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NEW QUESTION # 443
A patient is receiving therapeutic hypothermia post-cardiac arrest. Which of the following orders should a nurse clarify?
Answer: C
Explanation:
Sequential compression devices (SCDs) are not recommended for patients receiving therapeutic hypothermia (TH) post-cardiac arrest, because they may interfere with the cooling process and increase the risk of skin injury. SCDs are used to prevent deep vein thrombosis (DVT) by applying intermittent pneumatic pressure to the lower extremities, but they may also increase peripheral blood flow and heat exchange, which can counteract the effects of TH. SCDs may also cause skin breakdown, blisters, or burns in patients with impaired sensation and reduced perfusion due to TH. Therefore, a nurse should clarify the order for SCDs and consider alternative methods of DVT prophylaxis, such as pharmacological agents or early mobilization.
References:
* Therapeutic Hypothermia (TH) Education Components: This document states that "Avoid use of sequential compression devices (SCDs) during cooling phase as they may interfere with cooling process and increase risk of skin injury."
* Sequential Compression Devices: Clinical Effectiveness, Cost- Effectiveness and Guidelines: This document states that "One evidence-based guideline from the American Heart Association (AHA) and the American Stroke Association (ASA) recommended against the use of SCDs in patients undergoing therapeutic hypothermia after cardiac arrest, as they may interfere with the cooling process and increase the risk of skin injury."
NEW QUESTION # 444
Which of the following is a complication of the use of high concentrations of oxygen over long periods of time?
Answer: B
Explanation:
The toxic effects of oxygen primarily target the pulmonary system and Central Nervous System (CNS).
Signs and symptoms of oxygen toxicity include nausea, anxiety, visual disturbances, numbness, muscular twitching, and grand mal seizures.
Pulmonary oxygen toxicity is due to prolonged exposure to high FiO2 levels. The critical care nurse must carefully monitor patients requiring high levels of oxygen as these patients are at risk for absorption atelectasis and oxygen toxicity. Signs and symptoms include a nonproductive cough, substernal chest pain, general malaise, nausea, fatigue, and vomiting. Oxygen concentrations > 50% for more than 24 to
48 hours may damage the lungs and worsen respiratory problems. As soon as PaO2 levels return to clinically acceptable levels (≥ 60mmHg), oxygen delivery levels can be decreased.
NEW QUESTION # 445
Sodium bicarbonate is an important reversal agent which may be needed in the care of a critically ill patient. Which of the following medications will respond to sodium bicarbonate as a reversal agent for overdose/toxicity?
Answer: C
Explanation:
Antidotes help counteract the effects of poisons by neutralizing them or by antagonizing their effects.
Sodium bicarbonate is the specific antidote and reversal agent used for tricyclic antidepressants (TCAs).
Naloxone is the reversal agent used for opiates. Flumazenil is the antidote used for benzodiazepine toxicity. Glucagon and calcium are used to reverse an overdose of beta-blockers or calcium channel blockers.
NEW QUESTION # 446
Which of the following has the greatest influence on the risk of aspiration when using enteral feeding in a critically ill patient?
Answer: C
Explanation:
The position of the patient is one of the primary factors influencing aspiration risk. Studies have confirmed that aspiration and pneumonia are significantly more likely when patients are supine with the head of the bed elevated at less than 30 degrees. While the semirecumbent position with head of the bed elevations of >/= 30 degrees cannot guarantee absolute protection against aspiration, it is a method that is inexpensive and relatively easy to accomplish and monitor. Strict use of semirecumbent position (head of the bed at 30-45 degrees) is the most consistent and potent means to reduce the likelihood of aspiration.
The size of a feeding tube and the placement of the tube, whether it be oral, nasal, or via a gastrostomy, has not been shown to alter the risk of aspiration.
NEW QUESTION # 447
A patient with unilateral facial droop and slurred speech has a history of hyperlipidemia and hypertension. The nurse should anticipate an order for a
Answer: A
Explanation:
Given the symptoms of unilateral facial droop and slurred speech, a stroke is highly suspected. A head and neck CT scan is the most appropriate initial imaging to quickly evaluate for the presence of an ischemic or hemorrhagic stroke, which is critical for determining the appropriate treatment plan. An MRI may provide more detailed information later but is not the initial test of choice in the acute setting. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course
NEW QUESTION # 448
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