Pharmacology Adams/Holland Ch 29: Drugs for Shock

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? Select all that apply. 1. Premature ventricular contractions 2. Hypertension 3. Hyperthyroidism 4. Pheochromocytoma 5. Hypotension

1, 2, 3

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? Select all that apply. 1. Palpitations 2. Drop in blood pressure 3. Cold extremities 4. Headache 5. Blurred vision

1, 2, 3

The nurse is directed to prepare norepinephrine for administration to a patient. For which health problems is this medication indicated? Select all that apply. 1. Acute shock 2. Cardiac arrest 3. Septic shock 4. Hypovolemic shock 5. Cardiogenic shock

1, 2, 3

The paramedics are transporting to the emergency department a patient who is experiencing shock. What will the nurse prepare in anticipation of the patient's arrival? Select all that apply. 1. Cardiac monitor 2. Pulse oximeter 3. Oxygen 4. Whole blood 5. Dextran 40

1, 2, 3

Prior to administering dopamine, the nurse reviews a patient's current medication history. For which medications would dopamine cause a drug-drug interaction? Select all that apply. 1. MAO inhibitor 2. Phenytoin 3. Beta blocker 4. Digoxin 5. Aspirin

1, 2, 3, 4

A patient was seen in the emergency department after sustaining a fractured leg and multiple abrasions in a bicycle accident. Eight hours after discharge the patient is admitted in anaphylactic shock. The nurse would suspect which drugs prescribed for the initial injury as implicated in this reaction? Select all that apply. 1. A cephalosporin antibiotic 2. A topical antibiotic for use on abrasions 3. An NSAID for minor pain 4. An opioid analgesic for more severe pain 5. Normal saline wash for abrasions

1, 3, 4

Following a massive myocardial infarction, the patient develops cardiogenic shock. The patient's family asks the nurse what the patient's chances of survival are. What information does the nurse consider when formulating a response to these concerns? Select all that apply. 1. Cardiogenic shock is the major reason people die after having an MI. 2. Even though many people develop cardiogenic shock, the majority survive without residual effects. 3. Cardiogenic shock is the most lethal type of shock. 4. As long as the patient does not develop septic shock, survival is probable. 5. Cardiogenic shock results from pump failure.

1, 3, 5

A patient presents with anaphylaxis to the penicillin prescribed for an ear infection. The nurse plans immediate care for the patient based on which goals? Select all that apply. 1. Normalization of blood pressure 2. Reduction of blood volume 3. Identification of other allergies 4. Reduction of inflammatory response 5. Provision of basic life support

1, 4, 5

A patient who had an anaphylactic reaction has been successfully treated with epinephrine. The nurse anticipates administering which other drugs? Select all that apply. 1. Antibiotics 2. Antihistamines 3. Corticosteroids 4. Vasopressors 5. Vasodilators

2, 3

Following treatment with epinephrine, the patient reports the following symptoms. The nurse would be most concerned about which report? Select all that apply. 1. "I feel jittery." 2. "My heart is skipping beats." 3. "I have a pounding headache." 4. "I am so dizzy." 5. "That really hurt when you gave me that med."

2, 3

A patient has been treated with epinephrine. Which laboratory results could have been affected by this treatment? Select all that apply. 1. Digoxin level is elevated. 2. Potassium level is low. 3. Calcium level is high. 4. Sodium level is low. 5. Blood glucose is high.

2, 5

29.15 The client is receiving norepinephrine (Levophed). When monitoring the client's blood pressure, the nurse notes a pressure of 230/120 mm/Hg. What is the priority nursing action? 1. Notify the physician. 2. Increase the infusion. 3. Slow the rate of the infusion 4. Assess the client for signs/symptoms of a stroke.

3. Slow the rate of the infusion

29.1 The young client has a history of multiple allergies, and the physician prescribed epinephrine (EpiPen) for prevention of anaphylactic shock. The client's 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 that also include infection, nervous system damage, and loss of blood." 2. "Heart failure is the most serious kind of shock; others include infection, kidney failure, and loss of blood." 3. "There are many kinds of shock: heart failure, nervous system damage, loss of blood, and respiratory failure." 4. "Allergic response is the most fatal type of shock; other types involve loss of blood, heart failure, and liver failure."

Answer: 1 "There are many kinds of shock that also include infection, nervous system damage, and loss of blood."

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

Answer: 1 "This is a life-threatening situation; a prior hypersensitivity is not an absolute contraindication."

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

Answer: 1 Assess the client's blood pressure.

29.9 The client 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. Urinary output of at least 50 mL/hour. 2. Increased cardiac output. 3. Vasoconstriction and increased blood pressure. 4. Stabilization of fluid loss.

Answer: 1 Urinary output of at least 50 mL/hour.

29.3 The client comes to the emergency department with a severely infected pressure ulcer on the back. The client is in septic shock. The physician orders norepinephrine (Levophed) IV. Prioritize the nursing interventions for this client. 1. Connect the client to a cardiac monitor and pulse oximeter. 2. Assess the client's blood pressure. 3. Prepare for debridement of the pressure ulcer. 4. Administer oxygen. 5. Maintain a patient airway.

Answer: 1, 2, 3, 4, 5

29.10 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? Select all that apply. 1. The child is restless and confused. 2. The child's skin feels warm and dry. 3. The child is thirsty. 4. The child's skin feels cold and clammy. 5. The child is hyperactive and hyperverbal.

Answer: 1, 3, 4

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

Answer: 2 "It is a protein that pulls water into my blood vessels."

29.12 The physician has prescribed epinephrine (Adrenalin) for an elderly client. What is an important nursing assessment prior to administration of this drug? 1. A history of dizziness. 2. A history of narrow angle glaucoma. 3. A history of diabetes mellitus, type I. 4. A history of human immunodeficiency virus (HIV) infection.

Answer: 2 A history of narrow angle glaucoma.

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

Answer: 3 Auscultate breath sounds for crackles.

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

Answer: 3 B/P: 80/20 mm/Hg, P: 122, weak and thready, R: 28, and shallow.

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

Answer: 3 Have phentolamine (Regitine) available in the room.

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

Answer: 4 "This drug is a vasopressor and will help stabilize blood pressure by making the blood vessels smaller."

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

Answer: 4 Intravenous (IV) pump

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

Answer: 4 The client will experience adequate breathing patterns.

29. 21 The mechanism of action of norepinephrine is to: a. Produce vasoconstriction. b. Cause increased blood flow. c. Decrease cardiac output. d. Increase heart rate.

Answer: A Produce vasoconstriction.

29.20 Examples of vasoconstrictors used to treat shock include all of the following except: a. Propranolol (Inderal). b. Norepinephrine (Levophed). c. Mephentermine (Wyamine). d. Phenylephrine (Neo-synephrine).

Answer: A Propranolol (Inderal).

29.17 A client with cardiogenic shock would exhibit which of the following symptoms? a. Restlessness and anxiety b. Bradycardia c. Tachycardia and low blood pressure d. Low temperature

Answer: C Tachycardia and low blood pressure

29.18 What would the expected first treatment of shock be? a. Start an intravenous line. b. Take the blood pressure. c. Assess level of consciousness. d. Maintain the airway.

Answer: D Maintain the airway.

29.19 Colloids differ from crystalloids in that: a. They contain electrolytes. b. They readily leave the blood and enter cells. c. They promote urine output. d. They are too large to cross membranes.

Answer: D They are too large to cross membranes.

29.16 Hypovolemic shock is different from neurogenic shock in that it relates to: a. Inadequate cardiac output. b. An infectious process. c. A brain or spinal cord trauma. d. Volume depletion.

Answer: D Volume depletion.