PCU Exam 2024 Questions and Answers

PCU Exam 2024 Questions and Answers What are normal ABG values? - ph: acidic 7.35-7.45 basic CO2: basic 35-45 acidic HCO3-: acidic 22-26 basic Normal pao2 - 80-100 mmhg What ph levels are lethal? - outside 6.8-7.8 Where are abgs drawn from? What test is done to ensure adequate blood flow? - peripheral artery; allen's test for radial artery How do the kidneys help maintain acid-base balance? - retain/excrete basic HCO3 and retain/excrete acidic H+ Treatments for respiratory acidosis - -oxygen -intubation -bronchodilators -drug reversal agents -incentive spirometer -suction Treatments for respiratory alkalosis - -breathing into paper bag -anxiolytics -analgesics -reduce fever -reduce ventilation -return to normal altitude Treatments for metabolic acidosis - -IV sodium bicarbonate -manage blood sugar -antibiotics -reversal for OD -anti-diarrheal agents -dialysis -encourage respirations/ventilate Treatments for metabolic alkalosis - -antiemetics -stop suctioning -d/c drugs causing acid loss (diuretics, antacids) -hydrochloric acid (rare) What is systolic vs diastolic heart failure? - 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? - 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? - 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? - -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? - drowning: dyspnea, rales/crackles, orthopnea, weakness, nocturnal dyspnea, increased HR, nagging cough, gaining weight, hypotension What are symptoms of systolic heart failure? - s3, edema, weight gain, crackles, dyspnea, chest tightness, oliguria, JVD, weak pulses, cool pale skin, altered mental status Diagnostic tests for heart failure - -ECG -xray -ECHO -BNP (normal < 100 75 & under, < 450 75+) -cardiac biomarkers What are treatments for systolic HF? - -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? - beta blockers Which medications for HF interrupts RAAS activation to block vasoconstriction and ADH? - ace inhibitors (ACE-I), angiotension receptor blockers (arbs), ARNI What 3 things occur in diastolic HF? - 1. Pulmonary congestion 2. Pulmonary edema 3. Decreased O2 sats What are treatments for diastolic HF & why? - -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 - 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