Exam (elaborations)
Capstone Final Detailed Questions and Expert Answers
- Course
- Capstone: Shock
- Institution
- University Of California - San Francisco
Capstone Final Detailed Questions and Expert Answers
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Capstone Final Detailed Questions and ExpertAnswers
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 H - ANS ANS: A
Furosemide will lower the filling pressures and renal perfusion further for the
patient with septic shock. The
other orders are appropriate
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?
a. Infuse normal saline at 250 mL/hr.
b. Keep head of bed elevated to 30 degrees.
c. Hold nitroprusside (Nipride) if systolic BP <90 mm Hg.
,d. Titrate dobutamine (Dobutrex) to keep systolic BP >90 mm Hg - ANS 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
The health care provider orders the following interventions for a 67-kg patient
who has septic shock with a BP of 70/42 mm Hg and oxygen 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. Obtain blood and urine cultures.
b. Give vancomycin (Vancocin) 1 g IV
c. Start norepinephrine (Levophed) 0.5 mcg/min.
d. Infuse normal saline 2000 mL over 30 minutes.
e. Titrate oxygen administration to keep O2 saturation >95%. - ANS E, D, C, A, B
The initial action for this hypotensive and hypoxemic patient should be to improve
the oxygen saturation,
followed by infusion of IV fluids and vasopressors to improve perfusion. Cultures
should be obtained before administration of antibiotics.
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?
a. Inspiratory crackles.
,b. Cool, clammy extremities.
c. Apical heart rate 45 beats/min.
d. Temperature 101.2 F (38.4 C). - ANS ANS: C
Neurogenic shock is characterized by hypotension and bradycardia. The other
findings would be more
consistent with other types of shock.
Which preventive actions by the nurse will help limit the development of systemic
inflammatory response syndrome (SIRS) in patients admitted to the hospital
(select all that apply)?
a. Use aseptic technique when caring for invasive lines or devices.
b. Ambulate postoperative patients as soon as possible after surgery.
c. Remove indwelling urinary catheters as soon as possible after surgery.
d. Advocate for parenteral nutrition for patients who cannot take oral feedings.
e. Administer prescribed antibiotics within 1 hour for patients with possible sepsis
- ANS ANS: A, B, C, E
Because sepsis is the most frequent etiology for SIRS, measures to avoid infection
such as removing
indwelling urinary catheters as soon as possible, use of aseptic technique, and
early ambulation should be
included in the plan of care. Adequate nutrition is important in preventing SIRS.
Enteral, rather than parenteral, nutrition is preferred when patients are unable to
take oral feedings because enteral nutrition helps maintain the integrity of the
, intestine, thus decreasing infection risk. Antibiotics should be administered within
1 hour after being prescribed to decrease the risk of sepsis progressing to SIRS
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?
a. Increase the rate for the dopamine (Intropin) infusion.
b. Decrease the rate for the nitroglycerin (Tridil) infusion.
c. Increase the rate for the sodium nitroprusside (Nipride) infusion.
d. Decrease the rate for the 5% dextrose in normal saline (D5/.9 NS) infusion - ANS
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
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 (select all that apply)?
a. Prepare to administer atropine IV.
b. Obtain baseline body temperature.
c. Infuse large volumes of lactated Ringers solution.
d. Provide high-flow oxygen (100%) by non-rebreather mask.
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