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Hypovolemic Shock

100

A patient is receiving fluid boluses to treat hypovolemic shock. For which of the following assessment findings should the nurse stop the fluid boluses and notify the physician? 1. Tachycardia and hypotension 2. Crackles throughout the lung fields 3. Peripheral cyanosis 4. Increased oxygen saturation percentages

Rationale: 2 is correct response when identifying a symptom of pulmonary congestion from respiratory compromise due to fluid volume overload. 1 is not correct. These findings are indicative the shock is still present and needs more treatment. 3 is not correct. This finding indicates the shock has moved to the progressive stage, are symptoms of shock 4 is not correct. This finding indicates that oxygen is attaching to the hemoglobin, which does not occur with shock.

200

Which of the following is most important goal of nursing care for a client who is in Hypovolemic shock? 1.Manage fluid overload. 2.Manage increased cardiac output. 3.Manage inadequate tissue perfusion. 4.Manage vasoconstriction of vascular bed

3.manage inadequate tissue perfusion. Nursing intervention and collaborative management are focused on correcting and maintaining adequate tissue perfusion. Inadequate tissue perfusion may be caused by hemorrhage as in hypovolemic shock.

300

Which of the following assessment findings is an early indication of hypovolemic shock? 1.Diminished bowel sounds 2.Increased urinary output 3.Tachycardia 4.Hypertension

Rationale: 3 is correct. Tachycardia is an early symptom as the body compensates for a declining blood pressure the heart rate increases to circulate the blood faster to prevent tissue hypoxia. 1 is incorrect because this is a later symptom as the bowel begins to shut down when the body shunts the blood to vital organs away from the GI tract. 2 is incorrect. Urinary output will begin to decline not increase as the body conserves fluids to maintain the circulating volume to keep the blood pressure up. 4 is incorrect. Blood pressures are the same or declining when the circulating blood volume decreases with hypovolemia

400

When compensatory mechanisms for hypovolemic shock are activated, the nurse would expect which two patient findings to normalize? 1. Intensity of peripheral pulses and body temperature 2. Peripheral pulses and heart rate 3. Metabolic alkalosis and oxygen saturation 4. Cardiac output and blood pressure

Rationale: 4 is correct. The effectiveness of the sympathetic nervous system and the rennin-angiotensin-aldosterone system will increase blood volume and increase the heart rate to return the blood pressure and cardiac output for a brief time to within normal limits for that patient. 1 is incorrect. Intensity of pulses will be diminished and body temperature will remain cool due to vasoconstriction from shunting the blood to vital organs. 2. is incorrect. Peripheral pulses rate will remain diminished but tachycardic. 3 is incorrect. Metabolic acidosis is present during hypovolemic shock and alkalosis is not the result of the compensation mechanisms. Oxygen saturations are improved slightly but not within normal range.

500

Which type of fluid is most appropriate for volume replacement for a patient with non-hemorrhagic hypovolemic shock? 1. Lactated Ringers 2. 10% Dextrose in water 3. one-half normal saline 4. packed RBC’s

1 is correct. Lactated Ringers solution is an isotonic crystalloid that will stay within and expand the intravascular space for a longer period of time to raise the blood pressure by increasing the circulating blood volume. Normal Saline is the other acceptable solution that will improve this type of shock. 2 is incorrect. 10% Dextrose in Water is a hypertonic solution that will pull water from interstitial spaces and further deplete cellular hydration status. Therefore it is not recommended in hypovolemic shock. D5 W is a hypotonic solution because the dextrose is rapidly metabolized to water and CO2. Therefore, NS or LR is preferred for hypovolemic shock when replacing a fluid deficit. 3 is incorrect. One-half (1/2)NS is also a hypotonic solution that does not stay in the circulating volume. It is absorbed by the cells which will further deplete tissues fluids. 4 is incorrect. PRBCs are hypertonic solution that will pull water into the vascular system but deplete tissue perfusion further. If a decrease in RBCs is not the source of the hypovolemia then additional stress is placed on the circulating system to try to perfuse the increased number cells through capillary vessels that are constricted. An increased of lysis can occur with the consequences of thrombi or emboli formation complicating the already limited circulation present hypovolemic shock.

Septic Shock

100

Septic shock is caused by 1. Massive blood loss 2. Compromised myocardial contractility 3. Interruption of the sympathetic nervous system 4. Release of bacterial toxin in the blood vessel

The correct answer is 4 - septic shock is caused by severe infection. Toxins cause massive vasodilation causing decreased tissue perfusion and decreased tissue oxygenation.

200

Who is at risk for developing a septic shock? 1. An obese Patient 2. Patient who is on Corticosteroids 3. Immunosupressed Patient 4. Patient who has decreased Liver functions

The correct answer is 3 Immunosupressed Patient - An immunosupressed patient has decreased ability to deal with infections.

300

When assessing a client for early septic shock the nurse observes for which of the following? 1. Cool, Clammy Skin 2. Warm, flushed skin 3. Decreased systolic blood pressure 4. Hemorrhage

Answer 2. Warm, flushed skin from a high cardiac output with vasodilation occurs in warm shock or hyperdynamic phase (first phase) of septic shock. Other signs and symptoms of early septic shock include fever with restlessness and confusion, decreased blood pressure, with tachypnea and tachycardia, increased or normal urine output and N/V or diarrhea

400

Which nursing intervention is most important in preventing septic shock? 1. Administering I.V. fluid replacement therapy as ordered 2. Obtaining vital signs every 4 hours for all clients 3. Monitoring red blood Cells counts for elevation 4. Maintaining asepsis of indwelling urinary catheters

Answer 4 Maintaining asepsis of indwelling urinary catheters is essential to prevent infection. Preventing septic shock is a major focus of nursing care because of the mortality rate for septic shock. Septic shock is as high as 90% in some population

500

Which of the following is an indication of a complication of Septic Shock? 1. Anaphylaxis 2. ARDS 3. COPD 4. Mitral Valve prolapse

Answer B ARDS is a complication associated with septic shock. ARDS causes respiratory failure and may lead to death, even after the client has recovered from shock. Anaphylaxis is a type of distributive or vasogenic shock COPD is a functional category of pulmonary disease that consists of persistent obstruction of bronchial airflow and involves chronic bronchitis and chronic emphysema. Mitral valve prolapse is a condition in which the mitral valve is pushed back too far during ventricular contraction

Cardiogenic Shock

100

A patient arrives in the emergency department with symptoms of myocardial infarction, progressing to cardiogenic shock. Which of the following symptoms should the nurse expect the patient to exhibit with cardiogenic shock? 1. Hypertension. 2. Bradycardia. 3. Bounding pulse. 4. Confusion.

Answer: 4 Cardiogenic shock severely impairs the pumping function of the heart muscle, causing diminished blood flow to the organs of the body. This results in diminished brain function and confusion, as well as hypotension, tachycardia, and weak pulse. Cardiogenic shock is a serious complication of myocardial infarction with a high mortality rate.

200

Dobutamine (Dobutrex) is used to treat a client experiencing cardiogenic shock. Nursing intervention includes: 1. Monitoring for fluid overload. 2. Monitoring for cardiac dysrhythmias. 3. Monitoring respiratory status. 4. Monitoring for hypotension.

The correct answer is 2 Dobutamine is beneficial in cases where shock is caused by heart failure. The drug increases contractility, and has the potential to cause dysrhythmias

300

Which of the following drug is most commonly used to treat cardiogenic shock? 1. Dopamine (Intropin) 2. Enalapril (Vasotec) 3. Furosemide (Lasix) 4. Metoprolol (Lopressor)

Answer 1. Dopamine, a sympathomimetic drug, improves myocardial contractility and blood flow through vital organs by increasing perfusion pressure. Enalapril is an angiotensin converting enzyme inhibitor that directly lowers blood pressure. Furosemide is a diuretic and does not have a direct effect on contractility or tissue perfusion. Metoprolol is a beta adrenergic blocker that slows heart rate and lowers blood pressure, neither a desired effect in the treatment of Cardiogenic shock

400

Which of the following is the initial treatment goal for cardiogenic shock 1. Correct Hypoxia 2. Prevent infarction 3. Correct metabolic acidosis 4. Increase myocardial oxygen supply

Answer 4: A balance must be maintained between supply and demand. In a shock state, the myocardium requires more O2. If it ant get more O2 the shock worsens. Increasing the oxygen will also play a large role in correcting metabolic acidosis and hypoxia. Infarction typically causes the shock state, so prevention isn’t an appropriate foal for this condition

500

Which of the following steps has been shown to have a mortality benefit in patients with cardiogenic shock caused by to myocardial infarction (MI)? 1.Addition of glycoprotein IIb/IIIa inhibitors 2.β-Adrenergic agonists 3.Early cardiac catheterization followed by revascularization by (PCI) or surgical revascularization 4.Initial medical stabilization with BP control prior to catheterization 5.Thrombolytic infusion

The correct answer is 3 Early cardiac catheterization followed by revascularization by PCI or surgical revascularization. The SHOCK trial compared emergent revascularization for cardiogenic shock due to MI with initial medical stabilization and delayed revascularization. The results of the study revealed a mortality benefit at 30 days that increased over time at 6 months and 1 year. The American College of Cardiology/ American Heart Association guidelines recommend early revascularization (either PCI or coronary artery bypass grafting) for patients aged 75 years or younger with ST elevation or left bundle-branch block who develop shock within 36 hours of MI and who are suitable for revascularization that can be performed within 18 hours of shock. Patients admitted to hospitals without facilities for revascularization should be immediately transferred to a tertiary care center with such facilities.

Anaphylactic Shock

100

True or False All these are risk factors for Anaphylactic Shock - Drug Food Insect bites/stings

True

200

Which of these should not be done when the patient is having or is at risk for Anaphylactic Shock? 1. Ask the patient about their past and previous allergies, regardless of the data provided. 2. Place a pillow under the person's head if he or she is having trouble breathing 3. Give antihistamines, such as diphenhydramine, and corticosteroids, such as prednisone, to further reduce symptoms. 4. Avoid oral medication if the person is having difficulty breathing.

The correct answer is 2- Do NOT place a pillow under the person's head if he or she is having trouble breathing. This can block the airways.

300

A child reports to the camp nurse's office after stepping on a bee. The child has pain, erythema, and edema of the lower aspect of the left foot. As the nurse is observing the foot, the child says, "I feel like my throat is getting tight." The first action the nurse should take is: 1. Assess the child's airway and breathing 2. Call 911 and request an ambulance 3. Administer subcutaneous epinephrine 4. Remove the stinger from the foot

The Correct answer is 1 - the situation indicates that the child is having anaphylactic reaction. The first action by the nurse is to assess airway and breathing. Priority assessment is ABC.

400

Which of the following is signs and symptoms of anaphylactic reaction? 1. Cool pale skin 2. Respiratory distress 3. Low BP and Increased HR 4. Rash 5. Hearing Loss

The Correct answer is 1,2,3,4- These are the symptoms associated with Anaphylactic reaction

500

The nurse is caring for a client experiencing anaphylactic shock. Which of the following should be included in the plan of care for this client? SATA 1. Maintain an adequate airway. 2. Support the blood pressure. 3. Restore body fluids. 4. Remove the source of infection. 5. Remove the mechanical barrier to blood flow.

The Correct answer is 1 and 2

Neurogenic Shock

100

Which of this is a major clinical sign of Neurogenic Shock? 1. Hypotension and bradycardia 2. Hypertension and Tachycardia 3. Altered Mental status and Deep slow breathing 4. Hyperthermia and Tachycardia

The correct answer is 1. - Patients are generally hypotensive with warm, dry skin. The loss of sympathetic tone may impair the ability to redirect blood flow from the periphery to the core circulation leading to excessive heat loss and hypothermia. Bradycardia is a characteristic finding of neurogenic shock. They have Altered Mental status BUT rapid and shallow respirations.

200

Which of the following are the causes of Neurogenic Shock? (SATA) 1. Spinal cord injury 2. Spinal anesthesia 3. Depressant actions of medications 4. Glucose deficiency 5. Systemic vascular resistance

ALL OF THEM

300

A 70-year-old man presents to the emergency department with a 2-day history of fever, chills, cough, and right-sided pleuritic chest pain. On the day of admission, the patient’s family noted that he was more lethargic and dizzy and was falling frequently. The patient’s vital signs are:temperature, 101.5°F; heart rate 120 bpm; respiratory rate 30 breaths/min; blood pressure 70/35 mm Hg; and oxygen saturation as measured by pulse oximetry - 80% without oxygen supplementation. A chest radiograph shows a right lower lobe infiltrate. What is the first step in the initial management of this patient? (NOT SATA) 1. Antibiotic therapy 2. β-Blocker therapy to control heart rate 3. Intravenous (IV) fluid resuscitation 4. Supplemental oxygen and airway management 5. Vasopressor therapy with dopamine

The Correct answer is 4 Supplemental oxygen and airway management. The initial evaluation of any critically ill patient in shock should include assessing and establishing an airway, evaluating breathing (which includes consideration of mechanical ventilator support), and restoring adequate circulation. Adequate oxygenation should be ensured with a goal of achieving an arterial oxygen saturation of 90% or greater.

400

Which is these are symptoms of Progressive State of Shock? 1. Heart rate is Erratic 2. PaO2 is <80mm Hg and PaCO2 is >45mm Hg 3. Cold,Clammy Skin 4. Respiratory Alkalosis

The correct answer is 2.PaO2 is <80mm Hg and PaCO2 is >45mm Hg 1.Heart rate is Erratic - This is Irreversible Stage of Shock 3.Cold,Clammy Skin - This is Compensatory Stage of Shock 4.Respiratory Alkalosis - This is Compensatory Stage of Shock

500

The nurse is planning care for the client in Neurogenic shock. Which of the following actions would be least helpful in minimizing the effects of vasodilation below the level of the injury? 1. Monitoring vital signs before and during position changes 2. Using vasopressor medications as prescribed 3. Moving the client quickly as one unit 4. Applying Teds or compression stockings.

3. Moving the client quickly as one unit Reflex vasodilation below the level of the spinal cord injury places the client at risk for orthostatic hypotension, which may be profound. Measures to minimize this include measuring vital signs before and during position changes, use of a tilt-table with early mobilization, and changing the client’s position slowly. Venous pooling can be reduced by using Teds (compression stockings) or pneumatic boots. Vasopressor medications are administered per protocol.