ATI Critical Care Exam Questions With Correct Marking Scheme

ATI Critical Care Exam Questions With Correct Marking Scheme /.Before PFT's how long should a patient refrain from smoking? Using an inhaler? - Answer-smoking: 6-8 h inhaler: 4-6 h /.What test must you do before performing an arterial puncture? - Answer-Allen's test; patency of the ulnar artery- if blood returns to hand in 15s, then the radial artery can be used for the puncture /.How long should one apply pressure after an arterial puncture? - Answer-5 minutes (20 min if the patient is on anticoagulant therapy) /.What are the normal ranges for ABG's? (pH, PAO2, PACO2, HCO3, and SAO2) - Answer-pH: 7.35-7.45 PAO2: 80-100 mm Hg PACO2: 35-45 mm Hg HCO3: 21-28 mEq/L SAO2: 95-100% /.In what position should you place a patient if air embolism is expected? - Answer-left side in trendelenburg /.How long must a patient be NPO before a bronchoscopy? - Answer-4-8 hr /.What types of medications might one administer prior to a bronchoscopy? - Answer-anxiolytics atropine (to treat bradycardia) viscous lidocaine local anesthetic throat spray /.What should you be monitoring a patient for after a bronchoscopy? - Answer-significant fever (mild is ok up to 24 hrs after the procedure), productive cough, significant blood in sputum (small amounts are to be expected), hypoxemia, laryngspasm /.Prior to a thoracentesis what diagnostic procedure must be done? - Answer-CXR /.What position should the patient be in for a thoracentesis? - Answer-sitting up over the bedside table /.What are possible complications of a thoracentesis? How do we tell patients to identify pneumothorax? - Answer-mediastinal shifts pneumothorax (deviated trachea, pain at the end of inhalation or exhalation, affected side not moving with breath, increased HR, shallow respirations, nagging cough, air hunger) /.In what chest tube chamber (ONLY) should you see bubbling? - Answer-suction /.What is excessive drainage from a chest tube? - Answer-more than 70 ml/hr /.How should the nurse document for care following a chest tube? How often? - Answer-color and amount of drainage qh for 24h after insertion, then q8h mark date, hour, and drainage level on the container at the end of each shift /.What supplies should be kept at the side of a bed for a patient with a chest tube? - Answer-2 enclosed hemostats, sterile water, occlusive dressing /.What should the nurse instruct the patient to do during chest tube removal? - Answer-valsalva maneuver /.What should the nurse do in the case that a chest tube is disconnected? - Answer-1. have the client exhale as much as they can to remove air from the pleural space 2. immerse the end of the chest tube in sterile water to restore the water seal 3. apply dry sterile gauze /.What is the FiO2 and the flow rate for a nasal cannula? at what rate do we need to administer humidification? - Answer-24-44% 1-6 L/min humidification at 4 L/min /.What is the FiO2 and the flow rate for a simple face mask? - Answer-40-60% 5-8 L/min (less than this causes the patient to rebreathe CO2) /.What is the FiO2 and the flow rate for a partial rebreather mask? - Answer-40-75% 6-11 L/min /.What is the FiO2 and the flow rate for a non-rebreather? - Answer-80-95% 10-15 L/min /.What is the FiO2 and the flow rate for a venturi mask? - Answer-24-50% 4-10 L/min /.What is the FiO2 and the flow rate for a aerosol face mask, face tent, t-piece, and trach collar? - Answer-24-100% 10 L/min at least *** Humidification requires frequent monitoring /.What does hypercarbia look like? - Answer-restlessness, hypertension, HA /.What does oxygen toxicity look like? - Answer-non-productive cough, substernal pain, nasal stuffiness, n/v, fatigue, HA, sore throat, hypoventillation /.How does assist control (AC) work related to respiratory support? - Answer-overtakes breathing for an intubated client /.How does synchronized intermittent mandatory ventilation (SIMV) work related to respiratory support? - Answer-used in weaning; increases the work of breathing ventilator and patient work together /.How does assist inverse ratio ventillation (IVR) work related to respiratory support? - Answer-prolongs the inspiration phase to maximize oxygenation HIGH RISK FOR VOLUTRAUMA /.How does airway pressure release ventilation (APRV) work related to respiratory support? - Answer-patient and ventilator work together breath expelled by the lung's own natural recoil /.How does independent lung ventilation work related to respiratory support? - Answer-lungs are ventilated separately need: 2 ventilators, sedation, neuromuscular blocking agents /.How does PEEP work related to respiratory support? - Answer-preset pressure on expiration added to treat persistent hypoxemia /.How does pressure support ventilation (PSV) work r/t respiratory support? - Answer-greater oxygenation, makes the work of breathing easier, prevents alveolar collapse /.How do you document the placement of a tube for mechanical ventilation? - Answer-in cm at the client's teeth or lips /.What do the three ventilator alarms indicate? (volume, pressure, and apnea alarms) - Answer-volume (low pressure): low exhaled volume due to a disconnection, cuff leak, or tube displacement pressure (high pressure): excess secretions, client biting the tube, kinks in the tubing, coughing, pulmonary edema, bronchospasm, and pneumothorax apnea: ventilator does not detect spontaneous respiration in a set time period /.For an ET tube what should the cuff be set at? how often should you adjust the cuff pressure? - Answer-20 mm Hg q 8 h /.How long should you recommend that clients take decongestants? - Answer-no longer than 3-4d (rebound decongestion) ex: phenylephrine /.T/F: Intranasal glucocorticoid sprays should be used right at the onset of the symptoms of rhinitis. - Answer-F; they can prevent seasonal rhinitis /.What is the earliest age you can receive a flu vaccine? - Answer-6 m /.What drug should be administered for rapid resolution of bronchospasms? - Answer-short-acting beta 2 antagonists such as albuterol /.What is the biggest risk for a patient taking methylzanthines such as theophylline for pneumonia? (this medication works as a bronchodilator) - Answer-toxicity; very narrow therapeutic range; tell the patient that their blood levels must be checked and assess for tachycardia, nausea, and diarrhea /.What are anticholinergic medications (such as ipratropium) used for in relation to asthma? what special considerations should we take with these meds? - Answer-long acting to PREVENT bronchospasm by allowing the sympathetic nervous system to promote bronchodilation; watch for Ach effects (cant seee, cant pee, dry mouth) /.Are long acting b2 antagonists such as salmeterol used for prevention of asthma or used in the acute phase? - Answer-bronchodilator used to prevent. DONT USE IN THE ACUTE PHASE /.What anti-inflammatory medications are used for patient with asthma as maintenance drugs? - Answer-1. corticosteroids- fluticasone, prednisone (take with food) 2. leukotriene antagonists such as montelukast 3. mast cell stabilizers such as cromolyn 4. monoclonal antibodies- omalizumab (mmlc--- MILK) /.If ordered at the same time, which medication will you give first? 1. salmetrol and fluticasone 2. ipratropium and albuterol - Answer-1. salmetrol before fluticasone 2. albuterol before ipratropium ALWAYS GIVE THE BRONCHODILATOR FIRST TO INCREASE THE ABSORPTION OF THE ANTI-INFLAMMATORY AGENT /.What is the forced expiratory volume- forced vital capacity (FEV-FVC) ratio for a patient with COPD? - Answer-in a normal person is 100%, in COPD is 70%, in VERY SEVERE COPD is 50%