Prophecy general ICU A V3 latest 2022

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One of your patients coded but is now stabilized and you are catching up on charting. The step-down unit calls to get report on your other patient who is to be transfered. The nurses near you do not a... ppear busy. How should you prioritize your time? - ANSWER Give report and ask the nurses to prepare the patient for transfer. Your patient was intubated but still has oral medications on their list of medications. How should you ensure they receive their medications? - ANSWER Ask the provider to update the route of administration. What laboratory value should you monitor closely if your patient is vomiting coffee ground emesis? - ANSWER Hemoglobin What ECG finding is indicative of hyperkalema? - ANSWER peaked T wave You witness a patient that is not assigned to you fall out of bed and begin crying for help but you do not see the assigned nurse to assist the patient. What should you do first? - ANSWER Check on the patient's status and call for assistance. When assessing for fever in your intubated patient, placement of the thermometer in which area would be most accurate? - ANSWER Pulmonary artery or bladder Your patient has just completed IV potassium replacement. When should you collect their repeat potassium level? - ANSWER 30-60 min Your patient is receiving an antiarrhythmic agent. Which of the following assessment parameters is the MOST important for you to evaluate? - ANSWER ECG Your patient is undergoing a weaning trial from the ventilator. Fifteen minutes into the trial the patient's heart rate increases to 140 bpm and they start to grab at their oxygen and IV tubing. What should you do NEXT? - ANSWER C. Stop weaning and rest the patient While assessing a patient just admitted to the hospital, he admits to drinking 12 cans of beer a day, with the last drink being right before admission. What is the expected onset of delirium tremens? - ANSWER Within 48-72 hours You have administered a pain medication that has a half-life of 120 minutes, onset of action 6 min, tmax of 15 minutes, and is mostly excreted in the uring. when can the patient expect the medication to start working - ANSWER 6 minutes A lethargic but oriented patient is being admitted for sepsis and their family member is in the waiting area. Their belonging include a ring, cell phone, and wallet. The patient asks if they can keep the ring on and phone at bedside. What is your BEST response? - ANSWER It is best if your family takes your belongings. What is a significant complication of imaging studies performed with iv contrast - ANSWER Acute kidney injury What respiratory support would an alert patient with an acute COPD exacerbatiobn likely receive FIRST? - ANSWER Bipap Your intubated and unresponsive patient is scheduled for surgery in the morning. Who is the most appropriate person to make decisions for your patient? - ANSWER The healthcare POA When administering a titratable infusion what information must you check on the medication IV bag to confirm the correct dose is being administered? - ANSWER Concentration Your patient has a known baseline heart rate of around 45. The ECG monitor keeps alarming when the heart rate decreases below 50. Their vital signs are stable. What would you do? - ANSWER A. Adjust the alarm parameters How is dopamine usually administered in the icu when given intravenously - ANSWER Titratable continous infusion Which of the following can be given through an enteral feeding tube? - ANSWER Immediate release pills When donning an N-95 mask, how should you secure the nose? - ANSWER Fit the nose piece with both hands What type of medication is used in the critical care setting to help manage the symptoms of alcohol withdrawal? - ANSWER Benzodiazepines While admitting a patient with a history of IV drug use, what precautions should you take? - ANSWER Carefully inspect items for presence of sharps. Your patient is intubated and begins to cough up clear mucous inside their ETT. What should you do NEXT? - ANSWER A. Instill normal saline to lavage ETT*WRONG* B. Sit the patient up to 30 degrees in bed *wrong* C. Inspect their oral cavity and suction mouth D. Provide 100% oxygenation and prepare to suction What is a complication of long term TPN? - ANSWER Liver injury Which assessment establishes baseline hand perfusion before an ABG puncture or arterial line placement? - ANSWER Allen Test You find the concentration of an IV medication bag that is hanging and infusing into your patient does not match the concentration in the order. What should you do NEXT? - ANSWER Stop the infusion Your patient has a right chest tube that was placed after thoracotomy. They report that is very painful when they cough and request cough medicing. What should you do? - ANSWER Teach them to splint their right side when coughing and give pain medicine Your patient had an unplanned self-extubation. They are now alert and sitting up. Their pulse oximetry is 98% on 4 liters face mask. What action should you prioritize? - ANSWER A. Inspecting the oral cavity B. Checking blood pressure and the heart rate*WRONG C. Administering an albuterol nebulizer D. Performing an ordered STAT ABG *WRONG Your are admitting a patient who is sedated and intubated directly from the operating room after a major surgery. The anesthesia provider connects the patient to the ventilator in the ICU room and leaves before entering orders for the patient's ventilatory settings. How should you proceed? - ANSWER Contact the ICU intensivist or specialist assigned to the case For a patient with septic shock, What would you monitor to objectively determine the effectiveness and need to titrate a dobutamine infusion. - ANSWER ScVo2 Which of the following actions complies with ventilator acquired pneumonia (VAP) prevention protocols? - ANSWER Keep head of bed 30-45 degrees What assessment tool is needed for a patient who has uncomplicated retrosternal hemorrhage? - ANSWER Follow up imaging test Which condition may cause increased effects from a medication that is mostly metabolized by the liver? - ANSWER Hepatitis C An intubated patient with a GCS of 3 is admitted to the ICU from the ER after being found down for an unknown amount of time at home. The CT scan reveals profuse cerebral edema. When is the BEST time to notify organ donation services? - ANSWER Within 24 hours of admission to the ICU What order is included in the pre-procedural checklist for patients at risk for acute kidney injury who are to receive IV contrast? - ANSWER Pre-hydration with IV Fluids Your patient is intubated with an ETT and sedated without spontaneous monements when the ventilator alarms with a high-pressure warning. The ventilator tubing is free and unkinked. What should you do NEXT? - ANSWER Provide 100% oxygen and prepare to suction the patient Your postoperative patient suddenly becomes dyspneic, clutches their chest and their Sp02 drops to 89% the patient has a swollen left calf. what condition do you suspect? - ANSWER Pulmonary embolism What IV sedative would MOST likely be ordered for a non-intubated patient? - ANSWER Dexmedetkomidine (precedex) What is the normal cardiovasculat response to early sepsis? - ANSWER Increased cardiac output You have just received report on Patient A and Patient B. Patient A is intubated, sedated, and on a vasoactive infusion to keep their BP greater than 110 mmHg systolic on an arterial line. Patient B was extubated an hour ago and has a scheduled glucose check due in 1 hour. What is your PRIORITY action? - ANSWER Assess Patient B's respiratory status Which of the following diets would be BEST for a patient with renal failure? - ANSWER Low sodium, Low potassium and moderate protein Your patient on a furosemide infusion has a positive daily fluid balance, new bilateral crackles on auscultation and has gained weight since admission. What action should you take? - ANSWER Discuss increasing the furosemide infusion with the provider What ventilator adjustment do you expect when your patient's ABG is pH 7.40, PaCO2 112, BICARB 22? - ANSWER Decrease in FiO2 What information do you need from the provider to setup a cerebral intraventricular drainage system? - ANSWER Maximum ICP After turning a patient with CVP monitoring what should you do to ensure accuracy of the CVP reading? - ANSWER Zero the line at phlebostatic axis In a patient with septic shock, after fluid administration which of the following findings is MOST suggestive of the need to start a vasopressor? - ANSWER Mean arterial pressure 40-50 mmHg Your patient's family does not want to tell the patient of their life-threatening diagnosis and pleads with you not to let the patient know. What is the MOST appropriate response? - ANSWER Acknowledge the family's concerns and recommend a meeting with the family and interdisciplinary team. What is the BEST way to determine a STEMI? - ANSWER 12 Lead ECG What condition does the Confusion Assessment Method for ICU (CAM-ICU) detect? - ANSWER Delirium You are caring for an underweight, older adult who is intubated, sedated, and septic. You have implemented turning every 2 hours. While inspectingthe patient's back you notice bony prominences with intact but reddened skin. What should youinclude in the plan of care? - ANSWER Use of specialized air bed You are to administer 1 mg of morphine IV but it only comes in a 2 mg vial. How should you proceed? - ANSWER Waste 1 mg with a second nurse and then give the drug to the patient The provider has ordered 2 units of FFP to be transfused. Your patient's religious beliefs prevent them from accepting blood products. What is your BEST response? - ANSWER Inform the provider and discuss additional options. During cardiogenic shock what temporary intervention might be ordered to improve perfusion until definitive treatment is provided? - ANSWER Inotropic infusion While reviewing your patient's EHR prior to receiving report, you notice that their documented urine output for the past 24 hours is 600ml. What would be the MOST important action to take for this patient? - ANSWER confirm with the off-going nurse if this is a known situation. You are caring for a confused patient with edema who has large swollen wrist. You find that someone has taped their ID bracelet to the side of the bed. How should you secure their ID bracelet? - ANSWER Place a new ID bracelet on the patient's wrist while confirming perfusion to the hand You are caring for a patient with diabetic ketoacidosis with suspected sepsis. You have the following tasks to complete: Draw blood cultures, checkblood glucose, administer antibiotic, insert urinary catheter, and check urine for glucose. Which task should you complete FIRST? - ANSWER Draw blood culture A code is initiated and the second nurse is observed not following ACLS protocol. What is the BEST actionsto take? - ANSWER Stop the nurse immediately and institute ACLS protocol During the first hour of tPA infusion, how frequently should you monitor blood pressure? - ANSWER Every 15 minutes Which of the following is a priority for the bedside nurse when a patient gets inpatient hemodialysis? - ANSWER Maintaining adequate blood pressure What MUST you confirm before removing a cervical spine collar? - ANSWER Presence of active order to remove Which of the following signs or symptoms indicates a patient might not be tolerating the extubation? - ANSWER The patient is coughing and has tachycardia Which age group is MORE likely to experence a "Blown" vein - ANSWER older adults What acid/base imbalance is MOST likely to be found in a patient with COPD - ANSWER Respiratroy acidosis Which of the following should you do if your patient suddenly becomes diaphoretic, anxious, tachycardic, and has clammy skin? - ANSWER Check their glucose What information is MOST important for you to confirm in smart IV pump settings? - ANSWER Weight Besides the white blood cells, what laboratroy value is used in the diagnosis of sepsis? - ANSWER Lactic acid Which medication is associated with increased delirium in critical care patients? - ANSWER Lorazepam ( ativan) What is an effective way to evaluate for cyanosis in a person of color - ANSWER Check inner eyelids What cardiac condition shows cardiomegaly on chest x-ray - ANSWER Systolic heart failure Your patient begins to choke and a code blue is called. The provider is unsuccessful at removing the object and is unable to place the ETT. You would expect to prepare for what type of procedure - ANSWER Surgical airway [Show More]

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