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Which of the following situations may result in a low cardiac output and low cardiac index? (Select all that apply.)
- A. Exercise
- B. Hypovolemia
- C. Myocardial infarction
- D. Shock
Correct Answer: B
Rationale: Certainly. Hypovolemia, or low blood volume, can lead to low cardiac output and cardiac index because the heart has less blood to pump, resulting in reduced circulation. Exercise typically increases cardiac output to meet increased demand. Myocardial infarction may reduce cardiac output temporarily, but not consistently. Shock, a condition where the body's tissues do not receive enough oxygen and nutrients, can lead to low cardiac output, making it a possible cause.
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A nurse needs to communicate with a patients family regarding consent to treat an unconscious patient in the ICU. Which member of the group should the nurse approach first?
- A. A man she recognizes as the patients brother
- B. A teenage boy who approaches the nurse
- C. A woman who originally escorted the patient in
- D. A woman in the group whom the others look at and call over when the nurse approaches
Correct Answer: C
Rationale: The correct answer is C: A woman who originally escorted the patient in. This choice is correct because she is most likely the person responsible for the patient's care and thus likely has legal authority to make medical decisions on behalf of the patient. The other choices are incorrect because simply being recognized as the patient's brother (A), being a teenage boy who approaches the nurse (B), or being a woman whom the others look at and call over (D) does not necessarily indicate that they have the legal authority to make medical decisions for the unconscious patient.
When addressing an ethical dilemma, contextual, physiolo gical, and personal factors of the situation must be considered. Which of the following is an example of a personal factor?
- A. The hospital has a policy that everyone must have an aadbvirba.ncocme/dte sdt irective on the chart.
- B. The patient has lost 20 pounds in the past month and is fatigued all of time.
- C. The patient has expressed their beliefs concerning wha t quality of life means and their wishes.
- D. The primary care provider considers care to be futile in a given situation.
Correct Answer: C
Rationale: The correct answer is C because the patient's expressed beliefs and wishes regarding quality of life are personal factors that directly influence the ethical dilemma. This factor reflects the individual's values, beliefs, and preferences, which are essential in making ethical decisions that respect the patient's autonomy. Considering the patient's beliefs helps healthcare professionals navigate complex ethical situations by aligning the care provided with the patient's values. Choices A, B, and D do not directly relate to personal factors but rather focus on hospital policies, physiological symptoms, and the provider's perspective, respectively. Personal factors are crucial in ethical decision-making as they center on the patient's autonomy and preferences.
A 19-year-old is brought to the emergency department (ED) with multiple lacerations and tissue avulsion of the left hand. When asked about tetanus immunization, the patient denies having any previous vaccinations. The nurse will anticipate giving:
- A. Tetanus immunoglobulin (TIG) only.
- B. TIG and tetanus-diphtheria toxoid (Td).
- C. Tetanus-diphtheria toxoid and pertussis vaccine (Tdap) only.
- D. TIG and tetanus-diphtheria toxoid and pertussis vaccine (Tdap).
Correct Answer: D
Rationale: The correct answer is D because the patient has a high-risk wound (tissue avulsion) and no documented prior tetanus vaccination. TIG provides immediate passive immunity to tetanus, while Tdap stimulates active immunity. TIG covers immediate needs, while Tdap ensures long-term immunity. Choice A (TIG only) does not provide long-term immunity. Choice B (TIG and Td) does not include pertussis coverage, which Tdap (Choice D) does. Choice C (Tdap only) does not cover immediate needs as TIG does.
The family of a terminally ill patient is concerned about administering increasing doses of opioids for pain management. What is the nurse’s best response?
- A. Increasing opioids may hasten death, so alternative methods should be considered.
- B. Opioids are necessary to manage pain effectively and improve quality of life.
- C. We will reduce the opioid dose to avoid dependency.
- D. You should consult with a pain specialist about reducing the medication.
Correct Answer: B
Rationale: The correct answer is B because opioids are essential for effective pain management in terminally ill patients, improving their quality of life. Alternative methods may not provide sufficient pain relief. Choice A is incorrect as opioids do not necessarily hasten death when used appropriately for pain control. Choice C is incorrect because reducing opioid dose may lead to inadequate pain management. Choice D is incorrect as consulting a pain specialist to reduce medication may not be appropriate for terminally ill patients needing effective pain relief.
Four hours after mechanical ventilation is initiated for a patient with chronic obstructive pulmonary disease (COPD), the patient’s arterial blood gas (ABG) results include a pH of 7.51, PaO2 of 82 mm Hg, PaCO2 of 26 mm Hg, and HCO3 of 23 mEq/L (23 mmol/L). The nurse will anticipate the need to:
- A. Increase the FIO2.
- B. Increase the tidal volume.
- C. Increase the respiratory rate.
- D. Decrease the respiratory rate.
Correct Answer: D
Rationale: The correct answer is D: Decrease the respiratory rate. The ABG results show respiratory alkalosis with decreased PaCO2 and elevated pH. This indicates overventilation, so decreasing the respiratory rate will help normalize the PaCO2 and pH levels. Increasing the FIO2 (Choice A) is not needed as the PaO2 is within normal range. Increasing tidal volume (Choice B) can lead to further hyperventilation. Increasing the respiratory rate (Choice C) would exacerbate the respiratory alkalosis.