Springhouse review for critical care nursing certification

384 Pages·2007·3.59 MB·English

by  Springhouse

5060 FM.qxd 8/22/08 9:04 PM Page i
Springhouse Review for
CRITICAL CARE
NURSING CERTIFICATION
FOURTH EDITION
5060 FM.qxd 8/22/08 9:04 PM Page ii
5060 FM.qxd 8/22/08 9:04 PM Page iii
Springhouse Review for
CRITICAL CARE
NURSING CERTIFICATION
FOURTH EDITION
5060 FM.qxd 8/22/08 9:04 PM Page iv
STAFF The clinical treatments described and recommended in this
publication are based on research and consultation with nursing,
Executive Publisher medical, and legal authorities. To the best of our knowledge, these
Judith A. Schilling McCann, RN, MSN procedures reflect currently accepted practice. Nevertheless, they
can’t be considered absolute and universal recommendations. For
Editorial Director individual applications, all recommendations must be considered
in light of the patient’s clinical condition and, before adminis-
H. Nancy Holmes
tration of new or infrequently used drugs, in light of the latest
package-insert information. The authors and publisher disclaim
Clinical Director
any responsibility for any adverse effects resulting from the
Joan M. Robinson, RN, MSN suggested procedures, from any undetected errors, or from the
reader’s misunderstanding of the text.
Art Director
Mary Ludwicki © 2007 by Lippincott Williams & Wilkins. All rights reserved. This
book is protected by copyright. No part of it may be reproduced,
Editorial Project Manager stored in a retrieval system, or transmitted, in any form or by any
Ann Houska means—electronic, mechanical, photocopy, recording, or other-
wise—without prior written permission of the publisher, except
Clinical Project Manager for brief quotations embodied in critical articles and reviews
andtesting and evaluation materials provided by publisher to
Jennifer Meyering, RN, BSN, MS, CCRN
instructors whose schools have adopted its accompanying text-
book. Printed in the United States of America. For information,
Copy Editor
write Lippincott Williams & Wilkins, 323 Norristown Road, Suite
Linda Hager 200, Ambler, PA19002-2756.
Designer CCNC4010906—020607
Debra Moloshok (book design)
Digital Composition Services Library of Congress Cataloging-in-Publication Data
Diane Paluba (manager), Joyce Rossi Biletz, Springhouse review for critical care nursing certification.—4th ed.
DonnaS.Morris (project manager) p. ; cm.
Includes bibliographical references and index.
Manufacturing 1. Intensive care nursing—Examinations, questions, etc. 2.
Beth J. Welsh Intensive care nursing. I. Lippincott Williams & Wilkins. II. Title:
Review for critical care nursing certification.
Editorial Assistants [DNLM: 1. Critical Care--Examination Questions. 2. Critical
Care—Outlines. 3. Critical Illness—nursing—Examination
Megan L. Aldinger, Karen J. Kirk, Linda K. Ruhf
Questions.
4. Critical Illness—nursing--Outlines. WY18.2 S76952 2007]
Design Assistant
RT120.I5C38 2007
Georg W. Purvis IV 616.02'5076—dc22
ISBN13: 978-1-58255-506-5
Indexer ISBN10: 1-58255-506-0 (alk. paper) 2006019521
Barbara Hodgson
5060 FM.qxd 8/22/08 9:04 PM Page v
Contents
Contributors and consultants vii
Foreword ix
Chapter 1 Certification examination 1
Chapter 2 Cardiovascular disorders 16
Chapter 3 Pulmonary disorders 82
Chapter 4 Endocrine disorders 119
Chapter 5 Hematologic and immunologic disorders 139
Chapter 6 Neurologic disorders 162
Chapter 7 Gastrointestinal disorders 214
Chapter 8 Renal disorders 247
Chapter 9 Multisystem disorders 275
Chapter 10 Professional caring and ethical practice 292
Common drugs used in critical care 300
Care of the bariatric patient 313
Normal aging-related changes 315
Physiologic adaptations to pregnancy 317
Crisis values of laboratory tests 318
JCAHO pain management standards 320
Posttest 1 324
Posttest 2 346
Selected references 367
Index 369
v
5060 FM.qxd 8/22/08 9:04 PM Page vi
5060 FM.qxd 8/22/08 9:04 PM Page vii
Contributors and consultants
Tamara Capik, RN, BSN, CCRN
Registered Nurse—ICU
St. Joseph Hospital
Eureka, Calif.
EM Vitug Garcia, RN, DNS
Chief Nursing Officer/Associate Administrator, PCS
Mission Community Hospital
Panorama City, Calif.
Professor of Nursing Science
Breyer State University
Kamiah, Idaho
Kay Luft, MN, PhD-C, CCRN
Assistant Professor
Saint Luke’s College
Kansas City, Mo.
Catherine Pence, RN, MSN, CCRN
Assistant Professor
Northern Kentucky University
Highland Heights
Doris J. Rosenow, RN, PhD, CCRN, CNS-MS
Associate Professor
Texas A&M International University
Laredo
vii
5060 FM.qxd 8/22/08 9:04 PM Page viii
5060 FM.qxd 8/22/08 9:04 PM Page ix
Foreword
For more than 25 years, I have been privileged to write the credential
CCRNafter my name. Earning this certification was an early goal of mine
that I have maintained over the course of my career.
In the 1970s, I was an avid critical care nurse, spending most of my time
in coronary care units. Being certified as a critical care nurse represented a
way to demonstrate my knowledge and offered me many professional op-
portunities. For example, CCRN certification was recognized in employ-
ment applications and annual evaluations. It also was acknowledged on
my application for graduate studies. The CCRN credential opened many
doors to career advancement that would otherwise have gone unopened
for me. As a cardiovascular clinical specialist, I have participated in Na-
tional Teaching Institutes, including poster presentations, designed critical
care internships for new graduates, taught CCRN review courses, and
closely followed critically ill patients in multiple clinical settings. These ac-
tivities and the continuing support I received from the American Associa-
tion of Critical-Care Nurses and other CCRN colleagues ultimately led to
my continued study in nursing. As an academic nurse and outcomes re-
searcher, I was fortunate to be able to direct a critical care clinical nurse
specialist program and participate in studies of the critically ill. In essence,
the CCRN credential was an early career achievement that gave me the
confidence to continue learning.
Today, research is beginning to show relationships between additional
preparation and improved patient outcomes. CCRN certification, a valued
credential, is one way to demonstrate our expertise and continued profes-
sional growth. Not only does the CCRN build confidence and assist in ca-
reer growth for individual nurses, but it may be related to improved pa-
tient outcomes. Isn’t this the real essence of critical care nursing?
Taking the CCRN examination is challenging and is often viewed with
trepidation. However, with careful planning and preparation, you will be
successful. Taking the time to carefully review with specialty texts, such as
the Springhouse Review for Critical Care Nursing Certification,4th Edition,
will strengthen the knowledge you already have and update you on the
most current information in critical care nursing. This approach to prepara-
tion will optimize your ability to effectively earn the CCRN credential.
Chapter 1 of Springhouse Review for Critical Care Nursing Certification,4th
Edition, is an introduction to the CCRN certification examination. It covers
ix
5060 FM.qxd 8/22/08 9:04 PM Page x
x ❍ Foreword
eligibility requirements, application information, a review of the test plan,
study tips, and test-taking strategies. The chapter explains the types of
questions most likely to appear on the examination and offers effective
methods to improve your test performance.
Chapters 2 through 8 are organized by body systems for convenient
study. Each chapter reviews anatomy and physiology and then outlines
themajor pathologies of the body system. These discussions include clini-
cal signs and symptoms and pertinent laboratory values and diagnostic
tests. These chapters impart up-to-date information on disorders such as
arrhythmias, coronary artery disease, valvular disorders, pulmonary
embolism, acute respiratory failure, diabetes, acquired immunodeficiency
syndrome, disseminated intravascular coagulation, spinal cord injuries, in-
fectious neurologic diseases, acute gastrointestinal problems such as bowel
infarction, and acute renal failure, to name a few. Not only are the diseases
described in detail, but also their medical and nursing management and
rationales are presented. Review questions at the end of each chapter give
you the opportunity to evaluate your newly acquired knowledge.
Chapter 9 is unique because it offers information on multisystem disor-
ders, such as burns and septic shock, that so often plague critical care nurs-
es and their patients. Chapter 10 deals with professional issues of concern
to critical care nurses, such as ethical decision-making, caring, collabora-
tion, and continuous learning. This chapter ties the earlier chapters togeth-
er by providing the context for practice.
Throughout the text, you’ll find charts and diagrams that augment the
written word. Appendices provide information on drugs used in critical
care, care of the bariatric patient, normal aging-related changes, physiolog-
ic adaptations to pregnancy, crisis values of laboratory tests, and JCAHO
pain management standards. Two posttests offer additional opportunity
for self-evaluation before you take the examination. Each contains 50 ques-
tions similar to those on the actual examination, followed by the correct
answers and rationales. Finally, you’ll find a self-diagnostic profile to guide
your progress. The reference list is current and allows for further study.
Springhouse Review for Critical Care Nursing Certification,4th Edition, is a
great resource for your successful completion of the CCRN examination.
Furthermore, it’s a valuable aid for critical care nurses in general and espe-
cially for those new to critical care nursing. As you prepare for the exami-
nation, remember to study with the assurance that this resource will en-
hance your growing expertise. Achieving CCRN certification will be a
proud moment in your career, one I hope will add to your conviction about
the value of critical care nursing. Share your achievement and encourage
others to take the examination. Use your new self-confidence to get in-
volved in your professional associations and continue learning. I can think
of no greater service to our society than caring for the critically ill.
Joanne R. Duffy PhD, RN, CCRN
Associate Professor
The Catholic University of America
Washington, D.C.