NUR 445: Critical Care Exam 1 Brady
UPDATED ACTUAL Questions and
CORRECT Answers
critical care nursing - CORRECT ANSWER - being a direct care provider by being highly
vigilant and using their intelligence and cognition to do tasks and quickly pull together multiple
data to make decisions regarding subtle and/or deteriorating conditions
DNR order is influenced by - CORRECT ANSWER - goals of care, co-morbidities, pace
of clinical decline, availability of surrogate decision makers, and provider practice patterns
DNR policies - CORRECT ANSWER - 1) should be entered into pt's record with full
documentation by the responsible physician about the pts prognosis and the pts agreement, or
alternatively, the family's concern
2) DNR orders should require concurrence of another physician as standard policy
3) policies should specify that orders are reviewed periodically
4) pts with capacity must give their informed consent
5) for pts w/o capacity that incapacity must be thoroughly documented, along with the diagnosis,
prognosis and fam consensus
6) if applicable, DNR orders should be consistent with advance directives, or if not the reason for
those differences should be documented and explained.
****NEEDS TO BE RENEWED AT EVERY ADMISSION TO HOSPITAL (so has to be an
order// doesn't count as a standing order)** if pt has advance directive that says they do not want
extreme measures, then the dr can sign off on a DNR
order of decision making for end of life care - CORRECT ANSWER - -pt (if able to
speak/decide for themselves)
-living will or healthcare power of attorney
-fam closest to the pt
,comfort care - CORRECT ANSWER - in the name; no intervention is given/done that will
cause discomfort, even if it may be in the pts best interest. (if pt has a fever and it turns out to be
an infxn, you will tx the fever bc it makes them uncomforable, but you will not tx the infxn bc
you're not tx issues that will help the pt get better, just what will make them more
COMFORTable)// order has to be placed
POLST (Physician Orders for Life-Sustaining Treatment) - CORRECT ANSWER -
medical orders that are honored across all tx settings and are especially important to emergency
responders in the community.
-completed by the physician and the pt in the presence of a serious chronic illness
-should be incorporated into medical orders on admission to the hospital or skilled nursing
facility
pt rights - CORRECT ANSWER - a competent pt has the right to refuse any tx
pt without decision making capacity and their rights - CORRECT ANSWER - -some state
laws allow a guardian to be appointed for all or some decisions
-living wills, advance directives, durable powers of attorney, physician orders for life-saving tx
for pts who were competent but for some reason or another are no longer considered competent
pts who were never or not yet competent and their rights - CORRECT ANSWER - -law
for "best interest"; parents and legal guardians of children have a legal obligation to make
informed decisions based on the best interests of the pt
- there are procedures in every state to petition the court on an emergent basis to evaluate and
rule on what is in the best interest of the pt
Patient Self-Determination Act of 1990 - CORRECT ANSWER - designed to encourage
competent patients to consider what they would want in the event of a serious illness and to
facilitate them to complete advance directives
-all adults must be provided written information regarding an individual's rights under state law
to make medical decisions, including the right to refuse tx and the right to formulate advance
directives
-providers must have written policies and procedures to INFORM all adult pts at initiation of tx
of their right to execute an advanced directive and of the provider's policies on the
, implementation of that right, to DOCUMENT in the medical record whether an individual has
executed an advanced directive, to NOT CONDITION care and tx or otherwise discriminate on
the basis of whether a pt has executed an advance directive, to COMPLY with state laws on
advance directives, and to PROVIDE info and education to staff and the community on advance
directives
General Adaptation Syndrome (GAS) stages - CORRECT ANSWER - stage 1: alarm
stage 2: resistance or adaptation
stage 3: exhaustion
an alarm reaction is initiated by the.... - CORRECT ANSWER - hypothalamus
reactive response to stress - CORRECT ANSWER - Physiologic response to a psychologic
stressor
It's not a physical stressor present
anticipatory response to stress - CORRECT ANSWER - anticipates a disruption in
homeostasis
conditional response to stress - CORRECT ANSWER - associates a stimulus with danger;
may cause PTSD or phobias
affects of the combination of norepinephrine and epinephrine - CORRECT ANSWER -
VASOCONSTRICTION: increased BP, pallor, increased sweat gland action, goosebumps,
increased pupillary dilation, decreased GFR, nausea, stress ulcers
effects of epinephrine - CORRECT ANSWER - bronchodilation, increased cardiac output,
increased BP, more alert, increased muscle tone, vasodilation to skeletal muscles, increased
lipolysis (increased circulating free fatty acids), glycogenolysis and gluconeogenesis (increased
blood glucose)
UPDATED ACTUAL Questions and
CORRECT Answers
critical care nursing - CORRECT ANSWER - being a direct care provider by being highly
vigilant and using their intelligence and cognition to do tasks and quickly pull together multiple
data to make decisions regarding subtle and/or deteriorating conditions
DNR order is influenced by - CORRECT ANSWER - goals of care, co-morbidities, pace
of clinical decline, availability of surrogate decision makers, and provider practice patterns
DNR policies - CORRECT ANSWER - 1) should be entered into pt's record with full
documentation by the responsible physician about the pts prognosis and the pts agreement, or
alternatively, the family's concern
2) DNR orders should require concurrence of another physician as standard policy
3) policies should specify that orders are reviewed periodically
4) pts with capacity must give their informed consent
5) for pts w/o capacity that incapacity must be thoroughly documented, along with the diagnosis,
prognosis and fam consensus
6) if applicable, DNR orders should be consistent with advance directives, or if not the reason for
those differences should be documented and explained.
****NEEDS TO BE RENEWED AT EVERY ADMISSION TO HOSPITAL (so has to be an
order// doesn't count as a standing order)** if pt has advance directive that says they do not want
extreme measures, then the dr can sign off on a DNR
order of decision making for end of life care - CORRECT ANSWER - -pt (if able to
speak/decide for themselves)
-living will or healthcare power of attorney
-fam closest to the pt
,comfort care - CORRECT ANSWER - in the name; no intervention is given/done that will
cause discomfort, even if it may be in the pts best interest. (if pt has a fever and it turns out to be
an infxn, you will tx the fever bc it makes them uncomforable, but you will not tx the infxn bc
you're not tx issues that will help the pt get better, just what will make them more
COMFORTable)// order has to be placed
POLST (Physician Orders for Life-Sustaining Treatment) - CORRECT ANSWER -
medical orders that are honored across all tx settings and are especially important to emergency
responders in the community.
-completed by the physician and the pt in the presence of a serious chronic illness
-should be incorporated into medical orders on admission to the hospital or skilled nursing
facility
pt rights - CORRECT ANSWER - a competent pt has the right to refuse any tx
pt without decision making capacity and their rights - CORRECT ANSWER - -some state
laws allow a guardian to be appointed for all or some decisions
-living wills, advance directives, durable powers of attorney, physician orders for life-saving tx
for pts who were competent but for some reason or another are no longer considered competent
pts who were never or not yet competent and their rights - CORRECT ANSWER - -law
for "best interest"; parents and legal guardians of children have a legal obligation to make
informed decisions based on the best interests of the pt
- there are procedures in every state to petition the court on an emergent basis to evaluate and
rule on what is in the best interest of the pt
Patient Self-Determination Act of 1990 - CORRECT ANSWER - designed to encourage
competent patients to consider what they would want in the event of a serious illness and to
facilitate them to complete advance directives
-all adults must be provided written information regarding an individual's rights under state law
to make medical decisions, including the right to refuse tx and the right to formulate advance
directives
-providers must have written policies and procedures to INFORM all adult pts at initiation of tx
of their right to execute an advanced directive and of the provider's policies on the
, implementation of that right, to DOCUMENT in the medical record whether an individual has
executed an advanced directive, to NOT CONDITION care and tx or otherwise discriminate on
the basis of whether a pt has executed an advance directive, to COMPLY with state laws on
advance directives, and to PROVIDE info and education to staff and the community on advance
directives
General Adaptation Syndrome (GAS) stages - CORRECT ANSWER - stage 1: alarm
stage 2: resistance or adaptation
stage 3: exhaustion
an alarm reaction is initiated by the.... - CORRECT ANSWER - hypothalamus
reactive response to stress - CORRECT ANSWER - Physiologic response to a psychologic
stressor
It's not a physical stressor present
anticipatory response to stress - CORRECT ANSWER - anticipates a disruption in
homeostasis
conditional response to stress - CORRECT ANSWER - associates a stimulus with danger;
may cause PTSD or phobias
affects of the combination of norepinephrine and epinephrine - CORRECT ANSWER -
VASOCONSTRICTION: increased BP, pallor, increased sweat gland action, goosebumps,
increased pupillary dilation, decreased GFR, nausea, stress ulcers
effects of epinephrine - CORRECT ANSWER - bronchodilation, increased cardiac output,
increased BP, more alert, increased muscle tone, vasodilation to skeletal muscles, increased
lipolysis (increased circulating free fatty acids), glycogenolysis and gluconeogenesis (increased
blood glucose)
