A. CARDIOVASCULAR
| Directions: Please indicate your level of experience by selecting the correct number. Experience level: | |
| 1. No Experience | 2. Minimal Experience - requires supervision/assistance |
| 3. Competent | 4. Very Experienced - proficient |
| First name |
Last name |
| Social Security number |
Date |
A. CARDIOVASCULAR |
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| 1. Assessment | ||||
| a. Abnormal heart sounds/murmurs | A B C D | |||
| b. Auscultation (rate, rhythm) | A B C D | |||
| c. Blood pressure/non-invasive | A B C D | |||
| d. Doppler | A B C D | |||
| e. Pulses/circulation checks | A B C D | |||
| 2. Interpretation of lab results | ||||
| a. Cardiac enzymes & isoenzymes | A B C D | |||
| b. Coagulation studies | A B C D | |||
| 3. Equipment & procedures | ||||
| a. Assist with | ||||
| (1) Arterial line insertion | A B C D | |||
| (2) Central line insertion | A B C D | |||
| (3) Open chest emergency | A B C D | |||
| (4) PA catheter/Swan-Ganz insertion | A B C D | |||
| (5) Pericardiocentesis | A B C D | |||
| (6) Transesophageal echocardiogram | A B C D | |||
| b. Automatic internal cardioverter defibrillator | A B C D | |||
| c. Cardioversion | A B C D | |||
| d. CAVH-D | A B C D | |||
| e. Hemodynamic monitoring | ||||
| (1) Cardiac index | A B C D | |||
| (2) Cardiac output | A B C D | |||
| (3) CVP monitoring | A B C D | |||
| (4) Femoral artery sheath removal | A B C D | |||
| (5) MAP | A B C D | |||
| (6) PA/Swan-Ganz | A B C D | |||
| (7) PCW pressure | A B C D | |||
| (8) PVR | A B C D | |||
| (9) Radial a-line | A B C D | |||
| (10) SVO2 | A B C D | |||
| (11) SVR | A B C D | |||
| f. Intra aortic balloon pump | A B C D | |||
| g. Monitoring | ||||
| (1) 12 lead EKG interpretation | A B C D | |||
| (2) Arrhythmia interpretation | A B C D | |||
| (3) Lead placement | A B C D | |||
| (4) Rhythm strip assessment | A B C D | |||
| (5) Set up and run 12 lead EKG | A B C D | |||
| h. Pacemaker | ||||
| (1) External | A B C D | |||
| (2) Permanent | A B C D | |||
| (3) Temporary | A B C D | |||
| (4) Transthoracic (epicardial) | A B C D | |||
| i. Ventricular assist device (RVAD or LVAD) | A B C D | |||
| 4. Care of the patient with: | ||||
| a. Abdominal aortic aneurysm repair | A B C D | |||
| b. Acute MI | A B C D | |||
| c. Cardiac arrest | A B C D | |||
| d. Cardiac tamponade | A B C D | |||
| e. Congestive heart failure (CHF) | A B C D | |||
| f. EP study & ablation | A B C D | |||
| g. Heart transplant | A B C D | |||
| h. Immediate post open-heart surgery | A B C D | |||
| i. Infective endocarditis | A B C D | |||
| j. Myocardial contusion | A B C D | |||
| k. Pericarditis | A B C D | |||
| l. Post AICD insertion | A B C D | |||
| m. Post arthrectomy (DCA) | A B C D | |||
| n. Post commissurotomy, valve repair, | ||||
| valve replacement | A B C D | |||
| o. Post intracoronary stent placement | A B C D | |||
| p. Post percutaneous balloon valvuloplasty | A B C D | |||
| q. Post rotoblade | A B C D | |||
| r. Pre/post angioplasty | A B C D | |||
| s. Pre/post cardiac cath | A B C D | |||
| 5. Medications | ||||
| a. Amiodarone (Cardarone) | A B C D | |||
| b. Atropine | A B C D | |||
| c. Bicarbonate | A B C D | |||
| d. Bretylium (Bretylol) | A B C D | |||
| e. Digoxin (Lanoxin) | A B C D | |||
| f. Diltiazem (Cardizem) | A B C D | |||
| g. Dobutamine (Dobutrex) | A B C D | |||
| h. Dopamine (Intropin) | A B C D | |||
| i. Epinephrine (Adrenalin) | A B C D | |||
| j. Esmolol (Brevibloc) | A B C D | |||
| k. Inocor (Amrinone) | A B C D | |||
| l. Lidocaine (Xylocaine) | A B C D | |||
| m. Metoprolol (Lopressor) | A B C D | |||
| n. Nipride (Nitroprusside) | A B C D | |||
| o. Nitroglycerine (Tridil) | A B C D | |||
| p. Procainamide (Pronestyl) | A B C D | |||
| q. Reteplase recombinant (Retavase) | A B C D | |||
| r. Streptokinase | A B C D | |||
| s. TPA (Alteplase) | A B C D | |||
| t. Verapamil (Calan, Isoptin, Verelan) | A B C D | |||
| B. PULMONARY | ||||
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| 1. Assessment | ||||
| a. Adventitious breath sounds | A B C D | |||
| b. Rate and work of breathing | A B C D | |||
| 2. | Interpretation of lab results - arterial blood gases | A B C D | ||
| 3. Equipment & procedures | ||||
| a. Air leak troubleshooting | ||||
| (1) Mediastinal chest tube removal | A B C D | |||
| (2) Pleural chest tube removal | A B C D | |||
| b. Airway management devices/suctioning | ||||
| (1) Endotracheal tube/suctioning | A B C D | |||
| (2) Extubation | A B C D | |||
| (3) Nasal airway/suctioning | A B C D | |||
| (4) Oximetry | A B C D | |||
| (5) Sputum specimen collection | A B C D | |||
| (6) Tracheostomy/suctioning | A B C D | |||
| c. Assist with | ||||
| (1) Bronchoscopy | A B C D | |||
| (2) Chest tube insertion | A B C D | |||
| (3) Emergency tracheostomy | A B C D | |||
| (4) Thoracentesis | A B C D | |||
| d. Establishing an airway | ||||
| (1) Assist with intubation | A B C D | |||
| (2) Oral airway insertion | A B C D | |||
| e. Identification/intervention for respiratory complications | ||||
| (1) Aspiration | A B C D | |||
| (2) Laryngospasm | A B C D | |||
| (3) Tension pneumothorax | A B C D | |||
| (4) Use of Pleurevac or Thoraclex drainage | A B C D | |||
| (5) Use of water seal drainage | A B C D | |||
| f. O2 therapy & medication delivery systems | ||||
| (1) Ambu bag and mask | A B C D | |||
| (2) ET tube | A B C D | |||
| (3) Face masks | A B C D | |||
| (4) Nasal cannula | A B C D | |||
| (5) Portable O2 tank | A B C D | |||
| (6) Trach collar | A B C D | |||
| g. Ventilator management | ||||
| (1) External CPAP | A B C D | |||
| (2) High frequency jet ventilation | A B C D | |||
| (3) IMV | A B C D | |||
| (4) PEEP | A B C D | |||
| (5) Pressure support | A B C D | |||
| (6) Weaning modes & T-piece weaning | A B C D | |||
| 4. Care of the patient with: | ||||
| a. Acute pneumonia | A B C D | |||
| b. ARDS | A B C D | |||
| c. Chest trauma | A B C D | |||
| d. COPD | A B C D | |||
| e. Cor pulmonale | A B C D | |||
| f. Fresh tracheostomy | A B C D | |||
| g. Lobectomy | A B C D | |||
| h. Lung transplant | A B C D | |||
| i. Near drowning | A B C D | |||
| j. Pneumonectomy | A B C D | |||
| k. Pulmonary edema/hypertension | A B C D | |||
| l. Pulmonary embolism | A B C D | |||
| m. Status asthmaticus | A B C D | |||
| n. Thoracotomy | A B C D | |||
| o. Tuberculosis | A B C D | |||
| 5. Medications | ||||
| a. Alupent (Metaproterenol) | A B C D | |||
| b. Aminophylline (Theophylline) | A B C D | |||
| c. Bronkosol (Isoetharine hydrochloride) | A B C D | |||
| d. Corticosteroids | A B C D | |||
| e. Ventolin (Albuterol) | A B C D | |||
| C. NEUROLOGICAL | ||||
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| 1. Assessment | ||||
| a. Cranial nerves | A B C D | |||
| b. Glasgow coma scale | A B C D | |||
| c. Level of consciousness | A B C D | |||
| d. Pathologic reflexes | A B C D | |||
| e. Reflex/motor deficits | A B C D | |||
| f. Visual or communication deficits | A B C D | |||
| 2. Equipment & procedures | ||||
| a. Assist with lumbar puncture | A B C D | |||
| b. Halo traction/cervical tongs | A B C D | |||
| c. Intracranial pressure monitoring | A B C D | |||
| d. Nerve stimulators | A B C D | |||
| e. Rotating bed | A B C D | |||
| f. Seizure precautions | A B C D | |||
| g. Spinal precautions | A B C D | |||
| h. Stryker frame | A B C D | |||
| i. Use of hyper/hypothermia blanket | A B C D | |||
| 3. Care of the patient with: | ||||
| a. Aneurysm precautions | A B C D | |||
| b. Basal skull fracture | A B C D | |||
| c. Closed head injury | A B C D | |||
| d. Coma | A B C D | |||
| e. CVA | A B C D | |||
| f. DTs | A B C D | |||
| g. Encephalitis | A B C D | |||
| h. Externalized VP shunts | A B C D | |||
| i. Increased ICP | A B C D | |||
| j. Laminectomy | A B C D | |||
| k. Meningitis | A B C D | |||
| l. Metastatic tumor/intracranial tumor resection | A B C D | |||
| m. Multiple sclerosis | A B C D | |||
| n. Post craniotomy | A B C D | |||
| o. Spinal cord injury | A B C D | |||
| p. Ventriculostomy | A B C D | |||
| 4. Medications | ||||
| a. Barbiturate induced coma | A B C D | |||
| b. Decadron (Dexamethasone) | A B C D | |||
| c. Dilantin (Phenytoin) | A B C D | |||
| d. Epidural administration | A B C D | |||
| e. Phenobarbital | A B C D | |||
| f. Valium (Diazepam) | A B C D | |||
| D. GASTROINTESTINAL | ||||
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| 1. Assessment | ||||
| a. Abdominal/bowel sounds | A B C D | |||
| b. Nutritional | A B C D | |||
| 2. Interpretation of lab results | ||||
| a. Serum ammonia | A B C D | |||
| b. Serum amylase | A B C D | |||
| c. LFTs | A B C D | |||
| 3. Equipment & procedures | ||||
| a. Administration of tube feeding | A B C D | |||
| b. Balloon tamponade (Sengstaken Blakemore) | A B C D | |||
| c. Feeding pump | A B C D | |||
| d. Flexible feeding tube (i.e., Corpak, Dobhoff) | A B C D | |||
| e. Gravity feeding | A B C D | |||
| f. Iced saline lavage | A B C D | |||
| g. Management of | ||||
| (1) Gastrostomy tube | A B C D | |||
| (2) Jejunostomy tube | A B C D | |||
| (3) T-tube | A B C D | |||
| (4) TPN and lipids administration | A B C D | |||
| (5) PPN (peripheral parenteral nutrition) | A B C D | |||
| h. Placement of nasogastric tube | A B C D | |||
| i. Salem sump to suction | A B C D | |||
| 4. Care of the patient with: | ||||
| a. Blunt trauma | A B C D | |||
| b. Bowel obstruction | A B C D | |||
| c. Colostomy | A B C D | |||
| d. ERCP | A B C D | |||
| e. Esophageal bleeding | A B C D | |||
| f. GI bleeding | A B C D | |||
| g. GI surgery | A B C D | |||
| h. Hepatitis | A B C D | |||
| i. Ileostomy | A B C D | |||
| j. Inflammatory bowel disease | A B C D | |||
| k. Liver failure | A B C D | |||
| l. Liver transplant | A B C D | |||
| m. Pancreatitis | A B C D | |||
| n. Paralytic ileus | A B C D | |||
| o. Penetrating trauma | A B C D | |||
| 5. Medications | ||||
| a. AquaMephyton (Vitamin K) | A B C D | |||
| b. Inderal (Propranolol) | A B C D | |||
| c. Kayexelate | A B C D | |||
| d. Lactulose (Cephulac) | A B C D | |||
| e. Pitressin (Vasopressin) | A B C D | |||
| E. RENAL/GENITOURINARY | ||||
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| 1. Assessment | ||||
| a. A-V fistula/shunt | A B C D | |||
| b. Fluid status | A | |||