2024 ATI CRITICAL CARE EXAM QUESTIONS AND CORRECT ANSWERS GRADED A+. 1. Before PFT's how long should a patient refrain from smoking? Using an inhaler?: smoking: 6-8 h inhaler: 4-6 h 2. What test must you do before performing an arterial puncture?: 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 3. How long should one apply pressure after an arterial puncture?: 5 minutes (20 min if the patient is on anticoagulant therapy) 4. What are the normal ranges for ABG's? (pH, PAO2, PACO2, HCO3, and SAO2): pH: 7.35-7.45 PAO2: 80-100 mm Hg PACO2: 35 -45 mm Hg HCO3: 21-
28 mEq/L SAO2: 95-100% 5. In what position should you place a patient if air embolism is expected?: left side in trendelenburg 6. How long must a patient be NPO before a bronchoscopy?: 4-8 hr 7. What types of medications might one administer prior to a bronchoscopy? - : anxiolytics atropine (to treat bradycardia) viscous lidocaine local anesthetic throat spray 8. What should you be monitoring a patient for after a bronchoscopy?: signifi - cant 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 9. Prior to a thoracentesis what diagnostic procedure must be done?: CXR 10. What position should the patient be in for a thoracentesis?: sitting up over the bedside table 11. What are possible complications of a thoracentesis? How do we tell pa- tients to identify pneumothorax?: 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) 12. In what chest tube chamber (ONLY) should you see bubbling?: suction 13. What is excessive drainage from a chest tube?: more than 70 ml/hr 14. How should the nurse document for care following a chest tube? How often?: 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 15. What supplies should be kept at the side of a bed for a patient with a chest tube?: 2 enclosed hemostats, sterile water, occlusive dressing 16. What should the nurse instruct the patient to do during chest tube re- moval?: valsalva maneuver 17. What should the nurse do in the case that a chest tube is disconnected?: 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 18. What is the FiO2 and the flow rate for a nasal cannula? at what rate do we need to administer humidification?: 24-44% 1-6 L/min humidification at 4 L/min 19. What is the FiO2 and the flow rate for a simple face mask?: 40-60% 5-8 L/min (less than this causes the patient to rebreathe CO2) 20. What is the FiO2 and the flow rate for a partial rebreather mask?: 40-75% 6-11 L/min 21. What is the FiO2 and the flow rate for a non-rebreather?: 80-95% 10-15 L/min 22. What is the FiO2 and the flow rate for a venturi mask?: 24-50% 4-10 L/min 23. What is the FiO2 and the flow rate for a aerosol face mask, face tent, t-piece, and trach collar?: 24-100% 10 L/min at least *** Humidification requires frequent monitoring 24. What does hypercarbia look like?: restlessness, hypertension, HA 25. What does oxygen toxicity look like?: non-productive cough, substernal pain, nasal stuffiness, n/v, fatigue, HA, sore throat, hypoventillation 26. How does assist control (AC) work related to respiratory support?: over- takes breathing for an intubated client 27. How does synchronized intermittent mandatory ventilation (SIMV) work related to respiratory support?: used in weaning; increases the work of breathing ventilator and patient work together 28. How does assist inverse ratio ventillation (IVR) work related to respiratory support?: prolongs the inspiration phase to maximize oxygenation HIGH RISK FOR VOLUTRAUMA 29. How does airway pressure release ventilation (APRV) work related to respiratory support?: patient and ventilator work t ogether breath expelled by the lung's own natural recoil 30. How does independent lung ventilation work related to respiratory sup- port?: lungs are ventilated separately need: 2 ventilators, sedation, neuromuscular blocking agents 31. How does PEEP work related to respiratory support?: preset pressure on expiration added to treat persistent hypoxemia 32. How does pressure support ventilation (PSV) work r/t respiratory sup - port?: greater oxygenation, makes the work of breathing easier, prevents alveolar collapse 33. How do you document the placement of a tube for mechanical ventilation? - : in cm at the client's teeth or lips 34. What do the three ventilator alarms indicate? (volume, pressure, and apnea alarms): 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 35. For an ET tube what should the cuff be set at? how often should you adjust the cuff pressure?: 20 mm Hg q 8 h 36. How long should you recommend that clients take decongestants?: no longer than 3 -4d (rebound decongestion) ex: phenylephrine 37. T/F: Intranasal glucocorticoid sprays should be used right at the onset of the symptoms of rhinitis.: F; they can prevent seasonal rhinitis 38. What is the earliest age you can receive a flu vaccine?: 6 m 39. What drug should be administered for rapid resolution of bron - chospasms?: short -acting beta 2 antagonists such as albuterol 40. What is the biggest risk for a patient taking methylzanthines such as theo- phylline for pneumonia? (this medication works as a bronchodilator): toxicity; very narrow therapeutic range; tell the patient that their blood levels must be checked and assess for tachycardia, nausea, and diarrhea 41. What are anticholinergic medications (such as ipratropium) used for in relation to asthma? what special considerations should we take with these meds?: long acting to PREVENT bronchospasm by allowing the sympathetic ner - vous system to promote bronchodilation; watch for Ach effects (cant seee, cant pee, dry mouth)
28 mEq/L SAO2: 95-100% 5. In what position should you place a patient if air embolism is expected?: left side in trendelenburg 6. How long must a patient be NPO before a bronchoscopy?: 4-8 hr 7. What types of medications might one administer prior to a bronchoscopy? - : anxiolytics atropine (to treat bradycardia) viscous lidocaine local anesthetic throat spray 8. What should you be monitoring a patient for after a bronchoscopy?: signifi - cant 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 9. Prior to a thoracentesis what diagnostic procedure must be done?: CXR 10. What position should the patient be in for a thoracentesis?: sitting up over the bedside table 11. What are possible complications of a thoracentesis? How do we tell pa- tients to identify pneumothorax?: 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) 12. In what chest tube chamber (ONLY) should you see bubbling?: suction 13. What is excessive drainage from a chest tube?: more than 70 ml/hr 14. How should the nurse document for care following a chest tube? How often?: 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 15. What supplies should be kept at the side of a bed for a patient with a chest tube?: 2 enclosed hemostats, sterile water, occlusive dressing 16. What should the nurse instruct the patient to do during chest tube re- moval?: valsalva maneuver 17. What should the nurse do in the case that a chest tube is disconnected?: 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 18. What is the FiO2 and the flow rate for a nasal cannula? at what rate do we need to administer humidification?: 24-44% 1-6 L/min humidification at 4 L/min 19. What is the FiO2 and the flow rate for a simple face mask?: 40-60% 5-8 L/min (less than this causes the patient to rebreathe CO2) 20. What is the FiO2 and the flow rate for a partial rebreather mask?: 40-75% 6-11 L/min 21. What is the FiO2 and the flow rate for a non-rebreather?: 80-95% 10-15 L/min 22. What is the FiO2 and the flow rate for a venturi mask?: 24-50% 4-10 L/min 23. What is the FiO2 and the flow rate for a aerosol face mask, face tent, t-piece, and trach collar?: 24-100% 10 L/min at least *** Humidification requires frequent monitoring 24. What does hypercarbia look like?: restlessness, hypertension, HA 25. What does oxygen toxicity look like?: non-productive cough, substernal pain, nasal stuffiness, n/v, fatigue, HA, sore throat, hypoventillation 26. How does assist control (AC) work related to respiratory support?: over- takes breathing for an intubated client 27. How does synchronized intermittent mandatory ventilation (SIMV) work related to respiratory support?: used in weaning; increases the work of breathing ventilator and patient work together 28. How does assist inverse ratio ventillation (IVR) work related to respiratory support?: prolongs the inspiration phase to maximize oxygenation HIGH RISK FOR VOLUTRAUMA 29. How does airway pressure release ventilation (APRV) work related to respiratory support?: patient and ventilator work t ogether breath expelled by the lung's own natural recoil 30. How does independent lung ventilation work related to respiratory sup- port?: lungs are ventilated separately need: 2 ventilators, sedation, neuromuscular blocking agents 31. How does PEEP work related to respiratory support?: preset pressure on expiration added to treat persistent hypoxemia 32. How does pressure support ventilation (PSV) work r/t respiratory sup - port?: greater oxygenation, makes the work of breathing easier, prevents alveolar collapse 33. How do you document the placement of a tube for mechanical ventilation? - : in cm at the client's teeth or lips 34. What do the three ventilator alarms indicate? (volume, pressure, and apnea alarms): 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 35. For an ET tube what should the cuff be set at? how often should you adjust the cuff pressure?: 20 mm Hg q 8 h 36. How long should you recommend that clients take decongestants?: no longer than 3 -4d (rebound decongestion) ex: phenylephrine 37. T/F: Intranasal glucocorticoid sprays should be used right at the onset of the symptoms of rhinitis.: F; they can prevent seasonal rhinitis 38. What is the earliest age you can receive a flu vaccine?: 6 m 39. What drug should be administered for rapid resolution of bron - chospasms?: short -acting beta 2 antagonists such as albuterol 40. What is the biggest risk for a patient taking methylzanthines such as theo- phylline for pneumonia? (this medication works as a bronchodilator): toxicity; very narrow therapeutic range; tell the patient that their blood levels must be checked and assess for tachycardia, nausea, and diarrhea 41. What are anticholinergic medications (such as ipratropium) used for in relation to asthma? what special considerations should we take with these meds?: long acting to PREVENT bronchospasm by allowing the sympathetic ner - vous system to promote bronchodilation; watch for Ach effects (cant seee, cant pee, dry mouth)
