Exam 14: Overview of Shock and Sepsis

The nurse has just completed the assessment of a patient admitted with a gunshot wound to the femoral artery.Which is the priority nursing diagnosis for this patient?

The nurse is preparing to administer diphenhydramine to a patient who is experiencing a severe allergic reaction to peanuts.Which information about the drug should the nurse provide to the patient?

The nurse is administering albumin 5% to a patient in shock.Which nursing action is appropriate when assessing this patient?

An older adult patient is experiencing hypovolemic shock.Which is the priority intervention for this patient?

A patient is prescribed epinephrine for the prevention of anaphylactic shock.The patient states,"I thought shock was about heart failure." Which response by the nurse is most appropriate?

A nurse working in the intensive care unit (ICU)is caring for a patient in refractory stage of shock.When planning care,which does the nurse anticipate?

The nurse identifies the nursing diagnosis of Ineffective Peripheral Tissue Perfusion as being appropriate for a patient with septicemia.Which intervention will address this patient's health problem?

An older adult patient is recovering in the intensive care unit (ICU)from septicemia.Which intervention will help prevent further infection for this patient?

The nurse explains the purpose of an infusion of albumin 5% to a patient recovering from hypovolemic shock.Which statement indicates that the patient understands the instructions?

A nurse is caring for a patient who was involved in a motor vehicle accident who has lost approximately 1,500 mL of blood.Based on this data,which type of shock is the patient experiencing?

The nurse is providing care to a patient admitted to the emergency department (ED)with a gunshot wound and profound blood loss.Which order does the nurse anticipate for this patient?

Which is the highest priority nursing action when providing care to a patient with shock?

A patient develops hypovolemic shock secondary to pancreatitis.Which action by the nurse is most appropriate?

During the initial stage of shock,which clinical manifestation should the nurse monitor for when assessing the patient?

The nurse is providing care to a patient who is admitted to the emergency department with symptoms of a myocardial infarction (MI).Which is the primary purpose of the interventions administered to this patient?

A patient in neurogenic shock is receiving rapid intravenous fluids.Which assessment finding indicates the need for additional nursing interventions?

A patient being treated for hypovolemic shock is prescribed a low dose of dopamine.Which outcome does the nurse anticipate for this patient?

The nurse is conducting medication teaching for a patient who is prescribed an epi-pen.Which statements made by the patient indicates the need for additional instruction?

The nurse is providing care to a patient admitted with a spinal cord injury.The patient is bradycardic,hypotensive,and has cold and clammy skin.Which is the priority nursing action for this patient?

The nurse is providing care for a patient receiving treatment for cardiogenic shock.Which assessment finding indicates that the compensatory mechanism of vasoconstriction has occurred in this patient?