septic shock questions
Which blood glucose level is within the intended goal for a patient with septic shock? 1 90 mg/dL 2 140 mg/dL 3 190 mg/dL 4 2100 mg/dL
2) 140 mg/dL
Which intervention would the nurse perform first for a patient admitted with pneumonia and possible sepsis who arouses to name but is not oriented, has a blood pressure of 90/46 mm Hg, heart rate of 128 beats/min, respiratory rate of 28 breaths/min, temperature of 101.3°F (38.5°C), no urine output for 4 hours, and central venous pressure of 2 mm Hg?
Administer a 500 mL IV crystalloid bolus over 30 minutes.
Which sign or symptom does the nurse expect in a patient with sepsis? Select all that apply. One, some, or all responses may be correct.
increased serum creatinine levels, increased fluid intake and decreased output, adrenal insufficiency
Which problem would the nurse expect to occur in a patient with systemic inflammatory response syndrome (SIRS) related to sepsis? Select all that apply. One, some, or all responses may be correct. 1. Oliguria 2. Bradycardia 3. Hypotension 4. Hypothermia 5. Tissue hypoxia
1. oliguria 3. hypotension 5. tissue hypoxia
Which type of shock is the nurse concerned about for a patient who has been refusing treatment for an infection for the past month? 1 Septic 2 Obstructive 3 Cardiogenic 4 Hypovolemic
1. septic
Which condition is the nurse concerned about for a patient with type 2 diabetes who has a high fever and cough, decreased mean arterial pressure, and an increased level of lactic acid and who has been given fludrocortisone? 1. Septic shock 2. Addison disease 3. Hypovolemic shock 4. Bacterial infection
1. septic shock
Which intervention would help prevent sepsis and septic shock in a 65-year-old patient who is being treated at a hospital? 1. Using aseptic technique 2. Using automated ventilation 3. Placing an indwelling urinary catheter 4. Maintaining an IV access line at all times
1. using aseptic technique
Which finding may reflect increased cardiac output in patients with septic shock? 1. Bradycardia 2. Decreased stroke volume 3. Normal central venous pressure (CVP) 4. Increase in systolic blood pressure
normal central venous pressure (CVP)
Which clinical manifestation of septic shock distinguishes it from hypovolemic shock? Select all that apply. One, some, or all responses may be correct.
decreased blood pressure, increased blood glucose level
Which drug is prescribed to patients with septic shock but not with hypovolemic shock?
hydrocortisone
Which physiologic change in a patient with septic shock indicates a poor prognosis? 1 Rapid respiratory rate 2 Low oxygen saturation 3 Change in patient's cognition 4 Lactate level of 4.4 mmol/L
lactate level of 4.4 mmol/L
Which parameter indicates that the expected outcome of the sepsis resuscitation bundle has been met for a patient with septic shock? 1 Lactate level of 4 mg/dL 2 Mean arterial blood pressure of 55 mm Hg 3 Negative blood cultures after 24 hours 4 Presence of anuria for less than 24 hours
1 = lactate level of 4 mg/dL Effective fluid resuscitation will restore tissue perfusion, correcting lactic acidosis and meeting the goal of normalizing the lactate level. A lactate level of 4 mg/dL falls within the normal range of 3 to 7 mg/dL. Mean arterial pressure in septic shock should be maintained at 65 mm Hg for adequate tissue perfusion. Blood cultures may take 3 days to grow; appropriate treatment is initiated before culture results. The result of treatment of sepsis is to maintain a urine output of at least 20 mL/hr.
Which condition indicates an expected outcome of treatment for sepsis and septic shock? Select all that apply. One, some, or all responses may be correct. 1. Normal aerobic cellular metabolism 2. Arterial blood gases within normal range 3. Maintenance of urine output at least 40 mL/hr 4. Absence of multiple organ dysfunction syndrome 5. Maintenance of mean arterial blood pressure above 10 mm Hg of baseline
1, 2, 4
Which statement made by a student nurse indicates understanding of the etiology of severe sepsis? Select all that apply. One, some, or all responses may be correct. 1. "Sepsis is commonly seen in patients with acquired immune deficiency syndrome (AIDS)." 2. "Bacterial overgrowth is always the causative agent." 3. "Sepsis is seen primarily in small children." 4. "In an immunocompromised patient, bacteria and fungi can cause sepsis." 5. "Central venous access devices increase the risk for sepsis."
1, 4, 5
Which sign or symptom does the nurse expect in a patient with sepsis? Select all that apply. One, some, or all responses may be correct. 1. Increased serum creatinine levels 2. Increased fluid intake and decreased output 3. Decreased blood glucose levels 4. Adrenal insufficiency 5. Decreased central venous pressure (CVP)
1. increased serum creatinine levels 2. increased fluid intake and decreased output 4. adrenal insufficiency
After a cholecystectomy, an older-adult patient developed breathing difficulty and had a heart rate of more than 95 beats/min, a breathing rate of 20 beats/min, a temperature of 102.4ºF (39.1ºC), and an elevated blood glucose level. Which assessment will help confirm this patient's condition? 1 Blood culture 2 Thyroxin level 3 Hemoglobin level 4 Blood pressure level
1. blood culture
Which clinical manifestation may be associated with septic shock? 1 Cool skin 2 Urine output of 30 mL/hr 3 Lactic acid level of 5 mg/dL 4 Mean arterial pressure of 90 mm Hg
1. cool skin
A patient with human immune deficiency virus (HIV) is admitted with a bacterial infection. According to the Modified Early Warning System (MEWS), which parameter would the nurse assess to determine the patient's risk for septic shock? Select all that apply. One, some, or all responses may be correct. 1. Heart rate 2. Lung sounds 3. Heart rhythm 4. Diastolic blood pressure 5. White blood cell (WBC) count
1. heart rate The nurse using the MEWS system should assess the heart and respiratory rate, systolic blood pressure, level of consciousness, temperature, and urine output. The lung sounds, heart rhythm, diastolic blood pressure, and WBC are not factors.
The nurse is caring for a patient in the beginning stages of sepsis. Which factor would affect gas exchange and tissue perfusion at this time? Select all that apply. One, some, or all responses may be correct. 1. Tachypnea 2. Inflammation 3. Oxidative stress 4. Vascular changes 5. Decreased urine output
2. inflammation, 3. oxidative stress, 4. vascular changes
Which intervention would the nurse implement first for a patient who has been newly admitted for suspected septic shock? 1. Administer antibiotics. 2. Obtain blood cultures. 3. Assess the patient's bowel sounds. 4. Insert an indwelling urinary catheter.
2. obtain blood cultures
Which patient's blood glucose level is indicative of sepsis and septic shock? 1 Patient A= 110 mg/dL 2 Patient B= 190 mg/dL 3 Patient C= 150 mg/dL 4 Patient D= 130 mg/dL
2. patient B= 190 mg/dL
Arrange the events in chronological order with respect to septic shock. 1. Organ failure is evident, and poor clotting with uncontrolled bleeding occurs. 2. Microthrombi formation is widespread with clots forming where they are not needed. 3. The white blood cells present in the area of invasion secrete cytokines with increased perfusion to locally infected tissue. 4. The infection enters into the blood stream of the patient with further impaired oxygenation and perfusion to the body.
3, 4, 2, 1
Which patient is at the highest risk for developing septic shock? 1. A 45-year-old recovering from pancreatitis 2. A 20-year-old with testicular cancer and an orchiectomy 3. A 65-year-old with prostate cancer receiving chemotherapy 4. A 70-year-old with an elective total knee replacement
3. a 65 year old with prostate cancer receiving chemotherapy
Which condition is a risk factor for distributive shock? 1. Use of Ginkgo biloba 2. Diminished thirst reflex 3. Diminished immune response 4. Presence of cardiomyopathies
3. diminished immune response
Which clinical finding is associated with severe sepsis? 1. Temperature of 98°F (36.7°C) 2. White blood cell (WBC) count of 10,000/mm3 3. Plasma glucose level of 140 mg/dL 4. Platelet count of 180,000/µL
3. plasma glucose level of 140 mg/dL
Which type of shock is the nurse concerned about for an older-adult patient with a history of diabetes mellitus who has a blood pressure of 90/60 mm Hg, a white blood cell (WBC) count of 14,000/mm3, and a urine output of 0.2 mL/kg/hr? 1. Hypovolemic 2. Cardiogenic 3. Septic 4. Obstructive
3. septic
Which laboratory value would the nurse expect to increase if a patient with septic shock is progressing into disseminated intravascular coagulation (DIC)? 1. Fibrinogen 2. Hematocrit 3. Serum lactate 4. Platelet count
3. serum lactate
Which typical sign or symptom indicates the early stage of septic shock? 1. Pallor and cool skin 2. Blood pressure 84/50 mm Hg 3. Tachypnea 4. Polyuria
3. tachypnea
Which problem places a patient at the highest risk for septic shock? 1. Kidney failure 2. Cirrhosis 3. Lung cancer 4. Burns on 40% of the body
4. Burns on 40% of the body
Which intervention would the nurse perform first for a patient admitted with pneumonia and possible sepsis who arouses to name but is not oriented, has a blood pressure of 90/46 mm Hg, heart rate of 128 beats/min, respiratory rate of 28 breaths/min, temperature of 101.3°F (38.5°C), no urine output for 4 hours, and central venous pressure of 2 mm Hg? 1. Obtain blood cultures. 2. Insert an indwelling urinary catheter. 3. Apply vasopressors. 4. Administer a 500-mL IV crystalloid bolus over 30 minutes.
4. administer a 500 mL crystalloid bolus over 30 minutes.
Which drug may be used to treat adrenal insufficiency for a patient with sepsis and septic shock? 1 Insulin 2 Heparin 3 Dobutamine 4 Hydrocortisone
4. hydrocortisone
Which issue would the nurse anticipate finding in a patient with septic shock who has disseminated intravascular coagulation (DIC)? 1. Polycythemia 2. Thrombocytosis 3. Elevated serum bicarbonate levels 4. Low fibrinogen levels
4. low fibrinogen levels
A urine output of 13 mL/hr would indicate which condition? 1. The patient is normal. 2. The patient has septic shock. 3. The patient's urine output is increased. 4. The patient's urine output is decreased.
4. the patient's urine output is decreased
The nurse enters the room of an older patient with a urinary tract infection who has developed septic shock. Which cue would the nurse expect to notice during the assessment to support this diagnosis? Select all that apply. One, some, or all responses may be correct.
febrile, agitation, tachypnea, tachycardia, hypotension
Which assessment finding suggests that a patient who sustained a spider bite 12 hours ago has sepsis? Select all that apply. One, some, or all responses may be correct. 1. Increased respiratory rate 2. Decreased blood pressure 3. Altered breath sounds 4. Increased serum glucose level 5. Decreased anxiety 6. Increased serum potassium lev
1. increased respiratory rate 2. decreased blood pressure 4. increased serum glucose level
Which intervention will the nurse perform first for a patient with hypovolemic shock whose chart contains the provided information? 1. Notify anesthesia for endotracheal intubation. 2. Administer norepinephrine. 3. Administer normal saline solution 250 mL/hr. 4. Type and cross for 4 units of packed red blood cells (PRBCs).
1. notify anesthesia for endotracheal intubation
Which action will the nurse take first for a patient who has been prescribed an antibiotic to treat septic shock? 1. Administer the antibiotic immediately. 2. Ensure that blood cultures were drawn. 3. Administer the prescribed vasopressor. 4. Take the patient's vital signs.
2) ensure that blood cultures were drawn
For which reason does reduced urine output occur in patients experiencing sepsis during systemic inflammatory response syndrome? 1. Impaired oxygenation and perfusion 2. Production of proinflammatory cytokines 3. Capillary leaks, allowing plasma to leak into the tissues 4. Inappropriate clotting with microthrombi forming in some organ capillaries
1. impaired oxygenation and perfusion
