CPSS Exam 1|164 Questions with Verified Answers,100% CORRECT

CPSS Exam 1|164 Questions with Verified Answers Small bottle that contains the drug - CORRECT ANSWER Ampule Diameter of the needle - CORRECT ANSWER Gauge Enlarged base by which a hollow needle may be attached to ...

CPSS Exam 1|164 Questions with Verified Answers Small bottle that contains the drug - CORRECT ANSWER Ampule Diameter of the needle - CORRECT ANSWER Gauge Enlarged base by which a hollow needle may be attached to a device (as a syringe) - CORRECT ANSWER Hub Cylindrical container that holds liquids - CORRECT ANSWER Barrel A small container, usually with a closure, used especially for liquids - CORRECT ANSWER Vial What are the reasons to give an injection? - CORRECT ANSWER - if drug is poorly absorbed or degraded by GI system - if pt is uncooperative, unconscious, unable to take PO - used when localized therapy is desired - preferred when rapid & predictable drug response is desired in ER situations What is the needle size used for blood withdrawal? - CORRECT ANSWER 18 g What is the needle size used for IM injections? - CORRECT ANSWER 22g What is the needle size used for SubQ injections? - CORRECT ANSWER 25-27g What needle size is used for ID injections? - CORRECT ANSWER 26-27g What type of injection has the fastest rate of absorption? - CORRECT ANSWER IV > IM > SQ When are IM injections indicated? - CORRECT ANSWER - drugs are not easily absorbed PO - when you want an intermediate rate of onset & duration of action - when parenteral delivery is necessary What are the 3 main sites of IM injections? - CORRECT ANSWER - gluteal (upper outter quadrant) - deltoid (lateral & 3-4cm below the acromion) - vastus lateralis (antero-lateral, upper thigh) Which IM site is preferred in infants & kids under 3? - CORRECT ANSWER Vastus lateralis *painful due to fascia lata *lack of nerves and vessels Which IM site is preferred in kids over 2? - CORRECT ANSWER Gluteus maximus *higher risk of hitting siatic nerve in kids under 2 Which IM site is preferred in adults? - CORRECT ANSWER Deltoid *watch for radial nerve in kids What is an important technique to use when giving an IM injection? - CORRECT ANSWER Draw about 0.2ccs of air into syringe (air lock) Hold syringe like a dart at 90 degree angle Max amount injected is 3ccs *DO NOT MASSAGE- will break seal* What are the complications associated with IM injections? - CORRECT ANSWER - inject into vessel - inject into nerve - needle breaks off - sterile/septic abscess Which type of injection is used for drugs requiring slower absorption and longer duration of action? - CORRECT ANSWER SubQ *drugs must be soluble and potent in small concentrations What are the 3 common sites used for SC injections? - CORRECT ANSWER - upper outer arm - anterior thigh - lower abdomen What are the MC SC injections given? - CORRECT ANSWER Heparin & Insulin *refrigerate insulin *Do NOT aspirate or massage heparin injections How is insulin mixed? - CORRECT ANSWER Rolled between palms of hands - gently! What technique should be used when giving a SC injection? - CORRECT ANSWER Pinch SC tissue into roll with thumb & forefinger of non-dominant hand; inject at 45 degree angle Max amount 2ccs Which type of injection has little systemic affects and is mainly localized? - CORRECT ANSWER ID injections - TB & allergy testing What are the C/I to ID injections? - CORRECT ANSWER - dermatitis - cellulitis - previous positive TB test What are the most commonly used sites for ID injections? - CORRECT ANSWER Ventral forearm (TB) & back (allergy testing) *Rabies vaccine given ID in deltoid What technique should be used when giving an ID injection? - CORRECT ANSWER Move down 3-4 finger widths from the antecubital area Use 0.1ccs max Angle needle 10-15 degrees DO NOT ASPIRATE What are the absolute C/I for radial & brachial ABGs? - CORRECT ANSWER - no pulse/collateral circulation - cellulitis - aneurysm at puncture site - AV fistula or graft above puncture site What are the relative C/I for radial & brachial ABGs? - CORRECT ANSWER - chronic renal disease - arterial disease - bleeding disorders/ anticoagulant therapy What are the potential complications of ABGs? - CORRECT ANSWER - hemorrhage - thrombosis - transient arterial spasm - nerve damage - infections What artery is MC used for arterial puncture? - CORRECT ANSWER Radial artery Which artery runs along the lateral aspect of the volar forearm deep to the superficial fascia between the styloid process of the radius and the flexor carpi radialis tendon? - CORRECT ANSWER Radial artery Which artery is used if the radial artery is unavailable? - CORRECT ANSWER Brachial artery Which artery runs along the medial 1/3rd surface of the antecubital fossa and should be accessed above the antecubial crease? - CORRECT ANSWER Brachial artery Which artery is used only if the radial and brachial are not possible? Usually indicated when the pt is severely volume depleted or in shock? - CORRECT ANSWER Femoral artery Which artery lies midway between the ASIS and the pubic tubercle? - CORRECT ANSWER Femoral artery What are C/I to using the femoral artery? - CORRECT ANSWER - aortofemoral bypass graft - previous femoral artery surgery - leg ischemia - aneurysm of femoral artery What technique is used for femoral artery sampling? - CORRECT ANSWER Enter at steeper angle of 60-90 degrees Apply pressure for longer b/c inc risk of hematoma What is considered a positive Allen's test? - CORRECT ANSWER Color returns to hand within 15 seconds * over 6 seconds = delayed *over 15 seconds = abnormal What happens if too much heparin is left in the syringe? - CORRECT ANSWER Lowers the PCO2, bicarb & pH due to dilution of specimen What is the technique for drawing ABGs? - CORRECT ANSWER Hold syringe like a pencil Insert needle 45-60 degree angle *Obtain 2mL of arterial blood* Apply pressure for 5 mins- NOT the patient Why must air be quickly evacuated from the ABG collection? - CORRECT ANSWER Air will increase PaO2 & decrease PCO2 *gas bubble greater than 0.5-1% of volume of blood results in equilibrium between air & blood Why are ABGs placed in ice? - CORRECT ANSWER - avoid psudohypoxemia - allows more time to analyze specimen What are potential complications of ABGs? - CORRECT ANSWER - bruising - pain/tenderness - hemorrhage - decrease pulse due to arterial spasm - vessel trauma - vasovagal response - compression neuropathy - sepsis - ischemia or gangrene of hand or fingers What type of catheterization is performed on critically ill patients for continuous monitoring of arterial blood pressure as well as frequent blood gas sampling? - CORRECT ANSWER Radial artery catheterization What are the C/I to IV therapy? - CORRECT ANSWER - venipuncture should be avoided at the site of an active skin infection - IV lines should not be inserted distal to any site of thrombophlebitis - LE venipunctures should be avoided in elderly, pts with PVD & venous insufficiency What are the primary kind of IV needles we will use? - CORRECT ANSWER Over the catheter needles What type of needle is used for central monitoring and long term medication administration? - CORRECT ANSWER Inside the needle catheter Which type of IV fluid has a risk of causing edema, so should be avoided in HTN and CHF patients? - CORRECT ANSWER Isotonic - LR, NS Which type of IV fluid is helpful when pt is dehydrated, on dialysis, or in hyperglycemic conditions (DKA)? - CORRECT ANSWER Hypotonic- 0.45% NaCl, 2.5% Dextrose Which type of IV fluid is dangerous to use when the pt is dehydrated? - CORRECT ANSWER Hypertonic - D5, 0.45%NaCl, LR, D5%NS, blood products, and albumin Lactate is metabolized by the liver into? - CORRECT ANSWER Bicarbonate - buffers the blood if acidosis is present Which type of fluid is indicated for massive hemorrhage and resuscitation? - CORRECT ANSWER Lactated Ringer What is the ideal IV site in the hand? - CORRECT ANSWER Dorsal metacarpal veins What is the ideal IV site in the forearm? - CORRECT ANSWER Cephalic vein, Accessory Cephalic vein, & Median Cubital vein What is the rate of a micro/macro drip? - CORRECT ANSWER Microdrip - 60 drops/mL *good for peds* Macrodrip- 10-15 drops/mL *good for routine/rapid delivery* What is the formula for calculating flow rates? - CORRECT ANSWER (Volume mL) x (drip set) / (time in minutes) What are the complications of IV therapy? - CORRECT ANSWER Localized: - bruise, cellulitis, infiltration, extravasation, phlebitis Systemic: - sepsis, PE, air embolism, catheter fragment embolism, These complications can happen at insertion of needle if both walls of the vein are penetrated or at a later date if catheter moves and penetrates walls? - CORRECT ANSWER Infiltration or Extravasation (blistering) What areas should not be used for venipuncture? - CORRECT ANSWER - scars from burns & surgery - UE on the side of previous mastectomy - hematoma - IV/ blood transfusions on same arm - cannula/fistula/heparin lock - edematous extremities What type of antiseptic is used for blood cultures? - CORRECT ANSWER Povidone-iodine wipes What is the order of blood draw? - CORRECT ANSWER 1- blood culture tube (yellow black) 2- Non additive tube (red or STT) 3- coagulation tube (light blue) - NEVER DRAWN FIRST 4- Additive tubes (Heparin- Dark green; EDTA- lavender; oxalate/fluoride- light gray) What kind of symptoms should be avoided when performing a finger stick? - CORRECT ANSWER Avoid puncturing a finger that is cold, cyanotic, swollen, scarred or covered with rash What can be done to prevent a hematoma? - CORRECT ANSWER - puncture only top wall of vein - remove tourniquet before removing needle - use major superficial veins - apply pressure to site How many times must a sample be discarded before a specimen can be obtained for analysis using an indwelling catheter? - CORRECT ANSWER Discard a sample at least 3 times the volume of the line before a specimen is obtained for analysis What causes hemoconcentration (increased concentration of larger molecules & formed elements in blood)? - CORRECT ANSWER - prolonged tourniquet application (+2 mins) - massaging, squeezing, or probing site - long term IV therapy - sclerosed or occluded veins What effect may exercise have on pts blood sample? - CORRECT ANSWER increases: - CK - AST - LDH - platelet count What effect does stress have on pts blood sample? - CORRECT ANSWER Increases: - WBCs - adrenal hormone values (cortisol, catecholamines) - lactate (seen in hyperventilation/anxiety pts) What is the therapy for a red wound? - CORRECT ANSWER Keep site moist, clean and protected What is the therapy for a yellow wound? - CORRECT ANSWER Topical antimicrobial & application of prep to lift off pus, fibrin & necrotic tissue What is the therapy for a black wound? - CORRECT ANSWER Mechanical, surgical or chemical debridement to dissolve black necrotic tissue What is created when the anatomic integrity of the tissue is disrupted? - CORRECT ANSWER Wound What is the process whereby the integrity of the tissue is restored? - CORRECT ANSWER Healing How is an arterial ulcer diagnosed? - CORRECT ANSWER Noninvasive: ABI, US, transcutaneous oxygen pressure Arteriogram What medications are used to increase circulation to the area in question in arterial ulcers? - CORRECT ANSWER Pentoxifylline (Trental) Cilostazol (Pletal) What is the most common type of ulcer affecting the lower extremities? - CORRECT ANSWER Venous ulcers *medial malleolus *not too painful What is the treatment for venous ulcers? - CORRECT ANSWER Controlling edema Compression- typically 40mmHg (compression dressings, stockings, mechanical pumps) What are the 3 phases of wound healing? - CORRECT ANSWER Reaction (injury - 72 hrs) Regeneration (72 hrs - 3 weeks) Remodeling (3 weeks - 2 yrs) What phase consists of inflammation? - CORRECT ANSWER Reaction What phase consists of formation of granulation tissue, epithelialization & contraction? - CORRECT ANSWER Regeneration What phases consists of scar formation? - CORRECT ANSWER Remodeling What groups are high risk for wound healing? - CORRECT ANSWER Elderly Disabled Bedridden Head injuries Spinal injuries Nonblanchable erythema of INTACT skin? - CORRECT ANSWER Stage 1 pressure ulcer PARTIAL thickness skin loss involving epidermis, dermis, or both layers; presents clinically as an abrasion, blister or shallow crater? - CORRECT ANSWER Stage 2 pressure ulcer FULL thickness skin loss that extends down to, but not through, the underlying fascia; presents clinically as a deep crater with/without adjacent tissue? - CORRECT ANSWER Stage 3 pressure ulcer FULL thickness skin loss with extensive destruction, tissue necrosis, or damage to MUSCLE, bone, or supporting structures - CORRECT ANSWER Stage 4 pressure ulcers What is the Wagner Grading System for DM ulcers? - CORRECT ANSWER 1- superficial 2- ulcer extension 3- deep ulcer w/ abscess or osteomyelitis 4- gangrene to portion of forefoot 5- extensive gangrene of foot What are the different types of debridement? - CORRECT ANSWER autolytic mechanical chemical surgical What are the different ways to mechanically debride a wound (remove devitalized tissue, bacteria & proteolytic enzymes, and senescent cells)? - CORRECT ANSWER - pulse irrigation - vacuum assisted closure - sharp debridement What type of wound debridement is used to decrease fluid & bacterial burden, increase capillary ingrowth, and mechanically pull edges of wounds together? - CORRECT ANSWER Vacuum assisted closure device What are the clinical indications for enzymatic debridement? - CORRECT ANSWER - ideal for nonsurgical candidates or alternate care sites - break down eschar before sharp debridement - in conjunction with mechanical - infected wounds Most topical abx are compatible with enzymatic agents except? - CORRECT ANSWER Silver dressings What are the indications for non debridement? - CORRECT ANSWER - poor perfusion - pain control - exposed bone - hospice pts - dementia/unpredictable behavior - stable necrotic tissue - anticoagulant pt What are the final pathways to wound healing failure? - CORRECT ANSWER - Infection - Hypoxia (edema, radiation, scarring) - Cellular Failure (renal/liver failure, CA, nutrition, inflammation, steroids, vasculitis) - Trauma (pressure) What are the 4 types of topical dressings? - CORRECT ANSWER Passive dressing Mechanical dressings Dynamic dressing Anti-infective dressing What type of topical dressing is used for optimization of moist wound environment? - CORRECT ANSWER Passive dressings - hydrate & maintain moisture (Hydrogel) - absorb drainage (Alginate) - protect wound margins (zinc oxide) What type of dressing is used for mildly exuding wounds, clean wounds, & partial thickness wounds? - CORRECT ANSWER Hydrogel *absorbs 5xs its weight *cooling effect *facilitates autolytic debridement What are some examples of hydrogels? - CORRECT ANSWER Amorphous (SoloSite) Curasol What type of dressing is used for wounds with large amount of drainage? - CORRECT ANSWER Calcium Alginate *absorbs 30xs its weight *forms hydrophilic gel *maintains moist environment What type of dressing is used for highly exudative wound requiring a non-stick surface (e.g. venous stasis)? - CORRECT ANSWER Foam *absorbs 20xs its weight *non-adherent wound contact layer, hydrocellular foam, waterproof outer layer *allows for autolytic debridement & gaseous exchange Give an example of a foam? - CORRECT ANSWER Allevyn What type of topical dressing is used for pressure reduction or edema management? - CORRECT ANSWER Mechanical dressings - edema control (Profore) - fill dead space (VAC) -pressure reduction (Clinitron bed) What type of topical dressing is used for activation of wound environment? - CORRECT ANSWER Dynamic dressing - biological support (Apligraf) - remove nonvital tissue (Accuzyme) What activates endothelial cells & fibroblasts, stimulates vascular proliferation, migration, and new blood vessel formation & recruits smooth muscle cells and epricytes to stabilize newly formed vessels? - CORRECT ANSWER Platelet derived growth factors (pdGF) What modulates protease activity, keeps the growth factor active while bound, delivers growth factor back to wound over time & modifies hostile proteolytic environment of chronic wound? - CORRECT ANSWER Oxidized Regenerated Cellulose (ORC)/ Collagen What type of debridement is used for a wound requiring debridement of fibrinous exudate, other necrotic material or slough? - CORRECT ANSWER Enzymatic debridement *removes senescent fibroblasts - can't produce cytokines *removes necrotic tissue harboring bacteria Give an example of an enzymatic debridement application? - CORRECT ANSWER Accuzyme *apply directly to the wound Panafil What type of dressing is used to decrease bioburden? - CORRECT ANSWER Anti-infective dressings What type of dressing is indicated for venous ulcers or DM ulcers? - CORRECT ANSWER Acticoat (nanocrystalline silver coating) Wound with clean granular base; how to treat? - CORRECT ANSWER Protect & keep moist Ex- Hydrocolloid, Hydrogel, VAC device, secondary dressing, wet to damp saline Wound with crater; how to treat? - CORRECT ANSWER Fill the space with uniform contact Ex- Hydrogel, Alginate, Foam, hydrocolloid, VAC device, wet to damp saline Wound with necrotic/non-viable tissue; how to treat? - CORRECT ANSWER Debride and cleanse Ex- enzymatic dressing, hydrogel, calcium alginates, pulse irrigation, VAC device, hypertonic salts, wet to damp saline Wound with exudate; how to treat? - CORRECT ANSWER Absorb and contain Ex- Alginate, foam, VAC device, wet to damp saline Wound with sinus, tunnel, undermining; how to treat? - CORRECT ANSWER Prevent pre-mature closure, absorb exudate- treat with loose packing Ex- soak gauze w/ hydrogel; calcium alginate if high drainage, VAC device, wet to damp saline Wound with infection; how to treat? - CORRECT ANSWER Decrease local bacterial count Ex- pulse irrigation, long acting abx, antimicrobial, VAC device, wet to damp saline Which type of sutures pass through tissue easier & resists bacteria? - CORRECT ANSWER Monofilament strands Which type of sutures have greater strength and are easier handling and softer knots? - CORRECT ANSWER Multifilament strands List the absorbable synthetic sutures - CORRECT ANSWER Vicryl Monocryl PDS II Panacryl List the nonabsorbable synthetic sutures - CORRECT ANSWER Nylon Polyester Polypropylene (prolene) List the nonabsorbable organic sutures - CORRECT ANSWER Silk List the absorbable organic sutures - CORRECT ANSWER Plain gut & chromic gut Enzymatic degradation What's the most & least reactive absorbable suture? - CORRECT ANSWER Most- Fast gut Least- PDS II What's the most & least reactive non-absorbable suture? - CORRECT ANSWER Most- silk Least- prolene What are the stages of healing? - CORRECT ANSWER Inflammatory 0-7 - wound strength is minimal Proliferation 7-21 - rapid increase in wound strength Maturation 21+ - further CT remodeling What % of tensile strength is achieved by 2 weeks? - CORRECT ANSWER 25% Which type of organic absorbable suture is used for superficial skin closing? - CORRECT ANSWER Fast gut Which type of organic absorbable suture is used for superficial blood vessels? - CORRECT ANSWER Plain gut Which type of organic absorbable suture is used for oral mucosa or tongue? - CORRECT ANSWER Chromic gut What is the most common absorbable suture used? - CORRECT ANSWER Coated vicryl What is the fastest absorbing synthetic suture that is only used for superficial skin & mucosa? - CORRECT ANSWER Coated vicryl rapide What type of suture is used for SC areas with stress (joint surfaces)? - CORRECT ANSWER PDS II What type of suture is used for extended wound support, general soft tissue & orthopedics, tendons, ligaments, & used in pts with compromised wound healing (steroids, CA pts, obesity, malnourished)? - CORRECT ANSWER Panacryl What type of suture is used in areas such as the periocular area, lips, & other mucosal surfaces- loses strength when exposed to moisture? - CORRECT ANSWER Silk What type of suture is used in abdominal wall closures? - CORRECT ANSWER Steel What are the 2 types of needle points? - CORRECT ANSWER Taper point - soft, easy to penetrate skin Cutting point- tough, hard to penetrate skin Skin suture used for face, fingers, cosmetics? - CORRECT ANSWER 6-0 prolene Skin suture used everywhere, including dorsal of hand? - CORRECT ANSWER 5-0 ethilon Skin suture NOT used on face - CORRECT ANSWER 4-0 ethilon Most common SC closure, face? - CORRECT ANSWER 5-0 Vicryl Strong SC suture? - CORRECT ANSWER 4-0 Vicryl or PDS II What suture is used for tight spaces? - CORRECT ANSWER 5-0 vicryl What suture is used for intranasal & intraoral? - CORRECT ANSWER Intranasal - 5-0 chromic gut Intraoral - 4-0 chromic gut When should sutures be removed? - CORRECT ANSWER Eyelids- 3 days Face- 5 days Scalp - 7-10 days Trunk- 7-12 days UE - 7-14 days LE - 10-21 days What happens if wound edge is inverted? - CORRECT ANSWER Sunken scar will form What type of suture technique is most commonly used in skin closures? - CORRECT ANSWER Simple suture (simple interrupted) *most basic suture technique What type of buried suture technique is the closest to the surface than other buried sutures? - CORRECT ANSWER Intradermal suture *important to place knot on deep site of suture to prevent abscess formation What type of suture technique is continuous series of simple suture loops- knotted only at each end? - CORRECT ANSWER Simple running suture (baseball stitch) *can be diagonal or perpendicular to skin What type of suture technique assures a slightly greater independence or integrity of each loop? - CORRECT ANSWER Running locking suture What type of suture design adds an additional pass through the epidermis at a point close to wound edge on each site; strength determined by large pass while small pass is used to approximate edges? - CORRECT ANSWER Vertical mattress Involves making two sets of needles pass through the wound both in the same tissue plane at adjacent points. When is it most commonly used? - CORRECT ANSWER Horizontal mattress *classically used to secure seal around drain tube* What non suture wound closure method is used for scalp wounds b/c it causes minimal injury to hair follicles? Not for areas that bear weight? - CORRECT ANSWER Staples When closing with adhesive tape, what should be applied first to secure the tape? - CORRECT ANSWER Benzoin application first What is the type of tissue adhesive that is a cyanoacrylate? - CORRECT ANSWER Dermabond How close should sutures be placed to the wound edge & how far apart should they be? - CORRECT ANSWER 3-4 mm from wound edge 3-10 mm apart *face should be 2-3 mm from edge & 3-5 mm apart When should anesthesia be considered? - CORRECT ANSWER - any wound that decreases pt pain - assists clinician in performing a procedure If pt has an allergy to lidocaine, what should be used? - CORRECT ANSWER Ester type anesthetics (novocaine) or vice versa What kind of allergy is more common than allergies to amide anesthetics (lidocaine, mepivacaine, bupivacaine)? - CORRECT ANSWER Allergies to older ester solutions are more common (Procaine, Novacaine, Tetracaine) What is more painful to inject than lidocaine and is not as effective if repair will take longer than 30 mins? - CORRECT ANSWER Benadryl (1mg diluted with 4mL NS) What type of anesthetic is ideal for kids? - CORRECT ANSWER Topical Where should epi be avoided? - CORRECT ANSWER face, mucous membranes, digits, nose, penis, ears what's the most common local anesthetic? What is the Max amount given? - CORRECT ANSWER Lidocaine - NOT exceed 300mg What has the longest duration of action? - CORRECT ANSWER Bupivacaine (Marcaine) How can you decrease anesthetic pain? - CORRECT ANSWER Add 1mL of bicarbonate to 10mL of lidocaine 1% How do you clean a wound? - CORRECT ANSWER Use normal saline diluted with providone/iodine (betadine) 10:1 ratio