EXAM 1 medsurg IV
In terms of respiratory failure patients, there are two(2) types of respiratory failure patient noted to have; hypoxemia or hypercapnia. Select all the mechanism of pathophysiologic pathway for a patient having a hypoxemic respiratory failure. Select all that apply. V/Q mismatch Neuromuscular disorder CNS suppression Shunt Hypoventilation Abnormal airway Chest wall limitations Diffusion defect
V/Q mismatch Shunt Hypoventilation Diffusion defect
In preparation for discharge, the nurse teaches a patient with chronic stable angina how to use the prescribed short-acting and long-acting nitrates. Which patient statement indicates that the teaching has been effective? "I will put the nitroglycerin patch on as soon as I get home from work." "I will check my temperature before I take any nitroglycerin tablets." "I will stop what I am doing and sit down before I put the nitroglycerin under my tongue." "I will be sure to remove the first nitroglycerin pill before taking a second one"
"I will stop what I am doing and sit down before I put the nitroglycerin under my tongue."
Which statement made by a client with chronic biventricular failure indicates a need for further education on disease management? "If I gain more than 3 pounds in 2 days, I will go on a diet." "I will look at the labels for sodium content before buying processed foods." "If I start to have episodes where I get short of breath at night, I will call my healthcare provider." "I will plan my day so that I don't have to go up and down the stairs a lot."
"If I gain more than 3 pounds in 2 days, I will go on a diet."
A 52 year old male diagnosed with cirrhosis recently admitted due to hepatorenal syndrome associated with shortness of breath. Provider orders for ABG to be obtained and results show these values: pH: 7.44, pCO2: 56, HCO3: 42, pO2: 65, SaO2 58% . What is the nurse next course of action? -Monitor the patient and follow their electrolyte levels and continue maintenance fluid -Bolus the patient with 1000mL of lactated ringer now -Encourage provider to call pulmonology as this patient will need to get intubated -Encourage patient to increase respiration rate while slowly increasing the O2 needs
-Monitor the patient and follow their electrolyte levels and continue maintenance fluid
The patient is receiving amiodarone (Cordarone) via continuous intravenous infusion at 20 mL/hour to convert from atrial fibrillation to sinus rhythm. The drug is supplied as 450 mg in 250 mL D5W. The patient weighs 175 pounds. What dose of amiodarone is the patient receiving in mg/minute? Insert the correct numeric response only in the answer box. Do not include units of measurement. Round your final answer to the first decimal place
0.6
The patient is ordered on a Heparin intravenous infusion per the hospital's weight-based protocol. The patient is currently receiving 1500 units/hour. The PTT is 40 seconds. Per the protocol, the infusion needs to be increased by 2 units/kg/hr. The patient weight is 110 lbs. The drug is supplied in a concentration of 25,000 units in 500 mL D5W. How many units per hour will the patient be receiving when you increase the rate? Insert the correct numeric response only in the answer box. Do not include units of measurement. Round answer to the nearest WHOLE number.
1600
The nurse is caring for a group of clients who have sustained myocardial infarction (MI). The nurse observes the client with which type of MI most carefully for the development of left ventricular heart failure? Anterior wall Inferior wall Posterior wall Lateral wall
Anterior wall.
Which of the following medications should the nurse anticipate administering to a patient in atrial flutter? A. Amiodarone B. Metoprolol C. Lidocaine D. Adenosine
A. Amiodarone The rhythm displayed is ATRIAL FLUTTER and the dysrhythmia usually causes a decreased cardiac output. Amiodarone can be used to convert the rhythm because of its ability to slow AV conduction and decrease heart rate via calcium-channel and beta-blockade. Adenosine is indicated in the treatment of supraventricular tachycardia only. Metoprolol can be used to slow the heart rate in the event of a rapid rate however, it does not commonly convert the rhythm. Lidocaine is a class B antiarrhythmic drug that shortens the duration of the action potential. It is not indicated in the initial treatment of this rhythm.
Which of the following statements is true about the electrocardiographic (ECG) waveform in sinus rhythm? (Select all that apply). A. The ventricular heart rate is equal to atrial heart rate. B. The QRS complex duration is less than 0.12 seconds. C. Every QRS complex precedes a P wave. D. Every QRS complex is preceded by a P wave.
A. The ventricular heart rate is equal to atrial heart rate. B. The QRS complex duration is less than 0.12 seconds. D. Every QRS complex is preceded by a P wave.
The nurse is teaching a group of cardiac care nurses about the various cardiac rhythms and associated drug management. Which of the following drugs, named by the group, best reflects accurate understanding of the management of SVT? Epinephrine (Adrenalin). Atropine sulfate. Amiodarone (Cordarone). Adenosine (Adenocard).
Adenosine (Adenocard).
A patient with acute lung failure has been mechanically ventilated for 3 days and has been started on a spontaneous breathing trial. Which parameter would indicate that the patient is not tolerating weaning? Spontaneous tidal volumes of 300 to 350 mL. An SpO2 of 92%. A decrease in heart rate from 92 to 80 beats/min. An increase in respiratory rate from 22 to 38 breaths/min.
An increase in respiratory rate from 22 to 38 breaths/min.
A 17 year old male admitted to the trauma bay status post impact from a football game. Patient noted to have lost consciousness for 2 minute according to bystanders. When patient became lucid enough to communicate his complaints, he was noted to have mild shortness of breath associated with cough. Upon arrival to the ER, patient's vitals are: BP 102/62, HR 92, RR 18, SaO2 87% on room air. Labs were obtained and a chest x-ray was obtained (see picture below). Trauma surgeon had already assessed the patient and waiting on lab results and CXR results. Radiology technician shows you the x-ray film as shown below. What is your priority action? Prepare patient to be placed on a mechanical ventilation Have patient utilize incentive spirometry while waiting Anticipate for a thoracostomy Obtain pulmonary function test
Anticipate for a thoracostomy
The client denies any chest pain, dizziness, or dyspnea but does admit to feeling palpitations. The rhythm was discovered during a routine physical exam resulting in hospital admission. The patient states the palpitations began three days ago. What course of treatment should the nurse anticipate for this dysrhythmia INITIALLY? (Select all that apply). Radiofrequency catheter ablation. Synchronized cardioversion. Anticoagulation. Heart rate control. Defibrillation.
Anticoagulation. Heart rate control.
A patient develops the rhythm below following an inferior wall myocardial infarction, has a BP of 70/36 mm Hg, and is complaining of feeling faint. Treatment with atropine has been ineffective. (rhythm is bradycardia) Which action should the nurse take? Apply the transcutaneous external pacemaker (TCP). Have the patient perform the Valsalva maneuver. Continue to monitor the rhythm and blood pressure. Give the scheduled dose of metoprolol (Lopressor).
Apply the transcutaneous external pacemaker (TCP).
To evaluate the effectiveness of prescribed therapies for a patient with hypercapnic respiratory failure, which of the following diagnostic tests will be most useful to the nurse?
Arterial blood gas (ABG) analysis.
A client in respiratory failure is intubated and mechanically ventilated. The ventilator is set to deliver a volume target of 475 mL per breath at a respiratory rate of 20 breaths per minute. When the client attempts to initiate breaths above the preset rate, the 475 mL target is delivered. Which mode of ventilation is the client receiving? Synchronized intermittent mandatory ventilation (SIMV). Continuous positive airway pressure (CPAP). Assist/control ventilation (A/C). Pressure support ventilation (PSV).
Assist/control ventilation (A/C).
A client discharged from the hospital 2 weeks ago after a 5-day stay for severe dyspnea and acute decompensated heart failure now has 2+ pitting edema in the lower extremities and a nonproductive cough. The vital signs are: Temperature 98.9 degrees F; HR 112 bpm; RR 28 bpm; BP 170/110 mmHg; and SpO2 88% on room air. The client is exhibiting shortness of breath with exertion. The client required 3 pillows to sleep last night because lying flat resulted in severe dyspnea. Standing or sitting up relieved the shortness of breath. What is the most important assessment for the nurse to perform at this time? Determine the capillary refill. Auscultate lung sounds. Insert a foley catheter. Assess level of consciousness.
Auscultate lung sounds. The client is exhibiting signs of biventricular failure as evidenced by both left (cough, dyspnea, orthopnea, 88% pulse ox) and right-sided (2+ pitting edema in the lower extremities) failure. The highest priority is to assess airway and breathing first as impairment of these could cause life-threatening complications if not corrected immediately Assessment of level of consciousness and orientation as well as capillary refill is important to determine adequacy of tissue and end-organ perfusion once the extent of heart failure is fully assessed. Insertion of a foley catheter is not an assessment, it is an intervention and is not a priority at this time.
An elderly client with a 40 pack-year history of smoking and a recent myocardial infarction is admitted with acute shortness of breath. The nurse needs to determine whether the presenting symptoms are indicative of pneumonia versus heart failure. What is the diagnostic test that the nurse will monitor to determine whether the client has heart failure? B-type natriuretic peptide. Serial troponin levels. Twelve-lead electrocardiogram. Creatinine phosphokinase-MB levels.
B-type natriuretic peptide.
The nurse is caring for a 60 y/o male admitted to the ED with chest pain. For the same case study in the previous question. The client receives a diagnosis of ST elevation myocardial infarction. For each potential medication order, specify whether the medication is indicated in the plan of care. Beta Blockers Antibiotics Analgesics Liquid bowel regimen protocol 2L fluid bolus Antipyretics Anticoagulants
Beta Blockers Analgesics Antipyretics Anticoagulants
Which assessment data would indicate to the nurse that the client is at risk for a hemorrhagic stroke? Presence of bronchogenic carcinoma. Blood pressure 220/120 mmHg. Right-sided carotid bruit. Blood glucose level 480 mg/dL.
Blood pressure 220/120 mmHg.
A post open heart patient is brought to the recovery room and still intubated after undergoing a mitral valve replacement. Recent ABG values noted these results: pH: 7.32, pCO2: 54, HCO3: 23, pO2: 78, SaO2 78% What is the nurse's next course of action? Continue to monitor the patient until they are extubated Call anesthesia or Respiratory therapist to increase the FiO2 and respiration rate Give the patient a 500mL bolus of normal saline Administer Narcan 0.4mg IV now
Call anesthesia or Respiratory therapist to increase the FiO2 and respiration rate
How would the nurse differentiate a non-ST segment elevation myocardial infarction (NSTEMI) from unstable angina (UA)? Cardiac biomarkers. The cardiac medical history. Electrocardiographic (ECG) changes. Location of chest pain.
Cardiac biomarkers
A patient's sputum has turned green with shortness of breath increasing. Breath sounds are diminished throughout all lobes with rhonchi auscultated in the upper airways. Based on the physical assessment just described and the ABG results below, the nurse determines that the green sputum with rhonchi support a probable infection. The ABGs represent which interpretation? pH 7.37, paCO2 61 mmHG, HCO3 36 mEq/L, paO2 54 mmHg. Compensated respiratory acidosis with hypoxemia. Uncompensated metabolic alkalosis with hypoxemia. Compensated metabolic acidosis with hypoxemia. Uncompensated respiratory acidosis with hypoxemia.
Compensated respiratory acidosis with hypoxemia.
A client presenting with third-degree atrioventricular (AV) heart block with a ventricular escape rate of 40 bpm is admitted to the critical care unit. Which physical assessment finding would be of GREATEST concern in this client? Presence of an S4 gallup. Diminished breath sounds with scattered crackles. Hypertensive blood pressure. Confusion and lightheadedness
Confusion and lightheadedness
The nurse is caring for a 60 y/o male admitted to the ED with chest pain. The nurse reviews the diagnostic and laboratory findings. Which finding are most significant? SELECT all that apply. White Blood Cell Count Platelets Creatinine Kinase Cholesterol Troponin T Potassium ECG
Creatinine Kinase Cholesterol Troponin T
When caring for a client who is intubated and on mechanical ventilation the nurse knows which of the following to be TRUE regarding cuff pressures for the endotracheal tube. A leak in the cuff can be repaired by injection of a sealant. Pressures above 30 mmHg in the cuff prevent aspiration. Cuff pressures should not exceed 25 mmHg. Cuff pressures are self-regulating via a pressure release valve.
Cuff pressures should not exceed 25 mmHg.
According to the American Heart Association in terms of standardization of care for patient newly diagnosed with heart failure; to alleviate their symptoms and decrease mortality, which oral medication(s) is/are heart failure patients prescribed on? Select all that apply ZOCOR (simvastatin) DIOVAN (valsartan) PACERON (amiodarone) 200 mg INSPRA (eplerenone) BAYER (aspirin) 81 mg DEMADEX (toresemide) COREG (carvedilol)
DIOVAN (valsartan) INSPRA (eplerenone) DEMADEX (toresemide) COREG (carvedilol)
A client with an acute, anterior myocardial infarction (MI) has a heart rate of 125 bpm. What is the goal of the medical regimen for this client? Prevent atrial fibrillation and increase oxygen needs of vital organs. Increase venous return to right atrium and increase pulmonary arterial blood flow. Decrease cardiac workload and promote coronary artery perfusion. Increase left ventricular filling pressure and decrease cardiac output.
Decrease cardiac workload and promote coronary artery perfusion.
A patient's ventilator settings are adjusted to treat hypoxemia. The fraction of inspired oxygen is increased from 0.6 to 0.7, and the positive end-expiratory pressure is increased from 10 to 15 cm H2O. 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 most likely cause of this decrease in blood pressure? Decrease in cardiac output Increase in venous return Hypovolemia Oxygen toxicity
Decrease in cardiac output.
While caring for a client receiving mechanical ventilation, the nurse notices that the client suddenly becomes hypoxemic, and the ventilator begins to alarm. The nurse is unable to identify immediately why the ventilator is alarming. Which of the following interventions is the priority action for the nurse to take to prevent further complications? Silence alarm on the ventilator and continue troubleshooting. Call for the respiratory therapist to evaluate the problem. Detach client from the ventilator and deliver manual ventilations. Administer 100 percent oxygen via the ventilator to reverse hypoxemia.
Detach the client from ventilator and deliver manual ventilations.
A client admitted with heart failure has a history of anterior myocardial infarction four months ago and is demonstrating bibasilar lung crackles, a third heart sound (S3), and dyspnea with exertion. The echocardiogram results report the ejection fraction (EF) to be 62%. The nurse expects the client to have which type of heart failure? Systolic dysfunction. Diastolic dysfunction. Cardiac tamponade. Right-sided failure.
Diastolic dysfunction.
Match the 12-Lead ECG leads on the left to the corresponding myocardial infarction the patient would be experiencing if those leads are demonstrating ST segment elevation.
Figure A - Inferior MI Figure B - Lateral MI Figure C - Septal MI Figure D - Anterior MI
Choose the evidence-based, best practices used to prevent Ventilator-Associated Pneumonia (VAP)? (Select all that apply). HOB elevated 30-45 degrees unless contraindicated by the patient's condition. Allow family members to suction patient as needed to remove secretions. Change the ventilator circuit every shift. Oral care with chlorhexidine every shift. Assess readiness to extubate daily.
HOB elevated 30-45 degrees unless contraindicated by the patient's condition. Oral care with chlorhexidine every shift. Assess readiness to extubate daily.
You are caring for a patient who is admitted with a barbiturate overdose. The patient is unresponsive with a blood pressure of 90/60 mmHG, apical pulse of 110 beats/min, and respiratory rate of 6 breaths/min. Based on the initial assessment findings, you can recognize that the patient is at risk for which type of respiratory failure?
Hypercapnic respiratory failure related to alveolar hypoventilation.
In a client with dysphagia, which of the following symptoms is least likely to be exhibited? Pocketing of food. Coughing when drinking thin liquids. Excessive drooling. Increased appetite.
Increased appetite.
A nurse admits a patient from the emergency department with a diagnosis of acute coronary syndrome (ACS) due to unstable angina and possible non-ST segment elevation myocardial infarction (NSTEMI). The healthcare provider prescribes oxygen and nitroglycerin. By which mechanisms are these therapies thought to reduce or relieve chest pain? Increasing oxygen delivery and decreasing oxygen demand. Preventing dysrhythmias and decreasing cardiac contractility. Minimizing plaque formation and preventing vasospasm. Increasing preload and decreasing afterload.
Increasing oxygen delivery and decreasing oxygen demand.
A client arrives via private car to the emergency department complaining of chest pain. The initial monitored rhythm was sinus tachycardia with frequent premature ventricular complexes (PVCs). The client suddenly moans and loses consciousness. The monitor shows the following rhythm: The client is pulseless and is not breathing. Which of the following interventions is the nurse's most appropriate initial action? Initiate chest compressions at a rate of 100-120 bpm. Defibrillate with 100 joules via biphasic defibrillator. Apply oxygen at 100% via face mask. Administer 300 mg amiodarone (Cordarone) intravenously.
Initiate chest compressions at a rate of 100-120 bpm. The rhythm displayed is asystole. High quality CPR should be started immediately. This rhythm is not shockable and amiodarone is not indicated for this rhythm.
The nurse is caring for a client with respiratory acidosis secondary to end-stage acute respiratory distress syndrome (ARDS). Which result should the nurse anticipate on the arterial blood gas? High PaO2 and high PaCO2 High PaO2 and low PaCO2 Low PaO2 and low PaCO2 Low PaO2 and high PaCO2
Low PaO2 and high PaCO2
The client with respiratory failure has been intubated and placed on a ventilator and is requiring 100% oxygen delivery to maintain adequate oxygenation. Twenty-four hours later, the nurse notes newonset crackles and decreased breath sounds, and the most recent ABGs show a PaO2 level of 95 mm Hg. The ventilator is not set to provide positive end-expiratory pressure (PEEP). Why is the nurse concerned? The low PaO2 level may result in oxygen toxicity The level of oxygen delivery may indicate absorption atelectasis The 100% oxygen delivery requirement indicates immediate extubation Lung sounds may indicate absorption atelectasis
Lung sounds may indicate absorption atelectasis
A client has the following arterial blood gas (ABG) results: pH 7.31, PaCO2 35 mmHg, PaO2 94 mmHg, HCO3 18 mEq/L. Which of the following acid-base disturbances does the nurse recognize in these results? Metabolic acidosis. Respiratory acidosis. Respiratory alkalosis. Metabolic alkalosis.
Metabolic acidosis
A nurse assesses a patient with tachycardia. Which clinical manifestation requires immediate intervention by the nurse? Mild orthostatic hypotension. Increased urine output. P wave being close to the T wave on the ECG tracing. Midsternal chest pain.
Midsternal chest pain
The nurse would assess a patient with complaints of chest pain for which of the following clinical manifestations associated with a myocardial infarction (MI)? (Select all that apply). Nausea and vomiting. Diaphoresis. Ashen skin. A burst of energy. S3 or S4 heart sounds.
Nausea and vomiting. Diaphoresis. Ashen skin. S3 or S4 heart sounds.
Which of the following adverse hemodynamic effects has been associated with the use of positive pressure mechanical ventilation and high levels (greater than 8 cmH2O) of positive end-expiratory pressure (PEEP)? (Select all that apply). Reduced cardiac output. Decreased stroke volume. Increased systemic blood pressure. Decreased intrathoracic and pleural pressure. Decreased venous return.
Reduced cardiac output. Decreased stroke volume. Decreased venous return.
When caring for a client with acute myocardial infarction, the nurse recognizes that prompt pain management is essential for which reason? Pain medication should not be used until a definitive diagnosis has been established. Pain relief improves the oxygen supply and decreases oxygen demand. The discomfort will increase client anxiety and reduce coping. Relief of pain indicates that the myocardial infarction is resolving.
Pain relief improves the oxygen supply and decreases oxygen demand.
A client presents to the emergency department via ambulance complaining of 8 out of 10 substernal chest pain that radiates to the jaw and left shoulder. The pain started one hour ago. A twelve-lead electrocardiogram (ECG) demonstrates the following pattern: Which coronary artery is most likely occluded and causing the ECG changes? Right coronary artery. Left circumflex coronary artery. Left anterior descending coronary artery. Left main coronary artery.
Right coronary artery.
The nurse is planning care for a client who had a right hemispheric stroke. Which nursing diagnosis will the nurse include in the plan of care? Impaired physical mobility related to right-sided hemiplegia. Ineffective coping related to depression and distress about disability. Impaired verbal communication related to speech language deficits. Risk for injury related to denial of deficits and impulsiveness.
Risk for injury related to denial of deficits and impulsiveness.
Which electrocardiographic (ECG) change is MOST important for the nurse to communicate to the health care provider when caring for a patient with chest pain? ST segment elevation. Premature ventricular contractions (PVCs). ST segment depression. Inverted P waves.
ST segment elevation
Which laboratory result for a patient whose cardiac monitor displays the rhythm below is most important for the nurse to communicate to the health care provider? Serum glucose 228 mg/dL. Serum potassium 2.6 mEq/L. Serum sodium 130 mEq/L. Serum magnesium 2.0 mq/dL.
Serum potassium 2.6 mEq/L.
A client is demonstrating dysarthria following a stroke. The nurse understands that the client will have difficulty with which of the following activities? Verbal expression of a thought. Comprehending spoken words. Slow, mumbling speech quality. Carrying out purposeful motor activity
Slow, mumbling speech quality.
A client is admitted with a regular, wide-QRS tachycardia evident on the telemetry monitor as shown below: The blood pressure is 112/60 mmHg and the radial pulse is weak and thready. The client complains of palpitations. Mild shortness of breath without accessory muscle use is evident. What rhythm could this electrocardiogram represent? Unstable ventricular tachycardia. Atrial fibrillation with rapid ventricular response (RVR). Stable ventricular tachycardia. Pulseless electrical activity (PEA).
Stable ventricular tachycardia
You are evaluating a 48-year-old man with crushing substernal chest pain. The patient is pale, diaphoretic, cool to the touch, and slow to respond to your questions. The blood pressure is 58/32 mm Hg, the heart rate is 190/min, the respiratory rate is 18 breaths/min, and the pulse oximeter is unable to obtain a reading because there is no radial pulse. The 12 lead ECG displays the rhythm below. What intervention should you perform next? Start CPR Synchronized cardioversion Administer Atropine 0.5mg IV Deliver shock at 300 joules
Start CPR Patients with symptomatic wide complex tachycardia (SVT rate of 230bpm) will need to have synchronized cardioversion right away to prevent them have having a more lethal heart rhythm.
A nurse is assessing a client and notices pitting edema in the lower legs. The client has a history of mild congestive heart failure (CHF), which is controlled with medication, and reports that the swelling has become worse lately. Which could the increased edema indicate? The client has increased physical activity. The client has not been compliant with medications. The client has a possible progression of CHF. The client has been under stress.
The client has a possible progression of CHF.
Which statement best describes the electrical activity of the hear represented by measuring PR interval on the ECG?
The length of time for the electrical impulse to travel from the SA node to the purkinje fibers.
When admitting a somnolent patient in possible respiratory failure with a high PaCO2, which assessment information will be of MOST concern to the nurse? The patient's blood pressure is 162/94 mmHg. The patient complains of weakness. The patient's SpO2 is 90%. The patient is difficult to arouse.
The patient is difficult to arouse.
A client admitted at 1830 is presenting with a facial droop and aphasia. The nurse is reviewing the following assessment data to determine if there are any contraindications to the administration of tissue plasminogen activator (Alteplase rtPA). Which data would the nurse report to the healthcare provider as a contraindication to receiving tPA? The spouse reports the client was fine at 12 noon. CT scan shows old lacunar stroke with no active hemorrhage. The patient had a hip replacement 3 months ago. Blood pressure of 170/86 mmHg and pulse of 110 bpm.
The spouse reports the client was fine at noon.
A 70 kg patient with acute respiratory distress syndrome (ARDS) is intubated and mechanically ventilated on the following settings: Assist/control (A/C) mode, rate 12 breaths/min, tidal volume (TV) 700 mL, FiO2 1.00, and PEEP 15 cmH2O. The peak inspiratory pressure is 50 cmH2O with a plateau pressure of 40 cmH2O. The paO2 is 60 mmHg. The patient is receiving a continuous vecuronium (Norcuron) intravenous infusion. What will the nurse conclude on the basis of the information provided? The mode should be changed to allow for spontaneous breathing. The plateau pressure is appropriate given the PEEP setting. The PEEP should be decreased to improve oxygenation. The tidal volume needs to be decreased to avoid volutrauma.
The tidal volume needs to be decreased to avoid volutrauma. Because the patient has ARDS, low tidal volumes (6-8 mL/kg which would be 420 - 560 mL) are indicated to prevent volutrauma and allow for permissive hypercapnea. A tidal volume of 700 mL is therefore too high. Since the patient is receiving a paralytic, changing the ventilator mode to one that allows for spontaneous breathing is inappropriate at this time. The patient with ARDS requires high PEEP levels to prevent atelectasis and hypoxemia. Incremental adjustments of PEEP & FiO2 to keep the PaO2 55-80 mmHg is required. Decreasing PEEP would likely worsen oxygenation. In ARDS the plateau pressure should be kept at or below 30 cmH2O. Decreasing the TV and increasing the rate may help to decrease the plateau pressure.
According to the American Heart Association, which interventions are appropriate to use if patients are exhibiting signs of instability with a bradycardic heart rate? (Select all that apply). LEVOPHED (norepinephrine) 1-30 mcg/min infusion. Synchronized cardioversion. Transcutaneous external pacing. ATROPEN (atropine) 0.5 mg dose IV push. DOPAMINE (dopamine) 2-20 mcg/kg infusion.
Transcutaneous external pacing. ATROPEN (atropine) 0.5 mg dose IV push. DOPAMINE (dopamine) 2-20 mcg/kg infusion.
A client is learning about a low-sodium diet due to heart failure. Which food does the client select for lunch to demonstrate understanding of a low-sodium diet? Shrimp Ham Turkey Breast Hot Dog
Turkey breast
The patient with unilateral neglect is receiving care in a rehabilitation unit. Which patient behavior demonstrates the most optimal achievement of compensation to this deficit? Actively protects the affected side from injury. Visually scans and integrates affected side in activities. Arranges environment to compensate for the affected side. Focuses on grooming and dressing the unaffected side
Visually scans and integrates affected side in activities.
The nurse is teaching a client with newly diagnosed heart failure about starting on a 2 GM sodium diet to help control fluid retention and blood pressure. Which foods are to be restricted in such a diet? Dehydrated vegetables and fruits. Yogurt and cheese Fresh or frozen vegetables. Eggs and other high-protein foods.
Yogurt and Cheese.
Following a procedure that involved fentanyl (Sublimaze) and midazolam (Versed) for sedation, the elderly client with chronic obstructive pulmonary disease (COPD) has the following vital signs: BP 102/56 mmHg, pulse 98 beats/min, and respirations 8 breaths/min. Which arterial blood gas (ABG) result would represent this client after 15 minutes of this status? pH 7.25 PCO2 44 mmHg PaO2 81 mmHg HCO3 16 mEq/L pH 7.49 PCO2 30 mmHg PaO2 75 mmHg HCO3 26 Meq/L pH 7.40 PCO2 37 mmHg PaO2 84 mmHg HCO3 25 mEq/L pH 7.22 PCO2 69 mmHg PaO2 50 mmHg HCO3 23 mEq/L
pH 7.22 PCO2 69 mmHg PaO2 50 mmHg HCO3 23 mEq/L
