BKAT Study Set Questions & Answers
Normal blood gases; pH - ANSWER7.35-7.45
AnswerNormal blood gases: CO2 - ANSWER35-45
AnswerNormal blood gases: HcO3 - ANSWER22-26
AnswerNormal blood gases: PO2 - ANSWER80 or above
AnswerNormal vacuum pressures for suction? - ANSWER120-140 mmHg
AnswerWhat may a high pressure vent alarm indicate? - ANSWERPt is biting on the
tubing, excessive secretions in the tubing, kinked tubing
AnswerWhat may a low pressure vent alarm indicate? - ANSWERcuff leak or the tubing
is disconnected somewhere
AnswerHow do you verify positioning of an endotracheal tube? - ANSWER-auscultate
lung bases and apices for bilateral breath sounds
-observe chest for symmetric chest wall movement
-confirm with end tidal CO2 measure
GOLD STANDARD: chest x-ray
Answert/f: people with ET tubes should be suctioned routinely - ANSWERFALSE-- they
should be suctioned on an as needed basis
Answerwhat should ET tube cuff pressure be kept at? - ANSWER20-25 mmHg
AnswerWhat measures should nurses take to avoid ET tube problems? - ANSWER-
confirm that exit mark on ET tube remains constant when providing patient care,
repositioning, and transporting patient
-maintain proper cuff inflation (listen for an air leak-- if pt can talk, you must inflate more)
-continually monitor SpO2, RR, HR and rhythm, mental status, and ABGs
-pre-oxygenate before suctioning
AnswerWhat should be done if a patient is not tolerating ET tube suctioning? -
ANSWERSTOP and manually hyperventilate with 100% oxygen
AnswerMeasures to prevent aspiration? - ANSWER-avoid bolus tube feedings
-monitor tube feeding residuals
-maintain HOB at LEAST 30 degrees or greater
-maintain proper ET tube cuff inflation
, -perform frequent oral pharyngeal suctioning
-maintain an NG tube connected to low, intermittent suction if feeding tube is placed
below the pylorus
Answerwhat are recommendations for preventing ventilator associated pneumonia? -
ANSWER-manage ventilated patients without sedatives whenever possible
-interrupt sedation once a day (spontaneous breathing trials)
-provide early exercise and mobility
-provide regular oral care
-minimize pooling of secretions above the ET tube cuff
-use ET tubes with subglottic secretion drainage for patients likely to require greater
than 72 hours of intubation
-keep HOB elevated 30-45 degress
-change ventilator circuit only if visibly soiled or malfunctioning
AnswerWhat is the biggest complication associated with high cervical spinal cord
injuries? - ANSWERBREATHING-- the diaphragm is innervated by C3-C5 levels
C4-diaphragm
will likely need mechanical ventilation mgmt
Answersigns and symptoms of increased intracranial pressure? - ANSWER-altered
LOC
-headache
-bradycardia
-decreased respirations
-acute HTN with widening pulse pressure
-N/V
-worsening neuro deficits
-pupils that are nonreactive
AnswerWhat are the components of a neuro exam? (7) - ANSWER1. LOC
2. mental status and cognitive function
3. cranial nerves
4. motor
5. sensory
6. coordination
7. reflexes
AnswerWhat are the three components of the glasgow coma scale? - ANSWER1. eye
opening
2. motor
3. verbal
Normal blood gases; pH - ANSWER7.35-7.45
AnswerNormal blood gases: CO2 - ANSWER35-45
AnswerNormal blood gases: HcO3 - ANSWER22-26
AnswerNormal blood gases: PO2 - ANSWER80 or above
AnswerNormal vacuum pressures for suction? - ANSWER120-140 mmHg
AnswerWhat may a high pressure vent alarm indicate? - ANSWERPt is biting on the
tubing, excessive secretions in the tubing, kinked tubing
AnswerWhat may a low pressure vent alarm indicate? - ANSWERcuff leak or the tubing
is disconnected somewhere
AnswerHow do you verify positioning of an endotracheal tube? - ANSWER-auscultate
lung bases and apices for bilateral breath sounds
-observe chest for symmetric chest wall movement
-confirm with end tidal CO2 measure
GOLD STANDARD: chest x-ray
Answert/f: people with ET tubes should be suctioned routinely - ANSWERFALSE-- they
should be suctioned on an as needed basis
Answerwhat should ET tube cuff pressure be kept at? - ANSWER20-25 mmHg
AnswerWhat measures should nurses take to avoid ET tube problems? - ANSWER-
confirm that exit mark on ET tube remains constant when providing patient care,
repositioning, and transporting patient
-maintain proper cuff inflation (listen for an air leak-- if pt can talk, you must inflate more)
-continually monitor SpO2, RR, HR and rhythm, mental status, and ABGs
-pre-oxygenate before suctioning
AnswerWhat should be done if a patient is not tolerating ET tube suctioning? -
ANSWERSTOP and manually hyperventilate with 100% oxygen
AnswerMeasures to prevent aspiration? - ANSWER-avoid bolus tube feedings
-monitor tube feeding residuals
-maintain HOB at LEAST 30 degrees or greater
-maintain proper ET tube cuff inflation
, -perform frequent oral pharyngeal suctioning
-maintain an NG tube connected to low, intermittent suction if feeding tube is placed
below the pylorus
Answerwhat are recommendations for preventing ventilator associated pneumonia? -
ANSWER-manage ventilated patients without sedatives whenever possible
-interrupt sedation once a day (spontaneous breathing trials)
-provide early exercise and mobility
-provide regular oral care
-minimize pooling of secretions above the ET tube cuff
-use ET tubes with subglottic secretion drainage for patients likely to require greater
than 72 hours of intubation
-keep HOB elevated 30-45 degress
-change ventilator circuit only if visibly soiled or malfunctioning
AnswerWhat is the biggest complication associated with high cervical spinal cord
injuries? - ANSWERBREATHING-- the diaphragm is innervated by C3-C5 levels
C4-diaphragm
will likely need mechanical ventilation mgmt
Answersigns and symptoms of increased intracranial pressure? - ANSWER-altered
LOC
-headache
-bradycardia
-decreased respirations
-acute HTN with widening pulse pressure
-N/V
-worsening neuro deficits
-pupils that are nonreactive
AnswerWhat are the components of a neuro exam? (7) - ANSWER1. LOC
2. mental status and cognitive function
3. cranial nerves
4. motor
5. sensory
6. coordination
7. reflexes
AnswerWhat are the three components of the glasgow coma scale? - ANSWER1. eye
opening
2. motor
3. verbal
