PN3 Exam 3
1. As the numbers of infectious organisms enter the bloodstream and cause widespread
inflammation as a result of the infection escaping local control is termed:
- Systemic inflammatory response syndrome (SIRS)
2. A nurse is caring for a client with suspected sepsis. Which of the following clinical
manifestations support a diagnosis of sepsis? (SATA)
- Temperature of more than 101F (38.3C) or less than 96.5F (36C)
Heart rate of more than 90 beats per minute
Elevated lactic acid (lactate) levels
Abnormal WBC count with >10% bands
3. The nurse is caring for a client in the hospital for chemotherapy. The nurse identifies the
following risk factors that place them at a higher risk for shock. For what factors would
the nurse assess? (SATA)
- Altered mobility/immobility
Dehydration
Diminished immune response
4. The nurse is planning care for a client diagnosed with disseminated intravascular
coagulation (DIC) following severe burns. Which of the following should be included in
this plan of care?
- Avoid intramuscular injections
5. The nurse is caring for a client with suspected severe sepsis. Identify the top nursing
interventions for a client with severe sepsis? (SATA)
- Administer antibiotics
, Draw serum lactate levels Infuse vasopressors (within 6hrs)
Obtain blood cultures
6. Expected treatment for disseminated intravascular coagulation (DIC) includes which one
of the following medications?
- Fresh frozen plasma
7. A nurse is caring for several clients at risk for shock. Which laboratory value requires the
nurse to communicate with the health care provider?
- Lactate: 54 mg/dL (6 mmol/L)
8. A student is caring for a client in hypovolemic shock. Identify the accurate description of
the correct blood loss with the client mean arterial pressure (MAP):
- Lower blood volume lowers MAP
9. What medication would you administer first to a client in an anaphylactic shock?
- Epinephrine
10. A nurse is caring for a client who has hypovolemic shock. Which of the following should
the nurse recognize as an expected finding?
- Oliguria
11. A client is experiencing symptoms of distributive shock. What types of shock are
included in this category? (SATA)
- Neurogenic
Anaphylactic
Septic
1. As the numbers of infectious organisms enter the bloodstream and cause widespread
inflammation as a result of the infection escaping local control is termed:
- Systemic inflammatory response syndrome (SIRS)
2. A nurse is caring for a client with suspected sepsis. Which of the following clinical
manifestations support a diagnosis of sepsis? (SATA)
- Temperature of more than 101F (38.3C) or less than 96.5F (36C)
Heart rate of more than 90 beats per minute
Elevated lactic acid (lactate) levels
Abnormal WBC count with >10% bands
3. The nurse is caring for a client in the hospital for chemotherapy. The nurse identifies the
following risk factors that place them at a higher risk for shock. For what factors would
the nurse assess? (SATA)
- Altered mobility/immobility
Dehydration
Diminished immune response
4. The nurse is planning care for a client diagnosed with disseminated intravascular
coagulation (DIC) following severe burns. Which of the following should be included in
this plan of care?
- Avoid intramuscular injections
5. The nurse is caring for a client with suspected severe sepsis. Identify the top nursing
interventions for a client with severe sepsis? (SATA)
- Administer antibiotics
, Draw serum lactate levels Infuse vasopressors (within 6hrs)
Obtain blood cultures
6. Expected treatment for disseminated intravascular coagulation (DIC) includes which one
of the following medications?
- Fresh frozen plasma
7. A nurse is caring for several clients at risk for shock. Which laboratory value requires the
nurse to communicate with the health care provider?
- Lactate: 54 mg/dL (6 mmol/L)
8. A student is caring for a client in hypovolemic shock. Identify the accurate description of
the correct blood loss with the client mean arterial pressure (MAP):
- Lower blood volume lowers MAP
9. What medication would you administer first to a client in an anaphylactic shock?
- Epinephrine
10. A nurse is caring for a client who has hypovolemic shock. Which of the following should
the nurse recognize as an expected finding?
- Oliguria
11. A client is experiencing symptoms of distributive shock. What types of shock are
included in this category? (SATA)
- Neurogenic
Anaphylactic
Septic
