Pharm Chapter 28

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

Correct Answer: 1 Rationale 1: 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 (Albutein) does not act on the kidneys. Normal human serum albumin is not a concentrated saline solution.

The physician orders dopamine (Dopastat) intravenous (IV) for the patient in shock. What is a priority plan of the nurse with regard to administration of this drug? 1. Have phentolamine (Regitine) available in the room. 2. Have naltrexone (Revia) available in the room. 3. Have epinephrine (Adrenalin) available in the room. 4. Have flumazenil (Romazicon) available in the room.

Correct Answer: 1 Rationale 1: Extravasation of dopamine (Dopastat) can cause severe, localized vasoconstriction resulting in tissue necrosis. The antidote for this is phentolamine (Regitine). Epinephrine is used for anaphylaxis. Naltrexone (Revia) is used for opiate overdose. Flumazenil (Romazicon) is used for benzodiazepine overdose.

Examples of vasoconstrictors used to treat shock include all of the following except 1. propranolol (Inderal). 2. dobutamine (Dobutrex) 3. norepinephrine (Levophed). 4. phenylephrine (Neo-synephrine).

Correct Answer: 1 Rationale 1: Propranolol is a beta blocker used to treat hypertension. Rationale 2: Dobutamine is a vasoconstrictor used to treat vasodilatation and hypotension, which occur in shock. Rationale 3: Norepinephrine is a vasoconstrictor used to treat vasodilatation and hypotension, which occur in shock. Rationale 4: Phenylephrine is a vasoconstrictor used to treat vasodilatation and hypotension, which occur in shock.

The paramedics are transporting to the emergency department a patient who is experiencing shock. What will the nurse prepare in anticipation of the patients arrival? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Cardiac monitor 2. Pulse oximeter 3. Oxygen 4. Whole blood 5. Dextran 40

Correct Answer: 1,2 Rationale 1: When treating shock, the patient should be immediately connected to a cardiac monitor. Rationale 2: When treating shock, the patient should be immediately connected to a pulse oximeter. Rationale 3: Unless contraindicated, oxygen is administered via a nonrebreather mask. Rationale 4: The use of whole blood will be decided after the type of shock is determined. Rationale 5: The use of dextran 40 will be decided after the type of shock is determined.

The nurse is concerned that a patient receiving dobutamine (Dobutrex) is experiencing adverse effects from the medication. What did the nurse assess in the patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Palpitations 2. Drop in blood pressure 3. Cold extremities 4. Headache 5. Blurred vision

Correct Answer: 1,2,3 Rationale 1: Palpitations are an adverse effect of dobutamine (Dobutrex). Rationale 2: Hypotension is an adverse effect of dobutamine (Dobutrex). Rationale 3: Cold extremities are an adverse effect of dobutamine (Dobutrex). Rationale 4: Headache is an adverse effect of digoxin (Lanoxin). Rationale 5: Blurred vision is an adverse effect of digoxin (Lanoxin.)

A patient comes into the emergency department with systemic manifestations of anaphylaxis caused by a wasp sting. For which health problems would the nurse be concerned prior to administering epinephrine? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Premature ventricular contractions 2. Hypertension 3. Hyperthyroidism 4. Pheochromocytoma 5. Hypotension

Correct Answer: 1,2,3 Rationale 1: The drug must be used with caution in patients with dysrhythmias because epinephrine may worsen this condition. Rationale 2: The drug must be used with caution in patients with hypertension because epinephrine may worsen this condition. Rationale 3: The drug must be used with caution in patients with hyperthyroidism because epinephrine may worsen this condition. Rationale 4: Dopamine is contraindicated for pheochromocytoma. Rationale 5: Norepinephrine should not be administered to patients with hypotension.

The nurse is directed to prepare norepinephrine for administration to a patient. For which health problems is this medication indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Acute shock 2. Cardiac arrest 3. Septic shock 4. Hypovolemic shock 5. Cardiogenic shock

Correct Answer: 1,2,3 Rationale 1: The primary indication for norepinephrine is acute shock. Rationale 2: The primary indication for norepinephrine is cardiac arrest. Rationale 3: Norepinephrine is the vasopressor of choice for septic shock. Rationale 4: Dopamine is the medication of choice for hypovolemic shock. Rationale 5: Dopamine is the medication of choice for cardiogenic shock.

Prior to administering dopamine the nurse reviews a patients current medication history. For which medications would dopamine cause a drugdrug interaction? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. MAO inhibitor 2. Phenytoin 3. Beta blocker 4. Digoxin 5. Aspiring

Correct Answer: 1,2,3,4 Rationale 1: Concurrent administration with MAO inhibitors increases the alpha-adrenergic effects of dopamine. Rationale 2: Phenytoin may decrease the action of dopamine. Rationale 3: A beta blocker may inhibit the inotropic effect of dopamine. Rationale 4: Digoxin may increase the risk of dysrhythmias in the patient. Rationale 5: There is no evidence to suggest a drugdrug interaction will occur if dopamine is administered to a patient who takes aspirin.

The nurse works in a summer camp for children. One of the children says she was bitten by several wasps. The nurse plans to inject the child with epinephrine (EpiPen) if which symptoms are present? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The childs skin feels cold and clammy. 2. The child is thirsty. 3. The childs skin feels warm and dry. 4. The child is restless and confused. 5. The child is hyperactive and hyperverbal.

Correct Answer: 1,2,4 Rationale 1: General symptoms of shock include behavioral changes such as restlessness, anxiety, confusion, depression, and apathy. Thirst is a common complaint in shock. The skin may feel cold and clammy in shock. In shock, the skin is cold and clammy, not warm and dry. In shock, the patient will not be hyperactive or hyperverbal.

The patient will be receiving dopamine (Dopastat). What equipment will the nurse plan to obtain prior to infusion of this drug? 1. Oxygen cannula 2. Intravenous (IV) pump 3. Pulse oximeter 4. Sequential compression devices

Correct Answer: 2 Rationale 1: Inotropic medications are administered as a continuous infusion based on micrograms per kilograms per minute. Always infuse these medications via an intravenous (IV) pump. A pulse oximeter is an important piece of equipment, but not as important as an intravenous (IV) pump. An oxygen cannula is an important piece of equipment, but not as important as an intravenous (IV) pump. Sequential compression devices are important pieces of equipment, but not as important as an intravenous (IV) pump.

The physician has prescribed phenylephrine (Neo-Synephrine) for an elderly patient. What is an important nursing assessment prior to administration of this drug? 1. A history of type 1 diabetes mellitus 2. A history of narrow angle glaucoma 3. A history of dizziness 4. A history of human immunodeficiency virus (HIV) infection

Correct Answer: 2 Rationale 1: Vasoconstrictors may increase intraocular pressure, so the nurse should assess for narrow angle glaucoma. Dizziness is a general symptom and not specific to this drug. Type 1 diabetes mellitus is not adversely affected by administration of a vasoconstrictor drug. Human immunodeficiency virus (HIV) infection is not adversely affected by administration of a vasoconstrictor drug.

The patient is receiving normal serum albumin (Albuminar). What will be a priority outcome with this patient? 1. The patient will be normotensive, not hypertensive. 2. The patient will be free of a rash. 3. The patient will experience adequate breathing patterns. 4. The patient will remain alert and oriented.

Correct Answer: 3 Rationale 1: Albumin is a natural blood product and allergic reactions are possible. A serious symptom of an allergic reaction is dyspnea or difficulty breathing. Alertness and orientation are important, but are not priority outcomes. Hypotension, not hypertension, is a possible adverse outcome with normal serum albumin (Albuminar). A rash is a possible adverse outcome, but is not as much of a priority as dyspnea.

The patient comes to the emergency department with a severe allergic reaction to peanuts, and is in serious respiratory distress. The patients spouse tells the nurse that the patient has a known hypersensitivity to epinephrine (Adrenalin). What is the best response by the nurse? 1. I will let the physician know about this immediately; we will need to choose an alternative medication. 2. Im not sure what we can use then. Do you know what has been used before with this allergic response? 3. This is a life-threatening situation; a prior hypersensitivity is not an absolute contraindication. 4. This is a problem; we will need to use IV diphenhydramine (Benadryl).

Correct Answer: 3 Rationale 1: Although epinephrine is contraindicated for known hypersensitivity to the drug, in life-threatening situations there are no absolute contraindications to its use. Diphenhydramine (Benadryl) may not be the best choice, and the nurse must speak with conviction to decrease anxiety in the patient and spouse.

The patient has experienced hypovolemic shock as a result of severe burns. The physician orders a low dose of dopamine (Inotropin). What is the best evaluation by the nurse? 1. Vasoconstriction and increased blood pressure 2. Stabilization of fluid loss 3. Urinary output of at least 50 mL/hour 4. Increased cardiac output

Correct Answer: 3 Rationale 1: At low doses, dopamine (Inotropin) stimulates dopaminergic receptors, especially in the kidneys, leading to vasodilation and an increased blood flow through the kidneys. Increased cardiac output occurs with high, not low, doses of dopamine (Inotropin) when beta1-adrenergic receptors are stimulated. Vasoconstriction and increased blood pressure occurs with high, not low, doses of dopamine (Inotropin) when alpha-adrenergic receptors are stimulated. Dopamine (Inotropin) does not prevent or stabilize fluid loss.

Colloids differ from crystalloids in that 1. they contain electrolytes. 2. they readily leave the blood and enter cells. 3. they are too large to cross membranes. 4. they promote urine output.

Correct Answer: 3 Rationale 1: Colloids are made up of protein and other large molecules. Rationale 2: Crystalloids, not colloids, readily cross into cells. Colloids contain proteins that are too large to leave the blood. Rationale 3: Colloids contain proteins that are too large to leave the blood. Rationale 4: Crystalloids promote urine output, whereas colloids increase oncotic pressure.

A graduate nurse abruptly discontinues the intravenous (IV) norepinephrine (Levarterenol) once it has infused into the patient. What is the priority action of the more experienced nurse? 1. Obtain an oxygen saturation reading with a pulse oximeter. 2. Notify the physician. 3. Assess the patients blood pressure. 4. Administer oxygen via a rebreather mask.

Correct Answer: 3 Rationale 1: Discontinuation of vasopressor therapy is always gradual, due to the possibility of rebound hypotension and undesirable cardiac effects, so the nurse should immediately assess the patients blood pressure. The nurse will notify the physician, but the physician will want to know what the blood pressure is, so plan to assess blood pressure first. There is no indication to administer oxygen at this point. There is no indication to obtain an oxygen saturation percentage at this point.

The patient is in shock with a blood pressure of 60/20 mmHg. The physician orders isoproterenol (Isuprel) intravenously (IV). The family is quite anxious and asks what that liquid is for. What is the best response of the nurse? 1. This drug is a vasopressor and helps the heart beat more effectively, which will increase blood pressure. 2. Vasopressor drugs act on the renin-angiotension system and thus increase blood pressure. 3. This drug is a vasopressor and will help stabilize blood pressure by making the blood vessels smaller. 4. It is called a vasopressor and will help the kidneys increase and maintain blood pressure.

Correct Answer: 3 Rationale 1: In early shock, the body compensates for the fall in blood pressure by activating the sympathetic nervous system. The bodys ability is limited, so sympathomimetic vasoconstrictors, known as vasopressors, have been used to stabilize blood pressure in shock patients. Vasopressors do not act on the kidneys. Vasopressors do not increase cardiac contractility. Vasopressors do not affect the renin-angiotension system.

The young patient has a history of multiple allergies, and the physician prescribed epinephrine (EpiPen) for prevention of anaphylactic shock. The patients mother says to the nurse, I thought shock was about heart failure. What is the best response by the nurse? 1. There are many kinds of shock: heart failure, nervous system damage, loss of blood, and respiratory failure. 2. Allergic response is the most fatal type of shock; other types involve loss of blood, heart failure, and liver failure. 3. There are many kinds of shock that also include infection, nervous system damage, and loss of blood. 4. Heart failure is the most serious kind of shock; others include infection, kidney failure, and loss of blood.

Correct Answer: 3 Rationale 1: Obvious bleeding suggests hypovolemic shock, trauma to the brain or spinal cord suggests neurogenic shock, inadequate cardiac output would suggest cardiogenic shock, a recent infection may indicate septic shock, and a history of allergies with a sudden onset of symptoms may suggest anaphylactic shock. Kidney failure is not a type of shock. Respiratory failure is not a type of shock. Liver failure is not a type of shock.

The patient comes to the emergency department after suffering a bilateral traumatic amputation of his lower extremities. The physician orders normal serum albumin (Albuminar). The patient goes into shock. What will the best nursing assessment of this patient reveal? 1. B/P: 140/90 mmHg, P: 46, weak and irregular, R: 24, and shallow. 2. B/P: 50/0 mmHg, P: 126, weak and thready, R: 14, and shallow. 3. B/P: 80/20 mmHg, P: 122, weak and thready, R: 28, and shallow. 4. B/P: 130/88 mmHg, P: 90, bounding, R: 32, and shallow.

Correct Answer: 3 Rationale 1: The central problem with hypovolemic shock is the inability of the cardiovascular system to send sufficient blood to the vital organs, with the heart and brain being affected early in the progression of the disease. Assessing the patients cardiovascular status will result in a blood pressure that is low; a heart rate that may be rapid with a weak, thready pulse; and breathing that is rapid and shallow. A patient in shock will have a low blood pressure and a rapid, weak, not bounding, pulse. A patient in shock will have rapid respirations, a respiratory rate of 14 is considered normal. A patient in shock will have a low blood pressure; the heart rate will be rapid, not slowed.

The patient is receiving human serum albumin (Albutein) as treatment for shock. What is a priority assessment by the nurse? 1. Auscultate breath sounds for hyper-resonance. 2. Auscultate for an absence of breath sounds in the lower lobes. 3. Auscultate breath sounds for inspiratory stridor. 4. Auscultate breath sounds for crackles.

Correct Answer: 4 Rationale 1: Because human serum albumin (Albutein) pulls fluid into the vascular space, circulatory overload is a serious complication. The nurse must monitor breath sounds; crackles will be heard with pulmonary congestion. An absence of breath sounds is heard with a pneumothorax, not with pulmonary edema. Hyper-resonance is assessed by percussion, not auscultation. Stridor is auscultated with airway obstruction, not pulmonary edema.

A patient with cardiogenic shock would exhibit which of the following symptoms? 1. Bradycardia 2. Low temperature 3. Restlessness and anxiety 4. Tachycardia and low blood pressure

Correct Answer: 4 Rationale 1: Bradycardia is not associated with symptoms of shock. Rationale 2: Low temperature is not associated with metabolic changes Rationale 3: Restlessness and anxiety are typically associated with a neurogenic shock reaction. Rationale 4: Tachycardia and low blood pressure are associated with cardiogenic shock.

The patient is receiving norepinephrine (Levophed). When monitoring the patients blood pressure, the nurse notes a pressure of 230/120 mmHg. What is the priority nursing action? 1. Assess the patient for signs/symptoms of a stroke. 2. Notify the physician. 3. Slow the rate of the infusion until the physician assesses the patient. 4. Stop the infusion.

Correct Answer: 4 Rationale 1: Discontinuing the infusion results in a reversal of adverse effects such as hypertension. The nurse would notify the physician, but this should occur after discontinuing the infusion. The infusion must be stopped, not slowed, before the patient experiences the adverse effects of extreme hypertension.

Hypovolemic shock is different from neurogenic shock in that it relates to 1. an infectious process. 2. a brain or spinal cord trauma. 3. inadequate cardiac output. 4. volume depletion.

Correct Answer: 4 Rationale 1: Infectious process can indicate septic shock. Rationale 2: Brain or spinal cord trauma is possibly neurogenic shock. Rationale 3: Inadequate cardiac output suggests cardiogenic shock. Rationale 4: Volume depletion occurs in hypovolic shock.

What would be the expected first treatment of shock? 1. Start an intravenous line. 2. Assess level of consciousness. 3. Take the blood pressure. 4. Maintain the airway.

Correct Answer: 4 Rationale 1: Starting an IV would be dependent on the type of shock being treated. Rationale 2: Assessing level of consciousness is important in neurological assessment, but not the first priority. Rationale 3: Taking the blood pressure is critical, but not first priority. Rationale 4: Maintaining the airway is the first priority and intervention of maintaining the ABCs of life support.

The mechanism of action of norepinephrine is to 1. cause increased blood flow. 2. increase heart rate. 3. decrease cardiac output. 4. produce vasoconstriction.

Correct Answer: 4 Rationale 1: Vasoconstrictors do not cause increased blood flow. Rationale 2: These drugs can decrease heart rate with inotropic effect. Rationale 3: Vasoconstrictors do not decrease cardiac output. They can help with inotropic effect. Rationale 4: Vasoconstrictors such as norepinephrine produce vasoconstriction of the vessels, thereby increasing blood pressure.