Week 11: Shock/Neutropenia

Question 1

Shock is a life-threatening response to a main alteration in what system?

a. Circulation
b. Elimination
c. Mentation
d. Respiration

Answer 1

A. Circulation

Question 2

What is the primary goal in all shock states?

a. ensure adequate cellular hydration
b. maintain adequate tissue perfusion
c. prevent third spacing of fluids
c. support mechanical ventilation

Answer 2

B. Maintain adequate tissue perfusion

Question 3

Low blood flow types of shock include which two types?

a. hypovoelemic and neurogenic
b. anaphylactic and septic
c. cardiogenic and hypovolemic
d. none of the above

Answer 3

c. Cardiogenic and Hypovolmeic are both low blood flow types of shock

Hypovolemic: decreased circulating volume

Cardiogenic: heart failure

Question 4

Which patient being cared for in the ER is most at risk for developing hypovolemic shock?

a. A patient admitted with abdominal pain and an elevated white count.
b. A patient with a temperature of 39 and a general dermal rash
c. A patient with a 2-day history of nausea, vomiting, and diarrhea.
d. A patient with slight rectal bleeding from inflamed hemorrhoids.

Answer 4

C. A patient with a 2-day history of nausea, vomiting, and diarrhea

(because – FLUID LOSS = Hypovolemic)

Question 5

The majority of cases of cardiogenic shock are caused by which condition?

a. acute myocardial infarction
b. myocardial depression in sepsis
c. pulmonary embolism
d. significant hypovolemia

Answer 5

A. Acute myocardial infarction.

Question 6

The nurse suspects that a client who had a myocardial infarction is developing cardiogenic shock. Which is the most likely assessment findings of this complication?

a. Flushed, dry skin with bounding pedal pulses
b. warm, moist skin with irregular pedal pulses
c. cool, clammy skin with weak or thready pedal pulses
d. cool, dry skin with alternating weak and strong pedal pulses.

Answer 6

C. Cool, clammy skin with weak or thready pedal pulses.

Question 7

What three types of shock are classified as distributive shock?

a. Septic, cardiogenic, and anaphylactic
b. Neurogenic, anaphylactic and septic
c. Neurogenic, anaphylactic and hypovolemic
d. Septic, cardiogenic and hypovolemic

Answer 7

B. Neurogenic, anaphylactic and septic

Question 8

When neurogenic shock occurs, interruption in sympathetic nerve impulses causes which clinical manifestation?

a. Tachycardia
b. Hypertension
c. Hypoventilation
d. Vasodilation

Answer 8

D. Vasodilation

Question 9

The nurse is caring for an 18- year old athlete with possible cervical spine (c-5) injury following a diving accident. The nurse assesses a blood pressure of 70/50mmhg, heart rate 45 beats/min, and respiration’s 26/min. The patients skin is warm and flushed. What is the best interpretation of these findings by the nurse?

a. The patient is developing neurogenic shock
b. The patient is experiencing an allergic reaction.
c. The patient most likely has elevated temperature.
d. The vital signs are normal for this patient.

Answer 9

A. The patient is developing neurogenic shock.

Question 10

A patient’s localized infection has progressed to the point where septic shock is now suspected. Which of the following is an appropriate treatment modality for this patient?

a. Insulin infusion.
b. aggressive fluid resuscitation.
c. intravenous administration of epinephrine.
d. administration of nitrated and beta adrenergic blockers.

Answer 10

b. Aggressive fluid resuscitation

Question 11

The nurse is caring for a patient in the early stages of septic shock. The patient is slightly confused and flushed, with bounding peripheral pulses. Which hemodynamic values is the nurse most likely to assess

a. High pulmonary artery occlusive pressure and high cardiac output.
b. High systemic vascular resistance and low cardiac output.
c. Low pulmonary artery occlusive pressure and low cardiac output.
d. Low systemic vascular resistance and high cardiac output.

Answer 11

d. Low systemic vascular resistance and high cardiac output.

Question 12

The nurse had just completed an infusion of a 1-L bolus of 0.9% normal saline in a patient with severe sepsis. One hour later, which laboratory result requires immediate nursing action?

a. Creatinine 1.0mg/d:
b. Lactate 6mmol/L
c. Potassium 3.8mEq/L
d. Sodium 140 mEq/L

Answer 12

A. Creatinine 1.0 mg/dL

low— indicated Kidney’s are failing

Question 13

Key points of shock

Answer 13

• shock leads to MABP that is inadequate to meet demands of the tissues
• early symptoms of shock may be subtle
• all clients at risk of deterioration-require collaborative care
• good understanding of the pathophysiology of the different shock types
• psycho social support-frightening experience

Question 14

Which of the following lab findings fits with a diagnosis of cardiogenic shock?

a. Decreased liver enzymes.
b. Increased white blood cells.
c. Increased blood urea nitrogen (BUN) and creatinine levels.
d. Decreased red blood cells, hemoglobin, and hematrocrit,

Answer 14

C. increased blood urea nitrogen (BUN) and creatinine levels.

Question 15

A client arrives at the ER with upper GI bleeding and is in moderate distress. What is the priority nursing action?

a. obtain vital signs.
b. ask the client about the precipitating events
c. complete an abdominal physical assessment
d. insert a nasogastric (NG) tube and Hematest the emesis

Answer 15

a. Obtain vital signs.

ASSESS!!

Question 16

When caring for a patient in acute septic shock, the nurse would anticipate

a. administering osmotic and loop diuretics or both.
b. infusing large amounts of intravenous fluids.
c. administering intravenous diphenhydramine (Benadryl).    d. assisting with insertion of a ventricular assist device (VAD).

Answer 16

b. infusing large amounts of intravenous fluids.

Septic shock is characterized by a decreased circulating blood volume. Volume expansion with the administration of intravenous fluids is the cornerstone of therapy. The administration of diuretics is inappropriate. Ventricular assist devices (VADs) are useful for cardiogenic shock, not septic shock. Diphenhydramine (Benadryl) may be used for anaphylactic shock, but would not be helpful with septic shock

Question 17

When caring for a critically ill patient who is being mechanically ventilated, the nurse will astutely monitor for which of the following clinical manifestations of multiple organ dysfunction syndrome (MODS)?

a. Increased gastrointestinal (GI) motility
b. Increased serum albumin    c. Decreased blood urea nitrogen (BUN)/creatinine ratio
d. Decreased respiratory compliance

Answer 17

d. Decreased respiratory compliance

Clinical manifestations of multiple organ dysfunction syndrome (MODS) include symptoms of respiratory distress, signs and symptoms of decreased renal perfusion, decreased serum albumin and prealbumin, decreased GI motility, acute neurological changes, myocardial dysfunction, disseminated intravascular coagulation (DIC), and changes in glucose metabolism.

Question 18

A massive gastrointestinal bleed has resulted in hypovolemic shock in an older adult patient. Which of the following is a priority nursing diagnosis?

a. Acute pain
b. Impaired tissue integrity
c. Decreased cardiac output
d. Ineffective tissue perfusion

Answer 18

d. Ineffective tissue perfusion

The many deleterious effects of shock are all related to inadequate perfusion and oxygenation of the body system. This nursing diagnosis supersedes the other diagnoses.

Question 19

Which of the following laboratory findings fits with a diagnosis of cardiogenic shock?

a Decreased liver enzymes

b. Increased white blood cells
c. Increased blood urea nitrogen (BUN) and creatinine levels 
d. Decreased red blood cells, hemoglobin, and hematocrit

Answer 19

c. Increased blood urea nitrogen (BUN) and creatinine levels

The renal hypoperfusion that accompanies cardiogenic shock results in increased BUN and creatinine levels. Impaired perfusion of the liver results in increased liver enzymes, while red blood cell indices are typically normal because of relative hypovolemia. White blood cell levels do not typically rise in cardiogenic shock.

Question 20

A patient’s localized infection has progressed to the point where septic shock is now suspected. Which of the following is an appropriate treatment modality for this patient?

a. Insulin infusion
b. Aggressive fluid resuscitation 
c. Intravenous administration of epinephrine
d. Administration of nitrates and â-adrenergic blockers

Answer 20

b. Aggressive fluid resuscitation

Patients in septic shock require large amounts of fluid replacement. Nitrates and â-adrenergic blockers are most often used in the treatment of patients in cardiogenic shock. Epinephrine is indicated in anaphylactic shock, and insulin infusion is not normally necessary in the treatment of septic shock (but can be).

Question 21

The nurse would recognize which of the following clinical manifestations as suggestive of sepsis?

a. Respiratory rate of seven breaths per minute
b. Hyperglycemia in the absence of diabetes 
c. Sudden diuresis unrelated to drug therapy
d. Bradycardia with sudden increase in blood pressure

Answer 21

b. Hyperglycemia in the absence of diabetes

Hyperglycemia in patients with no history of diabetes is a diagnostic criterion for sepsis. Oliguria, not diuresis, typically accompanies sepsis along with tachycardia and tachypnea.

Question 22

How is shock best defined?

a. Cardiovascular collapse
b. Loss of sympathetic tone
c. Inadequate tissue perfusion
d. Blood pressure less than 90 mm Hg systolic

Answer 22

c. Inadequate tissue perfusion

Question 23

A patient has a spinal cord injury at T4. Vital signs include a falling blood pressure with bradycardia. What type of shock is the patient probably experiencing?

a. Relative hypervolemia
b. Absolute hypovolemia
c. Neurogenic shock from low blood flow
d. Neurogenic shock from a maldistribution of blood flow

Answer 23

d. neurogenic shock from a maldistibution of blood flow

Question 24

What early effect does shock have on the body?
a. Sympathetic nervous system activation that results in
stimulation of adrenergic receptors
b. Massive vasoconstriction in the heart and brain that
causes stimulation of the renin–angiotensin system
c. Decreased tissue perfusion that results in anaerobic
metabolism, leading to the development of lactic acidosis
d. Heart rate that is usually slow and irregular in the compensatory stage because of parasympathetic nervous stimulation

Answer 24

a. Sympathetic nervous system activation that results in

stimulation of adrenergic receptors

Question 25

A 78-year-old man is exhibiting confusion and a temperature of 40°C. He has diabetes and has purulent drainage from his right great toe. His assessment findings are as follows: BP,84/40 mm Hg; heart rate, 110/minute; respiratory rate, 42/minute and shallow; cardiac output, 8 L/min; and PAOP,4 mm Hg. What is this patient probably experiencing?

a. Sepsis
b. Septic shock
c. Multiple organ dysfunction syndrome
d. Systemic inflammatory response syndrome

Answer 25

b. Septic shock

Question 26

What treatment modalities would be included in the management of cardiogenic shock?
a. Dobutamine to increase myocardial contractility
b. Vasopressors to increase SVR
c. Corticosteroids to stabilize the cell wall in the infarcted
myocardium
d. Plasma volume expanders such as albumin to decrease anelevated preload

Answer 26

a. Dobutamine to increase myocardial contractility

Question 27

What are the most accurate assessment parameters for the nurse to use to determine adequate tissue perfusion in a patient with MODS?
a. Blood pressure, pulse, and respirations
b. Breath sounds, blood pressure, and body temperature
c. Pulse pressure, level of consciousness, and pupillary
response
d. Level of consciousness, urine output, skin colour, and
temperature

Answer 27

d. Level of consciousness, urine output, skin colour, and

temperature