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Are you ready to learn about Acute and Critical Care Monitoring and Assessment? I sure hope so because that is what this study guide is all about.

Below, you will find a ton of practice questions specifically on the topic of assessing and monitoring patients in the ICU or critical care unit. This information is designed specifically for Respiratory Therapist students to help prepare for their exams. If will come in handy for your Patient Assessment courses in RT school.

So if you’re ready, let’s go ahead and dive right in!

Acute and Critical Care Monitoring and Assessment Practice Questions:

1. What is Monitoring?
It is the repeated or continuous observation of measurements of patients parameters.

2. What are the benefits of monitoring?
Rapid detection of a change in a patients condition, allows you to evaluate therapeutic intervention, and it can be non-invasive.

3. What are the disadvantages of monitoring?
You have to set alarms, and the clinical condition may not match what appears with monitoring.

4. What is the standard for assessing ventilation or PaCO2?
Metabolism, lung mechanics, ventilation efficiency, and equipment function or ventilator.

5. What are the ventilatory measurements at the bedside in the ICU?
Lung volumes, airway pressure, FiO2, and flow.

6. Why do we monitor lung volumes and flows?
To determine the effectiveness of gas exchange across the alveolar-capillary membrane.

7. What are some other reasons that we monitor lung volumes?
To identify gas exchange in the lungs, to look for a change in clinical status, to look for a response to therapy, to check for a problem with the patient interface (circuit), and to evaluate the ability to wean.

8. Who should be monitored for lung volumes in intubated patients?
Patients considered for mechanical ventilation, patients being weaned from the ventilator, patients with abnormal breathing pattern, and to manage patients on the ventilator.

9. Who should be monitored for lung volumes in non-intubated patients?
Preoperative patients, those with an increased respiratory rate greater than 30/minute, those with neuromuscular diseases, CNS depressed, decorating blood gas, and those on NIV.

10. What are the pulmonary diseases that typically have high tidal volumes?
Metabolic acidosis, sepsis, and neurologic injuries.

11. What are problems with positive pressure ventilation?
Volutrauma, barotrauma, and dynamic hyperinflation,

12. What are the critical life functions?
Ventilation, Oxygenation, Circulation, and Perfusion.

13. During an emergency, which critical life function is your first priority?
Ventilation

14. During an emergency, which critical life function is your second priority?
Oxygenation

15. During an emergency, which critical life function is your third priority?
Circulation

16. During an emergency, which critical life function is your fourth priority?
Perfusion

17. What is used to assess the Ventilation?
Respiratory rate, tidal volume, chest movement, breath sounds, PaCO2, and EtCO2.

18. What is used to assess Oxygenation?
Heart rate, color, sensorium, PaO2, and SpO2.

19. What is used to assess Circulation?
Cardiac output, heart strength, and heart rate.

20. What is used to assess perfusion?
Blood pressure, sensorium, temperature, urine output, and hemodynamics.

21. What is an Advance Directive?
It is a set of instructions documenting what treatment a patient would want if he was unable to make medical decisions.

22. Lethargy, somnolence, and sleepiness are all signs of what?
Sleep apnea or excessive oxygen administration in a patient with COPD.

23. What does Obtunded mean?
It is a drowsy state that may have a decreased cough or gag reflex.

24. What are the Activities of Daily Living (ADL’s)?
Bathing, eating, dressing, toilet use, and continence.

25. What is Orthopnea?
Difficulty breathing except in the upright position and is a sign of CHF.

26. What is Dysphagia?
Difficulty swallowing; may cause aspiration.

27. What do we visually inspect during a respiratory assessment at the bedside?
General appearance, edema, clubbing, venous distention, capillary refill, diaphoresis, skin color, chest configuration, chest movement, breathing patterns, accessory muscle use, muscle conditions, nasal flaring, cough, and evidence of a difficult airway.

28. What is the general appearance?
Age, height, weight, nourishment, etc.

29. What is Edema?
The presence of excessive fluid in the tissues caused by CHF and it rated as +1, +2 or +3.

30. What is Clubbing of fingers?
It is caused by chronic hypoxemia and is suggestive of pulmonary disease, especially COPD.

31. What is Venous Distension?
It occurs with CHF and is seen during exhalation in obstructive lung diseases.

32. What is Capillary Refill?
An indication of peripheral circulation where you blanch the hand and wait for the color to return, which should return within 3 seconds.

33. What is Diaphoresis?
Sweating; night sweats indicate tuberculosis.

34. What is Ashen or Pallor?
Abnormal skin color due to anemia or acute blood loss.

35. What is Jaundice?
Increased bilirubin level in blood and tissue; mostly in the face and trunk.

36. What is Erythema?
Redness of the skin caused by infection, inflammation, or capillary congestion.

37. What is Cyanosis?
Blue or blue-gray (dusky) discoloration of the skin and mucous membranes which is caused by hypoxia.

38. What is Biot’s breathing?
An increased respiratory rate and depth with irregular periods of apnea but same depth with each breath caused by problems in the CNS.

39. What is Kussmaul’s breathing?
An increased depth, irregular rhythm, labored breathing sounds, and an increased respiratory rate (usually over 20 breaths per minute) caused by metabolic acidosis, renal failure, or diabetic ketoacidosis.

40. What does it mean when the patient is relying more on their accessory muscles for breathing?
Accessory muscles are used to increase ventilation in times of stress or when there is an increase in resistance or a decrease in compliance.

41. What are the Accessory Muscles of breathing?
Internal intercostal, scalene, sternocleidomastoid, pectoralis major, and abdominal muscles.

42. What are Retractions?
Intercostal or sternal occur when chest moves inward during inspiration instead of outward caused by severe airway obstruction or respiratory distress.

43. What is Nasal Flaring?
A sign of respiratory distress especially in infants.

44. What is the evidence of a Difficult Airway?
Short receding mandible (micrognathia), enlarged tongue (macroglossia), bull neck, or limited range of motion of the neck.

45. How to perform an assessment by palpation?
Feel and look for the pulse, tracheal deviation, tactile fremitus, tenderness, crepitus, and chest motion symmetry.

46. What is a Paradoxical Pulse?
The pulse varies with inspiration and may indicate severe air trapping as in status asthmaticus, tension pneumothorax, or cardiac tamponade.

47. What is Tracheal Deviation?
Palpate the trachea in the suprasternal notch and compare the space between the left clavicle and left border of the trachea.

48. When does the trachea deviate toward the abnormal side?
Pulmonary atelectasis, pulmonary fibrosis, pneumonectomy, or diaphragmatic paralysis.

49. When does the trachea deviate toward the normal side?
Massive pleural effusion, tension pneumothorax, neck or thyroid tumors, or large mediastinal mass.

50. What is Tactile Fremitus?
Vibrations felt on the chest wall caused by voice, pleural rub, or secretions in the airway (rhonchal fremitus).

51. What is Crepitus?
Bubbles of air under the skin that can be palpated and indicate the presence of subcutaneous emphysema.

52. How can you check for chest motion symmetry?
Check for asymmetrical chest expansion by placing hands on the chest and evaluating the distance moved by each during inspiration.

53. What is a resonant percussion note?
It occurs in normal air-filled lungs and makes a hollow sound.

54. What is a flat percussion note?
It is normally heard over the sternum, muscle, or areas of atelectasis.

55. What is a dull percussion note?
It is normally heard over fluid-filled organs such as the heart or liver; pleural effusion or pneumonia can cause this thudding sound.

56. What is a tympanic percussion note?
It is normally heard over air-filled stomach which sounds drum-like and indicates increased volume when heard over lungs.

57. What is a hyperresonant percussion note?
It is a booming sound heard in an area of the lung affected by a pneumothorax or emphysema.

58. How to perform an assessment by auscultation?
crackles, wheezes, stridor, pleural friction rub, and heart sounds,

59. When might you see a unilateral wheeze?
It is most commonly caused by foreign body aspiration and should recommend rigid bronchoscopy.

60. What is stridor?
It is caused by an upper airway obstruction due to epiglottitis, croup, post-extubation, or foreign body aspiration.

61. What is a pleural friction rub?
a coarse grating, raspy or crunchy sound caused by inflammation of the visceral and parietal pleura heard with TB, pleurisy, pneumonia, pulmonary infarction, or cancer

62. What are the anatomical landmarks that are seen on a chest x-ray?
Trachea, mediastinum, A-P diameter, costophrenic angles, diaphragm, vascular markings, heart shadow, soft tissue, and ribs.

63. What is the mediastinum?
The area between the lungs where the heart, lymphatics, blood vessels, and major bronchi are found and may shift with a pleural effusion or pneumothorax.

64. When is the A-P Diameter affected?
increased with COPD; causes barrel chest and hyperinflation

65. What are costophrenic angles?
The angle made by the outer curve of the diaphragm and the chest wall and are obliterated by pleural effusions.

66. How is the diaphragm affected?
It is dome-shaped normally, flattened with COPD and pneumothorax may cause left or right hemidiaphragms to shift downward appearing flattened on one side

67. What makes up the vascular markings?
Blood vessels, lymphatics, and lung tissue.

68. Describe the heart shadow:
The left ventricle is normally seen and cardiomegaly is seen with CHF.

69. What is the lateral decubitus position?
A position when the patient is lying on the affected side and it used to detect small pleural effusions.

70. What is the proper endotracheal tube position?
Below the vocal cords, approximately 2-6 cm above the carina at the level of the aortic arch.

71. What would you see on a croup x-ray?
The x-ray reveals tracheal narrowing with subglottic swelling that looks like a steeple sign or hourglass.

72. What would you see on an epiglottitis x-ray?
The x-ray reveals supraglottic tracheal narrowing with an enlarged and flattened epiglottis that looks like a thumb sign.

73. What are some factors that may contribute to an increased ETCO2?
Increased muscular activity, Malignant hyperthermia, Increased CO, Bicarb infusion, Tourniquet release, Effective drug therapy for bronchospasm, and Decreased minute ventilation.

74. How does decreased minute ventilation result in increased ETCO2?
The same amount of CO2 needs to be released and your body will compensate to release the CO2. ETCO2 level is measured by each breath. Decreased RR = Increased ETCO2 with each breath.

75. What are some factors that may contribute to a decreased ETCO2?
Decreased muscular activity, Hypothermia, Decreased CO, PE, Bronchospasm, and Increased RR = Decreased CO2 released with each breath.

76. What are some advantages of having an art line placed?
They are very accurate, they monitor continuously, and they measure HR constantly.

77. What are some disadvantages of having an arterial line in place?
It is invasive, there is an increased risk of infection and bleeding, and the transducer placement affects its effectiveness.

78. Where should the arterial line transducer be placed?
Phlebostatic Axis = level of the heart at the 4th intercostal.

79. An arterial line transducer that is placed too high results in what?
false hypotension

80. What are some factors that could contribute to an increased ICP?
Head trauma, suctioning, hematoma, and hydrocephalus.

81. What are some factors that could help contribute to a decreased ICP?
Osmotic diuretic (Mannitol) and a CSF leak.

82. What are the 3 major types of ICP monitoring devices?
Epidural probe, subarachnoid screw, and EVD.

83. What are 3 ways to verify the placement of an ET tube?
CXR, Auscultate all lung fields, and Monitor color change on CO2 detector.

84. An ET tube that is in too far may result in what?
Inflation of only one lung.

85. An ET tube in the stomach may result in what?
Hyperinflation of the stomach leading to vomiting and possibly aspiration.

86. What is the oxyhemoglobin dissociation curve?
It describes the balance between the two ways that oxygen is transported in the blood.

87. When there is a shift in the oxyhemoglobin curve, this means what?
It means that there is a change in the way oxygen is taken up by the hemoglobin molecule at the alveolar level as well as a change in the way it is delivered to the tissue.

88. When there is a right shift in the dissociation curve, what does it mean?
It means that there is a decrease in the oxygen saturation for any given PaO2. Hemoglobin has a less affinity for the oxygen so hemoglobin releases the oxygen more readily.

89. What are the factors that can cause a right shift in the oxyhemoglobin dissociation curve?
A rise in body temperature, reduced pH (acidosis), and rise in CO2 (hypercapnia), and a rise in 2,3 diphosphoglycerate.

90. With a right shift in the dissociation curve, the oxygen is what?
It is released quicker.

91. When there is a left shift in the dissociation curve, what does that mean?
It means that there is an increased oxygen saturation for any PaO2 thus the delivery of oxygen to the tissue is impaired. Hemoglobin latches onto the oxygen more.

92. What are the signs of cardiac arrest?
Unresponsiveness, apnea, no pulse, ventricular fibrillation, asystole, and a sudden decrease in heart rate or EtCO2.

93. How should compressions be administered?
100-120 compressions/min that are 2-2/4 inch in depth. You should allow for chest recoil and be sure to minimize interruptions.

94. How should breathing be managed during CPR?
Open the airway and use the “2 thumbs up” hold on the bag-valve-mask. Maintain 1 breath every 6 seconds and avoid interrupting compressions.

95. What does an irregular rhythm look like?
You will see a wide QRS and no P waves.

96. During a code blue, where and how should medications be administered?
In the line closest to the heart with 10-20 mL of NS flush.

97. When using intraosseous administration, how are medications given?
As a slow push and with 2% lidocaine if the patient is conscious.

98. When should atropine be used?
During symptomatic bradycardia, give 0.5 mg q3-5 min.

99. When should amiodarone be used and what is the dose?
It should be used in pulseless patients. The does is: 300 mg IV x 1 dose diluted in D5W followed by 150 mg.

100. Should you choose to worry about the patient’s ventilation status over their oxygen status?
Yes, yes you should. Ventilation is most important. Then Oxygenation. Then Circulation. Then perfusion.

Final Thoughts

So there you have it! That wraps up our study guide on Acute and Critical Care Monitoring and Assessment. I hope that you found this information to be helpful. I have no doubt that you can use these practice questions to help learn the material and ace your exams.

Thank you so much for reading and as always, breathe easy my friend.