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The nurse is assessing the exhaled tidal volume (EV ) in a mechanically ventilated patient. T What is the rationale for this assessment?
- A. Assess for tension pneumothorax.
- B. Assess the level of positive end-expiratory pressure.
- C. Compare the tidal volume delivered with the tidal volu me prescribed.
- D. Determine the patient’s work of breathing.
Correct Answer: D
Rationale: The correct answer is D: Determine the patient’s work of breathing. Assessing the exhaled tidal volume (EV) in a mechanically ventilated patient helps determine how much effort the patient is exerting to breathe. By monitoring the EV, the nurse can evaluate the patient's respiratory status and adjust ventilator settings if needed. It is crucial to ensure that the patient is not working too hard to breathe, as this can lead to respiratory distress.
Incorrect answers:
A: Assess for tension pneumothorax - Tension pneumothorax is typically assessed through other means such as physical examination and chest X-ray.
B: Assess the level of positive end-expiratory pressure - The level of positive end-expiratory pressure is usually set based on the patient's condition and not solely based on the exhaled tidal volume.
C: Compare the tidal volume delivered with the tidal volume prescribed - This comparison is important but does not directly relate to assessing the patient's work of breathing.
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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.
While family members are visiting, a patient has a respiratory arrest and is being resuscitated. Which action by the nurse is best?
- A. Ask family members if they wish to remain in the room during the resuscitation.
- B. Take the family members quickly out of the patient's room and remain with them.
- C. Assign a staff member to wait with family members just outside the patient's room.
- D. Encourage family members to stay, but advise them on the potential stress of the situation.
Correct Answer: A
Rationale: The correct answer is A because it respects the patient's right to privacy while also acknowledging the family's presence. By asking family members if they wish to remain in the room, the nurse allows them to make an informed decision based on their comfort level. This approach fosters open communication and shows respect for the family's emotions.
Choice B is incorrect because abruptly removing family members can increase their distress and feelings of powerlessness. Choice C is incorrect as it places the burden of support solely on a staff member, potentially isolating the family from the situation. Choice D is incorrect as it assumes family members should stay without considering their preferences or emotional well-being.
What diagnostic procedure is required to make a definitive diagnosis of pulmonary embolism?
- A. Arterial blood gas (ABG) analysis.
- B. Chest x-ray examination.
- C. High resolution multidetector CT angiogram.
- D. Ventilation-perfusion scanning.
Correct Answer: C
Rationale: The correct answer is C: High resolution multidetector CT angiogram. This diagnostic procedure is required for a definitive diagnosis of pulmonary embolism because it provides detailed imaging of the pulmonary vasculature, allowing visualization of blood clots in the pulmonary arteries.
A: Arterial blood gas (ABG) analysis does not directly diagnose pulmonary embolism but may show signs of hypoxemia or respiratory alkalosis, which can be seen in some cases of pulmonary embolism.
B: Chest x-ray examination may show nonspecific findings such as atelectasis or pleural effusion but cannot definitively diagnose pulmonary embolism.
D: Ventilation-perfusion scanning is another imaging modality used in the diagnosis of pulmonary embolism, but it is less commonly used compared to CT angiogram due to lower sensitivity and specificity.
When assessing an older patient admitted to the emergency department (ED) with a broken arm and facial bruises, the nurse observes several additional bruises in various stages of healing. Which statement or question by the nurse is most appropriate?
- A. Do you feel safe in your home?
- B. You should not return to your home.
- C. Would you like to see a social worker?
- D. I need to report my concerns to the police.
Correct Answer: A
Rationale: The correct answer is A: "Do you feel safe in your home?" This question is most appropriate because it directly addresses the potential issue of elder abuse without assuming or accusing the patient. It allows the patient to disclose any safety concerns and initiates a conversation about their well-being. Options B and D are inappropriate as they are accusatory and may escalate the situation. Option C is not as direct and may not effectively address the safety concerns of the patient.
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.