APEx Cardiopulmonary

A child aspirated a coin, and their left lung is hyperinflated. Where is the coin?

A patient complains of a recent syncopal episode with the following rhythm noted. What is the diagnosis?

A patient is complaining of increasing dyspnea, nonproductive cough, fever, and increased sweating at night. They are HIV positive and have been taking antiretroviral medications for the past five years. Current vitals are as follows: BP 118/68, HR 126, RR 36, SpO₂ 92% on room air. Based on the assessment, what would the initial diagnosis be?

A patient is diagnosed with pneumonia and resultant sepsis with the following vital signs: 102.3°F, BP 108/68, HR 124, and RR 28. What is the initial cardiovascular response to sepsis?

A pulmonary embolus ________?

A patient is complaining of chest pain that is radiating to their left arm and up into the jaw. They are alert, diaphoretic, and appear anxious. There is an audible S3 at the apex and crackles throughout the lung bases. Vitals and hemodynamic parameters are as follows: BP 80/60, HR 188, CVP 3, PAP 40/24, PCWP 20, CI 3.6, SVR 1340. While utilizing inotropes and vasodilators to maintain optimal PCWP, which of the following parameters is considered optimal for this patient?

An 80-kilogram patient diagnosed with an acute myocardial infarction is now suffering from aspiration pneumonia. Vital signs: BP 110/60, HR 110, R 16/assisted. Dopamine is infusing at 10 mcg/kg/min. Current ventilator settings are: SIMV 20, PC 22, V_te 462, (f) 26, PEEP 3 and FiO₂ 0.6. Current ABG: pH 7.34, PaCO₂ 50, HCO3^– 19, PaO₂ 50, and SpO₂ 90%. What would your next treatment priority be?

Oxygen saturation (SpO₂) refers to the percentage of oxygen that is?

When comparing EtCO₂ and PaCO₂, which statement is true?

Which of the following situations would NOT require an asthmatic patient to be intubated and mechanically ventilated?

You are transporting a 3-year-old, 15 kg patient involved in a motor vehicle collision (MVC) who is on a ventilator with the following settings: SIMV 20, Vt 60, FiO2 1.0, PEEP 5, PIP 22, Pplat 19. ABG results are: pH 7.01, PaCO2 70, HCO3- 14, PaO2 280, BE -8.  What is the arterial blood gas interpretation?

You are transporting a 4 kg, 3-day-old neonate in severe sepsis and metabolic acidosis who is intubated and sedated. Before intubation, the patient’s initial respiratory rate was 44, with a corresponding EtCO₂ of 22. What would be the most appropriate vent settings for this patient?

A patient is complaining of a severe headache. Their blood pressure has been ranging from 230/130 mmHg to 210/105 mmHg. They currently has nitroprusside (Nipride) infusing and being titrated. Which of the following medications would be deemed most appropriate for this patient?

A patient with an extensive anterior wall myocardial infarction has a blood pressure of 88/60, a pulmonary capillary wedge pressure (PCWP) of 15 mmHg, and a cardiac index (CI) of 2.0 L/min. Which of the following diagnoses best describes this condition?

A patient’s blood pressure is 84/60. What is their current MAP?

A patient was recently admitted for an inferior myocardial infarction. There is now a new systolic murmur upon cardiac auscultation. What is the most common cause of this?

Identify the following hemodynamic waveform:

A 1-year-old has a diagnosis of left upper lobe pneumonia.  Current vitals: BP 70/36, HR 138, RR 48, SpO₂ 87%, and T 102.1°F.  Current ABG: pH 7.20, PaCO₂ 68, HCO3^– 32, PaO₂ 65.  This presentation will result in which of the following changes?

A 12-kilogram child sustained a salt-water drowning and aspirated approximately 250 mL of fluid. Which of the following would NOT be a concern for potential problems?

A 3-year-old patient’s current ABGs are:

pH 7.30, PaCO₂ 24, PaO₂ 62, HCO3^– 16.  What is your interpretation?

A 4-year-old with a past medical history of asthma is in respiratory distress and appearing anxious. Current vitals: BP 80/32, HR 130, RR 38. Crackles are auscultated throughout the lungs. The patient is placed on the monitor, and sinus tachycardia is noted. Upon review of current arterial blood gas results, you would anticipate which of the following findings?

A ground glass appearance is noted on a patient’s chest film. Their current vent settings: SIMV 16, V_t 700, FiO₂ 0.80, and PEEP 5. Current ABGs: pH 7.34, PaCO₂ 38, PaO₂ 60, HCO3^– 24. What pulmonary condition is suspected?

A massive hemothorax in an adult is defined as a rapid accumulation of more than how much blood?

A mechanically ventilated patient who recently underwent a thoracotomy is being transported. You notice the water in the water-seal chamber of the drainage system falls during inspiration and rises during expiration. This fluctuation indicates what?

A normal central venous pressure (CVP)/right atrial pressure (RAP) reading would be?

A patient complaining of chest pain was noted to have a drop in their blood pressure after administration of nitroglycerin. The patient is diaphoretic and complaining of pain as 10/10. A 12-lead ECG reveals ST elevation in leads III, and aVF, and reciprocal changes noted predominantly in lead aVL. What type of myocardial infarction (MI) is suspected?

A patient has a diagnosis of pulmonary embolus and is in respiratory distress, appearing anxious and diaphoretic. Current vitals: BP 94/62, HR 120, RR 38. There are crackles auscultated throughout. What would anticipated findings be on their ABG?

A patient has a past medical history of hypertension, hypertriglyceridemia, coronary artery disease, and diabetes mellitus and is complaining of chest pain. Current vitals are: BP 152/90, HR 82, and RR 22. Upon auscultation, there is a noted split S2 on expiration and single S2 on inspiration. A 12-lead ECG is obtained and it has a normal P wave with each QRS complex, and a PR interval measuring 0.2 seconds. The QRS complexes measure 0.14 seconds and are positive in leads V5 and V6, and negative in V1. What do these findings indicate?

A patient has the following parameters: CVP 28, CI 1.2, PA S/D 48/29, PCWP 27, SVR 1700. What diagnosis is suspected?

A patient has the following waveform and is showing ventricular tachycardia on the monitor. The initial intervention for the patient is to?

A patient is complaining of crushing substernal chest pain with their 12-lead ECG showing Mobitz type I, second-degree AV block, and ST segment elevation in leads II, III, and aVF. Which vessel is most likely involved?

A patient is presenting with non-specific chest pressure that began approximately two hours prior to arrival. Their blood pressure in the left arm measures 204/106. The blood pressure is verified in their right arm with a measurement of 174/76. Which diagnosis should immediately be suspected?

A patient is suffering from an anaphylactic reaction. They have been given three doses of epinephrine 1:1000 solution, 0.5 mg IM via the anterior-lateral thigh. The patient is now suffering from severe chest pain. A 12-lead EKG is completed, and an acute anterior wall MI with associated ST-segment elevation is seen in V1-V4. What is this presentation called?

A patient is suffering from right heart failure. What hemodynamic change would NOT be expected?

A patient presents with increasing shortness of breath that is worse upon exertion and extreme fatigue. The patient can barely walk a few steps without having to sit down. They have a past medical history significant for myocardial infarction, type II diabetes mellitus and underwent a coronary artery by-pass graft two years ago. They deny chest pain currently. Vital signs: BP 94/64, HR 108 and irregular, RR 30/min and labored, T 98.2°F. There are faint crackles in the lower lobes bilaterally, decreased peripheral pulses in lower extremities, and pitting edema of bilateral lower extremities. Which nursing diagnosis LEAST fits this patient currently?

A patient was brought into the emergency department with a diagnosis of spontaneous pneumothorax. Upon assessment, they are noted to be very anxious and sitting on the edge of the bed appearing dyspneic. They complain of numbness/tingling around the mouth and dizziness. Current vitals: BP 132/84, HR 102, and RR 32. What is most likely causing the numbness/tingling around their mouth?

A patient presenting with an arterial blood gas demonstrating a respiratory acidosis is likely suffering from:

A patient that you are transporting from the scene of a motorcycle accident has a blood pressure of 102/58.  What is the mean arterial pressure (MAP)?

A patient with a tension pneumothorax is best treated by needle decompression at the following site:

A post-splenectomy patient is beginning to demonstrate signs of hypoxemia which is likely caused by which of the following?

A patient has left systolic failure and a cardiac index (CI) of 1.3. Which medication would improve contractility?

A patient is currently on a magnesium sulfate drip due to refractory ventricular tachycardia after suffering from an acute myocardial infarction. They suddenly become hypotensive, experience respiratory depression, and hyporeflexia. What is the next best action?

A patient is experiencing left ventricular diastolic failure. What is the focus of first-line therapy?

Acute respiratory failure is defined as?

All intra-aortic balloon pump (IABP) systems use helium as the driving gas because of which of the following characteristics?

An 8-year-old patient’s initial ABG values were: pH 7.25, PaCO₂ 51, PaO₂ 104, HCO3^– 27, SpO₂ 97%, EtCO₂ 54. They have been on the transport ventilator during the one-hour flight. Now the EtCO₂ is showing 34. What would you anticipate the pH to be?

As you evaluate a chest x-ray from a patient presenting with chronic obstructive pulmonary disease (COPD) related symptoms, you note hyperinflated lungs and tracheal deviation. What is your diagnosis?

Beck’s triad is characterized by which of the following?

Common causes of an elevated pulmonary artery pressure include all of the following except?

Coronary artery perfusion is dependent upon?

Diagnosis of a left bundle branch block (LBBB) meeting Sgarbossa criteria uses which diagnostic indicator for an award of 5 points?

During transport, there are rust colored “flakes” noted in the intra-aortic balloon pump (IABP) tubing. This indicates what?

Electrical alternans may be caused by?

How is cardiac output (Q) determined?

Identify and diagnose the following chest x-ray.

Identify and diagnose the following chest x-ray.

Identify the following 12-lead:

Identify the timing error.

Identify the timing error.

Identify the timing error.

Identify the timing error.

Identify the underlying problem based on the following hemodynamic parameters:

CVP 2, PCWP 4, CI 1.8, SVR 400

Identify the underlying problem based on the following parameters:

CVP 2, PCWP 7, CI 1.5, SVR 1800

Identify the underlying problem based on the following parameters:

• CVP 1
• CI 1.6
• PA S/D 12/8
• PCWP 5
• SVR 300

Identify the underlying problem based on the following parameters:

• CVP 1
• CI 1.8
• PA S/D 11/5
• PCWP 4
• SVR 1800

If the intra-aortic balloon migrates upward, which site is most likely to be affected?

In a junctional rhythm, if the junctional impulse reaches the atrium and ventricle at the same time, how does the P wave appear on the 12-lead?

In a patient experiencing status asthmaticus, all of the following are expected findings EXCEPT for?

Inadvertant migration of the intra-aortic balloon may cause all of the following EXCEPT:

Oxygen delivery (DO₂) is a product of what?

Pulmonary capillary wedge pressure (PCWP) could be best described by which of the following phrases?

The central venous pressure (CVP) monitors what?

The dicrotic notch on the pulmonary artery waveform is reflective of what mechanical event in the heart?

The following hemodynamic parameters are obtained:  CVP 8, CI 1.4, and PCWP 13.  This could indicate what problem for the patient?

The intra-aortic balloon pump (IABP) is indicated in all of the following patients EXCEPT:

The patient has a low central venous pressure (CVP), low systemic vascular resistance (SVR), and adequate cardiac index (CI). What is the diagnosis?

The patient’s peripheral arterial line is showing a very sharp waveform with readings that appear exaggerated. This may be due to:

The patient’s pulmonary artery (PA) catheter is exhibiting a large defined waveform with an obvious notch on the left side of the waveform. The distal tip is most likely located in the:

The primary trigger used for most intra-aortic balloon pump (IABP) operations is?

The pulmonary artery catheter parameters read as follows: CVP 13, CI 1.4, PCWP 18. What is the diagnosis?

The team is called to transfer a patient who underwent a coronary artery bypass graft (CABG) three hours earlier. Upon assessment, the following values are noted. The team requests the patient’s previous values for comparison to determine any changes in the patient’s status. Below are the current and previous values.

After comparing these values, what does the team suspect is occurring with this patient?

The team is called to transport a patient who underwent a heart transplant approximately eight hours ago. Upon assessment, they are noted to be pale, cool, and clammy to the touch. They appear anxious but are alert and awake. Assessment reveals jugular vein distention and diffuse crackles throughout both lungs. Current vitals: BP 96/56, HR 124, RR 28, SpO2 97% on oxygen at 3LPM via nasal cannula. Which of the following medications would be beneficial for this patient?

The team is transporting a patient on an intra-aortic balloon pump (IABP) and notice that the patient’s urine output has stopped. What is the likely problem?

The team is caring for an 18-month-old, 10 kg patient experiencing a heart rate of 230 beats per minute.  The best medication for this patient is:

The _____________ measures filling pressures on the right side of the heart as the tip of the catheter lies in the right atrium.

Upon review of a patient’s labs, their potassium level is noted to be 3.1 mEq/L. When looking at their ECG, what would be expected?

Upon viewing the following chest x-ray, what is the suspected diagnosis?

What finding indicates impending respiratory arrest in a pediatric status asthmaticus patient?

What is the formula for determining a mean arterial pressure (MAP)?

What is the goal for the SvO₂ in the septic shock patient?

What is the normal range for the pulmonary capillary wedge pressure (PCWP)?

What is the normal systemic vascular resistance (SVR) measurement?

What therapy is NOT indicated in the treatment of a patient with a rhythm of torsades de pointes?

What would be the anticipated findings in the early stages of septic shock?

What would most likely cause dyspnea with a normal pulmonary capillary wedge pressure (PCWP), an increase in pulmonary artery diastolic pressure (PADP), an increase in pulmonary vascular resistance (PVR), and an increase in central venous pressure (CVP)?

When attempting to “wedge” a pulmonary artery (PA) catheter, how much air should be placed into the balloon?

When evaluating a patient in acute respiratory failure, identify the most common finding.

When obtaining a pulmonary capillary wedge pressure (PCWP) on a cardiac patient, there is a large “V” wave present on the waveform. After confirming correct placement of the pulmonary artery (PA) catheter and ensuring that the balloon is not ruptured, what condition is suspected?

When transporting and assessing a patient with a pulmonary catheter, if the pulmonary artery diastolic pressure is more than 5 mmHg above the pulmonary capillary wedge pressure (PCWP), it signals which abnormal condition?

When treating a patient with a diagnosis of pulmonary embolism, which 12-lead ECG finding could be present?

Which auscultation landmark would pulmonic stenosis best be heard?

Which best describes over-sensing of the cardiac pacemaker?

Which medication is recommended for sedation of a patient in an obstructive shock state secondary to pulmonary hypertension?

Which of the following hemodynamic parameters would be most indicative of cardiogenic shock?

Which of the following hemodynamic parameters would indicate left ventricular failure in a patient with chronic obstructive pulmonary disease (COPD)?

Which of the following is a secondary complication in a COPD patient?

Which of the following pressures is augmented by the intra-aortic balloon pump (IABP) inflation?

Which of the following pulmonary artery pressures (PAP) are within normal limits?

Which timing error is the most harmful?

While monitoring the arterial line of a patient with an intra-aortic balloon pump (IABP), the balloon augmentation starts at what part of the arterial waveform?

While setting up the intra-aortic balloon pump (IABP), the standard timing ratio is?

You are transferring a patient who recently underwent a left lower lobectomy. When auscultating lung sounds, you notice diminished breath sounds in the right posterior lobe. What is the suspected cause of this?

You are transporting a patient from the ICU that is two days post-trauma. While packaging for transport, you are given the following hemodynamic parameters: CVP 1, PCWP 6, CI 2.2, SVR 400. What is your diagnosis?

You are transporting a patient with an active myocardial infarction. Which MI would cause potential ventricular asynchrony?

Your patient presents with jugular venous distention, distant heart sounds, and on chest x-ray has a widened mediastinum.  Based on this information, the patient is likely presenting with what condition:

Your patient presents with the following hemodynamic parameters: CVP 10 mmHg, PCWP 20 mmHg, cardiac output 2 L/min, SVR 2,000 dynes/sec/cm^-5.  What type of shock is this patient in?