ICU Test Semester 1 Flashcards
Which of the following ventilator strategies would be most appropriate for a 62 kg patient with ARDS
CMV-VC, Vt 400 mL, RR 18 bpm, FiO2 0.70, PEEP 14 cmH2O
CMV-PC, Vt 450 mL, RR 12 bpm, FiO2 0.70, PEEP 7.5 cmH2O
SIMV-VC, Vt 480 mL, RR 18 bpm, PS 16 cmH2O, FiO2 0.70, PEEP 15 cmH2O
MMV-Pressure Adaptive, Vt 500 mL, RR 12 bpm, PS 16 cmH2O, FiO2 0.70, PEEP 10 cmH2O
CMV-VC, Vt 400 mL, RR 18 bpm, FiO2 0.70, PEEP 14 cmH2O
Which receptor will the use of moderate (5-10 mg/kg/min) Dopamine primarily stimulate?
a1 Adrenergic
B1 Adrenergic
B2 Adrenergic
Dopaminergic
B1 Adrenergic
You are assessing a patient with chronic CHF who appear to be fluid overloaded. Which of the following diuretic would you recommend due to the fact that it has the fastest peak effect?
Mannitol
Acetazolamide
Fureosemide
Thiomerin
Fureosemide
__________ is the agent of choice for treating life threatening VRE
Ceftriaxone
Doxcycline
Synercid
Zithromax
Synercid
What is the main use of HMEs
Warm and humidify gases delivered to the trachea from the ventilator
Humidity therapeutic gases delivered at high flows to the lower airway
Provide extra humidity for a patient with thick secretions
Warm and humidify gases delivered to the trachea from the ventilator
Which of the following drugs may increase blood pressure without causing peripheral vasoconstriction?
Epinephrine
Dopamine
Dobutamine
Norepinephrine
Vasopressin
Dobutamine
You are in CMV PC mode with the I:E ratio set to maintain a constant I:E ratio of 1:1. The rate is set at 15 and the inspiratory flow is returning to baseline. You then decrease the rate to 12 br/min. Which of the following occurs?
MV increases and mean airway pressure increases
Vt decreases and mean airway pressure remains unchanged
Vt decreases and mean airway pressure decreases
MV decreases and mean airway pressure remains unchanged
MV decreases and mean airway pressure remains unchanged
Your patient has an artline to monitor blood pressure. His pressure has been consistently 120-125 mmHg mmHg and 75-80 mmHg diastolic . The monitor suddenly starts to alarm low BP and is displaying the following
There is an air bubble in the transducing pressure line
Which of the following best defines acute lung injury
P(A-a)O2 <5 despite an Fio2 greater than or equal to 0.50
PaO2 <60 mmHg despite an FiO2 greater than or equal to 0.50
P/F ratio <300
pH >7.40
P/F ratio <300
Which of the following would result in a an overall decrease in V/Q
Pulmonary embolus
Emphysema
Hypovolemic shock
Pulmonary fibrosis
Pulmonary fibrosis
Which set of weaning parameters would best support discontinuing mechanical ventilation
80 kg pt, RR 35, Vt 330 mL, VC 1200 mL, NIF -25 cmH2O
70 kg pt, RR 12, Vt 500 mL, VC 600 mL, NIF -15 cmH2O
75 kg pt, RR 19, Vt 900 mL, VC 1300 mL, NIF -22 cmH2O
60 kg pt, RR 16, Vt 320 mL, VC 900 mL, NIF -31 cmH2O
60 kg pt, RR 16, Vt 320 mL, VC 900 mL, NIF -31 cmH2O
A physician has ordered you to extubate an orally intubated patient. Which of the following should be done before the tube itself is removed?
I. Suction the oropharynx
II. Pre-oxygenate
III. Ensure cuff is deflated
IV. Suction ETT
All of the above
You have received report on a patient who is on day 9 of ventilation? The original reason for ventilation has been resolved and the plan is to stop sedation, perform an SBT, and hopefully extubate. To help enacte the plan you should
I. Consult with the nurse on stopping feeds
II. Request another CXR
III. Test for cuff leak
IV. Perform an SBT for 30 min
I and III
Which of the following compliacations is the result of an ETT
I, Tracheal Ulcers
II. Tracheal Cartilage Loss
III. Tracheal Malacia
IV. Tracheoesophageal fistula
All of the above
What mode should be used for non-invasive vetnilation considering the following ABG; pH 7.31, 55, 65, 26, -1, 92%
CPAP
Pressure Support
SIMV
Continuous mandatory ventilation
Pressure Support
Verification of safety equipment by the bedside
Confirming contents in the intubation buckets and difficult airway carts
Reviewing vent monitoring record for the patient for their entire ICU stay
All of the above
A and B
A and B
You are preparing to enter the room of a trach patient who is on contact isolation. In addition to being schedule for a full assessment the prior shift RT has told you that the patient is requiring more suction than normal. In light of what task you may have to perform once in the room, what isolation precautions apply to this patient?
I. Private room
II. Negative Pressure Room
III. Gloves
IV. Goggles
V. Mask/goggles
I, III, IV and V
You are assessing a patient with a right subclavian central line that is monitored with a pressure transducing system. You notice that the CVP waveform fluctuates from 3-6 mmHg. Which of the following statements is true
The most accurate reading is 3 mmHg
The most accurate reading is 6 mmHg
Indication that there is an incorrectly placed central line
Need to replace the transducer
The most accurate reading is 3 mmHg
Which of the following ventilation strategies would be consistent with TBI protocol
Permissive hypercapnia
Frequent LVRM
Hyperoxemia
Inverse ratio ventilation
Hyperoxemia
In CMV-PC adaptive mode, which of the following events would occur if the ETT suddenly became partially occluded due to a slight kinking in the airway
The vent would immediately cycle to high pressure alarm setting
Deliver Vt would increase
The airway pressure would rise in steps with each subsequent breath
Nothing would change
The airway pressure would rise in steps with each subsequent breath
In microbiology, a culture and sensitivity test is
A method to help understand the cultural difference of patient and to be sensitive to their beliefs
Growing organisms on media in the presence of antibiotics
Manufacturing various antibiotics and testing them on patients
Growing organisms on media in the presence of antibiotics
Your patient has he following ECG, what can you determine
Other Parameters- BP 98/74 mmHg, PAP 35/26, PAWP 22 mmHg, CVP 10 mmHg
Stroke volume has likely decrease
Your patient has a #8 trach tube in situ and is ventilated in CMV-VC, RR12, Vt 500 mL, FiO2 50% and PEEP 5 cmH2O. The minimal bedside safety equipment should include
OPE, BVM, #6 trach tube, obturator
OPE, BVM, #6 trach, #8 trach, obturator
OPA, BVM, PEEP valve, #6 trach tube, obturator
OPA, BVM, PEEP valve, #6 trach tube, #8 trach tube, obturator
OPE, BVM, #6 trach, #8 trach, obturator
What finding on a chest x-ray is most helpful in differentiating ARDS from CHF
Normal HR
Bilateral alveolar infiltrates
Air bronchograms
Interstitial fluid
Normal HR
A left shift in WBC count is caused by an increase in the number of
Immature basophils
Immature eosinophils
Immature neutrophils
Immature basophils, eosinophils, and neutrophils
Immature neutrophils
Second degree heart Type 2 block
Tx for Second degree heart Type 2 block
Transcutaneous pacing
The patient SOB is increasing, her RR is 32 with accessory much use, and she has ++ JVD. On auscultation you hear coarse crackles throughout. Her CXR shows an enlarged heart with bilateral white fluffy infiltrates. Base on this which of the following would you expect
Decreased CVP, Decrease PAP, decreased PAWP
Decreased CVP, decreased PAP, Decreased PAWP
Increased CVP, Increased PAP, Decreased PAWP
Increased CVP, Increased PAP, Increased PAWP
Increased CVP, Increased PAP, Increased PAWP
Ventricular Fibrillation
Anti arrhythmic for VF
Cordarone
Your are receiving a 19 yr old female who is post op neurosurgery for the removal of a benign pituitary tumor. The patient is sedated intubated and ventilated. The plan is to return the patient to the OR in 24 hours to complete the surgery and then wake and extubate. The patient has a history of moderate asthma and takes Symbicort BID. Her asthma has been well controlled with this. The physical wanted pharmacological management of her asthma to continue while she in intubated which of the following would meet this need.
Combivent Q4
Pulmicort and Oxese BID
Ventolin Q4 and Flovent BID
Ventolin and Atrovent Q4
Ventolin Q4 and Flovent BID
Your patient has a TBI. Which of the following would be indicated to reduce the cerebral edema and increase ICP
Administration of collodial diuretic
Administration of vasopressor
Permissive hypercapnia
Administration of Lasix
Administration of collodial diuretic
A chest x-ray is obtained and the tip of the ETT is resting at the fourth rib. Which of the following action should be taken
The tube should be advanced 2 cm
The tube should be advanced until equal breath sounds are heard
The tube should remain at this level
The tube should be withdrawn 3 cm
The tube should be withdrawn 3 cm
Your are in CMV PC mode and the I:E ratio is set to maintain a constant I:E ratio of 1:1. The rate is set to 16 and the inspiratory flow is returning to baseline. You decrease rate to 12 breath which of the following will occur
MV increase and mean airway pressure increases
Vt decreases and mean airway pressure is unchanged
Vt decreases and mean airway pressure decreases
MV decreases and mean airway pressure is unchanged
MV decreases and mean airway pressure is unchanged
Which of the follow would result in an overall decrease in V/Q
Pulmonary Embolus
Emphysema
Hypovolemic shock
Pulmonary fibrosis
Pulmonary fibrosis
A patient is on volume controlled ventilation with the following settings
Vt 600 mL, RR 14 br/min. The low Vte alarm is set at 400 mL and is suddenly activated; the low pressure alarm is also activated. The Vte read 0 mL and PIP reads 2 cmH2O
Which of the following is likely the cause
Disconnection from the Y
Loss of volume from tubing compensation
Small leak around ETT
Active patient inspiration
Disconnection from the Y
