A patient is brought to the emergency department unconscious following a barbiturate overdose. Which potential complication will the nurse include when developing the plan of care?

Correct Answer: A

Rationale: The correct answer is A: Hypercapnic respiratory failure related to decreased ventilatory effort. Barbiturates can depress the central nervous system, leading to decreased respiratory drive and effort, resulting in hypercapnia (elevated CO2 levels) and respiratory acidosis. This can progress to respiratory failure. The other choices are incorrect because hypoxemic respiratory failure related to diffusion limitations (B) or shunting of blood (C) are not typically associated with barbiturate overdose. Hypercapnic respiratory failure related to increased airway resistance (D) is also unlikely with barbiturate overdose, as the primary mechanism is central respiratory depression.

Correct Answer: D

Rationale: The correct answer is D because NIPPV is appropriate for patients with respiratory failure due to myasthenia gravis to provide ventilatory support. Myasthenia gravis is a neuromuscular disorder that can lead to respiratory muscle weakness. NIPPV can help improve ventilation and oxygenation in these patients. Choice A is incorrect because NIPPV may not be suitable for patients with unstable cardiac output and blood pressure. Choice B is incorrect as NIPPV is not typically used for respiratory failure caused by head injury with loss of consciousness. Choice C is incorrect because NIPPV may not be the first-line intervention for cystic fibrosis patients with copious secretions.

Correct Answer: C

Rationale: The correct answer is C: white-out infiltrates bilaterally. In ARDS, chest x-ray typically shows diffuse bilateral infiltrates leading to a white-out appearance. This is due to widespread alveolar damage and flooding of alveoli with fluid. The other choices are incorrect because A (infiltrates only on the upper lobes) is not typical for ARDS, B (enlargement of the heart with bilateral lower lobe infiltrates) suggests congestive heart failure, and D (normal chest x-ray) would not be expected in a patient with deteriorating respiratory function like in ARDS.

Correct Answer: C

Rationale: The correct answer is C: 'I need to talk to you about the unit policies regarding client assignments.' This response addresses the issue directly by discussing the unit policies and the expectations for client assignments. It shows a professional approach and aims to resolve the situation through communication and clarification. Choice A is incorrect because it focuses on personal feelings rather than addressing the refusal to perform the task. Choice B is incorrect as involving the director of nursing may escalate the situation unnecessarily. Choice D is incorrect as it assumes facts not in evidence and could lead to a defensive response from the AP.

Correct Answer: A

Rationale: The correct answer is A. Keeping an appointment with a client demonstrates fidelity, which is the ethical principle of keeping promises and commitments made to clients. By honoring the appointment, the nurse shows respect for the client's time and trust in the therapeutic relationship. Choice B is incorrect because allowing a new mother to hold her stillborn infant relates more to compassion and empathy rather than fidelity. Choice C is incorrect as confirming a signed consent form is related to autonomy and informed consent, not fidelity. Choice D is incorrect as refusing to disclose information to the media pertains to confidentiality and privacy, not fidelity.