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NCA 623 Mod 9 Shock Exam Study Guide
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NCA 623 Mod 9 Shock ExamStudy Guide
Increased risks of fatal reactions from anaphylactic shock include all of the following
EXCEPT:
-delay in administering antihistamines.
-delay in obtaining a Lactate level.
-delay in administering epinephrine.
-delay in maintaining airway. - Answer -delay in obtaining a Lactate level.
A 54-year-old female is brought in by emergency medical services (EMS) with
complaints of dizziness and near-syncope. Her review of systems is positive for nausea
but no other symptoms. She has a known history of COR Pulmonale and Heart Failure
(EF 38 %), but denies any new or changed medication doses. Physical exam reveals 3 +
pitting edema to both lower extremities, jugular vein distension (JVD), S1 S2, sinus
tachycardia on telemetry, and crackles on the pulmonary exam. Cool and mottled
extremities are present. Her abdomen is soft, non-tender, and non-distended.
Peripheral pulses are thready in all extremities and equal bilaterally. Vital signs are: B/P
78/64 (68) mmHg, HR 138bpm, RR 24bpm, O2 Sat 91 % on room air, Temp 97.6F.
Hemodynamic parameters are notable for low CO/CI, high CVP, high PCWP, high SVR,
and low SVO2. What type of shock is this patient most likely experiencing?
Septic
Obstructive
Cardiogenic
Hypo - Answer Cardiogenic
As the AGACNP caring for a patient with suspected sepsis presenting with hypotension
and pyrexia, you understand which of the following are important to achieve during the
first 1-3 hours of care according to recommended sepsis bundles? Select all that apply:
-Obtain blood cultures
-Obtain lactic acid level
-Initiate Proton Pump Inhibitor (PPI)
-Initiate broad-spectrum antimicrobial therapy.
,-Obtain PFT
-Initiate vasopressor therapy if the patient remains hypotensive despite fluid
resuscitation
-Initiate fluid resuscitation with 30ml/kg of ideal body weight with crystalloid fluid -
Answer -Obtain blood cultures
-Obtain lactic acid level
-Initiate broad-spectrum antimicrobial therapy.
-Initiate vasopressor therapy if the patient remains hypotensive despite fluid
resuscitation
-Initiate fluid resuscitation with 30ml/kg of ideal body weight with crystalloid fluid
A 54-year-old male with a PMH lung transplant presents to the emergency department
with a complaint of increased O2 requirement (on 2L NC at baseline, now requiring 3L
NC) and productive cough. The patient's vital signs are 100.0F, HR 108bpm, BP 90/50
mmHg, O2 sat 94% and WBC 12K. The physical exam reveals crackles in the right lower
lobe, her abdomen is soft/round/non-tender, and she has good perfusion in all
extremities. What would be the next appropriate steps for treating this patient?
-Administer crystalloid infusion, obtain infectious workup (blood, urine, sputum
cultures, and CXR), and start empiric antibiotics.
-Start epinephrine 0.01mg/kg, and start empiric antibiotics.
-Initiate 3 grams of Methylprednisolone, obtain a Computed Tomography (CT) chest, and
start empiric antibiotics.
-Obtain Computed Tomography (CT) of the chest, and administer crystalloid infusion. -
Answer -Administer crystalloid infusion, obtain infectious workup (blood, urine, sputum
cultures, and CXR), and start empiric antibiotics.
All of the following are true of a passive leg raise (PLR) except?
-PLR may serve as a therapeutic intervention.
-PLR tests for volume responsiveness.
-PLR can be performed on all patients.
-PLR produces a cardiac output comparable to a fluid bolus. - Answer -PLR can be
performed on all patients.
When assessing a patient's volume status, the AGACNP knows that all of the following
are appropriate tools for assessment, EXCEPT:
-Passive leg raise
, -Urinalysis
-Fluid bolus challenge
-IVC measurement with bedside ultrasound. - Answer -Urinalysis
Interventions that improve cardiac output in hemodynamically compromised patients
include all EXCEPT:
-performing a passive leg raise.
-administering a fluid bolus of 500 mls.
-increasing systemic vascular resistance.
-administration of inotropes. - Answer -increasing systemic vascular resistance.
During states of shock, the body activates compensatory mechanisms in an effort to
maintain perfusion. Which of the following individuals is at greatest risk for failure to
respond to shock states?
-a 58 YOF with a history of stroke.
-all of the individuals are equally at risk.
-a 78 YOM admitted with septic shock.
-a 16 YOF with history of stable multiple myeloma. - Answer -a 78 YOM admitted with
septic shock.
The first system to show signs of dysfunction in systemic inflammatory response
syndrome and multi-organ dysfunction syndrome is the:
-respiratory system.
-neurologic system,
-cardiovascular disease.
-renal system. - Answer -respiratory system.
A patient in the ICU with a past medical history of congestive heart failure, HTN, and DM
admitted for acute hypoxic respiratory failure s/t MRSA PNA has a central venous line in
place being used for medication administration and CVP monitoring. The CVP is
currently 18mmHG. The patient's sCr is 0.5 on BMP, and ABG is 7.34/46/70/23 on 5L NC.
As the AGACNP, what would be your next best intervention?
-Continue Q1 hour monitoring of CVP and Q6 hour ABGs
-Administer 2L Lactated Ringers fluid bolus
-Prepare for endotracheal intubation
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