21mar quiz

Your pt is a 68 y/o male complaining diffuculty breathing for 2 days. He is sitting up conscious, alert, & oriented & apprears to be in mild respiratory distress. Physical examination reveals cool, dry, pink skin; he is thin & well defined accessory muscles, & you note diffuse wheezing to all lung fields. HR=102, BP=136/96, RR=20, SaO2=92%. The pt gives a 20 pack a year history of smoking. These findings are most typical of:
A) asthma
B) congestive heart failure
C) emphysema
D) chronic bronchitis

You have applied a CC-oximeter to your pt & it is displaying an SpCO of 15%. Wh/ of the following is the most appropriate interpretation of this findings?
A) This is consistent w/ a fatal level of carbon monoxide poisoning.
B) This is a normal reading for a non-smoker & nothing to worry about.
C) This is a normal reading for a smoker & nothing to worry about.
D) This is consistent w/ mild carbon monoxide poisoning.

Your pt is a 23 y/o femail in moderate respiratory distress, complaining of difficult breathing. She describes an acute onset of shortness of breath 15 minutes ago that has been getting progressively worse & has not responded to her Atrovent inhaler. Physical examination reveals cool, pale, & diaphoretic skin & clear lung sounds bilaterally. She has a history of asthma, is a smoker, & had breast reduction surgery yesterday. Medications include atrovent & albuterol inhalers & birth control pills. HR=129, BP=100/60, RR=26, SaO2=91%. In addition to 100% O2, wh/ of the following is the most appropriate treatment?
A) Albuterol & Atrovent via nebulizer, IV of NS KVO
B) IV of NS w/ 250cc fluid challenge
C) Albuterol & Atrovent via nebulizer, Epinephrine 1:1000 SQ IV of NS w/ 250cc fluid challenge
D) IV of NS at a keep open rate

A male pt w/ an acute exacerbation of his emphysema presents in severe distress w/ decreased air movement & diffuse inspiratory wheezes in all fields. HR=132, BP=142/88, RR=30, SaO2=88%. Wh/ of the following blood gas values is most likely?
A) PCO2 70mmHg
B) PO2 100mmHg
C) pH 7.6
D) PCO2 35mmHg

Your pt is a 16 y/o male who attempted suicide. He is unconscious & apneic, lying supine on a garage floor. The family states they found the pt unconscious in the front seat of a car that was running in an enclosed garage. HR=70, BP=100/60, RR=0. In addition to an IV of normal saline, wh/ of the following is the most appropriate?
A) Remove the pt from the garage, intubate, & transport to the nearest hospital.
B) Remove the pt from the garage, initiate BVM ventilationw w/ 100% O2, intubate & transport to nearest facility.
C) Intubate, remove the pt from the garage & transport to a hospital w/ a hyperbaric chamber.
D) Remove pt from the garage, initiate BVM ventilations w/ 100% O2, intubate & transport to a hospital w/ a hyperbaric chamber.

Wh/ of the following best explains the process of osmotic diuresis associated with hyperglycemia?
A) Decreased insulin levels result in decreased ADH secretion.
B) Glucose in the urine lowers osmotic pressure inside the kidney tubule, preventing water reabsorption.
C) Elevated blood glucose levels result in increased ADH secretion.
D) Glucose in the urine raises osmotic pressure inside the kidney tubule, drawing water into the tubule.

Your pt is a 45 y/o type I diabetic complaining of a 5 day history of abdominal pain, nausea & vomiting, increased urination & thirst. His skin & mucus membranes are warm & dry. HR=112 & regular, BP=94/60, RR=12 & regular. Your treatment for this pt would most likely include:
A) IV of NS KVO, 50% dextrose IVP
B) IV of D5W KVO, 50% dextrose IVP
C) IV of NS 1-2L
D) IV of NS KVO, nitroglycerin 0.4mg SL, every 3-5 minutes.

You encounter a pt complaining polyuria, polyphagia, polydipsia, & abdominal pain. Based on these complaints, wh/ of the following would you also expect to find?
A) Kussmaul's respirations & fruity breath odor.
B) Complaint of chest pain * SOB.
C) Blood glucose of less than 70 mg/dL
D) Blood glucose between 80-120 mg/dL

Your pt is a 72 y/o male who is conscious but lethargic & sitting in a chair. His son states that the pt has been a bit slow lately & has been gaining weight. The medical history includes hypothyroidism & myocardial infarction. The pt has been compliant w/ his Synthroid & has nitroglycerin for use as needed. The pt responds to verbal stimuli, is confused, has a large tongue, & pale, cold, doughy skin. His only complaint is constipation. HR=60, BP=112/80, RR=10 & shallow, SaO2=92%, temperature=88F, blood glucose=180 mg/gL. Your treatment should include:
A) infusion of 1-2 liters of warm normal saline
B) atropine 0.5mg IV
C) rewarm w/ heat packs
D) O2, 4 lpm by NC

Hyperglycemia is most likely a result of damage to the pancreatic _____ cells?
A) beta
B) delta
C) acinar
D) alpha

A pt presents w/ a history of frequent urination, signs & symptoms of dehydration, & blood glucose of 958 mg/dL. There is no acetone odor on his breath. To wh/ of the following can the absence of an acetone odor most likely be attributed?
A) The ability to use enough glucose to meet metabolic need.
B) The ability to convert to the use of amino acids for energy metabolism.
C) Elimination of ketoacids through Kussmaul's respiration.
D) Elimination of ketoacids by the blood buffer system.