CCRN-K (Adult) flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Clinical judgment definition

The observed outcome of critical thinking and decision making: a nurse notices cues, interprets them, responds with an action, and reflects on the result. The exam asks which step a described behavior represents.

Mean arterial pressure formula

MAP equals systolic pressure plus twice the diastolic pressure, divided by three. A value below 65 mmHg indicates inadequate organ perfusion in most adults and requires prompt intervention.

Narrowing pulse pressure meaning

A falling difference between systolic and diastolic pressure can indicate rising intracranial pressure, cardiac tamponade, or severe hypovolemia. It is a trend finding, not a normal variant, in a deteriorating adult.

Oliguria threshold

Urine output below 0.5 mL per kilogram per hour for two consecutive hours in an adult suggests hypoperfusion or early acute kidney injury and should be reported rather than attributed to positioning.

qSOFA bedside criteria

Three bedside sepsis red flags: respiratory rate 22 or higher, altered mentation, and systolic blood pressure 100 mmHg or lower. Two or more positive criteria in a patient with suspected infection warrant escalation.

SOFA score meaning

A six-organ dysfunction score covering respiration, coagulation, liver, cardiovascular, central nervous system, and renal function. A rise of two or more points in suspected infection defines sepsis under current consensus.

CAM delirium criteria

Requires acute onset with fluctuating course plus inattention, and then either disorganized thinking or altered level of consciousness. Hypoactive delirium presents as quiet withdrawal and is the form most often missed.

Opioid sedation reassessment

Reassess pain and sedation after IV opioids within about 30 minutes and after oral analgesics within about 60 minutes. A sedation score of three or higher or respiratory rate below ten suggests opioid-induced respiratory depression.

Trend versus single value

Deterioration is often signaled by change over time: a heart rate rise of 10, a systolic fall of 20 mmHg, or a climbing early warning score over one shift warrants a rapid response call.

Structured handoff elements

Situation, background, assessment, and recommendation, closed with a stated time frame and read-back. Closed-loop communication confirms the receiving clinician understood and accepted the plan.

Rapid response call triggers

Nurse-initiated criteria typically include acute respiratory distress, new oxygen requirement, systolic pressure below 90, heart rate outside set limits, new confusion, or staff concern. Staff concern alone is a valid trigger.

Informed consent elements

Capacity, disclosure of risks, benefits, and alternatives, and voluntary choice. The nurse verifies and witnesses consent; obtaining consent and determining the best option belong to the provider and patient.

Competent treatment refusal

A patient with decision-making capacity may refuse any treatment, including life-sustaining therapy. Document the discussion of consequences, notify the provider, and continue to provide comfort care.

Living will versus DPOAHC

A living will records treatment preferences; a durable power of attorney for health care names a surrogate decision maker. A do-not-resuscitate order is a physician order, not a family-signed document.

Substituted judgment standard

Surrogates decide as the patient would have decided, based on known values and prior statements. Best-interest reasoning applies only when the patient's wishes are genuinely unknown.

Futility conflict pathway

When the team judges a requested treatment non-beneficial, the accepted route is ethics consultation and the institution's conflict policy, or transfer of care. Unilateral withdrawal or unilateral compliance is not acceptable.

HIPAA minimum necessary rule

Only the minimum protected health information needed by those directly involved in care may be shared. Discussion in public areas, hallways, elevators, or on social media is a reportable breach.

Mandatory reporting duties

State law commonly requires reporting suspected child, older adult, or dependent adult abuse, specified communicable diseases, and impaired colleagues. The nurse reports to the designated agency, not first to the family.

Impaired colleague response

Remove the colleague from patient care to protect patients, then report through the chain of command or employee assistance program. The nurse does not privately investigate or confront the colleague alone.

Capacity versus competency

Capacity is a clinical determination made at the bedside about understanding, appreciation, reasoning, and expressing a choice. Competency is a legal status decided by a court.

Advocacy behavior example

Speaking up when the plan conflicts with the patient's stated goals, requesting clarification of orders, and escalating through the chain of command are advocacy actions scored as professional caring.

Active listening indicator

Sitting at eye level, asking open questions, summarizing the patient's words, and responding to emotion before giving information are observable caring behaviors rather than personality traits.

Nurse fatigue and safety

Fatigue impairs attention and clinical judgment comparably to alcohol. Recognizing one's own fatigue and handing off or escalating is a professional-caring and patient-safety behavior.

Chain of command use

When a concern is not resolved by the immediate provider, the nurse escalates to the charge nurse, supervisor, and attending in sequence until the concern is addressed. Delay is not an acceptable option.

Recognize cues step

The first clinical judgment step: identify relevant and irrelevant data from assessment, labs, monitors, and the patient's story, and separate expected findings from those signaling a change.

Analyze cues step

The second step: link cues to likely explanations, compare with typical patterns, and identify what else would confirm or refute each hypothesis before acting.

Prioritize hypotheses step

The third step: rank explanations by urgency and likelihood. Life-threatening possibilities are ruled out first even when a benign explanation is more probable.

Take action step

The fifth step: implement the chosen intervention, delegate appropriately, and document. Actions must match the priority problem and the nurse's scope of practice.

Evaluate outcomes step

The final step: judge whether the patient's response matched the expected outcome, and if not, re-enter the cycle rather than repeating the same ineffective action.

Ethical principle of veracity

Telling the truth to the patient, including disclosing errors that affected care. Apologizing and reporting the error is expected; concealing it to avoid distress is not.

Palliative care versus hospice

Palliative care is comfort-focused care available at any stage of serious illness alongside curative treatment. Hospice applies when life expectancy is generally six months or less and curative treatment has stopped.

Family presence during resuscitation

Institutional policy governs, but evidence supports offering a designated facilitator to accompany family who wish to be present. Family presence is offered, never required or refused categorically.