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You are holding a class on shock for the staff nurses at your institution. What
would you tell them about the stages of shock? - ANSWERS-In the compensation
stage, catecholamines are released.
A client with an acute myocardial infarction demonstrates signs of cardiogenic
shock. Which medications will the nurse expect to be prescribed for this client?
Select all that apply. - ANSWERS-Dopamine
Dobutamine
Nitroglycerin
Vasopressin
A confused client exhibits a blood pressure of 112/84, pulse rate of 116 beats per
minute, and respirations of 30 breaths per minute. The client's skin is cold and
clammy. The nurse next - ANSWERS-Administers oxygen by nasal cannula at 2
liters per minute
The nurse is aware that fluid replacement is a hallmark treatment for shock.
Which of the following is the crystalloid fluid that helps treat acidosis? -
ANSWERS-Lactated Ringer's
The nurse is caring for a client diagnosed with shock. During report, the nurse
reports the results of which assessments that signal early signs of the
decompensation stage? Select all that apply. - ANSWERS-Vital signs
,Skin color
Urine output
Peripheral pulses
In the treatment of shock, which of the following vasoactive drugs result in
reduced preload and afterload, reducing oxygen demand of the heart? -
ANSWERS-Nitroprusside
The health care provider prescribes a vasoactive agent for a patient in cardiogenic
shock. The nurse knows that the drug is prescribed to increase blood pressure by
vasoconstriction. Which of the following is most likely the drug that is ordered? -
ANSWERS-Levophed
The nurse assesses a patient who experienced a reaction to a bee sting. The
patient's clinical findings indicate a pre-shock condition, which is evidenced by: -
ANSWERS-Cold, clammy skin and tachycardia.
A client is admitted to the emergency department after a motorcycle accident.
Upon assessment, the client's vital signs reveal blood pressure of 80/60 mm Hg
and heart rate of 145 beats per minute. The client's skin is cool and clammy.
Which medical order for this client will the nurse complete first? - ANSWERS-
100% oxygen via a nonrebreather mask
The nurse is planning care for a client diagnosed with cardiogenic shock. Which
nursing intervention is most helpful to decrease myocardial oxygen consumption?
- ANSWERS-Maintain activity restriction to bedrest.
A nurse is caring for a client in the compensatory stage of shock. What clinical
finding would the client exhibit? - ANSWERS-compensatory respiratory alkalosis
, A confused client exhibits a systolic blood pressure of 108, heart rate of 112 beats
per minute, and respirations of 28 breaths per minute. The client's skin is cold and
clammy. The nurse assesses this shock as - ANSWERS-Compensatory
A nurse caring for a client after epidural anesthesia observes that the client is
beginning to present with dry skin and bradycardia with hypotension. What type
of shock is the nurse assessing - ANSWERS-neurogenic
The nurse caring for the patient in shock recognizes which physiologic responses
that are common to all shock states? (Select all that apply.) - ANSWERS-Activation
of the inflammatory response
Hypoperfusion of tissues
Must produce energy through anaerobic metabolism
The nurse is caring for a client who develops hypotension, declining mental
status, and severely decreased urinary output. Which intravenous fluid will the
nurse expect to be prescribed for this client? - ANSWERS-Lactated Ringer's
solution
The nurse is aware that fluid replacement is a hallmark treatment for shock.
Which of the following is the crystalloid fluid that helps treat acidosis? -
ANSWERS-Lactated Ringer's
A client admitted for outpatient surgery has been NPO for several hours. The
client, sitting in bed, experiences a transient neurogenic shock following insertion
of an intravenous catheter. The nurse first - ANSWERS-Lays the client flat with the
feet elevated