Drips + Drugs
A patient in cardiogenic shock is started on dobutamine. Which finding would prompt the nurse to titrate the drip DOWN?
A. Blood pressure rises from 88/54 to 102/68
B. Heart rate increases from 78 to 130 with new PVCs
C. Extremities become warmer to touch
D. Urine output improves to 40 mL/hr
B. Heart rate increases from 78 to 130 with new PVCs
The nurse is caring for a client with an intra-aortic balloon pump (IABP). Which finding requires immediate notification of the provider?
What is absence of a pedal pulse or a cool, pale extremity distal to the insertion site? Rationale: This suggests limb ischemia from the femoral catheter a limb-threatening emergency
The nurse is preparing a client for elective electrical cardioversion for atrial fibrillation. Which pre-procedure action is a priority?
What is verifying the client has been anticoagulated appropriately (or a transesophageal echo has ruled out atrial thrombus)? Rationale: Cardioversion can dislodge an atrial thrombus, causing embolic stroke, if the client hasn't been adequately anticoagulated.
Which term describes a permanent, localized dilation of an artery to at least 1.5 times its normal diameter, most often affecting the abdominal or thoracic aorta?
An aortic aneurysm.
A client 6 hours post-CABG has a chest tube output of 250 mL in the last hour (previously averaging 40 mL/hr), with a heart rate of 118 bpm and BP 92/58 mmHg. The nurse suspects which complication?
Postoperative hemorrhage/bleeding.
The nurse notes a patients nitroprusside infusion has been running for 48 hours. Which laboratory value should the nurse monitor closely for signs of toxicity?
What is thiocyanate/cyanide level? Rationale: Prolonged nitroprusside use, especially with renal impairment, risks cyanide/thiocyanate toxicity
A client with a ventricular assist device (VAD) reports new shortness of breath and the nurse notes jugular venous distention and hepatomegaly. Which complication does the nurse suspect?
What is right ventricular failure (RVF)? Rationale: VADs support the left ventricle; if the right ventricle can't keep pace with increased venous return, RVF develops.
A client becomes unresponsive and pulseless with ventricular fibrillation on the monitor. Place the nurse's actions in the correct order: (A) Resume chest compressions immediately after the shock, (B) Deliver defibrillation, (C) Begin chest compressions, (D) Confirm the rhythm and absence of a pulse, (E) Administer epinephrine during ongoing compressions.
D, C, B, A, E.
A client in hypertensive crisis has a BP of 220/128 mmHg, new confusion, blurred vision, and a headache. Which finding tells the nurse this is a hypertensive emergency rather than hypertensive urgency?
Evidence of new target-organ damage (the neurologic changes confusion, blurred vision) accompanying the severe BP elevation, not the BP number alone.
The nurse is caring for a client recovering in the ICU after cardiac surgery involving cardiopulmonary bypass. The client's core temperature is 34.8°C (94.6°F). Which nursing action is the priority?
Initiate active rewarming measures and monitor core temperature closely.
A patient on a norepinephrine infusion for septic shock develops cool, mottled fingertips with delayed capillary refill. Which is the priority nursing action and why?
What is notifying the provider of peripheral ischemia and anticipating a possible dose adjustment or line site change? Rationale: Norepinephrine's potent alpha-adrenergic vasoconstriction can compromise peripheral perfusion; recognizing early ischemic signs prevents tissue necrosis.
The nurse is monitoring a client on the IABP and observes the balloon inflating late relative to the dicrotic notch on the arterial waveform. What is the expected consequence of this timing error?
What is decreased diastolic augmentation and reduced effectiveness of coronary perfusion support? Rationale: Correct inflation at the dicrotic notch (aortic valve closure) maximizes diastolic augmentation; late timing blunts the therapeutic benefit.
A client with a dual-chamber pacemaker (DDD) has a rhythm strip showing pacer spikes with no following QRS complexes at the expected rate. The client is asymptomatic with a heart rate of 68 in a normal underlying rhythm. What does the nurse recognize, and is this an emergency?
This is failure to capture, but because the client has an adequate underlying intrinsic rhythm, it is not an immediate emergency the nurse should still notify the provider and monitor closely, since the client would be at risk if the intrinsic rhythm failed.
The nurse is comparing two clients: one with a stable, chronic thoracic aortic aneurysm and one with an acute aortic dissection. Which finding is expected ONLY in the client with the acute dissection?
What is sudden-onset severe pain with pulse or blood pressure differences between extremities?
A client is 2 hours post-CABG. The nurse notes a sudden decrease in chest tube output from 80 mL/hr to 5 mL/hr, along with hypotension, jugular venous distention, and muffled heart sounds. Which complication does the nurse suspect?
Cardiac tamponade
Rationale: Sudden cessation of chest tube drainage with these findings suggests blood is pooling in the pericardial sac rather than draining, compressing the heart.
A patient in cardiogenic shock is on a dobutamine infusion for inotropic support. The provider also orders a beta-blocker (metoprolol) for a new finding of rate-related myocardial ischemia on the same shift. The nurse recognizes a potential conflict between these two orders. What is the nurse's priority action, and why?
The nurse should hold the metoprolol and clarify the order with the provider before administering it, because beta-blockers directly antagonize the beta-adrenergic mechanism dobutamine relies on for its inotropic effect giving both simultaneously could blunt dobutamine's benefit and worsen the client's cardiogenic shock, even though the beta-blocker is reasonable for the ischemia indication in isolation.
The nurse is caring for a client on ECMO. Rank the following nursing priorities from HIGHEST to LOWEST: (1) Assess distal limb perfusion at the cannulation site, (2) Monitor oxygenator/circuit function, (3) Monitor coagulation labs for bleeding risk, (4) Provide sedation and comfort measures.
What is 2, 1, 3, 4? Rationale: Circuit/oxygenator integrity is the life-support mechanism itself (airway/breathing equivalent), followed by limb perfusion (circulation), then bleeding surveillance, then comfort.
A client's pacemaker is coded as "VVI." The nurse understands this means the device does which of the following?
What is pace the ventricle, sense the ventricle, and inhibit pacing when intrinsic ventricular activity is sensed? Rationale: Understanding the NBG code (chamber paced, chamber sensed, response to sensing) is essential for interpreting pacemaker function and identifying malfunction.
A client with a known abdominal aortic aneurysm (AAA) reports new, severe abdominal and back pain with a drop in blood pressure from 148/86 to 90/58 mmHg. Which nursing actions are appropriate? Select all that apply: (A) Notify the provider/rapid response immediately, (B) Establish or verify large-bore IV access, (C) Encourage the client to ambulate to assess pain tolerance, (D) Prepare for likely emergent surgical intervention, (E) Continue routine q4h vital sign monitoring.
What are A, B, D?
Which statement correctly differentiates valvular stenosis from valvular insufficiency?
Stenosis creates a pressure overload as the chamber works harder to eject or fill past a narrowed valve, while insufficiency creates a volume overload from blood regurgitating backward.
Rationale: This distinction explains differing hypertrophy (stenosis) versus dilation (insufficiency) patterns over time.
Which inotrope is classified as a phosphodiesterase III inhibitor and carries the highest risk of hypotension due to its combined inotropic and vasodilatory effect?
A. Milrinone
B. Norepinephrine
C.Vasopressin
D. Dopamine
A. Milrinone
A patient in cardiogenic shock is on dobutamine and norepinephrine infusions. Over the past hour, the nurse notes the heart rate has climbed from 92 to 138, the client reports new chest discomfort, and the cardiac monitor shows occasional PVCs. The nurse pages the provider, who is currently in another emergency and says over the phone, "Just increase the dobutamine to improve the cardiac output,I'll be there when I can." The nurse also recalls the client's last potassium level, drawn 6 hours ago, was 3.2 mEq/L What is the nurse's priority action, and what is the reasoning?
The nurse's priority is to hold off on increasing the dobutamine and instead escalate concern to the provider (or a supervisor/rapid response if unavailable), because the new tachycardia, chest discomfort, and PVCs in the context of an unaddressed low potassium level raise a concern for hypokalemic dysrhythmias
A client in the ICU with a history of an ICD goes into VF. The ICD fires once but the client remains in VF on the monitor and is unresponsive. Bystander CPR was not started because staff assumed the ICD would resolve it. It has now been over a minute since the arrest was witnessed. What are the nurse's priority actions, and what was the critical error in the response so far?
begin chest compressions immediately, call for the code team/crash cart, prepare for external defibrillation regardless of the ICD, and continue standard ACLS. Critical error: an ICD firing does not replace CPR — compressions should have started immediately when the client was found unresponsive/pulseless, since ICD shocks can fail to convert the rhythm and the client had no perfusion for over a minute without compressions.
A client with a thoracic aortic aneurysm develops sudden severe back pain and hypotension. The nurse must decide between three hypotheses: (1) musculoskeletal back strain, (2) aortic rupture/dissection, (3) renal colic. Which is the priority hypothesis to act on, and why?
What is aortic rupture/dissection, because it is immediately life-threatening and the sudden pain plus hemodynamic instability in a known aneurysm client cannot be attributed to a benign cause until ruled out?
A client is post-op day 1 from a carotid endarterectomy. Vital signs show BP 185/100 mmHg, and the nurse notes new slurred speech and right facial droop. Prioritize the nurse's next three actions.
(1) Immediately notify the provider/activate rapid response for a new focal neurologic deficit, (2) manage BP per protocol (commonly ~120–170 mmHg, avoiding both hyper- and hypotension), (3) continue frequent neuro checks and assess the operative site for hematoma or airway compromise.
Rationale: New neuro deficits post-CEA suggest stroke, hyperperfusion syndrome, or an expanding hematoma all urgent; BP control matters because both baroreflex failure and hyperperfusion syndrome are recognized post-op risks.