ARF & ARDS
An intubated patient has ABG results of pH 7.32, PaCO₂ 48 mmHg, and PaO₂ 52 mmHg on FiO₂ 0.80. Despite high oxygen delivery, hypoxemia persists due to this underlying mechanism.
What is shunting caused by alveolar flooding and collapse in ARDS.
Key concept = oxygen can’t reach perfused alveoli → refractory hypoxemia
A patient has urine output <400 mL/day, rising creatinine, hyperkalemia, and fluid overload with crackles. This phase of acute kidney injury is occurring.
oliguric phase of acute kidney injury
A patient with liver failure becomes confused and develops asterixis due to accumulation of this substance.
ammonia
This condition is characterized by hyperglycemia, ketosis, metabolic acidosis, and Kussmaul respirations.
DKA
A patient presents with hypothermia, bradycardia, hypotension, and altered mental status. This life-threatening endocrine condition is most likely occurring.
myxedema coma
A nurse increases tidal volume in a patient with ARDS to improve oxygenation. This complication is most likely to occur as a result.
barotrauma or volutrauma due to alveolar overdistention
A patient with AKI has potassium 6.4 mEq/L, peaked T waves, and muscle weakness. This is the immediate priority intervention.
initiate treatment for hyperkalemia (e.g., calcium gluconate, insulin with dextrose, or dialysis)
This medication is given in hepatic encephalopathy to reduce ammonia by trapping it in the GI tract.
lactulose
This condition presents with severe hyperglycemia, profound dehydration, and minimal or no ketosis.
hyperosmolar hyperglycemic state (HHS)
A patient presents with temperature 40°C (104°F), heart rate 160 bpm, agitation, and hypotension. This life-threatening endocrine condition is most likely occurring.
thyroid storm
everything is sped up (hypermetabolic crisis)
A patient with sepsis becomes increasingly dyspneic with bilateral crackles, refractory hypoxemia, and requires escalating oxygen support. This diagnosis should be suspected.
acute respiratory distress syndrome (ARDS)
A patient has anemia, hypocalcemia, hyperphosphatemia, and a history of long-standing diabetes. These findings indicate this condition rather than acute kidney injury.
chronic kidney disease
CKD pattern = chronic changes (bone, RBC, electrolytes)
AKI = sudden change
A patient with hepatic encephalopathy is given high-protein meals to improve nutrition. This complication may worsen.
increased ammonia levels and worsening encephalopathy
protein → ammonia production
A patient presents with DKA and BP 88/54 mmHg. This is the first intervention.
initiate IV fluid resuscitation with normal saline
A patient in thyroid storm is tachycardic and febrile. This is the priority medication to reduce life-threatening complications.
beta-blocker (e.g., propranolol)
A ventilated patient with ARDS has worsening oxygenation despite FiO₂ 100%. This ventilator adjustment is most appropriate before increasing oxygen further.
What is increasing PEEP to improve alveolar recruitment
FiO₂ already maxed → recruit alveoli with PEEP
A nurse rapidly administers large volumes of IV fluids to a patient in the oliguric phase of AKI with crackles and edema. This complication is most likely to occur.
pulmonary edema from fluid overload
A patient with liver failure develops rising creatinine and low urine output without structural kidney damage due to this underlying mechanism.
renal vasoconstriction in hepatorenal syndrome
A nurse administers insulin before correcting fluid volume in DKA. This complication is most likely.
worsening hypotension due to fluid shifts?
Trap = insulin early → intravascular collapse risk
This condition involves elevated thyroid hormones without severe systemic instability, unlike thyroid storm.
thyrotoxicosis
Storm = crisis + instability
Thyrotoxicosis = elevated hormones but stable
A patient presents with PaO₂ 48 mmHg, PaCO₂ 65 mmHg, and pH 7.25. This type of respiratory failure is present, requiring both oxygenation and ventilation support.
What is combined hypoxemic and hypercapnic respiratory failure
A patient in the diuretic phase of AKI begins producing large amounts of urine with falling creatinine levels. This complication is now the priority concern.
risk for dehydration and electrolyte imbalance (especially hypokalemia)
A patient with liver failure has rising ammonia levels, worsening confusion, and decreasing level of consciousness. This indicates this complication is progressing.
worsening hepatic encephalopathy
A patient with DKA initially presents with hyperkalemia, but after insulin therapy, this electrolyte imbalance is most likely to develop.
What is hypokalemia
A patient with hyperthyroidism develops a fever and is given aspirin. This complication may worsen as a result.
increased free thyroid hormone levels due to protein-binding displacement