Chapter 65 Multisystem Failure

Chapter 65  Multisystem Failure

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. The nurse is caring for a client who has sustained multiple injuries from a motor vehicle accident. The nurse realizes that the client will have a release of stress hormones that are useful for all of the following EXCEPT:
1.
preventing loss of fluids.
2.
preventing hypotension.
3.
preventing infection.
4.
preventing ingestion of food.

ANS: 4
The purpose of the release of stress hormones following an insult to the body is to aid in restoring balance to the system and to prevent secondary complications, including loss of fluids, hypotension, and infection. The stress hormones are not released to prevent the ingestion of food.

PTS: 1 DIF: Analyze REF: Neuroendocrine System Response

2. The nurse is planning care for a client diagnosed with acute respiratory distress syndrome (ARDS)? Which of the following is not included in the management of this disorder?
1.
Treating the underlying cause
2.
Promoting gas exchange
3.
Providing oxygen therapy
4.
Promoting urine output

ANS: 4
The nursing management of ARDS includes facilitating oxygenation and ventilation, which is accomplished by treating the underlying cause, promoting gas exchange, and providing oxygen therapy. Promoting urine output is not part of the management of this disorder.

PTS: 1 DIF: Apply
REF: Acute Respiratory Distress Syndrome: Planning and Implementation

3. The nurse, caring for a client diagnosed with shock, realizes that the stage in which the body attempts to remedy the problem by initiating the homeostatic mechanism would be?
1.
Initial stage
2.
Compensatory stage
3.
Multiple organ failure stage
4.
Refractory stage

ANS: 2
During the compensatory stage, the body tries to remedy the problem. If it cannot, cellular damage will occur and organ failure and death may follow. During the initial stage, there is a decrease in cardiac output and impaired tissue perfusion. In multiple organ failure, every system in the body is affected. In the refractory stage, the body can no longer respond to therapy and the shock condition is considered irreversible.

PTS: 1 DIF: Analyze REF: The Four Stages of the Shock Syndrome

4. A client experiences a bee sting, complains of difficulty breathing, and shows sign of hypoxia and hypotension. The nurse realizes these are signs of anaphylactic shock, and she should do which of the following first?
1.
Get a medical alert bracelet for the patient.
2.
Give epinephrine intravenously or via endotracheal tube.
3.
Check with the family for a history.
4.
Admit the client through the admitting department.

ANS: 2
Anaphylactic shock is a medical emergency, and treatment is needed immediately. The nurse should expect to give epinephrine to promote bronchodilation and vasoconstriction. The other choices can be done after the client’s airway and ventilation are stabilized.

PTS: 1 DIF: Apply REF: Anaphylactic Shock: Pharmacology