Critical Care Exam: BKAT ICU Post-Test Questions and Answers, Exams of Nursing

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BKAT CRITICAL CARE EXAM | BKAT ICU POST TEST

| ALL QUESTIONS AND CORRECT ANSWERS |

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ANSWERS

Is medication that is excreted through the kidneys increased or decreased in dosage for patients in acute renal failure? ---------CORRECT ANSWER--- --------------Decreased Recommended renal diet ---------CORRECT ANSWER-----------------Low Na+, low phosphorus, and low protein Sudden development of dyspnea and tachycardia in acute renal failure patients in most indicative of what? ---------CORRECT ANSWER--------------- --Fluid overload Low intermittent suction is used with OGT and NGT to do what? --------- CORRECT ANSWER-----------------Decompress the stomach and prevent vomiting Best way to confirm OGT/NGT placement ---------CORRECT ANSWER------ -----------X-ray "Coffee ground" NGT aspirate may indicate what? ---------CORRECT ANSWER-----------------Bleeding that has occurred in the recent past and become partially digested

Signs and symptoms of blood transfusion reactions ---------CORRECT ANSWER-----------------Back pain, dark urine, chills, fainting, dizziness, fever, flank pain, skin flushing, and shortness of breath Most important treatment in burn patients with 24 hours following airway securment ---------CORRECT ANSWER-----------------IV fluid resuscitation Why should a hypothermic patient not be rapidly re-warmed? --------- CORRECT ANSWER-----------------Rebound increased ICP True or false: A medical power of attorney gives the person the right to make all medical decisions for the patient while in critical care? --------- CORRECT ANSWER-----------------False ACLS rhythms that amiodarone is used to treat ---------CORRECT ANSWER-----------------V-fib and pulseless v-tach Amiodarone dosage for ACLS ---------CORRECT ANSWER----------------- 300 mg Signs and symptoms of cyanide toxicity ---------CORRECT ANSWER--------- --------Mental status changes, tachycardia, seizure, a need for an increase in dose, and unexplained metabolic acidosis

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

diltiazem (cardizem) works by? ---------CORRECT ANSWER----------------- (calcium channel blocker) slows ventricular rate by slowing conduction through the SA and AV node Diltazem (cardizem) biggest effect on which hemodynamic --------- CORRECT ANSWER-----------------hypotension diltazem is used for patients with ---------CORRECT ANSWER----------------- a-fib or a-flutter amiodarone (Cordarone) is a ---------CORRECT ANSWER----------------- antiarrythmic prolongs the cardiac duration You MUST use a __________ when using amiodarone infusion --------- CORRECT ANSWER-----------------0.22 micron filter Watch out for ____________ in patients on a amiodarone infusion --------- CORRECT ANSWER-----------------hypotension, prolongation of QT interval and bradycardia amiodarone is used for patients with ---------CORRECT ANSWER------------- ----a-fib, a-flutter and VT

how much amiodarone is given to a stable VT with a pulse and a unstable pulseless VT/VF? ---------CORRECT ANSWER-----------------150mg over 10min for VT with pulse 300mg push; repeat x1 at 150mg Epinephrine has what effect on the body? ---------CORRECT ANSWER------ -----------increases HR, BP, and contractility what is the first line drug for pulseless arrest? ---------CORRECT ANSWER- ----------------Epinephrine What rhythms are considered fatal? ---------CORRECT ANSWER-------------- ---V-fib, Vtach (pulseless), and asystole Epinephrine is also given for? ---------CORRECT ANSWER----------------- anaphylaxis and as a vasopressor for hypotension Heparin is used for? Antidote is? ---------CORRECT ANSWER----------------- anticoagulant Protamine Sulfate What is the osmotic diuretic of choice to decrease intracranial pressure? --- ------CORRECT ANSWER-----------------mannitol

How does mannitol work? ---------CORRECT ANSWER-----------------pulls fluids into intravascular space to be excreted by the kidneys to reduce intracranial pressure what insulin is given IV? What is the peak? ---------CORRECT ANSWER-----------------Regular insulin can only be given IV 2 - 4 hr peak time Which insulin has a peak of 8-14 hrs? ---------CORRECT ANSWER----------- ------NPH Atropine is ineffective in which heart rhythms types? ---------CORRECT ANSWER-----------------high degree AV blocks: 2nd degree type2 and 3rd degree Atropine works by? ---------CORRECT ANSWER-----------------increasing heart rate-increasing conduction through SA node Atropine is given to treat? ---------CORRECT ANSWER----------------- symptomatic bradycardia Dilantin is given to treat ---------CORRECT ANSWER-----------------seizure disorders

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

Digoxin WILL NOT cause rapid AV conduction or hypertension --------- CORRECT ANSWER-----------------True what medication is a antiarrhythmic that suppresses automaticity and depolarization? ---------CORRECT ANSWER-----------------lidocaine Lidocaine is used to treat? ---------CORRECT ANSWER----------------- ventricular dysrhythmias lidocaine toxicity sign ---------CORRECT ANSWER-----------------mental confusion/change in LOC Monitor serum levels with _________ ---------CORRECT ANSWER----------- ------Lidocaine DO NOT give _______ medications to patients with suppressed respirations ---------CORRECT ANSWER-----------------Narcotics (morphine, dilaudid) What changes on a EKG would you expect to see on a patient with a acute MI? ---------CORRECT ANSWER-----------------ST elevation normal QRS: Prolonged QRS indicates: ---------CORRECT ANSWER-----------------<0. seconds is normal QRS

prolonged QRS indicates intraventricular conduction defect, typically a bundle branch block Distinguishing V-fib ---------CORRECT ANSWER-----------------fibrillatory waves with no recognizable pattern Defib the Vfib Distinguishing V-Tach ---------CORRECT ANSWER-----------------atrial rhythm and rate cannot be identified "Tombstones" First degree block interpretation ---------CORRECT ANSWER----------------- 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 ---------CORRECT ANSWER----- ------------"Wenckebach" "Longer, Longer... drop" prolonged PR intervals and the missing QRS Type 2 second degree block interpretation ---------CORRECT ANSWER----- ------------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 ---------CORRECT ANSWER------------- ----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 ---------CORRECT ANSWER-----------------abnormal p-waves that produce a saw-tooth appearance Failure to Capture interpreation ---------CORRECT ANSWER----------------- spike without a complex Failure to Pace interpretation ---------CORRECT ANSWER-----------------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 ---------CORRECT ANSWER-----------------undersensing: giving help when not needed; spikes occur on the ECG where they shouldnt Pacemaker ECG rhythms ---------CORRECT ANSWER-----------------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 ---------CORRECT ANSWER-------- ---------R on T phenomenon

Indications for a pacemaker? ---------CORRECT ANSWER----------------- symptomatic bradycardia higher AV blocks (2nd degree type 2 or Complete) what is not a treatment for higher degree AV blocks ---------CORRECT ANSWER-----------------atropine because of the impaired conduction through the AV node A-flutter happens because? ---------CORRECT ANSWER-----------------an irritable spot of the atrium fires rapidly A-flutter can cause _______ ---------CORRECT ANSWER-----------------an increase in ventricular rate A-flutter is treated by: ---------CORRECT ANSWER----------------- antiarrhythmics (cardizem, beta blockers) cardioversion What do you do if you notice a lethal rhythm on the monitor (VT/VF)? --------

• CORRECT ANSWER-----------------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. ---------CORRECT ANSWER----------------- 200 360

Normal PR interval is ---------CORRECT ANSWER-----------------0.12-0. seconds Patient presents with anginal pectoris. what is initial management? --------- CORRECT ANSWER-----------------allow rest, amdinister oxygen, nitroglycerin, etc. Causes of elevated cardiac enzymes ---------CORRECT ANSWER------------ -----MI, pericarditis, closed chest trauma, cardiac surgery Goal of treatment for cardiogenic shock (any shock) ---------CORRECT ANSWER-----------------increase the patient's cardiac output A patient exhibits depression after their recent MI, you should --------- CORRECT ANSWER-----------------encourage the patient to verbalize their concerns and allow interaction with family How does a cardiac tamponade occur ---------CORRECT ANSWER----------- ------blood or fluid accumulates in the pericardial space what does a cardiac tamponade do to the heart ---------CORRECT ANSWER-----------------prevents the heart to pump effectively (impaired ventricular filling and contraction)

S/S of cardiac tamponade ---------CORRECT ANSWER-----------------pulsus paradoxus, decreased BP, JVD, tachycardia, muffled heart sounds PAP values ---------CORRECT ANSWER-----------------Systolic: 15- 25 Diastolic: 8- 18 PAOP (wedge) ---------CORRECT ANSWER----------------- 6 - 12 PA Catheter waveforms ---------CORRECT ANSWER----------------- PAOP (wedge) reflects pressures in the ---------CORRECT ANSWER-------- ---------left ventricle An elevated PAOP may indicate ---------CORRECT ANSWER----------------- left ventricular failure If you notice a continual PAOP wave form is present you should --------- CORRECT ANSWER-----------------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 ---------CORRECT ANSWER-----------------Flush the line

What reading reflects the right atrium ---------CORRECT ANSWER------------ -----CVP An elevated CVP may indicate ---------CORRECT ANSWER----------------- fluid overload, right ventricular failure, pulmonary HTN, cardiac tamponade Eventually ______ sided heart failure will lead to an elevated _______. ----- ----CORRECT ANSWER-----------------right sided HF will eventually lead to increased CVP decreased CVP can be from ---------CORRECT ANSWER----------------- hypovolemia True/False Medication can be administered through an a-line ---------CORRECT ANSWER-----------------False: no medications are to be given via a-line Arterial line waveform:

• Overdampened
• Underdampened ---------CORRECT ANSWER------------------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 --------- CORRECT ANSWER----------------- 5 - 10 minutes

Why would a ventilators high pressure alarm be sounding --------- CORRECT ANSWER-----------------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 ---------CORRECT ANSWER-----------------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..... ---------CORRECT ANSWER------------------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 --------- CORRECT ANSWER-----------------diminished After a patient is intubated you should? ---------CORRECT ANSWER--------- --------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 --------- CORRECT ANSWER-----------------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.... ---------CORRECT ANSWER-----------------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 ---------CORRECT ANSWER-----------------pneumothorax impaired gas exchange, SOB S/s of tension pneumothorax ---------CORRECT ANSWER----------------- deviated trachea, acute respiratory distress trauma patients are at risk for developing _____ embolisms, especially those with long bone fractures. ---------CORRECT ANSWER-----------------fat S/s of fat embolus ---------CORRECT ANSWER-----------------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 ____________ ---------CORRECT ANSWER-----------------hypoventilation

ABG Interpretation ---------CORRECT ANSWER-----------------pH: 7.35-7. PaCO2: 35- 45 HCO3: 22- 26 (ROME) What antibiotics are given to TB patients ---------CORRECT ANSWER------- ----------INH, Rifampin, Rocephin What antibiotics should be renal-dosed ---------CORRECT ANSWER--------- --------Vancomycin, gentamycin, and tobramycin Before suctioning a patient be sure the vacuum pressure is set to --------- CORRECT ANSWER----------------- 120 PPE for suctioning with a open sterile system ---------CORRECT ANSWER- ----------------mask, eye protection, gloves Most important intervention for a patient with cervical spinal cord injury is to ---------CORRECT ANSWER-----------------immobilize the head and neck You have just received an patient with a high level SCI what are you concerned with and why ---------CORRECT ANSWER----------------- respirations high level spinal cord injuries could lead to paralysis/dysfunction of the respiratory muscles and cause respiratory arrest

What is an early sign of increased ICP ---------CORRECT ANSWER---------- -------change in LOC treatment for increased ICP ---------CORRECT ANSWER-----------------keep HOB 30, keep patient calm/quiet, avoid suctioning, avoid hip flexion, medications to decrease What medications may help decrease ICP ---------CORRECT ANSWER----- ------------mannitol and hypertonic saline List interventions made the RN during the acute phase of a stroke --------- CORRECT ANSWER------------------minimize stimulation, provide quiet enviornment

• control secretions
• prevent injuries
• monitor for seizures
• close assessment of neurologic Is a positive babinski normal in adults? ---------CORRECT ANSWER---------- -------positive babinski is a dorsiflexion (upward) of toes. it is abnormal in patients >1 yr it indicates lesion of corticospinal tract What is the most important part of a neuro assessment ---------CORRECT ANSWER-----------------LOC ________ ________ is a common complication of any kind of neurologic surgery. ---------CORRECT ANSWER-----------------Diabetes Insipidus

S/S of diabetes insipidus ---------CORRECT ANSWER----------------- increased UOP, dehydration, thirst, relative hypernatremia S/s of DKA ---------CORRECT ANSWER-----------------fruity breath, deep/rapid breathing in effort to blow off CO2. elevated blood glucose, dehydration, polyuria, thirst, metabolic acidosis Treatment for DKA ---------CORRECT ANSWER-----------------IV insulin, fluid replacement, potassium replacement as acidosis is corrected, corrected acidosis If you suspect hypoglycemia interventions would be ---------CORRECT ANSWER-----------------check the glucose give oral glucose containing substance (if appropriate) monitor vital signs Patient with DM who are acutely ill generally require _____ doses of insulin due to _______ response - --------CORRECT ANSWER-----------------higher doses of insulin due to stress response peak action of regular and NPH ---------CORRECT ANSWER----------------- 2 - 4 is regular 8 - 14 is NPH

glucocorticoids: ---------CORRECT ANSWER------------------increase ADH productiona and aldosterone leading to sodium and water retention and decreased UOP

• increase blood glucose Normal adult UOP ---------CORRECT ANSWER-----------------30ml/hr what lab value is the best indicator of renal function ---------CORRECT ANSWER-----------------creatinine Your patient with acute renal failure is ST with JVD, and their labs show a K+ (5.9) Na+ (150), they have 3+ edema. What is up> ---------CORRECT ANSWER-----------------fluid overloaded and electrolyte imbalance Lab values for BUN and Creatinine K+ ---------CORRECT ANSWER-----------------BUN 10- 20 Creatinine < K+ 3.5-4. Renal failure diet consist of ---------CORRECT ANSWER-----------------low protein, low K+, low Na+, and a volume restriction Your patient has a NG tube you should keep the HOB ---------CORRECT ANSWER----------------->/30 degress to prevent aspiration

EKG changes in hyperkalemia would present as ---------CORRECT ANSWER-----------------tall peaked t-waves, wide QRS Urine specific gravity is ---------CORRECT ANSWER-----------------1.003- 1.030 How do you check placement of NG tube ---------CORRECT ANSWER------- ----------auscultation/ph fluid but first CXR Coffee ground material in NG tube may indicate blood. you should do what with this drainage ---------CORRECT ANSWER-----------------have it tested for blood low intermittent suction is used for: ---------CORRECT ANSWER--------------- --preventing aspirations, reducing abdominal distention, to facilitate drainage with absent bowel sounds or decreased motility True/False you should use low intermittent suction to control bleeding --------- CORRECT ANSWER-----------------False it can make it worse in active GI bleed Cold gastric lavage- you would use ---------CORRECT ANSWER--------------- --isotonic fluid (NS) not distilled water

What is the earliest detection of gastric bleeding in patients with gastric tubes? ---------CORRECT ANSWER-----------------check the gastric contents for microscopic blood Explain advanced directives:

• living will
• Healthcare power of attorney ---------CORRECT ANSWER----------------- living will indicates what care/procedures the patient would choose if unable to make decisions healthcare POA appoints a person to make decisions regarding care blood transfusion reactions
• symptoms
• treatment ---------CORRECT ANSWER-----------------increased temperature, low back pain, chills if you suspect reaction STOP the transfusion a burn patient's most important treatment is during the first ___ hrs with _________ _________ ---------CORRECT ANSWER-----------------24 hrs with fluid resuscitation infection control intervention for a healthcare worker *most important --------
• CORRECT ANSWER-----------------hand hygeine with obese patients it is important to remember the safety of the ____ and pt ---------CORRECT ANSWER-----------------nurse and patient

when rewarming a hypothermic patient you would do this __________ to prevent _____ and _____ ---------CORRECT ANSWER-----------------slowly to prevent vasodilation and hypotention Total patient care involves ---------CORRECT ANSWER----------------- spiritual and emotional needs as well as physical NEVER tell a patient ---------CORRECT ANSWER-----------------everything will be alright Normal Central Venous Pressure (CVP) range ---------CORRECT ANSWER----------------- 2 - 8 mmHg Normal Pulmonary Artery Occlusion Pressure (PAOP) range --------- CORRECT ANSWER----------------- 6 - 12 mmHg Normal Pulmonary Artery Systolic (PAS) range ---------CORRECT ANSWER----------------- 20 - 30 mmHg Normal Pulmonary Artery Diastolic (PAD) range ---------CORRECT ANSWER----------------- 5 - 15 mmHg Normal Pulmonary Artery Mean (PAM) ---------CORRECT ANSWER---------- ------- 11 - 20 mmHg

Normal Systemic Vascular Resistance (SVR) range ---------CORRECT ANSWER----------------- 800 - 1200 mmHg Preload ---------CORRECT ANSWER-----------------volume left in the left ventricle at the end of diastole What is preload affected by? ---------CORRECT ANSWER----------------- venous return to the heart, atrial kick, total volume, and ventricular compliance What drugs can affect preload? ---------CORRECT ANSWER----------------- Furosemide and nitroglycerin Afterload ---------CORRECT ANSWER-----------------Amount of pressure heart has to overcome to pump blood out What drugs may affect afterload? ---------CORRECT ANSWER----------------- Vasoconstricters and vasodilators Contractility ---------CORRECT ANSWER-----------------the contractile force of the heart, how much will it take to move the preload out against the afterload What is the appropriate hold time after pulling an arterial line? --------- CORRECT ANSWER----------------- 5 - 10 min

What part of the heart does the PAOP affect? ---------CORRECT ANSWER- ----------------Left ventricle What part of the heart does the CVP affect? ---------CORRECT ANSWER--- --------------Right ventricle What does it mean when the PAOP is elevated? ---------CORRECT ANSWER-----------------Increased left ventricular end diastolic pressure that could be indicative of left ventricular dysfunction or failure What does it mean if CVP is elevated? ---------CORRECT ANSWER---------- -------Fluid overload or decreased compliance (such as with ARDS and COPD) Difference between stable and unstable angina ---------CORRECT ANSWER-----------------Stable angina: pain happens with certain activities but then goes away with rest. Unstable angina: chest pain can occur at rest, becomes more sever or frequent, or lasts longer ECG changes with an acute MI? ---------CORRECT ANSWER----------------- ST elevation or depression ECG changes with hyperkalemia ---------CORRECT ANSWER----------------- Peaked T waves