Continuous venovenous hemofiltration is used to

Correct Answer: A

Rationale: The correct answer is A because continuous venovenous hemofiltration (CVVH) primarily removes fluids and solutes through the process of convection. In CVVH, blood flows through a filter where hydrostatic pressure drives plasma water and solutes across a semipermeable membrane. This process mimics the natural filtration that occurs in the kidneys. Choice B is incorrect because CVVH does not specifically target plasma water only but also removes solutes. Choice C is incorrect because CVVH does not involve adding dialysate to remove plasma water and solutes. Choice D is incorrect because while CVVH may involve ultrafiltration and convection, it does not typically include dialysis as a primary mechanism for solute removal.

Correct Answer: D

Rationale: Step 1: The correct answer is D because the situation involves a patient with multiple trauma who is not responding to treatment and has no known family members. This indicates a complex ethical dilemma where the medical team may be unsure about the appropriate course of action. Step 2: In this scenario, an ethics consultation is necessary to help guide decision-making regarding the care of the patient. The lack of available family members complicates decision-making, and the consideration of care as futile adds another layer of complexity. Step 3: An ethics consultation can provide a structured framework for evaluating the situation, considering ethical principles such as beneficence, non-maleficence, autonomy, and justice. It can help the healthcare team navigate the ethical considerations and make a well-informed decision in the best interest of the patient. Summary: Choice A: While conflicts between the primary care provider and family may warrant discussions, the agreement on a treatment plan does not necessarily require an ethics consultation. Choice B: Disagreement

Correct Answer: C

Rationale: The correct answer is C: Primary nursing. Primary nursing is a care delivery model where one nurse is responsible for the total care of a group of clients over a 24-hour period. This promotes continuity of care, individualized attention, and better nurse-client relationships. In primary nursing, the nurse plans and directs care, coordinates with other healthcare team members, and serves as the main point of contact for the clients. A: Case management involves coordinating care across different healthcare providers and services, not necessarily focusing on a specific group of clients over a 24-hour period. B: Team nursing involves a team of healthcare providers working together to deliver care, rather than one nurse being responsible for a specific group of clients over a 24-hour period. D: Functional nursing divides tasks among different healthcare team members based on their specific skills, which may not provide the same level of continuity and individualized care as primary nursing.

Correct Answer: D

Rationale: The correct answer is D: Assess and intervene for causes of agitation. In a critically ill patient, agitation while intubated could indicate underlying issues like pain, delirium, or inadequate sedation. By assessing and addressing the root cause of agitation, the nurse can improve patient comfort and prevent potential harm from restraints. Removing restraints periodically for skin integrity (B) and range of motion (C) is important but should not be the primary focus when agitation is present. Maintaining restraints (A) without addressing the agitation could lead to increased distress and potential complications.

Correct Answer: D

Rationale: The correct answer is D: Titrate to a predefined endpoint using a standard sedation scale. This approach ensures individualized dosing based on the patient's response, minimizing the risk of over-sedation or under-treatment. It allows for careful monitoring and adjustment of dosage to achieve the desired level of sedation while avoiding adverse effects. A: Administering medication around the clock may lead to unnecessary sedation and increased risk of side effects. B: Administering medications through a feeding tube is not recommended for benzodiazepines as it may affect absorption and increase the risk of complications. C: Giving the highest allowable dose without considering individual response can result in excessive sedation and adverse effects.

Correct Answer: D

Rationale: The correct answer is D because reducing patient errors is the most important outcome of effective communication in healthcare. Clear and accurate communication among healthcare providers and patients can prevent misunderstandings, leading to fewer errors in diagnosis, treatment, and medication administration. This ultimately improves patient safety and outcomes. A: Demonstrating caring practices to family members is important but not the most crucial outcome of effective communication in healthcare. B: Ensuring that patient teaching is provided is essential, but patient safety through error reduction takes precedence. C: Meeting the diversity needs of patients is crucial for patient-centered care, but error reduction directly impacts patient safety, making it more critical.

Correct Answer: D

Rationale: The correct answer is D: “Recovery is possible, but it may take several months.” This response is the best choice as it provides a balanced and accurate explanation to the patient. Here's the rationale: 1. Hemodialysis is often used as a temporary measure to support kidney function while allowing time for the kidneys to recover. 2. Acute kidney injury can be reversible in some cases, especially if the underlying cause is identified and treated promptly. 3. Recovery time varies for each individual, and it can indeed take several months for kidney function to improve. 4. Choices A, B, and C are incorrect: - A is overly pessimistic and does not consider the potential for recovery. - B provides a specific timeframe that may not be accurate for all patients. - C is not a reliable indicator of kidney function recovery and may lead to confusion.

Correct Answer: B

Rationale: The correct answer is B: Restlessness. When the body experiences hypoxemia (low oxygen levels), the brain is deprived of oxygen, leading to early signs such as restlessness. This is due to the brain's attempt to increase oxygen intake by increasing activity. Cyanosis (A) is a late sign of hypoxemia when oxygen levels are critically low. Tachycardia (C) and tachypnea (D) are compensatory mechanisms in response to hypoxemia, but they are not early signs affecting the nervous system directly.

Correct Answer: D

Rationale: The correct action is D: Manually ventilate the patient with 100% oxygen. This is crucial to ensure adequate oxygenation and prevent hypoxia. Holding the ET tube can lead to extubation and airway compromise. Activating the rapid response team (A) may delay immediate intervention. Providing reassurance (B) is important but not the priority in this situation. Calling the health care provider (C) to reinsert the tube would also lead to a delay in providing essential respiratory support.