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FCCN LEVEL 1 EXAM
WITH COMPLETE SOLUTIONS.
"Heparin nomagram system - CORRECT ANSWER HNS will only accept Anti-Xa results that were drawn at
least 4 hrs after heparin start or dose change" "Heparin was stopped yesterday because Anti-Xa was in range. provider wants to resume heparin. what
dose do you use? - CORRECT ANSWER - go back to last dose where Anti-Xa was in goal"
"nursing pearls for MI - CORRECT ANSWER - ASA should be in chewable form for emergency ...be
prepared to give 4 tablets
- nitrate drips and or SL nitro can cause pin point headaches and hypotension
- keep your patient in bed. DO NOT get them up
- get 2 PIV sites"
"common inotropes used - CORRECT ANSWER - milrinone
"treatment options for kidney failure - CORRECT ANSWER - hemodialysis
- peritoneal dialysis
- CRRT
- kidney transplant
- no treatment"
"high K foods - CORRECT ANSWER - oranges
- strawberries
- bananas
- tomatoes
- potatoes
- dairy"
"high PHos foods - CORRECT ANSWER - dairy
- cola
- whole grain
- chocolate
- beer"
"causes of prerenal renal failure - CORRECT ANSWER - decreased intravascular volume (bleeding,
vomiting, diarrhea, sepsis)
- decreased cardiac function, CO
- vasodilation = sepsis and anaphylaxis
- abdominal compartment syndrome
- altered renal hemodynamics"
"medullary (ATN) intrarenal failure causes - CORRECT ANSWER - ischemic (same as prerenal)
- nephrotoxic
- antibiotics
- NSAIDs
- radiographic contrast"
"intrarenal renal failure assessment - CORRECT ANSWER - same as prerenal
- patient can be oliguric or non oliguric"
"hydrostatic pressure - CORRECT ANSWER - forces fluids and solutes through the capillary wall and into
the tissue spaces"
"colloid osmotic pressure - CORRECT ANSWER - pulling force of albumin in the intravascular spaces
- pull fluid into vasculature"
"maintenance fluid therapy - CORRECT ANSWER - replaces normal ongoing losses of water and
electrolytes (urine, sweat, respiration, stool)"
"replacement therapy - CORRECT ANSWER - corrects any existing water and or electrolyte deficits"
"isotonic fluids - CORRECT ANSWER - tonicity equal to plasma in the body
- no fluid shifts because the solutions are equally concentrated
- LR
- NS
- D5W"
"hypotonic fluids - CORRECT ANSWER - lower concentration of solutes in the vasculature than in the cell
- fluid shifts into the cell to dilute the electrolytes (CELL SWELLS)
- 0.45NS"
"hypertonic fluid - CORRECT ANSWER - higher concentration of solutes in the vasculature than in the cell
U WAVE is hallmark sign if you see a U wave then YOU need K+"
"hypokalemia - CORRECT ANSWER - 3.5 to 5
"hyperkalemia ECG changes - CORRECT ANSWER - tall tented T waves is the earliest sign
"treating hyperkalemia - CORRECT ANSWER - Calcium chloric or gluconate to antagonize cardiac
abnormalities
- Bicarbonate for pt with acidosis
- IV insulin and 50% dextrose to shift K into cells
- kayexelate (fecal excretion of K)
- dialysis for ARF"
"hypocalcemia - CORRECT ANSWER 8.5 - 10.
- tetany
- muscle cramps
- trousseau's and chvosteks sign
- colicky abdominal pain"
"treating hypocalcemia - CORRECT ANSWER - IV calcium gluconate or calcium chloride (CENTRAL LINE)
- consider seizure precautions
- replace Mg in addition to Ca because pt might not respond to Ca treatment"
"hypercalcemia - CORRECT ANSWER caused by
- cancers and hyperparathyroidism
- excessive Ca and Vit. D supplements
- muscle weakness
- depressed CNS (confusion)
- dysrhythmias (prolong QT, AV block)
- abdominal pain"
"treating hypercalcemia - CORRECT ANSWER - administer IV NS to promote diuresis
- administer loop diuretics
- corticosteroids to decrease absorption from GI
- phosphates to decrease breakdown of bones by inhibiting release
- dialysis"
"hypomagnesemia - CORRECT ANSWER - tetany
- weakness
- confusion
- ECG changes (wide QRS, prolong PR/QT)"
"treating hypomagnesemia - CORRECT ANSWER - CPR
"hypomagnesemia and digoxin - CORRECT ANSWER - low MG increases pharmacologic action of digoxin
- look for N/V, bradycardia, AV block, yellow tinged vision"
"hypermagenesemia - CORRECT ANSWER - take too many antacids or laxatives
- respiratory depression
- muscle relaxation"
"hypophosphatemia - CORRECT ANSWER - cause by hyperparathyroidism, chronic diarrhea, long term
diuretic use, malnutrition and severe burns
- muscle weakness
- impaired cardiac function
- poor tissue oxygenation
- failure to wean from mechanical ventilation
- depressed CNS - confusion"
"treating low phosphorus - CORRECT ANSWER - increase intake of phos rich food
- IV
- assess for hypercalcemia
- consider Mg replacement simultaneously"
"hyperphosphatemia - CORRECT ANSWER - this is rare except for people with severe kidney dysfunction
- stroke
- heart attack
- poor circulation
- calcium combines with phosphate to form crystals that calcify on walls of vessels and heart
- crystals can form on skin too causing severe itching"
"systolic Blood Pressure - CORRECT ANSWER - pressure on arterial walls during ventricular contraction
- increase in CO/force of contraction with exercise will increase SBP but not necessarily affect DBP"
"optimizing perfusion - afterload - CORRECT ANSWER - since the heart ejects into the arteries....the
arteries affect the afterload
- constricted = more resistance and decreased CO
- dilated = less resistance and increased CO"
"high afterload - CORRECT ANSWER - constricted arteries
- physical assessment (cool extremities, pale, mottled
- treat = dilate arteries (ACE inhibitors, ARBs, morphine, rewarm patient)"
"SOO how to optimize perfusion - CORRECT ANSWER 1. consider fluid status
- consider how clamped down the patient is
- consider squeeze of the heart"
"low afterload - CORRECT ANSWER - low resistance = dilated arteries
- caused by sepsis, neurogenic shock
- physical = flushed and red skin, low BP
- treatment = ICU for vasopressors" "the patient has developed new coarse crackles, SOB, and JVD. he has a hx of CHF and pitting edema in the extremities. all of the assessments indicate he has high preload EXCEPT a. course crackles b. SOB c. JVD
d. edema - CORRECT ANSWER d"
"Pt. has dry mouth, tachycardia and low UO after diuresing 1.5 L from lasix. he has weak pedal pulses and pale lower extremities. Which best describes his hemodynamics a. high preload and vasodilated b. high preload and vasoconstricted c. low preload and dilated
d. low preload and constricted - CORRECT ANSWER d"
"what is blood pressure - CORRECT ANSWER - MAP = CO x SVR
- increase in CO or SVR will increase MAP and vice versa
- patient with MAP of 60 can have high or low CO and high or low SVR a good BP does not mean good perfusion"
"V1 and V2 look at what part of the heart - CORRECT ANSWER - septum"
"V3 and V4 look at what part of the heart - CORRECT ANSWER - anterior"
"V5 and V6 look at what part of the heart - CORRECT ANSWER - lateral"
"lead selection - CORRECT ANSWER - lead III is used to monitor patient who has no cardiac history
- lead II to look at P waves"
"precordial leads used - CORRECT ANSWER - V3 to monitor patient who has no cardiac history
- V1 to monitor dysrhythmias and differentiate from ventricular beats
- V1 to V6 if patient has injury or infarction....chooose lead that has the most ST elevation"
"for a normal ECG what leads do we pick - CORRECT ANSWER - Lead III and V3"
"for ECG with dysrhythmia what leads do we pick - CORRECT ANSWER - lead III and V1"
"ECG admission with AFIB with RVR what V lead do we choose - CORRECT ANSWER - V 1"
"dysrhythmias that are too fast - affects - CORRECT ANSWER - heart cant fill completely
- decreases preload
- lead to decreased CO and low BP
- heart cant deliver O2 to tissues"
"dysrhythmias that are too slow - affects - CORRECT ANSWER - low HR causes decrease in CO and low BP
- heart cant deliver O2 to tissue"
"is the patient tolerating the rhythm they are in?? - CORRECT ANSWER - vitals
- SOB
- chest pain
- diaphoresis
- light headed
- change in LOC"
"what is chest pain - CORRECT ANSWER - a decrease in the deliver of O2 to tissue"
"chronotrope - CORRECT ANSWER - affect HR"
"inotrope - CORRECT ANSWER - affect squeeze"
"ACE inhibitors - CORRECT ANSWER - initial dose can drop BP dramatically
- subsequent double dosing shold not drop the BP significantly -- BP is not a good parameter for finding effective dose for HF patient"
"commone causes for INR increase - CORRECT ANSWER - hepatic congestion from RHF decreases liver
production of vitamin K dependent clotting factors
- infection and hyperthyroidism increase break down of clotting factors
- poor oral intake of vitamin K"
"calcium channel blockers - dihydropyridines - CORRECT ANSWER - potent vasodilators that do not
normally effect contractility or conduction
"calcium channel blockers - non dihydropyridines - CORRECT ANSWER - effect the AV node and are used
to treat HTN and cardiac arrhythmias
"heparin antidote - CORRECT ANSWER - protamine sulfate"
"coumadin antidote - CORRECT ANSWER - vitamin K"
"positive inotropes - CORRECT ANSWER - increase the force of contraction of the heart"
"negative inotropes - CORRECT ANSWER - weaken the force of contraction of the heart
- decrease how hard the heart has to work"
"what are inotropes used for - CORRECT ANSWER - low cardiac output due to poor heart contraction
ex. cardiogenic shock after MI, HF, following cardiac surgery"
"how do inotropes work on the body - CORRECT ANSWER - work by increasing the release of calcium or
influx of calcium into the heart muscle cell
never give Ca blocker with inotrope"
"MEds to give before dialysis - CORRECT ANSWER - insulin
- pain meds
- phosphate binders
- anti seizure
- anti psychotic
- HR control and long acting antihypertensives
- heparin
- anti rejection
- meds given TID or more"
"meds to Hold before dialysis - CORRECT ANSWER - antibiotics
- diuretics
- short acting antihypertensives
- once a day meds like vitamins and aspirin"
"leading causes of CKD - CORRECT ANSWER 1. diabetes
2. HTN"
"best time for blood transfusion to dialysis pt - CORRECT ANSWER - during dialysis"
"how long to wait to draw labs after dialysis - CORRECT ANSWER - 2 hrs"
"ultrafiltration - CORRECT ANSWER - removes fluid"
"AV fistula - CORRECT ANSWER - listen for bruit
- feel for thrill
- requires 2 to 3 months to heal before using
- lasts longest
- fewest infections
- fewest clotting problems"
"can a dialysis catheter be used as IV access during a code - CORRECT ANSWER - yes"
"creatinine - CORRECT ANSWER - gold standard for measuring kidney function
"AV graft - CORRECT ANSWER - synthetic graft material that connects artery to vein
"cortical intrarenal failure causes - CORRECT ANSWER - caused by infection , immune system, vascular
damage, HTN, diabetes"
"labs for intrarenal failure - CORRECT ANSWER - high urine Na
- low specific gravity
- high BUN
- creatinine high
- low urine osmolality
- positive urine sediment
- moderate proteinuria"
"treating intrarenal failure - CORRECT ANSWER - maintain fluid balance
- prevent further damage
- manage complications"
"postrenal failure - CORRECT ANSWER - partial or complete obstruction of urinary tract that affects
normal flow of urine out of kidney"
"assessment for postrenal failure - CORRECT ANSWER - oliguric or anuric
"lab values for post renal failure - CORRECT ANSWER - BUN and creatinine elevated
- no proteinuria
- variable Na
- variable specific gravity"
"treating post renal failure - CORRECT ANSWER - KUB scan or ultrasound to locate obstruction"
“Minimum urine output for adult - CORRECT ANSWER 0.5mL/kg/hr"
"ADH (antidiuretic hormone) - CORRECT ANSWER - water retainer
- vasoconstrictor (also called Vasopressin)
- produced by hypothalamus
- store and released from posterior pituitary"
"ADH pathway - CORRECT ANSWER - hypothalamus senses low blood volumed and increased serum
osmolality
- signal pituitary to release ADH
- ADH causes kidney to retain water
- water retention increases blood volume and decreases serum osmolality"
"ANP (atrial natriuretic peptide) - CORRECT ANSWER - cardiac hormone stored in atria
- released when atrial pressure increases *works opposite of RAAS by decreasing BP and reducing intravascular volume
- important diagnostic marker in CHF"
"different ways to treat hyponatremia - CORRECT ANSWER - hypovolemic (give IV fluid)
- euvolemic (fluid restriction)
- hypervolemic (diuretic)"
"order for electrolyte replacement therapy - CORRECT ANSWER 1. Mg
2. K
- phosphorus
- Ca"
"physical assessment of perfusion - CORRECT ANSWER - pulses
- blood pressure
- skin
- kidneys
- sensorium"
"oxygenation - CORRECT ANSWER - SPO
- nasal cannula and oxygen mask help oxygenate"
"ventilation - CORRECT ANSWER - how fast and deep pt is breathing
- look at CO2 on ABG to assess ventilation
- BiPAP, Ambu bagsm and ventilators help ventilate *patient can have good oxygenation but not be ventilating adequately"
