During a home health visit a nurse talks with a patient and his family caregiver about the patient's medications. The patient has hypertension and renal disease. Which of the following findings place him at risk for an adverse drug event? (Select all that apply.)

Correct Answer: B

Rationale: The correct answer is B. Taking a total of eight different medications during the day places the patient at risk for an adverse drug event due to the potential for drug interactions, side effects, and medication errors. With multiple medications, there is a higher risk of medication non-adherence and confusion. The other choices are incorrect because: A: Taking two medications for hypertension is a common practice and may not necessarily increase the risk of an adverse drug event. C: Having one physician who reviews all medications is a positive factor that can help prevent adverse drug events by ensuring proper coordination of care. D: The patient's health history of renal disease is important to consider when prescribing medications but does not directly place him at risk for an adverse drug event unless specific medications are contraindicated for renal disease.

Correct Answer: A

Rationale: The correct answer is A: Restlessness. Restlessness is an early sign of hypoxemia due to the body's attempt to increase oxygen intake. Hypotension (B) is a late sign in hypoxemia. Central cyanosis (C) is a late sign when the lips and mucous membranes appear blue. Cardiac dysrhythmias (D) are also a late sign in hypoxemia due to inadequate oxygen supply to the heart. Restlessness is the earliest indicator of hypoxemia compared to the other options.

Correct Answer: B

Rationale: The correct answer is B: Pneumothorax. High levels of PEEP in ARDS can lead to overdistension of alveoli, causing barotrauma and increasing the risk of pneumothorax. Pneumothorax is a serious complication that can lead to respiratory distress and requires immediate intervention. Pulmonary embolism (A) is a concern in ARDS but is not directly related to high PEEP levels. Bronchospasm (C) is not a common complication of high PEEP in ARDS. Pleural effusion (D) is caused by fluid accumulation in the pleural space, which is not directly related to high PEEP levels.

Correct Answer: B

Rationale: The correct answer is B: on the right side. When the patient with left lower-lobe pneumonia is positioned on the right side, gravity helps drain secretions from the affected area, improving ventilation and gas exchange. Placing the patient on the left side (A) may worsen oxygenation by further compromising the already affected lobe. High-Fowler's position (C) may not be as effective in promoting drainage as side-lying positions. The tripod position (D) is commonly used for patients with respiratory distress, but in this case, side positioning is more beneficial for improving gas exchange in the specific affected area.

Correct Answer: B

Rationale: The correct answer is B: Chest tube insertion on the left side. Tracheal deviation to the right side indicates tension pneumothorax, where air accumulates in the pleural space, displacing the mediastinum and trachea. Inserting a chest tube on the left side will decompress the pneumothorax, restoring normal breathing. Option A is incorrect because the chest tube should be inserted on the side opposite the deviation. Option C, intubation, is not the first-line treatment for tension pneumothorax. Option D, tracheostomy, is not indicated in this emergent scenario.