Critical Care Nursing Cardiac Questions

Critical Care Nursing Cardiac Questions Related

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The primary care provider orders the following mechanica l ventilation settings for a patient who weighs 75 kg and whose spontaneous respiratory rate is 22 breaths/min. What arterial blood gas abnormality may occur if the patient continues taob ibrbe.c otamc/thesyt pneic at these ventilator settings? Settings: Tidal volume: 600 mL (8 mL per kg) FiO 2: 0.5 Respiratory rate: 14 breaths/min Mode assist/control Positive end-expiratory pressure: 10 cm H O

  • A. Metabolic acidosis
  • B. Metabolic alkalosis
  • C. Respiratory acidosis
  • D. Respiratory alkalosis
Correct Answer: C

Rationale: The correct answer is C: Respiratory acidosis may occur if the patient continues at these ventilator settings. Respiratory acidosis happens when the lungs cannot remove enough of the carbon dioxide (CO2) produced by the body. In this case, the low respiratory rate of 14 breaths/min may not be sufficient to adequately remove CO2, leading to its accumulation in the blood. This results in a decrease in blood pH, causing respiratory acidosis.

Summary of other choices:
A: Metabolic acidosis - Not the correct answer as the ventilator settings are more likely to affect the respiratory system rather than the metabolic system.
B: Metabolic alkalosis - Not the correct answer as the ventilator settings are not related to causing an increase in blood pH, which is characteristic of metabolic alkalosis.
D: Respiratory alkalosis - Not the correct answer as the low respiratory rate would not lead to excessive elimination of CO2, causing alkalosis.

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The nurse is caring for a mechanically ventilated patient an d responds to a high inspiratory pressure alarm. Recognizing possible causes for the alarma, btihrbe.c nomu/rtesset assesses for which of the following? (Select all that apply.)

  • A. Coughing or attempting to talk
  • B. Disconnection from the ventilator
  • C. Kinks in the ventilator tubing
  • D. Need for suctioning
Correct Answer: B

Rationale: The correct answer is B: Disconnection from the ventilator. This is the correct choice because a high inspiratory pressure alarm can indicate a disconnection, leading to inadequate ventilation and increased pressure in the circuit. This can be a life-threatening situation that requires immediate attention.

Explanation of why other choices are incorrect:
A: Coughing or attempting to talk - While coughing or talking may affect the patient's ability to ventilate properly, it is not directly related to the high inspiratory pressure alarm.
C: Kinks in the ventilator tubing - Kinks in the tubing may cause increased resistance to airflow, but they are more likely to trigger a low pressure alarm rather than a high inspiratory pressure alarm.
D: Need for suctioning - Suctioning may be necessary for airway clearance, but it is not directly related to the high inspiratory pressure alarm.

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

A client who has active tuberculosis (TB) is admitted to the medical unit. What action is most important for the nurse to implement?

  • A. Fit the client with a respirator mask.
  • B. Assign the client to a negative air-flow room.
  • C. Don a clean gown for client care.
  • D. Place an isolation cart in the hallway.
Correct Answer: B

Rationale: The correct answer is B: Assign the client to a negative air-flow room. This is crucial to prevent the spread of TB to other patients and healthcare workers. Negative air-flow rooms help contain airborne pathogens. Option A is not sufficient as it only protects the client, not others. Option C is important for infection control but not the priority in this situation. Option D is not as effective as placing the client in a negative air-flow room. Overall, option B is the best choice to ensure the safety of everyone in the unit.

An unresponsive 79-year-old is admitted to the emergency department (ED) during a summer heat wave. The patient’s core temperature is 105.4°F (40.8°C), blood pressure (BP) 88/50, and pulse 112. The nurse initially will plan to:

  • A. Apply wet sheets and a fan to the patient.
  • B. Provide O2 at 6 L/min with a nasal cannula.
  • C. Start lactated Ringer's solution at 1000 mL/hr.
  • D. Give acetaminophen (Tylenol) rectal suppository.
Correct Answer: A

Rationale: The correct answer is A: Apply wet sheets and a fan to the patient. This is the initial treatment for hyperthermia to aid in lowering the body temperature. Wet sheets help in evaporative cooling, while a fan enhances heat loss through convection. This approach is crucial in managing heat-related illnesses quickly. Choices B, C, and D are incorrect as they do not directly address the urgent need to reduce the patient's elevated core temperature. Providing O2, IV fluids, or acetaminophen can be considered later in the management, but the priority is to rapidly lower the body temperature in a hyperthermic patient to prevent further complications.

Comparing the patient’s current (home) medications with those ordered during hospitalization and communicating a complete list of medications to the next care provider when the patient is transferred within an organization or to another setting a re strategies toward best achieving what patient related goal?

  • A. Improving accuracy of patient identification.
  • B. Preventing errors related to look-alike and sound-alike medications.
  • C. Reconciling medications across the continuum of care.
  • D. Reducing harms associated with administration of anti coagulants.
Correct Answer: C

Rationale: Step 1: Reconciling medications is essential for patient safety as it involves comparing current and ordered medications to ensure accuracy.
Step 2: This process helps prevent medication errors, adverse drug reactions, and duplications across different care settings.
Step 3: Communicating a complete list of medications to the next care provider ensures continuity of care and reduces the risk of medication discrepancies.
Step 4: By reconciling medications across the continuum of care, healthcare providers can better coordinate patient care and optimize treatment outcomes.

In summary, choice C is correct as it focuses on medication reconciliation to improve patient safety and care coordination. Choices A, B, and D are incorrect as they do not directly address the comprehensive process of reconciling medications across care settings.

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