Test I part I

Question 1

according to the AANA standard #9 on monitoring and alarms, how often is blood pressure, heart rate, and respiration required to be documented for all anesthestics?

Answer 1

Q 5min

Question 2

AANA standard #9 states:

Answer 2

monitor, evaluate, and document the patients physiologic condition as appropriate for the procedure and anesthetic technique

Question 3

AANA std #9 states that when a physiological monitoring device is used, what must be done regarding the alarms?

Answer 3

variable pitch and threshold alarms are turned on and audible

Question 4

_________________ is how close the value is to the true value

Answer 4

accuracy

Question 5

____________ how repeatable are the measurements

Answer 5

precision

Question 6

__________________ is a simple and reliable means of monitoring heart and breath sounds

Answer 6

stethoscopy

Question 7

what are the two ways stethoscopy can be accomplished?

Answer 7

1. precordial stethoscope
2. esophageal stethoscope

Question 8

precordial stethoscope is most commonly used with which surgical population?

Answer 8

peds (but can be used on adults as well)

Question 9

_______________ is a metal bell attached to tubing and a custom earpiece

Answer 9

precordial stethoscope

Question 10

T/F: a precordial stethoscope can be used during all forms of anesthesia: MAC, regional, and general

Answer 10

true

Question 11

______________ is a form of stethoscopy that monitors heart sounds, breath sounds, and temperature

Answer 11

esophageal stethoscope

Question 12

esophageal stethoscope can only be used during which anesthesia technique?

Answer 12

general

Question 13

what population would you avoid the use of an esophageal stethoscope?

Answer 13

esophageal or gastric bypass surgery
pt with esophageal varices

Question 14

T/F: there is a high risk of pharyngeal or esophageal trauma, and/or insertion into lung with an esophageal stethoscope

Answer 14

false; low risk

Question 15

when might you see a pulse deficit (i.e. pulse rate less than heart rate)

Answer 15

with ectopy, Afib, PVCs, PEA

Question 16

______________ is a detectable peripheral arterial pulsation

Answer 16

pulse rate

Question 17

what is the most common and required diagnostic tool in the OR?

Answer 17

ECG

Question 18

approximately __________ of patients for non-cardiac surgery have risk factors for CAD

Answer 18

1/3

Question 19

what is the incidence of perioperative ischemia in patients with CAD scheduled for cardiac or non-cardiac surgery?

Answer 19

20-80%

Question 20

ST trending with a continuous ECG in the OR may reduce __________________

Answer 20

morbidity

Question 21

indications for ECG

Answer 21

1. measurement of heart rate
2. diagnosis of arrhythmias, electrolyte imbalances, and conduction defects
3. diagnosis of ischemia
4. pathologic Q waves

Question 22

continuous ECG monitoring is a standard of care and required for any patient receiving and anesthetic. This includes which components of the ECG?

Answer 22

1. heart rate
2. heart rhythm
3. for some pts: ST segments & T waves

Question 23

a lead composed of 2 electrodes of opposite polarity is called a _______________

Answer 23

bipolar lead

Question 24

a lead composed of a single positive electrode and a reference point is a ________________

Answer 24

unipolar

Question 25

which ECG leads are your bipolar leads?

Answer 25

std limb leads (I, II, III)

Question 26

which leads are your unipolar leads?

Answer 26

precordial leads (V1-V6)

Question 27

what leads are your modified unipolar leads?

Answer 27

goldbergers augmented leads (aVR, aVF, aVL)

Question 28

what view of the heart is not "visible" with a 3 lead ECG?

Answer 28

anterior

Question 29

T/F: improper placement of ECG leads in a 3 lead system in pt with CAD will not be an issue

Answer 29

false; may lead to abnormal ECG pattern (ST deviation, inverted T waves, Q waves)

Question 30

the _____________ lead placement ECG has been deemed a standard of care for at risk patients

Answer 30

5

Question 31

what are the 2 most common ECG monitoring leads used in a 5-lead placement

Answer 31

II and V5

Question 32

which lead in a 5-lead is preferred for arrhythmia monitoring , due to its ability to monitor P-waves

Answer 32

II

Question 33

which lead in a 5-lead system has been found to detect ischemia earliest and most frequently

Answer 33

V3

Question 34

which leads in a 5-lead placement are preferred for ischemia monitoring

Answer 34

V3-V5

Question 35

for standard limb leads (I, II, III) what is the basic morphology of the waveforms?

Answer 35

positive deflection

Question 36

what is the basic morphology of the ECG waveform in aVR lead?

Answer 36

negative deflection

Question 37

basic morphology of ECG waveform in aVL lead?

Answer 37

P & T are negative QRS biphasic

Question 38

what is the basic morphology of the ECG waveform in aVF?

Answer 38

positive deflection

Question 39

what is the basic morphology of the ECG waveform in the precordial leads (V1-6)

Answer 39

P & T positive QRS starts negative and ends positive.

Question 40

what are the most common cause of ECG artifact in the OR

Answer 40

ECU (most common) Intraoperative nerve monitoring (IONM) stimulation shavers

Question 41

which part of the ECG is the most sensitive to myocardial ischemia

Answer 41

ST segment

Question 42

ST elevation with/without tall T waves is ______________ ischemia; which is d/t ______________

Answer 42

transmural ; Acute coronary artery occlusion or spasm

Question 43

which type of myocardial ischemia is more likely to have a Q wave

Answer 43

transmural

Question 44

ST depression is indicative of ___________________ ischemia ; most often d/t ______________, and/or ____________

Answer 44

subendocardial; stable angina; significant but stable CAD

Question 45

what will the ECG monitor look like with hypokalemia

Answer 45

ST depression, flattened T wave

Question 46

decreased __________ prolongs repolarization as seen in long QT syndrome and torsades de points

Answer 46

potassium

Question 47

with mildly elevated hyperkalemia, what ECG changes will you see

Answer 47

narrow, peaked T waves, short QT interval

Question 48

with moderately elevated hyperkalemia, what ECG changes will you see

Answer 48

QRS widening, flat P wave, PR prolongation, 2nd and 3rd degree heart block

Question 49

with extremely elevated hyperkalemia, what EKG changes will you see

Answer 49

ventricular flutter, asystole

Question 50

ECG changes with hypercalcemia

Answer 50

short QT, decreased T wave amplitude or inversion