Nurse 4705 EXAM 3 (FINAL CLASS EXAM EVER!!!!)

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*A patient with an ectopic pregnancy that is hemodynamically stable is a level _____ ?*

2 (Vital Signs, Risk of Bleeding from ectopic pregnancy)

The gaol of vasopressor therapy is to get the MAP above _____ ?

65 mm Hg

Diabetes puts at higher risk for sepsis? A. True B. False

A. True

ACUTE CORONARY SYNDROME

Changes in _____ is a strong indicator of sepsis?

LOC

*Nitrates are contraindicated for use with these drugs?*

Phosphodiesterase inhibitors: Sildenafil (Viagra), alcohol or other antihypertensive medications

The *right coronary artery* (RCA) supplies the ______ ?

Right Atrium, Right ventricle and Posterior surface of the Left Ventricle + SA node AND AV bundle

The preferred biomarker for ACS?

TROPONIN

You are rapidly infusing normal saline, which action is most important? 1. Palpate peripheral edema 2.Monitor urine output 3. Listen to lung sounds 4. Check for jugular venous distention

*3. Listen to lung sounds*

The iceberg effect is seen with _________ burns?

electrical

ATI: A nurse working in a provider's office is assessing a client who has a severe sunburn. Which of the following is the proper classification of this burn? A. Superficial B. Superficial partial-thickness C. Deep partial-thickness D. Full-thickness

*A. Superficial* A sunburn is a super cial burn. Super cial burns damage the top layer of the skin.

A nurse is preparing to administer fentanyl (Sublimaze) to a client who was admitted 24 hr ago with deep partial-thickness and full-thickness burns over 60% of his body. The nurse should plan to use which of the following routes to administer the medication? A. Subcutaneous B. Intramuscular C. Intravenous D. Transdermal

*C. Intravenous*

The patient sustained a full-thickness burn encompassing the entire right arm. What is the best indicator an *escharotomy* achieved its desired effect? A. Patient rates the pain at less than 4. B. Blood pressure remains above 120/80 mm Hg. C. Right fingers blanch with a 2-second refill. D. Patient maintains full range of motion for the right arm.

*C. Right fingers blanch with a 2-second refill.* Circulation to the extremities can be severely impaired by deep circumferential burns and subsequent edema that impairs the blood supply. *An escharotomy (electrocautery incision through the full-thickness eschar) is performed to restore circulation.* Normal refill is less than 2 seconds.

The patient walks to the emergency department in clothing saturated with alkali solution after a can of drain cleaner exploded at home a few minutes earlier. *What nursing action is most important?* A. Assess the patient's lungs. B. Administer a tetanus immunization. C. Wash the skin with copious amounts of water. D. Obtain a set of vital signs.

*C. Wash the skin with copious amounts of water.*

The patient's skin has been exposed to nitrogen mustard. What action should you take first? A. Perform copious irrigation with water. B. Place the patient in isolation. C. Administer the antidote, atropine (AtroPen). D. Brush the substance off the skin.

*D. Brush the substance off the skin.*

What is included in a primary survey at the scene of an emergency? A. Pulse oximetry B. Electrocardiogram C. Indwelling bladder catheter D. Cervical immobilization

*D. Cervical immobilization* *Primary=ABCDE* Out-of-hospital, a cervical immobilization device or head blocks are applied as part of the primary survey. The other options are included in the secondary survey. Reference: 1767

The patient is diagnosed with heatstroke with a temperature 105.8° F (41° C). You are instituting cooling measures. What is most important for you to do? A. Administer acetaminophen (Tylenol). B. Continue measures until the temperature is 99° F (37.2° C). C. Monitor glucose hourly. D. Control shivering.

*D. Control shivering.* You are responsible for closely monitoring the patient's temperature and for controlling shivering. Shivering increases core temperature (heat is generated by muscle activity) and complicates cooling efforts. If necessary, intravenous *chlorpromazine (Thorazine)* is used to control shivering. Antipyretics are not effective because the elevated temperature is not related to infection. Aggressive cooling continues until core temperature 102° F (38.9° C). It is not essential to monitor glucose this frequently.

Which is an example of distributive shock? A. Myocardial infarction B. Traumatic hemorrhage C. Bowel obstruction D. T3 spinal cord injury

*D. T3 spinal cord injury* A myocardial infarction causes cardiogenic shock, and hemorrhage and bowel obstruction cause hypovolemic shock. *Distributive shock includes: Neurogenic shock, Anaphylactic shock and Septic shock* and results from *massive vasodilation.* Cariogenic shock is not distributive!

The patient is receiving aggressive fluid resuscitation. Which is the best indicator that the patient's cardiac output is adequate? A. Systolic blood pressure B. Blood urea nitrogen (BUN) level C. Sodium (Na+) serum level D. Urine output

*D. Urine output* Although blood pressure helps to determine whether the patient's cardiac output is adequate, an *assessment of end-organ perfusion* (e.g., urine output, neurologic function, peripheral pulses) provides more relevant information regarding the adequacy of the cardiac output.

*What do you do during secondary survey G?*

*Give comfort measures*

*What is done during secondary survey H?*

*Head-to-Toe assessment to look for type of injury and history*

Decision point C is _______ ?

*How many resources will they use* (scans, fluids, medications IV, IM, NEBS, consultations, simple procedure, complex procedure).

The *circumflex* (CX) coronary artery supplies the ________ ?

*Left Atrium* and Lateral, Inferior and Posterior surface of the *Left Ventricle*

Know the components of the primary and secondary survey.

*Primary* survey focuses on airway, breathing, circulation, and disability, exposure (ABCDE) *Secondary* survey is a brief, systematic process to identify all injuries

Rabies post-exposure prophylaxis involves an initial injection of _______ followed by five injections of ______ on days 0, 3, 7, 14, 28?

*Rabies Immune Globulin (RIG), Human Diploid Cell Vaccine (HDCV [Rabavert])*

The 3 coronary arteries are the _____ , _____ and _______?

*Right, Left anterior descending and Circumflex*

Sepsis is the number one cause of death in hospitals? A. True B. False

*True*

HOW IS CHRONIC STABLE ANGINA DIFFERENT FROM UNSTABLE ANGINA?

*UNSTABLE*-pain does not resolve with rest or nitroglycerin. Pattern, onset duration unpredictable. *CHRONIC STABLE*-pain is precipitated by activity. Pattern, onset, duration, etc. predictable.

*For the following ingested poisons, identify all those for which gastric lavage may be considered.* a. Aspirin b. Lorazepam (Ativan) c. Iron supplements d. Bleach e. Acetaminophen (Tylenol) f. Drain cleaner

*a. Aspirin* *b. Lorazepam (Ativan)* *c. Iron supplements* *d. Bleach* Patients who ingest caustic agents , co-ingest sharp objects or ingest non-toxic substances should not receive lavage

Nasotracheal or endotracheal intubation is instituted in burn patients who have? a. electrical burns causing cardiac dysrhythmias. b. thermal burn injuries to the face, neck, or airway. c. respiratory distress resulting from eschar formation around the chest. d. symptoms of hypoxia as a result of carbon monoxide poisoning.

*b. thermal burn injuries to the face, neck, or airway.*

To maintain a positive nitrogen balance in a major burn, the patient must? a.increase normal caloric intake by about 3 times. b.eat a high-protein, low-fat, high-carbohydrate diet. c.eat at least 1500 calories per day in small, frequent meals. d.eat rice and whole wheat for the chemical effect on nitrogen balance.

*b.eat a high-protein, low-fat, high-carbohydrate diet.*

When a patient reports chest pain, unstable angina must be identified and treated because? a. the pain may be severe and disabling. b. ECG changes and dysrhythmias may occur during an attack. c. atherosclerotic plaque deterioration may cause complete thrombus of the vessel lumen. d. the spasm of a major coronary artery may cause total occlusion of the vessel with progression to MI.

*c. atherosclerotic plaque deterioration may cause complete thrombus of the vessel lumen.*

*What is the goal of the Surviving Sepsis Campaign?*

A global initiative with a GOAL *to improve the treatment of sepsis and reduce the mortality rates associated with it*. Teamed up with the IHI and created sepsis resuscitation bundles.

How would you administer the Lactated Ringers for a patient in anaphylactic shock?

As rapidly as possible by a pressure pump. The patient's fluid is not in the vasculature and fluid replacement is needed.

A nurse is caring for a client who has ingested a toxic agent. Which of the following actions should the nurse plan to take? (Select all that apply.) A. Induce vomiting. B. Instill activated charcoal. C. Perform a gastric lavage with aspiration. D. Administer syrup of ipecac. E. Complete a whole-bowel irrigation.

B, C, E

A nurse in the emergency department is caring for a client who has an allergic reaction to a bee sting. The client is experiencing wheezing and swelling of the tongue. Which of the following medications should the nurse expect to administer first? A. Methylprednisolone (Solu-Medrol) IV bolus B. Diphenhydramine (Benadryl) subcutaneously C. Epinephrine (Adrenaline) IV D. Albuterol (Proventil) inhaler

C. Epinephrine (Adrenaline) IV Using the airway-breathing-circulation (ABC) priority-setting framework, epinephrine is administered first. It is a rapid-acting medication that promotes effective oxygenation and is used to treat anaphylactic shock. *It causes broncho-dilation and vasocontriction*

The patient is brought to the emergency department after an explosion at a chemical plant. The patient's clothes and skin are wet with a chemical substance. You notice that the patient is breathing at a rate of 24 breaths/minute. What action should you take *first*? A. Administer oxygen. B. Auscultate the lungs. C. Perform copious skin irrigation. D. Obtain vital signs including oxygen saturation.

C. Perform copious skin irrigation.

The runner reports nausea, weakness, and cramps after completing a 5-km race today. You find a heart rate of 110 beats/minute and diaphoresis. What intervention should you initiate? A. Cover patient with a wet sheet. B. Obtain a temperature. C. Provide fluids. D. Assess for rhabdomyolysis.

C. Provide fluids Heat cramps are severe cramps in large muscle groups fatigued by heavy work. Nausea, tachycardia, pallor, weakness, and profuse diaphoresis are often present. The condition is seen most often in healthy, acclimated athletes. Cramps resolve with rest and sodium and water replacement. Covering the patient with a wet sheet and assessing for rhabdomyolysis are measures used with heat exhaustion and heatstroke. Enough symptoms are evident to initiate treatment, which is more important that further assessment. Reference: 1773

For what is percutaneous coronary intervention (PCI) most clearly indicated? A. Chronic stable angina B. Left-sided heart failure C. Coronary artery disease (CAD) D. Acute MI

D. Acute MI

What is the continuum of sepsis?

Infection->SIRS->Sepsis->Severe Sepsis->Septic Shock

What does MONA stand for?

Morphine, Oxygen, Nitroglycerin, Aspirin (MONA)

The response of the immune system to a burn injury includes? a. bone marrow stimulation. b. impaired function of WBCs. c. an increase in immunoglobulin levels. d. becoming overwhelmed by microorganisms entering denuded tissue.

b. impaired function of WBCs. INFECTION!

b. thermal burn injuries to the face, neck, or airway.

A patient's deep partial-thickness burns are treated with the *open method*. When caring for the patient, the nurse? a. ensures that sterile water is used in the debridement tank. b. wears a cap, mask, gown, and gloves during patient contact. c. uses sterile gloves to remove the dressings and wash the wounds. d. applies topical antimicrobial ointment with clean gloves to prevent wound trauma.

b. wears a cap, mask, gown, and gloves during patient contact.

Women experiencing ACS or an MI tend to have pain in the ______ rather than _______ ?

back, substernally

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A patient is admitted to the emergency department with a diagnosis of STEMI. Which action is the *nurse's priority*? A. Having the patient chew a 325-mg aspirin. B. Administering meperidine (Demerol) for pain relief. C. Giving verapamil (Calan) to lower blood pressure. D. Preparing an insulin drip to manage complications.

*A. Having the patient chew a 325-mg aspirin.*

You are rapidly infusing normal saline, which action is most important in evaluating for an adverse reaction to rapid fluid infusion? 1. Palpate Ms. D for any peripheral edema 2. Monitor Ms. D's urine output 3. Listen to Ms. D's lung sounds 4. Check Ms. D for jugular venous distention

3. Listen to Ms. D's lung sounds

Blood pressure 86/40 Heart rate 112 beats/min O2 saturation 93% Respiratory rate 32 per min Temperature 103 F (39.4 C) axillary Which information in your assessment requires the most immediate action? 1. Elevated temperature 2. Left lung crackles 3. Nonpalpable pulses 4. Low blood pressure

4. Low blood pressure

When taking nitrates you take 1 tablet sublingual. If chest pain doesn't improve after ___ minutes call 9-11. IF chest pain does improve repeat every ___minutes for a total of ___doses?

5 minutes, 5 minutes, 3 (doses)

What intervention is of *primary importance* in a patient with septic shock? A. Obtain an electrocardiogram (ECG). B. Start two 14-gauge intravenous (IV) access lines. C. Administer norepinephrine (Levophed). D. Measure the mean arterial pressure (MAP).

B. Start two 14-gauge intravenous (IV) access lines.

When caring for a patient in acute septic shock, you would anticipate A. administering osmotic and/or loop diuretics. B. administering intravenous diphenhydramine (Benadryl). C. assisting with insertion of a ventricular assist device (VAD). D. infusing large amounts of intravenous (IV) fluids.

D. infusing large amounts of intravenous (IV) fluids.

During the rehabilitation phase of a burn injury, the contour of scarring can be controlled with? a. pressure garments. b. avoidance of sunlight. c. splinting joints in extension. d. application of emollient lotion

a. pressure garments. Pressure garments help keep scars flat and prevent elevation and enlargement above the original burn injury area. Lotions and splinting are used to prevent contractures. Avoidance of sun is necessary for 1 year to prevent hyperpigmentation and sunburn injury to healed burn areas.

136.3 million were seen in the ED in 2011. 27 percent are seen in the first 15 minutes? A. True B. False

True

The three conditions that are included as manifestations of acute coronary syndrome are ________, _________and _______________ ?

UA, STEMI and NSTEMI

The patient arrives at the emergency department with full-thickness burns over the entire chest and back. *What is the patient's priority need?* A. Fluid resuscitation B. Intravenous (IV) antibiotics C. Tetanus immunization D. Intramuscular (IM) analgesic

*A. Fluid resuscitation* Hypovolemic shock is a risk

What offers the most benefit for emergency department patients who present with a nontraumatic, out-of-hospital cardiac arrest followed by the return of circulation? A. Hypothermia B. Hyperventilation C. Pericardial thump D. Intracardiac medications

A. Hypothermia

What are the components of the primary survey in ED nursing?

ABCDE-Airway, Breathing, Circulation, Disability, Exposure

The patient with ACS had balloon angioplasty and a drug-eluding stent placed. What is required nursing care in the first 6 hours after the procedure (select all that apply)? A. Assess the pedal pulse in the affected leg. B. Ambulate the patient to prevent thrombus. C. Provide oxygen by mask. D. Administer a glycoprotein IIb/IIIa inhibitor. E. Regularly obtain vital signs.

ADE Neurovascular assessments are performed in the affected leg, a IIb/IIIa inhibitor is given to prevent abrupt closure of the stented vessel, and regularly obtained vital signs help monitor cardiac function. The patient is kept on bed rest with an extended leg and a pressure dressing on the insertion site. Oxygen, if needed, usually is administered in lower concentrations by nasal cannula.

A nurse is caring for a client who has sustained burns to 35% of his total body surface area. Of this total, 20% are full-thickness burns on the arms, face, neck, and shoulders. The client's voice is hoarse, and he has a brassy cough. These findings are indicative of which of the following? A. Pulmonary edema B. Bacterial pneumonia C. Inhalation injury D. Carbon monoxide poisoning

C. Inhalation injury

Knowing the most common causes of household fires, which of the following prevention strategies would the nurse focus on when teaching about fire safety? a. Set hot water temperature at 140° F (60° C). b. Use only hardwired smoke detectors. c. Encourage regular home fire exit drills. d. Never permit older adults to cook unattended.

c. Encourage regular home fire exit drills.

During treatment with tissue plasminogen activator (tPA) for a patient with a STEMI, the nurse is most concerned on finding? a. BP of 102/60 with an HR of 78. b. oozing of blood from the IV site. c. a decrease in the responsiveness of the patient. d. the presence of intermittent accelerated idioventricular dysrhythmias.

c. a decrease in the responsiveness of the patient.

A burn patient has a nursing diagnosis of impaired physical mobility related to a limited range of motion (ROM) resulting from pain. An appropriate nursing intervention for this patient is to? a. have the patient perform ROM exercises when pain is not present. b. teach the patient the importance of exercise to prevent contractures. c. provide analgesic medications before physical activity and exercise. d. arrange for the physical therapist to encourage exercise during hydrotherapy.

c. provide analgesic medications before physical activity and exercise. The limited range of motion in this situation is related to the patient's inability or reluctance to exercise the joints because of pain, and the appropriate intervention is to help control the pain so that exercises can be performed. The patient is probably never without some pain, and although exercises and enlisting the help of the physical therapist are important, neither of these interventions addresses the cause.

Which method of oxygen administration will be best to increase Ms. D's oxygen saturation? 1. Nasal cannula 2. Nonrebreather mask 3. Venturi mask 4. Simple face mask

*2. Nonrebreather mask* 100% O2

Blood pressure 102/38 mm Hg Heart rate 102 beats/ min O2 saturation 76% Respiratory rate 40 per min Temperature 102.4 F (39.1 C) orally Based on the initial history and assessment, which physician order will you *implement first*? 1. Insert a Foley catheter and send a urine specimen for culture and sensitivity testing. 2. Start oxygen and titrate to maintain oxygen saturation at 90% or higher. 3. Place the patient on a cardiac monitor. 4. Check the blood glucose level.

*2. Start oxygen and titrate to maintain oxygen saturation at 90% or higher.*

What causes ACS?

*A thrombus forms when a plaque is disrupted, causing platelet aggregation and ischemia of heart tissue*

An 18-year-old male who fell through the ice on a pond near his farm was admitted to the emergency department with signs and symptoms of severe hypothermia. The nurse should anticipate which of the following interventions? A. Active core rewarming B. Immersion in a hot bath C. Rehydration and massage D. Passive external rewarming

*A. Active core rewarming* Active core rewarming involves the application of heat directly to the core and is indicated for severe hypothermia. Passive rewarming is used in mild hypothermia. Immersion in a hot bath, rehydration, and massage are not appropriate interventions in the treatment of severe hypothermia.

An 18-year-old man who fell through the ice on a pond near his farm was admitted to the emergency department with signs and symptoms of severe hypothermia. You anticipate which intervention? A. Active core rewarming B. Immersion in a hot bath C. Rehydration and massage D. Passive external rewarming Rationale

*A. Active core rewarming* Active core rewarming involves the application of heat directly to the core with warm IV fluids, and it is indicated for severe hypothermia. *This prevents afterdrop.* Passive rewarming is used in mild hypothermia. Immersion in a hot bath, rehydration, and massage are not appropriate interventions in the treatment of severe hypothermia

What is the main risk of rewarming procedures? A. Afterdrop B. Hyperthermia C. Metabolic alkalosis D. Reflexive vasoconstriction

*A. Afterdrop* The risk is afterdrop, a further drop in core temperature. This occurs when cold peripheral blood returns to the central circulation. Because rewarming shock can produce hypotension and dysrhythmias, the core should be rewarmed before the extremities. Metabolic acidosis and reflexive vasoconstriction are additional consequences of hypothermia.

The patient has sepsis. What is most important to prevent the patient from progressing to MODS? A. Aggressive intravenous (IV) fluid resuscitation B. Delivery of supplemental oxygen via a nasal cannula C. Administration of an IV inotrope D. Administration of an IV β-adrenergic blocker

*A. Aggressive intravenous (IV) fluid resuscitation* Aggressive fluid resuscitation and antibiotics are necessary for SIRS and sepsis to prevent MODS, because restoring adequate circulation at a cellular level is essential. More aggressive oxygen therapy is needed. IV inotropes and β-adrenergic blockers are used for patients with cardiogenic shock.

Which of the following assessment parameters will the nurse address during the secondary assessment of a patient in triage? A. Blood pressure and heart rate B. Patency of the patient's airway C. Neurologic status and level of consciousness D. Presence or absence of breath sound and quality of breathing

*A. Blood pressure and heart rate* Vital signs are considered to be a part of the secondary assessment in the triage process. Airway, breathing, and a brief neurologic assessment are components of the primary survey.

What is a classic sign of unstable angina and coronary artery disease (CAD) in *women*? A. Fatigue B. Hypotension C. Atrial fibrillation D. Headache

*A. Fatigue* Common symptoms that women experience are fatigue (most prominent symptom), shortness of breath, indigestion, and anxiety.

*A. Fluid resuscitation*

A patient is admitted to the emergency department with a diagnosis of STEMI. Which action is the nurse's priority? A. Having the patient chew a 325-mg aspirin. B. Administering meperidine (Demerol) for pain relief. C. Giving verapamil (Calan) to lower blood pressure. D. Preparing an insulin drip to manage complications.

*A. Having the patient chew a 325-mg aspirin.* In this situation, the nurse's top priority is to have the patient chew a 325-mg aspirin. Several other nursing actions also are important in patients with STEMI, including oxygen administration, morphine for pain relief and venodilation, beta blockers and nitroglycerin to improve hemodynamics, and reperfusion therapy by means of percutaneous intervention or fibrinolytics. Meperidine would not be an analgesic of choice. Verapamil is a calcium channel blocker, and these drugs are no longer considered beneficial in patients with STEMI. Most agents used for STEMI do not cause hyperglycemia; therefore, an insulin drip is not indicated.

Which is a sign of the *compensatory stage* of shock? A. Increased respiratory rate B. Warm, flushed skin C. Anasarca D. Metabolic acidosis

*A. Increased respiratory rate*

One of the strongest indicators in terms of labs for sepsis and septic shock is? A. Lactate > 2 mmol/L B. Platelets <100,000 C. Creatnine > 2 mg/dL D. Bilirubin > 2 mg/dL

*A. Lactate > 2 mmol/L*

Isosorbide mononitrate (Imdur) and Isosorbide denitrate (Isordil) are ______ forms of long-acting Nitrates? A. Oral B. Transdermal C. IV D. Sublingual

*A. Oral* (Isosorbide mono*nitrate*) Others: Transdermal is Nitro-Dur Sublingual is Nitrostat (Short-acting) IV form is Tridil (Short-acting)

Which situation would be appropriate for the administration of activated charcoal? A. Overdose of digitalis (Digoxin) taken 30 minutes earlier B. Severe alcohol poisoning C. Acetaminophen (Tylenol) overdose with N-acetylcysteine (Mucomyst) D. Consumption of an alkaline substance

*A. Overdose of digitalis (Digoxin) taken 30 minutes earlier* The most common and effective intervention is activated charcoal given within 1 hour of poison ingestion. Many toxins adhere to the charcoal and pass through the gastrointestinal tract rather than being absorbed into the circulation. *Activated charcoal does not absorb ethanol, hydrocarbons, alkali, iron, boric acid, lithium, methanol, or cyanide.* It does absorb and neutralize antidotes. When Mucomyst is used for acetaminophen (Tylenol) toxicity, it should not be given immediately before, with, or shortly after charcoal.

*When planning emergent care for a patient with a suspected MI, the nurse will anticipate administration of?* A. Oxygen, nitroglycerin, aspirin, and morphine. B. Oxygen, furosemide (Lasix), nitroglycerin, and meperidine. C. Aspirin, nitroprusside (Nipride), dopamine (Intropin), and oxygen. D. Nitroglycerin, lorazepam (Ativan), oxygen, and warfarin (Coumadin).

*A. Oxygen, nitroglycerin, aspirin, and morphine. * *MONA* The American Heart Association's guidelines for emergency care of the patient with chest pain include the administration of oxygen, nitroglycerin, aspirin, and morphine. These interventions serve to relieve chest pain, improve oxygenation, decrease myocardial workload, and prevent further platelet aggregation.

A fibrinolytic agent is administered in the emergency department to the patient diagnosed with an acute myocardial infarction (MI). Which is the best indicator that the drug has achieved its therapeutic effect? A. Return of ST segment to baseline on the ECG B. Early, rapid decline in the CK-MB enzyme levels C. Increase in the prothrombin time, international normalized ratio, and partial thromboplastin time laboratory values D. Vital signs within normal range

*A. Return of ST segment to baseline on the ECG*

*Why is the number of cases of sepsis and septic shock increasing?* (LECTURE)

*Antibiotic Resistant Bacteria* (most cases of sepsis caused by bacteria-endotoxins cause the inflammatory response)

After teaching a patient with chronic stable angina about nitroglycerin, you recognize the need for further teaching when the patient states the following: A. "I will replace my nitroglycerin supply every 6 months." B. "I can take up to five tablets every 3 minutes for relief of my chest pain." C. "I will take acetaminophen (Tylenol) to treat the headache caused by nitroglycerin." D. "I will take the nitroglycerin 10 minutes before planned activity that usually causes chest pain."

*B. "I can take up to five tablets every 3 minutes for relief of my chest pain."* Its good to know you need to replace every 6 months. The recommended dose of nitroglycerin is one tablet taken sublingually (SL) or one metered spray for symptoms of angina. If symptoms are unchanged or worse after 5 minutes, the patient should be instructed to activate the EMS system. If symptoms improve dramatically its up to 3 tablets every 5 minutes NOT 5 every 3. Lewis, 775

*Which of the following is correct?* A. the circumflex artery is a branch of the right coronary artery. B. A branch of the right coronary artery supplies the right atrium and right ventricle C. The major branches of the right coronary artery are the septal and diagonal arteries D. The left main coronary artery is another name for the left anterior descending artery

*B. A branch of the right coronary artery supplies the right atrium and right ventricle* A-Left D-The LAD artery is a branch of the Left Main Coronary Artery, along with the Circumflex artery

A patient's localized infection has progressed to the point where septic shock is now suspected. Which of the following is an appropriate treatment modality for this patient? A. Insulin infusion B. Aggressive fluid resuscitation C. Intravenous administration of epinephrine D. Administration of nitrates and β-adrenergic blockers

*B. Aggressive fluid resuscitation* Patients in septic shock require large amounts of fluid replacement. Nitrates and β-adrenergic blockers are most often used in the treatment of patients in cardiogenic shock. Epinephrine is indicated in anaphylactic shock, and insulin infusion is not normally necessary in the treatment of septic shock (but can be).

Which patient should be triaged first and proceed to definitive care? A. Soft audible wheezing, speaks in sentences B. Gross hemorrhaging, pulse 140 beats/minute C. Partial-thickness forearm burn, pain rated 8/10 D. Lower extremity open fracture, positive pedal pulse

*B. Gross hemorrhaging, pulse 140 beats/minute* The triage process ranks patients according to who is most unstable or critical. In the primary survey, the patient with hemorrhaging and signs of shock is more hemodynamically unstable than the patient who can speak in sentences despite audible wheezing. The patients with forearm pain and a lower extremity facture are more stable and can wait for care. Reference: 1767

A patient is admitted to the emergency department complaining of chest pain, and the ECG shows an evolving STEMI. What should the nurse anticipate? A. Administering 400 mg of ibuprofen. B. Having the patient chew 4 baby aspirin. C. Administering an ACE inhibitor within 1 hour of the onset of chest pain D. Providing oxygen by nasal cannula to achieve an arterial oxygen saturation of 94%.

*B. Having the patient chew 4 baby aspirin.* The first dose of aspirin (162 to 325 mg) should be given immediately after the onset of symptoms or as soon as possible. Each baby aspirin (81 mg) should be chewed to allow rapid absorption across the buccal mucosa. Nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen, are avoided, because they increase the risk of mortality, reinfarction, hypertension, heart failure, and myocardial rupture. Current guidelines recommend administration of oxygen by nasal cannula only if the arterial oxygen saturation is below 90%. Treatment with ACE inhibitors should begin within 24 hours of symptom onset.

Which statement is true regarding multiple organ dysfunction syndrome (MODS)? A. Drotrecogin Alfa (Xigris) is given to prevent MODS. B. It is the failure of two or more organ systems. C. The renal system is usually the first system to fail. D. MODS causes septic shock.

*B. It is the failure of two or more organ systems.* MODS results from SIRS and is the failure of two or more organ systems. They fail because homeostasis cannot be maintained without intervention. The respiratory system is often the first system to show signs of dysfunction in SIRS and MODS. Xigris is a human activated protein C and given only to those at high risk for death, as indicated by an Apache II score greater than 25. The respiratory system usually shows symptoms first. Septic shock and many other disorders can cause MODS

*The patient was accidentally bitten by her house cat while trying to feed it. The cat has had regular care by a veterinarian. What is a main concern for nursing care?* A. Have the wound sutured within 6 hours B. Monitor for infection by Pasteurella species C. Provide rabies prophylaxis D. Teach about delayed neuropathies

*B. Monitor for infection by Pasteurella species* *The most common infectious organisms isolated from dog and cat bites are Pasteurella species*. Most healthy cats and dogs carry this organism in their mouths. Bites are often not sutured. *The danger of a cat bite is a puncture wound that is deep, possibly in the joint*. Rabies is a concern if the bite was not provoked and involved a wild animal or an unvaccinated domestic animal. Rabies postexposure prophylaxis is done when the animal is not found or a carnivorous wild animal causes the bite. Because her house cat had regular care, rabies is not a concern. Delayed neuropathies are an issue with Lyme disease (hard tick bite).

A nurse is caring for a patient with second- and third-degree burns to 50% of the body. The nurse prepares fluid resuscitation based on knowledge of the Parkland (Baxter) formula that includes which of the following recommendations? A. The total 24-hour fluid requirement should be administered in the first 8 hours. B. One half of the total 24-hour fluid requirement should be administered in the first 8 hours. C. One third of the total 24-hour fluid requirement should be administered in the first 4 hours. D. One half of the total 24-hour fluid requirement should be administered in the first 4 hours.

*B. One half of the total 24-hour fluid requirement should be administered in the first 8 hours.* Fluid resuscitation with the Parkland (Baxter) formula recommends that one half of the total fluid requirement should be administered in the first 8 hours, one quarter of total fluid requirement should be administered in the second 8 hours, and one quarter of total fluid requirement should be administered in the third 8 hours.

You are caring for a patient with superficial partial-thickness burns on the face sustained within the last 12 hours. On assessment, you expect to find which symptom? A. Blisters B. Reddening of the skin C. Destruction of all skin layers D. Damage to sebaceous glands

*B. Reddening of the skin* The clinical appearance of superficial partial-thickness burns includes erythema, blanching with pressure, and pain and minimal swelling with no vesicles or blistering during the first 24 hours.

*What intervention is of primary importance in a patient with septic shock?* A. Obtain an electrocardiogram (ECG). B. Start two 14-gauge intravenous (IV) access lines. C. Administer norepinephrine (Levophed). D. Measure the mean arterial pressure (MAP).

*B. Start two 14-gauge intravenous (IV) access lines.* Except for cardiogenic and neurogenic shock, all other types of shock involve decreased circulating blood volume. The cornerstone of therapy for septic shock is volume expansion. Insert two large-bore (14- to 16-gauge) IV catheters, and then administer *crystalloids (normal saline) and colloids (albumin) for fluid resuscitation.*

*A patient in the emergency department with chest pain that is unrelieved by nitroglycerin is diagnosed with an acute MI. Why is IV morphine now prescribed?* A. To relieve the chest pain B. To decrease cardiac workload C. To depress respirations D. To prevent ventricular remodeling

*B. To decrease cardiac workload* Morphine is given as a vasodilator to decrease the cardiac workload by lowering myocardial oxygen consumption, reducing contractility, and decreasing blood pressure and heart rate. It also helps to reduce anxiety and fear. The pain from an MI is from ischemia, and efforts are directed at improving perfusion and oxygenation of tissue rather than at masking the pain. Respiration depression is a side effect that you monitor for. Oxygenation is of prime importance. Ventricular remodeling is part of the healing process later on and a reason for an angiotensin-converting enzyme (ACE) inhibitor to be prescribed.

A patient has 25% TBSA burned from a car fire. His wounds have been debrided and covered with a silver-impregnated dressing. Your priority intervention for wound care is to A. reapply a new dressing without disturbing the wound bed. B. observe the wound for signs of infection during dressing changes. C. apply cool compresses for pain relief between dressing changes. D. wash the wound aggressively with soap and water three times each day.

*B. observe the wound for signs of infection during dressing changes.* Infection is the most serious threat for further tissue injury and possible sepsis.

The patient had a near-drowning episode but is currently symptom free in the emergency department. What should be done to care for the patient after this incident? A.Obtain a chest x-ray. B.Emphasize future water safety. C.Admit for observation. D.Evaluate complete blood cell count (CBC) results.

*C. Admit for observation* Complications can develop in patients who are essentially free of symptoms immediately after the near-drowning episode. Secondary drowning is a delayed death from drowning due to pulmonary complications. All victims of near-drownings should be observed in the hospital for a minimum of 23 hours. Radiographs and CBC evaluations are not essential. Teaching is important, but continued observation is essential

The patient with Prinzmetal's angina is prescribed nitroglycerin tablets. What should you teach the patient about this drug? A. Do not use the tablets if they taste tingling when used. B. Store the medication bottle in the bathroom so it is easily located. C. Do not take any drug for erectile dysfunction, such as Viagra. D. Call 911 if you experience flushing when taking the tablet.

*C. Do not take any drug for erectile dysfunction, such as Viagra.*

Which of the following laboratory findings fits with a diagnosis of cardiogenic shock? A. Decreased liver enzymes B. Increased white blood cells C. Increased blood urea nitrogen and creatinine levels D. Decreased red blood cells, hemoglobin, and hematocrit

*C. Increased blood urea nitrogen and creatinine levels* The *renal hypoperfusion* that accompanies cardiogenic shock results in increased BUN and creatinine levels. Impaired perfusion of the liver results in increased liver enzymes while red blood cell indices are typically normal because of relative hypovolemia. White blood cell levels do not typically rise in cardiogenic shock.

ATI: A nurse is caring for a client who has sustained burns to 35% of his total body surface area. Of this total, 20% are full-thickness burns on the arms, face, neck, and shoulders. The client's voice is hoarse, and he has a brassy cough. These ndings are indicative of which of the following? A. Pulmonary edema B. Bacterial pneumonia C. Inhalation injury D. Carbon monoxide poisoning

*C. Inhalation injury* Wheezing and hoarseness are indicative of inhalation injury and should be reported to the provider immediately.

When caring for a patient with an *electrical burn injury*, the nurse should question a health care provider's order for? A. Mannitol 75 gm IV. B. Urine for myoglobulin. C. Lactated Ringer's at 25 ml/hr. D. Sodium bicarbonate 24 mEq every 4 hours.

*C. Lactated Ringer's at 25 ml/hr.* Electrical injury puts the patient at risk for *myoglobinuria*, which can lead to *acute renal tubular necrosis (ATN)*. Treatment consists of infusing lactated Ringer's at a rate sufficient to maintain urinary output at 75 to 100 ml/hr. *Mannitol can also be used to maintain urine output*. *Sodium bicarbonate may be given to alkalinize the urine*. The urine would also be monitored for the presence of myoglobin. An infusion rate of 25 ml/hr is not sufficient to maintain adequate urine output in prevention and treatment of ATN.

Which medication is the treatment of choice for STEMI-associated pain? A. Aspirin B. Lorazepam (Ativan) C. Morphine D. Hydromorphone (Dilaudid)

*C. Morphine* Morphine improves hemodynamics. By promoting venodilation, the drug reduces cardiac preload. By promoting modest arterial dilation, it may cause some reduction in afterload. The combined reductions in preload and afterload lower the cardiac oxygen demand, thereby helping to preserve the ischemic myocardium and relieving the patient's pain.

Which of the following guidelines for the assessment of intimate partner violence (IPV) should the emergency nurse follow? A. All female patients and patients under 18 should be assessed for IPV. B. Patients should be assessed for IPV provided corroborating evidence exists. C. Patients should be routinely screened for family and IPV. D. Patients whom the nurse deems high risk should be assessed for IPV.

*C. Patients should be routinely screened for family and IPV.* In the emergency department, the nurse needs to screen for family and IPV. Routine screening for this risk factor is required. Such assessment should not be limited to female, high-risk, or young patients, and evidence need not be present in order to screen for the problem.

What is the main reason a patient is instructed to take the nitroglycerin patch off for 8 hours every night? A. Hypotension will occur. B. It is not needed because the patient is inactive. C. The interruption prevents tolerance to nitroglycerin. D. It causes nightmares.

*C. The interruption prevents tolerance to nitroglycerin.*

Which is an accurate statement about emergency care? A. The advantage of a jaw-thrust maneuver is that it is quicker than the head-tilt, chin-lift method to open the airway. B. Supplemental oxygen should be administered at 2 liters through a nasal cannula to all emergency patients. C. The most significant indicator of shock is a change in the level of consciousness. D. The A in the AVPU acronym used to assess level of consciousness stands for "airway."

*C. The most significant indicator of shock is a change in the level of consciousness.* *Altered mental status* and delayed capillary refill (longer than 3 seconds) are the most significant signs of shock. *The advantage of the jaw thrust is that it avoids hyperextension of the neck.* High-flow oxygen (100%) delivered by a non-rebreather mask (while monitoring the patient's response) is routine for all emergency patients. *The AVPU acronym (alert [A], responsive to voice [V], responsive to pain [P], and unresponsive [U])* provides a quick method for assessing the level of consciousness. Reference: 1769

When administering any vasoactive drug during the treatment of shock, the nurse knows that the goal of the therapy is to? A. constrict vessels to maintain BP. B. increase urine output to 50 mL/hr. C. maintain a MAP of at least 60 mm Hg. D. dilate vessels to improve tissue perfusion.

*C. maintain a MAP of at least 60 mm Hg.* Vasoactive drugs are those that can either dilate or constrict blood vessels, and both are used in various stages of shock treatment. When using either vasodilators or vasoconstrictors, it is important to maintain a *MAP of at least 60 mm Hg* so that adequate perfusion is maintain

In terms of pathophysiology and presentation how is chronic stable angina different from unstable angina?

*Chronic Stable Angina* is intermittent and reversible, usually occurring during periods of physical exertion or emotional stress. Episodes of pain tend to be the same pattern, onset, duration and intensity of symptoms. *Unstable Angina* more severe chest pain, lasting a longer duration. Does not resolve with rest or nitroglycerine. Accompanied by SOB, diaphoresis, nausea and lightheadedness.

For which of the following is percutaneous coronary intervention (PCI) most clearly indicated? A. Chronic stable angina B. Left-sided heart failure C. Coronary artery disease D. Acute myocardial infarction

*D. Acute myocardial infarction* PCI is indicated to restore coronary perfusion in cases of myocardial infarction. Chronic stable angina and CAD are normally treated with more conservative measures initially. PCI is not relevant to the pathophysiology of heart failure.

An 18-year-old woman has been admitted to the emergency department after ingesting an entire bottle of chewable multivitamins in a suicide attempt. You should anticipate which intervention? A. Induced vomiting B. Whole-bowel irrigation C. Administration of fresh frozen plasma D. Administration of activated charcoal

*D. Administration of activated charcoal* Among the *most common treatments for poisoning is administration of activated charcoal*. Induced vomiting is not typically indicated, and there is no need for plasma administration. Whole-bowel irrigation may be used as an adjunct therapy later in treatment, but the use of activated charcoal is central to the treatment of poisonings.

An 18-year-old female has been admitted to the emergency department after ingesting an entire bottle of chewable multivitamins in a suicide attempt. The nurse should anticipate which of the following interventions? A. Induced vomiting B. Whole bowel irrigation C. Administration of fresh frozen plasma D. Administration of activated charcoal

*D. Administration of activated charcoal* Among the most common treatments for poisoning is the administration of activated charcoal. Induced vomiting is not typically indicated, and there is no need for plasma administration. Whole bowel irrigation may be used as an adjunct therapy later in treatment, but the use of activated charcoal is central to the treatment of poisonings

A patient was admitted to the emergency department 24 hours earlier with complaints of chest pain that were subsequently attributed to ST-segment-elevation myocardial infarction (STEMI). Which of the following complications of MI should the nurse anticipate? A. Unstable angina B. Cardiac tamponade C. Sudden cardiac death D. Cardiac dysrhythmias

*D. Cardiac dysrhythmias* The most common complication after MI is dysrhythmias, which are present in 80% of patients. Unstable angina is considered a precursor to MI rather than a complication. Cardiac tamponade is a rare event, and sudden cardiac death is defined as an unexpected death from cardiac causes; cardiac dysfunction in the period following an MI would not be characterized as sudden cardiac death.

What is a classic manifestation of chronic stable angina? A. Pain remains during rest. B. Characteristics vary between episodes. C. Discomfort is described as sharp or stabbing. D. Discomfort often is described as squeezing or choking.

*D. Discomfort often is described as squeezing or choking.* Chronic, stable angina is described as pain, pressure, or an ache in the chest. It is an unpleasant feeling, often described as a constrictive, squeezing, heavy, choking, or suffocating sensation. It usually is relieved with rest or when the precipitating factor is removed. The symptoms and triggers tend to remain consistent. *Angina is rarely sharp or stabbing* and usually does not change with position or breathing. Page: 772, Lewis

When planning emergent care for a patient with a suspected MI, the nurse will anticipate administration of? A. Oxygen, furosemide (Lasix), nitroglycerin, and meperidine. B. Aspirin, nitroprusside (Nipride), dopamine (Intropin), and oxygen. C. Nitroglycerin, lorazepam (Ativan), oxygen, and warfarin (Coumadin). D. Oxygen, nitroglycerin, aspirin, and morphine.

*D. Oxygen, nitroglycerin, aspirin, and morphine.* These interventions serve to relieve chest pain, improve oxygenation, decrease myocardial workload, and prevent further platelet aggregation.

Which is an example of distributive shock? A. Myocardial infarction B. Traumatic hemorrhage C. Bowel obstruction D. T3 spinal cord injury

*D. T3 spinal cord injury* *Neurogenic shock* is related to distributive shock. Neurogenic shock is a hemodynamic phenomenon that can occur within 30 minutes of a spinal cord injury. It results in massive vasodilation without compensation due to the loss of sympathetic nervous system vasoconstrictor tone. A myocardial infarction causes cardiogenic shock, and hemorrhage and bowel obstruction cause *hypovolemic shock*. 1718, 1722

You should immerse a burn patient in water or use ice? A. True B. False

*False* Ice causes vasoconstriction Water leads to heat loss

*What are the 3 parts of the Secondary Survey F?*

*Full set of vitals, Five interventions, Facilitate family presence*

The primary complications of dog and cat bites include _________ and _________ ?

*Infection* (Pasteurella species) and *Mechanical Destruction*. Greater risk of infection with cats due to deeper puncture wounds.

Know the goals of vasopressor therapy used while treating sepsis

*Maintain MAP above 65 mm Hg.* Endotoxins on bacteria cause vasodilation, which is why sepsis is a distributive form of shock, treated with vasopressors. The goal is to increase BP to maximize perfusion and prevent capillary leakage that also contributes to organ failure. *Norepinephrine is first line choice then Dopamine*

What is the MOA of nitrates and what is the net effect of this?

*Nitrates dilate all vessels* but predominantly veins and coronary arteries. The net effect of this is decreased oxygen demand and increased oxygen supply. This works by *DECREASING PRELOAD* (blood pools in the veins and doesn't return to the heart) and dilating coronary arteries (allows more blood to reach heart muscle during ventricular diastole)

The ______ artery supplies the Right Atrium and Right Ventricle?

*Right Coronary Artery*

Name the three main coronary arteries in the heart and identify the areas of the heart that receive blood from these arteries.

*Right coronary artery*-supplies the right atrium and right ventricle. *Left anterior descending*-Anterior surface of left ventricle, lateral surface of left ventricle and inter ventricular septum *Circumflex*-Left Atrium, inferior and posterior surface of left ventricle

Distributive shock is shock that results from blood vessel problems, namely excessive vasodilation and impaired distribution of blood. The three types of distributive shock are?

*Septic shock, Neurogenic shock and Anaphylactic shock*

*What are the parts of the Surviving Sepsis Campaign bundle to be completed within 3 hours?*

*To be completed within 3 hours:* -Measure lactate level -Obtain blood cultures before antibiotic therapy -Administer broad spectrum antibiotic -Administer crystalloid for hypotension or lactate > 4 mmol/L. -*Target CVP > 8.*

*What are the parts of the Surviving Sepsis Campaign bundle to be completed within 6 hours?*

*To be completed within 6 hours:* -For hypotension that does not respond to fluid resuscitation administer vasopressors to *maintain MAP above 65* or *SBP > 90 mm Hg*. -*Maintain the Central Venous Oxygen Saturation (ScvO2) > 70* -Re-measure lactate

Effective interventions to decrease absorption or increase elimination of an ingested poison include which of the following (select all that apply)? a.Hemodialysis b.Milk dilution c.Eye irrigation d.Gastric lavage e.Activated charcoal

*a. Hemodialysis* *d. Gastric lavage* *e. Activated charcoal*

*A therapeutic measure used to prevent hypertrophic scarring during the rehabilitative phase of burn recovery is?* a.applying pressure garments. b.repositioning the patient every 2 hours. c.performing active ROM at least every 4 hours. d.massaging the new tissue with water-based moisturizers.

*a. applying pressure garments.* Pressure can help keep a scar flat and reduce hypertrophic scarring. Gentle pressure can be maintained on the healed burn with custom-fitted pressure garments.

Priority Decision: *The priority of management of the near-drowning patient is?* a. correction of hypoxia. b. correction of acidosis. c. maintenance of fluid balance. d. prevention of cerebral edema.

*a. correction of hypoxia.*

*The initial cause of hypovolemia during the emergent phase of burn injury is?* a. increased capillary permeability. b. loss of sodium to the interstitium. c. decreased vascular oncotic pressure. d. fluid loss from denuded skin surface

*a. increased capillary permeability.* Although all the selections add to the hypovolemia that occurs in the emergent burn phase, *the initial and most pronounced effect is caused by fluid shifts out of the blood vessels as a result of increased capillary permeability.*

The nurse suspects stable angina rather than MI pain in the patient who reports chest pain that? a. is relieved by nitroglycerin. b. is a sensation of tightness or squeezing. c. does not radiate to the neck, back, or arms. d. is precipitated by physical or emotional exertion.

*a. is relieved by nitroglycerin.*

When assessing a patient's full-thickness burn injury during the emergent phase, the nurse would expect to find? a. leathery, dry, hard skin. b. red, fluid-filled vesicles. c. massive edema at the injury site. d. serous exudate on a shiny, dark-brown wound

*a. leathery, dry, hard skin.* Dry, waxy white, leathery, or hard skin is characteristic of full-thickness burns in the emergent phase, and they may turn brown and dry in the acute phase. Deep partial-thickness burns in the emergent phase are red and shiny and have blisters. Edema may not be as extensive in full-thickness burns because of thrombosed vessels.

Priority Decision: A patient is brought to the emergency department following a skiing accident in which he was not found for several hours. He is rigid and has slowed respiratory and heart rates. *During the initial assessment of the patient, the nurse should?* a. manage and maintain ABCs (airway, breathing, circulation). b. initiate active core-rewarming interventions. c. monitor the core temperature via the axillary route. d. expose the patient to check for areas of frostbite and other injuries.

*a. manage and maintain ABCs (airway, breathing, circulation).*

A patient with hypovolemic shock is receiving lactated Ringer's for fluid replacement therapy. During this therapy, it is most important for the nurse to monitor the patient's? a. serum pH. b. serum sodium. c. serum potassium. d. hemoglobin and Hct.

*a. serum pH.* *Lactated Ringer's solution may increase lactate levels, which a damaged liver cannot convert to bicarbonate*, and may intensify the metabolic lactic acidosis that occurs in progressive shock, necessitating careful attention to the patient's acid-base balance. Sodium and potassium levels as well as hemoglobin and hematocrit levels should be monitored in all patients receiving fluid replacement therapy

During the *secondary survey* of a trauma patient in the emergency department, it is important that the nurse obtain details of the incident primarily because? a. the mechanism of injury can indicate specific injuries. b. important facts may be forgotten when needed later for legal actions. c. alcohol use associated with many accidents can affect treatment of injuries. d. many types of accidents or trauma must be reported to government agencies

*a. the mechanism of injury can indicate specific injuries.*

When teaching the patient with angina about taking sublingual nitroglycerin tablets, the nurse instructs the patient? a. to lie or sit and place one tablet under the tongue when chest pain occurs. b. to take the tablet with a large amount of water so it will dissolve right away. c. that if one tablet does not relieve the pain in 15 minutes, the patient should go to the hospital. d. that if the tablet causes dizziness and a headache, the medication should be stopped and the doctor notified.

*a. to lie or sit and place one tablet under the tongue when chest pain occurs.*

When teaching an older adult with CAD how to manage the treatment program for angina, the nurse instructs the patient? a. to sit for 3 to 5 minutes before standing when getting out of bed. b. to exercise only twice a week to avoid unnecessary strain on the heart. c. that lifestyle changes are not as necessary as they would be in a younger person. d. that aspirin therapy is contraindicated in older adults because of the risk for bleeding.

*a. to sit for 3 to 5 minutes before standing when getting out of bed.*

The nurse suspects the possibility of sepsis in the burn patient based on changes in? a. vital signs. b. urinary output. c. gastrointestinal function. d. burn wound appearance.

*a. vital signs.* Early signs of sepsis include an elevated temperature and increased pulse and respiratory rate accompanied by decreased BP and, later, decreased urine output and perhaps paralytic ileus. A burn wound may become locally infected without causing sepsis.

During the early emergent phase of burn injury, the patient's laboratory results would most likely include? a. ↑ Hct, ↓ serum Na, ↑ serum K. b. ↓ Hct, ↓ serum albumin, ↓ serum Na, ↑ serum K. c. ↓ Hct, ↑ serum Na, ↑ serum K. d. ↑ Hct, ↓ serum Na, ↓ serum K

*a. ↑ Hct, ↓ serum Na, ↑ serum K.*

Appropriate treatment modalities for the management of cardiogenic shock include (select all that apply)? a.dobutamine to increase myocardial contractility. b.vasopressors to increase systemic vascular resistance. c.circulatory assist devices such as an intraaortic balloon pump. d.corticosteroids to stabilize the cell wall in the infarcted myocardium. e.Trendelenburg positioning to facilitate venous return and increase preload.

*a.dobutamine to increase myocardial contractility.* *c.circulatory assist devices such as an intraaortic balloon pump.* Dobutamine (Dobutrex) is used in cardiogenic shock with severe systolic dysfunction. Dobutamine increases myocardial contractility, decreases ventricular filling pressures, decreases systemic vascular resistance and pulmonary artery wedge pressure, and increases cardiac output, stroke volume, and central venous pressure. Dobutamine may increase or decrease the heart rate. The workload of the heart may be reduced in cardiogenic shock with the use of circulatory assist devices such as an intraaortic balloon pump or ventricular assist device.

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

*b. CVP of 15mm Hg.* b. Rationale: The endpoint of fluid resuscitation in septic and hypovolemic shock is a CVP of 15 mm Hg or a PAWP of 10-12mm Hg. The CO is too low, and the heart rate is too high, to indicate adequate fluid replacement.

A homeless man is brought to the emergency department in profound hypothermia with a temperature of 85° F (29.4° C). On initial assessment, the nurse would expect to find? a. shivering and lethargy. b. fixed and dilated pupils. c. respirations of 6-8/min. d. BP obtainable only by Doppler.

*b. fixed and dilated pupils.* PATIENTS WITH PROFOUND HYPOTHERMIA APPEAR DEAD

An abnormal finding that the nurse would expect to find in early, *compensated shock* is? a. metabolic acidosis. b. increased serum sodium. c. decreased blood glucose. d. increased serum potassium.

*b. increased serum sodium.* In early compensated shock, *activation of the RAAS renin-angiotensin system stimulates the release of aldosterone, which causes sodium reabsorption and potassium excretion by the kidney, elevating serum sodium levels, and decreasing serum potassium levels*. Blood glucose levels are elevated during the compensated stage of shock in response to catecholamine stimulation of the liver, which releases its glycogen stores in the form of glucose. Metabolic acidosis does not occur until the progressive stage of shock, when compensatory mechanisms become ineffective and anaerobic cellular metabolism causes lactic acid production.

The nurse assesses absent bowel sounds and abdominal distention in a patient 12 hours postburn. The nurse notifies the health care provider and prepares to? a. withhold all oral intake except water. b. insert a nasogastric tube for decompression. c. administer a histamine-2 blocking agent such as cimetidine (Tagamet). d. administer nutritional supplements through a feeding tube placed in the duodenum.

*b. insert a nasogastric tube for decompression.* The patient with large burns often develops paralytic ileus within a few hours, and a nasogastric tube is inserted and connected to low, intermittent suction. After GI function returns, feeding tubes may be used for nutritional supplementation and H2R blockers may be used to prevent Curling's ulcers. Free water is not given to drink because of the potential for water intoxication.

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, it is most important for the nurse to assess? a. urine output. b. lung sounds. c. peripheral circulation. d. central venous pressur

*b. lung sounds.* Generally, the first organ system affected by mediator-induced injury in MODS is the respiratory system. Adventitious sounds and areas absent of breath sounds will be present. Other organ damage also occurs, but lungs are usually first.

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 assessment findings include? a. a lactic acidosis with a pH of 3.32. b. marked hypotension and refractory hypoxemia. c. unresponsiveness that responds only to painful stimuli. d. profound vasoconstriction with absent peripheral pulse

*b. marked hypotension and refractory hypoxemia*

A patient has 25% TBSA burned from a car fire. His wounds have been debrided and covered with a silver-impregnated dressing. *The nurse's priority intervention for wound care would be to?* a.reapply a new dressing without disturbing the wound bed. b.observe the wound for signs of infection during dressing changes. c.apply cool compresses for pain relief in between dressing changes. d.wash the wound aggressively with soap and water three times a day.

*b. observe the wound for signs of infection during dressing changes.*

A 78-year-old man has confusion and temperature of 104° F (40° C). He is a diabetic with purulent drainage from his right great toe. His assessment findings are BP 84/40 mm Hg; heart rate 110; respiratory rate 42 and shallow; CO 8 L/min; and PAWP 4 mm Hg. This patient's symptoms are most likely indicative of? a.sepsis. b.septic shock. c.multiple organ dysfunction syndrome. d.systemic inflammatory response syndrome.

*b. septic shock.* To meet the diagnostic criteria for sepsis, the temperature must be greater than 100.9° F (38.3° C), or the core temperature must be less than 97.0° F (36° C). Hemodynamic parameters for septic shock include elevated heart rate; decreased pulse pressure, blood pressure, systemic vascular resistance, *central venous pressure, and pulmonary artery wedge pressure*; normal or elevated pulmonary vascular resistance; and decreased, normal, or increased pulmonary artery pressure, cardiac output, and mixed venous oxygen saturation.

One clinical manifestation the nurse would expect to find during the emergent phase in a patient with a full-thickness burn over the lower half of the body is? a. fever. b. shivering. c. severe pain. d. unconsciousness.

*b. shivering.* Shivering often occurs in a patient with a burn as a result of chilling that is caused by heat loss, anxiety, or pain. Severe pain is not common in full-thickness burns, nor is unconsciousness unless there are other factors present. Fever is a sign of infection in later burn phases.

A patient has a core temperature of 90° F (32.2° C). The most appropriate rewarming technique would be? a.passive rewarming with body-to-body contact. b.active core rewarming using warmed IV fluids. c.passive rewarming using air-filled warming blankets. d.active external rewarming by submersing in a warm bath.

*b.active core rewarming using warmed IV fluids.*

A hospitalized patient with a history of chronic stable angina tells the nurse that she is having chest pain. The nurse bases his actions on the knowledge that ischemia? a.will always progress to myocardial infarction. b.will be relieved by rest, nitroglycerin, or both. c.indicates that irreversible myocardial damage is occurring. d.is frequently associated with vomiting and extreme fatigue.

*b.will be relieved by rest, nitroglycerin, or both.* This is how you can differentiate chronic stable angina from ACS. UA, STEMI and NSTEMI won't be relived by these interventions alone. *Chronic stable angina* refers to chest pain that occurs intermittently over a long period with the *same pattern of onset, duration, and intensity of symptoms*. The chest pain is *relieved by rest or by rest and medication (e.g., nitroglycerin)*. Ischemia does not cause myocardial damage

*Collaborative care of the patient with non-ST-segment-elevation myocardial infarction (NSTEMI) differs from that of a patient with ST-segment-elevation myocardial infarction (STEMI) in that NSTEMI is more frequently treated initially with?* a. PCI. b. CABG. c. acute intensive drug therapy. d. reperfusion therapy with fibrinolytics.

*c. acute intensive drug therapy.* Because a NSTEMI is an acute coronary syndrome that indicates a transient thrombosis or incomplete coronary artery occlusion, treatment involves intensive drug therapy with antiplatelets, GPIIB inhibitors, anti-thrombotics, and heparin to prevent clot extension, in addition to nitroglycerin IV. Reperfusion therapy using fibrinolytics, coronary artery bypass graft (CABG), or PCI is used for treatment of STEMI.

During rewarming of a patient's toes that have suffered deep *frostbite*, the nurse? a. applies sterile dressings to blisters. b. places the feet in a cool water bath. c. ensures that analgesics are administered. d. massages the digits to increase circulation.

*c. ensures that analgesics are administered.*

When administering any vasoactive drug during the treatment of shock, the nurse knows that the goal of the therapy is to? a. constrict vessels to maintain BP. b. increase urine output to 50 mL/hr. c. maintain a MAP of at least 60 mm Hg. d. dilate vessels to improve tissue perfusion

*c. maintain a MAP of at least 60 mm Hg.* Vasoactive drugs are those that can either dilate or constrict blood vessels, and both are used in various stages of shock treatment. When using either vasodilators or vasoconstrictors, it is important to maintain a *MAP of at least 60 mm Hg so that adequate perfusion is maintained.*

A second 12-lead ECG performed on a patient 4 hours after the onset of chest pain reveals ST-segment elevation. The nurse recognizes that this finding indicates a? a. transient ischemia typical of unstable angina. b. lack of permanent damage to myocardial cells. c. myocardial infarction associated with prolonged and complete coronary thrombosis. d. myocardial infarction associated with transient or incomplete coronary artery occlusion.

*c. myocardial infarction associated with prolonged and complete coronary thrombosis.* STEMI-complete occlusion NSTEMI-incomplete occlusion UA-incomplete occlusion

*The nurse suspects sepsis as a cause when the laboratory test results of a patient in shock include?* a. hypokalemia. b. increased BUN. c. thrombocytopenia. d. decreased hemoglobin.

*c. thrombocytopenia.* During the inflammatory process platelets adhere to the cell wall.

To detect and treat the most common complication of MI, the nurse? a. measures hourly urine output. b. auscultates the chest for crackles. c. uses continuous cardiac monitoring. d. takes vital signs q2hr for the first 8 hours

*c. uses continuous cardiac monitoring* The MOST COMMON complication is cardiac dysrhythmias, particularly ventricular dysrhythmias

Fluid and electrolyte shifts that occur during the early emergent phase include? a.adherence of albumin to vascular walls. b.movement of potassium into the vascular space. c.sequestering of sodium and water in interstitial fluid. d.hemolysis of red blood cells from large volumes of rapidly administered fluid.

*c.sequestering of sodium and water in interstitial fluid.*

Priority Decision: A patient with acute pancreatitis is experiencing hypovolemic shock. *Which of the following 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 bag.

*d. Administer high flow oxygen (100%) with a non-rebreather bag.* Fluids could be started next, blood cultures done before any antibiotic therapy, and lab specimens then could be drawn.

A patient is admitted to the burn center with burns of his head and neck, chest and back, and left arm and hand following an explosion and fire in his garage. On admission to the unit, the nurse auscultates wheezes throughout the lung fields. On reassessment, the nurse notes that the wheezes are gone and the breath sounds are greatly diminished. *Which of the following actions is the most appropriate for the nurse to take next?* a.Place the patient in high Fowler's position. b.Encourage the patient to cough and auscultate the lungs again. c.Document the results and continue to monitor the patient's progress. d.Anticipate the need for endotracheal intubation and notify the physician.

*d. Anticipate the need for endotracheal intubation and notify the physician.*

While teaching women about the risks and incidence of CAD, the nurse stresses that? a. women have an increased incidence of sudden death compared with men. b. smoking is not as significant a risk factor for CAD in women as it is in men. c. estrogen replacement therapy in postmenopausal women decreases the risk for CAD. d. CAD is the leading cause of death in women, with a higher mortality rate following myocardial infarction (MI) than in men

*d. CAD is the leading cause of death in women, with a higher mortality rate following myocardial infarction (MI) than in men*

A patient is admitted unconscious to the emergency department by his family, who brought an empty container of Elavil found near the patient. A large oral-gastric tube is inserted and the nurse prepares to administer? a. cathartics. b. syrup of ipecac. c. a gastric lavage. d. activated charcoal.

*d. activated charcoal.*

A 52-year-old man is admitted to the emergency department with severe chest pain. The nurse suspects an MI on finding that the patient? a. has pale, cool, clammy skin. b. reports nausea and vomited once at home. c. is anxious and has a feeling of impending doom. d. has had no relief of the pain with rest or position change

*d. has had no relief of the pain with rest or position change*

Tachycardia that is a response of the sympathetic nervous system to the pain of ischemia is detrimental because not only does it increase oxygen demand, but it? a. increases CO. b. causes reflex hypotension. c. may lead to ventricular dysrhythmias. d. impairs perfusion of the coronary arteries.

*d. impairs perfusion of the coronary arteries.*

The key factor in describing any type of shock is? a. hypoxemia. b. hypotension. c. vascular collapse. d. inadequate tissue perfusion

*d. inadequate tissue perfusion* Although all the factors may be present, regardless of the cause, the end result is inadequate supply of oxygen and nutrients to body cells from inadequate tissue perfusion

In late, irreversible shock in a patient with massive thermal burns, the nurse would 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.* d. Rationale: In late irreversible shock, progressive cellular destruction causes changes in lab findings that indicate organ damage. *Increasing ammonia levels indicate impaired liver function*. Metabolic acidosis is usually severe as cells continue anaerobic metabolism, and the respiratory alkalosis that may occur in the progressive stage has failed to compensate for the acidosis. Potassium levels increase and blood glucose decrease

A patient has a spinal cord injury at T4. Vital signs include a falling blood pressure with bradycardia. The nurse recognizes that the patient is experiencing? a. a relative hypervolemia. b. an absolute hypovolemia. c. neurogenic shock from low blood flow. d. neurogenic shock from massive vasodilation

*d. neurogenic shock from massive vasodilation* Relative HYPO-volemia not HYPER-volemia

A patient has a 20% TBSA deep partial-thickness and full-thickness burn to the right anterior chest and entire right arm. It is most important that the nurse assess the patient for? a. presence of pain. b. swelling of the arm. c. formation of eschar. d. presence of pulses in the arms.

*d. presence of pulses in the arms.*

*Priority Decision:* The initial intervention in the emergency management of a burn of any type is to? a. establish and maintain an airway. b. assess for other associated injuries. c. establish an IV line with a large-gauge needle. d. remove the patient from the burn source and stop the burning process

*d. remove the patient from the burn source and stop the burning process* if chemical burn brush solids before washing

Priority Decision: The initial intervention in the emergency management of a burn of any type is to? a. establish and maintain an airway. b. assess for other associated injuries. c. establish an IV line with a large-gauge needle. d. remove the patient from the burn source and stop the burning process.

*d. remove the patient from the burn source and stop the burning process.*

The nurse performing a *primary survey* in the emergency department is assessing? a. the acuity of the patient's condition to determine priority of care. b. whether the patient is responsive enough to provide needed information. c. whether the resources of the emergency department are adequate to treat the patient. d. the status of airway, breathing, circulation, disability, and exposure/environmental control

*d. the status of airway, breathing, circulation, disability, and exposure/environmental control*

The most accurate assessment parameters for the nurse to use to determine adequate tissue perfusion in the patient with MODS are? a.blood pressure, pulse, and respirations. b.breath sounds, blood pressure, and body temperature. c.pulse pressure, level of consciousness, and pupillary response. d.level of consciousness, urine output, and skin color and temperature.

*d.level of consciousness, urine output, and skin color and temperature.* LOC is a key indicator with different types of shock

*d.neurogenic shock from massive vasodilation.*

Superficial partial thickness involves __________, Deep partial thickness burns involve the _________, full-thickness involves _________ ?

*epidermis, dermis, fat/bone/muscle*

__________ is a syndrome characterized by decreased tissue perfusion and impaired cellular metabolism?

*shock*

According to the emergency severity index (ESI) a person who is dying is a level _____ ?

Ms. D is admitted the ICU with a diagnosis of probable sepsis and septic shock. Which of the data that you have collected in the health history and physical assessment are significant in developing and confirming the diagnoses of sepsis and septic shock? (Select all that apply) 1. Increased patient temperature 2. Atrial fibrillation rhythm 3. Cloudy, blood-streaked urine 4. Decreased blood pressure 5. Elevated heart rate 6. Abdominal and back pain 7. History of diabetes mellitus

1. Increased patient temperature 3. Cloudy, blood-streaked urine 4. Decreased blood pressure 5. Elevated heart rate 6. Abdominal and back pain 7. History of diabetes mellitus

Epinephrine comes in two different concentrations, 1:10,000 and 1:1000. Which one is for cardiac arrest?

1:10,000-cardiac arrest 1:1000-anaphylactic shock

Hematocrit 32% Hemoglobin level 10.9 g/dL Platelet count 96,000/mm White blood cells 26,000/mm Blood urea nitrogen 56 mg/dL Creatinine level 2.9 mg/dL Glucose 330 mg/dL Potassium level 5.2 mEq/L Sodium level 140 mEq/L Which laboratory value requires the most immediate nursing action? 1. Creatinine level 2. Glucose level 3. Potassium level 4. Hemoglobin level

2. Glucose level

Priority Decision: The nurse has received the change of shift report on his group of patients. Indicate the priority order 1-4 for the nurse to see these patients? a. a 40-year-old female returning from the PACU following surgical debridement of her back and legs. b. a 76-year-old male with partial-thickness burns of his arms and abdomen who is complaining of severe pain. c. a 62-year-old female just admitted following partial-thickness burns to her anterior chest, face, and neck. d. an 18-year-old male with full-thickness burns of his lower extremities who is refusing to go for his scheduled dressing change

3214 c. a 62-year-old female just admitted following partial-thickness burns to her anterior chest, face, and neck. (inhalation injury-ABC) b. a 76-year-old male with partial-thickness burns of his arms and abdomen who is complaining of severe pain. a. a 40-year-old female returning from the PACU following surgical debridement of her back and legs. (need to assess VS, LOC, etc.) d. an 18-year-old male with full-thickness burns of his lower extremities who is refusing to go for his scheduled dressing change

*What does the term acute coronary syndrome mean?*

A distinct condition caused by a similar sequence of pathologic events-a temporary or permanent blockage of a coronary artery. Excessive demand or inadequate supply of oxygen and nutrients to the heart muscle, associated with plaque disruption, thrombus formation and vasoconstriction. This consists of 3 major syndromes: Unstable Angina (UA), non-STEMI and STEMI.

Which are diagnostic criteria for sepsis according to the 2008 Surviving Sepsis Campaign (select all that apply)? A. More than 10% immature forms in the white blood cell (WBC) count B. Temperature greater than 102.2° F (39° C) C. Tachycardia greater than 120 beats/minute D. Baseline systolic blood pressure greater than 160 mm Hg

A, B, C The definition of sepsis is documented or suspected infection and some of the other criteria for systemic inflammatory response syndrome (SIRS). SIRS criteria include a WBC count greater than 12,000/mm3 or less than 4000/mm3 or more than 10% immature forms, temperature greater than 100.9° F or less than 97° F, heart rate greater than 90 beats/minute, and systolic blood pressure less than 90 mm Hg or a decrease in systolic blood pressure of greater than 40 mm Hg from baseline.

Which are diagnostic criteria for sepsis according to the 2008 *Surviving Sepsis Campaign* (select all that apply)? A. More than 10% immature forms in the white blood cell (WBC) count B. Temperature greater than 102.2° F (39° C) C. Tachycardia greater than 120 beats/minute D. Baseline systolic blood pressure greater than 160 mm Hg

Appropriate treatment modalities for the management of cardiogenic shock include (select all that apply) A. dobutamine (Dobutrex) to increase myocardial contractility. B. vasopressors to increase systemic vascular resistance. C. circulatory assist devices such as an intraaortic balloon pump. D. corticosteroids to stabilize cell walls in the infarcted myocardium. E. Trendelenburg positioning to facilitate venous return and increase preload.

A, C Cariogenic shock is not distributive and dos not require vasopressors.

A nurse is planning care for a client who has burn injuries. Which of the following interventions should be included in the plan of care? (Select all that apply.) A. Use standard precautions when performing wound care. B. Encourage fresh vegetables in the diet. C. Increase protein intake. D. Instruct client to consume 3,000 calories daily. E. Restrict fresh flowers in room.

A, C, E *5000 CALORIES*

Match the heat-related emergencies with their characteristics (answers may be used more than once). a. Rectal temperature of 99.6°-104° F (37.5°-40° C) b. Treated with rapid cooling methods c. Related to salt deficiency following heavy work without adequate fluids d. High risk of mortality and morbidity e. Volume and electrolyte depletion f. Elevated core temperature without sweating g. Oxygen administration necessary h. Causes mild confusion, headache, and dilation of pupils i. Extremity swelling is only symptom 1. Heat edema 2. Heat cramps 3. Heat exhaustion 4. Heat stroke

A-Heat Exhaustion B-Heat stroke C-Heat cramps D-Heat stroke E-Heat exhaustion F-Heat Stroke G-Heat Stroke H-Heat Exhaustion I-Heat edema

A nurse is caring for a client in a clinic who asks the nurse why her provider prescribed 1 aspirin per day. Which of the following is an appropriate response by the nurse? A. "Aspirin reduces the formation of blood clots that could cause a heart attack." B. "Aspirin relieves the pain due to myocardial ischemia." C. "Aspirin dissolves clots that are forming in your coronary arteries." D. "Aspirin relieves headaches that are caused by other medications."

A. "Aspirin reduces the formation of blood clots that could cause a heart attack."

A nurse is admitting a client who has a suspected myocardial infarction (MI) and a history of angina. Which of the following findings will help the nurse distinguish angina from an MI? A. Angina can be relieved with rest and nitroglycerin. B. The pain of an MI resolves in less than 15 min. C. The type of activity that causes an MI can be identi ed. D. Angina can occur for longer than 30 min.

A. Angina can be relieved with rest and nitroglycerin.

A nurse is caring for a client and reviewing a new prescription for an afterload-reducing medication. The nurse should recognize that this medication is administered for which of the following types of shock? A. Cardiogenic B. Obstructive C. Hypovolemic D. Distributive

A. Cardiogenic B. INCORRECT: In obstructive shock, the high afterload is due to obstruction of blood ow. Afterload-reducing agents will not remove the obstruction. C. INCORRECT: Fluid replacement and reduction of further fluid loss are the focus of management of hypovolemic shock. D. INCORRECT: Afterload-reducing medication is not administered to a client with distributive shock because the client already has decreased afterload. *massive vasodilation*

A nurse in the emergency department is assessing a client who is unresponsive. The client's partner states, "He was pulling weeds in the yard and dropped to the ground." Which of the following techniques should the nurse use to open the client's airway? A. Head-tilt, chin-lift B. Modified jaw thrust C. Hyperextension of the head D. Flexion of the head

A. Head-tilt, chin-lift

*A nurse is planning care for a client who has septic shock. Which of the following is the priority action for the nurse to take?* A. Maintaining adequate fluid volume with IV infusions B. Administering antibiotic therapy C. Monitoring hemodynamic status D. Administering vasopressor medication

A. INCORRECT: Maintaining the client's fluid volume by administration of IV uids is an appropriate action, but it is not the priority action. *B. CORRECT: Using the safety and risk reduction framework, administration of antibiotics is the priority action by the nurse. Eliminating endotoxins and mediators from bacteria will reduce the vasodilation that is occurring.* C. INCORRECT: Monitoring the client's hemodynamic status is an appropriate action, but it is not the priority action. D. INCORRECT: Administering vasopressor medication is an appropriate action, but it is not the priority action. *SEPTIC SHOCK IS ALSO A TYPE OF DISTRIBUTIVE SHOCK, WHERE MASSIVE VASODILATION CAUSES RELATIVE HYPOVOLEMIA*

The patient sustained superficial frostbite. How should you conduct the rewarming process? A. Immerse the affected area in a water bath. B. Gently rub the area to improve circulation. C. Apply layers of heavy blankets and clothing. D. Stop rewarming efforts if the patient reports stinging sensation.

A. Immerse the affected area in a water bath. Immerse the affected area in a water bath (102° to 108° F) (38.9° C to 42.2° C). The area should be handled carefully and never squeezed, massaged, or scrubbed because it is easily damaged. Avoid heavy blankets and clothing because *friction and weight can lead to sloughing of damaged tissue*. Rewarming is extremely painful. Patients often experience a warm, stinging sensation as tissue thaws, and pain management should be provided.

With sepsis mortality goes up by 7.5% for every hour without antibiotics? A. True B. False

A. True

When assessing a patient with a partial-thickness burn, you expect to find (select all that apply) A. blisters. B. exposed fascia. C. exposed muscles. D. intact nerve endings. E. red, shiny, wet appearance.

A. blisters. D. intact nerve endings. E. red, shiny, wet appearance.

Which of the following is not part of the Surviving Sepsis Bundle for the first 3 hours? A. Measure lactate level B. Obtain blood cultures before administration of antibiotics C. Administer broad-spectrum antibiotics D. Administer 30 mL/kg crystalloids for hypotension or lactate ≥4 mmol/L E. ALL

ALL

Know the treatment for common poisons (Table is 69-11 in Lewis is a nice resource).

Acetaminophen (Tylenol)- poisoning treated with N-Acetylcysteine and activated charcoal. Aspirin-Gastric lavage, activated charcoal and hemodialysis

___________ describes any condition characterized by signs and symptoms of sudden myocardial ischemia—a sudden reduction in blood flow to the heart?

Acute Coronary Syndrome (ACS)

A nurse in the emergency department is completing an assessment of a client who is in shock. Which of the following ndings should the nurse expect? (Select all that apply.) A. Heart rate 60/min B. Seizure activity C. Respiratory rate 42/min D. Increased urine output E. Weak, thready pulse

B, C, E NOT A, D, E: Tachycardia, Tachypnea, Decreased UOP

A nurse in a cardiac unit is assisting with the admission of a client who is to undergo hemodynamic monitoring. Which of the following actions should the nurse anticipate performing? A. Administer large volumes of IV fluids. B. Assist with insertion of pulmonary artery catheter. C. Obtain Doppler pulses of the extremities. D. Gather supplies for insertion of a peripheral IV catheter.

B. Assist with insertion of pulmonary artery catheter. This measures PAWP. CVP can be inferred from this. Normal CVP 3-8

The marathon runner presents at the medical tent after completing the race. Which sign or symptom indicates a heatstroke? A. Reports nausea and vomiting B. Body temperature more than 105.8° F (41° C) and dry skin C. Profuse diaphoresis with a body temperature of 101.4° F (38° C) D. Complaints of leg cramping

B. Body temperature more than 105.8° F (41° C) and dry skin *Heat stroke* is characterized by a core temperature *greater than 104° F (40° C)*, altered mentation, *absence of perspiration*, and circulatory collapse. There are neurologic symptoms. Nausea, vomiting, and leg cramping are seen in heat cramps. Profuse diaphoresis occurs with heat exhaustion.

A nurse on a medical-surgical unit is caring for a group of clients. The nurse should notify the rapid response team for which of the following clients? A. Client who has an ulceration of the right heel whose blood glucose is 300 mg/dL B. Client who reports right calf pain and shortness of breath C. Client who has blood on a pressure dressing in the femoral area following a cardiac catheterization D. Client who has dark red coloration of left toes and absent pedal pulse

B. Client who reports right calf pain and shortness of breath

The nurse would recognize which of the following clinical manifestations as suggestive of sepsis? A. Respiratory rate of seven breaths per minute B. Hyperglycemia in the absence of diabetes C. Sudden diuresis unrelated to drug therapy D. Bradycardia with sudden increase in blood pressure

B. Hyperglycemia in the absence of diabetes *Hyperglycemia in patients with no history of diabetes is a diagnostic criterion for sepsis.* Oliguria, not diuresis, typically accompanies sepsis along with *tachycardia* and *tachypnea*.

When caring for a patient in acute septic shock, the nurse would anticipate? A. Administering osmotic and/or loop diuretics. B. Infusing large amounts of intravenous fluids. C. Administering intravenous diphenhydramine (Benadryl). D. Assisting with insertion of a ventricular assist device (VAD).

B. Infusing large amounts of intravenous fluids. Septic shock is characterized by a decreased circulating blood volume. Volume expansion with the administration of intravenous fluids is the cornerstone of therapy. The administration of diuretics is inappropriate. VADs are useful for cardiogenic shock, not septic shock. Diphenhydramine (Benadryl) may be used for anaphylactic shock, but would not be helpful with septic shock.

The nurse is examining the ECG of a patient who has just been admitted with a suspected MI. Which of the following ECG changes is most indicative of prolonged or complete coronary occlusion? A. Sinus tachycardia B. Pathologic Q wave C. Fibrillatory P waves D. Prolonged PR interval

B. Pathologic Q wave The presence of a pathologic Q wave, as often accompanies STEMI, is *indicative of complete coronary occlusion*. Sinus tachycardia, fibrillatory P waves (e.g., atrial fibrillation), or a prolonged PR interval (first-degree heart block) are not direct indicators of extensive occlusion. Pathologic Q wave=Complete oQclusion

B. Pathologic Q wave The presence of a pathologic Q wave, as often accompanies STEMI, is indicative of complete coronary occlusion. Sinus tachycardia, fibrillatory P waves (e.g., atrial fibrillation), or a prolonged PR interval (first-degree heart block) are not direct indicators of extensive occlusion.

What should you teach patients with chronic stable angina? A. Do isometric arm exercises to build endurance. B. Wear a face mask when outdoors in cold weather. C. Drive to an emergency department if there is no relief after three nitroglycerin tablets. D. Notify a physician if you experience headache with nitroglycerin.

B. Wear a face mask when outdoors in cold weather.

A nurse is caring for a client who was admitted 24 hr ago with deep partial-thickness and full-thickness burns to 40% of his body. Which of the following are expected ndings in this client? (Select all that apply.) A. Hypertension B. Bradycardia C. Hyperkalemia D. Hyponatremia E. Decreased hematocrit

C, D A. INCORRECT: *Hypotension* occurs when a client is in shock. B. INCORRECT: *Tachycardia* occurs when a client is in shock. C. CORRECT: Hyperkalemia occurs when a client is in shock as a result of leakage of uid from the intracellular space. D. CORRECT: Hyponatremia occurs when a client is in shock as a result in sodium retention in the interstitial space. E. INCORRECT: An *increased hematocrit* occurs when a client is in shock.

A patient is admitted with first- and second-degree burns covering the face, neck, entire right upper extremity, and the right anterior trunk area. Using the rule of nines, the nurse would calculate the extent of these burns as being? A. 9%. B. 18%. C. 22.5%. D. 36%.

C. 22.5%. Using the rule of nines, the face and neck together encompass 4.5% of the body area; the right upper arm encompasses 9% of the body area; and the entire anterior trunk encompasses 18% of the body area. Since the patient has burns on only the right side of the anterior trunk, the nurse would assess that burn as encompassing half of the 18%, or 9%. Therefore adding the three areas together, the nurse would correctly calculate the extent of this patient's burns to cover approximately 22.5% of the total body surface area.

A nurse is reviewing the common emergency management protocol for clients during a cardiac emergency. Which of the following is an appropriate action by the nurse? A. Administer IV dobutamine (Dobutrex). B. Administer IV dopamine (Intropin). C. Administer IV epinephrine (Adrenaline). D. Administer IV atropine (Atropair).

C. Administer IV epinephrine (Adrenaline).

The patient presents to the emergency department with crushing chest pain. The electrocardiogram (ECG) is completed within 5 minutes and is normal. What future action is most important? A. Administer 30 mL of antacid. B. Reassure the patient. C. Repeat the ECG later. D. Obtain blood for a complete blood cell (CBC) count.

C. Repeat the ECG later.

C. The most significant indicator of shock is a change in the level of consciousness.

A nurse on a cardiac unit is reviewing the laboratory ndings of a client who has a diagnosis of myocardial infarction (MI) and reports that his dyspnea began 2 weeks ago. Which of the following cardiac enzymes would con rm the infarction occurred 14 days ago? A. CK-MB B. Troponin I C. Troponin T D. Myoglobin

C. Troponin T

The patient was found after lying out all night in the winter. Profound bradycardia and absent pulses are present. What action should be attempted before the patient is pronounced dead? A. Defibrillate with 360 joules B. Apply high-flow oxygen C. Warm patient to 86° F (30° C) D. Start warmed, intravenous fluids

C. Warm patient to 86° F (30° C) The patient *should be warmed, if possible, before being pronounced dead.* Severe hypothermia makes the *person appear dead because the metabolic rate is so slow* that it can be difficult to detect the heart rate and respirations. Reflexes may be absent, and the *pupils can be fixed and dilated*. A person is not considered dead until he is warm (at least 86° F [30° C]) and dead. Reference: 1776

What is considered a level 1 on the ESI?

Cardiac Arrest, Respiratory Arrest, Sp02 of less than 90, OD < 6 RR, Anaphylaxis, hypoglycemic with change in LOC, falls head trauma

A type of shock in which a patient experiences deceased cardiac output and tissue hypoxia despite adequate intravascular volume?

Cardiogenic Shock

Which types of shock would not require fluid resuscitation?

Cariogenic and Neurogenic Shock

The _________ artery supplies the Left Atrium?

Circumflex

The initial treatment of dog and cat bites includes?

Cleaning, Irrigation, Debridement and Analgesics

After teaching a patient with chronic stable angina about nitroglycerin, the nurse recognizes the need for further teaching when the patient states? A. "I will replace my nitroglycerin supply every 6 months." B. "I will take acetaminophen (Tylenol) to treat the headache caused by nitroglycerin." C. "I will take the nitroglycerin 10 minutes before planned activity that usually causes chest pain." D. "I can take up to five tablets every 3 minutes for relief of my chest pain."

D. "I can take up to five tablets every 3 minutes for relief of my chest pain." It is *3 tablets every 5 minutes* not 5 every 3. THAT IS ONLY IF SYMPTOMS IMPROVE AFTER FIRTS ONE!!!! If symptoms are unchanged or worse after 5 minutes, the patient should be instructed to activate the emergency medical services (EMS) system.

When caring for a critically ill patient who is being mechanically ventilated, the nurse will astutely monitor for which of the following clinical manifestations of multiple organ dysfunction syndrome (MODS)? A. Increased gastrointestinal (GI) motility B. Increased serum albumin C. Decreased blood urea nitrogen (BUN)/creatinine ratio D. Decreased respiratory compliance

D. Decreased respiratory compliance Clinical manifestations of MODS include symptoms of respiratory distress, signs and symptoms of decreased renal perfusion, decreased serum albumin and prealbumin, decreased GI motility, acute neurologic changes, myocardial dysfunction, disseminated intravascular coagulation (DIC), and changes in glucose metabolism.

The patient had an SCD incident caused by a lethal rhythm and now has an implantable cardioverter-defibrillator (ICD). He arrives in the emergency department today unresponsive and in ventricular fibrillation. What action should you take? A. Administer amiodarone (Cordarone). B. Administer epinephrine. C. Check the ICD's battery. D. Defibrillate.

D. Defibrillate.

Multiple patients arrive in the emergency department from a house fire. Which patient is a priority? A. Patient with erythremic, dry burns over the arms and a history of taking prednisone B. Patient with moist blisters over the chest and who reports pain as 10 C. Patient with dry, black skin on one hand and a history of diabetes mellitus D. Patient with multiple reddened skin areas on the chest and with high-pitched respiratory sounds

D. Patient with multiple reddened skin areas on the chest and with high-pitched respiratory sounds Airway injury is a priority, and *stridor results from a narrowing of the airway caused by edema*. A history of prednisone use or diabetes is a concern for long-term infection risk.

Multiple patients arrive in the emergency department from a house fire. *Which patient is a priority?* A. Patient with erythremic, dry burns over the arms and a history of taking prednisone B. Patient with moist blisters over the chest and who reports pain as 10 C. Patient with dry, black skin on one hand and a history of diabetes mellitus D. Patient with multiple reddened skin areas on the chest and with high-pitched respiratory sounds

D. Patient with multiple reddened skin areas on the chest and with high-pitched respiratory sounds.

What intervention is of primary importance in a patient with septic shock? A. Obtain an electrocardiogram (ECG). B. Administer norepinephrine (Levophed). C. Measure the mean arterial pressure (MAP). D. Start two 14-gauge intravenous (IV) access lines.

D. Start two 14-gauge intravenous (IV) access lines. *Except for cardiogenic and neurogenic shock, all other types of shock involve decreased circulating blood volume.* The cornerstone of therapy for septic shock is volume expansion. Insert two large-bore (14- to 16-gauge) IV catheters, and then administer crystalloids (normal saline) and colloids (albumin) for fluid resuscitation.

What are the components of the secondary survey in ED nursing?

FGH

Silver sulfadiazine (Silvadene) and Mafenide acetate (Sulfamylon) are used to prevent ________ of burns?

Infection by bacteria (watch for sulfa allergies)

Know treatment for cat and dog bites

Initial treatment: clean with copious irrigation, debridement, tetanus prophylaxis, and analgesics Prophylactic antibiotics for bites at risk for infection • Wounds over joints • Wounds less than 6 to 12 hours old • Puncture wounds • Bites on hand or foot Rabies prophylaxis essential in management of animal bites

*Aspirin* 162-325 should be taken ASAP after symptom onset during ACS. What does it do?

It inhibits platelet aggregation and vasoconstriction by inhibiting thromboxane

How do electrical burns cause ATN and kidney injury?

Myoglobin and hemoglobin from damaged muscle and RBCs clog the kidneys

Tridil is IV _________ ?

Nitroglycerin

*Severe sepsis* is when you have a systematic inflammation due to an infection (sepsis) and ________ ?

Organ Dysfunction

*What does PQRST stand for in the assessment of angina?*

P-Precipating factors Q-Quality of pain R-Radiation of pain S-Severity of pain T-Timing

___________ is an inflammatory state affecting the whole body?

SIRS

In terms of ACS, NSTEMI or UA usually result from a partially or intermittently occluded artery where as ________ results from a fully occluded artery?

STEMI

The *left anterior descending* (LCA) supplies the _______ ?

Septum, anterior and lateral surface of Left Ventricle

Lactated Ringers is a crystalloid, isotonic solution used to help patients with anaphylactic shock. How does lactated ringers help correct metabolic acidosis?

The lactate in Lactated Ringers is metabolized into bicarbonate by the liver

What is *relative hypovolemia?*

This is when a patient is normovolemic but experiences hypotension due to vasodilation. Patients with distributive shock (septic, neurogenic and anaphylactic) experience *relative hypovolemia* while patients with cardiogenic and hypovolemic shock experience *absolute hypovolemia*. This is why neurogenic shock is not treated with fluids, but rather vasopressors and atropine.

Describe the criteria for each of the phases of burn injury and the approximate time frame of each phase. a. Emergent b. Acute c. Rehabilitation

a. Fluid loss and formation of edema—usually 24 to 48 hours but might be up to 5 days. b. Mobilization of fluid and diuresis—weeks to months. c. Burned area covered and wounds healed—weeks to months

A patient with deep partial-thickness burns over 45% of his trunk and legs is going for debridement in the cart shower 48 hours postburn. The drug of choice to control the patient's pain during this activity is? a. IV morphine. b. midazolam (Versed). c. IM meperidine (Demerol). d. long-acting oral morphine

a. IV morphine. Morphine is the drug of choice for pain control, and during the emergent phase, it should be administered IV because *GI function is impaired* and IM injections will not be absorbed adequately.

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 hemodynamic monitoring reveals a change in? a. SvO2 from 62% to 54%. b. SV from 52 to 68 mL/beat. c. CO from 4.2 L/min to 4.8 L/min. d. SVR from 1300 to 1120 dyne/sec/cm5.

a. SvO2 from 62% to 54%. A decreased mixed venous oxygen saturation (SvO2) indicates that the patient has used the venous oxygen reserve and is at greater risk for anaerobic metabolism. The SvO2 decreases when more oxygen is used by the cells, as in activity or hypermetabolism. All the other values indicate an improvement in the patient's condition. *Maintain ScvO2 > 70*

The nurse recognizes that fibrinolytic therapy for the treatment of an MI has not been successful when the patient? a. continues to have chest pain. b. develops major GI or genitourinary (GU) bleeding during treatment. c. has a marked increase in CK enzyme levels within 3 hours of therapy. d. develops premature ventricular contractions and ventricular tachycardia during treatment

a. continues to have chest pain. Relief of chest pain, return of ST segment to baseline and reprofusion dysrthmias are al signs it worked

To help a burn patient who has developed an increasing dread of painful dressing changes, it would be most appropriate to ask the health care provider to prescribe? a. midazolam (Versed) to be used with morphine before dressing changes. b. morphine in a dosage range so that more may be given before dressing changes. c. buprenorphine (Buprenex) to be administered with morphine before dressing changes. d. patient-controlled analgesia so that the patient may have control over analgesic administration.

a. midazolam (Versed) to be used with morphine before dressing changes. Midazolam is useful when patients'anticipation of the pain experience increases their pain because it causes a short-term memory loss; and, if given before a dressing change, the patient will not recall the event. A dosage range of morphine is useful, as is patient-controlled analgesia, but seldom will these doses effectively relieve the discomfort of dressing changes. Buprenorphine is an opioid agonist/antagonist and cannot be used with other opioids.

During the *rehabilitation phase* of a burn injury, the contour of scarring can be controlled with? a. pressure garments. b. avoidance of sunlight. c. splinting joints in extension. d. application of emollient lotion

a. pressure garments.

A patient is admitted to the CCU with a diagnosis of unstable angina. Which of the following medications would the nurse expect the patient to receive (select all that apply)? a.antiplatelet therapy. b.fibrinolytic therapy. c.β-adrenergic blockers. d.prophylactic antibiotics. e.intravenous nitroglycerin.

a.antiplatelet therapy. c.β-adrenergic blockers. e.intravenous nitroglycerin. Oxygen, nitroglycerin, aspirin (chewable), and morphine may be used to treat unstable angina. For patients with unstable angina with negative cardiac markers and ongoing angina, a combination of aspirin, heparin, and a glycoprotein IIb/IIIa inhibitor (e.g., eptifibatide [Integrilin]) is recommended. β-Adrenergic blockers decrease myocardial oxygen demand by reducing heart rate, blood pressure, and contractility.

When assessing a patient with a partial-thickness burn, the nurse would expect to find (select all that apply)? a.blisters. b.exposed fascia. c.exposed muscles. d.intact nerve endings. e.red, shiny, wet appearance.

a.blisters. d.intact nerve endings. e.red, shiny, wet appearance. partial-thickness involves the dermis

A patient admitted to the hospital for evaluation of chest pain has no abnormal serum cardiac markers 4 hours after the onset of pain. A noninvasive diagnostic test that can differentiate angina from other types of chest pain is a (n)? a. ECG. b. exercise stress test. c. coronary angiogram. d. transesophageal echocardiogram

b. exercise stress test.

A patient's deep partial-thickness burns are treated with the open method. When caring for the patient, the nurse? a. ensures that sterile water is used in the debridement tank. b. wears a cap, mask, gown, and gloves during patient contact. c. uses sterile gloves to remove the dressings and wash the wounds. d. applies topical antimicrobial ointment with clean gloves to prevent wound trauma.

b. wears a cap, mask, gown, and gloves during patient contact. b. Rationale: When the patient's wounds are exposed with the open method, the staff must wear caps, masks, gowns, and gloves. Sterile water is not necessary in the debridement tank, and topical antiinfective agents should be applied with sterile gloves. If some dressings are used with the open method, they are removed and wounds washed with clean gloves.

An elderly man arrives in triage disoriented and tachypneic. His skin is hot and dry. His wife states that he was fine earlier today. The nurse's next priority would be to? a.obtain a detailed medical history from his wife. b.assess his vital signs, including a rectal temperature. c.determine the kind of insurance he has before treating him. d.start supplemental oxygen and have the ED physician see him.

b.assess his vital signs, including a rectal temperature. *After the primary survey, the triage nurse should obtain a full set of vital signs, including temperature. Core body temperature can be obtained rectally. Clinical manifestations of heatstroke include hot, dry skin; altered mental status (ranging from confusion to coma); hypotension; tachycardia; weakness, and a temperature higher than 104° F (40° C).* Reference: 1769

While obtaining patient histories, the nurse identifies that the patient with the highest risk for CAD is? a. a white man, age 54, who is a smoker and has a stressful lifestyle. b. an African American man, age 65, with obesity and a blood pressure (BP) of 130/86. c. a white woman, age 72, with a BP of 172/100 and who is physically inactive. d. an Asian woman, age 45, with a cholesterol level of 240 mg/dL and a BP of 130/75.

c. a white woman, age 72, with a BP of 172/100 and who is physically inactive.

Angina occurs with myocardial ischemia as a result of? a. death of myocardial tissue. b. dysrhythmias caused by cellular irritability. c. lactic acid accumulation during anaerobic metabolism. d. elevated pressure in the ventricles and pulmonary vessels.

c. lactic acid accumulation during anaerobic metabolism.

The nurse explains to the patient who is to undergo a coronary artery bypass graft (CABG) that the procedure most often involves? a. using a synthetic graft as a tube for blood flow from the aorta to a coronary artery distal to an obstruction. b. resecting a stenosed coronary artery and inserting a synthetic arterial tube graft to replace the diseased artery. c. loosening the internal mammary artery from the chest wall and attaching it to a coronary artery distal to a stenosis. d. anastomosing reversed segments of a saphenous artery from the aorta to the coronary artery distal to an obstructio

c. loosening the internal mammary artery from the chest wall and attaching it to a coronary artery distal to a stenosis.

At the end of the emergent phase and the initial acute phase of burn injury, a patient has a serum sodium level of 152 mEq/L (152 mmol/L) and a serum potassium level of 2.8 mEq/L (2.8 mmol/L). The nurse recognizes that these imbalances could occur as a result of? a. free oral water intake. b. prolonged hydrotherapy. c. mobilization of fluid and electrolytes at the acute phase. d. excessive fluid replacement with dextrose in water without potassium supplementation.

c. mobilization of fluid and electrolytes at the *acute phase.*

c. mobilization of fluid and electrolytes at the acute phase. At the end of the emergent phase, fluid mobilization moves potassium back into the cells and sodium returns to the vascular space, causing *hypokalemia and hypernatremia*. As diuresis in the acute phase continues, sodium will be lost in the urine and potassium will continue to be low unless it is replaced. Excessive fluid replacement with 5% dextrose in water without potassium supplementation can cause hyponatremia with hypokalemia. Prolonged hydrotherapy and free oral water intake can cause a decrease in both sodium and potassium.

An elderly woman arrives in the ED complaining of severe pain in her right shoulder. The nurse notes that her clothes are soiled with urine and feces. She tells the nurse that she lives with her son and that she "fell." She is tearful and asks you if she can be admitted. The nurse should consider which of the following? a.Paranoia b.Possible cancer c.Family violence d.Orthostatic hypertension

c.Family violence

Priority Decision: A patient hospitalized for evaluation of unstable angina experiences severe chest pain and calls the nurse. Prioritize the interventions below from 1 (highest priority) to 6 (lowest priority). These are the appropriate medical orders and/or protocols available to the nurse. a. Notify the physician. b. Perform a focused assessment of the chest. c. Assess pain (PQRST) and medicate as ordered. d. Administer oxygen per nasal cannula. e. Obtain a 12-lead ECG. f. Check patient's VS.

d, c, f, e, b, a d. Administer oxygen per nasal cannula. (FIRST) c. Assess pain (PQRST) and medicate as ordered. f. Check patient's VS. e. Obtain a 12-lead ECG. b. Perform a focused assessment of the chest. a. Notify the physician.

The development of MODS is confirmed in a patient who manifests? a. a urine output of 30 mL/hr, a BUN of 65 mg/dL, and a WBC of 1120/mL. b. upper GI bleeding, Glasgow Coma Scale (GCS) score of 7, and an Hct of 25%. c. respiratory rate of 45/min, a PaCO2 of 60, and a chest x-ray with bilateral diffuse patchy infiltrates. d. an elevated serum amylase and lipase, a serum creatinine of 3.8 mg/dL, and a platelet count of 15,000/m

d. an elevated serum amylase and lipase, a serum creatinine of 3.8 mg/dL, and a platelet count of 15,000/m d. Rationale: The presence of MODS is confirmed when there is defined clinical evidence of failure of more than one organ. Elevated serum lipase and amylase levels indicate pancreatic failure, a serum creatinine of 3.8 mg/dL indicates kidney failure, and a platelet count of 15,000/mL indicates hematologic failure. Other criteria include urine output less than 0.5 mL/kg/hr, BUN 100 mg/dL or greater, WBC count 1000/mL, upper or lower GI bleeding, GCS score 6 or less, and hematocrit 20% or less. A respiratory rate of 45/min, PaCO2 of 60, and a chest x-ray with bilateral diffuse, patchy infiltrates indicate respiratory failure but not other organ damage.

During administration of IV norepinephrine (Levophed), the nurse should assess the patient for? a. hypotension. b. marked diuresis. c. metabolic alkalosis. d. decreased tissue perfusion

d. decreased tissue perfusion As a vasopressor, norepinephrine may cause severe vasoconstriction, which would further decrease tissue perfusion, especially if fluid replacement is inadequate. Vasopressors generally cause hypertension, reflex bradycardia, and decreased urine output because of decreased renal blood flow; they do not directly affect acid-base balance.

A patient in shock has a nursing diagnosis of fear related to severity of condition and perceived threat of death as manifested by verbalization of anxiety about condition and fear of death. An appropriate nursing intervention for the patient is to? a. administer antianxiety agents. b. allow caregivers to visit as much as possible. c. call a member of the clergy to visit the patient. d. inform the patient of the current plan of care and its rationale.

d. inform the patient of the current plan of care and its rationale.

A patient is being treated for second- and third-degree burns over 30% of his body and is now ready for discharge. The nurse provides discharge instructions related to wound care. Which statement indicates that the patient understands the instructions? a."I can expect occasional periods of low-grade fever and can take Tylenol every 4 hours." b."I must wear my Jobst elastic garment all day and can only remove it when I'm going to bed." c."I will need to take sponge baths at home to avoid exposing the wounds to unsterile bath water." d."If any healed areas break open I should cover them with a sterile dressing and then immediately report it."

d."If any healed areas break open I should cover them with a sterile dressing and then immediately report it."

A patient is admitted to the burn center with burns of his head and neck, chest and back, and left arm and hand following an explosion and fire in his garage. On admission to the unit, the nurse auscultates wheezes throughout the lung fields. On reassessment, the nurse notes that the wheezes are gone and the breath sounds are greatly diminished. Which of the following actions is the most appropriate for the nurse to take next? a.Place the patient in high Fowler's position. b.Encourage the patient to cough and auscultate the lungs again. c.Document the results and continue to monitor the patient's progress. d.Anticipate the need for endotracheal intubation and notify the physician.

d.Anticipate the need for endotracheal intubation and notify the physician.

erase

infarct

Urine output of less than 0.5 mL/kg is an indicator of sepsis. What causes this?

lack of perfusion to kidneys

Why are post-op patients 10 times more likely to die from sepsis?

more prone to infection

The hallmarks of _________ shock are hypotension and bradycardia?

neurogenic

The presence of infection (confirmed or suspected) together with systemic manifestations of infection is called?

sepsis

Severe sepsis with hypotension that persists despite adequate fluid resuscitation is the definition of _______ ?

septic shock

When myocardial ischemia is temporary and reversible, the condition is called ____________ ?

Nurse 4705 EXAM 3 (FINAL CLASS EXAM EVER!!!!)

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