The nurse has just completed an infusion of a 1000 mL bolus of 0.9% normal saline in a patient with severe sepsis. One hour later, which laboratory result requires immediate nursing action? a.Creatinine 1.0 mg/dL ANS: B The nurse has been administering 0.9% normal saline
intravenous fluids as part of early goal-directed therapy protocols in a patient with severe sepsis. To evaluate the effectiveness of fluid therapy, which physiological parameters would be most important for the nurse to assess? ANS: D A patient is admitted to the critical care unit following coronary artery bypass surgery. Two hours postoperatively, the nurse assesses the following information: pulse is 120 beats/min; blood pressure is 70/50 mm Hg; pulmonary artery diastolic pressure is 2 mm Hg; cardiac output is 4 L/min; urine output is 250 mL/hr; chest drainage is 200 mL/hr. What is the best interpretation by the nurse? ANS: D A patient is admitted after collapsing at the end of a summer marathon. She is lethargic, with a heart rate of 110 beats/min, respiratory rate of 30 breaths/min, and a blood pressure of 78/46 mm Hg. The nurse anticipates administering which therapeutic intervention? ANS: C The nurse is caring for a patient in the early stages of septic shock. The
patient is slightly confused and flushed, with bounding peripheral pulses. Which hemodynamic values is the nurse most likely to assess? d. Low systemic vascular resistance and high cardiac output ANS: D The nurse is caring for a patient admitted with severe sepsis. Vital signs assessed by the nurse include blood pressure 80/50 mm Hg, heart rate 120 beats/min, respirations 28 breaths/min, oral temperature of 102 F, and a right atrial pressure (RAP) of 1 mm Hg. Assuming physician orders, which intervention should the nurse carry out first? ANS: D Which patient being cared for in the emergency department is most at risk for developing hypovolemic shock? ANS: C The nurse
is caring for a patient admitted with cardiogenic shock. Hemodynamic readings obtained with a pulmonary artery catheter include a pulmonary artery occlusion pressure (PAOP) of 18 mm Hg and a cardiac index (CI) of 1.0 L/min/m2. What is the priority pharmacological intervention? ANS: A Positive inotropic agents (e.g., dobutamine) are given to increase the contractile force of the heart. As contractility increases, cardiac output and index increase and improve tissue perfusion. Administration of furosemide will assist only in managing fluid volume overload. Phenylephrine administration enhances vasoconstriction, which may increase afterload and further reduce cardiac output. Sodium nitroprusside is given to reduce afterload. There is
no evidence to support a need for afterload reduction in this scenario. A patient is admitted to the cardiac care unit with an acute anterior myocardial infarction. The nurse assesses the patient to be diaphoretic and tachypneic, with bilateral crackles throughout both lung fields. Following insertion of a pulmonary artery catheter by the physician, which hemodynamic values is the nurse
most likely to assess? a.High pulmonary artery diastolic pressure and low cardiac output ANS: A The nurse is caring for a patient in cardiogenic shock who is being treated with an intraaortic balloon pump (IABP). The family inquires about the primary reason for the device. What is the best statement by the nurse to
explain the IABP? a.The action of the machine will improve blood supply to the damaged heart. ANS: A 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? ANS: A . 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? ANS: D 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 ANS: C
A patient with cardiogenic shock has the following vital signs: BP 86/50, pulse 126, respirations 30. The PAWP is increased and cardiac output is low. The nurse will anticipate a.infusion of 5% human albumin. ANS: B The emergency department (ED) receives notification that a patient who has just been in an automobile accident is being transported to your facility with anticipated arrival in 1 minute. In preparation for the patients arrival, the nurse will obtain a.500 mL of 5% albumin. ANS: C Which of these findings is the best indicator that the fluid resuscitation for a patient with hypovolemic shock has been successful? ANS: B Which intervention will the nurse include in the plan of care for a patient who has cardiogenic shock? a.Avoid elevating head of bed. ANS: C When the nurse is assessing a patient who is receiving a nitroprusside (Nipride) infusion to treat cardiogenic shock, which finding indicates that the medication is effective? a.No heart murmur is audible. ANS: B Which intervention will the nurse include in the plan of care for patient with cardiogenic shock?The appropriate nursing interventions for a patient with cardiogenic shock includes: Prevent recurrence. Identifying at-risk patients early, promoting adequate oxygenation of the heart muscle, and decreasing cardiac workload can prevent cardiogenic shock. Hemodynamic status.
When caring for a client in cardiogenic shock the nurse plans to administer Which of the following drugs to raise the blood pressure?Dobutamine and Dopamine are vasopressors that have a POSITIVE inotropic effect on the heart. This means these medications increase the strength of the heart's contractions (increases contractility), which increases stroke volume. 15.
What is cardiogenic shock?Cardiogenic shock, also known as cardiac shock, happens when your heart cannot pump enough blood and oxygen to the brain and other vital organs. This is a life-threatening emergency. It is treatable if diagnosed right away, so it's important to know the warning signs.
What laboratory finding is consistent with cardiogenic shock?Patients with cardiogenic shock usually have a low cardiac index (<2.2 L/min/m2) and elevated ventricular filling pressures (ie, pulmonary capillary wedge pressure [PCWP] >15 mmHg and/or central venous pressure [CVP] >10 mmHg), and a decreased mixed venous oxygen saturation (table 1) [2-4].
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