BKAT Study Set QUESTIONS WITH
CORRECT ANSWERS
Normal blood gases; pH - CORRECT ANSWER-7.35-7.45
Normal blood gases: CO2 - CORRECT ANSWER-35-45
Normal blood gases: HcO3 - CORRECT ANSWER-22-26
Normal blood gases: PO2 - CORRECT ANSWER-80 or above
Normal vacuum pressures for suction? - CORRECT ANSWER-120-140 mmHg
What may a high pressure vent alarm indicate? - CORRECT ANSWER-Pt is biting on
the tubing, excessive secretions in the tubing, kinked tubing
What may a low pressure vent alarm indicate? - CORRECT ANSWER-cuff leak or the
tubing is disconnected somewhere
How do you verify positioning of an endotracheal tube? - CORRECT ANSWER--
auscultate lung bases and apices for bilateral breath sounds
-observe chest for symmetric chest wall movement
-confirm with end tidal CO2 measure
GOLD STANDARD: chest x-ray
t/f: people with ET tubes should be suctioned routinely - CORRECT ANSWER-FALSE--
they should be suctioned on an as needed basis
what should ET tube cuff pressure be kept at? - CORRECT ANSWER-20-25 mmHg
,What measures should nurses take to avoid ET tube problems? - CORRECT
ANSWER--confirm that exit mark on ET tube remains constant when providing
patient care, repositioning, and transporting patient
-maintain proper cuff inflation (listen for an air leak-- if pt can talk, you must inflate
more)
-continually monitor SpO2, RR, HR and rhythm, mental status, and ABGs
-pre-oxygenate before suctioning
What should be done if a patient is not tolerating ET tube suctioning? - CORRECT
ANSWER-STOP and manually hyperventilate with 100% oxygen
Measures to prevent aspiration? - CORRECT ANSWER--avoid bolus tube feedings
-monitor tube feeding residuals
-maintain HOB at LEAST 30 degrees or greater
-maintain proper ET tube cuff inflation
-perform frequent oral pharyngeal suctioning
-maintain an NG tube connected to low, intermittent suction if feeding tube is
placed below the pylorus
what are recommendations for preventing ventilator associated pneumonia? -
CORRECT ANSWER--manage ventilated patients without sedatives whenever
possible
-interrupt sedation once a day (spontaneous breathing trials)
-provide early exercise and mobility
-provide regular oral care
-minimize pooling of secretions above the ET tube cuff
-use ET tubes with subglottic secretion drainage for patients likely to require greater
than 72 hours of intubation
-keep HOB elevated 30-45 degress
-change ventilator circuit only if visibly soiled or malfunctioning
What is the biggest complication associated with high cervical spinal cord injuries? -
CORRECT ANSWER-BREATHING-- the diaphragm is innervated by C3-C5 levels
, C4-diaphragm
will likely need mechanical ventilation mgmt
signs and symptoms of increased intracranial pressure? - CORRECT ANSWER--
altered LOC
-headache
-bradycardia
-decreased respirations
-acute HTN with widening pulse pressure
-N/V
-worsening neuro deficits
-pupils that are nonreactive
What are the components of a neuro exam? (7) - CORRECT ANSWER-1. LOC
2. mental status and cognitive function
3. cranial nerves
4. motor
5. sensory
6. coordination
7. reflexes
What are the three components of the glasgow coma scale? - CORRECT ANSWER-1.
eye opening
2. motor
3. verbal
What is a negative and positive babinski reflex? what do each indicate? - CORRECT
ANSWER-negative (normal) response: toes curl downward
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