A client who has been on a mechanical ventilator for three days develops a fever of 101 degrees Fahrenheit green sputum, and right lower lobe crackles. The nurse contacts the physician regarding possible development of which complication?

Ventilator -associated pneumonia

Pulmonary embolism

Stress ulcer

Pneumothorax

Answer and Explanation

The Correct Answer is A

A) Ventilator-associated pneumonia (VAP):
Ventilator-associated pneumonia (VAP) is a type of pneumonia that develops in patients who have been on mechanical ventilation for more than 48 hours. It is a common and serious complication in critically ill patients on ventilators. Symptoms such as fever, green sputum, and right lower lobe crackles are indicative of a respiratory infection, which, in this case, is most likely VAP. VAP typically presents with signs of infection such as elevated temperature, purulent sputum, and new infiltrates on a chest x-ray, in addition to lung crackles.

B) Pulmonary embolism (PE):
Although pulmonary embolism (PE) can cause symptoms like tachypnea, chest pain, and dyspnea, it does not typically cause a fever, green sputum, or localized crackles in the lungs. PE is usually characterized by sudden onset of respiratory distress, often accompanied by hemoptysis or chest pain, and would not typically present with the localized findings in the lower lobe (e.g., crackles).

C) Stress ulcer:
Stress ulcers can occur in critically ill patients, especially those on mechanical ventilation, due to the stress response and reduced blood flow to the stomach. However, stress ulcers typically cause gastrointestinal symptoms, such as melena (black, tarry stools) or hematemesis (vomiting blood).

D) Pneumothorax:
A pneumothorax occurs when air accumulates in the pleural space, causing a collapse of the lung. It can lead to symptoms such as sudden chest pain, dyspnea, and diminished breath sounds on one side of the chest. However, it would not typically cause fever, green sputum, or localized crackles.

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Correct Answer is D

Explanation

A) Avoid use of the microwave for three months:
Microwaves do not interfere with pacemaker function. Modern pacemakers are designed to be resistant to electromagnetic interference from household devices like microwaves. Therefore, there is no need to avoid microwave use. The nurse should focus on other areas of safety that are more pertinent to the functioning of the pacemaker.

B) Use cellular phone sparingly:
Cellular phones generally do not interfere with the operation of most modern pacemakers. The nurse may advise the client to avoid holding a mobile phone directly over the pacemaker (i.e., on the chest) for prolonged periods, but there is no need to avoid using the phone entirely. Current guidelines suggest using the phone on the opposite ear from the side of the pacemaker if concerned, but the phone itself does not pose a significant risk.

C) Resume outdoor activities in two days:
Although outdoor activities may be safe after some time, the client should avoid strenuous physical activity or exercise for a period after receiving a pacemaker. The recommended rest period after pacemaker placement typically ranges from several days to a few weeks, depending on the individual and the procedure. However, resuming outdoor activities like walking or mild exercise is often appropriate earlier than two days, but not in all cases, and should be guided by the healthcare provider.

D) No heavy lifting for two months:
After the insertion of a biventricular pacemaker (which is often used in cases of heart failure), the patient should avoid heavy lifting and strenuous activities for at least 6-8 weeks to allow the lead wires to properly stabilize within the heart and to reduce the risk of dislodging the pacemaker leads. Lifting objects heavier than 10-15 pounds (4.5-7 kg) can strain the chest muscles and disrupt pacemaker lead placement.

A. Ondansetron and Metoclopramide B. Aspirin and ibuprofen C. Metoprolol and Furosemide D. Pantoprazole Docusate Sodium

Correct Answer is B

Explanation

A) Ondansetron and Metoclopramide:
Ondansetron is an antiemetic used to prevent nausea and vomiting, and Metoclopramide is a medication that promotes gastric emptying and is often used to treat nausea and gastroesophageal reflux. Neither of these medications are typically associated with ototoxicity. Ototoxicity is more commonly seen with medications that affect the inner ear or auditory pathways, particularly those that are used in high doses or over extended periods.

B) Aspirin and ibuprofen:
Both aspirin (a nonsteroidal anti-inflammatory drug, NSAID) and ibuprofen are associated with ototoxicity, especially when used in high doses or over prolonged periods. Ototoxicity from NSAIDs can result in symptoms such as tinnitus (ringing in the ears) or even hearing loss. This occurs due to their impact on the cochlea and auditory nerve.

C) Metoprolol and Furosemide:
Metoprolol is a beta-blocker used for managing hypertension, heart failure, and other cardiovascular conditions, and Furosemide is a diuretic often used to treat conditions such as heart failure and edema. Neither of these drugs is typically associated with ototoxicity. However, high doses of furosemide, particularly when given rapidly or intravenously, may be associated with transient hearing loss.

D) Pantoprazole and Docusate Sodium:
Pantoprazole is a proton pump inhibitor (PPI) used to treat gastrointestinal issues like acid reflux and ulcers. Docusate sodium is a stool softener used to treat constipation. Neither of these medications is known to cause ototoxicity. These drugs generally do not affect hearing or the auditory system.

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A client who has been on a mechanical ventilator for three days develops a fever of 101 degrees Fahrenheit green sputum, and right lower lobe crackles. The nurse contacts the physician regarding possible development of which complication?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is caring for a client with a permanent biventricular pacemaker. What should the nurse include in the discharge teaching?

Correct Answer is D

Explanation

Which commonly prescribed is does the nurse identify as ototoxic?

Correct Answer is B

Explanation

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