A patient who is undergoing withdrawal of mechanical ventilation appears anxious and agitated. The patient is on a continuous morphine infusion and has an additional order for lorazepam 1 to 2 mg IV as needed (prn). The patient has received no lorazepam during this course of illness. What is the most appropriate nursing intearbvirbe.ncotmio/tnes tt o control agitation?

Correct Answer: B

Rationale: Step-by-step rationale for why choice B is correct: 1. Midazolam is a benzodiazepine used for sedation and anxiolysis. 2. It acts quickly and has a short duration of action, suitable for acute agitation. 3. Lorazepam (also a benzodiazepine) is in the same drug class, ensuring compatibility. 4. Lorazepam is specifically ordered for this patient, indicating its appropriateness. 5. Administering midazolam addresses the patient's agitation efficiently and safely. Summary of why other choices are incorrect: A: Fentanyl is an opioid analgesic, not ideal for managing agitation. C: Increasing morphine infusion can exacerbate sedation or respiratory depression. D: Paralytic agents are used for neuromuscular blockade, not agitation control.

Correct Answer: A

Rationale: The correct answer is A: 46.8; meets criteria for ARDS. The PaO /FiO ratio is calculated by dividing the arterial oxygen partial pressure (PaO) by the fraction of inspired oxygen (FiO). In this case, PaO is 78 mm Hg and FiO is 0.6 (60%). Therefore, the calculation would be 78/0.6 = 130. This value is less than 300, which is indicative of ARDS according to the Berlin criteria. Choices B and C are incorrect as they do not align with the criteria for ARDS. Choice D is incorrect because the data provided is sufficient to compute the ratio.

Correct Answer: C

Rationale: The correct answer is C because inquiring about specific cultural rituals and preferences shows respect for the patient's cultural beliefs and values. By asking about these aspects, the nurse can provide care that aligns with the patient's cultural background, promoting comfort and understanding. This action also demonstrates a commitment to individualized care. Choice A is incorrect because standardized care may not always be culturally appropriate. Choice B is incorrect as avoiding discussions about death can hinder effective communication and support. Choice D is incorrect as advising families to strictly follow hospital guidelines may overlook the importance of cultural considerations in end-of-life care.

Correct Answer: C

Rationale: The correct answer is C: Notify the health care provider. When the PA waveform indicates the catheter is in the wedged position, it means the catheter tip is in the pulmonary artery, potentially causing complications. The nurse should notify the healthcare provider immediately to assess and reposition the catheter to prevent further issues. Zero balancing the transducer (A) or activating the fast flush system (B) are not appropriate actions for this situation. Deflating and reinflating the PA balloon (D) could exacerbate the issue and should only be done under the guidance of the healthcare provider.

Correct Answer: B

Rationale: The correct answer is B: Inhaled bronchodilators and intravenous corticosteroids. Bronchodilators help to quickly open up the airways during an asthma exacerbation, providing immediate relief. Intravenous corticosteroids help reduce airway inflammation and prevent further worsening of symptoms. Corticosteroids by mouth (Choice A) are not as effective as intravenous administration during an acute exacerbation. Prone positioning or continuous lateral rotation (Choice C) is not a recommended treatment for asthma exacerbation. Sedation and inhaled bronchodilators (Choice D) are not appropriate as sedation can depress respiratory function and worsen the condition.

Correct Answer: D

Rationale: The correct answer is D because continuous venovenous hemodialysis combines ultrafiltration, convection, and dialysis techniques. Ultrafiltration removes excess fluid, convection helps in removing solutes, and dialysis involves the diffusion of solutes across a semipermeable membrane. This comprehensive approach ensures effective removal of both fluid and solutes in critically ill patients. Incorrect Answer Analysis: A: Removing fluids and solutes through convection alone is not the complete process in continuous venovenous hemodialysis. B: While volume overload is addressed, continuous venovenous hemodialysis involves more than just removing plasma water. C: Adding dialysate is not the primary method in continuous venovenous hemodialysis; it involves ultrafiltration, convection, and dialysis techniques.

Correct Answer: A

Rationale: The correct answer is A because palliative care indeed focuses on providing relief from pain and other symptoms, enhancing quality of life for patients with serious illnesses. This aligns with the essence of palliative care, which is to provide holistic support to improve comfort and well-being. The other choices are incorrect: B is wrong because palliative care does not aim to cure the underlying disease but rather to alleviate suffering; C is incorrect as palliative care can be initiated earlier in the disease trajectory, not just during the final days; and D is inaccurate because patients can continue receiving treatments alongside palliative care to manage symptoms and improve their quality of life.

Correct Answer: B

Rationale: The correct answer is B because informed consent requires the patient to have knowledge and competence to make a decision. This involves understanding the risks, benefits, and alternatives of the proposed treatment. Choice A is incorrect as it pertains to a physical ability unrelated to decision-making. Choice C is incorrect as consent must be verbal or written, not just nodding. Choice D is incorrect as consent can be obtained in various ways, not specifically through reading and writing in English.

Correct Answer: D

Rationale: The correct answer is D: Maintaining quiet during hours of sleep. This action is essential in reducing environmental stress in the critical care unit as it promotes a restful environment for patients and allows for better sleep quality. Noise can disrupt sleep patterns and increase stress levels. Constant evaluation of patient status (A) is important but does not directly address environmental stress. Limiting visits to immediate family (B) can be beneficial in some cases but may not always reduce environmental stress. Bathing all patients during hours of sleep (C) may actually increase stress as it can be disruptive and uncomfortable for patients. Overall, maintaining a quiet environment during sleep hours is the most effective nursing action to reduce environmental stress in the critical care unit.