BKAT Critical Care Review Test Updated 2023/2024 Correct Answers

BKAT Critical Care Review Normal Central Venous Pressure (CVP) range - ANSWER 2-8 mmHg Normal Pulmonary Artery Occlusion Pressure (PAOP) range - ANSWER 6-12 mmHg Normal Pulmonary Artery Systolic (PAS) range - ANSWER 20-30 mmHg Normal Pulmonary Artery Diastolic (PAD) range - ANSWER 5-15 mmHg Normal Pulmonary Artery Mean (PAM) - ANSWER 11-20 mmHg Normal Systemic Vascular Resistance (SVR) range - ANSWER 800-1200 mmHg Preload - ANSWER volume left in the left ventricle at the end of diastole What is preload affected by? - ANSWER venous return to the heart, atrial kick, total volume, and ventricular compliance What drugs can affect preload? - ANSWER Furosemide and nitroglycerin Afterload - ANSWER Amount of pressure heart has to overcome to pump blood out What drugs may affect afterload? - ANSWER Vasoconstricters and vasodilators Contractility - ANSWER the contractile force of the heart, how much will it take to move the preload out against the afterload What is the appropriate hold time after pulling an arterial line? - ANSWER 5-10 min What part of the heart does the PAOP affect? - ANSWER Left ventricle What part of the heart does the CVP affect? - ANSWER Right ventricle What does it mean when the PAOP is elevated? - ANSWER Increased left ventricular end diastolic pressure that could be indicative of left ventricular dysfunction or failure What does it mean if CVP is elevated? - ANSWER Fluid overload or decreased compliance (such as with ARDS and COPD) Difference between stable and unstable angina - ANSWER Stable angina: pain happens with certain activities but then goes away with rest. Unstable angina: chest pain can occur at rest, becomes more sever or frequent, or lasts longer ECG changes with an acute MI? - ANSWER ST elevation or depression ECG changes with hyperkalemia - ANSWER Peaked T waves What conditions may cause elevated cardiac enzymes? - ANSWER Trauma, acute MI, CABG, and pericarditis What is the goal of treatment with cariogenic shock? - ANSWER to increase cardiac output What are the effects of nitroprusside (Nipride) and dobutamine (Dobutrex) on preload, afterload, and contractility? - ANSWER They both increase cardiac output, heart rate, and contractility Special precautions of Nipride - ANSWER It can cause severe hypotension and cyanide toxicity Where to listen to assess with a murmur associated with aortic stenosis - ANSWER right upper sternal border What is the most important thing to watch for when administering tPa? - ANSWER mental status changes Anti-clotting medications - ANSWER Aspirin, clopidogrel (Plavix), ticagrelor (Brilinta), warfarin (Coumadin), heparin, apixaban (Eliquis), and enoxaparin (Lovenox) Heart rate controlling medications - ANSWER Beta blockers (-lol), calcium channel blockers (-ipine), Digoxin Heart rhythm controlling medications - ANSWER Na+ channel blockers (lidocaine) and K+ channel blockers (amiodarone) R on T phenomenon - ANSWER When pacing, a strong ventricular stimulus occurring on top of the T wave that can initiate a sustained ventricular tachyarrythmia Normal PR interval - ANSWER 0.12-0.20 seconds What can a long PR interval (>0.20 seconds) indicate? - ANSWER 1st degree heart block, hypokalemia, acute rheumatic fever, or carditis associated with Lyme disease Normal QRS complex - ANSWER 0.12 seconds or less What could a wide QRS complex (>0.12 seconds) indicate? - ANSWER Right or left BBB, pacemaker, hyperkalemia, or ventricular pre-excitation associated with Wolf-Parkinson-White pattern Normal QT interval - ANSWER Less than or equal to 0.04 seconds What could a long QT interval (>0.04 seconds) indicate? - ANSWER Antibiotic use or hyperkalemia What to watch out for with Dopamine administration in regards to skin - ANSWER Reflex erythema, central blanching, and piloerection Heparin antidote - ANSWER protamine sulfate Coumadin antidote - ANSWER Vitamin K Antidote for Coumadin - ANSWER Vitamin K ACLS drug and dose for symptomatic sinus bradycardia - ANSWER Atropine 0.5 mg repeated up to a total dose of 3 mg Signs and symptoms of digitalis toxicity - ANSWER Loss of appetite, nausea, vomiting, diarrhea, tachycardia, and vision changes including blind spots, blurred vision, seeing spots, and changes in how colors look Causes of low volume ventilator alarm - ANSWER Tube disconnection Causes of high pressure ventilator alarm - ANSWER Biting on ETT, coughing, mucus plug, bronchospasm, mucus or water in the tube, or kinked tubing How much is too much output in chest tube over one hour following surgery? - ANSWER >150 mL Appropriate pressure for suctioning is - ANSWER 120 mmHg Causes of decreased breath sounds - ANSWER Pneumonia, heart failure, pleural effusion, and increased chest wall thickness Nursing action to check for proper ETT placement - ANSWER Listen to bilateral breath sounds Most common reason for development of PE following trauma with multiple long bone fractures - ANSWER Fat emboli What is the most important nursing action in relation to cervical spine injury? - ANSWER Respiratory impairment is the most common complication of CSI, so need to protect airway, maintain adequate respirations, and keep spine straight Earliest sign of increased ICP - ANSWER Headache and vomiting Drug frequently used to decrease ICP - ANSWER Mannitol How many hours can lapse between onset of stroke symptoms and administration of tPA? - ANSWER Up to 4.5 hours Most important part of neurological assessment - ANSWER Evaluation of LOC Signs of diabetes insipidus in a post operative craniotomy patient - ANSWER Extreme thirst and urine output >1000 mL What anti-seizure medication should never be mixed with D5W and why? - ANSWER Dilantin because it causes crystallization Signs and symptoms of DKA - ANSWER Frequent urination, extreme thirst, elevated glucose, elevated urine ketones, nausea and/or vomiting, abdominal pain, confusion, and fruity-smelling breath Signs and symptoms of hypoglycemia - ANSWER Shakiness, dizziness, hunger, irritability, anxiety, and headache Treatment for DKA - ANSWER IV fluids and correction of potassium of </= 3.3 before insulin, administration of 0.1 unit/kg bolus of insulin, and insulin infusion at 0.1 units/kg/hr Peak action time of regular insulin - ANSWER 2-4 hours Peak action time of NPH insulin - ANSWER 8-14 hours What is cortisone? - ANSWER A synthetic form a cortisol for replacement of cortisol, a hormone produced in then adrenal gland Normal BUN ranges - ANSWER 7-20 Normal creatinine range - ANSWER 0.5-1.3 Normal potassium range - ANSWER 3.5-5 Normal urine specific gravity range - ANSWER 1.003-1.030 Adequate urine output level - ANSWER At least 0.5 mL/kg/hr Is medication that is excreted through the kidneys increased or decreased in dosage for patients in acute renal failure? - ANSWER Decreased Recommended renal diet - ANSWER Low Na+, low phosphorus, and low protein Sudden development of dyspnea and tachycardia in acute renal failure patients in most indicative of what? - ANSWER Fluid overload Low intermittent suction is used with OGT and NGT to do what? - ANSWER Decompress the stomach and prevent vomiting Best way to confirm OGT/NGT placement - ANSWER X-ray "Coffee ground" NGT aspirate may indicate what? - ANSWER Bleeding that has occurred in the recent past and become partially digested Signs and symptoms of blood transfusion reactions - ANSWER Back pain, dark urine, chills, fainting, dizziness, fever, flank pain, skin flushing, and shortness of breath Most important treatment in burn patients with 24 hours following airway securment - ANSWER IV fluid resuscitation Why should a hypothermic patient not be rapidly re-warmed? - ANSWER Rebound increased ICP True or false: A medical power of attorney gives the person the right to make all medical decisions for the patient while in critical care? - ANSWER False ACLS rhythms that amiodarone is used to treat - ANSWER V-fib and pulseless v-tach Amiodarone dosage for ACLS - ANSWER 300 mg Signs and symptoms of cyanide toxicity - ANSWER Mental status changes, tachycardia, seizure, a need for an increase in dose, and unexplained metabolic acidosis