Critical Care Evolve Final

The patient's creatinine level is 1.1 mg/dL. The nurse would expect the patient's blood urea nitrogen (BUN) level to be 0.5 to 0.1 mg/dL. 0.11 to 0.22 mg/dL. 5 to 10 mg/dL 11 to 22 mg/dL.

11 to 22 mg/dL. The BUN/creatinine ratio provides useful information. The normal BUN/creatinine ratio is 10:1 to 20:1 (e.g., BUN level, 20 mg/dL, and creatinine level, 1 mg/dL).

Check ALL THAT APPLY A 55-year-old trauma patient hit the steering wheel and has a cardiac contusion. Which are potential complications of the injury? (Select all that apply.) Flail chest Dysrhythmias Hypotension Myocardial ischemia

Dysrhythmias Hypotension Myocardial ischemia A flail chest is commonly associated with rib fractures, which are not present in this patient. Cardiac contusions present with signs and symptoms of ineffective heart functioning, including dysrhythmias, decreased cardiac output (i.e., hypotension), and myocardial ischemia that may progress to infarction.

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)? Increased gastrointestinal (GI) motility Increased serum albumin Decreased blood urea nitrogen (BUN)/creatinine ratio Decreased respiratory compliance

Decreased Respiratory Compliance

Which of the following statements is correct regarding burn classification? (Select all that apply.) Deep partial-thickness injuries involve destruction of epidermis and most of the dermis. Full-thickness burns involve all layers of the skin down to the bone. Partial-thickness burns involve injury to the dermal layer. Superficial burns involve only the epidermis.

Deep partial-thickness injuries involve destruction of epidermis and most of the dermis. Partial-thickness burns involve injury to the dermal layer. Superficial burns involve only the epidermis. Deep partial-thickness burns involve the epidermis and most of the dermis. Partial-thickness burns may extend to varying depths of the dermis. Superficial burns involve only the epidermis. Full-thickness injuries do not necessarily involve the bone but do involve deeper structures such as subcutaneous fat, fascia, and muscle.

The nurse admits a patient to the coronary care unit in cardiogenic shock. The nurse anticipates administering which medication in an effort to improve cardiac output? Dopamine (Intropin) Phenylephrine (Neo-Synephrine) Dobutamine (Dobutrex) Nitroprusside (Nipride)

Dobutamine (Dobutrex) Positive inotropic agents such as dobutamine (Dobutrex) are given to increase the contractile force of the heart in cardiogenic shock. Dopamine (Intropin) is used primarily in low cardiac output states to restore vasculare tone and increase blood pressure. Neo-Synephrine would be contraindicated in cardiogenic shock, as the vasoconstriction it produces would exacerbate cardiac ischemia. Nitroprusside (Nipride) can improve cardiac performance in shock states by its reduction of systemic vascular resistance.

Which statement correctly reflects crystalloid fluid replacement therapy in shock states? Lactated Ringer's should not be infused if lactic acidosis is severe. 3 mL of crystalloid is administered to replace 10 mL of blood loss. Administration of colloids is preferred over crystalloids. Solutions of 0.45% normal saline are used routinely in shock.

Lactated Ringer's should not be infused if lactic acidosis is severe. LR solutions contain lactate, which the liver converts to bicarbonate. If liver function is normal, this will counteract lactic acidosis. However, LR should not be infused if lactic acidosis is severe. Three mL of crystalloid is administered to replace every 1 mL of blood loss. There is no evidence to support colloid administration being more beneficial than crystalloid administration in shock states. Hypotonic solutions such as 0.45% normal saline are not administered in shock states as these solutions rapidly leave the intravascular space, causing interstitial and intracellular edema.

Medications used to treat or prevent upper gastrointestinal bleeding include all of the following EXCEPT: anatacids (e.g., Maalox). histamine receptor blockers (e.g., ranitidine). lactulose (e.g., Cephulac). mucosal barrier enhancers (e.g., Carafate).

Lactulose Rationale: Antacids, histamine receptor blockers, and mucosal barrier enhancers are administered to prevent and/or treat upper GI bleeding. Lactulose is given to decrease ammonia production in the patient with liver failure.

Burn injury severity is determined not only by the type of burn injury but also by: (Select all that apply.) mechanism of burn injury. patient age. preexisting health status related injuries.

mechanism of burn injury. patient age preexisting health status. related injuries.

Hyperventilation is often seen in patients with renal failure as a compensatory mechanism for: volume deficits. uremic toxins. infection. metabolic acidosis.

metabolic acidosis. Patients may hyperventilate as the lungs attempt to compensate for the metabolic acidosis often seen in acute kidney injury. Patients with kidney injury from prerenal causes may be hypotensive and tachycardic as a result of volume deficits. Body temperature may be decreased (as a result of the antipyretic effect of the uremic toxins), normal, or increased (as a result of infection).

Signs and symptoms of acute renal failure include: bradycardia, with decreased respiration, low serum bicarbonate, and elevated pH. lethargy, tachypnea, and elevated serum bicarbonate. slowed respirations and low pH. tachypnea, low pH, and low serum bicarbonate.

tachypnea, low pH, and low serum bicarbonate. Rationale: In acute renal failure, patients may hyperventilate as the lungs attempt to compensate for the metabolic acidosis as reflected in a low pH and serum bicarbonate level.

Spinal cord injury causes a loss of sympathetic output, resulting in distributive shock with hypotension and bradycardia. Although blood pressure may respond to fluid resuscitation, what other therapy may be required to compensate for loss of sympathetic innervation? Colloids Glucocorticoids Proton pump inhibitors Vasopressors

Vasopressors Rationale: Blood pressure may respond to IV fluids, but vasopressor therapy is often required to compensate for the loss of sympathetic innervation and resultant vasodilation.

Check ALL THAT APPLY When obtaining report on a trauma patient, which question would be helpful in determining potential injuries associated with the mechanism of injury? (Select all that apply.) Was the patient wearing a seat belt? Where was the patient in the car? Where are the family members? Was fluid resuscitation initiated?

Was the patient wearing a seat belt? Where was the patient in the car? When obtaining report on a trauma patient, several questions should be asked to help determine potential complications associated with the mechanism of injury. It is especially important to ask where the patient was sitting in the car and whether he or she was wearing a seatbelt. Asking the distance of a fall assists with understanding of complications from blunt forces. Information concerning the initiation of fluid resuscitation is helpful in determining tissue perfusion needs but may not provide insight into possible complications associated from the mechanism of injury. Information about the family is important for communication but does not assess etiology of injury

T/F One of the major side effects of administration of packed red blood cells is volume overload.

True

T/F Systemic inflammatory response syndrome (SIRS) is the initial stage of progressive deterioration in anaphylactic shock.

True

The patient is admitted with hepatitis and asks the nurse what his prognosis is. The nurse states: "Unfortunately, damaged liver cells do not regenerate, so recovery will depend on how much we can save." "The damaged liver cells will be replaced by scar tissue but will no longer be functional." "Liver cells can regenerate, so most patients with hepatitis recover and regain normal liver function." "Most people with hepatitis require liver transplantation. If we can find a donor, you should be all right."

"Liver cells can regenerate, so most patients with hepatitis recover and regain normal liver function." Liver cells have the capacity to regenerate. Over time, liver cells that become damaged are removed by the body's immune system and are replaced with healthy liver cells. Therefore, most patients with hepatitis recover and regain normal liver function.

patient with severe sepsis. Vital sign assessment notes blood pressure 95/60 mm Hg, heart rate 110 beats/min, respirations 32 breaths/min, oxygen saturation (SpO2) 96% on 45% oxygen via Venturi mask, temperature 101.5° F, central venous pressure (CVP/RAP) 2 mm Hg, and urine output of 10 mL for the last hour. Given this report, the nurse obtains orders for treatment that include which of the following? (Select all that apply.) Administer infusion of 500 mL 0.9% normal saline every 4 hours as needed if the CVP is < 5 mm Hg. Increase supplemental oxygen therapy to 60% venture mask. Administer 40 mg furosemide (Lasix) intravenously as needed if the urine output is less than 30 mL/hr. Administer acetaminophen (Tylenol) 650 mg suppository per rectum as needed to treat temperature > 101° F.

Administer infusion of 500 mL 0.9% normal saline every 4 hours as needed if the CVP is < 5 mm Hg. Administer acetaminophen (Tylenol) 650 mg suppository per rectum as needed to treat temperature > 101° F. Fluid volume resuscitation is a priority in patients with severe sepsis to maintain circulating blood volume and end organ perfusion and oxygenation. A 500-mL IV bolus of 0.9% normal saline is appropriate given the patients CVP of 2 mm Hg and hourly urine output of 10 mL/hr. There is no evidence to support the need to increase supplemental oxygen. Administration of furosemide (Lasix) in the presence of a fluid volume deficit is contraindicated. The fever may need to be treated.

The nurse is examining the patient's urinalysis and notices the presence of red blood cells and albumin as well as nitrogenous waste products and sodium. The nurse realizes that: red blood cells are normally found in urine. albumin is an abnormal finding in urine. urinary sodium levels should be higher than serum levels. nitrogenous waste products in urine indicate kidney disease.

Albumin is an abnormal finding in the urine

The patient is admitted with severe ascites related to chronic liver disease. In trying to determine the cause of the ascites, the nurse should evaluate which laboratory values? Blood glucose levels Albumin levels Fibrinogen levels Clotting factors

Albumin levels Altered carbohydrate metabolism may result in unstable blood glucose levels. Low albumin levels are also thought to be associated with the development of ascites, a complication of hepatic failure. Fibrinogen is an essential protein that is necessary for normal clotting. A low plasma fibrinogen level, coupled with decreased synthesis of many blood clotting factors, predisposes the patient to bleeding.

Which of the following are causes of acute pancreatitis? (Choose all that apply.) Alcoholism An unknown cause (idiopathic) Biliary obstruction Hepatitis

Alcoholism An unknown cause (idiopathic) Biliary obstruction

The patient is admitted with second and third degree burns on both legs and one third of his lower torso. Which of the following therapies may be prescribed to prevent stress ulcers in this patient? Antacids H2 receptor blockers Anticholinergic drugs All of the above

All of the above

In which circumstances should patients should be transferred to specialized burn center for treatment? (Select all that apply.) Partial-thickness and full-thickness burns greater than 10% in TBSA in patients over the age of 50 Burns involving the face, eyes, ears, hands, feet, perineum, major joints Inhalation injury Electrical burns, including lightning injury Burn patients with concomitant trauma

All of them

The patient is about to receive 2 units of packed red blood cells. It is important for the nurse to monitor for complications of blood transfusions. These include: (Choose all that apply.) anaphylaxis. hyperkalemia. hypothermia. infection.

All of them

A restrained patient's status after a motor vehicle crash includes dyspnea and complaints of severe chest pain. Upon assessment you note that he does not have any femoral pulses. Which of the following complications and related diagnostic test should be considered? Aortic dissection and aortogram Cardiac tamponade and pericardiocentesis Hemothorax and chest x-ray Pulmonary contusion and chest x-ray

Aortic dissection and aortogram Rationale: Signs of aortic disruption include weak femoral pulses, dysphagia, dyspnea, hoarseness, and pain. A chest x-ray study may demonstrate a widened mediastinum, tracheal deviation to the right, depressed left mainstem bronchus, first and second rib fractures, and left hemothorax. The diagnosis is confirmed by an aortogram.

Check ALL THAT APPLY Which interventions are appropriate to consider in the management of the geriatric trauma patient? (Select all that apply.) Ask the patient if he or she has fallen recently. Obtain a detailed medical history. Administer intravenous fluids rapidly to maintain blood pressure. Frequently assess for signs of acute delirium Observe for signs of infection, primarily elevated temperature. Obtain a detailed list of current medications.

Ask the patient if he or she has fallen recently. Obtain a detailed medical history. Frequently assess for signs of acute delirium. Obtain a detailed list of current medications.

Check ALL THAT APPLY To maintain the patient's airway, which interventions are appropriate to implement with a trauma patient who sustained a spinal cord injury? (Select all that apply.) Avoid hyperextension of the neck. Observe respiratory pattern. Insert an oral airway if patient is alert Elevate the head of bed 30 degrees Observe depth of ventilation. Maintain complete spinal immobilization.

Avoid hyperextension of the neck Maintain complete spinal immobilization. Observe respiratory pattern Observe depth of ventilation. Maintaining a patent airway is an essential intervention in the care of the trauma patient. When the patient has a spinal cord injury, additional precautions are needed, including the following: avoid hyperextension or rotation of the neck; maintain spinal immobilization; observe ventilatory effort, rate, depth, and effectiveness of breathing; monitor motor and sensory function; and anticipate the need for intubation and mechanical ventilation. Oral airways should not be inserted in an awake patient, as it will cause an airway obstruction. The patient&#8217;s head of bed should remain flat, and spinal precautions should be taken.

The nurse is caring for a patient admitted with severe sepsis. The physician orders include the administration of large volumes of isotonic saline solution as part of early goal-directed therapy. Which of the following best represents a therapeutic endpoint for goal-directed fluid therapy? Central venous pressure > 8 mm Hg Heart rate > 60 beats/min Mean arterial pressure > 50 mm Hg Serum lactate level > 6 mEq/L

Central venous pressure > 8 mm Hg Early goal-directed therapy includes administration of IV fluids to keep the central venous pressure at 8 mm Hg or greater. Additional therapeutic endpoints include a heart rate at less than 110 beats per minute and a mean arterial blood pressure at 65 mm Hg or greater. Serum lactate levels are elevated in sepsis; target levels should be < 2.2 mEq/L.

Shock is a life-threatening response to alterations in: circulation. elimination. mentation. respiration.

Circulation Rational: Shock begins when the cardiovascular system fails to function properly because of an alteration in at least one of the four essential circulatory components: blood volume, myocardial contractility, blood flow, or vascular resistance.

Fresh frozen plasma (FFP) is administered to replace: clotting factors. erythrocytes. leukocytes. platelets.

Clotting Factors Fresh frozen plasma is administered to replace all clotting factors except platelets. Platelets are given rapidly to help control bleeding caused by low platelet counts.

Prevention of hypothermia is crucial in caring for trauma patients. Which treatments are appropriate for preventing hypothermia? (Select all that apply.) Administer cool humidified oxygen. Cover the patient with an external warming device. Leave the patient's clothing on, even if wet. Warm fluids and blood products before or during administration. Warm the room in the emergency department and critical care unit

Cover the patient with an external warming device. Warm fluids and blood products before or during administration Warm the room in the emergency department and critical care unit. Oxygen should be warm and humidified to prevent hypothermia. External warming devices are effective in preventing or treating hypothermia. All of the patients clothes should be removed so that the body can be inspected. Wet clothing increases the risk of hypothermia. After clothing is removed, the patient is warmed. Warming fluids and blood products reduces the risk of hypothermia. Warming the temperature in the rooms where care is provided is a strategy for preventing hypothermia

A patient admitted after a house fire is starting to complain of hoarseness. The nurse notes that respirations are now 32 breaths/min and stridor and wheezing are audible. What is the priority intervention for this patient? Administration of pain medication Emergency intubation Insertion of chest tube Insertion of arterial line

Emergency intubation Early intubation is the priority for smoke inhalation injuries, and this patient is displaying airway problems. Pain is important, but airway is of a higher priority. There is no indication for a chest tube. Insertion of an arterial line would be beneficial but is not the top priority.

The nurse is admitting to the ICU a patient in early sepsis. What is the nurse's best understanding of the patient's nutritional requirements? Total parenteral nutrition is preferred. Enteral nutrition initiated within the first 24 to 48 hours is critical. The caloric needs of the patient in sepsis are significantly lower. Early enteral feeding may lead to diarrhea, delaying wound healing.

Enteral nutrition initiated within the first 24 to 48 hours is critical. Early enteral nutrition within 24 to 48 hours of admission to an intensive care unit is supported by evidence and recommended in patients with severe sepsis, septic shock, or both. Enteral nutrition is the preferred route of administration, as this method assists the intestinal mucosa in maintaining its barrier function. The caloric needs of a patient in sepsis are high and require increased caloric intake. Early enteral feeding decreases diarrhea.

T/F Positive inotropic agents, such as dopamine, are given to increase the contractile force of the heart and are used in the management of hypovolemic shock.

False Positive inotropic agents, such as dopamine, are given to increase the contractile force of the heart; however, they are used in cardiogenic shock. Fluids are administered in the management of hypovolemic shock.

T/F One of the effects shock has on the body is that cells undergo aerobic metabolism, which leads to the development of lactic acidosis.

False: ANAEROBIC not AEROBIC metabolism causes lactic acidosis

Your patient was a passenger in a motor vehicle crash yesterday and suffered an open fracture of the femur. His condition was stable until an hour ago, when he began to complain of shortness of breath. His heart rate is 104/minute, respiratory rate is 30/minute, B/P is 90/60 mm Hg, and temperature is now 38.4°C. You suspect that he: -has a fat embolism. -has developed metabolic acidosis. - is developing systemic inflammatory response syndrome - is experiencing early multisystem organ failure.

Fat Embolism Rationale: These are classic signs and symptoms of a fat embolism. The history of a long-bone fracture increases the suspicion of fat embolism.

A 55-year-old trauma patient who hit the steering wheel and has a pulmonary contusion requires mechanical ventilation. Which of the following is NOT a potential complication of this injury? Flail chest Hemothorax Pericardial tamponade Pneumonia

Flail chest Rationale: A flail chest is commonly associated with rib fractures, which are not present in this patient.

The endocrine functions of the pancreas are accomplished by groups of alpha and beta cells that compose the islets of Langerhans. Alpha cells secrete: insulin. both insulin and glucagon. glucagon trypsinogen and chymotrypsinogen.

Glucagon The endocrine functions of the pancreas are accomplished by groups of alpha and beta cells that compose the islets of Langerhans. Beta cells secrete insulin, and alpha cells secrete glucagon. Both are essential to carbohydrate metabolism. When beta cells are affected by disease, blood glucose levels can increase. Trypsinogen and chymotrypsinogen are digestive enzymes secreted in an inactive form so autodigestion of the gland does not occur.

Which statement correctly represents hemodynamic values associated with the initial stages of septic shock state? Low heart rate; high blood pressure High heart rate; low right atrial pressure High PAOP; low cardiac output High SVR; normal blood pressure

High heart rate; low right atrial pressure In septic shock, inflammatory mediators damage the endothelial cells that line blood vessels, producing profound vasodilation and increased capillary permeability. Initially this results in a high heart rate, hypotension, and low SVR, and subsequently in low right atrial pressure.

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

Hyperglycemia in 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.

A patient has sustained deep partial-thickness and full-thickness burns over 60% of her body. Shortly after admission, her blood pressure drops rapidly to a systolic pressure of 70 mm Hg. You know this is primarily due to: carbon monoxide poisoning. extreme pain. hypovolemic shock. sepsis.

Hypovolemic shock occurs soon after burn injury as a result of dramatic fluid shift. Carbon monoxide poisoning would present with signs of acute hypoxemia. Extreme pain would cause a sympathetic response and behavioral symptoms. Sepsis is a significant risk factor for burn-injured patients but would not present this quickly after initial injury.

The nurse is admitting a patient with a diagnosis of a Mallory-Weiss tear. The patient reports that he has taken antacids for the past 5 years for his gastroesophageal reflux (GERD), ibuprofen for the past 10 years for arthritis, and Protonix for the last year for treatment of an ulcer. He also drinks one glass of wine with his evening meal daily. Using the above information, the nurse realizes that the most significant cause of the Mallory-Weiss tear may be: antacids. ibuprofen. Protonix. wine intake.

Ibuprofen

Which of the following are common complications of burn patients? (Select all that apply.) Hypometabolism Immunosuppression Paralytic ileus Stress ulcer

Immunosuppression Paralytic ileus Stress ulcer

A nurse is assigned a patient who has carbon monoxide (CO) poisoning. Which of the following is the priority nursing diagnosis? Ineffective airway clearance Impaired gas exchange Ineffective breathing pattern Acute confusion

Impaired gas exchange The most common pulmonary burn complication is CO poisoning. The hemoglobin becomes fully saturated with carbon monoxide and thus is unable to carry oxygen. The patient develops impaired gas exchange. There is no mention of problems with increased secretions or difficulty breathing at this time. Although the patient may manifest confusion, it is probably related to hypoxemia.

T/F The nurse would expect to find the following hemodynamic alterations in a patient with cardiogenic shock: decreased cardiac output, increased pulmonary artery occlusion pressure, and increased systemic vascular resistance.

True

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

Increased BUN and Creatinine 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.

The patient is admitted with generalized edema and hypertension. The patient states that his urine output has been less than normal. An indwelling urinary catheter is inserted, but very little urine is obtained. The patient has distended neck veins and his blood pressure is 210/110 mm Hg. The nurse assesses that the patient's fluid retention is due to: prerenal causes. intrarenal causes. volume depletion. uremia.

Intrarenal Causes

The provider has placed an esophagogastric balloon to tamponade bleeding varices. Of the three types of tubes used for tamponade, the: Sengstaken-Blakemore tube has the most lumens. Minnesota tube allows for aspiration of gastric contents. Linton tube allows for gastric and esophageal suction. treatment of gastric varices requires the Minnesota tube.

Linton tube allows for gastric and esophageal suction. Three types of tubes are used for tamponade: Sengstaken-Blakemore, Minnesota, and Linton tubes. The adult Sengstaken-Blakemore tube has three lumina: one for gastric aspiration, similar to that in a nasogastric tube; one for inflation of the esophageal balloon; and one for inflation of the gastric balloon. The Minnesota tube has an additional lumen that allows for aspiration of esophageal secretions. The Minnesota tube is commonly used because it allows for suction of secretions above and below the balloon. The Linton tube has a gastric balloon only, and lumens for gastric and esophageal suction; it is reserved for those with bleeding gastric varices.

Which of the following nursing actions is most important for a patient with acute kidney injury? Maintain accurate intake, output, and daily weight measurements Obtain a drug trough level immediately after an antibiotic is administered. Insert an indwelling urinary catheter. Restrict fluids to 200 mL per day.

Maintain accurate intake, output, and daily weight measurements. Accurate measurement of intake and output, and determination of daily weights are two vital nursing interventions. Fluid intake levels are often restricted to the amount of urine output in a 24-hour period plus insensible losses (approximately 600-1000 mL/day). Indwelling urinary catheters should not routinely be inserted because they increase the risk of infection, and many patients are oliguric for several days. A trough level is drawn just before the next dose is given and is an indicator of how the body has cleared the drug. Values are useful in determining drug dosages, but they are not as important as output and weight.

Large volume crystalloid solution to treat hypovolemia can be accomplished with which of the following infusions? (Select all that apply.) 5% dextrose Albumin Lactated Ringer's (LR) Normal saline

Normal Saline Lactated Ringers LR solution and 0.9% normal saline are isotonic solutions that are commonly infused to treat hypovolemia. Solutions of 5% dextrose in water and 0.45% normal saline are hypotonic and are not used for fluid resuscitation. Hypotonic solutions rapidly leave the intravascular space, causing interstitial and intracellular edema. A systematic review of 30 randomized controlled trials found no benefit in giving colloids (e.g., albumin) over crystalloids and recommended against the administration of colloids in most patient populations

A 53-year-old patient has kidney and ureteral stones and is hospitalized for urinary retention and severe flank pain. What classification of acute kidney injury is the patient in danger of developing? Acute tubular necrosis Intrarenal Postrenal Prerenal

Postrenal The etiology of acute kidney injury (AKI) is classified as prerenal, postrenal, or intrarenal. Classification depends on where the precipitating factor exerts its pathophysiological effect on the kidney. Acute kidney injury resulting from obstruction of the flow of urine is classified as postrenal, or obstructive renal injury. Obstruction can occur at any point along the urinary system. Conditions that result in AKI by interfering with renal perfusion are classified as prerenal. Most prerenal causes of AKI are related to intravascular volume depletion, decreased cardiac output, renal vasoconstriction, or pharmacological agents that impair autoregulation and GFR. These conditions reduce the glomerular perfusion and the GFR, and the kidneys are hypoperfused. Conditions that produce AKI by directly acting on functioning kidney tissue (either the glomerulus or the renal tubules) are classified as intrarenal. The most common intrarenal condition is acute tubular necrosis (ATN).

Which condition is a common cause of death after chest trauma? Cardiac tamponade Flail chest Hemothorax Pulmonary contusion

Pulmonary contusion Pulmonary contusion as a result of blunt chest trauma increases the risk for development of pneumonia, acute lung injury, and/or ARDS. Cardiac tamponade is life threatening if untreated, but it is not a common complication after blunt chest trauma. Flail chest and hemothorax may result with blunt chest trauma, but they are not common causes of death

This is a common cause of death after chest trauma because it frequently leads to the development of acute respiratory distress syndrome (ARDS) or pneumonia. Cardiac tamponade Hypothermia Neurogenic shock Pulmonary contusion

Pulmonary contusion Rationale: Pulmonary contusion increases the risk for development of ARDS or pneumonia.

Which of the following statements are true regarding chemical injuries? (Select all that apply.) Chemical burns are not as severe as thermal burns Systemic effects such as CNS depression, pulmonary edema, and hypotension may occur. These injuries affect only the localized area of chemical contact. Tissue damage continues until the chemical is completely removed or neutralized.

Systemic effects such as CNS depression, pulmonary edema, and hypotension may occur Tissue damage continues until the chemical is completely removed or neutralized. Systemic effects occur after burn injury as a result of release of chemical mediators. Chemicals can continue to cause tissue damage until removed or neutralized. Alkali agents cause the greatest tissue damage because of the protein denaturation and liquefaction that occurs. Chemical burns can be more severe than thermal burns. Chemicals can be absorbed, causing wider injury than the area of contact.

T/F Colloids contain proteins, increase osmotic pressure, and expand plasma volume. Compared with crystalloids, smaller volumes of colloids are given.

True

T/F Intravenous fluid resuscitation is instituted for patients with greater than 15% to 20% total body surface area (TBSA) burns.

True

The majority of cases of cardiogenic shock are caused by: acute myocardial infarction. myocardial depression in sepsis. pulmonary embolism. significant hypovolemia.

acute myocardial infarction The most common cause of cardiogenic shock is an extensive left ventricular myocardial infarction. Myocardial depression in sepsis is a secondary problem associated with the acidosis/anaerobic metabolism of septic shock. Pulmonary embolism is a cause of obstructive shock. Fluid loss is the major cause of hypovolemic shock.

The patient has an elevated blood urea nitrogen (BUN) level and an elevated creatinine level but a normal BUN/creatinine ratio. This indicates: normal kidney function. acute tubular necrosis (ATN). prerenal conditions. problems other than kidney failure.

acute tubular necrosis (ATN). A normal BUN/creatinine ratio is present in ATN. In ATN, there is actual injury to the renal tubules and a rapid decline in the GFR; hence, urea and creatinine levels both rise proportionally as a result of increased reabsorption and decreased clearance. If the ratio is greater than 20:1 (e.g., BUN level 60 mg/dL and creatinine level 1 mg/dL), problems other than acute kidney injury should be suspected. In prerenal conditions, an increased BUN/creatinine ratio is typically noted.

A temporary wound cover composed of a graft of skin transplanted from another human, living or dead, is called a(n): alloderm. allograft. biobrane. xenograft.

allograft. An allograft is transplanted skin from another human being. Alloderm is an allograft from another human being with cells removed that target the immune response. Biobrane is a nylon mesh dressing embedded with collagen. Xenograft is a skin graft from a different species.

The nurse is caring for a patient who has an elevated blood urea nitrogen level (BUN). Factors that can elevate BUN include: (Select all that apply.) low-protein diet. blood in the gastrointestinal tract. starvation dehydration. fever.

blood in the gastrointestinal tract starvation. dehydration. fever The serum blood urea nitrogen (BUN) level is used to evaluate kidney function. The BUN level is not a reliable indicator of kidney function because the rate of protein metabolism (urea is a by-product of protein metabolism) is not constant. Extrarenal factors including dehydration, a high-protein diet, starvation, blood in the gastrointestinal tract, corticosteroids, and fever all can elevate the BUN level. For example, when a patient has gastrointestinal bleeding, the blood in the gut breaks down and results in an increased protein load and hence an elevated BUN level.

The patient is admitted with cirrhosis and has a blood sugar of 250 mg/dL. The nurse understands that the patient's hyperglycemia is a result of: a dysfunctional pancreas. altered fat metabolism due to fatty liver. low albumin levels. cirrhotic diabetes.

cirrhotic diabetes. With liver disease, altered carbohydrate metabolism may result in unstable blood glucose levels, a condition called cirrhotic diabetes. Low albumin is present but does not affect blood glucose. Altered fat metabolism may result in a fatty liver and cause fatigue and decreased activity tolerance. Cirrhosis is not associated with pancreatic dysfunction.

A trauma patient with a fractured forearm complains of extreme, throbbing pain at the fracture site, and paresthesia in his wrist and hand. Upon further assessment you note that his forearm is extremely edematous and you are now having difficulty palpating a radial pulse. You emergently notify the physician because you suspect: Compartment Syndrome Fat Emboli Hypothermia Rhabdomyolysis

compartment syndrome. Rationale: These signs and symptoms are characteristic of compartment syndrome.

The nurse is developing a care plan for the patient in cardiogenic shock, and the goals for therapy include: increasing preload. decreasing afterload. increasing myocardial workload. increasing systemic vascular resistance (SVR).

decreasing afterload. The goal of therapy is to increase cardiac output by decreasing preload and afterload and increasing contractility. Increasing myocardial workload, preload, and SVR would worsen cardiogenic shock.

The patient has end-stage chronic liver failure and has been vomiting "coffee-ground" material. The provider has ordered the insertion of a nasogastric tube. In inserting the tube, the nurse must be aware that: esophageal varices may be present and rupture could lead to bleeding. the splanchnic system does not develop collateral circulation in low-pressure veins. portal hypertension is a result of varices formation. the most common site for varices formation is the rectum.

esophageal varices may be present and rupture could lead to bleeding. In chronic liver failure, liver cell structure and function are impaired, resulting in portal hypertension. As a result, part of the venous blood in the splanchnic system is diverted from the liver to the systemic circulation by the development of connections to neighboring low-pressure veins. This phenomenon is termed collateral circulation. Bleeding esophageal or gastric varices are usually a medical emergency because they cause massive upper GI bleeding.

Acute renal failure is potentially reversible in the: convalescent phase. initiation phase. maintenance phase. recovery phase.

initiation phase. Rationale: Acute renal failure is potentially reversible during the initiation phase. During the maintenance phase, intrinsic renal damage is well established, and the glomerular filtration rate (GFR) stabilizes at approximately 5 to 10 mL per minute. This recovery/convalescent phase is the period during which the renal tissue recovers and repairs itself.

Poor patient outcomes after a traumatic injury are associated with: - chest tube placement for treatment of a hemothorax. - immediate decompression of a tension pneumothorax. - massive transfusions of blood products. - peritoneal lavage to diagnose intraabdominal bleeding.

massive transfusions of blood products. Rationale: Research has shown that patients receiving massive blood transfusions have poorer outcomes.

The patient has end-stage liver disease. The nurse realizes that, because of this, the patient is at risk for: (Select all that apply.) gram-negative sepsis. pulmonary embolus. low blood ammonia levels. nutritional deficiencies. confusion/coma.

gram-negative sepsis. pulmonary embolus. nutritional deficiencies. confusion/coma. Kupffers cells in the liver play an important role in fighting infections throughout the body. Loss of this function predisposes the patient to severe infections, particularly gram-negative sepsis. The liver also removes activated clotting factors from the general circulation to prevent widespread clotting in the system. Loss of this function predisposes the patient to clot formation and to complications such as pulmonary embolus. Decreased metabolism and storage of vitamins A, B₁₂, and D, and of iron, glucose, and fat predispose the patient to many nutritional deficiencies. The liver loses a well-known function of detoxifying drugs, ammonia, and hormones. Loss of ammonia conversion to urea in the liver is responsible for many of the altered thought processes seen in liver failure, because ammonia is allowed to enter the central nervous system directly. These alterations range from minor sensory perceptual changes, such as tremors, slurred speech, and impaired decision making, to dramatic confusion or profound coma

A 24-year-old woman is admitted with jaundice, weakness, nausea, and vomiting. She is febrile upon admission. You realize these are all signs of: a Mallory-Weiss tear. hepatic encephalopathy. hepatitis. pancreatitis.

hepatitis. Rationale: Patients with hepatitis are often asymptomatic. In many patients, prodromal symptoms of anorexia, nausea, vomiting, abdominal pain, and fatigue may be present. Symptoms may then progress to a low-grade fever, an enlarged and tender liver, and jaundice.

The patient is diagnosed with portal hypertension. The nurse would expect to see signs of: (Select all that apply.) hyperdynamic circulation (high-output failure). development of esophageal or gastric varices. decreased cardiac output. a stable cardiac rhythm and rate. clear lung sounds and increased organ perfusion.

hyperdynamic circulation (high-output failure). development of esophageal or gastric varicose. Portal hypertension causes two main clinical problems for the patient: hyperdynamic circulation and development of esophageal or gastric varices. Liver cell destruction causes shunting of blood and increased cardiac output. Vasodilation is also present (so vasodilators are not needed), which causes decreased perfusion to all body organs, even though the cardiac output is very high. This phenomenon is known as high-output failure or hyperdynamic circulation. Clinical signs and symptoms are those of heart failure and include jugular vein distention, pulmonary crackles, and decreased perfusion to all organs. Initially, the patient may have hypertension, flushed skin, and bounding pulses. Blood pressure decreases and dysrhythmias are common.

All burn patients are at increased risk for acute respiratory distress syndrome (ARDS) due to: carboxyhemoglobinemia. a decrease in cardiac output. increased capillary permeability. myoglobinemia.

increased capillary permeability. Overwhelming systemic inflammatory response syndrome (SIRS) and increased capillary permeability throughout the body, including the lungs, increase the risk of ARDS. Carboxyhemoglobinemia causes restlessness, confusion, and loss of consciousness. Decreased cardiac output decreases pulmonary blood flow but is not a direct cause of ARDS. Myoglobinemia causes acute kidney injury.

Hepatic encephalopathy causes altered levels of consciousness and frequently impaired motor function due to: impaired fat metabolism. increased bilirubin production. increased release of aldosterone. increased serum ammonia.

increased serum ammonia. Rationale: The exact cause of hepatic encephalopathy is unknown, but it is thought to be abnormal ammonia metabolism. Increased serum ammonia levels are thought to interfere with normal cerebral metabolism.

A nurse is caring for a patient with blunt chest trauma after a motor vehicle accident. The patient starts to complain of pain from the chest to the shoulder and a sense of impending doom. Upon assessing the patient, the nurse notes that the patient has diminished breath sounds on the left side, jugular vein distention, and tracheal deviation to the right. The nurse anticipates: - insertion of an indwelling urinary catheter. - insertion of a chest tube. - a chest radiograph. - administration of pain medications.

insertion of a chest tube.

The patient is admitted with hepatorenal syndrome. The patient is comatose and the family is distraught. The nurse should inform the family that: hemodialysis is needed to maintain his life. it may be time to address end-of-life decisions. since the liver failure is an isolated problem, the renal failure can be easily treated. the prognosis is good since treatment will be started soon.

it may be time to address end-of-life decisions. Rationale: This patient has developed complications of liver failure, and has a poor prognosis. It would be appropriate for the critical care team to begin to address end-of-life decisions with the family.

The nurse is caring for a patient with hepatic encephalopathy. Management of hepatic encephalopathy involves addressing precipitation factors. The nurse should provide: (Select all that apply.) lactulose enemas. oral neomycin. metronidazole for 14 days. evaluation of ordered medications for liver toxicity. increasing dietary protein levels to aid in healing.

lactulose enemas. oral neomycin. evaluation of ordered medications for liver toxicity. Management of hepatic encephalopathy involves addressing precipitating factors such as infection, gastrointestinal bleeding, and electrolyte and acid-base imbalances. Lactulose, neomycin, and metronidazole are medications that can be administered to reduce bacterial breakdown of protein in the bowel. Metronidazole is given 500&#160;mg to 1.5&#160;g/day for 1 week. Metronidazole may cause epigastric discomfort, which may in turn result in poor compliance with long-term treatment. Restriction of medications that are toxic to the liver is another important treatment. All medications that are metabolized by the liver should be reviewed for their therapeutic effect. Protein intake is limited to 20 to 40 g/day

The patient is brought in to the emergency department by his family who states that he had been confused for several days prior to admission. On the day of admission he became very lethargic and was hard to arouse. They state that he has a history of liver disease and used to drink heavily. The nurse anticipates that the physician will order: antacids. ibuprofen. lactulose. proton pump inhibitor.

lactulose. Rationale: The patient's history and clinical signs indicate the possibility of hepatic encephalopathy, which would be treated with lactulose.

Cirrhosis causes severe alterations in the function of liver cells that: lead to decreased resistance to blood flow in the liver. can be reversed with rest and lead to return of normal function. lead to necrosis followed by regeneration of fibrous liver tissue. lead to focal areas of necrosis so damage is localized.

lead to necrosis followed by regeneration of fibrous liver tissue. Cirrhosis causes severe alterations in the structure and function of liver cells. It is characterized by inflammation and liver cell necrosis that may be focal or diffuse. Fat deposits may also be present. The enlarged liver cells cause compression of the liver lobule and lead to increased resistance to blood flow and portal hypertension. Necrosis is followed by regeneration of liver tissue, but not in a normal fashion. Fibrous tissue is laid down over time, and this distorts the normal architecture of the liver lobule. These fibrotic changes are usually irreversible, resulting in chronic liver dysfunction.

A primary goal in all shock states is to: ensure adequate cellular hydration. maintain adequate tissue perfusion. prevent third spacing of fluids. support mechanical ventilation.

maintain adequate tissue perfusion. Care of a patient in shock is directed toward correcting or reversing the altered circulatory component and reversing tissue hypoxia. Restoring circulating intravascular volume is the priority in improving tissue perfusion and oxygen delivery.

Intrarenal causes of acute kidney injury from prerenal conditions can be prevented by: administering diuretics before procedures. inserting an indwelling urinary catheter. maintaining adequate hydration administering low-dose dopamine.

maintaining adequate hydration. Adequate hydration is the best strategy to prevent acute kidney injury from prerenal conditions. Diuretic therapy in the treatment of patients with acute kidney injury is controversial. The widespread use of diuretics is currently being discouraged. The role of dopamine is also controversial in the treatment of acute kidney injury. Low-dose dopamine continues to be ordered in acute kidney injury despite numerous studies that fail to show any benefit. Indwelling urinary catheters should not routinely be inserted because they increase the risk of infection.

In implementing large-volume gastric lavage for a patient with gastrointestinal (GI) bleeding, the nurse is aware that: iced saline is required to stop GI bleeding. gastric tubes are left in place to reduce acid production. small-bore gastric tubes are always used. most upper GI hemorrhages are self-limiting

most upper GI hemorrhages are self-limiting Of all upper GI hemorrhages, 80% to 90% are self-limiting and stop with lavage therapy alone or on their own. A large-bore nasogastric tube, not a small-bore tube, is inserted and is connected to suction. Iced lavage is used in some centers, although the evidence for this use is not well documented. After lavage, the nasogastric tube may be left in or removed. Nasogastric tubes left in place may increase hydrochloric acid secretion in the stomach and cause increased bleeding

Blood pooling in the capillary bed and arterial blood pressure too low to support perfusion of vital organs cause: acute respiratory distress syndrome (ARDS). disseminated intravascular coagulation (DIC). increased cerebral perfusion pressure. multisystem organ failure and/or dysfunction.

multisystem organ failure and/or dysfunction. Maldistribution of blood flow refers to the uneven distribution of flow to various organs and pooling of blood in the capillary beds. This impaired blood flow leads to impaired tissue perfusion and a decreased oxygen supply to the cells, all of which contribute to multiple organ failure. Damage to the type II pneumocytes leads to ARDS. Consumption of clotting factors may cause DIC. Low arterial blood pressure leads to decreased cerebral perfusion pressure.

The patient has been on the progressive care unit for the past 7 days with the diagnosis of liver failure. The nurse notes that the patient has developed a flapping tremor of the hand. The nurse should: notify the provider because this is a sign that the disease is progressing. continue to monitor the patient until more overt symptoms appear. request that the provider increase the patient's protein intake to 60 g/day. recognize that the tremors are normal for someone with liver disease.

notify the provider because this is a sign that the disease is progressing. Asterixis, a flapping tremor of the hand, is an early sign of hepatic encephalopathy that can be assessed by the nurse. The provider needs to be notified as early as possible. Measures for decreasing ammonia production are necessary. Protein intake is limited to 20 to 40 g/day. Tremors are not normal in patients with liver failure. They are a sign of progression of the disease.

The nurse is caring for a patient getting peritoneal dialysis. The patient complains of abdominal pain, chills, and nausea. The dialysate return is cloudy. The nurse notifies the provider that the patient is exhibiting symptoms of: peritonitis. catheter blockage. mechanical dysfunction of the dialysate. intolerance of peritoneal fluid volume.

peritonitis. Peritonitis is the most common complication of peritoneal dialysis therapy and is usually caused by contamination in the system. Aseptic technique must occur when handling the peritoneal catheter and connections. Peritonitis is manifested by abdominal pain, cloudy peritoneal fluid, fever and chills, nausea and vomiting, and difficulty in draining fluid from the peritoneal cavity. Potential complications resulting from mechanical problems include perforation of the abdominal viscera during insertion of the catheter, poor drainage in or out of the abdominal cavity as a result of catheter blockage, patient discomfort from the pressure of the fluid within the peritoneal cavity, and pulmonary complications as a result of the pressure of the fluid in the peritoneal cavity.

The patient's creatinine clearance is 5 mL/min. This value signifies: hyperactive kidneys. inaccurate lab results. normal renal function. renal dysfunction.

renal dysfunction. Rationale: A normal creatinine clearance is about 84 to 138 mL per minute. The clinician would recognize this patient's creatinine clearance as being consistent with severe renal dysfunction.

The patient is admitted with ascites and general malaise. His skin is jaundiced and he is complaining of nausea. The physician is concerned about inserting a nasogastric tube because of the patient's esophageal varices. The nurse realizes that esophageal or gastric varices are due to: ascites. cirrhosis. fatty liver. portal hypertension.

portal hypertension. Rationale: In chronic cirrhotic liver failure, liver cell structure and function are impaired, resulting in increased portal venous pressure, which is called portal hypertension. As a result, part of the venous blood in the splanchnic system may be diverted from the liver to the systemic circulation by the development of connections to neighboring low-pressure veins. As these veins experience increases in pressure, they become distended with blood, the vessels enlarge, and varices develop.

The patient is admitted for general malaise and low urine output. The patient is alert and oriented and states that he has lost 5 pounds over the past few days. His heart rate is 124 beats per minute. His blood pressure is 88/40 mm Hg. His mouth is dry and he has flat neck veins and poor skin turgor. The nurse assesses that his low urine output is due to: prerenal causes. intrarenal causes. fluid overload. uremia.

prerenal causes. The patient's general appearance is assessed for signs of uremia (retention of nitrogenous substances normally excreted by the kidneys), such as malaise, fatigue, disorientation, and drowsiness. The skin is assessed for color, texture, bruising, petechiae, and edema. The patient's hydration status is also carefully assessed. Current and admission body weight and intake and output information are evaluated. Skin turgor, mucous membranes, breath sounds, presence of edema, neck vein distention, and vital signs (blood pressure and heart rate) are all key indicators of fluid balance. An oliguric patient with weight loss, tachycardia, hypotension, dry mucous membranes, flat neck veins, and poor skin turgor may be volume depleted (prerenal cause). Weight gain, edema, distended neck veins, and hypertension in the presence of oliguria indicate fluid overload and suggest an intrarenal cause.

The primary priority for the critical care nurse in regards to the trauma patient is: Decrease the patient's risk for multisystem organ dysfunction. Ensure adequate fluid resuscitation. Increase the physiological reserve of the trauma patient. Provide adequate oxygenation and ensure tissue perfusion.

provide adequate oxygenation and ensure tissue perfusion. Rationale: The priority is to maintain adequate oxygenation and tissue perfusion.

A 72-year-old patient fractured his pelvis in a motor vehicle accident 2 days ago. He suddenly becomes anxious and short of breath. His respiratory rate is 34 breaths per minute, and he is complaining of midsternal chest pain. His oxygen saturation drops to 75%. You suspect: cardiac tamponade. myocardial infarction. pulmonary embolus. tension pneumothorax.

pulmonary embolus. Rationale: The patient's history and respiratory signs and symptoms indicate pulmonary embolus.

The kidneys help to maintain acid-base equilibrium by: (Select all that apply.) reabsorbing filtered bicarbonate in response to acidosis. producing new bicarbonate in response to acidosis. excreting hydrogen ions in response to alkalosis. excreting bicarbonate in response to acidosis. producing ammonia when the patient is acidotic

reabsorbing filtered bicarbonate in response to acidosis. producing new bicarbonate in response to acidosis. producing ammonia when the patient is acidotic. The kidneys help to maintain acid-base equilibrium in three ways: by reabsorbing filtered bicarbonate, producing new bicarbonate, and excreting small amounts of hydrogen ions (acid) buffered by phosphates and ammonia. The tubular cells are capable of generating ammonia to help with excretion of hydrogen ions. This ability of the kidney to assist with ammonia production and excretion of hydrogen ions (in exchange for sodium) is the predominant adaptive response by the kidney when the patient is acidotic. When alkalosis is present, increased amounts of bicarbonate are excreted in the urine and cause the serum pH to return toward norma

Decreased blood flow through the kidney results in: decreased systolic blood pressure. increased excretion of sodium and water. peripheral vasodilation. release of renin from the kidney.

release of renin from the kidney. Renin is released whenever blood flow through the afferent and efferent arterioles decreases. A decrease in the sodium ion concentration of the blood flowing past the specialized cells (e.g., in hypovolemia) also stimulates the release of renin. Renin activates the renin-angiotensin-aldosterone cascade, which ultimately results in angiotensin II production. Angiotensin II causes vasoconstriction and release of aldosterone from the adrenal glands, thereby raising blood pressure, increasing blood flow, and increasing sodium and water reabsorption in the distal tubule and collecting ducts.

The patient is complaining of difficulty swallowing. The nurse realizes that swallowing: is a simple process involving involuntary mechanisms. uses the pharynx, which has the sole function of swallowing. requires the pharynx to function for only a few seconds at a time. consists of pharyngeal and esophageal stages only.

requires the pharynx to function for only a few seconds at a time. Swallowing is a complex mechanism involving oral (voluntary), pharyngeal, and esophageal stages. It is made more complex because the pharynx serves several other functions, the most important of which is respiration. The pharynx participates in the function of swallowing for only a few seconds at a time to aid in the propulsion of food, which is triggered by the presence of fluid or food in the pharynx.

The nurse is caring for a patient who is 90 years old. The patient's creatinine level is within normal limits. The nurse understands that the reason for the normal value is: renal blood flow remains constant throughout life. the number of glomeruli increases with collateral circulation. serum creatinine levels may remain the same in the elderly. peritubular density increases as glomeruli decrease in number.

serum creatinine levels may remain the same in the elderly. After age 40, renal blood flow gradually diminishes at a rate of 10% per decade. With advancing age, there is also a decrease in renal mass, number of glomeruli, and peritubular density. Serum creatinine levels may remain the same in the elderly patient even with a declining glomerular filtration rate (GFR) because of decreased muscle mass and hence decreased creatinine production.

Various pharmacological therapies have been researched in the treatment of acute pancreatitis and have shown that: anticholinergic medications help by decreasing secretin secretion. somatostatin is ineffective in the treatment of pancreatitis. prophylactic systemic antibiotics improve survival. calcitonin is essential in preventing complications of hypocalcemia.

somatostatin is ineffective in the treatment of pancreatitis. Various pharmacological therapies have been researched in the treatment of acute pancreatitis. Drugs given to rest the pancreas have been studied, specifically anticholinergics, glucagon, somatostatin, cimetidine, and calcitonin, but these have not been shown to be effective. Prevention of stress ulcers is achieved through the use of histamine blockers and antacids.Antibiotics have also been studied in the treatment of inflammation of the pancreas with the idea of preventing pancreatic pseudocysts or abscesses. It is not known whether antibiotics improve survival or merely prevent septic complications. The role of prophylactic systemic antibiotics in acute pancreatitis is unsettled, as studies evaluating the benefits and harms have produced disparate results.

The trauma patient presenting with left lower rib fractures develops left upper quadrant tenderness, hypotension, and referred pain to the left shoulder. You suspect: bowel obstruction. cardiac tamponade. pulmonary contusion. splenic injury.

splenic injury. Rationale: Splenic injury occurs most often as a result of blunt trauma to the abdomen. However, penetrating trauma to the left upper quadrant of the abdomen or fracture of the anterior left lower ribs also contributes to splenic injuries. The patient may present with left upper quadrant tenderness, peritoneal irritation, and/or referred pain to the left shoulder (Kehr's sign). Hypotension or signs of hypovolemic shock may also be noted.

Treatment of bleeding ulcers includes thermal endoscopic methods. The purpose of these therapies is to: decrease gastric acid secretion. prevent stomach atony. provide better visualization of the gastric fundus. tamponade the vessel to stop active bleeding.

tamponade the vessel to stop active bleeding. Rationale: Thermal methods of endoscopic therapy include use of the heater probe, laser photocoagulation, and electrocoagulation. All of these therapies act to tamponade the vessel to stop active bleeding.

The nurse is caring for a patient complaining of abdominal pain. The nurse notes that the patient's abdomen is more distended that it was earlier that morning. The nurse understands that: the patient may have trapped air or fluid in the abdominal cavity. the pigmentation of the skin may indicate nutrition status. an abdominal mass may be present and growing. strong abdominal contractions indicate the lack of disease.

the patient may have trapped air or fluid in the abdominal cavity. Abdominal distention, particularly in the presence of pain, should always be investigated because it usually indicates trapped air or fluid within the abdominal cavity. Pigmentation of skin (jaundice), lesions, discolorations, old or new scars, and vascular and hair patterns may indicate general nutrition and hydration status but not acute issues. The nurse looks for any obvious abdominal masses, which are seen best on deep inspiration. Pulsations, if they are seen, usually originate from the aorta. Motility of the stomach may be reflected in movement of the abdomen in lean patients, and is a normal sign. However, strong contractions are abnormal and indicate the presence of disease.

A major complication of an electrical burn injury is acute kidney injury caused by: excessive fluid resuscitation. the catabolic effect of the electrical current through the kidneys. the direct effects of the electrical current as it traverses the intima of the kidney. the release of myoglobin that can cause acute kidney injury.

the release of myoglobin that can cause acute kidney injury. Myoglobin is released by damaged tissue and causes damage to renal tubules, contributing to acute kidney injury. Fluid resuscitation promotes renal blood flow and does not contribute to acute kidney injury. Catabolism affects the entire body and is not isolated to renal dysfunction.

The patient is receiving continuous renal replacement therapy (CRRT). The nurse should become concerned when: the blood tubing becomes warm to touch. the ultrafiltrate is showing a pink tinge. there are no dark fibers in the hemofilter after 2 hours. the patient's temperature drops by one degree.

the ultrafiltrate is showing a pink tinge. The ultrafiltrate is assessed for blood (pink-tinged to frank blood), which is indicative of hemofilter membrane rupture. The CRRT system is frequently assessed to ensure filter and lines are visible at all times, kinks are avoided, and the blood tubing is warm to the touch. The hemofilter is assessed every 2 to 4 hours for clotting (as evidenced by dark fibers or a rapid decrease in the amount of ultrafiltration without a change in the patient's hemodynamic status). If clotting is suspected, the system is flushed with 50 to 100 mL of normal saline and observed for dark streaks or clots. Temperature is monitored because significant amounts of heat can be lost when blood is circulating through the extracorporeal circuit. Specialized devices to warm the dialysate or replacement fluid or rewarm the blood returning to patient are available.

An older patient is admitted with partial-thickness burns on the buttocks, perineum, and both legs after climbing into a bathtub without testing the water first. This type of injury is considered: radiation. electrical. thermal. chemical.

thermal. Thermal burns are caused by steam, scald, heat, and fire. Radiation burns are caused by industrial or medical equipment but appear similar to thermal burns. Electrical burns are caused by alternating or direct current exposure or lightning. Chemical burns are caused by acid or alkaline substances

In caring for the patient with hepatitis, it is important for the nurse to understand that: liver transplantation is a first-line treatment to prevent complications. hepatitis is self-limiting and is followed by full recovery. no special precautions are needed when caring for someone with this disease. universal precautions should be followed to prevent spread of the virus.

universal precautions should be followed to prevent spread of the virus. Special precautions must be taken to prevent spread of the virus when caring for the patient with hepatitis. These include the universal precautions while handling all items that are contaminated with the patient's body secretions, including patient care items such as thermometers, dishes, and eating utensils. Liver transplantation is the standard care of treatment for patients with progressive, irreversible acute or chronic liver disease for which there are no other medical or surgical options. The leading indication for liver transplantation is hepatitis C.

In distributive shock, the major physiological problem causing the shock is: blood loss and actual hypovolemia. decreased cardiac output. third spacing of fluids into peritoneal space. vasodilation and relative hypovolemia.

vasodilation and relative hypovolemia. Distributive shock presents with widespread vasodilation and decreased systemic vascular resistance that results in a relative hypovolemia. Blood loss is associated with hypovolemic shock. Decreased cardiac output is a primary cause of cardiogenic shock. Primary internal sequestration of fluids that causes internal fluid loss is associated with hypovolemic shock.

When neurogenic shock occurs, interruption in sympathetic nerve impulses causes: tachycardia. hypertension. hypoventilation. vasodilation.

vasodilation. In neurogenic shock, there is an interruption of impulse transmission or blockage of sympathetic outflow, resulting in vasodilation, inhibition of baroreceptor response, and impaired thermoregulation. Interruption of sympathetic nerve innervation would result in bradycardia. Interruption of sympathetic nerve innervation would result in hypotension. Hypoventilation is not a physiological mechanism.

Hyponatremia in renal dysfunction is the result of: dehydration. potassium deficit. sodium excess. water overload.

water overload. Rationale: Hyponatremia is generally the result of water overload.