Critical Care Exit: HESI Exit Exam Quick read Top Notch Q&A. Graded A

Critical Care Exit HESI Nurse plans to administer a dose of metoprolol at 0900 to a client with HTN. At 0800 nurse notes telemetry pattern shows second degree heart block with Ventricular rate of 50. Action Nurse is reviewing client ECG and determines PR interval prolonged. Indicates When assessing a restless, intubated client on mechanical ventilation, nurse auscultates breath sounds on right side only. Action Nurse called to a train derailment likely caused by terrorist bomb. Triage in order Client with pneumonia admitted with severe SOB, ABGs pH 7.30, PaO2 60, PaCO2 62, HCO3 35. Which needs immediate communication to HCP Assess a 78 year old with L sided HF. Symptoms Caring for a burn patient with serum potassium of 4. Question which medication Patient admitted with deep 2nd degree burns of thighs, chest and arms covering 40% BSA. Fluid shift after burn so nurse expects Patient bedridden for 2 wks with following lab values: pH 7.37, PO2 90, PCO2 40, HCO3 25, hypoalbuminemia and hypocalcemia. Priority action Which age group should nurse assess first There has been a major disaster. Triage nurse should give which patient priority Move which patient to medical surgical unit One open bed in ICU but reserved for patient coming from PACU with respiratory problems, what to do Carotid picture Someone with wound vac how to make sure it is effective Magnesium antidote Patient having trouble swallowing when wife gives drink of water Chest tube becomes disconnected Patient in ventricular fibrillation Know calcium levels….there was a question with calcium 5.0 and the answer was patient with hyperthyroidism taking inderal (propanalol) Chest tube volume 125 Heart sounds audio Patient on benzos ??? Abdominal rigidity 4 patients-which one more concern 4 patients with conditions of concern-priority Patient on Heparin going for surgery in a.m.,-priority Patient with fever of 101-best nursing Dx Listening and hearing silence, then kortokoff sound what to do Patient with pancreatitis and elevated liver function-what expect of patient Patient with dark, tarry stool Patient receiving Morphine in PCA pump Vasopressin Patient comes in with Hx of MRSA Patient with thick secretions Chronic renal failure-S/S Patient would get a black tag during a disaster if he/she exhibited which S/S Know your shocks S/S (hypovolemic, cardiogenic, etc-1 Q for each) 2 RNs must check blood products together before administration Glasgow Coma Scale Myasthenia crisis vs. cholinergic crisis Diabetic ketoacidosis Hold Digoxin for HR 60 Stroke Pulmonary air embolus prevention Head trauma and seizures Hypoventilation Hyperventilation Cardiac enzymes that you need to know how often to assess after initial CVA MI treatment Ventilators Have to put in order of consideration to be delivered Early signs of cerebral hypoxia Necessary for Blood Product infusions Checking blood before infusing What does the PR interval represent Isotonic solutions Tracheostomy To assess CVA for hemorrhagic or ischemic Aphasia, agraphia, slow, cautious, anxious, memory ok Cannot recognize faces, loss of depth perception, impulsive behavior, poor judgement, constant smile, loss of tonal hearing Most important indicator of increased ICP Spinal shock If the U wave is most prominent what condition Burns Pic of patient and description of burns, need to decide what % burned 5 Ps of neurovascular status (important with fractures) S/S of shock S/S of IICP Suspected Post op bleeding if assess Primary medications given in ED for respiratory distress ABG normals for the following: pH, pCO2, HCO3 Calculation of the heart rate using an EKG rhythm strip Intracranial hypertension from a traumatic brain injury is admitted to the trauma unit CPR-Arrange in other of priority Endometrial carcinoma receiving brachytherapy and has radioactive Cesium (Cs) loaded in a vaginal applicator 65-year-old female arrives in the ER with shortness of breath and chest pain, nurse accidentally administers 10 mg of morphine sulfate instead of 4 mg as prescribed. Later, the client's respiratory rate is 10 breaths/minute, oxygen saturation is 98%, and she states that her pain has subsided Deep vein thrombosis on heparin protocol based on a tPTT of 65 to 95 seconds. The current PTT result is 35 seconds Calculate the rate of this rhythm strip A client is admitted to the emergency room because of an overdose of acetaminophen (Tylenol) For increase magnesium level Patient admitted with a Dx of diabetic ketoacidosis (DKA) with scant urinary output, K+2.5 mEq/l, pH of 7.26, T 98ºF, HR 128 bpm, RR 36, and BP 90/52 Irregular respiratory rate with periods of apnea lasting 10 to 15 seconds The alarm of a client’s pulse oximeter sounds and the nurse notes that the oxygen saturation rate is indicated at 85% Doing CPR on intubated client with palpable pulse during 2-min cycle of chest compressions, absent breath sounds over left lung Unresponsive client who ingested an unknown number of meperidine (DEMOROL) 50mg tablets. Naloxone (NARCAN) 0.4mg IV is administered, and the client is now responding to verbal stimuli. Which finding in the next hour requires immediate action by the nurse Patient in the MICU. What problem is a client probably experiencing who has an easily obliterated radial pulse and below-normal pressures, (BP), (CVP), (PAP), and pulmonary under pressure PRI interval Which is the highest for carcinogenic shock Patient with wrist restraints the nurse first slides two fingers under the restraints and then notes that the ties are secured to the side rail using a quick-release tie Nursing home patient admitted with urinary sepsis and has a single-lumen, peripherally-inserted central catheter (PICC). Four medications are prescribed for 9:00 the nurse is running behind schedule During a family baseball game, an adult male is hot on the head with a bat, and he is suspected of sustaining an epidural bleed CPR for a pregnant lady Patient has received 250 ml of 0.9% normal saline through the IV line in the last hour and is now tachypneic, and has a pulse rate of 120 beats/minute, with a pulse volume of +4. In EKG reading which complex represents depolarization of the ventricles The risk for metabolic shock syndrome 23 year-old male brought to the ER by a group of fraternity brothers after a hazing event at the university. Blood alcohol level (BAL) of 3.8 and a Glasgow Coma Scale of 3 The nurse in the emergency department is using the simple triage and rapid transport (START) system to assess victims of a hurricane Electrical burn pt A pt on a trachea/endotrach with gurgling sound Metabolic syndrome IV Line Priority pt Endotrach has slipped into right main bronchus of no breath sounds are heard (Audio/Visual) 39 to 48 Glucose Disseminated intravascular coagulation (DIC) Septic shock-best class of medicine to give are A 6-year old boy was hit with a bat while playing at school. He has a splinter of wood imbedded in his eye Patient admitted two hours ago with confusion, Kussmaul respirations, and warm, flushed skin. The healthcare provider determines the client is in acute renal failure (ARF) 14-year-old male arrives at the ER in status epilepticus. He was diagnosed with a seizure disorder in childhood Most important symptom the nurse should monitor the client for while assisting with the insertion of a subclavian central venous catheter Patient with Hx of chronic atrial fibrillation Most important for the nurse to use an IV pump and/or Buretrol when initiating IV therapy after which surgical procedure Acute renal failure with a serum potassium of 7.5mEq/L. based on this finding A client admitted to the hospital is suspected of having meningitis infant admitted to the NICU is tachypneic, tachycardic, and has bounding brachial pulses Feedings for low albumin BNP 500, prescribed diuretic Acute Pancreatitis Mechanical life support Pulmonary Edema CVP via PA port In EKG reading which wave represents depolarization of the atrium Math IV Allen's test Pacemaker-Failure to sense DIC Diabetes -acute confusion Priority-compartment syndrome Head injury Pulmonary embolism-S&S Subcutaneous emphysema is felt as a crackling sensation beneath the fingertips MODS (Multiple Organ Dysfunction Syndrome) after an Abdominal Gunshot wound Ventilator-ET Anaphylactic-bracelet Shock –hemorrhagic Heat stroke CPR-absent lung sounds Myxedema coma S&S Burn CVA – Anosognosia Patient in cardiac arrest and monitor shows pulseless VT Determine the following acid-base disorders Identify the waveforms found in a normal EKG