The nurse cares for a terminally ill patient who is experiencing pain that is continuous and severe. How should the nurse schedule the administration of opioid pain medications?

Correct Answer: A

Rationale: The correct answer is A: Give around-the-clock routine administration of analgesics. This is the best approach for managing continuous and severe pain in a terminally ill patient. By providing scheduled doses of opioid pain medications, the nurse ensures a consistent level of pain relief, preventing peaks and troughs in pain control. This approach also helps in preventing the patient from experiencing unnecessary suffering. Choice B (PRN doses) may lead to inadequate pain control as the patient may wait too long before requesting medication. Choice C (keeping the patient sedated) is not appropriate as the goal is pain management, not sedation. Choice D (balancing pain control and respiratory rate) is important, but the priority should be on effectively managing the pain first.

Correct Answer: C

Rationale: The correct answer is C: Respiratory acidosis may occur if the patient continues at these ventilator settings. Respiratory acidosis happens when the lungs cannot remove enough of the carbon dioxide (CO2) produced by the body. In this case, the low respiratory rate of 14 breaths/min may not be sufficient to adequately remove CO2, leading to its accumulation in the blood. This results in a decrease in blood pH, causing respiratory acidosis. Summary of other choices: A: Metabolic acidosis - Not the correct answer as the ventilator settings are more likely to affect the respiratory system rather than the metabolic system. B: Metabolic alkalosis - Not the correct answer as the ventilator settings are not related to causing an increase in blood pH, which is characteristic of metabolic alkalosis. D: Respiratory alkalosis - Not the correct answer as the low respiratory rate would not lead to excessive elimination of CO2, causing alkalosis.

Correct Answer: A

Rationale: The correct answer is A: American Association of Critical-Care Nurses (AACN). This organization focuses exclusively on critical care nursing, offering specialized education, resources, and certifications for critical care nurses. AACN advocates for high standards of care in critical care settings. The other choices do not specifically cater to critical care nursing practice. The American Heart Association focuses on cardiovascular health, the American Nurses Association is a general nursing organization, and the Society of Critical Care Medicine is more physician-centric. Therefore, A is the best choice for supporting critical care nursing practice.

Correct Answer: A

Rationale: The correct answer is A: Kidney, ureter, bladder (KUB) x-ray. This procedure is noninvasive and commonly used to assess kidney function by visualizing the size, shape, and position of the kidneys. Renal ultrasound is also noninvasive and can provide detailed images of the kidneys. However, MRI and IVP are more invasive procedures that involve the use of contrast agents and are not typically used solely for diagnostic purposes to assess kidney function. Overall, KUB x-ray and renal ultrasound are the preferred noninvasive options for evaluating kidney function.

Correct Answer: A

Rationale: The correct answer is A: One chronic and one acute illness. This is because Type 2 diabetes mellitus is a chronic condition, while influenza is an acute illness. The nurse should develop goals addressing the management and control of the chronic condition (diabetes) as well as the treatment and recovery from the acute illness (influenza). This approach ensures comprehensive care that considers both the long-term management of the chronic illness and the immediate needs related to the acute illness. Choices B, C, and D are incorrect because they do not address the combination of chronic and acute illnesses presented in the scenario. Choice B focuses solely on two acute illnesses, which overlooks the ongoing management required for the chronic condition. Choice C combines an acute and an infectious illness, but fails to account for the chronic illness component. Choice D involves two chronic illnesses, neglecting the immediate care needed for the acute illness.

Correct Answer: D

Rationale: The correct answer is D: Facilitation of learning. In this scenario, the nurse needs to effectively educate the patient on managing her diet, insulin injections, and handling emergencies. Facilitation of learning involves assessing the patient's learning needs, providing relevant information, demonstrating skills, and evaluating understanding. This competency is crucial for promoting patient education and empowerment in managing their condition. A: Clinical judgment involves making decisions based on assessment data, which is important but not the primary focus in this situation. B: Advocacy and moral agency involve standing up for patients' rights and values, which is important but not as directly relevant to the patient's education needs. C: Caring practices involve showing empathy and compassion, which are essential but not the main competency required for educational purposes in this case.

Correct Answer: B

Rationale: The correct answer is B: Change in sputum characteristics. This is a cue for postoperative pneumonia in a COPD patient because it can indicate an infection in the lungs. Postoperative pneumonia is a common complication in patients with COPD due to impaired lung function and weakened immune system. Other choices are incorrect: A) Bradycardia is not a specific indicator of postoperative pneumonia. C) Hypoventilation and respiratory acidosis can be seen in patients with COPD but are not specific to postoperative pneumonia. D) Pursed-lip breathing is a coping mechanism for patients with COPD and is not directly related to postoperative pneumonia.

Correct Answer: C

Rationale: The correct answer is C: Moral distress. In this scenario, the nurse is experiencing conflicting moral values between the decision made for the patient and their own beliefs. This internal conflict leads to moral distress, a common response when healthcare professionals feel unable to act in accordance with their ethical beliefs. This can lead to emotional turmoil, frustration, and moral residue. A: A sense of abandonment is incorrect because the nurse is still caring for the patient, so there is no physical abandonment. B: Increased family stress is incorrect as the nurse's internal conflict does not directly impact family stress. D: A sense of negligence is incorrect as negligence implies failure to provide proper care, which is not the case here.

Correct Answer: B

Rationale: The correct answer is B: Use of best available research data. Evidence-based practice involves integrating the best available research evidence with clinical expertise and patient values to make informed decisions about patient care. It emphasizes using scientifically proven data to guide practice and improve patient outcomes. Expert legal testimony (A) is not necessarily evidence-based. Evolution of nursing practice over time (C) does not specifically focus on research data. Individual optimization of patient outcomes (D) is a goal of evidence-based practice, but it does not fully encompass the concept.