Deck 6: Shock

Question 1

You are caring for a patient who has been in a multiple trauma that has lead to severe blood loss. What type of device will you need to acquire to transfuse several units of blood quickly?

A)Cardiac monitor
B)Pulse oximetry
C)Blood warming device
D)Infusion controller

Answer 1

Blood warming device

Question 2

You began administering blood to a patient 45 minutes ago. You enter the room to assess the patient and find the patient flushed and dyspneic. On auscultation the patient has crackles in the bases of both lungs. What complication of blood transfusion therapy is the patient most likely experiencing?

A)Hypovolemia
B)Transfusion reaction
C)Fluid overload
D)Bacteremia

Answer 2

Fluid overload

Question 3

You are caring for a patient who is receiving a platelet transfusion. Which of the following would indicate a therapeutic effect of the transfusion?

A)A decrease in temperature
B)A decrease of blood oozing from puncture sites and gums
C)An increase hemoglobin
D)An increase hematocrit

Answer 3

A decrease of blood oozing from puncture sites and gums

Question 4

You are preparing to give a patient a transfusion. The patient states that in previous transfusions he has always developed a rash. What medication do you suspect the physician will order prior to the transfusion?

A)Diphenhydramine (Benadryl)
B)Acetylsalicylic acid (ASA, aspirin)
C)Acetaminophen (Tylenol)
D)Ibuprofen (Motrin)

Question 5

You are caring for a patient in hypovalemic shock who will require plasma expansion. What do you suspect the physician will order?

A)Cryoprecipitate
B)Packed red blood cells
C)Albumin
D)Platelets

Question 6

Your patient has come into the emergency department with a self-inflicted wrist laceration that has severe bleeding. You have begun to apply pressure to the wound. What would your immediate priority be?

A)See to the patient's need for psychiatric evaluation.
B)Lower the patient's body temperature to decrease circulation.
C)Place the extremity below the level of the heart.
D)Monitor the patient for signs of shock.

Question 7

Your patient has been stung by a bee. What signs and symptoms would you see if the patient had an allergic reaction to the sting?

A)Normal respiratory rate
B)Prolonged expiratory phase
C)Wheezing on inspiration
D)Decreased respiratory rate

Question 8

You are caring for a patient in shock. Which parameter would you want to monitor to determine if treatment is effective?

A)Cardiac output
B)Respiratory rate
C)Peripheral pulse rate
D)Central venous pressure

Question 9

Which finding would make you suspect that your patient might be in cardiogenic shock?

A)Decreased or muffled heart sounds
B)A cardiac index greater than 2.2 L/min
C)Bounding pulses
D)Increased cardiac output

Question 10

You are caring for a patient who was brought into the emergency department unresponsive, hypotensive and tachypneic. Upon further assessment, you realize that the patient's temperature is 106 degrees Fahrenheit. You suspect heat stroke. What would your priority nursing intervention be?

A)Obtain a history from the patient.
B)Take oral temperature to monitor effectiveness of treatment.
C)Call the family for consent to treat.
D)Take off the patient's clothing, wrap him or her in wet towels and place a fan on the patient.

Question 11

You are about to administer blood to a patient. You have verified that it is the correct blood for the patient with another nurse. What do you need to assess before you start the blood?

A)Vital signs
B)Skin color
C)Hemoglobin level
D)Creatinine level

Question 12

Which IV fluids would you need to hang with a transfusion?

A)Lactated ringers
B)Dextrose 5% and normal saline 0.9%
C)Dextrose 5% and normal saline 0.45%
D)Normal saline 0.9%

Question 13

You are caring for a patient who has been receiving a blood transfusion for the last 30 minutes. On assessment, you find the patient to be dyspneic and show bilateral crackles and a heart rate of 110. Which of the following complications do you suspect the patient is experiencing?

A)Immune response
B)Hypovolemia
C)Fluid overload
D)Polycythemia vera

Question 14

You determine that the patient you are caring for is having a transfusion reaction. You stop the blood immediately. Which action would you take next?

A)Notify a physician.
B)Determine the patient's white blood cell count.
C)Administer normal saline at KVO.
D)Administer normal saline bolus.

Question 15

You are caring for a patient with a gunshot wound. As a result of the patient's Coumadin therapy, the prothrombin time is twice the normal amount. Which blood product do you expect the physician to order?

A)Fresh frozen plasma
B)Random donor platelets
C)Red blood cells
D)Crystalloids

Question 16

An elderly patient comes into the emergency department to rule out stroke. On admission, vital signs are pulse 90, blood pressure 150/100 and respirations 20. Upon reassessment 30 minutes later, vital signs are pulse 78, blood pressure 170/90 and respirations 24 and irregular. What should be the nurse's first priority?

A)Have the patient describe how they are feeling.
B)Check the patient's Dilantin level.
C)Decrease fluids.
D)Encourage the patient to drink.

Question 17

You are caring for a postpartum mother who is in hypovalemic shock from hemorrhage. What would you expect to be the priority for this patient?

A)Oxygen at 3 to 4 liters
B)Oxytocic drug via IV
C)Heart rate every 5 minutes
D)Increase IV fluid rate

Question 18

What would the nurse do to prevent a woman who had a cesarean birth from having early postpartum hemorrhage?

A)IV fluids at 125 mL/hr
B)Assess uterus every 15 minutes
C)Abdominal dressing for drainage
D)Monitor urinary output

Question 19

You are caring for a patient who has been taking methylergonovine maleate (Methergine) for postpartum hemorrhage. It is not helping to control the hemorrhage. What procedure will most likely be ordered for this patient?

A)Dilatation and curettage
B)Laparotomy
C)Hysterotomy
D)Hysterectomy

Question 20

You are caring for a patient who has been stung by a bee. The patient has dyspnea, pruritis and localized swelling on the arm where he was stung. What would your priority intervention be for this patient?

A)Remove the stinger.
B)Place blankets over the patient.
C)Listen for stridor and check the patient's tongue for swelling.
D)Put the patient in the Trendelenburg position.

Question 21

You are caring for an infant with a diagnosis of sepsis. Which is the priority assessment for this infant?

A)Skin integrity
B)Temperature
C)Jaundice
D)Respiratory function

Question 22

Your patient came in to the emergency department with chest pain. Over the last hour the patient's blood pressure has dropped, pulse has increased and respirations have increased. What do you suspect these changes indicate?

A)Cardiogenic shock
B)Cardiac tamponade
C)Pulmonary embolism
D)Aortic aneurysm

Question 23

What would you want to assess your patient for if they have a myocardial infarction that is developing into cardiogenic shock?

A)Ventricular dysrhythmia
B)Bradycardia
C)Rising diastolic blood pressure
D)Falling central venous pressure

Question 24

You are caring for a patient in cardiogenic shock who has a multilumen pulmonary artery catheter in place. What cardiac output (CO) and pulmonary capillary wedge pressure (PCWP) would you see if the patient were unstable?

A)CO 5 L/min, PCWP low
B)CO 4 L/min, PCWP high
C)CO 3 L/min, PCWP high
D)CO 2 L/min, PCWP low

Question 25

Your patient is in cardiogenic shock and has had an intraaortic balloon pump placed through the left femoral artery. On assessment you note that the left foot is cool and mottled and the pedal pulse weak. What is the priority for this patient?

A)Document the data because it is expected.
B)Reevaluate in an hour.
C)Increase the rate on the nitroglycerin drip.
D)Notify the physician.