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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.
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Four hours after mechanical ventilation is initiated for a patient with chronic obstructive pulmonary disease (COPD), the patient’s arterial blood gas (ABG) results include a pH of 7.51, PaO2 of 82 mm Hg, PaCO2 of 26 mm Hg, and HCO3 of 23 mEq/L (23 mmol/L). The nurse will anticipate the need to:
- A. Increase the FIO2.
- B. Increase the tidal volume.
- C. Increase the respiratory rate.
- D. Decrease the respiratory rate.
Correct Answer: D
Rationale: The correct answer is D: Decrease the respiratory rate. The ABG results show respiratory alkalosis with decreased PaCO2 and elevated pH. This indicates overventilation, so decreasing the respiratory rate will help normalize the PaCO2 and pH levels. Increasing the FIO2 (Choice A) is not needed as the PaO2 is within normal range. Increasing tidal volume (Choice B) can lead to further hyperventilation. Increasing the respiratory rate (Choice C) would exacerbate the respiratory alkalosis.
A normal urine output is considered to be
- A. 80 to 125 mL/min.
- B. 180 L/day.
- C. 80 mL/min.
- D. 1 to 2 L/day.
Correct Answer: D
Rationale: The correct answer is D (1 to 2 L/day) because the average adult typically produces 1 to 2 liters of urine per day. This range is considered normal for maintaining proper hydration and eliminating waste products. Choice A (80 to 125 mL/min) is incorrect as it represents the rate of urine production per minute, which is not commonly used to measure daily urine output. Choice B (180 L/day) is unrealistic and far exceeds the normal range for urine output. Choice C (80 mL/min) is too low for daily urine output and would not be sufficient for adequate waste elimination.
What is the best way to monitor agitation and effectivenes s of treating it in the critically ill patient?
- A. Confusion Assessment Method (CAM-ICU)
- B. FACES assessment tool
- C. Glasgow Coma Scale
- D. Richmond Agitation Sedation Scale
Correct Answer: D
Rationale: The correct answer is D: Richmond Agitation Sedation Scale (RASS). RASS is specifically designed to monitor agitation and sedation levels in critically ill patients, providing a standardized and objective assessment. It includes clear descriptors for different levels of agitation and sedation, allowing for consistent monitoring and treatment adjustments. CAM-ICU is mainly used for delirium assessment, not agitation. FACES assessment tool is more appropriate for pain assessment. Glasgow Coma Scale is focused on assessing level of consciousness, not agitation specifically. By using RASS, healthcare providers can accurately track agitation levels and evaluate the effectiveness of interventions in managing agitation in critically ill patients.
The charge nurse is supervising care for a group of patients monitored with a variety of invasive hemodynamic devices. Which patient should the charge nurse evaluate first?
- A. A patient with a central venous pressure (RAP/CVP) oafb i6rb .mcomm/ teHstg and 40 mL of urine output in the past hour
- B. A patient with a left radial arterial line with a BP of 11 0/60 mm Hg and slightly dampened arterial waveform
- C. A patient with a pulmonary artery occlusion pressure of 25 mm Hg and an oxygen saturation of 89% on 3 L of oxygen via nasal cannula
- D. A patient with a pulmonary artery pressure of 25/10 mm Hg and an oxygen saturation of 94% on 2 L of oxygen via nasal cannula
Correct Answer: C
Rationale: The correct answer is C because a pulmonary artery occlusion pressure of 25 mm Hg indicates possible fluid overload or cardiac issue requiring urgent evaluation. This value is high, suggesting increased pressure in the left side of the heart. Additionally, the oxygen saturation of 89% on 3 L of oxygen indicates potential respiratory compromise. This patient needs immediate assessment and intervention to prevent worsening of their condition.
Choice A is incorrect as a central venous pressure of 6 mm Hg is within normal limits, and the urine output is adequate. Choice B is incorrect as a BP of 110/60 mm Hg is acceptable, and a slightly dampened arterial waveform is not an immediate concern. Choice D is incorrect as a pulmonary artery pressure of 25/10 mm Hg is within normal range, and an oxygen saturation of 94% on 2 L of oxygen is acceptable.
The patient is undergoing a necessary but painful procedure that is greatly increasing her anxiety. The nurse decides to use guided imagery to help alleviate the patients anxiety. What is a key part of this technique?
- A. Provide the patient with an external focus point such as a picture.
- B. Have the patient take slow, shallow breaths while staring at a focus point.
- C. Have the patient remember tactile sensations of a pleasant experience.
- D. Encourage the patient to consciously relax all of her muscles.
Correct Answer: C
Rationale: The correct answer is C because guided imagery involves using the patient's imagination to focus on pleasant sensory experiences. This helps distract the patient from the current situation and reduces anxiety. By remembering tactile sensations of a pleasant experience, the patient can create a calming mental image.
Choice A is incorrect because guided imagery does not require an external focus point like a picture. Choice B is incorrect because the technique does not involve staring at a focus point but rather focusing on mental images. Choice D is incorrect because while relaxation is beneficial, guided imagery specifically focuses on visualization of positive experiences to reduce anxiety.