Cardiac Catastrophes
A patient develops new-onset chest pain 3 days post–MI that worsens when lying flat and improves when leaning forward. What complication do you suspect?
Acute pericarditis
Classic post-MI inflammatory complication (Dressler’s syndrome); friction rub and pain positional
Which six signs characterize acute arterial ischemia?
Pain, Pallor, Pulselessness, Paresthesia, Poikilothermia, Paralysis
“6 Ps” hallmark of acute arterial occlusion
A client presents with barking cough, inspiratory stridor, and clear nasal drainage. What diagnosis fits best?
Acute laryngotracheobronchitis (croup)
Viral croup with airway narrowing; treat with corticosteroids and humidified O₂
ABG: pH 7.30, PaCO₂ 50, HCO₃⁻ 24. What is the interpretation?
Respiratory acidosis (uncompensated)
CO₂ retention → ↓pH
Which oxygen saturation goal is most appropriate for a COPD patient with pneumonia?
Maintain SpO₂ between 88–92%
Higher levels may suppress hypoxic drive; prevent CO₂ retention
A patient with STEMI suddenly develops severe hypotension and a new systolic murmur. What is the nurse’s priority action?
Notify the provider immediately—suspect papillary muscle rupture
Papillary muscle rupture → acute mitral regurgitation → shock; surgical emergency
A patient with Buerger’s disease continues to smoke. Which complication is most likely if behavior doesn’t change?
Ischemic ulceration and amputation
Tobacco use perpetuates vessel inflammation and occlusion
How does pneumonia cause respiratory acidosis?
Impaired alveolar ventilation leads to CO₂ retention
Blocked gas exchange traps CO₂ → ↓pH
ABG: pH 7.52, PaCO₂ 28, HCO₃⁻ 24. Likely cause?
Respiratory alkalosis from hyperventilation
Blowing off CO₂ elevates pH
Why should you avoid elevating the leg above the heart in acute arterial ischemia?
Reduces arterial flow to already ischemic tissue
Impairs perfusion and can worsen necrosis
Following PCI, the patient reports chest pain again. Which nursing action takes priority?
Notify provider and prepare for repeat ECG
Possible stent thrombosis or reocclusion — must be confirmed by ECG and treated urgently
A patient develops absent pedal pulses after endovascular aneurysm repair (EVAR). What is the priority nursing action?
Report immediately—possible graft occlusion
Absent distal pulses = graft blockage; surgical emergency
A patient with TB has a positive sputum culture but negative chest X-ray. What does this indicate?
Active disease not yet radiographically visible
Culture = gold standard; imaging may lag behind
A patient in DKA presents with Kussmaul respirations. What acid–base imbalance is present?
Metabolic acidosis
Acid gain → compensatory hyperventilation
A patient recovering from MI develops shortness of breath and crackles. What complication is suspected?
Left-sided heart failure
LV dysfunction → pulmonary congestion
Following PCI, the patient reports chest pain again. Which nursing action takes priority?
Notify provider and prepare for repeat ECG
Possible stent thrombosis or reocclusion — must be confirmed by ECG and treated urgently
Which finding differentiates hypertensive urgency from hypertensive emergency?
Presence of target organ damage
Emergencies include end-organ effects (e.g., encephalopathy, chest pain, renal failure)
Which breath sound is characteristic of idiopathic pulmonary fibrosis (IPF)?
Fine “Velcro-like” crackles at lung bases
Fibrotic scarring causes high-pitched inspiratory crackles
Vomiting and gastric suction lead to which imbalance?
Metabolic alkalosis
Loss of gastric acid → ↑pH
How does uncontrolled hypertension contribute to aneurysm rupture?
Increases shearing force on arterial wall
Chronic high pressure weakens vessel integrity
Which clinical finding best distinguishes cardiogenic shock from hypovolemic shock?
Ventricular remodeling
ACE inhibitors reduce afterload and prevent dilation/scarring of ventricle after MI
A patient on IV antihypertensive infusion becomes acutely confused. What is your first step?
Slow or stop the infusion
Rapid BP reduction decreases cerebral perfusion → stroke risk
A client with pulmonary hypertension develops peripheral edema and JVD. What secondary complication is this?
Cor pulmonale (right-sided heart failure)
Increased pulmonary vascular resistance → right ventricular overload
ABG: pH 7.25, PaCO₂ 30, HCO₃⁻ 18. What does this represent?
Metabolic acidosis with partial respiratory compensation
Low pH + low bicarb; CO₂ decreased from compensation
Explain why COPD patients are at risk for both hypoxia and respiratory acidosis.
Chronic alveolar hypoventilation → CO₂ retention + impaired oxygen diffusion
Decreased ventilation limits O₂ intake and CO₂ removal