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CCRN Nicole Kupchik Practice Exam 1
Notes
ST elevation in leads II, III, aVF is a? Reciprocal changes will be seen in leads? - Correct Answers-inferior wall MI I, aVL Initial priority of care for a pt experiencing sustained tonic clonic seizures? - Correct Answers-Call for help and safely guide pt to the floor A pt presents with pneumonia and sepsis, received 4 days of abx and fluids, increasingly SOB, increase in FiO2 requirements, CXR shows b/l infiltrates. ABG is 7.20/ 68/102/28. The pt is developing? - Correct Answers-ARDS = PaO2 </ 300 PaO2/FiO2 = 102/100%(1) = 102 What is a major complication of htn crisis? - Correct Answers-Encephalopathy What labs should closely be monitored if pt is given lisinopril? - Correct Answers- Potassium bc ACE inhibitor - blocks angiotensin II - decreases aldosterone Pt with acute MI, in cardiogenic shock. BP 86/ HR 110 Cardiac Index 1. SVR 1929 What med should be given? - Correct Answers-Dobutamine bc the goal here is to improve contractility and reduce afterload What should you monitor closely post gastric bypass? - Correct Answers-HR, RR, temp, WBC and MAP Best intervention to promote safety of a pt recieving hemodialysis? - Correct Answers- Direct visualization of the connection be the machine and the access device
What mode of ventilation is this: The ventilator is set to deliver 12 breaths/ min at a set volume. The volume of the remaining 8 breaths varies. - Correct Answers-SIMV - synchronized intermittent mandatory ventilation What mode of ventilation is this: Any additional breathes taken by the pt are assisted by the ventilator to achieve the prescribed volume - Correct Answers-CMV - controlled mandatory volume A 45 yr old presents w sepsis. You administer 500 bolus of LR. What indicates that the intervention is having its intended effect? - Correct Answers-ScvO2 - 72% A pt has been receiving VTE prophylaxis with SQ heprin since admission, 6 days ago. Today, plt count decreased significantly to 43,000 and he was found to have a new DVT. What was the cause of this? - Correct Answers-HIT - Heprin induced thrombocytopenia
- drop in plt count
- new DVT Hemodynamics of R sided heart failure - Correct Answers-Decreased CO/CI Increased CVP Decreased/Normal POAP Increased SVR Labs to expect w DI - Correct Answers-Increased serum osmo Decreased urine osmo Increase serum NA There is a lack of ADH Hemodynamics of hypovolemic shock - Correct Answers-Decreased CO Decreased Preload Increased Afterload Increased SVR - to increase BP Increase in HR- to compensate for A pt w asthma exacerbation has an ABG of: 7.35/42/82/ And a RR of 38 as he uses accessory muscles. What do you suspect? - Correct Answers-Severe airflow obstruction This ABG is not normal given their RR Lab findings of a post-renal kidney injury d/t obstruction? - Correct Answers-Decreased urine output
A patient w bacterial endocarditis should be closely observed for which clinical changes? - Correct Answers-Neurological impairment A feeding tube is noted to be 35 cm at the nares but is documented to be at 75 cm at the nares. What should the RN do? - Correct Answers-Hold tube feedings and obtain and abd radiograph What kind of meds should NOT be prescribed to s/p bariatric surgery pts? - Correct Answers-Extended release meds d/t absorption concerns ex: Toprol XL What intervention to anticipate w a saddle pulmonary embolus? - Correct Answers-IV thrombolytic infusion In which situation would you hold the administration of Mannitol? - Correct Answers- Serum osmolality greater than 320 mOms/kg What are signs of hypokalemia on an EKG? - Correct Answers-U waves Bradycardia Flattening t waves What are signs of hyperkalemia on an EKG? - Correct Answers-Peaked T waves in V3- V Widened QRS Juxtaglomerular cells - Correct Answers-secretes renin (in the kidneys) when blood pressure drops Long term steroid use + stress can lead to? - Correct Answers-Secondary adrenal insufficiency Side effects of Neosynepherine? - Correct Answers-Reflexive bradycardia Treatment for pt with worsening pulmonary htn (PAH)? - Correct Answers-IV Epoprostenol (Flolan) or Treprostinil (Remodulin) PO Sildenifil (Viagra) or Bosentan (Tracleer) The kidneys release which glycoprotein hormone to increase RBC production in the bone marrow? - Correct Answers-Erythropoietin It is released when decreased lvls of O2 are detected What do kidneys release in response to low blood flow in order to increase BP and restore renal perfusion? - Correct Answers-Renin Where is aldosterone produced? - Correct Answers-adrenal cortex of adrenal gland
What does aldosterone help regulate? - Correct Answers-Helps regulating BP by reabsorbing water and NA Where is ADH released from? - Correct Answers-Pituitary gland in the brain What does ADH do? - Correct Answers-Facilitates reabsorption of water in nephron of kidney After a massive R ventricular MI, what should you initially give pt to help raise BP? - Correct Answers-500 NS bolus Description of pleuritic chest pain? - Correct Answers-Increases with inspiration and decreases when pt sits up and leans forward Monitor for _______ when giving Chlorpropamide (Diabinese)? - Correct Answers- Hypoglycemia This medication is used as an antidiuretic in DI pts but is primarily a glucose-lowering agent What to do for symptomatic bradycardia s/p cardiac transplant? - Correct Answers- Connect pericardial pacing wires to a generator and pace pt Labs in SIADH? - Correct Answers-Decreased serum osmolality (concentration) Decreased serum NA Elevated urine osmolality (concentration) What is SIADH? - Correct Answers-Involves excessive release of antidiuretic hormone - causes fluid retention, causing edema, increased urine osmolarity (concentration) and hyponatremia First priority when considering esophageal tamponade balloon (Blakemore tube) - Correct Answers-Verify balloon pressures are appropriate and at prescribed lvl Neo is ordered on a pt. RN evaluates the effectiveness of this medication based on? - Correct Answers-Increased SVR bc it causes vasoconstriction What finding contradicts thrombolytic therapy? - Correct Answers-Sudden onset of severe chest pain and back pain Uncontrolled BP of 195/ St elevation of II, III and aVF New diastolic murmur over the sternal border ^ indicate aortic dissection and should be ruled our prior to giving and thrombolytic agents
Emergent pacing is required for: - Correct Answers-2nd degree heart block Type 2 w 5 second pauses Which electrolyte needs to be assessed and optimized to facilitate muscle strength to improve chances of extubation? - Correct Answers-Phosphate Which electrolyte needs to be assessed and optimized to facilitate skeletal muscle strength? - Correct Answers-Magnesium Which electrolyte needs to be assessed and optimized to facilitate intravascular osmotic pressure? - Correct Answers-Sodium Peritoneal dialysis works on which principal? - Correct Answers-Osmosis and diffusion What is diffusion? - Correct Answers-The movement of particles from an area of high concentration to an area of low concentration. What test is most appropriate to rule our MI? - Correct Answers-Troponin I How to treat a pt with SIADH? Presenting with: Serum osmo (concentration) 256 Serum Na 120 Urine osmo (concentration) 563 Urine Na 24 - Correct Answers-1. Fluid restriction (first intervention)
- Lasix What meds are used in DI to enhance ADH? - Correct Answers-DDAVP Tegretol S/p CABG you detect muffled heart sounds, JVD, Pulses paradoxus in the arterial waveform and clear lung sounds. What is your next action? - Correct Answers-Notify cardiac surgeon These are signs of cardiac tamponade What is pulse paradoxus - Correct Answers-Decrease in SBP > 10 mm Hg during inspiration Initial treatment for HHNS? - Correct Answers-Fluid replacement w isotonic solution Potential complications of vasopressin in a pt with an upper GI bleed with a hx of CAD, type II DM and hypercholesterolemia? - Correct Answers-Myocardial ischemia and htn
In a pt w CAD, htn can increase myocardial oxygen demand. Additional vasoconstriction of coronary vessels reduces myocardial oxygen supply thus raiding the potential of acute myocardial ischemia. A pt w COPD has an ABG of: 7.34/49/ RR 28 and mildly labored SaO2 91% What is the most appropriate action? - Correct Answers-Titrate FiO2 to maintain SpO
90% Pt stops conversing w you and doesn't engage w family? - Correct Answers-Withdrawal What do you suspect if there are no fluctuations w respirations occurring in the water seal chamber? - Correct Answers-The chest tube is occluded or kinked What would you see in the chest tube chamber if air accumulated in the chest? - Correct Answers-Bubbling in the water seal chamber Can not give rtPA if BP is greater than? - Correct Answers-185/ What steps should be followed when setting up an A-line transducer? - Correct Answers-Level at phlebostatic axis (4th intracoastal space) with the HOB 0-60 degrees What drug decreases mortality and slows cardiac remodeling? - Correct Answers-ACE inhibitors Ex: captopril, enalapril, lisinopril Reversal agent for warfarin is? - Correct Answers-Vitamin K Reversal agent for Heprin is? - Correct Answers-Protamine What injury is not seen on CXR immediately after accident, but can lead to rapid development of ARDS? - Correct Answers-Blossoming pulmonary contusions A pt w pneumonia and sepsis has not developed fine crackles in b/l lower lobes and has a S3 heart sound (ventricular gallop). What med will this pt be given? - Correct Answers-Lasix 40mg S4 heart sound (atrial gallop) "believe me" represents: - Correct Answers-Ventricles are non-compliant w atrium Ex: ischemia, CAD, L ventricular hypertrophy, htn, pulmonary stenosis
What is the appropriate action? - Correct Answers-Examine the catheter tubing for obstruction bc the pt could be experiencing autonomic hyperreflexia. This disorder is seen in spinal injuries above T6. According to the ACC/AHA Guidlines for Managment of Heart Failure, you should educate a pt post MI on? - Correct Answers-Betablockers ACE inhibitors Statins Purpose of a Z point technique when obtaining a PAOP? - Correct Answers-Can be used to estimate the ventricular end diastolic pressure Immediate intervention to improve BP in ESLD pt? - Correct Answers-Position pt on his (left) side What lab value changes should be anticipated in DIC (disseminated intravascular coagulation)? - Correct Answers-Fibrinogen decreased Platelets decreased Fibrin split products elevated D-dimer elevated What causes a shift to the left on the oxyhemoglobin dissociation curve? - Correct Answers-Alkalosis Hemodynamic state of the hyperdynamic stage of septic shock? - Correct Answers- Increased CO Decreased SVR Decreased PAOP Decreased CVP Poor wound healing is associated with? - Correct Answers-Decreased albumin is an indicator of protein deficiency and poor nutrition You should anticipate which of the following diagnostic to investigate the new murmur, hypotension, rapid breathing and desaturation? - Correct Answers-Echocardiogram and cardiac surgery A Lorazepam infusion causes a metabolic acidosis d/t the accumulation of? - Correct Answers-Propylene glycol The ICP (from a ventriculostomy) is trending up from 6 to 17 mm Hg over the last 4 hours. The best initial intervention is to: - Correct Answers-Elevate HOB to 45 degrees An ICU admission is warranted for an acute asthma exacerbation pt if: - Correct Answers-The pt is unable to communicate in full sentences
What should be your first action for a low pressure alarm on a ventilator? - Correct Answers-Silence the alarm and assess the patient What's the primary principle in managing metabolic acidosis? - Correct Answers- Sodium bicarbonate should be administered with caution to avoid overcorrection What describes ultrafiltration in CRRT? - Correct Answers-Movement of water across a semipermeable membrane using a pressure gradient What is hyperosmolar hyperglycemia syndrome (HHS)? - Correct Answers-- severe hyperglycemia but don't have the ketones in the urine
- has enough insulin A cardinal sign of HHS is? - Correct Answers-Elevated serum glucose and altered mental status ST segment elevations in leads V1-V4 indicated an occlusion in which coronary artery?
- Correct Answers-LAD In a pt w aortic stenosis you can expect which of the following upon exam? - Correct Answers-Systolic murmur What valves are open during systole? - Correct Answers-aortic and pulmonic What valves are open during diastole? - Correct Answers-tricuspid and mitral A pt has sustained blunt chest injury. The pt develops dyspnea and confusion and has distant heart sounds with a drop in BP. The pt now has visible JVD. The cause may be:
- Correct Answers-Cardiac tamponade What EKG changes would be most alarming prior to the placement of an AV fistula? - Correct Answers-Elevated ST segment The major risk of severe thrombocytopenia? - Correct Answers-Intracranial hemorrhage Medications for SAH w increased ICP - Correct Answers-Osmotic diuretics Hypertonic saline Antihypertensives
