NSG 232 Cumulative review for Exam #1-Questions with
Correct Answers/ Verified/ Latest Update
When caring for a patient in acute septic shock, the nurse would anticipate- - ✔✔-Infusing
large amounts of intravenous fluids.
Septic shock is characterized by- - ✔✔-a decreased circulating blood volume.
What is the cornerstone of therapy for septic shock? - ✔✔-Volume expansion with the
administration of intravenous fluids.
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)? - ✔✔-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.
The many deleterious effects of shock are all related to- - ✔✔-inadequate perfusion and
oxygenation of every body system.
Hyperglycemia in the absence of diabetes can be an indicator of? - ✔✔-possible onset of
sepsis. People with no prior diabetic history who present with hyperglycemia may be going
into septic shock.
What is the primary precipitating factor in septic shock? - ✔✔-Infection leading to an
inflammatory response
What is the primary precipitating factor for neurogenic shock? - ✔✔-trauma to spinal cord.
,What happens in neurogenic shock? - ✔✔-spinal cord injury leads to loss of sympathetic
tone, resulting in massive vasodilation.
What is the precipitating factor for hypovolemic shock? - ✔✔-Loss of blood or flood from
vasculature.
The key factor in describing any type of shock is_ - ✔✔_ inadequate tissue perfusion.
What are some precipitating factors of obstructive shock? - ✔✔_Abdominal compartment
syndrome, pulmonary embolism
Which shock is characterized by increased systemic vascular resistance (SVR), decreased CO,
and decreased pulmonary artery wedge pressure (PAWP)? - ✔✔Hypovolemic shock
In SEPTIC shock, bacterial endotoxins cause vascular changes that result in_ -
✔✔_DECREASED systemic vascular resistance with INCREASED cardiac output.
What are two common characteristics of NEUROGENIC shock? - ✔✔_Bradycardia and
hypotension
ABSOLUTE hypovolemia results when_ - ✔✔_fluid is lost through hemorrhage, GI loss
(vomiting/diarrhea), fistula drainage, diabetes insipidus, or diuresis.
RELATIVE hypovolemia results when_ - ✔✔_fluid volume moves out of the vascular space
into the extravascular space. (Third spacing)
What are diuretics? - ✔✔Drugs that act on the renal tubule to promote the excretion of
sodium, chloride and water
Give an example of an osmotic diuretic, one use and one unwanted effect - ✔✔Mannitol.
Used to prevent acute renal failure. Increases ECF as an unwanted effect; hyponatraemia
,Drug Therapy - problem with IM medications - ✔✔after medication pools in tissue
when fluid mobilization begins, inadvertent overdose from intersititial accumulation of
previous IM meds
Drug Therapy - tetanus immunization - ✔✔tetanus toxoid
given routinely to all burn patients
due to likelihood of anaerobic burn wound contamination
if not received within last 10 years
Drug Therapy - systemic antibiotics when - ✔✔clinical diagnosis of invasive burn wound
sepsis or some other source of infection {PNA etc}
Drug Therapy - venous thromboembolism phrophlaxis - ✔✔Use: burn patients at risk for
DVT (LE burns, obesity)
Meds: Lovenox, heparin
Alt tx for ^ bleeding risk: mechanical VTE prophylaxis. SCD's and/or
graduated compression stocking
Nutritional Therapy - when - ✔✔after fluid needs established
Nutritional Therapy - importance after fluid needs established - ✔✔takes priority in inital
emergent phase
early & aggressive nutritional support within hours of burn injury
Nutritional Therapy - patients with large burn >20% TBSA - complication - ✔✔can develop
paralytic ileus within a few hours
due to body's response to major trauma
Nutritional Therapy - GI assess - ✔✔bowel sounds q 8 hours
, Nutritional Therapy - what happends after major burn injury - metabolism -
✔✔hypermetabolic state
proportional to size of wound
Nutritional Therapy - resting metabolic expenditure - ✔✔may be increased by 50% - 100%
above normal
core temp is elevated
catecholamines, which stimulate catabolism & heat production increased
Nutritional Therapy - massive catabolism - ✔✔characterized by protein breakdown &
increased gluconeogenesis
Nutritional Therapy - interventions - ✔✔protein powder added to food & liquids
supplemental vitains as early as emergent phase, with iron supplements often started in
acute phase
patient with burns - ✔✔most likely in shock from hypovolemia
full-thickness & deep partial-thickness sensations - ✔✔initially anesthetic due to nerve
ending destruction
superficial to moderate partial-thickness burns - sensations - ✔✔painful
partial-thickness burns - ✔✔blisters filled w/fluid & protein may form
fluid is not lost from body as much as it is sequestered in the intersitital and third spaces
patient with larger burn areas - ✔✔may have signs of an adynamic ileus
such as absent or decreased bowel sound
result of body's response to massive trauma & potassium shifts
Correct Answers/ Verified/ Latest Update
When caring for a patient in acute septic shock, the nurse would anticipate- - ✔✔-Infusing
large amounts of intravenous fluids.
Septic shock is characterized by- - ✔✔-a decreased circulating blood volume.
What is the cornerstone of therapy for septic shock? - ✔✔-Volume expansion with the
administration of intravenous fluids.
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)? - ✔✔-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.
The many deleterious effects of shock are all related to- - ✔✔-inadequate perfusion and
oxygenation of every body system.
Hyperglycemia in the absence of diabetes can be an indicator of? - ✔✔-possible onset of
sepsis. People with no prior diabetic history who present with hyperglycemia may be going
into septic shock.
What is the primary precipitating factor in septic shock? - ✔✔-Infection leading to an
inflammatory response
What is the primary precipitating factor for neurogenic shock? - ✔✔-trauma to spinal cord.
,What happens in neurogenic shock? - ✔✔-spinal cord injury leads to loss of sympathetic
tone, resulting in massive vasodilation.
What is the precipitating factor for hypovolemic shock? - ✔✔-Loss of blood or flood from
vasculature.
The key factor in describing any type of shock is_ - ✔✔_ inadequate tissue perfusion.
What are some precipitating factors of obstructive shock? - ✔✔_Abdominal compartment
syndrome, pulmonary embolism
Which shock is characterized by increased systemic vascular resistance (SVR), decreased CO,
and decreased pulmonary artery wedge pressure (PAWP)? - ✔✔Hypovolemic shock
In SEPTIC shock, bacterial endotoxins cause vascular changes that result in_ -
✔✔_DECREASED systemic vascular resistance with INCREASED cardiac output.
What are two common characteristics of NEUROGENIC shock? - ✔✔_Bradycardia and
hypotension
ABSOLUTE hypovolemia results when_ - ✔✔_fluid is lost through hemorrhage, GI loss
(vomiting/diarrhea), fistula drainage, diabetes insipidus, or diuresis.
RELATIVE hypovolemia results when_ - ✔✔_fluid volume moves out of the vascular space
into the extravascular space. (Third spacing)
What are diuretics? - ✔✔Drugs that act on the renal tubule to promote the excretion of
sodium, chloride and water
Give an example of an osmotic diuretic, one use and one unwanted effect - ✔✔Mannitol.
Used to prevent acute renal failure. Increases ECF as an unwanted effect; hyponatraemia
,Drug Therapy - problem with IM medications - ✔✔after medication pools in tissue
when fluid mobilization begins, inadvertent overdose from intersititial accumulation of
previous IM meds
Drug Therapy - tetanus immunization - ✔✔tetanus toxoid
given routinely to all burn patients
due to likelihood of anaerobic burn wound contamination
if not received within last 10 years
Drug Therapy - systemic antibiotics when - ✔✔clinical diagnosis of invasive burn wound
sepsis or some other source of infection {PNA etc}
Drug Therapy - venous thromboembolism phrophlaxis - ✔✔Use: burn patients at risk for
DVT (LE burns, obesity)
Meds: Lovenox, heparin
Alt tx for ^ bleeding risk: mechanical VTE prophylaxis. SCD's and/or
graduated compression stocking
Nutritional Therapy - when - ✔✔after fluid needs established
Nutritional Therapy - importance after fluid needs established - ✔✔takes priority in inital
emergent phase
early & aggressive nutritional support within hours of burn injury
Nutritional Therapy - patients with large burn >20% TBSA - complication - ✔✔can develop
paralytic ileus within a few hours
due to body's response to major trauma
Nutritional Therapy - GI assess - ✔✔bowel sounds q 8 hours
, Nutritional Therapy - what happends after major burn injury - metabolism -
✔✔hypermetabolic state
proportional to size of wound
Nutritional Therapy - resting metabolic expenditure - ✔✔may be increased by 50% - 100%
above normal
core temp is elevated
catecholamines, which stimulate catabolism & heat production increased
Nutritional Therapy - massive catabolism - ✔✔characterized by protein breakdown &
increased gluconeogenesis
Nutritional Therapy - interventions - ✔✔protein powder added to food & liquids
supplemental vitains as early as emergent phase, with iron supplements often started in
acute phase
patient with burns - ✔✔most likely in shock from hypovolemia
full-thickness & deep partial-thickness sensations - ✔✔initially anesthetic due to nerve
ending destruction
superficial to moderate partial-thickness burns - sensations - ✔✔painful
partial-thickness burns - ✔✔blisters filled w/fluid & protein may form
fluid is not lost from body as much as it is sequestered in the intersitital and third spaces
patient with larger burn areas - ✔✔may have signs of an adynamic ileus
such as absent or decreased bowel sound
result of body's response to massive trauma & potassium shifts
