Adult-Gerontology Acute Care Nursing Flashcards

Which finding most directly indicates severe acute pancreatitis per the Revised Atlanta Classification?

Answer: Organ failure persisting more than 48 hours

The Revised Atlanta Classification defines severe acute pancreatitis as persistent organ failure lasting more than 48 hours involving respiratory, cardiovascular, or renal systems.

When managing a patient on continuous renal replacement therapy (CRRT), which electrolyte imbalance requires the most frequent monitoring?

Answer: Hypophosphatemia

Hypophosphatemia is the most common electrolyte complication of CRRT due to continuous phosphate removal via dialysate/replacement fluid.

An older adult with new-onset AF has a CHA2DS2-VASc score of 3. What is the most appropriate clinical decision?

Answer: Anticoagulation is recommended; stroke risk outweighs average bleeding risk

A CHA2DS2-VASc score of 3 indicates high stroke risk. Anticoagulation is clearly recommended unless contraindicated by individual bleeding risk assessment.

A post-surgical patient develops fever, rigors, and hypotension 48 hours after central venous catheter insertion. Blood cultures are drawn. Which action should be taken first?

Answer: Begin empiric broad-spectrum antibiotics after cultures are drawn, before results return

In suspected CLABSI with signs of sepsis, empiric broad-spectrum antibiotics must be initiated promptly after blood cultures are drawn. Delaying treatment for culture results increases mortality.

A nurse notes a sudden GCS decline from 14 to 9, left pupil dilation, and right-sided hemiplegia. Which neurological emergency is most likely?

Answer: Uncal herniation with brainstem compression

Rapid decline in consciousness with ipsilateral pupil dilation and contralateral hemiplegia is the classic triad of uncal (transtentorial) herniation — a neurosurgical emergency.

A COPD patient on BiPAP shows pH 7.28, PaCO2 68 mmHg, PaO2 58 mmHg after 1 hour on IPAP 14/EPAP 6. What is the most appropriate next step?

Answer: Prepare for endotracheal intubation; NIV is failing

After 1-2 hours of appropriate NIV, failure to improve pH, persistent severe acidosis (pH below 7.30), and worsening hypoxemia indicate NIV failure requiring endotracheal intubation.