When the V/Q lung scan result returns with a mismatch ratio that is greater than 1, which condition should be suspected?

Correct Answer: C

Rationale: The correct answer is C: Pulmonary embolus. A V/Q lung scan is used to evaluate the ventilation-perfusion ratio in the lungs. A mismatch ratio greater than 1 indicates a significant ventilation-perfusion mismatch, which is commonly seen in pulmonary embolism where there is a blockage in the pulmonary artery. This leads to decreased perfusion in areas of the lung, causing the mismatch. Therefore, when the mismatch ratio is greater than 1, pulmonary embolus should be suspected. Choices A, B, and D do not directly correlate with a mismatch ratio on a V/Q lung scan, making them incorrect in this context.

Correct Answer: B

Rationale: The correct answer is B: Cardiac output and blood pressure. In ARDS patients on high PEEP, monitoring cardiac output and blood pressure is crucial due to the risk of hemodynamic compromise. High PEEP can decrease venous return, leading to decreased cardiac output and hypotension. Monitoring these parameters helps detect and prevent complications like hypotension, which can further compromise oxygenation. Choice A is incorrect because while monitoring respiratory rate and depth is important in ARDS, the priority in this scenario is monitoring hemodynamic status due to the potential impact of high PEEP on cardiac function. Choice C is incorrect as monitoring white blood cell count is not directly related to complications of high PEEP in ARDS patients. Choice D is incorrect because sputum production and characteristics are not the priority for monitoring in this scenario; cardiac output and blood pressure are more critical indicators of potential complications.

Correct Answer: A

Rationale: The correct answer is A: Dyspnea and tachypnea. These are common early clinical manifestations of ARDS because the condition leads to rapid, shallow breathing (tachypnea) and shortness of breath (dyspnea) due to the impaired gas exchange in the lungs. Cyanosis and apprehension (B) may occur later in ARDS progression. Hypotension and tachycardia (C) are more associated with septic shock rather than early ARDS. Respiratory distress and frothy sputum (D) are more characteristic of conditions like pulmonary edema rather than ARDS.

Correct Answer: D

Rationale: The correct answer is D: End tidal CO2 monitoring. This is the first assessment of tube placement because it provides immediate feedback on the effectiveness of ventilation. End tidal CO2 monitoring measures the amount of CO2 exhaled, indicating proper placement in the airway. If the tube is correctly positioned, CO2 will be detected. Chest X-Ray (A) is not immediate and delays intervention. Auscultation (B) may not always confirm placement. Pulse oximetry (C) can be misleading as oxygen saturation can be maintained even with incorrect tube placement.

Correct Answer: C

Rationale: The correct answer is C because the statement indicates a misunderstanding of health care proxy selection. A person can choose anyone, not just a family member, as their health care proxy. Statement A is correct as a health care proxy can be changed at any time. Statement B is also correct as the proxy makes end-of-life decisions when the person is incapacitated. Statement D is correct as the health care proxy only comes into effect when the person is unable to make decisions.