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Complex Adult Health final QUESTIONS AND ANSWERS 100% CORRECT

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Complex Adult Health final QUESTIONS AND ANSWERS 100% CORRECT Indication for arterial line placement? Correct Answer: Hemodynamic monitoring Multiple blood samples Diagnostic or interventional r... adiology procedures Continuous cardiac output monitoring What test must be preformed prior to an arterial line placement? Correct Answer: Allen's test How often should a fast flush test be preformed? Correct Answer: Every 8 hours After blood draws If the hemodynamic status changes When changing tubing What are the most common sites for arterial line insertion? Correct Answer: Radial Femoral Axillary Dorsalis Pedis Brachial Arteries Positioning for radial arterial line placement: Correct Answer: 30-60 degrees of dorsiflexion with the aid of a roll of gauze and an armband. Avoid hyperabduction of the thumb. How often should the atrial line catheter be changed out? Correct Answer: Every 7 days Causes of inaccuracy in arterial line readings: Correct Answer: Air bubbles in the catheter system Failure to zero the transducer air-fluid interface Blood in the catheter system Blood clot at the catheter tip Kinking of the tubing system Catheter tip lodging against the arterial wall Soft, compliant tubing Long tubing Too many stopckcks (>3) What is the pathology of afterload? Correct Answer: The pressure in which the heart must pump against in order to eject blood during systole. Medications that reduce afterload/preload include? Correct Answer: Vasodilators What is the pathology of preload? Correct Answer: The filling pressure of the heart at end of diastole. What is systemic vascular resistance (SVR)? Correct Answer: Resistance the left ventricle must overcome to open the aortic valve and eject a volume of blood into systemic circulation. Systemic vascular resistance (SVR) is used for what calculations? Correct Answer: Blood pressure Blood flow Cardiac function What is pulmonary vascular resistance (PVR)? Correct Answer: Resistacne the right ventricle must overcome to open the pulmonic valve and eject a volume of blood in the pulmonary vasculature. What is pulmonarartery occlusion pressure (PAOP)? Correct Answer: The pressure created by the volume of blood that remains in the left heart at end-diastole. Inotropic drugs mode of action: Correct Answer: Negative inotropic drugs weaken the force of muscular contractions. Positive inotropic drugs increase the strength of muscular contractions. Inotropic drug examples: Correct Answer: Dobutamine Digoxin Milrinone Dopamine Vasodilator mode of actions: Correct Answer: Relaxes the smooth muscles of the blood vessels opening them up. Vasodilator drug examples: Correct Answer: CCBS: Verapamil (Calan, Isoptin) Diltiazem (Cardizem) Atorvastatin (Lipitor) Nitrates: Sildenafil (Viagra) Nitroprusside (Nipride, Nitropress) ACE: Captopril (Capoten) Lisinopril (Prinivil, Zestril) Kayexalate Correct Answer: Exchanges K+ ions for Na+ Excess K+ ions are fecally excreted Calcium Gluconate Correct Answer: Prevents and treats cardiac toxicity related to increased K+ levels What is the purpose of Continuous Renal Replacement Therapy (CRRT)? Correct Answer: Dialysis This is a blood filtering therapy that replaced the normal blood-filtering function of the kidneys in patients with renal failure and acute kidney injuries. The prerenal system Correct Answer: Delivers blood to the kidneys. A prerenal block is: Correct Answer: An interruption on the way to the kidneys. The intrarenal system Correct Answer: Processes ultra-filtrate by tubular secretion & re-absorption. An intrarenal block is: Correct Answer: Direct damage to the kidneys. The postrenal system Correct Answer: Excretes kidney waste products through the ureters, bladder, and urethra. A postrenal block is: Correct Answer: Obstruction of urine output. Causes: Enlarged prostate Kidney stones Bladder tumor Bladder injury S/SX of the oliguric phase of acute kidney injury (AKI): Correct Answer: <400 mL/24hr Increase BUN, Cr, uric acid, K, Mg Metabolic Acidosis S/SX of the diuretic phase of acute kidney injury (AKI): Correct Answer: Urine output 1-3L/day Decreased K & Na S/SX of the risk stage of acute kidney injury (AKI): Correct Answer: Cr >1.5xbaseline Urine output <0.5ml/kg/hr for 6+ hours S/SX of the injury stage of acute kidney injury (AKI): Correct Answer: Cr >2xbaseline Urine output <0.5ml/kg/hr for 12+ hours S/SX of the risk failure of acute kidney injury (AKI): Correct Answer: Cr >3xbaseline Urine output <0.3ml/kg/hr for 12+ hours Priority assessment findings of acute kidney injury (AKI): Correct Answer: Respiratory: Crackles Pleural Effusion Kussmaul respirations Cardiovascular: CHF, hypo/hypertension Cardiac dysrhythmias Pericarditis, pericardial effusion Neurologic: Altered mentation, confusion, lethargy Decreased seizure threshold S/SX of hypovolemic shock: Correct Answer: Elevated HR, decreased BP, tachypnea, oliguria, cool pale skin, decreased mental status, flat neck veins, decreased CO CI RAP PAP PAOP, elevated SVR, decreased SvO2. Dehydration causes elevated HCT Blood loss causes decreased HCT Possible causes of hypovolemic shock: Correct Answer: External loss of blood External loss of fluid Internal sequestration of blood fluid (3rd spacing) Management of hypovolemic shock: Correct Answer: Eliminate and treat the cause Replace lost volume with appropriate fluid (NS or LR) Initial shock Correct Answer: Inadequate intravascular volume Initial shock clinical presentation: Correct Answer: There are no obvious clinical indications of hypoperfusion seen in this stage of shock May see a drop in cardiac output Compensatory shock Correct Answer: Inadequate myocardial contractility Compensatory shock neural compensation S/SX: Correct Answer: HR & contractility increase Systemic vasoconstriction and redistribution of blood occurs Venous vasoconstriction augments venous return to the heart Blood is shunted from the kidneys, GI tract, and skin Respiratory rate and depth are increased Increased blood glucose levels Dilated pupils, peripheral vasoconstriction, Sweat gland activity causing cool moist skin Compensatory shock endocrine compensation S/SX: Correct Answer: Increased blood glucose Reabsorbtion of salt and water increasing intracascular volume and BP RAAS >Renin > Angiotensinogen > Angiotensinogen 1 > Angiotensinogen 2 > increases BP and venous return to the heart Angiotensinogen 2 activates the adrenal cortex for the release of aldosterone Compensatory shock chemical compensation S/SX: Correct Answer: Perfusion begins to decline Rate and depth of respiration increase Hyperventillation >CO2 is released > Respiratory alkalosis occurs Vasoconstriction of cerebral blood vessels occurs > Cerebral hypoxia & ischemia may result Compensatory shock clinical presentation: Correct Answer: Elevated HR Narrowed pulse pressure Rapid, deep respirations causing respiratory alkalosis Thirst Cool, moist skin [Show More]

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