Deck 37: Shock States

Question 1

A patient who sustained a gunshot wound walks into the emergency department and collapses.Which priority directions should the nurse who assumes this patient's care give to those coming to assist? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)Check the airway.
B)Bring a wheelchair.
C)Put direct pressure on the wound.
D)Check for identification.
E)Check the pulse.

Answer 1

Check the airway.
Put direct pressure on the wound.
Check the pulse.

Question 2

A patient was admitted to the emergency department for treatment of a severe infection.Which traditional assessment would raise the nurse's concern that this patient may be developing shock?

A)Hot,dry skin
B)Respiratory rate 11
C)Pulse rate 118 and weak
D)Anxiety

Answer 2

Pulse rate 118 and weak

Question 3

A patient with cardiac decompensation is started on dobutamine at 1 mcg/kg/min with an order to titrate to effect.After receiving this dose for several minutes,the patient develops tachycardia and occasional premature ventricular contractions.What nursing intervention is indicated?

A)Increase the dose to 1.5 mcg/kg/min.
B)Discontinue the infusion.
C)Decrease the infusion to 0.5 mcg/kg/min.
D)Contact the prescriber immediately.

Answer 3

Decrease the infusion to 0.5 mcg/kg/min.

Question 4

A patient was admitted to the emergency department for treatment of severe infection.Which objective parameters would increase the nurse's concern that shock is developing? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)Serum lactate level is 5.4 mmol/L.
B)Base deficit is −9 mmol/L.
C)SvO₂ is 68%.
D)pHi is 6.9.
E)Arterial pH is 7.38.

Question 5

A patient in shock has been sedated using a propofol (Diprivan)drip.How will the nurse assess this patient's mental status?

A)Temporarily discontinue the drip and assess mental status within a few minutes.
B)Temporarily discontinue the drug and plan to assess mental status in an hour.
C)Use "train of four" testing while the medication is still infusing.
D)This assessment will have to wait until the sedating drug is no longer needed.

Question 6

A patient in shock has just been started on IV Dopamine at 5 mcg/kg/min.Which findings would the nurse evaluate as indication of a possible adverse effect of this therapy? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)Persistent hypotension
B)Heart rate 118
C)Development of a bundle branch block
D)Drop in urine output
E)Mottling of extremities

Question 7

A patient being evaluated for septic shock has a serum lactate level of 5 mmol/L.What intervention does the nurse anticipate?

A)Decreasing the amount of oxygen being given
B)Immediate initiation of fluid resuscitation
C)Repeat of the testing in 4 hours
D)Bedside fingerstick level of blood glucose

Question 8

A nurse is providing care to a patient with progressive shock.Which patient problem is characteristic of this stage and is priority in guiding the selection of interventions for this patient?

A)The patient's airway is often compromised.
B)Perfusion of oxygen and nutrients to tissues is insufficient.
C)The patient experiences maximal physiologic and psychologic stress in this stage.
D)Skin integrity continues to be impaired.

Question 9

A patient being treated for a severe infection has a temperature of 35.8°C.Which additional finding would indicate to the nurse that initiation of treatment for sepsis is likely?

A)A shift to the left on the white blood cell differential
B)Heart rate 88
C)Respiratory rate 10
D)Acute alteration in mental status

Question 10

Which finding would cause the nurse to be concerned that a patient who sustained chest trauma is experiencing cardiac tamponade?

A)Distant heart sounds
B)Decrease of right arterial pressure
C)Sudden development of hypertension
D)Development of an S₃ heart sound

Question 11

A patient is being treated with acetaminophen and a cooling blanket for persistent hyperthermia.Which assessment finding would the nurse evaluate as indicating therapy has been too aggressive?

A)The patient complains of a severe headache.
B)The patient's urine output has dropped.
C)The patient begins to shiver.
D)The patient develops a cough.

Question 12

The nurse is monitoring a patient at risk for development of left ventricular failure and cardiogenic shock.Which findings would the nurse immediately discuss with the primary healthcare provider? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)Development of an S₃ heart sound
B)Sustained systolic hypertension
C)Development of bilateral crackles
D)Decrease in pulmonary arterial wedge pressure (PAWP)
E)Decrease in cardiac index

Question 13

The nurse is evaluating a patient being treated for neurogenic shock after a spinal cord injury.Which assessment would the nurse evaluate as patient improvement?

A)Temperature of 97.8°F
B)Heart rate of 70 beats/min
C)Resistance to ventilator-assisted breaths
D)Pink tone to the skin

Question 14

A patient hospitalized for treatment of a severe urinary tract infection may be developing septic shock.The nurse would monitor for the development of which finding associated with early septic shock?

A)Cold extremities
B)Increase in serum lactate levels
C)Decreased SCVO₂
D)Widening of pulse pressure

Question 15

A patient is admitted to the emergency department with severe burn injuries.The nurse's priority actions are to prevent development of which type of shock?

A)Cardiogenic
B)Hypovolemic
C)Distributive
D)Obstructive

Question 16

An adult patient is demonstrating anaphylaxis from an insect sting.What is the nurse's priority intervention?

A)Benadryl (diphenhydramine)50 mg intravenously
B)Oxygen at 3 liters via nasal cannula
C)Epinephrine 1:1000 0.5 mg sq
D)Normal saline at 150 mL/hr

Question 17

A patient admitted to the emergency department following chest trauma has tracheal deviation to the left.The nurse would prepare for which emergency medical intervention?

A)Open thoracotomy
B)Placement of a chest tube
C)Open excision of the pericardial sac
D)Immediate cardiopulmonary resuscitation

Question 18

A patient who had a myocardial infarction this morning is now developing cardiogenic shock.Which nursing intervention is indicated?

A)Increase IV fluids.
B)Administer vasoconstricting drugs.
C)Provide care in a calm,reassuring manner.
D)Withhold oral fluids and nutrition.

Question 19

A patient who has been receiving norepinephrine (Levophed)at a rate of 10 mcg/min will have the drug discontinued.How should the nurse plan to manage this intervention?

A)Stop the infusion,but leave normal saline infusing at a rate to keep the vein open.
B)Stop the infusion and place an intermittent infusion cap on the IV access device.
C)Decrease the rate to 5 mcg/min for 30 minutes before discontinuing the infusion.
D)Decrease the rate by 1 mcg/min every 30 minutes while monitoring the patient's response.

Question 20

A patient has been admitted to the emergency department with bleeding from a traumatic amputation of the leg.Which findings would the nurse interpret as indicating this patient's blood loss is severe? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)Heart rate is 120.
B)Blood has soaked the dressing applied by first responders.
C)Blood pressure is 78/50.
D)Mild anxiety is present.
E)Respiratory rate is 29 breaths/min.