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78 Yr Old Female Fell At Home 1 Wk Ago. She Has Been On Coumadin For A-Fib For Over 1 Year. She Presents With A Complaint Of Headache. Her Family States: "Mom Has Been Acting Weird For The Past Couple Days." Scenario Is Consistent With? [Correct Ans Is: - Subdural Hematoma A Subdural Bleed Is Usually A Slow Accumulating, Venous Bleed. Abnormal Neuro Changes May Not Be Seen For Days Or Weeks. Epidural Hematoma? [Correct Ans Is: - May Bleed And Accumulate Rapidly Since They Result From Arterial Bleeding. Cerebral Aneurysm Rupture? [Correct Ans Is: - Is Associated With Patient Complaining Of "Worst HA In Their Life." During A Pt's Admission To The ICU, The RN Notes Hgb 9g/Dl And Hct 27 Ml/Dl. Which Meds Should Be Confirmed With The Provider Prior To Administration? [Correct Ans Is: - Sulfa-Trimethoprim (Bactrim) Anemia Can Be Caused Or Exacerbated By Some Meds, Including Sulfa, Antibiotics And ACE. A 56 Yr Male Presents In Heart Block With A Ventricular Rate Of 38 Caused From An Intentional Overdose From CCB. What Is Appropriate Antidote? [Correct Ans Is: - Calcium Which Is The Earliest Sign Of Supratentorial (Uncal) Herniation? [Correct Ans Is: - Ipsilateral Pupil Dilation. Pt Post-Operative Day 2 After A Right Hemicolectomy For Ischemic Bowel. The Post- Operative Course Has Been Complicated With Pain Control Concerns. As The Patient Is Getting Out Of Bed For The First Time The Patient Complains Of Sudden Wet Sounding Cough. The Assesses New Onset Tachycardia [Correct Ans Is: - Pulmonary Embolism - Clinical Signs Of Sudden SOB, Anxiety Points To PE
Glucagon Is An Antidote For? [Correct Ans Is: - Beta Blockers Which Port Do You Get To Measure Mixed Venous Blood? [Correct Ans Is: - Distal Port DIC - Which Medication Does The Nurse Anticipate To Be Ordered And Started Urgently? [Correct Ans Is: - Heparin Continous Infusion 4 Units/Kg/Hr Other Tx Would Be To Eliminate The Cause. Which Lab Value Would Expect To See In A Patient With Pancreatitis? [Correct Ans Is: - Decreased Albumin, Elevated Amylase And Lipase Reversal For Warfarin Overdose? [Correct Ans Is: - Vit K A Pt With 3 Vessel CABG With PA Catheter In Place. Pt Has Crackles In Bilateral Bases, S3,S4 Heart Sounds Are Audible, In Addition To Holosystolic Murmur. The Nurse Suspects Mitral Valve Insufficiency. Which Set Of Data Confirms This Suspicion? [Correct Ans Is: - CVP Elevated PA Pressure Elevated PAOP Elevated As Mitral Regurgitation Develops Blood Moves Back Into The Right Atrium From The Left Ventricle. This In Turn Causes An Increase In Left Atrial Pressure, Pulmonary Artery Pressure, And Cvp Pressure. Pt With Traumatic Brain Injury, What Intervention Should You Include To Prevent An Increase In ICP? [Correct Ans Is: - Keep Patient's Head In A Neutral Midline Position. You Are Caring For A Patient With An Acute Episode Of Asthma Exacerbation. The First Line Of Treatment Is: [Correct Ans Is: - Beta 2 Agonist - Immediate Tx Of Asthma Exacerbation Is To Bronchodilate The Airways To Facilitate Ventilation. Beta 2 Agonists Such As Albuterol Are A Mainstay In The Management Of Asthma And Can Be Administered Via Nebulizer If Needed.
Beta Blocks To What For Cardiac Contractility? [Correct Ans Is: - Decrease What Does Plateau Pressure Measure? [Correct Ans Is: - It Reflects Lung Pressure And Is Needed To Calculate Static (Lung) Compliance. Salicylate Overdose Treatment? [Correct Ans Is: - Activated Charcoal, Urine Alkalization, Dialysis. Pericardial Friction Run Would Show What On An 12 Lead EKG? [Correct Ans Is: - ST Elevation In II, III, Avf, And V2-V A 56 Yr-Old Male Is Admitted To The ICU With A Blood Pressure Of 225/135 And Complains Of A Headache And Nausea. He Reports He Ran Out Of Blood Pressure Meds Three Days Ago, But Also Appears To Be Confused To The Date And Situation. What Is The Most Appropriate Treatment Approach? [Correct Ans Is: - Rapidly Lower The Diastolic Pressure To 100 With IV Antihypertensive Meds, Then Continue To Gradually Reduce The Diastolic Pressure To 85 With Oral Antihypertensive Meds. The Maximum Initial Decrease Should Be No More Than 25% Reduction From Initial Presenting Value. Reducing The Blood Pressure Too Quickly Can Lead To Cerebral Edema Or Renal Failure. A Patient Has Sepsis, Receives Lactated Ringers 500ml IV Bolus. Which Finding Indicate That This Intervention Is Having It's Intended Effect? [Correct Ans Is: - Scvo2 Of 72% Early Goal Directed Therapy For Sepsis Includes Early Fluid Resuscitation At 30 Ml/Kg To Maintain A CVP Of 8-12 Or 12-15 If Mechanically Ventilated, MAP Greater Than 65, Scvo2 Greater Than 70%, And Urine Output Greater Than 0.5 Kg/Hr 72 Male Patient In ICU For 6 Days On The Ventilator For Treatment Of A COPD Exacerbation. He Has Been Receiving VTE Prophylaxis And Subcutaneous Heparin Since Admission. Today His Platelet Count Decreased Significantly To 43,000 And Was Found To Have New DVT On His Right Upper Extremity. What Do You Suspect Is The Most Likely Cause Of These Findings? [Correct Ans Is: - HIT
The Hallmark Sign Of HIT Is A Significant Decrease In Platelet Count Over A 24 Hours Period (>50%) Within 5-10 Days Of Administering Heparin. The Other Hallmark Sign Is A New Development Of DVT Despite Being On VTE Prophylaxis. TRALI: [Correct Ans Is: - Is A Complication From A Blood Transfusion Reaction, Which Causes Acute Lung Injury Typically Within 6 Hours Of A Blood Transfusion. 2 Hallmark Signs Of HIT: [Correct Ans Is: - Decrease In Platelet Count Over A 24 Hr Period. New Development Of DVT Despite Being On VTE Prophylaxis. Values In Early Compensated Hypovolemic Shock? [Correct Ans Is: - CO 4.0 L/Min, HR 135, SV 65, SVR 1700, MAP 65 In Hypovolemic States, Circulating Volume Is Depleted Therefore Preload And Contractility Are Decreased Which Leads To A Decrease In SV And CO. HR And SV Increase As Compensatory Measure To Preserve CO, MAP And Cerebral Perfusion. Post-Renal Failure Values: [Correct Ans Is: - Urine Output < 200; Urine Sodium 30; BUN: Creatinine Ratio 15:1; Urine Specific Gravity 1. BUN: Creatinine Ratio Is 15:1, But Both The BUN & Creatinine Are Elevated. Urine Sodium Is Typically 1-40 Meq/L. What To Do In The Event Of HIT: [Correct Ans Is: - Stop Heparin And Administer An Alternative Direct Thrombin Inhibitor. Warfarin Is Contraindicated In HIT? T/F [Correct Ans Is: - True - There Is Also No Evidence That Shows Protamine, Corticosteroids, And Benadryl Are Effective Treatments For HIT Patients With Right Ventricular Infarctions Become Preload Dependent. Meds That Decrease Preload Should Be Avoided - Which Meds Are These? [Correct Ans Is: - Morphine, Nitro, Beta Blockers And Diuretics. Polymorphic Ventricular Tachycardia Aka Torsades Is Treated By? [Correct Ans Is: - Magnesium
Elevated Urine Osmolality; Decreased Serum Osmolality; And Decreased Serum Sodium Is What Symptom? [Correct Ans Is: - SIADH - Causes Retention Of Water. Urine Production Is Minimal And Concentrated & Leads To An Increased Urine Osmolality. What Does Neo Drug Increase? [Correct Ans Is: - SVR - Peripheral Constriction Treatment For Narrow Complex, Regular Rhythm? [Correct Ans Is: - Administer 6mg Adenosine Rapidly IVP Half Life Of Metformin? [Correct Ans Is: - 6 Hours - Close Monitoring Is Required To Ensure The Blood Glucose Level Does Not Climb Too Quickly While Dextrose Is Being Administered. Most Accurate Reflection Of Daily Fluid Balance? [Correct Ans Is: - Record A Daily Weight At The Same Time Each Day. Wide Mediastinum On Chest X-Ray, Narrow Pulse Pressure, And Hypotension Are Signs Of What? [Correct Ans Is: - Cardiac Tamponade A Patient With Hyponatremia Would Need What? [Correct Ans Is: - Help Maintaining A Safe Environment. Hypona Impairs Judgment, And Causes Confusion. Peritoneal Dialysis Works On The Principles Of Both? [Correct Ans Is: - Diffusion And Osmosis. HHNS Leads To What? [Correct Ans Is: - Large Fluid Deficits And May Require Multiple Liters Of Fluid, Which Is Determined By The Patient's Level Of Dehydration And Hyperosmolality. What Parameters Are Consistent With Pulsus Paradoxes? [Correct Ans Is: - Decrease In SBP>10 During Inspiration. Before Administering Rtpa What Must Happen? [Correct Ans Is: - Lower The BP To At Least 185/110. An Elevated BP Prior To Rtpa Can Cause Hemorrhage. Ibutilide Can Cause What? [Correct Ans Is: - Torsades
A Person With Disecting AAA Would Receive What Drug? [Correct Ans Is: - PRN IV Narcotic Analgesia - BP Management Is A Priority In The Care Of A Patient With A Dissecting AAA. Pain Is The Primary Driver Of HTN. Autonomic Hyperreflexia Is What? [Correct Ans Is: - This Disorder Is Seen With Spinal Injuries Occurring Above The T6 Spine. Cause Of Autonomic Hyperreflexia? [Correct Ans Is: - Bladder Obstruction, Constipation, Pressure Ulcers, And Pain. Usually When The Noxious Stimulus Is Identified And Removed, The Symptoms Resolve. Checking Urinary Catheter For Obstruction Is The Most Appropriate Next Action. MEDS For Asymptomatic Left Ventricular Systolic Dysfunction? [Correct Ans Is: - ACE Or (ARB), Beta-Blockers And Statins For All Patients With A History Of MI And For All Patients With A Reduced Ejection Fraction. What Is The Z Point Technique? [Correct Ans Is: - Is A Method Used To Estimate Ventricular End Diastolic Pressure. It Is Taken Just Before The Closure Of The Mitral Valve And Is Especially Useful When An A Wave Does Not Exist On The PAOP Tracing Such As In Atrial Fib. Ascites Position For Relief? [Correct Ans Is: - Place Pt On Left Side. DIC Lab Values? [Correct Ans Is: - Fibrinogen Decreased FSP Elevated Platelets Decreased D-Dimer Elevated Decreased Albumin Is An Indicator Of What? [Correct Ans Is: - Protein Deficiency And Poor Nutrition, Which Are Major Contributors To Poor Wound Healing.
FSP Elevated Platelets Decreased D-Dimer Elevated HOB Position For ICP? Other Tx? [Correct Ans Is: - 45 Degrees Increase Sedation Or Mannitol As Prescribed. Opening The Ventriculostomy Drain Requires Specific Orders? [Correct Ans Is: - True Brain Death Criteria? [Correct Ans Is: - Positive Apnea Test Absent Oculovestibular And Oculocephalic Reflex Respiratory Acidosis ST Elevation Is Indicative Of What? [Correct Ans Is: - Cardiac Ischemia And Should Be Treated As Myocardial Infarction CDC Indications For Urinary Catheter Include: [Correct Ans Is: - End-Of-Life Care, Strict I&O, Immobility, Select Surgical Procedures, Sacral Wounds, Urinary Retention/Obstruction A Saddle Embolus Is Life Threatening And Requires Which Immediate Intervention? [Correct Ans Is: - IV Thrombolytic For Clot Lysis. Subcutaneous And IV Heparin Inhibit Thrombus Growth And Promote Resolution Of The Formed Clot, But Will Treat The A Saddle Pulmonary Embolus.
Indiscrimate Pacing Spikes Indicate That The Pacer Is Not What? [Correct Ans Is: - Not Sensing Or Seeing The Cardiac Activity Present. Sensitivity Should Be Decreased. A Sudden Increase In Left Atrial Diastolic Pressure Will Result In? [Correct Ans Is: - Mitral Regurgitation Late Stages Of Shock Results In What Lab Values? [Correct Ans Is: - Increased Potassium Decreased Bicarbonate Increased Lactic Acid Juxtaglomerular Cells Secrete What? [Correct Ans Is: - Renin In Response To Reduced Glomerular Filtration Pressure. Secondary Adrenal Insufficiency Is Caused By: [Correct Ans Is: - Long Term Steroid Use, Additional Stress Can Overwhelm The Hypothalamic - Pitutary-Adrenal System. Neosynephrine Stimulates What? Side Effects Would Include: [Correct Ans Is: - Alpha Receptors - Causes Vasoconstriction, Resulting In Increase BP Reflexive Bradycardia Heptojugular Reflex Is Suggestive Of Which Following Condition? [Correct Ans Is: - Right Sided Heart Failure Fever Is Associated With What? [Correct Ans Is: - Worse Neuro Outcomes. This Is Secondary To The Increase In Cerebral Metabolism And Oxygen Consumption
Alpha Cells Produce? Beta Cells? Delta Cells? [Correct Ans Is: - Glucagon Insulin Somatostatin Serum Osmolality Of 320 Is Indicative Of: [Correct Ans Is: - DI - Profound Dehydration Will Lead To An Elevated Serum Osmolality Because Of Water Loss. Contraindications Of Rtpa Include: [Correct Ans Is: - Gastro Or Other Bleeding Complications (Within 3 Months) First Sign Of Problems From A Shunt Include: [Correct Ans Is: - Change In LOC Or Mental Status Ominous Sign Of Acute Asthma Exacerbation: [Correct Ans Is: - Hypercapnia Or Elevated Paco2 Indicates Patient Is Becoming Fatigued And Going Into Acute Respiratory Failure. Nephrogenic DI Would Cause What? [Correct Ans Is: - The Kidneys Not Respond To ADH Lactated Ringers At 100ml Hr Before And After Procedure Is Often Prescribed To Prevent What? [Correct Ans Is: - Contrast Induced Nephropathy Keeping The TV (Tidal Volume) Low Is The Best Way To Decrease Pressures And Avoid What? [Correct Ans Is: - Barometric Trauma In ARDS Which Of The Following Parameters Most Accurately Estimates End-Organ Perfusion? [Correct Ans Is: - Urinary Output, Lactate, Scvo
Aortic Stenosis Cause Increased Noise During Systole And Impaired Outflow, Leading To: [Correct Ans Is: - Pulmonary Edema And Crackles. Tx For Neurogenic Shock? [Correct Ans Is: - Vasoconstrictor (Phenylephrine) Over Large Volume Of Fluid Resuscitation Liver Failure Labs: [Correct Ans Is: - Elevated Bilirubin Decreased Albumin Elevated PTT, PT & INR When The Liver Fails: [Correct Ans Is: - Ammonia Levels Build Causing Encephalopathy. Bilirubin Levels Rise Causing Jaundice And Coagulation Times Often Prolong Putting Patient At Risk For Bleeding. Patients With HIT May Develop: [Correct Ans Is: - Thrombosis, DVT, PE, STROKE, MI, Renal Impairment Vancomycin Has A Risk Of Nephrotoxicity And RN Should Monitor Which Lab Value: [Correct Ans Is: - Elevated Serum Creatinine Cerebral Insults Include: [Correct Ans Is: - Ipsilateral Pupil Changes And Contralateral Motor Extremity Changes. Diuretic Phase Of ATN Would Include Which Lab Value: [Correct Ans Is: - Decreased Urine Osmolality Kernig's Sign Is Indicative Of: [Correct Ans Is: - Meningitis - Pt Cannot Extend The Knee When The Hip Is Flexed. DKA Patients Have A Profound Decrease In What: [Correct Ans Is: - Fluids Pancreatitis Leads To What? [Correct Ans Is: - ARDS, DIC, Hypovolemic Shock
Pulmonary Arterial HTN Results From: [Correct Ans Is: - Vasoconstriction Of Vasculature Leading To And Within The Lungs Management Of Pancreatitis: [Correct Ans Is: - Preventing Hypoxemia, Resting Pancreas, Pain Mgmnt, Volume Resuscitation. Inner Layer Of The Heart Muscle, Between The Endocardium? [Correct Ans Is: - Myocardium Higher Cognitive Functions (Impulsivity) And Personality Are Controlled By What Part Of The Brain: [Correct Ans Is: - Frontal Lobe Tachycardia, Tachypnea, And Left Shoulder Pain Indicates Possible What: [Correct Ans Is: - Anastomotic Leak Intubation: Fio2 < 60% Maintain Plateau Pressures < Maintain Tidal Volume < 8 [Correct Ans Is: - Goals For Ventilated Pts. Position With The HOB 30 Degrees With Midline Neck Alignment: [Correct Ans Is: - First Line Therapy For Optimizing Cerebral Perfusion. Is Serum Osmolality Elevated Or Decreased In DI? [Correct Ans Is: - Elevated Due To Volume Loss - The Urine Will Be Dilute (Decreased Urine Osmo) And Hemoconcentration With Increased Sodium Levels. Beta Blockers, ACE, & Aldosterone Antagonists Are Used For: [Correct Ans Is: - Heart Failure Pts. Right BBB & 2nd TYPE 2 Heart Block: [Correct Ans Is: - Located In Bundle Of HIS And R Bundle Branch Are Located In Anterior Wall, So Both Of These May Be Affected In Anterior MI.
Side Effect Of Dexamethasone: [Correct Ans Is: - Decreased Potassium And Calcium Levels, Hypoglycemia, And Myopathy That Results In Proximal Muscle Weakness. Ablify, Haldol, Seroquel, And Droperidol Can Cause What? [Correct Ans Is: - QT Prolongation Which Electrolyte Is Affected With Hypothermia: [Correct Ans Is: - Hypokalemia Cardiac Tamponade Is A Risk After What? [Correct Ans Is: - Discontinuation Of Epicardial Pacing Wires. Signs Include Decreased Cardiac Output, Increased Preload And Intra-Cardiac Pressures, And Decreased Contractility. Hyperglycemia, Hypocalcemia And Hypokalemia Are R/T To Pancreatitis? [Correct Ans Is: - True DIC Lab Values: [Correct Ans Is: - Decreased Fibrinogen Increased D-Dimer Decreased Platelets Tx For Heart Failure: [Correct Ans Is: - Positive Inotropic Agents, Diuretics & Vasodilators ARDS Tx: [Correct Ans Is: - High Levels Of PEEP & Low Tidal Volume What Is The Best Indicator For Neurogenic Shock? [Correct Ans Is: - Bradycardia Low Cardiac Output And Hypotension Are Consistent Across Shock States. Gold Standard Of Care For Acute Coronary Syndrome? [Correct Ans Is: - PCI PCI Should Be Completed Within 90 Mins For STEMI And 24 Hours For NTE-ACS. If Not Possible To Get Patient In Cath Lab Within 90-120 Mins, Fibrinolytics Should Be Considered.
A Mechanically Ventilated Patient Has Been Started On Inhaled (Flolan) For The Tx Of ARDS And Refractory Hypoxemia. Which Hemodynamic Value Evaluates The Effectiveness Of This Intervention? [Correct Ans Is: - Decreased PAP Which Of Following Is Recommended To Prevent Shivering During Induction And The Maintenance Phase In Therapeutic Hypothermia? [Correct Ans Is: - Blow Warm Air Across The Face Or Body The Pt Is Placed On CRRT - The Nurse Know Which Is A Priority When Receiving CRRT? [Correct Ans Is: - Frequent Electrolyte Monitoring To Minimize Electrolyte Shifts The Doc Asks The Nurse To Determine The Capture Threshold. Which Of The Following Should The Nurse Do? [Correct Ans Is: - Slowly Decrease The Ma Output Until The Capture Is Lost. A Pt With ARDS Needs To Receive How Many Ml/Kg Of Tidal Volume? [Correct Ans Is: - 4 - 5ml/Kg Tidal Volume In Order To Prevent Volutrauma. A Lower Respiratory Rate Will Help Provide This. Short Expiratory Time, PEEP, And Larger Tidal Volumes Will All Promote Air Trapping Or Auto Peep. Thus Increasing Intrathoracic Pressure And Reducing Cardiac Output. Which Of The Following Is An Appropriate Strategy When Providing Mechanical Ventilation For The Patient With Status Asthmaticus? [Correct Ans Is: - Use Lower Respiratory Rates A Patient Is Admitted With Serum Calcium Of 15.1 Meq/L. Which Of The Following Interventions Should The Nurse Anticipate? [Correct Ans Is: - Rule Out Hypokalemia, Then Administer Diuretics. Which Of The Following Patients Is Likely To Experience A Heart Block? [Correct Ans Is: - Mitral Valve Repair
The Patient With Chronic Alcohol Abuse Is Admitted With A Serum Phosphorus Of 1.8 Meq/L. The Nurse Will Need To Observe The Patient Closely For: [Correct Ans Is:
- Hypoventilation Low Phosphorous Causes What? [Correct Ans Is: - Constipation, Not Diarrhea Which Of Following Nursing Behaviors Is Usually Most Helpful To Patients And Families Regarding End-Of-Life Decisions? [Correct Ans Is: - Acting As An Arbitrator Between Family Members. Pt Receiving PCA, Morphine 1 Mg Per Hour IV Infusion, And 2 Mg Q 15 Minutes As PRN Doses. Pt Is Having Episodes Of Sleep Apnea And Is Arousable Only By Touch. Priority Interventions Include: [Correct Ans Is: - STOP The Continuous Infusion And Give Naloxone Slow IV Until Patient Awakens. Which Patient According To Ranson's Criteria Has Poorest Prognosis When It Comes To Acute Pancreatitis? [Correct Ans Is: - WBC 32,000; Glucose 220; LDH 400 A Shunt Requires More Than Oxygen To Correct Hypoxemia, For Example: [Correct Ans Is: - PEEP Will A V/Q Mismatch Respond To Oxygen Administration? [Correct Ans Is: - True What Should The Patient Watch Out For When It Comes To Myasthenia Gravis: [Correct Ans Is: - Muscle Weakness Which Of The Following Is The Earliest Indication That The Patient May Be Aspirating Oral Feedings? [Correct Ans Is: - Tachypnea And Tachycardia The Patient Was Admitted Status Post Motor Vehicle Crash. The Patients Sustained An Intracranial Bleed, Is Hypotensive, And Is Tachycardic. The Patient's Clinical Status Is Most Likely Due To Which Of The Following? [Correct Ans Is: - Shock From Multiple Trauma Neurogenic Shock And Brain Herniation Result In Bradycardia? [Correct Ans Is: - True
