BKAT ICU Post Test-with 100 verified solutions.docx, Exams of Nursing

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BKAT ICU Post Test-with 100% verified

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decreases preload and afterload by vasodilation (mainly afterload) Dobutamine mechanism of action contractility Dopamine at a low-end dose "renal dose" 0.5-4mcg/kg/min increases renal and mesentric perfusion Dopamine at a mid-range dose 4-10mcg/kg/min increases contractility and heart rate Dopamine at a high-range dose greater than 10mcg/kg/min vasoconstriction and increases BP Dopamine and Levophed infiltration leads to tissue necrosis Dopamine antidote regitine (phentolamine) TpA monitor for bleeding-hemorrhagic CVA

diltiazem (cardizem) works by? (calcium channel blocker) slows ventricular rate by slowing conduction through the SA and AV node Diltazem (cardizem) biggest effect on which hemodynamic hypotension diltazem is used for patients with a-fib or a-flutter amiodarone (Cordarone) is a antiarrythmic prolongs the cardiac duration You MUST use a when using amiodarone infusion 0.22 micron filter Watch out for in patients on a amiodarone infusion hypotension, prolongation of QT interval and bradycardia amiodarone is used for patients with a-fib, a-flutter and VT how much amiodarone is given to a stable VT with a pulse and a unstable pulseless VT/VF? 150mg over 10min for VT with pulse 300mg push; repeat x1 at 150mg Epinephrine has what effect on the body? increases HR, BP, and contractility what is the first line drug for pulseless arrest?

Epinephrine What rhythms are considered fatal? V-fib, Vtach (pulseless), and asystole Epinephrine is also given for? anaphylaxis and as a vasopressor for hypotension Heparin is used for? Antidote is? anticoagulant Protamine Sulfate What is the osmotic diuretic of choice to decrease intracranial pressure? mannitol How does mannitol work? pulls fluids into intravascular space to be excreted by the kidneys to reduce intracranial pressure what insulin is given IV? What is the peak? Regular insulin can only be given IV 2-4 hr peak time Which insulin has a peak of 8-14 hrs? NPH Atropine is ineffective in which heart rhythms types? high degree AV blocks: 2nd degree type2 and 3rd degree Atropine works by?

increasing heart rate-increasing conduction through SA node Atropine is given to treat? symptomatic bradycardia Dilantin is given to treat seizure disorders DO NOT give with dilantin because will happen. DO NOT give with dextrose containing solutions because it will crystalize Which corticosteroid is usually given in insufficient adrenal activity or hypersensitivity/inflammation reactions? Cortisone If chronically using cortisone be sure to to prevent. If chronically using cortisone be sure to taper the medications to prevent acute adrenal insufficiency This medication is a cardiac glycoside that increases contractility. Digoxin Digoxin increases contractility by slowing the heart rate which decreases conduction through the AV node What should be monitored in patients taking Digoxin? hypotension, bradycardia, and symptoms of toxicity Signs/Symptoms of Digoxin toxicity nausea, yellow vision/halo, paroxysmal atrial tachycardia (PAT with block). True/Flase:

Digoxin WILL NOT cause rapid AV conduction or hypertension True what medication is a antiarrhythmic that suppresses automaticity and depolarization? lidocaine Lidocaine is used to treat? ventricular dysrhythmias lidocaine toxicity sign mental confusion/change in LOC Monitor serum levels with Lidocaine DO NOT give medications to patients with suppressed respirations Narcotics (morphine, dilaudid) What changes on a EKG would you expect to see on a patient with a acute MI? ST elevation normal QRS: Prolonged QRS indicates: <0.12 seconds is normal QRS prolonged QRS indicates intraventricular conduction defect, typically a bundle branch block

Distinguishing V-fib fibrillatory waves with no recognizable pattern Defib the Vfib Distinguishing V-Tach atrial rhythm and rate cannot be identified "Tombstones" First degree block interpretation looks like sinus rhythm but the PR is longer than normal. there will be 1 p for every qrs, but the PR interval will be greater than 0.20 sec Type 1 second degree block interpretation "Wenckebach" "Longer, Longer... drop" prolonged PR intervals and the missing QRS Type 2 second degree block interpretation PR interval is constant...QRS is missing "2 small p waves right after each other" give atropine, dopamine, or epi to increase HR is symptomatic bradycardic Third degree AV block interpretation a strip of p-waves laid independently over a strip of QRS complexes. Note that the p wave doesn't conduct the QRS complex that follows it.

A-flutter interpretation abnormal p-waves that produce a saw-tooth appearance Failure to Capture interpreation spike without a complex Failure to Pace interpretation no pacemaker activity or spike at the set rate on an ECG. usually caused by battery or circuit failure, cracked or broken pacing leads, loose connections, oversensing, or the pacing output is too low---

can lead to asystole Failure to Sense undersensing: giving help when not needed; spikes occur on the ECG where they shouldnt Pacemaker ECG rhythms failure to capture: spike without a p wave or QRS complex following it failure to pace: no spike on ECG at the rate set failure to sense: spike when intrinsic activity already present (undersensing) no spike when patient needs it (oversensing) Which ventricular stimulus is dangerous R on T phenomenon

Indications for a pacemaker? symptomatic bradycardia higher AV blocks (2nd degree type 2 or Complete) what is not a treatment for higher degree AV blocks atropine because of the impaired conduction through the AV node A-flutter happens because? an irritable spot of the atrium fires rapidly A-flutter can cause an increase in ventricular rate A-flutter is treated by: antiarrhythmics (cardizem, beta blockers) cardioversion What do you do if you notice a lethal rhythm on the monitor (VT/VF)? check the patient first -establish unresponsiveness call for help -begin CPR if needed When defibrillating VT/VF use joules for biphasic defibrillator or joules for monophasic.

Normal PR interval is 0.12-0.20 seconds Patient presents with anginal pectoris. what is initial management? allow rest, amdinister oxygen, nitroglycerin, etc. Causes of elevated cardiac enzymes MI, pericarditis, closed chest trauma, cardiac surgery Goal of treatment for cardiogenic shock (any shock) increase the patient's cardiac output A patient exhibits depression after their recent MI, you should encourage the patient to verbalize their concerns and allow interaction with family How does a cardiac tamponade occur blood or fluid accumulates in the pericardial space what does a cardiac tamponade do to the heart prevents the heart to pump effectively (impaired ventricular filling and contraction)

S/S of cardiac tamponade pulsus paradoxus, decreased BP, JVD, tachycardia, muffled heart sounds PAP values Systolic: 15- 25 Diastolic: 8- 18 PAOP (wedge) 6- PA Catheter waveforms PAOP (wedge) reflects pressures in the left ventricle An elevated PAOP may indicate left ventricular failure If you notice a continual PAOP wave form is present you should ensure the balloon is deflated, reposition the patient and try have the patient cough You should not do what to PA catheter if a continual wedge pressure is present Flush the line

What reading reflects the right atrium CVP An elevated CVP may indicate fluid overload, right ventricular failure, pulmonary HTN, cardiac tamponade Eventually sided heart failure will lead to an elevated. right sided HF will eventually lead to increased CVP decreased CVP can be from hypovolemia True/False Medication can be administered through an a-line False: no medications are to be given via a-line Arterial line waveform: -Overdampened -Underdampened -dicrotic notch on the downslope -overdampened: air bubbles, blood clots, kinked tubing, loose connections -underdampened:excessive tubing length or too many stopcocks

How long should pressure be held when removing an a- line 5-10 minutes Why would a ventilators high pressure alarm be sounding increased secretions or mucus plugs patient biting on the tube coughing or trying to talk pulmonary edema *anything that would cause decreased airway compliance Why would a ventilators low pressure alarm be sounding not enough air moving through the ventilator circuit *most commonly due to disconnection of tubing You have a patient that just received thoracic surgery. -You should observe/assess for? -how much is considered excess drainage output for this patient post op -how do you know it is working properly -you should never..... -assess for air leaks, chest tube drainage quality, breath sounds -anything greater than 150ml/hr is excessive drainage -the water seal chamber should fluctuate with respiration, but there should not be bubbles -never raise the chest tube drainage system above the level of the chest in a chest tube what breath sound would indicate atelectasis diminished

After a patient is intubated you should? get an x-ray to confirm placement and confirmed by a physician RN should listen for bilateral breath sounds When caring for patients with ETT or trach always assess placement and cuff function Your patient with an ETT is making audible sounds (or can be a trach without a passy-mauir valve) it is most likely related to.... the cuff is deflated which allows air to pass through the vocal cords In a patient with any kind of chest trauma ALWAYS assess for symptoms of pneumothorax impaired gas exchange, SOB S/s of tension pneumothorax deviated trachea, acute respiratory distress trauma patients are at risk for developing embolisms, especially those with long bone fractures. fat S/s of fat embolus may develop after surgery SOB, tachycardia, petechiae over upper body

Your patient has diminished breath sounds and you notice limited movement of their chest. This can indicate possible atelectasis due to hypoventilation ABG Interpretation pH: 7.35-7. PaCO2: 35- 45 HCO3: 22- (ROME) What antibiotics are given to TB patients INH, Rifampin, Rocephin What antibiotics should be renal-dosed Vancomycin, gentamycin, and tobramycin