Deck 34: Shock,sepsis,and Multiple-Organ Dysfunction Syndrome

Question 1

The nurse is caring for a patient in cardiogenic shock.Which hemodynamic parameters would the nurse expect to note to support this diagnosis?

A) Increased right atrial pressure
B) Decreased pulmonary artery wedge pressure
C) Increased cardiac output
D) Decreased cardiac index

Answer 1

Decreased cardiac index

Question 2

A patient has been admitted with septic shock related to tissue necrosis.The nurse knows the initial goal for medical management for this patient is which intervention?

A) Limiting fluids to minimize the possibility of heart failure
B) Finding and eradicating the cause of infection
C) Discontinuing invasive monitoring as a possible cause of sepsis
D) Administering vasodilator substances to increase blood flow to vital organs

Answer 2

Finding and eradicating the cause of infection

Question 3

A patient has been admitted with a neurologic disorder.With which disorder should the nurse be the most vigilant for the development of neurogenic shock?

A) Ischemic stroke
B) Spinal cord injury
C) Guillain-Barré syndrome
D) Brain tumor

Answer 3

Spinal cord injury

Question 4

The nurse is caring for a patient in cardiogenic shock.The nurse recognizes that the patient's signs and symptoms are the result of what problem?

A) Inability of the heart to pump blood forward
B) Loss of circulating volume and subsequent decreased venous return
C) Disruption of the conduction system when reentry phenomenon occurs
D) Suppression of the sympathetic nervous system

Question 5

A patient has been admitted with anaphylactic shock due to an unknown allergen.The nurse understands that the decrease in the patient's cardiac output is the result of which mechanism?

A) Peripheral vasodilation
B) Increased venous return
C) Increased alveolar ventilation
D) Decreased myocardial contractility

Question 6

A patient has been admitted with anaphylactic shock due to an unknown allergen.The nurse understands that the patient is probably having an immunoglobulin E (IgE)-mediated response as a result of what physiologic mechanism?

A) Direct activation of mast cells and basophils
B) Nonimmunologic stimulation of biochemical mediators
C) Repeat exposure to an antigen in the presence of preformed IgE antibodies
D) Activation of the systemic inflammatory response

Question 7

A patient with a known penicillin allergy develops anaphylactic shock after a dose of ampicillin was given in error.Which medication would the nurse administer first?

A) Methylprednisolone
B) Gentamicin
C) Atropine
D) Epinephrine

Question 8

A nursing instructor is discussing the difference between primary and secondary multiple-organ dysfunction syndrome (MODS)with a nursing student.Which statement indicates the student understood the information?

A) Primary MODS is the result of inflammation in organs not involved in the initial insult.
B) Primary MODS is the result of a direct organ injury.
C) Primary MODS is due to a disorganization of the inflammatory immune system response.
D) Primary MODS is due to disruption of the coagulation system.

Question 9

A patient has developed septic shock.The nurse knows that the patient is at risk for gastrointestinal dysfunction.What happens to the gastrointestinal tract in the patient with septic shock?

A) Anorexia leads to loss of gastric enzymes
B) Lack of food ingestion leads to intestinal hypomotility
C) Hypoperfusion results in loss of gut barrier function
D) Low cardiac output causes decreased hydrochloric acid secretion

Question 10

The nurse is caring for a patient who what just admitted with septic shock.The nurse knows that certain interventions should be completed within 3 hours of time of presentation.Which intervention would be a priority for the nurse to implement upon receipt of a practitioner's order?

A) Administer fresh frozen plasma
B) Obtain a serum lactate level
C) Administer epinephrine
D) Measure central venous pressure

Question 11

The nurse is caring for a patient in hypovolemic shock secondary to cirrhosis of the liver.The nurse understands that this type of shock results from shifting of fluid into the abdominal cavity.What is the resulting hypovolemia called?

A) Absolute hypovolemia
B) Distributive hypovolemia
C) Relative hypovolemia
D) Compensatory hypovolemia

Question 12

A patient has been admitted with hypovolemic shock due to blood loss.Which finding would the nurse expect to note to support this diagnosis?

A) Distended neck veins
B) Decreased level of consciousness
C) Bounding radial and pedal pulses
D) Widening pulse pressure

Question 13

A nurse is caring for a patient in septic shock due to urinary sepsis.Which pathophysiologic mechanism results in septic shock?

A) Bacterial toxins lead to vasodilation.
B) White blood cells are released to fight invading bacteria.
C) Microorganisms invade organs such as the kidneys and heart.
D) Decreased red blood cell production and fluid loss

Question 14

A patient is being admitted with cardiogenic shock secondary to acute heart failure.In addition to a diuretic,which medication would the nurse anticipate the practitioner ordering for the patient?

A) Epinephrine
B) Nitroprusside
C) Dobutamine
D) Nitroglycerine

Question 15

The nurse is caring for a patient with sepsis due to necrotic tissue.The nurse knows that necrotic tissue can stimulate the inflammatory immune response.Which biochemical mediator is secreted in response to endotoxin or tissue injury?

A) Arachidonic acid metabolite
B) Platelet-activating factor
C) Tumor necrosis factor
D) Interleukin

Question 16

A patient has been admitted with septic shock due to urinary sepsis.The practitioner inserts a pulmonary artery (PA)catheter.Which hemodynamic value would the nurse expect to note to support this diagnosis?

A) Cardiac output (CO) of 8 L/min
B) Right atrial pressure (RAP) of 17 mm Hg
C) Pulmonary artery occlusion pressure (PAOP) of 23 mm Hg
D) Systemic vascular resistance (SVR) of 1100 dyne/s/cm-5

Question 17

A patient is being admitted from the emergency department (ED)with cardiogenic shock secondary to unstable angina unresponsive to medications.The patient was intubated and ventilated in the ED.Which intervention should the nurse prepare to initiate when the practitioner arrives in the unit?

A) Administration of sodium bicarbonate
B) Rapid infusion of crystalloids
C) Insertion of an intraaortic balloon pump (IABP)
D) Insertion of dialysis catheters for continuous renal replacement therapy (CRRT)

Question 18

A patient has been admitted with hypovolemic shock due to traumatic blood loss.Which nursing measure can best facilitate the administration of large volumes of fluid?

A) Inserting a large-diameter peripheral intravenous catheter
B) Positioning the patient in the Trendelenburg position
C) Encouraging the patient to drink at least 240 mL of fluid each hour
D) Administering intravenous fluids under pressure with a pressure bag

Question 19

A nurse is discussing the concept of shock with a new graduate nurse.Which statement indicates the new graduate nurse understood the information?

A) Shock is a physiologic state resulting in hypotension and tachycardia.
B) Shock is an acute, widespread process of inadequate tissue perfusion.
C) Shock is a degenerative condition leading to organ failure and death.
D) Shock is a condition occurring with hypovolemia that results in hypotension.

Question 20

The nurse is caring for a patient with systemic inflammatory response syndrome (SIRS)due to pneumonia.What is SIRS due to infection called?

A) Infectivity
B) Anaphylaxis
C) Sepsis
D) Acute respiratory distress syndrome (ARDS)

Question 21

The nurse is caring for a patient in septic shock due secondary to pneumonia.The nurse knows that evidence-based guidelines for the treatment of septic shock include which interventions?

A) Administer norepinephrine to maintain mean arterial pressure of 65 mm Hg.
B) Administer low-dose dopamine to maintain urine output greater than 30 mL/h.
C) Start enteral nutrition within the first 48 hours after diagnosis of septic shock.
D) Administer 30 mL/kg crystalloid for hypotension or lactate greater than or equal to 4 mmol/L.
E) Perform an adrenocorticotropic hormone (ACTH) stimulation test to identify patients who need hydrocortisone

Question 22

A patient is admitted with a brain and spinal cord injury secondary to a motor vehicle crash.The nurse is monitoring the patient for signs of neurogenic shock.Clinical findings in neurogenic shock are related to which pathophysiologic process?

A) Loss of sympathetic nervous system innervation
B) Parasympathetic nervous system stimulation
C) Injury to the hypothalamus
D) Focal injury to cerebral hemispheres

Question 23

A patient is admitted after she develops disseminated intravascular coagulation (DIC)after a vaginal delivery.Which laboratory value would the nurse expect to note to support this diagnosis?

A) Decreased fibrinogen degradation products
B) Decreased D-dimer concentrations
C) Decreased platelet counts
D) Increased serum glucose levels

Question 24

The nurse is caring for a patient in shock with an elevated lactate level.Which order should the nurse question in the management of this patient?

A) Start an insulin drip for blood sugar greater than 180 mg/dL.
B) Administer sodium bicarbonate to keep arterial pH greater than 7.20.
C) Start a norepinephrine drip to keep mean arterial blood pressure greater than 65 mm Hg.
D) Administer crystalloid fluids.

Question 25

A patient in cardiogenic shock is being treated in the critical care unit.Which findings would the nurse expect to note in the patient to support this diagnosis?

A) Warm, dry skin
B) Heart rate greater than 100 beats/min
C) Weak, thready pulse
D) Increased right atrial pressure
E) Decreased pulmonary artery occlusion pressure

Question 26

The nurse is caring for a patient with multiple-organ dysfunction syndrome (MODS).The nurse understands that earlier nutritional support is critical for the patient to prevent profound weight loss.Why does this occur in patient MODS?

A) Patient experiences hypometabolism.
B) Patient experiences hypermetabolism.
C) Patient experiences anorexia.
D) Patient has gut dysfunction.

Question 27

A patient has developed septic shock.The nurse knows that the clinical manifestations of ischemic hepatitis show up 1 to 2 days after the insult.Which finding would the nurse expect to note to support this diagnosis?

A) Elevated serum creatinine
B) Decreased bilirubin
C) Jaundice
D) Decreased serum transaminase

Question 28

A patient is admitted after she develops disseminated intravascular coagulation (DIC)after a vaginal delivery.The nurse knows that DIC is known to occur in patients with retained placental fragments.What is the pathophysiologic consequence of DIC?

A) Hypersensitivity response to an antigen
B) Excessive thrombosis and fibrinolysis
C) Profound vasodilatation
D) Loss of intravascular volume

Question 29

A patient is being admitted with septic shock.The nurse appreciates that the key to treatment is finding the cause of the infection.Which cultures would the nurse obtain before initiating antibiotic therapy?

A) Blood cultures ´2
B) Wound cultures
C) Urine cultures
D) Sputum cultures
E) Complete blood count (CBC) with differential

Question 30

An elderly patient is admitted with pneumonia.This morning the patient is febrile,tachycardic,tachypneic,and confused.The nurse suspects the patient may be developing what problem?

A) Sepsis
B) Delirium
C) Adult respiratory distress syndrome
D) Acute kidney injury