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A patient in the ICU is recovering from open-heart surgery. The nurse enters his room and observes that his daughter is performing effleurage on his arms and talking in a low voice about an upcoming family vacation that is planned. The room is dimly lit, and she hears the constant beeping of his heart monitor. From the hall she hears the cries of a patient in pain. Which of the following are likely stressors for the patient? Select all that apply.
- A. His daughters conversation
- B. His daughters effleurage
- C. The beeping of the heart monitor
- D. The dim lighting of the room
Correct Answer: C
Rationale: The correct answer is C: The beeping of the heart monitor is a likely stressor for the patient recovering from open-heart surgery in the ICU. The constant beeping can cause anxiety and uncertainty about their health status. The daughter's conversation and effleurage are likely comforting and supportive for the patient, reducing stress. The dim lighting may create a calming environment, and the distant cries of a patient in pain may evoke empathy but may not directly stress the recovering patient. Therefore, the beeping of the heart monitor stands out as a stressor among the choices provided.
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In determining the glomerular filtration rate (GFR) or creatinine clearance, a 24-hour urine is obtained. If a reliable 24-hour urine collection is not possible,
- A. it is not possible to determine the GFR.
- B. the BUN may be used to determine renal function.
- C. an elevated BUN/creatinine ratio can be used.
- D. a standardized formula may be used to calculate GFR.
Correct Answer: D
Rationale: The correct answer is D because when a reliable 24-hour urine collection is not possible, a standardized formula can be used to estimate GFR. The Cockcroft-Gault equation or the Modification of Diet in Renal Disease (MDRD) equation are commonly used formulas to estimate GFR based on serum creatinine levels, age, gender, and race. These formulas provide a reasonable estimation of kidney function in the absence of a 24-hour urine collection.
Choice A is incorrect because there are alternative methods available to estimate GFR. Choice B is incorrect because BUN alone is not sufficient to accurately determine renal function. Choice C is incorrect because an elevated BUN/creatinine ratio is not a direct measure of GFR and may be influenced by factors other than kidney function, such as hydration status or liver function.
Which of the following is (are) official journal(s) of the A merican Association of Critical-Care Nurses? (Select all that apply.)
- A. American Journal of Critical Care
- B. Critical Care Clinics of North America
- C. Critical Care Nurse
- D. Critical Care Nursing Quarterly
Correct Answer: A
Rationale: Step-by-step rationale:
1. The American Association of Critical-Care Nurses (AACN) publishes the American Journal of Critical Care (AJCC).
2. The AJCC is a peer-reviewed journal that covers critical care nursing practice, research, and education.
3. The content in AJCC aligns with AACN's mission and standards for critical care nursing.
4. Hence, AJCC is an official journal of AACN.
Summary of other choices:
- B: Critical Care Clinics of North America - Not an official journal of AACN.
- C: Critical Care Nurse - Not an official journal of AACN.
- D: Critical Care Nursing Quarterly - Not an official journal of AACN.
A 20-year-old patient arrives in the emergency department (ED) several hours after taking 25 to 30 acetaminophen (Tylenol) tablets. Which action will the nurse plan to take?
- A. Give N-acetylcysteine (Mucomyst).
- B. Discuss the use of chelation therapy.
- C. Start oxygen using a non-rebreather mask.
- D. Have the patient drink large amounts of water.
Correct Answer: A
Rationale: The correct answer is A: Give N-acetylcysteine (Mucomyst). N-acetylcysteine is the antidote for acetaminophen overdose. It helps replenish glutathione, which is depleted by acetaminophen metabolism. This prevents liver damage. Choice B, chelation therapy, is not indicated for acetaminophen overdose. Choice C, oxygen therapy, is not directly related to acetaminophen overdose treatment. Choice D, drinking water, will not address the overdose and may not be safe in high doses. Therefore, the best course of action is to administer N-acetylcysteine to prevent liver damage in acetaminophen overdose.
The nurse is caring for a patient with an admitting diagnosis of congestive failure. While attempting to obtain a pulmonary artery occlusion pressure in the supine position, the patient becomes anxious and tachypneic. What is the best action by the nurse?
- A. Limit the patient’s supine position to no more than 10 seconds.
- B. Administer anxiety medications while recording the pressure.
- C. Encourage the patient to take slow deep breaths while asbuirpb.icnoem./ test
- D. Elevate the head of the bed 45 degrees while recording pressures.
Correct Answer: D
Rationale: The correct answer is D: Elevate the head of the bed 45 degrees while recording pressures.
Rationale:
1. Elevating the head of the bed will help improve the patient's breathing by reducing the pressure on the diaphragm.
2. This position will also help alleviate the patient's anxiety and tachypnea, promoting better oxygenation.
3. Recording pressures in this position will provide accurate data for monitoring the patient's condition.
Summary:
A: Limiting the supine position to 10 seconds does not address the underlying issues causing the patient's anxiety and tachypnea.
B: Administering anxiety medications without addressing the positioning issue may not effectively manage the patient's symptoms.
C: Encouraging the patient to take slow deep breaths is helpful, but changing the position of the patient is more crucial in this situation.
Conditions that produce acute kidney injury by directly acting on functioning kidney tissue are classified as intrarenal. The most common intrarenal condition is
- A. prolonged ischemia.
- B. exposure to nephrotoxic substances.
- C. acute tubular necrosis (ATN).
- D. hypotension for several hours.
Correct Answer: C
Rationale: Rationale:
1. Acute tubular necrosis (ATN) is the most common intrarenal condition as it directly affects kidney tubules.
2. ATN is characterized by damage to renal tubular cells due to various factors like toxins or ischemia.
3. Prolonged ischemia (choice A) can lead to ATN but is not the most common intrarenal condition.
4. Exposure to nephrotoxic substances (choice B) can cause ATN, but ATN itself is more common.
5. Hypotension for several hours (choice D) can result in ischemia and subsequent ATN, but ATN is still the primary intrarenal condition.