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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.
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While caring for a critically ill patient, the nurse knows that fostering patient control over the environment is a method for stress reduction. What nursing intervention gives the patient the most environmental control while still adhering to best practice principles?
- A. Ask the patient whether he or she wants to get out of bed.
- B. Give the patients bath at the same time every day.
- C. Explain painful procedures only after giving pain medication.
- D. Choose menu items for the patient to ensure a balanced diet.
Correct Answer: A
Rationale: Step 1: Asking the patient whether he or she wants to get out of bed allows the patient to make a decision regarding their immediate environment, promoting autonomy and control.
Step 2: This intervention respects the patient's preferences and fosters a sense of dignity and empowerment, reducing stress.
Step 3: Best practice principles in nursing emphasize patient-centered care and promoting patient autonomy.
Summary:
Choice A is correct as it directly involves the patient in decision-making, enhancing their sense of control. Choices B, C, and D do not provide the same level of autonomy and control to the patient, making them less effective in reducing stress and promoting patient well-being.
The nurse is caring for a patient with acute kidney injury who is being treated with hemodialysis. The patient asks if he will need dialysis for the rest of his life. Which of the following would be the best response?
- A. “Unfortunately, kidney injury is not reversible; it is permanent.”
- B. “Kidney function usually returns within 2 weeks.”
- C. “You will know for sure if you start urinating a lot all at once.”
- D. “Recovery is possible, but it may take several months.”
Correct Answer: D
Rationale: The correct answer is D: “Recovery is possible, but it may take several months.” This response is the best choice as it provides a balanced and accurate explanation to the patient. Here's the rationale:
1. Hemodialysis is often used as a temporary measure to support kidney function while allowing time for the kidneys to recover.
2. Acute kidney injury can be reversible in some cases, especially if the underlying cause is identified and treated promptly.
3. Recovery time varies for each individual, and it can indeed take several months for kidney function to improve.
4. Choices A, B, and C are incorrect:
- A is overly pessimistic and does not consider the potential for recovery.
- B provides a specific timeframe that may not be accurate for all patients.
- C is not a reliable indicator of kidney function recovery and may lead to confusion.
Which statement is a likely response from someone who h as survived a stay in the critical care unit?
- A. “I don’t remember much about being in the ICU, but if I had to be treated there again, it would be okay. I’m glad I can see my grandchildren again.”
- B. “If I get that sick again, do not take me to the hospital. I would rather die than go through having a breathing tube put in again.”
- C. “My family is thrilled that I am home. I know I need some extra attention, but my children have rearranged their schedules to help me ou t.”
- D. “Since I have been transferred out of the ICU, I cannot get enough to eat. They didn’t let me eat in the ICU, so I’m making up for it no w.”
Correct Answer: A
Rationale: Rationale: Choice A is the correct answer because it reflects a positive attitude towards potential future treatments in the critical care unit and gratitude for being able to see family again. The survivor acknowledges the past experience but remains optimistic.
Summary:
- Choice B is incorrect as it shows a strong aversion to hospital care, indicating a preference for death over treatment.
- Choice C is incorrect as it focuses on the family's reaction and not the survivor's personal experience or perspective.
- Choice D is incorrect as it highlights a trivial aspect (eating) rather than reflecting on the ICU experience or future treatments.
The nurse is caring for an older adult patient who is in card iogenic shock and has failed to respond to medical treatment. The primary care provider conducts a conference to explain that they have exhausted treatment options and suggest that the patient be made a “do not resuscitate” status. This scenario illustrates what medical concept?
- A. Brain death
- B. Futility
- C. Incompetence
- D. Life-prolonging procedures
Correct Answer: B
Rationale: The correct answer is B: Futility. In this scenario, the primary care provider suggests making the patient a "do not resuscitate" status because further medical treatment is deemed futile. Futility refers to situations where medical interventions are unlikely to achieve the desired outcome. This decision is made when the benefits of continuing treatment do not outweigh the burdens on the patient.
Summary:
A: Brain death does not apply here as the patient is not brain dead.
C: Incompetence refers to the patient's ability to make decisions, not the medical concept being illustrated.
D: Life-prolonging procedures are not being discussed; the focus is on the futility of further treatment.
The nurse is caring for a postoperative patient in the critica l care unit. The physician has ordered patient-controlled analgesia (PCA) for the patient. The nurse understands what facts about the PCA? (Select all that apply.)
- A. It is a safe and effective method for administering anal gesia.
- B. It has potentially fewer side effects than other routes of analgesic administration.
- C. It is an ideal method to provide critically ill patients so me control over their treatment.
- D. It does not work well without family assistance
Correct Answer: A
Rationale: Step-by-step rationale for why Answer A is correct:
1. Patient-controlled analgesia (PCA) allows patients to self-administer pain medication within preset limits, promoting pain management.
2. PCA is considered safe and effective as it provides better pain control, reduces the risk of overdose, and allows for individualized dosing.
3. Healthcare providers can monitor and adjust the PCA settings as needed to ensure optimal pain relief.
4. Studies have shown that PCA is a preferred method for postoperative pain management due to its efficacy and safety profile.
5. Overall, PCA is a reliable and beneficial approach to analgesia administration in postoperative patients.
Summary of why other choices are incorrect:
B: While PCA may have fewer side effects compared to some routes, this is not a defining characteristic of PCA.
C: While patients do have some control over their treatment with PCA, the primary focus is on pain management rather than giving control to critically ill patients.
D: PCA can be used effectively without family