A patient with ARDS has been on PEEP therapy for 24 hours. What complication should the nurse monitor for during this therapy?

Correct Answer: B

Rationale: In the context of ARDS (Acute Respiratory Distress Syndrome), the correct answer is B) Barotrauma from excessive airway pressures. ARDS patients often require positive end-expiratory pressure (PEEP) therapy to improve oxygenation. However, prolonged or excessive PEEP can lead to barotrauma, where the increased pressure in the airways can damage lung tissue and cause complications such as pneumothorax or subcutaneous emphysema. Option A) Increased cardiac output is incorrect because PEEP therapy typically does not directly affect cardiac output in the context of ARDS. Option C) Decreased pulmonary compliance could be a possible consequence of ARDS itself, but it is not specifically related to the complication of PEEP therapy. Option D) Reduction in alveolar oxygen diffusion is not a direct complication of PEEP therapy but rather a potential consequence of ARDS pathology. Educationally, understanding the potential complications of PEEP therapy in ARDS patients is crucial for nurses caring for these critically ill individuals. Monitoring for signs of barotrauma, such as subcutaneous emphysema, asymmetrical chest movement, or sudden deterioration in oxygenation, is essential to prevent further harm and provide timely interventions. Nurses must also ensure proper PEEP settings and closely monitor the patient's response to therapy to optimize outcomes and prevent complications.

Correct Answer: C

Rationale: In the context of caring for a patient with acute respiratory distress syndrome (ARDS), the correct answer is option C) The patient's PaO2 is 90 mm Hg, and the SaO2 is 92%. This information indicates that prone positioning, a technique used to improve oxygenation in ARDS patients by optimizing ventilation-perfusion matching, is effective. An increase in PaO2 and SaO2 levels suggests improved oxygen exchange, indicating the success of the intervention. Option A is incorrect because intact skin on the back is more indicative of pressure ulcer prevention rather than the effectiveness of prone positioning for ARDS. Option B is unrelated to the effectiveness of prone positioning and pertains more to infection control. Option D is also incorrect as minimal mucous return after endotracheal suctioning does not directly correlate with the effectiveness of prone positioning in ARDS management. Educationally, understanding the rationale behind the correct answer reinforces the importance of monitoring oxygenation parameters in patients with ARDS undergoing prone positioning. It highlights the significance of using evidence-based practice to assess the effectiveness of interventions and make informed clinical decisions to optimize patient outcomes.

Correct Answer: B

Rationale: Humidifying the oxygen can help alleviate nasal discomfort caused by the drying effect of high-flow oxygen. Sitting up or using an extra pillow may improve comfort but will not address the dryness caused by the oxygen flow. Switching to a face mask is not necessary unless the patient requires a higher oxygen concentration.

Correct Answer: A

Rationale: The correct answer is A) 'I need to talk to you about unit expectations regarding delegating and completing tasks.' This response is appropriate because it directly addresses the behavior of delegating unfairly and leaving tasks incomplete. It opens the door for a constructive conversation about the issue, focusing on unit expectations and professional behavior. Option B is incorrect because it does not promote a solution-focused approach and may lead to defensiveness or conflict. Option C is not the best choice as it immediately threatens to involve higher authority without attempting to address the issue directly with the staff nurse first. Option D is also incorrect as it uses accusatory language that can escalate the conflict rather than resolve it. In an educational context, it is crucial for nurse leaders to address conflicts in a professional and constructive manner. By choosing option A, the charge nurse demonstrates effective communication skills, leadership, and a commitment to resolving conflicts within the team to maintain a safe and efficient work environment. It also promotes a culture of accountability and teamwork, essential for ensuring client safety and quality care delivery.

Correct Answer: B

Rationale: In this scenario, option B is the correct choice because it aligns with the legal standard used to determine negligence in a situation where a client is injured while under a nurse's care. The standard of care is established by what a reasonable, prudent nurse would do in a similar situation. Therefore, the testimony of another staff nurse regarding the expected actions of a competent and careful nurse is crucial in assessing whether negligence occurred. Option A is incorrect because the opinion of an expert nurse is not the standard used in legal proceedings to determine negligence. Option C is incorrect as the opinion of the client's attorney does not establish the standard of care for nursing practice. Option D is also incorrect because the client's provider's testimony does not define the standard of care for nursing. Educationally, understanding the legal implications of nursing practice is essential for all healthcare professionals. Nurses need to be aware of the standards of care expected of them and how these standards are applied in legal situations involving patient injuries. By knowing the correct legal standard of care, nurses can ensure they practice in a manner that minimizes the risk of negligence allegations and protects both themselves and their patients.