Shock and Multiple Organ Dysfunction Syndrome NCLEX fully solved & updated(100% accuracy)
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Shock, Sepsis & Multiple Organ Dysfunction NCLEX
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Shock, Sepsis & Multiple Organ Dysfunction NCLEX
A
(Furosemide will lower the filling pressures and renal perfusion further for the patient with septic shock. Patients in septic shock require large amounts of fluid replacement. If the patient remains hypotensive after initial volume resuscitation with minimally 30 mL/kg, vasopressors such as n...
Shock and Multiple Organ
Dysfunction Syndrome NCLEX
fully solved & updated(100%
accuracy)
A
(Furosemide will lower the filling pressures and renal perfusion
further for the patient with septic shock. Patients in septic shock
require large amounts of fluid replacement. If the patient remains
hypotensive after initial volume resuscitation with minimally 30
mL/kg, vasopressors such as norepinephrine may be added. IV
corticosteroids may be considered for patients in septic shock who
cannot maintain an adequate BP with vasopressor therapy despite
fluid resuscitation.) - answer A 78-kg patient with septic shock has a
pulse rate of 120 beats/min with low central
venous pressure and pulmonary artery wedge pressure. Urine
output has been 30 mL/hr for the past 3 hours. Which order by the
health care provider should the nurse question?
a. Administer furosemide (Lasix) 40 mg IV.
b. Increase normal saline infusion to 250 mL/hr.
c. Give hydrocortisone (Solu-Cortef) 100 mg IV.
d. Titrate norepinephrine to keep systolic blood pressure (BP) above
90 mm Hg.
B
(The patient's elevated PAWP indicates volume excess in relation to
cardiac pumping ability, consistent
,with cardiogenic shock. A saline infusion at 250 mL/hr will
exacerbate the volume excess. The other
actions will help to improve cardiac output, which should lower the
PAWP and may raise the BP.) - answer A nurse is caring for a patient
whose hemodynamic monitoring indicates a blood pressure of 92/54
mm Hg, a pulse of 64 beats/min, and an elevated pulmonary artery
wedge pressure (PAWP). Which intervention ordered by the health
care provider should the nurse question?
a. Elevate head of bed to 30 degrees.
b. Infuse normal saline at 250 mL/hr.
c. Hold nitroprusside if systolic BP is less than 90 mm Hg.
d. Titrate dobutamine to keep systolic BP is greater than 90 mm Hg.
B
(Neurogenic shock is characterized by hypotension and bradycardia.
The other findings would be more consistent with other types of
shock.) - answer A 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. Heart rate 45 beats/min
c. Cool, clammy extremities
d. Temperature 101.2°F (38.4°C)
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.) - answer An
older patient with cardiogenic shock is cool and clammy.
Hemodynamic monitoring indicates a high systemic vascular
resistance (SVR). Which intervention should the nurse anticipate?
a. Increase the rate for the dopamine infusion.
b. Decrease the rate for the nitroglycerin infusion.
c. Increase the rate for the sodium nitroprusside infusion.
d. Decrease the rate for the 5% dextrose in normal saline (D5/.9 NS)
infusion.
C
(When fluid resuscitation is unsuccessful, vasopressor drugs are
given to increase the systemic vascular resistance (SVR) and blood
pressure and improve tissue perfusion. Furosemide would cause
diuresis and further decrease the BP. Nitroglycerin would decrease
the preload and further drop cardiac output and BP. Nitroprusside is
an arterial vasodilator and would further decrease SVR.) - answer
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. furosemide
b. nitroglycerin
c. norepinephrine
d. sodium nitroprusside
C
, (Proton pump inhibitors are given to decrease the risk for stress
ulcers in critically ill patients. The other
assessments will also be done, but these will not help in
determining the effectiveness of the pantoprazole
administration.) - answer 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. Ask the patient about nausea.
c. Check stools for occult blood.
d. Palpate for abdominal tenderness.
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 the heart rate and myocardial
oxygen demand. 5% albumin would also increase the PAWP.
Hydrocortisone might be considered for
septic or anaphylactic shock.) - answer 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% albumin infusion
b. furosemide (Lasix) IV
c. epinephrine (Adrenalin) drip
d. hydrocortisone (Solu-Cortef)
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