A nurse is assessing an older adult brought to the emergency department following a fall and wrist fracture. She notes that the patient is very thin and unkempt, has a stage 3 pressure ulcer to her coccyx, and has old bruising to the extremities in addition to her new bruises from the fall. She defers all of the questions to her caregiver son who accompanied her to the hospital. The nurse's next step is to:

Correct Answer: C

Rationale: The correct answer is C: Call adult protective services because you suspect elder mistreatment. In this scenario, the patient's presentation raises concerns for elder abuse, as evidenced by the presence of a stage 3 pressure ulcer, old bruising, and the patient's unkempt appearance. By involving adult protective services, the nurse can initiate an investigation to ensure the safety and well-being of the patient. This step is crucial in addressing potential abuse and protecting the vulnerable adult. Summary: A: Calling social services for nursing home placement is premature without investigating the suspected abuse. B: Asking the son to step out may not address the potential abuse and could hinder the assessment. D: While assessing cognitive status is important, addressing suspected elder mistreatment takes precedence in this situation.

Correct Answer: C

Rationale: The correct answer is C: Pulmonary embolus. A V/Q lung scan is used to evaluate the ventilation-perfusion ratio in the lungs. A mismatch ratio greater than 1 indicates a significant ventilation-perfusion mismatch, which is commonly seen in pulmonary embolism where there is a blockage in the pulmonary artery. This leads to decreased perfusion in areas of the lung, causing the mismatch. Therefore, when the mismatch ratio is greater than 1, pulmonary embolus should be suspected. Choices A, B, and D do not directly correlate with a mismatch ratio on a V/Q lung scan, making them incorrect in this context.

Correct Answer: B

Rationale: The correct answer is B, impaired gas exchange due to alveolar-capillary membrane damage. In ARDS, inflammation and injury to the alveolar-capillary membrane lead to increased permeability and fluid accumulation, impairing gas exchange. Reduced hemoglobin levels (choice A) do not directly cause hypoxemia in ARDS. Decreased perfusion to pulmonary capillaries (choice C) may contribute to hypoxemia but is not the primary mechanism in ARDS. Increased airway resistance due to bronchoconstriction (choice D) affects ventilation, not gas exchange, and is not the primary cause of hypoxemia in ARDS.

Correct Answer: B

Rationale: The correct answer is B: Cardiac output and blood pressure. In ARDS patients on high PEEP, monitoring cardiac output and blood pressure is crucial due to the risk of hemodynamic compromise. High PEEP can decrease venous return, leading to decreased cardiac output and hypotension. Monitoring these parameters helps detect and prevent complications like hypotension, which can further compromise oxygenation. Choice A is incorrect because while monitoring respiratory rate and depth is important in ARDS, the priority in this scenario is monitoring hemodynamic status due to the potential impact of high PEEP on cardiac function. Choice C is incorrect as monitoring white blood cell count is not directly related to complications of high PEEP in ARDS patients. Choice D is incorrect because sputum production and characteristics are not the priority for monitoring in this scenario; cardiac output and blood pressure are more critical indicators of potential complications.

Correct Answer: A

Rationale: The correct answer is A: Dyspnea and tachypnea. These are common early clinical manifestations of ARDS because the condition leads to rapid, shallow breathing (tachypnea) and shortness of breath (dyspnea) due to the impaired gas exchange in the lungs. Cyanosis and apprehension (B) may occur later in ARDS progression. Hypotension and tachycardia (C) are more associated with septic shock rather than early ARDS. Respiratory distress and frothy sputum (D) are more characteristic of conditions like pulmonary edema rather than ARDS.