Blood Flows Like the Wind Blows
Which hemodynamic pressure best reflects right ventricular preload?
Central Venous Pressure
This rhythm presents with a rapid, regular narrow-complex tachycardia around 150–250 bpm, often with no visible P waves, and the first intervention in a stable patient is a non-pharmacologic maneuver.
SVT
This condition presents with a pulsatile abdominal mass and may be asymptomatic until rupture, when the patient develops sudden hypotension and back pain.
abdominal aortic aneurysm (AAA)
This ABG shows pH 7.30, PaCO₂ 55 mmHg, HCO₃⁻ 24 mEq/L and indicates this primary problem.
uncompensated respiratory acidosis
A BP of 220/120 with signs of end-organ damage such as confusion or chest pain defines this condition.
hypertensive emergency
Which intervention has the highest priority for a patient in ventricular fibrillation?
Immediate defibrillation
A patient is conscious with a wide-complex tachycardia at 180 bpm, complaining of chest pain and hypotension. This intervention should be performed immediately.
Synchronized cardioversion
A patient presents with sudden, severe “tearing” chest pain radiating to the back and unequal blood pressures between arms. This is the most likely diagnosis.
aortic dissection
A ventilated patient has PaCO₂ 72 mmHg and pH 7.18. This ventilator adjustment is most appropriate.
increasing the respiratory rate (or tidal volume) to improve ventilation
In hypertensive emergency, the goal is to reduce mean arterial pressure by this percentage within the first hour.
no more than 25%?
What is the primary purpose of an arterial line?
To obtain continuous blood pressure readings.
This lethal rhythm shows chaotic, irregular deflections with no identifiable QRS complexes, and the priority intervention is immediate unsynchronized shock.
Ventricular fibrillation-Defibrillation immediately
A patient with suspected aortic dissection has BP 190/100 and HR 110. This is the priority medication strategy.
rapid blood pressure control using IV beta-blockers (e.g., esmolol or labetalol)?
A ventilated patient has PaO₂ 52 mmHg despite FiO₂ 0.80. This ventilator change is indicated.
increasing PEEP
A patient on nitroprusside drops from 220/120 to 150/88 in 20 minutes. This is the priority nursing action.
decrease the infusion rate
This test is a bedside vascular assessment that is used to evaluate arterial blood flow to the hand, specifically the patency of the radial and ulnar arteries
Allen Test
A patient in SVT receives adenosine and briefly becomes asystolic on the monitor. The nurse should take this action next.
Continue to monitor the patient, as transient asystole is an expected effect of adenosine
A patient with an abdominal aortic aneurysm reports severe abdominal pain and hypotension. This common nursing action should be avoided.
What is aggressive palpation of the abdomen
A high-pressure alarm sounds and the patient is agitated and coughing. This is the nurse’s first action.
assess the patient for causes such as biting the tube, secretions, or bronchospasm
A nurse rapidly lowers a patient’s BP from 220/120 to 120/70 within 30 minutes. This complication is most likely to occur.
ischemia due to decreased perfusion (e.g., stroke, myocardial infarction, or kidney injury)
A patient in septic shock develops oozing from IV sites, petechiae on the trunk, and hematuria. What syndrome do you suspect is developing?
Multiple Organ Dysfunction Syndrome
Two patients present with atrial fibrillation. One is stable with HR 110; the other is hypotensive and altered. These are the two different initial management strategies.
rate control (beta-blocker or calcium channel blocker) for stable AFib, and synchronized cardioversion for unstable AFib
A patient with a known thoracic aneurysm suddenly becomes hypotensive, pale, and diaphoretic. This is the nurse’s first action.
What is initiate large-bore IV access and prepare for rapid fluid/blood resuscitation
An ABG shows pH 7.48, PaCO₂ 30 mmHg, HCO₃⁻ 24 mEq/L. This condition is present and this is the likely cause.
respiratory alkalosis caused by hyperventilation
A patient in hypertensive crisis develops dyspnea and crackles in both lungs. This type of end-organ damage is occurring and requires immediate intervention.
What is acute pulmonary edema (cardiac end-organ damage)