A patient has a spinal cord injury at T4. Vital signs include falling blood pressure with bradycardia. The nurse recognizes that the patient is experiencing:
a. a relative hypervolemia.
b. an absolute hypovolemia.
c. neurogenic shock from low blood flow.
d. neurogenic shock from massive vasodil...
NCLEX Shock, MODS fully
solved & updated(100%
accuracy)
A patient has a spinal cord injury at T4. Vital signs include falling
blood pressure with bradycardia. The nurse recognizes that the
patient is experiencing:
a. a relative hypervolemia.
b. an absolute hypovolemia.
c. neurogenic shock from low blood flow.
d. neurogenic shock from massive vasodilation. - answer d
Rationale: Neurogenic shock results in massive vasodilation without
compensation as a result of the loss of sympathetic nervous system
vasoconstrictor tone. Massive vasodilation leads to a pooling of
blood in the blood vessels, tissue hypoperfusion, and, ultimately,
impaired cellular metabolism. Clinical manifestations of neurogenic
shock are hypotension (from the massive vasodilation) and
bradycardia (from unopposed parasympathetic stimulation).
When caring for a patient in acute septic shock, what should the
nurse anticipate?
a- Infusing large amounts of IV fluids
b- Administering osmotic and/or loop diuretics
c- Administering IV diphenhydramine (Benadryl)
d- Assisting with insertion of a ventricular assist device (VAD) -
answer A- Septic shock is characterized by a decreased circulating
blood volume. Volume expansion with the administration of IV fluids
is the cornerstone of therapy. The administration of diuretics is
inappropriate. VADs are useful for cardiogenic shock not septic
shock. Diphenhydramine (Benadryl) may be used for anaphylactic
shock but would not be helpful with septic shock.
, A 78-year-old man has confusion and temperature of 104° F (40° C).
He is a diabetic with purulent drainage from his right heel. After an
infusion of 3 L of normal saline solution, his assessment findings are
BP 84/40 mm Hg; heart rate 110; respiratory rate 42 and shallow;
CO 8 L/minute; and PAWP 4 mm Hg. This patient's symptoms are
most likely indicative of:
a. sepsis.
b. septic shock.
c. multiple organ dysfunction syndrome.
d. systemic inflammatory response syndrome. - answer Correct
answer: b
Rationale: Septic shock is the presence of sepsis with hypotension
despite fluid resuscitation along with the presence of inadequate
tissue perfusion. To meet the diagnostic criteria for sepsis, the
patient's temperature must be higher than 100.9° F (38.3° C), or the
core temperature must be lower than 97.0° F (36° C). Hemodynamic
parameters for septic shock include elevated heart rate; decreased
pulse pressure, blood pressure, systemic vascular resistance,
central venous pressure, and pulmonary artery wedge pressure;
normal or elevated pulmonary vascular resistance; and decreased,
normal, or increased pulmonary artery pressure, cardiac output, and
mixed venous oxygen saturation.
Appropriate treatment modalities for the management of
cardiogenic shock include (select all that apply):
a. dobutamine to increase myocardial contractility.
b. vasopressors to increase systemic vascular resistance.
c. circulatory assist devices such as an intraaortic balloon pump. d.
corticosteroids to stabilize the cell wall in the infarcted
myocardium.
e. Trendelenburg positioning to facilitate venous return and
increase preload. - answer Correct answers: a, c
Rationale: Dobutamine (Dobutrex) is used in patients in cardiogenic
shock with severe systolic dysfunction. Dobutamine increases
myocardial contractility, decreases ventricular filling pressures,
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