Cardiac
Respiratory
Neuro
Multisystem and Hemodynamics
Renal, GI and Endocrine
100
What pulse change might a nurse expect in the presence of cardiac tamponade?
Pulsus Paradoxus - BP fluctuates with respirations
100
What are the normal values for a blood gas?
pH 7.35-7.45
PaCO2 35-45
HCO3 22-26
100
What medication are you going to give for a patient experiencing an active seizure?
Lorazepam
100
Which of the following types of shock would most likely result in a SvO2 of 82%?
Hypovolemic, Anaphylactic, Septic, Cardiogenic
Septic - In septic shock the oxygen utilization at the cellular level is low, so the blood coming back has more oxygen in it than normal.
100
A patient with an AKI has the following blood gas:
pH 7.32, PaCO2 35, HCO3 18
Name the imbalance and what is the cause?
Metabolic Acidosis caused by the kidneys inability to excrete the acid byproducts of metabolism
200
Physical assessment findings that are indicative of a significant right ventricular infarction would include?
Signs of right sided heart failure :)
200
A trauma patient a femur fracture suddenly develops agitation, tachypnea, tachycardia and mild hypoxemia. Lungs are clear but you notice a petechial rash on their upper body. What's happening?
Fat embolism
200
A patient has a LEFT cerebral ischemic stroke. The patient is most likely to have which of the following?
LEFT babinski reflex, eye deviation to the RIGHT, LEFT homonymous hemianopia, RIGHT pronator drift
Right pronator drift
If the stroke is big enough, the eyes will deviate TOWARDS the stroke
200
What is the primary hemodynamic effect of Dobutamine?
Stimulates beta-1 receptors and increases contractility
200
Why does my patient with an intestinal obstruction have a BP of 82/48?
Movement of fluid from the vasculature to third spacing is a common phenomenon in bowel obstructions. Typically worse with small bowel.
300
A patient is admitted to PCU after PCI with a stent. A femoral approach was used and a closure device was deployed in cath lab, on arrival the site is clean/dry/intact. Suddenly the patient complains of severe back pain. Vitals: 78/48, HR 124, RR 26. What is likely happening?
Retroperitoneal Bleed - looks like hypovolemic shock potentially.
What might you see on their back?
300
Name the issue:
pH 7.30, PaCO2 50, HCO3 24
Uncompensated Respiratory Acidosis
300
What does B.E.F.A.S.T. stand for?
Balance
Eyes
Face
Arms
Speech
Time
300
You are fluid resuscitating a septic patient. What are some signs that you have given them enough?
Decreased HR, Increased BP, Increased UO, decreasing lactate, adequate CO
300
Which of the following findings would you expect in a patient with HHS?
pH 7.15, urine specific gravity of 1.030, K of 6.1 or serum osmolality of 270 mOsm/kg
Urine specific gravity of 1.030 - due to high blood glucose levels the patient will have had aggressive diuresis
400
What medication would be most likely given to a patient with hypertrophic cardiomyopathy?
Metoprolol, levophed, dopamine or dobutamine?
Metoprolol
Issue is with filling. The beta blocker slows the HR and allows for a longer filling time
400
Which of the following may be an effect of mechanical ventilation and PEEP?
Atelectasis, oxygen toxicity, ARDS, reduced CO
Reduced CO due to increased intrathoracic pressure - decreases blood return to the heart ... so a decrease in?
400
A 32 year old admitted with racoon eyes has clear fluid draining from his nose. What do you do?
Tape rolled gauze under nose, insert NGT, suction as needed, insert nasal packing until MD arrives
Rolled Gauze under nose.
Likely has basilar skull fracture
400
You are concerned that your ART line waveform has changed. The patient is stable. What are your next steps?
Rezero the transducer, check a square wave test, check a manual blood pressure
400
After a CT scan with contrast, what nursing intervention is most important to reducing kidney injury?
Ensuring adequate fluid intake! Flush the contrast out before it can damage the kidneys.
500
Atrial Fibrillation with RVR
500
Talk me through how a chest tube works and how you set it up. How do you assess it's working?
What if it gets pulled out?
500
The absence of what 3 reflexes is most predictive of brain death?
Corneal, Cough, Gag
Loss of ANY of these three should make you call lifecenter for organ donation!
500
What is the primary hemodynamic effect of furosemide?
Reduction in preload
500
A 35 year old man developed AKI after upper GIB secondary to esophageal varices in which he lost a great deal of blood. What type of renal failure is this (pre, intra, post)?
Due to blood loss the patient is likely experiencing Pre-renal failure.