Clinical Simulations Exam 159 Questions with Verified Answers
Visuals (things you will always choose...) - CORRECT ANSWER -general
... [Show More] 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 Less]