A patient with acute respiratory distress syndrome (ARDS) develops refractory hypoxemia despite maximal ventilatory support and prone positioning. Which of the following adjunctive therapies is most likely to improve oxygenation and reduce mortality in this patient?

Correct Answer: C

Rationale: In a patient with ARDS who is experiencing refractory hypoxemia despite maximal ventilatory support and prone positioning, the use of extracorporeal membrane oxygenation (ECMO) is a potentially life-saving adjunctive therapy. ECMO works by providing temporary support for gas exchange outside the body, allowing the lungs to rest and heal while providing adequate oxygenation and carbon dioxide removal. The use of ECMO has been associated with improved oxygenation and reduced mortality in severe cases of ARDS, especially in patients who fail conventional therapies. High-frequency oscillatory ventilation (HFOV) has not consistently shown mortality benefit in ARDS, continuous renal replacement therapy (CRRT) is not directly indicated for hypoxemia in ARDS, and inhaled nitric oxide (iNO) has shown limited benefit in improving oxygenation in ARDS without a clear impact on mortality.

Correct Answer: B

Rationale: The assessment of a patient who has ingested poison must include determining the poison ingested and the amount (I), the time from ingestion and the signs and symptoms (II), as well as the weight of the patient (III). These factors are essential in evaluating the severity of the poisoning and determining the appropriate treatment plan. However, the patient's immunization history (IV) is not directly relevant to the assessment of ingested poison and thus is not essential in this context.

Correct Answer: D

Rationale: Burnout is a state of emotional, physical, and mental exhaustion caused by excessive and prolonged stress. In this scenario, when staff nurses in the Pediatric Ward are working more than they can handle, they may experience burnout. Burnout can lead to a decrease in enthusiasm for work, feelings of depersonalization, and a reduced sense of personal accomplishment. These consequences can ultimately impact the quality of patient care provided by the nurses. Burnout not only affects the well-being of the healthcare workers but can also result in lower patient care quality, medical errors, and decreased overall job performance. Addressing and preventing burnout is crucial in maintaining a high standard of care and ensuring the well-being of healthcare professionals.

Correct Answer: C

Rationale: Naloxone, also known by the brand name Narcan, is used to reverse the effects of opioid overdose. Opioids can cause respiratory depression, sedation, and other signs of toxicity. Administering naloxone can quickly reverse these effects, restoring the patient's breathing and consciousness. This makes it the appropriate choice for reversing all signs of toxicity related to opioids. Digibind (Digoxin) is used to reverse toxicity from digoxin specifically. Atropine sulfate is used for bradycardia. Diazepam (Valium) is a benzodiazepine used for anxiety, seizures, and muscle relaxation, not for reversing toxicity.

Correct Answer: A

Rationale: In a patient with severe abdominal pain due to end-stage pancreatic cancer, the priority intervention to manage their symptoms would be to provide adequate pain relief. Opioid analgesics are the cornerstone of pain management for cancer patients experiencing severe pain. They work by binding to opioid receptors in the central nervous system, thereby reducing the perception of pain. Opioids are highly effective in managing cancer pain, including abdominal pain, and can significantly improve the patient's quality of life by providing relief from distressing symptoms. Therefore, administering opioid analgesics should be the nurse's primary intervention in this case to address the patient's severe abdominal pain. Initiating enteral nutrition, recommending hot compresses, or referring to a gastroenterologist may be relevant interventions depending on the patient's overall care plan but addressing the pain should be the immediate priority in this scenario.

Correct Answer: A

Rationale: Immersing oneself in the local community and participating in their everyday activities allows the nurse, as a community organizer, to establish trust and build rapport with the people. By actively engaging with the community members, the nurse can show genuine interest and commitment to their well-being, which fosters a sense of connection and mutual understanding. This approach is crucial for gaining the trust of the community, as it demonstrates that the nurse is invested in listening to their needs and working together to address health concerns effectively.

Correct Answer: A

Rationale: The patient's presentation of recurrent episodes of sudden, severe vertigo lasting hours with nausea, vomiting, and nystagmus, along with unilateral weakness on vestibular function tests, is most consistent with vestibular neuritis. Vestibular neuritis is characterized by inflammation of the vestibular nerve leading to sudden onset vertigo that can last for hours to days. It is often associated with nausea, vomiting, and nystagmus. Unilateral weakness on vestibular function tests indicates dysfunction of one vestibular system. Differential diagnosis for this type of presentation includes other conditions such as Meniere's disease, BPPV, and acoustic neuroma. However, the combination of symptoms and unilateral vestibular weakness makes vestibular neuritis the most likely diagnosis in this case.

Correct Answer: B

Rationale: The severe abdominal cramps experienced by the multiparous patient Amy, 28 hours after a Cesarean delivery (CS) and while breastfeeding, are likely caused by the release of Oxytocin during the breastfeeding session. Oxytocin is a hormone that is naturally produced during breastfeeding to stimulate the contraction of the uterus and help reduce postpartum bleeding. These contractions may result in cramping sensations in the abdomen, specifically at the site of the uterus. It is a normal physiological response and an indication that the body is working as it should to support the postpartum recovery process.

Correct Answer: D

Rationale: The prioritized nursing intervention in this situation should be assessing for the risk of harm to self or infant. It is crucial to ensure the safety of the postpartum client and her infant as depression can increase the risk of self-harm or harm to the newborn. By assessing for any potential risks, the nurse can take appropriate actions to prevent any harm and ensure the well-being of both the client and the infant. Once the assessment is completed, further interventions like encouraging participation in support groups, referring to a mental health professional, or administering medications can be considered based on the assessment findings.