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UNIVERSITY OF BOLTON

SCHOOL OF HEALTH & HUMAN SCIENCES

SEMESTER TWO EXAMINATION 2016

MANAGING THE ACUTELY ILL PATIENT

MODULE NO: HLT 6005

Date: Wednesday 11th May 2016 Time: 5.00pm-6.30pm INSTRUCTIONS TO CANDIDATES: There are 50 questions. Answer 50 questions. All questions carry equal marks.

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School of Health & Human Sciences Semester Two Examination 2016 Managing the Acutely Ill Patient Module No. HLT6005

1. What is the function of the cell membrane?

A. Regulates the transition of proteins B. Contains genes, regulates metabolism C. Produces proteins D. Synthesises carbohydrate molecules E. It serves as the cells external boundary, separating it from other cells & from

the external environment

2. What are the Two used medications in the cardiac arrest algorithm:

A. Amoxicillin and adrenaline B. Atropine and amlodipine C. Diazepam and atropine D. Adrenaline and amiodarone E. Amiodarone and diazepam

3. Compensation or illness can be defined best by which of the following?

A. The body’s inability to maintain homeostasis B. The body working harder to maintain homeostasis C. The point at which only medical assistance can reverse a disease D. The point at which blood pressure falls

E. All of the above

4. Which one of the following is an early sign that a compensatory mechanism has been activated in response to blood loss?

A. Urine output will be reduced B. Systolic blood pressure will fall C. The respiratory rate will be reduced D. Capillary refill will be less than 2 seconds E. The mean arterial pressure will be less than 60 mmHg

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School of Health & Human Sciences Semester Two Examination 2016 Managing the Acutely Ill Patient Module No. HLT6005

5. Adenosine Triphosphate (ATP) is generated in the;

A. Mitochondria B. Lysosomes C. Centrosomes D. Ribosomes E. Vacuole

6. Shock is a term that is always characterised by which one of the following?

A. An increase in blood volume B. A decrease in effective circulating blood volume C. A reduction in blood volume D. A reduction in heart rate E. An obstruction to blood flow

7. Which one of the following makes up the perfusion triad?

A. Cardiac pump, blood volume, respiratory rate B. Blood volume, plasma volume, interstitial volume C. Intravascular fluid, interstitial fluid, intracellular fluid D. Cardiac pump, blood volume, peripheral vascular resistance E. Muffled heart sound, low blood pressure, jugular vein distension

8. Which one is NOT part of the sepsis six guideline? A. Give High- flow oxygen B. Take blood cultures C. Give IV Anti-biotic D. Start IV Fluid resuscitation E. Check Troponin

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School of Health & Human Sciences Semester Two Examination 2016 Managing the Acutely Ill Patient Module No. HLT6005

9. An elevated level of carbon dioxide in the blood will be represented by which blood gas

A. pH – 7.20, p02 – 7.5, pCo2 – 15, HCO3 - 23 B. pH – 7.35, pO2 – 8.5, pCO2 – 7.5, HCO3 -24 C. pH – 7.50, pO2 – 10, pCO2 – 6.5, HCO3 – 22 D. pH – 7.32, pO2 – 11, pCO2 – 10, HCO3 – 24 E. pH – 7.25, pO2 – 13, pC02 – 9, HCO3 – 24

10. Which fluid is the safest to use for the immediate replacement of blood volume?

A. Glucose 5% B. Haemaccel C. Dextran D. Sodium Chloride 0.9% E. Sodium Chloride 1.45%

11. Which one of the following observations will directly assess how well a person is oxygenating?

A. Pulse pressure B. Blood pressure C. Oxygen saturation D. Capillary refill E. Respiratory rate

12. Chemoreceptors are responsible for monitoring which of the following;

A. Chemical concentration B. Body Temperature C. Osmotic pressure D. Pressure E. Fluid balance

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School of Health & Human Sciences Semester Two Examination 2016 Managing the Acutely Ill Patient Module No. HLT6005

13. The fluid compartments classified in the body are correctly classified as;

A. Intracellular, intravenous, intrathecal, B. First space, second space, third space C. Intravascular, interstitial, intracellular D. Arterial, capillary, venous E. Intracellular

14. In which fluid compartment is the majority of the bodies’ water stored?

A. Extracellular B. Third space C. Interstitial D. Intravascular E. Intracellular

15. What is the function of the pancreas in the negative feedback loop?

A. Maintaining oxygen B. Compensation C. Homeostatic control D. Blood glucose and insulin regulation. E. Releasing Oxytocin

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School of Health & Human Sciences Semester Two Examination 2016 Managing the Acutely Ill Patient Module No. HLT6005

16. Look at the image shown. What is the name of the structure shown by the arrow labelled “11”?

A. Cricoid cartilage B. Trachea C. Thyroid cartilage D. Vocal fold E. Glottis

17. Ventilation refers to which one of the following?

A. Movement of air between the environment and the lungs B. Intracellular movement of air C. Extracellular movement of air. D. Movement of carbon dioxide around the body E. Movement of oxygen around the body.

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School of Health & Human Sciences Semester Two Examination 2016 Managing the Acutely Ill Patient Module No. HLT6005

18. Name the piece of equipment in the following picture:

A. Laryngeal mask B. Airway insertion device C. I-gel D. Naso-pharyngeal airway E. Oro-pharyngeal airway

19. Which of the following best describes what processes occur during the generation of a P- wave on an ECG?

A. The whole of the heart muscle repolarises B. The heart is at complete rest C. Atrial depolarisation D. Ventricular depolarization E. The atrioventricular node initiates a contraction

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School of Health & Human Sciences Semester Two Examination 2016 Managing the Acutely Ill Patient Module No. HLT6005

20. Homeostasis can be defined as:

A. The inability of the body to maintain its own environment B. The condition of a system when it is able to maintain its essential variables within limits acceptable to its own structure in the face of unexpected disturbances C. The balance of oxygen and fluid within the body D. The process through which cell energy is produced E. The process that prevents inflammation in healthy tissues

21. What does the acronym AVPU stand for? A. Air ventilation pulse urine output B. Alert variant professionals understanding C. Airway vented patient unconsciousness D. Alert voice pain unresponsive E. Air voice pain unresponsive 22. A pulse oximeter measures which of the following?

A. The amount of O2 in the arteries B. The amount of O2 passing through the heart C. The amount of O2 attached to haemoglobin passing through the tissues D. The amount of red bold cells passing through the tissues E. The percentage of O2 in the blood which passes through the lungs

23. Which of the following improves outcomes for the patient in the event of a ‘Ventricular Tachycardia’ (VT) cardiac arrest? A. Early rescue breaths B. Early chest compressions C. Early call for help D. Early defibrillation E. Early oxygen delivery

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School of Health & Human Sciences Semester Two Examination 2016 Managing the Acutely Ill Patient Module No. HLT6005

24. Which one of the following observations is not part of the minimum data set that should be obtained as a part of screening acutely ill patients?

A. Urine Output B. Respiratory Rate C. Blood Pressure D. Peak expiratory flow E. Pulse rate

25. Systemic inflammatory response syndrome (SIRS) occurs when /is characterised by

A. Increased organ perfusion B. Increased blood pressure C. reduced platelet activation D. Localised activation of inflammation E. Widespread activation of the inflammatory process leading to reduced blood pressure and organ perfusion.

26. Type 2 respiratory failure is characterised by which of the following? A. Decreased O2 and increased Co2

B. Decreased O2 and decreased Co2 C. Increased O2 and increased Co2 D. Increased O2 and decreased Co2 E. None of the above

27. A low level of oxygen in the blood is referred to as which one of the following?

A. Hypoxia B. Hypercapnia C. Hypoxemia D. Hypocapnia E. Hyperopia

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School of Health & Human Sciences Semester Two Examination 2016 Managing the Acutely Ill Patient Module No. HLT6005

28. Mean Arterial Pressure represents;

A. The difference between the systolic and diastolic pressure B. The pulse pressure C. The perfusion pressure of blood at tissue level D. Both B and C E. The osmotic pressure in the venous system

29. A patient whom you are caring has physiological observations of; respiratory rate- 18 breaths per minute; pulse 82 beats per minute; BP 110/66 mmHg. Which one of the following statements is true?

A. The patient has observations which suggest that they are haemodynamically stable. B. There is insufficient information provided in order to make a reasoned assessment of this patients’ needs C. The patient is likely to be physiological unstable D. A doctor or outreach nurse team should be made aware of this patient E. The patient should receive four hourly observations

30. Which one of the following is a sign of an upper airway obstruction?

A. Chest pain B. Low blood pressure C. Unequal chest expansion D. Vomiting E. Snoring sounds

31. Read the following definition and decide which of the following terms it is explaining;

“The ability of a system to maintain its essential variables within limits acceptable to its own structure in the face of unexpected disturbances” A. The perfusion triad B. Compensation C. Positive feedback D. Homeostasis E. Negative feedback

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School of Health & Human Sciences Semester Two Examination 2016 Managing the Acutely Ill Patient Module No. HLT6005

32. A blood small blood loss, of 300 ml, will have which one of the following effects on blood pressure?

A. The systolic pressure will rise B .No effect on blood pressure will be seen due to a small blood loss C. The Diastolic pressure will rise D .The systolic pressure will fall E .The mean arterial pressure will reduce

33. A widening pulse press is a sign of:

A .Vasodilation B. Vasoconstriction C. Hypotension D. Hypertension E .Hypercapnia

34.Chest expansion will be reduced in which of the following conditions?

A. Tension pneumothorax B. Pulmonary oedema C. Metabolic acidosis D. Pulmonary embolism E. Cor pulmonale

35. ABCDE stands for:

A. Airway, body, circulation, disability, examination B. Airway, breathing, circulation, disability, exposure C. Agony, breathing, circulation, death, exposure D. Airway, breathing, circulation, disability, examination E. Anaphylaxis, body, colour, death, examination

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School of Health & Human Sciences Semester Two Examination 2016 Managing the Acutely Ill Patient Module No. HLT6005

36 . What are the key components of a breathing assessment?

A. The use of accessory muscles B. The rate, rhythm and depth of respiration C. The shape and expansion of the chest D. The colour of a patients skin and mucous membrane E. All of the above

37. In a person with anaphylactic shock which one of the following best describes what happens to the total volume of body water?

A. Total body water volume is reduced B. Total body water volume is increased C. Total body water volume remains the same, it is just wrongly distributed D. The blood volume is increased E. The body water volume becomes more concentrated

38. Effective capillary refill time is:

A. Less than 2 seconds B. Less than 4 seconds C. Less than 6 second D. Less than 8 seconds E. Less than 10 seconds

39. Which of the following is not a classification of shock?

A. Hypovolemic B. Neurogenic C. Obstructive D. Septic E. Compensator

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School of Health & Human Sciences Semester Two Examination 2016 Managing the Acutely Ill Patient Module No. HLT6005

40. Look at the image shown. What is the name of the structure shown by the arrow labelled “9”?

A. Glottis B. Epiglottis C. Tongue D. Larynx E. Trachea

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School of Health & Human Sciences Semester Two Examination 2016 Managing the Acutely Ill Patient Module No. HLT6005

41. Who is responsible for defibrillating a patient?

A. The doctor B. The senior nurse C. The anaesthetist D. Anyone who is trained in the use of a defibrillator E. The cardiologist

42. What factors may need to be considered when monitoring a person’s blood pressure reading?

A. Age B. Pregnancy C. Athletes D. BP controlled E. All of the above

43. An increase in heart rate could occur when a person is A. Dehydrated B. Asleep C. Talking quickly D. Hypothermic E. Bradycardic

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School of Health & Human Sciences Semester Two Examination 2016 Managing the Acutely Ill Patient Module No. HLT6005

44. In the image below, the device labeled with the letter “B” should NOT be used in patients with which one of the following?

A .Bleeding disorder or those taking anticoagulants B. Fractured base of skull C. Patient who have pneumothorax D. Semi-conscious patients E. Patients with severe chest injuries

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School of Health & Human Sciences Semester Two Examination 2016 Managing the Acutely Ill Patient Module No. HLT6005

45. If inflammation is widespread in the body which one of the following effects will it have on the blood pressure?

A. Decrease the blood pressure B. Increase the blood pressure C .Be clinically undetectable D. Decrease the pulse rate E .Increase the SpO2%

46 . A patient who is in shock will normally have which one of the following?

A. A reduced urine output B. A prolonged capillary refill time C. A rapid heart rate D. A rapid respiratory rate E. All of the above

47. In a person with septic shock, which one of the following principally occurs and leads to a reduction in blood flow?

A. Vasodilation and a leak of fluid out of vasculature and into the tissue B. Widespread vasoconstriction C. The development of an arrhythmia D. Slow pulse E. Septic shock does not affect blood flow

48. What is the aim of giving Aspirin to a person with a suspected ‘Acute Coronary Syndrome?’

A. Relieve pain B. Suppress inflammation C. Dissolve blood clots blocking the coronary vessels D. Prevent further platelet aggregation E. All of the above

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School of Health & Human Sciences Semester Two Examination 2016 Managing the Acutely Ill Patient Module No. HLT6005

49 . Normal cardiac rhythms originate from: A. The Bundle of His B. Atrioventricular node C. Sinoatrial node D. The left Bundle Branches E. The Purkinje fibers

50. Look at the image shown. What is the name of the structure shown by the arrow labelled “10”?

A. Hypopharynx B. Oesophagus C. Trachea D. Glottis E. Nasopharynx

END OF QUESTIONS