Deck 29: Drugs for Shock

Question 1

A newly licensed nurse abruptly discontinues the intravenous (IV) norepinephrine (Levophed) once it has infused into the patient. What is the priority action of the more experienced nurse?

A) Obtain an oxygen saturation reading with a pulse oximeter.
B) Notify the physician.
C) Assess the patient's blood pressure.
D) Administer oxygen via a rebreather mask.

Answer 1

Assess the patient's blood pressure.

Question 2

The patient has experienced hypovolemic shock as a result of severe burns. The physician orders a low dose of dopamine (Intropin). What is the best evaluation by the nurse?

A) Vasoconstriction and increased blood pressure
B) Stabilization of fluid loss
C) Urinary output of at least 50 mL/hour
D) Increased cardiac output

Answer 2

Urinary output of at least 50 mL/hour

Question 3

The physician has prescribed epinephrine (Adrenalin) for an older adult patient. What is an important nursing assessment prior to administration of this drug?

A) A history of type 1 diabetes mellitus
B) A history of narrow angle glaucoma
C) A history of dizziness
D) A history of human immunodeficiency virus (HIV) infection

Answer 3

A history of narrow angle glaucoma

Question 4

The patient comes to the emergency department after suffering a bilateral traumatic amputation of his lower extremities. The physician orders normal serum albumin (Albuminar). The patient goes into shock. What will the best nursing assessment of this patient reveal?

A) B/P: 140/90 mmHg, P: 46, weak and irregular, R: 24, and shallow.
B) B/P: 50/0 mmHg, P: 126, weak and thready, R: 14, and shallow.
C) B/P: 80/20 mmHg, P: 122, weak and thready, R: 28, and shallow.
D) B/P: 130/88 mmHg, P: 90, bounding, R: 32, and shallow.

Question 5

The patient is in shock with a blood pressure of 60/20 mmHg. The physician orders dobutamine intravenously (IV). The family is quite anxious and asks what "that liquid" is for. What is the best response of the nurse?

A) "This drug is a vasopressor and helps the heart beat more effectively, which will increase blood pressure."
B) "Vasopressor drugs act on the renin-angiotension system and thus increase blood pressure."
C) "This drug is a vasopressor and will help stabilize blood pressure by making the blood vessels smaller."
D) "It is called a vasopressor and will help increase blood flow to peripheral muscles."

Question 6

The nurse works in a summer camp for children. One of the children says she was bitten by several wasps. The nurse plans to inject the child with epinephrine (EpiPen) if which symptoms are present?

A) The child's skin feels cold and clammy.
B) The child is thirsty.
C) The child's skin feels warm and dry.
D) The child is restless and confused.
E) The child is hyperactive and hyperverbal.

Question 7

The patient is receiving normal serum albumin (Albuminar). What will be a priority outcome with this patient?

A) The patient will be afebrile.
B) The patient will be free of a rash.
C) The patient will experience adequate breathing patterns.
D) The patient will remain alert and oriented.

Question 8

The patient is receiving human serum albumin (Albuminar) as treatment for shock. What is a priority assessment by the nurse?

A) Auscultate breath sounds for hyper-resonance.
B) Auscultate for an absence of breath sounds in the lower lobes.
C) Auscultate breath sounds for inspiratory stridor.
D) Auscultate breath sounds for crackles.

Question 9

The patient comes to the emergency department with a severe allergic reaction to peanuts and is in serious respiratory distress. The patient's spouse tells the nurse that the patient has a known hypersensitivity to epinephrine (Adrenalin). What is the best response by the nurse?

A) "I will let the physician know about this immediately; we will need to choose an alternative medication."
B) "I'm not sure what we can use then. Do you know what has been used before with this allergic response?"
C) "This is a life-threatening situation; a prior hypersensitivity is not an absolute contraindication."
D) "This is a problem; we will need to use IV diphenhydramine (Benadryl)."

Question 10

A patient with cardiogenic shock would exhibit which symptom?

A) Bradycardia
B) Low temperature
C) Restlessness and anxiety
D) Tachycardia and low blood pressure

Question 11

Colloids differ from crystalloids in that

A) they contain electrolytes.
B) they readily leave the blood and enter cells.
C) they are too large to cross membranes.
D) they promote urine output.

Question 12

The patient will be receiving dopamine (Intropin). What equipment will the nurse prioritize prior to infusion of this drug?

A) Oxygen cannula
B) Intravenous (IV) pump
C) Pulse oximeter
D) Sequential compression devices

Question 13

The mechanism of action of norepinephrine is to

A) cause increased blood flow.
B) increase heart rate.
C) decrease cardiac output.
D) produce vasoconstriction.

Question 14

Hypovolemic shock is different from neurogenic shock in that it relates to

A) an infectious process.
B) a brain or spinal cord trauma.
C) inadequate cardiac output.
D) volume depletion.

Question 15

Following a massive myocardial infarction, the patient develops cardiogenic shock. The patient's family asks the nurse what the patient's chances of survival are. What information does the nurse consider when formulating a response to these concerns?

A) Cardiogenic shock is the major reason people die after having an MI.
B) Even though many people develop cardiogenic shock, the majority survive without residual effects.
C) Cardiogenic shock is the most lethal type of shock.
D) As long as the patient does not develop septic shock, survival is probable.
E) Cardiogenic shock results from pump failure.

Question 16

What would be the expected first treatment of shock?

A) Start an intravenous line.
B) Assess level of consciousness.
C) Take the blood pressure.
D) Maintain the airway.

Question 17

The patient is recovering from hypovolemic shock. The nurse hangs a bag of normal human serum albumin (Albutein) and educates the patient about this fluid. The nurse evaluates that learning has occurred when the patient makes which statement?

A) "It is a protein that pulls water into my blood vessels."
B) "It is a protein that causes my kidneys to conserve fluid."
C) "It is a super-concentrated salt solution that helps me conserve body fluid."
D) "It is a liquid that has electrolytes in it to pull water into my blood vessels."

Question 18

The patient is receiving norepinephrine (Levophed). When monitoring the patient's blood pressure, the nurse notes a pressure of 230/120 mmHg. What is the priority nursing action?

A) Assess the patient for signs/symptoms of a stroke.
B) Notify the physician.
C) Slow the rate of the infusion
D) Increase the infusion.

Question 19

The physician orders dopamine (Intropin) intravenous (IV) for the patient in shock. What is a priority plan of the nurse with regard to administration of this drug?

A) Have phentolamine (Regitine) available in the room.
B) Have naltrexone (Revia) available in the room.
C) Have epinephrine (Adrenalin) available in the room.
D) Have flumazenil (Romazicon) available in the room.

Question 20

The young patient has a history of multiple allergies, and the physician prescribed epinephrine (EpiPen) for prevention of anaphylactic shock. The patient's mother says to the nurse, "I thought shock was about heart failure." What is the best response by the nurse?

A) "There are many kinds of shock: heart failure, nervous system damage, loss of blood, and respiratory failure."
B) "Allergic response is the most fatal type of shock; other types involve loss of blood, heart failure, and liver failure."
C) "There are many kinds of shock that also include infection, nervous system damage, and loss of blood."
D) "Heart failure is the most serious kind of shock; others include infection, kidney failure, and loss of blood."

Question 21

The nurse is concerned that a patient receiving dobutamine (Dobutrex) is experiencing adverse effects from the medication. What did the nurse assess in the patient?

A) Palpitations
B) Drop in blood pressure
C) Cold extremities
D) Headache
E) Blurred vision

Question 22

Prior to administering dopamine, the nurse reviews a patient's current medication history. For which medications would dopamine cause a drug-drug interaction?

A) MAO inhibitor
B) Phenytoin
C) Beta blocker
D) Digoxin
E) Aspirin

Question 23

The paramedics are transporting to the emergency department a patient who is experiencing shock. What will the nurse prepare in anticipation of the patient's arrival?

A) Cardiac monitor
B) Pulse oximeter
C) Oxygen
D) Whole blood
E) Dextran 40

Question 24

A patient who had an anaphylactic reaction has been successfully treated with epinephrine. The nurse anticipates administering which other drugs?

A) Antibiotics
B) Antihistamines
C) Corticosteroids
D) Vasopressors
E) Vasodilators

Question 25

Following treatment with epinephrine, the patient reports the following symptoms. The nurse would be most concerned about which report?

A) "I feel jittery."
B) "My heart is skipping beats."
C) "I have a pounding headache."
D) "I am so dizzy."
E) "That really hurt when you gave me that med."

Question 26

A patient was seen in the emergency department after sustaining a fractured leg and multiple abrasions in a bicycle accident. Eight hours after discharge the patient is admitted in anaphylactic shock. The nurse would suspect which drugs prescribed for the initial injury as implicated in this reaction?

A) A cephalosporin antibiotic
B) A topical antibiotic for use on abrasions
C) An NSAID for minor pain
D) An opioid analgesic for more severe pain
E) Normal saline wash for abrasions

Question 27

A patient has been treated with epinephrine. Which laboratory results could have been affected by this treatment?

A) Digoxin level is elevated.
B) Potassium level is low.
C) Calcium level is high.
D) Sodium level is low.
E) Blood glucose is high.

Question 28

A patient presents with anaphylaxis to the penicillin prescribed for an ear infection. The nurse plans immediate care for the patient based on which goals?

A) Normalization of blood pressure
B) Reduction of blood volume
C) Identification of other allergies
D) Reduction of inflammatory response
E) Provision of basic life support

Question 29

The nurse is directed to prepare norepinephrine for administration to a patient. For which health problems is this medication indicated?

A) Acute shock
B) Cardiac arrest
C) Septic shock
D) Hypovolemic shock
E) Cardiogenic shock

Question 30

A patient comes into the emergency department with systemic manifestations of anaphylaxis caused by a wasp sting. For which health problems would the nurse be concerned prior to administering epinephrine?

A) Premature ventricular contractions
B) Hypertension
C) Hyperthyroidism
D) Pheochromocytoma
E) Hypotension