Respiratory Emergencies
A patient with a pneumothorax suddenly develops tracheal deviation, severe dyspnea, and JVD. What is the priorityimmediate intervention?
Needle decompression in the 2nd ICS mid-clavicular line.
Which clinical finding differentiates HHS from DKA?
Marked hyperosmolarity and absence of significant acidosis/ketones.
Which finding is most concerning for worsening left-sided heart failure?
New onset crackles and increasing dyspnea.
Which intervention best prevents increased ICP?
Keep HOB 30° with neutral neck alignment.
What finding indicates prerenal AKI?
Urine specific gravity >1.030 (concentrated).
A client with a large pleural effusion is scheduled for a thoracentesis. What finding requires the nurse to hold the procedure and notify the provider?
INR 3.5 (high bleeding risk).
A DKA patient has K⁺ = 3.1 mEq/L. What is the priority action before initiating insulin infusion?
Replace potassium to prevent life-threatening arrhythmias.
A patient with ACS arrives with ongoing chest pain unrelieved by nitro ×3. What is the nurse’s priority?
Start MONA protocol: give morphine for persistent ischemic pain.
BONUS: what is MONA?
A TBI patient becomes agitated, with widened pulse pressure and irregular respirations. What does this indicate?
Cushing’s triad → impending brain herniation.
A patient with ESRD has peaked T waves. What is the immediate treatment?
IV calcium gluconate to stabilize the cardiac membrane.
A patient with ARDS on a ventilator has worsening PaO₂ despite FiO₂ 100%. Which intervention aligns with evidence-based management?
Initiate prone positioning to improve oxygenation.
Which fluid is expected first in treating DKA or HHS?
0.9% NS (aggressive isotonic fluid resuscitation).
A patient with pericarditis reports sudden relief of chest pain when sitting forward. What is the major complication the nurse must monitor for?
Cardiac tamponade.
Which client with suspected stroke is eligible for tPA?
Symptom onset < 4.5 hrs, BP < 185/110, no bleed on CT.
Which early sign suggests progression from sepsis to septic shock?
Persistent hypotension despite fluids.
A client with acute respiratory failure has the following ABG: pH 7.28, PaCO₂ 68, HCO₃⁻ 25. Which ventilator mode adjustment is expected?
Increase respiratory rate to blow off CO₂ (correct respiratory acidosis).
DKA treatment causes a rapid drop in serum glucose. Why do nurses add dextrose to IV fluids?
To prevent hypoglycemia and cerebral edema.
Which ECG rhythm requires immediate defibrillation?
Ventricular fibrillation.
A patient with ischemic stroke suddenly becomes lethargic after tPA. What is the priority?
Stop tPA and assess for intracranial hemorrhage.
A patient with SIRS develops increasing creatinine, altered mentation, and liver dysfunction. What complication is developing?
MODS (multi-organ dysfunction syndrome).
A post-op patient suddenly develops sharp CP, tachycardia, hypoxia, and restlessness. What is the FIRST action?
Apply high-flow O₂ via non-rebreather (suspected pulmonary embolism).
A patient recovering from DKA shows increased CO₂ and rising bicarbonate. What does this indicate?
Metabolic acidosis is resolving (closing anion gap).
A post-MI patient suddenly develops hypotension, muffled heart sounds, and JVD. What is the priority action?
Emergency pericardiocentesis for tamponade.
A severe TBI patient has ICP 28 mmHg despite sedation. Which evidence-based intervention is next?
Hypertonic saline 3% infusion to reduce cerebral edema.
A patient with severe aortic stenosis develops syncope and chest pain. What is the priority intervention?
Prepare for emergent valve replacement (definitive treatment).