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The nurse is caring for a patient in noncardiogenic shock who is cool, clammy and whose hemodynamic monitoring indicates a high systemic vascular resistance (SVR). Which of the following actions should the nurse anticipate implementing?
- A. Increase the rate for the prescribed dopamine infusion
- B. Decrease the rate for the prescribed nitroglycerin infusion
- C. Decrease the rate for the prescribed 5% dextrose in water (D5W) infusion
- D. Increase the rate for the prescribed sodium nitroprusside infusion
Correct Answer: D
Rationale: Nitroprusside is an arterial vasodilator that will decrease the high SVR and afterload, improving cardiac output in noncardiogenic shock. Increasing dopamine would increase SVR, nitroglycerin primarily affects preload, and D5W does not directly address SVR.
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The nurse is caring for a patient in pulmonary edema as result of cardiogenic shock has the following vital signs: BP 86/50, pulse 126, respirations 30. Which of the following actions should the nurse anticipate implementing?
- A. Infusion of 5% human albumin
- B. Administration of furosemide IV
- C. Titration of an epinephrine drip
- D. Administration of hydrocortisone
Correct Answer: B
Rationale: Furosemide, a diuretic, is appropriate to reduce fluid overload in pulmonary edema due to cardiogenic shock, helping to alleviate symptoms like dyspnea. Albumin and normal saline would worsen fluid overload, epinephrine would increase myocardial oxygen demand, and hydrocortisone is used for septic or anaphylactic shock, not cardiogenic shock.
Norepinephrine has been prescribed for a patient who was admitted with dehydration and hypotension. Which of the following patient information indicates that the nurse should consult with the health care provider before administration of the norepinephrine?
- A. The patient's central venous pressure is 3 mm Hg
- B. The patient is receiving low dose dopamine
- C. The patient is in sinus tachycardia at 100-110 beats/minute
- D. The patient has had no urine output since being admitted
Correct Answer: A
Rationale: A low central venous pressure (3 mm Hg) indicates hypovolemia, and fluid resuscitation should be prioritized before administering norepinephrine to avoid exacerbating hypotension. The other findings are consistent with hypovolemic shock and do not contraindicate norepinephrine after adequate fluid replacement.
The new RN is being mentored while caring for a patient with neurogenic shock. Which of the following actions by the new RN indicates a need for further teaching?
- A. Keeping the room temperature at 75°F to prevent hypothermia
- B. Checking the heart rate every 1-2 hours
- C. Preparing to administer prescribed IV atropine
- D. Increasing the nitroprusside infusion rate for a patient with a high SVR
Correct Answer: D
Rationale: Increasing the nitroprusside infusion rate is inappropriate for neurogenic shock, as it is a vasodilator and could worsen hypotension. The other actionsâ??maintaining warm room temperature, monitoring heart rate, and preparing atropineâ??are appropriate for managing neurogenic shock, which involves bradycardia and hypothermia risk.
Which of the following interventions should the nurse implement first when a patient in the emergency department develops anaphylactic shock?
- A. Administer normal saline 500 mL IV
- B. Insert a second IV catheter
- C. Administer epinephrine 0.3 mg intramuscularly
- D. Start a dopamine infusion at 5 mcg/kg/minute
Correct Answer: C
Rationale: Epinephrine is the first-line treatment for anaphylactic shock, as it rapidly reverses vasodilation, bronchoconstriction, and histamine effects. Fluid resuscitation, additional IV access, and vasopressors like dopamine are secondary actions after epinephrine administration.
During change-of-shift report, the nurse learns that a patient has been admitted with dehydration and hypotension after having vomiting and diarrhea for 3 days. Which of the following findings is most important for the nurse to report to the health care provider?
- A. Decreased bowel sounds
- B. Apical pulse 110 beats/minute
- C. Pale, cool, and dry extremities
- D. New onset of confusion and agitation
Correct Answer: D
Rationale: New onset confusion and agitation indicate progression to the progressive stage of hypovolemic shock, signaling inadequate cerebral perfusion and the need for immediate intervention. The other findings are consistent with compensatory shock but are less urgent.