Acid–Base & Oxygenation
A patient’s ABG shows pH 7.30, PaCO₂ 55 mm Hg, HCO₃⁻ 24 mEq/L.
Question: What imbalance is present?
Respiratory acidosis
Rationale: High CO₂ and low pH indicate hypoventilation and CO₂ retention
Which intervention should the nurse expect first for chest pain suspected to be MI?
A. 12-lead ECG B. O₂ 2 L/min C. Morphine IV D. Thrombolytic therapy
B. Obtain a 12-lead ECG
Rationale: ECG within 10 minutes is priority for diagnosis and reperfusion decision
List the 6 Ps of acute arterial ischemia.
Answer: Pain, Pallor, Pulselessness, Paresthesia, Paralysis, Poikilothermia (coolness)
Which immunoglobulin is elevated in allergic rhinitis?
IgE with eosinophils
Identify the priority treatment for ventricular fibrillation.
Immediate CPR and defibrillation
Rationale: VF is a lethal rhythm; early defibrillation saves lives
Which action should the nurse take first when a COPD patient on 4 L O₂ via nasal cannula becomes drowsy and has an end-tidal CO₂ increase?
A. Decrease O₂ to 1–2 L/min B. Place patient supine C. Encourage deep breathing D. Notify provider immediately
A. Decrease O₂ to 1–2 L/min
Rationale: Excess oxygen can suppress the hypoxic drive, causing oxygen-induced hypoventilation
A client with chest pain has elevated troponins and ST depression. What is the diagnosis?
NSTEMI
Rationale: ST depression with elevated troponins = non-ST-elevation MI
A patient with Raynaud’s reports finger color changes in cold weather. What should the nurse instruct the patient to do?
Wear warm gloves and avoid sudden temperature changes.
Rationale: Prevents vasospasm by maintaining warmth and consistent circulation to the extremities.
Client with influenza asks why antibiotics weren’t prescribed. Nurse’s best response?
“Antibiotics don’t work against viruses.”
After the insertion of a permanent pacemaker, what key discharge teaching should the nurse include for the patient to promote safety and proper device function? Name 2
Patients should check their pulse daily to ensure the pacemaker is functioning, avoid lifting the affected arm or raising it above shoulder level for 4–6 weeks, keep the incision site clean and dry, and report redness, drainage, or fever immediately.
What acid base is this?
pH 7.50 / PaCO₂ 30 mm Hg / HCO₃⁻ 24 mEq/L
Respiratory alkalosis
Rationale: Low PaCO₂ with high pH indicates hyperventilation.
The nurse notes VT after an MI. What is the priority?
Prepare for immediate defibrillation if unstable
Rationale: Ventricular tachycardia can progress to VF and cardiac arrest
After an EVAR (Endovascular Aneurysm Repair), these postoperative findings would cause concern because they may indicate serious complications such as graft occlusion, embolization, or bleeding. Name one
Absent pedal pulses, cool or pale extremities, decreased urine output, new or severe back or abdominal pain, hypotension, and tachycardia
Rationale: These findings may signal graft occlusion, renal artery involvement, or endoleak/rupture, all of which require immediate intervention. Monitoring circulation, renal perfusion, and hemodynamic stability is critical after EVAR.
Which findings in a tonsillectomy patient indicate bleeding? (Select all that apply.)
A. Frequent swallowing B. Tachycardia C. Restlessness D. Green emesis
A, B, C
Rationale: Frequent swallowing, tachycardia, and restlessness are early signs of bleeding after a tonsillectomy.
Which drug combination improves outcomes post-MI? (Select all that apply.)
A. Beta-blocker B. ACE inhibitor C. Aspirin D. Calcium supplement
Beta-blockers, ACE inhibitors, and aspirin are core post-MI therapies that reduce mortality, prevent cardiac remodeling, and decrease recurrence. Calcium supplements have no role in post-MI management.
A client with pneumonia develops respiratory acidosis. Which nursing interventions help improve ventilation? (Select all that apply.)
A. Incentive spirometer B. Ambulation C. High-Fowler’s position D. Restrict fluids
A, B, C
Rationale: Promotes alveolar expansion and gas exchange
In hypertensive emergency (BP 214/116 mm Hg, blurred vision), what should be initiated first?
Start IV antihypertensive and continuous BP monitoring
Rationale: Prevent target-organ damage and gradual BP reduction
A patient with endocarditis suddenly develops confusion and hemiparesis. What complication is suspected?
Embolic stroke
Rationale: Vegetations can break off and embolize to the brain
What assessment suggests pleural effusion rather than pneumonia?
Diminished breath sounds and dullness on percussion
Rationale:
Pleural effusion causes fluid to collect in the pleural space, leading to decreased air movement and muffled or absent breath sounds, whereas pneumonia causes crackles and increased breath sounds from lung tissue consolidation.
A patient on digoxin and furosemide has clear lungs and normal HR. What does this indicate?
Therapeutic response, improved cardiac output and reduced pulmonary congestion
Explain the “ROME” rule for acid–base interpretation.
Respiratory = Opposite, Metabolic = Equal
Rationale: In respiratory disorders, pH and PaCO₂ move in opposite directions; in metabolic, they move the same way
Rank the stages of MI healing in correct order:
Granulation tissue, Necrosis begins, Ventricular remodeling, Scar formation, Inflammatory infiltration
Answer 1 Necrosis begins 2 Inflammatory infiltration 3 Granulation tissue 4 Scar formation 5 Ventricular remodeling
Rationale: Reflects progression from cell death to scar tissue and remodeling
Rheumatic fever occurs __ weeks after __ infection and primarily affects the __ causing __ that can progress to __.
Rheumatic fever occurs 2–3 weeks after group A streptococcal pharyngitis infection and primarily affects the heart, causing valvular scarring that can progress to rheumatic heart disease.
A patient with idiopathic pulmonary fibrosis reports exertional dyspnea. What teaching is most appropriate?
Use pursed-lip breathing during activity
Rationale: Maintains airway pressure and improves gas exchange
A client on clonidine abruptly stops the drug. What is the nurse’s concern?
Rebound hypertension
Rationale: Sudden withdrawal triggers sympathetic surge