A patient with a 5-year history of bipolar disorder was recently discharged from an inpatient hospital stay. She was admitted in a manic episode with a decreased need for sleep, flight of ideas, rapid speech, increased impulsive behavior, and delusional thinking. She was previously stabilized on lithium 900 mg PO at bedtime. Her lithium serum concentration 4 weeks ago was 0.8 mEq/L but was 0.2 mEq/L on admission. During hospitalization, lithium was restarted and olanzapine 10 mg PO at bedtime was added which stabilized her symptoms. Four weeks after discharge, she returns to clinic with a complaint of 30 pound weight gain. Today’s lithium level is 0.9 mEq/L and she has no manic or psychotic symptoms. The psychiatrist would like your opinion regarding her continued drug therapy. What is your most appropriate recommendation?

Which of the following pediatric vaccines is administered orally?

A 71-year-old male presents for a follow-up appointment after a recent ED visit for COPD exacerbation. He doesn’t believe his medications are “working as well as they used to.” He has had 2 exacerbations in the past year, during his most recent hospitalization he was also diagnosed with pneumonia, and he wants to avoid more hospitalizations. His current respiratory medications include albuterol HFA MDI 2 puffs q4h prn SOB and olodaterol 2.5mcg/inh 2 inhalations daily.  Diagnostic testing: FEV1 45% predicted, FEV1/FVC ratio: 42%  Symptoms: mMRC: 1  Eosinophil count: 57  What do you recommend for maintenance therapy? 

The nurse notes that a patient’s endotracheal tube (ET), which was at the 21-cm mark, is now at the 24-cm mark and the patient appears anxious and restless. Which action should the nurse take first?

The nurse on the medical-surgical unit is caring for a 69-year-old male client with pain and swelling of the right lower extremity. Nurses’ Notes   Day 1. 0930 Admission note: Client admitted from the Emergency Department via stretcher and transferred to bed. Client is alert and oriented. Saline lock IV in the R antecubital vein patent. Right lower extremity noted to have 2+ pedal edema, pain 8/10 in right calf. Warmth noted to right calf. Positive Homan’s sign to R lower extremity noted. Client has positive motion and sensation to right lower extremity. Right pedal pulse weak, palpable. R lower extremity elevated on 2 pillows. VS: BP 145/82, HR 96, RR 16, Temp 36.7C (98F). Client ordered to be on complete bedrest. Client made aware. 1010: Radiology called results of right leg ultrasound: Positive for deep vein thrombosis of the right posterior tibial vein. Provider made aware. New orders pending. 1030: Patient begins to experience SOB, anxiety, O2 Sat 83%, RR 38, HR 108, BP 149/88, patient seems to be apprehensive and anxious Which of the following actions should the nurse anticipate including in the patient’s plan of care? Select all that apply

When planning care for a patient on a mechanical ventilator, the nurse understands that the application of positive end-expiratory pressure (PEEP) to the ventilator settings has which therapeutic effect?

Three days post motor vehicle crash, the nurse noticed the patient’s chest tube drainage changed from serous fluid to milky white. The nurse suspects the patient may have had which of the following occur?

A male client has been admitted with chest trauma after a motor vehicle accident and has undergone subsequent intubation. A nurse checks the client when the high-pressure alarm on the ventilator sounds, and notes that the client has absence of breath sounds in right upper lobe of the lung. The nurse immediately assesses for other signs of which of the following:

The nurse cares for a 78-year-old female admitted to the medical intensive care unit in respiratory distress. Nurses’ Notes   0900. Client was admitted to the ICU in respiratory distress after minimal response to high flow oxygen for a pulse oximeter reading of 83% in room air. Crackles heard bilaterally in lower lobes with diminished breath sounds in right middle lobe; S1S2 auscultated; bowel sounds positive in all 4 quadrants; skin warm dry and intact. VS T 99.8F(37.7C); HR 110; RR 30 bpm; B/P 168/90; pulse oximeter is 87% on 100% non-rebreather; pain-0/10. Laboratory Report Lab Results Reference range ABG pH 7.2 7.35-7.45 ABG P02 65 mm Hg 75-100 mm Hg ABG PC02 51 mm Hg 35-45 mmHg ABG HC03 28 mEq/L 22-26 mEq/L WBC 5,600 cells/mm3 4.5 – 10.5 x 103 cells/mm3 Platelets 250,000/ mm3 140,000 to 450,000/ mm3 Potassium(serum) 4.0 mEq/L 3.5 to 5 mEq/L Sodium (serum) 140 mEq/L 135 to 145 mEq/L Magnesium 1.5 mEq/L 1.5 to 2.1 mEq/L Lactate level 4.5 mEq/L 0.5 to 2.2 mEq/L Blood culture Gram negative cocci Negative Urine culture pending Negative Sputum culture pending Negative What does the nurse determine is the priority for this client’s care?

A patient in acute respiratory failure is receiving ACV with a positive end-expiratory pressure (PEEP) of 10 cm H20. What sign alerts the nurse to undesirable effects of increased airway and thoracic pressure?