A client in the ICU who is receiving a propofol infusion is being prepared for a ventilator weaning trial. What is the nurse's first response to managing the propofol drip before the spontaneous awakening trial?
Increase the rate of the propofol infusion
Decrease the rate of the propofol Infusion
Keep the propofol rate the same
Stop propofol and start dexmedetomidine
The Correct Answer is B
A. Increase the rate of the propofol infusion: Increasing the propofol rate would deepen sedation, which is the opposite of the goal for a spontaneous awakening trial (SAT). Over-sedation can suppress respiratory drive and prevent accurate assessment of the patient’s ability to breathe independently.
B. Decrease the rate of the propofol infusion: The first step before a SAT is to reduce the sedative infusion to allow the patient to awaken safely. Decreasing propofol gradually helps assess neurological status, responsiveness, and readiness to tolerate ventilator weaning while minimizing the risk of agitation or hemodynamic instability.
C. Keep the propofol rate the same: Maintaining the current sedation level would prevent the patient from awakening for assessment. This delays evaluation of readiness for extubation and prolongs mechanical ventilation unnecessarily.
D. Stop propofol and start dexmedetomidine: Switching sedatives is not the initial action for a spontaneous awakening trial. The priority is to reduce sedation gradually to assess the patient’s neurological and respiratory status, not to change agents, which could introduce new pharmacologic effects and complicate monitoring.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Administer amiodarone 150 mg IV: Amiodarone is used to treat ventricular arrhythmias such as ventricular tachycardia or fibrillation. Second-degree Mobitz type II block is a conduction failure at the level of the His-Purkinje system, leading to dropped QRS complexes and bradycardia, not a tachyarrhythmia requiring antiarrhythmic therapy.
B. Begin transcutaneous pacing: Mobitz type II block is a high-grade AV block with a significant risk of progressing to complete heart block. The patient is hypotensive and symptomatic (confused, lethargic), indicating poor perfusion. Immediate transcutaneous pacing is recommended to maintain adequate heart rate and cardiac output until a more permanent solution, such as transvenous pacing, is established.
C. Begin cardioversion: Cardioversion is indicated for unstable tachyarrhythmias with a pulse, such as atrial fibrillation with rapid ventricular response or ventricular tachycardia with a pulse. This patient has a bradyarrhythmia due to AV block, so cardioversion would not correct the underlying conduction defect.
D. Administer nitroglycerine 5 mcg/min IV: Nitroglycerin reduces preload and can lower blood pressure. Given the patient’s hypotension (84/52 mmHg), administering nitroglycerin would worsen perfusion and does not address the underlying conduction abnormality causing the syncopal episode.
Correct Answer is C
Explanation
A. Change the chest tube drainage system: Replacing the entire drainage system may be necessary if it is malfunctioning, but this is not the first action. Immediate assessment is required to determine the cause of the sudden decrease in drainage before taking corrective steps.
B. Increase the suction pressure on the chest tube drainage system: Adjusting suction without understanding the reason for decreased drainage could worsen the situation or create unnecessary negative pressure. Suction adjustments should only be made after identifying the underlying issue.
C. Assess the tubing of the chest tube and drainage system: The first action is to inspect the tubing for kinks, clots, disconnections, or obstructions, which are the most common causes of sudden decreased drainage. Ensuring the system is intact and functional preserves lung re-expansion and prevents complications.
D. Call the provider immediately to report the decrease in drainage: Reporting to the provider is important if a problem is identified, but the nurse must first assess and gather information about the situation. Immediate assessment provides critical data for accurate reporting and timely intervention.
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