N476 Exam Three
respiratory acidosis s/s
- decreased BP - decreased RR - Increased HR - Restlessness - Confusion - Headache - Sleepy/coma
Metabolic alkalosis s/s
- hypoventilation - low potassium (dysrhythmias, muscle cramps/weakness, vomiting, tetany, tremors, EKG changes)
metabolic acidosis s/s
- kussmaul's breathing - hyperkalemia (muscle twitching, weakness, arrhythmias) - decreased BP - confusion
Prophylactic treatment for gut bacteria?
PPIs
prerenal AKI
decreased blood supply s/s: volume depleted, decreased CO, elevated BUN and Cre, electrolyte imbalance
Patients with disseminated intravascular coagulation are clinically known to first develop
microvascular thrombosis
Methods used to confirm ET tube placement
- Auscultate breath sounds present over bilateral lung fields and absent over epigastrium - Chest x-ray - ETCO2 color metric device (color change)
Diagnostic tests for pulmonary embolism
- Duplex ultrasonography - Ventilation-Perfusion scan - D-dimer
respiratory alkalosis causes
- Increased temperature - Aspirin toxicity - Hyperventilation
Treatment of metabolic acidosis?
- Monitor intake and output - Give BiCarb - Administer IV solution to increases bases and decreases acids - Initiate seizure precaution - Monitor Vitamin K+ levels
Metabolic alkalosis interventions
- Monitor potassium and calcium levels - Admin IV fluids to help the kidneys get rid of bicarb - Replace K+ - Give antiemetics for vomiting (Zofran or Phenergan) - Watch for signs of respiratory distress
Prerenal AKI
- Most common cause - Any condition that decreases blood flow, renal perfusion, or blood pressures -Can be reversible --> If addressed quickly - Watch urine output closely! - If kidney perfusion restored, no longer term damage at this point - If not restored, continuation of decreased GFR, increased BUN, and decreased urine output. Increased risk for AKI.
Postrenal AKI
- Obstruction after the kidney - BPH--> obstruction that hinders the flow of urine from beyond the kidney through the remainder of the urinary tract - Can be reversible if addressed within 48 hours
respiratory alkalosis interventions
- Provide emotional support - Fix the breathing problem! - Encourage good breathing patterns - Rebreathing into a paper bag - Give anti-anxiety meds or sedatives to decrease breathing rate - Monitor K+ and Ca- levels
respiratory alkalosis s/s
- RR >20 - Increased HR - Confused and tired - Tetany - EKG changes - Positive Chvostek sign
respiratory acidosis interventions
- administer O2 - Semi Fowler's - Turn, cough, deep breathe -Pneumonia: increase fluids to thin secretions and administer antibiotics - Monitor K levels - If CO2 >50, may need an endotracheal tube
components of the ventilator bundle to prevent ventilator associated pneumonia include
- peptic ulcer disease prophylaxis - deep vein thrombosis prophylaxis - daily awakenings - daily oral care with chlorhexidine
A nurse is preparing to suction a client who has a tracheostomy. Identify the sequence of actions the nurse should take. A. Adjust the suction. B. Apply suction while rotating the catheter. C. Don sterile gloves. D. Check the function of the suction catheter. E. Insert the catheter without suction. F. Hyperoxygenate the client. Assess for secretion clearance.
1) Adjust the suction. 2) Don sterile gloves. 3) Check the function of the suction catheter. 4) Hyperoxygenate the client. 5) Insert the catheter without suction. 6) Apply suction while rotating the catheter. 7) Assess for secretion clearance
In ventilator setting mode, to mimic normal respirations, the duration of inspiratory to expiratory ratio is usually set at
1:2 to mimic spontaneous respiration
A nurse is caring for a client who has pneumonia and a prescription for oxygen therapy at 5 L/min via nasal cannula. Which of the following actions should the nurse take? A. Attach a humidifier bottle to the base of the flow meter. B. Remove the nasal cannula while the client eats. C. Secure the oxygen tubing to the bed sheet near the client's head. D. Apply petroleum jelly to the nares as needed to soothe mucous membranes.
A. Attach a humidifier bottle to the base of the flow meter.
A nurse is preparing an adolescent client who has pneumonia for percussion, vibration, and postural drainage. Prior to the procedure, which of the following nursing actions should the nurse complete first? A. Auscultate lung fields. B. Assess pulse and respirations. C. Assess characteristics of her sputum. D. Instruct to slowly exhale with pursed lips.
A. Auscultate lung fields.
The nurse is caring for a client who has heart failure and a history of asthma. The nurse reviews the provider's orders and recognizes that clarification is needed for which of the following medications? A. Carvedilol B. Fluticasone C. Captopril D. Isosorbide dinitrate
A. Carvedilol
A client is admitted to the emergency room with a respiratory rate of 7/min. Arterial blood gases (ABG) reveal the following values. Which of the following is an appropriate analysis of the ABGs? pH 7.22 PaCO2 68 mm Hg Base excess -2 PaO2 78 mm Hg Saturation 80% Bicarbonate 26 mEq/L A. Respiratory acidosis B. Metabolic acidosis C. Metabolic alkalosis D. Respiratory alkalosis
A. Respiratory acidosis
A nurse is caring for a client who has streptococcal pneumonia and a prescription for penicillin G by intermittent IV bolus. 10 minutes into the infusion of the third dose, the client reports that the IV site itches and that he feels dizzy and short of breath. Which of the following actions should the nurse take first? A. Stop the infusion. B. Call the client's provider. C. Elevate the head of the bed. D. Auscultate the client's breath sounds.
A. Stop the infusion
A nurse is performing tracheostomy care for a client and suctioning to remove copious secretions. Which of the following actions should the nurse take? A. Suction two to three times with a 60-second pause between passes. B. Perform chest physiotherapy prior to suctioning. C. Lubricate the suction catheter tip with sterile saline. D. Hyperventilate the client on 100% oxygen prior to suctioning.
A. Suction two to three times with a 60-second pause between passes.
A nurse is reviewing the arterial blood gas (ABG) results of a client who the provider suspects has metabolic acidosis. Which of the following results should the nurse expect to see? A. pH below 7.35 B. HCO3 above 26 mEq/L C. PaO2 below 70 mm Hg D. PaCO2 above 45 mm Hg
A. pH below 7.35
When should osmotic diuretics be used?
Anuria/oliguria - Mannitol
A home health nurse visits a client who has COPD and receives oxygen at 2 L/min via nasal cannula. The client reports difficulty breathing. Which of the following actions is the nurse's priority? A. Increase the oxygen flow to 3 L/min. B. Assess the client's respiratory status. C. Call emergency services for the client. D. Have the client cough and expectorate secretions.
B. Assess the client's respiratory status.
A nurse on a medical-surgical unit is performing an admission assessment of a client who has COPD with emphysema. The client reports that he has a frequent productive cough and is short of breath. The nurse should anticipate which of the following assessment findings for this client? A. Respiratory alkalosis B. Increased anteroposterior diameter of the chest C. Oxygen saturation level 96% D. Petechiae on chest
B. Increased anteroposterior diameter of the chest RESPIRATORY ACIDOSIS (due to increased arterial CO2)
A nurse is collaborating on care for a client who has COPD. Which of the following tasks should the nurse recommend be referred to an occupational therapist for assistance? A. Instructing how to measure oxygen saturation B. Instructing how to use kitchen tools to prepare a meal C. Instruction how to plan a diet based on individual caloric needs D. Instructing how to perform pursed-lip breathing
B. Instructing how to use kitchen tools to prepare a meal
A nurse is providing teaching to a client who is postoperative following coronary artery bypass graft (CABG) surgery and is receiving opioid medications to manage discomfort. Aside from managing pain, which of the following desired effects of medications should the nurse identify as most important for the client's recovery? A. It decreases the client's level of anxiety. B. It facilitates the client's deep breathing. C. It enhances the client's ability to sleep. D. It reduces the client's blood pressure.
B. It facilitates the client's deep breathing.
A nurse is performing pulmonary hygiene for a client who has pneumonia and positions the client on his left side in Trendelenburg position. From which of the following lung segments should the nurse expect secretions to be mobilized with the client in this position? A. Lateral segment of the left lower lobe B. Lateral segment of the right lower lobe C. Posterior segment of the right middle lobe D. Posterior segment of the right lower lobe
B. Lateral segment of the right lower lobe
A nurse is assessing a client for hypoxemia during an asthma attack. Which of the following manifestations should the nurse expect? A. Nausea B. Dysphagia C. Agitation D. Hypotension
C. Agitation
A nurse is caring for a child who has a tracheostomy. After suctioning the tracheostomy, the nurse should use which of the following findings to determine that the procedure was effective? A. Increased respiratory rate B. Stable oxygen saturation C. Clear breath sounds D. Brisk capillary refill
C. Clear breath sounds
A nurse in a provider's office is assessing an older adult client whose son reports that the client has been sick with a respiratory illness for the past 6 days. Which of the following assessment findings is a manifestation of pneumonia in the older adult client? A. Bradycardia B. Night sweats C. Confusion D. Narrowed pulse pressure
C. Confusion
A nurse is caring for a client who has pneumonia. Which of the following actions should the nurse take to promote thinning of respiratory secretions? A. Encourage the client to ambulate frequently. B. Encourage coughing and deep breathing. C. Encourage the client to increase fluid intake. D. Encourage regular use of the incentive spirometer.
C. Encourage the client to increase fluid intake.
A nurse is caring for a client with a tracheostomy. The client's partner has been taught to perform suctioning. Which of the following actions by the partner should indicate to the nurse a readiness for the client's discharge? A. Attending a class given about tracheostomy care B. Verbalizing all steps in the procedure C. Performing the procedure independently D. Asking appropriate questions about suctioning
C. Performing the procedure independently
A client is planning to perform nasotracheal suction for a client who has COPD and an artificial airway. Which of the following actions should the nurse take? A. Perform suctioning for up to four passes. B. Apply suction to the catheter when advancing it into the trachea. C. Preoxygenate the client with 100% oxygen for up to 3 min. D. Limit each suction pass to 25 seconds.
C. Preoxygenate the client with 100% oxygen for up to 3 min.
A nurse is caring for a client who has a tracheostomy. Which of the following interventions should the nurse implement when performing tracheostomy care? A. Use aseptic technique. B. Clean the inner cannula with mild soap and water. C. Secure new tracheostomy ties before removing old ones. D. Apply suction when inserting the catheter.
C. Secure new tracheostomy ties before removing old ones.
What should be given for hyperkalemia?
Calcium gluconate
Intarenal AKI
Damaged within the nephron within the kidney - Could be any condition that produces an ischemic or toxic insult directly at the site of the nephron -Cause Acute Tubular Necrosis (ATN)
A nurse is assessing a client who has COPD. The nurse should expect the client's chest to be which of the following shapes? A. Pigeon B. Funnel C. Kyphotic D. Barrel
D. Barrel
A nurse in the emergency department is assessing an older adult client who has community- acquired pneumonia. Which of the following findings should the nurse expect? A. Unequal pupils B. Hypertension C. Tympany upon chest percussion D. Confusion
D. Confusion
A nurse is caring for a client who has chronic obstructive pulmonary disease (COPD). The client tells the nurse, "I can feel the congestion in my lungs, and I certainly cough a lot, but I can't seem to bring anything up." Which of the following actions should the nurse take to help this client with tenacious bronchial secretions? A. Maintaining a semi-Fowler's position as often as possible B. Administering oxygen via nasal cannula at 2 L/min C. Helping the client select a low-salt diet D. Encouraging the client to drink 2 to 3 L of water daily
D. Encouraging the client to drink 2 to 3 L of water daily
A nurse is developing a plan of care for a client who has COPD. The nurse should include which of the following interventions in the plan? A. Restrict the client's fluid intake to less than 2 L/day. B. Provide the client with a low-protein diet. C. Have the client use the early-morning hours for exercise and activity. D. Instruct the client to use pursed-lip breathing.
D. Instruct the client to use pursed-lip breathing.
A nurse is implementing a plan of care for a client who has AIDS with recurring pneumonia. Which of the following actions should the nurse take? A. Encourage fluid intake of 1500 mL/day. B. Position head of bed at 10 degrees. C. Cough and deep breathe every 8 hr. D. Obtain a sputum culture.
D. Obtain a sputum culture.
A nurse is auscultating the breath sounds of a client who has asthma. When the client exhales, the nurse hears continuous high-pitched squeaking sounds. The nurse should document this as which of the following adventitious breath sounds? A. Crackles B. Rhonchi C. Stridor D. Wheezes
D. Wheezes
Causes of metabolic acidosis?
DKA, acute/chronic kidney injury, malnutrition, severe diarrhea, UTI
Causes of metabolic alkalosis?
DKA, diarrhea, vomiting, diuretics
2.5% dextrose
HYPOTONIC treats intracellular dehydration such as DKA
respiratory acidosis causes
Drugs (opioids and sedatives) Edema (fluid in the lungs) Pneumonia (excess mucus in the lungs) Respiratory center of the brain is damaged Emboli (pulmonary) Spasms of the bronchial (asthma) Sac elasticity (COPD & Emphysema)
The nurse is caring for a client experiencing anaphylactic reaction. Which medications would the nurse potentially anticipate administering?
Epinephrine, Methylprednisolone, Diphenhydramine, Ranitidine
0.33% NS
HYPOTONIC never give to pts with burns or liver disease
5% dextrose in LR
HYPERTONIC replaces fluids for burns, bleeding, dehydration
5% dextrose in 0.45% saline
HYPERTONIC commonly used as maintenance fluid
D5NS
HYPERTONIC used when low levels of Na or Cl and for metabolic acidosis
0.45% NS
HYPOTONIC Helps kidneys excrete excess fluids
5% dextrose (D5W)
ISOTONIC replaces deficits of total body water - NOT used alone: dilution of electrolytes can occur
LR
ISOTONIC replaces fluids for burns, bleeding, dehydration
0.9% NS
ISOTONIC - helpful for sodium or chloride replacement - used with blood products
Metabolic alkalosis patho
Kidney problem Too much Bicarb, Too little hydrogen Lungs compensate and will retain CO2
metabolic acidosis patho
Kidney problem Too much Hydrogen, Too little BiCarb Lungs compensate and will blow off CO2
What to give first for fluid overload?
Loop diuretics (furosemide (Lasix), bumetanide, torsemide)
respiratory alkalosis patho
Lung problem Lungs losing too much CO2 Kidneys Compensate and excrete HCO3 and retain hydrogen
respiratory acidosis patho
Lung problem the lungs are retaining to much CO2 Kidneys compensate and excrete hydrogen and retain bicarb
Renin plays a role in blood pressure regulation by what process? a. Activation of the renin-angiotensin-aldosterone cascade. b. Suppression of angiotensin production. c. Decreasing of sodium reabsorption. d. Inhibition of aldosterone release.
a. Activation of the renin-angiotensin-aldosterone cascade.
A nurse is caring for a patient with hypovolemic shock. The patient has thready pulses and the nurse cannot hear the patients' blood pressure? a. Assess the blood pressure through palpation b. Obtain an electronic blood pressure c. Record "unable to obtain blood pressure" d. Estimate the blood pressure
a. Assess the blood pressure through palpation
What term describes increased BUN and serum creatine? a. Azotemia b. Acute kidney injury c. Oliguria d. Prerenal disease
a. Azotemia
The nurse is caring for a young adult patient admitted with shock. The nurse understands which assessment findings best assess tissue perfusion in a patient in shock? (Select all that apply.) a. Blood pressure b. Heart rate c. Level of consciousness d. Pupil response e. Respirations f. Urine output
a. Blood pressure c. Level of consciousness f. Urine output
The nurse is caring for a patient who is mechanically ventilated. The nurse understands that what statement should be considered when determining appropriate nursing interventions? a. Communication with intubated patients is often difficult. b. Controlled ventilation is the preferred mode for most patients. c. Patients with chronic obstructive pulmonary disease wean easily from mechanical ventilation. d. Wrist restraints are applied to all patients to avoid self-extubating.
a. Communication with intubated patients is often difficult.
The nurse is caring for a patient admitted with cardiogenic shock. Hemodynamic readings obtained with a pulmonary artery catheter include a pulmonary artery occlusion pressure(PAOP) of 18 mm Hg and a cardiac index (CI) of 1.0 L/min What is the priority pharmacological intervention? a. Dobutamine b. Furosemide c. Phenylephrine d. Sodium nitroprusside
a. Dobutamine
The nurse is caring for an 18-year-old athlete with a possible cervical spine (C5) injury following a diving accident. The nurse assesses a blood pressure of 70/50 mm Hg, heart rate of 45 beats/min, and respirations of 26 breaths/min. The patient's skin is warm and flushed. What is the best interpretation of these findings by the nurse? a. The patient is developing neurogenic shock. b. The patient is experiencing an allergic reaction. c. The patient most likely has an elevated temperature. d. The vital signs are normal for this patient.
a. The patient is developing neurogenic shock.
The patient has elevated blood urea nitrogen (BUN) and serum creatinine levels with a normal BUN/creatinine ratio. What do these levels most likely indicate? a. Increased nitrogen intake b. Acute kidney injury, such as acute tubular necrosis (ATN) c. Hypovolemia d. Fluid resuscitation
b. Acute kidney injury, such as acute tubular necrosis (ATN)
What is the most common intrarenal injury? a. Nephrotoxic substances b. Acute tubular necrosis c. Hypotension d. Ischemia
b. Acute tubular necrosis
Ten minutes following administration of an antibiotic, the nurse assesses a patient to have edematous lips, hoarseness, and expiratory stridor. Vital signs assessed by the nurse include blood pressure 70/40 mm Hg, heart rate 130 beats/min, and respirations 36 breaths/min. What is the priority intervention? a. Diphenhydramine 50 mg intravenously b. Epinephrine 3 to 5 mL of a 1:10,000 solution intravenously c. Methylprednisolone 125 mg intravenously d. Ranitidine 50 mg intravenously
b. Epinephrine 3 to 5 mL of a 1:10,000 solution intravenously
The patient has a temporary percutaneous catheter in place for treatment of acute kidney injury. The catheter has been in place for 5 days. What action should the nurse take? a. Prepare to assist with a routine dialysis catheter change to replace the existing catheter. b. Evaluate the patient for signs and symptoms of infection. c. Teach the patient that the catheter is designed for long-term use. d. Use one of the three lumens for fluid administration
b. Evaluate the patient for signs and symptoms of infection.
The nurse assesses a patient who is admitted for an overdose of sedatives. The nurse expects to find which acid-base alteration? a. Hyperventilation and respiratory acidosis b. Hypoventilation and respiratory acidosis c. Hypoventilation and respiratory alkalosis d. Respiratory acidosis and normal oxygen levels
b. Hypoventilation and respiratory acidosis
What is the treatment for an acute exacerbation of asthma? a. Corticosteroids and sedation b. Inhaled bronchodilators and intravenous corticosteroids c. Prone positioning d. Inhaled bronchodilators
b. Inhaled bronchodilators and intravenous corticosteroids
With sudden cessation of renal function, all body systems are affected by the inability to maintain fluid and electrolyte balance and eliminate metabolic waste. In critically ill patients, what statement regarding renal dysfunction is true? a. It is a very rare problem. b. It affects nearly two thirds of patients. c. It has a low mortality once renal replacement therapy has been initiated. d. It has little effect on morbidity, mortality, or quality of life
b. It affects nearly two thirds of patients.
A mode of pressure-targeted ventilation that provides positive pressure to decrease the workload of spontaneous breathing through what action by the endotracheal tube? a. Continuous positive airway pressure b. Positive end-expiratory pressure c. Pressure support ventilation d. T-piece adapter
b. Positive end-expiratory pressure
Which patient being cared for in the emergency department is most at risk for developing hypovolemic shock? a. A patient admitted with abdominal pain and an elevated white blood cell count b. A patient with a temperature of 102 F and a general dermal rash c. A patient with a 2-day history of nausea, vomiting, and diarrhea d. A patient with slight rectal bleeding from inflamed hemorrhoids
c. A patient with a 2-day history of nausea, vomiting, and diarrhea
The nurse caring for a patient with an endotracheal tube understands that endotracheal suctioning is needed to facilitate removal of secretions. What additional information is the nurse aware of concerning this intervention? a. It decreases intracranial pressure. b. It depresses the cough reflex. c. It is done as indicated by patient assessment. d. It is more effective if preceded by saline instillation to loosen secretions.
c. It is done as indicated by patient assessment.
A patient is admitted after collapsing at the end of a summer marathon. She is lethargic, with a heart rate of 110 beats/min, respiratory rate of 30 breaths/min, and a blood pressure of 78/46 mm Hg. The nurse anticipates administering which therapeutic intervention? a. Human albumin infusion b. Hypotonic saline solution c. Lactated Ringer's bolus d. Packed red blood cells
c. Lactated Ringer's bolus
A woman arrives in the emergency department after a marathon. Her vitals show: HR: 112/min, RR 32/min, BP: 76/48 mm Hg. Which nursing intervention should the nurse anticipate? a. Packed RBC infusion b. Hypotonic Saline Solution c. Lactated Ringers bolus d. Albumin infusion
c. Lactated Ringers bolus
The nurse is caring for a patient with acute respiratory distress syndrome who is hypoxemic despite mechanical ventilation. The primary care provider (PCP) orders a nontraditional ventilator mode as part of treatment. Despite sedation and analgesia, the patient remains restless and appears to be in discomfort. The nurse informs the PCP of this assessment and anticipates what order? a. Continuous lateral rotation therapy b. Guided imagery c. Neuromuscular blockade d. Prone positioning
c. Neuromuscular blockade
A patient presents to the emergency department in acute respiratory failure secondary to community-acquired pneumonia. The patient has a history of chronic obstructive pulmonary disease. The nurse anticipates which treatment to facilitate ventilation? a. Emergency tracheostomy and mechanical ventilation b. Mechanical ventilation via an endotracheal tube c. Noninvasive positive-pressure ventilation (NPPV) d. Oxygen at 100% via bag-valve-mask device
c. Noninvasive positive-pressure ventilation (NPPV)
A mode of pressure-targeted ventilation that provides positive pressure to decrease the workload of spontaneous breathing through what action by the endotracheal tube? a. Continuous positive airway pressure b. Positive end-expiratory pressure c. Pressure support ventilation d. T-piece adapter
c. Pressure support ventilation
A 10 year old patient was hit in the left flank by an incoming pitch during a baseball game. What would be concerning to see on his Urinalysis results? a. Sodium levels in the urine b. Glucose in the urine c. Red blood cells and aluminum in the urine d. Creatine levels similar to blood creatine
c. Red blood cells and aluminum in the urine
What is an early sign of hypoxemia? a. Clubbing of nail beds b. Hypotension c. Restlessness d. Hypotension
c. Restlessness
What is a normal urine output? a. 80 to 125mls/min b. 180 L/day c. 80mls/min d. 1 to 2 L/day
d. 1 to 2 L/day
How could a nurse evaluate the effectiveness of intravenous fluids? a. Blood Pressure b. Oral Temperature and capillary refills c. Breath sounds d. Atrial pressure and urine output
d. Atrial pressure and urine output
The nurse is caring for a patient admitted with severe sepsis. Vital signs assessed by the nurse include blood pressure 80/50 mm Hg, heart rate 120 beats/min, respirations 28 breaths/min, oral temperature of 102q F, and a right atrial pressure (RAP) of 1 mm Hg. Assuming physician orders, which intervention should the nurse carry out first? a. Acetaminophen suppository b. Blood cultures from two sites c. IV antibiotic administration d. Isotonic fluid challenge
d. Isotonic fluid challenge
The nurse caring for a patient diagnosed with acute respiratory failure identifies "Risk for Ineffective Airway Clearance" as a nursing diagnosis. What nursing intervention is relevant to this diagnosis? a. Elevate head of bed to 30 degrees. b. Obtain order for venous thromboembolism prophylaxis. c. Provide adequate sedation. d. Reposition patient every 2 hours.
d. Reposition patient every 2 hours.
The primary care provider orders the following mechanical ventilation settings for a patient who weighs 75 kg and whose spontaneous respiratory rate is 22 breaths/min. What arterial blood gas abnormality may occur if the patient continues to be tachypneic at these ventilator settings? Settings: Tidal volume: 600 mL (8 mL per kg) FiO2: 0.5 Respiratory rate: 14 breaths/min Mode assist/control Positive end-expiratory pressure: 10 cm H2O a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis
d. Respiratory alkalosis
What is the most common cause of AKI in critically ill patients? a. Fluid overload b. Medications c. Hemodynamic instability d. Sepsis
d. Sepsis
A patient is admitted to the critical care unit following coronary artery bypass surgery. Two hours postoperatively, the nurse assesses the following information: pulse is 120 beats/min; blood pressure is 70/50 mm Hg; pulmonary artery diastolic pressure is 2 mm Hg; cardiac output is 4 L/min; urine output is 250 mL/hr; chest drainage is 200 mL/hr. What is the best interpretation by the nurse? a. The assessed values are within normal limits. b. The patient is at risk for developing cardiogenic shock. c. The patient is at risk for developing fluid volume overload. d. The patient is at risk for developing hypovolemic shock
d. The patient is at risk for developing hypovolemic shock
The removal of plasma water and some low-molecular weight particles by using a pressure or osmotic gradient is identified by what term? a. Dialysis b. Diffusion c. Clearance d. Ultrafiltration
d. Ultrafiltration
A patient presents to the emergency department demonstrating agitation and reporting numbness and tingling in the fingers. Arterial blood gas levels reveal the following: pH 7.51, PaCO2 25, HCO3 25. How should the nurse interprets these blood gas values? a. Compensated metabolic alkalosis b. Normal values c. Uncompensated respiratory acidosis d. Uncompensated respiratory alkalosis
d. Uncompensated respiratory alkalosis
The nurse is caring for a patient admitted with the early stages of septic shock. The nurse assesses the patient to be tachypneic, with a respiratory rate of 32 breaths/min. Arterial blood gas values assessed on admission are pH 7.50, CO2 28 mm Hg, HCO3 26. Which diagnostic study result reviewed by the nurse indicates progression of the shock state? a. pH 7.40, CO2 40, HCO3 24 b. pH 7.45, CO2 45, HCO3 26 c. pH 7.35, CO2 40, HCO3 22 d. pH 7.30, CO2 45, HCO3 18
d. pH 7.30, CO2 45, HCO3 18
risk factors for the development of hyperglycemia in the critically ill patient include
diabetes, increased cortisol, obesity
intrarenal AKI
failure of nephrons
In acute respiratory distress syndrome, symptoms that are included in the initial phase include
hyperventilation with respiratory alkalosis and fine crackles in lungs
expected responses of a patient experiencing s/s of neurogenic shock
hypotension and bradycardia
fluids/products that may be used to replace major blood loss in a patient in shock include
isotonic fluids, platelets, packed RBCs, fresh frozen plasma
postrenal AKI
obstruction of outflow
Metabolic alkalosis causes
too many antacids, diuretics, excess vomiting, hyperaldosteronism