NR 575 EXAM PREP LATEST ACUTE CARE PRACTICUM II ANSWERED 20232024, Exams of Nursing

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NR 575 EXAM PREP LATEST

ACUTE CARE PRACTICUM II

ANSWERED

2023/

1. What are the three main components of the Rapid Response Team (RRT) and what are their roles in acute care settings? (3 points)

• The three main components of the RRT are the team leader, the critical care nurse, and the respiratory therapist. The team leader is usually a physician or an advanced practice nurse who coordinates the assessment and management of the patient. The critical care nurse provides bedside care and monitors the patient's vital signs and interventions. The respiratory therapist assists with airway management and oxygen therapy.

2. What are some common causes of acute respiratory failure and how can they be prevented or treated? (4 points)

• Some common causes of acute respiratory failure are pneumonia, asthma, chronic obstructive pulmonary disease (COPD), pulmonary embolism, acute lung injury, and acute respiratory distress syndrome (ARDS). They can be prevented or treated by avoiding smoking, infections, allergens, and environmental toxins, as well as by administering bronchodilators, corticosteroids, antibiotics, anticoagulants, mechanical ventilation, and extracorporeal membrane oxygenation (ECMO) as indicated.

3. What are the indications and contraindications for initiating non-invasive positive pressure ventilation (NIPPV) in patients with acute respiratory failure? (3 points)

• The indications for initiating NIPPV are hypoxemic or hypercapnic respiratory failure that is not responsive to conventional oxygen therapy, impending intubation, or extubation failure. The contraindications for initiating NIPPV are hemodynamic instability, cardiac arrest, facial trauma or surgery, upper airway obstruction, copious secretions, or inability to cooperate or protect the airway.

4. What are the types and complications of central venous catheters (CVCs) and how can they be prevented or managed? (4 points)

• The types of CVCs are peripherally inserted central catheters (PICCs), subclavian catheters, internal jugular catheters, and femoral catheters. The complications of CVCs are infection, thrombosis, air embolism, pneumothorax, hemothorax, and catheter malposition or migration. They can be prevented or managed by following aseptic technique, using ultrasound guidance, securing and dressing the catheter properly, flushing and locking the catheter regularly, monitoring for signs and symptoms of complications, and removing the catheter as soon as possible.

5. What are the indications and complications of intra-aortic balloon pump (IABP) therapy and how can they be monitored and managed? (4 points)

• The indications for IABP therapy are cardiogenic shock, acute myocardial infarction, unstable angina, ventricular arrhythmias, mechanical complications of myocardial infarction, or as a bridge to cardiac surgery or transplantation. The complications of IABP therapy are limb ischemia, bleeding, infection, balloon rupture or displacement, aortic dissection or perforation, and embolization. They can be monitored and managed by assessing the insertion site, distal pulses, blood pressure, cardiac output, arterial blood gases, chest x-ray, electrocardiogram (ECG), and IABP waveforms and parameters regularly; by maintaining adequate anticoagulation; by adjusting the balloon inflation and deflation timing; and by treating any complications promptly.

6. What are the indications and complications of continuous renal replacement therapy (CRRT) and how can they be monitored and managed? (4 points)

• The indications for CRRT are acute kidney injury (AKI), fluid overload, electrolyte imbalances, acid-base disorders, sepsis, or multiple organ dysfunction syndrome (MODS) that are not responsive to conventional therapies. The complications of CRRT are hypotension, bleeding, infection, clotting, catheter dysfunction, or electrolyte imbalances. They can be monitored and managed by assessing the patient's vital signs, fluid status, laboratory values, and CRRT settings and effluent regularly; by maintaining adequate anticoagulation; by replacing fluids and electrolytes as needed; and by treating any complications promptly.

7. What are the types and modes of mechanical ventilation and how can they be adjusted to optimize gas exchange and minimize lung injury? (4 points)

• The types of mechanical ventilation are volume-controlled ventilation

and pressure-controlled ventilation. The modes of mechanical ventilation are assist-control ventilation, synchronized intermittent mandatory ventilation, pressure support ventilation, pressure-regulated volume control ventilation, airway pressure release ventilation, and high-frequency oscillatory ventilation. They can be adjusted by setting the tidal volume, respiratory rate, inspiratory Remember that questions on the exam will be application-style questions, not a simple recollection of information. A few math questions will be included, so remember your clinical calculations. Review your assigned readings and lecture notes. Below are some recommended focus areas.

1. What are the components of evidence-based practice?

• Nursing research, quality improvement, clinical practice guidelines, evidence-based management
• Best current evidence and practice used to make decisions about patient care.

2. Understand the parts of an SBAR handoff and how to use SBAR.

• S-situation: what is going on. B-background: what happened before. A-assessment: relevant data (vitals, test results). R-recommendation: what should happen next

3. Be able to identify and apply interventions and education to improve patient safety.
4. What can a Rapid Response Team do for you?

• Save lives and reduce the risk of harm by providing care BEFORE a medical emergency occurs. (intervene rapidly for patients who are beginning to decline.
• Critical care experts who are on-site and available at any time.

5. What is the difference between critical thinking and clinical judgment?

• Cynical judgment is the end product of critical thinking
• Critical thinking: comparing what you already know with information you are given in order to decide what to do next

6. What are the steps in the NCSBN Clinical Judgment Measurement Model (Look at Iggy p. 20)? Be able to apply them to scenarios.

• NCBSN clinical judgment: Recognize cues, analyze, prioritize hypothesis, generate solutions, take action, evaluate outcomes

7. What is Tanner’s Model of Clinical Judgment?

• Tanner’s clinical judgment: noticing, interpreting, responding, reflecting

8. What is the ANA Code of Ethics? Recognize the 9 provisions and interpret how they apply to professional identity and the nurse’s responsibilities to self and others.

• Guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession
  9. What are the attributes of professional identity in nursing? Look at Giddens.

10. What is an adverse event, a near miss, and a sentinel event?

• Adverse event- Unintended harm to the patient by an act of commission or omission NOT from underlying disease
• Near miss- could have harmed the patient but did not
• Sentinel event- a severe variation in the standard of care that is caused ny human or system error and resulted in avoidable patient death or major harm

11. What are latent and active errors?

• Latent- hidden errors that lie inactive (flaw in system)
• Active- caused by an individual (failure to check med order)

12. What is a culture of safety? What kinds of components help create a culture of safety?

• Investigate what went wrong instead of blaming
• Empower staff to participate in an error reporting system without fear of punishment

13. How are adverse events responded to in a culture of safety?

• What went wrong instead of who did it
• A person must take accountability

14. When should patient education begin?

• As soon as possible (but patient needs to be willing to learn)
• Time of admission and continues until discharge

15. What are barriers to patient learning?

• Lack of support, time, education, financial resources, language barriers, cultural difference, literacy level, motivation, age

16. What motivates adult learners?

• Focus is on the immediate need to address issues or solve problems
• Perceived need to learn

17. What are the three domains of learning? Know how to apply them.

• Cognitive- thinking
• Affective- attitudes, beliefs, values
• Psychomotor- skill (teach back)

18. What is the focus of the Joint Commission related to healthcare delivery?

• Improve health care for better outcomes and safety measures

19. How is quality measured?

20. What is the best indication of a patient’s pain?

• Whatever the patient says

21. What are the components of a complete pain assessment?

• PQRSTU
• Location, intestisty, quality, onset, duration, aggravating factors, alleviating factors, quality of life, comfort goal
• Palliative (when did it start, what happened)
• Quality (what does it feel like)
• Region or radiating (where is the pain does it radiate anywhere)
• Severity (0-10)
• Time when did it start (constant pain or comes and goes)
• You (how does it affect you)

22. What is around-the-clock analgesia and when should it be used?

• Continuous pain control (reduces breakthrough pain)

23. What is multimodal pain therapy? Why is it important?

• Combines drugs with different underlying mechanisms.
• Lowers dose of each drug used and reduces potential for adverse effects and also greater pain relief

24. What are important safety precautions when using a PCA?

• ONLY THE PT CAN PRESS THE BUTTON
• Pt must cognitively understand the use of the equipment and be able to physically press the button
• Only press when in pain (the machine will never give you the med if its not time)

25. What is the difference between addiction, tolerance, and dependence? Which are normal responses to treatment with opioids?

• Normal- tolerance (reduced response to med: need more to feel pain relief) and dependence (body NEEDS medication to do normal functioning)
• Addiction is abnormal (abnormal need for medication in the absence of pain)

26. What are the consequences of unrelieved pain?

• Depression, anxiety, impaired ADLs, sleep disturbance, decreased immune response, and decreased lung capacity, affect the quality of life and socialization

27. What is the difference between nociceptive and neuropathic pain? Recognize examples.

• Nociceptive pain is normal (a protective mechanism) aching, cramping, throbbing
• Neuropathic pain is abnormal nerve pain (burning, shooting, sharp)

28. What is the difference between somatic and visceral pain?

• Somatic- Sharp pain that is well localized to a specific area of injury
• Visceral- within the body cavity poorly localized (can lead to radiating to other areas)

29. What is the most dangerous side effect of opioids? What about the most common?

• RESPIRATORY DEPRESSION- MOST DANGEROUS
• Constipation- most common

30. What are the three classes or types of pain medications used?

• Non opioid- NSAIDs Tylenol
• Opiods- morphine, fentanyl, oxycodone
• Adjuvant- local anesthetics, antidepressants, anticonvulsants

31. What are adjuvant therapies? When are they used?

• Can be used in addition to other meds to treat pain (when there is evidence of decreased opioid responsiveness is present)

32. What are contraindications to use of acetaminophen? What are priority complications? Are there dosing limits?

• Drug allergy, severe liver disease
• LIMIT IS 3 GRAMS DAILY
• Hepatotoxicity

33. How can you prevent excessive sedation in patients receiving opioids?

• Decrease dose, opiod rotation, changin route, assess before (sedation level, respirations)

34. What is naloxone used for?

• Reversal for an opioid overdose

35. Review the Checklist of Nonverbal Pain Indicators (Iggy).

• Moaning, crying, grimacing, guarding, reduced socialization, irritability, difficulty concentrating, changes in eating or sleeping, facial expressions

36. What are non-pharmacological pain relief measures? Physical, mind-body, psychological?

• Ways to reduce pain WITHOUT medication
• Massage acupuncture, heat/cold, guided imagery, relaxation, breathing, mediation, CBT, biofeedback, hypnosis

37. What actions are taken in the surgical patient to prevent infection?

• Skin prep, handwashing, sterile clothing, controlled blood sugar, controlled body temp, safe hair removal, ATB treatment

38. Apply knowledge of gas exchange and perfusion to assess risk, interpret findings, and prioritize interventions in the surgical patient.

• Gas exchange- slow respirations, decrease lung expansions (due to anesthesia)
• Perfusion- if there is no perfusion to the incision it won’t heal, decreased perfusion to lower extremities can cause DVT (leg exercises)

39. What is the focus of SCIP measures?

• REDUCE SURGICAL COMPLICATIONS
• Continuation of beta blockers, selecting correct ATB for prophylactic, appropriate hair removal, VTE and DVT prophylaxis

40. What is the focus of the NPSGs related to the surgical patient?

• National patient safety goals: provide inforamtion regarding informed consent, NPO status, prep for surgery, exercise after surgery, plans for pain management
• RIGHT PATIENT RIGHT SITE RIGHT TIME
• TIME OUT- everyone stops and listens (NURSES SHOULD ADVOCATE FOR PATIENTS)

41. What are some priority complications in the surgical patient? (think respiratory, perfusion, infection, and GI). Evaluate scenarios to identify signs of these risks.

• RESPIRATORY DEPRESSION (sedation- slows everything)
• DVT- from immobility

42. Why are patients NPO for surgery?

• Reduce the risk of aspiration
• During surgery you do not have reflexes so if you eat that food can come up and you could breathe that into ur lungs causing you to aspirate. (if you had reflexes you would be able to cough or get that food out)

43. What patients may be at greater risk for surgical complications?

• Infants, elderly, smoking, poor lifestyle choices, high BMI, immoblie, history of malignant hyperthermia

44. What diagnostic studies might you anticipate for the surgical patient? Why?

• CBC, liver and kidney labs, ABG, vitals, EKG, Chest X-ray, F + E, blood sugar, PT, PTT, INR

45. Who is responsible for informed consent?

• THE DOCTOR- obtains it
• nurse - makes sure it was given and can answer questions

46. What are risks for dehydration? Fluid overload?

• Dehydration: Infants- not able to communicate thirst, higher fluid exchange ratios. Elderly- blunted thirst sensation, Excessive sweating, hyperventilation, not enough intake, diuretic use, excessive sodium, diabetes
• Fluid Overload: Elderly- live disease, hyperaldosteronism, CHF, steroid use, Stress
  47. What are signs and symptoms of dehydration? Fluid overload?
• Dehydration- increased HR, RR, specific gravity, H&H, BUN, thirst. Decreased BP, urine output, weak thready pulse, poor skin turgor, dry flaky skin, dark urine, sunken eyes, flat neck and hand veins, rapid wt loss
• Overload- Increased BP, HR, RR, urine output, decreased specific gravity, bounding pulses, distended neck and hand veins, wt gain, crackles, edema, taught shiny skin
  48. What are interventions for dehydration? Fluid overload?
• Dehydration- Fluid replacement, fall precautions (dizziness), daily wt, i+o
• Overload- Fluid restriction, diuretic use, pressure preuction, daily wt, i+o
  49. What is the best way to evaluate effectiveness of treatment for fluid imbalances?
• Track wt gain/loss 1 - 2 lb within 24 hours or 3+ in a week
  50. What are risk factors for hyponatremia? Hypernatremia?
• Hypo- excessive sweating, diuretic use, wound discharge, inadequate sodium intake, hyperglycemia, hyperlipidemia, decrease aldosterone
• Hyper- excessive intake of sodium, Cushing’s disease, hyperaldosteronism, corticosteroid use
  51. What are signs and symptoms of hyponatremia? Hypernatremia?
• Hypo- increased HR, hypotension, hypothermia, confusion, lethargy, decreased DTR, hyperactive bowel sounds, cramping, nausea, increased intestinal motility, decreased specific gravity.
• Hyper- increased thirst, hyperthermia, dry membranes, increased specific gravity, muscle twitch, decreased DTR hypotension
  52. What is a critical finding in hyponatremia?
• Decreased mental status and confusion
• HIPPONATREMIA- hippo=fat. Cells get fat (in brain)
  53. What are interventions for hyponatremia? Hypernatremia?
• Hypo- increased sodium, admin hypertonic fluids (3% Sodium Chloride), monitor pt for seizures
• Hyper-decrease sodium, admin hypotonic fluids, monitor for seizure
  54. What kinds of foods are high in sodium?
• canned /processed, salted nuts, frozen dinners, smoked/cured fish, meat, poultry, vegetable juice, cottage cheese

55. What are risk factors for hypokalemia? Hyperkalemia?

• Hypo- Overuse of diuretics, laxatives, enemas, excessive vomiting/diarrhea, NPO status, increased aldo, cushings, insufficient potassium intake
• Hyper- older adults, excessive intake, use of ACE, ARB, Spironolactone, RBC transfusion

56. What are signs and symptoms of hypokalemia? Hyperkalemia?

• Hypo- AMS, lethargy, hypo bowel sounds, abdominal distention, inverted Flat T waves, shallow breathing
• Hyper- AMS, restlessness, hyper bowel sounds, peaked T waves, oliguria

57. What are priority assessments/findings for potassium imbalances?
58. What kinds of foods are high in potassium?

• Avocados, broccoli, dairy products, dried fruit, cantaloupe, bananas

59. What are treatments for hypokalemia? Hyperkalemia?

• Hypo- insulin, high potassium diet, k sparing diuretic
• Hyper- low potassium diet, loop diuretic, sodium polystyrene sulfonate (Kayexalate)

60. What does insulin do related to potassium? How does sodium polystyrene sulfonate work?

• Insulin helps spare potassium from urinary excretion (pushing potassium into cells)
• Sodium polystyrene sulfonate helps remove excess potassium from the body and allows it to be eliminated in stool

61. Which diuretics are potassium sparing?

• Spironolactone (aldactone)

62. What are osmotic diuretics used for?

• Reduce intracranial pressure and intraocular pressure

63. What are diuretic medication interactions?

• NSAID, ACE, ARB, Potassium supplements

64. What do loop diuretics do?

• Cause rapid loss of fluid and electrolytes (SUPER STRONG)