All of the following patients require intravenous push (IVP) medications. The nurse would administer which patient's medication first?
A scheduled dose of IVP furosemide for a patient displaying signs of shortness of breath.
PRN IVP diphenhydramine for a patient complaining of itching.
PRN IVP morphine for a patient complaining of moderate pain.
A scheduled dose of IVP digoxin for a patient in atrial fibrillation.
The Correct Answer is A
Choice A rationale
Shortness of breath in a patient scheduled for furosemide suggests acute fluid overload or pulmonary edema, which is a life-threatening condition requiring immediate intervention. Furosemide is a potent loop diuretic that reduces preload by increasing renal excretion of water and sodium. Rapid administration helps alleviate respiratory distress by decreasing pulmonary vascular congestion. In the triage hierarchy, respiratory stability always takes precedence over pain management or non-emergent cardiac rate control.
Choice B rationale
Diphenhydramine is an antihistamine used to treat allergic reactions or pruritus. While itching is uncomfortable, it is not a physiological priority compared to a patient experiencing respiratory compromise. Unless the itching is accompanied by signs of anaphylaxis, such as airway swelling or hypotension, this medication can be safely delayed until more urgent patient needs are met. This choice represents a comfort measure rather than a life-saving respiratory intervention for the nurse.
Choice C rationale
Morphine is an opioid analgesic indicated for pain management. While managing pain is a core nursing responsibility, it falls below the airway, breathing, and circulation (ABC) priority framework. Pain is subjective and, although distressing, does not pose the same immediate risk of mortality as acute shortness of breath. The nurse must first ensure the patient in choice A can breathe adequately before addressing the moderate pain levels of this patient.
Choice D rationale
Digoxin is an inotropic agent used to control the ventricular rate in atrial fibrillation and improve cardiac contractility. While important for long-term hemodynamic stability, it does not typically require the same immediate "stat" administration as a diuretic for a patient currently struggling to breathe. If the patient is hemodynamically stable, the scheduled dose can follow the administration of the furosemide. Priority is given to the most unstable patient based on current symptoms.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","D","F"]
Explanation
Choice A rationale
A stable and intact respiratory drive is a mandatory physiological requirement for extubation. The patient must be able to initiate their own breaths and maintain adequate minute ventilation without the assistance of the mechanical ventilator. This ensures that once the artificial airway is removed, the patient can sustain gas exchange and acid base balance. Assessing spontaneous breathing trials helps confirm that the respiratory muscles are strong enough to overcome the resistance of the upper airway.
Choice B rationale
A heart rate of 190 bpm represents extreme sinus tachycardia or a tachyarrhythmia, indicating significant physiological stress, pain, or hemodynamic instability. Normal adult heart rates should range between 60 to 100 bpm. Attempting to extubate a patient with such a high heart rate would likely lead to cardiovascular collapse or respiratory failure. The sympathetic nervous system is overactive, and the patient's myocardial oxygen demand is too high to safely tolerate the work of spontaneous breathing.
Choice C rationale
A respiratory rate of 30 breaths per minute is elevated, often indicating tachypnea and increased work of breathing. Normal respiratory rates are typically 12 to 20 breaths per minute. A rate of 30 suggests the patient may be struggling to maintain adequate tidal volumes or is experiencing respiratory distress. Weaning and extubation are generally deferred if the rate is consistently high, as it serves as a predictor for post extubation fatigue and the potential need for reintubation.
Choice D rationale
Hemodynamic stability is essential, meaning the patient should have a stable blood pressure and heart rate, ideally without significant vasopressor support. A mean arterial pressure of ≥65 mmHg is generally targeted. If a patient is hemodynamically unstable, the additional metabolic demand of breathing on their own could exacerbate heart failure or shock. Stability ensures that the cardiovascular system can support the increased oxygen consumption required when mechanical ventilatory support is withdrawn from the patient.
Choice E rationale
Patients must be awake, alert, and able to follow commands to protect their own airway after extubation. Being difficult to arouse or unable to follow instructions suggests that the patient cannot cough effectively or clear secretions, posing a high risk for aspiration and airway obstruction. Neurological readiness is as critical as pulmonary readiness. A Glasgow Coma Scale score of ≥8 is often used as a benchmark for considering the safety of removing an endotracheal tube.
Choice F rationale
The primary reason the patient required mechanical ventilation must be resolved or significantly improved before extubation is considered. For example, if the patient had pneumonia, the infection should be controlled and inflammatory markers decreasing. If the underlying cause is still present, the patient will likely fail a spontaneous breathing trial. Reversal of the initial pathology ensures that the patient has the physiological reserve to maintain independent ventilation over the long term without returning to failure.
Correct Answer is D
Explanation
Choice A rationale
While PEEP can eventually lead to improved lung compliance, its primary and immediate mechanical purpose is not the reduction of the work of breathing. In fact, excessively high levels of PEEP can sometimes increase the work of breathing by causing overdistention of the alveoli, making it harder for the patient to initiate a breath or move air effectively. Its therapeutic focus remains on gas exchange rather than the muscular effort of ventilation.
Choice B rationale
This choice is scientifically incorrect because PEEP is specifically designed to increase the functional residual capacity, which is the volume of air remaining in the lungs at the end of a normal expiration. By maintaining positive pressure, PEEP prevents the total collapse of the lungs during the expiratory phase. Decreasing this capacity would lead to widespread atelectasis and a significant decline in the surface area available for gas exchange at the alveolar-capillary membrane.
Choice C rationale
Tidal volume is the amount of air moved in or out of the lungs during a single respiratory cycle and is typically determined by the ventilator settings or the patient's effort. While PEEP improves the environment for air delivery, it is not used as a primary mechanism to increase the specific volume of a single breath. Instead, it maintains a baseline pressure that keeps the respiratory architecture open for the duration of the cycle.
Choice D rationale
The fundamental purpose of PEEP is to improve oxygenation by keeping alveoli open at the end of expiration, a process known as recruitment. This prevents atelectasis and increases the surface area for gas exchange. By maintaining open alveoli, it reduces intrapulmonary shunting, where blood flows past unventilated lung tissue. This mechanism allows for a lower fraction of inspired oxygen to be used while maintaining adequate arterial oxygen tension and systemic delivery.
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