NURS 4350 MIDTERM EXAM QUESTIONS WITH
ALL PASSED ANSWERS!!
List trends affecting patient management in the ICU Answer - 1. Increasing
complexity of illness
2. Aging population
3. More ethical issues
4. Control of costs and quality
5. Rapidly changing technology
6. Early transfer from ICU
7. Staff intensitivists
8. E-ICUs
9. Inclusion of family in all aspects of care
What are some basic criteria used to identify patients who should be admitted
to an ICU? Answer - -Have or at risk for unstable airway
-Have or at risk of poor breathing
- high intensity interventions
- vigilant nursing care
-abcs
-Have or at risk for poor circulation
-Need constant supervision and monitoring
,How does the body's stress response affect blood glucose levels? Answer - -
Physiologic stress stimulates release of cortisol and epinephrine from adrenal
glands, further stimulating glucagon
-stress increases - cortisol levels increas
Identify two abnormal responses to critical illness that require medical workup
Answer - *Depression and delirium* are difficult to assess and are overlooked
and should be addressed
List the basic steps used to analyze heart rhythm Answer - 1. Determine heart
rate: number of complexes in 6 sec x 10
2. Determine heart rhythm: regular or irregular, look at R to R intervals
3. Identify P waves: 1 p wave to each QRS complex?
4. Measure PR interval: .12-.2 seconds
5. Evaluate QRS complex: (<.12 sec), narrow or wide
6. Additional: QT interval, <50% R-R interval, male <.42, female <.43
How would you identify normal sinus rhythm? Answer - 1. Rate: 60-100
2. Rhythm: regular
3. P-waves: present
4. PR interval: .12-.2 sec
5. QRS: <.12, narrow
How would you identify sinus bradycardia? Answer - -Meets criteria for normal
sinus rhythm, but rate is <60 bpm
-Bradycardia decreases CO due to fewer ejections
, How would you identify sinus tachycardia? Answer - -Meets all the criteria for
normal sinus rhythm, but rate is >100 bpm
-Tachycardia decreases diastolic filling and stroke volume because no time for
heart to fill
How would you identify atrial fibrillation? Answer - -Most frequent
dysrhythmia
-Rate: supraventricular tachycardia >150, otherwise 60-100
-Rhythm: Irregular
-P wave: no
-QRS complex: narrow
-Can occur with RVR (tachycardia), sinus, flutter, or supraventricular tachycardia
How would you identify premature ventricular contractions? Answer - -Large,
bizarre complexes that can come early, followed by a pause; can progress to
serious ventricular dysrhythmias
-Unifocal (same area), multifocal (different areas), ventricular bigeminy (PVC
after every other QRS) or ventricular trigeminy (after every third QRS)
what causes pvcs Answer - Associated conditions which → irritability
Hypokalemia, Hypoxia, myocardial ischemia, Acidosis, Cardiomyopathy Drug
toxicity
How would you identify ventricular tachycardia (VT)? Answer - Rate: >200
Rhythm: slightly irregular
P-waves: may be present
ALL PASSED ANSWERS!!
List trends affecting patient management in the ICU Answer - 1. Increasing
complexity of illness
2. Aging population
3. More ethical issues
4. Control of costs and quality
5. Rapidly changing technology
6. Early transfer from ICU
7. Staff intensitivists
8. E-ICUs
9. Inclusion of family in all aspects of care
What are some basic criteria used to identify patients who should be admitted
to an ICU? Answer - -Have or at risk for unstable airway
-Have or at risk of poor breathing
- high intensity interventions
- vigilant nursing care
-abcs
-Have or at risk for poor circulation
-Need constant supervision and monitoring
,How does the body's stress response affect blood glucose levels? Answer - -
Physiologic stress stimulates release of cortisol and epinephrine from adrenal
glands, further stimulating glucagon
-stress increases - cortisol levels increas
Identify two abnormal responses to critical illness that require medical workup
Answer - *Depression and delirium* are difficult to assess and are overlooked
and should be addressed
List the basic steps used to analyze heart rhythm Answer - 1. Determine heart
rate: number of complexes in 6 sec x 10
2. Determine heart rhythm: regular or irregular, look at R to R intervals
3. Identify P waves: 1 p wave to each QRS complex?
4. Measure PR interval: .12-.2 seconds
5. Evaluate QRS complex: (<.12 sec), narrow or wide
6. Additional: QT interval, <50% R-R interval, male <.42, female <.43
How would you identify normal sinus rhythm? Answer - 1. Rate: 60-100
2. Rhythm: regular
3. P-waves: present
4. PR interval: .12-.2 sec
5. QRS: <.12, narrow
How would you identify sinus bradycardia? Answer - -Meets criteria for normal
sinus rhythm, but rate is <60 bpm
-Bradycardia decreases CO due to fewer ejections
, How would you identify sinus tachycardia? Answer - -Meets all the criteria for
normal sinus rhythm, but rate is >100 bpm
-Tachycardia decreases diastolic filling and stroke volume because no time for
heart to fill
How would you identify atrial fibrillation? Answer - -Most frequent
dysrhythmia
-Rate: supraventricular tachycardia >150, otherwise 60-100
-Rhythm: Irregular
-P wave: no
-QRS complex: narrow
-Can occur with RVR (tachycardia), sinus, flutter, or supraventricular tachycardia
How would you identify premature ventricular contractions? Answer - -Large,
bizarre complexes that can come early, followed by a pause; can progress to
serious ventricular dysrhythmias
-Unifocal (same area), multifocal (different areas), ventricular bigeminy (PVC
after every other QRS) or ventricular trigeminy (after every third QRS)
what causes pvcs Answer - Associated conditions which → irritability
Hypokalemia, Hypoxia, myocardial ischemia, Acidosis, Cardiomyopathy Drug
toxicity
How would you identify ventricular tachycardia (VT)? Answer - Rate: >200
Rhythm: slightly irregular
P-waves: may be present
