Critical Care and Emergency Nursing Flashcards

According to KDIGO criteria, which urine output threshold defines oliguria in acute kidney injury (AKI)?

Answer: < 0.5 mL/kg/hr for 6 hours

KDIGO defines oliguria as urine output < 0.5 mL/kg/hr for at least 6 consecutive hours, which is Stage 1 AKI.

Which nursing intervention is MOST effective in preventing ventilator-associated pneumonia (VAP)?

Answer: Daily sedation vacation combined with oral care using chlorhexidine

Daily sedation vacation reduces ventilator days and oral chlorhexidine reduces oropharyngeal colonisation; together they are the most evidence-based VAP prevention bundle components.

Norepinephrine is the first-line vasopressor for septic shock. What is its primary mechanism of action?

Answer: Alpha-1 agonism causing vasoconstriction and increased SVR

Norepinephrine primarily stimulates alpha-1 adrenergic receptors, causing potent vasoconstriction that restores mean arterial pressure in distributive shock.

A patient with diabetic ketoacidosis (DKA) initially has serum K+ of 5.8 mmol/L. As insulin infusion begins, what electrolyte change should the nurse anticipate?

Answer: Potassium will fall rapidly as insulin drives K+ into cells

Insulin facilitates cellular uptake of potassium; once insulin infusion begins, serum potassium drops rapidly and requires close monitoring with replacement.

A patient post-anterior MI develops hypotension, tachycardia, raised JVP, and cool clammy skin. Which type of shock is most consistent with these findings?

Answer: Cardiogenic shock

Elevated JVP with hypotension and cold peripheries following a large MI indicates cardiogenic shock due to left ventricular pump failure with venous congestion.

A mechanically ventilated patient with COPD exacerbation has the following ABG: pH 7.28, PaCO2 68 mmHg, HCO3 28 mEq/L. What acid-base disturbance is present?

Answer: Respiratory acidosis with partial metabolic compensation

Low pH with elevated PaCO2 defines respiratory acidosis; the elevated bicarbonate reflects partial renal (metabolic) compensation occurring over time.

When monitoring a patient with a pulmonary artery catheter (Swan-Ganz), which measurement BEST reflects left ventricular preload?

Answer: Pulmonary artery occlusion pressure (PAOP/PCWP)

PAOP (wedge pressure) reflects left atrial pressure and left ventricular end-diastolic pressure, making it the best surrogate for left ventricular preload.