The cookie settings on this website are set to 'allow all cookies' to give you the very best experience. Please click Accept Cookies to continue to use the site.

Test Bank for Brunner and Suddarth’s Medical Surgical Nursing – 12e by Suzanne C. Smeltzer RNC EdD FAAN

$35.00
(No reviews yet) Write a Review
SKU:
Test Bank for Brunner and Suddarth’s Medical Surgical Nursing – 12e by Suzanne C. Smeltzer RNC EdD FAAN
Availability:
Test Bank for Brunner and Suddarth’s Medical Surgical Nursing – 12e by Suzanne C. Smeltzer RNC EdD FAAN

Description

Import Settings:

Base Settings: Brownstone Default

Information Field: Chapter

Information Field: Client Needs

Information Field: Cognitive Level

Information Field: Difficulty

Information Field: Integrated Process

Information Field: Objective

Information Field: Page and Header

Highest Answer Letter: E

Multiple Keywords in Same Paragraph: No

 

 

 

 

 

Chapter: Chapter 15: Shock and Multiple Organ Dysfunction Syndrome

 

 

 

 

Multiple Choice

 

 

 

 

  1. An understanding of the pathophysiologic rationale behind shock is something every nurse needs to have. Which of the following statements best describes the pathophysiology for shock?
  2. A) Blood is shunted from vital organs to peripheral areas of the body.
  3. B) Cells lack an adequate blood supply and are deprived of oxygen and nutrients.
  4. C) Circulating blood volume is decreased.
  5. D) Hemorrhage occurs as a result of trauma.

 

Ans: B

Chapter: 15

Client Needs: D-4

Cognitive Level: Comprehension

Difficulty: Difficult

Integrated Process: Nursing Process

Objective: 1

Page and Header: 313, Overview of Shock

 

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. Option A is incorrect; blood is shunted from peripheral areas of the body to the vital organs. Options C and D can be true statements, depending on the type of shock, but they are not the best answers to describe the pathophysiologic rationale for shock.

 

 

 

 

  1. You are assessing your patient. When prioritizing the patient’s care, you recognize that your patient is at risk for hypovolemic shock when
  2. A) fluid circulating in the blood vessels decreases.
  3. B) cardiac output is increased.
  4. C) blood pressure increases.
  5. D) pulse is fast and bounding.

 

Ans: A

Chapter: 15

Client Needs: D-4

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 4

Page and Header: 322, Hypovolemic Shock

 

Feedback: Hypovolemic shock is characterized by a decrease in intravascular volume. Cardiac output is decreased, blood pressure decreases, and pulse is fast but weak.

 

 

 

 

  1. You are admitting a patient with a diagnosis of a gastrointestinal bleed who is in the compensatory stage of shock. You know that an early sign that accompanies initial shock is what?
  2. A) Increased urine output
  3. B) Decreased heart rate
  4. C) Hyperactive bowel sounds
  5. D) Cool, clammy skin

 

Ans: D

Chapter: 15

Client Needs: D-4

Cognitive Level: Analysis

Difficulty: Difficult

Integrated Process: Nursing Process

Objective: 2

Page and Header: 315, Stages of Shock

 

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 patient’s 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.

 

 

 

 

  1. You are caring for a patient in liver failure who is exhibiting signs and symptoms of hypovolemic shock. You anticipate that the physician will order the administration of a crystalloid for the management of this patient. Which crystalloid fluid is most commonly used to treat hypovolemic shock?
  2. A) Lactated Ringer’s
  3. B) Albumin
  4. C) Dextran
  5. D) 3% NaCl

 

Ans: A

Chapter: 15

Client Needs: D-2

Cognitive Level: Application

Difficulty: Difficult

Integrated Process: Nursing Process

Objective: 5

Page and Header: 323, Hypovolemic Shock

 

Feedback: Crystalloids are electrolyte solutions used for the treatment of hypovolemic shock. Lactated Ringer’s 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.

 

 

 

 

  1. A patient is receiving dopamine, a vasoactive drug used for shock, to increase her stroke volume. What should the nurse be aware of when monitoring a vasoactive drug?
  2. A) The drug should be discontinued immediately after blood pressure increases.
  3. B) The drug dose should be weaned down prior to discontinuing.
  4. C) The drug may cause respiratory alkalosis.
  5. D) The drug reduces oxygen demands of the heart.

 

Ans: B

Chapter: 15

Client Needs: D-2

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 6

Page and Header: 322, General Management Strategies in Shock

 

Feedback: When vasoactive medications are discontinued, they should never be stopped abruptly because this could cause severe hemodynamic instability, perpetuating the shock state. This makes option A incorrect. Options C and D are incorrect; vasoactive drugs do not cause respiratory alkalosis or reduce oxygen demands on the heart.

 

 

 

 

  1. A nurse in the ICU receives report from the nurse in the emergency department about a new patient being admitted with a neck injury he received while diving into a lake. The emergency-department 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?
  2. A) Anaphylactic shock
  3. B) Neurogenic shock
  4. C) Septic shock
  5. D) Hypovolemic shock

 

Ans: B

Chapter: 15

Client Needs: A-2

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 3

Page and Header: 331, Circulatory Shock

 

Feedback: Neurogenic shock can be caused by spinal cord injury. In this case, it resulted from diving into waters of unknown depth. 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. Option A is incorrect; anaphylactic shock is caused by an identifiable offending agent such as a bee sting. Option C is incorrect; septic shock is caused by bacteremia in the blood and presents with a tachycardia. Option D is incorrect; hypovolemic shock presents with tachycardia and a probable source of blood loss.

 

 

 

 

  1. Patients who are in shock have special needs, including nutritional needs. What are these special nutritional needs directly related to?
  2. A) The use of albumin as a food source by the body because of the need for increased caloric intake
  3. B) The loss of fluids due to stress ulcers and decreased stomach acids due to increased parasympathetic activity
  4. C) The release of catecholamines that creates an increase in metabolic rate and caloric requirements
  5. D) The increase in gastrointestinal function during shock and the resulting diarrhea

 

Ans: C

Chapter: 15

Client Needs: A-1

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 7

Page and Header: 322, General Management Strategies in Shock

 

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.

Option A is a good answer, but all body proteins are used during times of great stress, which results in generalized muscle wasting. Option B is incorrect; the special nutritional needs of shock are not related to increased parasympathetic activity but related to increased sympathetic activity. Option D is incorrect; gastrointestinal function does not increase during shock; it decreases.

 

 

 

 

  1. You are transferring a patient who is in the progressive stage of shock into ICU from your medical-surgical unit. You are aware that the shock affects many organ systems and that nursing management of the patient will focus on what?
  2. A) Reviewing the cause of shock and trying to limit the progression
  3. B) Assessing and understanding shock and the significant changes in assessment data to guide the plan of care
  4. C) Giving the prescribed treatment but shifting focus to providing family time as the patient is unlikely to survive
  5. D) Giving progressive care to the patient and family using critical pathways for shock therapy

 

Ans: B

Chapter: 15

Client Needs: A-1

Cognitive Level: Application

Difficulty: Difficult

Integrated Process: Nursing Process

Objective: 8

Page and Header: 319, Stages of Shock

 

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. Option A is incorrect; reviewing the cause of shock and trying to limit the progression is important, but it must be followed by a plan of care. Option C is incorrect; it is important during the progressive of shock to give the prescribed treatment, but the patient still has a chance of survival; providing family time in important, but patient survival is still the priority. Option D is incorrect; giving progressive care to the patient and family is not defined, and using critical pathways for shock therapy sounds good, but there is no information in the stem of the question that indicates we are using a critical pathway. This answer is designed to distract the test-taker.

 

 

 

 

  1. When caring for a patient in shock, one of the major nursing goals is to reduce the risk that the patient will develop complications from shock. What does this require the nurse to do?
  2. A) Provide an accurate diagnosis, plan of care, and appropriate interventions to allow the patient the best chance for survival
  3. B) Keep the physician updated with the most accurate information; in shock the nurse is often powerless to help.
  4. C) Monitor for significant changes and evaluate patient outcomes on a scheduled basis focusing on blood pressure and skin temperature
  5. D) Understand the underlying mechanisms of shock, recognize the subtle and more obvious signs, and then provide rapid assessment and response

 

Ans: D

Chapter: 15

Client Needs: D-3

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 4

Page and Header: 313, Introduction

 

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. Option A is a good answer but not the best answer; an accurate diagnosis is not as important as understanding the underlying mechanisms of shock. Option B is incorrect; 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. Option C is incorrect; 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.

 

 

 

 

  1. You are caring for a patient in the ICU who is suffering from multiple organ dysfunction syndrome (MODS). What should your plan of care focus on?
  2. A) Encouraging the family to stay hopeful and educating the family to the fact that, in most cases, the prognosis is good
  3. B) Encouraging the family to leave the hospital and to take time for themselves as care of MODS patients may last for years
  4. C) Promoting communication with the patient and family along with addressing end-of-life issues
  5. D) Discussing organ donation on a number of different occasions to allow the family time to adjust to the idea

 

Ans: C

Chapter: 15

Client Needs: D-4

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 1

Page and Header: 333, Multiple Organ Dysfunction Syndrome

 

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 patient’s wishes. Option A is incorrect; most cases of MODS result in death. Option B is incorrect; encouraging the family to leave the hospital and to take time for themselves does allow time for the family to grieve and make plans, but the life expectancy of patients with MODS is usually measured in hours and possibly days, but not in years. Option D is incorrect; discussing 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.

 

 

 

 

  1. Your patient is in hypovolemic shock. You know that antidiuretic hormone (ADH) plays a role during hypovolemic shock. What assessment finding will you likely observe related to the role of the antidiuretic hormone (ADH) during hypovolemic shock?
  2. A) Increased hunger
  3. B) Decreased thirst
  4. C) Decreased urinary output
  5. D) Increased capillary perfusion

 

Ans: C

Chapter: 15

Client Needs: D-4

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 1

Page and Header: 314, Overview of Shock

 

Feedback: During hypovolemic shock, a state of hypernatremia occurs. Hypernatremia stimulates the release of antidiuretic hormone (ADH) by the pituitary gland. ADH causes the kidneys to retain water further in an effort to raise blood volume and blood pressure. Options A, B, and C are incorrect; in a hypovolemic state the body shifts blood away from anything that is not a vital organ, so hunger is not an issue; thirst is increased as the body tries to increase fluid volume; and capillary profusion decreases as the body shunts blood away from the periphery and to the vital organs.

 

 

 

 

  1. When caring for a patient at risk for shock, what assessment finding would the nurse consider a potential sign of shock?
  2. A) Elevated systolic blood pressure
  3. B) Elevated mean arterial pressure
  4. C) Shallow, rapid respirations
  5. D) Bradycardia

 

Ans: C

Chapter: 15

Client Needs: D-4

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 2

Page and Header: 317, Stages of Shock

 

Feedback: A symptom of shock is shallow, rapid respirations. Options A and B are incorrect; systolic blood pressure drops in shock, and MAP is less than 65 mm Hg. Option D is incorrect; bradycardia occurs in neurogenic shock; other states of shock have tachycardia as a symptom.

 

 

 

 

  1. You are precepting a new graduate nurse in the ICU. The two of you are caring for a patient who is receiving large volumes of crystalloid fluid as a result of shock. What would you teach the new nurse to monitor the patient for symptoms of?
  2. A) Hypothermia
  3. B) Bradycardia
  4. C) Coffee ground emesis
  5. D) Pain

 

Ans: A

Chapter: 15

Client Needs: D-2

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 5

Page and Header: 324, Hypovolemic Shock

 

Feedback: Temperature should be monitored closely to ensure that rapid fluid resuscitation does not precipitate hypothermia. Intravenous fluids may need to be warmed during the administration of large volumes. Option B is incorrect; the nurse should monitor the patient for cardiovascular overload and pulmonary edema when large volumes of intravenous solution are administered. Option C is incorrect; coffee ground emesis is an indication of a gastrointestinal bleed, not shock. Option D is incorrect; pain is related to cardiogenic shock.

 

 

 

 

  1. You are caring for a patient in the ICU whose condition is deteriorating. You receive orders for dopamine, which is an intravenous vasoactive drug. What would be your priority assessment and interventions specific to the administration of vasoactive medications?
  2. A) Frequent vitals, monitoring the central line site, and providing accurate drug titration
  3. B) Reviewing medications, performing a focused cardiovascular assessment, and providing patient education
  4. C) Reviewing the laboratory findings, monitoring urine output, and assessing for peripheral edema
  5. D) Routine vitals, monitoring the peripheral IV site, and providing early discharge instructions

 

Ans: A

Chapter: 15

Client Needs: D-2

Cognitive Level: Application

Difficulty: Difficult

Integrated Process: Nursing Process

Objective: 6

Page and Header: 321, General Management Strategies in Shock

 

Feedback: When vasoactive medications are administered, vital signs must be monitored frequently (at least every 15 minutes until stable, or more often if indicated). Vasoactive medications should be administered through a central venous line because infiltration and extravasation of some vasoactive medications can cause tissue necrosis and sloughing. An intravenous pump should be used to ensure that the medications are delivered safely and accurately. Individual medication dosages are usually titrated by the nurse, who adjusts drip rates based on the prescribed dose and the patient’s response. Option B is incorrect; reviewing medications, performing a focused cardiovascular assessment, and providing patient education are important nursing tasks, but they are not specific to the administration of intravenous vasoactive drugs. Option C is incorrect; reviewing the laboratory findings, monitoring urine output, and assessing for peripheral edema are not the priorities for administration of intravenous vasoactive drugs. Option D is incorrect; the vitals are taken on a frequent basis when monitoring administration of intravenous vasoactive drugs, vasoactive medications should be administered through a central venous line, and early discharge instructions would be inappropriate in this time of crisis.

 

 

 

 

  1. The nurse in the ICU is admitting a 57year-old-man with a diagnosis of possible septic shock. When the nurse assesses him, she notes that the patient has a normal blood pressure, increased heart rate, decreased bowel sounds, and his skin is cold and clammy. What would the nurse suspect?
  2. A) The patient is in the compensatory stage of shock.
  3. B) The patient is in the progressive stage of shock.
  4. C) The patient will stabilize and be released by tomorrow.
  5. D) The patient is in the irreversible stage of shock.

 

Ans: A

Chapter: 15

Client Needs: A-1

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 2

Page and Header: 315, Stages of Shock

 

Feedback: In the compensatory stage of shock, the blood pressure remains within normal limits. Vasoconstriction, increased heart rate, and increased contractility of the heart contribute to maintaining adequate cardiac output. Patients display the often-described ìfight or flightî response. The body shunts blood from organs such as the skin, kidneys, and gastrointestinal tract to the brain and heart to ensure adequate blood supply to these vital organs. As a result, the skin is cool and clammy, and his bowel sounds are hypoactive. Option B is incorrect; in progressive shock, the blood pressure drops. Option C is incorrect; in septic shock, the patient’s chance of survival is low and he will certainly not be released within 24 hours. Option D is incorrect; if the patient were in the irreversible stage of shock, his blood pressure would be very low and his organs would be failing.

 

 

 

 

  1. You are part of the health care team in the emergency department that is caring for a patient brought in by paramedics in the irreversible stage of shock. What would be your best nursing intervention?
  2. A) Provide opportunities for the family to spend time with the patient, and help them to understand the irreversible stage of shock.
  3. B) Inform the patient’s family early that the patient will likely not survive, which allows the family time to make plans and move forward.
  4. C) Closely monitor fluid replacement therapy, and inform the family that the patient will probably survive and return to her normal life.
  5. D) Protect the patient’s airway, optimize intravascular volume, and support the pumping action of the heart.

 

Ans: A

Chapter: 15

Client Needs: A-2

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 4

Page and Header: 319, Stages of Shock

 

Feedback: The irreversible (or refractory) stage of shock represents the point along the shock continuum at which organ damage is so severe that the patient does not respond to treatment and cannot survive. Providing opportunities for the family to spend time with the patient and helping them to understand the irreversible stage of shock is the best intervention. Option B is a good answer; informing the patient’s family early that the patient will likely not survive does allow the family to make plans and move forward, but informing the family too early will rob the family of hope and interrupt the grieving process. Option C is incorrect; the chance of surviving the irreversible (or refractory) stage of shock is very small, and the nurse needs to help the family cope with the reality of the situation. Option D is incorrect; with the chances of survival so small, the priorities shift from aggressive treatment and safety to addressing the end-of -life issues.

 

 

 

 

  1. You are working in the ICU and have just been notified that you are receiving a patient from the Obstetrics unit who is in hypovolemic shock due to massive blood loss during delivery. You know that the best choice for fluid replacement for this patient is what?
  2. A) 5% Albumin because it is inexpensive and is always readily available
  3. B) Dextran because it increases intravascular volume and counteracts coagulopathy
  4. C) Whatever fluid that is most readily available in the ICU, due to the nature of the emergency
  5. D) Lactated Ringer’s solution because it increases volume, buffers acidosis, and is the best choice for patients with liver failure

 

Ans: C

Chapter: 15

Client Needs: D-2

Cognitive Level: Application

Difficulty: Difficult

Integrated Process: Nursing Process

Objective: 5

Page and Header: 320, General Management Strategies in Shock

 

Feedback: The best fluid to treat shock remains controversial. In emergencies, the ìbestî fluid is often the fluid that is readily available. Fluid resuscitation should be initiated early in shock to maximize intravascular volume. Both crystalloids and colloids can be administered to restore intravascular volume. There is no consensus regarding whether crystalloids or colloids like dextran and albumin should be used; however, with crystalloids, more fluid is necessary to restore intravascular volume. Option A is incorrect; albumin is very expensive and is a blood product so it is not always readily available for use. Option B is incorrect; dextran does increase intravascular volume, but it increases the risk for coagulopathy. Option D is incorrect; Lactated Ringer’s is a good solution choice because it increases volume and buffers acidosis but should not be used in patients with liver failure because the liver is unable to covert lactate to bicarbonate.

 

 

 

 

  1. You are caring for a trauma patient in the ICU who is in shock. The patient is a 47-year-old, obese male who was in a motor vehicle accident. You know that patients in shock require excess energy requirements. What would be the main concern in meeting this patient’s elevated energy requirements?
  2. A) Loss of adipose tissue
  3. B) Loss of skeletal muscle
  4. C) Inability to convert adipose tissue to energy
  5. D) Inability to maintain normal body mass

 

Ans: B

Chapter: 15

Client Needs: D-4

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 7

Page and Header: 322, General Management Strategies in Shock

 

Feedback: Nutritional energy requirements are met by breaking down lean body mass. In this catabolic process, skeletal muscle mass is broken down even when the patient has large stores of fat or adipose tissue. Loss of skeletal muscle greatly prolongs the patient’s recovery time. Loss of adipose tissue, the inability to convert adipose tissue to energy, or the inability to maintain normal body mass are not main concerns in meeting nutritional energy requirements for this patient.

 

 

 

 

  1. You are the nurse in the emergency department who is caring for a patient recently admitted with a myocardial infarction. The patient’s heart is pumping an inadequate supply of oxygen to the tissue. What would you assess for?
  2. A) Dysrhythmias
  3. B) Increase in blood pressure
  4. C) Decrease in heart rate
  5. D) Decrease in oxygen demands

 

Ans: A

Chapter: 15

Client Needs: D-4

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 4

Page and Header: 325, Cardiogenic Shock

 

Feedback: Cardiogenic shock occurs when the heart’s ability to pump blood is impaired and the supply of oxygen is inadequate for the heart and tissues. Symptoms of cardiogenic shock include angina pain and dysrhythmias. Cardiogenic shock does not exhibit increased blood pressure, decreased heart rate, or a decrease in oxygen demands.

 

 

 

 

  1. The nurse is caring for a patient admitted with cardiogenic shock. The patient is experiencing chest pain. There is an order for the administration of morphine for the onset of chest pain. What is the rationale for administering morphine for this patient?
  2. A) It decreases urine output.
  3. B) It stimulates the patient so he or she is more alert.
  4. C) It decreases gastric secretions.
  5. D) It dilates the blood vessels.

 

Ans: D

Chapter: 15

Client Needs: D-2

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 4

Page and Header: 325, Cardiogenic Shock

 

Feedback: For patients experiencing chest pain, morphine is the drug of choice because it dilates the blood vessels and controls the patient’s anxiety. Morphine would not be ordered to decrease urine output or to stimulate the patient. The rationale behind using morphine would not be to decrease gastric secretions.

 

 

 

 

  1. You are caring for a patient at risk of shock. What physiologic response would you know to look for while assessing for shock?
  2. A) Activation of infectious response
  3. B) Increased blood pressure
  4. C) Hypoperfusion of tissues
  5. D) Temperature

 

Ans: C

Chapter: 15

Client Needs: D-3

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 1

Page and Header: 313, Overview of Shock

 

Feedback: Regardless of the initial cause of shock, certain physiologic responses are common to all types of shock. These physiologic responses include hypoperfusion of tissues, hypermetabolism, and activation of the inflammatory response.

 

 

 

 

  1. What does the basic nursing care of patients with shock require?
  2. A) Expertise in understanding causes of shock
  3. B) Understanding of primary prevention of shock
  4. C) Restoring intravascular volume
  5. D) An ongoing systematic assessment

 

Ans: D

Chapter: 15

Client Needs: D-4

Cognitive Level: Comprehension

Difficulty: Easy

Integrated Process: Teaching/Learning

Objective: 1

Page and Header: 313, Overview of Shock

 

Feedback: Nursing care of patients with shock requires ongoing systematic assessment. Options A, B, and C are incorrect; basic nursing care of patients with shock does not require understanding the causes of shock, understanding the primary prevention of shock, or restoring intravascular volume.

 

 

 

 

  1. Why are antiarrhythmic medications required in the treatment of shock?
  2. A) To prevent serious cardiac dysrhythmias
  3. B) All patient with shock have serious cardiac dysrhythmias
  4. C) They are not required
  5. D) To stabilize cardiac afterload

 

Ans: B

Chapter: 15

Client Needs: D-2

Cognitive Level: Knowledge

Difficulty: Easy

Integrated Process: Nursing Process

Objective: 6

Page and Header: 326, Cardiogenic Shock

 

Feedback: Multiple factors, such as hypoxemia, electrolyte imbalances, and acidñbase imbalances, contribute to serious cardiac dysrhythmias in all patients with shock. Antiarrhythmic medications are required to stabilize the heart rate. Option A is incorrect; antiarrhythmic medications treat dysrhythmias, they don’t prevent them. Option C is incorrect; they are required. Option D is incorrect; antiarrhythmic drugs do not stabilize cardiac afterload.

 

 

 

 

  1. In a state of shock, compensatory mechanisms occur in the body. What is a compensatory mechanism to increase cardiac output during hypovolemic states?
  2. A) Third spacing of fluid
  3. B) Vasodilation
  4. C) Tachycardia
  5. D) Gastric hypermotility

 

Ans: C

Chapter: 15

Client Needs: D-4

Cognitive Level: Comprehension

Difficulty: Easy

Integrated Process: Nursing Process

Objective: 2

Page and Header: 316, Stages of Shock

 

Feedback: Tachycardia is a primary compensatory mechanism to increase cardiac output during hypovolemic states. The third spacing of fluid takes fluid out of the vascular space. Vasodilation would not increase cardiac output during hypovolemic states. Gastric hypermotility would not increase cardiac output.

 

 

 

 

Multiple Selection

 

 

 

 

  1. You are caring for a patient with shock. What cardiac signs or symptoms would indicate acute organ dysfunction? (Mark all that apply.)
  2. A) Drop in systolic blood pressure greater than 40 mm Hg from baseline blood pressure
  3. B) Hypotension that responds to fluid resuscitation
  4. C) Vasopressor support is not needed
  5. D) Serum lactate greater than 4 mmol/L
  6. E) Mean arterial pressure (MAP) less than 65 mm Hg

 

Ans: A, D, E

Chapter: 15

Client Needs: D-4

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 3

Page and Header: 330, Circulatory Shock

Feedback: Signs of acute organ dysfunction in the cardiovascular system include systolic blood pressure less than 90 mm Hg or mean arterial pressure (MAP) less than 65 mm Hg, or drop in systolic blood pressure greater than 40 mm Hg from baseline blood pressure. Is hypotension responsive to fluid resuscitation, or is vasopressor support needed? Is the serum lactate greater than 4 mmol/L? Options B and C are incorrect.

 

 

 

 

Multiple Choice

 

 

 

 

  1. Patients who survive shock may be discharged home to finish the recovery phase of their disease process. The home health nurse plays an integral part in monitoring these patients. What is an important part of the care given by the home health nurse?
  2. A) Providing supervision to home health aides in providing necessary patient care
  3. B) Assisting patient and family to identify and mobilize community resources
  4. C) Providing ongoing medical care during the family’s rehabilitation phase
  5. D) Reinforcing the importance of continuous assessment to prevent further episodes of shock

 

Ans: B

Chapter: 15

Client Needs: D-4

Cognitive Level: Application

Difficulty: Difficult

Integrated Process: Caring

Objective: 8

Page and Header: 334, Promoting Home and Community-Based Care

 

Feedback: The home care nurse reinforces the importance of continuing medical care and helps the patient and family identify and mobilize community resources. Option A is incorrect; the home health nurse is part of a team that provides patient care in the home. The nurse does not directly supervise home health aides. Option C is incorrect; the nurse provides nursing care to both the patient and family, not just the family. Option D is incorrect; the nurse performs continuous and ongoing assessment of the patient; he does not just reinforce the importance of that assessment.

 

 

 

 

  1. Some interventions are used in all types of shock. What is one of these interventions?
  2. A) Aggressive hypoglycemic control
  3. B) Use of hypotonic IV fluids
  4. C) Early enteral nutritional support
  5. D) Maintaining the competence of the vascular system

 

Ans: C

Chapter: 15

Client Needs: D-4

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 7

Page and Header: 318, Stages of Shock

 

Feedback: Other aspects of management may include early enteral nutritional support or aggressive hyperglycemic control with IV insulin. Option B is incorrect; IV fluids are used to meet patient needs or are the available fluids at the time. They are not just hypotonic IV fluids. Option D is incorrect; improvement, not just maintenance, of the competence of the vascular system is the goal.

 

 

 

 

  1. In all types of shock, nutritional demands increase rapidly as the body depletes its stores of glycogen. Enteral nutrition is the preferred method of meeting these increasing energy demands. What is the basis for enteral nutrition being the preferred method of meeting the bodies needs?
  2. A) It increases the possibility of infectious complications of nutritional support.
  3. B) It decreases the energy expended through the functioning of the GI system.
  4. C) It assists in expanding the intravascular volume of the body.
  5. D) It promotes GI function through direct exposure to nutrients.

 

Ans: D

Chapter: 15

Client Needs: D-4

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 7

Page and Header: 322, General Management Strategies in Shock

 

Feedback: Parenteral or enteral nutritional support should be initiated as soon as possible. Enteral nutrition is preferred, promoting GI function through direct exposure to nutrients and limiting infectious complications associated with parenteral feeding. This makes option A incorrect. Options B and C are incorrect; enteral feeding does not decrease the energy expended through the functioning of the GI system or assist in expanding the intravascular volume of the body.

 

 

 

 

  1. You are the ICU nurse caring for a patient with multiple organ dysfunction syndrome due to shock. What is a critical part of your role?
  2. A) Providing information and support to family members
  3. B) Preparing the family for a long recovery process
  4. C) Educating the patient regarding the use of supportive fluids
  5. D) Demonstrating necessary skills for the rehabilitation phase of recovery

 

Ans: A

Chapter: 15

Client Needs: D-4

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 9

Page and Header: 333, Multiple Organ Dysfunction Syndrome

 

Feedback: Providing information and support to family members is a critical role of the nurse. Options B, C, and D are incorrect; most patients with multiple organ dysfunction syndrome do not recover, so there is no rehabilitation phase of recovery as there is no recovery process. Educating the patient about the use of supportive fluids is a distracter to this test question.

 

 

 

 

  1. The ICU nurse is caring for a patient in shock. What is one of the most important functions of the nursing role in caring for this patient?
  2. A) Documenting the administration of medications
  3. B) Monitoring for complications and side effects of treatment
  4. C) Reporting adverse effects of treatment
  5. D) Safely administering prescribed fluids

 

Ans: B

Chapter: 15

Client Needs: D-4

Cognitive Level: Analysis

Difficulty: Difficult

Integrated Process: Nursing Process

Objective: 8

Page and Header: 324, Hypovolemic Shock

 

Feedback: General nursing measures include ensuring safe administration of prescribed fluids and medications and documenting their administration and effects. An important function of the nursing role is monitoring for complications and side effects of treatment and reporting them promptly. Options A, C, and D are all correct answers; however, they are not more important functions of nursing care than monitoring for complications and side effects of treatment.

 

 

 

 

Multiple Selection

 

 

 

 

  1. Patients in shock can experience fluid replacement complications. What does the nurse monitor the patient for? (Mark all that apply.)
  2. A) Hypovolemia
  3. B) Difficulty breathing
  4. C) Cardiovascular overload
  5. D) Pulmonary edema
  6. E) Hypoglycemia

 

Ans: B, C, D

Chapter: 15

Client Needs: D-4

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 4

Page and Header: 324, Hypovolemic Shock

Feedback: Fluid replacement complications can occur, often when large volumes are administered rapidly. Therefore, the nurse monitors the patient closely for cardiovascular overload, signs of difficulty breathing, and pulmonary edema. Options A and E are incorrect; hypovolemia is what necessitates fluid replacement, and hypoglycemia is not a concern with fluid replacement, hyperglycemia is.

 

 

 

 

Multiple Choice

 

 

 

 

  1. When circulatory shock occurs, there is massive vasodilation causing pooling of the blood in the periphery of the body. As an ICU nurse caring for a patient in circulatory shock, you know that the pooling of blood in the periphery leads to what?
  2. A) Increased stroke volume
  3. B) Increased cardiac output
  4. C) Decreased heart rate
  5. D) Decreased venous return

 

Ans: D

Chapter: 15

Client Needs: D-4

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 1

Page and Header: 327, Circulatory Shock

 

Feedback: Pooling of blood in the periphery results in decreased venous return. Decreased venous return results in decreased stroke volume and decreased cardiac output. Decreased cardiac output, in turn, causes decreased blood pressure and, ultimately, decreased tissue perfusion. Option C is incorrect; heart rate increases in an attempt to meet the demands of the body.

 

 

 

 

Multiple Selection

 

 

 

 

  1. The nursing instructor is discussing shock with a class of junior nursing students. Which subclassifications of circulatory shock would the instructor discuss? (Mark all that apply.)
  2. A) Anaphylactic
  3. B) Hypovolemic
  4. C) Cardiogenic
  5. D) Septic
  6. E) Neurogenic

 

Ans: A, D, E

Chapter: 15

Client Needs: D-4

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Teaching/Learning

Objective: 4

Page and Header: 327, Circulatory Shock

Feedback: The varied mechanisms leading to the initial vasodilation in circulatory shock provide the basis for the further subclassification of shock into three types: septic shock, neurogenic shock, and anaphylactic shock. Options B and C are incorrect; hypovolemic and cardiogenic shock are not subclassifications of circulatory shock.

 

 

 

 

Multiple Choice

 

 

 

 

  1. You are the triage nurse in the emergency department (ED) when a grandfather carries his 4-year-old grandson into the ED. The child is not breathing, and the grandfather states the boy was stung by a bee just outside the ED where they were waiting for the mother to get off work. What characteristics of anaphylactic shock would lead you to believe this is what is happening to the patient?
  2. A) Rapid onset of acute hypertension
  3. B) Rapid onset of respiratory distress
  4. C) Rapid onset of neurologic compensation
  5. D) Rapid onset of cardiac arrest

 

Ans: B

Chapter: 15

Client Needs: D-4

Cognitive Level: Analysis

Difficulty: Difficult

Integrated Process: Nursing Process

Objective: 4

Page and Header: 332, Circulatory Shock

 

Feedback: Characteristics of severe anaphylaxis usually include rapid onset of hypotension, neurologic compromise, respiratory distress, and cardiac arrest. Options A, C, and D are incorrect as the scenario does not indicate the child has acute hypertension, neurologic compensation, or cardiac arrest.

 

 

 

 

  1. The ICU nurse is caring for a patient in neurogenic shock. What would the nurse know is a characteristic of neurogenic shock?
  2. A) Hypertension
  3. B) Cool, moist skin
  4. C) Bradycardia
  5. D) Signs of sympathetic stimulation

 

Ans: C

Chapter: 15

Client Needs: D-4

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 4

Page and Header: 331, Circulatory Shock

 

Feedback: In neurogenic shock, the sympathetic system is not able to respond to body stressors. Therefore, the clinical characteristics of neurogenic shock are signs of parasympathetic stimulation. It is characterized by dry, warm skin rather than the cool, moist skin seen in hypovolemic shock. Another characteristic is hypotension with bradycardia, rather than the tachycardia that characterizes other forms of shock.

 

 

 

 

  1. Vasoactive medications are given in all forms of shock. Why are these medications used?
  2. A) To increase myocardial resistance
  3. B) To decrease strength of cardiac contractility
  4. C) To maintain hemodynamic stability
  5. D) To initiate vasoconstriction

 

Ans: D

Chapter: 15

Client Needs: D-2

Cognitive Level: Application

Difficulty: Difficult

Integrated Process: Nursing Process

Objective: 6

Page and Header: 321, General Management Strategies in Shock

 

Feedback: Vasoactive medications are administered in all forms of shock to improve the patient’s hemodynamic stability when fluid therapy alone cannot maintain adequate MAP. Specific medications are selected to correct the particular hemodynamic alteration that is impeding cardiac output. These medications help increase the strength of myocardial contractility, regulate the heart rate, reduce myocardial resistance, and initiate vasoconstriction. Therefore options A, B, and C are incorrect.

 

 

 

 

  1. The ICU nurse caring for a patient with shock is administering vasoactive medications as per orders. The nurse knows that these medications should be what?
  2. A) Administered through a central venous line
  3. B) Titrated by dial-a-flow tubing
  4. C) Given by IV push for rapid onset of action
  5. D) Mixed with enteral feedings

 

Ans: A

Chapter: 15

Client Needs: D-4

Cognitive Level: Knowledge

Difficulty: Easy

Integrated Process: Nursing Process

Objective: 6

Page and Header: 321, General Management Strategies in Shock

 

Feedback: Vasoactive medications should be administered through a central venous line because infiltration and extravasation of some vasoactive medications can cause tissue necrosis and sloughing. An IV pump or controller should be used to ensure that the medications are delivered safely and accurately. Therefore options B, C, and D are incorrect.

 

 

 

 

  1. You are caring for a patient in the irreversible stage of shock. What is an essential part of your nursing care?
  2. A) Preparing the family for a long recovery process
  3. B) Giving the patient brief explanations of what is happening
  4. C) Avoiding stimulating the patient by touch
  5. D) Keeping visitors to a minimum

 

Ans: B

Chapter: 15

Client Needs: D-4

Cognitive Level: Application

Difficulty: Easy

Integrated Process: Caring

Objective: 2

Page and Header: 319, Stages of Shock

 

Feedback: As in the progressive stage of shock, the nurse focuses on carrying out prescribed treatments, monitoring the patient, preventing complications, protecting the patient from injury, and providing comfort. Offering brief explanations to the patient about what is happening is essential even if there is no certainty that the patient hears or understands what is being said. Simple comfort measures, including reassuring touches, should continue to be provided despite the patient’s nonresponsiveness to verbal stimuli. Option A is incorrect; this patient is not expected to recover. Option D is incorrect; family needs to spend time with a patient who is not expected to recover.

 

 

 

 

  1. The ICU nurse is caring for a patient in hypovolemic shock. What is a serious complication the nurse knows to monitor the patient for?
  2. A) Anaphylaxis
  3. B) Decreased oxygen consumption
  4. C) Abdominal compartment syndrome
  5. D) Decreased serum osmolality

 

Ans: C

Chapter: 15

Client Needs: D-4

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 3

Page and Header: 320, General Management Strategies in Shock

 

Feedback: Abdominal compartment syndrome (ACS) is a serious complication that may occur when large volumes of fluid are administered. Option A is incorrect; the scenario does not describe an antigen-antibody reaction of any type. Option B is incorrect; decreased oxygen consumption by the body is not a concern in hypovolemic shock. Option D is incorrect; with a decrease in fluids in the intravascular space, increased serum osmolality would occur.

 

 

 

 

  1. Sepsis is an evolving process, with neither clearly definable clinical signs and symptoms nor predictable progression. As the ICU nurse caring for a patient with sepsis, you know that tissue perfusion declines and the patient begins to show signs of organ dysfunction. What signs of end-organ damage would you expect to become evident?
  2. A) Urinary output increases
  3. B) Skin becomes warm and dry
  4. C) Adventitious lung sounds occur in lung bases
  5. D) Heart and respiratory rates are elevated

 

Ans: D

Chapter: 15

Client Needs: D-4

Cognitive Level: Application

Difficulty: Difficult

Integrated Process: Nursing Process

Objective: 2

Page and Header: 329, Circulatory Shock

 

Feedback: As sepsis progresses, tissues become less perfused and acidotic, compensation begins to fail, and the patient begins to show signs of organ dysfunction. The cardiovascular system also begins to fail, the blood pressure does not respond to fluid resuscitation and vasoactive agents, and signs of end-organ damage are evident (eg, renal failure, pulmonary failure, hepatic failure). As sepsis progresses to septic shock, the blood pressure drops, and the skin becomes cool, pale, and mottled. Temperature may be normal or below normal. Heart and respiratory rates remain rapid. Urine production ceases, and multiple organ dysfunction progressing to death occurs. Therefore, options A and B are incorrect. Option C is incorrect; adventitious lung sounds occur throughout the lung fields, not just in the bases of the lungs.