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A comprehensive study set for the bkat (basic knowledge assessment test) in critical care nursing. It covers a wide range of topics, including normal blood gas values, ventilator management, stroke care, electrolyte imbalances, renal failure, gastrointestinal issues, transfusion reactions, shock management, and cardiac conditions. The correct answers to various questions, making it a valuable resource for nurses preparing for the bkat or seeking to enhance their knowledge in critical care nursing. The detailed explanations and explanations of key concepts can be particularly useful for university students, nursing professionals, and lifelong learners interested in expanding their understanding of critical care nursing practices and protocols.
Typology: Exams
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Normal blood gases; pH - CORRECT ANSWER-7.35-7. Normal blood gases: CO2 - CORRECT ANSWER-35- Normal blood gases: HcO3 - CORRECT ANSWER-22- Normal blood gases: PO2 - CORRECT ANSWER-80 or above Normal vacuum pressures for suction? - CORRECT ANSWER-120-140 mmHg What may a high pressure vent alarm indicate? - CORRECT ANSWER-Pt is biting on the tubing, excessive secretions in the tubing, kinked tubing What may a low pressure vent alarm indicate? - CORRECT ANSWER-cuff leak or the tubing is disconnected somewhere How do you verify positioning of an endotracheal tube? - CORRECT ANSWER-- auscultate lung bases and apices for bilateral breath sounds -observe chest for symmetric chest wall movement -confirm with end tidal CO2 measure GOLD STANDARD: chest x-ray t/f: people with ET tubes should be suctioned routinely - CORRECT ANSWER-FALSE-- they should be suctioned on an as needed basis what should ET tube cuff pressure be kept at? - CORRECT ANSWER-20-25 mmHg
What measures should nurses take to avoid ET tube problems? - CORRECT ANSWER--confirm that exit mark on ET tube remains constant when providing patient care, repositioning, and transporting patient -maintain proper cuff inflation (listen for an air leak-- if pt can talk, you must inflate more) -continually monitor SpO2, RR, HR and rhythm, mental status, and ABGs -pre-oxygenate before suctioning What should be done if a patient is not tolerating ET tube suctioning? - CORRECT ANSWER-STOP and manually hyperventilate with 100% oxygen Measures to prevent aspiration? - CORRECT ANSWER--avoid bolus tube feedings -monitor tube feeding residuals -maintain HOB at LEAST 30 degrees or greater -maintain proper ET tube cuff inflation -perform frequent oral pharyngeal suctioning -maintain an NG tube connected to low, intermittent suction if feeding tube is placed below the pylorus what are recommendations for preventing ventilator associated pneumonia? - CORRECT ANSWER--manage ventilated patients without sedatives whenever possible -interrupt sedation once a day (spontaneous breathing trials) -provide early exercise and mobility -provide regular oral care -minimize pooling of secretions above the ET tube cuff -use ET tubes with subglottic secretion drainage for patients likely to require greater than 72 hours of intubation -keep HOB elevated 30-45 degress -change ventilator circuit only if visibly soiled or malfunctioning What is the biggest complication associated with high cervical spinal cord injuries? - CORRECT ANSWER-BREATHING-- the diaphragm is innervated by C3-C5 levels
C4-diaphragm will likely need mechanical ventilation mgmt signs and symptoms of increased intracranial pressure? - CORRECT ANSWER-- altered LOC -headache -bradycardia -decreased respirations -acute HTN with widening pulse pressure -N/V -worsening neuro deficits -pupils that are nonreactive What are the components of a neuro exam? (7) - CORRECT ANSWER-1. LOC
positive (pathologic) response= toes curl upward a positive babinski in adults indicates dysfunction in the motor pathways of the brain or spinal cord what is the initial dosing of tpa? - CORRECT ANSWER--0.9 mg/kg -10% as a bolus over 1 minute and 90% as continuous infusion over 60 minutes What are the requirements for receiving tpa? - CORRECT ANSWER--onset of stroke was within 3-4.5 hours -CT negative for bleed or lesion -glucose > During the thrombolytic infusion of tpa, neuros need to be assessed every ___ minutes - CORRECT ANSWER- What are the frequency of neuro checks after receiving thrombolytic tpa infusion? - CORRECT ANSWER--VS and neuro checks every 15 min for 1 hour -every 30 min for 6 hours -then every hour for 16 hours what are possible complications of rTPA? - CORRECT ANSWER--signs of ICH or ICP -systemic bleeding (wait 6 hours before inserting devices like foleys, etc) -angioedema of airway for patients receiving rTPA or IA therapy, treat prn for SBP > ____ mmHg or DBP > ____ mmHG - CORRECT ANSWER-treat for SBP >180 or DBP >105 mmHG we want to manage hypertension!!! Acute mgmt measures for ischemic stroke patients? - CORRECT ANSWER-1. aspirin within 24 hours
Do not increase Na more than ___ mEq/L in 24 hours period d/t risk for central pontine myelinolysis - CORRECT ANSWER- what is occurring in diabetes insipidus? - CORRECT ANSWER-not enough production of ADH!!! What are s/sx of DI? - CORRECT ANSWER--increased urine output (>250 cc/hr) -increased thirst -dehydration symptoms -dilute urine (low specific gravity 1.001-1.005) -decreased urine osmolality (<400 mOsm/kg H20) -low urine Na -concentrated blood (serum osmolality >295 mOsm/L) -hypernatremia (>145) Treatment for Diabetes Insipidus (DI)? - CORRECT ANSWER-1. replace volume (oral fluids/IV fluids)
Physical findings -poor skin turgor -kussmaul respirations -fruity breath -tachycardia -hypotension -mental status changes what are the three main components of treatment for DKA? - CORRECT ANSWER-1. REHYDRATE
Why can hypokalemia occur in dka treatmnet/ - CORRECT ANSWER-because potassium shifts with insulin what are s/sx of hyperglycemia? - CORRECT ANSWER-polydipsia polyphagia polyuria fruity breath nausea/vomiting What are s/sx of hypoglycemia? - CORRECT ANSWER-increased HR, sweating, shaking, HA, vision changes (blurred) What is treatment for hypoglycemia? - CORRECT ANSWER-1. if eating, give 15 g of fast acting carbohydrate like juice, oral gel, or glucose tablets -NOTE: repeat up to three times
Onset/Peak/Duration of REGULAR insulin (humulin r)? - CORRECT ANSWER-Onset: 30-60 minutes Peak: 1-5 hours Duration: 6-10 hours Onset/Peak/Duration of intermediate acting insulin (NPH)? - CORRECT ANSWER- Onset: 1-2 hours Peak: 6-14 hours Duration: 16-24 hours Onset/Peak/Duration of Long-acting insulin (Lantus)? - CORRECT ANSWER-Onset: 1- 2 hours Peak: relatively peakless Duration: 18-24 hours Lab indicators of renal failure - CORRECT ANSWER-INCREASED CREATININE (>1.2) INCREASED BUN (>20) INCREASED POTASSIUM FlUID OVERLOAD what adjustments are made with meds in renal failure? - CORRECT ANSWER-med dosages are decreased or the time between subsequent dosages is increased diet restrictions in acute renal failure (What would a tube feed consist of)? - CORRECT ANSWER-low potassium low sodium low phos low protein what are some complications of acute renal failure? - CORRECT ANSWER--fluid overload -hyperkalemia (cardiac dysrhythmias)
-metabolic acidosis What is normal urine output? - CORRECT ANSWER-30 mL/hr CAUTI prevention measures - CORRECT ANSWER--frequently assess need for catheter -prevent dependent loops -always assure that bag is less than half full -perform peri care every shift -maintain tubing free of kinks -if breaks in system are noted, replace catheter and collecting system NG tube placement verification - CORRECT ANSWER-Gold standard for confirmation is x-ray Assessing for GI bleed - CORRECT ANSWER-coffee ground drainage in suction container Aspiration precautions for gI patient - CORRECT ANSWER--elevate hob 30- degrees -consider post-pyloric placement of feeding tube if residuals continue to be above 500 mL -Consider prokinetics to promote gastric emptying (such as erythromycin, metoclopramide, or naloxone) after three consecutive residuals > 500 mL what are some indications for GI suction? - CORRECT ANSWER-to decompress the stomach (aspiration of gastric fluid content) if theres an obstruction what should be your first action when a transfusion reaction occurs? - CORRECT ANSWER-stop the infusion!
what are some types of transfusion reactions? - CORRECT ANSWER-hemolytic febrile rxn allergic TRALI transfusion related immunmodulation (TRIM) treatment for hemolytic transfusion reaction - CORRECT ANSWER-Hemolytic transfusion reactions are treated as follows: Stop transfusion as soon as a reaction is suspected Replace the donor blood with normal saline Examine the blood to determine if the patient was the intended recipient and then send the unit back to the blood bank Furosemide may be administered to increase renal blood flow Low-dose dopamine may be considered to improve renal blood flow Make efforts to maintain urine output at 30-100 mL/h treatment for anaphylactic blood reaction - CORRECT ANSWER-Anaphylactic reactions are treated as follows: Stop the transfusion immediately Support the airway and circulation as necessary Administer epinephrine, diphenhydramine, and corticosteroids Maintain intravascular volume treatment for febrile infusion reaction - CORRECT ANSWER-Aggressive treatment of simple febrile reactions is not necessary; however, because the nonspecific symptoms are similar to those of a hemolytic transfusion reaction, differentiating this entity from a hemolytic reaction is necessary The transfusion should be terminated Evaluate the patient for evidence of hemolysis The patient's fever can be treated with acetaminophen
what are the compensatory mechanisms for patients in shock? - CORRECT ANSWER- epi and norepi are released >> increase HR, SBP, RR, dilate coronaries ACTH, cortisol released and blood sugar increases RAAS system activated >> na+ and water retention occur with decrease in urine output Treatment for hypovolemic shock - CORRECT ANSWER-1. fluids fluids fluids! (crystalloid/colloid replacement, RBC for hemorrhage)
CVP/PAWP decreased SVR decreased Treatment for anaphylactic shock? - CORRECT ANSWER-1. REMOVE the causative factor
what is a medical power of attorney - CORRECT ANSWER-someone that you permit to speak on your behalf in regard to medical decisions, in the case that you cannot speak for yourself what is a living will - CORRECT ANSWER-A living will (sometimes called an advance directive, health care directive, or advanced medical directive expresses your wishes regarding medical treatment in very specific situations. what can be a respiratory complication from a long bone fracture? - CORRECT ANSWER-fat embolus-- dyspnea, SOB, what is the initial treatment for burn patients? - CORRECT ANSWER-FLUIDS, FLUIDS, FLUIDS What are some possible complications of chest trauma? - CORRECT ANSWER-PE, pneumothorax, pleural effusion, ARDS when treating a patient with hypothermia, what are the effects/concerns with rewarming them? - CORRECT ANSWER--closely monitor for mass vasodilation and subsequent hypotension -gently handle -prevent afterdrop (continued cooling of temp even after rewarming) What is the initial treatment for chest pain? - CORRECT ANSWER-REST What is the most prominent EKG change that occurs in acute MI? - CORRECT ANSWER-ST segment elevation in two or more contiguous leads Cardiac enzymes are elevated in which conditions? in contrast, not elevated in what conditions? - CORRECT ANSWER-MI pericarditis myocarditis not so much elevated in congestive heart failure
What is normal chest tube drainage PER HOUR? - CORRECT ANSWER-no more than 100 mL/hr what conditions commonly cause heart murmurs? - CORRECT ANSWER-oAortic dissection oAortic regurgitation (both acute and chronic) oMitral valve regurgitation (both acute and chronic) oMitral valve stenosis What are drugs that INCREASE preload? - CORRECT ANSWER-•Colloids •Crystalloids •Blood Hetastarch Drugs that DECREASE preload? - CORRECT ANSWER-•Dilators:
-epinephrine -norepinephrine -dopamine -neosynephrine Drugs that DECREASE afterload? - CORRECT ANSWER-dilators -nitroprusside -nitroglycerin -amrinone -alpha and calcium channel blockers what are some complications when using thrombolytics? - CORRECT ANSWER- oBleeding/Hemorrhage oAllergic rxns oHypotension oHemorrhagic stroke oReperfusion arrhythmias what are some indications for external pacing? - CORRECT ANSWER--symptomatic bradycardia -tachydysrhythmias -prophylaxis following a surgery, code, etc. S/sx of cardiac tamponade - CORRECT ANSWER-o Rise in filling pressure with decreased CO and hypotension o JVD o Elevated CVP, severe hypotension, and tachycardia o Pulses paradoxus o Narrowing pulse pressure o Tachycardia o Dysrhythmias
o Decreased ECG voltage o Decreased UOP o Anxiety/restlessness o Chest pain radiating to neck, shoulders, back o Tachypnea o Muffled heart tones are a late sign o Chest x-ray may show enlarged cardiac silhouette o Discomfort that's relieved by sitting or leaning forward energy settings for biphasic defibrillator? - CORRECT ANSWER- med for asystole - CORRECT ANSWER-epi (1mg) med for V tach with pulse? - CORRECT ANSWER-150 mg Amiodarone MEd for atrial fib/atrial flutter? - CORRECT ANSWER-calcium channel blockers like cardizem Med for bradycardia - CORRECT ANSWER-atropine Drugs to decrease afterload/SVR/PVR - CORRECT ANSWER-Arterial Dilators) Nitroprusside, nitroglycerin, amrinone, alpha (Regitine) & Ca channel blockers Drugs to increased afterload/SVR/PVR - CORRECT ANSWER-PRessors -epinephrine -norepinephrine -neosynephrine/phenylephrine Drugs to decrease contractility/SVI - CORRECT ANSWER-Beta blockers (atenolol, metoprolol, propranolol, labetolol, esmolol) and Ca channel blockers
Drugs to increase contractility/SVI - CORRECT ANSWER-Positive inotropes dobutamine, dopamine, milrinone, and digoxin Drugs to decrease preload/CVP/PAWP - CORRECT ANSWER-Venous Dilators - Nitroglycerin, nitroprusside, amrinone, alpha & Ca channel blockers Diuretics - Furosemide, bumex, mannitol Indication for dopamine/Intropes - CORRECT ANSWER-Acts on SNS to increased HR and BP. Indicated for hypotension, low CO, decreased renal blood flow. Use if patient is bradycardic. Doses of dopamine - CORRECT ANSWER-Low: 0.5-2 mcg/kg/min (dopaminergic) Intermediate: 2-10 mcg/kg/min (beta receptors, increases CO) High: over 10 mcg/kg/min (alpha receptors, vasoconstrict) SE of dopamine? - CORRECT ANSWER--Watch volume and starting BP. -Use central line. -Inactivated by sodium bicarb. -Can cause acidosis. SE: ectopic beats, tachycardia, tissue necrosis d/t extravasation Indication for norepinepherine/Levophed - CORRECT ANSWER-Indicated for diastolic hypotension (specifically decreased SVR) and septic shock. Stimulates alpha & beta receptors. Increased contractility, HR, and vasoconstriction. SE of norepinepherine - CORRECT ANSWER-Replace volume first because it can cause GI and renal hypoperfusion. Have a central line. SE: dizziness, HA, hyperglycemia, myocardial/mesenteric/renal ischemia, tissue necrosis with extravasation. side effects of epinephrine? - CORRECT ANSWER-SE: myocardial/mesenteric/renal ischemia, tachycardia, hyperglycemia, HA, tissues necrosis with extravasation
SE of neosynephrine - CORRECT ANSWER-Use central line. Wean this first! SE: Reflex bradycardia, myocardial/mesenteric/renal ischemia, tissue necrosis with extravasation Indications for vasopressin - CORRECT ANSWER-Antidiuretic hormone used to vasocontric. Endogenous hormone. Vasoconstricts peripheral arterioles & vasodilates coronary, pulmonary, and CNS circulation. Effective for hypotension, shock, decreases needs of other pressors, and Cardiac surgery. SE of vasopressin? - CORRECT ANSWER-SE: Skin/mesenteric ischemia, bradycardia, decrease UOP & result in hyponatremia, use with caution in neurosurgery patients SE of dobutamine? - CORRECT ANSWER-SE: ectopic beats, tachycardia, arrhythmias, tissue necrosis with extravasation. What is CVP measuring? - CORRECT ANSWER-pressure in the right atrium What is MAP measuring? - CORRECT ANSWER-basically a ratio of systolic/diastolic -the pressure in the arteries during one cardiac cycle what is PAP measuring? - CORRECT ANSWER-pressure in the pulmonary artery/lungs what is pulmonary artery wedge pressure? - CORRECT ANSWER-it's occluding off the artery to give us a measure of pressure in the LEFT ATRIUM what are causes of overdamped waveform? - CORRECT ANSWER-occlusions kinks compliant tubing excess tubing or stopcocks loose connections
low fluid level in flush bag What are causes of underdamped waveform? - CORRECT ANSWER-air bubbles in transducer stopcocks defective transducer consider severe HTN what is normal MAP range? - CORRECT ANSWER-70- what is normal CVP? - CORRECT ANSWER-1- what is normal RV? - CORRECT ANSWER-15-28/0- What is normal PAS/PAD/PAM? - CORRECT ANSWER-15-25/6- MEAN PA 10- What is normal wedge pressure? - CORRECT ANSWER-4- what is normal SVR? - CORRECT ANSWER-800-1200 mmHG what are some complications of having an art line? - CORRECT ANSWER-arterial insufficiency peripheral neuropathy hemorrhage infection Describe procedure for removing an art line - CORRECT ANSWER-1. MD order