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Continuous renal replacement therapy (CRRT) differs from conventional intermittent hemodialysis in that
- A. a hemofilter is used to facilitate ultrafiltration.
- B. it provides faster removal of solute and water.
- C. it does not allow diffusion to occur.
- D. the process removes solutes and water slowly.
Correct Answer: D
Rationale: The correct answer is D because CRRT removes solutes and water slowly, which is beneficial for hemodynamically unstable patients. This slow removal allows for gradual fluid and electrolyte balance adjustments, reducing the risk of hemodynamic instability.
A: Incorrect - A hemofilter is indeed used in CRRT, but this choice does not highlight the key difference between CRRT and intermittent hemodialysis.
B: Incorrect - CRRT actually provides slower solute and water removal compared to intermittent hemodialysis.
C: Incorrect - Diffusion does occur in CRRT, as it is a key mechanism for solute removal in the process.
In summary, the key difference between CRRT and intermittent hemodialysis is the slow removal of solutes and water in CRRT, making choice D the correct answer.
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One of the strategies shown to reduce perception of stress in critically ill patients and their families is support of spirituality. What nursing action is most clearly supportive of the patients spirituality?
- A. Referring patients to the Catholic chaplain
- B. Providing prayer booklets to patients and families
- C. Asking about beliefs about the universe
- D. Avoiding discussing religion with those of other faiths
Correct Answer: C
Rationale: The correct answer is C because asking about beliefs about the universe allows the nurse to understand the patient's spiritual needs and provide appropriate support. This action shows respect for the patient's beliefs and can help establish a connection between the patient and the nurse. Referring patients to a specific religious figure (choice A) may not align with the patient's beliefs. Providing prayer booklets (choice B) assumes the patient's belief system and may not be helpful. Avoiding discussing religion (choice D) can hinder the nurse-patient relationship and overlook potential sources of support for the patient.
A patient is declared brain dead and a do not resuscitate (DNR) order is put in place. The nurse caring for the patient does not agree with this manne r of care but does not express any concerns to the charge nurse. The nurse’s feeling that the p atient is being killed will likely create what response for this nurse?
- A. A sense of abandonment
- B. Increased family stress
- C. Moral distress
- D. A sense of negligence
Correct Answer: C
Rationale: The correct answer is C: Moral distress. In this scenario, the nurse is experiencing conflicting moral values between the decision made for the patient and their own beliefs. This internal conflict leads to moral distress, a common response when healthcare professionals feel unable to act in accordance with their ethical beliefs. This can lead to emotional turmoil, frustration, and moral residue.
A: A sense of abandonment is incorrect because the nurse is still caring for the patient, so there is no physical abandonment.
B: Increased family stress is incorrect as the nurse's internal conflict does not directly impact family stress.
D: A sense of negligence is incorrect as negligence implies failure to provide proper care, which is not the case here.
The nurse is caring for a patient in the critical care unit whaobi,r ba.cfotemr/ tebset ing declared brain dead, is being managed by the OPO transplant coordinator. Thir ty minutes into the shift, assessment by the nurse includes a blood pressure 75/50 mm Hg, hear t rate 85 beats/min, and respiratory rate 12 breaths/min via assist/control ventilation. The oxygen saturation (SpO ) is 99% and 2 core temperature 93.8° F. Which primary care provider ord er should the nurse implement first?
- A. Apply forced air warming device to keep temperature > 96.8° F
- B. Obtain basic metabolic panel every 4 hours until surgery
- C. Begin phenylephrine (Neo-Synephrine) for systolic BP < 90 mm Hg
- D. Draw arterial blood gas every 4 hours until surgery
Correct Answer: C
Rationale: The correct answer is C: Begin phenylephrine (Neo-Synephrine) for systolic BP < 90 mm Hg. The nurse should implement this order first because the patient's low blood pressure (75/50 mm Hg) indicates hypotension, which can lead to inadequate perfusion to vital organs. Phenylephrine is a vasoconstrictor that can help increase the patient's blood pressure and improve perfusion. It is crucial to address hypotension promptly to prevent further complications.
Choice A is incorrect because maintaining the patient's temperature above 96.8°F is not the most urgent concern in this scenario. Choice B is incorrect as obtaining a basic metabolic panel every 4 hours is not the immediate priority when the patient is experiencing hypotension. Choice D is incorrect as drawing arterial blood gas every 4 hours is not the most urgent intervention needed to address the patient's low blood pressure.
A patient with end-stage heart failure is experiencing consaibdirebr.caobmle/te dsty spnea. What is the appropriate pharmacological management of this symptom ?
- A. Administration of 6 mg of midazolam and initiation of a continuous midazolam infusion.
- B. Administration of morphine, 5 mg IV bolus, and initia tion of a continuous morphine infusion.
- C. Hourly increases of the midazolam (Versed) infusion b y 100% dose increments.
- D. Hourly increases of the morphine infusion by 100% dose increments.
Correct Answer: B
Rationale: The correct answer is B: Administration of morphine, 5 mg IV bolus, and initiation of a continuous morphine infusion. Morphine is the preferred pharmacological management for severe dyspnea in end-stage heart failure due to its potent analgesic and anxiolytic properties.
Step-by-step rationale:
1. Morphine is a potent opioid that helps relieve dyspnea by reducing anxiety, decreasing respiratory drive, and improving overall comfort.
2. The initial IV bolus of 5 mg provides rapid relief of dyspnea.
3. Initiating a continuous morphine infusion ensures sustained relief of dyspnea.
4. Midazolam (choice A) is a benzodiazepine used for sedation and anxiety, but it is not the first-line treatment for dyspnea in this scenario.
5. Increasing the midazolam (choice C) or morphine (choice D) infusions by 100% dose increments hourly is not appropriate as
A patient is being mechanically ventilated in the synchronized intermittent mandatory ventilation mode at a rate of 4 breaths/min. Spontaneous re spirations are 12 breaths/min. The patient receives a dose of morphine sulfate, and now respi rations decrease to 4 breaths/min. What adjustments may need to be made to the patient’s ve ntilator settings?
- A. Add positive end-expiratory pressure (PEEP).
- B. Add pressure support.
- C. Change to assist/control ventilation at a rate of 4 breathabsi/rmb.cionm. /test
- D. Increase the synchronized intermittent mandatory ventilation respiratory rate.
Correct Answer: C
Rationale: The correct answer is C: Change to assist/control ventilation at a rate of 4 breaths/min. When the patient's spontaneous respirations decrease to match the ventilator rate, it indicates that the patient is not actively participating in breathing. Changing to assist/control ventilation allows the patient to trigger breaths when they desire, ensuring a more synchronized and comfortable breathing pattern.
A: Adding PEEP may help improve oxygenation but is not directly related to the issue of decreased spontaneous respirations.
B: Adding pressure support provides additional support during inspiration but does not address the underlying issue of decreased spontaneous respirations.
D: Increasing the SIMV respiratory rate would not address the patient's decreased spontaneous respirations and could potentially lead to overventilation.