Adaptive Quizzing- Shock, Sepsis, MODS (Ch 66)

A nurse is developing a care plan for optimum nutrition for a patient with multiple organ dysfunction syndrome (MODS) caused by sepsis. Which nutritional combination is most appropriate for this patient? 1.Protein and calories 2. Minerals and protein 3. Calories and carbohydrates 4. Carbohydrates and minerals

1.Protein and calories Protein and calorie malnutrition is one of the primary signs of hypermetabolism in MODS. The goal of nutritional support is to preserve organ function by providing early and optimal nutrition. Minerals and carbohydrates may be incorporated into the patient's nutrition plan but are not as helpful as protein and calories.

A patient has neurologic dysfunction related to sepsis. Which assessment finding is specific to this dysfunction? 1. Shivering 2. Hypotension 3. Altered mental status 4. Decreased urine output

3.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.

A patient in septic shock is receiving fluid resuscitation. How will the nurse most accurately measure urine output? 1. Daily weights 2. Nasogastric tube 3. Strict input and output 4. Indwelling urinary catheter

4. 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 futile?

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? 1 Lactic acid 2 Base deficit 3 Blood cultures 4 Arterial blood gas

1 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 supportive therapies does a patient admitted with septic shock require? Select all that apply 1 Stress ulcer prophylaxis 2 Maintaining a patent airway 3 Good blood glucose control 4 Aggressive fluid resuscitation 5 Close temperature monitoring 6 Blood cultures before antibiotics

1 Stress ulcer prophylaxis 3 Good blood glucose control 4 Aggressive fluid resuscitation 5 Close temperature monitoring 6 Blood cultures before antibiotics Supportive therapies for patients with septic shock include stress ulcer prophylaxis, good blood glucose control, aggressive fluid resuscitation, close temperature monitoring, and blood cultures before antibiotics. Maintaining an open airway is a supportive therapy for neurogenic and anaphylactic shock.

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? 1. Discuss realistic goals and likely outcomes. 2. Emphasize hope that the patient will recover. 3 Encourage the caregiver to withdraw life support. 4. Ask the caregiver if he or she would like to see the clergy

1. 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.

Septic shock is classified as which type of shock? 1. Distributive 2. Obstructive 3. Cardiogenic 4. Hypovolemic

1. Distributive Septic shock is classified as distributive shock, which is a result of abnormal distribution of blood flow causing an inadequate supply of blood to meet the metabolic needs of the body's tissue and organs. Septic shock is characterized by hypotension and inadequate tissue perfusion resulting in inadequate supply of blood to meet the metabolic needs of the body's tissues and organs. Neurogenic shock, anaphylactic shock, and septic shock are all classified as distributive shock. Cardiogenic shock occurs when there is either systolic or diastolic dysfunction of the heart's pumping action, resulting in reduced cardiac output. Obstructive shock develops when a physical obstruction to blood flow occurs with a decrease in cardiac output. Hypovolemic shock occurs after a loss of intravascular fluid volume.

A massive gastrointestinal bleed has resulted in hypovolemic shock in an older patient. What is a priority nursing diagnosis? 1. Acute pain 2. Impaired tissue integrity 3. Decreased cardiac output 4.Ineffective tissue perfusion

1. Ineffective tissue perfusion The many deleterious effects of shock are all related to inadequate perfusion and oxygenation of every body system. Ineffective tissue perfusion supersedes acute pain, impaired tissue integrity, and decreased cardiac output, because circulation is a priority. Acute pain may occur, but is not a priority at this time. Tissue integrity is not impaired.

Which criterion is a clinical manifestation of sepsis? 1. Infection 2 Hypoglycemia 3.Normal body temperature 4.Systolic blood pressure of 100 mm Hg or highe

1. Infection

Which criterion is a clinical manifestation of sepsis? 1. Infection 2. Hypoglycemia 3. Normal body temperature 4. Systolic blood pressure of 100 mm Hg or higher

1. 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.

What therapy is provided to a patient with acute respiratory distress syndrome (ARDS)? 1. Mechanical ventilation 2. Oxygen via a Venturi mask 3. Oxygen via a non-rebreather mask 4. Small volume nebulizer treatments

1. Mechanical ventilation A patient with acute respiratory distress syndrome (ARDS) would be intubated and receive mechanical ventilation. Small volume nebulizer treatments would open airways; however, this intervention will not sufficiently treat ARDS. Oxygen via a Venturi mask or a non-rebreather mask would be insufficient to promote oxygenation and perfusion.

Which findings indicate the development of acute respiratory distress syndrome (ARDS) in a patient with systemic inflammatory response syndrome (SIRS)? Select all that apply. 1. Pulmonary hypertension Correct 2. Decreased lung compliance 3. Decreased minute ventilation 4. Abnormally slow breathing rate 5. Bilateral diffuse infiltrates in the chest

1. Pulmonary hypertension 2. Decreased lung compliance 3. 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.

When caring for a patient with sepsis and a suspected infection, which is the priority nursing intervention? 1. Initiate broad spectrum antibiotics. 2. Obtain blood cultures after antibiotic initiation. 3. Provide pain medication to increase patient comfort. 4. Hold antibiotic therapy until the organism is identified.

1.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.

Which term is used to describe a constellation of symptoms or a syndrome in response to an infection characterized by a dysregulated patient response along with new organ dysfunction? 1. Shock 2 Sepsis 3 Inflammation 4 Organ dysfunction

2 Sepsis Sepsis is a constellation of symptoms or syndrome in response to an infection. It is characterized by a dysregulated patient response. Shock is a syndrome characterized by decreased tissue perfusion and impaired cellular metabolism. Inflammation is the body's response to a microorganism entering the body. Organ dysfunction refers to the failure of an organ system in an acutely ill patient in whom homeostasis cannot be maintained without intervention.

Which type of shock can be treated by minimizing spinal cord trauma with stabilization? 1. Septic shock 2. Neurogenic shock 3. Anaphylactic shock 4. Hypovolemic shock

2. Neurogenic shock Neurogenic shock is caused by severe injury to the spinal cord and results in loss of sympathetic stimulation of blood vessels. Apart from administering vasoconstrictor agents, minimizing the spinal cord trauma with stabilization is a supporting therapy for neurogenic shock. Septic shock occurs in response to a systemic infection. Obtaining the cultures before starting antibiotics is appropriate care for septic shock. A life-threatening allergic reaction to a sensitizing substance causes anaphylactic shock. Avoiding exposure to allergens is supportive therapy for anaphylactic shock. Excessive loss of intravascular fluid causes hypovolemic shock. Besides restoring fluid volume, correcting the cause of fluid loss is supportive therapy.

What organ system is often the first to show signs and symptoms in multiple organ dysfunction syndrome (MODS)? 1. Neurologic 2. Respiratory 3. Cardiovascular 4. Gastrointestinal

2. Respiratory Inflammatory mediators have a direct effect on the pulmonary vasculature causing increased capillary permeability and eventually movement of fluid into the interstitial spaces of the lung, eventually causing alveolar edema, often making the respiratory system the first to show signs and symptoms of MODS. While MODS affects the gastrointestinal, cardiovascular, and neurologic systems as well, these systems do not as commonly exhibit manifestations of MODS first. Test-Taking Tip: Key words or phrases in the question stem such as first, primary, early, or best are important. Similarly, words such as only, always, never, and all in the alternatives are frequently evidence of a wrong response. No real absolutes exist in life; however, every rule has its exceptions, so answer with care.

A patient is showing signs of anaphylactic shock from an insect sting. Which health care provider's order does the nurse implement first? 1. Diphenhydramine 50 mg IV 2 Oxygen via nasal cannula at 3 L 3. Epinephrine 1:1000, 0.5 mg IM 4. Normal saline intravenous (IV) to run at 150 mL/hr

3. Epinephrine 1:1000, 0.5 mg IM The patient experiencing anaphylaxis will have 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 open airway has been established.

The nurse is caring for a patient who developed cardiogenic shock. Which medical diagnosis does the nurse suspect? 1. Urosepsis 2. Hemorrhage 3 Myocardial infarction 4 Tension pneumothorax .

3. Myocardial infarction Myocardial infarction may produce necrotic areas of cardiac tissue that lead to impaired contractility and decreased cardiac output. This may lead to a cardiogenic shock state. Hemorrhage may lead to a hypovolemic shock state, tension pneumothorax may lead to an obstructive shock state, and urosepsis may lead to a septic shock state.

Which should the nurse evaluate when performing an assessment of end organ function on a patient who received fluid volume resuscitation for septic shock? Select all that apply. 1. Visual acuity 2. Oral mucosa 3. Urine output 4. Bowel sounds 5. Peripheral pulses 6. Neurologic function

3. Urine output 5. Peripheral pulses 6. Neurologic function The goal for fluid resuscitation is restoration of tissue and end organ perfusion. An assessment of end organ perfusion includes urine output, peripheral pulses, and neurologic function. Visual acuity, oral mucosa, and bowel sounds do not provide relevant data for the nurse to evaluate end organ function.

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? 1. SpO2 greater than 94% 2. Lactic acid less than 2.0 mmol/L 3. Mean arterial pressure greater than 65 mm Hg 4. Systolic blood pressure greater than 80 mm Hg

3.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 SpO2.

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 1. Change the intravenous (IV) site daily. 2. Administer antibiotics prophylactically. 3. Pay strict attention to thorough handwashing. 4. Use aseptic technique during invasive procedures. 5. Thoroughly clean or discard equipment between patients

3.Pay strict attention to thorough handwashing. 4.Use aseptic technique during invasive procedures. 5.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

Multiple organ dysfunction syndrome (MODS), a complication of sepsis, is the failure of how many organ systems? 1. All 2.One or more 3. Two or more 4. Three or more

3.Two or More Multiple organ dysfunction syndrome is the failure of two or more organ systems in an acutely ill patient for whom homeostasis cannot be maintained without intervention. It is not the failure of all systems. One or more is below the threshold for the definition, and three or more is included in the stipulation of two or more

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? 1 "Metabolic changes such as hypermetabolism in MODS are short-lived and self-limiting." 2 "Evidence of liver dysfunction can be noted fairly early due to changes in liver enzyme levels." 3"When systemic inflammatory response syndrome (SIRS) progresses to MODS, mortality rates increase a bit but are still less than 40%-50%." Correct 4 "We would generally see dyspnea, changes in pulmonary artery wedge pressure (PAWP), tachypnea, and a decreasing PaO2/FIO ratio as early signs

4 "We would generally see dyspnea, changes in pulmonary artery wedge pressure (PAWP), tachypnea, and a decreasing PaO2/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 PaO2/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.

A nurse is caring for a patient diagnosed with septic shock. The patient develops dyspnea, tachycardia, and bilateral lung crackles. The nurse suspects the patient has developed acute respiratory distress syndrome (ARDS). Which intervention is the nurse's priority? 1 Repeat chest radiograph 2 Draw arterial blood gasses 3 Start broad spectrum antibiotics 4 Pulmonary management with mechanical ventilation

4 Pulmonary management with mechanical ventilation Patients with ARDS need aggressive pulmonary management with mechanical ventilation. Repeat chest radiograph may be done after initiation of mechanical ventilation. Arterial blood gas measures respiratory alkalosis in early stages of septic shock and metabolic acidosis in late stages of septic shock. Broad spectrum antibiotics are important in the early component of therapy and should be started within the first hour of severe sepsis or septic shock, but once breathing is compromised, that becomes the priority.