The nurse sees a 76-year-old woman in the outpatient clinic. She states that she recently started noticing a glare in the lights at home. Her vision is blurred; and she is unable to play cards with her friends, read, or do her needlework. The nurse suspects that the woman may have:

Correct Answer: C

Rationale: The correct answer is C: Cataract(s). The symptoms described by the patient, such as glare in lights, blurred vision, and difficulty with near vision tasks, are indicative of cataracts, which is a common age-related condition where the lens of the eye becomes cloudy. Presbyopia (A) is a normal age-related condition causing difficulty focusing on near objects. Presbycusis (B) is age-related hearing loss, not related to the symptoms described. Depression (D) may present with some visual disturbances, but the patient's symptoms are more consistent with cataracts.

Correct Answer: A

Rationale: The correct answer is A: Check the tubing for any kinks. This is the first intervention to implement because increased peak airway pressure can be caused by a kink in the tubing, leading to ineffective ventilation. Checking for kinks ensures proper airflow to the client's lungs. Suctioning for secretions (B) may be necessary but should come after ruling out tubing issues. Assessing the lip line of the ET tube (C) is important for proper placement but does not address the immediate high peak airway pressure concern. Sedating the client with a muscle relaxant (D) should not be the first intervention as it does not address the underlying cause of the high peak airway pressure.

Correct Answer: B

Rationale: The correct answer is B: Frequent oral care with chlorhexidine. This is key in preventing VAP by reducing bacterial colonization in the oral cavity, decreasing the risk of aspiration. Nasopharyngeal suctioning (A) can irritate the airway and increase the risk of infection. Administering prophylactic antibiotics (C) can lead to antibiotic resistance. Increasing tidal volumes (D) can worsen lung injury in ARDS patients. Overall, maintaining good oral hygiene is crucial in preventing VAP in patients with ARDS.

Correct Answer: B

Rationale: The correct answer is B: Endotracheal intubation and positive pressure ventilation. In hypercapnic respiratory failure, the patient's respiratory rate is low, indicating inadequate ventilation. The SpO2 of 89% and increasing lethargy suggest severe hypoxemia and impending respiratory failure. Endotracheal intubation allows for mechanical ventilation to improve oxygenation and ventilation. Positive pressure ventilation can help improve gas exchange and prevent further deterioration. A: Administration of 100% oxygen by non-rebreather mask would not address the underlying issue of inadequate ventilation in hypercapnic respiratory failure. C: Insertion of a mini-tracheostomy with frequent suctioning is not the initial intervention for managing hypercapnic respiratory failure. D: Initiation of bilevel positive pressure ventilation (BiPAP) may not be sufficient for this patient with impending respiratory failure; endotracheal intubation provides better control over ventilation and oxygenation.

Correct Answer: A

Rationale: The correct answer is A because in the fibrotic phase of ARDS, the chance of survival is poor. Supporting the family and helping them understand this realistic expectation is crucial for their emotional preparation. Choice B is incorrect because maintaining mechanical ventilation at home post-discharge is not feasible. Choice C is incorrect as transferring the patient to a long-term care facility may not be appropriate at this stage. Choice D is incorrect because stating that the disease process has started to resolve is inaccurate in the fibrotic phase.