Chapter 34: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome

The nurse is caring for a patient in hypovolemic shock secondary to cirrhosis of the liver. The nurse understands that this type of shock results from shifting of fluid into the abdominal cavity. What is the resulting hypovolemia called? A. Absolute hypovolemia B. Distributive hypovolemia C. Relative hypovolemia D. Compensatory hypovolemia

A. Absolute hypovolemia 𝘈𝘣𝘴𝘰𝘭𝘶𝘵𝘦 𝘩𝘺𝘱𝘰𝘷𝘰𝘭𝘦𝘮𝘪𝘢 𝘰𝘤𝘤𝘶𝘳𝘴 𝘸𝘩𝘦𝘯 𝘵𝘩𝘦𝘳𝘦 𝘪𝘴 𝘢 𝘭𝘰𝘴𝘴 𝘰𝘧 𝘧𝘭𝘶𝘪𝘥 𝘧𝘳𝘰𝘮 𝘵𝘩𝘦 𝘪𝘯𝘵𝘳𝘢𝘷𝘢𝘴𝘤𝘶𝘭𝘢𝘳 𝘴𝘱𝘢𝘤𝘦. 𝘛𝘩𝘪𝘴 𝘤𝘢𝘯 𝘳𝘦𝘴𝘶𝘭𝘵 𝘧𝘳𝘰𝘮... 𝘪𝘯𝘵𝘦𝘳𝘯𝘢𝘭 𝘴𝘩𝘪𝘧𝘵𝘪𝘯𝘨 𝘰𝘧 𝘧𝘭𝘶𝘪𝘥 𝘧𝘳𝘰𝘮 𝘵𝘩𝘦 𝘪𝘯𝘵𝘳𝘢𝘷𝘢𝘴𝘤𝘶𝘭𝘢𝘳 𝘴𝘱𝘢𝘤𝘦 𝘵𝘰 𝘵𝘩𝘦 𝘦𝘹𝘵𝘳𝘢𝘷𝘢𝘴𝘤𝘶𝘭𝘢𝘳 𝘴𝘱𝘢𝘤𝘦 (805).

A nurse is caring for a patient in septic shock due to urinary sepsis. Which pathophysiologic mechanism results in septic shock? A. Bacterial toxins lead to vasodilation. B. White blood cells are released to fight invading bacteria. C. Microorganisms invade organs such as the kidneys and heart. D. Decreased red blood cell production and fluid loss.

A. Bacterial toxins lead to vasodilation.

The nurse is caring for a patient in cardiogenic shock. The nurse recognizes that the patient's signs and 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

A. Inability of the heart to pump blood forward 𝘊𝘢𝘳𝘥𝘪𝘰𝘨𝘦𝘯𝘪𝘤 𝘴𝘩𝘰𝘤𝘬 𝘳𝘦𝘴𝘶𝘭𝘵𝘴 𝘧𝘳𝘰𝘮 𝘵𝘩𝘦 𝘪𝘮𝘱𝘢𝘪𝘳𝘦𝘥 𝘢𝘣𝘪𝘭𝘪𝘵𝘺 𝘰𝘧 𝘵𝘩𝘦 𝘷𝘦𝘯𝘵𝘳𝘪𝘤𝘭𝘦 𝘵𝘰 𝘱𝘶𝘮𝘱 𝘣𝘭𝘰𝘰𝘥 𝘧𝘰𝘳𝘸𝘢𝘳𝘥, 𝘸𝘩𝘪𝘤𝘩 𝘭𝘦𝘢𝘥𝘴 𝘵𝘰 𝘢 ↓ 𝘪𝘯 𝘚𝘵𝘳𝘰𝘬𝘦 𝘝𝘰𝘭𝘶𝘮𝘦 𝘢𝘯𝘥 𝘢𝘯 ↑ 𝘪𝘯 𝘵𝘩𝘦 𝘣𝘭𝘰𝘰𝘥 𝘭𝘦𝘧𝘵 𝘪𝘯 𝘵𝘩𝘦 𝘷𝘦𝘯𝘵𝘳𝘪𝘤𝘭𝘦 𝘢𝘵 𝘵𝘩𝘦 𝘦𝘯𝘥 𝘰𝘧 𝘴𝘺𝘴𝘵𝘰𝘭𝘦 (809).

A patient has been admitted in septic shock due to urinary sepsis. The practitioner inserts a pulmonary artery (PA) catheter. Which hemodynamic value would the nurse expect to find to support this diagnosis? A. Increased Cardiac output (CO) B. Increased Right atrial pressure (RAP) C. Increased Pulmonary artery occlusion pressure (PAOP) D. Increased Systemic vascular resistance (SVR)

A. Increased Cardiac output (CO)

The nurse is caring for a patient in cardiogenic shock. Which hemodynamic parameters would the nurse expect to find to support this diagnosis? A. Increased right atrial pressure B. Decreased pulmonary artery wedge pressure C. Increased cardiac output D. Decreased cardiac index

A. Increased right atrial pressure D. Decreased cardiac index 𝘚𝘺𝘮𝘱𝘵𝘰𝘮𝘴 𝘪𝘯𝘪𝘵𝘪𝘢𝘭𝘭𝘺 𝘳𝘦𝘧𝘭𝘦𝘤𝘵 𝘴𝘪𝘨𝘯𝘴 𝘰𝘧 ↓ 𝘪𝘯 𝘤𝘢𝘳𝘥𝘪𝘢𝘤 𝘰𝘶𝘵𝘱𝘶𝘵: 𝘗𝘵 𝘸𝘰𝘶𝘭𝘥 𝘩𝘢𝘷𝘦 𝘢𝘯 𝘪𝘯𝘤𝘳𝘦𝘢𝘴𝘦𝘥 𝘙 𝘢𝘵𝘳𝘪𝘢𝘭 𝘱𝘳𝘦𝘴𝘴𝘶𝘳𝘦 𝘢𝘯𝘥 𝘢 𝘊𝘢𝘳𝘥𝘪𝘢𝘤 𝘪𝘯𝘥𝘦𝘹 𝘓𝘌𝘚𝘚 𝘛𝘏𝘈𝘕 2.2 𝘓/𝘮𝘪𝘯/𝘮2; (𝘉𝘰𝘹 34.7, 810).

A patient has been admitted with hypovolemic shock due to traumatic blood loss. Which nursing measure can best facilitate the administration of large volumes of fluid? A. Inserting a large-diameter peripheral intravenous catheter B. Positioning the patient in the Trendelenburg position C. Encouraging the patient to drink at least 240 mL of fluid each hour D. Administering intravenous fluids under pressure with a pressure bag

A. Inserting a large-diameter peripheral intravenous catheter

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 stimulation C. Injury to the hypothalamus D. Focal injury to cerebral hemispheres

A. Loss of sympathetic nervous system innervation 𝘕𝘦𝘶𝘳𝘰𝘨𝘦𝘯𝘪𝘤 𝘴𝘩𝘰𝘤𝘬 𝘪𝘴 𝘵𝘩𝘦 𝘳𝘦𝘴𝘶𝘭𝘵 𝘰𝘧 𝘵𝘩𝘦 𝘭𝘰𝘴𝘴 𝘰𝘧 𝘴𝘺𝘮𝘱𝘢𝘵𝘩𝘦𝘵𝘪𝘤 𝘵𝘰𝘯𝘦. (801)

A patient has been admitted in anaphylactic shock due to an unknown allergen. The nurse understands that the decrease in the patient's cardiac output is the result of which mechanism? A. Peripheral vasodilation B. Increased venous return C. Increased alveolar ventilation D. Decreased myocardial contractility

A. Peripheral vasodilation

The nurse is caring for a patient in shock with an elevated lactate level. Which order should the nurse question in the management of this patient? A. Start an insulin drip for blood sugar greater than 180 mg/dL. B. Administer sodium bicarbonate to keep arterial pH greater than 7.20. C. Start a norepinephrine drip to keep MAP greater than 65 mm Hg. D. Administer crystalloids fluids.

B. Administer sodium bicarbonate to keep arterial pH greater than 7.20.

A patient is admitted after she develops disseminated intravascular coagulation (DIC) after a vaginal delivery. The nurse knows that DIC is known to occur in patients with retained placental fragments. What is the pathophysiologic consequence of DIC? A. Hypersensitivity response to an antigen B. Excessive thrombosis and fibrinolysis C. Profound vasodilatation D. Loss of intravascular volume

B. Excessive thrombosis and fibrinolysis

A patient has been admitted in 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

B. Finding and eradicating the cause of infection

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

B. Heart rate greater than 100 beats/min C. Weak, thready pulse D. Increased right atrial pressure 𝘚𝘺𝘮𝘱𝘵𝘰𝘮𝘴 𝘪𝘯𝘪𝘵𝘪𝘢𝘭𝘭𝘺 𝘳𝘦𝘧𝘭𝘦𝘤𝘵 𝘴𝘪𝘨𝘯𝘴 𝘰𝘧 ↓ 𝘪𝘯 𝘤𝘢𝘳𝘥𝘪𝘢𝘤 𝘰𝘶𝘵𝘱𝘶𝘵: 𝘗𝘵 𝘸𝘰𝘶𝘭𝘥 𝘩𝘢𝘷𝘦 𝘤𝘰𝘰𝘭, 𝘱𝘢𝘭𝘦, 𝘮𝘰𝘪𝘴𝘵 𝘴𝘬𝘪𝘯; 𝘐𝘯𝘤𝘳𝘦𝘢𝘴𝘦𝘥 𝘱𝘶𝘭𝘮𝘰𝘯𝘢𝘳𝘺 𝘢𝘳𝘵𝘦𝘳𝘺 𝘰𝘤𝘤𝘭𝘶𝘴𝘪𝘰𝘯 𝘱𝘳𝘦𝘴𝘴𝘶𝘳𝘦 (𝘉𝘰𝘹 34.7, 810).

The nurse is caring for a patient who was just admitted in 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 a practitioner's order? A. Administer fresh-frozen plasma. B. Obtain a serum lactate level. C. Administer epinephrine. D. Measure central venous pressure.

B. Obtain a serum lactate level.

A nursing instructor is discussing the difference between primary and secondary multiple organ dysfunction syndrome (MODS) with a nursing student. Which statement indicates the student understood the information? A. Primary MODS is the result of inflammation in organs not involved in the initial insult. B. Primary MODS is the result of a direct organ injury. C. Primary MODS is due to a disorganization of the inflammatory immune system response. D. Primary MODS is due to disruption of the coagulation system.

B. Primary MODS is the result of a direct organ injury.

A nurse is discussing the concept of shock with a new graduate nurse. Which statement indicates the new graduate nurse understood the information? A. Shock is a physiologic state resulting in hypotension and tachycardia. B. Shock is an acute wide spread process of inadequate tissue perfusion. C. Shock is a degenerative condition leading to organ failure and death. D. Shock is a condition occurring with hypovolemia that results in hypotension.

B. Shock is an acute wide spread process of inadequate tissue perfusion. 𝘚𝘩𝘰𝘤𝘬 𝘪𝘴 𝘢𝘯 𝘢𝘤𝘶𝘵𝘦, 𝘸𝘪𝘥𝘦𝘴𝘱𝘳𝘦𝘢𝘥 𝘱𝘳𝘰𝘤𝘦𝘴𝘴 𝘰𝘧 𝘪𝘮𝘱𝘢𝘪𝘳𝘦𝘥 𝘵𝘪𝘴𝘴𝘶𝘦 𝘱𝘦𝘳𝘧𝘶𝘴𝘪𝘰𝘯 𝘵𝘩𝘢𝘵 𝘳𝘦𝘴𝘶𝘭𝘵𝘴 𝘪𝘯 𝘤𝘦𝘭𝘭𝘶𝘭𝘢𝘳, 𝘮𝘦𝘵𝘢𝘣𝘰𝘭𝘪𝘤, 𝘢𝘯𝘥 𝘩𝘦𝘮𝘰𝘥𝘺𝘯𝘢𝘮𝘪𝘤 𝘢𝘭𝘵𝘦𝘳𝘢𝘵𝘪𝘰𝘯𝘴. (801)

A patient has been admitted with a neurologic disorder. With which disorder should the nurse be the most vigilant for the development of neurogenic shock? A. Ischemic stroke B. Spinal cord injury C. Guillain-Barré syndrome D. Brain tumor

B. Spinal cord injury

A patient is admitted after she develops disseminated intravascular coagulation (DIC) after a vaginal delivery. Which laboratory value would the nurse expect to find to support this diagnosis? A. Decreased fibrinogen degradation products B. Decreased D-dimer concentrations C. Decreased platelet counts D. Increased serum glucose levels

C. Decreased platelet counts

A patient is being admitted in cardiogenic shock secondary to acute heart failure. In addition to a diuretic, which medication would the nurse anticipate the practitioner ordering for the patient? A. Epinephrine B. Nitroprusside C. Dobutamine D. Nitroglycerine

C. Dobutamine

A patient has developed septic shock. The nurse knows that the patient is at risk for gastrointestinal dysfunction. What happens to the gastrointestinal tract in the patient with septic shock? A. Anorexia leads to loss of gastric enzymes. B. Lack of food ingestion leads to intestinal hypomotility. C. Hypoperfusion results in loss of gut barrier function. D. Low cardiac output causes decreased hydrochloric acid secretion.

C. Hypoperfusion results in loss of gut barrier function.

A patient is being admitted from the emergency department (ED) in cardiogenic shock secondary to unstable angina unresponsive to medications. The patient was intubated and ventilated in the ED. Which intervention should the nurse prepare to initiate when the practitioner arrives in the unit? A. Administration of sodium bicarbonate B. Rapid infusion of crystalloids C. Insertion of an intra-aortic balloon pump (IABP) D. Insertion of dialysis catheters for continuous renal replacement therapy (CRRT)

C. Insertion of an intra-aortic balloon pump (IABP)

A patient has developed septic shock. The nurse knows that the clinical manifestations of ischemic hepatitis show up 1 to 2 days after the insult. Which finding would the nurse expect to find to support this diagnosis? A. Elevated serum creatinine B. Decreased bilirubin C. Jaundice D. Decreased serum transaminase

C. Jaundice

A patient has been admitted in anaphylactic shock due to an unknown allergen. The nurse understands that the patient is probably having an immunoglobulin E (IgE) mediated response as a result of what physiologic mechanism? A. Direct activation of mast cells and basophils B. Nonimmunologic stimulation of biochemical mediators C. Repeat exposure to an antigen in the presence of preformed IgE antibodies D. Activation of the systemic inflammatory response

C. Repeat exposure to an antigen in the presence of preformed IgE antibodies

The nurse is caring for a patient with systemic inflammatory response syndrome (SIRS) due to pneumonia. What is SIRS due to infection called? A. Infectivity B. Anaphylaxis C. Sepsis D. Acute respiratory distress syndrome (ARDS)

C. Sepsis

A patient with known penicillin allergy develops anaphylactic shock after a dose of ampicillin was given in error. Which medication would the nurse administered first? A. Methylprednisolone B. Gentamicin C. Atropine D. Epinephrine

D. Epinephrine

A patient has been admitted in 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. Narrowed pulse pressure

D. Narrowed pulse pressure