Complex E2 Jeopardy

Question 1

The nurse is caring for a patient in shock. Which is a priority action by the nurse?

Answer 1

Maintain adequate tissue perfusion

Question 2

The nurse admits a patient to the coronary care unit in cardiogenic shock. The nurse anticipates administering which medication in an effort to improve CO by increasing the contractile force of the heart?

Answer 2

Dobutamine (Dobutrex)

Question 3

A patient with acute pancreatitis has hypovolemic shock. Which order will the nurse implement first?

Answer 3

Fluid bolus

Question 4

What hemodynamic monitoring parameter indicates to the nurse that administering large amount of crystalloid fluids to a patient in septic shock has been effective?

Answer 4

Elevated CVP

Question 5

Which laboratory test result indicates to the nurse sepsis as a cause of shock?

Answer 5

Thrombocytopenia (low plt count)

Question 6

Polydipsia, polyuria, abdominal pain, nausea, and “fruity” breath are typical findings in…?

Answer 6

DKA

Question 7

The patient is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What manifestation should the nurse expect to find?

Answer 7

With increased AHD, the permeability of renal distal tubules is increased, so water is reabsorbed into circulation. Decreased output of concentrated urine with increased urine osmolality and specific gravity occur. In addition, fluid retention with weight gain, serum hypoosmolality, dilutional hyponatremia, and hypochloremia occur.

Question 8

A patient with diabetes insipidus (DI) is treated with nasal desmopressin acetate (DDAVP). The nurse determines that the drug is not having an adequate therapeutic effect when the patient experiences

Answer 8

A urine with a specific gravity of 1.002 is very dilute, indicating there there continues to be excessive loss of water and that treatment of DI is inadequate

Question 9

In HHS, laboratory results are similar to those in DKA, but with three major exceptions. Which lab findings should the nurse anticipate in a patient with HHS?

Answer 9

Higher serum glucose, higher osmolality, and minimal ketosis

Question 10

A patient with SIADH is treated with water restriction. Which three findings would indicate that treatment has been effective?

Answer 10

Improvement in the patient’s condition is reflected by increased UO, normalization of serum Na, and more water in the urine, thus decreasing the specific gravity

Question 11

Autonomic dysreflexia is characterized by an exaggerated response of the sympathetic nervous system to a variety of stimuli. Common causes of autonomic dysreflexia include

Answer 11

Bladder distention

Question 12

The nurse is educating a new RN on the therapeutic effect of head-of-bed elevation and neutral head and neck alignment on a patient with increased ICP. Which statement by the new RN indicates that teaching has been effective?

Answer 12

1. Facilitating venous drainage
2. Decreasing venous obstruction

Question 13

The nurse is monitoring a patient’s ICP. While the nurse is providing hygiene measures, she observes that the ICP reading is sustained at 18 mm Hg. What is the priority nursing action?

Answer 13

Cease stimulating the patient

Question 14

What is the priority intervention in the ED for the patient with a stroke?

Answer 14

Maintaining respiratory function with a patent airway and oxygen administration

Question 15

What should the nurse do when providing care for a patient with an acute attack of trigeminal neuralgia?

Answer 15

Maintain a quiet, comfortable, draft-free environment.

Because attacks of trigeminal neuralgia may be precipitated by hot or cold air movement on the face, jarring movements, or talking, the environment should be of moderate temperature and free of drafts. The patient should not be expected to converse during the acute period. Patients often prefer to carry out their own oral care because they are afraid someone else may inadvertently injure them or precipitate an attack. The nurse should stress that oral hygiene be done because patients often avoid it. Residual food in the mouth after eating occurs more often with Bell’s Palsy.

Question 16

A patient has sustained deep partial thickness and full thickness burns over 60% of her body. Shortly after admission, her blood pressure drops rapidly to a systolic pressure of 70 mm Hg. You know this is primarily due to

Answer 16

Hypovolemic shock

Question 17

Your patient weighs 60 kg and has a 40% total body surface area (TBSA) burn injury. Fluid resuscitation orders are for 4 mL/kg/% burn of a Lactated Ringer’s solution. What volume should the nurse anticipate infusing during the first 8 hours?

Answer 17

4800 mL

Question 18

Which type of burn injury would cause myoglobinuria, long bone fractures, dysrhythmias, and/or cardiac arrest?

Answer 18

Electrical

Question 19

Which burn patient should have endotrachial intubation?

Answer 19

Thermal burn injuries to the face, neck, or airway

Question 20

All burn patients are at increased risk for acute respiratory distress syndrome (ARDS) due to

Answer 20

Increased capillary permeability

Question 21

A 53-year old patient has kidney and ureteral stones and is hospitalized for urinary retention and severe flank pain. The nurse interprets the level of kidney injury to be

Answer 21

Postrenal

Question 22

The patient is admitted for general malaise and low urine output. The patient is alert and oriented and states that he has lost 5 pounds over the past few days. His hear rate is 124 beats/min. His blood pressure is 88/40 mm Hg. His mouth is dry and he has flat neck veins and poor skin turgor. The nurse interprets that his low UO is due to

Answer 22

Prerenal causes

Question 23

The patient is admitted with generalized edema and hypertension. The patient states that his UO has been less than normal. An indwelling urinary catheter is inserted, but very little urine is obtained. The patient has distended neck veins, and his blood pressure is 210/110 mm Hg. The nurse interprets that the patient’s fluid retention is due to

Answer 23

Intrarenal causes

Question 24

The patient has a potassium level of 7 mEq/L but is not scheduled for a dialysis treatment for the next 3 days. To reduce plasma and body potassium levels, the nurse prepares to administer

Answer 24

Sodium polystyrene sulfonate (Kayexalate)

Question 25

A patient with AKI is a candidate for continuous renal replacement therapy (CRRT). What is the most common indication for the use of CRRT?

Answer 25

Fluid overload.

CRRT is indicated for the patient with AKI as an alternative or adjunct to HD to slowly remove solutes and fluid in the hemodynamically unstable patient. It is especially useful for treatment of fluid overload, but HD is indicated for treatment of hyperkalemia, pericarditis, or other serious effects of uremia

Question 26

When a nurse is performing a primary survey in the ED, what is being assessed?

Answer 26

The status of airway, breathing, circulation, disability, and exposure/environmental control

Question 27

When is the placement of a nasograstic tube contraindicated during emergency care?

Answer 27

Head or facial trauma

Question 28

In which patient situation would therapeutic hypothermia be started in the ED?

Answer 28

Postcardiac arrest for 24 hours after the return of spontaneous circulation (postdefibrillation) improves mortality and neurologic outcomes.

I.e.: 62-year-old man defibrillated by emergency medical technicians (EMTs); on ED arrival, he is not responsive, his heart rhythm and BP are stable

Question 29

A trauma patient with a fractured forearm complains of extreme, throbbing pain at the fracture site and paresthesia in the fingers. Upon further assessment, you note that the forearm is extremely edematous, and you are now having difficulty palpating a radial pulse. You notify the physician immediately because you suspect

Answer 29

Compartment syndrome

Question 30

Spinal cord injury causes a loss of sympathetic output, resulting in distributive shock with hypotension and bradycardia. Although blood pressure may respond to fluid resuscitation, what other therapy may be required to compensate for loss of sympathetic innervation?

Answer 30

Vasopressors

Question 31

The nurse is caring for a patient who has a peptic ulcer. To treat the ulcer and prevent more ulcers from forming, the nurse should be prepared to administer what medication?

Answer 31

H2-histamine receptor blockers

Question 32

The patient is admitted with upper GI bleeding following an episode of forceful retching associated with excessive alcohol intake. The nurse suspects a Mallory-Weiss tear and is aware of what related fact?

Answer 32

A Mallory-Weiss tear is a longitudinal tear in the gastroesophageal mucosa

Question 33

Lactulose is considered the first-line treatment for hepatic encephalopathy and works by what process?

Answer 33

Trapping ammonia in the bowel for excretion

Question 34

The nurse is caring for a patient with severe ascites secondary to chronic liver failure. The patient lying supine in bed reports difficulty breathing. The nurse’s first action should be to take what action?

Answer 34

Position the patient in a semi-Fowler’s position

Question 35

Why is pain control a nursing priority in patients with acute pancreatitis?

Answer 35

Pain increases pancreatic secretions

Question 36

What is the best action by the nurse to level and zero a hemodynamic monitoring system transducer?

Answer 36

Position the air-fluid interface of the zeroing tranducer at the phlebostatic axis (fourth intercostal space, midaxillary line)

Question 37

The nurse is educating a patient’s family member about a pulmonary artery catheter (PAC). Which statement by the family member best indicates understanding of the purpose of the PAC?

Answer 37

“The catheter will allow the primary health care provider to better manage fluid therapy.”

Question 38

Which of the following situations may result in a low cardiac output and low cardiac index?

Answer 38

Hypovolemia, myocardial infarction, and shock

Question 39

What is the primary reason that hemodynamic monitoring is used to severe respiratory failure?

Answer 39

To evaluate cardiac status and blood flow to tissues

Question 40

During hemodynamic monitoring, the nurse finds that the patient has a decreased CO with unchanged pulmonary artery wedge pressure (PAWP), HR, and SVR. The nurse identifies that the patient has a decrease in what?

Answer 40

Contractility

Question 41

Identify at least 3 nursing interventions indicated for the following desired outcomes of prevention of aspiration for enteral feedings

Answer 41

X-ray confirmation of tube location before feeding. Recheck the tube’s insertion length at regular intervals. Position the patient with the HOB elevated 30-45 degrees during feedings. Following intermittent feedings, keep the HOB elevated for 30-60 mins. Measuring gastric residuals is per institutional policy as there is a lot of disagreement about whether gastric residuals should be checked. Monitor for sensation of fullness, nausea, and vomiting. Promotility medications may be prescribed.

Question 42

What 2 nursing interventions are indicated during parenteral nutrition to prevent the following complications of infection

Answer 42

-Refrigerate solutions until 30 minutes before use
-Aseptically change dressing to catheter site per institutional protocol and assess for signs of infection
-Label data and time started
-Change filter and tubing every 24 hours if lipids are being administered or every 72 hours if amino acids and dextrose are being administered
-Label tubing with date and time attached
-Do not infuse solution in 1 bottle more than 24 hours
-Do not add anything to the solution

Question 43

The patient is to start total parenteral nutrition (TPN). The nurse knows to prepare which site for catheter insertion?

Answer 43

Subclavian vein, IJ, femoral

Question 44

A patient who is receiving continuous enteral feedings has just vomited 250 mL of milky green fluid. What is the most likely cause of the vomiting?

Answer 44

Tube feeding intolerance

Question 45

The patient is to start total parenteral nutrition (TPN). The nurse knows to prepare which site for catheter insertion?

Answer 45

Subclavian vein, IJ, femoral

Question 46

What are the risks of total parenteral nutrition?

Answer 46

Elevated blood sugar, infection at the catheter site, volume overload

Question 47

What are the first 2 steps in a transfusion reaction?

Answer 47

1. Stop transfusion
2. Start normal saline

Question 48

The nurse is preparing to administer a blood transfusion. What are the first four steps?

Answer 48

1. Verify the order for the transfusion
2. Verify that the physician has discussed risks, benefits, and alternatives with the patient
3. Ensure that the patient has a patent 16- to 22-gauge IV
4. Prime the transfusion tubing and filter with normal saline

Question 49

Epinephrine may be used for severe _________ transfusion reactions, and the infusion may be restarted after treatment with antihistamines in mild cases

Answer 49

Allergic transfusion reactions

Question 50

Which type of transfusion reaction occurs with leukocyte or plasma protein incompatibility and may be avoided with leukocyte reduction filters?

Answer 50

Febrile nonhemolytic reaction is the most common transfusion reaction

Question 51

Which characteristics are related to an acute hemolytic transfusion reaction

Answer 51

ABO incompatibility, destruction of donor RBCs, acute kidney injury occurs