NUR 265 – Comprehensive Study Guide
Q&A
= Fundamental Concept | = Applied Knowledge
Cardiovascular (Heart Failure, ACS, Dysrhythmias)
1. Q: What are the key differences in assessment findings between left-sided and right-
sided heart failure?
A: Left-sided failure leads to pulmonary congestion (crackles, dyspnea, orthopnea).
Right-sided failure leads to systemic congestion (JVD, peripheral edema, hepatomegaly).
2. Q: A patient with an acute MI has ST-elevation on ECG. What is the priority intervention?
A: Reperfusion therapy—either percutaneous coronary intervention (PCI) or fibrinolytics
if PCI is not timely available.
3. Q: What is the primary nursing priority for a patient experiencing atrial fibrillation with a
rapid ventricular response?
A: Assess for hemodynamic stability (BP, level of consciousness). Unstable patients
require immediate synchronized cardioversion.
4. Q: Why is a continuous IV infusion of heparin used for acute coronary syndromes?
A: To prevent thrombus extension and new clot formation on coronary plaque.
5. Q: What teaching is essential for a patient starting warfarin (Coumadin)?
A: Consistent Vitamin K intake, frequent INR monitoring, signs of bleeding, and many
drug interactions.
(Continue in this format for other systems...)
Respiratory (COPD, Asthma, Pneumonia, ARDS)
6. Q: How do you differentiate between rescue and maintenance inhalers for
COPD/asthma?
A: Rescue (albuterol) – for acute symptoms. Maintenance (ICS, tiotropium) – daily to
reduce inflammation and prevent attacks.
7. Q: What position maximizes oxygenation in a patient with severe unilateral pneumonia?
A: Good lung down (if tolerated) to improve perfusion to the ventilated lung.
, 8. Q: What is the hallmark sign of ARDS (Acute Respiratory Distress Syndrome)?
A: Refractory hypoxemia that does not improve significantly with supplemental oxygen.
9. Q: Priority action for a post-op patient with sudden dyspnea, chest pain, and
tachycardia?
A: Suspect pulmonary embolism. Administer O2, call rapid response, prepare for
diagnostics (CTPA).
10. Q: What does "pink puffer" and "blue bloater" refer to in COPD?
A: Pink Puffer = emphysema (barrel chest, dyspneic). Blue Bloater = chronic bronchitis
(cyanosis, edema, frequent infections).
Neurological (Stroke, Seizures, Increased ICP)
11. Q: What is the time-critical intervention window for administering tPA for an ischemic
stroke?
A: Within 4.5 hours of symptom onset, after ruling out hemorrhage.
12. Q: Nursing care during a tonic-clonic seizure?
A: Protect from injury (pad side rails, lower to floor), turn to side, do not restrain or
place anything in mouth.
13. Q: What are late signs of increased intracranial pressure (ICP)?
A: Cushing's triad: hypertension with widened pulse pressure, bradycardia, and irregular
respirations.
14. Q: How do you assess for a potential stroke in the field?
A: Use a tool like FAST (Face drooping, Arm weakness, Speech difficulty, Time to call
911).
15. Q: What is autonomic dysreflexia and its trigger?
A: Life-threatening hypertensive crisis in spinal cord injuries above T6, often triggered by
a full bladder or bowel.
Renal/Endocrine (AKI, CKD, DKA, SIADH)
16. Q: What is the most sensitive indicator of fluid status in a renal patient?
A: Daily weight (1 kg = 1 L fluid).
17. Q: Compare the lab findings in DKA and HHS (HHNS).
A: DKA: hyperglycemia, ketosis & acidosis, occurs faster. HHS: extreme
hyperglycemia, no significant ketosis, higher mortality.
, 18. Q: Priority for a patient in diabetic ketoacidosis (DKA)?
A: Fluid resuscitation (0.9% NS) to correct hypovolemia, then insulin therapy.
19. Q: What is the primary teaching for a patient with SIADH?
A: Fluid restriction to correct hyponatremia.
20. Q: Signs of hyperkalemia in a patient with renal failure?
A: Peaked T-waves on ECG, muscle weakness, arrhythmias.
Gastrointestinal (Bleeding, Liver Failure, Pancreatitis)
21. Q: Difference between bright red blood per rectum (BRBPR) and melena?
A: BRBPR = lower GI bleed or rapid upper bleed. Melena = black, tarry stool from upper
GI bleed.
22. Q: Priority for acute pancreatitis management?
A: NPO and aggressive IV fluids to rest the pancreas and prevent hypovolemic shock.
23. Q: What are signs of hepatic encephalopathy?
A: Altered LOC, asterixis (flapping tremor), fetor hepaticus.
24. Q: Why are lactulose and rifaximin given for liver failure?
A: To reduce ammonia levels by acidifying the colon and reducing ammonia-producing
bacteria.
25. Q: What is the biggest risk after a paracentesis for ascites?
A: Hypovolemia/fluid shift leading to hypotension. Monitor VS and albumin levels.
Shock, Sepsis, Multi-System
26. Q: The first sign of sepsis is often?
A: Altered mental status (confusion) or tachycardia.
27. Q: In septic shock, why do we give fluids first, then vasopressors?
A: To correct absolute hypovolemia (from vasodilation & capillary leak) before using
drugs to increase vascular tone.
28. Q: Compare distributive, cardiogenic, and hypovolemic shock.
A: Distributive (warm, vasodilated - sepsis), Cardiogenic (cold, pulmonary edema - MI),
Hypovolemic (cold, flat veins - hemorrhage).
Q&A
= Fundamental Concept | = Applied Knowledge
Cardiovascular (Heart Failure, ACS, Dysrhythmias)
1. Q: What are the key differences in assessment findings between left-sided and right-
sided heart failure?
A: Left-sided failure leads to pulmonary congestion (crackles, dyspnea, orthopnea).
Right-sided failure leads to systemic congestion (JVD, peripheral edema, hepatomegaly).
2. Q: A patient with an acute MI has ST-elevation on ECG. What is the priority intervention?
A: Reperfusion therapy—either percutaneous coronary intervention (PCI) or fibrinolytics
if PCI is not timely available.
3. Q: What is the primary nursing priority for a patient experiencing atrial fibrillation with a
rapid ventricular response?
A: Assess for hemodynamic stability (BP, level of consciousness). Unstable patients
require immediate synchronized cardioversion.
4. Q: Why is a continuous IV infusion of heparin used for acute coronary syndromes?
A: To prevent thrombus extension and new clot formation on coronary plaque.
5. Q: What teaching is essential for a patient starting warfarin (Coumadin)?
A: Consistent Vitamin K intake, frequent INR monitoring, signs of bleeding, and many
drug interactions.
(Continue in this format for other systems...)
Respiratory (COPD, Asthma, Pneumonia, ARDS)
6. Q: How do you differentiate between rescue and maintenance inhalers for
COPD/asthma?
A: Rescue (albuterol) – for acute symptoms. Maintenance (ICS, tiotropium) – daily to
reduce inflammation and prevent attacks.
7. Q: What position maximizes oxygenation in a patient with severe unilateral pneumonia?
A: Good lung down (if tolerated) to improve perfusion to the ventilated lung.
, 8. Q: What is the hallmark sign of ARDS (Acute Respiratory Distress Syndrome)?
A: Refractory hypoxemia that does not improve significantly with supplemental oxygen.
9. Q: Priority action for a post-op patient with sudden dyspnea, chest pain, and
tachycardia?
A: Suspect pulmonary embolism. Administer O2, call rapid response, prepare for
diagnostics (CTPA).
10. Q: What does "pink puffer" and "blue bloater" refer to in COPD?
A: Pink Puffer = emphysema (barrel chest, dyspneic). Blue Bloater = chronic bronchitis
(cyanosis, edema, frequent infections).
Neurological (Stroke, Seizures, Increased ICP)
11. Q: What is the time-critical intervention window for administering tPA for an ischemic
stroke?
A: Within 4.5 hours of symptom onset, after ruling out hemorrhage.
12. Q: Nursing care during a tonic-clonic seizure?
A: Protect from injury (pad side rails, lower to floor), turn to side, do not restrain or
place anything in mouth.
13. Q: What are late signs of increased intracranial pressure (ICP)?
A: Cushing's triad: hypertension with widened pulse pressure, bradycardia, and irregular
respirations.
14. Q: How do you assess for a potential stroke in the field?
A: Use a tool like FAST (Face drooping, Arm weakness, Speech difficulty, Time to call
911).
15. Q: What is autonomic dysreflexia and its trigger?
A: Life-threatening hypertensive crisis in spinal cord injuries above T6, often triggered by
a full bladder or bowel.
Renal/Endocrine (AKI, CKD, DKA, SIADH)
16. Q: What is the most sensitive indicator of fluid status in a renal patient?
A: Daily weight (1 kg = 1 L fluid).
17. Q: Compare the lab findings in DKA and HHS (HHNS).
A: DKA: hyperglycemia, ketosis & acidosis, occurs faster. HHS: extreme
hyperglycemia, no significant ketosis, higher mortality.
, 18. Q: Priority for a patient in diabetic ketoacidosis (DKA)?
A: Fluid resuscitation (0.9% NS) to correct hypovolemia, then insulin therapy.
19. Q: What is the primary teaching for a patient with SIADH?
A: Fluid restriction to correct hyponatremia.
20. Q: Signs of hyperkalemia in a patient with renal failure?
A: Peaked T-waves on ECG, muscle weakness, arrhythmias.
Gastrointestinal (Bleeding, Liver Failure, Pancreatitis)
21. Q: Difference between bright red blood per rectum (BRBPR) and melena?
A: BRBPR = lower GI bleed or rapid upper bleed. Melena = black, tarry stool from upper
GI bleed.
22. Q: Priority for acute pancreatitis management?
A: NPO and aggressive IV fluids to rest the pancreas and prevent hypovolemic shock.
23. Q: What are signs of hepatic encephalopathy?
A: Altered LOC, asterixis (flapping tremor), fetor hepaticus.
24. Q: Why are lactulose and rifaximin given for liver failure?
A: To reduce ammonia levels by acidifying the colon and reducing ammonia-producing
bacteria.
25. Q: What is the biggest risk after a paracentesis for ascites?
A: Hypovolemia/fluid shift leading to hypotension. Monitor VS and albumin levels.
Shock, Sepsis, Multi-System
26. Q: The first sign of sepsis is often?
A: Altered mental status (confusion) or tachycardia.
27. Q: In septic shock, why do we give fluids first, then vasopressors?
A: To correct absolute hypovolemia (from vasodilation & capillary leak) before using
drugs to increase vascular tone.
28. Q: Compare distributive, cardiogenic, and hypovolemic shock.
A: Distributive (warm, vasodilated - sepsis), Cardiogenic (cold, pulmonary edema - MI),
Hypovolemic (cold, flat veins - hemorrhage).
