Critical Care Exam #3

3. The client with chronic kidney disease presents with severe anemia, the nurse administers a dose of epoition alfa, during the hemodialysis procedure,which finding indicates the med worked? -increased urine output, -decreased BUN -increased oxygen -increased hemoglobin

ANS- hemoglobin

7. The nurse is preparing the client with acute kidney injury for hemodialysis with in the ICU. What assessment should the nurse obtain prior to begining the procedure? -weight pt in the ICU bed scale -assess the fistula site -assess urine color -assess cap refill

ANS- weight pt in ICU bed scale

44. The nurse is reviewing the lab result for a patient with acute pancreatitis. Which lab result does the nurse expect for a patient with acute pancreatitis? SATA. -Increase in glucose -increase in BUN -decrease in albumin -increase in platelets -decrease in tryglycerides

- Decrease in albumin level - Increase in serum glucose level - Increase in blood urea nitrogen (BUN)

1. The nurse is providing care for a newly admitted client with hepatic failure. Which intervention should the nurse perform when providing care for this patient?

-encourage high protein -monitor BUN, ALT -measure abdominal girth -take glucometer every 2 to 4 -give stool softeners

9. SATA You are providing patient education with active hepatitis B. What will you include in the discharge instructions? -eat large meals that are spread out throughout the day. -follow a diet low in fat and high in carbs -do not share razors, utilences, touthbrushes and other types of personal hygine -perform aerobic excerises daily -acetaminophene

ANS - follow a diet low in fat and high in carbs - do not share razors, utilences, touthbrushes and other types of personal hygine

32. SATA. Which clinical manifestations of inflammatory bowel syndrome are common to patients with both ulcerative colitis and chrones disease? -dirrheal stools -cramping and abdomal pain -lesions that penetrate the intestion -strictiors are common -restricted to rectum

ANS -dirrheal stools ANS--cramping and abdomal pain

45. SATA- The nurse is caring for a patient with chronic pancreatitis. Which assessment findings are related to this disease process? -dirrhea -polyphagia -jaundic -weight gain -polydipisia

ANS -polyphagia ANS-jaundic ANS-polydipisia

SATA. You are providing patient education with active hepatitis B. What will you include in the discharge instructions? -eat large meals that are spread out throughout the day. -follow a diet low in fat and high in carbs -do not share razors, utilences, touthbrushes and other types of personal hygine -perform aerobic excerises daily -acetaminophen

ANS- -follow a diet low in fat and high in carbs. -do not share razors, utilences, touthbrushes and other types of personal hygine.

47. (SHERPATH? )The nurse is caring for a female patient after an abdominal perianal rescetion of a rectal turmor. Which assessment findings is most concerning and warrents immediate healthcare provder notification? -albumin 2.6 -pain level 5/10 -hemoglobin 7 -temp (high)

ANS- Hemoglobin at 7

13. Which nursing interventions are required with hepatits A? -private room with door closed -gown and gloves only when handling soiled linen -gown mask and gl9ves for all persons entering the room -gowna and glves when handling articles contamined with urine and feces

ANS--gowns and glves when handling articles contamined with urine and feces

42. Which of the following medications would not be administered to a patient experiencing pancreatitis? -Protein pumpinhibitors -histamin 2 blockers -insulin -chlorinergics -dextrose

ANS-Insulin ANS- Dextrose

12. The patient with hepatitis is extremely confused and diagnosed with hepatic encephalophy. What lab result would correlate with this mental status change? -bilirubin 7 -ALT 56 -ammonia 100 -AST 10

ANS-ammonia at 100

8. The nurse is caring for a client admittied to the surgical ICU on the first day post op after a kidney transplant. What information should the nurse include in the plan of care to prevent hypovolemia? -provide sport drinks for hydration -give 1:1 IV fluids input and output -increase sodium

ANS-give IV 1:1

49. During the olurgic maintence phase of acute kidney injury, for which abnormal finding will the nurse monitor for in a patient? -hypocalcemia -hypernaturemia -hyperphosphatemia -hypothermia

ANS-hypocalcemia

43. A client is admitted to the ICU with hepatic encephalophy secendary to cirrohis. The client is lethargic and confused and the health care provider prescribes lactolose. Which finding indicates a positive response to the medication? -decreased - of the skin -decreased ammonia levels -an increase in alert and orientation -multiple diarrheal stools per day

ANS-increase in alert and orientation

46. SATA- The nurse is caring for a patient with colorectal cancer. Which assessment finding indicates the possibility of metastasis? -elevated hemoglobin level -lower back pain -elevated bilirubin level -dry mouth -Ascities

ANS-lower back pain ANS-elevated bilirubin level ANS-Ascities

2. The client is in the ICU is receiving continous renal replacement therapy due to acute kidney injury AKI, the nurse detects blood leaking from the central venous catheter insertion site, what action should the nurse perform after receiving elevated clotting times? -lie the patient on their back -decrease the infusion rate -obtain electrolyte level -lower heparin dose

ANS-lower heparin dose

5. The nurse is applying care for a client in need of surgical intensive care. The client is one day post liver transplant. What intervention should the nurse include in the plan of care? -monitor temp every 4 -increase fruit and vegetables -assess lungs 12 -assist client to ambulate

ANS-monitor temp q4hr

48. Which clinical finding in a patient indicates ulcerative colitis? -blood and mucus in stool -thickening of the bowel wall -inflammation of the ilium colon -bowel fistulas

ANS-presence of blood and mucus in the stool

31. SATA The nurse is caring for a patient who is a recent receipant of a kidney transplant. Which intervention should the nurse perform in the immediate post op period? SATA. -record central venous pressure -report for urine output more than 500 ml -notify the health care provider of a sudden decrease in urine output -monitor pt for hyponaturemia and hypokalemia -replace urine output with fluids for the first 5 hours

ANS-record CVP ANS-monitor pt for hyponaturemia and hypokalemia

33. A patient with acute kidney injury has the following labs. GFR 92, BUN 17, potassium 4.9, creatine 1.0, patients 24 hours urine output is 1.75 liters. Based on these labs which stage of Acute kidney injury is this patent in? -recovery -initiation -diuresis -oliguric

ANS-recovery phase

38. (Sole 6, #7/8) (same quesiton but answers are different so I think shes using an older/newer version). A patient who is receiving continuous enteral feedings has just vomited 250 mL of milky green fluid. What action but the nurse takes priority? -contact provider -slow rate of infusion -stop the tube feeding -assess the patients lungs

ANS-stop the tube feeding

6. You are providing education to a patient with CKD about calcium acetate. what statement made by the patient indicates they understood your teaching about the medication. SATA. -Its important to consume high amounts of oatmeal, fish and deer -take this med with meals or immediately after -this med will help keep my calcium levels normal -this med will help prevent my phosphate level from increasing

ANS-the med will help prevent my phosphate level from increasing ANS--take this med with meals or immediately after

4. A patient with stage 5 chronic kidney disease is experiencing extreme pruritus, and sever areas of crystallized white deposits on the skin. As the nurse you know that this is due to excessive amounts of

ANS-urea

34.(SOLE chapter 4, question #5). A 65-year-old patient with a history of metastatic lung carcinoma has been unresponsive to chemotherapy. The medical team has determined that there are no additional treatments available that will prolong life or improve the quality of life in any meaningful way. Despite the poor prognosis, the patient continues to receive chemotherapy and full nutrition support. This is an example of what end-of-life concept? a. Medical futility b. Palliative care c. Terminal weaning d. Withdrawal of treatment

ANS: A Medical futility is a situation in which therapy or interventions will not provide a foreseeable possibility of improvement in the patient's health status. Palliative care focuses on symptom relief and is not limited to the dying. Terminal weaning refers to withdrawal of artificial ventilation interventions. Withdrawal of treatment refers to removal of established therapies in a terminally ill patient.

10. (sole 15, q 9)The nurse is caring for a patient who has undergone major abdominal surgery. The nurse notices that the patient's urine output has been less than 20 mL/hour for the past 2 hours. It is 0200 in the morning. The patient's blood pressure is 100/60 mm Hg, and the pulse is 110 beats per minute. Previously, the pulse was 90 beats per minute with a blood pressure of 120/80 mm Hg. The nurse should: a. contact the provider and expect an order for a normal saline bolus. b. wait until 0900 when the provider makes rounds to report the assessment findings. c. continue to evaluate urine output for 2 more hours. d. ignore the urine output, as this is most likely postrenal in origin.

ANS: A Most prerenal causes of AKI are related to intravascular volume depletion, decreased cardiac output, renal vasoconstriction, or pharmacological agents that impair autoregulation and GFR (Box 15-2).8 These conditions reduce the glomerular perfusion and the GFR, and the kidneys are hypoperfused. For example, major abdominal surgery can cause hypoperfusion of the kidney as a result of blood loss during surgery or as a result of excess vomiting or nasogastric suction during the postoperative period. The body attempts to normalize renal perfusion by reabsorbing sodium and water. If adequate blood flow is restored to the kidney, normal renal function resumes. Most forms of prerenal AKI can be reversed by treating the cause.

26. (sole 17, #46). The patient is getting neomycin for treatment of hepatic encephalopathy. While the patient is receiving this medication, it is especially important that the nurse: a. evaluate renal function studies daily. b. give the medication every 12 hours. c. evaluate liver studies for signs of neomycin-induced damage. d. obtain stool guaiac tests to ensure that pathogens are being destroyed.

ANS: A Neomycin is a broad-spectrum antibiotic that destroys normal bacteria found in the bowel, thereby decreasing protein breakdown and ammonia production. Neomycin is given orally every 4 to 6 hours. This drug is toxic to the kidneys (not liver) and therefore cannot be given to patients with renal failure. Daily renal function studies are monitored when neomycin is administered. Guaiac tests are used to detect occult bleeding.

23.(Sole 17, question #37). The nurse is caring for a patient with severe pancreatitis and who is orally intubated and on mechanical ventilation. The patient's calcium level this morning was 5.5 mg/dL. The nurse notifies the provider and: a. places the patient on seizure precautions. b. expects that the provider will come and remove the endotracheal tube. c. withhold any further calcium treatments. d. place an oral airway at the bedside.

ANS: A Patients with severe hypocalcemia (serum calcium level less than 6 mg/dL) should be placed on seizure precaution status, and respiratory support equipment should be available (e.g., oral airway, suction). In this case, the patient is already intubated so an oral airway is not needed. This value is critically low and replacement of calcium is expected.

A patient with Hepatitis is extremely confused. The patient is diagnosed with Hepatic Encephalopathy. What lab result would correlate with this mental status change? A. Ammonia 100 mcg/dL B. Bilirubin 7 mg/dL C. ALT 56 U/L D. AST 10 U/L

ANS: A When ammonia levels become high (normal 15-45 mcg/dL) it affects brain function. Therefore, the nurse would see mental status changes in a patient with this ammonia level.

40.(sole 6, SATA #1). Which statement(s) about total parenteral nutrition is (are) true? (Select all that apply.) a. Assessing fluid volume status and preventing infection are important nursing considerations. b. Fingerstick glucose levels are assessed every 6 hours and prn. c. Total parenteral nutrition is administered through a feeding tube and pump. d. Total parenteral nutrition, with added lipids, provides adequate levels of protein, carbohydrates, and fats. e. (somthing about soy based lipids)

ANS: A, B, D All are correct except administration via a feeding tube and pump. A tube and pump are used to deliver enteral nutrition.

36. (sole 4, SATA question #5). When providing palliative care, the nurse must keep in mind that the family may include which of the following? (Select all that apply.) a. Unmarried life partners of same sex b. Unmarried life partners of opposite sex c. Roommates d. Close friends e. Parents

ANS: A, B, D, E (she put that roommates were also considered) The definition of family varies and may include unmarried life partners of the same or opposite sex, close friends, and other close individuals who have no legal relationship with the patient.

28. (Sole 17, SATA #3).(this question on the test only showed the correct answers with 2 blank spaces) When caring for the patient with upper GI bleeding, the nurse assesses for which of the following? (Select all that apply.) a. Severity of blood loss b. Hemodynamic stability c. Vital signs every 30 minutes d. Signs of hypervolemic shock e. Necessity for fluid resuscitation

ANS: A, B, E Initial evaluation of the patient with upper GI bleeding involves a rapid assessment of the severity of blood loss, hemodynamic stability and the necessity for fluid resuscitation, and frequent monitoring of vital signs and assessments of body systems for signs of hypovolemic shock. Vital signs should be monitored at least every 15 minutes.

29. (Sole 17, SATA #4). Nursing priorities for the management of acute pancreatitis include: (Select all that apply.) a. managing respiratory dysfunction. b. assessing and maintaining electrolyte balance. c. withholding analgesics that could mask abdominal discomfort. d. stimulating gastric content motility into the duodenum. e. utilizing supportive therapies aimed at decreasing gastrin release.

ANS: A, B, E Nursing and medical priorities for the management of acute pancreatitis include several interventions. Managing respiratory dysfunction is a high priority. Fluids and electrolytes are replaced to maintain or replenish vascular volume and electrolyte balance. Analgesics are given for pain control, and supportive therapies are aimed at decreasing gastrin release from the stomach and preventing the gastric contents from entering the duodenum.

19. (Sole 15, SATA #6). The patient is in the critical care unit and will receive dialysis this morning. The nurse will: (Select all that apply.) a. evaluate morning laboratory results and report abnormal results. b. administer the patient's antihypertensive medications. c. assess the dialysis access site and report abnormalities. d. weigh the patient to monitor fluid status. e. give all medications except for antihypertensive medications.

ANS: A, C, D The patient receiving hemodialysis requires specialized monitoring and interventions by the critical care nurse. Laboratory values are monitored and abnormal results reported to the nephrologist and dialysis staff. The patient is weighed daily to monitor fluid status. On the day of dialysis, dialyzable (water-soluble) medications are not given until after treatment. The dialysis nurse or pharmacist can be consulted to determine which medications to withhold or administer. Supplemental doses are administered as ordered after dialysis. Administration of antihypertensive agents is avoided for 4 to 6 hours before treatment, if possible. Doses of other medications that lower blood pressure (narcotics, sedatives) are reduced, if possible. The percutaneous catheter, fistula, or graft is assessed frequently; unusual findings such as loss of bruit, redness, or drainage at the site must be reported. After dialysis, the patient is assessed for signs of bleeding, hypovolemia, and dialysis disequilibrium syndrome.

25.(sole 17, question #44). The nurse is caring for a patient with severe ascites due to chronic liver failure. The patient is lying supine in bed and complaining of difficulty breathing. The nurse's first action should be to: a. measure abdominal girth to determine the amount of fluid accumulation. b. position the patient in a semi-Fowler's position. c. prepare the patient for emergent paracentesis. d. administer diuretics.

ANS: B Ascites is problematic because as more fluid is retained, it pushes up on the diaphragm, thereby impairing breathing. Positioning the patient in a semi-Fowler's position allows for free diaphragm movement. Frequent monitoring of abdominal girth alerts the nurse to fluid accumulation, but the most immediate and easiest action would be to place the patient in semi-Fowler's position. Paracentesis is sometimes done to relieve symptoms, but it is not usually done emergently. Diuretics must be administered cautiously because if the intravascular volume is depleted too quickly, acute renal failure may be induced.

11. (sole 15, q12) The patient undergoes a cardiac catheterization that requires the use of contrast dyes during the procedure. To detect signs of contrast-induced kidney injury, the nurse should: a. not be concerned unless urine output decreases. b. evaluate the patient's serum creatinine for up to 72 hours after the procedure. c. obtain an order for a renal ultrasound. d. evaluate the patient's post void residual volume to detect intrarenal injury.

ANS: B Contrast- induced kidney injury is diagnosed by an increase in serum creatinine of 25%, or 0.5 mg/dL, within 48 to 72 hours following the administration of contrast. Urine output usually remains normal. The renal ultrasound and postvoid residual assessment are not warranted.

35.(sole 4, quesiton #10). A patient with end-stage heart failure is experiencing considerable dyspnea. Appropriate pharmacological management of this symptom includes: a. administration of 6 mg of midazolam (Versed) and initiation of a continuous midazolam infusion. b. administration of morphine, 5 mg IV bolus, and initiation of a continuous morphine infusion. c. hourly increases of the midazolam (Versed) infusion by 100% dose increments. d. hourly increases of the morphine infusion by 100% dose increments.

ANS: B Morphine is an excellent agent to control the symptom of dyspnea. A 5-mg IV bolus and initiation of a morphine drip is an appropriate initial intervention to control dyspnea. Initial dosing of midazolam should be 2 to 4 mg, and more is indicated for anxiety. The morphine dose should be titrated incrementally by 50% dose increases. Midazolam is indicated for management of dyspnea and is titrated incrementally by 50% dose increases.

21.(Sole 17, question #29). The patient is admitted for GI bleeding, but the source is not known. Before ordering endoscopy, the provider orders Sandostatin (octreotide) to be given intravenously. The purpose of this medication is to: a. increase portal pressure and improve liver function. b. decrease splanchnic blood flow and portal pressure. c. vasodilate the splanchnic arteriolar bed. d. increase blood flow in the liver's collateral circulation.

ANS: B Somatostatin or octreotide is commonly ordered to slow or stop bleeding. Early administration provides for stabilization before endoscopy. These drugs decrease splanchnic blood flow and reduce portal pressure, and have minimal adverse effects. Vasopressin is used to lower (not increase) portal pressure by vasoconstriction of the splanchnic arteriolar bed. Ultimately, it decreases pressure and flow in liver collateral circulation channels to decrease bleeding. However, vasopressin is not a first-line therapy because of its adverse effects.

You are providing education to a patient with CKD about calcium acetate. Which statement by the patient demonstrates they understood your teaching about this medication? Select-all-that-apply: A."This medication will help keep my calcium level normal." B. "I will take this medication with meals or immediately after." C. "It is important I consume high amounts of oatmeal, poultry, fish, and dairy products while taking this medication." D. "This medication will help prevent my phosphate level from increasing."

ANS: B and D Calcium acetate (also known as PhosLo) is a phosphate binder, which will help keep the patient's phosphate level from becoming too high. It helps excrete the phosphate taken in the food by excreting it out of the stool. Therefore, it should be taken with meals or immediately after. Option C is wrong because the patient should AVOID these types of foods high in phosphate.

27. (Sole 17, question #2) The nurse is caring for a critically ill patient with respiratory failure who is being treated with mechanical ventilation. As part of the patient's care to prevent stress ulcers, the nurse would provide: (Select all that apply.) a. vagal stimulation. b. proton pump inhibitors. c. anticholinergic drugs d. antacids. e. cholinergic drugs.

ANS: B, C, D Administration of antacids and H2-receptor blockers, and the suppression of vagal stimulation with anticholinergic drugs and proton pump inhibitors (PPI) are effective forms of therapy.

30.(Sole 17, SATA #5). The patient is admitted with end-stage liver disease. The nurse evaluates the patient for which of the following? (Select all that apply.) a. Hypoglycemia b. Malnutrition c. Ascites d. Hypercoagulation e. Disseminated intravascular coagulation

ANS: B, C, E Altered carbohydrate metabolism may result in unstable blood glucose levels. The serum glucose level is usually increased to more than 200 mg/dL. This condition is termed cirrhotic diabetes. Altered carbohydrate metabolism may also result in malnutrition and a decreased stress response. Protein metabolism, albumin synthesis, and serum albumin levels are decreased. Low albumin levels are also thought to be associated with the development of ascites, a complication of hepatic failure. Fibrinogen is an essential protein that is necessary for normal clotting. A low plasma fibrinogen level, coupled with decreased synthesis of many blood-clotting factors, predisposes the patient to bleeding. Clinical signs and symptoms range from bruising and nasal and gingival bleeding to frank hemorrhage. Disseminated intravascular coagulation may also develop.

15. (sole 15, q 30) The patient has just returned from having an arteriovenous fistula placed. The patient asks, "When will they be able to use this and take this other catheter out?" The nurse should reply, a. "It can be used immediately so the catheter can come out anytime." b. "It will take 2 to 4 weeks to heal before it can be used." c. "The fistula will be usable in about 4 to 6 weeks." d. "The fistula was made using graft material so it depends on the manufacturer."

ANS: C An arteriovenous fistula is an internal, surgically created communication between an artery and a vein. This method produces a vessel that is easy to cannulate but requires 4 to 6 weeks before it is mature enough to use.

41.(Sole 6, SATA #2). Which intervention(s) is (are) critical during intravenous lipid administration? (Select all that apply). a. Assess glucose levels q6hr b. Change the tubing every 24 hours. c. Hold lipids when administering antibiotics through the same line. d. Monitor triglyceride levels. e.( maintain elevation of the head of the bed )

ANS: B, D, E? Lipids are very good media for bacterial growth; lipid tubing should be changed every 24 hours. Triglyceride levels must be monitored until stable when administering lipids.

37. (Sole chapter 6, question #4). A patient has been admitted to the critical care unit after a stroke. After "failing" a swallow study, the patient is placed on enteral feedings. Following placement of a nasogastric tube for tube feeding, what is the next critical step? a. Administer medications. b. Cap off and wait 24 hours before starting feedings. c. Obtain a chest radiograph. d. Start the tube feeding.

ANS: C Correct placement must be verified by radiograph before use of the tube.

16. (Sole 15, q32). The nurse is assessing a patient with a new arteriovenous fistula, but does not hear a bruit or feel a thrill. Pulses distal to the fistula are not palpable. The nurse should: a. reassess the patient in an hour. b. raise the arm above the level of the patient's heart. c. notify the provider immediately. d. apply warm packs to the fistula site and reassess.

ANS: C Inadequate collateral circulation past the fistula or graft may result in loss of this pulse. The physician is notified immediately if no bruit is auscultated, no thrill is palpated, or the distal pulse is absent. Loss of bruit and thrill indicate a loss of blood flow most likely due to clotting. The patient will need to return to surgery as soon as possible for declotting. Raising the arm above the level of the heart will not help. Warm packs may or may not help.

14. (sole 15, q26). The patient is diagnosed with acute kidney injury and has been getting dialysis 3 days per week. The patient complains of general malaise and is tachypneic. An arterial blood gas is ordered and shows that the patient's pH is 7.19, with a PCO2 of 30 mm Hg and a bicarbonate level of 13 mEq/L. The nurse prepares to: a. administer morphine to slow the respiratory rate. b. prepare for intubation and mechanical ventilation. c. administer intravenous sodium bicarbonate. d. cancel tomorrow's dialysis session.

ANS: C Metabolic acidosis is the primary acid-base imbalance seen in acute kidney injury. Treatment of metabolic acidosis depends on its severity. Patients with a serum bicarbonate level of less than 15 mEq/L and a pH of less than 7.20 are usually treated with intravenous sodium bicarbonate. The goal of treatment is to raise the pH to a value greater than 7.20. Rapid correction of the acidosis should be avoided, because tetany may occur as a result of hypocalcemia. Renal replacement therapies also may correct metabolic acidosis because it removes excess hydrogen ions and bicarbonate is added to the dialysate and replacement solutions; therefore, dialysis would not be cancelled. The tachypnea is a compensatory mechanism for the metabolic acidosis, and treatments to decrease the respiratory rate are not indicated. Treatment is aimed at correcting the metabolic acidosis, and this scenario does not provide data to support the need for intubation.

39.(sole 6, #15). An important nutritional consideration in the elderly population is: a. decreased protein requirements. b. increasing caloric requirements with age. c. potential for drug-nutrient interaction related to polypharmacy. d. presence of other diseases that decrease caloric needs.

ANS: C Patients taking multiple medications have a greater potential for drug-nutrient interactions; elderly persons may be taking multiple medications.

18. (Sole 15, q43). The patient is on intake and output (I&O) as well as daily weights. The nurse notes that output is considerably less than intake over the last shift, and daily weight is 1 kg more than yesterday. The nurse should: a. draw a trough level after the next dose of antibiotic. b. obtain an order to place the patient on fluid restriction. c. assess the patient's lungs. d. insert an indwelling catheter.

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

You're providing education to a patient with an active Hepatitis B infection. What will you include in their discharge instructions? Select all that apply: A. "Take acetaminophen as needed for pain." B. "Eat large meals that are spread out through the day." C. "Follow a diet low in fat and high in carbs." D. "Do not share toothbrushes, razors, utensils, drinking cups, or any other type of personal hygiene product." E. "Perform aerobic exercises daily to maintain strength."

ANS: C and D The patient should NOT take acetaminophen (Tylenol) due to its effective on the liver. The patient should eat small (NOT large), but frequent meals...this may help with the nausea. The patient should rest (not perform aerobic exercises daily) because this will help with liver regeneration.

20. (Sole chapter 17, question #17). The nurse is caring for a patient with the diagnosis of sepsis. The patient is on a ventilator in the critical care unit, and is receiving a proton pump inhibitors (PPI) to reduce the risk for a stress ulcer. In this scenario, a stress ulcer is likely secondary to: a. infection with Helicobacter pylori bacteria. b. decreased acetylcholine production. c. a decreased number of parietal cells. d. ischemia associated with sepsis.

ANS: D A stress ulcer is an acute form of peptic ulcer that often accompanies severe illness, systemic trauma, or neurological injury. Ischemia is the prior etiology associated with stress ulcer formation. Ischemic ulcers develop within hours of an event such as hemorrhage, multisystem trauma, severe burns, heart failure, or sepsis. The shock, anoxia, and sympathetic responses decrease mucosal blood flow leading to ischemia. The secretion of acid is important in the pathogenesis of ulcer disease. Acetylcholine (a neurotransmitter), gastrin (a hormone), and secretin (a hormone) stimulate the chief cells, which stimulate acid secretion. Parietal cell mass in people with peptic ulcer disease is 1.5 to 2 times greater than in persons without disease. Infection with Helicobacter pylori bacteria is a major cause of duodenal ulcers.

24. (Sole 17, question #40). The nurse is caring for a patient with acute pancreatitis. To provide adequate pain control, the nurse: a. should suggest that the patient receive epidural analgesia. b. provides oral pain medication on an "as needed" (PRN) basis. c. removes any nasogastric tubes. d. administers pain medication on a routine schedule.

ANS: D Analgesic administration is a nursing priority. Adequate pain control requires the use of IV opiates, often in the form of a patient-controlled analgesia (PCA) pump. In the case in which a PCA pump is not ordered, pain medications are administered on a routine schedule, rather than as needed, to prevent uncontrollable abdominal pain. Insertion of a nasogastric tube connected to low intermittent suction may help ease pain.

17.(Sole 15, q35). Continuous renal replacement therapy (CRRT) differs from conventional intermittent hemodialysis in that: a. a hemofilter is used to facilitate ultrafiltration. b. it provides faster removal of solute and water. c. it does not allow diffusion to occur. d. the process removes solutes and water slowly.

ANS: D CRRT is a continuous extracorporeal blood purification system managed by the bedside critical care nurse. It is similar to conventional intermittent hemodialysis in that a hemofilter is used to facilitate the processes of ultrafiltration and diffusion. It differs in that CRRT provides a slow removal of solutes and water as compared to the rapid removal of water and solutes that occurs with intermittent hemodialysis.

22. (Sole 17, quesiton #30). The nurse is caring for a patient who has a Sengstaken-Blakemore tube in place. In caring for this patient, the nurse must: a. maintain as little traction as possible. b. apply external traction using side rail of the bed. c. deflate the gastric balloon before the esophageal balloon. d. deflate the esophageal balloon before the gastric balloon.

ANS: D It is crucial that the esophageal balloon be deflated before the gastric balloon is deflated, or else the entire tube will be displaced upward and occlude the airway. Correct positioning and traction are maintained by using an external traction source or a nasal cuff around the tube at the mouth or nose. External traction can be attached to a helmet or to the foot of the bed (not the side rail). Proper amounts of traction are essential because too little traction lets the balloon fall away from the gastric wall, resulting in insufficient pressure being placed on the bleeding vessels. Too much traction causes discomfort, gastric ulceration, or vomiting.

50. During the postoperative period after surgery for a kidney transplant, the client's creatinine level is 3.1 mL/dL. What should the nurse do first in response to this laboratory result? A. Notify the health care provider B. Check the intravenous infusion C. Obtain current blood test results D. Assess for decreased urine output

D. Assess for decreased urine output