The nurse receives a 72-year old female who is admitted to the medical intensive care unit (MICU) from the general medicine floor in respiratory distress. The MICU nurse learns from the floor nurse that the client was admitted two days prior for aspiration pneumonia from a nursing home and has been receiving antibiotic treatment since admission.MICU Nursing notes:0800: Client arrives to the ICU in respiratory distress on 15L oxygen via a non-rebreather mask after no improvement in oxygenation status on 12L high-flow nasal cannula on the general medicine floor. Client appears to have labored breathing and accessory muscle use. Fine crackles are auscultated bilaterally in the upper and lower lobes. Client is diaphoretic, restless, and minimally following commands. Vital signs taken, Labs drawn, EKG, and Chest x-ray done at bedside.Vital Signs upon arrival to MICU: T – 100.4’FHR – 125 – sinus tachycardiaRR – 38BP – 165/78 (MAP 110)SpO2 – 87% on 15L non-rebreather mask.Pertinent Laboratory Results:WBC11,500 mcL (5,000-10,000 mcL)Hgb11.5 g/dL (14-18 g/dL in men and 12-16 g/dL in women)K+4.1 mEq/L (3.5-4.5 mEq/L)Na+138 mEq/L (135–145 mEq/L)Mg1.6 mEq/L (1.5-2.0 mEq/L)ABG Results on 15L Non-Rebreather Mask:pH7.28PaO255 mmHgPaCO265 mmHgHCO3-30 mEq/LLactic acid3.0 mmol/L (0.5-2.2 mmol/L)Imaging:Electrocardiogram: Sinus TachycardiaCXR: Bilateral diffuse pulmonary ground glass opacities consistent with pulmonary edema

Based on the current client data above, which intervention would the nurse anticipate?

The nurse is aware that pulmonary edema will lead to an alveolar dead space VQ mismatch.  

The nurse is monitoring a client who is being weaned from mechanical ventilation by a trial of spontaneous breathing. The client, prior to weaning, had a blood pressure of 126/70, heart rate of 72, and respiratory rate of 12. Which of the following signs or symptoms would best indicate the client is not tolerating the weaning process?

A client is to be dialyzed within the next three hours. The client has an order for 20mg of propranolol (Inderal) in two hours. In order to prevent hypotension during dialysis, the nurse should:

Select the five findings that require immediate follow-up. 

When caring for a client in the ICU, the nurse notes an order for tolvaptan (Samsca).  The nurse identifies this medication as belonging to the Vaptan class.  The nurse knows the purpose of this medication is:  

A client in the ICU has a history of hypertension, CAD, and chronic systolic heart failure. On assessment, the nurse notes the client has pitting edema of the ankles and moist rales heard in the bilateral lung bases. The client’s serum sodium is 129 mEq/L. The client would most benefit from: 

When assessing the blood urea nitrogen (BUN) for a client, the nurse needs to be aware of factors that can influence the BUN levels, which include:  

The client has acute lung injury (ALI) and is ventilated with an FiO2 of 50%, 10cmH2O of PEEP, tidal volume of 750mL, and a rate of 16 breaths per minute. Coarse rhonchi are heard over the upper airways and the client has become agitated with an O2 saturation of 85%. Which priority action should the nurse take?