Exam (elaborations)

Medical-Surgical Nursing: Assessment and Management of Clinical Problems 10e 878

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Course
RNSG 1538 (RNSG1538)

Institution
Del Mar College

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Uploaded on September 25, 2023
Number of pages 13
Written in 2023/2024
Type Exam (elaborations)
Contains Questions & answers

sepsissirshelp shock and multiple organ dysfun
test bank medical surgical nursing assessment a

Institution
Del Mar College
Course
RNSG 1538 (RNSG1538)

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Chapter 66: Shock, Sepsis, and Multiple Organ
Dysfunction Syndrome Test Bank
MULTIPLE CHOICE

1. A 78-kg patient with septic shock has a urine output of 30 mL/hr for the past 3
hours. The pulse rate is 120/minute and the central venous pressure and pulmonary
artery wedge pressure are low. Which order by the health care provider will the
nurse question?

a. Give PRN furosemide (Lasix) 40 mg IV.
b. Increase normal saline infusion to 250 mL/hr.
c. Administer hydrocortisone (Solu-Cortef) 100 mg IV.
d. Titrate norepinephrine (Levophed) to keep systolic BP >90 mm Hg.

ANS: A

Furosemide will lower the filling pressures and renal perfusion further for the patient
with septic shock. The other orders are appropriate.

DIF: Cognitive Level: Apply (application) REF: 1596
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

2. A nurse is caring for a patient with shock of unknown etiology whose
hemodynamic monitoring indicates BP 92/54, pulse 64, and an elevated pulmonary
artery wedge pressure. Which collaborative intervention ordered by the health care
provider should the nurse question?

1. Infuse normal saline at 250 mL/hr.
2. Keep head of bed elevated to 30 degrees.
3. Hold nitroprusside (Nipride) if systolic BP <90 mm Hg.
4. Titrate dobutamine (Dobutrex) to keep systolic BP >90 mm Hg.

ANS: A

The patients elevated pulmonary artery wedge pressure indicates volume excess. A
saline infusion at 250 mL/hr will exacerbate the volume excess. The other actions
are appropriate for the patient.

DIF: Cognitive Level: Apply (application) REF: 1589
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

3. A 19-year-old 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?

Test Bank - Medical-Surgical Nursing: Assessment and Management of Clinical Problems 10e
877

, 1. Inspiratory crackles.
2. Cool, clammy extremities.
3. Apical heart rate 45 beats/min.
4. Temperature 101.2 F (38.4 C).

ANS: C

Neurogenic shock is characterized by hypotension and bradycardia. The other
findings would be more consistent with other types of shock.

DIF: Cognitive Level: Understand (comprehension) REF: 1590

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

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

1. Increase the rate for the dopamine (Intropin) infusion.
2. Decrease the rate for the nitroglycerin (Tridil) infusion.
3. Increase the rate for the sodium nitroprusside (Nipride) infusion.
4. Decrease the rate for the 5% dextrose in normal saline (D5/.9 NS) infusion.

ANS: C

Nitroprusside is an arterial vasodilator and will decrease the SVR and afterload,
which will improve cardiac output. Changes in the D5/.9 NS and nitroglycerin
infusions will not directly decrease SVR. Increasing the dopamine will tend to
increase SVR.

DIF: Cognitive Level: Apply (application) REF: 1600
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

5. 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

1. nitroglycerine (Tridil).
2. norepinephrine (Levophed).
3. sodium nitroprusside (Nipride).
4. methylprednisolone (Solu-Medrol).

Test Bank - Medical-Surgical Nursing: Assessment and Management of Clinical Problems 10e
878

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Exam (elaborations)

Medical-Surgical Nursing: Assessment and Management of Clinical Problems 10e 878

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