Prophecy General ICU RN A V1, V2 &V3
Prophecy General ICU RN A V1
What is cardiac tamponade?
Fluid in the pericardial sac causing decreasing preload. This decreases SV and ultimately CO.
Effects of Hyper/Hypokalemia and calcemia on EKG
Hypokalemia causes U waves
Hyperkalemia causes peaked T waves
Normal BP?
90-120/60-80
Normal HR?
60-100 bpm
Normal CO?
4-8 L/min
Normal SVR?
800-1,200 dynes/seconds
Normal PVR?
37-250 dynes/sec/cm5
Normal SVo2?
60-80%
Normal PAP?
Systolic: 15-30 mm Hg
Diastolic: 4-12 mm Hg
Normal CVP?
2-6 mmHg
V-fib in relation to CO
V-fib produces an ineffective stroke, decreasing SV and CO.
RV failure - treatment after RV MI
Right sided measurements are more related to fluid balance and build up of fluid in the peripheral side.
RV failure leads to insufficient LV preload. The result is low SV and CO. Treatment involves fluid
loading with hypertonic fluids (3% saline, mannitol, 20% albumin)
IABP optimal timing
Inflation during diastole (AV closure) and deflation during systole (QRS)
IABP functions
Decrease afterload and increase coronary artery perfusion
IABP waveforms
Unassisted Systolic
Unassisted End Systolic
Assisted Diastolic
Assisted End Diastolic
Unassisted End Diastolic
MI Leads
Septal V1, V2
Anterior V3, V4
Lateral I, aVL, V5, V6
Inferior II, III, aVF
Endocarditis
inflammation of the inner lining of the heart
Where do most thrombi occur?
In the legs
Amiodarone
Antiarrhythmic
Nicardipine/Cardene
Ca Channel Blocker works on periphery
Cardizem/Diltiazem
Ca channel blocker works on periphery/heart
Dobutamine (500 mg/250 mL)
Inotrope & Dilator (Beta 1/2 agonist)
Dopamine (400 mg/250 mL)
Vasopressor (catecholamine, dopamine agonist at low doses, beta agonist at 5-10, and alpha agonist at
larger)
Epinephrine (5 mg/250 mL)
Vasopressor/catecholamine (Beta agonist, alpha agonist at large doses)
Esmolol (2500mg/250mL)
Beta blocker
Levophed/Norepinephrine (4 mg/250 mL)
Vasopressor/catecholamine (more Alpha agonist, beta agonist at high doses)
Lidocaine (2 g/500 mL)
Antiarrythmic
Neosynephrine/Phenylephrine (20 mg/250 mL)
Vasopressor (alpha agonist)
Nipride/Nitroprusside (50 mg/250 mL or 100 mg/250 mL)
Arterial vasodilator
Nitroglycerin (25 mg/250 mL)
Vasodilator
Precedex/dexmedetomidine (200 mcg/50 mL & 400 mcg/100 mL)
Sedative
Primacor/Milrinone (50 mg/250 mL & 40 mg/250 mL)
Inotrope/vasodilator (useful PHTN & low RV function) (Phosphodiesterase inhibitor in vascular and
cardiac tissue)
Vasopressin (20 mg/100 mL)
Vasopressor (vasopressin I agonist in periphery)
Prophecy General ICU RN A V2
Common complications of massive transfusions are
Dilutional Coagulopathy, DIC, hypothermia, and fibrinolysis
ABG pH 7.25, pCO2 40, pO2 90, HCO3 20mEq/L
Metabolic Acidosis
Long term use of TPN may lead to:
Liver Failure
Which of the following is a potential complication of high PEEP
Pneumothorax
What is a common assessment finding for a patient returning from a small bowel resection?
Hypoactive bowel sounds
Your patient suddenly becomes diaphoretic, anxious, tachycardic, and has clammy skin. Which of the
following would you suspect.
A)WRONG Hypoxemia
B) Acute MI
C) Panic Attack
D) Hypoglycemia
The staff nurse asks the nursing assistant to check on a patient. The nursing assistant reports back that the
patient is experiencing chest pain and is diaphorectic. Which of the following can the staff nurse delegate
to the assistant?
A) Calling the physician WRONG
B) Gathering vitals and assessing the cause for the change in status
C) Informing the charge nurse that a patient needs attention
D) Obtaining a medication for the nurse to administer to the patient
Your patient returned from PACU after surgery and is very drowsy. She attempts to eat a candy bar and
begins to choke. The physician is unable to clear the airway. You would expect to prepare for which of
the following. emergency procedures?
A) Endotracheal Intubation WRONG
B) Chest tube insertion
C) Tracheostomy
D) Bronchoscopy
The initial insulin therapy for a patient with acute DKA is usually administered by which route
Intravenous bolus followed by a continuous infusion
Screening tests for DIC include:
D-Dimer and FDPs
Which of the following hormones is secreted by the hypothalamus in an effort to regulate water balance?
ADH
Which of the following IV sedatives would most likely be ordered for a non-intubated patient?
Precedex
Your patient is in bed and eating lunch when they begin to cough and gag. Suddenly they become
dyspneic and bradycardic with excessive salivation. What do you suspect happened?
Aspiration
Which of the following is a response of the cardiovascular system to early sepsis?
Increased cardiac output and reduced systemic vascular resistance
Which patient would you expect to be extubated?
Patient is awake, follow commands with RR of 14, FiO2 40%, and PEEP 5
Hypertensive crisis
Nicardipine
Your patient sustained a crushed pelvis in a MVC. You notice a pinkish sediment in the urinary catheter
tubing and decreased urinary output. Which of the following conditions would you suspect?
Rhabdomyolysis
Which class of drugs should be avoided in patients with asthma?
Beta Blockers
CAM-ICU is a measure for which condition?
Delirium
Which of the following drugs would you expect to administer in a patient diagnosed with myasthenia
gravis?
Mestinon
ABG pH 7.56, paCO2 24 mmHG, HCO3 23 mEq/L
Respiratory Alkalosis
When assessing a chest tube, which of the following indicates a possible air leak
Excessive bubbling in the water chamber
Which of the following medications improves contractility, increases stroke volume, and increases
cardiac output?
Dobutamine
Muffled heart sounds would indicate what condition?
Cardiac tamponade
Pain assessment in an unconscious patient
Requires astute assessment skills using multiple approaches
Which of the following tests should be performed prior to administering tPA
CT Scan
Which of the following classes of drugs are used in an effort to therapeutically decrease venous return and
reduce peripheral vascular resistance?
Vasodilators
Identify the type of renal failure that results from bilateral obstruction of urine outflow
Post-renal failure
A patient exhibits hypotension without an increase in HR is indicative of
Neurogenic Shock
Your patient is taking the following medications: Zoloft, Lanoxin, Protonix, lasix, and coumadin. Which
medication would you hold for a blood pressure of 80/50?
Lasix
A patient was admitted with a hemoglobin of 6, hematocrit of 25, has clammy skin, confusion, and
agitation, BP 80/40, HR 145. What type of shock is this?
Hypovolemic
The patient is admitted with suspected Guillain-Barre syndrome. The nurse would expect CSF analysis to
reveal which of the following to confirm the diagnosis?
CSF protein of 60 mg/dL and WBC 0 cells/mm3
Your patient is receiving IV medications of Nitroglycerin and Verapamil. Which of the following should
the nurse observe for during the assessment?
Hypotension
CVP measures the pressure in the
right atrium
Which lab value is used to determine the severity of sepsis
lactic acid
Which of the following hormones is secreted by the thyroid gland?
calcitonin
An adrenocorticotropic hormone (ACTH) stimulation test would be ordered for which diagnosis?
Adrenal crisis
The most common cause for the patient to file a nursing negligence claim is
Ineffective communication
Which medication is a paralytic
Vecuronium
90% of thrombi develop in which area of the body?
Legs
Which of the following medications is usually the first to be administered during status epilepticus
Ativan
Pt's BP on admission was 110/40, and Hgb was 10.5. The BP is now 80/50 and pt is vomiting coffee
ground emesisi. You expect Hgb to be:
8
You note the appearance of a U wave on the ECG tracing of your patient, This would indicate that the
nurse check laboratory values for the presence of
Hypokalemia
Must be performed prior to A-line insertion
Allen test
Diet best for patient with renal failure?
low sodium, low potassium, and moderate protein
You're caring for a 49 yo head trauma pt with an ICP line. What is the formula for calculating the CPP?
MAP - ICP
Pt presents with fever, chills, cough, SOB and chest pain. Which diagnosis would you anticipate?
Pneumonia
CVP normal range
2-8 mmHg
Pt presents with stiff neck, headache and fever for the last 24 hr. What condition would you suspect?
Bacterial meningitis
Hypotensive crisis, which med would you anticipate giving?
Levophed
Hypotonic solution
0.45% NS
What pathological condition might you suspect in a patient with a serum sodium of 165 and serum
osmolality of 330?
Diabetes Insipidus
Med commonly used to decrease ICP
Mannitol
ABG 7.35, paCO2 60mmHg, HCO3 38 mEq
Compensated respiratory acidosis
Contraindicated for Lorazepam
Pt with acute angle-closure glaucoma
Prophecy general ICU A V3
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 appear busy.
How should you prioritize your time?
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?
Ask the provider to update the route of administration.
What laboratory value should you monitor closely if your patient is vomiting coffee ground emesis?
Hemoglobin
What ECG finding is indicative of hyperkalema?
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?
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?
Pulmonary artery or bladder
Your patient has just completed IV potassium replacement. When should you collect their repeat
potassium leve l?
30-60 min
Your patient is receiving an antiarrhythmic agent. Which of the following assessment parameters is the
MOST important for you to evaluate?
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?
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?
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
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?
It is best if your family takes your belongings.
What is a significant complication of imaging studies performed with iv contrast
Acute kidney injury
What respiratory support would an alert patient with an acute COPD exacerbatiobn likely receive FIRST?
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?
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?
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?
A. Adjust the alarm parameters
How is dopamine usually administered in the icu when given intravenously
Titratable continous infusion
Which of the following can be given through an enteral feeding tube?
Immediate release pills
When donning an N-95 mask, how should you secure the nose?
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?
Benzodiazepines
While admitting a patient with a history of IV drug use, what precautions should you take?
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?
A. Instill normal saline to lavage ETTWRONG
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?
Liver injury
Which assessment establishes baseline hand perfusion before an ABG puncture or arterial line placement?
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?
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?
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?
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?
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.
ScVo2
Which of the following actions complies with ventilator acquired pneumonia (VAP) prevention
protocols?
Keep head of bed 30-45 degrees
What assessment tool is needed for a patient who has uncomplicated retrosternal hemorrhage?
Follow up imaging test
Which condition may cause increased effects from a medication that is mostly metabolized by the liver?
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?
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 contras t?
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?
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?
Pulmonary embolism
What IV sedative would MOST likely be ordered for a non-intubated patient?
Dexmedetkomidine (precedex)
What is the normal cardiovasculat response to early sepsis?
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?
Assess Patient B's respiratory status
Which of the following diets would be BEST for a patient with renal failure?
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?
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?
Decrease in FiO2
What information do you need from the provider to setup a cerebral intraventricular drainage system?
Maximum ICP
After turning a patient with CVP monitoring what should you do to ensure accuracy of the CVP reading?
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?
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?
Acknowledge the family's concerns and recommend a meeting with the family and interdisciplinary team.
What is the BEST way to determine a STEMI?
12 Lead ECG
What condition does the Confusion Assessment Method for ICU (CAM-ICU) detect?
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?
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?
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?
Inform the provider and discuss additional options.
During cardiogenic shock what temporary intervention might be ordered to improve perfusion until
definitive treatment is provided?
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?
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?
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?
Draw blood culture
A code is initiated and the second nurse is observed not following ACLS protocol. What is the BEST
actionsto take?
Stop the nurse immediately and institute ACLS protocol
During the first hour of tPA infusion, how frequently should you monitor blood pressure?
Every 15 minutes
Which of the following is a priority for the bedside nurse when a patient gets inpatient hemodialysis?
Maintaining adequate blood pressure
What MUST you confirm before removing a cervical spine collar?
Presence of active order to remove
Which of the following signs or symptoms indicates a patient might not be tolerating the extubation?
The patient is coughing and has tachycardia
Which age group is MORE likely to experence a "Blown" vein
older adults
What acid/base imbalance is MOST likely to be found in a patient with COPD
Respiratroy acidosis
Which of the following should you do if your patient suddenly becomes diaphoretic, anxious, tachycardic,
and has clammy skin?
Check their glucose
What information is MOST important for you to confirm in smart IV pump settings?
Weight
Besides the white blood cells, what laboratroy value is used in the diagnosis of sepsis?
Lactic acid
Which medication is associated with increased delirium in critical care patients?
Lorazepam ( ativan)
What is an effective way to evaluate for cyanosis in a person of color
Check inner eyelids
What cardiac condition shows cardiomegaly on chest x-ray
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
Surgical airway
