ACCS PREP (NBRC PRACTICE EXAM 1) QUESTIONS WITH CORRECT ANSWERS

ACCS PREP (NBRC PRACTICE EXAM 1) QUESTIONS WITH CORRECT ANSWERS .A 50 year old male present to the Ed with syncope and shock. He is admitted to the intensive care and pulmonary artery catheter is inserted. patient data is as follows: BP 70/40 MAP 50 CVP 20 RV 45/0 PAP 45/15 Mean PAP 25 PCWP 7 QT 2.5 SVR 18 (1440 dynes) PVR 8.4 (670 dynes) ABG (RA) pH:7.32,CO2 32,PaO2 59 SpO2, 89%. Mixed VBG: pH 7.28 CO2 38 PaO2 28 SpO2 49% Ca-vO2 difference is 8.0 vol%. The adult critical care specialist should recommend that the patient be treated quickly for: A. acute pulmonary embolism B. left heart failure C. right heart failure D. hypervolemia - ANSWERS-A. acute pulmonary embolism (PAP, CVP) Normal: BP 120/80.....MAP 90......CVP 10.....RV 25/0.....PAP 25/8.....Mean PAP 14.....PCWP 8-10.......Qt 4-8..... SVR 20 or 1600dynes (Left heart system) PVR 2.5 or 200 dynes (Right heart - pulmonary sytem) ----- Left heart failure (PCWP, MAP, QT) Right heart failure (CVP, PAP) Hypervolemia (all values are increased ) .cerebral angiography - ANSWERS-exams head, brain, and neck blood vessels to identify abnormalities: aneurysms, strokes, blockages .Positron Emission Tomography (PET) - ANSWERS-Narrow neck vessels checks (cancer, brain disorders, heart disease) .A patient has been intubated in the ED and has an end-tidal CO2 reading of 4%. The specialist should suspect that the: A. patient has a pulmonary embolus B. ET tube is in the correct position C. ET tube is in the esophagus D. ET tube is in the right main stem bronchus - ANSWERS-B. ET tube is in the correct position NOTE: ETCO2 will be if in the esophagus .Post-operatively, Mr. Hart has a 2-3 mm ST segment elevation on his 12 lead electrocardiograph. This is indicative of - ANSWERS-Myocardial Injury .Acute Cerebral Infarction: - ANSWERS-ischemic stroke by sudden brain blood vessel blockage (clot) .Acute Cerebral Infarction (Dx Test) - ANSWERS-Imaging: CTA, PET, MRA, CT scan (chest, abs, brain) ---- Blood tests, platelet, electrolyte, Prothrombin time, partial thromboplastin time (measures clotting time) .Cerebrovascular Accident (CVA) - ANSWERS-general for stroke includes ischemic(clot) & hemorrhagic (rupture) stroke .CVA Diagnostic Test - ANSWERS-Imaging: CT. MRI, Ultrasound, angiography ----- Blood tests: CBC,electrolytes, clotting test, thyroid hormone test ---- Electrocardiogram (EKG) .Which of the following would most accurately provide necessary information regarding fluid management in the care of a critically ill patient with pulmonary edema? A. Bedside PFT