Chapter 01: Critical Care Nursing Practice
Urden: Critical Care Nursing, 8th Edition

MULTIPLE CHOICE

	1.	During World War II, what type of wards were developed to care for critically injured patients?
a.	Intensive care	
b.	Triage	
c.	Shock	
d.	Postoperative	

ANS:	C
During World War II, shock wards were established to care for critically injured patients. Triage wards establish the order in which a patient is seen or treated upon arrival to a hospital. Postoperative wards were developed in 1900 and later evolved into intensive care units.

PTS:	1	DIF:	Cognitive Level: Remembering	REF:	p. 1
OBJ:	Nursing Process Step: N/A	TOP:	Critical Care Nursing Practice
MSC:	NCLEX: Safe and Effective Care Environment

	2.	What type of practitioner has a broad depth of specialty knowledge and expertise and manages complex clinical and system issues?
a.	Registered nurses	
b.	Advanced practice nurses	
c.	Clinical nurse leaders	
d.	Intensivists	

ANS:	B
Advanced practice nurses (APNs) have a broad depth of knowledge and expertise in their specialty area and manage complex clinical and systems issues. Intensivists are medical practitioners who manage the critical ill patient. Registered nurses (RNs) are generally direct care providers. Clinical nurse leaders (CNLs) generally do not manage system issues.

PTS:	1	DIF:	Cognitive Level: Remembering	REF:	p. 2
OBJ:	Nursing Process Step: N/A	TOP:	Critical Care Nursing Practice
MSC:	NCLEX: Safe and Effective Care Environment

	3.	What type of practitioner is instrumental in ensuring care that is evidence based and that safety programs are in place?
a.	Clinical nurse specialist	
b.	Advanced practice nurse	
c.	Registered nurses	
d.	Nurse practitioners	

ANS:	A
Clinical nurse specialists (CNSs) serve in specialty roles that use their clinical, teaching, research, leadership, and consultative abilities. They are instrumental in ensuring that care is evidence based and that safety programs are in place. Advanced practice nurses (APNs) have a broad depth of knowledge and expertise in their specialty area and manage complex clinical and systems issues. Registered nurses are generally direct care providers. Nurse practitioners (NPs) manage direct clinical care of groups of patients.

PTS:	1	DIF:	Cognitive Level: Remembering	REF:	p. 2
OBJ:	Nursing Process Step: N/A	TOP:	Critical Care Nursing Practice
MSC:	NCLEX: Safe and Effective Care Environment

	4.	Which professional organization administers critical care certification exams for registered nurses?
a.	State Board of Registered Nurses	
b.	National Association of Clinical Nurse Specialist	
c.	Society of Critical Care Medicine	
d.	American Association of Critical-Care Nurses	

ANS:	D
American Association of Critical-Care Nurses (AACN) administers certification exams for registered nurses. The State Board of Registered Nurses (SBON) does not administer certification exams. National Association of Clinical Nurse Specialists (NACNS) does not administer certification exams. Society of Critical Care Medicine (SCCM) does not administer nursing certification exams for registered nurses.

PTS:	1	DIF:	Cognitive Level: Remembering	REF:	p. 3
OBJ:	Nursing Process Step: N/A	TOP:	Critical Care Nursing Practice
MSC:	NCLEX: Safe and Effective Care Environment

	5.	Emphasis is on human integrity and stresses the theory that the body, mind, and spirit are interdependent and inseparable. This statement describes which methodology of care?
a.	Holistic care	
b.	Individualized care	
c.	Cultural care	
d.	Interdisciplinary care	

ANS:	A
Holistic care focuses on human integrity and stresses that the body, mind, and spirit are interdependent and inseparable. Individualized care recognizes the uniqueness of each patient’s preferences, condition, and physiologic and psychosocial status. Cultural diversity in health care is not a new topic, but it is gaining emphasis and importance as the world becomes more accessible to all as the result of increasing technologies and interfaces with places and peoples. Interdisciplinary care is care among a variety of health care professionals with the patient’s health as the common goal.

PTS:	1	DIF:	Cognitive Level: Remembering	REF:	p. 4
OBJ:	Nursing Process Step: N/A	TOP:	Critical Care Nursing Practice
MSC:	NCLEX: Safe and Effective Care Environment

	6.	The American Association of Critical-Care Nurses (AACN) has developed short directives that can be used as quick references for clinical use that are known as
a.	Critical Care Protocol.	
b.	Practice Policies.	
c.	Evidence-Based Research.	
d.	Practice Alerts.	

ANS:	D
The American Association of Critical-Care Nurses (AACN) has promulgated several evidence-based practice summaries in the form of “Practice Alerts.” Evidence-based nursing practice considers the best research evidence on the care topic along with clinical expertise of the nurse and patient preferences. Critical care protocol and practice policies are established by individual institutions.

PTS:	1	DIF:	Cognitive Level: Remembering	REF:	p. 3
OBJ:	Nursing Process Step: N/A	TOP:	Critical Care Nursing Practice
MSC:	NCLEX: Safe and Effective Care Environment

	7.	What type of therapy is an option to conventional treatment?
a.	Alternative	
b.	Holistic	
c.	Complementary	
d.	Individualized	

ANS:	A
The term alternative denotes that a specific therapy is an option or alternative to what is considered conventional treatment of a condition or state. The term complementary was proposed to describe therapies that can be used to complement or support conventional treatments. Holistic care focuses on human integrity and stresses that the body, mind, and spirit are interdependent and inseparable. Individualized care recognizes the uniqueness of each patient’s preferences, condition, and physiologic and psychosocial status.

PTS:	1	DIF:	Cognitive Level: Remembering	REF:	p. 4
OBJ:	Nursing Process Step: N/A	TOP:	Critical Care Nursing Practice
MSC:	NCLEX: Safe and Effective Care Environment

	8.	Prayer, guided imagery, and massage are all examples of what type of treatment?
a.	Alternative therapy	
b.	Holistic care	
c.	Complementary care	
d.	Individualized care	

ANS:	C
The term complementary was proposed to describe therapies that can be used to complement or support conventional treatments. Spirituality, prayer, guided imagery, massage, and animal-assisted therapy are all examples of complementary care. The term alternative denotes that a specific therapy is an option or alternative to what is considered conventional treatment of a condition or state. Holistic care focuses on human integrity and stresses that the body, mind, and spirit are interdependent and inseparable. Individualized care recognizes the uniqueness of each patient’s preferences, condition, and physiologic and psychosocial status.

PTS:	1	DIF:	Cognitive Level: Understanding	REF:	p. 4
OBJ:	Nursing Process Step: N/A	TOP:	Critical Care Nursing Practice
MSC:	NCLEX: Safe and Effective Care Environment

	9.	What is the systematic decision-making model used by nurses termed?
a.	Nursing diagnosis	
b.	Nursing interventions	
c.	Nursing evaluations	
d.	Nursing process	

ANS:	D
The nursing process is a systematic decision-making model that is cyclic, not linear. An essential and distinguishing feature of any nursing diagnosis is that it describes a health condition. Nursing interventions constitute the treatment approach to an identified health alteration. Evaluation of attainment of the expected patient outcomes occurs formally at intervals designated in the outcome criteria.

PTS:	1	DIF:	Cognitive Level: Understanding	REF:	n/a
OBJ:	Nursing Process Step: General	TOP:	Critical Care Nursing Practice
MSC:	NCLEX: Safe and Effective Care Environment

	10.	What is a health condition primarily resolved by nursing interventions or therapies called?
a.	Nursing diagnosis	
b.	Nursing interventions	
c.	Nursing outcomes	
d.	Nursing process	

ANS:	A
An essential and distinguishing feature of any nursing diagnosis is that it describes a health condition. Nursing interventions constitute the treatment approach to an identified health alteration. Evaluation of attainment of the expected patient outcomes occurs formally at intervals designated in the outcome criteria. The nursing process is a systematic decision-making model that is cyclic, not linear.

PTS:	1	DIF:	Cognitive Level: Remembering	REF:	n/a
OBJ:	Nursing Process Step: General	TOP:	Critical Care Nursing Practice
MSC:	NCLEX: Safe and Effective Care Environment

	11.	Designing therapeutic activities that move a patient from one state of health to another is an example of which of the following?
a.	Nursing diagnosis	
b.	Nursing interventions	
c.	Nursing outcomes	
d.	Nursing process	

ANS:	B
Nursing interventions constitute the treatment approach to an identified health alteration. An essential and distinguishing feature of any nursing diagnosis is that it describes a health condition. Evaluation of attainment of the expected patient outcomes occurs formally at intervals designated in the outcome criteria. The nursing process is a systematic decision-making model that is cyclic, not linear.

PTS:	1	DIF:	Cognitive Level: Remembering	REF:	n/a
OBJ:	Nursing Process Step: General	TOP:	Critical Care Nursing Practice
MSC:	NCLEX: Safe and Effective Care Environment

	12.	A patient was admitted to a rural critical care unit in Montana. Critical care nurses are assisting with monitoring and care of the patient from the closest major city. What is this type of practice termed?
a.	Tele-nursing	
b.	Tele-ICU	
c.	Tele-informatics	
d.	Tele-hospital	

ANS:	B
Tele-ICU is a form of telemedicine. Telemedicine was initially used in outpatient areas, remote rural geographic locations, and areas where there was a dearth of medical providers. Currently, there are tele-ICUs in areas where there are limited resources onsite. However, experts (critical care nurses, intensivists) are located in a central distant site.

PTS:	1	DIF:	Cognitive Level: Understanding	REF:	p. 5
OBJ:	Nursing Process Step: General	TOP:	Critical Care Nursing Practice
MSC:	NCLEX: Safe and Effective Care Environment

	13.	Which core competency for interprofessional practice can be described as working with individuals of other professions to maintain a climate of mutual respect and shared values?
a.	Interprofessional teamwork and team-based care	
b.	Values and ethics for interprofessional practice	
c.	Interprofessional communication	
d.	Roles and responsibilities for collaborative practice	

ANS:	B
Values and ethics for interprofessional practice mean working with individuals of other professions to maintain a climate of mutual respect and shared values. Roles and responsibilities for collaborative practice include using knowledge of one’s own role and the roles of other professions to appropriately assess and address the health care needs of the patients and populations served. Interprofessional communication includes communicating with patients, families, communities, and other health professionals in a responsive and responsible manner that supports a team approach to maintaining health and treatment of disease. Interprofessional teamwork and team-based care means applying relationship-building values and principles of team dynamics to perform effectively in different team roles to plan and deliver patient population-centered care that is safe, timely, efficient, effective, and equitable.

PTS:	1	DIF:	Cognitive Level: Remembering	REF:	p. 5|Box 1-5
OBJ:	Nursing Process Step: General	TOP:	Critical Care Nursing Practice
MSC:	NCLEX: Safe and Effective Care Environment

	14.	What is the stepwise decision-making flowchart for a specific care process named?
a.	Algorithm	
b.	Practice guideline	
c.	Protocol	
d.	Order set	

ANS:	A
An algorithm is a stepwise decision-making flowchart for a specific care process or processes. A practice guideline is usually created by an expert panel and developed by a professional organization. Protocols are more directive and rigid than guidelines, and providers are not supposed to vary from a protocol. An order set consists of preprinted provider orders that are used to expedite the order process after a standard has been validated through analytic review of practice and research.

PTS:	1	DIF:	Cognitive Level: Understanding	REF:	p. 6
OBJ:	Nursing Process Step: Intervention	TOP:	Critical Care Nursing Practice
MSC:	NCLEX: Safe and Effective Care Environment

	15.	Which nursing intervention continues to be one of the most error-prone for critical care nurses?
a.	Inappropriate care	
b.	Intimidating and disruptive clinician behavior	
c.	Injury to patients by falls	
d.	Medication administration	

ANS:	D
Medication administration continues to be one of the most error-prone nursing interventions for critical care nurses. Intimidating and disruptive clinician behaviors can lead to errors and preventable adverse patient outcomes. Patient safety has been described as an ethical imperative and one that is inherent in health care professionals’ actions and interpersonal processes; examples include inappropriate care and injury to patients by falls.

PTS:	1	DIF:	Cognitive Level: Remembering	REF:	p. 7
OBJ:	Nursing Process Step: Assessment	TOP:	Critical Care Nursing Practice
MSC:	NCLEX: Safe and Effective Care Environment

	16.	A practitioner and nurse are performing a dressing change on an unresponsive patient in room 14. The practitioner asks the nurse for an update on the patient in room 13. Which action should the nurse take next?
a.	Give the update to the practitioner.	
b.	Refuse to give the update because of Health Insurance Portability and Accountability Act (HIPAA) requirements.	
c.	Give the update because the is patient’s unconscious.	
d.	Refuse to give the update because of Occupational Safety and Health Administration (OSHA) requirements.	

ANS:	B
Most specific to critical care clinicians is the privacy and confidentiality related to protection of health care data. This has implications when interacting with family members and others and the often very close work environments, tight working spaces, and emergency situations. A patient’s unconscious state is not a reason for another patient’s care to be discussed in his or her presence. Research shows hearing is the last sense to deteriorate. Occupational Safety and Health Administration (OSHA) has to do with safety in the workplace, not privacy and confidentiality.

PTS:	1	DIF:	Cognitive Level: Applying	REF:	p. 8
OBJ:	Nursing Process Step: N/A	TOP:	Critical Care Nursing Practice
MSC:	NCLEX: Safe and Effective Care Environment

MULTIPLE RESPONSE

	1.	What considerations are taken into account in evidence-based nursing practice? (Select all that apply.)
a.	Clinical expertise of the nurse	
b.	Availability of staff and facility equipment	
c.	Research evidence on the topic	
d.	Patient knowledge of the disease	
e.	Patient preference regarding care	

ANS:	A, C, E
Evidence-based nursing practice considers the best research evidence on the care topic along with clinical expertise of the nurse and patient preferences. For instance, when determining the frequency of vital sign measurement, the nurse would use available research and nursing judgment (stability, complexity, predictability, vulnerability, and resilience of the patient). Availability of staff and facility equipment and the patient’s knowledge of the disease do not factor into evidence-based nursing practices.

PTS:	1	DIF:	Cognitive Level: Remembering	REF:	p. 3
OBJ:	Nursing Process Step: Assessment	TOP:	Critical Care Nursing Practice
MSC:	NCLEX: Safe and Effective Care Environment

	2.	The concept of diversity encompasses what thoughts and actions? (Select all that apply.)
a.	Sensitivity to ethnic differences	
b.	Openness to different lifestyles	
c.	Openness to different values	
d.	Reticence to different beliefs	
e.	Lack of concern regarding different opinions	

ANS:	A, B, C
Diversity includes not only ethnic sensitivity but also sensitivity to openness to difference lifestyles, opinions, values, and beliefs. Reticence and lack of concern are not part of the concept of diversity.

PTS:	1	DIF:	Cognitive Level: Evaluating	REF:	p. 4
OBJ:	Nursing Process Step: N/A	TOP:	Critical Care Nursing Practice
MSC:	NCLEX: Safe and Effective Care Environment

	3.	According to American Association of Critical-Care Nurses, what are the responsibilities of a critical care nurse? (Select all that apply.)
a.	Respecting the values, beliefs, and rights of the patient	
b.	Intervening when the best interest of the patient is in question	
c.	Helping the patient obtain necessary care	
d.	Making decisions for the patient and patient’s family	
e.	Monitoring and safeguarding the quality of care the patient receives	
f.	Acting as a gatekeeper for the patient, the patient’s family, and other health care professionals	

ANS:	A, B, C, E
American Association of Critical-Care Nurses (AACN) critical care nurse role responsibilities include respecting the values, beliefs, and rights of the patient; intervening when the best interest of the patient is in question; helping the patient obtain necessary care; and monitoring and safeguarding the quality of care the patient receives. The nurse is not to make decisions for the patient or the patient’s family but should support their decisions. The nurse should act as a liaison, not a gatekeeper, for the patient and the patient’s family and other health care professionals.

PTS:	1	DIF:	Cognitive Level: Evaluating	REF:	p. 2|Box 1-1
OBJ:	Nursing Process Step: N/A	TOP:	Critical Care Nursing Practice
MSC:	NCLEX: Safe and Effective Care Environment

	4.	According to Kupperschmidt, what factors are needed to become a skilled communicator? (Select all that apply.)
a.	Becoming candid	
b.	Becoming reflective	
c.	Setting goals	
d.	Surveying the team	
e.	Becoming aware of self-deception	

ANS:	A, B, E
Kupperschmidt and colleagues posed a five-factor model for becoming a skilled communicator: becoming aware of self-deception, becoming authentic, becoming candid, becoming mindful, and becoming reflective, all of which lead to being a skilled communicator. The HWE model was offered by Blake, who suggested five steps: rallying the team, surveying the team, establishing work groups, setting goals and developing action steps, and celebrating successes along the way.

PTS:	1	DIF:	Cognitive Level: Evaluating	REF:	p. 9
OBJ:	Nursing Process Step: General	TOP:	Critical Care Nursing Practice
MSC:	NCLEX: Safe and Effective Care Environment