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NUR 406 Exam 1 Review Questions and Answers: A Comprehensive Guide for Nursing Students, Exams of Nursing

Morehead State University (MSU)Nursing

A comprehensive set of review questions and answers for nur 406 exam 1, covering essential topics in nursing practice. It delves into key concepts such as nursing standards, algorithms, practice guidelines, protocols, and the nursing process. The document also explores ethical considerations in nursing, including principles like beneficence, non-maleficence, veracity, and justice. Additionally, it examines stress management, coping mechanisms, and communication strategies relevant to critical care nursing. This resource is valuable for nursing students preparing for their nur 406 exam.

Typology: Exams

2024/2025

Available from 02/26/2025

Nursebenjamin
Nursebenjamin 🇺🇸

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NUR 406 Exam 1 Review questions with correct answers
1. Answer- Standards:: communicate the EXPECTATIONS of safe and effective nursing
practice within the scope of the practice. (regulated by the Board of Nursing)
2. Answer- Algorithms:: a stepwise decision-making flowchart for a specific care process
or processes. Algorithms guide the clinician through the "if, then" decision making process
3. Answer- Practice Guidelines:: usually created by an expert panel and developed by a
professional organization. Typically written in text prose style rather than a flowchart.
4. Answer- Protocols:: a common tool in research studies. Protocols are more directive and
rigid than guidelines, and providers are not supposed to vary from a protocol. Built in alerts
signal the provider to potentially serious problems.
5. Answer- What is the AACN and what does it do?: The AACN is the American Association
of Critical-Care Nurses, most closely associated with critical care nurses. The world's largest
specialty nursing organization created in 1969. Develops and administers many critical care
specialty certifications examination for registered nurses. Created the beacon of excellence
reward for exceptional care through improved outcomes and greater overall satisfaction.
6. Answer- Nursing process: what is it?: Assess, Diagnose, Planning, Implementing, Eval-
uating
7. Answer- Components of evidence-based practice:: Evidence-based nursing practice
considers the BEST RESEARCH EVIDENCE on the care topic, along with CLIN- ICAL
EXPERTISE of the nurse, and PATIENT PREFERENCE. AANC has promul- gated
several EBP summaries in the form of a "practice alert"
8. Respect for persons/autonomy:: honor the patients right to autonomy or to self-
determine a course of action without coercion or undue interference from others.
9. Beneficence and non-maleficence:: actions that maximize good and minimize harm to
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Download NUR 406 Exam 1 Review Questions and Answers: A Comprehensive Guide for Nursing Students and more Exams Nursing in PDF only on Docsity!

NUR 406 Exam 1 Review questions with correct answers

  1. Answer- Standards:: communicate the EXPECTATIONS of safe and effective nursing practice within the scope of the practice. (regulated by the Board of Nursing)
  2. Answer- Algorithms:: a stepwise decision-making flowchart for a specific care process or processes. Algorithms guide the clinician through the "if, then" decision making process
  3. Answer- Practice Guidelines:: usually created by an expert panel and developed by a professional organization. Typically written in text prose style rather than a flowchart.
  4. Answer- Protocols:: a common tool in research studies. Protocols are more directive and rigid than guidelines, and providers are not supposed to vary from a protocol. Built in alerts signal the provider to potentially serious problems.
  5. Answer- What is the AACN and what does it do?: The AACN is the American Association of Critical-Care Nurses, most closely associated with critical care nurses. The world's largest specialty nursing organization created in 1969. Develops and administers many critical care specialty certifications examination for registered nurses. Created the beacon of excellence reward for exceptional care through improved outcomes and greater overall satisfaction.
  6. Answer- Nursing process: what is it?: Assess, Diagnose, Planning, Implementing, Eval- uating
  7. Answer- Components of evidence-based practice:: Evidence-based nursing practice considers the BEST RESEARCH EVIDENCE on the care topic, along with CLIN- ICAL EXPERTISE of the nurse, and PATIENT PREFERENCE. AANC has promul- gated several EBP summaries in the form of a "practice alert"
  8. Respect for persons/autonomy:: honor the patients right to autonomy or to self- determine a course of action without coercion or undue interference from others.
  9. Beneficence and non-maleficence:: actions that maximize good and minimize harm to

the patient, often in a delicate balance.

  1. Veracity:: the quality of being truthful, a principle that underlies a trusting rela- tionship between nurse and patient
  2. Fidelity:: an essential aspect of nursing, is the quality of keeping commitments and includes commitments to confidentiality and privacy; it is based on the virtue of caring.
  3. Justice:: equitable distribution of limited resources (usually organs for trans- plant, access to healthcare, which is not a constitutional right)
  4. 8 Steps in the ethical decision making model:: 1. Identify health problems
  5. Define the ethical issue(s)
  6. Gather additional information (contextual data, useful information)
  7. Identify the stakeholders and delineate the decision-maker
  8. Examine ethical norms and other relevant norms (personal values, beliefs, moral convictions of all involved in the decision process should be examined as they may

motivation to learn is internal and problem-oriented focusing on life events. b. Andragogy: adult learning theory name

c. Adults tend to have a strong sense of: self concept and are goal oriented learners...they like to make their own decisions.

  1. Ethics:: a generic term for the reasoned inquiry and understanding of a moral life.
  2. Morals:: traditions or belief about what is right or wrong in human behavior. Standards of moral principles, rules, virtues, rights and responsibilities.
  3. Ethical dilemma:: Hard to differentiate between what is most right
  4. Moral distress:: occurs when a person knows the ethically appropriate action but feels unable to act on it because of one or more barriers. i. 4 A's to moral distress: ASK, AFFIRM, ASSESS, ACT
  1. Regression:: an unconscious defense mechanism characterized by a retreat, in the face of stress, to behaviors characteristic of an earlier development level (whining, clinging to staff, etc.). This is expected sometimes.
  2. Denial:: conscious and unconscious attempt to disavow knowledge or meaning of an event to reduce anxiety and fear. i. defense mechanism to protect
  3. Stages of General Adaption Syndrome (Stress):: 1. ALARM reaction: initiated by hypothalamus-’hypothalamus triggers release of corticotrophin releasing factor (CRF)’ CRF signals pituitary gland’ pituitary gland releases cortisol and aldosterone’ SNS of ANS releases neurotransmitters ("fight or flight")’fight or flight triggers in- crease of VS, glucose, sweating, tremors, and nausea
  4. RESISTANCE: Persons system begins to fight back, leading to adaptation and return of normal functioning.
  5. EXHAUSTION: If stressors continue, exhaustion occurs, in which the person's reserves have been depleted. a. Reversal of exhaustion: restoration of one's reserves through medication, nutri- tion, and other stress reducing measures.
  6. Manifestation of ineffective coping:: -verbalization of an inability to cope, -anxiety -being unable to meet basic needs -inappropriate use of defense mechanism -diminished problem solving behaviors -apathetic or use destructive behavior.
  7. Anxiety:: i. Physiological Effect: activation of the sympathetic nervous system and hypothalamic-pituitary-adrenal axis. Anxiety elicits changes in neurohumoral release patterns

ii. Women, patients with minimal social support, and those with longer CCU lengths of stay are at higher risk for developing anxiety iii. ALSO, pain triggers anxiety, and increased anxiety intensifies pain.

  1. Effective coping for patients and family:: These are learned and practiced over a lifetime and are based on person's sense of effectives of any given strategy for adapting to stressor. -Helping patients maintain control, support complementary therapies (music, relax- ation, prayer, etc.) and create a healing environment.
  2. Nursing effective coping skills:: REFLECTION, maintains good health, eat well, exercise, pray, journal, etc.
  3. Patient barriers to communication:: -sedatives, -paralytic agents, -endo-tracheal tubes, -language issue
  4. Interventions for patients with sensory deficits:: i. Picture boards ii. Notepad iii. Magic slate iv. Computer keyboards

v. Interpreter vi. Use of touch

  1. PTSD:: PTSD should be thought of as a "normal" response to abnormal and impossible demands. This may occur after a patient and family experience and survive critical illness and face greater challenges after -Advise family members to keep a journal to review later
  2. What contributes to a critical care patient and families developing PTSD:: i.

Uncertainty ii. Environment iii. Anxious waiting iv. Disrupted sleep

v. Financial concern vi. Witness of emergent intervention vii. Confrontation of fear and death

  1. Spiritual Distress:: disruption in the life principle that pervades a person's entire being and that integrates and transcends one's biologic and psychosocial nature. ...can lead to hopelessness, unwillingness to seek further treatment, or refusal to consent to helpful therapeutic intervention.
  2. Hopelessness:: subjective state in which an individual sees extremely limited or no alternatives and is unable to mobilize energy on his or her own behalf. i. These patients lose self-esteem, isolate, may be less involved in recovery etc.
  1. Hypotension, resp depress

ii. Lorazepam (15-20 min onset)

  1. Se: hypotension, resp depress, nephrotoxicity

iii. Midazolam (2-5 min onset)

  1. Se: hypotension, resp. depress.
  2. Propofol: onset, SE: -Major sedative-- hypnotic -rapid onset! (1-2 min) -Se: hypotension, respiratory depression, pancreatitis, hyper triglyceridemia
  3. Major central alpha-adrenergic receptor agonist:: i. Dexmedetomidine (5-10 min onset) ii. Se: bradycardia, hypotension, loss of airway reflex
  1. Common sedative SE:: -Hypotension -Resp Depression
  2. Circadian de-synchronization contributors:: i. External influence: posture, exercise, and light ii. "zeitgebers" can shift the rhythm, causing it to peak at different times, or fragment it iii. Light is the most influential zeitgeber, therefore nurses should limit the light in the environment during nocturnal hours to facilitate sleep.
  3. Sleep Disturbance:: insufficient duration or stages of sleep that results in discomfort and interferes with quality of life.

i. May stem from psychological stress associated with critical illness and the environ- ment, surgical stress, noise, interruptions for care, painful procedures or physiologic processes, excessive bright light, and muscular and joint discomfort resulting from bed rest. ii. May delay recovery

iii. Intensification of pain related to sleep disturbance is a significant problem in acutely and critically ill patients. (this is because during sleep somatastatin is released, without this substance, pain is experienced)

  1. Non-Rapid Eye Movement:: is dominated by the PARASYMPATHETIC ner- vouse system. Body tries to maintain homestatic regulation, decreasing level of energy expenditure. Stages of NREM N1-N N1: Comprises 2-5% of sleep. Slow, side-to-side eye movements. Brief memory impairment may occur, resulting in possibility of decrease awareness of educational care instructions during transition from wake to sleep. N2: Occupies about 45% of sleep. Deep sleep and higher arousal threshold required to awaken patient. N3: Constitutes 15-20% of cycle. Often referred to as "slow-wave sleep"

d. Body's response to decreased oxygen levels and increased CO2 levels is lowest during REM.

e. An increase in premature ventricular contractions and tachydysrhytmias may be associated with respiratory pauses during REM and can lead to O2 REDCUTION, (mainly in pulmonary or cardiac disease patients)

  1. Acute Pain: last how long? is cause identifiable?: short duration, usually corresponds to the healing process (30 days), but should not exceed 6 months. Implies tissue damage that is usually from an identifiable cause.
  2. Chronic Pain: how long does it last?: persists for more than 6 months after the healing process from the original injury, and it may or may not be associated with an illness, It develops with the healing process is incomplete or when acute pain is poorly managed.
  3. Nociceptive Pain:: arises from activation of nociceptors, and it can be somatic or visceral. -Somatic pain involves superficial tissues, such as the skin, muscles, joints, and bones. Its location is well-defined. -Visceral pain involves organs such as the heart, stomach, and liver. Its location is diffuse, and it can be referred to a different location in the body.
  4. Neuropathic Pain:: arises from a lesion or disease affecting the somatosensory system. The origin of neuropathic pain may be peripheral or central. -Neuralgia and neuropathy are examples related to peripheral neuropathic pain, which implies damage to the peripheral somatosensory system. -Central neuropathic pain involves the central somatosensory cortex and can be experienced by patients after a cerebral stroke. -Neuropathic pain can be difficult to manage and frequently requires a multimodal approach that combines several pharm/nonpharm approaches.
  5. Cold Application:: reduced postprocedural pain, postop cardiac patient chest tube sites

for 20 min

  1. Massage:: postop cardiac patients 20 min massage between postop day 2 and 5
  2. Relaxation:: decreases oxygen consumption and muscle tone, and decreases HR and BP. Gives patient sense of control. Deep breathing exercises are helpful.
  3. Guided imagery:: imagination to provide control over pain , Can be used to distract or relax
  4. Music Therapy:: has a soothing effect, educate the pt and family regarding the role of music and about other sources of distraction for the patient to assist with relaxation of pain control
  5. Healthcare provider concerns about long-term pain management:: -Addic- tion

over TPN). Must have gastric motility and ability to digest.

  1. Enteral Feeding Access: Nasal intubation vs tube eneterostomy: Nasal intubation is the simplest and most commonly used route for enteral access. Tube eneterostomy (gastrostomy or jejunostomy) is used primarily for long-term feedings (6-12 weeks or more).
  2. Other Info about feedings:: • Assess PEG tube site for infection and skin breakdown (clean daily)
  • Prevent occlusion of feeding tubes by using 20-30 mL of warm water q3-4 hrs during continuous feedings and before/after intermittent feedings
  • Prevent aspiration by keeping HOB up
  • Diarrhea/constipation is common in patients receiving enteral nutrition
  1. TPN:: delivery of all nutrients by intravenous route. Short term nutrition support for a few days less than 2 weeks. Discard solutions within 24 hours of hanging. Inline 0.22 micron filter needed. Monitor glucose q4-6hrs. Serum electrolytes monitored weekly or twice weekly.
  2. Process of Aging & Physical Decline:: Atherosclerosis, HTN, myocardial in- farction, stroke, Dysrhythmias (Afib, PVC, SVT), heart failure. Rise in systolic BP until age 80. Increased vascular stiffness. Orthostatic HTN, decreased elastic recoil of the lungs causing increased lung volume, distention of alveolar spaces, and a decrease in surface area of airspace. Sclerosis of nephrons, fall in the renal bloodflow of 50%. Glomerular filtration rate declines to 45% by age 80. Increased blood glucose, increase serum lipid profile, decreased albumin, increase uric acid, decrease calcium. Decreased esophageal and gastric motility. Dysphagia. Decrease gastric absorption of nutrients. Reduction in synthesis of cholesterol, total bile pool. Alzheimers. Common infections: Pneumonia, UTI's, intra-abdominal infections, gram-negative bacteremia, decubitus ulcers. Decline in T Cells. Seborrheic kerato- sis. Bone demineralization.
  3. Medication Management in older adults:: Aging process is associated with changes in gastric acid secretion, fat content increases, lean body mass decreases, and total body water decreases, which can alter medication disposition. Liver and Kidneys are less able to metabolize and excrete medications, leading to change in absorption rates, time to peak plasma concentration, and clearance. Increased gastric pH.
  4. Witholding Care:: not giving care
  5. Withdrawing of life support measures:: discontinuation of life support. Usually dialysis first, along with diagnostic tests and vasopressors. Next, intravenous fluids, monitoring, lab tests, and antibiotics.
  6. Legal and Ethical Issues when pt can't make own decisions:: When the patient is unable to make decisions, autonomy should be applied to the surrogates. The Patient self-
  1. Penetrating Trauma:: occur with stabbings, firearms, or impalements—injuries that penetrate the skin and result in damage to internal structures. Damage is creat- ed along the path of penetration. Penetrating injuries can be misleading inasmuch as the condition of the outside wound does not determine the extent of internal injury. Inside the body, the bullet can ricochet off bone and create further damage along its pathway. With penetrating stab wounds, factors that determine the extent of the injury include the type and length of object used and the angle of insertion.
  2. Goal for critically injured patients:: to minimize the time from initial insult to definitive care and to optimize prehospital care so that the patient arrives to the hospital alive.
  3. Care of seriously injured patient continuum: (6 phases): prehospital resus- citation, hospital resuscitation, definitive care and operative phase, critical care, intermediate care, rehabilitation.
  4. Understand the interventions that are needed for assault and rape victims.- : pellico
  5. Triage:: Red: highest priority patients, need immediate attn. Yellow: medium priority, can wait but still need attention Green: ambulatory patient Black: dead or those with minimal chance of survival
  6. ABCDE's of primary survey:: -Airway and Alertness with cervical spine protec- tion -Breathing and ventilation -Circulation with hemorrhage control -Disability: neurologic status, use the Glasgow coma scale -Exposure and environmental control
  7. Opioids:: Most commonly used and recommended as first-line analgesics are the agonists. Opioid reversal agent: naloxone. DC naloxone as soon as the pt is responsive to

physical stimulation and is able to take deep breaths.

  1. Pain Care Bundle in the ICU:: • Assess: Assess pain 4x/shift and prn
  • Treat: Treat pain within 30 min then reassess
  • Prevent: administer pre-procedural analgesia and/or non-pharmacologic interven- tions. Treat pain first, then sedate