Chapter 39: Care of Patients with Shock

Chapter 39: Care of Patients with Shock

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. The intensive care nurse is educating the spouse of a client who is being treated for shock. The spouse states, “The doctor said she has shock. What is that?” What is the nurse’s best response?

ANS:  A

Any problem that impairs oxygen delivery to tissues and organs can start the syndrome of shock and lead to a life-threatening emergency. Shock represents the “whole-body response,” affecting all organs in a predictable sequence. Compensation mechanisms attempt to maintain homeostasis and deliver necessary oxygen to organs but eventually will fail without reversal of the cause of shock, resulting in death.

DIF:    Cognitive Level: Knowledge/Remembering                       REF:   p. 809

TOP:   Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology)

MSC:  Integrated Process: Nursing Process (Implementation)

2. The nurse is caring for multiple clients in the emergency department. The client with which condition is at highest risk for distributive shock?

ANS:  A

Distributive shock is the type of shock that occurs when blood volume is not lost from the body but is distributed to the interstitial tissues, where it cannot circulate and deliver oxygen. Neurally-induced distributive shock may be caused by pain, anesthesia, stress, spinal cord injury, or head trauma. The other clients are at risk for hypovolemic and cardiogenic shock.

DIF:    Cognitive Level: Comprehension/Understanding               REF:   p. 812

TOP:   Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology)

MSC:  Integrated Process: Nursing Process (Assessment)

3. The nurse is assessing a client who has hypovolemic shock. Which laboratory value indicates that the client is at risk for acidosis?

ANS:  B

The syndrome of hypovolemic shock results in inadequate tissue perfusion and oxygenation; thus some cells are metabolizing anaerobically. Such metabolism increases the production of lactic acid, resulting in an increase in hydrogen ion production and acidosis. Other laboratory values associated with acidosis include increased creatinine (impaired renal function) and increased partial pressure of arterial carbon dioxide. Urine specific gravity is not associated with acidosis.

DIF:    Cognitive Level: Comprehension/Understanding               REF:   p. 812

TOP:   Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Laboratory Values) MSC:           Integrated Process: Nursing Process (Analysis)

4. A client brought to the emergency department after a motor vehicle accident is suspected of having internal bleeding. Which question does the nurse ask to determine whether the client is in the early stages of hypovolemic shock?

ANS:  C

The first manifestations of hypovolemic shock result from compensatory mechanisms. Signs of shock are first evident as changes in cardiovascular function. As shock progresses, changes in skin, respiration, and kidney function progress. The other questions would not identify early stages of shock.

DIF:    Cognitive Level: Application/Applying or higher               REF:   N/A

TOP:   Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology)

MSC:  Integrated Process: Nursing Process (Assessment)

5. A client who has acidosis resulting from hypovolemic shock has been prescribed intravenous fluid replacement. Which fluid does the nurse prepare to administer?

ANS:  B

Ringer’s lactate is an isotonic solution that acts as a volume expander. Also, the lactate acts as a buffer in the presence of acidosis. The other solutions do not contain any substance that would buffer or correct the client’s acidosis.

DIF:    Cognitive Level: Application/Applying or higher               REF:   N/A

TOP:   Client Needs Category: Physiological Integrity (Pharmacological and Parenteral Therapies—Parenteral/Intravenous Therapies)

MSC:  Integrated Process: Nursing Process (Implementation)