FPC / CFRN - Review Exam - Version B with complete solutions (LATEST 2022) 137 Questions with 100% Correct Answers

FPC / CFRN - Review Exam - Version B with complete solutions (LATEST 2022) 137 Questions with 100% Correct Answers Document Content and Description Below FPC / CFRN - Review Exam - Version B with complete solutions (LATEST 2022) 137 Questions with 100% Correct Answers Myxedema coma is also known as... A. Thyroid storm B. Adrenal insufficiency C. H ypothyroidism D. Hyperaldosteronism - Hypothyroidism Most common presentation of a patient with hypothyroidism are all of the following, Except... A. Cold intolerance with coarse hair B. Almost exclusively over the age of sixty C. 90% of cases occur in the winter D. Primarily in men - Primarily in men Hypothroidism occurs primarily in women, almost exclusively over the age of sixty, with 90% of the cases occurring in the winter months. Your patient presents with following parameters: CVP 0, CI 1, PA S/D 8/4, wedge 3, and SVR 1,800. What is your diagnosis? A. Hypovolemic shock B. Right ventricular infarction C. CHF D. Sepsis - Hypovolemic shock Careful interpretation of the CVP is important!Central venous pressure (CVP) describes the pressure of blood in the thoracic vena cava, near the right atrium of the heart. CVP reflects the amount of blood returning to the heart and the ability of the heart to pump the blood into the arterial system. Drug of choice for profound hypotension in septic shock is? A. Isotonic crystalloid solution B. Levophed C. Nipride D. Dobutamine - Levophed Sepsis is by far the most common cause of distributive shock. The average normal ICP range is... A. 0-10 mmHg B. 10-20 mmHg C. 20-30 mmHg D. 30 mmHg - Normal ICP range is 0-10 mmHg, but range can go as high as 15 mmHg. The formula to calculate MAP is A. 2/3 DBP × SBP B. 2 × DBP + SBP divided by 3 C. 2 × SBP + DBP D. 2 + DBP × SBP divided by 3 - 2 × DBP + SBP / 3(normal 80-100 mmHg) Normal coronary perfusion pressure (CPP) is A. 50-60 mmHg B. 70-90 mmHg C. 80-100 mmHg D. 50 mmHg - Normal 50-60 mmHg Coronary perfusion pressure: (CPP) = DBP-PAWP The patient presents with the following hemodynamic parameters: CVP 1, CI 1.7, PA S/D 12/6, wedge 6, and SVR 300. Vital signs are 78/40, HR 60, RR 16, SaO2 98%. The most likely cause is... A. RVMI B. Neurogenic shock C. Septic shock D. Hypovolemic shock - Neurogenic shock SVR 800, think distributive shock. Next look at the CI; is it less than 2.5? Hypotension and either a normal heart and/or bradycardia present narrows the type of distributive shock as being neurogenic shock. Severe hypothermic Pt's are at highest risk for which of the following rhythm? A. A-Fib B. Asystole C. V-Fib D. Sinus Brady - V-FibSevere: 20-28 (coma, VF common) The drug of choice for a patient exhibiting signs and symptoms of malignant hyperthermia is: A. Anectine B. Sodium bicarbonate C. Dantrolene D. Glucagon - Dantrolene Malignant hyperthermia: Characteristic signs are muscular rigidity, followed by a hypercatabolic state; with increased oxygen consumption, increased carbon dioxide production (hypercapnea, usually measured by capnography), tachycardia (fast heart rate), and an increase in body temperature (hyperthermia) at a rate of up to ~2°C per hour, temperatures up to 42°C (108°F) are not uncommon. Induction agent of choice with bronchospastic patients - Ketamine (ketalar) Ativan: indication dose, max - Lorazepam, seizures, 1-2 mg, max 4 mg Mannitol dose - 1-2 g/kg Mannitol: an osmotic diuretic, acts by osmosis to ensure urine production and may prevent heme deposition in the kidney. Can be administered to avoid acute renal failure when fluid administration has been ineffective. Drug choice for cyclic antidepressant OD - Sodium bicarbonate Drug choice for beta-blocker OD - Glucagon Fentanyl dose - Sublimaze (3 μg/kg)Treatment for malignant hyperthermia - Dantrium (dantrolene) Drug for GI bleeds - Sandostatin (octreotide) You have been requested to transport a twenty-year-old female from an ICU with a history of TCA overdose two hours prior to your arrival at the sending facility. Your cardiovascular assessment of the patient would most likely include all of the following with this type of toxicity, EXCEPT... A. Early sinus bradycardia B. Widening QRS C. Prolonged QT and PR interval D. Early tachycardia - Early sinus bradycardia Sinus tachycardia is the most common cardiac disturbance seen following TCA overdose. Rhabdomyolysis treatment - - preventing shock and preserving kidney fxn - NS with sodium bicarbonate Your patient presents with ABG's of pH 7.39, pCO2 68 HCO3 32, pO2 82. He has history of COPD and weighs 65 kg. He presents with a history of SOB for 3 days with a RR 20 and is on 4 L/minute of oxygen by NC. He speaks in four- to five-word sentences. What acid-base disorder is present? A. Metabolic acidosis with partial compensation B. Respiratory acidosis with complete compensation C. Metabolic alkalosis with no compensation D. Respiratory alkalosis with no compensation - Respiratory acidosis with complete compensation. The pCO2 is elevated, which is the primary disorder, and the compensatory response is the increased HCO3. The pH is normal, so there is complete compensation.Which formula can be used when calculating a cerebral perfusion pressure (CPP)? A. [(DBP × 2) + SBP] divided by 3 B. MAP − ICP C. ICP − DBP D. [(DBP + 2) × SBP] divided by 3 - MAP − ICP = CPP Normal range (mmHg): 70-90 You are managing a patient who has been diagnosed with hepatic encephalopathy. His ammonia levels are elevated. Your management in preparing this patient for transport is to inhibit elevated protein level by... A. Administering whole blood B. Stop GI bleeding and evacuate bowel of blood C. Aggressive fluid resuscitation D. Aggressive pain control - Stop GI bleeding and evacuate bowel of blood Bowel cleansing is the mainstay of therapy for hepatic encephalopathy. Evacuation of gutderived toxins (intestinal blood, bacteria) and administration of Lactulose (orally or as an enema) is one of the cornerstones of the treatment of hepatic encephalopathy. Lactulose may be given orally to acidify the ammonia in the colon and form the ammonium that can be easily excreted. It is used as a laxative for evacuating blood from intestines and for reducing ammonia production by intestinal bacteria. Gastrointestinal bleeding should also be controlled. Grey Turner's sign may indicate? A. Meningitis B. Splenic injuryC. Retroperitoneal bleed D. Gallbladder - Retroperitoneal bleed Grey Turner's sign refers to bruising of the flanks and can indicate retroperitoneal or intraabdominal bleeding, which can take up to 24-48 hours to show up on assessment. It can be caused by acute pancreatitis, blunt abdominal trauma, ruptured abdominal aortic aneurysm, or ruptured/hemorrhagic ectopic pregnancy. Most commonly seen injuries with side impact or "lay it down" motorcycle crashes include all of the following, EXCEPT: A. Open fracture of the femur B. Pelvic fractures C. Abrasions to the affected side D. Tibia/fibula or malleolus fractures - Pelvic fractures Your patient was struck from behind while driving. The most common area of injury from a rear-end collision is: A. Ankle fracture B. Coup Contrecoup injury pattern C. C2 fracture D. T12-L1 injuries - T12-L1 injuries Dry chemicals such as lime should be... A. Brushed off before irrigation B. Neutralized with a special agent before irrigation C. Irrigated immediately with water or physiologic saline D. Wrapped in a dressing and not irrigated - Brushed off before irrigationChemical burns differ from thermal burns in that the burning process continues until the agent is inactivated by reaction of tissues: neutralized or diluted with water. Dry chemicals, such as lime, should be brushed off before irrigation. Water and physiologic saline are fluids of choice for wound irrigation. Hamman's sign may indicate which of the following? A. Tension pneumothorax B. Tracheobronchial injury C. Aortic rupture D. Cardiac tamponade - Tracheobronchial injury Hamman's sign is a crunching sound heard with auscultation and may be synchronized with the patient's heart beat. This sign is associated with tracheobronchial injury. Recommended urinary output when managing a burn patient without an electrical injury is: A. 100 mL/hr B. 10-20 mL/hr C. 30-50 mL/hr D. 100 mL/hr - 30-50 mL/hr Hydrofluoric burns can be managed with copious amounts of water and... A. Calcium gluconate B. Osmotic diuretics C. Glucagon D. Pyroxidine - Calcium gluconateHydrofluoric acid exposure is often treated with calcium gluconate, a source of Ca2+ that sequesters the fluoride ions. HF chemical burns can be treated with a water wash and 2.5% calcium gluconate gel or special rinsing solutions. However, because it is absorbed, medical treatment is necessary; rinsing off is not enough and in some cases, amputation may be necessary. The management approach for a patient experiencing brain herniation can include all of the following, EXCEPT: A. Serum sodium goal 155 B. Serum osmolality less than 320 C. Hypertonic saline, mannitol D. Hyperventilation to maintain EtCO2 at 20-30 mmHg - Hyperventilation to maintain EtCO2 at 20-30 mmHg Routine hyperventilation is not longer recommended in the initial management of the patient with traumatic brain injury. The patient's EtCO2 should be maintained between 35-45 mmHg. Classic picture of neurogenic shock presents with... A. Hypertension B. Absence of tachycardia C. Cool skin D. Pallor - Absence of tachycardia Loss of sympathetic tone below the level of the injury results in loss of autoregulation, a decrease in vascular tone, and inability of the heart to increase its intrinisic rate. The classic picture of neurogenic shock presents with the absence of tachycardia. You are transporting a patient with a spinal cord injury above T6 level. His baseline vital signs prior to lift off: BP 160/80, HR 62, RR 20. During transport, the patient begins to complain of a throbbingheadache with nasal stuffiness. Your assessment reveals that the patient is becoming increasingly agitated. His skin color is flushed and profusely diaphoretic. Repeat vital signs are a BP 206/100, HR 52, RR 26. Your initial management of the patient would be... A. Insert a foley catheter B. Administer nitroglycerin to help reduce blood pressure C. Hang a Nipride drip if diastolic is greater than 130 mmHg D. Do nothing because increased HTN is expected with altitude and spinal cord injuries. - Insert a foley catheter Autonomic dysreflexia (AD), also known as "autonomic hyperreflexia or hyperreflexia," is a potentially life-threatening condition, which can be considered a medical emergency requiring immediate attention. AD occurs most often in spinal cord-injured individuals with spinal lesions above the T6 spinal cord level. Acute AD is a reaction of the autonomic (involuntary) nervous system to overstimulation. Your patient presents with motor loss, numbness to touch, vibration on the same side of the spinal injury, loss of pain, and temperature sensation on the opposite side. You suspect that the most likely spinal cord syndrome present is: A. Brown-Séquard B. Central cord C. Anterior cord syndrome D. Neurogenic shock - Brown-Séquard Any presentation of spinal injury that is an incomplete lesion can be called a partial Brown-Séquard or incomplete Brown-Séquard syndrome, so long as it has characterized by features of a motor loss and numbness to touch and vibration on the same side of the spinal injury and loss of pain and temperature sensation on the opposite side. Most often occurs from a penetrating injury that has damaged one side of the spinal cord.Blood supply to the anterior portion of the spinal cord is interrupted, causing a complete motor paralysis below the level of the lesion due to interruption of the corticospinal tract. Loss of pain and temperature sensation at and below the level of the lesion due to interruption of the spinothalamic tract. Retained proprioception and vibratory sensation due to intact dorsal columns. Most often occurs after hyperflexion injury - "Anterior cord" syndrome It is characterized by disproportionately greater motor impairment in upper compared to lower extremities and variable degree of sensory loss below the level of injury. Most often occurs after hyperextension injury. - "Central cord" syndrome Sinusoidal patterns are commonly associated with all of the following, EXCEPT: A. Fetal hypovolemia or anemia B. Accidental tap of the umbilical cord during amniocentesis C. Pregnancy-induced hypertension (PIH) D. Placental abruption - Pregnancy-induced hypertension A uniform sine wave pattern indicates fetal hypovolemia or anemia and may occur in cases of erythroblastosis fetalis, accidental tap of the umbilical cord during amniocentesis, fetomaternal transfusion, placental abruption, or another type of accident. Diving injuries - 1 ATM for every ??? feet descent - 1 ATM for every 33 feet descent You will be transporting a stable twenty-seven-year-old man with nontraumatic pneumocephalous secondary to gas producing necrotizing bacteria from rural hospital at 8,500 feet elevation to a local hospital at 1,200 feet sea level. What might be the best transport option? What gas law will most affect this patient negatively? A. Ground; Boyle's law B. Fixed wing transport pressurized to 9,000 AGL; Charles' law C. Rotor transport; Boyle's law D. Rotor transport; Charles' law - Ground; Boyle's lawPneumocephalus is the presence of air or gas within the cranial cavity. It is usually associated with disruption of the skull: after head and facial trauma, tumors of the skull base, after neurosurgery or otorhinolaryngology, and rarely, spontaneously. Pneumocephalus can occur in scuba diving, but is very rare in this context. Unpressurized aircraft is not recommended for this patient's condition. When performing a pericardiocentesis, the insertion site is... A. Below the subxyphoid process B. Just right of the subxyphoid process C. Just left of the subxyphoid process D. Above the subxyphoid process - Just left of the subxyphoid process The initial treatment of a patient with a suspected cardiac tamponade is a rapid intravenous fluid bolus. Pericardial blood will generally NOT CLOT because it has been defibrinated by heart motion. ABG reveals pH 7.41, pCO2 38, HCO3 22, pO2 56 of a 70-kg patient on a ventilator with the following settings: Vt 700, F 14, FIO2 0.5, I:E 1:2, PIP 46, Pplat 40, and PEEP 5. How will you manage this patient? A. Increase FIO2 B. Increase PEEP C. Decrease Vt D. All of the above - Increase FIO2 The pCO2 is 60 mmHg, indicating hypoxemia. Treatment includes increasing the FIO2. Increasing levels of PEEP in critically ill patients may also provide acceptable oxygenation and can reduce the FIO2 to nontoxic levels (FIO2 0.5). The level of PEEP must be balanced such that excessive intrathoracic pressure does not occur (preventing barotrauma/decreased venous return). When managing pO2 of 60, you would?A. Increase FIO2 and apply/or increase PEEP B. Increase Vt and apply/or increase PEEP C. Increase FIO2 D. Increase Vt - Increase FIO2 and apply/or increase PEEP You are transporting a seventy-five-year-old man with a diagnosis of inferior wall MI. During the flight you note V-Tach. Vital signs are: 70/palp, HR 150, RR 24, SpO2 94% on high flow oxygen with NRM at 15 L/min. He is awake and complains of chest pain and SOB. How will you manage this patient? A. Administer lidocaine and nitroglycerin B. Administer normal saline bolus C. Consider sedation and synchronize cardiovert at 100 joules D. Have the patient cough forcefully - Consider sedation and synchronize cardiovert at 100 joules. The patient you are transporting reveals the following ABG: pH 7.51, pCO2 28, HCO3 24, pO2 110. He is a 60-kg male patient with Vt 650, F14, FIO2 0.21, I:E 1:2, PIP 46, Pplat 42, and PEEP 0. What is your ABG interpretation, and how will you correct it? A. Respiratory acidosis; increase respiratory rate (F) B. Respiratory alkalosis; decrease Vt C. Metabolic alkalosis; increase FIO2 D. Respiratory alkalosis; increase PEEP - Respiratory alkalosis; decrease Vt The pCO2 is decreased and the pH is increased, indicating a respiratory alkalosis. The HCO3 is normal, indicating there is no compensation. Minute ventilation is... A. RR × weight in kgB. RR × SPO2 C. Vt × weight in kg D. Vt × RR - Vt × RR Tidal volume times the respiratory rate equal minute ventilation. Minute ventilation is defined as the total volume of air (gas) moved into and out of the lungs each minute. The formula is known as VE = Vt × f. VE signifies minute ventilation; Vt signifies tidal volume and f signifies respiratory rate. Alveolar minute volume is the amount of gas that reaches the alveoli for gas exchange in one minute. The formula is VAmin = (VT-VD) × Respiratory Rate. High-pressure alarms can be caused by all of the following, EXCEPT: A. Hypovolemia B. Connections C. Pneumothorax D. Obstructions - Hypovolemia Low-pressure alarms can be caused by all of the following, EXCEPT: A. Hypovolemia B. Leaks in ventilator tubing C. Pneumothorax D. Connections - Pneumothorax Pneumothorax can trigger high-pressure alarms when resistance to ventilation is too high. You are managing a four-year-old boy who is requiring intubation. The appropriate size ET tube for this patient would be...A. 3.5 B. 4.0 C. 4.5 D. 5.0 - 5.0 Using the formula 16 + age in years divided by 4 equals an ET tube size of 5.0. Vt is calculated at: A. 3-5 mL/kg B. 5-8 mL/kg C. 6-10 mL/kg D. 10-15 mL/kg - 5-8 mL/kg Vt (tidal volume) of 5-8 mL/kg is generally indicated, with the lowest values recommended in the presence of obstructive airway disease and ARDS. The goal is to adjust the TV so that plateau pressures are less than 35 cm H2O. The test most often used to diagnose a pulmonary embolism is: A. Chest x-ray B. V/Q lung scan C. 12-lead ECG D. ABG - V/Q lung scan A ventilation/perfusion lung scan, also known as a V/Q lung scan, is a type of medical imaging that is used to evaluate the circulation of air and blood within the lungs. The ventilation portion of the exam assesses the ability of air to reach all sections of the lungs, and the perfusion portion evaluates how well blood circulates within the lungs. The test is commonly done to evaluate for the presence of blood clots or abnormal blood flow inside the lungs, such as a pulmonary embolism (PE).Acute respiratory failure is defined as: A. pO2 60 mmHg and pCO2 50 B. pO2 80 mmHg and pCO2 60 C. pO2 60 mmHg and pCO2 30 D. pO2 90 mmHg and pCO2 50 - pO2 60 mmHg and pCO2 50 Acute respiratory failure (ARF) exists when breathing fails in its ability to maintain arterial blood gases within a normal range. By definition, ARF is present when the blood gases demonstrate a pO2 60 mmHg (hypoxic respiratory failure) and a pCO2 50 mmHg (ventilatory respiratory failure), which is usually accompanied by fall in the pH 7.3. What personal protective equipment (PPE) should be worn when transporting a patient with bacterial meningitis? A. Mask, gloves, gown, and eye protection B. Gloves only C. Mask and gloves D. Gloves and eye protection - Mask, gloves, gown, and eye protection The most common type of decompression sickness typically seen diving emergencies is: A. Musculoskeletal B. Pulmonary C. Arterial gas embolism D. Cutaneous - Pulmonary Decompression Sickness (DCS) Musculoskeletal decompression illness (Type I DCS), better known as the "bends," is the most common type of DCS, which may comprise limb or joint pain (shoulder and elbow pain most common), skin rash, pruritus, and joint swelling ("skin bends"). Type II DCS comprises more serious manifestations such asheadache, fatigue, visual disturbances, motor/sensory neurologic impairment/deficits, confusion, seizures, coma, and death Situations that involve a LEFT shift in the oxygen-hemoglobin dissociation curve are all of the following, EXCEPT: A. Alkalosis B. Hypocapnia C. Hypothermia D. Increased levels of 2,3-DPG - Increased levels of 2,3-DPG The oxyhemoglobin dissociation curve describes the relation between the partial pressure of oxygen and the oxygen saturation. The effectiveness of hemoglobin-oxygen binding can be affected by several factors. Situations that involve a RIGHT shift in the oxygen-hemoglobin dissociation curve are all of the following, EXCEPT: A. Alkalosis B. Hypercapnia C. Hyperthermia D. Increased level of 2,3-DPG - Alkalosis Alkalosis causes a left shift. A scaphoid abdomen, unequal breath sounds, dyspnea, and a shift in the PMI are a classic presentation of which of the following in the neonate patient? A. Tension pneumothorax B. Diaphragmatic hernia C. Aspiration pneumoniaD. RDS, formerly known as hyaline membrane disease - Diaphragmatic hernia Diaphragmatic hernia is caused early in gestation when the pleuroperitoneal cavity fails to close. Abdominal contents migrate into the thoracic cavity, compressing developing lungs and causing pulmonary hyoplasia. Because any distention of the bowel further compromises respiratory function, the transport team should insert a large-bore (10 Fr) orogastric tube and initiate suction. Positive-pressure ventilation with a face mask should be avoided. Hypoglycemia in the neonate can be treated with: A. D 25% 2-4 mL/kg B. D 10% 2-4 mL/kg C. D 10% 5-10 mL/kg D. D 5% 2-4 mg/kg - D-10% (2-4 mL/kg) A serum glucose of 40 mg/dL represents hypoglycemia in the newborn. The newborn weighing less than 1,000 g should receive 5% dextrose in water because of their intolerance of the higher glucose loads resulting in hyperglycemia. Hypoglycemia should be treated in the neonate presenting with readings o