Nokea
A patient with chronic obstructive pulmonary disease (COPD) is admitted to the hospital with acute exacerbation and respiratory failure requiring mechanical ventilation. Which of the following ventilator settings is most appropriate for minimizing the risk of ventilator-induced lung injury (VILI) in this patient?
- A. Low tidal volume and high positive end-expiratory pressure (PEEP)
- B. High tidal volume and low respiratory rate
- C. Spontaneous breathing mode with pressure support ventilation (PSV)
- D. Synchronized intermittent mandatory ventilation (SIMV)
Correct Answer: A
Rationale: Patients with COPD are at increased risk for developing ventilator-induced lung injury (VILI) due to their underlying lung pathology. Using a low tidal volume strategy (6-8 ml/kg predicted body weight) has been shown to reduce the risk of VILI in these patients. Additionally, applying high positive end-expiratory pressure (PEEP) helps to recruit collapsed alveoli, improve oxygenation, and decrease the risk of barotrauma by keeping the alveoli open throughout the respiratory cycle. Therefore, the most appropriate ventilator settings to minimize the risk of VILI in a COPD patient with acute exacerbation and respiratory failure requiring mechanical ventilation would be low tidal volume and high PEEP.
You may also like to solve these questions
A 24-year-old woman presents with cyclic pelvic pain, dysmenorrhea, and dyspareunia. On pelvic examination, tender nodules are palpated along the uterosacral ligaments. Which of the following conditions is most likely to be responsible for these findings?
- A. Pelvic inflammatory disease (PID)
- B. Endometriosis
- C. Ovarian cyst rupture
- D. Uterine fibroids
Correct Answer: B
Rationale: The symptoms of cyclic pelvic pain, dysmenorrhea (painful menstruation), dyspareunia (painful intercourse), and tender nodules along the uterosacral ligaments are classic findings associated with endometriosis. In endometriosis, tissue similar to the lining of the uterus (endometrium) grows outside the uterus, commonly on the ovaries, fallopian tubes, and pelvic peritoneum. The presence of tender nodules along the uterosacral ligaments is known as "nodularity" and is a characteristic feature of advanced endometriosis. It occurs due to the formation of endometrial implants that respond to hormonal changes during the menstrual cycle, resulting in inflammation, scarring, and pain in affected areas.
Which of the following characteristics of Cushing disease is TRUE? The disease occurs in women between 20 to 40 year of age. II.The use of Corticosteroids for multiple immune conditions is a cause of the disease process. III. Condition is aggravated by excessive production of ACTH. IV.The surgical treatment of choice is Transphenoidal hypophysectomy
- A. II & III
- B. I, II, III, & IV
- C. I, II, & III
- D. I & Il
Correct Answer: A
Rationale: Statement II is correct because the use of corticosteroids for multiple immune conditions can lead to the development of Cushing's disease.
Mr. C is an older patient with a known history of peripheral vascular disease. The nurse places a heating pad directly on the patient's lower leg to relieve muscle spasms. The heating pad causes a burn, the area becomes infected, and the patient eventually must have a skin graft. This is an example of which of the following?
- A. Malpractice
- B. Vicarious liability
- C. Assault
- D. Negligence
Correct Answer: D
Rationale: Negligence refers to the failure to take proper care in doing something. In this scenario, the nurse failed to exercise the standard of care expected in placing a heating pad directly on Mr. C's lower leg, knowing his history of peripheral vascular disease. This failure led to a burn and subsequent infection that required a skin graft for treatment. The actions of the nurse were negligent as they did not meet the expected standard of care, resulting in harm to the patient. This situation does not fit the definition of assault, malpractice, or vicarious liability, making negligence the most appropriate choice.
Which of the following statements is TRUE?
- A. History taking must be long regardless if the child appears to be well
- B. No proper history can be obtained without observation of the child and the mother.
- C. Nurse Nanie should refrain from asking about the illness of other members of the family.
- D. An example of what can be elicited from a social history is how the disease started.
Correct Answer: D
Rationale: An example of what can be elicited from a social history is how the disease started. This statement is true because a social history typically includes information about factors such as the onset of the illness, the child's living environment, family dynamics, and any recent events that may have contributed to the child's current condition. Understanding how the disease started can provide valuable insights into possible triggers or underlying causes, helping healthcare providers develop an appropriate treatment plan. A comprehensive social history is essential for providing holistic care to the child and addressing all relevant factors that may impact their health and well-being.
What should be the INITIAL S'TEP in the process of change for the senior nurse
- A. set goals and priorities regarding the change process.
- B. Plan strategies to implement the change.
- C. Identify potential solutions and strategies for the change.
- D. Identify the inefficiency that needs improvement or correction
Correct Answer: D
Rationale: The initial step in the process of change for the senior nurse should be to identify the inefficiency that needs improvement or correction. Before setting goals, planning strategies, or identifying solutions, it is essential to first pinpoint the specific area or aspect that requires change. By identifying the inefficiency, the senior nurse can gain a clear understanding of the root cause of the issue and focus efforts on addressing it effectively. This step lays the foundation for the rest of the change process by providing a specific target for improvement.