Test 3: Shock

A client with shock brought on by hemorrhage has a temperature of 97.6° F (36.4° C), a heart rate of 140 beats/minute, a respiratory rate of 28 breaths/minute, and a blood pressure of 60/30 mm Hg. For this client, the nurse should question which physician order? a) "Infuse I.V. fluids at 83 ml/hour." b) "Administer oxygen by nasal cannula at 3 L/minute." c) "Draw samples for hemoglobin and hematocrit every 6 hours." d) "Monitor urine output every hour."

"Infuse I.V. fluids at 83 ml/hour."

A patient is treated in the emergency department (ED) for shock of unknown etiology. The first action by the nurse should be to a. check the blood pressure. b. obtain an oxygen saturation. c. attach a cardiac monitor. d. check level of consciousness.

1.Correct Answer: B Rationale: The initial actions of the nurse are focused on the ABCs, and assessing the airway and ventilation is necessary. The other assessments should be accomplished as rapidly as possible after the oxygen saturation is determined and addressed.

When vasoactive medications are administered, the nurse must monitor vital signs at least how often? a) 30 minutes b) Hourly c) 15 minutes d) 45 minutes

15 min

Which of the following would be a pulse pressure indicative of shock? a) 130/90 b) 120/90 c) 100/60 d) 90/70

90/70

A patient in compensated septic shock has hemodynamic monitoring with a pulmonary artery catheter and an arterial catheter. Which information obtained by the nurse indicates that the patient is still in the compensatory stage of shock? a. The cardiac output is elevated. b. The central venous pressure (CVP) is increased. c. The systemic vascular resistance (SVR) is high. d. The PAWP is high.

A

A patient outcome that is appropriate for the patient in shock who has a nursing diagnosis of decreased cardiac output related to relative hypovolemia is a. urine output of 0.5 ml/kg/hr. b. decreased peripheral edema. c. decreased CVP. d. oxygen saturation 90% or more.

A

A patient with a myocardial infarction (MI) and cardiogenic shock has the following vital signs: BP 86/50, pulse 126, respirations 30. Hemodynamic monitoring reveals an elevated PAWP and decreased cardiac output. The nurse will anticipate a. administration of furosemide (Lasix) IV. b. titration of an epinephrine (Adrenalin) drip. c. administration of a normal saline bolus. d. assisting with endotracheal intubation.

A

All of these collaborative interventions are ordered by the health care provider for a patient stung by a bee who develops severe respiratory distress and faintness. Which one will the nurse administer first? a. Epinephrine (Adrenalin) b. Normal saline infusion c. Dexamethasone (Decadron) d. Diphenhydramine (Benadryl)

A

The nurse evaluates that fluid resuscitation for a 70 kg patient in shock is effective on finding that the patient's a. urine output is 40 ml over the last hour. b. hemoglobin is within normal limits. c. CVP has decreased. d. mean arterial pressure (MAP) is 65 mm Hg.

A

When assessing the hemodynamic information for a newly admitted patient in shock of unknown etiology, the nurse will anticipate administration of large volumes of crystalloids when the a. cardiac output is increased and the central venous pressure (CVP) is low. b. pulmonary artery wedge pressure (PAWP) is increased, and the urine output is low. c. heart rate is decreased, and the systemic vascular resistance is low. d. cardiac output is decreased and the PAWP is high.

A

While assessing a patient in shock who has an arterial line in place, the nurse notes a drop in the systolic BP from 92 mm Hg to 76 mm Hg when the head of the patient's bed is elevated to 75 degrees. This finding indicates a need for a. additional fluid replacement. b. antibiotic administration. c. infusion of a sympathomimetic drug. d. administration of increased oxygen.

A

A client is experiencing septic shock and infrequent bowel sounds. To ensure adequate nutrition, the nurse administers a) A full liquid diet b) Isotonic enteral nutrition every 6 hours c) A continuous infusion of total parenteral nutrition d) An infusion of crystalloids at an increased rate of flow

A continuous infusion of total parenteral nutrition

For which of the following patients in shock would a nurse observe an elevated leukocyte count and a fever accompanied by warm, flushed skin during the assessment? a) A patient with an overwhelming bacterial infection b) A patient who has lost blood during a child birth c) A patient who has had an overdose of opioids d) A patient who has had severe allergic reaction to a bee sting

A patient with an overwhelming bacterial infection

You are the nurse caring for a client in septic shock. You know to closely monitor your client. What finding would you observe when the client's condition is in its initial stages? a) A slow and imperceptible pulse b) A weak and thready pulse c) A slow but steady pulse d) A rapid, bounding pulse

A rapid, bounding pulse

A man burns a portion of his leg that is the size of the palm of his hand. What percentage of body surface area has he burned? A. 1% B. 4% C. 9% D. 18%

A. 1%

Shock develops in a person after being stung by a bee. Which of the following types of shock is most likely? A. Anaphylactic B. Neurogenic C. Cardiogenic D. Septic

A. Anaphylactic

Which of the following is NOT one of the clinical manifestations of MODS? A. Bradycardia B. Dyspnea C. Altered mental status D. Tachypnea

A. Bradycardia

Which problem is a pathophysiological consequence common to all shock states? A. Hypoperfusion B. Vasoconstriction C. Pulmonary edema D. Hypertension

A. Hypoperfusion

During the first 24 hours after a severe burn injury, which of the following physiologic responses typically occurs? A. Increased capillary permeability B. Inhibition of stress hormone release C. Increased cardiac contractility and cardiac output D. Increased peripheral vascular resistance

A. Increased capillary permeability

Which of the following laboratory alterations would indicate that a patient is developing renal failure in MODS? A. Increased serum creatinine B. Decreased lactate dehydrogenase (LDH) levels C. Decreased blood urea nitrogen (BUN) D. Hypokalemia

A. Increased serum creatinine

Which set of clinical manifestations is highly characteristic of a septic shock state? A. Tachycardia, hypotension, and warm skin B. Confusion, bradycardia, and truncal rash C. Severe respiratory distress, jugular venous distention, and chest pain D. Decreased cardiac output, hypertension, and poor skin turgor

A. Tachycardia, hypotension, and warm skin

Which of the following conditions presents the most significant risk factor for developing septic shock? A. Use of immunosuppressant medications B. History of severe allergies C. Diagnosis of chronic congestive heart failure D. Genetic predisposition to disorders of hemostasis

A. Use of immunosuppressant medications

Why would a third-degree, circumferential burn of the thigh require prompt medical attention? A. Wound contraction and edema can severely impair limb circulation. B. It is difficult to perform skin grafts of the limbs. C. Burn shock is inevitable. D. Third-degree burns are very painful.

A. Wound contraction and edema can severely impair limb circulation.

Clinical manifestations of hypovolemic shock include all of the following except: A. pulmonary edema. B. tachycardia. C. hypotension. D. oliguria.

A. pulmonary edema.

After receiving handoff report from the night shift, the nurse completes the morning assessment of a patient with severe sepsis. Vital sign assessment notes blood pressure 95/60 mm Hg, heart rate 110 beats/min, respirations 32 breaths/min, oxygen saturation (SpO2) 96% on 45% oxygen via Venturi mask, temperature 101.5° F, central venous pressure (CVP/RAP) 2 mm Hg, and urine output of 10 mL for the last hour. Given this report, the nurse obtains orders for treatment that include which of the following? (Select all that apply.) A.Administer infusion of 500 mL 0.9% normal saline every 4 hours as needed if the CVP is < 5 mm Hg. B.Increase supplemental oxygen therapy to 60% venture mask. C.Administer 40 mg furosemide (Lasix) intravenously as needed if the urine output is less than 30 mL/hr. D.Administer acetaminophen (Tylenol) 650 mg suppository per rectum as needed to treat temperature > 101° F

A.Administer infusion of 500 mL 0.9% normal saline every 4 hours as needed if the CVP is < 5 mm Hg. D.Administer acetaminophen (Tylenol) 650 mg suppository per rectum as needed to treat temperature > 101° F Fluid volume resuscitation is a priority in patients with severe sepsis to maintain circulating blood volume and end organ perfusion and oxygenation. A 500-mL IV bolus of 0.9% normal saline is appropriate given the patient's CVP of 2 mm Hg and hourly urine output of 10 mL/hr. There is no evidence to support the need to increase supplemental oxygen. Administration of furosemide (Lasix) in the presence of a fluid volume deficit is contraindicated. The fever may need to be treated

The nurse is caring for a patient admitted with severe sepsis. The physician orders include the administration of large volumes of isotonic saline solution as part of early goal-directed therapy. Which of the following best represents a therapeutic endpoint for goal-directed fluid therapy? A.Central venous pressure > 8 mm Hg B.Heart rate > 60 beats/min C.Mean arterial pressure > 50 mm Hg D.Serum lactate level > 6 mEq/L

A.Central venous pressure > 8 mm Hg Early goal-directed therapy includes administration of IV fluids to keep the central venous pressure at 8 mm Hg or greater. Additional therapeutic endpoints include a heart rate at less than 110 beats per minute and a mean arterial blood pressure at 65 mm Hg or greater. Serum lactate levels are elevated in sepsis; target levels should be < 2.2 mEq/L.

Which statement correctly reflects crystalloid fluid replacement therapy in shock states? A.Lactated Ringer's should not be infused if lactic acidosis is severe. B.3 mL of crystalloid is administered to replace 10 mL of blood loss. C.Administration of colloids is preferred over crystalloids. D.Solutions of 0.45% normal saline are used routinely in shock

A.Lactated Ringer's should not be infused if lactic acidosis is severe. LR solutions contain lactate, which the liver converts to bicarbonate. If liver function is normal, this will counteract lactic acidosis. However, LR should not be infused if lactic acidosis is severe. Three mL of crystalloid is administered to replace every 1 mL of blood loss. There is no evidence to support colloid administration being more beneficial than crystalloid administration in shock states. Hypotonic solutions such as 0.45% normal saline are not administered in shock states as these solutions rapidly leave the intravascular space, causing interstitial and intracellular edema.

The majority of cases of cardiogenic shock are caused by: A.acute myocardial infarction. B.myocardial depression in sepsis. C.pulmonary embolism. D.significant hypovolemia.

A.acute myocardial infarction. The most common cause of cardiogenic shock is an extensive left ventricular myocardial infarction. Myocardial depression in sepsis is a secondary problem associated with the acidosis/anaerobic metabolism of septic shock. Pulmonary embolism is a cause of obstructive shock. Fluid loss is the major cause of hypovolemic shock.

Fresh frozen plasma (FFP) is administered to replace: A.clotting factors. B.erythrocytes. C.leukocytes. D.platelets.

A.clotting factors. Fresh frozen plasma is administered to replace all clotting factors except platelets. Platelets are given rapidly to help control bleeding caused by low platelet counts.

1. The health care provider prescribes these actions for a patient who has possible septic shock with a BP of 70/42 mm Hg and oxygen saturation of 90%. In which order will the nurse implement the actions? Put a comma and space between each answer choice (a, b, c, d, etc.) ____________________ a. Obtain blood and urine cultures. b. Give vancomycin (Vancocin) 1 g IV. c. Infuse vasopressin (Pitressin) 0.01 units/min. d. Administer normal saline 1000 mL over 30 minutes. e. Titrate oxygen administration to keep O2 saturation >95%.

ANS: E, D, C, A, B The initial action for this hypotensive and hypoxemic patient should be to improve the oxygen saturation, followed by infusion of IV fluids and vasopressors to improve perfusion. Cultures should be obtained before administration of antibiotics.

11. Norepinephrine (Levophed) has been prescribed for a patient who was admitted with dehydration and hypotension. Which patient information indicates that the nurse should consult with the health care provider before administration of the norepinephrine? a. The patient's central venous pressure is 3 mm Hg. b. The patient is receiving low dose dopamine (Intropin). c. The patient is in sinus tachycardia at 100 to 110 beats/min. d. The patient has had no urine output since being admitted.

ANS: A Adequate fluid administration is essential before administration of vasopressors to patients with hypovolemic shock. The patient's low central venous pressure indicates a need for more volume replacement. The other patient data are not contraindications to norepinephrine administration. DIF: Cognitive Level: Application REF: 1733-1735 | 1736 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

15. A patient with septic shock has a BP of 70/46 mm Hg, pulse 136, respirations 32, temperature 104° F, and blood glucose 246 mg/dL. Which of these prescribed interventions will the nurse implement first? a. Give normal saline IV at 500 mL/hr. b. Infuse drotrecogin- (Xigris) 24 mcg/kg. c. Start insulin drip to maintain blood glucose at 110 to 150 mg/dL. d. Titrate norepinephrine (Levophed) to keep mean arterial pressure (MAP) at 65 to 70 mm Hg.

ANS: A Because of the low systemic vascular resistance (SVR) associated with septic shock, fluid resuscitation is the initial therapy. The other actions also are appropriate and should be initiated quickly as well. DIF: Cognitive Level: Application REF: 1735-1737 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

1. A patient with septic shock has a urine output of 20 mL/hr for the past 3 hours. The pulse rate is 120 and the central venous pressure and pulmonary artery wedge pressure are low. Which of these orders by the health care provider will the nurse question? a. Give furosemide (Lasix) 40 mg IV. b. Increase normal saline infusion to 150 mL/hr. c. Administer hydrocortisone (SoluCortef) 100 mg IV. d. Prepare to give drotrecogin alpha (Xigris) 24 mcg/kg/hr.

ANS: A Furosemide will lower the filling pressures and renal perfusion further for the patient with septic shock. The other orders are appropriate. DIF: Cognitive Level: Application REF: 1724-1726 | 1731 | 1733 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

21. The patient with neurogenic shock is receiving a phenylephrine (Neo-Synephrine) infusion through a left forearm IV. Which assessment information obtained by the nurse indicates a need for immediate action? a. The patient's IV infusion site is cool and pale. b. The patient has warm, dry skin on the extremities. c. The patient has an apical pulse rate of 58 beats/min. d. The patient's urine output has been 28 mL over the last hour.

ANS: A The coldness and pallor at the infusion site suggest extravasation of the phenylephrine. The nurse should discontinue the IV and, if possible, infuse the medication into a central line. An apical pulse of 58 is typical for neurogenic shock but does not indicate an immediate need for nursing intervention. A 28 mL urinary output over 1 hour would require the nurse to monitor the output over the next hour, but an immediate change in therapy is not indicated. Warm, dry skin is consistent with early neurogenic shock, but it does not indicate a need for a change in therapy or immediate action. DIF: Cognitive Level: Application REF: 1733-1734 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

14. Which information obtained by the nurse when caring for a patient who has cardiogenic shock indicates that the patient may be developing multiple organ dysfunction syndrome (MODS)? a. The patient's serum creatinine level is elevated. b. The patient complains of intermittent chest pressure. c. The patient has crackles throughout both lung fields. d. The patient's extremities are cool and pulses are weak.

ANS: A The elevated serum creatinine level indicates that the patient has renal failure as well as heart failure. The crackles, chest pressure, and cool extremities are all consistent with the patient's diagnosis of cardiogenic shock. DIF: Cognitive Level: Application REF: 1740-1741 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

18. A patient is treated in the emergency department (ED) for shock of unknown etiology. The first action by the nurse should be to a. administer oxygen. b. attach a cardiac monitor. c. obtain the blood pressure. d. check the level of consciousness.

ANS: A The initial actions of the nurse are focused on the ABCs—airway, breathing, circulation—and administration of oxygen should be done first. The other actions should be accomplished as rapidly as possible after oxygen administration. DIF: Cognitive Level: Application REF: 1729-1731 | 1732 | 1733 | 1736-1737 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

2. A patient with shock of unknown etiology whose hemodynamic monitoring indicates BP 92/54, pulse 64, and an elevated pulmonary artery wedge pressure has the following collaborative interventions prescribed. Which intervention will the nurse question? a. Infuse normal saline at 250 mL/hr. b. Keep head of bed elevated to 30 degrees. c. Give nitroprusside (Nipride) unless systolic BP <90 mm Hg. d. Administer dobutamine (Dobutrex) to keep systolic BP >90 mm Hg.

ANS: A The patient's elevated pulmonary artery wedge pressure indicates volume excess. A normal saline infusion at 250 mL/hr will exacerbate this. The other actions are appropriate for the patient. DIF: Cognitive Level: Application REF: 1719 | 1721-1722 | 1735 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

1. A patient with neurogenic shock has just arrived in the emergency department after a diving accident. He has a cervical collar in place. Which of the following actions should the nurse take (select all that apply)? a. Prepare to administer atropine IV. b. Obtain baseline body temperature. c. Prepare for intubation and mechanical ventilation. d. Administer large volumes of lactated Ringer's solution. e. Administer high-flow oxygen (100%) by non-rebreather mask.

ANS: A, B, C, E All of the actions are appropriate except to give large volumes of lactated Ringer's solution. The patient with neurogenic shock usually has a normal blood volume, and it is important not to volume overload the patient. In addition, lactated Ringer's solution is used cautiously in all shock situations because the failing liver cannot convert lactate to bicarbonate. DIF: Cognitive Level: Application REF: 1736-1737 OBJ: Special Questions: Alternate Item Format TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

9. Which of these findings is the best indicator that the fluid resuscitation for a patient with hypovolemic shock has been successful? a. Hemoglobin is within normal limits. b. Urine output is 60 mL over the last hour. c. Pulmonary artery wedge pressure (PAWP) is normal. d. Mean arterial pressure (MAP) is 65 mm Hg.

ANS: B Assessment of end organ perfusion, such as an adequate urine output, is the best indicator that fluid resuscitation has been successful. The hemoglobin level, PAWP, and MAP are useful in determining the effects of fluid administration, but they are not as useful as data indicating good organ perfusion. DIF: Cognitive Level: Application REF: 1733-1735 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

23. Which information about a patient who is receiving vasopressin (Pitressin) to treat septic shock is most important for the nurse to communicate to the heath care provider? a. The patient's heart rate is 108 beats/min. b. The patient is complaining of chest pain. c. The patient's peripheral pulses are weak. d. The patient's urine output is 15 mL/hr.

ANS: B Because vasopressin is a potent vasoconstrictor, it may decrease coronary artery perfusion. The other information is consistent with the patient's diagnosis and should be reported to the health care provider but does not indicate a need for a change in therapy. DIF: Cognitive Level: Application REF: 1735-1736 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

22. The following therapies are prescribed by the health care provider for a patient who has respiratory distress and syncope after a bee sting. Which will the nurse administer first? a. normal saline infusion b. epinephrine (Adrenalin) c. dexamethasone (Decadron) d. diphenhydramine (Benadryl)

ANS: B Epinephrine rapidly causes peripheral vasoconstriction, dilates the bronchi, and blocks the effects of histamine and reverses the vasodilation, bronchoconstriction, and histamine release that cause the symptoms of anaphylaxis. The other interventions also are appropriate but would not be the first ones administered. DIF: Cognitive Level: Application REF: 1736-1737 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

17. When caring for a patient who has septic shock, which assessment finding is most important for the nurse to report to the health care provider? a. BP 92/56 mm Hg b. Skin cool and clammy c. Apical pulse 118 beats/min d. Arterial oxygen saturation 91%

ANS: B Since patients in the early stage of septic shock have warm and dry skin, the patient's cool and clammy skin indicates that shock is progressing. The other information also will be reported, but does not indicate deterioration of the patient's status. DIF: Cognitive Level: Application REF: 1723 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

7. A patient with cardiogenic shock has the following vital signs: BP 86/50, pulse 126, respirations 30. The PAWP is increased and cardiac output is low. The nurse will anticipate a. infusion of 5% human albumin. b. administration of furosemide (Lasix) IV. c. titration of an epinephrine (Adrenalin) drip. d. administration of hydrocortisone (SoluCortef).

ANS: B The PAWP indicates that the patient's preload is elevated and furosemide is indicated to reduce the preload and improve cardiac output. Epinephrine would further increase heart rate and myocardial oxygen demand. Normal saline infusion would increase the PAWP further. Hydrocortisone might be used for septic or anaphylactic shock. DIF: Cognitive Level: Application REF: 1735 | 1736 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

12. When the nurse is assessing a patient who is receiving a nitroprusside (Nipride) infusion to treat cardiogenic shock, which finding indicates that the medication is effective? a. No heart murmur is audible. b. Skin is warm, pink, and dry. c. Troponin level is decreased. d. Blood pressure is 90/40 mm Hg.

ANS: B Warm, pink, and dry skin indicates that perfusion to tissues is improved. Since nitroprusside is a vasodilator, the blood pressure may be low even if the medication is effective. Absence of a heart murmur and a decrease in troponin level are not indicators of improvement in shock. DIF: Cognitive Level: Application REF: 1721 | 1723 | 1733-1735 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

8. The emergency department (ED) receives notification that a patient who has just been in an automobile accident is being transported to your facility with anticipated arrival in 1 minute. In preparation for the patient's arrival, the nurse will obtain a. 500 mL of 5% albumin. b. lactated Ringer's solution. c. two 14-gauge IV catheters. d. dopamine (Intropin) infusion.

ANS: C A patient with multiple trauma may require fluid resuscitation to prevent or treat hypovolemic shock, so the nurse will anticipate the need for 2 large bore IV lines to administer normal saline. Lactated Ringer's solution should be used cautiously and will not be ordered until the patient has been assessed for possible liver abnormalities. Although colloids may sometimes be used for volume expansion, crystalloids should be used as the initial therapy for fluid resuscitation. Vasopressor infusion is not used as the initial therapy for hypovolemic shock. DIF: Cognitive Level: Application REF: 1731 | 1732 | 1733 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

3. A patient with massive trauma and possible spinal cord injury is admitted to the emergency department (ED). Which finding by the nurse will help confirm a diagnosis of neurogenic shock? a. Cool, clammy skin b. Inspiratory crackles c. Apical heart rate 48 beats/min d. Temperature 101.2° F (38.4° C)

ANS: C Neurogenic shock is characterized by hypotension and bradycardia. The other findings would be more consistent with other types of shock. DIF: Cognitive Level: Comprehension REF: 1721-1722 | 1723 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

16. When the charge nurse is evaluating the skills of a new RN, which action by the new RN indicates a need for more education in the care of patients with shock? a. Placing the pulse oximeter on the ear for a patient with septic shock b. Keeping the head of the bed flat for a patient with hypovolemic shock c. Decreasing the room temperature to 68° F for a patient with neurogenic shock d. Increasing the nitroprusside (Nipride) infusion rate for a patient with a high SVR

ANS: C Patients with neurogenic shock may have poikilothermia. The room temperature should be kept warm to avoid hypothermia. The other actions by the new RN are appropriate. DIF: Cognitive Level: Application REF: 1721-1722 | 1724 OBJ: Special Questions: Delegation TOP: Nursing Process: Evaluation MSC: NCLEX: Safe and Effective Care Environment

6. To evaluate the effectiveness of the omeprazole (Prilosec) being administered to a patient with systemic inflammatory response syndrome (SIRS), which assessment will the nurse make? a. Auscultate bowel sounds. b. Ask the patient about nausea. c. Monitor stools for occult blood. d. Check for abdominal distention.

ANS: C Proton pump inhibitors are given to decrease the risk for stress ulcers in critically ill patients. The other assessments also will be done, but these will not help in determining the effectiveness of the omeprazole administration. DIF: Cognitive Level: Application REF: 1735-1737 | 1742-1743 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

10. Which intervention will the nurse include in the plan of care for a patient who has cardiogenic shock? a. Avoid elevating head of bed. b. Check temperature every 2 hours. c. Monitor breath sounds frequently. d. Assess skin for flushing and itching.

ANS: C Since pulmonary congestion and dyspnea are characteristics of cardiogenic shock, the nurse should assess the breath sounds frequently. The head of the bed is usually elevated to decrease dyspnea. Elevated temperature and flushing or itching of the skin are not typical of cardiogenic shock. DIF: Cognitive Level: Application REF: 1721 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

5. After receiving 1000 mL of normal saline, the central venous pressure for a patient who has septic shock is 10 mm Hg, but the blood pressure is still 82/40 mm Hg. The nurse will anticipate the administration of a. nitroglycerine (Tridil). b. drotrecogin alpha (Xigris). c. norepinephrine (Levophed). d. sodium nitroprusside (Nipride).

ANS: C When fluid resuscitation is unsuccessful, vasopressor drugs are administered to increase the systemic vascular resistance (SVR) and improve tissue perfusion. Nitroglycerin would decrease the preload and further drop cardiac output and BP. Drotrecogin alpha may decrease inappropriate inflammation and help prevent systemic inflammatory response syndrome, but it will not directly improve blood pressure. Nitroprusside is an arterial vasodilator and would further decrease SVR. DIF: Cognitive Level: Application REF: 1731 | 1733-1735 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

13. Which assessment is most important for the nurse to make in order to evaluate whether treatment of a patient with anaphylactic shock has been effective? a. Pulse rate b. Orientation c. Blood pressure d. Oxygen saturation

ANS: D Because the airway edema that is associated with anaphylaxis can affect airway and breathing, the oxygen saturation is the most critical assessment. Improvements in the other assessments also will be expected with effective treatment of anaphylactic shock. DIF: Cognitive Level: Application REF: 1724-1725 | 1732 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

4. A patient with cardiogenic shock is cool and clammy and hemodynamic monitoring indicates a high systemic vascular resistance (SVR). Which action will the nurse anticipate taking? a. Increase the rate for the prescribed dopamine (Intropin) infusion. b. Decrease the rate for the prescribed nitroglycerin (Tridil) infusion. c. Decrease the rate for the prescribed 5% dextrose in water (D5W) infusion. d. Increase the rate for the prescribed sodium nitroprusside (Nipride) infusion.

ANS: D Nitroprusside is an arterial vasodilator and will decrease the SVR and afterload, which will improve cardiac output. Changes in the D5W and nitroglycerin infusions will not directly increase SVR. Increasing the dopamine will tend to increase SVR. DIF: Cognitive Level: Application REF: 1733-1734 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

19. During change-of-shift report, the nurse learns that a patient has been admitted with dehydration and hypotension after having vomiting and diarrhea for 3 days. Which finding is most important for the nurse to report to the health care provider? a. Decreased bowel sounds b. Apical pulse 110 beats/min c. Pale, cool, and dry extremities d. New onset of confusion and agitation

ANS: D The changes in mental status are indicative that the patient is in the progressive stage of shock and that rapid intervention is needed to prevent further deterioration. The other information is consistent with compensatory shock. DIF: Cognitive Level: Application REF: 1728-1729 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

20. A patient who has been involved in a motor vehicle crash is admitted to the emergency department (ED) with cool, clammy skin; tachycardia; and hypotension. Which of these prescribed interventions should the nurse implement first? a. Place the patient on continuous cardiac monitor. b. Draw blood to type and crossmatch for transfusions. c. Insert two 14-gauge IV catheters in antecubital space. d. Administer oxygen at 100% per non-rebreather mask

ANS: D The first priority in the initial management of shock is maintenance of the airway and ventilation. Cardiac monitoring, insertion of IV catheters, and obtaining blood for transfusions also should be rapidly accomplished, but only after actions to maximize oxygen delivery have been implemented. DIF: Cognitive Level: Application REF: 1732 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation

A confused client exhibits a blood pressure of 112/84, pulse rate of 116 beats per minute, and respirations of 30 breaths per minute. The client's skin is cold and clammy. The nurse next a) Administers oxygen by nasal cannula at 2 liters per minute b) Calls the Rapid Response Team c) Re-assesses the vital signs d) Contacts the admitting physician

Administers oxygen by nasal cannula at 2 liters per minute

You are caring for a client in shock who is deteriorating. You are infusing IV fluids and giving medications as ordered. What type of medications are you most likely giving to this client? a) Hormone antagonist drugs b) Antimetabolite drugs c) Adrenergic drugs d) Anticholinergic drugs

Adrenergic drugs

Which of the following colloids is expensive but rapidly expands plasma volume? a) Lactated Ringer's b) Dextran c) Albumin d) Hypertonic saline

Albumin

Which type of shock occurs from an antigen-antibody response? a) Neurogenic b) Anaphylactic c) Septic d) Cardiogenic

Anaphylactic

When teaching a client with newly diagnosed hypertension about the pathophysiology of this disease, the nurse states that arterial baroreceptors, which monitor arterial pressure, are located in the carotid sinus. Which other area should the nurse mention as a site of arterial baroreceptors? a) Right ventricular wall b) Aorta c) Brachial artery d) Radial artery

Aorta

A client admitted with a massive myocardial infarction rapidly develops cardiogenic shock. Ideally, the physician would use the intra-aortic balloon pump (IABP) to support the injured myocardium. However, this client has a history of unstable angina pectoris, aortic insufficiency, hypertension, and diabetes mellitus. Which condition is a contraindication for IABP use? a) Diabetes mellitus b) Unstable angina pectoris c) Hypertension d) Aortic insufficiency

Aortic insufficiency

A patient is treated in the emergency department (ED) for shock of unknown etiology. The first action by the nurse should be to a. check the blood pressure. b. obtain an oxygen saturation. c. attach a cardiac monitor. d. check level of consciousness.

B

A patient who has been involved in a motor-vehicle crash is admitted to the ED with cool, clammy skin, tachycardia, and hypotension. All of these orders are written. Which one will the nurse act on first? a. Insert two 14-gauge IV catheters. b. Administer oxygen at 100% per non-rebreather mask. c. Place the patient on continuous cardiac monitor. d. Draw blood to type and crossmatch for transfusions.

B

A patient who has just been admitted with septic shock has a BP of 70/46, pulse 136, respirations 32, temperature 104.0° F, and blood glucose 246 mg/dl. Which order will the nurse accomplish first? a. Start insulin drip to maintain blood glucose at 110 to 150 mg/dl. b. Give normal saline IV at 500 ml/hr. c. Titrate norepinephrine (Levophed) to keep MAP at 65 to 70 mm Hg. d. Infuse drotrecogin- (Xigris) 24 mcg/kg.

B

A patient who is receiving chemotherapy is admitted to the hospital with acute dehydration caused by nausea and vomiting. Which action will the nurse include in the plan of care to best prevent the development of shock, systemic inflammatory response syndrome (SIRS), and multiorgan dysfunction syndrome (MODS)? a. Administer all medications through the patient's indwelling central line. b. Place the patient in a private room. c. Restrict the patient to foods that have been well-cooked or processed. d. Insert a nasogastric (NG) tube for enteral feeding.

B

Norepinephrine (Levophed) has been ordered for the patient in hypovolemic shock. Before administering the drug, the nurse ensures that the a. patient's heart rate is less than 100. b. patient has received adequate fluid replacement. c. patient's urine output is within normal range. d. patient is not receiving other sympathomimetic drugs.

B

The nurse caring for a patient in shock notifies the health care provider of the patient's deteriorating status when the patient's ABG results include a. pH 7.48, PaCO2 33 mm Hg. b. pH 7.33, PaCO2 30 mm Hg. c. pH 7.41, PaCO2 50 mm Hg. d. pH 7.38, PaCO2 45 mm Hg.

B

To monitor a patient with severe acute pancreatitis for the early organ damage associated with MODS, the most important assessments for the nurse to make are a. stool guaiac and bowel sounds. b. lung sounds and oxygenation status. c. serum creatinine and urinary output. d. serum bilirubin levels and skin color.

B

While caring for a seriously ill patient, the nurse determines that the patient may be in the compensatory stage of shock on finding a. cold, mottled extremities. b. restlessness and apprehension. c. a heart rate of 120 and cool, clammy skin. d. systolic BP less than 90 mm Hg.

B

The nurse would recognize which of the following clinical manifestations as suggestive of sepsis? A) Respiratory rate of seven breaths per minute B) Hyperglycemia in the absence of diabetes C) Sudden diuresis unrelated to drug therapy D) Bradycardia with sudden increase in blood pressure

B Hyperglycemia in patients with no history of diabetes is a diagnostic criterion for sepsis. Oliguria, not diuresis, typically accompanies sepsis along with tachycardia and tachypnea.

A patient's localized infection has progressed to the point where septic shock is now suspected. Which of the following is an appropriate treatment modality for this patient? A) Insulin infusion B) Aggressive fluid resuscitation C) Intravenous administration of epinephrine D) Administration of nitrates and β-adrenergic blockers

B Patients in septic shock require large amounts of fluid replacement. Nitrates and β-adrenergic blockers are most often used in the treatment of patients in cardiogenic shock. Epinephrine is indicated in anaphylactic shock, and insulin infusion is not normally necessary in the treatment of septic shock (but can be).

When caring for a patient in acute septic shock, the nurse would anticipate A) Administering osmotic and/or loop diuretics. B) Infusing large amounts of intravenous fluids. C) Administering intravenous diphenhydramine (Benadryl). D) Assisting with insertion of a ventricular assist device (VAD).

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

A patient in septic shock has not responded to fluid resuscitation, as evidenced by a decreasing BP and cardiac output. The nurse anticipates the administration of a. nitroglycerine (Tridil). b. dobutamine (Dobutrex). c. norepinephrine (Levophed). d. sodium nitroprusside (Nipride).

B AND C

Which of the following shock states is (are) characterized by acute, severe bronchoconstriction? A. Cardiogenic B. Anaphylactic C. Hypovolemic D. All of the above

B. Anaphylactic

What is the primary cause of hypotension in early stages of septic shock? A. Blood loss B. Arterial vasodilation C. Activation of the parasympathetic nervous system D. Heart failure

B. Arterial vasodilation

Anaphylactic shock manifests with the rapid onset of which set of symptoms? A. Bradycardia, decreased arterial pressure, and oliguria B. Dyspnea, hypotension, and urticaria C. Hypertension, anxiety, and tachycardia D. Fever, hypotension, and erythematous rash

B. Dyspnea, hypotension, and urticaria

Which of the following is NOT a reaction of multiple organ dysfunction syndrome (MODS)? A. Maldistribution of blood flow B. Hypometabolism C. Myocardial depression D. Supply-dependent oxygen consumption

B. Hypometabolism

Which of the following physiological alterations would you expect to see in the delayed response to a severe burn injury? A. Hypoglycemia B. Hypovolemia C. Hypometabolism D. Bleeding from wound beds

B. Hypovolemia

Which of the following shock states manifests with tachycardia, vasoconstriction, and movement of large volumes of interstitial fluid to the vascular compartment? A. Anaphylactic B. Hypovolemic C. Neurogenic D. Septic

B. Hypovolemic

What is the cause of neurogenic shock? A. Decreased volume B. Massive vasodilation C. Sympathetic overstimulation D. Increased systemic vascular resistance

B. Massive vasodilation

Which of the following conditions is not a potential cause of cardiogenic shock? A. Tension pneumothorax B. Spinal cord injury C. Tamponade D. Cardiac arrhythmias

B. Spinal cord injury

Which burn injury is characterized by the immediate appearance of large water-filled blisters and a red wound bed? A. First degree B. Superficial partial thickness (second degree) C. Deep partial thickness (second degree) D. Third degree

B. Superficial partial thickness (second degree)

Which of the following is TRUE regarding MODS? A. Progressive dysfunction of one organ system B. Uncontrolled inflammatory response C. Another term for sepsis D. A cause of low mortality

B. Uncontrolled inflammatory response

Anaphylactic shock occurs in response to severe: A. viral infections. B. allergic reactions. C. brain injuries. D. burn injuries.

B. allergic reactions.

The most common cause of multiple organ dysfunction syndrome (MODS) is: A. myocardial infarction. B. septic shock. C. chronic pulmonary disease. D. autoimmune disease.

B. septic shock.

The nurse is admitting to the ICU a patient in early sepsis. What is the nurse's best understanding of the patient's nutritional requirements? A.Total parenteral nutrition is preferred. B.Enteral nutrition initiated within the first 24 to 48 hours is critical. C.The caloric needs of the patient in sepsis are significantly lower. D.Early enteral feeding may lead to diarrhea, delaying wound healing.

B.Enteral nutrition initiated within the first 24 to 48 hours is critical. Early enteral nutrition within 24 to 48 hours of admission to an intensive care unit is supported by evidence and recommended in patients with severe sepsis, septic shock, or both. Enteral nutrition is the preferred route of administration, as this method assists the intestinal mucosa in maintaining its barrier function. The caloric needs of a patient in sepsis are high and require increased caloric intake. Early enteral feeding decreases diarrhea.

Which statement correctly represents hemodynamic values associated with the initial stages of septic shock state? A.Low heart rate; high blood pressure B.High heart rate; low right atrial pressure C.High PAOP; low cardiac output D.High SVR; normal blood pressure

B.High heart rate; low right atrial pressure In septic shock, inflammatory mediators damage the endothelial cells that line blood vessels, producing profound vasodilation and increased capillary permeability. Initially this results in a high heart rate, hypotension, and low SVR, and subsequently in low right atrial pressure.

A primary goal in all shock states is to: A.ensure adequate cellular hydration. B.maintain adequate tissue perfusion. C.prevent third spacing of fluids. D.support mechanical ventilation.

B.maintain adequate tissue perfusion. Care of a patient in shock is directed toward correcting or reversing the altered circulatory component and reversing tissue hypoxia. Restoring circulating intravascular volume is the priority in improving tissue perfusion and oxygen delivery.

Which of the following is a clinical characteristic of neurogenic shock? a) Cool skin b) Tachycardia c) Moist skin d) Bradycardia

Bradycardia

A patient with hypovolemic shock has a urinary output of 15 ml/hr. The nurse understands that the compensatory physiologic mechanism that leads to altered urinary output is a. activation of the sympathetic nervous system (SNS), causing vasodilation of the renal arteries. b. stimulation of cardiac -adrenergic receptors, leading to increased cardiac output. c. release of aldosterone and antidiuretic hormone (ADH), which cause sodium and water retention. d. movement of interstitial fluid to the intravascular space, increasing renal blood flow.

C

The triage nurse receives a call from a community member who is driving an unconscious friend with multiple injuries after a motorcycle accident to the hospital. The caller states that they will be arriving in 1 minute. In preparation for the patient's arrival, the nurse will obtain a. a liter of lactated Ringer's solution. b. 500 ml of 5% albumin. c. two 14-gauge IV catheters. d. a retention catheter.

C

When caring for a patient with cardiogenic shock and possible MODS, which information obtained by the nurse will help confirm the diagnosis of MODS? a. The patient has crackles throughout both lung fields. b. The patient complains of 8/10 crushing chest pain. c. The patient has an elevated ammonia level and confusion. d. The patient has cool extremities and weak pedal pulses.

C

When the nurse is caring for a patient in cardiogenic shock who is receiving dobutamine (Dobutrex) and nitroglycerin (Tridil) infusions, the best evidence that the medications are effective is that the a. systolic BP increases to greater than 100 mm Hg. b. cardiac monitor shows sinus rhythm at 96 beats/min. c. PAWP drops to normal range. d. troponin and creatine kinase levels decrease.

C

Which of the following laboratory findings fits with a diagnosis of cardiogenic shock? A) Decreased liver enzymes B) Increased white blood cells C) Increased blood urea nitrogen and creatinine levels D) Decreased red blood cells, hemoglobin, and hematocrit

C The renal hypoperfusion that accompanies cardiogenic shock results in increased BUN and creatinine levels. Impaired perfusion of the liver results in increased liver enzymes while red blood cell indices are typically normal because of relative hypovolemia. White blood cell levels do not typically rise in cardiogenic shock.

Low levels of which molecule contribute to the pathophysiology of septic shock? A. Nitric oxide B. Interleukin 1 C. Activated protein C D. Epinephrine

C. Activated protein C

Why do individuals with severe burns have difficulty breathing and often require intubation, even if there was no smoke inhalation causing acute lung injury? A. Severe pulmonary edema develops immediately following all severe burn injuries. B. Pulmonary emboli typically form after severe burn injuries. C. Airway edema is a common occurrence with severe burn injuries. D. Pneumothorax and pleural effusions occur with severe burn injuries.

C. Airway edema is a common occurrence with severe burn injuries.

Which of the following pathophysiological events causes the severe hypotension observed in neurogenic shock? A. Increased capillary permeability B. Diuresis C. Decreased peripheral vascular resistance D. All of the above

C. Decreased peripheral vascular resistance

Which burn injury involves most of the dermis and leaves only a few epidermal appendages intact? A. First degree B. Superficial partial thickness (second degree) C. Deep partial thickness (second degree) D. Third degree

C. Deep partial thickness (second degree)

Which of the following shock states is (are) characterized by vasodilation of the systemic arteries? A. Hypovolemic B. Cardiogenic C. Distributive D. All of the above

C. Distributive

Individuals with severe burns are often at risk for becoming hypothermic. Which of the following descriptions best characterizes the underlying cause of this problem? A. Burn patients experience hypothermia as a rebound reaction from the heat damage. B. Burn patients tend to be hypothermic due to hypotension and ischemia. C. Evaporative heat loss from major burn wounds can lead to hypothermia. D. Blood coagulation limits the blood circulating to the body core, thereby causing hypothermia.

C. Evaporative heat loss from major burn wounds can lead to hypothermia.

Which of the following is the appropriate first-line treatment for shock? A. Large amounts of fluid volume B. Medications to increase systemic vascular resistance C. Identify and treat underlying cause D. Enhance cardiac output

C. Identify and treat underlying cause

Which of the following is a TRUE statement regarding cardiogenic shock? A. The most common cause is infection. B. It responds well to multiple treatments. C. Mortality improves with revascularization strategies. D. Compensatory adaptive responses result in hypotension.

C. Mortality improves with revascularization strategies.

Which of the following is the most reliable indicator of adequate fluid resuscitation in the treatment of burns? A. Blood pressure B. Heart rate C. Urine output D. Skin turgor

C. Urine output

Secondary MODS is defined as the progressive dysfunction of two or more organ systems resulting from: A. a drug overdose. B. severe hemorrhaging. C. an uncontrolled inflammatory response. D. myocardial depression.

C. an uncontrolled inflammatory response.

Causes of hypovolemic shock include all of the following except: A. dehydration. B. blood loss. C. brainstem injury. D. diuresis.

C. brainstem injury.

Arterial baroreceptors are located in the: A. renal artery. B. superior vena cava. C. carotid arteries. D. circle of Willis.

C. carotid arteries.

A consequence of switching from aerobic to anaerobic cellular metabolism during shock states is: A. increased ATP production. B. cellular dehydration. C. lactic acidosis. D. free radical formation.

C. lactic acidosis.

During hemorrhagic shock, the clinical manifestations of pale skin and cool extremities are most directly caused by: A. hypothermia. B. accumulation of toxic metabolites. C. vasoconstriction of peripheral arterioles. D. increased tissue oxygen demand.

C. vasoconstriction of peripheral arterioles.

The nurse admits a patient to the coronary care unit in cardiogenic shock. The nurse anticipates administering which medication in an effort to improve cardiac output? A.Dopamine (Intropin) B.Phenylephrine (Neo-Synephrine) C.Dobutamine (Dobutrex) D.Nitroprusside (Nipride)

C.Dobutamine (Dobutrex) Positive inotropic agents such as dobutamine (Dobutrex) are given to increase the contractile force of the heart in cardiogenic shock. Dopamine (Intropin) is used primarily in low cardiac output states to restore vasculare tone and increase blood pressure. Neo-Synephrine would be contraindicated in cardiogenic shock, as the vasoconstriction it produces would exacerbate cardiac ischemia. Nitroprusside (Nipride) can improve cardiac performance in shock states by its reduction of systemic vascular resistance.

Large volume crystalloid solution to treat hypovolemia can be accomplished with which of the following infusions? (Select all that apply.) A.5% dextrose B.Albumin C.Lactated Ringer's (LR) D.Normal saline

C.Lactated Ringer's (LR) D.Normal saline LR solution and 0.9% normal saline are isotonic solutions that are commonly infused to treat hypovolemia. Solutions of 5% dextrose in water and 0.45% normal saline are hypotonic and are not used for fluid resuscitation. Hypotonic solutions rapidly leave the intravascular space, causing interstitial and intracellular edema. A systematic review of 30 randomized controlled trials found no benefit in giving colloids (e.g., albumin) over crystalloids and recommended against the administration of colloids in most patient populations

Which of the following type of shock are older adults more likely to develop? a) Septic shock b) Neurogenic shock c) Cardiogenic shock d) Anaphylactic shock

Cardiogenic shock

In which type of shock does the patient experience a mismatch of blood flow to the cells? a) Cardiogenic b) Circulatory c) Septic d) Hypovolemic

Circulatory

5. When assessing the hemodynamic information for a newly admitted patient in shock of unknown etiology, the nurse will anticipate administration of large volumes of crystalloids when the a. cardiac output is increased and the central venous pressure (CVP) is low. b. pulmonary artery wedge pressure (PAWP) is increased, and the urine output is low. c. heart rate is decreased, and the systemic vascular resistance is low. d. cardiac output is decreased and the PAWP is high.

Correct Answer: A Rationale: A high cardiac output and low CVP suggest septic shock, and massive fluid replacement is indicated. Increased PAWP indicates that the patient has excessive fluid volume (and suggests cardiogenic shock), and diuresis is indicated. Bradycardia and a low systemic vascular resistance (SVR) suggest neurogenic shock, and fluids should be infused cautiously.

19. While assessing a patient in shock who has an arterial line in place, the nurse notes a drop in the systolic BP from 92 mm Hg to 76 mm Hg when the head of the patient's bed is elevated to 75 degrees. This finding indicates a need for a. additional fluid replacement. b. antibiotic administration. c. infusion of a sympathomimetic drug. d. administration of increased oxygen.

Correct Answer: A Rationale: A postural drop in BP is an indication of volume depletion and suggests the need for additional fluid infusions. There are no data to suggest that antibiotics, sympathomimetics, or additional oxygen are needed.

21. A patient outcome that is appropriate for the patient in shock who has a nursing diagnosis of decreased cardiac output related to relative hypovolemia is a. urine output of 0.5 ml/kg/hr. b. decreased peripheral edema. c. decreased CVP. d. oxygen saturation 90% or more.

Correct Answer: A Rationale: A urine output of 0.5 ml/kg/hr indicates adequate renal perfusion, which is a good indicator of cardiac output. The patient may continue to have peripheral edema because fluid infusions may be needed despite third-spacing of fluids in relative hypovolemia. Decreased central venous pressure (CVP) for a patient with relative hypovolemia indicates that additional fluid infusion is necessary. An oxygen saturation of 90% will not necessarily indicate that cardiac output has improved.

15. The nurse evaluates that fluid resuscitation for a 70 kg patient in shock is effective on finding that the patient's a. urine output is 40 ml over the last hour. b. hemoglobin is within normal limits. c. CVP has decreased. d. mean arterial pressure (MAP) is 65 mm Hg.

Correct Answer: A Rationale: Assessment of end-organ perfusion, such as an adequate urine output, is the best indicator that fluid resuscitation has been successful. The hemoglobin level is not useful in determining whether fluid administration has been effective unless the patient is bleeding and receiving blood. A decrease in CVP indicates that more fluid is needed. The MAP is at the low normal range, but does not clearly indicate that tissue perfusion is adequate.

12. All of these collaborative interventions are ordered by the health care provider for a patient stung by a bee who develops severe respiratory distress and faintness. Which one will the nurse administer first? a. Epinephrine (Adrenalin) b. Normal saline infusion c. Dexamethasone (Decadron) d. Diphenhydramine (Benadryl)

Correct Answer: A Rationale: Epinephrine rapidly causes peripheral vasoconstriction, dilates the bronchi, and blocks the effects of histamine and reverses the vasodilation, bronchoconstriction, and histamine release that cause the symptoms of anaphylaxis. The other interventions are also appropriate but would not be the first ones administered.

23. A patient in compensated septic shock has hemodynamic monitoring with a pulmonary artery catheter and an arterial catheter. Which information obtained by the nurse indicates that the patient is still in the compensatory stage of shock? a. The cardiac output is elevated. b. The central venous pressure (CVP) is increased. c. The systemic vascular resistance (SVR) is high. d. The PAWP is high.

Correct Answer: A Rationale: In the early stages of septic shock, the cardiac output is high. The other hemodynamic changes would indicate that the patient had developed progressive or refractory septic shock.

13. A patient with a myocardial infarction (MI) and cardiogenic shock has the following vital signs: BP 86/50, pulse 126, respirations 30. Hemodynamic monitoring reveals an elevated PAWP and decreased cardiac output. The nurse will anticipate a. administration of furosemide (Lasix) IV. b. titration of an epinephrine (Adrenalin) drip. c. administration of a normal saline bolus. d. assisting with endotracheal intubation.

Correct Answer: A Rationale: The PAWP indicates that the patient's preload is elevated and furosemide is indicated to reduce the preload and improve cardiac output. Epinephrine would further increase myocardial oxygen demand and might extend the MI. The PAWP is already elevated, so normal saline boluses would be contraindicated. There is no indication that the patient requires endotracheal intubation.

26. An assessment finding indicating to the nurse that a 70-kg patient in septic shock is progressing to MODS includes a. respiratory rate of 10 breaths/min. b. fixed urine specific gravity at 1.010. c. MAP of 55 mm Hg. d. 360-ml urine output in 8 hours.

Correct Answer: B Rationale: A fixed urine specific gravity points to an inability of the kidney to concentrate urine caused by acute tubular necrosis. With MODS, the patient's respiratory rate would initially increase. The MAP of 55 shows continued shock, but not necessarily progression to MODS. A 360-ml urine output over 8 hours indicates adequate renal perfusion.

22. A patient who has just been admitted with septic shock has a BP of 70/46, pulse 136, respirations 32, temperature 104.0° F, and blood glucose 246 mg/dl. Which order will the nurse accomplish first? a. Start insulin drip to maintain blood glucose at 110 to 150 mg/dl. b. Give normal saline IV at 500 ml/hr. c. Titrate norepinephrine (Levophed) to keep MAP at 65 to 70 mm Hg. d. Infuse drotrecogin- (Xigris) 24 mcg/kg.

Correct Answer: B Rationale: Because of the low systemic vascular resistance (SVR) associated with septic shock, fluid resuscitation is the initial therapy. The other actions are also appropriate and should be initiated quickly as well.

17. Norepinephrine (Levophed) has been ordered for the patient in hypovolemic shock. Before administering the drug, the nurse ensures that the a. patient's heart rate is less than 100. b. patient has received adequate fluid replacement. c. patient's urine output is within normal range. d. patient is not receiving other sympathomimetic drugs.

Correct Answer: B Rationale: If vasoconstrictors are given in a hypovolemic patient, the peripheral vasoconstriction will further decrease tissue perfusion. A patient with hypovolemia is likely to have a heart rate greater than 100 and a low urine output, so these values are not contraindications to vasoconstrictor therapy. Patients may receive other sympathomimetic drugs concurrently with Levophed.

4. While caring for a seriously ill patient, the nurse determines that the patient may be in the compensatory stage of shock on finding a. cold, mottled extremities. b. restlessness and apprehension. c. a heart rate of 120 and cool, clammy skin. d. systolic BP less than 90 mm Hg.

Correct Answer: B Rationale: Restlessness and apprehension are typical during the compensatory stage of shock. Cold, mottled extremities, cool and clammy skin, and a systolic BP less than 90 are associated with the progressive and refractory stages.

6. A patient who has been involved in a motor-vehicle crash is admitted to the ED with cool, clammy skin, tachycardia, and hypotension. All of these orders are written. Which one will the nurse act on first? a. Insert two 14-gauge IV catheters. b. Administer oxygen at 100% per non-rebreather mask. c. Place the patient on continuous cardiac monitor. d. Draw blood to type and crossmatch for transfusions.

Correct Answer: B Rationale: The first priority in the initial management of shock is maintenance of the airway and ventilation. Cardiac monitoring, insertion of IV catheters, and obtaining blood for transfusions should also be rapidly accomplished, but only after actions to maximize oxygen delivery have been implemented.

11. A patient who is receiving chemotherapy is admitted to the hospital with acute dehydration caused by nausea and vomiting. Which action will the nurse include in the plan of care to best prevent the development of shock, systemic inflammatory response syndrome (SIRS), and multiorgan dysfunction syndrome (MODS)? a. Administer all medications through the patient's indwelling central line. b. Place the patient in a private room. c. Restrict the patient to foods that have been well-cooked or processed. d. Insert a nasogastric (NG) tube for enteral feeding.

Correct Answer: B Rationale: The patient who has received chemotherapy is immune compromised, and placing the patient in a private room will decrease the exposure to other patients and reduce infection/sepsis risk. Administration of medications through the central line increases the risk for infection and sepsis. There is no indication that the patient is neutropenic, and restricting the patient to cooked and processed foods is likely to decrease oral intake further and cause further malnutrition, a risk factor for sepsis and shock. Insertion of an NG tube is invasive and will not decrease the patient's nausea and vomiting.

8. The nurse caring for a patient in shock notifies the health care provider of the patient's deteriorating status when the patient's ABG results include a. pH 7.48, PaCO2 33 mm Hg. b. pH 7.33, PaCO2 30 mm Hg. c. pH 7.41, PaCO2 50 mm Hg. d. pH 7.38, PaCO2 45 mm Hg.

Correct Answer: B Rationale: The patient's low pH in spite of a respiratory alkalosis indicates that the patient has severe metabolic acidosis and is experiencing the progressive stage of shock; rapid changes in therapy are needed. The values in the answer beginning "pH 7.48" suggest a mild respiratory alkalosis (consistent with compensated shock). The values in the answer beginning "pH 7.41" suggest compensated respiratory acidosis. The values in the answer beginning "pH 7.38" are normal.

25. To monitor a patient with severe acute pancreatitis for the early organ damage associated with MODS, the most important assessments for the nurse to make are a. stool guaiac and bowel sounds. b. lung sounds and oxygenation status. c. serum creatinine and urinary output. d. serum bilirubin levels and skin color.

Correct Answer: B Rationale: The respiratory system is usually the system to show the signs of MODS because of the direct effect of inflammatory mediators on the pulmonary system. The other assessment data are also important to collect, but they will not indicate the development of MODS as early.

14. The triage nurse receives a call from a community member who is driving an unconscious friend with multiple injuries after a motorcycle accident to the hospital. The caller states that they will be arriving in 1 minute. In preparation for the patient's arrival, the nurse will obtain a. a liter of lactated Ringer's solution. b. 500 ml of 5% albumin. c. two 14-gauge IV catheters. d. a retention catheter.

Correct Answer: C Rationale: A patient with multiple trauma may require fluid resuscitation to prevent or treat hypovolemic shock, so the nurse will anticipate the need for 2 large bore IV lines to administer normal saline. Lactated Ringer's solution should be used cautiously and will not be ordered until the patient had been assessed for possible liver abnormalities. Although colloids may sometimes be used for volume expansion, it is generally accepted that crystalloids should be used as the initial therapy for fluid resuscitation. A catheter would likely be ordered, but in the 1 minute that the nurse has to obtain supplies, the IV catheters would take priority.

18. When the nurse is caring for a patient in cardiogenic shock who is receiving dobutamine (Dobutrex) and nitroglycerin (Tridil) infusions, the best evidence that the medications are effective is that the a. systolic BP increases to greater than 100 mm Hg. b. cardiac monitor shows sinus rhythm at 96 beats/min. c. PAWP drops to normal range. d. troponin and creatine kinase levels decrease.

Correct Answer: C Rationale: Because PAWP is increased in cardiogenic shock as a result of the increase in volume and pressure in the left ventricle, normalization of PAWP is the best indicator of patient improvement. The changes in BP and heart rate could occur with dobutamine infusion even if patient tissue perfusion was not improved. Troponin and creatine kinase (CK) levels are indicators of cardiac cellular death and are not used as indicators of improved tissue perfusion.

27. When caring for a patient who has just been admitted with septic shock, which of these assessment data will be of greatest concern to the nurse? a. BP 88/56 mm Hg b. Apical pulse 110 beats/min c. Urine output 15 ml for 2 hours d. Arterial oxygen saturation 90%

Correct Answer: C Rationale: The best data for assessing the adequacy of cardiac output are those that provide information about end-organ perfusion such as urine output by the kidneys. The low urine output is an indicator that renal tissue perfusion is inadequate and the patient is in the progressive stage of shock. The low BP, increase in pulse, and low-normal O2 saturation are more typical of compensated septic shock.

9. The patient with neurogenic shock is receiving a phenylephrine (Neo-Synephrine) infusion through a left-forearm IV. Which assessment information obtained by the nurse indicates a need for immediate action? a. The patient has an apical pulse rate of 58 beats/min. b. The patient's urine output has been 28 ml over the last hour. c. The patient's IV infusion site is cool and pale. d. The patient has warm, dry skin on the extremities.

Correct Answer: C Rationale: The coldness and pallor at the infusion site suggest extravasation of the Neo-Synephrine. The nurse should discontinue the IV and, if possible, infuse the medication into a central line. An apical pulse of 58 is typical for neurogenic shock but does not indicate an immediate need for nursing intervention. A 28-ml output over 1 hour would require the nurse to monitor the output over the next hour, but an immediate change in therapy is not indicated. Warm, dry skin indicates that the patient is in early neurogenic shock.

24. When caring for a patient with cardiogenic shock and possible MODS, which information obtained by the nurse will help confirm the diagnosis of MODS? a. The patient has crackles throughout both lung fields. b. The patient complains of 8/10 crushing chest pain. c. The patient has an elevated ammonia level and confusion. d. The patient has cool extremities and weak pedal pulses.

Correct Answer: C Rationale: The elevated ammonia level and confusion suggest liver failure in addition to the cardiac failure. The crackles, chest pain, and cool extremities are all consistent with cardiogenic shock and do not indicate that there are failures in other major organ systems.

7. A patient with massive trauma and possible spinal cord injury is admitted to the ED. The nurse suspects that the patient may be experiencing neurogenic shock in addition to hypovolemic shock, based on the finding of a. cool, clammy skin. b. shortness of breath. c. heart rate of 48 beats/min d. BP of 82/40 mm Hg.

Correct Answer: C Rationale: The normal sympathetic response to shock/hypotension is an increase in heart rate. The presence of bradycardia suggests unopposed parasympathetic function, as occurs in neurogenic shock. The other symptoms are consistent with hypovolemic shock.

3. A patient with hypovolemic shock has a urinary output of 15 ml/hr. The nurse understands that the compensatory physiologic mechanism that leads to altered urinary output is a. activation of the sympathetic nervous system (SNS), causing vasodilation of the renal arteries. b. stimulation of cardiac -adrenergic receptors, leading to increased cardiac output. c. release of aldosterone and antidiuretic hormone (ADH), which cause sodium and water retention. d. movement of interstitial fluid to the intravascular space, increasing renal blood flow.

Correct Answer: C Rationale: The release of aldosterone and ADH lead to the decrease in urine output by increasing the reabsorption of sodium and water in the renal tubules. SNS stimulation leads to renal artery vasoconstriction. -Receptor stimulation does increase cardiac output, but this would improve urine output. During shock, fluid leaks from the intravascular space into the interstitial space.

10. A patient in septic shock has not responded to fluid resuscitation, as evidenced by a decreasing BP and cardiac output. The nurse anticipates the administration of a. nitroglycerine (Tridil). b. dobutamine (Dobutrex). c. norepinephrine (Levophed). d. sodium nitroprusside (Nipride).

Correct Answer: C Rationale: When fluid resuscitation is unsuccessful, administration of vasopressor drugs is used to increase the systemic vascular resistance (SVR) and improve tissue perfusion. Nitroglycerin would decrease the preload and further drop cardiac output and BP. Dobutamine will increase stroke volume, but it would also further decrease SVR. Nitroprusside is an arterial vasodilator and would further decrease SVR.

16. The nurse is caring for a patient admitted with a urinary tract infection and sepsis. Which information obtained in the assessment indicates a need for a change in therapy? a. The patient is restless and anxious. b. The patient has a heart rate of 134. c. The patient has hypotonic bowel sounds. d. The patient has a temperature of 94.1° F.

Correct Answer: D Rationale: Hypothermia is an indication that the patient is in the progressive stage of shock. The other data are consistent with compensated shock.

20. The best nursing intervention for a patient in shock who has a nursing diagnosis of fear related to perceived threat of death is to a. arrange for the hospital pastoral care staff to visit the patient. b. ask the health care provider to prescribe a sedative drug for the patient. c. leave the patient alone with family members whenever possible. d. place the patient's call bell where it can be easily reached.

Correct Answer: D Rationale: The patient who is fearful should feel that the nurse is immediately available if needed. Pastoral care staff should be asked to visit only after checking with the patient to determine whether this is desired. Providing time for family to spend with the patient is appropriate, but patients and family should not feel that the nurse is unavailable. Sedative administration is helpful but does not as directly address the patient's anxiety about dying.

2. A diabetic patient who has had vomiting and diarrhea for the past 3 days is admitted to the hospital with a blood glucose of 748 mg/ml (41.5 mmol/L) and a urinary output of 120 ml in the first hour. The vital signs are blood pressure (BP) 72/62; pulse 128, irregular and thready; respirations 38; and temperature 97° F (36.1° C). The patient is disoriented and lethargic with cold, clammy skin and cyanosis in the hands and feet. The nurse recognizes that the patient is experiencing the a. progressive stage of septic shock. b. compensatory stage of diabetic shock. c. refractory stage of cardiogenic shock. d. progressive stage of hypovolemic shock.

Correct Answer: D Rationale: The patient's history of hyperglycemia (and the associated polyuria), vomiting, and diarrhea is consistent with hypovolemia, and the symptoms are most consistent with the progressive stage of shock. The patient's temperature of 97° F is inconsistent with septic shock. The history is inconsistent with a diagnosis of cardiogenic shock, and the patient's neurologic status is not consistent with refractory shock.

A diabetic patient who has had vomiting and diarrhea for the past 3 days is admitted to the hospital with a blood glucose of 748 mg/ml (41.5 mmol/L) and a urinary output of 120 ml in the first hour. The vital signs are blood pressure (BP) 72/62; pulse 128, irregular and thready; respirations 38; and temperature 97° F (36.1° C). The patient is disoriented and lethargic with cold, clammy skin and cyanosis in the hands and feet. The nurse recognizes that the patient is experiencing the a. progressive stage of septic shock. b. compensatory stage of diabetic shock. c. refractory stage of cardiogenic shock. d. progressive stage of hypovolemic shock.

D

The best nursing intervention for a patient in shock who has a nursing diagnosis of fear related to perceived threat of death is to a. arrange for the hospital pastoral care staff to visit the patient. b. ask the health care provider to prescribe a sedative drug for the patient. c. leave the patient alone with family members whenever possible. d. place the patient's call bell where it can be easily reached.

D

The nurse is caring for a patient admitted with a urinary tract infection and sepsis. Which information obtained in the assessment indicates a need for a change in therapy? a. The patient is restless and anxious. b. The patient has a heart rate of 134. c. The patient has hypotonic bowel sounds. d. The patient has a temperature of 94.1° F.

D

When caring for a critically ill patient who is being mechanically ventilated, the nurse will astutely monitor for which of the following clinical manifestations of multiple organ dysfunction syndrome (MODS)? A) Increased gastrointestinal (GI) motility B) Increased serum albumin C) Decreased blood urea nitrogen (BUN)/creatinine ratio D) Decreased respiratory compliance

D Clinical manifestations of MODS include symptoms of respiratory distress, signs and symptoms of decreased renal perfusion, decreased serum albumin and prealbumin, decreased GI motility, acute neurologic changes, myocardial dysfunction, disseminated intravascular coagulation (DIC), and changes in glucose metabolism.

A massive gastrointestinal bleed has resulted in hypovolemic shock in an elderly patient. Which of the following is a priority nursing diagnosis? A) Acute pain B) Impaired tissue integrity C) Decreased cardiac output D) Ineffective tissue perfusion

D The many deleterious effects of shock are all related to inadequate perfusion and oxygenation of every body system. This nursing diagnosis supersedes the other diagnoses.

In MODS, which of the following events contribute to organ failure? A. Microvascular clotting B. Interstitial edema C. Exhaustion of fuel supply D. All of the above

D. All of the above

Which of the following types of shock is NOT related to low systemic vascular resistance? A. Septic B. Neurogenic C. Anaphylactic D. Cardiogenic

D. Cardiogenic

Which of the following is NOT one of the three essential elements of survival of a major burn injury? A. Meticulous wound management B. Adequate fluids C. Early grafting D. Early antibiotics

D. Early antibiotics

Which of the following features is highly characteristic of a septic shock state? A. High peripheral vascular resistance B. Inhibition of the sympathetic nervous system C. Metabolic alkalosis D. Hypermetabolism

D. Hypermetabolism

Which burn injury is essentially painless in the wound bed? A. First degree B. Superficial partial thickness (second degree) C. Deep partial thickness (second degree) D. Third degree

D. Third degree

Neurogenic shock is caused by: A. spinal cord injuries below T6. B. inhibition of the parasympathetic nervous system. C. injury to the cerebral cortex. D. a lack of sympathetic activity.

D. a lack of sympathetic activity.

All of the following alterations would indicate that a patient is developing liver failure in MODS except: A. increased serum ammonia levels. B. jaundice. C. increased levels of liver enzymes. D. increased serum urea levels.

D. increased serum urea levels.

In the cardiac cycle, the ventricles contract during: A. the refractory period. B. diastole. C. repolarization. D. systole.

D. systole.

Blood pooling in the capillary bed and arterial blood pressure too low to support perfusion of vital organs cause: A.acute respiratory distress syndrome (ARDS). B.disseminated intravascular coagulation (DIC). C.increased cerebral perfusion pressure. D.multisystem organ failure and/or dysfunction.

D.multisystem organ failure and/or dysfunction. Maldistribution of blood flow refers to the uneven distribution of flow to various organs and pooling of blood in the capillary beds. This impaired blood flow leads to impaired tissue perfusion and a decreased oxygen supply to the cells, all of which contribute to multiple organ failure. Damage to the type II pneumocytes leads to ARDS. Consumption of clotting factors may cause DIC. Low arterial blood pressure leads to decreased cerebral perfusion pressure.

In distributive shock, the major physiological problem causing the shock is: A.blood loss and actual hypovolemia. B.decreased cardiac output. C.third spacing of fluids into peritoneal space. D.vasodilation and relative hypovolemia.

D.vasodilation and relative hypovolemia. Distributive shock presents with widespread vasodilation and decreased systemic vascular resistance that results in a relative hypovolemia. Blood loss is associated with hypovolemic shock. Decreased cardiac output is a primary cause of cardiogenic shock. Primary internal sequestration of fluids that causes internal fluid loss is associated with hypovolemic shock.

When neurogenic shock occurs, interruption in sympathetic nerve impulses causes: A.tachycardia. B.hypertension. C.hypoventilation. D.vasodilation.

D.vasodilation. In neurogenic shock, there is an interruption of impulse transmission or blockage of sympathetic outflow, resulting in vasodilation, inhibition of baroreceptor response, and impaired thermoregulation. Interruption of sympathetic nerve innervation would result in bradycardia. Interruption of sympathetic nerve innervation would result in hypotension. Hypoventilation is not a physiological mechanism.

A client who experienced shock is now nonresponsive and having cardiac dysrhythmias. The client is being mechanically ventilated, receiving medications to maintain renal perfusion, and is not responding to treatment. In this stage, it is most important for the nurse to a) Encourage the family to touch and talk to the client. b) Inform the family that everything is being done to assist with the client's survival. c) Open up discussion among the family members about nursing home placement. d) Contact a spiritual advisor to provide comfort to the family.

Encourage the family to touch and talk to the client.

A nurse is assisting with the orientation of a newly hired graduate. Which of the following behaviors of the graduate nurse would the other nurse identify as not adhering to strict infection control practices? a) Wearing clean gloves when inserting a needle in preparation of starting intravenous fluids b) Swabbing the port of a central line for 15 seconds with an alcohol pad prior to medication administration c) Hanging tape on the bedside table when changing a wet-to-dry sterile dressing d) Rubbing the hands together with antiseptic solution until dry when exiting the client's room

Hanging tape on the bedside table when changing a wet-to-dry sterile dressing

Elevating the patient's legs slightly to improve cerebral circulation is contraindicated in which of the following disease processes? a) Multiple sclerosis b) Myocardial infarction c) Diabetes d) Head injury

Head injury

A client has developed shock as the result of the MVA. His treatment is focused on preventing the development of more than one type of shock and to minimize the effects of the type of shock he is demonstrating. Which of the following is NOT a category of shock? a) Hepatic b) Circulatory c) Cardiogenic d) None of the options are correct

Hepatic

You are caring for a client in the compensation stage of shock. You know that in this stage of shock epinephrine and norepinephrine are released into the circulation. What positive effect does this have on your client? a) Decreases blood return to the heart b) Decreases carbon dioxide exchange c) Increases myocardial contractility d) Contracts bronchioles

Increases myocardial contractility

The nursing instructor is discussing shock with the senior nursing students. The instructor tells the students that shock is a life-threatening condition. What else should the instructor tell the students about shock? a) It begins when peripheral blood flow is inadequate. b) It causes respiratory distress syndrome. c) It occurs when arterial blood flow and oxygen delivery to tissues and cells are inadequate. d) It is a component of any trauma.

It occurs when arterial blood flow and oxygen delivery to tissues and cells are inadequate.

A large volume of intravenous fluids is being administered to an elderly client who experienced hypovolemic shock following diarrhea. The nurse is evaluating the client's response to treatment and notes the following as a sign of an adverse reaction: a) Positive increase in the fluid balance ratio b) Decreased pulse rate to 110 beats/minute c) Jugular venous distention d) Vesicular breath sounds

JVD

A client experiencing vomiting and diarrhea for 2 days has a blood pressure of 88/56, a pulse rate of 122 beats/minute, and a respiratory rate of 28 breaths/minute. The nurse places the client in which position?

Modified Trendelenburg

Which positioning strategy should be utilized for the patient diagnosed with hypovolemic shock? a) Semi-Fowler's b) Prone c) Supine d) Modified Trendelenburg

Modified Trendelenburg

A client experiences an acute myocardial infarction. Current blood pressure is 90/58, pulse is 118 beats/minute, and respirations are 30 breaths/minute. The nurse intervenes first by administering the following prescribed treatment: a) Oxygen at 2 L/min by nasal cannula b) Dopamine (Intropin) intravenous solution c) NS at 60 mL/hr via an intravenous line d) Morphine 2 mg intravenously

Oxygen at 2 L/min by nasal cannula

As the body tries to adjust to accommodate injury (and thus avoid shock), many physical responses are expected. When the pathophysiological compensations are not sufficient, which stage of shock does the client experience? a) Compensation stage b) Catecholamine stage c) Irreversible stage d) Progressive stage

Progressive stage

Morphine sulfate has which of the following effects on the body? a) No effect on preload or afterload b) Reduces preload c) Increases preload d) Increases afterload

Reduces preload

The client exhibits a blood pressure of 110/68 mm Hg, pulse rate of 112 beats/min, temperature of 102°F with skin warm and flushed. Respirations are 30 breaths/min. The nurse assesses the client may be exhibiting the early stage of which shock? a) Cardiogenic b) Anaphylactic c) Septic d) Neurogenic

Septic

Which type of shock is caused by an infection? a) Septic b) Hypovolemic c) Cardiogenic d) Anaphylactic

Septic

When a patient is in the compensatory stage of shock which of the following symptoms occurs? a) Tachycardia b) Bradycardia c) Urine output of 45 cc/hour d) Respiratory acidosis

Tachycardia

A nurse is providing care to all of the following clients. Which client would be most at risk for septic shock? a) The client with pneumonia in the left lower lobe of the lung b) The client with testicular cancer who is receiving intravenous chemotherapy c) The 45-year-old client with a sudden onset of frequent premature ventricular contractions (PVCs) d) The client with a BMI of 25 who has lost 3 pounds as the result of vomiting

The client with testicular cancer who is receiving intravenous chemotherapy

A client is receiving support through an intra-aortic balloon counterpulsation. The catheter for the balloon is inserted in the right femoral artery. The nurse evaluates the following as a complication of the therapy: a) Bilateral pedal pulses are 1+. b) Vesicular breath sounds are audible in the lung periphery. c) The right foot is cooler than the left foot. d) The balloon deflates prior to systole.

The right foot is cooler than the left foot.

A nurse knows that the major clinical use of dobutamine (Dobutrex) is to: a) prevent sinus bradycardia. b) increase cardiac output. c) treat hypertension. d) treat hypotension.

increase cardiac output.

Stress ulcers occur frequently in acutely ill patient. Which of the following medications would be used to prevent ulcer formation? Select all that apply. a) Furosemide (Lasix) b) Famotidine (Pepcid) c) Lansoprazole (Prevacid) d) Desmopressin (DDAVP) e) Ranitidine (Zantac)

• Ranitidine (Zantac) • Lansoprazole (Prevacid) • Famotidine (Pepcid)