NUR 2755 MDC4 Final Exam |
Multidimensional Care IV Study Guide
Questions and Answers
Question 1
Patient with MODS following septic shock develops progressive dyspnea, requires
intubation, ↑ BG, ↑ lactic acid. What is the most appropriate nursing intervention?
Correct Answer
Initiate mechanical ventilation + closely monitor respiratory status
Question 2
The nurse is caring for a client who is known to be at risk for cardiogenic embolic
strokes. What arrhythmia does this client most likely have.
Correct Answer
Atrial fibrillation
Question 3
Assessment findings of pneumothorax:
Correct Answer
Sudden sharp chest pain , Dyspnea / shortness of breath
Tachypnea, tachycardia, Asymmetrical chest expansion, Absent or diminished breath
sounds on affected side, Hyperresonance on percussion of affected side, Tracheal
deviation, Restlessness, anxiety, cyanosis
Question 4
A nurse who is a member of the local disaster response team is learning about blast
injuries. The nurse should plan for what event that occurs in the tertiary phase of the
blast injury?
Correct Answer
Victims are thrown by the pressure wave.
Page 1 of 30
,Question 5
How can you reduce the risk in a burn pt for contractures and hypertrophic scarring?
Early physical/occupational therapy. SATA
Correct Answer
Splinting and positioning.
Range of motion exercises.
Pressure garments.
Surgical grafting if needed.
Question 6
A client who is in shock is receiving dopamine in addition to IV fluids. What principle
should inform the nurse's care planning during the administration of a vasoactive
drug?
Correct Answer
The drug dose should be tapered down once vital signs improve.
Question 7
An industrial site has experienced a radiation leak and workers who have been
potentially affected areen route to the hospital. To minimize the risks of
contaminating the hospital, managers should perform What action?
Correct Answer
Establish a triage outside the hospital.
Question 8
Patient in compensatory shock has cool/pale skin, ↓ urine output, and ↑ RR. What
interventions improve prognosis?
Correct Answer
Start IV fluid therapy + provide supplemental O₂
Page 2 of 30
, Question 9
In the compensatory (early) stage of shock, the body is trying to maintain perfusion
through sympathetic activation.Assessments consistent with this stage:
Correct Answer
tachycardia, tachypnea, cool clammy skin, restlessness, and decreased urine output.
Question 10
A patient with TBI is at risk for developing diabetes insipidus. What is the nurse's
priority intervention?
Correct Answer
Monitor urine output and specific gravity
Question 11
The ED nurse is planning the care of a client who has been admitted following a
sexual assault. The nurse knows that all of the nursing interventions are aimed at what
goal?
Correct Answer
Encouraging the client to gain a sense of control over his or her life
Question 12
A patient with MODS has progressed to the irreversible stage. What should the
nurse's plan of care include?
Correct Answer
Promote communication with family and address end-of-life issues
Question 13
A patient exhibiting an altered level of consciousness (LOC) due to blunt-force trauma
to the head is admitted to the ED. The physician determines the patients injury is
causing increased intracranial pressure (ICP). The nurse should gauge the patients
LOC on the results of what diagnostic tool?
Correct Answer
Glasgow Coma Scale (Coma Scale: eye opening, verbal response, and motor
response.)
Page 3 of 30
Multidimensional Care IV Study Guide
Questions and Answers
Question 1
Patient with MODS following septic shock develops progressive dyspnea, requires
intubation, ↑ BG, ↑ lactic acid. What is the most appropriate nursing intervention?
Correct Answer
Initiate mechanical ventilation + closely monitor respiratory status
Question 2
The nurse is caring for a client who is known to be at risk for cardiogenic embolic
strokes. What arrhythmia does this client most likely have.
Correct Answer
Atrial fibrillation
Question 3
Assessment findings of pneumothorax:
Correct Answer
Sudden sharp chest pain , Dyspnea / shortness of breath
Tachypnea, tachycardia, Asymmetrical chest expansion, Absent or diminished breath
sounds on affected side, Hyperresonance on percussion of affected side, Tracheal
deviation, Restlessness, anxiety, cyanosis
Question 4
A nurse who is a member of the local disaster response team is learning about blast
injuries. The nurse should plan for what event that occurs in the tertiary phase of the
blast injury?
Correct Answer
Victims are thrown by the pressure wave.
Page 1 of 30
,Question 5
How can you reduce the risk in a burn pt for contractures and hypertrophic scarring?
Early physical/occupational therapy. SATA
Correct Answer
Splinting and positioning.
Range of motion exercises.
Pressure garments.
Surgical grafting if needed.
Question 6
A client who is in shock is receiving dopamine in addition to IV fluids. What principle
should inform the nurse's care planning during the administration of a vasoactive
drug?
Correct Answer
The drug dose should be tapered down once vital signs improve.
Question 7
An industrial site has experienced a radiation leak and workers who have been
potentially affected areen route to the hospital. To minimize the risks of
contaminating the hospital, managers should perform What action?
Correct Answer
Establish a triage outside the hospital.
Question 8
Patient in compensatory shock has cool/pale skin, ↓ urine output, and ↑ RR. What
interventions improve prognosis?
Correct Answer
Start IV fluid therapy + provide supplemental O₂
Page 2 of 30
, Question 9
In the compensatory (early) stage of shock, the body is trying to maintain perfusion
through sympathetic activation.Assessments consistent with this stage:
Correct Answer
tachycardia, tachypnea, cool clammy skin, restlessness, and decreased urine output.
Question 10
A patient with TBI is at risk for developing diabetes insipidus. What is the nurse's
priority intervention?
Correct Answer
Monitor urine output and specific gravity
Question 11
The ED nurse is planning the care of a client who has been admitted following a
sexual assault. The nurse knows that all of the nursing interventions are aimed at what
goal?
Correct Answer
Encouraging the client to gain a sense of control over his or her life
Question 12
A patient with MODS has progressed to the irreversible stage. What should the
nurse's plan of care include?
Correct Answer
Promote communication with family and address end-of-life issues
Question 13
A patient exhibiting an altered level of consciousness (LOC) due to blunt-force trauma
to the head is admitted to the ED. The physician determines the patients injury is
causing increased intracranial pressure (ICP). The nurse should gauge the patients
LOC on the results of what diagnostic tool?
Correct Answer
Glasgow Coma Scale (Coma Scale: eye opening, verbal response, and motor
response.)
Page 3 of 30
