Final Exam Flashcards
A patient has increased ICP - what intervention should be taken first?
HOB @ 30 degree
SV = 60cc
HR = 90 bpm
What is the CO?
5.4L
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
Volume resuscitation is usually accomplished with:
IV crystalloid infusion
If the pressure drops, and flow remains unchanged, resistance ______ in order to increase pressure
Increases
The section of the GI tract that is involved in an upper GI bleed is:
Proximal to the ligament of Treitz
Pt reports SOB, productive cough, tachycardia, and orthopnea, what is his diagnosis?
LVHF
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
Major purpose of dialysis
Correct imbalances of fluid and electrolytes and remove wastes
_________ is solely filtered from the bloodstream via the glomerulus, it is NOT reabsorbed back into the bloodstream and is excreted through the urine
Creatinine
Disease may decrease contractility of the myocardium. This means if preload decreases, stroke volume will:
Decrease
For glomerular filtration to take place, it is important to maintain:
adequate cardiac output
Decreased oxygen delivery to myocardial cells will affect:
Contractility
Metabolic acidosis is closely associated with ARF because of the kidney’s inability to:
Excrete H+ ions
Patient presents with slurred speech, facial droops, and arm weakness. What is the priority?
Get him to a head CT STAT
Respiratory acidosis is caused by:
Alveolar hypoventilation
The normal cardiac output for an adult at rest is:
5L/min
The cardiac arrhythmia that can cause immediate decompensation in a patient with aortic valve stenosis is:
Atrial fibrillation
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.
A nursing intervention to reduce secondary brain injury is:
Space out patient care activities
Acute respiratory failure would result in what type of pH?
Low - acidotic
Which statement is correct regarding the normal relationship between oxygen and hemoglobin?
Oxygen loosely and reversibly binds to hemoglobin
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)
The pulmonary edema associated with ARDS is caused by:
Injured alveolar-capillary membrane - fluid infiltration
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:
- Less risk of bacterial translocation
- Providing central venous access
- Maintaining gut morphology and function
- 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:
- Tachycardia
- Bradycardia
- Respiratory acidosis
- SOB
- 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:
15
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
70
In mitral regurgitation, blood flows back into the:
LA
Peptic ulcers occurs in the:
Stomach and duodenum
When would you see periorbital bruising?
Basal skull #
Interstitial fluid is located:
Within tissue spaces
