Shock Sepsis MODS AQ

When reciting to the nursing instructor mechanisms that can trigger the systemic inflammatory response syndrome (SIRS) associated with sepsis, which listed by the student nurse requires correction? Burns Abscess Pancreatitis Hypertension

Hypertension Hypertension is not a mechanism that triggers SIRS. SIRS is a response to a variety of mechanisms, including burns, abscess, and pancreatitis.

When caring for a patient in acute septic shock, what should the nurse anticipate? Administering osmotic or loop diuretics Administering IV diphenhydramine (Benadryl) Infusing large amounts of intravenous (IV) fluids Assisting with insertion of a ventricular assist device (VAD)

Infusing large amounts of intravenous (IV) fluids Septic shock is characterized by a decreased circulating blood volume. Volume expansion with the administration of IV fluids is the cornerstone of therapy. The administration of diuretics is inappropriate. Diphenhydramine may be used for anaphylactic shock, but would not be helpful with septic shock. VADs are useful for cardiogenic shock, not septic shock.

Which nursing interventions are appropriate to manage hematologic dysfunctions in a patient with systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS)? Select all that apply. Avoiding multiple venipunctures Minimizing intramuscular injections Infusing insulin and glucose continuously Ensuring continuous echocardiographic monitoring Providing positive end-expiratory pressure ventilation

Avoiding multiple venipunctures Minimizing intramuscular injections Platelet count is decreased in patients with SIRS and MODS with hematologic dysfunction. This decrease increases the risk of bleeding. Therefore multiple venipunctures should be avoided and intramuscular injections should be minimized in order to minimize traumatic interventions. Continuous infusion of insulin and glucose may be needed to maintain blood glucose levels in cases in which there is endocrine dysfunction rather than hematologic dysfunction. Continuous echocardiographic monitoring helps to manage cardiovascular dysfunctions rather than hematologic dysfunctions. Positive end-expiratory pressure ventilation helps to manage respiratory dysfunction associated with SIRS and MODS.

Which type of shock causes an absence of bowel sounds? Neurogenic shock Cardiogenic shock Hypovolemic shock Anaphylactic shock

Hypovolemic shock Absence of bowel sounds is associated with hypovolemic shock. Decreased bowel sounds are seen with cardiogenic shock. Bowel dysfunction is associated with neurogenic shock. Abdominal pain, nausea, and vomiting are seen with anaphylactic shock.

A nurse is caring for a patient in the intensive care unit (ICU) admitted with septic shock. The patient has been in the ICU for 36 hours. After 24 hours, which finding increases the patient's risk for developing multiple organ dysfunction syndrome (MODS)? Increased cardiac output Decreased coronary artery perfusion Increased systemic vascular resistance Decreased myocardial oxygen metabolism

Increased cardiac output If increased cardiac output persists after 24 hours, the patient in septic shock is at risk of developing hypotension and MODS. Coronary artery perfusion is not primarily altered in septic shock. Decreased, not increased, systemic vascular resistance is associated with an increased risk of MODS. Septic shock does not typically alter myocardial oxygen metabolism.

A patient being cared for in the critical care unit for pancreatitis and subsequent development of multiple organ dysfunction syndrome (MODS) is exhibiting gastrointestinal symptoms including bleeding. Which prescriptions does the nurse anticipate the healthcare provider will order to address the gastrointestinal issues? Select all that apply. Maalox Sucralfate Atorvastatin Loperamide Omeprazole

Maalox Sucralfate Omeprazole Antacids like Maalox, proton pump inhibitors like omeprazole, and sucralfate are all indicated to treat issues related to injury to the gastric mucosa in MODS. Atorvastatin is a cholesterol-lowering agent and thus not indicated in this situation. Loperamide is an antidiarrheal and not appropriate based upon the information provided.

The nurse is evaluating the effectiveness of a continuous infusion of insulin for a patient diagnosed with multiple organ dysfunction syndrome (MODS). Which blood glucose value would indicate an acceptable level in this situation? 68 mg/dL 156 mg/dL 184 mg/dL 200 mg/dL

156 mg/dL Glycemic control is attempted through continuous insulin infusions. The goal is to keep the glucose level between 140 and 180 mg/dL, thus 156 mg/dL would be considered acceptable. The level 68 mg/dL is too low, and 184 mg/dL and 200 mg/dL are too high.

A nurse is caring for multiple patients. Which patient does the nurse monitor most closely for possible development of sepsis? A 7-year-old patient with ear pain and history of chronic otitis media An 86-year-old patient with a fever and history of chronic urinary tract infections A 54-year-old patient with a sore throat and no significant previous medical problems A 62-year-old patient with complaints of cough and history of chronic obstructive pulmonary disease (COPD)

An 86-year-old patient with a fever and history of chronic urinary tract infections Advanced age, recent surgery, history of chronic disease, and immunosuppressive therapy put a patient at risk of infection. Due to these factors, the 86-year-old patient with a fever and chronic infections has the highest risk for developing sepsis. The 62-year-old patient has risk factors of advanced age and chronic disease, but the lack of fever puts this patient at a lower risk. The 7-year-old patient only exhibits one risk factor, and the 54-year-old patient does not exhibit any risk factors.

When caring for a patient with multiple organ dysfunction syndrome, what treatment should the nurse anticipate for stress ulcer prophylaxis? Select all that apply. Antacids Diuretics Sucralfate Proton pump inhibitors Calcium channel blockers

Antacids Sucralfate Proton pump inhibitors The patient with multiple organ dysfunction syndrome is at risk of developing stress ulcers due to decreased peristalsis and mucosal ischemia. Antacids, sucralfate, and proton pump inhibitors are the appropriate treatment used for stress ulcer prophylaxis. Diuretics are used to treat fluid imbalance and improve renal function. Calcium channel blockers are used to treat cerebral vasospasms.

A patient admitted to the hospital after a motor vehicle accident (MVA) is in hypovolemic shock. On examination, the nurse finds that the patient is becoming anxious, and the urine output is decreasing. What appropriate action should the nurse perform? Begin crystalloid fluid replacement. Start fluids only if deterioration occurs. Prepare for administering blood products. Wait for the patient to compensate naturally.

Begin crystalloid fluid replacement. When the volume of blood loss is less than 30 percent, crystalloid fluid replacements are performed to reverse tissue dysfunction. Blood products are administered when the blood volume loss is more than 30 percent. The nurse should not wait for deterioration to occur to start the fluid replacement therapy. This is because the body can typically compensate naturally for a blood volume loss up to 15 percent.

What type of medication does the nurse anticipate being prescribed by the health care provider to manage confusion, disorientation, and delirium in a patient with systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS)? Vasopressors Loop diuretics Proton pump inhibitors Calcium channel blockers

Calcium channel blockers Impaired perfusion of the brain may cause confusion, disorientation, and delirium in the patient. The health care provider is likely to prescribe calcium channel blockers to a patient exhibiting confusion, disorientation, and delirium to reduce cerebral vasospasm and improve perfusion of the brain. Vasopressors may be prescribed to combat cardiovascular dysfunction. Loop diuretics are prescribed if there is renal dysfunction. Proton pump inhibitors are prescribed to manage gastrointestinal symptoms.

A nurse is assessing a patient admitted with septic shock. The nurse notes the patient is anxious, confused, and agitated. The nurse knows that these symptoms are signs of impairment of which process? Kidney perfusion Cerebral perfusion Respiratory failure Cardiovascular dysfunction

Cerebral perfusion Patients in septic shock who have impaired cerebral perfusion may develop anxiety, confusion, and agitation. Decreased kidney perfusion results in sodium and water retention and decreased urine output. Signs of respiratory failure include tachypnea, crackles, and cyanosis. Signs of cardiovascular dysfunction include tachycardia and hypotension.

The nurse is reviewing orders for laboratory work for a patient who is experiencing shock. Which of the following tests would the nurse expect to be ordered? Select all that apply. Creatinine Arterial blood gases Complete blood count Glycosated hemoglobin Prostate surface antigen

Creatinine Arterial blood gases Complete blood count Creatinine is a blood test to check kidney function, which is crucial for a patient with shock. Arterial blood gases would be ordered to assess acid-base balance and oxygenation status. A complete blood count would also be ordered to assess red and white blood cell function. Prostate surface antigen (PSA) is done as a screening for prostate cancer and would not be ordered for a patient experiencing shock. Although a glucose level would need to be checked on a patient in shock, a glycosated hemoglobin assessment, which examines blood glucose control over 12 weeks, would not be ordered for a patient in shock.

Which findings in a patient with systemic inflammatory response syndrome (SIRS) help the nurse identify cardiovascular system dysfunction? Select all that apply. Decrease in heart rate Decrease in stroke volume Decrease in cardiac output Decrease in blood pressure Decrease in mean arterial pressure Decrease in systemic vascular resistance

Decrease in blood pressure Decrease in mean arterial pressure Decrease in systemic vascular resistance A patient with SIRS may have cardiovascular system dysfunction manifested as a decrease in blood pressure, mean arterial pressure, and systemic vascular resistance. Heart rate, stroke volume, and cardiac output tend to increase in such patients

A nurse is caring for a patient diagnosed with septic shock. For which sign of peripheral hypoperfusion does the nurse assess the patient? Diaphoresis Warm, dry skin Redness of the skin Strong peripheral pulses

Diaphoresis One sigh of peripheral hypoperfusion is diaphoresis. Because the patient will sweat, warm, dry skin does not indicate peripheral hypoperfusion. Rather than red skin, the patient will exhibit pallor and cyanosis with peripheral hypoperfusion. Strong peripheral pulses are not present with peripheral hypoperfusion.

Which interventions might the nurse anticipate implementing to prevent healthcare-associated infections for a patient suffering from multiple organ dysfunction syndrome (MODS)? Select all that apply. Daily arterial blood gases (ABGs) Early surgery to remove necrotic tissue Ambulating patient as early as possible Daily assessment of continuing need for invasive lines and devices Strict use of aseptic and sterile technique in relation to lines and tubes

Early surgery to remove necrotic tissue Ambulating patient as early as possible Daily assessment of continuing need for invasive lines and devices Strict use of aseptic and sterile technique in relation to lines and tubes Prevention of healthcare-associated infections is a priority for the care of a patient suffering from MODS. Removing necrotic tissue removes a possible medium for microorganisms. Early mobilization aids in pulmonary management to decrease the risk for infection. Assessing for the need for ongoing invasive lines and devices allows these to be discontinued when no longer needed to decrease entry routes for infection. Strict use of aseptic and sterile technique as indicated helps decrease the possibility of infection. Daily arterial blood gases may be indicated with MODS, but obtaining these does not directly address the risk for infection.

What electrolyte change is likely in patients with systemic inflammatory response syndrome (SIRS) and multiorgan dysfunction syndrome (MODS)? Hyperkalemia Hyponatremia Hypercalcemia Hypophosphatemia

Hypophosphatemia In patients with SIRS and MODS, hypophosphatemia is common. The release of aldosterone increases urinary potassium loss, and catecholamines cause potassium to move into the cells. As a result, hypokalemia rather than hyperkalemia occurs. The release of antidiuretic hormone and aldosterone results in sodium and water retention. Hence, hyponatremia does not occur. Other changes include hypocalcemia rather than hypercalcemia.

The health care provider prescribes 5% sodium chloride solution for the initial fluid replacement in a patient with hypovolemic shock. Which factors should the nurse consider when administering this solution to the patient? Select all that apply. Monitor the patient for bleeding. Protect the infusion from sunlight. Monitor the patient for renal failure. Infuse the solution through a central line. Monitor the patient closely for signs of hypernatremia.

Infuse the solution through a central line. Monitor the patient closely for signs of hypernatremia. A 5% sodium chloride solution is a hypertonic solution that is used for initial volume expansion in patients with hypovolemic shock. The patient should be monitored for signs of hypernatremia, such as disorientation and convulsions. The infusion should be administered through a central line, because it can damage the peripheral veins. The solution does not increase the risk of bleeding and is not photosensitive. Also, it does not increase the risk of renal failure.

A patient diagnosed with sepsis fails to respond to fluid resuscitation. The healthcare provider orders the patient to be started on a vasopressor. The nurse evaluates which response to determine the effectiveness of the vasopressor? SpO 2 greater than 94% Lactic acid less than 2.0 mmol/L Mean arterial pressure greater than 65 mm Hg Systolic blood pressure greater than 80 mm Hg

Mean arterial pressure greater than 65 mm Hg The goal of vasopressor therapy is to maintain a mean arterial pressure greater than 65 mm Hg. Fluids can be increased or vasopressor therapy can be decreased if the patient develops hypotension. Vasopressors do not have an effect on lactic acid results or SpO 2.

The nurse is monitoring a patient with neurogenic shock caused by a spinal cord injury. The nurse finds that the PaO 2 is below 60 mm Hg. How should the nurse interpret this finding? Select all that apply. Need for more aggressive fluid therapy Need for higher oxygen concentrations Need for advanced pulmonary management Need for intubation and mechanical ventilation Need for a different mode of oxygen administration

Need for higher oxygen concentrations Need for intubation and mechanical ventilation Need for a different mode of oxygen administration Arterial blood gases (ABGs) provide definitive information on ventilation and oxygenation status and acid-base balance. A PaO 2 below 60 mm Hg indicates hypoxemia and the need for higher oxygen concentrations or for a different mode of oxygen administration. A rising PaCO 2 with a persistently low pH and PaO 2 indicate the need for advanced pulmonary management. Most patients in shock are intubated and on mechanical ventilation. Low PaO 2 implies the need for ventilation and not fluid resuscitation.

What occurs when the inflammatory response is activated in a patient with systemic inflammatory response syndrome (SIRS)? Release of mediators Decrease in metabolism Damage of the mesothelium Decrease in vascular permeability

Release of mediators A release of mediators occurs when the inflammatory response is activated. Other changes that occur include an increase in metabolism or hypermetabolism, direct damage to the endothelium, and an increase in vascular permeability.

The primary health care provider prescribes antibiotics and vasopressors for a patient. Which type of shock does the nurse expect to be treating? Septic shock Neurogenic shock Cardiogenic shock Anaphylactic shock

Septic shock Septic shock occurs in response to infection. Therefore antibiotics are prescribed for a patient with septic shock. Cardiogenic shock occurs when systolic or diastolic function of the heart is impaired. Sympathomimetic drugs are used for the treatment of cardiogenic shock. Injury to the spinal cord at the fifth thoracic vertebra or above causes neurogenic shock. Vasconstricting medications are prescribed to prevent vasodilation for a patient in septic shock. Anaphylactic shock is a life-threatening allergic reaction to a sensitizing substance. Antihistamines, bronchodilators, and corticosteroids are used in the treatment of anaphylactic shock.

A patient diagnosed with multiple organ dysfunction syndrome is developing pulmonary edema. The nurse realizes that which factor is the cause of the edema? Tissue hypoxia Unregulated apoptosis Microvascular coagulopathy Uncontrolled systemic inflammation

Uncontrolled systemic inflammation During sepsis, early activation of immune cells is followed by down-regulation of their activity, which leads to a state of immune deficiency and increased risk of superinfection. Proinflammatory mediators increase capillary permeability, resulting in edema in organs such as the lungs. This is why the patient is developing pulmonary edema. Evidence of tissue hypoxia will occur in the gastrointestinal tract and the brain first. Unregulated apoptosis is uncontrollable cellular death. Pulmonary edema is not a symptom of unregulated apoptosis. Microvascular coagulopathy will manifest as abnormal clotting factors and microembolism production.

Patients in septic shock require large amounts of fluid replacement. The nurse would expect the healthcare practitioner to order an amount of fluids in which range to achieve adequate fluid resuscitation? 20-40 mL/kg 30-50 mL/kg 40-50 mL/kg 40-60 mL/kg

30-50 mL/kg Patients in septic shock require volume resuscitation of 30-50 mL/kg with isotonic crystalloids to achieve adequate fluid resuscitation. A volume of 20-40 mL/kg is too little. A volume of 40-50 mL/kg does not express the full expected range. A volume of 60 mL/kg is too high an upper limit.

A nurse is caring for a 60-year-old patient with sepsis stemming from cellulitis to the right lower extremity. The patient's core temperature is 101.6° F (38.8° C). Which strategy to reduce the patient's temperature should the nurse implement? Administer antipyretics. Cover the patient adequately. Give the patient a warm bath. Increase the room temperature.

Administer antipyretics. The nurse should treat the patient's fever with antipyretics and remove the patient's covers or use light sheets. Bathing the patient with warm water will not assist in lowering the patient's core body temperature, and the nurse should decrease the room temperature.

What action should the nurse take when caring for a patient with multiple organ dysfunction syndrome (MODS)? Avoid giving sedatives. Require bed rest for several weeks. Utilize the parenteral mode for nutrition. Aim for glycemic control at 140 to 180 mg/dL.

Aim for glycemic control at 140 to 180 mg/dL. When caring for a patient with multiple organ dysfunction syndrome (MODS), the nurse should pay attention to the glycemic control with a goal of 140 to 180 mg/dL. The aim of proper nutritional support is to preserve organ function. Sedation may be given to patients with MODS because it helps to decrease the oxygen demand. Patients should not be put on bed rest for several weeks. Early ambulation helps to reduce infections. The enteral mode is the preferred mode of nutrition. However, if it is not possible or it does not meet the caloric needs of the patient, parenteral nutrition should be initiated or added.

A patient is admitted to the hospital with a suspected diagnosis of obstructive shock. What could be the possible causes of this type of shock? Select all that apply. Spinal cord injury Cardiac tamponade Tension pneumothorax Hypersensitivity to antibiotics Superior vena cava syndrome

Cardiac tamponade Tension pneumothorax Superior vena cava syndrome Obstructive shock develops when a physical obstruction to blood flow occurs resulting in decreased cardiac output. This can be caused by restricted diastolic filling of the right ventricle from compression caused by cardiac tamponade, tension pneumothorax, or superior vena cava syndrome. Hypersensitivity to antibiotics may cause anaphylactic shock. Spinal cord injury may lead to neurogenic shock

What is the best intervention for a patient with multiple organ dysfunction syndrome (MODS), renal failure, and signs of hemodynamic instability? Hemodialysis Diuretic therapy Aggressive oxygen therapy Continuous renal replacement therapy

Continuous renal replacement therapy Continuous renal replacement therapy is considered the best intervention for the patient. In patients with renal failure and hemodynamic instability, continuous renal replacement therapy is better tolerated than hemodialysis. Diuretic therapy may be given in patients with prerenal manifestations due to MODS. However, diuretics are not administered in renal failure, because they are nephrotoxic and can worsen the acute tubular necrosis, leading to acute kidney injury. Aggressive oxygen therapy is not an intervention for renal failure. It is given to MODS patients with acute respiratory distress syndrome.

The nurse is reviewing the prescriptions of a patient being treated for multiple organ dysfunction syndrome (MODS). Which medication listed does the nurse expect is being used to manage cardiac manifestations? Digoxin Lisinopril Metoprolol Dobutamine

Dobutamine Vasopressors are used to address issues related to the cardiovascular system in MODS. Dobutamine is a vasopressor which directly stimulates beta-1 receptors of the heart to increase myocardial contractility and stroke volume and is used to address cardiac manifestations. Lisinopril is an ACE Inhibitor. Metoprolol is a beta blocker. Digoxin is a cardiac glycoside.

A nurse is caring for a patient who is in a state of cardiogenic shock caused by myocardial infarction. The nurse uses pulse oximetry to monitor the oxygen saturation levels. Where should the nurse attach the pulse oximetry probe to get an accurate reading? Select all that apply. Ear Toes Nose Fingers Forehead

Ear Nose Forehead Pulse oximetry is used to monitor oxygen saturation. The patient in a state of shock has poor peripheral circulation, and a peripheral reading may not be accurate. Therefore the probe should be attached to the ear, nose, or forehead for a reliable measurement. Pulse oximetry readings obtained through the toes and fingers may not be accurate due to compromised peripheral circulation.

The nurse is mentoring a graduate nurse and is explaining the use of fluids in a patient who is experiencing hypovolemic shock. Which of the following fluids increases osmotic pressure to provide rapid volume expansion? Lactated Ringer's 3% sodium chloride Fresh frozen plasma Human serum albumin

Human serum albumin Human serum albumin is a colloidal fluid that increases osmotic pressure and will provide rapid volume expansion. Lactated Ringer's and 3% sodium chloride are used for initial volume replacement in shock, but they do not provide rapid volume expansion. Fresh frozen plasma is used to replace blood loss and replace coagulation factors.

What laboratory findings of a patient with systemic inflammatory response syndrome (SIRS) suggest progression to hepatic dysfunction? Select all that apply. Bilirubin 30 µmol/L Urine Na + 24 mEq/L Increase in serum ammonia Decrease in serum transferrin Ventilation-perfusion (V/Q) mismatch

Increase in serum ammonia Decrease in serum transferrin Loss of liver function leads to the accumulation of waste products such as ammonia. Hence an increase in the serum ammonia level indicates hepatic dysfunction. In patients with SIRS, the plasma transferrin level helps to assess protein synthesis. When hepatic dysfunction occurs, there is a decrease in serum transferrin. In hepatic dysfunction, there is accumulation of bilirubin. A bilirubin level greater than 34 µmol/L suggests hepatic dysfunction. A urine NA + level of 24 mEq/L indicates acute tubular necrosis or an intrarenal manifestation of renal system dysfunction. It does not indicate hepatic dysfunction. Ventilation-perfusion (V/Q) mismatch suggests development of acute respiratory distress syndrome (ARDS) rather than hepatic dysfunction.

A patient in septic shock is receiving fluid resuscitation. How will the nurse most accurately measure urine output? Daily weights Nasogastric tube Strict input and output Indwelling urinary catheter

Indwelling urinary catheter The nurse will insert an indwelling urinary catheter to measure adequate urine output. Strict input and output and daily weights are not exact enough for measuring urine output. A nasogastric tube is not related to measuring urine output.

Which criterion is a clinical manifestation of sepsis? Infection Hypoglycemia Normal body temperature Systolic blood pressure of 100 mm Hg or higher

Infection One clinical manifestation of sepsis is infection. Hypoglycemia, normal body temperature, and a systolic blood pressure of 100 mm Hg or higher are not associated with sepsis. Rather, the nurse would expect hyperglycemia, fever, and hypotension as clinical manifestations of sepsis.

A nurse is caring for a patient with sepsis. Which laboratory value will the nurse monitor to measure the byproduct of anaerobic metabolism caused by significant hypoperfusion and impaired oxygen utilization at the cellular level? Lactic acid Base deficit Blood cultures Arterial blood gas

Lactic acid Lactic acid is the measurement of the byproduct of anaerobic metabolism caused by significant hypoperfusion and impaired oxygen utilization at the cellular level in sepsis patients. Base deficit indicates acid production secondary to hypoxia. Blood cultures are used to determine the organism causing infection. Arterial blood gas measures respiratory alkalosis in early stages of septic shock and metabolic acidosis in late stages of septic shock.

Which medical emergency is caused by the failure of two or more organ systems? Crush syndrome Toxic shock syndrome Multiple organ dysfunction syndrome (MODS) Systemic inflammatory response syndrome (SIRS)

Multiple organ dysfunction syndrome (MODS) Multiple organ dysfunction syndrome is caused by the failure of two or more organ systems in an acutely ill patient. A crushing injury to the skeletal muscle causes crush syndrome, which is characterized by shock and renal failure. Bacterial toxins cause toxic shock syndrome, which is characterized by high fever, hypotension and malaise. Systemic inflammatory response syndrome (SIRS) is a systemic inflammatory response caused by infection, ischemia, infarction and injury.

Which laboratory level would indicate dysfunction of the hematologic system in a patient with multiple organ dysfunction syndrome (MODS), by its decrease? D-dimer Platelet count Prothrombin time Fibrin-split products

Platelet count A decrease in the platelet count, or thrombocytopenia, is a manifestation of dysfunction of the hematologic system in a patient with MODS. Other findings include an increase in D-dimer, increase in prothrombin time, and increase in fibrin-split products.

A nurse is examining a patient with anaphylactic shock due to an insect bite. What types of skin manifestations would the nurse expect to find? Select all that apply. Pallor Pruritus Flushing Urticaria Cold, clammy skin

Pruritus Flushing Urticaria Insect bites may cause allergic reactions and anaphylactic shock. The skin manifestations may include pruritus, flushing, and urticaria caused by massive vasodilation, release of vasoactive mediators, and an increase in capillary permeability. Pallor and cold, clammy skin changes are usually seen in cardiogenic, hypovolemic, and obstructive shock caused by decreased circulatory volume and tissue perfusion.

When a patient suffers from hypovolemic shock due to loss of blood, the nurse should administer large volumes of packed red blood cells (RBCs). What should be the appropriate course of action for the nurse? Warm the pack before administering. Check the patient's hypersensitivity to the product. Provide antibiotics based on the clinical condition. Replace clotting factors based on laboratory studies.

Replace clotting factors based on laboratory studies. When administering large volumes of packed RBCs, it is important to replace clotting factors to prevent coagulopathy. Because the pack contains only RBCs and not the clotting factors, it should be given extrinsically. Generally, the crystalloid and colloid solutions are warmed before being administered to avoid hypothermia. However, packed red blood cells should not be warmed, because high temperature can damage the red blood cells. The blood products are almost always cross typed and matched before administration. Antibiotics are not related to the administration of RBCs.

Which system shows initial signs of dysfunction in systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS)? Respiratory system Cardiovascular system Gastrointestinal system Central nervous system

Respiratory system The pulmonary vasculature is directly affected by inflammatory mediators. Hence the initial signs of dysfunction in systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) are seen in the respiratory system. Cardiovascular changes are detected later when there is myocardial depression. Effects on the gastrointestinal system are seen when the motility gets decreased. Neurologic dysfunctions are seen when the patient's mental status begins to show signs of change.

What is the most commonly reported cause for death in patients with multiple organ dysfunction syndrome (MODS)? Ulcers Sepsis Renal failure Electrolyte imbalances

Sepsis The mortality rate of patients with multiple organ dysfunction syndrome (MODS) is 70 percent to 80 percent. The most common cause of death reported is sepsis. Although decreased perfusion increases the risk for ulceration in the gastrointestinal (GI) system, this condition does not usually lead to death. Renal failure requires the use of dialysis until functionality returns or a transplant occurs; this condition does not result in death. Electrolyte imbalances are due to fluid and electrolyte imbalances that affect mental status; this condition does not usually cause death.

What finding in the laboratory reports of a patient with multiple organ dysfunction syndrome (MODS) suggests to the nurse that the patient has acute tubular necrosis? Bilirubin is 3 mg/dL. Urine Na + is 22 mEq/L. Urine specific gravity is 1.026. Blood urea nitrogen (BUN)/creatinine ratio is 22:1.

Urine Na + is 22 mEq/L. A urine Na + greater than 20 mEq/L is suggestive of acute tubular necrosis. A bilirubin level higher than 2 mEq/L suggests hepatic dysfunction rather than renal dysfunction. Urine specific gravity above 1.020 and a BUN/creatinine ratio higher than 20:1 indicate renal hypoperfusion rather than acute tubular necrosis.

Which medication would the nurse administer to treat renal complications associated with systemic inflammatory response syndrome (SIRS)? Antacids Sucralfate Furosemide Omeprazole

Furosemide A SIRS-affected (systemic inflammatory response syndrome) patient is administered a loop diuretic such as furosemide to address renal complications related to hypoperfusion and a decreased glomerular filtration rate. Antacids, sucralfate, and omeprazole act as a stress ulcer prophylaxis for the gastrointestinal system.

When examining a patient with septic shock, what symptoms would the nurse expect to find? Select all that apply. Paralytic ileus Pulsus paradoxus Distended jugular vein Decreased urinary output Gastrointestinal (GI) bleeding

Paralytic ileus Decreased urinary output Gastrointestinal (GI) bleeding Patients suffering from septic shock may experience decreased tissue perfusion, which may result in a paralytic ileus, GI bleeding, and decreased urinary output. Pulsus paradoxus and jugular vein distension are found in obstructive shock and are mainly the result of compromised hemodynamics.

Which laboratory finding in a patient with multiple organ dysfunction syndrome (MODS) suggests prerenal manifestations of renal dysfunction? Urine Na + is 22 mEq/L. Urine specific gravity is 1.010. Urine osmolality is decreased. Urine specific gravity is increased.

Urine specific gravity is increased. An increase in urine specific gravity suggests prerenal manifestations in patients with MODS. This occurs due to renal hypoperfusion. A urine Na + level above 20 mEq/L is a sign of intrarenal manifestations in MODS. It occurs due to acute tubular necrosis. Other intrarenal manifestations of MODS are urine specific gravity of around 1.010 and a decrease of the urine osmolality.

Which patient being cared for by the nurse in a critical care unit would the nurse suspect may have multiple organ dysfunction syndrome (MODS)? A: BUN/Creatinine 24:1; Urine spec gravity 1.032 B: ALT 50 U/L, AST 40 U/L, urine specific gravity 1.018 C: BG 82 mg/dL, Urine specific gravity 1.028 Dark concentrated urine D: RBC 3.5x10^6, HCT 33%. Hgb 10.5 g/dL. GI Bleed, decreased peristalsis

A MODS requires involvement of at least two organ systems. Patient A has a BUN/creatinine ratio greater than 20:1 and a urine specific gravity greater than 1.020, which indicates renal involvement; dyspnea, tachypnea, and a PAWP less than 18 mm HG indicate respiratory involvement thus supporting a potential diagnosis of MODS. Patient B has symptomology indicating involvement of only the hepatic system; the ALT (normal 10-40 U/L) and AST (normal 10-30 U/L) are both elevated and the patient has jaundice. The urine specific gravity is less than 1.020 (greater than 1.020 indicates renal hypoperfusion) and blood pressure are within normal limits. Patient C's blood glucose is within normal limits (70-120 mg/dL), but urine specific gravity is elevated and the urine is dark indicating possible involvement of only one system (renal). Patient D has a decreased Hct (normal Hct 39%-50% for males and 35%-47% for females) and a decreased RBC count; normal values range from 3.8/4.3-5.1/5.7 x 10 6/μL (male/female) and a decreased Hgb (normal Hgb 13.2- 17.3 g/dL for males and 11.7- 15.5 g/dL for females which may indicate blood loss but does not support a diagnosis of MODS.

While planning the management of oxygen delivery in a patient with shock, what appropriate measures should the nurse undertake? Select all that apply. Administer supplemental oxygen as prescribed. Space activities that increase oxygen consumption. Space activities that decrease oxygen consumption. Monitor continuously by using a central venous catheter. Encourage the patient to move around to increase lung expansion.

Administer supplemental oxygen as prescribed. Space activities that increase oxygen consumption. Monitor continuously by using a central venous catheter. To optimize oxygen supply and ventilation in a patient suffering from shock, the activities that increase oxygen consumption should be evenly spaced. Mixed venous oxygen saturation should be monitored through a central venous catheter. The patient should not exert energy by excessive moving around because it increases oxygen demand.

A patient has neurologic dysfunction related to sepsis. Which assessment finding is specific to this dysfunction? Shivering Hypotension Altered mental status Decreased urine output

Altered mental status Neurologic dysfunction commonly presents as mental status changes with systemic inflammatory response syndrome. These acute changes can be an early sign of sepsis. Shivering is the body's response to temperature regulation. Hypotension is a result of decreased cardiac output. Decreased urine output is a result of impaired renal function.

Which cardiovascular change is commonly found in patients with systemic inflammatory response syndrome (SIRS)? Decrease in heart rate Decrease in capillary refill Decrease in central venous pressure Decrease in pulmonary artery wedge pressure

Decrease in capillary refill Patients with systemic inflammatory response syndrome (SIRS) have decreased capillary refill. Other cardiovascular changes include increases rather than decreases in heart rate, central venous pressure, and pulmonary artery wedge pressure.

A patient is showing signs of anaphylactic shock from an insect sting. Which primary health care provider's prescription does the nurse implement first? Diphenhydramine 50 mg IV Oxygen via nasal cannula at 3 L Epinephrine 1:1000, 0.5 mg subcutaneous (SQ) Normal saline intravenous (IV) to run at 150 mL/hr

Epinephrine 1:1000, 0.5 mg subcutaneous (SQ) The patient in anaphylaxis experiences bronchial spasm and constriction. The administration of epinephrine is necessary to reverse this process and facilitate an open airway. Although administering normal saline, diphenhydramine, and oxygen are appropriate, they must be done after an airway has been established.

Why is there a loss of lean body mass in patients with systemic inflammatory response syndrome (SIRS) and multiorgan dysfunction syndrome (MODS)? Hypoglycemia occurs. Fatty acids are mobilized for fuel. Glucose is converted to glycogen. Glucose is converted to amino acids.

Fatty acids are mobilized for fuel. Both SIRS and MODS trigger a hypermetabolism response leading to mobilization of fatty acids for fuel. Such a catabolic state leads to loss of lean body mass. Because catecholamines and glucocorticoids are released, hyperglycemia occurs, not hypoglycemia. Hyperglycemia also occurs because glycogen stores are converted into glucose. Once glycogen is depleted, amino acids are converted into glucose and there is a reduction in protein stores.

A pregnant patient is hospitalized with severe hemorrhage. The nurse expects what laboratory results? Select all that apply. Increased lactate levels Increased sodium levels Decreased hematocrit levels Decreased blood glucose levels Increased natriuretic peptide levels

Increased lactate levels Decreased hematocrit levels Severe hemorrhage results in blood loss and hypovolemic shock in the patient. Due to the loss of blood, the patient has increased lactate levels and decreased hematocrit levels. Loss of blood does not result in sodium retention and does not increase serum sodium levels. Loss of blood will not increase insulin levels and does not decrease blood glucose levels in the patient. Hypovolemia will not stimulate cardiac myocytes and will not increase the production of natriuretic peptide levels. Therefore the patient will probably not have increased sodium levels, decreased blood glucose levels, or increased natriuretic peptide levels.

When caring for a patient with sepsis and a suspected infection, which is the priority nursing intervention? Initiate broad spectrum antibiotics. Obtain blood cultures after antibiotic initiation. Provide pain medication to increase patient comfort. Hold antibiotic therapy until the organism is identified.

Initiate broad spectrum antibiotics Once an infection is suspected, the nursing priority is to begin broad spectrum antibiotics therapy. Adjustments to antibiotic therapy, if needed, are based on culture results, but antibiotic therapy should not be delayed in patients with sepsis. Pain medication may be necessary but is not a nursing priority for treating infection. Blood cultures should be drawn before antibiotic therapy.

What is the goal in the care of a systemic inflammatory response syndrome (SIRS) patient whose bilirubin level is 3 mg/dL? Patient will be free of stress ulcers. Patient will not feel abdominal distension. Patient will maintain adequate tissue perfusion. Patient will maintain intraabdominal pressures.

Patient will maintain adequate tissue perfusion The nurse will plan to maintain adequate tissue perfusion for a systemic inflammatory response syndrome (SIRS) patient with bilirubin level of 3 mg/dL. An elevation of the bilirubin indicates impaired liver function. Stress ulcer prophylaxis is routine and would have been initiated before SIRS occurred. Abdominal distention and increased intraabdominal pressures are associated with impaired liver function. Monitoring these conditions is essential but is of a lower priority than maintaining tissue perfusion.

A patient who suffered multiple fractures from a vehicle accident is being observed for potential development of multiple organ dysfunction syndrome (MODS). Which assessment data would indicate potential development of the syndrome? Select all that apply. Severe dyspnea Respiratory rate of 32 breaths/minute Heart rate of 110 beats/minute Urine Na + of 18 mEq/L BUN/creatinine ratio of 18:1 Blood pressure of 86/42 mm Hg

Severe dyspnea Respiratory rate of 32 breaths/minute Heart rate of 110 beats/minute Blood pressure of 86/42 mm Hg Severe dyspnea, tachycardia, tachypnea, and hypotension indicate involvement of two organ systems, supporting a potential diagnosis of MODS. The BUN/creatinine ratio is below the 20:1 ratio, which does not support a diagnosis of MODS, and the urine sodium is within the normal range of 40-220 mEq/L/24 hours.

Systemic inflammatory response syndrome (SIRS) in a patient seems to have progressed to dysfunction of the renal system. How are the manifestations of acute tubular necrosis different from those of renal hypoperfusion? Urine osmolality is increased in acute tubular necrosis and decreased in renal hypoperfusion. Urine Na + is less than 20 mEq/L in acute tubular necrosis and greater than 20 mEq/L in renal hypoperfusion. Urine specific gravity is around 1.010 in acute tubular necrosis and greater than 1.020 in renal hypoperfusion. Blood urea nitrogen/creatinine ratio is greater than 20:1 in acute tubular necrosis and less than 10:1 to 15:1 in renal hypoperfusion.

Urine specific gravity is around 1.010 in acute tubular necrosis and greater than 1.020 in renal hypoperfusion In patients with acute tubular necrosis, the urine specific gravity is around 1.010, whereas it is greater than 1.020 in patients with renal hypoperfusion. Urine Na + is greater than 20 mEq/L in patients with acute tubular necrosis and greater than 20 mEq/L in patients with renal hypoperfusion. Urine osmolality is decreased in cases of acute tubular necrosis, whereas it is increased in cases of renal hypoperfusion. Blood urea nitrogen/creatinine ratio is less than 10:1 to 15:1 in cases of acute tubular necrosis and greater than 20:1 in cases of renal hypoperfusion

A patient is receiving 5% human serum albumin. The nurse should monitor for which complications associated with the infusion? Select all that apply. Urticaria Bleeding Hyponatremia Fluid overload Hyperchloremic acidosis

Urticaria Fluid overload Colloidal solutions such as 5% human serum albumin may cause fluid and sodium retention, resulting in fluid overload. Therefore to prevent the risk of fluid overload in the patient, the nurse should check for signs of fluid overload, or hypervolemia. Colloidal solutions can cause chills, fever, and urticaria. Therefore the nurse should assess the patient for symptoms of urticaria in order to provide appropriate treatment. Unlike dextrose, human serum albumin does not increase the risk of bleeding in the patient. Human serum albumin causes sodium retention, so the nurse should check for the symptom of hypernatremia, not hyponatremia. Human serum albumin does not cause a decrease in plasma bicarbonate concentration and does not result in hyperchloremic acidosis.

A nurse is caring for a patient diagnosed with septic shock. After an infusion of 30 mL/kg of intravenous fluids, the patient is assessed and has a temperature of 101.4°F (38.6°C), a heart rate of 92 beats/minute, respiration rate of 20 breaths/minute, and a blood pressure of 80/60 mm Hg. Which nursing intervention is a priority for this patient? Redraw lactic acid. Administer a vasopressor. Insert an indwelling urinary catheter. Obtain a 12-lead echocardiograph (ECG).

Administer a vasopressor. Patients in septic shock with persistent hypotension who do not respond to fluid resuscitation should be placed on a vasopressor. The physiologic goal is to increase cardiac output and end organ perfusion. The nurse should redraw the lactic acid, obtain a 12-lead ECG, and insert an indwelling urinary catheter while caring for this patient, but these can take place following administration of a vasopressor.

A patient who suffered a massive myocardial infarction two weeks ago developed multiple organ dysfunction syndrome three days ago. Despite mechanical ventilation, sedation, and nutritional and cardiac support, the patient has not responded. The primary care provider has indicated that further interventions will likely be unsuccessful. Which option does the nurse anticipate being discussed next with the patient's family? Discussion of life support withdrawal and initiation of end-of-life care Transfer to a long-term acute care facility for more intensive care and support Consult requests for primary care providers with expertise in multiple organ failure Testing to determine if the patient meets the clinical and legal criteria for brain death

Discussion of life support withdrawal and initiation of end-of-life care If a patient is not responding to treatment efforts, the healthcare team and the patient's family will need to discuss realistic goals and options, such as withdrawal of life support and end-of-life care. Transfer to a different facility will not change the probable outcome. A patient who has not responded to treatment for MODS would not be helped by additional consults. Determining whether or not the patient meets the legal criteria for brain death may occur but would not be the next option.

What are the immediate effects of the inflammatory response that precedes multiple organ dysfunction syndrome (MODS)? Select all that apply. Organ damage Hypermetabolism Microvascular clots Increased vascular permeability Direct damage of the endothelium Mediators leak out of the endothelium

Hypermetabolism Increased vascular permeability Direct damage of the endothelium Inflammatory cascade causes direct damage of the endothelium, increased vascular permeability, and hypermetabolism quickly. Vascular permeability allows mediators and proteins to leak from the endothelium further on in the cascade; microvascular clots are a late effect of inflammation which will eventually lead to impaired perfusion, and finally organ damage which precipitates MODS.

A nurse is evaluating a patient admitted with sepsis who received large amounts of fluid resuscitation in the emergency room. Which is the priority for the nurse to evaluate concerning possible complications caused by large fluid volume administration? Hypothermia and coagulopathy Hypokalemia and hyperglycemia Reflex bradycardia and headache Cardiac stimulation and bronchodilation

Hypothermia and coagulopathy When large amounts of fluid are required, the nurse must assess the patient for two major complications: hypothermia and coagulopathy. Hypokalemia and hyperglycemia must be assessed when patients receive hydrocortisone. Reflex bradycardia and headache are side effects of phenylephrine. Cardiac stimulation and bronchodilation are intentionally induced with the use of epinephrine in anaphylactic shock.

A patient in cardiogenic shock is prescribed a dose of sodium nitroprusside. What appropriate actions should the nurse perform to safely administer sodium nitroprusside? Select all that apply. Avoid using with D 5W. Protect solution from light. Monitor the body temperature. Wrap infusion bottle with opaque covering. Monitor the serum cyanide levels and signs of cyanide toxicity.

Protect solution from light. Wrap infusion bottle with opaque covering. Monitor the serum cyanide levels and signs of cyanide toxicity. Sodium nitroprusside is a vasodilator used in cardiogenic shock. The drug tends to release cyanide ions when exposed to sunlight. Therefore it should be protected from exposure to sunlight by wrapping the infusion bottle with an opaque covering. The patient's serum cyanide levels should be checked, and the patient should be monitored for signs of cyanide toxicity. This includes metabolic acidosis, tachycardia, altered level of consciousness, seizures, coma, and almond smell on the breath. The medication should be reconstituted with D 5W only. Monitoring vital signs like body temperature is important but may not directly impact the treatment being administered.

Which system of the body is often the first to show signs of dysfunction in systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS)? Neurologic system Respiratory system Cardiovascular system Gastrointestinal system

Respiratory system Systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) occur due to a systemic inflammatory response. Inflammatory mediators have a direct effect on the pulmonary vasculature. Thus the respiratory system is often the first system to show signs of dysfunction. Signs of nervous system dysfunction, such as mental changes, can be early signs of SIRS and MODS. However, the nervous system is not the first system to show signs of SIRS and MODS. When the respiratory system is affected, ventilation-perfusion mismatch becomes worse. Tissue oxygen demands increase, leading to cardiovascular changes. Hence, cardiovascular changes occur after changes in the respiratory system. In the early stages of SIRS and MODS, there is shunting away of blood from the gastrointestinal tract, making it vulnerable to ischemic injury. However, such changes show signs of dysfunction later than does the respiratory system.

A nurse caring for a patient with sepsis completes an intravenous fluid infusion as ordered. Which is a goal for fluid resuscitation when caring for a patient diagnosed with sepsis? Restore tissue perfusion Increase circulating fluid volume Restore blood flow to the myocardium Achieve and maintain a mean arterial pressure of 50 mm Hg

Restore tissue perfusion The goal for fluid resuscitation is the restoration of tissue perfusion. Increasing circulating fluid volume is the goal for hypovolemic shock. Restoring blood flow to the myocardium is the goal for cardiogenic shock. Achieving and maintaining a mean arterial pressure of 65 mm Hg is the goal when using vasopressors.

Which term is used to describe persistent hypotension despite adequate fluid resuscitation requiring vasopressors along with inadequate tissue perfusion resulting in tissue hypoxia? Sepsis Septic shock Inflammation Organ dysfunction

Septic shock Septic shock is characterized by persistent hypotension despite adequate fluid resuscitation requiring vasopressors along with inadequate tissue perfusion resulting in tissue hypoxia. Sepsis is a constellation of symptoms or a syndrome in response to an infection; it is characterized by a dysregulated patient response. Inflammation is the body's response to a microorganism. Organ dysfunction refers to the failure of an organ system in an acutely ill patient such that homeostasis cannot be maintained without intervention.

The nurse is caring for a patient who has hypovolemic shock. Which medical diagnosis does the nurse suspect? Insect bite Severe burns Myocardial infarction Pulmonary embolism

Severe burns Hypovolemic shock states are a result of a decrease in vascular volume, which leads to a decrease in cardiac output. Severe burns will cause loss of intravascular fluids from the skin and may lead to this shock state. Insect bites may lead to an anaphylactic shock state. Pulmonary embolism may lead to an obstructive shock state, and myocardial infarction may lead to a cardiogenic shock state.

A patient diagnosed with multiple organ dysfunction syndrome (MODS) is severely dyspneic, tachycardic, hypotensive, confused, and disoriented. The patient's family asks the nurse why the patient is being prescribed amlodipine. Which response by the nurse is most appropriate? "Amlodipine is being used to reduce cerebral vasospasm." "The amlodipine is being used to treat low blood pressure." "Amlodipine is the drug of choice to increase oxygen delivery to the other organs." "The amlodipine will help your family member breathe easier and decrease the need for oxygen."

"Amlodipine is being used to reduce cerebral vasospasm." Calcium channel blockers like amlodipine are used to reduce cerebral vasospasm in patients with MODS. They block uptake of calcium into the myocardium resulting in vasodilation. Amlodipine does not increase blood pressure; it decreases blood pressure. Amlodipine can increase oxygen delivery to cardiac and other muscles and decrease the need for oxygen, but that is not the indicated use in MODS.

The certified nursing assistant (CNA) reports that bright red blood has been found in the stool of a patient diagnosed with multiple organ dysfunction syndrome (MODS). The CNA asks the nurse about the cause of the blood in the stool. Which explanation by the nurse is most accurate? "Decreased oxygen to the gastric mucosa leads to breakdown." "Decreased gastric motility is common in MODS and can lead to blood in the stool." "Acid in the stomach is working overtime since the patient is receiving enteral feedings." "The medications used to treat MODS can cause many side effects, including blood in the stools."

"Decreased oxygen to the gastric mucosa leads to breakdown Decreased perfusion leads to breakdown of the protective gastrointestinal (GI) mucosa, leading to GI bleeding, risk for ulceration, and bacterial movement from the GI tract into the circulation. The statement that acid production is increased due to the enteral feedings is an incorrect statement. Decreased gastric motility is common in critical illness and leads to paralytic ileus and abdominal distention, not GI bleeding. The medications used to treat MODS do not include GI bleeding as a side effect.

A patient presents to the emergency department (ED) in a state of shock. On assessment, the nurse finds that the patient is cyanotic and has crackles on auscultation of the lungs. As which type of shock will the nurse classify this? Neurogenic shock Cardiogenic shock Hypovolemic shock Anaphylactic shock

Cardiogenic shock A patient with cardiogenic shock shows peripheral hypoperfusion presenting as cyanosis and has crackles on auscultation of the lungs due to pulmonary congestion. In neurogenic shock, the patient demonstrates symptoms related to the injury such as hypotension and bradycardia. The patient in hypovolemic shock may experience tachycardia as a late sign. In anaphylactic shock, the patient may experience wheezing and stridor.

A patient experiences a myocardial infarction (MI). The nurse closely monitors the patient for complications and recognizes that hypotension is a warning sign of which condition? A secondary MI Cardiogenic shock Pulmonary edema Fatal dysrhythmias

Cardiogenic shock One of the initial cardinal signs of cardiogenic shock after a myocardial infarction (MI) is a slow, steady drop in blood pressure. Hypotension after an MI may be an indirect sign of a secondary MI or a fatal dysrhythmia. Depending on the origin of pulmonary edema, patients may experience hypotension or hypertension.

How should the nurse meet the nutritional and metabolic needs of a patient with systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS)? Select all that apply. Maintain glucose levels below 108 mg/dL. Carry out stress ulcer prophylaxis in the patient. Avoid parenteral nutrition to reduce risk of infection. Monitor abdominal distention and intraabdominal pressure. Monitor plasma transferrin and prealbumin levels frequently.

Carry out stress ulcer prophylaxis in the patient. Monitor abdominal distention and intraabdominal pressure. Monitor plasma transferrin and prealbumin levels frequently. Stress ulcer prophylaxis is essential for the patient with systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) to manage gastrointestinal system complications and meet the nutritional and metabolic needs of the patient. Maintaining proper intraabdominal pressure and checking for abdominal distention is also necessary, because increased intraabdominal pressure affects the gastrointestinal tract and other systems as well. Plasma transferrin and prealbumin levels should be monitored frequently to assess hepatic protein synthesis. Parenteral nutrition should be initiated or added if the enteral route cannot be used or cannot meet the patient's caloric needs. Glucose levels of 81 to 108 mg/dL increase mortality. Blood glucose should be controlled with a goal of 140 to 180 mg/dL.

The family of a critically ill patient receiving enteral nutrition to support nutritional and metabolic needs ask the nurse why a feeding tube is being used instead of intravenous (IV) feedings. Which response by the nurse best explains the basis for enteral versus parenteral feedings? "Providing feedings through a gastrostomy tube is safer and has a lower rate of infection." "Nutrition provided through the IV route cannot provide enough support for these patients." "It is difficult to maintain IV access in patients with MODS, so we generally place a tube for feeding." "Different physicians prefer different methods; your physician prefers feedings be done through a feeding tube."

"Providing feedings through a gastrostomy tube is safer and has a lower rate of infection." In MODS, the enteral route is preferred for feedings as they are safer, have a lower rate of infection and complications, and are more efficient. The statement that intravenous feedings cannot provide enough support is an inaccurate statement. While issues related to MODS could make IV access difficult, this is not the best explanation. Physicians may have differing preferences; however, this is not the best response to this question.

The family of a patient being treated for multiple organ dysfunction syndrome (MODS) asks the nurse why the patient is being sedated and placed on mechanical ventilation. Which explanation by the nurse provides the best explanation for the anticipated outcomes secondary to these interventions? "This allows the gastrointestinal system to rest which helps prevent hyperglycemia." "All patients with MODS are sedated and placed on mechanical ventilation as a preventive measure." "Sedation and mechanical ventilation help to decrease oxygen demands and increase oxygen delivery to organs." "Sedation and mechanical ventilation help keep the patient from having a heart attack, which is common with MODS."

"Sedation and mechanical ventilation help to decrease oxygen demands and increase oxygen delivery to organs." Hypoxemia is common in MODS; sedation and mechanical ventilation help to decrease oxygen demands and maintain adequate oxygen delivery to organs. While decreasing oxygen demands may help prevent the failure of other systems, it does not necessarily allow the gastrointestinal system to rest. Not all patients with MODS require sedation and mechanical ventilation. Sedation and mechanical ventilation do not necessarily prevent heart attacks.

The nurse is teaching a group of nursing assistive personnel about nutritional support for patients diagnosed with multiple organ dysfunction syndrome (MODS). Which statement by the nurse reflects the overall goal of nutritional support in patients with MODS? "The overall goal of nutritional support in MODS is to preserve organ function." "Nutritional support in MODS is intended to increase the metabolic rate and support healing." "Blood glucose can rise during MODS, so nutritional support is used to maintain acceptable glucose levels." "During MODS, caloric expenditure greatly exceeds intake, so the goal of nutritional support is to equalize intake and expenditure."

"The overall goal of nutritional support in MODS is to preserve organ function." The main goal of nutritional support is to preserve organ function, not to increase the metabolic rate, maintain acceptable glucose levels, or balance caloric intake and expenditure. Early and optimal nutrition decreases morbidity and mortality rates of MODS patients.

An instructor working with nursing students in the critical care unit is assessing their knowledge of multiple organ dysfunction syndrome (MODS). Which statement indicates correct understanding of the concept? "Metabolic changes such as hypermetabolism in MODS are short-lived and self-limiting." "Evidence of liver dysfunction can be noted fairly early due to changes in liver enzyme levels." "When systemic inflammatory response syndrome (SIRS) progresses to MODS, mortality rates increase a bit but are still less than 40%-50%." "We would generally see dyspnea, changes in pulmonary artery wedge pressure (PAWP), tachypnea, and a decreasing PaO 2/FIO ratio as early signs."

"We would generally see dyspnea, changes in pulmonary artery wedge pressure (PAWP), tachypnea, and a decreasing PaO 2/FIO ratio as early signs." The respiratory system is generally the first to show signs of dysfunction in MODS, which means dyspnea, tachypnea, changes in PAWP and a decreasing PaO 2/FIO ratio may be early indicators. Liver dysfunction often begins long before clinical evidence of the dysfunction is apparent. Prognosis once MODS develops is poor, with a 70%-80% mortality rate. Metabolic changes are not self limiting, as they can trigger a hypermetabolic response and last for several days.

What actions should the nurse take to optimize tissue oxygenation in a patient with systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS)? Select all that apply. Avoid giving analgesics. Advise the patient to rest. Administer sedatives to the patient. Perform all activities at a particular time of the day. Frequently reposition the patient for ulcer prophylaxis.

Advise the patient to rest. Administer sedatives to the patient. The patient with systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) should be restricted to very limited activity to maintain tissue oxygenation. Resting reduces the body's oxygen demand. Hence the patient should rest. Sedation is used to help the patient rest. Analgesics should be given to reduce pain and thereby reduce the demand for oxygen. The nurse should provide care at intervals to reduce the patient's oxygen demand, not at a particular time of the day. The patient should not be repositioned frequently because this may increase oxygen demand on the body.

Which sign of neurologic dysfunction is commonly seen in both systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS)? Difficulty breathing Increased heart rate Increased liver enzymes Confusion, agitation, and lethargy

Confusion, agitation, and lethargy The sign of neurologic dysfunction commonly seen in systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) is change in mental status, which may cause the patient to become confused, agitated, and lethargic. The patient's heart rate increases due to changes in the cardiovascular system. The patient's liver enzymes increase due to dysfunction in the hepatic system and finally the dysfunction results in hepatic encephalopathy. The patient's dyspnea is caused by changes in the respiratory system by inflammatory mediators.

A patient involved in a motor vehicle accident was admitted to the intensive care unit with a closed-head injury. Which clinical manifestation warns the nurse that the patient's condition is progressing to multiple organ dysfunction syndrome (MODS)? Hypotension and dysrhythmias Urine output less than 400 mL/day Alteration in level of consciousness Decreased PaO 2 with an increase in FiO 2

Decreased PaO 2 with an increase in FiO 2 Decreased PaO 2 with an increase in FiO 2 (refractory hypoxemia) is the correct answer, because the lungs are the first organ to show signs of dysfunction and are the main organ affected in multiple organ dysfunction syndrome. Hypotension and dysrhythmias can occur with hypovolemia and hypoxia without progressing to multiple organ dysfunction syndrome. Urine output less than 400 mL/day develops later in the course of multiple organ dysfunction syndrome, when the kidneys become involved. Alteration in level of consciousness is probably already present with the closed head injury, and also can occur with hypoperfusion, microvascular coagulopathy, or cerebral ischemia, and will not necessarily progress to multiple organ dysfunction syndrome.

When caring for a critically ill patient who is being mechanically ventilated, the nurse will astutely monitor for which clinical manifestation of multiple organ dysfunction syndrome (MODS)? Increased serum albumin Decreased respiratory compliance Increased gastrointestinal (GI) motility Decreased blood urea nitrogen (BUN)/creatinine ratio

Decreased respiratory compliance Clinical manifestations of MODS include symptoms of respiratory distress, signs and symptoms of decreased renal perfusion, decreased serum albumin and prealbumin, decreased GI motility, acute neurologic changes, myocardial dysfunction, disseminated intravascular coagulation (DIC), and changes in glucose metabolism. Serum albumin is not increased, GI motility decreases in MODS, and the BUN/Creatinine ratio likely will increase.

A student nurse is caring for a patient diagnosed with sepsis. The student nurse tells the nurse the care plan regarding the administration of antibiotics. Which nursing action requires correction? Provide broad spectrum antibiotics. Administer antibiotics within one hour. Draw blood cultures before the administration of antibiotics. Delay antibiotics administration if the causative organism is unknown.

Delay antibiotics administration if the causative organism is unknown More specific antibiotics may be ordered once the organism has been identified, but administration of antibiotics should not be delayed. Broad spectrum antibiotics are given first. Antibiotics are an important early component of therapy and should be started in the first hour. The nurse should obtain blood cultures before antibiotics are started.

A nurse is caring for a patient with multiple organ dysfunction syndrome (MODS) caused by sepsis. Which is the most appropriate communication with the caregiver when further treatment is futile? Discuss realistic goals and likely outcomes. Emphasize hope that the patient will recover. Encourage the caregiver to withdraw life support. Ask the caregiver if he or she would like to see the clergy.

Discuss realistic goals and likely outcomes. When further treatment is futile, the nurse should have a conversation with the patient's caregiver about realistic goals and likely outcomes for a patient with MODS. The nurse should not give the caregiver false hope. Discussing options is appropriate communication with the caregiver, but encouraging the caregiver to withdraw life support does not empower the caregiver's autonomy. Asking the caregiver if he or she want to see the clergy is not the most appropriate response at this time. This is more appropriate to offer after discussion of goals and likely outcomes.

The release of platelet-activating factors in patients who have sepsis triggers which response? Third spacing Formation of microthrombi Increased capillary permeability Decreased production of cytokines

Formation of microthrombi The release of platelet-activating factors in patients with sepsis triggers the formation of microthrombi, causing obstruction of the microvasculature. Third spacing involves fluid moving out of the vascular space into the extravascular space as a result of hypovolemia. The release of vasoactive mediators in anaphylactic shock causes increased capillary permeability; this does not occur with sepsis. In sepsis, the production of cytokines is increased.

Which drug helps manage renal manifestations in a patient with systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS)? Sucralfate Furosemide Omeprazole Acetaminophen

Furosemide Furosemide is a loop diuretic that helps to manage renal manifestations in a patient with systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS). Sucralfate is administered for prophylaxis against stress ulcers, which are gastrointestinal manifestations of SIRS and MODS. Omeprazole is a proton pump inhibitor that has the same action. Acetaminophen is an antipyretic drug given as an acute intervention to manage fevers in patients who are in shock.

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

Hyperglycemia in the 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 tachypnea and tachycardia, not bradypnea and bradycardia.

What are the results of hypermetabolic response in systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS)? Select all that apply. Glycolysis Glycogenesis Hypoglycemia Hyperglycemia Glycogenolysis Gluconeogenesis

Hypoglycemia Hyperglycemia Glycogenolysis Gluconeogenesis In systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS), there is rapid conversion of glucose from glycogen stores and amino acids due to hypermetabolic response. In the progressive stage, despite increases in glycogenolysis and gluconeogenesis, the liver is unable to maintain an adequate glucose level and the patient develops hypoglycemia. Acute adrenal insufficiency in SIRS and MODS also results in a hypoglycemic state. At the initial stage, there is a release of catecholamines and glucocorticoids, which leads to hyperglycemia and insulin resistance. Due to the hypermetabolic response, glycogenolysis occurs and glycogen stores are rapidly converted to glucose. Once glycogen is depleted, amino acids are converted to glucose through a process called gluconeogenesis. In SIRS and MODS, there is gluconeogenesis, or conversion of amino acids to glucose, rather than glycolysis, or breakdown of glucose. There is glycogenolysis or conversion of glycogen to glucose rather than glycogenesis, or formation of glycogen.

What laboratory finding correlates with a medical diagnosis of cardiogenic shock? Decreased liver enzymes Increased white blood cells Decreased red blood cells, hemoglobin, and hematocrit Increased blood urea nitrogen (BUN) and serum creatinine levels

Increased blood urea nitrogen (BUN) and serum creatinine levels The renal hypoperfusion that accompanies cardiogenic shock results in increased BUN and creatinine levels. Impaired perfusion of the liver results in increased liver enzymes, whereas white blood cell levels typically do not increase in cardiogenic shock. Red blood cell indices are typically normal because of relative hypovolemia.

A nurse has received the laboratory work of a patient who is suspected to have hypovolemic shock. What would be the laboratory findings if the patient is in the early stages of hypovolemic shock? Select all that apply. Metabolic acidosis Increased sodium levels Increased liver enzymes Increased glucose levels Decreased potassium levels

Increased sodium levels Increased glucose levels Decreased potassium levels The patient may have increased glucose levels, increased sodium levels, and decreased potassium levels in the early stages of shock. Glucose levels increase due to the release of liver glycogen stores in response to sympathetic nervous system stimulation and cortisol. Sodium levels increase due to the increased secretion of aldosterone, causing renal retention of sodium. Potassium levels decrease because of the increased secretion of aldosterone, causing the renal excretion of potassium. Metabolic acidosis is a manifestation of late shock; respiratory alkalosis is seen in early shock due to hyperventilation. Increased liver enzymes indicate liver cell destruction in the progressive stage of shock.

Which findings indicate the development of acute respiratory distress syndrome (ARDS) in a patient with systemic inflammatory response syndrome (SIRS)? Select all that apply. Pulmonary hypertension Decreased lung compliance Decreased minute ventilation Abnormally slow breathing rate Bilateral diffuse infiltrates in the chest

Pulmonary hypertension Decreased lung compliance Bilateral diffuse infiltrates in the chest In patients with SIRS, the inflammatory mediators leading to pulmonary hypertension directly affect the pulmonary vasculature. The patient with acute respiratory distress syndrome shows decreased compliance due to the combined effects of pulmonary vasoconstriction and bronchoconstriction. There are bilateral diffuse fluffy infiltrates seen on the chest x-ray. The minute ventilation increases as the patient experiences tachypnea.

A nurse is taking care of a patient with hypovolemic shock from a motor vehicle accident (MVA). The health care provider prescribes human serum albumin for fluid replacement. What should the nurse do to safely administer this medication? Select all that apply. Monitor for circulatory overload. Use 5% solution of serum albumin. Monitor for chills, fever, and urticaria. Monitor for bleeding from potential sites. Prevent exposing the infusion to sunlight.

Monitor for circulatory overload. Use 5% solution of serum albumin. Monitor for chills, fever, and urticaria. Human serum albumin is used for increasing plasma colloid osmotic pressure and for rapid volume expansion. The patient should be monitored for circulatory overload. Because the patient is hypovolemic, a 5% solution of serum albumin should be used. Also, note that a 25% solution is used in patients with fluid and sodium restrictions. The infusion can cause mild side effects like chills, fever, and urticaria. Because the infusion is not reactive to light, protection from sunlight is not required, and it does not increase the risk of bleeding.

A patient being cared for in the critical care unit following a fall from a ladder which caused a severe fracture of the left tibia, several rib fractures, and splenic bruising is being assessed by the nurse. The family reports that the patient seems confused and has become agitated. The nurse notes that the patient's oxygen saturation is decreasing, respiratory rate is 30, blood pressure is 86/50 mm Hg, and capillary refill is greater than 3 seconds. What does the nurse suspect may be occurring with this patient? Neurogenic shock Obstructive shock Rupture of the spleen Multiple organ dysfunction syndrome

Multiple organ dysfunction syndrome Decreasing oxygen saturation, systolic blood pressure, tachypnea, and delayed capillary refill in a critically ill patient can indicate development of multiple organ dysfunction syndrome (MODS), which can occur in critically ill patients. Neurogenic and obstructive shock can precede the development of MODS. Neurogenic shock is characterized by hypotension, bradycardia, and an inability to regulate body temperature. Obstructive shock is characterized by jugular venous distention and pulsus paradoxus. A ruptured spleen is characterized by abdominal pain, hypotension, and signs of shock.

Which types of shock are associated with decreased cerebral perfusion? Select all that apply. Septic shock Neurogenic shock Obstructive shock Cardiogenic shock Anaphylactic shock Hypovolemic shock

Obstructive shock Cardiogenic shock Hypovolemic shock Manifestations of cardiogenic shock include decreased cerebral perfusion causing anxiety, confusion and agitation. Decreased cerebral perfusion associated with obstructive shock causes anxiety, confusion, and agitation. Decreased cerebral perfusion associated with hypovolemic shock causes anxiety, confusion and agitation. Septic shock causes mental changes like confusion, agitation, and coma in the late stages. Loss of reflex activity and flaccid paralysis are seen with neurogenic shock. Anxiety, metallic taste, confusion, and impending doom are signs of hypovolemic shock.

A patient is diagnosed with multiple organ dysfunction syndrome. While aggressive treatment is continued, the nurse suspects infection. What is the most appropriate action that the nurse should perform? Discontinue the aggressive treatment. Reduce oxygen delivery to the patient. Wait for laboratory reports to confirm the suspicion. Obtain a prescription for broad-spectrum antibiotic therapy.

Obtain a prescription for broad-spectrum antibiotic therapy. If an infection is suspected, broad-spectrum antibiotics should be started immediately to limit the infection. Aggressive treatment for infection control should be carried out in parallel. These patients are usually hypoxemic. Therefore oxygen should be administered strictly as prescribed. Cultures can be sent, and based on the reports, specific antibiotics can be added.

A patient with multiple organ dysfunction syndrome (MODS) has a temperature of 102.2 o F and has copious amounts of purulent drainage and redness surrounding a diabetic wound on the right foot. Of the prescribed options, which action should be the nurse's priority action? Obtain wound and blood cultures. Start broad-spectrum antibiotic therapy. Change the dressing on the wound using strict sterile technique. Restrict patient visitors to immediate family only, and require that they wear a mask when visiting.

Obtain wound and blood cultures. The immediate need when an infection is suspected in a MODS patient is to determine the cause; thus wound and blood cultures would be the first action. Antibiotics would be started after the cultures are obtained and sent for analysis. The dressing may need to be changed, but this would not be the first action of the nurse. Restricting patient visitors and requiring them to wear a mask would not be the first step the nurse would complete for suspected infection.

The nurse is evaluating lab results related to the hematologic system for a patient diagnosed with multiple organ dysfunction syndrome (MODS) following a traumatic injury. Which lab results indicate involvement of the hematologic system? Select all that apply. Hct 42% PT 18 sec RBCs 5.0 x 10 6/μL D-Dimer 280 ng/mL Platelets 125 x 10 3/μL

PT 18 sec D-Dimer 280 ng/mL Platelets 125 x 10 3/μL Increased PT, increased D-dimer, and decreased platelets indicate involvement of the hematologic system. Normal PT is 11-16 sec; normal platelets are 150-400 x 10 3/ μL, and normal D-dimer is less than 250 ng/mL. These all indicate involvement of the hematologic system. Normal Hct is 39%-50% for males and 35%-47% for females, thus this result is within normal range. RBC values range from 3.8/4.3-5.1/5.7 x 10 6/μL (male/female) thus this result is within normal limits.

A patient diagnosed with septic shock receives aggressive fluid resuscitation. The nurse performs a passive leg raise challenge to assess which process? Organ perfusion Tissue perfusion Mean arterial pressure Patient responsiveness to fluids

Patient responsiveness to fluids Performing a passive leg raise provides the nurse with an indication of patient responsiveness to fluids. If the passive leg raise is positive, the patient is fluid-responsive and should receive additional fluids. If the passive leg raise is negative, the patient is not fluid-responsive, and a vasopressor should be started. The passive leg raise does not provide information about organ perfusion, tissue perfusion, and mean arterial pressure.

What causes acute kidney injury (AKI) in systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS)? Select all that apply. Decreased urine output Use of nephrotoxic drugs Sodium and water reabsorption Effects of inflammatory mediators Decreased perfusion to the kidneys

Use of nephrotoxic drugs Effects of inflammatory mediators Decreased perfusion to the kidneys Antibiotics commonly used to treat gram-negative bacteria are often nephrotoxic. These nephrotoxic drugs are one of the causes of acute kidney injury (AKI). Inflammatory mediators and hypoperfusion are causes of AKI. Decreased urine output and aldosterone-mediated sodium and water reabsorption are manifestations rather than causes of AKI.

A nurse is caring for a 52-year-old patient receiving chemotherapy for lung cancer. Which strategies should the nurse take to reduce the risk for opportunistic infections thereby reducing the risk of sepsis? Select all that apply. Change the intravenous (IV) site daily. Administer antibiotics prophylactically. Pay strict attention to thorough handwashing. Use aseptic technique during invasive procedures. Thoroughly clean or discard equipment between patients.

Pay strict attention to thorough handwashing. Use aseptic technique during invasive procedures. Thoroughly clean or discard equipment between patients. Patients who are immunocompromised are at a high risk for opportunistic infection. Strategies to decrease the risk of infection include paying attention to strict handwashing, using aseptic technique during invasive procedures, and thoroughly cleaning or discarding equipment between patients. Changing the IV site daily increases the risk of infection. Antibiotics are not administered prophylactically.

The nurse is caring for a patient with systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS). Which interventions to prevent and treat infection are appropriate to be included on the patient's plan of care? Select all that apply. Placing the patient under stress ulcer prophylaxis Removing necrotic tissue through aggressive surgery Maintaining strict asepsis of the invasive devices and procedures Starting a broad-spectrum antibiotic if there are signs of infection Assessing the ongoing need for invasive lines and other devices daily

Placing the patient under stress ulcer prophylaxis Removing necrotic tissue through aggressive surgery Maintaining strict asepsis of the invasive devices and procedures Assessing the ongoing need for invasive lines and other devices daily In patients with systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS), stress ulcer prophylaxis should be in place, especially for those patients who have bleeding risk factors. Removal of necrotic tissue is very important because it can provide a culture medium for microorganisms. Strict asepsis must be maintained when using invasive devices and procedures to decrease the probability of infections. The ongoing need for invasive lines and other devices should be assessed daily to decrease the risk of health care-associated infections (HAIs). Cultures from blood or wound exudates should be obtained before starting a broad spectrum antibiotic. Antibiotics should not be started if there are signs only suggestive of infection.

The intensive care unit nurse is caring for a patient who is ventilated mechanically. To prevent sepsis in this patient, which nursing intervention does the nurse include in the plan of care? Provide oral care every two to four hours. Turn patient from side to side every eight hours. Position patient in a supine position every two hours. Use clean gloves when suctioning the endotracheal tube.

Provide oral care every two to four hours. Providing oral care every two to four hours is correct, because research has found that the oral flora of critically ill patients are predominately gram-negative organisms that can potentially cause ventilator-associated pneumonia. Oral care will help reduce the organisms. Turning the patient from side to side every eight hours is incorrect, because patients need to be turned at least every two hours to prevent accumulation of mucus, which could lead to pneumonia. Positioning the patient in a supine position is incorrect, because patients should have the head of the bed elevated during mechanical ventilation. The nurse should use sterile gloves when conducting endotracheal suctioning of the patient.

The nurse is caring for a patient with multiple organ dysfunction syndrome (MODS) who exhibits signs of cardiovascular dysfunction. Which interventions are appropriate for volume management in the patient? Select all that apply. Providing volume replacement therapy Decreasing the preload by administering diuretics Monitoring arterial pressure-based cardiac output (APCO) Using central venous catheter for hemodynamic monitoring Maintaining mean arterial pressure at greater than 45 mm Hg

Providing volume replacement therapy Monitoring arterial pressure-based cardiac output (APCO) Using central venous catheter for hemodynamic monitoring Volume management is done by providing volume replacement therapy in a patient with MODS who also exhibits signs and symptoms of cardiovascular dysfunction. Arterial pressure-based cardiac output (APCO) is used for minimally invasive hemodynamic monitoring. A central venous catheter may also be used for hemodynamic monitoring. Volume replacement therapy maintains arterial pressure at greater than 65 mm Hg, not 45 mm Hg, and increases rather than decreases preload.

What is the clinical manifestation of systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) on the respiratory system? Pulmonary edema Pulmonary fibrosis Pulmonary embolism Pulmonary hypertension

Pulmonary hypertension Systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) affect the respiratory system and lead to pulmonary hypertension. Pulmonary edema is caused by fluid accumulation in the air spaces. Pulmonary fibrosis is a respiratory disorder caused by scars in the lung tissues or inhalation of airborne toxins. A pulmonary embolism is caused by blood clots or blockage in the pulmonary arteries.