A client with acute respiratory distress syndrome (ARDS) requires care planning. Which of the following interventions should be included in the plan?

Correct Answer: D

Rationale: The correct answer is D, placing the client in a prone position. This intervention optimizes oxygenation by improving ventilation-perfusion matching in ARDS. When the client is in a prone position, there is better distribution of ventilation to the dorsal lung regions, reducing the risk of ventilator-induced lung injury. Choice A is incorrect because low-flow oxygen may not be sufficient to meet the oxygen demands of a client with ARDS. Choice B is incorrect because excessive oral intake can lead to fluid overload in ARDS. Choice C is incorrect because high-protein and high-carbohydrate foods may be difficult for the client to tolerate and can contribute to increased carbon dioxide production.

Correct Answer: C

Rationale: The correct answer is C: Heparin. Heparin is a common anticoagulant used to prevent further clotting in patients with pulmonary embolism. It works by inhibiting blood clot formation. Furosemide (A) is a diuretic used for conditions like heart failure and edema, not for pulmonary embolism. Dexamethasone (B) is a corticosteroid used for inflammation and immune suppression, not for pulmonary embolism. Atropine (D) is used to treat bradycardia and not indicated for pulmonary embolism. Administering heparin is crucial to prevent worsening of the pulmonary embolism and potential life-threatening complications.

Correct Answer: A

Rationale: In the context of pharmacology and medical-surgical nursing, understanding the relationship between decreased plasma volume and cardiac output is crucial. The correct answer is A) Flattened neck veins when the client is in a supine position. This finding supports the nursing diagnosis of Decreased Cardiac Output because decreased plasma volume leads to reduced preload, resulting in decreased venous return to the heart. In the supine position, flattened neck veins indicate decreased venous return and impaired filling of the right side of the heart, ultimately leading to decreased cardiac output. Option B) Full and bounding pedal and post-tibial pulses is incorrect because this finding is more indicative of increased cardiac output or volume overload rather than decreased cardiac output related to decreased plasma volume. Option C) Pitting edema located in feet, ankles, and calves is incorrect as it is a sign of fluid retention, typically seen in conditions like heart failure where there is an excess of fluid volume, not decreased plasma volume. Option D) Shallow respirations with crackles on auscultation is more indicative of respiratory issues such as pulmonary edema rather than decreased cardiac output related to decreased plasma volume. Understanding these clinical findings in the context of pharmacology helps nurses make accurate assessments and diagnose alterations in cardiac function promptly, leading to appropriate interventions to improve patient outcomes.

Correct Answer: A

Rationale: In this scenario, the correct action that can be delegated to the nursing assistant is to provide oral care every 3-4 hours (Option A). This task is within the scope of practice for a nursing assistant and helps maintain the client's oral hygiene, which is important in preventing infections and promoting comfort. Monitoring for indications of dehydration (Option B) and administering 0.45% saline by IV line (Option C) are tasks that require a higher level of clinical judgment and understanding of the client's condition, which should be performed by a registered nurse. Assessing daily weights for trends (Option D) is also a critical nursing responsibility that involves interpreting and analyzing data to monitor the client's fluid status accurately. Educationally, understanding the principles of delegation is crucial for newly graduated RNs. Delegating tasks effectively involves considering the complexity of the task, the stability of the client, and the competency of the healthcare team members. By delegating appropriate tasks, RNs can optimize client care outcomes and promote teamwork within the healthcare setting.

Correct Answer: A

Rationale: In the scenario of a client with respiratory failure experiencing respiratory acidosis while on mechanical ventilation, increasing the ventilator rate from 6 to 10 per minute is the correct action to take. Respiratory acidosis occurs when the lungs cannot remove enough carbon dioxide, leading to an increase in carbonic acid in the blood and a decrease in blood pH. By increasing the ventilator rate, you can enhance the removal of carbon dioxide, helping to correct the acidosis. Option B, decreasing the ventilator rate from 10 to 6 per minute, would further decrease the efficiency of carbon dioxide removal, exacerbating the respiratory acidosis. Option C, increasing the oxygen concentration from 30% to 40%, does not directly address the underlying cause of respiratory acidosis, which is inadequate carbon dioxide elimination. Option D, decreasing the oxygen concentration from 40% to 30%, also does not address the root cause of respiratory acidosis and may lead to hypoxemia without improving the acidosis. Understanding the principles of mechanical ventilation and the management of respiratory acidosis is crucial for nurses caring for patients with respiratory failure. Adjusting ventilator settings based on the patient's ABG results is a key aspect of providing effective respiratory care.