Prophecy general ICU A V3 Questions & Answers, Distinction Level Assignment Has everything.

Prophecy general ICU A V3 A code is initiated and the second nurse is observed not following ACLS protocol. What is the BEST actionsto take? ans: Stop the nurse immediately and institute ACLS protocol A lethargic but oriented patient is being admitted for sepsis and their family member is in the waiting area. Their belonging include a ring, cell phone, and wallet. The patient asks if they can keep the ring on and phone at bedside. What is your BEST response? ans: It is best if your family takes your belongings. After turning a patient with CVP monitoring what should you do to ensure accuracy of the CVP reading? ans: Zero the line at phlebostatic axis An intubated patient with a GCS of 3 is admitted to the ICU from the ER after being found down for an unknown amount of time at home. The CT scan reveals profuse cerebral edema. When is the BEST time to notify organ donation services? ans: Within 24 hours of admission to the ICU Besides the white blood cells, what laboratroy value is used in the diagnosis of sepsis? ans: Lactic acid During cardiogenic shock what temporary intervention might be ordered to improve perfusion until definitive treatment is provided? ans: Inotropic infusion During the first hour of tPA infusion, how frequently should you monitor blood pressure? ans: Every 15 minutes For a patient with septic shock, What would you monitor to objectively determine the effectiveness and need to titrate a dobutamine infusion. ans: ScVo2 How is dopamine usually administered in the icu when given intravenously ans: Titratable continous infusion In a patient with septic shock, after fluid administration which of the following findings is MOST suggestive of the need to start a vasopressor? ans: Mean arterial pressure 40-50 mmHg One of your patients coded but is now stabilized and you are catching up on charting. The step-down unit calls to get report on your other patient who is to be transfered. The nurses near you do not appear busy. How should you prioritize your time? ans: Give report and ask the nurses to prepare the patient for transfer. The provider has ordered 2 units of FFP to be transfused. Your patient's religious beliefs prevent them from accepting blood products. What is your BEST response? ans: Inform the provider and discuss additional options. What acid/base imbalance is MOST likely to be found in a patient with COPD ans: Respiratroy acidosis What assessment tool is needed for a patient who has uncomplicated retrosternal hemorrhage? ans: Follow up imaging test What cardiac condition shows cardiomegaly on chest x-ray ans: Systolic heart failure What condition does the Confusion Assessment Method for ICU (CAM-ICU) detect? ans: Delirium What ECG finding is indicative of hyperkalema? ans: peaked T wave What information do you need from the provider to setup a cerebral intraventricular drainage system? ans: Maximum ICP What information is MOST important for you to confirm in smart IV pump settings? ans: Weight What is a complication of long term TPN? ans: Liver injury What is a significant complication of imaging studies performed with iv contrast ans: Acute kidney injury What is an effective way to evaluate for cyanosis in a person of color ans: Check inner eyelids What is the BEST way to determine a STEMI? ans: 12 Lead ECG What is the normal cardiovasculat response to early sepsis? ans: Increased cardiac output What IV sedative would MOST likely be ordered for a non-intubated patient? ans: Dexmedetkomidine (precedex) What laboratory value should you monitor closely if your patient is vomiting coffee ground emesis? ans: Hemoglobin What MUST you confirm before removing a cervical spine collar? ans: Presence of active order to remove What order is included in the pre-procedural checklist for patients at risk for acute kidney injury who are to receive IV contrast? ans: Pre-hydration with IV Fluids What respiratory support would an alert patient with an acute COPD exacerbatiobn likely receive FIRST? ans: Bipap What type of medication is used in the critical care setting to help manage the symptoms of alcohol withdrawal? ans: Benzodiazepines What ventilator adjustment do you expect when your patient's ABG is pH 7.40, PaCO2 112, BICARB 22? ans: Decrease in FiO2 When administering a titratable infusion what information must you check on the medication IV bag to confirm the correct dose is being administered? ans: Concentration When assessing for fever in your intubated patient, placement of the thermometer in which area would be most accurate? ans: Pulmonary artery or bladder When donning an N-95 mask, how should you secure the nose? ans: Fit the nose piece with both hands Which age group is MORE likely to experence a "Blown" vein ans: older adults Which assessment establishes baseline hand perfusion before an ABG puncture or arterial line placement? ans: Allen Test Which condition may cause increased effects from a medication that is mostly metabolized by the liver? ans: Hepatitis C Which medication is associated with increased delirium in critical care patients? ans: Lorazepam ( ativan) Which of the following actions complies with ventilator acquired pneumonia (VAP) prevention protocols? ans: Keep head of bed 30-45 degrees Which of the following can be given through an enteral feeding tube? ans: Immediate release pills Which of the following diets would be BEST for a patient with renal failure? ans: Low sodium, Low potassium and moderate protein Which of the following is a priority for the bedside nurse when a patient gets inpatient hemodialysis? ans: Maintaining adequate blood pressure Which of the following should you do if your patient suddenly becomes diaphoretic, anxious, tachycardic, and has clammy skin? ans: Check their glucose Which of the following signs or symptoms indicates a patient might not be tolerating the extubation? ans: The patient is coughing and has tachycardia While admitting a patient with a history of IV drug use, what precautions should you take? ans: Carefully inspect items for presence of sharps. While assessing a patient just admitted to the hospital, he admits to drinking 12 cans of beer a day, with the last drink being right before admission. What is the expected onset of delirium tremens? ans: Within 48-72 hours While reviewing your patient's EHR prior to receiving report, you notice that their documented urine output for the past 24 hours is 600ml. What would be the MOST important action to take for this patient? ans: confirm with the off-going nurse if this is a known situation. You are caring for a confused patient with edema who has large swollen wrist. You find that someone has taped their ID bracelet to the side of the bed. How should you secure their ID bracelet? ans: Place a new ID bracelet on the patient's wrist while confirming perfusion to the hand You are caring for a patient with diabetic ketoacidosis with suspected sepsis. You have the following tasks to complete: Draw blood cultures, checkblood glucose, administer antibiotic, insert urinary catheter, and check urine for glucose. Which task should you complete FIRST? ans: Draw blood culture You are caring for an underweight, older adult who is intubated, sedated, and septic. You have implemented turning every 2 hours. While inspectingthe patient's back you notice bony prominences with intact but reddened skin. What should youinclude in the plan of care? ans: Use of specialized air bed You are to administer 1 mg of morphine IV but it only comes in a 2 mg vial. How should you proceed? ans: Waste 1 mg with a second nurse and then give the drug to the patient You find the concentration of an IV medication bag that is hanging and infusing into your patient does not match the concentration in the order. What should you do NEXT? ans: Stop the infusion You have administered a pain medication that has a half-life of 120 minutes, onset of action 6 min, tmax of 15 minutes, and is mostly excreted in the uring. when can the patient expect the medication to start working ans: 6 minutes You have just received report on Patient A and Patient B. Patient A is intubated, sedated, and on a vasoactive infusion to keep their BP greater than 110 mmHg systolic on an arterial line. Patient B was extubated an hour ago and has a scheduled glucose check due in 1 hour. What is your PRIORITY action? ans: Assess Patient B's respiratory status You witness a patient that is not assigned to you fall out of bed and begin crying for help but you do not see the assigned nurse to assist the patient. What should you do first? ans: Check on the patient's status and call for assistance. Your are admitting a patient who is sedated and intubated directly from the operating room after a major surgery. The anesthesia provider connects the patient to the ventilator in the ICU room and leaves before entering orders for the patient's ventilatory settings. How should you proceed? ans: Contact the ICU intensivist or specialist assigned to the case Your intubated and unresponsive patient is scheduled for surgery in the morning. Who is the most appropriate person to make decisions for your patient? ans: The healthcare POA Your patient begins to choke and a code blue is called. The provider is unsuccessful at removing the object and is unable to place the ETT. You would expect to prepare for what type of procedure ans: Surgical airway Your patient had an unplanned self-extubation. They are now alert and sitting up. Their pulse oximetry is 98% on 4 liters face mask. What action should you prioritize? ans: A. Inspecting the oral cavity B. Checking blood pressure and the heart rate*WRONG C. Administering an albuterol nebulizer D. Performing an ordered STAT ABG *WRONG Your patient has a known baseline heart rate of around 45. The ECG monitor keeps alarming when the heart rate decreases below 50. Their vital signs are stable. What would you do? ans: A. Adjust the alarm parameters Your patient has a right chest tube that was placed after thoracotomy. They report that is very painful when they cough and request cough medicing. What should you do? ans: Teach them to splint their right side when coughing and give pain medicine Your patient has just completed IV potassium replacement. When should you collect their repeat potassium level? ans: 30-60 min Your patient is intubated and begins to cough up clear mucous inside their ETT. What should you do NEXT? ans: A. Instill normal saline to lavage ETT*WRONG* B. Sit the patient up to 30 degrees in bed *wrong* C. Inspect their oral cavity and suction mouth D. Provide 100% oxygenation and prepare to suction Your patient is intubated with an ETT and sedated without spontaneous monements when the ventilator alarms with a high-pressure warning. The ventilator tubing is free and unkinked. What should you do NEXT? ans: Provide 100% oxygen and prepare to suction the patient Your patient is receiving an antiarrhythmic agent. Which of the following assessment parameters is the MOST important for you to evaluate? ans: ECG Your patient is undergoing a weaning trial from the ventilator. Fifteen minutes into the trial the patient's heart rate increases to 140 bpm and they start to grab at their oxygen and IV tubing. What should you do NEXT? ans: C. Stop weaning and rest the patient Your patient on a furosemide infusion has a positive daily fluid balance, new bilateral crackles on auscultation and has gained weight since admission. What action should you take? ans: Discuss increasing the furosemide infusion with the provider Your patient was intubated but still has oral medications on their list of medications. How should you ensure they receive their medications? ans: Ask the provider to update the route of administration. Your patient's family does not want to tell the patient of their life-threatening diagnosis and pleads with you not to let the patient know. What is the MOST appropriate response? ans: Acknowledge the family's concerns and recommend a meeting with the family and interdisciplinary team. Your postoperative patient suddenly becomes dyspneic, clutches their chest and their Sp02 drops to 89% the patient has a swollen left calf. what condition do you suspect? ans: Pulmonary embolism