1.

You are assigned to care for a 58 year-old man who is scheduled for a cardiac angiogram
during your shift. What actions should you take? Check all that apply.
A. Explain that the patient will receive short-acting anesthesia
B. Review the patient's allergies, specifically checking to see if he has an allergy to
contrast dye
C. Inform the patient that his wife should stay at home until the procedure is finished, as
family members often distract the team in the cath lab
D. Review and reconcile his medications. Confirm that he did not take his warfarin
E. Check the patient's most recent labs paying particular attention to the PT INR

Rationale: Contrast dyes contain iodine and allergy could lead to anaphylactic response; might
receive light sedation but needs to be awake and able to follow directions

2. A 62-year-old woman has been hospitalized in the ICU for several weeks. Her hospital stay
has been complicated by aspiration pneumonia and sepsis, requiring prolonged courses of
antibiotics. For the past few days, she has been having high temperatures again, and her
stool output has increased dramatically. Her most recent stool samples have tested positive
for Clostridium difficile toxin, and her laboratory tests reveal serum Na 138 mEq/L, K 3.5
mEq/L, Cl 115 mEq/L, albumin 4.4 g/dL, pH 7.32, Paco2 30 mm Hg, and HCO3 – 15 mEq/L.
Which one of the following acid-base disturbances is consistent with this patient's ABG?
A. AG metabolic acidosis.
B. Normal AG metabolic acidosis.
C. Saline-responsive metabolic alkalosis.
D. Acute respiratory acidosis.

Rationale: This ABG is consistent with a metabolic acidosis. The pH is less than 7.40 (indicating
an acidosis), and the HCO3 − and Paco2 are decreased from normal. In a metabolic acidosis,
the decrease in HCO3 is the primary disorder.

3. A 27-year-old man with no medical history is admitted to the hospital after being "found
down" at a party, where he reportedly ingested a fifth of whiskey during a 20-minute
period. On arrival at the emergency department, he was neurologically unresponsive with
the following ABG values: pH 7.23, Paco2 58 mm Hg, Pao2 111 mm Hg, HCO3 − 24 mEq/L,
and Sao2 100% on 2 L/minute of oxygen by nasal cannula. Which one of the following
actions is best?
A. Administer albuterol 4 puffs every 20 minutes for 4 hours; then 2-4 puffs every 2-4
hours as needed.
B. Administer 100% oxygen by face mask.
C. Give NaHCO3− 100 mEq intravenous piggyback over 30 minutes.
D. Intubate and transfer to the ICU.
Rationale: Given this patient's neurologic status and his elevated Paco2, he should be intubated
and transferred to the ICU. In patients without chronic obstructive pulmonary disease, a Paco2
greater than 50 mm Hg is usually an indication for mechanical ventilation regardless of
oxygenation.