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• W2410106600 abstract "Carol Rauen, rn-bc, ms, ccrn, pccn, cen, the department editor, is an independent clinical nurse specialist in The Outer Banks of North Carolina and a staff nurse in the burn trauma intensive care unit at Sentara Norfolk General Hospital in Virginia. Carol welcomes feedback from readers and practice questions from potential contributors at rauen.carol104@gmail.com.RAUENThora Tollefson, rn, msn, ccrn, fnp-bc, surgical intensive care staff nurse and critical care nurse residency coordinator at Ministry St Joseph’s Hospital in Marshfield, Wisconsin, wrote the adult CCRN questions.TOLLEFSONHeather Dietzler, rn, msn, cne, clinical nurse specialist at the Marshfield Clinical in Marshfield, Wisconsin, wrote the CMC questions.DIETZLERThe dictionary definition of competence is “the ability to do something successfully or efficiently.” Synonyms for competence include capability, ability, proficiency, expertise, adeptness, skill, mastery, talent, and know-how. Successfully achieving certification is one avenue to demonstrate knowledge and competence in acute and critical care nursing. CCRN, PCCN, CMC, and CSC are credentials of competence.Weaning should be a protocol-driven and multidisciplinary procedure. Weaning should not begin until the patient is hemodynamically stable. Breathing over the ventilator (A) is not a criterion for weaning. The only reason to delay weaning after being intubated (B) would be to ensure that the anesthesia is no longer affecting the drive to breathe. Ventilator patients should be given a sedation holiday daily to assess their ability to breathe/wean (C); spontaneous breathing trails should be done for all patients who meet the other criteria for weaning.Patients experiencing a traumatic event may exhibit signs of posttraumatic stress disorder (PTSD) for weeks to years after an event has occurred. Nurses can provide support, identify coping strategies, and work with patients’ families to support the patient. A patient’s reactions to a traumatic event may differ depending on past experiences, how they cope, and the patient’s family support system. Having no flashbacks (A) and experiencing a full range of emotions (C) are long-term outcomes. Patients should be encouraged to discuss the traumatic event with providers or family members (D). During the hospital stay, sleep routines should be encouraged along with pain-control strategies to help the patient reach the point where no sedatives are required to sleep at night.If the laceration is found on secondary assessment, any bleeding would not be life-threatening. Before the wound can be closed (A) it needs to be cleaned and examined (D) for any foreign objects. The patient is awake and alert, so a head CT (B) would not be immediately indicated. The need for tetanus prophylaxis (C) would depend on a patient’s immunization history.A patient is at risk of intra-abdominal hypertension developing after abdominal surgery, which will reduce venous return and impede cardiac outflow because of back pressure from the abdominal cavity. Normal intra-abdominal pressure is 0 to 12 mm Hg. The increased pressure in the abdominal cavity and decreased cardiac output also reduce perfusion of the abdominal organs, resulting in decreased urine filtration and urine output. The goal is to maintain perfusion to the abdominal organs and decrease pressure within the abdominal cavity. One way to reduce pressure within the abdominal cavity is to reduce abdominal contents by resetting the nasogastric tube to suction (B). Elevating the head of the bed (A) may worsen the intra-abdominal pressure. Administering furosemide (C) will not correct the underlying problem of increased abdominal pressure. Diltiazem (D) will not treat the underlying problem of decreased venous return to the heart and decreased CO.The AACN Synergy Model relies on the patient’s characteristics to drive the nurse’s competencies; the interaction is synergistic. Collaboration (A) and advocacy (B) would have occurred between the nurse and the transfer service to facilitate the family presence during transfer. The actual act of determining the need for the family presence to decrease anxiety regarding the move is caring practices. Clinical judgment (C), in the Synergy Model, refers to the science of nursing practice.A stroke volume variance reflects a patient’s fluid status. A variance of greater than 13% indicates more fluid is needed. There is no indication of contractility complications (A) or the need for the additional support of vasopressors (B). Nitroglycerine (C) is a vasodilator and would be counterproductive as this patient most likely has issues with blood pressure regulation.The R-on-T phenomenon that predisposes a patient to dangerous arrhythmias can occur in a paced rhythm when the pacemaker is undersensing the patient’s intrinsic rhythm. Increasing the sensitivity by lowering the millivoltage (mV) setting will allow the pacemaker to see more of the patient’s own intrinsic electrical activity that it was not able to see in the complication described. Increasing or decreasing the milliamperage (A, C) will only increase or decrease the energy used to elicit the depolarization.An MI can damage the ventricle, causing the chordae to rupture and creating mitral regurgitation. A systolic murmur can be heard with mitral regurgitation and may cause signs and symptoms of SOB and palpitations. When these are present shortly after the MI, cardiogenic shock is a likely complication. Additional prominent signs and symptoms such as diaphoresis, electrocardiographic changes, and chest pain would most likely occur for reocclusion of the LAD (B). Ventricular tachycardia (C) can be a complication but would not cause a systolic murmur. Aortic insufficiency (D) is not a common complication of an MI.When BiPAP is applied, the positive end-expiratory pressure (PEEP) causes the alveoli to open and remain expanded on exhalation. This causes continuous compression on the capillary bed, making it more difficult for blood to pump from the right ventricle through the lungs and causing increased pressure in the right ventricle and pulmonary artery. Continuous pulmonary capillary compression impedes venous return and PA outflow, increases ICP, and diminishes both BP and CO.Electrolytes play a significant role in cardiac conduction. It is important that electrolyte levels be monitored in a patient with the risk factors of alcohol abuse and prolonging QT intervals because these are precursors for the dysrhythmia torsades de pointes. ABGs (B) will most likely be monitored, but doing so is not a priority for this issue. Antiarrhythmic agents (C) and haloperidol (D) and are inappropriate interventions because they may prolong the QT interval further.AACN Certcorp publishes a study bibliography that identifies the sources from which items are validated. The document may be found in the AACN Certification exam handbook. The contributor of each question written for this column has listed the source used in developing each item." @default.
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• W2410106600 date "2016-02-01" @default.
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• W2410106600 title "Certification: A C edential of Competence" @default.
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