All the following medications are ordered for a mechanically ventilated patient with acute respiratory distress syndrome (ARDS) and acute renal failure. Which medication should the nurse discuss with the health care provider before administration?

Correct Answer: C

Rationale: The correct answer is C: IV gentamicin (Garamycin) 60 mg. Gentamicin is a nephrotoxic medication and should be used with caution in patients with acute renal failure, as it can further impair kidney function. Before administering this medication, the nurse should discuss with the healthcare provider to evaluate the risks versus benefits and consider alternative options. A: IV ranitidine (Zantac) 50 mg IV - This medication is commonly used to reduce gastric acid secretion and is not contraindicated in a patient with ARDS and acute renal failure. B: sucralfate (Carafate) 1 g per nasogastric tube - Sucralfate is a mucosal protective agent and is not directly related to renal function. It is safe for use in patients with renal failure. D: IV methylprednisolone (Solu-Medrol) 40 mg - Methylprednisolone is a corticoster

Correct Answer: C

Rationale: The correct answer is C: white-out infiltrates bilaterally. In ARDS, chest x-ray typically shows diffuse bilateral infiltrates leading to a white-out appearance. This is due to widespread alveolar damage and flooding of alveoli with fluid. The other choices are incorrect because A (infiltrates only on the upper lobes) is not typical for ARDS, B (enlargement of the heart with bilateral lower lobe infiltrates) suggests congestive heart failure, and D (normal chest x-ray) would not be expected in a patient with deteriorating respiratory function like in ARDS.

Correct Answer: C

Rationale: The correct answer is C: 'I need to talk to you about the unit policies regarding client assignments.' This response addresses the issue directly by discussing the unit policies and the expectations for client assignments. It shows a professional approach and aims to resolve the situation through communication and clarification. Choice A is incorrect because it focuses on personal feelings rather than addressing the refusal to perform the task. Choice B is incorrect as involving the director of nursing may escalate the situation unnecessarily. Choice D is incorrect as it assumes facts not in evidence and could lead to a defensive response from the AP.

Correct Answer: A

Rationale: The correct answer is A. Keeping an appointment with a client demonstrates fidelity, which is the ethical principle of keeping promises and commitments made to clients. By honoring the appointment, the nurse shows respect for the client's time and trust in the therapeutic relationship. Choice B is incorrect because allowing a new mother to hold her stillborn infant relates more to compassion and empathy rather than fidelity. Choice C is incorrect as confirming a signed consent form is related to autonomy and informed consent, not fidelity. Choice D is incorrect as refusing to disclose information to the media pertains to confidentiality and privacy, not fidelity.

Correct Answer: C

Rationale: The correct answer is C: Review the events leading up to each medication administration error. This is the first step the committee should plan to initiate because it is crucial to understand the root causes of the errors. By reviewing the events, the committee can identify system failures, communication breakdowns, or other contributing factors leading to medication errors. This information is essential for developing targeted interventions to prevent future errors. Choice A (Provide an inservice on medication administration to all the nurses) is not the best initial strategy because simply providing education may not address the underlying issues that contribute to errors. Choice B (Require staff nurses to demonstrate competency by passing a medication administration examination) is important but should come after understanding the root causes of errors to ensure that the examination is effective in preventing future errors. Choice D (Develop a quality improvement program for nurses involved in medication administration errors) is a reactive approach and should be implemented after identifying the causes of errors to provide appropriate support and training for those involved.