Correct Answer: D

Rationale: The correct answer is D (Respiratory alkalosis). Morphine sulfate can cause respiratory depression, leading to decreased respiratory rate. In this case, the patient's breaths decrease from 12 to 4 breaths/min, indicating hypoventilation. With decreased ventilation, there is less CO2 elimination, resulting in respiratory alkalosis. The other choices can be ruled out: A (Metabolic acidosis) and B (Metabolic alkalosis) are less likely caused by morphine sulfate, and C (Respiratory acidosis) is incorrect because the scenario describes hypoventilation, not hyperventilation.

Correct Answer: A

Rationale: The correct answer is A: Clinical practice guidelines. Clinical practice guidelines are evidence-based recommendations that assist nurses in providing appropriate care based on research. They outline best practices for specific patient populations or conditions, helping nurses make informed decisions. Summary: - B: Computerized physician order entry: While it may improve accuracy and efficiency, it does not specifically ensure care based on research. - C: Consulting with advanced practice nurses: While collaboration is valuable, it does not guarantee care based on research. - D: Implementing Joint Commission National Patient Safety Goals: Important for patient safety, but not directly related to ensuring care based on research.

Correct Answer: A

Rationale: The correct answer is A because it aligns with the ethical principle of patient autonomy, which emphasizes the patient's right to make decisions about their own care. Withholding or withdrawing life-sustaining treatments, including nutrition, antibiotics, and blood products, respects the patient's autonomy. This choice also reflects the principle of beneficence, as it aims to prevent unnecessary suffering and respects the patient's wishes. Option B is incorrect because it focuses on pain and anxiety management rather than the broader ethical considerations of withholding life-sustaining treatments. Option C is incorrect because withdrawing life-sustaining treatments while a patient is receiving paralytic agents can pose additional risks and complications, potentially conflicting with the principles of nonmaleficence and beneficence. Option D is incorrect because the primary goal of withdrawing or withholding treatments is not to hasten death but to respect the patient's autonomy and quality of life. This choice does not align with the ethical principles of patient-centered care.

Correct Answer: D

Rationale: The correct answer is D: Determine the patient’s work of breathing. Assessing the exhaled tidal volume (EV) in a mechanically ventilated patient helps determine how much effort the patient is exerting to breathe. By monitoring the EV, the nurse can evaluate the patient's respiratory status and adjust ventilator settings if needed. It is crucial to ensure that the patient is not working too hard to breathe, as this can lead to respiratory distress. Incorrect answers: A: Assess for tension pneumothorax - Tension pneumothorax is typically assessed through other means such as physical examination and chest X-ray. B: Assess the level of positive end-expiratory pressure - The level of positive end-expiratory pressure is usually set based on the patient's condition and not solely based on the exhaled tidal volume. C: Compare the tidal volume delivered with the tidal volume prescribed - This comparison is important but does not directly relate to assessing the patient's work of breathing.

Correct Answer: A

Rationale: The correct answer is A because it respects the patient's right to privacy while also acknowledging the family's presence. By asking family members if they wish to remain in the room, the nurse allows them to make an informed decision based on their comfort level. This approach fosters open communication and shows respect for the family's emotions. Choice B is incorrect because abruptly removing family members can increase their distress and feelings of powerlessness. Choice C is incorrect as it places the burden of support solely on a staff member, potentially isolating the family from the situation. Choice D is incorrect as it assumes family members should stay without considering their preferences or emotional well-being.