Final EAQ

Which initial action would the nurse take during the primary survey of a patient who is suspected of having a spinal cord injury and is immobilized with a cervical collar? A.Administer oxygen. B.Monitor airway patency. C.Initiate IV lines. D.Maintain the patient in a supine position. E.Prepare the patient for rapid-sequence intubation.

A B D

Which desired outcome would the nurse associate with a patient receiving mechanical ventilation, as well as positive end-expiratory pressure (PEEP)? A.Expand collapsed alveoli. B.Decrease alveolar volume C.Decrease bronchospasms. D.Prevent spontaneous breathing

A.Expand collapsed alveoli.

Which lobe of the brain is affected if a patient has Broca aphasia? A.Frontal lobe B.Parietal lobe C.Occipital lobe D.Temporal lobe

A.Frontal lobe

Which cardiac parameter would the nurse assess to determine the adequacy of fluid resuscitation in a patient who has sustained burns? A.Heart rate less than 120 beats/minute B.Manual systolic blood pressure (BP) greater than 90 mm Hg C.Arterial line systolic BP greater than 90 mm Hg D.Manual mean arterial pressure greater than 65 mm Hg E.Arterial line mean arterial pressure greater than 65 mm Hg

A.Heart rate less than 120 beats/minute C.Arterial line systolic BP greater than 90 mm Hg E.Arterial line mean arterial pressure greater than 65 mm Hg

While administering hemodialysis, which action does the nurse take when the patient' s assessment findings include nausea, lightheadedness, and a blood pressure (BP) of 86/62 mm Hg? A.Infuse normal saline solution. B.Infuse 5% dextrose solution. C.Administer ondansetron (Zofran). D.Administer acetaminophen (Paracetamol)

A.Infuse normal saline solution.

Which instruction is most important when the nurse provides teaching for a patient who is scheduled to begin continuous ambulatory peritoneal dialysis (CAPD) treatments? A.It is essential for you to maintain aseptic technique to prevent peritonitis." B."You will be allowed a more liberal protein diet after you complete CAPD." C."It is important for you to maintain a daily written record of blood pressure and weight." D."You will need to continue regular medical and nursing follow-up visits while performing CAPD."

A.It is essential for you to maintain aseptic technique to prevent peritonitis."

Which information will a transcranial doppler (TCD) ultrasonography provide? A.It measures the velocity of blood flow in the cerebral arteries. B.It identifies red blood cells in the cerebrospinal fluid. C.It visualizes cerebral blood vessels. D.It measures brain oxygenation

A.It measures the velocity of blood flow in the cerebral arteries.

When evaluating a patient receiving supplemental oxygen at 6 liters/minute due to hypoxemia secondary to acute respiratory failure, which cue indicates the patient is responding to the treatment? A.PaO2 75 mmHg B.PaCO2 65 mmHg C.Coarse breath sounds D.Yellow-tinged sputum

A.PaO2 75 mmHg

Which action will the nurse take to prevent complications when a patient is using an oxygen-conserving cannula? A.Pad the tubing over the patient's ears. B.Adjust the tubing to fit tightly over the face. C.Clean the cannula with a disinfectant solution daily. D.Decrease the O flow rate when patient is exercising.

A.Pad the tubing over the patient's ears

For the patient with severe acute respiratory distress syndrome (ARDS), which position would the nurse utilize to improve the patient's oxygenation? A.Prone B.Lateral C.Supine D.Lateral recumbent

A.Prone

Which condition does the nurse suspect in a patient whose assessment findings include pericarditis, a glomerular filtration rate (GFR) of 10 mL/minute, a potassium level of 4 mEq/L, and a sodium bicarbonate level of 16 mEq/L? A.Uremia B.Hypoalbuminemia C.Cardiac irritability D.Metabolic acidosis

A.Uremia

Which artery would be obstructed if a patient sustained a stroke and is experiencing cranial nerve deficits? A.Vertebral artery B.Middle cerebral artery C.Anterior cerebral artery D.Posterior cerebral artery

A.Vertebral artery

Which clinical manifestation of multiple organ dysfunction syndrome (MODS) would the nurse monitor for in a patient being mechanically ventilated? A.Increased serum albumin B.Decreased respiratory compliance C.Increased gastrointestinal (GI) motility D.Decreased blood urea nitrogen (BUN)/creatinine ratio

B.Decreased respiratory compliance

The nurse suspects which cause of severe itching all over the body in a patient with chronic kidney disease (CKD)? Select all that apply. One, some, or all responses may be correct. Sodium intake of 2 to 4 g/day Protein intake of 1.2 g/kg/day Calorie intake of 25 kcal/kg/day Calcium intake of 1000 to 1500 mg/day A.Edema B.Dry skin C.Sensory neuropathy D.Abnormal liver function E. Calcium-phosphate deposition in the skin

B.Dry skin C.Sensory neuropathy E. Calcium-phosphate deposition in the skin

Which statement describes the reason for a loss of lean body mass in patients with systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS)? A.Hypoglycemia occurs. B.Fatty acids are mobilized for fuel. C.Glucose is converted to glycogen. D.Glucose is converted to amino acids

B.Fatty acids are mobilized for fuel.

Which action will the nurse take first when swelling and ecchymosis of the right foot and ankle are noted during the secondary survey for a patient who has been involved in a motor vehicle accident? A.Apply cold packs to the ankle and foot. B.Elevate the foot and ankle above the heart. C.Check dorsalis pedis and posterior tibial pulses. D.Administer acetaminophen per hospital protocols.

C.Check dorsalis pedis and posterior tibial pulses.

The nurse anticipates which clinical finding in a patient with anaphylactic shock? A.Stridor B.Pruritus C.Anxiety DPallor E.Chest pain

A, B, C, E

The nurse is caring for a patient with acute respiratory distress syndrome (ARDS) who is receiving mechanical ventilation. The nurse monitors for which complication? A.Barotrauma B.Stress ulcers C.Acute kidney injury D.Venous thromboembolism (VTE) E.Ventilator-associated pneumonia F.Congestive heart failure (CHF)

A. B. C. D. E. Complications of ARDS are many and develop because of the condition itself or its treatment. These complications include barotrauma, stress ulcers, acute kidney injury, VTE, and ventilator-associated pneumonia. Barotrauma occurs when alveoli are overdistended with excess pressure during mechanical ventilation. In ARDS, blood is diverted from the gastrointestinal system to the lungs to help meet the need body's demand for oxygen, thereby producing stress ulcers. Decreased renal perfusion and decreased oxygen delivery to the kidneys in ARDS often results in acute kidney injury. ARDS puts patients at risk for venous stasis and immobility resulting in VTE. Finally, ventilator-associated pneumonia occurs for many reasons, including prolonged mechanical ventilation, impaired host defense, and aspiration of gastric contents. CHF is not a complication associated with mechanical ventilation.

Which information would the nurse include when providing education to a patient who is scheduled for kidney transplant surgery? A.The patency of the vascular access must be maintained. B. The kidney may not function immediately postoperatively. C.Immunosuppressive drugs will be administered before the procedure. D.Dialysate will be reinfused into the peritoneal cavity before surgery. E. An antibiotic solution will be instilled into the bladder through a urinary catheter.

A. B. E. Because dialysis may be needed after the transplant, the patency of the vascular access must be maintained. The transplanted kidney does not always function immediately; the patient should know that dialysis may have to be continued for several weeks. A urinary catheter is placed into the bladder, and an antibiotic solution is instilled to distend the bladder and decrease the risk for infection. Immunosuppressive therapy is started after (not before) surgery. A patient on peritoneal dialysis must empty the peritoneal cavity of all dialysate solution before going to surgery.

The nurse expects which assessment finding in a patient with peritonitis experiencing early septic shock? A.Crackles B.Coma C.Decreased urine output D. Cool and mottled skin E.A heart rate of 120 beats/min

A. C E The clinical presentation of a patient with early septic shock includes crackles, decreased urine output, and tachycardia. Coma and cool and mottled skin occur with late septic shock

Which injured child will be given a yellow tag by first responders at a school bus crash? A.A child with a broken leg B.A child with minor scrapes C.A child in respiratory distress D.A child with a bruised and swollen arm E.A child complaining of abdominal pains F.A child who is drowsy and has a head wound

A. D

Which complication would the nurse be alert for in a patient with an electrical burn? . A. Myoglobinuria B.Systemic toxicity C.Protein hydrolysis D. Pneumonia

A. Myoglobinuria

Which response would the nurse provide when the family of a patient with acute respiratory failure secondary to chronic obstructive pulmonary disease (COPD) and an oxygen saturation of 92% asks the nurse to increase the oxygen being given to improve oxygen saturation levels? A."People with COPD require higher CO levels to stimulate breathing." B."We can try increasing the oxygen slowly to see the patient's response." C. "I will contact the health care provider (HCP) to change the current orders." D."Let's see how the patient responds to this oxygen level prior to increasing the rate."

A."People with COPD require higher CO levels to stimulate breathing."

Which initial action does the nurse take for a patient with an unobstructed airway who is experiencing anaphylactic shock? A.Administer oxygen. B.Initiate fluid resuscitation. C.Prepare to intubate the patient. D.Initiate pharmacologic intervention

A.Administer oxygen.

Which initial action would the nurse take for a patient who was exposed to carbon monoxide poisoning who tells the nurse, "I can't remember what happened"? A.Apply 100% oxygen. B.Implement pulse oximetry. C.Obtain arterial blood gases. D.Prepare the patient for intubation.

A.Apply 100% oxygen.

When arterial blood gases for a patient with respiratory failure who is receiving bilevel positive airway pressure (BiPAP) indicate a PaO of 48 mm Hg, which interprofessional action will the nurse anticipate? A.Assisting with endotracheal intubation B.Increasing the respiratory rate of the BiPAP C.Placing the patient in the prone position D.Encouraging the patient to take deeper breaths

A.Assisting with endotracheal intubation

A kidney transplant candidate ' s Estimated Post-Transplant Survival (EPTS) score is based on which factor? A.Diabetes B.Age C.Length of time on dialysis D.Previous transplants F.Pretransplant glomerular filtration rate (GFR)

A.B C. D Each kidney transplant candidate gets an individual Estimated PostTransplant Survival (EPTS) score. This score ranges from 0% to 100%. The score is related to how long a candidate will need a functioning kidney transplant when compared with other candidates. The EPTS score is based on age, length of time on dialysis, previous transplants, and presence of diabetes. The glomerular filtration rate (GFR) is not a criterion in the EPTS scoring system

Which complication is associated with peritoneal dialysis (PD)? A.Hernias B.Protein loss C.Peritonitis D. Bronchitis E.Exit site infection

A.B.C.D E With PD, increased intraabdominal pressure from the dialysate volume can cause hernias to develop in predisposed persons, such as multiparous women and older men. The peritoneal membrane is permeable to plasma proteins, amino acids, and polypeptides. These substances are lost in the dialysate fluid. Peritonitis results from contact contamination or an exit site or tunnel infection. Atelectasis, pneumonia, and bronchitis may occur from repeated upward displacement of the diaphragm, resulting in decreased lung expansion. Infection of the peritoneal catheter exit site is most often caused by Staphylococcus aureus or Staphylococcus epidermidis (from skin flora).

Which action will the nurse take first when caring for a patient who has had a large skin exposure to a powdered toxic chemical? A.Brush the dry powder off the skin. B.Clean the skin with soap and water. C.Inspect the skin for evidence of burns. D. Irrigate the skin with large amounts of water.

A.Brush the dry powder off the skin.

The nurse recognizes that which intervention would help a patient with stage 5 chronic kidney disease who experiences restless leg syndrome, jerking, and altered mental ability? A.Dialysis B.Calcium phosphate binders C.Intravenous (IV) 10% calcium gluconate D.Blood transfusion

A.Dialysis

Which complication would the nurse monitor for in a patient receiving 0.9% NaCl (normal saline) for shock? A.reactions B.Circulatory overload C.Hypernatremia D.Acute renal failure

B.Circulatory overload

Which action is included in the secondary assessment for a patient who has possible traumatic injuries? A.Obtaining blood pressure (BP) and heart rate B.Palpating the spine for deformities and pain C.Inspecting the genitalia for bleeding and obvious injuries D.Inspecting the back for ecchymosis, abrasions, and wounds E.Assessing for use of accessory muscle or abdomen when breathing F.Checking for circulation, pain, and numbness of any areas that have swelling

B. C. D.F.

When the nurse is caring for a patient with chronic obstructive pulmonary disease (COPD) exacerbation who requires oxygen administration, which assessment finding is of most concern? A.Bilateral rhonchi B. Increased lethargy C.PaCO2 50 mm Hg D. O2 saturation 92%

B. Increased lethargy

To prevent complications, which instruction would the nurse provide to a patient who is undergoing peritoneal dialysis (PD) treatments? A.Limit protein intake. B. Reposition frequently. C.Avoid orthopedic binders. D.Schedule routine International Normalized Ratio (INR) tests.

B. Reposition frequently.

Which explanation will the nurse give when teaching a patient who is at risk for respiratory failure about the benefits of pursed-lip breathing? A."It decreases the work of breathing." B."It increases the saturation of oxygen." C."It lengthens the inspiratory phase of breathing." D."It prevents accessory muscle use during breathing."

B."It increases the saturation of oxygen."

After teaching a class about the use of blood transfusions to treat anemia in patients with chronic kidney disease (CKD), the nurse identifies that which statement made by a student indicates effective learning? A."When receiving transfusions, the patient should take iron orally and also phosphate binders." B. "Multiple blood transfusions may lead to iron overload in the patient." C."Erythropoietin treatment helps patients with iron-deficiency anemia." D."Transfusions decrease the development of antibodies, which makes it harder to find a compatible donor for a kidney transplant."

B."Multiple blood transfusions may lead to iron overload in the patient."

Which amount of fluid would the nurse anticipate incorporating into a patient's plan of care for fluid replacement due to septic shock? A.10 mL/kg B.30 mL/kg C.50 mL/kg D.70 mL/kg

B.30 mL/kg

A patient with acute respiratory distress syndrome (ARDS) on mechanical ventilation is receiving vecuronium by continuous IV infusion. The nurse anticipates that which other types of medications will be prescribed? A.A sedative and a diuretic B.An analgesic and sedative CAn antibiotic and analgesic D.A diuretic and an antibiotic

B.An analgesic and sedative

The nurse would question which information that is included in an education module about nutrition therapy for patients with acute kidney injury (AKI)? A.IV fat emulsions provide a good source of nonprotein calories. B.If a patient cannot maintain adequate oral intake, parenteral nutrition is the preferred route for nutrition support. C. A patient who is treated with parenteral nutrition may need daily hemodialysis. D.Fat intake is increased so that the patient receives at least 30% to 40% of total calories from fat.

B.If a patient cannot maintain adequate oral intake, parenteral nutrition is the If a patient cannot maintain adequate oral intake, enteral nutrition (EN) is the preferred route for nutrition support

For the patient receiving mechanical ventilation who is experiencing anxiety, which nonpharmacologic relaxation intervention would the nurse provide? A.Lorazepam B.Music therapy C.Sedation holiday D.Range-of-motion exercises

B.Music therapy

Which oxygen delivery device may be used for a patient who requires oxygen administration in low concentrations of 24% at 1 L/min for a long duration? A.Face mask B.Nasal cannula C.Tracheostomy collar D.Partial and non-rebreather masks

B.Nasal cannula

When the nurse notes difficulty in waking a patient with respiratory failure who also reports a headache, which diagnostic test will be useful to check? A.PaO2 B.PaCO2 C.Pulse oximetry D.Electrocardiogram

B.PaCO2

Which finding for a patient with acute respiratory distress syndrome (ARDS) who is receiving mechanical ventilation with positive end-expiratory pressure (PEEP) indicates that current therapies are effective? A.pH is 7.28. B.PaO is greater than or equal to 60 mm Hg. C.PaO is unchanged when patient is turned to prone position. D. Blood pressure (BP) drops to 88/40 mm Hg with an increase in PEEP

B.PaO is greater than or equal to 60 mm Hg. The overall goals in caring for the patient with ARDS are to have a PaO between 55 and 80 mm Hg

Which patient seen in the emergency department after exposure to severe cold temperatures requires the most rapid action by the nurse? A.Patient with severely painful, cold, pale fingertips B.Patient with pale, firm feet that are insensitive to touch C. Patient with temperature 96°F (35.6°C) and shivering D.Patient with edema and blisters on the lower leg and foot

B.Patient with pale, firm feet that are insensitive to touch

When determining room assignments, the nursing team leader would choose a patient with which diagnosis to cohort with a patient who is 2 days post kidney transplantation? A.Hepatitis C B.Renal calculi D.Osteomyelitis E.Bronchial pneumonia

B.Renal calculi

A nurse is assessing a patient who was burned after contact with gasoline. Which complication would the nurse monitor? A.Liqueficative necrosis B.Systemic toxicity C.Myoglobinuria D.Severe metabolic acidosis

B.Systemic toxicity

The nurse anticipates which type of enteral nutritional therapy for a patient who is newly admitted to an intensive care unit (ICU) with septic shock? A.The calories will be adjusted based on daily weights. B.The patient will be started on a small amount of nutrition (10 mL/hr). C.The patient will be started on feedings after the condition stabilizes. D.Only total albumin is used to determine the patient's nutritional status.

B.The patient will be started on a small amount of nutrition (10 mL/hr).

Which statement is true of the train-of-four (TOF) assessment technique used during the administration of neuromuscular blocking agents? A.The procedure involves the use of a central nerve stimulator. B.The provider uses an instrument to elicit muscle twitches in the patient. C.The process requires the provider to elicit four twitches in the muscles. D. The procedure is done to counteract the effects of the neuromuscular blocking agent.

B.The provider uses an instrument to elicit muscle twitches in the patient.

For the intubated patient, which length of time would the nurse allow for the patient's spontaneous breathing trial (SBT) to last? A.Face mask Nasal cannula Tracheostomy collar Partial and non-rebreather masks B.At least 15 minutes but not more than 30 minutes At least 30 minutes but not more than 60 minutes C.At least 30 minutes but not more than 120 minutes D.At least 60 minutes but not more than 120 minutes

C.At least 30 minutes but not more than 120 minutes

Which intervention would the nurse implement to limit auto-positive end-expiratory pressure (PEEP) occurring while the patient receives mechanical ventilatory support? A.Use bronchoconstrictors. B.Increase the inspiratory times. C.Decrease the respiratory rates. D.Use small-diameter endotracheal tubes

C. Decrease the respiratory rates.

When a patient is admitted to the hospital with increased respiratory difficulties, which cue in the health record would indicate the patient has acute respiratory distress syndrome (ARDS)? A.V/Q mismatch B.Purulent sputum C.Refractory hypoxemia D.Bilateral opacities of chest x-ray E. Bowel obstruction with perforation

C.D.E A hallmark indication of ARDS is refractory hypoxemia, which is when the patient's condition worsens in spite of increasing levels of O administration. The chest x-ray of a patient with ARDS would reveal bilateral opacities that are not related to pleural effusions. Bowel obstruction with perforation causes widespread inflammation and infection. Septic mediators gain entrance to the bloodstream and often move toward the lungs to proliferate. This can be the beginning of acute respiratory failure (ARF), which if left untreated, can progress to ARDS. A V/Q mismatch can occur with other disorders such as pulmonary emboli. Purulent sputum would be indicative of an infection.

Which clinical manifestation would the nurse anticipate while caring for a patient with third-degree burns? A.Erythema B.Fluid-filled vesicles C.Hard, leathery skin D.Insensitivity to pain E. Mild to moderate edema

C.Hard, leathery skin D.Insensitivity to pain

Which occurrence causes dysrhythmias in patients with systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS)? A.Metabolic acidosis resulting in an increase in lactate levels B.Increased capillary permeability in the cardiovascular system C.Hypokalemia due to activities of aldosterone and catecholamines D.Aldosterone-mediated sodium and water reabsorption in kidneys

C.Hypokalemia due to activities of aldosterone and catecholamines

When a patient with acute respiratory distress syndrome who is receiving mechanical positive pressure ventilation has a PaO /FIO (P/F) ratio of 90, which action will the nurse anticipate taking? A.Increase respiratory rate on ventilator B.Decrease ventilator tidal volume setting C.Increase ventilator O concentration (FIO ) 2 2 D.Decrease positive end-expiratory pressure (PEEP)

C.Increase ventilator O concentration (FIO ) 2 2

Which dietary recommendation would the nurse give to a patient with chronic kidney disease (CKD) who is scheduled for hemodialysis? A.Drink more fluids. B.Eat protein-rich foods. C.Take folic acid supplementation. D.Take phosphate supplementation

C.Take folic acid supplementation.

Which finding is consistent with a left-hemispheric stroke A.Impaired judgment b.Unilateral weakness of the left extremities c.Unilateral weakness of the right extremities d.Spatial-perceptual deficits

C.Unilateral weakness of the right extremities

Which information will the nurse educator include when teaching staff nurses about hypercapnic respiratory failure? A.Low arterial blood oxygen levels are the primary abnormality. B.Arterial blood pH increases in response to decreased ventilation. C.Ventilatory failure leads to carbon dioxide (CO ) retention in arterial blood. 2 D.Oxygen transfer between the alveoli and the pulmonary capillaries is inadequate. E.Arterial carbon dioxide (PaCO ) is greater than 50 mm Hg, and arterial pH is less than 7.35.

C.Ventilatory failure leads to carbon dioxide (CO ) retention in arterial blood. E.Arterial carbon dioxide (PaCO ) is greater than 50 mm Hg, and arterial pH is less than 7.35.

At which rate must blood flow in the brain be maintained for normal functioning? A.200 to 400 mL/min B.400 to 600 mL/min C. 650 to 750 mL/min D. 750 to 1000 mL/min

D. 750 to 1000 mL/min

A nurse is teaching a student nurse about multiple organ dysfunction syndrome (MODS). Which statement by the student indicates correct understanding of the concept? A."Metabolic changes such as hypermetabolism in MODS are shortlived and self-limiting." B."Evidence of liver dysfunction can be noted fairly early due to changes in liver enzyme levels." C."When systemic inflammatory response syndrome (SIRS) progresses to MODS, mortality rates increase a bit but are still 80% to 90%." D."We would generally see dyspnea, changes in pulmonary artery wedge pressure (PAWP), tachypnea, and a decreasing PaO /FIO ratio as early signs."

D."We would generally see dyspnea, changes in pulmonary artery wedge pressure (PAWP), tachypnea, and a decreasing PaO /FIO ratio as early signs."

For the patient receiving mechanical ventilation after sustaining a stroke, which data findings determine the patient's ventilator settings? A.Ideal body weight, vital signs, and family preference B.Ethics committee results, current physiologic state, and ideal body weight C.Respiratory muscle strength, ethics committee results, and family preference D.Arterial blood gases (ABGs), current physiologic state, and respiratory muscle strength

D.Arterial blood gases (ABGs), current physiologic state, and respiratory muscle strength

The nurse notes an increase in the depth and rate of the respirations of a patient with septic shock. The nurse suspects which causative factor for the change in the patient's respiratory effort? A.Loss of blood B.Increased pain C.IV fluid overload D.Attempt to correct metabolic acidosis

D.Attempt to correct metabolic acidosis

Which ethnic group has the highest incidence of stroke? A.Asians B.Mexicans C.Caucasians D.Blacks

D.Blacks

2 AM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/55575301 39/49 Which dietary intake guideline will the nurse recommend to a patient with pre-end-stage renal disease (ESRD)? A.Sodium intake of 2 to 4 g/day B.Protein intake of 1.2 g/kg/day C.Calorie intake of 25 kcal/kg/day D.Calcium intake of 1000 to 1500 mg/day

D.Calcium intake of 1000 to 1500 mg/day A patient with kidney disease must maintain good nutrition with supplements. A calcium intake of 1000 to 1500 mg/day is beneficial in the patient with pre-ESRD to prevent hypocalcemia. Sodium intake should be individualized, or 1 to 3 g/day is appropriate for patients with pre-ESRD. Protein intake should be restricted to 0.6 to 1 g/day for patients with preESRD. A calorie intake of 25 kcal/kg/day will not be sufficient for patients with pre-ESRD. A calorie intake of 30 to 35 kcal/kg/day is recommended for this patient.

The nurse would monitor for which complication in a patient with acute kidney injury (AKI)? A.Polyphagia B.Hypernatremia C.Hypotensive shock D.Cardiac dysrhythmias

D.Cardiac dysrhythmias

Which process causes hypercapnic respiratory failure in a patient who arrives in the emergency department after an overdose of opioids? A.Decreased ability to expand the lungs B.Trapping of carbon dioxide (CO2 ) in the airways C.Damage to the nerve supply to respiratory muscles D.Depressed central nervous system response to CO

D.Depressed central nervous system response to CO

When diagnostic testing indicates ventilation-perfusion (V/Q) mismatch in a patient with respiratory failure who is hypoxemic, which prescribed action will the nurse implement first? A.Infuse IV levofloxacin. B.Administer albuterol per nebulizer. C.Administer IV methylprednisolone. D.Give oxygen using a non-rebreather mask

D.Give oxygen using a non-rebreather mask

A patient diagnosed with septic shock receives aggressive fluid resuscitation. The nurse performs a passive leg raise challenge to assess which process? A.Organ perfusion B.Tissue perfusion C.Mean arterial pressure D.Patient responsiveness to fluids

D.Patient responsiveness to fluids

The nurse monitors for which complication in a patient following the surgical creation of a subcutaneous arteriovenous fistula (AVF) for the administration of hemodialysis? A.Bruit B.Bulging under the skin surface at the site C.Arterial blood flowing through the vein D.Steal syndrome

D.Steal syndrome

The nurse provides care for a patient with neurogenic shock whose spine has been stabilized. The nurse prioritizes treatment of the patient's hypotension and bradycardia for which primary purpose? A.To restore circulating volume B.To prevent oxygen loss to the brain C.To restore the oxygen delivery to the heart D.To prevent further spinal cord damage

D.To prevent further spinal cord damage

The nurse would assess for which condition in a patient with chronic kidney disease mineral and bone disorder (CKDMBD)? A.Asterixis B.Uremic frost C.Gastroparesis D.Uremic red eye

D.Uremic red eye

The nurse assesses a patient and suspects a diagnosis of neurogenic shock based on which finding? A.Dyspnea B. Bradycardia C,Weak pulses D.Hypotension E.Unstable temperature

b. d. e.

Which intervention would the nurse expect to incorporate into the plan of care for a patient receiving ventilation support for multiple organ dysfunction syndrome (MODS) to reduce the chance for respiratory complications? A.Turn the patient from side to side every 2 hours. B.Increase IV fluids to 3000 mL/24 hours. C.Use continuous lateral rotation therapy. D.Administer breathing treatments every 2 hours

c. Rationale Continuous lateral rotation therapy via a continuous-motion bed frame is used to increase mobilization and prevent nosocomial infections in the ventilated patient. Turning the patient every 2 hours can also be helpful, but this is not as effective as continuous lateral rotation therapy. Increasing fluids to 3000 mL/24 hours may lead to other complications and is not the best choice in this situation. While breathing treatments can also be helpful, continuous lateral rotation therapy is the most effective choice. p. 981 Turn the patient from side to side every 2 hours. Increase IV fluids to 3000 mL/24 hours. Use continuous lateral rotation therapy. Administer breathing treatments every 2 hour