Analyzing traditional and accelerated nursing student exam answer changing behaviors: A retrospective study.

OBJECTIVE: This study examined differences in exam answer changing behavior among baccalaureate students based on program pace, semester in the program, exam scores, and grade point average. DESIGN: The study is a retrospective review of quantitative data. SETTING: The data was collected using standardized testing results taken by students at a private, liberal arts university in the midwestern United States. PARTICIPANTS: 774 normed standardized nursing exams were reviewed retrospectively for number and type of answer changes and analyzed between traditional and accelerated baccalaureate students early, middle, and late in the curriculum. RESULTS: Most answer changes (50%) were beneficial to grades. Answer changing decreased late in the program. Students scoring higher changed fewer answers. Program pace and grade point average did not influence answer changing. CONCLUSION: Answer changing should not be generally discouraged. Promoting adequate preparation and test taking skills may benefit nursing students, especially early in programs.

Identification and Management of Acute Cardiac Tamponade.

Although incidence is rare, acute cardiac tamponade (CT) is a cardiovascular condition often resulting in a high mortality rate. In acute CT, rapid accumulation of fluid occurs in the pericardial sac and prevents the heart's chambers from adequately filling with blood, leading to reduced diastolic filling, diminished stroke volumes, and subsequent hemodynamic instability. Health care providers should be aware of at-risk patients and the earliest signs and symptoms because an acute CT is considered a medical emergency.

Identifying Barriers to Hospitalized Patients' Participation in a Free Smoking Cessation Support Program.

Hospitalized patients who smoke were surveyed to determine per- ceived barriers to participation in a smoking cessation support pro- gram. Identification of barriers allows.healthcare teams to develop support programs that maximize participation.

Care of the patient with pulmonary arterial hypertension.

Patients presenting with pulmonary arterial hypertension (PAH), the rarest of the groups of pulmonary hypertension diagnoses, are infrequently seen in the critical care arena. However, when patients with PAH present in the intensive care unit, it is generally related to an exhaustion of treatments. This article focuses on the current state of the literature addressing the group designation, pathophysiology, symptom expression, and treatment modalities of the patient with PAH.

Development of a Conceptual Model for Smoking Cessation: Physical Activity, Neurocognition, and Executive Functioning.

PURPOSE: Considerable research has shown adverse neurobiological effects of chronic alcohol use, including long-term and potentially permanent changes in the structure and function of the brain; however, much less is known about the neurobiological consequences of chronic smoking, as it has largely been ignored until recently. In this article, we present a conceptual model proposing the effects of smoking on neurocognition and the role that physical activity may play in this relationship as well as its role in smoking cessation. METHODS: Pertinent published peer-reviewed articles deposited in PubMed delineating the pathways in the proposed model were reviewed. RESULTS: The proposed model, which is supported by emerging research, demonstrates a bidirectional relationship between smoking and executive functioning. In support of our conceptual model, physical activity may moderate this relationship and indirectly influence smoking behavior through physical activity-induced changes in executive functioning. CONCLUSIONS: Our model may have implications for aiding smoking cessation efforts through the promotion of physical activity as a mechanism for preventing smoking-induced deficits in neurocognition and executive function.

Free-living physical activity characteristics, activity-related air trapping and breathlessness, and utilization of transtheoretical constructs in COPD: A pilot study.

OBJECTIVE: Many patients with Chronic Obstructive Pulmonary Disease (COPD) experience air trapping at rest and during exercise. This study examined the relationship between air trapping and air hunger breathlessness during acute physical activity (PA) engagement. In addition, we examined free-living movement patterns of COPD patients, as well as their utilization of psycho-behavioral factors known to influence PA behavior. METHODS: Ten current or former smokers with COPD (M age=70 years) participated. Baseline pulmonary function measurements were gathered and participants completed a graded exercise test (2, 2.5, and 3 mph; 5 min each). At each stage, air hunger breathlessness was rated using the Multidimensional Dyspnea Profile (MDP). Inspiratory capacity (IC) measurements were also collected to monitor air trapping. Data regarding PA and sedentary behavior was measured over 7 days using accelerometry. RESULTS: The results (mean [SD]) showed air trapping during exercise. IC levels across baseline and the 3 stages, respectively, were 1.66 (.62) L, 1.33 (.52) L, 1.35 (.58) L, and 1.28 (.57) L. A significant difference occurred between baseline and stage 1 (p=.01). Coincident low-to-moderate air-hunger breathlessness was observed across baseline and the 3 stages (Likert scale 0-10): 0.44 (1.01), 1.44 (2.12), 2.33 (2.59), and 2.67 (2.64). Participants utilized few PA-related psycho-behavioral strategies and spent the majority (67.4%) of their waking hours in sedentary behavior, while only engaging 5 min a day of moderate intensity PA and 0 min at vigorous-intensity PA. CONCLUSIONS: These COPD patients were intolerant to low levels of exercise intensity, resulting in little PA engagement, and also utilized few PA-related psycho-behavioral strategies.

Exercise and cognitive function: a randomized controlled trial examining acute exercise and free-living physical activity and sedentary effects.

OBJECTIVE: To simultaneously examine the effects of acute exercise intensity and free-living physical activity and sedentary behavior on cognitive function in young, healthy adults. PATIENTS AND METHODS: Using a counterbalanced, crossover, randomized controlled design, 87 young adults (mean age, 21.4 years) completed various cognitive assessments with and without an acute bout of exercise preceding the assessment. Participants were randomized into 1 of 4 groups to complete a 30-minute bout of acute exercise: control (no exercise), light intensity (40%-50% of predicted maximum heart rate [HR(max)]), moderate intensity (51%-70% of predicted HR(max)), or vigorous intensity (71%-85% of predicted HR(max)). Subjectively and objectively determined (accelerometry) physical activity and sedentary behavior were assessed to examine the association between these free-living behaviors and cognitive function. The study duration was August 26, 2013, to September 11, 2014. RESULTS: Concentration-related cognition (mean ± SD Feature Match test score) was significantly higher after a 30-minute acute bout of moderate-intensity exercise (145.1±26.9) compared with cognitive assessment without exercise (121.3±19.2; P=.004). Furthermore, questionnaire-determined sedentary behavior was inversely associated with visual attention and task switching (Trail Making Test A score) (ß=-0.23; P=.04). Last, estimated cardiorespiratory fitness (volume of maximum oxygen consumption) was positively associated with reasoning-related cognitive function (Odd One Out test score) (ß=0.49; P=.05); when adding metabolic equivalent of task minutes per week to this model, the results were not significant (ß=0.47; P=.07). CONCLUSION: These findings provide some support for acute moderate-intensity exercise, sedentary behavior, and cardiorespiratory fitness being associated with executive functioning-related cognitive function in young, healthy adults.

Care of the patient with an acute pulmonary embolism.

There are evidence-based prevention strategies known to reduce the risk of pulmonary embolism formation. However, pulmonary emboli remain a leading cause of death in critically ill patients with a 3-month mortality of 10% to 15%. This article addresses patients' risk factors, pulmonary embolism prevention strategies, clinical manifestations, and treatment modalities the interdisciplinary team should understand.

Physical activity and nicotine dependence among a national sample of young U.S. adults who smoke daily: evaluation of cross-sectional and longitudinal associations to determine which behavior drives this relationship.

The association between nicotine dependence and physical activity (PA) is relatively unknown. No study has concurrently examined the cross-sectional and longitudinal associations between PA and nicotine dependence, which was the primary purpose of this study. A secondary purpose was to examine how well nicotine dependence and PA behavior track over a two-year period. Data from the 2003-2005 National Youth Smoking Cessation Survey (NYSCS) were used, with young adults (18-24 yrs; n=1168) being followed over a two-year period. Physical activity was assessed using a questionnaire and nicotine dependence was assessed using the modified Fagerstrom Test for Nicotine Dependence scale. This study identified three notable findings: 1) baseline PA and nicotine dependence demonstrated a bidirectional, cross-sectional association (e.g., ß=-0.23; 95% CI: -0.44 to -0.02; p=0.02); 2) when examined longitudinally, nicotine dependence influenced PA (OR=0.90; 95% CI: 0.82-0.99; p=0.04), but there was no evidence of the reverse pathway (i.e., PA influencing 2-year follow-up smoking status [OR=0.95; 95% CI: 0.66-1.39; p=0.82) or nicotine dependence (ß=0.05; 95% CI: -0.14 to 0.24, p=0.61]); and 3) both PA (OR=3.52, 95% CI: 2.68-4.69; p<0.001) and nicotine dependence (ß=0.52; 95% CI: 0.46-0.58, p<0.001) tracked relatively well over a two-year period during early adulthood. These findings suggest that both behaviors (physical activity and nicotine dependence) track over time, but nicotine dependence appears to be driving the cross-sectional relationship between nicotine dependence and physical activity, as opposed to the reverse pathway.

Physical activity moderates the association between nicotine dependence and depression among U.S. smokers.

PURPOSE: Research demonstrates that nicotine dependence and depression are associated and that physical activity is effective in reducing depression symptoms. However, our understanding of the potential beneficial effects of physical activity on depression in current smokers is more limited. The purpose of this study was to examine whether physical activity moderates the association between nicotine dependence and depression in U.S. smokers. DESIGN: Cross-sectional. SETTING: National Health and Nutrition Examination Survey 2005-2006. SUBJECTS: Four hundred forty-one current adult smokers. MEASURES: Participants wore an accelerometer for at least 4 days and completed questionnaires to assess nicotine dependence and depression. ANALYSIS: Effect modification and statistical interaction models were used. RESULTS: Both models were significant. With regard to the statistical interaction model, and after controlling for age, gender, race/ethnicity, education, comorbidity index, homocysteine, cotinine, total cholesterol, sedentary behavior, and vitamins C, D, and E, objectively measured physical activity moderated the association between nicotine dependence and depression (interaction variable: odds ratio = 3.43; 95% confidence interval: 1.02-11.51; p = .04). CONCLUSION: In this national sample of current smokers, physical activity moderated the association between nicotine dependence and depression. These results suggest that those individuals with nicotine dependence and who are less physically active are more likely to be depressed than what would be expected on the basis of the individual effects of nicotine and physical inactivity separately.

Association between physical activity and major depressive disorder among current or former smokers with pulmonary disease.

OBJECTIVE: To examine the association between physical activity and major depressive disorder (MDD) in a nationally representative sample of current or former smokers with pulmonary impairments. METHODS: The analyzed sample from the National Health and Nutrition Examination Survey (NHANES) 2007-2010 included 536 adults who indicated that they were current or former smokers, had at least mild pulmonary impairment (FEV1/FVC<0.70), and provided depression and physical activity data. RESULTS: After controlling for asthma status, pulmonary impairment, age, poverty-to-income ratio (PIR), education, gender, marital status, body mass index (BMI), cotinine, comorbidity index, race-ethnicity, and smoking status, those who met physical activity guidelines had a 59% (odds ratio (OR)=0.41; 95% confidence interval (CI): 0.18-0.94) lower odds of having MDD. Using multivariate linear regression with depression symptoms as the outcome variable, and after adjustments, physical activity was inversely associated with depression symptoms in a dose-response manner; lowest tertile was the referent group, middle tertile coefficient: -1.06 (95% CI: -1.98 to -0.14), and highest tertile coefficient: -1.10 (95% CI: -1.84 to -0.34). CONCLUSIONS: Physical activity inversely associates with MDD in adults with pulmonary impairments, and does so in a dose-response manner. This suggests that individuals with pulmonary impairments should be encouraged to engage in enjoyable, safe forms of physical activity in a progressive manner.

Do nicotine intake and acute heart rate response to smoking rank nicotine dependence the same?

In this study, two proposed scales of nicotine dependence were compared: self-administered nicotine intake and acute heart rate sensitivity to smoking. Our aim was to determine if these nicotine dependence scales would rank relative dependence the same in a sample of 15 male chronic smokers who smoked their first cigarette in the morning after overnight abstinence. Heart rate and plasma nicotine levels were measured before and 5, 10, 15, and 30 min after smoking. The results of this pilot study suggest that heart rate sensitivity and nicotine intake do not have a direct linear relationship, but rather a curvilinear relationship. A marked increase in heart rate sensitivity was observed at approximately the 70th percentile of nicotine intake.

Chest tubes in the critically ill patient.

This article is meant as a review for critical care nurses caring for patients with chest tubes. The types of chest tubes, equipment needed, types of chest drainage systems, chest tube placement and setup, nursing care, chest tube removal, and complications will be discussed.

Caring for the critically ill patient with tuberculosis.

Pulmonary tuberculosis is still a major health problem in the United States as well as around the world. The purpose of this article is to provide critical care nursing staff as well as other healthcare providers with a foundation to recognize and manage patients with pulmonary tuberculosis. Topics discussed include etiology, risk factors, pathophysiology, multidrug-resistant tuberculosis, extrapulmonary tuberculosis, signs and symptoms, diagnostic testing, and the role of the critical care nurse in the management of these patients.

Understanding the alphabet soup of mechanical ventilation.

Invasive mechanical ventilation has evolved from a fairly simplistic, basic machine with just a few knobs into an exceedingly complicated, microprocessor-based life support system. This article sorts out the "alphabet soup" concerning mechanical ventilation and focuses on invasive procedures.

Trends in caring for adult respiratory distress syndrome patients.

Acute respiratory distress syndrome is considered the most severe form of acute lung injury resulting in high morbidity and mortality. This syndrome is characterized by noncardiogenic pulmonary edema, diffuse pulmonary infiltrates, and hypoxemia refractory to oxygen delivery. Critical care nurses should be aware of newer treatment modalities available for patients with acute respiratory distress syndrome.