Chapter 19: Shock
Linton: Introduction to Medical–Surgical Nursing, 6th Edition
MULTIPLE CHOICE
1. What are the four types of shock?
a.
Multiple organ, cardiogenic, renal, and anaphylactic
b.
Cardiogenic, renal, hypovolemic, and septic
c.
Renal, hypervolemic, obstructive shock, and neurogenic
d.
Hypovolemic, cardiogenic, obstructive shock, and vasogenic
2. Although several life-supporting systems of the body are involved in the pathophysiologic
characteristics of shock, shock itself results from failure of which system?
a.
Circulatory
b.
Endocrine
c.
Neurologic
d.
Respiratory
3. A nurse is assessing a patient who is in shock. What should the nurse be aware that one
common sign will be, regardless of the cause of the shock?
a.
The skin is cool and dry with cyanotic nail beds.
b.
The skin is cool and moist with cyanotic nail beds.
c.
The nail beds are reddened, and the skin is moist and warm.
d.
The nail beds are reddened, and the skin is dry and warm.
4. What should a nurse assessing a patient in the progressive stage of shock expect to find?
a.
Bounding pulse, decreased respirations, and decreased blood pressure
b.
Bounding pulse, shallow respirations, and significantly increased blood pressure
c.
Thready pulse and deep respirations with decreased blood pressure
d.
Thready pulse and irregular respirations with increased blood pressure
5. What should a nurse expect of a patient’s respirations caused by the falling blood pressure and
impaired blood circulation during the refractory stage of shock?
a.
Rapid and deep
b.
Rapid and shallow
c.
Slow and deep
d.
Slow and shallow
6. A licensed practical/vocational nurse (LPN/LVN) is assisting in developing a nursing care
plan for a patient in shock. Which nursing diagnosis should be included?
a.
Increased cardiac output, related to hypertension
b.
Increased cardiac output, related to hypotension
c.
Decreased cardiac output, related to hypovolemia
d.
Decreased cardiac output, related to hypertension
7. How does the intraaortic balloon pump (IABP) assist a patient who is in cardiogenic shock to
increase cardiac output?
a.
Provides generalized vasoconstriction
b.
Inflates during the diastole phase
c.
Constricts the vena cava
d.
Adds hypertonic fluid to the circulating volume
8. A nurse is explaining to a family member the pathophysiologic characteristic of vasogenic
shock. What information should the nurse include?
a.
The intravascular compartment fills beyond capacity, allowing fluid to leak out,
compressing vital organs.
b.
The circulating volume causes excessive constriction of the vessels, causing blood
pooling.
c.
Widely fluctuating blood pressures stimulate vascular collapse, causing severe
alterations in peripheral perfusion.
d.
Although the circulating volume is intact, excessive vascular dilation causes
drastic drops in the blood pressure.
9. A nurse is caring for a patient who has a cervical spine injury and assesses progressive
hypotension. What does this signify?
a.
Anaphylaxis
b.
Respiratory alkalosis
c.
Multiple organ dysfunction syndrome (MODS)
d.
Neurogenic shock
10. While shopping in the mall, a nurse sees a lady suddenly fall to the floor. On immediate
assessment, the nurse realizes she is not in cardiac arrest and has no need for cardiopulmonary
resuscitation (CPR). What should be the immediate actions by the nurse?
a.
Check the pulse and respirations and call for a blood pressure cuff.
b.
Check the pulse, respirations, skin color, and temperature.
c.
Call for help and check the pulse, respiration, and mental status.
d.
Ask someone to help place large blankets or coats under her legs and trunk.
11. A nurse is explaining the rationale behind the use of Hypothermic devices to a patient’s
family. When relaying information what explanation should the nurse provide when asked
why this garment provides compression to the legs and abdomen?
a.
To help restore cellular perfusion
b.
Decreases internal hemorrhage
c.
Cools the patient to create less metabolic demand
d.
Applies pressure during the systole phase and relax pressure during the diastole
phase
12. A nurse is speaking to the family of a 65-year-old Latino woman. To whom should the nurse
address most of the conversation to keeping in mind cultural considerations?
a.
66-year-old husband
b.
Entire family, in general
c.
42-year-old daughter (oldest child)
d.
40-year-old son (only son)
13. In treating a person outside of a medical facility, a nurse knows that immediate circulatory
support for the vital organs must begin as quickly as possible because, without oxygen, the
brain cells will begin to die in how many minutes?
a.
4
b.
6
c.
14
d.
24
14. The stages of shock proceed in a definite sequence. What is the correct order?
a.
Progressive, compensatory, refractory
b.
Refractory, progressive, compensatory
c.
Compensatory, progressive, refractory
d.
Distributive, compensatory, refractory
15. What causes the cool, damp skin of patients in compensatory shock?
a.
Constriction of peripheral blood vessels because of the shunting of blood to the
vital organs
b.
Action of the antidiuretic hormone released in shock by the adrenal glands
c.
Decreasing levels of arterial carbon dioxide, which are pooling in the arms and
legs
d.
Activation of the baroreceptors in the renal arteries
16. Which position enhances cerebral blood flow to counteract the symptoms of compensatory
shock?
a.
Fowler
b.
Trendelenburg
c.
Gravity neutral
d.
Side lying
17. A nurse is administering heparin, subcutaneous twice daily, to a patient in cardiogenic shock.
What is the expected action of this drug?
a.
Inotropic to improve cardiac contractibility
b.
Anticoagulant to prevent blood clots
c.
Antidysrhythmic to restore normal cardiac contractibility
d.
Vasopressor to increase blood pressure
18. Which nursing interventions will best assist a patient cope with decreased cardiac output?
a.
Dovetailing nursing care tasks allows rest periods for the patient.
b.
Maintaining enough cover prevents the patient from shivering.
c.
Turning, coughing, deep breathing, and ambulating the patient every 2 hours
reduce the risk of embolism.
d.
Analgesics should be administered cautiously.
19. One of the most important assessments that a nurse makes is to check urine output. Which
value objectively validates minimal acceptable renal perfusion for the average-size person?
a.
0.5 mL/kg/hr
b.
0.5 mL/lb/hr
c.
1 mL/lb/hr
d.
0.2 mL/kg/hr
20. A patient is in the compensatory stage of shock. What symptoms displayed by the patient
would indicate the need to implement immediate nursing action?
a.
Irritable and restless
b.
Listless and confused
c.
Unconscious
d.
Anxious and fearful
21. A patient in the progressive stage of shock is receiving medication to manage the symptoms.
What is the desired effect of the medication?
a.
Increase in cardiac output
b.
Decrease in blood pressure
c.
Decrease in urine output
d.
Lower temperature
22. A family member asks why her father, who is being treated for cardiogenic shock, needs
parenteral feeding because he is capable of eating small amounts. What is the best response by
the nurse?
a.
“Parenteral feedings reduce the risk of constipation.”
b.
“Parenteral feedings meet the patient’s hypermetabolic needs.”
c.
“Parenteral feedings are more convenient and less time consuming.”
d.
“Parenteral feedings decrease the hazard of infection.”
23. A patient’s family voices concern regarding the purpose of some of the interventions for
systemic inflammatory response syndrome (SIRS). What explanation by the nurse is most
appropriate when explaining the rationale of treatment?
a.
“Applying a MAST garment is mandatory to promote and conserve body heat.”
b.
“Inserting an IABP is required to decrease fluid leaking into the extravascular
space.”
c.
“Maintaining strict isolation is vital to prevent an overlying bacterial infection.”
d.
“Aggressive treatment is necessary to support the multiple failing organs.”
24. An older Japanese patient in progressive shock lingers on the verge of death. What
intervention does the patient’s cultural background dictate?
a.
Allow any and all cultural rituals at the bedside.
b.
Encourage the family to talk to the patient who can be comforted by their familiar
voices.
c.
Restrict the ministrations of the folk healer.
d.
Suggest that small children not see the patient.
COMPLETION
25. A nurse explains that pericardial tamponade and pulmonary embolus can place the patient at
risk for _____ shock.
26. A nurse explains that when shock forces the body into anaerobic metabolism, organ damage is
caused by a product of that metabolism, which is _____.
27. A nurse explains that the minimal acceptable hourly urine output for a patient in shock who
weighs 220 lb is _____.
28. A nurse is aware that immobility and insertion of urinary catheters, although therapeutic, also
places the patient at risk for _____.