Clinical Simulations Exam 159 Questions with Verified Answers,100% CORRECT

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Clinical Simulations Exam 159 Questions with Verified Answers Visuals (things you will always choose...) - CORRECT ANSWER -general appearance -appearance of chest -respiratory pattern -sensorium... -posture -patient color -pulse Infant normals - CORRECT ANSWER Pulse: 110 - 160 BP: 60/40 mm Hg RR: 30 to 60 Birth Wt: 3000g APGAR: 7 to 10 Hemodynamic Normals - CORRECT ANSWER BP: 120/80 (90/60 to 140/90) MAP: 93 to 94 CVP: 2 to 6 mm Hg (4 to 12 cmH2O) PAP: 25/8 (mean 13 to 14) PWP/PCWP: 4 to 12 mm Hg CO: 4 to 8 LPM CI: 2.5 to 4 L/min/sq m UNACCEPTABLE bedside ventilatory parameters - CORRECT ANSWER VC: < 10mL/kg (or < 2 x VT) MIP/NIF: <20 cm H2O RR: >20 bmp or < 8 Vt: < 5mL/kg Ve: > 10 LPM MEP: < 40 cm H2O Vent Parameters... - CORRECT ANSWER Tidal Volume: 5 to 10 mL/kg -------asthma/ards use 4 mL/kg Pressure: Pplat from VC or up to 3 cm H2O Rate: 10 to 20 FiO2: 40 to 60% or set to prior PEEP: 2 to 6 or set to prior Infant vent settings - CORRECT ANSWER Vt: 4-6 mL/kg PIP: 20 to 30 Rate: 20 to 30 FiO2: 40 to 60% PEEP: 2 to 4 Airway resistance - CORRECT ANSWER PIP-Plateau Used to indicate the amount of pressure support neccessary to overcome airway resistance Body box is most accurate measurement Acid-fast Bacillus (AFB) - CORRECT ANSWER Staining (Ziehl-Neelsen) Dx of TB Organisms appear red against blue background Takes 2-3 weeks - Albumin - CORRECT ANSWER Normal 3.5-5.0 g/dl Decreased levels are seen in liver disease Angiogram - CORRECT ANSWER X-rays of vessels (veins and arteries) Evaluates blood flow to the brain, heart, lungs, etc. - Anion Gap - CORRECT ANSWER Normal: 8-18 MEq/L Identifys the cause of metabolic acidosis - Ascorbic acid level - CORRECT ANSWER Determination of the amount of vitamin C in the blood - Babinski relfex - CORRECT ANSWER Tests brainstem and spinal cord function Dorsiflex of the toes after stroking foot indacates positive test (lesion may be present) Used in stable, yet unconcious patients Basal metabolic rate - CORRECT ANSWER Term: Basal energy expenditure (BEE), Minimal energy expenditure (MEE) Determined through indirect calorimetry Helpful in determining a patients nutrional needs Basic metabolic panel (BMP) - CORRECT ANSWER Blood test (glucose, lytes, fuid levels, and kidney function) BCG vaccine - CORRECT ANSWER Immunization for TB - Bilirubin level - CORRECT ANSWER Normal: 0.1-1.0 mg/dl Orange-yellow pigment of bile May be useful if patient appears jaundiced Blood alcohol level - CORRECT ANSWER Sedation or tranquility: 50 mg/dl Lack of coordination: 50-150 mg/dl Intoxication (delerium): 140-200 mg/dl Unconsciousness: 300-400 mg/dl Fatal: >400 mg/dl Blood digoxin level - CORRECT ANSWER Increases cardiac contractility in patients with CHF Therapeutic: 0.9-2.0 ng/mL Toxic: > 3.0 ng/mL BGL - CORRECT ANSWER Normals: 20-30 (pre-term), > 30 (term), 80-120 (adults) - Blood magnesium level - CORRECT ANSWER Normal 1.5-2.5 Present in chronic diarrhea Blood natriuretic peptide (BNP) - CORRECT ANSWER Secreted when heart failure develops Dx CHF Helpful in determining if symptoms are from CHF Blood type crossmatch - CORRECT ANSWER Helps in determining compatibility of a donor's blood Blood urea nitroen (BUN) - CORRECT ANSWER Normal: 8-25 Elevated may indicate presence of renal disease - Bone marrow transplant - CORRECT ANSWER Indications: Aplastic anemia, leukemia, or immune deficiency syndromes - Bowel sounds - CORRECT ANSWER Used to determine presence of congenital diaphragmatic hernia in newborns Bronchoalveolar lavage (BAL) - CORRECT ANSWER Used to diagnose nosocominal pneumonias and VAP Bronchogram - CORRECT ANSWER X-ray of the bronchi Dx bronchiectasis in the presence or lesions - Calcium choride - CORRECT ANSWER Raise the calcium content of the blood Iincompatible with epinephrine - Caloric stimulation - CORRECT ANSWER Used to assess brain death Calorimetry - CORRECT ANSWER Measurement of pateints daily energy expenditure Used to assess patients nutritional status Capillary blood gas - CORRECT ANSWER Obtained from skin of the infant's warmed heel Used to evaluate infan't PCO2 and pH Capillary PO2 isn't reliable Capillary refill - CORRECT ANSWER Normal: < 2 seconds Carboxyhemoglobin level - CORRECT ANSWER Normal: 0-1% (non-smokers), 2-12% (smokers), >20% (CO poisoning) Measured using a co-oximetry or hemoximetry Cardiac catheterization - CORRECT ANSWER Measures pressures and oxygen saturation (atria and ventricles) Identify and treat blockages (coronary arteries) - Cardiac enzymes/CPK isoenzymes - CORRECT ANSWER Measures MB isoenzyme of CPK-MB and troponin to detect myocardial damage Carotid massage - CORRECT ANSWER Performed by rubbing the skin over the carotid artery to decrease HR Indicated for atrial tachycardia Cerebral perfusion pressure - CORRECT ANSWER MAP-ICP Normal: 70-90 Increased risk of Ischemia: < 70 Cerebrospinal fluid (CSF) - CORRECT ANSWER Normal: 100-400 mL Preformed with a lumbar puncture (pressure 10-15) - Chaddock reflex - CORRECT ANSWER Extension of great toe, flexion of wrist, and fanning of fingers - Chest fleuroscopy - CORRECT ANSWER Limited because radiation is so toxic Used to assess congenital heart disease or valvular disease Chest X-ray - CORRECT ANSWER Term: Chest radiogram or chest roentgenogram Basic lab test in stable patient Coagulation studies - CORRECT ANSWER Activated partial trhomboplastin time is used to monitor heparin therapy (normal: 24-32 sec.) Prothrombin time: Used to measure Warfarin (Coumadin) therapy (normal: 12-15 sec.) Colloid infusion - CORRECT ANSWER Administration of solution containing proteins for patients with ARDS Colloid osmotic (oncotic) pressure - CORRECT ANSWER Term: Plasma oncotic pressure May determine pulmonary edema CBC - CORRECT ANSWER Measures RBC, HB, HT, WBC, and platelets Computed tomography (CT) scan - CORRECT ANSWER Term: Tomgrams/Tomography Cross-sectional X-ray Dx of pulmonary embolism or bronchiectasis COOMB's test - CORRECT ANSWER Term: Antiglobulin test Used to anticpate hemolytic disease in newborns CORD pH - CORRECT ANSWER Measures pH in the umbilical cord Useful when capillary blood is not available - Corneal reflex - CORRECT ANSWER Closure of eyelids resulting from direct corneal irritation Coronary angiogram - CORRECT ANSWER Term: Angiography Used to assess acute myocardial infarction - Creatinine - CORRECT ANSWER Normal: 0.7-1.3 Indicator of renal function More accurate than BUN - Creatinine clearance - CORRECT ANSWER Normal: 90-120 mL/min Measurement of the amount of creatinine present in urine Culture and sensitivity - CORRECT ANSWER Term: C&S Sputum or blood are cultured for 24 hrs. and then are exposed to antibiotics to evaluate their effectiveness D-dimer - CORRECT ANSWER Determined the presence of a pulmonary embolus Delle suction device - CORRECT ANSWER Removes meconium from uppper airway of a neonate Deep pain response - CORRECT ANSWER Patients resonse to painful stimulation (sternal rub, pinching, inserting needle or catheter) Lack of response indicates unconsciousness, anesthesia, or neurologic deficit - Deep tendon reflexes - CORRECT ANSWER Rubber hammer thingy Absence of reflex (damaged to the muscle, peripheral nerve, nerve roots, or spinal cord) Dextrostix - CORRECT ANSWER Provides rapid means of identifying hypo/hyerglycemia Drug toxicology screen - CORRECT ANSWER Indicated for overdose or ingestion of toxic substance Dubowitz score - CORRECT ANSWER Method of determining gestational age of a newborn Term: 40 Echocardiogram - CORRECT ANSWER Term: Echocardiography, ultrasound Determine congenital heart defect (neonates and children) valve pathologies, pericardial effusion, or acquired heart disease (adults) Edrophonium chloride (Tensilon) test - CORRECT ANSWER Dx myasthenia gravis Electroencephalography (EEG) - CORRECT ANSWER Evaluates seizures during polysomnograms Electrolytes - CORRECT ANSWER Term: Serum electrolytes Measures: Na+, K+, Cl-, HCO3- Basic lab for stable patients - Electromyography - CORRECT ANSWER Recording of muscle activity Elisa test - CORRECT ANSWER Detects antibodies for AIDS End tidal CO2 level - CORRECT ANSWER Normal: 25-35 torr or 3-5% Measured with capnograph or capnometer Eosinophils - CORRECT ANSWER Normal: 1-3% of WBC Increased levels indicate asthma or allergies May decrease with steroid therapy - Esophageal pH monitoring - CORRECT ANSWER Determine gastroesophageal reflux Extracorporeal membrane oxygenation (ECMO) - CORRECT ANSWER Provides support and control of circulation and perfusion Used in open heart surgery, ARDS/IRDS, PPHN, or ventricular failure Gag reflex - CORRECT ANSWER Term: Pharyngeal reflex Tests integrity of vagus and glossopharyngeal nerves Not indicated in patients with artificial airway Reflex dissapears in anesthetized patients, myasthenia gravis, and drug overdose Gastroesophageal reflux disease (GERD) - CORRECT ANSWER Backflow of stomach contents into the esophagus Aspiration of gastic contents may cause asthma like symptoms Glasgow coma scale (GCS) - CORRECT ANSWER Total score: 3-15 Glucose tolerance test - CORRECT ANSWER Dx of diabetes Gram stain - CORRECT ANSWER Purple: Gram + Red: Gram - Grimace - CORRECT ANSWER Term: Reflex irritability Elicited by tactile stimulation or insertion of catheter into the nares Heel stick - CORRECT ANSWER Method of obtaining blood sample from neonate - Hering-breeuer inflation reflex - CORRECT ANSWER Stops inspiration and stimulates expiration Holter monitor - CORRECT ANSWER Portable ECG monitor Hyperbaric oxygen (HBO) therapy - CORRECT ANSWER Treats decompression sickness, CO poisoning, anaerobic infections, and facilitates wound healing Treatment conducted @ 2-3 atmospheres Indirect calorimetry - CORRECT ANSWER Assess nutritional status of patient Induced (therapeutic) hypothermia - CORRECT ANSWER Tx that lowers patients body temp. to reduce ischemic injury to tissue Indicated for cardiac arrest and stroke Inductive plethysmography - CORRECT ANSWER Used in sleep studies to monitor chest motion Inhaled nitric oxide (iNO) therapy - CORRECT ANSWER Indicated in patients recieving mechanical ventialtion Actions: Pulmonary vasodilator, decreases PAP, and increased oxygenation - IgE levels - CORRECT ANSWER Major role in allergic reactions Inotropic agents - CORRECT ANSWER Drugs that incrased the strength or force of contaction of the mycardium Digitalis and digoxin - Intraocular pressure - CORRECT ANSWER Internal pressure of the eye Not necessary to evaluate heart and lungs Intracranial pressure (ICP) - CORRECT ANSWER Normal: 5-10 Indicated for neurological disease or trauma to the head - Intravenous pyelogram (IVP) - CORRECT ANSWER X-ray examination of renal system Jugular vein distention (JVD) - CORRECT ANSWER Normal in supine patients abnormal in upright patients May be result of CHF, pneumothorax Lactate dehydrogenese (LDH) - CORRECT ANSWER Normals: 12-18 hrs Indicator of myocardial infarction Contraindications: Procainamide, anesthetics, aspirin Lactate levels - CORRECT ANSWER Normal: 4.5-19.8 mg/dl Indicated in shock, heart failure, lung disease, and intense exercise Lactated ringer's solution - CORRECT ANSWER Intravenous solution (glucose, lytes, and nutrients) Used interchageably with saline during resuscitation Lcithin/sphingomyelin (L/S) ratio - CORRECT ANSWER Used to predict lung maturity in fetus Mature lungs: 2:1 or greater - Liver enzymes - CORRECT ANSWER Indicate liver disease Lumbar puncture - CORRECT ANSWER Term: Spinal tap Dx guillain-barre syndrome (elevated levels of protein in CSF) - Lung fluoroscoopy - CORRECT ANSWER Limited X-ray that projects image onto a screen M-mode echocardiography - CORRECT ANSWER Measures valve operation and chamber motion Magnetic resonance imaging (MRI) - CORRECT ANSWER Detects malignancies, edema, and hylar lymph node enlargement in the chest wall Mantoux test - CORRECT ANSWER Term: Purified protein derivative test TB skin test Positive test determined when hardened, raised red area appears 24-72 hours after injection - Maxillomandibular - CORRECT ANSWER Concerning the maxilla and mandible - Medroxprogeterone (Provera) - CORRECT ANSWER Treats abnormal menstruation and vaginal bleeding Methacholine challenge test - CORRECT ANSWER Term: Bronchial provocation Patient inhales methacholine followed by spirometry 20% decrease in FEV1 indicates airway hyperreactivity Methmoglobin level - CORRECT ANSWER Normal: < 1% iNO therapy may increase levels Military anti-shock trousers (MAST) - CORRECT ANSWER Garment designed to put external pressure on lower extremities Indicated in low BP, severe blood loss, spinal cord injury, and pulmonary embolism Moro reflex - CORRECT ANSWER Term: Startle reflex Newborns response to any surprise, such as a loud noise Normal: Flexion of legs, drawing of arms across the chest, and a breif cry - Muller's maneuver - CORRECT ANSWER Forced inspiratory effort against a closed glottis Opposite of the Valsalva maneuver Neuromuscular blockade - CORRECT ANSWER Drugs that cause paralysis of the skeletal muscles - Ocular pressure - CORRECT ANSWER Pressure in the eye May be elevated by glaucoma - P50 - CORRECT ANSWER Value of PaO2 when blood is 50% saturated with O2 Pancreatic enzymes - CORRECT ANSWER Part of the digestion process Paradoxical pulse - CORRECT ANSWER Pulsus paradoxus Variance in the pulse strength or rate during respiration Peak expiratory flow rate (PEFR) - CORRECT ANSWER Maximum flow measured during forced expiratory maneuver Monitors lung function of patients with asthma Normal: 600 L/min 10 L/sec Pedal edema - CORRECT ANSWER Pitting edema Tissue swelling of ankles Associated with diseases of the kidney, liver, heart, and lung Should be assessed if patient Hx of CHF, COPD, MI, pulmonary edema, and/or renal failure Percent shunt - CORRECT ANSWER Qs/Qt Increased shunting results in refractory hypoxemia Normal: 5% shunting; increases with atelectasis, ARDS, and pneumonia - Peripheral reflexes - CORRECT ANSWER Tests integrity of peripheral nerves Permissive hypercapnia - CORRECT ANSWER PCO2 is maintained at a higher than normal level (>45 mm Hg) Decreased Vt (protect agains baro/volutrauma) Indicated for ARDS, status asthmaticus Sodium bicarbonate may be administered to treat acidosis Phrenic nerve pacing - CORRECT ANSWER Electrode that stimulates the diaphragm (inspiration) Indicated for hypoventilation caused by neuromuscular disorder/disease Plasmaphersis - CORRECT ANSWER Blood is centrifuged and cellular components are infused back into the body Treats myasthenia gravis, and Guillain-barre syndrome Platelet count - CORRECT ANSWER Important role in coagulation and hemostasis Normal: 150,00-400,000 /mm3 - Pleural biobsy - CORRECT ANSWER Removal of small piece of pleural tissue Procedure: Thoracentesis - Pupillary (light) reflex - CORRECT ANSWER Constricts in response to light - Radioisotope implantation - CORRECT ANSWER Chemotherapy for certain types of cancer Rapid shallow breathing index (RSBI) - CORRECT ANSWER Ratio of respiratory frequency to tidal volume (f/Vt in liters) Predicts the success from weaning on mechanical ventilation Weaning indication: < 100 - Range of motion - CORRECT ANSWER Range of a joints movement Respiratory exchange ratio - CORRECT ANSWER Evaluates the degree of exertion during an exercise test Normal: 0.8 - Reye's syndrome - CORRECT ANSWER Combination of encephalopathy (brain dysfunction) and fatty infiltration of internal organs that follows a viral illness Incidence: < 18 yrs. old Associated with administration of aspirin Rh factor - CORRECT ANSWER Term: Rh blood group Antigens found on surface of RBC Rh + or - Prenatal assessment (mothers may cause erythroblastosis fetalis) - Right ventricular stroke work index (RVSWI) - CORRECT ANSWER Measurement of the pumping function of the right ventricle Normal: 7.0-12.0 g/beat Rubella titer - CORRECT ANSWER Determine immune status to rubella - Serological evaluation - CORRECT ANSWER Serum (clotting mechanism is removed from blood) Measures Lytes, BUN, creatinine, enzymes, glucose, and protein - Serum amylase - CORRECT ANSWER Incidence: Pancreatitis, salivary gland disorder, and tumors Serum immunoglobulins - CORRECT ANSWER Amount of antibodies found in the serum May be elevated in pateints with allergies and/or asthma - Serum magnesium - CORRECT ANSWER Normal: 1.7-2.1 mg/dl Increases in patients with renal disease Decreases in patients with Diarrhea, taking antibiotics and diuretics Silverman-Anderson score - CORRECT ANSWER Elevates the degree of respiratory distress in neonates Range from 0-10 (10 being the worst) - Specific conductance (SGAW) - CORRECT ANSWER Airway conductance Normal: 0.42-1.67 Specific gravity of pleural fluid - CORRECT ANSWER Determines whether fluid is transudate or exudate Protein < 50% of serum protein is transudative fluid Specific gravity of urine - CORRECT ANSWER Indicator of how concentrated the urine is Normal: 1.003-1.030 g/mL Increased in CHF and dehydration Decreased in excessive fluid Surfactant replacement therapy - CORRECT ANSWER Indication: Hyaline membrane disease/IRDS Survanta, Infasurf, Curosurf, and Surfaxin Sweat chloride test - CORRECT ANSWER Dx of cystic fibrosis > 60 mEq/L is positive for CF T-cell count - CORRECT ANSWER Measurement of number of T-type lymphocytes Reduced in patients with AIDS Thallium stress test - CORRECT ANSWER Imaging that shows how well blood flows into the heart muscle Procedure: Thallium is injected while patient is on ergometer or treadmill Theophylline level - CORRECT ANSWER Therapeutic range for bronchodilator: 10-20 mcg/mL Should be between 5-10 mcg/mL when treating infants with apnea of prematurity Thoracic cage (chest) configuration - CORRECT ANSWER Normal, barrel chest, kyphosis, scoliosis, pectus carinatum (pigeon breast), pectus excavatum (funnel breast) Throat culture - CORRECT ANSWER Should not be performed in children with suspected epiglottitis Thrombolytic therapy - CORRECT ANSWER Administered to break up or dissolve blood thrombus (pulmonary embolism, MI, or stroke) Tissue plasminogen activator (t-PA), Urokinase, Streptokinase Tracheal reflex - CORRECT ANSWER Term: Carinal reflex Spontaneous coughing in response to stimulation of the trachea with a catheter Assess the protective reflex to prevent aspiration Troponin test - CORRECT ANSWER Identifies MI's High risk of death from MI: >0.1 ng/mL Normal: < 0.1 ng/mL Transillumination test - CORRECT ANSWER fiberoptic light on chest of newborn to determine presence of pneumothorax or congential diaphragmatic hernia. Should be done prior to X-Ray Transtracheal aspiration - CORRECT ANSWER Needle is inserted into trachea and saline is introduced then aspirated Useful to identify anaerobic bacteria Two-dimensional echocardiography - CORRECT ANSWER Indications: Patients with coronary artery disease, valve function, or *exercise testing Tympanic temperature - CORRECT ANSWER Measurement of temperature in the outer ear in order to monitor body temperature - Upper & lower gastrointestinal (GI) series - CORRECT ANSWER Radiographic and fluorscopic examinations of the stomach and duodenum - Urinalysis - CORRECT ANSWER Color, pH, protein, glucose, blood, bilirubin Uvulopalatrpharyngoplasty (UPPP) - CORRECT ANSWER Procedure: Soft palate , uvula, tonsils, adenoids, andsometimes posterior pharyngeal wall are removed Indications: Intractable snoring, or OSA Ventilation-perfusion (V/Q) scan: Procedure - CORRECT ANSWER 1) Inhalation of radioisotope gas to determine distribution of gas throughout the lungs. 2) Injection of radioactive iodine for perfusion 3) Scanning of the chest to determine distribution of volume and perfusion Vestibular Nystagmus - CORRECT ANSWER Constant, involuntary, circular movement of the eye from physiological stimulation of the labyrinth of the ear - Wilson Mitiky syndrome - CORRECT ANSWER Term: Pulmonary dysmaturity Chronic disease in low birth weight infants that resembles bronchopulmonary dysplasia Infants do well initially then develop tachypnea, cyanosis, and retractions [Show More]

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