CRITICAL CARE EXAM WELL- ELABORATED
WITH QUESTIONS AND 100% CORRECT
ANSWERS
What is ocreotide, a prokinetic, used for? - CORRECT ANSWER paralytic ileus and
partial obstruction
T/F: UC is the form of IBD in which all of the layers of the GI track are affected and
there are skip lesions. - CORRECT ANSWER FALSE: CHRONS; UC is primarily the
rectum and the recto sigmoid colon and the lesions are not full thickness
T/F: Barium enemas are contraindicated for diverticulitis - CORRECT ANSWER true
What are the medications for UC/Chrons? any special considerations? - CORRECT
ANSWER 5-aminosalicylic acid- reduces inflame and inhibits prostaglandin release
(surfasalazine: 2-4 wk for therapeutic effects, avoid sun, urine/skin/contact lenses can
have yellow-orange color, watch for agranulocytosis and kidney toxicity; olsalazine
(non-sulfa): same but lesser effects)
Corticosteroids
Immunosuppressant’s (cyclosporine, methotrexate, azathioprine)
Immunomodulatory (infliximab)- watch for bleeding and infection, stay away from
crowds
Antidiarrheal (loperamide, atropine)
What is the dietary recommendation to someone with hepatitis? - CORRECT ANSWER
high cal, high carb, low to mod fat, low to mod pro, small and frequent meals
what is the ref range for indirect bilirubin? total? - CORRECT ANSWER I: 0.2-0.8 mg/dl
T: 0.3-1 mg/dl
what is normal serum protein? serum alb? - CORRECT ANSWER pro: 6.4-8.3 g/dl
alb: 3.5-5 g/dl
What are the normal values for AST? ALT? ALP? - CORRECT ANSWER AST: 4-36 u/l
ALT: 0-35 u/l
ALP: 30-120 u/l
What is the expected ref range for RBC's? HBG? HCT? - CORRECT ANSWER RBC:
F- 4.2-5.4 mil/ul, M- 4.7-6.1 mil/ul
HBG: F- 12-16 g/dl, M- 14-18 g/dl
HCT: F- 37-47%, M- 42-52%
,What kinds of meds are used for hepatitis? - CORRECT ANSWER diuretics, BB
(decrease rf bleeding with varices), lactulose (get rid of ammonia), no absorbable abx
(get rid of ammonia)
What is the teaching that should be done with a client undergoing an EEG? -
CORRECT ANSWER wash hair prior, be sleep deprived if needed, will be stimulated
with hyperventilation to flashing lights to induce seizure-like activity, avoid taking any
stimulant or sedative meds 12-24 hours’ prior
what does the GCS scoring mean? - CORRECT ANSWER >/= 8 is severe head trauma
9-12 is moderate injury
13 is minor injury
Following a lumbar puncture, what should the nurse do with a reported HA? -
CORRECT ANSWER put the patient supine
administer opioids
encourage the patient to increase fluids
What information is essential before a pateint undergoes a cerebral angiography? -
CORRECT ANSWER are they pregnant?
do they take blood thinners?
are they allergic to shellfish or iodine?
have they eaten in the last 4-6 hours?
Meningitis vaccines: Who receives the hemophilic type b (Hib) vaccine? the
pneumococcal polysaccharide vaccine (PPSV)? the meningococcal vaccine (MCV4)? -
CORRECT ANSWER Hib: babies
PPSV: elderly who smoke, are immunocompromised, have chronic disease, or live in a
long term care facility
MCV4: college students
What are the signs of meningitis? - CORRECT ANSWER HA, nuchal rigidity (kernigs
and brudzinski), n/v, hyperactive DTR's, tachycardia, seizures, red macular rash, and
restlessness
If CSF comes back cloudy and with decreased glucose what is the suspected dx? -
CORRECT ANSWER bacterial meningitis; clear will be viral
t/f: meningitis must be reported to the public health dept. - CORRECT ANSWER t
t/f: a patient with increased ICP should be given opioids for pain - CORRECT ANSWER
f; can mask the effects of increased ICP
What medications are contraindicated when taking phenytoin? - CORRECT ANSWER
oral contraceptives and warfarin
,What kind of seizure is vagal nerve stimulation used for? what should a patient do at the
onset of a seizure if they are receiving this therapy? - CORRECT ANSWER partial
put a magnet over the vagal nerve stimulating device
What is the definition of status epilepticus? - CORRECT ANSWER
>1 seizure in 30 minutes
a single seizure lasting longer than 5 minutes
T/F: The patient should not take their seizure meds before a brain tissue biopsy. -
CORRECT ANSWER
F; they should d/c all med but their seizure meds
What medications are used for a patient with a brain tumor? - CORRECT ANSWER
1. non-opioid analgesics
2. corticosteroids (decrease cerebral edema)
3. anticonvulsants
4. H2 antagonists (cushings stress ulcers)
5. Antiemetics
What is patient position following a post-op supratentorial craniotomy? infratentorial? -
CORRECT ANSWER supra: HOB 30 with neutral alignment
infra: flat and side lying turning side to side q2h fo 24-48 hours
How do you detect CSF leakage post head trauma? - CORRECT ANSWER halo sign:
yellow stain surrounded by blood on a paper towel
fluid tests: positive for glucose
Cushing's triad indicated head injury and increased ICP. What are the three aspects of
this condition? - CORRECT ANSWER hyperon, widening pulse pressure, and
bradycardia
what is the last sense to go after experiencing a head injury? - CORRECT ANSWER
hearing
What is another name for a medically-induced coma and why do we do these? -
CORRECT ANSWER barbiturate coma
decreases metabolic demand and allows time for increased ICP to resolve
what is cerebral salt wasting? - CORRECT ANSWER complication of neuro surgery
prevents renin and aldosterone release and causes excessive excretion of sodium
hypovolemia
What are the functions of the left side of the brain, what can you expect to see with a
stroke in this area? - CORRECT ANSWER functions: language, math, analytic thinking
deficits: expressive and receptive aphasia, agnosia (cannot remember the names of
familiar objects), alexia (difficulty reading), agraphia, right extremity hemiplegia
, what are the functions of the right side of the brain? what can you expect to see with a
stroke in this area? - CORRECT ANSWER jobs: visual/spatial awareness and
proprioception
deficits: altered perception of deficits (overestimation of abilities), one sided neglect,
loss of depth perception, poor impulse control and judgement, left hemiplegia, visual
changes such as hemianopsia
Above which point on the spine do we see SCI pose the largest risk for impaired
spontaneous ventilation? - CORRECT ANSWER C4
When does neurogenic shock happen? what does one see? - CORRECT ANSWER
w/in 24 hours of SCI
decreased CO, HR, vasodilation, edema, hypotension, decreased temperature
T/F: Upper motor neuron injuries (above L1 and L2) will convert to spastic muscle tone
after neurogenic shock, and LMN injuries convert to flaccid paralysis. - CORRECT
ANSWERT
What are baclofen and dantrolene used for? - CORRECT ANSWER muscle relaxors
such as with severe muscle spasticity following an SCI
Injury below what level of the spine is autonomic dysrreflexia no longer a concern? -
CORRECT ANSWER T6
What are some patient education points with levothyroxine? - CORRECT ANSWER
take 30-60 min before breakfast, monitor for tachycardia/SOB/palpitations, consult with
MD before taking calcium/iron/antacids
what are the signs of hypothyroidism? - CORRECT ANSWER irritability, cold
intolerance, pallor, weight gain, bradycardia, periorbital edema, thick
skin/fingernails/eyebrows, sweeling in hands, feet, and face, hoarseness, decreased
libido, decreased taste/smell
What does the ACTH test (cosynotropin test) reveal? - CORRECT ANSWER with
primary, plasma cortisol levels don’t rise
with secondary, plasma cortisol levels are decreased
What is the treatment for addisonian crisis? - CORRECT ANSWER to combat
hyperkalemia: insulin/dextrose and loop/thiazide diuretics
NS to replenish fluid volume and
sodium bicarb to combat acidity
hydrocortizone
h2 antagonists
Insulin review - CORRECT ANSWER **** No mixing long acting insulin with anything
WITH QUESTIONS AND 100% CORRECT
ANSWERS
What is ocreotide, a prokinetic, used for? - CORRECT ANSWER paralytic ileus and
partial obstruction
T/F: UC is the form of IBD in which all of the layers of the GI track are affected and
there are skip lesions. - CORRECT ANSWER FALSE: CHRONS; UC is primarily the
rectum and the recto sigmoid colon and the lesions are not full thickness
T/F: Barium enemas are contraindicated for diverticulitis - CORRECT ANSWER true
What are the medications for UC/Chrons? any special considerations? - CORRECT
ANSWER 5-aminosalicylic acid- reduces inflame and inhibits prostaglandin release
(surfasalazine: 2-4 wk for therapeutic effects, avoid sun, urine/skin/contact lenses can
have yellow-orange color, watch for agranulocytosis and kidney toxicity; olsalazine
(non-sulfa): same but lesser effects)
Corticosteroids
Immunosuppressant’s (cyclosporine, methotrexate, azathioprine)
Immunomodulatory (infliximab)- watch for bleeding and infection, stay away from
crowds
Antidiarrheal (loperamide, atropine)
What is the dietary recommendation to someone with hepatitis? - CORRECT ANSWER
high cal, high carb, low to mod fat, low to mod pro, small and frequent meals
what is the ref range for indirect bilirubin? total? - CORRECT ANSWER I: 0.2-0.8 mg/dl
T: 0.3-1 mg/dl
what is normal serum protein? serum alb? - CORRECT ANSWER pro: 6.4-8.3 g/dl
alb: 3.5-5 g/dl
What are the normal values for AST? ALT? ALP? - CORRECT ANSWER AST: 4-36 u/l
ALT: 0-35 u/l
ALP: 30-120 u/l
What is the expected ref range for RBC's? HBG? HCT? - CORRECT ANSWER RBC:
F- 4.2-5.4 mil/ul, M- 4.7-6.1 mil/ul
HBG: F- 12-16 g/dl, M- 14-18 g/dl
HCT: F- 37-47%, M- 42-52%
,What kinds of meds are used for hepatitis? - CORRECT ANSWER diuretics, BB
(decrease rf bleeding with varices), lactulose (get rid of ammonia), no absorbable abx
(get rid of ammonia)
What is the teaching that should be done with a client undergoing an EEG? -
CORRECT ANSWER wash hair prior, be sleep deprived if needed, will be stimulated
with hyperventilation to flashing lights to induce seizure-like activity, avoid taking any
stimulant or sedative meds 12-24 hours’ prior
what does the GCS scoring mean? - CORRECT ANSWER >/= 8 is severe head trauma
9-12 is moderate injury
13 is minor injury
Following a lumbar puncture, what should the nurse do with a reported HA? -
CORRECT ANSWER put the patient supine
administer opioids
encourage the patient to increase fluids
What information is essential before a pateint undergoes a cerebral angiography? -
CORRECT ANSWER are they pregnant?
do they take blood thinners?
are they allergic to shellfish or iodine?
have they eaten in the last 4-6 hours?
Meningitis vaccines: Who receives the hemophilic type b (Hib) vaccine? the
pneumococcal polysaccharide vaccine (PPSV)? the meningococcal vaccine (MCV4)? -
CORRECT ANSWER Hib: babies
PPSV: elderly who smoke, are immunocompromised, have chronic disease, or live in a
long term care facility
MCV4: college students
What are the signs of meningitis? - CORRECT ANSWER HA, nuchal rigidity (kernigs
and brudzinski), n/v, hyperactive DTR's, tachycardia, seizures, red macular rash, and
restlessness
If CSF comes back cloudy and with decreased glucose what is the suspected dx? -
CORRECT ANSWER bacterial meningitis; clear will be viral
t/f: meningitis must be reported to the public health dept. - CORRECT ANSWER t
t/f: a patient with increased ICP should be given opioids for pain - CORRECT ANSWER
f; can mask the effects of increased ICP
What medications are contraindicated when taking phenytoin? - CORRECT ANSWER
oral contraceptives and warfarin
,What kind of seizure is vagal nerve stimulation used for? what should a patient do at the
onset of a seizure if they are receiving this therapy? - CORRECT ANSWER partial
put a magnet over the vagal nerve stimulating device
What is the definition of status epilepticus? - CORRECT ANSWER
>1 seizure in 30 minutes
a single seizure lasting longer than 5 minutes
T/F: The patient should not take their seizure meds before a brain tissue biopsy. -
CORRECT ANSWER
F; they should d/c all med but their seizure meds
What medications are used for a patient with a brain tumor? - CORRECT ANSWER
1. non-opioid analgesics
2. corticosteroids (decrease cerebral edema)
3. anticonvulsants
4. H2 antagonists (cushings stress ulcers)
5. Antiemetics
What is patient position following a post-op supratentorial craniotomy? infratentorial? -
CORRECT ANSWER supra: HOB 30 with neutral alignment
infra: flat and side lying turning side to side q2h fo 24-48 hours
How do you detect CSF leakage post head trauma? - CORRECT ANSWER halo sign:
yellow stain surrounded by blood on a paper towel
fluid tests: positive for glucose
Cushing's triad indicated head injury and increased ICP. What are the three aspects of
this condition? - CORRECT ANSWER hyperon, widening pulse pressure, and
bradycardia
what is the last sense to go after experiencing a head injury? - CORRECT ANSWER
hearing
What is another name for a medically-induced coma and why do we do these? -
CORRECT ANSWER barbiturate coma
decreases metabolic demand and allows time for increased ICP to resolve
what is cerebral salt wasting? - CORRECT ANSWER complication of neuro surgery
prevents renin and aldosterone release and causes excessive excretion of sodium
hypovolemia
What are the functions of the left side of the brain, what can you expect to see with a
stroke in this area? - CORRECT ANSWER functions: language, math, analytic thinking
deficits: expressive and receptive aphasia, agnosia (cannot remember the names of
familiar objects), alexia (difficulty reading), agraphia, right extremity hemiplegia
, what are the functions of the right side of the brain? what can you expect to see with a
stroke in this area? - CORRECT ANSWER jobs: visual/spatial awareness and
proprioception
deficits: altered perception of deficits (overestimation of abilities), one sided neglect,
loss of depth perception, poor impulse control and judgement, left hemiplegia, visual
changes such as hemianopsia
Above which point on the spine do we see SCI pose the largest risk for impaired
spontaneous ventilation? - CORRECT ANSWER C4
When does neurogenic shock happen? what does one see? - CORRECT ANSWER
w/in 24 hours of SCI
decreased CO, HR, vasodilation, edema, hypotension, decreased temperature
T/F: Upper motor neuron injuries (above L1 and L2) will convert to spastic muscle tone
after neurogenic shock, and LMN injuries convert to flaccid paralysis. - CORRECT
ANSWERT
What are baclofen and dantrolene used for? - CORRECT ANSWER muscle relaxors
such as with severe muscle spasticity following an SCI
Injury below what level of the spine is autonomic dysrreflexia no longer a concern? -
CORRECT ANSWER T6
What are some patient education points with levothyroxine? - CORRECT ANSWER
take 30-60 min before breakfast, monitor for tachycardia/SOB/palpitations, consult with
MD before taking calcium/iron/antacids
what are the signs of hypothyroidism? - CORRECT ANSWER irritability, cold
intolerance, pallor, weight gain, bradycardia, periorbital edema, thick
skin/fingernails/eyebrows, sweeling in hands, feet, and face, hoarseness, decreased
libido, decreased taste/smell
What does the ACTH test (cosynotropin test) reveal? - CORRECT ANSWER with
primary, plasma cortisol levels don’t rise
with secondary, plasma cortisol levels are decreased
What is the treatment for addisonian crisis? - CORRECT ANSWER to combat
hyperkalemia: insulin/dextrose and loop/thiazide diuretics
NS to replenish fluid volume and
sodium bicarb to combat acidity
hydrocortizone
h2 antagonists
Insulin review - CORRECT ANSWER **** No mixing long acting insulin with anything
