Deck 66: Shock, sepsis, and Multiple Organ Dysfunction Syndrome

Question 1

A nurse is assessing a patient who is receiving a nitroprusside infusion to treat cardiogenic shock. Which finding indicates that the drug is effective?

A)No new heart murmurs
B)Decreased troponin level
C)Warm, pink, and dry skin
D)Blood pressure of 92/40 mm Hg

Answer 1

Warm, pink, and dry skin

Question 2

The nurse is caring for a patient who has septic shock. Which assessment finding is most important for the nurse to report to the health care provider?

A)Skin cool and clammy
B)Heart rate of 118 beats/min
C)Blood pressure of 92/56 mm Hg
D)O2 saturation of 93% on room air

Answer 2

Skin cool and clammy

Question 3

A nurse is caring for a patient whose hemodynamic monitoring indicates a blood pressure of 92/54 mm Hg,a pulse of 64 beats/min,and an elevated pulmonary artery wedge pressure (PAWP). Which intervention ordered by the health care provider should the nurse question?

A)Elevate head of bed to 30 degrees.
B)Infuse normal saline at 250 mL/hr.
C)Hold nitroprusside if systolic BP is less than 90 mm Hg.
D)Titrate dobutamine to keep systolic BP is greater than 90 mm Hg.

Answer 3

Infuse normal saline at 250 mL/hr.

Question 4

A 78-kg patient with septic shock has a pulse rate of 120 beats/min with low central venous pressure and pulmonary artery wedge pressure. Urine output has been 30 mL/hr for the past 3 hours. Which order by the health care provider should the nurse question?

A)Administer furosemide (Lasix) 40 mg IV.
B)Increase normal saline infusion to 250 mL/hr.
C)Give hydrocortisone (Solu-Cortef) 100 mg IV.
D)Titrate norepinephrine to keep systolic blood pressure (BP) above 90 mm Hg.

Question 5

During change-of-shift report,the nurse is told that a patient has been admitted with dehydration and hypotension after having vomiting and diarrhea for 4 days. Which finding is most important for the nurse to report to the health care provider?

A)New onset of confusion
B)Decreased bowel sounds
C)Heart rate 112 beats/min
D)Pale, cool, and dry extremities

Question 6

Which assessment information is most important for the nurse to obtain when evaluating whether treatment of a patient with anaphylactic shock has been effective?

A)Heart rate
B)Orientation
C)Blood pressure
D)Oxygen saturation

Question 7

Which intervention will the nurse include in the plan of care for a patient who has cardiogenic shock?

A)Check temperature every 2 hours.
B)Monitor breath sounds frequently.
C)Maintain patient in supine position.
D)Assess skin for flushing and itching.

Question 8

Norepinephrine has been prescribed for a patient who was admitted with dehydration and hypotension. Which patient data indicate that the nurse should consult with the health care provider before starting the norepinephrine?

A)The patient is receiving low dose dopamine.
B)The patient's central venous pressure is 3 mm Hg.
C)The patient is in sinus tachycardia at 120 beats/min.
D)The patient has had no urine output since being admitted.

Question 9

A patient with septic shock has a BP of 70/46 mm Hg,pulse of 136 beats/min,respirations of 32 breaths/min,temperature of 104°F,and blood glucose of 246 mg/dL. Which intervention ordered by the health care provider should the nurse implement first?

A)Give normal saline IV at 500 mL/hr.
B)Give acetaminophen (Tylenol) 650 mg rectally.
C)Start insulin drip to maintain blood glucose at 110 to 150 mg/dL.
D)Start norepinephrine to keep systolic blood pressure above 90 mm Hg.

Question 10

The emergency department (ED)nurse receives report that a seriously injured patient involved in a motor vehicle crash is being transported to the facility with an estimated arrival in 5 minutes. In preparation for the patient's arrival,the nurse will obtain

A)a dopamine infusion.
B)a hypothermia blanket.
C)lactated Ringer's solution.
D)two 16-gauge IV catheters.

Question 11

To evaluate the effectiveness of the pantoprazole (Protonix)ordered for a patient with systemic inflammatory response syndrome (SIRS),which assessment will the nurse perform?

A)Auscultate bowel sounds.
B)Ask the patient about nausea.
C)Check stools for occult blood.
D)Palpate for abdominal tenderness.

Question 12

A patient who has been involved in a motor vehicle crash arrives in the emergency department (ED)with cool,clammy skin; tachycardia; and hypotension. Which intervention ordered by the health care provider should the nurse implement first?

A)Insert two large-bore IV catheters.
B)Provide O2 at 100% per non-rebreather mask.
C)Draw blood to type and crossmatch for transfusions.
D)Initiate continuous electrocardiogram (ECG) monitoring.

Question 13

A patient with cardiogenic shock has the following vital signs: BP 102/50,pulse 128,respirations 28. The pulmonary artery wedge pressure (PAWP)is increased,and cardiac output is low. The nurse will anticipate an order for which medication?

A)5% albumin infusion
B)furosemide (Lasix) IV
C)epinephrine (Adrenalin) drip
D)hydrocortisone (Solu-Cortef)

Question 14

A patient with massive trauma and possible spinal cord injury is admitted to the emergency department (ED). Which assessment finding by the nurse will help confirm a diagnosis of neurogenic shock?

A)Inspiratory crackles
B)Heart rate 45 beats/min
C)Cool, clammy extremities
D)Temperature 101.2°F (38.4°C)

Question 15

When the nurse educator is evaluating the skills of a new registered nurse (RN)caring for patients experiencing shock,which action by the new RN indicates a need for more education?

A)Placing the pulse oximeter on the ear for a patient with septic shock
B)Keeping the head of the bed flat for a patient with hypovolemic shock
C)Maintaining a cool room temperature for a patient with neurogenic shock
D)Increasing the nitroprusside infusion rate for a patient with a very high SVR

Question 16

An older patient with cardiogenic shock is cool and clammy. Hemodynamic monitoring indicates a high systemic vascular resistance (SVR). Which intervention should the nurse anticipate?

A)Increase the rate for the dopamine infusion.
B)Decrease the rate for the nitroglycerin infusion.
C)Increase the rate for the sodium nitroprusside infusion.
D)Decrease the rate for the 5% dextrose in normal saline (D5/.9 NS) infusion.

Question 17

Which data collected by the nurse caring for a patient who has cardiogenic shock indicate that the patient may be developing multiple organ dysfunction syndrome (MODS)?

A)The patient's serum creatinine level is elevated.
B)The patient complains of intermittent chest pressure.
C)The patient's extremities are cool and pulses are weak.
D)The patient has bilateral crackles throughout lung fields.

Question 18

A patient is admitted to the emergency department (ED)for shock of unknown etiology. The first action by the nurse should be to

A)obtain the blood pressure.
B)check the level of orientation.
C)administer supplemental oxygen.
D)obtain a 12-lead electrocardiogram.

Question 19

After receiving 2 L of normal saline,the central venous pressure for a patient who has septic shock is 10 mm Hg,but the blood pressure is still 82/40 mm Hg. The nurse will anticipate an order for

A)furosemide .
B)nitroglycerin .
C)norepinephrine .
D)sodium nitroprusside .

Question 20

Which finding is the best indicator that the fluid resuscitation for a 90-kg patient with hypovolemic shock has been effective?

A)Hemoglobin is within normal limits.
B)Urine output is 65 mL over the past hour.
C)Central venous pressure (CVP) is normal.
D)Mean arterial pressure (MAP) is 72 mm Hg.

Question 21

A patient with suspected neurogenic shock after a diving accident has arrived in the emergency department. A cervical collar is in place. Which actions should the nurse take ?

A)Prepare to administer atropine IV.
B)Obtain baseline body temperature.
C)Infuse large volumes of lactated Ringer's solution.
D)Provide high-flow O2 (100%) by nonrebreather mask.
E)Prepare for emergent intubation and mechanical ventilation.

Question 22

The following interventions are ordered by the health care provider for a patient who has respiratory distress and syncope after eating strawberries. Which will the nurse complete first?

A)Give epinephrine.
B)Administer diphenhydramine.
C)Start continuous ECG monitoring.
D)Draw blood for complete blood count (CBC)

Question 23

Which preventive actions by the nurse will help limit the development of systemic inflammatory response syndrome (SIRS)in patients admitted to the hospital ?

A)Ambulate postoperative patients as soon as possible after surgery.
B)Use aseptic technique when manipulating invasive lines or devices.
C)Remove indwelling urinary catheters as soon as possible after surgery.
D)Administer prescribed antibiotics within 1 hour for patients with possible sepsis.
E)Advocate for parenteral nutrition for patients who cannot take in adequate calories.

Question 24

After reviewing the information shown in the accompanying figure for a patient with pneumonia and sepsis,which information is most important to report to the health care provider?

A)Temperature and IV site appearance
B)Oxygen saturation and breath sounds
C)Platelet count and presence of petechiae
D)Blood pressure, pulse rate, respiratory rate.

Question 25

Which finding about a patient who is receiving vasopressin to treat septic shock indicates an immediate need for the nurse to report the finding to the health care provider?

A)The patient's urine output is 18 mL/hr.
B)The patient is complaining of chest pain.
C)The patient's peripheral pulses are weak.
D)The patient's heart rate is 110 beats/minute.

Question 26

A 198-lb patient is to receive a dobutamine infusion at 5 mcg/kg/min. The label on the infusion bag states: dobutamine 250 mg in 250 mL of normal saline. When setting the infusion pump,the nurse will set the infusion rate at how many milliliters per hour?

Question 27

After change-of-shift report in the progressive care unit,who should the nurse care for first?

A)Patient who had an inferior myocardial infarction 2 days ago and has crackles in the lung bases
B)Patient with suspected urosepsis who has new orders for urine and blood cultures and antibiotics
C)Patient who had a T5 spinal cord injury 1 week ago and currently has a heart rate of 54 beats/minute
D)Patient admitted with anaphylaxis 3 hours ago who now has clear lung sounds and a blood pressure of 108/58 mm Hg

Question 28

The health care provider orders the following interventions for a 67-kg patient who has septic shock with a blood pressure of 70/42 mm Hg and O? saturation of 90% on room air. In which order will the nurse implement the actions? (Put a comma and a space between each answer choice [A,B,C,D,E].)

A)Give vancomycin 1 g IV.
B)Obtain blood and urine cultures
C)Start norepinephrine 0.5 mcg/min.
D)Infuse normal saline 2000 mL over 30 minutes.
E)Titrate oxygen administration to keep O? saturation above 95%.

Question 29

A patient who has neurogenic shock is receiving a phenylephrine infusion through a right forearm IV. Which assessment finding obtained by the nurse indicates a need for immediate action?

A)The patient's heart rate is 58 beats/min.
B)The patient's extremities are warm and dry.
C)The patient's IV infusion site is cool and pale.
D)The patient's urine output is 28 mL over the past hour.