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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.
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Which organization requires a mechanism for addressing ethical issues?
- A. American Association of Critical-Care Nurses
- B. American Hospital Association
- C. Society of Critical Care Medicine
- D. The Joint Commission
Correct Answer: D
Rationale: The correct answer is D, The Joint Commission, because it is a regulatory body that accredits healthcare organizations and requires them to have mechanisms for addressing ethical issues to ensure patient safety and quality of care. The other choices (A, B, C) are professional organizations that focus on specific areas of healthcare practice and do not have the authority to set regulatory standards for addressing ethical issues in healthcare organizations.
After coronary artery bypass graft surgery a patient is transported to the surgical intensive care unit at noon and placed on mechanical ventilation. How sh ould the nurse interpret the patient’s initial arterial blood gas levels? pH 7.31 PaCO 48 mm Hg Bicarbonate 22 mEq/L PaO 115 mm Hg O saturation 99%
- A. Normal arterial blood gas levels with a high oxygen le vel
- B. Partly compensated respiratory acidosis, normal oxygen
- C. Uncompensated metabolic acidosis with high oxygen laebvirbe.lcso m/test
- D. Uncompensated respiratory acidosis; hyperoxygenated
Correct Answer: B
Rationale: The correct answer is B: Partly compensated respiratory acidosis, normal oxygen. The pH of 7.31 indicates acidosis, the PaCO2 of 48 mm Hg shows respiratory acidosis, and the bicarbonate level of 22 mEq/L is slightly elevated, indicating the kidneys are compensating. The PaO2 of 115 mm Hg and oxygen saturation of 99% are normal, ruling out hypoxemia. Therefore, the patient is experiencing partly compensated respiratory acidosis.
A: Normal arterial blood gas levels with a high oxygen level - Incorrect. The pH is low, indicating acidosis, which is not normal.
C: Uncompensated metabolic acidosis with high oxygen level - Incorrect. Metabolic acidosis would have a primary issue with bicarbonate levels, which is not the case here.
D: Uncompensated respiratory acidosis; hyperoxygenated - Incorrect. The oxygen levels are normal, ruling out hyperoxygenation.
When it is noted that a patient’s endotracheal tube is not se cured tightened, he respiratory care practitioner assists the nurse in taping the tube. After the tu be is retaped, the nurse auscultates the patient’s lungs and notes that the breath sounds over the left lung fields are absent. The nurse suspects is the cause of this finding?
- A. The endotracheal tube is in the right mainstem bronchus.
- B. The patient has a left pneumothorax.
- C. The patient has aspirated secretions during the proceduarbeir.b .com/test
- D. The stethoscope earpiece is clogged with wax.
Correct Answer: A
Rationale: The correct answer is A: The endotracheal tube is in the right mainstem bronchus. When the endotracheal tube is not secured properly and is retaped, there is a possibility that it may have migrated into the right mainstem bronchus, leading to absent breath sounds in the left lung fields. This condition is known as endobronchial intubation. In such cases, ventilation primarily occurs in the right lung, resulting in decreased or absent breath sounds on the contralateral side. Choices B, C, and D are incorrect as they do not explain the absence of breath sounds over the left lung fields in this specific scenario.
A 54-year-old patient arrives in the emergency department (ED) after exposure to powdered lime at work. Which action should the nurse take first?
- A. Obtain the patient’s vital signs.
- B. Obtain a baseline complete blood count.
- C. Decontaminate the patient by showering with water.
- D. Brush off any visible powder on the skin and clothing.
Correct Answer: D
Rationale: The correct answer is D because brushing off any visible powder on the skin and clothing is the first step in managing exposure to powdered lime. This action helps to remove the source of exposure and prevent further absorption through the skin. It is crucial to prevent additional contact and reduce the risk of further harm. Obtaining vital signs (choice A) and a complete blood count (choice B) can be important but should come after the initial decontamination. Decontaminating the patient by showering with water (choice C) is not recommended for lime exposure as it can react with water and cause further injury.
Which action will the nurse need to do when preparing to assist with the insertion of a pulmonary artery catheter?
- A. Determine if the cardiac troponin level is elevated.
- B. Auscultate heart and breath sounds during insertion.
- C. Place the patient on NPO status before the procedure.
- D. Attach cardiac monitoring leads before the procedure.
Correct Answer: D
Rationale: The correct answer is D: Attach cardiac monitoring leads before the procedure. This is essential to monitor the patient's cardiac rhythm and detect any abnormalities during catheter insertion. Cardiac monitoring leads provide real-time information on the patient's heart rate and rhythm, allowing the nurse to promptly address any complications.
A: Determining if the cardiac troponin level is elevated is not directly related to assisting with pulmonary artery catheter insertion.
B: Auscultating heart and breath sounds during insertion is important but does not take precedence over attaching cardiac monitoring leads.
C: Placing the patient on NPO status before the procedure may be necessary for other procedures, but it is not specifically required for assisting with pulmonary artery catheter insertion.