AACN Certification CCRN/PCCN
Critical Care Exam 1
AACN - certify nurses; protect consumer by establishing high standards of professional practice
CCRN - certification for nurses who provide care in critically ill adult, pediatric, or neonatal populations
PCCN - certification for nurses who provide acute care in progressive care, telemetry, and similar units
CNML - certification for critical care managers and leaders
CCNS - certification for acute and critical care clinical nurse specialists
Level A (Scale for Rating Research Evidence) - meta-analysis or met synthesis studies; results consistently
support specific action, intervention, or treatment
Level B (Scale for Rating Research Evidence) - randomized and nonrandomized controlled studies;
results consistently support specific action, intervention, or treatment
Level C (Scale for Rating Research Evidence) - qualitative, descriptive, or correlational studies, reviews,
or trials with inconsistent results
Level D (Scale for Rating Research Evidence) - Peer-reviewed with clinical studies to support
recommendations
Level E (Scale for Rating Research Evidence) - theory-based evidence from expert opinions
Level M (Scale for Rating Research Evidence) - Manufacturer's recommendation only
,Ask-Tell-Ask (Communication) - Communication technique that assesses concerns before providing info
Situational Awareness (Communication) - being aware of one's surroundings
Calgary Family Assessment - Assessment that involves structural, developmental, and functional
assessments
Family Bundle - Provide structure for planning and carrying out family care; based on 5 concepts:
evaluate, plan; involve; communicate; support (EPICS)
Principles - widely applied ethical approach based of 4 fundamental moral principles to contemporary
ethical dilemmas; respect for autonomy; beneficence; no maleficence; justice
Beneficence - the duty to provide benefits to others when in a position to do so, to help balance harms
and benefits; the benefits of an action should outweigh the burdens
Futility - states that care should not be given if it is futile in terms of improving comfort or the medical
outcome
Veracity - states that persons are obligated to tell the truth in their communication with others
Fidelity - requires that one has a moral duty to be faithful to the commitments made to others
Elements of Informed Consent - competence (capacity); voluntariness; disclosure of information
Living Will - a witnessed written document or oral statement voluntarily executed by a person that
expresses the person's instructions concerning life-prolonging procedure; not legally binding in some
states
Proxy - a competent adult, not designated to make health care decisions for an incapacitated person,
but is authorized by state statute to make healthcare decisions for the person
, Surrogate - a competent adult designated by a person to make health care decisions should that person
become incapacitated
Patient Self-Determination act (End-of-life issue) - requires that all healthcare facilities that receive
Medicare or Medicaid funding inform their patients about their right to initiate an advance directive and
the right to consent to or refuse medical treatment
Withholding, Limiting, or Withdrawing Therapy - Priority should be anticipating patient symptoms;
assessment of patient response; titration of therapy to relieve emotional and physical distress; common
meds used are analgesics (i.e. Morphine) and anxiolytics (ie. benzodiazepines)
Ventilator Withdrawal - Known as "terminal weaning"; consist of titration of ventilator support to
minimal levels, removal of ventilator, but not artificial airway, or complete estuation; titrate pain meds
and sedation as needed to relieve symptoms of respiratory distress
Commonly withheld therapy - vasopressors; antibiotics; done when goal of treatment shifts to palliation
instead of cure; address these before withdrawing or withholding ventilation
Ethical Principles for withholding and withdrawing life-sustaining treatment - life-sustaining treatment
should not be withdrawn while patient is receiving paralytic agents. When paralytic drugs are
discontinued, patient must demonstrate sufficient motor activity to allow thorough clinical assessment
before withdrawal of support
Hemodynamic Assessment - Used to titrate therapies to a specific end point; detect inadequate tissue
perfusion; quantify severity of disease; and guide therapy
normal cardiac output (CO) (hemodynamic values) - 4 to 8 L/minute
normal central venous pressure (CVP) and Right atrial pressure (RAP) (hemodynamic values) - 2 to 6 mm
Hg
Normal stroke volume (SV) (hemodynamic values) - 60 to 130 mL/beat
Critical Care Exam 1
AACN - certify nurses; protect consumer by establishing high standards of professional practice
CCRN - certification for nurses who provide care in critically ill adult, pediatric, or neonatal populations
PCCN - certification for nurses who provide acute care in progressive care, telemetry, and similar units
CNML - certification for critical care managers and leaders
CCNS - certification for acute and critical care clinical nurse specialists
Level A (Scale for Rating Research Evidence) - meta-analysis or met synthesis studies; results consistently
support specific action, intervention, or treatment
Level B (Scale for Rating Research Evidence) - randomized and nonrandomized controlled studies;
results consistently support specific action, intervention, or treatment
Level C (Scale for Rating Research Evidence) - qualitative, descriptive, or correlational studies, reviews,
or trials with inconsistent results
Level D (Scale for Rating Research Evidence) - Peer-reviewed with clinical studies to support
recommendations
Level E (Scale for Rating Research Evidence) - theory-based evidence from expert opinions
Level M (Scale for Rating Research Evidence) - Manufacturer's recommendation only
,Ask-Tell-Ask (Communication) - Communication technique that assesses concerns before providing info
Situational Awareness (Communication) - being aware of one's surroundings
Calgary Family Assessment - Assessment that involves structural, developmental, and functional
assessments
Family Bundle - Provide structure for planning and carrying out family care; based on 5 concepts:
evaluate, plan; involve; communicate; support (EPICS)
Principles - widely applied ethical approach based of 4 fundamental moral principles to contemporary
ethical dilemmas; respect for autonomy; beneficence; no maleficence; justice
Beneficence - the duty to provide benefits to others when in a position to do so, to help balance harms
and benefits; the benefits of an action should outweigh the burdens
Futility - states that care should not be given if it is futile in terms of improving comfort or the medical
outcome
Veracity - states that persons are obligated to tell the truth in their communication with others
Fidelity - requires that one has a moral duty to be faithful to the commitments made to others
Elements of Informed Consent - competence (capacity); voluntariness; disclosure of information
Living Will - a witnessed written document or oral statement voluntarily executed by a person that
expresses the person's instructions concerning life-prolonging procedure; not legally binding in some
states
Proxy - a competent adult, not designated to make health care decisions for an incapacitated person,
but is authorized by state statute to make healthcare decisions for the person
, Surrogate - a competent adult designated by a person to make health care decisions should that person
become incapacitated
Patient Self-Determination act (End-of-life issue) - requires that all healthcare facilities that receive
Medicare or Medicaid funding inform their patients about their right to initiate an advance directive and
the right to consent to or refuse medical treatment
Withholding, Limiting, or Withdrawing Therapy - Priority should be anticipating patient symptoms;
assessment of patient response; titration of therapy to relieve emotional and physical distress; common
meds used are analgesics (i.e. Morphine) and anxiolytics (ie. benzodiazepines)
Ventilator Withdrawal - Known as "terminal weaning"; consist of titration of ventilator support to
minimal levels, removal of ventilator, but not artificial airway, or complete estuation; titrate pain meds
and sedation as needed to relieve symptoms of respiratory distress
Commonly withheld therapy - vasopressors; antibiotics; done when goal of treatment shifts to palliation
instead of cure; address these before withdrawing or withholding ventilation
Ethical Principles for withholding and withdrawing life-sustaining treatment - life-sustaining treatment
should not be withdrawn while patient is receiving paralytic agents. When paralytic drugs are
discontinued, patient must demonstrate sufficient motor activity to allow thorough clinical assessment
before withdrawal of support
Hemodynamic Assessment - Used to titrate therapies to a specific end point; detect inadequate tissue
perfusion; quantify severity of disease; and guide therapy
normal cardiac output (CO) (hemodynamic values) - 4 to 8 L/minute
normal central venous pressure (CVP) and Right atrial pressure (RAP) (hemodynamic values) - 2 to 6 mm
Hg
Normal stroke volume (SV) (hemodynamic values) - 60 to 130 mL/beat
