Shock, Hemodynamics, Biliary tract

Which dietary selections made by the client indicate understanding of previously taught dietary principles associated with having viral hepatitis? a) turkey salad, french fries, sherbet b) cottage cheese, mixed fruit salad, milkshake c) salad, sliced chicken sandwich, gelatin dessert d) cheeseburger, tortilla chips, chocolate pudding

C) salad, sliced chicken sandwich, gelatin dessert

The patient is admitted with an unusual infection. The nurse knows that a mechanical tissue trauma that can trigger SIRS will not occur with this patient because what types of injuries cause a mechanical tissue trauma trigger of SIRS (SATA)? a) Burns b) Fungi c) Viruses d) Crush injuries e) Surgical procedures

a) Burns d) Crush injuries e) Surgical procedures

What intervention may prevent GI bacterial and endotoxin translocation in a critically ill patient with SIRS? a) Early enteral feedings b) Surgical removal of necrotic tissue c) Aggressive multiple antibiotic therapy d) Strict aseptic technique in all procedures

a) Early enteral feedings

The nurse teaches a client who is concerned about hepatitis transmission routes. Which type of hepatitis spreads more frequently through food? a) Hepatitis A b) Hepatitis B c) Hepatitis C d) Hepatitis D

a) Hepatitis A

The patient is in the compensatory stage of shock. What manifestations indicate this to the nurse(select all that apply)? a) Pale and cool b) Unresponsive c) Lower BP than baseline d) Moist crackles in the lungs e) Hyperactive bowel sounds f) Tachypnea and tachycardia

a) Pale and cool c) Lower BP than baseline f) Tachypnea and tachycardia

What is one of the most challenging nursing interventions to promote healing in a patient with viral hepatitis? a) Providing adequate nutritional intake b) Promoting strict bed rest during icteric phase c) Providing pain relief without using liver-metabolized drugs d) Providing quiet diversional activities during periods of fatigue

a) Providing adequate nutritional intake

A 70-year-old patient is malnourished, has a history of type 2 diabetes mellitus, and is admitted from the nursing home with pneumonia. For which kind of shock should the nurse closely monitor this patient? a) Septic shock b) Neurogenic shock c) Cardiogenic shock d) Anaphylactic shock

a) Septic shock

When caring for a patient in cardiogenic shock, the nurse recognizes that the metabolic demands of turning and moving the patient exceed the oxygen supply when what change is revealed in hemodynamic monitoring? a) SvO2 from 62% to 54% b) CO from 4.2 L/min to 4.8 L/min c) Stroke volume (SV) from 52 to 68 mL/beat d) SVR from 1300 dyne/sec/cm5 to 1120 dyne/sec/cm5

a) SvO2 from 62% to 54%

What physical problems could precipitate hypovolemic shock (select all that apply)? a) burns b) ascites c) Vaccines d) Insect bites e) Hemorrhage f) Ruptured spleen

a) burns b) ascites e) Hemorrhage f) Ruptured spleen

A client who is obese and has a history of alcohol abuse is admitted to the hospital with a diagnosis of acute pancreatitis. Which is an appropriate initial client treatment goal? a) decreased pain b) selection of appropriate food choices c) joining alcoholics anonymous d) a loss of 4 pounds (1.8kg) per week

a) decreased pain

The nurse is caring for a client with hemodynamically stable sepsis who complains of abdominal pain. Which of these primary health care provider prescriptions would the nurse do first? a) draw peripheral blood cultures from two different sites b) administer levofloxacin 500mg intravenously over 30 minutes c) administer 1 L intravenous bolus of ringer's lactate over 30 minutes d) take the client to x-ray for abdominal computed tomography (CT) scan

a) draw peripheral blood cultures from two different sites

When caring for a client who has a blood pressure of 80/60mm Hg and heart rate of 120 beats/minute after a motor vehicle accident, the nurse anticipates the need to rapidly implement which type of collaborative action? a) increase circulating blood volume b) administer arterial vasopressors c) stimulate increased heart rate d) correct electrolyte disturbances

a) increase circulating blood volume

Which initial change in acid-base balance will the nurse expect when a client is in the progressive stage of shock? a) metabolic acidosis b) metabolic alkalosis c) respiratory acidosis d) respiratory alkalosis

a) metabolic acidosis

Which clinical findings would the nurse expect when assessing a client who has cardiogenic shock? Select all that apply. One, some, or all responses may be correct. a) pallor b) agitation c) tachycardia d) narrow pulse pressure e) decreased respirations

a) pallor b) agitation c) tachycardia d) narrow pulse pressure

After a client sustains multiple internal injuries in a motor vehicle accident, the blood pressure suddenly drops from 134/90 to 80/60 mm Hg. What is the likely cause of this drop in blood pressure? a) reduction in the circulating blood volume b) diminished vasomotor stimulation to the arterial wall c) vasodilation resulting from diminished vasoconstrictor tone d) cardiac decompensation resulting from electrolyte imbalance

a) reduction in the circulating blood volume

Which available staff member would be best for the nursing manager to assign to take frequent vital signs for a client with suspected shock? a) registered nurse b) nursing student c) licensed practical nurse d) unlicensed assistive personnel

a) registered nurse

In the compensatory stage of hypovolemic shock, to what organs does blood flow decrease after the sympathetic nervous system activates the α-adrenergic stimulation (select all that apply)? a) Skin b) Brain c) Heart d) Kidneys e) Gastrointestinal tract

a) skin d) Kidneys e) Gastrointestinal tract

Which clinical manifestations would the nurse expect when assessing a client who is diagnosed with cardiogenic shock? Select all that apply. One, some, or all responses may be correct. a) tachycardia b) restlessness c) warm, moist skin d) decreased urinary output e) bradypnea

a) tachycardia b) restlessness d) decreased urinary output

A client is hospitalized with acute pancreatitis. Which would be included in the client's plan of care? a) use of intravenous (IV) fluids b) season foods sparingly c) eat small meals frequently d) limit coffee to three cups per day

a) use of intravenous (IV) fluids

Which statement by the client, recovering from an acute case of viral hepatitis, indicates understanding of the discharge instructions presented by the nurse? Select all that apply. One, some, or all responses may be correct. a)'I will avoid alcohol because my liver is scarred and the alcohol causes more damage' b)'I will eat four to seven small snacks or meals per day' c)'I will take acetaminophen for pain rather than aspirin' d)'I will eats foods high in carbohydrates, but moderate in fats and proteins' e)'I will not have to use condoms during intercourse, because I have beaten this'

a)'I will avoid alcohol because my liver is scarred and the alcohol causes more damage' b)'I will eat four to seven small snacks or meals per day' d)'I will eats foods high in carbohydrates, but moderate in fats and proteins'

The nurse identifies a need for further teaching when the patient with Hep B makes which statement? a) "I should avoid alcohol completely for at least a year." b) "I must avoid all physical contact with my family until jaundice is gone." c) "I should use a condom to prevent spread of the disease to my sexual partner." d) "I will need to rest several times a day, gradually increasing my activity as I tolerate it."

b) "I must avoid all physical contact with my family until jaundice is gone."

A patient with a gunshot wound to the abdomen is being treated for hypovolemic and septic shock. To monitor the patient for early organ damage associated with MODS, what is the most important for the nurse to assess? a) Urine output b) Breath sounds c) Peripheral circulation d) Central venous pressure

b) Breath sounds

The nurse determines that a large amount of crystalloid fluids administered to a patient in septic shock is effective when hemodynamic monitoring reveals what? a) CO of 2.6 L/min b) CVP of 15 mm Hg c) PAWP of 4 mm Hg d) Heart rate (HR) of 106 bpm

b) CVP of 15 mm Hg

Which patient manifestations confirm the development of MODS? a) Upper GI bleed, GCS score of 7, Hct: 25% b) Elevated serum bilirubin, serum creatinine of 3.8 mg/dL, and platelet count of 15,000/uL c) Urine output of 30 mL/hr, BUN of 45 mg/dL, and WBC of 1120/uL d) RR: 45, PaCO2: 60 mmHg, Chest x-ray with bilateral diffuse patchy infiltrates

b) Elevated serum bilirubin, serum creatinine of 3.8 mg/dL, and platelet count of 15,000/uL

Which type of hepatitis is a DNA virus, can be transmitted via exposure to infectious blood or body fluids, is required for HDV to replicate, and increases the risk of the chronic carrier for hepatocellular cancer? a) HAV b) HBV c) HCV d) HEV

b) HBV

Which types of hepatitis develop into a chronic form of the disease? Select all that apply. One, some, or all responses may be correct. a) Hepatitis A b) Hepatitis B c) Hepatitis C d) Hepatitis D e) Hepatitis E

b) Hepatitis B c) Hepatitis C d) Hepatitis D

Which hemodynamic monitoring description of the identified shock is accurate? a) Tachycardia with hypertension is characteristic of neurogenic shock. b) Increased pulmonary artery wedge pressure (PAWP) and a decreased cardiac output (CO) in cardiogenic shock c) Anaphylactic shock is characterized by increased systemic vascular resistance (SVR), decreased CO, and decreased PAWP. d) In septic shock, bacterial endotoxins cause vascular changes that result in increased SVR and decreased CO.

b) Increased pulmonary artery wedge pressure (PAWP) and a decreased cardiac output (CO) in cardiogenic shock

What abnormal finding should the nurse expect to find in early compensatory shock? a) Metabolic acidosis b) Increased serum sodium c) Decreased blood glucose d) Increased serum potassium

b) Increased serum sodium

A patient with severe trauma has been treated for hypovolemic shock. The nurse recognizes that the patient is in the irreversible stage of shock when what is included in assessment findings? a) A lactic acidosis with a pH of 7.32 b) Marked hypotension and refractory hypoxemia c) Unresponsiveness that responds only to painful stimuli d) Profound vasoconstriction with absent peripheral pulses

b) Marked hypotension and refractory hypoxemia

During the incubation period of viral hepatitis, the nurse would expect the patient to report? a) Dark urine and easy fatigability b) No symptoms except diagnostic results c) Anorexia and RUQ discomfort d) Constipation or diarrhea with light-colored stools

b) No symptoms except diagnostic results

When a family member of a client with cardiogenic shock asks the nurse for more information about the condition, how would the nurse describe cardiogenic shock? a) an irreversible phenomenon b) a failure of the circulatory pump c) usually a fleeting reaction to tissue injury d) generally caused by decreased blood volume

b) a failure of the circulatory pump

A client is hospitalized with a diagnosis of acute pancreatitis. The plan of care is focused on the goals of maintaining nutrition, promoting rest, maintaining fluids and electrolytes, and decreasing anxiety. Which interventions would the nurse implement? Select all that apply. One, some, or all responses may be correct a) provide a low-fat diet b) administer analgesics c) teach relaxation exercises d) encourage walking in the hall e) monitor cardiac rate and rhythm f) observe for signs of hypercalcemia

b) administer analgesics c) teach relaxation exercises e) monitor cardiac rate and rhythm

The nurse reviews the laboratory results of a client with acute pancreatitis. Which test is significant in determining the client's response to treatment? a) platelet count b) amylase level c) red blood cell count d) erythrocyte sedimentation rate

b) amylase level

Which finding will the nurse expect when caring for a client who is in hypovolemic shock? a) slow heart rate b) cool skin temperature c) bounding radial pulses d) increased urine output

b) cool skin temperature

A client has paracentesis, during which 1500mL of fluid is removed. The nurse would monitor the client carefully for which reaction? a) hypertensive crisis b) hypovolemic shock c) abdominal distension d) tenting of the integument

b) hypovolemic shock

The nurse will anticipate the need to administer which type of medication when a client with cardiogenic shock has an increased pulmonary artery wedge pressure reading of 30 mm Hg. a) vasopressor b) loop diuretic c) antidysrhythmic d) beta-adrenergic blocker

b) loop diuretic

The nurse is providing care to a client with ascites secondary to liver failure. Which interventions are appropriate to include in the client's care? Select all that apply. One, some, or all responses may be correct. a) high-protein diet b) low-sodium diet c) daily abdominal girth measurements d) encourage increased fluid intake by mouth e) daily weights

b) low-sodium diet c) daily abdominal girth measurements e) daily weights

When caring for a client in late hypovolemic shock, which complication will the nurse anticipate? a) hypokalemia b) metabolic acidosis c) respiratory alkalosis d) decreased Pco2 levels

b) metabolic acidosis

The nurse suspects sepsis as a cause of shock when the laboratory test results indicate a) hypokalemia. b) thrombocytopenia. c) decreased hemoglobin. d) increased blood urea nitrogen (BUN)

b) thrombocytopenia.

The nurse determines that further discharge instruction is needed when the patient with acute pancreatitis makes which statement? a) "I should observe for fat in my stools." b) "I must not use alcohol to prevent future attacks of pancreatitis." c) "I shouldn't eat any salty foods or foods with high amounts of sodium." d) "I will not need to monitor my blood glucose levels when I am at home."

c) "I shouldn't eat any salty foods or foods with high amounts of sodium."

A client with hepatitis A experiences anorexia, fatigue, and jaundice. The client's spouse and adult children living at home ask whether they should receive gamma globulin. Which response would the nurse make to the client's family? a) 'Gamma globulin is unnecessary, as long as you follow droplet precautions until the client is asymptomatic' b) 'Gamma globulin injections provide passive immunity for hepatitis B, not hepatitis A c) 'You should call your primary health care provider immediately about obtaining gamma globulin injections' d) 'your family member's type of hepatitis is no longer communicable, and gamma globulin is not required'

c) 'You should call your primary health care provider immediately about obtaining gamma globulin injections'

Which interventions should be used for anaphylactic shock (SATA)? a) Antibiotics b) Vasodilators c) Antihistamines d) O2 supplementation e) Colloid volume expansion f) Crystalloid volume expansion

c) Antihistamines d) O2 supplementation e) Colloid volume expansion f) Crystalloid volume expansion

Priority Decision: What is the priority nursing responsibility in the prevention of shock? a) Frequently monitoring all patients' vital signs b) Using aseptic technique for all invasive procedures c) Being aware of the potential for shock in all patients at risk d) Teaching patients health promotion activities to prevent shock

c) Being aware of the potential for shock in all patients at risk

When administering any vasoactive drug during the treatment of shock, the nurse should know that what is the goal of the therapy? a) Increasing urine output to 50 mL/hr b) Constriction of vessels to maintain BP c) Maintaining a MAP of at least 60 mm Hg d) Dilating vessels to improve tissue perfusion

c) Maintaining a MAP of at least 60 mm Hg

What treatment measure is used in the management of the patient with acute pancreatitis? a) Surgery to remove the inflamed pancreas b) Pancreatic enzyme supplements administered with meals c) NG suction to prevent gastric contents from entering duodenum d) Endoscopic pancreatic sphincterotomy using endoscopic retrograde cholangiopancreatography (ERCP)

c) NG suction to prevent gastric contents from entering duodenum

A patient with acute pancreatitis has a nursing diagnosis of pain r/t distention of the pancreas and peritoneal irritation. In addition to effective use of analgesics, what should the nurse include in this patient's plan of care? a) Provide diversional activities to distract the patient from pain b) Provide small, frequent meals to increase the patient's tolerance of food c) Position the patient on the side with the HOB elevated 45 degrees for pain relief d) Ambulate the patient every 3-4 hours to increase circulation and decrease abdominal congestion

c) Position the patient on the side with the HOB elevated 45 degrees for pain relief

Which finding by the nurse who is caring for a client after major abdominal surgery may indicate impending hypovolemic shock? a) urine output 1000mL in 8 hours b) oral temperature 101 degree F (38.3 degree C) c) client report of feeling very thirsty d) bounding radial and femoral pulses

c) client report of feeling very thirsty

Which type of shock would the nurse suspect when a client is admitted to the emergency department after a motor vehicle accident with abdominal pain, a blood pressure decrease from 120/76 mm Hg to 60/40 mm Hg, and a heart rate increase from 82 beats/minutes to 121 beats/minute? a) septic shock b) cardiogenic shock c) hemorrhagic shock d) neurogenic shock

c) hemorrhagic shock

A patient in the progressive stage of shock had rapid, deep respirations. The nurse determines that the patient's hyperventilation is compensating for metabolic acidosis when the patient's arterial blood gas (ABG) results include: a) pH 7.42, PaO2 80 mmHg b) pH 7.44, PaO2 69 mmHg c) pH 7.38, PaCO2 30 mmHg d) pH 7.32, PaCO2 48 mmHg

c) pH 7.38, PaCO2 30 mmHg

A client with an obstruction of the pancreatic ducts is diagnosed with acute pancreatitis. A subtotal pancreatectomy is performed. The nurse would monitor the client for which postoperative complication? a) constipation b) cholecystitis c) paralytic ileus d) respiratory distress

c) paralytic ileus

Which bacteria may causes toxic shock syndrome in female clients? a) treponema pallidum b) enterococcus faecalis c) staphylococcus aureus d) neisseria gonorrhoeae

c) staphylococcus aureus

Discharge planning for a client with chronic pancreatitis includes dietary education. Which client statement indicates to the nurse that further teaching is needed? a) 'I must eat foods high in calories' b) 'I should avoid alcoholic beverages' c) 'I will eat more often but in smaller amounts' d) 'I can eat foods high in fat now that the acute stage is over'

d) 'I can eat foods high in fat now that the acute stage is over'

Which statement describing systemic inflammatory response syndrome (SIRS) and/or multiple organ dysfunction syndrome (MODS) is accurate? a) MODS may occur independently from SIRS b) All patients with septic shock develop MODS c) The GI system is often the first to show evidence of dysfunction in SIRS and MODS d) A common initial mediator that causes endothelial damage leading to SIRS and MODS is endotoxin

d) A common initial mediator that causes endothelial damage leading to SIRS and MODS is endotoxin

Priority Decision: A patient with acute pancreatitis is experiencing hypovolemic shock. Which initial orders for the patient will the nurse implement first? a) Start 1000 mL of normal saline at 500 mL/hr. b) Obtain blood cultures before starting IV antibiotics. c) Draw blood for hematology and coagulation factors. d) Administer high-flow oxygen (100%) with a non-rebreather mask.

d) Administer high-flow oxygen (100%) with a non-rebreather mask.

As the body continues to try to compensate for hypovolemic shock, there is increased angiotensin II from the activation of the renin-angiotensin-aldosterone system. What physiologic change occurs related to the increased angiotensin II? a) Vasodilation b) Decreased blood pressure (BP) and CO c) Aldosterone release results in sodium and water excretion d) Antidiuretic hormone (ADH) release increases water reabsorption

d) Antidiuretic hormone (ADH) release increases water reabsorption

Progressive tissue hypoxia leading to anaerobic metabolism and metabolic acidosis is characteristic of the progressive stage of shock. What changes in the heart contribute to this increasing tissue hypoxia? a) Arterial constriction causes decreased perfusion. b) Vasoconstriction decreases blood flow to pulmonary capillaries. c) Increased capillary permeability and profound vasoconstriction cause increased hydrostatic pressure. d) Decreased perfusion occurs, leading to dysrhythmias, decreased CO, and decreased oxygen delivery to cells.

d) Decreased perfusion occurs, leading to dysrhythmias, decreased CO, and decreased oxygen delivery to cells.

During administration of IV norepinephrine (Levophed), what should the nurse assess the patient for? a) Hypotension b) Marked diuresis c) Metabolic alkalosis d) Decreased tissue perfusion

d) Decreased tissue perfusion

The patient returned from a 6-week mission trip to Somalia with complaints of nausea, malaise, fatigue, and achy muscles. What type of hepatitis is this patient most likely to have contracted? a) HBV b) HCV c) HDV d) HEV

d) HEV

Following a needle stick, what is used as prophylaxis against HBV? a) Interferon b) HBV vaccine c) HBIG d) HBIG and HBV vaccine

d) Hepatitis B immune globulin (HBIG) and HBV vaccine

What is the key factor in describing any type of shock? a) Hypoxemia b) Hypotension c) Vascular collapse d) Inadequate tissue perfusion

d) Inadequate tissue perfusion

What mechanism that can trigger SIRS is related to MI or pancreatitis? a) Abscess formation b) Microbial invasion c) Global perfusion deficits d) Ischemic or necrotic tissue

d) Ischemic or necrotic tissue

The nurse is caring for a client with a diagnosis of acute pancreatitis and alcoholism. The client asks, 'How does my drinking relate to my diagnosis?' Which effect of alcohol would the nurse include when responding? a) It promotes the formation of calculi in the cystic duct b) It stimulates the pancreas to secrete more insulin than it can immediately produce c) It alters the composition of enzymes so they are capable of damaging the pancreas d) It increases enzyme secretion and pancreatic duct pressure that causes backflow of enzymes into the pancreas

d) It increases enzyme secretion and pancreatic duct pressure that causes backflow of enzymes into the pancreas

Which complication of acute pancreatitis requires prompt surgical drainage to prevent sepsis? a) Tetany b) Pseudocyst c) Pleural effusion d) Pancreatic abscess

d) Pancreatic abscess

When assessing a patient with acute pancreatitis, the nurse would expect to find a) Hyperactive bowel sounds b) Hypertension and tachycardia c) A temperature greater than 102 F (38.9 C) d) Severe LUQ or midepigastric pain

d) Severe LUQ or midepigastric pain

Which type of shock is associated with a ruptured abdominal aneurysm? a) vasogenic shock b) neurogenic shock c) cardiogenic shock d) hypovolemic shock

d) hypovolemic shock

The blood pressure for a client with possible ruptured spleen after a motor vehicle accident is 100/60 mm Hg. Based on this information, which additional assessment finding will the nurse expect? a) warm and flushed skin b) decreased heart rate c) increased pulse pressure d) reduced peripheral pulses

d) reduced peripheral pulses