FCCS Review 2024-2025 Questions & Correct Answers. Already Graded A+, Exams of Nursing

Download FCCS Review 2024-2025 Questions & Correct Answers. Already Graded A+ and more Exams Nursing in PDF only on Docsity! FCCS Review 2024-2025 Questions & Correct Answers. Already Graded A+ 41 y/o pt in the SICU following debridement of b/l lower extremities for necrotizing fasciitis is intubated on AC. Temp 102, HR 116, RR 16, BP 92/46. ABG shows pH 7.23, PO2 133, PCO2 38, Na 139, K 3.7, Cl 102, Bicarb 16, lactate 4. Dx is metabolic acidosis w/ anion gap d/t infection. What is the most appropriate intervention? Increase VT Continue resuscitation Decrease RR Administer bicarb - ANSContinue resuscitation. Don't need to increase VT bc the pt doesn't have respiratory acidosis. If you decrease the RR, the pt will go into respiratory acidosis. A 22 y/o pt ingested drugs >4 hours ago. She came to the ICU obtunded w/ arousal to tactile stimulation. She is hemodynamically stable. RR 8 with an NG tube in place. What is the next step for tx of the ingestion? - ANSMonitor / watchful waiting. The pt ingested the drugs more than 4 hours ago. Monitor RR and intubate if necessary. A 24 y/o male comes in following a concussion. CT reveals a frontal lobe contusion. He does not require intubation and is kept on 3 L O2 NC. He then suddenly has a generalized seizure. What is the DOC? What do you give after the seizure? What med class is an absolute contraindication for seizures? - ANS1. lorazepam IV 2. dilantin 3. NMB A 50 y/o pt is having a COPD exacerbation. You have tried steroids, bronchodilators, etc. with no improvement. PCO2 is in the 90s, pH is 7.20. You decide to intubate. Vent settings are: VT 375, RR 20, FiO2 .35, PEEP 5. CXR is normal. A few minutes later, his BP drops to 70/40. Lungs are clear/equal. Vent shows peak airway pressure of 55 (high) and plateau pressure of 15. End expiratory hold gives auto-peep of 15. What is the cause of this pt's HoTN and why? - ANSAuto-peep is the cause. COPD pts have difficulty exhaling --> pressure buildup in alveoli. We use PEEP for the pressure and to improve oxygenation. Auto-peep comes from breath-stacking --> intrinsic peep. Alveoli enlarge --> high peak airway pressure. All leads to low venous return --> low CO --> HoTN a 55 y/o male comes in with AMS and diffuse abdominal pain. He takes HCTZ and a multivitamin. HR 120 sinus tach. He is moaning in pain and unable to articulate what is happening. CT reveals lytic lesions in the vertebrae. You administer a 3L NS bolus which shows mild improvement. What is the dx and what is causing his symptoms? How do you tx? - ANSDx: multiple myeloma The hypercalcemia is what is causing the symptoms. Tx: Fluids, then diuretic or bisphosphonate if symptoms persist. A 70 y/o pt has been hospitalized for 15 days. He had a cholecystectomy and abscess formation which was tx appropriately. He has a central line in the right IJ. The site looks visibly infected, and he has a fever, is tachy, and hypotensive. WBCs are high. Blood culture and initial gram stain reveals G(+) cocci. What is the dx? What is the MC pathogen? What is the tx? - ANS1. line-related infection 2. coag (-) staph epidermis 3. vanco + zosyn + ceftriaxone if MRSA: vanco + ceftriaxone if MSSA: zosyn + ceftriaxone A 70 y/o pt with CHF presents with SOB, accessory muscle use, RR 34, SpO2 90% on 8L O2. CXR reveals infiltrates in a bat wing pattern. She also has LE edema. She is dx with a CHF exacerbation w/ respiratory failure. Her ABG shows pH 7.3, PO2 64, CO2 50. What is the best tx for this pt? - ANSNon-invasive BiPAP. A young asthmatic pt is on the vent. His lungs are very tight. He is on the AC setting and there is a lot of auto-PEEP. You correct it by reducing the rate, giving him more time to exhale and making sure he has enough flow. FiO2 is at .50. He is sedated and seems comfortable. On ABG the pH is 7.24, CO2 is 65, O2 is 80, and bicarb is 29. What would you do with the vent settings in this case? - ANSKeep the settings where they are. You can't hyperventilate the pt to blow off CO2 b/c the asthma will worsen. As long as the pH is > 7.2, the settings are okay as they are. CO2 will correct over time. A young pt after an MVA comes to the ER hypotensive and tachycardic. CXR is clear. He has a contusion on his chest wall and torso. He is unconscious. What will give you the best insight on what is causing his shock? Hb SCV Urine Output FAST exam - ANSFAST exam An 84 y/o pt fell down the stairs. He is moaning and crying. He has a C-collar in place. His neck is painful and he has bruising on his face. He is tachy but BP is okay. You administer 2L O2 bc SpO2 was 92%. Shortly after he deteriorates, becoming altered and then comatose. His left pupil > the right. He is herniating from cerebral edema. How do you treat him? - ANSIntubate and ventilate, maintaining c-spine precautions. Administer mannitol. An ESRD pt w/ hyperkalemia develops dyspnea and requires intubation. Which paralytic agent/NMB should you avoid and why? - ANSSuccinylcholine Worsens hyperkalemia How do you manage DKA? - ANSCheck potassium Multiple L bolus via at least 2 peripheral IVs Insulin infusion, 0.1U/kg/hr until sugar reaches 250 mg/dl Switch NS to D5W Once anion gap is closed, administer long-acting insulin 1 hr prior to d/c infusion How do you treat septic shock (4 things)? - ANS2-3 L bolus NE Vasopressin Steroids If a pt has a thyromental distance of 2 cm, what can you expect about their airway? - ANSDifficult airway w/ an anteriorly displaced larynx What are the classifications of hemorrhagic shock? - ANSI: <15%; HR <100, BP normal, RR normal II: 15-30%; HR >100, BP normal, RR 20-30 III: 30-40%; HR >120, BP low, RR 30-40 IV: >40%; HR >140, BP low, RR >40 What decreases during pregnancy by ~25%? - ANSFunctional residual capacity What intervention improves outcomes with ROSC after cardiac arrest? - ANSTargeted temperature management. 32-36 C What is the most appropriate management for both STEMI and non-STEMI? nitro if bp >80 morphine q 30 min bb oxygen if sats are <94% - ANSOxygen What is the most important sign in a critically ill pt? Why? - ANSTachypnea Indicates metabolic acidosis w/ respiratory alkalosis compensation What is the tx for meningitis? - ANSyoung pt: ceftriaxone + vanco > 50 pt: add ampicillin What is the tx of hyperkalemia? - ANScalcium gluconate + insulin + dextrose bicarb, kayexalate, albuterol definitive tx: dialysis When treating hyponatremia, what is the first thing to assess? When do you give 3% NaCl? How do you correct it? - ANS1. fluid status 2. seizures or changes in mental status 3. slowly, 8-12 meq over 24 hr Which medication improves outcomes for pts with STEMI? - ANSACE-I Give if BP is stable. It decreases LV remodeling and decreases afterload. Which NSTEMI needs to be sent to the cath lab immediately? - ANSNSTEMI w/ shock Which two conditions are the most indicated for BiPAP? - ANSCOPD exacerbation Cardiogenic pulmonary edema Which type of respiratory failure occurs with CNS depression after an OD? - ANSAcute hypercapnic respiratory failure --> mixed