MCQs

Chapter 1: The history and development of critical care nursing

1. What disease caused the development of critical care services?

a. Polio

b. Spanish flu

c. Tuberculosis

d. Diphtheria

2. What was the name of the publication that triggered the most recent significant development in UK critical care services?

a. Critical Care Services

b. Critical to Success

c. ITU Steps

d. The Copenhagen report

3. How is the level of care defined for, “Patients requiring more detailed observation or intervention, including support for a single failing organ system or post-operative care and those ‘stepping down’ from higher levels of care?”

a. Level 0

b. Level 1

c. Level 3

d. Level 2

4. Which type of research is at the top of the hierarchy of evidence?

a. Cohort studies

b. Critically Appraised Topics

c. Randomised Controlled Trials

d. Systematic Review

5. What can cause unconscious bias?

a. Personal views being influenced by background

b. Personal views are influenced by our experiences

c. Making quick judgements and assessments of patients without realising

d. All of these

Chapter 2: Humanising critical care

1. Which of the following is an example of humanising behaviours?

a. Physical touch

b. Loss of control

c. Isolation from family and friends

d. Loss of ability to communicate

2. What is the biggest barrier to communication in the critical care unit?

a. The staff

b. The equipment

c. Sedation

d. Illness

3. What is Step 3 of the WHO analgesic ladder?

a. Non-opioid analgesic

b. Weak opioid

c. Strong opioid

d. NSAID

4. Sedation can be used to ______

a. Reduce anxiety

b. Control agitation

c. For amnesia during neuromuscular blockade

d. All of these

5. What is the name of the first clinically validated scale to measure sedation levels?

a. The Waterlow Scale

b. The Ramsey Scale

c. The TISS Scale

d. The APACHE Score

Chapter 3: Critical care continuum

1. What is the name of the hospital-wide critical care service?

a. Critical Care Outreach

b. Critical Care Steps

c. Critical Care Continuum

d. Critical Care Success

2. What are the aims of critical care outreach?

a. To assess the acutely unwell person, advise the personal care team, and stabilise

b. To ensure timely referral and admission to critical care, if appropriate

c. To follow up those transfer out of critical care

d. All of these

3. What is the name of the physiological track and trigger scoring system?

a. Test and trace

b. National Early Warning Score 2

c. Outreach trigger

d. HELLP

4. What approach to assessing the acutely ill patient is recommended by RCUK (2015)?

a. ALI

b. SBAR

c. EWS

d. ABCDE

5. What tool can be used when communicating and handing over a patient?

a. ALI

b. SBAR

c. EWS

d. ABCDE

Chapter 4: Infection prevention and control in critical care

1. A recent, large scale European study in adult Critical Care found a Healthcare Associated Infection prevalence rate of

a. 3.5%

b. 8.4%

c. 12.6%

d. 16.2%

2. Which of the following adult body sites is usually “sterile”?

a. Bladder

b. Fingernails

c. Vagina

d. Gut

3. Which of the following respiratory pathogens is not transmitted through aerosols?

a. Tuberculosis

b. Chickenpox

c. Influenza

d. Measles

4. Which of the following is recommended for physically clean hands that are contaminated with multidrug-resistant organisms?

a. Soap and water

b. Soap and water followed by alcohol hand rub

c. Chlorhexidine antiseptic wash

d. Alcohol hand rub

5. Which of the following is the best approach when managing peripheral cannulas?

a. Always remove and re-insert at 72 hours

b. If healthy at 72 hours with poor venous access retain for a further 24 hours then remove and re-insert

c. If healthy at 72 hours with poor venous access retain and closely observe

d. Remove at either 72 or 96 hours depending on the patient's other comorbidities

Chapter 5: Critical care related to the respiratory system

1. What is the normal adult breathing rate at rest?

a. 12–18

b. 6–10

c. 15–25

d. 20–25

2. Type 1 respiratory failure is characterised by ______

a. Hypoxaemia with high CO₂ levels (hypercapnia)

b. Hypoxaemia with normal or low levels of CO₂ (hypocapnia)

c. Normal oxygen levels with low CO₂ levels (hypocapnia)

d. Normal oxygen levels with high CO₂ levels (hypercapnia)

3. What is the normal range of pH in arterial blood?

a. 7.3–7.4

b. 7.4–7.5

c. 7.35–7.45

d. 7.25–7.35

4. Which statement is correct?

a. A person with a tracheostomy does not require artificial humidification

b. A person with an endotracheal tube does not require artificial humidification

c. A person receiving oxygen therapy via a face mask does not require humidification

d. Insertion of an artificial airway disrupts the normal humidification of the airway

5. All people with an endotracheal tube ______

a. Should not receive oral hygiene

b. Must receive rigorous oral hygiene at least twice a day

c. Does not require a nasogastric tube

d. Does not require assistance with communication

Scenario 1:

Maseem has type 2 respiratory failure and is a risk of hypercapnic respiratory failure. He is struggling to breathe.

1. What would be the best position in which to support his breathing?

a. Fowler’s (Semi-recumbent)

b. Prone

c. Orthopnoeic

d. Trendelenburg

2. What is the target oxygen saturation level for Maseem?

a. 95–100%

b. 90–95%

c. 88–92%

d. 80–85%

Scenario 2:

Lucy has pneumonia as a result of a Covid 19 infection. She is in intensive care and ventilated. To enable ventilation she is heavily sedated and paralysed. Her lungs are not recovering as expected despite treatment so the intensive care team decide to change her position.

1. What position should be considered to help oxygen exchange in her lungs?

a. Fowler’s (Semi-recumbent)

b. Prone

c. Orthopnoeic

d. Trendelenburg

2. What are the risks in Lucy being in the prone position?

a. Dislodged airway

b. Pressure sores

c. Disrupted nasogastric feed

d. All of these

Chapter 6: Critical care related to the cardiac system

1. What is the correct sequence of ECG?

a. PSRTQ

b. PQRST

c. RSTPQ

d. STPQR

2. The blood flow through the heart is ______

a. Left atrium; Right atrium; Right ventricle; Left ventricle

b. Left ventricle; Right ventricle; Left atrium; Right atrium

c. Right atrium; Right ventricle; Left atrium; Left ventricle

d. Right ventricle; Right atrium; Left atrium; Left ventricle

3. The correct sequence of the valves as blood flows through the heart is ______

a. Tricuspid; Pulmonary; Mitral; Aortic

b. Mitral; Pulmonary; Aortic; Tricuspid

c. Pulmonary; Tricuspid; Mitral; Aortic

d. Aortic; Mitral; Pulmonary; Tricuspid

4. How many leads are recorded when recording an ECG?

a. 10

b. 4

c. 12

d. 6

5. Which of the following blood vessels contains deoxygenated blood?

a. Aorta

b. Pulmonary veins

c. Pulmonary artery

d. Carotid artery

Scenario 1:

Alan is admitted to the hospital with a very low level of haemoglobin in his blood.

1. What would be the best blood product to treat his anaemia?

a. Packed Red Blood Cells

b. Platelets

c. Fresh frozen plasma

d. Albumin

2. How would his anaemia affect him?

a. Tiredness

b. Breathlessness

c. Dizziness

d. All of these

Scenario 2:

Elisha is intensive care for the treatment of heart failure.

1. Would her Starling’s curve be ______?

a. Normal

b. Flattened

c. Raised

d. Unchanged

2. What are the dangers of giving too much fluid to someone with heart failure?

a. Overload causing reduced cardiac output

b. Increase in cardiac output

c. Increased sweating

d. Increased conscious level

Chapter 7: Critical care related to the systemic inflammatory response

Scenario 1:

Erin is an 81-year-old lady who has fallen and broken her neck of femur. She has had surgery 2 days ago to fix this. She has an IV cannula leftover from surgery that isn’t being used and a urinary catheter until she is able to get out of bed and be more mobile to the toilet.

1. Erin has the following observations, Respiratory rate – 22/min; SpO₂ – 94% on nasal cannula oxygen at 3 lpm; Systolic blood pressure – 155 mmHg; Heart rate – 96 bpm; Conscious level – mild confusion (previously she was cognisant); Temperature – 35.8°C. What is her NEWS 2 score?

a. 10

b. 8

c. 7

d. 3

2. On calculating Erin’s NEWS2 score, what would you do?

a. Repeat her observations in an hour’s time.

b. Start the sepsis 6

c. Leave it, she looks alright and she’s eaten her lunch

d. Talk to a colleague as you’re not sure what to do.

3. If Erin’s NEWS2 score is 10 would you consider sepsis?

a. YES

b. NO

4. Based on the presenting case about and symptoms provided, which of the following are risk factors for Erin to be considered for sepsis (tick all that apply)

a. New altered mental state

b. Surgery within the last 6 weeks

c. Raised respiratory rate >21 bpm

d. Systolic blood pressure 155 mmHg.

e. Heart rate >91 bpm

f. Temperature < 36°C

g. Skin mottled or redness around the wound.

5. What might be the suspected cause or site of Erin’s sepsis?

a. Surgical wound site

b. IV cannula

c. Urinary catheter

d. Pneumonia/chest infection

e. All the above

Scenario 2:

Erin is an 81-year-old lady who has fallen and broken her neck of femur. She has had surgery 2 days ago to fix this. She has an IV cannula leftover from surgery that isn’t being used and a urinary catheter until she is able to get out of bed and be more mobile to the toilet.

1. What causes sepsis?

a. Inflammation ‘gone bad’

b. The heart fails

c. The blood pressure falls

d. There’s an infection

2. Why is there a loss of fluid from the circulation in sepsis?

a. The person doesn’t drink enough

b. The person urinates too much

c. The fluid leaves the circulation entering the extravascular circulation

d. Fluid is not lost from the circulation it doesn’t circulate because the heart fails.

Scenario 3:

Arif (68) is feeling unwell at home. He feels hot but is shivering and very tired. He is normally well although he does smoke. He is producing green sputum, which is new, and he is feeling breathless. He has pneumonia.

1. Why is Arif shivering?

a. Because he is cold

b. Because he tired

c. Because his hypothalamus has reset to a higher temperature and the body is trying to warm up to that temperature

d. Because his body is trying to shut down.

2. What effect does his pneumonia have on oxygen uptake in the lungs?

a. It reduces oxygen uptake

b. It increases oxygen uptake

c. No difference

d. Pneumonia does not affect gas exchange in the lungs.

Chapter 8: Critical care related to the renal and liver systems

1. Which organ secretes bile?

a. The bile duct

b. The bowel

c. The liver

d. The pancreas

2. The Loop of Henle can be found in the ______

a. Gall bladder

b. Liver

c. Nephron

d. Bladder

3. What is the level of urine output that is associated with acute kidney injury?

a. 30 mls/hr

b. 45 mls/hr

c. 0.5mls/kg/hr for more than 6 hours

d. 5mls/kg/hr for more than 6 hours

4. Pyelonephritis is inflammation of ______

a. The brain

b. The bowel

c. The liver

d. The renal pelvis

5. How is Stage 3a of chronic kidney disease defined?

a. an eGFR of 45–59ml/min

b. an eGFR of 30–44ml/min

c. an eGFR of 15–29ml/min

d. <15l/min

Scenario 1:

Moa has a urinary catheter and for the last 8 hours, her urine output has been 25 ml/hr. Her body weight is 80kg. She hasn’t been drinking very much and she has no intravenous therapy.

1. How is this quantity of urine output classified?

a. Oliguria

b. Anuria

c. Polyuria

d. Normal

2. What should be the first thing to consider to improve Moa’s urine output?

a. Give a diuretic

b. Nothing, she’ll drink it she’s thirsty

c. Encourage fluid intake orally or intravenously if necessary

d. Monitor her fluid balance and review tomorrow

Scenario 2:

Eric has yellow sclera and skin. He suffers from gallstones.

1. What is the term given for this yellow colour?

a. Anaemia

b. Jaundice

c. Inflammation

d. Cyanosis

2. What is the probable cause of the yellowing?

a. He drinks too much tea

b. His liver isn’t working properly

c. He has bruised himself

d. A gall stone is blocking his bile duct

Chapter 10: Critical care related to the gastrointestinal system

1. Which of the following are all risk factors for refeeding syndrome?

a. Obesity, parenteral nutrition, and insulin-dependent diabetes.

b. Obesity, parenteral nutrition, and type II diabetes.

c. Low body weight, no or reduced food intake for more than 10 days, low levels of potassium, phosphate or magnesium before feeding and a history of alcohol or drug misuse.

d. Low body weight, reduced food intake for more than 5 days and high levels of potassium, phosphate, or magnesium after feeding.

2. According to the European Society of Intensive Care Medicine (2017) early enteral feeding should be delayed if the affected person is experiencing which of the following:

a. Uncontrolled shock

b. Overt bowel ischaemia

c. Upper GI bleeding, gastric aspirates greater than 500 mls for 6 hours

d. All of these

3. According to the ‘nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition guideline’ (NICE 2006), when should healthcare professionals consider enteral tube feeding in people who are malnourished or at risk of malnutrition?

a. The person has inadequate oral intake and a functional, accessible gastrointestinal tract

b. The person has adequate oral intake and a functional, accessible gastrointestinal tract

c. The person has inadequate oral intake and a non-functioning, accessible gastrointestinal tract

d. The person has inadequate oral intake and a non-functioning, inaccessible gastrointestinal tract

4. What is the normal pH of gastric aspirates?

a. There is no normal pH for gastric aspirates

b. 6.5–7.5

c. 5.5–6.5

d. Less than 5.5

5. What volume of sterile water to BAPEN recommend flushing enteral feeding tubes with between medications?

a. 10 mls

b. 20 ml

c. 30 ml

d. 40 mls

Scenario 1:

Sheena is admitted to intensive care and is likely to be intubated and ventilated for several days.

1. How quickly should nutritional replacement be commenced after admission?

a. Immediately/as soon as possible.

b. 12–24 hours following admission

c. 24–48 hours following admission

d. It’s not a priority

2. What would be the most appropriate route to give her the nutrition?

a. Orally

b. Intravenously

c. Nasogastrically

d. Subcutaneously

Scenario 2:

Ruby is having a nasogastric tube inserted for feeding whilst she is intubated and ventilated. She appears malnourished and thin.

1. How would you know the nasogastric tube is in the stomach?

a. The woosh test

b. The test pH level of aspirate is 1–5.5

c. Blue litmus paper test

d. Absence of respiratory distress

2. What syndrome is Ruby at risk of when the feeding starts?

a. Refeeding Syndrome

b. Hyperlipidaemia

c. Hyperglycaemia

d. Gastric bleed

Chapter 11: Critical care related to neurology physiology and disorders

1. A subdural haematoma ______

a. Occurs outside the dura membrane

b. Occurs under the dura membrane

c. Occurs in the subarachnoid space

d. On the brain itself

2. How much oxygen and nutrients do the brain consume from each cardiac output?

a. 5%

b. 10%

c. 20%

d. 50%

3. The hindbrain contains the ______

a. Pons; Medulla oblongata; Cerebellum

b. Thalamus; Hypothalamus; Cerebrum

c. Cerebrum; Diencepahlon; Hypothalamus

d. Pons; Cerebrum; Hypothalamus

4. Calculation of the Glasgow Coma Score is based on an assessment of the ______

a. Pain; Blood Pressure; Pulse

b. Eye response; Verbal response; Motor response

c. Blood pressure; pupil response; pulse rate

d. Respiratory rate; pulse rate; pupil response

5. The normal pupil response to the light source is ______

a. Sluggish

b. Non-reactive

c. Brisk

d. Slow

Scenario 1:

Sanjeev has been admitted to intensive care for observation following a fall from a ladder. You are doing his observations and you note that his eyes are opening to speech, he appears confused and he’s not obeying commands but moves to localised pain.

1. What is his Glasgow Coma Score?

a. 12

b. 11

c. 10

d. 13

2. You note that his blood pressure is 220/80 mmHg, his pulse is 52 bpm and his breathing pattern is erratic. What is the name given to these symptoms?

a. McBurney’s sign

b. Cushing reflex

c. Positive Q sign

d. Braxton Hicks

Scenario 2:

As a result of traumatic brain injury, Rose is sedated and ventilated in intensive care. In order to ensure the perfusion of Rose’s brain continues, her cerebral perfusion pressure is calculated.

1. How do you calculate cerebral perfusion pressure?

a. MAP = CPP–ICP

b. ICP = CPP–MAP

c. CPP = ICP–MAP

d. CPP = MAP–ICP

2. What is the normal cerebral flow to a 1500 gram brain?

a. 750 ml/min

b. 50 ml/min

c. 1500 ml/hr

d. 800 ml/hr

Chapter 12: Critical care related to the skin and integumentary system

1. Which of the following make up the major components of the integumentary system?

a. The epidermis, dermis and hypodermis

b. Skin hair and nails

c. Epidermis and dermis

d. Dermis and hypodermis

2. In which layer of the skin would you find blood vessels, glands, nerves and hair follicles?

a. Epidermis

b. Dermis

c. Hypodermis

d. Horny layer

3. What is the main function of the acid mantle?

a. To maintain the balance of bacteria on the skin and maintain skin integrity

b. To provide oxygen to the epidermis

c. To regulate body temperature

d. The production of keratin and lamellar granules

4. The functions of the skin include:

a. Protection, sensation and respiration

b. Protection, sensation and absorption

c. Sensation, absorption and respiration

d. Absorption, red cell production and sensation

5. What is the name of the cells of the skin that protect the body from infection by mounting an immune response?

a. Keratinocytes

b. Melanocytes

c. Langerhans cells

d. Merkel cells

Scenario 1:

George has been admitted to intensive care with smoke inhalation following a house fire. He has sustained 50% third degree and 20% second-degree burn injuries to his skin.

1. The loss of skin will leave George prone to ______

a. Significant heat loss

b. Infection

c. Pain

d. All of these

2. When calculating the extent of the burn, what method would you use?

a. Waterlow score

b. Wallace Rule of Nine

c. MUST

d. RASS

Scenario 2:

Freda has been admitted to intensive care and has had prolonged sedation and ventilation. She has been fed via a nasogastric tube. She has suffered from diarrhoea for some time and there is erythema around her perineal area.

1. What is this called?

a. Allergy rash

b. Pressure sore

c. Incontinence Associated Dermatitis

d. Malabsorption

2. If there is no improvement following the implementation of a care plan, at what point would you refer to a specialist such as a tissue viability nurse?

a. 1 week

b. 10 days

c. 3–5 days

d. 1 day

Chapter 14: Critical care related to women during pregnancy and childbirth

1. What can cause Placental abruption?

a. Advanced maternal age

b. Hypertension

c. Drug use

d. All of these

2. What is the timeframe in which secondary primary postpartum haemorrhage occur?

a. Up to 24 hours postpartum

b. Up to 6 hours postpartum

c. Up to 12 weeks postpartum

d. Up to 10 days postpartum

3. What is the main reason for postnatal women’s admission to intensive care?

a. Obstetric haemorrhage

b. Eclampsia

c. Pre-eclampsia

d. Respiratory failure

4. Antepartum haemorrhage (APH) is defined as ______

a. Bleeding from the genital tract after birth

b. Bleeding from the foetus

c. Bleeding from trauma

d. Bleeding from the genital tract after 24 weeks of pregnancy before the birth of the baby

5. What are the reasons for primary postpartum haemorrhage?

a. Tone, tissue, thrombin, trauma

b. Placenta, tissue, thrombin, birth

c. Placenta, caesarean section, birth, tissue

d. Tone, birth, caesarean section, uterine rupture

Scenario 1:

Maire is 28 weeks pregnant and has been admitted to your intensive care unit from the maternity ward where she’s been monitored for preeclampsia.

1. What indications of developing eclampsia should you would observe?

a. Seizures

b. Headache

c. Drowsiness

d. Epigastric pain

2. What are the complications of HELLP syndrome?

a. Disseminated intravascular coagulation

b. Pulmonary oedema

c. Renal failure

d. All of these

Scenario 2:

Shauna gave birth 5 weeks ago and was rushed into your critical care unit from the emergency department in a collapsed state. She is tachycardic, hypotensive and has a poor urine output. She is peripherally shut down with cold clammy extremities. She is confused and disorientated.

1. How long postpartum can a haemorrhage occur?

a. Up to 4 hours

b. Up to 2 days

c. Up to 8 weeks

d. Up to 10 days

2. Shauna is too ill to breastfeed what should you do?

a. Consult with her midwife to facilitate expression

b. Nothing, the milk will dry up

c. Offer the baby to the breast to feed

d. Give drugs to reduce lactation

Chapter 15: The psychological care of the critically ill

1. How many subtypes of delirium are there?

a. 2

b. 3

c. 4

d. 5

2. Delirium can result in ______

a. Longer stay in critical care

b. Post-traumatic stress disorder

c. Higher mortality

d. All of these

3. Which of the following is the main cause of delirium?

a. Sensory overload

b. The endotracheal tube

c. The intravenous lines

d. The continual presence of the nurse

4. What tool would you use to assess for delirium?

a. MUST

b. APACHE

c. CAM-ICU

d. NEWS

5. What does the acronym PADIS stand for?

a. Pain, activity, distress, immobility

b. Progress, activity, delirium, inactivity

c. Pattern, assessment, distress, inactivity

d. Pain, agitation/sedation, delirium, Immobility

Scenario 1:

Lieut has been ventilated for a week in intensive care. He is now waking up from the sedation but remains ventilated via a tracheostomy. During the night shift, he becomes distressed agitated and is pulling at his airway and intravenous lines and trying to get out of bed.

1. What would be the most appropriate management of this situation?

a. Give him some night sedation so that he sleeps

b. Apply physical restraints so he doesn’t pull out his airway and lines

c. Sit with him, provide reassurance and orientation

d. None of these

2. What might have caused his distress and agitation?

a. Noise pollution

b. Light pollution

c. Sleep deprivation

d. All of these

Scenario 2:

Freda insists on bringing her 8-year-old daughter to visit her grandmother who is ventilated but awake but confused about your critical care unit.

1. How would you manage this situation?

a. Why is Freda insisting on bringing the daughter?

b. Check the unit policy on children visiting.

c. Is the environment safe for her to visit?

d. All of these

2. If the child visits her grandmother what support measures would you consider?

a. Sedate the grandmother so she’s not confused.

b. Provide pre-visit information targeted at children.

c. Insist the child visits alone so as not to crowd the bed area

d. Insists the child brings her best friend.

Chapter 16: Supporting those at the end of life in critical care

1. End of life care is:

a. Care only in the last hours of life

b. Care only in the last days of life

c. Care in the last year of life, including care in the last days of life

d. Care in the last weeks of life

2. Decision making about the end of life care can be challenging. In the critical care setting nurses are:

a. Pivotal to decision making about the end of life care

b. Involved at some end of life care decisions

c. Not involved in any decision making about the end of life care

d. Involved occasionally at the end of life care decisions

3. The multi-professional team is central to palliative care delivery in the critical care setting because:

a. The involvement of a range of professionals ensures that all aspects of the complex nature of a person’s needs are assessed and effectively managed

b. It is not possible for the nurse to support every aspect of a person’s care

c. Teams are not able to communicate effectively to support care delivery

d. There is a range of equipment that is used in the critical care setting

4. Palliative care teams should be involved in the care of a person:

a. Only when the person has been identified as being in the last weeks or days of life

b. When the team providing care have identified that there are no further treatment options available

c. At any point in a person’s disease trajectory, earlier involvement can have a positive impact on care delivery for the person and their family

d. Only when a person has symptoms

5. There is an increased potential for burnout for nurses working in critical care due to the often-complex cases and the length of time that nurses care for and support people and their families. Self-care can be facilitated by:

a. Avoiding discussions with others about worries or concerns

b. Team working and supportive discussions with colleagues, including debrief and supervision opportunities

c. Keeping things bottled up, other people may be feeling stressed and it is not fair to burden others

d. Continuing to work when you feel exhausted and drained

Chapter 17: Rehabilitation after critical illness

1. Long term immobility and critical illness can result in ______

a. Polyneuropathy

b. Myopathy

c. Muscle loss

d. All of these

2. How long after discharge from critical care, must adults who have stayed in critical care for more than 4 days and were at risk of morbidity, have a review?

a. 2 to 3 months

b. 2 to 3 weeks

c. 4 to 6 months

d. 4 to 6 weeks

3. What is the charity support group called who can help people and their relatives understand and support in their recovery from their stay in ICU?

a. ICU Steps

b. ICU Stay

c. ICU Stress

d. ICU Survivors

4. How does NICE (CG83) define the 2 domains of recovery?

a. Physical and psychological

b. Physical and non-physical

c. Psychological and non-physical

d. Social and psychological

5. Critical illness myopathy is ______

a. Loss of neurological function

b. Muscle weakness

c. Paralysis

d. Rhabdomyolysis

Scenario 1:

Asheem has suffered from severe sepsis and has spent 4 weeks in intensive care. He has had respiratory, circulatory and renal failure. He is now beginning to recover and is starting to wean from his ventilator.

1. What factors can help Asheem orientate to time and place?

a. Keeping the lights on all day and night

b. Constantly talking to him throughout the day and night

c. Letting him sleep all day

d. A constant reminder of time and day

2. What prevents Asheem from mobilising early in his recovery?

a. The ventilator

b. Nothing

c. Monitoring

d. His intravenous lines

Scenario 2:

Keema has been recovering from a prolonged stay in ICU. She is not sleeping well and although she feels better physically, she feels depressed and she can’t believe what her family have said about her stay in ICU.

1. What strategy could the ICU staff use to help her understand her illness and stay in ICU?

a. Counselling

b. Physical rehabilitation

c. Patient diaries

d. A visit to the ICU

2. What community-based services may support Keema?

a. Clinical psychologist

b. Social worker

c. Community psychiatric nurse

d. All of these