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NRSG 327 :SHOCK: FINAL EXAM QUESTIONS WITH THE
LATEST SCORE
Main drug for cardiogenic shock -- Answer ✔✔ dopamine MOA of dopamine -- Answer ✔✔ inotropic and vasopressor Increases contractility What is the most important goal of nursing care for pt in shock? -- Answer ✔✔ manage inadequate tissue perfusion Characteristic of cardiogenic shock -- Answer ✔✔ decreased myocardial contractility Presence of inadequate intravascular volume Blood gases for deteriorating shock would indicate A) respiratory acidosis B) metabolic acidosis C) respiratory alkalosis D) metabolic alkalosis -- Answer ✔✔ metabolic acidosis Pink frothy sputum+ SOB + agitation= -- Answer ✔✔ pulmonary edema Early shock indicator is _____ HR -- Answer ✔✔ increased Define shock -- Answer ✔✔ A syndrome characterized by decreased tissue perfusion and impaired cellular metabolism that results in an imbalance between the supply and demand for oxygen and nutrients
Main players in oxygen supply -- Answer ✔✔ oxygen Hgb CO (cardiogenic shock) CO= -- Answer ✔✔ HR x SV SV= -- Answer ✔✔ preload, afterload, and contractility Cardiogenic shock refers to ______ Distributive/neurogenic shock refers to ______ Hypovolemic shock refers to ____ -- Answer ✔✔ contractility (the pump) Afterload (the pipes)preload (the volume) Preload -- Answer ✔✔ decreased ventricular filling time decreases preload Increased: Assess for peripheral edema, decreased output, pulmonary edema, jvd Afterload -- Answer ✔✔ resistance that ventricles overcome to eject blood out Dependent on vessels, valves, viscosity Assess MAP, strength of pulse, murmur Contractility -- Answer ✔✔ we can't measure this, look for overall CO, EF (echo) What does narrowing pulse pressure mean? -- Answer ✔✔ systolic pressure going down and CO going down What does widening pulse pressure mean? -- Answer ✔✔ systolic pressure is going up, neuro or head injuries ICP
A client who was in an automobile collision is now in hypovolemic shock. Why is it important for the nurse to take the client's vital signs frequently during the compensatory stage of shock? -- Answer ✔✔ arteriolar constriction occurs Why is acidosis bad in shock? -- Answer ✔✔ interferes with vessels ability to constrict & hgb to bind Decreases myocardial contractility Decreased ability to get rid of CO2 which is a potent vasodilator S&S of progressive shock -- Answer ✔✔ altered LOC Hotn, cool clammy, cyanosis, weak thready pulse, slow cap refill, dysrhythmia Hypercapnia, increased RR/WOB, pulmonary edema Migration of gastric acid & bacteria to body, NV, hypoactive BS, increased liver enzymes [ ] urine, BUN/CR What happens when cells are starved of oxygen and die? -- Answer ✔✔ they rupture and release cytotoxic wastes which kills nearby cells Release vasoactive hormones that dilate vessels S&S of irreversible shock -- Answer ✔✔ LOC, coma, ICP Hotn, dysrhythmias, brady, arrest, mottled Resp failure, distress, mixed acidosis No BS, increased ammonia Anuria DIC Normal blood gasses HCO Paco Ph -- Answer ✔✔ ph= 7.35-7. HCO3= 22-26 (low is acidic- metabolic)
Paco2= 35-45 (low is basic- resp) What type of shock would be associated with a fractured femur in an MVA -- Answer ✔✔ hypovolemic What should nurse do if pt has reaction to penicillin with dyspnea and hypotension (anaphylaxis) -- Answer ✔✔ administer epinephrine and prepare to intubate if necessary What is the key sign of neurogenic shock -- Answer ✔✔ bradycardia Primary treatment of septic shock -- Answer ✔✔ infuse large amount of IV fluids (treat preload first, then afterload, then contractility) What is the best way to monitor effectiveness of fluid replacement -- Answer ✔✔ monitor BP What percentage of fluid loss= hypovolemic shock -- Answer ✔✔ 155 loss (dependent on overall health, how well hydrated, age, liver function, nutrition, age) Ways volume loss occurs -- Answer ✔✔ GI loss Major burns Diuresis (diabetic, DKA, meds) High fever Ways blood loss occurs -- Answer ✔✔ trauma Surgery Gi bleed AAA PPH How much blood do we have in our body? -- Answer ✔✔ 6 L average
Systemic: 3rd spacing and shock SIRS criteria -- Answer ✔✔ temp >38C < WBC >12 < HR> RR> Altered LOC (elderly) 2+ required Sepsis continuum -- Answer ✔✔ sepsis (2+ SIRS) Severe sepsis (sepsis+ organ dysfunction) Septic shock (sepsis + tissue perfusion abnormalities + hotn despite fluids) S&S of septic shock -- Answer ✔✔ tachy (cardia/pnea) Hypotension Temp dysregulation Decreased output Altered LOC GI dysfunction ARDS DIC Main diagnostic test for septic shock -- Answer ✔✔ LACTATE Why is lactate increased in septic shock -- Answer ✔✔ increased metabolic rate leads to increase in lactic acid Key diagnostic How to treat afterload in septic shock -- Answer ✔✔ Vasopressors
Why is NE the best vasopressor for septic shock? What is the #2 choice? -- Answer ✔✔ it increases afterload, but has minimal impact on HR #2 is vasopressin Med to treat contractility in septic shock -- Answer ✔✔ dobutamine
- increases contractility and HR Why is a septic pt at high risk of DVT? -- Answer ✔✔ microclotting due to systemic fibrin activation What does histamine cause -- Answer ✔✔ vasodilation and increased capillary permeability (particularly in airway) S&S of anaphylactic shock -- Answer ✔✔ angioedema Difficulty swallowing Increased WOB Narrowing airway Stridor Anxious, impending doom Flushed Itchy Treatment of anaphylactic shock -- Answer ✔✔ Remove the cause, maintain open airway, administration of Epinephrine, volume expanders, antihistamines, steroids MOA of Benadryl -- Answer ✔✔ stop histamine response Works on H1 receptor Used in anaphylactic shock (IV) MOA of ranitidine (Zantac) -- Answer ✔✔ used in anaphylactic shock Blocks H2 receptors, affecting GI symptoms of anaphylaxis
