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Which of the following are physiological effects of positive end-expiratory pressure (PEEP) used in the treatment of acute respiratory distress syndrom e (ARDS)? (Select all that apply.)
- A. Increase functional residual capacity
- B. Prevent collapse of unstable alveoli
- C. Improve arterial oxygenation
- D. Open collapsed alveoli
Correct Answer: A
Rationale: The correct answer is A: Increase functional residual capacity. Positive end-expiratory pressure (PEEP) helps increase the functional residual capacity by keeping the alveoli open at the end of expiration. This prevents alveolar collapse, improves ventilation-perfusion matching, and enhances oxygenation.
B: Prevent collapse of unstable alveoli - This is incorrect because PEEP actually helps prevent the collapse of all alveoli, not just unstable ones.
C: Improve arterial oxygenation - This is partially correct, but the primary mechanism through which PEEP improves oxygenation is by increasing functional residual capacity.
D: Open collapsed alveoli - This is incorrect because PEEP helps prevent alveolar collapse rather than actively opening already collapsed alveoli.
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The nurse wishes to enhance sleep cycles in her critically ill patient. Research has shown that which nursing action improves sleep in critically ill patients?
- A. Repositioning every 2 hours
- B. Hypnotic medications
- C. Five-minute back effleurage
- D. Adequate pain control
Correct Answer: D
Rationale: The correct answer is D: Adequate pain control. Pain can significantly disrupt sleep in critically ill patients. By ensuring adequate pain control, the nurse can help improve the patient's ability to rest and sleep. This intervention targets a key factor affecting sleep cycles in critically ill patients. Repositioning every 2 hours (A) may help prevent pressure ulcers but does not directly address sleep improvement. Hypnotic medications (B) may have adverse effects and are not recommended as a first-line intervention. Five-minute back effleurage (C) may provide temporary relaxation but is not as effective as adequate pain control in improving sleep quality.
Which statement regarding ethical concepts is true?
- A. A living will is the same as a healthcare proxy.
- B. A signed donor card ensures that organ donation will o ccur in the event of brain death.
- C. A surrogate is a competent adult designated by a perso n to make healthcare decisions in the event the person is incapacitated.
- D. A persistent vegetative state is the same as brain deatha ibnir bm.cooms/tt esstt ates.
Correct Answer: C
Rationale: Rationale: Choice C is correct because a surrogate is indeed a competent adult designated to make healthcare decisions for an incapacitated person. This individual is typically chosen by the person themselves through a legal document like a healthcare proxy. This ensures that someone trusted can make important decisions when the person is unable to do so. Choices A, B, and D are incorrect because a living will and healthcare proxy serve different purposes, a signed donor card does not guarantee organ donation in the event of brain death (medical criteria are also required), and a persistent vegetative state is different from brain death (brain death implies irreversible cessation of brain function while a vegetative state involves some level of brain function).
A nurse is caring for an elderly man recently admitted to the ICU following a stroke. She assesses his cognitive function using a new cognitive assessment test she learned about in a recent article in a nursing journal. She then brings a cup of water and a straw to the patient because she observes that his lips are dry. Later, she has the patient sit in a wheelchair and takes him to have some blood tests performed. He objects at first, saying that he can walk on his own, but the nurse explains that it is hospital policy to use the wheelchair. That evening, she recognizes signs of an imminent stroke in the patient and immediately pages the physician. Which action taken by the nurse is the best example of evidence-based practice?
- A. Giving the patient a cup of water
- B. Transferring the patient in a wheelchair
- C. Recognizing signs of imminent stroke and paging the physician
- D. Using the cognitive assessment test
Correct Answer: C
Rationale: The correct answer is C: Recognizing signs of an imminent stroke and paging the physician. This action exemplifies evidence-based practice as it involves timely identification of a critical medical condition based on clinical assessment and prompt communication with the physician for further intervention. This aligns with the principles of evidence-based practice, which emphasize the integration of best available evidence with clinical expertise and patient values.
The other choices are incorrect:
A: Giving the patient a cup of water - While providing hydration is important for patient care, it does not demonstrate evidence-based practice in this scenario.
B: Transferring the patient in a wheelchair - Although using a wheelchair may be hospital policy, it does not directly relate to evidence-based practice in this context.
D: Using the cognitive assessment test - While assessing cognitive function is essential, it does not directly address the immediate medical needs of the patient as recognizing signs of an imminent stroke does.
A client who is taking clonidine (Catapres, Duraclon) reports drowsiness. Which additional assessment should the nurse make?
- A. Has the client experienced constipation recently?
- B. Did the client miss any doses of the medication?
- C. How long has the client been taking the medication?
- D. Does the client use any tobacco products?
Correct Answer: C
Rationale: The correct answer is C. Assessing how long the client has been taking clonidine is crucial as drowsiness is a common side effect that typically improves over time as the body adjusts to the medication. This information helps determine if the drowsiness is a temporary side effect or a more concerning issue.
Choice A (constipation) is not directly related to drowsiness as a side effect of clonidine. Choice B (missed doses) may contribute to drowsiness but is not the primary assessment priority. Choice D (tobacco use) is not directly related to clonidine-induced drowsiness.
Which of the following professional organizations best supports critical care nursing practice?
- A. American Association of Critical-Care Nurses
- B. American Heart Association
- C. American Nurses Association
- D. Society of Critical Care Medicine
Correct Answer: A
Rationale: The correct answer is A: American Association of Critical-Care Nurses (AACN). This organization focuses exclusively on critical care nursing, offering specialized education, resources, and certifications for critical care nurses. AACN advocates for high standards of care in critical care settings. The other choices do not specifically cater to critical care nursing practice. The American Heart Association focuses on cardiovascular health, the American Nurses Association is a general nursing organization, and the Society of Critical Care Medicine is more physician-centric. Therefore, A is the best choice for supporting critical care nursing practice.