Nurs 4 - Mod 6 - Shock (EAQ's)

If the patient in shock is to receive 1000 mL of normal saline in two hours, at what rate should the infusion pump be set? Record your answer using a whole number. ___mL/hour

500 For the 1000 mL of normal saline to be infused in two hours, the infusion pump should be set at 500 mL per hour (1000 mL divided by two hours).

When caring for a patient with multiple organ dysfunction syndrome, what treatment should the nurse anticipate for stress ulcer prophylaxis? Select all that apply. 1 Antacids 2 Diuretics 3 Sucralfate 4 Proton pump inhibitors 5 Calcium channel blockers

1 - Antacids 3 - Sucralfate 4 - Proton pump inhibitors The patient with multiple organ dysfunction syndrome is at risk of developing stress ulcers due to decreased peristalsis and mucosal ischemia. Antacids, sucralfate, and proton pump inhibitors are the appropriate treatment used for stress ulcer prophylaxis. Diuretics are used to treat fluid imbalance and improve renal function. Calcium channel blockers are used to treat cerebral vasospasms.

The nurse is reviewing orders for laboratory work for a patient who is experiencing shock. Which of the following tests would the nurse expect to be ordered? Select all that apply. 1 Creatinine 2 Arterial blood gases 3 Complete blood count 4 Glycosated hemoglobin 5 Prostate surface antigen

1 - Creatinine 2 - Arterial blood gases 3 - Complete blood count Creatinine is a blood test to check kidney function, which is crucial for a patient with shock. Arterial blood gases would be ordered to assess acid-base balance and oxygenation status. A complete blood count would also be ordered to assess red and white blood cell function. Prostate surface antigen (PSA) is done as a screening for prostate cancer and would not be ordered for a patient experiencing shock. Although a glucose level would need to be checked on a patient in shock, a glycosated hemoglobin assessment, which examines blood glucose control over 12 weeks, would not be ordered for a patient in shock.

A nurse is caring for a patient who is in a state of cardiogenic shock caused by myocardial infarction. The nurse uses pulse oximetry to monitor the oxygen saturation levels. Where should the nurse attach the pulse oximetry probe to get an accurate reading? Select all that apply. 1 Ear 2 Toes 3 Nose 4 Fingers 5 Forehead

1 - Ear 3 - Nose 5 - Forehead Pulse oximetry is used to monitor oxygen saturation. The patient in a state of shock has poor peripheral circulation, and a peripheral reading may not be accurate. Therefore the probe should be attached to the ear, nose, or forehead for a reliable measurement. Pulse oximetry readings obtained through the toes and fingers may not be accurate due to compromised peripheral circulation.

The nurse would recognize which clinical manifestation as suggestive of sepsis? 1 Hyperglycemia in the absence of diabetes 2 Sudden diuresis unrelated to drug therapy 3 Respiratory rate of seven breaths per minute 4 Bradycardia with sudden increase in blood pressure

1 - Hyperglycemia in the absence of diabetes Hyperglycemia in patients with no history of diabetes is a diagnostic criterion for sepsis. Oliguria, not diuresis, typically accompanies sepsis, along with tachypnea and tachycardia, not bradypnea and bradycardia.

A pregnant patient is hospitalized with severe hemorrhage. The nurse expects what laboratory results? Select all that apply. 1 Increased lactate levels 2 Increased sodium levels 3 Decreased hematocrit levels 4 Decreased blood glucose levels 5 Increased natriuretic peptide levels

1 - Increased lactate levels 3 - Decreased hematocrit levels Severe hemorrhage results in blood loss and hypovolemic shock in the patient. Due to the loss of blood, the patient has increased lactate levels and decreased hematocrit levels. Loss of blood does not result in sodium retention and does not increase serum sodium levels. Loss of blood will not increase insulin levels and does not decrease blood glucose levels in the patient. Hypovolemia will not stimulate cardiac myocytes and will not increase the production of natriuretic peptide levels. Therefore the patient will probably not have increased sodium levels, decreased blood glucose levels, or increased natriuretic peptide levels.

When examining a patient in the progressive stage of shock, which factors related to the gastrointestinal (GI) system should the nurse consider? Select all that apply. 1 Increased risk of GI bleeding 2 Increased likelihood of GI ulcers 3 Increased motility and peristalsis 4 Increased ability to absorb nutrients 5 Increased risk of bacterial migration from the GI tract to the bloodstream.

1 - Increased risk of GI bleeding 2 - Increased likelihood of GI ulcers 5 - Increased risk of bacterial migration from the GI tract to the bloodstream. In the progressive stage of shock, the GI system gets affected by prolonged decreased tissue perfusion. As the blood supply to the GI tract is decreased, the normally protective mucosal barrier becomes ischemic. This ischemia predisposes the patient to ulcers and GI bleeding. It also increases the risk of bacterial migration from the GI tract to the blood. The decreased perfusion to the GI tract also results in a decreased ability to absorb nutrients, decreased motility, and slowed peristalsis.

A nurse is caring for a patient with sepsis. Which laboratory value will the nurse monitor to measure the byproduct of anaerobic metabolism caused by significant hypoperfusion and impaired oxygen utilization at the cellular level? 1 Lactic acid 2 Base deficit 3 Blood cultures 4 Arterial blood gas

1 - Lactic acid Lactic acid is the measurement of the byproduct of anaerobic metabolism caused by significant hypoperfusion and impaired oxygen utilization at the cellular level in sepsis patients. Base deficit indicates acid production secondary to hypoxia. Blood cultures are used to determine the organism causing infection. Arterial blood gas measures respiratory alkalosis in early stages of septic shock and metabolic acidosis in late stages of septic shock.

The nurse is caring for a patient who is experiencing cardiogenic shock as a result of myocardial infarction. Which nursing assessment finding is most concerning? 1 PaO2 60 mm Hg 2 Heart rate 96 beats/minute 3 Blood pressure 100/56 mm Hg 4 Urine output 260 mL in eight hours

1 - PaO2 60 mm Hg A PaO2 of 60 is below the normal 80 to 100 mm Hg. The patient experiencing cardiogenic shock will exhibit hypotension and tachycardia, and therefore a blood pressure of 100/56 mm Hg and heart rate of 96 would not apply. A urine output of 260 cc/8 hrs is borderline but not reportable without a continued trending pattern.

Which system shows initial signs of dysfunction in systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS)? 1 Respiratory system 2 Cardiovascular system 3 Gastrointestinal system 4 Central nervous system

1 - Respiratory system The pulmonary vasculature is directly affected by inflammatory mediators. Hence the initial signs of dysfunction in systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) are seen in the respiratory system. Cardiovascular changes are detected later when there is myocardial depression. Effects on the gastrointestinal system are seen when the motility gets decreased. Neurologic dysfunctions are seen when the patient's mental status begins to show signs of change.

The nurse reviews the medical record of a patient with pneumonia and notes that the patient has hypotension, hypothermia, leukocytosis, and hypoxemia. What should the nurse infer from these findings? 1 The patient has septic shock. 2 The patient has neurogenic shock. 3 The patient has cardiogenic shock. 4 The patient has hypovolemic shock.

1 - The patient has septic shock. Septic shock is most commonly found in the patient having gram-negative bacterial infections, such as pneumonia. Because it is characterized by hypotension, hypothermia, leukocytosis, and hypoxemia in patients with infections, the nurse concludes that the patient has septic shock. Neurogenic shock is most commonly seen in the patient who has an injury. Cardiogenic shock is caused by cardiovascular disorders, such as a myocardial infarction and cardiomyopathy. Hypovolemic shock is caused by hemorrhage or trauma.

Which type of shock is associated with hyperglycemia, presence of pulmonary infiltrates in chest x-ray and increased levels of blood urea nitrogen (BUN)? 1 Septic 2 Obstructive 3 Cardiogenic 4 Hypovolemic

3 - Cardiogenic Increased blood levels of glucose, nitrogen, and cardiac markers and presence of pulmonary infiltrates are seen in cardiogenic shock. Increased blood levels of lactate, glucose, and positive blood cultures are signs of septic shock. Manifestations of obstructive shock are specific to the area or organ of obstruction. Electrolyte imbalances and decreased hemoglobin and hematocrit are seen in hypovolemic shock.

A patient is admitted to the hospital with a suspected diagnosis of obstructive shock. What could be the possible causes of this type of shock? Select all that apply. 1 Spinal cord injury 2 Cardiac tamponade 3 Tension pneumothorax 4 Hypersensitivity to antibiotics 5 Superior vena cava syndrome

2 - Cardiac tamponade 3 - Tension pneumothorax 5 - Superior vena cava syndrome Obstructive shock develops when a physical obstruction to blood flow occurs resulting in decreased cardiac output. This can be caused by restricted diastolic filling of the right ventricle from compression caused by cardiac tamponade, tension pneumothorax, or superior vena cava syndrome. Hypersensitivity to antibiotics may cause anaphylactic shock. Spinal cord injury may lead to neurogenic shock.

A patient experiences a myocardial infarction (MI). The nurse closely monitors the patient for complications and recognizes that hypotension is a warning sign of which condition? 1 A secondary MI 2 Cardiogenic shock 3 Pulmonary edema 4 Fatal dysrhythmias

2 - Cardiogenic shock One of the initial cardinal signs of cardiogenic shock after a myocardial infarction (MI) is a slow, steady drop in blood pressure. Hypotension after an MI may be an indirect sign of a secondary MI or a fatal dysrhythmia. Depending on the origin of pulmonary edema, patients may experience hypotension or hypertension.

A patient is suspected to have septic shock due to untreated cellulitis in the lower extremity. What findings would the nurse expect to observe when assessing this patient? Select all that apply. 1 Rhonchi 2 Crackles 3 Cyanosis 4 Hyperventilation 5 Decreased urine output

2 - Crackles 4 - Hyperventilation 5 - Decreased urine output In septic shock, the combined effects of the inflammatory mediators result in damage to the endothelium, vasodilation, increased capillary permeability, and neutrophil and platelet aggregation and adhesion to the endothelium. The patient with septic shock may develop crackles due to increased vasodilation and respiratory failure. Initially, the patient may hyperventilate to compensate, resulting in respiratory alkalosis. Symptoms such as decreased urine output are related to renal hypoperfusion. Rhonchi and cyanosis are symptoms of cardiogenic shock.

Which type of shock is associated with bradycardia? 1 Septic shock 2 Neurogenic shock 3 Anaphylactic shock 4 Hypovolemic shock

2 - Neurogenic shock Neurogenic shock is associated with bradycardia. Myocardial dysfunction and changes in body temperature are signs of septic shock. Reduction in preload, capillary refill, and stroke volume are clinical manifestations of hypovolemic shock. Chest pain is seen in anaphylactic shock.

Which type of shock can be treated by minimizing spinal cord trauma with stabilization? 1 Septic shock 2 Neurogenic shock 3 Anaphylactic shock 4 Hypovolemic shock

2 - Neurogenic shock Neurogenic shock is caused by severe injury to the spinal cord and results in loss of sympathetic stimulation of blood vessels. Apart from administering vasoconstrictor agents, minimizing the spinal cord trauma with stabilization is a supporting therapy for neurogenic shock. Septic shock occurs in response to a systemic infection. Obtaining the cultures before starting antibiotics is appropriate care for septic shock. A life-threatening allergic reaction to a sensitizing substance causes anaphylactic shock. Avoiding exposure to allergens is supportive therapy for anaphylactic shock. Excessive loss of intravascular fluid causes hypovolemic shock. Besides restoring fluid volume, correcting the cause of fluid loss is supportive therapy.

A nurse caring for a patient with multiple organ dysfunction syndrome understands that the patient may be at increased risk of bleeding. What nursing interventions should the nurse perform to manage this patient? Select all that apply. 1 Decrease fluid intake. 2 Observe bleeding sites. 3 Provide enteral feedings. 4 Minimize traumatic interventions. 5 Administer platelets and clotting factors.

2 - Observe bleeding sites. 4 - Minimize traumatic interventions. 5 - Administer platelets and clotting factors. The patient with multiple organ dysfunction syndrome is at a risk of bleeding due to increased bleeding time, thrombocytopenia, and dysfunctional clotting process. The nursing interventions should be aimed at preventing potential bleeding and replacing factors being lost. The patient should be observed for frank or occult bleeding from potential sites. The factors like platelets and clotting factors should be replaced if deficient. Traumatic interventions such as intramuscular injections or multiple venipunctures should be avoided. Decreasing the fluid intake and providing enteral feedings will not help in minimizing hematologic complications.

The nurse is caring for a patient with a tension pneumothorax. The nurse recognizes that the symptoms of tachypnea, decreased blood pressure, and decreased urine output are caused by which type of shock? 1 Septic 2 Obstructive 3 Hypovolemic 4 Anaphylactic

2 - Obstructive The nurse recognizes these as signs of obstructive shock, which is a result of a physical obstruction of blood flow; can be related to tension pneumothorax, pulmonary embolism, and cardiac tamponade. Hypovolemic shock is a result of low blood volume. Septic shock is a result of a serious infection that has compromised cellular, circulatory, and metabolic function. Anaphylactic shock is a result of hypersensitivity to a sensitizing substance.

The nurse is evaluating lab results related to the hematologic system for a patient diagnosed with multiple organ dysfunction syndrome (MODS) following a traumatic injury. Which lab results indicate involvement of the hematologic system? Select all that apply. 1 Hct 42% 2 PT 18 sec 3 RBCs 5.0 x 106/μL 4 D-Dimer 280 ng/mL 5 Platelets 125 x 103/μL

2 - PT 18 sec 4 - D-Dimer 280 ng/mL 5 - Platelets 125 x 103/μL Increased PT, increased D-dimer, and decreased platelets indicate involvement of the hematologic system. Normal PT is 11-16 sec; normal platelets are 150-400 x 103/ μL, and normal D-dimer is less than 250 ng/mL. These all indicate involvement of the hematologic system. Normal Hct is 39%-50% for males and 35%-47% for females, thus this result is within normal range. RBC values range from 3.8/4.3-5.1/5.7 x 106/μL (male/female) thus this result is within normal limits.

A nurse is monitoring a patient for signs and symptoms related to septic shock. Which are late signs of this emergency condition? Select all that apply. 1 Respiratory alkalosis 2 Altered mental status 3 Cool and mottled skin 4 Myocardial dysfunction 5 Decreased urine output

3 - Cool and mottled skin 4 - Myocardial dysfunction Late signs of septic shock are cool and mottled skin and myocardial dysfunction. The release of platelet-activating factors increases coagulation, resulting in the formation of microthrombi and decreased blood flow in the microcirculation. The patient in early stages of septic shock may have warm and flushed skin, respiratory alkalosis, altered mental status, and decreased urine output.

A patient receiving care for multiple organ dysfunction syndrome (MODS), which has affected the respiratory, cardiac, and renal systems is receiving medications to address renal manifestations. Which prescription is indicated to address these issues? 1 Aldactone 2 Metolazone 3 Furosemide 4 Chlorothiazide

3 - Furosemide Acute kidney injury is common in patients with MODS. Loop diuretics such as furosemide are used to eliminate water and salt from the body. Aldactone is a potassium-sparing diuretic. Metolazone and chlorothiazide are both thiazide diuretics.

When caring for a patient in acute septic shock, what should the nurse anticipate? 1 Administering osmotic or loop diuretics 2 Administering IV diphenhydramine (Benadryl) 3 Infusing large amounts of intravenous (IV) fluids 4 Assisting with insertion of a ventricular assist device (VAD)

3 - Infusing large amounts of intravenous (IV) fluids Septic shock is characterized by a decreased circulating blood volume. Volume expansion with the administration of IV fluids is the cornerstone of therapy. The administration of diuretics is inappropriate. Diphenhydramine may be used for anaphylactic shock, but would not be helpful with septic shock. VADs are useful for cardiogenic shock, not septic shock.

A patient diagnosed with sepsis fails to respond to fluid resuscitation. The healthcare provider orders the patient to be started on a vasopressor. The nurse evaluates which response to determine the effectiveness of the vasopressor? 1 SpO2 greater than 94% 2 Lactic acid less than 2.0 mmol/L 3 Mean arterial pressure greater than 65 mm Hg 4 Systolic blood pressure greater than 80 mm Hg

3 - Mean arterial pressure greater than 65 mm Hg The goal of vasopressor therapy is to maintain a mean arterial pressure greater than 65 mm Hg. Fluids can be increased or vasopressor therapy can be decreased if the patient develops hypotension. Vasopressors do not have an effect on lactic acid results or SpO2.

Which types of shock are associated with decreased cerebral perfusion? Select all that apply. 1 Septic 2 Neurogenic 3 Obstructive 4 Cardiogenic 5 Anaphylactic 6 Hypovolemic

3 - Obstructive 4 - Cardiogenic 6 - Hypovolemic Manifestations of cardiogenic shock include decreased cerebral perfusion causing anxiety, confusion and agitation. Decreased cerebral perfusion associated with obstructive shock causes anxiety, confusion, and agitation. Decreased cerebral perfusion associated with hypovolemic shock causes anxiety, confusion and agitation. Septic shock causes mental changes like confusion, agitation, and coma in the late stages. Loss of reflex activity and flaccid paralysis are seen with neurogenic shock. Anxiety, metallic taste, confusion, and impending doom are signs of anaphylactic shock.

Multiple organ dysfunction syndrome (MODS), a complication of sepsis, is the failure of how many organ systems? 1 All 2 One or more 3 Two or more 4 Three or more

3 - Two or more Multiple organ dysfunction syndrome is the failure of two or more organ systems in an acutely ill patient for whom homeostasis cannot be maintained without intervention. It is not the failure of all systems. One or more is below the threshold for the definition, and three or more is included in the stipulation of two or more.

The nurse recalls that cardiogenic shock is differentiated from other forms of shock because the patient with cardiogenic shock typically experiences what? 1 Hypotension 2 Dysrhythmias 3 Volume excess 4 Volume depletion

3 - Volume excess In cardiogenic shock the heart fails as a pump. This usually results in fluid retention and poor perfusion of organs, including the kidneys, which adds to the fluid volume excess. As cardiogenic shock progresses, hypotension will develop, but it is not the cause of cardiogenic shock. Dysrhythmias may or may not be present with cardiogenic shock. Volume depletion is not generally seen with cardiogenic shock. It is, however, seen more with hypovolemic or distributive forms of shock.

What laboratory finding correlates with a medical diagnosis of cardiogenic shock? 1 Decreased liver enzymes 2 Increased white blood cells 3 Decreased red blood cells, hemoglobin, and hematocrit 4 Increased blood urea nitrogen (BUN) and serum creatinine levels

4 - Increased blood urea nitrogen (BUN) and serum creatinine levels The renal hypoperfusion that accompanies cardiogenic shock results in increased BUN and creatinine levels. Impaired perfusion of the liver results in increased liver enzymes, whereas white blood cell levels typically do not increase in cardiogenic shock. Red blood cell indices are typically normal because of relative hypovolemia.

A nurse is caring for a patient diagnosed with septic shock. The patient develops dyspnea, tachycardia, and bilateral lung crackles. The nurse suspects the patient has developed acute respiratory distress syndrome (ARDS). Which intervention is the nurse's priority? 1 Repeat chest radiograph 2 Draw arterial blood gasses 3 Start broad spectrum antibiotics 4 Pulmonary management with mechanical ventilation

4 - Pulmonary management with mechanical ventilation Patients with ARDS need aggressive pulmonary management with mechanical ventilation. Repeat chest radiograph may be done after initiation of mechanical ventilation. Arterial blood gas measures respiratory alkalosis in early stages of septic shock and metabolic acidosis in late stages of septic shock. Broad spectrum antibiotics are important in the early component of therapy and should be started within the first hour of severe sepsis or septic shock, but once breathing is compromised, that becomes the priority.