Shock Saunders Questions
A client who had a myocardial infarction is at risk for cardiogenic shock. The nurse plans care knowing that the primary cause of cardiogenic shock results from which process? 1.) A pump failure and reduction in cardiac output 2.) A physical obstruction that decreases filling or outflow of blood 3.) Dilated vasculature decreasing the movement of blood to the body 4.) Loss of vasoconstrictor tone, leading to pooling of blood in vessels
1.) A pump failure and reduction in cardiac output Cardiogenic shock is caused by the heart itself not being able to pump effectively, resulting in decreased cardiac output. Cardiac output reflects blood reaching the tissues and vasculature. The remaining options do not describe the pathophysiology associated with cardiogenic shock.
The nurse is caring for a client hospitalized for heart failure exacerbation and suspects the client may be entering a state of shock. The nurse plans for which intervention as the priority for this client? 1.) Administration of dopamine 2.) Administration of whole blood 3.) Administration of intravenous fluids 4.) Administration of packed red blood cells
1.) Administration of dopamine The client in this question is likely experiencing cardiogenic shock secondary to heart failure exacerbation. It is important to note that if the shock state is cardiogenic in nature, the infusion of volume-expanding fluids may result in pulmonary edema; therefore, restoration of cardiac function is the priority for this type of shock. Cardiotonic medications such as digoxin, dopamine, or norepinephrine may be administered to increase cardiac contractility and induce vasoconstriction. Whole blood, intravenous fluids, and packed red blood cells are volume-expanding fluids and may further complicate the client's clinical status; therefore, they should be avoided. Note the strategic word, priority, and focus on the subject, suspected shock in a client hospitalized for heart failure exacerbation. Recalling that this client is at risk for fluid volume overload will direct you to the correct option. Also, note that options 2, 3, and 4 are comparable or alike and involve the administration of intravenous solutions.
The nurse caring for a client suspected of being in hypovolemic shock is trying to anticipate treatment and management interventions. What plan is most appropriate for this client? Select all that apply. 1.) Oxygen administration 2.) Mental status checks every 15 minutes 3.) Further assessment to confirm the type of shock 4.) High-dose diuretics to minimize fluid accumulation 5.) Laboratory blood draws every 30 minutes to trend abnormal values
1.) Oxygen administration 2.) Mental status checks every 15 minutes 3.) Further assessment to confirm the type of shock The avenues of treatment and management for hypovolemic shock encompass varying levels of complexity and acuity, and each treatment plan will depend on what type of shock the client is experiencing; thus further assessment is needed to confirm hypovolemic shock. Oxygen is an important intervention to ensure tissue perfusion. Mental status checks are also important to monitor for any deterioration in the client's condition. High-dose diuretics would worsen hypovolemic shock and every 30 minute blood draws are not necessary.
Which finding indicates that tissue perfusion has been improved in a client with septic shock? 1.) The client's capillary refill is less than 3 seconds. 2.) The client's blood glucose has decreased to 120 mg/dL. 3.) The client tolerated a rapid infusion of isotonic intravenous fluids. 4.) The client's pulse oximetry is maintained at 94% on 4 liters per minute of oxygen via nasal cannula.
1.) The client's capillary refill is less than 3 seconds. The primary goal of treatment and management of shock is to improve tissue perfusion. Ongoing assessments to perform to note improvement in perfusion include capillary refill time and mental status checks. Note the subject of the question, improved tissue perfusion. This will help to identify the answer option that gives assessment data related to improved tissue perfusion, option 1. The remaining options do not provide evidence of improved tissue perfusion.
The nurse plans care understanding that which is the primary reason clients experience vasodilation in septic shock? 1.) There is a release of endotoxins from bacteria. 2.) There is heart failure with diminished cardiac output. 3.) There is blood or fluid loss, and the body compensates by dilating the blood vessels. 4.) There is an obstruction of blood flow, and the body compensates by dilating the blood vessels.
1.) There is a release of endotoxins from bacteria. A massive infection can lead to sepsis as a result of endotoxins being released, which causes vasodilation, pooling of blood, and capillary permeability. The remaining options do not provide the reason for vasodilation in septic shock.
A new graduate nurse is taking a critical care course focusing on cardiogenic shock. Which statement made by the graduate nurse indicates that the teaching was effective? 1.) Cardiogenic shock is caused by diuretics. 2.) Cardiac tissue death can lead to cardiogenic shock. 3.) Cardiac arrest is the most common cause for cardiogenic shock. 4.) Each valve within the heart must be faulty to decrease cardiac output.
2.) Cardiac tissue death can lead to cardiogenic shock. Cardiogenic shock is the failure of the heart to pump adequately. This results in decreased cardiac output and decreased tissue perfusion. Cardiac tissue or vessel necrosis can lead to an occlusion within the heart vessels themselves, thus affecting the heart's ability to pump properly. It is not caused by diuretics. Options 3 and 4 are incorrect. Note the strategic word, effective. This will help you focus on a statement made by the graduate nurse that is correct. Thinking about the pathophysiology of cardiogenic shock, focus on the answer option that has to do with injury to the heart itself that would decrease output or prevent the heart from pumping correctly.
A client at risk for shock secondary to pneumonia develops restlessness and is agitated and confused. Urinary output has decreased, and the blood pressure is 92/68 mm Hg. The nurse suspects which stage of shock based on this data? 1.) Stage 1 2.) Stage 2 3.) Stage 3 4.) Stage 4
2.) Stage 2 Shock is categorized by four stages. Stage 1 is characterized by restlessness, increased heart rate, cool and pale skin, and agitation. Stage 2 is characterized by a cardiac output that is less than 4 to 6 liters per minute, systolic blood pressure of less than 100 mm Hg, decreased urinary output, confusion, and cerebral perfusion pressure that is less than 70 mm Hg. Stage 3 is characterized by edema, excessively low blood pressure, dysrhythmias, and weak and thready pulses. Stage 4 is characterized as unresponsiveness to vasopressors, profound hypotension, slowed heart rate, and multiple organ failure. Most often, the client will not survive. Think about the stages of shock. Noting the signs of restlessness, agitation, and confusion, as well as the low blood pressure and decreased urinary output, will direct you to Stage 2 as the correct answer.
The nurse is caring for a client with cardiogenic shock. After reviewing the medication administration record, the nurse determines a need for follow-up when noticing which entry in the record? 1.) Digoxin 0.5 mg/day orally 2.) Morphine sulfate 2 mg intravenous (IV) PRN for chest pain 3.) Verapamil 10 mg IV; may repeat every 15 minutes 4.) Dopamine IV 1 mcg/kg/min to maintain systolic BP >100 mm Hg
3.) Verapamil 10 mg IV; may repeat every 15 minutes Medication management for clients in cardiogenic shock needs to focus on increasing cardiac output. Vasopressors and positive inotropes are examples of medications that will achieve this outcome. Additionally, clients may be prescribed pain medication to treat secondary symptoms and medications that help maintain blood pressure. Note the strategic words, need for follow-up. This directs you to look for the incorrect answer out of the options. To answer this question, you must be familiar with cardiotonic medications that will help improve cardiac output, tissue perfusion, and blood pressure management. Option 3 is a calcium channel blocker. This classification of medication helps to manage hypertension, not hypotension, along with angina pectoris and certain cardiac dysrrhythmias.
The charge nurse understands that there is a need for further teaching when the nurse caring for a client with septic shock states which of the following? 1.)" Frequent assessments of mental status may be necessary." 2.) "It will be important to watch the trend of the client's lab values." 3.) "Blood transfusions may be needed to help with the client's coagulopathy." 4.) "Administering antibiotics is the best way to correct and treat septic shock."
4.) "Administering antibiotics is the best way to correct and treat septic shock." Antibiotics are an important piece of the treatment and management of shock, but the treatment and management encompass many different interventions and methods, not just administering antibiotics. Discovering what the underlying condition is will be crucial in treating the client properly, and restoration of tissue perfusion and circulating volume must be achieved first. Options 1, 2, and 3 are correct actions. Note the strategic words, need for further teaching. These words indicate a negative event query and the need to select the incorrect statement. Many different interventions and methods, not just the administration of antibiotics, are used to treat and manage shock. This will help you deduce that answer option 4 is the correct choice.
What primary characteristic of cardiogenic shock helps determine what nursing interventions are performed? 1.) Blood pools in the heart, so care is focused on diuresing. 2.) Urinary output is low, so care is focused on increasing circulating volume. 3.) Hypotension is severe, so care is focused on blood pressure monitoring. 4.) Cardiac output is compromised, so care is focused on restoring tissue perfusion.
4.) Cardiac output is compromised, so care is focused on restoring tissue perfusion. Cardiogenic shock occurs when the heart fails to pump adequately, thus reducing cardiac output and compromising tissue perfusion. The goal of management and treatment for cardiogenic shock is to restore cardiac output and tissue perfusion; then treatment of the underlying cause can be managed. Options 1, 2, and 3 are not primary characteristics. Note the strategic word, primary. Also focus on the subject, interventions for cardiogenic shock. Using the pathophysiology of cardiogenic shock should help you remember that this shock is all about the mechanics of the heart. If it cannot pump, cardiac output decreases, and so does tissue perfusion. Answer option 4 focuses on that.
The nurse is monitoring the client after cardiac surgery. The nurse notes the following signs and symptoms: decreased urinary output, decreased bowel sounds, capillary refill >4 seconds, and changes in mental status. What would the nurse do next? 1.) Continue to monitor; these may be signs of potential shock. 2.) Collect an arterial blood gas to check to see whether the client is compensating. 3.) Place the client on oxygen; these are signs of increased oxygen requirement. 4.) Contact the primary health care provider (PHCP); these may be signs of potential shock.
4.) Contact the primary health care provider (PHCP); these may be signs of potential shock. Signs and symptoms of shock may mirror other signs and symptoms of sepsis or other severe complications. Early recognition of signs and symptoms that are not expected need to be reported to the PHCP immediately. Contacting the PHCP is the next action. Options 1 and 2 delay necessary interventions. Oxygen would already be administered to a client after cardiac surgery. Note the strategic word, next. This directs you to prioritize care and choose the nursing intervention that responds appropriately to what is occurring with the client. Focus on the data in the question. To answer this question correctly, you must be able to distinguish early signs of shock. This will direct you to option 4.
A client in shock develops a central venous pressure (CVP) of 2 mm Hg and mean arterial pressure (MAP) of 60 mm Hg. Which prescribed intervention would the nurse implement first? 1.) Increase the rate of O2 flow. 2.) Obtain arterial blood gas results. 3.) Insert an indwelling urinary catheter. 4.) Increase the rate of intravenous (IV) fluids.
4.) Increase the rate of intravenous (IV) fluids. The MAP and CVP are both low for this client, indicating a shock state. Shock is the result of inadequate tissue perfusion. Fluid volume should be immediately restored first to provide adequate perfusion for the client in a shock state. Although increasing the rate of O2 flow may be a necessary intervention, perfusion is the first priority. Obtaining arterial blood gas results and inserting an indwelling urinary catheter may be necessary interventions to monitor the client's response to prescribed therapy, but these are not the priority. Note the strategic word, first. Although all interventions are appropriate for the client in a shock state, focus on the client's diagnosis and think about the pathophysiology that occurs in shock; recall that adequate perfusion is the priority.
Due to an extreme staff shortage, the nurse has been sent to the intensive care unit to assist registered nurses in the care of clients. The nurse understands that which factor is most important to consider when treating a client with cardiogenic shock? 1.) Use of diuretics to decrease circulating volume 2.) Use of whole blood to easily restore fluid volume 3.) Use of intravenous and oral fluids to restore circulating volume 4.) Restriction of volume expanders because of secondary pulmonary edema
4.) Restriction of volume expanders because of secondary pulmonary edema Because there are several types of shock, it is important to know which shock state the client is in so that it can be managed appropriately. A client in cardiogenic shock may have secondary issues such as pulmonary edema due to the ineffective pumping mechanism of the heart. Fluid restoration is a key ingredient in treating shock states although it must be used conservatively in clients with cardiogenic shock. Therefore, options 2 and 3 are incorrect. Option 1 is incorrect because the problem is with the pumping action of the heart and not increased blood volume. Note the strategic words, most important. This indicates that there may be more than one correct answer. Thinking about the pathophysiology of cardiogenic shock, remember that the heart is pumping ineffectively; because of this, blood will pool from the vasodilation. Cardiac function, therefore, must be restored before fluid volume can be replaced. The body will become overloaded with fluid volume if the heart cannot pump and distribute it effectively.
