CRITICAL CARE NURSING A HOLISTIC APPROACH 11TH EDITION MORTON FONTAINE TEST BANK LATEST 2024 UPDATE WITH CORRECT QUESTIONS &ANSWERS(CHAPTER 1-56) 100% APPROVED GRADED A+ (ANSWER KEY AT THE END OF EVERY CHAPTER)

TEST BANK CRITICAL CARE NURSING A HOLISTIC APPROACH 11TH EDITION MORTON FONTAINE TEST BANK LATEST 2024 UPDATE WITH CORRECT QUESTIONS &ANSWERS(CHAPTER 1-56) 100% APPROVED GRADED A+ (ANSWER KEY AT THE END OF EVERY CHAPTER) Chapter 1 Critical Care Nursing Practice: Promoting Excellence-Caring,Collaboration Evidence 1. A nurse is the only one in the ICU who has not achieved certification in critical care nursing. She often will ask her fellow nurses what to do in caring for a patient because she doubts the accuracy of her knowledge and her intuition. She loves her work but wishes she could do it with a greater level of competence. What is the most important effect that obtaining certification would likely have on the nurses practice? A) Recognition by peers B) Increase in salary and rank C) More flexibility in seeking employment D) Increased confidence in making decisions 2. A hospital interviews two different candidates for a position in the ICU. Both candidates have around 10 years of experience working in the ICU. Both have excellent interpersonal skills and highly positive references. One, however, has certification in critical care nursing. Which of the following is the most compelling and accurate reason for the hospital to hire the candidate with certification? A) The certified nurse will have more knowledge and expertise. B) The certified nurse will behave more ethically. C) The certified nurse will be more caring toward patients. D) The certified nurse will work more collaboratively with other nurses. 3. A nurse is caring for an elderly man recently admitted to the ICU following a stroke. She assesses his cognitive function using a new cognitive assessment test she learned about in a recent article in a nursing journal. She then brings a cup of water and a straw to the patient because she observes that his lips are dry. Later, she has the patient sit in a wheelchair and takes him to have some blood tests performed. He objects at first, saying that he can walk on his own, but the nurse explains that it is hospital policy to use the wheelchair. That evening, she recognizes signs of an imminent stroke in the patient and immediately pages the physician. Which action taken by the nurse is the best example of evidence-based practice? A) Giving the patient a cup of water B) Transferring the patient in a wheelchair C) Using the cognitive assessment test D) Recognizing signs of imminent stroke and paging the physician 4. A nurse is on a committee that is trying to reduce the occurrence of hospital-acquired infections in the ICU. Her role is to conduct research to find which interventions have been shown to be most effective in reducing these infections. She consults many different sources and finds conflicting information. Which of the following sources should she consider the most authoritative? A) AACN expert panel report B) A meta-analysis of randomized controlled trials in the American Journal of Nursing C) A systematic review of qualitative studies in the Journal of Advanced Nursing D) A single randomized controlled trial in the American Journal of Critical Care 5. A nurse who has been recently hired to manage the nursing staff of the ICU is concerned at the lack of evidence-based practice she sees among the staff. Which of the following would be the best step for her to take to promote incorporating evidence into clinical practice? A) Only hire nurses certified in critical care nursing. B) Leave copies of several different nursing journals in the nurses lounge. C) Demonstrate to the staff the best nursing-related search terms to use in Google or Yahoo! D) Introduce the staff to the PubMed search engine and assign them topics to research on it. 6. A physician visits a patient in the ICU while the nurse is out. The patient complains that the pain medication is not effective and that he would like to receive an increased dose. The physician has the nurse paged and consults with him in the hallway regarding the patients request for stronger pain medication. The nurse explains that patient was started on a morphine drip only 20 minutes ago and that the drug has not had time to take effect yet. The physician agrees and tells the patient to give it just a bit more time. Which component of a healthy work environment is most evident in this scenario? A) Skilled communication B) Appropriate staffing C) True collaboration D) Meaningful recognition 7. A nurse in the ICU is responding to a patient who has just gone into cardiac arrest. A moment later, the nurse is notified that another patient has just gone into anaphylactic shock due to a drug allergy. She is conflicted as to what to do, as she is the only nurse available at the moment to tend to both patients. Which component of a healthy work environment is lacking in this scenario? A) Effective decision making B) Appropriate staffing C) Authentic leadership D) Meaningful recognition 8. An ICU nurse has provided excellent care for a 6-year-old girl who had been admitted to the ICU for a head injury. The nurse was attentive not only to the needs of the patient but also went out of her way to care for the needs of the girls family. According to research, which of the following forms of recognition would the nurse value the most? A) A card from the girls family B) A plaque from the ICU physicians naming her as Nurse of the Year C) A letter of commendation from the hospitals administration D) A bouquet of flowers from her supervisor 9. A patient in the ICU has recently been diagnosed with diabetes mellitus. Before being discharged, this patient will require detailed instructions on how to manage her diet, how to self-inject insulin, and how to handle future diabetic emergencies. Which nurse competency is most needed in this situation? A) Clinical judgment B) Advocacy and moral agency C) Caring practices D) Facilitation of learning 10. An elderly patient is admitted to the ICU with stage IV lung cancer, diabetes mellitus, and congestive heart failure. The health care team assembled to care for her is large and diverse, including an oncologist, a pulmonologist, an endocrinologist, a cardiologist, and others. The patient is not expected to survive more than a few weeks, and her husband is overwhelmed with stress and grief. Which nurse competency or competencies are most needed in this situation? Select all that apply. A) Clinical judgment B) Caring practices C) Collaboration D) Response to diversity 11. An Ethiopian man with AIDS has recently been admitted to the ICU with a case of pneumonia. The man is new to the U.S. and has no health insurance. He would likely be eligible for the states Medicaid coverage, but does not understand how to access this coverage. Which competency or competencies are most needed in this situation? Select all that apply. A) Clinical judgment B) Advocacy and moral agency C) Collaboration D) Systems thinking E) Response to diversity F) Clinical inquiry 12. A nurse decides to seek certification in critical care nursing. What is the most important benefit for the individual nurse in becoming certified in a specialty? A) It will result in a salary increase. B) It is required to work in critical care. C) It demonstrates the nurses personal expertise. D) It is mandated by employers. 13. The American Association of Critical-Care Nurses (AACN) sponsors certification in critical care nursing for several critical care subspecialties. What is the most important benefit of such certification for the profession of nursing? A) Provides positive publicity for nursing B) Validates nurses expert knowledge and practice C) Mandated by government regulations D) Demonstrates basic knowledge in the field 14. A nurse has achieved certification in critical care nursing. What is the most important effect that this certification will have on the nurses practice? A) Recognition by peers B) Increase in salary and rank C) More flexibility in seeking employment D) Increased confidence in critical thinking 15. The nurse cites evidence-based practice as a rationale for a patient care decision. What is the best description of evidence-based practice? A) Decisions based on expert legal testimony B) Use of best available research data C) Evolution of nursing practice over time D) Individual optimization of patient outcomes 16. The nurse caring for a critically ill patient implements several components of care. What component is an example of the use of evidence-based practice? A) Use of a protocol for admission of a patient to the unit B) Application of an insulin sliding scale method from research C) Checking the patients armband before giving a medication D) Limiting visits to immediate family only for 2 hours a day 17. The nurse wishes to increase the use of evidence-based practice in the critical care unit where he works. What is a significant barrier to the implementation of evidence-based practice? A) Use of computerized records by the hospital B) Health Information Privacy and Portability Act (HIPPA) C) Lack of knowledge about literature searches D) Strong collaborative relationships in the work setting 18. The nurse has identified an increase in medication errors in the critical care unit over the past several months. What aspect of medication procedures should be evaluated first? A) Adherence to procedures by nursing staff B) Clarity of interdisciplinary communication C) Number of new employees on the unit D) Changes in administration procedures 19. A critical care unit has decided to implement several measures designed to improve intradisciplinary and interdisciplinary collaboration. In addition to an expected improvement in patient outcomes, what is the most important effect that should result from these measures? A) Identification of incompetent practitioners B) Improvement in manners on the unit C) Increased staff retention D) Less discussion in front of patients and families 20. A nurse wishes to practice using the Synergy Model developed by the American Association of Critical-Care Nurses (AACN). What nursing behavior best supports use of this model? A) Attending mandatory hospital-wide in-service programs B) Self-directed study of best practice for the patients she cares for C) Gathering demographic data on the patients admitted to the unit D) Participating in a research study as a data collector 21. As part of the Synergy Model, the nurse has identified a patient characteristic of resiliency. What patient behavior demonstrates resiliency? A) Dysfunctional grieving behaviors after receiving bad news B) Developing a list of questions for the physician C) Denial of any possible negative outcomes for a procedure D) Assigning blame to others for undesired outcomes of illness 22. A patient is admitted to the critical care unit after receiving a mechanical heart implantation. In making a nursing assignment, the charge nurse best demonstrates application of the Synergy Model by assigning which nurse to care for this patient? A) A newly hired new graduate nurse, for the experience B) A nurse with a patient in the next room, for proximity C) The most senior nurse on the unit, for political reasons D) The nurse with most experience with this device, for expertise 23. A Muslim patient has been admitted to the critical care unit with complications after childbirth. Based on the Synergy Model, which nurse would be the most inappropriate to assign to care for this patient? A) New graduate female nurse B) Most experienced female nurse C) New graduate male nurse D) Female nurse with postpartum experience 24. Todays critical care nursing environment is constantly changing. What nursing behavior best illustrates awareness of current events affecting critical care nursing? A) Participating in the hospitals efforts to recruit new nurses B) Volunteering to serve on a disaster response planning committee C) Adhering to content taught in basic nursing program D) Attending hospital-mandated in-services without other education Answer Key 1. D 2. A 3. C 4. B 5. D 6. C 7. B 8. A 9. D 10. B, C 11. B, D, E 12. C 13. B 14. D 15. B 16. B 17. C 18. B 19. C 20. B 21. B 22. D 23. C 24. B Chapter 2 The Patient’s Experience With Critical Illness 1. The critical care unit environment is very stressful for patients, families, and staff. What nursing action is directed at reducing environmental stress? A) Constant evaluation of patient status B) Limiting visits to immediate family C) Bathing all patients during hours of sleep D) Maintaining quiet during hours of sleep 2. A patient is transferred to the ICU from the Birth Center of the hospital in the middle of the night after experiencing complications during delivery of her baby. The patients husband is anxious and explains to the ICU nurse that he doesnt understand why his wife has been moved to the ICU. She is going to die, isnt she? he asks the nurse. What is the nurses best response? A) Explain that every measure will be taken to provide his wife with the best care possible. B) Explain that the nurse is fully trained and has years of experience. C) Offer the husband a place to relax. D) Have appropriate staff discuss his health insurance with him. 3. A patient is admitted to the ICU with injuries sustained from a fall from a third-story window. The patient is conscious, his breathing is labored, and he is bleeding heavily from the abdomen. He groans constantly and complains of severe pain, but his movements are minimal. His heart rate is elevated. Which of these is a sign that he is in the second phase of the stress response? Select all that apply. A) Bleeding heavily from his abdomen B) Labored, slow breathing C) Severe pain D) Elevated heart rate E) Minimal movement 4. A patient in the ICU is recovering from open-heart surgery. The nurse enters his room and observes that his daughter is performing effleurage on his arms and talking in a low voice about an upcoming family vacation that is planned. The room is dimly lit, and she hears the constant beeping of his heart monitor. From the hall she hears the cries of a patient in pain. Which of the following are likely stressors for the patient? Select all that apply. A) His daughters conversation B) His daughters effleurage C) The beeping of the heart monitor D) The dim lighting of the room E) The cries of the other patient from the hall 5. A patient in the ICU is complaining that he is not sleeping well at night because of anxiety. Which of the following would be the most helpful intervention for the nurse to make? A) Provide the patient with a bath immediately following his first 90-minute REM sleep cycle. B) Increase the patients pain medication. C) Provide the patient with 5 minutes of effleurage and then minimize disruptions. D) Monitor the patients brain waves by polysomnography to determine his sleep pattern. 6. A nurse walks into a patients room and begins preparing a syringe to perform a blood draw on the patient. The nurse observes that the patient is firmly gripping the side of the bed, averting her eyes, and sweating from her forehead when she sees the needle. What would be the best intervention for the nurse to make? A) Proceed with blood draw as quickly as possible, to get it over with. B) Offer to come back later to perform the blood draw. C) Encourage the patient to deep breathe. D) Describe briefly the blood draw procedure and explain why it is necessary. 7. A 15-year-old boy is in the ICU and preparing for an appendectomy. He is clearly anxious and fidgets with his IV constantly. He complains that he doesnt want to be there and he is sick of everyone telling him what to do. What would be the best way for the nurse to address this patients anxiety? A) Use physical restraints to keep him from pulling out his IV. B) Offer him the remote to the television. C) Lower the head of his bed so that he can rest more easily. D) Explain to the patient in detail what the appendectomy will consist of. 8. A nurse in a burn unit observes that a patient is tensed up and frowning but silent. The nurse asks the patient, Can you tell me what you are thinking now? The patient responds, I cant take this pain any more! I feel like Im about to die. What would be the best response for the nurse to give to the patient, considering that the patient is already receiving the maximum amount pain medication that is safe? A) Try to get rid of those negative thoughtsthey only make it worse. B) Try thinking instead, This pain will go away; I can overcome it. C) Your pain medication is already at the highest possible dose. D) Would you like me to raise the head of your bed? 9. A patient on mechanical ventilation is experiencing severe agitation due to being on the ventilator. Which nursing intervention would be best? A) Performing breathing exercises with the patient B) Offering the patient a patient-controlled analgesic device C) Asking the physician to prescribe an antianxiety medication D) Offering the patient the patients own MP3 player to listen to 10. A 10-year-old female patient in ICU receiving chemotherapy has requested that her dog be allowed to visit her. She is currently sharing a room with another patient. The nurse knows that the hospital does allow for pet visits with owners, but has strict guidelines. Which of the following scenarios is most likely to be permitted? A) The girls father may bring the dog in on a leash for a 20-minute visit. B) The girls sister may bring the dog in with a shirt on (to prevent shedding) for an overnight stay. C) The girls mother may bring the dog in on a leash for a visit as long as he has had all his vaccinations. D) The dog may be brought in for a brief visit once the girl is moved to a private room. 11. The nurse understands that a patient being cared for in a critical care unit experiences an acute stress response. What nursing action best demonstrates understanding of the physiological parts of the initial stress response? A) Adequate pain control B) Intravenous sedation C) Treatment for elevated blood pressure D) Ignoring an elevated glucose level 12. A critically ill patient experiences stress and anxiety from many factors. Treatment of the patient focuses on reducing stressors and providing supportive care such as nutrition, oxygenation, pain management, control of anxiety, and specific care of the illness or injury. What is the best rationale for these interventions? A) Helps to support the patients immune system B) Part of good nursing care C) Mandated by hospital policy D) Reassures the patient and family 13. A patient in a critical care unit has increased stress from the constant noise and light levels. What nursing intervention best attenuates these sources of stress? A) Need for constant observation and evaluation B) Dimming lights during the night C) Frequent nursing group rounds for all patients D) Use of tile floors for ease in cleaning 14. The nurse is caring for a patient who is orally intubated and on a mechanical ventilator. The nurse believes that the patient is experiencing excess anxiety. For this patient, what behavior best indicates anxiety? A) Restlessness B) Verbalization C) Increased respiratory rate D) Glasgow Coma Scale score of 3 15. The critical care unit environment is very stressful for patients, families, and staff. What nursing action is directed at reducing environmental stress? A) Constant expert evaluation of patient status B) Limiting visits to immediate family C) Bathing all patients during hours of sleep D) Maintaining a quiet environment during hours of sleep 16. The nurse wishes to enhance sleep cycles in her critically ill patient. Research has shown that which nursing action improves sleep in critically ill patients? A) Repositioning every 2 hours B) Hypnotic medications C) Five-minute back effleurage D) Adequate pain control 17. The nurse is caring for a critically ill patient with a very concerned family. Given that the family is under high stress, what nursing intervention will best ameliorate their stress while preserving independence? A) Encourage the family to participate in patient care tasks. B) Teach the family to ask questions of the health care team. C) Ask the family to select a family representative for communication. D) Limit visits to immediate family members for limited times. 18. While caring for a critically ill patient, the nurse knows that fostering patient control over the environment is a method for stress reduction. What nursing intervention gives the patient the most environmental control while still adhering to best practice principles? A) Ask the patient whether he or she wants to get out of bed. B) Give the patients bath at the same time every day. C) Explain painful procedures only after giving pain medication. D) Choose menu items for the patient to ensure a balanced diet. 19. The nurse is using presence to reduce the anxiety of a critically ill patient. What nursing behavior demonstrates an effective use of presence? A) Staying in the patients room to complete documentation B) Having a conversation in the patients room that excludes the patient C) Maintaining eye contact with the patient during explanations D) Focusing on specific nursing care tasks while in the patients room 20. The nurse is caring for a critically ill patient who can speak. The nurse notices that the patient is demonstrating behaviors indicative of anxiety but is silent. What nursing strategy would give the nurse the most information about the patients feelings? A) Explain procedures to the patient and family. B) Ask the patient to share his or her internal dialogue. C) Encourage the patient to nap before visiting hours. D) Ensure that the patient has adequate pain control. 21. The patient is undergoing a necessary but painful procedure that is greatly increasing her anxiety. The nurse decides to use guided imagery to help alleviate the patients anxiety. What is a key part of this technique? A) Provide the patient with an external focus point such as a picture. B) Have the patient take slow, shallow breaths while staring at a focus point. C) Have the patient remember tactile sensations of a pleasant experience. D) Encourage the patient to consciously relax all of her muscles. 22. One of the strategies shown to reduce perception of stress in critically ill patients and their families is support of spirituality. What nursing action is most clearly supportive of the patients spirituality? A) Referring patients to the Catholic chaplain B) Providing prayer booklets to patients and families C) Asking about beliefs about the universe D) Avoiding discussing religion with those of other faiths 23. A critically ill patient tells the nurse that he is not afraid to die because he believes in reincarnation. What is the most appropriate nursing response? A) What if reincarnation is not real? B) This belief gives you strength. C) I dont believe in reincarnation. D) You shouldnt base your hopes on such a belief. 24. A critically ill patient who is intubated and agitated is restrained with soft wrist restraints. Based on research findings, what is the best nursing action? A) Maintain the restraints to protect patient safety. B) Remove the restraints periodically to check skin integrity. C) Remove the restraints periodically for range of motion. D) Assess and intervene for causes of agitation. Answer Key 1. D 2. A 3. C, E 4. C, E 5. C 6. D 7. B 8. B 9. D 10. D 11. A 12. A 13. B 14. A 15. D 16. C 17. B 18. B 19. C 20. B 21. C 22. C