NURS 4350 Crit Care Final Exam Questions and Answers Already Passed Latest Update

NURS 4350 Crit Care Final Exam Questions and Answers Already Passed Latest Update what are the hemodynamic indicators of preload? - Answers CVP PCWP how is low or high preload treated? - Answers low; increase fluid volume w/ IVP high; fluid overload correct w/ diuretics what hemodynamic changes would you see in cardiogenic shock? - Answers decreased LV pumping = decreased CO, BP, systolic emptying, perfusion increased preload, left filling pressure, PCWP, PAP, PVR interventions for cardiogenic shock - Answers reperfusion = O2, vasopressors decrease <3 workload w/ vasopressors, dobutamine/milrinone if a patient has a high SVR and high BP, what drugs might be used? - Answers ACE inhibitors; decrease vascular resistance/decrease remodeling beta blockers; increased vasodilation & decrease HR/afterload when a PA catheter is in place, how do you know if the balloon is wedged? - Answers connected to monitor for waveform to display when should a nurse call a rapid response? - Answers patient failing outside of ICU: - patient deteriorating quickly - acute change in condition - any concern about a pt's condition goal: prevent ICU admission, or facilitate timely transfer to ICU = prevent codes when should a nurse call a code? - Answers when pt has no pulse, not breathing, or rhythm not compatible with life (asystole, PEA, VF, VT) which dysrhythmias are treated with defibrillation? - Answers v. fib v. tach if pulseless what to assess for a pt in VT - Answers K, Mag, and O2 what drug is used during CPR for the patient with asystole? - Answers epinephrine w/ CPR steps to analyzing a rhythm strip: - Answers 1. count QRS complexes to determine HR 2. evaluate if rhythm is ir/regular 3. identify P waves per QRS complex 4. measure PR interval (0.12-0.20) 5. measure QRS complex (<0.12) 6. look at QT interval what are the characteristics of a. fib? - Answers irregular HR lacking P waves d/t premature ventricular contractions what predisposes patients to a ventricular dysrhythmias? - Answers a preexisting dysthymias of any kind what do the waveforms of VT look like? - Answers increased HR wide QRS complexes jagged, sawtooth shape what do the waveforms of VF look like? - Answers chaotic activity no pulse wavy quivering line describe ECG characteristics of pacemaker rhythms - Answers causes a pacer spike seen before P wave, before QRS, or both common clinical indicators of SIRS and sepsis - Answers temp >38 or <36 hypotension HR >90 RR > 20, PaCO2 <32 WBC >12,000, <4,000 hypoxemia, oliguria, elevated lactate important evidence-based initial interventions carried out when sepsis is suspected - Answers initial resuscitation with IV fluids obtaining cultures/lactate b/f broad spectrum antibiotics vasopressors if unresponsive to fluids protective lung ventilation when should vasopressors be added to sepsis interventions? - Answers when hypotension does not respond to fluids (norepi recommended) which diagnoses are associated with the development of MODS? - Answers shock --> SIRS intravascular inflammation key lab indicators of AKI - Answers elevated kidney function tests (creatine, BUN) elevated K decreased HGB/HCT abnormal urinalysis risk factors for AKI - Answers CKD advanced age, DM, HTN, CHF, hypovolemia, heart problems nephrotoxic drugs (NSAIDS, contrast dyes, ACE-I, aminoglycosides) how to limit risk for AKI when using contrast dye - Answers screen patients pre-procedure