Question 1

A patient has been admitted with septic shock related to tissue necrosis.The nurse knows the initial goal for medical management for this patient is which intervention?

Accepted Answer

A)   Limiting fluids to minimize the possibility of heart failure
B)   Finding and eradicating the cause of infection
C)   Discontinuing invasive monitoring as a possible cause of sepsis
D)   Administering vasodilator substances to increase blood flow to vital organs B

Question 2

A patient is being admitted from the emergency department (ED)with cardiogenic shock secondary to unstable angina unresponsive to medications.The patient was intubated and ventilated in the ED.Which intervention should the nurse prepare to initiate when the practitioner arrives in the unit?

Accepted Answer

A)   Administration of sodium bicarbonate
B)   Rapid infusion of crystalloids
C)   Insertion of an intraaortic balloon pump (IABP) 
D)   Insertion of dialysis catheters for continuous renal replacement therapy (CRRT)  C

Question 3

The nurse is caring for a patient in shock with an elevated lactate level.Which order should the nurse question in the management of this patient?

Accepted Answer

A)   Start an insulin drip for blood sugar greater than 180 mg/dL.
B)   Administer sodium bicarbonate to keep arterial pH greater than 7.20.
C)   Start a norepinephrine drip to keep mean arterial blood pressure greater than 65 mm Hg.
D)   Administer crystalloid fluids. B

Question 4

A patient has been admitted with anaphylactic shock due to an unknown allergen.The nurse understands that the patient is probably having an immunoglobulin E (IgE)-mediated response as a result of what physiologic mechanism?

Accepted Answer

A)   Direct activation of mast cells and basophils
B)   Nonimmunologic stimulation of biochemical mediators
C)   Repeat exposure to an antigen in the presence of preformed IgE antibodies
D)   Activation of the systemic inflammatory response

Question 5

The nurse is caring for a patient who what just admitted with septic shock.The nurse knows that certain interventions should be completed within 3 hours of time of presentation.Which intervention would be a priority for the nurse to implement upon receipt of a practitioner's order?

Accepted Answer

A)   Administer fresh frozen plasma
B)   Obtain a serum lactate level
C)   Administer epinephrine
D)   Measure central venous pressure

Question 6

A patient is admitted after she develops disseminated intravascular coagulation (DIC)after a vaginal delivery.Which laboratory value would the nurse expect to note to support this diagnosis?

Accepted Answer

A)   Decreased fibrinogen degradation products
B)   Decreased D-dimer concentrations
C)   Decreased platelet counts
D)   Increased serum glucose levels

Question 7

The nurse is caring for a patient with multiple-organ dysfunction syndrome (MODS).The nurse understands that earlier nutritional support is critical for the patient to prevent profound weight loss.Why does this occur in patient MODS?

Accepted Answer

A)   Patient experiences hypometabolism.
B)   Patient experiences hypermetabolism.
C)   Patient experiences anorexia.
D)   Patient has gut dysfunction.

Question 8

A patient has been admitted with hypovolemic shock due to blood loss.Which finding would the nurse expect to note to support this diagnosis?

Accepted Answer

A)   Distended neck veins
B)   Decreased level of consciousness
C)   Bounding radial and pedal pulses
D)   Widening pulse pressure

Question 9

A patient is admitted with a brain and spinal cord injury secondary to a motor vehicle crash.The nurse is monitoring the patient for signs of neurogenic shock.Clinical findings in neurogenic shock are related to which pathophysiologic process?

Accepted Answer

A)   Loss of sympathetic nervous system innervation
B)   Parasympathetic nervous system stimulation
C)   Injury to the hypothalamus
D)   Focal injury to cerebral hemispheres

Question 10

A patient with a known penicillin allergy develops anaphylactic shock after a dose of ampicillin was given in error.Which medication would the nurse administer first?

Accepted Answer

A)   Methylprednisolone
B)   Gentamicin
C)   Atropine
D)   Epinephrine

Question 11

A patient has developed septic shock.The nurse knows that the patient is at risk for gastrointestinal dysfunction.What happens to the gastrointestinal tract in the patient with septic shock?

Accepted Answer

A)   Anorexia leads to loss of gastric enzymes
B)   Lack of food ingestion leads to intestinal hypomotility
C)   Hypoperfusion results in loss of gut barrier function
D)   Low cardiac output causes decreased hydrochloric acid secretion

Question 12

The nurse is caring for a patient in septic shock due secondary to pneumonia.The nurse knows that evidence-based guidelines for the treatment of septic shock include which interventions?

Accepted Answer

A)   Administer norepinephrine to maintain mean arterial pressure of 65 mm Hg.
B)   Administer low-dose dopamine to maintain urine output greater than 30 mL/h.
C)   Start enteral nutrition within the first 48 hours after diagnosis of septic shock.
D)   Administer 30 mL/kg crystalloid for hypotension or lactate greater than or equal to 4 mmol/L.
E)   Perform an adrenocorticotropic hormone (ACTH)  stimulation test to identify patients who need hydrocortisone

Question 13

A nursing instructor is discussing the difference between primary and secondary multiple-organ dysfunction syndrome (MODS)with a nursing student.Which statement indicates the student understood the information?

Accepted Answer

A)   Primary MODS is the result of inflammation in organs not involved in the initial insult.
B)   Primary MODS is the result of a direct organ injury.
C)   Primary MODS is due to a disorganization of the inflammatory immune system response.
D)   Primary MODS is due to disruption of the coagulation system.

Question 14

A patient has developed septic shock.The nurse knows that the clinical manifestations of ischemic hepatitis show up 1 to 2 days after the insult.Which finding would the nurse expect to note to support this diagnosis?

Accepted Answer

A)   Elevated serum creatinine
B)   Decreased bilirubin
C)   Jaundice
D)   Decreased serum transaminase

Question 15

A patient has been admitted with septic shock due to urinary sepsis.The practitioner inserts a pulmonary artery (PA)catheter.Which hemodynamic value would the nurse expect to note to support this diagnosis?

Accepted Answer

A)   Cardiac output (CO)  of 8 L/min
B)   Right atrial pressure (RAP)  of 17 mm Hg
C)   Pulmonary artery occlusion pressure (PAOP)  of 23 mm Hg
D)   Systemic vascular resistance (SVR)  of 1100 dyne/s/cm-5

Question 16

The nurse is caring for a patient with sepsis due to necrotic tissue.The nurse knows that necrotic tissue can stimulate the inflammatory immune response.Which biochemical mediator is secreted in response to endotoxin or tissue injury?

Accepted Answer

A)   Arachidonic acid metabolite
B)   Platelet-activating factor
C)   Tumor necrosis factor
D)   Interleukin

Question 17

A patient has been admitted with anaphylactic shock due to an unknown allergen.The nurse understands that the decrease in the patient's cardiac output is the result of which mechanism?

Accepted Answer

A)   Peripheral vasodilation
B)   Increased venous return
C)   Increased alveolar ventilation
D)   Decreased myocardial contractility

Question 18

The nurse is caring for a patient in cardiogenic shock.The nurse recognizes that the patient's signs and symptoms are the result of what problem?

Accepted Answer

A)   Inability of the heart to pump blood forward
B)   Loss of circulating volume and subsequent decreased venous return
C)   Disruption of the conduction system when reentry phenomenon occurs
D)   Suppression of the sympathetic nervous system

Question 19

A patient is being admitted with cardiogenic shock secondary to acute heart failure.In addition to a diuretic,which medication would the nurse anticipate the practitioner ordering for the patient?

Accepted Answer

A)   Epinephrine
B)   Nitroprusside
C)   Dobutamine
D)   Nitroglycerine

Question 20

The nurse is caring for a patient in cardiogenic shock.Which hemodynamic parameters would the nurse expect to note to support this diagnosis?

Accepted Answer

A)   Increased right atrial pressure
B)   Decreased pulmonary artery wedge pressure
C)   Increased cardiac output
D)   Decreased cardiac index

Exam 34: Shock,sepsis,and Multiple-Organ Dysfunction Syndrome