After the change-of-shift report, which patient should the progressive care nurse assess first?

Correct Answer: D

Rationale: The correct answer is D. The patient receiving IV heparin with a PTT of 98 seconds is at risk for bleeding due to the therapeutic range of 60-80 seconds. Assessing this patient first is crucial to prevent potential bleeding complications. A high PTT indicates the blood is not clotting properly, increasing the risk of bleeding. Prompt assessment and possible adjustment of heparin infusion are needed. A: The patient with a temperature of 101.4°F may have a fever but is not at immediate risk compared to the patient with a high PTT. B: The patient on BiPAP with a respiratory rate of 16 is stable and does not require immediate assessment. C: The patient post-percutaneous coronary intervention needing to void is a routine need and does not require immediate attention compared to the patient with a critical lab value.

Correct Answer: C

Rationale: The correct answer is C because placing the patient with the head of the bed elevated 30 degrees is the best position for obtaining an accurate PAOP reading. Elevating the head of the bed helps to align the phlebostatic axis with the atrium, ensuring an accurate measurement of PAOP. This position reduces the impact of hydrostatic pressure on the reading. Options A and D are incorrect because the supine position and recording during exhalation or just before the increase in pressures during inhalation can lead to inaccurate readings. Option B is incorrect because documenting the average PAOP after three measurements does not address the importance of positioning for accuracy.

Correct Answer: A

Rationale: The correct answer is A because when family members are confused about the patient's condition or treatment, it can indicate a lack of communication or understanding, leading to a potential ethical dilemma. This confusion may result in conflicting views on what is best for the patient, potentially leading to disagreements and ethical conflicts. Choice B is incorrect because although family conflict can lead to ethical dilemmas, it is not a direct warning sign that an ethical dilemma exists. Choice C is incorrect because the family asking not to inform the patient about treatment is more related to communication preferences rather than a clear indication of an ethical dilemma. Choice D is incorrect because a deteriorating patient condition, while concerning, does not directly signal an ethical dilemma unless there are specific ethical considerations involved in the treatment decisions.

Correct Answer: D

Rationale: The correct answer, D, is supported by the fact that providing aggressive care to patients when nurses believe it is futile can lead to personal ethical conflicts and burnout. This is because nurses may experience moral distress when their values conflict with the care they are providing. This can result in emotional exhaustion and decreased job satisfaction, ultimately leading to burnout. Choice A is incorrect because attending funerals can be a way for nurses to process their grief and find closure, rather than creating additional stress. Choice B is incorrect because caring for dying patients can have emotional impacts on nurses, regardless of their professional approach. Choice C is incorrect because balancing care needs with personal emotional needs can be challenging and may not always be achievable.

Correct Answer: B

Rationale: The correct answer is B: Improvement in symptoms and quality of life. In palliative care, the primary focus is on enhancing the patient's quality of life by managing symptoms and providing comfort. This is achieved through effective symptom control, psychosocial support, and improving overall well-being. Complete resolution of the underlying disease (A) is often not possible in palliative care as the focus shifts from curative treatments to comfort care. Increased adherence to curative treatments (C) may not be the main goal in palliative care, as the emphasis is on improving the patient's comfort rather than prolonging life. Achievement of long-term survival goals (D) is not typically the primary outcome in palliative care, as the focus is on providing support and care for patients with life-limiting illnesses.

Correct Answer: B

Rationale: The correct answer is B: “This injection is being given to prevent blood clots from forming.” Enoxaparin is an anticoagulant used to prevent blood clots. It is administered through injection, not orally (A). Enoxaparin does not dissolve existing blood clots (C). Contacting the primary care provider to discuss the medication is not necessary in this scenario (D). The correct choice emphasizes the purpose of enoxaparin in preventing new blood clots.

Correct Answer: C

Rationale: The correct answer is C: Collaboration with patients, families, and team members. By addressing the family's concern about lack of communication with the physician and arranging a meeting between the intensivist and the family, the nurse is demonstrating collaboration skills in facilitating communication and ensuring the family's questions are addressed. This competency emphasizes the importance of working together with patients, families, and the healthcare team to provide optimal care. Incorrect choices: A: Advocacy and moral agency in solving ethical issues - While advocacy is important in nursing, in this scenario, the focus is on communication and collaboration rather than ethical issues. B: Clinical judgment and clinical reasoning skills - Although these skills are crucial in critical care nursing, the situation described does not primarily involve clinical judgment but rather communication and collaboration. D: Facilitation of learning for patients, families, and team members - While patient education is important, the main focus of the scenario is on addressing the family's concerns and facilitating communication, rather than educational aspects.

Correct Answer: B

Rationale: The correct answer is B: Administer oxygen as prescribed. Dyspnea in a hospice patient often indicates respiratory distress, and administering oxygen can help improve oxygenation and alleviate breathing difficulty. Positioning the patient flat on their back (A) may worsen dyspnea due to increased pressure on the diaphragm. Restricting fluid intake (C) is not appropriate as dehydration can exacerbate respiratory distress. Chest physiotherapy (D) may not be suitable for a hospice patient experiencing dyspnea as it can be physically taxing and may not address the underlying cause effectively.

Correct Answer: A

Rationale: The correct answer is A: Bilateral infiltrates on chest x-ray study. ARDS diagnosis requires bilateral infiltrates on chest x-ray, indicative of non-cardiogenic pulmonary edema. Choice B, decreased cardiac output, is not a diagnostic criterion for ARDS. Choice C, PaO2/FiO2 ratio of less than 200, is a key diagnostic criteria for ARDS, indicating severe hypoxemia. Choice D, PAOP of more than 18 mm Hg, is used to differentiate between cardiogenic and non-cardiogenic causes of pulmonary edema, but it is not a direct diagnostic criterion for ARDS.