Ch 14 - Test bank
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Ch 14 - Test bank
Medical Surgical 1 (Southeastern University)
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Ch 14 - Test bank
Medical Surgical 1 (Southeastern University)
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Chapter 14: Shock and Multiple Organ Dysfunction Syndrome
1.
A nurse in the ICU is planning the care of a patient who is being treated for shock. Which of the
following statements best describes the pathophysiology of this patients health problem?
A)
Blood is shunted from vital organs to peripheral areas of the body.
B)
Cells lack an adequate blood supply and are deprived of oxygen and nutrients.
C)
Circulating blood volume is decreased with a resulting change in the osmotic pressure gradient.
D)
Hemorrhage occurs as a result of trauma, depriving vital organs of adequate perfusion.
Ans:
B
Feedback:
Shock is a life-threatening condition with a variety of underlying causes. Shock is caused when the cells
have a lack of adequate blood supply and are deprived of oxygen and nutrients. In cases of shock, blood
is shunted from peripheral areas of the body to the vital organs. Hemorrhage and decreased blood
volume are associated with some, but not all, types of shock.
2.
In an acute care setting, the nurse is assessing an unstable patient. When prioritizing the patients care,
the nurse should recognize that the patient is at risk for hypovolemic shock in which of the following
circumstances?
A)
Fluid volume circulating in the blood vessels decreases.
B)
There is an uncontrolled increase in cardiac output.
C)
Blood pressure regulation becomes irregular.
D)
The patient experiences tachycardia and a bounding pulse.
Ans:
A
Feedback:
Hypovolemic shock is characterized by a decrease in intravascular volume. Cardiac output is decreased,
blood pressure decreases, and pulse is fast, but weak.
3.
The emergency nurse is admitting a patient experiencing a GI bleed who is believed to be in the
compensatory stage of shock. What assessment finding would be most consistent with the early stage of
compensation?
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A)
Increased urine output
B)
Decreased heart rate
C)
Hyperactive bowel sounds
D)
Cool, clammy skin
Ans:
D
Feedback:
In the compensatory stage of shock, the body shunts blood from the organs, such as the skin and
kidneys, to the brain and heart to ensure adequate blood supply. As a result, the patients skin is cool and
clammy. Also in this compensatory stage, blood vessels vasoconstrict, the heart rate increases, bowel
sounds are hypoactive, and the urine output decreases.
4.
The nurse is caring for a patient who is exhibiting signs and symptoms of hypovolemic shock following
injuries suffered in a motor vehicle accident. The nurse anticipates that the physician will promptly order
the administration of a crystalloid IV solution to restore intravascular volume. In addition to normal
saline, which crystalloid fluid is commonly used to treat hypovolemic shock?
A)
Lactated Ringers
B)
Albumin
C)
Dextran
D)
3% NaCl
Ans:
A
Feedback:
Crystalloids are electrolyte solutions used for the treatment of hypovolemic shock. Lactated Ringers and
0.9% sodium chloride are isotonic crystalloid fluids commonly used to manage hypovolemic shock.
Dextran and albumin are colloids, but Dextran, even as a colloid, is not indicated for the treatment of
hypovolemic shock. 3% NaCl is a hypertonic solution and is not isotonic.
5.
A patient who is in shock is receiving dopamine in addition to IV fluids. What principle should inform
the nurses care planning during the administration of a vasoactive drug?
A)
The drug should be discontinued immediately after blood pressure increases.
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B)
The drug dose should be tapered down once vital signs improve.
C)
The patient should have arterial blood gases drawn every 10 minutes during treatment.
D)
The infusion rate should be titrated according the patients subjective sensation of adequate
perfusion.
Ans:
B
Feedback:
When vasoactive medications are discontinued, they should never be stopped abruptly because this
could cause severe hemodynamic instability, perpetuating the shock state. Subjective assessment data are
secondary to objective data. Arterial blood gases should be carefully monitored, but every10-minute
draws are not the norm.
6.
A nurse in the ICU receives report from the nurse in the ED about a new patient being admitted with a
neck injury he received while diving into a lake. The ED nurse reports that his blood pressure is 85/54,
heart rate is 53 beats per minute, and his skin is warm and dry. What does the ICU nurse recognize that
that patient is probably experiencing?
A)
Anaphylactic shock
B)
Neurogenic shock
C)
Septic shock
D)
Hypovolemic shock
Ans:
B
Feedback:
Neurogenic shock can be caused by spinal cord injury. The patient will present with a low blood
pressure; bradycardia; and warm, dry skin due to the loss of sympathetic muscle tone and increased
parasympathetic stimulation. Anaphylactic shock is caused by an identifiable offending agent, such as a
bee sting. Septic shock is caused by bacteremia in the blood and presents with a tachycardia.
Hypovolemic shock presents with tachycardia and a probable source of blood loss.
7.
The intensive care nurse caring for a patient in shock is planning assessments and interventions related
to the patients nutritional needs. What physiologic process contributes to these increased nutritional
needs?
A)
The use of albumin as an energy source by the body because of the need for increased adenosine
triphosphate (ATP)
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B)
The loss of fluids due to decreased skin integrity and decreased stomach acids due to increased
parasympathetic activity
C)
The release of catecholamines that creates an increase in metabolic rate and caloric requirements
D)
The increase in GI peristalsis during shock and the resulting diarrhea
Ans:
C
Feedback:
Nutritional support is an important aspect of care for patients in shock. Patients in shock may require
3,000 calories daily. This caloric need is directly related to the release of catecholamines and the
resulting increase in metabolic rate and caloric requirements. Albumin is not primarily metabolized as an
energy source. The special nutritional needs of shock are not related to increased parasympathetic
activity, but are instead related to increased sympathetic activity. GI function does not increase during
shock.
8.
The nurse is transferring a patient who is in the progressive stage of shock into ICU from the medical
unit. The medical nurse is aware that shock affects many organ systems and that nursing management of
the patient will focus on what intervention?
A)
Reviewing the cause of shock and prioritizing the patients psychosocial needs
B)
Assessing and understanding shock and the significant changes in assessment data to guide the plan
of care
C)
Giving the prescribed treatment, but shifting focus to providing family time as the patient is
unlikely to survive
D)
Promoting the patients coping skills in an effort to better deal with the physiologic changes
accompanying shock
Ans:
B
Feedback:
Nursing care of patients in the progressive stage of shock requires expertise in assessing and
understanding shock and the significance of changes in assessment data. Early interventions are essential
to the survival of patients in shock; thus, suspecting that a patient may be in shock and reporting subtle
changes in assessment are imperative. Psychosocial needs, such as coping, are important considerations,
but they are not prioritized over physiologic health.
9.
When caring for a patient in shock, one of the major nursing goals is to reduce the risk that the patient
will develop complications of shock. How can the nurse best achieve this goal?
A)
Provide a detailed diagnosis and plan of care in order to promote the patients and familys coping.
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B)
Keep the physician updated with the most accurate information because in cases of shock the nurse
often cannot provide relevant interventions.
C)
Monitor for significant changes and evaluate patient outcomes on a scheduled basis focusing on
blood pressure and skin temperature.
D)
Understand the underlying mechanisms of shock, recognize the subtle and more obvious signs, and
then provide rapid assessment.
Ans:
D
Feedback:
Shock is a life-threatening condition with a variety of underlying causes. It is critical that the nurse apply
the nursing process as the guide for care. Shock is unpredictable and rapidly changing so the nurse must
understand the underlying mechanisms of shock. The nurse must also be able to recognize the subtle as
well as more obvious signs and then provide rapid assessment and response to provide the patient with
the best chance for recovery. Coping skills are important, but not the ultimate priority. Keeping the
physician updated with the most accurate information is important, but the nurse is in the best position to
provide rapid assessment and response, which gives the patient the best chance for survival. Monitoring
for significant changes is critical, and evaluating patient outcomes is always a part of the nursing
process, but the subtle signs and symptoms of shock are as important as the more obvious signs, such as
blood pressure and skin temperature. Assessment must lead to diagnosis and interventions.
10.
The nurse is caring for a patient in the ICU who has been diagnosed with multiple organ dysfunction
syndrome (MODS). The nurses plan of care should include which of the following interventions?
A)
Encouraging the family to stay hopeful and educating them to the fact that, in nearly all cases, the
prognosis is good
B)
Encouraging the family to leave the hospital and to take time for themselves as acute care of
MODS patients may last for several months
C)
Promoting communication with the patient and family along with addressing end-of-life issues
D)
Discussing organ donation on a number of different occasions to allow the family time to adjust to
the idea
Ans:
C
Feedback:
Promoting communication with the patient and family is a critical role of the nurse with a patient in
progressive shock. It is also important that the health care team address end-of-life decisions to ensure
that supportive therapies are congruent with the patients wishes. Many cases of MODS result in death
and the life expectancy of patients with MODS is usually measured in hours and possibly days, but not
in months. Organ donation should be offered as an option on one occasion, and then allow the family
time to discuss and return to the health care providers with an answer following the death of the patient.
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