ATLS 10TH EDITION UPDATED ACTUAL EXAM
QUESTIONS AND CORRECT ANSWERS FULL
SOLUTION GRADED A+
◉ A 78-kg patient with septic shock has a pulse rate of 120 beats/min
with low central venous pressure and pulmonary artery wedge
pressure. Urine output has been 30 mL/hr for the past 3 hours. Which
order by the health care provider should the nurse question?
a. Administer furosemide (Lasix) 40 mg IV.
b. Increase normal saline infusion to 250 mL/hr.
c. Give hydrocortisone (Solu-Cortef) 100 mg IV.
d. Titrate norepinephrine to keep systolic blood pressure (BP) above
90 mm Hg. Answer: ANS: A
Furosemide will lower the filling pressures and renal perfusion further
for the patient with septic shock. Patients in septic shock require large
amounts of fluid replacement. If the patient remains hypotensive after
initial volume resuscitation with minimally 30 mL/kg, vasopressors
such as norepinephrine may be added. IV corticosteroids may be
considered for patients in septic shock who cannot maintain an
adequate BP with vasopressor therapy despite fluid resuscitation.
DIF: Cognitive Level: Apply (application)
◉ A nurse is caring for a patient whose hemodynamic monitoring
indicates a blood pressure of 92/54 mm Hg, a pulse of 64 beats/min,
,and an elevated pulmonary artery wedge pressure (PAWP). Which
intervention ordered by the health care provider should the nurse
question?
a. Elevate head of bed to 30 degrees.
b. Infuse normal saline at 250 mL/hr.
c. Hold nitroprusside if systolic BP is less than 90 mm Hg.
d. Titrate dobutamine to keep systolic BP is greater than 90 mm Hg.
Answer: ANS: B
The patient's elevated PAWP indicates volume excess in relation to
cardiac pumping ability, consistent with cardiogenic shock. A saline
infusion at 250 mL/hr will exacerbate the volume excess. The other
actions will help to improve cardiac output, which should lower the
PAWP and may raise the BP.
DIF: Cognitive Level: Apply (application)
◉ A patient with massive trauma and possible spinal cord injury is
admitted to the emergency department (ED). Which assessment
finding by the nurse will help confirm a diagnosis of neurogenic
shock?
a. Inspiratory crackles c. Cool, clammy extremities
b. Heart rate 45 beats/min d. Temperature 101.2°F (38.4°C) Answer:
ANS: B
Neurogenic shock is characterized by hypotension and bradycardia.
The other findings would be more consistent with other types of
shock.
, DIF: Cognitive Level: Understand (comprehension)
◉ An older patient with cardiogenic shock is cool and clammy.
Hemodynamic monitoring indicates a high systemic vascular
resistance (SVR). Which intervention should the nurse anticipate?
a. Increase the rate for the dopamine infusion.
b. Decrease the rate for the nitroglycerin infusion.
c. Increase the rate for the sodium nitroprusside infusion.
d. Decrease the rate for the 5% dextrose in normal saline (D5/.9 NS)
infusion. Answer: ANS: C
Nitroprusside is an arterial vasodilator and will decrease the SVR and
afterload, which will improve cardiac output. Changes in the D5/.9
NS and nitroglycerin infusions will not directly decrease SVR.
Increasing the dopamine will tend to increase SVR.
DIF: Cognitive Level: Apply (application)
◉ After receiving 2 L of normal saline, the central venous pressure for
a patient who has septic shock is 10 mm Hg, but the blood pressure is
still 82/40 mm Hg. The nurse will anticipate an order for
a. furosemide . c. norepinephrine .
b. nitroglycerin . d. sodium nitroprusside . Answer: ANS: C
When fluid resuscitation is unsuccessful, vasopressor drugs are given
to increase the systemic vascular resistance (SVR) and blood pressure
and improve tissue perfusion. Furosemide would cause diuresis and
further decrease the BP. Nitroglycerin would decrease the preload and
QUESTIONS AND CORRECT ANSWERS FULL
SOLUTION GRADED A+
◉ A 78-kg patient with septic shock has a pulse rate of 120 beats/min
with low central venous pressure and pulmonary artery wedge
pressure. Urine output has been 30 mL/hr for the past 3 hours. Which
order by the health care provider should the nurse question?
a. Administer furosemide (Lasix) 40 mg IV.
b. Increase normal saline infusion to 250 mL/hr.
c. Give hydrocortisone (Solu-Cortef) 100 mg IV.
d. Titrate norepinephrine to keep systolic blood pressure (BP) above
90 mm Hg. Answer: ANS: A
Furosemide will lower the filling pressures and renal perfusion further
for the patient with septic shock. Patients in septic shock require large
amounts of fluid replacement. If the patient remains hypotensive after
initial volume resuscitation with minimally 30 mL/kg, vasopressors
such as norepinephrine may be added. IV corticosteroids may be
considered for patients in septic shock who cannot maintain an
adequate BP with vasopressor therapy despite fluid resuscitation.
DIF: Cognitive Level: Apply (application)
◉ A nurse is caring for a patient whose hemodynamic monitoring
indicates a blood pressure of 92/54 mm Hg, a pulse of 64 beats/min,
,and an elevated pulmonary artery wedge pressure (PAWP). Which
intervention ordered by the health care provider should the nurse
question?
a. Elevate head of bed to 30 degrees.
b. Infuse normal saline at 250 mL/hr.
c. Hold nitroprusside if systolic BP is less than 90 mm Hg.
d. Titrate dobutamine to keep systolic BP is greater than 90 mm Hg.
Answer: ANS: B
The patient's elevated PAWP indicates volume excess in relation to
cardiac pumping ability, consistent with cardiogenic shock. A saline
infusion at 250 mL/hr will exacerbate the volume excess. The other
actions will help to improve cardiac output, which should lower the
PAWP and may raise the BP.
DIF: Cognitive Level: Apply (application)
◉ A patient with massive trauma and possible spinal cord injury is
admitted to the emergency department (ED). Which assessment
finding by the nurse will help confirm a diagnosis of neurogenic
shock?
a. Inspiratory crackles c. Cool, clammy extremities
b. Heart rate 45 beats/min d. Temperature 101.2°F (38.4°C) Answer:
ANS: B
Neurogenic shock is characterized by hypotension and bradycardia.
The other findings would be more consistent with other types of
shock.
, DIF: Cognitive Level: Understand (comprehension)
◉ An older patient with cardiogenic shock is cool and clammy.
Hemodynamic monitoring indicates a high systemic vascular
resistance (SVR). Which intervention should the nurse anticipate?
a. Increase the rate for the dopamine infusion.
b. Decrease the rate for the nitroglycerin infusion.
c. Increase the rate for the sodium nitroprusside infusion.
d. Decrease the rate for the 5% dextrose in normal saline (D5/.9 NS)
infusion. Answer: ANS: C
Nitroprusside is an arterial vasodilator and will decrease the SVR and
afterload, which will improve cardiac output. Changes in the D5/.9
NS and nitroglycerin infusions will not directly decrease SVR.
Increasing the dopamine will tend to increase SVR.
DIF: Cognitive Level: Apply (application)
◉ After receiving 2 L of normal saline, the central venous pressure for
a patient who has septic shock is 10 mm Hg, but the blood pressure is
still 82/40 mm Hg. The nurse will anticipate an order for
a. furosemide . c. norepinephrine .
b. nitroglycerin . d. sodium nitroprusside . Answer: ANS: C
When fluid resuscitation is unsuccessful, vasopressor drugs are given
to increase the systemic vascular resistance (SVR) and blood pressure
and improve tissue perfusion. Furosemide would cause diuresis and
further decrease the BP. Nitroglycerin would decrease the preload and
