a nurse is planning care for a client who is receiving mechanical ventilation which of the following modes of ventilation that increase the effort of a nurse is planning care for a client who is receiving mechanical ventilation which of the following modes of ventilation that increase the effort of
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1. When planning care for a client on mechanical ventilation, which mode of ventilation that increases the effort of the client's respiratory muscles should NOT be included in the plan of care?

Correct answer: Assist-control

Rationale: Assist-control ventilation mode delivers a preset tidal volume at a set rate; however, it may not be suitable for clients who need to maintain some level of respiratory muscle activity. This mode provides full support for each breath, potentially leading to decreased respiratory muscle strength over time. Therefore, it is important to avoid using assist-control mode for clients who require increased effort of respiratory muscles to prevent muscle atrophy and promote optimal respiratory function.

2. A patient with generalized anxiety disorder (GAD) is prescribed escitalopram. The nurse should educate the patient that the full therapeutic effect of this medication may take:

Correct answer: D

Rationale: Escitalopram, an SSRI used in treating generalized anxiety disorder, typically takes 6-8 weeks to achieve its full therapeutic effect. While some improvement may be noticed earlier, the maximum benefit is usually experienced after this timeframe. Options A, B, and C are incorrect because they underestimate the time required for escitalopram to reach its full effectiveness. Educating patients about the realistic timeline for medication effectiveness is crucial in managing expectations and ensuring adherence to the prescribed treatment.

3. When starting therapy with trastuzumab, which finding should the nurse instruct the client to report?

Correct answer: A

Rationale: The correct answer is A: Dyspnea. Dyspnea can indicate pulmonary toxicity, a severe adverse effect of trastuzumab. It is crucial for the client to report any breathing difficulties promptly to ensure timely intervention and prevent further complications. Choices B, C, and D are incorrect because constipation, tinnitus, and dry mouth are not commonly associated with trastuzumab therapy and are not indicative of serious adverse effects that require immediate attention.

4. A nurse is caring for an intubated and sedated geriatric client. What intervention is most appropriate for reducing the risk for a friction and shear injury?

Correct answer: Use a mechanical lift to reposition the client every 2 hours

Rationale:

5. When Ryan was born, the hospital assessed his health with the Apgar scale, and the score was 5. What does this mean with respect to his breathing pattern?

Correct answer: B

Rationale: An Apgar score of 5 suggests that Ryan needed help establishing a regular breathing pattern after birth. Choice A is incorrect because a score of 5 indicates the need for assistance. Choice C is incorrect as an Apgar score of 5 does not reflect excellent condition. Choice D is incorrect as it signifies a critical condition, which is not the case with an Apgar score of 5.

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