Page 473 - Critical Care Nursing Demystified

458 CRITICAL CARE NURSING DeMYSTIFIED

2. D. The patient with massive transfusion is prone to lactic acidosis, which is a form of
metabolic acidosis indicated with a pH that is low (acidosis) and an HCO that is low
3
(metabolic acidosis). Hyperkalemia, hypocalcemia, and low platelets can occur as well.
These values indicate hypokalemia, hypercalcemia, and normal platelets.
3. D. Class III hemorrhage consists of 30%–40% of blood loss, a heart rate greater than
120, tachypnea, mental status changes, and a drop of 20 mm Hg in the MAP.
4. A. Insertion of a nasogastric tube could possibly perforate the sinuses and wind up in
the brain in a patient with severe facial fractures.
5. B. This patient is hemorrhaging and the left lung can fill up with blood from an unex-
pected bleed in the chest. Clamp the chest tube to prevent massive hemorrhage, notify
the physician, and prepare the patient for an exploratory thoracostomy.
6. C. The pressure from a tension pneumothorax pushes the trachea away from the
affected side. Since this is a right tension pneumothorax, the trachea is deviated to the
left and the left side has diminished or absent breath sounds.
7. B. Thermal burns are caused most frequently by residential fires and involve tissue
destruction from heat applied to the skin layers. Radiation and chemical burns are
most frequent in commercial or industrial accidents. Electrical burns involve lightning
or exposure to electricity in household incidents.
8. C. According to the Rule of Nines, each leg is 9% of the BSA, so both anterior/posterior
portions would be 9% + 9% or 18%.
9. C. The fluid to give according to the Rule of Nines would be calculated as 165 divided Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
by 2.2 = 75 kg.

75 kg × 70 (BSA burned) × 4 (mL ordered) = 10,500 mL
10. D. In an SCI, the level of injury, especially with an axial loading injury, can compromise
the innervation of the cord to the diaphragm, which controls breathing patterns. The
patient may die from hypoventilation, so keen observation and early intubation may
be necessary to support this patient.

Chapter 7

1. C, D, and F. Dental work can cause additional physical stressors, so the patient’s phy-
sician needs to know about the dental work so that steroid therapy dosages can be
adjusted as needed. Fatigue, weakness, and dizziness are signs of inadequate steroid
therapy and the physician should be notified. A Medic Alert bracelet is essential to
communicate the patient’s history of Addison’s disease. A 10-day treatment of ste-
roids is not adequate for people with Addison’s disease. Instead, steroid treatment
is done over a lifetime, because someone with Addison’s does not produce enough
steroids. Daily weights should be assessed to monitor changes in fluid balance, not
caloric intake. The flu is another physical stressor that may require steroid adjustment
and the physician should be notified if the patient has the flu.
2. D. Pituitary hormone functions of secretion and inhibition are regulated by the hypo-
thalamus.