Past exam

Question 1

(1) As soon as the patient is admitted to the recovery room, a priority of the nurse is to:

a) Assess the pain level of the patient
b) Attach the oxygen therapy, ECG dots and oxygen saturation probe
c) Assess airway patency and respiratory status
d) Assess level of consciousness

Answer 1

c) Assess airway patency and respiratory status

Question 2

(2) A patient has recently been diagnosed with early stage breast cancer. Which of the following is most appropriate for the nurse to focus on?

a) Maintaining the patient’s hope
b) Preparing a will and advanced directive
c) Discussing replacement child care for the patient’s children
d) Discussing the patient’s past experiences with her grandmother’s cancer

Answer 2

d) Discussing the patient’s past experiences with her grandmother’s cancer

Question 3

3) What are the causes of intra renal failure?

a) Low blood pressure
b) Nephrotoxic medications
c) High blood pressure
d) Alcohol

Answer 3

b) Nephrotoxic medications

Question 4

4) Shock is generally characterised by:

a) High blood pressure and high heart rate
b) Low blood pressure and high heart rate
c) Low blood pressure and low heart rate
d) Low blood pressure and high temperature

Answer 4

b) Low blood pressure and high heart rate

Question 5

5) How long does it take for a superficial partial thickness burn to heal?

a) 5-10 days
b) 21-28 days
c) 30 days to months
d) Cannot regenerate skin

Answer 5

a) 5-10 days

Question 6

6) A patient is brought to the emergency department unconscious following a barbiturate overdose. The nurse recognises that the patient is at risk of:

a) Hypercapnic respiratory failure related to ventilatory failure.
b) Hypoxemic respiratory failure related to diffusion limitations
c) Hypoxemic respiratory failure related to shunting of blood from under ventilated alveoli.
d) Hypercapnic respiratory failure related to ventilation-perfusion mismatch due to increased airway resistance.

Answer 6

a) Hypercapnic respiratory failure related to ventilatory failure.

Question 7

7) What is the correct formula for adequate fluid resuscitation in burns patients?

a) 2mls x % of TBSA x weight in kgs
b) 52mls x % of TBSA x weight in kgs
c) 30mls x % of TBSA x weight in kgs
d) 5mls x % of TBSA x weight in kgs

Answer 7

a) 2mls x % of TBSA x weight in kgs

Question 8

8) What are the priorities in caring for the family an emergency situation?

a) Remove from the vicinity
b) Establish what is appropriate and communicate with family re choices
c) Invite the family in
d) Have the Dr speak with the family immediately

Answer 8

c) Invite the family in

Question 9

9) A 15 year old patient arrives at the emergency department with mild diarrhoea,
What triage score would you give this patient?

a) 1
b) 2
c) 3
d) 4
e) 5

Answer 9

d) 4

Question 10

10) Invasive monitoring includes:

a) Arterial, central venous and PICC monitoring
b) Arterial and central monitoring
c) Arterial, central and pulmonary artery monitoring
d) Central, PICC and pulmonary artery monitoring

Answer 10

c) Arterial, central and pulmonary artery monitoring

Question 11

2. Identify the reversible causes of cardiac arrest and explain why they are reversible:

Answer 11

The reversible causes of cardiac arrest include four “H’s”:
hypoxia
hypovolaemia
hyperkalaemia, hypokalaemia, other electrolyte disturbances
hypothermia
and four “Ts”:
tension pneumothorax
cardiac tamponade
drug toxicity and therapeutics
thromboembolism and other outflow obstructions

Question 12

What is the action, indications and dosage of Adrenaline in the advanced life algorithm?

Answer 12

Action
A naturally occurring catecholamine with alpha and beta effects, leading to peripheral vasoconstriction via its alpha-adrenergic action, directing blood to the myocardium and brain.

Indications:
• Ventricular Fibrillation / pulseless Ventricular Tachycardia
after initial shocks have failed.
• Asystole, pulseless electrical activity (PEA)

Dosage
Initial adult dose is 1mg (1ml of 1:1,000 or 10mls of 1:10,000)
This dose may be repeated every three minutes during CPR. An infusion of adrenaline may be required after return of circulation.

Question 13

What is the action, indications and dosage of Amioderone in the advanced life algorithm?

Answer 13

Amiodarone is an antiarrhythmic drug that has effects on sodium, potassium and calcium channels. It also has alpha and beta adrenergic blocking properties.

Indications:
• First line anti-arrhythmic for failed defibrillation of VT/VF.
• Prophylaxis of recurrent VF/VT.

Dose:
• Initial bolus dose is 300mg diluted to 20mls of 5% dextrose and administered over 3 minutes. An additional dose of 150mg may be considered. This may be followed by an infusion of 15mg/kg over 24 hours.

Question 14

7. The acid-base balance maintained within the body is critical to the effective functioning of the body systems. Severe imbalances can be very serious and lethal to the patient.
   Identify possible causes if your patient when their ABG’s have a reading showing increased Co2 and decreased ph. i.e.

Ph 7.25, PaC02 65mmhg

Answer 14

asthma
chronic obstructive pulmonary disease (COPD)
severe obesity (which can interfere with expansion of the lungs)
neuromuscular disorders (such as multiple sclerosis)
obstructed airways (due to choking or other causes)
sedative overdose
cardiac arrest

Question 15

8. Explain the differences between CPAP and BiPAP:

Answer 15

CPAP- Continuous positive airway pressure device for oxygenation. Delivers one continuous airway pressure through a mask to prevent airways closing

BIPAP- Bilevel positive airway pressure device for ventilation. Delivers two different air pressures through the mask. High pressure whilst inhalation and low pressure for exhalation

Question 16

9. What types of patients would you expect to see treated with CPAP and BiPAP for respiratory support and why?

Answer 16

CPAP- Reduces pulmonary odema, reduces cardiac workload, for patients with congenital heart failure, or sleep apnea
BiPAP- Gives the lungs more room to move which increases mechanical ventilation. For pt with COPD or pneumonia.

Question 17

11. Outline the principles of aseptic technique in the operating room.

Answer 17

?

Question 18

12. Using the rule of nines, calculate the percentage of burn to an adult patient with burns to his anterior trunk and bilateral anterior legs.

Answer 18

bilateral anterior leg x 2 = 18%
anterior trunk = 18%
Total 36%

Question 19

15. Explain the following four terms:
• Beneficence
• Maleficence
• Autonomy
• Justice

Answer 19

Respect for a persons Autonomy - Acknowledge a person’s right to make choices, to hold views, and to take actions based on personal values and beliefs

Justice - Treat others equitably, distribute
benefits/burdens fairly.

Non maleficence - Obligation not to inflict harm intentionally

Beneficence - Provide benefits to persons and contribute to their welfare

Question 20

16. What is the name given to a legal document in which adults can set out in writing their decisions about future treatment?

Answer 20

Advanced care directive

Question 21

Mechanical ventilation is often required for high acuity patients in Intensive care units.
Discuss the care of the patient with mechanical ventilation; include two nursing interventions per problem.
Write this as a care plan

Answer 21

Airway
correct location of tubes as evidenced by ascultation or end tidal CO2 monitoring. assess cuff to reduce risk of aspiration, evaluate adequacy and function of humidification device

Breathing
Looking at the patient to assess for bilateral movement of the chest, Monitoring data from the ventilator such as RR, tidal volume, minute volume and airway
pressures monitor ABGs for signs of acidosis indicating inadequate ventilation

Circulation
assessment of heart rate and rhythm, blood
pressure, central venous pressure, peripheral perfusion,
urine output and chest X-ray, as well as serum electrolytes. assessment of haemoglobin is also significant because anaemia can have on the patient’s oxygen-carrying capacity. multi-lead electrocardiography monitoring to enable timely
assessment and treatment of cardiac arrhythmias
or myocardial ischaemia. Consideration of DVTs ensure prophylaxis in place.

Disability -
Assess GCS and assess pupil size and motor and sensory function. Assessment of temperature as an elevated temperature can signal the patient’s response to infection. BSL This is of particular significance
in patients who are ventilated as they frequently
have an elevated blood glucose level as a
result of initiation of the body’s stress response that
occurs in critical illness. pain scores and anxiety assessment

Exposure
Expose patient regularly for signs of brusing denoting internal bleeding. Ventilated patients are at increased risk of impairment in skin integrity chiefly through immobility associated with sedation and ventilation - pressure ulcer prevention. Semi-recumbent positioning rather than supine positioning has been recommended as a measure to reduce the risk of ventilator associated pneumonia

Other considerations -
all equipment for O2 is present and suction, oxygen are working.
oral care and daily wash
patient safety: Primary and secondary survey
patient and family education