Pulmonary Embolism
A postoperative patient suddenly develops shortness of breath and chest pain. SpO₂ is 85% on room air, HR 120, BP 100/64.
What is the nurse’s first action?
A. Apply oxygen via nonrebreather mask
B. Call the rapid response team
C. Start IV heparin as prescribed
D. Place the patient in high Fowler’s position
Apply oxygen via nonrebreather mask
A COPD patient is drowsy, PaCO₂ 68 mmHg, PaO₂ 54 mmHg. What should the nurse do first?
A. Encourage deep breathing
B. Increase O₂ to 6 L/min
C. Notify provider and prepare for intubation
D. Ambulate the patient
Notify provider and prepare for intubation
High pressure alarm sounds on a ventilator. First action?
A. Check tubing for kinks or secretions
B. Suction the patient every hour
C. Call respiratory therapy
D. Restart the ventilator
Check tubing for kinks or secretions
COVID-19 patient on HFNC 60 L/min with FiO₂ 60%. SpO₂ drops from 94% to 86%. Priority?
A. Decrease O₂ to prevent toxicity
B. Prepare for intubation
C. Encourage activity
D. Place flat in bed
Prepare for intubation
A septic patient develops worsening hypoxemia despite 100% oxygen. What should the nurse suspect?
A. Pulmonary embolism
B. ARDS
C. Heart failure
D. Pleural effusion
ARDS
A patient on IV heparin for a PE has a platelet count of 72,000 and bleeding gums. What should the nurse do first?
A. Notify the provider
B. Stop the heparin infusion
C. Administer vitamin K
D. Decrease the infusion rate
Stop heparin immediately
ABGs: pH 7.48, PaCO₂ 30, PaO₂ 58. How should the nurse interpret this?
A. Respiratory alkalosis from hyperventilation
B. Metabolic alkalosis from vomiting
C. Respiratory acidosis from CO₂ retention
D. Metabolic acidosis from tissue hypoxia
Respiratory alkalosis from hyperventilation
Low pressure alarm sounds. What does this mean?
A. Patient biting the tube
B. Cuff leak or disconnection
C. Mucus plug
D. Increased lung resistance
Cuff leak or disconnection
COVID patient: D-dimer 1500, platelets 110k, chest pain, SOB. What complication?
A. Myocarditis
B. Pulmonary embolism
C. Pneumonia
D. Renal failure
Pulmonary embolism
A student asks about ARDS. Which statement is correct?
A. “The alveoli fill with fluid and collapse, impairing gas exchange.”
B. “The heart can’t pump blood through the lungs.”
C. “The lungs make too much surfactant.”
D. “It’s caused by dehydration of lung tissues.”
“The alveoli fill with fluid and collapse, impairing gas exchange.”
ABGs show pH 7.31, PaCO₂ 50 mmHg, PaO₂ 56 mmHg in a patient with a PE. How should the nurse interpret this?
A. Respiratory alkalosis with hypoxemia
B. Respiratory acidosis with hypoxemia
C. Metabolic acidosis from renal failure
D. Metabolic alkalosis from vomiting
Respiratory acidosis with hypoxemia
A patient with acute respiratory failure becomes confused, RR 10, shallow breathing, PaCO₂ 60. What is the priority?
A. Apply a rebreather mask
B. Prepare for ventilatory support
C. Encourage deep breathing
D. Recheck ABG in one hour
Prepare for ventilatory support
Patient on FiO₂ 100% for 48 hrs develops chest pain and cough. Cause?
A. Pneumonia
B. Oxygen toxicity
C. Pulmonary embolism
D. Pleural effusion
Oxygen toxicity
COVID patient labs: D-dimer 1200, platelets 95k, PT 16, troponin 0.8. What complication?
A. DIC
B. AKI
C. Superinfection
D. Electrolyte imbalance
DIC
A ventilated ARDS patient on high PEEP develops subcutaneous emphysema. What is this most likely?
A. Pulmonary embolism
B. Pneumothorax from barotrauma
C. Worsening pulmonary edema
D. Infection from ETT
Pneumothorax from barotrauma
A patient on warfarin for PE has an INR of 4.8. What should the nurse do?
A. Continue the current dose
B. Hold warfarin and notify provider
C. Give protamine sulfate
D. Document and recheck tomorrow
Hold warfarin and notify provider
A patient on 4 L O₂ remains at 85% SpO₂ and is increasingly distressed. What should the nurse do?
A. Encourage slow, deep breathing
B. Switch to a nonrebreather mask
C. Continue current therapy
D. Lower the O₂ flow
Switch to a nonrebreather mask
Tracheostomy dislodges and patient cannot breathe. Priority?
A. Call code blue
B. Insert new sterile trach tube immediately
C. Ventilate with bag-mask
D. Cover stoma with gauze
Insert new sterile trach tube immediately
COVID patient on vent develops fever, thick sputum, and new crackles. What is this?
A. Ventilator-associated pneumonia
B. Heart failure
C. Pleural effusion
D. ARDS worsening
Ventilator-associated pneumonia
A patient with ARDS on PEEP 14 has BP 88/52. What does this indicate?
A. Worsening infection
B. Decreased cardiac output from high intrathoracic pressure
C. Bleeding from anticoagulants
D. Metabolic acidosis
Decreased cardiac output from high intrathoracic pressure
A patient on heparin asks, “When will I switch to oral anticoagulants?” The nurse should respond:
A. “When your INR is above 4 for two days.”
B. “When your INR reaches 2–3 for at least 24 hours.”
C. “As soon as your provider says so.”
D. “When your D-dimer is normal.”
“When your INR reaches 2–3 for at least 24 hours.”
A patient with Guillain-Barré has rising CO₂ but clear lungs on chest x-ray. This represents:
A. Oxygenation failure
B. Ventilatory failure
C. Metabolic acidosis
D. Pulmonary embolism
Ventilatory failure
Ventilated patient becomes agitated, SpO₂ drops, high peak pressures. Suspect?
A. Pneumothorax
B. Secretions
C. Anxiety
D. Low tidal volume
Pneumothorax
COVID patient on dexamethasone develops glucose 340 mg/dL. Cause?
A. Stress response
B. Corticosteroid therapy
C. Sepsis
D. Pancreatitis
Corticosteroid therapy
O₂ sat improves from 82% to 94% after proning. What does this mean?
A. Prone position improved alveolar oxygenation
B. Cardiac output improved
C. Pulmonary edema worsened
D. Patient no longer needs ventilator
Prone position improved alveolar oxygenation