Exam 1 (Monitoring)

Question 1

What monitoring device is always necessary for anesthesia?

Answer 1

EtCO2, even with nasal cannula

Question 2

Red wavelengths operate at what wavelength?

Answer 2

660nm

Question 3

Infrared wavelengths of light operate at?

Answer 3

940nm

Question 4

deO2Hb absorbs more or less red light than O2Hb?

Answer 4

more

Question 5

O2Hb absorbs more or less infrared light than deO2Hb?

Answer 5

less

Question 6

What is the formula for the DC & AC ratio?

Answer 6

R= (AC660 / DC 660) / (AC 940 / DC 940)

Question 7

At what nm does carboxyhemoglobin absorb as much light as O2Hb?

Answer 7

660nm

Question 8

What Hb does not abosrb light at 940nm?

Answer 8

Carboxyhemoglobin

Question 9

Each 1% increase in COHb will increase/decrease SpO2 by ____%?

Answer 9

• Increase
• 1%

Question 10

Venous blood pulsations will increase/decrease SpO2?

Answer 10

decrease

Question 11

Will methylene blue injection increase or decrease SpO2?

Answer 11

decrease

Question 12

When are PulseOx and ABG within +/- 2%?

Answer 12

When sats >70%

Question 13

Are sats reading affected by anesthetic vapors?

Answer 13

No

Question 14

What are some disadvantages to PulseOx?

Answer 14

• Poor function with poor perfusion
• Delayed hypoxic event detection
• Erratic w/ dysrhythmias

Question 15

What are some disadvantages to PulseOx?

Answer 15

• Poor function with poor perfusion
• Delayed hypoxic event detection
• Erratic w/ dysrhythmias
• Inaccurate w/ different hemoglobins
• etc

Question 16

Where should PulseOx not be placed?

Answer 16

Index fingers to prevent corneal abbrasions

Question 17

Where should PulseOx be placed with epidurals?

Answer 17

On the toe d/t vasodilation

Question 18

What is phase I of the Korotkoff sounds?
What about phase V?

Answer 18

• SBP
• DBP (very hard to hear in kids)

Question 19

What part of automatic BP monitoring is in most agreement with invasive?
What about least in agreement?

Answer 19

• The MAP, it is the closet to invasive
• Least agreement is the SBP

Question 20

What conditions produce errors with non-invasive BP monitoring?
How are the reading affected>?

Answer 20

• atherosclerosis
• edema
• obesity
• chronic HTN
• SBP will read low & DBP will read high

Question 21

The MAP will be ____ during hypertension?
What about hypotension?

Answer 21

• Underestimated
• Overestimated

Question 22

Use caution with non-invasive BP monitoring in Pt’s with following conditions?

Answer 22

• severe coagulopathies
• peripheral neuropathies
• arterial/venous insufficiency
• recent thrombolytic therapy

Question 23

Wave #1 of an arterial line waveform comes when?

Answer 23

After the R-wave

Question 24

With arterial waveforms as the measuring site moves more distal, what happens to the waveform (4)?

Answer 24

• arterial upstroke is steeper
• systolic peak is higher
• Dicrotic notch is later
• End-diastolic pressure is lower

Question 25

How many waveforms are required for an acurate a-line tracing?

Answer 25

6-10 harmonic waves

Question 26

Multiple dicrotic notches means the the A-line bag is?

Answer 26

Underdamped

Question 27

What measurement is false with an underdamped A-line?

Answer 27

SBP is elevated

Question 28

How does the inspiratory phase of positive pressure ventilation affect intra-thoracic pressure & LV preload & afterload?

Answer 28

- Intra-thoracic pressure increases - LV Preload increases - LV afterload decreases

Question 29

How does inspiratory phase of positive pressure ventilation affect PVR, RV pre- & afterload, & venous return?

Answer 29

- PVR increases - RV preload decreases - RV afterload increases - venous return decreases

Question 30

Increased SPV is an indication of what?

Answer 30

hypovolemia

Question 31

What is the difference between SPV & PPV?

Answer 31

- SPV is measured at end-expiratory - PPV is measured over the entire respiratory cycle

Question 32

Stroke volume variation correlated resistance & compliance based on?

Answer 32

Age & gender

Question 33

What challenges does the Mainstream sampling have?

Answer 33

- Water vapor - secretions - blood - more interfaces for disconnects

Question 34

What challenges does the Side-stream sampling have?

Answer 34

- kinked sample tubing - water vapor - failure of sampling pump - leaks in line - slow response time

Question 35

Which gas is not absorbed by IR radiation?

Answer 35

O2

Question 36

Side-stream analyzers do not account for what in values?

Answer 36

H2O

Question 37

What are the Cons of Fuel or Galvanic cell O2 analyzers?

Answer 37

- Short life span (months) - Slow response time (monitor O2 in inspiratory limb)

Question 38

What are the Pros of Paramagnetic O2 analyzers?

Answer 38

- Rapid response - Breath by breath monitoring

Question 39

The total pressure exerted by a mixture of gases is equal to the sum of the partial pressures of each gas is who's law?

Answer 39

Dalton

Question 40

Which type of SSEP is MOST COMMONLY monitored during surgical procedures?

Answer 40

Short-latency

Question 41

Which of the four types of adult hemoglobin is LEAST LIKELY to be measured at the 940 nm wavelength?

Answer 41

Carboxyhemoglobin

Question 42

What is the amount of tidal volume exhaled during phase I?

Answer 42

1/3

Question 43

Physiologic effects of hypocarbia are: - respiratory alkalosis and increased ICP. - blunting of respiratory drive and respiratory acidosis. - respiratory alkalosis and potassium shift to intravascular space. - blunting of respiratory drive and decreased cerebral blood flow.

Answer 43

blunting of respiratory drive and decreased cerebral blood flow.

Question 44

The capnogram has a prolonged upstroke with an alpha angle >110 degrees, what is the problem causing the change?

Answer 44

The ETT is partially obstructed.

Question 45

What are the LIKELY causes of decreased EtCO2? - Hypothermia and poor gas sampling. - Hyperventilation and increased metabolic rate. - Hyperthermia and cardiac arrest. - Hypothermia and rebreathing.

Answer 45

Hypothermia and poor gas sampling.