ch. 34 practice questions

a

For which reason does reduced urine output occur in patients experiencing sepsis during systemic inflammatory response syndrome? a. Impaired oxygenation and perfusion b. Production of pro-inflammatory cytokines c. Capillary leaks, allowing plasma to leak into the tissues d. Inappropriate clotting with micro-thrombi forming in some organ capillaries

C (The symptoms associated with sepsis show lots of variations as the disease develops. Most of the physiologic changes fluctuate in severe sepsis; therefore many patients are discharged from the hospital quicker and sicker than they should be.)

For which reason would a patient who was given treatment for sepsis and discharged from the hospital present again a few days later with severe sepsis? a. Increased physical activity b. Excessive consumption of liquids c. A delay in the disease progression d. Oversleep during the treatment regimen

e

The health care provider prescribed IV fluids, antiemetics, and continuous telemetry monitoring for a patient at risk for hypovolemic shock secondary to GI fluid losses. Which cue would lead the nurse to conclude the interventions are effective? Select all that apply. One, some, or all responses may be correct. a. Hemoglobin 8.0 g/dL b. Capillary refill greater than 5 seconds c. weak DTRs d. Blood pressure 80/54 mm Hg e. Urine output 950 mL/24 hr

B

Which assessment finding would the nurse report to the health care provider as a possible indicator of compensatory stage of shock for a patient admitted with a bleeding duodenal ulcer who is NPO status and has a nasogastric tube in place connected to low continuous suction? a. Serum potassium level of 4.7 mEq/L b. Decrease in mean arterial pressure (MAP) from 76 mm Hg to 62 mm Hg c. Urine output of 30 mL/hr d. Increased confusion

a

Which change in a patient with hypovolemic shock indicates to the nurse that the fluid resuscitation therapy is effective? a. Urine output increase from 5 mL/hr to 35 mL/hr b. Heart rate increase from 62 beats/min to 76 beats/min c. Respiratory rate increase from 22 breaths/min to 26 breaths/min d. Core body temperature decrease from 98.8°F (37.1°C) to 98.2°F (36.8°C)

a (Infection can result in septic shock if it is not treated on time)

Which type of shock is the nurse concerned about for a patient who has been refusing treatment for an infection for the past month? a. Septic b. obstructive c. Cardiogenic d. hypovolemic

C

Which type of shock is the nurse concerned about for an older-adult patient with a history of diabetes mellitus who has a blood pressure of 90/60 mm Hg, a white blood cell (WBC) count of 14,000/mm3, and a urine output of 0.2 mL/kg/hr? a. Hypovolemic b. Cardiogenic c. Septic d. Obstructive

D

Which vasodilator drug may be used to help manage hypovolemic shock? a. Milrinone b. Dobutamine c. Phenylephrine hydrochloride (HCl) d. Sodium nitroprusside

a, d, e (The patient who is unrestrained in a motor vehicle accident is prone to multiple trauma and bleeding. Surgical patients are at high risk for hypovolemic shock because of fluid loss and hemorrhage. Older-adult patients are prone to shock; a GI virus results in fluid losses. Unless injured or working in excessive heat, the construction worker and the athlete are not at risk for hypovolemic shock; they may be at risk for dehydration.)

A patient in which situation has an increased risk for hypovolemic shock? Select all that apply. One, some, or all responses may be correct. a. Unrestrained in motor vehicle accident b. Construction worker c. Athlete d. Surgical ICU patient e. 85-year-old with GI virus

a

A patient whose laboratory report shows decreased mean arterial pressure of 14 mm Hg from the patient's normal baseline may experience which effect on metabolism? a. Mild acidosis b. Hypoxia of vital organs c. Multiple organ dysfunctions d. Buildup of toxic metabolites

a

A patient with human immune deficiency virus (HIV) is admitted with a bacterial infection. According to the Modified Early Warning System (MEWS), which parameter would the nurse assess to determine the patient's risk for septic shock? Select all that apply. One, some, or all responses may be correct. a. Heart rate b. lung sounds c. Heart rhythm d. Diastolic blood pressure e. White blood cell (WBC) count

a (GI ulcers may hemorrhage, causing massive GI bleeding and hypovolemic shock. As the kidneys fail, fluid is typically retained, causing fluid volume excess, not hypovolemia. NSAIDs such as naproxen and ibuprofen, not acetaminophen, predispose the patient to GI bleeding and hypovolemia. Although a kidney stone may cause hematuria, there is not generally massive blood loss and hypovolemia)

A patient with which condition has an increased risk for hypovolemic shock? a. GI ulcer b. Kidney failure c. Arthritis and daily acetaminophen use d. Kidney stone

C (Kidney failure results in increased blood volume (hypervolemia) as the failing kidney is unable to produce urine. A myocardial infarction may lead to cardiogenic shock or heart failure, with resulting fluid volume excess rather than hypovolemia. BPH obstructs the outflow of urine into the bladder as prostatic tissue enlarges; blood volume is not reduced.)

A patient with which issue has an increased risk for hypovolemic shock? a. Acute kidney failure b. Myocardial infarction c. Overdosed on bumetanide d. Benign prostatic hyperplasia (BPH)

a

After a cholecystectomy, an older-adult patient developed breathing difficulty and had a heart rate of more than 95 beats/min, a breathing rate of 20 beats/min, a temperature of 102.4ºF (39.1ºC), and an elevated blood glucose level. Which assessment will help confirm this patient's condition? a. Blood culture b. Thyroxin level c. Hemoglobin level d. Blood pressure level

The white blood cells present in the area of invasion secrete cytokines with increased perfusion to locally infected tissue., The infection enters into the blood stream of the patient with further impaired oxygenation and perfusion to the body., Microthrombi formation is widespread with clots forming where they are not needed., Organ failure is evident, and poor clotting with uncontrolled bleeding occurs.

Arrange the events in chronological order with respect to septic shock. Microthrombi formation is widespread with clots forming where they are not needed. The white blood cells present in the area of invasion secrete cytokines with increased perfusion to locally infected tissue. The infection enters into the blood stream of the patient with further impaired oxygenation and perfusion to the body. Organ failure is evident, and poor clotting with uncontrolled bleeding occurs.

C (Maintaining the patient flat with the feet elevated improves venous return and perfusion to the brain, The head of bed elevated at 30 degrees describes a semi-Fowler position used to prevent aspiration.)

In which position will the nurse place a patient whose heart rate suddenly increases to 122 beats/min and blood pressure drops to 84/48 mm Hg to improve the patient's blood pressure and organ perfusion? a. Sims b. Lithotomy c. Feet elevated, head of bed flat d. Head of bed 30 degrees, legs flat

b, c, d, e (Oxygenation affects perfusion but not the MAP.)

The MAP is affected by the viscosity of the blood, the amount of blood pumped by the heart (cardiac output), the total blood volume, and the size of the vascular bed. Oxygenation affects perfusion but not the MAP. a. Oxygenation b. Blood viscosity c. Cardiac output d. Total blood volume e. Size of vascular bed

a, b, c, d, e (Clinical manifestations found in the initial stage of hypovolemic shock include decreased systolic and increased diastolic blood pressure and decreased urinary output. The nurse would palpate peripheral pulses as their strength diminishes with hypovolemic shock. The patient in the progressive stage of shock would show changes in their mental status. The nurse would assess skin color and temperature. The patient would become cold and clammy because of decreased peripheral circulation.)

The nurse identifies a patient admitted with an upper GI bleed is at an increased risk for hypovolemic shock. Which action would the nurse take to decrease this risk? Select all that apply. One, some, or all responses may be correct. a. Observe vital signs. b. Assess urinary output. c. Palpate peripheral pulses. d. Monitor level of consciousness. e. Check skin color and temperature.

B, C, D

The nurse is caring for a patient in the beginning stages of sepsis. Which factor would affect gas exchange and tissue perfusion at this time? Select all that apply. One, some, or all responses may be correct. a. tachypnea b. Inflammation c. Oxidative stress d. Vascular changes e. oliguria

a, b, c (An apical heart rate of 82 beats/min is normal but does not reflect that adequate circulation is being maintained)

The nurse is evaluating the plan of care for a patient with hypovolemic shock to determine whether circulation has improved. Which cue would lead the nurse to document that the goal is met? Select all that apply. One, some, or all responses may be correct. a. 24-hour urine output 1200 mL b. Palpable pedal pulses bilaterally c. Mean arterial pressure 73 mm Hg d. Apical heart rate 82 beats/min e. IV fluids infusing 100 mL/hr

a, b, c, d, e (The nurse would assess the patient for headaches as they can be a sign of drug toxicity. Hourly urine output would be monitored as the medication can decrease urinary output because of its effect on kidney perfusion. Chest pain is a sign of myocardial vasoconstriction, so the nurse would assess for this adverse effect. The nurse will monitor the IV site for extravasation as this medication can cause tissue necrosis if it leaks into the surrounding tissues. The nurse should check the blood pressure every 15 minutes for signs of drug excess.)

The nurse is planning care for a patient receiving phenylephrine to treat hypovolemic shock. Which parameter would the nurse assess to prevent complications? Select all that apply. One, some, or all responses may be correct. a. Headaches b. Hourly urine output c. Presence of chest pain d. IV site every 30 minutes e. Blood pressure every 15 minutes

C

The nurse is planning care for a patient with dehydration to minimize complications. Which action would the nurse take to prevent hypovolemic shock? a. Administer oxygen. b. Insert a urinary catheter. c. Give IV fluids. d. Assess peripheral pulses.

C (Anticoagulants such as warfarin can decrease perfusion. Sepsis causes septic shock. Anemia causes hypoxia but not hypovolemic shock. Heart failure causes excess fluid. Hypertension increases vascular resistance but does not cause hypovolemic shock.)

The nurse is reviewing the health record of a patient with hypovolemic shock. Which factor would the nurse suspect caused the decrease in perfusion? Select all that apply. One, some, or all responses may be correct. a. Sepsis b. Anemia c. Warfarin d. Heart failure e. Hypertension

a

The nurse will instruct a patient who had an ambulatory care surgical procedure to immediately report which sign of hypovolemic shock? a. Dizziness b. lack of appetite c. Mild pain at the site of the procedure d. Clear-yellow drainage from incision

a

The nurse would further evaluate a patient with which issue for septic shock? a. A temperature of 100ºF (37.7ºC) and total bilirubin level of 7 mg/dL b. Frequent urination and a pre-existing disorder such as diabetes c. An elevated white blood cell count with creatinine level of less than 0.5 mg/dL d. A heart rate of 40 beats/min at rest and a respiratory rate of more than 18 breaths/min

a (Vital sign trends must be taken into consideration; a BP of 90/60 mm Hg may be normal for this patient. Calling the surgeon is not necessary at this point, and increasing IV fluids is not indicated. The same equipment should be used when vital signs are taken postoperatively.)

Which action will the nurse take for a postoperative patient with a blood pressure (BP) of 90/60 mm Hg, a heart rate of 80 beats/min, and a respiratory rate of 22 breaths/min? a. Compare these vital signs with the last several readings. b. Request the surgeon see the patient. c. Increase the rate of IV fluids. d. Reassess vital signs using different equipment.

a (Systemic inflammatory response syndrome (SIRS) manifests similarly to sepsis in which the patient is underperfused but an infectious cause may not be present. Worsening confusion suggests the patient is progressing in a shock state, and a Rapid Response Team should be called to assess and treat the patient's hypoperfusion. Establishing an IV for fluid administration is an appropriate action, but should not be done before calling the Rapid Response Team. Reorienting the patient and activating the bed alarm will not address the underlying cause of the confusion.)

Which action will the nurse take immediately for a patient who is admitted with new-onset hypotension, tachycardia, tachypnea, and elevated white blood cell count but whose blood cultures are negative? a. Notify the Rapid Response Team. b. Establish an IV for possible fluid administration. c. Activate the bed alarm. d. Reorient the patient frequently.

a (The nurse should immediately notify the Rapid Response Team or primary health care provider if the patient with sepsis shows signs of systemic inflammatory response syndrome to ensure the patient's safety. The nurse should start a blood transfusion and IV fluids after receiving an order from the primary health care provider. The nurse can keep the patient on mechanical ventilation upon informing the primary health care provider.)

Which action will the nurse take immediately for a patient with sepsis who is showing signs of systemic inflammatory response syndrome (SIRS)? a. Notify the Rapid Response Team. b. Start blood replacement therapy. c. Start administering IV fluids. d. Keep the patient on mechanical ventilation.

a, b, c, d, e (should administer antibiotics to fight infection. Oxygen should be given to improve gas exchange. Inotropic drugs increase the contractility of the heart. Blood pressure should be monitored as a decrease is an early sign of septic shock. An increasing serum lactate level would indicate presence of sepsis)

Which action would the nurse take to decrease a patient's risk for shock? Select all that apply. One, some, or all responses may be correct. a. Give antibiotics. b. Administer oxygen. c. Initiate inotropic drugs. d. Monitor blood pressure. e. Obtain serum lactate level.

C

Which assessment data indicate that antibiotic therapy has been effective for treating a patient with sepsis? a. Serum creatinine increases from 1.2 mg/dL to 2.1 mg/dL. b. White blood cell count decreases from 15,000/mm3 to 13,500/mm3. c. Serum lactate level decreases from 2.3 mmol/L to 0.8 mmol/L. d. Serum glucose increases from 112 mg/dL to 146 mg/dL.

a, b, d (the difference between systolic and diastolic pressure (pulse pressure) is decreased. Blood pressure in the body drops also, causing postural hypotension. The decrease in blood volume causes a simultaneous decrease in cardiac output. There is a compensatory increase in pulse rate to restore cardiac output in shock. Peripheral pulses become weak in hypovolemic shock.)

Which assessment finding is a cardiovascular manifestation of hypovolemic shock? Select all that apply. One, some, or all responses may be correct. a. Narrow pulse pressure b. Postural hypotension c. Decreased pulse rate d. Decreased cardiac output e. Bounding peripheral pulses

C

Which clinical finding is associated with severe sepsis? a. Temperature of 98°F (36.7°C) b. White blood cell (WBC) count of 10,000/mm3 c. Plasma glucose level of 140 mg/dL d. Platelet count of 180,000/µL

c, d

Which clinical manifestation of septic shock distinguishes it from hypovolemic shock? Select all that apply. One, some, or all responses may be correct. a. Increased lactic acid level b. Increased potassium level c. Decreased blood pressure d. Increased blood glucose level e. Decreased mean arterial pressure

a, b, d (After a thorough treatment for septic shock, the patient would have a normal aerobic cellular metabolism. As a result, the arterial blood gas values would also come within normal ranges. An effective treatment would resolve or prevent multiple organ dysfunctions. Maintenance of urine output should be at least 20 mL/hr. Maintenance of mean arterial blood pressure should be within 10 mm Hg of baseline.)

Which condition indicates an expected outcome of treatment for sepsis and septic shock? Select all that apply. One, some, or all responses may be correct. a. Normal aerobic cellular metabolism b. Arterial blood gases within normal range c. Maintenance of urine output at least 40 mL/hr d. Absence of multiple organ dysfunction syndrome e. Maintenance of mean arterial blood pressure above 10 mm Hg of baseline

a, b, c

Which condition is a risk factor for hypovolemic shock? Select all that apply. One, some, or all responses may be correct. a. Hemophilia b. Dehydration c. Diuretic therapy d. Spinal cord injury e. Myocardial infarction

a, c, d

Which condition is identified as a specific cause of distributive shock? Select all that apply. One, some, or all responses may be correct. a. Sepsis b. cardiac tamponade c. Anaphylaxis d. capillary leak e. Pericarditis

a

Which condition is the nurse concerned about for a patient with type 2 diabetes who has a high fever and cough, decreased mean arterial pressure, and an increased level of lactic acid and who has been given fludrocortisone? a. Septic shock b. Addison disease c. Hypovolemic shock d. Bacterial infection

B

Which condition is the nurse concerned about in a patient who underwent a radical colon resection for metastatic cancer and has developed septic shock, is neurologically unresponsive, is unable to breathe without mechanical ventilator support, requires dialysis for renal function, is not tolerating tube feedings, and is beginning to show signs of hepatic failure? a. Late stage of septic shock b. Multiple organ dysfunction syndrome (MODS) c. Intracerebral hemorrhage d. Adverse reaction to sedating agents

c (The patient who underwent a kidney transplant will need to take lifelong immune suppressant therapy and is at risk for infection from internal and external organisms. Pernicious anemia is related to lack of vitamin B12, not to bone marrow failure (aplastic anemia), which would place the patient at risk for infection. Inflammation of the pericardial sac is an inflammatory condition that does not pose a risk for septic shock. Although owning pets, especially cats and reptiles, poses a risk for infection, the patient with immunosuppression after a kidney transplant has a very high risk for infection, sepsis, and death.)

Which condition places a patient at highest risk for sepsis? a. Pernicious anemia b. Pericarditis c. Post kidney transplant d. Owning an iguana

D (Heart and respiratory rates increased from the patient's baseline level or a slight increase in diastolic blood pressure may be the only objective manifestation of this early stage of shock. Catecholamine release occurs early in shock as a compensation for fluid loss; blood pressure will be normal. Early in shock, the patient displays rapid, not slow, respirations. Dysrhythmias are a late sign of shock; they are related to lack of oxygen to the heart.)

Which condition represents an early symptom of hypovolemic shock? a. Hypotension b. Bradypnea c. Heart blocks d. Tachycardia

a (A MAP of 8 mm Hg below baseline is associated with the initial stage of hypovolemia. In this stage, the production of lactic acid occurs in some tissues, but the overall metabolism remains aerobic. Oxygen perfusion to the vital organs will be maintained because of the effectiveness of the compensatory mechanisms. The secretion of renin, aldosterone, and antidiuretic hormones will not occur. These hormones are secreted when there is a further decrease in the mean arterial pressure of 10 to 15 mm Hg below the normal baseline.)

Which condition would the nurse be concerned about for a patient whose mean arterial pressure (MAP) is 8 mm Hg below the normal baseline? a. Production of lactic acid b. Overall metabolism is anaerobic c. Improper perfusion of oxygen to vital organs d. Increased secretion of renin, aldosterone, and antidiuretic hormones

B (Severe sepsis may result in adrenal insufficiency. Therefore low doses of corticosteroids are prescribed in the form of IV hydrocortisone during the treatment to prevent adrenal insufficiency. In hypovolemic shock, adrenal insufficiency may not occur. Milrinone helps in improving contractility, and its administration is not limited to septic shock. Sodium nitroprusside improves myocardial perfusion and is not limited to septic shock. Phenylephrine HCl helps in improving mean arterial pressure and therefore can be prescribed in patients with sepsis and hypovolemia.)

Which drug is prescribed to patients with septic shock but not with hypovolemic shock? a. Milrinone b. Hydrocortisone c. Sodium nitroprusside d. Phenylephrine hydrochloride (HCl)

C (The serum lactate level would be elevated in a patient with septic shock and DIC. The fibrinogen, hematocrit, and platelet count would be decreased, which leads to excess bleeding.)

Which laboratory value would the nurse expect to increase if a patient with septic shock is progressing into disseminated intravascular coagulation (DIC)? a. Fibrinogen b. Hematocrit c. Serum lactate d. Platelet count

D (Low-dose corticosteroids may be given during the treatment of adrenal insufficiency in patients with sepsis and septic shock. Hydrocortisone may be given IV for treatment of these patients. Insulin may be given to control blood glucose levels. Heparin may be given to patients with sepsis and septic shock to manage microvascular abnormalities. Dobutamine is an inotropic agent used for treating hypovolemic shock. It helps to manage hypotension.)

Which drug may be used to treat adrenal insufficiency for a patient with sepsis and septic shock? a. Insulin b. heparin c. Dobutamine d. Hydrocortisone

a

Which finding indicates the need to decrease the rate of a continuous IV infusion of norepinephrine for a patient in shock? a. Blood pressure of 170/96 mm Hg b. Respiratory rate of 22 breaths/min c. Urine output of 70 mL/hr d. Heart rate of 98 beats/min

C (Increased cardiac output is reflected by tachycardia rather than bradycardia. Increased stroke volume and a normal systolic blood pressure may also reflect increased cardiac output.)

Which finding may reflect increased cardiac output in patients with septic shock? a. Bradycardia b. Decreased stroke volume c. Normal central venous pressure (CVP) d. Increase in systolic blood pressure

a (transfusion is not part of the sepsis resuscitation bundle. Cooling baths are not indicated because the patient is hypothermic, nor is this part of the sepsis resuscitation bundle. NPO status is not indicated for this patient, nor is it part of the sepsis resuscitation bundle.)

Which intervention is included in the sepsis resuscitation bundle? a. Administer broad-spectrum antibiotics. b. Start a blood transfusion. c. Initiate cooling baths. d. Enforce NPO status.

B

Which intervention is the priority for a 49-year-old patient who had a car accident and is admitted to the emergency department? a. Administer oxygen. b. Maintain a patent airway. c. Examine for overt bleeding. d. Maintain an established catheter.

a (Instead of automated ventilation, it is better to use mechanical ventilation. Indwelling urinary catheters and IV access lines should be removed as soon as possible if there is no need for them)

Which intervention would help prevent sepsis and septic shock in a 65-year-old patient who is being treated at a hospital? a. Using aseptic technique b. Using automated ventilation c. Placing an indwelling urinary catheter d. Maintaining an IV access line at all times

D

Which intervention would the nurse perform first for a patient admitted with pneumonia and possible sepsis who arouses to name but is not oriented, has a blood pressure of 90/46 mm Hg, heart rate of 128 beats/min, respiratory rate of 28 breaths/min, temperature of 101.3°F (38.5°C), no urine output for 4 hours, and central venous pressure of 2 mm Hg? a. Obtain blood cultures. b. Insert an indwelling urinary catheter. c. Apply vasopressors. d. Administer a 500-mL IV crystalloid bolus over 30 minutes.

b (A decreased segmented neutrophil count is indicative of late sepsis. Serum lactate is increased in late sepsis. Monocytosis is usually seen in diseases such as tuberculosis and Rocky Mountain spotted fever. An increased platelet count does not indicate sepsis; late in sepsis, platelets may decrease because of consumptive coagulopathy.)

Which laboratory result is seen in late sepsis? a. Decreased serum lactate b. Decreased segmented neutrophil count c. Increased numbers of monocytes d. Increased platelet count

B

Which laboratory value is indicative of septic shock? a. Partial pressure of arterial carbon dioxide (PaCO2) 58 mm Hg b. Lactate level 9.0 mmol/L c. Partial thromboplastin time (PTT) 64 seconds d. Potassium 2.8 mEq/L

a, b, c, d, e

Which medication may be included in the care plan of a patient with septic shock? Select all that apply. One, some, or all responses may be correct. a. Vasoconstrictors b. Insulin therapy c. Inotropic agents d. Low-dose corticosteroids e. Broad-spectrum IV antibiotics

a, d

Which metabolic change occurs as a result of tissue ischemia during the compensatory stage of hypovolemic shock? Select all that apply. One, some, or all responses may be correct. a. Acidosis b. Alkalosis c. Hypokalemia d. Hyperkalemia e. Vasodilatation

c

Which parameter indicates a desired patient response to an infusion of the vasopressor agent norepinephrine to treat hypovolemic shock? a. Heart rate change from 112 to 123 beats/min b. Decreased peripheral pulses c. Mean arterial pressure change from 66 to 78 mm Hg d. Urine output that remains at 30 mL/hr

D (Lactate levels of 4 mmol/L or higher are associated with a 30% mortality rate. A rapid respiratory rate, low oxygen saturation, and a change in the patient's cognition are present during this stage of severe sepsis; however, these can be reversed with appropriate and timely treatment.)

Which physiologic change in a patient with septic shock indicates a poor prognosis? a. Rapid respiratory rate b. Low oxygen saturation c. Change in patient's cognition d. Lactate level of 4.4 mmol/L

B (Septic shock is always due to an underlying infection. An elevated WBC count is associated with septic shock. There is a progressive organ dysfunction resulting in low blood pressure and decreased urinary output. The respiratory rate is increased to compensate for hypoxia in the tissues.)

Which physiologic change is related to septic shock? a. High blood pressure b. Elevated white blood cell (WBC) count c. Increased urinary output d. Decreased respiratory rate

a, d, e

Which physiologic change is seen in a patient with prolonged sepsis? Select all that apply. One, some, or all responses may be correct. a. Hypoxia b. Increase in white blood cell (WBC) levels c. Increase in platelet count d. Decrease in urine output e. Change in patient cognition

B, C, E

Which point would the nurse consider during the psychosocial assessment of a patient who is suspected to have hypovolemia? Select all that apply. One, some, or all responses may be correct. a. Questions should not be repeated. b. The patient should respond to the question asked. c. The nurse should check if the patient becomes irritated or upset. d. Questions should be phrased in a "yes" or "no" format. e. The nurse should determine if the patient is able to concentrate on a question for long.

c (In sepsis, there may be no loss of blood volume, and the hemoglobin level will not be affected.)

Which statement by a patient at risk for sepsis indicates the need for further teaching about self-management? a. "I will maintain good hygiene." b. "I will check my temperature regularly." c. "I will go for a hemoglobin check weekly." d. "I will check my blood pressure regularly."

a, d, e

Which statement made by a student nurse indicates understanding of the etiology of severe sepsis? Select all that apply. One, some, or all responses may be correct. a. "Sepsis is commonly seen in patients with acquired immune deficiency syndrome (AIDS)." b. "Bacterial overgrowth is always the causative agent." c. "Sepsis is seen primarily in small children." d. "In an immunocompromised patient, bacteria and fungi can cause sepsis." e. "Central venous access devices increase the risk for sepsis."