1.
Which signs and symptoms are typical of Hyperglycemic hypermolar non-ketonic coma
Correct Answer(s)
B. 65 year old
D. BS level of 700
F. No keytones in urine
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
2.
What is the purpose of Kussmal Respirations in a patient with DKA?
Correct Answer
A. To blow off CO2 which compensates for the bodies acidic state
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
3.
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:
Correct Answer
C. Oral medications are not effective against DM 1 because the pancrease isn't producing any endogenous insulin to be supplemented
Explanation
The pancreas of a DM 1 patient doesn't produce ANY insulin so it must be provided through insulin injections
4.
What set of ABG's would be reflective of DKA?
Correct Answer
B. PH- 7.32, CO2- 32, HCO3- 20, O2- 82
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
5.
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:
Correct Answer(s)
B. Regular
C. Humalog
D. Lantus
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
6.
What would you advise your DM patient in respect to exercise? (Choose all that apply)
Correct Answer(s)
A. Exercising while positive for Keytones is not recommended
C. Pt should eat a 15 gram carb snack prior to exercise
Explanation
exercise reduces BS so insulin should not be administered prior to exercise- a snack should; pt's BS should be less than 250
7.
Metformin (Glucophage) works by:
Correct Answer
A. Inhibiting the production of glucose by the liver
8.
When teaching about oral anti-diabetics, you should tell the patient to: (choose all that apply)
Correct Answer(s)
B. Take medication immediately before meals to increase effectiveness
C. Do not skip meals
D. This medication may affect the effectiveness of birth control pills
Explanation
Taking the meds should be correlaed with meals not times of day; thiazolinide can decrease the effectiveness of BCPs
9.
One serving of Carbs equals _____grams (enter just the number, not the grams!)
Correct Answer(s)
15
10.
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
Correct Answer(s)
A. Breakfast
D. Bedtime
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
11.
When teaching your diabetic patient about preventing diabetic retinopathy, you advise them to: (choose all that apply)
Correct Answer(s)
A. Maintain a normal BS
C. Control hypertension
D. Report loss of vision to physician
Explanation
opthalmologist visits- NOT optometrist!!!
12.
What drug is always associated with Diabetic Nephropathy?
Correct Answer
A. ACE inhibitors- prils
13.
The most common and effective treatment options for patients with Diabetic Neuropathies are:
Correct Answer
C. Medications
Explanation
Reglan for delayed gastric emptying, non-opiod analgesics, neurontin, viagra
14.
What diabetic complication accounts for 50% of diabetic deaths?
Correct Answer
B. CAD
Explanation
CAD causes MI's and Strokes which account for 50% of diabetic deaths
15.
Which of the following complications can contribute to Foot and leg problems/amputations? (check all that apply)
Correct Answer(s)
A. Neuropathy
B. PVD
C. Immunocompromise
16.
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?
Correct Answer
B. 11%
Explanation
1% for groin, 1% for hand (a palmar size burn) and 4.5% for each thigh
17.
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?
Correct Answer
B. 5818 mL
Explanation
The first number is the total 24 hour fluid resuscitation amount; the last number is the weight x 4mL
18.
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?
Correct Answer
C. Paralytic ileus
19.
What type of shock is a burn patient prone to?
Correct Answer
C. Hypovolemic
20.
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?
Correct Answer
C. 100%
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
21.
An escharotomy would be used to treat:
Correct Answer
C. Compartment syndrome
22.
Which of the following would be used to prevent Hypertrophic scarring?
Correct Answer(s)
B. Pressure garments
C. Massage
Explanation
injectible steriods are also used to prevent scarring along with lubrication, splints and manual lymphatic drainage
23.
What indicators let the burn team know that skin has a better chance of re-growth? (choose all that apply)
Correct Answer(s)
A. Ability to blanch
B. Presence of hair follicles
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
24.
What would indicate a risk of Restrictive Pulmonary system alterations?
Correct Answer
C. Circumferencial burn on thorax
Explanation
Restrictive alterations are caused by circumferencial burns on the neck or thorax that swell and cause tightening decreasing tidal volume
25.
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?
Correct Answer
B. Kidneys
Explanation
The large molcules get caught in the kidneys filtration system clogging them up and causing kidney failure
26.
What are the s/s of hypovolemic shock? (Choose all that apply)
Correct Answer(s)
B. Tachypnea
D. Anuria
Explanation
cold, clammy skin; tachycardia and +1 to absent peripheral pulses
27.
A patient with a known infection begins to experience persistent hypotension. This patient is suffering from:
Correct Answer
C. Septic Shock
28.
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
Correct Answer
A. True
Explanation
Their PaO2/FiO2 ratio is 257. Any value under 300 is considered pulmonary shunting, a sign of Septic Shock
29.
The following lab values are indicative for Septic Shock (Choose all that apply)
Correct Answer(s)
B. WBC 3500
C. Temp 101.0 F
D. RR of 24
30.
What is the first step in the Septic Bundle?
Correct Answer
D. Blood, urine, sputum and wound cultures
Explanation
Cultures need to happen before ATB therapy
31.
What is the cause of hypotension in Septic Shock?
Correct Answer
B. Damage to endothelial cells that affect constriction of blood vessels
32.
Why would lactate levels be monitored in a patient with Septic Shock?
Correct Answer
B. To determine if aerobic metabolism is replacing anaerobic metabolism
33.
Xigris is an antibiotic used as a last resort to treat septic shock d/t it's toxic side effects
Correct Answer
B. False
Explanation
It isn't an antibiotic- it reduces microvascular injury and enhances microvascular perfusion
34.
MODS or MSOF is defined by the failure of 1 or more organs
Correct Answer
B. False
Explanation
2 or more organs
35.
Unexplained fevers with negative cultures could indicate the failure of this organ
Correct Answer
C. Gallbladder
36.
How can DIC lead to MODS?
Correct Answer
C. DIC causes microvascular clots which block organ perfusion robbing the organs of oxygen
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
37.
When the lungs suffer from an extreme inflammatory response, the pulmonary vascular and alveolar endothelium are damaged; the causes a decrease in surfactant, increased capillary permeability and refractory hypoxemia. What is another name for this pathology?
Correct Answer
ARDS
38.
What can cause kidney failure in sepsis patients? (Choose all that apply)
Correct Answer(s)
A. The use of nephrotoxic medications
B. Hypotension
C. DIC
39.
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:
Correct Answer
B. Continue to monitor
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.
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:
Correct Answer
C. Administer amiodarone IV
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 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:
Correct Answer
C. Synchronized Electric Cardioversion
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!!:)
42.
You go in to check on your patient and they do not have a pulse. This first thing you do is:
Correct Answer
C. Begin CPR
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.
43.
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:
Correct Answer
C. Atropine
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
44.
Shock, CPR,epi; shock, CPR, epi; shock, CPR, epi- what type of patient would receive this treatment?
Correct Answer
B. Pulseless VF/VT
Explanation
pts with no shockable rhythm are PEA and Asystole- these patients would receive CPR, epi, CPR, epi (or one time dose of vasopressin)
45.
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
Correct Answer
0.3, 0.5, 1:1000
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"
46.
Which type of skin cancer has the best prognosis?
Correct Answer
A. Basal Cell Carcinoma
47.
What populations would you find Kaposi's Sarcoma in? (choose all that apply)
Correct Answer(s)
B. AIDS patients
C. Mediterranean
E. Eastern African
48.
Your patient has a skin lesion that is rough, scaly ad thickened in appearance. It is most likely a:
Correct Answer
B. Squamous Cell Carcinoma
49.
What stage of hypovolemic shock involves the begining of anaeobic metabolism and subsequent respiatory and metabolic acidosis?
Correct Answer
C. Stage 3
50.
What stage of hypovolemic shock involves the onset of reduced urine output?
Correct Answer
B. Stage 2