Book Review Questions: Test 2

Question 1

What are the most common precipitating factors for ketoacidosis and hyperosmolar nonketotic syndrome

Answer 1

infection, conditions that induce stress (MI, CVA, trauma, or surgery), pregnancy, medications (especially steroids), and misuse of alcohol

Question 2

What four assessment findings are associated with metabolic syndrome? Why is it important to assess serum glucose on patients with metabolic syndrome?

Answer 2

central obesity, abnormal lipid panel, fasting BG greater than 110, and hyperinsulinemia. Glucose monitoring should be implemented in order to detect hyperglycemia in this population. Hyperglycemia causes endovascular inflammation and result in increased complications, increased length of stay in the ccu, and increased mortality

Question 3

What are two differences in the assessment findings between patients with DKA and HHNS

Answer 3

DKA: metabolic acidosis,
HHNS: visual disturbance such as blurred vision due to increased blood osmolality

Question 4

What interventions are critical prioir to the administration of insulin to the patient with DKA

Answer 4

assess K+ levels and prepare for replacement. Assess volume status and initiate replacement. Check pH, bicarb, serum sodium, calcium, phosphate, and magnesium

Question 5

What medications can increase insulin resistance and the blood sugar in patients with type 2 diabetes

Answer 5

steroids, thiazide diuretics, calcium channel blockers, propranolol, phenytoin, sympathomimetics

Question 6

what are the most common complications that may occur during management of Dka HHNS

Answer 6

hypoglycemia, hypokalemia, fluid volume overload with heart failure, cerebral edema, ARDS

Question 7

why is treatment of hyperglycemia during critical illness important

Answer 7

can cause inflammatory response, linked to poor patient outcomes, maintain between 80 and 110

Question 8

what are the major causes of intrinsic renal failure in the critically ill patient? What can the nurse do to prevent intrinsic renal failure in the critically ill patient?

Answer 8

intrinsic or intrarenal failure is primarily caused by a prolonged reduction in renal perfusion but may also be precipitated by other conditions, including nephrotoxic agents. By maintaining an adequate MAP and ensuring renal perfusion as well as avoiding administration of nephrotoxic agents, the nurse may help to prevent AKI.

Question 9

Which of the electrolyte imbalances is the most dangerous in AKI? Why? How is it managed emergently?

Answer 9

Hyperkalemia: may result in death from diastolic arrest or ventricular fibrillation. Potassium may be counteracted with IV calcium or driven intracellulary with insulin and glucose or sodium bicarb. Longer term reductions in K+ might be achieved with a cation exchange resin or renal replacement therapy.

Question 10

Why is peritoneal dialysis of limited use in patients with AKI?

Answer 10

not a speedy or efficient enough to adequately remove the midsized waste such as urea that accumulate rapidly in catabolic AKI patients. Volume of fluid is placed in the peritoneum in PD tends to have a negative impact on respiratory function. Lastly, several studies have demonstrated poorer outcomes for patients who received PD rather than other modalities of treatment for AKI

Question 11

What are the advantages of hemodialysis for the patient in AKI

Answer 11

results in a higher rate of return of renal function and decreased mortality for critically ill patients in AKI. Excess fluid can be removed as quickly as the patient can tolerate electrolyte imbalances may be returned to normal more quickly

Question 12

What is the function of the replacement fluid utilized in some forms of CRRT?

Answer 12

convection occurs when replacement gluid flows through the filter at a fast rate, creating a solute drag that removes fluids and small to midsized molecules

Question 13

What are the indications of fluid volume excess seen in the patient with AKI?

Answer 13

• rapid bounding pulse
• skin pale and cool
• elevated BP
• JDD
• nonpitting edema in dependent areas
• increased CVP or PAWP
• increased shallow resps
• dyspnea on exertion or in supine position
• crackles
• increase in weight

Question 14

a 19 year old female presents to the ED having fallen off a trampoline, she is unable to move from the nipple line down. She has no prior history and no open wounds. What meds would she receive?

Answer 14

Methylprednisolone, 2,250 mg IV over 15 minutes

Question 15

What does the primary assessment of a trauma patient consist of? Secondary assessment?

Answer 15

Primary: Airway, breathing, circulation, and disability.
Secondary: Exposing the patient to check for other injuries, getting vitals, giving comfort, head to toe assessment, obtain accurate history, inspect the patient’s posterior

Question 16

How does elevating the head of the bead for the patient decrease the incidence of ventilator associated pneumonia?

Answer 16

reduces risk of aspiration

Question 17

What interventions are included in evidence-based management of a central venous catheter

Answer 17

hand hygiene, maximal barrier precautions on insertion, chlorhexidine skin antisepsis, optimal catheter site selection, aily review of line necessity with prompt removal of unnecessary lines

Question 18

Why does disseminated intravascular coagulation result in both thrombosis and bleeding?

Answer 18

• Coagulation cascade
• thrombin production which should be balanced by chemical mediators is not and continues unrestrained
• excessive thrombin production activates fibrinogen, resulting in fibrin formation.
• fibrin is in microcirculation, depositing, platelets and coagulation factors are consumed, resulting in deficiency of clotting factors and patient begins to bleed.

Question 19

what are the four determinants of cardiac output? What is the relationship between preload and contractility?

Answer 19

heart rate, preload, afterload, and contractility.
-myocardial fiber stretch from an adequate end diastolic volume or preload is required to optimize contractility. If the volume becomes too large, the myocardial fibers are over-stretched, leading to failure.

Question 20

Upon entering a patient’s room the nurse notices blood backing up in the tubing leading from the art cath to the flush/transducer system

a. What are the nursing actions to correct this?
b. will this cause the arterial waveform to be overdamped or underdamped?

Answer 20

a. Nursing actions are to ensure that the pressure bag is inflated to 300mm Hg. Ensure there is adequate saline solutions in the flush bag. Use the fast flush device on the pressure monitoring systems to clear the tubing of blood
b. this will cause the arterial line to be overdamped

Question 21

what conditions would cause an increase in RA pressure

Answer 21

• fluid volume excess
• right ventricular failure
• pulmonary htn
• tricuspid stenosis or insufficiency
• pulmonic stenosis or insufficiency
• pulmonary embolism