Complex Care Exam 3 Review

What are the most common causes of pancreatitis?

Gallstone migration and alcoholism

The complex process of the body releasing glucagon to simulate glucose release from long term energy needs. In this process, fat and protein nutrients are rapidly broken down into end products that are changed into glucose. This helps to protect the brain that has a limited supply of glucose and protects the brain from the effects of hypoglycemia.

Glycogenolysis

A patient is admitted with septic shock. The nurse appreciates that the key to treatment is finding the cause of infection. Which cultures would the nurse obtain before initiating antibiotic therapy?

Wound cultures, blood cultures, urine culture

Sepsis should be suspected for a patient with a lactate level of: a. 2.0 mmol/liter b. 2.2 mmol/liter c. 4.0 mmol/liter d. 3.0 mmol/liter

a. 2.0 mmol/liter

Neurogenic shock is what type of shock? a. Distributive b. Cardiogenic c. Hypovolemic

a. Distributive

_____________________________- is an example of a drug that is used to increase contractility and helps to maintain the blood pressure and perfusion. Patient may also have vasopressin (norepinephrine) to raise blood pressure. a. Dobutamine b. Dopamine c. Sodium Nitroprusside (Sodium Nipride) d. Epinephrine

a. Dobutamine

The adrenal medulla is a part of the sympathetic nervous system and is responsible for the release of epinephrine and norepinephrine. These catecholamines are utilized by the body for what: a. Fight or flight response b. Fight infection c. equilibrium of water and potassium in body

a. Fight or flight response

A patient is admitted to the intensive care unit and is at risk of developing a stress ulcer. What medication might the patient be given to decrease these risks? a. H2 antagonist b. heparin c. antacids d. vasopressin

a. H2 antagonist

In MODs, organ dysfunction may occur in a sequential or progressive pattern. Certain cellular and biochemical activities evoke the inflammatory and immune responses implicated in SIRs and MODS a. True b. False

a. True

In a patient with anaphylactic shock, vasodilation of the arterial system results in a decrease in afterload of the heart and a decrease in systemic vascular resistance. a. True b. False

a. True

Pancreatitis is an inflammation of the pancreas that produces exocrine and endocrine dysfunction that may also involve surrounding tissues, remote organ systems or both and is most commonly caused by gallstone migration or alcoholism. a. True b. False

a. True

Septic shock and sepsis are associated with a wide variety of intrinsic and extrinsic precipitating factors and all critically ill patients are at risk for this. This is caused by a variety of microorganisms but the respiratory system is the most common site of infection and gram positive bacteria are the predominant cause. a. True b. False

a. True

What is a major primary nursing intervention with pancreatitis? a. administration of pain medication b. teaching relaxation techniques c. providing a regular diet d. preventing pressure ulcers

a. administration of pain medication

In a patient with an anaphylactic reaction what MUST be initially assessed and immediately addressed if compromised? a. airway b. lungs c. breathing d. heart

a. airway

A patient arrives to the Emergency Department who is hypotensive, tachycardic, with a acute onset of hematochezia. The patient is thought to be in hypovolemic shock from a gastrointestinal bleed. What will the nurse expect to see in a patient with hematochezia? a. bright red stools b. coffee ground emesis c. black, tarry, or dark red stools d. No answer text provided.

a. bright red stools

Cardiogenic shock results in: a. decline in ventricular contractility, decreased compliance, and increase in end systolic volume b. decline in ventricular contractility, decrease in compliance, and increase is afterload c. increase in left ventricular contractility, increase in compliance and decrease in end systolic volume

a. decline in ventricular contractility, decreased compliance, and increase in end systolic volume

A patient has been admitted with a brain tumor. The patient starts to exhibit signs of an increase in ADH. When large amounts of ADH are released the nurse should anticipate what changes in the patients sodium levels? a. decrease b. rapid increase then decrease c. depends on the potassium levels d. increase

a. decrease

Which pathophysiologic mechanism occurs in the syndrome of inappropriate antidiuretic hormone (SIADH)? a. dilution hyponatremia, reducing sodium concentration to critically low levels b. hypokalemia from massive diuresis c. serum osmolality greater than 30 d. massive diuresis, leading to hemoconcentration

a. dilution hyponatremia, reducing sodium concentration to critically low levels

_______________________________- shock results from a maldistribution of circulating blood volume. a. distributive b. Hypovolemic c. cardiogenic

a. distributive

A patient with a known penicillin allergy develops anaphylactic shock after a dose of ampicillin was given in error. Which medication would the nurse administer first? a. epinephrine b. gentamicin c. atropine d. methylprednisolone

a. epinephrine

To meet short term energy requirements, __________________________ stimulates release of glycogen stores from liver and muscle cells. Through glycogenolysis the glycogen stored in the liver is converted to glucose so it can be used by the cells. a. glucagon b. insulin c. glucose d. proteins

a. glucagon

The patient has been admitted from a skilled nursing facility with urinary sepsis. The patient has severe muscle wasting. What is he process by which fat and protein are converted to glucose for fuel? a. gluconeogenesis b. digestion c. biotransformation d. glycogenolysis

a. gluconeogenesis

A patient is receiving TPN. During rounds the dietitian states that she believes that the patient is getting too much glucose. Identify one are in which excess glucose is stored as glycogen. a. hepatic cells b. gallbladder c. stomach d. pancreas

a. hepatic cells

A patient is being admitted from the ED with cardiogenic shock secondary to unstable angina and unresponsive to medications. The patient was intubated and ventilated in the ED. Which intervention should the nurse prepare to initiate when the practitioner arrives? a. insertion of IABP b. insertion of dialysis catheter for continuous renal replacement therapy c. administration of sodium bicarbonate d. rapid infusion of crystalloids

a. insertion of IABP

In what stage of shock do the compensatory mechanisms begin failing to meet tissue metabolic needs and the shock cycle is perpetuated. a. progressive b. inital c. final d. refractory

a. progressive

A patient is administered with a traumatic head injury. The patient starts to exhibit signs of a decrease in ADH. What is the function of ADH? a. regulate fluid balance b. normalize potassium levels c. maintain hemostasis d. control blood pressure

a. regulate fluid balance

The nurse is caring for a patient with systemic inflammatory response SIRS due to pneumonia. What is SIRS due to infection called? a. sepsis b. ARDS c. infectivity d. anaphylaxis

a. sepsis

A patient is admitted with a diagnosis of acute pancreatitis. Which lab value is the most predictive o pancreatitis? a. serum lipase b. serum glucose c. hemoglobin and hematocrit d. serum amylase

a. serum lipase

A nurse is discussing the concept of shock with a new graduate nurse. Which statement indicates the new graduate nurse understood the information? a. shock is an acute, widespread process of inadequate tissue perfusion b. shock is a degenerative condition leading to organ failure and death c. shock is a condition occurring with hypovolemia that results in hypotension d. shock is a physiologic state resulting in hypotension and tachycardia

a. shock is an acute, widespread process of inadequate tissue perfusion

A patient has been admitted with a neuro disorder. Which disorder should he nurse be most vigilant for development of neurogenic shock? a. spinal cord injury b. Gillian Barre syndrome c. brain tumor d. ischemic stroke

a. spinal cord injury

Using the parkland formula for fluid resuscitation and your knowledge of injury calculations using the rule of nines, calculate the estimated fluid requirements during the first 8 hours for a 50kg patient with full thickness burns to the back, entire right arm, and perineum. a. 5600 b. 2800 c. 10000 d. 4000

b. 2800

Cortisol is released by the adrenal cortex in response to physiologic stress caused by: (Select all that apply) a. trauma b. All of the above c. fasting state d. infection

b. All of the above

In a type 2 diabetic patient, all beta cells are nonfunctional a. True b. False

b. False

Neurogenic shock is a common form of shock and is the most common cause is a spinal cord injury a. True b. False

b. False

Patients with full thickness burns will never need pain medication because these burns are not painful due to destruction of nerves. a. True b. False

b. False

Some simple things such as raising the head of the bed and raising the legs can promote return of blood to the heart in a hypovolemic patient. a. True b. False

b. False

A patient is admitted to eh burn unit with extensive burns after a house fire. The patients vital signs and exam include HR of 140, urine output of 25ml/h and clear lung sounds. What adjustment if any needs to be made to the fluids resuscitation plan? a. fluids should be switched to packed red blood cells b. IV rate should be increased and fluid status closely watched c. IV rate should be decreased and colloids started d. continue as planned, everything looks good

b. IV rate should be increased and fluid status closely watched

A patient with pancreatitis will typically have an elevated serum amylase and lipase. Although both can be elevated, which test is more specific to the pancreas and more accurate for identifying pancreatitis? a. Amylase b. Lipase

b. Lipase

Patient is admitted with DKA. The patient's arterial blood gas indicates the patient has uncompensated metabolic acidosis. The patient has rapid, regular respirations. Which medical interventions would the nurse expect to initiate to correct the acidosis? a. administer sodium bicarbonate b. administer insulin and fluids intravenously c. prepare for intubation d. initiate oxygen therapy via face mask

b. administer insulin and fluids intravenously

A patient presents to the ED with s/s of a GI bleed. On exam the nurse notes that the patient has melena. What is this describing? a. bright red stools b. black tarry or dark red stools c. bleeding from the mouth d. bright red or coffee ground emesis

b. black tarry or dark red stools

The nurse knows that during the resuscitation of a patient with DKA, the intravenous line should be changed to a solution containing glucose when what happens? a. IV insulin has been infusing for 4 hours b. blood glucose drops to 200mg/dl c. blood glucose drops to 100mg/dl d. patient becomes more alert

b. blood glucose drops to 200mg/dl

A patient is admitted with GI hemorrhage due to esophagogastric varices. The patient has been started on a vasopressin drip. The nurse would monitor for which side effect of the medication? a. constipation b. chest pain c. bleeding d. diarrhea

b. chest pain

A patient is admitted after being burned in a car fire. The wound surface is red with patchy white areas that blanch with pressure but no blister formation. What kinds of burn would the nurse document in the patient's record? a. superficial partial thickness burns b. deep dermal partial thickness burns c. full thickness burn d. moderate partial thickness burn

b. deep dermal partial thickness burns

Through what mechanism does the endocrine system help maintain equilibrium? a. control of skeletal muscle b. hormones c. neuronal control d. control of smooth muscle

b. hormones

A patient is receiving insulin due to the development of steroid induced hyperglycemia. In addition to lower blood glucose levels, what other physiologic effect may occur when insulin is administered? a. hypercalcemia b. hypokalemia c. cellular dehydration d. breakdown of proteins

b. hypokalemia

What type of burn is typically caused by a brief contact with flames, hot liquid or exposure to dilute chemicals and is light to bright red or mottled appearance, blisters may form and the wound may appear wet or weeping? a. deep thermal partial thickness b. partial thickness c. superficial d. full thickness

b. partial thickness

The nurse is caring for a critically ill patient with type 1 diabetes. The nurse understands that the patient is at risk for developing DKA secondary to what etiology? a. inadequate fluid intake of food b. physiologic and psychologic stress c. increased release of ADH d. excess insulin administration

b. physiologic and psychologic stress

The nurse is caring for a patient who has been newly diagnosed with type 1 diabetes. Which laboratory result would the nurse note confirming this diagnosis? a. absence of ketones in the urine b. presence of ketones in the urine c. fasting glucose of 45mg/dl d. hemoglobin of 3%

b. presence of ketones in the urine

The nurse understands that the onset of seizures in the patient with diabetes insipidus is indicative of which situation? a. hyperosmolality b. severe dehydration c. toxic ammonia levels d. increased potassium levels

b. severe dehydration

The 3 hours sepsis bundle includes

blood cultures, crystalloid fluids, antibiotics within 45 minutes, lactate level

A 75kg patient has a 3rd degree burn to the chest and front of the leg. The patient is in need of fluid administration utilizing the Parkland formula. How much fluid will this patient receive in the first 8 hours. a. 2000ml b. 8100ml c. 4050ml

c. 4050ml

What is the name of a condition in patients with acute liver failure that is the inability to voluntarily sustain a fixed position of the extremities and is recognized by a downward flapping of the hands when the patient extends the arms and dorsiflexes the wrists? a. decerebrate b. Decorticate c. Asterixis

c. Asterixis

Patient is admitted with extreme fatigue, vomiting, headache. The patient has type 1 diabetes that has been well controlled with an insulin pump. The patient states 'I know it could not be my diabetes because my pump gives me 24 hours control'. Which reply would be the nurse's best response? a. You're right. This is probably a virus b. we'll get an abdominal CT to see if your pancreas is inflamed c. We'll check your serum glucose and ketones d. you know a lot about your pump and you are correct

c. We'll check your serum glucose and ketones

A patient has been admitted with severe abdominal pain. When examining the patient the nurse notes hypoactive bowel sounds, abdominal guarding, distention, and a discoloration around the umbilicus. The nurse suspects the patient may have what condition? a. peptic ulcer disease b. acute liver failure c. acute pancreatitis d. esophageal varices

c. acute pancreatitis

A patient is brought into the ED after a house fire. The patient sustained an inhalation injury. The nurse is aware that this injury puts the patient at risk to develop which complication? a. lung cancer b. asthma c. adult respiratory distress syndrome (ARDS) d. tension pneumothorax

c. adult respiratory distress syndrome (ARDS)

A patient with thyrotoxicosis has been admitted. The nurse would expect to observe which neurologic symptom? a. depression b. seizures c. agitation d. lethargy

c. agitation

The nurse is caring for a patient with a traumatic brain injury. The nurse suspects the patient is developing diabetes insipidus. Which test or procedure would confirm this diagnosis? a. serum glucose levels b. water deprivation test c. antidiuretic hormone (ADH) stimulation test d. skill radiographs

c. antidiuretic hormone (ADH) stimulation test

Patients that are in fires in confined spaces are at risk for having an elevated: a. myoglobin b. Potassium level c. carboxyhemaglo d. oxygen saturation

c. carboxyhemaglo

A patient is admitted with multiple trauma. Which hormone would the nurse expect to be increased in response to physiologic stress? a. corticosteroid b. glucocorticoid c. cortisol d. mineralocorticoid

c. cortisol

A patient is admitted with severe hyperglycemia due to new onset type 2 diabetes. Which signs and symptoms obtained as a part of the patients history might indicate the presence of hyperglycemia? a. decreased urine output accompanied by peripheral edema b. period of hyperactivity with weight gain c. increased thirst and increased urinary output d. recent episodes of tachycardia and missed heart beats

c. increased thirst and increased urinary output

Hypovolemic shock occurs from inadequate fluid volume in what? a. heart b. cells c. intravascular space

c. intravascular space

A patient is admitted with a brain and spinal cord injury secondary to a motor vehicle crash. The nurse is monitoring the patient for s/s of neurogenic shock. Clinical findings of neurogenic shock are related to which pathophysiological process? a. injury to the hypothalamus b. focal injury to the cerebral hemispheres c. loss of sympathetic nervous system innervation d. parasympathetic nervous system initiation

c. loss of sympathetic nervous system innervation

Insulin augments the transport of ________________________ into the cells, decreases the mobilization of fats, and stimulates protein synthesis. a. calcium b. sodium c. potassium d. water

c. potassium

An elderly patient is admitted with pneumonia. This morning the patient is febrile, tachycardia, and tachypneic, and confused. The nurse suspects the patient may be developing what problem? a. ARDS b. AKI c. sepsis d. delirium

c. sepsis

Parathyroid gland regulates

calcium homeostasis

The nurse is managing a patient with hyperglycemia. Which findings would the nurse expect to note to support this diagnosis?

change in LOC, kussmaul respirations, abdominal pain

Using the rule of nines, calculate the percent of injury in an adult who was injured as follows: patient sustained partial and full thickness burns to half of his left arm, his entire left leg and his perineum. a. 28% b. 45.5% c. 16% d. 23.5%

d. 23.5%

In a patient with shock, enteral nutrition should be started within how many hours? a. nutritional support is not needed b. Consider after 7 days c. 48-72 d. 24.48

d. 24.48

When utilizing the Rule of Nines a patient with a burn to the front of the chest, front and back of the arm, and front of leg would have what % body surface burn area? a. 31.5% b. 27% c. 45% d. 36%

d. 36%

A patient is brought into the ED after a house fire. Total body surface area is estimated at 25% deep partial thickness burns to are of the chest, back, and left arm, and 20% full thickness burns to right arm , upper leg, and areas of face. The patient's weight is 85kg. What is the initial plan for fluid replacement? a. 11475 ml lactated ringer solution evenly divided over the first 24 hours b. 11900 ml of dextran evenly divided over the first 24 hours c. 2868 ml of NS for first 8 hours then 5737 of hypertonic NS over next 16 hours d. 7650 ml lactated ringer solution for first 8 hours then 7650 over the next 16 hours

d. 7650 ml lactated ringer solution for first 8 hours then 7650 over the next 16 hours

Less than 24 hours ago a patient sustained full-thickness burns, to his face, chest, back, and bilateral upper arms, in a house fire. He also sustained an inhalation injury. The patient was intubated and ventilated and is now showing signs of increasing agitation and rising peak airway pressures. The nurse suspects the patient's change in condition is due to which problem? a. Uncontrolled pain b. Hypovolemia c. Worsening hypoxemia d. Decreased pulmonary compliance

d. Decreased pulmonary compliance

A nurse instructor is discussing the differences between primary and secondary multiple organ dysfunction syndrome (MODS) with a nursing student. Which statement indicates the student understands the information? a. primary MODS is due to a disorganization of the inflammatory immune system response b. Primary MODS is due to disruption of the coagulation system c. Primary MODS is the result of inflammation in organs not involved in the initial insult d. Primary MODS is the result of direct organ injury

d. Primary MODS is the result of direct organ injury

The nurse is caring for a patient in shock with an elevated lactate level. Which order should the nurse question in the management of this patient? a. start a norepinephrine drip to keep mean arterial pressure greater than 65 b. administer crystalloid fluid c. start an insulin drip for blood sugar greater than 180 d. administer sodium bicarb to keep arterial pH greater than 7.2

d. administer sodium bicarb to keep arterial pH greater than 7.2

What cells in the pancreas are responsible for insulin production? a. delta b. PP c. alpha d. beta

d. beta

A patient has been admitted with hypovolemic shock due to blood loss. Which finding would the nurse expect to note to support the diagnosis? a. bounding radial and pedal pulses b. widening pulse pressure c. distended neck veins d. decreased level of consciousness

d. decreased level of consciousness

The patient has been admitted with septic shock related to tissue necrosis. The nurse knows the initial goal for medical management for the patient is which intervention? a. discontinuing invasive monitoring as a possible cause of sepsis b. administering vasodilator substances to increase the blood flow to vital organs c. limiting fluids to minimize the possibility of heart failure d. finding and eradicating the cause of infection

d. finding and eradicating the cause of infection

Decreased insulin and increased glucagon result in what physiologic process? a. decreased fat mobilization b. decreased ketosis c. increased glycogen storage d. increased glycogenolysis

d. increased glycogenolysis

A patient with thyrotoxicosis has been admitted. What effect of increased T3 and T4 levels might the nurse expect to see in this patient? a. decreased metabolic rate b. decreased cardiac output c. increased calcium levels d. increased oxygen consumption

d. increased oxygen consumption

Patients who must receive total parenteral nutrition must do so with the use of a central venous catheter. What is a concern with the use of a central venous catheter? a. migration of the catheter b. bleeding c. catheter removal d. infection

d. infection

A patient has been admitted with hypovolemic shock due to traumatic blood loss. Which nursing measure can best facilitate the administration of large volumes of fluids? a. positioning the patient in Trendelenburg b. encourage the patient to drink at least 240ml of fluid an hour c. administering intravenous fluids under pressure with a pressure bag d. inserting a large diameter peripheral intravenous catheter

d. inserting a large diameter peripheral intravenous catheter

A patient is brought into the ED with extensive burns after a house fire. Which is an important nursing intervention for this patient during the resuscitation phase? a. apply splints and initiate TPN b. measure sedimentation rate and systemic antibiotics c. oral anti-inflammatory drugs and prep for insertion of an arterial line d. iv opiates and assessment of pulses in both arms

d. iv opiates and assessment of pulses in both arms

A patient is being given vasopressin to control variceal bleeding. The nurse knows this med causes splanchnic and systemic vasoconstriction, subsequently reducing portal blood flow and pressure. What medication might be given to offset the systemic side effects of vasopressin? a. dopamine b. dobutamine c. heparin d. nitroglycerine

d. nitroglycerine

The nurse is caring for a patient who is admitted with septic shock. The nurse knows that certain interventions should be completed within 3 hours of time of presentation. Which intervention would be a priority for the nurse to implement upon receipt of a partitions order? a. administer epinephrine b. measure central venous pressure c. administer fresh frozen plasma d. obtain a serum lactate level

d. obtain a serum lactate level

The nurse understands that earlier nutritional support is critical for the patient to prevent profound weight loss. Why does this occur in patients with MODS? a. patient experiences anorexia b. patient has gut dysfunction c. patient experiences hypometabolism d. patient experiences hypermetabolism

d. patient experiences hypermetabolism

A patient has been admitted with anaphylactic shock due to an unknown allergen. The nurse understands that the decrease in the patient's cardiac output is the result of which mechanism? a. increased venous return b. increased alveolar ventilation c. decreased myocardial contractility d. peripheral vasodilation

d. peripheral vasodilation

A patient with DKA receives insulin and fluids, the nurse knows careful assessment must be given to which electrolytes? a. sodium b. phosphorous c. calcium d. potassium

d. potassium

A patient is admitted to the burn unit after electrocution. The patient sustained extensive burns. The nurse should have a high degree of suspicion for which complication associated with this type of burn injury? a. venous thromboembolism b. pneumothorax c. stress ulcers d. rhabomyosis

d. rhabomyosis

ADH regulates

fluids balance

2 most common organs to demonstrate dysfunction in severe sepsis

lungs, heart

Refractory stage of shock

mottled skin, unresponsive, absent peripheral pulses