NUR 430 EXAM 3 | COMPREHENSIVE NURSING STUDY GUIDE,
PRACTICE QUESTIONS & ANSWERS 2026/2027
OPO - ANS ✔✔Organ Procurement Organization
- Early notification of OPO necessary
- NEVER mention donation to the families as a nurse
- IDN should be involved at the earliest possible moment
- Exactly when donation is discussed varies, but IDN should be the one approaching the families, not
nursing staff
When do I refer OPO? - ANS ✔✔- Any cardiac death (tissue donation, call with cardiac arrest of any type)
For vented patients, call with any of the following:
- GCS of </= 5, regardless of sedation, call within 1 hour
- At first mention of ANY end-of-life discussions
- Before any withdrawal of support and/or terminal extubating
- If family mentions donations
- Within 1 hour of time of death
Donor Mangement Goals - ANS ✔✔- Increase the number of organs transplanted per donor
- Have certain parameters to treat the patient with once donation is established
- Once brain death is declared, our goal switches from meaningful recovery of the patient to organ
management and not letting this gift they are giving to others go to waste
Clinical Parameters for Donor Management Goals - ANS ✔✔- MAP= 60-100 mmHg
- CVP= 4-10 mmHg
- Ejection fraction: >50%
- Vasopressors= <1 and low dose
- Arterial blood gas pH= 7.3-7.45
- PaO2/FiO2 ratio= >300
- Serum sodium= 135-155
- Blood glucose= <150
- Urine output (averaged over 4 hours)= 0.5-3.0
RN Role for donor management - ANS ✔✔- Refer patient to OPO in a timely manner
Vital Signs:
- At least every hour
- Hemodynamic readings from a-line
- Give these numbers to the donor people (OPO)
I & O:
- Very strict
- Everything going into the NG, IV
Oxygenation status
,Obtain specimens
- Drawing like 20 different labs to test for several things
Assist with any procedures required (x-ray, CI, bronchoscopy)
Provide any care within scope as directed by OPO
Brain Death - ANS ✔✔Irreversible cessation of all brain function
- Including the brain stem
Brain Death Testing: Requirements - ANS ✔✔Patient MUST be:
- Normothermic (temp greater than 36 C/98.5 F)
- Cannot be hypotensive (SBP > 90)
- No positive drug screen
- Cannot have had recent dose of paralytics (NMBAs)
- Cannot be acidotic
Confirmatory Testing for Brain Death - ANS ✔✔- Cerebral motor response
- Brainstem Reflexes; pupillary reflexes, oculocephalic reflex, oculovestibular reflex, corneal and jaw
reflexes, gag and cough reflexes
- Apnea Testing
- EEG
- Cerebral Angiography (gold standard for conclusive brain death)
*Neurologist does all of these reflexes and tests on the patient; nurse assists*
Confirmatory Testing: Cerebral Motor Response - ANS ✔✔- Movement of painful stimuli (nailbed
pressure on fingers, toes, sternal rubbing, pinching)
- Negative= no movement and suggests brain death
Confirmatory Testing: Pupillary Reflexes (Brainstem Reflex) - ANS ✔✔Absence of pupil movement in
response to light suggests brain death
Confirmatory Testing: Oculocephalic Reflex (Brainstem Reflex) - ANS ✔✔AKA Doll's Eyes
- Fast turning of the head to both sides
- When the MD turns the head to the right, your eyes should go to the left
- *In brain death, their eyes will not move*
Confirmatory testing: Oculovestibular reflex (Brainstem Reflex) - ANS ✔✔AKA Cold Caloric Test
- Put HOB at 30 degrees
- Take ice cold water or NS and inject into the ear
- Observe for 1-5 minutes before putting water into the other ear
- *Brain death= no movement of eyes towards the stimulant* (cold water)
Confirmatory Testing: Corneal and Jaw reflexes (Brainstem Reflex) - ANS ✔✔Corneal= soft cotton is
whisked on the corneal
- Normal: pt. should blink or grimace
- Brain death= no response
,Jaw= put pain on jaw using nail beds
- Brain death= no response
Confirmatory Testing: Gag and Cough Reflexes (Brainstem Reflex) - ANS ✔✔Gag= take tongue blade and
tick the back of the throat and move around
- Testing for gag reflex
- Brain death= no gag reflex
Cough= suction through ET tube
- Brain death= no cough
Confirmatory Testing: Apnea Testing - ANS ✔✔- The loss of brain stem function results in the loss of
centrally controlled breathing
- Hook patient to pulse ox, preoxygenate for 10 minutes with 100% oxygen, begin reducing settings if the
patient keeps their sats greater than 90 then we draw an ABG for baseline... then we decrease ventilator
to settings that allows the patient to initiate breaths on their own and monitor
- STOP apnea testing if BP < 90 consistently despite going up on vasopressors OR if O2 sat <80 for 2
minutes
- *Results are positive for apnea test if respirations are absent and PCO2 >60 or 20 above the baseline for
the patient* (meaning brain death)
Blunt Trauma - ANS ✔✔When you have rapid deceleration; so as body stops suddenly the internal
organs continue to move forward
- Motor vehicle crashes (MVC)
- Falls
- Contact sports
- Blunt force injuries
Penetrating Trauma - ANS ✔✔Those that puncture the body and result in damage to internal structures
- Stabbings
- Firearms
- Impalements
Resuscitation Phases of Trauma - ANS ✔✔- Prehospital Resuscitation
- Hospital Resuscitation
- Definitive Care and Operative Phase/ Damage Control Resuscitation
- Critical Care
- Intermediate Care
- Rehabilitation
First Peak vs Second Peak of Trauma - ANS ✔✔The first peak of trauma deaths occur within 48 hours
after initial injury, and the second peak occurs days to weeks after the injury
- First peak= death often occurs on scene or very soon after hospital admission
- Second peak= death often occurs in CC unit as a consequence of complications from initial injury such
as MODS or infection
Resuscitation Phases of Trauma: *Prehospital Resuscitation* - ANS ✔✔- This is in the field, when the
ambulance rolls up
, - ID of life-threatening injuries and transport (ground or air) to closely appropriate medical facility
EMS focus= ABCs!
- Airway
- Hemorrhage (control it)
- Immobilization and transfer
Actions
- Airway (are they breathing? Air moving in and out? Effective breathing?)
- Spine and fracture stabilization (c-collar)
- Pain control
- Communication to hospital (can we care for patient here at the hospital near by? Do they need flown to
a larger trauma center?)
Resuscitation Phases of Trauma: *Hospital Resuscitation- Primary Survey* - ANS ✔✔Primary Survey is
the ED initial assessment (ABCDE's of trauma) (right when they arrive to hospital)
- Airway
- Breathing
- Circulation
- Disability
- Exposure
(more detailed of these on cards 27-31)
Phase of Trauma Cont. Hospital resuscitation: Second Survey - ANS ✔✔Secondary survey beings when
the primary survey is completed, and any life-threatening issues have been identified
- Head-to-toe exam and thorough patient history; allergies, medication currently used, PMH, last meal,
events related to injury
- Recommended tests: EKG, X-rays, *CTs*, ultrasounds, catheters, NGT
- Recommended labs: CBC (H/H), electrolytes, Coag panel, T&s, toxicology screen, pregnancy, lactate
Resuscitation Phases of Trauma: *Definitive Care and Operative Phase/ Damage Control Resuscitation* -
ANS ✔✔Includes:
- Permissive Hypotension
- Massive Transfusion Protocols
- Damage control surgery
(more details of these cards 32-35)
Resuscitation Phases of Trauma: *Critical Care* - ANS ✔✔Early detection and treatment of
complications!
- This is where the second peak of trauma deaths occur: MODS and ARDS
Priority nurses care:
- Ongoing assessments
- Monitoring trends in labs and diagnostics
- Maintaining a balance between oxygen and supply and demand (prevent hypoxemia)
- *Observing for the lethal triad of death:*
· Acidosis < 7.2
PRACTICE QUESTIONS & ANSWERS 2026/2027
OPO - ANS ✔✔Organ Procurement Organization
- Early notification of OPO necessary
- NEVER mention donation to the families as a nurse
- IDN should be involved at the earliest possible moment
- Exactly when donation is discussed varies, but IDN should be the one approaching the families, not
nursing staff
When do I refer OPO? - ANS ✔✔- Any cardiac death (tissue donation, call with cardiac arrest of any type)
For vented patients, call with any of the following:
- GCS of </= 5, regardless of sedation, call within 1 hour
- At first mention of ANY end-of-life discussions
- Before any withdrawal of support and/or terminal extubating
- If family mentions donations
- Within 1 hour of time of death
Donor Mangement Goals - ANS ✔✔- Increase the number of organs transplanted per donor
- Have certain parameters to treat the patient with once donation is established
- Once brain death is declared, our goal switches from meaningful recovery of the patient to organ
management and not letting this gift they are giving to others go to waste
Clinical Parameters for Donor Management Goals - ANS ✔✔- MAP= 60-100 mmHg
- CVP= 4-10 mmHg
- Ejection fraction: >50%
- Vasopressors= <1 and low dose
- Arterial blood gas pH= 7.3-7.45
- PaO2/FiO2 ratio= >300
- Serum sodium= 135-155
- Blood glucose= <150
- Urine output (averaged over 4 hours)= 0.5-3.0
RN Role for donor management - ANS ✔✔- Refer patient to OPO in a timely manner
Vital Signs:
- At least every hour
- Hemodynamic readings from a-line
- Give these numbers to the donor people (OPO)
I & O:
- Very strict
- Everything going into the NG, IV
Oxygenation status
,Obtain specimens
- Drawing like 20 different labs to test for several things
Assist with any procedures required (x-ray, CI, bronchoscopy)
Provide any care within scope as directed by OPO
Brain Death - ANS ✔✔Irreversible cessation of all brain function
- Including the brain stem
Brain Death Testing: Requirements - ANS ✔✔Patient MUST be:
- Normothermic (temp greater than 36 C/98.5 F)
- Cannot be hypotensive (SBP > 90)
- No positive drug screen
- Cannot have had recent dose of paralytics (NMBAs)
- Cannot be acidotic
Confirmatory Testing for Brain Death - ANS ✔✔- Cerebral motor response
- Brainstem Reflexes; pupillary reflexes, oculocephalic reflex, oculovestibular reflex, corneal and jaw
reflexes, gag and cough reflexes
- Apnea Testing
- EEG
- Cerebral Angiography (gold standard for conclusive brain death)
*Neurologist does all of these reflexes and tests on the patient; nurse assists*
Confirmatory Testing: Cerebral Motor Response - ANS ✔✔- Movement of painful stimuli (nailbed
pressure on fingers, toes, sternal rubbing, pinching)
- Negative= no movement and suggests brain death
Confirmatory Testing: Pupillary Reflexes (Brainstem Reflex) - ANS ✔✔Absence of pupil movement in
response to light suggests brain death
Confirmatory Testing: Oculocephalic Reflex (Brainstem Reflex) - ANS ✔✔AKA Doll's Eyes
- Fast turning of the head to both sides
- When the MD turns the head to the right, your eyes should go to the left
- *In brain death, their eyes will not move*
Confirmatory testing: Oculovestibular reflex (Brainstem Reflex) - ANS ✔✔AKA Cold Caloric Test
- Put HOB at 30 degrees
- Take ice cold water or NS and inject into the ear
- Observe for 1-5 minutes before putting water into the other ear
- *Brain death= no movement of eyes towards the stimulant* (cold water)
Confirmatory Testing: Corneal and Jaw reflexes (Brainstem Reflex) - ANS ✔✔Corneal= soft cotton is
whisked on the corneal
- Normal: pt. should blink or grimace
- Brain death= no response
,Jaw= put pain on jaw using nail beds
- Brain death= no response
Confirmatory Testing: Gag and Cough Reflexes (Brainstem Reflex) - ANS ✔✔Gag= take tongue blade and
tick the back of the throat and move around
- Testing for gag reflex
- Brain death= no gag reflex
Cough= suction through ET tube
- Brain death= no cough
Confirmatory Testing: Apnea Testing - ANS ✔✔- The loss of brain stem function results in the loss of
centrally controlled breathing
- Hook patient to pulse ox, preoxygenate for 10 minutes with 100% oxygen, begin reducing settings if the
patient keeps their sats greater than 90 then we draw an ABG for baseline... then we decrease ventilator
to settings that allows the patient to initiate breaths on their own and monitor
- STOP apnea testing if BP < 90 consistently despite going up on vasopressors OR if O2 sat <80 for 2
minutes
- *Results are positive for apnea test if respirations are absent and PCO2 >60 or 20 above the baseline for
the patient* (meaning brain death)
Blunt Trauma - ANS ✔✔When you have rapid deceleration; so as body stops suddenly the internal
organs continue to move forward
- Motor vehicle crashes (MVC)
- Falls
- Contact sports
- Blunt force injuries
Penetrating Trauma - ANS ✔✔Those that puncture the body and result in damage to internal structures
- Stabbings
- Firearms
- Impalements
Resuscitation Phases of Trauma - ANS ✔✔- Prehospital Resuscitation
- Hospital Resuscitation
- Definitive Care and Operative Phase/ Damage Control Resuscitation
- Critical Care
- Intermediate Care
- Rehabilitation
First Peak vs Second Peak of Trauma - ANS ✔✔The first peak of trauma deaths occur within 48 hours
after initial injury, and the second peak occurs days to weeks after the injury
- First peak= death often occurs on scene or very soon after hospital admission
- Second peak= death often occurs in CC unit as a consequence of complications from initial injury such
as MODS or infection
Resuscitation Phases of Trauma: *Prehospital Resuscitation* - ANS ✔✔- This is in the field, when the
ambulance rolls up
, - ID of life-threatening injuries and transport (ground or air) to closely appropriate medical facility
EMS focus= ABCs!
- Airway
- Hemorrhage (control it)
- Immobilization and transfer
Actions
- Airway (are they breathing? Air moving in and out? Effective breathing?)
- Spine and fracture stabilization (c-collar)
- Pain control
- Communication to hospital (can we care for patient here at the hospital near by? Do they need flown to
a larger trauma center?)
Resuscitation Phases of Trauma: *Hospital Resuscitation- Primary Survey* - ANS ✔✔Primary Survey is
the ED initial assessment (ABCDE's of trauma) (right when they arrive to hospital)
- Airway
- Breathing
- Circulation
- Disability
- Exposure
(more detailed of these on cards 27-31)
Phase of Trauma Cont. Hospital resuscitation: Second Survey - ANS ✔✔Secondary survey beings when
the primary survey is completed, and any life-threatening issues have been identified
- Head-to-toe exam and thorough patient history; allergies, medication currently used, PMH, last meal,
events related to injury
- Recommended tests: EKG, X-rays, *CTs*, ultrasounds, catheters, NGT
- Recommended labs: CBC (H/H), electrolytes, Coag panel, T&s, toxicology screen, pregnancy, lactate
Resuscitation Phases of Trauma: *Definitive Care and Operative Phase/ Damage Control Resuscitation* -
ANS ✔✔Includes:
- Permissive Hypotension
- Massive Transfusion Protocols
- Damage control surgery
(more details of these cards 32-35)
Resuscitation Phases of Trauma: *Critical Care* - ANS ✔✔Early detection and treatment of
complications!
- This is where the second peak of trauma deaths occur: MODS and ARDS
Priority nurses care:
- Ongoing assessments
- Monitoring trends in labs and diagnostics
- Maintaining a balance between oxygen and supply and demand (prevent hypoxemia)
- *Observing for the lethal triad of death:*
· Acidosis < 7.2
