A patient with terminal illness expresses a desire to spend quality time with their family but feels guilty for being a burden. How should the palliative nurse respond?

Correct Answer: C

Rationale: In this situation, the most appropriate response for the palliative nurse is to validate the patient's feelings of guilt and offer support to address their concerns. It is important to acknowledge the patient's emotions and help them navigate through their guilt in a compassionate and understanding manner. By validating their feelings, the nurse can create a safe space for the patient to express their concerns and work towards finding solutions to alleviate their guilt. This approach fosters trust and a therapeutic relationship between the patient and the nurse, ultimately promoting emotional well-being and facilitating open communication.

Correct Answer: A

Rationale: The most appropriate intervention for managing hepatic encephalopathy in this patient receiving palliative care for end-stage liver disease is to administer lactulose or other ammonia-lowering agents to reduce ammonia levels. Hepatic encephalopathy is believed to be primarily caused by the accumulation of ammonia in the bloodstream due to compromised liver function. Lactulose works by acidifying the gut lumen, which facilitates the excretion of ammonia in the form of ammonium ions. By reducing ammonia levels, hepatic encephalopathy symptoms, such as confusion and altered mental status, can be improved. Initiating other supportive measures like managing precipitating factors, maintaining hydration, and addressing nutritional issues should also be part of the holistic approach in managing hepatic encephalopathy in palliative care. However, addressing the underlying cause by reducing ammonia levels with lactulose is the priority intervention in this scenario.

Correct Answer: A

Rationale: In a patient with acute gastrointestinal bleeding requiring urgent intervention, the healthcare team should prioritize performing endoscopic hemostasis with mechanical or thermal techniques. Endoscopy allows for direct visualization of the source of bleeding in the gastrointestinal tract, enabling targeted interventions such as clipping, cauterization, or injection of epinephrine to achieve hemostasis. This approach is effective in managing acute bleeds and can help stop the bleeding quickly, reducing the need for more invasive procedures or surgeries. Administering proton pump inhibitors (PPIs) may be considered for acid-related bleeding, but it is not the primary intervention for acute bleeding requiring urgent management. Strict bed rest may not be necessary and can increase the risk of complications such as deep vein thrombosis. Transfusion of fresh frozen plasma may be indicated if there is evidence of coagulopathy, but addressing the bleeding source should be the initial priority to

Correct Answer: A

Rationale: ** In a patient with ARDS, the priority intervention to manage respiratory failure is to initiate lung-protective mechanical ventilation with low tidal volume. ARDS is characterized by widespread inflammation and injury to the alveoli, leading to impaired gas exchange and severe hypoxemia. Lung-protective ventilation strategies aim to minimize ventilator-induced lung injury by using lower tidal volumes (around 6 mL/kg of predicted body weight) to reduce barotrauma and volutrauma.

Correct Answer: D

Rationale: In the scenario described, with the patient having an acute exacerbation of chronic kidney disease (CKD) leading to hyperkalemia and metabolic acidosis, the priority intervention to manage the metabolic derangements is to perform emergent hemodialysis for potassium removal. Hemodialysis is the most effective and rapid method to lower dangerously high potassium levels in the blood. It is crucial in cases of severe hyperkalemia where other measures such as medications or dietary modifications may not be sufficient or fast enough to correct the elevated potassium levels. Additionally, hemodialysis can also help in improving metabolic acidosis by removing waste products and excess electrolytes from the blood. Overall, emergent hemodialysis is the most appropriate intervention for managing the acute metabolic abnormalities in this critically ill patient.