121 Finals Flashcards by Kaileigh Wing

When performing an Allens test, which artery do you let go of to watch for return of circulation?

Ulnar

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You mislabeled an ABG specimen with the wrong patient information. This would be considered an:
A) Preanalytical
B) Analytical
C) Postanalytical

A: Preanalytical

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Decreased serum Na+ levels are associated with all of the following except?
A) dehydration
B) muscle cramps
C) weakness
D) nausea

A: Dehydration

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What does a shark fin wave form indicate?

An obstruction like with Asthma or COPD
(Think Bronchospasms)

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Which of following electrodes is used to measure PO2?
A) Clark
B) Spectrophotometry
C) Sanz
D) Severinghaus

A) Clark

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Volatile acids are eliminated through the
A) intestines
B) Kidneys
C) Liver
D) Lungs

D) Lungs

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Which of the following is not an advantage for a mainstream capnometer?
A) Short lag time
B) crisp waveform
C) the sensor is placed at the patients airway
D) secretions and humidity block the sensor

D) secretions and humidity block the sensor

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___________ is how close a measured value is to the true value

Accuracy

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When a waveform is shorter than normal but still squared off, what does it indicate (i.e. not inspiring enough air).
A) obstruction like in astha or COPD
B) hyperventilation
C) Hyoventilation

B) Hyperventilation

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What is the normal Range for Glucose?

70-139

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Critical Thinking:
A 72-yr old male with hx of hypertension and end-stage renal disease on hemodialysis is admitted to the hospital with pneumonia. You are about to start his neb tx w/ albuterol. You notice on the bedside cardiac monitor his heart rate is 50 bpm, T-wave are tall and QRS are wider than when you gave the tx 4 hrs prior. Which electrolyte abnormality do you need to think about?
A) HCO3-
B) K+
C) Na+
D) Cl-

B) K+

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When analyzing capillary samples, which of the following does not closely correlate to the arterial sample?
A) PCO2
B) PO2
C) pH
D) HCO3

B) PO2

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What is the normal range for K+

3.5-5.1

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To be in control a value must be within how many standard deviations of the average
A) 1
B) 2
C) 3
D) 4

B) 2

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Capnography measure?
A) PtCO2
B) PetCO2
C) PaCO2
D) PaO2

B) PetCO2

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Where is the primary place to get an ABG?
A) Carotid
B) Radial
C) Brachial
D) Femoral

B) Radial

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Not enough O2 at the tissue level due to low PaO2 describes
A) Hypoxic hypoxia
B) anemic hypoxia
C) circulatory hypoxia
D) histotoxic hypoxia

A) Hypoxic Hypoxia

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Depression of the CNS can be caused by
A) Alkalosis
B) Acidosis

B) Acidosis

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A Pt with chronic Kidney failure would have which of the following:
A) decreased amylase
B) elevated amylase
C) decreased BUN
D) elevated BUN

D) Elevated BUN

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What are 3 factors that can affect the accuracy of a pulse ox reading

Dark/Fake nails
Fluorescent lights
Medical dyes

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Which of the following statements about pulse ox is FALSE
A) they are accurate within 3-5%
B) they require annual calibration
C) they are less accurate at values less than 80%
D) they should be cleaned between Pts

B) They require annual calibration

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Critical Thinking:
A 68 yr-old male is admitted with SOB. Auscultations reveal bilateral crackles in the base, pedal edema in both legs, BNP of 980 and normal renal function. What is most likely the cause of his SOB?
A) kidney failure
B) spleen injury
C) liver failure
D) CHF

D) CHF

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What pt population are you most likely to see and/or use transcutaneous monitoring in?
A) adult
B) Infant
C) adolescent
D) elderly

B) Infant

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Your pt has pulse ox with good waveform and PI on the monitor of 2.0. What should you do?
A) Draw an ABG
B) Fina another site for the SpO2 probe as there is not enough perfusion to this area for true readings
C) trust the SpO2 value on the monitor

C) Trust the SpO2 value on the monitor

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Which arterial blood gas reading is used to indicate the respiratory component of acid-base state? A) PCO2 B) PO2 C) Cl- D) HCO3

A) PCO2

If a Pt is having a problem related to acid-base balance, which 2 organs are most likely to be affected? A) Lungs and Kidneys B) Lungs and Liver C) Heart and Lungs D) Kidneys and Heart

A) Lungs and Kidneys

On and Levy Jennigs Chart which of the following is not a term used? A) Trend B) Shift C) out of control value D) slide

D) Slide

Following endotracheal intubation, a colorimetric CO2 sensor is placed in line. The device changes color from purple to yellow. What does this indicate? A) There is CO2 present in the exhaled gas B) the color change does not tell us anything C) there is no CO2 present in the exhaled gas D) The ETT is in the esophogus

A) There is CO2 in the exhaled gas

Which 3 parameters are directly measure with electrodes in an ABG analyzer?

PH, PCO2, PO2

Critical Thinking: A 20 yr-old female presents with c/o extreme fatigue. Your tests show that she has a hematocrit of 25%. It is likely she has: A) Diabetes B) anemia C) anorexia D) hepatitis

B) Anemia

Not enough O2 at the tissue level due to a low cardia output describes A) anemic Hypoxia B) histotoxic hypoxia C) circulatory hypoxia D) hypoxic hypoxia

C) Circulatory hypoxia

A pt presenting with signs of leukocytosis with a WBC of 15k probably has A) significant infection B) elevated Na+ & Cl- C) leukemia D) abnormal hematocrit

A) significant infection

Critical Thinking: You have been asked to draw an ABG on a Pt. What blood values will you look at prior to drawing the ABG that will tell you how well your Pt blood will clot? A) PT, PTT B) anion gap C) glucose D) creatinine

A) PT, PTT

Which of the following ABG samples should be analyzed: A) one that doesn't contain heparin B) one that has been sitting out for 12 min at room temp C) one that has been determined to be venous blood D) one that has an air bubble

B) one that has been sitting out for 12 min at room temp

Critical thinking: During CPR, the PETCO2 is slowly decreasing from 25 mmHg to 20mmHg to 15mmHg. Why is this happening and what is the appropriate response?

The chest compressions are not adequate and therefore not pushing enough blood through the body. Switch out persons providing compressions as the person is probably fatigued.

what is produced by anaerobic matabolism A) hydrochloric acid B) CO2 C) lactic acid D) HCO2

C) lactic acid

When PFT machine calibration is done what size syringe is used for this process? A) 100 mL B) 3L C) 300 mL D) 10 mL

B) 3L

during helium dilution test how much helium does the pt breath? A) 10% B) 79% C) 50% D) 100%

A) 10%

During a methacholine challenge test how far does the FEV1 need to drop for it to be considered a positive test A) 5% B) 10% C) 12% D) 20%

D) 20%

How long must it be before a pt has taken a short acting bronchodilator before they can do spirometry testing? A) 4 hrs B) 8 hrs C) 12 hrs D) 24 hrs

A) 4 hrs

During a nitrogen washout test a pt breaths in? A) 50% nitrogen B) 79% nitrogen C) 100% O2 D) room air

C) 100% O2

Which of the following is false about RSBI? A) it is easily performed B) it is used to commonly determine readiness to wean from a ventilator C) it is derived by calculation Vt/f D) normal range is 60-105

C) it is derived by calculation Vt/f

what percent change in FEV1 is needed to determine if there is a significant response to bronchodilator therapy? A) 5% B) 12% C) 20% D) 25%

B) 12%

During a nitrogen washout test, the test is stopped when nitrogen reaches A) 79% B) 21% C) 1.5% D) 0%

C) 1.5%

Which of the following is not necessary to chart after a hallway oximetry exercise test A) Resting SPO2 B) distance walked C) amount of O2 used D) time of last inhaler

D) time of last inhaler

Critical Thinking: A pt with no cardiac hx is having a hallway oximetry exercise test to determine the need for O2 at home What value does the SPo2 need to drop to, to support the need of O2 A) 89% B) 80% C) 88% D) 85%

C) 88%

Which of the following can be considered an Obstructive characteristic A) stiff lungs B) small lung volumes C) FEV1/FVC > 0.7 D) airway weakening and air trapping

D) airway weakening and air trapping

You have the following pt scheduled for methacholine testing today. Which pt needs to be rescheduled A) just came from the gym B) had coffee this morning C) had a lung infection 3 months ago D) took their inhalers today

A, B & D

In a pt with air trapping which lung volume test will more accurately measure residual volume A) helium dilution B) DLCO C) Nitrogen washout D) body plethysmography

D) Body plethysmography

Name the Lung Volumes and Capacities from top to bottom

1. Inspiratory Reserve 2. Tidal Volume 3. Expiratory Reserve 4. Residual Volume 5. Insp+Tidal= Inspiratory Capacity 6. Exp+Residual=Functional Residual Capacity 7. Insp+Tidal+Exp= Vital Capacity 9. All Reserves= Total Lung Capacity

During a DLCO test the pt inhales a gas mixture that has A) 100% O2 B) carbon Dioxide C) carbon monoxide D) helium

C) Carbon monoxide

Match the Definitions: 1. air left in the lungs after normal exhale? 2. volume inspired with a normal breath 3. the largest amount of air the lungs can hold? 4. amount of air you can exhale after normal exhalation 5. volume of air you can forcefully exhale in 1 second 6. amount of air you can exhale after maximal inspiration 7. greatest amount of air you can breathe in 12-15 sec 8. mL of gas the lungs can transfer to the blood 9. amount of air you can inhale after a normal inspiration 10. ratio of volume exhaled in 1 second to the total volume exhaled 11. amount of air you can forcefully exhale after maximal inspiration 12. fastest flowrate generated at the very beginning of forced expirations 13. air left in the lungs after maximal exhalation 14. amount of air you can inhale after normal exhalation A. VT= Tidal Volume B. MVV= maximum voluntary ventilation C. TLC= Total lung Capacity D. PEF= peak expiratory flow E. DLCO= diffusion capacity F. VC= Vital capacity G. IC= inspiratory capacity H. IRV= inspiratory reserve volume I. RV= Residual volume J. FRC= Functional residual capacity K. FVC= Forced vital capacity L. FEV1 M. ERV= Expiratory reserve volume N. FEV1/FVC

1= J 2= A 3= C 4= M 5= L 6= F 7= B 8= E 9= H 10= N 11= K 12= D 13= I 14= G

At rest and low to moderate levels of exercise, cellular metabolism is largely A) lactic B) aerobic C) facultative D) anaerobic

B) Aerobic

Critical Thinking: You have a male pt who is being assessed to come off of the ventilator a MIP is performed, and the pt is able to create -130cmH2O. This tells us he is more likely to fail when he comes off the ventilator. A) True B) False

B) False

What are 3 reasons to stop a 6 min walk test?

1. Chest pain 2. leg cramps 3. pale dusky appearance

All of the following are reasons to not accept a spirometry except A) a cough in the 1st sec B) an extra breath C) an exhalation for 7 sec D) a valsalva maneuver

C) a exhalation for 7 seconds

What is required to determine the predicted values when performing a PFT? A) Height, Weight, age B) Height, weight, age, ethnicity C) height, age, gender, ethnicity D) weight, height

C) height, age, gender, ethnicity

Which of the following is not an indication for pulmonary function testing A) to determine if there is a restrictive disease B) to determine if there is an obstructive disease C) to assess preoperative risk D) to determine if there is lung cancer

D) to determine if there is lung cancer

How to determine Peak Flow

Divide the greatest of 3 attempts to their personal best. i.e. personal best= 500, best of 3 attempt= 300 so do 300/500=.60 or 60% therefore yellow zone

During a 6 min walk test when is the pt allowed to slow down or rest A) after 3 min B) as needed C) they are not allowed to D) every min

B) as needed

Which is the most commonly performed PFT? A) lung volumes B) DLCO C) spirometry D) MVV

C) Spirometry

Which gas law is body plethysmography based on A) Charles B) Boyles C) Henrys D) Ficks

B) Boyles

Spirometry measures all of the following except A) pressure B) volume C) time D) Flow

A) Pressure

Why do we do DLCO testing?

to see how long it take for a gas to diffuse through the alveolar capillary membrane

Critical thinking: A pt is scheduled for an exercise bronchoprovocation test. They are unable to complete the required exercise for testing. Which test is an acceptable alternative to determine exercise induced bronchospasms? A) Mannitol B) regular spirometry C) DLCO D) Methcholine

A) Mannitol

High FENO values may support which Dx A) Pulmonary Embolus B) lung cancer C) COPD D) Asthma

D) Asthma

What ist he max number of spirometry test that should be done in one sitting A) 8 B) 5 C) 10 D) 3

A) 8

What are reasons a CPET might be done A) to determine surgical risk B) to Dx exercise induced asthma C) to determine disability D) do diagnose COPD

A & C

Common errors regarding spirometry include all of the following except A) previous history of lung cancer B) failure to take a deep breath C) hesitant start D) stopping before 6 sec exhalation

A) previous history of lung cancer

A physician is looking for an arterial septal defect. Which of the following diagnostic tests will help determine that? A) Echocardiogram B) PET Scan C) MRI D) CXR

A) Echocardiogram

Which of the following statement is False about malnutrition? A) calories taken in are greater than calories burned B) muscle tissue may be consumed C) it affects surfactant storage D) it affects the body's ability to heal

A) calories taken in are greater than calories burned

Which of the following is a parenteral route of nutrition A) eating a meal by mouth B) nutrients given through nasogastric tube C) nutrients given through an IV D) nutrients given through a PEG tube

C) Nutrients given through an IV

The ABCs of X-rays

A= Airway B= Bones C= Cardiac D= Diaphragm E= Equal/Effusions F= Fissures G= Gastric Bubble H= Hilum I= Impression

The cessation of brething due to a failure of signals beign sent from the brain to the mucscles that control breathing is known as A) centra sleep apnea B) pickwickian syndrome C) obstructive sleep apnea D) mixed sleep apnea

A) Central sleep apnea

The intrinsic rate of the sinoatrial node is A) 40-60 B) 80-120 C) 20-40 D) 60-100

D) 60-100

A hard to wean off the ventilator pt would be a good candidate for indirect calorimetry A) True B) False

A) True

What does EEG measure

Brain activity

CXR in which the beam passing from the pt back to the front is what A) AP B) Lateral decubitus C) PA D) oblique

C) PA

You are transporting your pt to MRI for an exam. They require 2L of O2 at all times. Will they be able to bring their portable tank with them? Why?

No, unless it is an approved MRI transport machine and tank

Which test is considered to be invasive A) Transthoracic TTE B) Transesophageal TEE

B) TEE

Match the definition: 1. Ability to respond to an electrical impulse 2. contracts when stimulated by electrical impulse 3. transmits an electrical impulse 4. produces an electrical impulse A. automaticity B. excitability C. conductivitiy D. contractility

1= B 2= D 3= C 4= A

A physician is looking for a pulmonary embolus. Which of the following diagnostic tests should they order? A) Echocardiogram B) CXR C) PET scan D) VQ Scan

D) VQ Scan

At what point in the conductivity pathway of the heart does the signal split to continue to both the right ventricle and the left ventricle A) Sinoatrial node B) bundle of HIS C) purkinjie fibers D) atrioventricular node

B) Bundle of HIS

Common signs/symptoms of sleep apnea include A) Morning headache B) excessive daytime sleepiness C) snoring D) All of the above

D) All of the above

Why might a COPD pt be at risk for malnutrition in relation to their COPD?

Higher WOB= burns more calories, SOB can make eating more difficult

Who is not at risk for malnutrition A) pt with severe trauma B) hypothermic pt C) mechanically ventilated pt with high fever D) pt with burns

B) hypothermic pt

areas on an xray that block the passage of xray radiation and therefore appear whiter are known as A) radiopaque B) radiolucent C) translucent D) omnilucent

A) Radiopaque

A common finding on a CXR with pleural effusions would be A) Blunted costophrenic angles B) enlarged heart C) sharp costophrenic angles D) ground glass opacities

A) Blunted costophrenic angles

How many large ECG boxed are in a 6 sec strip A) 6 B) 20 C) 30 D) 36

C) 30

One a CXR the heart shadow should be no larger than ______ of the thoracic diameter?

50%

the phase of sleep cycle where pts lose most of their muscle tone and have rapid eye movement is A) Stage 1 B) Stage 2 C) Stage 3 D) REM

D) REM

Which represents depolarization of the ventricles A) T Wave B) QRS Complex C) P wave D) PR Interval

B) QRS Complex

A Physician is looking to see if a lung cancer has spread to any other areas of the body. What diagnostic test should they order? A) PET Scan B) MRI C) VQ Scan D) Echocardiogram

A) PET Scan

Which of the follow rhythms would you shock A) sinus bradycardia B) V-Fib C) V-Tach with no pulse D) Asystole

B & C

A lot TLC can be caused by A) a restrictive disease B) an obstructive disease

A) A restrictive disease

A high RV/TLC ratio indicates A) pulmonary embolism B) pulmonary fibrosis C) air trapping D) restrictive disease

C) Air trapping

Which of the following PFT test best measures the TLC including trapped air A) nitrogen washout B) Body Box C) Spirometry D) Helium Dilution

B) Body box

Which of the following can be measured during a spirometry test A) Vital Capacity B) Residual Volume C) Functional Residual Capacity D) All of the Above

A) Vital Capacity

What are 2 disease processes that can cause a low DLCO

1. Emphysema 2. Pulmonary fibrosis

Normal ranges for ABGs CO2, CO3 and pH

CO2= 45-35 CO3= 22-26 pH= 7.34-7.45

The official interpretation of your 22 yr old pt spirometry is released and the pulmonoligist has determined it is normal. What testing would you recommend next for this pt. A) DLCO testing B) Lung volume via body box C) No further testing D) Bronchoprovocation testing

D) Bronchoprovocation testing

Obstruction Severity Levels and the values

Mild= >80 Moderate= 50-79 Severe= 30-49 Very Severe= <30

How to determine if it's restrictive or Obstructive?

1. Look at FEV1/FVC, is it greater than 70? Answer: Yes- no obstruction, then look at FVC is it greater than 80? Yes= Normal No= Posible restriction, needs more testing Answer No (not greater than 70) Obstruction is present. - Look at FEV1 and determine severity (mild/mod/severe/very severe) - is % change >200 mL & 12%? Yes= obstruction w/ significant bronchodilator response No= Obstruction w. no significant response to bronchodilator

How to differentiate the Obstructive and Restrictive on Flow Volume Curve

Remember: Obstructive looks like a Lower Case 'b' and Restrictive looks like a tall 'R'

What is Na+ and it's value

Sodium 136-145

What is K+ and it's value

Potassium 3.5-5.1

What is Ca+ and it's value

Calcium 8.5-10.2

What is Cl- and it's value

Chloride 98-107

What is CO2 and it's value

Carbon Dioxide 22-32

What is BUN and it's value

Blood Urea Nitrogen 8-23

What is Cr and it's value

Creatinine .7-1.3

What is BNP and it's value

Brain Natriuretic Peptide <100

What is Hg and it's value

Hemoglobin 12.5-15.5

What is Hct and it's value

Hematocrit 45% of formed elements

What is a positive sweat test result

>60 mml/L