A nurse is assisting in explaining the pathophysiology of systemic inflammatory response syndrome (SIRS) to a group of newly licensed nurses. Which of the following statements by the nurse is accurate?

"Activation of the inflammatory cascade causes increased perfusion."

The major organ prone to injury during SIRS is the heart."

Spleen dysfunction causes blood clotting issues."

"A deregulated cytokine storm causes an inflammatory response."

Answer and Explanation

The Correct Answer is D

A. Activation of the inflammatory cascade in SIRS typically leads to decreased perfusion and tissue damage due to widespread inflammation and capillary leakage.

B. SIRS can affect multiple organs, but it is particularly known for impacting the lungs and kidneys rather than the heart.

C. While SIRS can involve coagulation issues, these are not specifically due to spleen dysfunction but rather to the widespread inflammatory response.

D. SIRS is driven by a deregulated cytokine storm, which leads to an excessive and uncontrolled inflammatory response, potentially resulting in multiple organ failure.

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Correct Answer is B

Explanation

A. It is not appropriate to provide reassurances that may be unrealistic; rather, the focus should be on providing accurate information.

B. Tailoring the information to the client’s level of understanding ensures that the client is well-informed and can participate in decision-making, which can reduce anxiety and improve outcomes.

C. Notifying the family is important but not the primary action related to preoperative teaching.

D. Describing the surgery is typically the surgeon's role, but the nurse can reinforce postoperative expectations as part of preoperative teaching.

A. Hepatotoxicity B. GI bleeding C. Mental confusion D. Tinnitus

Correct Answer is A

Explanation

A. Hepatotoxicity is not a primary sign of salicylate toxicity; salicylate toxicity is more commonly associated with gastrointestinal issues, mental confusion, and tinnitus.

B. GI bleeding is a common sign of salicylate toxicity due to its effect on the gastrointestinal lining.

C. Mental confusion can occur as a result of salicylate toxicity affecting the central nervous system.

D. Tinnitus is a classic symptom of salicylate toxicity.

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A nurse is assisting in explaining the pathophysiology of systemic inflammatory response syndrome (SIRS) to a group of newly licensed nurses. Which of the following statements by the nurse is accurate?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has just learned he will need exploratory surgery the next day. As the nurse contributes to the preoperative teaching plan, which of the following actions should she take?

Correct Answer is B

Explanation

Signs of Salicylate toxicity include all of the following except:

Correct Answer is A

Explanation

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A nurse is reinforcing teaching with a client about the use of transcutaneous electrical nerve stimulation (TENS) to manage chronic pain. Which of the following statements by the client indicates the need for further teaching?

A nurse is assisting in explaining the pathophysiology of systemic inflammatory response syndrome (SIRS) to a group of newly licensed nurses. Which of the following statements by the nurse is accurate?

A nurse is assisting with preoperative teaching for a client. Which of the following outcomes should the nurse expect?