Critical Care Exam 3-final count down

A client's assessment and diagnostic testing are suggestive of acute pancreatitis. When the nurse is performing the health interview, what assessment questions address likely etiologic factors? Select all that apply. A. "Would you say that you eat a particularly high-fat diet?" B. "How many alcoholic drinks do you typically consume in a week? C. "Have you ever been diagnosed with gallstones?" D. "Does anyone in your family have cystic fibrosis?" E. "Have you ever been tested for diabetes?"

A. "Would you say that you eat a particularly high-fat diet?" B. "How many alcoholic drinks do you typically consume in a week?" C. "Have you ever been diagnosed with gallstones?" E. "Have you ever been tested for diabetes?" Eighty percent of clients with acute pancreatitis have biliary tract disease such as gallstones or a history of long-term alcohol abuse. Diabetes and high-fat consumption are also associated with pancreatitis. Cystic fibrosis is not a noted etiologic factor for pancreatitis

A nurse is aware that both the sympathetic and parasympathetic portions of the autonomic nervous system affect GI motility. What are the actions of the sympathetic nervous system? Select all that apply. A. Causes blood vessel constriction B. Relaxes the sphincters C. Creates an inhibitory effect on the GI tract D. Decreases gastric motility E. Increases secretary activities

A. Causes blood vessel constriction C. Creates an inhibitory effect on the GI tract D. Decreases gastric motility Generally, the sympathetic nervous system inhibits the gastrointestinal tract and the parasympathetic nerve stimulates the tract, increasing peristalsis and secretary activities.

A client is admitted to the orthopedic unit with a fractured femur after a motorcycle accident. The client has been placed in traction until his femur can be rodded in surgery. For what early complications should the nurse monitor this client? Select all that apply. A. Compartment syndrome B. Systemic infection C. Complex regional pain syndrome D. Deep vein thrombosis E. Fat embolism

A. Compartment syndrome D. Deep vein thrombosis E. Fat embolism Early complications include shock, fat embolism, compartment syndrome, and venous thromboemboli (deep vein thrombosis [DVT], pulmonary embolism [PE]). Infection and complex regional pain syndrome are later complications of fractures.

Complications common to patients receiving hemodialysis for acute kidney injury include which of the following? (Select all that apply.) A. Dysrhythmias B. Hemolysis C. Hypotension D. Muscle cramps E. Air embolism

A. Dysrhythmias C. Hypotension Hypotension is common and is usually the result of preexisting hypovolemia, excessive amounts of fluid removal, or excessively rapid removal of fluid. Dysrhythmias may occur during dialysis. Causes of dysrhythmias include a rapid shift in the serum potassium level, clearance of antidysrhythmic medications, preexisting coronary artery disease, hypoxemia, or hypercalcemia from rapid influx of calcium from the dialysate solution. Muscle cramps occur more commonly in chronic renal failure. Hemolysis, air embolism, and hyperthermia are rare complications of hemodialysis.

Which of the following patients would require greater amounts of fluid resuscitation to prevent acute kidney injury associated with rhabdomyolysis? (Select all that apply.) A. Penetrating wound to both legs B. Gunshot wound to the abdomen C. Lightning strike of the left arm and chest D. Crush injury to right arm E. Pulmonary contusion and rib fracture

A. Lightning strike of the left arm and chest B. Crush injury to right arm Causes of rhabdomyolysis include crush injuries, compartment syndrome, burns, and injuries from being struck by lightning. Acute kidney injury may result from a gunshot wound related to prolonged

A client with sickle cell disease is treated for a thrombotic event. Which organs or body systems does the nurse recognize as being at greatest risk for thrombosis in a client with sickle cell disease? Select all that apply. A. Lungs B. Spleen C. Central nervous system D. Liver E. Cardiac system

A. Lungs B. Spleen C. Central nervous system Any organ can be the site of a thrombotic event in sickle cell disease; however, the lungs, central nervous system, and the spleen are at greatest risk due to these areas having slower circulation. The liver is often involved in sequestration in adults, and hemolysis may occur. Anemia affects the heart.

The nurse is caring for a patient receiving intravenous ibuprofen for pain management. The nurse recognizes which laboratory assessment to be a possible side effect of the ibuprofen? A. ALT 25 U/L B. Creatinine: 3.1 mg/dL C. White blood count 13, 550 mm3 D. Platelet count 350,000 billion/L

B. Creatinine: 3.1 mg/dL Ibuprofen can result in renal insufficiency, which may be noted in an elevated serum creatinine level. Thrombocytopenia (low platelet count) is another possible side effect. This platelet count is elevated. An elevated white blood count indicates infection. Although ibuprofen is cleared primarily by the kidneys, it is also important to assess liver function, which would show elevated liver enzymes, not low values such as shown here.

The nurse educator is reviewing the blood supply of the GI tract with a group of medical nurses. The nurse is explaining the fact that the veins that return blood from the digestive organs and the spleen form the portal venous system. What large veins will the nurse list when describing this system? Select all that apply. A. Inferior vena cava B. Gastric vein C. Splenic vein D. Inferior mesenteric vein E. Saphenous vein

B. Gastric vein C. Splenic vein D. Inferior mesenteric vein This portal venous system is composed of five large veins: the superior mesenteric, inferior mesenteric, gastric, splenic, and cystic veins, which eventually form the vena portae that enters the liver. The inferior vena cava is not part of the portal system. The saphenous

The nurse working in the ED is evaluating a client for signs and symptoms of appendicitis. Which of the client's signs/symptoms should the nurse report to the physician? A. Left lower quadrant pain B. Nausea C. High fever D. Pain when pressure is applied to the right lower quadrant

B. Nausea Nausea, with or without vomiting, is typically associated with appendicitis. Pain is generally felt in the right lower quadrant. Rebound tenderness, or pain felt upon the release of pressure applied to the abdomen, may be present with appendicitis. Low-grade fever is associated with appendicitis.

uremia

Buildup of toxins in the blood, most commonly caused by chronic or end-stage kidney disease. The term literally means "urine in the blood".

The nurse caring for a client with diverticulitis is preparing to administer the client's medications. The nurse anticipates administration of which category of medication because of the client's diverticulitis? A. Antiemetic B. Antianxiety C. Antispasmodic D. Anti-inflammatory

C. Antispasmodic The nurse anticipates administration of antispasmodic medication to decrease intestinal spasm associated with diverticulitis. The client may also be ordered an opioid analgesic to relieve the associated pain. There is no indication that the client needs antianxiety, antiemetic, or anti-inflammatory medications at this time.

25-year-old client comes to the emergency department with excessive bleeding from a cut sustained when cleaning a knife. Blood work shows a prolonged prothrombin time (PT), but a vitamin K deficiency is ruled out. When assessing the client, areas of ecchymosis are noted on other areas of the body. Which of the following is the most plausible cause of the client's signs and symptoms? A. Lymphoma B. Leukemia C. Hepatic dysfunction D. Hemophilia

C. Hepatic dysfunction Prolongation of the PT, unless it is caused by vitamin K deficiency, may indicate severe hepatic dysfunction. Liver dysfunction can lead to decreased amount of factors needed for coagulation and hemostasis. The majority of hemophiliacs are diagnosed as children. The scenario does not describe signs or symptoms of lymphoma or leukemia.

A client recovering from a total gastrectomy has a low red blood cell count. Which medication will the nurse expect to be prescribed for this client? A. Transfusions of packed RBCs B. Oral iron tablets C. Vitamin B12 injections D. Erythropoietin injections

C. Vitamin B12 injections Intrinsic factor is secreted by the parietal cells in the stomach, which binds to vitamin B12 so it can be absorbed in the ileum. With the loss of some parietal cells, there is a deficiency in vitamin B12, which leads to a decreased production of red blood cells or pernicious anemia. Treatment would be vitamin B12 injections for life. Oral iron tablets would be prescribed for iron deficiency anemia. Erythropoietin injections would be prescribed for anemia caused by kidney disease. The client is not actively bleeding and would not need transfusions of packed RBCs.

A client has a 10-year history of Crohn's disease and is seeing the physician due to increased diarrhea and fatigue. What is the recommended dietary approach to treat Crohn's disease? A. low-fiber diet B. lactose-rich foods C. dietary approach varies. D. high-fiber diet

C. dietary approach varies. The dietary approach varies. A high-fiber diet may be indicated when it is desirable to add bulk to loose stools. A low-fiber diet may be indicated in cases of severe inflammation or stricture. A high-calorie and high-protein diet helps replace nutritional losses from chronic diarrhea. The client may need nutritional supplements, depending on the area of the bowel affected. When the small intestine is inflamed, some clients experience lactose intolerance, requiring avoidance of lactose-rich foods.

The patient is on intake and output (I&O), as well as daily weights. The nurse notes that output is considerably less than intake over the last shift, and daily weight is 1 kg more than yesterday. The nurse should A. obtain an order to place the patient on fluid restriction. B. draw a trough level after the next dose of antibiotic. C. insert an indwelling catheter. D. assess the patient's lungs.

D. assess the patient's lungs. The scenario indicates retention of fluid; therefore, the nurse must assess for symptoms of fluid overload, for example, by auscultating the lung fields. Adequate hydration is essential and fluid restriction would be determined by the provider upon physical examination and analysis of laboratory results. An indwelling urinary catheter should not routinely be inserted because it increases the risk of infection. A trough level is drawn just before the next dose of a drug is given and is an indicator of how the body has cleared the drug; it would not be done secondary to imbalanced intake and output.

Petechiae

Small pinpoint hemorrhages