GUIDE QUESTIONS WITH ACTUAL
DETAILED ANSWERS 2025-2026
EDITION.
Prioritization - Answer Airway
Breathing
Circulation
Maintain airway!!
Five Rights of Delegation - Answer Right task
Right circumstance
Right person
Right directions and communication
Right supervision and evaluation
Do not delegate anything you can EAT (evaluate, assess and teach)
Hypoxemia - Answer - Low oxygen levels inside the arterial blood
- The body is going to try to compensate by increasing RR and HR
- Hypovolemia, Hypoventilation, and interruption of arterial flow can lead to this condition
,- Hypoxemia dominos (turns into) Hypoxia because of that low oxygen in the blood means that
we have low oxygen delivery to the tissues
What is the ABG level that would be considered hypoxemia? - Answer - PaO2 less than 80
mmHg
Hypoxia/Hypoxemia (Early Signs) - Answer Brain: Mental Status Change
- Restlessness
- Agitation "irritability"
- Anxiety
- Confusion
Vital Signs will be High
- RR - Tachypnea (over 20 RR)
- HR- Tachycardia (over 100 bpm)
- BP - Hypertension (over 140 sys)
You will see Patient Positioning/Sign Respiratory Distress.
- Accessory muscle use "Retractions"
- Nasal Flaring
- Adventitious Lung Sounds (Ex. Crackles, Stridor, Wheezing, Ronchi, etc)
- Tripoding: Patient leaning over trying to catch their breath
Skin:
- Pale skin and mucous membranes
Why are vital signs high when a patient starts to develop early signs of hypoxia? - Answer Body
is scramming for oxygen so it is trying to move the little oxygen it has around the body; Vitals
are high because the body is desperately trying to push that oxygen around.
Hypoxia (Late Signs) - Answer Brain:
,- Bradypnea (below 12)
- Bradycardia (below 60)
- Hypotension
Skin Blue
- aka Cyanotic Skin and Mucous Membranes
ECG dysrhythmias
- basically funky heart rhythms as the heart lacks oxygen
Why are the vital signs low when patient starts to develop late signs of hypoxia? - Answer The
body fails to compensate
Surgical patients (postoperative): Management of Care - Answer Focus on safety and
physiologic systems
Patent airway is priority
Immediate assessment of vitals signs and repeated frequently to ensure stability
Pain assessment
Surgical patients (postoperative): Management of Care: Enhance Recovery After Surgery (ERAS)
- Answer Getting the client up and moving early (mobility)
Providing fluids and food early (nutrition)
Using mild analgesics (pain)
Managing any nausea or vomiting as soon as possible
Discontinuing IV fluids early or in a sensible timeframe
, -Explain special equipment post-op
-Pre- and post-op medication
-Breathing exercises (coughing, incentive spirometer)
-Importance of changing positions
-Pain management
-Special considerations related to surgery type
Postoperative: Infection control (preventing infections) - Answer If antibiotics are prescribed:
-Should be given 1-hour prior to incision and stopped within 24 hours after the surgery
Prepare surgical site according to recommended guidelines
-Remove dirt, hair (with clippers), or bacteria
Client may shower with aseptic agent prior to surgery
Provide good wound care
Postoperative: Increased risk for developing infection - Answer Over 65 years old
Smokers
Immunocompromised or obese
Existing infections