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Todays critical care nursing environment is constantly changing. What nursing behavior best illustrates awareness of current events affecting critical care nursing?
- A. Participating in the hospitals efforts to recruit new nurses
- B. Volunteering to serve on a disaster response planning committee
- C. Adhering to content taught in basic nursing program
- D. Attending hospital-mandated in-services without other education Answer Key
Correct Answer: B
Rationale: The correct answer is B because volunteering to serve on a disaster response planning committee demonstrates awareness of current events affecting critical care nursing. By actively participating in planning for potential disasters, the nurse shows a proactive approach to staying informed and prepared for emergencies. This behavior indicates a commitment to staying up-to-date with the evolving landscape of critical care nursing.
Choices A, C, and D are incorrect because:
A: Participating in recruitment efforts may be important but does not directly demonstrate awareness of current events affecting critical care nursing.
C: Adhering to basic nursing program content is necessary but does not show active engagement with current events in critical care nursing.
D: Attending hospital-mandated in-services is valuable, but without seeking additional education or involvement in current events, it does not illustrate awareness of the changing critical care nursing environment.
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Which interventions can the nurse use to facilitate communication with patients and families who are in the process of making decisions regarding end- of-life care options? (Select all that apply.)
- A. Communication of uniform messages from all healthca re team members
- B. An integrated plan of care that is developed collaborat ively by the patient, family, and healthcare team
- C. Facilitation of continuity of care through accurate shift -to-shift and transfer reports
- D. Limitation of time for families to express feelings in order to control family grief
Correct Answer: A
Rationale: The correct answer is A: Communication of uniform messages from all healthcare team members. This intervention is crucial to ensure consistency in information provided to patients and families, reducing confusion and enhancing trust. When all team members convey the same messages, it helps in clarifying options and facilitating decision-making.
Choices B and C are incorrect as they focus on care planning and continuity, which are important but not specifically related to facilitating communication in end-of-life care decisions. Choice D is incorrect as it suggests limiting time for families to express feelings, which can hinder effective communication and support during such a sensitive time.
The central venous oxygen saturation (ScvO2) is decreasing in a patient who has severe pancreatitis. To determine the possible cause of the decreased ScvO2, the nurse assesses the patient’s:
- A. Lipase.
- B. Temperature.
- C. Urinary output.
- D. Body mass index.
Correct Answer: B
Rationale: The correct answer is B: Temperature. Decreased ScvO2 in severe pancreatitis can be due to systemic inflammatory response leading to increased metabolic demand and decreased tissue oxygen delivery. Monitoring temperature helps assess for presence of infection or sepsis, which can further decrease tissue oxygenation. Lipase (A) is specific for pancreatitis diagnosis, not directly related to ScvO2. Urinary output (C) is important for assessing renal function, not directly related to ScvO2. Body mass index (D) does not provide information on tissue oxygenation status in this context.
The nurse is caring for a patient whose ventilator settings i nclude 15 cm H O of positive end-expiratory pressure (PEEP). The nurse understands that although beneficial, PEEP may result in what possible problem?
- A. Fluid overload secondary to decreased venous return.
- B. High cardiac index secondary to more efficient ventric ular function.
- C. Hypoxemia secondary to prolonged positive pressure a t expiration.
- D. Low cardiac output secondary to increased intrathoracic pressure
Correct Answer: D
Rationale: Rationale for Correct Answer (D - Low cardiac output secondary to increased intrathoracic pressure):
1. PEEP increases intrathoracic pressure, which can impede venous return to the heart.
2. Impaired venous return reduces preload, leading to decreased cardiac output.
3. Decreased cardiac output can result in inadequate tissue perfusion and oxygenation.
4. Therefore, PEEP may cause low cardiac output due to increased intrathoracic pressure.
Summary of Incorrect Choices:
A. Fluid overload is not directly related to PEEP but more to fluid administration or kidney function.
B. High cardiac index is unlikely as PEEP can decrease cardiac output.
C. Hypoxemia is not a direct result of PEEP but may occur due to other factors like inadequate ventilation or oxygenation settings.
A 22-year-old patient who experienced a near-drowning accident in a local pool, but now is awake and breathing spontaneously, is admitted for observation. Which assessment will be most important for the nurse to take during the observation period?
- A. Auscultate heart sounds.
- B. Palpate peripheral pulses.
- C. Auscultate breath sounds.
- D. Check pupil reaction to light.
Correct Answer: C
Rationale: The correct answer is C: Auscultate breath sounds. After a near-drowning incident, the main concern is potential respiratory complications such as aspiration pneumonia or pulmonary edema. Auscultating breath sounds will help the nurse assess for any signs of respiratory distress or complications. This assessment is crucial for early detection and intervention.
A: Auscultating heart sounds is important but not as crucial as assessing breath sounds in this scenario.
B: Palpating peripheral pulses is important for circulation assessment but does not address the immediate concern of respiratory complications.
D: Checking pupil reaction to light is more relevant for neurological assessment and not as critical as assessing breathing in this situation.
An Ethiopian man with AIDS has recently been admitted to the ICU with a case of pneumonia. The man is new to the U.S. and has no health insurance. He would likely be eligible for the states Medicaid coverage, but does not understand how to access this coverage. Which competency or competencies are most needed in this situation? Select all that apply.
- A. Clinical judgment
- B. Advocacy and moral agency
- C. Collaboration
- D. Systems thinking
Correct Answer: B
Rationale: The correct answer is B: Advocacy and moral agency. In this scenario, the Ethiopian man with AIDS is in a vulnerable position due to lack of health insurance and understanding of Medicaid coverage. Advocacy skills are crucial to help him navigate the complex healthcare system and access the necessary resources. Moral agency involves advocating for the patient's rights and well-being, ensuring that he receives appropriate care despite his socioeconomic status. Clinical judgment, collaboration, and systems thinking are important competencies but not as directly relevant in this specific situation of advocating for the patient's access to Medicaid coverage.