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

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. 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. 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). 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. 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 6. To evaluate the effectiveness of the pantoprazole (Protonix) ordered for a patient with systemic inflammatory response syndrome (SIRS), which assessment will the nurse perform? 1. Auscultate bowel sounds. 2. Palpate for abdominal pain. 3. Ask the patient about nausea. 4. Check stools for occult blood. 7. 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? 1. 5% human albumin 2. Furosemide (Lasix) IV 3. Epinephrine (Adrenalin) drip 4. Hydrocortisone (Solu-Cortef) Test Bank - Medical-Surgical Nursing: Assessment and Management of Clinical Problems 10e 879 DIF: Cognitive Level: Apply (application) REF: 1601 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 8. The emergency department (ED) nurse receives report that a patient involved in a motor vehicle crash is being transported to the facility with an estimated arrival in 1 minute. In preparation for the patients arrival, the nurse will obtain 1. hypothermia blanket. 2. lactated Ringers solution. 3. two 14-gauge IV catheters. 4. dopamine (Intropin) infusion. 9. Which finding is the best indicator that the fluid resuscitation for a patient with hypovolemic shock has been effective? 1. Hemoglobin is within normal limits. 2. Urine output is 60 mL over the last hour. 3. Central venous pressure (CVP) is normal. 4. Mean arterial pressure (MAP) is 72 mm Hg. a. Check temperature every 2 hours. 2. Monitor breath sounds frequently. 3. Maintain patient in supine position. 4. Assess skin for flushing and itching. 10. Norepinephrine (Levophed) 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? 1. The patients central venous pressure is 3 mm Hg. 2. The patient is in sinus tachycardia at 120 beats/min. 3. The patient is receiving low dose dopamine (Intropin). 4. The patient has had no urine output since being admitted. .....................................................continued........................................................................