Nokea
What risk is the rationale for the recommendation of endot racheal rather than nasotracheal intubation?
- A. Basilar skull fracture
- B. Cervical hyperextension
- C. Impaired ability to "mouth" words
- D. Sinusitis and infection
Correct Answer: A
Rationale: The correct answer is A: Basilar skull fracture. Endotracheal intubation is recommended over nasotracheal intubation to avoid the risk of further damaging a basilar skull fracture. Nasotracheal intubation can potentially cause further injury due to the passage of the tube through the nasal cavity, which could exacerbate a basilar skull fracture.
Summary of other choices:
B: Cervical hyperextension - Not directly related to the choice between endotracheal and nasotracheal intubation.
C: Impaired ability to "mouth" words - Not a significant factor in determining the choice of intubation method.
D: Sinusitis and infection - While nasotracheal intubation can potentially lead to sinusitis and infection, the primary concern in this scenario is the risk of aggravating a basilar skull fracture.
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In calculating the glomerular filtration rate (GFR) results for women, the creatinine clearance is usually:
- A. the same as for men.
- B. greater than that for men.
- C. multiplied by 0.85
- D. multiplied by 1.15.
Correct Answer: C
Rationale: The correct answer is C: multiplied by 0.85. This is because women typically have lower muscle mass compared to men, resulting in lower creatinine production. Therefore, to adjust for this difference, the creatinine clearance for women is multiplied by 0.85. This correction factor helps to more accurately estimate the GFR in women.
Choices A and B are incorrect because the creatinine clearance for women is not the same as or greater than that for men due to the physiological differences in muscle mass. Choice D is also incorrect as multiplying by 1.15 would overestimate the GFR in women.
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.
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.
While neuromuscular blocking agents are used in the management of some ventilated patients what is their primary mode of action?
- A. Analgesia
- B. Anticonvulsant
- C. Paralysis
- D. Sedation
Correct Answer: C
Rationale: The correct answer is C: Paralysis. Neuromuscular blocking agents work by blocking the transmission of nerve impulses at the neuromuscular junction, leading to muscle paralysis. This is essential in ventilated patients to facilitate mechanical ventilation and prevent patient-ventilator dyssynchrony.
Rationale:
A: Analgesia - Neuromuscular blocking agents do not provide pain relief. They do not have any direct analgesic properties.
B: Anticonvulsant - Neuromuscular blocking agents do not prevent or treat seizures. They do not have anticonvulsant effects.
D: Sedation - While sedatives may be used in conjunction with neuromuscular blocking agents, the primary mode of action of these agents is muscle paralysis, not sedation.
A Muslim patient has been admitted to the critical care unit with complications after childbirth. Based on the Synergy Model, which nurse would be the most inappropriate to assign to care for this patient?
- A. New graduate female nurse
- B. Most experienced female nurse
- C. New graduate male nurse
- D. Female nurse with postpartum experience
Correct Answer: C
Rationale: Step-by-step rationale:
1. The Synergy Model emphasizes matching nurse competencies with patient needs.
2. A male nurse may not be culturally appropriate for a Muslim female patient due to religious beliefs.
3. Gender segregation is important in Islamic culture, especially concerning intimate care.
4. Therefore, assigning a new graduate male nurse to care for a Muslim female patient in critical condition is the most inappropriate choice.
Summary:
- Choice A is incorrect because being a new graduate does not impact cultural competence.
- Choice B is incorrect as experience does not necessarily make a nurse the best fit for a specific patient.
- Choice D is incorrect as postpartum experience is relevant, but cultural considerations are more critical in this scenario.