RLE FIN

Question 1

When the cell presents with the same concentration on the inside and outside with no shifting of fluids this is called?
A. Hypotonic
B. Hypertonic
C. Isotonic
D. Osmosis

Answer 1

C. Isotonic

Question 2

Which of the following is not a hypertonic fluid?
A. 3% Saline
B. D5W
C. 10% Dextrose in Water (D10W)
D. 5% Dextrose in Lactated Ringer’s

Answer 2

B. D5W

Question 3

What type of fluid would a patient with severe hyponatremia most likely be started on?
A. Hypotonic
B. Hypertonic
C. Isotonic
D. Colloid

Answer 3

B. Hypertonic

Question 4

When administering a hypertonic solution the nurse should closely watch for?
A. Signs of dehydration
B. Pulmonary Edema
C. Fluid volume deficient
D. Increased Lactate level

Answer 4

B: Pulmonary Edema

Question 5

A patient with cerebral edema would most likely be order what type of solution?
A. 3% Saline
B. 0.9% Normal Saline
C. Lactated Ringer’s
D. 0.225% Normal Saline

Answer 5

A. 3% Saline

Question 6

solutions cause cell dehydration and help increase fluid in the extracellular space.
A. Hypotonic
B. Osmosis
C. Isotonic
D. Hypertonic

Answer 6

D. Hypertonic

Question 7

D5W solutions are sometimes considered a hypotonic solution as well as an isotonic solution because after the body metabolizes the dextrose the solution acts as a hypotonic solution.
True
False

Answer 7

True

Question 8

Which solution below is NOT a hypertonic solution?
A. 5% Dextrose in 0.9% Saline
B. 5% Saline
C. 5% Dextrose in Lactated Ringer’s
D. 0.33% saline (1/3 NS)

Answer 8

D. 0.33% saline (1/3 NS)

Question 9

Which patient below would NOT be a candidate for a hypotonic solution?
A. Patient with increased intracranial pressure
B. Patient with Diabetic Ketoacidosis
C. Patient experiencing Hyperosmolar Hyperglycemia
D. All of the options are correct

Answer 9

A. Patient with increased intracranial pressure

Question 10

Which condition below could lead to cell lysis, if not properly monitored?
A. Isotonicity
B. Hypertonicity
C. Hypotonicity
D. None of the options are correct

Answer 10

C. Hypotonicity

Question 11

fluids remove water from the extracellular space into the intracellular space.
A. Hypotonic
B. Hypertonic
C. Isotonic
D. Colloids

Answer 11

A. Hypotonic

Question 12

Isotonic fluids cause shifting of water from the extracellular space to the intracellular space.
True
False

Answer 12

False

Question 13

A patient is being admitted with dehydration due to nausea and vomiting. Which fluid would you expect the patient to be started on?
A. 5% Dextrose in 0.9% Saline
B. 0.33% saline
C. 0.225% saline
D. 0.9% Normal Saline

Answer 13

D. 0.9% Normal Salin

Question 14

The doctor orders an isotonic fluid for a patient. Which of the following is not an isotonic fluid?
A. 0.9% Normal Saline
B. Lactated Ringer’s
C. 0.45% Saline
D. 5% Dextrose in 0.225% saline

Answer 14

C. 0.45% Saline

Question 15

Which of the following is not a hypertonic fluid?

3% Saline
10% Dextrose in Water (D10W)
Lactated Ringer’s

Answer 15

Lactated Ringer’s

Question 16

What type of fluid would a patient with severe hyponatremia most likely be started on?
Hypotonic
Hypertonic
Isotonic
Colloid

Answer 16

Isotonic

Question 17

Septic shock causes system wide vasodilation which leads to an increase in systemic vascular resistance. In addition, septic shock causes increased capillary permeability and clot formation in the microcirculation throughout the body.

True
False

Answer 17

False

Question 18

A patient is diagnosed with septic shock. As the nurse you know this is a __________ form of shock. In addition, you’re aware that __________ and _________ are also this form of shock.

A. obstructive; hypovolemic and anaphylactic

B. distributive; anaphylactic and neurogenic

C. obstructive; cardiogenic and neurogenic

D. distributive; anaphylactic and cardiogenic

Answer 18

B. distributive; anaphylactic and neurogenic

Question 19

Your patient, who is post-op from a gastrointestinal surgery, is presenting with a temperature of 103.6 ‘F, heart rate 120, blood pressure 72/42, increased white blood cell count, and respirations of 21. An IV fluid bolus is ordered STAT. Which findings below indicate that the patient is progressing to septic shock? Select all that apply:

A. Blood pressure of 70/34 after the fluid bolus

B. Serum lactate less than 2 mmol/L

C. Patient needs Norepinephrine to maintain a mean arterial pressure (MAP) greater than 65 mmHg despite fluid replacement

D. Central venous pressure (CVP) of 18

Answer 19

A,C

Question 20

You’re providing care to four patients. Select all the patients who are at risk for developing sepsis:

A. A 35-year-old female who is hospitalized with renal insufficiency and has a Foley catheter and central line in place.

B. A 55-year-old male who is a recent kidney transplant recipient.

C. A 78-year-old female with diabetes mellitus who is recovering from colon surgery.

D. A 65-year-old male recovering from right lobectomy for treatment of lung cancer.

Answer 20

ALL

Question 21

A patient with a severe infection has developed septic shock. The patient’s blood pressure is 72/44, heart rate 130, respiration 22, oxygen saturation 96% on high-flow oxygen, and temperature 103.6 ‘F. The patient’s mean arterial pressure (MAP) is 53 mmHg. Based on these findings, you know this patient is experiencing diminished tissue perfusion and needs treatment to improve tissue perfusion to prevent organ dysfunction. In regards to the pathophysiology of septic shock, what is occurring in the body that is leading to this decrease in tissue perfusion? Select all that apply:

A. Absolute hypovolemia

B. Vasodilation

C. Increased capillary permeability

D. Increased systemic vascular resistance

E. Clot formation in microcirculation

F. A significantly decreased cardiac output

Answer 21

B, C, E

Question 22

A patient is at risk for septic shock when a microorganism invades the body. Which microorganism is the MOST common cause of sepsis?

A. Fungus

B. Virus

C. Parasite

D. Bacteria

Answer 22

D. Bacteria

Question 23

A patient with a fever is lethargic and has a blood pressure of 89/56. The patient’s white blood cell count is elevated. The physician suspects the patient is developing septic shock. What other findings indicate this patient is in the “early” or “compensated” stage of septic shock? Select all that apply:

A. Urinary output of 60 mL over 4 hours

B. Warm and flushed skin

C. Tachycardia

D. Bradypnea

Answer 23

B, C

Question 24

Your patient is receiving aggressive treatment for septic shock. Which findings demonstrate treatment is NOT being successful? Select all that apply:

A. MAP (mean arterial pressure) 40 mmHg

B. Urinary output of 10 mL over 2 hours

C. Serum Lactate 15 mmol/L

D. Blood glucose 120 mg/dL

E. CVP (central venous pressure) less than 2 mmHg

Answer 24

A, B, C, E

Question 25

The physician orders a patient in septic shock to receive a large IV fluid bolus. How would the nurse know if this treatment was successful for this patient? A. The patient’s blood pressure changes from 75/48 to 110/82. B. Patient’s CVP 2 mmHg C. Patient’s skin is warm and flushed. D. Patient’s urinary output is 20 mL/hr.

Answer 25

A. The patient’s blood pressure changes from 75/48 to 110/82.

Question 26

A patient in septic shock receives large amounts of IV fluids. However, this was unsuccessful in maintaining tissue perfusion. As the nurse, you would anticipate the physician to order what NEXT? A. IV corticosteroids B. Colloids C. Dobutamine D. Norepinephrine

Answer 26

D. Norepinephrine

Question 27

Your patient, who is post-op from a kidney transplant, has developed septic shock. Which statement below best reflects the interventions you will perform for this patient? A. Administer Norepinephrine before attempting a fluid resuscitation. B. Collect cultures and then administer IV antibiotics. C. Check blood glucose levels before starting any other treatments. D. Administer Drotrecogin Alpha within 48-72 hours.

Answer 27

B. Collect cultures and then administer IV antibiotics.

Question 28

A patient in septic shock is experiencing hyperglycemia. The patient is started on an insulin drip. A blood glucose goal for this patient would be: A. <110 mg/dL B. <80 mg/dL C. >200 mg/dL D. <180 mg/dL

Answer 28

D. <180 mg/dL

Question 29

A patient is on IV Norepinephrine for treatment of septic shock. Which statement is FALSE about this medication? A. “The nurse should titrate this medication to maintain a MAP of 65 mmHg or greater.” B. “This medication causes vasodilation and decreases systemic vascular resistance.” C. “It is used when fluid replacement is not unsuccessful.” D. “It is considered a vasopressor.”

Answer 29

B. “This medication causes vasodilation and decreases systemic vascular resistance.”

Question 30

Your patient’s blood pressure is 72/56, heart rate 126, and respiration 24. The patient has a fungal infection in the lungs. The patient also has a fever, warm/flushed skin, and is restless. You notify the physician who suspects septic shock. You anticipate that the physician will order what treatment FIRST? A. Low-dose corticosteroids B. Crystalloids IV fluid bolus C. Norepinephrine D. 2 units of Packed Red Blood Cells

Answer 30

C. Norepinephrine

Question 31

Appropriate treatment modalities for the management of cardiogenic shock include (SELECT ALL THAT APPLY): A. Dobutamine to increase myocardial contractility. B. Vasopressors to increase systemic vascular resistance. C. Circulatory assist devices such as an intraaortic balloon pump. D. Corticosteroids to stabilize the cell wall in the infarcted myocardium. E. Trendelenburg positioning to facilitate venous return and increase preload

Answer 31

A, C

Question 32

Which medication below can be used within the first 24-48 hours of septic shock and provides anti-inflammatory and antithrombotic effects? A. Colloids B. Corticosteroids C. Drotrecogin alpha D. Norepinephrine

Answer 32

C. Drotrecogin alpha

Question 33

A patient is on IV Norepinephrine for treatment of septic shock. Which statement is FALSE about this medication? A. "The nurse should titrate this medication to maintain a MAP of 65 mmHg or greater." B. "This medication causes vasodilation and decreases systemic vascular resistance." C. "It is used when fluid replacement is not successful." D. "It is considered a vasopressor.

Answer 33

B. "This medication causes vasodilation and decreases systemic vascular resistance."