NUR 2020 Final Exam NUR 2020 Final Exam, Exams of Nursing

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Hypothesis - correct answers A statement of a relationship between variables that the research study is designed to test Population - correct answers The entire group of people who have the problem or would be affected by the question of concern Sample - correct answers A representative group of the entire population Participant - correct answers A member of the sample Sampling - correct answers The way in which each subject is chosen Random Convenience - correct answers Name two different ways of Sampling Convenience Sampling - correct answers Sampling that is conveniently obtained Often through location or ease of selecting May be biased in their traits Random Sampling - correct answers Sampling where each member of the population has an equal chance of being in the group

Very difficult to accomplish, but MOST representative of the population Convenience Sampling - correct answers When conducting healthcare research, which type of sampling is usually used? Groups - correct answers Allow for comparisons and to evaluate the effect of an independent variable on the dependent variable Experimental Group - correct answers Which group is exposed to the intervention Control Group - correct answers Which group is not exposed to the intervention Control Group - correct answers Which group helps determine if the change (if any) of the experimental group is due to the intervention Variable (Examples: Lipitor and Cholesterol Levels) - correct answers Used to describe something that varies or changes Independent Variables (Example: Lipitor) - correct answers Variables that can vary by themselves or that can be caused to vary

Dependent Variables (Example: Cholesterol Levels) - correct answers Variables that change as a result of the independent variable Validity (Example: A thermometer reading thermal temperature) Also think Specifity - correct answers The degree to which an assessment tool actually measures what it is supposed to measure Reliability If reliable, it will produce the same results when used again in different circumstances. - correct answers The degree of consistency or dependability with which an assessment tool measures something. Probability - correct answers Te likelihood that something is due to chance rather than to the interaction of the dependent and independent variables The p-value - correct answers Generally stated in the form of a mathematical expression Low - correct answers We want our probability to be as _____ as possible

Level of Significance - correct answers Associated with probability Statistical evidence that the results were not due to chance Statistical Tests (Crunching numbers) - correct answers Used to determine the probability of the results Each test has a different purpose and can be used only when specific criteria are met Clinical Significance (Will it change what we do at the bedside?) - correct answers Whether the result produces clinically important changes Average - correct answers What is the Mean High / Low - correct answers What is the Range of Scores How much those in the sample vary from the mean - correct answers What is Standard Deviation (SD)

1. Statement of the Problem - question to be answered
2. Review of Literature - familiarization with what is known

3. Theoretical Framework - sets the stage for the project
4. Identification of Variables
5. Formation of the Hypothesis
6. Selection of Research Design - nature, tool, participants
7. Implementing the Study - data collection
8. Analyze the Data - perform statistical tests
9. Interpret and Present Findings - report data
10. Limitations of the Study - factors, reliability
11. Disseminate - publishing / presenting the research - correct answers Steps in the Research Process (Just look at this card..... No need to memorize) Quantitative (Think Quantity and Numbers) - correct answers Emphasizes experimentation and statistical analysis Focuses on measurable observation (those that can be reported as numbers) Objective Experimental; truest and purest form of research Quasi-experimental; less control and may lack control group Non-experimental; less control and may lack control group Logitudinal studies; long over the coarse of time

Descriptive; describing the population Methodological; develop tools for future use - correct answers Name types of Quantitative research Ex post facto Research - correct answers Deals with an event in the past and another variable of interest Experimental Research (MOST objective and measurable) - correct answers What type of research? Subjects are randomly assigned Researcher manipulates (gives a treatment) to one group (experimental group) The other group (control group) does not receive treatment Qualitative (Think subjective and no number crunching) - correct answers What type of research? Concerned with the subjective and contexual Looks at phenomena in their environment instead of trying to isolate them Not reported with statistical tests

Ethnography - correct answers Describes the characteristics of a particular culture Researcher becomes involved in the culture and tries to include as many variables as possible Meta-Analysis Think: Find a topic, find research articles on that topic, combine them and use them for research - correct answers Process of examining multiple research studies about the same topic and combining the findings of all as a group Provides larger samples and broader representation of populations Allows comparison of different interventions Can be problematic because of wide variations in studies Nuremburg Code - correct answers Provides a set of principles to govern human research Voluntary - correct answers The ______________ consent of the human subject is absolutely essential Goals for patient care and ways to assess those goals Set a level of care (judge its quality) Describe roles and responsibilities of nurses - correct answers What is our purpose for standards of clinical practice?

(24 hour cycles) sleep temperature blood pressure urine production - correct answers What cycles are circadian? (cycles less than 24 hours) SA node firing REM/NREM sleep Nerve action potentials - correct answers What cycles are Ultradian (cycles greater than 24 hours) menstrual cycle hibernation aging - correct answers What cycles are Infradian? co-morbid conditions pre-op psych illness smoking hx multiple abnormal lab results infections

fever advanced age severity of illness - correct answers What are some non-modifiable risk factors for ICU delirium in adults? dementia benzo's before ICU admission elevated creatinine level low arterial pH severity of illness - correct answers What are some non-modifiable risk factors for ICU delirium in older adults? medications (morphine, fentanyl, versed) windowless units length of stay sleep deprivation infections older adults: benzo's opioid, haloperidol - correct answers What are some potentially modifiable risk factors for ICU delirium in adults and older adults? Richmond Agitation Sedation Scale (RASS)

Intensive Care Delirium Screening Checklist (ICDSC) - correct answers What 2 screening tools do we have for ICU delirium? Inattention Disorientation Hallucinations/delusions Psychomotor agitation or retardation Inappropriate Speech or Mood Sleep/Wake cycle disturbance Symptom Fluctuation - correct answers What does the Intensive Care Delirium Screening Checklist (ICDSC) look for? (7) Autonomy Beneficence Nonmaleficence Justice Veracity Fidelity - correct answers What are the ethical principles? (6) Failure to act in a reasonable and prudent manner - correct answers What is negligence? Nurse had duty to treat

Nurse did not carry out duty Nurse caused injury Action caused injury - correct answers What 4 things must be present for malpractice to take place? Required to care for assigned patients regardless of feelings Contractual relationship Not required to practice if situation violates moral or religious beliefs - correct answers What does duty to treat involve?

1. competence
2. voluntary
3. disclosure of information - correct answers What are the elements of informed consent? Extraordinary care is treatment where the risks outweigh the benefits Ordinary: antibiotics, O2 therapy, Extraordinary: chemo, experimental, - correct answers What is the difference between ordinary and extraordinary care? A living will - correct answers An advanced directive about treatment desired and what should be withheld

A durable POA - correct answers What determines who can make decisions? Patient's right to initiate advance directive Patient's right to consent for or refuse treatment - correct answers What does the Patient Self-Determination Act (1990) say? absence of spontaneous respirations absence of spontaneous movement cessation of brain function

• no response on neuro exam
• isoelectric EEG
• Bilateral absence of cortical response
• absence of cerebral blood flow in the absence of hypothermia or drug induced states - correct answers What is the criteria used for brain death determination? Diastole - correct answers The coronary arteries fill during? Diastole - correct answers The ventricles fill during? 120 cc - correct answers What is the average EDV?

50 cc - correct answers What is the average ESV? 70 cc - correct answers What is the average SV? 4-8 L - correct answers What is the average CO? Accelerated rhythym - correct answers What is the name of a rhythm that fires above it's normal intrinsic rate, but less than 100? Ectopic beat - correct answers What is the name of a beat originating outside the normal pacemaker's control Pacemaker - correct answers What is responsible for setting the rhythm and rate Drugs Ischemia Electrolytes (Potassium, Magnesium) - correct answers Name 3 main causes of dysrhythmias Left Main Coronary Artery - correct answers The "Widowmaker" is which coronary artery?

RCA - Right Coronary Artery - correct answers Which coronary artery supplies blood to the RA, SA node, AV bundle, RV, and posterior portion of the LV? Left Anterior Descending - correct answers Which coronary artery supplies blood to the anterior LV, anterior 2/3 of interventricular septum, and lateral LV? Circumflex - correct answers Which coronary artery supplies blood to the LA and the posterior LV? 0.12 - 0.20 - correct answers What is a normal PR interval? Less than 0.12 - correct answers What is a normal QRS? SA Node (60-100) AV Bundle (40-60) Purkinje system (20-40) - correct answers What are the 3 pacemakers of the heart?

1. Is there a P wave?
2. What is the PR interval?
3. What is the QRS complex?
4. What is the rate?

5. What is the rhythm? - correct answers What 5 things must you do to accurately identify an EKG rhythm? SVT - Supraventricular Tachycardia - correct answers Any tachycardia in which the origin is above the ventricles and has a rate greater than 150 BPM is known as what? 250-350 BPM - correct answers What is the atrial rate when in Atrial Flutter? You can lose up to 30% of your Cardiac Output Blood can clot in the atria - correct answers What is the risk of losing your atrial kick? EKG rhythm - correct answers What comes first - the EKG rhythm or the contraction? HR X SV - correct answers Cardiac Output =? The larger the muscle, the larger the waveform - correct answers Why is the P wave smaller than the QRS? Coronary sinus - correct answers Coronary veins return blood b ack to the heart through the?

Aorta Aortic valve - correct answers Coronary arteries branch off the _____ and immediately above _____? SA node becomes fibrotic (a fib) Pacemaker cells in SA node decrease (10% remain at 75) PR, QRS, QT intervals increase Peak HR decreases (need increased SV to maintain CO) Stiff ventricles d/t HTN and diastolic dysfunction Diastolic dysfunction causes 50% of HF in elderly >80 - correct answers Name some normal aging of the heart facts (6) R-R Interval - correct answers The distance between the peaks of the depolarization of the ventricle during each cardiac cycle P-P Interval - correct answers The distance between the peaks of the depolarization of the atria during each cardiac cycle PR Interval (0.12-.20) - correct answers The time it takes for the impulse to travel through the atria and sit in the AV node briefly Rhythm: Regular

Rate: 60-100 BPM P Waves: Normal / Upright P-R Interval: .12 -. QRS Complex: .04 - .12 - correct answers Define NSR Rhythm: Rate: P Waves: P-R Interval: QRS Complex: Rhythm: Regular Rate:BELOW 60 BPM P Waves: Normal / Upright P-R Interval: .12 -. QRS Complex: .04 - .12 - correct answers Define: Sinus Bradycardia Rhythm: Rate: P Waves: P-R Interval: QRS Complex: Rhythm: Regular

Rate:ABOVE 100, BELOW 150 BPM P Waves: Normal / Upright P-R Interval: .12 -. QRS Complex: .04 - .12 - correct answers Define: Sinus Tachycardia Rhythm: Rate: P Waves: P-R Interval: QRS Complex: Rhythm: IRREGULAR Rate: 60-100 BPM P Waves: Normal / Upright P-R Interval: .12 -. QRS Complex: .04 - .12 - correct answers Define: Sinus Dysrhythmia Rhythm: Rate: P Waves: P-R Interval: QRS Complex: Rhythm: IRREGULAR

Rate: Normal- SLOW P Waves: Normal / Upright P-R Interval: .12 -. QRS Complex: .04 - .12 - correct answers Define: Sinus Pause Ablation Pacemakers ICD - Implantable Cardioverter-Defibrilators - correct answers Additional treatments for cardiac dysrhythmias beyond medications Ablation - correct answers Radiofrequency used to eliminate the pathways Used to treat patients with tachydysrhythmias (A fib, SVT, V tach) Pacemakers - correct answers Used to treat symptomatic bradycardia (2nd degree AV block - Type II, Third degree block, Sick sinus syndrome Transcutaneous Transvenous Epicardial (mostly post-bypass patients) - correct answers Name some temporary methods of pacing

When the pacemaker is set at a specific rate and it only paces when the patient demands it (needs it) - correct answers What is Demand pacing? When the pacemaker is set at a specific rate and it is continuously pacing the patient - correct answers What is asynchronous pacing? Output. It is measured in milliamperes (mA) - correct answers The energy that we are giving the patient is known as the pacemaker's? Sensitivity - correct answers The ability to sense what the patient's heart is doing is called the pacemaker's? Spike - correct answers An indicator that indicates that the pacemaker has sent out a signal is the? Capture - correct answers The waveform that the heart sends out after the spike is the pacemaker's P wave (if it's an atrial pace) QRS (if it's a ventricular pace) Failure to pace - correct answers What pacemaker complication? The pacemaker is not pacing.

Failure to capture - correct answers What pacemaker complication? The patient is not catching what the pacemaker is sending out Failure to sense - correct answers What pacemaker complication? The pacemaker is not picking up the patient's heart rhythm Positioning Check/replace batteries Adjust settings - correct answers What are some interventions for pacemaker complications? Put the patient on their left side - correct answers How should you position the patient if a pacemaker complication arises? ICD - Implantable Cardioverter-Defibrilators - correct answers What is used to treat survivors of sudden death or those at high risk? NO MRIs NO Metal detectors Shock may be uncomfortable - correct answers What patient instruction is needed for patients who have an ICD implanted?

BP = Cardiac Output X Systemic Vascular Resistance - correct answers Blood Pressure Equation is?

1. Invasive catheter in the patient (Swan-Ganz catheter, arterial line, CVC
2. Noncompliant tubing - decreases artifact and increases accuracy
3. Transducer - takes intravascular pressure and changes it into waveforms and numbers
4. Pressurized Flush system
5. Bedside monitor - correct answers What are the 5 components of Hemodynamic monitoring? 70-100 mmHg - correct answers Normal MAP increased pressure - correct answers Increased volume causes an CVP - Central Venous Pressure - correct answers A CVC (central venous catheter) can measure? Right Atrial Pressure - correct answers Central Venous Pressure is an indirect reading of? RAT - Right Arterial Pressure PAP - Pulmonary Artery Pressure

PAOP - Pulmonary Artery Occlusive Pressure (aka wedge) Cardiac Output SvO2 - correct answers What can a Pulmonary Artery Catheter (aka Swan Ganz catheter) measure? RAP - correct answers What is a direct measurement of the pressure of the Right Atrium? 2-6 mmHg - correct answers Normal RAP - (Right Atrial Pressure) aka CVP (Central Venous Pressure)? RAP/CVP - correct answers Helpful in measuring blood volume, pulmonary hypertension, right sided HF PAP - correct answers What is a direct measurement of the pressure in the Pulmonary Artery? 15-25 / 8-15 mmHg - correct answers Normal PAP (Pulmonary Artery Pressure)? 15 mmHg - correct answers Mean PAP? PAP - correct answers Helpful in measuring blood volume, pulmonary hypertension, ARDS

PAOP or wedge - correct answers What is a reflection of the left atrial pressure? 8-12 mmHg - correct answers PAOP - (Pulmonary Artery Occlusion Pressure) or "wedge" mean pressure? PAOP - correct answers Helpful in measuring blood volume, left sided HF SvO2 - correct answers What measurement determines the adequacy of cardiac and pulmonary function? Pulmonary Artery - correct answers Where is SvO2 measured? SvO2 = O2 delivered - O2 consumed - correct answers What does the SvO2 reading measure? 60-75% - correct answers Normal SvO2 =? Less than 60% - correct answers Low SvO2 =? Greater than 75% - correct answers High SvO2=?

Decreased delivery - hypoxemia, anemia, MI Increased consumption - fever, shivering, sepic shock - correct answers Causes of low SvO2? Increased delivery - increased FiO2 Decreased consumption - hypothermia - correct answers Causes of high SvO2? Statins - correct answers Most effective med to lower LDL? What drugs reduce oxygen demand, increase oxygen supply - correct answers Antianginal Drugs What are the (2) anginal symptoms specific to women? - correct answers SOB and Fatigue Ability of the myocardium to contract and relax Associated with availability of Ca+ Increased catecholamines (SNS) - correct answers Contractility Lab values showing increased risk for CHD - correct answers LDL = Over 100 HDL <50 for women, <40 for men