Shock EAQ Practice Quiz

A client who had a myocardial infarction develops cardiogenic shock despite treatment in the emergency department. Which client responses are related to cardiogenic shock? Select all that apply. a. Tachycardia b. Restlessness c. Warm, moist skin d. Decreased urinary output e. Bradypnea

a. Tachycardia b. Restlessness d. Decreased urinary output

A client who sustained serious burns now has a stress ulcer. Which clinical indicators of shock should the nurse immediately report to the primary healthcare provider? Select all that apply. a. Weakness b. Diaphoresis c. Tachycardia d. Cold extremities e. Flushed skin tone

a. Weakness b. Diaphoresis c. Tachycardia d. Cold extremities

A nurse assesses a client who is experiencing profound (late) hypovolemic shock. When monitoring the client's arterial blood gas results, which response does the nurse expect? a. Hypokalemia b. Metabolic acidosis c. Respiratory alkalosis d. Decreased carbon dioxide level

b. Metabolic acidosis

A client is admitted with full-blown anaphylactic shock that developed due to a type 1 latex allergic reaction. Which findings will the nurse observe upon assessment? Select all that apply. a. Stridor b. Fissuring c. Hypotension d. Dyspnea e. Cracking of the skin

a. Stridor c. Hypotension d. Dyspnea

A client who was in an automobile collision is now in hypovolemic shock. Why is it important for the nurse to take the client's vital signs frequently during the compensatory stage of shock? a. Arteriolar constriction occurs. b. The cardiac workload decreases. c. Contractility of the heart decreases. d. The parasympathetic nervous system is triggered

a. Arteriolar constriction occurs.

During the progressive stage of shock, anaerobic metabolism occurs. The nurse expects that initially the anaerobic metabolism will cause what? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis

a. Metabolic acidosis

The nurse concludes that a client is experiencing hypovolemic shock. Which physical characteristic supports this conclusion? a. Oliguria b. Crackles c. Dyspnea d. Bounding pulse

a. Oliguria

A client is diagnosed with gastric cancer, and a subtotal gastrectomy is performed. After surgery the client begins to hemorrhage. What clinical findings support the nurse's conclusion that the client is experiencing hypovolemic shock? Select all that apply. a. Oliguria b. Bradypnea c. Diaphoresis d. Tachycardia e. Hypertension

a. Oliguria c. Diaphoresis d. Tachycardia

A client has a colon resection with an anastomosis. What assessments by the nurse support a suspicion of impending shock? Select all that apply. a. Oliguria b. Lethargy c. Irritability d. Hypotension e. Slurred speech

a. Oliguria c. Irritability d. Hypotension

A nurse is assessing a client with cardiogenic shock. Which clinical findings should the nurse expect? Select all that apply. a. Pallor b. Agitation c. Tachycardia d. Narrow pulse pressure e. Decreased respirations

a. Pallor b. Agitation c. Tachycardia d. Narrow pulse pressure

The nurse is caring for a client who had a massive myocardial infarction and developed cardiogenic shock. Which clinical manifestations support these diagnoses? Select all that apply. a. Rapid pulse b. Deep respirations c. Warm, flushed skin d. Increased blood pressure e. Decreased urinary output

a. Rapid pulse e. Decreased urinary output

A client is in cardiogenic shock. Which explanation of cardiogenic shock should the nurse include when responding to a family member's questions about the condition? a. An irreversible phenomenon b. A failure of the circulatory pump c. Usually a fleeting reaction to tissue injury d. Generally caused by decreased blood volume

b. A failure of the circulatory pump

A client is considered to be in septic shock when what changes are assessed in the client's labwork? a. Blood glucose is 70-100 mg/dL b. An increased serum lactate level c. An increased neutrophil level d. A white blood count of 5000 cells/µL

b. An increased serum lactate level

The nurse is caring for a client who is experiencing cardiogenic shock. Which assessment findings support this diagnosis? Select all that apply. a. Polyuria b. Dyspnea c. Diaphoresis d. Tachycardia e. Hypertension

b. Dyspnea c. Diaphoresis d. Tachycardia

On the morning of surgery a client is admitted for resection of an abdominal aortic aneurysm. While awaiting surgery, the client suddenly develops symptoms of shock. Which nursing action is priority? a. Prepare for blood transfusions. b. Notify the surgeon immediately. c. Make the client nothing by mouth (NPO). d. Administer the prescribed preoperative sedative.

b. Notify the surgeon immediately. Immediate surgical intervention to clamp the aorta is necessary for survival; the aneurysm has ruptured Preparing for blood transfusions may be done eventually, but notifying the surgeon is the priority.

A client is experiencing hypovolemic shock with decreased tissue perfusion. Which information should the nurse consider when planning care? a. The body initially attempts to compensate by releasing more red blood cells. b. The body initially attempts to compensate by maintaining peripheral vasoconstriction. c. The body initially attempts to compensate by decreasing mineralocorticoid production. d. The body initially attempts to compensate by producing less antidiuretic hormone (ADH).

b. The body initially attempts to compensate by maintaining peripheral vasoconstriction. With shock, arteriolar vasoconstriction occurs, raising the total peripheral vascular resistance and shifting blood to the major organs

A client who is in hypovolemic shock has a hematocrit value of 25%. What does the nurse anticipate that the primary healthcare provider will prescribe? a. Lactated Ringer solution b. Serum albumin c. Blood replacement d. High molecular dextran

c. Blood replacement the expected hct for women = 37% to 47% for men = 42% to 52%

A healthcare provider in the emergency department identifies that a client is in cardiogenic shock. Which type of drug does the nurse anticipate will be prescribed? a. Loop diuretic b. Cardiac glycoside c. Sympathomimetic d. Alpha-adrenergic blocker

c. Sympathomimetic are vasopressors!!!

The nurse is caring for a client admitted with shock secondary to severe gastrointestinal bleeding. Once the client is stabilized, what intervention should the nurse do next? a. Monitor the peripheral pulses. b. Check the level of consciousness. c. Take a blood sample for laboratory tests. d. Control the bleeding with a pressure dressing

c. Take a blood sample for laboratory tests.

A nurse providing care to a client who had major abdominal surgery monitors the client for postoperative complications. Which clinical findings are indicators of impending hypovolemic shock? a. Diuresis, irritability, and fever b. Lethargy, cold skin, and hypertension c. Thirst, cool skin, and orthostatic hypotension d. Bounding pulse, restlessness, and slurred speech

c. Thirst, cool skin, and orthostatic hypotension

To prevent septic shock in the hospitalized client, what should the nurse do? a. Maintain the client in a normothermic state. b. Administer blood products to replace fluid losses. c. Use aseptic technique during all invasive procedures. d. Keep the critically ill client immobilized to reduce metabolic demands.

c. Use aseptic technique during all invasive procedures.

A client receiving a blood transfusion that was just initiated reports urticaria and difficulty breathing. The heart rate has increased, the blood pressure is falling, and the client is becoming extremely apprehensive. Which type of shock does the nurse suspect the client is experiencing? a. Septic shock b. Cardiogenic shock c. Neurogenic shock d. Anaphylactic shock

d. Anaphylactic shock

What is the term for shock associated with a ruptured abdominal aneurysm? a. Vasogenic shock b. Neurogenic shock c. Cardiogenic shock d. Hypovolemic shock

d. Hypovolemic shock

Which complication of anaphylactic shock in the adolescent client is most important for the nurse to detect early? a. Urticaria b. Tachycardia c. Restlessness d. Laryngeal edema

d. Laryngeal edema

A client undergoes a bowel resection. When assessing the client 4 hours postoperatively, the nurse identifies which finding as an early sign of shock? a. Respirations of 10 b. Urine output of 30 mL/hour c. Lethargy d. Restlessness

d. Restlessness