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Critical illness often results in family conflicts. Which scenario is most likely to result in the greatest conflict?
- A. A 21-year-old college student of divorced parents hosp italized with multiple trauma. She resides with her mother. The parents are amicable with each other and have similar values. The father blames the daughter’s b oyfriend for causing the accident.
- B. A 36-year-old male admitted for a ruptured cerebral an eurysm. He has been living with his 34-year-old girlfriend for 8 years, and they have a 4-year-old daughter. He does not have written advance directives. His parents aarbriribv.ceo mfr/otemst out-of-state and are asked to make decisions about his health care. He h as not seen them in over a year.
- C. A 58-year-old male admitted for coronary artery bypas s surgery. He has been living with his same-sex partner for 20 years in a committed relationship. He has designated his sister, a registered nurse, as his healthca re proxy in a written advance directive.
- D. A 78-year-old female admitted with gastrointestinal blaebeirdbi.cnogm./ tHeset r hemoglobin is decreasing to a critical level. She is a Jehovah’s Witness and refuses the treatment of a blood transfusion. She is capable of making her ow n decisions and has a clearly written advance directive declining any transfu sions. Her son is upset with her and tells her she is “committing suicide.”
Correct Answer: D
Rationale: The correct answer is D because it involves a conflict between the patient's autonomy and her son's beliefs. The patient, a Jehovah's Witness, has clearly stated her refusal of a blood transfusion in her advance directive, which aligns with her religious beliefs. Her son's disagreement with her decision creates a significant ethical dilemma and conflict. This scenario highlights the clash between respecting the patient's autonomy and the son's concerns for her well-being.
Choice A is less likely to result in the greatest conflict as both parents have similar values and are amicable, with the conflict being directed towards the daughter's boyfriend.
Choice B involves a conflict between the patient's girlfriend and parents, but the patient's lack of advance directives and estranged relationship with his parents do not present as significant a conflict as in the correct answer.
Choice C involves a designated healthcare proxy and a committed relationship, which are less likely to result in a conflict as compared to the clash of beliefs and autonomy seen in Choice D.
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The nurse caring for a patient diagnosed with acute respiratory failure identifies “Risk for Ineffective Airway Clearance” as a nursing diagnosis. Wh at nursing intervention is relevant to this diagnosis?
- A. Elevate head of bed to 30 degrees.
- B. Obtain order for venous thromboembolism prophylaxi s.
- C. Provide adequate sedation.
- D. Reposition patient every 2 hours.
Correct Answer: A
Rationale: The correct answer is A: Elevate head of bed to 30 degrees. Elevating the head of the bed helps promote optimal airway clearance by facilitating drainage of secretions and reducing the risk of aspiration. This position also improves lung expansion and oxygenation. Choice B is important for preventing venous thromboembolism but not directly related to airway clearance. Choice C may not be appropriate as excessive sedation can impair airway clearance. Choice D is important for preventing pressure ulcers but does not directly address airway clearance.
A young adult patient with metastatic cancer, who is very close to death, appears restless. The patient keeps repeating, 'I am not ready to die.' Which action is best for the nurse to take?
- A. Remind the patient that no one feels ready for death.
- B. Sit at the bedside and ask if there is anything the patient needs.
- C. Insist that family members remain at the bedside with the patient.
- D. Tell the patient that everything possible is being done to delay death.
Correct Answer: B
Rationale: The correct answer is B because sitting at the bedside and asking if there is anything the patient needs demonstrates empathy and support. It allows the patient to express their concerns and fears, providing emotional comfort. It shows the nurse is actively listening and willing to help address any immediate needs or concerns.
Choice A is incorrect because it dismisses the patient's feelings and may come across as invalidating. Choice C is incorrect because insisting that family members remain may not be what the patient needs at that moment and could cause additional stress. Choice D is incorrect because it does not address the patient's emotional distress and may not be true in the context of terminal illness.
Which of the following strategies will assist in creating a h ealthy work environment for the critical care nurse? (Select all that apply.)
- A. Celebrating improved outcomes from a nurse-driven protocol with a pizza party
- B. Implementing a medication safety program designed b y pharmacists
- C. Modifying the staffing pattern to ensure a 1:1 nurse/patient ratio
- D. Offering quarterly joint nurse-physician workshops to discuss unit issues
Correct Answer: B
Rationale: The correct answer is B because implementing a medication safety program designed by pharmacists promotes a safe work environment for critical care nurses by reducing medication errors. Pharmacists are experts in medications and can provide valuable insights to improve safety.
A: Celebrating with a pizza party may boost morale but does not directly address work environment factors.
C: Modifying staffing ratios may improve patient care but doesn't necessarily address the overall work environment.
D: Joint workshops foster collaboration but may not directly impact the work environment's safety and health.
The nurse is caring for a 48-year-old patient who is intubated and on a ventilator following extensive abdominal surgery. Although the patient is respo nsive, the nurse is not able to read the patient’s lips as the patient attempts to mouth the words. Which of the following assessment tools would be the most appropriate for the nu rse to use when assessing the patient’s pain level? (Select all that apply.)
- A. The FACES scale
- B. Pain Intensity Scale
- C. The PQRST method
- D. The Visual Analogue Scale
Correct Answer: A
Rationale: The correct answer is A: The FACES scale. This scale uses facial expressions to assess pain, making it suitable for a patient who is unable to verbalize. The nurse can show the patient a series of faces depicting varying levels of pain and ask them to point to the one that best represents their pain level. This method is non-verbal and easy for patients to understand.
The other choices are incorrect:
B: The Pain Intensity Scale requires the patient to rate their pain on a numerical scale, which may be difficult for a non-verbal patient.
C: The PQRST method is a mnemonic for assessing pain characteristics (provocation, quality, region, severity, timing), but it requires patient communication.
D: The Visual Analogue Scale involves marking a point on a line to indicate pain intensity, which is not suitable for a non-verbal patient.
The nurse is caring for a patient with an arterial monitoring system. The nurse assesses the patient’s noninvasive cuff blood pressure to be 70/40 mm Hg. The arterial blood pressure measurement via an intraarterial catheter in the same arm is assessed by the nurse to be 108/70 mm Hg. What is the best action by the nurse?
- A. Activate the rapid response system.
- B. Place the patient in Trendelenburg position.
- C. Assess the cuff for proper arm size.
- D. Administer 0.9% normal saline bolus.
Correct Answer: C
Rationale: Rationale for Correct Answer (C - Assess the cuff for proper arm size):
1. The cuff blood pressure (70/40 mm Hg) is significantly lower than the arterial blood pressure (108/70 mm Hg).
2. Discrepancy suggests cuff size mismatch, leading to inaccurate readings.
3. Assessing cuff size ensures accurate blood pressure measurement.
4. Ensures appropriate interventions based on accurate readings.
Summary of Incorrect Choices:
A: Rapid response not warranted based solely on blood pressure discrepancy.
B: Trendelenburg position not indicated for cuff size issue.
D: Normal saline bolus not appropriate without accurate blood pressure measurement.