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What is the basic underlying pathophysiology of acute respiratory distress syndrome?
- A. A decrease in the number of white blood cells availabl e.
- B. Damage to the right mainstem bronchus.
- C. Damage to the type II pneumocytes, which produce suarbfiarbc.tcaomnt/t.e st
- D. Decreased capillary permeability.
Correct Answer: C
Rationale: The correct answer is C: Damage to the type II pneumocytes, which produce surfactant. Acute respiratory distress syndrome (ARDS) is characterized by damage to the alveolar epithelium, including type II pneumocytes responsible for producing surfactant. Surfactant reduces surface tension in the alveoli, preventing collapse. Damage to type II pneumocytes impairs surfactant production, leading to alveolar collapse and impaired gas exchange. Choices A, B, and D are incorrect because ARDS is not primarily caused by a decrease in white blood cells, damage to the right mainstem bronchus, or decreased capillary permeability.
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The charge nurse is supervising care for a group of patients monitored with a variety of invasive hemodynamic devices. Which patient should the charge nurse evaluate first?
- A. A patient with a central venous pressure (RAP/CVP) oafb i6rb .mcomm/ teHstg and 40 mL of urine output in the past hour
- B. A patient with a left radial arterial line with a BP of 11 0/60 mm Hg and slightly dampened arterial waveform
- C. A patient with a pulmonary artery occlusion pressure of 25 mm Hg and an oxygen saturation of 89% on 3 L of oxygen via nasal cannula
- D. A patient with a pulmonary artery pressure of 25/10 mm Hg and an oxygen saturation of 94% on 2 L of oxygen via nasal cannula
Correct Answer: C
Rationale: The correct answer is C because a pulmonary artery occlusion pressure of 25 mm Hg indicates possible fluid overload or cardiac issue requiring urgent evaluation. This value is high, suggesting increased pressure in the left side of the heart. Additionally, the oxygen saturation of 89% on 3 L of oxygen indicates potential respiratory compromise. This patient needs immediate assessment and intervention to prevent worsening of their condition.
Choice A is incorrect as a central venous pressure of 6 mm Hg is within normal limits, and the urine output is adequate. Choice B is incorrect as a BP of 110/60 mm Hg is acceptable, and a slightly dampened arterial waveform is not an immediate concern. Choice D is incorrect as a pulmonary artery pressure of 25/10 mm Hg is within normal range, and an oxygen saturation of 94% on 2 L of oxygen is acceptable.
Critical illness often results in family conflicts. Which scenario is most likely to result in the greatest conflict?
- A. A 21-year-old college student of divorced parents hosp italized with multiple trauma. She resides with her mother. The parents are amicable with each other and have similar values. The father blames the daughter’s b oyfriend for causing the accident.
- B. A 36-year-old male admitted for a ruptured cerebral an eurysm. He has been living with his 34-year-old girlfriend for 8 years, and they have a 4-year-old daughter. He does not have written advance directives. His parents aarbriribv.ceo mfr/otemst out-of-state and are asked to make decisions about his health care. He h as not seen them in over a year.
- C. A 58-year-old male admitted for coronary artery bypas s surgery. He has been living with his same-sex partner for 20 years in a committed relationship. He has designated his sister, a registered nurse, as his healthca re proxy in a written advance directive.
- D. A 78-year-old female admitted with gastrointestinal blaebeirdbi.cnogm./ tHeset r hemoglobin is decreasing to a critical level. She is a Jehovah’s Witness and refuses the treatment of a blood transfusion. She is capable of making her ow n decisions and has a clearly written advance directive declining any transfu sions. Her son is upset with her and tells her she is “committing suicide.”
Correct Answer: D
Rationale: The correct answer is D because it involves a conflict between the patient's autonomy and her son's beliefs. The patient, a Jehovah's Witness, has clearly stated her refusal of a blood transfusion in her advance directive, which aligns with her religious beliefs. Her son's disagreement with her decision creates a significant ethical dilemma and conflict. This scenario highlights the clash between respecting the patient's autonomy and the son's concerns for her well-being.
Choice A is less likely to result in the greatest conflict as both parents have similar values and are amicable, with the conflict being directed towards the daughter's boyfriend.
Choice B involves a conflict between the patient's girlfriend and parents, but the patient's lack of advance directives and estranged relationship with his parents do not present as significant a conflict as in the correct answer.
Choice C involves a designated healthcare proxy and a committed relationship, which are less likely to result in a conflict as compared to the clash of beliefs and autonomy seen in Choice D.
The family is considering withdrawing life-sustaining measures from the patient. The nurse knows that ethical principles for withholding or withdrawi ng life-sustaining treatments include which of the following?
- A. Any treatment may be withdrawn and withheld, includ ing nutrition, antibiotics, and blood products.
- B. Doses of analgesic and anxiolytic medications must be adjusted carefully and should not exceed usual recommended limits.
- C. Life-sustaining treatments may be withdrawn while a patient is receiving paralytic agents.
- D. The goal of withdrawal and withholding of treatments is to hasten death and thus relieve suffering.
Correct Answer: A
Rationale: The correct answer is A because it aligns with the ethical principle of patient autonomy, which emphasizes the patient's right to make decisions about their own care. Withholding or withdrawing life-sustaining treatments, including nutrition, antibiotics, and blood products, respects the patient's autonomy. This choice also reflects the principle of beneficence, as it aims to prevent unnecessary suffering and respects the patient's wishes.
Option B is incorrect because it focuses on pain and anxiety management rather than the broader ethical considerations of withholding life-sustaining treatments.
Option C is incorrect because withdrawing life-sustaining treatments while a patient is receiving paralytic agents can pose additional risks and complications, potentially conflicting with the principles of nonmaleficence and beneficence.
Option D is incorrect because the primary goal of withdrawing or withholding treatments is not to hasten death but to respect the patient's autonomy and quality of life. This choice does not align with the ethical principles of patient-centered care.
Noise in the critical care unit can have negative effects on the patient. Which of the following interventions assists in reducing noise levels in the criticala cbiarbr.ec osme/ttetisnt g? (Select all that apply.)
- A. Asking the family to bring in the patient’s i-Pod or other device with favorite music.
- B. Inviting the volunteer harpist to play on the unit on a re gular basis.
- C. Remodeling the unit to have two-patient rooms to facil itate nursing care.
- D. Remodeling the unit to install acoustical ceiling tiles.
Correct Answer: A
Rationale: Step 1: Bringing in the patient's i-Pod with favorite music can provide personalized, soothing sounds, reducing stress and anxiety for the patient.
Step 2: Familiar music can create a calming environment, distracting the patient from external noise.
Step 3: Listening to music may improve patient comfort and overall experience in the critical care unit.
Summary: Option A is correct as it directly addresses noise reduction by providing a personalized, calming environment for the patient. Options B, C, and D do not specifically target noise reduction but focus on other aspects of care or facility improvement.
The nurse obtains a heart rate of 92 and a blood pressure of 110/76 prior to administering a scheduled dose of verapamil (Calan) for a client with atrial flutter. Which action should the nurse implement?
- A. Give intravenous (IV) calcium gluconate.
- B. Withhold the drug and notify the healthcare provider.
- C. Administer the dose as prescribed.
- D. Recheck the vital signs in 30 minutes and then administer the dose.
Correct Answer: C
Rationale: The correct answer is C: Administer the dose as prescribed. Verapamil is a calcium channel blocker used to treat atrial flutter. The vital signs obtained are within normal range for this medication. A heart rate of 92 and blood pressure of 110/76 are not contraindications for administering verapamil. Option A is incorrect as calcium gluconate is not indicated in this situation. Option B is incorrect because the vital signs are stable and do not warrant withholding the medication. Option D is incorrect as there is no need to delay the administration of verapamil based on the vital signs provided.