The client with ARDS is on a ventilator, and the high alarm indicates an increase in the peak airway pressure. Which intervention should the nurse implement first?

Correct Answer: A

Rationale: The correct answer is A: Check the tubing for any kinks. This should be implemented first because an increase in peak airway pressure may indicate an obstruction in the tubing, causing inadequate ventilation. Checking for kinks ensures the client receives adequate oxygenation and ventilation. Suctioning for secretions (B) would be secondary if kinks are ruled out. Assessing the lip line of the ET tube (C) is important but not as urgent as checking for kinks. Sedating the client with a muscle relaxant (D) is not appropriate as the first intervention for high peak airway pressure.

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: D

Rationale: The correct answer is D because NIPPV is appropriate for patients with respiratory failure due to myasthenia gravis to provide ventilatory support. Myasthenia gravis is a neuromuscular disorder that can lead to respiratory muscle weakness. NIPPV can help improve ventilation and oxygenation in these patients. Choice A is incorrect because NIPPV may not be suitable for patients with unstable cardiac output and blood pressure. Choice B is incorrect as NIPPV is not typically used for respiratory failure caused by head injury with loss of consciousness. Choice C is incorrect because NIPPV may not be the first-line intervention for cystic fibrosis patients with copious secretions.

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.