FCCN 2 EXAM QUESTIONS AND VERIFIED ANSWERS 100% GUARANTEED PASS

FCCN 2 EXAM QUESTIONS AND VERIFIED ANSWERS 100% GUARANTEED PASS "Phenylphrine hemodynamic - CORRECT ANSWER SVR Vasoconstrictor Resistance LV will meet" "Negative chronotrope - CORRECT ANSWER decreases heart rate beta blockers The "olols"" "DI - CORRECT ANSWER Lots of urine, replace fluid" "Distributive Shock - CORRECT ANSWER Fill tank Vasoconstrict" "SVO2 - CORRECT ANSWER Venous Gas Oxygen 60-80 Pt with HF is walking around SVO2 will decrease" "Inflammation Sepsis - CORRECT ANSWER Microembli-Microclots Cytokines-CRRT clotting" "SIADH - CORRECT ANSWER Kidneys hold fluid, not peeing" "CPAP - CORRECT ANSWER Inspiratory Pressure Enhances Oxygenation" "BiPAP - CORRECT ANSWER inspiratory and expiratory pressure Enhances Ventilation" "Intubation Kit Meds - CORRECT ANSWER Pre= Versed and Fentanyl Sedatives= Prop, etomidate, ketamine Paralytics= Succ, roc Pressor= phenylephrine" "FiO2 - CORRECT ANSWER Fraction of inspired oO2 RA 21% max 100% Maintain SpO2 target <60%" "What does ROME stand for? - CORRECT ANSWER Respiratory Opposite Metabolic Equal" "Is high pH Acidic or Basic? - CORRECT ANSWER Basic (Alkalosis)" "What could be the cause of Metabolic Acidosis? - CORRECT ANSWER DKA, Anaerobic Metabolism, Diarrhea, Shock, Renal Failure" "PEEP stands for? What does it assess? - CORRECT ANSWER PEEP stands for Positive End Expiratory Pressure and it assesses oxygenation. Another word for PEEP is CPAP" "Would a patient with a high CO2 be placed on CPAP or BiPAP? - CORRECT ANSWER BiPAP because CO2 is a ventilation issue" "Intubation Medication Administration includes what classes of drugs and in what order? - CORRECT ANSWER Pre-Medication -Midazolam (amnesia), Fentanyl Induction (sedative) -Etomdiate, Ketamine, Propofol Neuromuscular Blockade (paralytic) -Succinylcholine, Rocuronium" "Milrinone, Epinephrine, dopamine, and dobutamine act as inotropes or chronotropes for what? - CORRECT ANSWER Inotropes for contractility" "qSOFA will be positive if it has two or more of which criteria? - CORRECT ANSWER Increased respiratory rate, altered mentation, and low blood pressure" "Vasopressin is a vasodilator or vasoconstrictor? - CORRECT ANSWER Vasoconstrictor" "Norepinephrine, phenylephrine, and dopamine dilate or constrict arteries to do what? - CORRECT ANSWER They constrict arteries to increase afterload" "What are a couple of ways to decrease preload? - CORRECT ANSWER Give nitroglycerin, give diuretics, or start CRRT" "What are a couple of ways to increase preload? - CORRECT ANSWER Give crystalloids, colloids or blood products" "Which way to SvO2 and Cardiac output trend? - CORRECT ANSWER They trend in the same direction" "How is MAP calculated? - CORRECT ANSWER Cardiac Output times Resistance" "What is a normal SvO2 - CORRECT ANSWER 60%-80%" "How does hypovolemic shock effect preload and after-load? What is the Physical assessment? What is the treatment? - CORRECT ANSWER Decreases preload because patient is dehydrated, veins are dilated. Increased after-load (SNS, RAAS) Patient would be cool and clamped down, tachycardia, low urine output, thirsty, dry mucus membranes, and narrowing pulse pressure Treatment: includes giving a fluid bolus or blood and then the compensatory mechanisms will reverse" "How does distributive shock effect preload and after-load and contractility? What is the Physical assessment? What is the treatment? - CORRECT ANSWER There is massive vasodilation so a decreased preload, dilated veins and 3rd spacing. Decreased after-load because of dilated arteries. There is also decreased contractility but a high cardiac output from dilated arteries Patient would be flushed, peripherally dilated, tachycardic, concentrated urine, hypotensive, and high temperature Treatment: need to fill the tank first, then clamp down with pressors, then add inotrope if needed" "ABG: PaO2 - CORRECT ANSWER assess oxygenation normal 80-100 arterial blood oxygen saturation < 80 = hypoxemia > 100 = O2 therapy" "Causes of low PaO2 - CORRECT ANSWER pulmonary disorders anemia" "ABG: PaCO2 - CORRECT ANSWER assess ventilation normal: 35-45 < 35 = alkalosis > 45 = acidosis" "Respiratory acidosis - CORRECT ANSWER CO2 >45 with a low pH" "What S&S would you see with resp acidosis? - CORRECT ANSWER headache tachycardia confusion restless" "What are possible causes of resp acidosis? - CORRECT ANSWER over sedation head and chest trauma COPD" "Respiratory alkalosis - CORRECT ANSWER CO2 < 35 and high pH" "What S&S would you find in Respiratory alkalosis - CORRECT ANSWER rapid, deep respirations anxiety fear" "What are possible causes of resp alkalosis - CORRECT ANSWER fever sepsis PE (initial stage)" "ABG: HCO3 - CORRECT ANSWER normal: 22-26 measures acid/base balance < 22 = acidosis > 26 = alkalosis" "Metabolic acidosis - CORRECT ANSWER HCO3 < 22, low pH" "What findings would be present in a pt with metabolic acidosis? - CORRECT ANSWER Kussmaul resp lethagy/ coma N/V ab pain" "What are causes of metabolic acidosis? - CORRECT ANSWER DKA anaerobic metabolism shock renal failure" "Metabolic alkalosis - CORRECT ANSWER HCO3 >26 with an increased pH" "What are some findings associated with metabolic alkalosis? - CORRECT ANSWER slow, shallow breathing confusion convulsions" "What are causes of metabolic alkalosis? - CORRECT ANSWER loss of acids (vomiting, NG suction) or increased bicarbonate administration/ ingestion" "ABG anaylsis steps - CORRECT ANSWER 1. evaluate pH to identify acidosis vs alkalosis 2. primary imbalance: match CO2 or HCO3 state is opposite of pH 3. Compensation: assess whether CO2 or HCO3 state is opposite of pH" "pH - CORRECT ANSWER normal: 7.35-7.45 < 7.35= acidosis > 7.45= alkalosis" "CPAP - CORRECT ANSWER continuous positive airway pressure enhances oxygenation" "BiPAP - CORRECT ANSWER Bi-level positive airway pressure IPAP (inspiratory)/ EPAP (expiratory) improve ventilation" "rapid sequence intubation (RSI) - CORRECT ANSWER administration of induction agent and neuromuscular blockade agent virtually simultaneously pre-oxygenation required" "Intubation indications - CORRECT ANSWER inadequate oxygenation inadequate ventilation inability to protect airway" "Shock index - CORRECT ANSWER SI= HR/SBP if SI is greater than or equal to 0.9 there is a high likelihood of post-intubation hypotension" "Preparation for intubation - CORRECT ANSWER notfiy RT and pharmacist discuss need for intubation & obtain consent confirm the pt does not have a DNI order verify equipment and PPE assure functioning IV access position patient ensure verbilization of "procedural pause" preoxygenate" "RN to verify which equipment for intubation - CORRECT ANSWER anesthesia bag or self-inflating bag appropriately sized anesthesia mask working wall suction with yankauer suction catheter" "For intubation where doe RN get medications - CORRECT ANSWER from "intubation kit" in pyxis" "pre-medicate intubation with what meds - CORRECT ANSWER midazolam (amnesia), fentanyl" "Induction (sedative) meds for intubation - CORRECT ANSWER etomdiate, ketamine, propofol" "neuromuscular blockade (paralytic) meds for intubation - CORRECT ANSWER confirm with provider prior to administration succinylcholine chloride, recouronium" "When and who will be notified if intubation is unsuccessful? - CORRECT ANSWER anesthesia back-up after 10 mins or 2 attempts to hep secure the airway" "RN role during intubation - CORRECT ANSWER monitor pt vitals, especially oxygen saturations administer intubation meds monitor time of intubation attempts assist with suctioning as needed" "Endotracheal tube confirmation - CORRECT ANSWER chest rise bilateral breath sounds end-tidal CO2 detection- capnography on bedside monitor or G5 ventilator/ pH paper changes color in response to different concentrations of CO2 Chest x-ray" "Complications of intubation - CORRECT ANSWER pulmonary aspiration (cricoid pressure, VAP) cardiac/ resp arrest ECG changes: bradycardia or PVC hypoxemia dental accident trauma/ bleeding to oral/ nasal, pharyngeal soft tissue laryngospasm/ bronchospasm" "FIO2 - CORRECT ANSWER fraction of inspired oxygen the ventilator will administer to the patient minimum (room air) = 21% maximum = 100% impactions on FIO2 - increased FiO2 to increase PaO2 - decrease FiO2 to decrease PaO2" "PEEP - CORRECT ANSWER positive end expiratory pressure improves oxygenation --> increase PEEP to increase PaO2 - provides positive pressure to airways during expiration and helps keep alveoli open - indicated for hypoxemia which is secondary to diffuse lung injury" "Disadvantages of PEEP - CORRECT ANSWER increased thoracic pressure decreases venous return to the heart - decreased BP -increase ICP high levels can cause: -barotrauma --> tension pnuemothorax -decreased renal perfuson -hepatic congestion" "Respiratory rate on a ventilator - CORRECT ANSWER minimum number of breaths/min the vent will ensure your pt takes impacts ventilation - increase the RR to blow off CO2 - decrease the rate to conserve CO2 lung protective goal: maintain CO2 35-45 except COPD pts neuro: PaCO2 goals set to decrease increased ICP" "Tidal volume on a ventilator - CORRECT ANSWER calculated based on predicated body weight height & gender)- chart located on vent set at 6mLs/kg per ideal body weight increasing tidal volume, if able, would improve ventilation (decrease CO2)" "Minute ventilation (MV) - CORRECT ANSWER = tidal volume x RR volume inspired during one min normal - 5-8L/min - high= hyperventilation - low= small breaths" "Pressure support on a ventilator - CORRECT ANSWER administered during spontaneous inspiration when pt initiates own breath (SIMV, CPAP) helps to overcome airway resistance pf breathing through an artificial airway decreases the work of breathing associated with spontaneous breathing" "Peak airway pressure - CORRECT ANSWER peak inspiratory pressure (PIP) is the highest level of pressure applied to the lungs during inhalation to reach set tidal volume alarm limit set at 30-35" "Driving pressure - CORRECT ANSWER = tidal volume compliance or plateau pressure - PEEP - amount of pressure required to achieve tidal volume" "SIMV mode - CORRECT ANSWER synchronized intermitent mandatory ventilation" "What is SIMV do? - CORRECT ANSWER mandator ventilator assisted breaths have a set tidal volume patient initiated breaths: tidal volumes caries with each breath initial mode for ventilation or a weaning mode disadvantage: increased work of breathing/ patient/ ventilator asynchrony" "SIMV breath delivery - CORRECT ANSWER delivers either by volume or pressure" “CVP measures what side of the heart - CORRECT ANSWER Right side venous return from preload right side" "If CVP is high - CORRECT ANSWER Volume overload, Direusis" "If CVP is low - CORRECT ANSWER Give fluids" "LHF - CORRECT ANSWER MI= low cardiac output= LV pump not working, support pump, increase afterload with inotropes" "O2 point of neuromuscular blocking agents - CORRECT ANSWER Decrease metabolism and the consumption of oxygen through muscle use." "Phenlyephrine - CORRECT ANSWER IV Push Does NOT increase HR Pure alpha vasoconstrictor Life saving drug" "Vec - CORRECT ANSWER is a paralytic SUCC is not" "metabolic alkalosis causes - CORRECT ANSWER severe vomiting, excessive GI suctioning, diuretics, excessive NaHCO3 NOT DKA" "Lisinipril - CORRECT ANSWER Ace inhibitor Decrease BP Dilating arteries Increasing CO Decreasing SVR" "Not a high pressure alarm - CORRECT ANSWER development of pneumothorax" "Milirone - CORRECT ANSWER For low cardiac output, R HF" "Corticosteroids are part of - CORRECT ANSWER Sepsis with adrenal insufficiencies" "HHS - CORRECT ANSWER 1000mL fluids pressure bag Next Potassium" "CMV has - CORRECT ANSWER Preset Volumes" "P/F Ratios - CORRECT ANSWER Mild 200-300 Moderate 100-200 SEVERE less than 100" "Inotrope impacts - CORRECT ANSWER cardiac contractility" "Chronotrope impacts - CORRECT ANSWER Heart rate" "1st line in sepsis - CORRECT ANSWER Norepi" "Milrinone - CORRECT ANSWER Moderate dilation RHF" "Dobutamine - CORRECT ANSWER Modest dilation Enhances Coronary flow LHF" "AFIB Meds - CORRECT ANSWER Dilt Verapamil Ca Channel Beta" "Beta Blockers - CORRECT ANSWER -olol: slow HR, decrease vasoconstriction, decrease O2 consumption. Used in: HF, HTN, HR control, angina, migraine. AE: HF, bronchospasm, dizzy, constipation, suppresses hypoglycemia indicators. Contra: asthma, bradycardia, SSS. Nursing: check HR before giving. Teach: take med at bedtime, do not stop abruptly. Propranolol=essential tremors, Parkinsons" "Ace Inhibitors - CORRECT ANSWER "PRIL" Captopril, Enalapril, Afosiopril Antihypertensive. Blocks ACE in lungs from converting angiotensin I to angiotensin II (powerful vasoconstrictor). Decreases BP, Decreased Aldosterone secretions, Sodium and fluid loss. Check BP before giving (hypotension) *Orthostatic Hypotension" "Ca channel blockers - CORRECT ANSWER "pine" Decreases force of contraction- blocks Ca" "Resp Acidosis - CORRECT ANSWER low pH, high CO2 CNS depression/sedation/injury/disease Retaining CO2" "Respiratory alkalosis - CORRECT ANSWER high pH, low CO2 pain/fever/sepsis hyperventilation" "Metabolic acidosis - CORRECT ANSWER low pH, low HCO3 Diarrhea DKA hyperkalemia" "Metabolic Alkalosis - CORRECT ANSWER high pH, high HCO3 Vomiting/suctioning/hypokalemia" "PEEP - CORRECT ANSWER positive end expiratory pressure Provides Positive pressure to airway during expiration and helps keep alveoli open" "RR - CORRECT ANSWER Minimum number of breaths per min the vent will ensure pt takes Increase the rate to blow off CO2 Decrease rate to retain" "Tidal Volume - CORRECT ANSWER Amount of air that moves in and out of the lungs during a normal breath Calculated on predicted weight 6mL/kg ideal" "Minute ventilation - CORRECT ANSWER TVxRR volume inspired during 1 min normal is 5-8L/min" "Peak airway pressure - CORRECT ANSWER hightes pressure recorded at the end of inspiration" "SIMV - CORRECT ANSWER synchronized intermittent mandatory ventilation Mandatory breaths have a set tidal volume Pt initiated breaths have varying TV Initial mode for ventilation or weaning mode Disadvantages= increased WOB can lead to pt/vent asynchrony" "AC/CMV - CORRECT ANSWER Assist control or continuous mandatory ventilation Pt initiated or ventilator control breaths HAVE A SET TV Disadvantage: hyperventilation which may cause respiratory alkalosis or hyperinflation, less comfortable for the pt" "Pneumothorax - CORRECT ANSWER accumulation of air in the pleural space Can be caused by trauma surgery or idiopathic" How do you calculate Minute Ventilation? - CORRECT ANSWER Respiratory Rate x Tidal Volume" "What are three reasons to intubate? - CORRECT ANSWER 1. Pt is unable to protect their airway 2. Pt is unable to oxygenate properly 3. Pt is unable to ventilate properly" "Which of the following would not be an indication that the patient may need to be intubated? A. Pt has increased work of breathing, anxiety B. Pt is tyachacardic, with wheezing and grunting C. Pt has periodic resolving pleural effusions upon Xray findings D. Pt is in tripod position and having retractions or nasal flaring - CORRECT ANSWER C" "What is the role of the RN during intubation? - CORRECT ANSWER To monitor the patient!" "In order to avoid VAP (a complication of intubation) what should be done? - CORRECT ANSWER Oral cares" "Which of the following is not a disadvantage to PEEP? A. Barotrauma B. Valutrauma C. Decreased blood pressure, Increased ICP D. Increased blood pressure, Decreased ICP - CORRECT ANSWER D" "What Ventilator setting is considered for lung protective ventilation? - CORRECT ANSWER Tidal volume (because it wont over distend the alveoli)" "CMV and SIMV - CORRECT ANSWER Continuous mandatory ventilation has a set rate of breaths and tidal volume, cannot breathe over the vent. Synchronized intermittent mandatory ventilation has assisted breaths and the tidal volume varies with each breath, may breath over the vent" "What is better for ARD's patients, CMV or SIMV? - CORRECT ANSWER CMV" "Problem solving: patient deterioration while intubated (what does DOPES stand for?) - CORRECT ANSWER Displacement (verify tube is at the same location) Obstruction (biting, coughing, mucus plug, kinked) Pneumothorax! (would cause a high pressure alarm) Equipment (malfunction) Stacked Breaths" "Examples of high pressure alarms on a ventilator - CORRECT ANSWER Pneumothorax, Excessive secretions, mucus plug, biting the ETT, fighting the ventilator" "Examples of low pressure alarms on a ventilator - CORRECT ANSWER Leak in the ventilator circuit, cuff leak, ETT displacement, apnea" "What does a pulse oximetry measure? - CORRECT ANSWER It measures the oxygen saturation of hemoglobin" "P/F ratio calculation tells us what? - CORRECT ANSWER It tells us the degree of sickness of our patients lungs, and helps us assess oxygenation" "Normal, mild, moderate and severe ARD's are indicated by a P/F ratio of what? - CORRECT ANSWER Normal (>300) Mild (200-300) Moderate (100-200) Severe (<100)" "What is a plateau pressure? - CORRECT ANSWER Plateau pressures is the pressure exerted on small airways and alveoli during mechanical ventilation (ideally no higher than 30 cm H2O) High plateau pressures put the patient at risk for alveolar over distention and associated lung injury Plateu pressure monitoring may not be accurate in obese patients due to poor chest wall compliance" "What is Nitric Oxide? - CORRECT ANSWER It is a selective vasodilator of pulmonary vessels. It improves ventilation/perfusion, decreases pulmonary artery pressure, and improves oxygenation (should see immediate effects)" "What do Neuromuscular Blockers (paralytics) do to oxygen consumption? - CORRECT ANSWER Paralytics greatly decrease O2 consumption so O2 supply can adequately meet O2 demand" "Indications for using NMD - CORRECT ANSWER To facilitate short procedures, facilitate mechanical ventilation, to reduce muscle oxygen consumption, to prevent. respiratory or other movements, and to treat muscle activity" "What is the clinical use for neuromuscular blockades? - CORRECT ANSWER Generally they are reserved for patients with severe, refractory, or life threatening hypoxemia who are not responsive to other sedatives or analgesics" "What is Succinylcholine? - CORRECT ANSWER It is a paralytic used during intubation with a rapid onset (30-60 seconds) but a short duration (4-10 min)" "What should be given before NMD's are given? - CORRECT ANSWER Make sure the patient gets pain and sedation medication first! Side note: Dexmedetomidine should not be used for sedation with NMD due to light sedative properties" "Titrate dose of non depolerizing NMD agent to achieve how many twitches? - CORRECT ANSWER 1/4 or 2/4 which is 85%-90% if blocked receptors" "Which pressor should be used to bridge the pressor before propofol is given? - CORRECT ANSWER Phenylephrine" "Which pressor is used first line for sepsis? - CORRECT ANSWER Norepinephrine" "Which pressor is primarily used for right sided heart failure? (after-load reduction) - CORRECT ANSWER Milrinone" "Why should an extra dose of Flolan be with you while administering a dose and what is its indication of use? - CORRECT ANSWER Flolan is used for pulmonary arterial hypertension and you will need an extra dose because its half like is only 6 seconds" "What is the greatest sign that a patient is deteriorating neurologically? - CORRECT ANSWER Loss of consciousness" "Which pressor does not have an immediate effect on heart rate? - CORRECT ANSWER Norepinephrine" "Is Epinephrine a positive or negative inotrope or chronotrope and what does that mean? - CORRECT ANSWER Epinephrine is a positive inotrope which means that it straightens the hearts contractility." "ACE inhibitors, clavidepine and nipride are vasodilators that will decrease or increase what? - CORRECT ANSWER Decrease after-load" "What is an indication for tPA? - CORRECT ANSWER Ischemic stroke" "How does cardiogenic shock effect SNS and RAAS? What is the Physical assessment? What is the treatment? - CORRECT ANSWER SNS (Bad) has an increase in HR, contractility, resistance makes worse. RAAS (bad) increased resistance and fluid retention makes worse Patient will be cool and clamped down, mottled, crackles, and peripheral edema Treatment: Block SNS and RAAS, decrease preload in left failure (lasix and or dialysis), decrease afterload (dilate arteries with (nipride, ACE inhibitors and ARB's), then increase contractility with (inotropes)" "Types of shock and their main problem - CORRECT ANSWER Hypovolemic - Preload Distributive - Afterload Cardiogenic - Contractility" "Lactate is a measure of what and should be under what number? - CORRECT ANSWER Perfusion and under 2" "Early Sepsis - CORRECT ANSWER Hyper-dynamic characterized by: - Decreased peripheral vascular resistance - Vasodilation --> Decreased preload and MAP - Increased cardiac output ( CO = HR * SV) - Fever - Increased heart rate - Rapid respirations - Decreased blood pressure - Anaerobic metabolism = lactate is released - SvO2 is high because embolis is blocking delivery method" "Late Sepsis - CORRECT ANSWER Hypo-dynamic characterized by: - Decreased cardiac output - Global hypoperfusion - Myocardial depression - Low preload - Cold and clammy temp <35.0 (known as the harbinger of death - brain unable to regulate temperature) - Elevated SvO2 drops as Lactic acidosis increases and organs fail (this means that the body is starting to compensate and consume more oxygen thus dropping that value)" "To avoid complications with PA catheter what should be done? - CORRECT ANSWER Site care q7d and prn, also to have a level zero'd square wave and good waveform analysis" "Which color port do meds go through with the swan? - CORRECT ANSWER The white/clear port" "What is considered a safe dose for 3% normal saline to be given at? - CORRECT ANSWER 40cc an hour" "Your patient has DKA. 0600 Na is at 117. 0700 Na is at 120. The patient has 3% NS infusing at 80mL/hr. Which intervention is most appropriate? - CORRECT ANSWER Decrease the infusion rate of 3% NS" "Your patient is post-op on CABG and CVC line infection with mild septic shock. Three days after sepsis onset, BP is stable 120/80 when on 0.05 mcg/kg/min norepinephrine. When stopped, the patients MAP drops to 55. CVP is 12. What is an appropriate intervention? - CORRECT ANSWER Hydrocortisone 50 mg IV q6h (Steroids!)" "Your patient has DKA. Blood pressure is 75/35. Which list is the correct order: Highest priority to lower priority? - CORRECT ANSWER Volume, potassium, insulin" Diagnostic tests of respiratory failure - CORRECT ANSWER ABG analysis Sputum analysis" "Respiratory failure imaging exams - CORRECT ANSWER bronchoscopy chest x-ray MRI CT" "Respiratory failure cardiovascular indicators - CORRECT ANSWER tachycardia- classic first sx dysrhythmias- new or changed acute HTN with tachycardia (sympathetic response) hypotension due to tachycardia if hypovolemic cyanosis/ pallor" "Respiratory failure respiratory indicators - CORRECT ANSWER extreme work of breathing (SOB) use of accessory muscles for breathing (retractions)/ nasal flaring dyspnea (SOB) wheezing/ grunting sputum/ coughing body position (upright or may spontaneously lean forward while sitting to help take a deeper breath)" "Bradypnea causes - CORRECT ANSWER excessive sedation tissue damage diabetic coma depressed resp center of the brain" "Tachypnea causes - CORRECT ANSWER Fever anxiety resp distress restrictive lung disease obesity" "Kussmaul casues - CORRECT ANSWER rapid and deep breathing occurs in metabolic acidosis as the resp system tries to lower CO2 level in blood to compensate" "Cheyne- stokes causes - CORRECT ANSWER alternating rapid and shallow breathing seen in pts with HF, kidney failure, CNS damage" "Respiratory failure CNS indicators - CORRECT ANSWER anxiety restless/ agitation confusion delirium as hypoxia worsens, LOC decreases (somnolence/ coma)"