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NR 341 UPDATED ACTUAL EXAM 2025 STRUCTURED
QUESTIONS AND CORRECT ANSWERS ALREADFY RATED
AND GRADED A+
Critical Care Nursing - CORRECT ANSWER >>> - deals with human responses to critical illness
- focus on both the patient's and family's responses Evolution of Critical Care - CORRECT ANSWER >>> - began with polio units, recovery rooms, and coronary care units
- patient outcomes have improved eICU - CORRECT ANSWER >>> a new application of critical care from a remote monitoring site Competencies for Acute and Critical Care Nurses - CORRECT ANSWER >>> - clinical reasoning
- advocacy
- caring
- collaboration
- holistic nursing care
- response to diversity American Association of Critical Care Nurses - CORRECT ANSWER >>> - largest specialty organization
- assists NURSES to attain knowledge and influence
- healthy work environment initiative
AACN's Vision - CORRECT ANSWER >>> create a healthcare system driven by patient's and family's needs in which critical care nurses make their optimum contributions AACN: Professional Journals - CORRECT ANSWER >>> - Critical Care Nurse
- American Journal of Critical Care
- AACN Advanced Critical Care AACN Membership Benefits - CORRECT ANSWER >>> - professional journals
- evidence-based interventions
- continuing education Society of Critical Care Medicine - CORRECT ANSWER >>> - multiprofessional membership
- healthcare system in which all critically ill and injured persons receive care Synergy Model - CORRECT ANSWER >>> nurses are assigned patients based on their acuity and level of experience of critical care nurses on duty Critical Care Certification - CORRECT ANSWER >>> - validate knowledge
- promote professional excellence
- help nurses maintain up to date knowledge
- AACN oversees this CCRN - CORRECT ANSWER >>> adult, neonatal and pediatric intensive care PCCN - CORRECT ANSWER >>> for those working in step-down units
Loudest Activity - CORRECT ANSWER >>> Pneumatic Tube Arrival Modification of Environment - CORRECT ANSWER >>> - noise reduction (soothing music, private areas)
- adequate lighting (natural lighting, night day synchronization)
- design new units to promote health and safety Psychosocial Support - CORRECT ANSWER >>> - ensure safety
- reduce sleep deprivation
- reduce sensory overload
- increase pleasant sensory input
- provide reorientation Discharge from Critical Care - CORRECT ANSWER >>> - fear of abandonment
- learn new routines
- new staff
- new roommates
- prepare patients Post Critical Care Symptoms - CORRECT ANSWER >>> - fatigue, sleep disturbance
- pain, muscle weakness
- poor concentration
- poor appetite
- PTSD
Geriatric Concerns - CORRECT ANSWER >>> - diminished ability to adapt or cope with stressors
- greater risk for negative outcomes Calgary Family Assessment - CORRECT ANSWER >>> - structural (decision maker)
- developmental (stage)
- functional (how they interact) EPICS Approach: Addressing Family Needs - CORRECT ANSWER >>> - Evaluate
- Plan
- Involve
- Communicate
- Support VALUE: Addressing Family Needs - CORRECT ANSWER >>> - Value what they tell you
- Acknowledge emotions
- Listen to family
- Understand the patient as a person
- Elicit questions form family members Family Present During Codes - CORRECT ANSWER >>> allows them to witness everything that has been done Ethical Decision Making Process - CORRECT ANSWER >>> - assess
- consider options
- develop plan with patient
Extraordinary Care - CORRECT ANSWER >>> - complex, invasive, experimental treatments
- ACLS, dialysis, unproved therapies What is in between ordinary and extraordinary care? - CORRECT ANSWER >>> feeding tube for hydration CPR Issues - CORRECT ANSWER >>> - DNR is needed to not initiate a code
- advance directives are useful
- family presence during codes is promoted Withholding - CORRECT ANSWER >>> not initiating Withdrawal - CORRECT ANSWER >>> weaning or removing Helping Families make Decisions - CORRECT ANSWER >>> - communicate frequently
- engage in consistent, honest communication
- base decisions on patient's wishes
- provide support Self Determination Act - CORRECT ANSWER >>> - right to initiate advance directive
- right to consent or refuse treatment Advance Directive - CORRECT ANSWER >>> - communication about preference for treatments if patient is incapacitated
- living will (treatment desired and withheld)
- durable power of attorney for health care
Organ and Tissue Transplantation - CORRECT ANSWER >>> - brain dead are often candidates
- everyone has a right to donate organs
- conflict of patient's designation versus family member's view
- designated requestors seek consent Living Will - CORRECT ANSWER >>> treatment desired and what should be withheld Durable Power of Attorney for Health Care - CORRECT ANSWER >>> - determines who makes decisions
- healthcare surrogate or proxy Medical Futility - CORRECT ANSWER >>> situation in which therapy or interventions will not provide a foreseeable possibility to improve the patient's health Palliative Care - CORRECT ANSWER >>> - designed to relieve symptoms that negatively affect patient and family
- implemented with all patients, not just the dying Nursing Interventions for Palliative Care - CORRECT ANSWER >>> - frequent repositioning
- good hygiene
- skin care
- creation of peaceful environment
- pain relief Terminal Weaning - CORRECT ANSWER >>> - ventilator withdrawal
ABCDE Delirium Bundle - CORRECT ANSWER >>> - awakening
- breathing coordination
- choice of sedation
- delirium monitoring
- early mobility Fetanyl - CORRECT ANSWER >>> fastest onset Morphine - CORRECT ANSWER >>> longest duration Epidural - CORRECT ANSWER >>> - opioid or local anesthetic
- facilitates mobility and pulmonary hygiene NSAIDS - CORRECT ANSWER >>> - decrease need for opioid
- risks of GI bleeding and renal (ibuprofen) or liver (acetaminophen) insufficiency Pharmacological Treatment for Anxiety - CORRECT ANSWER >>> - benzodiazepine
- propofol
- dexmedetomidine Ventilation - CORRECT ANSWER >>> movement of O2 and CO2 in and out of the alveoli Oropharyngeal Sizing - CORRECT ANSWER >>> - hold airway against side of patients face
- extend from the corner of the patient's mouth to the angle of the jaw
Oropharyngeal - CORRECT ANSWER >>> - keeps tongue from falling back and blocking the upper airway
- used in unresponsive patients with no gag reflex Oropharyngeal Airway Insertion - CORRECT ANSWER >>> - open mouth
- insert with tip pointing up to avoid pushing tongue back
- once tip reaches soft palate, rotate 180 degrees
- top should rest on patient's lips Nasopharyngeal Airways - CORRECT ANSWER >>> - curved, flexile rubber or plastic tubes inserted into nostril
- used on responsive patients
- relieves upper airway obstruction and facilitates passage of suction catheter Nasopharyngeal Airway Insertion - CORRECT ANSWER >>> - lubricate and insert into nostril that appears most open
- insert until the flange is against the nostril opening
- check to ensure airflow
- good if they need to be suctioned frequently Suctioning - CORRECT ANSWER >>> - suction intermittenly (10-15 sec)
- suction only as far into the mouth as you can see and only when catheter is withdrawn
- suction only as far into the nose as the distance from the tip of the nose to the earlobe
- pre oxygenate before suctioning Hypoxemic Respiratory Failure Type 1 - CORRECT ANSWER >>> - when you don't have enough oxygen in your blood but your levels of carbon dioxide are close to normal
- sedation and paralysis indicated ARDS Interventions - CORRECT ANSWER >>> - sedation and comfort
- oxygenation
- prone
- fluids and electrolytes
- nutrition Contraindications for an Artificial Airway - CORRECT ANSWER >>> when a patient has a DNR order Intubation Procedure - CORRECT ANSWER >>> - pre-oxygenate 100%
- do not allow more than 30 second attempts
- not successful wait 3-5 minutes before reattempt Intubation: Confirming Tube Position - CORRECT ANSWER >>> - auscultation
- bilateral chest rise
- tube location at teeth
- CO2 detector (gold is good)
- XRAY Ventilatory Associated Pneumonia (VAP) - CORRECT ANSWER >>> - 10 - 20% develop VAP
- mortality can be as high as 80%
- only with patients on ventilators VAP Bundle - CORRECT ANSWER >>> - HOB 30-45 degrees
- interrupt sedation daily to assess readiness to wean
- provide daily oral care with chlorhexidine
- provide prophylaxis for DVT and PUD Nasoendotracheal Advantages - CORRECT ANSWER >>> - comfortable for prolonged intubation
- suitable for oral surgery
- blind intubation
- can take oral feedings
- resists kinking Nasoendotracheal Disadvantages - CORRECT ANSWER >>> - trauma to nasal mucosa
- risk for sinusitis
- risk for bacteremia
- smaller diameter than oral route Contraindications for Nasoendotracheal Intubation - CORRECT ANSWER >>> - basilar skull fracture
- coagulopathy
- nasal cavity obstruction
- retropharyngeal abscess Tracheostomy - CORRECT ANSWER >>> - allows person to breath without nose or mouth
- used primarily in situation where a prolonged need for airway support is anticipated Assist/Control Mode - CORRECT ANSWER >>> - delivers preset volumes, rate and flow rate
High Pressure Volume - CORRECT ANSWER >>> - blockage in the circuit
- patient biting ETT
- mucus plug
- patient coughing
- bag patient Low Minute Volume Alarm - CORRECT ANSWER >>> - apnea (CPAP)
- disconnection of the patient from the ventilator
- bag patient Accidental Extubation - CORRECT ANSWER >>> - ensure ambu bag is attached to oxygen and it is on
- attach face mask to ambu bag
- ensure good seal
- supply patient with ventilation Norcuron (Cecuronium Bromide) - CORRECT ANSWER >>> neuromuscular blocking agent Dexamethasone - CORRECT ANSWER >>> corticosteroid that prevents the release of substance in the body that cause inflammation Ipratropium - CORRECT ANSWER >>> relaxes muscles around the airways so that they open up and you can breath easily Rapid Response - CORRECT ANSWER >>> - failure to recognize causes death
- implemented to address changes in condition before cardiac or respiratory arrest
When to call RRT? - CORRECT ANSWER >>> changes in
- heart rate, systolic BP
- RR, oxygen saturation
- mental status
- urinary output
- lab values Code Blue - CORRECT ANSWER >>> - cardiac or respiratory arrest
- lifesaving resuscitation and intervention needed Sequence of Events: BLS - CORRECT ANSWER >>> - advance directives
- airway open
- breathing (O2)
- chest compressions ACLS: Airway and Breathing - CORRECT ANSWER >>> - airway management
- manual ventilation
- intubation
- delivery of tidal volume Bag Valve Mask - CORRECT ANSWER >>> - connected to an oxygen source set at 15L/min
- ever 5-6 seconds ACLS: Circulation - CORRECT ANSWER >>> - large bore IV's
- biggest veins
Uncompensated - CORRECT ANSWER >>> PaCO2 or HCO3 are abnormal and pH is abnormal Intubation Equipment - CORRECT ANSWER >>> - o2 flowmeter and o2 tubing
- suction apparatus
- suction catheter
- ambu bag
- laryngoscope
- stylet
- stethoscope
- tape
- syringe
- magil forceps
- towels for position What you need to know about your intubation - CORRECT ANSWER >>> - mode
- size
- position at the teeth Leader of the Code - CORRECT ANSWER >>> - physician
- directs code
- makes diagnoses and treatment decisions Primary Nurse - CORRECT ANSWER >>> - provides info
- measures vitals
- assists with procedures
- administers meds
Second Nurse - CORRECT ANSWER >>> - coordinates crash cart
- prepares meds
- assembles equipment Nursing Supervisor - CORRECT ANSWER >>> - controls crowd
- contacts attending physician
- assists with meds and procedures
- ensures a bed is available it critical care
- assists with transfer Nurse or Assistant - CORRECT ANSWER >>> records events Role of Nurse During Intubation - CORRECT ANSWER >>> - makes sure RSI available
- inform patient what is going on
- preoxygenate patient Reversible Causes of Cardiac Arrest: H - CORRECT ANSWER >>> - hypovolemia (decreased amount of circulating blood)
- hypoxia
- hydrogen ion (acidosis)
- hypo/hyperkalemia
- hypothermia Reversible Causes of Cardiac Arrest: T - CORRECT ANSWER >>> - tension pneumothorax
- tamponade (fluid collecting in sac around heart)
