Critical Care Test Mix

From the Nursing center CE collection
http://www.nursingcenter.com/prodev/static.asp?pageid=604061

Critical Care of the Morbidly Obese Specialty CE Collections, September 2005
Managing three critical cancer complications Specialty CE Collections, September 2005
Sepsis: Taking a deeper look Specialty CE Collections, September 2005
When your patient is in liver failure Specialty CE Collections, September 2005
1.
Which comorbidity experienced by the patient described in this case study presented the most serious challenge postoperatively?
Questions 1-14 are associated with the article, "Critical Care of the Morbidly Obese."
a. restrictive respiratory disease
b. sleep apnea
c. osteoarthritis of the lumbar spine
d. depression

2.
Based on this case study, dehydration and third space sequestration of fluids were first signaled by
a. decreased urine output and persistent tachycardia.
b. an elevation in temperature.
c. a decrease in blood pressure.
d. increased levels of BUN and potassium.

3.
Which of the following signs was most suggestive of abdominal compartment syndrome?
a. presence of obvious intraperitoneal pressure during exploratory surgery
b. evidence of leaking at anastamoses sites
c. elevated liver enzymes and creatinine
d. a drop in blood pressure and urinary output

4.
All of the following were related to the patient’s polyneuropathy of critical illness except
a. vitamin B deficiency.
b. disuse atrophy.
c. intraoperative neuromuscular blocking agents.
d. compromised kidney function.

5.
According to the author, intensive care is reserved for those patients
a. with a deep vein thrombosis (DVT) or pulmonary embolus (PE)
b. who experience excessive blood/volume loss requiring volume resuscitation.
c. who require mechanical ventilation.
d. with acute respiratory distress syndrome (ARDS).

6.
Which of the following is included in the criteria used for postoperative intermediate care placement?
a. continuation of TPN or gastric feedings.
b. aspiration pneumonia.
c. anastomotic leakage.
d. moderate to severe respiratory distress or sleep apnea requiring CPAP.

7.
If a patient returns from the operating room with a systolic BP of 90, HR of 120 and urine output of 20cc/hr, the most appropriate action is to
a. administer vasopressors immediately.
b. consider volume replacement before administering vasopressor agents.
c. begin volume replacement while simultaneously administering vasopressors.
d. administer neuromuscular blocking agents and monitor vital signs and output.

8.
For the morbidly obese patient at risk for DVT and PE, the most appropriate prophylaxis is
a. thigh high pulsatile venous compression and anticoagulant therapy.
b. venous compression stockings alone.
c. anticoagulants alone as patients may not tolerate leg compression.
d. a combination of anticoagulation therapy plus below the knee or foot devices for leg compression.

9.
Among morbidly obese patients, the respiratory system is most often compromised by
a. underlying chronic respiratory conditions like COPD.
b. diminished lung or chest-wall compliance.
c. oversedation from polypharmacy seen frequently in this population.
d. increased expiratory reserve volume due to excessive weight gain.

10.
Of the pharmacokinetic properties of drugs, obesity has the greatest potential for altering
a. the absorption of drugs.
b. the distribution of drugs.
c. both the metabolism and distribution of drugs.
d. both the distribution and excretion of drugs.

11.
In dosing intravenous unfractionated heparin, Yee and Norton (1998) stress
a. the importance of setting maximum starting doses to avoid overdosing morbidly obese patients.
b. that multiple factors, including smoking and gender, affect final dosing.
c. that renal elimination of heparin is decreased in morbidly obese patients.
d. that ideal body weight (IBW) best correlates with final dosing.

12.
Among the low-molecular weight heparins, a capped dose of 10,000 IU when patients reach 83 kilograms (kg) is recommended for
a. dalteparin (Fragmin).
b. tinzaparin (Innohep).
c. enoxaparin (Lovenox).
d. fondaparinax (Arixtra).

13.
Which of the following is true about neuromuscular blocking agents used in the ICU
a. Use these agents as a last resort and for as short a time as possible.
b. Once an infusion of atracurium is hung, use IBW for titrating further doses.
c. Both atracurium and vecuronium should be tritrated to response.
d. Atracurium should be dosed using IBW.

14.
For obtaining blood pressure measurements in morbidly obese patients it is best to
a. use a regular-sized cuff on the forearm.
b. use a large cuff on the upper arm.
c. use a regular or large cuff on the lower leg.
d. use the method employed during surgery if feasible.

15.
Which serum sodium level may signal SIADH?
Questions 15-29 are associated with the article, "Managing three critical cancer complications."
a. 128 mEq/liter
b. 138 mEq/liter
c. 144 mEq/liter
d. 150 mEq/liter

16.
Which serum osmolality level may signal SIADH?
a. 270 mOsm/kg water
b. 282 mOsm/kg water
c. 290 mOsm/kg water
d. 300 mOsm/kg water

17.
A urine sodium level greater than which of the following may signal SIADH?
a. 5 mEq/liter
b. 10 mEq/liter
c. 15 mEq/liter
d. 20 mEq/liter

18.
Which of the following signs and symptoms characterizes hyponatremia?
a. weight loss
b. irritability
c. hyperactivity
d. increased appetite

19.
Which statement regarding hyponatremia is correct?
a. Hyponatremia increases extracellular water
b. A serum sodium level of 125 mEq/liter can cause death.
c. Hyponatremia increases intracellular water.
d. Brain cell dehydration causes progressive neurologic symptoms.

20.
Which statement is correct about demeclocycline used to treat SIADH?
a. It must be used in combination with fluid restriction.
b. It can cause a reversible dose-related diabetes insipidus syndrome.
c. Its use is restricted to patients with a sodium level less than 115 mEq/liter.
d. The dosage is 500 mg/day.

21.
Fluid restriction below which amount is appropriate for a patient with SIADH?
a. 750 ml/day
b. 1,000 ml/day
c. 1,500 ml/day
d. 2,000 ml/day

22.
Which of the following malignancies is least likely to cause SCC?
a. brain cancer
b. breast cancer
c. lung cancer
d. prostate cancer

23.
What area does SCC most frequently affect?
a. cervical spine
b. thoracic spine
c. lumbar spine
d. sacral spine

24.
Which statement correctly describes signs and symptoms of SCC?
a. Pain may decrease when the patient lies down.
b. Sensory deficits in the extremities progress distally.
c. Bladder and bowel incontinence precedes urinary retention and constipation.
d. Moving or coughing may increase radicular pain.

25.
Which of the following studies is the most sensitive and specific for diagnosing SCC?
a. CT scan
b. myelography
c. MRI
d. spinal X-rays

26.
Which of the following interventions is used least to manage SCC?
a. surgery
b. corticosteroids
c. radiation therapy
d. back brace

27.
Excessive circulating ADH causes
a. water diuresis.
b. dilute urine.
c. dilute plasma.
d. hypernatremia.

28.
Which of the following statements about SCC is incorrect?
a. Direct tumor pressure on the spinal cord can cause SCC.
b. Metastases eroding the vertebrae can cause bone fragments to press on the spinal cord.
c. Compression causes cord tissue hypoxia, venous stasis, and edema.
d. Paralysis is the first indicator of pressure on a spinal cord nerve root.

29.
How does an anaphylactoid reaction differ from an anaphylactic reaction?
a. An anaphylactoid reaction occurs on initial exposure to the drug.
b. An anaphylactoid reaction doesn't involve release of inflammatory mediators.
c. An anaphylactoid reaction causes hypertension.
d. An anaphylactoid reaction involves previously formed antibodies.

30.
During the inflammatory response of sepsis
Questions 30-44 are associated with the article, "Sepsis: Taking a deeper." look
a. red blood cells release proinflammatory cytokines.
b. tumor necrosis factor-alpha attracts lymphocytes to the infection site.
c. endothelial cellular injury occurs at the infection site.
d. cytokines inhibit the coagulation cascade.

31.
In a patient with sepsis, activated protein C
a. has prothrombotic properties.
b. has anti-inflammatory properties.
c. levels are increased.
d. has antifibrinolytic properties.

32.
Which statement is correct about the effect of severe sepsis on fibrinolysis?
a. Fibrinolysis is inhibited.
b. Fibrinolysis increases for a sustained time.
c. Plasminogen activator inhibitor-1 decreases.
d. Thrombin activates fibrinolysis.

33.
In the procoagulant state of sepsis
a. D-dimers are negative.
b. platelets are increased.
c. protein C is increased.
d. platelets are decreased.

34.
As sepsis progresses, the endothelium lining blood vessels
a. secretes the vasoconstrictor nitrous oxide.
b. allows fluid to escape from the vascular space into the interstitial spaces.
c. causes abnormal vasoconstriction.
d. inhibits local clot formation.

35.
The standard initial treatment of sepsis is
a. providing antibiotic therapy.
b. eliminating the source of infection.
c. providing fluid resuscitation.
d. administering an I.V. vasopressor drug.

36.
To improve the chance of survival for a patient with sepsis, keep his blood glucose between
a. 80 and 110 mg/dl.
b. 115 and 125 mg/dl.
c. 130 and 140 mg/dl.
d. 145 and 155 mg/dl.

37.
Which statement is correct about drotrecogin alfa (activated)?
a. It's indicated for the treatment of SIRS.
b. It's recombinant human activated protein C.
c. It's administered as an I.V. infusion over 24 hours.
d. It may cause microvascular thrombosis.

38.
Treat the patient's physiologic responses to sepsis by
a. administering antibiotics after obtaining appropriate cultures.
b. administering an I.V. vasopressor before I.V. crystalloids.
c. administering high-dose steroids.
d. using high tidal volume mechanical ventilation.

39.
An indicator of renal dysfunction is a urinary output of less than
a. 0.5 ml/kg/hour.
b. 1 ml/kg/hour.
c. 1.5 ml/kg/hour.
d. 2 ml/kg/hour.

40.
Current research on serologic markers of sepsis indicates that
a. C-reactive protein levels will pinpoint sepsis.
b. procalcitonin levels can differentiate between sepsis and SIRS.
c. protein C is deficient in patients with severe sepsis.
d. there's no genetic predisposition to sepsis.

41.
Which statement is correct about sublingual capnometry?
a. It may help assess hypoperfusion in patients with sepsis.
b. It's an invasive monitoring technique.
c. It allows for continuous monitoring.
d. It predicts sepsis.

42.
Which combination of patient symptoms is characteristic of SIRS?
a. temperature, 96° F; heart rate, 106; respirations, 28
b. temperature, 96.8° F; heart rate, 82; respirations, 16
c. temperature, 97.6° F; heart rate, 94; respirations, 20
d. temperature, 99° F; heart rate, 100; respirations, 18

43.
Criteria for SIRS include a white blood cell (WBC) count less than
a. 4,000 cells/mm3.
b. 8,000 cells/mm3.
c. 10,000 cells/mm3.
d. 12,000 cells/mm3.

44.
Which of the following signs and symptoms meet the definition for severe sepsis?
a. urinary tract infection, WBC count of 13,000 cells/mm3, temperature of 101.2° F, heart rate of 90, and respirations of 20
b. abdominal surgical-site infection, confusion, urinary output less than 0.5 ml/kg/hour, Paco2 of 28 mm Hg, and WBC count of 3,500 cells/mm3
c. gangrenous right lower leg, no response to verbal stimuli, hypotension unresponsive to fluid resuscitation, anuria, and WBC count of 20,000 cells/mm3
d. bacterial pneumonia, WBC count of 11,500 cells/mm3, temperature of 99.8° F, heart rate of 88, and respirations of 22

45.
Blood is supplied to the liver from the
Questions 45-59 are associated with the article, "When your patient is in liver failure."
a. hepatic artery and internal jugular vein.
b. hepatic vein and internal jugular vein.
c. hepatic artery and portal vein.
d. hepatic vein and portal vein.

46.
The liver is responsible for
a. cleaning blood, storing nutrients, and making bile.
b. coagulating blood, storing bile, and making nutrients.
c. conjugating carbohydrates, excreting bile, and making blood.
d. converting bile, storing blood, and making glycogen.

47.
The two main categories of liver disease are
a. fulminant and chronic.
b. hepatocellular and cholestatic.
c. viral and biliary.
d. acute and end stage.

48.
Cholestatic liver disease may be caused by
a. tumor.
b. alcohol abuse.
c. drug overdose.
d. hepatitis C.

49.
Which of the following contributes to development of ascites?
a. low serum sodium
b. low serum albumin
c. low portal pressure
d. low hemoglobin

50.
Fever, hypotension, and abdominal pain in a patient with ascites may indicate
a. steatorrhea.
b. cirrhosis.
c. peritonitis.
d. acute fatty liver.

51.
All of the following may be GI-associated signs of liver failure except
a. steatorrhea.
b. fetor hepaticus.
c. asterixis.
d. clay-colored stools.

52.
Which signs and symptoms would lead you to suspect liver failure?
a. increased urine bilirubin and polyuria
b. decreased blood urea nitrogen and decreased libido
c. decreased serum creatinine and amenorrhea
d. elevated unconjugated bilirubin levels and jaundice

53.
Impaired ability of the liver to metabolize bilirubin at the cellular level is best described as which type of jaundice?
a. prehepatic
b. parenchymal
c. obstructive
d. posthepatic

54.
The accumulation of bile acids under the skin may cause
a. petechiae.
b. spider angiomas.
c. xanthomas.
d. pruritus.

55.
The definitive test to assess the cause and severity of liver dysfunction is
a. an ERCP.
b. a computed tomography scan.
c. a liver biopsy.
d. an ultrasound

56.
The best approach for liver biopsy in a patient with uncorrected coagulopathy is
a. transjugular.
b. percutaneous.
c. open surgical.
d. laparoscopic.

57.
Which therapy for bleeding esophageal varices involves injecting a strong irritating agent into the area to cause scarring?
a. sclerotherapy
b. balloon tamponade
c. endoscopic electrocautery
d. banding

58.
The initial treatment for a pleural effusion in a patient with ascites is
a. I.V. diuretics.
b. thoracentesis.
c. paracentesis.
d. transjugular intrahepatic portosystemic shunt.

59.
The best way to prevent hepatorenal syndrome is to
a. administer I.V. diuretics every 2 hours.
b. monitor closely for low serum sodium.
c. administer nonsteroidal anti-inflammatory drugs.
d. administer potassium-sparing diuretics.