High Acuity Nursing, 7e (Wagner)
Chapter 1 High-Acuity Nursing
1) The patient who had surgery yesterday reports his chest feels tight. Assessment reveals
respiratory rate of 29, inspiratory wheezes, stridor, and an oxygenation saturation of 80%. The
nurse would consider this patient to be which priority for transfer to the intensive care unit
(ICU)?
1. Priority 1
2. Priority 2
3. Priority 3
4. Priority 4
Answer: 1
Explanation: 1. This patient is exhibiting signs of an acute respiratory event for which intubation
or other intensive treatment may be necessary. Priority 1 patients are acutely ill and need
intensive treatment and monitoring not provided outside of the ICU.
2. Priority 2 refers to patients who need intensive monitoring and may potentially need additional
interventions. They are typically not evolving an acute event as is the case with this patient.
3. Priority 3 patients are critically ill but have little chance of recovery from their illnesses.
Limits are placed on therapeutic interventions and they can be cared for in areas other than the
ICU if necessary.
4. Priority 4 patients have no signs or symptoms that indicate intensive monitoring or treatment
are necessary.
Page Ref: 2
Cognitive Level: Analyzing
Client Need/Sub: Safe Effective Care Environment : Management of Care
Standards: QSEN Competencies: I.A.11 Examine nursing roles in assuring coordination,
integration, and continuity of care. | AACN Essential Competencies: IX.11 Provide nursing care
based on evidence that contributes to safe and high-quality patient outcomes within healthcare
microsystems. | NLN Competencies: Context and Environment: Practice: Apply professional
standards; show accountability for nursing judgment and actions; develop advocacy skills. |
Nursing/Integrated Concepts: Nursing Process: Planning
LO & MNL LO: LO01: Describe the various healthcare environments in which high-acuity
clients receive care.
1
Copyright © 2019 Pearson Education, Inc.
,2) The daughter of a patient who is dying questions the placement of her father on the medical-
surgical care unit (MSCU). She requests he be placed in the intensive care unit (ICU) because of
concern her father may not receive close observation on a busy hospital unit. Which action is
indicated by the nurse?
1. Notify the intensive care unit of an impending transfer.
2. Tell the daughter that her father does not meet criteria for placement in the more expensive
ICU.
3. Discuss the care that can be provided on the unit with the family member.
4. Contact the physician.
Answer: 3
Explanation: 1. The nurse cannot make this transfer decision independently.
2. Telling the daughter that her father does not meet criteria for transfer is not therapeutic.
Bringing up the issue of cost may cause the daughter to offer to pay the difference between the
costs of the two units. This would create a serious ethical dilemma.
3. The best initial response is to help the daughter understand the level of care and observation
that will be provided on the MSCU to help her understand that her father's care will be a priority.
4. The nurse should try to intervene in this situation before involving the physician.
Page Ref: 2
Cognitive Level: Analyzing
Client Need/Sub: Safe Effective Care Environment : Management of Care
Standards: QSEN Competencies: I.A.11 Examine nursing roles in assuring coordination,
integration, and continuity of care. | AACN Essential Competencies: IX.11 Provide nursing care
based on evidence that contributes to safe and high-quality patient outcomes within healthcare
microsystems. | NLN Competencies: Context and Environment: Practice: Apply professional
standards; show accountability for nursing judgment and actions; develop advocacy skills. |
Nursing/Integrated Concepts: Nursing Process: Implementation
LO & MNL LO: LO01: Describe the various healthcare environments in which high-acuity
clients receive care.
2
Copyright © 2019 Pearson Education, Inc.
, 3) A nurse who is contemplating taking a position in an intensive care unit is reviewing her
strengths and weaknesses. Which characteristics of the nurse will be of the greatest benefit in the
intensive care environment?
1. Feels comfortable in ever-changing situations
2. Closely evaluates the pros and cons of each decision for a long period of time before making a
decision
3. Is quiet and introverted
4. Is excited about all new experiences
Answer: 1
Explanation: 1. The nurse in the intensive care unit must be open to ever-changing situations.
The nurse must be flexible.
2. The rapid changes in the intensive care unit do not allow for extended time when considering
actions.
3. A quiet and introverted nurse may not be a good match for the high-paced, high-acuity care
unit due to the need for teamwork and interaction.
4. Excitement about all experiences is a beneficial characteristic in healthcare but is not the most
important factor for this care unit.
Page Ref: 5
Cognitive Level: Analyzing
Client Need/Sub: Safe Effective Care Environment : Management of Care
Standards: QSEN Competencies: II.B.1 Demonstrate awareness of own strengths and limitations
as a team member. | AACN Essential Competencies: II.8 Promote achievement of safe and
quality outcomes of care for diverse populations. | NLN Competencies: Context and
Environment: Practice: Apply professional standards; show accountability for nursing judgment
and actions; develop advocacy skills. | Nursing/Integrated Concepts: Nursing Process:
Assessment
LO & MNL LO: LO02: Identify the need for resource allocation and staffing strategies for high-
acuity clients.
3
Copyright © 2019 Pearson Education, Inc.
Chapter 1 High-Acuity Nursing
1) The patient who had surgery yesterday reports his chest feels tight. Assessment reveals
respiratory rate of 29, inspiratory wheezes, stridor, and an oxygenation saturation of 80%. The
nurse would consider this patient to be which priority for transfer to the intensive care unit
(ICU)?
1. Priority 1
2. Priority 2
3. Priority 3
4. Priority 4
Answer: 1
Explanation: 1. This patient is exhibiting signs of an acute respiratory event for which intubation
or other intensive treatment may be necessary. Priority 1 patients are acutely ill and need
intensive treatment and monitoring not provided outside of the ICU.
2. Priority 2 refers to patients who need intensive monitoring and may potentially need additional
interventions. They are typically not evolving an acute event as is the case with this patient.
3. Priority 3 patients are critically ill but have little chance of recovery from their illnesses.
Limits are placed on therapeutic interventions and they can be cared for in areas other than the
ICU if necessary.
4. Priority 4 patients have no signs or symptoms that indicate intensive monitoring or treatment
are necessary.
Page Ref: 2
Cognitive Level: Analyzing
Client Need/Sub: Safe Effective Care Environment : Management of Care
Standards: QSEN Competencies: I.A.11 Examine nursing roles in assuring coordination,
integration, and continuity of care. | AACN Essential Competencies: IX.11 Provide nursing care
based on evidence that contributes to safe and high-quality patient outcomes within healthcare
microsystems. | NLN Competencies: Context and Environment: Practice: Apply professional
standards; show accountability for nursing judgment and actions; develop advocacy skills. |
Nursing/Integrated Concepts: Nursing Process: Planning
LO & MNL LO: LO01: Describe the various healthcare environments in which high-acuity
clients receive care.
1
Copyright © 2019 Pearson Education, Inc.
,2) The daughter of a patient who is dying questions the placement of her father on the medical-
surgical care unit (MSCU). She requests he be placed in the intensive care unit (ICU) because of
concern her father may not receive close observation on a busy hospital unit. Which action is
indicated by the nurse?
1. Notify the intensive care unit of an impending transfer.
2. Tell the daughter that her father does not meet criteria for placement in the more expensive
ICU.
3. Discuss the care that can be provided on the unit with the family member.
4. Contact the physician.
Answer: 3
Explanation: 1. The nurse cannot make this transfer decision independently.
2. Telling the daughter that her father does not meet criteria for transfer is not therapeutic.
Bringing up the issue of cost may cause the daughter to offer to pay the difference between the
costs of the two units. This would create a serious ethical dilemma.
3. The best initial response is to help the daughter understand the level of care and observation
that will be provided on the MSCU to help her understand that her father's care will be a priority.
4. The nurse should try to intervene in this situation before involving the physician.
Page Ref: 2
Cognitive Level: Analyzing
Client Need/Sub: Safe Effective Care Environment : Management of Care
Standards: QSEN Competencies: I.A.11 Examine nursing roles in assuring coordination,
integration, and continuity of care. | AACN Essential Competencies: IX.11 Provide nursing care
based on evidence that contributes to safe and high-quality patient outcomes within healthcare
microsystems. | NLN Competencies: Context and Environment: Practice: Apply professional
standards; show accountability for nursing judgment and actions; develop advocacy skills. |
Nursing/Integrated Concepts: Nursing Process: Implementation
LO & MNL LO: LO01: Describe the various healthcare environments in which high-acuity
clients receive care.
2
Copyright © 2019 Pearson Education, Inc.
, 3) A nurse who is contemplating taking a position in an intensive care unit is reviewing her
strengths and weaknesses. Which characteristics of the nurse will be of the greatest benefit in the
intensive care environment?
1. Feels comfortable in ever-changing situations
2. Closely evaluates the pros and cons of each decision for a long period of time before making a
decision
3. Is quiet and introverted
4. Is excited about all new experiences
Answer: 1
Explanation: 1. The nurse in the intensive care unit must be open to ever-changing situations.
The nurse must be flexible.
2. The rapid changes in the intensive care unit do not allow for extended time when considering
actions.
3. A quiet and introverted nurse may not be a good match for the high-paced, high-acuity care
unit due to the need for teamwork and interaction.
4. Excitement about all experiences is a beneficial characteristic in healthcare but is not the most
important factor for this care unit.
Page Ref: 5
Cognitive Level: Analyzing
Client Need/Sub: Safe Effective Care Environment : Management of Care
Standards: QSEN Competencies: II.B.1 Demonstrate awareness of own strengths and limitations
as a team member. | AACN Essential Competencies: II.8 Promote achievement of safe and
quality outcomes of care for diverse populations. | NLN Competencies: Context and
Environment: Practice: Apply professional standards; show accountability for nursing judgment
and actions; develop advocacy skills. | Nursing/Integrated Concepts: Nursing Process:
Assessment
LO & MNL LO: LO02: Identify the need for resource allocation and staffing strategies for high-
acuity clients.
3
Copyright © 2019 Pearson Education, Inc.
