Ch. 69 Shock Flashcards
A patient is treated in the emergency department for shock following an automobile accident. The nurse knows that shock is a clinical syndrome in which cellular dysfunction and organ failure occur primarily as a result of which of the following conditions? a. Hypotension b. Loss of blood c. Severe infection d. Impaired tissue perfusion
ANS: D
Shock is a syndrome characterized by decreased tissue perfusion and impaired cellular metabolism, resulting in an imbalance between the supply of and demand for oxygen and nutrients.
Which hemodynamic results would the nurse anticipate in a patient who is in cardiogenic shock? a. Increased heart rate (HR), blood pressure (BP), and cardiac output (CO) b. Increased HR, decreased BP and CO c. Decreased HR, BP, and CO d. Decreased HR, increased BP and CO
ANS: B
A patient in cardiogenic shock would have an increased HR and a decreased BP and CO.
A patient with hypovolemic shock has a urinary output of 15 mL/hour. What does the nurse understand is the compensatory physiological mechanism that leads to altered urinary output?
a.
Release of aldosterone, which increases serum osmolarity, causing release of antidiuretic hormone (ADH)
b.
Movement of interstitial fluid to the intravascular space, increasing renal blood flow
c.
Activation of the sympathetic nervous system, causing vasodilation of the renal arteries
d.
-Adrenergic receptor stimulation that causes increased CO as a result of increased HR and myocardial contractility
ANS: A
The release of aldosterone and ADH leads to the decrease in urinary output by increasing the reabsorption of sodium and water in the renal tubules.
While caring for a seriously ill patient, the nurse determines that the patient may be in the compensatory stage of shock on observing which of the following findings?
a.
Cold, mottled extremities
b.
Restlessness and apprehension
c.
An HR of 120 beats/min and cool, clammy skin
d.
A systolic BP less than 90 mm Hg and a widening pulse pressure
ANS: B
Restlessness and apprehension are typical during the compensatory stage of shock.
A patient has been admitted with a spinal cord injury. The nurse anticipates neurogenic shock with a spinal cord injury at which level of the spine? a. T4 b. T6 c. T8 d. L2
ANS: A
Neurogenic shock can occur with a spinal cord injury at the level of T5 or above.
The nurse determines that the patient in shock has progressed beyond the compensated stage when laboratory tests reveal which of the following results? a. Increased blood glucose levels b. Increased serum sodium levels c. Decreased serum calcium levels d. Increased serum potassium levels
ANS: D
Decreased potassium is found in early shock because of increased secretion of aldosterone, causing renal excretion of potassium; however, when the patient’s shock progresses beyond the compensated stage, the potassium increases because cellular death liberates intracellular potassium.
A patient with massive trauma and possible spinal cord injury is admitted to the emergency department. The nurse suspects that the patient may be experiencing neurogenic shock in addition to hypovolemic shock based on which of the following findings? a. Bradycardia b. Hypotension c. Cool, clammy skin d. A subnormal body temperature
ANS: A
The normal sympathetic response to shock and hypotension is an increase in HR. The presence of bradycardia suggests unopposed parasympathetic function, as occurs in neurogenic shock.
When caring for a patient in shock, the nurse notifies the physician of the patient’s deteriorating status when the patient’s arterial blood gas results include which of the following findings? a. pH 7.48, partial pressure of arterial carbon dioxide (PaCO2) 33 mm Hg b. pH 7.33, PaCO2 30 mm Hg c. pH 7.50, PaCO2 50 mm Hg d. pH 7.38, PaCO2 45 mm Hg
ANS: B
The patient’s low pH despite a respiratory alkalosis indicates that the patient has severe metabolic acidosis and is experiencing the progressive stage of shock. Rapid changes in therapy are needed.
During the initial management of any patient in shock, the nurse knows that which of the following is an appropriate intervention? a. Fluid resuscitation b. Administration of vasopressors c. Administration of inotropic agents d. Administration of high-flow oxygen
ANS: C
An inotropic agent (e.g., dobutamine [Dobutrex]) is often added to offset the decrease in stroke volume.
A patient in septic shock has not responded to fluid resuscitation, as evidenced by a decreasing BP and CO. The nurse anticipates the administration of which of the following medications? a. Nitroglycerine (Tridil) b. Dobutamine c. Norepinephrine (Levophed) d. Sodium nitroprusside (Nipride)
ANS: B
When fluid resuscitation is unsuccessful, administration of vasopressor drugs is used to increase the systemic vascular resistance and improve tissue perfusion.
Which of the following nursing interventions prevents the development of shock?
a.
Routine checking of stools for occult blood
b.
Keeping patients warm to prevent chilling or shivering
c.
Identifying situations in which patients are at risk for shock
d.
Frequent monitoring of patient status to detect compensatory changes
ANS: C
To prevent shock, the nurse needs to identify patients at risk. In general, patients who are older, those with debilitating illnesses, and those who are immunocompromised are at an increased risk. Any person who sustains surgical or accidental trauma is at high risk for shock resulting from hemorrhage, spinal cord injury, and other conditions. Any patient who is at risk for decreased oxygen delivery or tissue hypoxia is also at risk for the development of shock.
A patient stung by a bee develops severe respiratory distress and is in anaphylactic shock. Which medication will the nurse prepare to administer immediately? a. Epinephrine (Adrenalin) b. Crystalloid fluids c. Dexamethasone (Decadron) d. Diphenhydramine (Benadryl)
ANS: A
Epinephrine is the medication of choice to treat anaphylactic shock.
Which type of shock does the nurse suspect with a patient who is short of breath and has wheezes, rhinitis, and stridor? a. Cardiogenic shock b. Neurogenic shock c. Anaphylactic shock d. Septic shock
ANS: C
A patient in anaphylactic shock exhibits shortness of breath, wheezes, rhinitis, and stridor, and often has swelling of the lips and tongue.
A patient with multiple traumas is brought to the emergency department. The nurse initiates two peripheral intravenous (IV) sites and begins fluid resuscitation with which of the following fluids? a. Dextran b. 0.9% saline c. 3.0% saline d. Dextrose 5% in water in one-half normal saline
ANS: B
Fluid resuscitation is accomplished by using normal saline, that is, 0.9% saline.
The nurse evaluates that fluid resuscitation for a patient in shock is effective on observing which of the following findings? a. Urinary output is 1 mL/kg/hour. b. Pulse pressure becomes narrower. c. Pulmonary artery occlusive pressure decreases. d. BP is within the patient’s normal range.
ANS: A
A urinary output of at least 0.5 mL/kg/hour indicates adequate renal perfusion, which is a good indicator of CO.