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Fccs Exam/356 Questions and Answers/100% Verified!!
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Fccs Exam/356 Questions andAnswers/100% Verified!!
What is the most important sign in a critically ill pt? Why? - -Tachypnea
Indicates metabolic acidosis (often w/ respiratory alkalosis compensation)
-A pt misses dialysis for a few days and comes in with fluid overload. He's
tachycardic and tachypneic. On physical exam, you find JVD, pulsus
paradoxus (20 mmHg drop during inspiration), and HoTN (80/40) with
distant, muffled heart sounds. Lungs are clear to auscultation. What is the
dx? - -Cardiac tamponade; obstructive shock
-If a pt has a thyromental distance of 2 cm, what can you expect about their
airway? - -Difficult airway w/ an anteriorly displaced larynx
-A COPD pt comes in with difficulty breathing. He then becomes apneic and
unresponsive. How would you ventilate this pt? - -BVM
-A pt arrives after falling from a ladder and has a frontal laceration. On
examination, you find papilledema and labored breathing w/o being able to
clear secretions. What is your biggest concern when intubating this pt? - -
Cerebral edema/increasing ICP
Intubation tends to cause an increase in ICP. Administer lidocaine prior to
intubation to inhibit vagal stimulation.
-An ESRD pt w/ hyperkalemia develops dyspnea and requires intubation.
Which paralytic agent/NMB should you avoid and why? - -Succinylcholine
Worsens hyperkalemia
-A pt is admitted after an OD. He starts to have apneic episodes and his
SpO2 is dropping. You place him on a non-rebreather mask w/ 100% O2, yet
his SpO2 remains at 80%. Why is it not being corrected?
Then, if you try a BVM and it also fails, and video laryngoscopy is
unavailable, what is your next best choice for an airway? - -The pt is having
apneic episodes, which means that administering high-flow O2 will be
ineffective.
Choose an LMA if the BVM fails.
, -What intervention improves outcomes with ROSC after cardiac arrest? - -
Targeted temperature management.
32-36 C
-A shunt means there is perfusion without ventilation. What disease process
is an example of a shunt? - -Pneumonia
-Which type of respiratory failure occurs with CNS depression after an OD? -
-Acute hypercapnic respiratory failure --> mixed
-A 50 y/o pt is having a COPD exacerbation. You have tried steroids,
bronchodilators, etc. with no improvement. PCO2 is in the 90s, pH is 7.20.
You decide to intubate. Vent settings are: VT 375, RR 20, FiO2 .35, PEEP 5.
CXR is normal. A few minutes later, his BP drops to 70/40. Lungs are
clear/equal. Vent shows peak airway pressure of 55 (high) and plateau
pressure of 15. End expiratory hold gives auto-peep of 15.
What is the cause of this pt's HoTN and why? - -Auto-peep is the cause.
COPD pts have difficulty exhaling --> pressure buildup in alveoli.
We use PEEP for the pressure and to improve oxygenation. Auto-peep comes
from breath-stacking --> intrinsic peep. Alveoli enlarge --> high peak airway
pressure. All leads to low venous return --> low CO --> HoTN
-A COPD pt is admitted to the ICU for exacerbation. Pt is on a vent. Pt is tx
w/ bronchodilators, steroids, and Abx. ABG was normal 1 hr ago, but now the
peak airway pressure is up to 55 and plateau pressure is also high at 50. Pt
becomes hypotensive at 70/40. You observe tracheal deviation to the R.
Normal breath sounds on the right, diminished on the left. No wheezing. WBC
is normal.
What is the dx and treatment? - -Tension pneumothorax
Needle decompression/chest tube
-A pt in ARDS s/p pneumonia is on 100% FiO2 with PEEP of 22. PO2 is 88%.
Peak airway pressure and plateau are both high. VT is 5 ml/kg.
How can you decrease the airway pressures? - -Decrease the PEEP, even
though it will decrease PaO2.
(Note: you can't decrease the VT because it is already on the low end).
, -A young asthmatic pt is on the vent. His lungs are very tight. He is on the
AC setting and there is a lot of auto-PEEP. You correct it by reducing the rate,
giving him more time to exhale and making sure he has enough flow. FiO2 is
at .50. He is sedated and seems comfortable. On ABG the pH is 7.24, CO2 is
65, O2 is 80, and bicarb is 29.
What would you do with the vent settings in this case? - -Keep the settings
where they are.
You can't hyperventilate the pt to blow off CO2 b/c the asthma will worsen.
As long as the pH is > 7.2, the settings are okay as they are. CO2 will correct
over time.
-Which two conditions are the most indicated for BiPAP? - -COPD
exacerbation
Cardiogenic pulmonary edema
-A 70 y/o pt with CHF presents with SOB, accessory muscle use, RR 34,
SpO2 90% on 8L O2. CXR reveals infiltrates in a bat wing pattern. She also
has LE edema. She is dx with a CHF exacerbation w/ respiratory failure. Her
ABG shows pH 7.3, PO2 64, CO2 50.
What is the best tx for this pt? - -Non-invasive BiPAP.
-A pt comes in w/ a femur fx and a rod is placed. Post-op he develops
dyspnea and fever. HR 140, RR 30, SpO2 92% on non-rebreather. He is
transferred to the ICU where you intubate, place a central line, and start
resuscitating him. Hb 8.2, lactate 3.2, SVO2 is 52%.
Why is his SVO2 low? How can we improve it? - -Decreased O2 delivery and
increased consumption.
(normal is 65-70)
Administer packed RBCs - 1U of blood will change his Hb from 8.2 to 9.2. O2,
fluid, and VT would not work.
-A young pt after an MVA comes to the ER hypotensive and tachycardic. CXR
is clear. He has a contusion on his chest wall and torso. He is unconscious.
What will give you the best insight on what is causing his shock?
Hb
SCV
Urine Output
FAST exam - -FAST exam
, -41 y/o pt in the SICU following debridement of b/l lower extremities for
necrotizing fasciitis is intubated on AC. Temp 102, HR 116, RR 16, BP 92/46.
ABG shows pH 7.23, PO2 133, PCO2 38, Na 139, K 3.7, Cl 102, Bicarb 16,
lactate 4. Dx is metabolic acidosis w/ anion gap d/t infection.
What is the most appropriate intervention?
Increase VT
Continue resuscitation
Decrease RR
Administer bicarb - -Continue resuscitation. Don't need to increase VT bc the
pt doesn't have respiratory acidosis. If you decrease the RR, the pt will go
into respiratory acidosis.
-A pt has obstructive uropathy. A catheter is placed d/t the obstructive
kidney injury. After the cath is placed, he has massive diuresis to the point
where he is hypotensive, tachy, and lactate is 2x the ULN from decreased
perfusion.
How would you correct this? - -Fluids - LR
-When treating hyponatremia, what is the first thing to assess?
When do you give 3% NaCl?
How do you correct it? - -1. fluid status
2. seizures or changes in mental status
3. slowly, 8-12 meq over 24 hr
-What are the classifications of hemorrhagic shock? - -I: <15%; HR <100,
BP normal, RR normal
II: 15-30%; HR >100, BP normal, RR 20-30
III: 30-40%; HR >120, BP low, RR 30-40
IV: >40%; HR >140, BP low, RR >40
-An 84 y/o pt fell down the stairs. He is moaning and crying. He has a C-
collar in place. His neck is painful and he has bruising on his face. He is tachy
but BP is okay. You administer 2L O2 bc SpO2 was 92%. Shortly after he
deteriorates, becoming altered and then comatose. His left pupil > the right.
He is herniating from cerebral edema.
How do you treat him? - -Intubate and ventilate, maintaining c-spine
precautions. Administer mannitol.
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