CCRN Critical Care Registered Nurse Exam Test Bank: Practice Questions and Answers, Exams of Nursing

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CCRN CRITICAL CARE REGISTERED NURSE EXAM TEST BANK LATEST 2024

Which of the following ventilator settings is most likely to decrease the work of breathing? - ANSWER>>Pressure support A nurse is caring for a patient with an acute inferior wall MI, post coronary artery stent deployment. For optimal care of this patient, the nurse should? - ANSWER>>continuously monitor the patient in lead II A patient with aortic regurgitation will have which of the following upon auscultation? - ANSWER>>a diastolic murmur, loudest at the second intercostal space, right sternal border Which of the following patients, who are all receiving mechanical ventilation, is most likely a candidate for a spontaneous awakening trial? - ANSWER>>a patient who is receiving a propofol infusion Cardiogenic shock secondary to left ventricular failure will generally result in: - ANSWER>>a narrow pulse pressure. Massive atelectasis occurs in the presence of acute respiratory distress syndrome (ARDS). What are the 2 causes of the atelectasis that is typical of ARDS? - ANSWER>>a surfactant deficiency and pulmonary edema Which of the following is an effect of hypothermia? - ANSWER>>a shift of the oxyhemoglobin dissociation curve to the left It is important for a nurse to identify the signs of respiratory depression during procedural sedation. Which of the following is a LATE sign of respiratory depression? - ANSWER>>SpO 88% The most common cause of acute hepatic failure is - ANSWER>>an acetaminophen overdose.

Which of the following is most likely to lead to cardiopulmonary arrest for a patient with status asthmaticus? - ANSWER>>air trapping The ECG demonstrates ST elevation in leads II, III, and aVF. The nurse needs to monitor the patient closely for which of the following? - ANSWER>>sinus bradycardia, an acute systolic murmur in the fifth intercostal space, midclavicular Which of the following hemodynamic profiles would benefit from aggressive fluid administration, pressors, and antibiotic therapy? - ANSWER>>right atrial pressure (RAP) 5 mmHg; pulmonary artery occlusion pressure (PAOP) 7 mmHg; systemic vascular resistance (SVR) 400 dynes/sec/cm-5; cardiac output (CO) 8 L/min Which of the following is indicative of a mixed acid-base disorder? - ANSWER>>The decreased PaCO2 is evidence of respiratory alkalosis, and the decreased HCO3 is evidence of metabolic acidosis. pH 7.33; PaCO2 29; PaO2 72; HCO3 15 Lab tests show urine sodium less than 20, urine osmolality greater than the serum osmolality, BUN 70, and creatinine 3.1. This is a sign of what type of renal failure? - ANSWER>>BUN/creatinine ratio of ~ 20:1 indicate that the renal tubular basement membrane remains intact. renal hypoperfusion without tubular basement membrane involvement A patient with Type 1 diabetes has been started on metoprolol for heart disease. The nurse needs to inform the patient that the first sign of hypoglycemia might be which of the following?

• ANSWER>>mental status change

The beta blocker (metoprolol) will mask the early signs of hypoglycemia that are due to sympathetic stimulation (tachycardia, palpitations, irritability, headache, shakiness, and diaphoresis). One hemodynamic benefit of intra-aortic balloon pump therapy is that: - ANSWER>>balloon deflation decreases left ventricular afterload. A patient presents with hypotension refractory to initial treatment, and a pulmonary artery catheter is placed. The hemodynamic profile demonstrates right atrial (RA) pressure 1 mmHg, pulmonary artery pressure (PAP) 19/6 mmHg, pulmonary artery occlusion pressure (PAOP) 4 mmHg, systemic vascular resistance (SVR) 1,500 dynes/sec/cm-5, and SvO2 55%. What is most likely the cause of this patient's hypotension, and what is the appropriate treatment? - ANSWER>>hypovolemic shock; fluids Volume depletion results in decreased preload. A compensatory response to volume depletion results in an increase in the SVR in an attempt to maintain pressure. A patient has right middle and lower lobe pneumonia. Which of the following is an appropriate intervention for this patient? - ANSWER>>Avoid turning the patient to his right side. A patient with a history of thyroid disease was admitted with elevated TSH and decreased T and T4. Based on these lab results and the patient history, which of the following assessments would be expected for this patient? - ANSWER>>delayed tendon reflexes, shallow respirations, bradycardia This patient's lab results are typical of hypothyroidism. The patient assessment would most likely include delayed tendon reflexes, shallow respirations (which may lead to respiratory acidosis), and bradycardia. Which of the following is a complication of acute pancreatitis? - ANSWER>>hypocalcemia Calcium is used up for autodigestion, and this precipitates hypocalcemia.

Which of the following is NOT needed to calculate the creatinine clearance? - ANSWER>>serum BUN A 70 kg patient required intubation for status asthmaticus. A propofol infusion was started at 40 mcg/kg/min, and the patient appears calm. The ventilator settings are: FiO20.30, assist-control mode 12 breaths/minute, tidal volume 400 mL, and an increased peak flow rate. The patient's respiratory rate is 28 breaths/minute, and the SpO2 is 0.98. Which of the following interventions should the nurse anticipate? - ANSWER>>Administer vecuronium (Norcuron) PRN. What would be expected for a patient with intrarenal failure who requires hemodialysis? - ANSWER>>low urine osmolality, high urine sodium Which clinical sign might BOTH patients (one with systolic heart failure and one with diastolic heart failure) have in common? - ANSWER>>lung crackles A patient presented with status asthmaticus and required mechanical ventilation. Which of the following findings would be expected shortly after intubation? - ANSWER>>peak inspiratory pressure 68 cm H2O pressure; plateau pressure 25 cm H2O pressure Due to bronchospasm, the airway pressure will be elevated (elevated peak inspiratory pressure), but the lung pressure itself (plateau pressure) will not be elevated above 30 cm H2O pressure A patient presents with hypotension refractory to initial treatment, and a pulmonary artery catheter was placed. The hemodynamic profile revealed the following: right atrial (RA) pressure 10 mmHg, pulmonary artery pressure (PAP) 49/25 mmHg, pulmonary artery occlusion pressure (PAOP) 24 mmHg, systemic vascular resistance (SVR) 1,900 dynes/sec/cm-5, and SvO2 48%. What is most likely the cause of this patient's hypotension and the appropriate treatment for it?

• ANSWER>>cardiogenic shock; IABP This patient's hemodynamic profile includes an elevated RA pressure, PAP, PAOP, and SVR. This is reflective of cardiogenic shock. Mechanical support with an IABP is an effective treatment for this patient.

Which of the following is most likely to result in a low SvO2? - ANSWER>>A fever increases the metabolic rate and oxygen consumption, which may lead to a drop in the mixed venous oxygen saturation. A patient is being treated for status epilepticus, and he requires intubation and mechanical ventilation. Which of the following possible pathophysiological changes might the nurse anticipate? - ANSWER>>elevated creatine kinase (CK) The destruction of skeletal muscle cells occurs secondary to seizure activity, which results in the release of creatine kinase (CK) into the serum. A 19-year-old male was admitted with traumatic injuries secondary to a motor vehicle accident. The ECG demonstrates a sinus rhythm with a short PR interval and the presence of a slow rise of the initial upstroke of the QRS. This patient is at risk for developing which of the following? - ANSWER>>pre-excited atrial fibrillation This patient has Wolff-Parkinson-White (WPW) syndrome, as evidenced by a short PR interval with the presence of a delta wave A patient has a blood pressure of 78/40, a right atrial (RA) pressure of 1 mmHg, a pulmonary artery occlusion pressure (PAOP) of 4 mmHg, a systemic vascular resistance (SVR) of 1, dynes/s/cm-5, and a cardiac output (CO) of 3 L/min. Which of the following statements about this patient is correct? - ANSWER>>The patient has hypovolemic shock; provide fluid resuscitation. The hemodynamic profile described in the question is that of hypovolemic shock. The SVR would not be elevated in septic shock Which of the following is an effective strategy for the assessment of and management of pain for a critically ill adult? - ANSWER>>If the patient cannot accurately self-report pain, consider asking a family member, who knows the patient, whether the patient's behavior may indicate the presence of pain.

A patient with right ventricular infarction would most likely have which of the following hemodynamic pressure findings? - ANSWER>>right atrial (RA) pressure 14 mmHg, pulmonary artery occlusion pressure (PAOP) 5 mmHg Due to decreased RV ejection, the right atrial pressure increases. Failure of the RV results in decreased left ventricular preload (low PAOP). The lungs will be clear, but the cardiac output and the B/P may decrease A patient is 5 days status post subarachnoid hemorrhage, and she develops a change in level of consciousness and hyponatremia. Which of the following orders should the nurse anticipate? - ANSWER>>Maintain the cerebral perfusion pressure (CPP) with 0.9 normal saline. This patient has signs of vasospasm, and maintaining the CPP (in order to prevent worsening of the vasospasm) is a priority. A patient's family has unrealistic expectations for the patient's recovery. What is the most effective strategy for the nurse to employ in this situation? - ANSWER>>Attempt to get information from the family that explains their point of view, and revise explanations accordingly. Which of the following is a priority treatment for a patient with DKA who presents with hyperglycemia, ketosis, and normal serum potassium? - ANSWER>>Administer potassium. Which of the following is a systemic effect of targeted temperature management (TTM) during the cooling phase? - ANSWER>>hyperglycemia secondary to insulin resistance A patient presented to the Emergency Department with a history of palpitations and dyspnea, persisting on and off for 1 week. The heart monitor shows atrial fibrillation with rapid ventricular response, and the blood pressure is 112/70. Treatment will most likely include: - ANSWER>>a calcium channel blocker and anticoagulation.

A ventricular septal defect is most likely to have which of the following clinical findings - ANSWER>>systolic murmur at the fifth intercostal space, left sternal border A patient has a fever, and a lumbar puncture is positive for protein and WBCs. This patient most likely has a positive: - ANSWER>>Brudzinski's sign. Which of the following describes an effect of a heparin infusion? - ANSWER>>It prevents the conversion of thrombin to fibrinogen. A patient presents with hypotension refractory to initial treatment, and a pulmonary artery catheter was placed. The hemodynamic profile demonstrated the following: right atrial (RA) pressure 0 mmHg, pulmonary artery pressure (PAP) 19/6 mmHg, pulmonary artery occlusion pressure (PAOP) 4 mmHg, systemic vascular resistance (SVR) 400 dynes/sec/cm-5, and SvO 80%. What is most likely the cause of this patient's hypotension, and what is the appropriate treatment? - ANSWER>>septic shock; vasopressors The massive vasodilation, loss of vascular tone, and capillary leak caused by endotoxins results in decreased preload and decreased afterload A patient with right middle lobe pneumonia would be expected to have which of the following assessment findings over the affected area? - ANSWER>>bronchial breath sounds and whispered pectoriloquy A patient has a pulmonary embolism with hypotension, hypoxemia (which requires the patient to be on 100% oxygen), and severe tachypnea. Which of the following would provide the quickest resolution of this patient's signs and symptoms? - ANSWER>>the administration of a fibrinolytic agent A patient presents with left leg pain. The ankle brachial index (ABI) is 0.7. This patient would benefit from which of the following interventions? - ANSWER>>putting the legs in the dependent position

The clinical signs described in the question are indicative of peripheral artery occlusive disease. Putting the legs in the dependent position will aid perfusion. Which of the following describes clinical signs of variant (Prinzmetal's) angina? - ANSWER>>ST elevation, resolves with nitrate therapy A patient has a blood pressure of 78/40, a right atrial (RA) pressure of 13 mmHg, a pulmonary artery occlusion pressure (PAOP) of 5 mmHg, a systemic vascular resistance (SVR) of 1, dynes/sec/cm-5, and a cardiac output (CO) of 1.9 L/min. Which of the following statements about this patient is correct? - ANSWER>>The patient has right ventricular infarct; provide fluids. The hemodynamic profile described is that of right ventricular (RV) failure, which may be secondary to acute RV infarct. A patient has a blood pressure of 78/40, a right atrial (RA) pressure of 8 mmHg, a pulmonary artery occlusion pressure (PAOP) of 19 mmHg, a systemic vascular resistance (SVR) of 1, dynes/sec/cm-5, and a cardiac output (CO) of 1.9 L/min. Which of the following statements about this patient is correct? - ANSWER>>The patient has cardiogenic shock; provide positive inotropes. The hemodynamic profile described is that of cardiogenic shock. In septic shock, the PAOP and the SVR would not be elevated. Each of the following ECG changes is indicative of an acute pulmonary embolism (PE) EXCEPT for: - ANSWER>>a prolonged QT interval The physician determines that the patient has ARDS. The patient has developed refractory hypoxemia, bilateral infiltrates, and pulmonary edema, as confirmed by a chest X-ray. Which of the following findings would be expected for a patient with this diagnosis? - ANSWER>>PAOP is normal or low

Which of the following ABG results (which were obtained from patients with status asthmaticus who were receiving oxygen at 3 L/minute via a nasal cannula) most likely indicates an immediate need for intubation and mechanical ventilation? - ANSWER>>pH 7.29; PaCO2 50; HCO3 25; PaO2 70 An orientee's patient experiences cardiac arrest and requires resuscitation. The preceptor, who is orienting the new nurse to the unit, sees that the orientee has placed the patient in the reverse Trendelenburg position. What would be the preceptor's best response at this time? - ANSWER>>Place the patient in a supine position. The hospital Nursing Practice Committee wants to provide criteria for the maintenance of a central venous catheter in order to decrease the CLABSI rate. Which of the following is a reason to maintain a central venous catheter? - ANSWER>>The patient requires acute hemodialysis. A patient assessment reveals a fever and nuchal rigidity. A lumbar puncture is done, and the cerebrospinal fluid (CSF) results include the following: clear in appearance, glucose 60 mg/dL, mildly elevated protein, mildly elevated WBC count, and opening pressure 150 cm H2O. Treatment for this patient will most likely include which of the following? - ANSWER>>supportive care A patient is being treated for cocaine intoxication. Which of the following would most likely NOT be indicated for this patient? - ANSWER>>a conservative administration of fluids A patient is status post motor vehicle accident with a large chest bruise. The nurse knows that this patient needs to be assessed for which of the following? - ANSWER>>positive troponin, aortic valve damage A patient with ST elevation in leads II, III, and aVF is most likely to develop a ______ , whereas a patient with ST elevation in V1, V2, and V3 is most likely to develop ______ - ANSWER>>third- degree AV block, a second-degree AV block (Type II)

A patient has global ST elevation and pain with deep inspiration. Which of the following medications should the nurse expect the physician to order? - ANSWER>>nonsteroidal anti- inflammatory drug Which of the following patients may be a candidate for palliative care? - ANSWER>>a patient with a traumatic brain injury (who is able to follow commands) and also has ARDS A patient is 3 days status post a head injury with the following clinical findings: a urine output of 300 mL/hour, increased serum sodium, and increased serum osmolality. The nurse should anticipate an order for which of the following? - ANSWER>>vasopressin The nurse notices that during inspiration and expiration, the water in the water seal chamber is bubbling for a patient with a left-sided chest tube. What does this assessment indicate? - ANSWER>>pleural air leak A patient complains of boring abdominal pain. The abdomen is rigid with no rebound tenderness. Grey Turner's sign and Trousseau's sign are present. The amylase, lipase, WBC count, and serum glucose are elevated. Which of the following problems does this patient most likely have, and which intervention is most appropriate? - ANSWER>>hemorrhagic pancreatitis; a close pulmonary assessment A patient was admitted with a 4-month history of numerous medical problems, and he is malnourished with a body mass index (BMI) of 15. Enteral feeding was initiated. The nurse should monitor this patient for which of the following? - ANSWER>>hypomagnesemia A patient with chronic alcoholism presents with abdominal pain, lethargy, decreased deep tendon reflexes, and muscle weakness. What is a likely cause of this clinical presentation and a potential complication? - ANSWER>>hypophosphatemia; hypoventilation A 65-year-old male complains of sharp left shoulder pain, and upon a clinical exam, he demonstrates abdominal distension with absent bowel sounds. This patient most likely has: - ANSWER>>Sharp left shoulder pain (Kehr's sign) is a clinical sign that is caused by diaphragmatic irritation that occurs with splenic rupture.

S1 heart sounds - ANSWER>>loudest in apex s2 sounds - ANSWER>>loudest at base louder with pulmonary embolism s3 heart sounds - ANSWER>>associated with kidney failure cor pulmonale pulmonary htn mitral, aortic, or tricuspid insufficiency s4 heart sounds - ANSWER>>associated with aortic stenosis htn ventricular hypertrophy myocardial ischemia normal pulse pressure - ANSWER>>40-60 mmHg systolic bp is an indirect measurement of - ANSWER>>CO and SV narrowing pulse pressure seen often in - ANSWER>>severe hypovolemia or severe drop in CO diastolic pressure is an indirect measurement of - ANSWER>>SVR widen pulse pressure indicates - ANSWER>>vasodilation drop in SVR often seen in septic shock

when does murmur insufficiency occur - ANSWER>>when valve is closed (regurgitation) acute or chronic when does stenosis occur - ANSWER>>when valve is open chronic systolic murmur stuff semilunar valves are open during/what to know - ANSWER>>systole aortic stenosis pulmonic stenosis systolic murmur stuff AV valves close during/what to know - ANSWER>>systole mitral/tricuspid insufficiency large V waves on PAOP Ventricular septal defects Diastolic murmur stuff semilunar valves close when/which insufficiencies - ANSWER>>diastole Aortic and pulmonic Diastolic murmur stuff AV valves open during/what to know - ANSWER>>diastole mitral stenosis with afib tricuspid stenosis

best place to hear ventricular septal defect - ANSWER>>sternal border, 5th ICS best place to hear papillary muscle rupture - ANSWER>>apex, surgical emergency happens with MI unstable angina - ANSWER>>troponin negative ST depression or T wave inversion can go away sometimes with nitro NSTEMI - ANSWER>>troponin positive ST depression T Wave inversion unrelenting chest pain what is Variant or prinzmental angina - ANSWER>>unstable angina associated with transient ST elevation elevation due to coronary artery spasm troponin negative when does Variant or prinzmental angina occur and what can precipitate it - ANSWER>>at rest, may be cyclic ETOH, nicotine, cocaine(one hell of a drug) what can happen with nitro administration Variant or prinzmental angina - ANSWER>>relief of pain and ST return to normal do you give beta blockers to cocaine overdose - ANSWER>>NO

WHAT IS A EKG WITH ST ELEVATION IN V3R AND V4R - ANSWER>>RIGHT VENTRICULAR INFARCT

WHAT MI HAS THE HIGHEST MORTALITY - ANSWER>>ANTERIOR, OMINIOUS SIGN

ANTERIOR MI CAN LEAD TO - ANSWER>>HEART FAILURE

TIME FOR REPERFUSION OF A STEMI OF PCI - ANSWER>>PCI 90 MINUTED FROM DOOR TO

BALOON INFLATION

TIME FOR FIBROLYNIC THERAPY FOR STEMI - ANSWER>>30 MINUTES

IS A NSTEMI EMERGENT TO REPERFUSE - ANSWER>>NO, DIAGNIOSTIC CATH WITHIN 24 HR

Complication of PCI - ANSWER>>Acute stent thrombosis WHAT TO MONITOR FOR WHEN REMOVING A SHEATH - ANSWER>>VASOVAGAL RESPONSE WHAT IS A HYPERTENSIVE EMERGENCY/CRISIS - ANSWER>>ELEVATED BP WITH EVIDENCE OF END ORGAN(BRAIN,HEART,KIDNEY, RETINA) DAMAGE WHAT IS HYPERTENSIVE URGENCY - ANSWER>>elevated BP without evidence of acute end- organ damage WHAT MEDICINES WOULD YOU GIVE A HYPERTENSIVE EMETRGENCY - ANSWER>>NITROPRUSSIDE PRELOAD AND AFTERLOAD REDUCER

LABETOLOL

6 P's of PAD - ANSWER>>Pain, paralysis, pallor, paresthesia, poikilothermy, Pulselessness WHAT IS A NORMAL ABI - ANSWER>>>0. DO WE ELEVATE FOR PAD - ANSWER>>NO, DECREASES PERFUSION What is WPW syndrome? - ANSWER>>A syndrome of pre-excitation of the ventricles of the heart due to an accessory pathway known as the bundle of Kent. It is seen as a short PR interval, a U wave, and a long QRS complex. AGE SEEN FOR WPW - ANSWER>>YOUNGER THAN 30 WHAT CAN WPW PRESENT AS - ANSWER>>PRE-EXCITED ATRIAL FIBRILATION WHAT NOT TO GIVE TO PRE-EXCITED ATRIL FIBRILATION - ANSWER>>ADENOSINE DIGOXIN CALCIUM CHANNEL BLOCKERS CAN CAUSE VFIB PROLONGING OF THE QT CAN RESULT IN - ANSWER>>TORSADES DE POINTES DRUG Causes of prolonged QT - ANSWER>>AMIODARONE QUINIDINE HALOPERINOL PROCAINAMIDE

ELECTROLYTE CAUSES OF PROLONGED QT - ANSWER>>HYPOKALEMIA

HYPOMAGNESIA

HYPOCALCEMIA

PACEMAKER CODE READING - ANSWER>>FIRST INITIAL: CHAMBER PACED

SECOND INITIAL: CHAMBER BEING SENSED

THIRD INITIAL: RESPONSE TO SENSING

main cause of DEATH FOR heart failure - ANSWER>>SUDDEN DEATH ARRHYTHMIA HYPERTROPHIC CARDIOMYOPATHY IS SILILAR TO? AND HAS TROUBLE? - ANSWER>>RIGHT SIDED HEART FAILURE FILLING DILATED CARDIOMYOPATHY IS SIMILAR TO? HAS TROUBLE? - ANSWER>>LEFT SIDED HEART FAILURE EJECTING THREE HEMODYNAMIC CHANGES IN CARDIOGENIC SHOCK - ANSWER>>ELEVATED PAOP ELEVATED SVR DROP IN CO IABP inflates during - ANSWER>>diastole Cardiac Tamponade s/s - ANSWER>>JVD, narrow pulse pressure, hypotension ( Becks Triad) pulsus parodoxus seen in - ANSWER>>CARDIAC TAMPONADE

WHICH VALVE IS MOST LIKELY TO RUPTURE WITH TRAUMA - ANSWER>>AORTIC VALVE

WHAT TO DO WITH THE GOOD LUNG - ANSWER>>GOOD LUNG DOWN

WHEN IS PERFUSION OF THE ANTERIOR CHEST ALVEOLI SEEN - ANSWER>>WHEN YOU PRONE

WHAT IS EXTREME V/Q MISMATCH - ANSWER>>100 FIO2 WITH HYPOXEMIA

WHAT IS A PATHOLOGICAL SHUNT EXAMPLE - ANSWER>>ARDS

BLOOD THROUGH LUNGS BUT NOT OXYGENATED

REFRACTORY HYPOXEMIA

TREATMENT OF RESPIRATORY SHUNT - ANSWER>>O2 AND PEEP

WHAT CAUSES A SHIFT TO THE LEFT FOR RESPIRATORY - ANSWER>>"HOLD ONTO O2"

HIGH FIO2, LOW TISSUE O

ALKOLOSIS

LOW PACO

HYPOTHERMIA

LOW 2,3 DPG

WHAT CAUSES A SHIFT TO THE RIGHT RESPIRATORY - ANSWER>>HGB RELEASED EASIER

LOW FIO2, HIGH TISSUE O

ACIDOSIS

HIGH PACO

FEVER

HIGH 2,3 DPG

What is static compliance in respiratory - ANSWER>>measurement of elastic properties in lungs TV divided by plateau pressure (minus peep) what is dynamic compliance in respiratory - ANSWER>>measurement of elastic properties in airways TV divided by PIP (minus peep) Normal anion gap - ANSWER>>8- 12 Normal cardiac index - ANSWER>>2.5-4 L/min/m Normal SVR - ANSWER>>800-1200 dynes/sec/cm- 5 normal cardiac output - ANSWER>>4-8 L/min Normal PAOP (wedge) pressure - ANSWER>>5-12 mmHg Normal Right ventricle pressure - ANSWER>>25/4 mmHg acute respiratory failure defined as - ANSWER>>PaO2 <60 with or without elevation of CO2 > or PH <7. ventilator management status asthmaticus - ANSWER>>Low ventilation rate to increase exhalation time Low tidal volume to prevent auto-PEEP

increase I:E ratio >1:3- 4 Definition of pulmonary hypertension - ANSWER>>mean arterial pressure greater than 25, wedge greater than 15 Most aspirations occur in the ________ lung - ANSWER>>right ARDS criteria - ANSWER>>1. acute onset

2. bilateral patchy airspace disease
3. PCWP < 18
4. PaO2/FiO2 < 200 no signs of cardiac failure or fluid overload echo excludes hydrostatic pulmonary edema in pts without ARDS risk factors severity of hypoxemia: PaO2/FiO2 ratio < 300 mmHg with PEEP > 5 mild: 200- 300 moderate: 100- 200 severe: < 100 lungs are less compliant with increased pulmonary arterial pressure. acute lung injury criteria - ANSWER>>same as cards but pf ratio is between 201- 300 pulmonary stabilization measures ARDS/ALI - ANSWER>>PEEP >

plateau pressure less than 30 Tidal volume 5-6 ml/kg do we use steroids for ARDS/ALI - ANSWER>>NOPE only with specific COVID patients how far above the carina do you want your ETT - ANSWER>>3-5 cm WHAT HAPPENS TO BP IN COMPENSATORY SHOCK - ANSWER>>MAINTAINS WHAT HAPPENS TO BP WITH PROGRESSIVE SHOCK - ANSWER>>HYPOTENSION HYPOVOLEMIA SHOCK DOES WHAT TO BP - ANSWER>>NARROWS PULSE PRESSURE SVR for hypovolemic shock - ANSWER>>ELEVATED WHEN GIVING BLOOD WHAT ELECTROLYTES CAN GO LOW AND WHAT ENZYME CAN CAUSE A LEFT SHIFT FROM NOT BEING IN BLOOD - ANSWER>>Ca and Mg 2,3 dpg what is the trauma triad of death - ANSWER>>hypothermia, acidosis, coagulopathy what is released in anaphylaxis - ANSWER>>IGE MEDIATED TRAUMA FIRST LINE ASSESSMENT - ANSWER>>ABCDE Airway: ensure patent airway (intubation?) Breathing: provide 100% oxygen and ventilation

Circulation: 2 large-bore IVs with warm isotonic lactated ringers Disability: perform quick neuro exam (LOC, motor, pupils) --GCS Expose/Environmental: remove clothes, provide warmth/cooling as needed TRAUMA SECOND LINE ASSESSMENT - ANSWER>>FGHI Full set of vitals --Focused adjuncts: ECG monitor, pulse ox, CO2 detector, urinary catheter, gastric tube, radiography, FAST, CT, DPL, labs --Family presence Give comfort measures (pain management) History Inspect posterior (turn patient over) SYSTEMIC EFFECTS OF HYPOTHERMIA - ANSWER>>Insulin resistance (hyperglycemia) Electrolyte and fluid shifts Shivering Skin breakdown Decreased cardiac output (up to 25%) Alteration in coagulation (platelet dysfunction) Increased risk for infection (neutrophil and macrophage functions decrease at temperatures <35C) What is cardiac output? - ANSWER>>heart rate x stroke volume CVP measures - ANSWER>>right ventricular preload PAOP measures - ANSWER>>left ventricular preload

PVR measures - ANSWER>>right ventricular afterload SVR measures - ANSWER>>left ventricular afterload WHAT DOES CARDIAC INDEX MEASURE - ANSWER>>reflects cardiac output for body surface area normal cardiac index - ANSWER>>2.5-4 L/min/m2 normal stroke volume - ANSWER>>50-100 mL/beat Normal PVR - ANSWER>>50- 250 Normal PAOP (wedge) pressure - ANSWER>>8-12 mm Hg Normal RAP - ANSWER>>2-6 mmHg Normal CAPP - ANSWER>>60- 80 normal SvO2 (mixed venous oxygen saturation) - ANSWER>>60-75% HEMODYNAMIC PROFILE FOR CARDIOGENIC SHOCK - ANSWER>>BP DOWN CVP UP PAP UP PAOP UP CO DOWN

SV DOWN

SVR UP

PVR UP

SVO2 DOWN

HEMODYNAMIC PROFILE FOR HYPOVOLEMIA - ANSWER>>BP DOWN

CVP DOWN

PAP DOWN

PAOP DOWN

CO DOWN

SV DOWN

SVR UP

PVR DOWN

SVO2 DOWN

HEMODYNAMIC PROFILE FOR SEPTIC EARLY - ANSWER>>BP DOWN

CVP DOWN

PAP DOWN

PAOP DOWN

CO UP

SV UP

SVR DOWN

PVR NO CHANGE

SVO2 UP

HEMODYNAMIC PROFILE FOR SEPTIC LATE - ANSWER>>BP DOWN

CVP DOWN

PAP DOWN

PAOP UP

CO DOWN

SV DOWN

SVR UP

PVR NO CHANGE

SVO2 DOWN

ACUTE MITRAL VALVE INSUFFICIENCY WAVE CHANGES - ANSWER>>- PAOP waveform changes appearance

• when the PA catheter balloon is inflated, giant V waves appear on the PAOP tracing "GIANT V WAVES" - ANSWER>>ACUTE MITRAL VALVE INSUFFICIENCY What is a over dampened DYNAMIC RESPONSE TEST - ANSWER>>FALSELY DECREASED SYSTOLIC AND HIGH DIASTOLIC What is a UNDER dampened DYNAMIC RESPONSE TEST - ANSWER>>FALSELY HIGH SYSTOLIC AND LOW DIASTOLIC WHAT MAY OCCUR WITH AN EPIDURAL HEMATOMA - ANSWER>>PUPIL CHANGES BEFORE CHANGE OF LOC FIRST SIGN OF NEURO CHANGE - ANSWER>>DECREASED LOC WHAT CRANIAL ASSESSES PUPILLARY RESPONSE - ANSWER>>OCOLOMOTOR III WHAT IS CUSHING TRIAD - ANSWER>>WIDENING PULSE PRESSURE, bradycardia, and respiratory depression

What is homonymous hemianopsia? - ANSWER>>-loss of one half of the field of vision on the same side in both eyes What is uncal herniation? - ANSWER>>medial portion of temporal lobe herniates through tentorium cerebelli WHAT HAPPENS WITH A UNCAL HERNIATION - ANSWER>>LATERAL SHIFT NO INITIAL CHANGE IN LOC BLOWN PUPIL SEEN BEFORE CHANGE IN LOC MOST COMMON CAUSE OF UNCAL HERNIATION - ANSWER>>epidural hematoma WHAT IS CENTRAL HERNIATION - ANSWER>>Downward shift of cerebral hemisphere, compressing the brainstem WHAT HAPPENS DURING A CENTRAL HERNIATION - ANSWER>>PUPILS BOTH DILATE BILATERAL BABINSKI REFLEX CEREBRAL EDEMA USUALLY THE CAUSE SAH REBLEED OR VASOSPASM S/S - ANSWER>>CHANGE IN LOC WHAT THERAPY IS FOR BRAIN TUMORS - ANSWER>>STERIODAL first sign of increased ICP - ANSWER>>Change in LOC NORMAL ICP - ANSWER>>0- 10