An assessment finding of pulsus alternans may indicate evidence ...

[Caiter2013]

An assessment finding of pulsus alternans may indicate evidence of
 
  a. left-sided heart failure.
  b. jugular venous distention.
  c. pulmonary embolism.
  d. myocardial ischemia.

Question 2

The use of PCA infusion pumps allows the patient to
 
  a. act preemptively by administering a bolus of medication when pain begins.
  b. choose between the use of opioids or NSAID medication to control pain.
  c. decrease the risk of respiratory depression.
  d. control pain medication in 2-hour increments.

[choc0chan]

Answer to Question 1

A
Pulsus alternans describes a regular pattern of pulse amplitude changes that alternate between stronger and weaker beats. This finding is suggestive of end-stage left ventricular heart failure.

Answer to Question 2

A
The patient can self-administer a bolus of medication the moment the pain begins, acting preemptively. Allowing the patient to self-administer opioid doses does not diminish the role of the critical care nurse in pain management. The nurse advises about necessary changes to the prescription and continues to monitor the effects of the medication and doses. The patient is closely monitored during the first 2 hours of therapy and after every change in the prescription. If the patient's pain does not respond within the first 2 hours of therapy, a total reassessment of the pain state is essential. If the patient is pressing the button to bolus medication more often than the prescription, the dose may be insufficient to maintain pain control. Naloxone must be readily available to reverse adverse opiate respiratory effects.

[Caiter2013]

TYSM

[bigsis44]

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