Chapter 37 High Acuity Nursing 6th Edition by Kathleen Dorman Wagner

Chapter 37 High Acuity Nursing 6th Edition by Kathleen Dorman Wagner

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

Question 1

Type: MCSA

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

Correct Answer: 3

Rationale 1: The wound infection was not contained because of the release of cortisol by the adrenal glands.

Rationale 2: The hypothalamus does not activate white blood cells.

Rationale 3: Mediators, bioactive substances that stimulate physiologic changes in cells, are released from endothelial cells. It is these mediators that control inflammation, activate coagulation, deposit fibrin, and inhibit fibrinolysis to contain the inflammatory activity to the site of the infection.

Rationale 4: Permeability of the vessel walls is increased in order to contain infection.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 37-1

 

Question 2

Type: MCSA

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.”[1]
4. “Developing an infection depends on many factors, even things like age and gender.”

Correct Answer: 4

Rationale 1: The nurse has no way of knowing if there was a way to prevent this patient’s infection.

Rationale 2: The nurse can offer some explanation about the development of infection instead of referring the patient to the surgeon.

Rationale 3: Commenting about being in the hospital instead of home when the infection developed does not address the patient’s concerns.

Rationale 4: How endothelial cells respond to alterations in the environment differ, according to the host genetics, age, gender, nature of the pathogen, and location of the vascular bed. The nurse should explain to the patient that the development of a wound infection depends upon these variables.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 37-1

 

Question 3

Type: MCSA

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

Correct Answer: 1

Rationale 1: Systemic inflammatory response syndrome is correct because the clinical manifestations include a respiratory rate of greater than 20 breaths per minute and a white blood cell count below 4,000/mm³. These findings meet the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference criteria of sepsis.

Rationale 2: Homeostasis is incorrect because the clinical manifestations are not compatible with the state of equilibrium found in homeostasis.

Rationale 3: Localized inflammation may exist and contribute to the patient’s condition, but is not the specific problem of concern.

Rationale 4: There is no indication of the failure of organ systems.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 37-2

Wagner, High Acuity Nursing, 6/E Test Bank

Wagner, High Acuity Nursing, 6/E Test Bank