Critical Care Final Exam 2023 with verified questions and answers

A new area of hyperresonance is noted during chest wall percussion of a patient who is receiving continuous mechanical ventilation. The most likely cause for this finding is: Pneumothorax What lab test can be used as a screening tool for CHF? Brain Natriuretic Peptide (BNP) Which of the following represents the characteristics of Sinus Tachycardia: I. Atrial rate of 250-350/minute II. no identifiable P waves, erratic, wavy baseline III.regular ventricular rhythm at a rate of 100-160 beats/min IV. QRS duration of .12 seconds III & IV A chest tube to drain a hemothorax should be placed in the: 5th intercostal space, midaxillary line which of the following include factors that may cause obstruction of an artificial airway? I. foreign objects such as dentures II. mucus plugging III. rapid mobilization of secretions from the lung IV. vocal cord paralysis II & III Bobby is a 22yo male who was involved in a MVA. He suffered spinal cord damage at C2-3. What would you expect to find during your assessment of Bobby's breathing? unable to breathe on his own, supported by mechanical ventilation The highest percentage of water in the body is found in which fluid compartment? Intracellular Which of the following indicates adequate tissue perfusion in the critically ill patient? I. warm extremities II. capillary refill time of 6 seconds III. urinary output of 40 mL/hr I & II A 40yo male was involved in a serious MVA and taken to the nearest hospital emergency department. The paramedics report that the man was not wearing his seat belt at the time of the collision. Upon physical exam, he was noted to have pain and tenderness to the chest. What would you expect to find in this patient? paradoxical chest wall movement What rhythm has the potential of changing into a lethal rhythm? ventricular escape rhythm Hypokalemia (low potassium levels) may be caused from which of the following? I. diuretic therapy II. corticosteroids III. renin-angiotensin IV. aldosterone I & II Which of the following is true regarding physical assessment findings with pneumothorax? I. common symptoms include dyspnea and chest pain II. it results in an increased resonance to percussion III. it will decrease vital capacity IV. tactile fremitus will be increased I, II, & III T/F: A falling arterial blood pressure is an early sign of decreased cardiac output. False If drainage from a mediastinal chest tube suddenly decreases, the patient may rapidly develop: cardiac tamponade Bradycardia is related to what? vagal nerve stimulation Following thoracic surgery, patients experience pain and stress. If pain is not treated, which of the following will occur? I. decrease in clotting time II. increased oxygen consumption III. decreased oxygen delivery to the tissues IV. increased vital capacity II & III What is associated with increased rate and depth of ventilation? hypoxemia Why is the electrical impulse temporarity delayed at the atrioventricular (AV) node? To allow: better filling of the ventricles What is the ventricular heart rate when the AV node paces the heart? 40-60 beats/min What is represented by the P wave on the ECG tracing? depolarization of the atria What does the QRS complex represent? depolarization of the ventricles What is the normal range for the PR interval? 0.12-0.2 seconds The normal QRS complex does not exceed what time on the horizontal axis? 0.12 seconds What does the T wave on the ECG represent? ventricular repolarization If the ventricles become the dominant pacemaker of the hear, the ventricular rate would be ____ beats per minute. 20-40 A patient with HIV has a PPD skin test to evaluate for possible TB. An induration of what size would be considered positive for this patient? /=5 mm In order to help you interpret your patient's acid base status, you scan the patient's chart to find the following electrolyte values reported on this morning's AM lab. Na+ 140 mEq/L; Cl- 117 mEq/L; HCO3- 12mEq/L; what is the anion gap? 11 mEq/L A 32 yo female with moderate persistent asthma was prescribed inhaled corticosteroids one month ago to control her asthma. In order to assess if this treatment is being effective in controlling airway inflammation, what test should be performed? Exhaled nitric oxide (eNO) Oncotic pressure can be described as: water magnet that holds fluid in the vascular system What findings may suggest that a patient is malnourished? weak cough What clinical scenario is associated with a mixed acid-base disturbance of respiratory and metabolic acidosis? CPR A patient is enrolled in a pulmonary rehab program which includes smoking cessation. On the patient's first visit, a physical assessment and lab tests are performed. The patient's carboxyhemoglobin (COHb) is 8%. This indicates: the patient is still smoking What type of blood cell is useful against allergic reactions and defends against parasitic infestations? eosinophils Elevation of the blood urea nitrogen (BUN) and creatinine levels in the blood suggests what type of problem? renal failure In regards to nutrition, it is best for the COPD patient to AVOID which of the following in order to avoid a possible increase in CO2 production? carbohydrates Which of the folling would be considered a normal anion gap? A) 11mEq/L B) 18mEq/L C) 23mEq/L D) 34mEq/L A) 11mEq/L Aldosterone secretion causes more sodium to be excreted in the urine. T/F False The extracellular fluid compartment is composed of plasma and interstitial fluid.T/F True Neutropenia may be caused by which of the following? I. chemotherapy to treat cancere II. decreased bone marrow production III. HIV IV. stress I, II, & III You are providing respiratory care to a patient well known to you who has Cystic Fibrosis. A sputum specimen has been sent to the lab, but results of the culture are not available yet. The results of the CBC show leukocytosis, with an increase above normal in the number of neutrophils. This means the patient most likely has a: bacterial infection A 45 yo homeless patient is admitted to the hospital with signs and symptoms of pneumonia. The patient appears cachetic, and lab results indicate a protein level that is below normal. This patient's malnourished condition, may cause which of the following? I. depressed immune functions II. increase in CO2 production III. surfactant deficiency IV. increase in interstitial fluid I, III, and IV Interpret the following ABG. pH 7.55 PaCO2 30 mixed metabolic alkalosis and respiratory alkalosis The highest percentage of water in the body is found in which fluid compartment? intracellular Describe the significance of an increase in the number of circulating bands: the bone marrow is releasing more neutrophils to fight infection what enzyme is associated with cardiac muscle damage? Troponin I What establishes the capillary oncotic pressure? Presence of proteins such as albumin, in the plasma Metabolic alkalosis may result from which of the following: I. vomiting II. diuretic therapy III. ingestion of certain poisons IV. administration of corticosteroids I, II, and IV Another term for blood platelets is: thrombocyte Which of the following is NOT a type of White blood cell? A) erythrocyte B) eosinophil C) monocyte D) lymphocyte erythrocyte Lukemia, a disease of the bone marrow, is a common cause of: leukopenia A bacterial infection is often suspected when a patient has an elevated ______ count. neutrophil Immature neutrophils are referred to as _____. bands Polycythemia is an elevation in the number of ______. red blood cells A low sodium (Na+) level is known as ______. hyponatremia Patients with an elevated sweat chloride level should be evaluated for _______. cystic fibrosis An abnormally low level of serum glucose is consistent with a diagnosis of ______. malnutrition Tho tests most commonly performed to evaluate kidney function are _______. BUN and Creatinine T/F: In a healthy adult male, the hematocrit (Hct) is about 48%. True What is a formed element found in the circulating blood? Platelets What type of White blood cell is typically most prevalent in the circulating blood? neutrophil What type of white blood cell is useful against allergic reactions and defends against parasitic infestations? eosinophil A left shift in the WBC differential is evidence by what? increase in the number of immature leukocytes What type of leukocytosis is typically seen in patients with viral infections? lymphocytosis What is a major cation of the extracellular fluid? sodium The normal value for sodium (Na+) is 3.5-4.8mEq/L. T/F false Elavation of the blood urea nitrogen (BUN) and creatinine levels in the blood suggests what type of problem? renal failure During evaluation of the enzymes, what disorder is associated with elevation of CK-MB on electrophoresis? myocardial infarction Elevation of troponin is associated with what disorder? acute myocardial infarction What organism is responsible for the majority of bacterial pneumonia cases? streptococcus pneumoniae How do we calculate pulse pressure? systolic - diastolic How do we calculate mean arterial pressure (MAP)? systolic pressure + (diastolic pressure x 2) / 3 How do we calculate Cardiac Index (CI)? cardiac output / body surface area How do we calculate Systemic Vascular Resistance (SVR)? (MAP - CVP) / CO x 80 How do we calculate Pulmonary Vascular Resistance (PVR)? (MPAP - PCWP) / CO x 80 What is normal CVP? 1-6 What is normal MPAP? 10-20 What is normal PCWP? 4-12 What is normal Diastolic pulmonary artery pressure? 6-15 What is normal Systolic pulmonary artery pressure? 20-30 The Cuff pressure of an artificial airway should be maintained at or below ________mmHg, or ______cmH2). 20mmHg; 27cmH2O T/F: Obstruction is more likely with larger diameter artificial airway. False T/F: The critical care assessment cannot be accurate unless sophisticated technical equipment is used to monitor the patient. False What breath sound suggests bronchial narrowing? wheezing To decrease the incidence of ventilator associated pneumonia, the HOB(head of bed) should be elevated a minimum of ____ degrees. 30 Which of the collowing may cause airway obstruction of an artificial airway? (choose all that apply) A) bilateral vocal cord paralysis B) kinking of the tube C) mucus plugging D) spasms of the larynx E) swelling of the larynx F) loss of tonicity of the submandibular muscles which support the tongue G) smaller diameter tubes H) sopious secretions all of the above Which of the following may cause airway obstruction in a patient who is breathing Spontaneously (no artificial airway)? Choose all that apply. A) bilateral vocal cord paralysis B)copious secretions C) aspiration D) laryngospasm E) bronchospasm F) loss of tonicity of the submandibular muscles which support the tongue all of the above For the average adult male, the cm marking on an endotracheal tube at the lip should be ____cm. 23 Spinal cord damage BELOW which point will NOT impair diaphragmatic innervation? C6 What bottle (chamber) must be present in every chest drainage system to prevent air from entering the pleural space? water seal Congestive heart failure is related to what type of pleural effusion? transudative You have calculated a patient's estimated % shunt to be 15%. This would be considered? Mild Mr. Smith's cardiac output is 5L/min and his body surface area is 2.5m2. The calculated Cardiac Index is: 2.0L/min/m2 What would cause an abnormally low PA (pulmonary artery) pressure? vasodilation A 52 yo male has just undergone major abdominal surgery. He is on mechanical ventilation and has a PA catheter in place. You note that the PCWP is 8mmHg, and the PAP is 35/20mmHg. This is most likely due to: Non cardiogenic pulmonary edema (ARDS) The CVP catheter is capable of measuring which of the following? I. right ventricular function II. venous return III. circulating blood volume IV. PCWP (pulmonary capillary wedge pressure) I, II, and III When the balloon is DEFLATED, the distal port of the PA catheter measures: PAP (pulmmonary artery pressure) Periods of wakefulness, and able to respond to those around external stimuli. Oriented to time, place, and person. Alert Does not awaken completely. Responds to noises and painful stimulation, but responds very slowly to verbal stimulation stuporous Awakens, but with difficulty. When aroused, responds appropriately but soon falls asleep again Obtunded Eyes are open but not able to arouse; irreversible brain damage but breathing may not be affected Persistent vegatative state State of complete unconsciousness. Does not respond to stimuli and does not move voluntarily comatose What does the dicrotic notch represent on a pulmonary artery pressure waveform? Pulmonic valve closure For the pulmonary capillary wedge pressure to reflect pulmonary venous and left atrial pressures, blood flow must be uninterrupted between the catheter tip and the left heart. This condition only exists in lung zone: 3 The optimal time to measure pressures via a pulmonary artery catheter would be during/at: end exhalation _______may cause an INCREASE in mixed venous oxygen saturation(SvO2)? hypothermia What is the earliest indication of overall tissue hypoxia? decrease in SvO2 Length of muscle fibers at end-diastole; pressure of volume of blood in ventricle at end diastole...describes what? preload total force (diastolic pressure and resistance) opposing ventricular ejection afterload right ventricular preload is..? RAP left ventricular preload is? PCWP right ventricular afterload is? PVR left ventricular afterload is? SVR the volume of blood ejected from the ventricle with each contraction is what? stroke volume an agent that alters cardiac contractility, positive (increases) vs. negative (decreases) describes what? inotropic an agent that laters heart rate, positive (increases) vs. negative (positive) describes what? chronotropic the beginning of the second hump on an arterial pressure waveform, when the pressure being measured is the pulmonary arterial pressure; it represents the closure of the pulmonic valve dicrotic notch atrial systole; atria contract and push remaining blood into ventricles describes what? atrial kick the force of myocardial muscle fiber contraction for a given preload and afterload is a measure of the heart's contractility contractility a number that can be used to evaluate the vascular component of the afterload of the right ventricle pulmonary vascular resistance (PVR) a number that can be used to evaluate the vascular component of the afterload of the left ventricle systemic vascular resistance (SVR) % of end diastolic blood volume ejected with each heartbeat. provides an estimate of ventricular contractibility ejection fraction normal ejection fraction is? 65-75% if the ejection fraction is ___% or less, exercise tolerance is limited; the heart cannot maintain adequate cardiac output. 30 the more the heart is filled, the greater the contractile force and stroke volume, within physiological limits is what? starling's law cardiac output per body size; cardiac output divided by body surface area. equalizes cardiac output between individuals of different body size. describes what? cardiac index blood returning to the heart via the inferior and superior vena cava and the coronary sinus venous return difference between the systolic and diastolic blood pressures pulse pressure Pulse pressure below normal or narrow may indicate _______? hypovolemia Normal blood pressure of 120/80 = a pulse pressure of what? 40mmhg indications for placing an arterial line: (3) 1) severe hypotension (shock) 2) severe hypertension 3) unstable respiratory failure Pressures greater than _____ are termed hypertensive. 140/90 Pressures lower than _____ are termed hypotensive. 90/60 _______ occurs with hypovolemia, cardiac failure, and vasodilation. hypotension _______ occurs with vasoconstriction, increased contractility, and hypervolemia. hypertension MAP equation systolic pressure + (diastolic pressure x 2) / 3 normal SvO2 68-77% normal cardiac output (CO) 4-8 normal cardiac index (CI) 2.5-5 normal systemic vascular resistance (SVR) 900-1400 dynes normal pulmonary vascular resistance (PVR) 110-250 dynes _____ can help distinguish cardiogenic pulmonary edema (left heart failure) from noncardiogenic pulmonary edema, as occurs in ARDS. PCWP wedge pressure A/an _______ in PCWP would be present with cardiogenic pulmonary edema. increase the presence of a _________PCWP indicates noncardiogenic pulmonary edema normal Balloon is _________ during diastolem which displaces blood back toward the coronary arteries, enhancing coronary perfusion. inflated balloon ________ at the beginning of systole. deflates