AIR CRITICAL CARE FINAL EXAM

AIR CRITICAL CARE FINAL EXAM A new area of hyperresonance is noted during chest wall percussion of a patient who is receiving continuous mechanical ventilation. The most likely cause for this finding is: - CORRECT ANSWER-Pneumothorax What lab test can be used as a screening tool for CHF? - CORRECT ANSWER-Brain Natriuretic Peptide (BNP) Which of the following represents the characteristics of Sinus Tachycardia: I. Atrial rate of 250-350/minute II. no identifiable P waves, erratic, wavy baseline III.regular ventricular rhythm at a rate of 100-160 beats/min IV. QRS duration of <.12 seconds - CORRECT ANSWER-III & IV A chest tube to drain a hemothorax should be placed in the: - CORRECT ANSWER-5th intercostal space, midaxillary line which of the following include factors that may cause obstruction of an artificial airway? I. foreign objects such as dentures II. mucus plugging III. rapid mobilization of secretions from the lung IV. vocal cord paralysis - CORRECT ANSWER-II & III Bobby is a 22yo male who was involved in a MVA. He suffered spinal cord damage at C2-3. What would you expect to find during your assessment of Bobby's breathing? - CORRECT ANSWER-unable to breathe on his own, supported by mechanical ventilation The highest percentage of water in the body is found in which fluid compartment? - CORRECT ANSWER-Intracellular Which of the following indicates adequate tissue perfusion in the critically ill patient? I. warm extremities II. capillary refill time of 6 seconds III. urinary output of 40 mL/hr - CORRECT ANSWER-I & II A 40yo male was involved in a serious MVA and taken to the nearest hospital emergency department. The paramedics report that the man was not wearing his seat belt at the time of the collision. Upon physical exam, he was noted to have pain and tenderness to the chest. What would you expect to find in this patient? - CORRECT ANSWER-paradoxical chest wall movement What rhythm has the potential of changing into a lethal rhythm? - CORRECT ANSWERventricular escape rhythm Hypokalemia (low potassium levels) may be caused from which of the following? I. diuretic therapy II. corticosteroids III. renin-angiotensin IV. aldosterone - CORRECT ANSWER-I & II Which of the following is true regarding physical assessment findings with pneumothorax? I. common symptoms include dyspnea and chest pain II. it results in an increased resonance to percussion III. it will decrease vital capacity IV. tactile fremitus will be increased - CORRECT ANSWER-I, II, & III T/F: A falling arterial blood pressure is an early sign of decreased cardiac output. - CORRECT ANSWER-False If drainage from a mediastinal chest tube suddenly decreases, the patient may rapidly develop: - CORRECT ANSWER-cardiac tamponade Bradycardia is related to what? - CORRECT ANSWER-vagal nerve stimulation Following thoracic surgery, patients experience pain and stress. If pain is not treated, which of the following will occur? I. decrease in clotting time II. increased oxygen consumption III. decreased oxygen delivery to the tissues IV. increased vital capacity - CORRECT ANSWER-II & III What is associated with increased rate and depth of ventilation? - CORRECT ANSWER-hypoxemia Why is the electrical impulse temporarity delayed at the atrioventricular (AV) node? To allow: - CORRECT ANSWER-better filling of the ventricles What is the ventricular heart rate when the AV node paces the heart? - CORRECT ANSWER-40-60 beats/min What is represented by the P wave on the ECG tracing? - CORRECT ANSWERdepolarization of the atria What does the QRS complex represent? - CORRECT ANSWER-depolarization of the ventricles What is the normal range for the PR interval? - CORRECT ANSWER-0.12-0.2 seconds The normal QRS complex does not exceed what time on the horizontal axis? - CORRECT ANSWER-0.12 seconds What does the T wave on the ECG represent? - CORRECT ANSWER-ventricular repolarization If the ventricles become the dominant pacemaker of the hear, the ventricular rate would be ____ beats per minute. - CORRECT ANSWER-20-40 A patient with HIV has a PPD skin test to evaluate for possible TB. An induration of what size would be considered positive for this patient? - CORRECT ANSWER-</=5 mm In order to help you interpret your patient's acid base status, you scan the patient's chart to find the following electrolyte values reported on this morning's AM lab. Na+ 140 mEq/L; Cl- 117 mEq/L; HCO3- 12mEq/L; what is the anion gap? - CORRECT ANSWER-11 mEq/L A 32 yo female with moderate persistent asthma was prescribed inhaled corticosteroids one month ago to control her asthma. In order to assess if this treatment is being effective in controlling airway inflammation, what test should be performed? - CORRECT ANSWER-Exhaled nitric oxide (eNO) Oncotic pressure can be described as: - CORRECT ANSWER-water magnet that holds fluid in the vascular system What findings may suggest that a patient is malnourished? - CORRECT ANSWERweak cough What clinical scenario is associated with a mixed acid-base disturbance of respiratory and metabolic acidosis? - CORRECT ANSWER-CPR A patient is enrolled in a pulmonary rehab program which includes smoking cessation. On the patient's first visit, a physical assessment and lab tests are performed. The patient's carboxyhemoglobin (COHb) is 8%. This indicates: - CORRECT ANSWER-the patient is still smoking What type of blood cell is useful against allergic reactions and defends against parasitic infestations? - CORRECT ANSWER-eosinophils Elevation of the blood urea nitrogen (BUN) and creatinine levels in the blood suggests what type of problem? - CORRECT ANSWER-renal failure In regards to nutrition, it is best for the COPD patient to AVOID which of the following in order to avoid a possible increase in CO2 production? - CORRECT ANSWERcarbohydrates Which of the folling would be considered a normal anion gap? A) 11mEq/L B) 18mEq/L C) 23mEq/L D) 34mEq/L - CORRECT ANSWER-A) 11mEq/L Aldosterone secretion causes more sodium to be excreted in the urine. T/F - CORRECT ANSWER-False The extracellular fluid compartment is composed of plasma and interstitial fluid.T/F - CORRECT ANSWER-True Neutropenia may be caused by which of the following? I. chemotherapy to treat cancere II. decreased bone marrow production III. HIV IV. stress - CORRECT ANSWER-I, II, & III You are providing respiratory care to a patient well known to you who has Cystic Fibrosis. A sputum specimen has been sent to the lab, but results of the culture are not available yet. The results of the CBC show leukocytosis, with an increase above normal in the number of neutrophils. This means the patient most likely has a: - CORRECT ANSWER-bacterial infection A 45 yo homeless patient is admitted to the hospital with signs and symptoms of pneumonia. The patient appears cachetic, and lab results indicate a protein level that is below normal. This patient's malnourished condition, may cause which of the following? I. depressed immune functions II. increase in CO2 production III. surfactant deficiency IV. increase in interstitial fluid - CORRECT ANSWER-I, III, and IV Interpret the following ABG. pH 7.55 PaCO2 30 - CORRECT ANSWER-mixed metabolic alkalosis and respiratory alkalosis The highest percentage of water in the body is found in which fluid compartment? - CORRECT ANSWER-intracellular Describe the significance of an increase in the number of circulating bands: - CORRECT ANSWER-the bone marrow is releasing more neutrophils to fight infection what enzyme is associated with cardiac muscle damage? - CORRECT ANSWERTroponin I What establishes the capillary oncotic pressure? Presence of - CORRECT ANSWERproteins such as albumin, in the plasma Metabolic alkalosis may result from which of the following: I. vomiting II. diuretic therapy III. ingestion of certain poisons IV. administration of corticosteroids - CORRECT ANSWER-I, II, and IV Another term for blood platelets is: - CORRECT ANSWER-thrombocyte Which of the following is NOT a type of White blood cell? A) erythrocyte B) eosinophil C) monocyte D) lymphocyte - CORRECT ANSWER-erythrocyte Lukemia, a disease of the bone marrow, is a common cause of: - CORRECT ANSWERleukopenia A bacterial infection is often suspected when a patient has an elevated ______ count. - CORRECT ANSWER-neutrophil Immature neutrophils are referred to as _____. - CORRECT ANSWER-bands Polycythemia is an elevation in the number of ______. - CORRECT ANSWER-red blood cells A low sodium (Na+) level is known as ______. - CORRECT ANSWER-hyponatremia Patients with an elevated sweat chloride level should be evaluated for _______. - CORRECT ANSWER-cystic fibrosis An abnormally low level of serum glucose is consistent with a diagnosis of ______. - CORRECT ANSWER-malnutrition Tho tests most commonly performed to evaluate kidney function are _______. - CORRECT ANSWER-BUN and Creatinine T/F: In a healthy adult male, the hematocrit (Hct) is about 48%. - CORRECT ANSWERTrue