Critical Care
A client suddenly becomes confused and has an SpO₂ of 87% despite oxygen. What is nurse next priority action?
Call Rapid Response.
A client develops sudden dyspnea after a procedure. Breath sounds are absent over the right lung, and imaging identifies air, rather than blood, in the pleural space. What condition should the nurse report?
A client develops sudden dyspnea after a procedure. Pneumothorax.
Why: Air in the pleural space can collapse part or all of the lung. The nurse continues to assess breathing and oxygenation while treatment is arranged.
A patient’s ECG shows sinus bradycardia at 38 beats/min. The patient reports dizziness and has a blood pressure of 78/46 mmHg. Which medication should the nurse prepare to administer?
Atropine.
A client with COPD is drowsy and breathing ineffectively. ABG: pH 7.31, PaCO₂ 55, HCO₃ 28.
Partially compensated respiratory acidosis.
A client with a tracheostomy suddenly needs manual breathing support. What two pieces of emergency equipment does the guide say should already be at the bedside?
Bag-valve mask and suction.
A family asks the bedside nurse whether their loved one can donate organs. Who determines suitability and discusses donation with the family?
The organ procurement organization (OPO) or its designated representative. The nurse notifies the OPO and supports the family.
A mechanically ventilated patient suddenly triggers a high pressure alarm. The tubing is not kinked, but the patient has coarse breath sounds and visible secretions in the endotracheal tube. What should the nurse do first?
Suction the airway.
A client’s EKG shows a PR interval longer than 0.20 seconds, and every P wave is followed by a QRS complex. Which rhythm should the nurse identify?
First-degree AV block. The key finding is a prolonged PR interval with no dropped QRS complexes.
A postoperative client has large-volume gastric drainage through an NG tube. The nurse reviews the client ABG: pH 7.52, PaCO₂ 35, HCO₃ 29.
Uncompensated metabolic alkalosis.
An ICU nurse reports emotional exhaustion, detachment from patients, poor sleep, and difficulty leaving distressing cases at work. Which work-related problem should the nurse recognize and seek support for?
Burnout.
A client with end-stage disease declines further curative treatment and says, “I want to spend my remaining time at home.” The family wants to honor that wish but worries they cannot manage the client’s pain and shortness of breath. What should the nurse discuss first?
Home hospice care.
A client with sepsis develops ARDS and remains poorly oxygenated on a ventilator. Which positioning intervention may improve lung recruitment?
Prone positioning.
A client is recovering from cardiac catheterization after a myocardial infarction. During the nurse’s assessment, which new finding suggests that blood flow to the brain is impaired?
New onset of confusion
A nervous client awaiting surgery hyperventilates and feels dizzy. ABG: pH 7.57, PaCO₂ 26, HCO₃ 24.
Uncompensated respiratory alkalosis.
A client taking digoxin reports nausea and new visual changes; potassium is 2.2. What should the nurse suspect and do with the next scheduled dose?
Hold digoxin and contact the provider. Suspect digoxin toxicity.
Shortly after receiving succinylcholine for intubation, a patient develops jaw rigidity, a rapidly increasing end-tidal CO₂, and a rising temperature. Which medication should the nurse prepare to administer?
Dantrolene.
A client with severe ARDS is mechanically ventilated. The team orders a neuromuscular blocker to improve ventilator synchrony. Before administering it, what must the nurse ensure the client receives?
Give the prescribed sedation and pain medication.
After an MI, a client develops hypotension, cool clammy skin, confusion, low urine output, and pulmonary congestion. These findings suggest that the damaged heart cannot pump enough blood to perfuse organs. What complication should the nurse suspect?
Cardiogenic shock.
An infant has had diarrhea for four days and is breathing rapidly. ABG: pH 7.37, PaCO₂ 29, HCO₃ 15.
Fully compensated metabolic acidosis
A ventilator’s high-pressure alarm sounds. The client is coughing, and the nurse sees a kink in the tubing. What should the nurse do first?
Assess the client oxygenation
Three patients are being considered for organ donation: one has asthma, one patient who had one drink 10 years ago, and one who is HIV positive. Which patient has a condition that may prevent organ donation?
The HIV positive patient
While repositioning a patient, the chest tube drainage tubing separates from the collection system. What should the nurse do immediately to restore the water seal?
Place the distal end in sterile water.
A patient reports chest discomfort that began while resting and has continued for 15 minutes. The ECG shows new ischemic changes, and resting has not relieved the discomfort. Which cardiac condition should the nurse suspect?
Unstable angina.
A client is breathing rapidly and reports dizziness. The practice ABG is pH 7.48, PaCO₂ 25 mmHg, HCO₃ 20 mEq/L, PaO₂ 90 mmHg. What is the acid-base interpretation?
Partially compensated respiratory alkalosis.
A client returns after femoral arterial cardiac catheterization. The dressing is dry, but the affected foot is cooler than the other foot and its distal pulse is difficult to find. What assessment must the nurse prioritize?
Neurovascular assessment.