Critical Care Nursing Cardiac Questions

Critical Care Nursing Cardiac Questions Related

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The nurse is caring for a patient in the critical care unit whaobi,r ba.cfotemr/ tebset ing declared brain dead, is being managed by the OPO transplant coordinator. Thir ty minutes into the shift, assessment by the nurse includes a blood pressure 75/50 mm Hg, hear t rate 85 beats/min, and respiratory rate 12 breaths/min via assist/control ventilation. The oxygen saturation (SpO ) is 99% and 2 core temperature 93.8° F. Which primary care provider ord er should the nurse implement first?

  • A. Apply forced air warming device to keep temperature > 96.8° F
  • B. Obtain basic metabolic panel every 4 hours until surgery
  • C. Begin phenylephrine (Neo-Synephrine) for systolic BP < 90 mm Hg
  • D. Draw arterial blood gas every 4 hours until surgery
Correct Answer: C

Rationale: The correct answer is C: Begin phenylephrine (Neo-Synephrine) for systolic BP < 90 mm Hg. The nurse should implement this order first because the patient's low blood pressure (75/50 mm Hg) indicates hypotension, which can lead to inadequate perfusion to vital organs. Phenylephrine is a vasoconstrictor that can help increase the patient's blood pressure and improve perfusion. It is crucial to address hypotension promptly to prevent further complications.

Choice A is incorrect because maintaining the patient's temperature above 96.8°F is not the most urgent concern in this scenario. Choice B is incorrect as obtaining a basic metabolic panel every 4 hours is not the immediate priority when the patient is experiencing hypotension. Choice D is incorrect as drawing arterial blood gas every 4 hours is not the most urgent intervention needed to address the patient's low blood pressure.

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The patient diagnosed with acute respiratory distress synd rome (ARDS) would exhibit which symptom?

  • A. Decreasing PaO levels despite increased FiO adminis tration
  • B. Elevated alveolar surfactant levels
  • C. Increased lung compliance with increased FiO administration 2
  • D. Respiratory acidosis associated with hyperventilation
Correct Answer: A

Rationale: The correct answer is A because in ARDS, there is a severe impairment in gas exchange leading to hypoxemia. Decreasing PaO2 levels despite increased FiO2 administration indicate poor oxygenation, a hallmark of ARDS. Elevated alveolar surfactant levels (Choice B) do not directly correlate with ARDS pathophysiology. Increased lung compliance with increased FiO2 administration (Choice C) is not characteristic of ARDS, as ARDS leads to decreased lung compliance. Respiratory acidosis associated with hyperventilation (Choice D) is not a typical finding in ARDS, as hyperventilation is usually present in an attempt to compensate for hypoxemia.

The nurse is caring for a postoperative patient with chroni c obstructive pulmonary disease (COPD). Which assessment would be a cue to the patient developing postoperative pneumonia?

  • A. Bradycardia
  • B. Change in sputum characteristics
  • C. Hypoventilation and respiratory acidosis
  • D. Pursed-lip breathing
Correct Answer: B

Rationale: The correct answer is B: Change in sputum characteristics. This is a cue for postoperative pneumonia in a COPD patient because it can indicate an infection in the lungs. Postoperative pneumonia is a common complication in patients with COPD due to impaired lung function and weakened immune system. Other choices are incorrect: A) Bradycardia is not a specific indicator of postoperative pneumonia. C) Hypoventilation and respiratory acidosis can be seen in patients with COPD but are not specific to postoperative pneumonia. D) Pursed-lip breathing is a coping mechanism for patients with COPD and is not directly related to postoperative pneumonia.

How should the nurse interprets these blood gas values? 2 3

  • A. Compensated metabolic alkalosis
  • B. Normal values
  • C. Uncompensated respiratory acidosis
  • D. Uncompensated respiratory alkalosis
Correct Answer: C

Rationale: The correct interpretation is uncompensated respiratory acidosis (Choice C) based on the values. Step 1: Evaluate pH - pH is <7.35, indicating acidosis. Step 2: Determine PaCO2 - PaCO2 is >45 mmHg, indicating respiratory cause. Step 3: Check HCO3- - HCO3- is within normal range, indicating uncompensated state. Choices A, B, and D are incorrect because they do not align with the given blood gas values.

When assisting with the placement of a pulmonary artery (PA) catheter, the nurse notes that the catheter is correctly placed when the monitor shows a:

  • A. Typical PA pressure waveform.
  • B. Tracing of the systemic arterial pressure.
  • C. Tracing of the systemic vascular resistance.
  • D. Typical PA wedge pressure (PAWP) tracing.
Correct Answer: D

Rationale: Step-by-step rationale for Answer D being correct:
1. PA catheter measures PA pressures.
2. PAWP reflects left atrial pressure.
3. Correct placement shows typical PAWP tracing.
4. PA pressure waveform (A) is not specific to PAWP.
5. Systemic arterial pressure tracing (B) is unrelated.
6. Systemic vascular resistance tracing (C) is not monitored by PA catheter.

The primary care provider orders the following mechanica l ventilation settings for a patient who weighs 75 kg and whose spontaneous respiratory rate is 22 breaths/min. What arterial blood gas abnormality may occur if the patient continues taob ibrbe.c otamc/thesyt pneic at these ventilator settings? Settings: Tidal volume: 600 mL (8 mL per kg) FiO 2: 0.5 Respiratory rate: 14 breaths/min Mode assist/control Positive end-expiratory pressure: 10 cm H O

  • A. Metabolic acidosis
  • B. Metabolic alkalosis
  • C. Respiratory acidosis
  • D. Respiratory alkalosis
Correct Answer: C

Rationale: The correct answer is C: Respiratory acidosis may occur if the patient continues at these ventilator settings. Respiratory acidosis happens when the lungs cannot remove enough of the carbon dioxide (CO2) produced by the body. In this case, the low respiratory rate of 14 breaths/min may not be sufficient to adequately remove CO2, leading to its accumulation in the blood. This results in a decrease in blood pH, causing respiratory acidosis.

Summary of other choices:
A: Metabolic acidosis - Not the correct answer as the ventilator settings are more likely to affect the respiratory system rather than the metabolic system.
B: Metabolic alkalosis - Not the correct answer as the ventilator settings are not related to causing an increase in blood pH, which is characteristic of metabolic alkalosis.
D: Respiratory alkalosis - Not the correct answer as the low respiratory rate would not lead to excessive elimination of CO2, causing alkalosis.

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