A patient admitted to the ICU develops delirium characterized by acute onset confusion and agitation. What intervention should the healthcare team prioritize to manage the patient's delirium?

Correct Answer: B

Rationale: The healthcare team should prioritize implementing environmental modifications to promote orientation in a patient with delirium. Delirium is a state of acute confusion and agitation that can be triggered by various factors such as medications, infections, or metabolic disturbances. Environmental modifications involve creating a calm, quiet, and well-lit environment for the patient. Promoting proper orientation through the use of clocks, calendars, and familiar objects can help reduce confusion and improve the patient's understanding of their surroundings. These interventions are non-pharmacological and aim to address the underlying causes of delirium while minimizing the need for additional medications that may have potential side effects. Antipsychotic medications and benzodiazepines should be used judiciously and under close supervision due to the risk of adverse effects in older adults and critically ill patients. Referring the patient to a psychiatrist may be considered if the delirium is complex or if there are underlying psychiatric issues contributing to the presentation.

Correct Answer: B

Rationale: The nurse's best approach to address the patient's fear of needles before a blood draw is to provide the patient with information about relaxation techniques and distraction methods (Option B). Dismissing the patient's fear (Option A), ignoring the fear and proceeding quickly (Option C), or telling the patient that the fear is irrational and unfounded (Option D) would not be helpful and could potentially escalate the patient's anxiety. Providing information on relaxation techniques such as deep breathing or visualization, as well as distraction methods like listening to music or engaging in conversation, can help the patient feel more comfortable and reduce their fear and anxiety during the blood draw procedure. It is important for the nurse to acknowledge and address the patient's concerns in a supportive and empathetic manner to build trust and ensure a successful blood draw experience.

Correct Answer: D

Rationale: The Good Samaritan Law offers legal protection to individuals who voluntarily provide assistance at the scene of an emergency or accident. These laws vary by state, but generally, they grant immunity from civil liability for the individual providing aid as long as they act in good faith and without expectation of compensation. In this case, the retired nurse who stopped to help in the emergency at the scene of an accident would likely be covered by the Good Samaritan Law, protecting her from being sued by the injured party for any unintended consequences of her efforts to assist.

Correct Answer: B

Rationale: In a patient with acute respiratory failure and hypercapnia due to a COPD exacerbation, the most appropriate intervention is the initiation of non-invasive positive pressure ventilation (NIPPV). NIPPV helps improve ventilation and oxygenation by providing mechanical support to the patient's breathing without the need for endotracheal intubation. It can reduce the work of breathing, decrease carbon dioxide retention, and improve respiratory muscle function. This intervention is particularly beneficial for COPD exacerbations as it can help alleviate hypercapnia and hypoxemia, leading to improved outcomes and potentially reducing the need for invasive ventilation methods. Therefore, NIPPV is the recommended management strategy in this scenario.

Correct Answer: A

Rationale: The clinical presentation of a patient with progressive dyspnea, non-productive cough, fine inspiratory crackles, and HRCT findings of diffuse reticular opacities and traction bronchiectasis is highly suggestive of idiopathic pulmonary fibrosis (IPF). IPF is a specific subtype of ILD characterized by progressive scarring of the lung tissue, leading to the symptoms mentioned above. The presence of reticular opacities and traction bronchiectasis on HRCT is a typical finding in IPF.

Correct Answer: A

Rationale: IgA is the primary immunoglobulin class involved in providing passive immunity to newborn infants through breast milk. IgA antibodies are highly concentrated in colostrum and breast milk, offering important protection to newborns against infections. IgG antibodies can also be passed from the mother to the fetus through the placenta, providing passive immunity during pregnancy, but IgA is the main immunoglobulin class transferred through breast milk for protecting the infant's gastrointestinal and respiratory tracts. IgE is mainly involved in allergies and hypersensitivity reactions, while IgM is an early responder in the immune response to infections.

Correct Answer: C

Rationale: During a transurethral resection of the prostate (TURP), fluid irrigation is commonly used to distend the bladder and flush out tissue debris. However, it is important to prioritize preventing fluid overload in the patient. Limiting the duration of irrigation fluid instillation is a crucial action to prevent excessive fluid absorption and subsequent fluid overload. Prolonged irrigation may lead to an increased risk of fluid overload and electrolyte imbalances, which can result in serious complications such as hyponatremia and fluid volume excess. Monitoring the patient's serum electrolyte levels can be important, but limiting the duration of irrigation is a more immediate and proactive measure to prevent fluid overload. Administering diuretic medications before the procedure may not be appropriate without assessing the patient's specific fluid status and needs. Adjusting the irrigation fluid temperature, while important for hemostasis, does not directly

Correct Answer: D

Rationale: Factor V Leiden mutation is the most common inherited predisposition to venous thrombosis. In this condition, there is a specific mutation in the factor V gene (also known as factor V Leiden) that makes factor V resistant to inactivation by activated protein C. This resistance leads to excessive clot formation, increasing the risk of recurrent venous thrombosis like DVT and PE. Patients with Factor V Leiden mutation may have a history of recurrent unprovoked venous thrombosis at a young age. In comparison, antithrombin III deficiency, protein C deficiency, and protein S deficiency are other inherited thrombophilias that may increase the risk of venous thrombosis, but Factor V Leiden mutation is the most likely cause in this case based on the presentation of recurrent episodes without apparent provoking factors.

Correct Answer: B

Rationale: Proton pump inhibitors (PPIs) are commonly prescribed for conditions involving excessive stomach acid production, such as peptic ulcer disease. One of the potential adverse effects of PPIs, such as omeprazole or pantoprazole, is the risk of hypokalemia. Hypokalemia is a condition characterized by low levels of potassium in the bloodstream. Prolonged use of PPIs can inhibit the absorption of potassium in the intestines, leading to a decrease in potassium levels in the body. Hypokalemia can present with symptoms such as muscle weakness, fatigue, irregular heartbeat, and in severe cases, it can result in life-threatening complications like cardiac arrhythmias. Therefore, it is essential for the nurse to closely monitor the patient for signs and symptoms of hypokalemia while on PPI therapy, especially if the patient is at risk for developing electrolyte imbalances.