PCU Exam (Q&A A+ Graded 100% Verified)

PCU Exam (Q&A A+ Graded 100% Verified) What are normal ABG values? ANS: pH: acidic 7.35-7.45 basic CO2: basic 35-45 acidic HCO3-: acidic 22-26 basic normal paO2 ANS: 80-100 mmHg what pH levels are lethal? ANS: outside 6.8-7.8 where are ABGs drawn from? what test is done to ensure adequate blood flow? ANS: peripheral artery; allen's test for radial artery How do the kidneys help maintain acid-base balance? ANS: retain/excrete basic HCO3 and retain/excrete acidic H+ treatments for respiratory acidosis ANS: -oxygen -intubation -bronchodilators -drug reversal agents -incentive spirometer -suction treatments for respiratory alkalosis ANS: -breathing into paper bag -anxiolytics -analgesics -reduce fever -reduce ventilation -return to normal altitude treatments for metabolic acidosis ANS: -IV sodium bicarbonate -manage blood sugar -antibiotics -reversal for OD -anti-diarrheal agents -dialysis -encourage respirations/ventilate treatments for metabolic alkalosis ANS: -antiemetics -stop suctioning -d/c drugs causing acid loss (diuretics, antacids) -hydrochloric acid (rare) what is systolic vs diastolic heart failure? ANS: systolic: type of L sided HF with reduced EF of 40%; impaired contraction diastolic: type of L sided HF with preserved EF 50%; impaired relaxation what 3 things occur in systolic HF? ANS: 1. SNS activation (increased HR, contractility, peripheral vasoconstriction) 2. RAAS activation (sodium + water retention, peripheral vasoconstriction) 3. LV dilation what are symptoms of right sided heart failure? ANS: swelling: swelling, weight gain, edema, large neck vein (JVD), lethargy, irregular HR, nocturia, girth, hepatic tenderness, anorexia, ascitis what are treatments for right sided heart failure? ANS: -sodium and fluid restriction to manage preload -moderate doses of diuretics -ACE, ARBs, beta blockers if due to L ventricular failure what are symptoms of left sided heart failure? ANS: drowning: dyspnea, rales/crackles, orthopnea, weakness, nocturnal dyspnea, increased HR, nagging cough, gaining weight, hypotension what are symptoms of systolic heart failure? ANS: s3, edema, weight gain, crackles, dyspnea, chest tightness, oliguria, JVD, weak pulses, cool pale skin, altered mental status diagnostic tests for heart failure ANS: -ECG -xray -ECHO -BNP (normal 100 75 & under, 450 75+) -cardiac biomarkers what are treatments for systolic HF? ANS: -ARNIs, ACE-Is, ARBs -beta blockers -aldosterone antagonists -diuretics -vasodilators -anticoagulation -physical activity -inotropic agents (w/ caution - can cause dysrhythmia) which medication for HF interrupts SNS to normalize HR, decrease afterload and contractility? ANS: beta blockers which medications for HF interrupts RAAS activation to block vasoconstriction and ADH? ANS: ace inhibitors (ACE-I), angiotension receptor blockers (ARBs), ARNI what 3 things occur in diastolic HF? ANS: 1. pulmonary congestion 2. pulmonary edema 3. decreased O2 sats what are treatments for diastolic HF & why? ANS: -beta blockers to slow HR -ACE-I & ARBs to manage preload + afterload -diuretics (use less than systolic HF, need to maintain adequate preload for filling) stages of kidney failure ANS: 1. creatinine 1.5-1.9, UO 0.5ml/kg/hr or 6-12 hrs 2. creatinine 2.0-2.9, UO 0.5ml/kg/hr for 12+ hrs 3. creatinine 4.0 OR 3x baseline, UO 0.3ml/kg/hr 24+ hours types of kidney dysfunction ANS: prerenal: BUN:Cr ratio 20:1 (BUN Cr) caused by hypotension, HF intrarenal: BUN:Cr ratio 10:1 direct hit to the kidneys by medications, contrast, diuretics, heavy metals, acute tubular necrosis postrenal: prostate cancer, kidney stones, BPH what lab values indicate liver failure? ANS: elevated ALT 5-40 & AST 7-56, alkaline phoshatase, serum ammonia, bilirubin decrease albumin, sodium, potassium elevated PT and INR STEMI vs NSTEMI vs UA ANS: STEMI - ST elevation, positive biomarkers, full occlusion NSTEMI - ST depression, partial occlusion, positive biomarkers UA - ST depression, normal biomarkers non-surgical treatment for STEMI & NSTEMI; surgical treatment for STEMI ANS: -aspirin -nitroglycerin, morphine -O2 -anticoagulation/heparin -P2Y12 inhibitor (plavix, brilinta) -angiomax (thrombin inhibitor) -glycoprotein receptor agonist -beta blocker, ACEI or ARB -fibrinolytic agents (STEMI ONLY) -emergent PCI (STEMI), elective PCI (UA/NSTEMI) -CABG when are fibrinolytic agents used? ANS: in the presence of STEMI, with symptom onset within 12 hours what is the preferred reperfusion strategy for STEMI? ANS: PCI (percutaneous coronary intervention) occlusion of the left main coronary artery (LMCA) results in what types of MI? ANS: anterior, septal, and lateral occlusion of the posterior descending artery results in what type of STEMI? ANS: posterior STEMI an anterior wall MI affects which leads and involves which vessel is involved? ANS: V3 & V4; LAD + diagonal LAD branch a septal wall MI affects which leads and involves which vessel is involved? ANS: V1 & V2; septal branch of LAD a lateral wall MI involves which vessel? ANS: left circumflex an inferior wall MI involves which vessel? ANS: RCA a posterior wall MI involves which vessel? ANS: posterior descending branch complications of MI ANS: pulmonary edema, RVMI, cardiogenic shock, reinfarction, dysrhythmias 4 types of PCIs ANS: 1. balloon angioplasty - balloon across lesion 2. stent placement - mesh over steonic area 3. atherectomy - removes plaque 4. laser angioplasty - lasers lesion hyperkalemia is defined as what? causes? effects? ANS: 5.5+, renal dysfunction, potassium sparing diuretics, rhabdomyolysis, RBC transfusion muscle weakness, hypoactive reflexes, numbness, n/v, peaked T waves, prolonged PR interval ECG changes in hyperkalemia ANS: peaked T wave wide QRS prolonged PR interval AV blocks, bradycardia, asystole treatment for hyperkalemia ANS: kayexelate insulin calcium to protect heart albuterol loop diuretics dialysis hypokalemia causes? effects? treatments? ANS: insulin, albuterol, NaHCO3-, fluid loss, malnutrition, alcoholism, loop diuretics muscle weakness, n/v, flat/inverted T wave, prolonged QT, U waves IV or oral potassium what are some ECG changes in hypokalemia? ANS: flat/inverted T wave, prolonged QT, U waves vtach/fib can occur what is the purpose of a chest tube? ANS: withdraw and drain fluid or air from the pleural space, or for lung re-expansion following pneumothorax, trauma, surgery 3 parts of a chest tube ANS: 1. drainage chamber - measure fluid accumulation 2. water seal chamber - one way valve for fluid to escape; bubbling indicates leak or air escape 3. suction control chamber - regulates negative pressure where on the chest tube should you check for leaks? ANS: water seal chamber how do you know the chest tube is working effectively? ANS: appropriate drainage, no leaks or kinks, return of breath sounds and lung expansion what do you do if there is a possible occlusion in the chest tube? ANS: milk the tube where is bubbling on the chest tube expected if connected to wall suction? ANS: suction control chamber antihypertensive of choice for CVA ANS: labetalol what are signs of a GI bleed? ANS: -bright red or coffee ground emesis -black tarry stools with or without blood clots -elevated BUN (not Cr) -dropping H&H -hyperactive BS+ what is the most common cause of a GI bleed? ANS: peptic ulcer disease + esophageal varices what are some acute interventions for GI bleed? 3 advanced interventions? ANS: -O2 or intubation -IV fluids -blood transfusion -NG tube -sclerotherapy -banding -balloon tamponade what is the threshold for blood transfusion? ANS: Hgb 7 signs/symptoms of stroke ANS: -intense headache -sudden weakness or numbness, esp unilateral -loss of vision -loss of speech or difficulty understanding -trouble walking, loss of balance or coordination what are symptoms more typical in hemorrhagic stroke? ANS: headache, IICP, decreased LOC, seizures R vs L sided stroke ANS: R - impulsive, left weakness/sensory loss, right gaze preference L - aphasia, right weakness/sensory loss, left gaze preference what are interventions for ischemic stroke? ANS: administer tPA, give fluids to induce HTN, O2 what are interventions for hemorrhagic stroke? ANS: anticipate intubation, manage BP, monitor ICP in ICU, surgical intervention, elevate HOB, mannitol what is the assessment tool for alcohol withdrawal? ANS: CIWA signs/sx of alcohol withdrawal ANS: agitation, anxiety, delirium, increased HR & BP, sweating, n/v, trauma, sweating, tremors, hallucinations, seizures treatments for alcohol withdrawal ANS: -O2, suction, intubate if needed -fluids -lorazepam/benzos, vitamins what is NIPPV used for? ANS: hypoxemia or hypercapnia in pts who are not candidates for intubation - can maintain spontaneous ventilation, hemodynamically stable, patent airway contraindications for NIPPV ANS: apnea, hemodynamically unstable, somnolence, aspiration/secretions, unable to protect airway, claustrophobia CPAP vs BiPAP ANS: CPAP: -blows constant pressure while you breathe in -blows the same pressure when you exhale BiPAP: -blows set pressure while you breathe in -blows lower pressure while you breathe in so it's easier to exhale what glucose level indicates DKA? what are other signs/sx? ANS: BG 250 positive ketones excessive thirst + urination blurry vision n/v fatigue low K+ from diuresis (first high K+ from acidosis) fruity breath hot flushed skin compensatory respirations (kussmaul) metabolic acidosis anion gap and pH in DKA ANS: 10; pH 3.5 treatment for DKA ANS: fluids insulin restore electrolytes correct acidosis is bicarb used to treat DKA? ANS: no, unless pH 6.9 should insulin be d/c'd if hypoglycemia occurs in DKA? ANS: no, anion gap must be closed. add dextrose what type of medication is digoxin? ANS: pos