Practice

Question 1

What is the difference between SaO2 and PaO2?

Answer 1

SaO2 is an indirect measure of the amount of oxygen bound to hemoglobin, while PaO2 directly measures the amount of oxygen dissolved in the blood.

Moreover, PaO2 is a more precise measurement but requires invasive methods to obtain, whereas SaO2 offers a quicker and non-invasive means of estimation.

It’s also important to note that SaO2 can be affected by conditions such as carbon monoxide poisoning because it
cannot differentiate between oxygen and carbon monoxide, both of which bind to hemoglobin.

Question 2

What is MvO2?

Answer 2

MvO2 (Myocardial Oxygen Consumption) quantifies the oxygen used by the heart muscle. Understanding MvO2 is vital in clinical settings, especially in managing conditions like heart failure or coronary artery disease.

Example sentence: MvO2 calculation involves factors like heart rate and systolic blood pressure.

Question 3

What is the difference between hypoxia and hypoxemia?

Answer 3

Hypoxemia refers to low levels of oxygen in the blood, specifically measured by parameters like PaO2. Hypoxia occurs when there is an inadequate supply of oxygen to the body’s tissues.

Example sentence: Hypoxemia can result from respiratory issues like asthma or pneumonia.

Question 4

What is the pathophysiology of ARDS (Acute Respiratory Distress Syndrome)?

Answer 4

The pathophysiology of ARDS can be divided into three stages: exudative, proliferative, and fibrotic. Each stage reflects progressive changes in lung tissue and function.

Example sentence: The exudative stage of ARDS involves damage to the alveolar epithelium and vascular endothelium.

Question 5

What are the stages of ARDS?

Answer 5

Exudative Stage: Characterized by alveolar damage, edema, and inflammatory membranes composed of fibrin and cellular debris. Damage to type I and type II alveolar cells leads to decreased surfactant production and impaired gas exchange.

Example sentence: The exudative stage of ARDS is marked by alveolar collapse and impaired gas exchange.

Question 6

What is the Proliferative Stage of ARDS?

Answer 6

Surviving type II alveolar cells proliferate to repair and replace damaged epithelium. Fibroblast activity increases, leading to interstitial fibrosis.

Example sentence: The proliferative stage of ARDS involves repair of damaged epithelium and increased fibroblast activity.

Question 7

What is the Fibrotic Stage of ARDS?

Answer 7

Characterized by extensive fibrosis and collagen deposition in the interstitial, alveolar, and vascular spaces. Can lead to significant reductions in lung compliance and permanent reductions in lung function.

Example sentence: The fibrotic stage of ARDS is marked by extensive scarring and reduced lung compliance.

Question 8

What are the optimal ventilator settings for ARDS?

Answer 8

Key strategies include low tidal volume ventilation (4-6 ml/kg of predicted body weight) and limiting plateau pressures below 30 cmH2O.

Example sentence: Low tidal volume ventilation is crucial in ARDS to prevent volutrauma and reduce mortality.

Question 9

What are the symptoms of sepsis?

Answer 9

Symptoms of sepsis include signs of infection, tachycardia, hypotension, abnormal body temperatures, clammy or sweaty skin, confusion, shortness of breath, and extreme pain or discomfort.

Example sentence: Patients with sepsis may present with tachycardia, hypotension, and confusion.

Question 10

Tell me the pathophysiology of sepsis

Answer 10

Sepsis is triggered by an infection, leading to activation of innate immune cells and release of cytokines. Exaggerated systemic inflammation results in vascular changes, hypotension, and fluid leakage into tissues.

Example sentence: The pathophysiology of sepsis involves an exaggerated immune response and systemic inflammation.

Question 11

What role do cytokines play in the immune response?

Answer 11

Cytokines help in fighting the infection and signal other immune cells to join the response.

Example sentence: These cytokines not only help in fighting the infection but also signal other immune cells to join the response.

Question 12

What are the effects of vascular changes during the innate immune response?

Answer 12

Vasodilation increases blood flow to the affected area, facilitating the arrival of more immune cells.

Example sentence: The cytokines released during the innate immune response induce vasodilation to increase blood flow to the affected area, facilitating the arrival of more immune cells.

Question 13

What is a cytokine storm?

Answer 13

A cytokine storm refers to the massive and uncontrolled release of cytokines into the bloodstream, causing widespread inflammation, tissue damage, and organ failure.

Example sentence: In severe cases, the immune response becomes overly aggressive, leading to a cytokine storm.

Question 14

What is disseminated intravascular coagulation (DIC)?

Answer 14

DIC is characterized by the widespread formation of blood clots in small vessels throughout the body, obstructing blood flow and leading to tissue damage and organ failure.

Example sentence: Sepsis activates the coagulation cascade, which can lead to disseminated intravascular coagulation (DIC).

Question 15

How does sepsis affect the adaptive immune response?

Answer 15

Sepsis can suppress or delay the adaptive immune response, allowing the infection and inflammatory response to spiral out of control.

Example sentence: While the innate immune response is immediate, the adaptive immune system is slower to respond in sepsis.

Question 16

What role do endothelial cells play in sepsis?

Answer 16

Endothelial cells contribute to inflammation, coagulation, and barrier dysfunction in sepsis, leading to edema and impaired organ function.

Example sentence: In sepsis, endothelial cells are activated and damaged, contributing to inflammation, coagulation, and barrier dysfunction.

Question 17

Dopamine: What is dopamine and how is it synthesized?

Answer 17

Dopamine is a neurotransmitter and hormone produced in the body primarily in dopaminergic neurons of the brain and adrenal medulla. It is synthesized from the amino acid tyrosine, converted to L-DOPA and then to dopamine by DOPA decarboxylase.

Source: www.CRNASchoolPrepAcademy.com

Question 18

Dopamine: How is dopamine broken down in the body?

Answer 18

Dopamine is broken down by monoamine oxidase (MAO) and catechol-O-methyltransferase (COMT) into homovanillic acid (HVA), which is excreted by the kidneys.

Source: www.CRNASchoolPrepAcademy.com

Question 19

Phenylephrine: What is phenylephrine and how does it work?

Answer 19

Phenylephrine is a synthetic compound used as a medication. It works by selectively stimulating alpha-1 adrenergic receptors on vascular smooth muscle, leading to vasoconstriction.

Source: www.CRNASchoolPrepAcademy.com

Question 20

Vasopressin: What is vasopressin and where is it synthesized?

Answer 20

Vasopressin, also known as antidiuretic hormone (ADH), is a peptide hormone synthesized in the hypothalamus and stored in the posterior pituitary gland.

Source: www.CRNASchoolPrepAcademy.com

Question 21

Milrinone: What is milrinone and how does it work?

Answer 21

Milrinone is a selective phosphodiesterase-3 inhibitor that enhances cardiac output by increasing cAMP in cardiac cells, improving contractility. It primarily acts on the heart and arteries.

Source: www.CRNASchoolPrepAcademy.com

Question 22

What is Milrinone?

Answer 22

A selective phosphodiesterase-3 inhibitor. This category of drug enhances cardiac output by increasing cAMP in cardiac cells, which amplifies the calcium influx into heart muscles, improving contractility.

It primarily acts on the heart and arteries, rather than veins.

Question 23

How is Milrinone metabolized and excreted?

Answer 23

Milrinone is primarily metabolized in the liver and has a renal excretion pathway. It has a biological half-life of about 2.3 hours, which can be extended in patients with severe renal impairment.

Question 24

How is Milrinone dosed?

Answer 24

Milrinone is administered intravenously, often starting with a loading dose followed by a continuous infusion. The typical loading dose is around 50 micrograms/kg administered over 10 minutes. The continuous infusion rate usually ranges from 0.375 to 0.75 micrograms/kg per minute, adjusted based on the patient’s response and renal function.

The precise dosing aims to optimize cardiac output while minimizing the risk of potential side effects like arrhythmias or hypotension.

Question 25

What is Dobutamine?

Answer 25

Dobutamine is synthesized chemically as a synthetic catecholamine. It acts as a beta-1 adrenergic agonist, primarily stimulating the heart to increase its contractility and cardiac output. ## Footnote

Question 26

How is Dobutamine metabolized and excreted?

Answer 26

Dobutamine is predominantly metabolized in the liver through catechol-O-methyltransferase (COMT) enzymes, which methylate the molecule, making it less active. The breakdown products are then excreted primarily via the kidneys. ## Footnote

Question 27

How is Dobutamine dosed?

Answer 27

Dobutamine is administered via intravenous infusion. The dosing starts at a rate of 2.5 to 10 micrograms per kilogram per minute and can be adjusted based on the clinical response and patient's hemodynamic condition. ## Footnote It is typically used for short-term management of acute heart failure and for increasing cardiac output in patients who have diminished cardiac function.

Question 28

What can Swan-Ganz catheter readings show in septic patients?

Answer 28

Increased Cardiac Output (CO): In sepsis, the body attempts to compensate for low blood pressure and poor tissue perfusion by increasing cardiac output. ## Footnote Decreased Systemic Vascular Resistance (SVR): Vasodilation occurs in response to inflammatory mediators, leading to decreased resistance. Decreased Pulmonary Capillary Wedge Pressure (PCWP): Reflects reduced blood volume and pressure in the cardiac system, often due to vasodilation and fluid shifting.

Question 29

What are the characteristics of Cardiogenic Shock?

Answer 29

Cardiac Output (CO): Decreased, due to impaired cardiac function. ## Footnote Systemic Vascular Resistance (SVR): Increased, as the body attempts to compensate for low cardiac output by constricting blood vessels. Pulmonary Capillary Wedge Pressure (PCWP): Increased, indicative of fluid congestion in the lungs due to heart failure.

Question 30

What are the characteristics of Hypovolemic Shock?

Answer 30

Cardiac Output (CO): Decreased, as a result of low blood volume. ## Footnote Systemic Vascular Resistance (SVR): Increased, as the body tries to maintain blood pressure by vasoconstriction. Pulmonary Capillary Wedge Pressure (PCWP): Decreased, indicating reduced blood volume.

Question 31

What are the normal values for Central Venous Pressure (CVP), Pulmonary Artery Systolic Pressure, Pulmonary Artery Diastolic Pressure, Mean Arterial Pressure (MAP), and Pulmonary Capillary Wedge Pressure (PCWP)?

Answer 31

Central Venous Pressure (CVP): 2-6 mmHg. Reflects right atrial pressure, useful for assessing right ventricular function and venous return. ## Footnote Pulmonary Artery Systolic Pressure: 20-30 mmHg. Indicates the pressure in the pulmonary artery during the heart's contraction phase. Pulmonary Artery Diastolic Pressure: 5-15 mmHg. Measures the pressure in the pulmonary artery when the heart rests between beats. Mean Arterial Pressure (MAP): 60-100 mmHg. Averages the pressure within the arteries over a complete cycle of heartbeats, crucial for ensuring adequate organ perfusion. Pulmonary Capillary Wedge Pressure (PCWP): 8-12 mmHg. Estimates left atrial pressure; valuable for assessing left ventricular function and possible heart failure.

Question 32

What complications can occur with the placement of a central line?

Answer 32

Complications from placing a central line can include: Infection: Risks increase with the duration the line is in place. Bleeding: Especially if the patient has a clotting disorder or is on anticoagulation therapy. Arrhythmias: Occur if the catheter irritates the heart’s electrical system. Air Embolus: Can be life-threatening if air enters the circulatory system. Pneumothorax: Air or gas

Question 33

What complications can occur with the placement of a central line?

Answer 33

Complications from placing a central line can include: - Infection: Risks increase with the duration the line is in place. - Bleeding: Especially if the patient has a clotting disorder or is on anticoagulation therapy. - Arrhythmias: Occur if the catheter irritates the heart’s electrical system. - Air Embolus: Can be life-threatening if air enters the circulatory system. - Pneumothorax: Air or gas in the chest cavity, potentially collapsing the lung.

Question 34

What is the average cardiac output?

Answer 34

The average cardiac output, which is the volume of blood the heart pumps per minute, is approximately 4.9 liters. This figure can vary based on body size and condition.

Question 35

V-fib ACLS protocol?

Answer 35

For ventricular fibrillation (V-fib) during ACLS: - Immediate Defibrillation: This is the most critical step in V-fib treatment. - CPR: Follow with 2 minutes of chest compressions before reassessing the rhythm. Compressions should be at least 2 inches (5 cm) deep for adults, but not more than 2.4 inches. Aim for a rate of 100-120 compressions per minute. - Epinephrine Administration: Give 1 mg every 3-5 minutes during the resuscitation effort. - Continuous Chest Compressions: Maintain compressions for 2 minutes between rhythm checks and medication administration. ## Footnote - Epinephrine Dose: 1 mg of 1:10,000 solution - Epinephrine Frequency: Every 3-5 minutes - Amiodarone Dose: First dose: 300 mg bolus; Second dose: 150 mg - Amiodarone Frequency: First dose as soon as possible, second dose if VF/VT persists - Chest Compression Quality: Depth: At least 2 inches (5 cm) for adults, not exceeding 2.4 inches, Rate: 100 to 120 compressions per minute - Defibrillation Energy: Biphasic Defibrillators: Typically start at 120-200 joules. Depending on the manufacturer, subsequent shocks might be the same or higher. Monophasic Defibrillators: Generally start at 360 joules

Question 36

Study arrhythmias, be able to recognize a

Answer 36

Second degree: Mobitz Type I, II, third degree, SVT,V-Fib, V-tach. ## Footnote - See detailed information in the text above

Question 37

What is Ventricular Tachycardia (V-Tach)?

Answer 37

A fast heart rhythm that originates from abnormal electrical signals in the ventricles. It may result from various factors, including ischemic damage to the heart muscle, leading to rapid, regular, or irregular heartbeats. ## Footnote Treatment depends on the stability of the patient. Stable patients may be treated with antiarrhythmic drugs, while unstable ones require immediate cardioversion.

Question 38

What is the Circle of Willis?

Answer 38

The Circle of Willis is a critical arterial structure located at the base of the brain. It forms a ring or circle of blood vessels that provides a safety mechanism for blood flow. If one part of the circle becomes blocked or narrowed, it can re-route the blood via alternative pathways, helping maintain cerebral perfusion. The Circle of Willis connects the anterior and posterior blood supplies to the brain, allowing for collateral circulation between the major brain arteries. It consists of the anterior cerebral artery, anterior communicating artery, internal carotid arteries, posterior cerebral arteries, posterior communicating arteries, and the basilar artery. This system is essential for stabilizing brain blood flow.

Question 39

What are the unpaired cartilages of the larynx?

Answer 39

The unpaired cartilages of the larynx are crucial structures involved in its anatomy and function: - Epiglottis: This is a leaf-shaped flap of cartilage located just behind the tongue, at the top of the larynx. The epiglottis functions as a switch to route food to the esophagus and air to the trachea. - Cricoid Cartilage: Shaped like a signet ring, the cricoid cartilage is located below the thyroid cartilage. It forms the complete ring around the airway and provides a connection point for the larynx and trachea. - Thyroid Cartilage: The largest cartilage of the larynx, it forms the bulk of its front wall. Notably, the thyroid cartilage includes the prominent laryngeal prominence or 'Adam's apple,' which is more pronounced in males. This cartilage shields other components of the larynx and provides attachment points for vocal cords and muscles. ## Footnote It comprises several cartilages, including the thyroid, cricoid, and arytenoid cartilages, which are key structural components. The epiglottis, another significant part, guards the entrance of the trachea during swallowing. Inside the larynx, the vocal cords, or vocal folds, are located, which vibrate to produce sound when air passes through them. Muscles and ligaments control the tension and position of these vocal cords, impacting voice pitch and loudness.

Question 40

What are the main parts of the brain structure?

Answer 40

1. Cerebrum: The largest part, responsible for higher cognitive functions such as thinking, planning, and emotions. It's divided into left and right hemispheres and further into lobes (frontal, parietal, temporal, and occipital) that handle different functions like speech, movement, and sensory processing. 2. Cerebellum: Located at the back of the brain, it's involved in motor control and coordination. It also plays roles in cognitive functions like attention and language. 3. Brainstem: Connects the cerebrum with the spinal cord and controls essential life functions such as breathing, heart rate, and blood pressure.

Question 41

What is the function of the Cerebellum?

Answer 41

Located at the back of the brain, it's involved in motor control and coordination. It also plays roles in cognitive functions like attention and language. ## Footnote Example: The cerebellum helps in maintaining balance while walking.

Question 42

What does the Brainstem control?

Answer 42

Connects the cerebrum with the spinal cord and controls essential life functions such as breathing, heart rate, and blood pressure. It includes the midbrain, pons, and medulla oblongata. ## Footnote Example: Damage to the brainstem can result in serious complications like difficulty breathing.

Question 43

What is the Limbic System responsible for?

Answer 43

A group of structures that deal with emotions, memories, and arousal. This system includes the hippocampus, amygdala, and thalamus. ## Footnote Example: The limbic system plays a key role in emotional responses to different situations.

Question 44

What is the proper EKG lead placement for V1?

Answer 44

4th intercostal space right of the sternum ## Footnote Example: Proper EKG lead placement is crucial for accurate heart monitoring.

Question 45

Which EKG lead is used to monitor arrhythmias?

Answer 45

Lead II is commonly used to monitor arrhythmias due to its clear view of the heart's electrical axis. ## Footnote Example: Lead II is essential in detecting irregular heart rhythms.

Question 46

What EKG lead is used to monitor Ischemia in the left ventricle?

Answer 46

Lead V5 is often used to monitor ischemia in the left ventricle, providing a good angle on lateral wall changes. ## Footnote Example: Monitoring ischemia in the left ventricle is crucial for identifying potential heart issues.

Question 47

What is the difference between a pacemaker and AICD?

Answer 47

Pacemaker: Primarily used to manage bradyarrhythmias by sending electrical impulses to maintain a regular heart rate. Automated Implanted Cardioverter Defibrillator (AICD): Designed to detect and treat life-threatening arrhythmias by delivering shocks to restore normal heart rhythm, particularly useful in patients at risk of sudden cardiac arrest. ## Footnote Example: Understanding the difference between pacemakers and AICDs is important for managing heart conditions.

Question 48

How can you identify Myocardial infarctions on a 12 lead EKG?

Answer 48

Inferior MI: Look for ST elevation in leads II, III, and aVF. Anterior MI: ST elevation is seen in the precordial leads V1-V4. Lateral MI: Can be divided into: Low Lateral MI - ST elevation in leads V5 and V6, High Lateral MI - ST elevation in leads I and aVL. S for Septal MI: Leads V1, V2, A for Anterior MI: Leads V3, V4, I for Inferior MI: Leads II, III, aVF, L for Lateral MI: Leads I, aVL, V5, V6 ## Footnote Example: Recognizing the specific EKG changes can help diagnose the location of a heart attack.

Question 49

What is an appropriate intervention for cardiogenic shock?

Answer 49

The goal of the intervention is to quickly restore blood pressure and heart function. Depending on the cause of cardiogenic shock, a variety of drugs or mechanical support devices may be used: Clot-busting or anti-clotting drugs (tPA, aspirin, heparin), inotropes/vasopressors (dopamine, dobutamine, norepinephrine, epinephrine), nitroglycerin (vasodilator) Mechanical support devices: Intra-aortic balloon pump (IABP), Impella, or ECMO ## Footnote Example: Prompt intervention is crucial in managing cardiogenic shock.

Question 50

IABP Mechanism

Answer 50

The IABP enhances cardiac output indirectly and stabilizes the patient hemodynamically.

Question 51

Impella Mechanism

Answer 51

The Impella device functions as a microaxial flow pump that mechanically sucks blood from the left ventricle and expels it into the ascending aorta.

Question 52

Impella Effect

Answer 52

The active reduction of left ventricular volume decreases the work of the heart while maintaining or increasing cardiac output.

Question 53

ECMO Mechanism

Answer 53

ECMO draws blood from the body, oxygenates it externally, and then pumps it back into the bloodstream.

Question 54

ECMO Effect

Answer 54

ECMO is used in critical care situations where both cardiac and respiratory support is needed.

Question 55

Preload Definition

Answer 55

Refers to the volume of blood in the ventricles at the end of diastole before the heart contracts.

Question 56

Afterload Definition

Answer 56

Represents the resistance that the left ventricle must overcome to pump blood out during systole.

Question 57

Contractility Definition

Answer 57

The inherent capacity of the cardiac muscle to contract independent of changes in preload or afterload.

Question 58

Inferior MI Leads

Answer 58

ST elevation in leads II, III, and aVF indicates an inferior MI.

Question 59

Anterior MI Leads

Answer 59

ST elevation in leads V1 to V4 indicates an anterior MI.

Question 60

Lateral MI Leads

Answer 60

ST elevation in V5 and V6 for low lateral wall involvement, and in leads I and aVL for high lateral wall involvement.

Question 61

STEMI Leads Interpretation

Answer 61

ST elevation in leads V5 and V6 indicates a lateral wall MI. Leads II and III indicate an inferior MI. Leads V1 to V4 indicate an anterior wall MI.

Question 62

Inferior Wall Infarction

Answer 62

The inferior wall is mainly supplied by the right coronary artery (RCA). An infarction in the inferior wall often indicates a blockage in the RCA.

Question 63

What does inferior mean when we are talking inferior wall?

Answer 63

The term "inferior" refers to the underside or lower part of the heart, particularly affecting the lower portion of the left ventricle. The inferior wall is mainly supplied by the right coronary artery (RCA). ## Footnote An infarction in the inferior wall often indicates a blockage in the RCA, which can significantly affect the heart's ability to function efficiently.

Question 64

Where is the aorta on the heart?

Answer 64

The aorta begins at the left ventricle of the heart and forms an arch as it extends upward into the chest; it continues down into the abdomen where it branches into the iliac arteries. ## Footnote

Question 65

Where are the carotid arteries?

Answer 65

Each carotid artery branches into two main divisions: Internal Carotid Artery: This artery travels upward into the skull, providing oxygenated blood to the brain. External Carotid Artery: Supplies oxygenated blood to the face and neck regions. ## Footnote Additionally, the aorta, which is the largest artery stemming from the heart, has several key branches: Brachiocephalic Trunk: The first major branch off the aortic arch, which further divides into the right subclavian and the right common carotid arteries. Subclavian Arteries: Located under the clavicle, supplying blood to the arms, with the left subclavian artery arising directly from the aorta and the right as a branch of the brachiocephalic trunk.

Question 66

Interpret these strips and tell me what you would do about them.

Answer 66

Normal Sinus Rhythm (NSR) with Possible Small ST-Elevation: Interpretation: Regular rhythm indicating normal electrical activity, but possible ST-elevation could suggest early signs of myocardial ischemia. Action: Obtain a full 12-lead EKG to confirm ST-elevation and closely monitor the patient. Continuous cardiac monitoring and assessment of symptoms related to ischemia or infarction are recommended. Trigeminy: Interpretation: A pattern where every third heartbeat is premature; typically, this is seen with premature ventricular contractions (PVCs). Action: Assess electrolyte levels as imbalances can contribute to arrhythmias. Management may include beta-blockers to stabilize the heart rhythm, reducing anxiety, and advising the patient to limit caffeine and tobacco intake. Asystole: Interpretation: A flatline EKG indicating no electrical activity in the heart and the most severe form of cardiac arrest. Action: Immediate CPR and administration of epinephrine,1 mg of epinephrine IV/IO every 3-5 minutes, according to Advanced Cardiac Life Support (ACLS) protocols. Identify and treat reversible causes guided by the H’s and T’s (Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hyper-/hypokalemia, Hypothermia, Tension pneumothorax, Tamponade, Toxins, Thrombosis - pulmonary and cardiac). First-Degree Heart Block: Interpretation: A condition where the electrical impulse moves more slowly than normal through the AV node, but all impulses are conducted. This is often indicated by a prolonged PR interval on the EKG. Action: Typically, treatment is not required unless the patient is symptomatic. Ongoing monitoring and regular follow-ups to watch for progression to higher degrees of block are indicated.

Question 67

Be able to trace a drop of blood through the heart and know the heart valves?

Answer 67

Body > inferior/superior vena cava > right atrium > tricuspid valve> right ventricle > pulmonary arteries > lungs > pulmonary vein > left atrium > bicuspid valve > left ventricle > aortic valve > aorta > body From the Body: Blood returns to the heart from the body, carrying carbon dioxide and waste materials, entering through the superior and inferior vena cava. Right Atrium: Blood enters the right atrium and then passes through the tricuspid valve. Tricuspid Valve: Between the right atrium and right ventricle. Right Ventricle: After moving through the tricuspid valve, blood enters the right ventricle. Pulmonary Valve: At the exit of the right ventricle into the pulmonary artery. Pulmonary Arteries: The right ventricle pumps the blood out through the pulmonary arteries to the lungs. Lungs: In the lungs, the blood picks up oxygen and releases carbon dioxide. Pulmonary Veins: Oxygenated blood returns to the heart via the pulmonary veins. Left Atrium: Blood enters the left atrium and moves through the bicuspid valve (also known as the mitral valve). Mitral (Bicuspid) Valve: Between the left atrium and left ventricle. Left Ventricle: Blood flows into the ## Footnote

Question 68

What is the function of the left ventricle?

Answer 68

The left ventricle is the heart's main pumping chamber where blood flows into. ## Footnote Page 16 www.CRNASchoolPrepAcademy.com

Question 69

What is the role of inotropic effects?

Answer 69

Inotropic effects relate to the strength or force of the heart's contractions. Positive inotropic agents increase the force of contraction, while negative inotropic agents decrease it. ## Footnote Page 16 www.CRNASchoolPrepAcademy.com

Question 70

What is the normal range for ICP in adults?

Answer 70

In adults, the normal range for ICP is typically between 5-15 mmHg when in a supine position, with the mean ICP ideally remaining under 15 mmHg. ## Footnote Page 17 www.CRNASchoolPrepAcademy.com

Question 71

How does CO2 affect ICP?

Answer 71

CO2 has a potent effect on cerebral blood flow, influencing ICP. Elevated CO2 levels lead to cerebral vasodilation, increasing blood volume in the skull and raising ICP. Conversely, lowering CO2 levels through hyperventilation causes cerebral vasoconstriction, decreasing ICP. ## Footnote Page 17 www.CRNASchoolPrepAcademy.com

Question 72

What actions can be taken if a patient has high ICP?

Answer 72

To address high ICP, actions can include elevating the head of the bed to promote venous drainage, controlled hyperventilation to lower CO2 levels and decrease cerebral blood volume, draining CSF if an external ventricular drain is in place, and using osmotherapy with mannitol to draw fluid out of the brain. ## Footnote Page 17 www.CRNASchoolPrepAcademy.com

Question 73

Positioning the patient with the head elevated about 30 degrees helps reduce ICP by promoting venous drainage from the head.

Answer 73

Positioning the patient with the head elevated about 30 degrees helps reduce ICP by promoting venous drainage from the head.

Question 74

Hyperventilation: Temporarily lowering carbon dioxide levels through controlled hyperventilation leads to vasoconstriction, which can decrease cerebral blood volume and lower ICP.

Answer 74

Hyperventilation: Temporarily lowering carbon dioxide levels through controlled hyperventilation leads to vasoconstriction, which can decrease cerebral blood volume and lower ICP.

Question 75

Drain CSF: If an external ventricular drain is in place, CSF can be drained to quickly reduce pressure.

Answer 75

Drain CSF: If an external ventricular drain is in place, CSF can be drained to quickly reduce pressure.

Question 76

Osmotherapy: Mannitol, a diuretic, can be used to draw fluid out of the brain tissue, lowering ICP. Another option is hypertonic saline.

Answer 76

Osmotherapy: Mannitol, a diuretic, can be used to draw fluid out of the brain tissue, lowering ICP. Another option is hypertonic saline.

Question 77

Loop Diuretics: Medications like Lasix (furosemide) can be used to decrease fluid volume, which can help reduce ICP.

Answer 77

Loop Diuretics: Medications like Lasix (furosemide) can be used to decrease fluid volume, which can help reduce ICP.

Question 78

Corticosteroids: Although their use is more limited, steroids like dexamethasone can reduce inflammation and edema surrounding tumors or lesions.

Answer 78

Corticosteroids: Although their use is more limited, steroids like dexamethasone can reduce inflammation and edema surrounding tumors or lesions.

Question 79

Barbiturates: These can be used to lower metabolic demand of brain tissue and reduce cerebral blood flow, thus lowering ICP.

Answer 79

Barbiturates: These can be used to lower metabolic demand of brain tissue and reduce cerebral blood flow, thus lowering ICP.

Question 80

What increases ICP?

Answer 80

Medical Conditions: The presence of brain tumors, hemorrhages (such as subarachnoid or intraventricular), subdural hematomas, strokes, aneurysms, and infections like meningitis or encephalitis can all directly increase brain volume, thereby raising ICP. Increased CSF: Conditions that increase the production of cerebrospinal fluid or obstruct its flow can lead to accumulation and increased pressure, as seen in hydrocephalus. Physical Factors: Head trauma often results in swelling and bleeding within the brain, further elevating ICP. Physiological Activities: Actions like Valsalva maneuvers, coughing, suctioning, exposure to noxious stimuli, or seizures can transiently raise ICP. Similarly, positioning the patient with the head of the bed lowered can impede venous drainage from the brain, increasing pressure.

Question 81

Learn the cranial nerves: names & number

Answer 81

I. Olfactory Nerve: Responsible for the sense of smell. II. Optic Nerve: Carries visual information from the retina to the brain. III. Oculomotor Nerve: Controls most of the eye's movements, the constriction of the pupil, and maintains an open eyelid. IV. Trochlear Nerve: Controls the superior oblique muscle, which is responsible for rotating the eye. V. Trigeminal Nerve: Responsible for facial sensations and motor functions such as biting and chewing. VI. Abducens Nerve: Controls the lateral rectus muscle, which turns the eye outward. VII. Facial Nerve: Controls facial expressions, and functions in the conveyance of taste sensations from the anterior two-thirds of the tongue. VIII. Vestibulocochlear Nerve: Serves hearing and balance, helping to transmit sound and equilibrium information from the inner ear to the brain.

Question 82

What is atmospheric pressure at sea level?

Answer 82

1 atm = 760 Torr Atmospheric pressure is crucial for the administration of anesthetic gases due to its impact on their partial pressures. The partial pressure of a gas, according to Dalton's Law, is the pressure it would exert if it alone occupied the entire volume. In the context of anesthesia, the efficacy and concentration of inhaled anesthetics depend significantly on the atmospheric pressure because it influences the partial pressures of the gases delivered. For example, at higher altitudes where atmospheric pressure is lower, anesthetic gases may have reduced effectiveness unless adjustments are made to increase their concentration. This adjustment is necessary to ensure that the partial pressure of the anesthetic gas remains sufficient to achieve the desired clinical effect.

Question 83

What part of the kidney does water reabsorption take place?

Answer 83

Water reabsorption primarily takes place in the proximal convoluted tubule (PCT) of the kidney. This segment of the nephron is highly efficient at reclaiming water and solutes from the filtrate that enters the kidney. Approximately 65-70% of the filtered water is reabsorbed in the PCT, facilitated by the osmotic gradient established by the active transport of ions and other solutes.

Question 84

Why does renal failure cause anemia?

Answer 84

Renal failure leads to anemia primarily because the kidneys produce a hormone called erythropoietin (EPO), which is crucial for the production of red blood cells in the bone marrow. In chronic kidney disease (CKD) or other forms of renal failure, the damaged kidneys cannot produce adequate amounts of EPO. This deficiency hampers the bone marrow's ability to produce sufficient red blood cells, leading to anemia. Thus, patients with renal failure often experience symptoms of anemia due to this reduced EPO production and consequent lower red blood cell count.

Question 85

Which blood component is more likely to cause infection and why?

Answer 85

Platelets are more likely to cause transfusion-transmitted infections primarily because of their higher leukocyte content. Leukocytes, or white blood cells.

Question 86

Which blood component is more likely to cause infection and why?

Answer 86

Platelets are more likely to cause transfusion-transmitted infections primarily because of their higher leukocyte content. ## Footnote Leukocytes, or white blood cells, can harbor viruses and bacteria, increasing the risk of transmitting infections through platelet transfusions. Additionally, platelets are stored at room temperature, which can allow for bacterial proliferation. This combination of factors makes platelets a critical focus in efforts to reduce the risk of transfusion-related infections.

Question 87

Where are platelets made?

Answer 87

Platelets are produced in the bone marrow, the soft tissue inside bones. Specifically, they are derived from very large bone marrow cells called megakaryocytes. These megakaryocytes release fragments of their cytoplasm into the bloodstream, which become platelets. The process of platelet production is regulated by thrombopoietin, a hormone primarily produced in the liver and kidneys. ## Footnote This regulation ensures the maintenance of a steady level of platelets necessary for normal blood clotting.

Question 88

What is the normal platelet count?

Answer 88

The normal platelet count in human blood ranges from 150,000 to 400,000 platelets per microliter. This range is considered adequate for normal clotting functions. Platelet counts outside of this range can indicate various medical conditions. ## Footnote Lower counts may suggest problems like thrombocytopenia, which can lead to excessive bleeding, while higher counts might indicate thrombocytosis, which can increase the risk of thrombosis.

Question 89

Tell me everything you know about hemoglobin.

Answer 89

Hemoglobin (Hb or Hgb) is the protein in red blood cells that binds and transports oxygen from the lungs to the rest of the body and carries carbon dioxide back to the lungs. A normal Hb in males is 14-18 g/dl and in females is 12-16 g/dl. ## Footnote Anemia is the result of low levels of hemoglobin and often occurs as a result of low iron, which is used for the production of Hb. Symptoms of anemia include fatigue, feeling cold, dizziness, pale skin, trouble breathing, and weakness.

Question 90

What clotting factors make up Cryo?

Answer 90

Cryoprecipitate, often referred to as 'cryo,' is a blood product used in the treatment of conditions involving severe clotting factor deficiencies. It is derived from plasma and contains several important clotting factors: Fibrinogen (Factor I), Factor VIII, Factor XIII, Von Willebrand Factor, and Fibronectin. ## Footnote Fibrinogen is essential for the final step of the clotting cascade, Factor VIII is critical for the clotting cascade, Factor XIII stabilizes the fibrin clot formed at the end of the coagulation process, Von Willebrand Factor is important for platelet adhesion to wound sites, and Fibronectin plays a role in cell adhesion and wound healing.

Question 91

What lab tests are used to monitor Heparin & Coumadin?

Answer 91

Heparin Monitoring: PTT (Partial Thromboplastin Time) ## Footnote This test measures the efficacy of the intrinsic pathway of the coagulation cascade, which heparin primarily affects. PTT assesses how long it takes for a clot to form, and heparin therapy aims to prolong this time to prevent clot formation. Coumadin Monitoring: PT (Prothrombin Time) and INR (International Normalized Ratio) ## Footnote These tests measure the time it takes for blood to clot by assessing the extrinsic pathway, which is influenced by Coumadin. The INR is a standardized number that comes from the PT test, allowing for consistent monitoring of.

Question 92

What is the difference between and what makes up: normal saline & LR?

Answer 92

Normal Saline is a simple solution of sodium chloride in water. ## Footnote It's commonly used for hydration and as a vehicle for delivering intravenous medications. It is isotonic and increases the extracellular fluid volume.

Question 93

What electrolyte do you need to watch when giving blood?

Answer 93

Calcium (Ca++): ## Footnote Hypocalcemia: Can occur during transfusions as the citrate used as a preservative in stored blood binds with calcium in the recipient’s blood, reducing free calcium levels. Monitoring and, if necessary, supplementing calcium can prevent symptoms associated with low calcium levels such as muscle spasms or cardiac dysrhythmias.

Question 94

What is total body water?

Answer 94

Total body water (TBW) refers to the total amount of water content within a human body, making up about 60% of an adult's body weight. This body water is distributed as intracellular water (ICW) and extracellular water (ECW). ## Footnote Intracellular water constitutes approximately two-thirds of the TBW and is contained within cells, while extracellular water makes up the remaining one-third, residing outside the cells in spaces such as blood plasma and interstitial fluids. This water balance is crucial for maintaining various physiological functions, including temperature regulation, metabolic processes, and the transportation of nutrients and waste products.

Question 95

What are the components of intracellular fluid?

Answer 95

Intracellular fluid (ICF) is the liquid found inside cells and is the largest component of total body water. The ICF is composed primarily of water, which makes up about 70-85% of the cell's volume. ## Footnote It also contains various dissolved ions such as potassium, magnesium, and phosphate, which are crucial for cell function.

Question 96

What are the components of intracellular fluid?

Answer 96

Intracellular fluid (ICF) is the liquid found inside cells and is the largest component of total body water. The ICF is composed primarily of water, which makes up about 70-85% of the cell's volume. It also contains various dissolved ions such as potassium, magnesium, and phosphate, which are crucial for cell function. Small molecules such as glucose and amino acids, as well as large water-soluble molecules like proteins, are also significant components.

Question 97

What are the components of extracellular fluid?

Answer 97

Blood Plasma: This is the liquid component of blood in which blood cells are suspended. It contains water, salts, proteins, and various other substances. Interstitial Fluid (IF): This fluid surrounds and bathes all body cells, providing a medium through which substances can pass back and forth between blood and cells. Lymph: A fluid that circulates in the lymphatic system, derived from interstitial fluid. It helps return proteins and excess interstitial fluid to the blood. Transcellular Fluid: Includes specialized fluids such as cerebrospinal fluid (CSF) around the brain and spinal cord, synovial fluid in joints, aqueous humor in the eyes, serous fluid in body cavities, and digestive secretions in the gastrointestinal tract.

Question 98

What is 15% of 50?

Answer 98

15% of 50 is 7.5. ## Footnote To find 15% of 50, you multiply 50 by 0.15.

Question 99

What is 25% of 50?

Answer 99

25% of 50 is 12.5. ## Footnote To find 25% of 50, you can multiply 50 by 0.25.

Question 100

If a patient weighs 50kg and medication is 0.6mg/kg how much would you give?

Answer 100

You would administer 30 mg of the medication to the patient. ## Footnote To calculate the dosage of medication for a patient weighing 50 kg at a dose of 0.6 mg/kg, you multiply the patient's weight by the dosage per kilogram.

Question 101

What is the normal range for ABG?

Answer 101

pH: 7.35-7.45, CO2 (Carbon Dioxide): 35-45 mmHg, HCO3 (Bicarbonate): 22-26 mEq/L.

Question 102

What is the oxyhemoglobin curve (shift to the right vs. shift to the left) and how does this affect the O2 affinity to hemoglobin?

Answer 102

Leftward Shift: Indicates increased oxygen affinity, where hemoglobin holds onto oxygen more tightly. This can occur due to alkalosis, low carbon dioxide levels, hypothermia, or decreased levels of 2,3-DPG. While this shift results in higher arterial oxygen saturation (SaO2), it can hinder oxygen delivery to tissues. Rightward Shift: Indicates decreased oxygen affinity, where hemoglobin releases oxygen more readily, facilitating delivery to tissues. This shift can be triggered by acidosis, elevated carbon dioxide levels, fever, or increased levels of 2,3-DPG. Although arterial oxygen saturation might be slightly lower, more oxygen is available to the tissues, which is crucial during states of increased metabolic demand.

Question 103

What is normal Tidal Volume, FRC: Functional residual capacity, VC: vital capacity, PIP: peak inspiratory pressure?

Answer 103

Tidal Volume (TV): This is the volume of air inhaled or exhaled in a normal breath, typically ranging from 6-8 mL/kg of ideal body weight. It's a crucial measurement in mechanical ventilation settings. Functional Residual Capacity (FRC): This is the volume of air remaining in the lungs after a normal exhalation, averaging about 3 liters. FRC is important for maintaining adequate gas exchange during the breathing cycle. Vital Capacity (VC): This is the maximum amount of air a person can expel from the lungs after a maximum inhalation, usually between 3-5

Question 104

What is Tidal Volume (TV)?

Answer 104

Tidal Volume (TV) is a normal breath, typically ranging from 6-8 mL/kg of ideal body weight. It's a crucial measurement in mechanical ventilation settings. ## Footnote Example: A patient with an ideal body weight of 70 kg would have a tidal volume of approximately 420-560 mL.

Question 105

What is Functional Residual Capacity (FRC)?

Answer 105

Functional Residual Capacity (FRC) is the volume of air remaining in the lungs after a normal exhalation, averaging about 3 liters. FRC is important for maintaining adequate gas exchange during the breathing cycle. ## Footnote Additional Information: FRC is a combination of residual volume and expiratory reserve volume.

Question 106

What is Vital Capacity (VC)?

Answer 106

Vital Capacity (VC) is the maximum amount of air a person can expel from the lungs after a maximum inhalation, usually between 3-5 liters. It's used to assess the strength of thoracic muscles and the elasticity of the lungs. ## Footnote Example: A person with a vital capacity of 4 liters can exhale up to 4 liters of air after taking the deepest possible breath.

Question 107

What is Peak Inspiratory Pressure (PIP)?

Answer 107

Peak Inspiratory Pressure (PIP) measures the highest level of airway pressure delivered during inhalation with mechanical ventilation, typically between 25-30 cm H2O. Monitoring PIP helps to ensure that ventilation is not causing harm due to excessive pressure.

Question 108

What is the percentage of O2 in room air?

Answer 108

Room air contains about 21% oxygen (O2). When administering supplemental oxygen through various devices, the concentration delivered to the patient varies.

Question 109

Describe the Haldane effect?

Answer 109

The Haldane Effect is an important physiological phenomenon that describes how deoxygenated blood has a higher capacity to carry carbon dioxide (CO2). This effect enhances CO2 transport from tissues to the lungs. When hemoglobin releases oxygen to body tissues, it increases its ability to pick up CO2 produced by cellular metabolism, and then releases this CO2 in the lungs where it is reoxygenated.

Question 110

Where does the respiratory drive come from?

Answer 110

The respiratory drive primarily originates from the respiratory centers located in the brainstem, specifically in the medulla oblongata and the pons. These centers control involuntary respiration by integrating sensory input from chemoreceptors and other sensors in the body.

Question 111

Describe the Bohr effect?

Answer 111

The Bohr effect is a physiological phenomenon in which increased levels of carbon dioxide (CO2) or decreased pH levels in the blood reduce hemoglobin's affinity for oxygen. This effect ensures that oxygen is released more readily where it is most needed, enhancing the efficiency of oxygen delivery to metabolically active tissues.

Question 112

What size of the endotracheal tube?

Answer 112

The size of the endotracheal tube typically recommended for adults varies between males and females due to anatomical differences in airway size. For males, the appropriate size generally ranges from 7 to 8 mm in internal diameter. For females, a slightly smaller size is often suitable, typically ranging from 6 to 7 mm.

Question 113

How does a pulse ox work?

Answer 113

A pulse oximeter works based on the principles of Beer's Law, which relates the absorption of light to the properties of the material through which the light is passing. Specifically, a pulse oximeter uses LEDs to emit light at two wavelengths, 660 nm (red light) for deoxyhemoglobin and 940 nm (infrared light) for oxyhemoglobin, through a translucent part of the body like a fingertip or earlobe.

Question 114

What are the different vent settings?

Answer 114

CMV (Controlled Mechanical Ventilation): Provides all breaths for the patient, with no need for patient effort. Used when the patient is unable to initiate breaths

Question 115

What are the different vent settings? Understand them and why you would choose one over the other.

Answer 115

CMV (Controlled Mechanical Ventilation): Provides all breaths for the patient, with no need for patient effort. Used when the patient is unable to initiate breaths adequately. ## Footnote Example sentence: CMV is commonly used in patients who are deeply sedated or paralyzed.

Question 116

What are the different vent settings? Understand them and why you would choose one over the other.

Answer 116

SIMV (Synchronized Intermittent Mandatory Ventilation): Delivers a set number of controlled breaths while allowing spontaneous breathing. Useful for weaning patients from mechanical ventilation as it supports their breathing efforts without fully taking over. ## Footnote Example sentence: SIMV is often used to gradually decrease the ventilatory support as the patient's condition improves.

Question 117

What are the different vent settings? Understand them and why you would choose one over the other.

Answer 117

Pressure Control Ventilation (PC): Delivers breaths at a set pressure, making it useful in protecting the lungs from high inflation pressures (pressure-limited). This mode adjusts the volume delivered based on the patient’s lung compliance. ## Footnote Example sentence: PCV is commonly used in patients with acute respiratory distress syndrome to prevent barotrauma.

Question 118

What are the different vent settings? Understand them and why you would choose one over the other.

Answer 118

Pressure Support Ventilation (PS): Augments spontaneous breaths with a preset amount of pressure, aiding patients who can initiate breaths but need support to maintain adequate ventilation. ## Footnote Example sentence: PSV is often utilized in patients who are starting to wean off the ventilator.

Question 119

What are the different vent settings? Understand them and why you would choose one over the other.

Answer 119

PEEP (Positive End-Expiratory Pressure): Maintains a minimum level of pressure in the lungs at the end of exhalation to prevent alveolar collapse and improve oxygenation. ## Footnote Example sentence: PEEP is essential in managing patients with acute respiratory failure.

Question 120

What would a high PEEP do to my BP and why?

Answer 120

High PEEP (Positive End-Expiratory Pressure) in mechanical ventilation can have significant hemodynamic effects, primarily by increasing intrathoracic pressure. This elevation in pressure affects several cardiovascular dynamics: Increased Central Venous Pressure (CVP): High PEEP can increase pressure in the chest cavity, leading to a rise in CVP. Decreased Venous Return: The elevated intrathoracic pressure can compress the large veins returning blood to the heart, reducing the amount of blood that fills the ventricles. Decreased Cardiac Output: With less blood returning to the heart, the output of the heart decreases. As a result of these changes, particularly the reduced cardiac output, there can be a notable decrease in blood pressure. This effect is critical to monitor, especially in patients who may already be experiencing cardiovascular instability. ## Footnote Example sentence: High PEEP can lead to hemodynamic compromise in patients with compromised cardiac function.

Question 121

What is peak airway pressure?

Answer 121

Peak airway pressure is the highest level of pressure reached in the airways during inhalation while using a mechanical ventilator. This pressure reflects the sum of the pressures needed to overcome the resistance of the airway system (including the endotracheal tube and the bronchi) and the elastic resistance of the alveoli. Monitoring peak airway pressure is crucial as it helps to assess the resistance within the airways and the compliance of the lungs, ensuring that ventilation is both effective and safe, avoiding excessive pressure that could damage the lungs. ## Footnote Example sentence: Peak airway pressure should be closely monitored to prevent ventilator-associated lung injury.

Question 122

What is it measured in?

Answer 122

Peak airway pressure in the context of mechanical ventilation is typically measured in centimeters of water (cmH2O). This unit of measurement is standard in respiratory medicine, particularly when assessing pressures within the airways and lungs during mechanical ventilation. Using cmH2O allows for precise control and monitoring of the pressures being administered to ensure they remain within safe limits to avoid ventilator-induced lung injury. ## Footnote Example sentence: Measuring peak airway pressure in cmH2O helps in adjusting ventilator settings accurately.

Question 123

How does PEEP affect hemodynamics?

Answer 123

Increased Intrathoracic Pressure: PEEP increases the pressure in the thoracic cavity, which can compress the large veins like the vena cava, reducing the amount of blood returning to the heart (venous return). Increased Right Ventricular Afterload: The increased intrathoracic pressure elevates pulmonary vascular resistance, which the right ventricle must work against to pump blood into the pulmonary circulation. This increased workload can lead to right ventricular strain. Elevated Central Venous Pressure (CVP): The increased intrathoracic pressure pushes against the venous system, raising the pressure within the central veins. Reduced Cardiac Output: Due to the decreased venous return and increased afterload on the right heart, the overall cardiac output can diminish. This reduction in cardiac output can result in decreased perfusion pressures and potential impacts on organ function. ## Footnote Example sentence: PEEP can have profound effects on hemodynamics, especially in patients with compromised cardiovascular function.

Question 124

What is the difference between LMA and ETT?

Answer 124

Laryngeal Mask Airway (LMA): The LMA sits above the vocal cords and does not enter the trachea, which means it cannot isolate the airway or protect against aspiration as effectively as an ETT. It is easier to insert because it does not require direct laryngoscopy, leading to fewer adverse events such as sore throats or coughing during emergence. Ideal for elective cases or as a rescue device in difficult airway situations, but not suitable for patients at risk of aspiration, such as those who are morbidly obese or pregnant beyond the first trimester. ## Footnote Example sentence: LMA is commonly used in situations where endotracheal intubation may not be feasible.

Question 125

What is the difference between LMA and ETT?

Answer 125

Laryngeal Mask Airway (LMA): ## Footnote It does not enter the trachea, making it less effective at protecting against aspiration compared to an ETT. It is easier to insert and is suitable for elective cases or difficult airway situations, but not for patients at risk of aspiration. Endotracheal Tube (ETT): ## Footnote Inserted directly into the trachea, providing a secure airway that protects against aspiration. Preferred in emergency situations or when complete airway control is needed.

Question 126

What are the adrenergic and cholinergic systems?

Answer 126

Adrenergic: ## Footnote Part of the sympathetic nervous system, stimulates fight or flight responses. Includes alpha and beta receptors responding to norepinephrine and epinephrine. Cholinergic: ## Footnote Part of the parasympathetic system, associated with rest and digest functions. Includes nicotinic and muscarinic receptors binding to acetylcholine.

Question 127

Where are alpha, beta & dopamine receptors found and their function?

Answer 127

Alpha and Beta Receptors: ## Footnote Found at sympathetic neuroeffector junctions. Alpha mediates vasoconstriction, beta involved in heart rate and smooth muscle. Dopamine Receptors: ## Footnote Predominantly in the CNS, also in peripheral areas like the kidney and vasculature. Regulate movement, mood, and behavior.

Question 128

What are the receptors associated with the parasympathetic nervous system?

Answer 128

Muscarinic Receptors: ## Footnote G protein-coupled receptors found in heart muscles, smooth muscles, and glands. Decrease heart rate and manage parasympathetic functions. Nicotinic Receptors: ## Footnote Ligand-gated ion channels primarily at neuromuscular junctions. Cause fast excitatory potentials affecting muscle contraction and autonomic responses.

Question 129

Where are the nicotinic and muscarinic receptors found and their function?

Answer 129

Nicotinic Receptors: ## Footnote Found at neuromuscular junctions of skeletal muscles. Ion channel proteins that allow cation passage upon binding with acetylcholine. Muscarinic Receptors: ## Footnote Primarily in the heart and smooth muscles within the parasympathetic system. G-protein-coupled receptors that activate a second-messenger system.

Question 130

Which pain receptor provides spinal analgesia and which provides supra spinal anesthesia?

Answer 130

Spinal Analgesia: ## Footnote Achieved through mu, kappa, and delta receptors in the spinal cord, reducing pain perception without affecting consciousness. Supraspinal Analgesia: ## Footnote Facilitated by mu1 receptors in the brain, providing pain relief at a higher, central nervous system level.

Question 131

What is supraspinal analgesia?

Answer 131

Supraspinal analgesia is primarily facilitated by the mu1 receptors in the brain, providing pain relief at a higher, central nervous system level. ## Page 32 www.CRNASchoolPrepAcademy.com Please do not reproduce, copy or share. This document is protected by copyright.

Question 132

What is the sympathetic nervous system responsible for?

Answer 132

The sympathetic nervous system activates the 'fight or flight' response during perceived threats, with functions like dilating pupils, increasing heart rate, and inhibiting gastrointestinal activity. ## CRNA SCHOOL CLINICAL INTERVIEW GUIDE

Question 133

What is the parasympathetic nervous system responsible for?

Answer 133

The parasympathetic nervous system engages the 'rest and digest' response when the body is at rest, supporting energy-conserving and restorative processes like constricting pupils and stimulating gastrointestinal activity. ## CRNA SCHOOL CLINICAL INTERVIEW GUIDE

Question 134

What drugs activate the sympathetic nervous system?

Answer 134

Agonists like epinephrine, norepinephrine, and dopamine can enhance the fight or flight response by increasing heart rate and blood pressure. ## CRNA SCHOOL CLINICAL INTERVIEW GUIDE

Question 135

What drugs activate the parasympathetic nervous system?

Answer 135

Agonists like muscarinic agonists and acetylcholinesterase inhibitors enhance rest and digest functions. ## CRNA SCHOOL CLINICAL INTERVIEW GUIDE

Question 136

What are the receptors associated with the sympathetic nervous system?

Answer 136

Alpha receptors (alpha-1 and alpha-2), beta receptors (beta-1, beta-2, and beta-3), and dopamine receptors are associated with the sympathetic nervous system. ## CRNA SCHOOL CLINICAL INTERVIEW GUIDE

Question 137

How does a blood pressure cuff work?

Answer 137

A blood pressure cuff works by measuring vibrations in the arterial walls caused by blood flow, detected through Korotkoff sounds. ## CRNA SCHOOL CLINICAL INTERVIEW GUIDE

Question 138

What happens if the bp cuff is too small?

Answer 138

If the bp cuff is too small, it constricts the arm excessively, leading to a falsely high blood pressure reading. ## CRNA SCHOOL CLINICAL INTERVIEW GUIDE

Question 139

What factors can cause a bp cuff not to work?

Answer 139

Factors like a jammed air valve, incorrect cuff size, and incorrect placement can cause a blood pressure cuff not to function properly. ## CRNA SCHOOL CLINICAL INTERVIEW GUIDE

Question 140

What can make a bp cuff not work?

Answer 140

Several factors can cause a blood pressure cuff not to function properly, leading to inaccurate readings: ## Footnote Jammed Air Valve: If the air valve on the cuff is jammed, it may not hold air adequately, leading to difficulty in maintaining the pressure required to measure blood pressure correctly. Incorrect Cuff Size: Using a cuff that is too small or too large for the patient's arm can lead to false readings, as previously mentioned. Incorrect Placement: The cuff must be placed correctly on the patient's arm, aligned at heart level and wrapped snugly. Incorrect placement can affect the pressure readings by either overestimating or underestimating the arterial pressure.

Question 141

What is the proper way to place a bp cuff on the arm?

Answer 141

To correctly place a blood pressure cuff on the arm, ensure the cuff's lower edge is about 1 inch above the bend of the elbow. The cuff should be snug but not too tight, allowing enough space to slide two fingertips under the top edge of the cuff. Most importantly, the cuff should have a marker (often a double line or an arrow) that needs to be aligned with the artery on the inside of the arm (typically near the bicep). This alignment helps ensure that the cuff inflates and deflates accurately around the artery for a correct reading. ## Footnote Page 34 www.CRNASchoolPrepAcademy.com Please do not reproduce, copy or share. This document is protected by copyright.