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The patient diagnosed with acute respiratory distress synd rome (ARDS) would exhibit which symptom?
- A. Decreasing PaO levels despite increased FiO adminis tration
- B. Elevated alveolar surfactant levels
- C. Increased lung compliance with increased FiO administration 2
- D. Respiratory acidosis associated with hyperventilation
Correct Answer: A
Rationale: The correct answer is A because in ARDS, there is a severe impairment in gas exchange leading to hypoxemia. Decreasing PaO2 levels despite increased FiO2 administration indicate poor oxygenation, a hallmark of ARDS. Elevated alveolar surfactant levels (Choice B) do not directly correlate with ARDS pathophysiology. Increased lung compliance with increased FiO2 administration (Choice C) is not characteristic of ARDS, as ARDS leads to decreased lung compliance. Respiratory acidosis associated with hyperventilation (Choice D) is not a typical finding in ARDS, as hyperventilation is usually present in an attempt to compensate for hypoxemia.
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Which of the following is (are) official journal(s) of the A merican Association of Critical-Care Nurses? (Select all that apply.)
- A. American Journal of Critical Care
- B. Critical Care Clinics of North America
- C. Critical Care Nurse
- D. Critical Care Nursing Quarterly
Correct Answer: A
Rationale: Step-by-step rationale:
1. The American Association of Critical-Care Nurses (AACN) publishes the American Journal of Critical Care (AJCC).
2. The AJCC is a peer-reviewed journal that covers critical care nursing practice, research, and education.
3. The content in AJCC aligns with AACN's mission and standards for critical care nursing.
4. Hence, AJCC is an official journal of AACN.
Summary of other choices:
- B: Critical Care Clinics of North America - Not an official journal of AACN.
- C: Critical Care Nurse - Not an official journal of AACN.
- D: Critical Care Nursing Quarterly - Not an official journal of AACN.
The nurse is caring for a patient following insertion of a left subclavian central venous catheter (CVC). Which action by the nurse best reduces th e risk of catheter-related bloodstream infection (CRBSI)?
- A. Review daily the necessity of the central venous cathet er.
- B. Cleanse the insertion site daily with isopropyl alcohol.
- C. Change the pressurized tubing system and flush bag daily.
- D. Maintain a pressure of 300 mm Hg on the flush bag.
Correct Answer: A
Rationale: The correct answer is A: Review daily the necessity of the central venous catheter. This action reduces the risk of CRBSI by promoting early removal of unnecessary catheters, which is a key strategy in preventing infections. Unnecessary catheters increase the risk of infection due to prolonged exposure to the patient's skin flora and possible contamination during insertion. Reviewing daily ensures the catheter is only kept when necessary, minimizing the duration of catheter use and reducing the chances of infection.
Summary of other choices:
B: Cleansing the insertion site daily with isopropyl alcohol is important for maintaining skin integrity but does not directly reduce the risk of CRBSI.
C: Changing the pressurized tubing system and flush bag daily is important for maintaining catheter patency but does not directly reduce the risk of CRBSI.
D: Maintaining a pressure of 300 mm Hg on the flush bag is important for proper catheter function but does not directly reduce the risk of CR
As part of the Synergy Model, the nurse has identified a patient characteristic of resiliency. What patient behavior demonstrates resiliency?
- A. Dysfunctional grieving behaviors after receiving bad news
- B. Developing a list of questions for the physician
- C. Denial of any possible negative outcomes for a procedure
- D. Assigning blame to others for undesired outcomes of illness
Correct Answer: B
Rationale: The correct answer is B because developing a list of questions for the physician shows active engagement in their healthcare, seeking information, and taking control of their situation, which are characteristics of resiliency. This behavior indicates the patient's willingness to understand and cope with their health condition. Choices A, C, and D are incorrect as they demonstrate maladaptive coping mechanisms such as dysfunctional grieving, denial, and blame assignment, which are not indicative of resiliency. Resiliency involves adaptability, problem-solving, and seeking support, which are better exemplified by choice B.
A patient with end-stage heart failure is experiencing consaibdirebr.caobmle/te dsty spnea. What is the appropriate pharmacological management of this symptom ?
- A. Administration of 6 mg of midazolam and initiation of a continuous midazolam infusion.
- B. Administration of morphine, 5 mg IV bolus, and initia tion of a continuous morphine infusion.
- C. Hourly increases of the midazolam (Versed) infusion b y 100% dose increments.
- D. Hourly increases of the morphine infusion by 100% dose increments.
Correct Answer: B
Rationale: The correct answer is B: Administration of morphine, 5 mg IV bolus, and initiation of a continuous morphine infusion. Morphine is the preferred pharmacological management for severe dyspnea in end-stage heart failure due to its potent analgesic and anxiolytic properties.
Step-by-step rationale:
1. Morphine is a potent opioid that helps relieve dyspnea by reducing anxiety, decreasing respiratory drive, and improving overall comfort.
2. The initial IV bolus of 5 mg provides rapid relief of dyspnea.
3. Initiating a continuous morphine infusion ensures sustained relief of dyspnea.
4. Midazolam (choice A) is a benzodiazepine used for sedation and anxiety, but it is not the first-line treatment for dyspnea in this scenario.
5. Increasing the midazolam (choice C) or morphine (choice D) infusions by 100% dose increments hourly is not appropriate as
Family members have a need for information. Which intervention best assists in meeting this need?
- A. Handing family members a pamphlet that explains all of the critical care equipment
- B. Providing a daily update of the patient’s progress and f acilitating communication with the intensivist
- C. Telling them that you are not permitted to give them a status report but that they can be present at 4:00 PM for family rounds with the intensivist
- D. Writing down a list of all new medications and doses a nd giving the list to family members during visitation
Correct Answer: B
Rationale: The correct answer is B because providing a daily update of the patient's progress and facilitating communication with the intensivist directly addresses the family members' need for information in a timely and personalized manner. This intervention ensures that the family is kept informed about the patient's condition and treatment plan, fostering transparency and trust. It also allows for any questions or concerns to be addressed promptly, aiding in the family's understanding and involvement in the patient's care.
Now, let's summarize why the other choices are incorrect:
A: Handing out a pamphlet may provide information, but it lacks the personalized touch and real-time updates that are crucial for meeting the family's need for information.
C: Restricting information and only allowing family members to be present at specific times may create frustration and hinder communication, not effectively meeting their information needs.
D: Providing a list of medications is helpful, but it does not offer a comprehensive update on the patient's progress or facilitate direct communication with the medical team, which are