Chapter 66: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome

Chapter 66: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. A 78-kg patient with septic shock has a pulse rate of 120 beats/min with low central venous pressure and pulmonary artery wedge pressure. Urine output has been 30 mL/hr for the past 3 hours. Which order by the health care provider should the nurse question?

ANS:  A

Furosemide will lower the filling pressures and renal perfusion further for the patient with septic shock. Patients in septic shock require large amounts of fluid replacement. If the patient remains hypotensive after initial volume resuscitation with minimally 30 mL/kg, vasopressors such as norepinephrine may be added. IV corticosteroids may be considered for patients in septic shock who cannot maintain an adequate BP with vasopressor therapy despite fluid resuscitation.

DIF:    Cognitive Level: Apply (application)           REF:               1600

TOP:   Nursing Process: Implementation     MSC:  NCLEX: Physiological Integrity

2. A nurse is caring for a patient whose hemodynamic monitoring indicates a blood pressure of 92/54 mm Hg, a pulse of 64 beats/min, and an elevated pulmonary artery wedge pressure (PAWP). Which intervention ordered by the health care provider should the nurse question?

ANS:  B

The patient’s elevated PAWP indicates volume excess in relation to cardiac pumping ability, consistent with cardiogenic shock. A saline infusion at 250 mL/hr will exacerbate the volume excess. The other actions will help to improve cardiac output, which should lower the PAWP and may raise the BP.

DIF:    Cognitive Level: Apply (application)           REF:               1600

TOP:   Nursing Process: Planning               MSC:  NCLEX: Physiological Integrity

3. A 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?

ANS:  B

Neurogenic shock is characterized by hypotension and bradycardia. The other findings would be more consistent with other types of shock.

DIF:    Cognitive Level: Understand (comprehension)                   REF:   1590

TOP:   Nursing Process: Assessment           MSC:  NCLEX: Physiological Integrity

4. An older patient with cardiogenic shock is cool and clammy. Hemodynamic monitoring indicates a high systemic vascular resistance (SVR). Which intervention should the nurse anticipate?

ANS:  C

Nitroprusside is an arterial vasodilator and will decrease the SVR and afterload, which will improve cardiac output. Changes in the D5/.9 NS and nitroglycerin infusions will not directly decrease SVR. Increasing the dopamine will tend to increase SVR.

DIF:    Cognitive Level: Apply (application)           REF:               1599

TOP:   Nursing Process: Planning               MSC:  NCLEX: Physiological Integrity