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A patient who is orally intubated and receiving mechanical ventilation is anxious and is fighting the ventilator. Which action should the nurse take next?
- A. Verbally coach the patient to breathe with the ventilator.
- B. Sedate the patient with the ordered PRN lorazepam (Ativan).
- C. Manually ventilate the patient with a bag-valve-mask device.
- D. Increase the rate for the ordered propofol (Diprivan) infusion.
Correct Answer: A
Rationale: The correct answer is A: Verbally coach the patient to breathe with the ventilator. This approach allows the nurse to address the patient's anxiety and help them synchronize their breathing with the ventilator, promoting better ventilation and oxygenation. It is important to first try non-invasive interventions before resorting to sedation or manual ventilation. Sedating the patient (B) should be a last resort to avoid potential complications. Manual ventilation (C) may disrupt the ventilator settings and cause respiratory distress. Increasing the rate of propofol infusion (D) is not indicated unless the patient's sedation level is inadequate.
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A patient’s vital signs are pulse 87, respirations 24, BP of 128/64 mm Hg, and cardiac output is 4.7 L/min. The patient’s stroke volume is ______ mL. (Round to the nearest whole number.)
- A. 54
- B. 64
- C. 74
- D. 84
Correct Answer: A
Rationale: The stroke volume is calculated by dividing the cardiac output by the heart rate. Given the cardiac output of 4.7 L/min and a heart rate of 87 bpm, the stroke volume is 54 mL (4700 mL/87 bpm ≈ 54 mL). Therefore, choice A (54) is the correct answer. Choices B, C, and D are incorrect as they do not match the calculated stroke volume based on the provided cardiac output and heart rate.
While family members are visiting, a patient has a respiratory arrest and is being resuscitated. Which action by the nurse is best?
- A. Ask family members if they wish to remain in the room during the resuscitation.
- B. Take the family members quickly out of the patient's room and remain with them.
- C. Assign a staff member to wait with family members just outside the patient's room.
- D. Encourage family members to stay, but advise them on the potential stress of the situation.
Correct Answer: A
Rationale: The correct answer is A because it respects the patient's right to privacy while also acknowledging the family's presence. By asking family members if they wish to remain in the room, the nurse allows them to make an informed decision based on their comfort level. This approach fosters open communication and shows respect for the family's emotions.
Choice B is incorrect because abruptly removing family members can increase their distress and feelings of powerlessness. Choice C is incorrect as it places the burden of support solely on a staff member, potentially isolating the family from the situation. Choice D is incorrect as it assumes family members should stay without considering their preferences or emotional well-being.
Critical illness often results in family conflicts. Which scenario is most likely to result in the greatest conflict?
- A. A 21-year-old college student of divorced parents hosp italized with multiple trauma. She resides with her mother. The parents are amicable with each other and have similar values. The father blames the daughter’s b oyfriend for causing the accident.
- B. A 36-year-old male admitted for a ruptured cerebral an eurysm. He has been living with his 34-year-old girlfriend for 8 years, and they have a 4-year-old daughter. He does not have written advance directives. His parents aarbriribv.ceo mfr/otemst out-of-state and are asked to make decisions about his health care. He h as not seen them in over a year.
- C. A 58-year-old male admitted for coronary artery bypas s surgery. He has been living with his same-sex partner for 20 years in a committed relationship. He has designated his sister, a registered nurse, as his healthca re proxy in a written advance directive.
- D. A 78-year-old female admitted with gastrointestinal blaebeirdbi.cnogm./ tHeset r hemoglobin is decreasing to a critical level. She is a Jehovah’s Witness and refuses the treatment of a blood transfusion. She is capable of making her ow n decisions and has a clearly written advance directive declining any transfu sions. Her son is upset with her and tells her she is “committing suicide.”
Correct Answer: D
Rationale: The correct answer is D because it involves a conflict between the patient's autonomy and her son's beliefs. The patient, a Jehovah's Witness, has clearly stated her refusal of a blood transfusion in her advance directive, which aligns with her religious beliefs. Her son's disagreement with her decision creates a significant ethical dilemma and conflict. This scenario highlights the clash between respecting the patient's autonomy and the son's concerns for her well-being.
Choice A is less likely to result in the greatest conflict as both parents have similar values and are amicable, with the conflict being directed towards the daughter's boyfriend.
Choice B involves a conflict between the patient's girlfriend and parents, but the patient's lack of advance directives and estranged relationship with his parents do not present as significant a conflict as in the correct answer.
Choice C involves a designated healthcare proxy and a committed relationship, which are less likely to result in a conflict as compared to the clash of beliefs and autonomy seen in Choice D.
Peritoneal dialysis is different from hemodialysis in that peritoneal dialysis
- A. is more frequently used for acute kidney injury.
- B. uses the patient’s own semipermeable membrane (peritoneal membrane).
- C. is not useful in cases of drug overdose or electrolyte imbalance.
- D. is not indicated in cases of water intoxication.
Correct Answer: B
Rationale: The correct answer is B because peritoneal dialysis utilizes the patient's own semipermeable membrane, the peritoneal membrane, as the filtration surface. This allows for the exchange of waste products and excess fluids without the need for external dialysis equipment. Choice A is incorrect as peritoneal dialysis can be used for both acute and chronic kidney injury. Choice C is incorrect as peritoneal dialysis can help manage drug overdose and electrolyte imbalances. Choice D is incorrect as peritoneal dialysis can be used in cases of water intoxication to help remove excess fluids.
The nurse is caring for a patient with a left radial arterial lianbierb, .caonmd/t eas tp ulmonary artery catheter inserted into the right subclavian vein. Which action by th e nurse best ensures the safety of the patient being monitored with invasive hemodynamic moni toring lines?
- A. Document all waveform values.
- B. Limit the pressure tubing length.
- C. Zero reference the system daily.
- D. Ensure alarm limits are turned on.
Correct Answer: C
Rationale: The correct answer is C: Zero reference the system daily. Zero referencing ensures accuracy and calibration of pressure monitoring system by setting the baseline pressure to zero. This is crucial to prevent inaccuracies in measurements. Choice A is important but doesn't directly address the accuracy of the monitoring system. Choice B may help in preventing errors but doesn't address the accuracy of pressure measurement. Choice D is important for alerting the nurse but doesn't directly relate to the accuracy of hemodynamic monitoring.