A client with severe chest trauma suddenly develops obstructive shock. The nurse suspects tension pneumothorax based on the finding(s) of .

A patient who has had chest pain for several hours is admitted with a diagnosis of rule out acute coronary syndrome (ACS). Which laboratory test should the nurse monitor to best determine whether the patient has had a myocardial infarction (MI)?

A Patient is receiving a neuromuscular blocking agent (NMBA), or “paralytic” drug, to improve synchrony with mechanical ventilation. While reviewing the plan of care, which finding should prompt the nurse to intervene immediately?

A client in the ICU is being treated for hemodynamic instability related to severe pump failure after an extensive myocardial infarction. The client is receiving maximum doses of vasopressors and mechanical ventilation. Despite aggressive treatment, the client’s hemodynamic values continue to decline. Which assessment finding most strongly indicates the client may be entering the refractory stage of shock?

Use the table below to indicate whether each action is indicated or not indicated to reduce the risk for ventilator-associated pneumonia (VAP)

A client recovering from an episode of cardiogenic shock is scheduled for a transesophageal echocardiogram (TEE) to further evaluate cardiac function. Which client statement indicates a need for further teaching about the procedure?

A client with a chest tube following coronary artery bypass grafting (CABG) suddenly develops hypotension, jugular venous distention, and muffled heart sounds. The nurse notes a sudden stoppage of chest tube drainage. Which action is the priority?

During the acute postoperative period following surgical repair of an abdominal aortic aneurysm (AAA), which goal should the nurse prioritize?

A postoperative patient has been receiving IV fluids at 125 mL/hr for the past 12 hours. Urine output over the last 4 hours has trended downward from 60 mL to 42 mL to 28 mL to 20 mL. Current assessment findings include blood pressure dropping to 88/52 mmHg, heart rate increasing to 124/min, respirations 26/min and shallow, cool clammy skin, capillary refill greater than 3 seconds, weak thready pulses, increasing restlessness and confusion, and a lactate level of 4.2 mmol/L.For each finding below, select whether it requires immediate provider notification or if it should be continued to monitor.

An 89‑year‑old male, Joe Bison, was admitted two days ago after sustaining a left femur fracture from a mechanical fall at home. He underwent surgical repair and has been largely non‑ambulatory, requiring assistance for transfers. The patient has a history of limited mobility, increasing his risk for venous thromboembolism (VTE). He has been receiving low‑dose subcutaneous heparin for prophylaxis but has intermittently refused sequential compression devices (SCDs) due to discomfort. Today, the nurse notes the following vital‑sign trends: Joe Bison_Chart.png Questions: Based on these findings, the nurse determines that Mr. Bison is most likely experiencing shock. The most likely cause of shock is . Options for Blank 1: Options for Blank 2: hypovolemic cardiogenic obstructive distributive myocardial infarction (MI) hemorrhage sepsis pulmonary embolism (PE)