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The patient is in need of immediate hemodialysis, but has no vascular access. The nurse prepares the patient for insertion of
- A. a percutaneous catheter at the bedside.
- B. a percutaneous tunneled catheter at the bedside.
- C. an arteriovenous fistula.
- D. an arteriovenous graft.
Correct Answer: A
Rationale: The correct answer is A: a percutaneous catheter at the bedside. This is the most appropriate option for immediate hemodialysis when the patient has no vascular access. A percutaneous catheter can be quickly inserted at the bedside, allowing for immediate initiation of hemodialysis.
Choice B, a percutaneous tunneled catheter, involves a more complex insertion process and is not typically done at the bedside. Choices C and D, arteriovenous fistula and arteriovenous graft, require advanced planning and surgical procedures, making them unsuitable for immediate hemodialysis in this scenario.
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The nurse notes that the patient’s arterial blood gas levels indicate hypoxemia. The patient is not intubated and has a respiratory rate of 22 breaths/min. what is the nurse’s first intervention to relieve hypoxemia?
- A. Call the physician for an emergency intubation proced ure.
- B. Obtain an order for bilevel positive airway pressure (BiPAP).
- C. Provide for oxygen administration.
- D. Suction secretions from the oropharynx.
Correct Answer: C
Rationale: The correct answer is C: Provide for oxygen administration. The first intervention for hypoxemia is to increase oxygen levels to improve oxygen saturation in the blood. Oxygen administration can be achieved through various devices such as nasal cannula, face mask, or non-rebreather mask. This intervention helps to increase the oxygen supply to the patient's tissues and organs, addressing the underlying cause of hypoxemia. Calling for emergency intubation (choice A) is not the first step unless the patient's condition deteriorates. Obtaining an order for BiPAP (choice B) may be beneficial in some cases but is not the initial intervention for hypoxemia. Suctioning secretions (choice D) may be necessary if airway obstruction is present but is not the first step in addressing hypoxemia.
A nurse is caring for a patient in the final stages of dying. What is the most appropriate nursing action?
- A. Encourage the patient to eat to maintain strength.
- B. Provide emotional support and comfort measures.
- C. Perform frequent assessments to monitor for recovery signs.
- D. Implement aggressive interventions to prolong life.
Correct Answer: B
Rationale: The correct answer is B: Provide emotional support and comfort measures. In the final stages of dying, the focus shifts from curative treatment to providing comfort and dignity. Emotional support helps alleviate anxiety and fear, promoting a peaceful transition. Comfort measures like pain management improve quality of life. Encouraging the patient to eat may be futile as the body shuts down. Performing frequent assessments for recovery signs is not appropriate in this situation. Implementing aggressive interventions could go against the patient's wishes for a natural death.
Which of the following assists the critical care nurse in ensuring that care is appropriate and based on research?
- A. Clinical practice guidelines
- B. Computerized physician order entry
- C. Consulting with advanced practice nurses
- D. Implementing Joint Commission National Patient Safe ty Goals
Correct Answer: A
Rationale: The correct answer is A: Clinical practice guidelines. Clinical practice guidelines are evidence-based recommendations that assist nurses in providing appropriate care based on research. They outline best practices for specific patient populations or conditions, helping nurses make informed decisions.
Summary:
- B: Computerized physician order entry: While it may improve accuracy and efficiency, it does not specifically ensure care based on research.
- C: Consulting with advanced practice nurses: While collaboration is valuable, it does not guarantee care based on research.
- D: Implementing Joint Commission National Patient Safety Goals: Important for patient safety, but not directly related to ensuring care based on research.
A family member approaches the nurse caring for their gra vely ill son and states, “We want to donate our son’s organs.” What is the best action by the nu rse?
- A. Arrange a multidisciplinary meeting with physicians.
- B. Consult the hospital’s ethics committee for a ruling.
- C. Notify the organ procurement organization (OPO).
- D. Obtain family consent to withdraw life support.
Correct Answer: C
Rationale: The correct answer is C: Notify the organ procurement organization (OPO). This is the best action because the OPO is responsible for coordinating organ donation and transplantation. By involving the OPO, the nurse ensures that the donation process is handled appropriately and ethically.
Choice A: Arranging a multidisciplinary meeting with physicians may be necessary but should not be the first step in this situation.
Choice B: Consulting the hospital’s ethics committee may be helpful, but the immediate priority is to involve the OPO to facilitate organ donation.
Choice D: Obtaining family consent to withdraw life support is not the nurse’s role in this situation. The focus should be on organ donation to honor the family's wishes.
A nurse has achieved certification in critical care nursing. What is the most important effect that this certification will have on the nurses practice?
- A. Recognition by peers
- B. Increase in salary and rank
- C. More flexibility in seeking employment
- D. Increased confidence in critical thinking
Correct Answer: D
Rationale: The correct answer is D: Increased confidence in critical thinking. Achieving certification in critical care nursing validates the nurse's expertise and knowledge in this specialized area, leading to increased confidence in their ability to critically think through complex patient situations. This confidence translates into improved clinical decision-making and patient outcomes.
A: Recognition by peers - While recognition by peers is important for professional growth, the primary benefit of certification is enhancing clinical skills.
B: Increase in salary and rank - While certification may lead to salary increases in some cases, the most significant impact is on improving clinical skills.
C: More flexibility in seeking employment - While certification may enhance employability, the focus is on improving critical thinking skills rather than employment opportunities.