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The patient has been admitted to the hospital with nausea and vomiting that started 5 days earlier. Blood pressure is 80/44 mm Hg and heart rate is 122 beats/min; the patient has not voided in 8 hours, and the bladder is not distended. The nurse anticipates a prescription for “stat” administration of
- A. a blood transfusion.
- B. fluid replacement with 0.45% saline.
- C. infusion of an inotropic agent.
- D. an antiemetic.
Correct Answer: B
Rationale: The correct answer is B: fluid replacement with 0.45% saline. The patient's low blood pressure, tachycardia, and lack of urine output indicate hypovolemia. Fluid replacement with saline will help restore circulating volume, improve blood pressure, and support renal perfusion. A: Blood transfusion is not indicated as the primary issue is hypovolemia, not anemia. C: Inotropic agents are used to increase cardiac contractility but are not the initial treatment for hypovolemia. D: Antiemetics may help with symptoms but do not address the underlying issue of fluid loss and hypovolemia.
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Which of the following patients is at the greatest risk of developing acute kidney injury? A patient who
- A. has been on aminoglycosides for the past 6 days
- B. has a history of controlled hypertension with a blood pressure of 138/88 mm Hg
- C. was discharged 2 weeks earlier after aminoglycoside therapy of 2 weeks
- D. has a history of fluid overload as a result of heart failure
Correct Answer: D
Rationale: The correct answer is D because a patient with a history of fluid overload due to heart failure is at the greatest risk of developing acute kidney injury. Heart failure can lead to decreased kidney perfusion causing acute kidney injury. In this scenario, the patient's fluid overload exacerbates the situation, further compromising kidney function.
Choice A is incorrect as aminoglycosides can cause kidney injury but the duration of 6 days is less concerning compared to chronic fluid overload from heart failure in choice D. Choice B is incorrect because controlled hypertension does not directly increase the risk of acute kidney injury. Choice C is incorrect as the patient being discharged 2 weeks earlier after aminoglycoside therapy does not necessarily indicate a higher risk compared to chronic fluid overload.
Which statement is true regarding venous thromboembolisambir b(.VcoTm/Ete)s ta nd pulmonary embolus (PE)?
- A. PE should be suspected in any patient who has unexpla ined cardiorespiratory complaints and risk factors for VTE.
- B. Bradycardia and hyperventilation are classic symptom s of PE.
- C. Dyspnea, chest pain, and hemoptysis occur in nearly a ll patients with PE.
- D. Most critically ill patients are at low risk for VTE and PE and do not require prophylaxis.
Correct Answer: A
Rationale: The correct answer is A because PE should be suspected in patients with unexplained cardiorespiratory complaints and risk factors for VTE. This is important because PE can present with nonspecific symptoms, making it crucial to consider it in the differential diagnosis.
Explanation:
1. PE can present with various symptoms, including dyspnea, chest pain, and hemoptysis, but these are not present in all patients.
2. Bradycardia and hyperventilation are not classic symptoms of PE, as it can present with tachycardia and other respiratory findings.
3. Critically ill patients are actually at higher risk for VTE and PE, so prophylaxis is typically recommended.
In summary, choice A is correct because it emphasizes the importance of considering PE in patients with cardiorespiratory complaints and risk factors for VTE, while the other choices contain inaccuracies or incomplete information.
When fluid is present in the alveoli what is the result?
- A. Alveoli collapse and atelectasis occurs.
- B. Diffusion of oxygen and carbon dioxide is impaired.
- C. Hypoventilation occurs.
- D. The patient is in heart failure.
Correct Answer: A
Rationale: The correct answer is A: Alveoli collapse and atelectasis occurs. When fluid is present in the alveoli, it impairs the surface tension necessary for the alveoli to remain open, leading to collapse and atelectasis. This prevents proper gas exchange, resulting in hypoxemia. Choice B is incorrect because impaired gas diffusion typically occurs with conditions affecting the alveolar-capillary membrane, not fluid in the alveoli. Choice C is incorrect as hypoventilation refers to decreased ventilation, not specifically related to fluid in the alveoli. Choice D is incorrect as fluid in the alveoli is not a direct indicator of heart failure.
Which scenarios contribute to effective handoff communicaabitribo.cno ma/tte csth ange of shift? (Select all that apply.)
- A. The nephrology consultant physician is making rounds and asks the nurse to provide an update on the patient’s status and assist in p lacing a central line for hemodialysis.
- B. The noise level is high because twice as many staff me mbers are present and everyone is giving report in the nurse’s station.
- C. The unit has decided to use a standardized checklist/toaobli rbfo.cro mc/hteasnt ge-of-shift reports and patient transfers.
- D. Both the off-going and the oncoming nurses conduct a standardized report at the patient’s bedside and review key assessment findings.
Correct Answer: A
Rationale: The correct answer is A because it demonstrates effective handoff communication by involving key stakeholders (nephrology consultant physician), requesting specific patient updates, and collaborating on patient care tasks (placing a central line). This scenario promotes continuity of care and ensures important information is shared.
Explanation for why other choices are incorrect:
B: High noise level disrupts communication and can lead to errors or omissions in handoff information.
C: While using a standardized checklist can be beneficial, it alone does not guarantee effective communication if not utilized properly or if key information is missed.
D: Conducting reports at the patient's bedside is beneficial for patient involvement but may not address the need for involving relevant healthcare providers like the consultant physician in the handoff process.
The patient is in the critical care unit and will receive dialysis this morning. The nurse will (Select all that apply.)
- A. evaluate morning laboratory results and report abnormal results.
- B. administer the patient’s antihypertensive medications.
- C. assess the dialysis access site and report abnormalities.
- D. weigh the patient to monitor fluid status.
Correct Answer: A
Rationale: The correct answer is A because evaluating morning lab results is crucial to monitor the patient's condition before dialysis. Abnormal results may impact the dialysis treatment plan. Option B is incorrect as administering antihypertensive medications is not directly related to dialysis. Option C is incorrect as assessing the dialysis access site is the responsibility of the dialysis team. Option D is incorrect as weighing the patient is not typically done immediately before dialysis.