Gas Exchange
A critically ill client becomes restless, anxious, and confused. This problem should be ruled out first.
What is hypoxemia (hypoxia)?
Rationale: Restlessness, anxiety, and confusion may be early cerebral signs of inadequate oxygenation. Immediately assess airway, breathing, oxygen saturation, and work of breathing.
This cardiac structure normally initiates the electrical impulse that produces atrial depolarization and the P wave.
What is the sinoatrial (SA) node?
Rationale: The SA node is the heart's primary pacemaker. Its impulse spreads across the atria, creating atrial depolarization represented by the P wave.
This irregularly irregular rhythm lacks consistent P waves and increases the risk for atrial thrombus formation.
What is atrial fibrillation?
Rationale: Chaotic atrial activity prevents coordinated atrial contraction. Blood stasis, especially in the left atrial appendage, increases embolic stroke risk.
This type of shock results from insufficient circulating volume, such as severe hemorrhage or fluid loss.
What is hypovolemic shock?
Rationale: Reduced intravascular volume decreases venous return, preload, stroke volume, and cardiac output. Control the loss and restore volume while monitoring perfusion.
This bedside device must be immediately available if a ventilator fails or becomes disconnected.
What is a bag-valve-mask resuscitation device?
Rationale: A bag-valve device provides backup ventilation. Functional suction should also be available at the bedside.
This heated and humidified system can deliver oxygen at flows high enough to meet or exceed the client's inspiratory demand.
What is high-flow nasal cannula (HFNC)?
Rationale: HFNC provides predictable oxygen delivery, humidification, dead-space washout, and a small amount of positive airway pressure.
This ECG interval reflects conduction from the start of atrial depolarization through the AV node before ventricular depolarization.
What is the PR interval?
Rationale: The PR interval includes atrial depolarization and AV nodal delay. Prolongation suggests slowed atrioventricular conduction.
A client has symptomatic sinus bradycardia with hypotension. This medication is commonly used first in the ACLS bradycardia algorithm.
What is atropine?
Rationale: Atropine blocks parasympathetic influence and may increase SA-node firing and AV conduction. If ineffective, pacing or vasoactive support may be required.
This vasopressor is commonly a first-line infusion for septic shock after appropriate fluid resuscitation.
What is norepinephrine?
Rationale: Norepinephrine primarily raises vascular tone and mean arterial pressure. It requires close hemodynamic and tissue-perfusion monitoring, preferably through reliable vascular access
A ventilated client triggers a low-pressure alarm. Name the most likely general cause.
What is an air leak or circuit disconnection?
Rationale: Low-pressure alarms commonly indicate disconnection, loose tubing, or cuff leakage. Assess ventilation immediately and manually ventilate if needed.
What is this blood gas?
ABG: pH 7.30, PaCO2 55 mm Hg, HCO3- 25 mEq/L.
What is uncompensated respiratory acidosis?
Rationale: The pH is acidotic and PaCO2 is elevated in the acid direction. The normal bicarbonate indicates no meaningful metabolic compensation.
This term describes the ability of cardiac pacemaker cells to generate an electrical impulse without external stimulation.
What is automaticity?
Rationale: Automaticity allows specialized cardiac cells—particularly those in the SA node—to spontaneously initiate electrical impulses that control the heart rate.
This medication briefly blocks AV nodal conduction and may terminate a regular, narrow-complex SVT.
What is adenosine?
Rationale: Adenosine has an extremely short half-life and transiently slows AV nodal conduction. Continuous monitoring and rapid IV administration are required.
A client has pulmonary edema, hypotension, cool skin, and evidence of pump failure after an MI. Identify the type of shock.
What is cardiogenic shock?
Rationale: Cardiac pump failure reduces forward flow while blood backs up into the lungs. Management supports oxygenation and perfusion without indiscriminate fluid loading.
A chemically paralyzed client cannot move. These two needs must still be addressed because paralysis provides neither.
What are sedation/amnesia and analgesia?
Rationale: Neuromuscular blockers cause paralysis but do not relieve pain or guarantee unconsciousness. Sedation, analgesia, and respectful communication remain essential.
This ARDS mechanism causes severe hypoxemia that responds poorly to supplemental oxygen alone.
What is intrapulmonary shunting (refractory hypoxemia)?
Rationale: Perfused alveoli that are fluid-filled or collapsed cannot ventilate effectively, so blood passes through the lungs without adequate oxygenation.
A client’s telemetry monitor suddenly displays an abnormal rhythm, but the client is awake, asymptomatic, and has a regular pulse. State the nurse’s priority action before initiating treatment.
What is assess the client and verify the rhythm by checking the electrodes, lead connections, and obtaining a diagnostic ECG?
Rationale: Artifact, loose electrodes, or poor lead contact can imitate a dysrhythmia. The nurse should assess the client first, verify electrode placement and connections, and confirm the rhythm with a diagnostic ECG before treating a monitor tracing alone.
A conscious client has an unstable tachyarrhythmia with a pulse. This timed electrical therapy is indicated.
What is synchronized cardioversion?
Rationale: Synchronization delivers energy with the R wave to avoid shocking during ventricular repolarization. Sedate the conscious client when feasible without delaying emergency treatment.
A septic client initially has warm skin, bounding pulses, and hypotension. Explain the primary perfusion problem.
What is pathologic vasodilation and maldistribution of blood flow?
Rationale: Distributive shock lowers systemic vascular resistance and causes relative hypovolemia. Cellular perfusion can be inadequate despite warm extremities early in the course.
A client with a rapid rhythm is hypotensive and confused. Before naming the rhythm, state the central clinical judgment question.
What is whether the client is stable and adequately perfusing?
Rationale: The same rhythm can require monitoring or emergency intervention depending on blood pressure, mental status, chest pain, heart failure, and other signs of poor perfusion.
A client on HFNC remains tachypneic, fatigued, and hypoxemic despite a high FiO2. State the priority interpretation and action.
What is failure of noninvasive support requiring immediate escalation and preparation for intubation?
Rationale: Persistent hypoxemia and respiratory fatigue suggest impending failure. Support oxygenation, notify the team, and prepare for advanced airway management.
Explain why a dysrhythmia can impair perfusion even when an electrical rhythm is visible on the monitor.
What is electrical activity that fails to produce an adequate rate, filling time, coordinated contraction, or stroke volume?
Rationale: Perfusion depends on effective mechanical contraction and cardiac output, not merely electrical activity. Assess the client and pulse rather than treating the monitor alone.
The monitor shows ventricular fibrillation and the client has no pulse. Name the two immediate priorities.
What are high-quality CPR and unsynchronized defibrillation?
Rationale: Ventricular fibrillation produces no effective cardiac output. Begin CPR and defibrillate as soon as possible while following the cardiac-arrest algorithm.
A client in shock has a central line. Name the most important preventable line complication and two nursing prevention actions.
What is central line-associated bloodstream infection, prevented with aseptic access and meticulous dressing/hub care?
Rationale: Central access provides a direct route to the bloodstream. Hand hygiene, sterile technique, hub disinfection, intact dressings, and daily evaluation of line necessity reduce infection risk.
A client has organized electrical activity on the monitor but no palpable pulse. Identify the rhythm category and the immediate treatment approach.
What is pulseless electrical activity (PEA), treated with high-quality CPR, epinephrine, and correction of reversible causes rather than defibrillation?
Rationale: PEA is cardiac arrest without a shockable rhythm. Treat the client, not the electrical tracing: perform CPR, give epinephrine per algorithm, and search for reversible causes.