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A patient is being mechanically ventilated in the synchronized intermittent mandatory ventilation mode at a rate of 4 breaths/min. Spontaneous reabsiprbi.rcaotmio/tensst are 12 breaths/min. After receiving a dose of morphine sulfate, respirations decrease to 4 breaths/min. Which acid-base disturbance will likely occur?
- A. Metabolic acidosis
- B. Metabolic alkalosis
- C. Respiratory acidosis
- D. Respiratory alkalosis
Correct Answer: D
Rationale: The correct answer is D (Respiratory alkalosis). Morphine sulfate can cause respiratory depression, leading to decreased respiratory rate. In this case, the patient's breaths decrease from 12 to 4 breaths/min, indicating hypoventilation. With decreased ventilation, there is less CO2 elimination, resulting in respiratory alkalosis. The other choices can be ruled out: A (Metabolic acidosis) and B (Metabolic alkalosis) are less likely caused by morphine sulfate, and C (Respiratory acidosis) is incorrect because the scenario describes hypoventilation, not hyperventilation.
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A 19-year-old is brought to the emergency department (ED) with multiple lacerations and tissue avulsion of the left hand. When asked about tetanus immunization, the patient denies having any previous vaccinations. The nurse will anticipate giving:
- A. Tetanus immunoglobulin (TIG) only.
- B. TIG and tetanus-diphtheria toxoid (Td).
- C. Tetanus-diphtheria toxoid and pertussis vaccine (Tdap) only.
- D. TIG and tetanus-diphtheria toxoid and pertussis vaccine (Tdap).
Correct Answer: D
Rationale: The correct answer is D because the patient has a high-risk wound (tissue avulsion) and no documented prior tetanus vaccination. TIG provides immediate passive immunity to tetanus, while Tdap stimulates active immunity. TIG covers immediate needs, while Tdap ensures long-term immunity. Choice A (TIG only) does not provide long-term immunity. Choice B (TIG and Td) does not include pertussis coverage, which Tdap (Choice D) does. Choice C (Tdap only) does not cover immediate needs as TIG does.
The primary health care provider writes an order to discon tinue a patient’s left radial arterial line. When discontinuing the patient’s invasive line, what is the priority nursing action?
- A. Apply an air occlusion dressing to insertion site.
- B. Apply pressure to the insertion site for 5 minutes.
- C. Elevate the affected limb on pillows for 24 hours.
- D. Keep the patient’s wrist in a neutral position.
Correct Answer: B
Rationale: The correct answer is B: Apply pressure to the insertion site for 5 minutes. This is the priority nursing action because it helps prevent bleeding and hematoma formation after removing the arterial line. Applying pressure for 5 minutes allows for adequate hemostasis.
A: Applying an air occlusion dressing to the insertion site is not the priority action. It does not address the immediate need to control bleeding.
C: Elevating the affected limb on pillows for 24 hours is not necessary and does not address the immediate need for hemostasis.
D: Keeping the patient's wrist in a neutral position is not the priority action when discontinuing an arterial line. It does not address the need for hemostasis and preventing bleeding.
Which of the following strategies will assist in creating a h ealthy work environment for the critical care nurse? (Select all that apply.)
- A. Celebrating improved outcomes from a nurse-driven protocol with a pizza party
- B. Implementing a medication safety program designed b y pharmacists
- C. Modifying the staffing pattern to ensure a 1:1 nurse/patient ratio
- D. Offering quarterly joint nurse-physician workshops to discuss unit issues
Correct Answer: B
Rationale: The correct answer is B because implementing a medication safety program designed by pharmacists promotes a safe work environment for critical care nurses by reducing medication errors. Pharmacists are experts in medications and can provide valuable insights to improve safety.
A: Celebrating with a pizza party may boost morale but does not directly address work environment factors.
C: Modifying staffing ratios may improve patient care but doesn't necessarily address the overall work environment.
D: Joint workshops foster collaboration but may not directly impact the work environment's safety and health.
When it is noted that a patient’s endotracheal tube is not se cured tightened, he respiratory care practitioner assists the nurse in taping the tube. After the tu be is retaped, the nurse auscultates the patient’s lungs and notes that the breath sounds over the left lung fields are absent. The nurse suspects is the cause of this finding?
- A. The endotracheal tube is in the right mainstem bronchus.
- B. The patient has a left pneumothorax.
- C. The patient has aspirated secretions during the proceduarbeir.b .com/test
- D. The stethoscope earpiece is clogged with wax.
Correct Answer: A
Rationale: The correct answer is A: The endotracheal tube is in the right mainstem bronchus. When the endotracheal tube is not secured properly and is retaped, there is a possibility that it may have migrated into the right mainstem bronchus, leading to absent breath sounds in the left lung fields. This condition is known as endobronchial intubation. In such cases, ventilation primarily occurs in the right lung, resulting in decreased or absent breath sounds on the contralateral side. Choices B, C, and D are incorrect as they do not explain the absence of breath sounds over the left lung fields in this specific scenario.
Acute kidney injury from postrenal etiology is caused by
- A. obstruction of the flow of urine.
- B. conditions that interfere with renal perfusion.
- C. hypovolemia or decreased cardiac output.
- D. conditions that act directly on functioning kidney tissue.
Correct Answer: A
Rationale: The correct answer is A because postrenal acute kidney injury is caused by obstruction of urine flow, leading to pressure build-up in the kidneys and subsequent damage. Obstructions can be due to conditions such as kidney stones, tumors, or enlarged prostate. Choices B, C, and D are incorrect as they relate to pre-renal and intrinsic renal causes of acute kidney injury, not specifically postrenal obstruction. B refers to decreased blood flow to the kidneys, C to low volume or poor heart function affecting kidney perfusion, and D to direct damage to kidney tissue, which do not characterize postrenal etiology.