*SUPERF-INGimportant* 23Qw/exp cardiogenic shock, hypovolemic shock, distributive (septic) shock, anaphylactic shock, , central venous access device

The nurse is caring for a client with papillary muscle rupture. When assessing the client, the nurse is alert to the development of symptoms related to _________ shock? 1. Cardiogenic 2. Anaphylactic 3. Neurogenic 4. Septic

1. Cardiogenic The papillary muscle holds the valves in place and may be damaged during MI, the most common reason for cardiogenic shock. Anaphylactic shock develops from hypersensitivity reactions. Neurogenic shock results from spinal cord injury or vasodilatation below the level of spinal anesthesia, and septic shock results from overwhelming infection.

The nurse is preparing medications for a patient being treated for cardiogenic shock. Which medications will the nurse most likely provide to this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Dopamine 2. Norepinephrine 3. Dobutamine 4. Epinephrine 5. Phenylephrine

1. Dopamine 2. Norepinephrine 3. Dobutamine 5. Phenylephrine Rationale 1: Dopamine is commonly used in the treatment of cardiogenic shock. Rationale 2: Norepinephrine is commonly used in the treatment of cardiogenic shock. Rationale 3: Dobutamine may be used in the patient with cardiogenic shock who has an adequate blood pressure. Rationale 4: Epinephrine is not used in the treatment of cardiogenic shock. Rationale 5: Phenylephrine is a vasopressor and may be used in the patient with cardiogenic shock who is receiving dobutamine.

The nurse is caring for a patient who is experiencing cardiogenic shock as a result of myocardial infarction. Which of the following assessments would concern the nurse the most? 1. Pao2 60 mm/hg 2. blood pressure 100/56 mm Hg 3. urine output 260 cc/8 hrs 4. heart rate 96

1. Pao2 60 mm/hg A PaO2 of 60 is below the normal of 80 to 100 mm Hg. The patient experiencing cardiogenic shock will exhibit hypotension and tachycardia and therefore a blood pressure of 100/56 mm Hg and heart rate of 96 would not apply. A urine output of 260 cc/8 hrs is borderline but not reportable without a continued trending pattern.

A patient with cardiomyopathy is demonstrating signs of cardiogenic shock. The nurse realizes that this type of shock is due to: 1. Reduced cardiac output 2. Increased stroke volume 3. Reduced blood volume 4. Blood flow blocked in the pulmonary circulation

1. Reduced cardiac output In cardiogenic shock, cardiac output is reduced, leading to poor tissue perfusion.

The nurse is caring for a client with hypovolemic shock from trauma. Administration of albumin is indicated for:(Select all that apply) 1. Supporting the client's blood pressure 2. Increasing plasma volume 3. Improving the oxygen-carrying capacity 4. Prevent bleeding 5. Preventing febrile transfusion reactions

1. Supporting the client's blood pressure 2. Increasing plasma volume Albumin is a colloid volume expander and will support the client's blood pressure

The nurse is caring for a patient with hypovolemic shock. The nurse should realize that this patient's heart sounds will change in which way? 1. diminished S2 2. accentuated S2 3. diminished S1 and S2 4. no change in S1 or S2

1. diminished S2 The S2 sound diminishes due to a fall in blood pressure. An accentuated S2 may be heard with HTN, exercise, excitement, and conditions of pulmonary HTN such as CHF and cor pulmonale. S1 diminishes with first-degree heart block, mitral regurgitation, CHF, CAD, and pulmonary or systemic HTN. The nurse should expect a change in the S2 sound.

The nurse suspects that a patient diagnosed with a myocardial infarction is developing cardiogenic shock. What manifestation did the nurse assess to come to this conclusion? 1. jugular vein distention 2. warm extremities 3. laryngospasm 4. urticaria

1. jugular vein distention Jugular vein distention is seen in cardiogenic shock. Warm extremities are seen in early septic shock and anaphylactic shock. Laryngospasm and urticaria are seen in anaphylactic shock.

The client is recovering from hypovolemic shock. The nurse hangs a bag of normal human serum albumin and educates the client about this fluid. The nurse evaluates that learning has occurred when the client makes which statement? 1. "It is a liquid that has electrolytes in it to pull water into my blood vessels.". 2. "It is a protein that pulls water into my blood vessels.". 3. "It is a protein that causes my kidneys to conserve fluid.". 4. "It is a super-concentrated salt solution that helps me conserve body fluid.".

2. "It is a protein that pulls water into my blood vessels.". Colloids are proteins or other large molecules that stay suspended in the blood for long periods because they are too large to easily cross membranes. They draw water molecules from the cells and tissues into the blood vessels through their ability to increase plasma oncotic pressure. Crystalloids are intravenous (IV) solutions that contain electrolytes, not proteins, in concentrations resembling those of plasma. They are used to replace lost fluids and promote urine output. Normal human serum albumin does not act on the kidneys. Normal human serum albumin is not a concentrated saline solution.

The nurse is caring for a patient who has hypovolemic shock from hemorrhage. The nurse would expect to find which of the following clinical manifestations? 1. bradycardia, hypothermia 2. decreased capillary refill, tachycardia 3. tightness in throat and chest, anxiety 4. hypotension, lactic acidosis

2. decreased capillary refill, tachycardia In a patient with hypovolemic shock because of hemorrhage, assessment findings will be related to intravascular fluid loss that include cool skin, decreased capillary refill, hypotension, orthostatic changes, tachycardia, and decreased urine output. Bradycardia and hypothermia are findings associated with spinal cord injury; tightness in throat and chest and anxiety are findings associated with anaphylaxis; and hypotension and lactic acidosis are findings associated with sepsis, all of which may result in hypovolemic shock states from other causes.

A patient has developed severe cardiogenic shock and is on a mechanical ventilator. The family asks why the patient's hands feel so cold. What is the nurse's best response? 1. "We keep the intensive care unit cool to reduce patients' metabolic rates." 2. "The patient has developed a fever and chills." 3. "This happens frequently to patients in shock states." 4. "Blood vessels constrict in shock, which takes the blood away from hands and feet."

4. "Blood vessels constrict in shock, which takes the blood away from hands and feet." Vasoconstriction results from catecholamine release, which is a compensatory mechanism in shock. The diversion of warm blood away from the extremities results in cold hands and feet.

The nurse suspects that a patient is experiencing cardiogenic shock. Which parameter indicates that the nurse's suspicion is correct? 1. Cardiac output of 8.9 L/min 2. Pulmonary artery wedge pressure (PAWP) of 8 mm Hg 3. Central venous pressure (CVP) of 5 mm Hg 4. Cardiac index (CI) of 1.8 L/min/m2

4. Cardiac index (CI) of 1.8 L/min/m2 The cardiac index (CI) is a measure of cardiac output and tissue perfusion in relation to the patient's body surface area. This reading would be consistent with cardiogenic shock.

If the client is entering hypovolemic shock, the nurse anticipates which item to be a priority? 1. Maintenance of the client's airway 2. Administration of norepinephrine (Levophed) 3. Administration of sodium bicarbonate 4. Maintenance of volume

4. Maintenance of volume If the client has lost a significant amount of blood or other body fluids, immediate maintenance of blood volume through the administration of fluid and electrolytes or blood products is essential. Sodium bicarbonate may be administered to counteract the acidosis that can occur during shock. Norepinephrine would be administered in cardiogenic shock. The client's airway would be established as an initial action, and treatment of the underlying cause would follow next.

A client is diagnosed with cardiogenic shock. The nurse should plan interventions to address which of the following potential complications of this disorder? 1. Pulmonary embolism 2. Deep vein thrombosis 3. Renal failure 4. Myocardial infarction

4. Myocardial infarction In cardiogenic shock, there is a reduction in oxygenated arterial blood that decreases perfusion throughout the body. The most serious complication of cardiogenic shock is myocardial infarction. Pulmonary embolism, deep vein thrombosis, and renal failure are not considered the most serious complications of cardiogenic shock.

The patient has developed cardiogenic shock and is decompensating. What pattern of hemodynamic alterations does the nurse expect to find? A) High preload, high afterload, low cardiac index, tachycardia B) Low preload, low afterload, high cardiac index, bradycardia C) Low preload, high afterload, high cardiac index, tachycardia D) High preload, low afterload, high cardiac index, tachycardia

A) High preload, high afterload, low cardiac index, tachycardia

A nursing assessment of a patient with hypovolemic shock is most likely to reveal what assessment findings? Select all that apply. A) Tachycardia B) Oliguria C) Disoriented to time and place D) Diuresis E) Bradycardia F) Hypotension

A) Tachycardia B) Oliguria C) Disoriented to time and place F) Hypotension

When caring for a client in cardiogenic shock, the nurse plans to administer which of the following drugs to raise the blood pressure? A) aminophylline B) dopamine C) lanoxin D) furosemide

A) aminophylline Dopamine is a vasopressor drug that produces vasoconstriction and raises the blood pressure. Aminophylline is a bronchodilator. Lanoxin is a cardiac glycoside and strengthens cardiac contractility and slows conduction. Furosemide is a diuretic that promotes fluid loss. Application Implementation

The critical care nurse is caring for a patient who is in cardiogenic shock. What assessments must the nurse perform on this patient? Select all that apply. A) Platelet level B) Fluid status C) Cardiac rhythm D) Action of medications E) Sputum volume

B) Fluid status C) Cardiac rhythm D) Action of medications The critical care nurse must carefully assess the patient in cardiogenic shock, observe the cardiac rhythm, monitor hemodynamic parameters, monitor fluid status, and adjust medications and therapies based on the assessment data. Platelet levels and sputum production are not major assessment parameters in a patient who is experiencing cardiogenic shock.

A nurse reviews laboratory results for a client who was admitted for a myocardial infarction and cardiogenic shock 2 days ago. Which laboratory test result should the nurse expect to find? a. Blood urea nitrogen (BUN) of 52 mg/dL b. Creatinine of 2.3 mg/dL c. BUN of 10 mg/dL d. BUN/creatinine ratio of 8:1

a. Blood urea nitrogen (BUN) of 52 mg/dL Shock leads to decreased renal perfusion. An elevated BUN accompanies this condition. The creatinine should be normal because no kidney damage occurred. A low BUN signifies overhydration, malnutrition, or liver damage. A low BUN/creatinine ratio indicates fluid volume excess or acute renal tubular acidosis.

A client is hospitalized after a myocardial infarction. Which hemodynamic parameters does the nurse correlate with cardiogenic shock? (Select all that apply.) a. Decreased cardiac output b. Increased cardiac output c. Increased mean arterial pressure (MAP) d. Decreased MAP e. Increased afterload f. Decreased afterload

a. Decreased cardiac output d. Decreased MAP e. Increased afterload Myocardial infarction (MI) is a major cause of direct pump failure. With MI, cardiac output and MAP are decreased and afterload is increased. The other parameters do not correlate with pump failure

A client who has acidosis resulting from hypovolemic shock has been prescribed intravenous fluid replacement. Which fluid does the nurse prepare to administer? a. Normal saline b. Ringer's lactate c. 5% dextrose in water d. 5% dextrose in 0.45% normal saline

b. Ringer's lactate Ringer's lactate is an isotonic solution that acts as a volume expander. Also, the lactate acts as a buffer in the presence of acidosis. The other solutions do not contain any substance that would buffer or correct the client's acidosis.

The nurse would recognize cardiogenic shock from other types of shock by the data collection findings for which of the following? a. Bronchospasm b. Oliguria c. Pulmonary edema d. Tachypnea

c. Pulmonary edema The presence of pulmonary edema is what differentiates cardiogenic shock from other forms of shock.

The nurse is caring for a patient in cardiogenic shock who is being treated with an infusion of dobutamine (Dobutrex). The physician's order calls for the nurse to titrate the infusion to achieve a cardiac index of >2.5 L/min/m2 . The nurse measures a cardiac output, and the calculated cardiac index for the patient is 4.6 L/min/m2 . What is the best action by the nurse? a. Obtain a stat serum potassium level. b. Order a stat 12-lead electrocardiogram. c. Reduce the rate of dobutamine (Dobutrex). d. Assess the patient's hourly urine output.

c. Reduce the rate of dobutamine (Dobutrex). Dobutamine (Dobutrex) is used to stimulate contractility and heart rate while causing vasodilation in low cardiac output states improving overall cardiac performance. The patient's cardiac index is well above normal limits, so the rate of infusion of the medication should be reduced so as not to overstimulate the heart. There is no evidence to support the need for a serum potassium or 12-lead electrocardiogram. Assessment of hourly urine output is important in the care of the patient in cardiogenic shock, but it is not a priority in this scenario.

Nursing care for a client in hypovolemic shock caused by trauma should include a. giving narcotics for pain relief. b. maintaining a cool environment. c. placing the client in Trendelenburg position. d. providing nasogastric suctioning

d. providing nasogastric suctioning An early physiologic response to shock is a decrease in splanchnic circulation. This reduces blood supply to the stomach and bowel, causing inadequate gastrointestinal tissue perfusion and delayed gastric emptying; thus vomiting with aspiration of gastric contents into the lungs may occur. For this reason and for diagnostic purposes, nasogastric suction is often used during treatment of shock.