Nokea
The nurse is caring for a 70-kg patient in septic shock with a pulmonary artery catheter. Which hemodynamic value indicates an appropriate response to therapy aimed at enhancing oxygen delivery to the organs and tissues?
- A. Arterial lactate level of 1.0 mEq/L
- B. Cardiac output of 2.5 L/min
- C. Mixed venous (SvO ) of 40%
- D. Cardiac index of 1.5 L/min/m2
Correct Answer: C
Rationale: The correct answer is C: Mixed venous (SvO2) of 40%. In septic shock, improving oxygen delivery to tissues is vital. SvO2 reflects the balance between oxygen delivery and consumption. A value of 40% indicates adequate oxygen delivery to tissues.
A: Arterial lactate level of 1.0 mEq/L - Although a low lactate level is good, it does not directly indicate improved oxygen delivery.
B: Cardiac output of 2.5 L/min - Cardiac output should ideally increase to improve oxygen delivery, so 2.5 L/min is low for a 70-kg patient.
D: Cardiac index of 1.5 L/min/m2 - Cardiac index is cardiac output adjusted for body surface area. 1.5 L/min/m2 is low and indicates inadequate cardiac function for a patient in septic shock.
You may also like to solve these questions
The nurse manager recognizes which action as an effectiveab sirtbr.acotmeg/teys tf or promoting changes in practice?
- A. Asking the clinical nurse specialist to lead a journal clu b on open visitation after each nurse is tasked to read one research article about visitation.
- B. Discussing pros and cons of open visitation at the next staff meeting.
- C. Inviting the nurses with the most experience to develop a revised policy.
- D. Tasking the unit-based nurse practice council to invite volunteers to serve on the council to revise the current policy toward more liberaal bviribs.ciotamt/iteosnt .
Correct Answer: A
Rationale: The correct answer is A because it involves a structured approach to promoting changes in practice. By asking the clinical nurse specialist to lead a journal club on open visitation after each nurse reads a research article, it ensures that all nurses are informed and engaged in the topic. This approach promotes evidence-based practice and encourages active participation.
Option B is less effective as discussing pros and cons at a staff meeting may not ensure that all nurses have the necessary knowledge to make informed decisions. Option C may not consider diverse perspectives and may not involve all staff members equally. Option D involves a select group of volunteers and may not reflect the views of the entire team. Overall, option A is the most inclusive and educational approach to promoting changes in practice.
The nurse is preparing to obtain a right atrial pressure (RA P/CVP) reading. What are the most appropriate nursing actions? (Select all that apply.)
- A. Compare measured pressures with other physiological parameters.
- B. Flush the central venous catheter with 20 mL of sterile saline.
- C. Inflate the balloon with 3 mL of air and record the pres sure tracing.
- D. Obtain the right atrial pressure measurement during en d exhalation.
Correct Answer: A
Rationale: The correct answer is A because comparing measured pressures with other physiological parameters ensures accuracy and consistency. This step helps in interpreting the RA P/CVP reading correctly. Choice B is incorrect as flushing the catheter with saline is not necessary for obtaining the pressure reading. Choice C is incorrect as inflating the balloon with air is not part of the correct procedure. Choice D is incorrect because obtaining the measurement during exhalation can affect the accuracy of the reading.
A patient declared brain dead is an organ donor. The following events occur: 1300 Diagnostic tests for brain death are completed. 1330 primary care provider reviews diagnostic test results and writes in the progress note that the patient is brain deaadb.i r1b.4co0m0/ tePsat tient is taken to the operating room for organ retrieval. 1800 All organs have b een retrieved for donation. The ventilator is discontinued. 1810 Cardiac monitor shows fla tline. What is the official time of death recorded in the medical record?
- A. 1300
- B. 1330
- C. 1400
- D. 1800
Correct Answer: E
Rationale: The correct answer is not provided, but based on the events described, the official time of death recorded in the medical record should be 1810 (Choice D). At this time, the cardiac monitor shows flatline, indicating the cessation of cardiac activity, which is the universally accepted point of declaring death.
Choice A (1300) is incorrect because that is when diagnostic tests for brain death were completed, but the patient was not officially declared dead at that time.
Choice B (1330) is incorrect as this is when the primary care provider reviewed the test results and documented brain death in the progress note, but the patient was not officially declared dead at this time either.
Choice C (1400) is incorrect as there is no significant event occurring at this time that signifies the patient's death.
Therefore, the most appropriate and official time of death recorded in the medical record would be 1810 when the cardiac monitor shows flatline.
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.
To prevent any unwanted resuscitation after life-sustaininga btirrbe.acotmm/teenstt s have been withdrawn, the nurse should ensure that what intervention has been im plemented?
- A. Do-not-resuscitate (DNR) orders are written before dis continuation of the treatments.
- B. The family is not allowed to visit until the death occur s.
- C. DNR orders are written as soon as possible after the di scontinuation of the treatments.
- D. The change-of-shift report includes the information thaatb irtbh.ceo pma/tetiset nt is not to be resuscitated.
Correct Answer: A
Rationale: The correct answer is A because writing DNR orders before discontinuation of life-sustaining treatments ensures clear communication and legal documentation of the patient's wishes. Choice B is incorrect as family support is essential in end-of-life care. Choice C is incorrect as DNR orders should be established before withdrawing treatment. Choice D is incorrect as the DNR order should be in place before shift change for immediate implementation if needed.