Tüm alıştırma soruları

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A nurse is assessing a client admitted with an acute exacerbation of peptic ulcer disease. The client's baseline blood pressure was $134/78$ mm Hg, and the resting heart rate was $82$ beats per minute. Which new assessment finding is the most critical early indicator that the client is developing a life-threatening physiological complication?

A blood pressure of

118/92

mm Hg with a resting heart rate of

112

beats per minute.

An arterial blood gas (ABG) result showing a pH of

7.44

, PaCO

_2

38

mm Hg, and HCO

_3^-

24

mEq/L.

A single episode of dark, coffee-ground emesis measuring approximately

60

mL.

A report of sharp, localized epigastric pain that worsens when the client is placed in a flat, supine position.

Cevabı ve açıklamayı göster

Cevap: A blood pressure of $118/92$ mm Hg with a resting heart rate of $112$ beats per minute.

Cevap

The finding of a blood pressure of

118/92

mm Hg with a resting heart rate of

112

beats per minute.

In the early (compensatory) stage of hypovolemic shock, which is a major risk for clients with peptic ulcer disease, the sympathetic nervous system is stimulated. This causes peripheral vasoconstriction, which elevates the diastolic blood pressure, leading to a narrowed pulse pressure (the difference between systolic and diastolic pressure). This subtle narrowing, combined with tachycardia, is often the very first detectable sign of hemodynamic compromise, occurring well before a significant drop in systolic blood pressure.

Adım Adım Çözüm

Analyze the client's baseline vital signs.

Baseline pulse pressure was

134 - 78 = 56

mm Hg. Baseline heart rate was

82

bpm.

Establishing a baseline is necessary to identify subsequent physiological deterioration.

Evaluate the new vital signs for signs of hemodynamic compromise.

New pulse pressure is

118 - 92 = 26

mm Hg. The heart rate increased to

112

bpm.

A narrowing pulse pressure combined with tachycardia is a classic hallmark of the compensatory stage of hypovolemic shock.

Compare the severity of the vital sign changes against the other clinical findings.

The ABG is normal, the coffee-ground emesis is expected and small in volume, and the pain worsened by positioning is a typical localized symptom.

The systemic cardiovascular changes represent an immediate, life-threatening risk that takes absolute priority over localized or expected symptoms.

Anahtar Kavram

Early Recognition of Hypovolemic Shock

Tahmini Süre:1m 15s

Soru 782Soru →

While assessing a client experiencing an acute asthma exacerbation, the nurse notes severe work of breathing with a respiratory rate of $36\text{ breaths/minute}$ . Initial arterial blood gas (ABG) results show a pH of $7.52$ , $PaCO_2$ of $28\text{ mmHg}$ , and $PaO_2$ of $72\text{ mmHg}$ . After one hour of continuous bronchodilator therapy, the client appears quieter, the respiratory rate decreases to $14\text{ breaths/minute}$ , and wheezing is no longer audible. A repeat ABG reveals a pH of $7.36$ , $PaCO_2$ of $44\text{ mmHg}$ , and $PaO_2$ of $62\text{ mmHg}$ . Which of the following is the priority nursing action?

Prepare for immediate endotracheal intubation and mechanical ventilation.

Document the clinical changes as a positive response to the continuous bronchodilator therapy.

Administer the scheduled dose of intravenous methylprednisolone.

Decrease the supplemental oxygen delivery to prevent oxygen toxicity.

Cevabı ve açıklamayı göster

Cevap: Prepare for immediate endotracheal intubation and mechanical ventilation.

Cevap

The priority action is to prepare for immediate endotracheal intubation and mechanical ventilation.

The correct action directly addresses a life-threatening airway emergency. A client experiencing an asthma attack should initially present with hyperventilation (respiratory alkalosis). When the respiratory rate slows, wheezing disappears (silent chest), and the PaCO2 normalizes or elevates, it signifies severe respiratory muscle fatigue. The client is losing the ability to move air and is progressing toward respiratory arrest, requiring immediate intubation.

Adım Adım Çözüm

Analyze the initial assessment data.

The initial ABG showed respiratory alkalosis (pH

7.52

, PaCO2

28\text{ mmHg}

), which is an expected compensatory response as the client hyperventilates to overcome airway resistance.

Understanding the baseline helps identify deterioration.

Evaluate the reassessment findings and repeat ABG.

The client has become quieter, respiratory rate has dropped to

14\text{ breaths/minute}

, and wheezing has stopped. The repeat ABG shows a 'normal' pH (

7.36

) and PaCO2 (

44\text{ mmHg}

), with worsening hypoxemia (PaO2

62\text{ mmHg}

These findings must be correlated clinically to determine the client's actual physiological state.

Synthesize the data to determine the clinical trajectory.

The lack of wheezing combined with rising PaCO2 in an acute asthma attack signifies a 'silent chest'—a life-threatening condition where airflow is so restricted that breath sounds cannot be generated, and the respiratory muscles are too fatigued to maintain ventilation.

Recognizing impending respiratory failure dictates immediate life-saving interventions.

Select the priority intervention.

Prepare for immediate endotracheal intubation and mechanical ventilation.

Airway and breathing are the highest priorities; mechanical assistance is required when the client can no longer maintain independent ventilation.

Anahtar Kavram

Impending Respiratory Failure in Asthma (Silent Chest)

Soru 783Soru →

While pushing an intravenous (IV) medication, the nurse observes that the client suddenly develops intense facial flushing and reports a severe, pounding headache along with chest tightness. A rapid assessment reveals a blood pressure of 82/48 mmHg, a heart rate of 118 beats/min with an irregular rhythm, and a respiratory rate of 24 breaths/min. Which of the following is the priority nursing action?

Check the medication record for potential IV fluid incompatibilities.

Administer an ordered PRN dose of intravenous epinephrine.

Stop the medication injection immediately.

Place the client in a left lateral Trendelenburg position.

Cevabı ve açıklamayı göster

Cevap: Stop the medication injection immediately.

Cevap

The correct priority action is to stop the medication injection immediately.

The client's sudden onset of facial flushing, severe headache, chest tightness, hypotension, and irregular pulse during an IV push administration are the hallmark signs of speed shock. Speed shock is a systemic reaction that occurs when a medication is introduced too rapidly into the circulation, causing the drug concentration to reach toxic levels instantly. The absolute first priority is to stop the injection to prevent any further medication from entering the client's bloodstream.

Adım Adım Çözüm

Analyze the client's sudden onset of symptoms during the IV push.

The combination of severe facial flushing, pounding headache, chest tightness, hypotension, and irregular pulse directly correlates with the rapid introduction of the medication.

Recognizing the specific clinical presentation differentiates speed shock from other infusion reactions like anaphylaxis or air embolism.

Determine the highest priority intervention based on the complication.

The nurse must immediately halt the delivery of the offending agent.

Speed shock occurs when a drug reaches toxic proportions in the blood instantly due to rapid administration. Stopping the injection prevents further toxicity before initiating supportive care.

Anahtar Kavram

Parenteral Therapy Safety: Speed Shock Recognition and Management

Soru 784Soru →

A nurse is planning care for a client who has just returned to the clinical unit following a bedside right-sided thoracentesis for a pleural effusion. Which interventions should the nurse implement to monitor for and reduce the risk of potential complications? Select all that apply.

Geçerli olan tümünü seçin

Auscultate breath sounds and monitor oxygen saturation levels closely.

Position the client flat in a supine position for at least two hours.

Observe the client for a sudden onset of resting tachycardia and narrowing pulse pressure.

Delegate the initial post-procedure vital sign assessments to the unlicensed assistive personnel (UAP).

Inspect the puncture site dressing for visible fluid leakage or active hemorrhage.

Cevabı ve açıklamayı göster

Cevap: Auscultate breath sounds and monitor oxygen saturation levels closely.; Observe the client for a sudden onset of resting tachycardia and narrowing pulse pressure.; Inspect the puncture site dressing for visible fluid leakage or active hemorrhage.

Cevap

The correct interventions are to auscultate breath sounds and monitor oxygen saturation, observe for tachycardia and narrowing pulse pressure, and inspect the puncture site dressing for bleeding.

Following an invasive procedure like a thoracentesis, the client is at an elevated risk for complications including pneumothorax, hypovolemic shock, and bleeding. Auscultating breath sounds and closely monitoring oxygenation helps detect a pneumothorax, which often presents with diminished breath sounds on the affected side. Observing for resting tachycardia and a narrowing pulse pressure allows for the early identification of shock resulting from internal bleeding or fluid shifts. Finally, inspecting the dressing ensures that external hemostasis is maintained and no excessive pleural fluid is leaking.

Adım Adım Çözüm

Identify the primary risks associated with a thoracentesis.

Recognize that pneumothorax, internal or external bleeding, and infection are the most significant potential complications.

Understanding potential complications directs the focus of the post-procedure nursing assessment.

Evaluate each listed intervention for its safety and effectiveness in risk reduction.

Determine that airway and breathing assessments, hemodynamic monitoring, and site inspection are critical and correct actions.

Early detection of respiratory compromise or hypovolemic shock significantly improves client outcomes.

Identify and eliminate unsafe or contraindicated actions from the options.

Exclude supine positioning and the delegation of initial assessments to a UAP.

Supine positioning impairs diaphragmatic excursion, and the RN must establish the initial post-procedure baseline because the client is considered unstable.

Anahtar Kavram

Post-procedure monitoring and complication prevention following a thoracentesis.

Soru 785Soru →

A client with a severe exacerbation of asthma is admitted to the emergency department. The healthcare provider prescribes an intravenous loading dose of aminophylline $5\text{ mg/kg}$ to be infused over $30\text{ minutes}$ . The client weighs $154\text{ lbs}$ . The pharmacy dispenses aminophylline $500\text{ mg}$ mixed in $500\text{ mL}$ of $5\%$ dextrose in water (D5W). At what rate in $\text{mL/hr}$ should the nurse program the infusion pump?

Cevabı ve açıklamayı göster

Cevap: 700

Cevap

700

To find the correct infusion rate, first convert the weight to kilograms (

154\text{ lbs} \div 2.2 = 70\text{ kg}

). Next, calculate the dose (

70\text{ kg} \times 5\text{ mg/kg} = 350\text{ mg}

). Since the medication is supplied as

500\text{ mg}

500\text{ mL}

1\text{ mg/mL}

concentration), the total volume needed is

350\text{ mL}

. Finally, to find the hourly rate for a

30\text{-minute}

(

0.5\text{ hour}

) infusion, divide the volume by the time in hours (

350\text{ mL} \div 0.5\text{ hr} = 700\text{ mL/hr}

Adım Adım Çözüm

Convert the client's weight from pounds to kilograms.

70\text{ kg}

Weight-based dosages require the client's weight to be expressed in kilograms (

154 \div 2.2 = 70

Calculate the total required dose of aminophylline in milligrams.

350\text{ mg}

Multiply the prescribed dose by the client's weight in kilograms (

5\text{ mg/kg} \times 70\text{ kg} = 350\text{ mg}

Determine the required fluid volume in milliliters to deliver the calculated dose.

350\text{ mL}

The supplied concentration is

500\text{ mg}

500\text{ mL}

, which simplifies to

1\text{ mg/mL}

. Therefore, a

350\text{ mg}

dose is contained in a volume of

350\text{ mL}

Calculate the infusion pump rate in milliliters per hour (

\text{mL/hr}

700\text{ mL/hr}

The

350\text{ mL}

volume must be infused over

30\text{ minutes}

, which is

0.5\text{ hours}

. Divide the volume by the time in hours to find the hourly rate (

350\text{ mL} \div 0.5\text{ hours} = 700\text{ mL/hr}

Anahtar Kavram

Weight-based intravenous medication dosage calculation and infusion pump rate programming.

Soru 786Soru →

A nurse receives a handoff report for a client who is $48\text{ hours}$ post-coronary artery bypass graft surgery. The previous shift reports that the mediastinal chest tube drainage abruptly stopped $2\text{ hours}$ ago. Upon entering the room, the client appears highly restless and reports a severe sensation of tightness in the chest. Current vital signs reveal a heart rate of $124\text{ beats/min}$ , a respiratory rate of $24\text{ breaths/min}$ , and a blood pressure of $96/82\text{ mm Hg}$ . Auscultation of the chest reveals muffled heart tones.

Based on these clinical findings, which of the following is the priority nursing action?

Contact the rapid response team and prepare the client for an emergent echocardiogram and pericardiocentesis.

Initiate a rapid intravenous fluid bolus of normal saline to treat the suspected onset of hypovolemic shock.

Document the cessation of chest tube drainage and reassess the client's hemodynamic status in 15 minutes.

Place the client in the modified Trendelenburg position to facilitate venous return and improve blood pressure.

Cevabı ve açıklamayı göster

Cevap: Contact the rapid response team and prepare the client for an emergent echocardiogram and pericardiocentesis.

Cevap

The correct action is to contact the rapid response team and prepare the client for an emergent echocardiogram and pericardiocentesis.

The client is exhibiting classic signs of cardiac tamponade (Beck's triad: hypotension with a narrowing pulse pressure, muffled heart tones, and systemic venous congestion leading to restlessness and chest tightness). The abrupt cessation of chest tube drainage post-coronary artery bypass graft suggests the tube is clotted, causing blood to accumulate in the pericardial space. This is a life-threatening emergency (obstructive shock) that restricts ventricular filling and requires immediate pericardial decompression via pericardiocentesis or surgical re-exploration. The correct action is to activate the rapid response team and prepare for this procedure.

Adım Adım Çözüm

Analyze the client's clinical presentation and vital signs.

The client has a markedly narrowing pulse pressure (

96/82\text{ mm Hg}

), tachycardia (

124\text{ beats/min}

), muffled heart tones, and sudden cessation of chest tube drainage.

Identifying these classic findings (Beck's triad) is essential to differentiate the complication from general postoperative pain or simple hypovolemia.

Formulate a clinical judgment based on the findings.

The findings strongly indicate cardiac tamponade, caused by blood accumulating in the pericardial sac after the chest tube clotted.

Cardiac tamponade restricts ventricular filling, severely compromising cardiac output and creating a life-threatening obstructive shock state.

Determine the highest priority nursing intervention.

Immediate medical intervention to drain the accumulated fluid (pericardiocentesis or surgical re-exploration) is required.

Nursing actions must prioritize activating the emergency response team (ABCs) because cardiac tamponade is rapidly fatal without mechanical decompression.

Anahtar Kavram

Cardiac Tamponade Recognition and Emergency Management

Soru 787Soru →

A client is receiving a continuous intravenous (IV) infusion of heparin for the treatment of a pulmonary embolism. The client has a single peripheral IV catheter. The healthcare provider prescribes a scheduled dose of IV piggyback levofloxacin. Upon checking a drug reference guide, the nurse determines that levofloxacin is physically incompatible with heparin. What is the most appropriate action by the nurse?

Insert a second peripheral IV catheter to administer the levofloxacin.

Stop the heparin infusion, flush the line with 0.9% sodium chloride, infuse the levofloxacin, flush again, and restart the heparin.

Attach the levofloxacin tubing to the highest Y-site port on the primary IV tubing to allow the medications to dilute.

Administer the levofloxacin concurrently through the existing line at a slower rate to prevent precipitation.

Cevabı ve açıklamayı göster

Cevap: Insert a second peripheral IV catheter to administer the levofloxacin.

Cevap

The most appropriate action is to insert a second peripheral IV catheter to administer the levofloxacin.

Establishing a new intravenous line is the only action that prioritizes patient safety by maintaining the continuous therapeutic level of heparin while simultaneously ensuring the timely administration of the antibiotic. Because the two medications are chemically incompatible, they cannot share a line, and because heparin has a very short half-life, it cannot be safely paused.

Adım Adım Çözüm

Identify the primary pharmacological concern with the current infusions.

Heparin is a critical, high-alert medication with a very short half-life (60 to 90 minutes) that requires continuous infusion to maintain therapeutic anticoagulation for a pulmonary embolism.

Understanding the pharmacokinetics of the primary infusion is essential before deciding whether it can be safely paused.

Evaluate the compatibility of the two prescribed intravenous medications.

The scenario explicitly states that levofloxacin is physically incompatible with heparin.

Incompatible medications cannot be mixed in the same IV tubing or bag, as they may precipitate or inactivate each other.

Determine the safest method to administer the incompatible secondary medication.

Because heparin cannot be safely paused for the 30 to 60 minutes required for an antibiotic piggyback, and the medications cannot share the same line, a separate IV access must be established.

This guarantees that the client receives the necessary antibiotic therapy without compromising the critical anticoagulation treatment.

Anahtar Kavram

Continuous infusions of critical medications with short half-lives (like heparin or vasoactive drips) should not be interrupted to administer incompatible secondary infusions. A separate IV access must be established.

Soru 788Soru →

A 28-year-old client is receiving mechanical ventilation in the intensive care unit following a severe traumatic brain injury. An external ventricular drain is in place, and the monitor displays a sustained intracranial pressure (ICP) of 24 mm Hg. The nurse evaluates the client's morning arterial blood gas (ABG) results, which reveal a pH of 7.29, PaCO2 of 54 mm Hg, PaO2 of 92 mm Hg, and HCO3- of 25 mEq/L (25 mmol/L). Which of the following interventions is the highest priority for the nurse to implement to reduce the risk of further neurological damage?

Request a prescription to increase the mechanical ventilator respiratory rate.

Administer an intravenous infusion of sodium bicarbonate to resolve the metabolic acidosis.

Place the client in a supine position without head elevation to maximize cerebral arterial perfusion.

Request that the unlicensed assistive personnel closely monitor the client for subtle changes in pupillary reaction.

Cevabı ve açıklamayı göster

Cevap: Request a prescription to increase the mechanical ventilator respiratory rate.

Cevap

Request a prescription to increase the mechanical ventilator respiratory rate.

The correct answer addresses the root cause of the worsening physiological state. The client has an elevated intracranial pressure (24 mm Hg) and respiratory acidosis (PaCO2 54 mm Hg). Carbon dioxide is a potent vasodilator of cerebral blood vessels. When vessels dilate, more blood enters the rigid cranial vault, causing intracranial pressure to spike and risking fatal brain herniation. By increasing the mechanical ventilator's respiratory rate, the client will blow off the excess carbon dioxide. As PaCO2 normalizes, the cerebral blood vessels will constrict, reducing cerebral blood volume and safely lowering the intracranial pressure.

Adım Adım Çözüm

Analyze the client's arterial blood gas results.

The results show uncompensated respiratory acidosis (low pH, high PaCO2, normal HCO3-).

Identifying the acid-base imbalance is necessary to determine the underlying physiological stressor affecting the brain.

Correlate the laboratory findings with the client's neurological status.

The elevated PaCO2 (hypercapnia) is directly causing cerebral vasodilation.

Carbon dioxide is a potent cerebral vasodilator. Wide vessels increase cerebral blood volume, which exacerbates the already dangerously elevated intracranial pressure of 24 mm Hg (normal is 5 to 15 mm Hg).

Determine the most effective intervention to reduce physiological risk.

The nurse must act to decrease the PaCO2 level back to a normal range (35 to 45 mm Hg).

Increasing the respiratory rate on the mechanical ventilator will blow off the excess carbon dioxide, leading to cerebral vasoconstriction and a subsequent decrease in intracranial pressure.

Anahtar Kavram

Hypercapnia (elevated PaCO2) causes cerebral vasodilation, which significantly increases intracranial pressure. Managing ventilation to maintain normocapnia is a critical risk reduction strategy in traumatic brain injury.

Soru 789Soru →

An adult individual recovering from a severe gastrointestinal resection is receiving total parenteral nutrition (TPN) via a peripherally inserted central catheter (PICC). The nurse observes that the current bag of TPN has less than $20\text{ mL}$ remaining. The hospital pharmacy informs the unit that the next prepared nutritional solution will be delayed by approximately two hours. Based on the client's current therapy, which of the following is the most appropriate nursing action to take next?

Decrease the infusion pump rate of the current bag by half to ensure the remaining fluid lasts until the new supply arrives.

Flush the central venous catheter with

0.9\%

sodium chloride and cap the port to maintain line patency during the delay.

Initiate an infusion of

10\%

dextrose in water at the exact same flow rate as the current total parenteral nutrition.

Hang a continuous infusion of

0.9\%

sodium chloride at the prescribed rate to maintain vascular volume.

Cevabı ve açıklamayı göster

Cevap: Initiate an infusion of $10\%$ dextrose in water at the exact same flow rate as the current total parenteral nutrition.

Cevap

The most appropriate nursing action is to initiate an infusion of

10\%

dextrose in water at the exact same flow rate as the current total parenteral nutrition.

Total parenteral nutrition (TPN) contains a high concentration of glucose, which causes the pancreas to release a steady, elevated amount of insulin. If the TPN infusion is abruptly stopped or significantly delayed, the high levels of circulating insulin will rapidly lower the client's blood glucose, leading to severe rebound hypoglycemia. To prevent this dangerous complication, standard nursing protocol dictates immediately hanging an intravenous solution with a similar glucose concentration, typically

10\%

dextrose in water (D10W), and infusing it at the exact same flow rate until the next bag of TPN is available.

Adım Adım Çözüm

Identify the primary physiological risk associated with an abrupt cessation of total parenteral nutrition (TPN).

The high glucose content in TPN stimulates a steady, elevated release of endogenous insulin. Stopping the infusion suddenly creates a high risk for profound rebound hypoglycemia.

Anticipating complications based on pharmacokinetics and physiology is a critical component of safe parenteral therapy management.

Determine the necessary nursing intervention to prevent this specific complication during a delay.

The client requires a substitute intravenous fluid that provides a comparable concentration of glucose to match the circulating insulin levels.

Maintaining a steady supply of glucose prevents the blood sugar from dropping precipitously while the body gradually adjusts its insulin output.

Select the most appropriate intravenous solution from standard protocols.

10\%

dextrose in water (D10W) administered at the same rate as the TPN is the standard emergency substitute.

D10W contains a sufficient glucose concentration to mimic many standard TPN formulations and is readily accessible in emergency or delay situations.

Anahtar Kavram

Prevention of rebound hypoglycemia during abrupt cessation of total parenteral nutrition.

Tahmini Süre:1m 0s

Soru 790Soru →

A nurse is managing the care of a postoperative client who is receiving intravenous (IV) morphine via a patient-controlled analgesia (PCA) pump. Which of the following nursing actions are appropriate for this client? Select all that apply.

Geçerli olan tümünü seçin

Verify the patient-controlled analgesia (PCA) pump programming and medication parameters with a second registered nurse.

Delegate the assessment of the client's sedation level and pain relief to the unlicensed assistive personnel (UAP).

Ensure that naloxone and emergency resuscitation equipment are readily available at the client's bedside.

Authorize the client's family members to push the PCA dosing button while the client is asleep to maintain continuous pain control.

Assess the client's respiratory rate, oxygen saturation, and level of sedation at established regular intervals.

Connect a newly prescribed intravenous (IV) piggyback antibiotic to the PCA tubing Y-site based solely on the visual clarity of both solutions.

Cevabı ve açıklamayı göster

Cevap: Verify the patient-controlled analgesia (PCA) pump programming and medication parameters with a second registered nurse.; Ensure that naloxone and emergency resuscitation equipment are readily available at the client's bedside.; Assess the client's respiratory rate, oxygen saturation, and level of sedation at established regular intervals.

Cevap

The correct actions are to verify the PCA pump settings with a second registered nurse, ensure naloxone is readily available at the bedside, and regularly assess the client's respiratory rate, oxygen saturation, and sedation level.

Safe management of a PCA pump requires a multifaceted approach to prevent medication errors and respiratory depression. This includes performing an independent double-check of pump parameters with a second nurse, continuously assessing the client's respiratory and neurological status, and maintaining immediate access to the reversal agent naloxone. These actions directly uphold physiological integrity and patient safety.

Adım Adım Çözüm

Identify the primary risks associated with intravenous opioid administration via a PCA pump.

The main risks are oversedation and life-threatening respiratory depression.

Understanding the risks directs the nurse toward the necessary safety and monitoring interventions.

Evaluate the administrative safety protocols for PCA pumps.

The pump settings and medication dosage must be verified by two registered nurses.

Independent double-checks catch programming errors before the medication reaches the client.

Determine the necessary bedside emergency equipment.

An opioid antagonist (naloxone) and resuscitation equipment must be immediately accessible.

Rapid reversal of opioid toxicity is critical if respiratory depression occurs.

Analyze the delegation and operational safety rules of PCA therapy.

Assessments cannot be delegated to UAPs, and family members cannot push the PCA button (PCA by proxy).

Assessments require nursing judgment, and PCA safety relies on the client being awake enough to self-administer the dose.

Evaluate IV compatibility principles for parenteral therapies.

A drug reference must always be consulted before administering medications together.

Visual inspection cannot detect all forms of chemical incompatibility, which could cause harm or drug inactivation.

Anahtar Kavram

Safe administration, monitoring, and complication management of parenteral opioid analgesics via Patient-Controlled Analgesia (PCA).

Soru 791Soru →

A hospitalized individual with community-acquired pneumonia is currently receiving supplemental oxygen via nasal cannula at $2\text{ L/min}$ . During hourly rounds, the nursing staff observes that the individual has become highly restless, confused, and is utilizing accessory muscles to breathe.

Parameter	Current Value
Heart rate	$122\text{ bpm}$
Respiratory rate	$32\text{ breaths/min}$
Blood pressure	$148/88\text{ mm Hg}$
Oxygen saturation	$84\%$

ABG Component	Result	Reference Range
$\text{pH}$	$7.26$	$7.35 - 7.45$
$\text{PaCO}_2$	$66\text{ mm Hg}$	$35 - 45\text{ mm Hg}$
$\text{PaO}_2$	$54\text{ mm Hg}$	$80 - 100\text{ mm Hg}$
$\text{HCO}_3^-$	$24\text{ mEq/L}$	$22 - 26\text{ mEq/L}$

Which action represents the priority intervention for this individual?

Increase the nasal cannula flow rate to

6\text{ L/min}

and reassess the respiratory status in

15\text{ minutes}

Administer the prescribed as-needed intravenous anxiolytic medication to reduce the client's severe restlessness.

Infuse a rapid bolus of isotonic crystalloids to manage the elevated heart rate and impending shock.

Notify the healthcare provider immediately and prepare the room for emergent airway management.

Cevabı ve açıklamayı göster

Cevap: Notify the healthcare provider immediately and prepare the room for emergent airway management.

Cevap

The priority intervention is to notify the healthcare provider immediately and prepare for emergent airway management (intubation).

The correct answer involves recognizing that the individual is in acute respiratory failure. The ABG reveals severe uncompensated respiratory acidosis with significant hypoxemia. Combined with clinical signs of increased work of breathing and altered mental status, this indicates impending respiratory collapse. The priority is to secure the airway and provide mechanical ventilation.

Adım Adım Çözüm

Analyze the arterial blood gas values and vital signs.

The ABG indicates uncompensated respiratory acidosis (

\text{pH} < 7.35

, elevated

\text{PaCO}_2

) with severe hypoxemia (

\text{PaO}_2 < 60\text{ mm Hg}

Understanding the physiological state is crucial for identifying acute decompensation and prioritizing interventions.

Correlate laboratory findings with the physical assessment data.

The client's severe restlessness, confusion, and use of accessory muscles are direct physiological responses to severe oxygen deprivation and carbon dioxide retention.

Restlessness and confusion are hallmark early neurological signs of profound hypoxia.

Determine the most appropriate and definitive nursing intervention.

The client is in acute respiratory failure and requires immediate positive pressure ventilation or intubation.

Conservative measures (like increasing a nasal cannula) are no longer sufficient, and delaying advanced airway interventions could lead to respiratory arrest.

Anahtar Kavram

Acute Respiratory Failure and ABG Interpretation

Tahmini Süre:1m 0s

Soru 792Soru →

A nurse is planning care for a client who returned to the surgical unit 2 hours ago following a lumbar laminectomy. Which of the following nursing interventions should the nurse implement to reduce the risk of postoperative complications? Select all that apply.

Geçerli olan tümünü seçin

Maintain the client's spine in proper alignment by logrolling with assistance when turning.

Elevate the head of the bed to a 60-degree angle to promote optimal lung expansion.

Inspect the surgical dressing and the bedsheets directly underneath the client for clear drainage.

Delegate the initial postoperative transfer and ambulation to the unlicensed assistive personnel (UAP).

Encourage the client to use an overhead trapeze bar to reposition themselves independently.

Perform bilateral neurological assessments of the lower extremities every 2 to 4 hours.

Cevabı ve açıklamayı göster

Cevap: Maintain the client's spine in proper alignment by logrolling with assistance when turning.; Inspect the surgical dressing and the bedsheets directly underneath the client for clear drainage.; Perform bilateral neurological assessments of the lower extremities every 2 to 4 hours.

Cevap

The appropriate interventions are maintaining spinal alignment by logrolling, inspecting the dressing and bedsheets for drainage, and performing frequent lower extremity neurological assessments.

The correct interventions focus on protecting the spinal surgical site, detecting early signs of neurological compromise, and identifying potential bleeding or cerebrospinal fluid leaks. Logrolling maintains spinal alignment, inspecting the dressing and bedsheets helps identify dependent pooling of blood or CSF, and frequent lower extremity neurological checks are vital for catching early signs of nerve compression.

Adım Adım Çözüm

Analyze the client's surgical procedure and postoperative risks.

The client had a lumbar laminectomy, which involves the spine. Primary risks include spinal instability, nerve compression, hemorrhage, and cerebrospinal fluid (CSF) leak.

Understanding the specific surgical risks dictates the necessary nursing interventions for risk reduction.

Evaluate the positioning and mobility options.

Logrolling is identified as safe and necessary. High Fowler's positioning and trapeze bar use are identified as contraindicated due to promoting spinal flexion and twisting.

Maintaining proper spinal alignment is critical to prevent injury to the surgical site.

Evaluate the assessment and delegation options.

Frequent neurological checks and dependent dressing inspections are identified as correct. Delegating the initial ambulation to a UAP is identified as an unsafe delegation.

The RN must retain tasks requiring clinical judgment, such as initial postoperative assessments and mobility trials.

Anahtar Kavram

Postoperative Risk Reduction for Spinal Surgery

Soru 793Soru →

A nurse is caring for an adult client who is receiving a unit of packed red blood cells (PRBCs) for symptomatic anemia. Twenty minutes after the transfusion is initiated, the client reports sudden lower back pain and feeling unusually cold. The nurse notes the client is restless with a blood pressure of 88/52 mmHg. Arrange the following nursing actions in the correct order of priority. (Place the highest priority action first.)

Öğeleri doğru sıraya koymak için sürükleyin

Cevabı ve açıklamayı göster

Cevap

The correct order of interventions is to first stop the transfusion, then initiate normal saline with new tubing, assess the client's vital signs, notify the provider and blood bank, and finally send the blood product to the blood bank.

In the event of a suspected acute hemolytic transfusion reaction (indicated by lower back pain, chills, and hypotension), the absolute first priority is to stop the infusion to prevent further exposure to the offending antigen. The next step is to maintain patent IV access with normal saline using completely new tubing; using the old tubing would infuse more of the reactive blood. Once the source is stopped and access is secured, the nurse performs a rapid clinical assessment. This assessment data is then communicated to the healthcare provider to guide emergency pharmacological interventions. Finally, after the client is stabilized and acute actions are completed, the remaining blood product and tubing are sent to the blood bank for investigation.

Adım Adım Çözüm

Recognize the signs of an acute hemolytic transfusion reaction and immediately stop the transfusion.

Further entry of incompatible blood into the client's circulation is halted.

Stopping the source of the harm is always the most critical first step to minimize the severity of the reaction and prevent further physiological deterioration.

Maintain intravenous access with new tubing and 0.9% sodium chloride.

A patent intravenous line is secured without infusing the remaining blood.

The client is hypotensive and will likely require emergency intravenous medications and fluid resuscitation. New tubing prevents pushing the remaining reactive blood into the client.

Perform a rapid clinical assessment of vital signs and respiratory status.

Current hemodynamic and respiratory data are obtained.

Accurate clinical data is required to determine the severity of the reaction and to provide a complete report to the healthcare provider.

Notify the healthcare provider and the blood bank.

The provider is informed of the reaction and assessment data.

The provider must prescribe emergency interventions (e.g., vasopressors, antihistamines), and the blood bank must initiate their adverse reaction protocol.

Return the blood product, tags, and tubing to the blood bank.

The physical evidence of the transfusion is sent for laboratory analysis.

The blood bank must analyze the remaining product and equipment to confirm the type and underlying cause of the adverse reaction.

Anahtar Kavram

Management of Acute Hemolytic Transfusion Reactions

Soru 794Soru →

A client is admitted to the medical-surgical unit with infective endocarditis. The client's vital signs include a temperature of 102.4°F (39.1°C), heart rate of 112 bpm, and blood pressure of 108/64 mmHg. The healthcare provider prescribes intermittent intravenous (IV) infusions of penicillin G and gentamicin. The client currently has a single 20-gauge peripheral IV line established. Which action by the nurse represents the safest administration technique for these medications?

Administer the penicillin G, flush the IV line thoroughly with 0.9% sodium chloride, and then infuse the gentamicin.

Connect the gentamicin as a secondary infusion to the Y-site of the penicillin G tubing for simultaneous delivery.

Combine both the penicillin G and gentamicin into a single IV bag of 0.9% sodium chloride to reduce the number of infusions.

Delay the antibiotic administration and contact the healthcare provider to request placement of a second peripheral IV line.

Cevabı ve açıklamayı göster

Cevap: Administer the penicillin G, flush the IV line thoroughly with 0.9% sodium chloride, and then infuse the gentamicin.

Cevap

The nurse should administer the medications sequentially, flushing the IV line thoroughly with 0.9% sodium chloride between the penicillin G and gentamicin infusions.

The correct action is to administer the antibiotics sequentially and flush the IV line between them. Penicillins and aminoglycosides (like gentamicin) act synergistically in the body to treat severe infections such as endocarditis. However, they are chemically incompatible in vitro (outside the body). If mixed in the same IV bag or tubing, the penicillin will directly inactivate the aminoglycoside. Flushing the line completely with normal saline between the infusions ensures that the medications do not mix, allowing for safe and effective delivery of both drugs.

Adım Adım Çözüm

Identify the classification and specific compatibility of the prescribed medications.

The nurse recognizes that penicillin G (a penicillin) and gentamicin (an aminoglycoside) are chemically incompatible in vitro.

Penicillins can physically inactivate aminoglycosides if they come into direct contact in IV tubing or a solution bag.

Determine the safest administration strategy given the client's current IV access.

The client has a single peripheral IV line. Since both infusions are prescribed intermittently (rather than as continuous life-sustaining drips), they can be administered one after the other.

Sequential administration avoids the need for an unnecessary second IV stick while ensuring timely antibiotic delivery.

Apply the standard nursing procedure for administering incompatible medications through a single line.

The nurse infuses the first medication, flushes the line completely with a neutral, compatible solution (like normal saline), and then infuses the second medication.

Flushing clears the tubing of the first drug, preventing in-vitro mixing and ensuring both medications retain their therapeutic efficacy when they enter the bloodstream.

Anahtar Kavram

Parenteral therapy compatibility and safe sequential administration of incompatible antibiotics.

Soru 795Soru →

A nurse is preparing to administer a prescribed intravenous (IV) push medication through a client's non-valved central venous catheter (CVC). Arrange the following steps in the correct order of execution. All steps must be used.

Öğeleri doğru sıraya koymak için sürükleyin

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Cevap

The correct sequence for administering an IV push medication through a non-valved central venous catheter is: Scrub the connector, aspirate and flush with normal saline, administer the medication, flush with normal saline again using a push-pause technique, and finally instill the heparin flush.

The SASH sequence (Saline, Administer, Saline, Heparin) is the standard evidence-based practice for administering medications through a non-valved central venous catheter. Asepsis must be established first by scrubbing the hub. An initial saline flush with aspiration confirms placement. After medication administration, a second saline flush clears the drug. Finally, a heparin flush maintains patency.

Adım Adım Çözüm

Scrub the needleless connector with an antimicrobial swab and allow it to dry completely.

The entry port is disinfected.

Prevents the introduction of microorganisms into the bloodstream, minimizing the risk of central line-associated bloodstream infections (CLABSI).

Attach a syringe of normal saline, aspirate for blood return, and flush the catheter.

Placement and patency are verified.

Aspiration ensures the catheter tip is appropriately situated in the vascular space, while the initial flush ensures there is no resistance or occlusion.

Administer the prescribed intravenous medication over the recommended duration.

The medication is delivered safely.

Administering at the correct rate prevents adverse reactions and toxicity.

Flush the catheter with normal saline using a push-pause technique.

The medication is cleared from the line.

Ensures the entire dose reaches the vascular system and clears the line to prevent incompatibility with subsequent infusions. The push-pause method creates turbulence to clean the catheter walls.

Instill the prescribed heparin flush solution into the catheter lumen.

The catheter is locked with heparin.

Maintains catheter patency in non-valved central lines by preventing blood coagulation inside the lumen between uses.

Anahtar Kavram

The SASH (Saline, Administer, Saline, Heparin) method ensures safe medication administration and maintains patency in non-valved central venous catheters.

Soru 796Soru →

An emergency department nurse evaluates a client presenting with a three-day history of profound watery diarrhea and poor oral fluid intake. The client exhibits marked lethargy and dry mucous membranes. Initial assessment reveals a heart rate of $116\text{ beats/min}$ , a respiratory rate of $28\text{ breaths/min}$ , and a blood pressure of $94/60\text{ mm Hg}$ . Arterial blood gas analysis demonstrates a pH of $7.29$ , a $PaCO_2$ of $32\text{ mm Hg}$ , and an $HCO_3^-$ of $15\text{ mEq/L}$ . Which action represents the highest priority for this client?

Establish intravenous access and commence a prescribed crystalloid fluid challenge

Prepare to administer prescribed intravenous sodium bicarbonate to correct the acidosis

Collect a stool specimen to determine the underlying infectious etiology

Administer a prescribed oral anti-motility medication to halt further fluid losses

Cevabı ve açıklamayı göster

Cevap: Establish intravenous access and commence a prescribed crystalloid fluid challenge

Cevap

Establish intravenous access and commence a prescribed crystalloid fluid challenge

The correct action directly addresses the most immediate threat to the client's life: hypovolemic shock. The clinical presentation of lethargy, tachycardia, tachypnea, and hypotension indicates poor tissue perfusion. Administering an intravenous crystalloid fluid challenge will rapidly expand the intravascular volume, improve cardiac output, and reverse the tissue hypoxia that is exacerbating the metabolic acidosis.

Adım Adım Çözüm

Analyze the vital signs and clinical presentation.

The client has tachycardia (

116\text{ beats/min}

), tachypnea (

28\text{ breaths/min}

), borderline low blood pressure (

94/60\text{ mm Hg}

), and lethargy.

Identifying abnormal parameters establishes that the client is experiencing severe volume depletion and early hypovolemic shock.

Interpret the arterial blood gas (ABG) values.

pH is

7.29

(acidosis),

PaCO_2

32\text{ mm Hg}

(partial respiratory compensation), and

HCO_3^-

15\text{ mEq/L}

(primary metabolic acidosis).

Severe diarrhea causes a direct loss of bicarbonate, and subsequent poor tissue perfusion adds lactic acid, resulting in significant metabolic acidosis.

Prioritize nursing interventions based on ABCs (Airway, Breathing, Circulation).

Circulatory collapse is the most immediate life-threatening issue. Intravenous fluid replacement takes precedence.

Restoring intravascular volume treats the root cause of the shock state and helps correct the metabolic acidosis by improving tissue perfusion.

Anahtar Kavram

Hypovolemic Shock and Metabolic Acidosis Management

Soru 797Soru →

A nurse is evaluating a client who underwent a large-volume paracentesis to relieve severe ascites $90$ minutes ago. The client suddenly reports profound dizziness and a feeling of impending doom. Current vital signs reveal a heart rate of $122$ beats per minute, a respiratory rate of $24$ breaths per minute, and a blood pressure of $84/50$ mm Hg. Which immediate action should the nurse perform?

Administer the client's scheduled daily dose of oral spironolactone.

Guide the client into a high Fowler's posture to maximize lung expansion.

Position the client flat in bed while raising the lower extremities.

Begin a focused abdominal examination by deeply palpating the quadrants.

Cevabı ve açıklamayı göster

Cevap: Position the client flat in bed while raising the lower extremities.

Cevap

The immediate priority is to support the client's circulation by positioning them flat with their lower extremities elevated.

The client is exhibiting classic signs of paracentesis-induced circulatory dysfunction (hypovolemic shock) caused by a rapid fluid shift after a large volume of fluid is removed. The priority action is to optimize venous return and cerebral perfusion. Positioning the client flat with the legs elevated (modified Trendelenburg) immediately uses gravity to divert blood from the lower extremities back to the central circulation, supporting blood pressure and cardiac output.

Adım Adım Çözüm

Analyze the client's clinical presentation and vital signs following the invasive procedure.

The tachycardia (

122

bpm) and severe hypotension (

84/50

mm Hg), combined with dizziness, indicate acute hypovolemic shock.

Large-volume paracentesis can cause rapid fluid shifts from the intravascular space into the peritoneal cavity, leading to paracentesis-induced circulatory dysfunction.

Identify the highest priority nursing need using the airway, breathing, and circulation (ABC) framework.

The primary life-threatening issue is a severe deficit in circulation.

Inadequate circulating blood volume leads to decreased tissue perfusion and potential organ failure.

Select the most effective and immediate mechanical intervention to support the cardiovascular system.

Place the client in a modified Trendelenburg position (flat with legs elevated).

This positioning utilizes gravity to immediately divert venous blood from the lower extremities back to the heart, temporarily improving cardiac output and vital organ perfusion.

Anahtar Kavram

Management of Paracentesis-Induced Circulatory Dysfunction

Soru 798Soru →

A client with symptomatic anemia requires a transfusion of packed red blood cells (PRBCs). The client's only intravenous (IV) access is a 20-gauge peripheral catheter currently infusing 5% dextrose in water (D5W) at 75 mL/hr. What is the most appropriate action by the nurse?

Delegate the assessment of the client's vital signs and monitoring for adverse reactions during the first 15 minutes to an unlicensed assistive personnel (UAP).

Connect the PRBC transfusion tubing to the lowest Y-site port of the primary D5W infusion line to run them concurrently.

Stop the continuous D5W infusion, flush the IV catheter with 0.9% sodium chloride, and administer the PRBCs with 0.9% sodium chloride.

Calculate the required drip rate to ensure the entire unit of PRBCs infuses slowly over a 6-hour period to prevent fluid overload.

Cevabı ve açıklamayı göster

Cevap: Stop the continuous D5W infusion, flush the IV catheter with 0.9% sodium chloride, and administer the PRBCs with 0.9% sodium chloride.

Cevap

The most appropriate action is to stop the continuous D5W infusion, flush the IV catheter with 0.9% sodium chloride, and administer the PRBCs with 0.9% sodium chloride.

Packed red blood cells (PRBCs) are exclusively compatible with 0.9% sodium chloride (normal saline). Administering blood with solutions containing dextrose, such as D5W, causes hemolysis (rupture) of the red blood cells, which can trigger a severe or life-threatening reaction. Because the client has only one IV access site, the nurse must stop the incompatible D5W infusion, completely flush the line with 0.9% sodium chloride to clear any remaining dextrose from the catheter, and then administer the transfusion safely using normal saline as the primer and flush.

Adım Adım Çözüm

Identify the fluid compatibility of the prescribed blood product.

Packed red blood cells (PRBCs) are only compatible with 0.9% sodium chloride (normal saline).

Solutions containing dextrose, such as D5W, cause hemolysis of red blood cells, while solutions like Lactated Ringer's contain calcium that can cause the blood to clot.

Evaluate the client's current intravenous access.

The client has a single IV line currently infusing an incompatible fluid (D5W).

The nurse must use the existing access safely or establish a new line.

Formulate a safe administration plan.

Stop the D5W infusion, thoroughly flush the line with 0.9% sodium chloride, and administer the blood using only 0.9% sodium chloride.

Flushing the line completely removes the incompatible dextrose solution, preventing a dangerous in-line hemolytic reaction and allowing safe blood administration through the single access site.

Anahtar Kavram

Blood Product Administration Safety and IV Fluid Compatibility

Soru 799Soru →

A client admitted to the intensive care unit with acute decompensated heart failure is prescribed a continuous intravenous infusion of dobutamine at $7.5$ mcg/kg/min. The client weighs $176$ lb. The medication is supplied by the pharmacy as dobutamine $500$ mg in $250$ mL of $5\%$ dextrose in water. At what rate in mL/hr should the nurse set the infusion pump? (Record your answer using a whole number.)

Cevabı ve açıklamayı göster

Cevap: 18

Cevap

The nurse should set the infusion pump to deliver 18 mL/hr.

To determine the correct IV pump setting in mL/hr, first convert the weight to kilograms (

176 \div 2.2 = 80

kg). Next, calculate the dose per minute (

7.5 \times 80 = 600

mcg/min), then convert to the hourly dose (

600 \times 60 = 36,000

mcg/hr). Convert this to milligrams (

36,000 \div 1000 = 36

mg/hr). The concentration of the IV bag is

2

mg/mL (

500

\div 250

mL). Finally, divide the required hourly dose by the concentration (

36 \div 2 = 18

mL/hr).

Adım Adım Çözüm

Convert the client's weight from pounds to kilograms.

176 \div 2.2 = 80

The medication is prescribed based on weight in kilograms (mcg/kg/min).

Calculate the total dose required per minute.

7.5 \times 80 = 600

mcg/min

This establishes the total amount of dobutamine the client needs every minute.

Convert the minute dose to an hourly dose.

600 \times 60 = 36,000

mcg/hr

The final pump rate must be programmed in mL/hr, so the dose must be calculated per hour.

Convert the hourly dose from micrograms to milligrams.

36,000 \div 1000 = 36

mg/hr

The supplied medication concentration is provided in milligrams (mg), so the units must match.

Calculate the concentration of the supplied medication.

500 \div 250 = 2

mg/mL

This determines how many milligrams of dobutamine are in each milliliter of the IV fluid.

Calculate the final infusion pump rate.

36 \div 2 = 18

mL/hr

Dividing the required hourly dose by the concentration yields the volume required per hour.

Anahtar Kavram

Weight-based intravenous infusion calculation requires converting weight to kilograms, determining the hourly medication requirement, and applying the supplied concentration to find the volume per hour.

Soru 800Soru →

A nurse is evaluating a client who is receiving aggressive intravenous fluid resuscitation for severe dehydration. The client suddenly reports severe orthopnea and a feeling of impending doom. Which of the following clinical assessment findings indicate the development of acute pulmonary edema? (Select all that apply.)

Geçerli olan tümünü seçin

Bilateral fine crackles progressing from the lung bases upward

A narrowing pulse pressure with a weak, thready peripheral pulse

Production of pink, frothy sputum upon coughing

Arterial blood gas (ABG) revealing uncompensated metabolic alkalosis

Auscultation of a prominent S3 gallop rhythm at the cardiac apex

Cevabı ve açıklamayı göster

Cevap: Bilateral fine crackles progressing from the lung bases upward; Production of pink, frothy sputum upon coughing; Auscultation of a prominent S3 gallop rhythm at the cardiac apex

Cevap

The correct findings that indicate acute pulmonary edema are bilateral fine crackles progressing upward, the production of pink, frothy sputum, and the presence of an S3 gallop rhythm.

Acute pulmonary edema occurs when excessive hydrostatic pressure in the pulmonary vasculature forces fluid across the alveolar-capillary membrane into the air spaces. This alveolar flooding manifests as bilateral crackles that progress upward and the production of pink, frothy sputum from ruptured capillaries. Furthermore, the excess fluid volume increases cardiac preload, stretching the left ventricle and producing a classic S3 gallop rhythm during ventricular filling.

Adım Adım Çözüm

Analyze the clinical scenario and the client's current interventions.

The client is receiving aggressive intravenous fluid resuscitation and is now exhibiting sudden, severe respiratory distress and anxiety.

Rapid fluid volume expansion significantly increases the risk of left ventricular volume overload, forcing fluid backward into the pulmonary circuit.

Identify respiratory manifestations of alveolar flooding.

Crackles starting at the lung bases and pink, frothy sputum are identified as confirming signs.

Increased pulmonary capillary hydrostatic pressure pushes fluid and red blood cells into the alveoli, causing adventitious lung sounds and blood-tinged, aerated secretions.

Identify cardiac manifestations associated with acute fluid volume overload.

An S3 gallop rhythm is recognized as an expected finding.

The S3 sound is generated by the rapid rush of blood into an already distended left ventricle during early diastole.

Differentiate pulmonary edema from other pathophysiological shock and acid-base states.

Narrowing pulse pressure and metabolic alkalosis are excluded as correct choices.

A narrowing pulse pressure indicates low stroke volume (shock), while pulmonary edema classically causes respiratory acidosis due to impaired gas exchange, not metabolic alkalosis.

Anahtar Kavram

Acute Pulmonary Edema Assessment and Recognition

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