Critical Care Nursing Exam 2 Questions and Answers, Exams of Sociology

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N450 Exam 2 Questions with Complete Solutions Graded

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What is critical care nursing? - Correct Answer Specialty of nursing that deals specifically with human responses to life-threatening problems. Critical care nurse certification - Correct Answer * application/analysis level *STRONG critical thinking abilities *required number of clinical hours is an exam prereq *renewed every three years *Extensive on-going edu *CCRN must have been in critical care for a minimum of two years to be eligible for the examination Are critical care nurses vulnerable? - Correct Answer YUP AACN Six Standards for establishing and maintaining a healthy work environment are? - Correct Answer Skilled communication true collaboration effective decision making appropriate staffing meaningful recognition authentic leadership Roles of the CCRN include? - Correct Answer bedside clinicians nurse educators/researchers/managers clinical nurse specialists nurse practitioners

PATIENT ADVOCATE!

(AACN defines advocacy as respecting and supporting the basic values, rights and beliefs of the critically ill patient) Where do CCRN's practice? - Correct Answer ICUs Cardiac cath bone marrow transplant units solid organ transplant units step down units rapid response team telemetry units ER Recovery rooms home health managed care What is the definition of a critically ill patient? - Correct Answer Critically ill patients are defined as those puts who are at high risk for actual or potential life-threatening health problems The more critically ill the patient is, the more likely he/she is to be highly vulnerable, unstable and complex, thereby requiring intense and vigilant nursing care. What are the six most common nursing diagnosis for critical care patients - Correct Answer Nutrition Anxiety Pain Impaired Communication Sensory-perceptual problems

Sleep problems Six most common nursing diagnosis for critical care patients:

1. Nutrition - Correct Answer Malnutrition is linked to higher mortality rates hypermetabolic or catabolic states malnourished on admit tests and procedures Treatments: pt specific, prevent or correct nutritional deficiencies, enteral nutrition, parental nutrition, monitor I&O's Healing nutrients: Sufficient Kcals, protein, etc... Six most common nursing diagnosis for critical care patients:
2. Anxiety - Correct Answer pts are afraid fear of death, pain, loss of control, uncertainty Dignity: may be nude/partially exposed feel embarrassed/helpless Treatment: explain all procedures, pay attention to the environment, assess and reassess Six most common nursing diagnosis for critical care patients:
3. Pain - Correct Answer Invasive monitoring, ET tubes, immobilization treatment: continuous IV sedation, pain assessment, intervention, evaluation, advocate Six most common nursing diagnosis for critical care patients:
4. Impaired Communication - Correct Answer sedative and paralyzing drugs, ET tube

Treatment/intervention: promote alternate forms of communication, timely and appropriate communication of procedures and interventions, interpreters, touch Six most common nursing diagnosis for critical care patients:

5. Sensory perception problems - Correct Answer delusions, memory deficits, lethargy, restlessness, poor sleep, delirium, physical conditions, medications, sensory overload Treatment: treat underlying cause, noises can be limited. Six most common nursing diagnosis for critical care patients:
6. sleep problems - Correct Answer noise, machines, commotion, anxiety treatment/interventions: 2 hr sleep periods to include REM, avoid interruptions during key sleep times, turn down lights at night, earplugs, eyeshades, clocks, calendars, familiar visitors, sounds, personal items, cluster cares, provide comfort measures. Teaching learning strategies in vulnerable populations: - Correct Answer 1. decrease stress and promote comfort (think maslow)
7. identify what the patient/family already knows
8. identify what the pt/family are concerned about
9. repeat information PRN (calmly and patiently) anxiety, patin, fatigue, drugs affect comprehension
10. FAMILY: consistent info, notification of changes, set ways to obtain info for facilities, VISITS one family member is usually appointed as the spokesperson Family members of all patients undergoing resuscitation and invasive procedures should be given the option of presence at the bedside. - Correct Answer For patients: Almost all children want their parents present during medical procedures; and adult patients

report that having family members at the bedside comforted and helped them. o For family members: Their presence at the bedside helped in removing doubt about the patient's condition by witnessing that everything possible was being done. It decreased their anxiety and fear about what was happening to their loved one. It facilitated their need to be together8,10 and the need to help and support their loved one. They experienced a sense of closure and their presence facilitated the grief process should death occur. All patient care units should have an approved written practice document (i.e., policy, procedure, or standard of care) for presenting the option of family presence during resuscitation and bedside invasive procedures. [Level D] - Correct Answer Ed triage: - Correct Answer process of quickly sorting patients and assigning right resources in the right place at the right time. the process of determining patient acuity- pts with threat to life must be treated first. five level emergency severity index (ESI) ESI- 1 is unstable ESI- 2 is threatened ESI- 3 - 5 = Stable (Page 1675 in the text) The primary survey of triage INCLUDES? - Correct Answer Airway Breathing Circulation Disability Exposure/environment ***ALWAYS CHECK AIRWAY FIRST****

Primary Survey: Airway - Correct Answer assess airway with simultaneous cervical spine immobilization *assess for obstructed airway *assess for foreign objects/loose teeth *assess for respiratory distress Interventions: Oral suctioning jaw thrust (Can't move neck till c spine X-rays r/o injury) nasal or oral airway cervical spine immobilization Primary Survey: Breathing - Correct Answer Assess ventilation respiratory rate assess chest wall movement for paradoxical breathing with inspiration and expiration color of skin and mucous membranes auscultate lungs observe for JVD and trachea position chest trauma use of accessory muscles or retractions AIRFLOW DOES NOT ENSURE ADEQUATE VENTILATION Interventions: administer oxygen

ventilate with BVM w/ 100% o2 IF R absent or inadequate prepare for intubation IF severe respiratory distress suction airway equipment available prepare for needle thoracotomy or chest tube insertion *paradoxical=uneven. One side of the chest wall is rising while the other side is not Primary Survey: Circulation - Correct Answer assessment: palpate carotid or femoral pulse assess quality and rate assess skin color, temp, or moisture observe CRT check blood pressure observe for bleeding Interventions: initiate CPR/ACLS IF absent pulse insert TWO large bore IVS 14 or 16G and have 0.9%NS administer IV fluids/blood products as indicated control bleeding obtain blood samples for type and crossmatch *quality of pulse: weak? thready? bounding? Primary Survey:

Disability - Correct Answer assess neurological status assess LOC assess pupils- PERRLA alert, voice, pain, unresponsive Glasgow coma scale P. 1365

1. standardized way to assess the LOC in head injured pts.
2. lower the score, the lower the patient's conscious state
3. helps predict progression of patient's condition Primary Survey: Glasgow Coma Scale- Range 3 - 15 - Correct Answer Eye opening- max score of 4 best verbal response- max score of 5 best motor response- max score of 6 GSC of 8 or < indicates severe injury GSC of 9 - 12= moderate injury GSC of 13 - 15 usually obtained with a minor injury Primary Survey Exposure and environmental controls - Correct Answer remove puts clothes for complete assessment Intervention: once exposed, prevent heat loss by keeping the patient covered and warm Primary survey:

• identify deformaties
• brief pain assessment
• interventions: frequently assess LOC, mental status, pupil eye reactivity, protect airway, immobilize/splint as needed, reassess pain - Correct Answer Secondary Survey: - Correct Answer begins after primary surgery and any life saving interventions considered a brief, systematic process with the goal of identifying all injuries Secondary Survey: F= full set of vitals, five interventions or focused adjuncts, facilitates family presence - Correct Answer include pulse ox telemetry, pulse ox, urinary cath, NG/OG tube, basic lab studies facilitate lab and diagnostic studies determine if family want to be present determine teatanus prophylaxis Secondary Survey: G= Give comfort measures - Correct Answer pain level assess anxiety repositioning provide emotional support Secondary Survey: H= history and head to toe assessment

i= insect the posterior surfaces - Correct Answer detailed hx head neck face chest abdomen and flank pelvis and perineum extremities logroll pt until cleared Intervention and evaluation after secondary survey complete: - Correct Answer record findings ongoing monitoring of: airway patency and effectiveness ALWAYS HIGHEST PRIORITY, monitor RR and rhythm, o2 saturation and ABGs if ordered, assess LOC VS pulses UO and skin perfusion, ABGS May need to transport to: diagnostic tests CT, admit to ICU, telemetry, or general unit bed, another facility Assessment of a male patient during the primary survey indicates delayed capillary refill of the extremities. He cannot explain the events before admission to the ED. Which action should the nurse take immediately? a. Apply leads to the patient's chest to initiate ECG monitoring. b. Insert one or two large-bore IV catheters to start IV fluid resuscitation. c. Continue the primary survey to complete a brief neurologic examination. d. Initiate pulse oximetry by placing a monitoring device on the patient's index finger. - Correct Answer d. Initiate pulse oximetry by placing a monitoring device on the patient's index finger. Artificial Airways - Correct Answer Placement of a tube into the trachea to bypass upper airway and laryngeal structures Endotracheal intubation may occur via mouth or nose past larynx

Indications: Upper airway obstruction Apnea Respiratory distress Ineffective clearance of secretions Endotracheal Tube - Correct Answer Preparation: consent and patient teaching Equipment: Self-inflating BVM attached to O2, suction equipment, IV access Intubation: Sniffing patient, pre-oxygenate w/100% O2, +/or ventilate between successive attempts Inflate cuff Confirm placement Secure ET tube per protocol Document position ex 23 cm at the lip Monitor pulse oximetry and obtain ABGs Disaster is defined as? - Correct Answer A disaster is defined as any human made or natural event that causes destruction and devastation that cannot be relieved without assistance (Stanhope & Lancaster, 2010) Emergency is defined as? - Correct Answer The term emergency refers to any extraordinary event that requires a rapid and skilled response and that can be managed by a communities existing resources (Lewis, Heitkemper, Dirksen, O'Brien & Bucher, 2011). Mass Casualty Incident (MCI): - Correct Answer An emergency is differentiated from a Mass Casualty Incident (MCI) in that an MCI is a manmade or natural event or disaster that overwhelms a community's ability to respond with existing resources (Lewis et al., 2011). Usually involve large numbers of victims, physical and emotional suffering, and permanent changes within a community.

Require assistance from resources outside the affected community (e.g., American Red Cross, Federal Emergency Management Agency [FEMA]). Natural Events: Tornados, earthquakes, hurricanes, droughts Man-Made Agents (may be utilized as agents of terrorism): Biological (Anthrax, Small Pox, Pneumonic Plague, Botulism, Smallpox, Inhalation Tularemia, Viral hemorrhagic fever) Chemical (Sarin, Phosgene, Mustard gas) Radiological/ Nuclear (nuclear bomb or damage to nuclear reactor) Explosive (TNT, dynamite) Anthrax - Correct Answer *bacterium that forms spores *transmission: inhalation of powder of form, inhalation of spores form infected animal products, NOT spread from person to person *s/s: cutaneous: spores that develop into painless blisters then ulcers with black centers *treatment: treatment after infection is usually a 60 - day course of antibiotics Pneumonic Plague - Correct Answer *Bacterium found in rodents and their fleas *Transmission: respiratory droplets from an infected person (6 foot range) *S/s: bloody or watery sputum *treatment: if close contact with person within 7 days of exposure, treatment is with antibiotics prophylactically *no vaccination available Botulism - Correct Answer *toxin made by a bacterium

• transmission: food, a person ingests preformed toxin, NOT spreadable from person to person

*s/s: double and/or blurred vision, drooping eyelids, slurred speech, difficulty swallowing, depending muscle weakness, (SIMILAR to stroke s/s) *treatment: antitoxin to reduce severity of disease (most effective when administer early in course of disease) *No vaccine available Smallpox - Correct Answer *virus *transmission: very contagious, contact with infected person (direct and prolonged, face- to-face), body fluids, contaminated objects *s/s: high fever, rash that progresses to raised bumps and pus-filled blisters that curst and scab, then fall off in about three weeks, leaving a pitted scar (similar to cystic acne) *treatment: no proven treatment, supportive therapy *Vaccine available Inhalation Tularemia - Correct Answer *highly infections bacterium *transmission: insect (usually tick or deerfly bites) *s/s: skin ulcers, if inhaled: abrupt onset of fever and chills, headache, muscles aches, joint pain, dry cough, and progressive weakness *treatment: antibiotics for 10 - 14 days *no vaccine available Viral Hemorrhagic Fever - Correct Answer *five families of viruses (examples: ebola, Lass, Dengue, yellow, Marburg) *Transmission: viral reservoirs such as rodents and arthropods or an animal host, may be transmitted person to person via close contact or bodily fluids *s/s: flu like systems initially, as disease worsens: bleeding under skin, in internal organs, or from body orifices (Mouth, eyes, ears) shock *treatment: supportive therapy *No vaccine

Ricin - Correct Answer *poison made from waste left over from processing castor beans *transmission: deliberate act of poisoning by inhalation or injection, cannot be spread from person to person through casual contact *Incubation period: inhalation: within 8hrs, Ingestion: <6hrs *s/s: inhalation: respiratory distress, fever, nausea, tightness in chest, heavy sweating, pulmonary edema, decreased blood pressure, respiratory failure, death. Ingestion: N/V, severe dehydration, decreased blood pressure, hallucinations, seizures, hematuria, liver, spleen and kidney failure, skin and eyes=redness and pain *treatment: supportive care Sarin - Correct Answer clear, odorless, and tasteless liquid that can evaporate into a gas and spread into the environment. *transmission: agent in the air, ingested in water or food, clothing *s/s: pinpoint pupils, eye pain and blurred vision, in large doses: loss of consciousness, convulsions, paralysis, respiratory failure, death *treatment: antidote available: most effective if given as soon as possible after exposure Radiation - Correct Answer *form of energy both human made and natural *Exposure is cumulative *s/s: ARS: N/V, diarrhea, bone marrow depletion, weight loss, loss of appetite, flu symptoms, MAY lead to cancers (with low doses and in those surviving ARS) *Treatment: supportive care The role of the nurse in a disaster: - Correct Answer Prevention/Mitigation Preparedness Response Recovery The role of the nurse in a disaster:

Prevention/Mitigation - Correct Answer Actions or measures that can either prevent the occurrence of a disaster or reduce the severity of its effects Role of the nurse Mass prophylaxis and vaccination campaigns Coordination with the Strategic National Stockpile (SNS) Assess and report environmental health hazards Be aware of high-risk targets and current vulnerabilities Contingency planning and preparation IF a disaster Monitor psychological or sociological conditions that could lead to unrest and violence such as overcrowding, extreme disrespect, and violence within a community The role of the nurse in a disaster: Prevention/Mitigation continued - Correct Answer Mitigation- reducing the severity of the impact (lessening the effects) should a disaster occur Mitigation examples: Nurse working with community leaders to ensure the maintenance of backup generator power to mitigate the effects of a power failure Nurse teaching disaster victims about importance of safe water and/or sanitation to prevent ingesting water tainted with cholera if the water supply is lost during a MCI The role of the nurse in a disaster: Preparedness (personal) - Correct Answer Personal Maintain personal and family preparation Ready America Emergency Supply List Family Emergency Plan Maintain physical and mental well being

Traumatic Incident Stress: Information for Emergency Response Workers The role of the nurse in a disaster: Preparedness (Professional) - Correct Answer Professional Keep copies of licensure and certifications in safe location Maintain personal equipment needed in a disaster Attend disaster preparedness courses (PPE) Be aware of disaster plans in workplace and community Become a Member of a National Disaster Medical System (NDMS) Disaster Medical Assistance Team (DMAT) Community Emergency Response Team (CERT American Red Cross Know where to find information The role of the nurse in a disaster: Preparedness (Community) - Correct Answer Written disaster plans from US Department of Homeland Security's Federal Emergency Management Agency (FEMA) The Lessons Learned Information Sharing Community wide disaster drills Awareness of past disasters and effects on health care Awareness of community resources Adequate warning system The role of the nurse in a disaster:

Response - Correct Answer Role of the nurse Nurse as Epidemiologist (Who, What, Where, When) Responding to a call to go to the scene of an incident First Responder Relieving nurses who were initially involved in these activities Triage-Separate casualties and allocate treatments Nurse as Communicator Shelter Management/Special Needs Shelters Stress Management The role of the nurse in a disaster: Response: Disaster Triage - Correct Answer Immediate Triage (sorting)- When an emergency or MCI occurs, first responders are dispatched The Simple Triage And Rapid Treatment ( START) system was developed to allow first responders to triage multiple victims in 15 seconds < based on : Respiration, Perfusion, and Mental Status (RPM) The START system is designed to assist rescuers to find the most seriously injured patients to attend to first. As more rescue personnel arrive on the scene, the patients will be re-triaged for further evaluation, treatment, stabilization, and transportation. This system allows first responders to open blocked airways and stop severe bleeding quickly. START (Simple, Triage, And, Rapid, Treatment) Can be completed in 15 seconds, prioritizes and tracks patients Categories: Red - immediate Yellow - delayed

Green - minor Black - deceased The role of the nurse in a disaster: Response: Disaster Triage RED TAG - Correct Answer RED TAG Needs immediate treatment (altered RPMs) RESPIRATION: Opening airway, starts to breathe Breathing is greater than 30 (or less than 10) PERFUSION: Absent radial pulses Delayed capillary refill time (>2 seconds) Bleeding that needs to be controlled MENTAL: Does not follow instructions The role of the nurse in a disaster: Response: Disaster Triage RED TAG (EXAMPLES) - Correct Answer RED TAG(Example) Patient has an open head wound Bleeding controlled Respirations are 16 Pulse is 88 (radial) He is unconscious

The role of the nurse in a disaster: Response: Disaster Triage YELLOW TAG - Correct Answer YELLOW TAG (Treatment can be delayed, urgent need, has a condition that could change) RESPIRATION: Patent airway Respirations between 11 - 29 breaths per minute PERFUSION: Radial pulse present Capillary refill less than 2 seconds No uncontrolled breathing MENTAL: Can follow instructions Cannot walk away The role of the nurse in a disaster: Response: Disaster Triage YELLOW TAG (EXAMPLES) - Correct Answer Yellow Tag (Example) Respirations are 26 Pulse is 100 (radial) He is awake and oriented Patient states he can't move or feel his legs The role of the nurse in a disaster: Response: Disaster Triage

GREEN TAG - Correct Answer GREEN TAG (Walking, wounded, minor) May have obvious wounds Considered to be walking wounded Has no abnormal criteria for respirations, perfusion, mental or motor status The role of the nurse in a disaster: Response: Disaster Triage GREEN TAG (EXAMPLES) - Correct Answer GREEN TAG (Example) Patient walks over to you and has an obvious broken arm Respirations are 22 Pulse is 124 radial He is awake, alert and crying The role of the nurse in a disaster: Response: Disaster Triage BLACK TAG - Correct Answer BLACK TAG (deceased or beyond help) RESPIRATION: Does not have respirations If the patient is not breathing and does not start to breathe with simple airway maneuvers, the patient should receive a black tag PERFUSION: Absent radial pulse with no respirations MENTAL: Unconscious with no respirations The role of the nurse in a disaster:

Response: Disaster Triage BLACK TAG (EXAMPLES) - Correct Answer BLACK TAG Example (unlikely to survive given injury severity) You walk up to a patient and notice a large head wound with brain matter showing: REPSIRATIONS: Absent, and remains absent with airway repositioning PERFUSION: Radial pulse absent Capillary refill, not present MENTAL: Unconscious The role of the nurse in a disaster: Response: Secondary "SAVE" triage - Correct Answer "SAVE" TRIAGING SYSTEM- ongoing process reassessing and assigning victims for transport to appropriate treatment/holding area; follows primary triage with START phase SAVE triage developed to direct limited resources to the subgroup of patients expected to benefit most from their use All patients with at least 50% chance of survival using available resources will get care; this prioritization is determined by SAVE The role of the nurse in a disaster: Response: Secondary "SAVE" triage (Continued) - Correct Answer A part of the RESPONSE role of the nurse is utilizing S. A. V. E. Secondary Triage: Reassessment of patients based on S. T. A. R. T. triage, GCS, more thorough history and physical, etc.

Continued observation Periodic reassessment for improvement Provide basic care Determination of those not needing care Treated in order of severity and resources SAVE (Secondary, Assessment, Victim, Endpoint) evaluates: Those who will die regardless of care Those who will survive with or without care Those who will benefit from limited immediate field intervention and use of resources During a disaster time with a limited number of resources the ethics of determining who receives care varies from a typical emergency room situation with few patients and numerous resources: The decision to advocate for the sickest patient is overruled by the utilitarian principle of doing the greatest good for the greatest number of patients The various needs and even rights of an individual are set aside to provide the basic good of survival for the greatest number possible (Wagner & Dahnke, 2015). The role of the nurse in a disaster: Response: NIMS - Correct Answer The National Incident Management System (NIMS) is a template that facilitates a systematic, proactive approach to guide departments and agencies at all levels of government, nongovernmental organizations, and the private sector to work together seamlessly and manage incidents involving all threats and hazards National Response (Plan) Framework: provides the context for how the community works together to complete response activities with focus on immediate needs after a disaster. It enables first responders, decision-makers, and supporting entities to provide a unified national response. Provides the template for incident management at all levels:

Doctrine Concepts Principles Terminology Organizational processes The role of the nurse in a disaster: Response: NIMS Components - Correct Answer Preparedness Communications and Information Management Resource Management Command and Management Ongoing Management and Maintenance The National Response Framework (NRF) - Correct Answer The National Response Framework (NRF) presents the guiding principles that enable all response partners to prepare for and provide a unified national response to disasters and emergencies. The National Response Plan was replaced by the National Response Framework effective March 22, 2008. The second edition of the NRF was updated in 2013 and provides context for how the whole community works together and how response efforts relate to other parts of the national preparedness. Focus on immediate needs Saves lives, protects property and environment, and meets basic needs after an incident has occurred. Response activities take place immediately, during and in the first few days after an MCI. New focus describes the important roles of individuals, families and households in response activities Hospital Emergency Incident Command System (HEICS) - Correct Answer An Incident Command System at the hospital level used as a tool for emergency management

The HEICS Organizational Chart shows a chain of command which incorporates four sections under the overall leadership of an Emergency Incident Commander (IC) Logistics, Planning, Finance and Operations, has a Chief appointed by the IC responsible for their section The role of the nurse in a disaster: Recovery - Correct Answer Role of the Nurse in the recovery phase: Assist in community clean-up Risk Assessment (don't forget environmental) Infectious disease monitoring and containment Tertiary prevention Referrals for mental health as indicated; PTSD symptoms may occur International recovery efforts The role of the nurse in a disaster: Recovery triage - Correct Answer The process of separating casualties and allocating treatment based on the victim's potential for survival. Emergency Triage Emergency Severity Index Disaster Triage Prevention Levels in Disaster Management - Correct Answer Primary Develop disaster management plan in the community Secondary Assess victims and triage for care (screening)

Tertiary Uncover dangers that may cause additional problems Pulse Pressure: - Correct Answer is the difference between the SBP and DBP Example- If BP = 120/80, pulse pressure 120 - 80= 40 Increases in exercise Decreases with heart failure or hypovolemia Mean arterial pressure (MAP): - Correct Answer is the perfusion pressure felt by organs in the body MAP = (SBP+2DBP)/3 Need a MAP > 60 to sustain vital organs or ischemia will result due to poor perfusion Normal MAP 70 - 105 mm Hg Cardiac Output (CO) - Correct Answer CO is the volume of blood pumped by the heart in 1 minute CO=SV x HR Normal = 4 - 8L/min Cardiac Index - Correct Answer Cardiac Index (CI) is the CO adjusted for body size (height and weight) and is a more precise measurement of the efficiency of the pumping action of the heart CI=CO/Body surface area (BSA) CI normal =2.2.- 4L/min/m2 Example- CO vs CI more accurate for ballet dancer vs football lineman Stroke Volume: - Correct Answer The volume ejected with each heartbeat Normal SV = 60 - 150ml/beat SV=CO/HR