A patient is receiving therapeutic hypothermia post-cardiac arrest. Which of the following orders
should a nurse clarify?
A.
chemistry labs every day
B.
ABGs every 4 hours and with any ventilator changes
C.
hourly intake and output
D.
sequential compression devices
Correct Answer: A
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. Reference: 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.”
Question #2 (Topic: demo questions)
A patient who had a liver resection now has a copious amount of serous drainage from the surgical
incision. Which of the following should a nurse anticipate when caring for this patient?
A.
preparing for an incision and debridement of the wound
B.
applying several abdominal dressings
C.
administering antibiotics
D.
applying a drainage pouch to the site
Correct Answer: B
Explanation:
A copious amount of serous drainage from a liver resection incision may indicate a bile
leak, which can cause pain, infection, and delayed healing. The nurse should anticipate applying
several abdominal dressings to absorb the fluid and protect the wound. The nurse should also monitor
the patient for signs of infection, such as fever, increased white blood cell count, and foul-smelling
drainage. The nurse should notify the surgeon of the excessive drainage and follow the orders for
further interventions, such as imaging studies, drainage catheter placement, or surgical repair.
Antibiotics may be prescribed, but they are not the first-line treatment for a bile leak. Incision and
debridement of the wound may be necessary if there is necrotic tissue or infection, but it is not the
initial action. Applying a drainage pouch to the site may not be sufficient to contain the large amount
of fluid and may increase the risk of skin breakdown. Reference: Problems after cancer surgery to
remove part of your liver: This article states that “The bile ducts connect the liver and gallbladder to
the small bowel. There is a risk of bile leaking from the ducts on the cut surface of the liver. This may
cause pain, sickness and a high temperature. Rarely, you might need another operation to repair the
leak.” Understanding Liver Abscess Treatment - Saint Luke’s Health System: This article states that
“The provider uses CT scan or ultrasound to help place the wire in the right spot. A thin, flexible tube
(catheter) is then placed over the wire and into the abscess. The tube is left in place for 5 to 7 days to
drain the fluid. In some cases, surgery may be done to cut into the liver abscess and drain it.”
How Much Time Does it Take to Recover from Liver Surgery?: This article states that “If you have any
drainage from your incision or if the area around your incision is puffy or red, visit your surgeon. Take
a shower every day with warm water. When you are ready to take solid foods, make sure to eat 4 to 6
small meals every day. Do not lift heavy weights for 8 weeks after your surgery.”
Question #3 (Topic: demo questions)
A patient's IV with norepinephrine (Levophed) infusing is red, swollen, and the IV pump is alarming
A nurse should anticipate
A.
administering phentolamine (Regitine).
B.
providing a warm compress.
C.
lowering the extremity below heart level.
D.
removing the IV immediately
Correct Answer: A
Explanation:
Phentolamine (Regitine) is the antidote for norepinephrine extravasation, which is the
leakage of the
vasopressor from the vein into the surrounding tissue. Phentolamine reverses the vasoconstriction
and ischemia caused by norepinephrine by blocking the alpha-adrenergic receptors. Phentolamine
should be administered intradermally around the site of extravasation as soon as possible, and the
infusion should be stopped but the IV catheter should not be removed until some of the
norepinephrine is aspirated. A warm compress may worsen the tissue damage by increasing the
absorption of norepinephrine, and lowering the extremity may increase the edema and pain.
Removing the IV immediately may prevent the aspiration of norepinephrine and the administration
of phentolamine.
Reference:
Episode 240: What to do with norepinephrine extravasation: This article explains the steps to take
when norepinephrine extravasates, including the use of phentolamine, and the reasons to avoid cold
compress, lowering the extremity, and removing the IV.
What are current recommendations for treatment of drug extravasation?: This article summarizes
the latest recommendations for treatment of extravasation, and lists phentolamine as the immediate
topical therapy for norepinephrine extravasation.
Question #4 (Topic: demo questions)
A patient is admitted with Gl bleeding. During the assessment, the nurse notes the patient to be
tremulous, anxious, and startles every time he is touched by the nurse. Which of the following is the
most pertinent part of the patient's history to obtain?
A.
last alcohol intake
B.
medication history
C.
time of last meal
D.
psychiatric history
Correct Answer: A
Explanation:
The patient’s symptoms of tremulousness, anxiety, and startle response suggest that he may be
experiencing alcohol withdrawal, which can occur within hours to days after the last drink. Alcohol
withdrawal can cause severe complications, such as seizures, delirium tremens, and death, if not
treated promptly and appropriately. Alcohol withdrawal can also worsen GI bleeding by increasing
gastric acid secretion, impairing clotting factors, and causing hypertension and tachycardia.
Therefore, the most pertinent part of the patient’s history to obtain is the last alcohol intake, which
can help determine the risk and severity of withdrawal and guide the management of the patient.
Reference:
Management of moderate and severe alcohol withdrawal syndromes: This article states that
“Symptoms of alcohol withdrawal occur because alcohol is a central nervous system depressant.
When a person drinks frequently, the brain compensates for alcohol’s depressant effects by
increasing the activity of excitatory neurotransmitters, such as norepinephrine, serotonin, dopamine,
and glutamate, and reducing the activity of inhibitory neurotransmitters, such as gamma
aminobutyric acid (GABA). When alcohol intake is abruptly discontinued or reduced, this
neuroadaptation is unmasked, resulting in a hyperexcitable state that is responsible for the
characteristic withdrawal symptoms.”
Question #5 (Topic: demo questions)
A patient with a history of asthma presents with acute onset of dyspnea, a non-productive cough,
and tachypne
a. He is very anxious, restless, and tachycardic. Which of the following is a first-line drug for these
symptoms?
A.
leukotriene inhibitor
B.
anticholinergic
C.
mast cell stabilizer
D.
beta-agonist
Correct Answer: D
Explanation:
Beta-agonists are the first-line drugs for acute asthma exacerbations because they rapidly reverse
bronchoconstriction and improve airflow. They act by stimulating beta-2 receptors in the smooth
muscle of the airways, causing relaxation and dilation. Beta-agonists can be administered by
inhalation, nebulization, or injection. Examples of beta-agonists include albuterol, levalbuterol, and
terbutaline.
Reference:
Management of Acute Asthma Exacerbations | AAFP: This article states that “Quick-relief medicines
include: Albuterol (ProAir HFA, Proventil-HFA, Ventolin HFA, others). Levalbuterol (Xopenex, Xopenex
HFA).”
Asthma attack - Diagnosis and treatment - Mayo Clinic: This article states that “If you’re in the yellow
zone, the plan will tell you how many puffs of your quick-relief medicine to take and how often you
can repeat the dose. Young children or people who have difficulty with an inhaler use a device called
a nebulizer to inhale the medicine in a mist. Quick-relief medicines include: Albuterol (ProAir HFA,
Proventil-HFA, Ventolin HFA, others). Levalbuterol (Xopenex, Xopenex HFA).”