A nurse is assisting in providing care for a client who has multiple organ dysfunction syndrome (MODS). Which of the following actions is the priority when planning care for this client?

Discussing the client's resting times with the family

Ensuring that the client and their family are kept informed about the client's care

Being aware of the client's wishes regarding care

Scheduling periods of rest for the client

Answer and Explanation

The Correct Answer is C

A. Discussing rest times with the family is important but is not the priority in managing MODS.

B. Keeping the client and family informed is crucial, but the priority is to understand and respect the client's wishes regarding their care.

C. In a client with MODS, understanding and respecting the client’s wishes, particularly regarding end-of-life care, is the priority. This ensures that care aligns with the client’s values and goals.

D. Scheduling rest is essential for managing fatigue and conserving energy but does not take precedence over respecting the client's care preferences.

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Correct Answer is C

Explanation

A. DIC is not a genetic disorder, nor is it related to vitamin K deficiency. It is a complex condition involving widespread activation of the clotting cascade.

B. DIC typically results in a decreased platelet count due to the consumption of platelets during excessive clotting.

C. DIC is caused by abnormal coagulation involving the excessive conversion of fibrinogen to fibrin, leading to widespread clot formation and bleeding.

D. Lifelong heparin usage is not a standard treatment for DIC. Management usually focuses on treating the underlying cause and providing supportive care.

A. Background B. Recommendation C. Situation D. Assessment

Correct Answer is A

Explanation

A. The Background section of the SBAR communication tool is where relevant medical history, including a family history of malignant hyperthermia, should be included. This information is critical for the surgical team to be aware of before administering anesthesia.

B. The Recommendation section is for suggesting specific actions or interventions based on the current situation and background.

C. The Situation section describes the immediate issue or reason for the handoff, not past medical history.

D. The Assessment section includes the nurse's evaluation of the client’s current condition, not family history.

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A nurse is assisting in providing care for a client who has multiple organ dysfunction syndrome (MODS). Which of the following actions is the priority when planning care for this client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assisting with the care of a client who has septic shock and is at risk for disseminated intravascular coagulation (DIC). Which of the following nursing statements indicates an understanding of the condition?

Correct Answer is C

Explanation

A nurse is reviewing the client's medical record and notices a family history of malignant hyperthermia. In which of the following sections of the SBAR communication tool should the nurse include this information when completing handoff to the surgical team?

Correct Answer is A

Explanation

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