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Which assessment would cue the nurse to the potential of aa bc iru bt .ce o mre /ts ep sti ratory distress syndrome (ARDS) in a patient admitted with respiratory distress?
- A. Increased oxygen saturation via pulse oximetry
- B. Increased peak inspiratory pressure on the ventilator
- C. Normal chest radiograph with enlarged cardiac structures
- D. PaO /FiO ratio > 300 2 2
Correct Answer: B
Rationale: The correct answer is B. Increased peak inspiratory pressure on the ventilator would cue the nurse to the potential of ARDS in a patient with respiratory distress. ARDS is characterized by severe respiratory failure with bilateral pulmonary infiltrates. An increase in peak inspiratory pressure on the ventilator indicates that the lungs are becoming stiffer, which is a common finding in ARDS due to increased inflammation and fluid accumulation in the alveoli. This finding alerts the nurse to the possibility of ARDS and the need for further assessment and intervention.
Summary of other choices:
A: Increased oxygen saturation via pulse oximetry is a nonspecific finding and may not specifically indicate ARDS.
C: Normal chest radiograph with enlarged cardiac structures is more indicative of heart failure rather than ARDS.
D: PaO2/FiO2 ratio > 300 is a criterion used to diagnose ARDS, but a value higher than 300 actually indicates mild ARDS, so it would not necessarily cue the nurse
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The nurse manager recognizes which action as an effectiveab sirtbr.acotmeg/teys tf or promoting changes in practice?
- A. Asking the clinical nurse specialist to lead a journal clu b on open visitation after each nurse is tasked to read one research article about visitation.
- B. Discussing pros and cons of open visitation at the next staff meeting.
- C. Inviting the nurses with the most experience to develop a revised policy.
- D. Tasking the unit-based nurse practice council to invite volunteers to serve on the council to revise the current policy toward more liberaal bviribs.ciotamt/iteosnt .
Correct Answer: A
Rationale: The correct answer is A because it involves a structured approach to promoting changes in practice. By asking the clinical nurse specialist to lead a journal club on open visitation after each nurse reads a research article, it ensures that all nurses are informed and engaged in the topic. This approach promotes evidence-based practice and encourages active participation.
Option B is less effective as discussing pros and cons at a staff meeting may not ensure that all nurses have the necessary knowledge to make informed decisions. Option C may not consider diverse perspectives and may not involve all staff members equally. Option D involves a select group of volunteers and may not reflect the views of the entire team. Overall, option A is the most inclusive and educational approach to promoting changes in practice.
An Ethiopian man with AIDS has recently been admitted to the ICU with a case of pneumonia. The man is new to the U.S. and has no health insurance. He would likely be eligible for the states Medicaid coverage, but does not understand how to access this coverage. Which competency or competencies are most needed in this situation? Select all that apply.
- A. Clinical judgment
- B. Advocacy and moral agency
- C. Collaboration
- D. Systems thinking
Correct Answer: B
Rationale: The correct answer is B: Advocacy and moral agency. In this scenario, the Ethiopian man with AIDS is in a vulnerable position due to lack of health insurance and understanding of Medicaid coverage. Advocacy skills are crucial to help him navigate the complex healthcare system and access the necessary resources. Moral agency involves advocating for the patient's rights and well-being, ensuring that he receives appropriate care despite his socioeconomic status. Clinical judgment, collaboration, and systems thinking are important competencies but not as directly relevant in this specific situation of advocating for the patient's access to Medicaid coverage.
The nurse responds to a ventilator alarm and finds the patient lying in bed holding the endotracheal tube (ET). Which action should the nurse take next?
- A. Activate the rapid response team.
- B. Provide reassurance to the patient.
- C. Call the health care provider to reinsert the tube.
- D. Manually ventilate the patient with 100% oxygen.
Correct Answer: D
Rationale: The correct action is D: Manually ventilate the patient with 100% oxygen. This is crucial to ensure adequate oxygenation and prevent hypoxia. Holding the ET tube can lead to extubation and airway compromise. Activating the rapid response team (A) may delay immediate intervention. Providing reassurance (B) is important but not the priority in this situation. Calling the health care provider (C) to reinsert the tube would also lead to a delay in providing essential respiratory support.
The charge nurse is supervising the care of four critical ca re patients being monitored using invasive hemodynamic modalities. Which patient should t he charge nurse evaluate first?
- A. A patient in cardiogenic shock with a cardiac output (CabOirb). coofm 2/te.0st L/min
- B. A patient with a pulmonary artery systolic pressure (PA P) of 20 mm Hg
- C. A hypovolemic patient with a central venous pressure (CVP) of 6 mm Hg
- D. A patient with a pulmonary artery occlusion pressure (PAOP) of 10 mm Hg
Correct Answer: A
Rationale: The correct answer is A because the patient in cardiogenic shock with a cardiac output of 2.0 L/min is experiencing a life-threatening condition that requires immediate evaluation. Cardiogenic shock indicates poor cardiac function, which can lead to multi-organ failure. Monitoring cardiac output is crucial in managing these patients.
Choice B is incorrect because a pulmonary artery systolic pressure of 20 mm Hg is within normal range and does not indicate an immediate life-threatening condition.
Choice C is incorrect because a CVP of 6 mm Hg in a hypovolemic patient may indicate volume depletion, but it is not as urgent as the patient in cardiogenic shock.
Choice D is incorrect because a PAOP of 10 mm Hg is within normal range and does not suggest an immediate critical condition.
The client has been in the CCU for several weeks and has been very unstable. One family member stays at the bedside constantly and even naps in a bedside chair. The nurse understands that the family member is exhibiting which family member response to critical illness?
- A. Exhibiting extreme distrust of the health care team
- B. Seeking evidence for future legal or punitive action
- C. Trying to maintain a level of control over the situation
- D. Experiencing extreme fatigue from constant stress
Correct Answer: C
Rationale: The correct answer is C: Trying to maintain a level of control over the situation. The family member staying at the bedside constantly and even napping there is likely trying to cope with the stressful situation by maintaining a sense of control and connection to the patient. This behavior can be a way for the family member to feel more involved and helpful during a time of uncertainty and powerlessness. Choices A and B involve negative assumptions about the family member's intentions without evidence. Choice D may be a result of the family member's actions but does not address the underlying motivation for their behavior.