answered
B. Shystocytes on blood smear - ANS ✔✔The nurse is caring for a patient with petechiaae
underneath compression stockings and slight oozing around venipuncture sites. The nurse
notices what on the lab results that indicates this patient may be experiencing DIC?
A. Increased hemoglobin levels
B. Shystocytes on the blood smear
C. Decreased lactic acid
D. Decreased potassium
D. Decreased volume and lung compliance on the ventilator - ANS ✔✔What will the nurse
assess in a patient experiencing the fibrotic phase of acute lung injury resulting in
hypoventilation, hypoxemia?
A. Pulmonary artery pressure of 18/9 mmHg
B. Stridor on inspiration
C. Bilateral effusion can be seen on radiographic exams
D. Decreased volume and lung compliance on the ventilator
,A. Assist control mode refers to the patient receiving a set total lung capacity but the rate is
maintained by the patient's own rate of breathing - ANS ✔✔Which statement made by a new
graduate nurse about invasive mechanical ventilation techniques requires additional teaching?
A. Assist control mode refers to the patient receiving a set total lung capacity but the rate is
maintained by the patient's own rate of breathing
B. Total control mode controls both the rate and volume that are preset and delivered without
the machine responding to any of the patient' own breaths
C. Synchronized intermittent mandatory ventilation (SIMV) refers to the patient setting an
independent rate but limited tidal volume based on the patient's own strength. A minimum rate
is also used as a backup to prevent hypoventilation
D. Continuous positive airway pressure will increase the residual capacity and keep the alveoli
open. rate and volume are controlled by the patient. This is one step weaning process
C. Hyperoxygenate with 100% O2 and suction the patient - ANS ✔✔A patient with ARDS is on a
mechanical ventilator with a heart rate of 128, SaO2 of 88%, and the ventilator settings are FiO2
50%, PEEP 8 cm, AC 10 with total respiratory rate of 30, and tidal volume 00 mL. There are
coarse rhonci audible in all lung fields. The appropriate nursing action would be to:
A. Administer the ordered neuromuscular blockade medications
B. Increase the PEEP to 10 cm and sedate the patient
C. Hyperoxygenate with 100% oxygen and suction the patient
,D. Increase the FiO2 to 60% and tidal volume to 750 mL for 2 minutes
B. Provide adequate rest and recovery time between procedures - ANS ✔✔Which nursing
action would best optimize overall oxygenation and ventilation in the patient with ARDS?
A. Hyperventilate the patient after suctioning
B. Provide adequate rest and recovery time between procedures
C. Suction the patient every 30 minutes
D. Administer sedation infrequently
A. Increased intracranial pressure
B. A spinal injury
D. Abdominal compartment syndrome - ANS ✔✔The nurse recognizes that utilizing the prone
position to enhance oxygenation in a patient with ARDS is contraindicated one the patient has:
(Select all that apply)
A. Increased intracranial pressure
B. A spinal injury
C. Right below the knee amputation
, D. Abdominal compartment syndrome
E. Failed weaning attempt
B. Establish IV access - ANS ✔✔An older client is experiencing hypovolemic shock. Which action
would be give the highest priority for this client?
A. Complete health history
B. Establish IV access
C. Administer analgesics for pain control
D. Bolus of 0.45% NaCl at 999mL/hr
B. Increased CO - ANS ✔✔A client being treated for hypovolemic shock is prescribed a titrating
dose of dopamine. What will the nurse assess while administering this medication?
A. Decreased cardiac irritability
B. Increased CO
C. urinary output of at least 3 mL/hr
D. Stabilization of fluid loss