Medical Surgical Nursing An Integrated Approach 3rd Edition by Lois White -Test Bank

Medical Surgical Nursing An Integrated Approach 3rd Edition by Lois White -Test Bank

Chapter 6—Caring for Clients in Shock

MULTIPLE CHOICE

1. A client has sustained a gunshot wound to the left femoral artery. Which type of shock should the nurse watch for?
a. cardiogenic c. hypovolemic
b. neurogenic d. septic

ANS: C
Hypovolemic shock is characterized by a decreased circulating blood volume resulting in inadequate tissue perfusion and oxygenation for normal cell function. Hypovolemic shock is caused by an acute blood loss from trauma, fluid shifts, and/or loss from surgery, fluid loss from burns, vomiting, diarrhea, and severe electrolyte imbalances.

PTS: 1 DIF: Application REF: White (2013)

2. Hypovolemic shock is a decrease in the client’s circulating blood volume that leads to inadequate tissue perfusion and then which of the following?
a. bradycardia c. hypotension
b. vasodilation d. hypoxia

ANS: D
Hypovolemic shock is a decrease in the client’s circulating blood volume that leads to inadequate tissue perfusion (the passage of blood through tissues or vasculature). Inadequate tissue perfusion deprives the cells from oxygen resulting in hypoxia, the inability of the cell to maintain normal metabolic activities including energy production and waste removal from a lack of oxygen. As a result, the body cells become injured and die, leading to organ damage and failure, and potentially the client’s death.

PTS: 1 DIF: Comprehension REF: White (2013)

3. Severe shock results when the client has lost more than what percentage of the circulating blood volume?
a. less than 20% c. 5%
b. between 20 and 40% d. more than 40%

ANS: D
The term mild hypovolemic shock is used when less than 20% of the circulating blood volume is lost. Moderate shock occurs when blood loss volume is between 20 to 40%, and severe shock results when the client has lost more than 40% of the circulating blood volume.

PTS: 1 DIF: Comprehension REF: White (2013)

4. What type of product would a physician most likely order for a client to treat hypovolemic shock?
a. 0.9% normal saline c. nasoenteric feeding
b. oral rehydration fluid d. hypotonic IV fluid

ANS: A
Commonly prescribed fluids for hypovolemic shock include Lactated Ringers (LR) or normal saline (0.9% sodium chloride), which not only help correct the volume loss, but also help with electrolyte replacement.

PTS: 1 DIF: Comprehension REF: White (2013)

5. In the Emergency Department, a client has been given large amount of IV fluid to treat hypovolemic shock. Which electrolyte imbalance is MOST common after large amounts have been infused?
a. hyponatremia c. hypernatremia
b. hypokalemia d. hypocalcemia

ANS: B
Electrolyte replacement may be necessary, especially if large amount of fluids are needed to correct the client’s hypovolemia. Hypokalemia is common in this client population after large amounts of fluids have been infused. Also, either hyponatremia or hypernatremia may also occur, depending on the type of intravenous solution used. Less commonly, calcium imbalance may be present. The nurse should take care to remember that cardiac arrhythmias can occur as a result of electrolyte imbalance.

PTS: 1 DIF: Comprehension REF: White (2013)

6. This drug is a good choice for the treatment of hypovolemic shock because of its positive inotropic effects, ability to cause peripheral vasoconstriction with less tachycardia, resulting in increased cardiac output and improving hypotension. Which drug would the physician choose?
a. Dobutamine c. Neosynephrine
b. Dopamine d. Epinephrine

ANS: D
Epinephrine and norepinephrine both have positive inotropic effects and cause peripheral vasoconstriction as well with less tachycardic effects than dopamine, resulting in increased cardiac output as well as improving hypotension, and make them a good choice for the treatment of hypovolemic shock.

PTS: 1 DIF: Comprehension REF: White (2013)

7. Dopamine has been ordered for a client. Which is the best route for administration?
a. oral c. via central IV line
b. subcutaneous d. via peripheral IV

ANS: C
Central line administration rather than infusion through a peripheral vein is optimum for the administration of Dopamine and carries less risk of infiltration or extravasation.

PTS: 1 DIF: Comprehension REF: White (2013)

8. A common early sign of cardiogenic shock is:
a. weak, thready pulse c. cyanosis of the extremities
b. peripheral edema d. mild tachycardia

ANS: D
Common early signs and symptoms of cardiogenic shock are mild tachycardia, slight decrease in the client’s blood pressure, decreased urinary output, and anxiety, and restlessness. Later signs include weak, thready peripheral pulses, peripheral edema, cool extremities, and cyanosis of the extremities and circumoral areas.

PTS: 1 DIF: Comprehension REF: White (2013)

9. Which staff member is the liaison between the entire healthcare team caring for a client with cardiogenic shock?
a. physician c. head nurse coordinator
b. nurse d. cardiologist

ANS: B
The nurse is often the liaison between the entire team and is responsible for much of the communication. The nurse provides the primary hands-on care for the client and communicates changes in vital signs, diagnostic tests, and client exam to the physician who gives the orders for the client’s care.

PTS: 1 DIF: Comprehension REF: White (2013)

10. A client in cardiogenic shock with significant hypotension is placed in which position?
a. trendelenberg c. prone
b. reverse trendelenberg d. side-lying

ANS: A
The client in cardiogenic shock with significant hypotension is placed either in supine or Trendelenburg position. Trendelenberg position encourages increased vascular return and blood flow toward the most vital organs, the brain and the heart.

PTS: 1 DIF: Comprehension REF: White (2013)

11. What is the relationship between age and the risk of sepsis?
a. risk decreases with age c. is greatest in middle age
b. risk stays the same with aging d. increases with age

ANS: D
A client’s risk of sepsis increases with age, and thus advanced age is a risk factor for developing sepsis. Other clients at risk are those that are immunocompromised, newborns and infants, malnourished or debilitated, and diabetics.

PTS: 1 DIF: Comprehension REF: White (2013)

12. Upon entering the client’s room and performing an initial assessment, the nurse finds the client to have warm, flushed skin, fever above 100.4 degrees F, mild tachycardia, and a respiratory rate of 26. The nurse suspects the client is in which phase of septic shock?
a. early c. advanced
b. moderate d. late

ANS: A
Early symptoms of septic shock include warm, flushed skin, fever above 100.4 degrees Fahrenheit, mild tachycardia and elevated respiratory rate above 20 breaths/minute, and a white blood cell count lower than 4,000 or greater than 10,000. At this point the client’s blood pressure and pulse oximetry are usually normal. As sepsis progresses the client may become anxious, start to show mild hypotension, hypoxia, higher fever and more significant mental status changes as well as worsening of tachycardia and metabolic acidosis occurs. As the sepsis progresses into septic shock, the client exhibits severe tachycardia, cool and clammy extremities, weak and thready peripheral pulses and significant hypotension as well as hypoxia and respiratory distress. The client may be unresponsive and have minimal urine output.

PTS: 1 DIF: Application REF: White (2013)

13. After reporting the client’s signs and symptoms of early shock to the physician, the nurse is told that the physician will be ordering a specialist to consult on the case. Which type of specialist is the physician most likely to consult with on this client’s care?
a. hematologist c. cardiologist
b. infectious disease d. respiratory

ANS: B
Finding and treating the cause of septic shock is essential to the client’s long-term prognosis. Infectious disease specialists may be asked to consult on the case and assist the primary physician. The primary course of treatment is intravenous antibiotics, fluid resuscitation and vasopressors as well as supplemental oxygenation. The treatment of sepsis centers around identifying the cause and treating the pathogen as specifically as possible while supporting the body’s circulatory and respiratory symptoms.

PTS: 1 DIF: Application REF: White (2013)

14. Neurogenic shock is a potential complication of a spinal cord injury. This is caused by the interruption of which part of the nervous system response?
a. central nervous system c. sympathetic nervous system
b. parasympathetic nervous system d. peripheral nervous system

ANS: C
Neurogenic shock is a potential complication of a spinal cord injury that results in hypotension, bradycardia, low perfusion and hypoxia to body tissues as a result of the interruption of the sympathetic nervous system response.

PTS: 1 DIF: Comprehension REF: White (2013)

15. Symptoms of neurogenic shock can occur within which time frame?
a. within 30-60 minutes of the injury c. within 24 hours of the injury
b. within 12 hours of the injury d. within 48 hours of the injury

ANS: A
The client in neurogenic shock exhibits some of the same signs and symptoms as the other four types of shock such as weak and thready peripheral pulses, cool and clammy extremities, decreased urinary output, peripheral cyanosis and increased respiratory rate. Symptoms can occur as quickly as within 30 to 60 minutes of the injury.

PTS: 1 DIF: Comprehension REF: White (2013)

16. Physiologic changes within the body in response to anaphylactic reactions include:
a. severe hypertension c. hypervolemia
b. bronchoconstriction d. bradycardia

ANS: B
Physiologic changes within the body in response to anaphylactic reactions include bronchoconstriction, severe hypotension, tachycardia, hypovolemia and tissue hypoperfusion as well as a febrile response. Symptoms of this type reaction include shortness of breath, coughing, chest tightness or chest pain, weakness and dizziness. Feelings of tightening of the throat and generalized itching or abdominal pain and headache can occur. Additional signs include hypotension, tachycardia, fever, hives, swelling of face and lips and generalized edema.

PTS: 1 DIF: Comprehension REF: White (2013)

17. The highest “at risk” clients for anaphylactic shock include clients with which type of medication allergy?
a. Benadryl c. Coumadin
b. Aspirin d. Penicillin

ANS: D
The highest “at-risk” clients have Penicillin allergies and insect sting reactions.

PTS: 1 DIF: Comprehension REF: White (2013)

18. Severe anaphylactic reactions that can lead to anaphylactic shock include which of the following?
a. itching c. angioedema
b. hives d. bronchoconstriction with wheezing

ANS: D
Mild anaphylactic reactions cause itching, hives, and some angioedema as well as nasal congestion, rhinorrhea, hoarseness, excessive salivation, headache, nausea and vomiting or diarrhea. More severe reactions leading to anaphylactic shock manifest in severe hypotension, tachycardia, bronchoconstriction with wheezing, tachypnea and cyanosis as well as chest pain and arrhythmias. Syncope, seizures and cardiac arrest may also occur.

PTS: 1 DIF: Comprehension REF: White (2013)

19. The most serious complication of anaphylactic shock is:
a. itching and hives c. bronchoconstriction with wheezing
b. tachycardia d. death

ANS: D
The most serious complication of anaphylactic shock is death. Other complications are organ damage secondary to prolonged hypoperfusion and include renal failure, cerebral hypoxic changes, respiratory distress syndrome, cardiac ischemia or MI, ischemic gut syndrome, and possible hepatic failure.

PTS: 1 DIF: Comprehension REF: White (2013)

20. The drug of choice for an anaphylactic reaction is:
a. Ranitidine c. Epinephrine
b. Benadryl d. oral corticosteroids

ANS: C
Epinephrine, which contains alpha and beta properties, is the drug of choice and can be administered intravenously, subcutaneously or via endotracheal tube. IV administration is the preferred route. Epinephrine causes vasoconstriction, decreased vascular permeability and reverses bronchoconstriction.

PTS: 1 DIF: Comprehension REF: White (2013)

MULTIPLE RESPONSE

1. The nurse is preparing to teach a client how to administer an Epi-Pen. Which of the following would the nurse be sure to include in the teaching plan?
a. Keep Epi-Pen refrigerated at all times.
b. Do not inject Epi-Pen intravenously.
c. Do not inject Epi-Pen into the buttocks.
d. Do not expose the Epi-Pen to extreme heat or sunlight.
e. The thigh is the preferred location for injection of the Epi-Pen.
f. More than one dose of the Epi-pen may be needed.

ANS: B, C, D, E, F
An Epi-Pen is a commercially available subcutaneous, single pre-filled injection into the outer thigh for one-time use for anaphylactic reactions. Clients need a prescription for this and it can be purchased at most retail pharmacies. Do not inject the Epi-Pen intravenously or into the buttocks as it may not be effective for a severe reaction. Keep Epi-Pen at room temperature and do not expose to extreme heat or direct sunlight. More than one dose of the Epi-Pen may be needed.

PTS: 1 DIF: Application REF: White (2013)

2. Which of the following are TRUE about shock? (Select all that apply.)
a. Shock is the body’s response to inadequate tissue perfusion.
b. If left untreated, the client progress initially into seizures.
c. All types of shock share hypotension, hypoperfusion and hypoxia.
d. The nurse should know signs and symptoms of shock.
e. The nurse should know the necessary assessment skills for shock.
f. It is not necessary for the nurse to know the appropriate treatment for each type of shock.

ANS: A, C, D, E, F
Shock is the body’s response to inadequate tissue perfusion, and if left untreated will progress into cell death, organ failure, and a life-threatening emergency. Hypovolemic, cardiogenic, septic, neurogenic, and anaphylactic shock share common manifestations of hypotension, hypoperfusion, and hypoxia. The nurse caring for a client experiencing shock must be knowledgeable of the signs and symptoms, necessary assessment skills, and appropriate treatment for each type of shock. Prompt nursing care is essential for a positive client outcome.

PTS: 1 DIF: Comprehension REF: White (2013)