Download Review Exam - Version B Questions With Complete Solutions and more Exams Health sciences in PDF only on Docsity! FPC / CFRN - Review Exam - Version B Questions With Complete Solutions Myxedema coma is also known as... A. Thyroid storm B. Adrenal insufficiency C. Hypothyroidism D. Hyperaldosteronism - CORRECT ANSWERHypothyroidism Most common presentation of a patient with hypothyroidism are all of the following, Except... A. Cold intolerance with coarse hair B. Almost exclusively over the age of sixty C. >90% of cases occur in the winter D. Primarily in men - CORRECT ANSWERPrimarily in men Hypothroidism occurs primarily in women, almost exclusively over the age of sixty, with 90% of the cases occurring in the winter months. Your patient presents with following parameters: CVP 0, CI 1, PA S/D 8/4, wedge 3, and SVR 1,800. What is your diagnosis? A. Hypovolemic shock B. Right ventricular infarction C. CHF D. Sepsis - CORRECT ANSWERHypovolemic shock Careful interpretation of the CVP is important! Central venous pressure (CVP) describes the pressure of blood in the thoracic vena cava, near the right atrium of the heart. CVP reflects the amount of blood returning to the heart and the ability of the heart to pump the blood into the arterial system. Drug of choice for profound hypotension in septic shock is? A. Isotonic crystalloid solution B. Levophed C. Nipride D. Dobutamine - CORRECT ANSWERLevophed Sepsis is by far the most common cause of distributive shock. The average normal ICP range is... FPC / CFRN - Review Exam - Version B Questions With Complete Solutions A. 0-10 mmHg B. 10-20 mmHg C. 20-30 mmHg D. >30 mmHg - CORRECT ANSWERNormal ICP range is 0-10 mmHg, but range can go as high as 15 mmHg. The formula to calculate MAP is A. 2/3 DBP × SBP B. 2 × DBP + SBP divided by 3 C. 2 × SBP + DBP D. 2 + DBP × SBP divided by 3 - CORRECT ANSWER2 × DBP + SBP / 3 (normal 80-100 mmHg) Normal coronary perfusion pressure (CPP) is A. 50-60 mmHg B. 70-90 mmHg C. 80-100 mmHg D. <50 mmHg - CORRECT ANSWERNormal 50-60 mmHg Coronary perfusion pressure: (CPP) = DBP-PAWP The patient presents with the following hemodynamic parameters: CVP 1, CI 1.7, PA S/D 12/6, wedge 6, and SVR 300. Vital signs are 78/40, HR 60, RR 16, SaO2 98%. The most likely cause is... A. RVMI B. Neurogenic shock C. Septic shock D. Hypovolemic shock - CORRECT ANSWERNeurogenic shock SVR < 800, think distributive shock. Next look at the CI; is it less than 2.5? Hypotension and either a normal heart and/or bradycardia present narrows the type of distributive shock as being neurogenic shock. Severe hypothermic Pt's are at highest risk for which of the following rhythm? A. A-Fib B. Asystole C. V-Fib D. Sinus Brady - CORRECT ANSWERV-Fib Severe: 20-28 (coma, VF common) FPC / CFRN - Review Exam - Version B Questions With Complete Solutions Bowel cleansing is the mainstay of therapy for hepatic encephalopathy. Evacuation of gutderived toxins (intestinal blood, bacteria) and administration of Lactulose (orally or as an enema) is one of the cornerstones of the treatment of hepatic encephalopathy. Lactulose may be given orally to acidify the ammonia in the colon and form the ammonium that can be easily excreted. It is used as a laxative for evacuating blood from intestines and for reducing ammonia production by intestinal bacteria. Gastrointestinal bleeding should also be controlled. Grey Turner's sign may indicate? A. Meningitis B. Splenic injury C. Retroperitoneal bleed D. Gallbladder - CORRECT ANSWERRetroperitoneal bleed Grey Turner's sign refers to bruising of the flanks and can indicate retroperitoneal or intraabdominal bleeding, which can take up to 24-48 hours to show up on assessment. It can be caused by acute pancreatitis, blunt abdominal trauma, ruptured abdominal aortic aneurysm, or ruptured/hemorrhagic ectopic pregnancy. Most commonly seen injuries with side impact or "lay it down" motorcycle crashes include all of the following, EXCEPT: A. Open fracture of the femur B. Pelvic fractures C. Abrasions to the affected side D. Tibia/fibula or malleolus fractures - CORRECT ANSWERPelvic fractures Your patient was struck from behind while driving. The most common area of injury from a rear-end collision is: A. Ankle fracture B. Coup Contrecoup injury pattern C. C2 fracture D. T12-L1 injuries - CORRECT ANSWERT12-L1 injuries Dry chemicals such as lime should be... A. Brushed off before irrigation B. Neutralized with a special agent before irrigation C. Irrigated immediately with water or physiologic saline D. Wrapped in a dressing and not irrigated - CORRECT ANSWERBrushed off before irrigation FPC / CFRN - Review Exam - Version B Questions With Complete Solutions Chemical burns differ from thermal burns in that the burning process continues until the agent is inactivated by reaction of tissues: neutralized or diluted with water. Dry chemicals, such as lime, should be brushed off before irrigation. Water and physiologic saline are fluids of choice for wound irrigation. Hamman's sign may indicate which of the following? A. Tension pneumothorax B. Tracheobronchial injury C. Aortic rupture D. Cardiac tamponade - CORRECT ANSWERTracheobronchial injury Hamman's sign is a crunching sound heard with auscultation and may be synchronized with the patient's heart beat. This sign is associated with tracheobronchial injury. Recommended urinary output when managing a burn patient without an electrical injury is: A. 100 mL/hr B. 10-20 mL/hr C. 30-50 mL/hr D. >100 mL/hr - CORRECT ANSWER30-50 mL/hr Hydrofluoric burns can be managed with copious amounts of water and... A. Calcium gluconate B. Osmotic diuretics C. Glucagon D. Pyroxidine - CORRECT ANSWERCalcium gluconate Hydrofluoric acid exposure is often treated with calcium gluconate, a source of Ca2+ that sequesters the fluoride ions. HF chemical burns can be treated with a water wash and 2.5% calcium gluconate gel or special rinsing solutions. However, because it is absorbed, medical treatment is necessary; rinsing off is not enough and in some cases, amputation may be necessary. The management approach for a patient experiencing brain herniation can include all of the following, EXCEPT: A. Serum sodium goal 155 B. Serum osmolality less than 320 C. Hypertonic saline, mannitol D. Hyperventilation to maintain EtCO2 at 20-30 mmHg - CORRECT ANSWERHyperventilation to maintain EtCO2 at 20-30 mmHg FPC / CFRN - Review Exam - Version B Questions With Complete Solutions Routine hyperventilation is not longer recommended in the initial management of the patient with traumatic brain injury. The patient's EtCO2 should be maintained between 35-45 mmHg. Classic picture of neurogenic shock presents with... A. Hypertension B. Absence of tachycardia C. Cool skin D. Pallor - CORRECT ANSWERAbsence of tachycardia Loss of sympathetic tone below the level of the injury results in loss of autoregulation, a decrease in vascular tone, and inability of the heart to increase its intrinisic rate. The classic picture of neurogenic shock presents with the absence of tachycardia. You are transporting a patient with a spinal cord injury above T6 level. His baseline vital signs prior to lift off: BP 160/80, HR 62, RR 20. During transport, the patient begins to complain of a throbbing headache with nasal stuffiness. Your assessment reveals that the patient is becoming increasingly agitated. His skin color is flushed and profusely diaphoretic. Repeat vital signs are a BP 206/100, HR 52, RR 26. Your initial management of the patient would be... A. Insert a foley catheter B. Administer nitroglycerin to help reduce blood pressure C. Hang a Nipride drip if diastolic is greater than 130 mmHg D. Do nothing because increased HTN is expected with altitude and spinal cord injuries. - CORRECT ANSWERInsert a foley catheter Autonomic dysreflexia (AD), also known as "autonomic hyperreflexia or hyperreflexia," is a potentially life-threatening condition, which can be considered a medical emergency requiring immediate attention. AD occurs most often in spinal cord-injured individuals with spinal lesions above the T6 spinal cord level. Acute AD is a reaction of the autonomic (involuntary) nervous system to overstimulation. Your patient presents with motor loss, numbness to touch, vibration on the same side of the spinal injury, loss of pain, and temperature sensation on the opposite side. You suspect that the most likely spinal cord syndrome present is: A. Brown-Séquard B. Central cord C. Anterior cord syndrome FPC / CFRN - Review Exam - Version B Questions With Complete Solutions on high flow oxygen with NRM at 15 L/min. He is awake and complains of chest pain and SOB. How will you manage this patient? A. Administer lidocaine and nitroglycerin B. Administer normal saline bolus C. Consider sedation and synchronize cardiovert at 100 joules D. Have the patient cough forcefully - CORRECT ANSWERConsider sedation and synchronize cardiovert at 100 joules. The patient you are transporting reveals the following ABG: pH 7.51, pCO2 28, HCO3 24, pO2 110. He is a 60-kg male patient with Vt 650, F14, FIO2 0.21, I:E 1:2, PIP 46, Pplat 42, and PEEP 0. What is your ABG interpretation, and how will you correct it? A. Respiratory acidosis; increase respiratory rate (F) B. Respiratory alkalosis; decrease Vt C. Metabolic alkalosis; increase FIO2 D. Respiratory alkalosis; increase PEEP - CORRECT ANSWERRespiratory alkalosis; decrease Vt The pCO2 is decreased and the pH is increased, indicating a respiratory alkalosis. The HCO3 is normal, indicating there is no compensation. Minute ventilation is... A. RR × weight in kg B. RR × SPO2 C. Vt × weight in kg D. Vt × RR - CORRECT ANSWERVt × RR Tidal volume times the respiratory rate equal minute ventilation. Minute ventilation is defined as the total volume of air (gas) moved into and out of the lungs each minute. The formula is known as VE = Vt × f. VE signifies minute ventilation; Vt signifies tidal volume and f signifies respiratory rate. Alveolar minute volume is the amount of gas that reaches the alveoli for gas exchange in one minute. The formula is VAmin = (VT-VD) × Respiratory Rate. High-pressure alarms can be caused by all of the following, EXCEPT: A. Hypovolemia B. Connections C. Pneumothorax D. Obstructions - CORRECT ANSWERHypovolemia Low-pressure alarms can be caused by all of the following, EXCEPT: FPC / CFRN - Review Exam - Version B Questions With Complete Solutions A. Hypovolemia B. Leaks in ventilator tubing C. Pneumothorax D. Connections - CORRECT ANSWERPneumothorax Pneumothorax can trigger high-pressure alarms when resistance to ventilation is too high. You are managing a four-year-old boy who is requiring intubation. The appropriate size ET tube for this patient would be... A. 3.5 B. 4.0 C. 4.5 D. 5.0 - CORRECT ANSWER5.0 Using the formula 16 + age in years divided by 4 equals an ET tube size of 5.0. Vt is calculated at: A. 3-5 mL/kg B. 5-8 mL/kg C. 6-10 mL/kg D. 10-15 mL/kg - CORRECT ANSWER5-8 mL/kg Vt (tidal volume) of 5-8 mL/kg is generally indicated, with the lowest values recommended in the presence of obstructive airway disease and ARDS. The goal is to adjust the TV so that plateau pressures are less than 35 cm H2O. The test most often used to diagnose a pulmonary embolism is: A. Chest x-ray B. V/Q lung scan C. 12-lead ECG D. ABG - CORRECT ANSWERV/Q lung scan A ventilation/perfusion lung scan, also known as a V/Q lung scan, is a type of medical imaging that is used to evaluate the circulation of air and blood within the lungs. The ventilation portion of the exam assesses the ability of air to reach all sections of the lungs, and the perfusion portion evaluates how well blood circulates within the lungs. The test is commonly done to evaluate for the presence of blood clots or abnormal blood flow inside the lungs, such as a pulmonary embolism (PE). Acute respiratory failure is defined as: FPC / CFRN - Review Exam - Version B Questions With Complete Solutions A. pO2 <60 mmHg and pCO2 >50 B. pO2 <80 mmHg and pCO2 >60 C. pO2 <60 mmHg and pCO2 >30 D. pO2 <90 mmHg and pCO2 >50 - CORRECT ANSWERpO2 <60 mmHg and pCO2 >50 Acute respiratory failure (ARF) exists when breathing fails in its ability to maintain arterial blood gases within a normal range. By definition, ARF is present when the blood gases demonstrate a pO2 < 60 mmHg (hypoxic respiratory failure) and a pCO2 > 50 mmHg (ventilatory respiratory failure), which is usually accompanied by fall in the pH < 7.3. What personal protective equipment (PPE) should be worn when transporting a patient with bacterial meningitis? A. Mask, gloves, gown, and eye protection B. Gloves only C. Mask and gloves D. Gloves and eye protection - CORRECT ANSWERMask, gloves, gown, and eye protection The most common type of decompression sickness typically seen diving emergencies is: A. Musculoskeletal B. Pulmonary C. Arterial gas embolism D. Cutaneous - CORRECT ANSWERPulmonary Decompression Sickness (DCS) Musculoskeletal decompression illness (Type I DCS), better known as the "bends," is the most common type of DCS, which may comprise limb or joint pain (shoulder and elbow pain most common), skin rash, pruritus, and joint swelling ("skin bends"). Type II DCS comprises more serious manifestations such as headache, fatigue, visual disturbances, motor/sensory neurologic impairment/deficits, confusion, seizures, coma, and death Situations that involve a LEFT shift in the oxygen-hemoglobin dissociation curve are all of the following, EXCEPT: A. Alkalosis B. Hypocapnia C. Hypothermia D. Increased levels of 2,3-DPG - CORRECT ANSWERIncreased levels of 2,3-DPG FPC / CFRN - Review Exam - Version B Questions With Complete Solutions C. Circumflex D. Inferior vena cava - CORRECT ANSWERRight coronary artery (RCA) "Lateral Wall" ST elevation in... - CORRECT ANSWERI, aVL, V5, V6 "Septal Wall" ST elevation in... - CORRECT ANSWERV1, V2 "Anterior Wall" ST elevation in... - CORRECT ANSWERV3, V4 "Inferior Wall" ST elevation in... - CORRECT ANSWERII, III, and aVF Normal CVP/RAP pressures are... A. 15 - 25 mmHg B. 8 - 12 mmHg C. 2 - 6 mmHg D. 8 - 15 mmHg - CORRECT ANSWER2 - 6 mmHg Central venous pressure (CVP and Right atrial pressure (RAP) - Reflection of right atrial pressure preload. PCWP (pulmonary capillary wedge pressure) evaluates... A. Right arterial pressures B. Right and left sided heart pressures C. Cardiac output D. Preload to the left side of the heart - CORRECT ANSWERPreload to the left side of the heart SVR (systemic vascular resistance) measures afterload for the left heart and are Decreased in... A. Hypovolemic shock B. Cardiogenic shock C. Distributive shock D. RVMI - CORRECT ANSWERDistributive shock If SVR is <800, "think" distributive shock (vasodilatory shock) --- Septic shock, neurogenic shock, or anaphylactic shock If SVR is >1200 "think" hypovolemic shock, cardiogenic shock, or right ventricular myocardial infarction (RVMI) Cardiac output is determined by... FPC / CFRN - Review Exam - Version B Questions With Complete Solutions A. blood pressure and heart rate B. heart rate and stroke volume C. cardiac index and heart rate D. contractility and preload - CORRECT ANSWERCO = HR × SV Cardiac output (CO) = 4-8 L/min You are transporting a patient who you note has tea-colored urine in small amount in the foley catheter bag. The nurse reports that his output is only 50 mL in the last twenty- four hours. What treatment would you expect to initiate during the two-hour flight? A. Rapid fluid resuscitation, sodium bicarbonate drip, and consider Lasix and mannitol. B. Rapid fluid resuscitation, potassium replacement therapy, and aggressive pain management. C. Fluid restriction, sodium bicarbonate drip, and consider Lasix and mannitol. D. Fluid restriction, potassium replacement therapy, and aggressive pain management. - CORRECT ANSWERRapid fluid resuscitation, sodium bicarbonate drip, and consider Lasix and mannitol. The main goal of treatment is to treat shock and preserve kidney function. After a forced aircraft landing, the pilot is incapacitated; your main priority is to? A. Assume crash position B. Turn off oxygen C. Turn off throttle, fuel, and then battery D. Turn on the emergency locator transmitter (ELT) - CORRECT ANSWERTurn off throttle, fuel, and then battery You are doing a night flight when you encounter bad weather. The helicopter suddenly impacts the ground and the cockpit is filled with smoke. The best action of the flight team immediately after experiencing the hard landing should be which of the following? A. Grab the fire extinguisher and portable radio. B. Make a call for help on the emergency frequency. C. Exit the helicopter after the aircraft has come to a complete stop and meet at a predesignated position a safe distance from the aircraft. D. Stay in the helicopter as it offers the only available shelter in the area. - CORRECT ANSWERExit the helicopter after the aircraft has come to a complete stop and meet at a predesignated position a safe distance from the aircraft. What medications would you expect to administer to a patient presenting with severe chest/abdominal pain, diaphoresis, and is restless? SBP is 170/palp and heart rate in 116. You note a difference in blood pressures when taken on each arm. FPC / CFRN - Review Exam - Version B Questions With Complete Solutions A. Nitroglycerin and atenolol B. Nipride and b-blockers C. Lasix and nitroglycerin D. Bumex and Dobutrex - CORRECT ANSWERNipride and Beta-blockers. Aortic dissection Management: ~ Lower SBP to 100-110 mmHg. ~Beta-blockers blockers to slow the heart rate and decrease ejection fraction (metoprolol, esmolol), pain analgesics. ~ Fluids only if hypotensive. ~ HTN crisis: Nipride, Hyperstat to patient's normal within 30-60 min. ~Surgery On 12-lead ECG, "posterior" wall MIs manifest as... A. ST elevation in II, III, AVF B. ST depression in II, III, AVF C. ST depression in V1-V4 with abnormally tall R waves D. ST elevation in V1-V4 with abnormally tall R waves - CORRECT ANSWERST depression in V1-V4 with abnormally tall R waves Acute respiratory failure is defined as: A. pO2 <60 mmHg and pCO2 >50 B. pO2 <80 mmHg and pCO2 >60 C. pO2 <60 mmHg and pCO2 >30 D. pO2 <90 mmHg and pCO2 >50 - CORRECT ANSWERpO2 <60 mmHg and pCO2 >50 Acute respiratory failure (ARF) exists when breathing fails in its ability to maintain arterial blood gases within a normal range. ARF is present when the blood gases demonstrate a pO2 < 60 mmHg (hypoxic respiratory failure) and a pCO2 > 50 mmHg (ventilatory respiratory failure), which is usually accompanied by fall in the pH < 7.3. A sign of hyperventilation and hypocalcemia is: A. Kehr's B. Grey Turner's C. Trousseau's D. Brudzinski's - CORRECT ANSWERTrousseau's FPC / CFRN - Review Exam - Version B Questions With Complete Solutions The CT scan of patients with a tension pneumocephalus typically show air that compresses the frontal lobes of the brain, which results in a tented appearance of the brain in the skull known as the Mount Fuji sign. The name is derived from the resemblance of the brain to Mount Fuji in Japan, a volcano known for its symmetrical cone. Calculate the following patient's cerebral perfusion pressure (CPP): BP 180/90, HR 120, RR 24, SpO2 98%, CVP 2, ICP 25. A. 80 B. 120 C. 65 D. 95 - CORRECT ANSWER95 90 × 2 = 180; 180 × 2 = 360 360 divided by 3 = 120 120-25 = 95 Calculate the following patient's cerebral perfusion pressure (CPP): BP 150/75, HR 140, RR 28, SpO2 100%, CVP 2, ICP 25. A. 98 B. 125 C. 65 D. 75 - CORRECT ANSWER75 MAP = [(75 × 2) + 150] divided by 3 = 100. CPP = 100-25 = 75 mmHg MAP = [(DBP × 2) + SBP] divided by 3 CPP = MAP − ICP Henry's law best describes which of the following patient conditions? A. Bends B. Barotrauma C. Shallow water blackout D. Arterial gas embolism (AGE) - CORRECT ANSWERBends Henry's law states that at a constant temperature, the amount of a given gas dissolved in a given type and volume of liquid is directly proportional to the partial pressure of that gas in equilibrium with that liquid. An everyday example of Henry's law is given by carbonated soft drinks. FPC / CFRN - Review Exam - Version B Questions With Complete Solutions Poisoning of the cytochrome oxidase enzyme system may cause... A. Histotoxic hypoxia B. Hypemic hypoxia C. Hypoxic hypoxia D. Stagnant hypoxia - CORRECT ANSWERHistotoxic hypoxia Histotoxic hypoxia interferes with the utilization phase of respiration because of metabolic poisoning or dysfunction. Cyanide, sulfide, azide, and carbon monoxide all bind to cytochrome oxidase, thus competitively inhibiting the protein from functioning, which results in chemical asphyxiation of cells. Methanol [methylated spirits] is converted into formic acid, which also inhibits the same oxidase system. On a long fixed wing flight, an option may be to place water on the ET tube cuff to counteract. Which gas law is it? A. Henry's law B. Graham's law C. Dalton's law D. Boyle's law - CORRECT ANSWERBoyle's law Boyle's law (expansion or contraction of a gas) describes the inversely proportional relationship between the absolute pressure and volume of a gas, if the temperature is kept constant within a closed system. The air in the ETT cuff, for example, expands with altitude (ascent) and contracts during descent. All of the following are signs of cardiac tamponade, EXCEPT: A. Pulsus paradoxus B. Pulsus alternans C. Kussmual's sign D. Pulseless electrical activity (PEA) - CORRECT ANSWERPulsus alternans The patient suspected of having a cardiac tamponade will exhibit signs and symptoms of decreased cardiac output such as, cool, clammy skin, altered mental sratus, tachycardia, pulsus paradoxus (a drop in systolic blood pressure > 15 mmHg during normal inspiration), distant muffled heart tones, jugular venous distention, unless the patient is hypovolemic, hypotension, and electrical alternans. FPC / CFRN - Review Exam - Version B Questions With Complete Solutions What finding would you expect to see on the lateral neck x-ray to confirm suspicion of epiglottitis? A. McDonald's sign B. Steeple sign C. Angel wing sign D. Thumb print sign - CORRECT ANSWERThumb print sign The thumbprint sign is a finding on a lateral C-spine radiograph that suggests the diagnosis of epiglottitis. The sign is caused by a thickened free edge of the epiglottis, which causes it to appear more radiopaque than normal, resembling the distal thumb. You are transporting a normotensive patient, who is presenting with a history of head injury and complaining of extreme thirst. Your assessment reveals he is excreting large amounts of diluted urine, sunken appearance to the eyes, dry mouth, and tachycardia is noted. The initial treatment of the patient would be? A. Restrict fluids B. Administer Sandostatin C. Aggressive fluid replacement and vasopressin D. Administer anti-thyroid medication - CORRECT ANSWERAggressive fluid replacement and vasopressin The most common type in humans is central DI, caused by a deficiency of arginine vasopressin (AVP), also known as antidiuretic hormone (ADH). The regulation of urine production occurs in the hypothalamus, which produces ADH. The hormone is stored for later release in the posterior lobe of the pituitary gland. The cause of central diabetes insipidus is usually damage to the pituitary gland or hypothalamus, most commonly due to surgery, a tumor, illness (such as meningitis), inflammation or a head injury. Your patient presents upper body obesity with thin arms and legs. He has a rounded face "buffalo hump" and is complaining fatigue. He is hypertensive and hyperglycemic. What condition is he most likely presenting? A. Myxedema coma B. Thyroid storm C. Addison's disease D. Cushing's syndrome - CORRECT ANSWERCushing's syndrome * Hyperaldosteronism * Hypertension * Women have facial hair, moon-face, buffalo hump FPC / CFRN - Review Exam - Version B Questions With Complete Solutions Some individuals may require a longer period between drinking and flying depending on the amount of alcohol consumed and their personal metabolism. You are doing a night flight when you encounter bad weather. The helicopter suddenly impacts the ground and the cockpit is filled with smoke. The best action of the flight team immediately after experiencing the hard landing should be which of the following? A. Grab the fire extinguisher and portable radio. B. Make a call for help on the emergency frequency. C. Exit the helicopter after the aircraft has come to a complete stop and meet at a predesignated position a safe distance from the aircraft. D. Stay in the helicopter as it offers the only available shelter in the area. - CORRECT ANSWERExit the helicopter after the aircraft has come to a complete stop and meet at a predesignated position a safe distance from the aircraft. Usually meeting at the nose of the aircraft, which is twelve o'clock position. The MD has ordered a brain natriuretic peptide (BNP), which would evaluate the patient for... A. Sepsis B. Hypovolemia C. Right ventricular MI D. CHF - CORRECT ANSWERCHF BNP is a blood test used to measure the amount of BNP hormone in the blood. BNP is produced by the heart and shows how well the heart is functioning. Normally, only a low amount of BNP is found in the heart. But if the heart has to work harder for a longer period of time, such as in heart failure, the heart releases more BNP, increasing the blood level of BNP. In some cases, this test can diagnose heart failure in a patient who does not have obvious heart failure symptoms. BNP values tend to increase with age and are higher in women than men. Lab findings — Normal BNP level: 0-99 picograms per milliliter (pg/mL). Abnormal BNP level: 100 pg/mL or greater is indicative that heart failure may be present. The ELT takes a minimum of ____________ g's to activate. A. 2 B. 4 C. 6 D. 8 - CORRECT ANSWER4 FPC / CFRN - Review Exam - Version B Questions With Complete Solutions The ELT is activated by an impace exceeding 4g's and broadcasts on the universal distress channel 121.5. Preeclampsia is characterized by of the following, EXCEPT: A. Hypertension B. Edema C. Proteinuria D. Seizures - CORRECT ANSWERSeizures or Low Platelet Count Preeclampsia is characterized by hypertension, proteinuria, and edema. Hemolytic disease of the newborn can be prevented by the administration of which of the following to a Rhesus negative mother who had a pregnancy with a Rhesus positive infant? A. Albumin B. Rho(D) immune globulin C. Steroids D. Indomethacin - CORRECT ANSWERRho(D) immune globulin The commonly used terms Rh factor, Rh positive, and Rh negative refer to the D antigen only. Rho(D) immune globulin is a medicine solution of IgG anti-D (anti-RhD) antibodies used to prevent the immunological condition known as Rhesus disease (or hemolytic disease of newborn). When the disease is mild, the fetus may have mild anemia with reticulocytosis. When the disease is moderate or severe, the fetus can have a more marked anemia and erythroblastosis (erythroblastosis fetalis). When the disease is very severe, it can cause morbus hemolyticus neonatorum, hydrops fetalis, or stillbirth. Stagnant hypoxia - CORRECT ANSWEROccurs when conditions exist that result in Reduced total Cardiac Output, "pooling of the blood" within certain regions of the body, a decreased blood flow to the tissues, or restriction of blood flow. Which of the following paralytics stimulates motor end plate acetylcholine receptors causing persistent depolarization? A. Succinylcholine B. Rocuronium C. Vecuronium FPC / CFRN - Review Exam - Version B Questions With Complete Solutions D. Pancuronium - CORRECT ANSWERSuccinylcholine Neuromuscular blocking agents (NMBA) binds with cholinergic receptor sites of motor neurons preventing the neurotransmitter from relaying the signal. The interruption in this signal pathway is what causes paralysis. Succinylcholine (anectine) is classified as a noncompetitive depolarizing agent because it binds with the motor end-plate receptor site, causing a continuous depolarization to take place. It is this depolarization that causes the initial fasciculations (irregular muscle contractions produced by depolarization of the muscle membrane before complete cessation of muscle activity). As the acetycholinesterase enzyme breaks down the NMBA, there is a return of fasciculations. When administering a defasciculating neuromuscular blockade, the dose recommended is? A. 5% normal RSI dosage of NMBA B. 10% normal RSI dosage of NMBA C. 15% normal RSI dosage of NMBA D. 20% normal RSI dosage of NMBA - CORRECT ANSWER10% normal RSI dosage of NMBA The administration of a defasiculation dose of a competitivenon depolarizing NMBA, such as vecuronium (Norcuron), can prevent fasciculations that occur when succinylcholine (Anectine) is administered. Administration of 10% of the initial NMBA dose is recommended to prevent this complication, especially in trauma patients who have sustained significant skeletal fractures for the purpose of preventing further injury at the fracture site/s. In aviation, "You may fly instrument flight rules (IFR) in visual meteorological conditions (VMC), you cannot fly VFR in _________." A. VMC B. IFR C. Instrument meteorological conditions (IMC) D. DMC - CORRECT ANSWERInstrument meteorological conditions (IMC) In aviation, VMC is an aviation flight category in which VFR flight is permitted—that is, conditions in which pilots have sufficient visibility to fly the aircraft maintaining visual separation from terrain and other aircraft. They are the opposite of IMC. FPC / CFRN - Review Exam - Version B Questions With Complete Solutions B. The larynx is located more anterior in infants and children C. The epiglottis is long and narrow and angled away from the trachea. D. In children, younger than six years of age, the narrowest portion of the trachea is at the cricoid process. - CORRECT ANSWERIn children, younger than six years of age, the narrowest portion of the trachea is at the cricoid process. In children younger than "10 years of age", the narrowest portion of the trachea is at the cricoid process. The vocal cords are attached lower anteriorly and the tongue (especially in infants) is proportionately larger. Pediatric - "10, 11, 12" Rules - CORRECT ANSWERUncuffed tube under 10 Needle cricothyrotomy only under 11 No nasal intubation under 12 Late decelerations may indicate... A. Cord compression B. Acidosis C. Anemia D. Uterine placental insufficiency - CORRECT ANSWERUterine placental insufficiency A late deceleration is one that begins close to the apex of the contraction, gradually decelerates, and gradually returns to the FHR baseline after the contraction is over. Late decelerations always indicate uteroplacental insufficiency; there is inadequate oxygen exchange in the placenta during a contraction. When a contraction is stronger, the insufficiency is greater and the deceleration is proportional. Late decelerations are one of the most ominous fetal heart rate patterns. All of the following are considered stressors of flight, EXCEPT? A. g-forces B. Increased partial pressure of oxygen C. Barometric pressure D. Decreased humidity - CORRECT ANSWERIncreased partial pressure of oxygen You are transporting a twenty-five-year-old woman with a history of suspected overdose. The following ABGs were obtained prior to your arrival at the sending facility: pH 7.52, pCO2 27, HCO3 24, pO2 110. You would most likely suspect: A. Narcotic overdose B. TCA overdose FPC / CFRN - Review Exam - Version B Questions With Complete Solutions C. Early salicylate poisoning D. Insulin overdose - CORRECT ANSWEREarly salicylate poisoning The ABG interpretation of a pH 7.52, pCO2 27 and HCO3 24 is a noncompensated respiratory alkalosis, which is present is early salicylate poisoning. The metabolic changes eventually lead to renal depletion of fluids and electrolytes, hypoglycemia, hypokalemia, and a mixed presentation of respiratory and metabolic alkalosis coupled with metabolic acidosis, which may provoke cardiac dysrhythmias, acute pulmonary edema, renal failure or neurological injury. The clinical presentation of salicylate poisoning can also include gastrointestinal bleeding and an unexplained elevated anion gap (metabolic acidosis). Salicylate levels are obtained four to six hours after ingestion. Earlier samples may be unreliable because the pharmacokinetics is not stable before that time. The most important information in assessing severity, however is the patient's clinical condition. If the PIP does not change on a ventilator patient with respiratory acidosis, always... A. Increase Vt before rate B. Decrease Vt before rate C. Increase rate before Vt D. Decrease rate before Vt - CORRECT ANSWERDecrease Vt before rate Elevated peak inspiratory pressures (PIP) can be managed by decreasing the flow rate and tidal volume initially. If necessary, increasing the respiratory rate can be done to correct an underlying respiratory acidosis. Trouble-shooting high-pressure alarms on the ventilator can be caused by all of the following, EXCEPT: A. Secretions B. Obstructions C. ET tube main-stem placement D. Leak in ventilator tubing - CORRECT ANSWERLeak in ventilator tubing Leaks and/or loose connections are associated with low ventilator alarms. Normal range for right atrial pressure is: A. 2-6 mmHg B. 8-12 mmHg C. 4-8 mmHg D. 0-5 mmHg - CORRECT ANSWER2-6 mmHg FPC / CFRN - Review Exam - Version B Questions With Complete Solutions Systemic vascular resistance (SVR) measures? - CORRECT ANSWERAfterload for the Left heart The most likely causes of Metabolic Alkalosis can include all of the following, EXCEPT: A. Vomiting B. NG suctioning C. Diarrhea D. Diuretics - CORRECT ANSWERDiarrhea Diarrheal dehydration can cause metabolic acidosis, especially in the pediatric patient. Metabolic alkalosis can be caused by loss of hydrogen ions through the kidneys or GI tract. Vomiting or nasogastric (NG) suction generates metabolic alkalosis by the loss of gastric secretions, which are rich in hydrochloric acid (HCL). Renal losses (use of diuretics) of hydrogen ions occur when the distal delivery of sodium increases in the presence of excess aldosterone, resulting in reabsorption of sodium, leading to the secretion of hydrogen ions and potassium ions. The administration of sodium bicarbonate in amounts that exceed the capacity of the kidneys to excrete this excess bicarbonate may cause metabolic alkalosis. Shifting of hydrogen ions into the intracellular space can also occur, which is mainly seen with hypokalemia. Digitalis toxicity can easily be exacerbated by... A. Acute MI B. Electrolyte abnormalities C. Undiagnosed diabetes D. Beta-blockers - CORRECT ANSWERBeta-blockers A group of medicines extracted from foxglove plants are called "digitalin." The use of digitalis purpurea extract containing cardiac glycosides for the treatment of heart conditions is used to increase cardiac contractility (positive inotrope) and as an antiarrhythmic agent to control the heart rate, particularly in atrial fibrillation. Digitalis is often prescribed for patients in atrial fibrillation, especially if they have been diagnosed with CHF. Digitalis works by inhibiting sodium-potassium ATPase. This results in an increased intracellular concentration of sodium, which in turn increases intracellular calcium by passively decreasing the action of the sodium-calcium exchanger in the sarcoplasmic reticulum. The increased intracellular calcium gives a positive inotropic effect.