Nokea
The ICU nurse caring for a patient in shock is administering vasoactive medications as per orders. The nurse should know that vasoactive medications should be administered in what way?
- A. Through a central venous line
- B. By a gravity infusion IV set
- C. By IV push for rapid onset of action
- D. Mixed with parenteral feedings to balance osmosis
Correct Answer: A
Rationale: Whenever possible, vasoactive medications should be administered through a central venous line because infiltration and extravasation of some vasoactive medications can cause tissue necrosis and sloughing. An IV pump or controller must be used to ensure that the medications are delivered safely and accurately. They are never mixed with parenteral nutrition.
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The nurse is caring for a patient who is exhibiting signs and symptoms of hypovolemic shock following injuries suffered in a motor vehicle accident. The nurse anticipates that the physician will promptly order the administration of a crystalloid IV solution to restore intravascular volume. In addition to normal saline, which crystalloid fluid is commonly used to treat hypovolemic shock?
- A. Lactated Ringers
- B. Albumin
- C. Dextran
- D. 3% NaCl
Correct Answer: A
Rationale: Crystalloids are electrolyte solutions used for the treatment of hypovolemic shock. Lactated Ringers and0.9\%$ sodium chloride are isotonic crystalloid fluids commonly used to manage hypovolemic shock. Dextran and albumin are colloids, but Dextran, even as a colloid, is not indicated for the treatment of hypovolemic shock.3\% \mathrm{NaCl}$ is a hypertonic solution and is not isotonic.
The nurse is transferring a patient who is in the progressive stage of shock into ICU from the medical unit. The medical nurse is aware that shock affects many organ systems and that nursing management of the patient will focus on what intervention?
- A. Reviewing the cause of shock and prioritizing the patients psychosocial needs
- B. Assessing and understanding shock and the significant changes in assessment data to guide the plan of care
- C. Giving the prescribed treatment, but shifting focus to providing family time as the patient is unlikely to survive
- D. Promoting the patients coping skills in an effort to better deal with the physiologic changes accompanying shock
Correct Answer: B
Rationale: Nursing care of patients in the progressive stage of shock requires expertise in assessing and understanding shock and the significance of changes in assessment data. Early interventions are essential to the survival of patients in shock; thus, suspecting that a patient may be in shock and reporting subtle changes in assessment are imperative. Psychosocial needs, such as coping, are important considerations, but they are not prioritized over physiologic health.
In all types of shock, nutritional demands increase rapidly as the body depletes its stores of glycogen. Enteral nutrition is the preferred method of meeting these increasing energy demands. What is the basis for enteral nutrition being the preferred method of meeting the bodys needs?
- A. It slows the proliferation of bacteria and viruses during shock.
- B. It decreases the energy expended through the functioning of the GI system.
- C. It assists in expanding the intravascular volume of the body.
- D. It promotes GI function through direct exposure to nutrients.
Correct Answer: D
Rationale: Parenteral or enteral nutritional support should be initiated as soon as possible. Enteral nutrition is preferred, promoting GI function through direct exposure to nutrients and limiting infectious complications associated with parenteral feeding. Enteral feeding does not decrease the proliferation of microorganisms or the amount of energy expended through the functioning of the GI system and it does not assist in expanding the intravascular volume of the body.
A critical care nurse is aware of similarities and differences between the treatments for different types of shock. Which of the following interventions is used in all types of shock?
- A. Aggressive hypoglycemic control
- B. Administration of hypertonic IV fluids
- C. Early provision of nutritional support
- D. Aggressive antibiotic therapy
Correct Answer: C
Rationale: Nutritional support is necessary for all patients who are experiencing shock. Hyperglycemic (not hypoglycemic) control is needed for many patients. Hypertonic IV fluids are not normally utilized and antibiotics are necessary only in patients with septic shock.
The ICU nurse is caring for a patient with multiple organ dysfunction syndrome (MODS) due to shock. What nursing action should be prioritized at this point during care?
- A. Providing information and support to family members
- B. Preparing the family for a long recovery process
- C. Educating the patient regarding the use of supportive fluids
- D. Facilitating the rehabilitation phase of treatment
Correct Answer: A
Rationale: Providing information and support to family members is a critical role of the nurse. Most patients with MODS do not recover, so the rehabilitation phase of recovery is not a short-term priority. Educating the patient about the use of supportive fluids is not a high priority.