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A patient’s ventilator settings are adjusted to treat hypoxemia. The fraction of inspired oxygen is increased from.60 to.70, and the positive end-expiratory pressure is increased from 10 to 15 cm H O. Shortly after these adjustments, the nurse notes that the patient’s blood pressure drops from 120/76 mm Hg to 90/60 mm Hg. What is the m ost likely cause of this decrease in blood pressure?
- A. Decrease in cardiac output
- B. Hypovolemia
- C. Increase in venous return
- D. Oxygen toxicity
Correct Answer: B
Rationale: The correct answer is B: Hypovolemia. When the ventilator settings are adjusted to treat hypoxemia by increasing FiO2 and PEEP, it can lead to increased oxygenation but also potentially decrease venous return to the heart, causing a decrease in blood pressure. This decrease in blood pressure is most likely due to hypovolemia, as the increased PEEP can increase intrathoracic pressure, reducing venous return and preload, leading to a decrease in cardiac output and subsequent decrease in blood pressure. This choice is the most likely cause as the other options (A: Decrease in cardiac output, C: Increase in venous return, D: Oxygen toxicity) do not directly correlate with the changes in ventilator settings described in the question.
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A nurse is on a committee that is trying to reduce the occurrence of hospital-acquired infections in the ICU. Her role is to conduct research to find which interventions have been shown to be most effective in reducing these infections. She consults many different sources and finds conflicting information. Which of the following sources should she consider the most authoritative?
- A. AACN expert panel report
- B. A meta-analysis of randomized controlled trials in the American Journal of Nursing
- C. A systematic review of qualitative studies in the Journal of Advanced Nursing
- D. A single randomized controlled trial in the American Journal of Critical Care
Correct Answer: B
Rationale: The correct answer is B: A meta-analysis of randomized controlled trials in the American Journal of Nursing.
1. Meta-analyses provide a comprehensive overview of multiple studies, increasing the reliability of the findings.
2. Randomized controlled trials are considered the gold standard in research design for assessing intervention effectiveness.
3. The American Journal of Nursing is a reputable source in the field of nursing, ensuring the credibility of the study.
4. By synthesizing data from various trials, the meta-analysis can offer a more robust and generalizable conclusion compared to a single trial or qualitative studies.
Incorrect choices:
A: AACN expert panel report - Expert opinions may vary and lack the empirical evidence provided by research studies.
C: A systematic review of qualitative studies in the Journal of Advanced Nursing - Qualitative studies may provide valuable insights but may not offer concrete evidence on intervention effectiveness like quantitative studies.
D: A single randomized controlled trial in the American Journal of Critical Care - Single trials may not capture the full picture and
What factors are common to both pain and anxiety? (Select all that apply.)
- A. Cyclical exacerbation of one another
- B. Require good nursing assessment for proper treatment
- C. Response only to real phenomena
- D. Perception is majorly influence by previous experience
Correct Answer: A
Rationale: The correct answer is A: Cyclical exacerbation of one another. Pain and anxiety can intensify each other in a cyclical manner. Pain can trigger anxiety, making the pain feel worse, and anxiety can heighten pain perception. This relationship is well-documented in research and clinical practice.
Choice B is incorrect because although both pain and anxiety benefit from thorough nursing assessment, it is not a factor common to both conditions.
Choice C is incorrect as both pain and anxiety can be influenced by real and perceived phenomena, not solely real phenomena.
Choice D is incorrect because while previous experiences can impact pain and anxiety perception, it is not a factor common to both conditions.
The VALUE mnemonic is a helpful strategy to enhance communication with family members of critically ill patients. Which of the following statements describes a VALUE strategy?
- A. View the family as guests on the unit.
- B. Acknowledge family emotions.
- C. Learn as much as you can about family structure and f unction.
- D. Use a trained interpreter if the family does not speak English.
Correct Answer: B
Rationale: The correct answer is B: Acknowledge family emotions. This is a key component of the VALUE strategy as it emphasizes empathy and understanding towards the emotions that family members may be experiencing during a difficult time. By acknowledging their emotions, healthcare providers can build trust and establish a supportive relationship with the family.
Choice A is incorrect because the VALUE strategy focuses on treating family members as integral members of the care team, not just as guests. Choice C is incorrect as learning about family structure and function is important but not specifically part of the VALUE strategy. Choice D is incorrect as using a trained interpreter is important for effective communication but is not specific to the VALUE mnemonic.
A nurse observes that a 38-year-old single father whose 11-year-old daughter is in the ICU is struggling to explain to his 6-year-old son the likelihood that the daughter will die. The young boy asks what will happen to his sister when she dies, but the father breaks down in tears and seems unable to respond. Which of the following would be the most appropriate intervention for the nurse to make?
- A. Suggest that the father contact his pastor, rabbi, or other spiritual leader for counself or him and his son
- B. Sit down with the father and son and share her own religious beliefs
- C. Ask the patients doctor to explain to the father the odds of the daughter surviving
- D. Leave the father and son to grieve alone
Correct Answer: A
Rationale: The correct answer is A. The nurse should suggest that the father contact his spiritual leader for counseling. This option is appropriate as it recognizes the importance of spirituality in coping with difficult situations. It offers emotional support and guidance to the father and his son during a time of crisis.
Option B is incorrect as the nurse sharing her own religious beliefs may not align with the father's beliefs, potentially causing confusion or discomfort.
Option C is not the best intervention, as the doctor's role is primarily medical, and explaining the odds of survival may not address the emotional and spiritual needs of the family.
Option D is also incorrect as leaving the father and son to grieve alone does not provide them with the necessary support and guidance during such a challenging time.
The nurse is preparing to provide postmortem care for a patient who has just died. Which action should the nurse take first?
- A. Close the patient’s eyes and place a pillow under the head.
- B. Wash the patient’s body and apply a clean gown.
- C. Remove all medical equipment and tubes.
- D. Confirm that a death certificate has been signed.
Correct Answer: A
Rationale: Rationale:
A: Closing the patient's eyes and placing a pillow under the head is the first step in postmortem care to maintain dignity and prevent airway occlusion.
B: Washing the body and changing clothes can be done later and is not the priority.
C: Removing medical equipment can wait until after ensuring the patient's comfort.
D: Confirming the death certificate is important but not the immediate first step in postmortem care.