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The initial bundle of care in sepsis includes which of the following? (Select all that apply.)

Administer anti-hypertensives

Obtain blood cultures

Administer broad spectrum antibiotics

Obtain lactate levels

Administer IV fluid bolus

Answer and Explanation

Correct Answer : B,C,D,E

The initial bundle of care in sepsis includes the following:

Obtain blood cultures: Blood cultures help identify the specific microorganism causing the infection, which is important for guiding appropriate antibiotic therapy.
Administer broad-spectrum antibiotics: Early administration of antibiotics is crucial in sepsis to target the suspected or likely infectious organisms. Broad-spectrum antibiotics cover a wide range of potential pathogens until more specific information from culture results is available.
Obtain lactate levels: Measuring lactate levels helps assess tissue perfusion and can be used as an indicator of the severity of sepsis. Elevated lactate levels are associated with tissue hypoperfusion and increased mortality.
Administer IV fluid bolus: Early aggressive fluid resuscitation is an essential component of sepsis management. Administering intravenous fluids helps restore intravascular volume and improve tissue perfusion.
Administration of vasopressors: Especially in the setting of hypotension and to maintain MAP above 65mmHg.

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Correct Answer is D

Explanation

Cholelithiasis refers to the presence of gallstones in the gallbladder or bile ducts. The most common symptom is right upper quadrant abdominal pain, which may be colicky or steady. Nausea and vomiting are also commonly associated with cholelithiasis.

Coffee ground emesis and constipation are not typical findings associated with cholelithiasis. Absent bowel sounds may be a sign of bowel obstruction but are not specific to cholelithiasis.

A. I can use a cool air dryer to help circulate air to relieve the itch. B. I can use a hot air dryer to help circulate air to relieve the itch. C. "I can use a damp towel to trickle water into the cast to relieve the Itch." D. "I can use a plastic hanger to slide into the cast to relieve the Itch."

Correct Answer is A

Explanation

This statement demonstrates an understanding of proper cast care for itch relief. Using a cool air dryer on a low setting can help circulate air and provide relief from itching under the cast. It is important not to use a hot air dryer as it may cause discomfort, skin irritation, or burn. Trickling water or inserting objects into the cast can lead to moisture accumulation and potential complications.

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The initial bundle of care in sepsis includes which of the following? (Select all that apply.)

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Naxlex Comprehensive Predictor Exams

Which assessment findings will the nurse anticipate in the client with cholelithiasis?

Correct Answer is D

Explanation

A 5-year-old with an arm cast from a fractured wrist complains of itching under his cast. The nurse knows cast care teaching for the parent has been successful when the parent states:

Correct Answer is A

Explanation

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