NR 340
NR 340 Evolve Specialty Exam (ESE) Study Guide
NR 340 Evolve Specialty Exam
NR 340 Evolve Specialty
NR 340 Evolve Specialty Exam (ESE)
... [Show More] Study Guide
Instructions: The contents on this guide are intended to help you organize your preparation for the Evolve Specialty Exam (ESE) for NR340. This is not intended to serve as a direct reflection of the exact questions that will be presented in the exam. As you review the topics listed below, be sure that you can
1. understand the pathophysiology;
2. identify the appropriate assessment skills;
3. interpret the appropriate lab or other diagnostic findings;
4. develop a safe and competent plan of care with rationale;
5. associate the nursing implications with the appropriate medications or other treatments;
6. teach the rationale for all the above; and
7. prioritize especially r/t interventions and use of the nursing process.
Medication Calculations r/t IV (mg/min to ml/hour; mcg/ml, etc.)
Cardiovascular
• Angina—MI (with rationale)
o Assessment
o Diagnostics
o Interventions with rationale, including the effect of the Valsalva maneuver
o Teaching with rationale
o Critical medications: Vasopressin, TNG, Dopamine, Thrombolytics, MSO4 (positive effects with AMI? Rationale –NCLEX question!)
o Rationale for increasing perfusion as a priority for AMI
• Heart failure
o Common cause(s)
o Distinguish right from left failure
o Diagnostics
o Interventions with rationale
• Hypertensive crisis
o Assessment
o Interventions with rationale
o IV medications and implications: Rationale and cautions for medications below
Thiazide diuretic
Potassium-sparing diuretic
Cardiac glycoside
Inotropic agent (Why is it called vasodilator?)
Beta-blocker
ACE inhibitor
Angiotensin-receptor blocker
Calcium-channel blocker
Nitroprusside (Nipride)
o Complications
o Teaching with rationale
o Dysrhythmia identification
o Relationship of electrical images to underlying anatomy
o Effect on cardiac output
o Appropriate assessments and teachings r/t the above
o Diagnostics including laboratory work
o Modalities for management
o Use of Heparin versus Coumadin (including labs r/t dosing, antidotes, safety issues, and teaching)
• Cardiac therapeutic modalities
o Intra-aortic balloon pumps
o Pacemakers: transcutaneous pacemakers
Care of client with newly inserted pacemaker, including teaching
o Cardioversion
Emergency versus scheduled with rationale
Medications
o Defibrillation
Assessment
Medications
Insertable for long-term use
• Shock
o Identification of those at risk
o Types with rationales
o Management for each type with understanding of rationales
o Assessment
o Stages with rationales
o Interventions with rationales
o Administration of blood products
Differentiation of product use (with rationales)
Precautions of each
Nursing precautions and interventions
Protocol for administration (hanging)
• DIC
o Identification of those at risk
o Diagnostics
o Assessment
o Interventions with rationales
• CPR
o Assessment with rationale
o Procedure with rationale
• Multiple organ dysfunction syndrome (MODS)
o Identification of those at risk
o Diagnostics
o Assessment
o Interventions with rationales
• Systemic inflammatory response syndrome (SIRS)
o Identification of those at risk
o Diagnostics
o Assessment
o Interventions with rationales
• Hemodynamics
o PA catheter
Insertion
Assessment
Interpretation of information (rationale)
o Mean arterial pressure (MAP)
Assessment
Interpretation of values (rationale)
o Cardiac output
Assessment
Interpretation of values (rationale)
o CVP
Insertion
Assessment
Interpretation of values (rationale)
Heart and Other Organ Transplant
• S&S of rejection
• Antirejection drugs
• Treatment with rationales
• Types of cardiomyopathy
o Pathophysiology
o Causes
o S&S
o Treatment with rationales
Respiratory
• ARDS
o Causes (use rationales to understand the reason for the causes!) [Both adult and children]
o Pathophysiology r/t alveolar hypoventilation and ventilation-perfusion mismatch
o Assessment
Right to left shunting
Early indicators
Late indicators
o Interventions with rationales including, but not limited to, the following
Oxygen therapy
Mechanical ventilation
Patient position
Corticosteroids
Fluid therapy
Anxiety reduction
Nutritional support
Correction of hypoxemia
Correction of hypercapnia
Bronchodilators
o Interpretation of ABGs
Process for safely drawing ABGs (Allen’s test)
o Ventilator care
Assessments
Interpretation of alarms (rationale)
ET tube placement
Suctioning
• Procedure
• Safety issues with rationale
• Precautions with rationale
• Teaching (hospital vs. home procedure)
o Chest tubes
Insertion
Assessment
Interventions (including supplies needed and safety with rationale)
Risks
Neurological
• ICP
• Calculation of ICP; CCP
• Factors that increase ICP
• Assessment, including application of Glasgow Coma Scale
• Nursing interventions to reduce ICP
• Management of CSF leak
• Use of osmotic diuretic
• Using rationales, describe the use of the following for patients with ↑ ICP.
1. Sedatives
2. Antipyretics
3. Analgesics
4. Stool softeners
5. Corticosteroids
6. Antihypertensives
7. Loop diuretics
8. Anticonvulsants
9. Calcium channel blockers
10. Triple H therapy
11. Hypothermia
• Subarachnoid hemorrhage (SAH)
o Pathophysiology
o Major warning sign(s)
o Causes of bleed (include EDH and SDH)
o Management with rationale
• Skull fractures
o Diagnostics and treatments with rationale
o Rationale as contraindication for thrombolytic therapy
• CVA: hemorrhagic versus ischemic
o Diagnostics and treatments with rationale
o Rationale as contraindication for thrombolytic therapy
• Spinal cord injury (SCI)
o Pathology of injury
o Assessment (with rationale)
o Phases of management with concentration on teaching using rationales
• Acute phase
• Rehabilitative phase
Burns
Types
Severity (rationale)
Assessment of burns
Rule of nines
Lund and Browder (do not need to memorize the chart; choice for children)
Stages (with rationale)
Nursing assessment
Interventions per stage (rationale)
Antimicrobial agents
Pancreas & Liver
Types
Cirrhosis
Acute liver failure
Hepatic encephalopathy
Pancreatitis
Assessment findings
Diagnostics
Treatments
Acute GI/GU/Renal
Acute GI Bleeding
Causes
Assessment
Diagnostics
Treatment, including management of colon resection
Peritonitis
Causes
Assessment
Diagnostics
Treatment
Acute renal failure (ARF)
Assessment
Differentiate prerenal, intrarenal, and postrenal
Interventions with rationale
Management of elevated K+
Chronic renal failure (ESRD)
Assessment
Interventions with rationale
Dialysis
Pharmacologic therapy
Management of elevated K+
Acute Endocrine Dysfunctions
Types
Adrenal insufficiency
Diabetic ketoacidosis (DKA)
HHNS
SIADH/DI
Causes
Assessment with rationale
Diagnostics
Treatment with rationale
Developed by J. Driscoll: 03-22-2010; 03-25-10 [Show Less]