Exam 12: Shock,sepsis,and Multiple Organ Dysfunction Syndrome

The nurse has just completed administration of a 500 mL bolus of 0.9% normal saline in a patient with hypovolemic shock.The nurse assesses the patient to be slightly confused,with a mean arterial blood pressure (MAP)of 50 mm Hg,a heart rate of 110 beats/min,urine output of 10 mL for the past hour,and a central venous pressure (CVP/RAP)of 3 mm Hg.What is the best interpretation of these results by the nurse?

While monitoring a patient for signs of shock,the nurse understands which system assessment to be of priority?

The nurse is caring for a patient in cardiogenic shock being treated with an intraaortic balloon pump (IABP).The family inquires about the primary reason for the device.What is the best statement by the nurse to explain the IABP?

The nurse is caring for a patient admitted with cardiogenic shock.Hemodynamic readings obtained with a pulmonary artery catheter include a pulmonary artery occlusion pressure (PAOP)of 18 mm Hg and a cardiac index (CI)of 1.0 L/min/m².What is the priority pharmacological intervention?

A patient is admitted to the cardiac care unit with an acute anterior myocardial infarction.The nurse assesses the patient to be diaphoretic and tachypneic,with bilateral crackles throughout both lung fields.Following insertion of a pulmonary artery catheter by the physician,which hemodynamic values is the nurse most likely to assess?

The nurse is caring for a patient in the early stages of septic shock.The patient is slightly confused and flushed,with bounding peripheral pulses.Which hemodynamic values is the nurse most likely to assess?

The nurse is caring for a patient admitted to the critical care unit 48 hours ago with a diagnosis of severe sepsis.As part of this patient's care plan,what intervention is most important for the nurse to discuss with the multidisciplinary care team?

The nurse has been administering 0.9% normal saline intravenous fluids in a patient with severe sepsis.To evaluate the effectiveness of fluid therapy,which physiological parameters would be most important for the nurse to assess?

The nurse is caring for a patient in spinal shock.Vital signs include blood pressure 100/70 mm Hg,heart rate 70 beats/min,respirations 24 breaths/min,oxygen saturation 95% on room air,and an oral temperature of 94.8° F.Which intervention is most important for the nurse to include in the patient's plan of care?

A patient is admitted to the critical care unit following coronary artery bypass surgery.Two hours postoperatively,the nurse assesses the following information: pulse is 120 beats/min; blood pressure is 70/50 mm Hg; pulmonary artery diastolic pressure is 2 mm Hg; cardiac output is 4 L/min; urine output is 250 mL/hr; chest drainage is 200 mL/hr.What is the best interpretation by the nurse?

After receiving a handoff report from the night shift,the nurse completes the morning assessment of a patient with severe sepsis.Vital signs are: blood pressure 95/60 mm Hg,heart rate 110 beats/min,respirations 32 breaths/min,oxygen saturation (SpO₂)96% on 45% oxygen via Venturi mask,temperature 101.5° F,central venous pressure (CVP/RAP)2 mm Hg,and urine output of 10 mL for the past hour.The nurse initiates which provider prescription first?

Which patient being cared for in the emergency department is most at risk for developing hypovolemic shock?

Fifteen minutes after beginning a transfusion of O negative blood to a patient in shock,the nurse assesses a drop in the patient's blood pressure to 60/40 mm Hg,heart rate 135 beats/min,respirations 40 breaths/min,and a temperature of 102° F.The nurse notes the new onset of hematuria in the patient's Foley catheter.What are the priority nursing actions?

The nurse is caring for an athlete with a possible cervical spine (C5)injury following a diving accident.The nurse assesses a blood pressure of 70/50 mm Hg,heart rate 45 beats/min,and respirations 26 breaths/min.The patient's skin is warm and flushed.What is the best interpretation of these findings by the nurse?

The nurse is caring for a patient with severe sepsis who was resuscitated with 3000 mL of lactated Ringer's solution over the past 4 hours.Morning laboratory results show a hemoglobin of 8 g/dL and hematocrit of 28%.What is the best interpretation of these findings by the nurse?

The nurse is caring for a patient admitted with severe sepsis.Vital signs assessed by the nurse include blood pressure 80/50 mm Hg,heart rate 120 beats/min,respirations 28 breaths/min,oral temperature of 102° F,and a right atrial pressure (RAP)of 1 mm Hg.Which intervention should the nurse carry out first?

A patient is admitted after collapsing at the end of a summer marathon.The patient is lethargic,with a heart rate of 110 beats/min,respiratory rate of 30 breaths/min,and a blood pressure of 78/46 mm Hg.The nurse anticipates administering which therapeutic intervention?

The nurse is caring for a patient admitted following a motor vehicle crash.Over the past 2 hours,the patient has received 6 units of packed red blood cells and 4 units of fresh frozen plasma by rapid infusion.To prevent complications,what is the priority nursing intervention?

The nurse is caring for a patient in cardiogenic shock who is being treated with an infusion of dobutamine.The physician's order calls for the nurse to titrate the infusion to achieve a cardiac index of greater than or equal to 2.5 L/min/m².The nurse measures a cardiac output,and the calculated cardiac index for the patient is 4.6 L/min/m².What is the best action by the nurse?

The nurse is caring for a patient admitted with the early stages of septic shock.The nurse assesses the patient to be tachypneic,with a respiratory rate of 32 breaths/min.Arterial blood gas values assessed on admission are pH 7.50,CO₂ 28 mm Hg,HCO₃ 26.Which diagnostic study result reviewed by the nurse indicates progression of the shock state?