Burns and Shock
A burn patient arrives with singed nasal hairs and hoarseness. What is the nurse's priority?
Secure the airway and prepare for intubation.
Which dysrhythmia has no identifiable P waves and an irregularly irregular rhythm?
Atrial fibrillation.
What ventilator intervention helps reduce the risk of aspiration and VAP?
Elevate the head of the bed 30 to 45 degrees.
Which endocrine disorder causes concentrated urine and hyponatremia?
SIADH.
During START triage, which color is assigned to walking wounded?
Green
Which medication prevents platelet aggregation during an acute MI?
Aspirin.
Which fluid is used during the first 24 hours of burn resuscitation?
Lactated Ringer's.
Which medication is commonly given first for symptomatic bradycardia?
Atropine.
A ventilator's high-pressure alarm suddenly sounds. What should the nurse assess first?
The patient for secretions, coughing, or airway obstruction.
A patient has polyuria, hypernatremia, and dilute urine. Which disorder is most likely?
Diabetes insipidus.
Which type injury primarily affects the lungs and tympanic membranes? (think trauma/terrorism)
Primary blast injury.
Which medication increases myocardial contractility in cardiogenic shock?
Dobutamine.
A patient with circumferential burns develops weak radial pulses and cool fingers. What complication is occurring?
Compartment syndrome requiring an escharotomy.
A rhythm has progressively longer PR intervals until one QRS is dropped. What rhythm is this?
Second-degree AV block Type I (Mobitz I).
Which assessment finding best differentiates ARDS from routine pneumonia?
Severe hypoxemia that is difficult to correct with oxygen.
Which medication is commonly used to treat diabetes insipidus?
Desmopressin (DDAVP).
A patient arrives after a chemical spill. What should the nurse do before beginning a head-to-toe assessment?
Remove contaminated clothing and begin decontamination.
Which laboratory value is most useful for evaluating tissue perfusion during shock?
Serum lactate.
A patient with septic shock has warm flushed skin and BP 82/48. Which intervention should occur FIRST?
Begin aggressive IV fluid resuscitation.
A patient suddenly loses consciousness and the monitor shows ventricular fibrillation. What is the priority intervention?
Immediate defibrillation.
A postoperative patient suddenly develops dyspnea, tachycardia, and pleuritic chest pain. What condition should the nurse suspect?
Pulmonary embolism.
A patient becomes difficult to arouse after a head injury and develops unequal pupils. What complication should the nurse suspect?
Increased intracranial pressure.
A trauma patient has bowel protruding from the abdomen. What is the priority nursing intervention?
Cover with a sterile saline-moistened dressing.
A patient receiving heparin begins bleeding from the gums. Which laboratory test should the nurse review?
aPTT.
Four hours after a 50% TBSA burn, urine output is only 10 mL/hr. What does this most likely indicate?
Inadequate fluid resuscitation.
Following pacemaker insertion, the ECG shows pacing spikes without QRS complexes. What complication has occurred?
Failure to capture.
During endotracheal suctioning, the patient's heart rate drops from 92 to 48 bpm. What should the nurse do?
Stop suctioning immediately and oxygenate the patient.
A patient receiving hypertonic saline suddenly becomes confused and develops pulmonary edema. What serious complication is occurring?
Fluid overload from hypertonic saline.
Following blunt abdominal trauma, a patient reports left shoulder pain. Which organ injury should the nurse suspect?
Splenic injury (Kehr's sign).
A nurse is preparing IV potassium chloride. What important safety principle should always be followed?
Never administer potassium IV push.
A patient has HR 132, BP 110/70, lactate 5.2, cool skin, and confusion. Why is this patient already considered to be in shock despite a "normal" blood pressure?
Shock is identified by tissue hypoperfusion; hypotension is a late finding.
A patient with an acute MI develops crackles, hypotension, and cool clammy skin after receiving several liters of IV fluids. Which type of shock has most likely developed?
Cardiogenic shock.
A patient receiving mechanical ventilation has bilateral infiltrates, severe hypoxemia, normal cardiac function, and requires high PEEP. What syndrome is occurring?
Acute Respiratory Distress Syndrome (ARDS).
A patient with Cushing syndrome suddenly becomes hypotensive after bilateral adrenalectomy. Which life-threatening complication should the nurse suspect?
Acute adrenal insufficiency (Addisonian crisis).
Five patients arrive simultaneously after a building collapse. Which patient should receive the RED tag?
The patient with life-threatening injuries who is likely to survive with immediate treatment.
A patient with septic shock has a MAP of 58 mmHg after receiving 30 mL/kg of IV fluids. What intervention should the nurse anticipate next?
Initiation of a vasopressor (such as norepinephrine) to achieve a MAP of at least 65 mmHg.