1/8/2008 Baseline Exam for New Grads

PULMONARY
1. A patient is receiving ventilation through an endotracheal tube (ETT) via a positive pressure ventilator. SpO2 monitoring shows 97% with a good pleth waveform. The patient remains sedated and paralyzed. A low pressure alarm should provoke the critical care nurse to ___________________. 1 2 3 4

A. Page the respiratory therapist because ventilatory management is not in the nurses scope of practice.

B. Suction the mucous plug and insert a bite block to prevent further kinking of the ETT by the patient.

C. Check the patient for possible endotracheal tube dislodgement.

D. Ignore this alarm because it signals that the ventilator is re-cycling.

2. What does R.S.I. stand for? 1 2 3 4

A. Nothing medically relevant, named for the company that distributes intubation equipment.

B. Rapid Sequence Intubation

C. Rescue, Sedate, and Intubate

D. Received Sedation for Induction

3. Arterial Blood Gas (ABG) results are received on a patient that is being ventilated via a positive pressure ventilator. The patient has a known intracranial hemorrhage. The physician is attempting to prevent increases in ICP by decreasing the PaCO2. What changes to the ventilator would the critical care nurse expect? 1 2 3 4

pH 7.23
PaO2 100 mm Hg
PaCO2 47 mm Hg
HCO3 23 mm Hg
BE 1

A. Decrease the flow rate.

B. Increase the PEEP

C. Decrease the Tidal Volume (VT)

D. Increase the Rate (f)

4. A patient is in need of a standard central line to be placed in his subclavian vein. A complication that that nurse should observe for during and after the procedure is (are) __________________________. 1 2 3 4

A. Decreased Breath Sounds indicating a Pneumothorax.

B. Lidocaine Toxicity

C. Appropriate Arterial Pressure Waveform

D. Appropriate Bubbling in the Drainage Kit When Attached to Suction.

5. The FiO2 indicates the percentage of the inspired atmosphere that is oxygen. Normal FiO2 is _____________. 1 2 3 4

A. 100 %

B. 95-97%

C. Greater than 90% on room air

D. 21%

6. A patient has the following arterial blood gasses (ABGs) resulted. After careful examination, the nurse concludes that they indicate _________________________. 1 2 3 4
pH 7.30
PaO2 87
PaCO2 50
PaHCO3 24
BE -2
SaO2 95%

A. Normal ABG values

B. Metabolic Acidosis

C. Respiratory Acidosis

D. Metabolic Alkalosis

E. Respiratory Acidosis

7. A patient is being intubated for respiratory arrest by a first year EM resident. Auscultation of the lung fields reveals appropriate air movement in the right lung field and no breath sounds in the left lung field. The patients trachea is midline. End tidal CO2 detector confirms ETT placement in the trachea. SpO2 97% minimal amplitude noted on the pleth waveform. What immediate intervention by the resident would most likely correct the problem? 1 2 3 4

A. Chest tube placement in the left chest wall to relieve a pneumothorax.

B. Pull back the ETT as it is most likely inserted deep into the right mainstem bronchus.

C. Immediate chest thoracatomy for decreased breath sounds.

D. Needle decompression of the right sided chest wall.

8. An 87 year old woman is brought to the Emergency Department after being extracted from beneath her car after an MVC where her car caught on fire. She has no sensation or motor control below the nipple line, gross deformity to her pelvis and left lower extremity and approximately 50 % burns to her chest and abdomen. The decision has been made to protect her airway via ETT. Her Med-alert bracelet indicates she has Myasthenia Gravis. Which of the following drugs would be inappropriate to use as a paralyzing agent?
1 2 3 4

A. Succinylcholine

B. Rocuronium

C. Vecuronium

D. Pancuronium

9. A chest tube is placed in a patient to relieve a known pneumothorax. The chest tube is sewn in place after a chest x-ray has confirmed good placement. The critical care nurse notes that there is continuous bubbling noted in the water seal chamber of the chest drainage kit. She also notes a “rice crispy” texture to the patient’s subcutaneous tissue when she palpates the chest. These assessment findings are most indicative of ________________. 1 2 3 4

A. Cardiac Tamponade

B. Trachea and/or Bronchial Tree Injury

C. Ventricular Hemmorhage

D. Empyema

10. A patient is being prepped for a shoulder reduction to be performed while the patient undergoes conscious sedation. SpO2 is 100% HR-87. BP 135/80. The most important intervention to be performed by the nurse prior to initiating conscious sedation is _______________________. 1 2 3 4

A. Obtaining a physician signature prior to administering any sedatives.

B. Initiating at least 2 large bore IV’s in case the patient has an allergic reaction to the medication.

C. Administering high flow oxygen via non-rebreathing mask.

D. Determining the last PO intake of the patient.

CARDIOVASCULAR

1. The p wave on a standard ECG strip indicates _______________________. 1 2 3 4

A. Ventricular Repolarization

B. Atrial Contraction

C. Sinoatrial Node Depolarization

D. AV Node Hyperpolarization

2. The following ECG rhythm strip indicates ___________________. 1 2 3 4
A. Ventricular Tachycardia

B. Normal Sinus Rhythm

C. Third Degree AV Block

D. SVT

3. A patient experiencing chest pain has ST segment elevation in leads II, III, and aVF and changes in reciprocal leads. This indicates a(n) ___________________. 1 2 3 4

A. Anterior Wall Myocardial Infarction

B. Inferior Wall Myocardial Infarction

C. Aortic Stenosis

D. Occlusion of the Left Anterior Descending (LAD) Coronary Artery.

4. A patient is being prepped to go to the Cath Lab following a coronary event. He is awake, alert and oriented. His skin is warm and dry. Vital signs are stable. Which of the following drugs is NOT likely to be administered? 1 2 3 4

A. Negative Chronotropic Agent

B. Preload Reducer

C. IIb/IIIa glycoprotein inhibitor

D. Thrombolytic therapy

E. All are correct

F. None are correct

5. A 57 year old experiencing a decompensated congestive heart failure (CHF) is brought to the AED. In addition to other therapy, he received 6 mg Morphine Sulfate and 4 Nitroglycerin sublingual tablets en route without relief. His current blood pressure is 180/125 and HR is 87 bpm. A Nitroglycerin infusion has been ordered to be started and titrated to effect. What is the appropriate rate to begin this infusion? (The Nitroglycerin is mixed 50 mg/250 cc) 1 2 3 4

A. 5 cc/hr

B. The patient should receive Nitroprusside and an A-line because the Nitroglycerin is not working.

C. allow the pump to accurately determine the rate based on Guardrail drug default settings.

D. no less then 32 cc/hr

6. A patient with a subclavian line has had a CVP calculated to be 20 mm Hg. The medical student would like to increase the patient’s preload by administering fluid. Spo2 is 91% with a poor waveform. The appropriate nursing response would be __________________. 1 2 3 4

A. Administer the fluid as ordered and document the clinical status of the patient.

B. Suggest that the CVP is too low and recommend an additional vasoconstrictor.

C. Suggest that the CVP is too high and that a diuretic may be more appropriate to decrease the patients preload.

D. Do nothing and have a more experienced nurse take over.

7. To adequately affect cardiac output, the nurse would initiate therapy that would affect all of the following variables EXCEPT _______________________. 1 2 3 4

A. Afterload

B. Preload

C. Heart Rate

D. Stroke Volume

E. All of the above

F. None of the above.

8. Which of the following is not a conduction system of the heart? 1 2 3 4

A. Sino-Atrial Nodal Pathway

B. Bauchman’s Bundle

C. Bundle of His

D. Vena Caval Bundle

9. The most common cardiac structure injured during trauma is which of the following?
1 2 3 4

A. Right Ventricle

B. Left Ventricle

C. Right Atrium

D. Left Atrium

10. Which of the following drugs does not decrease ventricular preload? 1 2 3 4

A. Lasix

B. Nitroglycerin

C. Nitroprusside

D. Hespan


NEUROLOGY

1. According to the Monro-Kellie hypothesis, a cerebral perfusion pressure (CPP) of 60-80 mm Hg is necessary to maintain cerebral blood flow. How does one calculate CPP?
1 2 3 4

A. Mean Arterial Pressure (MAP) – ICP (Intercranial Pressure)

B. Diastolic Pressure + 2 (Systolic Pressure)
3

C. Systolic Pressure– Diastolic Pressure

D. (1/3) Pulse Pressure + Diastolic Pressure

2. A patient experiencing a embolic cerebrovascular accident must receive thrombolytic therapy within 3 hours of the initial presentation of symptoms. At 6:50 pm, a 58 year old African American male presents to triage with obvious left sided weakness and facial droop. He is able to move all extremities. BP is 167/87, HR 98. He is awake, alert and able to provide only a limited history secondary to history of dementia. Live in family states that he has recently been ill and his current symptoms began at 2:00 p.m. the same day while he was holding his grandchild. Appropriate nursing triage interventions would be? 1 2 3 4

A. Ask the family to register the patient while you take him immediately to a monitored bed and alert the other healthcare members.

B. Direct the patient towards the waiting room and tell the family that he will be taken back as soon as shift change has been completed.

C. Direct the patient towards the waiting room and explain to the family that the doctors will not be able to do much since the patient is “outside the window” of any thrombolytic therapy.

D. Assign the patient a non-urgent acuity rating due to his history of neurological pathology and attribute his facial droop to an acute Bell’s palsy. Vitals are stable and the family has been instructed to report any acute changes in patient condition while they wait.

3. For optimal effect, the transducer of External Ventricular Drain (EVDs) should be level with what external anatomical landmark? 1 2 3 4

A. The phlebostatic axis.

B. The distal apex of the nasal cartilage

C. The angle of Louis (aka supra-sternal notch)

D. The tragus of the ear.

4. The internal anatomical equivalent of the answer to question #2 is ___________________. 1 2 3 4

A. The cerebral peduncle

B. The Foramen of Monro (aka the interventricular foramen)

C. The tricuspid valve in the floor of the right atrium

D. The Foramen of Lushka


5. A dilated or “blown” pupil is noted in the right eye of a young man experiencing a neurological herniation syndrome. What cranial nerve has been directly affected?
1 2 3 4

A. CN II

B. CN III

C. CN V

D. CN XI

6. Which of the following drugs used in neurologic emergencies has it’s primary mechanism of action sited in the renal tubules? What is the desired effect of this drug? 1 2 3 4

A. Rocuronium; increased sedation

B. Fosphenytoin; lowered seizure threshold

C. Mannitol; increased urine output

D. Atropine; decreased HR and increased CPP

7. A trauma patient s/p MVC arrives to the AED. He has no gross movement below is waist. He has no sensation below his umbilicus. Where is the likely site of his injury?
1 2 3 4

A. T4

B. L4

C. C4

D. T10

8. A 23 year old Hispanic male presents to triage after suffering a KSW to the mid back. He is carried in by his friends and immediately taken to a trauma room. He has no other injuries except for his KSW. Foley insertion reveals gross hematuria. After a complete neurologic exam, the critical care nurse notes that he has lost motor control and fine touch and vibratory sensation to the left side of his body below the level of injury. He has also lost pain and temperature sensation to the right side of his body below the level of injury. What neurologic syndrome is this man experiencing? 1 2 3 4

A. TIA

B. Central Cord Syndrome

C. Cauda Equina Syndrome

D. Brown-Sequard Syndrome

9. A patient is stating that he “has the worst headache of his life” that began right after having sex with his wife. He currently has no neurological deficits. What triage diagnosis does this man have until proven otherwise? 1 2 3 4

A. Headache

B. Epidural Hematoma

C. Subarachnoid Hemorrhage.

D. “Watershed” Infarction.

10. An EVD has been place in a patient suffering a hemorrhagic stroke. Blood is noted in the collecting chamber. The nurse should ______________________. 1 2 3 4

A. STAT page the physician for orders

B. Flush the blood back into the brain in order to maintain adequate flow.

C. Realize this is a normal finding when bleeding is extensive.

D. Test the fluid for a halo sign to confirm CSF.