Shock States
All forms of shock have which characteristic in common?
a. Inadequate circulating fluid levels
b. Loss of SNS innervation
c. Tissue oxygen supply in excess of oxygen demand
d. Imbalance between tissue oxygen supply and oxygen demand
d. Imbalance between tissue oxygen supply and oxygen demand
Which two underlyign shock-related factors cause the majority of clinical manifestations associated with shock?
a. Fluid deficiencies and electrolyte imbalances
b. Activation of compensatory mechanisms and inadequate oxygen delivery
c. Impaired alveolar oxygenation and increased CO
d. Loss of organ function and decreased oxygen carrying capacity of the blood
b. Activation of compensatory mechanisms and inadequate oxygen delivery
Which therapy would most effectively increase the CO component of a patient's oxygen delivery?
a. O2 therapy by nasal cannula
b. Normal saline at 200 mL/hr
c. Low-dose dopamine
d. Acetaminophen
b. Normal saline at 200 mL/hr
In the treatment of shock, it is recommended that vasoactive drug therapy be considered at what point relative to fluid resuscitation?
a. At the same time as fluid resuscitation
b. As soon as fluid resuscitation has been completed
c. Immediately before starting fluid resuscitation
d. If fluid resuscitation fails to sufficiently improve perfusion
d. If fluid resuscitation fails to sufficiently improve perfusion
Which condition characterizes cardiogenic shock?
a. Impaired cardiac contractility and CO
b. Increased SV in the face of decreasing CO
c. Increasing SV in the face of increasing CO
d. Hypovolemic shock as the result of a massive MI
a. Impaired cardiac contractility and CO
When shock develops, the body attempts to meet the crisis through which mechanism?
a. Releasing cortisol, norepinephrine, and epinephrine
b. Activating the PNS
c. Decreasing venous return to the right heart
d. Inhibiting release of aldosterone
a. Releasing cortisol, norepinephrine, and epinephrine
Which statement best describes the use of traditional parameters (BP, HR, and appearance) to assess a patient for the presence of shock?
a. They accurately reflect a shock state
b. They are of little use in the assessment of shock states
c. They provide supportive data but cannot be relied on
d. They can be used for diagnosis of some shock states but not others
c. They provide supportive data but cannot be relied on
Why is it important to closely monitor the oxygen concentration being delivered to a patient with shock?
a. High oxygen concentrations can impair the immune system
b. High oxygen concentrations can reduce venous return to the heart
c. High oxygen concentration decreases creatinine clearance by the kidney
d. High oxygen concentration can result in tissue hypoxia
b. High oxygen concentrations can reduce venous return to the heart
All vasopressor drugs have which action in common?
a. Vasodilation
b. Increase heart contractility
c. Vasoconstriction
d. Increase stroke volume
c. Vasoconstriction
Which combination of assessments should alert the nurse that the patient may be developing cardiogenic shock? (SATA)
a. Sustained systolic BP less than 90 mmHg
b. Cardiac index of less than 2.2 L/min
c. Pulmonary artery wedge pressure of less than 4 mmHg
d. Patient reports continuing chest pain and dyspnea
e. Reduced mentation
a. Sustained systolic BP less than 90 mmHg
b. Cardiac index of less than 2.2 L/min
d. Patient reports continuing chest pain and dyspnea
e. Reduced mentation
Angiotensin II plays an important role in increasing blood pressure through which action?
a. Decreasing afterload
b. Blocking aldosterone release
c. Vasoconstriction
d. Stimulating secretion of renin
c. Vasoconstriction
In the assessment of shock, arterial pH can be measured in conjunction with which 2 parameters to evaluate the patient's acid-base balance state?
a. Serum lactate and base excess/deficit
b. Pulse oximetry and blood pressure
c. Gastric tonometry and gastric pH
d. Venous oxygen saturation and pulmonary artery wedge pressure
a. Serum lactate and base excess/deficit
Why would the nurse be alert for shivering in a patient who is receving physical cooling measures?
a. Shivering indicates cooling has reached its maximum effectiveness
b. Once shivering begins, cooling measures should be d/c
c. Shivering increases metabolism and oxygen consumption
d. The onset of shivering indicates hypothermia is reversing
c. Shivering increases metabolism and oxygen consumption
The nurse is titrating norepinephrine on a patient for treatment of shock. The HCP has just ordered that the drug be d/c. How should the nurse comply with this order?
a. Stop the drip immediately
b. Gradually decrease the rate of flow over time
c. Increase the maintenance IV fluid rate prior to discontinuing
d. Decrease the rate over a 1-hour period and discontinue
c. Increase the maintenance IV fluid rate prior to discontinuing
Initial management of cardiogenic shock focuses on which goals? (SATA)
a. Reduce pulmonary edema
b. Provide fluid resuscitation
c. Control cardiac dysrhythmias
d. Increase BP
e. Increase CO
a. Reduce pulmonary edema
c. Control cardiac dysrhythmias
d. Increase BP
e. Increase CO
How is the compensatory stage of shock best characterized?
a. Anaerobic metabolism and lactic acidosis begin
b. Neuroendocrine responses are activated
c. Organ function becomes compromised
d. The patient becomes resistant to treatment
b. Neuroendocrine responses are activated
A patient's lactate level is 5.3 mmol/L. What would this value indicate to the nurse?
a. The patient's arterial pH is likely to be alkalotic
b. The patient is receiving oxygen therapy at. too. high a concentration
c. The patient is likely to be experiencing tissue hyperperfusion
d. The patient is experiencing significant anaerobic metabolism
d. The patient is experiencing significant anaerobic metabolism
A patient in septic shock has an NMBA initiated. Which. other drug is most likely to be administered in conjunction with the NMBA?
a. Propofol
b. Lorazepam
c. Diazepam
d. Norepinephrine
a. Propofol
The provider has just ordered dobutamine for a patient in shock. The nurse is aware that this type of drug has which physiologic effect?
a. Vasodilation
b. Vasoconstriction
c. Increase contractility
d. Decreases pulmonary vascular resistance
b. Vasoconstriction
A patient in cardiogenic shock is undergoing placement of a left ventricular assist device. What is a major purpose of this procedure?
a. To control cardiac dysrhythmias
b. To decrease afterload
c. To increase oxygen demand
d. To rest the injured myocardium
d. To rest the injured myocardium