2014 Critical care Clinical Assessment

68 Questions | Total Attempts: 104

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2014 Critical care Clinical Assessment


Questions and Answers
  • 1. 
    Baroreceptor-mediated vascular compensation by increasing vascular tone can sustain a constant blood pressure in a patient losing as much as what percent (%) of blood volume before being associated with a drop in mean arterial pressure (MAP)?
    • A. 

      14%

    • B. 

      16%

    • C. 

      18%

    • D. 

      20%

  • 2. 
    Which of the following are considered 'flow parameters'?
    • A. 

      SV, CVP, CO

    • B. 

      CI, DO2, PaOP

    • C. 

      SVI, CI, DO2

    • D. 

      CVP, HR, urine output

  • 3. 
    ScvO2 is affected by:
    • A. 

      Hemoglobin changes (bleeding, hemodilution)

    • B. 

      Cardiac output changes (preload, afterload, contractility, heart rate)

    • C. 

      Metabolic demand (fever, shivering, stress, muscle activity)

    • D. 

      Oxygenation (Sp02, Pa02)

    • E. 

      All of the above

  • 4. 
    What is the clinical utility of ScvO2? 
    • A. 

      Reveals occult tissue hypoxia

    • B. 

      Determines the balance of oxygen delivery and consumption

    • C. 

      Helps determine the adequacy of cardiac output

    • D. 

      Helps determine whether blood transfusion is needed when used in conjunction with hemobglobin/hematocrit levels

    • E. 

      All of the above

  • 5. 
    Literature supports that Systolic Blood Pressure, CVP and HR show a considerable lack of sensitivity and specificity as predictors of fluid responsiveness.
    • A. 

      True

    • B. 

      False

  • 6. 
    Which of the following is not at sign of SIRS?
    • A. 

      Tachycardia

    • B. 

      Tachypnea

    • C. 

      Elevated lactate

    • D. 

      Temperature (elevated or abnormally low)

    • E. 

      WBC (elevated or abnormally low)

  • 7. 
    In the original EGDT study by Manny Rivers, et al., what was the key differences between the control and treatment arm protocols? (select all that apply)
    • A. 

      Scv02 endpoint >70%

    • B. 

      CVP endpoint 8-12mm Hg

    • C. 

      MAP endpoint >65 and

    • D. 

      Urine Output endpoint >0.5 ml/kg/hr

  • 8. 
    When giving epinephrine, a clinician might expect to see what happen with parameter using the CardioFlo Sensor?
    • A. 

      Increase CO and SV

    • B. 

      Decrease CO and SV

    • C. 

      Increase SV and Stroke Volume Variation (SVV)

    • D. 

      Decrease SV and SVV

  • 9. 
    Compliance has an inverse effect on pulse pressure.
    • A. 

      True

    • B. 

      False

  • 10. 
    Pulse Pressure is proportional to what?
    • A. 

      Heart Rate

    • B. 

      Stroke Volume

    • C. 

      Cardiac Output

    • D. 

      ScvO2

  • 11. 
    A hypovolemic patient may show an elevated SVV (>10%).
    • A. 

      True

    • B. 

      False

  • 12. 
    If an elevated SVV does not respond to fluid, it may indicate that?
    • A. 

      The patient had a bad day

    • B. 

      The patient needs a colloid

    • C. 

      The patient’s ventricle is failing

    • D. 

      The patient should be removed from mechanical ventilation

  • 13. 
    A 44 year old trauma patient comes into the emergency room after a motor vehicle accident. The patient has tachycardia, hypotension, a firm abdomen, and an abdominal tap is positive for blood.  The patient is sent to the operating room for an exploratory laparotomy. Anesthesia starts a radial arterial line with a CardioFlo sensor and a 14/14ga. Double lumen central line. Parameters show: H/RB/PSp02CVPSVSW11070/40 (55)9923522% Anesthesia gives 2 units of packed red blood cells (PRC ), and 1000cc Normal Saline after which: H/RB/PSp02CVPSVSW10090/60 (75)9974518%Given this information, what do YOU think the next step would be? 
    • A. 

      IV infusion to maintenance (TKO) drip only and cont. monitoring

    • B. 

      Continue to give volume (blood or crystalloid)

    • C. 

      Start the patient on an inotrope (increase contractility)

    • D. 

      Give the patient Lasix (diuretic)

    • E. 

      Open up the latest People magazine and keep up with the Kardashians.

  • 14. 
    Entering Height and Weight in to a Vigileo monitor using a CardioFlo sensor are important because:
    • A. 

      They account for the effects of age

    • B. 

      It supports Boulain's principle of the "taller the better"

    • C. 

      Height and weight correlate with the length and width of the aorta

    • D. 

      CardioFlo does not require the entry of height and weight

  • 15. 
    How is Stroke Volume Variation (SVV) calculated?
    • A. 

      SVmin - SVmean / SVmax

    • B. 

      SVmax-SVmin / SVmean

    • C. 

      SVmax - SVmin / SVmax

    • D. 

      SVmax—Svmin / 60 sec.

  • 16. 
    A 67 year old male is having a Total Hip Revision procedure. The patient has history of diabetes and a strong family history of coronary artery disease. The patient has received cardiology clearance. Anesthesia starts a radial arterial line with the FloTrac system and a 14/14ga double lumen central line. One hour into the procedure the patient experiences significant blood loss after removal of the old implant and suffers a splitting of the femur which now requires wires. Parameters show: H/RB/PSp02CVPSVSW98100/60 (75)9944518% After infusion of 2 units of packed red blood cells (PRC) and 750 cc of Normal Saline after which:H/RB/PSp02CVPSVSW10095/58 (70)9973518% Given what YOU know, the best answer is:
    • A. 

      IV infusion maintenance drip (TKO) and continue monitoring

    • B. 

      Continue to give volume (blood or crystalloid)

    • C. 

      Start the patient on an inotrope

    • D. 

      Give the patient Lasix (diuretic)

    • E. 

      Grab a guitar and sing the blues

  • 17. 
    The administration of vasopressors will always result in an increase in SV
    • A. 

      True

    • B. 

      False

  • 18. 
    In the presence of arrhythmia the SVV will be inaccurate
    • A. 

      True

    • B. 

      False

  • 19. 
    In the presence of arrhythmia, the SV/CO will be accurate
    • A. 

      True

    • B. 

      False

  • 20. 
    Pulmonary Hypertension may result in elevated CVP readings
    • A. 

      True

    • B. 

      False

  • 21. 
    Underdamped arterial waveforms will underestimate SV/CO
    • A. 

      True

    • B. 

      False

  • 22. 
    Overdamped arterial waveforms will underestimate SV/CO
    • A. 

      True

    • B. 

      False

  • 23. 
    Pulmonary Hypertension will increase SV and decrease SVV
    • A. 

      True

    • B. 

      False

  • 24. 
    PGDT refers to:
    • A. 

      Post-operative goal directed therapy

    • B. 

      Premimum goal directed therapy

    • C. 

      Peri-operative goal directed therapy

    • D. 

      Peri-operative goal designated time

  • 25. 
    The best references (peer review journal articles) to utilize with OR customers for PGDT are
    • A. 

      Benes, Ramsingh, Hamilton

    • B. 

      Benes, Hamilton, McGee

    • C. 

      McGee, Ramsingh, Benes

    • D. 

      McGee, Manecke, Ramsingh

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