NBRC Exam Latest Update

NBRC Exam Latest Update Normal Urine Output - ANSWER 40mL/hr (approximatley 1 Liter a day) Intake exceeds output - ANSWER -weight gain -electrolyte imbalance -increased hemodynamic pressures -decreased lung compliance Central Venous Pressure (CVP) - ANSWER can indicate changes in fluid balance Normal CVP - ANSWER 2-6mmHg or 4-12cmH20 -decreased CVP can indicate hypovalemia (fluid therapy) -increased CVP can indicate hypervalemia (diuretics) Stuporous, confused , sleepy - ANSWER consider sleep apnea or excessive O2 therapy (COPD patient) Semicomatose - ANSWER responds only to painful stimuli Obtunded - ANSWER drowsy state, may have decreased cough or gag reflux (protect airway) Coma - ANSWER does not respond to painful stimuli Electrolyte Imbalance Traits - ANSWER anger, combative, irritable Drug Overdose Traits - ANSWER Euphoria-intense feelings of emotions (joy) Panic Traits - ANSWER severe hypoxemia, tension pnemothorax, status asthmaticus, or possibly AAA (abdominal aortic anerysm) Activites of Daily Living (ADL) Scoring - ANSWER Katz Scoring System 0-dependent 6-independent Orthopnea - ANSWER difficulty breathing except in the upright position (CHF) Genreal malaise - ANSWER run down feeling, nausea, weakness, fatique, headache (consider electrolyte imbalance) COPD diet - ANSWER high fats, low carbs (carbs causes higher CO2) Edema - ANSWER caused by CHF and renal failure occurs primarily in arms and ankles Ascites - ANSWER accumulation of fluid in the abdomen generally caused by liver failure Clubbing of fingers - ANSWER caused by chronic hypoxemia presence of clubbing suggests pulmonary disease Venous distension or Jugular venous distension (JVD) - ANSWER occurs with CHF seen during exhalation in patients with obstructive lung disease Capillary refill - ANSWER indication of peripheral circulation color should return within 3 seconds Diaphoresis - ANSWER heart failure (recommend diuretics, positive inotropic agents) fever, infection (recommend antibiotics) anxiety, nervousness (recommend sedatives) tuberculosis/night sweats (recommend antitubercular drugs) Cheyne-Stokes Breathing - ANSWER gradually increasing then decreasing rate and depth in a cycle lasting from 30- 180 seconds, with periods of apnea lasting up to 60 seconds Cause: Increased intracranial pressure, brainstem inury, drug overdose Biot's Breathing - ANSWER increased respiratory rate and depth with irregular periods of apnea. Each breath has the same depth Cause: CNS problem Kussmaul's breathing - ANSWER increased respiratory rate (usually over 20 breaths/min), increased depth, irregular rhythm, breathing sounds labored Cause: metabolic acidosis, renal failure, diabetic ketoacidosis Dry or nonproductive cough may indicate - ANSWER a tumor in the lungs Productive cough may indicate - ANSWER an infection or chronic lung disease Tachycardia indications - ANSWER hypoxemia, anxiety, stress (recommend oxygen therapy) Bradycardia indications - ANSWER heart failure, shock, code/emergency (recommend atropine) Paradoxical pulse/pulsus paradoxus - ANSWER pulse/blood pressure varies with respiration. May indicate severe air trapping (status asthmaticus, tension pneumothorax, cardica tampanade)-felt on exhalation Tracheal deviation pulled toward the abnormal side (same side of pathology) - ANSWER -pulmonary atelectasis -pulmonary fibrosis -pneumonectomy