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: 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: B

Rationale: The correct answer is B because developing a list of questions for the physician shows active engagement in their healthcare, seeking information, and taking control of their situation, which are characteristics of resiliency. This behavior indicates the patient's willingness to understand and cope with their health condition. Choices A, C, and D are incorrect as they demonstrate maladaptive coping mechanisms such as dysfunctional grieving, denial, and blame assignment, which are not indicative of resiliency. Resiliency involves adaptability, problem-solving, and seeking support, which are better exemplified by choice B.

Correct Answer: C

Rationale: The correct answer is C because providing specific information such as descending trends in parameters helps the family understand the patient's condition objectively. This allows them to prepare emotionally and make informed decisions. Option A is incorrect because false hope should not be given. Option B is not the best approach as the nurse should still provide some information to the family. Option D is inappropriate and insensitive as it focuses on funeral arrangements rather than addressing the family's concerns about the patient's condition.

Correct Answer: C

Rationale: The correct answer is C: Pressure support ventilation. This mode delivers a set pressure to support each spontaneous breath, decreasing the workload of breathing. Pressure support ventilation assists the patient's inspiratory efforts without providing a set tidal volume like in volume-targeted ventilation. Continuous positive airway pressure (Choice A) maintains a constant level of positive pressure throughout the respiratory cycle but does not actively support spontaneous breathing efforts. Positive end-expiratory pressure (Choice B) maintains positive pressure at the end of expiration to prevent alveolar collapse but does not directly support spontaneous breathing. T-piece adapter (Choice D) is a weaning device that allows the patient to breathe spontaneously without ventilatory support.

Correct Answer: B

Rationale: The correct answer is B because after 5 days, the risk of infection increases. Evaluating the patient for signs and symptoms of infection is crucial for early detection and treatment. Choice A is incorrect because routine dialysis catheter changes are not necessary after only 5 days. Choice C is incorrect as percutaneous catheters are for short-term use. Choice D is incorrect as using the catheter for fluid administration may increase the risk of infection.

Correct Answer: D

Rationale: The correct answer is D because CRRT removes solutes and water slowly, which is beneficial for hemodynamically unstable patients. This slow removal allows for gradual fluid and electrolyte balance adjustments, reducing the risk of hemodynamic instability. A: Incorrect - A hemofilter is indeed used in CRRT, but this choice does not highlight the key difference between CRRT and intermittent hemodialysis. B: Incorrect - CRRT actually provides slower solute and water removal compared to intermittent hemodialysis. C: Incorrect - Diffusion does occur in CRRT, as it is a key mechanism for solute removal in the process. In summary, the key difference between CRRT and intermittent hemodialysis is the slow removal of solutes and water in CRRT, making choice D the correct answer.

Correct Answer: B

Rationale: The correct answer is B: Assess the patient’s lungs. Rhabdomyolysis can lead to acute kidney injury due to myoglobin release from damaged muscle cells. IV fluids and mannitol are given to prevent kidney damage by promoting myoglobin excretion. Assessing the patient’s lungs is crucial to monitor for potential complications such as acute respiratory distress syndrome (ARDS) which can occur as a result of rhabdomyolysis. This assessment helps to ensure early detection and prompt intervention if respiratory issues arise. Summary of Incorrect Choices: A: Assess the patient’s hearing - This is not directly related to rhabdomyolysis or its treatment. C: Decrease IV fluids once the diuretic has been administered - Decreasing IV fluids can exacerbate kidney injury in rhabdomyolysis. D: Give extra doses before giving radiological contrast agents - Mannitol is not routinely given before radiological contrast agents in the context of rhabdomyolysis management.

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.