Critical Care exam 3
The client is diagnosed with neurogenic shock. Which signs/symptoms should the nurse assess in this client? 1. Cool moist skin 2. Bradycardia 3. Wheezing 4. Decreased Bowel sound
ANS: 2 Feedback: this is the only shock that has decreased heart rate
The client diagnosed with Paricaditis has the following health-care provider orders. Which HCP order has the highest priority? 1. Provide clear liquid diet 2. Initiate IV antibiotic therapy 3. Obtain STAT chest x-ray 4. Perform hourly glucose check
ANS: 2 Feedback: you need to deliver antibiotics to this patient within the hour of order.
You are caring for a client in the compensation stage of shock. You know that one of the body's mechanisms of compensation in this stage of shock is the renin-angiotensin-aldosterone system. What does this system do? A) Increases catacholamine secretion B) Increases the production of antidiuretic hormone C) Restores blood pressure D) Decreases peripheral blood flow
ANS: 8
. A patient has been admitted with anaphylactic shock due to an unknown allergen. The nurse understands that the decrease in the patients cardiac output is the result of which mechanism? a. Peripheral vasodilation b. Increased venous return c. Increased alveolar ventilation d. Decreased myocardial contractility
ANS: A
A 48-year-old man presents to the ED complaining of severe substernal chest pain radiating down his left arm. He is admitted to the coronary care unit (CCU) with a diagnosis of myocardial infarction (MI). What nursing assessment activity is a priority on admission to the CCU? A) Begin ECG monitoring. B) Obtain information about family history of heart disease. C) Auscultate lung fields. D) Determine if the patient smokes.
ANS: A
A client is admitted to the emergency department after a motorcycle accident. Upon assessment, the client's vital signs reveal blood pressure of 80/60 mm Hg and heart rate of 145 beats per minute. The client's skin is cool and clammy. Which medical order for this client will the nurse complete first? A) 100% oxygen via a nonrebreather mask B) C-spine x-rays C) Two large-bore IVs and begin crystalloid fluids D) Type and cross match
ANS: A
A nurse assesses a client who is in cardiogenic shock. What statement best indicates the nurse's understanding of cardiogenic shock? A) A decrease of cardiac output and evidence of tissue hypoxia in the presence of adequate intravascular volume. B) A decrease in cardiac output and evidence of inadequate circulating blood volume and movement of plasma into interstitial spaces. C) Generally caused by decreased blood volume. D) Due to severe hypersensitivity reaction resulting in massive systemic vasodilation.
ANS: A
A nurse identifies which of the following as a cause for increased central venous pressure? A) Fluid overload B) Dehydration C) Hyperlipidemia D) Hyperglycemia
ANS: A
A nurse is evaluating the treatment of a patient with septic shock. Which of the following hemodynamics would the nurse identify with therapeutic treatment ? A) decreased preload, decreased blood pressure, decreased afterload, and increased heart rate B) increased preload, increased blood pressure, decreased heart rate, and increased afterload C) Decreased preload, decreased blood pressure, decreased heart rate, and decreased afterload D) Increase preload, increase Heart rate, decrease afterload and increase blood pressure
ANS: A
A nurse recognizes septic shock as having which of the following hemodynamics? A) decreased preload, decreased blood pressure, decreased afterload, and increased heart rate B) increased preload, increased blood pressure, decreased heart rate, and decreased afterload C) Decreased preload, decreased blood pressure, decreased heart rate, and decreased afterload D) Increase preload, increase Heart rate, decrease afterload and increase blood pressure
ANS: A
A patient is recovering from an MI and is currently in the first stage of recovery. The nurse knows that this stage consist of which of the following? A) Education about follow up appointments B) Monitoring exercise through a tele C) supervising a patients exercise D) Allowing the patient to exercise but not having to monitor them with a tele
ANS: A
A patient was complaining of of chest pain and upon assessment this patient has an elevated tropin with an ST depression. The nurse understands this as being associated with which of the following issues? A) Non STIMI B) Arrrythmias C) STIMI D) Increased Potassium levels
ANS: A
The nurse is caring for a patient in cardiogenic shock. The nurse recognizes that the patient's symptoms are the result of what problem? a. Inability of the heart to pump blood forward b. Loss of circulating volume and subsequent decreased venous return c. Disruption of the conduction system when reentry phenomenon occurs d. Suppression of the sympathetic nervous system
ANS: A
The nurse is caring for a patient who has been diagnosed with an elevated cholesterol level. The nurse is aware that plaque on the inner lumen of arteries is composed chiefly of what? A) Lipids and fibrous tissue B) White blood cells C) Lipoproteins D) High-density cholesterol
ANS: A
The nurse knows when the cardiovascular system becomes ineffective in maintaining an adequate mean arterial pressure (MAP). Select the reading below that indicates tissue hypoperfusion. A) 60 mm Hg B) 70 mm Hg C) 80 mm Hg D) 90 mm Hg
ANS: A
When developing a teaching plan for a client with endocarditis, which of the following points is most essential for the nurse to include? A) "Report fever, anorexia, and night sweats to the physician." B) "Take prophylactic antibiotics after dental work and invasive procedures." C) "Include potassium rich foods in your diet." D) "Monitor your pulse regularly."
ANS: A
A patient is admitted to the emergency department after sustaining abdominal injuries and a broken femur from a motor vehicle accident. The patient is pale, diaphoretic, and is not talking coherently. Vital signs upon admission are temperature 98 F (36 C), heart rate 130 beats/minute, respiratory rate 34 breaths/minute, blood pressure 50/40 mmHg. The healthcare provider suspects which type of shock? a.) Hypovolemic b.) Cardiogenic c.) Neurogenic d.) Distributive
ANS: A Feedback: The indicators of hypovolemic shock is the low BP and elevated heart rate. Furthermore, trauma is associated with this kind of shock
A patient is admitted with a brain and spinal cord injury secondary to a motor vehicle crash. The nurse is monitoring the patient for signs of neurogenic shock. Clinical findings in neurogenic shock are related to which pathophysiologic process? a. Loss of sympathetic nervous system innervation b. Parasympathetic nervous system loss c. Injury to the hypothalamus d. Focal injury to cerebral hemispheres
ANS: A Feedback: SNS goes on vacation and PNS takes over causing decrease HR and vasodilation as well as relative hyopvolemia
A nursing instructor is educating a nursing student about the treatment of Unstable angina. Which of the following treatments would the instructor include? (elect all that apply) A) give nitroglycerin only after you assess blood pressure B) Administer PRN dose of dopamine C) Administer morphine to relieve patients pain D) Administer dobutamine as needed E) Administer O2 to increase the blood supply in the myocardium
ANS: A, C,E Feedback: this treatment back includes MONA morphine oxygen nitroglycerin and antiplatlets
Which mechanisms responsible for a myocardial infarction (MI)? (Select all that apply.) a. Coronary artery thrombosis b. Plaque rupture c. Coronary artery spasm near the ruptured plaque d. Preinfarction angina e. Hyperlipidemia
ANS: A,B,C
A patient is being admitted with septic shock. The nurse appreciates that the key to treatment is finding the cause of the infection. Which cultures would the nurse obtain before initiating antibiotic therapy? (Select all that apply.) a. Blood cultures 2 b. Wound cultures c. Urine cultures d. Sputum cultures e. Complete blood count (CBC) with differential
ANS: A,B,C,D Feedback: culture everything
A nurse is is assessing a patient with IABP . Which of the following would signify that the treatment is working? (Select all that apply) A) Alert and oriented times 4 B) Increased urine output C) Decreased pedal pulses D) Increased BP E) Decreased urine output
ANS: A,B,D
A nurse is caring for a patient post IABP. Which of the following nursing interventions should the nurse expect to preform? (Select all that apply) A) Assess pedal pulses hourly B) Monitor in's and out's C) Assess for JVD D) Monitor for bleeding E) Have patient on bed rest while balloon pump is in
ANS: A,B,D,E
A nurse caring for a patient diagnosed with atherosclerosis. the nurse is educating about cholesterol management, which of the following would the nurse include in this pt teaching? A) Have a lot of fish in your diet B) smoking cessation C) Increase your red meat consumption D) Include yogurt in your diet E) include 30 mins of exercise 5 days a week F) Include more oats in your diet
ANS: A,B,D,E,F Feedback: the best diet for a pt trying to control their cholesterol is the Mediterranean diet. you should further advice them to avoid tobacco use and manage their blood sugar.
A nurse is evaluating a patient who has had a IABP place. Which of the following would indicate to the nurse that this procedure worked? (Select all that apply) A) increased urine output B) pedal pulses strong bilaterally C) Slight hematoma over groin sight D) Pt is able to ambulate without shortness of breath E) pt is alert and oriented times 4
ANS: A,B,E
A nursing instructor is teaching a group of students about things that affect the contractility of the heart. The instructor knows teaching is effective when a student identifies which of the following factors affect the contractility of the heart? (Select all that apply) A) Coronary blood flow B)Decreased MAP C) Inotropic drugs, D) Physiologic depressants E) increased SVR
ANS: A,C,D
A patient has come into the ER with sever chest pain when they were mowing their lawn but has since then been relieved. The doctor suspects this patient has stable angina. Which of the following can the nurse expect to be apart of this patients treatment plan? (Select all that apply) A) Nitroglycerin tablets B) levephed C) Give O2 D) metaprolol E) Cardizem
ANS: A,C,D,E Feedback: The goal is to reduce O2 demands on the heart. you can do this by using vasodilators like nitroglycerin, beta blockers such as metaprolol and calcium channel blockers. furthermore, these patients may benefit from O2 and anti-platelet
A nurse is caring for a patient who has experienced a with NON STIMI which of the following nursings interventions should the nurse expect to do? (Select all that apply) A) Check vital signs after 15 minutes B) make them a one plus assist to the commode C) Encourage a diet of high fiber and low sodium D) Educate to stop smoking, try vaping instead. E) Comfort the patients anxiety
ANS: A,C,E
A client is being cared for in the Neurological Intensive Care Unit following a spinal cord injury. Which assessment finding indicates that the client may be experiencing neurogenic shock? A) HR, 120 bpm; BP, 88/58 mm Hg B) HR, 48 bpm; BP, 90/60 mm Hg C) Shortness of breath D) Cool, moist skin
ANS: B
A nurse identifies which of the following medications as being used to increase cadiac output? A) levophede B) DIgoxin C) dobutamine D) Cardizem
ANS: B
A nurse is assessing a patient who has experienced an infection of a surgical wound. the nurse notices that the patient is pale and cyanotic. Upon further inspection the nurse sees that the patient has become lethargic and has a decreased Co2 levels and an increased HR. Which of the following stages of shock would the nurse identify this patient as being in? A) progressive B) Compensatory C) Initiation D) Refractory
ANS: B
A nurse recognizes which of the following conditions is associated with a predictable level of pain that occurs as a result of physical or emotional stress? A) Anxiety B) Stable angina C) Unstable angina D) Variant angina
ANS: B
A patient has been admitted with septic shock related to tissue necrosis. The nurse knows the initial goal for medical management for this patient is which intervention? a. Limiting fluids to minimize the possibility of heart failure b. Finding and eradicating the cause of infection c. Discontinuing invasive monitoring as a possible cause of sepsis d. Administering vasodilator substances to increase blood flow to vital organs
ANS: B
An adult patient is admitted to the ED with chest pain. The patient states that he had developed unrelieved chest pain that was present for approximately 20 minutes before coming to the hospital. To minimize cardiac damage, the nurse should expect to administer which of the following interventions? A) Thrombolytics, oxygen administration, and nonsteroidal anti-inflammatories B) Morphine sulphate, oxygen, and bed rest C) Oxygen and beta-adrenergic blockers D) Bed rest, albuterol nebulizer treatments, and oxygen
ANS: B
Following a motor vehicle collision, a client is admitted to the emergency department with a blood pressure of 88/46, pulse of 54 beats/min with a regular rhythm, and respirations of 20 breaths/min with clear lung sounds. The client's skin is dry and warm. The nurse assesses the client to be in which type of shock? A) Cardiogenic B) Neurogenic C) Septic D) Anaphylactic
ANS: B
The nurse is caring for a client newly diagnosed with sepsis. The client has a serum lactate concentration of 6 mmol/L and fluid resuscitation has been initiated. Which value indicates that the client has received adequate fluid resuscitation? A) ScvO2 of 60% B) Mean arterial pressure of 70 mm Hg C) Central venous pressure of 6 mm Hg D) Urine output of 0.2 mL/kg/hr
ANS: B
What parameter must be assessed frequently in the patient with an intraaortic balloon in place? a. Skin turgor in the affected extremity b. Peripheral pulses distal to the insertion site c. Blood pressures in both arms and legs d. Oxygen saturation
ANS: B
Which of the following actions is the first priority of care for a client exhibiting signs and symptoms of coronary artery disease? A) Decrease anxiety B) Enhance myocardial oxygenation C) Administer sublingual nitroglycerin D) Educate the client about his symptoms
ANS: B
A nurse is caring for a patient with septic shock. The nurse knows to assess the patient carefully for which of the following lethal complications? A) Increased preload causing respiratory issues B) DIC from decreased clotting factors C) Super bug from antibiotic use D) Arrhythmia from use of vasopressors
ANS: B Feedback: The bacterial infection that causes septic shock also causes continuous damage to tissues and cells causing bleeding and then coagulation which eventually leads to the body running out of clotting factors leading to DIC A) With septic shock you have decreased preload C) this is not a lethal issue, and usally doesnt come about unless you do not finish you antibiotic therapy D) This could oocur however, this is why we give fluids before giving vasopressors in an attempt to get the BP up.
A 78-year-old man has confusion and temperature of 104° F (40° C). He is a diabetic with purulent drainage from his right heel. After an infusion of 3 L of normal saline solution, his assessment findings are BP 84/40 mm Hg; heart rate 110; respiratory rate 42 and shallow; CO 8 L/minute; and PAWP 4 mm Hg. This patient's symptoms are most likely indicative of a.sepsis. b.septic shock. c.multiple organ dysfunction syndrome d.systemic inflammatory response syndrome
ANS: B Feedback: The pts fever, confusion and purulent drainage are indicators of an infection. Furthermore, the pt has a decreased BP, increased HR and a decreased CO with shallow breathing which can indicate increased preload. These are all symptoms of a septic shock
A nurse is assessing a patient and finds that their MAP is 50. The nurse understands this indicates which of the following? A) There is too much oxygen going to non vital organs B) Circulation to vital organs may be compromised and poor tissue perfusion C) Shock is occurring D) The body has enough consistent pressure in your arteries to deliver blood throughout your body
ANS: B Feedback: This is a low MAP normal is 70. A low MAP indicates that there is not enough consistent pressure to the arteries so the blood is not being distributes evenly through the body.
A nurse would identify which of the following hemodynamics as being correlated with cardiogenic shock? A) Increased CVP as well as PA and decreased SVR and PVR with an increase HR and BP B) Increased CVP and PA as well as increased SVR and PVR with a decrease BP and in increased HR C) Increased CVP and PVR as well as increase SVR and PA with a decreased BP and HR D) Decreased SVR and PVR as well as PA and CVP with a decreased HR and increased BP
ANS: B Feedback: this patient will present with an increased preload as well as an increased afterload. You will also notice this patient will have an increased HR and a decreased blood pressure
A nurse is treating a patient with unstable angina, who reports increased chest pain. Which of the following is the priority for this nurse? A) Administer sublingual does of nitroglycerin B) Check patients blood pressure C) Make sure a stress test has been ordered D) Call the doctor and report findings
ANS: B Feedback: you want to give nitroglycerin but before you do you must assess BP
2.The healthcare provider is caring for a patient with a diagnosis of hemorrhagic pancreatitis. The patient's central venous pressure (CVP) reading is 2 (low), blood pressure is 90/50 mmHg, lung sounds are clear, and jugular veins are flat. .What type of treatment would the nurse expect for this patient? A) Diuretics B) IV Fluids C) Dopamine D) Dobutamine
ANS: B Feedback: This patient is experiencing low preload which is a volume issue. This patient can be treated with fluids.
A nurse understands that which of the following patients would benefit from arterial pressure monitoring? A) A patient who is developing sepsis B) A critically ill patient being given a vasodilator C) A patient with increased pulmonary artery pressure and is experiencing dyspnea D) A patient who is experiencing decreased tissue to perfusion
ANS: B Feeedback: A arterial line monitor is done in the radial pulse and is used for a real time blood pressure monitoring. C) this patient needs to be monitored with the pulmonary artery monitor. D) this patient will be monitored by the serum lactate level
The nurse is caring for a patient who what just admitted with septic shock. The nurse knows that certain interventions should be completed within 3 hours of time of presentation. Which intervention would be a priority for the nurse to implement upon receipt of the practitioners order? a. Administer fresh frozen plasma b. Obtain a serum lactate level c. Administer epinephrine d. Measure central venous pressure
ANS: B Feedback: According to the Surviving Sepsis Campaign Bundles, the following interventions should be completed within 3 hours of time of presentation 1. Measure lactate level. 2. Obtain blood cultures prior to administration of antibiotics. 3. Administer broad spectrum antibiotics. 4. Administer 30 mL/kg crystalloid for hypotension or lactate 4 mmol/L
A patient has been admitted with hypovolemic shock due to blood loss. Which finding would the nurse expect to note to support this diagnosis? a. Distended neck veins b. Decreased level of consciousness c. Bounding radial and pedal pulses d. Widening pulse pressure
ANS: B Feedback: Signs of hypovolemia include flattened neck veins, a decreased level of consciousness, weak and thready peripheral pulses, and a narrowed pulse pressure
The following pt come into a clinic. The nurse would identify which of the following as most at risk for an MI? (Select-all-that-apply) A. A 35 year old patient who exercises 3 times per week for 30 minutes a day and has a history of cervical cancer B. A 25 year old male with a BMI of 30 and reports smoking 2 packs of cigarettes a day C. A 45 year old female that reports her father died at the age of 42 from a myocardial infraction. D. A 29 year old that has type I diabetes. E. A 55 African american male who broke his leg while jogging
ANS: B,C,D
A patient in cardiogenic shock is being treated in the critical care unit. Which findings would the nurse expect to note in the patient to support this diagnosis? (Select all that apply.) a. Warm, dry skin b. Heart rate greater than 100 beats/min c. Weak, thready pulse d. Increased right atrial pressure e. Decreased pulmonary artery occlusion pressure
ANS: B,C,D Feedback this is considered a cold shock. So the patient would be cool and pale. With a weak pulse because of the increased afterload. and the SNS that is stimulated because of the decreased tissue perfusion and low BP would increase the HR
. A patient with coronary artery disease (CAD) is admitted with chest pain. The patient is suddenly awakened with severe chest pain. Three nitroglycerin sublingual tablets are administered 5 minutes apart without relief. A 12-lead electrocardiograph (ECG) reveals nonspecific ST segment elevation. The nurse suspects the patient may have which disorder? a. Silent ischemia b. Stable angina c. Unstable angina d. Prinzmetal angina
ANS: C
A nurse recognizes anaphylactic shock as having which of the following hemodynamics? A) decreased PVR, increased CVP and PA, and decreased SVR B) Increased PVR, increased CVP and PA, and increased SVR C) Increased PVR, decreased CVP and PA, and decreased SVR D) Decreased PVR, increased CVP and PA, and decreased SVR
ANS: C
A patient is complaining about chest pain even at rest. The doctor has diagnosed the patient with prinzmatal's variant angina. The nurse knows that which of the following classes of medications will most likely be included in this patients treatment? A) Beta blockers B) Vasoconstrictors C) Calcium channel blockers D) Diuretics
ANS: C
A patient is recovering in the hospital from cardiac surgery. The nurse has identified the diagnosis of risk for ineffective airway clearance related to pulmonary secretions. What intervention best addresses this risk? A) Administration of bronchodilators by nebulizer B) Administration of inhaled corticosteroids by metered dose inhaler (MDI) C) Patients consistent performance of deep breathing and coughing exercises D) Patients active participation in the cardiac rehabilitation program
ANS: C
Assessment of a patient with pericarditis may reveal which signs and symptoms? a. Ventricular gallop and substernal chest pain b. Narrowed pulse pressure and shortness of breath c. Pericardial friction rub and pain d. Pericardial tamponade and widened pulse pressure
ANS: C
Based on this scenario, what stage of shock is this patient most likely experiencing: A 74-year-old patient is extremely confused and does not respond to commands or stimulation. The patient respiratory rate is 28 and labored, oxygen saturation 86%, heart rate 120, blood pressure 70/40, mean arterial pressure is 50 mmHg, and temperature is 97 'F. The patient's heart rhythm is atrial fibrillation. The patient's urinary output is 5 mL/hr. The patient's labs: blood pH 7.15, serum lactate 15 mmol/L, BUN 55 mg/dL, Creatinine 6 mg/dL. In addition, the patient is now starting to have slight oozing of blood around puncture sites.* A. Initial B. Proliferative C. Progressive D. Compensatory
ANS: C
The nurse assesses a BP reading of 80/50 mm Hg from a patient in shock. What stage of shock does the nurse recognize the patient is in? A) Initial B) Irreversible C) Progressive D) Compensatory
ANS: C
The nurse assesses a patient who experienced a reaction to a bee sting. The patient's clinical findings indicate a pre-shock condition, which is evidenced by: A) Crackles and shallow breathing. B) A heart rate of 140. C) Cold, clammy skin and tachycardia. D) A systolic blood pressure of 75 mm Hg.
ANS: C
The nurse developing a patient education plan for the patient with endocarditis. What information would be included in the plan? a. Endocarditis is a viral infection that is easily treated with antibiotics. b. The risk of this diagnosis is occlusion of the coronary arteries. c. A long course of antibiotics is needed to treat this disorder. d. Complications are rare after antibiotics have been started
ANS: C
The nurse is caring for a client diagnosed with septic shock. Which assessment data warrant immediate intervention by the nurse? A) Vital signs T 100.4 f P 104 R 26 BP 102/60. B) White blood count of 18,000 C) A urinary output of 90 mL in the last 4 hours D) The client complains of thirst
ANS: C
The nurse is caring for a client in septic shock. The nurse knows to closely monitor the client. What finding would the nurse observe when the client's condition is in its initial stages? A) A slow but steady pulse B) A weak and thready pulse C) A rapid, bounding pulse D) A slow and imperceptible pulse
ANS: C
The nurse is providing an educational workshop about coronary artery disease (CAD) and its risk factors. The nurse explains to participants that CAD has many risk factors, some that can be controlled and some that cannot. What risk factors would the nurse list that can be controlled or modified? A) Gender, obesity, family history, and smoking B) Inactivity, stress, gender, and smoking C) Obesity, inactivity, diet, and smoking D) Stress, family history, and obesity
ANS: C
What is a negative effect of IV nitroglycerin for shock management that the nurse should assess for in a client? A) Reduced afterload. B) Increased cardiac output. C) Decreased blood pressure. D) Reduced preload.
ANS: C
When a client is in the compensatory stage of shock, which symptom occurs? A) Bradycardia B) Urine output of 45 mL/hr C) Tachycardia D) Respiratory acidosis
ANS: C
A patient is admitted with a fever of unknown origin. The patient is complaining of fatigue, malaise, joint pain, and shivering. This pts vital signs are as follows temp, 103 F, heart rate, 90 beats/min; respiratory rate, 22 breaths/min; blood pressure, 132/78; and oxygen saturation, 94% on 2L nasal cannula. The patient has developed a cardiac murmur. The nurse suspects that the patient has developed which problem? a. Pericarditis b. Heart failure c. Endocarditis d. Pulmonary embolus
ANS: C Feedback: A symptom of endocarditis is fever and heart murmurs
A patient who has pericarditis related to radiation therapy, becomes dyspneic, and has a rapid, weak pulse. Heart sounds are muffled, and a 12 mmHg drop in blood pressure is noted on inspiration. The healthcare provider's interventions are aimed at preventing which type of shock? A) Cardiogenic B) Distributive C) Obstructive. D) Neurogenic
ANS: C Feedback: Obstructive shock has 3 causes: cardiac tamponade, tension pnumothorax and pulmonary embolisM. The fact that this patient was experiencing muffled heart sounds which is a symptom of cardiac tamponade
A nurse would identify which of the following assessment findings is an early indication of hypovolemic shock? a.) Diminished bowel sounds b.) Increased urinary output c.) Tachycardia d) Hypertension
ANS: C Feedback: Tachycardia is the only early sign listed. It is the bodies way of compensating for the low BP. Diminished bowel sounds, and decreased urinary output are later signs. and you would have decreased BP not increased.
A nurse is caring for a patient diagnosed with obstructive shock. Upon assessing this patient the nurse notices that they have a blood pressure of 90/50 and evident jugular vein distention. Further more the nurse notes that this patient has muffled heart sounds. Which of the following treatments can the nurse expect this patient to receive? A) Thrombolysis B) IBAP C) Pericardiocentesis D) Dobutamine
ANS: C Feedback: The cause of this patients obstructive shock is cardiac tamponade. As evidence by becks triad that this pt is presenting with. The treatment for cardiac tamponade is Pericardiocentesis . A) this is used to treat pulmonary emboli B) This is a treatment for cardiac shock D) This is a positive inotrope used for cardiogenic shock
A nurse is evaluating the treatment of a patient with cadiogenic shock. Which of the following hemodynamics would the nurse identify with therapeutic treatment ? A) Increased CVP as well as PA and decreased SVR and PVR with an increase HR and BP B) Increased CVP and PA as well as decreased SVR and PVR with a decrease BP and increased heart rate C) Decreased CVP and PA as well as decreased SVR and PVR with a increased BP and decreased HR D) Decreased SVR and PVR as well as PA and CVP with a decreased HR and increased BP
ANS: C Feedback: When looking for whether or not a treatment is therapeutic a nurse needs to see the opposite of the original hemodynamic. cardiogenic shock will have increased preload, increased afterload, increased HR, decreased BP
The healthcare provider is caring for a patient who has septic shock and a blood pressure of 90/50 Which of these should the healthcare provider administer to the patient first? a) Antibiotics to treat the underlying infection. b.) Corticosteroids to reduce inflammation. c.) IV fluids to increase intravascular volume. d.) Vasopressors to increase blood pressure
ANS: C Feedback: If the pts BP is low then you take care of that before anything else
A nurse is assessing the results from the patients SvO2 test. The nurse sees that the patients SvO2 level is 85%. This nurse would understand that this level would indicate which of the following? A) This patient has too much oxygen being administered to the tissues B) This patient is experiencing ischemia C) This patient has not enough oxygen going to the tissues D) This patient is experiencing hypovolemic shock
ANS: C Feedback: SvO2 measures the amount of O2 bound to hemoglobin returning to the right side - it reflex left sided left overs. Normal is 65-75% You do not want this higher than normal because that indicates that the body did not drop off the O2 on its way through he left side so the left side of the body does not have enough blood
Which statements are INCORRECT about the compensatory stage of shock. Select all that apply:* A. This stage is reversible. B. During this stage blood is shunted away from the kidneys, lungs, skin, and gastrointestinal system to the brain and heart. C. During this stage blood flow to the kidneys is reduced, which causes the kidneys to activate the renin-angiotensin system, and this will lead to major vasodilation to the arterial and venous system. D. One hallmark sign of this stage is that there is an increase in capillary permeability. E. A patient is at risk for a paralytic ileus during this stage.
ANS: C,D Feedback: hese options reflect INCORRECT statements about the compensatory stages and all the other stages are TRUE about this stage. Option C is wrong because although the kidneys activate the RAS, this does NOT lead to vasodilation but VASOCONSTRICTION to the arterial and venous system. Option D is wrong because this is a hallmark sign in the PROGRESSIVE stage not compensatory.
A client who was diagnosed with heart failure has developed cardiogenic shock as a complication of the condition and needs an intra-aortic balloon pump placed. Which of the following statements accurately describes an intra-aortic balloon? A) The catheter is typically inserted in the subclavian artery and inflated in the abdominal aortic artery B) The IABP increases systemic vascular resistance to strengthen the heart's ventricles C) The balloon inflates during systole to increase pressure in the aorta D) The balloon is regularly inflated and deflated to support the pumping action of the heart
ANS: D
A doctor is describing their diagnosis to a patient. The doctor says that the patients coronary arteries are spasming and there is reversible elevated ST segments on their EKG. The nurse understands the doctor is educating the patient about which of the following? A) Unstable angina B) Stable angina C) Non STIMI MI D) Prinzmatal's Variant angina
ANS: D
A nurse is assessing a patients lactate level. The nurse understands that this lab tells us which of the following information? A) The continuous monitoring of the patients blood pressure B) The right sided preload C) The patients left vertical functioning D) If the patient has decrease tissue perfusion
ANS: D
A nurse recognizes which of the following classes of medications is used to maximize cardiac performance in clients with heart failure by increasing ventricular contractility? A) Beta-adrenergic blockers B) Calcium channel blockers C) Diuretics D) Inotropic agents
ANS: D
A nurse understands that Which of the following is the primary reason for administering morphine to a client with an MI? A) To sedate the client B) To decrease the client's pain C) To decrease the client's anxiety D) To decrease oxygen demand on the client's heart
ANS: D
A patient is complaining of chest pain that continues to get worse and is unpredictable. The nurse would understand that these symptoms could indicate which of the following cardiac issues? A) prinzmatal varant angina B) Myocadial infarction C) Pericarditis D) Unstable angina
ANS: D
A patient presents to the walk-in clinic complaining of intermittent chest pain on exertion, which is eventually attributed to angina. The nurse should inform the patient that angina is most often attributable to what cause? A) Decreased cardiac output B) Decreased cardiac contractility C) Infarction of the myocardium D) Coronary arteriosclerosis
ANS: D
A patient reports having crushing chest pain that radiates to the jaw. You administer sublingual nitroglycerin and obtain a 12 lead EKG. Which of the following EKG findings confirms your suspicion of a possible myocardial infraction? A. absent Q wave B. QRS widening C. absent P-wave D. ST segment elevation
ANS: D
A patient with a known penicillin allergy develops anaphylactic shock after a dose of ampicillin was given in error. Which medication would the nurse administer first? a. Methylprednisolone b. Gentamicin c. Atropine d. Epinephrine
ANS: D
During what stage of shock does the body attempt to utilize the hormonal, neural, and biochemical responses of the body?* A. Refractory B. Initial C. Proliferative D. Compensatory
ANS: D
The nurse is developing a patient education plan for a patient with ineffective endocarditis. Which instruction would be included as part of that plan? a. Increase fluid intake to increase cardiac output. b. Take sodium replacement tablets to replace sodium lost with diuretics. c. Increase daily activity until shortness of breath occurs. d. Take prophylactic antibiotics before undergoing any invasive procedure.
ANS: D
The nurse obtains a blood pressure of 120/78 mm Hg from a patient in hypovolemic shock. Since the blood pressure is within normal range for this patient, what stage of shock does the nurse realize this patient is experiencing? A) Irreversible stage B) Progressive stage C) Initial stage D) Compensatory stage
ANS: D
Which stage of shock encompasses mechanical ventilation, altered level of consciousness, and profound acidosis? A) Compensatory B) Precompensatory C) Progressive D) Irreversible
ANS: D
Which stage of shock is best described as that stage when the mechanisms that regulate blood pressure fail to sustain a systolic pressure above 90 mm Hg? A) Irreversible B) Compensatory C) Refractory D) Progressive
ANS: D
A nurse recognizes neurogenic shock as having which of the following hemodynamics? A) Increased CVP as well as PA and decreased SVR and PVR with an increase HR and BP B) Increased CVP and PA as well as decreased SVR and PVR with a decrease BP and increased heart rate C) Increased CVP and PVR as well as increase SVR and PA with a decreased BP and HR D) Decreased SVR and PVR as well as PA and CVP with a decreased HR and decreased BP
ANS: D Feedback : This is the only shock that has decreased HR
A nurse is teaching an older patient about the signs and symptoms of a myocardial infarction. Which statement by the patient would indicate that the teaching was effective? a. "The pain in my chest may last a long time." b. "I will feel like I have an elephant sitting on the center of my chest." c. "The chest pain will be sharp and over the center of my chest." d. "The pain may not be severe and may not be in my chest."
ANS: D Feedback: Myocardial infarction in older adults is often associated with ST-segment depression rather than ST elevation. Sensation of chest pain may be altered and may be less intense and of shorter duration. Other atypical symptoms may include dyspnea, confusion, and failure to thrive, which result in unrecognized signs and symptoms of cardiac problems and delays in diagnosis and treatment.
The nurse is caring for a client in the compensation stage of shock. The nurse knows that one of the body's mechanisms of compensation in this stage of shock is the renin-angiotensin-aldosterone system. What does this system do? A) Increases catecholamine secretion B) Restores blood pressure C) Decreases peripheral blood flow D) Increases the production of antidiuretic hormone
ANS: b
A nurse would identify which of the following hemodynamics as being correlated with hypovolemic shock? A) increase preload, increased afterload, increased HR, increased BP B) increased preload, increased afterload, increased HR, decreased BP C) Decreased preload, increased afterload, decreased HR, decreased BP D) Increased preload, decreased afterload increased HR and increased BP
ANS: d
In the treatment of shock, which vasoactive drug results in reduced preload and afterload, reducing the oxygen demand of the heart? A) Dopamine B) Methoxamine C) Epinephrine D) Nitroprusside
ANS: d
Which classification of dysrhythmia is most common with an inferior wall infarction in the first hour after ST segment elevation myocardial infarction (STEMI)? a. Sinus tachycardia b. Multifocal PVCs c. Atrial fibrillation d. Sinus bradycardia
ANS: d
A patient has a spinal cord injury at T4. Vital signs include falling blood pressure with bradycardia. The nurse recognizes that the patient is experiencing which of the following? a) relative hypervolemia. b) an absolute hypovolemia c)neurogenic shock from low blood flow d) neurogenic shock from massive vasodilation.
ANS: d Feedback: Septic shock is a form of distributed shock and all distributed shocks cause vasodilation.
