Module 3 Summer - Texas Tech University Health Sciences Center El Paso
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Nursing Statements | True/False
- The patient should be taught to eat small frequent meals. — True
- Mr. Smith should be advised to avoid spicy food and caffeine. — True
- Diets for patients with acute pancreatitis should be high in fat. — False
- Nutrition education should begin prior to Mr. Smith's discharge. — True
- The patient should be taught to drink beer instead of whiskey. — False
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The patient should be taught to eat small frequent meals. — True
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Mr. Smith should be advised to avoid spicy food and caffeine. — True
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Diets for patients with acute pancreatitis should be high in fat. — False
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Nutrition education should begin prior to Mr. Smith's discharge. — True
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The patient should be taught to drink beer instead of whiskey. — False
Explanation
Nutritional management of acute pancreatitis focuses on reducing pancreatic stimulation and inflammation while supporting adequate intake. Small, frequent meals help minimize the digestive workload on the pancreas compared to large meals, and avoiding spicy foods and caffeine reduces gastric and pancreatic stimulation that can exacerbate symptoms. A low-fat diet, not a high-fat diet, is recommended, since fat is a strong stimulant of pancreatic enzyme secretion and can worsen pancreatic inflammation. Nutrition education should begin before discharge to ensure the client understands necessary dietary modifications to prevent recurrence. Finally, given that alcohol is a major causative factor in this client's pancreatitis, complete alcohol cessation, not substitution of one type of alcohol for another, is the appropriate teaching point, since beer would still cause the same harmful effects on the pancreas.
A client enters the Emergency Department with suspected anaphylactic shock. What should you assess and address first?
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Cool and moist skin
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Mottled skin and petechiae
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Hypertension and tachycardia
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Laryngeal edema and bronchospasm
Explanation
Following the ABC (airway, breathing, circulation) priority framework, airway compromise from laryngeal edema and bronchospasm represents the most immediate life-threatening concern in anaphylactic shock, as these findings indicate potential airway obstruction and severe respiratory distress that must be assessed and addressed first to prevent respiratory arrest.
Why the other options are incorrect:
A. Cool and moist skin — While skin changes can occur in shock states, they are not the priority assessment compared to a potentially compromised airway.
B. Mottled skin and petechiae — These findings reflect poor perfusion, but addressing airway compromise takes priority over skin assessment findings in anaphylactic shock.
C. Hypertension and tachycardia — Anaphylactic shock typically presents with hypotension, not hypertension, and even if present, cardiovascular findings are secondary to the immediate priority of securing the airway.
The nurse is caring for a client who underwent a total hip replacement yesterday. What should the nurse do to prevent dislocation of the new prosthesis?
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Have the client reposition himself independently
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Keep the hip flexed by placing pillows under the client's knee
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Keep the affected leg in a position of adduction
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Protect the affected leg from internal rotation
Explanation
Preventing internal rotation of the affected leg is essential after a total hip replacement, as internal rotation combined with adduction and hip flexion significantly increases the risk of prosthesis dislocation. Nurses typically use positioning devices such as abduction pillows and instruct on proper leg alignment to protect the new joint.
Why the other options are incorrect:
A. Have the client reposition himself independently — Immediately after surgery, the client requires guidance and assistance with repositioning to ensure proper alignment and avoid movements that could dislocate the prosthesis.
B. Keep the hip flexed by placing pillows under the client's knee — Excessive hip flexion is a risk factor for posterior dislocation and should be avoided, particularly flexion beyond 90 degrees.
C. Keep the affected leg in a position of adduction — Adduction, particularly combined with internal rotation, significantly increases the risk of hip dislocation and should be avoided; an abduction pillow is used instead.
A 40-year-old male is brought to the ED by paramedics from a house fire with full-thickness burns on his chest and arms and is approximately 42% burned with 2nd and 3rd-degree burns. The client has also suffered smoke inhalation. What is the team's priority in the care of a client who has been burned and suffered smoke inhalation?
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Place a large endotracheal tube and visualize the airway.
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Place 2 large bore IV catheters for burn resuscitation.
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Get a carboxyhemoglobin level and prepare for B12 infusion.
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Place a Foley catheter and measure the initial urinary output.
Explanation
Following the ABC (airway, breathing, circulation) priority framework, airway management is always the first priority, particularly critical in a client with suspected smoke inhalation, who is at high risk for rapid airway edema and obstruction due to thermal and chemical injury to the respiratory tract. Early intubation and airway visualization are essential before airway swelling progresses to the point where intubation becomes difficult or impossible.
Why the other options are incorrect:
B. Place 2 large bore IV catheters for burn resuscitation — While fluid resuscitation is a critical component of burn care, it follows airway management in the priority sequence, as securing the airway takes precedence over circulation interventions.
C. Get a carboxyhemoglobin level and prepare for B12 infusion — While assessing for carbon monoxide poisoning is important in smoke inhalation, and hydroxocobalamin (a B12 derivative) may be used for cyanide toxicity, these diagnostic and treatment steps come after securing the airway, not before.
D. Place a Foley catheter and measure the initial urinary output — Monitoring urinary output is important for assessing fluid resuscitation adequacy, but it is a lower priority than establishing and securing the airway in this acute emergency.
When thinking about distributive shock, which of the following statements is the most true?
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The patient has an effective pump, a decreased volume, and undilated vessels.
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The patient has an ineffective pump, adequate volume, and undilated vessels.
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The patient has an effective pump, adequate volume, and over-dilated vessels.
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The patient has an effective pump, adequate volume, and normal vessels.
Explanation
Distributive shock, which includes septic, anaphylactic, and neurogenic shock, is characterized by massive vasodilation causing a relative hypovolemia despite adequate actual blood volume, while cardiac pump function itself typically remains effective. The primary problem lies in the abnormal distribution of blood flow due to widespread vessel dilation, resulting in inadequate tissue perfusion despite normal cardiac function and blood volume.
Why the other options are incorrect:
A. The patient has an effective pump, a decreased volume, and undilated vessels — This describes hypovolemic shock, where the primary problem is an actual loss of blood volume, not the vasodilation seen in distributive shock.
B. The patient has an ineffective pump, adequate volume, and undilated vessels — This describes cardiogenic shock, where the heart's pumping ability is impaired, rather than the vascular dilation characteristic of distributive shock.
D. The patient has an effective pump, adequate volume, and normal vessels — This does not describe a shock state at all, as distributive shock is specifically defined by abnormal, over-dilated vasculature, not normal vessel tone.
Correct Answer Is:
C
A patient is receiving an IV infusion containing 80,000 units of heparin in 1,250 mL D5W. The health care provider orders the infusion to run at 18 units/kg/hour. The patient weighs 92 kg. At what rate (mL/hr) should the IV pump be programmed?
Explanation
First, calculate the required hourly dose: 18 units/kg/hr × 92 kg = 1,656 units/hr. Next, determine the concentration of the solution: 80,000 units ÷ 1,250 mL = 64 units/mL. Finally, calculate the infusion rate: 1,656 units/hr ÷ 64 units/mL = 25.9 mL/hr.
Correct Answer Is:
25.9 mL/hr
A client with a fractured femur experiences sudden dyspnea, tachypnea, and tachycardia. An arterial blood gas reveals the following: pH, 7.45; PaCO2, 35 mm/Hg; PaO2, 58 mm/Hg; HCO3, 23 mEq/L. The nurse interprets that the client has probably experienced a fat embolus based on which parameter?
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PaCO2
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HCO3
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PaO2
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pH
Explanation
A hallmark feature of fat embolism syndrome is significant hypoxemia, reflected here by a PaO2 of 58 mm/Hg, which is well below the normal range. This profound hypoxemia occurs because fat globules obstruct pulmonary capillaries and trigger an inflammatory response, impairing gas exchange, and is a key diagnostic clue in the clinical picture of fat embolism following a long bone fracture.
Why the other options are incorrect:
A. PaCO2 — This value of 35 mm/Hg is within normal limits and reflects mild hyperventilation from tachypnea, but is not the defining parameter for fat embolism.
B. HCO3 — This value of 23 mEq/L is within the normal range, indicating no significant metabolic derangement, and is not specific to fat embolism.
D. pH — This value of 7.45 is within normal limits, reflecting compensated respiratory status, and does not specifically point to fat embolism the way the profound hypoxemia does.
What is the primary purpose for administering albumin to liver failure patients in stage four liver failure?
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To improve intravascular volume, increasing oncotic pressures
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To reduce unconjugated bilirubin levels, decreasing jaundice
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To reduce confusion by binding nitrogen, lowering ammonia levels
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To improve coagulation times, decreasing prothrombin times
Explanation
Correct Answer:
A
In advanced liver failure, the liver's decreased ability to synthesize albumin leads to low serum albumin levels, resulting in decreased colloidal oncotic pressure and fluid shifting out of the vascular space into the interstitial and peritoneal spaces (contributing to ascites). Administering albumin helps restore oncotic pressure, pulling fluid back into the intravascular space and improving overall intravascular volume and hemodynamic stability.
Why the other options are incorrect:
B. To reduce unconjugated bilirubin levels, decreasing jaundice — Albumin administration does not directly target bilirubin metabolism or reduce jaundice; this is unrelated to its primary therapeutic purpose in liver failure.
C. To reduce confusion by binding nitrogen, lowering ammonia levels — Ammonia reduction in hepatic encephalopathy is managed through medications like lactulose, not albumin, which does not have a primary role in nitrogen binding or ammonia clearance.
D. To improve coagulation times, decreasing prothrombin times — Coagulation factor deficiencies in liver failure are typically addressed with fresh frozen plasma or vitamin K, not albumin, which does not directly affect clotting factor synthesis or prothrombin time.
Vital signs: Temperature 38.5°C (101.3°F), Heart rate 92 bpm, Blood pressure 138/82 mmHg
Laboratory results show: WBC 14,000/mm³ (normal: 4,000-11,000/mm³), ESR 65 mm/hr (normal: men 0-15 mm/hr, women 0-20 mm/hr), CRP 12 mg/dL (normal: <1.0 mg/dL or <10 mg/L), X-ray reveals periosteal elevation and soft tissue swelling.
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Diabetic neuropathy
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Septic Arthritis
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Gout
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Cellulitis
Explanation
This client's presentation, joint pain, swelling, erythema, fever, and markedly elevated inflammatory markers (WBC, ESR, and CRP) along with imaging changes involving the joint area, is most consistent with septic arthritis, particularly concerning in a client with poorly controlled diabetes, which increases susceptibility to infection. The significantly elevated ESR and CRP reflect a robust inflammatory response typical of a joint infection requiring prompt diagnosis and treatment to prevent joint destruction.
Why the other options are incorrect:
A. Diabetic neuropathy — This condition typically presents with numbness, tingling, or burning pain due to nerve damage, not the fever, swelling, erythema, and markedly elevated inflammatory markers seen in this client.
C. Gout — While gout can cause joint pain, swelling, and redness, it is not typically accompanied by such significantly elevated ESR and CRP levels or fever to this degree, and the clinical picture here points more strongly toward an infectious process.
D. Cellulitis — This is a skin and soft tissue infection that would not typically explain the joint-focused symptoms and the degree of systemic inflammatory response reflected in these significantly elevated laboratory values.
Correct Answer Is:
(B) Septic Arthritis
Vital Signs:
- 1100 — Heart Rate: 120 beats/min, Respiratory Rate: 24 breaths/min, Blood Pressure: 120/70 mmHg (MAP 86)
- 1115 — Heart Rate: 130 beats/min, Respiratory Rate: 26 breaths/min, Blood Pressure: 115/70 mmHg (MAP 85)
- 1130 — Heart Rate: 150 beats/min, Respiratory Rate: 28 breaths/min, Blood Pressure: 90/68 mmHg (MAP 72)
- 1145 — Heart Rate: 151 beats/min, Respiratory Rate: 28 breaths/min, Blood Pressure: 80/50 mmHg (MAP 60)
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Irreversible stage
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Compensatory stage
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Initial stage
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Progressive stage
Explanation
This client's trending vital signs show a significant, sustained decline in blood pressure (MAP dropping from 86 to 60) along with worsening tachycardia and tachypnea, indicating that the body's compensatory mechanisms are failing to maintain adequate perfusion. This pattern, in a client with an underlying cardiac event (elevated troponin, chest pain), reflects progression beyond compensatory shock into the progressive stage, where declining organ perfusion becomes clinically evident and requires urgent intervention to prevent further deterioration.
Why the other options are incorrect:
A. Irreversible stage — This final stage is characterized by profound, unresponsive hypotension and multi-organ failure that does not respond to treatment; this client's presentation, while worsening, does not yet reflect this terminal stage.
B. Compensatory stage — During this earlier stage, blood pressure typically remains within normal limits as the body's compensatory mechanisms (tachycardia, vasoconstriction) successfully maintain perfusion; this client's significantly dropping blood pressure indicates progression beyond this stage.
C. Initial stage — This earliest stage involves subtle cellular changes without significant vital sign abnormalities; this client's marked, progressive changes in heart rate, respiratory rate, and blood pressure clearly indicate advancement beyond the initial stage.
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