Author Question: The nurse is preparing an educational session on sepsis. Which should the nurse include as a major ... (Read 109 times)

xroflmao · **on:** Jun 25, 2018

The nurse is preparing an educational session on sepsis. Which should the nurse include as a major risk factor for the development of this health problem?

A) Pneumococcal bacteria
B) Leukocytosis on the complete blood count
C) Undiagnosed urinary tract infection
D) Elevated temperature

Question 2

The nurse identifies the diagnosis of Ineffective Peripheral Tissue Perfusion as being appropriate for a client with septicemia. Which intervention will address this client's health problem?

A) Monitor heart rate every hour.
B) Assess temperature every 4 hours.
C) Monitor pupil reactions every 8 hours.
D) Monitor for cyanosis.

mrphibs · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

Answer: C

Sepsis is an entire-body inflammatory process. Sepsis is most often the result of gram-positive infections from Staphylococcus and Streptococcus bacteria but may also follow gram-negative bacterial infections such as Pseudomonas, Escherichia coli, and Klebsiella. A portal of entry for sepsis is the urinary system. Leukocytosis occurs with sepsis if the client is able to mount an immune response. An elevated temperature is a manifestation of sepsis.

Answer to Question 2

Answer: D

Assessing temperature and monitoring heart rate and pupil reaction are important when assessing a client with septicemia, but a change in skin color will alert the nurse immediately of decreased tissue perfusion.