Shock Treatment
A nurse is caring for a patient in hypovolemic shock due to severe bleeding. Which intervention should the nurse perform first?
A. Administer intravenous fluids
B. Monitor urine output
C. Place the patient in a high Fowler’s position
D. Obtain a blood sample for laboratory tests
Answer: A. Administer intravenous fluids
Rationale: Restoring fluid volume is the priority in hypovolemic shock to improve perfusion and prevent organ failure.
A nurse is caring for a patient in anaphylactic shock. Which medication should the nurse anticipate administering first?
A. Norepinephrine
B. Epinephrine
C. Antihistamines
D. Corticosteroids
Answer: B. Epinephrine
Rationale: Epinephrine is the first-line treatment for anaphylactic shock as it helps to constrict blood vessels, relax airway muscles, and reduce swelling.
A nurse is assessing a patient in anaphylactic shock. Which finding is the most concerning?
A. Hives and facial swelling
B. Blood pressure of 82/50 mmHg
C. Heart rate of 120 bpm
D. Stridor and difficulty breathing
Answer: D. Stridor and difficulty breathing
Rationale: Airway compromise is the most life-threatening symptom of anaphylactic shock. Immediate intervention with epinephrine is required.
A patient asks the nurse what a pulmonary artery catheter is. Which of the following is the most appropriate response?
A. "It is a device used to measure the pressure inside your lungs."
B. "It is a tube inserted into the heart to monitor blood flow and heart function."
C. "It is a catheter placed in your urinary system to help measure kidney function."
D. "It is a type of intravenous line that helps deliver fluids directly into the bloodstream."
Correct Answer: B. "It is a tube inserted into the heart to monitor blood flow and heart function."
Rationale:
A pulmonary artery catheter (also known as a Swan-Ganz catheter) is used to measure pressures in the heart and lungs, assess cardiac output, and help guide treatment in critically ill patients, particularly those with heart or lung problems. It is inserted through a vein and threaded into the pulmonary artery to monitor hemodynamic status.
A patient presents with chest pain. What does this most likely indicate?
A. Ongoing ischemia
B. A panic attack
C. Gastroesophageal reflux disease (GERD)
D. Costochondritis
Correct Answer: A. Ongoing ischemia
Rationale:
Chest pain, especially if it is persistent or severe, is often a sign of ongoing ischemia, which refers to a lack of adequate blood flow to the heart muscle. This can be caused by conditions such as acute coronary syndrome (e.g., myocardial infarction or unstable angina). While other conditions such as GERD, costochondritis, or panic attacks can cause chest pain, the possibility of ischemia requires immediate assessment and intervention to prevent serious complications like heart attack.
A patient with pulmonary embolism develops obstructive shock. Which of the following is the most critical intervention for the nurse to perform?
A. Administer intravenous fluids
B. Administer thrombolytic therapy to dissolve the clot
C. Increase the patient’s oxygen supply
D. Give a vasopressor to raise blood pressure
Answer: B. Administer thrombolytic therapy to dissolve the clot
Rationale: In obstructive shock due to pulmonary embolism, the primary goal is to dissolve or remove the clot to restore normal circulation.
A nurse is caring for a patient in cardiogenic shock with low cardiac output. Which medication would the nurse expect to administer to increase heart contractility?
A. Norepinephrine
B. Dobutamine
C. Dopamine
D. Nitroglycerin
Answer: B. Dobutamine
Rationale: Dobutamine is an inotropic medication that strengthens the heart's contractions and improves cardiac output in patients with cardiogenic shock.
A nurse is explaining cardiogenic shock to a student nurse. Which statement by the student requires correction?
A. "Cardiogenic shock occurs when the heart cannot pump enough blood to meet the body's needs."
B. "A common cause of cardiogenic shock is a severe myocardial infarction."
C. "Vasodilation is the main cause of cardiogenic shock."
D. "Patients in cardiogenic shock may have pulmonary congestion due to fluid backup."
Answer: C. "Vasodilation is the main cause of cardiogenic shock."
Rationale: Cardiogenic shock is caused by the heart’s inability to pump effectively, not by widespread vasodilation, which is seen in distributive shock (e.g., septic or anaphylactic shock).
A patient is being prepared for insertion of an intra-aortic balloon pump (IABP). Which of the following statements is correct regarding the function and placement of the IABP?
A. The IABP is placed through the femoral artery sheath and filled with oxygen.
B. The IABP inflates during systole to reduce the workload of the heart.
C. The IABP improves coronary artery perfusion by inflating during diastole.
D. The IABP sits just proximal to the left subclavian artery.
Correct Answer: C. The IABP improves coronary artery perfusion by inflating during diastole.
Rationale:
An elevated B-type natriuretic peptide (BNP) level in a patient is most indicative of which of the following conditions?
A. Fluid retention
B. Volume overload
C. Hypertension
D. Hypovolemia
Correct Answer: B. Volume overload
A patient arrives at the emergency department with severe respiratory distress, tracheal deviation, and hypotension. The provider suspects a tension pneumothorax. Which intervention is most likely to be performed as an initial treatment?
A. A needle will be inserted into the 2nd intercostal space, mid-clavicular line
B. Embolectomy
C. Pericardiocentesis
D. A needle will be inserted underneath the xiphoid process
Correct Answer: A. A needle will be inserted into the 2nd intercostal space, mid-clavicular line
Rationale:
Tension pneumothorax is a life-threatening emergency that requires immediate decompression. A needle thoracostomy (needle decompression) is performed by inserting a large-bore needle into the 2nd intercostal space at the mid-clavicular line to relieve trapped air and reduce pressure in the pleural space.
B. An embolectomy is a surgical procedure to remove an embolus, typically for pulmonary embolism, not tension pneumothorax.
C. Pericardiocentesis is performed to drain fluid from the pericardial sac, usually for cardiac tamponade, not pneumothorax.
D. A needle inserted underneath the xiphoid process is used in pericardiocentesis, not for treating pneumothorax.
A patient in septic shock is being treated with norepinephrine and dobutamine. The nurse understands that the primary reason for administering norepinephrine in this patient is to:
A. Increase heart contractility and improve cardiac output
B. Decrease systemic vascular resistance and reduce blood pressure
C. Constrict blood vessels to increase blood pressure
D. Relieve airway constriction and improve oxygenation
Answer: C. Constrict blood vessels to increase blood pressure
Rationale: Norepinephrine is a vasopressor (adrenergic drug) that constricts blood vessels by stimulating alpha-1 receptors, which helps increase blood pressure in patients with shock, particularly in septic shock where there is vasodilation. Dobutamine, which is an inotrope, would be used to increase heart contractility and improve cardiac output (Choice A), but norepinephrine specifically raises blood pressure.
A patient in septic shock is prescribed hydrocortisone. What is the primary reason for administering this medication?
A. To aid in the body's response to antibiotics
B. To decrease inflammation
C. To improve red blood cell production
D. To aid in the body's response to vasopressors
Correct Answer: D. To aid in the body's response to vasopressors
Rationale: In septic shock, hydrocortisone is used to help restore vascular tone and improve the effectiveness of vasopressors like norepinephrine. It works by addressing adrenal insufficiency, which can occur in prolonged septic shock, thereby supporting blood pressure stabilization. While corticosteroids also have anti-inflammatory effects, their primary role in septic shock management is to enhance the body's response to vasopressors.
A patient is in septic shock. What is the nurse’s priority intervention?
A. Administering antibiotics
B. Starting IV therapy
C. Administering vasoconstrictors
D. Collecting cultures
Correct Answer: B. Starting IV therapy
Rationale: In septic shock, the first priority is fluid resuscitation with IV fluids to restore intravascular volume and improve perfusion. This helps stabilize blood pressure and prevent organ failure. While obtaining cultures and administering antibiotics are crucial steps, fluids must be given first to support circulation. Vasoconstrictors (vasopressors) may be needed if fluid resuscitation alone is insufficient to maintain blood pressure.
An increase in pulmonary artery pressure is most commonly an indication of which of the following conditions?
A. Right-sided heart failure
B. Left-sided heart failure
C. Chronic obstructive pulmonary disease (COPD)
D. Pulmonary embolism
Correct Answer: B. Left-sided heart failure
Rationale:
An increase in pulmonary artery pressure usually indicates a problem with the left side of the heart (e.g., left-sided heart failure) because the left side of the heart is responsible for pumping blood into the systemic circulation. If the left side of the heart cannot effectively pump blood, it causes a backup of blood into the lungs, increasing pressure in the pulmonary arteries. Lung diseases (such as COPD or pulmonary embolism) can also lead to increased pulmonary artery pressure by affecting the pulmonary vasculature, but left-sided heart failure is the most common cause.
3. Which interventions are appropriate when treating a patient with cardiogenic shock? (Select all that apply.)
A. Administer intravenous fluids cautiously to prevent overload
B. Administer inotropes to improve cardiac contractility
C. Administer high-dose vasopressors to improve blood pressure
D. Monitor for signs of pulmonary edema and administer diuretics if necessary
E. Provide oxygen therapy to improve tissue oxygenation
Correct Answers: A. Administer intravenous fluids cautiously to prevent overload, B. Administer inotropes to improve cardiac contractility, D. Monitor for signs of pulmonary edema and administer diuretics if necessary, E. Provide oxygen therapy to improve tissue oxygenation
A patient is experiencing anaphylactic shock. Which of the following medications should the nurse plan to administer? (Select all that apply.)
A. Bronchodilators
B. Antipyretics
C. Epinephrine IM
D. Colloids
E. H1 and H2 antagonists
F. Corticosteroids
Correct Answers: A. Bronchodilators, C. Epinephrine IM, E. H1 and H2 antagonists, F. Corticosteroids
Rationale:
4. Which of the following are typical findings in cardiogenic shock? (Select all that apply.)
A. Low cardiac output
B. Elevated central venous pressure (CVP)
C. Pulmonary congestion
D. Cool, clammy skin
E. Warm, dry skin
Correct Answers: A. Low cardiac output, B. Elevated central venous pressure (CVP), C. Pulmonary congestion, D. Cool, clammy skin
A patient is receiving a blood transfusion and their temperature increases from 36.5°C to 37.5°C, 15 minutes after administration. What should the nurse plan on implementing?
A. Discontinue the transfusion and administer antipyretics
B. Monitor the patient’s vital signs and continue the transfusion at the same rate
C. Administer PRN antipyretics and monitor the patient closely
D. Discontinue the transfusion and notify the healthcare provider immediately
Correct Answer: C. Administer PRN antipyretics and monitor the patient closely
Rationale:
A mild temperature increase of up to 1°C is a common and often benign occurrence during a blood transfusion, typically caused by a low-grade transfusion reaction. In this case, the nurse should administer PRN antipyretics to manage the fever and monitor the patient closely for any worsening symptoms or signs of more severe reactions.
6. Which of the following laboratory findings may indicate shock in a patient? (Select all that apply.)
A. Elevated lactate levels
B. Decreased hemoglobin
C. Increased creatinine
D. Decreased platelet count
E. Elevated BUN
Correct Answers: A. Elevated lactate levels, B. Decreased hemoglobin, C. Increased creatinine, E. Elevated BUN
In a patient in the early (compensated) stage of shock, which of the following lab values would most likely be observed? (Select all that apply.)
A. Increased epinephrine
B. Increased norepinephrine
C. Increased serotonin
D. Decreased epinephrine
E. Decreased norepinephrine
F. Decreased serotonin
Correct Answers: A. Increased epinephrine, B. Increased norepinephrine
Rationale:
Incorrect Answers:
Which of the following statements are true about vasodilators? (Select all that apply.)
A. Increases preload
B. Increases afterload
C. We want to monitor for tachycardia
D. Decreases the demands of the heart
E. The patients are put at risk for bleeding
F. Epinephrine is an example
Correct Answers: C. We want to monitor for tachycardia, D. Decreases the demands of the heart
Rationale:
Which of the following are risk factors for developing cardiogenic shock? (Select all that apply.)
A. Alkalosis
B. Severe hypoxemia
C. Arrhythmias
D. Pulmonary embolism
E. Myocardial infarction (MI)
F. Sepsis
Correct Answers: B. Severe hypoxemia, C. Arrhythmias, E. Myocardial infarction (MI)
Rationale:
The incorrect options:
Which findings could indicate that a patient has intravascular volume loss? (Select all that apply.)
A. Capillary refill greater than 3 seconds
B. Bradycardia
C. Mental status changes
D. Increased WBC
E. Cool, clammy skin
F. Urticaria
Correct Answers: A. Capillary refill greater than 3 seconds, C. Mental status changes, & E. Cool, clammy skin
Rationale:
Which of the following findings would the nurse expect to observe in a patient in obstructive shock due to cardiac tamponade? (Select all that apply.)
A. Dyspnea
B. Distended neck veins
C. Bounding central pulses
D. Hypotension
E. Angioedema
F. Muscle spasms
Correct Answers: A. Dyspnea, B. Distended neck veins, D. Hypotension
Rationale: