MS 2 Exam 1 Sole Ch. 1-6 & Iggy 5,8

1. A client is to receive 4 mg morphine sulfate IV push. The pharmacy delivers 5 mg in a 2-mL vial. How much should the nurse administer for one dose? (Record your answer using a decimal rounded to the nearest tenth.) ____ mL

1.6mL

2. A nurse is preparing to give an infusion of acetaminophen (Ofirmev). The pharmacy delivers a bag containing 50 mL of normal saline and the Ofirmev. At what rate does the nurse set the IV pump to deliver this dose? (Record your answer using a whole number.) ____ mL/hr

200mL/hr

In which of the following situations would a health care 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 health care team d) When a dying patient who is competent is receiving prn treatment for pain and anxiety

A A patient who requires heavy sedation, such as IV infusions of pain medications or anxiolytic medications, would not be competent to make health care decisions. A health care proxy or surrogate would be required in this situation.

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 man 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 woman 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 man 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 woman 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.

A Although he is younger, the 70-year-old with the complicated critical care course, limited social support, and a transfer to a long-term acute care facility is at greatest risk for decreased quality of life and functional decline. He will continue to need high-level nursing care and support for rehabilitation.

Patients often have recollections of the critical care experience. Which is likely to be the most common recollection of patients who required endotracheal intubation and mechanical ventilation? a) Difficulty in communicating b) Inability to get comfortable c) Pain d) Sleep disruption

A Although the patient may recall all of these potential experiences, recollection of difficult communication is most likely secondary to the endotracheal tube placement.

The family is considering the withdrawal of 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.

A Any treatment that is used to sustain life, including nutrition, fluids, antibiotics, blood products, and respiratory support, may be withdrawn in consultation with the patient and/ or surrogate provided that the patient has been deemed terminal or persistently vegetative.

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

A Assessment of structure should be done first so that the nurse can identify such things as who comprises the family and who assumes leadership and decision-making responsibilities. This assessment also assists in identifying which individuals are most important to the patient and how many people may be seeking information.

A critically ill patient has a living will in the chart. The patient's condition has deteriorated, but the spouse wants "everything done," regardless of the patient's wishes. Which ethical principle is the spouse violating? a) Autonomy b) Beneficence c) Justice d) Nonmaleficence

A Autonomy is respect for the individual and the ability of individuals to make decisions with regard to their own health and future. The spouse is violating the patient's autonomy in decision making.

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 ethic issues

A Completion of education related to human subject protection assists nurses in research.

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 the 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.

A DNR orders should be written before withdrawal of life support; this will prevent any unfortunate errors in unwanted resuscitation during the time period between initiation of withdrawal and the actual death.

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 distinct, complex illness for which a cure is always possible. d) The purpose of the health care system is to prevent disease and treat symptoms.

A Death is viewed as a failure by society and health care providers, a view that results in aggressive management of disease, even in unfavorable situations.

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."

A Forgoing life-sustaining treatments is not the same as active euthanasia or assisted suicide. Killing is an action causing another's death, whereas allowing dying is avoiding any intervention that interferes with a natural death following illness or trauma.

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) Creatinine: 3.1 mg/dL b) Platelet count 350,000 billion/L c) White blood count 13, 550 mm3 d) ALT 25 U/L

A Ibuprofen can result in renal insufficiency, which may be noted in an elevated serum creatinine level.

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

A Legally recognized documents that provide guidance on an individual's end-of-life choices are advance directives. Advance directives include living wills, durable powers of attorney for health care, and health care surrogate designations.

A patient with 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 nutritional support. This is an example of which end-of-life concept? a) Medical futility b) Palliative care c) Terminal weaning d) Withdrawal of treatment

A Medical futility is a situation in which therapy or interventions will not provide a foreseeable possibility of improvement in the patient's health status.

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.

A Neuromuscular blocking agents cause paralysis only; they do not cause sedation. Therefore, concomitant administration of sedatives is essential.

The nurse is a member of a committee to design a critical care unit in a new building. Which design trend would best 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

A New unit design trends to promote family-centered care include patient rooms that provide a larger family space and comfortable furniture and storage to promote open visitation, including overnight stays in the patient's room.

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.

A Nociceptors are stimulated by mechanical, chemical, or thermal stimuli. Nociceptors differ from other nerve receptors in the body in that they adapt very little to the pain response.

The nurse is caring for a critically ill trauma patient who is expected to be hospitalized for an extended period. 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) Provide aromatherapy with scents such as lavender that are known to help anxiety. 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.

A Nonpharmacological approaches are helpful in reducing stress and anxiety, and each of these activities has the potential for improving the patient's well-being. The patient is likely to benefit most from the presence of his or her own dog rather than the other activities, however; if unit protocol does not allow the patient's own dog, the nurse should investigate the use of therapy animals or the other options.

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 TV on to provide noise and distraction. d) Leave the lights on in the room so that the patient is not frightened of his or her surroundings.

A Planning care to promote periods of uninterrupted rest is important. Consulting with the pharmacist to adjust a medication schedule is an excellent example of this intervention.

A postsurgical patient is on a ventilator in the critical care unit. The patient has been tolerating the ventilator well and has not required any sedation. On assessment, the nurse notes the patient is tachycardic and hypertensive with an increased respiratory rate of 28 breaths/min. The patient has been suctioned recently via the endotracheal tube, and the airway is clear. The patient responds appropriately to the nurse's commands. The nurse should: a) assess the patient's level of pain. b) decrease the ventilator rate. c) provide sedation as ordered. d) suction the patient again.

A Pulse, respirations, and blood pressure frequently result from activation of the sympathetic nervous system by the pain stimulus. Because the patient is postoperative, the patient should be assessed for the presence of pain and need for pain medication.

A nurse is caring for a client who has lung cancer and is dying. Which prescription should the nurse question? a. Morphine 10 mg sublingual every 6 hours PRN for pain level greater than 5 b. Albuterol (Proventil) metered dose inhaler every 4 hours PRN for wheezes c. Atropine solution 1% sublingual every 4 hours PRN for excessive oral secretions d. Sodium biphosphate (Fleet) enema once a day PRN for impacted stool

A Rationale: Pain medications should be scheduled around the clock to maintain comfort and prevent reoccurrence of pain. The other medications are appropriate for this client.

A nurse discusses inpatient hospice with a client and the client's family. A family member expresses concern that her loved one will receive only custodial care. How should the nurse respond? a. "The goal of palliative care is to provide the greatest degree of comfort possible and help the dying person enjoy whatever time is left." b. "Palliative care will release you from the burden of having to care for someone in the home. It does not mean that curative treatment will stop." c. "A palliative care facility is like a nursing home and costs less than a hospital because only pain medications are given." d. "Your relative is unaware of her surroundings and will not notice the difference between her home and a palliative care facility."

A Rationale: Palliative care provides an increased level of personal care designed to manage symptom distress. The focus is on pain control and helping the relative die with dignity.

A nurse is caring for a client who is terminally ill. The client's spouse states, "I am concerned because he does not want to eat." How should the nurse respond? a. "Let him know that food is available if he wants it, but do not insist that he eat." b. "A feeding tube can be placed in the nose to provide important nutrients." c. "Force him to eat even if he does not feel hungry, or he will die sooner." d. "He is getting all the nutrients he needs through his intravenous catheter."

A Rationale: When family members understand that the client is not suffering from hunger and is not "starving to death," they may allow the client to determine when, what, or if to eat. Often, as death approaches, metabolic needs decrease and clients do not feel the sensation of hunger. Forcing them to eat frustrates the client and the family.

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

A, B, C Any treatment that is life sustaining may be withheld from a terminally ill patient during the end of life. These treatments include nutrition, dialysis, fluids, antibiotics, respiratory support, therapeutic medications, and blood products.

Which of the following statements is true about insulin and parenteral nutrition? (Select all that apply.) a) The amount of parenteral insulin is adjusted based on the previous 24-hour laboratory values. b) Insulin may be added to a parenteral nutrition solution. c) Subcutaneous insulin is used on a sliding scale during parenteral nutrition. d) Supplemental insulin is rarely required for patients receiving parenteral nutrition. e) Lingering hyperglycemia after parenteral nutrition has stopped requires continuing insulin.

A, B, C Hyperglycemia is common when receiving parenteral nutrition; insulin may be administered on a sliding scale for glucose control and/or added to the parenteral solution. The amount of insulin added to the parenteral solution is calculated based on the previous 24-hour laboratory values. Hypoglycemia can result from continuing the insulin after the parenteral nutrition is discontinued.

Family presence is encouraged during resuscitation and invasive procedures. Which findings about this practice 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 e) Families report that staff conversations during this time were distressing

A, B Families benefit from witnessing procedures and resuscitation. The presence of family members removes doubt about the patient's condition, allows them to witness that everything was done, and decreases anxiety about what is occurring.

A patient with severe burns had a dietitian consultation for nutritional support. The patient weighs 145 pounds. What recommendations by the dietitian does the nurse anticipate initiating? (Select all that apply.) a) At least 2307 kcal/day b) Juven formula c) 2 cal HN formula d) At least 1648 kcal/day e) Perative formula

A, B The severely stressed patient requires around 35 kcal/kg/day. This patient weighs 145 pounds, which is 65.9 kg. So this patient needs at least 2307 kcal/day. Juven is an appropriate formula; 2 cal HN is used for patients with heart and/or liver disease and Perative is used for patients with impaired GI function.

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.

A, B, C Palliation includes the relief of symptoms that may have a negative effect on the family or the patient.

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

A, B, C, D Adjustment of visiting hours to meet the needs of patients and families assists in reducing the stress of critical illness. All other responses are environmental stressors that may increase anxiety or affect sleep.

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 one another and cannot come to consensus. c) The family asks 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 the use of a medication that is not approved to treat the patient's condition.

A, B, C, D, E All of these are potential signs of an ethical dilemma.

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 e) Preexisting conditions

A, B, C, D, E All of these factors predispose the patient to pain or anxiety.

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. e) hostile environment.

A, B, C, D, E Anxiety is likely to result from loss of control, the inability to communicate, continuous noise and lighting, excessive stimulation (including repeated vital sign measurements), lack of mobility, and uncomfortable room temperatures. Increased anxiety levels often lead to increased pain perception. Environments that are perceived as hostile also contribute.

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 e) Provision of personal items

A, B, C, D, E Manipulating the environment so that it appears less hostile helps decrease anxiety, as does continually reorienting the patient. Focus techniques such as guided imagery and music therapy can create a state of relaxation. Personal items can reduce anxiety and provide a pleasant distraction.

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

A, B, C, D, E The definition of family varies and may include unmarried life partners of the same or opposite sex, close friends, and other close individuals who have no legal relationship with the patient. The patient gets to define who will be regarded as "family."

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 health care team members b) An integrated plan of care that is developed collaboratively by the patient, family, and health care 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

A, B, C, E Effective and consistent communication among the patient, family, and health care team members is required to promote positive outcomes during end-of-life care.

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 iPod or other device with favorite music b) Invite a 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

A, B, D A personal device with favorite music and headphones can be helpful in reducing ambient unit noise. Music therapy programs, such as harpists, can provide soothing sedative music that is often comforting to both patients and family members. Acoustical tiles help to reduce noise in the critical care setting and should be included in remodeling plans as well as new unit construction.

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 ECG e) responding only to painful stimuli

A, B, D Criteria for brain death include absence of cerebral blood flow, absence of brainstem reflexes, and flat electroencephalograph.

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 most critically ill patients some control over their treatment. d) provides good quality analgesia. e) doesn't work well without family assistance.

A, B, D PCA is safe and effective, provides good-quality analgesia, and has potentially fewer side effects than other routes. PCA management is rarely appropriate for critically ill patients because most patients are unable to depress the button, or they are too ill to manage their pain effectively. If the patient is cognitively intact, family assistance is not needed to use this modality and is not advisable; the patient needs to be able to push the button.

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 e) Ventilated patient

A, B, D elirium appears in approximately 80% of patients in the intensive care unit. Delirium is characterized by changing mental status, inattention, disorganized thinking, and altered levels of consciousness. Patients in the intensive care unit may not be able to verbalize because of the presence of an artificial airway, sedative medication, neuromuscular blocking agents, or brain injury. Effective nurse-to-patient communication and assessment skills would facilitate assessment of pain and anxiety. There are tools and assessment methods to assess pain in ventilated patients.

Which statements about total parenteral nutrition are correct? (Select all that apply.) a) assessing fluid volume status and preventing infection are important nursing considerations. b) fingerstick glucose levels are assessed every 6 hours and prn. c) total parenteral nutrition is administered through a feeding tube and pump. d) total parenteral nutrition with added lipids provides adequate levels of protein, carbohydrates, and fats. e) soy-based lipids should not be given during the first week of a critical illness.

A, B, D, E All are correct except administration via a feeding tube and pump. A tube and pump are used to deliver enteral nutrition.

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 e) Perception may be influenced by prior experience

A, B, D, E Both pain and anxiety are subjective in nature. One can exacerbate the other in a vicious cycle that often requires good nursing assessment to manage the precipitating problem and break the cycle. Anxiety is a response to a real or perceived fear. Pain is a response to real or "phantom" phenomenon but always involves transmission of nerve impulses. Both relate to the patient's perceptions of pain and fear. Previous experiences of both pain and/ or anxiety can influence the patient's perception of both. Anxiety is a response to real or perceived fear, and pain is a response to a real or "phantom" phenomenon.

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 e) it can be increased by noise and light

A, B, D, E Unlike pain, anxiety is linked to the reward and punishment centers in the limbic system of the brain. It is totally neurological and does not involve tissue injury. Like pain, it is a subjective phenomenon. Noise, light, and other stimuli can increase the intensity of anxiety. Both anxiety and pain are subjective in nature.

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

A, B, E "Terminal weaning" may include titration of ventilator support to minimal levels, removal of the ventilator with maintenance of the artificial airway, and complete extubation

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 e) Allow unlimited visitation tailored to the patient's individual needs

A, B, E Manipulation of the environment, such as the adjustment of lighting, is helpful in promoting sleep and rest. Clocks, calendars, photos, and other personal items promote orientation and personalize the environment; telling the patient the day and time and other current events assists in maintaining the patient's orientation. Allowing visitation that best meets the patient's needs will reduce stress as the patient's support systems are present. Conversations about other patients are private and should take place away from other patients.

Calorie-dense feedings: (Select all that apply.) a) are most useful in heart failure and liver disease. b) are most useful in malabsorption syndromes. c) contain 2 kcal/mL and 70 g protein/L. d) include increased fiber. e) are especially good for patients with lung disease.

A, C Calorie-dense feedings are used when volume should be minimized and protein requirements are high, such as in heart failure or liver disease. They contain 2 kcal/mL and 70 g protein/L.

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 of treatment 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 e) Cost savings of withdrawing treatment

A, C, D According to the ethical decision-making process, decisions should be made in light of the patient's wishes (autonomy), burden versus benefit (beneficence), other relevant principles, and potential outcomes of various options.

In the healthy individual, pain and anxiety: (Select all that apply.) a) activate the SNS. b) decrease stress levels. c) help remove one from harm. d) increase performance levels. e) limit SNS activity.

A, C, D In the healthy person, pain and anxiety are adaptive mechanisms used to increase performance levels or to remove one from potential harm. The "fight or flight" response occurs in response to pain and/or anxiety and involves the activation of the sympathetic nervous system. Pain and anxiety, however, can induce significant stress. The SNS is activated, not limited, by pain and/or anxiety.

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. e) While anxiety is unpleasant, it does not contribute to mortality or morbidity of the critically ill patient.

A, C, D Pain is defined by each patient, anxiety is associated with marked apprehension, and pain and anxiety are often interrelated. Critically ill patients commonly have both pain and anxiety. Anxiety does increase both morbidity and mortality in critically ill patients, especially those with cardiovascular disease.

A patient requires pancuronium 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. e) ensuring good nutrition with frequent feedings throughout the day.

A, C, D Pancuronium is a neuromuscular blocking agent (NMB) resulting in complete paralysis of the patient. Patients receiving NMB must be provided total care, including eye, skin, and oral care interventions. Patients are at high risk for deep vein thrombosis secondary to drug-induced paralysis and bed rest. Sedatives must be administered concurrently with NMB, because NMBs have no sedative effects.

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

A, C, D, E All except for apathy are characteristics of hyperactive delirium. Apathy is seen in hypoactive cases.

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) 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 e) Inform the patient that you have cared for many similar patients

A, D Patients feel safe when nurses exhibit technical competence, meet their needs, and provide reorientation. Family member presence may also contribute to feeling safe.

The nurse is caring for a 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 Intensity Scale c) The PQRST method d) the VAS e) the CAM tool

A, D he FACES scale and the Visual Analogue Scale can be used by simply having the patient point to the appropriate place. Because of this, they are the easiest to use with children, people with language barriers, and intubated patients.

The nurse is caring for an 80-year-old patient who has been treated for gastrointestinal bleeding. The family has agreed to withhold 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) DNR b) Change antibiotic to a less expensive medication c) Discontinue tube feeding d) Stop any further blood transfusions e) Water boluses every 4 hours with tube feeding

A, D, E A DNR order would be appropriate given the family's decision, as would prohibiting further transfusions. Giving water boluses is compatible with the patient's wishes, but stopping the feeding is not.

To reduce relocation stress in patients transferring out of the intensive care unit, 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 nurses' 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 e) help the patient and family focus on the positive meaning of a transfer

A, D, E Patients often have stress when they are moved from the safety of the critical care unit. Introducing the patient and his family to the nurse who will assume care and to the new environment are strategies to reduce relocation stress. Encouraging the patient and family to see the transfer as a positive sign of healing might lessen the stress they feel.

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.

B A standardized method for gathering data about family structure and function and recording it in an official document is the best approach. This strategy ensures that data are collected and kept in the medical record. Data are also easily retrievable by anyone who needs to know this information.

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

B A train-of-four response of two twitches (out of four) using a peripheral nerve stimulator indicates adequate paralysis.

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 the 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

B Active involvement of family is a critical dimension of end-of-life care. Family members should have access to the patient and inclusion in care to the degree they desire. Limitation of visitors is not consistent with effective end-of-life care practices.

The nurse is caring for a patient who has been declared brain dead. The patient is considered a potential organ donor. 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 health care 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

B After brain death has been determined, the organs must be perfused to maintain viability. Therefore, the patient remains on life support even though he or she is legally dead.

Which intervention is appropriate to assist the patient in coping 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

B Communication and explanations of procedures are priority interventions to help patients cope with admission.

The patient's spouse is very upset because his loved one, who is near death, has dyspnea and restlessness. The nurse explains that there are some ways to decrease this discomfort, including: a) respiratory therapy treatments. b) opioid medications given as needed. c) incentive spirometry d) increased hydration

B Dyspnea is best managed with close evaluation of the patient and the use of opioids, sedatives, and nonpharmacologic interventions (oxygen, positioning, and increased ambient air flow).

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 a written advance directive. 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 health care 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."

B Each of these situations may result in family conflict. The situation with the unmarried 36-year-old male without a written advance directive results in his distant parents being legally responsible for his health care decisions. Because of his long-standing commitment with his partner and lack of recent contact with his parents, this scenario is likely to cause the most conflict. The parents may make decisions based on their wishes, as they may not be knowledgeable of the patient's wishes.

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

B Fighting the ventilator is rated with the greatest number of points for compliance with the ventilator, and could indicate pain or anxiety.

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?"

B If the patient can describe the pain, the nurse can assess quality, such as sharp, dull, or crushing.

The nurse is caring for a critically ill patient on mechanical ventilation. The physician identifies the need for a bronchoscopy, which requires informed consent. For the physician 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

B Informed consent requires that a person know what is to be done and have the competence to make an informed decision. Most critically ill patients do not have this capacity; however, an assessment should be made to determine the patient's capacity.

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.

B Lorazepam (Ativan) 1 mg IV is an appropriate drug dose for a patient who is experiencing agitation during withdrawal of life support.

A patient with end-stage heart failure is experiencing considerable dyspnea. Appropriate palliative management of this symptom includes: a) administration of midazolam (Versed). b) administration of morphine. c) an increase in the amount of oxygen being delivered to the patient. d) aggressive use of inotropic and vasoactive medications to improve heart function.

B Morphine is an excellent agent to control the symptom of dyspnea.

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

B The VALUE mnemonic includes the following: V—Value what the family tells you. A—Acknowledge family emotions. L—Listen to the family members. U—Understand the patient as a person. E—Elicit (ask) questions of family members.

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 who you know is fluent in the native language and ask him if he can come up to the unit. d) Use the patient's 8-year-old child who is fluent in both English and the native language to translate for you.

B The best approach when communicating with someone whose primary language is not English is to use the interpreter services of the agency. These individuals are trained and knowledgeable.

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 among the patient, family, and health care team throughout the course of the illness. c) organizational support of palliative care principles. d) the relocation of the dying patient from the critical care unit to a lower level of care.

B The failure of clinicians, family members, and patients to openly discuss prognoses, end- of-life wishes, and preferences contributes to care conflicts such as in the Schiavo case. Early discussion of end-of-life wishes is required to promote positive outcomes for the patient and family; such discussions actually should predate illness.

Which of the following statements about palliative care is accurate? a) Withholding and withdrawing life- sustaining treatment are distinctly different in the eyes of the legal community. b) Reducing distressing symptoms is the primary goal of palliative care. c) Only the patient can determine what constitutes palliative care for him or her. d) Withdrawing life-sustaining treatments is considered euthanasia in most states.

B The goal of palliative care is to reduce the distressing symptoms many patients experience due to serious illnesses.

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 report. Which information do you convey regarding background? a) Urine output of 40 mL/2hr b) Current vital signs and history of aortic aneurysm repair 4 hours ago c) A statement that the patient is possibly hypovolemic d) A request for IV fluids

B The history and vital signs are part of the background.

The nurse identifies which patient at greatest risk for malabsorption of protein? a) The patient with gallbladder obstruction b) The patient with ileitis c) The patient with distal colon resection d) The patient with jejunal tumor

B The ileum is where protein is broken down and absorbed; the patient with ileitis would be at greatest risk for protein malabsorption.

The patient's spouse tells the nurse that there is no point in continuing to visit at the bedside because the patient is unresponsive. The best response by the nurse is a) "You're right. Your loved one is not aware of anything now." b) "This seems to be very difficult for you." 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?"

B The most therapeutic response by the nurse is to acknowledge the distress of the spouse.

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

B The need for information is one of the highest identified by family members of critically ill patients. A planned condition update helps the family know what to expect.

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

B The nurse can give a status report related to the patient's condition and current treatment plan as well as ensure that the family has daily meeting time with the intensivist for an update on diagnoses, prognoses, and the like.

You work in an intermediate care unit and 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 and that your ideas will be rejected by others. This situation 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

B These are examples of an unhealthy work environment. A healthy work environment values communication, collaboration, and effective decision making

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 treatment options have been exhausted and to suggest that the patient be given a "do not resuscitate" status. This scenario illustrates the concept of a) brain death b) futility c) incompetence d) life-prolonging procedures

B This is the definition of futility.

A nurse is caring for a terminally ill client who has just died in a hospital setting with family members at the bedside. Which action should the nurse take first? a. Call for emergency assistance so that resuscitation procedures can begin. b. Ask family members if they would like to spend time alone with the client. c. Ensure that a death certificate has been completed by the physician. d. Request family members to prepare the client's body for the funeral home.

B Rationale: Before moving the client's body to the funeral home, the nurse should ask family members if they would like to be alone with the client. Emergency assistance will not be necessary. Although it is important to ensure that a death certificate has been completed before the client is moved to the mortuary, the nurse first should ask family members if they would like to be alone with the client. The client's family should not be expected to prepare the body for the funeral home.

The nurse utilizes which of the following strategies when encountering an ethical dilemma in practice? (Select all that apply.) a) Change-of-shift report updates b) Ethics consultation services c) Formal multiprofessional ethics committees d) Pastoral care services e) Social work consultation

B, C Formal mechanisms such as multiprofessional ethics committees or referral services are strategies to address ethical issues.

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 e) high-risk OB units

B, C Recovery rooms and coronary care units were the first units designated to care for critically ill patients.

Risks of total parenteral nutrition include: (Select all that apply.) a) diarrhea. b) elevated blood sugar. c) infection at the catheter site. d) volume overload. e) aspiration.

B, C, D Diarrhea and aspiration are more common with enteral tube feedings; the other risks are common with total parenteral nutrition.

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 e) ensuring that a waiting room stocked with snacks is nearby

B, C, D Encouraging families to formulate questions assists in family care. Continuity of nursing care with consistent staff members assists in reducing stress. Communicating daily updates of the patient's condition meets the family's need for information.

Which interventions are critical during intravenous lipid administration? (Select all that apply.) a) Assess glucose levels every 6 hours. b) Change the tubing every 24 hours. c) Hold lipids when administering antibiotics through the same line. d) Monitor triglyceride levels periodically. e) Maintain elevation of the head of the bed.

B, D Lipids are very good media for bacterial growth; lipid tubing should be changed every 24 hours. Triglyceride levels must be monitored until stable when administering lipids. Glucose is monitored during treatment with parenteral nutrition, which contains a high level of glucose. Medications are not administered through the IV lines containing lipids or parenteral nutrition. Elevating the head of the bed is important for enteral (tube) feedings to prevent aspiration.

The correct order of actions for a patient starting enteral nutrition with a feeding tube is: _______________, _______________, _______________, _______________, _______________. a. initiate tube feeding b. insert feeding tube c. flush tube to verify patency d. obtain chest radiograph e. assess residuals

B, D, C, A, E Initially the feeding tube will be inserted and final placement verified via chest radiograph. The next step is to flush the feeding tube and start the tube feedings. Residuals are checked every 4 hours.

The nurse is caring for a patient admitted with a traumatic brain injury following a motor vehicle crash. Several weeks later, the patient is still ventilator dependent and unresponsive to stimulation but occasionally takes a spontaneous breath. The physician explains to the family that the patient has severe neurological impairment and is not expected 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

C A persistent vegetative state is a permanent, irreversible unconscious condition that demonstrates an absence of voluntary action or cognitive behavior, or an inability to communicate or interact purposefully with the environment.

Which statement regarding ethical concepts is true? a) A living will is the same as a health care 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 health care decisions in the event the person is incapacitated d) A persistent vegetative state is the same as brain death in most states

C A surrogate is a competent adult designated by a person to make health care decisions if that person becomes incapacitated.

Ideally, an advance directive should be developed by the a) family if the patient is in critical condition b) patient as a part of the hospital admission process c) patient before hospitalization d) patient's healthcare surrogate

C Advance directives should be made and signed while a person is in good health and in a state of mind to make decisions about what should happen if he or she becomes incapacitated (e.g., during a critical illness).

The family of your critically ill patient tells you that they have not spoken with the physician in over 24 hours and that they have some questions they want clarified. During morning rounds, you convey this concern to the attending intensivist and arrange a meeting with the family at 4:00 PM. 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

C Although one might consider that all of these competencies are being addressed, communication and collaboration with the family and physician best exemplify the competency of collaboration.

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 the patient is unconscious, complete care as quickly and quietly as possible. c) Tell the patient the day and time, and that you are providing a bath. Reassure the patient 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.

C Although unconscious, many patients can hear, understand, and respond to stimuli. Therefore, it is important to converse with the patient and reorient her to the environment.

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 b) Explain the unit routine c) Explain procedures before and while you are doing them d) Suction Mr. J's ET tube immediately when he starts to cough

C Anxiety is reduced when procedures are explained before completing them and when the nurse continues to talk to the patient during them.

Family assessment is essential 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' home environment c) Identification of immediate family, extended family, and decision makers d) Observation and assessment of how family members function with each other

C Assessment of the family structure is the first step and is essential before specific interventions can be designed. It identifies immediate family, extended family, and decision makers in the family.

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 health care providers. b) Critical care units often meet the needs of dying patients and their families. c) Disparities exist between patients' care preferences and the actual care provided. d) Pain and suffering of patients at end of life is well controlled in the hospital.

C Disparities and lack of communication are common in the relationships between patients and health care providers. Critical care units are often poorly equipped to meet the needs of dying patients. The SUPPORT study demonstrated that pain and suffering are widespread in hospitals.

The nurse knows that which of the following statements about organ donation 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 the withdrawal of life support so that the patient can become an organ donor

C Donation of selected organs after cardiac death is ethically and legally appropriate. Specific policies and procedures for donation after cardiac death facilitate this procedure.

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 evidence-based alcohol withdrawal protocol. b) 54-year-old postoperative aortic aneurysm resection with a 40 pack-year history of smoking c) 86-year-old from nursing home with dementia, postoperative from colon resection, still being mechanically ventilated d) 95-year-old with community-acquired pneumonia; family has brought in eyeglasses and hearing aid

C From this list, the 86-year-old postoperative nursing home resident is at greatest risk due to advanced age, cognitive impairment, and some degree of respiratory failure.

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 the withdrawal of life support. However, the nurse assists with the process to avoid confronting the charge nurse. Afterward the nurse feels guilty for "killing the patient." This scenario is likely to cause a) abandonment b) family stress c) moral distress d) negligence

C Moral distress occurs when the nurse acts in a manner contrary to personal or professional values.

A nurse caring for a patient with neurological impairment often must use painful stimuli to elicit the 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

C Nonmaleficence means not to intentionally harm others. The nurse does need to determine the patient's response to painful stimulation but does so in a way that is ethical.

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, limits visits of children to 1 hour

C Open visitation is considered best practice. Limiting visitation is not supported by research. Facilities should develop visitation schedules in collaboration with the patient and family.

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 advance directive on the chart b) The patient has lost 20 pounds in the past month and is fatigued all the 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

C Personal factors include competence, stated wishes, goals and hopes, definition of quality of life, and family relationships.

Which statement is true regarding the impact of culture on end-of-life decision making? a) Cultural beliefs should not take precedence over health care team decisions. b) It is easy and common to assess cultural beliefs affecting end-of-life care in the intensive care unit. 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.

C Religious doctrines and cultural beliefs have profound impact on end-of-life decisions.

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 be used only on heavily sedated patients. b) can be used only on pediatric patients. c) provide raw EEG data and a numeric value. d) require only five leads.

C The BIS and PSI have very simple steps for application, and results are displayed as raw EEG data and the numeric value.

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

C The Behavioral Pain Scale issues the most points, indicating the greatest amount of pain, to assessment of facial grimacing.

The patient's spouse is terrified by the prospect of removing life- sustaining treatments from the patient and asks why anyone would do that. The nurse explains, a) "It is to save you money so that you won't have such a large financial burden." b) "It will preserve limited resources for the hospital so that other patients may benefit from them." c) "It is to discontinue treatments that are not helping your loved one and that may be very uncomfortable." d) "We have done all we can for your loved one, and any more treatment would be futile."

C The goal of withdrawal of life-sustaining treatments is to remove treatments that are not beneficial and that may be uncomfortable.

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

C The greatest priority in managing delirium is to keep the patient safe. Sedation may contribute to the development of delirium.

The nurse recognizes that which patient is likely to benefit most from patient-controlled analgesia (PCA)? a) Patient with a C4 fracture and quadriplegia b) Patient with a femur fracture and closed head injury c) Postoperative patient who had elective bariatric surgery d) Postoperative cardiac surgery patient with mild dementia

C The patient undergoing bariatric surgery (an elective procedure) is the best candidate for PCA as this patient should be awake, cognitively intact, and will have the acute pain related to the surgical procedure.

Which statement made by a staff nurse identifying guidelines for palliative care would need to be 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.

C The purpose of palliative care is to relieve negative symptoms that affect the quality of life of a patient. Palliative care is an integral part of every injured or ill patient's care.

The synergy model of practice focuses on a) allowing unrestricted visiting for the patient 24 hours a day b) holistic and alternative therapies c) the needs of patients and their families, which drive nursing competency d) patients' needs for energy and support

C The synergy model of practice states that the needs of patients and families influence and drive competencies of nurses.

The primary mode of action for neuromuscular blocking agents used in the management of some ventilated patients is a) analgesia b) anticonvulsant therapy c) paralysis d) sedation

C These agents cause respiratory muscle paralysis. They do not provide analgesia or sedation. They do not have anticonvulsant properties

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 the administration of anticoagulants

C These are steps recommended in the National Patient Safety Goals to reconcile medications across the continuum of care.

Which intervention about visitation in the critical care unit is true? a) The majority of critical care nurses implement restricted visit 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

C Visiting should be based on the needs of patients and their families.

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's hourly to determine whether symptoms resolve on their own.

C When patients exhibit signs of anxiety or agitation, the first priority is to identify and treat the underlying cause, which could be hypoxemia, hypoglycemia, hypotension, pain, or withdrawal from alcohol and drugs.

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 for an update on the patient's status and to 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 nurses' 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. e) The off-going nurse is giving the patient medications at the same time as giving handoff report to the oncoming nurse.

C, D A reporting tool and bedside report improve handoff communication by ensuring standardized communication and review of assessment findings. Conducting report at the bedside also reduces noise that commonly occurs at the nurses' station during a change of shift.

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. e) animal therapy.

C, D, E Guided imagery is a powerful technique for controlling pain and anxiety, especially that associated with painful procedures. Similar to guided imagery, a music therapy program offers patients a diversionary technique for pain and anxiety relief. Likewise animal therapy has many benefits for the critically ill patient.

A specific request made by a competent person that directs medical care related to life-prolonging procedures in the event that person loses capacity to make decisions is called a a) DNR order b) healthcare proxy c) informed consent d) living will

D A living will is a formal advance directive that directs medical care related to life-prolonging procedures when a person does not have the capacity to make decisions regarding health care and treatment.

The nurse is caring for a critically ill patient with terminal cancer. The monitor alarms and shows a potentially lethal rhythm. The patient has no pulse. 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

D Because no orders have been written, it is imperative that a code be called. In this example, decisions regarding resuscitation status should be determined as soon as possible before a code event.

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 life support

D Because the tube feeding had not been yet placed in the care of this patient, this scenario is an example of withholding of life support.

A patient is receiving enteral tube feedings and has developed drug- nutrient interactions. The nurse recognizes which drug as having the potential for causing drug-nutrient reactions? a) Aspirin b) Enoxaparin c) Ibuprofen d) Phenytoin

D Bioavailability of phenytoin is reduced when administered with enteral feedings. The other drugs do not have significant drug-nutrient interactions.

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.

D Burnout may occur when nurses must provide aggressive care to patients for whom they believe it is futile or when the care choices made by patients and/or surrogates differ from those of clinicians.

Changing visitation policies can be challenging. The nurse manager recognizes which of 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 the 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

D Changes in policy are most effective through willing champions as part of a unit-based, staff-led practice council.

The constant noise of a ventilator, monitor alarms, and infusion pumps predisposes the patient to: a) anxiety b) pain c) powerlessness d) sensory overload

D Constant noise is a source of sensory overload.

The spouse 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. The spouse demands, "I want you to reassign us to another nurse. His current nurse is not in the room enough to make sure everything is okay." The nurse recognizes that this response most likely is due to the spouse'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

D Demanding behaviors often occur when the family member has a sense of loss of control or has had adverse outcomes in a previous hospitalization.

Designed 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 health care team d) wishes previously expressed by the patient

D Health care surrogates attempt to have decisions match the wishes of the patient.

The critical care nurse wants a better understanding of when to initiate an ethics consult. After attending an educational program, the nurse 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 reevaluation. b) Family members disagree as to a patient's course of treatment. The patient has designated a health care 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 the health care team is debating if care is futile.

D In the case of a seriously ill patient who is incapacitated and does not have a surrogate, an ethics consultation is warranted. While care does not have to be provided in the case of futility, disagreements may lead to the need for a consult to resolve the dilemma.

The nurse is caring for a patient who requires administration of a neuromuscular blocking agent to facilitate ventilation with nontraditional modes. The nurse understands that NMBAs provide: a) antianxiety effects b) complete analgesia c) high levels of sedation d) no sedation or analgesia

D Neuromuscular blocking (NMB) agents do not possess any sedative or analgesic properties.

A patient, who has a tube feeding, requires a chest x-ray study for evaluation of a cough. To reduce the risk of aspiration, the nurse: a) helps the radiology technician to position the patient to avoid dislodging the tube. b) slows the rate of the feedings until placement has been verified. c) cuts the infusion rate by half. d) stops feedings 10 to 15 minutes before placing flat to obtain the radiograph.

D Temporarily stopping feedings when flat minimizes the risk of aspiration if the patient will be supine.

Which of the following organizations requires a mechanism for addressing ethical issues? a) AACN b) AHA c) SCCN d) TJC

D The Joint Commission requires that a formal mechanism be in place to address patients' ethical concerns.

The nurse is caring for a patient receiving a 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) give the highest allowable dose for the greatest effect.

D The best approach for administering benzodiazepines (and all sedatives) is to administer and titrate to a desired endpoint using a standard sedation scale.

The nurse is concerned about the risk of alcohol withdrawal syndrome in a postoperative patient. Which statement by the nurse indicates 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."

D The most important treatment of alcohol withdrawal syndrome is prevention. Many units have protocols that are initiated early to prevent the syndrome.

A patient is receiving enteral feedings and reports fullness and abdominal discomfort. What action by the nurse is best? a) Connect the feeding tube to suction b) Continue the tube feeding c) Decrease the tube feeding d) Assess the patient's gastric residual

D The patient may not be tolerating the tube feeding. The nurse should assess the gastric residual and hold the feeding if it is greater than 500 mL.

The intensive care nurse is working on a committee to reduce noise in the unit. Which recommendation should the nurse propose first? a) Change telephones to blinking lights instead of audible ringtones b) Invest in call lights that page the nursing staff instead of beeping c) Recommend that nurses turn off cardiac monitors on stable patients d) Soundproof the pnuematic tube system

D The pneumatic tube system is extremely loud at 88dB[A] and should be the first proposal as it will have the biggest impact on noise on the unit.

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) arm binders or splints b) a higher dosage of lorazepam c) propofol d) soft wrist restraints

D The priority in caring for agitated patients is safety. The least restrictive methods of keeping the patient safe are appropriate.

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

D The synergy model of practice is care based on the unique needs and characteristics of the patient and family members

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

D Total parenteral nutrition is administered through a central intravenous line, such as the subclavian vein.

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) Richmond Agitation Sedation Scale.

D Various sedation scales are available to assist the nurse in monitoring the level of sedation and assessing response to treatment. The Richmond Agitation Sedation Scale is a commonly used tool that has been validated.

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 health care surrogate c) "Slow codes" are ethical and should be considered in futile situations if advanced directives are unavailable d) Withholding "extraordinary" resuscitation is legal and ethical if specified in advance directives and physician orders

D Withholding resuscitation and other care is legal and ethical if based on the patient's wishes.

A nurse teaches a client's family members about signs and symptoms of approaching death. Which manifestations should the nurse include in this teaching? (Select all that apply.) a. Warm and flushed extremities b. Long periods of insomnia c. Increased respiratory rate d. Decreased appetite e. Congestion and gurgling

D,E Rationale: Common physical signs and symptoms of approaching death including coolness of extremities, increased sleeping, irregular and slowed breathing rate, a decrease in fluid and food intake, congestion and gurgling, incontinence, disorientation, and restlessness.

19. An older adult has diabetic neuropathy and often reports unbearable foot pain. About which medication would the nurse plan to educate the client? a. Desipramine (Norpramin) b. Duloxetine (Cymbalta) c. Morphine sulfate d. Nortriptyline (Pamelor)

b. Duloxetine (Cymbalta)

2. A faculty member explains the concepts of addiction, tolerance, and dependence to students. Which information is accurate? (Select all that apply.) a. Addiction is a chronic physiologic disease process. b. Physical dependence and addiction are the same thing. c. Pseudoaddiction can result in withdrawal symptoms. d. Tolerance is a normal response to regular opioid use. e. Tolerance is said to occur when opioid effects decrease.

a. Addiction is a chronic physiologic disease process. d. Tolerance is a normal response to regular opioid use. e. Tolerance is said to occur when opioid effects decrease.

24. A postoperative client is reluctant to participate in physical therapy. What action by the nurse is best? a. Ask the client about pain goals and if they are being met. b. Ask the client why he or she is being uncooperative with therapy. c. Increase the dose of analgesia given prior to therapy sessions. d. Tell the client that physical therapy is required to regain function.

a. Ask the client about pain goals and if they are being met.

9. A nurse uses the Checklist of Nonverbal Pain Indicators to assess pain in a nonverbal client with advanced dementia. The client scores a zero. What action by the nurse is best? a. Assess physiologic indicators and vital signs. b. Do not give pain medication as no pain is indicated. c. Document the findings and continue to monitor. d. Try a small dose of analgesic medication for pain.

a. Assess physiologic indicators and vital signs.

7. A nurse on the postoperative unit administers many opioid analgesics. What actions by the nurse are best to prevent unwanted sedation as a complication of these medications? (Select all that apply.) a. Avoid using other medications that cause sedation. b. Delay giving medication if the client is sleeping. c. Give the lowest dose that produces good control. d. Identify clients at high risk for unwanted sedation. e. Use an oximeter to monitor clients receiving analgesia.

a. Avoid using other medications that cause sedation. c. Give the lowest dose that produces good control. d. Identify clients at high risk for unwanted sedation. e. Use an oximeter to monitor clients receiving analgesia.

2. A new nurse reports to the precepting nurse that a client requested pain medication, and when the nurse brought it, the client was sound asleep. The nurse states the client cannot possibly sleep with the severe pain the client described. What response by the experienced nurse is best? a. Being able to sleep doesnt mean pain doesnt exist. b. Have you ever experienced any type of pain? c. The client should be assessed for drug addiction. d. Youre right; I would put the medication back.

a. Being able to sleep doesnt mean pain doesnt exist.

7. The nurse receives a hand-off report. One client is described as a drug seeker who is obsessed with even tiny changes in physical condition and is on the light constantly asking for more pain medication. When assessing this clients pain, what statement or question by the nurse is most appropriate? a. Help me understand how pain is affecting you right now. b. I wish I could do more; is there anything I can get for you? c. You cannot have more pain medication for 3 hours. d. Why do you think the medication is not helping your pain?

a. Help me understand how pain is affecting you right now.

20. An emergency department (ED) manager wishes to start offering clients nonpharmacologic pain control methodologies as an adjunct to medication. Which strategy would be most successful with this client population? a. Listening to music on a headset b. Participating in biofeedback c. Playing video games d. Using guided imagery

a. Listening to music on a headset

6. A nursing student is studying pain sources. Which statements accurately describe different types of pain? (Select all that apply.) a. Neuropathic pain sometimes accompanies amputation. b. Nociceptive pain originates from abnormal pain processing. c. Deep somatic pain is pain arising from bone and connective tissues. d. Somatic pain originates from skin and subcutaneous tissues. e. Visceral pain is often diffuse and poorly localized.

a. Neuropathic pain sometimes accompanies amputation. c. Deep somatic pain is pain arising from bone and connective tissues. d. Somatic pain originates from skin and subcutaneous tissues. e. Visceral pain is often diffuse and poorly localized.

18. A client has received an opioid analgesic for pain. The nurse assesses that the client has a Pasero Scale score of 3 and a respiratory rate of 7 shallow breaths/min. The clients oxygen saturation is 87%. What action should the nurse perform first? a. Apply oxygen at 4 L/min. b. Attempt to arouse the client. c. Give naloxone (Narcan). d. Notify the Rapid Response Team.

b. Attempt to arouse the client.

25. A client is being discharged from the hospital after surgery on hydrocodone and acetaminophen (Lorcet). What discharge instruction is most important for this client? a. Call the doctor if the Lorcet does not relieve your pain. b. Check any over-the-counter medications for acetaminophen. c. Eat more fiber and drink more water to prevent constipation. d. Keep your follow-up appointment with the surgeon as scheduled.

b. Check any over-the-counter medications for acetaminophen.

4. A client with a broken arm has had ice placed on it for 20 minutes. A short time after the ice was removed, the client reports that the effect has worn off and requests pain medication, which cannot be given yet. What actions by the nurse are most appropriate? (Select all that apply.) a. Ask for a physical therapy consult. b. Educate the client on cold therapy. c. Offer to provide a heating pad. d. Repeat the ice application. e. Teach the client relaxation techniques.

b. Educate the client on cold therapy. d. Repeat the ice application. e. Teach the client relaxation techniques.

23. A nurse is caring for a client on an epidural patient-controlled analgesia (PCA) pump. What action by the nurse is most important to ensure client safety? a. Assess and record vital signs every 2 hours. b. Have another nurse double-check the pump settings. c. Instruct the client to report any unrelieved pain. d. Monitor for numbness and tingling in the legs.

b. Have another nurse double-check the pump settings.

17. A hospitalized client has a history of depression for which sertraline (Zoloft) is prescribed. The client also has a morphine allergy and a history of alcoholism. After surgery, several opioid analgesics are prescribed. Which one would the nurse choose? a. Hydrocodone and acetaminophen (Lorcet) b. Hydromorphone (Dilaudid) c. Meperidine (Demerol) d. Tramadol (Ultram)

b. Hydromorphone (Dilaudid)

22. A nurse is caring for four clients receiving pain medication. After the hand-off report, which client should the nurse see first? a. Client who is crying and agitated b. Client with a heart rate of 104 beats/min c. Client with a Pasero Scale score of 4 d. Client with a verbal pain report of 9

c. Client with a Pasero Scale score of 4

4. A nurse is assessing pain on a confused older client who has difficulty with verbal expression. What pain assessment tool would the nurse choose for this assessment? a. Numeric rating scale b. Verbal Descriptor Scale c. FACES Pain Scale-Revised d. Wong-Baker FACES Pain Scale

c. FACES Pain Scale-Revised

10. A student nurse asks why several clients are getting more than one type of pain medication instead of very high doses of one medication. What response by the registered nurse is best? a. A multimodal approach is the preferred method of control. b. Doctors are much more liberal with pain medications now. c. Pain is so complex it takes different approaches to control it. d. Clients are consumers and they demand lots of pain medicine.

c. Pain is so complex it takes different approaches to control it.

3. A postoperative client has an epidural infusion of morphine and bupivacaine (Marcaine). What actions does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Ask the client to point out any areas of numbness or tingling. b. Determine how many people are needed to ambulate the client. c. Perform a bladder scan if the client is unable to void after 4 hours. d. Remind the client to use the incentive spirometer every hour. e. Take and record the clients vital signs per agency protocol.

c. Perform a bladder scan if the client is unable to void after 4 hours. d. Remind the client to use the incentive spirometer every hour. e. Take and record the clients vital signs per agency protocol.

what are the risk factors for hip fractures?

falls females calcium or vit D deficiency inactivity smoking medical conditions (dizziness/arthritis) meds leading to bone loss

12. A nurse on the postoperative inpatient unit receives a hand-off report on four clients using patient- controlled analgesia (PCA) pumps. Which client should the nurse see first? a. Client who appears to be sleeping soundly b. Client with no bolus request in 6 hours c. Client who is pressing the button every 10 minutes d. Client with a respiratory rate of 8 breaths/min

d. Client with a respiratory rate of 8 breaths/min

1. A student asks the nurse what is the best way to assess a clients pain. Which response by the nurse is best? a. Numeric pain scale b. Behavioral assessment c. Objective observation d. Clients self-report

d. Clients self-report

16. A hospitalized client uses a transdermal fentanyl (Duragesic) patch for chronic pain. What action by the nurse is most important for client safety? a. Assess and record the clients pain every 4 hours. b. Ensure the client is eating a high-fiber diet. c. Monitor the clients bowel function every shift. d. Remove the old patch when applying the new one.

d. Remove the old patch when applying the new one.

21. An older client who lives alone is being discharged on opioid analgesics. What action by the nurse is most important? a. Discuss the need for home health care. b. Give the client follow-up information. c. Provide written discharge instructions. d. Request a home safety assessment.

d. Request a home safety assessment.

15. A nurse is preparing to give a client ketorolac (Toradol) intravenously for pain. Which assessment findings would lead the nurse to consult with the provider? a. Bilateral lung crackles b. Hypoactive bowel sounds c. Self-reported pain of 3/10 d. Urine output of 20 mL/2 hr

d. Urine output of 20 mL/2 hr

5. The nurse is assessing a clients pain and has elicited information on the location, quality, intensity, effect on functioning, aggravating and relieving factors, and onset and duration. What question by the nurse would be best to ask the client for completing a comprehensive pain assessment? a. Are you worried about addiction to pain pills? b. Do you attach any spiritual meaning to pain? c. How high would you say your pain tolerance is? d. What pain rating would be acceptable to you?

d. What pain rating would be acceptable to you?

The family members of a critically ill patient bring 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

B Discussing end-of-life issues is an example of a nurse acting ethically on behalf of the patient and family.

8. A client reports a great deal of pain following a fairly minor operation. The surgeon leaves a prescription for the nurse to administer a placebo instead of pain medication. What actions by the nurse are most appropriate? (Select all that apply.) a. Consult with the prescriber and voice objections. b. Delegate administration of the placebo to another nurse. c. Give the placebo and reassess the clients pain. d. Notify the nurse manager of the physicians request. e. Tell the client what the prescriber ordered.

a. Consult with the prescriber and voice objections. d. Notify the nurse manager of the physicians request.

5. A student nurse learns that there are physical consequences to unrelieved pain. Which factors are included in this problem? (Select all that apply.) a. Decreased immune response b. Development of chronic pain c. Increased gastrointestinal (GI) motility d. Possible immobility e. Slower healing

a. Decreased immune response b. Development of chronic pain d. Possible immobility e. Slower healing

8. A nurse on the medical-surgical unit has received a hand-off report. Which client should the nurse see first? a. Client being discharged later on a complicated analgesia regimen b. Client with new-onset abdominal pain, rated as an 8 on a 0-to-10 scale c. Postoperative client who received oral opioid analgesia 45 minutes ago d. Client who has returned from physical therapy and is resting in the recliner

b. Client with new-onset abdominal pain, rated as an 8 on a 0-to-10 scale

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

A A group of evidence-based interventions done as a whole to improve outcomes is termed a bundle of care. This is an example of the ventilator bundle.

In addition to residual stomach volume, what other evidence suggests feeding intolerance? a) Abdominal distension b) Absence of tympany on percussion c) Active bowel sounds d) Elevated blood glucose by fingerstick

A Abdominal distension is expected if the feedings are not being absorbed. Tympany occurs along with distension.

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

A Clinical practice guidelines are being implemented to ensure that care is appropriate and based on research.

Approximately 5 days after starting tube feedings, a patient develops extreme diarrhea. A stool specimen is collected to check for which possible cause? a) C. diff b) E. coli c) Occult blood d) Ova and parasites

A Patients receiving enteral nutrition who develop diarrhea are evaluated for antibiotic- associated causes, including Clostridium difficile.

Which of the following professional organizations best supports critical care nursing practice? a) AACN b) AHA c) ANA d) SCCM

A The American Association of Critical-Care Nurses is the specialty organization that supports and represents critical care nurses.

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 the management of VTE for your colleagues to read e) Using evidence-based strategies to prevent VAP

A, B, C, D, E All answers are correct. Attending a program to learn about sepsis—Acquires and maintains current knowledge and competency in patient care. Collaborating with pastoral services—Collaborates with the health care team to provide care in a healing, humane, and caring environment. Posting information for others—Contributes to the professional development of peers and other health care providers. Nurse practice council—Provides leadership in the practice setting. Evidence-based practices—Uses clinical inquiry in practice.

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 e) Critical Care Nursing Management

A, C American Journal of Critical Care and Critical Care Nurse are two official AACN publications.

Which of the following is a National Patient Safety Goal? Select all that apply. a) Accurately identify patients b) Eliminate the use of patient restraints c) Reconcile medications across the continuum of care d) Reduce risks of healthcare-acquired infection e) Reduce costs associated with hospitalization

A, C, D All except for eliminating the use of restraints and reducing costs are current National Patient Safety Goals.

Which strategy is important in 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 who 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 e) Developing a staffing model that accurately reflects the unit's needs

A, C, D Modifying the work environment to reduce physical demands is one strategy to assist the aging workforce. Examples include overhead lifts to prevent back injuries. Twelve-hour shifts can be quite demanding; therefore, allowing nurses flexibility in choosing shifts of shorter duration is a good option as well. Adequate staffing, including both registered nurses and nonlicensed assistive personnel to help with nursing and nonnursing tasks, is helpful.

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 SBAR technique for handoff communication

A, D, E Meaningful recognition, true collaboration, and skilled communication are elements of a healthy work environment.

A hospice nurse is caring for a dying client and her family members. Which interventions should the nurse implement? (Select all that apply.) a. Teach family members about physical signs of impending death. b. Encourage the management of adverse symptoms. c. Assist family members by offering an explanation for their loss. d. Encourage reminiscence by both client and family members. e. Avoid spirituality because the client's and the nurse's beliefs may not be congruent.

A,B,D Rationale: The nurse should teach family members about the physical signs of death, because family members often become upset when they see physiologic changes in their loved one. Palliative care includes management of symptoms so that the peaceful death of the client is facilitated. Reminiscence will help both the client and family members cope with the dying process. The nurse is not expected to explain why this is happening to the family's loved one. The nurse can encourage spirituality if the client is agreeable, regardless of whether the client's religion is the same.

A hospice nurse plans care for a client who is experiencing pain. Which complementary therapies should the nurse incorporate in this client's pain management plan? (Select all that apply.) a. Play music that the client enjoys. b. Massage tissue that is tender from radiation therapy. c. Rub lavender lotion on the client's feet. d. Ambulate the client in the hall twice a day. e. Administer intravenous morphine.

A,C Rationale: Complementary therapies for pain management include massage therapy, music therapy, Therapeutic Touch, and aromatherapy. Nurses should not massage over sites of tissue damage from radiation therapy. Ambulation and intravenous morphine are not complementary therapies for pain management.

A nurse admits an older adult client to the hospital. Which criterion should the nurse use to determine if the client can make his own medical decisions? (Select all that apply.) a. Can communicate his treatment preferences b. Is able to read and write at an eighth-grade level c. Is oriented enough to understand information provided d. Can evaluate and deliberate information e. Has completed an advance directive

A,C,D Rationale: To have decision-making ability, a person must be able to perform three tasks: receive information (but not necessarily oriented ´ 4); evaluate, deliberate, and mentally manipulate information; and communicate a treatment preference. The client does not have to read or write at a specific level. Education can be provided at the client's level so that he can make the necessary decisions. The client does not need to complete an advance directive to make his own medical decisions. An advance directive will be necessary if he wants to designate someone to make medical decisions when he is unable to.

A patient with a history of emphysema, diabetes, and hyperlipidemia is in the critical care unit on a ventilator. The nutrition assessment notes that the patient has a protein and vitamin deficiency and is underweight. Which formula for nutritional assessment is most appropriate? a) Elemental protein formula b) Fiber-added formula c) High medium-chain triglyceride formula d) Lactose-free formula

B Added fiber helps to control blood glucose and reduce hyperlipidemia.

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) Sepsis and fluid and electrolyte imbalances c) Fluid overload and pulmonary edema d) Hypoglycemia and renal insufficiency

B Because of the high dextrose concentration, including the fluid and electrolyte content, the patient is placed at high risk for sepsis and fluid and electrolyte imbalances.

The best nursing approach to prevent feeding tube obstruction is to a) dilute the feeding to make it flow more easily. b) flush the tube every 4 hours with 20 to 30 mL of tap water. c) pass a stylet daily to keep the tubing clear. d) use a larger bore tube where possible.

B Flushing the tubing every 4 hours helps prevent obstruction.

Malnutrition contributes to infection risk by a) hampering normal GI motility. b) impairing immune function. c) increased blood glucose. d) increasing drug interactions.

B Malnutrition impairs immune function.

A patient with acute pancreatitis is started on parenteral nutrition. The student nurse listed possible interventions for this patient. Which intervention needs correction before finalizing the plan of care? a) Change the intravenous tubing every 24 hours. b) Infuse antibiotics through the intravenous line. c) Monitor the blood glucose every 6 hours. d) Monitor the F&E balance.

B Medications should not be infused through the IV line infusing parenteral nutrition. The other actions are correct.

A nurse assesses a client who is dying. Which manifestation of a dying client should the nurse assess to determine whether the client is near death? a. Level of consciousness b. Respiratory rate c. Bowel sounds d. Pain level on a 0-to-10 scale

B Rationale: Although all of these assessments should be performed during the dying process, periods of apnea and Cheyne-Strokes respirations indicate death is near. As peripheral circulation decreases, the client's level of consciousness and bowel sounds decrease, and the client would be unable to provide a numeric number on a pain scale. Even with these other symptoms, the nurse should continue to assess respiratory rate throughout the dying process. As the rate drops significantly and breathing becomes agonal, death is near.

A nurse teaches a client who is considering being admitted to hospice. Which statement should the nurse include in this client's teaching? a. "Hospice admission has specific criteria. You may not be a viable candidate, so we will look at alternative plans for your discharge." b. "Hospice care focuses on a holistic approach to health care. It is designed not to hasten death, but rather to relieve symptoms." c. "Hospice care will not help with your symptoms of depression. I will refer you to the facility's counseling services instead." d. "You seem to be experiencing some difficulty with this stage of the grieving process. Let's talk about your feelings."

B Rationale: As both a philosophy and a system of care, hospice care uses an interdisciplinary approach to assess and address the holistic needs of clients and families to facilitate quality of life and a peaceful death. This holistic approach neither hastens nor postpones death but provides relief of symptoms experienced by the dying client.

The nurse is teaching a family member about various types of complementary therapies that might be effective for relieving the dying client's anxiety and restlessness. Which statement made by the family member indicates understanding of the nurse's teaching? a. "Maybe we should just hire an around-the-clock sitter to stay with Grandmother." b. "I have some of her favorite hymns on a CD that I could bring for music therapy." c. "I don't think that she'll need pain medication along with her herbal treatments." d. "I will burn therapeutic incense in the room so we can stop the anxiety pills."

B Rationale: Music therapy is a complementary therapy that may produce relaxation by quieting the mind and removing a client's inner restlessness. Hiring an around-the-clock sitter does not demonstrate that the client's family understands complementary therapies. Complementary therapies are used in conjunction with traditional therapy. Complementary therapy would not replace pain or anxiety medication but may help decrease the need for these medications.

A nurse cares for a dying client. Which manifestation of dying should the nurse treat first? a. Anorexia b. Pain c. Nausea d. Hair loss

B Rationale: Only symptoms that cause distress for a dying client should be treated. Such symptoms include pain, nausea and vomiting, dyspnea, and agitation. These problems interfere with the client's comfort. Even when symptoms, such as anorexia or hair loss, disturb the family, they should be treated only if the client is distressed by their presence. The nurse should treat the client's pain first.

A nurse plans care for a client who is nearing end of life. Which question should the nurse ask when developing this client's plan of care? a. "Is your advance directive up to date and notarized?" b. "Do you want to be at home at the end of your life?" c. "Would you like a physical therapist to assist you with range-of-motion activities?" d. "Have your children discussed resuscitation with your health care provider?"

B Rationale: When developing a plan of care for a dying client, consideration should be given for where the client wants to die. Advance directives do not need to be notarized. A physical therapist would not be involved in end-of-life care. The client should discuss resuscitation with the health care provider and children; do-not-resuscitate status should be the client's decision, not the family's decision.

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

C Correct placement must be verified by radiograph before use of the tube for either feeding or administering medications.

A patient who is receiving continuous enteral feedings has just vomited 250 mL of milky green fluid. What action by the nurse takes priority? a) Notify the provider b) Assess the patient's lungs and oxygen saturation c) Stop the tube feeding d) Slow the rate of infusion

C Nausea and vomiting are signs of tube feeding intolerance. The nurse should first stop the feeding.

An important nutritional consideration in the elderly population is a) a decrease in protein requirements. b) an increase in caloric requirements with age. c) the potential for drug-nutrient interaction related to polypharmacy. d) the presence of other diseases that decrease caloric needs.

C Patients taking multiple medications have a greater potential for drug-nutrient interactions; older adults may be taking multiple medications.

In evaluating a patient's nutrition, the nurse would monitor which blood test as the most sensitive indicator of protein synthesis and catabolism? a) Albumin b) BUN c) Prealbumin d) Triglycerides

C Prealbumin is the most sensitive indicator of protein synthesis and catabolism.

A hospice nurse is caring for a variety of clients who are dying. Which end-of-life and death ritual is paired with the correct religion? a. Roman Catholic - Autopsies are not allowed except under special circumstances. b. Christian - Upon death, a religious leader should perform rituals of bathing and wrapping the body in cloth. c. Judaism - A person who is extremely ill and dying should not be left alone. d. Islam - An ill or dying person should receive the Sacrament of the Sick.

C Rationale: According to Jewish law, a person who is extremely ill or dying should not be left alone. Orthodox Jews do not allow autopsies except under special circumstances. The Islamic faith requires a religious leader to perform rituals of bathing and wrapping the body in cloth upon death. A Catholic priest performs the Sacrament of the Sick for ill or dying people.

After teaching a client about advance directives, a nurse assesses the client's understanding. Which statement indicates the client correctly understands the teaching? a. "An advance directive will keep my children from selling my home when I'm old." b. "An advance directive will be completed as soon as I'm incapacitated and can't think for myself." c. "An advance directive will specify what I want done when I can no longer make decisions about health care." d. "An advance directive will allow me to keep my money out of the reach of my family."

C Rationale: An advance directive is a written document prepared by a competent individual that specifies what, if any, extraordinary actions a person would want taken when he or she can no longer make decisions about personal health care. It does not address issues such as the client's residence or financial matters.

An intensive care nurse discusses withdrawal of care with a client's family. The family expresses concerns related to discontinuation of therapy. How should the nurse respond? a. "I understand your concerns, but in this state, discontinuation of care is not a form of active euthanasia." b. "You will need to talk to the provider because I am not legally allowed to participate in the withdrawal of life support." c. "I realize this is a difficult decision. Discontinuation of therapy will allow the client to die a natural death." d. "There is no need to worry. Most religious organizations support the client's decision to stop medical treatment."

C Rationale: The nurse should validate the family's concerns and provide accurate information about the discontinuation of therapy. The other statements address specific issues related to the withdrawal of care but do not provide appropriate information about their purpose. If the client's family asks for specific information about euthanasia, legal, or religious issues, the nurse should provide unbiased information about these topics.

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

C Response to diversity considers all of these aspects when planning and implementing care.

Patients experiencing severe physiological stress increase their nutritional requirements to: a) 20 kcal/kg/day. b) 30 kcal/kg/day. c) 35 kcal/kg/day. d) 50 kcal/kg/day.

C Severely stressed individuals require 35 kcal/kg/day.

The vision of the American Association of Critical-Care Nurses is a health care system driven by a) a healthy work environment b) care for 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

C The AACN vision is a health care system driven by the needs of critically ill patients and families where critical care nurses make their optimum contributions.

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 the nurse to seek? a) ACNPG-AG b) CNML c) CCRN d) PCCN

C The CCRN certification is appropriate for nurses in bedside practice who care for critically ill patients.

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.

C The head of the bed should be kept elevated at least 30 degrees if possible during tube feedings to minimize reflux.

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

D Certification assists in validating knowledge of the field, promotes excellence in the profession, and helps nurses to maintain their knowledge of critical care nursing.

Select the physiological reasoning behind enteral therapy as the preferred source of nutritional therapy. a) Gut overgrowth increases. b) Gastroparesis increases. c) Bacterial translocation is initiated. d) Gut mucosa is preserved

D Enteral feedings prevent bacterial overgrowth and potential bacterial translocation from the gastrointestinal tract and preserve the gut mucosa.

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

D Many errors are directly attributed to faulty communication. Effective communication has been identified as an essential strategy to reduce patient errors and resolve issues related to patient care delivery.

Which statement is true about normal function of the gastrointestinal (GI) tract? a) Failure of the tight junctions allows bacteria to invade the GI tract. b) The gut lacks protective mechanisms; thus, infection is always a concern. c) Water is reabsorbed at the beginning of the colon. d) Without nutritional stimulation, mucosal villi atrophy.

D Mucosal villi replenish every 3 to 4 days; without nutritional stimulation, they atrophy. The other statements are false.

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

D Patients who are on a ventilator and who are receiving tube feedings are at a high risk for aspiration and ventilator-associated pneumonia.

A client tells the nurse that, even though it has been 4 months since her sister's death, she frequently finds herself crying uncontrollably. How should the nurse respond? a. "Most people move on within a few months. You should see a grief counselor." b. "Whenever you start to cry, distract yourself from thoughts of your sister." c. "You should try not to cry. I'm sure your sister is in a better place now." d. "Your feelings are completely normal and may continue for a long time."

D Rationale: Frequent crying is not an abnormal response. The nurse should let the client know that this is normal and okay. Although the client may benefit from talking with a grief counselor, it is not unusual for her to still be grieving after a few months. The other responses are not as therapeutic because they justify or minimize the client's response.

A nurse is caring for a dying client. The client's spouse states, "I think he is choking to death." How should the nurse respond? a. "Do not worry. The choking sound is normal during the dying process." b. "I will administer more morphine to keep your husband comfortable." c. "I can ask the respiratory therapist to suction secretions out through his nose." d. "I will have another nurse assist me to turn your husband on his side."

D Rationale: The choking sound or "death rattle" is common in dying clients. The nurse should acknowledge the spouse's concerns and provide interventions that will reduce the choking sounds. Repositioning the client onto one side with a towel under the mouth to collect secretions is the best intervention. The nurse should not minimize the spouse's concerns. Morphine will assist with comfort but will not decrease the choking sounds. Nasotracheal suctioning is not appropriate in a dying client.

The AACN Standards of 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

D The AACN Standards for Acute and Critical Care Nursing Practice delineate the nursing process as applied to critically ill patients: collect data, determine diagnoses, identify expected outcomes, develop a plan of care, implement interventions, and evaluate care.

The charge nurse is responsible for making the patient assignments on the critical care unit. An experienced, certified nurse is assigned to care for the acutely ill patient with sepsis who also requires continuous renal replacement therapy and mechanical ventilation. The nurse with less than 1 year of experience is assigned to two patients who are more stable. This assignment reflects implementation of the a) crew resource model b) National Patient Safety Goals c) QSEN model d) synergy model of practice

D This assignment demonstrates nursing care to meet the needs of the patient. The synergy model notes that the nurse competencies are matched to the patient characteristics.

A critically ill patient has a nonhealing wound and malnutrition. Which component of nutritional supplementation is most important for this patient to receive? a) Arginine b) Omega-3 fatty acids c) Branched-chain amino acids d) Vitamin A

D Vitamin A is vital for wound healing.

Objective data designating that the nutrition goals are not being met include a) hyperglycemia, normovolemia, and increased protein level. b) overhydration, hypoglycemia, and weight gain. c) weight gain, inconsistent glucose, and normovolemia. d) weight loss, elevated glucose, and dehydration.

D When nutritional goals are not being met, the patient experiences weight loss, elevated glucose levels, and either overhydration or dehydration.

3. The nurse in the surgery clinic is discussing an upcoming surgical procedure with a client. What information provided by the nurse is most appropriate for the clients long-term outcome? a. At least you know that the pain after surgery will diminish quickly. b. Discuss acceptable pain control after your operation with the surgeon. c. Opioids often cause nausea but you wont have to take them for long. d. The nursing staff will give you pain medication when you ask them for it.

b. Discuss acceptable pain control after your operation with the surgeon.

14. A client is put on twice-daily acetaminophen (Tylenol) for osteoarthritis. What finding in the clients health history would lead the nurse to consult with the provider over the choice of medication? a. 25pack-year smoking history b. Drinking 3 to 5 beers a day c. Previous peptic ulcer d. Taking warfarin (Coumadin)

b. Drinking 3 to 5 beers a day

1. A faculty member explains to students the process by which pain is perceived by the client. Which processes does the faculty member include in the discussion? (Select all that apply.) a. Induction b. Modulation c. Sensory perception d. Transduction e. Transmission

b. Modulation c. Sensory perception d. Transduction e. Transmission

13. A registered nurse (RN) and nursing student are caring for a client who is receiving pain medication via patient-controlled analgesia (PCA). What action by the student requires the RN to intervene? a. Assesses the clients pain level per agency policy b. Monitors the clients respiratory rate and sedation c. Presses the button when the client cannot reach it d. Reinforces client teaching about using the PCA pump

c. Presses the button when the client cannot reach it

11. A client who had surgery has extreme postoperative pain that is worsened when trying to participate in physical therapy. What intervention for pain management does the nurse include in the clients care plan? a. As-needed pain medication after therapy b. Client-controlled analgesia with a basal rate c. Pain medications prior to therapy only d. Round-the-clock analgesia with PRN analgesics

d. Round-the-clock analgesia with PRN analgesics

6. A nurse is assessing pain in an older adult. What action by the nurse is best? a. Ask only yes-or-no questions so the client doesnt get too tired. b. Give the client a picture of the pain scale and come back later. c. Question the client about new pain only, not normal pain from aging. d. Sit down, ask one question at a time, and allow the client to answer.

d. Sit down, ask one question at a time, and allow the client to answer.