Question 1

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?

Accepted Answer

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 B

Question 2

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?

Accepted Answer

A)   Anaphylactic shock
B)   Neurogenic shock
C)   Septic shock
D)   Hypovolemic shock  B

Question 3

When circulatory shock occurs, there is massive vasodilation causing pooling of the blood in the periphery of the body. An ICU nurse caring for a patient in circulatory shock should know that the pooling of blood in the periphery leads to what pathophysiological effect?

Accepted Answer

A)   Increased stroke volume
B)   Increased cardiac output
C)   Decreased heart rate
D)   Decreased venous return D

Question 4

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, the nurse knows that tissue perfusion declines during sepsis and the patient begins to show signs of organ dysfunction. What sign would indicate to the nurse that end-organ damage may be occurring?

Accepted Answer

A)   Urinary output increases
B)   Skin becomes warm and dry
C)   Adventitious lung sounds occur in the upper airway
D)   Heart and respiratory rates are elevated

Question 5

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?

Accepted Answer

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

Question 6

A critical care nurse is aware of the high incidence of ventilator-associated pneumonia (VAP) in patients who are being treated for shock. What intervention should be specified in the patients plan of care while the patient is ventilated?

Accepted Answer

A)   Performing frequent oral care
B)   Maintaining the patient in a supine position
C)   Suctioning the patient every 15 minutes unless contraindicated
D)   Administering prophylactic antibiotics, as ordered

Question 7

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?

Accepted Answer

A)   Increased urine output
B)   Decreased heart rate
C)   Hyperactive bowel sounds
D)   Cool, clammy skin

Question 8

The nurse is caring for a patient admitted with cardiogenic shock. The patient is experiencing chest pain and there is an order for the administration of morphine. In addition to pain control, what is the main rationale for administering morphine to this patient?

Accepted Answer

A)   It promotes coping and slows catecholamine release.
B)   It stimulates the patient so he or she is more alert.
C)   It decreases gastric secretions.
D)   It dilates the blood vessels.

Question 9

The intensive care nurse is responsible for the care of a patient with shock. What cardiac signs or symptoms would suggest to the nurse that the patient may be experiencing acute organ dysfunction? Select all that apply.

Accepted Answer

A)  Drop in systolic blood pressure of  40 mmHg40 \mathrm{~mm} \mathrm{Hg}40 mmHg  from baselines
B)   Hypotension that responds to bolus fluid resuscitation
C)   Exaggerated response to vasoactive medications
D)  Serum lactate  4 \mathrm{mmol} / \mathrm{L}">>4mmol/L>4 \mathrm{mmol} / \mathrm{L}>4mmol/L 
E)   Mean arterial pressure (MAP)  of  65 mmHg65 \mathrm{~mm} \mathrm{Hg}65 mmHg

Question 10

The nurse is caring for a patient whose progressing infection places her at high risk for shock. What assessment finding would the nurse consider a potential sign of shock?

Accepted Answer

A)   Elevated systolic blood pressure
B)   Elevated mean arterial pressure (MAP) 
C)   Shallow, rapid respirations
D)   Bradycardia

Question 11

A patient is being treated in the ICU for neurogenic shock secondary to a spinal cord injury. Despite aggressive interventions, the patients mean arterial pressure (MAP) has fallen to $55 \mathrm{~mm} \mathrm{Hg}$. The nurse should gauge the onset of acute kidney injury by referring to what laboratory findings? Select all that apply.

Accepted Answer

A)   Blood urea nitrogen (BUN)  level
B)   Urine specific gravity
C)   Alkaline phosphatase level
D)   Creatinine level
E)   Serum albumin level

Question 12

The nurse is caring for a patient in the ICU whose condition is deteriorating. The nurse receives orders to initiate an infusion of dopamine. What would be the priority assessment and interventions specific to the administration of vasoactive medications?

Accepted Answer

A)   Frequent monitoring of vital signs, monitoring the central line site, and providing accurate drug titration
B)   Reviewing medications, performing a focused cardiovascular assessment, and providing patient education
C)   Reviewing the laboratory findings, monitoring urine output, and assessing for peripheral edema
D)   Routine monitoring of vital signs, monitoring the peripheral IV site, and providing early discharge instructions

Question 13

The ICU nurse caring for a patient in shock is administering vasoactive medications as per orders. The nurse should know that vasoactive medications should be administered in what way?

Accepted Answer

A)   Through a central venous line
B)   By a gravity infusion IV set
C)   By IV push for rapid onset of action
D)   Mixed with parenteral feedings to balance osmosis

Question 14

A triage nurse in the ED is on shift 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 in a nearby park while they were waiting for the boys mother to get off work. Which of the following would lead the nurse to suspect that the boy is experiencing anaphylactic shock?

Accepted Answer

A)   Rapid onset of acute hypertension
B)   Rapid onset of respiratory distress
C)   Rapid onset of neurologic compensation
D)   Rapid onset of cardiac arrest

Question 15

The nurse in a rural nursing outpost has just been notified that she will be receiving a patient in hypovolemic shock due to a massive postpartum hemorrhage after her home birth. You know that the best choice for fluid replacement for this patient is what?

Accepted Answer

A)   5% albumin because it is inexpensive and is always readily available
B)   Dextran because it increases intravascular volume and counteracts coagulopathy
C)   Whatever fluid is most readily available in the clinic, due to the nature of the emergency
D)   Lactated Ringers solution because it increases volume, buffers acidosis, and is the best choice for patients with liver failure

Question 16

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?

Accepted Answer

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.

Question 17

The ICU nurse is caring for a patient in hypovolemic shock following a postpartum hemorrhage. For what serious complication of treatment should the nurse monitor the patient?

Accepted Answer

A)   Anaphylaxis
B)   Decreased oxygen consumption
C)   Abdominal compartment syndrome
D)   Decreased serum osmolality

Question 18

The nurse in the ICU is caring for a 47-year-old, obese male patient who is in shock following a motor vehicle accident. The nurse is aware that patients in shock possess excess energy requirements. What would be the main challenge in meeting this patients elevated energy requirements during prolonged rehabilitation?

Accepted Answer

A)   Loss of adipose tissue
B)   Loss of skeletal muscle
C)   Inability to convert adipose tissue to energy
D)   Inability to maintain normal body mass

Question 19

The ICU nurse is caring for a patient in neurogenic shock following an overdose of antianxiety medication. When assessing this patient, the nurse should recognize what characteristic of neurogenic shock?

Accepted Answer

A)   Hypertension
B)   Cool, moist skin
C)   Bradycardia
D)   Signs of sympathetic stimulation

Question 20

A critical care nurse is aware of similarities and differences between the treatments for different types of shock. Which of the following interventions is used in all types of shock?

Accepted Answer

A)   Aggressive hypoglycemic control
B)   Administration of hypertonic IV fluids
C)   Early provision of nutritional support
D)   Aggressive antibiotic therapy

Exam 14: Shock and Multiple Organ Dysfunction Syndrome