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Chapter 37 Question 1 A patient admitted with an infected wound is demonstrating signs of improvement. The nurse would attribute this improvement to which physiologic process? 1. Cortisol released from the adrenal glands 2. Hypothalamus activating white blood cells 3. Endothelial cells releasing mediators to contain the infection 4. Mediators that decrease permeability of vessel walls Question 2 A patient tells the nurse that he is upset because his surgical wound is infected and everyone else that he knows who had the same surgery did not have the same problem. How should the nurse respond to this concern? 1. “There really is nothing that could be done to prevent it.” 2. “You should talk to your surgeon about your concerns.” 3. “At least you are in the hospital when the infection started and not at home.” 4. “Developing an infection depends on many factors, even things like age and gender.” Question 3 A patient who underwent transurethral resection of the prostate 5 days ago returns to the emergency department. After assessing the patient and obtaining laboratory results the nurse notes a temperature of 96.8°F, a respiratory rate of 26, and a white blood cell (WBC) count of 3,000 mm3. The nurse anticipates additional treatment for which disorder? 1. Systemic inflammatory response syndrome 2. Homeostasis 3. Localized inflammation 4. Multiple organ dysfunction syndrome Question 4 The nurse is admitting a patient into the intensive care unit and is planning preventative measures to avoid the onset of the systemic inflammatory response syndrome. Which assessment findings would increase the patient’s risk of developing this syndrome? 1. Age 36 2. Body mass index of 23 3. Asian ancestry 4. 15 pack-year smoking history Question 5 A patient involved in a motor vehicle accident was admitted to the intensive care unit with a closed head injury. Which clinical manifestation would warn the nurse that the patient’s condition was progressing to multiple organ dysfunction syndrome? 1. Urine output less than 400 mL/day 2. Decreased PaO2 with an increase in FiO2 3. Alteration in level of consciousness 4. Hypotension that responds to fluids Question 6 The nurse will calculate the pressure-adjusted heart rate for a patient with cardiovascular dysfunction associated with MODS. Which information must the nurse obtain before this measurement can be calculated? 1. Heart rate 2. Central venous pressure 3. Mean arterial pressure 4. Temperature 5. PaFiO2 Question 7 A patient with a history of alcoholism and esophageal varices was admitted to the intensive care unit and developed multiple organ dysfunction syndrome. Which laboratory results would confirm the nurse’s suspicion of hepatic involvement? 1. Increased fibrinogen level 2. Decreased blood urea nitrogen 3. Increased serum bilirubin 4. Increased serum albumin Question 8 A patient diagnosed with sepsis and multiple organ dysfunction syndrome has developed acute renal failure. Which arterial blood gas (ABG) result would the nurse expect to find? 1. pH = 7.30, PaCO2= 38, HCO3 = 16, PaO2 = 60 2. pH = 7.50, PaCO2 = 30, HCO3 = 26, PaO2 = 90 3. pH = 7.35, PaCO2 = 45, HCO3 = 24, PaO2 = 70 4. pH = 7.46, PaCO2 = 42, HCO3= 28, PaO2 = 80 Question 9 A patient is in the intensive care unit with multiple organ dysfunction syndrome. Which assessment finding would suggest to the nurse that the patient is experiencing failure of the gastrointestinal system? 1. Increased flatus 2. Abdominal cramps 3. Absent bowel sounds 4. Complaint of epigastric burning Question 10 Which nursing interventions should be implemented to help prevent the development of multiple organ dysfunction in a critically ill patient who is being mechanically ventilated? 1. Enforcing hand washing before and after touching a patient 2. Following an evidence-based ventilator bundle 3. Using urinary catheters to prevent perineal skin breakdown 4. Complying with turning and repositioning schedules 5. Restricting visitors to immediate family only