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Which of the following factors predispose the critically ill patient to pain and anxiety? (Select all that apply.)
- A. Inability to communicate
- B. Invasive procedures
- C. Monitoring devices
- D. Preexisting conditions
Correct Answer: A
Rationale: The correct answer is A: Inability to communicate. Critically ill patients often experience pain and anxiety due to their inability to effectively communicate their needs and discomfort. This can lead to unaddressed pain and increased anxiety levels. Choices B, C, and D are incorrect because while invasive procedures, monitoring devices, and preexisting conditions can contribute to pain and anxiety in critically ill patients, they are not factors that directly predispose patients to these issues. It is the lack of communication that significantly hinders the ability to address and manage pain and anxiety effectively in these patients.
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The nurse is caring for a critically ill trauma patient who is expected to be hospitalized for an extended period of time. Which of the following nursing interventions would improve the patient’s well-being and reduce anxiety the most?
- A. Arrange for the patient’s dog to be brought into the unit (per protocol).
- B. Contact the pet therapy department to bring a therapy d og in to visit.
- C. Secure the harpist to come and play soothing music fora bairnb. choomu/tre set very afternoon.
- D. Wheel the patient out near the unit aquarium to observ e the tropical fish.
Correct Answer: B
Rationale: The correct answer is B because pet therapy has been shown to reduce anxiety and improve well-being in hospitalized patients. Interacting with therapy dogs can provide comfort, companionship, and a distraction from the hospital environment. Bringing in a therapy dog can help the trauma patient feel more relaxed and supported during their extended hospital stay.
Choice A may be comforting but does not address the therapeutic benefits of pet therapy. Choice C may provide soothing music, but pet therapy has been specifically proven to reduce anxiety in patients. Choice D, observing fish in an aquarium, may be calming but does not involve the interactive benefits of pet therapy.
An unresponsive 79-year-old is admitted to the emergency department (ED) during a summer heat wave. The patient’s core temperature is 105.4°F (40.8°C), blood pressure (BP) 88/50, and pulse 112. The nurse initially will plan to:
- A. Apply wet sheets and a fan to the patient.
- B. Provide O2 at 6 L/min with a nasal cannula.
- C. Start lactated Ringer's solution at 1000 mL/hr.
- D. Give acetaminophen (Tylenol) rectal suppository.
Correct Answer: A
Rationale: The correct answer is A: Apply wet sheets and a fan to the patient. This is the initial treatment for hyperthermia to aid in lowering the body temperature. Wet sheets help in evaporative cooling, while a fan enhances heat loss through convection. This approach is crucial in managing heat-related illnesses quickly. Choices B, C, and D are incorrect as they do not directly address the urgent need to reduce the patient's elevated core temperature. Providing O2, IV fluids, or acetaminophen can be considered later in the management, but the priority is to rapidly lower the body temperature in a hyperthermic patient to prevent further complications.
The patient has a temporary percutaneous catheter in place for treatment of acute kidney injury. The catheter has been in place for 5 days. The nurse should
- A. prepare to assist with a routine dialysis catheter change.
- B. evaluate the patient for signs and symptoms of infection.
- C. teach the patient that the catheter is designed for long-term use.
- D. use one of the three lumens for fluid administration.
Correct Answer: B
Rationale: The correct answer is B because after 5 days, the risk of infection increases. Evaluating the patient for signs and symptoms of infection is crucial for early detection and treatment. Choice A is incorrect because routine dialysis catheter changes are not necessary after only 5 days. Choice C is incorrect as percutaneous catheters are for short-term use. Choice D is incorrect as using the catheter for fluid administration may increase the risk of infection.
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.
The charge nurse is responsible for making the patient ass ignments on the critical care unit. She assigns the experienced, certified nurse to care for thea abicrbu.cteomly/t eisltl patient diagnosed with sepsis who also requires continuous renal replacement therapy and mechanical ventilation. She assigns the nurse with less than 1 year of experience to two patients who are more stable. This assignment reflects implementation of what guiding framework?
- A. Crew resource management model
- B. National Patient Safety Goals
- C. Quality and Safety Education for Nurses (QSEN) mod el
- D. Synergy model of practice
Correct Answer: D
Rationale: The correct answer is D: Synergy model of practice. The Synergy model emphasizes matching nurse competencies with patient needs for optimal outcomes. In this scenario, the charge nurse assigned the experienced, certified nurse to a complex patient requiring specialized care (sepsis, renal replacement therapy, ventilation), aligning with the model's principle of matching nurse expertise to patient acuity. Assigning the less experienced nurse to stable patients aligns with the model's focus on optimizing patient outcomes by matching nurse competencies appropriately.
A: Crew resource management model focuses on teamwork and communication to enhance safety, not specifically on nurse-patient assignments.
B: National Patient Safety Goals are broad guidelines for improving patient safety, not specific to nurse-patient assignments.
C: Quality and Safety Education for Nurses (QSEN) model focuses on integrating quality and safety competencies into nursing education, not specifically on nurse-patient assignments.