Critical Care Exam 3

A patient is admitted with a brain and spinal cord injury secondary to a motor vehicle crash. The nurse is monitoring the patient for signs of neurogenic shock. Clinical findings in neurogenic shock are related to which pathophysiologic process?

Loss of sympathetic nervous system innervation

The nursing management plan for a patient with thyrotoxicosis would include which intervention?

Maintaining a quiet, restful environment

Diabetes insipidus is caused by:

lack of ADH

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

true

In the patient with diabetes insipidus the patient produces vast quantities of very dilute urine, becomes severely dehydrated, and can become hypovolemic.

true

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

true

Type 1 diabetics must receive exogenous insulin either subcutaneous or IV because they do not produce any of their own insulin and this form of insulin restores the normal entry of glucose into the cells

true

raising the legs and placing the trunk of the patient flat can promote return of blood to the heart

true

A patient has thyroid storm. The nurse is providing medication instruction for home. The patient asks, "If I have a fever, should I take Tylenol or aspirin?" Which response would be the most appropriate?

"Take Tylenol rather than aspirin because aspirin increases the amount of free thyroid hormone in circulation."

A patient with a history of type 2 diabetes was admitted after aneurysm repair. The patient's serum glucose levels have been elevated for the past 2 days, and the patient is concerned about becoming dependent on insulin. Which statement is the nurse's best response to the patient's concerns?

"The stress on your body has temporarily increased your blood sugar levels."

A patient is admitted with diabetic ketoacidosis (DKA). The patient presents with dry, cracked lips and is begging for something to drink. What reply would be the nurse's best response?

"We can't give you anything to drink until we get your blood sugar under control."

A patient is admitted with extreme fatigue, vomiting, and headache. This patient has type 1 diabetes that has been well controlled with an insulin pump. The patient states, "I know it could not be my diabetes because my pump gives me 24-hour control." Which reply would be the nurse's best response?

"We'll check your serum blood glucose and ketones."

A patient has been admitted with hyperosmolar hyperglycemic state (HHS). The nurse knows that intravenous insulin is usually administered at what dosage?

0.1 U/kg/h

A patient with hyperglycemic hyperosmolar state (HHS) has a serum glucose level of 400 mg/dL and a serum sodium level of 138 mEq/L. What is the intravenous fluid of choice?

0.9% NS

Often patients that are in the acute phase of a critical illness will have a disruption in the amount of insulin that is secreted. This will cause a rise in the patient's blood sugar. The ADA recommends the use of continuous insulin infusions to maintain blood glucose in critically ill patients between_________ and ________ with frequent monitoring.

140-180

In the DKA patient, when the blood sugar reaches what level, should the intravenous fluids be changed to a 50/50 mixture of 0.9% normal saline and 5% dextrose?

200

In a patient with shock, enteral nutrition should be started within how many hours?

24-48

When insulin is given to a patient in DKA, the insulin will drive potassium back into the cells decreasing the potassium level. Care should be taken before giving insulin to ensure the patient's potassium level is greater than ________________.

3.3

In the HHS patient, the glucose level should decrease by ___________________ per hour with insulin administration?

50-70

Clinically HHS is distinguished from DKA by the presence of extremely elevated serum glucose, more profound dehydration, and minimal or absent ketosis. Another major difference is that protein and fats are not used to create new supplies of glucose in HHS as they are in DKA. The diagnostic criteria for HHS are blood glucose greater than_________________________.

600

The nurse is caring for a patient in hypovolemic shock secondary to cirrhosis of the liver. The nurse understands that this type of shock results from shifting of fluid into the abdominal cavity. What is the resulting hypovolemia called?

Absolute hypovolemia

A patient presents with ketoacidosis and a blood glucose level of 125 mg/dL. Diabetic ketoacidosis has been ruled out. The nurse knows that ketoacidosis can occur in which condition?

Acute pancreatitis

A patient is admitted with diabetic ketoacidosis (DKA). The patient's arterial blood gas indicates the patient has an uncompensated metabolic acidosis. The patient has rapid, regular respirations. Which medical intervention would the nurse expect to initiate to correct the acidosis?

Administer insulin and fluids intravenously.

The nurse is caring for a patient in septic shock due secondary to pneumonia. The nurse knows that evidence-based guidelines for the treatment of septic shock include which interventions? (Select all that apply.)

Administer norepinephrine to maintain mean arterial pressure of 65 mm Hg. Start enteral nutrition within the first 48 hours after diagnosis of septic shock. Administer 30 mL/kg crystalloid for hypotension or lactate greater than or equal to 4 mmol/L.

The nurse is caring for a patient in shock with an elevated lactate level. Which order should the nurse question in the management of this patient?

Administer sodium bicarbonate to keep arterial pH greater than 7.20.

A patient has been admitted with diabetic ketoacidosis (DKA). The nurse knows that the top priority in the initial treatment of DKA is which intervention?

Administering intravenous fluids

In caring for a patient with a thyrotoxicosis, the nurse would expect to observe which neurologic symptom?

Agitation

Patients discharged with antithyroid medications should be alerted to which potential side effect?

Agranulocytosis

A nurse is caring for a patient in septic shock due to urinary sepsis. Which pathophysiologic mechanism results in septic shock?

Bacterial toxins lead to vasodilation.

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

Blood cultures x2 Wound cultures Urine cultures Sputum cultures

The nurse knows that during the resuscitation of a patient with diabetic ketoacidosis (DKA), the intravenous (IV) line should be changed to a solution containing glucose when what happens?

Blood glucose drops to 200 mg/dL

A patient has been admitted with septic shock due to urinary sepsis. The practitioner inserts a pulmonary artery (PA) catheter. Which hemodynamic value would the nurse expect to note to support this diagnosis?

Cardiac output (CO) of 8 L/min

The most commonly prescribed medication to treat diabetes insipidus is ___________________ because it has strong antidiuretic action with little effect on the blood pressure.

DDAVP

The nurse is caring for a patient in cardiogenic shock. Which hemodynamic parameters would the nurse expect to note for this diagnosis?

Decreased cardiac index

A patient has been admitted with hypovolemic shock due to blood loss. Which finding would the nurse expect to note to support this diagnosis?

Decreased level of consciousness

A patient is admitted with diabetic ketoacidosis (DKA) and is experiencing polyuria. Which electrolyte disturbances would the nurse expect to see at this phase of DKA?

Decreased potassium and sodium levels.

Decreased urine osmolality is a sign of which disorder?

Diabetes insipidus

Patients who have sustained head trauma or have undergone resection of a pituitary tumor have an increased risk of developing which disorder?

Diabetes insipidus

A patient is admitted with a long history of mental illness. The patient's spouse states the patient has been drinking up to 10 gallons of water each day for the past 2 days and refuses to eat. The patient is severely dehydrated and soaked with urine. The nurse suspects the patient has which problem?

Dipsogenic DI

A patient is being admitted with cardiogenic shock secondary to acute heart failure. In addition to a diuretic, which medication would the nurse anticipate the practitioner ordering for the patient?

Epinephrine

A patient with a known penicillin allergy develops anaphylactic shock after a dose of ampicillin was given in error. Which medication would the nurse administer first?

Epinephrine

The nurse is caring for a patient with type 1 diabetes who was admitted with complaints of increased lethargy. Serum laboratory values validate the diagnosis of diabetic ketoacidosis (DKA). Which symptom is most suggestive of DKA?

Excessive thirst

The nurse is caring for a patient with type 1 diabetes who was admitted with complaints of increased lethargy. Serum laboratory values validate the diagnosis of diabetic ketoacidosis (DKA). Which medical intervention would the nurse expect to be ordered for this patient?

Extensive hydration

A patient has been admitted with septic shock related to tissue necrosis. The nurse knows the initial goal for medical management for this patient is which intervention?

Finding and eradicating the cause of infection

An older patient presents with a serum glucose level of 900 mg/dL, hematocrit of 55%, and no serum ketones. Immediate attention must be given to which intervention?

Fluid administration

A patient in cardiogenic shock is being treated in the critical care unit. Which findings would the nurse expect to note in the patient to support this diagnosis? (Select all that apply.)

Heart rate greater than 100 beats/min Weak, thready pulse Increased right atrial pressure

A patient is presenting with signs of diabetes insipidus (DI). Which findings would confirm this diagnosis?

Hyperosmolality and hypernatremia

A patient has developed septic shock. The nurse knows that the patient is at risk for gastrointestinal dysfunction. What happens to the gastrointestinal tract in the patient with septic shock?

Hypoperfusion results in loss of gut barrier function

Which pathophysiologic mechanism occurs in the patient with type 2 diabetes?

Imbalance between insulin production and use

The nurse is caring for a patient in cardiogenic shock. The nurse recognizes that the patient's signs and symptoms are the result of what problem?

Inability of the heart to pump blood forward

A patient is admitted with diabetic ketoacidosis (DKA). The nurse knows that the lack of insulin results in which process?

Increased gluconeogenesis

A patient with type 2 diabetes is admitted. He is very lethargic and hypotensive. A diagnosis of hyperglycemic hyperosmolar syndrome (HHS) is given. Which findings support this diagnosis?

Increased serum osmolality and increased serum glucose

A patient is admitted with diabetic ketoacidosis (DKA). The nurse knows that the dehydration associated with DKA results from which pathophysiologic mechanism?

Increased serum osmolality and urea

A patient in diabetic ketoacidosis (DKA) is comatose with a temperature of 102.2° F. The nurse suspects the patient may have which secondary disorder?

Infection

A patient has been admitted with hypovolemic shock due to traumatic blood loss. Which nursing measure can best facilitate the administration of large volumes of fluid?

Inserting a large-diameter peripheral intravenous catheter

A patient is being admitted from the emergency department (ED) with cardiogenic shock secondary to unstable angina unresponsive to medications. The patient was intubated and ventilated in the ED. Which intervention should the nurse prepare to initiate when the practitioner arrives in the unit?

Insertion of an intraaortic balloon pump (IABP)

The nurse is caring for a patient with type 1 diabetes who was admitted with complaints of increased lethargy. Serum laboratory values validate the diagnosis of diabetic ketoacidosis (DKA). Which statement best describes the rationale for administrating potassium supplements with the patient's insulin therapy?

Insulin drives the potassium back into the cells.

A patient has been admitted after surgery for removal of a brain tumor. The nurse suspects the patient may be developing diabetes insipidus (DI). Which findings would confirm the nurse's suspicion?

Intense thirst and passage of excessively large quantities of dilute urine

A patient with diabetic ketoacidosis (DKA) has an insulin drip infusing, and the nurse has just administered subcutaneous insulin. The nurse is alert for signs of hypoglycemia, which would include what findings?

Irritability and paresthesia

A patient has developed septic shock. The nurse knows that the clinical manifestations of ischemic hepatitis show up 1 to 2 days after the insult. Which finding would the nurse expect to note to support this diagnosis?

Jaundice

A patient was admitted with diabetic ketoacidosis (DKA). Glucose is 349 mg/dL, K is 3.7 mEq/L, and pH is 7.10. Which of the following interventions would you expect? (Select all that apply.)

NS 1.5 L IV fluid bolus Insulin infusion at 5 units/h Potassium 20 mEq/L of IV fluid

The nurse is caring for a patient who what just admitted with septic shock. The nurse knows that certain interventions should be completed within 3 hours of time of presentation. Which intervention would be a priority for the nurse to implement upon receipt of a practitioner's order?

Obtain a serum lactate level

A patient was admitted with diabetic ketoacidosis (DKA) an hour ago and is on an insulin drip. Suddenly, the nurse notices frequent premature ventricular contractions (PVCs) on the electrocardiogram. The nurse notifies the practitioner. The nurse would anticipate an order for which intervention?

Obtaining serum electrolytes

The nurse is caring for a patient with multiple-organ dysfunction syndrome (MODS). The nurse understands that earlier nutritional support is critical for the patient to prevent profound weight loss. Why does this occur in patient MODS?

Patient experiences hypermetabolism.

A patient has been admitted with anaphylactic shock due to an unknown allergen. The nurse understands that the decrease in the patient's cardiac output is the result of which mechanism?

Peripheral vasodilation

The nurse is caring for a critically ill patient with type 1 diabetes. The nurse understands that the patient is at risk for developing diabetic ketoacidosis (DKA) secondary to what etiology?

Physiologic and psychologic stress

A patient has been admitted with diabetic ketoacidosis, and treatment has been initiated. Which findings would lead the nurse to suspect the patient is dehydrated?

Poor skin turgor and flat neck veins

As a patient with diabetic ketoacidosis (DKA) receives insulin and fluids, the nurse knows careful assessment must be given to which electrolyte?

Potassium

When a patient with diabetic ketoacidosis (DKA) has insulin infusing intravenously, the nurse expects a drop in the serum levels of which electrolytes?

Potassium and phosphate

A patient is admitted with severe hyperglycemia. The patient is very lethargic and has a "fruity" odor to his breath. The nurse knows the odor on the patient's breath is indicative of which situation?

Presence of acetone

A nursing instructor is discussing the difference between primary and secondary multiple-organ dysfunction syndrome (MODS) with a nursing student. Which statement indicates the student understood the information?

Primary MODS is the result of a direct organ injury.

The nurse has admitted a patient with hyperglycemic hyperosmolar state (HHS). Which medical intervention would the nurse expect to see ordered for this patient?

Rapid rehydration with intravenous fluids

A patient has been admitted with anaphylactic shock due to an unknown allergen. The nurse understands that the patient is probably having an immunoglobulin E (IgE)-mediated response as a result of what physiologic mechanism?

Repeat exposure to an antigen in the presence of preformed IgE antibodies

The nurse understands that the onset of seizures in the patient with diabetes insipidus (DI) is indicative of which situation?

Severe dehydration

The nurse has admitted a patient with hyperglycemic hyperosmolar state (HHS). Which findings would the nurse expect to observe in this patient?

Severe hyperglycemia with minimal or absent ketosis

A nurse is discussing the concept of shock with a new graduate nurse. Which statement indicates the new graduate nurse understood the information?

Shock is an acute, widespread process of inadequate tissue perfusion.

A patient has been admitted with a neurologic disorder. With which disorder should the nurse be the most vigilant for the development of neurogenic shock?

Spinal cord injury

The 3 hours sepsis bundles includes:

Start antibiotics within 45 minutes (regardless of blood culture completion) crystalloid solution 30ml/kg for decreased BP or lactate >/= 4 blood cultures before antibiotics started lactate level

The nurse is caring for a patient with sepsis due to necrotic tissue. The nurse knows that necrotic tissue can stimulate the inflammatory immune response. Which biochemical mediator is secreted in response to endotoxin or tissue injury?

Tumor necrosis factor

The nurse is caring for a patient with a head injury who has developed diabetes insipidus (DI). What medication would the nurse expect to be prescribed for the patient?

Vasopressin

A patient weighs 140 kg and is 60 inches tall. The patient's blood sugar is being controlled by glipizide. Which topic would be important for the nurse to include in the patient's discharge education plan?

Weight loss

Neurogenic shock is uncommon and the most common cause is

a spinal cord injury

The nurse is caring for a patient with severe hypovolemic shock. Which assessment finding (s) indicate the refractory stage of shock? Select all that apply

absent peripheral pulse skin mottled unresponsive

What medication should be used to decrease the temperature in a patient having a thyroid storm?

acetminophen

In a patient with an anaphylactic reaction what MUST be initially assessed and immediately addressed if compromised?

airway

Cardiogenic shock results in:

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

The nurse is caring for a patient in cardiogenic shock. Which hemodynamic parameters would the nurse expect to note to support this finding?

decreased cardiac output and cardiac index

Neurogenic shock is what type of shock?

distributive

______- shock results from a maldistribution of circulating blood volume.

distributive

________- is an example of a drug that is used to increase contractility and helps to maintain the blood pressure and perfusion. Patient may also have vasopression (norepinephrine) to raise blood pressure.

dobutamine

Thyroid storm can occur in a patient without a pre-existing hyperthyroidism

false

The signs and symptoms of thyroid storm include the following:

hyperactivity of cardiac tissue, nervous tissue and smooth muscle tissue and tremendous heat production

Hypovolemic shock occurs from inadequate fluid volume in what?

intravascular space

The two most common organs to demonstrate dysfunction in severe sepsis are:

lungs heart

In what stage of shock do the compensatory mechanisms begin failing to meet tissue metabolic needs and the shock cycle is perpetuated.

progressive

An elderly patient is admitted with pneumonia. This morning the patient is febrile, tachycardic, tachypneic, and confused. The nurse suspects the patient may be developing what problem?

sepsis

The nurse is caring for a patient with systemic inflammatory response syndrome (SIRS) due to pneumonia. What is SIRS due to infection called?

sepsis

_______ is an acute widespread process of impaired tissue perfusion that results in cellular, metabolic, and hemodynamic alteration.

shock

A patient is admitted after surgery with a history of hyperthyroidism. The nurse suspects the patient may be developing thyroid storm. Which finding would confirm this suspicion?

tachycardia

Adequate pulmonary gas exchange is critical to oxygen transport and adequate cardiac output and hemoglobin are crucial to the oxygen transport.

true