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FCCN level 1 Exam With Complete
Solutions.
minimum urine output for adult - CORRECT ANSWER>>0.5mL/kg/hr
ADH (antidiuretic hormone) - CORRECT ANSWER>>- water retainer
- vasoconstrictor (also called Vasopressin)
- produced by hypothalamus
- store and released from posterior pituitary
ADH pathway - CORRECT ANSWER>>- hypothalamus senses low blood volumed and increased serum osmolality
- signal pituitary to release ADH
- ADH causes kidney to retain water
- water retention increases blood volume and decreases serum osmolality
ANP (atrial natriuretic peptide) - CORRECT ANSWER>>- cardiac hormone stored in atria
- released when atrial pressure increases
*works opposite of RAAS by decreasing BP and reducing intravascular volume
- important diagnostic marker in CHF
hydrostatic pressure - CORRECT ANSWER>>- forces fluids and solutes through the capillary wall and into the tissue spaces
colloid osmotic pressure - CORRECT ANSWER>>- pulling force of albumin in the intravascular spaces
- pull fluid into vasculature
maintenance fluid therapy - CORRECT ANSWER>>- replaces normal ongoing losses of water and electrolytes (urine, sweat, respiration, stool)
replacement therapy - CORRECT ANSWER>>- corrects any existing water and or electrolyte deficits
isotonic fluids - CORRECT ANSWER>>- tonicity equal to plasma in the body
- no fluid shifts because the solutions are equally concentrated
- LR
- NS
- D5W
hypotonic fluids - CORRECT ANSWER>>- lower concentration of solutes in the vasculature than in the cell
- fluid shifts into the cell to dilute the electrolytes (CELL SWELLS)
- 0.45NS
hypertonic fluid - CORRECT ANSWER>>- higher concentration of solutes in the vasculature than in the cell
- pulls fluid out of cells and into the vessels (CELL SHRINKS)
- D5 .45NS
- D5NS
- D5LR
- 3%, 7%, 23.4% NaCl
colloids - CORRECT ANSWER>>- pull fluid into bloodstream
Albumin
- 5% is osmotically equal to plasma
- 25% draws 4 times the normal volume into the circulation
blood - CORRECT ANSWER>>- not a risk free fluid replacement
- this is liquid transplant
third spacing - CORRECT ANSWER>>- fluid is not lost from the body but the fluid is not available for use in the intracellular or extracellular compartments (fluid is in between tissues/cells)
this patient is intravascularly dry and still needs more fluid
IV insulin and 50% dextrose to shift K into cells
kayexelate (fecal excretion of K)
dialysis for ARF
hypocalcemia - CORRECT ANSWER>>8.5 - 10.
- tetany
- muscle cramps
- trousseau's and chvosteks sign
- colicky abdominal pain
treating hypocalcemia - CORRECT ANSWER>>- IV calcium gluconate or calcium chloride (CENTRAL LINE)
- consider seizure precautions
- replace Mg in addition to Ca because pt might not respond to Ca treatment
hypercalcemia - CORRECT ANSWER>>caused by
- cancers and hyperparathyroidism
- excessive Ca and Vit. D supplements
- muscle weakness
- depressed CNS (confusion)
- dysrhythmias (prolong QT, AV block)
- abdominal pain
treating hypercalcemia - CORRECT ANSWER>>- administer IV NS to promote diuresis
- administer loop diuretics
- corticosteroids to decrease absorption from GI
- phosphates to decrease breakdown of bones by inhibiting release
- dialysis
hypomagnesemia - CORRECT ANSWER>>- tetany
- weakness
- confusion
- ECG changes (wide QRS, prolong PR/QT)
treating hypomagnesemia - CORRECT ANSWER>>- CPR
hypomagnesemia and digoxin - CORRECT ANSWER>>- low MG increases pharmacologic action of digoxin
- look for N/V, bradycardia, AV block, yellow tinged vision
hypermagenesemia - CORRECT ANSWER>>- take too many antacids or laxatives
- respiratory depression
- muscle relaxation
hypophosphatemia - CORRECT ANSWER>>- cause by hyperparathyroidism, chronic diarrhea, long term diuretic use, malnutrition and severe burns
- muscle weakness
- impaired cardiac function
- poor tissue oxygenation
- failure to wean from mechanical ventilation
- depressed CNS - confusion
treating low phosphorus - CORRECT ANSWER>>- increase intake of phos rich food
- IV
- assess for hypercalcemia
- consider Mg replacement simultaneously
hyperphosphatemia - CORRECT ANSWER>>- this is rare except for people with severe kidney dysfunction
- stroke
- heart attack
- poor circulation
- calcium combines with phosphate to form crystals that calcify on walls of vessels and heart
- crystals can form on skin too causing severe itching
order for electrolyte replacement therapy - CORRECT ANSWER>>1. Mg
- K
- phosphorus
- Ca
physical assessment of perfusion - CORRECT ANSWER>>- pulses
contractility = Squeeze of the heart
preload - CORRECT ANSWER>>- amount of fluid that is returning to the heart
- edema is not a part of intravascular volume
- you can have a lot of edema and be dehydrated at the same time
how constriction/dilation affected preload - CORRECT ANSWER>>dilation = less preload (more dry)
constriction = more preload (more wet)
optimizing perfusion - preload - CORRECT ANSWER>>low preload = give fluid (blood, fluids, colloids)
high preload = give diuretics/vasodilators/dialysis
your patient is experiencing angina, the provider orders nitroglycerin. what do you anticipate will happen
a. blood pressure will drecrease b. preload will increase c. preload will decrease d. A and C - CORRECT ANSWER>>D
optimizing perfusion - afterload - CORRECT ANSWER>>- since the heart ejects into the arteries....the arteries affect the afterload
- constricted = more resistance and decreased CO
- dilated = less resistance and increased CO
high afterload - CORRECT ANSWER>>- constricted arteries
- physical assessment (cool extremities, pale, mottled
- treat = dilate arteries (ACE inhibitors, ARBs, morphine, rewarm patient)
SOO how to optimize perfusion - CORRECT ANSWER>>1. consider fluid status
- consider how clamped down the patient is
- consider squeeze of the heart
low afterload - CORRECT ANSWER>>- low resistance = dilated arteries
- caused by sepsis, neurogenic shock
- physical = flushed and red skin, low BP
- treatment = ICU for vasopressors
the patient has developed new coarse crackles, SOB, and JVD. he has a hx of CHF and pitting edema in the extremities. all of the assessments indicate he has high preload EXCEPT
a. course crackles b. SOB c. JVD d. edema - CORRECT ANSWER>>d
Pt. has dry mouth, tachycardia and low UO after diuresing 1.5 L from lasix. he has weak pedal pulses and pale lower extremities. Which best describes his hemodynamics
a. high preload and vasodilated b. high preload and vasoconstricted c. low preload and dilated d. low preload and constricted - CORRECT ANSWER>>d
what is blood pressure - CORRECT ANSWER>>- MAP = CO x SVR
- increase in CO or SVR will increase MAP and vice versa
- patient with MAP of 60 can have high or low CO and high or low SVR
a good BP does not mean good perfusion
V1 and V2 look at what part of the heart - CORRECT ANSWER>>- septum
V3 and V4 look at what part of the heart - CORRECT ANSWER>>- anterior
V5 and V6 look at what part of the heart - CORRECT ANSWER>>- lateral
stable angina - CORRECT ANSWER>>- imbalance of O2 delivery and O2 demand
- caused by plaque in vessels
unstable angina - CORRECT ANSWER>>- occurs with plaque rupture
NSTEMI - CORRECT ANSWER>>- non full thickness infarction of myocardium
- slight increase in troponins
STEMI - CORRECT ANSWER>>- full thickness infarction of myocardium
Ischemia ECG - CORRECT ANSWER>>- flipped T wave
injury ECG - CORRECT ANSWER>>- ST elevation
infarction ECG - CORRECT ANSWER>>- Q waves form after 24 hrs of infarction
ST depression - CORRECT ANSWER>>- ISCHEMIA
ST elevation - CORRECT ANSWER>>- INJURY
what to do in torsades - CORRECT ANSWER>>- give Mg Sulfate
what drugs lengthen QTc - CORRECT ANSWER>>- antiarrhythmics
- antipsychotics
- antidepressants
where do we monitor bundle branch blocks - CORRECT ANSWER>>- V
what does a LBBB look like - CORRECT ANSWER>>- inverted and wide QRS and elevated T or opposite
what does a RBBB look like - CORRECT ANSWER>>- rSR bunny ear pattern
- wide QRS
- inverted T waves
chronotrope - CORRECT ANSWER>>- affect HR
inotrope - CORRECT ANSWER>>- affect squeeze
ACE inhibitors - CORRECT ANSWER>>- initial dose can drop BP dramatically
- subsequent double dosing shold not drop the BP significantly -- BP is not a good parameter for finding effective dose for HF patient
commone causes for INR increase - CORRECT ANSWER>>- hepatic congestion from RHF decreases liver production of vitamin K dependent clotting factors
- infection and hyperthyroidism increase break down of clotting factors
- poor oral intake of vitamin K
Heparin nomagram system - CORRECT ANSWER>>HNS will only accept Anti-Xa results that were drawn at least 4 hrs after heparin start or dose change
Heparin was stopped yesterday because Anti-Xa was in range. provider wants to resume heparin. what dose do you use? - CORRECT ANSWER>>- go back to last dose where Anti-Xa was in goal
calcium channel blockers - dihydropyridines - CORRECT ANSWER>>- potent vasodilators that do not normally effect contractility or conduction
calcium channel blockers - non dihydropyridines - CORRECT ANSWER>>- effect the AV node and are used to treat HTN and cardiac arrhythmias
meds to Hold before dialysis - CORRECT ANSWER>>- antibiotics
- diuretics
- short acting antihypertensives
- once a day meds like vitamins and aspirin
leading causes of CKD - CORRECT ANSWER>>1. diabetes
- HTN
best time for blood transfusion to dialysis pt - CORRECT ANSWER>>- during dialysis
how long to wait to draw labs after dialysis - CORRECT ANSWER>>- 2 hrs
ultrafiltration - CORRECT ANSWER>>- removes fluid
AV fistula - CORRECT ANSWER>>- listen for bruit
- feel for thrill
- requires 2 to 3 months to heal before using
- lasts longest
- fewest infections
- fewest clotting problems
can a dialysis catheter be used as IV access during a code - CORRECT ANSWER>>- yes
creatinine - CORRECT ANSWER>>- gold standard for measuring kidney function
treatment options for kidney failure - CORRECT ANSWER>>- hemodialysis
- peritoneal dialysis
- CRRT
- kidney transplant
- no treatment
AV graft - CORRECT ANSWER>>- synthetic graft material that connects artery to vein
- 4 to 8 weeks to heal
- increased risk for clotting and infection
renal diet - CORRECT ANSWER>>- restrict Na, K, PHos, and fluid
- normal protein is controlled depending on stage and treatment
high K foods - CORRECT ANSWER>>- oranges
- strawberries
- bananas
- tomatoes
- potatoes
- dairy
high PHos foods - CORRECT ANSWER>>- dairy
- cola
- whole grain
- chocolate
- beer
acute kidney injury - CORRECT ANSWER>>- decreased kidney function within 48 hrs
- UO < 0.5 ml/kg/hr for 6 to 12 hrs
determinants of renal function - CORRECT ANSWER>>- renal perfusion
- tubular function
- post renal structure
4 phases of AKI - CORRECT ANSWER>>- onset
- oliguric
- diuretic = indicates return of tubular function
- recovery
prerenal renal failure - CORRECT ANSWER>>- perfusion problem
- there is decreased renal perfusion
- nephrons are fully intact
- if not reversed...can lead to permanent damage
causes of prerenal renal failure - CORRECT ANSWER>>- decreased intravascular volume (bleeding, vomiting, diarrhea, sepsis)
- decreased cardiac function, CO
- vasodilation = sepsis and anaphylaxis
- abdominal compartment syndrome
treating intrarenal failure - CORRECT ANSWER>>- maintain fluid balance
- prevent further damage
- manage complications
postrenal failure - CORRECT ANSWER>>- partial or complete obstruction of urinary tract that affects normal flow of urine out of kidney
assessment for postrenal failure - CORRECT ANSWER>>- oliguric or anuric
lab values for post renal failure - CORRECT ANSWER>>- BUN and creatinine elevated
- no proteinuria
- variable Na
- variable specific gravity
treating post renal failure - CORRECT ANSWER>>- KUB scan or ultrasound to locate obstruction
