Ch 14 Shock and MODS
The nurse is performing glucose checks for sliding scale four times per day for a patient in the progressive stage of shock. What glucose range would the nurse expect to see for the best outcomes in this patient? a) 160-190 mg/dL b) 140-180 mg/dL c) 120-140 mg/dL d) 100-120 mg/dL
140-180 mg/dL Tight glycemic control (serum glucose of 80 to 100 mg/dL) is no longer recommended, as hypoglycemic events associated with regulating tight control in critically ill patients have been found to result in adverse patient outcomes (Griesdale, DeSouza, VanDam, et al., 2009). Current evidence suggests that maintaining serum glucose between 140 and 180 mg/ dL with aggressive insulin therapy and close monitoring is indicated in the management of the critically ill patient (Kavanagh & McCowen, 2010).
A nurse practitioner visits a patient in a cardiac care unit. She assesses the patient for shock, knowing that the primary cause of cardiogenic shock is: a) Cardiomyopathies. b) Arrhythmias. c) Valvular damage. d) A myocardial infarction.
A myocardial infarction. Cardiogenic shock is seen most frequently as a result of a myocardial infarction.
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 Adrenergic drugs are the main medications used to treat shock.
During preshock, the compensatory stage of shock, the body, through sympathetic nervous system stimulation, will release catecholamines to shunt blood from one organ to another. Which of the following organs will always be protected? a) Lungs b) Liver c) Kidneys d) Brain
Brain The body displays a "fight-or-flight" response, with the release of catecholamines. Blood will be shunted to the brain, heart, and lungs to ensure adequate blood supply. The organ that will always be protected over the others is the brain.
The nurse is caring for a patient with a systolic BP less than 80 mm Hg, respirations are rapid and shallow, heart rate is over 150 beats per minute, and the patient's urine output is 20 mL/hr. The nurse recognizes that the patient is demonstrating which stage of shock? a) Compensatory b) Irreversible c) Progressive d) Refractory
Compensatory In compensatory shock, the patient's BP is normal, respirations are above 20, and heart rate is above 100, but below 150. In progressive shock, the patient's skin appears mottled and mentation demonstrates lethargy. In refractory or irreversible shock, the patient requires complete mechanical and pharmacologic support.
The nurse assesses the patient for the negative effect of IV nitroglycerin (Tridil) for shock management which is: a) Increased cardiac output. b) Reduced preload. c) Reduced afterload. d) Decreased blood pressure.
Decreased blood pressure. A potentially serious side effect of IV Tridil is hypotension. Blood pressure needs to be monitored frequently according to the manufacturer's recommendation and institutional policy.
A patient visits a health clinic because of urticaria and shortness of breath after being stung by several wasps. The nurse practitioner immediately administers which medication to reduce bronchospasm? a) Prednisone b) Benadryl c) Proventil d) Epinephrine
Epinephrine Epinephrine is given for its vasoconstrictive actions, as well as for its rapid effect of reducing bronchospasm. Benadryl and Proventil (nebulized) are given to reverse the effects of histamine. Prednisone is given to reduce inflammation, if necessary.
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) Swabbing the port of a central line for 15 seconds with an alcohol pad prior to medication administration b) Rubbing the hands together with antiseptic solution until dry when exiting the client's room c) Wearing clean gloves when inserting a needle in preparation of starting intravenous fluids d) Hanging tape on the bedside table when changing a wet-to-dry sterile dressing
Hanging tape on the bedside table when changing a wet-to-dry sterile dressing The Centers for Disease Control and Prevention do not recommend hanging tape on bedside tables, siderails, linens, or clothing to use for dressings. The other options are activities that are proper infection control practices.
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 occurs when arterial blood flow and oxygen delivery to tissues and cells are inadequate. b) It is a component of any trauma. c) It causes respiratory distress syndrome. d) It begins when peripheral blood flow is inadequate.
It occurs when arterial blood flow and oxygen delivery to tissues and cells are inadequate. Shock is a life-threatening condition that occurs when arterial blood flow and oxygen delivery to tissues and cells are inadequate. Respiratory distress syndrome can be a complication of shock but is not necessarily caused by shock. Shock does not begin when peripheral blood flow is inadequate. Not every trauma victim goes into shock.
A client has experienced hypovolemic shock and is being treated with 2 liters of lactated Ringer's solution. It is now most important for the nurse to assess a) Bowel sounds b) Lung sounds c) Skin perfusion d) Mental status
Lung sounds The nurse must monitor the client during fluid replacement for side effects and complications. The most common and serious side effects include cardiovascular overload and pulmonary edema, which would be exhibited as adventitious lung sounds. Other assessments that the nurse would make include skin perfusion, changes in mentation, and bowel sounds.
Which positioning strategy should be used for the patient diagnosed with hypovolemic shock? a) Supine b) Semi-Fowler's c) Modified Trendelenburg d) Prone
Modified Trendelenburg A modified Trendelenburg position is recommended in hypovolemic shock. Elevation of the legs promotes the return of venous blood.
A patient arrives in the emergency department with complaints of chest pain radiating to the jaw. What medication does the nurse anticipate administering to reduce pain and anxiety as well as reducing oxygen consumption? a) Codeine b) Dilaudid c) Morphine d) Demerol
Morphine If a patient experiences chest pain, IV morphine is administered for pain relief. In addition to relieving pain, morphine dilates the blood vessels. This reduces the workload of the heart by both decreasing the cardiac filling pressure (preload) and reducing the pressure against which the heart muscle has to eject blood (afterload). Morphine also decreases the patient's anxiety and reduces the respiratory rate, and thus oxygen consumption.
The nurse is caring for a client in the irreversible stage of shock. The nurse is explaining to the client's family the poor prognosis. Which would the nurse be most accurate to explain as the rationale for imminent death? a) Endotoxins in the system b) Brain death c) Limited gas exchange d) Multiple organ failure
Multiple organ failure In the irreversible stage of shock, significant cells and organs are damaged. The client's condition reaches a "point of no return" despite treatment efforts. Death occurs from multiple system failure as the kidneys, heart, lungs, liver, and brain cease to function.
The nurse anticipates that a patient who is immunosuppressed is at the greatest risk for developing which of the following types of shock? a) Septic b) Neurogenic c) Anaphylactic d) Cardiogenic
Septic Septic shock is associated with immunosuppression, extremes of age, malnourishment, chronic illness, and invasive procedures. Neurogenic shock is associated with spinal cord injury and anesthesia. Cardiogenic shock is associated with disease of the heart. Anaphylactic shock is associated with hypersensitivity reactions.
A 57-year-old client has been brought to your ED via squad. He is unresponsive, and his wife reports his symptoms of elevated temperature and flushed skin. Physical assessment reveals a rapid, bounding pulse. The high school where the client is employed has had a significant increase in cases of staphylococcal and streptococcal infections among student athletes. His labs show an elevated WBC; cultures are forthcoming. You suspect which of the following may be the cause of the client's present condition? a) Neurogenic shock b) Cardiogenic shock c) Anaphylactic shock d) Septic shock
Septic shock Septic shock occurs most commonly in clients with gram-negative bacteremia (bacteria in the blood) caused by such pathogens as Escherichia coli, species of Pseudomonas, and gram-positive drug-resistant Staphylococcus aureus and streptococcal species. Unlike other forms of shock, clients with septic shock have an elevated leukocyte count and initially manifest a fever accompanied by warm, flushed skin and a rapid, bounding pulse. Clients in anaphylactic shock do not have elevated leukocyte counts nor a fever with warm, flushed skin. Injury to the spinal cord or head or overdoses of opioids, opiates, tranquilizers, or general anesthetics can cause neurogenic shock. A myocardial infarction is the leading cause of cardiogenic shock.
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) Vesicular breath sounds are audible in the lung periphery. b) The right foot is cooler than the left foot. c) The balloon deflates prior to systole. d) Bilateral pedal pulses are 1+.
The right foot is cooler than the left foot. When a client has an intra-aortic balloon counterpulsation, he or she is at risk for circulatory problems in the leg in which the catheter has been inserted. In this case, it is the right leg. A complication would be a right foot that is cooler than the left foot. Pedal pulses of 1+ bilaterally would not be a complication of this therapy but of other problems. The balloon is supposed to deflate prior to systole. It is normal for vesicular breath sounds to be audible in the lung periphery.
The nurse is reviewing diagnostic lab work of a client developing shock. Which laboratory result does the nurse note as a key in determining the type of shock? a) Hemoglobin: 14.2 g/dL b) Potassium: 4.8 mEq/L c) ESR: 19 mm/hour d) WBC: 42,000/mm3
WBC: 42,000/mm3 Septic shock has the highest mortality rate and is caused by an overwhelming bacterial infection; thus, an elevated WBC can indicate this type of shock. The other lab values are within normal limits.
A nurse knows that the major clinical use of dobutamine (Dobutrex) is to: a) increase cardiac output. b) prevent sinus bradycardia. c) treat hypotension. d) treat hypertension.
increase cardiac output. Dobutamine increases cardiac output for clients with acute heart failure and those undergoing cardiopulmonary bypass surgery. Physicians may use epinephrine hydrochloride, another catecholamine agent, to treat sinus bradycardia. Physicians use many of the catecholamine agents, including epinephrine, isoproterenol, and norepinephrine, to treat acute hypotension. They don't use catecholamine agents to treat hypertension because catecholamine agents may raise blood pressure.