Chapter 18

Question 1

1. A nurse in the ICU is planning the care of a patient who is being treated for shock. Which of the following statements best describes the pathophysiology of this patients health problem?
   A) Blood is shunted from vital organs to peripheral areas of the body.
   B) Cells lack an adequate blood supply and are deprived of oxygen and nutrients.
   C) Circulating blood volume is decreased with a resulting change in the osmotic
   pressure gradient.
   D) Hemorrhage occurs as a result of trauma, depriving vital organs of adequate
   perfusion.

Answer 1

B) Cells lack an adequate blood supply and are deprived of oxygen and nutrients.

Question 2

2. In an acute care setting, the nurse is assessing an unstable patient. When prioritizing the patients care, the nurse should recognize that the patient is at risk for hypovolemic shock in which of the following circumstances?
   A) Fluid volume circulating in the blood vessels decreases.
   B) There is an uncontrolled increase in cardiac output.
   C) Blood pressure regulation becomes irregular.
   D) The patient experiences tachycardia and a bounding pulse.

Answer 2

A) Fluid volume circulating in the blood vessels decreases.

Question 3

3. The emergency nurse is admitting a patient experiencing a GI bleed who is believed to be in the compensatory stage of shock. What assessment finding would be most consistent with the early stage of compensation?
   A) Increased urine output
   B) Decreased heart rate
   C) Hyperactive bowel sounds
   D) Cool, clammy skin

Answer 3

D) Cool, clammy skin

Question 4

4. The nurse is caring for a patient who is exhibiting signs and symptoms of hypovolemic shock following injuries suffered in a motor vehicle accident. The nurse anticipates that the physician will promptly order the administration of a crystalloid IV solution to restore intravascular volume. In addition to normal saline, which crystalloid fluid is commonly used to treat hypovolemic shock?
   A) Lactated Ringers
   B) Albumin
   C) Dextran
   D) 3% NaCl

Answer 4

A) Lactated Ringers

Question 5

5. A patient who is in shock is receiving dopamine in addition to IV fluids. What principle should inform the nurses care planning during the administration of a vasoactive drug?
   A) The drug should be discontinued immediately after blood pressure increases.
   B) The drug dose should be tapered down once vital signs improve.
   C) The patient should have arterial blood gases drawn every 10 minutes during treatment.
   D) The infusion rate should be titrated according the patients subjective sensation of adequate perfusion.

Answer 5

B) The drug dose should be tapered down once vital signs improve.

Question 6

6. A nurse in the ICU receives report from the nurse in the ED about a new patient being admitted with a neck injury he received while diving into a lake. The ED nurse reports that his blood pressure is 85/54, heart rate is 53 beats per minute, and his skin is warm and dry. What does the ICU nurse recognize that that patient is probably experiencing?
   A) Anaphylactic shock
   B) Neurogenic shock
   C) Septic shock
   D) Hypovolemic shock

Answer 6

B) Neurogenic shock

Question 7

7. The intensive care nurse caring for a patient in shock is planning assessments and interventions related to the patients nutritional needs. What physiologic process contributes to these increased nutritional needs?
   A) The use of albumin as an energy source by the body because of the need for increased adenosine triphosphate (ATP)
   B) The loss of fluids due to decreased skin integrity and decreased stomach acids due to increased parasympathetic activity
   C) The release of catecholamines that creates an increase in metabolic rate and caloric requirements
   D) The increase in GI peristalsis during shock and the resulting diarrhea

Answer 7

C) The release of catecholamines that creates an increase in metabolic rate and caloric requirements

Question 8

8. The nurse is transferring a patient who is in the progressive stage of shock into ICU from the medical unit. The medical nurse is aware that shock affects many organ systems and that nursing management of the patient will focus on what intervention?
   A) Reviewing the cause of shock and prioritizing the patients psychosocial needs
   B) Assessing and understanding shock and the significant changes in assessment data to guide the plan of care
   C) Giving the prescribed treatment, but shifting focus to providing family time as the patient is unlikely to survive
   D) Promoting the patients coping skills in an effort to better deal with the physiologic changes accompanying shock

Answer 8

B) Assessing and understanding shock and the significant changes in assessment data to guide the plan of care

Question 9

9. When caring for a patient in shock, one of the major nursing goals is to reduce the risk that the patient will develop complications of shock. How can the nurse best achieve this goal?
   A) Provide a detailed diagnosis and plan of care in order to promote the patients and family coping.
   B) Keep the physician updated with the most accurate information because in cases of shock the nurse often cannot provide relevant interventions.
   C) Monitor for significant changes and evaluate patient outcomes on a scheduled basis focusing on blood pressure and skin temperature.
   D) Understand the underlying mechanisms of shock, recognize the subtle and more obvious signs, and then provide rapid assessment.

Answer 9

D) Understand the underlying mechanisms of shock, recognize the subtle and more obvious signs, and then provide rapid assessment.

Question 10

10. The nurse is caring for a patient in the ICU who has been diagnosed with multiple organ dysfunction syndrome (MODS). The nurses plan of care should include which of the following interventions?
    A) Encouraging the family to stay hopeful and educating them to the fact that, in nearly all cases, the prognosis is good
    B) Encouraging the family to leave the hospital and to take time for themselves as acute care of MODS patients may last for several months
    C) Promoting communication with the patient and family along with addressing end of-life issues
    D) Discussing organ donation on a number of different occasions to allow the family time to adjust to the idea

Answer 10

C) Promoting communication with the patient and family along with addressing end of-life issues

Question 11

11. The acute care nurse is providing care for an adult patient who is in hypovolemic shock. The nurse recognizes that antidiuretic hormone (ADH) plays a significant role in this health problem. What assessment finding will the nurse likely observe related to the role of the ADH during hypovolemic shock?
    A) Increased hunger
    B) Decreased thirst
    C) Decreased urinary output
    D) Increased capillary perfusion

Answer 11

C) Decreased urinary output

Question 12

12. The nurse is caring for a patient whose progressing infection places her at high risk for shock. What assessment finding would the nurse consider a potential sign of shock?
    A) Elevated systolic blood pressure
    B) Elevated mean arterial pressure (MAP)
    C) Shallow, rapid respirations
    D) Bradycardia

Answer 12

C) Shallow, rapid respirations

Question 13

13. You are precepting a new graduate nurse in the ICU. You are collaborating in the care of a patient who is receiving large volumes of crystalloid fluid to treat hypovolemic shock. In light of this intervention, for what sign would you teach the new nurse to monitor the patient?
    A) Hypothermia
    B) Bradycardia
    C) Coffee ground emesis
    D) Pain

Answer 13

A) Hypothermia

Question 14

14. The nurse is caring for a patient in the ICU whose condition is deteriorating. The nurse receives orders to initiate an infusion of dopamine. What would be the priority assessment and interventions specific to the administration of vasoactive medications?
    A) Frequent monitoring of vital signs, monitoring the central line site, and providing accurate drug titration
    B) Reviewing medications, performing a focused cardiovascular assessment, and providing patient education
    C) Reviewing the laboratory findings, monitoring urine output, and assessing for peripheral edema
    D) Routine monitoring of vital signs, monitoring the peripheral IV site, and providing early discharge instructions

Answer 14

A) Frequent monitoring of vital signs, monitoring the central line site, and providing accurate drug titration

Question 15

15. The nurse in the ICU is admitting a 57-year-old man with a diagnosis of possible septic shock. The nurses assessment reveals that the patient has a normal blood pressure, increased heart rate, decreased bowel sounds, and cold, clammy skin. The nurses analysis of these data should lead to what preliminary conclusion?
    A) The patient is in the compensatory stage of shock.
    B) The patient is in the progressive stage of shock.
    C) The patient will stabilize and be released by tomorrow.
    D) The patient is in the irreversible stage of shock.

Answer 15

A) The patient is in the compensatory stage of shock.

Question 16

16. The nurse, a member of the health care team in the ED, is caring for a patient who is determined to be in the irreversible stage of shock. What would be the most appropriate nursing intervention?
    A) Provide opportunities for the family to spend time with the patient, and help them to understand the irreversible stage of shock.
    B) Inform the patients family immediately that the patient will likely not survive to allow the family time to make plans and move forward.
    C) Closely monitor fluid replacement therapy, and inform the family that the patient will probably survive and return to normal life.
    D) Protect the patients airway, optimize intravascular volume, and initiate the early rehabilitation process.

Answer 16

A) Provide opportunities for the family to spend time with the patient, and help them to understand the irreversible stage of shock.

Question 17

17. The nurse in a rural nursing outpost has just been notified that she will be receiving a patient in hypovolemic shock due to a massive postpartum hemorrhage after her home birth. You know that the best choice for fluid replacement for this patient is what?
    A) 5% albumin because it is inexpensive and is always readily available
    B) Dextran because it increases intravascular volume and counteracts coagulopathy
    C) Whatever fluid is most readily available in the clinic, due to the nature of the emergency
    D) Lactated Ringers solution because it increases volume, buffers acidosis, and is the best choice for patients with liver failure

Answer 17

C) Whatever fluid is most readily available in the clinic, due to the nature of the emergency

Question 18

18. The nurse in the ICU is caring for a 47-year-old, obese male patient who is in shock following a motor vehicle accident. The nurse is aware that patients in shock possess excess energy requirements. What would be the main challenge in meeting this patients elevated energy requirements during prolonged rehabilitation?
    A) Loss of adipose tissue
    B) Loss of skeletal muscle
    C) Inability to convert adipose tissue to energy
    D) Inability to maintain normal body mass

Answer 18

B) Loss of skeletal muscle

Question 19

19. The nurse in the ED is caring for a patient recently admitted with a likely myocardial infarction. The nurse understands that the patients heart is pumping an inadequate supply of oxygen to the tissues. For what health problem should the nurse assess?
    A) Dysrhythmias
    B) Increase in blood pressure
    C) Increase in heart rate
    D) Decrease in oxygen demands

Answer 19

A) Dysrhythmias

Question 20

20. The nurse is caring for a patient admitted with cardiogenic shock. The patient is experiencing chest pain and there is an order for the administration of morphine. In addition to pain control, what is the main rationale for administering morphine to this patient?
    A) It promotes coping and slows catecholamine release.
    B) It stimulates the patient so he or she is more alert.
    C) It decreases gastric secretions.
    D) It dilates the blood vessels.

Answer 20

D) It dilates the blood vessels.

Question 21

21. The nurse is providing care for a patient who is in shock after massive blood loss from a workplace injury. The nurse recognizes that many of the findings from the most recent assessment are due to compensatory mechanisms. What is a compensatory mechanism to increase cardiac output during hypovolemic states?
    A) Third spacing of fluid
    B) Dysrhythmias
    C) Tachycardia
    D) Gastric hypermotility

Answer 21

C) Tachycardia

Question 22

22. The intensive care nurse is responsible for the care of a patient with shock. What cardiac signs or symptoms would suggest to the nurse that the patient may be experiencing acute organ dysfunction? Select all that apply.
    A) Drop in systolic blood pressure of 40 mm Hg from baselines
    B) Hypotension that responds to bolus fluid resuscitation
    C) Exaggerated response to vasoactive medications
    D) Serum lactate >4 mmol/L
    E) Mean arterial pressure (MAP) of 65 mm Hg

Answer 22

A) Drop in systolic blood pressure of 40 mm Hg from baselines

D) Serum lactate >4 mmol/L
E) Mean arterial pressure (MAP) of 65 mm Hg

Question 23

23. An adult patient has survived an episode of shock and will be discharged home to finish the recovery phase of his disease process. The home health nurse plays an integral part in monitoring this patient. What aspect of his care should be prioritized by the home health nurse?
    A) Providing supervision to home health aides in providing necessary patient care
    B) Assisting the patient and family to identify and mobilize community resources
    C) Providing ongoing medical care during the familys rehabilitation phase
    D) Reinforcing the importance of continuous assessment with the family

Answer 23

B) Assisting the patient and family to identify and mobilize community resources

Question 24

24. A critical care nurse is aware of similarities and differences between the treatments for different types of shock. Which of the following interventions is used in all types of shock?
    A) Aggressive hypoglycemic control
    B) Administration of hypertonic IV fluids
    C) Early provision of nutritional support
    D) Aggressive antibiotic therapy

Answer 24

C) Early provision of nutritional support

Question 25

25. In all types of shock, nutritional demands increase rapidly as the body depletes its stores of glycogen. Enteral nutrition is the preferred method of meeting these increasing energy demands. What is the basis for enteral nutrition being the preferred method of meeting the bodys needs?
    A) It slows the proliferation of bacteria and viruses during shock.
    B) It decreases the energy expended through the functioning of the GI system.
    C) It assists in expanding the intravascular volume of the body.

D) It promotes GI function through direct exposure to nutrients.

Answer 25

D) It promotes GI function through direct exposure to nutrients.

Question 26

26. The ICU nurse is caring for a patient with multiple organ dysfunction syndrome (MODS) due to shock. What nursing action should be prioritized at this point during care?
    A) Providing information and support to family members
    B) Preparing the family for a long recovery process
    C) Educating the patient regarding the use of supportive fluids
    D) Facilitating the rehabilitation phase of treatment

Answer 26

A) Providing information and support to family members

Question 27

27. A critical care nurse is planning assessments in the knowledge that patients in shock are vulnerable to developing fluid replacement complications. For what signs and symptoms should the nurse monitor the patient? Select all that apply.
    A) Hypovolemia
    B) Difficulty breathing
    C) Cardiovascular overload
    D) Pulmonary edema
    E) Hypoglycemia

Answer 27

B) Difficulty breathing
C) Cardiovascular overload
D) Pulmonary edema

Question 28

28. When circulatory shock occurs, there is massive vasodilation causing the pooling of the blood in the periphery of the body. An ICU nurse caring for a patient in circulatory shock should know that the pooling of blood in the periphery leads to what pathophysiological effect?
    A) Increased stroke volume
    B) Increased cardiac output
    C) Decreased heart rate
    D) Decreased venous return

Answer 28

D) Decreased venous return

Question 29

29. A team of nurses are reviewing the similarities and differences between the different classifications of shock. Which subclassifications of circulatory shock should the nurses identify? Select all that apply.
    A) Anaphylactic
    B) Hypovolemic
    C) Cardiogenic
    D) Septic
    E) Neurogenic

Answer 29

A) Anaphylactic
D) Septic
E) Neurogenic