Stony Brook ICR Final Exam

From the onset of symptoms of a ischemic stroke, how many hours do you have to administer TPA?

no longer than 3 hours from onset

What is most critical in stroke evaluation?

last known well

What does not cause a seizure?

A. Brain Tumor

B. CVA

C. Brain Infection

D. Intestinal Blackage

D. Intestinal Blockage

What is an adverse effect to Dilantin?

Purple Glove Syndrome

What is an adverse effect to Lamictal?

Steven Johnson Syndrome

T/F: If a patient is seizing you should place a tongue blade in their mouth, restrain them and put them on their back

FALSE; put patient on side- make environment safe, never restrain them or put anything in their mouth, get ready to administer ativan

What type of heart medications are not for long term use?

calcium channel blockers

Who can perform an arterial line insertion?

LIP or Resp Therapist

Where is the phlebostatic axis?

4th intercostal space, midaxillary

What is a Glasgow Coma Scale used for?

used to assess level of consciousness, evaluating eye opening, verbal and motor response

What lab levels are important to check in stroke patients?

CBC/PTT

What are risk factors for strokes?

age, race, gender, history of stroke, HTN, smoking, DM, atherosclerosis

What are the symptoms of hyperglycemia?

warm and dry

What are the symptoms of hypoglycemia?

cool and clammy

Which is the only insulin that can be given IV?

Regular

Which insulin is given 1x/day and has no peak?

glargine

What is the main purpose of CVP?

to monitor fluid status- if it is high that represents fluid overload, low represents dehydration

What is normal CVP?

2-6

Why is TPN have its own designated port?

if mixing with meds and other products, there is an increased risk for infection

What are early warning scores?

screen patients for poor health outcomes and gives them a score

How does the body try to compensate during shock?

increases HR to maintain organ perfusion but eventually heart rate will decrease because its not getting enough blood and oxygen

What are the s/s of pancreatitis?

pain, high blood glucose, vomiting (check electrolytes)

What is the purpose of a chest tube?

to restore negative pressure and reexpand the lung

When is a chest tube indicated?

to drain blood, air or both

What are the signs of left sided heart failure?

bilateral moist crackles, paroxysmal nocturnal dyspnea and cyanosis (ANSWER WILL BE ALL OF THE ABOVE)

What are the signs of right sided heart failure?

JVD, peripheral edema-- answer will be all BUT bilateral crackles

Who do you call for an LVAD patient?

the LVAD coordinator at 631-444-LVAD, if they do not answer, then call the CTICU

What are important values to monitor for those taking supplements, digoxin and/or lasix?

Hypokalemia, Hyperkalemia and Dig Tox

What nursing interventions must be used when your patient is on Amiodarone?

inline filter, EKG monitoring, and a slowed rate of administration (1 mg/min for 6 hours, followed by .5 mg/mL for 18 hours)

What do you NOT expect with nitroglycerin?

increase in preload-- this is because the vessels will dilate to decrease oxygen consumption

When can a patient with a trach use a speaking valve?

when patient is fully alert, stable and can tolerate

T/F: Oral mechanical ventilation is indicated for trached patients

FALSE

What is the necessary emergency respiratory equipment for the bedside?

ambu bag and mask , flow meter, yankauer and suction

What is afterload?

force ventricle must overcome to eject blood volume pressure in arterial pressure, amount of resistance that heart can work against to eject remaining blood in left ventricle after systole

What is preload?

the degree of stretch on the heart before it contracts

What are ways to decrease aspiration?

raise the HOB with feeds, keep upright after feeding, have suction equipment available, always check placement, speech/swallow consult, check residual

How do you do chest pt? do you need an order?

cupped hands bang on back for 30-40 seconds, do not need an order

What are signs of renal failure?

increase in potassium, increase in BUN and creatinine

GFR decreases with _____ and ______, increases with __________.

dehydration and low BP; increases with overhydration

T/F: You can vent through the mouth with a larygectomy

false, you cannot vent through mouth

How do you prevent a feeding tube from clogging?

flush before and after meds, also pause fee when going to MRI

What size trach do you keep at the bedside?

one the same size and one smaller

What can chest pt help with?

mucus plugging

What is the first priority in pancreatitis?

fluid and electrolyte administration/repletion

When should an A line be zeroed?

movement, disconnection and transport

T/F: Arterial lines provide continuous BP readings

True

What is the greatest sign of hypercapnia?

lethargy

How is a new NG confirmed?

x ray

What is the most important nursing intervention for someone with an A-line dislodgement?

apply pressure

What are non invasive ways to prevent tube dislodgement?

mittens, distractions and comfort cart

Who orders a safety care?

nurse

What medications should not be used in patients with preexisting respiratory issues?

nonselective beta blocker

What patients shouldnt use beta blockers at all?

cardiogenic shock, heart block, sinus brady

When are pts usually put on ARBs?

because ACE is causing a cough

What is angina Pectoris?

transient myocardial ischemia without cellular death

What is the difference between lethargy and stupor?

lethargy- severe drowsiness but can be aroused by moderate stimuli

stupor- only vigorous and repeated stimuli will arouse the patient, and then patient will lapse back to unresponsive state