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The nurse notes that the patient’s arterial blood gas levels indicate hypoxemia. The patient is not intubated and has a respiratory rate of 22 breaths/min. what is the nurse’s first intervention to relieve hypoxemia?
- A. Call the physician for an emergency intubation proced ure.
- B. Obtain an order for bilevel positive airway pressure (BiPAP).
- C. Provide for oxygen administration.
- D. Suction secretions from the oropharynx.
Correct Answer: C
Rationale: The correct answer is C: Provide for oxygen administration. The first intervention for hypoxemia is to increase oxygen levels to improve oxygen saturation in the blood. Oxygen administration can be achieved through various devices such as nasal cannula, face mask, or non-rebreather mask. This intervention helps to increase the oxygen supply to the patient's tissues and organs, addressing the underlying cause of hypoxemia. Calling for emergency intubation (choice A) is not the first step unless the patient's condition deteriorates. Obtaining an order for BiPAP (choice B) may be beneficial in some cases but is not the initial intervention for hypoxemia. Suctioning secretions (choice D) may be necessary if airway obstruction is present but is not the first step in addressing hypoxemia.
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While waiting for cardiac transplantation, a patient with severe cardiomyopathy has a ventricular assist device (VAD) implanted. When planning care for this patient, the nurse should anticipate:
- A. Giving immunosuppressive medications.
- B. Preparing the patient for a permanent VAD.
- C. Teaching the patient the reason for complete bed rest.
- D. Monitoring the surgical incision for signs of infection.
Correct Answer: D
Rationale: The correct answer is D because monitoring the surgical incision for signs of infection is essential post-VAD implantation to prevent complications. This step is crucial in early identification and treatment of any potential infection, which can lead to serious outcomes.
A) Giving immunosuppressive medications is not typically required for VAD implantation, as the primary goal is to support cardiac function rather than prevent rejection.
B) Preparing the patient for a permanent VAD is premature, as the goal is often to bridge to transplantation or recovery, not permanent VAD placement.
C) Teaching the patient the reason for complete bed rest is not necessary for VAD implantation, as patients are typically encouraged to gradually increase activity levels under guidance.
Acute kidney injury from postrenal etiology is caused by
- A. obstruction of the flow of urine.
- B. conditions that interfere with renal perfusion.
- C. hypovolemia or decreased cardiac output.
- D. conditions that act directly on functioning kidney tissue.
Correct Answer: A
Rationale: The correct answer is A because postrenal acute kidney injury is caused by obstruction of urine flow, leading to pressure build-up in the kidneys and subsequent damage. Obstructions can be due to conditions such as kidney stones, tumors, or enlarged prostate. Choices B, C, and D are incorrect as they relate to pre-renal and intrinsic renal causes of acute kidney injury, not specifically postrenal obstruction. B refers to decreased blood flow to the kidneys, C to low volume or poor heart function affecting kidney perfusion, and D to direct damage to kidney tissue, which do not characterize postrenal etiology.
What were the findings of the Study to Understand Progno ses and Preferences for Outcomes and Risks of Treatment (SUPPORT)?
- A. Clear communication is typical in the relationships bet ween most patients and healthcare providers.
- B. Critical care units often meet the needs of dying patients and their families.
- C. Disparities exist between patients’ care preferences anadb iarbc.tcuomal/t ecsat re provided.
- D. Pain and suffering of patients at end of life is well cont rolled in the hospital.
Correct Answer: C
Rationale: The correct answer is C because the SUPPORT study revealed disparities between patients' care preferences and the actual care provided. This is supported by the findings that many patients did not receive treatments aligned with their preferences. Choice A is incorrect because the study actually highlighted communication challenges between patients and healthcare providers. Choice B is incorrect as the study showed that critical care units often do not meet the needs of dying patients and their families. Choice D is incorrect as the study found that pain and suffering of patients at the end of life are not always well controlled in hospitals.
What is the most critical element of effective early end-of-life decision making?
- A. Control of distressing symptoms such as nausea, anxie ty, and pain.
- B. Effective communication between the patient, family, aabnirdb. choema/tletsht care team throughout the course of the illness.
- C. Organizational support of palliative care principles.
- D. Relocation the dying patient from the critical care unit to a lower level of care.
Correct Answer: B
Rationale: The correct answer is B because effective communication ensures that the patient's wishes and values are understood and respected, leading to informed decision-making. It also promotes shared decision-making among the patient, family, and healthcare team, enhancing the quality of care. Choices A, C, and D are incorrect because while they are important aspects of end-of-life care, they do not address the core element of communication in facilitating meaningful and informed decisions.
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.