CHAPTER 34: SHOCK, SEPSIS, AND MULTIPLE-ORGAN DYSFUNCTION SYNDROME {Urden: Critical Care Nursing, 9th Edition}

C HAPTER 34: S HOCK , S EPSIS , AND
M ULTIPLE -O RGAN D YSFUNCTION
S YNDROME
Urden: Critical Care Nursing, 9th Edition



MULTIPLE CHOICE


1. A patient is being admitted from the emergency department (ED) with
cardiogenic shock secondary to unstable angina unr esponsive to
medications. The patient was intubated and ventilated in the ED. Which
intervention should the nurse prepare to initiate when the practitioner
arrives in the unit?
a. Administration of sodium bicarbonate
b. Rapid infusion of crystalloids
c. Insertion o f an intraaortic balloon pump (IABP)
d. Insertion of dial ysis catheters for continuous renal replacement
therapy (CRRT)



ANS: C



Mechanical circulatory assist devices are used if adequate tissue
perfusion cannot be immediatel y restored. Options include an
intraaortic balloon pump (IABP), a percutaneous ventricular assist
device (VAD), or an extracorporeal membrane ox ygenator. The IABP is
used to decrease m yocardial workload by improving m yocardial suppl y
and decreasing m yocardial demand. It achieves this goal by improving
coronary artery perfusion and reducing left ventricular afterload.

, Sodium bicarbonate, fluids, and dial ysis are not indicated in this
situation.



PTS: 1 DIF: Cognitive Level: Appl ying REF: p. 810
OBJ: Nursing Process Step: Intervention TOP:
Shock MSC: NC LEX: Physiologic Integrit y



2. A patient is being admitted with cardiogenic shock secondary to acute
heart failure. In addition to a diuretic, which medication would the nurse
anticipate the practitioner ordering for the patient?
a. Epinephrine
b. Nitroprusside
c. Dobutamine
d. Nitrogl ycerine



ANS: A



Inotropic agents are used to increase contractilit y and maintain
adequate blood pressure and tissue perfusion. Dobutamine is the
inotrope of choice. A vasopressor, preferabl y norepinephrine (not
Epinephrine), may be necessary to maintain blood pressure when
hypotension is severe. Diuretics may be used for preload reduction.
Vasodilating agents (Nitrogl ycerine and Nitroprusside) are used for
preload and afterload reduction onl y in specific situations in
conjunction with an inotrope or when the patient is no longer in shock.



PTS: 1 DIF: Cognitive Level: Appl ying REF: p. 810
OBJ: Nursing Process Step: Assessment TOP: Shock
MSC: NC LEX: Physiologic Integrit y

, 3. The nurse is caring for a patient who what just a dmitted with septic shock.
The nurse knows that certain interventions should be completed within 3
hours of time of presentation. Which intervention would be a priorit y for
the nurse to implement upon receipt of a practitioner’s order?
a. Administer fresh fro zen plasma
b. Obtain a serum lactate level
c. Administer epinephrine
d. Measure central venous pressure



ANS: B



According to the Surviving Sepsis Campaign Bundles, the following
interventions should be completed within 3 hours of time of
presentation.

1. Measure lactate level.
2. Obtain blood cultures prior to administration of antibiotics.
3. Administer broad spectrum antibiotics.
4. Administer 30 mL/kg crystalloid for hypotension or lactate ≥4
mmol/L.



PTS: 1 DIF: Cognitive Level: Appl ying REF: p. 821 |
Box 34-17 OBJ: Nursing Process Step: Intervention
TOP: Shock MSC: NC LEX: Physiologic Integrit y



4. The nurse is caring for a patie nt with systemic inflammatory response
s yndrome (S IRS) due to pneumonia. What is S IRS due to infection called?
a. Infectivit y
b. Anaphylaxis
c. Sepsis
d. Acute respiratory distress syndrome (ARDS)