NURS 342 Test 3 - Ch. 66 - Shock, Sepsis, and Multiple Organ Dysfunction

NURS 342 Test #3 - Ch. 66 - Shock, Sepsis, and Multiple Organ Dysfunction Syndrome - Evolve AND Lewis 10th ed. practice NCLEX questions ElliotReid7Top creator on Quizlet Save

Chapter 66: Shock, Sepsis, and Multi...

29 terms jullasaPreview NUR250 Final Group 1 - Sepsis - NC...20 terms Candibar1986Preview Shock and Sepsis NCLEX questions 28 terms T_Adams7Preview Shock 201 term feli P Evolve bridge to nclex ch 66...A nurse has administered corticosteroids to a patient with multiple organ dysfunction syndrome (MODS). In what order should the results of this medication occur in this situation.

• Renal excretion of potassium
• Increased intravascular volume
• Improved capillary permeability
• Enhanced renal artery perfusion

C, B, D, A

Corticosteroids are administered to patients who have MODS to suppress the inflammatory response. If the patient responds positively to the corticosteroids, capillary permeability should improve, stopping leakage of intravascular fluid and helping restore intravascular blood volume.Improved intravascular volume should help improve the blood pressure, and if compensatory sympathetic discharge is halted, renal blood flow increases. Increased renal blood flow should increase the glomerular filtration rate and renal excretion of potassium.A massive gastrointestinal bleed has resulted in hypovolemic shock in an older patient. What is a priority nursing diagnosis?

• Acute pain
• Impaired skin integrity
• Decreased cardiac output
• Ineffective tissue perfusion
• Ineffective tissue perfusion

The many deleterious effects of shock are all related to inadequate perfusion and oxygenation of every body system. This nursing diagnosis supersedes the other diagnoses.

A 50-yr-old woman with a suspected brain tumor is scheduled for a CT scan with contrast media. The nurse notifies the physician that the patient reported an allergy to shellfish. Which response by the physician should the nurse question?

• Infuse IV diphenhydramine before the procedure.
• Administer lorazepam (Ativan) before the procedure.
• Complete the CT scan without the use of contrast media.
• Premedicate with hydrocortisone sodium succinate (Solu-Cortef).
• Administer lorazepam (Ativan) before the procedure.

An individual with an allergy to shellfish is at an increased risk to develop anaphylactic shock if contrast media is injected for a CT scan. To prevent anaphylactic shock, the nurse should always confirm the patient's allergies before diagnostic procedures (e.g., CT scan with contrast media). Appropriate interventions may include cancelling the procedure, completing the procedure without contrast media, or premedication with diphenhydramine or hydrocortisone. IV fluids may be given to promote renal clearance of the contrast media and prevent renal toxicity and acute kidney injury. The use of an antianxiety agent such as lorazepam would not be effective in preventing an allergic reaction to the contrast media.When caring for a critically ill patient who is being mechanically ventilated, the nurse will monitor for which clinical manifestation of multiple organ dysfunction syndrome (MODS)?

• Increased serum albumin
• Decreased respiratory compliance
• Increased gastrointestinal (GI) motility
• Decreased blood urea nitrogen (BUN)/creatinine ratio
• Decreased respiratory compliance

Clinical manifestations of MODS include symptoms of respiratory distress, signs and symptoms of decreased renal perfusion, decreased serum albumin and prealbumin, decreased GI motility, acute neurologic changes, myocardial dysfunction, disseminated intravascular coagulation (DIC), and changes in glucose metabolism.A 64-yr-old woman is admitted to the emergency department vomiting bright red blood. The patient's vital signs are blood pressure of 78/58 mm Hg, pulse of 124 beats/min, respirations of 28 breaths/min, and temperature of 97.2°F (36.2°C). Which physician order should the nurse complete first?

• Obtain a 12-lead ECG and arterial blood gases.
• Rapidly administer 1000 mL normal saline solution IV.
• Administer norepinephrine (Levophed) by continuous IV infusion.
• Carefully insert a nasogastric tube and an indwelling bladder catheter.
• Rapidly administer 1000 mL normal saline solution IV.

Isotonic crystalloids, such as normal saline solution, should be used in the initial resuscitation of hypovolemic shock. Vasopressor drugs (e.g., norepinephrine) may be considered if the patient does not respond to fluid resuscitation and blood products. Other orders (e.g., insertion of nasogastric tube and indwelling bladder catheter and obtaining the diagnostic studies) can be initiated after fluid resuscitation is initiated.The nurse would recognize which clinical manifestation as suggestive of sepsis?

• Sudden diuresis unrelated to drug therapy
• Hyperglycemia in the absence of diabetes
• Respiratory rate of seven breaths per minute
• Bradycardia with sudden increase in blood pressure
• Hyperglycemia in the absence of diabetes

Hyperglycemia in patients with no history of diabetes is a diagnostic criterion for sepsis. Oliguria, not diuresis, typically accompanies sepsis along with tachypnea and tachycardia.

The nurse is caring for a 72-yr-old man in cardiogenic shock after an acute myocardial infarction. Which clinical manifestations would be most concerning?

• Restlessness, heart rate of 124 beats/min, and hypoactive bowel sounds
• Mean arterial pressure of 54 mm Hg; increased jaundice; and cold, clammy skin
• PaO2 of 38 mm Hg, serum lactate level of 46.5 mcg/dL, and puncture site bleeding
• Agitation, respiratory rate of 32 breaths/min, and serum creatinine of 2.6 mg/dL
• PaO2 of 38 mm Hg, serum lactate level of 46.5 mcg/dL, and puncture site bleeding

Severe hypoxemia, lactic acidosis, and bleeding are clinical manifestations of the irreversible state of shock. Recovery from this stage is not likely because of multiple organ system failure. Restlessness, tachycardia, and hypoactive bowel sounds are clinical manifestations that occur during the compensatory stage of shock. Decreased mean arterial pressure, jaundice, cold and clammy skin, agitation, tachypnea, and increased serum creatinine are clinical manifestations of the progressive stage of shock.The nurse is assisting in the care of several patients in the critical care unit. Which patient is most at risk for developing multiple organ dysfunction syndrome (MODS)?

• A 22-yr-old patient with systemic lupus erythematosus admitted with a pelvic fracture
• A 48-yr-old patient with lung cancer admitted for syndrome of inappropriate antidiuretic hormone and hyponatremia
• A 65-yr-old patient with coronary artery disease, dyslipidemia, and primary hypertension admitted for unstable angina
• A 82-yr-old patient with type 2 diabetes mellitus and chronic kidney disease admitted for peritonitis related to a peritoneal dialysis catheter

infection

• A 82-yr-old patient with type 2 diabetes mellitus and chronic kidney disease admitted for peritonitis related to a peritoneal dialysis catheter

infection A patient with peritonitis is at high risk for developing sepsis. In addition, a patient with diabetes is at high risk for infections and impaired healing.Sepsis and septic shock are the most common causes of MODS. Individuals at greatest risk for developing MODS are older adults and persons with significant tissue injury or preexisting disease. MODS can be initiated by any severe injury or disease process that activates a massive systemic inflammatory response.If the patient in shock is to receive 1000 mL of normal saline in 2 hours, at what rate should the infusion pump be set?500 mL per hour For the 1000 mL of normal saline to be infused in 2 hours, the infusion pump should be set at 500 mL per hour (1000 mL divided by 2 hours).What laboratory finding is consistent with a medical diagnosis of cardiogenic shock?

• Decreased liver enzymes
• Increased white blood cells
• Decreased red blood cells, hemoglobin, and hematocrit
• Increased blood urea nitrogen (BUN) and serum creatinine (Cr) levels
• Increased blood urea nitrogen (BUN) and serum creatinine (Cr) levels

The renal hypoperfusion that accompanies cardiogenic shock results in increased BUN and creatinine levels. Impaired perfusion of the liver results in increased liver enzymes, but white blood cell levels do not typically increase in cardiogenic shock. Red blood cell indices are typically normal because of relative hypovolemia.

A patient's localized infection has become systemic and septic shock is suspected. What medication is expected to treat septic shock refractory to fluids?

• Insulin infusion
• Furosemide (Lasix) IV push
• Norepinephrine administered by titration
• Administration of nitrates and β-adrenergic blockers
• Norepinephrine administered by titration

If fluid resuscitation using crystalloids is not effective, vasopressor medications such as norepinephrine (Levophed) and dopamine are indicated to restore mean arterial pressure (MAP). Nitrates and β-adrenergic blockers are most often used in the treatment of patients in cardiogenic shock. Furosemide (Lasix) is indicated for patients with fluid volume overload. Insulin infusion may be administered to normalize blood sugar and improve overall outcomes, but it is not considered a medication used to treat shock.After coronary artery bypass graft surgery a patient has postoperative bleeding that requires returning to surgery for repair. During surgery, the patient has a myocardial infarction (MI). After restoring the patient's body temperature to normal, which patient parameter is the most important for planning nursing care?

• Cardiac index (CI) of 5 L/min/m2
• Central venous pressure of 8 mm Hg
• Mean arterial pressure (MAP) of 86 mm Hg
• Pulmonary artery pressure (PAP) of 28/14 mm Hg
• Pulmonary artery pressure (PAP) of 28/14 mm Hg

Pulmonary hypertension as indicated by an elevated PAP indicates impaired forward flow of blood because of left ventricular dysfunction or hypoxemia. Both can be a result of the MI. The CI, CVP, and MAP readings are normal.The nurse is caring for a 29-yr-old man who was admitted 1 week ago with multiple rib fractures, pulmonary contusions, and a left femur fracture from a motor vehicle crash. The attending physician states the patient has developed sepsis, and the family members have many questions.Which information should the nurse include when explaining the early stage of sepsis?

• Antibiotics are not useful when an infection has progressed to sepsis.
• Weaning the patient away from the ventilator is the top priority in sepsis.
• Large amounts of IV fluid are required in sepsis to fill dilated blood vessels.
• The patient has recovered from sepsis if he has warm skin and ruddy cheeks.
• Large amounts of IV fluid are required in sepsis to fill dilated blood vessels.

Patients with sepsis may be normovolemic, but because of acute vasodilation, relative hypovolemia and hypotension occur. Patients in septic shock require large amounts of fluid replacement and may require frequent fluid boluses to maintain circulation. Antibiotics are an important component of therapy for patients with septic shock. They should be started after cultures (e.g., blood, urine) are obtained and within the first hour of septic shock. Oxygenating the tissues is the top priority in sepsis, so efforts to wean septic patients from mechanical ventilation halt until sepsis is resolving. Additional respiratory support may be needed during sepsis. Although cool and clammy skin is present in other early shock states, the patient in early septic shock may feel warm and flushed because of a hyperdynamic state.