Medical Concepts and Practices, Exams of Nursing

Download Medical Concepts and Practices and more Exams Nursing in PDF only on Docsity! PRACTICE TEST 1 CCRN 2024/2025 Practice Test 1 CCRN (Pass CCRN-Critical Care Registered Nurse) With Complete Solutions What Is Vasogenic Cerebral Edema? [Correct Ans Is: - Vasogenic Cerebral Edema Is An Increase In Extracellular Fluid Caused By A Breakdown Of The Blood-Brain Barrier With The Resultant Increase In Vascular Permeability. This Cerebral Edema Begins Locally And Becomes More Generalized. Common Causes Are Trauma (Including Surgical Trauma), Tumors, Hemorrhage, And Abscesses What Is Vasogenic Cerebral Edema? [Correct Ans Is: - Vasogenic Cerebral Edema Is An Increase In Extracellular Fluid Caused By A Breakdown Of The Blood-Brain Barrier With The Resultant Increase In Vascular Permeability. This Cerebral Edema Begins Locally And Becomes More Generalized. Common Causes Are Trauma (Including Surgical Trauma), Tumors, Hemorrhage, And Abscesses What Ventilator Parameter Indicates Fluid Volume Excess? [Correct Ans Is: - An A:A Gradient Greater Than 10 Mm Hg Is A Reflection Of A Diffusion Defect. Note That The Process Of Diffusion Is Between A (Alveolus) And (A) Arterial Blood. An Increase In Intraalveolar Fluid Dilutes And Inactivates Surfactant, Causing Alveolar Collapse (Decreasing Vital Capacity) And Decreases Lung Compliance. Peak Inspiratory Pressure Increases Reflect A Decrease In Lung Compliance What Ventilator Parameter Indicates Fluid Volume Excess? [Correct Ans Is: - An A:A Gradient Greater Than 10 Mm Hg Is A Reflection Of A Diffusion Defect. Note That The Process Of Diffusion Is Between A (Alveolus) And (A) Arterial Blood. An Increase In Intraalveolar Fluid Dilutes And Inactivates Surfactant, Causing Alveolar Collapse (Decreasing Vital Capacity) And Decreases Lung Compliance. Peak Inspiratory Pressure Increases Reflect A Decrease In Lung Compliance What Does Autonomy Refer To? [Correct Ans Is: - The Patient's Right To Make Decisions For Themselves What Does Autonomy Refer To? [Correct Ans Is: - The Patient's Right To Make Decisions For Themselves PRACTICE TEST 1 CCRN What Does Beneficence Mean? [Correct Ans Is: - Obligation To Do Good What Does Beneficence Mean? [Correct Ans Is: - Obligation To Do Good What Does Nonmaleficence Mean? [Correct Ans Is: - Obligation To Do No Harm What Does Nonmaleficence Mean? [Correct Ans Is: - Obligation To Do No Harm What Does Fidelity Mean? [Correct Ans Is: - The Obligation To Abide By Agreements And Responsibilities What Does Fidelity Mean? [Correct Ans Is: - The Obligation To Abide By Agreements And Responsibilities What Does Veracity Mean? [Correct Ans Is: - The Obligation To Tell The Truth What Does Veracity Mean? [Correct Ans Is: - The Obligation To Tell The Truth What Are Diagnosis-Related Groups? [Correct Ans Is: - Drgs Constitute A Prospective Payment Program For Medicare Patients. Payment Is Based On Primary And Secondary Diagnosis, Primary And Secondary Procedures, Age, And Length Of Hospitalization What Are Diagnosis-Related Groups? [Correct Ans Is: - Drgs Constitute A Prospective Payment Program For Medicare Patients. Payment Is Based On Primary And Secondary Diagnosis, Primary And Secondary Procedures, Age, And Length Of Hospitalization Bnp Is Secreted In Response To? [Correct Ans Is: - Ventricular Wall Stretch Bnp Is Secreted In Response To? [Correct Ans Is: - Ventricular Wall Stretch What Are Omnious Signs In A Patient With Status Asthmaticus? [Correct Ans Is: - A Normalization Or Increase In The Paco2. This Patient Is Still Tachypneic, And If Ventilation Is Normal, Paco2 Should Be Decreased. The Other Ominous Sign In This PRACTICE TEST 1 CCRN 2nd Letter-Chamber Sensed What Is The Difference Between An Anaphylactic And Anaphylactoid Reaction? [Correct Ans Is: - Anaphylactoid Reaction Is Clinically Indistinguishable From Anaphylactic Reaction But Does Not Require Previous Exposure To The Antigen. Anaphylactoid Reaction Is Not Ige Mediated, And Direct Activation And Degranulation Of Mast Cells Are Thought To Be Triggered By The Complement System. Anaphylactic Reaction Requires Previous Exposure To The Antigen And Is Ige Mediated What Is The Difference Between An Anaphylactic And Anaphylactoid Reaction? [Correct Ans Is: - Anaphylactoid Reaction Is Clinically Indistinguishable From Anaphylactic Reaction But Does Not Require Previous Exposure To The Antigen. Anaphylactoid Reaction Is Not Ige Mediated, And Direct Activation And Degranulation Of Mast Cells Are Thought To Be Triggered By The Complement System. Anaphylactic Reaction Requires Previous Exposure To The Antigen And Is Ige Mediated Mitral Stenosis Is Associated With What? [Correct Ans Is: - Pinkish Discoloration Of The Cheeks. It Is A Diastolic Murmur Mitral Stenosis Is Associated With What? [Correct Ans Is: - Pinkish Discoloration Of The Cheeks. It Is A Diastolic Murmur What Murmur Is Associated With Widened Pulse Pressure? [Correct Ans Is: - Aortic Regurg What Murmur Is Associated With Widened Pulse Pressure? [Correct Ans Is: - Aortic Regurg What Murmur Is Associated With Narrowed Pulse Pressure? [Correct Ans Is: - Mitral Regurg What Murmur Is Associated With Narrowed Pulse Pressure? [Correct Ans Is: - Mitral Regurg What Lead Changes Are Associated With Left Ventricle Hyperthrophy? [Correct Ans Is: - Strain Pattern In V5 And V6 (Asymmetric T Wave Inversion) PRACTICE TEST 1 CCRN When The Depth Of The S Wave In Lead V1 Or V2 Plus The Height Of The R Wave In Lead V5 Or V6 Is 35 Mm Or Greater, This Constitutes Voltage What Lead Changes Are Associated With Left Ventricle Hyperthrophy? [Correct Ans Is: - Strain Pattern In V5 And V6 (Asymmetric T Wave Inversion) When The Depth Of The S Wave In Lead V1 Or V2 Plus The Height Of The R Wave In Lead V5 Or V6 Is 35 Mm Or Greater, This Constitutes Voltage What Lead Changes Are Associated With Right Ventricle Hypertrophy? [Correct Ans Is: - Strain Pattern In V1 And V2. Prominent R Wave In V1 Reverse Progression Of The R Wave Across The Precordium. What Lead Changes Are Associated With Right Ventricle Hypertrophy? [Correct Ans Is: - Strain Pattern In V1 And V2. Prominent R Wave In V1 Reverse Progression Of The R Wave Across The Precordium. What Organ System Is The Most Common To Fail In Severe Sepsis? [Correct Ans Is: - Hematologic- Coagulopathies Are Common In Severe Sepsis What Organ System Is The Most Common To Fail In Severe Sepsis? [Correct Ans Is: - Hematologic- Coagulopathies Are Common In Severe Sepsis What Are The Early Signs Of Hypoglycemia? [Correct Ans Is: - The Early Signs Of Hypoglycemia Are Mediated By The Sympathetic Nervous System, Which Acts To Mobilize Glucose Stores (Tachycardia, Tachypnea, Diaphoresis). Later Signs Of Hypoglycemia Are Related To Low Glucose Levels In The Brain (Neuroglycopenia) **Early Signs Can Be Masked In Pts Taking Beta-Blockers What Are The Early Signs Of Hypoglycemia? [Correct Ans Is: - The Early Signs Of Hypoglycemia Are Mediated By The Sympathetic Nervous System, Which Acts To Mobilize Glucose Stores (Tachycardia, Tachypnea, Diaphoresis). Later Signs Of Hypoglycemia Are Related To Low Glucose Levels In The Brain (Neuroglycopenia) **Early Signs Can Be Masked In Pts Taking Beta-Blockers PRACTICE TEST 1 CCRN What Is The Systolic Bp At Different Locations If You Are Able To Palpate A Pulse? [Correct Ans Is: - If The Radial Artery Can Be Palpated, The Systolic Bp Is At Least 80 Mm Hg. If The Brachial Artery Can Be Palpated, The Systolic Bp Is At Least 70 Mm Hg. If Only The Carotid Artery Can Be Palpated, The Systolic Bp Is Approximately 60 Mm Hg What Is The Systolic Bp At Different Locations If You Are Able To Palpate A Pulse? [Correct Ans Is: - If The Radial Artery Can Be Palpated, The Systolic Bp Is At Least 80 Mm Hg. If The Brachial Artery Can Be Palpated, The Systolic Bp Is At Least 70 Mm Hg. If Only The Carotid Artery Can Be Palpated, The Systolic Bp Is Approximately 60 Mm Hg What Happens To Svo2 If Oxygen Delivery Decreases For Any Reason [Correct Ans Is: - Svo2 Is A Reflection Of Oxygen Reserve. If Oxygen Delivery Is Decreased, Oxygen Consumption Continues, And Oxygen Reserve Decreases. Svo2 Decreases Any Time The Delivery Of Oxygen Decreases Or The Consumption Of The Tissues Increases What Happens To Svo2 If Oxygen Delivery Decreases For Any Reason [Correct Ans Is: - Svo2 Is A Reflection Of Oxygen Reserve. If Oxygen Delivery Is Decreased, Oxygen Consumption Continues, And Oxygen Reserve Decreases. Svo2 Decreases Any Time The Delivery Of Oxygen Decreases Or The Consumption Of The Tissues Increases A Simple Way To Estimate Cvp Is To Add 5 Cm To The Measured Height That The Jugular Veins Are Distended Above The Sternal Angle (Angle Of Louis) With The Patient In A 45-Degree Angle [Correct Ans Is: - A Simple Way To Estimate Cvp Is To Add 5 Cm To The Measured Height That The Jugular Veins Are Distended Above The Sternal Angle (Angle Of Louis) With The Patient In A 45-Degree Angle [Correct Ans Is: - What Is The Most Common Cause Of Right Ventricular Failure? [Correct Ans Is: - Left Ventricular Failure- Causes Pulmonary Congestion And Pulmonary Htn Which Increases The Workload For The Right Side Of The Heart Other Causes- Primary Pulmonary Hypertension, Rv Infarction, Pulmonic Stenosis, Pe, Mitral Stenosis PRACTICE TEST 1 CCRN Dobutamine Is The Drug Of Choice For Cardiogenic Shock [Correct Ans Is: - Beta- Adrenergic Stimulant, Increases Hr And Contractility Dobutamine Is The Drug Of Choice For Cardiogenic Shock [Correct Ans Is: - Beta- Adrenergic Stimulant, Increases Hr And Contractility What Ekg Changes Occur With Lbbb? [Correct Ans Is: - Qrs Complex Greater Than 0.12 Second In Duration And A Qrs Complex That Is Positive In Leads V5 And V6 (Consider These Left Ventricular Leads) And Negative In Leads V1 And V2 (Right Ventricle Leads) Rbbb- Qrs Upright In V1 V2, Negative In V5 V6 What Ekg Changes Occur With Lbbb? [Correct Ans Is: - Qrs Complex Greater Than 0.12 Second In Duration And A Qrs Complex That Is Positive In Leads V5 And V6 (Consider These Left Ventricular Leads) And Negative In Leads V1 And V2 (Right Ventricle Leads) Rbbb- Qrs Upright In V1 V2, Negative In V5 V6 Sao2 Has The Least Impact On Oxygen Delivery. Hemoglobin And Cardiac Index Are More Important [Correct Ans Is: - Sao2 Has The Least Impact On Oxygen Delivery. Hemoglobin And Cardiac Index Are More Important [Correct Ans Is: - Weakness, Fatigue, Muscle Pain, And Abdominal Discomfort In A Patient Taking Metformin May Indicate What? [Correct Ans Is: - Lactic Acidosis And Rhadomyolysis Weakness, Fatigue, Muscle Pain, And Abdominal Discomfort In A Patient Taking Metformin May Indicate What? [Correct Ans Is: - Lactic Acidosis And Rhadomyolysis How Does Nifedipine (Procardia) Work? [Correct Ans Is: - Nifedipine Decreases Myocardial Oxygen Consumption By Dilating Veins And Arteries, Thereby Decreasing Preload And Afterload. Nifedipine Also Decreases Vasospasm And Potential For Vasospasm. Unlike Diltiazem And Verapamil, Nifedipine Does Not Significantly Decrease Contractility PRACTICE TEST 1 CCRN How Does Nifedipine (Procardia) Work? [Correct Ans Is: - Nifedipine Decreases Myocardial Oxygen Consumption By Dilating Veins And Arteries, Thereby Decreasing Preload And Afterload. Nifedipine Also Decreases Vasospasm And Potential For Vasospasm. Unlike Diltiazem And Verapamil, Nifedipine Does Not Significantly Decrease Contractility What Are The Components Of The Pulmonary Artery Waveform? [Correct Ans Is: - In A Pulmonary Artery Waveform The Three Components Of The Waveform Are Systole, Dicrotic Notch, And Diastole. Systole Is The Pressure Generated By The Right Ventricle So That The Pulmonic Valve Will Be Pushed Open, The Dicrotic Notch Is Caused By The Closure Of The Pulmonic Valve, And Diastole Is The Pressure In The Pulmonary Artery During Ventricular Diastole. The Diastolic Pressure Is A Reflection Of The Vascular Tone In The Pulmonary Vascular Bed. If The Vessels Are Constricted Or If There Is Back Pressure From The Left Side Of The Heart, The Diastolic Pressure Will Be High What Are The Components Of The Pulmonary Artery Waveform? [Correct Ans Is: - In A Pulmonary Artery Waveform The Three Components Of The Waveform Are Systole, Dicrotic Notch, And Diastole. Systole Is The Pressure Generated By The Right Ventricle So That The Pulmonic Valve Will Be Pushed Open, The Dicrotic Notch Is Caused By The Closure Of The Pulmonic Valve, And Diastole Is The Pressure In The Pulmonary Artery During Ventricular Diastole. The Diastolic Pressure Is A Reflection Of The Vascular Tone In The Pulmonary Vascular Bed. If The Vessels Are Constricted Or If There Is Back Pressure From The Left Side Of The Heart, The Diastolic Pressure Will Be High What Is Ankle-Brachial Index? [Correct Ans Is: - Abi Is Ankle-Brachial Index, Or Ankle Artery Pressure Divided By Brachial Artery Pressure. The Pressure At The Ankle Normally Is Higher Than The Pressure At The Brachial Artery, And The Normal Abi Is 1 Or Greater. This Measurement Is More Quantitative Than The Presence Or Absence Of Audible Doppler Pulses. If An Occlusion Is Developing, The Ankle Artery Pressure (Measured With A Blood Pressure Cuff And A Doppler Stethoscope) Will Decrease And The Calculated Abi Will Decrease Long Before The Pulses Are No Longer Audible What Is Ankle-Brachial Index? [Correct Ans Is: - Abi Is Ankle-Brachial Index, Or Ankle Artery Pressure Divided By Brachial Artery Pressure. The Pressure At The Ankle Normally Is Higher Than The Pressure At The Brachial Artery, And The Normal Abi Is 1 Or Greater. This Measurement Is More Quantitative Than The Presence Or Absence Of Audible Doppler Pulses. If An Occlusion Is Developing, The Ankle Artery Pressure (Measured With A Blood Pressure Cuff And A Doppler Stethoscope) Will Decrease And The Calculated Abi Will Decrease Long Before The Pulses Are No Longer Audible PRACTICE TEST 1 CCRN How Does Hypoxemia Affect Pulmonary Vascular Pressures? [Correct Ans Is: - It Causes The Vasculature To Constrict, Which Can Lead To Pulmonary Hypertension How Does Hypoxemia Affect Pulmonary Vascular Pressures? [Correct Ans Is: - It Causes The Vasculature To Constrict, Which Can Lead To Pulmonary Hypertension If You Notice A Sudden Change In Diastolic Pulmonary Artery Pressures You Should Suspect What? [Correct Ans Is: - Proximal Movement Of The Catheter. Recall That The Systolic Pressure Of The Pulmonary Artery And The Right Ventricle Are Approximately The Same. The Diastolic Pressure In The Pulmonary Artery Is Normally Approximately 10 Mm Hg, Whereas The Diastolic Pressure Of The Right Ventricle Is Normally Close To 0. Any Sudden Decrease In The Pa Diastolic Pressure Should Lead You To Suspect That The Catheter Has Flipped Back Into The Right Ventricle If You Notice A Sudden Change In Diastolic Pulmonary Artery Pressures You Should Suspect What? [Correct Ans Is: - Proximal Movement Of The Catheter. Recall That The Systolic Pressure Of The Pulmonary Artery And The Right Ventricle Are Approximately The Same. The Diastolic Pressure In The Pulmonary Artery Is Normally Approximately 10 Mm Hg, Whereas The Diastolic Pressure Of The Right Ventricle Is Normally Close To 0. Any Sudden Decrease In The Pa Diastolic Pressure Should Lead You To Suspect That The Catheter Has Flipped Back Into The Right Ventricle What Is Dic? [Correct Ans Is: - Dic Is A Consumptive Coagulopathy. The Clotting Cascade Is Stimulated, Causing Clotting In The Microcirculation. Platelet And Clotting Factors (Including Fibrinogen) Are Consumed And Become Depleted. Clotting Studies Are Prolonged. The Massive Clotting Stimulates The Fibrinolytic System. Fdps Are The Result Of This Fibrinolysis, And They Trigger More Bleeding What Is Dic? [Correct Ans Is: - Dic Is A Consumptive Coagulopathy. The Clotting Cascade Is Stimulated, Causing Clotting In The Microcirculation. Platelet And Clotting Factors (Including Fibrinogen) Are Consumed And Become Depleted. Clotting Studies Are Prolonged. The Massive Clotting Stimulates The Fibrinolytic System. Fdps Are The Result Of This Fibrinolysis, And They Trigger More Bleeding Management Of Care For Pt With Dic Includes... [Correct Ans Is: - Avoidance Of Injections, Replacement Of Fluids/Blood/Clotting Factors, Turning Frequently And Gently, And Not Using Automated Bp Cuffs (Risk Of Injury/Trauma) PRACTICE TEST 1 CCRN Goal To Improve Lv Filling To Enhance Co. Achieve This By Increasing Rv Filling Pressure (Rap) To Higher Than Normal To Increase The Passive Flow Of Blood Into Lv. Discontinue Venous Vasodilators (Nitroglycerin) And Given Fluid Boluses. Don't Give Diuretics Because They Would Decrease Rap And Co. Dobutamine Is Needed To Improve Rv Contractility What Do These Hemodynamic Parameters Indicate And How To Tx? Hr-112 Bp-90/46 (60) Rap-16 Pap 26/10 Paop- 5 Ci-2 [Correct Ans Is: - Right Ventricular Dysfunction- High Rap, Normal Pap, Paop Low= Decreased Blood Return To The Left Side Of Heart Goal To Improve Lv Filling To Enhance Co. Achieve This By Increasing Rv Filling Pressure (Rap) To Higher Than Normal To Increase The Passive Flow Of Blood Into Lv. Discontinue Venous Vasodilators (Nitroglycerin) And Given Fluid Boluses. Don't Give Diuretics Because They Would Decrease Rap And Co. Dobutamine Is Needed To Improve Rv Contractility How Does Milrinone Work? [Correct Ans Is: - Inotropic Agent, Has Arterial And Venous Vasodilating Qualities- Decreases Preload And Lessens The Filling Of The Left Side Of The Heart. Is Indicated For Chronic Lv Failure. How Does Milrinone Work? [Correct Ans Is: - Inotropic Agent, Has Arterial And Venous Vasodilating Qualities- Decreases Preload And Lessens The Filling Of The Left Side Of The Heart. Is Indicated For Chronic Lv Failure. Hyperthermia Cause What Change On The Oxyhemoglobin Dissociation Curve? [Correct Ans Is: - It Causes It To Shift To The Right, Which Decreases Hemoglobin's Affinity For Oxygen (Doesn't Like It So It Doesn't Hold On To It). So Your O2 Sats Would Be Lower Than Normal Ex: Pa02 Of 60 Normally Gives You An Sao2 Of 90%, But If Your Hyperthermic It Would Be Closer To 86% Hyperthermia Cause What Change On The Oxyhemoglobin Dissociation Curve? [Correct Ans Is: - It Causes It To Shift To The Right, Which Decreases Hemoglobin's Affinity For Oxygen (Doesn't Like It So It Doesn't Hold On To It). So Your O2 Sats Would Be Lower Than Normal Ex: Pa02 Of 60 Normally Gives You An Sao2 Of 90%, But If Your Hyperthermic It Would Be Closer To 86% PRACTICE TEST 1 CCRN What Activities Increase Myocardial Ischemia? [Correct Ans Is: - Using The Bedpan, Having The Bed Changed, Having Painful Procedures (Such As The Insertion Of An Intravenous Catheter), And Being Weighed On An Overbed Scale Increase Myocardial Oxygen Consumption And May Cause Myocardial Ischemia. Eating A Meal Also May Shunt Blood To The Gastrointestinal Tract And Cause Myocardial Ischemia What Activities Increase Myocardial Ischemia? [Correct Ans Is: - Using The Bedpan, Having The Bed Changed, Having Painful Procedures (Such As The Insertion Of An Intravenous Catheter), And Being Weighed On An Overbed Scale Increase Myocardial Oxygen Consumption And May Cause Myocardial Ischemia. Eating A Meal Also May Shunt Blood To The Gastrointestinal Tract And Cause Myocardial Ischemia What Is The Primary Role Of The Case Manager? [Correct Ans Is: - Advocate- Informing And Supporting In Decision Making, Informing About Available Resources And Negotiating Access To Resources What Is The Primary Role Of The Case Manager? [Correct Ans Is: - Advocate- Informing And Supporting In Decision Making, Informing About Available Resources And Negotiating Access To Resources What Are The Current Guidelines On Providing Oxygen To Copd Patients [Correct Ans Is: - Maintain Hypoxemia (Lower Than Normal O2 In Blood) But Prevent Hypoxia (Low O2 To Tissues). This Is Achieved By Maintain Sao2/Spo2 Around 90%. Therefore Some Patients May Need More Than 2l Of Oxygen. What Are The Current Guidelines On Providing Oxygen To Copd Patients [Correct Ans Is: - Maintain Hypoxemia (Lower Than Normal O2 In Blood) But Prevent Hypoxia (Low O2 To Tissues). This Is Achieved By Maintain Sao2/Spo2 Around 90%. Therefore Some Patients May Need More Than 2l Of Oxygen. What Electrolytes May Be Involved In A Patient With Prolonged Qt [Correct Ans Is: - Potassium, Calcium, And Magnesium. Low Levels Of Any Of These Would Result In Prolonged Repolarization, Which Would Be Seen As A Prolonged Qt Segment What Electrolytes May Be Involved In A Patient With Prolonged Qt [Correct Ans Is: - Potassium, Calcium, And Magnesium. Low Levels Of Any Of These Would Result In Prolonged Repolarization, Which Would Be Seen As A Prolonged Qt Segment If The Ventricles Are Depolarized Before The Atria In A Junctional Rhythm You Would Expect To Find The P Wave Where? [Correct Ans Is: - After The Qrs PRACTICE TEST 1 CCRN If The Ventricles Are Depolarized Before The Atria In A Junctional Rhythm You Would Expect To Find The P Wave Where? [Correct Ans Is: - After The Qrs A Patient Has Csf Leaking From Their Nose After A Transsphenoidal Hypophysectomy, What Do You Do? [Correct Ans Is: - It Is Normal To Have A Csf Leak For 48 Hrs After Surgery. Cover With A Sterile "Moustache" 2x2 Tapes Under Their Nose To Form A Barrier. If Your Dura Is Not Intact That You Would Expect A Leak, But It Does Increase Your Risk Of Infection A Patient Has Csf Leaking From Their Nose After A Transsphenoidal Hypophysectomy, What Do You Do? [Correct Ans Is: - It Is Normal To Have A Csf Leak For 48 Hrs After Surgery. Cover With A Sterile "Moustache" 2x2 Tapes Under Their Nose To Form A Barrier. If Your Dura Is Not Intact That You Would Expect A Leak, But It Does Increase Your Risk Of Infection What Is Wernicke's Syndrome And What Is It Associated With? [Correct Ans Is: - Thiamine Is Necessary For Use Of Glucose. Administration Of Glucose In Patients With Thiamine Deficiency May Cause Wernicke's Syndrome (Also Called Wernicke's Encephalopathy). The Syndrome Is Characterized By Diplopia, Nystagmus, Lack Of Coordination, And Decreased Metal Function What Is Wernicke's Syndrome And What Is It Associated With? [Correct Ans Is: - Thiamine Is Necessary For Use Of Glucose. Administration Of Glucose In Patients With Thiamine Deficiency May Cause Wernicke's Syndrome (Also Called Wernicke's Encephalopathy). The Syndrome Is Characterized By Diplopia, Nystagmus, Lack Of Coordination, And Decreased Metal Function Diastolic Murmurs Are Always Pathologic. Systolic Murmurs Can Be Pathologic (Related To Valve Disease Or Septal Defects) Or They Can Be Functional Related To Turbulence Of Blood Flow [Correct Ans Is: - Diastolic Murmurs Are Always Pathologic. Systolic Murmurs Can Be Pathologic (Related To Valve Disease Or Septal Defects) Or They Can Be Functional Related To Turbulence Of Blood Flow [Correct Ans Is: - What Causes A Dampened Pulmonary Artery Pressure And How Do You Correct It? [Correct Ans Is: - A Damped Pulmonary Artery Waveform May Be Caused By Air Or PRACTICE TEST 1 CCRN Pneumo, Right Pleural Effusion- Think Any Pressure On The Right Side Will Shift Things Toward The Left Pericardial Effusion- Layer Of Fluid Over The Heart Which Will Dampen The Sounds But Not Cause A Shift To The Left What Conditions Would Lead To A Shift In The Pmi From The Midclavicular Line To The Anterior Axillary Line? [Correct Ans Is: - Lv Hypertrophy, Right Tension Pneumo, Right Pleural Effusion- Think Any Pressure On The Right Side Will Shift Things Toward The Left Pericardial Effusion- Layer Of Fluid Over The Heart Which Will Dampen The Sounds But Not Cause A Shift To The Left What Does Failure To Capture Indicate And How Do You Correct It? [Correct Ans Is: - Failure To Capture Occurs When The Electricity From The Pacemaker Does Not Cause Depolarization Of The Ventricle (Or Atria If An Atrial Pacemaker). It Would Be Logical To Consider Using More Electricity (I.E., Milliamperage). You Can Also Try Repositioning The Pt On The Side Before They Lost Capture What Does Failure To Capture Indicate And How Do You Correct It? [Correct Ans Is: - Failure To Capture Occurs When The Electricity From The Pacemaker Does Not Cause Depolarization Of The Ventricle (Or Atria If An Atrial Pacemaker). It Would Be Logical To Consider Using More Electricity (I.E., Milliamperage). You Can Also Try Repositioning The Pt On The Side Before They Lost Capture What Is Failure To Sense And What Do You Do For It? [Correct Ans Is: - Pacer Spikes Seen Indiscriminately Within Pts Own Rhythm. Increase The Sensitivity What Is Failure To Sense And What Do You Do For It? [Correct Ans Is: - Pacer Spikes Seen Indiscriminately Within Pts Own Rhythm. Increase The Sensitivity What Is Oversensing On A Pacemaker? [Correct Ans Is: - Oversensing Occurs When The Pacemaker Senses An Event Besides What It Is Intended To Sense And Is Inhibited By This Event. Ex; The Pacer Senses The T Wave Or Other Inappropriate Signals And Is Inhibited What Is Oversensing On A Pacemaker? [Correct Ans Is: - Oversensing Occurs When The Pacemaker Senses An Event Besides What It Is Intended To Sense And Is PRACTICE TEST 1 CCRN Inhibited By This Event. Ex; The Pacer Senses The T Wave Or Other Inappropriate Signals And Is Inhibited How Do You Treat Oversensing [Correct Ans Is: - Decrease The Sensitivity If Causing Failure To Fire How Do You Treat Oversensing [Correct Ans Is: - Decrease The Sensitivity If Causing Failure To Fire Why Do Heart Failure Patients Take Ace Inhibitors [Correct Ans Is: - Hypoperfusion Of The Kidney Causes Stimulation Of The Raa System, Vasoconstriction And Retention Of Sodium And Water Occur. If The Hypoperfusion To The Kidney Was Caused By Hf, This Worsens Hf By Increasing Afterload And Preload. Ace Inhibitors Inhibit This Maladaptation (In Heart Failure) Why Do Heart Failure Patients Take Ace Inhibitors [Correct Ans Is: - Hypoperfusion Of The Kidney Causes Stimulation Of The Raa System, Vasoconstriction And Retention Of Sodium And Water Occur. If The Hypoperfusion To The Kidney Was Caused By Hf, This Worsens Hf By Increasing Afterload And Preload. Ace Inhibitors Inhibit This Maladaptation (In Heart Failure) Giving A Malnourished Patient Adequate Nutrition May Result In What Electrolyte Disturbance? [Correct Ans Is: - Severe Phosphate Deficiency. This Often Is Called Refeeding Syndrome. Nutritional Support Allows The Cells To Begin Making More Adenosine Triphosphate (Atp), And Phosphate Supplies Are Depleted. The Same Thing Happens In Diabetic Ketoacidosis With Treatment When Insulin Allows Glucose To Move Into The Cell Increasing Production Of Atp And Depletion Of Phosphate. Giving A Malnourished Patient Adequate Nutrition May Result In What Electrolyte Disturbance? [Correct Ans Is: - Severe Phosphate Deficiency. This Often Is Called Refeeding Syndrome. Nutritional Support Allows The Cells To Begin Making More Adenosine Triphosphate (Atp), And Phosphate Supplies Are Depleted. The Same Thing Happens In Diabetic Ketoacidosis With Treatment When Insulin Allows Glucose To Move Into The Cell Increasing Production Of Atp And Depletion Of Phosphate. What Cardiac Biomarker Would You Expect To Be Elevated Within 3 Hours Of Acute Mi? [Correct Ans Is: - Myoglobin- Effective For Ruling Out Mi (Sesitive For Mi) But Has A Lot Of False Positives. PRACTICE TEST 1 CCRN The Least Specific Is Likely To Be The Earliest What Cardiac Biomarker Would You Expect To Be Elevated Within 3 Hours Of Acute Mi? [Correct Ans Is: - Myoglobin- Effective For Ruling Out Mi (Sesitive For Mi) But Has A Lot Of False Positives. The Least Specific Is Likely To Be The Earliest What Are The Stages In The Ace Star Model [Correct Ans Is: - Systematic Review Of The Research Related To A Specific Clinical Question Is An Example Of Summary Of The Evidence. A Clinical Practice Guideline Is An Example Of Translation Of Evidence. A Pilot Test Would Be An Example Of Implementation Of Evidence What Are The Stages In The Ace Star Model [Correct Ans Is: - Systematic Review Of The Research Related To A Specific Clinical Question Is An Example Of Summary Of The Evidence. A Clinical Practice Guideline Is An Example Of Translation Of Evidence. A Pilot Test Would Be An Example Of Implementation Of Evidence What Are The Purpose Of Chest Pt? [Correct Ans Is: - Increase Mucociliary Clearance Of Secretions Which Decreases Airway Resistance And Decreases Shunt What Are The Purpose Of Chest Pt? [Correct Ans Is: - Increase Mucociliary Clearance Of Secretions Which Decreases Airway Resistance And Decreases Shunt The Reshaping That Occurs With Hf Results In The Heart Taking On What Shape? [Correct Ans Is: - More Spherical Shape- Think The Pmi Gets Displaced To The Left The Reshaping That Occurs With Hf Results In The Heart Taking On What Shape? [Correct Ans Is: - More Spherical Shape- Think The Pmi Gets Displaced To The Left What Are Signs Of Oxygen Toxicity? [Correct Ans Is: - Early Indications Of Oxygen Toxicity Are Substernal Distress, Paresthesias In Extremities, And Gastrointestinal Symptoms (E.G., Anorexia, Nausea, Vomiting, Fatigue, Malaise, Dyspnea, And Restlessness). Late Indications Are Hypercapnia, Cyanosis, Decreasing Compliance, Increasing A:A Gradient, And Pulmonary Edema What Are Signs Of Oxygen Toxicity? [Correct Ans Is: - Early Indications Of Oxygen Toxicity Are Substernal Distress, Paresthesias In Extremities, And Gastrointestinal PRACTICE TEST 1 CCRN Propensity For Ventricular Ectopy. Beta2 Receptors Cause Bronchodilation And Vasodilation. In This Case, The Increase In Heart Rate And Ectopy Potential Is Caused By Stimulation Of The Beta1 Receptors. The Increase In Afterload Is Caused By Stimulation Of The Alpha Receptors. Contractility Would Have Been Increased By Beta1 Stimulation, But The Patient's Myocardium Is Unable To Respond, And Contractility Remains Decreased What Are The Compensatory Mechanisms Of The Sns To The Heart, And How Are Those Affected By An Mi [Correct Ans Is: - Alpha Receptors Of The Sns Cause Vasoconstriction And Shift Blood From Nonessential (Skin, Bowel, Kidney) To Essential (Heart And Brain) Organs. Beta1 Receptors Increase Heart Rate (Positive Chronotropic Effect), Increase Contractility (Positive Inotropic Effect), And Increase Conductivity (Positive Dromotropic Effect). The Dromotropic Effect Increases The Propensity For Ventricular Ectopy. Beta2 Receptors Cause Bronchodilation And Vasodilation. In This Case, The Increase In Heart Rate And Ectopy Potential Is Caused By Stimulation Of The Beta1 Receptors. The Increase In Afterload Is Caused By Stimulation Of The Alpha Receptors. Contractility Would Have Been Increased By Beta1 Stimulation, But The Patient's Myocardium Is Unable To Respond, And Contractility Remains Decreased What Complications Of Copd Predispose The Patient To Developing Pes? [Correct Ans Is: - Copd Causes Pulmonary Hypertension, Right Ventricular Hypertrophy, And Right Atrial Enlargement. The Right Atrial Enlargement Causes Stretching Of The Atrial Tissue And Frequently Results In Atrial Dysrhythmias. Atrial Fibrillation Is Associated With Mural Thrombi And Pulmonary And Systemic Emboli. The Hypoxemia That Results From Copd Causes Release Of Erythropoietin From The Kidney, Which Stimulates Release Of Red Blood Cells From The Bone Marrow And Polycythemia. Polycythemia Causes Hypercoagulability. This Hypercoagulability, Especially Coupled With Inactivity, Increases The Risk Of Thrombosis And Emboli What Complications Of Copd Predispose The Patient To Developing Pes? [Correct Ans Is: - Copd Causes Pulmonary Hypertension, Right Ventricular Hypertrophy, And Right Atrial Enlargement. The Right Atrial Enlargement Causes Stretching Of The Atrial Tissue And Frequently Results In Atrial Dysrhythmias. Atrial Fibrillation Is Associated With Mural Thrombi And Pulmonary And Systemic Emboli. The Hypoxemia That Results From Copd Causes Release Of Erythropoietin From The Kidney, Which Stimulates Release Of Red Blood Cells From The Bone Marrow And Polycythemia. Polycythemia Causes Hypercoagulability. This Hypercoagulability, Especially Coupled With Inactivity, Increases The Risk Of Thrombosis And Emboli What Is The First Sign Of Uncal Herniation? [Correct Ans Is: - Ipsilateral Pupil Dilation With A Sluggish Reaction As A Result Of Pressure On Cranial Nerve Iii. Motor Weakness May Occur But Would Be On The Contralateral Side PRACTICE TEST 1 CCRN What Is The First Sign Of Uncal Herniation? [Correct Ans Is: - Ipsilateral Pupil Dilation With A Sluggish Reaction As A Result Of Pressure On Cranial Nerve Iii. Motor Weakness May Occur But Would Be On The Contralateral Side What Electrolyte Imbalances Predispose You To Digitalis Toxicity? [Correct Ans Is: - Hypokalemia, Hypercalcemia, And Hypomagnesemia Increase Sensitivity To Digitalis Toxicity K, Ca, And Mg Affect The Heart Na Is More Important In Extracellular And Neuromuscular Transmission What Electrolyte Imbalances Predispose You To Digitalis Toxicity? [Correct Ans Is: - Hypokalemia, Hypercalcemia, And Hypomagnesemia Increase Sensitivity To Digitalis Toxicity K, Ca, And Mg Affect The Heart Na Is More Important In Extracellular And Neuromuscular Transmission What Are The Steps Of Corrective Discipline [Correct Ans Is: - Counseling Is Informal And First. Verbal Warning Is Followed By Written Warning, If Necessary. Suspension For A Specified Number Of Days Occurs If The Problem Persists. Termination Is, Of Course, The Final Step. What Are The Steps Of Corrective Discipline [Correct Ans Is: - Counseling Is Informal And First. Verbal Warning Is Followed By Written Warning, If Necessary. Suspension For A Specified Number Of Days Occurs If The Problem Persists. Termination Is, Of Course, The Final Step. Ace-I Can Cause What Electrolyte Imbalance? [Correct Ans Is: - Hyperkalemia- Prevent Angio 1 From Converting To Angio Ii. Angio Ii Usually Blocks Aldosterone And Cause Vasoconstriction. Aldosterone Usually Holds On To Na And H2o In Exchange For K (Excretes It), But Since You Don't Have It You Get Rid Of Na And H20 And Hold On To K Ace-I Can Cause What Electrolyte Imbalance? [Correct Ans Is: - Hyperkalemia- Prevent Angio 1 From Converting To Angio Ii. Angio Ii Usually Blocks Aldosterone And Cause Vasoconstriction. Aldosterone Usually Holds On To Na And H2o In Exchange For K (Excretes It), But Since You Don't Have It You Get Rid Of Na And H20 And Hold On To K PRACTICE TEST 1 CCRN Pt Post Anterior Mi Gets Pci But Develops Signs Of Hf And Cardiogenic Shock. Started On Dobutamine At 5mcg/Kg/Min. Hemodynamics Are... Bp-80/60, Rap- 8, Pap-40/25, Paop-22, Svr-2500, Ci- 1.9, Venous Sat-56% Are These Parameters Ok/What Do They Show And What Tx Do You Expect? [Correct Ans Is: - Bp-Low, Rap- Slightly Elevated (2-6), Pap-High, Paop-High (8-12), Svri-High (1970-2390) , Ci-Low (2.8-4.2), Vsat-Low (75) Increasing The Dobutamine Will Increase Contractility To Improve Sv And Ci. It Also Causes Vasodilation To Decrease Preload (Paop) And Afterload (Svri) Pt Post Anterior Mi Gets Pci But Develops Signs Of Hf And Cardiogenic Shock. Started On Dobutamine At 5mcg/Kg/Min. Hemodynamics Are... Bp-80/60, Rap- 8, Pap-40/25, Paop-22, Svr-2500, Ci- 1.9, Venous Sat-56% Are These Parameters Ok/What Do They Show And What Tx Do You Expect? [Correct Ans Is: - Bp-Low, Rap- Slightly Elevated (2-6), Pap-High, Paop-High (8-12), Svri-High (1970-2390) , Ci-Low (2.8-4.2), Vsat-Low (75) Increasing The Dobutamine Will Increase Contractility To Improve Sv And Ci. It Also Causes Vasodilation To Decrease Preload (Paop) And Afterload (Svri) Remember Bp=Coxsvr If The Pts Bp Is Not Decreased Because Svr Is Decreased Than It Is Because Co Is Decreased, Therefore Treatment Should Be Directed Toward Increasing Co Rather Than Increasing Svr [Correct Ans Is: - Remember Bp=Coxsvr If The Pts Bp Is Not Decreased Because Svr Is Decreased Than It Is Because Co Is Decreased, Therefore Treatment Should Be Directed Toward Increasing Co Rather Than Increasing Svr [Correct Ans Is: -