EMERGENCY & CRITICAL CARE
A patient suddenly becomes unresponsive. You check for responsiveness, call for help, and find that the patient is not breathing normally but has a pulse.
What is your next action?
Provide rescue breaths at a rate of one breath every six seconds while continuously monitoring the patient's pulse.
Explanation:
According to the American Heart Association (AHA), if an adult patient has a pulse but is not breathing normally, the priority is to support ventilation rather than begin chest compressions. Reassess the pulse every two minutes. If the pulse is lost, initiate high-quality CPR immediately.
A nurse is preparing to administer insulin.
Which assessment should always be performed immediately before giving rapid-acting insulin?
Check the patient's current blood glucose level.
Explanation:
Rapid-acting insulin begins working within minutes. Administering it without confirming blood glucose may cause severe hypoglycemia.
An ECG shows an irregularly irregular rhythm without visible P waves.
Which dysrhythmia is most likely present?
Atrial fibrillation
Explanation:
Atrial fibrillation is characterized by chaotic atrial activity and an irregular ventricular response, increasing the risk of thromboembolic stroke.
A nurse receives four call lights simultaneously.
Which patient should be assessed first?
A. A patient requesting pain medication.
B. A patient who needs assistance to the bathroom.
C. A patient with new-onset chest pain.
D. A patient requesting a blanket.
C. A patient with new-onset chest pain.
Explanation
Chest pain may indicate acute coronary syndrome, making it the highest priority using the ABCs and urgent assessment principles.
A patient's urine output has been less than 30 mL/hour for the past three hours.
What is the nurse's priority assessment?
Assess the patient's fluid status and renal perfusion.
Explanation:
Persistent oliguria may indicate hypovolemia, acute kidney injury, or poor cardiac output. Early assessment can prevent further deterioration.
A patient with septic shock has a blood pressure of 78/45 mmHg despite receiving 30 mL/kg of crystalloid fluids.
Which vasopressor should be started first?
Norepinephrine
Explanation:
Norepinephrine is the first-line vasopressor recommended by the Surviving Sepsis Campaign because it effectively increases mean arterial pressure with fewer arrhythmias than dopamine.
A physician prescribes potassium chloride IV push for a patient with hypokalemia.
What should the nurse do?
Question the order and do not administer the medication.
Explanation:
Potassium chloride must never be given as an IV push because it can cause fatal cardiac arrhythmias and cardiac arrest.
A patient is conscious but develops supraventricular tachycardia (SVT) with a heart rate of 180 beats per minute.
What intervention should be attempted first?
Vagal maneuvers
Explanation:
For stable SVT, vagal maneuvers are the initial intervention because they may terminate the arrhythmia by increasing vagal tone.
A patient suddenly becomes confused and restless after surgery.
Which condition should the nurse suspect first?
Hypoxia
Explanation:
Acute confusion after surgery is often an early sign of inadequate oxygenation. Oxygen saturation should be assessed immediately.
A ventilated patient suddenly becomes agitated and begins "fighting the ventilator."
What should the nurse assess first?
Airway patency and ventilator tubing.
Explanation
Always evaluate for mechanical problems such as airway obstruction, kinking, disconnection, or secretions before administering sedatives.
A patient suddenly develops hypotension, distended neck veins, and muffled heart sounds after chest trauma.
Which life-threatening condition should the nurse suspect first?
Cardiac tamponade
Explanation:
These three findings form Beck's Triad, which strongly suggests cardiac tamponade. Blood accumulates inside the pericardial sac, compressing the heart and preventing adequate ventricular filling. Immediate pericardiocentesis is usually required.
A patient receiving heparin develops bleeding gums and hematuria.
Which laboratory value should the nurse review first?
Activated Partial Thromboplastin Time (aPTT)
Explanation:
The aPTT measures the anticoagulant effect of unfractionated heparin and helps determine whether the medication is within the therapeutic range.
A patient suddenly develops ventricular tachycardia without a pulse.
What is the first treatment?
Immediate defibrillation followed by high-quality CPR.
Explanation:
Pulseless ventricular tachycardia is a shockable rhythm requiring immediate defibrillation according to ACLS guidelines.
Which hospitalized patient has the highest risk of developing a pressure injury?
An immobile patient with poor nutrition and urinary incontinence.
Explanation:
Immobility, malnutrition, moisture, and decreased tissue perfusion significantly increase pressure injury risk.
A patient's central venous pressure rises from 8 mmHg to 18 mmHg while blood pressure continues to decrease.
Which complication should the nurse suspect?
Obstructive shock, such as cardiac tamponade or tension pneumothorax.
Explanation:
An elevated CVP combined with hypotension suggests impaired cardiac filling rather than simple hypovolemia. Prompt evaluation is essential.
During rapid sequence intubation, the patient's oxygen saturation suddenly falls from 98% to 72%.
What is the nurse's immediate priority?
Stop the intubation attempt and provide bag-valve-mask ventilation with 100% oxygen.
Explanation:
Preventing hypoxia always takes priority over completing the intubation. Oxygenation should be restored before another intubation attempt is made.
A patient receiving digoxin reports nausea, blurred vision, and seeing yellow halos around lights.
What should the nurse suspect?
Digoxin toxicity
Explanation:
Classic manifestations of digoxin toxicity include gastrointestinal symptoms, visual disturbances, and cardiac arrhythmias. Serum digoxin and potassium levels should be assessed immediately.
A patient develops ST-segment elevation in leads II, III, and aVF.
Which area of the heart is most likely affected?
Inferior wall myocardial infarction
Explanation:
Leads II, III, and aVF represent the inferior portion of the left ventricle, typically supplied by the right coronary artery.
A patient receiving oxygen at 2 L/min suddenly becomes short of breath with an SpO₂ of 82%.
What is the nurse's priority?
Assess the airway and increase oxygen delivery while notifying the healthcare provider or activating the rapid response team if needed.
Explanation:
Airway and breathing are always the first priorities. The nurse should intervene immediately to improve oxygenation before focusing on diagnostic testing.
A patient with acute respiratory distress syndrome (ARDS) is receiving mechanical ventilation.
Which ventilator strategy has been shown to improve survival?
Low tidal-volume ventilation (approximately 6 mL/kg of predicted body weight).
Explanation:
Lung-protective ventilation reduces ventilator-induced lung injury by limiting alveolar overdistension and improving outcomes in patients with ARDS.
A mechanically ventilated patient suddenly develops severe hypotension, absent breath sounds on the right side, and tracheal deviation toward the left.
What complication is most likely occurring?
Tension pneumothorax
Explanation:
Positive-pressure ventilation may worsen a pneumothorax, causing increased intrathoracic pressure that shifts the mediastinum and impairs venous return. Immediate needle decompression followed by chest tube insertion is required.
A patient accidentally receives ten times the prescribed dose of morphine and becomes difficult to arouse with a respiratory rate of six breaths per minute.
Which medication should the nurse prepare immediately?
Naloxone
Explanation:
Naloxone is an opioid antagonist that rapidly reverses opioid-induced respiratory depression. Airway management remains the highest priority.
A patient in ventricular fibrillation has received three shocks, epinephrine, and CPR. The rhythm remains ventricular fibrillation.
Which medication should be administered next?
Amiodarone 300 mg IV/IO bolus
Explanation:
According to ACLS guidelines, amiodarone is recommended for refractory ventricular fibrillation or pulseless ventricular tachycardia after repeated defibrillation attempts.
A nurse has four patients.
Which patient should be assessed first?
The patient with diabetic ketoacidosis and a potassium level of 2.8 mmol/L.
Explanation:
Severe hypokalemia can lead to life-threatening cardiac dysrhythmias. This patient requires immediate assessment and potassium replacement before insulin therapy continues.
A septic patient initially improves after fluid resuscitation. Two hours later, the patient's lactate level rises from 2.5 mmol/L to 5.8 mmol/L despite maintaining a mean arterial pressure above 65 mmHg.
What does the elevated lactate most likely indicate?
Persistent tissue hypoperfusion and ongoing cellular hypoxia despite adequate macrocirculation.
Explanation:
A normal blood pressure does not guarantee adequate tissue perfusion. Rising lactate levels suggest that oxygen delivery at the cellular level remains insufficient, indicating ongoing shock or impaired oxygen utilization. This finding warrants immediate reassessment of perfusion, source control, cardiac function, and the effectiveness of ongoing resuscitation.