October APE quiz

PEEP is intended to do which of the following?

• 
  A. Improve ventilation/perfusion matching
  

• B. Decrease functional residual capacity
  

• C. Increased venous return to the heart
  

• D. Increased cardiac output

Answer explanation

A. Improve ventilation/perfusion matching

- PEEP increases alveolar volume, thereby improving ventilation/perfusion matching and increasing functional residual capacity.
- A detrimental effect of PEEP (especially at high levels) is a decrease in venous return to the heart and a subsequent decrease in cardiac output.

Per CHOP policy, what should you do if your patient is currently receiving breast milk that is warmed?

• Use a random warmer liner found in the nutrition room.

• Go to the CSR and grab a new, unopened liner.

• Go to the CSR and grab a new, unopened liner. Label with patient information, date opened, and date of expiration (7 days). Then place into a storage baggie and place in the designated bin in the nutrition room.

• Go to the CSR and grab a new, unopened liner. Then place into a storage baggie and place in the designated bin in the nutrition room.

Answer explanation

Per CHOP policy, bottle warmer liners are one patient use and are good for 7 days. To stay in compliance with policy and regulatory requirements, must label with patients name and the first day of use and when it expires.

There is a bin in the nutrition room labeled "bottle warmers". Please place labeled liner into a baggie and place into bin for next use

An intubated, mechanically ventilated patient has a sudden decrease in SpO2 from 95% to 78%, and the ventilator is alarming high PIPs. Your first intervention is to:

• A. Increase the FiO2 and ventilator rate

• B. Assess the patency of the endotracheal tube

• C. Administer a neuromuscular blocking agent

• D. Prepare to reposition the endotracheal tube

Answer explanation

B. Assess the patency of the endotracheal tube

- Your first priority is assessing the patency of the ETT.
- Once you have confirmed whether the tube is or is not patent, that will help to direct your next interventions.
- The alarms for high peak pressure may indicate that the ETT is kinked or blocked with secretions.

Tags

NGSS.HS-LS1-3

A 1-month old infant presents with failure to thrive, frequent vomiting and irritability since birth. The mother reports having another infant with the same symptoms who died at 2 months of age. Which additional assessment finding would cause the nurse to suspect an inborn error of metabolism?

• A) Micrognathia
  

• B) Microglossia
  

• C) Petite Facial Features
  

• D) Musty Urine Odor

Answer explanation

Answer: D) Musty urine odor: This is a common indicator of a metabolic disorder, especially with a family history of siblings dying early
A) Micrognathia: This is not associated with an inborn error of metabolism
B) Microglossia: This is not associated with an inborn error of metabolism
C) Petite Facial Features: This is not associated with an inborn error of metabolism

Tags

NGSS.HS-LS3-2

The most urgent complication in a patient with Non-Hodgkin’s Lymphoma that needs to be evaluated at diagnosis and followed closely is:

• A. An elevated WBC > 50,000
  

• B. A uric acid of 5.0
  

• C. A mediastinal mass
  

• D. Complaints of left flank pain

Answer explanation

Answer-C: The presence of a mediastinal mass should be ruled out with all new patients with Non-Hodgkin’s lymphoma. Approximately 25% of patients with NHL have a mediastinal mass and present with a cough, wheezing, and malaise. This can rapidly progress to respiratory distress, tracheal compression and superior vena cava syndrome which constitute a medical emergency.

You have a patient with AML who is receiving continuous cytarabine for 7 days. According to the SOPs and policy, how should you set up the chemotherapy?

• Circle prime on day 1.

  Keep the same tubing, just change bags when empty on days 2-6.

  On day 7, when the pump beeps and all the chemo is infused from the bag, hang a 30 mL flush.

• Circle prime with each bag change.

  On day 7, when the pump beeps and all the chemo is infused from the bag, hang a 30 mL flush.

• Circle prime on day 1.

  Keep the same tubing, just change bags when empty on days 2-6.

  On day 7, when the pump beeps and all the chemo is infused from the bag, you can disconnect from the patient.

• Circle prime with each bag change.

  On day 7, when the pump beeps and all the chemo is infused from the bag, you can disconnect from the patient.

Answer explanation

According to CHOP policy and SOPs, circle prime on Day 1. Use ordered rate and subtract 30mL from your VTBI (~30mL to prime tubing).

The next days, DO NOT circle prime again. Tubing is good for 7 days and can just change bags.

Only the last day, day 7, when pump beeps done, hang 30mL flush to ensure patient is getting all 7 days worth of chemotherapy.

A mechanically ventilated patient suddenly develops high PIPs and absent breath sounds on the right side. What is the most appropriate immediate action?

• D. Increase the tidal volume

• A. Obtain a chest X-ray

• B. Disconnect the ventilator and manually ventilate

• C. Suction the endotracheal tube

Answer explanation

The sudden high PIP and absent breath sounds suggest a possible obstruction or pneumothorax. The immediate action is to disconnect the ventilator and manually ventilate to ensure adequate oxygenation.

Is it a difficult airway or a critical airway if you are able to bag from above?

Answer explanation

The main difference between a difficult and crtiical airway is where you are able to bag.

A difficult airway you are able to bag from above. Ideally you want to get the original airway back in place (get trach or step-down trach back in). But if you are unable to, cover trach stoma and bag from above.

A critical airway ARE NOT able to be bagged from above. These patients usually have some anatomical reason. We should not be getting critical airways out at KOPH but we have so preparedness is key!

When collecting a UA for a patient receiving MTX, what should you use?

• Regular urine cup

• filled vacutainer urine cup

• vacutainer urine cup used to fill urine syringe

Answer explanation

Using the vacutainer urine cup to cleanly get the urine into the urine syringe is the safest way to collect a UA for a patient receiving hazardous medications (therefore have hazardous waste).

This technique, when done properly, is the best way to prevent contamination of hazardous chemicals onto common surfaces. This method also protects the lab technicians running the test.

Never send just the vacutainer cup! There is a needle at the top and is considered a sharps!!!

Which is the best Halloween candy? (According to 2024 sales)

• M&Ms

• Reese's PB cups

• Haribo Gummy Bears

• Kit-Kat

• Sour-Patch Kids

Answer explanation

Also my fav!!!!!!

What are yours??