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H&H Quiz 3 - med/surg ch 69, shock stages, cardiogenic shock Questions With Complete Solutions
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H&H Quiz 3 - med/surg ch 69, shock stages, cardiogenic shock Questions With Complete Solutions
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H&H Quiz 3 - med/surg ch 69, shock stages, cardiogenicshock Questions With Complete Solutions
________________ is the amount the ventricle stretches at the
end of diastole.
A. Preload
B. Afterload
C. Stroke Volume
D. Contractility Correct Answer The answer is A. Preload is
the amount the ventricle stretches at the end of diastole (hence
it's the amount the ventricles stretches once it's filled with blood
and right before the contraction of the ventricle ....so it's the end-
diastolic volume).
. Based on this scenario, what stage of shock is this patient most
likely experiencing: A 74-year-old patient is extremely confused
and does not respond to commands or stimulation. The patient
respiratory rate is 28 and labored, oxygen saturation 86%, heart
rate 120, blood pressure 70/40, mean arterial pressure is 50
mmHg, and temperature is 97 'F. The patient's heart rhythm is
atrial fibrillation. The patient's urinary output is 5 mL/hr. The
patient's labs: blood pH 7.15, serum lactate 15 mmol/L, BUN 55
mg/dL, Creatinine 6 mg/dL. In addition, the patient is now
starting to have slight oozing of blood around puncture sites.
Correct Answer The answer is C. This is the progressive stage.
There are four stages of shock (in order): initial, compensatory,
progressive, and refractory. The patient's body is experiencing
,major signs and symptoms of shock. This is not found in the
initial stage of shock because the signs and symptoms are subtle.
During the compensatory stage, the body (for a while) can
compensate so major organs are not showing major signs and
symptoms of failure as they are in this scenario (the kidneys are
starting to fail based on the BUN, creatinine, urinary output). In
addition, the body is no longer compensating because the blood
pressure is very low along with the MAP (mean arterial
pressure). A big sign is that the patient's mental status is altered.
This represents that the brain is not being perfused very well.
The MAP should be 60 or greater to provide adequate perfusion.
The MAP here is 50 and this shows us the body is NOT
perfusing the organs, so the cells will experience hypoxic injury.
The patient is also starting to show early signs and symptoms of
DIC due to the slight oozing of blood around puncture sites. The
next stage (which is the last) is the refractory and this is where
organs have failed or are about too. Death is imminent. This
patient is not at that point but is getting close. This patient needs
very dynamic treatment in order to survive.
1. A patient is being treated for cardiogenic shock. Which
statement below best describes this condition? Select all that
apply:
A. "The patient will experience an increase in cardiac output due
to an increase in preload and afterload."
B. "A patient with this condition will experience decreased
cardiac output and decreased tissue perfusion."
,C. "This condition occurs because the heart has an inadequate
blood volume to pump."
D. "Cardiogenic shock leads to pulmonary edema." Correct
Answer The answers are: B and D. Cardiogenic shock occurs
when the heart can NOT pump enough blood to meet the
perfusion needs of the body. The cardiac output will be
DECREASED, which will DECREASE tissue perfusion and
cause cell injury to organs/tissues. In this condition, the heart is
WEAK and can't pump blood out of the heart. This can be due
to either a systolic (contraction) or diastolic (filling) issue along
with a structural or dysrhythmia issue. In cardiogenic shock,
there is NOT an issue with blood volume, but there is a problem
with the heart itself.
1. A patient is in hypovolemic shock. Select all the stages that a
patient can enter when in shock:
A. Proliferative
B. Compensatory
C. Exudative
D. Initial
E. Progressive
F. Fibrotic
G. Refractory Correct Answer D. Initial
, B. Compensatory
E. Progressive
G. Refractory
10. A patient in septic shock has not responded to fluid
resuscitation, as evidenced by a decreasing BP and CO. The
nurse anticipates the administration of which of the following
medications?
a.
Nitroglycerine (Tridil)
b.
Dobutamine
c.
Norepinephrine (Levophed)
d.
Sodium nitroprusside (Nipride) Correct Answer ANS: B
When fluid resuscitation is unsuccessful, administration of
vasopressor drugs is used to increase the systemic vascular
resistance and improve tissue perfusion.
10. TRUE or FALSE: All types of shock during the
compensatory (early) stage will cause a patient to experience
cold and clammy (moist or sweaty) skin. Correct Answer
FALSE: Patients who have septic shock will actually experience
warm and flushed skin during the early (compensatory stage)
because of the vasodilation occurring with this type of shock.
The other types of shock will have cold and clammy (sweaty)
skin due to decreased perfusion to the skin.
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