Med Surg Midterm
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.
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.
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.
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.
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.
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.
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.
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, C, D
16. 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.
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.
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.
A patient has been admitted in septic shock related to tissue necrosis.The nurse knows the initialgoal 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.
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.
A patient is admitted after she develops disseminated intravascular coagulation (DIC) after a vaginaldelivery. 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.
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.
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.
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.
A patient has developed septic shock. The nurse knows that the patient is at risk for gastrointestinaldysfunction. 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.
A patient is admitted after she develops disseminated intravascular coagulation (DIC) after a vaginaldelivery. 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.
A patient is being admitted from the emergency department (ED) in cardiogenic shock secondary tounstable 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.
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.
The nurse is caring for a patient with systemic inflammatory response syndrome (SIRS) due topneumonia. What is SIRS due to infection called?A. Infectivity B. Anaphylaxis C. Sepsis D. Acute respiratory distress syndrome (ARDS)
C.
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.
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.
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
D.
