ATI CRITICAL CARE EXAM FINALS()QUESTIONS AND ANSWERS

ATI CRITICAL CARE EXAM FINALS()QUESTIONS AND ANSWERS Before PFT's how long should a patient refrain from smoking? Using an inhaler? - CORRECT ANSWERE-smoking: 6-8 h inhaler: 4-6 h What test must you do before performing an arterial puncture? - CORRECT ANSWERE-Allen's test; patency of the ulnar artery- if blood returns to hand in 15s, then the radial artery can be used for the puncture How long should one apply pressure after an arterial puncture? - CORRECT ANSWERE-5 minutes (20 min if the patient is on anticoagulant therapy) What are the normal ranges for ABG's? (pH, PAO2, PACO2, HCO3, and SAO2) - CORRECT ANSWERE-pH: 7.35-7.45 PAO2: 80-100 mm Hg PACO2: 35-45 mm Hg HCO3: 21-28 mEq/L SAO2: 95-100% In what position should you place a patient if air embolism is expected? - CORRECT ANSWERE-left side in trendelenburg How long must a patient be NPO before a bronchoscopy? - CORRECT ANSWERE-4-8 hr What types of medications might one administer prior to a bronchoscopy? - CORRECT ANSWERE-anxiolytics atropine (to treat bradycardia) viscous lidocaine local anesthetic throat spray What should you be monitoring a patient for after a bronchoscopy? - CORRECT ANSWERE-significant fever (mild is ok up to 24 hrs after the procedure), productive cough, significant blood in sputum (small amounts are to be expected), hypoxemia, laryngspasm Prior to a thoracentesis what diagnostic procedure must be done? - CORRECT ANSWERE-CXR What position should the patient be in for a thoracentesis? - CORRECT ANSWEREsitting up over the bedside table What are possible complications of a thoracentesis? How do we tell patients to identify pneumothorax? - CORRECT ANSWERE-mediastinal shifts pneumothorax (deviated trachea, pain at the end of inhalation or exhalation, affected side not moving with breath, increased HR, shallow respirations, nagging cough, air hunger) In what chest tube chamber (ONLY) should you see bubbling? - CORRECT ANSWERE-suction What is excessive drainage from a chest tube? - CORRECT ANSWERE-more than 70 ml/hr How should the nurse document for care following a chest tube? How often? - CORRECT ANSWERE-color and amount of drainage qh for 24h after insertion, then q8h mark date, hour, and drainage level on the container at the end of each shift What supplies should be kept at the side of a bed for a patient with a chest tube? - CORRECT ANSWERE-2 enclosed hemostats, sterile water, occlusive dressing What should the nurse instruct the patient to do during chest tube removal? - CORRECT ANSWERE-valsalva maneuver What should the nurse do in the case that a chest tube is disconnected? - CORRECT ANSWERE-1. have the client exhale as much as they can to remove air from the pleural space 2. immerse the end of the chest tube in sterile water to restore the water seal 3. apply dry sterile gauze What is the FiO2 and the flow rate for a nasal cannula? at what rate do we need to administer humidification? - CORRECT ANSWERE-24-44% 1-6 L/min humidification at 4 L/min What is the FiO2 and the flow rate for a simple face mask? - CORRECT ANSWERE-40- 60% 5-8 L/min (less than this causes the patient to rebreathe CO2) What is the FiO2 and the flow rate for a partial rebreather mask? - CORRECT ANSWERE-40-75% 6-11 L/min What is the FiO2 and the flow rate for a non-rebreather? - CORRECT ANSWERE-80- 95% 10-15 L/min What is the FiO2 and the flow rate for a venturi mask? - CORRECT ANSWERE-24-50% 4-10 L/min What is the FiO2 and the flow rate for a aerosol face mask, face tent, t-piece, and trach collar? - CORRECT ANSWERE-24-100% 10 L/min at least *** Humidification requires frequent monitoring What does hypercarbia look like? - CORRECT ANSWERE-restlessness, hypertension, HA What does oxygen toxicity look like? - CORRECT ANSWERE-non-productive cough, substernal pain, nasal stuffiness, n/v, fatigue, HA, sore throat, hypoventillation How does assist control (AC) work related to respiratory support? - CORRECT ANSWERE-overtakes breathing for an intubated client How does synchronized intermittent mandatory ventilation (SIMV) work related to respiratory support? - CORRECT ANSWERE-used in weaning; increases the work of breathing ventilator and patient work together How does assist inverse ratio ventillation (IVR) work related to respiratory support? - CORRECT ANSWERE-prolongs the inspiration phase to maximize oxygenation HIGH RISK FOR VOLUTRAUMA How does airway pressure release ventilation (APRV) work related to respiratory support? - CORRECT ANSWERE-patient and ventilator work together breath expelled by the lung's own natural recoil How does independent lung ventilation work related to respiratory support? - CORRECT ANSWERE-lungs are ventilated separately need: 2 ventilators, sedation, neuromuscular blocking agents How does PEEP work related to respiratory support? - CORRECT ANSWERE-preset pressure on expiration added to treat persistent hypoxemia How does pressure support ventilation (PSV) work r/t respiratory support? - CORRECT ANSWERE-greater oxygenation, makes the work of breathing easier, prevents alveolar collapse How do you document the placement of a tube for mechanical ventilation? - CORRECT ANSWERE-in cm at the client's teeth or lips What do the three ventilator alarms indicate? (volume, pressure, and apnea alarms) - CORRECT ANSWERE-volume (low pressure): low exhaled volume due to a disconnection, cuff leak, or tube displacement pressure (high pressure): excess secretions, client biting the tube, kinks in the tubing, coughing, pulmonary edema, bronchospasm, and pneumothorax apnea: ventilator does not detect spontaneous respiration in a set time period For an ET tube what should the cuff be set at? how often should you adjust the cuff pressure? - CORRECT ANSWERE-20 mm Hg q 8 h How long should you recommend that clients take decongestants? - CORRECT ANSWERE-no longer than 3-4d (rebound decongestion) ex: phenylephrine T/F: Intranasal glucocorticoid sprays should be used right at the onset of the symptoms of rhinitis. - CORRECT ANSWERE-F; they can prevent seasonal rhinitis What is the earliest age you can receive a flu vaccine? - CORRECT ANSWERE-6 m What drug should be administered for rapid resolution of bronchospasms? - CORRECT ANSWERE-short-acting beta 2 antagonists such as albuterol What is the biggest risk for a patient taking methylzanthines such as theophylline for pneumonia? (this medication works as a bronchodilator) - CORRECT ANSWEREtoxicity; very narrow therapeutic range; tell the patient that their blood levels must be checked and assess for tachycardia, nausea, and diarrhea What are anticholinergic medications (such as ipratropium) used for in relation to asthma? what special considerations should we take with these meds? - CORRECT ANSWERE-long acting to PREVENT bronchospasm by allowing the sympathetic nervous system to promote bronchodilation; watch for Ach effects (cant seee, cant pee, dry mouth) Are long acting b2 antagonists such as salmeterol used for prevention of asthma or used in the acute phase? - CORRECT ANSWERE-bronchodilator used to prevent. DONT USE IN THE ACUTE PHASE What anti-inflammatory medications are used for patient with asthma as maintenance drugs? - CORRECT ANSWERE-1. corticosteroids- fluticasone, prednisone (take with food) 2. leukotriene antagonists such as montelukast 3. mast cell stabilizers such as cromolyn 4. monoclonal antibodies- omalizumab (mmlc--- MILK) If ordered at the same time, which medication will you give first? 1. salmetrol and fluticasone 2. ipratropium and albuterol - CORRECT ANSWERE-1. salmetrol before fluticasone 2. albuterol before ipratropium ALWAYS GIVE THE BRONCHODILATOR FIRST TO INCREASE THE ABSORPTION OF THE ANTI-INFLAMMATORY AGENT What is the forced expiratory volume- forced vital capacity (FEV-FVC) ratio for a patient with COPD? - CORRECT ANSWERE-in a normal person is 100%, in COPD is 70%, in VERY SEVERE COPD is 50% What is the typical oxygen order for a patient with COPD? - CORRECT ANSWERE-2-4 L/min nasal cannula; up to 40% via venturi mask What is the recommended daily exercise for a patient with COPD? - CORRECT ANSWERE-20 mins 2-3 days a week What is a positive expiratory pressure device used for? - CORRECT ANSWERE-used in COPD; patient breathes through it and during exhalation a ball within the apparatus rattles to break up mucus How long after exposure will TB show up on an intradermal test? - CORRECT ANSWERE-2-10 wk How long does it take to get results from a quantiferon tb gold test? - CORRECT ANSWERE-24 h When should a mantoux test be read for TB? what indicates a positive test? - CORRECT ANSWERE-48-72 hours 10 mm induration; 5 mm in immunocompromised How long are TB meds supposed to be taken for? What are the typical ones? - CORRECT ANSWERE-6-12 mo isoniazid rifampin pyrazinamide ethambutol (streptomycin sulfate only for extremely resistant strains) Isoniazid (INH) is a TB drug, antibacterial. What are special considerations and education points? - CORRECT ANSWERE-Teaching: take on empty stomach, take vitamin B6 to prevent neurotoxicity, monitor for hepatotoxicity (anorexia, fatigue, nausea, jaundice), dont drink alcohol due to hepatootoxicity