AACN Certification
CCRN/PCCN Critical Care
Exam 1
AACN - answercertify nurses; protect consumer by establishing high standards of
professional practice
CCRN - answercertification for nurses who provide care in critically ill adult, pediatric, or
neonatal populations
PCCN - answercertification for nurses who provide acute care in progressive care,
telemetry, and similar units
CNML - answercertification for critical care managers and leaders
CCNS - answercertification for acute and critical care clinical nurse specialists
Level A (Scale for Rating Research Evidence) - answermeta-analysis or metasynthesis
studies; results consistently support specific action, intervention, or treatment
Level B (Scale for Rating Research Evidence) - answerrandomized and nonrandomized
controlled studies; results consistently support specific action, intervention, or treatment
Level C (Scale for Rating Research Evidence) - answerqualitative, descriptive, or
correlational studies, reviews, or trials with inconsistent results
Level D (Scale for Rating Research Evidence) - answerPeer-reviewed with clinical
studies to support recommendations
Level E (Scale for Rating Research Evidence) - answertheory-based evidence from
expert opinions
Level M (Scale for Rating Research Evidence) - answerManufacturer's recommendation
only
Ask-Tell-Ask (Communication) - answerCommunication technique that assesses
concerns before providing info
Situational Awareness (Communication) - answerbeing aware of one's surroundings
Calgary Family Assessment - answerAssessment that involves structural,
developmental, and functional assessments
Family Bundle - answerProvide structure for planning and carrying out family care;
based on 5 concepts: evaluate, plan; involve; communicate; support (EPICS)
Principlism - answerwidely applied ethical approach based of 4 fundamental moral
principles to contemporary ethical dilemmas; respect for autonomy; beneficence;
nonmaleficence; justice
Beneficence - answerthe 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 - answerstates that care should not be given if it is futile in terms of improving
comfort or the medical outcome
Veracity - answerstates that persons are obligated to tell the truth in their
communication with others
,Fidelity - answerrequires that one has a moral duty to be faithful to the commitments
made to others
Elements of Informed Consent - answercompetence (capacity); voluntariness;
disclosure of information
Living Will - answera 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 - answera 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 - answera competent adult designated by a person to make health care
decisions should that person become incapacitated
Patient Self-Determination act (End-of-life issue) - answerrequires 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 - answerPriority should be anticipating
patient symptoms; assessment of patient response; titration of therapy to relieve
emotional and physical distress; common meds used are analgesics (ie. Morphine) and
anxiolytics (ie. benzodiazepines)
Ventilator WIthdrawal - answerKnown as "terminal weaning"; consist of titration of
ventilator support to minimal levels, removal of ventilator, but not artificial airway, or
complete extubation; titrate pain meds and sedation as needed to relieve symptoms of
respiratory distress
Commonly withheld therapy - answervasopressors; antibiotics; done when goal of
treatment shift to palliation instead of cure; address these before withdrawing or
withholding ventilation
Ethical Principles for withholding and withdrawing life-sustaining treatment - answerlife-
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 - answerUsed 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) - answer4 to 8 L/minute
normal central venous pressure (CVP) and Right atrial pressure (RAP) (hemodynamic
values) - answer2 to 6 mm Hg
Normal stroke volume (SV) (hemodynamic values) - answer60 to 130 mL/beat
normal mixed venous O2 sat (SvO2) (hemodynamic values) - answer60% to 75%
Normal central venous O2 sat (ScvO2) - answer65% to 85%
what affects BP reading - answerpresence of cardiac dysrhythmias; respiratory
variation; shivering; external cuff compression; decreased peripheral perfusion
Jugular Venous Pressure - answerProvides an estimate of intravascular volume; an
indirect measure of central venous pressure (CVP); Normal is 7 to 9 cm
jugular venous distention - answeroccurs when CVP is elevated due to fluid overload,
RV dysfunction, superior vena cava obstruction, right HF
, Assessment of jugular venous pressure - answerlook for highest point of pulsation;
measure the vertical distance between this pulsation and the angle of Louis in cm; add
5 cm to this number for an estimation of CVP
Lactate - answernormal levels is 0.5 to 1.6 mEq/L; determine tissue hypoperfusion in
circulatory shock, establish adequacy of resuscitation; assist in diagnosis of patients
who have metabolic acidosis
Indication of Arterial Line - answerhemodynamic instability; assess efficacy of
vasoactive medication; frequent ABG analysis
Indication of Central Venous Catheter - answermeasure right heart filling pressures;
estimate fluid status; guide volume resuscitation; assess central venous O2 sat
(ScvO2); administer large-volume fluid resuscitation or irritant medications; access to
place transvenous pacemaker
Indication of Pulmonary Artery Catheter - answeridentify and treat cause of
hemodynamic instability; assess pulmonary artery pressures; assess mixed venous O2
sat (SvO2); directly measure cardiac output (CO)
Invasive Hemodynamic monitoring nursing dx - answerineffective tissue perfusion;
decreased cardiac output (CO); fluid volume excess or deficit
Complication of Invasive hemodynamic monitoring - answerthrombosis; pneumothorax;
hemothorax; cardiac dysrhythmias; pericardial tamponade
components for validating accuracy of invasive hemodynamic monitoring -
answerpatient positioning (up to 45 degrees); zeroing the transducer; leveling the air-
fluid interface (zeroing stopcock) to the phlebostatic axis; assessing dynamic
responsiveness (do the square wave test)
Reason why zeroing stopcock must be positioned at phlebostatic axis - answerIf below,
will result in false elevation; if above, will result in false low reading
Accurate hemodynamic data - answerIt can be obtained when patient is supine, HOB
up to 45 degrees, or lateral positions from 30 to 90 degrees
Assessing dynamic responsiveness (doing the square wave test) - answeractivate the
fast flush valve/actuator on the pressure tubing system for at least 1 second; should be
done after catheter insertion; once per shift; and after opening the system
Overdamped dynamic responsiveness (square wave test) - answersquare wave test
results no oscillations, upstroke is slurred, or undershoot is not produced
Underdamped dynamic responsiveness (square wave test) - answersquare wave test
results in excessive oscillations
Causes of overdamped dynamic responsiveness (square wave test) - answerblood
clots, blood left in catheter after getting a blood sample, air bubbles, compliant tubing,
loose connections, kinks, PIP will drop suddenly
Causes of underdamped dynamic responsiveness (square wave test) -
answerexcessive tubing length (>48 inches); small bore tubing; sometimes unknown
Arterial Pressure Monitoring - answerFor patients at risk for compromised tissue
perfusion and volume status; need frequent lab work; has hypo or hypertension; and
takes vasoactive agents (ie. Dopamine); Radial artery is site of choice, also femoral and
brachial. Most accurate method of getting systemic BP; pressure should be @ 300 mm
Hg; gives beat-by-beat info; NIBP should be lower than invasive
Causes of higher NIBP compared to invasive - answerair bubbles in catheter; failure to
zero the transducer air-fluid interface; blood in catheter; blood clot at catheter tip;
CCRN/PCCN Critical Care
Exam 1
AACN - answercertify nurses; protect consumer by establishing high standards of
professional practice
CCRN - answercertification for nurses who provide care in critically ill adult, pediatric, or
neonatal populations
PCCN - answercertification for nurses who provide acute care in progressive care,
telemetry, and similar units
CNML - answercertification for critical care managers and leaders
CCNS - answercertification for acute and critical care clinical nurse specialists
Level A (Scale for Rating Research Evidence) - answermeta-analysis or metasynthesis
studies; results consistently support specific action, intervention, or treatment
Level B (Scale for Rating Research Evidence) - answerrandomized and nonrandomized
controlled studies; results consistently support specific action, intervention, or treatment
Level C (Scale for Rating Research Evidence) - answerqualitative, descriptive, or
correlational studies, reviews, or trials with inconsistent results
Level D (Scale for Rating Research Evidence) - answerPeer-reviewed with clinical
studies to support recommendations
Level E (Scale for Rating Research Evidence) - answertheory-based evidence from
expert opinions
Level M (Scale for Rating Research Evidence) - answerManufacturer's recommendation
only
Ask-Tell-Ask (Communication) - answerCommunication technique that assesses
concerns before providing info
Situational Awareness (Communication) - answerbeing aware of one's surroundings
Calgary Family Assessment - answerAssessment that involves structural,
developmental, and functional assessments
Family Bundle - answerProvide structure for planning and carrying out family care;
based on 5 concepts: evaluate, plan; involve; communicate; support (EPICS)
Principlism - answerwidely applied ethical approach based of 4 fundamental moral
principles to contemporary ethical dilemmas; respect for autonomy; beneficence;
nonmaleficence; justice
Beneficence - answerthe 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 - answerstates that care should not be given if it is futile in terms of improving
comfort or the medical outcome
Veracity - answerstates that persons are obligated to tell the truth in their
communication with others
,Fidelity - answerrequires that one has a moral duty to be faithful to the commitments
made to others
Elements of Informed Consent - answercompetence (capacity); voluntariness;
disclosure of information
Living Will - answera 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 - answera 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 - answera competent adult designated by a person to make health care
decisions should that person become incapacitated
Patient Self-Determination act (End-of-life issue) - answerrequires 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 - answerPriority should be anticipating
patient symptoms; assessment of patient response; titration of therapy to relieve
emotional and physical distress; common meds used are analgesics (ie. Morphine) and
anxiolytics (ie. benzodiazepines)
Ventilator WIthdrawal - answerKnown as "terminal weaning"; consist of titration of
ventilator support to minimal levels, removal of ventilator, but not artificial airway, or
complete extubation; titrate pain meds and sedation as needed to relieve symptoms of
respiratory distress
Commonly withheld therapy - answervasopressors; antibiotics; done when goal of
treatment shift to palliation instead of cure; address these before withdrawing or
withholding ventilation
Ethical Principles for withholding and withdrawing life-sustaining treatment - answerlife-
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 - answerUsed 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) - answer4 to 8 L/minute
normal central venous pressure (CVP) and Right atrial pressure (RAP) (hemodynamic
values) - answer2 to 6 mm Hg
Normal stroke volume (SV) (hemodynamic values) - answer60 to 130 mL/beat
normal mixed venous O2 sat (SvO2) (hemodynamic values) - answer60% to 75%
Normal central venous O2 sat (ScvO2) - answer65% to 85%
what affects BP reading - answerpresence of cardiac dysrhythmias; respiratory
variation; shivering; external cuff compression; decreased peripheral perfusion
Jugular Venous Pressure - answerProvides an estimate of intravascular volume; an
indirect measure of central venous pressure (CVP); Normal is 7 to 9 cm
jugular venous distention - answeroccurs when CVP is elevated due to fluid overload,
RV dysfunction, superior vena cava obstruction, right HF
, Assessment of jugular venous pressure - answerlook for highest point of pulsation;
measure the vertical distance between this pulsation and the angle of Louis in cm; add
5 cm to this number for an estimation of CVP
Lactate - answernormal levels is 0.5 to 1.6 mEq/L; determine tissue hypoperfusion in
circulatory shock, establish adequacy of resuscitation; assist in diagnosis of patients
who have metabolic acidosis
Indication of Arterial Line - answerhemodynamic instability; assess efficacy of
vasoactive medication; frequent ABG analysis
Indication of Central Venous Catheter - answermeasure right heart filling pressures;
estimate fluid status; guide volume resuscitation; assess central venous O2 sat
(ScvO2); administer large-volume fluid resuscitation or irritant medications; access to
place transvenous pacemaker
Indication of Pulmonary Artery Catheter - answeridentify and treat cause of
hemodynamic instability; assess pulmonary artery pressures; assess mixed venous O2
sat (SvO2); directly measure cardiac output (CO)
Invasive Hemodynamic monitoring nursing dx - answerineffective tissue perfusion;
decreased cardiac output (CO); fluid volume excess or deficit
Complication of Invasive hemodynamic monitoring - answerthrombosis; pneumothorax;
hemothorax; cardiac dysrhythmias; pericardial tamponade
components for validating accuracy of invasive hemodynamic monitoring -
answerpatient positioning (up to 45 degrees); zeroing the transducer; leveling the air-
fluid interface (zeroing stopcock) to the phlebostatic axis; assessing dynamic
responsiveness (do the square wave test)
Reason why zeroing stopcock must be positioned at phlebostatic axis - answerIf below,
will result in false elevation; if above, will result in false low reading
Accurate hemodynamic data - answerIt can be obtained when patient is supine, HOB
up to 45 degrees, or lateral positions from 30 to 90 degrees
Assessing dynamic responsiveness (doing the square wave test) - answeractivate the
fast flush valve/actuator on the pressure tubing system for at least 1 second; should be
done after catheter insertion; once per shift; and after opening the system
Overdamped dynamic responsiveness (square wave test) - answersquare wave test
results no oscillations, upstroke is slurred, or undershoot is not produced
Underdamped dynamic responsiveness (square wave test) - answersquare wave test
results in excessive oscillations
Causes of overdamped dynamic responsiveness (square wave test) - answerblood
clots, blood left in catheter after getting a blood sample, air bubbles, compliant tubing,
loose connections, kinks, PIP will drop suddenly
Causes of underdamped dynamic responsiveness (square wave test) -
answerexcessive tubing length (>48 inches); small bore tubing; sometimes unknown
Arterial Pressure Monitoring - answerFor patients at risk for compromised tissue
perfusion and volume status; need frequent lab work; has hypo or hypertension; and
takes vasoactive agents (ie. Dopamine); Radial artery is site of choice, also femoral and
brachial. Most accurate method of getting systemic BP; pressure should be @ 300 mm
Hg; gives beat-by-beat info; NIBP should be lower than invasive
Causes of higher NIBP compared to invasive - answerair bubbles in catheter; failure to
zero the transducer air-fluid interface; blood in catheter; blood clot at catheter tip;
