Midterm Flashcards
1
Q
What is one critical thing you want to be vigilant about on the monitor when inserting/discontinuing a Swan-Ganz catheter? A.) Aseptic technique B.) Arrhythmias/tachyarrhythmias C.) Heart rate D.) Capnography waveform
A
B.) Arrhythmias/tachyarrhythmias
2
Q
What could cause a HIGH pulmonary artery pressure?
A.) Hypovolemia
B.) Left ventricular failure
C.) Vasodilation
D.) Distal tip of PA catheter in the Right Atrium
A
B.) Left ventricular failure
3
Q
What is the safest site for CVP insertion?
A.) Right internal jugular
B.) Left internal jugular
C.) Right Subclavian
D.) Left Subclavian
A
A.) Right internal jugular
4
Q
The “a-wave” of the CVP occurs during which Cardiac Cycle?
A.) 1
B.) 2
C.) 3
D.) 4
A
A.) 1
5
Q
Which of the following answers is FALSE regarding the contraindication of pulmonary artery catheter placement?
A.) Complete left bundle branch block
B.) Congenital heart disease
C.) Wolff-Parkinson White syndrome
D.) Ebstein’s Malformation
A
B.) Congenital heart disease
6
Q
What is the major determinant of preload?
a. vessel diameter
b. viscosity of blood
c. venous return
d. blood volume
A
c. venous return
7
Q
CI is inversely proportional to _______?
a. CO
b. SV
c. HR
d. BSA
A
d. BSA
8
Q
What are the three main components needed to factor PVR?
a. MPAP, PAWP, SVO2
b. MPAP, PAWP, CI
c. MPAP, PAWP, CO
d. P1, P2, Flow
A
c. MPAP, PAWP, CO
9
Q
Where is SVO2 sampled?
a. Arterial puncture
b. Venous puncture
c. Right Atrium
d. Pulmonary Artery
A
d. Pulmonary Artery
10
Q
Using Reynolds’ number, when will you begin to see turbulent blood flow?
a. 100 – 200
b. 200 – 400
c. 300 – 500
d. 1300 – 1500
A
b. 200 – 400
11
Q
Where in the systemic vasculature is resistance most determined?
a. arteries
b. capillaries
c. arterioles
d. venules
A
c. arterioles
12
Q
- Which of the following are advantages to perioperative EKG monitoring?
- Low sensitivity to selectivity to myocardial infarction
- Low cost and widely available
- Electrodes can cause skin irritation
- Replaces the need in all situations for invasive cardiac monitoring.
A
• Low cost and widely available
13
Q
- On an EKG, what does the ST-segment represent?
- The period of time when there is no electrical activity in the heart
- The period of time when the atria receive no venous return
- The period of time when the atria are hyperpolarized
- The period of time when the ventricles are depolarized
A
• The period of time when the ventricles are depolarized
14
Q
- What type of ischemia is often manifested by ST-segment depression?
- Subendocardial
- Complete heart block
- Myocardial infarction
- Aortic stenosis
A
• Subendocardial
15
Q
- Which of the following are types of ST-segment depression?
- Upsloping
- Horizonatal
- Downsloping
- All of the above
A
• All of the above
16
Q
- Which of the following is a true statement regarding lead selection for perioperative anesthia?
- As long as a preoperative EKG was performed, it is not necessary to use continuous EKG monitoring during the perioperative period.
- Single lead monitoring is considered unacceptable especially in patients with known cardiac disease.
- EKG electrodes must always be placed on anteriorly regardless of required surgical positioning.
- Lead II is the best lead and is sensitive to every aspect of cardiac electrical activity.
A
• Single lead monitoring is considered unacceptable especially in patients with known cardiac disease.
17
Q
1) What animal did Stephen Hale demonstrate invasive BP monitoring on? • Dog • Cat • Horse • Dolphin
A
• Horse
18
Q
2) Who developed the auscultatory method to measure diastolic blood pressure? • Korotkoff • Hale • Ludwig • Galen
A
• Korotkoff
19
Q
3) What is the “Gold Standard” for non-invasive blood pressure monitoring? • Arterial line placement • Mercury sphygmomanometers scillometric method • Palpated pulse method
A
Mercury sphygmomanometers
20
Q
4) In a noisy environment what is the best method for non-invasive blood pressure monitoring? • Arterial line placement • Mercury sphygmomanometers • Oscillometric method • Palpated pulse method
A
• Palpated pulse method
21
Q
5) Which physics principle makes invasive blood pressure monitoring possible? • Bernoulli’s Principle • Pascal’s Principle • Henry’s Law • Budrovic Phenomenon
A
• Pascal’s Principle
22
Q
- What information may be obtained by using the TEE during cardiac valve replacement?
- Provide a baseline examination of the diseased valve
- Assessment of the repair after completion of valve replacement
- Examine for trace leaks or valvular regurgitation
- All of the above
A
• All of the above
23
Q
- During heart transplant surgery, the TEE is instrumental in determining?
- Level of cardioplegia
- Adequacy of air evacuation from the donor heart is checked with TEE before coming off cardiopulmonary bypass
- Presence of gastric regurgitation
- Tissue compatibility
A
• Adequacy of air evacuation from the donor heart is checked with TEE before coming off cardiopulmonary bypass
24
Q
- While in the short axis view, which characteristic of the left ventricle is evident?
- Its circular shape
- Thick walls
- Both A and B
- None of the above
A
• Both A and B
25
• True or False: A TEE is a noninvasive procedure used to diagnose cardiac function.
True
26
* Which surgery are you most likely to use a TEE when no contraindications are indicated?
* Total Knee Replacement
* Valve Replacement Surgery
* Laparoscopic cholecystectomy
* All of the above
• Valve Replacement Surgery
27
• Two-dimensional echocardiography is the most commonly used mode for a TEE?
True
28
```
• Which echocardiography mode is the easiest to assess mitral regurgitation?
A. Pulse wave Doppler
B. Color wave Doppler
C. Tissue Doppler
D. Two dimensional
```
B. Color wave Doppler
29
* What part of the body controls heat conservation and production?
* Basal ganglia
* Hypothalamus
* Skin
* Pituitary gland
• Hypothalamus
30
* Why does anesthesia affect temperature regulation?
* The brain doesn’t sense the temperature correctly.
* The operating room is usually kept cold.
* The paralysis and anesthesia impairs shivering and thermoregulatory vasoconstriction.
* The drugs used for anesthesia can affect the temperature regulatory system of the brain.
• The paralysis and anesthesia impairs shivering and thermoregulatory vasoconstriction.
31
* What can result from the increased sympathetic nervous system activity that increases the release of epinephrine and norepinephrine postoperatively?
* Elevating peripheral vascular resistance.
* Risk of metabolic academia related to tissue hypoxia.
* Increased risk of myocardial ischemia and dysrhythmia.
* Decrease of venous capacitance.
* All of the above.
• All of the above.
32
* What are some complications related to hypothermia?
* Immune system compromise.
* Increased duration of action of relaxants and sedatives.
* Decreased platelet function.
* All of the above.
• All of the above.
33
* What is most commonly the earliest sign of malignant hyperthermia?
* Increased potassium.
* Increased end-tidal carbon dioxide levels.
* Increased core temperature.
* Myoglobinuria.
• Increased end-tidal carbon dioxide levels.
34
The #1 side effect of PA line insertion is:
arrythmias
35
Is LBBB or RBBB a contraindication of PA line insertion?
LBBB
36
Approximate length for PA line insertion
IJ:
Femoral:
IJ 40-50
| Fem 70
37
For thermodilution, less injectate over/underestimates CO?
Less injectate overestimates CO
38
Normal SVO2 is:
60-80% (mixed venous O2)
39
Best two Leads to monitor are:
II, V
40
Gold standard for BP monitoring is:
Art Line
41
If BP cuff is too small:
false high
42
If BP cuff too big:
false low
43
If BP cuff is loose:
false high
44
if able to palpate a radial pulse, SBP is at least:
80-90mmHg
45
If able to palpate a central pulse (carotids), SBP is at least
50mmHg
46
MAP=
MAP=D+1/3(S-D)
47
Bladder of BP cuff should cover ____% of length of extremity and _______% circumference.
80%
| 40%
48
Art line is zero'd to ____ when sitting
ear
49
Patient will most likely need an art line if they have:
aortic stenosis
50
Easiest TEE view during resuscitation
Transgastric short axis view
51
#1 loss of body heat in OR is
radiation
52
If patient has hx of MH,
TIVA
| Run O2 through machine for 10 minutes (flushes)
53
Pulse oximetry two wavelengths:
660nm red absorbed by deoxyhemoglobin
| 940nm infared absorbed by oxyhemoglobin
54
Depolarizing agents include
Succinylcholine (anectine)
55
Nondepolarizing agents include
all others
56
ulnar nerve stimulates what muscle
adductor pollicus muscle
57
facial nerve stimulates what muscle
orbicularis oculi muscle
58
1 twitch on TOF means _____% of nerves are blocked
90%
59
2 twitches on TOF means _____% of nerves are blocked
80%
60
3 twitches on TOF means _____% of nerves are blocked
70%
61
succinylcholine gtt can present as a
non-depolarizing agent
62
depolarizing agents work faster/slower than non-depolarizing agents
faster
63
oliguria is defined as UOP< _____ mL/kg/hr
UOP< 0.5 mL/kg/hr
64
Best monitor to use if you only have 1 option?
Pulse Ox
65
BIS monitor value of 100 means what?
Fully awake
66
Medications should be titrated to keep BIS monitor around what value?
60
67
The agency that oversees and regulates anesthetic drug approval and labeling is part of
The Department of Health and Human Services
68
The legal concept that describes a situation where an outcome was forseeable before the event took place is
proximate cause
69
Damages that are awarded to the plantiff in a malpractice case that are designed to punish the defendant for negligent actions are referend to as punitive damages or
exemplary damages
70
A nurse anesthetist is wrongfully fired from his or her job and plans to sue the former employer for lost wages. According to the requirements of mitigation, that nurse anesthetist has a duty to
search for another job
71
An anesthesia group is sued for malpratice for the acts of one of their employees. The plaintiff wins the case and the group is forced to pay for damages. The principle under which anesthesia group can then sue the employee to gain back the damages they had to pay is known as
Indemnification
72
Failure to obtain informed consent prior to anesthesia would be known as
Breach of duty
73
Performing a procedure on a patient without first obtaining informed consent is known as
Collateral Attack
74
A person is found slumped unconscious in the hospital lobby. A brief assessment by medical personnel reveals that the patient is in cardiac arrest and resuscitation is begun. THe legal doctrine that allows the performance of life saving measures when there is not one available to sign a consent for care is:
Implied consent
75
Which of the following conditions distinguish a general anesthetic from monitored anesthesia care?
The patient is unable to protect their airway
THe patient is unconscious
The patient is unable to verbalize answers to simple questions
76
Goals of preoperative medication include:
Anxiolysis
Analgesia
Amnesia
77
Mendelsson:
Gastric contents >25mL
ph< 2.5
Particulate
