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The patient is in need of immediate hemodialysis, but has no vascular access. The nurse prepares the patient for insertion of
- A. a percutaneous catheter at the bedside.
- B. a percutaneous tunneled catheter at the bedside.
- C. an arteriovenous fistula.
- D. an arteriovenous graft.
Correct Answer: A
Rationale: The correct answer is A: a percutaneous catheter at the bedside. This is the most appropriate option for immediate hemodialysis when the patient has no vascular access. A percutaneous catheter can be quickly inserted at the bedside, allowing for immediate initiation of hemodialysis.
Choice B, a percutaneous tunneled catheter, involves a more complex insertion process and is not typically done at the bedside. Choices C and D, arteriovenous fistula and arteriovenous graft, require advanced planning and surgical procedures, making them unsuitable for immediate hemodialysis in this scenario.
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The patient has a Glasgow Coma Scale (GCS) score of 3 and discussions have been held with the family about withdrawing life support. Which statemen t by the nurse best describes requirements that must be met to sustain Centers for Medicare and Medicaid Services (CMS) Conditions of Participation?
- A. “I need to notify the organ procurement organization O PO of my patient’s impending death.”
- B. “I will contact the physician to obtain informed consen t for organ donation.”
- C. “The charge nurse will notify organ procurement organization OPO once the patient has been pronounced brain dead.”
- D. “I need the physician to evaluate my patient’s suitability for organ donation.”
Correct Answer: C
Rationale: The correct answer is C because notifying the organ procurement organization (OPO) once the patient has been pronounced brain dead is a requirement to sustain CMS Conditions of Participation. This step ensures that the proper protocols are followed for organ donation.
Choice A is incorrect because notifying the OPO of impending death is not a requirement for sustaining CMS Conditions of Participation.
Choice B is incorrect because obtaining informed consent for organ donation is not directly related to meeting the requirements of CMS Conditions of Participation.
Choice D is incorrect because while evaluating the patient's suitability for organ donation is important, it is not a specific requirement under CMS Conditions of Participation.
On their first visit to a critically ill patient, family members stand in the doorway of the room, making no effort to approach the patient. What is the most appropriate nursing action?
- A. Instruct the family where the patient can be touched and what to say.
- B. Engage the family in social conversation to ease them into the milieu.
- C. Use visiting hours to explain to the family the general status of the patient.
- D. Leave the family to adjust to the situation when they are ready.
Correct Answer: A
Rationale: The correct answer is A because instructing the family on where the patient can be touched and what to say helps empower them to interact appropriately with the patient. This action promotes the family's involvement in the patient's care, encourages communication, and fosters a supportive environment. Choice B is incorrect as engaging in social conversation may not address the family's hesitance to approach the patient directly. Choice C is incorrect because waiting for visiting hours to provide information may delay necessary support for the family. Choice D is incorrect as leaving the family without guidance may perpetuate their discomfort and hinder their ability to provide emotional support to the patient.
The nurse is educating a group of nursing students about end-of-life care. Which statement by a student indicates the need for further teaching?
- A. Terminally ill patients may benefit from around-the-clock analgesics.
- B. Hospice care can be initiated when curative treatment is no longer effective.
- C. Hydration and nutrition should always be maintained until the patient dies.
- D. Emotional support is a key component of end-of-life care.
Correct Answer: C
Rationale: The correct answer is C because maintaining hydration and nutrition until the patient dies is not always appropriate in end-of-life care, as some patients may be unable to tolerate oral intake or may be close to the end of life where artificial nutrition and hydration may not provide benefit and may even cause discomfort.
Explanation:
A: A is correct because terminally ill patients may indeed benefit from continuous pain management to ensure comfort.
B: B is correct because hospice care is typically initiated when curative treatment is no longer effective and focuses on providing comfort and quality of life.
D: D is correct because emotional support is crucial in end-of-life care to address the patient's psychological well-being and provide comfort.
In summary, choice C is incorrect as it does not consider individual patient needs and preferences in end-of-life care.
Acute kidney injury from postrenal etiology is caused by
- A. obstruction of the flow of urine.
- B. conditions that interfere with renal perfusion.
- C. hypovolemia or decreased cardiac output.
- D. conditions that act directly on functioning kidney tissue.
Correct Answer: A
Rationale: The correct answer is A because postrenal acute kidney injury is caused by obstruction of urine flow, leading to pressure build-up in the kidneys and subsequent damage. Obstructions can be due to conditions such as kidney stones, tumors, or enlarged prostate. Choices B, C, and D are incorrect as they relate to pre-renal and intrinsic renal causes of acute kidney injury, not specifically postrenal obstruction. B refers to decreased blood flow to the kidneys, C to low volume or poor heart function affecting kidney perfusion, and D to direct damage to kidney tissue, which do not characterize postrenal etiology.
The condition of a critically ill patient with a living will has deteriorated. The patient’s partner wants “everything done,” regardless of the patient’s wishe s. Which ethical principle is the partner violating?
- A. Autonomy
- B. Beneficence
- C. Justice
- D. Nonmaleficence
Correct Answer: A
Rationale: The correct answer is A: Autonomy. Autonomy is the ethical principle that respects an individual's right to make decisions about their own care and treatment. In this scenario, the partner wanting "everything done" regardless of the patient's wishes violates the patient's autonomy by not honoring their previously expressed wishes outlined in the living will. This decision disregards the patient's right to make choices about their own healthcare. Choices B, C, and D are incorrect because:
B: Beneficence focuses on doing good for the patient, but in this case, the partner's actions are not necessarily in the patient's best interest.
C: Justice pertains to fairness and equal treatment, which is not directly relevant to the situation described.
D: Nonmaleficence is the principle of doing no harm, but in this scenario, the harm is not necessarily physical but rather a violation of the patient's autonomy.