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Which of the following strategies will assist in creating a h ealthy work environment for the critical care nurse? (Select all that apply.)
- A. Celebrating improved outcomes from a nurse-driven protocol with a pizza party
- B. Implementing a medication safety program designed b y pharmacists
- C. Modifying the staffing pattern to ensure a 1:1 nurse/patient ratio
- D. Offering quarterly joint nurse-physician workshops to discuss unit issues
Correct Answer: B
Rationale: The correct answer is B because implementing a medication safety program designed by pharmacists promotes a safe work environment for critical care nurses by reducing medication errors. Pharmacists are experts in medications and can provide valuable insights to improve safety.
A: Celebrating with a pizza party may boost morale but does not directly address work environment factors.
C: Modifying staffing ratios may improve patient care but doesn't necessarily address the overall work environment.
D: Joint workshops foster collaboration but may not directly impact the work environment's safety and health.
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Which action will the nurse need to do when preparing to assist with the insertion of a pulmonary artery catheter?
- A. Determine if the cardiac troponin level is elevated.
- B. Auscultate heart and breath sounds during insertion.
- C. Place the patient on NPO status before the procedure.
- D. Attach cardiac monitoring leads before the procedure.
Correct Answer: D
Rationale: The correct answer is D: Attach cardiac monitoring leads before the procedure. This is essential to monitor the patient's cardiac rhythm and detect any abnormalities during catheter insertion. Cardiac monitoring leads provide real-time information on the patient's heart rate and rhythm, allowing the nurse to promptly address any complications.
A: Determining if the cardiac troponin level is elevated is not directly related to assisting with pulmonary artery catheter insertion.
B: Auscultating heart and breath sounds during insertion is important but does not take precedence over attaching cardiac monitoring leads.
C: Placing the patient on NPO status before the procedure may be necessary for other procedures, but it is not specifically required for assisting with pulmonary artery catheter insertion.
While waiting for cardiac transplantation, a patient with severe cardiomyopathy has a ventricular assist device (VAD) implanted. When planning care for this patient, the nurse should anticipate:
- A. Giving immunosuppressive medications.
- B. Preparing the patient for a permanent VAD.
- C. Teaching the patient the reason for complete bed rest.
- D. Monitoring the surgical incision for signs of infection.
Correct Answer: D
Rationale: The correct answer is D because monitoring the surgical incision for signs of infection is essential post-VAD implantation to prevent complications. This step is crucial in early identification and treatment of any potential infection, which can lead to serious outcomes.
A) Giving immunosuppressive medications is not typically required for VAD implantation, as the primary goal is to support cardiac function rather than prevent rejection.
B) Preparing the patient for a permanent VAD is premature, as the goal is often to bridge to transplantation or recovery, not permanent VAD placement.
C) Teaching the patient the reason for complete bed rest is not necessary for VAD implantation, as patients are typically encouraged to gradually increase activity levels under guidance.
The condition of a critically ill patient with a living will has deteriorated. The patient’s partner wants “everything done,” regardless of the patient’s wishe s. Which ethical principle is the partner violating?
- A. Autonomy
- B. Beneficence
- C. Justice
- D. Nonmaleficence
Correct Answer: A
Rationale: The correct answer is A: Autonomy. Autonomy is the ethical principle that respects an individual's right to make decisions about their own care and treatment. In this scenario, the partner wanting "everything done" regardless of the patient's wishes violates the patient's autonomy by not honoring their previously expressed wishes outlined in the living will. This decision disregards the patient's right to make choices about their own healthcare. Choices B, C, and D are incorrect because:
B: Beneficence focuses on doing good for the patient, but in this case, the partner's actions are not necessarily in the patient's best interest.
C: Justice pertains to fairness and equal treatment, which is not directly relevant to the situation described.
D: Nonmaleficence is the principle of doing no harm, but in this scenario, the harm is not necessarily physical but rather a violation of the patient's autonomy.
The charge nurse is supervising care for a group of patients monitored with a variety of invasive hemodynamic devices. Which patient should the charge nurse evaluate first?
- A. A patient with a central venous pressure (RAP/CVP) oafb i6rb .mcomm/ teHstg and 40 mL of urine output in the past hour
- B. A patient with a left radial arterial line with a BP of 11 0/60 mm Hg and slightly dampened arterial waveform
- C. A patient with a pulmonary artery occlusion pressure of 25 mm Hg and an oxygen saturation of 89% on 3 L of oxygen via nasal cannula
- D. A patient with a pulmonary artery pressure of 25/10 mm Hg and an oxygen saturation of 94% on 2 L of oxygen via nasal cannula
Correct Answer: C
Rationale: The correct answer is C because a pulmonary artery occlusion pressure of 25 mm Hg indicates possible fluid overload or cardiac issue requiring urgent evaluation. This value is high, suggesting increased pressure in the left side of the heart. Additionally, the oxygen saturation of 89% on 3 L of oxygen indicates potential respiratory compromise. This patient needs immediate assessment and intervention to prevent worsening of their condition.
Choice A is incorrect as a central venous pressure of 6 mm Hg is within normal limits, and the urine output is adequate. Choice B is incorrect as a BP of 110/60 mm Hg is acceptable, and a slightly dampened arterial waveform is not an immediate concern. Choice D is incorrect as a pulmonary artery pressure of 25/10 mm Hg is within normal range, and an oxygen saturation of 94% on 2 L of oxygen is acceptable.
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.