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• W2894818632 abstract "The journey to certification can be like climbing a mountain. In the Rocky Mountains of Colorado, people climb 14 000-ft peaks. I have summited a few of these mountains since moving here, and the pride and sense of accomplishment in reaching the top are like finally putting those CCRN letters after your name. Although the panoramic views that rewarded me at the peak were amazing, the sights along the way were wonderful too, and I almost missed those. I was so focused on putting one foot in front of the other that I was not noticing the beauty around me. If my friend had not reminded me to look around, I would not have noticed the mountain goat grazing nearby. I might have achieved the same goal, but without gaining the same value from the journey. Similarly, nurses benefit from the process of certification as well as the pride and respect they get from the credential. The journey to certification can provide increased knowledge, ability to advocate for patients, and camaraderie with fellow credentialing candidates while on the path to the credential. What do you value in the certification journey?Sara Knippa, MS, RN, CNS, CCRN, PCCN, ACCNS-AG, and Carol Ann Rauen, MS, RN-BC, CCRN, PCCN, CEN, are the column coeditors. Carol is an independent clinical nurse specialist and education consultant in St. Augustine, Florida, and Sara is a clinical nurse specialist/educator in the cardiac intensive care unit at University of Colorado Hospital, Aurora, Colorado. They welcome feedback from readers and practice questions from potential contributors at sara.knippa.cns@gmail.com. Sara wrote the introduction.KNIPPARAUENLiana Hochhalter, BA, BS, BSN, RN, CCRN, is a staff nurse in the medical intensive care unit at University of Chicago Medicine, Chicago, Illinois. Liana wrote CCRN practice questions 1 through 3.HOCHHALTERAriana Barnes, BSN, RN, SCRN, PHN, and Mary Kay Bader, MSN, RN, CCNS, SCRN, CNRN, CCRN, wrote CCRN practice questions 4 and 5. Ariana is a clinical nurse IV and Mary Kay is a neurointensive care clinical nurse specialist in the surgical intensive care unit at Mission Hospital, Mission Viejo, California.BARNESBADERKristin Sollars, MSN, RN, CCRN-K, and Marci Ebberts, MSN, RN, CCRN-K, are clinical education specialists at Saint Luke’s Health System, Kansas City, Missouri. Marci and Kristin wrote the CMC practice questions.SOLLARSEBBERTSThe patient has signs of hypovolemia associated with gastrointestinal bleeding. Obtaining blood for typing and screening is an imperative initial act to prepare blood for transfusion. Infusion of a proton pump inhibitor such as pantoprazole can mitigate bleeding when endoscopy is delayed due to a patient’s unstable condition. Blood cultures and antibiotics (A) would be appropriate if the concern were septic shock. The patient’s history of alcohol abuse and current assessment data point to gastrointestinal bleeding. Although the white blood cell count is mildly elevated, the elevation is not an absolute indicator of infection. Obtaining blood to determine serum amylase level and instituting nothing by mouth (C) would be appropriate for abdominal pain due to acute pancreatitis, whereas obtaining a blood sample for determining lactate level and preparing for surgery (D) would be indicated in small-bowel obstruction.Evidence indicates that patients and their family members may benefit from family presence during resuscitation efforts, and this response respectfully acknowledges the code leader’s request without compromising patient-and family-centered care. Escorting the family to the hallway (B) or to the waiting room (D) when the family members desire to stay does not address the family’s emotional needs and does not advocate for them. The statement in option C contains correct information, but the approach is confrontational and less likely to be effective.A history of dementia, advanced age, and use of benzodiazepines are risk factors for delirium. Trauma such as a motor vehicle collision and emergency surgery are additional risk factors. Dexmedetomidine (B) may decrease the length of delirium, and noninvasive ventilation is not a risk factor. Mechanical ventilation is a risk factor, but early extubation (C) reduces the risk. Malnutrition and infection are risk factors (D), but use of antibiotics and acetaminophen is not.Corticosteroids are administered to decrease vasogenic cerebral edema due to an intracranial mass. If a decrease in level of consciousness is due to increased intracranial pressure, corticosteroid administration can markedly improve neurological status. Discussing palliative care (A) with the decision maker may be indicated later, but more information on prognosis would be helpful first. Placing the patient in the Trendelenburg position (C) can increase the intracranial pressure and could lead to further neurological decompensation. Osmotic diuretics (D) are often used to treat cerebral edema after traumatic brain injury but will not affect the vasogenic edema around the mass.In patients without advanced monitoring, vasospasm is indicated by changes in the results of neurological assessment correlating with the area of possible vasospasm. The first intervention the nurse should implement is increasing the norepinephrine dose to restore perfusion and prevent delayed cerebral ischemia. Increasing the oxygen (A) will not assist with the perfusion and neurological changes. Cerebral angiography (B) may be considered if the provider deems that more invasive intervention is needed. Placing the head of the bed flat for the first 24 hours (C) is recommended in ischemic stroke, but not in a patient like this one who most likely has increased intracranial pressure.The most common and life-threatening risk associated with a catheter ablation is cardiac tamponade, which can become evident several days later. NSTEMI (A), cardiac contusion (B), and pulmonary embolism (D) would all cause chest pain, but the narrowed pulse pressure combined with the recent ablation makes cardiac tamponade (C) the most likely cause. Cardiac contusion (B) would be associated with trauma, not an ablation.Infective endocarditis after cardiac surgery occurs in 1% to 6% of patients and is associated with a high mortality rate. The first 12 weeks are the highest risk period. After a myocardial infarction, patients (A) are at no higher risk for endocarditis, and although intravenous drug use is a risk factor, smoking marijuana is not. Although a heart murmur (C) may indicate a valvular abnormality, further workup is needed to determine the risk for endocarditis. Heart failure (D) is not associated with endocarditis.A patient with a shockable rhythm, return of spontaneous circulation but no meaningful response is an ideal candidate for TTM. Targeted temperature management is not indicated for patients who are awake after cardiac arrest (A). A TTM protocol is only indicated for anoxic injury related to cardiac arrest (B, D).ST-segment elevation in leads II, III, and aVF represents ischemia to the inferior wall, which is supplied blood from the right coronary artery. This artery also supplies blood to the sinoatrial and atrioventricular nodes, so occlusion of the artery puts the patient at risk for bradycardic rhythms that may require pacing. Left-ventricular support (B) is necessary when the anterior wall of the myocardium has been injured. An acute septal defect (C) could be a complication if the myocardial injury was located near the ventricular septum, which would be indicated by ST elevation in leads V1 and V2. This patient could be at risk for right ventricular infarction, in which case fluid replacement would be indicated rather than diuresis (D) because the patient could be preload dependent.The radial patency test is performed to demonstrate blood flow continuing through the radial artery while bleeding is controlled with a compression device. Loss of the pulse oximetry waveform during compression of the ulnar artery indicates that blood flow through the radial artery is restricted too much. The correct action is to release pressure in the radial compression device to allow more blood flow through the radial artery. Loss of the pulse oximetry waveform does not indicate bleeding (A). The goal when a radial patency test is unsuccessful is to increase blood flow through the artery; elevation would decrease flow (C). A second radial compression device (D) would be indicated if a hematoma was developing.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 sources used in developing each item." @default.
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• W2894818632 date "2018-10-01" @default.
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• W2894818632 title "Value the Journey" @default.
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