Question 1

A patient is prescribed vasopressin 0.03 units/minute as treatment for septic shock. What action should the nurse take when providing this medication?

Accepted Answer

1. The dose of 0.03 units/min is usually added to a norepinephrine infusion.
2. This medication should always be administered via an infusion pump.
3. A rapid infuser is used to deliver large amounts of warmed crystalloid or blood to a patient over a short period of time. It is not used for medication administration.
4. This medication does not need to be administered with 0.9% normal saline.

Question 2

The nurse assesses muffled heart sounds in a patient recovering from thoracic injuries caused by a motor vehicle crash. What should the nurse anticipate being prescribed for this patient?

Accepted Answer

1. Muffled heart sounds are assessed in cardiac tamponade. A cardiac tamponade requires a pericardiocentesis.
2. Chest tube insertion would be used to treat a tension pneumothorax.
3. Surgical embolectomy is used to treat a pulmonary embolism.
4. Tissue plasminogen activator is used to treat a pulmonary embolism.

Question 3

A patient is brought to the emergency department with hypotension, tachycardia, reduced capillary refill, and oliguria. During the assessment, the nurse determines the patient is experiencing cardiogenic shock because of which additional finding?

Accepted Answer

1. Jugular vein distention is a manifestation of cardiogenic shock.
2. The mucous membranes are not dry in cardiogenic shock.
3. The skin turgor is not poor in cardiogenic shock.
4. Thirst is not a manifestation of cardiogenic shock.

Question 4

The nurse reviews medications prescribed for a patient being treated for cardiogenic shock. Which medications will the nurse most likely provide to this patient? Select all that apply.

Accepted Answer

1. Dopamine is commonly used in the treatment of cardiogenic shock.
2. Norepinephrine is commonly used in the treatment of cardiogenic shock.
3. Dobutamine may be used in the patient with cardiogenic shock who has an adequate blood pressure.
4. Epinephrine is not used in the treatment of cardiogenic shock.
5. Phenylephrine is a vasopressor and may be used in the patient with cardiogenic shock who is receiving dobutamine.

Question 5

A patient with neurogenic shock is demonstrating bradycardia. What action should the nurse take at this time?

Accepted Answer

1. Limiting movement will not correct bradycardia in the patient with neurogenic shock.
2. Crystalloids are used to correct vasodilation.
3. Phenylephrine is used in the patient with neurogenic shock to correct hypotension.
4. Bradycardia in neurogenic shock is corrected by the administration of atropine at the dose of 0.5 to 1.0 mg intravenous every 5 minutes to a total dose of 3 mg.

Question 6

A patient receives norepinephrine 30 mcg/min for treatment of refractory shock. Which assessment finding suggests the patient is experiencing peripheral vasoconstriction from the medication? Select all that apply.

Accepted Answer

1. At high doses of norepinephrine, decreased peripheral pulses indicates significant vasoconstriction.
2. At high doses of norepinephrine, a drop in body temperature indicates significant vasoconstriction.
3. At high doses of norepinephrine, paresthesias indicate significant vasoconstriction.
4. This medication does not cause a drop in blood pressure.
5. An increase in cardiac output is an expected effect of this medication and does not indicate significant vasoconstriction.

Question 7

A patient is receiving phenylephrine 50 mcg/min as treatment for shock. Which assessment finding indicates this medication is effective?

Accepted Answer

1. The expected effect of this medication is an increase in blood pressure.
2. Phenylephrine does not increase the heart rate.
3. Phenylephrine does not affect the respiratory rate.
4. Decreased peripheral pulses is a side/toxic effect of this medication.

Question 8

A patient received 8 units of packed red blood cells as treatment for hypovolemic shock. Which laboratory value should the nurse monitor for this patient?

Accepted Answer

1. Serum sodium is not affected by the blood transfusion.
2. Rapid infusions of large amounts of citrated blood can lead to hypocalcemia. Citrate is used in banked blood to prevent coagulation. Once infused, the citrate binds with the calcium in the patient's blood, leading to low serum calcium levels.
3. Serum potassium should not be affected by the blood transfusion.
4. White blood cells will not be affected by the blood transfusion.

Question 9

A patient receiving treatment for a spinal cord injury is demonstrating signs of neurogenic shock. What should the nurse expect to assess in this patient? Select all that apply.

Accepted Answer

1. In neurogenic shock the MAP is decreased, reflecting a reduced preload due to vasodilation.
2. In neurogenic shock the RAP is decreased, reflecting a reduced preload due to vasodilation.
3. In neurogenic shock JVD will not occur.
4. In neurogenic shock the CVP is decreased, reflecting a reduced preload due to vasodilation.
5. In neurogenic shock the PAWP is decreased, reflecting a reduced preload due to vasodilation.

Question 10

A patient is demonstrating signs of cardiogenic shock. Why should an intra-aortic balloon pump be considered for this patient? Select all that apply.

Accepted Answer

1. An intra-aortic balloon pump is not used to control heart rate in the patient with cardiogenic shock.
2. The intra-aortic balloon pump (IABP) may be used to decrease afterload.
3. The intra-aortic balloon pump (IABP) may be used to increase coronary perfusion.
4. An intra-aortic balloon pump is not used to improve pulmonary perfusion.
5. The intra-aortic balloon pump facilitates the movement of blood out of the left ventricle.

Question 11

The nurse assesses a mediastinal shift in a patient being treated for injuries from a motor vehicle crash. For which type of shock should the nurse plan care for this patient?

Accepted Answer

1. Obstructive shock can occur from such etiologies as tension pneumothorax. Tension pneumothorax occurs when a unilateral pneumothorax becomes so large that it shifts the mediastinum and compresses the cardiac chambers. This results in impaired filling, decreased cardiac output, hypotension, and reduced tissue perfusion.
2. Distributive shock is not caused by a tension pneumothorax.
3. Cardiogenic shock is not caused by a tension pneumothorax.
4. Hypovolemic shock is not caused by a tension pneumothorax.

Question 12

The nurse is caring for a patient recovering from a spinal cord injury sustained during a motor vehicle crash. What assessment finding indicates that the patient is developing neurogenic shock? Select all that apply.

Accepted Answer

1. Hypotension is a manifestation of neurogenic shock because of the loss of autonomic reflexes.
2. Bradycardia occurs because of the loss of sympathetic innervation.
3. Warm, dry skin occurs because of a loss of cutaneous control of sweat glands.
4. Abdominal cramping is not a manifestation of neurogenic shock.
5. Palpitations are not seen in neurogenic shock.

Question 13

A patient is experiencing acute respiratory distress after eating an item of a known food allergy. Which intervention should the nurse implement when providing emergency care to this patient? Select all that apply.

Accepted Answer

1. Epinephrine produces bronchodilation, improving the respiratory status. The route of administration is initially intramuscular.
2. Supplemental oxygen is used in the treatment of anaphylactic shock.
3. Hydrogen ion blockers such as diphenhydramine may be administered to block the histamine effects.
4. Vasopressin is not used in the treatment of anaphylactic shock.
5. Antithrombolytic agents are not used in the treatment of anaphylactic shock.

Question 14

A patient weighing 220 lbs is prescribed 10 mcg/kg/min of dopamine to improve cardiac output from cardiogenic shock. How many milligrams of dopamine should the patient receive in an hour? Record your answer rounding to the nearest whole number.

Accepted Answer

The answer of A patient weighing 220 lbs is prescribed...

Question 15

A patient demonstrates signs of obstructive shock, but the cause has yet to be determined. Which finding indicates the patient is experiencing a pulmonary embolism as the cause for obstructive shock?

Accepted Answer

1. Chest pain is a symptom associated with a massive pulmonary embolus.
2. Hypotension is seen in other causes of obstructive shock and is not a symptom that differentiates the cause as being from a pulmonary embolus.
3. Tachycardia is seen in other causes of obstructive shock and is not a symptom that differentiates the cause as being from a pulmonary embolus.
4. Oliguria is seen in other causes of obstructive shock and is not a symptom that differentiates the cause as being from a pulmonary embolus.

Question 16

A patient being treated for cardiogenic shock is being hemodynamically monitored. Which finding is consistent with the patient's diagnosis? Select all that apply.

Accepted Answer

1. This finding is consistent with pulmonary vascular congestion.
2. This finding is consistent with fluid volume overload.
3. This finding is consistent with pulmonary vascular congestion.
4. This finding is not consistent with cardiogenic shock.
5. This finding is not consistent with cardiogenic shock.

Question 17

Which assessment finding indicates that an infusion of intravenous epinephrine 4 mcg/min is effective in the treatment of a patient with anaphylactic shock?

Accepted Answer

1. An expected action for epinephrine is bronchodilation as evidenced by less wheezing.
2. Epinephrine increases heart rate.
3. Epinephrine increases blood pressure.
4. Epinephrine lowers the respiratory rate. This respiratory rate indicates that epinephrine has not been effective.

Quiz 8: Care of the Patient Experiencing Acute Coronary Syndrome