Mca Iii Clinical Skills Quiz

Front 1

map the electrical conduction system of the heart

Back 1

SA node -> AV node -> bundle branches -> bundle of his -> perkinje fibers

Front 2

normal PR interval

Back 2

.12-.20

Front 3

normal QRS interval

Back 3

<= .10

Front 4

intrinsic rate for SA Node

Back 4

60-100 bpm

Front 5

intrinsic rate for AV node

Back 5

40-60 bpm

Front 6

intrinsic rate for ventricles

Back 6

20-40 bpm

Front 7

differences btw. sinus brady, tachy, and normal

Back 7

brady < 60 bpm, tachy > 100 bpm, normal 60-100

Front 8

how do you treat sinus tachycardia

Back 8

treat the cause

Front 9

Tx for sinus bradycardia

Back 9

if symptomatic, atropine, epinephrine, TCP

Front 10

Tx for atrial fibrillation

Back 10

cardioversion, amiodarone, digoxin, procainamide

Front 11

Tx for vetricular fibrillation

Back 11

defibrillation, CPR, epinephrine

Front 12

what is the difference btw. cardioversion and defibrillation

Back 12

cardioversion uses lower voltage, non emergent situations, and syncs with the R wave
debrillation is only for emergencies

Front 13

Tx for chronic A Fib

Back 13

amiodarone, digoxin, coumadin

Front 14

most common disadvantage of dysrhythmias

Back 14

decreased CO

Front 15

parietal pleura

Back 15

lines the chest cavity, has pain fibers

Front 16

visceral pleura

Back 16

lines the lung, no pain fibers or nerve endings

Front 17

intrapleural space

Back 17

in between parietal and visceral pleural, contains 20-25 ml of fluid. acts as cohesion during inspiration

Front 18

pleural effusion

Back 18

more than 25 ml in intrapleural space

Front 19

intrapleural pressure

Back 19

below atmospheric pressure. if equal will lead to pneumo.

Front 20

where do insert a chest tube

Back 20

in intrapleural space

Front 21

2 reasons to insert chest tube

Back 21

remove air and/or fluid and to restore normal intrapleural pressure so lungs can re-expand

Front 22

mechanisms by which air & fluid can enter the intrapleural space

Back 22

1. traumatic chest injury
2. spontaneous pneumo
3. thoracotomy
4. insertion of central line
5. lymphatic drainage
6. CHF (colloid osmotic pressure)

Front 23

first compartment of pleural drainage system

Back 23

collection chamber: collects fluid and air

Front 24

second compartment of pleural drainage system

Back 24

water seal chamber: 2 cm water, bubbles, air leaves to
suction chamber

Front 25

exhalation, coughing, and sneezing will cause what in the suction chamber

Back 25

bubbling

Front 26

third compartment of pleural drainage system

Back 26

suction control chamber: 20 cm h2o.

Front 27

pt. assessment of water seal drainage system (patient)
(4)

Back 27

subjective: breathing, anxiety, chest discomfort, level of understanding

Front 28

pt. assessment of water seal drainage system (breathing)
(7)

Back 28

rate, regularity, depth, ease, breath sounds, vital signs, abnormal chest movements

Front 29

pt. assessment of water seal drainage system (chest tube site)
(3)

Back 29

dressing intact, dry or drainage, infection - temp - drainage purulent - swelling

Front 30

factors affecting drainage
(6)

Back 30

1. bottle below chest level
2. secured rack
3. no kinks/loops
4. chambers filled with fluid
5. air tight
6. suction control proper water level

Front 31

water seal chamber

Back 31

2 cm water
bubbling/fluctuations

Front 32

if no tidaling

Back 32

kink or lungs re-expanded

Front 33

increased bubbling

Back 33

air leak

Front 34

where do you position chest tubes and drainage system

Back 34

below chest level

Front 35

nursing care for chest tubes
(6)

Back 35

1. time of measurement & fluid level
2. HH
3. deep breathing & ROM
4. no milking/stripping unless ordered, check for air leaks
5. change dressing
6. observe for complications

Front 36

factors affecting drainage
(5)

Back 36

1. clamp on chest tube
2. below bed
3. pt. lying on tube
4. placement w/xray
5. if blood, blood clot

Front 37

how do you know a pt. has a pneumothorax

Back 37

1. decreased breath sounds or absent
2. abnormal chest wall movement

Front 38

how do you know a pt. has a tension pneumothorax
(4)

Back 38

1. mediastinal shift
2. tracheal deviation
3. severe respiratory and circulatory difficulty
4. air leak -> leak in tube or displacement

Front 39

where do you position the chest tube when transporting a pt.

Back 39

hang on edge of bed or the hangars below the bed

Front 40

complications associated with chest tubes
(5)

Back 40

1. malposition
2. vasovagal response causing hypoTN from rapid drainage
3. infection
4. PNA
5. shoulder disuse

Front 41

dry drainage system

Back 41

no use of water, uses regulator to control water suction. visual indicator to let nurse know the amt. of wall suction is adequate & working

Front 42

wet drainage system

Back 42

water bubbling in third chamber indicates adequate suctioning. chamber may need refilling.

Front 43

what do you do if you find the chest tube lying in bed beside the pt.

Back 43

put on gloves, grab sterile gauze & hold over chest opening and call for help

Front 44

assist control

Back 44

preset FiO2, TV and RR

Front 45

CPAP

Back 45

preset FiO2, pt. breathes spontaneously @ own rate and TV.
pressure during expiratory phase

Front 46

pressure support

Back 46

preset FiO2, no preset rate or TV
breathes @ own rate w/pre set amt applied during inspiration, used as weaning mode

Front 47

SIMV

Back 47

preset FiO2, rate and TV.
synchronizes with breathes.
weaning mode.

Front 48

PEEP

Back 48

positive pressure applied @ exhalation
goal: to prevent alveolar collapse
increases FRC
used w/ARDS

Front 49

disadvantage of PEEP

Back 49

decrease of venous return secondary to increase intrathoracic pressure, may see initial drop in BP

Front 50

pH norms

Back 50

7.35-7.45

Front 51

PaO2 norms

Back 51

80-100

Front 52

PaCO2 norms

Back 52

35-45

Front 53

HCO3 norms

Back 53

22-26

Front 54

base excess

Back 54

-2 -+ 2

Front 55

respiratory acidosis

Back 55

caused by hypoventilation. too much carbonic acid, hypercapnia

Front 56

Tx: respiratory acidosis

Back 56

1. hyperventilate
2. mechanical ventilation if other O2 therapies ineffective or pt. cannot blow off the CO2

Front 57

respiratory alkalosis

Back 57

results from hyperventilation, too much CO2

Front 58

Tx: respiratory alkalosis

Back 58

1. slow respiratory rate
2. treat causes which may result from hypoxemia

Front 59

metabolic acidosis

Back 59

accumulation of acids (not carbonic), too little bicarbonate, often seen in renal failure pts. compensation by excreting CO2.

Front 60

Tx: metabolic acidosis

Back 60

bicarbonate replacement

Front 61

metabolic alkalosis

Back 61

too much bicarbonate, loss of acid from vomiting or gastric suctioning

Front 62

Tx: metabolic alkalosis

Back 62

correct problem

Front 63

base excess

Back 63

will tell you if severe imbalance. + 2 alkalosis, -2 acidosis

Front 64

what O2 delivery system will deliver the highest possible FiO2 w/o intubation

Back 64

1. BiPap with 100% FiO2
2. non rebreather mask with 100% FiO2

Front 65

priority action after a pt. has been intubated
(3)

Back 65

1. auscultate breath sounds bilaterally
2. look for equal chest expansion
3. get stat chest xray

Front 66

complication of endotracheal intubation
(5)

Back 66

1. sinusitis with nasal intubation
2. tissue trauma
3. vocal cord paralysis
4. tooth chipping
5. aspiration

Front 67

safe pressure range to use with suctioning

Back 67

80-120 mmHg

Front 68

time limit for suctioning

Back 68

no more than 10 seconds

Front 69

when to suction your pt.
(4)

Back 69

1. auscultate rhonchi or corse breath sounds
2. coughing pt. with sputum
3. high pressure vent. alarms
4. min. every 4 hours

Front 70

what do you assess before and after suctioning the pt?
(5)

Back 70

1. breath sounds
2. HR
3. RR
4. O2 sat.
5. dysrhythmias

Front 71

what are potential complication associated with suctioning
(3)

Back 71

1. tissue trauma
2. hypoxia
3. dysrhythmias

Front 72

why should tape be change on oral and nasal ETTs?
(2)

Back 72

1. prevent skin breakdown
2. infection control

Front 73

how often should you change the tape
(3)

Back 73

1. when soiled or ineffective
2. 24-48 hours
3. change ETT position in mouth

Front 74

nursing care for pt with ETT
(8)

Back 74

1. assess condition of lips, skin, nares for breakdown, examine mouth for oral ETT
2. PNA precautions -> nystatin
3. suction PRN
4. change tape
5. clean suction tubing, saline flush tubing
6. empty suction containers
7. soft wrist restraints
8. Q2H turning

Front 75

components of hemodynamic pressure monitoring system
(7)

Back 75

1. transducer
2. non compliant pressure tubing
3. NS flush bag
4. pressure bag
5. continuous flush valve
6. pressure cable to monitor
7. 3 way stopcock connection

Front 76

describe nurses role in insertion of a PA catheter and an arterial line
(4)

Back 76

1. inflate the balloon
2. observe monitor for wave forms determining where the catheter is located
3. watch for dysrhythmias, evaluate pt's tolerance
4. order chest xray to verify placement

Front 77

pathway of pulmonary catheter during insertion

Back 77

right atrium, right ventricle, pulmonary artery, pulmonary artery wedge

Front 78

list clinical indications for using hemodynamic monitoring
(2)

Back 78

1. cardiac or pulmonary disease or dysfunction
2. hypovolemia

Front 79

preload

Back 79

volume w/in left ventricle at end of diastole; measured using PAWP

Front 80

afterload

Back 80

forces that oppose ventricular systole; measured calculating SVR/PVR

Front 81

contractility

Back 81

strength of ventricular contraction; not directly measured with hemodynamic monitoring

Front 82

heart rate

Back 82

measure via pulse or BPM, not via hemodynamic monitoring.

Front 83

CO

Back 83

HR x SV

Front 84

CVP

Back 84

reflects RV end diastolic pressure, normal 2-8 mmHG

Front 85

PA systolic

Back 85

reflects the peak pressure attained as the RV ejects its stroke volume into the pulmonary artery. normal 20-30 mmHG

Front 86

PA diastolic

Back 86

reflects the movement of blood from the PA into the lung capillaries. normal 10-15mmHG

Front 87

PAWP

Back 87

measurement of left ventricular end diastolic pressure, normal 8-12 mmHg

Front 88

cardiac output

Back 88

amt. of blood pumped by the heart in 1 min. from PA catheter with injectate through blue port on PA line. normal 4-8 L/min

Front 89

cardiac index

Back 89

CO adjusted for body surface area

Front 90

CVP elevated

Back 90

hypervolemia. RV failure, tricuspid regurgitation, percardial tamponade

Front 91

CVP decreased

Back 91

hypovolemia

Front 92

PAP elevated
(6)

Back 92

1. pulmonary disease
2. pulmonary embolism
3. COPD
4. pulmonary HTN
5. pulmonary edema
6. left ventricular failure

Front 93

PAP decreased

Back 93

hypovolemia

Front 94

PAWP elevated

Back 94

in increase in LVDP. CHF, mitral stenosis or regurgitation, PEEP, CPAP

Front 95

PAWP decreased

Back 95

hypovolemia

Front 96

CO and CI decreased

Back 96

hypovolemia, cardiac failure, increased SVR

Front 97

CO and CI increased

Back 97

exercise, anxiety, fever, tachy, collateral circulation, sepsis

Front 98

how do you determine when a pt. intubated and on mechanical ventilation should be suctioned
(4)

Back 98

1. coughing up secretions in tube or rhonchi
2. high pressure alarms
3. drop in O2 saturation
4. always listen to chest first

Front 99

when would a pt. be placed on PEEP
(3)

Back 99

1. high FiO2 and pt. not able to oxygenate well ARDS.
2. prevention of atelectasis
3. keep alveoli open to improve oxygenation

Front 100

identify means of communicating with pts who are intubated

Back 100

1. writing pad
2. mouthing words
3. pointing to pictures/words
4. use alphabet to form words
5. yes/no questions

Front 101

power failure in hospital and generator has not responded

Back 101

disconnect pt. from ventilator and bag the pt. with the ambu bag