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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.
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Which of the following situations may result in a low cardiac output and low cardiac index? (Select all that apply.)
- A. Exercise
- B. Hypovolemia
- C. Myocardial infarction
- D. Shock
Correct Answer: B
Rationale: Certainly. Hypovolemia, or low blood volume, can lead to low cardiac output and cardiac index because the heart has less blood to pump, resulting in reduced circulation. Exercise typically increases cardiac output to meet increased demand. Myocardial infarction may reduce cardiac output temporarily, but not consistently. Shock, a condition where the body's tissues do not receive enough oxygen and nutrients, can lead to low cardiac output, making it a possible cause.
Assuming each of these patients was discharged from the hospital, which older adult patient is at greatest risk for decreased functional status and quality of life?
- A. A 70-year-old who had coronary artery bypass surgery developed complications after surgery and had difficulty being weaned from meacbhirba.ncoicma/tle svt entilation. The patient required a tracheostomy and gastrostomy and is now being discharged to a long-term, acute care hospital. The patient lost their sig nificant other 3 years ago.
- B. A 79-year-old admitted for exacerbation of heart failure manages health care independently but needs diuretic medications adjusted . The patient states being compliant with prescribed medications but sometimes forgets to take them. The patient and 82-year-old spouse consider themselves to be independent and support each other.
- C. A 90-year-old admitted for a carotid endarterectomy lives in an assisted living facility (ALF) but is cognitively intact and claims to be the “social butterfly” at all of the events at the ALF. The patient is hospitalized for 4 days and discharged to the ALF.
- D. An 84-year-old who had stents placed to treat coronary artery occlusion has diabetes that has been managed, lives alone since losin g significant other 10 years ago, and was driving prior to hospitalization. The patieanbitr bw.caoms /dteisst charged home within 3 days of the procedure.
Correct Answer: A
Rationale: The correct answer is A because this patient had a complex surgery with complications, requiring long-term care and loss of a significant other, which can impact their emotional well-being and support system. This can lead to decreased functional status and quality of life.
Choice B is incorrect as the patient has support from a spouse and manages health care independently, indicating a good support system. Choice C is incorrect as the patient is cognitively intact and social, which suggests a good quality of life. Choice D is incorrect as the patient had a less complex procedure, well-managed diabetes, and was living independently, which indicates a lower risk for decreased functional status and quality of life compared to choice A.
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 male client who has been taking propranolol (Inderal) for 18 months tells the nurse that the healthcare provider discontinued the medication because his blood pressure has been normal for the past three months. Which instruction should the nurse provide?
- A. Obtain another antihypertensive prescription to avoid withdrawal symptoms.
- B. Stop the medication and keep an accurate record of blood pressure.
- C. Report any uncomfortable symptoms after stopping the medication.
- D. Ask the healthcare provider about tapering the drug dose over the next week.
Correct Answer: D
Rationale: The correct answer is D: Ask the healthcare provider about tapering the drug dose over the next week. This answer is correct because propranolol is a beta-blocker, and abrupt discontinuation can lead to rebound hypertension, angina, or even myocardial infarction due to the sudden withdrawal of the medication. Tapering the drug dose over time allows the body to adjust gradually and reduces the risk of these adverse effects.
Choice A is incorrect because obtaining another antihypertensive prescription is not necessary if the client's blood pressure has been normal for the past three months. Choice B is incorrect because abruptly stopping the medication without tapering can lead to withdrawal symptoms. Choice C is incorrect because simply reporting uncomfortable symptoms without taking appropriate action (tapering the drug dose) is not addressing the potential risks associated with abrupt discontinuation of propranolol.
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.