MS 3 Practice Test- Diabetes, Shock, Mods, ACLS, Burns And Cancer

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3. What type of shock is a burn patient prone to?

Cardiogenic

Anapylactic

Hypovolemic

4. What is the purpose of Kussmal Respirations in a patient with DKA?

To blow off CO2 which compensates for the bodies acidic state

To cool off the body reducing glucose metabolism

To hypoventilate which compensates for the bodies acidic state

Kussmaul respirations are deep and rapid; they blow off CO2 causing hyPERventilation, decreasing carbonic acid, increasing the base compensatory mechanisms to regulate the acidic state caused by DKA

Explanation

Kussmaul respirations are deep and rapid; they blow off CO2 causing hyPERventilation, decreasing carbonic acid, increasing the base compensatory mechanisms to regulate the acidic state caused by DKA

5. You go in to check on your patient and they do not have a pulse. This first thing you do is:

Crap your pants

Review their EKG to determine if they have a shockable rhythm

Begin CPR

Administer epinepherine

ok- maybe this was a no-brainer, but know if you find this patient you better start CPR first and let someone else get the equipment and go from there.

Explanation

ok- maybe this was a no-brainer, but know if you find this patient you better start CPR first and let someone else get the equipment and go from there.

6. A burn patient has singed nasal hairs and sooty sputum. They are put on 02 via NC 6 liters but their sats continue to fall. They are intubated and put on what % of oxygen?

25%

50%

100%

expectoration of carbon (soot) is a cardial sign of inhalation injury. Carbon Monoxide has a higher affinity for Hemoglobin than oxygen so the O2 needs to be at 100% to drive out the carbon monoxide from the hemoglobin molecule

Explanation

expectoration of carbon (soot) is a cardial sign of inhalation injury. Carbon Monoxide has a higher affinity for Hemoglobin than oxygen so the O2 needs to be at 100% to drive out the carbon monoxide from the hemoglobin molecule

7. A patient recently diagnosed with DM I asks why she can't just take oral anti-diabetic medications instead of insulin injections. You tell her:

Oral medications are not effective agains DM 1 because they do not stimulate enough insulin production from the pancreas

DM 1 patients can take oral anti-diabetic meds, but would have to take so many it would be too expensive

Oral medications are not effective against DM 1 because the pancrease isn't producing any endogenous insulin to be supplemented

The pancreas of a DM 1 patient doesn't produce ANY insulin so it must be provided through insulin injections

Explanation

The pancreas of a DM 1 patient doesn't produce ANY insulin so it must be provided through insulin injections

8. An escharotomy would be used to treat:

Hypovolemia

Paralytic ileus

Compartment syndrome

9. A patient with a known infection begins to experience persistent hypotension. This patient is suffering from:

Sepsis

Severe Sepsis

Septic Shock

10. How can DIC lead to MODS?

DIC causes severe bleeding robbing the organs of oxygen

DIC causes cellular toxins to be released in the blood stream,poisoning the organs

DIC causes microvascular clots which block organ perfusion robbing the organs of oxygen

Although DIC can cause bleeding d/t lack of clotting factors,that is not why organs lack perfusion- it's because of the clots

Explanation

Although DIC can cause bleeding d/t lack of clotting factors,that is not why organs lack perfusion- it's because of the clots

11. For a patient with an adequate BP and anaphylactic shock, you would administer between _____mg and ____mg of epinepherine at ______________ concentration (enter answers without mg and following each other with a comma and a space: x, y, x

If a patient's BP is low, the same dose of Epi is used but in a 1:10,000 concentration IV q 5"

Explanation

If a patient's BP is low, the same dose of Epi is used but in a 1:10,000 concentration IV q 5"

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12. What is the cause of hypotension in Septic Shock?

Slowing of the heart r/t electrolyte imbalances

Damage to endothelial cells that affect constriction of blood vessels

Hypovolemia

13. Why would lactate levels be monitored in a patient with Septic Shock?

To monitor kidney function

To determine if aerobic metabolism is replacing anaerobic metabolism

To monitor muscle wasting

14. Shock, CPR,epi; shock, CPR, epi; shock, CPR, epi- what type of patient would receive this treatment?

PEA

Pulseless VF/VT

Asystole

pts with no shockable rhythm are PEA and Asystole- these patients would receive CPR, epi, CPR, epi (or one time dose of vasopressin)

Explanation

pts with no shockable rhythm are PEA and Asystole- these patients would receive CPR, epi, CPR, epi (or one time dose of vasopressin)

15. What would indicate a risk of Restrictive Pulmonary system alterations?

Singed nasal hairs

Hoarse voice

Circumferencial burn on thorax

Full thickness burn on face

Restrictive alterations are caused by circumferencial burns on the neck or thorax that swell and cause tightening decreasing tidal volume

Explanation

Restrictive alterations are caused by circumferencial burns on the neck or thorax that swell and cause tightening decreasing tidal volume

16. What indicators let the burn team know that skin has a better chance of re-growth? (choose all that apply)

Ability to blanch

Presence of hair follicles

Dry appearance

Absence of pain

wet skin has sebaceous glands which increases chances of re-growth; absence of pain indicates loss of nerves which occurs with deeper burns which don't heal as well

Explanation

wet skin has sebaceous glands which increases chances of re-growth; absence of pain indicates loss of nerves which occurs with deeper burns which don't heal as well

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17. What drug is always associated with Diabetic Nephropathy?

ACE inhibitors- prils

Beta-Blockers- lols

CCB

18. The most common and effective treatment options for patients with Diabetic Neuropathies are:

Physical Therapy

Bio-feedback

Medications

Hydrotherapy

Reglan for delayed gastric emptying, non-opiod analgesics, neurontin, viagra

Explanation

Reglan for delayed gastric emptying, non-opiod analgesics, neurontin, viagra

19. A burn victim with 32% TBSA and a weight of 200lbs is admitted to the burn unit. Using the Parkland Formla, how many mL of fluids should this patient receive in the first 8 hours of fluid resuscitation?

11636 mL

5818 mL

364 mL

The first number is the total 24 hour fluid resuscitation amount; the last number is the weight x 4mL

Explanation

The first number is the total 24 hour fluid resuscitation amount; the last number is the weight x 4mL

20. A patient with pneumonia is on the vent. Their PaO2 is 90 and their FiO2 is set at 35%. This patient is experiencing pulmonary shunting

True

False

Their PaO2/FiO2 ratio is 257. Any value under 300 is considered pulmonary shunting, a sign of Septic Shock

Explanation

Their PaO2/FiO2 ratio is 257. Any value under 300 is considered pulmonary shunting, a sign of Septic Shock

21. Your patient has a skin lesion that is rough, scaly ad thickened in appearance. It is most likely a:

Basal Cell Carcinoma

Squamous Cell Carcinoma

Malignant Melanoma

22. The gut should be used within the first 6 hours after a burn patient arrives at the hospital- "use it or lose it" In what circumstances would this be contraindicated?

ETT and mechanical ventilation

Crackels in the lungs r/t fluid resuscitation

Paralytic ileus

Curlings Ulcer

23. The destruction of RBC's and muscle from heat injuries can cause free hemoglobin and myoglobin to build up in the blood. What organ system would this affect most?

Liver

Kidneys

Spleen

The large molcules get caught in the kidneys filtration system clogging them up and causing kidney failure

Explanation

The large molcules get caught in the kidneys filtration system clogging them up and causing kidney failure

24. Your patient arrives at the ER complaining he doesn't "feel well"- His Vitals are: T- 99.0, P-51, R-18, BP- 110/65 and 02 98%. He is alert x3 and denies any pain. You should:

Administer oxygen

Continue to monitor

Administer atropine

Administer fluids

Even though this patient is bradycardic, his BP, O2 sats and LOC tell you that he is stable and perfusing. He just needs to be monitored.

Explanation

Even though this patient is bradycardic, his BP, O2 sats and LOC tell you that he is stable and perfusing. He just needs to be monitored.

25. What diabetic complication accounts for 50% of diabetic deaths?

Diabetic Nephropathy

CAD

PVD

Infections

CAD causes MI's and Strokes which account for 50% of diabetic deaths

Explanation

CAD causes MI's and Strokes which account for 50% of diabetic deaths

26. Which type of skin cancer has the best prognosis?

Basal Cell Carcinoma

Squamous Cell Carcinoma

Malignant Melanoma

27. What stage of hypovolemic shock involves the onset of reduced urine output?

Stage 1

Stage 2

Stage 3

Stage 4

28. What stage of hypovolemic shock involves the begining of anaeobic metabolism and subsequent respiatory and metabolic acidosis?

Stage 1

Stage 2

Stage 3

Stage 4

29. What is the first step in the Septic Bundle?

Fluid resuscitation

Vasopressors

ATB therapy

Blood, urine, sputum and wound cultures

Cultures need to happen before ATB therapy

Explanation

Cultures need to happen before ATB therapy

30. MODS or MSOF is defined by the failure of 1 or more organs

True

False

2 or more organs

Explanation

2 or more organs

31. You have just admitted a burn patient who drove through McDonald's and spilled scalding hot coffee on his lap. His left hand, groin and the tops of both of his thighs have 2nd degree burns. What would his TBSA be?

6%

11%

17%

1% for groin, 1% for hand (a palmar size burn) and 4.5% for each thigh

Explanation

1% for groin, 1% for hand (a palmar size burn) and 4.5% for each thigh

32. Metformin (Glucophage) works by:

Inhibiting the production of glucose by the liver

Delaying the absorption of glucose in the intestine

Stimulating insulin release from the pancreas

Enhancing insulin action at the receptor sites

33. Xigris is an antibiotic used as a last resort to treat septic shock d/t it's toxic side effects

True

False

It isn't an antibiotic- it reduces microvascular injury and enhances microvascular perfusion

Explanation

It isn't an antibiotic- it reduces microvascular injury and enhances microvascular perfusion

34. What set of ABG's would be reflective of DKA?

PH- 7.30, CO2- 47, HCO3- 22, O2- 80

PH- 7.32, CO2- 32, HCO3- 20, O2- 82

PH- 7.38, CO2- 47, HCO3- 28, O2- 85

The first one is resp acidosis d/t increased CO2 and normal Bicarb; DKA is metabolic acidosis so Bicarb and pH would be below normal

Explanation

The first one is resp acidosis d/t increased CO2 and normal Bicarb; DKA is metabolic acidosis so Bicarb and pH would be below normal

35. Unexplained fevers with negative cultures could indicate the failure of this organ

Liver

Kidney

Gallbladder

36. What would you advise your DM patient in respect to exercise? (Choose all that apply)

Exercising while positive for Keytones is not recommended

Pt should administer insulin just prior to exercise

Pt should eat a 15 gram carb snack prior to exercise

It is ok to exercise if the patient's BS is less than 300

exercise reduces BS so insulin should not be administered prior to exercise- a snack should; pt's BS should be less than 250

Explanation

exercise reduces BS so insulin should not be administered prior to exercise- a snack should; pt's BS should be less than 250

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37. What are the s/s of hypovolemic shock? (Choose all that apply)

Flushed, warm skin

Tachypnea

Bradycardia

Anuria

Bounding peripheral pulses

cold, clammy skin; tachycardia and +1 to absent peripheral pulses

Explanation

cold, clammy skin; tachycardia and +1 to absent peripheral pulses

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38. Which signs and symptoms are typical of Hyperglycemic hypermolar non-ketonic coma

BS level of 400

65 year old

Keytones in Urine

BS level of 700

25 year old

No keytones in urine

HHNK- BS> 600; more common inindividuals >50 YO with type II diabetes. These pts still produce some insulin so they do not produce keytones in their urine. The other answers are typical of DKA

Explanation

HHNK- BS> 600; more common inindividuals >50 YO with type II diabetes. These pts still produce some insulin so they do not produce keytones in their urine. The other answers are typical of DKA

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39. When teaching your diabetic patient about preventing diabetic retinopathy, you advise them to: (choose all that apply)

Maintain a normal BS

Schedule annual optometrist visits

Control hypertension

Report loss of vision to physician

opthalmologist visits- NOT optometrist!!!

Explanation

opthalmologist visits- NOT optometrist!!!

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40. Your ER patient is being monitored by EKG- you notice her HR has gone from 85 to 120. Her QRS measures .16. When you assess her she says she isn't having any pain but feels like her heart is beating out of her chest. Your first intervention is:

Have her perform vagal manuvers such as bearing down and coughing

Administer adenosine IV (chemical cardioversion)

Administer amiodarone IV

stable Tachy with a wide QRS is V-tach- amiodarone is the treatment. The other treatments are for SVT- which has a narrow QRS

Explanation

stable Tachy with a wide QRS is V-tach- amiodarone is the treatment. The other treatments are for SVT- which has a narrow QRS

41. Your patient is on a daily dose of NPH insulin BID and Humalog SQ before meals. When would you expect to see your patient suffer from symptoms of hypoglycemia? Choose all that apply

Breakfast

Lunch

Dinner

Bedtime

NPH duration is 10-16 hours so would be given probably 7a an 7p. Most diabetic pts are hypoglycemic at breakfast but keep their levels up during the day. The 7am dose of NPH would be running out around bedtime, and then again at breakfast

Explanation

NPH duration is 10-16 hours so would be given probably 7a an 7p. Most diabetic pts are hypoglycemic at breakfast but keep their levels up during the day. The 7am dose of NPH would be running out around bedtime, and then again at breakfast

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42. Your patient has 2nd degree heart block and his body has compensated for it keeping him perfused with a good blood pressure. Today after your initial assessment, you notice your patient is not themself- they seem confused, are pale and clammy. Your first intervention would be:

Fluid resucitation

Epinepherine

Atropine

Remember APE- heart block=bradycardia and since this patient is not stable and showing signs of shock, begin the APE protocol: atropine, pacemaker and epi

Explanation

Remember APE- heart block=bradycardia and since this patient is not stable and showing signs of shock, begin the APE protocol: atropine, pacemaker and epi

43. The following lab values are indicative for Septic Shock (Choose all that apply)

Lactate 3.7 mmole/L

WBC 3500

Temp 101.0 F

RR of 24

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44. Your patient who has a hx of CAD complains of chest pain. You put him on the EKG and his HR is 160 BPM. The treatment for this patient would be:

Amiodarone IV

Adnosine IV (Chemical Cardiovesion)

Synchronized Electric Cardioversion

Since this patient is unstable (chest pain) and tachycardic (regardless of QRS interval) you would immediately cardiovert him (don't forget the versed first!!:)

Explanation

Since this patient is unstable (chest pain) and tachycardic (regardless of QRS interval) you would immediately cardiovert him (don't forget the versed first!!:)

45. What populations would you find Kaposi's Sarcoma in? (choose all that apply)

Pacific Island

AIDS patients

Mediterranean

European

Eastern African

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46. Which of the following complications can contribute to Foot and leg problems/amputations? (check all that apply)

Neuropathy

PVD

Immunocompromise

HTN

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47. Which of the following would be used to prevent Hypertrophic scarring?

Surgery

Pressure garments

Massage

Oral steriods

injectible steriods are also used to prevent scarring along with lubrication, splints and manual lymphatic drainage

Explanation

injectible steriods are also used to prevent scarring along with lubrication, splints and manual lymphatic drainage

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48. What can cause kidney failure in sepsis patients? (Choose all that apply)

The use of nephrotoxic medications

Hypotension

DIC

ARDS

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49. When teaching about oral anti-diabetics, you should tell the patient to: (choose all that apply)

Take their medication at the same time every day

Take medication immediately before meals to increase effectiveness

Do not skip meals

This medication may affect the effectiveness of birth control pills

Taking the meds should be correlaed with meals not times of day; thiazolinide can decrease the effectiveness of BCPs

Explanation

Taking the meds should be correlaed with meals not times of day; thiazolinide can decrease the effectiveness of BCPs

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50. Pick 2 insulins that should be given together to offer 24hour coverage (in one dose) AND coverage for meals (multiple doses) - Choose all options that could apply:

NPH

Regular

Humalog

Lantus

Lantus works 24 hours and either Regular OR Humalog can be used to cover meals. NPH covers 10-16 hours so 2 doses would be needed for 24 hours

Explanation

Lantus works 24 hours and either Regular OR Humalog can be used to cover meals. NPH covers 10-16 hours so 2 doses would be needed for 24 hours

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