SHARP ESO 2024/ 2025 Questions and Verified Answers| 100% Correct| A Grade (New Update), Exams of Nursing

Download SHARP ESO 2024/ 2025 Questions and Verified Answers| 100% Correct| A Grade (New Update) and more Exams Nursing in PDF only on Docsity! SHARP ESO 2024/ 2025 Questions and Verified Answers| 100% Correct| A Grade (New Update) QUESTION What are the contraindications for non invasive ventilation NIV? Answer: 1. Respiratory arrest 2. Inability to maintain a pateny airway or clear secretions 3. Risk for aspiration of hastric contents (nausea,vomiting, or bowel obstruction) 4. Preexisting pneumothorax without chest tube or pneumomediastinum 5. Epistaxis 6. Recent facial, oral or skull surgery or trauma 7. Encephalopathy/AMS 8. Hypotension due to suspected intravascular volume depletion 9. Unable to tolarate bipap QUESTION STATUS EPELIPTICUS (generalized tonic-clonic movements lasting more than 3 min or recurrent seizures without return of consciousness) Answer: 1. Protect airway, position in lateral decubitus position, protect pt fr injury 2. O2 min 10l/min NRBM 3. Lorazepam (Ativan) 2 mg IVP/IO over 1 min 4. Draw Na, K, glucose, BUN, Cr, and anticonvulsant levels if appropriate QUESTION SEVERE ANAPHYLAXIS (stridor, wheezing, respiratory distress, pallor, cyanosis, or clinical signs of shock) Answer: 1. O2 at min 10L NRBM 2. Epinephrine (1:1000) 0.3mg IM. Repeat in 5 mins. If no clinic improvement 3. If no response and pt still showing signs of shock, give Epinephrine (1:10,000) 0.1mg IVP/IO slowly over 5 mins. 4. (Hydrocortisone) Solucortef 100 mg IVP/IO 5. DIPHENHYDRAMINE (Benadryl) 25mg IVP/IO 6. INFUSE 250 ml LR or NS. Repeat in 5 minutes if no clinical improvement. QUESTION DOCUMENTATION Answer: Will be made by RN performing ESO standardized procedure including: Unstable or life-threatening condition, precipitating factors if any, treatment/medications administered, biphasic defibrillation or joules, pt's response to interventions, and when/which physician was notified. Code blue will be completed for all cardiac and respiratory arrest events. The RRT record will be completed for all RRT events that utilize ESOs. QUESTION How do you order specific treatments for the unstable or life-threatening condition? Answer: It will be ordered electronically in Cerner by the RN as a standardized procedure, or the Code Blue Record will be completed by RN and signed by the physician, then placed in the chart, this acts as an oder sheet QUESTION NARROW COMPLEX TACHYCARDIA (UNSTABLE) narrow QRS <0.12sec Only at SGH Answer: 1. O2 at minimum 10L/min NRBM 2. If ventricular rate is >150bpm, prepare for immediate cardioversion. Perform synchronized biphasic cardioversion starting at 75 Joules with no stacked shocks. 3. If patient is awake and responsive and drugs are immediately available, give midazolam (Versed) 0.5mg IV/IO to a total of 1mg IV/IO to achieve procedural sedation. 4. If patient has S/S of over sedation (decreased LOC, RR <10/min) Romazicon 0.2mg IVP/IO over 15 sec. May repeat in 45 sec based om pt's response, not to exceed 0.6mg. Romazicon is the reversal agent for Versed. QUESTION VENTRICULAR TACHYCARDIA (Wide Complex) UNSTABLE Answer: 1. O2 at minimum 10ml NRBM 2. If ventricular rate is >150: BIPHASIC- Synchronized cardioversion per approved energy dose listed on defibrillator 3. If patient is awake and responsive, give Midazolam (versed) 0.5mg IVP/IO prior to cardioversion. May repeat to a total of 1mg to achieve sedation. 4. Draw serum K, Mg QUESTION What's the reversal agent for midazolam (Versed) and when can you give it? Answer: Romazicon 0.1mg IVP/IO over 15sec. May repeat in 45sec based on patient's response, not to exceed 0.6mg- requires a physician order for over sedation (decreased level of consciousness, RR <10min) QUESTION VENTRICULAR FIBRILLATION/PULSELESS VENTRICULAR TACHYCARDIA Answer: No STACKED SHOCKS PROVIDE CONTINUOUS CPR UNLESS DEFIBRILLATING. GIVE MEDICATIONS DURING CPR. 1. CPR (2min) or until defibrillator arrives 2. O2 at min 15ml/min ambubag (8-10 breaths/min) 3. Defibrillate: Biphasic: jpules per approved energy dose 4. Epinephrine (1:10,000) 1mg IVP/IO 5. Defibrillate 6. Amiodarone 30mg IVP/IO 7. Defibrillate 8. Epinephrine (1:10,000) 1mg IVP/IO 9. Defibrillate 10. Amiodarone (150mg IVP/IO 11. If rhythm persists, defibrillate, CPR, Epinephrine (1:10,000) 1mg IVP/IO q 3-5min QUESTION CHEST PAIN Answer: 1. Consider giving aspirin 325mg, if no dose was given on this date 2. O2 start at minimum 4L/min NC 3. NTG 0.4mg SL if BP >/= 90 mmHG and /pr MAP >60mmHg and HR >50,may repeat every 3-5min x 2. 4. Morphine Suldate 2mg, if SBP >/= 90, IVP/IO q5 min up to a total of 10mg 5. 12 Lead EKG QUESTION HYPOTENSION (SYMPTOMATIC) Answer: 1. O2 at min 10L NRBM 2. If hypovolemia known or suspected, infuse 250ml LR or NS. Repeat in 5 mins if no clinical improvement (Note: evaluate if patient merts at least 2 Systemic Inflammatory Response Syndrome (SIRS) criteria plus infection) 3. If SBP <90mmHg, start Dopamine 400mg/250ml D5W infuse at 5mcg/kg/min. Titrate until SBP >/=90mmHg and or MAP >60mmHg or up to 20mcg/kg/min 4. In the presence of obvious blood loss, draw STAT H&H and Type & Cross 2 units PRBCs. QUESTION HYPOTENSION (SYMPTOMATIC) For Immediate Post Anesthesia Patients Answer: ONLY ADMINISTERED BY PACU OR ICU NURSES: 1. O2 at min 10L/min NRBM 2. Infuse 250 ml LR or NS. Repeat in 5 min if no clinical improvement. 3. If fluid bolus ineffective, Ephedrine 5mg IVP/IO 4. If no improvement within 3 min, repeat Ephedrine at 10mg IVP/IO 5. In the presence of obvious blood loss, draw stat H&H and Type & Cross 2 units PRBCs. QUESTION HYPOGLYCEMIA Answer: Follow the Hypoglycemic Standardized Procedure for ANY patient with a serum glucose or fingerstick <70mg/dl (<60mg/dl if pregnant) QUESTION INCREASED INTRACRANIAL PRESSURE (IIP) Answer: In the neurologically impaired patient with dilated pupil associated with other signs of impending herniation. (NOTE: IMPLEMENT ONLY IN THE ABSENCE OF SPECIFIC ICP ORDERS) 1. Raise HOB to at least 30 degrees if pt is not hypotensive; place pt's head in midline position. 2. Hyperventilate the intubated pt with FiO2 100% to maintain pCO2 30-35mmHg 3. Mannitol 20% 500 ml (100gm) rapid IVP/IO using a filter (if filter is readily available) 4. Draw baseline serum K, Na, BUN, Cr, Glucose, ABG 5. Insert urinary catheter QUESTION RESPIRATORY DEPRESSION- associated with prior narcotic or benzodiazepine administration Answer: 1. O2 at min 10L/min NRBM 2. Narcotic-associated respiratory depression: administer Naloxone (Narcan) as follows (maximum dose of 0.4mg) a. Apnea:0.4mg IVP/IO once b.RR <10: 0.1mg IVP/IO every min, may repeat 3x. QUESTION RESPIRATORY DEPRESSION- associated with prior narcotic or benzodiazepine administration at SMH and SCOR Special catheter inserted into the intraosseous space by a train physician or IO insertion competency validated RN. Safe and alternate route to IV therapy is initiated when IV access is urgently needed but is not available. QUESTION Unstable conditions Signs & Symptoms Answer: SIGNS: Tachypnea Apnea Respiratory depression Tachycardia Bradycardia Arrhythmia Hypotension Decrease 02 saturation Dyspnea Change in LOC Increased Intracranial Pressure Status Epilepticus SYMPTOMS: Dizziness Lightheaded ness Shortness of breath Chest pain Weakness Cold Diaphoretic Heart palpitations Anxiousness QUESTION General Procedure for all Life-Threatening Patient Conditions- what kind of access should a nurse obtain? Answer: a. Obtain IV/intraosseous (IO) access (large bore cannula in the antecubital vein should be the first target for IV access if a central line is not present) QUESTION General Procedure for all Life-Threatening Patient Conditions- what kind of fluid should be started to KVO? Answer: b. Begin IV infusion of Normal Saline (NS) to keep vein open (KVO) QUESTION General Procedure for all Life-Threatening Patient Conditions- If IV access is not available what medications can be given and how is it administered? Answer: c. If IV access is not available: Narcan, Atropine, and Epinephrine may be administered via endotracheal route at doses of 2 times the IV dose diluted in 10ml NS flush QUESTION General Procedure for all Life-Threatening Patient Conditions- what's the process after giving each medication? Answer: d. Flush IV line with 20ml of NS after each IV medication given and elevate extremity if applicable. QUESTION General Procedure for all Life-Threatening Patient Conditions- In applicable situations, what should be readily available? Answer: e. Oxygen QUESTION What's the proper techniques using circulation, airway, and breathing? Answer: 1. Compressions should be performed at a rate of 100/min for two minutes "push hard,push fast" allowing full chest recoil, and minimize interruptions in chest compressions after each intervention. 2. All external electrical therapy will be cardioverted/defibrillated with biphasic monitors using appropriate energy dose as designated by condition. QUESTION True/False In most cases, treatment (e.g. O2 administration) is administered concurrently. Answer: TRUE QUESTION True/False Stickers with appropriate energy levels of cardioversion/defibrillation should be placed on all defibrillators for quick reference. Answer: TRUE QUESTION ASYSTOLE Answer: 1. CPR (2 min) 2. O2 at 15ml/min ambu bag (8-10 breaths/min) 3. Epinephrine (1:10,000) 1mg IVP/IO, repeat q3-5 min as long as asystole persists.