71.

The clients urinary output is normal, whereas respiratory rate and heart rate are slightly elevated from baseline. Which of the following should the nurse suspect? a.) b.) c.) d.) Early stage of shock Compensatory stage of shock Intermediate stage of shock Refractory stage of shock

Bacause in the compemsatory satge of shock the urine output of the patient with shock is decreased already. Since the compensatory stage of shock is the first stage, early stage means before going to compensatory stage (p. 315)

72. A client has been admitted with a gastrointestinal ulcer. The client is NPO and has nasogastric tube in place connected to low suction. What form of shock should the nurse monitor this client for? a.) b.) c.) d.) Distributive shock Obstructive shock Cardiogenic shock Hypovolemic shock

Because hypovolemic shock can occur if the patient is in severe dehydration. Since the clients diet is NPO, the client is prohibited to drink water and also the client is on NGT and on low suction. Suction can also suction fluid of the body (p.322)

73. What are the pathophysiologic changes that place a client who has suffered a myocardial infarction at risk for cardiogenic shock? a.) b.) c.) d.) Decreased cardiac output and demand MAP Increased cardiac output and increased afterload Increased cardiac output and increased MAP Decreased cardiac output and increased MAP

In cardiogenic shock, cardiac output, which is a function of both stroke volume and heart failure is compromised. When stroke volume and heart rate decreased or become erratic, BP falls and tissue perfusion MI are the greatest risk for cardiogenic shock because of the potentially extensive damage to the left ventricle caused by occlusion of the left anterior descending coronary artery (p.325)

74. What is the pathophysiologic basis to the acidosis associated with hypovolemic shock? a.) Poor respiratory effort secondary to skeletal muscle weakness caused by the hydrogen ion excess b.) Lactic acid production resulting from decreased oxygen delivery to the tissues and increased anaerobic metabolism c.) Failure of the kidneys to excrete hydrogen ions and reabsorb bicarbonate ions as a result of renal hypertension d.) Increased sensitivity of the central chemoreceptors, enhancing the rate and depth of ventilation

Hypovolemic shock can be caused by external fluid losses, as in traumatic blood loss, or by internal fluid shifts, as in severe dehydration, severe edema or ascites Particularly if the cause of hypovolemic shock is hemorrhage, currently, the need for transfusion is based on the patients oxygenation needs, which are determined by vital signs, blood gas values and clinical appearance rather than an arbiturary laboratory value. (pp.322-323)

75. A client brought to the emergency room after a molar vehicle accident is suspected at having internal bleeding. What initial clinical manifestation of hypovolemic shock would the nurse expect to find in this client? a.) b.) c.) d.) Increased respiratory rate Decreased urinary output Increased heart rate Cool, pale skin

Hypovolemic shock can be caused by external fluid losses, as in traumatic blood loss, or by internal fluid shifts, as in severe dehydration, severe edema or ascites Major goals in the treatment of hypovolemic shock are to restore intravascular volume to reverse the sequence of events leading to inadequate tissue perfussion, to redistribute fluid volume, and to connect the underlying cause of the fluid loss as quickly as possible Since the patient has less fluids, the body system will not vreate urine to avoid further fluid loss (pp.322-323)