NR 341 FINAL LATEST EXAM 2026/2027
COMPREHENSIVE EXAM STUDY NOTES.
Organ Donation Triggers - ANSWER 1. talk about ventilator withdrawal/terminal wean
2. comfort care measures
3. GCS < or = 5
4. Brain death testing
5. Positive apnea test
Apnea Test - ANSWER -ran for 8-10 mins
-take patient off vent but keep O2
-positive: no respiratory movement = increased CO2
Support for Organ Donation - ANSWER -thyroid: levoythyroxine
-DI: DDAVP/vasopressin/desmopressin and monitor UO
-pancreas:(BG will run high) insulin, q 1 hour accu checks
-blood pressure: disconnect with SNS, neuro storm, put patient on levophed and
vasopressin
-respiratory: vent dependent, maintain Hgb around 10
Serum CO2 - ANSWER HCO3
Nursing role for the donor patient - ANSWER scripted and consistent
Brain death testing - ANSWER A: Apnea test
B: EEG
C: Cerebral angiography
D: Radionuclide cerebral perfusion scan
-will have A and C or D
Circulatory Death - ANSWER -after heart stops
-OD's
Organ Recipient Meds - ANSWER 1. Prednisone
2. Tacrolimus/Cyclosporine (need lab draws for therapeutic levels and nephrotoxic)
3. Mycophenolate Mofetil
Liver Biopsy - ANSWER -need to coach the patient how to breathe through the
procedure since the liver is accessed through the ribs
, -monitor for bleeding and pneumothorax
-keep patient lying on right side for minimum of 2 hours
Primary Survey - ANSWER -done in 1-2 mins to set priority for patient
-LOC: AVPU
-A: Airway -> fire, chemical, C spine injury
-B: Breathing -> contusion, fractured ribs, flail chest, neuro dysfunction to not able to
move diaphragm deep enough, abdominal trauma affected diaphragm
-C: Circulation -> control hemorrhage, 2 large bore IVs and administer fluids
-D: dysfunction - neuro disabilities and cranial nerves
-E: elements - is the patient safe, what is their exposure?
-F: full set of VS/family - get quick info, allergies, what happened at scene, med hx
-G: Get resuscitation adjuncts: FAST and EFAST
FAST - ANSWER US to scan abdomen
EFAST - ANSWER US scan to abdomen + lungs
Secondary Survey - ANSWER -patient needs to be stabilized first
-HI:
-H: full history
-I: inspecting full head to toe and back of patient
Halo Vest Care - ANSWER 1. Inspect the pins on the halo traction ring. Report to HCP if
pins are loose or signs of infection are present, including redness, tenderness, swelling, or
drainage at insertion sites.
2. Clean around pin sites carefully with half-strength hydrogen peroxide, water, or alcohol
on a cotton swab as directed.
3. Apply antibiotic ointment as prescribed.
4. To receive skin care, have patient lie down with the head resting on a pillow to reduce
pressure on the brace. Loosen one side of the vest. Gently wash the skin under the vest
with soap and water, rinse area, and then dry it thoroughly. At the same time, check the
skin for pressure points, redness, swelling, bruising, or chafing. Close the open side and
repeat the procedure on the opposite side.
5. If the vest becomes wet or damp, carefully dry it with a blow dryer.
6. Encourage patient to use assistive device (e.g., cane, walker) to improve balance;
encourage use of flat shoes.
7. Remind patient to turn the entire body, not just the head and neck, when trying to look
sideways.
8. In case of an emergency, keep a set of wrenches close to the halo vest at all times.
COMPREHENSIVE EXAM STUDY NOTES.
Organ Donation Triggers - ANSWER 1. talk about ventilator withdrawal/terminal wean
2. comfort care measures
3. GCS < or = 5
4. Brain death testing
5. Positive apnea test
Apnea Test - ANSWER -ran for 8-10 mins
-take patient off vent but keep O2
-positive: no respiratory movement = increased CO2
Support for Organ Donation - ANSWER -thyroid: levoythyroxine
-DI: DDAVP/vasopressin/desmopressin and monitor UO
-pancreas:(BG will run high) insulin, q 1 hour accu checks
-blood pressure: disconnect with SNS, neuro storm, put patient on levophed and
vasopressin
-respiratory: vent dependent, maintain Hgb around 10
Serum CO2 - ANSWER HCO3
Nursing role for the donor patient - ANSWER scripted and consistent
Brain death testing - ANSWER A: Apnea test
B: EEG
C: Cerebral angiography
D: Radionuclide cerebral perfusion scan
-will have A and C or D
Circulatory Death - ANSWER -after heart stops
-OD's
Organ Recipient Meds - ANSWER 1. Prednisone
2. Tacrolimus/Cyclosporine (need lab draws for therapeutic levels and nephrotoxic)
3. Mycophenolate Mofetil
Liver Biopsy - ANSWER -need to coach the patient how to breathe through the
procedure since the liver is accessed through the ribs
, -monitor for bleeding and pneumothorax
-keep patient lying on right side for minimum of 2 hours
Primary Survey - ANSWER -done in 1-2 mins to set priority for patient
-LOC: AVPU
-A: Airway -> fire, chemical, C spine injury
-B: Breathing -> contusion, fractured ribs, flail chest, neuro dysfunction to not able to
move diaphragm deep enough, abdominal trauma affected diaphragm
-C: Circulation -> control hemorrhage, 2 large bore IVs and administer fluids
-D: dysfunction - neuro disabilities and cranial nerves
-E: elements - is the patient safe, what is their exposure?
-F: full set of VS/family - get quick info, allergies, what happened at scene, med hx
-G: Get resuscitation adjuncts: FAST and EFAST
FAST - ANSWER US to scan abdomen
EFAST - ANSWER US scan to abdomen + lungs
Secondary Survey - ANSWER -patient needs to be stabilized first
-HI:
-H: full history
-I: inspecting full head to toe and back of patient
Halo Vest Care - ANSWER 1. Inspect the pins on the halo traction ring. Report to HCP if
pins are loose or signs of infection are present, including redness, tenderness, swelling, or
drainage at insertion sites.
2. Clean around pin sites carefully with half-strength hydrogen peroxide, water, or alcohol
on a cotton swab as directed.
3. Apply antibiotic ointment as prescribed.
4. To receive skin care, have patient lie down with the head resting on a pillow to reduce
pressure on the brace. Loosen one side of the vest. Gently wash the skin under the vest
with soap and water, rinse area, and then dry it thoroughly. At the same time, check the
skin for pressure points, redness, swelling, bruising, or chafing. Close the open side and
repeat the procedure on the opposite side.
5. If the vest becomes wet or damp, carefully dry it with a blow dryer.
6. Encourage patient to use assistive device (e.g., cane, walker) to improve balance;
encourage use of flat shoes.
7. Remind patient to turn the entire body, not just the head and neck, when trying to look
sideways.
8. In case of an emergency, keep a set of wrenches close to the halo vest at all times.
