ACID-BASE
A patient has a pH of 7.30. Is this acidosis or alkalosis?
Acidosis
Which medication class decreases heart rate and contractility by blocking the effects of epinephrine and norepinephrine?
Beta blockers.
Examples: metoprolol, carvedilol.
A patient's leg is cool, pale, and painful with a weak pedal pulse. Is this more consistent with arterial or venous disease?
Arterial disease/PAD.
Pain that begins near the umbilicus and then migrates to the right lower quadrant is classic for what condition?
BONUS: What is the name of the sign when you press deep in the lower left side of the abdomen and causes pain on the lower right side of the abdomen?
Appendicitis
BONUS: Rovsing's Sign
Which patient should the nurse see FIRST?
A. Patient with chronic back pain rated 7/10
B. Patient with oxygen saturation of 86% and increasing respiratory distress
C. Patient requesting discharge instructions
D. Patient waiting for a routine medication
B. Patient with oxygen saturation of 86% and increasing respiratory distress
A patient is hyperventilating and has a PaCO2 of 28mmHg. Which acid-base imbalance is most likely?
A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
B. Respiratory Alkalosis
A patient is prescribed furosemide. What is the nurse's priority electrolyte to monitor?
A. Sodium
B. Potassium
C. Calcium
D. Magnesium
B. Potassium
loop diuretics can cause hypokalemia
Which finding is more characteristic of venous insufficiency?
A. Cool extremity
B. Diminished pulses
C. Brown discoloration around the ankles
D. Pain relieved by dangling the leg
C. Brown discoloration around the ankles
A patient has severe right upper quadrant pain, especially after eating a fatty meal. Which organ is most likely involved?
Gallbladder
A patient arrives in the ER complaining of sudden shortness of breath and sharp chest pain. Their heart rate is 118/min, respiratory rate is 30/min, and SpO₂ is 88%. The patient recently had surgery and has been on bed rest.
What life-threatening condition should the nurse suspect?
Pulmonary embolism (PE)
Interpret these ABGs:
pH: 7.28/ PaCO2: 52/ HCO3: 24
The nurse is about to administer digoxin. The patient's apical pulse is 52/min. What should the nurse do?
Hold the medication and notify the provider.
Digoxin can decrease heart rate
A patient with PAD reports leg pain when walking that improves with rest. What is this called?
Intermittent claudication.
A patient has severe epigastric pain radiating to the back, nausea, and vomiting. What condition should the nurse suspect?
Pancreatitis
A patient arrives at the ER from a trauma and suddenly develops severe shortness of breath, absent breath sounds on the right side, hypotension, and distended neck veins after a chest injury. What life-threatening condition should the nurse suspect?
Tension pneumothorax
A patient with diabetic ketoacidosis has:
pH 7.20 / PaCO₂ 30 / HCO₃ 14
What is the primary disorder?
BONUS: What is the patient's respiratory compensation?
Metabolic acidosis.
Bonus: Kussmaul Respirations
A patient taking an ACE inhibitor reports swelling of their lips and tongue and difficulty breathing. What is the priority action?
Stop the medication and treat this as an emergency—airway takes priority.
Think angioedema
Which position generally improves arterial blood flow to a painful ischemic leg?
A. Elevate the leg above the heart
B. Keep the leg dependent
C. Place the leg in Trendelenburg
D. Apply a compression bandage
B. Keep the leg dependent.
Which assessment finding is most concerning for appendicitis?
A. Right lower quadrant pain
B. Nausea
C. Pain that suddenly disappears
D. Mild abdominal tenderness
C. Pain that suddenly disappears.
A patient suddenly develops unilateral weakness, facial drooping, and difficulty speaking. What is the priority?
Suspect stroke and activate the facility's stroke/emergency response immediately.
A patient has:
pH 7.48 / PaCO₂ 30 / HCO₃ 22
Interpret the ABG.
Uncompensated respiratory alkalosis.
A patient with heart failure is prescribed spironolactone. Which laboratory value is especially important to monitor?
Potassium.
Unlike furosemide, spironolactone is potassium-sparing → risk for hyperkalemia.
A patient with suspected PAD has a foot that is pale when elevated and becomes red when placed in a dependent position. What does this finding indicate?
Poor arterial perfusion.
You're caring for three patients:
Patient A: RUQ pain after fatty foods
Patient B: Epigastric pain radiating to the back
Patient C: Pain migrating from the umbilicus to RLQ
Match each patient to the condition.
A → Gallbladder disease/cholecystitis
B → Pancreatitis
C → Appendicitis
You're receiving report on four patients. Who should you assess FIRST?
A. Patient with pneumonia and SpO₂ 91% on their baseline oxygen
B. Patient with heart failure and 2+ edema
C. Patient with new-onset stridor and difficulty breathing
D. Patient with chronic atrial fibrillation and HR 88
C. New-onset stridor.