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BIOLOGY Unit 2 pt 2 Exam
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Unit 2 pt 2 Exam Unit 2 pt 2 Exam Unit 2 pt 2 Exam
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Unit 2 pt 2 Exam1. A 78-kg patient with septic shock has a urine output of 30 mL/hr for the past 3 hours. The pulse
rate is 120/minute and the central venous pressure and pulmonary artery wedge pressure are low.
Which order by the health care provider will the nurse question?
a.
Give PRN furosemide (Lasix) 40 mg IV.
b.
Increase normal saline infusion to 250 mL/hr.
c.
Administer hydrocortisone (Solu-Cortef) 100 mg IV.
d.
Titrate norepinephrine (Levophed) to keep systolic BP >90 mm Hg. - verified answer ANS: A
Furosemide will lower the filling pressures and renal perfusion further for the patient with septic
shock. The other orders are appropriate.
A nurse is caring for a patient with shock of unknown etiology whose hemodynamic monitoring
indicates BP 92/54, pulse 64, and an elevated pulmonary artery wedge pressure. Which collaborative
intervention ordered by the health care provider should the nurse question?
a.
Infuse normal saline at 250 mL/hr.
b.
Keep head of bed elevated to 30 degrees.
c.
Hold nitroprusside (Nipride) if systolic BP <90 mm Hg.
d.
Titrate dobutamine (Dobutrex) to keep systolic BP >90 mm Hg. - verified answer ANS: A
The patient's elevated pulmonary artery wedge pressure indicates volume excess. A saline infusion
at 250 mL/hr will exacerbate the volume excess. The other actions are appropriate for the patient.
A 19-year-old 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?
,a.
Inspiratory crackles.
b.
Cool, clammy extremities.
c.
Apical heart rate 45 beats/min.
d.
Temperature 101.2° F (38.4° C). - verified answer ANS: C
Neurogenic shock is characterized by hypotension and bradycardia. The other findings would be
more consistent with other types of shock.
An older patient with cardiogenic shock is cool and clammy and hemodynamic monitoring indicates
a high systemic vascular resistance (SVR). Which intervention should the nurse anticipate doing
next?
a.
Increase the rate for the dopamine (Intropin) infusion.
b.
Decrease the rate for the nitroglycerin (Tridil) infusion.
c.
Increase the rate for the sodium nitroprusside (Nipride) infusion.
d.
Decrease the rate for the 5% dextrose in normal saline (D5/.9 NS) infusion. - verified answer 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.
After receiving 2 L 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 an order for
a.
nitroglycerine (Tridil).
b.
norepinephrine (Levophed).
c.
,sodium nitroprusside (Nipride).
d.
methylprednisolone (Solu-Medrol). - verified answer ANS: B
When fluid resuscitation is unsuccessful, vasopressor drugs are administered to increase the
systemic vascular resistance (SVR) and blood pressure, and improve tissue perfusion. Nitroglycerin
would decrease the preload and further drop cardiac output and BP. Methylprednisolone (Solu-
Medrol) is considered if blood pressure does not respond first to fluids and vasopressors.
Nitroprusside is an arterial vasodilator and would further decrease SVR.
To evaluate the effectiveness of the pantoprazole (Protonix) ordered for a patient with systemic
inflammatory response syndrome (SIRS), which assessment will the nurse perform?
a.
Auscultate bowel sounds.
b.
Palpate for abdominal pain.
c.
Ask the patient about nausea.
d.
Check stools for occult blood. - verified answer ANS: D
Proton pump inhibitors are given to decrease the risk for stress ulcers in critically ill patients. The
other assessments also will be done, but these will not help in determining the effectiveness of the
pantoprazole administration.
A patient with cardiogenic shock has the following vital signs: BP 102/50, pulse 128, respirations 28.
The pulmonary artery wedge pressure (PAWP) is increased and cardiac output is low. The nurse will
anticipate an order for which medication?
a.
5% human albumin
b.
Furosemide (Lasix) IV
c.
Epinephrine (Adrenalin) drip
d.
Hydrocortisone (Solu-Cortef) - verified answer ANS: B
, The PAWP indicates that the patient's preload is elevated, and furosemide is indicated to reduce the
preload and improve cardiac output. Epinephrine would further increase heart rate and myocardial
oxygen demand. 5% human albumin would also increase the PAWP. Hydrocortisone might be
considered for septic or anaphylactic shock.
The emergency department (ED) nurse receives report that a patient involved in a motor vehicle
crash is being transported to the facility with an estimated arrival in 1 minute. In preparation for the
patient's arrival, the nurse will obtain
a.
hypothermia blanket.
b.
lactated Ringer's solution.
c.
two 14-gauge IV catheters.
d.
dopamine (Intropin) infusion. - verified answer ANS: C
A patient with multiple trauma may require fluid resuscitation to prevent or treat hypovolemic
shock, so the nurse will anticipate the need for 2 large bore IV lines to administer normal saline.
Lactated Ringer's solution should be used cautiously and will not be ordered until the patient has
been assessed for possible liver abnormalities. Vasopressor infusion is not used as the initial therapy
for hypovolemic shock. Patients in shock need to be kept warm not cool.
Which finding is the best indicator that the fluid resuscitation for a patient with hypovolemic shock
has been effective?
a.
Hemoglobin is within normal limits.
b.
Urine output is 60 mL over the last hour.
c.
Central venous pressure (CVP) is normal.
d.
Mean arterial pressure (MAP) is 72 mm Hg. - verified answer ANS: B
Assessment of end organ perfusion, such as an adequate urine output, is the best indicator that fluid
resuscitation has been successful. The hemoglobin level, CVP, and MAP are useful in determining the
effects of fluid administration, but they are not as useful as data indicating good organ perfusion.
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