to shift? a. Create an informal family information sheet that is kept on the bedside clipboard. That way, everyone can review it quickly when needed. b. Develop a standardized reporting form for family information that is incorporated into the patient’s medical record and updated as needed. c. Require that the charge nurse have a detailed list of information about each patient and family member. Thus, someone on the unit is always knowledgeable about potential issues. d. Try to remember to discuss family structure and dynamics as part of the change-of-shift report. 18. The wife of a patient who is hospitalized in the critical care unit following resuscitation for a sudden cardiac arrest at work demands to meet with the nursing manager. She states, “I want you to reassign my husband to another nurse. His current nurse is not in the room enough to make sure he is okay.” The nurse recognizes that this response most likely is due to the wife’s: a. desire to pursue a lawsuit if the assignment is not changed. b. inability to participate in the husband’s care. c. lack of prior experience in a critical care setting. d. sense of loss of control of the situation. 19. Open visitation policies are expected by many professional organizations. Which statement reflects adherence to current recommendations? a. Allow animals on the unit; however, these can only be “therapy” animals through the hospital’s pet therapy program. b. Allow family visitation throughout the day except at change of shift and during rounds. c. Determine, in collaboration with the patient and family, who can visit and when. Facilitate open visitation policies. d. Permit open visitation by adults 18 years of age and older; limit visits of children to 1 hour. 20. The VALUE mnemonic is a helpful strategy to enhance communication with family members of critically ill patients. Which of the following statements describes a VALUE strategy? a. View the family as guests on the unit. b. Acknowledge family emotions. c. Learn as much as you can about family structure and function. d. Use a trained interpreter if the family does not speak English. e. Evaluate each encounter with the family. 21. Changing visitation policies can be challenging. The nurse manager recognizes the following as an effective strategy for promoting changes in practice: a. Ask the clinical nurse specialist to lead a journal club on open visitation after each nurse is tasked to read one research article about visitation. b. Discuss pros and cons of open visitation at the next staff meeting. c. Invite the nurses with the most experience to develop a revised policy. d. Task the unit-based nurse practice council to invite volunteers to serve on the council to revise the current policy toward more liberal visitation. 1. Nursing strategies to help families cope with the stress of critical illness include: (Select all that apply.) a. asking the family to leave during the morning bath to promote the patient’s privacy. b. encouraging family members to make notes of questions they have for the physician during family rounds. c. if possible, providing continuity of nursing care. d. providing a daily update of the patient’s condition to the family spokesperson. 2. Family presence is encouraged during resuscitation and invasive procedures. The nurse knows that nurses are often reluctant to allow this to occur, yet families often perceive benefits. Which findings have been reported in the literature? (Select all that apply.) a. Families benefit by witnessing that everything possible was done. b. Families report reduced anxiety and fear about what is being done to the patient. c. Presence encourages family members to seek litigation for improper care. d. Presence reduces nurses’ involvement in explaining things to the family. 3. Noise in the critical care unit can have negative effects on the patient. Which of the following interventions assists in reducing noise levels in the critical care setting? (Select all that apply.) a. Ask the family to bring in the patient’s i-Pod or other device with favorite music. b. Invite the volunteer harpist to play on the unit on a regular basis. c. Remodel the unit to have two-patient rooms to facilitate nursing care. d. Remodel the unit to install acoustical ceiling tiles. e. Turn the volume of equipment alarms as low as they can be adjusted, and “off” if possible. 4. It is important for critically ill patients to feel safe. Which nursing strategies help the patient to feel safe in the critical care setting? (Select all that apply.) a. Allow family members to remain at the bedside. b. Be sure to consult with the charge nurse before making any patient care decisions. c. Provide informal conversation by discussing your plans for after work. d. Respond promptly to call bells or other communication for assistance. 5. The critical care environment is often stressful to a critically ill patient. Identify stressors that are common. (Select all that apply.) a. Alarms that sound from various devices b. Bright, fluorescent lighting c. Lack of day-night cues d. Sounds from the mechanical ventilator e. Visiting hours tailored to meet individual needs 6. A patient and his family are excited that he is transferring from the critical care unit to the intermediate care unit. However, they are also fearful of the change in environment and nursing staff. To reduce relocation stress, the nurse can: (Select all that apply.) a. ask the nurses on the intermediate care unit to give the family a tour of the new unit. b. contact the intensivist to see if the patient can stay one additional day in the critical care unit so that he and his family can adjust better to the idea of a transfer. c. ensure that the patient will be located near the nurse’s station in the new unit. d. invite the nurse who will be assuming the patient’s care to meet with the patient and family in the critical care unit prior to transfer. 7. The critical care environment is stressful to the patient. Which interventions assist in reducing this stress? (Select all that apply.) a. Adjust lighting to promote normal sleep-wake cycles. b. Provide clocks, calendars, and personal photos in the patient’s room. c. Talk to the patient about other patients you are caring for on the unit. d. Tell the patient the day and time when you are providing routine nursing interventions. Chapter 3: Ethical and Legal Issues in Critical Care Nursing 1. Ideally, an advance directive should be developed by the: a. family, if the patient is in critical condition. b. patient as part of the hospital admission process. c. patient before hospitalization. d. patient’s healthcare surrogate. 2. A critically ill patient has a living will in his chart. His condition has deteriorated. His wife says she wants “everything done,” regardless of the patient’s wishes. Which ethical principle is the wife violating? a. Autonomy b. Beneficence c. Justice d. Nonmaleficence 3. Which statement regarding ethical concepts is true? a. A living will is the same as a healthcare proxy. b. A signed donor card ensures that organ donation will occur in the event of brain death. c. A surrogate is a competent adult designated by a person to make healthcare decisions in the event the person is incapacitated. d. A persistent vegetative state is the same as brain death in most states. 4. Which of the following statements about resuscitation is true? a. Family members should never be present during resuscitation. b. It is not necessary for a physician to write “do not resuscitate” orders in the chart if a patient has a healthcare surrogate. c. “Slow codes” are ethical and should be considered in futile situations if advanced directives are not available. d. Withholding “extraordinary” resuscitation is legal and ethical if specified in advance directives and physician orders. 5. The nurse is caring for an elderly patient who is in cardiogenic shock. The patient has failed to respond to medical treatment. The intensivist in charge of the patient conducts a conference to explain that they have exhausted treatment options and suggest that the patient be made a “do not resuscitate” status. This scenario illustrates the concept of: a. brain death. b. futility. c. incompetence. d. life-prolonging procedures. 6. The nurse is caring for a patient admitted with a traumatic brain injury following a motor vehicle crash. The patient’s Glasgow Coma Score is 3 and intermittently withdraws when painful stimuli are introduced. The patient is ventilator dependent and occasionally takes a spontaneous breath. The physician explains to the family that the patient has severe neurological impairment and he does not expect the patient to recover consciousness. The nurse recognizes that this patient is: a. an organ donor. b. brain dead. c. in a persistent vegetative state. d. terminally ill. 7. A nurse caring for a patient with neurological impairment often must use painful stimuli to elicit a patient’s response. The nurse uses subtle measures of painful stimuli, such as nailbed pressure. She neither slaps the patient nor pinches the nipple to elicit a response to pain. In this scenario, the nurse is exemplifying the ethical principle of: a. beneficence. b. fidelity. c. nonmaleficence. d. veracity. 8. Which of the following organizations requires a mechanism for addressing ethical issues? a. American Association of Critical-Care Nurses b. American Hospital Association c. Society of Critical Care Medicine d. The Joint Commission 9. The nurse is caring for a patient who is not responding to medical treatment. The intensivist holds a conference with the family, and a decision is made to withdraw life support. The nurse’s religious beliefs are not in agreement with withdrawal. However, she assists with the process to avoid confronting the charge nurse. Afterward she feels guilty and believes she “killed the patient.” This scenario is likely to cause: a. abandonment. b. family stress. c. moral distress. d. negligence. 10. The nurse is caring for a patient who has been declared brain dead. The patient is considered a potential organ donor. In order to proceed with donation, the nurse understands that: a. a signed donor card mandates that organs be retrieved in the event of brain death. b. after brain death has been determined, perfusion and oxygenation of organs is maintained until organs can be removed in the operating room. c. the healthcare proxy does not need to give consent for the retrieval of organs. d. once a patient has been established as brain dead, life support is withdrawn and organs are retrieved. 11. The nurse is caring for a patient who is declared brain dead and is an organ donor. The following events occur: 1300 Diagnostic tests for brain death are completed. 1330 Intensivist reviews diagnostic test results and writes in the progress note that the patient is brain dead. 1400 Patient is taken to the operating room for organ retrieval. 1800 All organs have been retrieved for donation. The ventilator is discontinued. 1810 Cardiac monitor shows flatline. What is the official time of death recorded in the medical record? a. 1300 b. 1330 c. 1400 d. 1800 e. 1810 12. The nurse is caring for a critically ill patient on mechanical ventilation. The physician identifies the need for a bronchoscopy, which requires informed consent. If the physician were to obtain consent from the patient, the patient must be able to: a. be weaned from mechanical ventilation. b. have knowledge and competence to make the decision. c. nod his head that it is okay to proceed. d. read and write in English. 13. The nurse is caring for a critically ill patient with terminal cancer. The monitor alarms and shows ventricular tachycardia. The patient does not have a “do not resuscitate” order written on the chart. What is the appropriate nursing action? a. Contact the attending physician immediately to determine if CPR should be initiated. b. Contact the family immediately to determine if they want CPR to be started. c. Give emergency medications but withhold intubation. d. Initiate CPR and call a code. 14. When addressing an ethical dilemma, contextual, physiological, and personal factors of the situation must be considered. Which of the following is an example of a personal factor? a. The hospital has a policy that everyone must have an advanced directive on the chart. b. The patient has lost 20 pounds in the past month and is fatigued all of time. c. The patient has told you what quality of life means and his or her wishes. d. The physician considers care to be futile in a given situation. 15. A specific request made by a competent person that directs medical care related to life-prolonging procedures if the patient loses capacity to make decisions is called a: a. do not resuscitate order. b. healthcare proxy. c. informed consent. d. living will. 16. The American Nurses Credential Center Magnet Recognition Program supports many actions to ensure that nurses are engaged and empowered to participate in ethical decision making. Which of the following would assist nurses in being involved in research studies? a. Education on protection of human subjects b. Participation of staff nurses on ethics committees c. Written descriptions of how nurses participate in ethics programs d. Written policies and procedures related to response to ethical issues 17. The critical care nurse wants a better understanding of when to initiate an ethics consult. After attending an educational program, she understands that the following situation would require an ethics consultation: a. Conflict has occurred between the physician and family regarding treatment decisions. A family conference is held, and the family and physician agree to a treatment plan that includes aggressive treatment for 24 hours followed by re-evaluation. b. Family members disagree as to a patient’s course of treatment. The patient has designated a healthcare proxy and has a written advance directive. c. Patient postoperative coronary artery bypass surgery who sustained a cardiopulmonary arrest in the operating room. He was successfully resuscitated, but now is not responding to treatment. He has a written advance directive and his wife is present. d. Patient with multiple trauma and is not responding to treatment. No family members are known, and care is considered futile. 18. The nurse is aware that a shortage of organs exists. She knows that which of the following statements is true? a. Anyone who is comfortable approaching the family should discuss the option of organ donation. b. Brain death determination is required before organs can be retrieved for transplant. c. Donation of selected organs after cardiac death is ethically acceptable. d. Family members should consider withdrawing life support so that the patient can become an organ donor. 1. Warning signs that can assist the critical care nurse in recognizing that an ethical dilemma may exist include which of the following? (Select all that apply.) a. Family members are confused about what is happening to the patient. b. Family members are in conflict as to the best treatment options. They disagree with each other and cannot come to consensus. c. The family asks that the patient not be told of treatment plans. d. The patient’s condition has changed dramatically for the worse and is not responding to conventional treatment. e. The physician is considering trying a medication that is not approved to treat the patient’s condition. 2. The nurse is caring for a patient whose condition has deteriorated and who is not responding to standard treatment. The physician calls for an ethical consultation with the family to discuss potential withdrawal versus aggressive treatment. The nurse understands that applying a model for ethical decision making involves which of the following? (Select all that apply.) a. Burden versus benefit b. Family’s wishes c. Patient’s wishes d. Potential outcomes of treatment options 3. The nurse understands that many strategies are available to address ethical issues that may occur; these strategies include which of the following? (Select all that apply.) a. Change-of-shift report updates b. Ethics consultation services c. Formal multiprofessional ethics committees d. Pastoral care services 4. The nurse is caring for a patient with severe neurological impairment following a massive stroke. The physician has ordered tests to determine brain death. The nurse understands that criteria for brain death include: (Select all that apply.) a. absence of cerebral blood flow. b. absence of brainstem reflexes on neurological examination. c. Cheyne-Stokes respirations. d. flat electroencephalogram. 5. The nurse is caring for 80-year-old patient who has been treated for gastrointestinal bleeding. The family has agreed to withhold or withdraw additional treatment. The patient has a written advance directive specifying requests. The directive notes that the patient wants food and fluid to be continued. The nurse anticipates that several orders may be written to comply with this request, including which of the following? (Select all that apply.) a. “Do not resuscitate.” b. Change antibiotic to a less expensive medication. c. Discontinue tube feeding. d. Stop any further blood transfusions. Chapter 4: End-of-Life Care in the Critical Care Unit 1. A patient who is undergoing withdrawal of mechanical ventilation appears anxious and agitated. The patient is on a continuous morphine infusion and has an additional order for lorazepam (Ativan) 1 to 2 mg IV as needed (prn). The patient has received no lorazepam (Ativan) during this course of illness. What is the most appropriate nursing intervention to control agitation? a. Administer fentanyl (Duragesic) 25 mg IV bolus. b. Administer lorazepam (Ativan) 1 mg IV now. c. Increase the rate of the morphine infusion by 50%. d. Request an order for a paralytic agent. 2. A 75-year-old patient, who suffered a massive stroke 3 weeks ago, has been unresponsive and has required ventilatory support since the time of the stroke. The physician has approached the spouse regarding placement of a permanent feeding tube. The spouse states that the patient never wanted to be kept alive by tubes and personally didn’t want what was being done. After holding a family conference with the spouse, the medical team concurs and the feeding tube is not placed. This situation is an example of: a. euthanasia. b. palliative care. c. withdrawal of life support. d. withholding of life support. 3. What were the findings of the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT)? a. Clear communication is typical in the relationships between most patients and healthcare providers. b. Critical care units often meet the needs of dying patients and their families. c. Disparities exist between patients’ care preferences and actual care provided. d. Pain and suffering of patients at end of life is well controlled in the hospital. 4. A statement that provides a legally recognized description of an individual’s desires regarding care at the end of life is a (an): a. advance directive. b. guardianship ad litem. c. healthcare proxy. d. power of attorney. 5. A 65-year-old patient with a history of metastatic lung carcinoma has been unresponsive to chemotherapy. The medical team has determined that there are no additional treatments available that will prolong life or improve the quality of life in any meaningful way. Despite the poor prognosis, the patient continues to receive chemotherapy and full nutrition support. This is an example of what end-of-life concept? a. Medical futility b. Palliative care c. Terminal weaning d. Withdrawal of treatment 6. Designated healthcare surrogates should base healthcare decisions on: a. personal beliefs and values. b. recommendations of family members and friends. c. recommendations of the physician and healthcare team. d. wishes previously expressed by the patient. 7. Which statement made by a staff nurse identifying guidelines for palliative care would need corrected? a. Basic nursing care is a critical element in palliative care management. b. Common conditions that require palliative management are nausea, agitation, and sleep disturbance. c. Palliative care practices are reserved for the dying client. d. Palliative care practices relieve symptoms that negatively affect the quality of life of a patient. 8. Which statement is true regarding the impact of culture on end-of-life decision making? a. African-Americans prefer more conservative, less invasive care options during the end of life. b. Caucasians prefer aggressive and more invasive care options during the end of life. c. Culture and religious beliefs may affect end-of-life decision making. d. Perspectives regarding end-of-life care are similar between and within religious groups. 9. The most critical element of effective early end-of-life decision making is: a. control of distressing symptoms such as nausea, anxiety, and pain. b. effective communication between the patient, family, and healthcare team throughout the course of the illness. c. organizational support of palliative care principles. d. relocation the dying patient from the critical care unit to a lower level of care. 10. A patient with end-stage heart failure is experiencing considerable dyspnea. Appropriate pharmacological management of this symptom includes: a. administration of 6 mg of midazolam (Versed) and initiation of a continuous midazolam infusion. b. administration of morphine, 5 mg IV bolus, and initiation of a continuous morphine infusion. c. hourly increases of the midazolam (Versed) infusion by 100% dose increments. d. hourly increases of the morphine infusion by 100% dose increments. 11. Which statement is consistent with societal views of dying in the United States? a. Dying is viewed as a failure on the part of the system and providers. b. Most Americans would prefer to die in a hospital to spare loved ones the burden of care. c. People die of indistinct, complex illness for which a cure is always possible. d. The purpose of the healthcare system is to prevent disease and treat symptoms. 12. Which nursing intervention would need to be corrected on a care plan for a patient in order to be consistent with the principles of effective end-of-life care? a. Control of distressing symptoms such as dyspnea, nausea, and pain through use of pharmacological and nonpharmacological interventions b. Limitation of visitation to reduce the emotional distress experienced by family members c. Patient and family education on anticipated patient responses to withdrawal of therapy d. Provision of spiritual care resources as desired by the patient and family 13. In which of the following situations would a healthcare surrogate or proxy assume the end-of-life decision-making role for a patient? a. When a dying patient requires extensive heavy sedation, such as benzodiazepines and narcotics, to control distressing symptoms b. When a dying patient who is competent requests to withdraw treatment against the wishes of the family c. When a dying patient who is competent requests to continue treatment against the recommendations of the healthcare team d. When a dying patient who is competent is receiving prn treatment for pain and anxiety 14. Which statement is true regarding the effects of caring for dying patients on nurses? a. Attendance at funerals is inappropriate and will only create additional stress in nurses who are already at risk for burnout. b. Caring for dying patients is an expected part of nursing and will not affect the emotional health of the nurse if he or she maintains a professional approach with each patient and family. c. Most nurses who work with dying patients are able to balance care needs of patients with personal emotional needs. d. Provision of aggressive care to patients for whom they believe it is futile may result in personal ethical conflicts and burnout for nurses. 15. The family is considering withdrawing life-sustaining measures from the patient. The nurse knows that ethical principles for withholding or withdrawing life-sustaining treatments include which of the following? a. Any treatment may be withdrawn and withheld, including nutrition, antibiotics, and blood products. b. Doses of analgesic and anxiolytic medications must be adjusted carefully and should not exceed usual recommended limits. c. Life-sustaining treatments may be withdrawn while a patient is receiving paralytic agents. d. The goal of withdrawal and withholding of treatments is to hasten death and thus relieve suffering. 16. The patient’s husband is terrified by the prospect of removing life-sustaining treatments from the patient. He asks why anyone would do that. The nurse explains, a. “It is to save you money so you won’t have such a large financial burden.” b. “It will preserve limited resources for the hospital so other patients may benefit from them.” c. “It is to discontinue treatments that are not helping your wife and may be very uncomfortable for her.” d. “We have done all we can for your wife and any more treatment would be futile.” 17. All of the patient’s children are distressed by the possibility of removing life-support treatments from their mother. The child who is most upset tells the nurse, “This is the same as killing her! I thought you were supposed to help her!” The nurse explains to the family, a. “This is a process of allowing your mother to die naturally after the injuries that she sustained in a serious accident.” b. “The hospital would never allow us to do that kind of thing.” c. “Let’s talk about this calmly, and I will explain why assisted suicide is appropriate in this case.” d. “She’s lived a long and productive life.” 18. To prevent any unwanted resuscitation after life-sustaining treatments have been withdrawn, the nurse should ensure that: a. do-not-resuscitate (DNR) orders are written before discontinuation of the treatments. b. the family is not allowed to visit until the death occurs. c. DNR orders are written as soon as possible after the discontinuation of the treatments. d. the change-of-shift report includes the information that the patient is not to be resuscitated. 19. The patient’s husband is very upset because his wife, who is near death, has dyspnea and restlessness. The nurse explains to him that there are some ways to decrease her discomfort, including: a. respiratory therapy treatments. b. opioid medications given as needed. c. incentive spirometry. d. increased hydration. 20. The patient’s husband, experiencing anticipatory grieving, tells the nurse that he doesn’t see any point in continuing to visit at the bedside, because the patient is unresponsive. The best response for the nurse supports him by saying, a. “You’re right, she is not aware of anything going on around her now.” b. “Although she is not responding, she may be able to hear you and benefit from your presence.” c. “I’ll call you if she starts responding again.” d. “Why don’t you check to see if any other family member would like to visit her?” 21. Which of the following statements about comfort care is accurate? a. Withholding and withdrawing life-sustaining treatment are distinctly different in the eyes of the legal community. b. Each procedure should be evaluated for its effect on the patient’s comfort before being implemented. c. Only the patient can determine what constitutes comfort care for him or her. d. Withdrawing life-sustaining treatments is considered euthanasia in most states. 1. Select interventions that may be included during “terminal weaning” include which of the following? (Select all that apply.) a. Complete extubation following ventilator withdrawal b. Discontinuation of artificial ventilation but maintenance of the artificial airway c. Discontinuation of anxiolytic and pain medications d. Titration of ventilator support based upon blood gas determinations e. Titration of ventilator support to minimal levels based upon patient assessment of comfort 2. Which therapeutic interventions may be withdrawn or withheld from the terminally ill client?(Select all that apply.) a. Antibiotics b. Dialysis c. Nutrition d. Pain medications e. Simple nursing interventions such as repositioning and hygiene 3. Which interventions can the nurse use to facilitate communication with patients and families who are in the process of making decisions regarding end-of- life care options? (Select all that apply.) a. Communication of uniform messages from all healthcare team members b. An integrated plan of care that is developed collaboratively by the patient, family, and healthcare team c. Facilitation of continuity of care through accurate shift-to-shift and transfer reports d. Limitation of time for families to express feelings in order to control family grief e. Reassuring the patient and family that they will not be abandoned as the goals of care shift from aggressive treatment to comfort care 4. Palliation may include: (Select all that apply.) a. relieving pain. b. relieving nausea. c. psychological support. d. withdrawing life-support interventions. e. withholding tube feedings. 5. When providing palliative care, the nurse must keep in mind that the family may include which of the following? (Select all that apply.) a. Unmarried life partners of same sex b. Unmarried life partners of opposite sex c. Roommates d. Close friends e. Parents Chapter 5: Comfort and Sedation 1. Nociceptors differ from other nerve receptors in the body in that they: a. adapt very little to continual pain response. b. inhibit the infiltration of neutrophils and eosinophils. c. play no role in the inflammatory response. d. transmit only the thermal stimuli. 2. A 45-year-old male postsurgical patient is on a ventilator in the critical care unit. He has been tolerating the ventilator well and has not required any sedation. He becomes tachycardic and hypertensive. His respiratory rate has increased to 28 breaths/min. The ventilator is set on synchronized intermittent mandatory ventilation (SIMV) at a rate of 10 breaths/min. The patient has been suctioned recently via his endotracheal tube, and his airway is clear. He responds appropriately to the nurse’s commands. The nurse should: a. assess the patient’s level of pain. b. decrease the SIMV rate on the ventilator. c. provide sedation as ordered. d. suction the patient again. 3. The assessment of pain and anxiety is a continuous process. When critically ill patients exhibit signs of anxiety, the nurse’s first priority is to: a. administer antianxiety medications as ordered. b. administer pain medication as ordered. c. identify and treat the underlying cause. d. reassess the patient hourly to determine whether symptoms resolve on their own. 4. Both the electroencephalogram (EEG) monitor and the Bispectral Index Score (BIS) or Patient State Index (PSI) analyzer monitors are used to assess patient sedation levels in critically ill patients. The BIS and PSI monitors are simpler to use because they: a. can only be used on heavily sedated patients. b. can only be used on pediatric patients. c. provide raw EEG data and a numeric value. d. require only five leads. 5. The nurse is caring for a patient who requires administration of a neuromuscular blocking agent to facilitate ventilation with non-traditional modes. The nurse understands that neuromuscular blocking agents provide: a. antianxiety effects. b. complete analgesia. c. high levels of sedation. d. no sedation or analgesia. 6. The patient is receiving neuromuscular blockade. Which nursing assessment indicates a target level of paralysis? a. Glasgow Coma Scale score of 3 b. Train-of-four yields two twitches c. Bispectral index of 60 d. CAM-ICU positive 7. The nurse is concerned that the patient will pull out the endotracheal tube. As part of the nursing management, the nurse obtains an order for: a. a Posey-type vest. b. a higher dosage of lorazepam. c. propofol. d. soft wrist restraints. 8. Neuromuscular blocking agents are used in the management of some ventilated patients. Their primary mode of action is: a. analgesia. b. anticonvulsant. c. paralysis. d. sedation. 9. The most important nursing intervention for patients who receive neuromuscular blocking agents is to: a. administer sedatives in conjunction with the neuromuscular blocking agents. b. assess neurological status every 30 minutes. c. avoid interaction with the patient, because he or she won’t be able to hear. d. restrain the patient to avoid self-extubation. 10. The best way to monitor agitation and effectiveness of treating it in the critically ill patient is to use a/the: a. Confusion Assessment Method (CAM-ICU). b. FACES assessment tool. c. Glasgow Coma Scale. d. scale such as Richmond Agitation Sedation Scale. 11. The nurse is caring for a patient receiving intravenous ibuprofen for pain management. The nurse recognizes which laboratory assessment to be a possible side effect of the ibuprofen? a. Elevated creatinine b. Elevated platelet count c. Elevated white blood count d. Low liver enzymes 12. The nurse is assessing pain levels in a critically ill patient using the Behavioral Pain Scale. The nurse recognizes ________ as indicating the greatest level of pain. a. brow lowering b. eyelid closing c. grimacing d. relaxed facial expression 13. The nurse wishes to assess the quality of a patient’s pain. Which of the following questions is appropriate to obtain this assessment if the patient is able to give a verbal response? a. “Is the pain constant or intermittent?” b. “Is the pain sharp, dull, or crushing?” c. “What makes the pain better? Worse?” d. “When did the pain start?” 14. The nurse is assessing the patient’s pain using the Critical Care Pain Observation Tool. Which of the following assessments would indicate the greatest likelihood of pain and need for nursing intervention? a. Absence of vocal sounds b. Fighting the ventilator c. Moving legs in bed d. Relaxed muscles in upper extremities 15. The nurse is caring for four patients on the progressive care unit. Which patient is at greatest risk for developing delirium? a. 36-year-old recovering from a motor vehicle crash; being treated with an alcohol withdrawal protocol. b. 54-year-old postoperative aortic aneurysm resection with an elevated creatinine level c. 86-year-old from nursing home, postoperative from colon resection d. 95-year-old with community-acquired pneumonia; family has brought in eyeglasses and hearing aid 16. The nurse is caring for a patient with hyperactive delirium. The nurse focuses interventions toward keeping the patient: a. comfortable b. nourished c. safe d. sedated 17. The nurse is caring for a critically ill trauma patient who is expected to be hospitalized for an extended period of time. Which of the following nursing interventions would improve the patient’s well-being and reduce anxiety the most? a. Arrange for the patient’s dog to be brought into the unit (per protocol). b. Contact the pet therapy department to bring a therapy dog in to visit. c. Secure the harpist to come and play soothing music for an hour every afternoon. d. Wheel the patient out near the unit aquarium to observe the tropical fish. 18. The nurse recognizes that which patient is likely to benefit most from patient-controlled analgesia? a. 21-year-old with a C4 fracture and quadriplegia b. 45-year-old with femur fracture and closed head injury c. 59-year-old postoperative elective bariatric surgery d. 70-year-old postoperative cardiac surgery; mild dementia 19. The nurse is caring for a patient receiving benzodiazepine intermittently. The nurse understands that the best way to administer such drugs is to: a. administer around the clock, rather than as needed, to ensure constant sedation. b. administer the medications through the feeding tube to prevent complications. c. give the highest allowable dose for the greatest effect. d. titrate to a predefined endpoint using a standard sedation scale. 20. The nurse is concerned about the risk of alcohol withdrawal syndrome in a 45-year- old postoperative patient. Which statement indicates her understanding of management of this patient? a. “Alcohol withdrawal is common; we see it all of the time in the trauma unit.” b. “There is no way to assess for alcohol withdrawal.” c. “This patient will require less pain medication.” d. “We have initiated the alcohol withdrawal protocol.” 1. Nonpharmacological approaches to pain and/or anxiety that may best meet the needs of critically ill patients include: (Select all that apply.) a. anaerobic exercise. b. art therapy. c. guided imagery. d. music therapy. 2. Which of the following statements regarding pain and anxiety are true? (Select all that apply.) a. Anxiety is a state marked by apprehension, agitation, autonomic arousal, and/or fearful withdrawal. b. Critically ill patients often experience anxiety, but they rarely experience pain. c. Pain and anxiety are often interrelated and may be difficult to differentiate because their physiological and behavioral manifestations are similar. d. Pain is defined by each patient; it is whatever the person experiencing the pain says it is. 3. Which of the following factors predispose the critically ill patient to pain and anxiety? (Select all that apply.) a. Inability to communicate b. Invasive procedures c. Monitoring devices d. Nursing care 4. Choose the items that are common to both pain and anxiety. (Select all that apply.) a. Cyclical exacerbation of one another b. Require good nursing assessment for proper treatment c. Response only to real phenomena d. Subjective in nature 5. Anxiety differs from pain in that: (Select all that apply.) a. it is confined to neurological processes in the brain. b. it is linked to reward and punishment centers in the limbic system. c. it is subjective. d. there is no actual tissue injury. 6. Factors in the critical care unit that may predispose the client to increased pain and anxiety include: (Select all that apply.) a. an endotracheal tube. b. frequent vital signs. c. monitor alarms. d. room temperature. 7. In the healthy individual, pain and anxiety: (Select all that apply.) a. activate the sympathetic nervous system. b. decrease stress levels. c. help remove one from harm. d. increase performance levels. 8. The nurse is caring for a 48-year-old patient who is intubated and on a ventilator following extensive abdominal surgery. Although the patient is responsive, the nurse is not able to read the patient’s lips as the patient attempts to mouth the words. Which of the following assessment tools would be the most appropriate for the nurse to use when assessing the patient’s pain level? (Select all that apply.) a. The FACES scale b. Pain IntensityScale c. The PQRST method d. The Visual Analogue Scale 9. In the critically ill patient, an incomplete assessment and/or management of pain or anxiety may be hampered by which of the following? (Select all that apply.) a. Administration of neuromuscular blocking agents b. Delirium c. Effective nurse communication and assessment skills d. Nonverbal patients 10. Which of the following are accepted nonpharmacological approaches to managing pain and/or anxiety in critically ill patients? (Select all that apply.) a. Environmental manipulation b. Explanations of monitoring equipment c. Guided imagery d. Music therapy 11. The nurse is caring for a postoperative patient in the critical care unit. The physician has ordered patient-controlled analgesia (PCA) for the patient. The nurse understands that the PCA: (Select all that apply.) a. is a safe and effective method for administering analgesia. b. has potentially fewer side effects than other routes of analgesic administration. c. is an ideal method to provide critically ill patients some control over their treatment. d. provides good quality analgesia. 12. A patient requires neuromuscular blockade (NMB) as part of treatment of refractive increased intracranial pressure. The nursing care for this patient includes: (Select all that apply.) a. administration of sedatives concurrently with neuromuscular blockade. b. dangling the patient’s feet over the edge of the bed and assisting the patient to sit up in a chair at least twice each day. c. ensuring that deep vein thrombosis prophylaxis is initiated. d. providing interventions for eye care, oral care, and skin care. 13. The nurse is assessing the critically ill patient for delirium. The nurse recognizes which characteristics that indicate hyperactive delirium? (Select all that apply.) a. Agitation b. Apathy c. Biting d. Hitting e. Restlessness Chapter 6: Nutritional Support 1. A patient is having complications from abdominal surgery and remains NPO. Because enteral tube feedings are not possible, the decision is to initiate parenteral feedings. What are the major complications for this therapy? a. Aspiration pneumonia and sepsis b. Fluid and electrolyte imbalances and sepsis c. Fluid overload and pulmonary edema d. Hypoglycemia and renal insufficiency 2. A patient is being ventilated and has been started on enteral feedings with a nasogastric small-bore feeding tube. What is the primary reason the nurse must frequently assess tube placement? a. To assess for paralytic ileus b. To maintain the patency of the feeding tube c. To monitor for skin breakdown on the nose d. To prevent aspiration of the feedings 3. The patient is to start parenteral nutrition. The nurse knows to prepare which site for catheter insertion? a. Basilic vein b. Femoral vein c. Radial artery d. Subclavian vein 4. A patient has been admitted to the critical care unit after a stroke. After “failing” a swallow study, the patient is placed on enteral feedings. Following placement of a nasogastric tube for tube feeding, what is the next critical step? a. Administer medications. b. Cap off and wait 24 hours before starting feedings. c. Obtain a chest radiograph. d. Start the tube feeding. 5. A patient’s feeding tube has been successfully placed in the small intestine with continuous flow tube feeding. The nurse knows that this approach was chosen because: a. intermittent feedings cause increased nausea and vomiting. b. the increased filling of the stomach increases absorption. c. the intestinal mucosa normally receives nutrients from the stomach in peristaltic waves. d. this will prevent malabsorption syndrome. 6. A patient is being fed through a nasogastric tube placed in his stomach. The nurse would carry out which intervention to minimize aspiration risk? a. Add blue dye to the formula. b. Assess the residual every hour. c. Elevate the head of the bed 30 degrees. d. Provide feedings via continuous infusion. 7. A patient who is receiving continuous enteral feedings has just vomited 250 mL of milky green fluid. This is a concern because this most likely demonstrates that the patient has: a. a bowel obstruction. b. developed an ileus. c. gastrointestinal bleeding. d. tube feeding intolerance. 8. A patient is receiving enteral feedings and has just vomited 250 mL of milky green liquid. The nurse holds the tube feeding, which had been infusing at 100 mL/hr. The nurse knows that the next action should be: a. connect the feeding tube to suction. b. continue the tube feeding. c. decrease the tube feeding. d. recheck the residual in 2 hours. 9. In addition to residual stomach volume, what other evidence suggests feeding intolerance? a. Abdominal distention b. Absence of tympany on percussion c. Active bowel sounds d. Elevated blood glucose by fingerstick 10. Approximately 5 days after starting tube feedings, a patient develops extreme diarrhea. A stool specimen is collected to check for which possible cause? a. Clostridium difficile b. Escherichia coli c. Occult blood d. Ova and parasites 11. A patient with acute pancreatitis i