Final Exam Flashcards by Sophia Rasheed

A patient has increased ICP - what intervention should be taken first?

HOB @ 30 degree

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SV = 60cc
HR = 90 bpm
What is the CO?

5.4L

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Patient has a C6 SCI and had surgery to stabilize spine. HR fallen to 44
BP 78/40
Warm to touch

What is the cause of her change in condition?

Neurogenic shock

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Volume resuscitation is usually accomplished with:

IV crystalloid infusion

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If the pressure drops, and flow remains unchanged, resistance ______ in order to increase pressure

Increases

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The section of the GI tract that is involved in an upper GI bleed is:

Proximal to the ligament of Treitz

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Pt reports SOB, productive cough, tachycardia, and orthopnea, what is his diagnosis?

LVHF

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Pt has 3rd degree HB and PM is inserted. Later, the pt complains of dizziness and monitor 3rd degree HB with rate of 52bpm and shows no pacing spikes. What is the issue?

Failure to pace

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Major purpose of dialysis

Correct imbalances of fluid and electrolytes and remove wastes

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_________ is solely filtered from the bloodstream via the glomerulus, it is NOT reabsorbed back into the bloodstream and is excreted through the urine

Creatinine

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Disease may decrease contractility of the myocardium. This means if preload decreases, stroke volume will:

Decrease

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For glomerular filtration to take place, it is important to maintain:

adequate cardiac output

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Decreased oxygen delivery to myocardial cells will affect:

Contractility

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Metabolic acidosis is closely associated with ARF because of the kidney’s inability to:

Excrete H+ ions

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Patient presents with slurred speech, facial droops, and arm weakness. What is the priority?

Get him to a head CT STAT

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Respiratory acidosis is caused by:

Alveolar hypoventilation

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The normal cardiac output for an adult at rest is:

5L/min

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The cardiac arrhythmia that can cause immediate decompensation in a patient with aortic valve stenosis is:

Atrial fibrillation

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Your patient has a BP of 75/45 and it is time to administer an ACE inhibitor. What is most appropriate course of action?

Notify the physician and ask if the dose can be held.

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A nursing intervention to reduce secondary brain injury is:

Space out patient care activities

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Acute respiratory failure would result in what type of pH?

Low - acidotic

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Which statement is correct regarding the normal relationship between oxygen and hemoglobin?

Oxygen loosely and reversibly binds to hemoglobin

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What would the oxyhemoglobin curve look like for a patient experiencing hypothermia? hyperthermia? acidosis? alkalosis?

Hyperthermia, acidosis - right shift (reduced affinity)

Hypothermia, alkalosis - left shift (increased affinity)

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The pulmonary edema associated with ARDS is caused by:

Injured alveolar-capillary membrane - fluid infiltration

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What would be ordered for unconscious patient who is hypoglycemia and has no IV access?

Glucagon IM

ABG of a patient with 20 year history of COPD

Respiratory acidosis, uncompensated

The influence of aldosterone on the maintenance of body fluid levels is based on which principle?

Water follows sodium

First line treatment for hepatic encephalopathy

Lactulose

Regardless of etiology, the primary physiologic event of acute pancreatitis is:

Autodigestion

How does ARF affect the cardiovascular system?

Causes CHF

For a patient in DKA, in which order should treatment intervention be carried out?

fluids, check serum K+, initiate insulin infusion, continue to monitor K+

Which condition places a patient at risk for refeeding syndrome?

NPO for 7 days

What is the difference between external and internal expiration?

External respiration, also known as breathing, involves both bringing air into the lungs (inhalation) and releasing air to the atmosphere (exhalation). During internal respiration, oxygen and carbon dioxide are exchanged between the cells and blood vessels.

Enteral nutrition has which of the following advantages over TPN: 1. Less risk of bacterial translocation 2. Providing central venous access 3. Maintaining gut morphology and function 4. Less costly

1,3,4

In pacemakers, failure to capture means:

Depolarization does not occur after a pace-generated impulse

ECG has the following characteristics: - Atrial rate: 64 bpm - Ventricular rate: 38 bpm - No relationship between P waves and QRS complexes - PR interval not measured - QRS complex = 0.14s What intervention should you prepare for?

2nd degree Type 2 Block: prepare for pacemaker insertion

When evaluating a possible mixed acid-base problem, it is crucial to:

Assess the patient's current clinical picture

How do we know that our patient has progressed from sepsis into septic shock?

With sepsis, patients typically have a fever, tachycardia, diaphoresis, and tachypnea; blood pressure remains normal. Other signs of the causative infection may be present. As sepsis worsens or septic shock develops, an early sign, particularly in older people or the very young, may be confusion or decreased alertness.

Patient is in the diuresis stage of AKI, what risk would you assess for?

Electrolyte imbalance

Myocardial ischemia or infarction may cause which of the following?

Mitral regurgitation

Clinical indications of a right tension pneumothorax include which of the following?

Tracheal shift towards the left with diminished or absent breath sounds on the right

Accumulation of CSF results in:

Hydrocephalus

S/S that provide evidence of fluid volume deficit are:

Orthostatic hypotension

Esophageal varices dilate in response to:

Shunted splanchnic blood

Which lobe of the brain is most responsible for high-level cognitive function?

Frontal

The thirst centre in the hypothalamus is sensitive to:

Fluid osmolality

Your assessment of your patient includes rapid, shallow RR, respiratory alkalosis, and inspiratory crackles. What additional assessment finding would confirm a diagnosis of ARDS?

Hypoxemia unresponsive to supplemental oxygen

Which of the following findings would occur in dilated cardiomyopathy?

Syncope

Normal left ventricle size, often preserved systolic function, and a marked decrease in compliance of cardiac muscle describes:

To assess the severity of blood loss, the nurse should determine:

Hemodynamic status

Congestive heart failure, hemorrhage, and shock can develop which type of renal failure?

Prerenal

Begins with symmetrical muscle weakness and paraesthesia that is ascending

Guillain Barre Syndrome

Common clinical findings associated with pneumothorax: 1. Tachycardia 2. Bradycardia 3. Respiratory acidosis 4. SOB 5. Distended jugular veins

1, 4, 5

Progressive prolongation of PR interval followed by dropped P-wave

Second degree Type 1

What type of murmur will you hear in a patient with mitral stenosis?

Diastolic murmur

Map 80 ICP 15 CPP?

65 (80-15)

Patient has 3rd degree AV block - what may you anticipate?

Decreased LOC 2* decreased CO

A patient with COPD with hx of hypercapnia is on 10L simple face mask and begins to become drowsy and difficult to arouse - what action do you take next?

Change to 2L NP

An asthma episode that has failed to improve with conventional therapy

Status Asthmaticus

Jerry is febrile. Which direction would his oxyhemoglobin curve shift and what does this mean about the oxyhemoglobin relationship?

Right shift: decreased affinity; hemoglobin readily releases its oxygen, allowing more oxygen available to the tissues (increased energy requirements)

What type of AKI is patient at risk of if they are admitted with massive GI bleed?

Prerenal

What is a complication of cardioversion?

Thrombosis

__________ accumulates in the bowel proximal to the actual bowel obstruction, resulting in distension

Fluid

Pleuritic CP, SOB, pericardial friction rub

Pericarditis

Which of the following brain structures are protective because it is the primary collateral pathway when major cerebral vessels are occluded?

Circle of Willis

Normal adult stroke volume

50-100mL

What is the difference between shunt and deadspace

Shunt: Decreased ventilation, but adequate perfusion (Pulmonary edema, pneumonia, pleural effusion) Deadspace: Decreased perfusion, but adequate ventilation (Pulmonary embolism, hypovolemia)

What is resistance in the cardiovascular system?

Afterload

Normal ICP is usually less than:

Why do you need to control hyperthermia in a patient with bacterial endocarditis?

To decrease myocardial oxygen consumption

Fluids and solutes are moved from the vascular system into the tubular system of the nephron by

Glomerular filtration

Pain with acute pancreatitis described as:

Severe, dull pain around the top of your stomach that develops suddenly. This aching pain often gets steadily worse and can travel along your back or below your left shoulder blade

What imbalance do you see in relation to K+, PO4, and ABG secondary to AKI?

Hyperkalemia Hyperphosphatemia Acidosis

Your patient complains of dyspnea. On auscultation, you noted S3/S4 sounds. This is a sign of:

Increased left heart preload

Pt has right middle lobe pneumonia. Ventilation will decrease in his affected lung because

Gas follows the path of least resistance

Portal HTN is caused by:

Increased vascular resistance

Patient has LLL pneumonia. What is the most optimal side to position him?

Good lung down to optimize oxygenation and perfusion - right side

The compensatory mechanism that plays a major role in Na and H2O retention in heart failure is:

RAAS

JVD may be a sign of

Elevated right ventricular preload

What electrolyte is specifically important to cardiac contraction?

Calcium

Common precipitating factor for development of DKA

Infection

According to Monroe-Kellie hypothesis, an increase in one intracranial compartment results in the _____ of another

Decrease

Increased afterload can be caused by

Hypervolemia

Absolute and Non-absolute contraindication for fibrolytics after STEMI

Absolute: prior hemorrhage, recent surgery, recent head trauma, aneurysm Non-absolute: anticoagulants, pregnancy, HTN

Major cause of ascites in patient with liver failure

Portal HTN and low albumin

A major factor contributing to the onset of ARF as a complication of the liver is:

Portal vein HTN

Obstructive pulmonary disorders are characterized by decreased airflow ____ the lungs

FROM People with obstructive lung disease have shortness of breath due to difficulty exhaling all the air from the lungs. Because of damage to the lungs or narrowing of the airways inside the lungs, exhaled air comes out more slowly than normal

Most common indirect predisposing disorder of ARDS is

Sepsis

Aldosterone causes the kidneys to

Absorb Na

PaO2 < 60 and SpO2 < 90

Hypoxemia

Restrictive pulmonary disease

ILD, pulmonary fibrosis

In a patient with increased ICP, CPP must be greater than ____ to ensure adequate perfusion

In mitral regurgitation, blood flows back into the:

Peptic ulcers occurs in the:

Stomach and duodenum

When would you see periorbital bruising?

Basal skull #

Interstitial fluid is located:

Within tissue spaces