Exam 3 Med- Surg Advanced

Which finding about a patient who is receiving vasopressin to treat septic shock indicates an immediate need for the nurse to contact the health care provider? The patient's urine output is 18 mL/hr. The patient's heart rate is 110 beats/min. The patient's peripheral pulses are weak. The patient reports diffuse chest pressure.

The patient reports diffuse chest pressure. Because vasopressin is a potent vasoconstrictor, it may decrease coronary artery perfusion and cause chest pain or pressure. Low urine output, weal pulses, and tachycardia are consistent with the patient's diagnosis. They and should be reported to the health care provider but do not require an immediate need for a change in therapy.

When requested to plan the response to the potential use of smallpox as a biological weapon, what should the emergency department (ED) nurse manager expect to obtain? Vaccine Atropine Antibiotics Whole blood

Vaccine

When assessing an older patient admitted to the emergency department (ED) with a broken arm and facial bruises, the nurse observes several additional bruises in various stages of healing. Which statement or question by the nurse should be first? "You should not go home." "Do you feel safe at home?" "Would you like to see a social worker?" "I need to report my concerns to the police."

"Do you feel safe at home?"

The emergency department (ED) triage nurse is assessing four victims involved in a motor vehicle collision. Which patient has the highest priority for treatment? A patient with no pedal pulses A patient with an open femur fracture A patient with paradoxical chest motion A patient with bleeding facial lacerations

A patient with paradoxical chest motion

A patient who has experienced blunt abdominal trauma during a motor vehicle collision reports increasing abdominal pain. What topic will the nurse plan to teach the patient? Peritoneal lavage Abdominal ultrasonography Nasogastric (NG) tube placement Magnetic resonance imaging (MRI)

Abdominal ultrasonography For patients who are at risk for intraabdominal bleeding, focused abdominal ultrasonography is the preferred method to assess for intraperitoneal bleeding. An MRI would not be used. Peritoneal lavage is an alternative, but it is more invasive. An NG tube would not be helpful in the diagnosis of intraabdominal bleeding.

An unresponsive 79-yr-old patient is admitted to the emergency department (ED) during a summer heat wave. The patient's core temperature is 105.4° F (40.8° C), blood pressure (BP) is 88/50 mm Hg, and pulse is 112 beats/min. What action should the nurse plan to take? Apply wet sheets and a fan to the patient. Provide O2 at 2 L/min with a nasal cannula. Start lactated Ringer's solution at 1000 mL/hr. Give acetaminophen (Tylenol) rectal suppository.

Apply wet sheets and a fan to the patient.

Family members are in the patient's room when the patient has a cardiac arrest and the staff start resuscitation measures. Which action should the nurse take next?a. Keep the family in the room and assign a staff member to explain the care given and answer questions. Ask the family to wait outside the patient's room with a staff member to provide emotional support. Ask the family members whether they would prefer to remain in the patient's room or wait outside the room. Tell the family members that patients are comforted by having family members present during resuscitation efforts.

Ask the family members whether they would prefer to remain in the patient's room or wait outside the room.

Which interventions will the nurse plan for a comatose patient who will have targeted temperature management/therapeutic hypothermia? (Select all that apply.) Assist with endotracheal intubation. Insert an indwelling urinary catheter. Begin continuous cardiac monitoring. Prepare to give sympathomimetic drugs. Obtain a prescription for patient restraints.

Assist with endotracheal intubation, Insert an indwelling urinary catheter, Begin continuous cardiac monitoring.

Gastric lavage and administration of activated charcoal are prescribed for an unconscious patient who has been admitted to the emergency department (ED) after ingesting 30 lorazepam (Ativan) tablets. Which prescribed action should the nurse plan to do first? Insert a large-bore orogastric tube. Assist with intubation of the patient. Prepare a 60-mL syringe with saline. Give first dose of activated charcoal.

Assist with intubation of the patient.

The following interventions are part of the emergency department (ED) protocol for a patient who has been admitted with multiple bee stings to the hands. Which action should the nurse take first? Apply ice packs to both hands. Attempt to remove the patient's rings. Apply calamine lotion to itching areas. Give diphenhydramine (Benadryl) 50 mg PO.

Attempt to remove the patient's rings.

A 22-yr-old patient who experienced a drowning accident in a local pool, but now is awake and breathing spontaneously, is admitted for observation. Which assessment will be most important for the nurse to take during the observation period? Auscultate heart sounds. Palpate peripheral pulses. Check mental orientation. Auscultate breath sounds

Auscultate breath sounds

A patient arrives in the emergency department (ED) after topical exposure to powdered lime at work. Which action should the nurse take first? Obtain the patient's vital signs. Obtain a baseline complete blood count. Brush visible powder from the skin and clothing. Decontaminate the patient by showering with water.

Brush visible powder from the skin and clothing.

The following four patients arrive in the emergency department (ED) after a motor vehicle collision. In which order should the nurse assess them? (Put a comma and a space between each answer choice [A, B, C, D, E].) A 43-yr-old patient reporting 7/10 abdominal pain A 74-yr-old patient with palpitations and chest painc. A 21-yr-old patient with multiple fractures of the face and jaw A 37-yr-old patient with a misaligned lower leg and intact pulses

C, B, A, D

A patient who is unconscious after a fall from a ladder is transported to the emergency department by emergency medical personnel. What should the nurse do during the primary survey of the patient? Obtain a complete set of vital signs. Check a Glasgow Coma Scale score. Attach an electrocardiogram monitor. Ask about chronic medical conditions.

Check a Glasgow Coma Scale score. The Glasgow Coma Scale is included when assessing for disability during the primary survey. The other information is part of the secondary survey.

To evaluate the effectiveness of the pantoprazole (Protonix) given to a patient with systemic inflammatory response syndrome (SIRS), which assessment will the nurse perform? Auscultate bowel sounds. Ask the patient about nausea. Check stools for occult blood. Palpate for abdominal tenderness.

Check stools for occult blood. Proton pump inhibitors are given to decrease the risk for stress ulcers in critically ill patients. The other assessments will also be done, but these will not help in determining the effectiveness of the pantoprazole administration.

A patient with cardiogenic shock has the following vital signs: BP 102/50, pulse 128, respirations 28. The pulmonary artery wedge pressure (PAWP) is high, and cardiac output is low. Which treatment would the nurse expect to be prescribed? Furosemide Hydrocortisone Epinephrine drip 5% albumin infusion

Furosemide The PAWP indicates that the patient's preload is elevated. Furosemide is indicated to reduce the preload and improve cardiac output. Epinephrine would further increase the heart rate and myocardial oxygen demand. 5% albumin would also increase the PAWP. Hydrocortisone might be considered for septic or anaphylactic shock.

A patient with massive trauma and possible spinal cord injury is admitted to the emergency department (ED). Which assessment finding by the nurse will help confirm a diagnosis of neurogenic shock? Inspiratory crackles Heart rate 45 beats/min Cool, clammy extremities Temperature 101.2° F (38.4° C)

Heart rate 45 beats/min Neurogenic shock is characterized by hypotension and bradycardia. The other findings would be more consistent with other types of shock.

An older patient with cardiogenic shock is cool and clammy. Hemodynamic monitoring indicates a high systemic vascular resistance (SVR). Which intervention should the nurse anticipate? Increase the rate for the dopamine infusion. Decrease the rate for the nitroglycerin infusion. Increase the rate for the sodium nitroprusside infusion. Decrease the rate for the 5% dextrose in normal saline infusion.

Increase the rate for the sodium nitroprusside infusion. Nitroprusside is an arterial vasodilator and will decrease the SVR and afterload, which will improve cardiac output. Changes in the D5/.9 NS and nitroglycerin infusions will not directly decrease SVR. Increasing the dopamine will tend to increase SVR.

A nurse is caring for a patient whose hemodynamic monitoring indicates a blood pressure of 92/54 mm Hg, a pulse of 64 beats/min, and a high pulmonary artery wedge pressure (PAWP). Which intervention prescribed by the health care provider should the nurse question? Elevate head of bed to 30 degrees. Infuse normal saline at 250 mL/hr. Hold nitroprusside if systolic BP is less than 90 mm Hg. Titrate dobutamine to keep systolic BP is greater than 90 mm Hg.

Infuse normal saline at 250 mL/hr. The patient's elevated PAWP indicates volume excess in relation to cardiac pumping ability, consistent with cardiogenic shock. A saline infusion at 250 mL/hr will worsen the volume excess. The other actions will help to improve cardiac output, which should lower the PAWP and may raise the BP.

16. When the nurse educator is evaluating the skills of a new registered nurse (RN) caring for patients with shock, which action by the new RN indicates a need for more education? Placing the pulse oximeter on the ear for a patient with septic shock Keeping the head of the bed flat for a patient with hypovolemic shock Maintaining a cool room temperature for a patient with neurogenic shock Increasing the nitroprusside for a patient with cardiogenic shock and a high SVR

Maintaining a cool room temperature for a patient with neurogenic shock Patients with neurogenic shock have poikilothermia. The room temperature should be kept warm to avoid hypothermia. The other actions by the new RN are appropriate.

After change-of-shift report in the progressive care unit, who should the nurse care for first? Patient who had an inferior myocardial infarction 2 days ago and has crackles in the lung bases. Patient who had a T5 spinal cord injury 1 week ago and currently has a heart rate of 54 beats/min. Patient with suspected urosepsis who has new prescriptions for urine and blood cultures and antibiotics. Patient admitted with anaphylaxis 3 hours ago who has clear lung sounds and a blood pressure of 108/58 mm Hg.

Patient with suspected urosepsis who has new prescriptions for urine and blood cultures and antibiotics. Antibiotics should be given within the first hour for patients who have sepsis or suspected sepsis to prevent progression to systemic inflammatory response syndrome and septic shock. The data on the other patients indicate that they are more stable. Crackles heard only at the lung bases do not need immediate intervention in a patient who has had a myocardial infarction. Mild bradycardia does not usually need treatment in patients with a spinal cord injury. The findings for the patient admitted with anaphylaxis show resolution of bronchospasm and hypotension.

Anthe ice while ice skating. Which assessment will the nurse obtain first? Pulse Heart rhythm Breath sounds Body temperature

Pulse

A 19-yr-old patient is brought to the emergency department (ED) with multiple lacerations and tissue avulsion of the left hand. When asked about tetanus immunization, the patient denies having any previous vaccinations. What should the nurse anticipate giving? a. Tetanus immunoglobulin (TIG) only b. TIG and tetanus-diphtheria toxoid (Td) c. Tetanus-diphtheria toxoid and pertussis vaccine (Tdap) only d. TIG and tetanus-diphtheria toxoid and pertussis vaccine (Tdap)

TIG and tetanus-diphtheria toxoid and pertussis vaccine (Tdap) For an adult with no previous tetanus immunizations, TIG and Tdap are recommended. The other immunizations are not sufficient for this patient.

A patient who has deep human bite wounds on the left hand is being treated in the urgent care center. Which action will the nurse plan to take? Prepare to administer rabies immune globulin. Assist the health care provider with suturing the wounds. Teach the patient the reason for the use of prophylactic antibiotics. Keep the wounds dry until the health care provider can assess them.

Teach the patient the reason for the use of prophylactic antibiotics.

Which finding indicates that the nurse should discontinue active rewarming of a patient admitted with hypothermia? The patient begins to shiver. The BP decreases to 86/42 mm Hg. The patient develops atrial fibrillation. The core temperature is 94° F (34.4° C).

The core temperature is 94° F (34.4° C).

Which finding is the best indicator that the fluid resuscitation for a 90-kg patient with hypovolemic shock has been effective? There are no signs of hemorrhage. Hemoglobin is within normal limits. Urine output 65 mL over the past hour. Mean arterial pressure (MAP) is 72 mm Hg.

Urine output 65 mL over the past hour. Assessment of end organ perfusion, such as an adequate urine output, is the best indicator that fluid resuscitation has been successful. Urine output should be equal to or more than 0.5 mL/kg/hr. The hemoglobin level and MAP are useful in determining the effects of fluid administration, but they are not as useful as data indicating good organ perfusion. The absence of hemorrhage helps to prevent further fluid loss but does not reflect fluid balance.

Following an earthquake, patients are triaged by emergency medical personnel and transported to the emergency department (ED). Which patient will the nurse need to assess first? A patient with a red tag A patient with a blue tag A patient with a black tag A patient with a yellow tag

A patient with a red tag

A patient with hypotension and an elevated temperature after working outside on a hot day is treated in the emergency department (ED). Which patient statement indicates to the nurse that discharge teaching has been effective? "I'll take salt tablets when I work outdoors in the summer." "I should take acetaminophen (Tylenol) if I start to feel too warm." "I need to drink extra fluids when working outside in hot weather." "I'll move to a cool environment if I notice that I'm feeling confused"

"I need to drink extra fluids when working outside in hot weather." Oral fluids and electrolyte replacement solutions such as sports drinks help replace fluid and electrolytes lost when exercising in hot weather. Salt tablets are not recommended because of the risks of gastric irritation and hypernatremia. Antipyretic drugs are not effective in lowering body temperature elevations caused by excessive exposure to heat. A patient who is confused is likely to have more severe hyperthermia and will be unable to remember to take appropriate action.

Which preventive actions by the nurse will help limit the development of systemic inflammatory response syndrome (SIRS) in patients admitted to the hospital? (Select all that apply.) Ambulate postoperative patients as soon as possible after surgery. Use aseptic technique when manipulating invasive lines or devices. Remove indwelling urinary catheters as soon as possible after surgery. Administer prescribed antibiotics within 1 hour for patients with possible sepsis. Advocate for parenteral nutrition for patients who cannot take in adequate calories.

A, B, C, D Because sepsis is the most frequent etiology for SIRS, measures to avoid infection such as removing indwelling urinary catheters as soon as possible, use of aseptic technique, and early ambulation should be included in the plan of care. Adequate nutrition is important in preventing SIRS. Enteral, rather than parenteral, nutrition is preferred when patients are unable to take oral feedings because enteral nutrition helps maintain the integrity of the intestine, thus decreasing infection risk. Antibiotics should be given within 1 hour after being prescribed to decrease the risk of sepsis progressing to SIRS.

A patient with suspected neurogenic shock after a diving accident has arrived in the emergency department. A cervical collar is in place. Which actions should the nurse take? (Select all that apply.) Prepare to administer atropine IV. Obtain baseline body temperature. Infuse large volumes of lactated Ringer's solution. Provide high-flow O2 (100%) by nonrebreather mask. Prepare for emergent intubation and mechanical ventilation.

A, B, D, E All the actions are appropriate except to give large volumes of lactated Ringer's solution. The patient with neurogenic shock usually has a normal blood volume, and it is important not to volume overload the patient. In addition, lactated Ringer's solution is used cautiously in all shock situations because an ischemic liver cannot convert lactate to bicarbonate.

The following interventions are prescribed by the health care provider for a patient who has respiratory distress and syncope after eating strawberries. Which will the nurse complete first? Give diphenhydramine. Administer epinephrine. Start continuous ECG monitoring. Draw blood for complete blood count.

Administer epinephrine. Epinephrine rapidly causes peripheral vasoconstriction, dilates the bronchi, and blocks the effects of histamine and reverses the vasodilation, bronchoconstriction, and histamine release that cause the symptoms of anaphylaxis. The other interventions are also appropriate but would not be the first ones completed.

A 78-kg patient in septic shock has a pulse rate of 120 beats/min with low central venous pressure and pulmonary artery wedge pressure. After initial fluid volume resuscitation, the patient's urine output has been 30 mL/hr for the past 3 hours. Which order by the health care provider should the nurse question? Administer furosemide (Lasix) 40 mg IV. Increase normal saline infusion to 250 mL/hr. Give hydrocortisone (Solu-Cortef) 100 mg IV. Use norepinephrine to keep systolic BP above 90 mm Hg.

Administer furosemide (Lasix) 40 mg IV. Furosemide will lower the filling pressures and renal perfusion further for the patient with septic shock. Patients in septic shock need large amounts of fluid replacement. If the patient is still hypotensive after initial volume resuscitation with minimally 30 mL/kg, vasopressors such as norepinephrine may be added. IV corticosteroids may be considered for patients in septic shock who cannot maintain an adequate BP with vasopressor therapy despite fluid resuscitation.

A patient with septic shock has a BP of 70/46 mm Hg, pulse of 136 beats/min, respirations of 32 breaths/min, temperature of 104° F, and blood glucose of 246 mg/dL. Which intervention ordered by the health care provider should the nurse implement first? Acetaminophen (Tylenol) 650 mg rectally. Administer normal saline IV at 500 mL/hr. Start norepinephrine to keep blood pressure above 90 mm Hg. Start insulin drip to maintain blood glucose at 110 to 150 mg/dL.

Administer normal saline IV at 500 mL/hr. Because of the decreased preload associated with septic shock, fluid resuscitation is the initial therapy. The other actions also are appropriate and should be initiated quickly as well.

A patient is admitted to the emergency department (ED) in shock of unknown etiology. What should be the nurse's first action? Obtain the blood pressure. Check the level of orientation. Administer supplemental oxygen. Obtain a 12-lead electrocardiogram.

Administer supplemental oxygen. The initial actions of the nurse are focused on the ABCs—airway, breathing, and circulation—and administration of O2 should be done first. The other actions should be done as rapidly as possible after providing O2.

A patient arrives in the emergency department (ED) several hours after taking "25 to 30" acetaminophen (Tylenol) tablets. Which action will the nurse plan to take? Give N-acetylcysteine. Discuss the use of chelation therapy. Start oxygen using a non-rebreather mask. Have the patient drink large amounts of water.

Give N-acetylcysteine.

A triage nurse in a busy emergency department (ED) assesses a patient who reports 7/10 abdominal pain and states, "I had a temperature of 103.9° F (39.9° C) at home." What should be the nurse's first action? Give acetaminophen (Tylenol). Assess the patient's current vital signs. Ask the patient to provide a clean-catch urine for urinalysis. Tell the patient that it may be 1 to 2 hours before seeing a health care provider.

Assess the patient's current vital signs.

After the return of spontaneous circulation following the resuscitation of a patient who had a cardiac arrest, therapeutic hypothermia is prescribed. Which action will the nurse include in the plan of care? Initiate cooling per protocol. Avoid the use of sedative drugs. Check mental status every 15 minutes. Rewarm if temperature is below 91° F (32.8° C).

Initiate cooling per protocol. When therapeutic hypothermia is used postresuscitation, external cooling devices or cold normal saline infusions are used to rapidly lower body temperature to 89.6° to 93.2° F (32° to 34° C). Because hypothermia will decrease brain activity, assessing mental status every 15 minutes is not done at this stage. Sedative drugs are given during therapeutic hypothermia.

The emergency department (ED) nurse is starting targeted temperature management/therapeutic hypothermia in a patient who has been resuscitated after a cardiac arrest. Which actions in the hypothermia protocol can be delegated to an experienced licensed practical/vocational nurse (LPN/VN)? (Select all that apply.) Insert a urinary catheter to drainage. Continuously monitor heart rhythm. Assess neurologic status every 2 hours. Place cooling blankets above and below patient. Attach rectal temperature probe to cooling blanket control panel.

Insert a urinary catheter to drainage, Place cooling blankets above and below patient, Attach rectal temperature probe to cooling blanket control panel.

Which intervention will the nurse include in the plan of care for a patient who has cardiogenic shock? Check temperature every 2 hours. Monitor breath sounds frequently. Maintain patient in supine position. Assess skin for flushing and itching.

Monitor breath sounds frequently. Because pulmonary congestion and dyspnea are characteristics of cardiogenic shock, the nurse should assess the breath sounds frequently. The head of the bed is usually elevated to decrease dyspnea in patients with cardiogenic shock. Elevated temperature and flushing or itching of the skin are not typical of cardiogenic shock.

A patient has been admitted with dehydration and hypotension after having vomiting and diarrhea for 4 days. Which finding is most important for the nurse to report to the health care provider? New onset of confusion Decreased bowel sounds Heart rate 112 beats/min Pale, cool, and dry extremities

New onset of confusion The changes in mental status are indicative that the patient is in the progressive stage of shock and that rapid intervention is needed to prevent further deterioration. The other information is consistent with compensatory shock.

After a patient who has septic shock receives 2 L of normal saline intravenously, the central venous pressure is 10 mm Hg and the blood pressure is 82/40 mm Hg. What medication should the nurse anticipate? Furosemide Nitroglycerin Norepinephrine Sodium nitroprusside

Norepinephrine When fluid resuscitation is unsuccessful, vasopressor drugs are given to increase the systemic vascular resistance (SVR) and blood pressure and improve tissue perfusion. Furosemide would cause diuresis and further decrease the BP. Nitroglycerin would decrease the preload and further drop cardiac output and BP. Nitroprusside is an arterial vasodilator and would further decrease SVR.

During the primary assessment of a victim of a motor vehicle collision, the nurse determines that the patient has an unobstructed airway. Which action should the nurse take next? Palpate extremities for bilateral pulses. Observe the patient's respiratory effort. Check the patient's level of consciousness. Examine the patient for any external bleeding.

Observe the patient's respiratory effort. Even with a patent airway, patients can have other problems that compromise ventilation, so the next action is to assess the patient's breathing. The other actions are also part of the initial survey, but assessment of breathing should be done immediately after assessing for airway patency.

Which assessment information is most important for the nurse to obtain when evaluating whether treatment of a patient with anaphylactic shock has been effective? Heart rate Orientation Blood pressure Oxygen saturation

Oxygen saturation Because the airway edema that is associated with anaphylaxis can affect airway and breathing, the O2 saturation is the most critical assessment. Improvements in the other assessments will also be expected with effective treatment of anaphylactic shock.

A patient who has been involved in a motor vehicle crash arrives in the emergency department (ED) with cool, clammy skin; tachycardia; and hypotension. Which intervention prescribed by the health care provider should the nurse implement first? Insert two large-bore IV catheters. Provide O2 at 100% per non-rebreather mask. Draw blood to type and crossmatch for transfusions. Initiate continuous electrocardiogram (ECG) monitoring.

Provide O2 at 100% per non-rebreather mask. The first priority in the initial management of shock is maintenance of the airway and ventilation. ECG monitoring, insertion of IV catheters, and obtaining blood for transfusions should also be rapidly accomplished but only after actions to maximize O2 delivery have been implemented.

The nurse is caring for a patient who has septic shock. Which assessment finding is most important for the nurse to report to the health care provider? Skin cool and clammy Heart rate of 118 beats/min Blood pressure of 92/56 mm Hg O2 saturation of 93% on room air

Skin cool and clammy Because patients in the early stage of septic shock have warm and dry skin, the patient's cool and clammy skin indicates that shock is progressing. The other information will also be reported but does not indicate deterioration of the patient's status.

A nurse is assessing a patient who is receiving a nitroprusside infusion to treat cardiogenic shock. Which finding indicates that the drug is effective? No heart murmur Skin is warm and pink Decreased troponin level Blood pressure of 92/40 mm Hg

Skin is warm and pink Warm, pink, and dry skin indicates that perfusion to tissues is improved. Because nitroprusside is a vasodilator, the blood pressure may be low even if the drug is effective. Absence of a heart murmur and a decrease in troponin level are not indicators of improvement in shock.

During the primary survey of a patient with severe leg trauma, the nurse observes that the patient's left pedal and posterior tibial pulses are absent, and the entire leg is swollen. Which action will the nurse take next? a. Send blood to the lab for a complete blood count. b. Assess further for a cause of the decreased circulation. c. Finish the airway, breathing, circulation, disability survey. d. Start normal saline fluid infusion with a large-bore IV line.

Start normal saline fluid infusion with a large-bore IV line. The assessment data indicate that the patient may have arterial trauma and hemorrhage. When a life-threatening injury is found during the primary survey, the nurse should immediately start interventions before proceeding with the survey. Although a complete blood count is indicated, administration of IV fluids should be started first. Completion of the primary survey and further assessment should be completed after the IV fluids are initiated.

A patient who has neurogenic shock is receiving a phenylephrine infusion through a right forearm IV. Which assessmeNnt fiRndiIng oGbtaiBn.edCbyMthe nurse indicates a need for immediate action? The patient's heart rate is 58 beats/min. The patient's extremities are warm and dry. The patient's IV infusion site is cool and pale. The patient's urine output is 28 mL over the past hour.

The patient's IV infusion site is cool and pale. The coldness and pallor at the infusion site suggest extravasation of the phenylephrine. The nurse should discontinue the IV and, if possible, infuse the drug into a central line. An apical pulse of 58 beats/min is typical for neurogenic shock but does not indicate an immediate need for nursing intervention. A 28-mL urinary output over 1 hour would require the nurse to monitor the output over the next hour, but an immediate change in therapy is not indicated. Warm, dry skin is consistent with early neurogenic shock, but it does not indicate a need for a change in therapy or immediate action.

Norepinephrine has been prescribed for a patient who was admitted with dehydration and hypotension. Which data indicate that the nurse should consult with the health care provider before starting the norepinephrine? The patient is receiving low dose dopamine. The patient's central venous pressure is 3 mm Hg. The patient is in sinus tachycardia at 120 beats/min. The patient has had no urine output since admission.

The patient's central venous pressure is 3 mm Hg. Adequate fluid administration is essential before giving vasopressors to patients with hypovolemic shock. The patient's low central venous pressure indicates a need for more volume replacement. The other patient data are not contraindications to norepinephrine administration.

Which data collected by the nurse caring for a patient who has cardiogenic shock indicate that the patient may be developing multiple organ dysfunction syndrome (MODS)? The patient's serum creatinine level is high. The patient reports intermittent chest pressure. The patient's extremities are cool, and pulses are 1+. The patient has bilateral crackles throughout lung fields.

The patient's serum creatinine level is high. The high serum creatinine level indicates that the patient has renal failure as well as heart failure. The crackles, chest pressure, and cool extremities are all symptoms consistent with the patient's diagnosis of cardiogenic shock.

The emergency department (ED) nurse receives report that a seriously injured patient involved in a motor vehicle crash is being transported to the facility with an estimated arrival in 5 minutes. What should the nurse obtain in preparation for the patient's arrival? A dopamine infusion A hypothermia blanket Lactated Ringer's solution Two 16-gauge IV catheters

Two 16-gauge IV catheters A patient with multiple trauma may require fluid resuscitation to prevent or treat hypovolemic shock, so the nurse will anticipate the need for 2 large-bore IV lines to administer normal saline. Lactated Ringer's solution should be used cautiously and would not be prescribed until the patient has been assessed for liver abnormalities. Vasopressor infusion is not used as the initial therapy for hypovolemic shock. Patients in shock need to be kept warm not cool.

The urgent care center protocol for tick bites includes the following actions. Which action will the nurse take first when caring for a patient with a tick bite? Use tweezers to remove any remaining ticks. Check the vital signs, including temperature. Give doxycycline (Vibramycin) 100 mg orally. Obtain information about recent outdoor activities.

Use tweezers to remove any remaining ticks.