ABG
A patient in the PACU is difficult to arouse after receiving IV morphine. Respirations are 7/min and shallow. The ABG is pH 7.15, PaCO₂ 68, HCO₃⁻ 22. What is the acid–base imbalance?
Uncompensated respiratory acidosis. The pH is low, the PaCO₂ is high, and the HCO₃⁻ is normal
A patient’s coronary artery is completely blocked, causing myocardial injury and ST elevation. What cardiac emergency is occurring?
STEMI
A potential organ donor is identified. Who determines donation suitability and approaches the family about donation?
The organ procurement organization, or OPO.
A patient with asthma needs a rescue medication to relieve bronchospasm. Which medication should the nurse anticipate administering?
Albuterol
After femoral cardiac catheterization, how should the nurse position the patient’s affected leg and hip?
Keep the leg and hip straight while the patient remains flat, for about six hours.
Five days after abdominal surgery, a patient’s NG tube drains a large amount of gastric fluid. The patient becomes confused. The ABG is pH 7.52, PaCO₂ 35, HCO₃⁻ 29. What is the imbalance?
Uncompensated metabolic alkalosis. The pH and HCO₃⁻ are high; PaCO₂ is within the normal range.
A patient with bradycardia develops hypotension and dizziness. Which medication and device treatment should the nurse anticipate?
IV atropine and pacing if needed.
A hospitalized patient becomes newly confused, has a respiratory rate of 30, and an SpO₂ of 88% despite oxygen. What response should the nurse activate while supporting ABCs?
Rapid Response. Stay with the patient
A patient has alveolar collapse, pulmonary edema, and stiff lungs. Prone positioning is used to improve lung recruitment. What syndrome is this?
What is ARDS?
A ventilated patient is awake after sedation is reduced. During a trial of breathing with less ventilator support, the patient becomes restless, works harder to breathe, and their oxygen saturation falls. What trial is underway, and what do these changes mean?
A spontaneous breathing trial (SBT). The patient is not tolerating it and should be reassessed before extubation.
A patient has been vomiting repeatedly. The ABG is pH 7.52, PaCO₂ 35, HCO₃⁻ 29. What is the acid–base imbalance?
Uncompensated metabolic alkalosis. The pH and HCO₃⁻ are high; PaCO₂ is within the listed normal range.
A woman comes to the ED saying, “I don’t have chest pain, so I don’t think this could be my heart.” The nurse remains concerned about an MI. What symptoms should the nurse ask her about?
Unusual fatigue, indigestion, anxiety, cold sweats, weakness, dizziness, sleep disturbances, shoulder pain, and vomiting.
A ventilated patient’s oxygenation and blood pressure have improved, but the patient remains deeply sedated. The team wants to assess readiness to breathe without the ventilator. What trial should be coordinated first?
A spontaneous awakening trial, followed by a spontaneous breathing trial when appropriate. Sedation can hide whether the patient is ready to breathe independently.
A patient suddenly develops severe respiratory distress, absent breath sounds on one side, hypotension, and tracheal deviation. What complication should the nurse suspect?
Tension pneumothorax
A patient’s heart suddenly begins racing. The ECG shows a regular, rapid rhythm consistent with SVT. The patient is alert and has a stable blood pressure. Before medication is given, what should the nurse ask the patient to try?
A vagal maneuver, such as bearing down with the Valsalva maneuver. Bearing down stimulates the vagus nerve, which briefly slows conduction through the AV node. That may interrupt the electrical loop causing the rapid rhythm and return it to normal without medication.
A patient with diabetes stopped taking insulin while ill. They have fruity breath and deep, labored respirations. The ABG is pH 7.27, PaCO₂ 24, HCO₃⁻ 8. What is the acid–base imbalance?
Partially compensated metabolic acidosis. HCO₃⁻ is low and PaCO₂ has fallen as the patient breathes off CO₂, but the pH remains acidic.
A patient with dizziness has P waves that occur independently of the QRS complexes. A pacemaker is started, and each pacing spike appears immediately before a QRS complex. Identify the block and the chamber being paced.
Third-degree heart block with ventricular pacing. The unrelated P waves and QRS complexes identify third-degree block. A spike before the QRS indicates a ventricular pacer; a spike before the P wave indicates an atrial pacer.
A patient near the end of life chooses care focused on comfort instead of treatment to cure the illness. What type of care is this?
Hospice care.
A patient with ARDS is placed prone. What benefit does this position provide?
Improves lung recruitment, changes gravity’s effect on fluid in dependent lung areas, and reduces compression of the lungs by the heart.
A stable patient is found to have atrial fibrillation but cannot identify when it began. Before a planned attempt to restore the rhythm, which medication therapy should the nurse anticipate first to prevent complications.
Anticoagulant therapy to reduce the risk of thromboembolism.
A patient with asthma and respiratory distress becomes increasingly drowsy. The ABG is pH 7.36, PaCO₂ 69, HCO₃⁻ 36. What is the acid–base imbalance?
Fully compensated respiratory acidosis using the worksheet’s classification method. PaCO₂ is high, HCO₃⁻ has risen, and the pH is within the normal range on the acidic side.
The monitor shows ventricular tachycardia. The patient is unresponsive and has no pulse. What actions should the nurse initiate?
Call for help, begin CPR, activate Code Blue, and prepare for defibrillation and resuscitation medications.
A patient can no longer speak for themself. A family member asks the nurse to “do everything,” but the chart contains a POLST with different treatment orders. What should guide the nurse’s actions?
Review and follow the documented POLST orders, communicate them to the care team, and advocate for the patient’s recorded wishes.
Three patients need airway support: one is awake and coughing, one responds to voice and gags when suctioned, and one is unresponsive with no gag reflex. Which patient can receive an oropharyngeal airway.
The unresponsive patient with no gag reflex. An oropharyngeal airway can trigger gagging, vomiting, and aspiration in a patient who is responsive or still has a gag reflex
A patient with COPD becomes increasingly drowsy and has shallow respirations. The nurse reviews the ABG and notes a PaCO₂ of 49 mmHg. Does this result indicate hypoxia or hypercapnia?
Hypercapnia. The PaCO₂ is above 35–45 mmHg, indicating that the patient is retaining carbon dioxide.