Chapter 67: Nursing Management: Shock, Systemic Inflammatory Response Syndrome, and Multiple Organ Dysfunction Syndrome

Chapter 67: Nursing Management: Shock, Systemic Inflammatory Response
Syndrome, and Multiple Organ Dysfunction Syndrome

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE
1. A patient with septic shock has a urine output of 20 mL/hr for the past 3 hours. The pulse
rate is 120 and the central venous pressure and pulmonary artery wedge pressure are low.
Which of these orders by the health care provider will the nurse question?
a. Give furosemide (Lasix) 40 mg IV.
b. Increase normal saline infusion to 150 mL/hr.
c. Administer hydrocortisone (SoluCortef) 100 mg IV.
d. Prepare to give drotrecogin alpha (Xigris) 24 mcg/kg/hr.
ANS: A
Furosemide will lower the filling pressures and renal perfusion further for the patient
with septic shock. The other orders are appropriate.
DIF: Cognitive Level: Application REF: 1724-1726 | 1731 | 1733
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
2. A patient with shock of unknown etiology whose hemodynamic monitoring indicates BP
92/54, pulse 64, and an elevated pulmonary artery wedge pressure has the following
collaborative interventions prescribed. Which intervention will the nurse question?
a. Infuse normal saline at 250 mL/hr.
b. Keep head of bed elevated to 30 degrees.
c. Give nitroprusside (Nipride) unless systolic BP <90 mm Hg.
d. Administer dobutamine (Dobutrex) to keep systolic BP >90 mm Hg.
ANS: A
The patient’s elevated pulmonary artery wedge pressure indicates volume excess. A
normal saline infusion at 250 mL/hr will exacerbate this. The other actions are
appropriate for the patient.
DIF: Cognitive Level: Application REF: 1719 | 1721-1722 | 1735
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 finding by the nurse will help confirm a diagnosis of
neurogenic shock?
a. Cool, clammy skin
b. Inspiratory crackles
c. Apical heart rate 48 beats/min
d. Temperature 101.2° F (38.4° C)
Test Bank 67-2
ANS: C
Neurogenic shock is characterized by hypotension and bradycardia. The other findings
would be more consistent with other types of shock.
DIF: Cognitive Level: Comprehension REF: 1721-1722 | 1723
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
4. A patient with cardiogenic shock is cool and clammy and hemodynamic monitoring
indicates a high systemic vascular resistance (SVR). Which action will the nurse
anticipate taking?
a. Increase the rate for the prescribed dopamine (Intropin) infusion.
b. Decrease the rate for the prescribed nitroglycerin (Tridil) infusion.
c. Decrease the rate for the prescribed 5% dextrose in water (D5W) infusion.
d. Increase the rate for the prescribed sodium nitroprusside (Nipride) infusion.
ANS: D
Nitroprusside is an arterial vasodilator and will decrease the SVR and afterload, which
will improve cardiac output. Changes in the D5W and nitroglycerin infusions will not
directly increase SVR. Increasing the dopamine will tend to increase SVR.
DIF: Cognitive Level: Application REF: 1733-1734 TOP: Nursing Process:
Planning
MSC: NCLEX: Physiological Integrity
5. After receiving 1000 mL of normal saline, the central venous pressure for a patient who
has septic shock is 10 mm Hg, but the blood pressure is still 82/40 mm Hg. The nurse
will anticipate the administration of
a. nitroglycerine (Tridil).
b. drotrecogin alpha (Xigris).
c. norepinephrine (Levophed).
d. sodium nitroprusside (Nipride).
ANS: C
When fluid resuscitation is unsuccessful, vasopressor drugs are administered to increase
the systemic vascular resistance (SVR) and improve tissue perfusion. Nitroglycerin
would decrease the preload and further drop cardiac output and BP. Drotrecogin alpha
may decrease inappropriate inflammation and help prevent systemic inflammatory
response syndrome, but it will not directly improve blood pressure. Nitroprusside is an
arterial vasodilator and would further decrease SVR.
DIF: Cognitive Level: Application REF: 1731 | 1733-1735
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity