Chapter 29: Drug Therapy for Shock and Hypotension

A 4-year-old is admitted to the emergency department in shock after a motor vehicle accident. The client weighs 12.5 kg. What would be the minimum effective dose of adrenalin if the pediatric dose is 0.005 to 0.01 mg/kg IV? 87.5 mcg 62.5 mcg 75 mcg 80 mcg

62.5 mcg

Which type of shock occurs from an antigen-antibody response? Anaphylactic Cardiogenic Neurogenic Septic

Anaphylactic

You are caring for a client with shock. You are concerned about hypoxemia and metabolic acidosis with your client. What finding should you analyze for evidence of hypoxemia and metabolic acidosis in a client with shock? Red blood cells (RBCs) and hemoglobin count findings Arterial blood gas (ABG) findings White blood cell count findings Serum thyroid level findings

Arterial blood gas (ABG) findings

An understanding of the pathophysiologic rationale behind shock is something every nurse needs to have. Which of the following statements best describes the pathophysiology for shock? Blood is shunted from vital organs to peripheral areas of the body Cells lack an adequate blood supply and are deprived of oxygen and nutrients Circulating blood volume is decreased Hemorrhage occurs as a result of trauma

Cells lack an adequate blood supply and are deprived of oxygen and nutrients

You are caring for a patient in hypovolemic shock. What is a priority nursing action for this client? Monitor intake and weight. Assess lung and bowel sounds. Check peripheral pulses and skin temperature. Check blood pressure and pulse.

Check blood pressure and pulse. Hypotension and abnormal heart rate are common in patients suffering from shock. Blood pressure and pulse should be monitored continuously or at least every 5 to 15 minutes during acute shock and titration of vasopressor drug therapy. Other hemodynamic indices should be checked hourly.

A nurse is caring for a 25-year-old client who has been prescribed an adrenergic drug for shock. Which action should the nurse implement? Leave the room so that the client can sleep and not risk sleep deprivation psychosis. Prepare the family by telling them how sick their loved one is and that he may die. Observe the client closely for seizures, hypothermia, and dementia; if seen, stop the infusion immediately. Continually assess the client for physiological changes and notify the primary care provider with changes.

Continually assess the client for physiological changes and notify the primary care provider with changes.

An instructor is preparing a teaching plan for a group of students about adrenergic agonists. Which would the nurse include as an alpha- and beta-adrenergic agonist? Terbutaline Epinephrine Albuterol Phenylephrine

Epinephrine

Which would the nurse expect to be prescribed to a client experiencing acute bronchospasm? Epinephrine Metaraminol Norepinephrine Dopamine

Epinephrine

A client with significant burns develops shock and requires adrenergic drug therapy. The nurse interprets this as which type of shock? Septic Hypovolemic Neurogenic Cardiogenic--obstructive

Hypovolemic

A client presents to the ED status post-motor vehicle accident with hypotension, tachycardia, diaphoresis, pallor, and oliguria. Reports from the accident site indicate significant blood loss from the vehicle's only occupant. What type of shock does the nurse suspect is the client demonstrating? Hypovolemic Cardiogenic Distributive Anaphylactic

Hypovolemic Explanation: Clients with severe burns lose large amounts of fluid through their burns. Often, this causes hypovolemic shock. Septic shock is circulatory insufficiency resulting from overwhelming infection. Cardiogenic shock occurs when cardiac output is insufficient and perfusion to vital organs cannot be maintained (e.g., during ventricular arrhythmias). Anaphylactic shock is caused by a hypersensitivity to a substance resulting in massive vasodilation

In the field, emergency personnel are quick to treat the signs and symptoms of shock because it can quickly lead to organ failure and death. What causes the generalized metabolic acidosis associated with organ failure? Insufficient glucose metabolism GI bleed Cardiomyopathy Insufficient perfusion

Insufficient perfusion

The nurse would contact the health care provider before administering an adrenergic drug to a client who is also taking which drug? Antibiotic MAO inhibitor Diuretic Analgesic

MAO inhibitor Explanation:Adrenergic drugs are contraindicated in clients taking MAO inhibitors. It is essential not to give MAO inhibitors with adrenergic drugs because the combination may cause death. Concurrent use of MAO inhibitors and adrenergic drugs may lead to a danger of cardiac dysrhythmias, respiratory depression, and acute hypertensive crisis, with possible intracranial hemorrhage, convulsions, coma, and death.

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? Is a component of any trauma Occurs when arterial blood flow and oxygen delivery to tissues and cells are inadequate Begins when peripheral blood flow is inadequate Causes respiratory distress syndrome

Occurs when arterial blood flow and oxygen delivery to tissues and cells are inadequate

Clinical indications for the use of adrenergic drugs stem mainly from their effects on the heart, blood vessels, and bronchi. They are often used as emergency drugs. For which of the following conditions would these drugs be used? Choose all that apply. Liver failure Fractures Respiratory conditions Acute cardiovascular disorders Allergic disorders

Respiratory conditions Acute cardiovascular disorders Allergic disorders

A student asks the instructor what the goal of drug therapy is in hypotension and shock. What would the instructor respond? Restore and maintain adequate tissue perfusion. Resuscitate the client. Replace fluids the patient has lost. Restore life to the patient.

Restore and maintain adequate tissue perfusion.

A nurse is monitoring the vital signs of a patient who has been administered epinephrine. Which of the readings should nurse report immediately to the primary health care provider? Systolic blood pressure below 100 mm Hg Pulse rate of 60 beats per minute A diastolic blood pressure of 75 mm Hg Temperatures reading of 97.6°F

Systolic blood pressure below 100 mm Hg

When caring for a client in shock, one of the major nursing goals is to reduce the risk that the client will develop complications. What does this require the nurse to do? Provide an accurate diagnosis, plan of care, and appropriate interventions to allow the client the best chance for survival Monitor for significant changes and evaluate client outcomes on a scheduled basis focusing on blood pressure and skin temperature Keep the health care provider updated with the most accurate information; in shock the nurse is often powerless to help. Understand the underlying mechanisms of shock, recognize the subtle and more obvious signs, and then provide rapid assessment and response

Understand the underlying mechanisms of shock, recognize the subtle and more obvious signs, and then provide rapid assessment and response

A client experiencing a serious allergic reaction to a bee sting is brought to the emergency department. The client's right hand is swollen, red, and painful. She is extremely upset, short of breath, and the nurse detects wheezing and stridor. The nurse is ordered to administer epinephrine to relieve which of the clients symptoms? acute anxiety. acute bronchospasm. discoloration in her hand. pain and swelling around the sting site.

acute bronchospasm.

A client is admitted to the emergency department with signs and symptoms of cardiogenic shock. Isoproterenol is administered intravenously. What assessment should the nurse prioritize when monitoring for therapeutic effects? blood pressure level of consciousness signs and symptoms of hemorrhage deep tendon reflexes

blood pressure

You are assessing your patient. When prioritizing the patient's care, you recognize that your patient is at risk for hypovolemic shock when pulse is fast and bounding cardiac output is increased. fluid circulating in the blood vessels decreases blood pressure increases.

fluid circulating in the blood vessels decreases

Your 69-year-old patient is started on IV dopamine for management of hypotension following open-heart surgery. As you care for the patient, you monitor him for adverse effects of the drug, including fever. cyanosis. bradycardia. tachycardia.

tachycardia. Potential adverse effects of dopamine include tachycardia, dysrhythmia, and angina.

A nurse is preparing to administer an adrenergic agent for shock. Which nursing assessment should be completed quickly and accurately? urinary output physical assessment vital signs pain evaluation

v