Advanced Nursing Concepts by David W. Woodruff, MSN, RN, CNS | Comprehensive Study Guide 2025 Edition

1 We will guarantee your success on the CCRN certification exam! -- If you study the right things in the right ways -- Success Checklist: □ Attend the entire CCRN: Test Prep program (or use the entire A/V package). □ Study 5 hours per week for 90 days using the handout, pocket study guide, and flash cards. □ Listen to all of the audio CDs or watch all of the video-enhanced CDROMs. □ Identify areas of weakness that need additional study. □ Review the audio CDs (or CDROMs) of the topics you identified as requiring addi- tional study. □ Participate in the Nurses’ Success Network on-line study groups and post at least one comment or question per week. Login at: www.Nurses-Success-N User: ccrn Password: excellence □ Achieve a passing grade of at least 80% on the “Challenge Exam” on-line at the Nurses’ Success Network. □ Use the on-line resources recommended in the “Challenge Exam” results. The CCRN: Test Prep is a 90-day program to guarantee your success on the certifica- tion exam. You must use this program and take the exam within 90 days of register- ing for the guarantee for us to assure your success. Register for the guarantee on-line at :www.Nurses-Success-N CCRN: Test Prep Description: This unique two-day program presents the content of the CCRN exam in a question and answer format. By the conclusion of the program the participant will have answered 150 questions in the format and distribution of the actual exam. In-depth explanations will be presented for rationale behind correct and incorrect answers, along with the theoretical underpinnings of essential concepts. This unique, informative and fun seminar is perfect for CCRN preparation, or a comprehensive critical care review. Objectives: 1. Examine strategies for successful completion of the CCRN exam. 2. Describe common hematologic and immunologic dysfunction in the critical care patient. 3. Describe the process of coagulopathy in DIC. 4. Compare and contrast common GI disorders. 5. Plan care for the patient suffering from abdominal trauma. 6. Compare and contrast septic, hypovolemic, and cardiogenic shock. 7. Describe hemodynamic changes that occur with shock. 8. Plan care for patients with cardiopulmonary disorders. 9. Compare and contrast acute and chronic renal failure. 10. Describe clinical symptoms of electrolyte disturbances. 11. Plan care for patients with electrolyte and water emergencies. 12. Explain the benefits of several treatment options for acute respiratory failure. 13. Plan care for patients with respiratory disorders. 14. Describe a simple assessment plan for patients with increased intracranial pressure. 15. Evaluate nursing interventions for increased intracranial pressure. 16. Describe common endocrine dysfunctions in the critical care patient. 17. Compare and contrast diabetic ketoacidosis and hyperosmolar, hyperglycemic syndrome. 18. Define professional and ethical nursing care using AACN definitions. All content in CCRN: Test Prep is ©2004 by Ed4Nurses, Inc. and all rights are reserved. Copying or distribution in any form is strictly prohibited by US copyright law. 8:00 Introduction and Test Overview 8:30 Hematologic / Immunologic (3%) A&P Blood Products & Plasma Organ Transplantation Life-threatening coagulopathies Immunosuppression-Acquired Sickle Cell Crisis 9:45 Break 10:00 Gastrointestinal (6%) GI Bleed Hepatic Failure Acute Pancreatitis Bowel infarction/obstruction/perforation Abdominal Trauma 11:30 Multisystem (8%) Sepsis / Septic Shock / MODS Toxic Ingestions Toxic Exposures 12:00 Lunch 1:00 Multisystem (con’t) 1:30 Cardiovascular (32%) Acute Coronary Syndromes Cardiac Inflammatory Disease Conduction System Defects Acute Heart Failure & Pulmonary Edema Aortic Aneurysm Pericarditis 2:15 Break 2:30 Cardiovascular (continued) Cardiac Trauma Hypertensive Crisis Shock 4:30 Adjourn DAY 2 8:00 Renal (5%) Acute & Chronic Renal Failure Renal Trauma Electrolyte Imbalances 9:00 Pulmonary (17%) Acute Respiratory Failure Pulmonary Pharmacology 9:45 Break 10:00 Pulmonary (con’t) ARDS Pneumonia Pulmonary Embolus, Fat Embolus Asthma / COPD Chronic Lung Disease Thoracic Trauma / Thoracic Surgery 12:00 Lunch 1:00 Neurologic (5%) Aneurysm Encephalopathy Stroke (ischemic, hemorrhagic) Intracranial Hemorrhage Seizures Head Trauma Neurosurgery / ICP Monitoring 2:00 Break 2:15 Endocrine (4%) Diabetes Insipidus Diabetes Ketoacidosis & Hyperosmolar Coma Acute Hypoglycemia Hormones and Endocrine A&P 3:00 Professional Caring and Ethical Practice (20%) Advocacy Collaboration Caring Practice 4:00 Adjourn Today’s speaker: David W. Woodruff, MSN, RN, CNS David began his healthcare career as a paramedic. After years of treating patients “in the field”, David obtained his nursing degree. His extensive experience includes trauma nursing at a level-I trauma center, and staff positions in Neurological, Coronary, Medical and Surgical Intensive Care Units. David holds a Master’s degree in Adult Health nursing and is a Clinical Nurse Specialist in Critical Care Nursing. He is a member of AACN, The Society of Critical Care Medicine, and Sigma Theta Tau. He has served as an Instructor of Nursing, Unit Manager, Nursing Expert Witness, and President of a private nursing consulting firm. David presents seminars throughout the country on a variety of topics including critical care and medical-surgical nursing, and has published articles in Nursing, RN, and Image. He is widely regarded as a knowledgeable and thorough instructor who can make even the most difficult content material understandable. I would be happy to hear from you and answer any additional questions you may have. Feel free to contact me at: Phone: (330) 467-2629 e-mail: web: Introduction and Test Overview 1. Why Become Certified? A study conducted by the Nursing Credentialing Research Coalition found that certification has a profound impact on the personal, professional and practice outcomes of certified nurses. Overall, nurses in the study stated that certification enabled them to experience fewer adverse events and errors in patient care than before they were certified. Additional results revealed that certified nurses: • expressed more confidence in detecting early signs of complications; • reported more personal growth and job satisfaction; • believed they were viewed as credible providers; • received high patient satisfaction ratings; • reported more effective communication and collaboration with other health care providers; and • experienced fewer disciplinary events and work-related injuries. 2. What is “CCRN”? a. Registered service mark of AACN. b. Credential for certified critical care nurses. 3. What to Expect from “The Test” AACN – Certification Corporation Fees: $300 non-member $220 member of AACN Test dates: Year-round Requirements: RN license 1750 hours of clinical experience with acute and critical care patients within the previous 2 years (875 within the past year). Exam is computer-based, 150 questions, with a 3-hour time limit Paper-based testing is offered at the NTI Certification is for 3 years. Recertification can be by CERPs or re-testing. Cost of recertification is: $250 non-member, $170 member 4. Testing Dates, Places and Times AACN Certification Corporation 101 Columbia Aliso Viejo,CA Phone: (800) 899-2226 E-mail: Web: Applied Measurement Professionals Inc. (AMP) 8310 Nieman Road Lenexa, KS Phone: (800) 345-6559 Fax: (913) 541-0156 Business Hours: 8:30 am - 5:00 pm CST Monday-Friday E-mail: Web: Over 100 testing centers nationwide 5. What to bring with you: a. Photo ID i. Driver’s license ii. State ID card iii. Military ID card b. Second ID without photo c. Do not bring any personal items with you d. Please Note: This is a focused 90-day program designed to assure your success on the ANCC Med- Surg certification exam. You must register for the guarantee and complete the “Certification Checklist” within 90 days to be eligible for the guarantee. Hematologic / Immunologic (3%) 4 questions 1. The nurse is caring for a 32-year-old experiencing organ rejection after a kidney transplant. Which of the following signs will the patient exhibit? a. Decreased BUN/Creatinine b. Increased transaminase level c. Increased urine output d. Increased BUN/Creatinine 2. A primary chemical mediator in anaphylactic reaction is? a. Myocardial Depressant Factor b. Histamine c. Complement d. Interferon 3. Which of the following laboratory diagnostic findings will most likely be seen in DIC? a. PT and PTT prolonged b. Fibrinogen increased c. Platelet count increased d. D-dimer normal 4. The beneficial effects of heparin in DIC are thought to be due to its: a. Stimulating effect on platelet manufacture b. Neutralizing of free-circulating thrombin c. Antifibrinolysin activity d. Inhibition of platelet factor XII release Hematology 1. Functions: a. Medium for transport of O2 and CO2 and nutritients b. Maintains hemostatsis c. Maintains internal environment d. Immune e. Inflammation f. Stress Response i. Impaired skin barrier or irritated mucous membrane ii. Impaired gag, cough or swallow iii. Increased gastric pH, colonization = aspiration iv. Acute Stress Reactions 1. Catabolism 2. Decreased healing 3. Inhibit immune response 4. Inflammatory Response g. Hemostasis i. Termination of bleeding ii. Vascular response iii. Platelet response iv. Coagulation 1. Platelets 2. Thrombocytopenia 3. HITT response Disseminated Intravascular Coagulation (DIC) 1. Definition 2. Factors Triggering DIC 3. Etiology: a. Bleeding b. Trauma c. Sepsis d. Abrupto Placenta 4. Clinical Presentation a. Bleeding b. Signs of Thrombosis c. Clinical Presentation i. Petechiae ii. Ecchymosis iii. Purpura d. Labs in DIC i. Platelets ii. PTT iii. PT iv. Fibrinogen v. FDP/FSP vi. D-dimer vii. Antithrombin III 5. Medical Management a. Maintain ABC’s b. Careful or oral and mucosal bleeding c. Treat stimuli d. Correct hypovolemia, hypotension, hypoxia, and acidosis e. Stop microclotting to maintain perfusion f. Stop Bleeding g. Stop Thrombosis h. Administer IV Heparin i. Plasmapheresis j. Nursing Management k. Nursing Care of the Bleeding Patient l. Blood Products i. Risks of transfusion ii. PRBC’s iii. Platelets iv. FFP v. Cryoprecipitate vi. Adverse Reactions 6. Complications of DIC a. Mortality b. Hypovolemic Shock c. Acute Renal Failure d. Infection e. Acute Respiratory Distress Syndrome f. Stroke g. GI dysfunction 7. Nursing a. Administer Vitamin K and Folic Acid b. Treat Ischemic Pain c. Maintain skin integrity Acquired Immunodeficiency Syndrome (AIDS) 1. Etiology a. HIV, CD4 retrovirus b. High-risk groups i. High-risk sexual behavior ii. Infected sex partners iii. IV drug users iv. Recipients of blood products before 1985 c. Pathophysiology i. Invasion and destruction of T4 (helper) cells ii. Incubation 6 months to 10 years iii. Decreased immune response iv. Opportunistic infection 2. General principles for management a. Universal precautions b. Protect from infection c. Inflammatory response will be muted Transplantation Criteria for organ transplantation 1. Recipient criteria a. End-stage organ disease b. Absence of: i. Infection ii. Malignancy iii. Other failing organs iv. Substance abuse 1. Donor criteria a. Free of sepsis, cancer, prolonged hypotension b. Free of communicable disease Anti-rejection medications Drug Major Effects Side Effects Corticosteriods ↓ Inflammation ↑ Risk of infection GI bleed Hyperglycemia Adrenal suppression Cyclosporine ↓ Immune and inflammatory responses Potentiates other immunosuppressives Hepatotoxicity Nephrotoxicity Hyperkalemia Hypomagnesemia ATgam (antithymocyteglobulin) Reduces T-cell production ↑ Risk of infection Thrombocytopenia Imuran (azathioprine) ↓ Immune response ↑ Risk of infection Oral and gastric erosion Hepatotoxicity OKT3 (muromonab-CD3) Alters T-cell recognition of antigens ↑ Risk of infection Symptoms of infection ↓ WBC, platelet levels Prograf (tacrolimus) ↓ Inflammatory response GI distress HTN, chest pain Hyperkalemia Hypomagnesemia Nephrotoxicity Hepatotoxicity CellCept (mycophenolate) ↓ Immune response GI distress ↓ WBC, platelet levels Hypertension Hypokalemia 1. General patient care a. Support transplanted organ i. Heart Transplant ii. Lung iii. Liver iv. Pancreas v. Kidney b. Watch for signs of infection i. May be  due to  immune response Leukemia’s Acute Incidence Characteristics Acute Lymphocytic (ALL) Acute Myelogenous (AML) Age 2-4 Age 12-20 Anemia, Bleeding, Infection, ↓ RBC, H&H, ↑ WBC, Joint and bone pain Chronic Incidence Characteristics Chronic Lymphocytic (CLL) Chronic Myelogenous (CML) Age 50-70 Age 30-50 ↑ WBC, ↓ RBC, Enlarged spleen, Hepatomegaly, Swollen glands a. Diagnostics i. Bone marrow aspiration b. Treatment ii. Chemotherapy iii. Stem cell transplant iv. Transfusion 3. Multiple Myeloma a. Plasma cells invade bone marrow, and lymph system b. Bones become weak and painful c. Diagnostics i. X-rays ii. Bone marrow aspiration iii. Hypercalcemia d. Treatment i. Chemotherapy ii. Interferon iii. Bone marrow transplantation iv. Plasmapheresis v. Management of Hypercalcemia 4. Non-Hodgkin’s Lymphoma a. Malignant neoplasm of the lymphatic system b. Results in overgrowth of premature and ineffective cells c. Diagnostics i. Fever, swollen glands, night sweats, weight loss d. Treatment i. Chemotherapy ii. Radiation therapy iii. Stem cell transplant Sickle-Cell Crisis 1. Etiology a. More common in black males b. Presence of Hemoglobin S 2. Precipitating factors a. Dehydration b. Stress or strenuous exercise c. Infection d. Fever e. Bleeding f. Acidosis g. Hypoxia (smoking) h. Cold weather i. Pregnancy 3. Presentation a. Bone crisis i. Long bone pain b. Acute chest syndrome i. Chest pain ii. Dyspnea iii. Tachycardia iv. Bloody sputum v. Pulmonary fibrosis c. Abdominal crisis i. Sudden, constant abdominal pain ii. Not usually associated with N/V/D d. Joint crisis i. Stiff, painful joints e. Jaundice, bruising, blood in urine may occur with any 4. Management a. Oxygen b. Fluids c. Folic acid d. Hydroxyurea (Hydrea) e. Pain control i. Mild: Tylenol or NSAIDs ii. Moderate: Codeine, Oxycodone iii. Severe: Morphine, Dilaudid f. Transfusion 5. Complications a. Renal dysfunction b. Stroke c. Blindness d. Infection (spleen becomes clogged) Gastrointestinal (6%) 9 questions 1. Nursing interventions for the patient with hepatic failure include: a. Restrict protein in diet b. Avoid use of narcotics, sedatives and tranquilizers c. Administer lactulose and neomycin d. All the above 2. The most common cause of upper GI bleeding is: a. Peptic ulcer disease b. Esophageal varices c. AV malformation d. Gastric tumor 3. Octreotide is often used to control bleeding from esophageal varices. The primary action of Octreotide is to: a. Increase platelet aggregation b. Increase clotting factors c. Decrease venous return d. Decrease blood flow 4. The administration of vasopressin should be most carefully monitored in patients who have: a. Diabetes Insipidus b. Coronary artery disease c. Hypotension secondary to GI bleed d. Diabetes Mellitus 5. The inability of the liver to conjugate what substance is the primary contributor to hepatic coma? a. Ammonia b. Urea c. Fatty Acids d. Bilirubin 6. Ecchymosis around the umbilicus indicative of peritoneal bleeding is called a. Chvostek’s sign b. Grey Turner’s sign c. Cullen’s sign d. Trousseau’s sign 7. Pulmonary complications of acute pancreatitis may include: a. Adult Respiratory Distress Syndrome b. Elevation of the diaphragm and bilateral basilar rales c. Atelectasis, especially of the left base d. All of the above 8. Which of the following laboratory findings is most specific for pancreatitis? a. Leukocytosis b. Elevated serum and urinary amylase c. Hyperglycemia and hypokalemia d. Decreased serum albumin and total protein 9. Another diagnostic finding seen in the patient with pancreatitis would include: a. Increased Hct b. Hypocalcemia c. Hyperalbuminemia d. Decreased potassium