CHAPTER 66: SHOCK, SEPSIS, AND
MULTIPLE ORGAN DYSFUNCTION
SYNDROME LEWIS: MEDICAL-
SURGICAL NURSING, 10TH EDITION
QUESTIONS AND ANSWERS WITH
SOLUTIONS 2024
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. - ANSWER ANS: A
Furosemide will lower the filling pressures and renal perfusion further for the patient with septic shock.
Patients in septic shock require large amounts of fluid replacement. If the patient remains hypotensive
after initial volume resuscitation with minimally 30 mL/kg, vasopressors such as norepinephrine may be
added. IV corticosteroids may be considered for patients in septic shock who cannot maintain an
adequate BP with vasopressor therapy despite fluid resuscitation.
DIF: Cognitive Level: Apply (application)
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 ANS: B
The patient's elevated PAWP indicates volume excess in relation to cardiac pumping ability, consistent
with cardiogenic shock. A saline infusion at 250 mL/hr will exacerbate the volume excess. The other
actions will help to improve cardiac output, which should lower the PAWP and may raise the BP.
, DIF: Cognitive Level: Apply (application)
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 c. Cool, clammy extremities
b. Heart rate 45 beats/min d. Temperature 101.2°F (38.4°C) - ANSWER ANS: B
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)
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. - ANSWER 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)
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 . c. norepinephrine .
b. nitroglycerin . d. sodium nitroprusside . - ANSWER ANS: C
When fluid resuscitation is unsuccessful, vasopressor drugs are given to increase the systemic vascular
resistance (SVR) and blood pressure and improve tissue perfusion. Furosemide would cause diuresis and
further decrease the BP. Nitroglycerin would decrease the preload and further drop cardiac output and
BP. Nitroprusside is an arterial vasodilator and would further decrease SVR.
MULTIPLE ORGAN DYSFUNCTION
SYNDROME LEWIS: MEDICAL-
SURGICAL NURSING, 10TH EDITION
QUESTIONS AND ANSWERS WITH
SOLUTIONS 2024
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. - ANSWER ANS: A
Furosemide will lower the filling pressures and renal perfusion further for the patient with septic shock.
Patients in septic shock require large amounts of fluid replacement. If the patient remains hypotensive
after initial volume resuscitation with minimally 30 mL/kg, vasopressors such as norepinephrine may be
added. IV corticosteroids may be considered for patients in septic shock who cannot maintain an
adequate BP with vasopressor therapy despite fluid resuscitation.
DIF: Cognitive Level: Apply (application)
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 ANS: B
The patient's elevated PAWP indicates volume excess in relation to cardiac pumping ability, consistent
with cardiogenic shock. A saline infusion at 250 mL/hr will exacerbate the volume excess. The other
actions will help to improve cardiac output, which should lower the PAWP and may raise the BP.
, DIF: Cognitive Level: Apply (application)
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 c. Cool, clammy extremities
b. Heart rate 45 beats/min d. Temperature 101.2°F (38.4°C) - ANSWER ANS: B
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)
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. - ANSWER 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)
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 . c. norepinephrine .
b. nitroglycerin . d. sodium nitroprusside . - ANSWER ANS: C
When fluid resuscitation is unsuccessful, vasopressor drugs are given to increase the systemic vascular
resistance (SVR) and blood pressure and improve tissue perfusion. Furosemide would cause diuresis and
further decrease the BP. Nitroglycerin would decrease the preload and further drop cardiac output and
BP. Nitroprusside is an arterial vasodilator and would further decrease SVR.
