BKAT Study Set Questions And Answers
Normal blood gases; pH - correct answer 7.35-7.45
Normal blood gases: CO2 - correct answer 35-45
Normal
... [Show More] 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
positive (pathologic) response= toes curl upward
a positive babinski in adults indicates dysfunction in the motor pathways of the brain or spinal cord
what is the initial dosing of tpa? - correct answer -0.9 mg/kg
-10% as a bolus over 1 minute and 90% as continuous infusion over 60 minutes
What are the requirements for receiving tpa? - correct answer -onset of stroke was within 3-4.5 hours
-CT negative for bleed or lesion
-glucose >50
During the thrombolytic infusion of tpa, neuros need to be assessed every ___ minutes - correct answer 15
What are the frequency of neuro checks after receiving thrombolytic tpa infusion? - correct answer -VS and neuro checks every 15 min for 1 hour
-every 30 min for 6 hours
-then every hour for 16 hours
what are possible complications of rTPA? - correct answer -signs of ICH or ICP
-systemic bleeding (wait 6 hours before inserting devices like foleys, etc)
-angioedema of airway
for patients receiving rTPA or IA therapy, treat prn for SBP > ____ mmHg or DBP > ____ mmHG - correct answer treat for SBP >180 or DBP >105 mmHG
we want to manage hypertension!!!
Acute mgmt measures for ischemic stroke patients? - correct answer 1. aspirin within 24 hours
2. NS (Avoid hypotonic IV solutions)
3. blood glucose maintain less than or equal to 150 mg/dL
4. surgical consult
5. no indication for steroids or anticonvulsants
6. rehab (PT/OT/SLP consults)
in HEMORRHAGIC stroke patients, what do we want to keep their blood pressure at? - correct answer SBP >150 mmHG and DBP >105
what do we want to keep ischemic stroke pt's BPs who have not received tpa? - correct answer Treat PRN if SBP >220 mmHg, DBP >120 mmHG or MAP >130
what is the main complication with IV dilantin? - correct answer must ONLY be combined with NS
what occurs in SIADH? - correct answer too much ADH!!!
what are some neuro causes of SIADH? - correct answer TBI
SAH
stroke
CNS infection
brain tumors
Guillian-Barre (GBS)
MS
pituitary adenoma
What is the recommended treatment for SIADH? (3) - correct answer 1. fluid restriction
2. diuresis (Lasix)
3. administer sodium -- 3% saline (Frequent Na labs)
Do not increase Na more than ___ mEq/L in 24 hours period d/t risk for central pontine myelinolysis - correct answer 10
what is occurring in diabetes insipidus? - correct answer not enough production of ADH!!!
What are s/sx of DI? - correct answer -increased urine output (>250 cc/hr)
-increased thirst
-dehydration symptoms
-dilute urine (low specific gravity 1.001-1.005)
-decreased urine osmolality (<400 mOsm/kg H20)
-low urine Na
-concentrated blood (serum osmolality >295 mOsm/L)
-hypernatremia (>145)
Treatment for Diabetes Insipidus (DI)? - correct answer 1. replace volume (oral fluids/IV fluids)
2. replace ADH by giving DDAVP or Vasopressin
drugs given for increased ICP? - correct answer 3%
mannitol
23%
what are s/sx of DKA? - correct answer patient history
-polyuria
-polydipsia
-weight loss
-vomiting
-blurry vision
-weakness
-abdominal pain
Physical findings
-poor skin turgor
-kussmaul respirations
-fruity breath
-tachycardia
-hypotension
-mental status changes
what are the three main components of treatment for DKA? - correct answer 1. REHYDRATE
2. RESTORE GLUCOSE METABOLISM
3. CORRECT ELECTROLYTES AND ACIDOSIS
what is the progression of IVF administration during DKA? - correct answer -start with 1 L bolus NS over 1 hour
-500 mL/hr for 2 hours
-150 mL/hr for 1 hour
-once glucose 250 mg/dL, change to D5 NS 0.45% 125 mL/hr [Show Less]