N217T Exam 2 Board 1

Shock

100

A postoperative patient has significant blood loss followed by hypotension. What type of shock is most likely?

Hypovolemic shock

Hemorrhagic shock

200

What is the primary vascular problem occurring in distributive shock?

Systemic vasodilation

Decreased systemic vascular resistance

Loss of vascular tone

300

A patient has cardiac tamponade and develops obstructive shock. Explain why the tamponade causes shock.

Fluid/blood compresses the heart

Cardiac chambers cannot fill normally

Venous return is impaired

Cardiac output decreases

Blood flow to vital organs is reduced

400

A patient with anaphylaxis remains hypotensive despite receiving IV fluids. What medication should be given and why?

Epinephrine

Reverses severe vasodilation

Helps increase blood pressure

Relieves bronchoconstriction

Helps improve airway patency

500

A patient has cardiogenic shock with elevated preload and afterload. Why might a vasodilator be prescribed?

Decreases afterload

Decreases preload

Decreases systemic vascular resistance

Reduces the workload on the failing heart

Can improve forward cardiac output

Neuro/TBI

100

A patient with a TBI has a GCS of 3. What does that mean?

• No eye opening

• No verbal response

• No motor response

• Lowest possible GCS score

200

A patient opens their eyes only to painful stimulation, says inappropriate words, and localizes pain. Calculate the GCS.

• E2

• V3

• M5

• Total = 10

300

Why does elevating the head of the bed to about 30° help a patient with increased ICP?

• Promotes cerebral venous drainage

• Decreases venous congestion

• Can decrease ICP

• Helps maintain cerebral perfusion

400

A patient develops widening pulse pressure, bradycardia, and irregular respirations. What is the nurse concerned about?

• Cushing's triad

• Increased intracranial pressure

• Possible brain herniation

• Brainstem compression

500

A patient's BP is 88/50 and ICP is 20. Calculate MAP and CPP and explain why this is concerning.

• MAP ≈ 63 mm Hg
• CPP = MAP − ICP
• CPP ≈ 43 mm Hg
• CPP is too low (normal is 60 - 80)
• Cerebral perfusion is inadequate
• The provider should be notified/interventions initiated to improve cerebral perfusion

Cardiac Arrest/Perfusion

100

A patient suddenly becomes pulseless but the monitor continues to show electrical activity. What rhythm should the nurse suspect?

• Pulseless electrical activity

• PEA

200

Name 6 reversible causes that can lead to PEA.

• Hypovolemia
• Hypoxia
• Hypo/hyperkalemia
• Hypothermia
• Hydrogen ion excess
• Tamponade
• Thrombosis (MI/PE)
• Toxins
• Tension pneumo

 

300

A patient is in PEA. Should the nurse defibrillate? Explain.

• No

• PEA is a non-shockable rhythm

• Begin high-quality CPR

• Give epinephrine

• Search for and treat the underlying reversible cause

400

A patient suddenly goes into ventricular fibrillation after an MI. What is the most important intervention? 

Early defib? CPR? Finding the cause? 

• Immediate/early defibrillation

• High-quality CPR while preparing the defibrillator

• Rapid treatment is critical because VF is a shockable rhythm

500

A patient has cool extremities, weak pulses, delayed capillary refill, tachycardia, and hypotension. What does this tell you about tissue perfusion, and what treatment might improve it?

• Tissue perfusion is inadequate
• Cardiac output is reduced
• Vital organs may not be receiving enough 

Vascular/AAA

100

What is an abdominal aortic aneurysm?

• Abnormal dilation of the abdominal aorta

• Greater than approximately 30 mm in diameter

• Weakening/dilation of the arterial wall

200

A patient with an AAA reports new lower back and groin discomfort. Why should the nurse take this seriously?

• Pain can be an early manifestation of AAA

• Lower back pain can occur

• Groin/abdominal pain can occur

• May indicate expansion or complications

300

Which lifestyle or family-history factors can increase a person's risk for AAA?

• Cigarette smoking

• Family history of aneurysm

• Older age is also a known risk factor

• Atherosclerotic/vascular disease may increase risk

400

A patient asks where an abdominal aortic aneurysm most commonly occurs. What should the nurse explain?

• Infrarenal abdominal aorta

• Below the renal arteries

500

Why is blood pressure control particularly important for someone with an AAA?

• High pressure increases stress on the weakened arterial wall

• Excessive pressure can contribute to expansion

• An enlarged aneurysm can rupture

• Rupture can cause life-threatening hemorrhage

Neuro

100

What does MAP help determine in a patient with a severe traumatic brain injury?

• Cerebral perfusion

• Cerebral blood flow

• Helps determine CPP

200

What formula is used to calculate cerebral perfusion pressure?

• CPP = MAP − ICP

• Cerebral perfusion pressure depends on MAP and intracranial pressure

300

What three major findings make up Cushing's triad?  

• Widening pulse pressure

• Bradycardia

• Irregular/shallow respirations or apnea

400

A patient with severe TBI develops decerebrate posturing and signs of increased ICP. Why might mannitol be administered?

• Osmotic diuretic

• Pulls fluid out of swollen brain tissue

• Decreases cerebral edema

• Helps lower ICP

• Can help prevent further neurological deterioration

500

Your group is brave for picking neuro 500. Here's your prize: 

You get to steal a question from another group if they do not know it, even if your group is not next to steal.