Quiz Number 10 PDF

Certainly, I\'ll provide all 25 questions in the correct format: 10\. Electrolytes and Metabolism II 1\. All of the following may cause arterial hypotension in a surgical patient except: a\. Hypoxia b\. Hypervolemia c\. Transfusion reaction d\. Malignant hyperthermia Correct answer: b. Hyperv...

Certainly, I\'ll provide all 25 questions in the correct format: 10\. Electrolytes and Metabolism II 1\. All of the following may cause arterial hypotension in a surgical patient except: a\. Hypoxia b\. Hypervolemia c\. Transfusion reaction d\. Malignant hyperthermia Correct answer: b. Hypervolemia Explanation: Hypervolemia, which is an excessive volume of circulating blood, typically causes an increase in blood pressure rather than hypotension. The other options - hypoxia, transfusion reaction, and malignant hyperthermia - can all potentially lead to arterial hypotension in surgical patients through various mechanisms such as vasodilation, decreased cardiac output, or circulatory collapse. 2\. The anesthesiologist evaluates the patient\'s oxygenation and carbon dioxide removal by measuring arterial: 1. pH, 2. pCO2, 3. H2CO3, 4. pO2 a\. Only 3 b\. 1, 2, 3 c\. All but 3 d\. Only 2 and 4 Correct answer: c. All but 3 Explanation: Anesthesiologists typically measure arterial pH, pCO2, and pO2 to evaluate a patient\'s oxygenation and carbon dioxide removal. These parameters provide crucial information about the patient\'s acid-base balance, ventilation, and oxygenation status. H2CO3 (carbonic acid) is not directly measured but can be calculated from the other values. 3\. Which statement is not true about fluids? a\. Extracellular fluids consist of interstitial fluid and blood plasma b\. Hypovolemia is a deficit of both water and electrolytes c\. Lab report of a dehydrated patient shows a decrease in packed cell volume and hemoglobin d\. Extracellular fluid volume is proportionately larger in infants than in adults Correct answer: c. Lab report of a dehydrated patient shows a decrease in packed cell volume and hemoglobin Explanation: This statement is incorrect because in dehydration, there is a relative increase in packed cell volume and hemoglobin concentration. As the body loses water, the blood becomes more concentrated, leading to an increase (not a decrease) in these values. The other statements are correct descriptions of fluid distribution and balance. 4\. The center which regulates the rhythm of respirations is located in the: a\. Pituitary b\. Alveoli c\. Pons d\. Thalamus Correct answer: c. Pons Explanation: The respiratory rhythm is primarily regulated by centers in the brainstem, specifically in the medulla oblongata and pons. The pontine respiratory group in the pons plays a crucial role in modulating the respiratory rate and pattern. The pituitary, alveoli, and thalamus are not directly involved in generating the basic rhythm of respiration. 5\. In surgical patients, the most common cause of shock is oligemia which is a/an: a\. Decreased renal output b\. Deficient circulating blood volume c\. Expanded plasma volume d\. Increased vasodilation Correct answer: b. Deficient circulating blood volume Explanation: Oligemia refers to a deficiency in the volume of circulating blood. In surgical patients, this is often the most common cause of shock, as it can result from blood loss during surgery or inadequate fluid replacement. This deficient blood volume can lead to inadequate perfusion of tissues and organs, resulting in shock. 6\. Which of the following may cause apnea a\. Stimulation of the pharynx by irritating chemicals b\. Sudden cold stimulation applied to the skin c\. Sudden painful stimulation d\. All of the above Correct answer: d. All of the above Explanation: Apnea, which is a temporary cessation of breathing, can be triggered by various stimuli. Irritation of the pharynx by chemicals can cause a protective reflex apnea. Sudden cold stimulation (cold shock response) and sudden painful stimulation can both lead to a brief pause in breathing as part of the body\'s startle response. All these stimuli can potentially cause a temporary cessation of breathing. 7\. Which statement is not true about the sino-atrial node? a\. It is located in the wall of the right atrium b\. It is the heart\'s pacemaker c\. Impulses pass from it to the bundle of His d\. It initiates atrial contractions Correct answer: c. Impulses pass from it to the bundle of His Explanation: This statement is incorrect because impulses from the sino-atrial (SA) node do not pass directly to the bundle of His. Instead, the impulse from the SA node spreads through the atrial muscle fibers to the atrioventricular (AV) node, and from there to the bundle of His. The other statements are correct: the SA node is located in the right atrium, acts as the heart\'s primary pacemaker, and initiates atrial contractions. 8\. Oxygen is carried in the blood: a\. As physically dissolved oxygen in plasma b\. Through the pulmonary arteries into general circulation c\. In combination with the hemoglobin of the red blood cells d\. Only A and C Correct answer: d. Only A and C Explanation: Oxygen is carried in the blood in two ways: a small amount is physically dissolved in the plasma (option A), and the majority is bound to hemoglobin in red blood cells (option C). Option B is incorrect because pulmonary arteries carry deoxygenated blood from the heart to the lungs, not oxygenated blood into general circulation. 9\. After cardiovascular surgery, hypocalcemia may result from \_\_\_\_\_\_\_\_\_\_\_\_\_ and hyperkalemia may result from \_\_\_\_\_\_\_\_\_\_\_\_\_. a\. Multiple transfusion of citrated blood, red cell breakdown from pump perfusion b\. Increased water intake, stress due to surgery c\. Red cell breakdown from pump perfusion, multiple transfusion of citrated blood d\. Stress due to surgery, inadequate water intake Correct answer: a. Multiple transfusion of citrated blood, red cell breakdown from pump perfusion Explanation: Hypocalcemia after cardiovascular surgery can result from multiple transfusions of citrated blood because citrate binds calcium, reducing free calcium levels. Hyperkalemia can occur due to red cell breakdown from pump perfusion during cardiopulmonary bypass, as damaged red blood cells release their intracellular potassium into the bloodstream. 10\. The basic approach to the treatment of postoperative shock is to: a\. Administer vasodilators b\. Restore blood volume c\. Evaluate acid-base balance d\. Determine the cause Correct answer: d. Determine the cause Explanation: While all the options listed are important aspects of managing shock, the basic and most crucial first step in treating postoperative shock is to determine its cause. Identifying the underlying cause (e.g., hypovolemia, cardiac dysfunction, sepsis) allows for targeted and effective treatment. Once the cause is determined, appropriate interventions such as fluid resuscitation, vasopressors, or treating infections can be initiated. 11\. An accurate index of cardiac performance is: a\. The hematocrit b\. An arterial blood gas c\. Central venous pressure d\. Blood pressure Correct answer: c. Central venous pressure Explanation: Central venous pressure (CVP) is considered an accurate index of cardiac performance as it reflects the filling pressure of the right side of the heart. It provides information about blood volume status and right heart function. While the other options (hematocrit, arterial blood gas, and blood pressure) are important clinical parameters, they do not directly indicate cardiac performance as accurately as CVP. 12\. Solutions whose volumes and pressures remain the same if the two solutions are separated by a membrane are: a\. Hypertonic solutions b\. Isotonic solutions c\. Hypotonic solutions d\. None of the above Correct answer: b. Isotonic solutions Explanation: Isotonic solutions have the same osmotic pressure as the surrounding fluid (e.g., body fluids). When separated by a semipermeable membrane, there is no net movement of water between isotonic solutions, maintaining equal volumes and pressures. Hypertonic and hypotonic solutions would cause water movement across the membrane, changing volumes and pressures. 13\. To produce inspiration, \_\_\_\_\_\_\_\_\_\_\_\_\_ pressure must be lower than \_\_\_\_\_\_\_\_\_\_\_\_\_ pressure; it must be \_\_\_\_\_\_\_\_\_\_\_\_\_ to produce expiration. a\. Intrathoracic, atmospheric, higher b\. Intrapleural, osmotic, lowered c\. Atmospheric, intrapulmonic, higher d\. Alveoli, positive, lowered Correct answer: a. Intrathoracic, atmospheric, higher Explanation: During inspiration, the intrathoracic pressure must be lower than atmospheric pressure to allow air to flow into the lungs. For expiration, the intrathoracic pressure must be higher than atmospheric pressure to push air out of the lungs. This pressure difference is created by the expansion and contraction of the chest cavity, primarily through the action of the diaphragm and intercostal muscles. 14\. In a two-bottle water seal suction setup for chest drainage, the first bottle provides \_\_\_\_\_\_\_\_\_\_\_\_\_ and the second provides the \_\_\_\_\_\_\_\_\_\_\_\_\_. a\. Suction control, water seal b\. Water seal, drainage collection c\. Positive pressure, water seal d\. Water seal and collects drainage, suction control Correct answer: d. Water seal and collects drainage, suction control Explanation: In a two-bottle chest drainage system, the first bottle serves as both the water seal and collects the drainage from the chest. The water seal prevents atmospheric air from entering the pleural space. The second bottle provides suction control, regulating the amount of negative pressure applied to the system. This setup ensures effective drainage while maintaining the appropriate pressure in the pleural space. 15\. Operating for empyema include: a\. Thoracostomy and thoracosplasty b\. Segmental resection and wedge resection c\. Lobectomy and pneumonectomy d\. Thoracoplasty and decortication of the lung Correct answer: d. Thoracoplasty and decortication of the lung Explanation: For treating empyema (a collection of pus in the pleural space), thoracoplasty and decortication of the lung are appropriate surgical options. Decortication involves removing the thick, fibrous tissue (pleural peel) that forms over the lung in chronic empyema, allowing the lung to re-expand. Thoracoplasty, though less common now, involves removing ribs to allow the chest wall to collapse and obliterate the empyema space. These procedures aim to control infection and restore lung function. 16\. Following open heart surgery, drainage catheters may be inserted into: a\. The pericardium and anterior mediastinum b\. Either or both pleurae c\. Neither A nor B d\. Both A and B Correct answer: a. The pericardium and anterior mediastinum Explanation: After open heart surgery, drainage catheters are typically inserted into the pericardium (the sac surrounding the heart) and the anterior mediastinum (the space in the chest between the lungs). These drains help remove blood and fluid that accumulate after surgery, reducing the risk of complications such as cardiac tamponade or mediastinitis. While pleural drains may sometimes be used, they are not as routinely placed as pericardial and mediastinal drains following open heart surgery. 17\. The blood component administered to patient with a clotting problem is: a\. Packet Red Cells b\. Fresh Frozen Plasma c\. Serum Albumin d\. Both A and B Correct answer: b. Fresh Frozen Plasma Explanation: Fresh Frozen Plasma (FFP) is the blood component typically administered to patients with clotting problems. FFP contains all the coagulation factors and is used to correct deficiencies in multiple clotting factors. It\'s particularly useful in cases of coagulopathy, liver disease, or when reversing the effects of certain anticoagulant medications. Packed Red Cells are used to treat anemia, while Serum Albumin is used to maintain oncotic pressure in certain conditions, but neither directly addresses clotting problems. 18\. Which of the following statements concerning erythrocytes (RBC) is not true? a\. Transport oxygen and carbon dioxide b\. Produced in utero by liver and spleen c\. Produced only after birth in bone marrow d\. Do not have a nucleus when normal and mature Correct answer: c. Produced only after birth in bone marrow Explanation: This statement is incorrect because erythrocytes (red blood cells) are not produced only after birth in bone marrow. In fact, erythropoiesis (the production of red blood cells) occurs before birth as well. During fetal development, erythrocytes are initially produced in the yolk sac, then in the liver and spleen (as mentioned in option b), and finally in the bone marrow. The bone marrow becomes the primary site of erythropoiesis in late fetal development and continues this role after birth. 19\. Which of the following statement concerning the lymphatic system is not true? a\. It is part of the circulatory system b\. The thoracic duct is a main lymphatic duct c\. The system returns water and protein to blood d\. Lymph nodes act as absorbers and diffusers Correct answer: d. Lymph nodes act as absorbers and diffusers Explanation: This statement is not correct. Lymph nodes do not primarily act as absorbers and diffusers. Instead, they function as filters for the lymph fluid and play a crucial role in the immune system. Lymph nodes contain immune cells that trap and destroy pathogens, foreign particles, and abnormal cells. They also produce and store lymphocytes. The other statements are correct: the lymphatic system is part of the circulatory system, the thoracic duct is indeed a main lymphatic duct, and the system does return water and proteins to the blood. 20\. The continuous rhythmic lavage of the bladder to stimulate reflex control is: a\. Closed drainage b\. Tidal drainage c\. Postural drainage d\. Straight drainage Correct answer: b. Tidal drainage Explanation: Tidal drainage is a method of continuous rhythmic lavage of the bladder used to stimulate reflex control. This technique involves alternately filling and emptying the bladder with a prescribed volume of fluid at regular intervals. It\'s used to help retrain the bladder, promote bladder tone, and reduce the risk of infection in patients with neurogenic bladder or other conditions affecting bladder function. The other options (closed drainage, postural drainage, and straight drainage) refer to different medical procedures not specifically related to bladder reflex control stimulation. 21\. Edema can result from: a\. Kidney disease and severe burns b\. Lymphatic and venous blockage c\. Overdilation of arterioles d\. All of the above Correct answer: d. All of the above Explanation: Edema, which is the abnormal accumulation of fluid in body tissues, can indeed result from all of the mentioned causes. Kidney disease can lead to fluid retention, while severe burns can cause fluid shifts and increased capillary permeability. Lymphatic and venous blockages impair fluid drainage, leading to edema. Overdilation of arterioles can increase hydrostatic pressure in capillaries, promoting fluid movement into the interstitial space. Each of these mechanisms can contribute to the development of edema through different pathophysiological processes. 22\. Which of the following methods are not used to control blood loss in the OR? a\. Electrocoagulation and hot packs b\. Deoxydized cellulose and cotton pledgets c\. Bones wax and sponges d\. Hemostats and ligating clips Correct answer: b. Deoxydized cellulose and cotton pledgets Explanation: This answer is incorrect because deoxydized cellulose (such as Surgicel) and cotton pledgets are actually used to control blood loss in the operating room. Deoxydized cellulose is an absorbable hemostatic agent, and cotton pledgets can be used for applying pressure or absorbing blood. All the other options listed (electrocoagulation, hot packs, bone wax, sponges, hemostats, and ligating clips) are also commonly used methods for controlling blood loss during surgery. 23\. The main indication for dialysis in renal failure is a high \_\_\_\_\_\_\_\_\_\_\_\_\_\_. The methods of dialysis are \_\_\_\_\_\_\_\_\_\_\_\_\_\_ and \_\_\_\_\_\_\_\_\_\_\_\_\_\_. a\. Serum potassium, hemodialysis, peritoneal dialysis b\. Serum sodium, hemodialysis, peritoneal dialysis c\. Serum calcium, peritoneal dialysis, hemodialysis d\. Serum protein, peritoneal dialysis, hemodialysis Correct answer: a. Serum potassium, hemodialysis, peritoneal dialysis Explanation: In renal failure, a high serum potassium level (hyperkalemia) is often a primary indication for urgent dialysis due to its potentially life-threatening cardiac effects. The two main methods of dialysis are indeed hemodialysis and peritoneal dialysis. Hemodialysis uses an external machine to filter the blood, while peritoneal dialysis uses the patient\'s peritoneum as a natural filter. While other electrolyte imbalances and uremic symptoms are also considered, hyperkalemia is often the most critical factor in deciding to initiate emergency dialysis. 24\. A patient receiving IV therapy develops shortness of breath with increased respiratory rate and blood pressure. The diagnosis is \_\_\_\_\_\_\_\_\_\_\_\_\_\_ and the nurse should \_\_\_\_\_\_\_\_\_\_\_\_\_\_. a\. Pulmonary infarction, increase IV flow rate b\. Circulatory depression, decrease IV Flow rate c\. Pulmonary edema, stop the IV d\. Circulatory overload, slow the IV Correct answer: d. Circulatory overload, slow the IV Explanation: The symptoms described (shortness of breath, increased respiratory rate, and increased blood pressure) are consistent with circulatory overload, which can occur when IV fluids are administered too quickly or in excessive amounts. In this situation, the appropriate nursing intervention is to slow the IV infusion rate to reduce the fluid load on the circulatory system. Stopping the IV entirely might be necessary if symptoms persist, but slowing the rate is typically the first step in managing circulatory overload. 25\. All of the following are function of the spleen except: a\. Blood reservoir b\. Hemopoiesis c\. Red blood cell and platelet destruction d\. Stabilize arterial flow Correct answer: d. Stabilize arterial flow Explanation: The spleen has several important functions, but stabilizing arterial flow is not one of them. The spleen acts as a blood reservoir, storing a significant amount of blood that can be released when needed. It also plays a role in hemopoiesis (blood cell formation), particularly in fetal development and sometimes in adults under certain conditions. The spleen is also involved in the destruction of old or damaged red blood cells and platelets. However, stabilizing arterial flow is a function of the cardiovascular system, primarily through mechanisms like baroreceptor reflexes and vascular tone regulation, not the spleen.