A patient with respiratory failure has arterial pressure-based cardiac output (APCO) monitoring and is receiving mechanical ventilation with peak end-expiratory pressure (PEEP) of 12 cm H2O. Which information indicates that a change in the ventilator settings may be required?

Correct Answer: A

Rationale: The correct answer is A. A decrease in the arterial pressure (hypotension) with a low diastolic pressure (46 mmHg) may indicate inadequate perfusion, possibly due to inadequate cardiac output from the mechanical ventilation. This suggests that a change in ventilator settings may be required to improve oxygenation and perfusion. Option B is incorrect because a heart rate of 58 beats/minute alone does not provide direct information on the patient's hemodynamic status. Option C is incorrect as an increased stroke volume would usually be a positive indicator; it does not necessarily indicate a need for changing the ventilator settings. Option D is incorrect as a stroke volume variation of 12% is within normal limits and does not necessarily require a change in ventilator settings.

Correct Answer: B

Rationale: The correct answer is B: Avoid infusing vasoactive agents in the port used to obtain the TdCO measurement. This action ensures patient safety by preventing the introduction of vasoactive agents directly into the bloodstream during the measurement process. Infusing vasoactive agents can lead to inaccurate TdCO readings and potentially harm the patient. Choice A is incorrect because zero referencing the transducer system at the level of the phlebostatic axis is important for accurate pressure monitoring but not directly related to TdCO measurement safety. Choice C is incorrect as maintaining a pressure of 300 mm Hg on the flush solution bag is not directly related to the safety of TdCO measurement. Choice D is incorrect as limiting the length of noncompliant pressure tubing is important for accurate pressure readings but not directly related to the safety of TdCO measurement.

Correct Answer: D

Rationale: The correct answer is D because it demonstrates respect for the patient's autonomy and individual preferences. By asking the patient's husband about religious and cultural preferences, the nurse acknowledges the importance of involving the family in decision-making and shows sensitivity to the patient's beliefs. This approach promotes cultural competence and patient-centered care. Choice A is incorrect because insisting on a female doctor may not align with the patient's preferences and may limit the available medical staff. Choice B is also incorrect as dietary restrictions are not necessarily the most pressing issue in this scenario. Choice C is incorrect as it assumes a cultural practice without verifying the patient's specific preferences and may not be necessary or appropriate in this context.

Correct Answer: A

Rationale: The correct answer is A: American Association of Critical-Care Nurses (AACN). This organization focuses exclusively on critical care nursing, offering specialized education, resources, and certifications for critical care nurses. AACN advocates for high standards of care in critical care settings. The other choices do not specifically cater to critical care nursing practice. The American Heart Association focuses on cardiovascular health, the American Nurses Association is a general nursing organization, and the Society of Critical Care Medicine is more physician-centric. Therefore, A is the best choice for supporting critical care nursing practice.

Correct Answer: C

Rationale: The correct answer is C because it reflects patient-centered care by involving patients and families in decision-making. Collaborating with them on visitation preferences promotes a supportive environment. Choice A restricts animal visitation, not addressing human visitors. Choice B limits visitation during specific times, not individualized. Choice D imposes restrictions based on age, not on patient/family preferences. Therefore, Choice C is the most aligned with current recommendations for open visitation policies.

Correct Answer: A

Rationale: The correct answer is A: Elevated creatinine. Ibuprofen can cause kidney damage, leading to elevated creatinine levels. This is because ibuprofen is metabolized in the kidneys, and prolonged use can impair kidney function. Elevated platelet count (B), elevated white blood count (C), and low liver enzymes (D) are not typically associated with ibuprofen use. Platelet count and white blood count are more related to inflammation or infection, while low liver enzymes are not a common side effect of ibuprofen.

Correct Answer: A

Rationale: The correct answer is A: Increase functional residual capacity. Positive end-expiratory pressure (PEEP) helps increase the functional residual capacity by keeping the alveoli open at the end of expiration. This prevents alveolar collapse, improves ventilation-perfusion matching, and enhances oxygenation. B: Prevent collapse of unstable alveoli - This is incorrect because PEEP actually helps prevent the collapse of all alveoli, not just unstable ones. C: Improve arterial oxygenation - This is partially correct, but the primary mechanism through which PEEP improves oxygenation is by increasing functional residual capacity. D: Open collapsed alveoli - This is incorrect because PEEP helps prevent alveolar collapse rather than actively opening already collapsed alveoli.

Correct Answer: B

Rationale: The correct answer is B: Change in sputum characteristics. This is a cue for postoperative pneumonia in a COPD patient because it can indicate an infection in the lungs. Postoperative pneumonia is a common complication in patients with COPD due to impaired lung function and weakened immune system. Other choices are incorrect: A) Bradycardia is not a specific indicator of postoperative pneumonia. C) Hypoventilation and respiratory acidosis can be seen in patients with COPD but are not specific to postoperative pneumonia. D) Pursed-lip breathing is a coping mechanism for patients with COPD and is not directly related to postoperative pneumonia.

Correct Answer: A

Rationale: The correct answer is A: Inability to communicate. Critically ill patients often experience pain and anxiety due to their inability to effectively communicate their needs and discomfort. This can lead to unaddressed pain and increased anxiety levels. Choices B, C, and D are incorrect because while invasive procedures, monitoring devices, and preexisting conditions can contribute to pain and anxiety in critically ill patients, they are not factors that directly predispose patients to these issues. It is the lack of communication that significantly hinders the ability to address and manage pain and anxiety effectively in these patients.