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Four hours after mechanical ventilation is initiated for a patient with chronic obstructive pulmonary disease (COPD), the patient’s arterial blood gas (ABG) results include a pH of 7.51, PaO2 of 82 mm Hg, PaCO2 of 26 mm Hg, and HCO3 of 23 mEq/L (23 mmol/L). The nurse will anticipate the need to:
- A. Increase the FIO2.
- B. Increase the tidal volume.
- C. Increase the respiratory rate.
- D. Decrease the respiratory rate.
Correct Answer: D
Rationale: The correct answer is D: Decrease the respiratory rate. The ABG results show respiratory alkalosis with decreased PaCO2 and elevated pH. This indicates overventilation, so decreasing the respiratory rate will help normalize the PaCO2 and pH levels. Increasing the FIO2 (Choice A) is not needed as the PaO2 is within normal range. Increasing tidal volume (Choice B) can lead to further hyperventilation. Increasing the respiratory rate (Choice C) would exacerbate the respiratory alkalosis.
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The wife of a patient who is hospitalized in the critical car e unit following resuscitation for a sudden cardiac arrest at work demands to meet with the nu rsing manager. She states, “I want you to reassign my husband to another nurse. His current n urse is not in the room enough to make sure he is okay.” The nurse recognizes that this respo nse most likely is due to what unspoken need?
- A. Desire to pursue a lawsuit if the assignment is not chanagbierbd.c.o m/test
- B. Inability to participate in the husband’s care.
- C. Lack of prior experience in a critical care setting.
- D. Sense of loss of control of the situation.
Correct Answer: D
Rationale: The correct answer is D: Sense of loss of control of the situation. The wife's demand to reassign the nurse indicates her need for control over her husband's care, as she may feel overwhelmed by the sudden cardiac arrest and hospitalization. By requesting a different nurse, she seeks to regain a sense of control and assurance. The other choices are incorrect because: A does not align with the wife's immediate concern, B does not explain her request for a nurse reassignment, and C does not address her emotional response to the situation.
A nurse needs to communicate with a patients family regarding consent to treat an unconscious patient in the ICU. Which member of the group should the nurse approach first?
- A. A man she recognizes as the patients brother
- B. A teenage boy who approaches the nurse
- C. A woman who originally escorted the patient in
- D. A woman in the group whom the others look at and call over when the nurse approaches
Correct Answer: C
Rationale: The correct answer is C: A woman who originally escorted the patient in. This choice is correct because she is most likely the person responsible for the patient's care and thus likely has legal authority to make medical decisions on behalf of the patient. The other choices are incorrect because simply being recognized as the patient's brother (A), being a teenage boy who approaches the nurse (B), or being a woman whom the others look at and call over (D) does not necessarily indicate that they have the legal authority to make medical decisions for the unconscious patient.
The patient has a Glasgow Coma Scale (GCS) score of 3 and discussions have been held with the family about withdrawing life support. Which statemen t by the nurse best describes requirements that must be met to sustain Centers for Medicare and Medicaid Services (CMS) Conditions of Participation?
- A. “I need to notify the organ procurement organization O PO of my patient’s impending death.”
- B. “I will contact the physician to obtain informed consen t for organ donation.”
- C. “The charge nurse will notify organ procurement organization OPO once the patient has been pronounced brain dead.”
- D. “I need the physician to evaluate my patient’s suitability for organ donation.”
Correct Answer: C
Rationale: The correct answer is C because notifying the organ procurement organization (OPO) once the patient has been pronounced brain dead is a requirement to sustain CMS Conditions of Participation. This step ensures that the proper protocols are followed for organ donation.
Choice A is incorrect because notifying the OPO of impending death is not a requirement for sustaining CMS Conditions of Participation.
Choice B is incorrect because obtaining informed consent for organ donation is not directly related to meeting the requirements of CMS Conditions of Participation.
Choice D is incorrect because while evaluating the patient's suitability for organ donation is important, it is not a specific requirement under CMS Conditions of Participation.
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.
What is the best way to monitor agitation and effectivenes s of treating it in the critically ill patient?
- A. Confusion Assessment Method (CAM-ICU)
- B. FACES assessment tool
- C. Glasgow Coma Scale
- D. Richmond Agitation Sedation Scale
Correct Answer: D
Rationale: The correct answer is D: Richmond Agitation Sedation Scale (RASS). RASS is specifically designed to monitor agitation and sedation levels in critically ill patients, providing a standardized and objective assessment. It includes clear descriptors for different levels of agitation and sedation, allowing for consistent monitoring and treatment adjustments. CAM-ICU is mainly used for delirium assessment, not agitation. FACES assessment tool is more appropriate for pain assessment. Glasgow Coma Scale is focused on assessing level of consciousness, not agitation specifically. By using RASS, healthcare providers can accurately track agitation levels and evaluate the effectiveness of interventions in managing agitation in critically ill patients.