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The nurse is caring for a patient whose ventilator settings i nclude 15 cm H O of positive end-expiratory pressure (PEEP). The nurse understands that although beneficial, PEEP may result in what possible problem?
- A. Fluid overload secondary to decreased venous return.
- B. High cardiac index secondary to more efficient ventric ular function.
- C. Hypoxemia secondary to prolonged positive pressure a t expiration.
- D. Low cardiac output secondary to increased intrathoracic pressure
Correct Answer: D
Rationale: Rationale for Correct Answer (D - Low cardiac output secondary to increased intrathoracic pressure):
1. PEEP increases intrathoracic pressure, which can impede venous return to the heart.
2. Impaired venous return reduces preload, leading to decreased cardiac output.
3. Decreased cardiac output can result in inadequate tissue perfusion and oxygenation.
4. Therefore, PEEP may cause low cardiac output due to increased intrathoracic pressure.
Summary of Incorrect Choices:
A. Fluid overload is not directly related to PEEP but more to fluid administration or kidney function.
B. High cardiac index is unlikely as PEEP can decrease cardiac output.
C. Hypoxemia is not a direct result of PEEP but may occur due to other factors like inadequate ventilation or oxygenation settings.
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A 22-year-old patient who experienced a near-drowning accident in a local pool, but now is awake and breathing spontaneously, is admitted for observation. Which assessment will be most important for the nurse to take during the observation period?
- A. Auscultate heart sounds.
- B. Palpate peripheral pulses.
- C. Auscultate breath sounds.
- D. Check pupil reaction to light.
Correct Answer: C
Rationale: The correct answer is C: Auscultate breath sounds. After a near-drowning incident, the main concern is potential respiratory complications such as aspiration pneumonia or pulmonary edema. Auscultating breath sounds will help the nurse assess for any signs of respiratory distress or complications. This assessment is crucial for early detection and intervention.
A: Auscultating heart sounds is important but not as crucial as assessing breath sounds in this scenario.
B: Palpating peripheral pulses is important for circulation assessment but does not address the immediate concern of respiratory complications.
D: Checking pupil reaction to light is more relevant for neurological assessment and not as critical as assessing breathing in this situation.
Which acid-base disturbances commonly occurs with the hyperventilation and impaired gas exchange seen in severe exacerbation of asthma?
- A. Metabolic acidosis
- B. Metabolic alkalosis
- C. Respiratory acidosis
- D. Respiratory alkalosis
Correct Answer: D
Rationale: The correct answer is D: Respiratory alkalosis. Hyperventilation in severe asthma exacerbation leads to excessive removal of CO2, causing a decrease in carbonic acid levels, resulting in respiratory alkalosis. Metabolic acidosis (A) is not typically associated with hyperventilation. Metabolic alkalosis (B) is caused by excessive loss of acid or gain of bicarbonate, not by hyperventilation. Respiratory acidosis (C) is characterized by an increase in CO2 levels due to inadequate ventilation, which is the opposite of what occurs in severe asthma exacerbation.
An 80-year-old client is given morphine sulphate for postoperative pain. Which concomitant medication should the nurse question that poses a potential development of urinary retention in this geriatric client?
- A. Antacids.
- B. Tricyclic antidepressants.
- C. Nonsteroidal anti-inflammatory agents.
- D. Insulin.
Correct Answer: B
Rationale: The correct answer is B: Tricyclic antidepressants. Tricyclic antidepressants can cause anticholinergic effects, including urinary retention, especially in the elderly. Morphine sulfate can also contribute to urinary retention. Antacids (A) and nonsteroidal anti-inflammatory agents (C) are not known to cause urinary retention. Insulin (D) does not pose a risk for urinary retention in this scenario.
The nurse is caring for an older adult patient who is in card iogenic shock and has failed to respond to medical treatment. The primary care provider conducts a conference to explain that they have exhausted treatment options and suggest that the patient be made a “do not resuscitate” status. This scenario illustrates what medical concept?
- A. Brain death
- B. Futility
- C. Incompetence
- D. Life-prolonging procedures
Correct Answer: B
Rationale: The correct answer is B: Futility. In this scenario, the primary care provider suggests making the patient a "do not resuscitate" status because further medical treatment is deemed futile. Futility refers to situations where medical interventions are unlikely to achieve the desired outcome. This decision is made when the benefits of continuing treatment do not outweigh the burdens on the patient.
Summary:
A: Brain death does not apply here as the patient is not brain dead.
C: Incompetence refers to the patient's ability to make decisions, not the medical concept being illustrated.
D: Life-prolonging procedures are not being discussed; the focus is on the futility of further treatment.
The patient is admitted with complaints of general malaise and fatigue, along with a decreased urinary output. The patient’s urinalysis shows coarse, muddy brown granular casts and hematuria. The nurse determines that the patient has:
- A. acute kidney injury from a prerenal condition.
- B. acute kidney injury from postrenal obstruction.
- C. intrarenal disease, probably acute tubular necrosis.
- D. a urinary tract infection.
Correct Answer: C
Rationale: The correct answer is C: intrarenal disease, probably acute tubular necrosis. The patient's symptoms of general malaise, fatigue, decreased urinary output, along with the presence of coarse, muddy brown granular casts and hematuria in the urinalysis indicate kidney damage. Acute tubular necrosis is a common cause of acute kidney injury characterized by damage to the renal tubules, leading to impaired kidney function. The presence of granular casts and hematuria suggests tubular injury and bleeding within the kidney. Choices A and B are incorrect as they refer to prerenal and postrenal causes of kidney injury, respectively, which do not align with the patient's symptoms and urinalysis findings. Choice D is incorrect as a urinary tract infection would typically present with different symptoms and urinalysis findings.