Nokea
Which treatment can be used to dissolve a thrombus that is lodged in the pulmonary artery?
- A. Aspirin
- B. Embolectomy
- C. Heparin
- D. Thrombolytics
Correct Answer: D
Rationale: The correct answer is D: Thrombolytics. Thrombolytics are medications that can dissolve blood clots, making them effective in treating a thrombus lodged in the pulmonary artery. They work by activating the body's natural clot-dissolving system. Aspirin (A) is an antiplatelet drug and may prevent further clot formation but cannot dissolve an existing thrombus. Embolectomy (B) is a surgical procedure to remove a clot and is invasive, usually reserved for cases where thrombolytics are contraindicated. Heparin (C) is an anticoagulant that prevents clot formation but does not dissolve existing clots like thrombolytics do.
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The nurse is caring for a patient with a subarachnoid hemorrhage who is intubated and placed on a mechanical ventilator with 10 cm H2O of peak end-expiratory pressure (PEEP). When monitoring the patient, the nurse will need to notify the healthcare provider immediately if the patient develops:
- A. Oxygen saturation of 93%.
- B. Respirations of 20 breaths/minute.
- C. Green nasogastric tube drainage.
- D. Increased jugular venous distention.
Correct Answer: D
Rationale: The correct answer is D: Increased jugular venous distention. In a patient with a subarachnoid hemorrhage and on mechanical ventilation, increased jugular venous distention can indicate increased intracranial pressure, which can be life-threatening. The nurse should notify the healthcare provider immediately as it may require urgent intervention to prevent further neurological deterioration.
A: Oxygen saturation of 93% is within the acceptable range for a patient on mechanical ventilation and may not require immediate notification.
B: Respirations of 20 breaths/minute are within normal limits for a ventilated patient and do not necessarily indicate a critical condition.
C: Green nasogastric tube drainage may indicate the presence of bile and could be related to gastrointestinal issues, but it does not pose an immediate threat to the patient's neurological status.
The most common reasons for initiating dialysis in acute kidney injury include which of the following? (Select all that apply.)
- A. Acidosis
- B. Hypokalemia
- C. Volume overload
- D. Hyperkalemia
Correct Answer: C
Rationale: The correct answer is C: Volume overload. In acute kidney injury, impaired kidney function leads to fluid retention, causing volume overload. Dialysis helps remove excess fluid to restore fluid balance. Acidosis and hyperkalemia are potential complications of acute kidney injury but not the primary reasons for initiating dialysis. Hypokalemia is unlikely in acute kidney injury due to impaired excretion of potassium by the kidneys. Therefore, the most common reason for initiating dialysis in acute kidney injury is to manage volume overload.
A patient’s ventilator settings are adjusted to treat hypoxemia. The fraction of inspired oxygen is increased from.60 to.70, and the positive end-expiratory pressure is increased from 10 to 15 cm H O. Shortly after these adjustments, the nurse notes that the patient’s blood pressure drops from 120/76 mm Hg to 90/60 mm Hg. What is the m ost likely cause of this decrease in blood pressure?
- A. Decrease in cardiac output
- B. Hypovolemia
- C. Increase in venous return
- D. Oxygen toxicity
Correct Answer: B
Rationale: The correct answer is B: Hypovolemia. When the ventilator settings are adjusted to treat hypoxemia by increasing FiO2 and PEEP, it can lead to increased oxygenation but also potentially decrease venous return to the heart, causing a decrease in blood pressure. This decrease in blood pressure is most likely due to hypovolemia, as the increased PEEP can increase intrathoracic pressure, reducing venous return and preload, leading to a decrease in cardiac output and subsequent decrease in blood pressure. This choice is the most likely cause as the other options (A: Decrease in cardiac output, C: Increase in venous return, D: Oxygen toxicity) do not directly correlate with the changes in ventilator settings described in the question.
Positive end-expiratory pressure (PEEP) is a mode of ventaiblairbto.croym /atessst istance that produces which of the following conditions
- A. Each time the patient initiates a breath, the ventilator d elivers a full preset tidal volume.
- B. For each spontaneous breath taken by the patient, the tidal volume is determined by the patient’s ability to generate negative pressure.
- C. The patient must have a respiratory drive, or no breaths will be delivered.
- D. There is pressure remaining in the lungs at the end of eaxbiprbi.rcaotmio/tens tt hat is measured in cm H O.
Correct Answer: D
Rationale: The correct answer is D because positive end-expiratory pressure (PEEP) is a mode of ventilation where pressure is maintained in the lungs at the end of expiration. This helps prevent alveolar collapse and improves oxygenation. Option A is incorrect because PEEP does not deliver a full preset tidal volume with each breath initiation. Option B is incorrect because tidal volume in PEEP is not solely determined by the patient's ability to generate negative pressure. Option C is incorrect because in PEEP, breaths are delivered irrespective of the patient's respiratory drive.
What risk is the rationale for the recommendation of endot racheal rather than nasotracheal intubation?
- A. Basilar skull fracture
- B. Cervical hyperextension
- C. Impaired ability to "mouth" words
- D. Sinusitis and infection
Correct Answer: A
Rationale: The correct answer is A: Basilar skull fracture. Endotracheal intubation is recommended over nasotracheal intubation to avoid the risk of further damaging a basilar skull fracture. Nasotracheal intubation can potentially cause further injury due to the passage of the tube through the nasal cavity, which could exacerbate a basilar skull fracture.
Summary of other choices:
B: Cervical hyperextension - Not directly related to the choice between endotracheal and nasotracheal intubation.
C: Impaired ability to "mouth" words - Not a significant factor in determining the choice of intubation method.
D: Sinusitis and infection - While nasotracheal intubation can potentially lead to sinusitis and infection, the primary concern in this scenario is the risk of aggravating a basilar skull fracture.