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AACN CCRN (Adult) - Direct Care Eligibility Pathway Sample Questions (Q962-Q967):
NEW QUESTION # 962
International guidelines for management of severe sepsis and septic shock recommend which of the following as the FIRST-CHOICE vasopressor agent?
Answer: B
Explanation:
Norepinephrine is the first-choice vasopressor in the setting of severe sepsis and septic shock, according to the 2016 Surviving Sepsis Campaign international guidelines. Norepinephrine is a direct-acting vasoactive agent and has both alpha- and beta-adrenergic agonist properties, producing mixed vasopressor and inotropic effects.
Dopamine is recommended as an alternative vasopressor agent only in highly selected patients (eg, patients with low risk of tachyarythmias and absolute or relative bradycardia).
Epinephrine is an option in addition to norepinephrine to maintain BP in refractory patients. Its use is reserved for when other vasoconstrictors are inadequate.
Phenylephrine is not recommended in the treatment of septic shock except in the following circumstances:
* norepinephrine is associated with serious arrhythmias
* cardiac output is known to be high and blood pressure persistently low
* as salvage therapy when combined inotrope/vasopressor drugs and low-dose vasopressin have failed to achieve the MAP target It may be useful when dopamine, dobnutamine, norepinephrine, or epinephrine cause tachyarhythmias when a vasoconstrictor is required.
NEW QUESTION # 963
Which of the following is UNLIKELY to be necessary when treating a patient who is experiencing an Addisonian crisis?
Answer: C
Explanation:
An Addisonian crisis occurs when there are critically low cortisol levels. Hyperkalemia, not hypokalemia, occurs during an Addisonian crisis. Hypoglycemia is a symptom and may require replenishment. IV fluids will help to treat dehydration that accompanies an Addisonian crisis. Administering IV glucocorticoids is the most important treatment during an Addisonian crisis.
NEW QUESTION # 964
Which of the following will NOT precipitate Acute Respiratory Failure (ARF) in patients with Chronic Obstructive Pulmonary Disorder (COPD)?
Answer: B
Explanation:
Chronic Obstructive Pulmonary Disorder (COPD) exacerbations causing Acute Respiratory Failure (ARF) are due to conditions that decrease the ability to ventilate the lungs or due to conditions that increase the demand for oxygen. An increased, not decreased metabolic oxygen demand, will precipitate ARF in COPD patients. Decreased muscle strength, decreased chest wall elasticity, and increased airway resistance all decrease the ability to ventilate the lungs, potentially precipitating ARF.
NEW QUESTION # 965
A 32-year-old woman was admitted to the cardiovascular ICU following a tricuspid valve replacement related to recurrent bacterial endocarditis. She has a self-reported history of opioid abuse, but she has been clean and sober for 4 years. She discussed her status with her physician prior to her surgery. When she arrives from the operating room, she is in a great deal of pain. Post-operative pain management orders are for acetaminophen only. When you ask the surgeon for an opioid for pain management, they state, "She is an addict. She doesn't need anything for pain." What should your FIRST response be?
Answer: B
Explanation:
Discussing the situation with the doctor privately and professionally will allow the doctor the opportunity to feel less threatened by your concerns. This provides the opportunity for both parties to express viewpoints, understand each other's perspectives, and build rapport, which will ultimately benefit the patient.
If after your private discussion, the doctor still refuses to appropriately treat the patient's pain, then it would be acceptable to report the doctor to your chain of command.
NEW QUESTION # 966
You're the nurse caring for a patient who has recently been placed on a ventilator. The patient's spouse is clearly distressed and asks to speak with you privately. They tell you they're unsure if they can handle seeing their spouse this way and want to know if the ventilator is really necessary. How should you respond?
Answer: B
Explanation:
Arranging a meeting with the healthcare team allows the spouse to discuss the rationale and necessity of the ventilator, and is a way of addressing their concerns in a respectful and informative manner.
While the nurse can provide information about the necessity of the ventilator themselves, involving other members of the healthcare team (especially the physician), can provide a more cohesive and unified perspective. Simply reassuring them without addressing their concerns, suggesting acceptance without further discussion, or shifting focus to the positive aspects without acknowledging their distress does not fully address their concerns or promote understanding.
NEW QUESTION # 967
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