General Review Flashcards

A patient with acute decompensated heart failure has a pulmonary artery wedge pressure of 24 mmHg. What does this elevated value indicate?

Answer: Increased left atrial/left ventricular filling pressure

An elevated PAWP reflects increased left-sided filling pressures, typical of left heart failure.

Which arterial blood gas result indicates uncompensated respiratory acidosis?

Answer: pH 7.30, PaCO2 55, HCO3 24

Low pH with high PaCO2 and normal HCO3 indicates uncompensated respiratory acidosis.

A patient develops sudden hypotension, jugular venous distension, and muffled heart sounds after cardiac surgery. What is the most likely diagnosis?

Answer: Cardiac tamponade

Beck's triad—hypotension, JVD, and muffled heart sounds—is classic for cardiac tamponade.

What is the priority intervention for a patient in pulseless ventricular tachycardia?

Answer: Immediate defibrillation

Pulseless VT is a shockable rhythm requiring immediate defibrillation.

A patient receiving heparin develops a platelet count drop from 250,000 to 80,000. What condition should be suspected?

Answer: Heparin-induced thrombocytopenia

A significant platelet drop after heparin exposure suggests HIT, requiring heparin discontinuation.

Which finding best indicates effective fluid resuscitation in a patient with septic shock?

Answer: Urine output greater than 0.5 mL/kg/hr

Adequate urine output indicates restored perfusion to the kidneys and effective resuscitation.

A mechanically ventilated patient suddenly desaturates with high peak pressures and absent breath sounds on the right. What is the most likely cause?

Answer: Tension pneumothorax

Sudden desaturation with high pressures and unilateral absent breath sounds suggests tension pneumothorax.

A patient with diabetic ketoacidosis has a serum potassium of 5.8 mEq/L. Why must potassium be monitored closely during insulin therapy?

Answer: Insulin drives potassium into cells, causing rapid hypokalemia

Insulin shifts potassium intracellularly, so serum levels can fall quickly during DKA treatment.

Which ECG change is the earliest sign of hyperkalemia?

Answer: Peaked T waves

Tall, peaked T waves are the earliest ECG manifestation of hyperkalemia.

A patient with increased intracranial pressure shows Cushing's triad. Which set of vital signs reflects this?

Answer: Hypertension, bradycardia, irregular respirations

Cushing's triad is hypertension with widened pulse pressure, bradycardia, and irregular respirations.

What is the primary goal when managing a patient with acute respiratory distress syndrome on the ventilator?

Answer: Low tidal volume lung-protective ventilation

Low tidal volume (6 mL/kg) ventilation reduces ventilator-induced lung injury in ARDS.

A post-operative patient has a sudden drop in blood pressure, tachycardia, and cool clammy skin. Which type of shock is most likely?

Answer: Hypovolemic shock

Hemorrhage causing hypovolemia presents with hypotension, tachycardia, and cool clammy skin.

Which lab value is most specific for myocardial cell injury?

Answer: Troponin I

Troponin I is the most cardiac-specific and sensitive marker of myocardial injury.

A patient with severe sepsis has a lactate of 4.5 mmol/L. What does this elevated lactate indicate?

Answer: Tissue hypoperfusion and anaerobic metabolism

Elevated lactate reflects anaerobic metabolism from tissue hypoperfusion in sepsis.

A patient with a chest tube has continuous bubbling in the water-seal chamber. What does this most likely indicate?

Answer: An air leak in the system or patient

Continuous bubbling in the water-seal chamber indicates an air leak that must be investigated.

Which intervention is most appropriate for a patient with symptomatic bradycardia unresponsive to atropine?

Answer: Transcutaneous pacing

Transcutaneous pacing is the next step when atropine fails to treat symptomatic bradycardia.

A patient on a continuous insulin infusion has a glucose of 65 mg/dL. What is the priority nursing action?

Answer: Treat hypoglycemia and recheck glucose

A glucose of 65 mg/dL requires treating hypoglycemia and rechecking before continuing insulin.

Which clinical sign is most consistent with right ventricular failure?

Answer: Jugular venous distension and peripheral edema

Right-sided failure causes systemic venous congestion, leading to JVD and peripheral edema.

A patient with acute kidney injury has a rising creatinine and a urine output of 15 mL/hr. Which electrolyte imbalance poses the greatest immediate threat?

Answer: Hyperkalemia

Hyperkalemia in oliguric AKI can cause life-threatening cardiac dysrhythmias.

What is the most reliable indicator of correct endotracheal tube placement after intubation?

Answer: Waveform capnography confirming end-tidal CO2

Continuous waveform capnography is the most reliable method to confirm ET tube placement.