NUR 423 Exam 2 Book/quiz question practice

EtCO2 is an indicator of which alveolar factor?

Ventilation

A client who has been diagnosed with acute pancre-atitis states, "I'm not a drinker, and I have never had problems with my gallbladder. Why did I end up having a problem with my pancreas?"

Which other etiologies for pancreatitis should the nurse consider before responding? Taking some prescription medications

Which statement by the spouse of a client in renal fail-ure would the nurse evaluate as indicating accurate knowledge of continuous renal replacement therapy? 1. "With this therapy, it will be just like his kidneys were not damaged."

"He will probably have to stay in the critical care unit while on this therapy."

A client's pressure-adjusted heart rate (PAR) has increased since yesterday's measurement. Which information should the nurse provide to the client's family?

"Her cardiovascular status has worsened."

A nurse planning care for a client with acute pancre-atitis will monitor closely for which problems? (Select all that apply.

) Autonomic dysreflexia

Minute ventilation VE is calculated using which formula?

VE - VT x F

A 48-year-old woman has just been diagnosed with hemorrhagic pancreatitis. Which statement by the nurse is most accurate? "

A common cause of this problem in women is gall-bladder disease."

Client situations associated with respiratory alkalosis include which condition?

Anxiety

Acute kidney injury that develops from hypovolemic shock would be classified as which type of injury?

Prerenal

What is the purpose of the water-seal chamber in a three-chamber chest drainage system?

Prevent airflow back into the client

Viral pneumonia typically presents in which way? =

Progressive dyspnea and persistent fever

The hypercatabolic processes in clients with AKI make restriction of which nutrients an important consideration?

Proteins

A 35-year-old male is diagnosed with PUD. His father had a gastric ulcer. He smokes one pack of cigarettes per day, takes a diuretic to treat his hypertension, and is obese (310 pounds at 6 feet tall). He takes aspirin every day for his arthritis. How many risk factors for PUD does this person have?

Three

What is the purpose of surfactant?

To decrease alveolar surface tension

n the client with chronic liver disease, oral lactulose is given daily for which reason?

To prevent hepatic encephalopathy

What is a major underlying goal that drives the major-ity of medical management activities for the client experiencing acute liver failure? (Select all that apply.)

To prevent secondary complications

Severe acute pancreatitis usually has which effect on serum glucose?

Transient hyperglycemia

MODS is characterized by the dysfunction of how many organ systems?

Two or more

Mortality in MODS-related AKI is lower in which case?

Urine output is greater than 400 mL/day

Which statement is TRUE about infection in clients with ALF?

Use of antimicrobial medications may begin early. Infection can be identified by temperature and WBC count elevations.

What is a characteristic of acute lower GI bleeding?

Usually resolves spontaneously

A client whose left femur was surgically repaired 7 days ago has been on bedrest since surgery. This morning, the nurse is concerned with an acute change in the client's pulmonary status. Which factors of Vir-chow's triad would the nurse identify in this case, putting the client at risk for development of deep-vein thrombosis? (Select all that apply.)

Venous stasis. Venous enlargement

If the host inflammatory response becomes general-ized, what is the result?

Widespread involvement of endothelial cells

The client is assessed with the following: temperature 39.5°C (103°F), heart rate 110 beats/min, respiratory rate 12/min, WBC 15,000 cells/mm3 with greater than 10% bands. How many of the criteria for SIRS does this client exhibit?

3

What is the primary function of type II alveolar cells?

Surfactant production

According to the CURB-65 severity-of-CAP criteria, which value is considered a risk factor?

Systolic BP of 85 mmHg

Which type of embolism manifests as dyspnea, tachy-pnea, neurological symptoms, and petechiae?

Fat

Clients with occult GI bleeding often present with which manifestations?

Fatigue and syncope

1. The conducting airways serve which major functions? (Select all that apply.)

Filtering. Humidifying. Warming.

What is the cause of crackles?

Fluid or secretions in the small airways or alveoli

Treatment of ischemic bowel disease may include which measure?

Fluid resuscitation

Which complications are routinely addressed in the client with AKI? (Select all that apply.)

Fluid. Acid-base imbalance. Infection

In the client with chronic liver disease, which factor contributes to the development of hepatic encephalopathy?

GI bleeding

Normal blood flow past completely unventilated alve-oli is the definition of which term?

Capillary shunt

1. Hyperkalemia associated with AKI may lead to which problem?

Cardiac arrest

How does alcohol affect the pancreas?

Causes spasm of the sphincter of Oddi

1. Acute liver failure is defined as the presence of enceph-alopathy and which lab abnormality?

International normalized ratio greater than 1.5

The nurse is concerned that a client diagnosed with pancreatitis may be developing hypocalcemia. How would the nurse perform the Chvostek sign to check for this complication?

Tap the client's facial nerve in front of the ear.

A nurse is administering 80 mg of IV furosemide to a client in renal failure. To avoid ototoxicity, how long should it take to inject this medication?

20 minutes

What is the mortality rate for strangulation?

30%

To prevent acute kidney damage, the medical team works to maintain a trauma client's mean arterial pres-sure (MAP) of at least:

65 mmHg

The primary problem associated with failure to venti-late is which condition?

Alveolar hypoventilation

What is a common sign or symptom of PE?

Dyspnea

Which pathophysiologic condition occurs as a result of anaerobic metabolism?

Metabolic shutdown

What is the major cause of death from AKI?

Sepsis

Colorimetric capnography uses what measure to esti-mate EtCO2?

pH

A patient with hyperventilation as a response to metabolic acidosis (with full compensation) would present with which ABG?

pH of 7.35 PaO2 of 75 CO2 of 25 HCO3 16.

Which arterial blood gas pH results would the nurse most commonly note with chronic respiratory insuffi-ciency?

pH within normal limits

What is the typical point at which urine output is con-sidered adequate in the client in acute renal failure?

0.5 mL/kg/hr

Stress-related mucosal disease (SRMD) begins to develop in most critically ill clients within how many hours of admission to an ICU?

24

Which laboratory tests are the primary ones obtained to help diagnose pancreatitis?

Amylase and lipase

Herniation of the brain occurs more frequently when arterial ammonia levels are:

More than 200 mcg/dL

Respiratory compensation involves the excretion or retention of which gas or substance?

CO2

Which findings suggest a client with chronic kidney disease may have developed pericarditis?

Chest pain. Friction rub. Muffled heart sounds

Failure to oxygenate refers to which primary problem?

Hypoxemia

A client with acute liver failure has developed increas-ing ascites. Which client statement would alert the nurse that this situation is becoming dangerous? (Select all that apply.)

"I feel so short of breath today."."I am not urinating as much as normal today.", "I feel as if I can't take a deep breath."

9. A hospital has seen an increase in the number of its clients who develop SIRS and MODS. Which statement by the nurse in charge of quality reflects correct initial management of this increase?

"I will review the admission status of these clients."

The nurse explains that a client has multiple organ dysfunction syndrome that likely was caused by wide-spread inflammation. The client's spouse says, "But the doctor said he didn't have an infection." How should the nurse respond?

"Inflammation can occur even when there's no infection."

A 45-year-old man is diagnosed with a duodenal ulcer. He asks, "Now that I have an ulcer, what comes next?" What is the nurse's best response? "Most peptic ulcers heal with medical treatment."

"Most peptic ulcers heal with medical treatment."

A client presents to the emergency department with complaints of fatigue. Testing reveals anemia second-ary to a gastrointestinal bleed. The client says, "How could that be true? I have never seen blood in my stools." What is the nurse's best response? (Select all that apply.)

"Sometimes the blood is occult, which means you can't see it." "The blood may have made your stools black, not red." "If your stools are dark and sticky, it may be due to the presence of blood."

A client presents in the emergency department and reports taking an intentional overdose of acetamino-phen 3 days earlier. The client says, "I thought it would kill me, but I just got sick." What assessment finding would corroborate this client's report?

1. The client is vomiting. 2. The client has circumoral cyanosis. 3. The client's ALT and AST enzymes are elevated. 4. The client's BUN is elevated.

A client is scheduled for an ERCP. Which information should the nurse provide for the client? (Select all that apply.)

1. The procedure is not invasive. A radiographic contrast media will be injected. There is a chance that mechanical obstructions can be removed during the test.

At which intra-abdominal pressure, if sustained, would a client first be diagnosed as having intra-abdominal hypertension on the IAH/ACS continuum?

12 mmHg

A client with kidney failure had 980 mL of total output yesterday. The nurse would expect that fluid replacement therapy for this client today would be limited to ______ mL. (Fill in the blank.)

1780-1980 mL

In the adult client, the nurse would become concerned that the client is hypoventilating if the tidal volume falls to below which value?

4 mL/kg

A client was admitted after being severely injured in an explosion. How long would the nurse monitor this client for the development of primary MODS?

72 hours

When looking after a patient suspected of having a PE the chest x-ray has just been reported as being normal. The patient asks "Does this mean I didn't have a PE?" How do you answer?

A chest x-ray may be normal initially.

On the oxyhemoglobin dissociation curve, at a PaO2 less than 60 mmHg, any change in PaO2 yields how much of a change in SaO2?

A large change

3. A client has been admitted to the ICU for treatment of trauma to his lower extremities. Which prescription would the nurse anticipate to prevent stress-related mucosal disease (SRMD)? (Select all that apply.)=

A proton pump inhibitor (Prilosec). Aluminum carbonate (Gaviscon). H2 blocker (Cimetidine)

Brain natriuretic peptide (BNP) has been drawn to assess whether a client has heart failure or ARDS. What will the nurse expect the test to reveal if this cli-ent has heart failure rather than ARDS?

A value over than 100 pg/mL

A client is hospitalized with chronic respiratory insuf-ficiency. The nurse is developing a plan to address the problem of impaired oxygenation and ventilation. Which desired client outcome most accurately mea-sures progress in addressing this problem?

ABG within acceptable limits for client

The acidosis associated with kidney injury is directly related to which condition?.

Accumulation of hydrogen ions

Which drug is the major cause of ALF in the United States?

Acetaminophen

A patient presents with the following ABG: pH 7.20 paO2 60 C02 65 HC03 20. The nurse should assess for

Acute impaired ventilation (opiod overdose, neuromuscular fatigue).

What are the most common underlying causes of SIRS? (Select all that apply.)

Acute pancreatitis. Major surgery. Infection

A client is scheduled for chest tube removal today. How should the nurse plan to address pain control for this procedure?`

Administer a prn IV analgesic so that the drug's peak effect coincides with tube removal.

A client has had 6 liters of fluid removed by paracente-sis. What intervention would the nurse expect?

Administration of albumin

What is the major initial treatment for PE?

Anticoagulant therapy

What is pulse oximetry used to measure?

Arterial oxygen capillary hemoglobin saturation

Regardless of the etiology of acute pancreatitis, what is the primary pathophysiologic event?

Autodigestion

A client who has a right upper-lobe pneumothorax has had a chest tube for 2 days. While assessing the chest drainage system, the nurse notes continuous vigorous bubbling in the water-seal chamber. What should the nurse do? 1. Decrease the amount of wall suction attached to the system

Check all connections for a leak

A client who has COPD is in a state of chronic respira-tory insufficiency. Which assessment finding would the nurse attribute to that condition?

BP 145/88

A client has developed intra-abdominal hypertension (IAH). The nurse monitors for findings associated with which complication?

Bacterial translocation

nternal-origin problems that may require chest tube insertion include which types of injury? (Select all that apply.) =

Barotrauma. Procedural rupture of visceral pleura. Bleb rupture

A client is prescribed N-acetylcysteine (NAC) as treat-ment of an acetaminophen overdose. Which nursing interventions are essential? (Select all that apply.)

Be certain to give each dose on time. Warn the client that the taste and smell are not pleasant. Start the medication as soon as possible after the prescription is written.

.During expiration, the intrapulmonary pressure causes air to flow out of the lungs for which reason?

Because the intrapulmonary pressure is higher than atmospheric pressure

In a patient presenting with s/s of a PE the patient is assessed for possible DVT. Which assessment would assess for the most likely CAUSE of PE?

Bilateral LE Doppler studies to determine if patient has DVTs of the deep leg veins

Sustained, dark red, lower GI bleeding from the large intestine is a characteristic of which condition?

Bleeding diverticula

Which substance frequently accumulates in the bowel proximal to the actual bowel obstruction, resulting in distention?`

Blood

The nurse has orders to obtain blood cultures and begin IV antibiotic therapy. Which statement is correct regarding these orders?

Blood cultures should be obtained before starting antibiotics.

Which statements are TRUE concerning the diagnosis of ALF? (Select all that apply.)

Blood work includes chemistry and hematology values. CT scan of the head may be ordered. An arterial ammonia level is preferred.

A client is being admitted to the hospital for treat-ment of hemorrhagic pancreatitis. The emergency department report indicates that the client has a positive Cullen sign. The nurse admitting the client would look for which manifestation?

Bluish discoloration around the umbilicus

Beta agonist agents such as albuterol are given to relieve which acute airway problem?

Bronchoconstriction

The nurse should expect which normal finding in an RRT access device?

Bruit

How does the endothelium orchestrate the localinflammatory response? (Select all that apply.)

By promoting adhesion of white blood cells. By altering local vasomotor tone. By inducing thrombin generation.

Which is the priority nursing care of a patient whose pleural chest tube is bubbling in the water seal chamber throughout inspiration and expiration (he is not on positive pressure ventilation)?

Starting at the proximal end examine tube and connections to determine the source of the leak.

What is the condition in which the bowel "twists" itself to such an extent that circulation is interrupted? Strangulation

Strangulation

2. What is the best way to prevent MODS? Prevent SIRS and sepsis. 3. Which nursing interventions decrease the incidence of infection? (Select all that apply.)

Strict adherence to hand hygiene. Use of a ventilator bundle. Meticulous catheter care. Maintenance of client skin integrity

As a therapy for ALF, vitamin K can be administered through which routes? (Select all that apply.)

Subcutaneously

A client who has had flu-like symptoms for the last few days presents in the emergency department with increasing shortness of breath. The client states that the cough "has become worse over the last few hours, and I am coughing up thick stuff." The nurse would ask assessment questions about which manifestations of post-influenza bacterial pneumonia? (Select all that apply.)

Chills. Chest pain

What is a common cause of acute pancreatitis?

Chronic alcohol abuse

What factor must always be evaluated to place ABGs in the proper context?

Client status

Which client represents the population with the high-est risk of developing abdominal compartment syn-drome?

Client who is postoperative for repair of a liver lac-eration

The effective management of complications depends on which actions? (Select all that apply.)

Close monitoring

A client hospitalized with chronic liver failure begins coughing up small amounts of blood. What nursing action is indicated?

Collaborate with the client's primary care provider immediately.

Diverticula are found in which structure?

Colon

3. Which assessments would suggest impaired oxygen-ation and ventilation? (Select all that apply.)

Confusion. Increased lethargy. Decreased restlessness

What are the most common complaints associated with pulmonary disease? (Select all that apply.)

Cough. Sputum. Dyspnea E. Chest pain

Which nursing intervention would assist in maintain-ing effective clearance of airway secretions?

Coughing and deep breathing every 1 to 2 hours

The nurse is reviewing laboratory results and would be most concerned about kidney damage if the client's serum report revealed which value?

Creatinine 4.3 mg/dL

What is the most severe manifestation of hematologic dysfunction?.

DIC

What are risk factors for SIRS? (Select all that apply.)

Older age. Immunosuppression. Gut hypoperfusion. Malnutrition

Obstructive pulmonary diseases are associated with which condition?

Decreased expiratory airflow

ction One Review 1. Restrictive pulmonary diseases are associated with which condition?

Decreased lung expansion

It is suspected that a client has a systemic inflammation. Which findings would the nurse interpret as sup-porting this suspicion? (Select all that apply.) WBC of 14,400/mm3. Temperature of 38.0°C (100.4°F).

Decreased urine output. General malaise and confusion

The release of MDF by injured pancreatic tissue is believed to have what effect on the heart?

Decreases cardiac output

The intensity and description of pain associated with acute pancreatitis varies, often based on which factor?

Degree to which extrapancreatic invasion has occurred

Clients who have obstructive pulmonary disease have which pattern of FEVs?

Delayed FEVs

What is the definitive treatment for women with ALF related to HELLP syndrome?

Delivery of the fetus

Which assessment finding would cause the nurse to suspect that a client in chronic kidney failure is devel-oping pericarditis?

Development of a friction rub

What is the leading cause of chronic kidney failure?

Diabetes mellitus

Which condition may cause metabolic acidosis because of a decrease in bicarbonate levels?

Diarrhea

Dietary protein intake is monitored in clients with renal dysfunction for which reason?

Dietary protein intake increases nitrogenous waste products.

What is the cause of peptic ulcers?

Disruption of the mucosal barrier

A client with suspected bowel obstruction has had flat and upright x-rays of the abdomen. Which findings would the nurse evaluate as supporting the potential diagnosis? (Select all that apply.)

Distended bowel. Air-fluid levels in the bowel. A ladderlike pattern in bowel loops

A client is at high risk for pulmonary embolus. The nurse would monitor this client for the development of which common clinical manifestations? (Select all that apply.)

Dyspnea. Chest pain. Cough

A client has been in the ICU and intubated for 1 week. EtCO2 is attached to the client's mechanical ventilator circuit to assess for which development?

Early changes in ventilation

In developing a plan of care for the client with acute pancreatitis, the nurse plans to closely monitor respi-ratory status. Which factors may result in respiratory depression in this client? (Select all that apply.)

Effects of pain medication. Decreased lung expansion. Inflammatory changes in the lung

Which intervention is useful in decreasing kidney damage associated with acute pancreatitis?

Emergent drainage of developing pseudocysts

A client has been diagnosed with mild intra-abdominal hypertension (IAH). Which intervention is indicated?

Encourage use of incentive spirometry.

Mediators that stimulate the local inflammatory response are released from which type of activated cell?

Endothelial cells

A client who has a history of esophageal varices is vomiting blood. Which initial intervention does the nurse anticipate?.

Endotracheal intubation

When a client is admitted in acute respiratory distress, the initial history should focus on which priority?

Events leading to current admission

The client with acute renal failure should have intake and output measurements at least how often?

Every hour

Which conditions impair the accuracy of pulse oxime-try? (Select all that apply.)

Excessive movement .Hypothermia E. Improper sensor placement

Which intervention would the nurse expect to perform as the initial step in the medical management of severe acute pancreatitis?

Giving IV fluids at 250 mL/hr

Which grade of hepatic encephalopathy is associated with disorientation, slurred speech, and asterixis?

Grade II

Normal values for arterial blood gases include which value?

HCO3 26 mmHg

Metabolic compensation involves changes in the renal excretion or resorption of which combination of gases or substances?

HCO3, H+

The nurse is preparing to obtain an IAP(increased abdominal pressure) measurement using the transducer method. In which position should the nurse place the client in preparation for measuring the IAP? =

HOB flat

GI bleeding as a result of a Mallory-Weiss tear often presents with which manifestation?

Hematemesis

To assess the severity of blood loss, what should the nurse determine?

Hemodynamic status

The Cullen sign may be noted under which circum-stance?

Hemorrhage C. Hypovolemic shock

In the acute pancreatitis client, hypovolemic shock usually results from which conditions? (Select all that apply.)

Hemorrhage.Third-spacing. Kallikrein release. Vasodilation

Which hepatitis virus infection most commonly leads to the development of ALF?

Hepatitis B virus

A client who was severely injured in a motor vehicle crash 7 days ago has developed ARDS. The nurse has explained the concept of nonhydrostatic pulmonary edema to the client's family. Which statement by a family member would indicate understanding of this concept?

Her disease has injured the membranes in her lung so that fluid is leaking into her lungs from the tiny blood vessels.

A client is admitted to the hospital with complaints of severe chest pain and dyspnea. The client has an oral temperature of 38.3°C (101°F). Why is it important for the nurse to obtain a nutritional history from this client? (Select all that apply.)

High-carbohydrate diets increase carbon dioxide levels. Poor nutritional status increases susceptibility to infection.

Clients with long-term kidney dysfunction may develop which condition?

Hyperparathyroidism

What is the most common predisposing factor for development of thromboembolism?

Immobility

In the acutely ill client, pulmonary function testing helps monitor for which condition?

Impending ventilatory failure

A mean arterial pressure (MAP) below 65 mmHg may result in which condition?

Inadequate renal perfusion pressure

What are the risk factors for aspiration? (Select all that apply.)

Incompetent lower esophageal sphincter. Decreased level of consciousness. Elevated gastric pressure

Your patient has an O2 saturation of 95% on RA. On physical assessment you note that she is tachypneic (RR 28) and her breathing is shallow. Her HR has increased to 138 and her BP is 150/92. She denies pain but states she feels extremely anxious. She has breath sounds bilaterally and they are clear. She has an order for 2-6 L O2. The nurse's first priority is to

Increase O2 to 6L (patient is evincing clinical s/s of hypoxia despite a normal O2 saturation), re-assess, call the physician to inform her of this change in patient status.

Which assessment data are associated with increased severity scores in acute pancreatitis? (Select all that apply.)

Increased BUN. Decreased hematocrit. Decreased PaO2

A client's total bilirubin is elevated. Which other lab result would the nurse expect if this client has liver failure?

Increased alkaline phosphatase (ALP)

The spouse of a client asks why his wife has developed SIRS. The nurse reviews the client's history and dis-covers the client is 43 years old, is 5 feet 5 inches tall, weighs 200 pounds, has three children who were all born by cesarean section, has never smoked, and drinks wine with dinner three times a week. Which assessment finding would the nurse interpret as a risk factor for the development of SIRS?

Increased body mass index.

A client has been started on intermittent hemodialysis (IHD) to treat acute kidney failure. The nurse will closely monitor the client for which complications associated with IHD? (Select all that apply.)

Increased cardiac output. Acute myocardial infarction

Continuous renal replacement therapy has which major advantage over intermittent hemodialysis?

Increased hemodynamic stability

What is the result of increased metabolic demand?

Increased oxygen consumption

What is the cause of esophageal variceal bleeding?

Increased portal hypertension

A client is admitted to the emergency department with complaints of shortness of breath, cough, and fever. Which clinical manifestations would the nurse inter-pret as indicating early respiratory distress? (Select all that apply.)

Increased respiratory rate . Tachycardia . Agitation. Confusion

Which finding reflects worsening cardiovascular function?

Increasing PAR values

Which statement is correct regarding the normal rela-tionship between oxygen and hemoglobin?

Oxygen binds loosely and reversibly to hemoglobin.

Ulcerative colitis is defined as what type of process?

Inflammatory process

. The pulmonary edema associated with ARDS is caused by which condition?

Injured alveolar-capillary membrane

A client has been diagnosed with a bowel obstruction. Which nursing intervention is indicated?

Insertion of a nasogastric tube

A client has been diagnosed with grade II hepatic encephalopathy. The nurse should expect which assessment?

Intermittent asterixis

How is volume resuscitation generally accomplished in the client with an acute GI bleed?

Intravenous crystalloid infusion

What is the primary benefit of the redness, heat, and swelling associated with local inflammation?

It facilitates entry of immune cells into the area of injury.

Which statement is correct regarding MRSA pneumo-nia in high-acuity clients?

It increases the risk for death and septic shock.

How does the mortality rate for acute lower GI bleed-ing compare to that for acute upper GI bleeding?

It is about the same.

Which statement about the pathogenesis of SIRS is accurate?

It is an abnormal generalized proinflammatory response.

How is the primary treatment for stress-related muco-sal disease (SRMD) best described?

It is prophylactic, using antiulcer therapies.

Which statement correctly describes the primary pur-pose of CLRT?.

It prevents reduced stasis of fluid and gas.

How does hepatic failure alter cardiopulmonary function?

It results in severe second-and third-spacing of fluids.

Which statement is true regarding the relationship of ventilation to perfusion in an upright person?

It varies throughout the lung.

A client has developed a pulmonary problem that has resulted in decreased lung compliance. How will this affect the client's respiratory system?

It will increase the client's work of breathing.

A client with pneumonia develops what is believed to be an absolute pulmonary shunt. Oxygen therapy has been initiated per venti-mask. The nurse would expect which effect on the client's hypoxemia?

It will worsen.

In clients with subacute ALF, what is the timeframe of development of jaundice to development of encepha-lopathy?

Longer than 21 days

The nurse is conducting a physical assessment of a cli-ent diagnosed with ulcerative colitis. Which finding would the nurse evaluate as indicating the most seri-ous complication of this disease?

Loose, blood-tinged stools

A client has developed left lower lobe pneumonia; however, the remaining lung fields are clear. It is time to reposition the client in bed. Of the following posi-tions, which is most likely to optimize the ventilation-perfusion relationship?

Lying on the right side

What is the advantage of magnetic resonance cholangi-opancreatography (MRCP) over endoscopic retrograde cholangiopancreatography (ERPC)?

MRCP is noninvasive.

A client is diagnosed with DKA after being admitted to the hospital with a serum glucose of 650 mg/dL and positive serum ketones. Blood gases are: pH 7.25, PaCO2 36 mmHg, HCO3 14 mEq/L. This pH is most likely a result of which acid-base disturbance?

Metabolic acidosis

In a client who has had a GI bleed, an increased BUN suggests fluid volume deficit or which other condition?

Metabolism of blood in the intestines

A client with chest trauma has sustained a hemotho-rax, and preparations are made for chest tube place-ment. The chest tube will be inserted at which location?

Midaxillary at the fifth or sixth intercostal space

A client who typically has normal ABG values is found to have a PaO2 of 73 mmHg. Which classification of hypoxia exists?

Mild

Which drug is often prescribed for high-risk clients on long-term NSAID therapy to prevent the development of ulcers or SRMD?

Misoprostol

An increase in bicarbonate would have which effect on the pH?

More alkaline

Pain management of the client with acute pancreatitis would include which drug?

Morphine sulfate

Which medication can reverse the effects of acetamin-ophen toxicity?

N-acetylcysteine

A patient has the following ABG on room air: pH 7.39 PaO2 140 PaCO2 44 HCO3 25 What is your concern?

No concern, this is a normal ABG.

A client has been diagnosed with diminished renal reserve. Which symptoms would the nurse expect the client to report?

No symptoms

Which drug category is a common cause of prerenal kidney injury?

Nonsteroidal anti-inflammatory drugs

Evaluation of the effectiveness of interventions to resolve a problem with breathing pattern and ventila-tion is best measured by which desired patient out-come?

Normal respiratory rate, depth, and rhythm

Which intervention would the nurse plan to treat the epigastric pain of a client in the acute phase of pancre-atitis?

Offering nothing by mouth

Why is advancing age a risk factor for developing MODS?

Older adults have decreased functional reserve

Which therapy would be considered to relieve severe abdominal ascites?

Paracentesis

A client has the following ABG results: pH 7.50, PaCO2 30 mmHg, HCO3 20 mEq/L, PaO2 88 mmHg, SaO2 98%. How would the nurse interpret these results?

Partially compensated respiratory alkalosis

What is the most common cause of upper GI bleeding?

Peptic ulcer disease

If a client with a small-bowel obstruction develops rebound tenderness with boardlike distention, what should the nurse suspect?

Perforation

In peritoneal dialysis, which structure acts as the per-meable membrane to remove wastes and water?

Peritoneal membrane

If a pseudocyst were to rupture into the peritoneal cavity, the client would most likely develop which condition?

Peritonitis

Premature activation of which pancreatic enzymes is thought to cause the most pancreatic damage?

Phospholipase A, elastase

A client comes to the emergency department com-plaining of shortness of breath and chest pain. The ABG results are: pH 7.45, PaCO2 35 mmHg, PaO2 60 mmHg, HCO3 24 mEq/L. What should be the nurse's first intervention?

Place the client on oxygen.

The nurse is writing a plan of care for a client who was just admitted with acute pancreatitis. The nurse would include monitoring for which major pulmonary complications? (Select all that apply.)

Pleural effusion. Hypoxia. Respiratory failure. Pneumonia

. A client with acute kidney injury is at higher risk for which pulmonary disorder?

Pneumonia

Which condition is the most common indirect predis-posing disorder of ARDS?

Pneumonia

Which disease process would increase the thickness of the alveolar-capillary membrane?

Pneumonia

Which pulmonary disorder is considered a restrictive disease?

Pneumonia

1. A client who sustained severe injury in a motor vehicle crash presented to the emergency department with a blood pressure of 76/42 mmHg. Paramedics report that the client was pinned in the wreckage and that extrication took approximately 35 minutes. First blood pressure on scene was 86/50 mmHg. The nurse moni-tors this client for the development of renal failure of which origin?

Prerenal

A nurse is assessing a client's venous access site used for dialysis. Which assessment finding would the nurse interpret as indicating this site is patent? (Select all that apply.)

Presence of a thrill. Presence of a bruit

Where is the section of the GI tract that is involved in an upper GI hemorrhage located?

Proximal to the ligament of Treitz

What are the peritoneal signs of acute pancreatitis? (Select all that apply.)

Rebound tenderness. Rigid abdomen . Guarding

Sodium polystyrene sulfonate (Kayexalate) can be administered through which routes? (Select all that apply.)

Rectal. Oral

Anticholinergics may be ordered for the client with acute pancreatitis for which purpose?

Reducing GI motility

In a patient with ARDS the most evident finding of complete shunt is which of the following?

Refractory hypoxemia.

What are the results of the respiratory dysfunction associated with MODS?

Refractory hypoxia

Which two activities are the primary functions of renal replacement therapy? (Select all that apply.)

Removal of wastes. Removal of lipids

A client is admitted to the hospital with severe dys-pnea and a productive cough. History reveals that the client has smoked one to two packages of cigarettes daily for the last 45 years and was diagnosed with COPD 10 years ago. A diagnosis of right lower lobe pneumonia is established. Based on this data, the nurse would plan care for a client who has which type of acute lung disorder? =

Restrictive disease

Which statement correctly reflects the effects of abdominal compartment syndrome (ACS) on right arterial pressure and cardiac output?

Right arterial pressure is increased; cardiac output is decreased.

A nurse providing care for a client with acute pancre-atitis is intervening to optimize the client's cardiac output. The nurse assists the client to assume which position?.

Semi to high Fowler

A client has experienced intermittent abdominal pain for the last 6 months and is being evaluated for possi-ble pancreatitis. The nurse would expect serial serum lipase levels to be drawn rather than serum amylase levels for which reason?

Serum lipase remains elevated for a longer period.

Which levels should the nurse routinely monitor to assess the nutritional status of a client with acute kidney injury? (Select all that apply.)

Serum protein. Prealbumin

How is the chest pain typical of pleuritic pain best characterized?

Sharp

How is the classic pattern of pain typically described by the client with acute pancreatitis?.

Sharp, knifelike, often radiating to the back

Which condition is a life-threatening complication of acute GI bleeding?

Shock

Oxygen therapy is most effective in treating which condition?

Shuntlike effect

A client with right-sided pneumonia has impaired oxygenation and ventilation..

Side-lying on the unaffected side

Which drug, although not approved for use in the United States, can be obtained for emergency use to treat poisoning by Amanita phalloides?

Silibinin

Myoglobin release into the circulation is associated with which condition? (Select all that apply.)

Skeletal muscle damage

Serum osmolality is determined in large part by which factor?

Sodium levels

A client with end-stage renal disease (ESRD) has been admitted for treatment of a different diagnosis. The nurse would expect which intervention due to the presence of ESRD?

Sodium-restricted diet

What is the highest priority in the management of a client with severe acute pancreatitis?

Stabilizing hemodynamic status

Pneumothorax is characterized by which common clinical findings? (Select all that apply.)

Tachypnea. Shortness of breath. Decreased PaO2

It is suspected that a client is developing SIRS Which assessment findings would the nurse interpret as sup-porting this suspicion? (Select all that apply.)

Temperature 35.8°C (96.4°F) 2. Heart rate 108/min. PaCO2 28 mmHg. Respiratory rate 22/min

Which findings would the nurse expect when conduct-ing a focused gastrointestinal assessment on a client with liver failure? (Select all that apply.)

Tenderness under the right costal marginPresence of diarrhea. Report of anorexia

Pulmonary function tests are performed on a client diagnosed with right middle-lobe pneumonia. The client's tidal volume and vital capacity are both below normal. The nurse would plan care based on which interpretation of these results?

The client has respiratory muscle fatigue

A client who has a history of ulcerative colitis has been hospitalized for repair of a fractured humerus. A combination of which findings would prompt the nurse to collaborate with the healthcare provider regarding a transfer to the ICU? (Select all that apply.)

The client vomits coffee-ground material. The client's stool is hemoccult positive. The client is tachycardic.

The nurse closely observes a client admitted with acute pancreatitis for respiratory complications related to ineffectiveness of breathing pattern. Which situa-tions will increase the client's risk for this problem? (Select all that apply.)

The client's abdominal pain is severe and difficult to manage. The client is taking opioids for pain relief. The client's diaphragmatic excursion is diminished.

The medical team is concerned that a client's gut may be injured. Which assessment findings would the nurse interpret as supporting that concern? (Select all that apply.)

The client's bowel sounds are greatly diminished. The client has diarrhea. Tube feeding residuals are increasing.

A client who has developed MODS has had an average blood glucose of 165 mg/dL over the last three days. How would the nurse interpret this finding?

The client's glycemic control is adequate.

A client with a history of heart failure reports to the clinic complaining of tenderness at the right costal margin along with increasing shortness of breath. No other findings are reported. The nurse would ask assessment questions to determine if which common process is occurring?

The client's liver is engorged.

A client is receiving lactulose (Cephulac). Which find-ings would the nurse evaluate as indicating this medi-cation is having the desired effects? (Select all that apply.)

The client's serum ammonia level is dropping. The client is having two to four soft stools daily.

A client was hospitalized 12 hours ago for observation after being injured in a fall from a ladder. Which assessment findings associated with AKI would the nurse communicate to the rest of the medical team immediately? (Select all that apply.)

The client's urine output has been 20 mL for each of the last 2 hours. The client is becoming more azotemic. The client's last potassium level was 4.8 mEq/L.

Pressure gradient affects the diffusion of gases in which way?

The greater the difference, the more rapid the gas flow

Primary MODS can develop in response to which factor?

The insult itself

A client who has developed right middle-lobe pneumo-nia will experience decreased ventilation in the affected lung areas for which reasons? (Select all that apply.)

The pressure gradient is abnormal. Gas follows the path of least resistance. 5. The consolidation in the tissues will increase the pressure.

The team is intubating your patient. Which of the following color changes on colorimetric capnography will indicate that the tube is correctly placed?

The ring will turn from purple to yellow.

The nurse is reviewing the serial SOFA scores of a client with MODS. What is the benefit of understanding this trend?

The trend can provide information about the efficacy of interventions.

Filling of which chamber of the chest tube is necessary for the unit to function as a one way valve (allowing air to exit the chest during expiration and not re-enter the chest when the patient inhales)?

The water seal chamber

The kidneys compensate for significant reductions in GFR through which mechanism?.

There are no compensatory mechanisms.

Which statement correctly reflects the general timing of duodenal ulcer symptoms?

They tend to occur 2 to 3 hours after eating.

A client who was admitted for treatment of pancre-atitis 3 days ago continues to have very severe pain and nausea. An MRI done today reveals a pancreatic abscess. How does the nurse interpret this information?

This client's risk for death is greatly increased.

Permissive hypercapnia is contraindicated in which client population?

Those with unstable intracranial pressure