P Test 4 BD

What should be done when a patient is in respiratory distress?

Call for help, disconnect the vent, start bagging the patient, then reassess

Which of the following patients should the charge nurse assign to the LPN?

Patient with TB

Which of the following patients would the RN assess 1st? Patient with paradoxical chest movement

Patient with paradoxical chest movement

What are some complications of PEEP?

PneumothoraxSubQ Emphysema (crepatus) Decreased pre-load

D. Check the drainage system for an air leak. Continuous bubbling in the water seal chamber is NOT normal and indicates there is an air leak. However, oscillation of the water in the water seal chamber is normal.

You are providing care to a pt w/a chest tube. On assessment of drainage system, you note continu bubbling in the water seal chamber & oscillation. Which of the following is the CORRECT nursing intervention for this type of finding? A. Re-position the pt cause the tubing is kinked. B. Continue to monitor the drainage system. C. Increase suction to the drainage system until the bubbling stops. D. Check the drainage system for an air leak.

1. Patient is concerned about going to another country where he might increase his risk of getting Anthrax. He asks the nurse for a Rx of Cipro just in case.

You only need it for confirmed cases of Anthrax

Picture of dry suction chest drainage system. Continuous bubbling in which chamber indicates?

a leak

1. Which biologic agents of terrorism can be protected against with a vaccine? a) Anthrax ANSWER IN WORKBOOK b) Botulism c) Small Pox d) Tularemia e) Hemorrhagic fever f) Plague

a) Anthrax b) Botulism c) Small Pox

1. What is an appropriate short-term goal for a patient with ascites? a) Decrease 1 cm of girth in the waist by the end of the shift b) Lower albumin levels by the end of the shift c) The patient will only gain 2kg by the end of the shift

a) Decrease 1 cm of girth in the waist by the end of the shift (2 kg is more than 4 lbs, which indicates severe fluid retention and is not an appropriate goal.)

1. What can decrease a patient's high ammonia levels?

a) GI Bleed b) Vomiting and diarrhea

PEEP - what should the nurse watch for? a) Sub Q emphysema b) Tachycardia c) Tachyapnea d) Refractory hypoxemia

a) Sub Q emphysema

What can Cause SIRS? Select All a. Crushing Chest b. Systemic Lupus with Erythematous c. Peritonitis d. Encephalopathy

a, b, c, d 2 or more of the following conditions can cause SIRS or sepsis. hyperthermia, tachycardia or bradycardia, tachypnea, neurtrophilia or neutropenia, increased bands, and toxic change

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, b, e, f occurs from loss of intravascular fluid volume from fluid loss (e.g., hemorrhage/severe vomiting/diarrhea), fluid shift (e.g., burns/ascites), or internal bleeding (e.g., with a ruptured spleen).

Appropriate treatment modalities for the management of cardiogenic shock include (SATA). a. dobutamine to increase myocardial contractility b. vasopressors to increase SVR c. circulatory assist devices such as an intraaortic balloon pump d. corticosteroids to stabilize the cell wall in the infarcted myocardium e. Trendelenburg position to facilitate venous return and increase preload

a, c

Which mechanical device is used in the treatment of cardiogenic shock to reduce preload, make the heart pump more efficiently, and increase cardiac output? 1. Hypothermic device 2. Ventricular assist device (VAD) 3. Intraaortic Balloon pump (IABP) 4. Extracorporeal membrane oxygenation (ECMO)

3. Intraaortic Balloon pump (IABP)

The nurse is preparing to administer cefazolin (Ancef) 2 g in 100 mL of normal saline to a postoperative patient. What infusion rate on the infusion pump will infuse this medication over 20 minutes? _________mL/hr

300 Volume ÷ Time in hours = Rate in mL/hr. Therefore 100 mL ÷ 0.33 hr (20 min) = 300 mL/hr.

Patient with 110 heart rate but still has low cardiac output. What should the nurse do to increase output?

(Something like that) Balloon Pump

When is pressure support ventilation primarily used?

-Primarily used in conjunction with SIMV and CPAP to facilitate weaning from mechanical ventilation -And again- can be used as a stand alone mode

The nurse evaluates the effectiveness of dopamine therapy for a client in shock. Which of the following may indicate treatment is successful? (Select all that apply.) 1. Improved urine output 2. Increased blood pressure 3. Breath sounds are diminished 4. Slight hypotension occurs 5. Peripheral pulses are intact

1. Improved urine output 2. Increased blood pressure

A client with cirrhosis who has ascites receives 100 mL of 25% serum albumin IV. Which finding would best indicate that the albumin is having its desired effect? 1. reduced ascites 2. increased serum albumin level 3. decreased anorexia 4. increased ease of breathing

1. reduced ascites

The client has a right-sided chest tube. As the client is getting out of the bed it is acci- dentally pulled out of the pleural space. Which action should the nurse implement first? 1. Notify the health-care provider to have chest tubes reinserted STAT. 2. Instruct the client to take slow shallow breaths until the tube is reinserted. 3. Take no action and assess the client's respiratory status every 15 minutes. 4. Tape a petroleum jelly occlusive dressing on three (3) sides to the insertion site.

4. Tape a petroleum jelly occlusive dressing on three (3) sides to the insertion site. Taping on three sides prevents the development of a tension pneumothorax by inhibiting air from entering the wound during inhalation but allowing it to escape during exhalation.

PAO2 =

80 to 100

Your patient was hit in the back with a baseball bat. Shortly after the incident, he began to experience lightheadedness and blurry vision. You notice bruising around his umbilicus. What does this indicate? A) A. Cullen's sign B) B. Kehr's sign C) C. Stop sign D) D. Turner's sign

A) A. Cullen's sign

Which of the following patients is a priority to assess?

a. Patient who has singed facial hair secondary to an explosion with his gas grill. (Lung Injury - pg 452)

What is the purpose of PEEP? Alveoli expanded on expiration

Alveoli expanded on expiration Allows the ventilator to deliver 100% oxygen to the lungs." "PEEP prevents the lung air sacs from collapsing during exhalation." By preventing alveolar collapse during expiration, PEEP improves gas exchange and oxygenation.

What sign, indicative of a ruptured spleen, is described as ecchymosis around the umbilicus? A) A. Battle's sign B) B. Cullen's sign C) C. Grey-Turner's sign D) D. Kehr's sign

B) B. Cullen's sign

The nurse is caring for a patient being treated with an intraaortic balloon pump. Which intervention is most important to include in the patient's plan of care? A. Turning side to side every 2 hours B. Assessing peripheral pulses C. Padding bony prominences D. Applying splint to affected limb

B. Assessing peripheral pulses

While providing care for a patient who has a chest tube in place attached to a closed-chest drainage system, the nurse accidentally disconnects the chest tube from the system. Which of the following should the nurse do to prevent serious complication while preparing to reconnect the system? A. clamp chest tube close to pt's chest B. Submerge tend of the chest tube in 1 inch sterile water C. Gently milk chest tube in a proximal to distal direction D. tape sterile gauze around open end of chest tube

B. Submerge the end of the chest tube in 1 inch sterile water

In which of the clotting following conditions, is DIC usually developed: A. Von Willebrand's Disease B. Thrombocitic Thrombocytopenic Purpura C. Hemophilia A D. Hemophilia B

B. Thrombocitic Thrombocytopenic Purpura

A patient has undergone surgery that resulted in unexpected massive blood loss. The bodys normal systems compensate to prevent excessive blood loss through clotting. Under normal circumstances, what is the most important body process that is activated after the coagulation pathways are activated? A) Cellular phagocytosis B) Antigenantibody formation C) Coagulation inhibition D) Platelet attraction to collagen

C) Coagulation inhibition

Motor vehicle accident, a pt sustained blunt trauma to the head & face, resulting in hairline skull fracture & a LeFort III maxillofacial fracture. The pt also has bruising across the chest, upper abdomen and multiple small superficial bleeding abrasions/lacerations. On admission to the ED, what is the nursing care priority? A)Apply direct pressure to bleeding areas. B)Assess neurologic status. C)Perform endotracheal intubation. D)Administer tetanus booster immunization.

C) Perform endotracheal intubation.

The nurse is assigned to a patient in the Emergency Department who exhibits paradoxical chest movement. What intervention by the nurse can help improve oxygenation in this patient? A) Elevate the head of the bed 30 degrees. B) Splint the chest with 3-inch surgical tape. C) Turn the patient with the injured side down. D) Place the patient in the prone position.

C) Turn the patient with the injured side down.

On initial admission of a trauma victim to the ED, the nurse completes a primary survey. The patient is awake and tachypneic, is using accessory muscles of respiration, has unequal chest expansion, and is very anxious. There are absent breath sounds on the right and cyanosis on 100% oxygen, and the trachea is deviated to the left. What action takes the highest priority during the primary survey? A)Jaw thrust maneuver B)Suctioning the oral pharynx C)Chest tube insertion D)Assisting ventilation with bag-mask device

C)Chest tube insertion

As part of a major trauma, a patient has suffered a flail chest injury. What hallmark sign of flail chest does the nurse expect to find? A)Flail segment elevation during inhalation B)Evidence of rib fractures on chest radiograph C)Flail segment depression during inhalation D)Hypoxemia evident on arterial blood gases

C)Flail segment depression during inhalation

A client diagnosed with disseminated intravascular coagulation (DIC) is currently bleeding through the gastrointestinal tract. What will the nurse expect to provide for the client? A) Aspirin B) Coumadin C) Plasma, platelets, packed RBC's, and FFP(clotting factors) D) Heparin E) Cluster to reduce traumatic interventions

C, E DIC management Sepsis 6 Transfuse FFP find cause

A patient has been exposed to anthrax. Which antibiotic would the nurse anticipate administering? A. Penicillin B. Tetracycline C. Ciprofloxacin D. Cidofovir

C. Ciprofloxacin The nurse should anticipate administering ciprofloxacin or dicloxacillin.

Which of the following findings would not be considered part of a diagnosis for DIC (Disseminated Intravascular Coagulation), secondary to an underlying disease? A. Thrombocytopenia B. Elevated D-dimer, fibrin degradation products, and fibrinogen C. Markedly elevated LDH (released from damaged RBCs) D. Elevated PT/INR and PTT

C. Markedly elevated LDH (released from damaged RBCs)

Ecchymosis around the umbilicus (Cullen's sign) is indicative of hemorrhage in which of the following organs? A) A. Spleen B) B. Liver C) C. Stomach D) D. Pancreas

D) D. Pancreas

The nurse on a medical-surgical unit identifies that which patient has the highest risk for metabolic alkalosis? A. A patient with a traumatic brain injury B. A patient with type 1 diabetes mellitus C. A patient with acute respiratory failure D. A patient with nasogastric tube suction

D. A patient with nasogastric tube suction

You are providing care to a patient with a chest tube. On assessment of the drainage system, you note continuous bubbling in the water seal chamber and oscillation. Which of the following is the CORRECT nursing intervention for this type of finding? A. Reposition the patient because the tubing is kinked. B. Continue to monitor the drainage system. C. Increase the suction to the drainage system until the bubbling stops. D. Check the drainage system for an air leak.

D. Check the drainage system for an air leak. Continuous bubbling in the water seal chamber is NOT normal and indicates there is an air leak. However, oscillation of the water in the water seal chamber is normal.

All are diagnostic criteria for Disseminated Intravascular Coagulation (DIC) except: A. Elevated D-dimer B. Elevated PT/INR and PTT C. Thrombocytopenia D. Elevated ESR

D. Elevated ESR

While assessing an unresponsive apneic spinal cord injury patient, the nurse understands the need to open the airway with the jaw thrust maneuver and apply a cervical collar. What intervention would be the priority for the nurse to complete next? A. Inserting an intravenous line B. Assessing skin color, temperature, and moisture C. Determining the patient's level of consciousness D. Ventilating with a bag-valve mask at 100% oxygen

D. Ventilating with a bag-valve mask at 100% oxygen because breathing is the priority after the airway has been stabilized.

Disseminated Intravascular Coagulation (DIC) is diagnosed with the following lab results, elevated D-Dimer, prolonged PT, and _______________. A. Platelet count of < 50 K/uL B. Platelet count of > 100 K/uL C. Elevated fibrinogen D. Both B and C E. Both A and C

E. Both A and C

Which of the following patients in the ED is a priority to assess?

Flail Chest

Which of the following patients is the most at risk for developing SEPSIS?

Leukemia with resected abscess

To prevent ventilator associated pneumonia: SATA a. Frequent oral care b. Hrly & PRN suctioning c. Keep patients head elevated >30* d. Maintain a closed system e. Disconnect patient from the vent to suction

a, c, d, e No hourly suction just prn

A nurse is providing staff education about smallpox as a bioterrorism threat. Which of the following statements indicates an understanding of this agent (SATA) A. "Smallpox is transmitted person to person." B. "Infection is characterized by severe respiratory distress." C. "Smallpox vaccination ensures lifelong immunity." D. "Naturally occurring smallpox has been eradicated from the world." E. "Smallpox is often confused with varicella."

a, d, e

Following an earthquake, patients are triaged by emergency medical personnel and are transported to the hospital. Which of these patients will the nurse need to assess first? a. A patient with a red tag b. A patient with a blue tag c. A patient with a yellow tag d. A patient with a green tag

a. A patient with a red tag

A postoperative patient has a bronchial obstruction resulting from retained secretions and an oxygen saturation of 87%. What condition does the nurse suspect is occurring? a. Atelectasis b. Bronchospasm c. Hypoventilation d. Pulmonary embolism

a. Atelectasis most common cause of postop hypoxemia is atelectasis, may be result of bronchial obstruction caused by retained secretions or decreased respiratory excursion.

The patient with leukemia has acute disseminated intravascular coagulation (DIC) and is bleeding. What diagnostic findings should the nurse expect to find? a. Elevated D-dimers b. Elevated fibrinogen c. Reduced prothrombin time (PT) d. Reduced fibrin degradation products (FDPs)

a. Elevated D-dimers

Which of the following is a mechanism through which portal hypertension leads to ascites? Select one: a. Hydrostatic pressure is increased in the portal venous system. b. Hepatosplenomegaly develops and causes abdominal enlargement. c. Esophageal varices form in the lower esophagus. d. Hemorrhoids leak blood into the peritoneal cavity

a. Hydrostatic pressure is increased in the portal venous system.

A patient who is lethargic and exhibits deep, rapid respirations has the following arterial blood gas (ABG) results: pH 7.32, PaO2 88 mm Hg, PaCO2 37 mm Hg, and HCO3 16 mEq/L. How should the nurse interpret these results? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis

a. Metabolic acidosis The pH and HCO3 indicate that the patient has a metabolic acidosis. The ABGs are inconsistent with the other responses

During the primary assessment of a trauma victim, the nurse determines that the patient is breathing and has an unobstructed airway. Which action should the nurse take next? a. Observe the patient's respiratory effort. b. Check the patient's level of consciousness. c. Palpate extremities for capillary refill time. d. Examine the patient for any external bleeding.

a. Observe the patient's respiratory effort.

A patient experiences a chest wall contusion as a result of being struck in the chest with a baseball bat. The emergency department nurse would be most concerned if which finding is observed during the initial assessment? a. Paradoxical chest movement b. Complaint of chest wall pain c. Heart rate of 110 beats/minute d. Large bruised area on the chest

a. Paradoxical chest movement-Indicates pt may have flail chest, can severely compromise gas exchange & can rapidly lead to hypoxemia. Chest wall pain, slightly elevated pulse, chest bruising require further assessment or intervention, but the priority concern is poor gas exchange.

Diminished to absent breath sounds on the right side, tracheal deviation to the left side, and asymmetrical chest movement are indicative of which of the following disorders? a. Tension pneumothorax b. Pneumonia c. Pulmonary fibrosis d. Atelectasis

a. Tension pneumothorax Diminished to absent breath sounds on the right side, tracheal deviation to the left side, and asymmetrical chest movement are indicative of tension pneumothorax.

A client is actively bleeding from esophageal varices. Which of the following medications would the nurse most expect to be administered to this client? a. Vasopressin (Pitressin) b. Spironolactone (Aldactone) c. Propranolol (Inderal) d. Lactulose (Cephulac)

a. Vasopressin (Pitressin) Produces constriction of the splanchnic arterial bed and decreases portal pressure.

Patient with petechia. What labs would you expect in this patient? Select All: a. Low Plt b. Increased PTT c. Increased D-Dimer d. Increased Fibrin Split Products

a.Low Plt b.Increased PTT c.Increased D-Dimer d.Increased Fibrin Split Products

The nurse is caring for a pt in cardiogenic shock who is being treated with an intraaortic balloon pump (IABP). The family inquires about the primary reason for the device. What is the best statement by the nurse to explain the IABP? a.The action of the machine will improve blood supply to the damaged heart." b.The machine will beat for the damaged heart with every beat until it heals." c.The machine will help cleanse the blood of impurities that might damage the heart." d.The machine will remain in place until the patient is ready for a heart transplant."

a.The action of the machine will improve blood supply to the damaged heart." improves coronary artery perfusion, reduces afterload, and improves perfusion to vital organs.

Hemothorax/Pneumothorax Signs/Symptoms: What is subcutaneous emphysema?

air trapped in the tissue (usually neck, face, and chest)

A 64-year-old woman is admitted to the emergency department vomiting bright red blood. The patient's vital signs are blood pressure 78/58 mm Hg, pulse 124 beats/minute, respirations 28 breaths/minute, and temperature 97.2° F (36.2° C). Which physician order should the nurse complete first? a Obtain a 12-lead ECG and arterial blood gases. b Rapidly administer 1000 mL normal saline solution IV. c Administer norepinephrine (Levophed) by continuous IV infusion. d Carefully insert a nasogastric tube and an indwelling bladder catheter.

b Rapidly administer 1000 mL normal saline solution IV. Isotonic crystalloids, such as NS, should be used in the initial resuscitation of hypovolemic shock. Vasopressor drugs (e.g., norepinephrine) may be considered if the patient does not respond to fluid resuscitation and blood products.

A patient is hooked up to a chest drain. Which of the following is the nurse's main concern? a) Sub Q emphysema b) 600 mL blood drainage c) patient states extreme pain with deep inspiration

b) 600 mL blood drainage

A patient who has a chest drain hooked up to suction has an order to ambulate. What should the RN do? a) Don't do it because it is a contraindication for the chest drain b) Walk the patient but keep the chest below the patients waist level c) Clamp the chest tube while ambulating

b) Walk the patient but keep the chest below the patients waist level

An intensive care nurse, is assessing a patient with suspected sepsis. Which predisposing factors would expect to be found in the patient with septic shock? a. A 45 year old client with a history of renal insufficiency. b. A 65 year old with cancer & recovering from an abdominal peritoneal resection. c. A 27 year old with pyelonephritis responding to treatment with an antibiotic. d. A 50 year old with community acquired tuberculosis.

b. A 65 year old with cancer & recovering from an abdominal peritoneal resection.

Dobutamine (Dobutrex) is used to treat a client experiencing cardiogenic shock. Nursing intervention includes: a. Monitoring for fluid overload. b. Monitoring for cardiac dysrhythmias. c. Monitoring respiratory status. d. Monitoring for hypotension.

b. Monitoring for cardiac dysrhythmias.Objective: Dobutamine is beneficial where shock is caused by heart failure. Increases contractility & has potential to cause dysrhythmias.

Which statement by the nurse when explaining the purpose of positive end-expiratory pressure (PEEP) to the family members of a patient with ARDS is accurate? a. PEEP will push more air into the lungs during inhalation." b. PEEP prevents the lung air sacs from collapsing during exhalation." c. PEEP will prevent lung damage while the patient is on the ventilator." d. PEEP allows the breathing machine to deliver 100% oxygen to the lungs."

b. PEEP prevents the lung air sacs from collapsing during exhalation." By preventing alveolar collapse during expiration, PEEP improves gas exchange and oxygenation. PEEP will not prevent lung damage (e.g., fibrotic changes that occur with ARDS), push more air into the lungs, or change the fraction of inspired oxygen (FIO2) delivered to the patient.

Pt enters ED. Which of the following patients would be the priority to assess? a. Pain over scapula? b. Pt with facial fractures. c. Pt who is nauseated d. Pt with laceration on leg.

b. Pt with facial fractures. YES!!! Pg 1529 due to swelling of airway (Pain over scapula? =Sign of abd trauma pg 973)

1. What should you keep in the room with a patient who has a chest tube? a. A 20 cc syringe b. Sterile water c. Gauze pads & tape d. Suction

b. Sterile water

When planning the response to the potential use of smallpox as an agent of terrorism, the emergency department (ED) nurse-manager will plan to obtain sufficient quantities of a. blood. b. vaccine. c. atropine. d. antibiotics.

b. vaccine Smallpox infection can be prevented or eliminated by the administration of vaccine given rapidly after exposure.

Which of the following is TRUE about D-Dimer (a fibrin degradation product)? a) It is specific but not sensitive (50%). b) It is infrequently used to screen for a thrombotic event. c) It is helpful in ruling in DIC (disseminated intravascular congestion) if positive. d) It is the breakdown product of a fibrin mesh that has been stabilized by Factor VII.

c) It is helpful in ruling in DIC (disseminated intravascular congestion) if positive.

These four patients arrive in the emergency department after a motor vehicle crash. In which order should they be assessed? Put a comma and space between each answer choice (a, b, c, d, etc.) a. A 72-year-old with palpitations and chest pain b. A 45-year-old complaining of 6/10 abdominal pain c. A 22-year-old with multiple fractures of the face and jaw d. A 30-year-old with a misaligned right leg with intact pulses

c, a, b, d

What is the cellular process associated with ascites? a) Solutes from cells go into plasma b) Solutes go from tissues into cells c) Solutes from plasma go into cells d) Solutes from cells go into tissues

c, d

The emergency department (ED) triage nurse is assessing four victims of an automobile accident. Which patient has the highest priority for treatment? a. A patient with absent pedal pulses b. A patient with an open femur fracture c. A patient with a sucking chest wound d. A patient with bleeding of facial lacerations

c. A patient with a sucking chest wound

A patient is being manually weaned from mechanical ventilation. Which of the following should the nurse do to support the patient at this time? a. Turn off the ventilator for the prescribed period of time. b. Calmly reassure the pt & place them on CPAP for 1 hr prior to extubation. - c. Change the ventilator settings so the patient can breathe spontaneously between set breaths. d. Have intubation equipment at the bedside.

c. Change the ventilator settings so the patient can breathe spontaneously between set breaths.

A client with a chest tube is to be transported via a stretcher. When transporting the client, the nurse should keep the: a. Collection device attached to mechanical suction. b. Chest tube clamped distal to the water-seal chamber. c. Collection device below the level of the client's chest. d. Chest tube end covered with sterile gauze pads taped to the client

c. Collection device below the level of the client's chest.

A patient develops unexpected bleeding and the following test results were obtained Prolonged PT and APTT Decreased fibrinogen Increased fibrin split products Decreased platelets a. familial afribrinogenemia b. primary fibrinolysis c. DIC d. liver diseaseprimary fibrinolysisc. DICd. liver disease

c. DIC

The nurse is administering medications to a client that has elevated ammonia due to cirrhosis of the liver. What medication will the nurse give to detoxify ammonium and to act as an osmotic agent? a. Spironolactone b. Kanamycin c. Lactulose d. Cholestyramine

c. Lactulose

The nurse is caring for a patient who has an intraaortic balloon pump in place. Which action should be included in the plan of care? a. Position the patient supine at all times. b. Avoid the use of anticoagulant medications. c. Measure the patient's urinary output every hour. d. Provide passive range of motion for all extremities

c. Measure the patient's urinary output every hour.

During the primary assessment of a patient with a steel rod in the abdomen. What is the nurse's first priority? a. Assess bowel sounds b. Remove the rod carefully c. Obtain HR & BP d. Ventilate patient

c. Obtain HR & BP due to hemorrhage/hypovolemic shock

The nurse recognizes which client as being at highest risk for septic shock? a. 12-year-old with open fracture of the left femur and two peripheral IVs b. 35-year-old with HIV receiving enteral feedings via a percutaneous endoscopic gastrostomy (PEG) tube c. 65-year-old with pneumonia receiving IV fluids and broad-spectrum oral antibiotics d. 82-year-old with leukemia receiving broad-spectrum IV antibiotics via a triple-lumen central line

d. 82-year-old with leukemia receiving broad-spectrum IV antibiotics via a triple-lumen central line

The nurse on a medical-surgical unit identifies that which patient has the highest risk for metabolic alkalosis? a. A patient with a traumatic brain injury b. A patient with type 1 diabetes mellitus c. A patient with acute respiratory failure d. A patient with nasogastric tube suction

d. A patient with nasogastric tube suction Excessive nasogastric suctioning may cause metabolic alkalosis.

Gastric lavage and administration of activated charcoal are prescribed for an unconscious patient who has been admitted to the emergency department (ED) after ingesting 30 diazepam (Valium) tablets. Which action will the nurse plan to take first? a. Administer activated charcoal. b. Insert a large-bore orogastric tube. c. Prepare a 60-mL syringe with saline. d. Assist with intubation of the patient.

d. Assist with intubation of the patient. In an unresponsive patient, intubation is done before gastric lavage and activated charcoal administration to prevent aspiration. The other actions will be implemented after intubation.

Normal fibrinogen levels are 250-350mg/dL. Low fibrinogen levels indicate bleeding and are indicative of which of the following? a. Inflammation b. MI c. Coronary artery disease d. DIC

d. DIC

In late irreversible shock in a patient with massive thermal burns, what should the nurse expect the patient's laboratory results to reveal? a. Respiratory alkalosis b. Decreased potassium c. Increased blood glucose d. Increased ammonia (NH3) levels

d. Increased ammonia (NH3) levels In late irreversible shock, progressive cellular destruction causes chnges in lab findings that indicate organ damage. Increasing ammonia levels indicate impaired liver function.

As a health care provider, what can the nurse do to minimize effects of biological terrorism? a. Learn characteristics of terrorists b. Get self and family vaccinated. c. Stock up on supplies to treat biological d. Learn and recognize the early signs and symptoms.

d. Learn and recognize the early signs and symptoms.

When the ventilator alarm sounds, the nurse finds the patient lying in bed holding the endotracheal tube (ET). Which action should the nurse take first? a. Offer reassurance to the patient. b. Activate the hospital's rapid response team. c. Call the health care provider to reinsert the tube. d. Manually ventilate the patient with 100% oxygen.

d. Manually ventilate the patient with 100% oxygen.

The nurse is assessing a client who was admitted for treatment of shock. Which manifestation indicates that the client's shock is caused by sepsis? a. Hypotension b. Pale clammy skin c. Anxiety and confusion d. Oozing of blood at the IV site

d. Oozing of blood at the IV site late phase of sepsis-induced distributive shock is characterized by most of the same cardio manifestations as any other type of shock. The distinguishing feature is lack of ability to clot blood, causing the client to bleed from areas of minor trauma and to bleed spontaneously.

Which statement by the nurse when explaining the purpose of positive end-expiratory pressure (PEEP) to a family member of a patient with ARDS (acute respiratory distress syndrome)? A. Peep will prevent fibrosis of the lung from occurring. b. Peep will push more air into the lungs during inhalation. c. Peep allows the ventilator to deliver 100% oxygen to the lungs d. Peep prevents the air sacs from collapsing during exhalation.

d. Peep prevents the air sacs from collapsing during exhalation.

A patient who was involved in a motor vehicle crash has had a tracheostomy placed to allow for continued mechanical ventilation. How should the nurse interpret the following arterial blood gas results: pH 7.48, PaO2 85 mm Hg, PaCO2 32 mm Hg, and HCO3 25 mEq/L? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis

d. Respiratory alkalosis The pH indicates that the patient has alkalosis and the low PaCO2 indicates a respiratory cause. The other responses are incorrect based on the pH and the normal HCO3

The need for fluid resuscitation can be assessed best in the trauma patient by monitoring and trending which of the following tests? a. Arterial oxygen saturation b. Hourly urine output c. Mean arterial pressure d. Serum lactate levels

d. Serum lactate levels

Pt sustained rib fractures after hitting steering wheel of his car. The pt is spontaneously breathing & receiving O2 via a face mask; the O2 sat is 95%. During assessment, the O2 sat drops to 80%. The pts BP dropped from 128/76 to 84/60. Breath sounds are absent throughout the left lung fields. The nurse notifies HCP & anticipates: a. administration of lactated Ringers solution (1 L) wide open. b. chest x-ray study to determine the etiology of the symptoms. c. endotracheal intubation and mechanical ventilation. d. needle thoracostomy and chest tube insertion.

d. needle thoracostomy and chest tube insertion.

A patient has the following arterial blood gas results: pH 7.52; PaCO2 30 mmHg; HCO3- 24 mEq/L. The nurse determines that these results indicate: a. metabolic acidosis b. metabolic alkalosis c. respiratory acidosis d. respiratory alkalosis

d. respiratory alkalosis Ocurs with hyperventilation. Primary cause of respiratory alkalosis is hypoxemia from acute pulmonary disorders.

What bioterrorism agent can be spread from person to person & via respiratory droplets??

small pox fomites

What can be used to increase BP, HR, and CO in neurogenic shock?

vasopressors (dopamine and dobutamine)atropine for HR