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GNURS630 APA & Foundations > Midterm > Flashcards

Midterm Flashcards

1
Q 
What is one critical thing you want to be vigilant about on the monitor when 	inserting/discontinuing a Swan-Ganz catheter?
 		A.) Aseptic technique
 		B.) Arrhythmias/tachyarrhythmias
 		C.) Heart rate
		D.) Capnography waveform
A

B.) Arrhythmias/tachyarrhythmias

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2
Q

What could cause a HIGH pulmonary artery pressure?
A.) Hypovolemia
B.) Left ventricular failure
C.) Vasodilation
D.) Distal tip of PA catheter in the Right Atrium

A

B.) Left ventricular failure

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3
Q 
What is the safest site for CVP insertion?
     		A.) Right internal jugular
     		B.) Left internal jugular
     		C.) Right Subclavian
     		D.) Left Subclavian
A

A.) Right internal jugular

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4
Q 
The “a-wave” of the CVP occurs during which Cardiac Cycle?
     		A.) 1
     		B.) 2
     		C.) 3
     		D.) 4
A

A.) 1

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5
Q

Which of the following answers is FALSE regarding the contraindication of pulmonary artery catheter placement?
A.) Complete left bundle branch block
B.) Congenital heart disease
C.) Wolff-Parkinson White syndrome
D.) Ebstein’s Malformation

A

B.) Congenital heart disease

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6
Q

What is the major determinant of preload?

a. vessel diameter
b. viscosity of blood
c. venous return
d. blood volume

A

c. venous return

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7
Q

CI is inversely proportional to _______?

a. CO
b. SV
c. HR
d. BSA

A

d. BSA

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8
Q

What are the three main components needed to factor PVR?

a. MPAP, PAWP, SVO2
b. MPAP, PAWP, CI
c. MPAP, PAWP, CO
d. P1, P2, Flow

A

c. MPAP, PAWP, CO

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9
Q

Where is SVO2 sampled?

a. Arterial puncture
b. Venous puncture
c. Right Atrium
d. Pulmonary Artery

A

d. Pulmonary Artery

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10
Q

Using Reynolds’ number, when will you begin to see turbulent blood flow?

a. 100 – 200
b. 200 – 400
c. 300 – 500
d. 1300 – 1500

A

b. 200 – 400

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11
Q

Where in the systemic vasculature is resistance most determined?

a. arteries
b. capillaries
c. arterioles
d. venules

A

c. arterioles

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12
Q
  • Which of the following are advantages to perioperative EKG monitoring?
    • Low sensitivity to selectivity to myocardial infarction
    • Low cost and widely available
    • Electrodes can cause skin irritation
    • Replaces the need in all situations for invasive cardiac monitoring.
A

• Low cost and widely available

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13
Q
  • On an EKG, what does the ST-segment represent?
    • The period of time when there is no electrical activity in the heart
    • The period of time when the atria receive no venous return
    • The period of time when the atria are hyperpolarized
    • The period of time when the ventricles are depolarized
A

• The period of time when the ventricles are depolarized

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14
Q
  • What type of ischemia is often manifested by ST-segment depression?
    • Subendocardial
    • Complete heart block
    • Myocardial infarction
    • Aortic stenosis
A

• Subendocardial

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15
Q
  • Which of the following are types of ST-segment depression?
    • Upsloping
    • Horizonatal
    • Downsloping
    • All of the above
A

• All of the above

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16
Q
  • Which of the following is a true statement regarding lead selection for perioperative anesthia?
    • As long as a preoperative EKG was performed, it is not necessary to use continuous EKG monitoring during the perioperative period.
    • Single lead monitoring is considered unacceptable especially in patients with known cardiac disease.
    • EKG electrodes must always be placed on anteriorly regardless of required surgical positioning.
    • Lead II is the best lead and is sensitive to every aspect of cardiac electrical activity.
A

• Single lead monitoring is considered unacceptable especially in patients with known cardiac disease.

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17
Q 
1) What animal did Stephen Hale demonstrate invasive BP monitoring on?
	•	Dog 
	•	Cat 
	•	Horse 
	•	Dolphin
A

• Horse

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18
Q 
2) Who developed the auscultatory method to measure diastolic blood pressure?
	•	Korotkoff 
	•	Hale 
	•	Ludwig 
	•	Galen
A

• Korotkoff

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19
Q 
3) What is the “Gold Standard” for non-invasive blood pressure monitoring?
	•	Arterial line placement
	•	Mercury sphygmomanometers
scillometric method
	•	Palpated pulse method
A

Mercury sphygmomanometers

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20
Q 
4) In a noisy environment what is the best method for non-invasive blood pressure monitoring?
	•	Arterial line placement
	•	Mercury sphygmomanometers
	•	Oscillometric method
	•	Palpated pulse method
A

• Palpated pulse method

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21
Q 
5) Which physics principle makes invasive blood pressure monitoring possible?
	•	Bernoulli’s Principle
	•	Pascal’s Principle
	•	Henry’s Law
	•	Budrovic Phenomenon
A

• Pascal’s Principle

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22
Q
  • What information may be obtained by using the TEE during cardiac valve replacement?
    • Provide a baseline examination of the diseased valve
    • Assessment of the repair after completion of valve replacement
    • Examine for trace leaks or valvular regurgitation
    • All of the above
A

• All of the above

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23
Q
  • During heart transplant surgery, the TEE is instrumental in determining?
    • Level of cardioplegia
    • Adequacy of air evacuation from the donor heart is checked with TEE before coming off cardiopulmonary bypass
    • Presence of gastric regurgitation
    • Tissue compatibility
A

• Adequacy of air evacuation from the donor heart is checked with TEE before coming off cardiopulmonary bypass

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24
Q
  • While in the short axis view, which characteristic of the left ventricle is evident?
    • Its circular shape
    • Thick walls
    • Both A and B
    • None of the above
A

• Both A and B

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25
Q

• True or False: A TEE is a noninvasive procedure used to diagnose cardiac function.

A

True

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26
Q
  • Which surgery are you most likely to use a TEE when no contraindications are indicated?
    • Total Knee Replacement
    • Valve Replacement Surgery
    • Laparoscopic cholecystectomy
    • All of the above
A

• Valve Replacement Surgery

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27
Q

• Two-dimensional echocardiography is the most commonly used mode for a TEE?

A

True

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28
Q 
•	Which echocardiography mode is the easiest to assess mitral regurgitation? 
A. Pulse wave Doppler
B. Color wave Doppler 
C.  Tissue Doppler
D. Two dimensional
A

B. Color wave Doppler

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29
Q
  • What part of the body controls heat conservation and production?
    • Basal ganglia
    • Hypothalamus
    • Skin
    • Pituitary gland
A

• Hypothalamus

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30
Q
  • Why does anesthesia affect temperature regulation?
    • The brain doesn’t sense the temperature correctly.
    • The operating room is usually kept cold.
    • The paralysis and anesthesia impairs shivering and thermoregulatory vasoconstriction.
    • The drugs used for anesthesia can affect the temperature regulatory system of the brain.
A

• The paralysis and anesthesia impairs shivering and thermoregulatory vasoconstriction.

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31
Q
  • What can result from the increased sympathetic nervous system activity that increases the release of epinephrine and norepinephrine postoperatively?
    • Elevating peripheral vascular resistance.
    • Risk of metabolic academia related to tissue hypoxia.
    • Increased risk of myocardial ischemia and dysrhythmia.
    • Decrease of venous capacitance.
    • All of the above.
A

• All of the above.

32
Q
  • What are some complications related to hypothermia?
    • Immune system compromise.
    • Increased duration of action of relaxants and sedatives.
    • Decreased platelet function.
    • All of the above.
A

• All of the above.

33
Q
  • What is most commonly the earliest sign of malignant hyperthermia?
    • Increased potassium.
    • Increased end-tidal carbon dioxide levels.
    • Increased core temperature.
    • Myoglobinuria.
A

• Increased end-tidal carbon dioxide levels.

34
Q

The #1 side effect of PA line insertion is:

A

arrythmias

35
Q

Is LBBB or RBBB a contraindication of PA line insertion?

A

LBBB

36
Q

Approximate length for PA line insertion
IJ:
Femoral:

A

IJ 40-50

Fem 70

37
Q

For thermodilution, less injectate over/underestimates CO?

A

Less injectate overestimates CO

38
Q

Normal SVO2 is:

A

60-80% (mixed venous O2)

39
Q

Best two Leads to monitor are:

A

II, V

40
Q

Gold standard for BP monitoring is:

A

Art Line

41
Q

If BP cuff is too small:

A

false high

42
Q

If BP cuff too big:

A

false low

43
Q

If BP cuff is loose:

A

false high

44
Q

if able to palpate a radial pulse, SBP is at least:

A

80-90mmHg

45
Q

If able to palpate a central pulse (carotids), SBP is at least

A

50mmHg

46
Q

MAP=

A

MAP=D+1/3(S-D)

47
Q

Bladder of BP cuff should cover ____% of length of extremity and _______% circumference.

A

80%

40%

48
Q

Art line is zero’d to ____ when sitting

A

ear

49
Q

Patient will most likely need an art line if they have:

A

aortic stenosis

50
Q

Easiest TEE view during resuscitation

A

Transgastric short axis view

51
Q

1 loss of body heat in OR is

A

radiation

52
Q

If patient has hx of MH,

A

TIVA

Run O2 through machine for 10 minutes (flushes)

53
Q

Pulse oximetry two wavelengths:

A

660nm red absorbed by deoxyhemoglobin

940nm infared absorbed by oxyhemoglobin

54
Q

Depolarizing agents include

A

Succinylcholine (anectine)

55
Q

Nondepolarizing agents include

A

all others

56
Q

ulnar nerve stimulates what muscle

A

adductor pollicus muscle

57
Q

facial nerve stimulates what muscle

A

orbicularis oculi muscle

58
Q

1 twitch on TOF means _____% of nerves are blocked

A

90%

59
Q

2 twitches on TOF means _____% of nerves are blocked

A

80%

60
Q

3 twitches on TOF means _____% of nerves are blocked

A

70%

61
Q

succinylcholine gtt can present as a

A

non-depolarizing agent

62
Q

depolarizing agents work faster/slower than non-depolarizing agents

A

faster

63
Q

oliguria is defined as UOP< _____ mL/kg/hr

A

UOP< 0.5 mL/kg/hr

64
Q

Best monitor to use if you only have 1 option?

A

Pulse Ox

65
Q

BIS monitor value of 100 means what?

A

Fully awake

66
Q

Medications should be titrated to keep BIS monitor around what value?

A

60

67
Q

The agency that oversees and regulates anesthetic drug approval and labeling is part of

A

The Department of Health and Human Services

68
Q

The legal concept that describes a situation where an outcome was forseeable before the event took place is

A

proximate cause

69
Q

Damages that are awarded to the plantiff in a malpractice case that are designed to punish the defendant for negligent actions are referend to as punitive damages or

A

exemplary damages

70
Q

A nurse anesthetist is wrongfully fired from his or her job and plans to sue the former employer for lost wages. According to the requirements of mitigation, that nurse anesthetist has a duty to

A

search for another job

71
Q

An anesthesia group is sued for malpratice for the acts of one of their employees. The plaintiff wins the case and the group is forced to pay for damages. The principle under which anesthesia group can then sue the employee to gain back the damages they had to pay is known as

A

Indemnification

72
Q

Failure to obtain informed consent prior to anesthesia would be known as

A

Breach of duty

73
Q

Performing a procedure on a patient without first obtaining informed consent is known as

A

Collateral Attack

74
Q

A person is found slumped unconscious in the hospital lobby. A brief assessment by medical personnel reveals that the patient is in cardiac arrest and resuscitation is begun. THe legal doctrine that allows the performance of life saving measures when there is not one available to sign a consent for care is:

A

Implied consent

75
Q

Which of the following conditions distinguish a general anesthetic from monitored anesthesia care?

A

The patient is unable to protect their airway
THe patient is unconscious
The patient is unable to verbalize answers to simple questions

76
Q

Goals of preoperative medication include:

A

Anxiolysis
Analgesia
Amnesia

77
Q

Mendelsson:

A

Gastric contents >25mL
ph< 2.5
Particulate

GNURS630 APA & Foundations (1 decks)

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