Question

The nurse is caring for a mechanically ventilated patient with a pulmonary artery catheter who is receiving continuous enteral tube feedings. When obtaining continuous hermodynamic monitoring measurements, what is the best nursing action?

Answer 1

Correct Answers:

Level and zero reference the air-fluid interface of the transducer with the patient's head of bed elevated to 30 degrees and record hemodynamic values.

Rationale :

📐The transducer should be leveled at the phlebostatic axis to ensure accurate pressure measurements.

🛏️Hemodynamic measurements can be obtained with the head elevated up to 30° when positioning remains consistent.

🥣Maintaining head elevation during continuous enteral feeding decreases the risk of aspiration.

📝The nurse should document the patient’s position when recording the measurements.

📌Core Message

Level the transducer at the phlebostatic axis while maintaining the head of the bed at 30°.

Answer 2

Correct Answers:

Hypotension
Dysrhythmias
Clotting or bleeding

Rationale :

📉Rapid fluid removal can decrease circulating volume and cause hypotension.

💓Electrolyte shifts during dialysis can produce dangerous dysrhythmias.

🩸Anticoagulation used to maintain circuit patency increases the risk of bleeding.

🧬Blood contact with the extracorporeal circuit can also cause filter or access clotting.

📌Core Message

Dialysis complications include hypotension, dysrhythmias, bleeding, and circuit clotting.

Answer 3

Correct Answers:

Take the time to listen, assess the patient's and family's support systems, coping mechanisms, and potential for developing PTSD. Provide information on integrative support programs.

Rationale :

👂Active listening allows the spouse to express her fears and concerns.

🤝Assessing support systems identifies available emotional and practical resources.

🧠Burn injuries and disfigurement increase the risk of post-traumatic stress disorder.

🌱Integrative support programs can assist both partners with coping, adjustment, and rehabilitation.

📌Core Message

Provide therapeutic listening, assess coping resources, and connect the family with comprehensive support.

Answer 4

Correct Answers:

90

Rationale :

🧮Cerebral perfusion pressure is calculated using CPP = MAP − ICP.

➖The calculation is 108 − 18.

🎯The resulting CPP is 90 mm Hg.

🧠This value represents the pressure available to perfuse the brain tissue.

📌Core Message

Calculate CPP using MAP minus ICP: 108 − 18 = 90 mm Hg.

Answer 5

Correct Answers:

Coughing or attempting to talk

Rationale :

📢A high-pressure alarm indicates increased resistance to airflow.

😷Coughing raises intrathoracic and airway pressures against the ventilator breath.

🗣️Attempting to speak can create resistance and interfere with ventilator synchrony.

🔍The nurse should also assess for secretions, biting, bronchospasm, or a kinked tube.

📌Core Message

A high-pressure alarm commonly results from coughing, secretions, bronchospasm, or tubing obstruction.

Answer 6

Correct Answers:

Notify the physician immediately and anticipate taking the patient for a stat head CT scan.

Rationale :

🚨Sudden neurologic deterioration after alteplase suggests intracranial hemorrhage.

🧠Loss of movement, decreased responsiveness, and slurred speech require an immediate neurologic emergency response.

🩻A stat noncontrast head CT can identify acute intracranial bleeding.

⛔Further thrombolytic or anticoagulant therapy should be withheld until hemorrhage is excluded.

📌Core Message

After alteplase, sudden neurologic decline requires immediate notification and a stat head CT.

Answer 7

Correct Answers:

11.4

Rationale :

⚖️The prescribed dose is 4 mcg × 95 kg = 380 mcg/min.

⏰The hourly dose is 380 × 60 = 22,800 mcg/hr.

🧴The concentration is 500,000 mcg ÷ 250 mL = 2,000 mcg/mL.

✅The infusion rate is 22,800 ÷ 2,000 = 11.4 mL/hr.

📌Core Message

Dobutamine 4 mcg/kg/min for 95 kg at 500 mg/250 mL infuses at 11.4 mL/hr.

Answer 8

Correct Answers:

Dobutamine

Rationale :

💓Dobutamine primarily stimulates beta₁-adrenergic receptors.

💪Beta₁ stimulation increases myocardial contractility and stroke volume.

📈Improved contractility increases cardiac output in clients with cardiac dysfunction.

🩺Dobutamine is commonly used for short-term support in acute heart failure or cardiogenic shock.

📌Core Message

Dobutamine increases cardiac contractility and cardiac output through beta₁ stimulation.

Answer 9

Correct Answers:

Low systemic vascular resistance and high cardiac output

Rationale :

🔥Early septic shock produces widespread peripheral vasodilation.

📉Vasodilation causes a low systemic vascular resistance.

💗Compensatory tachycardia and increased contractility produce a high cardiac output.

🌡️These changes explain the client’s warm skin, flushing, and bounding pulses.

📌Core Message

Early septic shock is characterized by low SVR and high cardiac output.

Answer 10

Correct Answers:

Increase set tidal volume
Increase ventilator rate

Rationale :

🧪A pH of 7.31 indicates acidemia.

💨A PaCO₂ of 52 mm Hg identifies respiratory acidosis from inadequate ventilation.

📊Increasing tidal volume raises the amount of air delivered with each ventilator breath.

⏩Increasing the respiratory rate increases minute ventilation and promotes carbon dioxide elimination.

📌Core Message

Correct ventilatory respiratory acidosis by increasing tidal volume and ventilator rate.

1 :
The nurse is caring for a mechanically ventilated patient with a pulmonary artery catheter who is receiving continuous enteral tube feedings. When obtaining continuous hermodynamic monitoring measurements, what is the best nursing action?

2 :
What are some potential complications of CRRT as well as conventional dialysis? Select all that apply.

3 :
The wife of a burn victim in your unit approaches you very distraught. Her husband has survived and is stable; however, has suffered some disfigurement to his face and upper extremities. She doesn't know how he will handle this and how she can help him. What is the best thing you can do for her?

4 :
A patient with a head injury has an intracranial pressure (ICP) of 18 mmHg, blood pressure of 144/90 mmHg, and mean arterial pressure (MAP) of 108 mmHg. What is the cerebral perfusion pressure (CPP)?

5 :
The nurse is caring for a mechanically ventilated patient and responds to a high inspiratory pressure alarm. Recognizing possible causes for the alarm, the nurse assesses for which of the following?

7 :
Dobutamine (500mg/250mL) was ordered to start at 4mcg/kg/min on a 95 kg patient. What would be the infusion rate in ml/hr? Round to the nearest tenth.

8 :
The nurse understands that which of the following medications increases cardiac contractility?

9 :
The nurse is caring for a patient in the early stages of septic shock. The patient is slightly confused and flushed, with bounding peripheral pulses. Which hemodynamic values would the nurse anticipate?

10 :
The nurse obtains the following arterial blood gas (ABG) results for a client on a mechanical ventilator:
pH 7.31
PC02 52
HCO3 23
pa02 93
Which of the following ventilator changes would be appropriate for this client? Select all that apply.

1 : The nurse is caring for a mechanically ventilated patient with a pulmonary artery catheter who is receiving continuous enteral tube feedings. When obtaining continuous hermodynamic monitoring measurements, what is the best nursing action?

2 : What are some potential complications of CRRT as well as conventional dialysis? Select all that apply.

4 : A patient with a head injury has an intracranial pressure (ICP) of 18 mmHg, blood pressure of 144/90 mmHg, and mean arterial pressure (MAP) of 108 mmHg. What is the cerebral perfusion pressure (CPP)?

5 : The nurse is caring for a mechanically ventilated patient and responds to a high inspiratory pressure alarm. Recognizing possible causes for the alarm, the nurse assesses for which of the following?

7 : Dobutamine (500mg/250mL) was ordered to start at 4mcg/kg/min on a 95 kg patient. What would be the infusion rate in ml/hr? Round to the nearest tenth.

8 : The nurse understands that which of the following medications increases cardiac contractility?

9 : The nurse is caring for a patient in the early stages of septic shock. The patient is slightly confused and flushed, with bounding peripheral pulses. Which hemodynamic values would the nurse anticipate?

10 : The nurse obtains the following arterial blood gas (ABG) results for a client on a mechanical ventilator: pH 7.31 PC02 52 HCO3 23 pa02 93 Which of the following ventilator changes would be appropriate for this client? Select all that apply.

1 :
The nurse is caring for a mechanically ventilated patient with a pulmonary artery catheter who is receiving continuous enteral tube feedings. When obtaining continuous hermodynamic monitoring measurements, what is the best nursing action?

2 :
What are some potential complications of CRRT as well as conventional dialysis? Select all that apply.

4 :
A patient with a head injury has an intracranial pressure (ICP) of 18 mmHg, blood pressure of 144/90 mmHg, and mean arterial pressure (MAP) of 108 mmHg. What is the cerebral perfusion pressure (CPP)?

5 :
The nurse is caring for a mechanically ventilated patient and responds to a high inspiratory pressure alarm. Recognizing possible causes for the alarm, the nurse assesses for which of the following?

7 :
Dobutamine (500mg/250mL) was ordered to start at 4mcg/kg/min on a 95 kg patient. What would be the infusion rate in ml/hr? Round to the nearest tenth.

8 :
The nurse understands that which of the following medications increases cardiac contractility?

9 :
The nurse is caring for a patient in the early stages of septic shock. The patient is slightly confused and flushed, with bounding peripheral pulses. Which hemodynamic values would the nurse anticipate?

10 :
The nurse obtains the following arterial blood gas (ABG) results for a client on a mechanical ventilator:
pH 7.31
PC02 52
HCO3 23
pa02 93
Which of the following ventilator changes would be appropriate for this client? Select all that apply.