1. A. B. C. D. 2.

A client is admitted to the ICU with a spinal cord injury from a motor vehicle accident. Which shock state is this client most at risk for developing? Obstructive Hypovolemic - neurogenic shock is a type of hypovolemic shock (analysis) Cardiogenic Transport A client has lost a considerable amount of blood and is demonstrating signs of pending shock. Which of the following shock states is this client most likely developing? Cardiogenic Obstructive

A. B.

C. Transport Hemorrhage is a transport shock state. A loss of blood is one example of a transport shock state. D.Hypovolemic 3. The nurse is trying to determine the client's current stage of shock. Which of the following body systems will begin the renin-angiotensin-aldosterone cycle? A. Cardiovascular B. C. Endocrine Pulmonary

D. Renal - As a result of decreased blood flow to the kidneys, the juxtaglomerular cells in the kidneys excrete renin. This begins the process. 4. A client is progressing into the third stage of shock. The nurse will expect this client to demonstrate: A. B. C. D. E. F. Profound hypotension. Buildup of metabolic wastes. Intractable circulatory failure. Neuroendocrine responses. Demonstrating MODS.

Increase in lactic acidosis. The third stage of shock, progressive, results in major dysfunction of many organs leading to multiple organ dysfunction syndrome or MODS. 5. Until the physician arrives to evaluate the status of a client in the ICU, the nurse is going to begin assessing a client for shock. Which of the following would be considered traditional methods to assess this client? A. Assess blood pressure. B. Have a serum lactate level drawn. C. Obtain the equipment for a sublingual capnography. D. Prepare the client for a gastric tonometry. E. Measure urine output. F. Analyze arterial blood gas sample. This is one of the traditional methods used to assess a client for shock. Traditional signs used to assess for shock include blood pressure, heart rate, mentation, and urine output.

6. The nurse is caring for a client who became ill after working on a car in his garage at home. Which of the following would help diagnose the cause for this client's illness? A. B. C. D. Presence of pulsus paradoxus Carboxyhemoglobin level Base deficit Presence of Beck's triad

An elevated carboxyhemoglobin level confirms carbon monoxide poisoning. 7. A client has been diagnosed with sepsis. The nurse will most likely find which of the following when assessing this client:

A. B. C. D. E.

Sepsis is manifested by two characteristics, such as temperature >38 degrees C, heart rate >90 bmp, respiratory rate >20 breaths/minute, WBC count >12,000 per liter.
8. A client in shock is prescribed an inotropic drug to act on alpha and beta receptors. The nurse will most likely be administering: A. B. C. D. Milrinone. Dopamine. Dobutamine. Pavulon.

Lactic acidosis. Severe hypotension. Oliguria. Elevated temperature. Rapid shallow respirations. F. Mental status changes.

Dopamine has both alpha- and betareceptor effects.

9. The nurse is caring for a client experiencing anaphylactic shock. Which of the following should be included in the plan of care for this client? A. Remove the mechanical barrier to blood flow. B. Restore body fluids. C. Maintain an adequate airway. D. Decrease myocardial oxygen demand E. Remove the source of infection. F. Support the blood pressure. Immediate goal in the treatment of anaphylactic shock is to maintain an adequate airway and to support the blood pressure.

10. A patient arrives in the emergency department with symptoms of myocardial infarction, progressing to cardiogenic shock. Which of the following symptoms should the nurse expect the patient to exhibit with cardiogenic shock? A. Hypertension. B. Bradycardia. C. Bounding pulse. D. Confusion.
Answer: Answer:

D - Cardiogenic shock severely impairs the pumping function of the heart muscle, causing diminished blood flow to the organs of the body. This results in diminished brain function and confusion, as well as hypotension, tachycardia, and weak pulse. Cardiogenic shock is a serious complication of myocardial infarction with a high mortality rate. 11. Tissue plasminogen activator (t-PA) is considered for treatment of a patient who arrives in the emergency department following onset of symptoms of myocardial infarction. Which of the following is a contraindication for treatment with t-PA? A. Worsening chest pain that began earlier in the evening. B. History of cerebral hemorrhage. C. History of prior myocardial infarction. D. Hypertension. Answer: B 12. A history of cerebral hemorrhage is a contraindication to tPA because it may increase the risk of bleeding. TPA acts by dissolving the clot blocking the coronary artery and works best when administered within 6 hours of onset of symptoms. Prior MI is not a contraindication to tPA. Patients receiving tPA should be observed for changes in blood pressure, as tPA may cause hypotension. 13. A patient is hemorrhaging from multiple trauma sites. The nurse expects that compensatory mechanisms associated with hypovolemia would cause all of the following symptoms EXCEPT

A. hypertension B. oliguria C. tachycardia D. tachypnea

14. Patrick who is hospitalized following a myocardial infarction asks the nurse why he is taking morphine. The nurse explains that morphine: a. Decrease anxiety and restlessness b. Prevents shock and relieves pain c. Dilates coronary blood vessels d. Helps prevent fibrillation of the heart answer: B. Morphine is a central nervous system depressant used to relieve the pain associated with myocardial infarction, it also decreases apprehension and prevents cardiogenic shock. 15. A 64 year old male client with a long history of cardiovascular problem including hypertension and angina is to be scheduled for cardiac catheterization. During pre cardiac catheterization teaching, Nurse Cherry should inform the client that the primary purpose of the procedure is.. a. To determine the existence of CHD b. To visualize the disease process in the coronary arteries c. To obtain the heart chambers pressure d. To measure oxygen content of different heart chambers
answer: B. The lumen of the arteries can be assessed by cardiac catheterization. Angina is

usually caused by narrowing of the coronary arteries.

16. During the first several hours after a cardiac catheterization, it would be most essential for nurse Cherry to a. Elevate clients bed at 45 b. Instruct the client to cough and deep breathe every 2 hours c. Frequently monitor clients apical pulse and blood pressure d. Monitor clients temperature every hour answer: C. Blood pressure is monitored to detect hypotension which may indicate shock or hemorrhage. Apical pulse is taken to detect dysrhythmias related to cardiac irritability. 17. A client has 15% blood loss. Which of the following nursing assessment findings indicates hypovolemic shock? a. Systolic blood pressure less than 90mm Hg b. Pupils unequally dilated c. Respiratory rate of 4 breath/min d. Pulse rate less than 60bpm
answer: A. Typical signs and symptoms of hypovolemic shock includes systolic blood

pressure of less than 90 mm Hg. 18. All of the following are primary patient management goals for hypovolemic shock except a. increasing urinary output. b. controlling hemorrhage. c. restoring adequate cardiac output. d. maximizing oxygen delivery