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When caring for a patient with pulmonary hypertension, which parameter is most appropriate for the nurse to monitor to evaluate the effectiveness of the treatment?
- A. Central venous pressure (CVP)
- B. Systemic vascular resistance (SVR)
- C. Pulmonary vascular resistance (PVR)
- D. Pulmonary artery wedge pressure (PAWP)
Correct Answer: C
Rationale: The correct answer is C: Pulmonary vascular resistance (PVR). PVR is the most appropriate parameter to monitor in a patient with pulmonary hypertension as it directly reflects the resistance in the pulmonary circulation. A decrease in PVR indicates a reduction in the constriction of blood vessels in the lungs, suggesting improvement in pulmonary hypertension. Monitoring CVP (A) is more relevant in assessing fluid status, SVR (B) is more indicative of systemic vascular tone, and PAWP (D) is useful in assessing left-sided heart function, but they are not as specific to evaluating the effectiveness of treatment for pulmonary hypertension.
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The nurse caring for a mechanically ventilated patient note s the high pressure alarm sounding but cannot quickly identify the cause of the alarm. The nurasbeir bn.cootme/ste stht e patient’s oxygen saturation is decreasing and heart rate and respiratory rate are increasing. What is the nurse’s priority action?
- A. Ask the respiratory therapist to get a new ventilator
- B. Call the rapid response team to assess the patient
- C. Continue to find the cause of the alarm and fix it
- D. Manually ventilate the patient while calling for a respi ratory therapist
Correct Answer: B
Rationale: The correct answer is B. The nurse's priority is to ensure the patient's safety and well-being. Calling the rapid response team will allow for immediate assessment by a team of healthcare professionals to address the deteriorating condition. This step takes precedence over troubleshooting the ventilator or manually ventilating the patient. Asking for a new ventilator (A) or manually ventilating the patient (D) does not address the urgent need for a comprehensive assessment and intervention. Continuing to troubleshoot the alarm (C) can delay critical interventions needed for the patient's worsening condition. Thus, calling the rapid response team is the most appropriate action to address the escalating clinical situation promptly.
All of the patient’s children are distressed by the possibility of removing life-support treatments. The child who is most upset tells the nurse, “T his is the same as killing! I thought you were supposed to help!” What response would the nur se provide to the family?
- A. “This is a process of allowing death to occur naturally after the injuries that were sustained in a serious accident.”
- B. “The hospital would never allow us to do that kind of thing.”
- C. “Let’s talk about this calmly, and I will explain why asasbiirsbt.ecodm s/tuesict ide is appropriate in this case.”
- D. “Your parent lived a long and productive life.”
Correct Answer: A
Rationale: Correct Answer: A
Rationale:
1. Acknowledges the child's distress and concerns.
2. Explains the concept of allowing natural death after serious injuries.
3. Helps the family understand the ethical and medical reasoning behind removing life support.
4. Shows empathy and provides education to address misconceptions.
Summary of other choices:
B: Incorrect - Avoids addressing the family's concerns and provides a vague response.
C: Incorrect - Contains a typo and does not directly address the child's distress or misunderstanding.
D: Incorrect - Irrelevant response that does not address the ethical dilemma at hand.
A patient nearing death experiences increased secretions and noisy breathing. What is the nurse’s priority intervention?
- A. Provide suctioning every hour.
- B. Administer anticholinergic medications as prescribed.
- C. Elevate the head of the bed and reposition frequently.
- D. Restrict oral intake to minimize secretions.
Correct Answer: B
Rationale: The correct answer is B: Administer anticholinergic medications as prescribed. Anticholinergic medications can help dry up secretions and improve breathing in a patient nearing death. This intervention targets the underlying cause of increased secretions. Suctioning (choice A) may provide temporary relief but does not address the root issue. Elevating the head of the bed and repositioning (choice C) can help with comfort but do not directly address the secretions. Restricting oral intake (choice D) may lead to dehydration and discomfort without effectively managing the secretions. Administering anticholinergic medications is the priority as it directly targets the symptom of increased secretions, improving the patient's comfort and quality of life.
A child is receiving maintenance intravenous (IV) fluids at the rate of 1000 mL for the first 10 kg of body weight, plus 50 mL/kg per day for each kilogram between 10 and 20. How many milliliters per hour should the nurse program the infusion pump for a child who weighs 19.5 kg?
- A. 24
- B. 61
- C. 73
- D. 58
Correct Answer: B
Rationale: To calculate the IV fluids for a 19.5 kg child:
1. For the first 10 kg: 1000 mL
2. For the weight between 10-20 kg: (19.5 kg - 10 kg) * 50 mL/kg = 475 mL
Total IV fluids = 1000 mL + 475 mL = 1475 mL
To convert to mL per hour: 1475 mL / 24 hours = ~61 mL/hr
Therefore, the correct answer is B (61 mL/hr).
Incorrect Choices:
A (24 mL/hr): Incorrect, as it doesn't consider the additional fluids for the weight between 10-20 kg.
C (73 mL/hr) and D (58 mL/hr): Incorrect, as these values are not obtained from the correct calculation based on the given formula.
The patient undergoes a cardiac catheterization that requires the use of contrast dyes during the procedure. To detect signs of contrast-induced kidney injury, the nurse should
- A. not be concerned unless urine output decreases.
- B. evaluate the patient’s serum creatinine for up to 72 hours after the procedure.
- C. obtain an order for a renal ultrasound.
- D. evaluate the patient’s postvoid residual volume to detect intrarenal injury.
Correct Answer: B
Rationale: The correct answer is B because evaluating the patient's serum creatinine for up to 72 hours after the procedure is crucial in detecting contrast-induced kidney injury. An increase in serum creatinine levels indicates impaired kidney function due to the contrast dye. This monitoring allows for early detection and intervention to prevent further kidney damage.
Choice A is incorrect because a decrease in urine output is a late sign of kidney injury and may not be present in the early stages. Choice C is incorrect as a renal ultrasound is not typically used to detect contrast-induced kidney injury. Choice D is incorrect as postvoid residual volume assessment is not specific to detecting intrarenal injury related to contrast dye use.