Nokea
The nurse in a rural nursing outpost has just been notified that she will be receiving a patient in hypovolemic shock due to a massive postpartum hemorrhage after her home birth. You know that the best choice for fluid replacement for this patient is what?
- A. 5% albumin because it is inexpensive and is always readily available
- B. Dextran because it increases intravascular volume and counteracts coagulopathy
- C. Whatever fluid is most readily available in the clinic, due to the nature of the emergency
- D. Lactated Ringers solution because it increases volume, buffers acidosis, and is the best choice for patients with liver failure
Correct Answer: C
Rationale: The best fluid to treat shock remains controversial. In emergencies, the best fluid is often the fluid that is readily available. Fluid resuscitation should be initiated early in shock to maximize intravascular volume. Both crystalloids and colloids can be administered to restore intravascular volume. There is no consensus regarding whether crystalloids or colloids, such as dextran and albumin, should be used; however, with crystalloids, more fluid is necessary to restore intravascular volume. Albumin is very expensive and is a blood product so it is not always readily available for use. Dextran does increase intravascular volume, but it increases the risk for coagulopathy. Lactated Ringers is a good solution choice because it increases volume and buffers acidosis, but it should not be used in patients with liver failure because the liver is unable to covert lactate to bicarbonate.
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The nurse in the ED is caring for a patient recently admitted with a likely myocardial infarction. The nurse understands that the patients heart is pumping an inadequate supply of oxygen to the tissues. For what health problem should the nurse assess?
- A. Dysrhythmias
- B. Increase in blood pressure
- C. Increase in heart rate
- D. Decrease in oxygen demands
Correct Answer: A
Rationale: Cardiogenic shock occurs when the hearts ability to pump blood is impaired and the supply of oxygen is inadequate for the heart and tissues. Symptoms of cardiogenic shock include angina pain and dysrhythmias. Cardiogenic shock does not cause increased blood pressure, increased heart rate, or a decrease in oxygen demands.
The ICU nurse is caring for a patient in hypovolemic shock following a postpartum hemorrhage. For what serious complication of treatment should the nurse monitor the patient?
- A. Anaphylaxis
- B. Decreased oxygen consumption
- C. Abdominal compartment syndrome
- D. Decreased serum osmolality
Correct Answer: C
Rationale: Abdominal compartment syndrome (ACS) is a serious complication that may occur when large volumes of fluid are administered. The scenario does not describe an antigen-antibody reaction of any type. Decreased oxygen consumption by the body is not a concern in hypovolemic shock. With a decrease in fluids in the intravascular space, increased serum osmolality would occur.
The nurse in the ICU is caring for a 47-year-old, obese male patient who is in shock following a motor vehicle accident. The nurse is aware that patients in shock possess excess energy requirements. What would be the main challenge in meeting this patients elevated energy requirements during prolonged rehabilitation?
- A. Loss of adipose tissue
- B. Loss of skeletal muscle
- C. Inability to convert adipose tissue to energy
- D. Inability to maintain normal body mass
Correct Answer: B
Rationale: Nutritional energy requirements are met by breaking down lean body mass. In this catabolic process, skeletal muscle mass is broken down even when the patient has large stores of fat or adipose tissue. Loss of skeletal muscle greatly prolongs the patients recovery time. Loss of adipose tissue, the inability to convert adipose tissue to energy, and the inability to maintain normal body mass are not main concerns in meeting nutritional energy requirements for this patient.
The intensive care nurse caring for a patient in shock is planning assessments and interventions related to the patients nutritional needs. What physiologic process contributes to these increased nutritional needs?
- A. The use of albumin as an energy source by the body because of the need for increased adenosine triphosphate (ATP)
- B. The loss of fluids due to decreased skin integrity and decreased stomach acids due to increased parasympathetic activity
- C. The release of catecholamines that creates an increase in metabolic rate and caloric requirements
- D. The increase in GI peristalsis during shock and the resulting diarrhea
Correct Answer: C
Rationale: Nutritional support is an important aspect of care for patients in shock. Patients in shock may require 3,000 calories daily. This caloric need is directly related to the release of catecholamines and the resulting increase in metabolic rate and caloric requirements. Albumin is not primarily metabolized as an energy source. The special nutritional needs of shock are not related to increased parasympathetic activity, but are instead related to increased sympathetic activity. GI function does not increase during shock.
The intensive care nurse is responsible for the care of a patient with shock. What cardiac signs or symptoms would suggest to the nurse that the patient may be experiencing acute organ dysfunction? Select all that apply.
- A. Drop in systolic blood pressure of 40 mm Hg from baselines
- B. Hypotension that responds to bolus fluid resuscitation
- C. Exaggerated response to vasoactive medications
- D. Serum lactate >4 mmol/L
- E. Mean arterial pressure (MAP) of 65 mm Hg
Correct Answer: A,D,E
Rationale: Signs of acute organ dysfunction in the cardiovascular system include systolic blood pressure <90 mm Hg, mean arterial pressure (MAP) <65 mm Hg, drop in systolic blood pressure >40 mm Hg from baselines, or serum lactate >4 mmol/L. An exaggerated response to vasoactive medications and an adequate response to fluid resuscitation would not be noted.