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A 100-kg patient gets hemodialysis 3 days a week. In planning the care for this patient, the nurse recommends
- A. a diet of 2500 to 3500 kcal per day.
- B. protein intake of less than 50 grams per day.
- C. potassium intake of 10 mEq per day.
- D. fluid intake of less than 500 mL per day.
Correct Answer: A
Rationale: The correct answer is A: a diet of 2500 to 3500 kcal per day. During hemodialysis, the patient loses nutrients and energy, so a high-calorie diet is necessary to maintain proper nutrition and energy levels. 2500-3500 kcal/day is a suitable range for a 100-kg patient.
Choice B is incorrect because protein intake should be adequate to prevent malnutrition in hemodialysis patients, typically 1.2g/kg body weight/day. Choice C is incorrect as potassium intake should be restricted in hemodialysis patients due to impaired kidney function. Choice D is incorrect because fluid intake should be individualized based on the patient's fluid status and should not be limited to less than 500 mL per day.
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What were identified as the first critical care units? (Select all that apply.)
- A. Burn units.
- B. Coronary care units
- C. Recovery rooms.
- D. Neonatal intensive care units.
Correct Answer: A
Rationale: The correct answer is A: Burn units. Burn units were identified as the first critical care units due to the complex and intensive care required by burn patients. These units were established to provide specialized care for burn victims, including wound management, infection control, and fluid resuscitation.
Summary:
- Burn units were the first critical care units due to the specialized care needed for burn patients.
- Coronary care units focus on cardiac conditions, not the first identified critical care units.
- Recovery rooms are for post-operative care, not specifically for critical care.
- Neonatal intensive care units are specialized for newborns, not the first critical care units.
The patient is receiving neuromuscular blockade. Which nursing assessment indicates a target level of paralysis?
- A. Glasgow Coma Scale score of 3
- B. Train-of-four yields two twitches
- C. Bispectral index of 60
- D. CAM-ICU positive
Correct Answer: B
Rationale: The correct answer is B: Train-of-four yields two twitches. This assessment indicates a target level of paralysis because a train-of-four ratio of 2 twitches out of 4 suggests a 50% neuromuscular blockade, which is often the goal for patients receiving paralysis for procedures or ventilation.
A: A Glasgow Coma Scale score of 3 assesses consciousness, not neuromuscular blockade.
C: A Bispectral index of 60 measures depth of anesthesia, not paralysis level.
D: CAM-ICU assesses delirium, not neuromuscular blockade.
When performing an initial pulmonary artery occlusion pr essure (PAOP), what are the best nursing actions? (Select all that apply.)
- A. Inflate the balloon for no more than 8 to 10 seconds w hile noting the waveform change.
- B. Inflate the balloon with air, recording the volume nece ssary to obtain a reading.
- C. Maintain the balloon in the inflated position for 8 hours following insertion.
- D. Zero reference and level the air-fluid interface of the tr ansducer at the level of the phlebostatic axis.
Correct Answer: A
Rationale: The correct answer is A: Inflate the balloon for no more than 8 to 10 seconds while noting the waveform change. This is because inflating the balloon within this time frame allows for accurate measurement of PAOP without causing complications like pulmonary edema. Noting the waveform change helps in determining the accurate pressure reading.
Explanation of why other choices are incorrect:
B: Inflating the balloon with air and recording the volume necessary is not a recommended practice as it can lead to inaccurate readings and potential harm to the patient.
C: Maintaining the balloon inflated for 8 hours following insertion is unnecessary and could lead to complications such as vascular damage or thrombosis.
D: Zero referencing and leveling the transducer at the phlebostatic axis are important steps but not directly related to performing an initial PAOP measurement.
Which statement is consistent with societal views of dying in the United States?
- A. Dying is viewed as a failure on the part of the system and providers.
- B. Most Americans would prefer to die in a hospital to spaabrireb .lcoomve/teds to nes the burden of care.
- C. People die of indistinct, complex illness for which a cu re is always possible.
- D. The purpose of the healthcare system is to prevent dise ase and treat symptoms.
Correct Answer: D
Rationale: Rationale: The correct answer is D because the purpose of the healthcare system in the United States is primarily focused on disease prevention and symptom management. This aligns with societal views as healthcare is geared towards improving health outcomes and quality of life.
Incorrect choices:
A: Dying is not viewed as a failure of the system or providers, rather as a natural part of life.
B: Most Americans prefer to die at home or in hospice care rather than in a hospital.
C: Illnesses are not always curable, and death can result from various complex conditions beyond treatment.
Which of the following are accepted nonpharmacological approaches to managing pain and/or anxiety in critically ill patients? (Select all that apply.)
- A. Environmental manipulation
- B. Explanations of monitoring equipment
- C. Guided imagery
- D. Music therapy
Correct Answer: A
Rationale: Step 1: Environmental manipulation involves adjusting factors like lighting, noise levels, and room temperature to create a soothing environment, which can help reduce pain and anxiety.
Step 2: By controlling the physical surroundings, patients may feel more comfortable and relaxed, leading to improved pain management and reduced anxiety levels.
Step 3: Explanations of monitoring equipment and guided imagery are not directly related to environmental changes that can impact pain and anxiety.
Step 4: Music therapy, while beneficial for some patients, is not categorized as environmental manipulation.