exam 2

Question 1

ICU drug of choice for agitation?

Answer 1

Propofol

Question 2

Glasgow coma scale indicating severe brain damage?

Answer 2

3-8
8 we intubate.

Question 3

Signs that indicate brain death?

Answer 3

o Coma
o absence of brain stem reflexes
apnea

Question 4

Early signs of ICP

Answer 4

o CUSHINGS TRIAD-
 Systolic htn: widening pulse pressure.
 Bradycardia: full and bounding pulse
 Irregular respirations

Question 5

ICP Ocular Signs:

Answer 5

o Dilation of pupil of same side (ipsilateral)
o Unequal pupils in any form/side
o Ptosis (droopy lid)
o Diplopia
o Doll’s Eye (tip back, eye go back instead of opposite direction)
o Sluggish/Blurred

Question 6

Baclofen medication teaching?

Answer 6

o do not stop taking suddenly.
o do not drink alcohol

Question 7

Mild concussion discharge instructions?

Answer 7

Return if you have:
 persistent headache
 lethargy
 changes in behavior
 shortened attention span.
 change in intellectual abilities.

Question 8

Closed Head Injury- worsening assessment:

Answer 8

o Battles signs (behind ear)
o Raccoon eyes (under eyes)
o CSF leak (rhinorrhea, otorrhea): risk for meningitis
o ** glucose test; halo sign (tests spinal fluid leak)

Question 9

 Which order would you question for an incontinent spinal cord patient injury?

Answer 9

o No foley cath
o ** pt at risk for bladder issue in future

Question 10

Symptoms of autonomic dysreflexia

Answer 10

o (EMERGENCY) ** head of bed up
 blinding headache
 increase BP.
 bladder full get spasms.

Question 11

Spinal cord injury at T5 level? What are things the patient should not do?

Answer 11

o Avoid raising knees.
o ** @ risk for DVT

Question 12

Dilantin Patient teaching?

Answer 12

o Headache
o Nausea/Vomiting
o Constipation
o Trouble sleeping
o Need back up oral BC.

Question 13

Posturing that happening in ICP patients?

Answer 13

o Decorticate (flexor)
o Decerebrate (extensor)

Question 14

What drug is used to decrease cerebral inflammation?

Answer 14

o corticosteroid

Question 15

Dantrolene (used to manage muscle spasms) teaching

Answer 15

o severe hepatic impairment (liver testing needed)
o diarrhea
o anorexia
o nervousness
o hyperkalemia

Question 16

What to do to prevent complications from a traumatic brain injury TBI

Answer 16

nutrition
o monitor I&O
o monitor: glucose, Na, K, Mg
o protect from injury.

Question 17

DIC lab values

Answer 17

o LOW platelet
o LOW fibrinogen
o HIGH d-dimmer
o HIGH aPTT
o HIGH PT

Question 18

What would you not want to inject into a DIC patient?

Answer 18

o Vitamin K

Question 19

What sign in a critically ill pt would indicate they could be developing DIC?

Answer 19

o petechiae
o bleeding mucus membranes
o tachycardia
o hypotensive
o low temp

Question 20

What pt are at highest risk for developing DIC?

Answer 20

o sepsis
o abruptia placenta
o trauma
o malignancy
o shock
o toxins
o allergic reactions

Question 21

What is DIC?

Answer 21

o Inflammatory response (trigger) initiates a process of inflammations and coagulation
(clotting)
o ** result = bleeding/clotting condition

Question 22

Characteristics of cardiac tamponade?

Answer 22

o sudden chest pain
o SOB
o tachypnea
o dyspnea
o JVD
o hypotension
o pulses paradox

Question 23

Interventions for cardiac tamponade?

Answer 23

o ** quick removal of paracardial fluid!!
o Pericardiocentesis (needle & small cath into the pericardium)

Question 24

Abdominal Aortic Aneurysm assessment findings?

Answer 24

o abdominal pain
o persistent or intermittent low back or flank pain
o pulsating abdominal mass
o systolic bruit

Question 25

Abdominal aortic aneurysm surgery……?

Answer 25

o Not required always
o Monitor until 5cm large.

Question 26

Postop care for client with endovascular graft repair of a AAA?

Answer 26

o ALWAYS check pt pedal pulses

Question 27

3.5cm thoracic aneurysm education?

Answer 27

o Pt needs ultrasound every 6 months.

Question 28

Activity allowed/not allowed for an open AAA 4 hours post op?

Answer 28

o Cannot move side to side until 6hr post op
o Lie supine for 6hrs post op and @ 45 degree angle for 2 hrs
o Resume presurgical diet
o Encourage fluids

Question 29

Hypertensive crisis pt weighs 77 kg and needs sodium nitroprusside 50mg/250 ml to infuse at
0.5mcg/kg/min. What is the hourly rate in ml/hr for this pt? Round to the nearest tenth.

Answer 29

o 77kg x 0.5 = 38.5mcg/min
o Convert 38.5mcg to mg = 0.0385 mg
o 0.0385 mg / 50mg x 250 = 0.1925ml/min
o 0.1925 x 60 = 11.55 ml/hr or 11,6

Question 30

Gestational hypertension medication that is contraindicated?

Answer 30

o Vasodilators!!!

Question 31

Enalapril teaching:

Answer 31

o use w/ caution with diuretic therapy
o monitor potassium levels

Question 32

Beta Blocker (propranolol) teaching

Answer 32

o do not stop abruptly
o adm as prescribed
o hold if systolic BP <100 or pulse <60

Question 33

Amlodipine dietary modifications?

Answer 33

o NO GRAPE FRUIT JUICE!

Question 34

Diagnostic test needed to confirm thoracic aneurysm?

Answer 34

o CT scan to confirm aneurysm

Question 35

Describe the action of amlodipine for hypertension?

Answer 35

o Slows movement of calcium into smooth muscle cells, resulting in arterial dilation and
decreased blood pressure

Question 36

Captopril teaching?

Answer 36

o Take 1 hr before meals
o Monitor BP
o Monitor Angioedema

Question 37

Prazosin 1st time dose for postop aneurysm repair?

Answer 37

o 1st dose syncope
o **take at bedtime (makes u tired)

Question 38

Digoxin teaching?

Answer 38

o Apical Pulse <60 hold
o Levels between 0,8-2.0

Question 39

Description of a second degree heart blood, Type 1 (Wenckebach)

Answer 39

o long, Longer, LONGEST, gone

Question 40

Defibrillation first attempt unsuccessful… what medication should be administered?

Answer 40

Epinephrine

Question 41

Why order a TEE for a patient with A-fib scheduled for cardioversion?

Answer 41

o not as invasive (don’t go down throat) can show clotting first

Question 42

Where are the “wire” of a pacemaker tunneled into the heart?

Answer 42

o tunneled subcutaneously from generator of external jugular vein, into the apex of the
right ventricle

Question 43

Contraindications for the use of sotalol?

Answer 43

o bradycardia
o asthma
o heart failure
o bronchospasms

Question 44

Description of a “fixed or asynchronous” pacemaker?

Answer 44

o constant no matter what

Question 45

Discharge teaching for permanent pacemaker?

Answer 45

o no raising arm above shoulder 2 weeks
o lead dislodgement can happen
o fall precautions.
o cell phone of opposite side of pacemaker
o airport detector excuse from MD
o no MRI
o medical bracele

Question 46

Patient recovering from an MI needs medication for a HR of 44 degrees but they have a history of
glaucoma, what medication is contraindicated?

Answer 46

o Atropine contraindicated!!